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Outreach, Care, & Prevention to Engage HIV Seropositive Young MSM of Color

About this initiative... Background Grantees Journal Articles Initiative's Website

SPNS-related publications... Listing of SPNS Products Download SPNS technical assistance publications (government- and grantee-produced) from the TARGET Center Library keyword: SPNS

Background 

This initiative (HRSA-04-042) has funded eight demonstration projects targeting young (ages 13-24) men who have sex with men (MSM) of color. Funds support the development and evaluation of innovative service models designed to reach HIV-infected young MSM not engaged in clinical care and to link them to appropriate clinical, supportive, and preventive services. The initiative's objectives are to: 1) support innovative outreach to assist HIV-infected individuals learn their HIV status; 2) link HIV-infected persons with primary care services, and 3) prevent transmission of HIV infection from targeted clients. A priority is to fund AIDS service and community-based organizations with strong community ties.

Support is also provided to an evaluation center to coordinate the design and implementation of demonstration model evaluation. The evaluation center will evaluate model effectiveness in reaching and engaging the target population in clinical, supportive, and preventive services. The evaluation center will also support the replication of effective models.

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Grantees 

HRSA awarded grants under its Special Projects of National Significance program to the applicants listed below.

Men of Color Health Awareness Project, Inc
25 Franklin Street
Rochester, NY 14604

The purpose of this project is to modify and adapt comprehensive, theory based, and culturally appropriate prevention intervention programs for use with HIV-infected YCMSM, establish an effective outreach program which identifies infected YCMSM and links them into care, and increase counseling and testing of this population. This project will adapt the Many Men, Many Voices (3MV) curriculum for the younger target audience they will be enrolling and validate associated instruments; they also propose a randomized trial of the intervention. Finally, they will intensify outreach and co-locate services and expand other services to enhance
outreach. The local evaluation will be conducted by a University of Rochester School of Nursing research team.

Intervention

• Intensified outreach via provider presentations, case finding and high-risk education in community settings, presence at community events, monthly newsletter, website, speakers bureau, and peer-led support group
• Co-location of CTR and referral services with intensified outreach and MOCHA office activities Enhanced CTR and referrals for services via a care collaborative
• Primary care and case management via the care collaborative
• Individualized prevention counseling with HIV+ using revised Rochester
• STD/HIV Behavioral Counseling (RoSHBeC) model
• Small group level prevention intervention with HIV+ and peers using adapted 3MV curriculum

Outputs

• A revised RoSHBeC model and a revised 3MV curriculum
• A clearly established network with identified responsibilities and sufficient links and capacity to provide culturally competent comprehensive care to HIV+
• Two focus groups and four pilot test groups involving 48 persons to adapt 3MV

Short Term Outcomes

• Increase awareness in the community of purpose and goals of MOCHA and the care collaborative
• Increase use of website
• Increase availability of culturally competent care and support services
• Increase knowledge of individual serostatus and early identification of HIV+ clients and enrollment into care systems at earlier disease stages
• Increase the number of providers who are competent with the revised RoSHBeC model and 3MV curriculum
• Increase the number clients involved in behavior change via RoSHBeC counseling and 3MV groups

Long Term Outcomes

• Increase understanding among YMSM of factors that influence risk behavior
• Decrease risk taking behaviors among YMSM

Proposed Local Evaluation Strategy

• Focus groups to assess and adapt (if needed) individual- and group-level curricula
• Evaluation of process data/fidelity to the intervention focusing on process, utilization, and programmatic
• Randomized controlled trial “feasibility pilot test” comparing ni=16 (N=32) YCMSM at their office, recruited with fliers, HIV prevention intervention, and the general healthy/career development group; each has two hour weekly MMMV group sessions for six weeks
• Evaluations for this pilot at pretest, Week 6, and Month 3

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Dept of Health Services, County of LA
HIV Epidemiology Program Evaluation Center, LA Department of Health Services
600 South Commonwealth Ave., Suite 1920
Los Angeles, CA 90005-4001

The Los Angeles County HIV Epidemiology Program (LACHEP) will offer expanded, active, community-based outreach to HIV counseling and testing, followed by referral and linkage into care at one of two clinics: AltaMed and Drew University Oasis Clinic. The program will offer Latino and African American YMSM intensive integrated case management (ICM) sessions at local clinics. A randomized controlled study of the intervention will be used, as well as qualitative and quantitative methods to follow clients and evaluate the program.

