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Kacanek D, Yee LM, Yao TJ, Lee J, Chadwick EG, Williams PL, Barr EA, Berman CA, Davtyan M, DiPerna A, Flores A, Green J, Haddad LB, Hyzy L, Jacobson DL, James-Todd T, Jao J, Khadraoui A, Malee KM, Moscicki AB, Patel K, Robinson LG, Salomon L, Sanders K, Siminski S, Smith RA, Wolbach T, Powis KM. Health Outcomes around Pregnancy and Exposure to HIV/Antiretrovirals (HOPE) study protocol: a prospective observational cohort study of reproductive-aged women living with HIV. BMJ Open 2024; 14:e084835. [PMID: 38969382 PMCID: PMC11228391 DOI: 10.1136/bmjopen-2024-084835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2024] Open
Abstract
INTRODUCTION Over 265 000 women are living with HIV in the USA, but limited research has investigated the physical, mental and behavioural health outcomes among women living with HIV of reproductive age. Health status during the reproductive years before, during and after pregnancy affects pregnancy outcomes and long-term health. Understanding health outcomes among women living with HIV of reproductive age is of substantial public health importance, regardless of whether they experience pregnancy. The Health Outcomes around Pregnancy and Exposure to HIV/Antiretrovirals (HOPE) study is a prospective observational cohort study designed to investigate physical and mental health outcomes of young women living with HIV as they age, including HIV disease course, engagement in care, reproductive health and choices and cardiometabolic health. We describe the HOPE study design, and characteristics of the first 437 participants enrolled as of 1 January 2024. METHODS AND ANALYSIS The HOPE study seeks to enrol and follow 1630 women living with HIV of reproductive age, including those with perinatally-acquired HIV, at 12 clinical sites across 9 US states and Puerto Rico. HOPE studies multilevel dynamic determinants influencing physical, mental and social well-being and behaviours of women living with HIV across the reproductive life course (preconception, pregnancy, post partum, not or never-pregnant), informed by the socioecological model. Key research areas include the clinical course of HIV, relationship of HIV and antiretroviral medications to reproductive health, pregnancy outcomes and comorbidities and the influence of racism and social determinants of health. HOPE began enrolling in April 2022. ETHICS AND DISSEMINATION The HOPE study received approval from the Harvard Longwood Campus Institutional Review Board, the single institutional review board of record for all HOPE sites. Results will be disseminated through conference presentations, peer-reviewed journals and lay summaries.
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Affiliation(s)
- Deborah Kacanek
- Center for Biostatistics in AIDS Research, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Lynn M Yee
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tzy-Jyun Yao
- Center for Biostatistics in AIDS Research, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Jessica Lee
- Center for Biostatistics in AIDS Research, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Ellen G Chadwick
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Paige L Williams
- Departments of Epidemiology and Biostatistics, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Emily A Barr
- The University of Texas Health Science Center at Houston Cizik School of Nursing, Houston, Texas, USA
| | - Claire A Berman
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Mariam Davtyan
- Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Alex DiPerna
- Frontier Science Foundation, Amherst, New York, USA
| | - Amanda Flores
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Lisa B Haddad
- Population Council Center for Biomedical Research, New York City, New York, USA
| | - Laurie Hyzy
- Frontier Science Foundation, Amherst, New York, USA
| | - Denise L Jacobson
- Center for Biostatistics in AIDS Research, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Tamarra James-Todd
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Jennifer Jao
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anisa Khadraoui
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Kathleen M Malee
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Kunjal Patel
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Lisa-Gaye Robinson
- Broward Health, Children's Diagnostic and Treatment Center, Fort Lauderdale, Florida, USA
| | - Liz Salomon
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | | | | | - Renee A Smith
- Department of Pediatrics, University of Illinois Chicago, Chicago, Illinois, USA
| | | | - Kathleen M Powis
- Departments of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Immunology and Infectious Disease, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
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Raiford JL, DiNenno E, Beer L, Bowman S, Johnson Lyons S, Anderson SKE, Powell N, Nickson R, Hall G, Neblett Fanfair R. CDC Prioritizes HIV Prevention and Treatment to Reduce HIV Disparities Among Cis-Gender Black Women. J Womens Health (Larchmt) 2024. [PMID: 38968401 DOI: 10.1089/jwh.2024.0472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024] Open
Abstract
To succeed in ending the HIV epidemic in the United States, the Centers for Disease Control and Prevention (CDC) focuses on delivering combinations of scientifically proven, cost-effective, and scalable interventions to priority populations. Systemic factors continue to contribute to persistent health disparities and disproportionately higher rates of HIV diagnosis in some communities. The National HIV/AIDS Strategy has designated cis-gender Black women (CgBW) as a priority population to address the racial and ethnic inequities in HIV. This report presents the portfolio of projects, programs, and initiatives funded by the CDC's Division of HIV Prevention (DHP) to address disparities in HIV and improve health and QOL among CgBW. These funded activities include the development, planning, and implementation of HIV prevention programs, mass media campaigns, and behavioral interventions focused on CgBW. This report also summarizes DHP's community engagement, capacity building, and partnership efforts, and highlights research and surveillance activities focusing on CgBW. Finally, this report outlines future directions for CDC's efforts to improve access to HIV testing, treatment, and prevention for CgBW in the United States.
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Affiliation(s)
- Jerris L Raiford
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth DiNenno
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Linda Beer
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sloane Bowman
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shacara Johnson Lyons
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stefanie K E Anderson
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nakesha Powell
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rhondette Nickson
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Grace Hall
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Robyn Neblett Fanfair
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Chuku CC, Silva MF, Lee JS, Reid R, Lazarus K, Carrico AW, Dale SK. A network analysis of positive psychosocial factors and indication of suboptimal HIV care outcomes among Black women living with HIV. AIDS Care 2024:1-14. [PMID: 38958126 DOI: 10.1080/09540121.2024.2372714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/21/2024] [Indexed: 07/04/2024]
Abstract
Black women living with HIV (BWLWH) face barriers that impact health outcomes. However, positive psychosocial indicators may influence HIV care outcomes. Among this cross-sectional study of 119 BWLWH, a network analysis was utilized to examine relationships between positive psychosocial factors and HIV-related health outcomes. A preliminary polychoric analysis was conducted to examine correlations between the variables, and the network analyzed connections between resilience, self-efficacy, self-esteem, perceived social support, religious coping, post-traumatic growth, and an indicator variable for suboptimal HIV care outcomes (low medication adherence, detectable viral load, and missed HIV-related health visits) and determined the centrality measures within the network. Seven significant associations were found among the factors: self-efficacy and self-esteem, post-traumatic growth and resilience, post-traumatic growth and self-efficacy, post-traumatic growth and religious coping, perceived social support and resilience, self-esteem and resilience, self-esteem and perceived social support (bootstrapped 95% CI did not contain zero). Self-efficacy was the strongest indicator associated with the other factors. Although not statistically significant, the indicator for suboptimal HIV care outcomes was negatively associated with perceived social support and religious coping. Future interventions incorporating self-efficacy may be beneficial to the overall well-being of Black women.
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Affiliation(s)
- Chika Christle Chuku
- Department of Public Health, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Health Promotion and Disease Prevention, Florida International University, Miami, FL, USA
| | - Maria F Silva
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Jasper S Lee
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Rachelle Reid
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Kimberly Lazarus
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Adam W Carrico
- Department of Health Promotion and Disease Prevention, Florida International University, Miami, FL, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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Patel D, Beer L, Yuan X, Tie Y, Baugher AR, Jeffries WL, Dailey A, Henny KD. Explaining racial and ethnic disparities in antiretroviral therapy adherence and viral suppression among U.S. men who have sex with men. AIDS 2024; 38:1073-1080. [PMID: 38418843 PMCID: PMC11063929 DOI: 10.1097/qad.0000000000003860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To identify factors - including social determinants of health (SDOH) - that explain racial/ethnic disparities in antiretroviral therapy (ART) adherence and sustained viral suppression (SVS) among U.S. men who have sex with men (MSM) with HIV. DESIGN We used weighted data from 2017-2021 cycles of the Medical Monitoring Project. METHODS Among MSM taking ART, we calculated prevalence differences (PDs) with 95% confidence intervals (CIs) of ART adherence (100% ART adherence, past 30 days) and SVS (all viral loads in past 12 months <200 copies/ml or undetectable) for Black MSM (BMSM) and Hispanic/Latino MSM (HMSM) compared with White MSM (WMSM). Using forward stepwise selection, we calculated adjusted PDs with 95% CIs to examine if controlling for selected variables reduced PDs. RESULTS After adjusting for age, any unmet service need, federal poverty level (FPL), food insecurity, homelessness, time since HIV diagnosis, gap in health coverage, and education, the BMSM/WMSM PD for ART adherence reduced from -16.9 to -8.2 (51.5%). For SVS, the BMSM/WMSM PD reduced from -8.3 to -3.6 (56.6%) after adjusting for ART adherence, age, homelessness, food insecurity, gap in health coverage, FPL, any unmet service need, time since diagnosis, and ER visit(s). The HMSM/WMSM PD for ART adherence reduced from -9.3 to -2.9 (68.8%) after adjusting for age and FPL. The unadjusted HMSM/WMSM PD for SVS was not statistically significant. CONCLUSIONS Adjusting for SDOH and other factors greatly reduced racial/ethnic disparities in ART adherence and SVS. Addressing these factors - particularly among BMSM - could substantially improve health equity among MSM with HIV.
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Affiliation(s)
- Deesha Patel
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Linda Beer
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Xin Yuan
- DLH Corporation, Atlanta, GA, USA
| | - Yunfeng Tie
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Amy R Baugher
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - William L Jeffries
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Andre Dailey
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Kirk D Henny
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
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Ezell JM. The Health Disparities Research Industrial Complex. Soc Sci Med 2024; 351:116251. [PMID: 37865583 DOI: 10.1016/j.socscimed.2023.116251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/14/2023] [Indexed: 10/23/2023]
Abstract
Research focused on health disparities-whether relating to one's race/ethnicity, gender expression, sexual orientation, citizenship status, income level, etc.-constitutes a large, generative, and highly profitable portion of scholarship in academic, clinical, and government settings. Health disparities research is expressed as a means of bringing greater attention to, and ultimately addressing via evidence-based implementation science, acts of devaluation and oppression that have continually contributed to these inequities. Philosophies underlying health disparities research's expansive and growing presence mirror the formal logic and ethos of the Military Industrial Complex and the Prison Industrial Complex. The "Health Disparities Research Industrial Complex," operationalized in this article, represents a novel mutation and extension of these complexes, primarily being enacted through these three mechanisms: 1) The construction and maintenance of beliefs, behaviors, and policies in healthcare, and society more broadly, that create and sustain disadvantages in minority health; 2) the creation and funding of research positions that inordinately provide non-minoritized people and those without relevant lived experiences the ability to study health disparities as "health equity tourists"; and 3) the production of health disparities research that, due to factors one and two, is incapable of fully addressing the disparities. In this piece, these and other core elements of the Health Disparities Research Industrial Complex, and the research bubble that it has produced, are discussed. Additionally, strategies for reducing the footprint and impact of the Health Disparities Research Industrial Complex and better facilitating opportunities for meaningful implementation in the field are presented.
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Affiliation(s)
- Jerel M Ezell
- Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, CA, USA; Berkeley Center for Cultural Humility, University of California Berkeley, Berkeley, CA, USA.
