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UARP Annual Meeting
San Francisco, CA
February 10, 2006
Nina T. Harawa, John K. Williams, Hema C. Ramamurthi, Sergio
Avina, Cleo Manago, Kevin Pickett, Tony Wafford
Semi-Structured Focus Groups Interviews
 Recruitment
Direct recruitment
Posting of flyers
Referrals from other participants
Clients of drug treatment center
 Eligibility requirements (self report):
Male
18 years or older
African American
Had sex with a male partner in the past 12 month
Did not identify as gay
Reporting on responses to the following two sets of
focus group questions:

What are the general thoughts about condom use
among African American MSM? Do condoms really
protect people? Under what circumstances do
African American MSM use condoms?

How does being infected with HIV/AIDS or other
STDs affect the sex lives of African American MSM?
Do they continue to have sex? Do they disclose?
Do they use condoms?
Data Collection
Focus groups were conducted by a male
facilitator (the recruiter) who was familiar with
the issues facing African American NGI
MSM/W
Discussions were audio-taped and
transcribed
At the end of the discussion, participants
were asked to complete a short demographic
survey that was voluntary
Participants were paid $40 cash as incentive
Data Analysis
Constant comparison method of data
analysis (Strauss and Corbin,1975)
•Three readers read the transcripts,
coded phenomenon, and applied the
codes to other similar phenomenon in
the text.
•This process was repeated until entire
transcripts were coded and no new
codes originated.
• Interview transcripts were organized and
analyzed using Atlas.ti 5.0 software
Results (update)
30 men participated in the
group discussion, 29 completed
the post survey
Socio demographics
Average age was
= 41 (SD 9)
Education
High school or
vocational/technical trade = 47% ( n=14)
Some college
= 27% ( n= 8)
College completed
= 10% ( n= 3)
Some graduate school
= 10% ( n= 3)
Employment:
Unemployed/Disabled
= 53% ( n= 16)
Full time/Part time
= 40% ( n= 12)
Sexual Identity
“Heterosexual”
“Bisexual”
“Gay”
“Same Gender Loving”
“Down Low”
“Homosexual”
“Other”
4
10
10
1
1
2
1
Type of sexual partner(s)
Just men
62% (n= 18)
Just women
7% (n= 2)
Both men and women 28% (n= 8)
Neither
3% (n=1)
Condom use among African American
MSM
Protection
•HIV infection
•HIV reinfection
•STD infection
•Pregnancy
Aesthetics
•Loss of sexual pleasure versus prolonged
erection
Fear of disclosure
Distrust of condoms
Substance use
Condom Use – Protection
Protection from disease and pregnancy
“with MSM um, more specifically with AA men, condoms is
equated to health. So, you have to deal with the whole
concept of being healthy. Making healthy choices,
prevention. So, when you deal with those condoms, if you
don't equate condoms to health or condoms to life, why
am I using it? You know, um, but then with a woman, you
know, if you're having sex with a woman, you equate a
condom with maybe protection from STDs but no children.
So, you equate condoms with money. You know. So, with
men, it's condoms, you know, with health. With women,
condoms, children, money.”
Condom Use - Aesthetics
The experience of using condoms was often
associated negatively with loss of sensation,
but some participants saw this as positive.
Participant A3: “They keep me hard and make
the .. last longer …It makes it last longer than
me, I think.”
Condom Use – Fear of disclosure
Condom use with female partners was seen as carrying
risky social/relationship implications.
“..for example, on the down low brother type thing. This
man and his wife are having sex. He goes out and
has sex with a man. And he comes home now and
wants to put on a condom. My wife is like, well, why
you going to put that on. We haven't been using it for
such a long time. So now he has a fear of putting on
a condom because the wife wants to know why
you're putting on a condom. Uh, my tubes are tied, I
can't get pregnant. What's going on? Are you doing
something out there? So it creates a lot of
questions.”
Condoms - Distrust of condoms
Participants reported not trusting condoms for disease
protection and experiencing condom failure.
(HIV- Participant) “Just because you put on a condom
doesn't mean that you do or don't. You know, a
condom ain't going to save you. The hell, no….”
Condom use- Exchange/survival
sex
Exchange sex could be a motivator to use or not use
condoms.
“When you're prostituting and you're turning tricks and stuff
like that, you don't have time to put on condoms. You are
too busy trying to get your money.”
Drug use sometimes derailed intentions to use condoms.
“I don't think so. I think that, uh, the reason that most men
don't use condoms is that they either are intoxicated or
they are on some type of drug and they are caught up in
the heat of the moment and they don't stop to think. I
think the majority of people that are about to engage in
sex with a clear mind would pull out a condom and put it
on.”
The impact of being infected with
HIV on the sexual lives of African
American MSM
Rejection and isolation
Reduced sexual activity
“…for me, being HIV positive it cuts, it, it, my sex life
is short, actually. Uh, I'm not in a relationship. I
don't look for relationships and basically, if you
meet someone new, we might hit if off and be
compatible, have a lot of things in common. Then
you have to disclose because you have to disclose.
It's the only male thing to do. It's just right. But
then once you disclose, then they could be negative,
and if they are, they might not be educated on the
Theoretical Framework
Theory of Reasoned Action
Theory of Planned Behavior
d3
Behavioral
Beliefs
Past
Condom use
Attitudes
d2
Values
Intentions
Normative
Beliefs
Condom
use with
partners
d1
Subjective Norms
Comply
d4
Control Beliefs
Self-protection
Protection of others
Questioning
Condom failure
Loss of $$
Loss of sensation
d3
Past
Condom use
Attitudes
Substance use
Health
Responsibility
Money/Basic needs
Secrecy/privacy
Children
Lack of critical
thinking
Intentions
Planning for condoms
Engaging in less sex
Condom
use with
partners
Substance use
Normative
Beliefs
Control Beliefs
Subjective Norms
Comply
d4
Self-efficacy
Implications for Intervention
 Subjective norms re: condom use may be
less important for NGI than GI men
 Successful intervention should




Identify for what participants value and make the
connection to safer sex
Address why some participants do not value
protecting themselves or others
Directly address distrust, negative experiences,
and aesthetic issues related to condom use
Strategize around condom use while under the
influence or hustling