A Community-based Intervention to Increase PrEP Initiation in Prince George's County, Maryland: Reducing HIV Stigma and Increasing Social Support
Phase: NA
Conditions: Hiv, Mental Health Issue, Support, Family
Sponsor: George Mason University

A Community-based Intervention to Increase PrEP Initiation Among Black Sexual  
Minority Men in Prince George's County, Maryland: Reducing Internalized Stigma and 
Increasing Social Support  
  
November 14, 2023  
  
  
 

  
Aim: To develop and test an intervention to promote PrEP initiation and adherence 
among BSMM.  
  
Participant Recruitment: The investigators will recruit participants for the intervention using 
respondent-driven sampling, starting with 12 initial HIV negative BSMM participants at our first 
wave of recruitment.  will attempt to recruit participants from our previous sample of 32 
participants in aim 2; if investigators are unable to do so investigators will recruit additional 
participants using the same social media sampling approaches as described in aim 2. All 
potential participants will be screened for eligibility during the initial social media contact. These 
12 participants will function as the "seeds" for subsequent respondent-driven recruitment. Each 
seed will be compensated for their participation with a “primary incentive” ($20) and then asked 
to recruit 4 peers. The seed is rewarded with a secondary incentive ($10) for each eligible 
participant they recruit into the study. Each subsequent enrolled participant will complete the 
survey and be asked to recruit additional participants. They will be offered the same primary and 
secondary incentives. Each subsequent enrolled participant will identify the email address of the 
person who referred them. They will also be asked to recruit additional participants and are 
offered the same incentives. Chain referrals will continue until investigators reach the intended 
sample size of 130. RDS is an effective way to reach MSM populations and allows for the 
generation of weights which improve generalizability of results.   
  
Pre-Intervention Procedures: Investigators will test all participants for HIV at baseline using a 
rapid oral test (all potential intervention sites have available HIV testing capacity). Those who 
test positive will receive counseling and be referred for initiation of treatment. They will also be 
compensated $20. Of the 130 participants who test negative for HIV, these will be randomized 
into two groups (65 each) using simple randomization at baseline. Participants in the control 
group will complete the quantitative survey and receive general information on PrEP and be 
offered referral for PrEP initiation. These participants will be compensated $20.   
  
Intervention Procedures: The 65 participants in the intervention group will participate in the 
intervention over the following year. Based on the MPowerment model, 3 discussions will be led 
by 3 trained BSMM community members. These leaders will be recruited from BSMM 
community serving organizations, as members of these organizations have expertise in leading 
community-based events (letters of support attached). Each of these leaders will hold events as 
part of the proposed intervention, with each leader holding events for 15 to 17 participants. 
Location will be determined based on feedback from qualitative interviews in Aim 2; this may 
include a research space on campus at the University of Maryland, College Park, the Gay Men’s 
Health Collaborative, or Us Helping Us (see letters of support). In-person events will focus on 
five specific goals: Fostering a sense of community acceptance and social connection among 
BSMM, promoting self-acceptance of sexual identity, teaching skills for coping with experiences 
of racism, reducing PrEP stigma, and providing education on HIV risk. In accordance with the 
MPowerment model, In collaboration with the PI, the BSMM core group and volunteers would 
lead the development, implementation, and evaluation of all intervention events. Both peer 
leaders and the primary investigator (all BSMM) will collaborate to develop specific events 
(“MGroups”), guided by the findings in both the quantitative and qualitative studies. M-Groups 
will be held once every month. Events will be 2 hour in-person activities focused on the 
aforementioned goals. Participants will be compensated $10 for completing evaluations of 
events at every M-Group event they attend. In addition to attending events, participants will be  
referred to online BSMM social media groups focused on community connectedness and 
support among BSMM, and be invited to attend events held by BSMM-serving communitybased 

organizations (CBOs). Note that these activities are still in development, and may change 
substantially prior to the intervention initiation.   
  
Post-Intervention Procedures: After 12 months the intervention will conclude, though 
participants can maintain contact with their peer group leaders through social media and 
maintain membership in BSMM social media groups. Participants will be provided the 
quantitative survey online to complete and be compensated $20 for completing the survey. 
Investigators will also solicit our final open-ended feedback regarding the intervention from 
participants at this time. 6 months after baseline, participants will also be provided the 
quantitative survey online, and compensated $20. If at any point participants express interest in 
initiation of PrEP, they will be referred to BSMM CBOs for PrEP initiation.   
  
Data Collection: All participants (both groups) will complete an approximately 25-minute online 
survey at baseline and at 3, 6, 9, and 12 months. Questions will include sociodemographics 
(age, education level, income level, employment status, region of the United States), sexual 
identity, sexual behaviors (condom use, number of sexual partners, substance use during sex, 
transactional sex, partner concurrency) healthcare access (insurance status, multiple barriers to 
healthcare), and previously validated multi-item scales to measure each primary construct. 
Internalized homophobia will be measured using the Measure of Internalized Sexual Stigma for 
Lesbians and Gay Men (MISS-LG) 17-item scale. Internalized racial stigma will be measured 
using the Appropriated Racial Oppression Scale. This scale covers many dimensions of 
racial/ethnic stigma; only the 9 items related to internalized racism will be utilized for our 
research. Experienced homophobia and racism will be measured using the HIV Prevention 
Trials Network 061 (a multicenter study of BSMM in the United States) 25-item experienced 
homophobia scale, and 28-item experienced racism scale. HIV stigma will be measured using 
the 12-item personalized stigma subscale of the Rutgers-Modified Stigma Scale; this subscale 
is especially applicable to HIV negative individuals. Social support will be measured using the 
HIV Prevention Trials Network 061 6-item social support scale. These measures have been 
reviewed by both our research team and our BSMM community collaborators to ensure that 
items have appropriate face and content validity. As additional covariates, investigators will 
measure key psychosocial and behavioral factors. Depression will be measured using the 
Center for Epidemiologic Studies Depression (CES-D) 10-item scale. Anxiety will be measured 
using the Generalized Anxiety Disorder 7-item (GAD-7) scale. Alcohol use will be measured in 
frequency of alcohol use in the past 3 months and number of drinks at each use. Substance use 
will be measured in frequency of use of the following 9 substances: marijuana, inhaled nitrates 
(i.e. “poppers”), crack, cocaine, methamphetamine, heroin, MDMA (i.e. “ecstasy”), synthetic 
marijuana, and non-prescribed Vicodin/Oxycontin/Xanax in the past 3 months. Perceived HIV 
risk will be measured using the 8-item Perceived Risk of HIV Scale. Resilience will be measured 
using the 10-item Connor-Davidson Resilience Scale. For our outcomes, PrEP stigma will be 
measured using the 10-item Pre-Exposure Prophylaxis Stigma Scale. PrEP acceptability will be 
measured using the 7-item PrEP Acceptability scale. PrEP use will be measured with the 
question “Do you currently use PrEP?” (Yes/No). Finally, social desirability bias will be 
measured using the Socially Desirable Response Set Five-Item Survey.   
  
Data Analysis: First, weights will be generated based on RDS. Investigators will use these 
weights in all subsequent analyses. Investigators will test for associations between the 
intervention and two outcomes: PrEP initiation and PrEP adherence (both binary). In addition to 
descriptive analyses, investigators will generate modified Poisson regression (binary outcome) 
models. Fisher exact tests may be used as an alternative to Chi-square tests where expected 
cells are less than 10. While investigators do not expect confounding given the randomization, 

investigators will test and adjust for covariates with significant differences between control and 
intervention groups. All analyses will utilize the intention-to-treat approach.