This research proposal aims to study factors that lead to higher rates of HIV/AIDS diagnoses among African American men ages 18-24 compared to other groups. The researcher will conduct surveys and interviews with at least 100 men who have sex with men, including those of various races and socioeconomic backgrounds. Key research questions include examining differences in access to healthcare, levels of risk behavior, and how cultural and educational factors may influence HIV transmission patterns between racial groups. The goal is to better understand disparities and empower communities through more effective education and prevention strategies.

1. 1
This research proposal, offers a new and direct path to finding out what factors lead
to African American men testing positive for HIV/AIDS at higher rates then other
racial groups of men between the ages 18-24. There are five peer reviewed articles,
discussed within the literature review that offer insight to some factors that may
increase positive outcomes. The target population for this proposal is at least 100
men, but not limited to, who are positive and have engaged in sex with a man at
least once in their lifetime. For the research, I will find participates using the
availability and snowball methods to conduct surveys and intensive interviews
cross-sectionally. Using this more personal information to compare and contrast
lives, we can be better equipped to properly educate and give more useful sexual
health advice.
Contributions to the differences in HIV/AIDS infections between African
American Men and other racial groups.
For my research, I’d like to take a closer look at new HIV cases among African
American men. I’d like to know more about the patterns that these men share and
the things that they have done differently in order to gain their positive status. I’m
sure that my research can and will empower young men to make better decisions
about their sexual habits. Through my studies I’d like to find better ways to protect
these men, during their transition out into the world and give new insight to those
who believe that it can’t happen to them.

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The first question I’d like to ask is, “Why are new HIV cases higher in African
American men then those of other racial groups in the same age range?” I think that
this is important because African American men are fewer in the population but
make up more of the new HIV cases then many other racial groups in America. With
the number of men testing positive and the decline in childbirth to African American
men will be area for concern in years to come. Studies suggest that if there’s are no
new ways to educate these men on better sexual practices then we will have a
bigger problem on our hands; considering that not all men who test positive are gay.
My second area of concern is, “Does the access to healthcare make a
difference in whether or not a person will test positive.” In this question I’d like to
explore the income levels of newly infected men. I’d like to know whether men who
have private healthcare or government assisted healthcare test at the same levels as
other men in other groups or are they testing positive at the same rates across the
board. Within this question I’d look more into income levels to see how much of an
affect that has or doesn’t have on the sexual behavior of African American men.
My third and final question is: Do African American men participate in risker
behavior then men of other age groups? I’d look at the demography of men and the
ages of those who have tested positive recently and what area are they in. How
many partners they have been with? Did they use condoms during all types of sex
and was the protection used regularly. It’s also important in this area to get as much
individual information as I can about each individual case.
This study is to re-evaluate the information that we currently have and
combine it with new research to see just how HIV is moving between African

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American men. I think that’s it’s important to look at this information again to get a
better understating of how HIV is being passed in 2014. We know the ways of
transmission hasn’t changed, but the question is, what are young men not doing to
protect themselves against getting it that men in the past did? We have better
medical technology and know more about the infection now then we ever have.
The best way to get a better understand of this still silent epidemic is to study those
who are most sexually active and contracting it fastest.
ABREVITED INTRODUCTION
What are the factors that contribute to more African American gay men contracting
HIV at higher rates then other men? (Ebrahim, Anderson, Weidle, Purcell 2004;
Fede, Stewart, Hardin, Mayfield-Smith, and Sudduth 2011; Freeman, Zonszein, Islam,
Blank, and Strelnick 2010; Hall, Byers, Ling, Espinoza 2007; Hill and McNeely 2011;
Rubin, Colen, And Link 2010) Our main focus point is why are African American
men affected at higher rates then those of other racial groups? (Ebrahim, Anderson,
Weidle, Purcell 2004) Are socioeconomic factors playing a party in new HIV cases?
(Fede, Stewart, Hardin, Mayfield-Smith, and Sudduth 2011; Freeman, Zonszein,
Islam, Blank, and Strelnick 2010) How much does education play apart of how
individuals behave sexually? (Hill and McNeely 2011) How does HIV affect African
American Men differently from the way that it affects men of different races? (Rubin,
Colen, and Link 2010)