Intervention

• Active and passive community outreach, with mobile and clinic-based CTR, using incentives for post-testing
• One-hour integrated case management (ICM) sessions at two sites – one African American identified and the other Latino identified, with biweekly peer support groups for clients, partner counseling and referral services, and transition to standard case management after two years
• Weekly intervention visits at first, then bi-weekly, then monthly second year

Outputs

• 2,000 people reached during outreach use CTR; 100-200 HIV+ identified via active outreach; 100 HIV+ identified via passive outreach: 100 African Americans and 100 Latinos linked to ICM—90 African Americans and Latinos linked to standard case management (as control)
• 90 African Americans and 90 Latinos complete 42 ICM sessions, average ICM caseload of 25-35 clients
• All clients receive medical care quarterly, 1,000 additional services visits
• Client receives 30 prevention messages during ICM, with 100 ICM clients transitioned to standard case management

Short Term Outcomes

• Increased knowledge of HIV, HIV threat, and personal serostatus
• Increased use of HIV services, with decreased unmet need among HIV+ who are not getting care
• 75% kept appointment rate; 50% decrease in viral loads; 50% increase in CD4 counts; 50% increase in condom use; 50% decrease in high risk behaviors; 50% increase in voluntary disclosure to of serostatus to partners; 50% increase in asking about partner serostatus
• Increased rapport with ICM regarding prevention

Long Term Outcomes

• Increased use of HIV care services by previously undiagnosed HIV+
• HIV care seen by clients as of higher quality and more culturally competent
• Decreased morbidity and mortality related to HIV among HIV+
• Increased use of ongoing local continuum of care by HIV+

Proposed Local Evaluation Strategy

• Randomized, controlled design with two groups: African American and Hispanic (ni=90); control group of n=90 African American and Hispanic in traditional case management programs
• Stratified blocked randomization (two sites, race/ethnicity-specific)
• Data collection: repeated measures, structured face-to-face interviews, adopt validated tools where possible
• Qualitative component with providers
• Baseline and twice yearly follow-up face to face interviews over 36 months

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University of North Carolina at Chapel Hill
Department of Medicine/Division of Infectious Diseases (ID)
130 Mason Farm Road, CB #7030
Chapel Hill, NC 27599-7030

A collaborative between UNC and community-based prevention and case management agencies will conduct and evaluate a social marketing campaign on college campuses, promote access to HIV treatment and care among newly diagnosed African American HIV-infected college students at a consortium of colleges. They will assess the prevalence of acute HIV infections through a serosurvey, and compare outcomes between campuses exposed and not exposed to the intervention. UNC will partner with North Carolina Central University,
a historic Black university, and the Alliance of AIDS Services, a community-based AIDS service organization.

Intervention

• Elicitation research to develop a prevention intervention
• Outreach by CBO and campus organization staff to inform about HIV and promote CTR
• Media campaign on campuses and in local community
• Social marketing partnerships with campus groups and local businesses, freshman orientation education; CTR at student health centers and in the community
• Cultural competency training of CTR staff and use of RNA testing by CTR staff
• Health department Disease Intervention Specialists to locate HIV+ not in care and promote partner testing
• Provision of primary and specialty care via UNC ID clinic
• Prevention for positives program at UNC ID via new protocol follow-up by DIS and local case managers to locate HIV+ lost to care

Outputs

• Six focus groups will be held to develop prevention intervention
• Greater than 85/90% of HIV+ located and linked to care

Short Term Outcomes

• Increase penetration and receipt of prevention messages
• Increase use of CTR and knowledge of individual serostatus
• Decrease risk behaviors by HIV+ and within larger community
• Increase identification of HIV+ earlier in course of disease and increase access and retention in care
• Improve quality of primary care and prevention services

Long Term Outcomes

• Improve health outcomes and enhanced quality of life for HIV+ patients
• Decrease morbidity and mortality among HIV+ and decrease HIV transmission within community

Proposed Local Evaluation Strategy

• Compare individual at the participating campuses and those at similar non-participating campuses
• Focus groups and key informant interviews with peers, members of advisory board and staff
• Interviews pre-test and also end of Years 2 and 5
• Convenience sampling to assess n=100 general population and n=50 members of target population
• Seroprevalence study on intervention and control campuses in pooled batches to identify RNA+ samples versus antibody testing, to assess acute infection
• Linkages into care at UNC ID clinic will be tracked over time, but tools and method based on existing project evaluation (demographic, clinical, behavioral, utilization) at UNC ID clinic

