This application is in response to PA-11-119 HIV/AIDS Testing and Follow-up among the Underserved in the United States (R21), which invites grant applications on populations experiencing unique barriers or facilitators to testing and linkage to care. Deaf Men who have Sex with Men (D-MSM) are one such group, chronically excluded from HIV research, testing, surveillance, education and services. Data from Maryland, the only state to ask information about hearing status when screening for HIV, indicate that the prevalence of HIV in the general deaf and hard-of-hearing population is two to five times higher than for the hearing population. We expect the sub-set of D-MSM to be the highest risk group within the larger Deaf population. In 30 years of the HIV/AIDS epidemic, no national studies of HIV testing rates, risk behavior, prevention and treatment needs of D-MSM have been conducted in the US, a chronic problem we begin to address in this application. Internet- based technology can enable us to reach D-MSM for HIV research, services and education. The long term objective of this research is to improve HIV screening, testing, prevention, treatment and access for Deaf people, by developing innovative, culturally- and linguistically-accessible, Internet-based methods and interventions. As a first step, in this R21, we will develop and test online, visually-based qualitative and quantitative research tools (integrating American Sign Language [ASL] and English), while also conducting the first HIV testing and prevention needs assessment of D-MSM in ASL. Integrating the theory of intersectionality and a social cognitive approach, the four aims of this R21 allow us to develop and test the online tools needed to create effective health screening interventions with Deaf populations. Through Aim 1 we will utilize qualitative online interviews in ASL to assess the experiences of a geographically dispersed group of D-MSM in HIV risk behavior, knowledge, barriers and facilitators to testing, and prevention needs. For Aim 2, we will develop the quantitative measures needed to assess the Deaf experience of seeking services, including new Deaf-specific measures. In Aim 3, we will develop and test the resulting online, visually-based survey tools in ASL-English, including an HIV risk screening instrument. Through Aim 4, we will conduct the first online ASL- based HIV needs assessment of D-MSM using a national sample. The public health impact of this study resides in the contribution to advancing research in overcoming health disparities, by developing a suite of online tools and services available nationally to facilitate access to health services for Deaf people, and their providers, thereby addressing the needs of a chronically underserved population. PUBLIC HEALTH RELEVANCE: Deaf MSM (D-MSM) are a high-risk, underserved population experiencing chronic barriers to HIV testing and linkage to care. The principal challenge is that HIV research, testing, counseling and services is typically provided in English, while D-MSM communicate primarily through American Sign Language (ASL) and have, on average, very low (3rd-4th grade) English reading levels. Because the population is geographically dispersed through the USA, most places lack resources to provide confidential HIV testing services in ASL. This R21 is a feasibility and acceptability test of how to use technology to overcome the chronic barriers experienced by D- MSM. We will design, develop and test online methods to engage a diverse national sample of D-MSM in a study of HIV screening and prevention needs, using a combined ASL-English dual format. We plan to develop a suite of online ASL-English tools for providers, researchers, and surveillance to use, thus enabling D-MSM to finally engage in HIV prevention and care.