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Burns PA, Klukas E, Sims-Gomillia C, Omondi A, Bender M, Poteat T. As Much As I Can - Utilizing Immersive Theatre to Reduce HIV-Related Stigma and Discrimination Toward Black Sexual Minority Men. Community Health Equity Res Policy 2024; 44:151-163. [PMID: 36189845 DOI: 10.1177/0272684x221115920] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Despite advances in biomedical HIV prevention modalities such as pre-exposure prophylaxis to prevent the transmission of HIV, racial/ethnic and sexual/gender minority populations are disproportionately impacted by HIV epidemic. Alarming rates of HIV have persisted among Black gay and bisexual men, particularly in Southern states. METHODS Utilizing data from the ViiV ACCELERATE! initiative, we explored the impact of As Much As I Can, an immersive theatre production, on HIV-related stigma behaviors. A self-administered post-performance survey was conducted with a cohort (n = 322) of randomly selected audience members. RESULTS Overall, the results showed participants had a highly favorable experience, rating the performance with a mean score of 9.77/10. Respondents indicated they intended to change behaviors to promote HIV prevention education and to reduce stigma and discrimination including: (1) Say something if I hear stigmatizing language against people living with HIV (75.4%), (2) Say something if I hear anti-gay language (69.7%) and (3) Tell others about HIV prevention options (e.g., PrEP, PEP, condoms (64.1%). The findings show there is an association between HIV-related behavior intention and linkage to HIV care. Respondents who reported they were more likely to say something about HIV stigma were almost three times (O.R. 2.77; 95% C.I. 0.98-7.8) more likely to indicate they would follow up with a healthcare professional. CONCLUSIONS This study suggests that immersive theatre is an effective method for communicating HIV prevention education and reducing HIV-related structural stigma and discrimination that increases HIV vulnerability for Black sexual minority men.
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Affiliation(s)
- Paul A Burns
- John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Courtney Sims-Gomillia
- John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | - Angela Omondi
- John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | - Melverta Bender
- Mississippi State Department of Health/Office of STD/HIV, Jackson, MS, USA
| | - Tonia Poteat
- School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC, 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Arnold T, Barnett AP, Giorlando KK, Leigland A, Sims-Gomillia C, Whiteley L, Brown LK. A Comparison of COVID-19 Vaccine and PrEP Hesitancy Among Individuals Living in Mississippi: A Qualitative Study. AIDS Behav 2023; 27:3515-3520. [PMID: 37071335 PMCID: PMC10112324 DOI: 10.1007/s10461-023-04067-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 04/19/2023]
Abstract
Mississippi (MS) trails behind other states in both pre-exposure prophylaxis (PrEP) and COVID-19 vaccine uptake. This study investigated similarities in willingness to receive the COVID-19 vaccine and use PrEP. Semi-structured interviews were conducted between April 2021 and January 2022 with 15 clinical staff and 49 PrEP-eligible patients living in MS. Reflexive thematic analysis was conducted. Overall, 51% of patients were on PrEP, and 67% received the COVID-19 vaccine. Among PrEP users, 64% had received the vaccine. Participants reported similar hesitations (efficacy, side effects, and no perceived risk) and reasons for use (health autonomy and protecting themselves and others) regarding PrEP and the COVID-19 vaccine. Taking PrEP did not increase the likelihood of getting the COVID-19 vaccine, thus engaging in one prevention behavior does not lead to engaging in other prevention behaviors. However, results indicated commonalities in hesitancy and motivators to utilize both preventive measures. Future prevention and implementation efforts can be informed by these commonalities.
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Affiliation(s)
- Trisha Arnold
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA.
- Department of Psychiatry, Rhode Island Hospital, One Hoppin Street Coro West, 204, Providence, Rhode, RI, 02903, USA.
| | - Andrew P Barnett
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA
- Department of Psychiatry, Rhode Island Hospital, One Hoppin Street Coro West, 204, Providence, Rhode, RI, 02903, USA
| | - Kayla K Giorlando
- Department of Psychiatry, Rhode Island Hospital, One Hoppin Street Coro West, 204, Providence, Rhode, RI, 02903, USA
| | - Avery Leigland
- Department of Psychiatry, Rhode Island Hospital, One Hoppin Street Coro West, 204, Providence, Rhode, RI, 02903, USA
| | - Courtney Sims-Gomillia
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Laura Whiteley
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA
| | - Larry K Brown
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA
- Department of Psychiatry, Rhode Island Hospital, One Hoppin Street Coro West, 204, Providence, Rhode, RI, 02903, USA
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Barnett AP, Arnold T, Elwy AR, Brock JB, Giorlando KK, Sims-Gomillia C, Leigland A, Whiteley L, Brown LK. Considerations for PrEP Implementation at Federally Qualified Health Centers in Mississippi: Perspectives From Staff and Patients. AIDS Educ Prev 2023; 35:309-319. [PMID: 37535326 PMCID: PMC10483574 DOI: 10.1521/aeap.2023.35.4.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Pre-exposure prophylaxis (PrEP) uptake remains low in the southeastern United States ("the South"), likely owing to overlapping structural barriers, including the lack of nearby PrEP providers. Federally qualified health centers (FQHCs) are potential sites through which to expand PrEP availability in the South, and telemedicine is promising for these services. This study investigated considerations for PrEP implementation at FQHCs and the use of telemedicine through qualitative interviews with 19 FQHC staff and 17 PrEP-eligible patients in Mississippi. Results indicated that existing infrastructure and policies at FQHCs can support PrEP implementation and that additional needed resources include more education for providers and strategies to advertise PrEP services. Findings suggest that using telemedicine for PrEP can address some regional implementation barriers (e.g., transportation problems and confidentiality concerns) but may present new ones (e.g., concerns about patients performing home HIV/STI testing procedures). Results can inform future PrEP implementation efforts in the South.
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Affiliation(s)
- Andrew P. Barnett
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, United States
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Trisha Arnold
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, United States
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - A. Rani Elwy
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - James B. Brock
- Department of Internal Medicine, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Kayla K. Giorlando
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, United States
| | - Courtney Sims-Gomillia
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Avery Leigland
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, United States
| | - Laura Whiteley
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Larry K. Brown
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, United States
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
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