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Table 1 Overview of the Mpowerment Project

From: Facilitators and barriers to effective scale-up of an evidence-based multilevel HIV prevention intervention

Structure and principles underlying MP Description of MP
Overview of MP • Community-level, community mobilization intervention targeting all YGBM in a community
• Focuses on structural-level changes, including altering YGBM’s social milieu through development of a YGBM’s community that supports each other regarding sexual risk reduction and frequent HIV testing, and by providing a community space where men can find supportive, caring community in a safe environment where they encounter social norms supportive of sexual risk reduction and frequent HIV testing [32]
• Focuses on social-level issues, including norms and social support about safer sex and HIV testing
• Focuses on interpersonal factors, such as communication and sexual negotiation skill-building, and boyfriend issues
• Focuses on individual-level factors, such as clarifying misperceptions of what is safe and unsafe, why regular and frequent HIV testing is important, and internalized homonegativity
• MP initially only focused on sexual risk reduction, but now is also used to promote regular and frequent HIV testing and is being adapted to focus on the HIV Continuum of Care [33]
Guiding principles • 6 principles below, based on formative research and theories of social and behavioral change, underlie MP
• Has been intended, since initial development, that the MP is adapted for and by each community for their populations, settings, and cultural issues following careful consideration of the core elements and guiding principles
 Social focus • HIV prevention is not very salient to YGBM, they are not drawn to HIV prevention programs
• Must relate risk reduction and HIV testing to the satisfaction of more compelling needs, such as the development of new friends and social networks, enjoyment of social interactions, and enhancement of self-esteem
 Community-building • Primary goal of the MP: to create healthy friendship and social support networks
• Creates settings where YGBM can express their identities, form positive linkages with similar others, and draw support and band together to take action on issues of importance to them
 Peer-based • Seeks to mobilize men to support and encourage their peers about having safer sex and getting tested for HIV regularly
• Peers used as change agents because they exert tremendous influence at this life stage of life and are credible
 Empowerment philosophy • Designed to serve an empowering function within the YGBM community
• Behavior change is more lasting when people are actively involved in finding and implementing solutions to their problems
• Providing mechanism for designing and running the intervention activities fosters sense of personal commitment to and ownership of prevention activities and messages
 Diffusion of innovations • Develops process by which YGBM actively communicate with each other about and encourage each other to practice safer sex and get tested for HIV regularly (new behavioral practices) so they become mutually accepted norms
 Gay, sex, and ethnic/racial group positive • MP attempts to enrich and strengthen YGBM’s pride in being gay or same gender loving and nurture their exploration and celebration of their sexuality
• For MSM of color, the project nurtures pride in being of one’s ethnic/racial group
Core elements • 7 core elements, described below, work synergistically with the guiding principles and set in motion an ever-widening diffusion process through which young men communicate with and encourage each other about sexual risk reduction and regular, frequent HIV testing
 Coordinators • Paid CBO staff, typically young gay/bisexual men from the community, who facilitate the project and coordinate its activities
 Core group • 10 to 20 young men from major subgroups in the community and the coordinators
• The decision-makers for the project and design and carry out all project activities
 Formal outreach • Teams of YGBM go to locations frequented by other YGBM to promote safer sex and testing in engaging and interactive ways
• Distribute appealing literature on testing and HIV risk reduction (developed in-house) and condoms and lubricants
• Also create social outreach events to attract YGBM from different subgroups, at which to promote safer sex and testing
 Informal outreach • Men encourage friends to be safe sexually, attend project activities, and join project
• M-group participants are trained and motivated to conduct informal outreach
 M-groups • Peer-led, 3-h meetings of 8 to 10 young men
• Uses skills-building exercises to address factors contributing to unsafe sex or infrequent HIV testing among the men
 Publicity • Publicizes and attracts men to project
• By word of mouth, via social networking and websites, through the distribution of promotional materials at venues attracting YGBM, and through articles and advertisements in gay media