Project SOS (Saving OurSelves):  Engaging Black Gay, Bisexual, Transgender and other Men who have sex with Men in HIV Prevention and Care

Men who have Sex with Men (MSM) comprise the single largest group of individuals in the US who have become infected with HIV (Human Immunodeficiency Virus) in recent years, with Black MSM affected at dramatically disproportionate rates.  Black MSM, who may identify as gay, straight, bisexual, transgender, or none of these, are estimated to account for one quarter of the new HIV infections in the US annually (i.e. 15,000 per year), yet little prevention research has been directed toward this population.  In Massachusetts, HIV prevalence rates for Blacks are 11 times that of Whites. 

The purpose of Project SOS (Saving OurSelves) study is to prepare for a randomized trial of a community-level, multi-component intervention to reduce HIV incidence among Black MSM in 6 US cities (Boston, New York, Washington, DC, Atlanta, Los Angeles, and San Francisco). Approximately 400 men will be enrolled in each site, for a total of more than 2400 nationally.  The Fenway Institute has been selected as the Boston site, and the Multicultural AIDS Coalition will serve as a community collaborator on the study.

Which insights inform the development of this unique project?
Black MSM are not more likely to engage in risky behavior than non-Black MSM, but they are more likely to become infected. (1, 2, 3, 4, 5, 6)  Thus, risk behaviors alone do not account for the disproportionate number of HIV infections in this group, and interventions focused solely on reduction of risk behaviors will not likely stem the high rate of new infections in this population.

Several factors are likely to contribute to the disproportionate rate of HIV infection among Black MSM:

1) Low frequency of HIV testing resulting in a high proportion of Black MSM who are unaware of their HIV status.
2) High HIV prevalence and incidence rates within sexual networks resulting in increased likelihood of exposure to HIV during sex.
3) High prevalence of other STIs, which facilitate HIV transmission and acquisition.
4) Barriers to health care access and HIV/STI treatment resulting in high levels of undiagnosed and untreated HIV infection.

Two other factors that are not unique to Black MSM, but that have been shown to be associated with increased risk of HIV infection among MSM as a whole, are substance use and mental health issues, such as depression. (4)

Project SOS is a research study evaluating new approaches to reducing HIV risk in Black MSM through a four-pronged approach that seeks to address the multiplicity of risk factors by:

1) Asking participants to describe their sexual and social networks and to recruit sex partners into the study.
2) Providing Black MSM with a peer—someone whom each participant can relate to—who is specially trained to help Black MSM get the healthcare services and treatment they need in the community, whether they are at risk for HIV infection, or already infected.
3) Providing culturally sensitive testing and counseling for HIV.
4) Providing testing, counseling and treatment for Sexually Transmitted Infections (STIs).
5) Encouraging Black MSM to refer their sexual partners to participate in the study.

The hypothesized impact of the Project SOS is two-fold.  At the individual level, the intervention is designed to decrease a participant’s personal risk of acquiring or transmitting HIV by addressing his  risk factors, by, for example, identifying and treating undiagnosed HIV or STI infections, or by helping participants reduce drug or alcohol use associated with risky sex.  At a population level, the intervention is designed to lower the viral load in HIV infected men by identifying those who qualify for HIV treatment (some of whom may be newly aware of their status) and intervening to increase treatment, adherence, and access to health care.  By lowering both the proportion of men with undiagnosed HIV infection, and the viral load among those with chronic, untreated infection, we hope to reduce HIV transmission within networks of Black MSM.

Project SOS is scheduled to launch in June 2009 and will begin recruitment activities then.  Community education efforts are currently underway, and the project also interviewing for qualified staff.  For more information on Project SOS, please contact Project Director Benjamin Perkins at bperkins@fenwayhealth.org or (617) 927-6086.

Citations

 1.  HIV prevalence, unrecognized infection, and HIV testing among men who have sex with men--five U.S. cities, June 2004-April 2005 MMWR Morb.Mortal.Wkly.Rep. 2005-;54:597-601.

 2.  Sanchez T, Finlayson T, Drake A et al. Human immunodeficiency virus (HIV) risk, prevention, and testing behaviors--United States, National HIV Behavioral Surveillance System: men who have sex with men, November 2003-April 2005. MMWR Surveill Summ. 2006-;55:1-16.

 3.  Harawa NT, Greenland S, Bingham TA et al. Associations of race/ethnicity with HIV prevalence and HIV-related behaviors among young men who have sex with men in 7 urban centers in the United States. J Acquir.Immune.Defic.Syndr. 2004-;35:526-536.

 4.  Koblin BA, Husnik MJ, Colfax G et al. Risk factors for HIV infection among men who have sex with men. AIDS. 2006-;20:731-739.

 5.  Celentano DD, Sifakis F, Hylton J et al. Race/ethnic differences in HIV prevalence and risks among adolescent and young adult men who have sex with men. J Urban.Health. 2005;82:610-621.

 6.  Torian LV, Makki HA, Menzies IB et al. HIV infection in men who have sex with men, New York City Department of Health sexually transmitted disease clinics, 1990-1999: a decade of serosurveillance finds that racial disparities and associations between HIV and gonorrhea persist. Sex Transm.Dis. 2002;29:73-78.