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AIDS Project East Bay
1755 Broadway, Second Floor
Oakland, CA 94612

AIDS Project East Bay collaborates with the Sexual Minority Alliance of Alameda County (SMAAC) and Alameda County Medical Center (ACMC) in this project. New and adapted programs, within an existing network of programs, will comprise a youth-directed, community-based outreach based through a variety of approaches. The local evaluation design includes a prospective, repeated measures design, which also compares enrollees with a control group of those receiving other East Bay AIDS Center (EBAC) services. Local evaluation of outreach and testing activities is through process evaluation and comparison of previous periods in a historical cohort approach. A faculty member of the University of California San Francisco will participate in the local site evaluation.

Intervention

• Outreach, counseling, testing, and referral (CTR), and linkages into community-based programs
• Screen at ACMC (eventually developing rapid testing mobile van)
• Cohort design, with repeated measures
• Historical comparison group
• Target population: African American

Outputs

• Youth centered outreach n=7,500 high-risk young African American
• Rapid testing to n=450
• Link into care n=35
• Link to community involvement, prevention with positives, and self-empowerment for n=50
• Then enroll in Mpowerment and/or TLC
• Repeated measures design. ni=3,050 (total N=6100); control group is those receiving other EBAC; crosssectional for rest

Short Term Outcomes

• Increased awareness of HIV risks and benefits of HIV counseling/testing among African American MSM
• Increased knowledge of serostatus among high risk MSMs
• Increased engagement and retention of HIV+ into care
• Decreased risk behaviors by HIV+ in care
• Reduced risk behaviors among African American MSM

Long Term Outcomes

• Improve health and wellbeing, and quality and length of life of HIV+ MSM

Proposed Local Evaluation Strategy

• Outreach and testing to general population; process evaluation. Compare with historical data
• Intervention participants vs. stages of change
• Focus groups in first six months with members of target population
• Cohort design
• Process evaluation
• Outcome evaluation: primary outcomes include: improved clinical outcomes, adherence to treatment and appointments, improved CD4 and viral load measurements, improved safer sex behavior

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Harris County Public Health and Environmental Services
Harris County Public Health and Environmental Services Department
2223 West Loop South
Houston, TX 77027

The purpose of this project to be conducted through the Harris County Public Health and Environmental Services Department, is to engage HIV seropositive YCMSM into care, link them into appropriate services, and facilitate retention in care using existing locally defined categories of RWCA services. A new approach to case management will be evaluated which coordinates a variety of relevant services into one Client Management Team (CMT)—a wide-ranging and intensive service which provides outreach, medical care coordination, service linkage, peer counseling, health education, and other services to engage and retain high risk youth in care. Evaluation includes use of existing client data, and comparison with previously enrolled clients.

Intervention

• Consolidated case management based on combination of existing services.
• A multidisciplinary team will provide case management, outreach, peer counseling, medical care coordination, and health education risk reduction using a Client Management Team (CMT) approach
• Outreach is not for testing individuals at large, but rather outreach to existing or newly diagnosed HIV+ YCMSM
• During outreach clients come for services every week in 4-8 hours.
• Counseling and testing as needed, and individual sessions on education, services, etc.

Outputs

• Enroll 10 to 15 HIV+ by 8/05; enroll 85 by end of project
• A minimum of 50 to 80% of newly-identified HIV+ clients will enter primary care and/or case management
• A minimum of 50/60/90% of HIV+ clients will use primary care during 6 month period per year

Short Term Outcomes

• Increase proportion of HIV+ who know their serostatus
• Increase knowledge of HIV risk reduction and practice of safer sex
• Increase proportion of HIV+ that are identified, linked to care, and remain in care
• Increase client use of primary care and support services
• Improved or maintained CD4 counts
• Improved or maintained viral loads
• Increase knowledge of care system and how to use it
• Increase adherence to treatment regimens

Long Term Outcomes

• Reduce new HIV cases among YCMSM
• Slow and stabilize disease progression in HIV+

