Implementation of a Socio-structural Demonstration Project to Improve HIV Outcomes Among Young Black Men in the Deep South

  • Russell BrewerEmail author
  • Chris Daunis
  • Sabira Ebaady
  • Leo Wilton
  • Sarah Chrestman
  • Snigdha Mukherjee
  • Mary Moore
  • Renee Corrigan
  • John Schneider



We describe the background, rationale, intervention components, and formative results of a demonstration project aimed to ameliorate five socio-structural barriers to HIV services for young Black men aged 18–29 living with and at risk for HIV in Louisiana.


The interventions and activities consisted of (1) five person-centered approaches to enhance linkage to HIV services and improve socio-economic outcomes; (2) the implementation of systematic mystery shopping tests to document instances of housing discrimination; (3) the development and implementation of a multi-prong communications campaign to increase knowledge about the signs of housing discrimination and community resources among young Black men who have sex with men (YBMSM); (4) the integration of HIV/STI services and lesbian, gay, bisexual, and trans (LGBT)–inclusive events on Historically Black Colleges and Universities (HBCUs); and (5) the development of a safe space for YBMSM. A multi-method approach was used to evaluate the outcomes of the different interventions.


The majority (62%) of participants living with HIV were linked to HIV care and 49% had achieved viral suppression. More than 40% of participants were employed during the project. Thirty-seven percent (37%) of the mystery shopping tests showed definite or possible signs of housing discrimination. The housing campaign’s duration was limited with unknown long-term impact among YBMSM. Fifteen cases of syphilis were identified during two HBCU events. A safe space was specifically created for YBMSM at a community-based organization.


Multi-component holistic health interventions are needed to improve HIV outcomes and curb the high HIV rates among young Black men, particularly YBMSM in the United States and the Deep South.


Black men who have sex with men (BMSM) Social and structural factors HIV prevention South Young Black men 



The authors thank the participants, interventionists, CAB members, and integrated sector partners.


R. Brewer generated the initial concept and served as Principal Investigator of the study. All authors contributed to writing each of the manuscript sections.

Funding Information

This project was supported with funds from the Office of Minority Health (Grant no. 6 CPIMP141066-03-01). R. Brewer’s time was also supported by a grant from National Institute of Mental Health (NIMH) (R25MH067127) for the Visiting Professor Program at the University of California, San Francisco; Centers for Disease Control and Prevention (CDC) 5U01PS005122-03; and National Institute on Drug Abuse (NIDA) (3P30DA027828-08S1).

Compliance with Ethical Standards

Conflict of Interest

Dr. Russell Brewer currently serves as advisory to Gilead’s Implementation Science Group and ViiV Healthcare’s Accelerate Initiative.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Institutional Review Board approval was obtained for the study.

Informed Consent

Informed consent was obtained from individuals receiving the person-centered interventions.


