188 variables that may directly and obviously affect risk reduction, such as having access to condoms and knowing how to use them, but they must include variables that are culturally rooted. For example, experiences with racism may result in an individual using sex or drugs as a coping strategy and thus, placing themselves at risk for HIV. Other examples may revolve around barriers to seeking health care, expectations regarding African American strength, and mistrust of the health care system. The John Henryism hypothesis, named after the mythic railroad steel driver who overcame challenges only to die from neglecting his limitations, may prevent African Americans from seeking prevention and treat- ment options [33]. Understanding what guides decision- making is influenced by information that is passed from generation to generation about how to sustain life and avoid unexpected outcomes [12 ]. Thus, the culture and heritage of an individual must be addressed in order to affect health change. Other Contextual Variables The structure and organization of urban life has largely been segregated from non-ethnic groups, possibly serving as a protective factor for minority populations against stressors such as racism and discrimination. For African Americans, environmental and sociopolitical stressors based upon racial inequities significantly affect their overall health [34]. HIV interventions must address these challenges. In addition to having appropriate conceptual models and including culture, HIV interventions targeting African Americans need to address institutional variables. Institutional variables, rooted in a sociocultural context, may operate on an individual or community and health systems level [35]. At the individual level, structural factors include being poor, lacking health insurance, a regular health care provider and/or access to health care, and having perceptions of discrimination and mistrust of the medical system [35]. At the community and health systems levels, the lack of services or having available only resource-poor cursory or crisis-oriented services, and the lack of culturally competent providers, may all act as barriers to achieving optimal health [35, 36]. Other institutional variables that affect the lives of African Americans and specifically impact sexual decision-making include partnership availability and family dynamics. Social and sexual networks embedded within the complex structure of African American communities have a significant impact on sexual risk behaviors. Limited partner availability from high incarceration rates, poor health and premature death, and high homicide rates may affect sexual relationships and increase risk for HIV through concurrent partnerships rooted in segregated residential neighborhoods, housing complexes, Curr HIV/AIDS Rep (2010) 7:185–193 and education and health care systems [18, 19, 26 ]. Further, the meaning of sexual communication and the importance of understanding how a person integrates overt and covert messages about sex and sexuality at the individual level and within the African American family and community have rarely been addressed in HIV interventions [26 ]. Cultural Adaptation of Pre-Existing HIV Interventions If previously developed interventions are to be implemented, their limitations must first be addressed. Evidence-based HIV interventions (EBI) are now being adapted to enhance their relevancy for numerous at-risk African American populations. Request for applications (RFAs) are being released by the National Institute of Health (NIH) that can bolster the science- base of dissemination, adaptation, implementation, and operational research for EBI in the United States [37]. Adaptation kits are being created to enhance the ability of CBOs to adapt evidence-based programs [38]. To reduce racial disparities in HIV, adaptation models such as ADAPT- ITT [39] can be tailored to address the specific needs of African Americans (Table 1). Community Endorsement and Support Evidenced-based interventions may change risk behavior for study participants, but the truly successful interventions are those that can be implemented in the real world and still produce the same outcomes. Researchers have only recently begun to acknowledge the myriad of challenges in translational implementation research and HIV prevention [11, 39]. The existing racial disparities in the epidemiology of HIV/AIDS and the extended time that it has taken for research findings to translate into practice have created a national urgency to design effective interventions that can be scaled up rapidly. This context for the translational intervention sciences has produced an important new area of investigation that is now emerging as its own discipline of implementation science [40, 41 ]. According to the CDC, implementation research is defined as “the systematic study of how a specific set of activities and designated strategies are used to successfully integrate an evidence- based public health intervention within specific settings” (RFA-CD-07-005). These specific settings, especially as they refer to HIV interventions, are community settings. However, translational research of HIV interventions into African American communities is not without challenges. The first challenge involves external validity or translating specific findings from evidence-based HIV interventions to real-world situations, HIV/AIDS community agencies, health departments, and sexually transmitted disease (STD) clinics. EBI are usually designed under highly controlled trials, which are typically a very different context of community agencies