RENE DURAZZO Deputy Director for Programs, San Francisco AIDS Foundation "You don't know what kind of skill sets you need until you first have a clear picture of the issues and the ethnic and cultural underpinnings that are present in the community you want to help. If you don't have that clear understanding, whatever skills you offer are going to be off target." San Francisco AIDS Foundation San Francisco AIDS is an equal-opportunity epidemic, affecting people from every race, culture and lifestyle. To be effective, prevention workers at the San Francisco AIDS Foundation must be able to understand and respect many points of view. While the spread of the epidemic has slowed in many areas, new HIV infections continue to rise among poor, gay, African-American men in the rough Tenderloin district. To Rene Durazzo, deputy director for programs, it was clear that any productive effort to address the issue had to start with an understanding of the men's complex lifestyle -- an intersection of influences that includes race and ethnicity, sexual orientation, homelessness, poverty, intravenous drug use and an environment where violence is the norm. "We had to have a window through which to understand these men on their terms, in their language, within their experiences," he said. Partnered with the Center for AIDS Prevention Studies with Foundation funding, they launched a targeted qualitative interview process. First, they hired two staff members with a strong understanding of the men and their issues and stresses. Armed with those insights, they sat down one-on-one with 70 African-American gay men and conducted two-hour, in-depth interviews. Among key findings: Unprotected sex is a highly valued commodity among those with little to barter, and offering a condom would arouse fears of HIV infection and could lead to rejection. With this information, workers are developing a more responsive model for addressing HIV transmission in that subculture that can be applied in similar models to other populations at high risk for HIV. "We've taken a very broad look at what it means to address multicultural issues that moves well beyond race and ethnicity," Durazzo said. "If we didn't, we'd really be operating in a vacuum as to what these men are all about and what approach would influence them."