MySTYLE: Online Family-Based HIV Prevention for non-Heterosexual Black Adolescent Males in the South

In the United States, HIV/AIDS has disproportionately affected men who have sex with men (MSM).(1) In recent years, the highest rates of HIV have been concentrated among increasingly younger MSM, especially those of color in the Southern US.(1-4) Jackson MS, site of this study, has the highest prevalence of HIV among urban MSM in the US (39.5 per 100 MSM) and the third highest rate among Black MSM under the age of 25. (3, 5)Unfortunately, there is no evidenced-based prevention program for adolescent MSM (ages 13 to 18), who are the youngest, most vulnerable group.(6) Of 84 CDC-classified evidence-based interventions, only 9 were specifically designed for MSM, minorities were not adequately represented, and only 2 included MSM less than 18 years of age.(6) A prevention program specifically designed for this vulnerable group, non-heterosexual Black adolescent males (nHBAM), needs to be tested for efficacy and made available for widespread use, especially in the South. Providing early intervention to this population of adolescents may foster their early adoption of protective practices (e.g., safer sex, linkage to care for HIV/STD testing and treatment, PrEP use). Parents may exert the most significant, longitudinal influence in the lives of adolescents and research with heterosexual youth indicates that family-based interventions can be efficacious. Parents of non-heterosexual youth have not generally been included in research because of the perceived difficulty of gaining their consent or because of adolescents’ fears of engaging parents.(7) Fortunately, parents of non-heterosexual youth may be more accessible than commonly thought and they can be included safely. Elze, for example, found that 48% of non-heterosexual adolescents were willing to have caregivers contacted for study enrollment and all caregivers contacted provided consent.(8) In addition, four other recent pilot trials suggest that some parents of non-heterosexual youth may want help with their child’s sexuality, and that a short video (without in-person contact) can positively impact parent attitudes.(9-12) Drs. Brown and Crosby have successfully conducted a NIMH-funded HIV prevention study embracing the concept of parents/caregivers being a primary influence of their adolescents’ sexual risk and protective behaviors.(13-16) Known as Project STYLE, this randomized controlled trial successfully enrolled 721 racially and ethnically diverse heterosexual adolescent parent/caregiver dyads in three U.S. cities with a participation rate of 94%. It was efficacious and evidence from the RCT and a subsequent DVD version tested among Black adolescents suggests that parental involvement is highly protective.(13) STYLE has been designated as a “best evidence” intervention for risk reduction by the CDC. This success and similar research supports the utility of including parents in programs designed to promote sexual health among adolescents.(17, 18) The proposed project will adapt key elements of STYLE and its DVD to create on online HIV intervention program (MySTYLE) that will be delivered to non-heterosexual Black adolescent males (nHBAM), ages 13 to 18, and their parents/caregivers in Jackson, MS. The project will use formative work to adapt the family-based Project STYLE to the needs of nHBAM and their parents/caregivers. Working with an advisory board, an iterative development process will refine and tailor the online intervention. We recognize the inherent risks to adolescents of disclosing their sexual desire/activities to parents/caregivers. We will enroll those who indicate interest a program to support healthy adolescent relationships and acceptance of straight and gay adolescents. Adolescents will not need to reveal their sexual behavior or attitudes, although we expect that the majority of youth who participate will be non-heterosexual, similar to school-based Gay-Straight Alliances. In preparation for this project, we recruited 20 nHBAM and their caregivers for two focus groups from agencies, clinics and a school in a high HIV-prevalence neighborhood of Jackson, MS. The Year 1 formative phase will consist of: 1) interviews of adolescents, 2) interviews of parents/caregivers, and 3) interviews of stakeholders such as staff from LGBT organizations, schools, churches, and state agencies. Findings from the interviews will inform the Year 2 iterative development and refinement phase between the investigators, the media company (MEE Productions, see Facilities), and workgroups (composed of youth, parents, stakeholders, investigators). It will culminate in the creation of MySTYLE, which is proposed to use an engaging online novella to increase motivation and skills to support healthy sexual behavior, communication, and family processes (connectedness and parent practices) for nHBAM and their parents/caregivers. MySTYLE will be tested in a small Randomized Trial Phase in Year 3 with 80 adolescents. This trial will compare the eight-week family-based HIV prevention intervention program to an attention-equivalent eight-week family-based program promoting general healthy behaviors (e.g., nutrition, exercise, tobacco) relevant for Black adolescent males in the South (MyHEALTH). Aims: 1) To use interviews with youth, parents/caregivers, and other stakeholders to identify the relevant elements needed for a family-based intervention for Black adolescent males who do not identify as heterosexual and their parents/caregivers. 2) To use the ADAPT-ITT Model in an iterative approach between investigators, an advisory board, and a media company to refine and tailor MySTYLE. 3) To conduct a preliminary efficacy test of MySTYLE to assess effect size differences in HIV-related knowledge, attitudes, sexual behavior, and in acceptance of HIV testing, as well as parental attitudes and behavior.