Racial Pride and Condom Use in Post-Incarcerated African-American Men Who Have Sex With Men and Women: Test of a Conceptual Model for the Men in Life Environments Intervention

Abstract

African-American men who have sex with men and women (MSMW) are among those most heavily impacted by HIV in the United States, and those who have histories of incarceration are at further risk of infection. The Men in Life Environments (MILE) HIV prevention intervention was developed to provide culturally appropriate skills-based education and support for African-American MSMW with recent histories of incarceration. The MILE's conceptual framework was informed by three theories: Theory of Reasoned Action and Planned Behavior, Critical Thinking and Cultural Affirmation Model, and Empowerment Theory. The theory-based framework posits that improving racial pride is crucial in building self-efficacy and intentions that in turn promote health-protective behaviors. Therefore, our study aimed to assess whether baseline associations between racial pride and condom use self-efficacy, intentions, and behaviors among African-American MSMW with histories of incarceration align with our conceptual model. We report data on 212 participants recruited from Los Angeles County Sheriff's Department Men's Central Jail and the local community. Using structural equation modeling, we tested two separate models: one with female sexual partners and one with male sexual partners, while stratifying by participant's HIV status. Only among HIV-negative participants was greater racial pride associated with less condomless intercourse with men. In this group, greater self-efficacy and intentions-but not racial pride-predicted less condomless intercourse with women. Our findings suggest that racial pride is an important factor to address in HIV prevention interventions for post-incarcerated African-American MSMW.

Keywords: African-American; Bisexuality; Condom use; HIV prevention; Incarceration; Racial pride.

Figures

Fig. 1

Conceptual framework illustrating the effects of racial pride on self-efficacy, as well as mediated pathway from racial pride to condomless intercourse; constructs are based on overlapping constructs from three theories—Theory of Planned Behavior, Empowerment Theory, and Critical Thinking and cultural Affirmation. aDenotes a Theory of Planned Behavior-based construct. bDenotes an Empowerment Theory-based construct. cDenotes a Critical Thinking and Cultural Affirmation-based construct

Fig. 2

Racial pride, self-efficacy and intentions to use condoms, and frequency of intercourse (vaginal and anal) without condoms among HIV-negative African-American MSMW (n = 147) with female partners, displaying standardized coefficients (β) for direct associations only. E = error, X = indicator, and D = disturbance. Indirect effects are reported in the “Results” section. *p<.05, **p<.01, ***p<.001

Fig. 3

Racial pride, self-efficacy and intentions to use condoms, and frequency of intercourse (vaginal and anal) without condoms among HIV-positive African-American MSMW (n = 65) with female partners, displaying standardized coefficients (β) for direct associations only. E = error, X = indicator, and D = disturbance. Indirect effects are reported in the “Results” section. *p<.05, **p<.01, ***p<.001

Fig. 4

Racial pride, self-efficacy and intentions to use condoms, and frequency of anal intercourse (insertive and receptive) without condoms among HIV-negative African-American MSMW (n = 147) with male partners, displaying standardized coefficients (β) for direct associations only. E = error, X = indicator, and D = disturbance. Indirect effects are reported in the “Results”section. *p<.05, **p<.01, ***p<.001

Fig. 5

Racial pride, self-efficacy and intentions to use condoms, and frequency of anal intercourse (insertive and receptive) without condoms among HIV-positive African-American MSMW (n = 65) with male partners, displaying standardized coefficients (β) for direct associations only. E = error, X = indicator, and D = disturbance. Indirect effects are reported in the“Results”section. *p<.05, **p<.01, ***p<.001