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Lutete P, Matthews DW, Sabounchi NS, Paige MQ, Lounsbury DW, Rodriguez N, Echevarria N, Usher D, Walker JJ, Dickerson A, Hillesheim J, Frye V. Intersectional Stigma and Prevention Among Gay, Bisexual, and Same Gender-Loving Men in New York City, 2020: System Dynamics Models. Am J Public Health 2022; 112:S444-S451. [PMID: 35763732 PMCID: PMC9241454 DOI: 10.2105/ajph.2022.306725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2022] [Indexed: 11/04/2022]
Abstract
Objectives. To create causal loop diagrams that characterize intersectional stigma experiences among Black, gay, bisexual, same gender-loving, and other men who have sex with men and to identify intervention targets to reduce stigma and increase testing and prevention access. Methods. Between January and July 2020, we conducted focus groups and in-depth interviews with 80 expert informants in New York City, which were transcribed, coded, and analyzed. These qualitative insights were developed iteratively, visualized, and validated in a causal loop diagram (CLD) using Vensim software. Results. The CLD revealed 3 key feedback loops-medical mistrust and HIV transmission, serosorting and marginalization of Black and gay individuals, and family support and internalized homophobia-that contribute to intersectional HIV and related stigmas, homophobia, and systemic racism. On the basis of these results, we designed 2 novel intervention components to integrate into an existing community-level anti-HIV stigma and homophobia intervention. Conclusions. HIV stigma, systemic racism, and homophobia work via feedback loops to reduce access to and uptake of HIV testing, prevention, and treatment. Public Health Implications. The CLD method yielded unique insights into reciprocal feedback structures that, if broken, could interrupt stigmatization and discrimination cycles that impede testing and prevention uptake. (Am J Public Health. 2022;112(S4):S444-S451. https://doi.org/10.2105/AJPH.2022.306725).
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Affiliation(s)
- Priscila Lutete
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
| | - David W Matthews
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
| | - Nasim S Sabounchi
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
| | - Mark Q Paige
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
| | - David W Lounsbury
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
| | - Noah Rodriguez
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
| | - Natalie Echevarria
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
| | - DaShawn Usher
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
| | - Julian J Walker
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
| | - Alexis Dickerson
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
| | - Joseph Hillesheim
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
| | - Victoria Frye
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
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Mathews A, Farley S, Conserve DF, Knight K, Le'Marus A, Blumberg M, Rennie S, Tucker J. "Meet people where they are": a qualitative study of community barriers and facilitators to HIV testing and HIV self-testing among African Americans in urban and rural areas in North Carolina. BMC Public Health 2020; 20:494. [PMID: 32295568 PMCID: PMC7161271 DOI: 10.1186/s12889-020-08582-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 03/25/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND HIV testing programs in the United States aim to reach ethnic minority populations who experience high incidence of HIV, yet 40% of African Americans have never been tested for HIV. The objective of this study is to identify community-based strategies to increase testing among African Americans in both urban and rural areas. METHODS This study conducted focus group discussions (FGDs) informed by community-based participatory research principles to examine African American's concerns and ideas around HIV testing and HIV self-testing. Participants included highly affected (i.e., PLWH, MSM, PWID, low-income, teens and young adults) populations from African American communities in North Carolina, aged 15 years and older. We digitally transcribed and analyzed qualitative data using MAXQDA and axial coding to identify emergent themes. RESULTS Fifty-two men and women between 15 to 60 years old living in urban (n=41) and rural (n=11) areas of North Carolina participated in focus group discussions. HIV testing barriers differed by HIV testing setting: facility-based, community-based, and HIV self-testing. In community-based settings, barriers included confidentiality concerns. In facility-based settings (e.g., clinics), barriers included negative treatment by healthcare workers. With HIV self-testing, barriers included improper use of self-testing kits and lack of post-test support. HIV testing facilitators included partnering with community leaders, decentralizing testing beyond facility-based sites, and protecting confidentiality. CONCLUSIONS Findings suggest that HIV testing concerns among African Americans vary by HIV testing setting. African Americans may be willing to test for HIV at community events in public locations if client confidentiality is preserved and use HIV self-testing kits in private if post-test social support and services are provided. These community-identified facilitators may improve African American testing rates and uptake of HIV self-testing kits.
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Affiliation(s)
- Allison Mathews
- Department of Social Medicine, School of Medicine, The University of North Carolina at Chapel Hill, 333 South Columbia Street, MacNider Hall, Room #348 / CB #7240, Chapel Hill, NC, 27599-7240, USA.
- Institute for Global Health and Infectious Disease, School of Medicine, The University of North Carolina at Chapel Hill, 333 South Columbia Street, MacNider Hall, Room #348 / CB #7240, Chapel Hill, NC, 27599-7240, USA.
| | - Samantha Farley
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Donaldson F Conserve
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, The University of South Carolina, Columbia, SC, USA
| | - Kimberly Knight
- Institute for Global Health and Infectious Disease, School of Medicine, The University of North Carolina at Chapel Hill, 333 South Columbia Street, MacNider Hall, Room #348 / CB #7240, Chapel Hill, NC, 27599-7240, USA
| | - Alston Le'Marus
- Department of Clinical Psychology, Fielding Graduate University, Santa Barbara, CA, USA
| | - Meredith Blumberg
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stuart Rennie
- Department of Social Medicine, School of Medicine, The University of North Carolina at Chapel Hill, 333 South Columbia Street, MacNider Hall, Room #348 / CB #7240, Chapel Hill, NC, 27599-7240, USA
| | - Joseph Tucker
- Institute for Global Health and Infectious Disease, School of Medicine, The University of North Carolina at Chapel Hill, 333 South Columbia Street, MacNider Hall, Room #348 / CB #7240, Chapel Hill, NC, 27599-7240, USA
- London School of Hygiene & Tropical Medicine, London, UK
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