  1. 1.
    Centers for Disease Control and Prevention. HIV among African American Gay and Bisexual men. 2017. Available at Accessed July 26, 2017.
  2. 2.
    Centers for Disease Control and Prevention. HIV among African American Gay and Bisexual men. 2017. Available at Accessed 26 July 2017.
  3. 3.
    Maulsby C, Millett G, Lindsey K, Kelley R, Johnson K, Montoya D, et al. HIV among Black men who have sex with men (MSM) in the United States. A review of the literature. AIDS Behav. 2014;18(1):10–25. Scholar
  4. 4.
    Millett GA, Peterson JL, Wolitski RJ. Greater risk for HIV infection of black men who have sex with men: a critical literature review. Am J Public Health. 2006;96(6):12–8.CrossRefGoogle Scholar
  5. 5.
    Millett GA, Flores SA, Peterson JL, Bakeman R. Explaining disparities in HIV infection among black and white men who have sex with men: a metaanalysis of HIV risk behaviors. AIDS. 2007;21:2083–91.CrossRefPubMedGoogle Scholar
  6. 6.
    Millett GA, Peterson JL, Flores SA, Hart TA, Jeffries WL 4th, Wilson PA, et al. Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: a meta-analysis. Lancet. 2012;380:341–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Oster AM, Wiegand RE, Sionean C, Miles IJ, Thomas PE, Melendez-Morales L, et al. Understanding disparities in HIV infection between black and white MSM in the United States. AIDS. 2011;25:1103–12.CrossRefPubMedGoogle Scholar
  8. 8.
    Levy ME, Wilton L, Phillips G 2nd, Glick SN, Kuo I, Brewer RA, et al. Understanding structural barriers to accessing HIV testing and prevention services among black men who have sex with men (BMSM) in the United States. AIDS Behav. 2014;18:972–96. Scholar
  9. 9.
    Mayer K, Wang L, Koblin B, Mannheimer S, Magnus M, del Rio C, et al. Concomitant socioeconomic, behavioral, and biological factors associated with the disproportionate HIV infection burden among Black men who have sex with men in 6 U.S. cities. Plos One. 2014;9(1):1–10. Scholar
  10. 10.
    Nelson LE, Wilton L, Moineddin R, Zhang N, Siddiqi A, Sa T, et al. Economic, legal, and social hardships associated with HIV risk among Black men who have sex with men in six US cities. J Urban Health. 2016;93(1):170–88. Scholar
  11. 11.
    Garcia J, Parker C, Parker RG, Wilson PA, Philbin MM, Hirsch JS. “You’re really gonna kick us out?” Sustaining safe spaces for community-based HIV prevention and control among Black men who have sex with men. Plos One. 2015.
  12. 12.
    Halkitis PN, Wolitski RJ, Millett GA. A holistic approach to addressing HIV infection disparities in gay, bisexual, and other men who have sex with men. Am Psychol. 2013;68(4):261–73.CrossRefPubMedGoogle Scholar
  13. 13.
    Estabrook S, Rodriguez D, Parker B, Howell TJ. HOME: A holistic approach to HIV prevention and program evaluation for young MSM of color in NYC. 2012. Available at Accessed 26 July 2017.
  14. 14.
    Maulsby C, Millett G, Lindsey K, Kelley R, Johnson K, Montoya D, et al. A systematic review of HIV interventions for Black men who have sex with men (MSM). BMC Public Health. 2013;13:625. Scholar
  15. 15.
    Hickson DA, Truong NL, Smith-Bankhead N, Sturdevant N, Duncan DT, Schnorr J, et al. Rationale, design, and methods of the ecological study of sexual behaviors and HIV/STIs among African American men who have sex with men in the Southeastern United States (the MARI study). PLoS One. 2015;10(12):e0143823. Scholar
  16. 16.
    Center for American Progress. HIV/AIDS inequality: structural barriers to prevention, treatment, and care in communities of color. Why we need a holistic health approach to eliminate racial disparities in HIV/AIDS. 2012. Available at Accessed 26 July 2017.
  17. 17.
    Reif S, Safley D, McAllaster C, Wilson E, Whetten K. State of HIV in the US deep south. J Community Health. 2017;42:844–53. Scholar
