Bright Spot: d-up: Defend Yourself!

Photo by Charles Deluvio on Unsplash

This bright spot was originally published in the 100 Million Healthier Lives Change Library and is brought to you through partnership with 100 Million Healthier Lives and the Institute for Healthcare Improvement.


Detailed Description

d-up: Defend Yourself! is a community-level intervention for Black men who have sex with men (MSM). This cultural adaptation of the Popular Opinion Leader (POL) intervention is designed to change social norms and perceptions of Black MSM regarding condom use. Respected and trusted opinion leaders are enlisted and trained to change risky sexual norms in their own social networks.

Expected Outcomes

The goal of is to increase the number of Black MSM who use a condom when they have sex. The intervention focuses on changing the target social network's condom use norms. The primary objectives are to:

  • Identify a target social network of at least 100 black MSM, its social venues, friendship groups, and opinion leaders through community discovery activities
  • Enlist the support of gatekeepers
  • Create logos or conversation starters
  • Recruit, train, and support a minimum of 15% of friendship group members (opinion leaders) to carry out risk reduction conversations with their friends and acquaintances


Emerging bright spot (emerging evidence)

Failing Forward Moments

Additional details can be found on the Effective Interventions d-up website

Cost Details

As of July 2014, the cost of this intervention is as follows:

  • Cost for personnel (hours spent on intervention, including travel time)
  • Cost for facilities (e.g., office, facilities, maintenance, insurance, etc.)
  • Cost for equipment (e.g., television, computer, projector, VCR/DVD player, etc.)
  • Cost for supplies (e.g., paper, pens, markers, condoms, etc.)
  • Cost for conversation starters (e.g., logo posters, pins, dog tags, caps, etc.)
  • Cost for logos and other marketing materials
  • Cost for other expenses (e.g., catering/refreshments, incentives, staff travel expenses, etc.) There is no cost for using the implementation materials For the latest cost details, please contact the d-up!program directly.

Key Steps for Implementation

  • Recruit opinion leaders
  • Conduct opinion leader trainings
  • Monitor opinion leaders after they complete training and provide ongoing support
  • Hold opinion leader reunions
  • Recruit successive waves of opinion leaders
  • Revise messages and conversation starters as needed
  • Consider identifying other social networks to target once 15% of the members of each friendship group have delivered the necessary number of risk reduction conversations

Other Key Requirements

  • Have a system in place to ensure that confidentiality is maintained for all participants in the program CBOs must strive to offer culturally competent services by being aware of the demographic, cultural, and epidemiologic profile of their communities
  • Data must be collected and reported according to CDC requirements CBOs conducting outreach must establish a code of conduct CBO policies must exist for maintaining safety of workers and clients CBOs must establish criteria for, and justify the selection of, the target populations CBOs should know and disclose how their liability insurance and worker's compensation applies to volunteers

Required Staffing (FTEs)

1 program coordinator, 0.5 FTE 1 senior facilitator, 0.5 FTE 1 junior facilitator, 0.25 FTE 1 administrative assistant, 0.10 FTE 2 volunteers, 0.10 FTE each

Special Infrastructure

needs space for trainings and staff meetings (may be the CBO's office space). Training and meeting space should meet the following requirements:

  • Comfortable seating for having discussions and watching videos
  • In the same place for each session (e.g., meeting at a business for an hour before it opens)
  • Convenient to where opinion leaders live, work, and socialize
  • Easy to get to by using public transportation Each training space should fit 12 to 15 people comfortably, where they have room to get up, interact, and conduct role-plays
  • Large enough so that 2 sessions can be conducted at the same time, since opinion leaders will bring a friend to go through the training at session 4
  • Space for trainings and staff meetings 
  • Implementation manual
  • d-up! facilitator's guide opinion leader handbook
  • d-up! CD-ROM
  • Incentives (e.g., transportation passes, snacks)


4 Training Days; Tuesday-Friday preferred (especially if space is not available on a Sunday for set-up). Danya requires a minimum of 6-8 weeks notice in advance of a training date to effectively coordinate training logistics. Full details on intervention-specific training needs can be found here.

Types of Staff

All staff should have extensive experience working with Black MSM, and they should be culturally competent for working with members of this population. The intervention may also require Public Health Educators.

Outcome Measures

  • Number of opinion leaders trained
  • Number of opinion leaders trained reporting intentions to carry out risk reduction conversations
  • Number of opinion leaders reporting an increased awareness of how social and cultural issues can affect the risk behavior of Black MSM
  • Percentage of participants that report they are confident or very confident that they can carry out risk reduction conversations with their friends and acquaintances at the end of each opinion leader training session
  • Number of risk reduction conversations reported by opinion leaders with friends and acquaintances at the end of the first year
  • Percentage of Black MSM in the social network that have had a risk reduction conversation with a trained opinion leader by the end of the first year
  • Percentage of network members that demonstrate a positive change in attitudes toward safer sex 6 months after the final training wave
  • Percentage of network members that practice safer sex consistently for 6 months after the final training wave

Process Measures

  • Percentage of members from each friendship group trained as opinion leaders (target is 15%)
  • Percentage of trained opinion leaders that are Black MSM (target is 50%)
  • Percentage of opinion leaders that carried out 14 risk reduction conversations with their friends and acquaintances
  • Number of reunions held
  • Number of friendship groups
  • Size of friendship groups
  • Number of each friendship group's members who completed opinion leader training
  • Number of opinion leaders trained
  • Number of opinion leaders trained who are Black MSM
  • Number of opinion leaders who conducted 14 risk reduction conversations


Website of d-up: Defend Yourself!
HIV: d-up: Defend Yourself!
Resource - Website/webpage
Brought to you by CDC

 Related Topics

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Sexual and Reproductive Health

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LGBTQ+ People

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Black and African Americans