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Endalamaw A, Gilks CF, Ambaw F, Assefa Y. Equity in HIV/AIDS services requires optimization of mainstreaming sectors in Ethiopia. BMC Public Health 2024; 24:1477. [PMID: 38824520 PMCID: PMC11144345 DOI: 10.1186/s12889-024-19016-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 05/30/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Mainstreaming HIV and AIDS across sectors is crucial to close the disparities in service provision and coverage. However, evidence has shown that certain social groups are left behind in receiving HIV/AIDS services. The objective of this study was twofold: to understand the reasons behind the existing inequities and to explore challenges of equity in HIV/AIDS services in the Amhara region of Ethiopia. METHODS Twenty-two adults (aged 26-57 years) from eighteen sectors that are mainstreaming HIV and AIDS were purposefully selected until the point of saturation and participated in a semi-structured in-depth interview conducted between January 20 and February 17, 2023. Interviewees were asked to describe their mainstreaming experiences in equitable HIV/AIDS services, reflect on the challenges and barriers that impede equitable service provision, or explain the reasons behind the existence of inequity in HIV/AIDS services. The interviews were audio recorded, transcribed, translated, and iteratively analysed, with early analysis informing subsequent interviews. An inductive-reflexive thematic analysis was conducted, whereby themes and subthemes were identified, and the relationships between subthemes and patterns were critically reviewed. RESULTS The challenges to equitable HIV/AIDS service provision were grouped into eight thematic areas: (1) changing contexts that shifts public and government attention to emerging diseases, war and political instability, and poverty; (2) leadership-related, such as the lack of supervision and monitoring, not politicising HIV/AIDS (not providing political attention to HIV/AIDS) and weak intersectoral collaboration; (3) financial constraints due to a random budgeting and contract interruption with non-governmental organisations (NGOs); (4) lack of resources due to scarcity and unfair distribution; (5) inadequate skilled personnel due to inadequate numbers and lack of continuous professional and career development; (6) lack of equity-related evidence-based tools and guidelines; (7) inadequate understanding of equity due to lack of training and misunderstanding, and lack of access to equity-oriented tools and guidelines; and (8) cultural norms, values, and perceptions. CONCLUSIONS This study identified critical challenges faced in the equitable HIV/AIDS services provision. To achieve equity in HIV/AIDS services, mainstreaming sectors need to invest in mechanisms to sustain services in emergency situations; identify effective leaders to maintain collaboration, monitoring, and evaluation; institutionalise responsive budgeting and establish alternative funds to maintain non-governmental organisations initiatives; provide continuous up-to-date training and create a common evidence-sharing platform; implement proper recruitment, education, and professional development of HIV/AIDS focal persons; and promote and practice culturally safe care. It is, therefore, essential to optimise sectors that are mainstreaming HIV/AIDS and incorporate equity considerations in their strategic plans and working guidelines.
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Affiliation(s)
- Aklilu Endalamaw
- School of Public Health, The University of Queensland, Brisbane, Australia.
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Charles F Gilks
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Fentie Ambaw
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, Australia
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Molldrem S, Smith AKJ. Health policy counterpublics: Enacting collective resistances to US molecular HIV surveillance and cluster detection and response programs. SOCIAL STUDIES OF SCIENCE 2024; 54:451-477. [PMID: 38054426 PMCID: PMC11118791 DOI: 10.1177/03063127231211933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Health policies and the problems they constitute are deeply shaped by multiple publics. In this article we conceptualize health policy counterpublics: temporally bounded socio-political forms that aim to cultivate particular modes of conduct, generally to resist trajectories set by arms of the state. These counterpublics often emerge from existing social movements and involve varied forms of activism and advocacy. We examine a health policy counterpublic that has arisen in response to new forms of HIV public health surveillance by drawing on public documents and interview data from 2021 with 26 stakeholders who were critical of key policy developments. Since 2018, the national rollout of molecular HIV surveillance (MHS) and cluster detection and response (CDR) programs in the United States has produced sustained controversies among HIV stakeholders, including among organized networks of people living with HIV. This article focuses on how a health policy counterpublic formed around MHS/CDR and how constituents problematized the policy agenda set in motion by federal health agencies, including in relation to data ethics, the meaningful involvement of affected communities, informed consent, the digitization of health systems, and HIV criminalization. Although familiar problems in HIV policymaking, concerns about these issues have been reconfigured in response to the new sociotechnical milieu proffered by MHS/CDR, generating new critical positions aiming to remake public health. Critical attention to the scenes within which health policy controversies play out ought to consider how (counter)publics are made, how problems are constituted, and the broader social movement dynamics and activist resources drawn upon to contest and reimagine policymaking in public life.
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Harkness A, Giusto A, Hamilton AB, Hernandez‐Ramirez RU, Spiegelman D, Weiner BJ, Beidas RS, Larson ME, Lippman SA, Wainberg ML, Smith JD. Navigating grey areas in HIV and mental health implementation science. J Int AIDS Soc 2024; 27:e26271. [PMID: 38923301 PMCID: PMC11197965 DOI: 10.1002/jia2.26271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 04/29/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Implementation science (IS) offers methods to systematically achieve the Ending the HIV Epidemic goals in the United States, as well as the global UNAIDS targets. Federal funders such as the National Institutes of Mental Health (NIMH) have invested in implementation research to achieve these goals, including supporting the AIDS Research Centres (ARCs), which focus on high-impact science in HIV and mental health (MH). To facilitate capacity building for the HIV/MH research workforce in IS, "grey areas," or areas of IS that are confusing, particularly for new investigators, should be addressed in the context of HIV/MH research. DISCUSSION A group of IS experts affiliated with NIMH-funded ARCs convened to identify common and challenging grey areas. The group generated a preliminary list of 19 grey areas in HIV/MH-related IS. From the list, the authors developed a survey which was distributed to all ARCs to prioritize grey areas to address in this paper. ARC members across the United States (N = 60) identified priority grey areas requiring clarification. This commentary discusses topics with 40% or more endorsement. The top grey areas that ARC members identified were: (1) Differentiating implementation strategies from interventions; (2) Determining when an intervention has sufficient evidence for adaptation; (3) Integrating recipient perspectives into HIV/MH implementation research; (4) Evaluating whether an implementation strategy is evidence-based; (5) Identifying rigorous approaches for evaluating the impact of implementation strategies in the absence of a control group or randomization; and (6) Addressing innovation in HIV/MH IS grants. The commentary addresses each grey area by drawing from the existing literature (when available), providing expert guidance on addressing each in the context of HIV/MH research, and providing domestic and global HIV and HIV/MH case examples that address these grey areas. CONCLUSIONS HIV/MH IS is key to achieving domestic and international goals for ending HIV transmission and mitigating its impact. Guidance offered in this paper can help to overcome challenges to rigorous and high-impact HIV/MH implementation research.
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Affiliation(s)
- Audrey Harkness
- School of Nursing and Health StudiesUniversity of MiamiCoral GablesFloridaUSA
| | - Ali Giusto
- Department of PsychiatryColumbia University Irving Medical CenterNew York State Psychiatric InstituteNew YorkNew YorkUSA
| | - Alison B. Hamilton
- Center for the Study of Healthcare InnovationImplementation & Policy, VA Greater Los Angeles Healthcare SystemLos AngelesCaliforniaUSA
- Department of Psychiatry & Biobehavioral SciencesUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Raul U. Hernandez‐Ramirez
- Department of BiostatisticsCenter for Interdisciplinary Research on AIDSand Center for Methods in Implementation and Prevention ScienceYale School of Public HealthNew HavenConnecticutUSA
| | - Donna Spiegelman
- Department of BiostatisticsCenter for Interdisciplinary Research on AIDSand Center for Methods in Implementation and Prevention ScienceYale School of Public HealthNew HavenConnecticutUSA
| | - Bryan J. Weiner
- School of Public HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Rinad S. Beidas
- Department of Medical Social SciencesFeinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Michaela E. Larson
- School of Nursing and Health StudiesUniversity of MiamiCoral GablesFloridaUSA
- Division of Prevention ScienceUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Sheri A. Lippman
- Division of Prevention ScienceUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Milton L. Wainberg
- Department of PsychiatryColumbia University Irving Medical CenterNew York State Psychiatric InstituteNew YorkNew YorkUSA
| | - Justin D. Smith
- Department of Population Health SciencesSpencer Fox Eccles School of Medicine at the University of UtahSalt Lake CityUtahUSA
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Chu W, Tam CC, Harrison S. Associations between perceived discrimination experiences, treatment adherence self-efficacy, and depressive symptoms among people living with HIV in the Southern United States. AIDS Care 2024:1-10. [PMID: 38623601 DOI: 10.1080/09540121.2024.2341231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 04/05/2024] [Indexed: 04/17/2024]
Abstract
This study examined associations between perceived discrimination, treatment adherence self-efficacy, and depressive symptoms among people living with HIV (PLHIV) in the Southern United States. Cross-sectional survey data were collected from 402 PLHIV who self-reported on interpersonal discrimination experiences based on HIV status, sexuality, gender, income, and living condition. Participants also reported on adherence self-efficacy and depressive symptoms. We employed K-means clustering to identify groups based on discrimination experiences, and logistic regressions to examine group differences on adherence self-efficacy and depressive symptoms. Results suggested three groups: a cluster with high perceived discrimination across all identities/conditions (n = 41; 11%; Cluster 1); a cluster with high perceived discrimination based on HIV status, income, and living condition (n = 49; 13%; Cluster 2); and a cluster with low perceived discrimination across all identities/conditions (n = 288; 76%; Cluster 3). Compared to Cluster 3, Cluster 1 and 2 had 2.22 times (p = .037) and 3.98 times (p<.001) greater odds of reporting depressive symptoms. Compared to Cluster 3, Cluster 2 had 3.40 times (p = .003) greater odds of reporting lower adherence self-efficacy. Findings demonstrate the need for individual-level support for PLHIV with discrimination histories, and broader efforts to end the stigma, discrimination, and marginalization of PLHIV based on HIV status and other characteristics.
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Affiliation(s)
- Wendy Chu
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, USA
| | - Cheuk Chi Tam
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Sayward Harrison
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, USA
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Gamarel KE, Rodriguez-Bañuelos A, Ubong IA, Best JN, Jadwin-Cakmak L, Mitchell JW. Understanding the potential implementation determinants of Our Plan: a couples-based digital human immunodeficiency virus prevention intervention for same-gender male couples. Mhealth 2024; 10:16. [PMID: 38689615 PMCID: PMC11058597 DOI: 10.21037/mhealth-23-57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/31/2023] [Indexed: 05/02/2024] Open
Abstract
Background There has been a proliferation of digital health interventions (DHIs) focused on addressing human immunodeficiency virus (HIV) prevention and treatment outcomes, including couples-based interventions with same-gender male couples. However, the barriers and facilitators of implementing couples-based HIV and sexually transmitted infection (STI) prevention interventions using digital platforms in community-based organizations remains largely unknown. The goal of this study was to explore the implementation determinants of Our Plan, a couples-based DHI designed for new relationships of same-gender male couples and dyadic, sexual partnerships. Methods Qualitative interviews were conducted with 40 organization leaders, healthcare providers, and staff at acquired immunodeficiency syndrome (AIDS)-service and community-based organizations in 13 states serving populations in Ending the HIV Epidemic jurisdictions. Interview items and follow-up questions were guided by the Consolidated Framework for Implementation Research (CFIR) to inquire about implementation determinants of Our Plan. Results Most participants highlighted several relative advantages of Our Plan: increasing capacity to support couples, potential synergy with existing programs, and opportunities to increase patient engagement. Participants also discussed relative disadvantages: misalignment with organizational values in the provision of patient-centered models of care and low interest from some priority populations. Participants emphasized the need for adaptability of Our Plan to fit within their local contexts, which encompassed support for both implementers and end-users, cultural tailoring, and privacy and security features. The desired evidence needed to implement Our Plan focused on data on impact, acceptability, and usability and functionality from communities most heavily impacted by the HIV epidemic. The majority of participants described how Our Plan could be integrated within service delivery and aligned with their organization's aspirational values; however, some noted that their organizational culture valued in-person interactions, particularly among patients experiencing structural vulnerabilities. Finally, participants discussed how the implementation of Our Plan would require additional training and funding for staff to support end-users and a relationship with the developers so that they could demonstrate their investment in the communities that their organizations served. Conclusions Our Plan was deemed a promising tool among potential implementers. To ensure optimal implementation and organizational fit, Our Plan refinement and evaluation must include implementers and end-users most impacted by the HIV epidemic throughout the entire process.
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Affiliation(s)
- Kristi E. Gamarel
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Adrian Rodriguez-Bañuelos
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Ini-Abasi Ubong
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Janae N. Best
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Laura Jadwin-Cakmak
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Jason W. Mitchell
- Department of Health Promotion and Disease Prevention, Florida International University Robert Stempel College of Public Health & Social Work, Miami, FL, USA
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11
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Clemenzi-Allen AA, Hebert J, Reid MA, Mains T, Hammer H, Gandhi M, Pratt L, Wesson P. Interruptions in HIV and Behavioral Health Care for Criminal-Legal Involved People Living with HIV Following Implementation of Decarceration and Shelter in Place in San Francisco, California. AIDS Behav 2024; 28:1093-1103. [PMID: 38060113 PMCID: PMC10896806 DOI: 10.1007/s10461-023-04221-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/08/2023]
Abstract
Decarceration policies, enacted for SARS-CoV-2 mitigation in carceral settings, potentially exacerbated barriers to care for people living with HIV (PWH) with criminal legal involvement (CLI) during Shelter-in-Place (SIP) by limiting opportunities for engagement in provisions of HIV and behavioral health care. We compared health care engagement for PWH with CLI in San Francisco, California before and after decarceration and SIP using interrupted time series analyses. Administrative data identified PWH booked at the San Francisco County Jail with at least one clinic encounter from 01/01/2018-03/31/2020 within the municipal health care network. Monthly proportions of HIV, substance use, psychiatric and acute care encounters before (05/01/2019-02/29/2020) and after (03/01/2020-12/31/2020) SIP and decarceration were compared using Generalized Estimating Equation (GEE) log-binomial and logistic regression models, clustering on the patient-level. Of 436 patients, mean age was 43 years (standard-deviation 11); 88% cisgender-male; 39% white, 66% homeless; 67% had trimorbidity by Elixhauser score (medical comorbidity, psychotic disorder or depression, and substance use disorder). Clinical encounters immediately dropped following SIP for HIV (aOR = 0.77; 95% CI: 0.67, 0.90) and substance use visits (aRR = 0.83; 95% CI: 0.70, 0.99) and declined in subsequent months. Differential reductions in clinical encounters were seen among Black/African Americans (aRR = 0.93; 95% CI: 0.88, 0.99) and people experiencing homelessness (aRR = 0.92; 95% CI: 0.87, 0.98). Significant reductions in care were observed for PWH with CLI during the COVID-19 pandemic, particularly among Black/African Americans and people experiencing homelessness. Strategies to End the HIV Epidemic must improve engagement across diverse care settings to improve outcomes for this key population.
