According to a new study, engaging black men in barber shops holds promise for HIV prevention.
In a study out this week, researchers in New York City detail how getting heterosexual black men in Brooklyn barber shops to attend a safe-sex focused educational session helped curbed risky sexual behavior by many of those men in the months that followed.
"Barber shops are enjoyable, pleasurable places to be" for black men, says Tracey Wilson, a professor in the State University of New York Downstate Medical Center School of Public Health and lead author of the study, published by the American Journal of Public Health. "It seemed a natural place to base our programs."
The study focused on the "Brothers Talking with Brothers" program, an initiative that recruited barbers willing to talk with clients about better health over a tight-fade haircut, or to let program workers do the talking for them. The more than 50 participating shops were located in Brooklyn neighborhoods like Crown Heights and Flatbush where statistics showed a high risk of heterosexual HIV transmission.
Willing clients were screened for criteria including recent sexual activity without a condom and having at least two sexual partners within the past six months. According to the study, roughly half of participants then learned about reducing their risk of HIV infection in "a single small group, peer-led session" off-site that focused on safe sex as well as "community health empowerment, and identification of personal strengths and communication skills."
The rest of the men received information in a group format on prostate cancer – another malady that disproportionately affects the black community.
Six months later, both groups were asked about their sexual behavior – including whether they used condoms with their partners in the previous 90 days. The results: 64% of more than 320 men who participated in the HIV education program reported no condomless vaginal or anal sex, compared with 54% of more than 200 men in the control group.
Michael Joseph, an associate professor in the SUNY Downstate Medical Center School of Public Health who helped facilitate the HIV-prevention session, says the results are promising, particularly since researchers ran up against a pervasive barrier to HIV education and prevention in low-income black communities.
"There were a lot of conspiracy theories that the men were sharing" about AIDS as a government conspiracy against African Americans, Joseph says.
To push back, and to underscore the gravity of the situation they face, Joseph says he asked the men what they would do if the house next to theirs was on fire. All insisted they'd try to help or call the fire department.
"Notice, no one said, 'First, I'll try to figure out how the fire got started,'" Jones says he told them. "When it comes to HIV, there's an urgency. If you don't do something about that fire – HIV – it's going to get to your house."
The "Brothers Talking with Brothers" program is affiliated with the Brooklyn-based Arthur Ashe Institute for Urban Health and is one of multiple initiatives seeking to leverage the intimate relationships between black tonsorial stylists and their customers. Researchers see the approach as a way to reduce health disparities in the black community – and reverse misperceptions about medical institutions along the way.
In the Los Angeles area, for example, a separate study indicated that the barbershop connection was effective in reducing high blood pressure among black men, and was modeled on an earlier attempt in the Dallas area. In metro Chicago, barber shops recently hosted health screenings aimed at providing blood pressure tests, body-mass index checks and information on smoking cessation.
"A lot of men trust their barbers," says Dr. Marilyn Fraser, CEO of the Ashe Institute, a professor at SUNY Downstate Medical Center and co-author of the latest study. "Why not make sure health is woven into that relationship?"
Still, its organizers say the program's HIV-prevention study may be the first of its kind to focus on the reproductive health of heterosexual black men. And it comes at a time when black men make up a disproportionately high number of new HIV cases nationwide.
In 2017, black people made up around 13% of the U.S. population, but accounted for 43% of the roughly 38,700 new HIV diagnoses, according to the Centers for Disease Control and Prevention. Among adult and adolescent blacks who received an HIV diagnosis that year, 73% were men.
Although most HIV infections among black men are transmitted through same-sex encounters, "there exists an unacceptable burden of HIV transmission among black heterosexual men," the BTWB study states. Diagnosis rates among this population are "significantly higher" than among white heterosexual men, according to the study, and their risk of HIV infection is tied to the interplay of social, interpersonal and individual factors like income inequality, "an epidemic of incarceration," depression, substance use and condom use.
"Such factors speak to the need to address these broad social determinants and, at a minimum, ensure that HIV prevention efforts are centered in geographically high-risk heterosexual areas," the study says.
Wilson, Joseph and Fraser say their study results should lead to more barbershop-based initiatives to improve the health of black Americans. "A main thing we found was that barbers not only were willing but enthusiastic to partnership with us," Wilson says.
Fraser says the clients seemed just as eager to learn how to take better care of themselves – even if it meant being vulnerable around other men.
"We'll have these conversations that start and the men just don't want to leave," she says. "There are not enough places or safe spaces where they can talk about these things."