Addressing epistemic injustice in HIV research: a call for reporting guidelines on meaningful community engagement

The Tulumbe! Partnership: a case study in developing a community-led research agenda to address HIV among African immigrants in the United States

Grassroots, community organizations are trusted resources within communities, which puts them in an ideal position to effectively engage individuals impacted by health inequities in defining meaningful research priorities. A community-centered approach to HIV research is critical for African immigrants living in the United States, who experience stigma and other socio-structural barriers to HIV prevention, care, and research engagement. Supporting community organizations with financial resources and capacity building activities to lead the development of research agendas ensures better alignment with community interests and fosters sustainability. We developed a community-initiated and -led research engagement project-Tulumbe!, which prioritized community leadership in all project activities. Community forums, health care provider and community questionnaires, interviews, and report-back sessions were held to examine the research interests and health concerns voiced by African immigrants. The iterative, community-led engagement process of more than 200 African immigrants, health providers, and researchers resulted in a community-defined research agenda with six areas of focus: family communication; self-efficacy for African immigrant women; deconstructing masculinity for African immigrant men; sexual health education for African immigrant youth; HIV stigma; and health literacy. Time, resources, and flexibility are needed to develop a viable community-led research partnership. Investing in community leadership not only produced a patient-centered research agenda but also led to community ownership of the process and results; thus, all partners were committed to sustaining the work.

Reported community engagement in health equity research published in high-impact medical journals: a scoping review

OBJECTIVE

To assess reported community engagement in the design and conduct of health equity-focused articles published in high-impact journals.

DESIGN

Scoping review follows guidance from the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist.

DATA SOURCES

We selected the three highest-ranked journals from the 'Medicine-General and Internal' category including the Journal of the American Medical Association (JAMA), The Lancet and The New England Journal of Medicine (NEJM) along with all journals under their family of subspecialty journals (JAMA Network, The Lancet Group and the NEJM Group). Ovid MEDLINE was searched between 1 January 2021 to 22 September 2022.

ELIGIBILITY CRITERIA

We included health equity-focused articles and assessed for the reporting of community engagement at each stage of the research process.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted data from articles that met the inclusionary criteria. Inter-rater reliability was assessed using Cohen's kappa to measure the agreement between two independent reviewers. Disagreements were adjudicated by a third independent reviewer.

RESULTS

7616 articles were screened, 626 (8.2%) met our inclusion criteria: 457 (3.8%) were published by the JAMA Network; 167 (2.4%) by The Lancet Group; and 2 (0.2%) by the NEJM group. Most articles were from USA (68.4%) and focused on adult populations (57.7%). The majority of the articles focused on the topic of race/ethnicity (n=176, 28.1%), socioeconomic status (n=114, 18.2%) or multiple equity topics (n=111, 17.7%). The use of community engagement approaches was reported in 97 (15.5%) articles, of which 13 articles (13.4%) reported engagement at all stages. The most common form of reported engagement was in the acknowledgement or additional contribution section (n=86, 88.7%).

CONCLUSIONS

Community engagement is infrequently reported in health equity-focused research published in high-impact medical journals.

Overview of the US National HIV Strategy and Ending the HIV Epidemic Initiative

The US National HIV/AIDS Strategy (NHAS) is a comprehensive plan that outlines specific goals for Ending the HIV Epidemic in the United States (EHE) by 2025. The strategy also provides specific strategies to prevent new HIV infections and improve health outcomes for people with HIV. The EHE is a companion document which focuses on achieving the goals of the NHAS in specific US jurisdictions where the HIV epidemic is concentrated. This article provides an overview of the NHAS and EHE and provides examples of programs and strategies that can be used to end the HIV epidemic in the United States.

Navigating HIV-Related Stigma in Switzerland: A Qualitative Study

Objectives: This study sought to understand how people living with HIV experience, perceive, and navigate stigma in their everyday life and in care settings in an urban French-speaking area in Switzerland. Methods: Semi-structured interviews were carried out with 19 people living with HIV in Lausanne concerning their experience of HIV-related stigma in both everyday life and in healthcare settings. Content analysis was performed to identify main and sub-themes. Results: "Living with HIV" posed little or no difficulty for participants. However, the burden of anticipated and internalized HIV-related stigma played a disproportionately large role in their lives. Participants considered the general population's low level of knowledge about HIV as problematic in this regard. While participants reported few examples of enacted stigma generally, healthcare environments were sometimes experienced as sites of prejudice and discrimination. However, some healthcare professionals were also sources of information and knowledge, contributing to participants' "journeys of self-acceptance." Conclusion: Even in an urban environment in a country with ready access to healthcare and education, HIV-related stigma remains a concern for people living with HIV.