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Waldron EM, Goodman GR, Rivas AM, Ott C, Blyler A, McDonald VW, Campbell M, Underwood E, Bonner A, Wise JM, Elopre L, Kudroff K, Krakower D, Sherr K, Kempf MC, Psaros C. Perceptions of and preferences for PrEP use among African American women and providers in the U.S. South: a qualitative study. Psychol Health 2024:1-20. [PMID: 38441003 DOI: 10.1080/08870446.2024.2322079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 02/17/2024] [Indexed: 03/06/2024]
Abstract
OBJECTIVE African American (AA) women in the U.S. South experience significant HIV incidence, and efforts to support antiretroviral pre-exposure prophylaxis (PrEP) uptake and maintenance among this group have been insufficient. This study aimed to explore perceptions, attitudes, and implementation preferences surrounding PrEP use for AA women in the U.S. South. METHODS AND MEASURES The study team conducted qualitative interviews with AA cisgender women clients (n = 21) and their providers (n = 20) in Federally Qualified Health Centers and HIV clinics in Alabama. The research team employed directed qualitative content analysis to analyze interview data. RESULTS Five themes emerged: a) inconsistent access to PrEP and PrEP knowledge, b) need for improving low PrEP awareness, c) managing hesitancy to prescribe or use PrEP, d) perceived HIV vulnerability and inherent stigma, and e) normalizing PrEP as part of routine sexual healthcare to increase uptake and maintenance. Interviews revealed an openness towards PrEP as an HIV prevention strategy for AA, cisgender women in Alabama. CONCLUSION Improving PrEP uptake and maintenance among AA women in the U.S. South must go beyond increasing awareness to improving PrEP access and trust through visibility of AA women's PrEP use and incorporating PrEP education and services into routine sexual healthcare.
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Affiliation(s)
- Elizabeth M Waldron
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Georgia R Goodman
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
- The Fenway Institute at Fenway Health, Boston, MA, USA
| | - Alexa M Rivas
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Corilyn Ott
- School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA
- Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Abigail Blyler
- Positive Psychology Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Victoria W McDonald
- School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marquetta Campbell
- Maude L. Whatley Health Center, Whatley Health Services, Inc, Tuscaloosa, AL, USA
| | - Eric Underwood
- Maude L. Whatley Health Center, Whatley Health Services, Inc, Tuscaloosa, AL, USA
| | - Aharisi Bonner
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jenni M Wise
- School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Latesha Elopre
- Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kachina Kudroff
- Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Douglas Krakower
- The Fenway Institute at Fenway Health, Boston, MA, USA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Mirjam-Colette Kempf
- School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA
- Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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2
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Vallée A, Majerholc C, Zucman D, Livrozet JM, Laurendeau C, Bouée S, Prevoteau du Clary F. Mortality and comorbidities in a Nationwide cohort of HIV-infected adults: comparison to a matched non-HIV adults' cohort, France, 2006-18. Eur J Public Health 2024:ckae031. [PMID: 38409963 DOI: 10.1093/eurpub/ckae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) remains a significant cause of morbidity and mortality worldwide. The aim of this study was to describe the mortality rate and associated comorbidities in a nationwide population-based cohort of persons living with HIV (PLWHIV) and to compare it with mortality in an age and gender-matched cohort of non-HIV individuals in France. METHODS Using data from the French national health data system, we identified and included 173 712 PLWHIV (66.5% men) and 173 712 non-HIV participants (66.5% men) matched for age and gender. PLHIV were identified based on ICD-10 HIV diagnoses, HIV-specific laboratory tests, and/or prescriptions for antiretroviral therapy specific to HIV. Hazard ratios (HRs) of mortality were assessed using multiple Cox regression models. RESULTS During the 13 years of follow-up (2006-18), we observed 20 018 deaths among PLWHIV compared with 6262 deaths among non-HIV participants (11.52% vs. 3.60%, P < 0.001). The over-mortality of PLWHIV was expressed by univariable HR = 2.135 (2.072-2.199), which remained significant after adjustment for region, Complementary Universal Health Insurance and AME, with multivariable HR = 2.182 (2.118-2.248). The results remained significant after adjusting for comorbidities, including infectious diseases [HR = 1.587 (1.538-1.638)]. Notably, PLWHIV were more importantly associated with mortality in women [HR = 2.966 (2.767-3.180)], compared in men [HR = 1.961 (1.898-2.027)]. CONCLUSION Although the life expectancy of PLWHIV has globally increased, the causes of death should be prioritized in prevention policies and care management. Gender-specific policies should be highlighted, as we observed a higher impact of HIV mortality in women.