Proposed Local Evaluation Strategy

• Comparison group of those in system not enrolled in the program. ni=85; nc=30
• Client assessments from case management requirements (e.g., assessment form within ten working days of assessment and linked to service within 30 days). Centralized Patient Data Management System (CPCDMS) to collect data, with one face to face interview visit q30 days and at least one visit to natural environment every 90 days
• Comparison group is those clients enrolled into CPCDMS within two years of project start and those enrolled by other agencies meeting the inclusion criteria

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Bronx AIDS Services, Inc.
540 East Fordham Road
Bronx, NY 10458

The Bronx Boogie Down Project is a collaboration of Bronx AIDS Services, Inc. (BAS) and the Adolescent AIDS Program of the Children’s Hospital at Montefiore Medical Center (AAP). The project strives to improve outreach, care and prevention services to engage seropositive YCMSM in the region and help them stay in care. The project strives to use social and geographic mapping, performed by community ethnographer-organizers (CEOs), to identify high-risk areas for this target population, and then develop new methods of outreach to improve access to services and establish use of popular opinion leaders. Once outreach has taken place, the program expects to enroll 15 to 20 YCMSM of color to medical care per year and achieve risk reduction and retention in care among participants. The local evaluation includes mapping and focus groups with the target population followed by content analysis using Ethnograph, and process evaluation.

Intervention

• Ethnographic investigation, followed by outreach in mobile van with counseling and testing, then entry and retention into care with assistance of case management model
• Training of CEOs who will examine and map social and sexual networks
• Community organizing and individualized interviewing by CEOs that convey HIV information and identify HIV+ not in care
• Outreach to agencies that serve YMSM
• Standard and CTR and linking of HIV+ to care and accompanying HIV+ to appointments
• Case management and support services management with prevention counseling by case manager and/or support services manager Rapid testing of partners of HIV+

Outputs

• 10 CEOs trained and CEO interviews
• 100 MSM and maps four Bronx communities
• 80-100 HIV+ linked to care, 10 partners of HIV+ receive rapid testing
• Connection for seropositive into care via a case management model for n=15 to 20 YCMSM annually

Short Term Outcomes

• Increased use of CTR services.
• Increased knowledge of personal serostatus
• Increased use of services by HIV+
• Increased adherence of HIV+ to treatment plans and medications
• 60% of HIV+ who receive behavioral counseling will reduce one risky behavior

Long Term Outcomes

• Improved health status of HIV+
• Reduced HIV infection within the community
• Proposed Local Evaluation Strategy
• Primarily qualitative and ethnographic endeavor using social network evaluation, with mapping of target population and mapping YCMSM

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Wayne State University
540 East Canfield, Room 1128, Scott Hall
Detroit, MI 48201

This project strives to conduct innovative field and Internet outreach to encourage YCMSM to find out their HIV status and enroll, engage, and maintain in care. The investigators will use and evaluate a motivational interviewing (MI) strategy, with extensive MI training to field workers, to encourage at-risk YCMSM to be
counseled and tested for HIV. Traditional peer-outreach will be compared with traditional peer outreach in combination with MI. They will also conduct an evaluation of internet-based outreach to this population.

Intervention

• Traditional peer outreach versus traditional peer outreach plus motivational interviewing
• Comprehensive continuum of care based on a continuous relationship model and elements of social network theory, with community and Internet outreach
• MI during outreach to use CTR and during post-testing to engage in care
• Inter-disciplinary care using MI to promote retention in care and risk reduction
• Healthy Choices MI support group intervention, Brother-to-Brother prevention group intervention
• Agency outreach to capture HIV+ identified elsewhere, outreach and home visits for those lost to care
• Peer advocacy and recreation services

Outputs

• 150 YMSM reached per year via 1,500 community outreach contacts, with one-half using MI
• 100 YMSM reached per year via Internet outreach, with one-half using MI
• 52 YMSM use CTR in first year, with all clients who receive CTR receiving MI with regard to post-testing
• All HIV+ receive MI regarding enrolling in care, with 100%-80% HIV+ to receive MI regarding staying in care
• 18 support groups held, 60 youth to receive case management, 80 youth to receive advocacy services
• All lost-to-care receive attempted contact

Short Term Outcomes

• Increase knowledge of HIV risks, readiness to know serostatus, knowledge of individual serostatus
• Increase in number of clients who use CTR, enroll in care and arrive at first primary care appt
• Increased attendance at quarterly primary care visits, adherence to treatment regimens, self-efficacy and social support, readiness to change negative behaviors, and re-enrollment of lost-to-cares

