Table 2.

Summary of intervention characteristics and treatment of culture

Author	Black/AA participants (%)	Distinction between Black and AA?	Target population	Sexual orientation and/or gender identity	Part of HIV cascade	Theoretical foundations	Integration of culture	Method of delivery	Who facilitated the intervention?	Delivered in community setting?
MSM and/or TGW (n = 10)
Fernandez et al. [53] (2016)	100	93% AA, 2% Black-Latino, 2% multiple Black identities, 3% other	MSMW (18 +)	84% bisexual, 7% gay/homosexual, 6% unsure/questioning/other, 3% straight/heterosexual	Prevention	Information-Motivation-Behavioral Skills Model	Negative stigma toward and discrimination against bisexuality; harmful stereotypes and media depiction of Black/AA men	Digital, real-time chat with facilitators	Not all ethnically matched; all had experience working with ethnic minority MSM	No, but developed in partnership with community advisory board
Arnold et al. [54–56] (2019)	100	No	MSMW (18 +)	Identifying as not gay/homosexual or bisexual	Prevention	Information-Motivation-Behavioral Skills Model	Masculinity and gender norms; secrecy and compartmentalization of sex with other men, desire not to be seen as gay; internalized, family, and church homophobia; discreet, one-on-one, non-judgmental intervention delivery; “men’s health” framing rather than “HIV prevention”	In-person	AA men	No, but developed via community-based participatory research
Hightow-Weidman et al. [57] (2019)	100	No	YMSM (18–30)	67% gay, 20% bisexual, 13% other	Prevention	Integrated Behavioral Model	Duality of being gay and Black; racism, homophobia, cultural/familial beliefs on masculinity; social isolation and rejection from Black community and church due to gay identity and/or HIV status; ball culture	Digital	N/A	No, but developed via formative research with community
Williams et al. [58] (2013)	100	No	MSMW living with HIV and history of childhood sexual abuse (18 +)	Identifying as not gay	Prevention	Social Cognitive Theory; Ecological Model	Triple minority identity (ethnic, sexual, living with HIV); the meaning of being an AA man; early socialization on gender and culture; adult experiences of being bisexual vs heterosexual within AA community; HIV stigma; recognizing stressors; learned strategies to cope with and regulate trauma	In-person	Ethnically matched men	No
Harawa et al. [59] (2013)	100	No	MSMW (18 +)	60% bisexual, 14% heterosexual, 12% gay/homosexual, 7% on the down low, 2% SGL, 5% none of the above/other	Prevention	Theory of Reasoned Action; Theory of Planned Behavior; Empowerment Theory; Critical Thinking and Cultural Affirmation Model	AA culture (e.g., collectivism, spirituality); historical events (e.g., slavery, Tuskegee, Million Man March); Ghanaian Adinkra symbols; racism; lack of identification with gay labels; gender expectations; importance of keeping sex with other men discreet	In-person	Ethnically matched men	Yes, and developed in partnership with community agencies and advisory board
Harawa et al. [60] (2020)	100	No	MSM (18 +)	64% homosexual, gay, or SGL	Prevention	Dynamic Social Impact Theory; Social Comparison Theory; Social Cognitive Theory	Intersectionality of HIV-related stigma, homophobia within Black community, and racism from the White community	In-person	Peer mentors (participants able to choose mentors)	No, but developed via formative research with community and in partnership with community advisory board
Harawa et al. [61] (2018)	100	No	Recently incarcerated MSMW (18 +)	71% bisexual, 17% gay/homosexual/SGL, 7% heterosexual, 5% other/none of the above	Prevention	Theory of Reasoned Action; Theory of Planned Behavior; Empowerment Theory; Critical Thinking and Cultural Affirmation Model	Adapted from MAALES (above, Harawa et al. (2013)); HIV risks and harm-reduction options in prisons and jails; challenges faced with reentry; HIV testing and stigma in custody settings	In-person	AA men	No, but developed with input from community advisory board
Jemmott et al. [62] (2015)	100	No	MSM (18 +)	41% bisexual 41% gay, 10% on the down low, 8% straight	Prevention	Social Cognitive Theory; Theory of Reasoned Action; Theory of Planned Behavior;	Importance of keeping sex with other men discreet	In-person	Not gender, racially, or ethnically matched	No, but developed via formative research with community
Herbst et al. [63–65] (2014)	100	68% AA, 17% Caribbean/West Indian, 11% Afro-Latino, 3% mixed ancestry, 1% African	MSM (18 +)	78% gay/homosexual, 18% bisexual, 3% unsure, 1% straight/heterosexual	Prevention	Social Cognitive Theory; Behavioral Skills Acquisition Model; Transtheoretical Model of Behavior Change; Decisional Balance Model	“Culture of Black MSM” session to help participants recognize how racism and homophobia are related to sexual and substance use risk behavior; duality of being Black and gay; relationships between STIs and HIV; familial, cultural, religious norms; sexual relationship dynamics common among Black MSM	In-person	Peers	Yes, and developed by CBOs serving Black MSM and a university-based HIV/STI prevention and training program via formative research with community
