Book Description

Background: One of the biggest racial health disparities in the US concerns HIV/AIDS. African Americans have considerably higher rates of HIV/AIDS than do Whites, Hispanics, Asians, and Native Americans. The predominant approach to prevention has been to mount individual- or small-group multisession behavioral interventions. The reach of such interventions is very limited and thus, the field of HIV prevention has called for structural interventions that reach many people in their natural environments. This dissertation evaluates a serial drama, "Reality Check," which is a structural HIV prevention intervention for, 18-24 year old African Americans.Theory: Bandura's Social Cognitive Theory was used in the development of the intervention. Fishbein and Ajzen's Reasoned Action approach, was used to inform the survey instrument and statistical analysis models. Intervention: "Reality Check" is a 13-episode serial drama. Each day a new 6-9 minute, episode was streamed online while all previous episodes were available on the study's website. In addition to streaming the episodes, emails giving the locations of local venues where free HIV testing is available were sent, so that the barrier of not knowing will not interfere with viewers' ability to be tested should they decide to get tested. Method: A randomized controlled trial with baseline and multiple post- intervention assessments was used to evaluate the efficacy of the intervention. A total of 203 African Americans (162 women and 41 men) aged between 18 and 24 years located anywhere in the United States participated in the study. Confidential online longitudinal surveys were conducted at baseline, immediately after the intervention, and three months after the end of the intervention. The primary outcomes were condomless sex and HIV testing. Results: The intervention reduced the number of times participants reported having condomless sex but did not affect HIV testing. It also reduced homophobia and HIV/AIDS stigma as well as the number of times participants reported having vaginal sexual intercourse. Attrition was remarkably low with 93% and 87% of the participants completing the immediate-post intervention and 3-month follow-up assessments respectively.