Long Term Outcomes

• Decrease in unmet health care needs and HIV transmission related to not knowing serostatus
• Improve health and well-being of HIV+
• Reduction in high risk sexual and substance using behaviors

Proposed Local Evaluation Strategy

• Compare peer outreach to peer outreach plus motivational interviewing to assess the effect on readiness to accept diagnosis, receipt of HIV CTR, and return for test results; also linkage into care
• Randomized controlled trial with pre-post test comparisons: randomization to traditional versus traditional plus motivational interviewing to assess if intervention results in the pursuit of HIV CTR
• For field recruitment, field outreach three days per week
• Baseline, three, and six month follow-up
• For field: ni=50 (total N=100), for Internet: ni=75 (total N=150)

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Working for Togetherness 
Youth Empowerment Center
Chicago Area Priority Access Project
3333 W. Arthington St., #108
Chicago, IL 60624

The Chicago Area Priority Access (CAPA) Project at Working For Togetherness aims to decrease barriers within the HIV/AIDS healthcare delivery system for young African American MSM (YAAMSM) and increase integration of services for these young men. The three primary goals of the CAPA Project are to: 1) conduct outreach to deliver HIV prevention messages and increase early detection of seropositive YAAMSM; 2) develop an integrated, adolescent-specific continuum of care network for seropositive YAAMSM; and 3) create and operate a Youth Empowerment Center to increase youth self-efficacy to enter and remain in culturally- and developmentally-appropriate HIV primary care.

Project activities include maintaining and enhancing the CAPA Project Continuum of Care, housing and implementing preventive interventions for HIV-positive YAAMSM in the Youth Empowerment Center, performing local and multi-site evaluation activities, and disseminating project information and evaluation findings at local and national conferences.

The CAPA Project evaluation is assessing the effectiveness of “Mobile Tech” outreach in helping YAAMSM receive HIV prevention services, learn their HIV status, and access medical care. The project will also adapt a CDC – Effective Behavioral Intervention to determine effectiveness in reducing HIV risk behaviors among these youth. The completed evaluation is expected to deliver a protocol to replicate Mobile Tech outreach, provide research evidence on the effectiveness of CDC-EBI for YAAMSM, and offer a Collaborative Continuum for Care Model for community-based organizations and healthcare providers to link HIV-positive youth to care.

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Journal Articles 

Hightow-Weidman LB, Phillips G 2nd, Outlaw AY, Wohl AR, Fields S, Hildalgo J, & Legrand S.  Patterns of HIV Disclosure and Condom Use Among HIV-Infected Young Racial/Ethnic Minority Men Who Have Sex with Men. AIDS and Behavior, October 9, 2012. [Epublished ahead of print] PubMed Abstract

Phillips G 2nd, Hightow-Weidman LB, Arya M, Fields SD, Halpern-Felsher B, Outlaw AY, Wohl AR, & Hidalgo J. HIV testing behaviors of a cohort of HIV-positive racial/ethnic minority YMSM. AIDS and Behavior, October 2012; 16(7): 1917-1925.  PubMed Abstract

Tinsley M & Xavier J.  Outreach, Care and Prevention to Engage HIV Seropositive Young Men of Color Who Have Sex with Men: A Special Project of National Significance Program Initiative.  AIDS Patient Care and STDs, August 25, 2011; 25 (Supplement 1): S1-S2. (No abstract available).

Phillips G 2nd, Wohl A, Xavier J, Jones K, Hidalgo J. Epidemiologic data on young men of color who have sex with men. AIDS Patient Care and STDs, August 25, 2011; 25 (Supplement 1): S3-S8. PubMed Abstract

Hightow-Weidman LB, Jones K, Phillips G 2nd, Wohl A, Giordano TP; and the YMSM of Color SPNS Initiative Study Group. Baseline clinical characteristics, antiretroviral therapy use, and viral load suppression among HIV-positive young men of color who have sex with men. AIDS Patient Care and STDs, August 25, 2011; 25 (Supplement 1): S9-S14. PubMed Abstract

Hidalgo J, Coombs E, Cobbs WO, Green-Jones M, Phillips G 2nd, Wohl AR, Smith JC, Ramos AD, Fields SD, & the YMSM of Color SPNS Initiative Study Group.  Roles and challenges of outreach workers in HIV clinical and support programs serving young racial/ethnic minority men who have sex with men. AIDS Patient Care and STDs, August 25, 2011; 25 (Supplement 1): S15-S22. PubMed Abstract

