Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Sullivan PS, Hamouda O, Delpech V, Geduld JE, Prejean J, Semaille C, et al. Reemergence of the HIV epidemic among men who have sex with men in North America, Western Europe, and Australia, 1996–2005. Ann Epidemiol. 2009;19(6):423–31.

    Article  PubMed  Google Scholar 

  2. Prejean J, Song R, Hernandez A, Ziebell R, Green T, Walker F, et al. Estimated HIV incidence in the United States, 2006–2009. PLoS ONE. 2011;6(8):e17502.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Binson D, Michaels S, Stall R, et al. Prevalence and social distribution of men who have sex with men: United States and its urban centers. J Sex Res. 1995;32:245–54.

    Article  Google Scholar 

  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).

  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.

  7. Los Angeles County Department of Health Division if HIV and STD Programs. 2014 Annual HIV/STD Surveillance Report 2014.

  8. Koblin BA, Mayer KH, Eshleman SH, Wang L, Mannheimer S, del Rio C, et al. Correlates of HIV acquisition in a cohort of Black men who have sex with men in the United States: HIV prevention trials network (HPTN) 061. PLoS ONE. 2013;8(7):e70413.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Sullivan PS, Carballo-Dieguez A, Coates T, Goodreau SM, McGowan I, Sanders EJ, et al. Successes and challenges of HIV prevention in men who have sex with men. Lancet. 2012;380(9839):388–99.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Saberi P, Gamarel KE, Neilands TB, Comfort M, Sheon N, Darbes LA, et al. Ambiguity, ambivalence, and apprehensions of taking HIV-1 pre-exposure prophylaxis among male couples in San Francisco: a mixed methods study. PLoS ONE. 2012;7(11):e50061.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Bauermeister JA, Meanley S, Pingel E, Soler JH, Harper GW. PrEP awareness and perceived barriers among single young men who have sex with men. Curr HIV Res. 2013;11(7):520–7.

    Article  CAS  PubMed  PubMed Central  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.

  13. Wray JD. Editorial: can we learn from successful mothers? J Trop Pediatr Environ Child Health. 1972;18(4):279.

    CAS  PubMed  Google Scholar 

  14. Marsh DR, Schroeder DG, Dearden KA, Sternin J, Sternin M. The power of positive deviance. BMJ. 2004;329(7475):1177–9.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Friedman SR, Mateu-Gelabert P, Sandoval M, Hagan H, Des Jarlais DC. Positive deviance control-case life history: a method to develop grounded hypotheses about successful long-term avoidance of infection. BMC Public Health. 2008;8:94.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Gwadz MV, Clatts MC, Yi H, Leonard NR, Goldsamt L, Lankenau S. Resilience among young men who have sex with men in New York City. Sex Res Soc Policy. 2006;3(1):13.

    Article  Google Scholar 

  17. Wyatt GE. Enhancing cultural and contextual intervention strategies to reduce HIV/AIDS among African Americans. Am J Public Health. 2009;99(11):1941–5.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Herrick AL, Lim SH, Wei C, Smith H, Guadamuz T, Friedman MS, et al. Resilience as an untapped resource in behavioral intervention design for gay men. AIDS Behav. 2011;15(Suppl 1):S25–9.

    Article  PubMed  Google Scholar 

  19. Williams J, Wyatt G. The four Cs of HIV prevention with African Americans: crisis, condoms, culture and community. HIV/AIDS Rep. 2010;7:185–93.

    Article  Google Scholar 

  20. Greenwood GL, Paul JP, Pollack LM, Binson D, Catania JA, Chang J, et al. Tobacco use and cessation among a household-based sample of US urban men who have sex with men. Am J Public Health. 2005;95(1):145–51.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Lim SH, Ostrow D, Stall R, Chmiel J, Herrick A, Shoptaw S, et al. Changes in stimulant drug use over time in the MACS: evidence for resilience against stimulant drug use among men who have sex with men. AIDS Behav. 2010;16:151–8.

    Article  Google Scholar 

  22. Friedman SR, Sandoval M, Mateu-Gelabert P, Meylakhs P, Des Jarlais DC. Symbiotic goals and the prevention of blood-borne viruses among injection drug users. Subst Use Misuse. 2011;46(2–3):307–15.

    Article  PubMed  PubMed Central  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.

  24. Vosburgh HW, Mansergh G, Sullivan PS, Purcell DW. A review of the literature on event-level substance use and sexual risk behavior among men who have sex with men. AIDS Behav. 2012;16(6):1394–410.

    Article  PubMed  Google Scholar 

  25. Boone MR, Cook SH, Wilson P. Substance use and sexual risk behavior in HIV-positive men who have sex with men: an episode-level analysis. AIDS Behav. 2012;17:1883–7.

    Article  Google Scholar 

  26. Colfax G, Vittinghoff E, Husnik MJ, Mckirnan D, Buchbinder S, Koblin B, et al. Substance use and sexual risk: a participant-and episode-level analysis among a cohort of men who have sex with men. Am J Epidemiol. 2004;159:1002–12.

    Article  PubMed  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.