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Affiliation(s)
- A Asa Clemenzi-Allen
- San Francisco Department of Public Health, San Francisco, CA, USA.
- Division of HIV, Infection Diseases and Global Medicine, University of California, San Francisco, USA.
- , 798 Brannan St, San Francisco, CA, 94103, USA.
| | - Jillian Hebert
- Department of Family and Community Medicine, University of California, San Francisco, USA
| | - Michael Alistair Reid
- Division of HIV, Infection Diseases and Global Medicine, University of California, San Francisco, USA
| | - Tyler Mains
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Hali Hammer
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Monica Gandhi
- Division of HIV, Infection Diseases and Global Medicine, University of California, San Francisco, USA
| | - Lisa Pratt
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Paul Wesson
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
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12
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Randolph SD, Jeter E, Johnson R. Using an Equity in Research Framework to Develop a Community-Engaged Intervention to Improve Preexposure Uptake Among Black Women Living in the United States South. J Assoc Nurses AIDS Care 2024; 35:144-152. [PMID: 38949908 DOI: 10.1097/jnc.0000000000000453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024]
Abstract
ABSTRACT In the U.S. South, over half of new HIV diagnoses occur among Black Americans with research lagging for women who face increased HIV rates and low PrEP uptake, among other health inequities. Community engaged research is a promising method for reversing these trends with established best practices for building infrastructure, implementing research, and translating evidence-based interventions into clinical and community settings. Using the 5Ws of Racial Equity in Research Framework (5Ws) as a racial equity lens, the following paper models a review of a salon-based intervention to improve PrEP awareness and uptake among Black women that was co-developed with beauty salons, stylists, and Black women through an established community advisory council. In this paper we demonstrate how the 5Ws framework was applied to review processes, practices, and outcomes from a community-engaged research approach. The benefits of and challenges to successful collaboration are discussed with insights for future research and community impact.
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Affiliation(s)
- Schenita D Randolph
- Schenita D. Randolph, PhD, MPH, RN, FAAN, is an Associate Professor, Duke University School of Nursing, Durham, North Carolina, USA
- Elizabeth Jeter, PhD, is a Research Associate, Duke University School of Nursing, Durham, North Carolina, USA
- Ragan Johnson, DNP, FNP-BC, CNE, is an Associate Professor, Duke University School of Nursing, Durham, North Carolina, USA
| | - Elizabeth Jeter
- Schenita D. Randolph, PhD, MPH, RN, FAAN, is an Associate Professor, Duke University School of Nursing, Durham, North Carolina, USA
- Elizabeth Jeter, PhD, is a Research Associate, Duke University School of Nursing, Durham, North Carolina, USA
- Ragan Johnson, DNP, FNP-BC, CNE, is an Associate Professor, Duke University School of Nursing, Durham, North Carolina, USA
| | - Ragan Johnson
- Schenita D. Randolph, PhD, MPH, RN, FAAN, is an Associate Professor, Duke University School of Nursing, Durham, North Carolina, USA
- Elizabeth Jeter, PhD, is a Research Associate, Duke University School of Nursing, Durham, North Carolina, USA
- Ragan Johnson, DNP, FNP-BC, CNE, is an Associate Professor, Duke University School of Nursing, Durham, North Carolina, USA
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13
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Johnson KA, Owens C, Edelson HC, Yonker M, Robinson-Mosley S, Park J, Cook M. Food insecurity in pediatric HIV: understanding a critical challenge in the United States. AIDS Care 2024:1-9. [PMID: 38387444 DOI: 10.1080/09540121.2023.2287734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 11/20/2023] [Indexed: 02/24/2024]
Abstract
Advancing the well-being of individuals living with HIV necessitates attention to social determinants of health, including food insecurity. Through a clinical and community-based needs assessment, we aimed to gain insight into experiences of food insecurity among patients receiving care at a large pediatric HIV outpatient clinic in the Southeastern United States. We adopted a multimodal assessment approach involving a literature review, community profiling, key informant interviews, focus group discussions with staff, patients and parents and a community stakeholder advisory meeting. Our needs assessment demonstrates that food insecurity is an important aspect of the lived experience of children, adolescents and young adults living with HIV. Clinical staff agreed that food insecurity screening should be incorporated into the patient care workflow but ideally only in concert with providing resources that meet their needs. We formulated a recommendation matrix for addressing food insecurity based on priority importance and feasibility. Collaborative relationships between healthcare practitioners and leaders, community-based organizations and local and federal funding sources are vital for enhancing patients' access to sustainable, reliable solutions to this fundamental determinant of health. Our approach provides a tested model for other clinics seeking to identify and alleviate food insecurity among patients.
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Affiliation(s)
- Khaliah A Johnson
- Department of Pediatrics, Division of Pediatric Palliative Care, Emory University, Atlanta, GA, USA
- The Ponce de Leon Center, Grady Medical Center, Atlanta, GA, USA
| | - Caroline Owens
- Department of Anthropology, Emory University, Atlanta, GA, USA
- Department of Anthropology, Washington State University, Pullman, WA, USA
| | - Hannah Claire Edelson
- Department of Emergency Medicine, Oliver View- UCLA Medical Center, Los Angeles, CA, USA
| | - Magdalene Yonker
- The Ponce de Leon Center, Grady Medical Center, Atlanta, GA, USA
- Department of Psychiatry, Emory University, Atlanta, GA, USA
| | | | - Jenny Park
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Miranda Cook
- Laney Graduate School, Emory University, Atlanta, GA, USA
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14
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Park JW, Wilson-Barthes MG, Dulin AJ, Hogan JW, Mugavero MJ, Napravnik S, Carey MP, Fava JL, Dale SK, Earnshaw VA, Johnson B, Dougherty-Sheff S, Agil D, Howe CJ. Multilevel Resilience and HIV Virologic Suppression Among African American/Black Adults in the Southeastern United States. J Racial Ethn Health Disparities 2024; 11:313-325. [PMID: 37043167 PMCID: PMC10092932 DOI: 10.1007/s40615-023-01520-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 04/13/2023]
Abstract
OBJECTIVE To assess overall and by neighborhood risk environments whether multilevel resilience resources were associated with HIV virologic suppression among African American/Black adults in the Southeastern United States. SETTING AND METHODS This clinical cohort sub-study included 436 African American/Black participants enrolled in two parent HIV clinical cohorts. Resilience was assessed using the Multilevel Resilience Resource Measure (MRM) for African American/Black adults living with HIV, where endorsement of a MRM statement indicated agreement that a resilience resource helped a participant continue HIV care despite challenges or was present in a participant's neighborhood. Modified Poisson regression models estimated adjusted prevalence ratios (aPRs) for virologic suppression as a function of categorical MRM scores, controlling for demographic, clinical, and behavioral characteristics at or prior to sub-study enrollment. We assessed for effect measure modification (EMM) by neighborhood risk environments. RESULTS Compared to participants with lesser endorsement of multilevel resilience resources, aPRs for virologic suppression among those with greater or moderate endorsement were 1.03 (95% confidence interval: 0.96-1.11) and 1.03 (0.96-1.11), respectively. Regarding multilevel resilience resource endorsement, there was no strong evidence for EMM by levels of neighborhood risk environments. CONCLUSIONS Modest positive associations between higher multilevel resilience resource endorsement and virologic suppression were at times most compatible with the data. However, null findings were also compatible. There was no strong evidence for EMM concerning multilevel resilience resource endorsement, which could have been due to random error. Prospective studies assessing EMM by levels of the neighborhood risk environment with larger sample sizes are needed.
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Affiliation(s)
- Jee Won Park
- Center for Epidemiologic Research, Department of Epidemiology, School of Public Health, Brown University, Box G-S121-2, 121 South Main Street, Providence, RI, USA
- Program in Epidemiology, University of Delaware, Newark, DE, USA
| | - Marta G Wilson-Barthes
- Center for Epidemiologic Research, Department of Epidemiology, School of Public Health, Brown University, Box G-S121-2, 121 South Main Street, Providence, RI, USA
| | - Akilah J Dulin
- Center for Health Promotion and Health Equity, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Joseph W Hogan
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - Michael J Mugavero
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sonia Napravnik
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael P Carey
- Center for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital, Providence, RI, USA
| | - Joseph L Fava
- Center for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital, Providence, RI, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Bernadette Johnson
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sarah Dougherty-Sheff
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Deana Agil
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chanelle J Howe
- Center for Epidemiologic Research, Department of Epidemiology, School of Public Health, Brown University, Box G-S121-2, 121 South Main Street, Providence, RI, USA.
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15
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Tapia Y, Saleska J, Gonzalez-Valentino O, Liashenko J, Stafylis C, Brown B, Brooks R, Klausner JD. Proyecto Facil: Using the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) as a Diagnostic Tool to Improve Access to Human Immunodeficiency Virus Pre-Exposure Prophylaxis (PrEP) via Telemedicine. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2024; 36:16-32. [PMID: 38349353 DOI: 10.1521/aeap.2024.36.1.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Following the underutilization of pre-exposure prophylaxis (PrEP) among Latinx men who have sex with men (MSM) and transgender women in Southern California and the growing use of the delivery of PrEP through telemedicine, the California Department of Public Health implemented a telemedicine component to their already existing assistance program. We used the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to identify and characterize factors inhibiting the successful implementation of the telemedicine program through in-depth, online stakeholder interviews and online community focus groups with Latinx MSM and trans women in southern California. Obstacles reported by stakeholders were complicated enrollment process, preference for in-person care, more appealing private sector models of PrEP, while community members reported low awareness of the program, fear of complications due to immigration status, challenges to fulfill enrollment requirements. Findings can used for the future improvement of the ongoing program, as well as other similar PrEP telemedicine programs.
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Affiliation(s)
- Yara Tapia
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California
| | - Jessica Saleska
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California
| | | | - Joshua Liashenko
- University of California, Riverside School of Medicine, Riverside, California
| | - Chrysovalantis Stafylis
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California
| | - Brandon Brown
- University of California, Riverside School of Medicine, Riverside, California
| | - Ronald Brooks
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, California
| | - Jeffrey D Klausner
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California
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16
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James TG, Argenyi MS, Gravino A, Benevides TW. Human immunodeficiency virus diagnosis and care among adults with intellectual and developmental disabilities who are publicly insured. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024; 68:150-163. [PMID: 37859301 PMCID: PMC10979718 DOI: 10.1111/jir.13099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/18/2023] [Accepted: 09/26/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND This study aimed to assess the prevalence of human immunodeficiency virus (HIV) testing, HIV diagnosis and receipt of HIV care among adults with intellectual and developmental disabilities (IDDs) who are publicly insured in the USA. DESIGN This study is a cross-sectional analysis of Medicare-Medicaid linked data of adults with IDD who were publicly insured in 2012 (n = 878 186). METHODS We estimated adjusted prevalence ratios of HIV testing, diagnosis and receipt of antiretroviral therapy (ART). We also identified the relationship between predisposing (age, gender, race and ethnicity), enabling (Medicare, Medicaid or both; rural status; geographical location; and county income) and need-related characteristics (IDD diagnosis and other co-occurring conditions) associated with these outcomes. RESULTS Only 0.12% of adults with IDD who had no known HIV diagnosis had received an HIV test in the past year. The prevalence of HIV diagnosis among adults with IDD was 0.38%, although differences by type of IDD diagnosis were observed. Prevalence of HIV diagnosis differed by type of IDD. Among adults with IDD who were living with HIV, approximately 71% had received ART during 2012. The adjusted analyses indicate significant racial disparities, with Black adults with IDD making up the majority (59.11%) of the HIV-positive IDD adult population. CONCLUSIONS Adults with IDD are a unique priority population at risk for HIV-related disparities, and the level of risk is differential among subtypes of IDD. People with IDD, like other people with disabilities, should be considered in prevention programming and treatment guidelines to address disparities across the HIV care continuum.
