Observational "go-alongs" of follow-up HIV care visits of two virally suppressed Black sexual minority men

"I Don't Feel Judged, I Don't Feel Less of a Person" - Engaged and Supportive Providers in the HIV Care Experiences of Black Sexual Minority Men Living with HIV

Background

Black sexual minority men (BSMM) in the Southern region of the United States experience a disproportionate burden of HIV. Research findings suggest that having supportive patient-provider relationships are critical for sustained HIV care engagement. The present study explores the role of supportive healthcare providers in the care engagement among BSMM living with HIV (BSMM+) in the US South.

Methods

Semi-structured qualitative interviews were conducted with BSMM+ in Texas (n=27) to explore perceived barriers and facilitators of sustained care engagement. Interviews lasted 60 minutes on average, were transcribed, coded, and analyzed using applied thematic analysis.

Findings

Participants described how important having relationships with engaged and supportive HIV care and service providers is to sustained engagement in care and positive HIV clinical outcomes. Supportive providers were characterized as non-judgmental, meeting patients' needs, and making patients feel "seen". Less supportive providers were described as making their patients "feel like a number" and having lack of follow through on proposed support and resources. Supportive providers were associated with increased care engagement of their patients while less supportive providers often led to patients switching providers, losing touch with services, and getting off track with their care.

Discussion

We found that among BSMM+ an important facilitator of sustained care engagement was having positive, affirming, and knowledgeable healthcare providers, while negative and dismissive experiences with providers was a notable barrier to care engagement. This work highlights the need for a scale up of comprehensive, ongoing trainings in patient-centered and person-first communication for providers. Further, manageable provider caseloads can facilitate more thorough patient interactions where tailored HIV care and education can be provided in a safe and non-judgmental environment.

A Principal Investigator as a PrEP-Using Peer Change Agent for HIV Prevention among Black Gay and Bisexual Men: An Autoethnography

HIV pre-exposure prophylaxis (PrEP) use remains suboptimal among Black gay and bisexual men (GBM). Multilevel factors such as medication costs, intersectional stigma, patient-clinician communication, medical mistrust, side effect concerns, and low perceived HIV risk (PHR) are well-established PrEP initiation barriers for this group. Peer change agents (PCAs) are culturally congruent interventionists who can circumvent multilevel PrEP barriers among Black GBM. I led an intervention as a PrEP-using PCA to improve PHR and PrEP willingness among 69 Black GBM from 2019-2022 and conducted an autoethnography to better understand multilevel barriers and identify the personal/professional challenges of being an in-group HIV interventionist serving Black SMM. Findings provide novel perspectives regarding PrEP barriers, the role of cultural homophily in behavior change interventions, and how interpersonal dynamics can impact staff fatigue, protocol fidelity, and research participation. Recommendations to prepare and support culturally congruent research staff are also provided.

The innovative use of qualitative and mixed methods research to advance improvements along the HIV prevention and care continua

PURPOSE OF REVIEW

Despite enormous advances in prevention and care modalities, HIV continues to burden populations around the globe and is largely driven by social and behavioral processes. Mixed methods and qualitative research endeavors are best suited to uncovering and making sense of these dynamics, producing unique and actionable findings to alleviate the burden of HIV. We reviewed the global literature published on PubMed from 2020 to 2021 to identify studies that produced new insights into the social and behavioral dynamics that drive the HIV epidemic, focusing on mixed methods or purely qualitative study designs.

RECENT FINDINGS

Mixed methods and qualitative studies have revealed important nuances in the social and behavioral dynamics associated with the HIV prevention and care continua, from preexposure prophylaxis uptake and adherence to engagement in HIV care and treatment, and have important implications for attaining goals for controlling the epidemic.

SUMMARY

Articles reviewed contribute to advancing our understanding of complex social dynamics, structural level factors such as healthcare systems and policy, as well as the research endeavor itself and the need to diversify and sustain research to truly represent the perspectives of those most impacted by HIV. Numerous studies represent the unique ability of qualitative and mixed methods research to expand our understanding of and empathy for individuals living with and affected by HIV, offering new insights to help alleviate the burden of HIV.