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LITERATURE REVIEW
Contributions to differences in HIV/AIDS infections between different gay
male American racial groups.
The overall patterns of new cases of HIV infections still show that African
American men 13-29 still contract the infection at greater numbers then their peers.
(Ebrahim, Anderson, Weidle, Purcell 2004; Fede, Stewart, Hardin, Mayfield-Smith,
and Sudduth 2011; Freeman, Zonszein, Islam, Blank, and Strelnick 2010; Hall, Byers,
Ling, Espinoza 2007; Hill and McNeely 2011; Rubin, Colen, and Link 2010)
Though the overall number of new cases each year has dropped, the new cases of
African American men still out numbers that of other races. African American men
have the knowledge to protect themselves but for the most part haven’t. This has
lead to an increase within this group of men. Many African American men face a
different type of policing of their masculinity that has lead to them living closeted
and public lives. Hispanic and Asian males also show greater numbers of testing
positive then Whites, but less then those of Blacks. African American men age 40-54
also tend to show similar numbers of contracting HIV at the same occurrence levels
as men 13-29. All of the men who tested positive for HIV show a strong correlation
in their cultural patterns, social norms, and socioencomic status then whose who
didn’t contracted (Ebrahim, Anderson, Weidle, Purcell 2004; Hall, Byers, Ling,
Espinoza 2007; Hill and McNeely 2011).
African American men face greater difficulty dealing with homosexuality
within their community. The standards on manhood within African American
community are held high and examined closely and constantly, even when males are

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publicly involved sexually with women, dating, engaged for marriage, married,
widowed or have children their sexuality is constantly monitored and policed by
others. This lack in freedom of expression leads to a lack of discourses about HIV
status and sexual interest. Other men feel just as discouraged to come out, but often
find other ways of dealing with their sexuality. African American men are
considered to be the most undesirable sexually among men who engage in sex with
men ( Hall, Byers, Ling, Espinoza 2007). Therefore, African American men who
engage in sex with men a more likely to have sex with other African American men.
Over the past few years, knowledge has spread that HIV/AIDS is attacking the
African American community in large numbers. With this has increased the
disinterest in African American men being sexual partners for other men of different
racial groups of men who engage in sex with men. (Fede, Stewart, Hardin, Mayfield-
Smith, and Sudduth 2011; Hall, Byers, Ling, Espinoza 2007; Hill and McNeely 2011)
African American men usually tend to separate themselves from other racial
groups in public spaces, night venues, and peer groups. African American men 13-19
are more likely to seek out and engage in sex with men who are much older then
them ( Hill and McNeely 2011). As age increases the chances of exposure and
increased chances of coming in contact with positive individuals increases. White
youth and other racial groups showed interest in males their own age. Having more
sexual encounters with other youth who haven’t come in contact with the virus
lessens their chances of a positive HIV status. This increased segregation has lead
to African American men having very close social networks. Within these close
social networks, African American men typically engage in very risky sexual

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behavior and intravenous drug usage ( Hall, Byers, Ling, Espinoza 2007). Once HIV
is introduced within the network, it spreads quickly, with many other STDs
following. Because African American men seek out older partners they have
increased exposure and introduce it to younger sexual partners at higher rates then
other racial groups (Hall, Byers, Ling, Espinoza 2007; Hill and McNeely 2011).
In areas of increased poverty, African American men tested positive at about
the same levels as those in larger cities and metropolitan areas. Whites still tested
lower then all racial groups in all geographical areas. White men’s general
knowledge about how HIV is contracted and passed was about the same in
metropolitan and rural areas. Studies show that black men in more rural areas
lacked knowledge about how HIV is treated ( Freeman, Zonszein, Islam, Blank, and
Strelnick 2010). When the researchers looked at treatment of HIV, they found that
whites in cities knew more about medications, how to and where to find treatment
regardless of HIV status ( Freeman, Zonszein, Islam, Blank, and Strelnick 2010).
African American positive men, those within the health field, and higher educated
males knew about medications to treat HIV. In more rural areas, African American
men had little to no knowledge about HIV treatment.
Most of the African American men lacked the resources to receive costly HIV
treatments needed. White men who were studied had more resources to seek
treatment earlier in diagnosis of positive status and had more knowledge of free
healthcare programs to assist with high drug cost. African American men showed
higher levels of unemployment which lessons the chances of individuals having
private healthcare that offer newer treatment methods. Many unemployed African