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Affiliation(s)
- T G James
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - M S Argenyi
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - A Gravino
- Rutgers Center for Adult Autism Services, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - T W Benevides
- Institute of Public and Preventive Health & Department of Occupational Therapy, Augusta University, Augusta, GA, USA
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17
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Wurcel AG, Guardado R, Grussing ED, Koutoujian PJ, Siddiqi K, Senst T, Assoumou SA, Freund KM, Beckwith CG. Racial differences in testing for infectious diseases: An analysis of jail intake data. PLoS One 2023; 18:e0288254. [PMID: 38117818 PMCID: PMC10732427 DOI: 10.1371/journal.pone.0288254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 06/11/2023] [Indexed: 12/22/2023] Open
Abstract
HIV and hepatitis C virus (HCV) testing for all people in jail is recommended by the CDC. In the community, there are barriers to HIV and HCV testing for minoritized people. We examined the relationship between race and infectious diseases (HIV, HCV, syphilis) testing in one Massachusetts jail, Middlesex House of Corrections (MHOC). This is a retrospective analysis of people incarcerated at MHOC who opted-in to infectious diseases testing between 2016-2020. Variables of interest were race/ethnicity, self-identified history of psychiatric illness, and ever having experienced restrictive housing. Twenty-three percent (1,688/8,467) of people who were incarcerated requested testing at intake. Of those, only 38% received testing. Black non-Hispanic (25%) and Hispanic people (30%) were more likely to request testing than white people (19%). Hispanic people (16%, AOR 1.69(1.24-2.29) were more likely to receive a test result compared to their white non-Hispanic (8%, AOR 1.54(1.10-2.15)) counterparts. Black non-Hispanic and Hispanic people were more likely to opt-in to and complete infectious disease testing than white people. These findings could be related to racial disparities in access to care in the community. Additionally, just over one-third of people who requested testing received it, underscoring that there is room for improvement in ensuring testing is completed. We hope our collaborative efforts with jail professionals can encourage other cross-disciplinary investigations.
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Affiliation(s)
- Alysse G. Wurcel
- Department of Medicine Tufts Medical Center, Division of Geographic Medicine and Infectious Diseases, Boston, MA, United States of America
- Tufts University School of Medicine, Boston, MA, United States of America
| | - Rubeen Guardado
- Department of Medicine Tufts Medical Center, Division of Geographic Medicine and Infectious Diseases, Boston, MA, United States of America
| | - Emily D. Grussing
- Department of Medicine Tufts Medical Center, Division of Geographic Medicine and Infectious Diseases, Boston, MA, United States of America
- Tufts University School of Medicine, Boston, MA, United States of America
| | | | - Kashif Siddiqi
- Middlesex Sheriff’s Office, Medford, MA, United States of America
| | - Thomas Senst
- Middlesex Sheriff’s Office, Medford, MA, United States of America
| | - Sabrina A. Assoumou
- Boston University School of Medicine, Boston, MA, United States of America
- Boston Medical Center, Boston, MA, United States of America
| | - Karen M. Freund
- Tufts University School of Medicine, Boston, MA, United States of America
- Department of Medicine, Tufts Medical Center, Boston, MA, United States of America
| | - Curt G. Beckwith
- The Miriam Hospital/Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
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18
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Zalla LC, Cole SR, Eron JJ, Adimora AA, Vines AI, Althoff KN, Marconi VC, Gill MJ, Horberg MA, Silverberg MJ, Rebeiro PF, Lang R, Kasaie P, Moore RD, Edwards JK. Evaluating Clinic-Based Interventions to Reduce Racial Differences in Mortality Among People With Human Immunodeficiency Virus in the United States. J Infect Dis 2023; 228:1690-1698. [PMID: 37437108 PMCID: PMC10733732 DOI: 10.1093/infdis/jiad263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/23/2023] [Accepted: 07/10/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Mortality remains elevated among Black versus White adults receiving human immunodeficiency virus (HIV) care in the United States. We evaluated the effects of hypothetical clinic-based interventions on this mortality gap. METHODS We computed 3-year mortality under observed treatment patterns among >40 000 Black and >30 000 White adults entering HIV care in the United States from 1996 to 2019. We then used inverse probability weights to impose hypothetical interventions, including immediate treatment and guideline-based follow-up. We considered 2 scenarios: "universal" delivery of interventions to all patients and "focused" delivery of interventions to Black patients while White patients continued to follow observed treatment patterns. RESULTS Under observed treatment patterns, 3-year mortality was 8% among White patients and 9% among Black patients, for a difference of 1 percentage point (95% confidence interval [CI], .5-1.4). The difference was reduced to 0.5% under universal immediate treatment (95% CI, -.4% to 1.3%) and to 0.2% under universal immediate treatment combined with guideline-based follow-up (95% CI, -1.0% to 1.4%). Under the focused delivery of both interventions to Black patients, the Black-White difference in 3-year mortality was -1.4% (95% CI, -2.3% to -.4%). CONCLUSIONS Clinical interventions, particularly those focused on enhancing the care of Black patients, could have significantly reduced the mortality gap between Black and White patients entering HIV care from 1996 to 2019.
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Grants
- R01 DA011602 NIDA NIH HHS
- K23 EY013707 NEI NIH HHS
- G12 MD007583 NIMHD NIH HHS
- U01 AI038855 NIAID NIH HHS
- U01 HL146208 NHLBI NIH HHS
- UL1 RR024131 NCRR NIH HHS
- U01 HL146192 NHLBI NIH HHS
- U01 AI069432 NIAID NIH HHS
- K01 AI131895 NIAID NIH HHS
- U01 HL146241 NHLBI NIH HHS
- R01 AA016893 NIAAA NIH HHS
- N01 CP001004 NCI NIH HHS
- P30 AI027767 NIAID NIH HHS
- U01 DA036297 NIDA NIH HHS
- P30 AI050409 NIAID NIH HHS
- U01 HL146333 NHLBI NIH HHS
- F31 AI124794 NIAID NIH HHS
- P30 MH062246 NIMH NIH HHS
- U01 AI069434 NIAID NIH HHS
- NIDCD NIH HHS
- NIDCR NIH HHS
- NINR NIH HHS
- U54 GM133807 NIGMS NIH HHS
- P30 AI094189 NIAID NIH HHS
- U01 HL146245 NHLBI NIH HHS
- K24 DA000432 NIDA NIH HHS
- U01 HL146205 NHLBI NIH HHS
- R01AI157758, U01AI069918, F31AI124794, F31DA037788, G12MD007583, K01AI093197, K01AI131895, K23EY013707, K24AI065298, K24AI118591, K24DA000432, KL2TR000421, N01CP01004, N02CP055504, N02CP91027, P30AI027757, P30AI027763, P30AI027767, P30AI036219, P30AI050409, P30AI050410, P30AI094189, P30AI110527, P30MH62246, R01AA016893, R01DA011602, R01DA012568, R01AG053100, R24AI067039, R34DA045592, U01AA013566, U01AA020790, U01AI038855, U01AI038858, U01AI068634, U01AI068636, U01AI069432, U01AI069434, U01DA036297, U01DA036935, U10EY008057, U10EY008052, U10EY008067, U01HL146192, U01HL146193, U01HL146194, U01HL146201, U01HL146202, U01HL146203, U01HL146204, U01HL146205, U01HL146208, U01HL146240, U01HL146241, U01HL146242, U01HL146245, U01HL146333, U24AA020794, U54GM133807, UL1RR024131, UL1TR000004, UL1TR000083, UL1TR002378, Z01CP010214, and Z01CP010176 NIH HHS
- U01 DA036935 NIDA NIH HHS
- R24 AI067039 NIAID NIH HHS
- U01 HL146242 NHLBI NIH HHS
- N02CP55504 NCI NIH HHS
- U01 AI038858 NIAID NIH HHS
- 90051652 HRSA HHS
- U10 EY008057 NEI NIH HHS
- U01 AI068636 NIAID NIH HHS
- R01 AI157758 NIAID NIH HHS
- U01 HL146201 NHLBI NIH HHS
- NINDS NIH HHS
- U01 HL146193 NHLBI NIH HHS
- U10 EY008052 NEI NIH HHS
- U01 AA020790 NIAAA NIH HHS
- NHGRI NIH HHS
- UL1 TR002378 NCATS NIH HHS
- P30 AI110527 NIAID NIH HHS
- R34 DA045592 NIDA NIH HHS
- P30 AI027763 NIAID NIH HHS
- K01 AI093197 NIAID NIH HHS
- U01 AI069918 NIAID NIH HHS
- K24 AI118591 NIAID NIH HHS
- K24 AI065298 NIAID NIH HHS
- U01 AA013566 NIAAA NIH HHS
- UL1 TR000083 NCATS NIH HHS
- P30 AI027757 NIAID NIH HHS
- U01 HL146204 NHLBI NIH HHS
- R01 DA012568 NIDA NIH HHS
- U01 HL146202 NHLBI NIH HHS
- CDC-200-2006-18797 CDC HHS
- KL2 TR000421 NCATS NIH HHS
- UL1 TR000004 NCATS NIH HHS
- U01 HL146240 NHLBI NIH HHS
- NIDDK NIH HHS
- F31 DA037788 NIDA NIH HHS
- R01 AG053100 NIA NIH HHS
- U10 EY008067 NEI NIH HHS
- P30 AI036219 NIAID NIH HHS
- Z01 CP010176 Intramural NIH HHS
- U01 HL146194 NHLBI NIH HHS
- U24 AA020794 NIAAA NIH HHS
- U01 HL146203 NHLBI NIH HHS
- U01 AI068634 NIAID NIH HHS
- P30 AI050410 NIAID NIH HHS
- ViiV Healthcare
- NIH
- CDC
- Agency for Healthcare Research and Quality
- Health Resources and Services Administration
- Grady Health System
- Canadian Institutes of Health Research
- Ontario Ministry of Health and Long Term Care
- Government of Alberta, Canada
- National Institute of Allergy and Infectious Diseases
- National Cancer Institute
- National Heart, Lung, and Blood Institute
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
- National Human Genome Research Institute
- National Institute for Mental Health
- National Institute on Drug Abuse
- National Institute on Aging
- National Institute of Dental and Craniofacial Research
- National Institute of Neurological Disorders and Stroke
- National Institute of Nursing Research
- National Institute on Alcohol Abuse and Alcoholism
- National Institute on Deafness and Other Communication Disorders
- National Institute of Diabetes and Digestive and Kidney Diseases
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Affiliation(s)
- Lauren C Zalla
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Stephen R Cole
- Department of Epidemiology, Gillings School of Global Public Health
| | - Joseph J Eron
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill
| | - Adaora A Adimora
- Department of Epidemiology, Gillings School of Global Public Health
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill
| | - Anissa I Vines
- Department of Epidemiology, Gillings School of Global Public Health
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Vincent C Marconi
- Division of Infectious Diseases, School of Medicine
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - M John Gill
- Department of Medicine, University of Calgary, Alberta, Canada
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland
| | | | - Peter F Rebeiro
- Department of Medicine and Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Raynell Lang
- Department of Medicine, University of Calgary, Alberta, Canada
| | - Parastu Kasaie
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Richard D Moore
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jessie K Edwards
- Department of Epidemiology, Gillings School of Global Public Health
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19
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MOLLDREM STEPHEN, SMITH ANTHONYKJ, McCLELLAND ALEXANDER. Advancing Dialogue About Consent and Molecular HIV Surveillance in the United States: Four Proposals Following a Federal Advisory Panel's Call for Major Reforms. Milbank Q 2023; 101:1033-1046. [PMID: 37380617 PMCID: PMC10726778 DOI: 10.1111/1468-0009.12663] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 05/09/2023] [Accepted: 06/12/2023] [Indexed: 06/30/2023] Open
Abstract
Policy Points Molecular HIV surveillance and cluster detection and response (MHS/CDR) programs have been a core public health activity in the United States since 2018 and are the "fourth pillar" of the Ending the HIV Epidemic initiative launched in 2019. MHS/CDR has caused controversy, including calls for a moratorium from networks of people living with HIV. In October 2022, the Presidential Advisory Council on HIV/AIDS (PACHA) adopted a resolution calling for major reforms. We analyze the policy landscape and present four proposals to federal stakeholders pertaining to PACHA's recommendations about incorporating opt-outs and plain-language notifications into MHS/CDR programs.
