Men Who Have Sex With Men and HIV Risk Behavior: Exploring the Influence of Masculinity Within the Social Ecological Model

Ending the HIV Epidemic in Black America: Qualitative Insights Following COVID-19

BACKGROUND

The disproportionate effects of the human immunodeficiency virus (HIV) and the Coronavirus 2019 (COVID-19) on Black American communities highlight structural systems rooted in racism and must be addressed with national strategies that improve both biomedicine and social determinants of health.

PURPOSE

The purpose of this study was to qualitatively examine the experiences and interpretations of experts in the HIV workforce (local, state, and national HIV-related organizations) regarding the state of HIV and COVID-19 among Black Americans.

METHODS

Within key informant interviews and a focus group recorded and transcribed verbatim, fifteen members of the HIV workforce and Black community described their experiences and provided insights to inform ending the negative outcomes resulting from HIV and COVID-19.

RESULTS

Data were analyzed using NVivo software, and eight themes emerged to address disease disproportionality through a Black lens. Themes reflected (1) accessing information and care; (2) key potential partners/stakeholders; (3) investing in Black communities; (4) governmental support; (5) increasing engagement and advocacy; (6) HIV-related community conversations; (7) developments since COVID-19; and (8) the Ending the HIV Epidemic (EHE) trajectory.

CONCLUSIONS

Themes directly speak to recommendations to adjust education and policy strategies for HIV and COVID-19 prevention and intervention. Such recommendations, (1) amplifying Black voices, (2) investing sustainable dollars into Black communities, and (3) leaning into advocacy, can bolster the foundation for the HIV workforce and Black community to break ineffective response patterns and lead the fight against these systemic issues of inequity.

Facilitators and Barriers to Pre-Exposure Prophylaxis Uptake Willingness for Full-Service Sex Workers: A Social-Ecological Approach

Full-service sex workers (FSSWs) are at heightened risk of contracting HIV due to facing multi-level challenges to sexual health. This study investigated factors associated with willingness to use Pre-Exposure Prophylaxis (PrEP) - a daily HIV preventative medication, among FSSWs. Using social-ecological theory, an online survey was developed with initial guidance from a local sex worker advocacy organization to assess barriers and facilitators to PrEP uptake willingness. The survey was disseminated with the assistance of local and national sex work advocacy organizations. In our sample of FSSWs (n=83), two barriers and two facilitators initially were associated with PrEP uptake. However, in adopting a more conservative analysis, only anticipating stigmatizing disapproval from others for using PrEP and providing others with PrEP knowledge maintained statistical significance. These two variables collectively explained nearly 30% of the variance in PrEP uptake willingness. Implications for both future research and clinical work with FSSWs are discussed.

Medical-Legal Partnerships: a promising approach for addressing health-harming legal needs among people with HIV

Introduction

People with HIV (PWH), particularly those at the intersection of sexual and gender identities, face enduring obstacles to accessing HIV care, including structural stigma, structural racism and discrimination, housing instability, and limited access to health insurance. To address these challenges, Medical-Legal Partnerships (MLPs) in HIV care offer an innovative approach that integrates medical and legal services. By targeting health-harming legal needs (HHLN), MLPs aim to enhance the HIV care continuum outcomes for PWH.

Methods

This study examines the benefits and challenges of MLPs within organizations serving PWH through the social-ecological model. MLP providers (n=111) identified organizational-level challenges such as funding limitations, resource integration issues, and staffing constraints.

Results

MLPs demonstrated numerous benefits, including patient impact and benefits, comprehensive service provision, enhanced staff support and capacity, and potential for policy influence.

Discussion

These results underscore the feasibility of MLPs while offering valuable insights into their efficacy and challenges, guiding the implementation of MLPs to address health-harming legal needs, including discrimination, and thereby improving HIV care outcomes.

Multifaceted Determinants of Sexual Intercourse with Non-Regular Female Sex Partners and Female Sex Workers among Male Factory Workers in China-A Cross-Sectional Survey

With a stratified multi-stage sampling approach, 1361 male factory workers in the Longhua district of the Shenzhen Municipality of China were selected to investigate the multifaceted determinants of sexual intercourse with non-regular female sex partners (NRP) and female sex workers (FSW) among them. The results showed that 24.5% and 21.2% of participants had sexual intercourse with NRP and FSW in the past 6 months, respectively. More specifically, at the individual level, perceived higher job stress and maladaptive coping styles were linked with a higher likelihood of having sexual intercourse with NRP and FSW (adjusted odds ratios [AOR] ranged from 1.06 to 1.17). At the interpersonal level, those who had higher exposure to information related to sexual intercourse with NRP or FSW were more likely to have sex with these female sex partners (AOR: 1.08 & 1.11). At the social structural level, perceived social norms supporting multiple sex partnerships were linked with a higher likelihood of having sexual intercourse with NRP and FSW (AOR: 1.10 & 1.11). No interaction effects were found between the variables at different levels. Providing pre-employment training to clarify roles and job duties, introducing adaptive coping strategies, and addressing misconceptions of social norms are useful strategies to reduce sexual intercourse with NRP or FSW.