title: Efficacy of a culturally congruent HIV risk-reduction intervention for behaviorally bisexual black men: results of a randomized trial.
abstract: OBJECTIVE
  Black men who have sex with men and women (MSMW) experience high HIV rates and may not respond to interventions targeting gay-identified men. We tested the efficacy of the Men of African American Legacy Empowering Self (MAALES), a multisession, small-group holistically framed intervention designed to build skills, address sociocultural issues, and reduce risk behaviors in black MSMW.
  
  
  METHODS
  From 2007 to 2011, we enrolled 437 black MSMW into a parallel randomized controlled trial that compared MAALES to the control condition, a single, individualized HIV risk-reduction session.
  
  
  METHODS
  Participants completed surveys at baseline, 3 months, and 6 months postintervention. We used multiple regressions to compare risk behaviors at follow-up between the intervention and control groups while adjusting for baseline risk behaviors, time between assessments, other covariates, and clustering. We used inverse probability weighting (IPW) to adjust for loss-to-follow-up while carrying out these regressions with the 291 (76.4%) randomized participants who completed at least one follow-up.
  
  
  RESULTS
  Participants were largely low-income (55% reported monthly incomes <$1000); nearly half had previously tested HIV positive. At 6 months of follow-up, unadjusted within-group analyses demonstrated reduced risk behaviors for the MAALES but not the control group. Adjusted results indicated significant intervention-associated reductions in the numbers of total anal or vaginal sex acts [risk ratio = 0.61; 95% confidence interval (CI) 0.49–0.76], unprotected sex acts with women (risk ratio = 0.50; 95% CI 0.37–0.66), and female partners (risk ratio = 0.56; 95% CI 0.44–0.72). Near significant reductions were observed for number of male intercourse partners.
  
  
  CONCLUSIONS
  The MAALES intervention was efficacious at reducing HIV risk behaviors in black MSMW.
authors.forename: Nina T
authors.initials: NT
authors.lastname: Harawa
authors.forename: John K
authors.initials: JK
authors.lastname: Williams
authors.forename: W J
authors.initials: WJ
authors.lastname: McCuller
authors.forename: Hema C
authors.initials: HC
authors.lastname: Ramamurthi
authors.forename: Martin
authors.initials: M
authors.lastname: Lee
authors.forename: Martin F
authors.initials: MF
authors.lastname: Shapiro
authors.forename: Keith C
authors.initials: KC
authors.lastname: Norris
authors.forename: William E
authors.initials: WE
authors.lastname: Cunningham
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D001727:Bisexuality; D044383:Black People; D005500:Follow-Up Studies; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission*; D006801:Humans; D008297:Male; D008875:Middle Aged; D040242:Risk Reduction Behavior; D011795:Surveys and Questionnaires; D001741:Black or African American