HIV Testing Correlates: U.S. and Foreign Born High-Risk Black Heterosexual Men.

In the U.S., Black men are disproportionately affected by HIV, with some of the highest HIV incidence rates and lowest rates of HIV testing. We examined correlates of HIV testing and knowledge among participants of the Barbershop Talk with Brothers (BTWB) project, an HIV prevention program targeting high-risk sexual behaviors among Black heterosexual men in Brooklyn, New York. Specifically, we examined differences between U.S. vs. foreign-born status and HIV testing rates, HIV knowledge, and socio-demographic factors. Of the 855 men included, the mean age was 33 years and 35.0% were foreign-born. Lifetime HIV testing was reported at 84%, with greater proportion of U.S. vs foreign-born men reporting lifetime (88.6% vs. 75.0%) and recent testing (68.6% vs. 51.0%), p < 0.001. Among foreign-born men, recent HIV testing was associated with lower stigma and greater HIV transmission knowledge than those un-tested. The authors recommend tailored approaches to increasing HIV testing in Black communities, based on nativity and social factors.

Adjournment in Community HIV Prevention: Exploring Transitions in Community-Academic Partnerships.

Barbershop-based interventions have been increasingly implemented as a means to support culturally relevant and community-accessible health promotion and disease prevention efforts. Specifically, in neighborhoods of Brooklyn, New York, with high HIV seroprevalence rates, barbers have volunteered to support an initiative to help reduce sexual risk behavior. After implementing the Barbershop Talk With Brothers program for 5 years, we explored how program participation has affected barbers' HIV prevention and counseling skills to promote their clients' health, and assessed their views of next stages of the community-academic partnership, once the specific project ended. Through employing rigorous qualitative research methods with personnel at participating barbershops, key results include that although barbers self-identify as community leaders and even as health educators, they want ongoing support in educating customers about other topics like nutrition and physical activity, including upstream social determinants of health, such as housing and employment. They are also concerned regarding how best to support continuity of efforts and maintenance of partnerships between projects. These findings provide insight toward adjourning community-based participatory research projects, which can inform other academic researchers, organizations, and businesses that partner with community members.

HIV Prevention for Black Heterosexual Men: The Barbershop Talk with Brothers Cluster Randomized Trial.

Objectives. To identify the impact of a strengths-focused HIV prevention program among high-risk heterosexual Black men. Methods. Barbershops in Brooklyn, New York, neighborhoods with high rates of heterosexually transmitted HIV were randomized to the intervention or an attention control program. Men were recruited from barbershops between 2012 and 2016 and participated in a single small group, peer-led session focused on HIV risk reduction skills and motivation, community health empowerment, and identification of personal strengths and communication skills. The outcome was defined as 1 or more acts of condomless anal or vaginal sex in the preceding 90 days at a 6-month interview. Results. Fifty-three barbershops (24 intervention, 29 control) and 860 men (436 intervention, 424 control) were recruited; follow-up was completed by 657 participants (352 intervention, 305 control). Intervention exposure was associated with a greater likelihood of no condomless sex (64.4%) than control group participation (54.1%; adjusted odds ratio = 1.61; 95% confidence interval = 1.05, 2.47). Conclusions. Program exposure resulted in reduced sexual risk behaviors, and the program was acceptable for administration in partnership with barbershops. Public Health Implications. Dissemination of similar programs could improve public health in communities with high rates of HIV attributable to heterosexual transmission.

Lessons Learned from the Implementation of a Shared Community-Academic HIV Prevention Intervention.

BACKGROUND: Community-based participatory research (CBPR) is used to guide the design and evaluation of programs aimed at addressing complex health issues. Effective administrative management of CBPR projects is essential to ensuring the success and fidelity of these programs. OBJECTIVE: We identify an administrative framework to support the implementation and management of a community- academic CBPR initiative. METHODS: The Barbershop Talk with Brothers (BTWB) project was a cluster randomized CBPR intervention designed to reduce HIV among high-risk heterosexual men. Eight-hundred sixty men, representing 53 barbershops, participated in the project. RESULTS: The 3Ps framework is defined by 1) partnership, 2) product, and 3) process. We describe the implementation of the 3Ps through applied examples including partnership management strategies, planning of shared resources, and flexible budgeting that can support the unique infrastructure of a shared community-academic project. CONCLUSIONS: The 3Ps are a translatable framework for comparable shared community-academic research projects to adopt.

Barbershop Talk With Brothers: using community-based participatory research to develop and pilot test a program to reduce HIV risk among Black heterosexual men.