  18. 18. National HIV/AIDS Strategy for the United States: updated to 2020. 2015. Available at: Accessed 28 July 2017.
  19. 19.
    Brewer RA, Chrestman S, Mukherjee S, Mason KE, Dyer TV, Gamache P, et al. Exploring the correlates of linkage to HIV medical care among persons living with HIV (PLWH) in the Deep South: lessons learned from the Louisiana Positive Charge Initiative. AIDS Behav. 2018;22:2615–26. Scholar
  20. 20.
    Stopka TJ, Brinkley-Rubinstein L, Johnson K, Chan PA, Hutcheson M, Crosby R, et al. HIV clustering in Mississippi: spatial epidemiology study to inform implementation science in the Deep South. JMIR Public Health Surveill. 2018;4(2):e35. Scholar
  21. 21.
    Arnold T, Brinkley-Rubenstein L, Chan PA, Perez-Brumer A, Bologna ES, Beauchamps L, et al. Social, structural, behavioral and clinical factors influencing retention in pre-exposure prophylaxis (PrEP) care in Mississippi. PLoS One. 2017;12(2):e0172354. Scholar
  22. 22.
    Centers for Disease Control and Prevention. HIV surveillance report, 2015. vol. 27. Available at Accessed 28 July 2017.
  23. 23.
    State of Louisiana Department of Health and Hospitals, Office of Public Health, STD/HIV Program. 2016 STD/HIV Surveillance Report. Available at Accessed 24 Aug 2018.
  24. 24.
    State of Louisiana Department of Health and Hospitals, Office of Public Health, STD/HIV Program. Louisiana HIV, AIDS, and early Syphilis surveillance quarterly report. 2017. Available at Accessed 28 July 2017.
  25. 25.
    Office of Minority Health. HIV/AIDS initiative for minority men (AIMM). Available at Accessed 28 July 2017.
  26. 26.
    Chang C. Louisiana is the world’s prison capital. 2016. Available at Accessed 28 July 2017.
  27. 27.
    Sakala L. 2014. Breaking down mass incarceration in the 2010 census: state-by-state incarceration rates by race/ethnicity. Accessed 28 July 2017.
  28. 28.
  29. 29.
    Brewer RA, Magnus M, Kuo I, Wang L, Liu TY, Mayer KH. Exploring the relationship between incarceration and HIV among Black men who have sex with men in the United States. JAIDS. 2012;65:218–25.Google Scholar
  30. 30.
    Brewer RA, Magnus M, Kuo I, Wang L, Liu TY, Mayer KH. The high prevalence of incarceration history among Black men who have sex with men in the United States: associations and implications. Am J Public Health. 2014;104(3):448–54.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Schneider JA, Kozloski M, Michaels S, Skaathun B, Voisin D, Lancki N, et al. Criminal justice involvement history is associated with better HIV care continuum metrics among a population-based sample of young black MSM. AIDS. 2017;31(1):159–65.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Milloy MJ, Montaner J, Wood E. Incarceration of people living with HIV/AIDS: implications for treatment as prevention. Curr HIV/AIDS Rep. 2014;11(3):308–16. Scholar
  33. 33.
    Harawa N, Adimora A. Incarceration, African Americans and HIV: advancing a research agenda. J Natl Med Assoc. 2008;100(1):57–62.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Human Rights Watch. Paying the price. Failure to deliver HIV services in Louisiana Parish Jails. 2016. Available at Accessed 29 July 2017.
  35. 35.
    Maruschak LM. HIV in prisons, 2001–2010. 2015. Available at Accessed 29 July 2017.
  36. 36.
    Louisiana Office of Public Health, STD/HIV Program. Louisiana Statewide Coordinated Statement of Need and HIV Comprehensive Plan. 2008. Available at Accessed 29 July 2017.
  37. 37.
    Springer SA, Pesanti E, Hodges J, Macura T, Doros G, Altice FL. Effectiveness of antiretroviral therapy among HIV infected prisoners: reincarceration and the lack of sustained benefit after release to the community. Clin Infect Dis. 2004;38:1754–60.CrossRefPubMedGoogle Scholar
  38. 38.
