A Culturally Targeted Smoking Cessation/HIV Medication Adherence Intervention for African American MSM

African American men who have sex with men (MSM) accounted for the highest rate of HIV infections and AIDS cases in the US. African American HIV-infected MSM also report lower levels of antiretroviral adherence than Caucasian MSM. Poor medication adherence is associated with poor outcomes, including progression of HIV to AIDS and increased mortality as well as increasing infectivity in an unprotected sexual encounter. The negative effects of medication non-adherence are likely exacerbated by additional health behaviors, such as tobacco use. Tobacco use is more common among MSM than in the general population. Several factors may make African American HIV-infected MSM more vulnerable to the negative effects of tobacco use than other HIV-infected populations including access to healthcare, lower medication adherence, and higher rates of comorbid health factors such as diabetes and high blood pressure. The purpose of this study was to develop and assess the feasibility and acceptability of a group-based culturally targeted intervention for African American HIV-infected men to address both smoking cessation and HIV antiretroviral adherence. During the development phase of the study, focus groups suggested several distinct barriers to and facilitators of smoking cessation and medication adherence for this vulnerable population. These themes were incorporated into a single intervention based on an established smoking cessation intervention (Courage to Quit, King & Riley, 2001) and a treatment adherence intervention (Treatment Advocacy Program, McKirnan, Tolous-Shams, & Courtenay-Quirk, 2010). Pilot study (n=10) findings suggested the intervention was acceptable to participants. Eighty percent of participants came to more than half the intervention visits and the 1-month and 3-month follow-ups. Three of the eight participants that attended follow-ups reported biochemically verified quit rates at the 3-month follow-up. All participants that attended the follow-ups reported medication adherence rates above 95% at the 3-month follow-up. Findings from this formative study suggest this culturally targeted intervention can be effective for both smoking cessation and medication adherence. However, significant structural barriers to recruitment negatively affected the feasibility of this intervention. Future studies of this intervention should be deeply integrated in an establish clinic that serves African American HIV-infected men. Community-based organizations should be engaged for effective recruitment strategies and community education.