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Affiliation(s)
- Alexandre Vallée
- Department of Epidemiology and Public Health, Foch Hospital, Suresnes, France
| | - Catherine Majerholc
- Department of Internal Medicine, Réseau Ville-Hôpital Val de Seine, Foch Hospital, Suresnes, France
| | - David Zucman
- Department of Internal Medicine, Réseau Ville-Hôpital Val de Seine, Foch Hospital, Suresnes, France
| | - Jean-Michel Livrozet
- Department of Infectious and Tropical Diseases, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
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Devlin SA, Ridgway JP, Dawdani A, Enaholo OE, Liegeon G, Kasal N, Pyra M, Hirschhorn LR, Simon J, Haider S, Ducheny K, Johnson AK. Adapting Provider Training and Pre-Exposure Prophylaxis Advertising to Increase Pre-Exposure Prophylaxis Awareness and Uptake Among Black Cisgender Women. AIDS Patient Care STDS 2023; 37:574-582. [PMID: 38011350 PMCID: PMC10732154 DOI: 10.1089/apc.2023.0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
Black cisgender women (hereafter referred to as "women") have disproportionately high rates of HIV infection yet low rates of pre-exposure prophylaxis (PrEP) utilization. Barriers to PrEP uptake exist at the system, provider, and individual/client level. To learn how existing training and advertising can be adapted to address race- and sex-based gaps within PrEP service delivery, we conducted focus groups with providers and Black women. Participants were recruited at three health care organizations in the Midwest and South, screened for eligibility, and consented verbally. Focus groups occurred from August 2022 to February 2023. Women were asked about their knowledge and thoughts on PrEP. Providers were asked about factors influencing their decision-making about PrEP. A codebook was developed based on the Consolidated Framework for Implementation Research. Transcripts were coded using the Stanford Lightning Report Method. We completed four focus groups with 10 providers and 9 focus groups with 25 women. Three major themes emerged: (1) low comfort level and limited cultural sensitivity/competency among providers discussing HIV risk and PrEP with Black women, (2) women's concerns about PrEP's side effects and safety during pregnancy, and (3) lack of Black women representation in PrEP advertisement/educational materials. In addition, women in the South reported general medical mistrust and specific misconceptions about PrEP. PrEP trainings for providers need detailed information about the safety of PrEP for women and should include role-playing to enhance cultural competency. Likewise, PrEP advertisements/materials should incorporate information regarding side effects and images/experiences of Black women to increase PrEP awareness and uptake among this population. Clinical Trial Registration Number: NCT05626452.
