Assessing the feasibility and acceptability of the Mpowerment Project (MP), an evidence-based HIV community-level prevention intervention (EBI) developed in the US for gay men, in Barbados
A. Maiorana1, G. Rebchook2, N. Kassey3, R. Lall4, G. Bombereau4, J.J. Myers5
1University of California, Center for AIDS Prevention Studies, San Francisco, United States, 2UCSF, Center for AIDS Prevention Studies, San Francisco, United States, 3Caribbean HIV/AIDS Alliance, Basseterre, Saint Kitts and Nevis, 4Caribbean HIV/AIDS Alliance, Port of Spain, Trinidad and Tobago, 5University of California, San Francisco, Center for AIDS PRevention Studies, San Francisco, United States
Background: Limited epidemiological data suggest that men who have sex with men in the Eastern Caribbean are at HIV risk, but little is known about their risk factors and appropriate prevention interventions in countries where stigma and discrimination (S&D), homophobia, and buggery (sodomy) laws exist. This qualitative study assessed HIV prevention needs and the feasibility of implementing Mpowerment (MP) with gay men in Barbados. Core elements of MP, a community-level intervention, include mobilizing men to deliver HIV prevention messages to peers, outreach, community events, and creating safe spaces for personal and community development.
Methods: We conducted 2 focus groups with 12 gay men and in-depth interviews with 6 gay men and 9 providers (N=27). Audio-taped data were summarized and analyzed for salient themes.
Results: An incipient gay community exists. Two main groups of self-identified gay men are defined by social class and level of “outness”: 1) “Discreet” “bougies” of higher socio-economic background are closeted because of S&D; 2) “Flamboyant” “ghetto gays” of lower socio-economic background are 'out' and, because of their public presentation, exposed to S&D. Opportunities to socialize as openly gay are limited. Gay men have HIV knowledge but engage in HIV risk because of low self-esteem and lack of condom negotiation skills. Poor health-seeking behaviors, S&D, and mistrust of the health system increase their HIV vulnerability. HIV prevention consisting of condom distribution, outreach and testing promotion has mainly targeted the visible “ghetto gays.” In a societal context of homophobia and S&D, participants found MP feasible and acceptable to help men realize their strengths, self-worth and protect themselves from HIV. Existing human resources, social networks and venues could be used for implementing MP.
Conclusions: With tailoring, implementation of MP in Barbados holds promise for HIV prevention and community development and mobilization. MP may serve as a model for replication in other Caribbean countries.
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