Outlaw AY, Phillips G 2nd, Hightow-Weidman LB, Fields SD, Hidalgo J, Halpern-Felsher B, Green-Jones M; and the Young MSM of Color SPNS Initiative Study Group.  Age of MSM sexual debut and risk factors: results from a multisite study of racial/ethnic minority YMSM living with HIV. AIDS Patient Care and STDs, August 25, 2011; 25 (Supplement 1): S23-S29. PubMed Abstract

Hightow-Weidman LB, Jones K, Wohl AR, Futterman D, Outlaw A, Phillips G 2nd, Hidalgo J, Giordano TP; and the YMSM of Color SPNS Initiative Study Group. Early linkage and retention in care: findings from the outreach, linkage, and retention in care initiative among young men of color who have sex with men. AIDS Patient Care and STDs, August 25, 2011; 25 (Supplement 1): S31-S38. PubMed Abstract

Hightow-Weidman LB, Phillips G 2nd, Jones KC, Outlaw AY, Fields SD, Smith JC; and the YMSM of Color SPNS Initiative Study Group.  Racial and sexual identity-related maltreatment among minority YMSM: prevalence, perceptions, and the association with emotional distress.  AIDS Patient Care and STDs, August 25, 2011; 25 (Supplement 1): S39-S45. PubMed Abstract

Phillips G 2nd, Outlaw AY, Hightow-Weidman LB, Jones KC, Wohl AR, Futterman D, Skinner JA, Fields S, Hidalgo J; and the YMSM of Color SPNS Initiative Study Group.  Sexual Behaviors of Racial/Ethnic Minority Young Men Who Have Sex With men. AIDS Patient Care and STDs, August 25, 2011; 25 (Supplement 1): S47-S53. PubMed Abstract

Phillips G, Peterson J, Binson D, Hidalgo J, & Magnus M for the YMSM of Color SPNS Initiative Study Group.  House/ball culture and adolescent African-American transgender persons and men who have sex with men: a synthesis of the literature. AIDS Care, April, 2011; 23(4): 515-520. PubMed Abstract

Hightow-Weidman LB, Hurt CB, Phillips G 2nd, Jones K, Magnus M, Giordano TP, Outlaw A, Ramos D, Enriquez-Bruce E, Cobbs W, Wohl A, Tinsley M; and the YMSM of Color SPNS Initiative Study Group.  Transmitted HIV-1 drug resistance among young men of color who have sex with men: a multicenter cohort analysis. Journal of Adolescent Health, January 2011; 48(1): 94-99.  PubMed Abstract

Outlaw AY, Naar-King S, Parsons JT, Green-Jones M, Janisse H, & Secord E. (2010) Using Motivational Interviewing in HIV Field Outreach With Young African American Men Who Have Sex With Men: A Randomized Clinical Trial. American Journal of Public Health, April 1 2010; 100 (Supplement 1): S146-151. PubMed Abstract

Magnus M, Jones K, Phillips G, Binson D, Hightow-Weidman LB, Richards-Clarke C, Wohl AR, Outlaw A, Giordano TP, Quamina A, Cobbs W, Fields SD, Tinsley M, Cajina A, & Hidalgo J, for the YMSM of Color SPNS Initiative Study Group. Characteristics Associated With Retention Among African American and Latino Adolescent HIV-Positive Men: Results From the Outreach, Care, and Prevention to Engage HIV-Seropositive Young MSM of Color Special Project of National Significance Initiative. Journal of Acquired Immune Deficiency Syndromes, April 1, 2010: 53 (4): 529-536. PubMed Abstract

Hightow LB, Leone PA, Macdonald PD, McCoy SI, Sampson LA, & Kaplan AH. Men who have sex with men and women: a unique risk group for HIV transmission on North Carolina College campuses. Sexually Transmitted Diseases, October 2006; 33 (10): 585-593. PubMed Abstract

Fields SD, Wharton MJ, Marrero AI, Little A, Pannell K, & Morgan JH. Internet chat rooms: connecting with a new generation of young men of color at risk for HIV who have sex with other men. Journal of the Association of Nurses in AIDS Care, November-December 2006; 17(6): 53-60. PubMed Abstract

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