Curr HIV/AIDS Rep (2010) 7:185–193 DOI 10.1007/s11904-010-0058-0 The Four Cs of HIV Prevention with African Americans: Crisis, Condoms, Culture, and Community John K. Williams & Gail E. Wyatt & Gina Wingood Published online: 21 August 2010 # The Author(s) 2010. This article is published with open access at Springerlink.com Abstract HIV/AIDS continues to be a devastating epidemic with African American communities carrying the brunt of the impact. Despite extensive biobehavioral research, current strategies have not resulted in significantly decreasing HIV/ AIDS cases among African Americans. The next generation of HIV prevention and risk reduction interventions must move beyond basic sex education and condom use and availability. Successful interventions targeting African Americans must optimize strategies that integrate socio- cultural factors and address institutional and historical barriers that hinder or support HIV risk reduction behaviors. Community-based participatory research to decrease the HIV/AIDS disparity by building community capacity and infrastructure and advocating for and distrib- uting equitably, power and resources, must be promoted. Recommendations for paradigm shifts in using innovative theories and conceptual frameworks and for training researchers, clinicians, grant and journal reviewers, and community members are made so that culturally congruent J. K. Williams (*) : G. E. Wyatt Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 760 Westwood Plaza, C8-871C, Los Angeles, CA 90024-1759, USA e-mail: Keoniwmd@aol.com G. E. Wyatt e-mail: gwyatt@mednet.ucla.edu G. Wingood Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA e-mail: gwingoo@sph.emory.edu interventions may be tested and implemented at the community level. Keywords HIV prevention . African American . Culture . Condoms Introduction The Context In the United States, HIV/AIDS continues to be a devastating epidemic within African American communi- ties, posing a significant public health crisis [1]. HIV/AIDS represents a health disparity where blacks comprise 12% of the population but account for a disproportionately high number of the cases [1, 2]. The latest Centers for Disease Control and Prevention (CDC) statistics cite 51% of the 42,655 new HIV/AIDS diagnoses among blacks [1]. Blacks also account for 48% of the more than half million individuals living with HIV/AIDS [1]. While the public health response over the past nearly three decades has been to develop, test, and disseminate HIV prevention and risk reduction interventions, HIV/AIDS rates continue to be the worst among blacks as compared to other racial/ethnic groups [1]. The CDC and researchers in the public and private domains have sought to identify factors that heighten HIV risks and promote disease infection and transmission [3]. Despite evolving strategies that address the increasingly acquired information about the infection, there has been minimal translation to decreasing HIV/AIDS within African American communities. When HIV was initially identified, prevention efforts targeted certain risk groups [4, 5]. As the epidemic progressed in the mid-1990s, increasing numbers of