    Baillargeon J, Giordano TP, Rich JD, Wu ZH, Wells K, Pollock BH, et al. Accessing antiretroviral therapy following release from prison. J Am Med Assoc. 2009;301(8):848–57.CrossRefGoogle Scholar
  39. 39.
    Pellowski JA, Kalichman SC, Matthews KA, Adler N. A pandemic of the poor: social disadvantage and the U.S. HIV epidemic. Am Psychol. 2013;68(4):197–209.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Sams-Abiodun P, Rattler Jr G. Recognizing the underutilized economic potential of Black men in New Orleans. 2013. Available at Accessed 4 Oct 2017.
  41. 41.
    Metro Morphosis. The state of Black boys and men in Baton Rouge. 2015. Available at Accessed 4 Oct 2017.
  42. 42.
    Aidala AA, Wilson MG, Shubert V, Gogolishvili D, Globerman J, Rueda S, et al. Housing status, medical care, and health outcomes among people living with HIV/AIDS: a systematic review. Am J Public Health. 2016;106(1):e1–e23.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Corneil TA, Kuyper LM, Shoveller J, Hogg RS, Li K, Spittal PM, et al. Unstable housing, associated risk behaviour, and increased risk for HIV infection among injection drug users. Heath Place. 2006;12:79–85.CrossRefGoogle Scholar
  44. 44.
    Coady MH, Latka MH, Thiede H, Golub ET, Ouellet L, Hudson SM, et al. Housing status and associated differences in HIV risk behaviors among young injection drug users (IDUs). AIDS Behav. 2007;11(6):854–63.CrossRefPubMedGoogle Scholar
  45. 45.
    U.S. Department of Housing and Urban Development. Housing discrimination against racial and ethnic minorities. 2012. Available at Accessed 5 Oct 2017.
  46. 46.
    U.S. Department of Housing and Urban Development. An estimate of housing discrimination Against same-sex couples. 2013. Available at Accessed 5 Oct 2017.
  47. 47.
    Greater New Orleans Fair Housing Action Center. Where opportunity knocks the doors are locked. 2014. Available at Accessed 5 Oct 2017.
  48. 48.
    Louisiana Department of Health and Hospitals, Office of Public Health. 2013. People living with HIV/AIDS needs assessment. Available at Accessed 5 Oct 2017.
  49. 49.
    Louisiana AIDS Advocacy Network. Louisiana HIV/AIDS strategy for advocacy. A field manual for change 2014. Available at Accessed 5 Oct 2017.
  50. 50.
    Taylor SE, Dilorio C, Stephens TT, Soett JE. A comparison of AIDS related sexual risk behaviors among African-American college students. J Natl Med Assoc. 1997;89:397–403.PubMedPubMedCentralGoogle Scholar
  51. 51.
    Lewis JE, Malow RM, Ireland SJ. HIV/AIDS risk in heterosexual college students. A review of a decade of literature. J Am Coll Heal. 1997;45:147–58.CrossRefGoogle Scholar
  52. 52.
    Johnson RL, Douglas W, Nelson A. Sexual behaviors of African American male college students and the risk of HIV infection. J Natl Med Assoc. 1992;84:864–8.PubMedPubMedCentralGoogle Scholar
  53. 53.
    Campus Pride. The state of LGBTQ issues at historically Black colleges & universities. 2012. Available at universities. Accessed 11 Oct 2017.
  54. 54.
    Ford O. This is who i am: a phenomenological study of the lived experiences of Black gay men with an undergraduate degree from a Historically Black College or University. Electronic thesis or dissertation. Ohio University, 2007. Available at!etd.send_file%3Faccession%3Dohiou1195566951%26disposition%3Dinline Accessed 5 Oct 2017.
  55. 55.
    National Public Radio. To be young, gifted and gay at a Black college. Interview from May 23, 2007. Available at: Accessed 5 Oct 2017.
  56. 56.
    Means D, Jaeger AJ. Black in the rainbow: “Quaring” the Black gay male student experience at Historically Black Universities. J African American Males Education. 2013;4(2):124–40.Google Scholar
  57. 57.
    Sutton MY, Gray SC, Elmore K, Gaul Z. Social determinants of HIV disparities in the southern United States and in counties with Historically Black Colleges and Universities (HBCUs), 2013-2014. PLoS One. 2017;12:e0170714. Scholar
