Developing Concurrency Messaging to Address Racial Disparities in HIV/AIDS Utilizing Community-Based Participatory Research (CBPR)

Background:  In the United States, HIV rates are significantly higher among non-Hispanic Blacks than among any other racial or ethnic group. In Seattle and King County, Washington, non-Hispanic Blacks comprise 6% of the population, yet they represented 18% of all newly diagnosed cases of HIV between 2002 and 2006. Due to structural factors such as disproportionate incarceration rates and poverty, African-Americans have higher rates of sexual concurrency (sexual relationships that overlap in time).  Research has found that African-Americans are more likely to engage in dissortative mixing (lower risk individuals are more likely to have sexual relationships with higher risk individuals) and assortative mixing (African Americans are more likely than other ethnic groups to choose sexual partners within their own racial group).  Combined, these factors have the potential to increase differential rates of transmission over time.  Mathematics models have shown that even a slight decrease in the number of concurrent relationships in a given community can have a dramatic impact on the transmission of HIV.

Program background:  In 2005, the University of Washington (UW) Center for AIDS Research (CFAR) Socio-behavioral Prevention Research Core’s (SPRC) Community Advisory Board (CAB), which is comprised of University of Washington researchers and over nineteen community-based originations, co-wrote a successful R21 grant to utilize Community-Based Participatory Research (CBPR) methods to conduct formative research and develop a culturally-resonant social marketing campaign addressing sexual concurrency and the transmission of HIV in the local Black community. The strict adherence to CBPR principles and methods has resulted in a successful community academic partnership and a project which has resulted in rich data that has not only informed the concurrency messaging but has identified additional ways to collaborate and address disparities in the local Black community.

Evaluation Methods and Results:  To date, we have conducted 20 key-informant interviews, 11 focus groups and four community discussions. A marketing campaign is being developed in partnership with the CAB and will be evaluated by "street-intercept" methods, in accordance with our R21 grant.

Conclusions:  A number of key themes have been identified and include concurrency as dating; gender norms related to social acceptability of concurrent partnerships; stigma related to HIV and sexual orientation; lack of open discussion and communication about sexual relationships and HIV; lack of education and awareness of concurrency as a risk factor; and the need for an educational concurrency curriculum to be developed and implemented in conjunction with the concurrency social marketing campaign.

Implications for research and/or practice:  Translating the concept of concurrency from the mathematical models research in a non-technical way to community audiences has been the focus of this project. CBPR methods have the potential to reach populations that may otherwise be challenging to reach through more conventional research methodologies.  By learning from the "Community Concurrency Project" in King County, WA, researchers across the country will have the ability to research and implement creative, culturally-relevant and community-centered campaigns related to HIV and sexual concurrency.