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Affiliation(s)
- STEPHEN MOLLDREM
- Institute for Bioethics and Health Humanities, University of Texas Medical Branch
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20
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Ogunbajo A, Bogart LM, Mutchler MG, Klein DJ, Lawrence SJ, Goggin K, Wagner GJ. Unmet Social Needs are Associated with Lower Adherence to Antiretroviral Therapy (ART) Medication Among a Sample of Black People Living with HIV (PLHIV). AIDS Behav 2023; 27:3651-3660. [PMID: 37195472 PMCID: PMC10191094 DOI: 10.1007/s10461-023-04079-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 05/18/2023]
Abstract
The current study examined the prevalence and typology of unmet needs and the association between unmet needs and HIV antiretroviral therapy (ART) medication adherence among a sample of Black people living with HIV(PLHIV) (N = 304) in Los Angeles, CA. We found a high prevalence of unmet needs, with 32% of participants reporting having two or more unmet needs. The most common unmet needs category was basic benefits needs (35%), followed by subsistence needs (33%), and health needs (27%). Significant correlates of unmet needs included food insecurity, history of homelessness, and history of incarceration. A greater number of unmet needs and any unmet basic benefits needs were each significantly associated with lower odds of HIV ART medication adherence. These findings provide further evidence linking the social determinants of health and social disenfranchisement to ART medication adherence among Black PLHIV.
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Affiliation(s)
| | - Laura M Bogart
- RAND Corporation, Santa Monica, CA, United States of America
| | - Matt G Mutchler
- APLA Health & Wellness, Los Angeles, CA, United States of America
- California State University Dominguez Hills, Carson, CA, United States of America
| | - David J Klein
- RAND Corporation, Santa Monica, CA, United States of America
| | - Sean J Lawrence
- APLA Health & Wellness, Los Angeles, CA, United States of America
| | - Kathy Goggin
- Health Services and Outcome Research, Children's Mercy Kansas City and University of Missouri - Kansas City Schools of Medicine and Pharmacy, Kansas City, MO, United States of America
| | - Glenn J Wagner
- RAND Corporation, Santa Monica, CA, United States of America
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21
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Kasaie P, Stewart C, Humes E, Gerace L, Hyle EP, Zalla LC, Rebeiro PF, Silverberg MJ, Rubtsova AA, Rich AJ, Gebo K, Lesko CR, Fojo AT, Lang R, Edwards JK, Althoff KN. Impact of subgroup-specific heterogeneities and dynamic changes in mortality rates on forecasted population size, deaths, and age distribution of persons receiving antiretroviral treatment in the United States: a computer simulation study. Ann Epidemiol 2023; 87:S1047-2797(23)00171-0. [PMID: 37741499 PMCID: PMC10841391 DOI: 10.1016/j.annepidem.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/06/2023] [Accepted: 09/14/2023] [Indexed: 09/25/2023]
Abstract
PURPOSE Model-based forecasts of population size, deaths, and age distribution of people with HIV (PWH) are helpful for public health and clinical services planning but are influenced by subgroup-specific heterogeneities and changes in mortality rates. METHODS Using an agent-based simulation of PWH in the United States, we examined the impact of distinct approaches to parametrizing mortality rates on forecasted epidemiology of PWH on antiretroviral treatment (ART). We first estimated mortality rates among (1) all PWH, (2) sex-specific, (3) sex-and-race/ethnicity-specific, and (4) sex-race/ethnicity-and-HIV-acquisition-risk-specific subgroups. We then assessed each scenario by (1) allowing unrestricted reductions in age-specific mortality rates over time and (2) restricting the mortality rates among PWH to subgroup-specific mortality thresholds from the general population. RESULTS Among the eight scenarios examined, those lacking subgroup-specific heterogeneities and those allowing unrestricted reductions in future mortality rates forecasted the lowest number of deaths among all PWH and 9 of the 15 subgroups through 2030. The forecasted overall number and age distribution of people with a history of injection drug use were sensitive to inclusion of subgroup-specific mortality rates. CONCLUSIONS Our results underscore the potential risk of underestimating future deaths by models lacking subgroup-specific heterogeneities in mortality rates, and those allowing unrestricted reductions in future mortality rates.
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Affiliation(s)
- Parastu Kasaie
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Cameron Stewart
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Elizabeth Humes
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lucas Gerace
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Emily P Hyle
- Medical Practice Evaluation Center, Massachusetts General Hospital; Division of Infectious Diseases, Massachusetts General Hospital, Boston; Harvard Medical School, Boston
| | - Lauren C Zalla
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Peter F Rebeiro
- Department of Medicine & Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
| | | | - Anna A Rubtsova
- Emory University Rollins School of Public Health, Department of Behavioral, Social, and Health Education Sciences, Atlanta, GA
| | - Ashleigh J Rich
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Kelly Gebo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Anthony T Fojo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Raynell Lang
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jessie K Edwards
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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22
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Dibble KE, Murray SM, Baral SD, Zlotorzynska M, Wiginton JM, Stephenson R, Edwards OW, Lyons C, Rainey JC, Xue QL, Sanchez TH. Predicting salivary cortisol and sexual behavior stigma among MSM in the American Men's Internet Survey 2019. Sci Rep 2023; 13:18082. [PMID: 37872353 PMCID: PMC10593931 DOI: 10.1038/s41598-023-44876-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023] Open
Abstract
Physiological stress levels in response to sexual behavior stigma among men who have sex with men (MSM) in the United States (US) are understudied. The current study aims to explore the relationship between sexual behavior stigma and salivary cortisol both overall and stratified by race/ethnicity. If such an association exists, it may suggest that sexual behavior stigma can be physiologically measured or indicated by the presence of heightened salivary cortisol. A subsample of 667 MSM participants from the 2019 American Men's Internet Survey (AMIS; N = 10,129) submitted morning (AM) and evening (PM) saliva cortisol samples using at-home mail-in collection kits. Average daily cortisol and daily cortisol change were calculated; simple linear regressions estimated associations between cortisol measures and sexual behavior stigma characterized in four different ways (ever and recent experience of individual stigma items; average ever and recent experience of three stigma scales: stigma from family and friends, anticipated healthcare stigma, general social stigma). Participants reported a mean age of 36.0 years (SD = 14.9), with most being non-Hispanic white (n = 480, 72.0%), Hispanic (n = 164, 12.3%), or Black/African American (n = 146, 10.9%), and identified as homosexual/gay (n = 562, 84.3%). Reporting ever experiencing healthcare providers gossiping was significantly associated with higher PM cortisol (β = 0.12, p = 0.001) and higher average daily cortisol (β = 0.11, p = 0.004), while reporting ever experiencing police refusing to protect was associated with higher AM cortisol (β = 0.08, p = 0.03) and higher average daily cortisol (β = 0.09, p = 0.02). Recent experiences of stigma were not significant predictors of any measure of cortisol. Measures of salivary cortisol may be used to characterize sexual behavior stigma among MSM populations, however more insight is needed to determine its exact relationship and strength.
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Affiliation(s)
- Kate E Dibble
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6133, Baltimore, MD, 21205, USA.
| | - Sarah M Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Stefan D Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6133, Baltimore, MD, 21205, USA
| | - Maria Zlotorzynska
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - John Mark Wiginton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Rob Stephenson
- Department of Systems, Populations, and Leadership, School of Nursing, and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, 48109, USA
| | - O Winslow Edwards
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Carrie Lyons
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Jacob C Rainey
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Qian-Li Xue
- Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
| | - Travis H Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
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23
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Greenberg AE, Wutoh A, Bowleg L, Robinson B, Magnus M, Segarra L, Simon P, Wutoh A, Blankenship K, Burke M, Okeke NL, Corneli A, Hussen S, Holliday RC, Ciaranello A, Ghebremichael M, Haberer J, Irvin R, Irvin N, Antoine DG, Chen Z, Momplaisir F, Jordan-Sciutto K, So-Armah K, Kuo C, Flanigan T, Sanchez M, Levine AD, Sluis-Cremer N, Koethe JR, Dash C, Pereira FA, Rice AP, Newell A, Dācus J, Wood C, Elopre L, Rana A, Pitpitan E, Stockman JK, Sauceda J, Marquez C, Robinson S, Chi BH, Balkus J, Walters K, Lewin A, Schoonmaker A, Wong E, Refsland E. Centers for AIDS Research (CFAR) Diversity, Equity, and Inclusion Pathway Initiative (CDEIPI): Developing Career Pathways for Early-Stage Scholars From Racial and Ethnic Groups Underrepresented in HIV Science and Medicine. J Acquir Immune Defic Syndr 2023; 94:S5-S12. [PMID: 37707842 PMCID: PMC10567097 DOI: 10.1097/qai.0000000000003270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
BACKGROUND There is an urgent need to increase diversity among scientific investigators in the HIV research field to be more reflective of communities highly affected by the HIV epidemic. Thus, it is critical to promote the inclusion and advancement of early-stage scholars from racial and ethnic groups underrepresented in HIV science and medicine. METHODS To widen the HIV research career pathway for early-stage scholars from underrepresented minority groups, the National Institutes of Health supported the development of the Centers for AIDS Research (CFAR) Diversity, Equity, and Inclusion Pathway Initiative (CDEIPI). This program was created through partnerships between CFARs and Historically Black Colleges and Universities and other Minority Serving Institutions throughout the United States. RESULTS Seventeen CFARs and more than 20 Historically Black Colleges and Universities and Minority Serving Institutions have participated in this initiative to date. Programs were designed for the high school (8), undergraduate (13), post baccalaureate (2), graduate (12), and postdoctoral (4) levels. Various pedagogical approaches were used including didactic seminar series, intensive multiday workshops, summer residential programs, and mentored research internship opportunities. During the first 18 months of the initiative, 257 student scholars participated in CDEIPI programs including 150 high school, 73 undergraduate, 3 post baccalaureate, 27 graduate, and 4 postdoctoral students. CONCLUSION Numerous student scholars from a wide range of educational levels, geographic backgrounds, and racial and ethnic minority groups have engaged in CDEIPI programs. Timely and comprehensive program evaluation data will be critical to support a long-term commitment to this unique training initiative.
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24
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Magnus M, Segarra L, Robinson B, Blankenship K, Corneli A, Ghebremichael M, Irvin N, McIntosh R, Favor KE, Jordan-Sciutto KL, Kimberly J, Sluis-Cremer N, Koethe JR, Newell A, Wood C, Rana A, Stockman JK, Sauceda J, Marquez C, Chi BH, Orellana ER, Wutoh A, Bowleg L, Greenberg AE. Impact of a Multi-Institutional Initiative to Engage Students and Early-Stage Scholars From Underrepresented Racial and Ethnic Minority Groups in HIV Research: The Centers for AIDS Research Diversity, Equity, and Inclusion Pathway Initiative. J Acquir Immune Defic Syndr 2023; 94:S13-S20. [PMID: 37707843 PMCID: PMC10539009 DOI: 10.1097/qai.0000000000003266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
BACKGROUND The Centers for AIDS Research Diversity, Equity, and Inclusion Pathway Initiative (CDEIPI) aims to establish programs to develop pathways for successful careers in HIV science among scholars from underrepresented racial and ethnic populations. This article describes cross-site evaluation outcomes during the first 18 months (July 2021-December 2022) across 15 programs. METHODS The aims of the evaluation were to characterize participants, describe feasibility, challenges, and successes of the programs and provide a basis for the generalizability of best practices to Diversity, Equity, and Inclusion (DEI) programs in the United States. Two primary data collection methods were used: a quarterly programmatic monitoring process and a centrally managed, individual-level, participant quantitative and qualitative survey. RESULTS During the first year of evaluation data collection, 1085 racially and ethnically diverse scholars ranging from the high school to postdoctoral levels applied for CDEIPI programs throughout the United States. Of these, 257 (23.7%) were selected to participate based on program capacity and applicant qualifications. Participants were trained by 149 mentors, teachers, and staff. Of the N = 95 participants responding to the individual-level survey, 95.7% agreed or strongly agreed with statements of satisfaction with the program, 96.8% planned to pursue further education, and 73.7% attributed increased interest in a variety of HIV science topics to the program. Qualitative findings suggest strong associations between mentorship, exposure to scientific content, and positive outcomes. CONCLUSIONS These data provide evidence to support the feasibility and impact of novel DEI programs in HIV research to engage and encourage racially and ethnically diverse scholars to pursue careers in HIV science.