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Affiliation(s)
| | | | - Alicia Dawdani
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Ososese E. Enaholo
- The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Geoffroy Liegeon
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Nikki Kasal
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Maria Pyra
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lisa R. Hirschhorn
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | - Sadia Haider
- Division of Family Planning, Rush University, Chicago, Illinois, USA
| | | | - Amy K. Johnson
- The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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Arnold T, Whiteley L, Elwy RA, Ward LM, Konkle-Parker DJ, Brock JB, Giorlando KK, Barnett AP, Sims-Gomillia C, Craker LK, Lockwood KR, Leigland A, Brown LK. Mapping Implementation Science with Expert Recommendations for Implementing Change (MIS-ERIC): Strategies to Improve PrEP Use among Black Cisgender Women Living in Mississippi. J Racial Ethn Health Disparities 2023; 10:2744-2761. [PMID: 36396922 PMCID: PMC9672575 DOI: 10.1007/s40615-022-01452-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Black women are disproportionately affected by the HIV epidemic. Strategies to increase Black women's use of pre-exposure prophylaxis (PrEP) are needed. METHODS Interviews were conducted in Mississippi (MS) with Black, cisgender women at risk for HIV, and community healthcare clinic (CHC) staff who work directly with this population. Reflexive thematic analysis was used to identify barriers and select appropriate implementation strategies to increase PrEP care. RESULTS Twenty Black women and twelve CHC staff were interviewed. PrEP use barriers resulted from low HIV risk awareness, lack of PrEP knowledge, and structural and stigma-related barriers. Methods for PrEP education and motivation included normalizing PrEP in public communications, providing education at places where women congregate, and tailoring PrEP content with Black women as educators. The Expert Recommendations for Implementing Change (ERIC) project provides a way for implementation scientists to select strategies that are consistent within research and practice across studies. Strategies from the ERIC project were selected to address implementation barriers. CONCLUSIONS Tailoring PrEP implementation protocols to increase Black women's access, engagement, and adherence to PrEP is needed. This is one of the first implementation studies to incorporate these four implementation concepts into a single study: (1) implementation outcomes, (2) i-PARIHS, (3) ERIC's strategy list, and (4) operationalizing the strategies using the Proctor et al., guidelines. Results provide an in-depth comprehensive list of implementation strategies to increase PrEP uptake for Black women in MS.
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Affiliation(s)
- Trisha Arnold
- Brown University Warren Alpert Medical School, Providence, RI, USA.
- Department of Psychiatry, Rhode Island Hospital, Providence, USA.
| | - Laura Whiteley
- Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Rani A Elwy
- Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Lori M Ward
- Departments of Nursing, Medicine, and Population Health Sciences, University of Mississippi Medical Center, Jackson, USA
| | - Deborah J Konkle-Parker
- Departments of Nursing, Medicine, and Population Health Sciences, University of Mississippi Medical Center, Jackson, USA
| | - James B Brock
- Departments of Nursing, Medicine, and Population Health Sciences, University of Mississippi Medical Center, Jackson, USA
| | | | - Andrew P Barnett
- Brown University Warren Alpert Medical School, Providence, RI, USA
- Department of Psychiatry, Rhode Island Hospital, Providence, USA
| | - Courtney Sims-Gomillia
- Departments of Nursing, Medicine, and Population Health Sciences, University of Mississippi Medical Center, Jackson, USA
| | - Lacey K Craker
- Division of Prevention Science and Community Health, University of Miami, Miami, USA
| | - Khadijra R Lockwood
- Departments of Nursing, Medicine, and Population Health Sciences, University of Mississippi Medical Center, Jackson, USA
| | - Avery Leigland
- Department of Psychiatry, Rhode Island Hospital, Providence, USA
| | - Larry K Brown
- Brown University Warren Alpert Medical School, Providence, RI, USA
- Department of Psychiatry, Rhode Island Hospital, Providence, USA
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5
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Chandler R, Farinu OTO, Guillaume D, Francis S, Parker AG, Shah K, Hernandez ND. Digital Health App to Address Disparate HIV Outcomes Among Black Women Living in Metro-Atlanta: Protocol for a Multiphase, Mixed Methods Pilot Feasibility Study. JMIR Res Protoc 2023; 12:e42712. [PMID: 37713259 PMCID: PMC10541635 DOI: 10.2196/42712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/28/2023] [Accepted: 05/03/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Cisgender Black women in the southern United States are at heightened risk for HIV and adverse sexual and reproductive health outcomes. Mobile health interventions that target HIV risk while being adapted to the needs and lived experiences of Black women are remarkably limited. OBJECTIVE The study aims to refine SavvyHER, a mobile app for HIV prevention, with Black women residing in high HIV incidence areas of Georgia and evaluate the feasibility, acceptability, and usability of SavvyHER. This paper describes the procedures implemented to conduct this research. METHODS Community-based participatory research tenets guide this multiphase study to finalize the development of what we hypothesize will be an effective, sustainable, and culturally relevant HIV prevention and optimal sexual health and reproductive wellness app for Black women. This multiphased, mixed methods study consists of 3 phases. The first phase entails focus groups with Black women to understand their preferences for the functionality and design of a beta prototype version of SavvyHER. In the second phase, an app usability pretest (N=10) will be used to refine and optimize the SavvyHER app. The final phase will entail a pilot randomized controlled trial (N=60) to evaluate the app's feasibility and usability in preparation for a larger trial. RESULTS Findings from preliminary focus groups revealed educational content, app aesthetics, privacy considerations, and marketing preferred by Black women, thus informing the first functional SavvyHER prototype. As we adapt and test the feasibility of SavvyHER, we hypothesize that the app will be an effective, sustainable, and culturally relevant HIV prevention, sexual health, and reproductive wellness tool for Black women. CONCLUSIONS The findings from this research substantiate the importance of developing health interventions curated for and by Black women to address critical HIV disparities. The knowledge gained from this research can reduce HIV disparities among Black women through a targeted intervention that centers on their health needs and priorities. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/42712.