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American men in metropolitan areas receive healthcare though government
benefits and programs, while those in rural areas suffer because they have no
knowledge of the program or it is not offered in their area. African American men
tend to progress to a positive AIDS status quicker then Whites studied (Ebrahim,
Anderson, Weidle, Purcell 2004; Fede, Stewart, Hardin, Mayfield-Smith, and Sudduth
2011; Freeman, Zonszein, Islam, Blank, and Strelnick 2010; Hall, Byers, Ling,
Espinoza 2007; Hill and McNeely 2011; Rubin, Colen, And Link 2010).
There are several limitations to the studies performed. Mass groupings for
race treat highly heterogeneous populations as homogeneous groups (Freeman,
Zonszein, Islam, Blank, and Strelnick 2010). Most models posits that socioeconomic
status impacts access to and utilization of health care resources among gay men
(Hill and McNeely 2011). Some choose to focus directly on health inequalities by
comparing people from low versus high socioeconomic status to the mortality rates
of the areas they studied (Rubin, Colen, and Link 2010). Ring mapping causes a
problem within another study because information about individuals is lost in
efforts to group individuals (Fede, Stewart, Hardin, Mayfield-Smith, and Sudduth
2011). The greatest determinate is the fact that researchers don’t have all
knowledge of all individuals that have tested positive in America and are drawing
conclusions form public health records and those willing to participate; while not
studying those who have private health care access or unwilling to participate
(Ebrahim, Anderson, Weidle, Purcell 2004).
In conclusion, all of the research points to African American men having a
larger number disparities that are negatively effecting their community and causes a

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larger number of individuals to test positive annually. Educating individuals on HIV
is only half of the problem to lower the annual numbers. African American men have
to stop many of the social habits they have within their community that contribute
to higher positive results. Many of the social barriers that are created that keep
individuals who are positive from disclosing their status will have to be broken.
African American men will have to become more aware of their sexual wellness and
participate in more regular trips to doctors for annual fiscals (Ebrahim, Anderson,
Weidle, Purcell 2004; Fede, Stewart, Hardin, Mayfield-Smith, and Sudduth 2011;
Freeman, Zonszein, Islam, Blank, and Strelnick 2010; Hall, Byers, Ling, Espinoza
2007; Hill and McNeely 2011; Rubin, Colen, and Link 2010).
Research Design and Methods
Sampling
For this study, we will target the population of men who sex with other men
and have tested positive for HIV/AIDS. We are looking into the sexual patterns and
drug use that may have contributed to a positive status. Our main objective is to
compare the reasons why African American men test positive at higher rates then
those of other races. The goal is to interview as many men as possible that are HIV
positive. We want to interview men of all races and income levels within the United
States.
Nonprobability sampling using availability and snowballing methods is the
best way to find participates for this type of research. There’s no list of positive men
going around and many men don’t often discuss their positive status with strangers.
So I will have to rely on men trusting to disclose their sexual health status to me and

9. 9
possibly telling their positive partners, friends or family members to have the same
type of conversations. This is a type of exploratory research where we seek to find
what type of risky behaviors, educational background, and family life did positive
men engage in and have prior to their status change. Then compare it to other
positive men’s life experiences.
The cons of this sampling method and study are that this is a hard to reach
group period. Since this is a health issue and still vary taboo participates aren’t
usually always willing to come forward. Many African American men don’t discuss
their status with people outside their doctor; even other sexual partners.
Considering that I’m a black man myself I feel that I’ll be easier to relate to this
group and they may feel more comfortable to open up and share experiences. I feel
that for this research its best to interview as many men as possible. Another con is
the over representation of one race and under representation of other groups.
Considering that all men’s experiences are different there may be some over
generalization.
Measurement
Hypothesis: African American men are more likely to test positive for
HIV/AIDS during their life time then men of other racial groups.
For this hypothesis the independent variable is the race of the men
studied/interviewed. My dependent variable is this HIV status at the time of the
interview. We project that African American men are more likely to test positive
more then other races of men with lower education, income, and cultural factors all

