Keeping Step with Good Health

While African Americans make up only 13 percent of the U.S. population, they represent more than half of the new HIV infections each year. In Brooklyn’s Bedford-Stuyvesant neighborhood, which has the highest HIV and AIDS rate of any community in New York State, a new program is helping young black men ages 18–30 fight back. Called Keep It Up, the program combines health promotion and HIV prevention to help participants learn to take care of their health.

“This population tends to fall through the cracks of traditional health care,” says EDC’s Deborah McLean Leow. “Black men are less likely to have health insurance and less likely to seek non-emergency care, so when they do show up, they are sicker.”

Another barrier to care for black men is the stigma around HIV and AIDS in the community. Keep it Up gets around this perception by screening for other health problems that disproportionately affect African Americans, such as obesity, diabetes, hypertension, and asthma.

“Seeking preventive health care is at the bottom of the list of priorities for these men,” says Leow. “They tell us that while health is important, they are more concerned with jobs, family, and even survival. This program is rapid, noninvasive, and reduces the burden on them.”

Based on focus groups with both young men and women from all walks of life—from college students to prison parolees to health researchers and practitioners—Keep It Up was designed by EDC and Medgar Evers College. During the program’s pilot phase, 13 sessions were conducted at the nursing department of Medgar Evers College, a location chosen for its centrality to community members and because it is not associated with HIV testing.

Leow and other staff involved in the project took an active role in recruiting participants to Keep It Up. Dressed in Keep It Up apparel, they went to neighborhood spots and distributed flyers and spoke to prospective participants.

“Women—mothers, partners, sisters—play an important role in encouraging black men to take care of their health,” says Leow.

The program also invited nationally known hip hop recording artist Talib Kweli to be its spokesman. Kweli, who is from Brooklyn, appears in Keep It Up materials and contributed original songs to the program.

Strategies such as these proved very successful, with high numbers of participants reporting that they had seen posters, flyers, and t-shirts, or heard about the program from a friend. The assessment also found that recruitment worked best when sessions were held on consecutive days, so that men who came to initial sessions recruited others for sessions later in the same week.

During the sessions, participants were measured for body mass index (BMI); had their blood pressure read; had lung function assessed by blowing into a peak flow meter; and provided a blood sample for rapid cholesterol, diabetes, and HIV testing. Participants also answered questions about their medical histories and risky behaviors with relation to HIV and AIDS, diet, and substance abuse.

While waiting for their results, participants engaged in a computer-based learning module. In the module, they visit a virtual city—modeled after Brooklyn—to watch the lives of different residents unfold. For example, they can zoom through a window into a couple’s apartment, watch a parent read to a child, go into a nightclub, or go to church.

The module includes segments from the EDC-developed Safe in the City STD prevention program, interactive games on condom selection and use, original music from Talib Kweli, and an interview with young adults who lost their parents to AIDS.

“The module helped enforce the idea that the men had to keep up their health, not just for themselves, but for their loved ones and the community as a whole,” explains Leow.

Although no one in the pilot was found to be HIV positive, many of the men were found to have medical problems, including hypertension, obesity, high cholesterol, and psychological distress. In a follow-up session conducted three months later, participants reported success in following through with many of the program’s recommendations—such as exercise, changes in diet, and visits to a doctor’s office—and many of them referred friends and family to the program.

Keep It Up was funded by the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.