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Affiliation(s)
- Manya Magnus
- Department of Epidemiology, School of Public Health, George Washington University, Washington DC, USA
| | - Lorena Segarra
- Department of Epidemiology, School of Public Health, George Washington University, Washington DC, USA
| | - Brandi Robinson
- Department of Epidemiology, School of Public Health, George Washington University, Washington DC, USA
| | - Kim Blankenship
- Department of Sociology, College of Arts & Sciences, American University, Washington DC, USA
| | - Amy Corneli
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | | | - Nathan Irvin
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore,
MD, USA
| | - Roger McIntosh
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Kevin E. Favor
- Psychology and Human Services Department, Lincoln University; PA, USA
| | | | - Judy Kimberly
- Division of Biology & Medicine, Brown University, Providence, RI, USA
| | - Nicolas Sluis-Cremer
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - John R. Koethe
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN USA
| | - Alana Newell
- Department of Education, Innovation and Technology, Baylor College of Medicine; Houston, TX USA
| | - Christine Wood
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Aadia Rana
- Division of Infectious Diseases, Heersink School of
Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jamila K. Stockman
- Division of Infectious Diseases and Global Public Health,
Department of Medicine, University of California San Diego; San Diego, CA, USA
| | - John Sauceda
- Division of Prevention Science; University of California,
San Francisco; San Francisco, CA, USA/and CM: Division of HIV, Infectious Diseases
and Global Medicine; University of California, San Francisco; San Francisco, CA,
USA
| | - Carina Marquez
- Division of Prevention Science; University of California,
San Francisco; San Francisco, CA, USA/and CM: Division of HIV, Infectious Diseases
and Global Medicine; University of California, San Francisco; San Francisco, CA,
USA
| | - Benjamin H. Chi
- Department of Obstetrics and Gynecology, University of
North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Lisa Bowleg
- Department of Psychological & Brain Sciences,
Columbian College of Arts & Sciences, George Washington University,
Washington DC, USA
| | - Alan E. Greenberg
- Department of Epidemiology, School of Public Health, George Washington University, Washington DC, USA
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25
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Goodrum NM, Lopez CM, delMas S, Davies F, Lampe B, Eckard AR, Danielson CK, Rheingold AA, Moreland AD. Moving toward transdisciplinary approaches to addressing HIV and psychological trauma: Barriers and facilitators to building collaborations. J Trauma Stress 2023; 36:884-895. [PMID: 37490311 PMCID: PMC11027063 DOI: 10.1002/jts.22959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 07/26/2023]
Abstract
Most people living with HIV have experienced potentially traumatic events (e.g., physical assault, sexual assault, intimate partner violence) and, consequently, are at risk of trauma-related mental health difficulties, including posttraumatic stress disorder (PTSD). Yet, research and clinical efforts related to HIV and psychological trauma remain siloed. Guided by the four-phase model of transdisciplinary research, the current study explored barriers and facilitators to transdisciplinary HIV/trauma clinical and research collaborations to address the overlap between HIV and psychological trauma. This exploration represents an initial step in the development and conceptualization of a transdisciplinary team known as Team REACH (Resiliency, Engagement, and Accessibility for Comorbid HIV/PTSD), which seeks to address the overlap between HIV and psychological trauma. Barriers and facilitators were explored through individual qualitative interviews with 21 research and clinical staff members across two clinics within an academic medical center (i.e., an infectious diseases clinic and a trauma-focused specialty mental health clinic). The findings revealed a number of barriers, including a lack of awareness, time and funding concerns, and a lack of clarity regarding services or the division of responsibility. The results also highlight perceived facilitators for collaborations, such as existing infrastructure and relationships, shared goals, leadership support, knowledge of other agency activities, and staff/team buy-in. Recommendations for increased collaboration included ongoing communication, needs assessment and goal development, access to partners, and role establishment. These findings will guide the next steps in further developing transdisciplinary collaboration goals and have implications for increasing collaborative approaches to patient care and targeting processes to enhance team effectiveness for transdisciplinary goals.
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Affiliation(s)
- Nada M. Goodrum
- Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
| | - Cristina M. Lopez
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sara delMas
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Faraday Davies
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Brooke Lampe
- Division of Infectious Diseases, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Allison R. Eckard
- Division of Infectious Diseases, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Carla Kmett Danielson
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alyssa A. Rheingold
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Angela D. Moreland
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, South Carolina, USA
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26
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Rein SM, Lampe FC, Ingle SM, Sterne JAC, Trickey A, Gill MJ, Papastamopoulos V, Wittkop L, van der Valk M, Kitchen M, Guest JL, Satre DD, Wandeler G, Galindo P, Castilho J, Crane HM, Smith CJ. All-cause hospitalisation among people living with HIV according to gender, mode of HIV acquisition, ethnicity, and geographical origin in Europe and North America: findings from the ART-CC cohort collaboration. Lancet Public Health 2023; 8:e776-e787. [PMID: 37777287 PMCID: PMC10851157 DOI: 10.1016/s2468-2667(23)00178-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Understanding demographic disparities in hospitalisation is crucial for the identification of vulnerable populations, interventions, and resource planning. METHODS Data were from the Antiretroviral Therapy Cohort Collaboration (ART-CC) on people living with HIV in Europe and North America, followed up between January, 2007 and December, 2020. We investigated differences in all-cause hospitalisation according to gender and mode of HIV acquisition, ethnicity, and combined geographical origin and ethnicity, in people living with HIV on modern combination antiretroviral therapy (cART). Analyses were performed separately for European and North American cohorts. Hospitalisation rates were assessed using negative binomial multilevel regression, adjusted for age, time since cART intitiaion, and calendar year. FINDINGS Among 23 594 people living with HIV in Europe and 9612 in North America, hospitalisation rates per 100 person-years were 16·2 (95% CI 16·0-16·4) and 13·1 (12·8-13·5). Compared with gay, bisexual, and other men who have sex with men, rates were higher for heterosexual men and women, and much higher for men and women who acquired HIV through injection drug use (adjusted incidence rate ratios ranged from 1·2 to 2·5 in Europe and from 1·2 to 3·3 in North America). In both regions, individuals with geographical origin other than the region of study generally had lower hospitalisation rates compared with those with geographical origin of the study country. In North America, Indigenous people and Black or African American individuals had higher rates than White individuals (adjusted incidence rate ratios 1·9 and 1·2), whereas Asian and Hispanic people living with HIV had somewhat lower rates. In Europe there was a lower rate in Asian individuals compared with White individuals. INTERPRETATION Substantial disparities exist in all-cause hospitalisation between demographic groups of people living with HIV in the current cART era in high-income settings, highlighting the need for targeted support. FUNDING Royal Free Charity and the National Institute on Alcohol Abuse and Alcoholism.
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Affiliation(s)
- Sophia M Rein
- CAUSALab and Department of Epidemiology, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Institute for Global Health, UCL, London, UK.
| | | | - Suzanne M Ingle
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jonathan A C Sterne
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; NIHR Bristol Biomedical Research Centre, Bristol, UK; Health Data Research UK South-West, Bristol, UK
| | - Adam Trickey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - M John Gill
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Vasileios Papastamopoulos
- Department of Internal Medicine and Infectious Diseases, Evaggelismos General Hospital, Athens, Greece
| | - Linda Wittkop
- University of Bordeaux, INSERM, Bordeaux Population Health-U1219, CIC1401-EC, Bordeaux, France; CHU de Bordeaux-Bordeaux University Hospital, Service d'information médicale, INSERM, CIC-EC 1401, Bordeaux, Franc; SISTM, INRIA, University of Bordeaux, Talence, France
| | - Marc van der Valk
- Department of Infectious Diseases, Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Stichting HIV Monitoring, Amsterdam, Netherlands
| | - Maria Kitchen
- Department of Dermatology, Venereology, and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - Jodie L Guest
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Derek D Satre
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA; Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
| | - Pepa Galindo
- Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Jessica Castilho
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Heidi M Crane
- Department of Medicine and Department of Health Services, University of Washington, Seattle, WA, USA
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27
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Garcia DR, Fletcher J, Goldsamt L, Bell DL, Zheng Y, Navarra AMD. HIV Syndemic Factor Associations Among Adolescent Gay and Bisexual Men in the Youth Risk Behavior Survey 2015-2019: A Secondary Data Analysis. J Assoc Nurses AIDS Care 2023; 34:440-458. [PMID: 37603450 PMCID: PMC10528913 DOI: 10.1097/jnc.0000000000000423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
ABSTRACT This analysis of the Youth Risk Behavior Survey examined HIV syndemic factor associations (substance use, violence, mental health, and HIV risk behaviors) among adolescent gay, bisexual, and other men who have sex with men-a population with the highest prevalence of undiagnosed HIV infections. The representative sample ( n = 644) exhibited low condom use (52%) and HIV testing (21%). Adjusted multivariate logistic regression models showed that Blacks were less likely to report HIV testing (adjusted odds ratio [aOR] = 0.06, 95% confidence interval [CI] [0.01-0.44], p < .01), whereas Hispanics were more likely to report four or more lifetime sexual partners (aOR = 3.75, 95% CI [1.49-9.44], p < .01), compared with Whites. A syndemic of substance use and intimate partner violence (sexual, sexual dating, and/or physical dating violence) was associated with early intercourse, multiple sexual partners, and drugs/alcohol before intercourse. Multiple syndemic factor exposures were associated with additive risk, suggesting multilevel approaches for HIV prevention.
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Affiliation(s)
- David R. Garcia
- Provost’s Postdoctoral Research Fellow, Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Jason Fletcher
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Lloyd Goldsamt
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - David L. Bell
- Population and Family Health and Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Yaguang Zheng
- Rory Meyers College of Nursing, New York University, New York, NY, USA
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Filippone P, Serrano S, Campos S, Freeman R, Cluesman SR, Israel K, Amos B, Cleland CM, Gwadz M. Understanding why racial/ethnic inequities along the HIV care continuum persist in the United States: a qualitative exploration of systemic barriers from the perspectives of African American/Black and Latino persons living with HIV. Int J Equity Health 2023; 22:168. [PMID: 37649049 PMCID: PMC10466874 DOI: 10.1186/s12939-023-01992-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/15/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Racial/ethnic inequities along the HIV care continuum persist in the United States despite substantial federal investment. Numerous studies highlight individual and social-level impediments in HIV, but fewer foreground systemic barriers. The present qualitative study sought to uncover and describe systemic barriers to the HIV care continuum from the perspectives of African American/Black and Latino persons living with HIV (PLWH) with unsuppressed HIV viral load, including how barriers operated and their effects. METHODS Participants were African American/Black and Latino PLWH with unsuppressed HIV viral load (N = 41). They were purposively sampled for maximum variability on key indices from a larger study. They engaged in semi-structured in-depth interviews that were audio-recorded and professionally transcribed. Data were analyzed using directed content analysis. RESULTS Participants were 49 years old, on average (SD = 9), 76% were assigned male sex at birth, 83% were African American/Black and 17% Latino, 34% were sexual minorities (i.e., non-heterosexual), and 22% were transgender/gender-nonbinary. All had indications of chronic poverty. Participants had been diagnosed with HIV 19 years prior to the study, on average (SD = 9). The majority (76%) had taken HIV medication in the six weeks before enrollment, but at levels insufficient to reach HIV viral suppression. Findings underscored a primary theme describing chronic poverty as a fundamental cause of poor engagement. Related subthemes were: negative aspects of congregate versus private housing settings (e.g., triggering substance use and social isolation); generally positive experiences with health care providers, although structural and cultural competency appeared insufficient and managing health care systems was difficult; pharmacies illegally purchased HIV medication from PLWH; and COVID-19 exacerbated barriers. Participants described mitigation strategies and evidenced resilience. CONCLUSIONS To reduce racial/ethnic inequities and end the HIV epidemic, it is necessary to understand African American/Black and Latino PLWH's perspectives on the systemic impediments they experience throughout the HIV care continuum. This study uncovers and describes a number of salient barriers and how they operate, including unexpected findings regarding drug diversion and negative aspects of congregate housing. There is growing awareness that systemic racism is a core determinant of systemic barriers to HIV care continuum engagement. Findings are interpreted in this context.
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Affiliation(s)
- Prema Filippone
- New York University Silver School of Social Work, 1 Washington Place North, New York, NY, 10003, USA
| | - Samantha Serrano
- New York University Silver School of Social Work, 1 Washington Place North, New York, NY, 10003, USA
| | - Stephanie Campos
- New York University Silver School of Social Work, 1 Washington Place North, New York, NY, 10003, USA
| | - Robin Freeman
- New York University Silver School of Social Work, 1 Washington Place North, New York, NY, 10003, USA
| | - Sabrina R Cluesman
- New York University Silver School of Social Work, 1 Washington Place North, New York, NY, 10003, USA
| | - Khadija Israel
- New York University Silver School of Social Work, 1 Washington Place North, New York, NY, 10003, USA
| | - Brianna Amos
- New York University Silver School of Social Work, 1 Washington Place North, New York, NY, 10003, USA
| | - Charles M Cleland
- Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, NY, 10016, USA
| | - Marya Gwadz
- New York University Silver School of Social Work, 1 Washington Place North, New York, NY, 10003, USA.