10. 10
contributing. These men have a different very point of the world they live-in and
face contributing factors of oppression.
The concept for this research is that African American men test positive for
HIV at higher rates then men of other races. The operationalization characteristics
that lead to a positive status are more complicated. There are many things that we
have to research to find out what may have lead to his status. The most important
variables that I will question participates’ about is their educational background,
sexual partners, drug usage, current income level, and cultural influences.
It’s important to understand what is the highest level of schooling completed.
I’d prefer to measure schooling by years. Participates will be ranked as 0-12, some
college, completed college, master’s degree, and PhD. Another important question is
what is the earliest they remember having a formal sexual education class? At, what
age do they first remember hearing about HIV? Do they feel that the class was
informative? Did they understand, prior to a positive status, how HIV is passed
along? It’s important to remember that the quality of education isn’t the same.
Income affords some individuals more privilege then others. White men in
the study will probably have higher education level then their black peers. The
quality of the neighborhoods and tax brackets that these men come from provide a
better public education and home life. Black men between ages 18-24 test positive
at the highest rate while white males in this age range test positive at much lower
rates.
Many of the sexual cultural patterns that black men engage in play a larger
role of them testing positive at a higher rate then white men. Black youth tend to

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prefer older sexual partners then youth of other races. The act of engaging in sex
with men who are older that have had more sexual partners increase the exposure
to HIV. Many African American men don’t consider these risks because of the many
taboos that are associated with sex within the community in which they come from.
Some of these same individuals return to having sex with men in their age group
and expose them to HIV.
Research Methods
For my research I plan to use the mixed methods design to conduct surveys
and intensive interviews made cross sectionally using the availability and
snowballing sampling methods, where participates volunteer, there’s no probability
procedure used. I’m simply interviewing all males that are available and willing to
answer questions about their health (positive) status. Using this method would give
men a chance to come forward and to be open about their experiences that lead to a
positive status. Instead of harassing or embarrassing individuals with direct
questions about their health, snowballing would allow positive men to lead me to
other positive men that they may know and are comfortable with discussing their
past with me.
I’d prefer to conduct a cross-sectional observation. I’ll only interview
participates once because their status will not change nor the factors that influenced
their discussions prior to their positive status. Men who are positive and engage in
sex with both men and women will be included as well. I’ll need at least 100 men of
all ages, races, and backgrounds who have engage in sex with other men, at some
point in life, for this study. I’ll be paying close attention to men who tested positive

12. 12
between the ages 18-24; even though their current age is greater then the
comparison age group. Simply, why do African American men test positive at higher
rates during the age 18-24 then other age and racial groups. The greatest
disadvantage to snowballing is that I may not reach all racial groups in the
population or even men that are located in certain regions of the United States and
over generalization may occur.
For the questionnaire portion I’d prefer to ask very specific questions that will
give me the proper direction to take the interview. I don’t want to scare away
participates or make them feel undesired over others. Even though I’m only
interested in HIV positive men it’ll be the last thing I ask. For the questionnaire I’d
prefer to focus on basic background information to group the men by race, age, and
education. In my questionnaire, I’d have participates circle the choice that best fits
them and fill in blanks where necessary.
1. What is your age? 18-24, 25-30, 30-40, 40-50, 50-above
2. What is the highest level of education completed? 0-8, 9-12, high school,
some college, 2-yr/technical degree, completed 4yr, masters, PhD/Dr
3. Where did you receive your first sexual education class? 0-8, high school,
college, community education class
4. What age did you first have sex? _______________Years old
5. What was the sex of your first sexual partner? Woman, Man, or BOTH
6. What was the age of you first sexual partner? ____________years old
7. What is your current preference of sexual partners? Woman, Man, or BOTH
8. What is your race? Black, White, other _______________

