Pilot of Culturally Tailored Mpowerment for HIV Prevention

HIV in Lebanon and the Middle East is predominantly among men who have sex with men (MSM), and rates of HIV and sexual risk behavior are on the rise among young MSM (YMSM), driven in part by increased freedom of expression, social tolerance in areas such as Beirut, an influx of migration attributed to MSM refugees coming from war torn Iraq and Syria, and a flourishing sex tourism industry. At a time of political and societa upheaval across MENA, with no substantial HIV prevention programs for MSM anywhere in the region, Lebanon and MENA may be at risk for a critical surge in HIV infection in this vulnerable population. This context presents a great opportunity for an intervention like Mpowerment (MP) to make a critical impact. MP is an evidence-based community-level, structural, social and behavioral HIV prevention intervention developed for YMSM. It combines strategies for individual and community empowerment and mobilization, self-affirmation, sexual self-knowledge, and the creation of supportive social environments for YMSM. It has been widely disseminated in the U.S., but it has never been used in a Muslim-dominant setting;hence, the need for formative research to help us understand how to best tailor MP for this much understudied cultural setting that is not well understood. The gay community in Beirut has grown significantly in recent years with regard to organization, development and advocacy, making it ready to take on and be successful with a community driven intervention like MP. This 5-year project will culturally adapt and pilot MP for YMSM (age 18-29) in Beirut. Phase 1 will involve extensive formative research including innovative peer ethnography and focus groups to better understand the social networks of YMSM and how they communicate about HIV and sexual health with each other, and elicit feedback on how to culturally adapt the MP program for Beirut. In Phase 2 we will pilot specific MP components and adapt the intervention manual. Phase 3 will consist of a 2-year pilot implementation and controlled evaluation of MP to assess intervention effects on community levels of sexual risk behavior and HIV testing. Cohorts of 200 YMSM in each of Beirut and the comparison community of Jounieh will be used to evaluate intervention effects. This study is innovative in being the first implementation and evaluation of any psychosocial sexual health intervention for MSM in all of MENA, and the first study of the social network-driven MP program that will use social network (SN) methodology for evaluating and adapting the intervention. It will have impact by providing pioneering data to broaden the field's understanding of the cultural underpinnings of HIV risk behavior and how to intervene to promote HIV prevention among a highrisk group (YMSM) in a cultural setting in which very little prior work has been done. The goal of this research is to establish an evidence-based model for HIV prevention and sexual health promotion with YMSM in the Middle East and other Muslim-dominant countries.