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Affiliation(s)
- Rasheeta Chandler
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
| | - Oluyemi T O Farinu
- Department of Sociology, Georgia State University, Atlanta, GA, United States
| | - Dominique Guillaume
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Sherilyn Francis
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, United States
| | - Andrea G Parker
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, United States
| | - Kewal Shah
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, United States
| | - Natalie D Hernandez
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, United States
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6
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Sprague Martinez L, Scott JC, Rocco M, Rajabiun S, Flores Rodriguez C, Cummings R, McKinney-Prupis E, Minott M, Walker-Jones J, Downes A, Wangari Walter A. Policies enacted during COVID-19 came with unintended health benefits: why go back? BMC Health Serv Res 2023; 23:496. [PMID: 37194099 DOI: 10.1186/s12913-023-09448-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 04/25/2023] [Indexed: 05/18/2023] Open
Abstract
OBJECTIVES To explore the impact of COVID-19 on the implementation of bundled interventions to improve the engagement and retention of Black women in HIV care. METHODS Pre-implementation interviews conducted between January and April 202 L with 12 demonstration sites implementing bundled interventions for Black women with HIV. Directed content analysis was employed to examine the site interview transcripts. RESULTS The pandemic intensified barriers to care and harmful social conditions. However, COVID-19 also forced pivots in health care and social service delivery and some of these changes benefited Black women living with HIV. CONCLUSIONS The continuation of policies that support the material needs of Black women with HIV and ease access to care is critical. Racial capitalism impedes the enactment of these policies and thus threatens public health.
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Affiliation(s)
| | | | - Melanie Rocco
- Boston University School of Social Work, Boston, MA, US
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7
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Robillard AG, Troutman J, Perry C, Larkey L. A Pilot Study Examining a Culture-centric Story to Promote HIV Testing in African American Women in the South. J Assoc Nurses AIDS Care 2023; 34:207-215. [PMID: 36821838 DOI: 10.1097/jnc.0000000000000390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- Alyssa G Robillard
- Alyssa G. Robillard is an Associate Professor, Edson College of Nursing and Health Innovation at Arizona State University, Phoenix, Arizona. Jamie Troutman is the Program Evaluator, Quality Comprehensive Health Center, Charlotte, North Carolina, USA. Chelsea Perry was formerly a student, University of South Carolina, Arnold School of Public Health, Columbia, South Carolina. Linda Larkey is a Professor, Edson College of Nursing and Health Innovation at Arizona State University, Phoenix, Arizona
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Antoine YS, Amutah-Onukagha N, Vigue R, Bolarinwa E, Nicholson V, Lacroix-Williamson L, Zabie T. Reducing the spread of HIV through intergenerational communication and engagement among African American mothers and daughters. Ther Adv Infect Dis 2022; 9:20499361221145602. [PMID: 36569814 PMCID: PMC9780759 DOI: 10.1177/20499361221145602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
| | | | | | | | - Vanessa Nicholson
- Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | | | - Telesha Zabie
- School of Medicine, Windsor University, Cayon, Saint Kitts and Nevis
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9
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Kenya S, Young B, Rosenthal A, Escarfuller S, Blackmon J, Carrasquillo O. Untold Risk: HIV Transmission Behaviors in Miami's Historically Black Communities. J Racial Ethn Health Disparities 2022; 9:2404-2411. [PMID: 34791613 DOI: 10.1007/s40615-021-01177-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 12/29/2022]
Abstract