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9. Do you have a preference about the age of sexual partners? Yes or NO
10. What is your current income? Less then $20,000, $20,000-$30,000, $31000-
$40000, $50,000-$60000, $70,000-above
11. What was the income range of the household you grew up in? Less then
$20,000, $20,000-$30,000, $31000-$40000, $50,000-$60000, $70,000-above
12. What is your current HIV/AIDS status? Positive or Negative
If positive, at what age did you test positive? ______
Participants will be filtered and only participants who selected positive for question
number 12 will be interviewed. All others will be interviewed. But their information
will be included in the total number of participants surveyed. The interview will
start with question about the answer they gave for number 3. Where did they
receive sexual education class? When moving into question 4, I’d focus on if the class
was before or after that experience? Was the first sexual experience protected or
unprotected sex? What choices lead you to having sex with the person, age group
and race, over other individuals around you? Do you still prefer the same group, age
and sex, of people to have sex with? What did you parents tell you about sex? What
did you know about HIV prior to testing positive for HIV? What type of employment
do you have? What is your past work history? What is your current relationship
status?
I feel that it’s best to allow the participants to freely give information about
their past without them feeling overburden with one topic or simply a nosey
researcher. HIV is the focus of my study but I’d prefer to collect that information
during the climax or middle of the conversation instead of making it the obvious

14. 14
focus of interview. I’m interested in the foundations, age they tested positive, sexual
behavior, and differences among racial groups of positive men.
Ethics
Within this research I want to be sure not to offend any of participants with
my questions and rely on them to guide the interview and answer what questions
they are comfortable with. Because it’s illegal to give individuals health status
without their consent each time it is given, I won’t use any names in my study. I’d
prefer to give each participant a number and list the characteristics that make them
individual to other participant.
The goal is to keep all questions form offending anyone. I won’t have any
access to actual medical history but I can look at patterns of HIV infection given by
the CDC and other reliable resources. I will reassure participants that the things we
discuss won’t be repeated with their name or identity attached. Since, this research
is dependent on the participants openness I have to remain as open and willing to
answer any questions they may have about me, my research and how the
information they give me will be used.
I will require that all participants be at least 18 years old. Some of the men’s
first sexual experiences occurred when they were underage and illegal because they
were minors. I’m breaking no law by asking questions about these experiences. I’m
unsure if any of these men would be living lives that included illegal activity or
occupations For the purpose of the research I’m interested interviewing all men and
all includes those groups that participate in illegal activity. Some of the men may
feel depressed and contemplating suicide because of their current HIV status. For

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these participants that may need assistance with depression and contemplating
suicide we will advise them on seeking more counseling and offer preventative
mental help.
Conclusion
This study has the potential to discover new reason why African American
men are still contracting HIV at rates higher then those of other racial groups. I
understand my limits reaching men in other areas of the United States and over
generalizing but I do have an excellent opportunity to find out more about how
positive men here in Atlanta obtain their status. This information my not be useful
to understand how African American men in the state of Washington live but locally
it will give the medical community, outreach workers, and researchers a better idea
of where their services are most needed and what type things can possibly be done
to change the behaviors of African American men living locally.

16. 16
REFERENCES
Ebrahim MD, Shahul H., Anderson Ph.D. , John, Weidle Ph. D., Paul, Purcell Ph.D.
David W. 2004. Race/ethnic disparities in HIV testing and Knowledge about
treatment for HIV/AIDS: United States, 2001. Centers for Disease Control and
Prevention, Atl, GA
Fede Ph. D, Ana Lopez-de, Stewart MS MPH, John E., Hardin Ph. D., James W.,
Mayfield-Smith MA, MBA, Kathy and Sudduth MEd, Dawn. 2011. Spatial
Visualization of Multivariate Datasets: An Analysis of STD and HIV/AIDS Diagnosis
Rates and Socioeconomic Context Using Ring Maps. Association of Schools of Public
Health
Freeman, Katherine, Zonszein, Joel, Islam, Nadia, Blank, Arthur E. and Strelnick ,
Alvin. 2010. Mortality Trends And Disparities Among Racial/Ethnic and Sex
Subgroups in New York City 1990 to 2000. Springer
Hall Ph. D. H. Irene, Byers PhD Robert H, Ling MS Qiang, Espinoza, Lorena. 2007.
Racial/Ethnis and Age Disparities in HIV prevalence and Disease Progression
Among Men Who Have Sex With Men in the United States. American Journal of
Health.
Hill, William Allen and McNeely, Clea. 2011. HIV/AIDS Disparity between African-
American and Caucasian Men Who Have Sex with Men: Intervention Strategies for
the Black Church. Springer Science and Business Media.
Rubin Marcie S., Colen, Cynthia G., and Link, Bruce G. 2010. Examination of
Inequalities in HIV/AIDS Mortality In The United States From Fundamental cause
Perspective. American Journal of Public Health.