  58. 58.
    Watson J. HBCUs challenged to address LGBT, diversity issues. 2014. Available at Accessed 11 Oct 2017.
  59. 59.
    Hall NM, Peterson J, Johnson M. To test or not to test: barriers and solutions to testing African American college students for HIV at a Historically Black College/University. J Health Dispar Res Pract. 2014;7(1):2.PubMedPubMedCentralGoogle Scholar
  60. 60.
    Warren-Jeanpiere L, Sutton M, Jones S. Historically Black colleges and universities’ campus culture and HIV prevention attitudes and perceptions among students. J Coll Stud Dev. 2011;52L:740–8.CrossRefGoogle Scholar
  61. 61.
    Duncan C, Miller DM, Borskey EJ, Fomby B, Dawson P, Davis L. Barriers to safer sex practices among African American college students. J Natl Med Assoc. 2002;94:944–51.PubMedPubMedCentralGoogle Scholar
  62. 62.
    Garofalo R, Mustanski B, Johnson A, Emerson E. Exploring factors that underlie racial/ethnic disparities in HIV risk among young men who have sex with men. J Urban Health. 2010;87(2):318–23.CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    LeGrand S, Muessig KE, Pike EC, Baltierra N, Hightow-Weidman LB. If you build it will they come? Addressing social isolation within a technology-based HIV intervention for young Black men who have sex with men. AIDS Care. 2014;26(9):1194–200.CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Crawford I, Allison K, Zamboni B, Soto T. The influence of dual-identity development on the psychosocial functioning of African American gay and bisexual men. J Sex Res. 2002;39(3):179–89.CrossRefPubMedGoogle Scholar
  65. 65.
    Raymond HF, McFarland W. Racial mixing and HIV risk among men who have sex with men. AIDS Behav. 2009;13(4):630–7.CrossRefPubMedPubMedCentralGoogle Scholar
  66. 66.
    Kraft JM, Beeker C, Stokes JP, Peterson JL. Finding the “community” in community-level HIV/ AIDS interventions: formative research with young African American men who have sex with men. Health Educ Behav. 2000;4:430–41.CrossRefGoogle Scholar
  67. 67.
    Glick SN, Golden MR. Persistence of racial differences in attitudes toward homosexuality in the United States. J Acquir Immune Defic Syndr. 2010;4:516–23.CrossRefGoogle Scholar
  68. 68.
    Stokes J, Peterson J. Homophobia, self-esteem, and risk for HIV among African American men who have sex with men. AIDS Educ Prev. 1998;10(3):278–92.PubMedGoogle Scholar
  69. 69.
    Ayala G, Bingham T, Kim J, Wheeler DP, Millett GA. Modeling the impact of social discrimination and financial hardship on the sexual risk of HIV among Latino and Black men who have sex with men. Am J Public Health. 2012;102(S2):S242–9.CrossRefPubMedPubMedCentralGoogle Scholar
  70. 70.
    Myers H, Javanbakht M, Martinez M, Obediah S. Psychosocial predictors of risky sexual behaviors in African American men: implications for prevention. AIDS Educ Prev. 2003;15(supp A):66–79.CrossRefPubMedGoogle Scholar
  71. 71.
    McKirnan DJ, Vanable PA, Ostrow DG, Hope B. Expectancies of sexual ‘escape’ and sexual risk among drug and alcohol-involved gay and bisexual men. J Subst Abus. 2001;1–2:137–54.CrossRefGoogle Scholar
  72. 72.
    Harawa NT, Williams JK, Ramamurthi HC, Manago C, Avina S, Jones M. Sexual behavior, sexual identity, and substance abuse among low-income bisexual and non-gay-identifying African American men who have sex with men. Arch Sex Behav. 2008;37(5):748–762. 17.CrossRefPubMedPubMedCentralGoogle Scholar
  73. 73.
    Hightow-Weidman L, LeGrand S, Choi SK, Egger J, Hurt CB, Muessig JE. Exploring the HIV continuum of care among young black MSM. PLoS One. 2017;12(6):e0179688. Scholar
  74. 74.
    Miller RL, Forney JC, Hubbard P, Camacho LM. Reinventing Mpowerment for Black men: long- term community implementation of an evidence-based program. Am J Community Psychol. 2012;49:199–214.CrossRefPubMedGoogle Scholar