Advances in HIV prevention therapies have led to significant reductions in HIV transmission across the USA. However, these resources have not been equally utilized across all populations, with Black communities in the Southeastern USA experiencing among the greatest HIV disparities in the nation. Tailoring HIV programs to align with the cultural norms of minority communities is one approach that can increase uptake of HIV prevention services. However, accomplishing this requires a rich understanding of the unique risk factors and the context of HIV transmission among men and women within culturally distinct communities. To further our understanding, we examined HIV risk behaviors among Black adults living in geographic HIV hotspots of Miami-Dade County. Between December 2016 and April 2019, data on HIV risk behaviors use a standardized HIV assessment developed by the Florida Department of Health. Chi-square and t-test analyses were conducted to examine differences in population demographics and risk factors, and logistic regression was used to test for predictors of HIV status. Results indicate that a significant portion of participants had prior experience with HIV testing, a known protective factor against HIV transmission. Despite this, much of the sample also reported recent engagement in high-risk sexual behaviors. These findings emphasize the need for intervention development within the context of population-specific behaviors. Future research should further consider the importance of transmission behaviors among clusters of demographically similar populations at high risk for or living with HIV.
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Affiliation(s)
- Sonjia Kenya
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - BreAnne Young
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA.
| | - Amanda Rosenthal
- Kaiser Permanente, Los Angeles Medical Center, 4867 Sunset Blvd, Los Angeles, CA, 90027, USA
| | - Sebastian Escarfuller
- Stempel College of Public Health & Social Work, Florida International University, 11200 SW 8th Street, AHC5, Miami, FL, 33199, USA
| | - Jakisha Blackmon
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Olveen Carrasquillo
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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10
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Boga DJ, Dale SK. Black Women Living with HIV: A Latent Profile Analysis of Intersectional Adversities, Resilience, and Mental Health. AIDS Patient Care STDS 2022; 36:364-374. [PMID: 36040393 PMCID: PMC9514596 DOI: 10.1089/apc.2022.0053] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Black women living with HIV (BWLWH) face adversities, including discrimination (race, HIV, and gender related) and trauma. This study examines which latent profiles of resilience (R) and adversity (A) are most prevalent and their relationships to mental health among 119 BWLWH [age = 44.1 (standard deviation = 10.9)]. Questionnaires measured resilience (post-traumatic growth, trait/coping resilience, religious coping, social support), adversity (discrimination, trauma, microaggressions), and mental health [post-traumatic stress disorder (PTSD) symptoms, post-traumatic cognitions (PTC), and depressive symptoms]. Four salient profiles emerged through latent profile analysis and mental health differences were evaluated. Profile 1 (19.8%) reported lowest scores on 4 resilience measures, lowest traumas, and second lowest on discrimination (low resilience/low adversity-LR/LA). Profile 2 (13.8%) had second lowest on 3 resilience measures but second highest social support, highest/second highest on traumas and discrimination and microaggressions (low resilience/high adversity-LR/HA). Profile 3 (59.5%) exhibited higher scores on resilience and lowest scores on 3 of 4 adversity measures (high resilience/low adversity-HR/LA). Profile 4 (6.9%) reported high on 3 resilience measures, but third lowest on social support, and second highest/highest traumas, discrimination, and microaggressions (high resilience/high adversity-HR/HA). For PTC, the HR/LA group had significantly lower scores compared with the LR/LA and LR/HA groups; and LR/HA had higher PTC scores than the HR/HA group. PTSD scores were significantly lower for HR/LA than all profiles. Depression scores were significantly higher for LR/LA and LR/HA groups than HR/LA. Findings indicate that lower adversity alongside higher resilience leads to better mental health. Policies must address intersectional discrimination and prevent trauma impacting BWLWH; interventions are needed to improve social support and healing. Clinical Trial Registration number NCT02764853.