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Dr Ruel, Erin. 2014. Consent Form. Georgia State University.
Schutt, Russell K. 2012. Investigating The Social World: The Process and Practice of
Research. SAGE Publications.

18. 18
Appendix A: Consent Form
INFORMED CONSENT FORM
Date:_____________________________
Hello:
I am conducting a research project to better understand how African American men
health. This project consists of a social surveys and interviews to be given to a
representative sample of at least 100 adult, U.S. citizens male citizens 18-99. The
purpose of this research is:
1. To understand the relationship between everyday life and health.
2. To document the sexual behaviors and sexual choices men make.
3. To determine if there are disparities in health and income that affect
choices men make.
The survey will take approximately 15 minutes to complete. I hope you will be able
to respond to each question. If you do not wish to respond to a given question or to
the entire survey, please indicate this. It is important that you understand that you
are in no way obligated to respond to this questionnaire.
This is a confidential survey and no information which could identify you will be
recorded with your responses. Also, if you agree to respond, your answers will
remain strictly confidential. Again, neither your name nor your individual responses
will be given to any other individual or organization either inside or outside of the
Georgia State University environment.
I appreciate your willingness to cooperate in this important research effort. If you
have any questions about the content of the survey or my interview procedures,
please do not hesitate to contact me:
Emanuel Thomas
1050 General Classroom Building
University Plaza
Georgia State University
Atlanta, GA 30303
404-463-4795
_____________________________________________ __________________

19. 19
Sign Date
Appendix B: Questionnaire
1. What is your age? 18-24, 25-30, 30-40, 40-50, 50-above
2. What is the highest level of education completed? 0-8, 9-12, high school,
some college, 2-yr/technical degree, completed 4yr, masters, PhD/Dr
3. Where did you receive your first sexual education class? 0-8, high school,
college, community education class
4. What age did you first have sex? _______________Years old
5. What was the sex of your first sexual partner? Woman, Man, or BOTH
6. What was the age of you first sexual partner? ____________years old
7. What is your current preference of sexual partners? Woman, Man, or BOTH
8. What is your race? Black, White, other _______________
9. Do you preference about the age of sexual partners? Yes or NO
10. What is your current income? Less then $20,000, $20,000-$30,000, $31000-
$40000, $50,000-$60000, $70,000-above
11. What was the income range of the household you grew up in? Less then
$20,000, $20,000-$30,000, $31000-$40000, $50,000-$60000, $70,000-
above. circle
12. Do you have private, government assisted, or no healthcare coverage? (circle
one)
13. What is your current HIV/AIDS status? Positive or Negative
If positive, at what age did you test positive?_________

20. 20
Appendix C: Quick Interview Guide
The interview should consist of very open-ended question’s that give the
participate a chance to offer inform or a short story of life events, which will give
clues on which way to continue with interview. Because the questions a personal its
best to let the participate give the information their comfortable with giving and
proceed from there.
1. What were your high school years like?
2. How was your family life?
3. Were you regularly taken to the doctor and dentist as a child?
4. What age did you first have sex? Sex of partner?
5. Did your parents talk to you about sex? School? Friends? What did they
say or not say about sex?
6. What are your earliest memories of sex, sexual acts, or behavior?
7. What sex do you prefer to have sex with? Men, Women, or both?
8. What age were you when you found out you were positive?
9. How did you feel?
10. Were you working at that time? School? Living with partents?
11. Where did you find you were positive?
12. Since becoming positive have any of your sexual habits changed?
13. How has being positive affected your life?
14. What advice could you give, that would be useful to a younger person
that could potentially help them avoid a positive status?