Frye et al. [66–69] (2021)	100	54% AA, 30% African/other, 7% Afro-Latino, 9% Caribbean	YMSM, YTGW (18–29)	60% gay/SGL/queer, 30% bisexual, 8% straight/heterosexual/other, 2% questioning/unsure	Prevention (Testing)	Socio-ecological Model; Empowerment Theory; Self-efficacy Theory; Social Support Theory; Motivational Interviewing Theory	Intervention labeled “culturally-congruent,” but culture not defined	In-person	Peers	No, but developed via formative research with community
Youth (n = 7)
Klein et al. [70, 71] (2011)	100	No	Female youth (14–18)	Sample characteristics not described; intervention designed for heterosexual youth	Prevention	Social Cognitive Theory; Theory of Gender and Power	Adapted from SISTA [72], WiLLOW [73], and SIHLE [74]; culture defined as that of “young AA females”; cultivating gender and cultural pride through readings of poetry by AA women, AA art, learning about strong AA female role models; tailored language; games; AA teenage girls to perform as “Sistas” in video clips	Digital	N/A	No, but developed alongside team of young AA girls
DiClemente et al. [75] (2014)	100	No	Female youth (14–20)	Sample characteristics not described	Prevention	N/A	Intervention labeled “culturally appropriate,” but culture not defined	Digital	Phone counseling delivered by AA female health educators	No
Hadley et al. [76] (2016)	100	24% with an additional racial identity 5% with Hispanic/Latino ethnic identity	Youth (13–18) and caregivers	Sample characteristics not described	Prevention	Social Learning Theory	Adapted from STYLE [77]; DVD as a culturally sensitive technology for families; content tailored to youth; all featured actors were 16–18 (“near-peers”); different DVDs for youth and caregivers (e.g., hip-hop music for youth, parenting guidance for caregivers); developed with minority-owned health communications company specializing in culturally relevant products for urban and ethnic audiences	Digital	N/A	No
Jemmott et al. [78] (2020)	90	No	Youth (11–14) and caregivers	Sample characteristics not described	Prevention	Social Cognitive Theory; Theory of Planned Behavior	Video content labeled as “culturally appropriate,” but culture not defined	Hybrida	AA adults	Yes, and developed with input from community advisory board
Sznitman et al. [49, 79, 80] (2011)	100	No	Urban youth (14–17)	Sample characteristics not described	Prevention	Social Cognitive Theory of Mass Communication; Social Cognitive Theory	Broadly defined culture as “values, beliefs, norms, and behaviors shared by a group”; in-depth discussion of culture; acknowledgement of culture as dynamic and non-uniform; recognition of “skilled, expressive, and persuasive speech” as valued part of AA oral culture and dramatic formats as more persuasive than lecturing; Afrocentric vernacular; using ideas of Black masculinity that center on mutual respect and respectability rather than “sex as a conquest”; social pressures against delaying sex and using condoms	Digital (i.e., radio, TV)	Messages written by advertising professionals experienced in reaching AA youth	No, but developed via formative research with community and in partnership with community advisory board
Donenberg et al. [81] (2020)	100	No	Female youth (14–18) and their female caregivers	Sample characteristics not described	Prevention	Social-Personal Framework; Social Learning Theory*; Social Cognitive Theory*; Theory of Gender and Power	Adapted from SISTA [72], SIHLE [74], and STYLE [77]; “labor and power gender divisions”; gender-specific standards for which sexual behaviors are appropriate in heterosexual relationships; ethnic and gender empowerment	In-person	Black/AA women experienced at working with youth in health settings	No, but developed with input from community advisory board
DiClemente et al. [82, 83] (2014)	100	No	Female youth in juvenile justice system (13–17)	Sample characteristics not described	Prevention	ADAPT-ITT Model [84]; Social Cognitive Theory; Theory of Gender and Power	Adapted from HORIZONS [85]; intervention labeled as “culturally appropriate,” but culture not defined; ethnic and gender empowerment	In-person	AA female health educators	No, but developed with input from teen and community advisory boards
Women (n = 5)
