AIDS and Behavior

, Volume 22, Issue 5, pp 1699–1712 | Cite as

Using a “Positive Deviance” Framework to Discover Adaptive Risk Reduction Behaviors Among High-Risk HIV Negative Black Men Who Have Sex with Men

  • A. J. OberEmail author
  • D. T. DangerfieldII
  • S. Shoptaw
  • G. Ryan
  • B. Stucky
  • S. R. Friedman
Original Paper


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.


HIV/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.

Ethical Approval

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.


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • A. J. Ober
    • 1
    Email author
  • D. T. DangerfieldII
    • 2
  • S. Shoptaw
    • 3
  • G. Ryan
    • 1
  • B. Stucky
    • 1
  • S. R. Friedman
    • 4
  1. 1.RAND CorporationSanta MonicaUSA
  2. 2.Health Promotion and Disease Prevention, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA
  3. 3.Department of Family Medicine, David Geffen School of MedicineUniversity of Los Angeles CaliforniaLos AngelesUSA
  4. 4.National Development and Research InstituteNew YorkUSA

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