Interventions to reduce sexual risk behavior in African American men

The purpose of this review was to describe characteristics of interventions that have been conducted for African American men and identify similarities and differences between interventions for subpopulations of African American men. Of the 473 studies identified through database searching, 8 studies met the eligibility criteria for this review. Target populations within these studies included heterosexual men, homosexual and bisexual men, persons with mental health problems, and injection and non-injection drug users. Little variation was found in the theories and methods used in interventions for different target populations. However, several different behavioral determinants were addressed within these interventions. Although interventions for drug users generally did not exclude individuals based on sexual orientation, these interventions were able to address HIV sexual risk behavior in heterosexual, homosexual, and bisexual-identified men. Given these findings, multi-faceted approaches to HIV prevention are recommended in order to reduce HIV risk in African American men.^

The application of latent variable models to the assessment of determinants of HIV risk behavior

Studies on the relationship between psychosocial determinants and HIV risk behaviors have produced little evidence to support hypotheses based on theoretical relationships. One limitation inherent in many articles in the literature is the method of measurement of the determinants and the analytic approach selected. ^ To reduce the misclassification associated with unit scaling of measures specific to internalized homonegativity, I evaluated the psychometric properties of the Reactions to Homosexuality scale in a confirmatory factor analytic framework. In addition, I assessed the measurement invariance of the scale across racial/ethnic classifications in a sample of men who have sex with men. The resulting measure contained eight items loading on three first-order factors. Invariance assessment identified metric and partial strong invariance between racial/ethnic groups in the sample. ^ Application of the updated measure to a structural model allowed for the exploration of direct and indirect effects of internalized homonegativity on unprotected anal intercourse. Pathways identified in the model show that drug and alcohol use at last sexual encounter, the number of sexual partners in the previous three months and sexual compulsivity all contribute directly to risk behavior. Internalized homonegativity reduced the likelihood of exposure to drugs, alcohol or higher numbers of partners. For men who developed compulsive sexual behavior as a coping strategy for internalized homonegativity, there was an increase in the prevalence odds of risk behavior. ^ In the final stage of the analysis, I conducted a latent profile analysis of the items in the updated Reactions to Homosexuality scale. This analysis identified five distinct profiles, which suggested that the construct was not homogeneous in samples of men who have sex with men. Lack of prior consideration of these distinct manifestations of internalized homonegativity may have contributed to the analytic difficulty in identifying a relationship between the trait and high-risk sexual practices. ^