d-up: Defend Yourself!

d-up: Defend Yourself! is an intervention designed by and developed for Black men who have sex with men (MSM). The program is designed to promote condom use and assist Black MSM to recognize and handle risk related racial and sexual bias. The d-up! intervention mantra is: Brothers Keeping Brothers Safe and refers to black MSM influencing one another to practice safer sex and stop the transmission of HIV. The program works to shift social norms regarding condom use by enlisting opinion leaders whose advice is respected and trusted by their peers. Opinion leaders are trained to change risky sexual norms of peers in their own social networks. Opinion leaders are prepared to deliver messages that counter racial and sexual biases directed toward Black MSM in society and ultimately result in risky sexual behavior.

The Defend Yourself program has three main phases: 1) community discovery; 2) preparation of opinion leaders; 3) mobilization of opinion leaders. All phases are based on and supported by 2 theories: preparation for bias and diffusion of innovation. Preparation for bias refers to strategies used to promote positive identification with one's own racial or ethnic group to prepare people to succeed in the face of racial bias. Diffusion of innovation theory maintains that if a practice (such as condom use) is endorsed by a key community member, that practice will be adopted by the broader community over time.

Implementation materials, webinars, and the facilitators guide with handouts, activities and training aids are available through the CDC supported CDC supported Diffusion of Effective Behavioral Interventions (DEBI) program.

As an alternative to the discontinued face-to-face trainings, the newly created online training of facilitators for d-up! consists of 14 interactive modules that include over 200 videos of subject matter experts demonstrating elements of the intervention and offering implementation advice and lessons learned. This new training also includes applied practice experiences for participants and implementation planning tools to increase readiness to begin facilitating d-up! in their own agencies. Health professionals and individuals interested in implementing d-up! are encouraged to register for d-up! Online at Danya's HIP eLearning Center.

The overall goal of d-up! is to increase the number of black MSM who use a condom when they have sex.

The intervention was evaluated by a series of cross-sectional surveys. The first survey was administered before the intervention took place and then again every three months over the course of the year following the intervention.

Significant decreases in unprotected receptive anal intercourse at 4 months (by 23.8%, n=287) and 8 months (by 24.7%, n=299) was observed. Moreover, significant decreases in unprotected insertive anal intercourse (by 35.2%), unprotected receptive anal intercourse (by 44.1%), and any unprotected anal intercourse (by 31.8%) at 12 months (n=268) was also observed. The number of Black MSM reporting always using condoms for insertive anal sex and receptive anal sex increased by 23.0% and 30.3%, respectively. Moreover, the average number of partners for unprotected receptive anal sex decreased by 40.5%.