  75. 75.
    Saleh LD, Operario D, Smith CD, Arnold E, Kegeles S. “We’re going to have to cut loose some of our personal beliefs”: barriers and opportunities in providing HIV prevention to African American men who have sex with men and women. AIDS Educ Prev. 2011;23:521–32.CrossRefPubMedGoogle Scholar
  76. 76.
    Creswell JW. A concise introduction to mixed methods research. Thousand Oaks: Sage Publications; 2014.Google Scholar
  77. 77.
    LeBlanc TT, Sutton MY, Thomas P, Duffus WA. HIV and STI risk for young Blacks in high prevalence areas: implications for health equity in communities hosting historically black colleges and universities (HBCUs). J Health Dispar Res Pract. 2014;7(1):1–12.Google Scholar
  78. 78.
    Lewis MW, Ericksen KS. Improving the climate for LGBTQ students at an Historically Black University. Journal of LGBT Youth. 2016;13(3):249–69.CrossRefGoogle Scholar
  79. 79.
    Centers for Disease Control and Prevention. Lesbian, gay, bisexual, and transgender health. 2017. Available at Accessed 7 Nov 2017.
  80. 80.
    Hatzenbuehler ML, Keyes KM. Inclusive anti-bullying policies reduce suicide attempts in lesbian and gay youth. J Adolesc Health. 2013;53(1 suppl):S21–6.CrossRefPubMedPubMedCentralGoogle Scholar
  81. 81.
    Women’s Research & Resource Center. Facilitating campus climates of pluralism, inclusivity, and progressive change at HBCUs. 2011.Google Scholar
  82. 82.
    Hatzenbuehler ML, Birkett M, Van Wagenen A, Meyer IH. Protective school climates and reduced risk for suicide ideation in sexual minority youth. Am J Pub Health. 2014;104(2):279–86.CrossRefGoogle Scholar
  83. 83.
    Saewcy EM, Konishi C, Rose HA, Homma Y. School-based strategies to reduce suicidal ideation, suicide attempts, and discrimination among sexual minority and heterosexual adolescents in Western Canada. Int J Child, Youth Family Stud. 2014;1:89–112.Google Scholar
  84. 84.
    Heck NC, Livingston NA, Flentje A, Oost K, Stewart BT, Cochran BN. Reducing risk for illicit drug use and prescription drug misuse: high school gay-straight alliances and lesbian, gay, bisexual, and transgender youth. Addict Behav. 2014;39:824–8.CrossRefPubMedPubMedCentralGoogle Scholar
  85. 85.
    Hermanstyne KA, Green HD Jr, Cook R, Tieu HV, Dyer TV, Hucks-Ortiz C, et al. Social network support and decreased risk of seroconversion in Black MSM: results from the BROTHERS (HPTN 061) study. J Acquir Immune Defic Syndr. 2018;78(2):163–8.CrossRefPubMedPubMedCentralGoogle Scholar
  86. 86.
    The Advocate. 2017. Almost 2,000 Louisiana prisoners released; what comes next? Available at Accessed 7 Nov 2017.
  87. 87.
    Andrasik MP, Chandler C, Powell B, Humes D, Wakefield S, Kripke K, et al. Bridging the divide: HIV prevention research and Black men who have sex with men. Am J Public Health. 2014;104(4):708–14.CrossRefPubMedPubMedCentralGoogle Scholar
  88. 88.
    Griffin JP Jr, Floyd A. How to promote effective African American partnerships for community-based HIV/AIDS planning: lessons learned from the Atlanta Regional Minority Health Network. J Health Care Poor Underserved. 2006;17(1 Suppl):44–52.CrossRefPubMedGoogle Scholar

Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  1. 1.Department of MedicineUniversity of ChicagoChicagoUSA
  2. 2.Louisiana Public Health InstituteNew OrleansUSA
  3. 3.State University of New York at Binghamton, Human Development DepartmentUniversity Downtown CenterBinghamtonUSA
  4. 4.Faculty of HumanitiesUniversity of JohannesburgJohannesburgSouth Africa
  5. 5.Foundation for Advancement of International Medical Education and ResearchPhiladelphiaUSA
  6. 6.Dillard UniversityNew OrleansUSA
  7. 7.Greater New Orleans Fair Housing Action CenterNew OrleansUSA

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