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Lucas JA, Marino M, Datta R, Chan BL, Heintzman JD. Ethnicity, Language, and HIV Screening in Older Adult Safety-Net Patients. Am J Prev Med 2023; 65:112-116. [PMID: 36754743 PMCID: PMC10293068 DOI: 10.1016/j.amepre.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 02/09/2023]
Abstract
INTRODUCTION HIV screening should occur for all adults at least once by age 65 years. Older adults have low screening rates. Latinos, with historically low screening rates, have worse HIV outcomes than non-Hispanic White patients. Electronic health record data from a multistate network of community health centers were used to examine whether there are differences in HIV screening for Latino (English and Spanish preferring) and non-Hispanic White older adults. METHODS Data were from the Accelerating Data Value Across a National Community Health Center Network Clinical Research Network of PCORnet from 21 states in 2012-2021 among an open cohort of patients aged 50-65 years. Relative odds of ever having received HIV screening comparing Latinos with non-Hispanic Whites using generalized estimating equation logistic regression modeling were calculated, adjusting for relevant patient-level covariates. Analyses were conducted in 2022. RESULTS Among 251,645 patients, the covariate-adjusted odds of ever receiving HIV screening were 18% higher for English-preferring Latino patients (OR=1.18, 95% CI=1.11, 1.25) and 32% higher for Spanish-preferring Latinos than for non-Hispanic Whites (OR=1.32, 95% CI=1.24, 1.42). CONCLUSIONS Latinos seen in community health centers, regardless of language spoken, are more likely to be screened at least once for HIV than non-Hispanic Whites. This increased screening may be due at least in part to the community health center setting, a setting known to mitigate disparities, as well as due to participation efforts by community health centers in public health campaigns. Future research can prioritize understanding the cause of this relative advantage.
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Affiliation(s)
- Jennifer A Lucas
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Roopradha Datta
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Brian L Chan
- OCHIN, Inc., Portland, Oregon; Department of Medicine, Oregon Health & Science University, Portland, Oregon
| | - John D Heintzman
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon; OCHIN, Inc., Portland, Oregon
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Psaros C, Goodman GR, McDonald VW, Ott C, Blyler A, Rivas A, Shan L, Campbell M, Underwood E, Krakower D, Elopre L, Kudroff K, Sherr KH, Kempf MC. Protocol for WeExPAnd: a prospective, mixed-methods pilot demonstration study to increase access to pre-exposure prophylaxis among women vulnerable to HIV infection in the Southern USA. BMJ Open 2023; 13:e075250. [PMID: 37286316 DOI: 10.1136/bmjopen-2023-075250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION African American women (AA), particularly those living in the Southeastern USA, experience disproportionately high rates of HIV infection. Pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention tool that may circumvent barriers to traditional HIV prevention tools, such as condom use; however, very little is known about how to improve PrEP access and uptake among AA women who may benefit from PrEP use. This project aims to understand how to increase PrEP access among AA women in the rural Southern USA, which may ultimately affect HIV incidence in this population. METHODS AND ANALYSIS The goal of the current study is to systematically adapt a patient-provider communication tool to increase PrEP uptake among AA women receiving care at a federally qualified health centre in Alabama. We will use an iterative implementation process, by assessing the feasibility, acceptability and preliminary impact of the tool on PrEP uptake, using a pilot preintervention/postintervention design (N=125). We will evaluate women's reasons for declining a referral to a PrEP provider, reasons for incomplete referrals, reasons for not initiating PrEP after a successful referral and ongoing PrEP use at 3 and 12 months after PrEP initiation among our sample. The proposed work will significantly contribute to our understanding of factors impacting PrEP uptake and use among AA women, particularly in underserved areas in the Deep South that are heavily impacted by the HIV epidemic and experience worse HIV-related health outcomes relative to other areas in the USA. ETHICS AND DISSEMINATION This protocol has been approved by the Institutional Review Board (IRB) at University of Alabama at Birmingham (Birmingham, AL; protocol 300004276). All participants will review a detailed informed consent form approved by the IRB and will provide written or verbal informed consent prior to enrolment. Results will be disseminated through peer-reviewed manuscripts, reports, and local, national and international presentations. TRIAL REGISTRATION NUMBER NCT04373551.
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Affiliation(s)
- Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, Boston, Massachusetts, USA
| | - Georgia R Goodman
- Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, Boston, Massachusetts, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- The Fenway Institute at Fenway Health, Boston, Massachusetts, USA
| | | | - Corilyn Ott
- School of Nursing, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Abigail Blyler
- Positive Psychology Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alexa Rivas
- Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, Boston, Massachusetts, USA
| | - Liang Shan
- School of Nursing, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Marquetta Campbell
- Maude L. Whatley Health Center, Whatley Health Services, Inc, Tuscaloosa, Alabama, USA
| | - Eric Underwood
- Maude L. Whatley Health Center, Whatley Health Services, Inc, Tuscaloosa, Alabama, USA
| | - Douglas Krakower
- The Fenway Institute at Fenway Health, Boston, Massachusetts, USA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Latesha Elopre
- Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kachina Kudroff
- Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kenneth H Sherr
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Mirjam-Colette Kempf
- School of Nursing, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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THIMM‐KAISER MARCO, BENZEKRI ADAM, GUILAMO‐RAMOS VINCENT. Conceptualizing the Mechanisms of Social Determinants of Health: A Heuristic Framework to Inform Future Directions for Mitigation. Milbank Q 2023; 101:486-526. [PMID: 37062954 PMCID: PMC10262397 DOI: 10.1111/1468-0009.12642] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 02/28/2023] [Accepted: 03/09/2023] [Indexed: 04/18/2023] Open
Abstract
Policy Points A large body of scientific work examines the mechanisms through which social determinants of health (SDOH) shape health inequities. However, the nuances described in the literature are infrequently reflected in the applied frameworks that inform health policy and programming. We synthesize extant SDOH research into a heuristic framework that provides policymakers, practitioners, and researchers with a customizable template for conceptualizing and operationalizing key mechanisms that represent intervention opportunities for mitigating the impact of harmful SDOH. In light of scarce existing SDOH mitigation strategies, the framework addresses an important research-to-practice translation gap and missed opportunity for advancing health equity. CONTEXT The reduction of health inequities is a broad and interdisciplinary endeavor with implications for policy, research, and practice. Health inequities are most often understood as associated with the social determinants of health (SDOH). However, policy and programmatic frameworks for mitigation often rely on broad SDOH domains, without sufficient attention to the operating mechanisms, and effective SDOH mitigation strategies remain scarce. To expand the cadre of effective SDOH mitigation strategies, a practical, heuristic framework for policymakers, practitioners, and researchers is needed that serves as a roadmap for conceptualizing and targeting the key mechanisms of SDOH influence. METHODS We conduct a critical review of the extant conceptual and empirical SDOH literature to identify unifying principles of SDOH mechanisms and to synthesize an integrated framework for conceptualizing such mechanisms. FINDINGS We highlight eight unifying principles of SDOH mechanisms that emerge from landmark SDOH research. Building on these principles, we introduce and apply a conceptual model that synthesizes key SDOH mechanisms into one organizing, heuristic framework that provides policymakers, practitioners, and researchers with a customizable template for conceptualizing and operationalizing the key SDOH mechanisms that represent intervention opportunities to maximize potential impact for mitigating a given health inequity. CONCLUSIONS Our synthesis of the extant SDOH research into a heuristic framework addresses a scarcity of peer-reviewed organizing frameworks of SDOH mechanisms designed to inform practice. The framework represents a practical tool to facilitate the translation of scholarly SDOH work into evidence-based and targeted policy and programming. Such tools designed to close the research-to-practice translation gap for effective SDOH mitigation are sorely needed, given that health inequities in the United States and in many other parts of the world have widened over the past two decades.
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Affiliation(s)
- MARCO THIMM‐KAISER
- Center for Latino Adolescent and Family HealthDuke University
- School of Nursing, Duke University
| | - ADAM BENZEKRI
- Center for Latino Adolescent and Family HealthDuke University
- School of Nursing, Duke University
| | - VINCENT GUILAMO‐RAMOS
- Center for Latino Adolescent and Family HealthDuke University
- School of Nursing, Duke University
- School of Medicine, Duke University
- Presidential Advisory Council on HIV/AIDS, US Department of Health and Human Services
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Jackson L, Lee Y, Batey DS. Structural violence within communities and its impact on the well-being of people with HIV (PWH). AIDS Care 2023; 35:265-270. [PMID: 35727148 DOI: 10.1080/09540121.2022.2088679] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Structural violence (SV) is the concept that there are often invisible and intangible structures in place, whether political, economic, legal, cultural, religious, or social, that can inhibit individuals from reaching their full potential. There is a need to better understand the influence of SV on the well-being of people with HIV (PWH) in the Deep South. To address this gap in the literature, we interpreted data using a Structural Violence framework. In this community-based participatory research, in-depth interviews (n = 40) were conducted with PWH who previously established HIV medical care. In our study, we found that SV can have a widespread impact in communities, negatively impacting access to key tangible and emotional resources. SV themes included community crime and instability, financial insecurity, and disparate access to numerous resources known to influence health. Structures exacerbating unequal access to resources appear engrained within communities and often went unrecognized by participants as disadvantageous to achieving optimal HIV health. Greater effort is necessary to elucidate the influence and role of violent structures on access to key resources for and by PWH. A clearer understanding of SV's influence on HIV health can inform changes addressing these structural barriers to HIV health.
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Affiliation(s)
| | - Yookyong Lee
- Department of Social Work, University of Alabama at Birmingham (UAB), Birmingham, USA
| | - D Scott Batey
- Department of Social Work, University of Alabama at Birmingham (UAB), Birmingham, USA
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Barnett AP, Brown LK, Crosby R, Craker L, Washington R, Burns PA, Mena LA. Family-Related Factors and HIV-Related Outcomes Among Black Young Men Who Have Sex with Men in Mississippi. AIDS Behav 2022; 27:1548-1563. [PMID: 36318432 PMCID: PMC9628553 DOI: 10.1007/s10461-022-03889-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2022] [Indexed: 11/05/2022]
Abstract
Given their disproportionate HIV incidence, there is a critical need to identify factors related to HIV risk among Black young men who have sex with men (YMSM) in the southeastern United States. This study investigated the association of family factors and HIV-related outcomes among Black YMSM in Mississippi ages 14-20 (n = 72). Multivariable regression models evaluated associations of family factors and outcomes. Greater parent/child communication about sex was associated with fewer lifetime male sex partners and lower odds of lifetime anal sex. Greater parental monitoring was associated with greater likelihood of future condom use. Sexual orientation disclosure was associated with more lifetime male sex partners. Parental monitoring and parent/child communication about sex were protective, suggesting that family-based interventions are promising for HIV prevention among Black YMSM in Mississippi. Results also indicated that YMSM who are "out" to family are important to reach, and families could be useful in encouraging healthy behaviors.
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Affiliation(s)
- Andrew P. Barnett
- Bradley/Hasbro Children’s Research Center, Rhode Island Hospital, 1 Hoppin Street, Suite 204, Providence, RI 02903 USA ,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Larry K. Brown
- Bradley/Hasbro Children’s Research Center, Rhode Island Hospital, 1 Hoppin Street, Suite 204, Providence, RI 02903 USA ,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Richard Crosby
- Department of Health, Behavior, and Society, University of Kentucky, Lexington, KY USA
| | - Lacey Craker
- Bradley/Hasbro Children’s Research Center, Rhode Island Hospital, 1 Hoppin Street, Suite 204, Providence, RI 02903 USA ,Present Address: Division of Prevention Science and Community Health, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL USA
| | - Rodney Washington
- Department of Population Health Sciences, University of Mississippi Medical Center, Jackson, USA
| | - Paul A. Burns
- Department of Population Health Sciences, University of Mississippi Medical Center, Jackson, USA
| | - Leandro A. Mena
- Department of Population Health Sciences, University of Mississippi Medical Center, Jackson, USA ,Present Address: Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA USA
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Martinez O, Munoz-Laboy M, Davison R. Medical-legal partnerships: An integrated approach to advance health equity and improve health outcomes for people living with HIV. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:871101. [PMID: 36303611 PMCID: PMC9580720 DOI: 10.3389/frph.2022.871101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
Medical Legal Partnerships (MLPs) offer a structural integrated intervention that could facilitate improvements in medical and psychosocial outcomes among people living with HIV (PLWH). Through legal aid, MLPs can ensure that patients are able to access HIV services in a culturally sensitive environment. We conducted organizational-level qualitative research rooted in grounded theory, consisting of key informant interviews with MLP providers (n = 19) and members of the Scientific Collaborative Board (SCB; n = 4), site visits to agencies with MLPs (n = 3), and meetings (n = 4) with members of the SCB. Four common themes were identified: (1) availability and accessibility of legal and social services support suggest improvements in health outcomes for PLWH; (2) observations and experiences reveal that MLPs have a positive impact on PLWH; (3) 3 intersecting continua of care exist within MLPs: HIV care continuum; legal continuum of care; and social services continuum; and (4) engagement in care through an MLP increases patient engagement and community participation. The MLP approach as a structural intervention has the potential to alleviate barriers to HIV/AIDS treatment and care and thus dramatically improve health outcomes among PLWH.