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Affiliation(s)
- Devina J. Boga
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sannisha K. Dale
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Psychology, College of Arts and Sciences, University of Miami, Miami, Florida, USA
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11
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Chandler R, Guillaume D, Wells J, Hernandez N. Let Me Prep You to PREP Me: Amplifying the Voices of Black Women and Their Providers to Consider PrEP as an HIV Prevention Option. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031414. [PMID: 35162438 PMCID: PMC8835000 DOI: 10.3390/ijerph19031414] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/08/2022] [Accepted: 01/23/2022] [Indexed: 02/04/2023]
Abstract
Despite the high efficacy of pre-exposure prophylaxis (PrEP) in preventing HIV acquisition, PrEP uptake among Black cisgender women remains low. Our qualitative study assessed Black cisgender women's perspectives, attitudes, and acceptability towards PrEP, in addition to exploring PrEP-related attitudes, facilitators, and barriers to PrEP access among health care staff. This study was conducted to ascertain data to inform the development of our HIV prevention app-Savvy HER-which is being designed for Black cisgender women. Our findings indicated that Black women had low levels of PrEP acceptability and high levels of misconceptions, inaccurate knowledge, and stigma towards PrEP. Health care providers in our sample confirmed barriers of stigma, misconceptions, and knowledge among their patients coupled with difficulty accessing PrEP due to structural barriers. Our study indicated that there is a critical need to heighten Black cisgender women's PrEP knowledge and HIV risk perception in order to increase PrEP acceptability and uptake.
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Affiliation(s)
- Rasheeta Chandler
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA; (R.C.); (J.W.)
| | - Dominique Guillaume
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA; (R.C.); (J.W.)
- School of Nursing, Johns Hopkins University, Baltimore, MD 21224, USA
- Correspondence:
| | - Jessica Wells
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA; (R.C.); (J.W.)
| | - Natalie Hernandez
- Community Health and Preventative Medicine, Morehouse School of Medicine, Atlanta, GA 30310, USA;
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12
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Johnson J, Radix A, Copeland R, Chacón G. Building Racial and Gender Equity into a National PrEP Access Program. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2022; 50:55-59. [PMID: 35902091 PMCID: PMC9341199 DOI: 10.1017/jme.2022.37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Transgender and gender diverse (TGD), Black, and Latinx communities have long borne a disproportionate share of the U.S. HIV epidemic, yet these same key demographics are continually underrepresented in national PrEP prescriptions. Black, Latinx, and TGD individuals are also more likely to be uninsured, meaning that a proposed federal program to cover PrEP for people without insurance could provide significant benefit to potential PrEP users from these populations. However, coverage of PrEP costs alone will not end disparities in uptake. This commentary provides additional context and recommendations to maximize effectiveness of a national PrEP program for TGD, Black, and Latinx populations in the US.
