In their own voices: rural African American youth speak out about community-based HIV prevention interventions

Novel Recruitment Methods for Research Among Young Adults in Rural Areas Who Use Opioids: Cookouts, Coupons, and Community-Based Staff

OBJECTIVES

Rural communities in the United States are increasingly becoming epicenters of substance use and related harms. However, best practices for recruiting rural people who use drugs (PWUD) for epidemiologic research are unknown, because such strategies were developed in cities. This study explores the feasibility of web- and community-based strategies to recruit rural, young adult PWUD into epidemiologic research.

MATERIALS AND METHODS

We recruited PWUD from rural Kentucky to participate in a web-based survey about opioid use using web-based peer referral and community-based strategies, including cookouts, flyers, street outreach, and invitations to PWUD enrolled in a concurrent substance use study. Staff members labeled recruitment materials with unique codes to enable tracking. We assessed eligibility and fraud through online eligibility screening and a fraud detection algorithm, respectively. Eligibility criteria included being aged 18-35, recently using opioids to get high, and residing in the study area.

RESULTS

Recruitment yielded 410 complete screening entries, of which 234 were eligible and 151 provided complete, nonfraudulent surveys (ie, surveys that passed a fraud-detection algorithm designed to identify duplicate, nonlocal, and/or bot-generated entries). Cookouts and subsequent web-based peer referrals accounted for the highest proportion of screening entries (37.1%, n = 152), but only 29.6% (n = 45) of entries from cookouts and subsequent web-based peer referrals resulted in eligible, nonfraudulent surveys. Recruitment and subsequent web-based peer referral from the concurrent study yielded the second most screening entries (27.8%, n = 114), 77.2% (n = 88) of which resulted in valid surveys. Other recruitment strategies combined to yield 35.1% (n = 144) of screening entries and 11.9% (n = 18) of valid surveys.

CONCLUSIONS

Web-based methods need to be complemented by context-tailored, street-outreach activities to recruit rural PWUD.

Identifying Key Elements to Inform the Development of an HIV Health Behavior Maintenance Intervention

PURPOSE

To collect information that will inform the development of an intervention to support the maintenance of HIV-related health-promoting behaviors.

DESIGN

Focused, in-depth individual and group interviews.

SETTING

The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) and DOHMH-funded community-based organizations that primarily serve low-income people living with HIV within the five boroughs of NYC.

PARTICIPANTS

A total of 42 individuals who had participated in The Positive Life Workshop-an HIV self-management intervention adapted and implemented by the NYC DOHMH.

METHOD

Purposive sampling was used to recruit study participants. Five 60- to 90-minute focus groups (n = 38) and 4 individual interviews were conducted to assess motivations for and barriers to maintaining HIV-related health-promoting behaviors and to elicit feedback on the content and format for the proposed maintenance intervention. Thematic analysis was used to summarize the data.

RESULTS

Participants reported that relationships with family, a responsibility to protect others from HIV, and faith/spirituality supported the maintenance of health-promoting behaviors. Barriers to behavior maintenance included substance use and mental health issues. Meeting in small groups was also highlighted as a motivator to sustaining health behaviors, particularly in decreasing isolation and receiving affirmation from others.

CONCLUSION

Participants identified several factors that could be incorporated into an intervention to support HIV-related health-promoting behavior maintenance that could supplement existing HIV self-management interventions.

Qualitative evaluation of the relevance and acceptability of a web-based HIV prevention game for rural adolescents

African Americans in the rural Southern United States continue to experience disproportionate increases in new HIV/AIDS infections. Electronic gaming interventions hold promise but the use of HIV prevention games is limited. The purpose of this study was to assess the acceptability and relevance of a web-based HIV prevention game for African American rural adolescents. Findings from focus groups conducted with 42 participants suggested that the game was educational and somewhat entertaining but lacking in real-life scenarios and player-control. Findings are congruent with self-efficacy literature and constructivist approaches to learning. Findings have implications for gaming intervention development and further research.

Black southern rural adolescents' HIV stigma, denial, and misconceptions and implications for HIV prevention

The HIV/AIDS epidemic is becoming increasingly concentrated among African Americans who live in the rural South. HIV denial, stigma, and misconceptions have been identified as helping spread the virus among adults. However, little is known about these psychosocial factors among African American rural adolescents. This article presents findings from a study aimed at exploring the role HIV denial, stigma, and misconceptions play in the disproportionate impact of HIV/AIDS on African American adolescents in the rural South. A mixed-method study, which included questionnaires and focus group discussions, was used. Results indicated that the majority of participants had average HIV knowledge levels and that HIV denial, stigma, and misconceptions played a role in the current HIV/AIDS epidemic among rural African American adolescents. Nurses and health care professionals can play a key role in understanding and addressing HIV stigma, denial, and misconceptions among African American adolescents in the rural South to reduce HIV/AIDS health disparities among this population.

'I make sure I am safe and I make sure I have myself in every way possible': African-American youth perspectives on sexuality education

High rates of youth pregnancy and STIs play a major role in the physical, mental, and emotional health of young people. Despite efforts to provide sexuality education through diverse channels, we know little about the ways in which young people perceive school- and community-based efforts to educate them about sexual health. Forty-eight African-American young people participated in six focus groups to discuss their sexuality education experiences. Three major themes emerged that highlight experiences and perspectives on optimal strategies for promoting sexual health. These themes were: 1) experiences with school-based sexuality education (SBSE); 2) seeking information outside of schools; and 3) general principles of youth-centered sexuality education. Young people in the focus groups expressed their varying satisfaction with SBSE due to the restricted content covered and lack of comfort with the instruction methods. Participants described how they reached outside of SBSE for sexuality education, turning to those in the community, including local organisations, health care providers, and peers, also expressing variability in satisfaction with these sources. Finally, participants identified three important principles for youth-centred sexuality education: trust and confidentiality, credibility, and self-determination. These findings give voice to the often-unheard perspectives of African-American young people. Based on their responses, it is possible to gain a better understanding of the optimal combination of school, family, peer and community-based efforts to support them as they move towards adulthood.