POSSE Project: A Community-Level Intervention for Black YMSM

Black young men who have sex with men (BYMSM) are at high risk for contracting and
transmitting HIV, and represent a priority population for developing effective interventions.
Within the House Ball community (HBC), a clandestine subculture of the Black gay community,
HIV is highly stigmatized. This stigma, coupled with high HIV prevalence rates and elevated
levels of undiagnosed/untreated HIV infection, places BYMSM in HBCs at incredible risk for
HIV infection. Community-level interventions that target social norms, behavior, and stigma
in the HBC are sorely needed in order to make a broader impact among BYMSM. Building on prior
work in the community, this study proposes to launch an innovative
Effectiveness-Implementation Hybrid Type 2 trial to examine the effectiveness and
implementation of a community-level HIV prevention intervention (called POSSE) based on
popular opinion leader (POL) models across two cities with similar HBCs, Chicago and
Philadelphia. The proposed study has two specific aims: 1) To determine the effectiveness of
a POL intervention, POSSE, to decrease sexual risk behavior (UAI), STIs and HIV stigma among
BYMSM in the HBC; and 2) To evaluate the processes, strategies, barriers and facilitators for
the implementation of POSSE delivered across two distinct metropolitan areas with high HIV
prevalence among BYMSM and similar House Ball Communities. To examine these aims, the
investigators will first use social network strategies to identify, screen, and recruit POLs
(n=75) from the Philadelphia HBC. The investigators will then gather baseline behavioral and
biological (HIV/STI testing) data in both Chicago and Philadelphia (n=100 BYMSM per city) and
train the Philadelphia POLs to implement the POSSE intervention. The investigators will
conduct an implementation-focused process evaluation to assess fidelity to the POSSE
intervention; number, content, spread, and acceptability of risk reduction messages; age
appropriateness of the messages; acceptability of the overall intervention; and
barriers/facilitators to implementation. Next, the investigators will complete follow-up
assessments every 6 months post- intervention in both cities (n=100 BYMSM per city at each
assessment point). The investigators will also assess behavior change in those delivering the
intervention (POLs) at each assessment point. The investigators will conduct
implementation-focused qualitative interviews with POLs (n=15) and community participants
(n=30) from Philadelphia. Last, the investigators will implement POSSE in Chicago by
repeating the steps outlined above, continuing assessments in both cities, and conducting
qualitative interviews in Chicago.