Methods for recruiting men of color who have sex with men in prevention-for-positives interventions

Abstract

Men who have sex with men (MSM), especially MSM of color, are disproportionately impacted by HIV/AIDS compared to heterosexuals and Caucasians. Nonetheless, fewer sexual and ethnic minorities participate in prevention interventions for people with HIV. We consider recruitment for Positive Connections, a randomized controlled trial comparing unsafe sex prevention interventions primarily for HIV-positive (HIV+) MSM in six US epicenters. One community-based organization (CBO) in each city recruited adult MSM, particularly men of color and HIV+. Recruitment methods included on-line and print advertising, outreach events, health professionals, and social networks. Data on demographics, HIV status, and recruitment method were collected at registration. We tested for differences in registration proportions and attendance rates by recruitment strategy, stratified on race/ethnicity and serostatus. Of the 1,119 registrants, 889 attended the intervention. The sample comprised 41% African American, 18% Latino/Hispanic, and 77% HIV+. Friend referral was reported by the greatest proportion of registrants, particularly among African American (33%) and HIV+ men (25%). Print advertising yielded the largest proportions of non-Hispanic white (27%) and HIV-negative registrants (25%). Registrants recruited on-line were the least likely to attend (45% versus 69% average); this effect was strongest among Latino/Hispanic (27% attendance) and non-Hispanic white men (36%). Retention during the follow-up period did not differ by serostatus, race/ethnicity, or recruitment method. Differential attendance and retention according to recruitment strategy, serostatus, and racial/ethnic group can inform planning for intervention sample size goals.

Fig. 1

Timeline of the recruitment process by city

Fig. 2

Number of men active at each phase of the parent study. The percentages in each box represent the proportion of men progressing between study phases. Walk-up enrollees and registered men with missing recruitment method data are excluded from this figure

Fig. 3

Number of participants active in the study at each observation point plotted by recruitment method. Top row shows advertising-based recruitment methods and the bottom row shows in-person recruitment methods. Rg = registration, Bl = baseline, Pt = immediate postintervention, 6=6 months, 12= 12 months, 18=18 months

Fig. 4

Number of participants active in the study at each observation point plotted by recruitment method and race/ethnicity. Dark solid lines are African American, light solid lines are white, dark dashed lines are Hispanic/Latino, and light dashed lines are men of other/ mixed race/ethnicity. Top row shows advertising-based recruitment methods and the bottom row shows in-person recruitment methods. Rg = registration, Bl = baseline, Pt = immediate post-intervention, 6= 6 months, 12=12 months, 18=18 months

Fig. 5

Number of participants active in the study at each observation point plotted by recruitment method and serostatus. Dark lines are HIV-positive subjects, light lines are HIVnegative subjects. Top row shows advertising-based recruitment methods and the bottom row shows in-person recruitment methods. Rg = registration, Bl = baseline, Pt = immediate postintervention, 6=6 months, 12= 12 months, 18=18 months