An HIV prevention program that focuses on young gay men educating and
supporting one another about safer sex has proved very effective in a major
study in two West Coast communities.

Followup data showed a substantial and sustained reduction in unprotected anal
intercourse—the behavior most risky for HIV transmission—among participants.

Developed by team at the Center for AIDS Prevention Studies (CAPS) at the
University of California, San Francisco, the program was implemented in Santa
Barbara, Calif., and Eugene, Ore.  Data were analyzed to determine program
effectiveness and changes in patterns of high-risk behavior.

Named the “Mpowerment Project,” the program is based on empowering young gay
men to deal with the very real issues that they face in their daily
lives—homophobia, gay bashing, discrimination, isolation, and HIV/AIDS—and
then mobilizing them in a positive way to influence one another, said Susan
Kegeles, PhD,  an associate professor with UCSF CAPS and co-director of the
project with Robert B. Hays, PhD, also with CAPS.

“Life in the U.S. for young gay men is not easy, even in the 90s.  One need
only look at the example of Matthew Shepard to understand that young gay men
have very real fears about being openly gay in a society that does not support
them. Moreover, they are trying to find their way in terms of loving and
intimate relationships.  Many of them have experienced sexual abuse as young
people as well,” she said

“The Mpowerment program gives young gay men a place to deal with personal
issues about their homosexuality, about coming out, and about intimacy, and
then talk about HIV safety in that context.  It can’t work any other way,” she

Study findings are reported in a recent issue of the journal AIDS.

The researchers found that the proportion of men who engaged in unprotected
anal intercourse with non-primary partners decreased by 18 percent. The same
unsafe practice with boyfriends decreased by 28 percent.  These changes were
maintained one year following the end of the program, a goal that is very hard
to achieve, according to Kegeles.

Data analysis also showed that study participants increased their enjoyment of
safe sex, were better at communicating that they wanted to have safe sex, and
felt more support from their friends about having safer sex after
participating in the program than they did at its inception.

“The project messages were very sex-positive and included explicit suggestions
about a large variety of safer sexual practices, not just condom use,” Kegeles
said. “Eroticizing safer sex and encouraging men to think of new, fun and
satisfying ways of having low-risk sex was particularly important in view of
our knowledge from other studies that the more one believes that safe sex is
associated with diminished enjoyment, the less one engages in it.” 

“Ongoing studies show high numbers of young gay men nationwide are continuing
to engage in high-risk behavior and are contracting HIV at alarming rates, so
there is an urgent need for effective prevention programs that truly reach this
group,” said Thomas J. Coates, PhD, project co-investigator and executive
director of the UCSF AIDS Research Institute.

“A social focus was adopted as the organizing feature of this project because a
sole focus on HIV and AIDS would not be very compelling to young gay men, and
our findings show that in order to reach young gay men effectively, HIV
prevention activities must be integrated into their social network and must be
supported by that network,” he added. 

Various components of the program reached 500 or more gay and bisexual men aged
18-30 in each community. 

The two West Coast communities were chosen for the study because they were
similar in population size and about two hours drive from a large city, had a
large university, attracted many young people from surrounding areas for social
activities, and had no HIV prevention programs targeted at young gay men.

Sexual risk-taking behavior of young gay men is explained by factors at three
main levels—individual, inter-personal, and social—and the UCSF program
focuses on reaching all three simultaneously, according to Kegeles.

“Because young men engage in unsafe sexual behaviors for diverse reasons,
interventions that focus solely on one level of factors will miss men who
engage in high-risk sex for other reasons,” she said. 

At the individual level, for example, reasons for risk-taking include
perceptions that safe sex is less enjoyable than unsafe sex, inaccurate beliefs
about risky behaviors, and being depressed.  Interpersonal reasons include poor
communication skills and having a boyfriend, while social factors include a
lack of support for safer sex and frequent visits to gay bars or public
cruising areas that are associated with unprotected sex.

In the Mpowerment Project, the content of the HIV prevention messages was the
same in each community but local young gay men, both employees and volunteers,
developed outreach and social activities that would best carry the message to
young men within their respective settings.

“By local young gay men having a sense of ownership of the program, there was
an increased motivation to spread the message—adapting it as their own—to
their peers,” Kegeles said.

“Attracting as many young men as possible to the program was an important
objective. Every young man who became involved by attending a social event or a
small group discussion, or by volunteering in any capacity, became a potential
agent for encouraging and supporting safer sex among his social network,” she

## Components of the outreach effort included both formal and informal activities:

* Outreach teams went to areas where young gay men congregated (bars, community
events, social events the project created, etc.) to communicate the message. 
Fun and entertaining approaches were often used, such as performances and/or
* A young men’s center was set-up in each community with weekly events (video
parties, discussion groups, drop-in hours) and other special activities such as
dance parties, picnics, hikes, and bicycle rides where outreach was also
* Interesting and appealing hand-out materials about safe sex were distributed
by the outreach teams at places young gay men congregate in the community,
including project-sponsored social events.
* Men were trained and encouraged to support their friends in informal
conversations about having safe sex. 
* There were peer-led small group meetings that focused on eroticizing safer
sex, how to use condoms, clarifying misconceptions, sexual communication, and
nonverbal negotiating skills.  Participants also were encouraged to become
agents of change by taking the message to their friends.

“Much work remains if we are to eliminate HIV among young gays.  While our
results are encouraging, programs like these must be sustained.  Young men come
out everyday, and HIV prevention programs need to be in place so they too do
not get infected.,” Kegeles said.

She added that future research needs to focus on determining how this
prevention approach will work in larger, more complex, and more diverse

The project team also included Lance M. Pollack, PhD, of UCSF CAPS.  The study
was supported by grants from the National Institute for Mental Health.

UCSF CAPS is a program of the UCSF AIDS Research Institute, a campuswide
enterprise without walls that encompasses all UCSF AIDS programs under a single
umbrella and includes close to 1,000 investigators.