Billings et al. [86] (2015)	100	No	High-risk women (18–50)	Sample characteristics not described	Prevention	Empowerment Theory	Message of intervention reinforced via unscripted videos of AA women describing importance of self-confidence and pride in being a Black/AA woman; intersectionality as a Black woman; framing condom use as a goal for women (rather than a behavior for men)	Digital	Black/AA women	No
Gilbert et al. [87] (2021)	100	No, but 23% identified as Latinx	Women with drug history in CSPs (18 +)	66% heterosexual, 31% bisexual, 3% other	Prevention	Empowerment Theory; Social Cognitive Theory	Raises awareness of structural racism rooted in slavery and historical responses of resilience among Black/AA women; “explicit focus on structural racism along with its novel hybrid group format led by Black female CSP staff and a computerized individualized tool with Black women characters promoted effective cultural tailoring of content”; Afrocentric themes of historical trauma and resiliency	Hybrid	Black/AA women (counselors or case managers at CSPs)	Yes, and developed via community-based participatory research
Wingood et al. [88] (2013)	100	No	Women (18–29)	Sample characteristics not described	Prevention	Social Cognitive Theory; Theory of Gender and Power	“Valuing one’s body, perceiving one’s body as a temple” described as “culturally appropriate connotation”	In-person	Black/AA female health educators	No
Painter et al. [89] (2014)	100	No	Heterosexual women (18 +)	Sample characteristics not described	Prevention (Testing)	Health Belief Model; Transtheoretical Model of Health Behavior Change; Social Cognitive Theory	Shared cultural aspects of Black/AA women’s experiences that shape vulnerability to HIV (e.g., intersectionality of being a Black woman in the South); Black/AA women’s collective wisdom and lived experiences	In-person	Black/AA women	Yes, developed out of a CBO
DiClemente et al. [90] (2021)	100	No	Women (18–24)	Sample characteristics not described	Prevention	Social Cognitive Theory	Emphasizing gender and ethnic pride	Hybrid	Black/AA female health educators	Yes, and developed with input from community advisory board
Others (n = 3)
Bogart et al. [91] (2017)	100	No, but 6.5% identified as Latino	Adults living with HIV (18 +)	36.3% straight, 42.8% gay man, 1.9% lesbian, 13.5% bisexual man, 1.4% bisexual woman, 1.4% not sure, 2.8% other	Retention in/ Adherence to care/Linkage to treatment	Social-Ecological Theory; Information-Motivation-Behavioral Skills Model	Survival mechanisms historically used by Black/AA people to cope with oppression: (1) adaptive duality (2) collectivism, (3) indirect communication, and (4) mistrust of outsiders; defined “culturally congruent” as customized to fit values, beliefs, traditions, and practices; gives examples of cultural and social determinants of health behavior of AAs as medical mistrust, HIV misconceptions, and experiences with discrimination; recognizes cultural issues associated with treatment nonadherence (e.g., medical mistrust, discrimination, internalized stigma)	In-person	Black/AA peer counselors	Yes, developed with community advisory board and CBO
Stewart et al. [92] (2017)	100	No	Rural cocaine users (18 +)	Sample characteristics not described	Prevention	Social Cognitive Theory; Transtheoretical Model of Change	Culturally adaptation included revising intervention scripts to reflect rural drug setting, same-gender group sessions, restricting attendance to participants only, and hosting follow-ups in study offices rather than on the street; hygiene, condoms, and domestic violence identified as topics unique to community; engaging “book smarts and street smarts” by using both scientific and street terms and professional and lay facilitators	In-person	Black/AA health educator and peer leader	Yes, and developed via community-based participatory research
Yancey et al. [93] (2012)	100	No	Heterosexual men and women (18–44)	Sample characteristics not described	Prevention	NTU (Africentric) conceptual framework; Theory of Gender and Power; Nguzo Saba	Inspired by African cultural principles of Umoja-unity, Kujichagulia-self-determination, Ujima-collective work and responsibility, Ujama-cooperative economics, Niapurpose, Kuumba-creativity, and Imanifaith; entire session dedicated to intersection of culture- and gender-related issues; gender and culture stressed throughout the intervention	In-person	Co-ed facilitator teams	Yes, and developed via community-based participatory research

Abbreviations: AA African American, MSM men who have sex with men, TGW Transgender women, MSMW men who have sex with men and women, YMSM young men who have sex with men, YTGW young transgender women, SGL same gender loving, STI sexually transmitted infection, CBO community-based organization, CSP community supervision program

^a“Hybrid” delivery method refers to a combination of in-person and digital components