    Article  CAS  PubMed  Google Scholar 

  28. Spradley JP. The ethnographic interview. New York: Hold Rinehart and Winston; 1979.

    Google Scholar 

  29. Ryan G, Bernard H. Techniques to identify themes. Field Methods. 2003;15(1):85–109.

    Article  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.

  31. Denzin N, Lincoln Y. Handbook of qualitative research. 4th ed. Thousand Oaks, CA: Sage Publications; 2011.

    Google Scholar 

  32. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.

    Article  Google Scholar 

  33. Cohen J. Coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20(1):37–46.

    Article  Google Scholar 

  34. Grov C, Hirshfield S, Remien RH, Humberstone M, Chiasson MA. Exploring the venue’s role in risky sexual behavior among gay and bisexual men: an event-level analysis from a national online survey in the U.S. Arch Sex Behav. 2013;42(2):291–302.

    Article  PubMed  Google Scholar 

  35. Grov C. HIV risk and substance use in men who have sex with men surveyed in bathhouses, bars/clubs, and on Craigslist.org: venue of recruitment matters. AIDS Behav. 2012;16(4):807–17.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Wei C, Raymond HF, Guadamuz TE, Stall R, Colfax GN, Snowden JM, et al. Racial/ethnic differences in seroadaptive and serodisclosure behaviors among men who have sex with men. AIDS Behav. 2010;15(1):22–9.

    Article  Google Scholar 

  37. Eaton LA, Kalichman SC, Cain DN, Cherry C, Stearns HL, Amaral CM, et al. Serosorting sexual partners and risk for HIV among men who have sex with men. Am J Prev Med. 2007;33(6):479–85.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Kurtz SP, Buttram ME, Surratt HL, Stall RD. Resilience, syndemic factors, and serosorting behaviors among HIV-positive and HIV-negative substance-using msm. AIDS Educ Prev. 2012;24(3):193–205.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Coates RA, Calzavara LM, Read SE, Fanning MM, Shepherd FA, Klein MH, et al. Risk factors for HIV infection in male sexual contacts of men with AIDS or an AIDS-related condition. Am J Epidemiol. 1988;128(4):729–39.

    Article  CAS  PubMed  Google Scholar 

  40. Schechter MT, Boyko WJ, Douglas B, Willoughby B, McLeod A, Maynard M, et al. The Vancouver Lymphadenopathy-AIDS Study: 6. HIV seroconversion in a cohort of homosexual men. CMAJ. 1986;135(12):1355–60.

    CAS  PubMed  PubMed Central  Google Scholar 

  41. Jeffries WL, Zsembik BA, Peek CW, Uphold CR. A longitudinal analysis of sociodemographic and health correlates of sexual health among HIV-infected men in the USA. Sexual Health. 2009;6(4):285–92.

    Article  PubMed  Google Scholar 

  42. Carballo-Dieguez A, Bauermeister J. “Barebacking”: intentional condomless anal sex in HIV-risk contexts. Reasons for and against it. J Homosex. 2004;47(1):1–16.

    Article  PubMed  Google Scholar 

  43. Agronick G, O’Donnell L, Stueve A, Doval AS, Duran R, Vargo S. Sexual behaviors and risks among bisexually- and gay-identified young Latino men. AIDS Behav. 2004;8(2):185–97.

    Article  PubMed  Google Scholar 

  44. Tucker JS, Ober A, Ryan G, Golinelli D, Ewing B, Wenzel SL. To use or not to use: a stage-based approach to understanding condom use among homeless youth. AIDS Care. 2014;26(5):567–73.

    Article  PubMed  Google Scholar 

  45. Lorian CN, Grisham JR. Clinical implications of risk aversion: an online study of risk-avoidance and treatment utilization in pathological anxiety. J Anxiety Disord. 2011;25(6):840–8.

    Article  PubMed  Google Scholar 

  46. Jones J, Sullivan PS. Impulsivity as a risk factor for HIV transmission in men who have sex with men: a delay discounting approach. J Homosex. 2015;62(5):588–603.

    Article  PubMed  Google Scholar 

  47. Morgan E, Skaathun B, Michaels S, Young L, Khanna A, Friedman SR, et al. Marijuana use as a sex-drug is associated with HIV risk among black MSM and their network. AIDS Behav. 2016;20(3):600–7.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

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.

Author information

Authors and Affiliations

  1. RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA

    A. J. Ober, G. Ryan & B. Stucky

  2. Health Promotion and Disease Prevention, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    D. T. Dangerfield II

  3. Department of Family Medicine, David Geffen School of Medicine, University of Los Angeles California, Los Angeles, CA, USA

    S. Shoptaw

  4. National Development and Research Institute, New York, NY, USA

    S. R. Friedman

Authors
  1. A. J. Ober
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. T. Dangerfield II
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Shoptaw
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G. Ryan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. B. Stucky
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. R. Friedman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. J. Ober.

Ethics declarations

Funding

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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ober, A.J., Dangerfield, D.T., Shoptaw, S. et al. Using a “Positive Deviance” Framework to Discover Adaptive Risk Reduction Behaviors Among High-Risk HIV Negative Black Men Who Have Sex with Men. AIDS Behav 22, 1699–1712 (2018). https://doi.org/10.1007/s10461-017-1790-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-017-1790-x

Keywords

Search

Navigation