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13
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Conley C, Johnson R, Bond K, Brem S, Salas J, Randolph S. US Black cisgender women and pre-exposure prophylaxis for human immunodeficiency virus prevention: A scoping review. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221103098. [PMID: 35699104 PMCID: PMC9201306 DOI: 10.1177/17455057221103098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/28/2022] [Accepted: 05/06/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Black cisgender women in the United States experience a disproportionate burden of human immunodeficiency virus acquisition. Pre-exposure prophylaxis is an effective oral daily medication that reduces the risk of human immunodeficiency virus through sex by 99% when taken as prescribed. However, less than 2% of eligible Black cisgender women take pre-exposure prophylaxis. The purpose of this scoping review was to describe the types of research studies done in this area, gaps in knowledge, and potential areas of research needed to increase pre-exposure prophylaxis use among Black cisgender women in the United States. METHODS We conducted our search in MEDLINE (PubMed), Embase (Elsevier), CINAHL (EBSCOhost), PsycINFO (EBSCOhost), and Scopus (Elsevier) using a combination of keywords and database-specific subject headings for the following concepts: pre-exposure prophylaxis, African American/Black or minority, and women. We used the Joanna Briggs Institute's Reviewers' Manual process for Scoping Reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews to ensure comprehensive and standardized reporting of each part of the review. RESULTS Fifty-nine studies were included in the final review. Results of the study were classified according to the three phases of the Human Immunodeficiency Virus Prevention Cascade-demand side, supply side, and adherence and retention. The majority of studies (n = 24, 41%) were cross-sectional quantitative surveys and 43 (34%) focused on the demand-side phase of the Human Immunodeficiency Virus Prevention Cascade. Fifty-eight percent of studies either assessed women's pre-exposure prophylaxis knowledge, attitudes, and intentions to use, or assessed perceived barriers and facilitators. Seven studies (12%) tested pre-exposure prophylaxis uptake and adherence among Black cisgender women. CONCLUSION This review found multiple missed opportunities to increase women's demand for pre-exposure prophylaxis and health care provider screening and referral for pre-exposure prophylaxis. Additional studies are needed to effectively assess pre-exposure prophylaxis uptake and adherence among Black cisgender women.
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Affiliation(s)
| | | | - Keosha Bond
- City University of New York School of
Medicine, New York, NY, USA
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Turnbull I, Taylor D, Beatty A, Trimble J, Cabrera E. The Evolution of Dignity: An Intervention Model to Engage and Retain HIV-Positive Black Women in Care. JOURNAL OF HEALTHCARE, SCIENCE AND THE HUMANITIES 2021; 11:134-148. [PMID: 36818207 PMCID: PMC9930504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The Black community is currently battling two pandemics, one is HIV, and the other is COVID-19. Similarly, as with HIV, COVID-19 has shone a spotlight on our healthcare system's structural failings and revealed the disproportionate impact on the Black community, particularly Black women. Black women accounted for the largest proportion of new HIV diagnoses (58 %) among all women in 2018 and represented about one-quarter of new HIV diagnoses among all Black Americans. Additionally, Black women's exposure to an abundance of misinformation about the COVID-19 infection resulted in an increased risk of complications and death from the COVID-19 virus compared to other racial and ethnic groups. Factors that increase HIV transmission risks for Black women include living in poverty, intimate partner violence, and stigma associated with HIV. Moreover, environmental, physical, cultural, financial, social, and psychological barriers are identified as unique challenges for this population's cohort. After being diagnosed with HIV, Black often were unable to access quality HIV care. Access and retention in care are tantamount to the overall well-being of women who are HIV positive. Frequently healthcare providers may attempt to engage and retain patients using only clinical measures. Our non-clinical intervention, The Evolution of Dignity, supports medical outcomes by creating a process that empowers women to motivate themselves toward improved health outcomes while ensuring their engagement and retention in care. Thus, by implementing our comprehensive intervention, all of the necessary elements contributing and promoting improved service utilization and medical adherence are integrated.
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Affiliation(s)
- Ivy Turnbull
- Deputy Executive Director, AIDS Alliance for Children Youth & Families, 1627 Eye St. NW, Suite 835, Washington, DC 20006, Chair, National Black Women's HIV/AIDS Network, Inc, 1813 Laurel Street, Columbia, SC 29201-2626, Tel: 202-754-1858,
| | - Deane Taylor
- Member, Advisory Board, AIDS Alliance for Women, Infants, Children, Youth & Families, 1627 Eye St. NW, Suite 835, Washington, DC 20006, Tel: 312-498-8629,
| | - Alicia Beatty
- Member, Advisory Board, AIDS Alliance for Women, Infants, Children, Youth & Families, 1627 Eye St. NW, Suite 835, Washington, DC 20006, Tel:215-704-7380,
| | - June Trimble
- 1525 Kentucky Avenue, Lancaster, TX 75134, Tel: 469-664-2117,
| | - Elizabeth Cabrera
- Member, Advisory Board, AIDS Alliance for Women, Infants, Children, Youth & Families, 1627 Eye St. NW, Suite 835, Washington, DC 20006, Tel: 469-569-0160,
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