d-up: Defend Yourself!

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d-up: Defend Yourself! is a community-level intervention designed for and developed by Black men who have sex with men (MSM). d-up! is designed to promote social norms of 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. Brothers Keeping Brothers Safe refers to black MSM influencing one another to practice safer sex and stop transmission. When the social norm is shifted in a social network of black MSM the behavior of every individual in the network is impacted. Brothers Keeping Brothers Safe indicates that brothers are the most effective and far-reaching agents of behavior change for themselves that exists in the world.

 d-up! defend yourself!

d-up! finds and enlists opinion leaders whose advice is respected and trusted by their peers. These opinion leaders are trained to change risky sexual norms of their friends and acquaintances in their own social networks. d-up! opinion leaders are prepared to deliver messages that counter racial and sexual biases directed toward Black MSM in society (see Core Element #4) and to promote condom use among Black MSM.

NOTE: d-up! is adapted to Black MSM. Agencies interested in targeting other populations should adapt POL or adapt/implement other appropriate DEBIs instead.

d-Up! Part 1 Video: An introduction to d-up!

A brief overview of the intervention. 
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d-Up! Part 2 Video: Implementing d-up!

Follow a Community-Based Organization's (Brothers inc.) implementation of d-up! 
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Research and Development

Kenneth T. Jones, MSW, Phyllis Gray, MPH, Y. Omar Whiteside, MEd, Terry Wang, MSPH, Debra Bost, BA, Erica Dunbar, MPH, Evelyn Foust, MPH, and Wayne D. Johnson, MSPH (2008). Evaluation of an HIV prevention intervention adapted for Black men who have sex with men. American Journal of Public Health, 98 (6), 1043-1050.

Program Review Panel Information

The CDC requires all CDC-funded agencies using the d-up! intervention to identify, or establish, and utilize a Program Review Panel and complete Form 0.1113 to document this activity. The intervention researchers and developers are not involved in this activity. This is a CDC requirement for their grantees, and all questions in this regard should be directed to your agency's CDC Project Officer or to the health department funding your agency's implementation of the intervention.

The Program Review Panel guidelines, instructions for completion of Form 0.113, and the form itself are available under the Related Links section of the this website.

CDC Policy on Youth Peer Outreach Workers

CDC funded (directly or indirectly) agencies using youth (either paid or volunteer) in program outreach activities need to use caution and judgement in the venues/situations where youth workers are placed. Agencies should give careful consideration to the "age appropriateness" of the activity or venue. Additionally, agencies should comply with all relevant laws and regulations regarding entrance into adult establishments/environments. Laws and curfews should be clearly outlined in required safety protocols developed and implemented by agencies directly and indirectly funded by CDC.

If you have specific questions, please contact your CDC project officer.

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d-up! Core Elements

  • Direct d-up! to an identified at-risk target population in well-defined community venues where the population's size can be assessed.
  • Use key informants and systematic observation to identify the target population's social networks and to identify the most respected, credible, trustworthy, listened to, empathetic to friends, and self-confident persons in each network.
  • Over the life of the program, recruit and train as opinion leaders 15% of the persons from each friendship group in the social network that is found in the intervention venue.
  • Raise opinion leaders' awareness of how negative social and cultural factors impact Black MSM's sexual risk behavior in order to promote a norm of positive self-worth in their social networks and to address these biases in their conversations, as needed.
  • Teach opinion leaders skills for putting risk reduction endorsement messages into everyday conversations with friends and acquaintances.
  • Teach opinion leaders the elements of effective behavior change messages that target attitudes, norms, intentions, and self-efficacy related to risk. Train opinion leaders to personally endorse the benefits of safer sex in their conversations and to offer practical steps to achieve change.
  • Hold weekly sessions for small groups of opinion leaders to help them improve their skills and gain confidence in giving effective HIV prevention messages to others. Instruct, model, role-play, and provide feedback during these sessions. Make sure that all opinion leaders have a chance practice and shape their communication skills and get comfortable putting messages into conversations.
  • Have opinion leaders set goals to hold risk reduction conversations with at-risk friends and acquaintances in their own social network between weekly sessions.
  • Review, discuss, and reinforce the outcomes of the opinion leaders' conversations at later training sessions.
  • Use logos, symbols, or other items as "conversation starters" between opinion leaders and others.

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