Operario Don, Smith Carla Dillard, Arnold Emily, Kegeles Susan
Department of Community Health, Brown University, Providence, RI 02903, USA.
AIDS Educ Prev. 2010 Feb;22(1):37-48. doi: 10.1521/aeap.2010.22.1.37.
The Bruthas Project is a community-collaborative intervention to reduce HIV risk behavior among African American men who have sex with men and women (MSMW) but who do not form an identity around their same-sex behavior. The intervention was developed based on formative qualitative research with members of the population and involved four individualized risk reduction counseling sessions. Participants review general risk factors for HIV and are offered HIV testing and counseling (Session 1); discuss sexual dynamics and risk behaviors with female partners (Session 2); discuss sexual dynamics and risk behaviors with male partners (Session 3); review motivations and situational triggers for unsafe sex, and engage in role-play exercises that aim to reach personal risk reduction goals (Session 4). Community outreach and counseling are provided by African American men with whom participants can identify, and counseling is designed to respond to men's need for privacy, cultural affirmation, and masculine values. Thirty-six African American MSMW completed a pilot intervention, including baseline and 3-month follow-up assessments of sexual risk behaviors and psychosocial factors. Preanalysis and postanalysis found significant reductions in unprotected receptive and insertive anal sex with male partners, fewer numbers of female and male unsafe sex partners, and decreased sex while under the influence of drugs. Men also reported significantly increased social support, self-esteem, and reduced loneliness at follow-up. Positive outcomes suggest this is a promising approach for reducing HIV risk in this population.
布鲁萨斯项目是一项社区合作干预措施，旨在降低与男性和女性发生性行为的非裔美国男性（双性恋男性）中的艾滋病毒风险行为，这些男性并未围绕其同性性行为形成一种身份认同。该干预措施是基于对该人群成员进行的形成性定性研究而制定的，包括四次个性化的风险降低咨询会议。参与者回顾艾滋病毒的一般风险因素，并接受艾滋病毒检测和咨询（第1次会议）；与女性伴侣讨论性动态和风险行为（第2次会议）；与男性伴侣讨论性动态和风险行为（第3次会议）；回顾不安全性行为的动机和情境触发因素，并参与旨在实现个人风险降低目标的角色扮演练习（第4次会议）。社区外展和咨询由非裔美国男性提供，参与者能够认同这些人，并且咨询旨在满足男性对隐私、文化肯定和男性价值观的需求。三十六名非裔美国双性恋男性完成了一项试点干预，包括对性风险行为和心理社会因素的基线评估以及3个月的随访评估。分析前和分析后发现，与男性伴侣进行无保护的接受性和插入式肛交显著减少，女性和男性不安全的性伴侣数量减少，以及在药物影响下发生性行为的情况减少。男性还报告说，随访时社会支持显著增加，自尊心增强，孤独感降低。积极的结果表明，这是一种在该人群中降低艾滋病毒风险的有前景的方法。