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Affiliation(s)
- Omar Martinez
- College of Medicine, University of Central Florida, Orlando, FL, United States,*Correspondence: Omar Martinez
| | - Miguel Munoz-Laboy
- School of Social Welfare, Stony Brook University, Stony Brook, NY, United States
| | - Robin Davison
- College of Medicine, University of Central Florida, Orlando, FL, United States
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Goldin Evans M, Wallace M, Theall KP, Mahoney AM, Richardson L, Daniel CM. State-Level Recommendations to Reduce Inequities in Sexually Transmitted Infections. Womens Health Issues 2022; 32:427-430. [PMID: 35961852 DOI: 10.1016/j.whi.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/05/2022] [Accepted: 07/15/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Melissa Goldin Evans
- Mary Amelia Center for Women's Health Equity Research, Department of Social, Behavioral, and Population Science, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
| | - Maeve Wallace
- Mary Amelia Center for Women's Health Equity Research, Department of Social, Behavioral, and Population Science, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Katherine P Theall
- Mary Amelia Center for Women's Health Equity Research, Department of Social, Behavioral, and Population Science, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | | | - Lisa Richardson
- Institute of Women and Ethnic Studies, New Orleans, Louisiana
| | - Clare M Daniel
- Newcomb Institute, Tulane University, New Orleans, Louisiana
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Golub SA, Fikslin RA. Recognizing and disrupting stigma in implementation of HIV prevention and care: a call to research and action. J Int AIDS Soc 2022; 25 Suppl 1:e25930. [PMID: 35818865 PMCID: PMC9274207 DOI: 10.1002/jia2.25930] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 05/04/2022] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION There is robust evidence that stigma negatively impacts both people living with HIV and those who might benefit from HIV prevention interventions. Within healthcare settings, research on HIV stigma has focused on intra-personal processes (i.e. knowledge or internalization of community-level stigma that might limit clients' engagement in care) or inter-personal processes (i.e. stigmatized interactions with service providers). Intersectional approaches to stigma call us to examine the ways that intersecting systems of power and oppression produce stigma not only at the individual and interpersonal levels, but also within healthcare service delivery systems. This commentary argues for the importance of analysing and disrupting the way in which stigma may be (intentionally or unintentionally) enacted and sustained within HIV service implementation, that is the policies, protocols and strategies used to deliver HIV prevention and care. We contend that as HIV researchers and practitioners, we have failed to fully specify or examine the mechanisms through which HIV service implementation itself may reinforce stigma and perpetuate inequity. DISCUSSION We apply Link and Phelan's five stigma components (labelling, stereotyping, separation, status loss and discrimination) as a framework for analysing the way in which stigma manifests in existing service implementation and for evaluating new HIV implementation strategies. We present three examples of common HIV service implementation strategies and consider their potential to activate stigma components, with particular attention to how our understanding of these dynamics can be enhanced and expanded by the application of intersectional perspectives. We then provide a set of sample questions that can be used to develop and test novel implementation strategies designed to mitigate against HIV-specific and intersectional stigma. CONCLUSIONS This commentary is a theory-informed call to action for the assessment of existing HIV service implementation, for the development of new stigma-reducing implementation strategies and for the explicit inclusion of stigma reduction as a core outcome in implementation research and evaluation. We argue that these strategies have the potential to make critical contributions to our ability to address many system-level form stigmas that undermine health and wellbeing for people living with HIV and those in need of HIV prevention services.
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Affiliation(s)
- Sarit A Golub
- Department of Psychology, Hunter College, New York, New York, USA.,Basic and Applied Social Psychology, The Graduate Center of the City University of New York, New York, New York, USA.,Hunter Alliance for Research and Translation, Hunter College, New York, New York, USA.,Einstein-Rockefeller-CUNY Center for AIDS Research (ERC-CFAR), New York, New York, USA
| | - Rachel A Fikslin
- Department of Psychology, Hunter College, New York, New York, USA.,Basic and Applied Social Psychology, The Graduate Center of the City University of New York, New York, New York, USA.,Hunter Alliance for Research and Translation, Hunter College, New York, New York, USA
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Friedman SR, Williams LD, Jordan AE, Walters S, Perlman DC, Mateu-Gelabert P, Nikolopoulos GK, Khan MR, Peprah E, Ezell J. Toward a Theory of the Underpinnings and Vulnerabilities of Structural Racism: Looking Upstream from Disease Inequities among People Who Use Drugs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7453. [PMID: 35742699 PMCID: PMC9224240 DOI: 10.3390/ijerph19127453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 12/04/2022]
Abstract
Structural racism is increasingly recognized as a key driver of health inequities and other adverse outcomes. This paper focuses on structural racism as an "upstream" institutionalized process, how it creates health inequities and how structural racism persists in spite of generations of efforts to end it. So far, "downstream" efforts to reduce these health inequities have had little success in eliminating them. Here, we attempt to increase public health awareness of structural racism and its institutionalization and sociopolitical supports so that research and action can address them. This paper presents both a theoretic and an analytic approach to how structural racism contributes to disproportionate rates of HIV/AIDS and related diseases among oppressed populations. We first discuss differences in disease and health outcomes among people who use drugs (PWUD) and other groups at risk for HIV from different racial and ethnic populations. The paper then briefly analyzes the history of racism; how racial oppression, class, gender and other intersectional divisions interact to create health inequities; and how structural racism is institutionalized in ways that contribute to disease disparities among people who use drugs and other people. It examines the processes, institutions and other structures that reinforce structural racism, and how these, combined with processes that normalize racism, serve as barriers to efforts to counter and dismantle the structural racism that Black, indigenous and Latinx people have confronted for centuries. Finally, we discuss the implications of this analysis for public health research and action to undo racism and to enhance the health of populations who have suffered lifetimes of racial/ethnic oppression, with a focus on HIV/AIDS outcomes.
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Affiliation(s)
- Samuel R. Friedman
- Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA;
| | - Leslie D. Williams
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL 60612, USA;
| | - Ashly E. Jordan
- Center for Drug Use and HIV/HCV Research, New York, NY 10003, USA;
| | - Suzan Walters
- Department of Epidemiology, New York University School of Global Public Health, New York, NY 10003, USA; (S.W.); (E.P.)
| | - David C. Perlman
- Icahn School of Medicine at Mount Sinai, New York, NY 10003, USA;
| | - Pedro Mateu-Gelabert
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY 10027, USA;
| | | | - Maria R. Khan
- Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA;
| | - Emmanuel Peprah
- Department of Epidemiology, New York University School of Global Public Health, New York, NY 10003, USA; (S.W.); (E.P.)
| | - Jerel Ezell
- Africana Studies and Research Center, Cornell University, Ithaca, NY 14850, USA;
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Klein MD, Keen SK, Sanka P, Senter E, Lin FC, Jones H, Vandermolen JL, Simpson RJ. Social Disparities among Sudden Death victims with HIV. AIDS Behav 2022; 26:3974-3980. [PMID: 35672553 DOI: 10.1007/s10461-022-03723-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 05/18/2022] [Indexed: 11/01/2022]
Abstract
Although cardiovascular death is a growing source of mortality for people living with human immunodeficiency virus (HIV), the risk factors and circumstances surrounding sudden death in this population are poorly understood. We compared 399 adult sudden death victims reported by Emergency Medical Services in North Carolina to 1,114 controls. Sudden death was more common among HIV-positive than HIV-negative individuals (OR: 2.59, 95% CI: 1.15-5.83). In a multivariable model of sudden death victims including Black race, BMI, and history of divorce, incarceration, substance abuse, and respiratory disease, HIV-positive individuals were more likely to be Black (adjusted OR [aOR]: 6.04, 95% CI: 1.08-33.7) or divorced (aOR: 4.71, 95% CI: 1.04-21.3), adjusted for all other variables in the model. Compared to controls with HIV, sudden death victims with HIV were more likely to have a history of incarceration, divorce, respiratory disease, alcohol abuse, or dyslipidemia. A qualitative assessment of victims suggested that many died in isolation, suffering from past and current substance abuse and depression. HIV infection appears to be an important risk factor for sudden death, and incarceration history, social isolation, and medical comorbidities contribute to sudden death risk for HIV-positive individuals.
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Affiliation(s)
- Melissa D Klein
- Department of Medicine, Department of Medicine, Washington University in St. Louis School of Medicine, 63110, St. Louis, Missouri, United States of America.
| | - Susan K Keen
- Preventive Medicine Residency, Department of Family Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Pranavi Sanka
- Department of Medicine, Brown University, Providence, Rhode Island, United States of America
| | - Elizabeth Senter
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Feng-Chang Lin
- The North Carolina Translational & Clinical Sciences Institute, Chapel Hill, NC, United States of America
| | - Hannah Jones
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Justin L Vandermolen
- Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Ross J Simpson
- Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
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Lett E, Asabor EN, Tran N, Dowshen N, Aysola J, Gordon AR, Agénor M. Sexual Behaviors Associated with HIV Transmission Among Transgender and Gender Diverse Young Adults: The Intersectional Role of Racism and Transphobia. AIDS Behav 2022; 26:3713-3725. [PMID: 35661016 DOI: 10.1007/s10461-022-03701-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 12/31/2022]
Abstract
HIV prevalence and engagement in sexual behaviors associated with HIV transmission are high among transgender people of color. Per intersectionality, this disproportionate burden may be related to both interpersonal and structural racism and transphobia. The goal of this study was to estimate the association between interpersonal and structural discrimination and sexual behaviors among transgender and gender diverse (TGD) U.S. young adults. We used logit models with robust standard errors to estimate the individual and combined association between interpersonal and structural racism and transphobia and sexual behaviors in a national online sample of TGD young adults of color (TYAOC) aged 18-30 years (N = 228). Racism was measured at the interpersonal and structural level using the Everyday Discrimination Scale and State Racism Index, respectively. Transphobia was measured at the interpersonal and structural level using the Gender Minority Stress Scale and the Gender Identity Tally, respectively. We found that interpersonal racism was associated with transactional sex, and interpersonal transphobia was associated with alcohol/drug consumption prior to sex and transactional sex among TYAOC. We also found evidence of a strong joint association of interpersonal and structural racism and transphobia with alcohol/drug consumption prior to sex (OR 3.85, 95% CI 2.12, 7.01) and transactional sex (OR 3.54, 95% CI 0.99, 12.59) among TYAOC. Racism and transphobia have a compounding impact on sexual behaviors among TYAOC. Targeted interventions that reduce discrimination at both the interpersonal and structural level may help reduce the HIV burden in this marginalized population.
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Affiliation(s)
- Elle Lett
- Center for Applied Transgender Studies, Chicago, IL, USA.
- Perelman School of Medicine, University of Pennsylvania, Blockley Hall, Philadelphia, PA, 19146, USA.
| | | | - Nguyen Tran
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Nadia Dowshen
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jaya Aysola
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Allegra R Gordon
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Madina Agénor
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
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Doherty R, Walsh JL, Quinn KG, John SA. Association of Race and Other Social Determinants of Health With HIV Pre-Exposure Prophylaxis Use: A County-Level Analysis Using the PrEP-to-Need Ratio. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2022; 34:183-194. [PMID: 35647866 PMCID: PMC9196948 DOI: 10.1521/aeap.2022.34.3.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Research is limited on the effect of racism and social determinants of health on HIV pre-exposure prophylaxis (PrEP) use. This study used the PrEP-to-Need Ratio (PNR), which measures PrEP prescriptions divided by HIV diagnoses in the county, to evaluate sufficient PrEP use. AIDSVu datasets were compared to county-level social determinants of health. Standardized regression coefficients (β) were compared to identify strongest associations with PNR. Overall, factors including percent African American and percent uninsured had negative correlations with PNR, whereas median household income and severe housing cost burden had positive associations. Stratifying for population size, percent African American, percent uninsured, and severe housing cost burden were significant for low population areas, whereas median household income, percent in poverty, percent uninsured, and percent African American were significant for large populations. To reduce PrEP disparities, public health must develop strategies to reach those most in need, especially historically disadvantaged communities.
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Affiliation(s)
- Ryan Doherty
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer L. Walsh
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Katherine G. Quinn
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Steven A. John
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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