Using a “Positive Deviance” Framework to Discover Adaptive Risk Reduction Behaviors Among High-Risk HIV Negative Black Men Who Have Sex with Men
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Despite the high incidence of HIV among young Black MSM in the United States and engagement in high risk behaviors, many men in this group avoid infection. This suggests that some men may engage in systematic risk reduction behaviors when not always using condoms or abstaining from substances. Using a “positive deviance” framework, we conducted qualitative interviews with HIV-negative, Black MSM between 25 and 35 who reported unprotected anal sex and drug use in the past six months or current heavy drinking (N = 29) to discover behaviors that could facilitate remaining HIV-uninfected. Findings showed that MSM who remain HIV negative despite continuing to engage in high-risk behaviors may be engaging in adaptive risk reduction behaviors that, through successive decisions and advance planning along the timeline to a sexual event, could lead to increased condom use, avoidance or delay of a risky sexual event, or reduction of HIV positive partners.
KeywordsHIV/AIDS Black MSM Substance use Positive deviance Risk reduction
Primary support for this study was provided by National Institute on Drug Abuse Grant 5 03 DA035689-02. We acknowledge the Center for HIV Identification, Prevention and Treatment Services, University of California Los Angeles (P30 MH058107), and the UCLA Vine Street Clinic for their support and dedication.
Compliance with Ethical Standards
Funding for this study was providing by NIDA grant 5 R03 DA035689-02.
All procedures were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards and were in accordance with the ethical standards of and approved by the RAND Human Subjects Protection Committee.
- 4.Centers for Disease Control and Prevention. Prevalence and awareness of HIV infection among men who have sex with men—21 cities. Morb Mortal Wkly Rep. 2010;59:1201–7.Google Scholar
- 5.Centers for Disease Control and Prevention. Estimated HIV incidence among adults and adolescents in the United States, 2007–2010. HIV surveillance supplemental report 2012. 2012;17(4).Google Scholar
- 6.Balaji A, Bowles K, Le B, Paz-Bailey G, Oster A, editors. High HIV incidence and prevalence and associated factors among young MSM in 21 cities: US, 2008. 9th conference on retroviruses and opportunistic infections; 2012 March 5-8; Seattle.Google Scholar
- 7.Los Angeles County Department of Health Division if HIV and STD Programs. 2014 Annual HIV/STD Surveillance Report 2014.Google Scholar
- 12.Eaton LA, Driffin DD, Bauermeister J, Smith H, Conway-Washington C. Minimal awareness and stalled uptake of pre-exposure prophylaxis (PrEP) among at risk, HIV-negative, black men who have sex with men. AIDS Patient Care STDS. 2015.Google Scholar
- 23.Save the Children Federation. Promising behaviors to mitigate HIV/AIDS in Viet Nam identified through the positive deviance approach In: Save the Children Federation, editor. USA, Westport, CT2002.Google Scholar
- 27.Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol use disorders identification test. Arch Intern Med. 1998;158(16):1789–95.CrossRefPubMedGoogle Scholar
- 28.Spradley JP. The ethnographic interview. New York: Hold Rinehart and Winston; 1979.Google Scholar
- 30.The Positive Deviance Initiative. Basic Field Guide to the Positive Deviance Approach,. In: Tufts University Friedman School of Nutrition Science and Policy, editor. Positive Deviance Initative 2010.Google Scholar
- 31.Denzin N, Lincoln Y. Handbook of qualitative research. 4th ed. Thousand Oaks, CA: Sage Publications; 2011.Google Scholar