There is a need for feasible, evidence-based interventions that support HIV risk reduction among heterosexual Black men. In this article, we describe the process for development of the Barbershop Talk With Brothers (BTWB) program and evaluation. The BTWB program is a theoretically grounded and community-based HIV prevention program that seeks to improve individual skills and motivation to decrease sexual risk, and that builds men's interest in and capacity for improving their community's health. Formative data collection included barbershop observations and barber focus groups, brief behavioral risk assessments of men in barbershops, and focus groups and individual interviews. Based on this information and in consultation with our steering committee, we developed the BTWB program and accompanying program evaluation. From April through November 2011, 80 men were recruited and completed a baseline assessment of a pilot test of the program; 78 men completed the program and 71 completed a 3-month assessment. The pilot evaluation procedures were feasible to implement, and assessments of pre- and post-test measures indicate that key behavioral outcomes and proposed mediators of those outcomes changed in hypothesized directions. Specifically, attitudes and self-efficacy toward consistent condom use improved, and respondents reported lower levels of sexual risk behavior from baseline to follow-up (all p < 0.05). Perceptions of community empowerment also increased (p = 0.06). While HIV stigma decreased, this difference did not reach statistical significance. Our approach to community-engaged program development resulted in an acceptable, feasible approach to reaching and educating heterosexual Black men about HIV prevention in community settings.

Perceptions of HIV Risk and Explanations of Sexual Risk Behavior Offered by Heterosexual Black Male Barbershop Patrons in Brooklyn, NY.

To describe HIV risk factors among adult heterosexual Black men recruited from four barbershops located in high HIV seroprevalent neighborhoods of Brooklyn, NY. Data on HIV-risk related behaviors and other characteristics were collected from barbershop clients. All participants (n=60) completed brief risk assessments; and a subset (n=22) also completed focus groups and/or individual interviews. Of the subset of 22 men, 68% were US born, 59% had been in jail/prison, 32% were unemployed; and during the 3 months before the interviews, 68% reported at least two partners and 45% reported unprotected vaginal or anal sex with two or more women. Emergent themes included: 1) the psychological function of multiple partnerships; 2) calculated risk taking regarding condom use; 3) the role of emotional attachment and partner trust in condom use; 4) low perceived HIV risk and community awareness; and 5) lack of relationship between HIV testing and safer sex practices. Interventions among heterosexual Black men should focus not only on increasing HIV awareness and reducing sexual risk, but also on contextual and interpersonal factors that influence sexual risk.

Barbers as lay health advocates--developing a prostate cancer curriculum.

PURPOSE: The purpose of this study was to develop and test the efficacy of a prostate health curriculum designed to train African American and Afro Caribbean barbers to deliver prostate cancer control messages to their customers. PROCEDURES: The curriculum was drafted from information obtained from needs assessment surveys administered to barbers and customers from various barbershops in Brooklyn, New York. Focus groups were conducted to further inform the curriculum, which was pilot tested in training sessions. FINDINGS: The high incidence of late-stage diagnosis prostate cancer in African Americans has often been attributed to lack of screening. In surveys administered to 92 customers and 19 barbers, only 26% of customers and 42% of barbers reported having some knowledge of the prostate-specific antigen (PSA) screening test. More than 90% of the barbers expressed a willingness to obtain prostate cancer information to specifically share with their customers, and 83% of customers expressed an interest in obtaining prostate cancer information and willingness to receive that information from their barbers. Following the pilot training, barber knowledge of prostate cancer increased significantly (p < .0001). CONCLUSIONS: This pilot study suggests that there is a need for intervention programs that will raise awareness and increase prostate health knowledge and behavior in communities with elevated incidence of prostate cancer. The study further suggests that barbers are willing to use their leadership skills to educate and encourage their customers to engage in informed decision making.

Attachment styles and sleep measures in a community-based sample of older adults.

BACKGROUND: Measures of attachment style are often used to appraise social and emotional health. In developmental literature, the concept of attachment is used to explain relationships between children and their adult caregivers. While both attachment styles and sleep patterns are conceived as developmentally organized systems, very few studies have explored the link between the two. The present study examined whether attachment styles and sleep measures are associated among older adults. METHODS: Relationships between attachment styles (i.e., secure, fearful, preoccupied, and dismissive) and subjective sleep measures were assessed utilizing data from 70 older participants (mean age: 68+/-6 years; Blacks: 59% and Whites: 41%) in a community-based study assessing subjective health characteristics. After obtaining informed consent, each participant provided demographic and socioeconomic data, as well as relevant medical and subjective data. RESULTS: Independent of participants' demographic and subjective factors, significant correlations were found between the preoccupied attachment dimension and sleep measures. Specifically, individuals scoring high on the preoccupied attachment dimension were more likely to report daytime napping (r(p)=0.31, p<0.01) and to use sleep-inducing medications (r(p)=0.37, p<0.05). No significant correlations were found among sleep measures and the secure, dismissive, and fearful dimensions. CONCLUSIONS: Important relations have been observed between specific attachment styles and subjective sleep factors in our data. Although only one-dimension (preoccupied) demonstrated statistical significance, a trend was observed, suggesting possible associations between the secure attachment style dimension and subjective sleep measures. Future studies are needed to broaden our understanding of the relationship between attachment styles and sleep patterns.

Most Black women have a regular source of hair care--but not medical care.

In this issue, Brown, Naman, Homel et al. present the results of an innovative community-based health education program that the Arthur Ashe Institute for Urban Health has conducted in African-American beauty salons since 1996. Black Pearls: The Health and Beauty of the Black Woman is a beauty-salon-based health education and screening program in Brooklyn, NY that has recently been replicated in West Philadelphia, PA.