Abstract
Purpose
The aim of this study is to evaluate the efficacy and mediation of a culturally appropriate,
theory-based HIV/STI (sexually transmitted infection) risk-reduction intervention
delivered in barbershops by barbers via iPads to African-American young men in reducing
sexual risk behaviors.
Methods
In a cluster randomized controlled trial, 24 matched pairs of barbershops serving
African-American men ages 18–24 in the 10 Philadelphia, PA zip codes with the highest
HIV/AIDS prevalence were randomized to implement via iPads one of 2 interventions:
“Shape Up! Barbers Building Better Brothers,” an HIV/STI risk-reduction intervention
based on the theory of planned behavior and formative research or an attention-matched
violence-prevention control intervention. The primary outcome was self-reported consistent
condom use 3, 6, and 12 months postintervention, controlling for baseline consistent
condom use.
Results
Participants were 618 men, 319 in the HIV/STI intervention and 299 in the control
intervention. Generalized estimating equation analysis indicated that the direct effect
of the HIV/STI intervention in increasing consistent condom use postintervention was
nonsignificant (odds ratio = 1.13, 95% confidence interval: 0.73–1.75), adjusting
for clustering among participants in barbershops and baseline condom use. However,
mediation analysis using the product-of-coefficients approach revealed indirect effects
of the intervention. Consistent with the theory of planned behavior, the intervention
increased behavioral beliefs and self-efficacy regarding using condoms, which raised
condom use intention, which, in turn, boosted consistent condom use.
Discussion
Sexual risks among young African-American men can be reduced by barber-led theory-based,
culturally appropriate HIV/STI risk-reduction interventions in barbershops in high
HIV prevalence neighborhoods that increase behavioral beliefs and self-efficacy.
Keywords
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Article info
Publication history
Published online: January 21, 2023
Accepted:
October 19,
2022
Received:
November 7,
2021
Publication stage
In Press Corrected ProofFootnotes
Conflicts of interest: The authors have no conflicts of interest to declare.
Disclaimer: This study was supported by the National Institutes of Health, which had no role in the design and conduct of the study, collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.
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