The Bruthas Project: evaluation of a community-based HIV prevention intervention for African American men who have sex with men and women.

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.