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English D, Smith JC, Scott-Walker L, Lopez FG, Morris M, Reid M, Lashay C, Bridges D, Rosales A, Cunningham DJ. iTHRIVE 365: A Community-Led, Multicomponent Health Promotion Intervention for Black Same Gender Loving Men. ANNALS OF LGBTQ PUBLIC AND POPULATION HEALTH 2023; 4:363-383. [PMID: 39055282 PMCID: PMC11268836 DOI: 10.1891/lgbtq-2022-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Although health inequities among Black same gender loving men (SGLM) are well documented (e.g., chronic psychological disorders, HIV, suicide), there are few accessible, culturally affirming, and community-led interventions designed to reduce these inequities. The present manuscript describes the process through which we developed iTHRIVE 365, a multicomponent health-promotion intervention designed by Black SGLM for Black SGLM. We utilized a community-based participatory research approach (CBPR) that included collaboration between THRIVE SS, a Black SGLM-run community-based organization, and a multisectoral team of public health, research, and digital design professionals to develop the intervention. A five-phase development process included four phases of focus groups and a technical pilot to assess community priorities and incorporate input on each feature of the intervention. Directed content analysis indicated that participants wanted a multicomponent and technology-mediated intervention that promotes health knowledge and motivation, Black SGLM social support, access to affirming healthcare, and housing and economic resources. iTHRIVE 365 combines multilevel and culturally affirming intervention features to combat the effects of oppression and ultimately promote Black SGLM's biopsychosocial health.
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Affiliation(s)
- Devin English
- Devin English, Justin C. Smith, and Larry Scott-Walker contributed equally to this manuscript and are co-first authors
- Rutgers School of Public Health, Department of Urban-Global Public Health, Newark, NJ, USA
| | - Justin C. Smith
- Devin English, Justin C. Smith, and Larry Scott-Walker contributed equally to this manuscript and are co-first authors
- Positive Impact Health Centers, Atlanta, GA, USA
| | - Larry Scott-Walker
- Devin English, Justin C. Smith, and Larry Scott-Walker contributed equally to this manuscript and are co-first authors
- THRIVE Social Services (THRIVE SS), Inc., Atlanta, GA, USA
| | | | - Michael Morris
- THRIVE Social Services (THRIVE SS), Inc., Atlanta, GA, USA
| | - Malcolm Reid
- THRIVE Social Services (THRIVE SS), Inc., Atlanta, GA, USA
| | | | - Dwain Bridges
- THRIVE Social Services (THRIVE SS), Inc., Atlanta, GA, USA
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Bogart LM, Mutchler MG, Goggin K, Ghosh-Dastidar M, Klein DJ, Saya U, Linnemayr S, Lawrence SJ, Tyagi K, Thomas D, Gizaw M, Bailey J, Wagner GJ. Randomized Controlled Trial of Rise, A Community-Based Culturally Congruent Counseling Intervention to Support Antiretroviral Therapy Adherence Among Black/African American Adults Living with HIV. AIDS Behav 2022; 27:1573-1586. [PMID: 36399252 PMCID: PMC9673878 DOI: 10.1007/s10461-022-03921-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2022] [Indexed: 11/19/2022]
Abstract
Structural inequities have led to HIV disparities, including relatively low antiretroviral therapy adherence and viral suppression rates among Black Americans living with HIV. We conducted a randomized controlled trial of Rise, a community-based culturally congruent adherence intervention, from January 2018 to December 2021 with 166 (85 intervention, 81 control) Black adults living with HIV in Los Angeles County, California [M (SD) = 49.0 (12.2) years-old; 76% male]. The intervention included one-on-one counseling sessions using basic Motivational Interviewing style to problem solve about adherence, as well as referrals to address unmet needs for social determinants of health (e.g., housing services, food assistance). Assessments included electronically monitored adherence; HIV viral load; and baseline, 7-month follow-up, and 13-month follow-up surveys of sociodemographic characteristics, HIV stigma, medical mistrust, and HIV-serostatus disclosure. Repeated-measures intention-to-treat regressions indicated that Rise led to significantly (two-fold) higher adherence likelihood, lower HIV stigmatizing beliefs, and reduced HIV-related medical mistrust. Effects on HIV viral suppression, internalized stigma, and disclosure were non-significant. Moreover, Rise was cost-effective based on established standards: The estimated cost per person to reach optimal adherence was $335 per 10% increase in adherence. Interventions like Rise, that are culturally tailored to the needs of Black populations, may be optimal for Black Americans living with HIV (ClinicalTrials.gov #NCT03331978).
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Affiliation(s)
- Laura M. Bogart
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138 USA
| | - Matt G. Mutchler
- APLA Health & Wellness, Los Angeles, CA USA ,California State University Dominguez Hills, Carson, CA USA
| | - Kathy Goggin
- Children’s Mercy Kansas City and University of Missouri-Kansas City Schools of Medicine and Pharmacy, Kansas City, MO USA
| | | | - David J. Klein
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138 USA
| | - Uzaib Saya
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138 USA
| | - Sebastian Linnemayr
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138 USA
| | | | | | - Damone Thomas
- APLA Health & Wellness, Los Angeles, CA USA ,HEALING with HOPE Corp., Los Angeles, CA USA
| | - Mahlet Gizaw
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138 USA
| | | | - Glenn J. Wagner
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138 USA
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Perceived discrimination, adherence to antiretroviral therapy, and HIV care engagement among HIV-positive black adults: the mediating role of medical mistrust. J Behav Med 2022; 45:285-296. [PMID: 35028783 PMCID: PMC8957584 DOI: 10.1007/s10865-021-00277-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 12/22/2021] [Indexed: 02/04/2023]
Abstract
Perceived discrimination and medical mistrust are contributors to HIV inequities. The current study examined whether medical mistrust mediated the associations between perceived discrimination and adherence to antiretroviral therapy (ART) as well as care engagement in a sample of 304 Black adults living with HIV. Perceived discrimination and medical mistrust were measured using validated scales; ART adherence was electronically monitored for a month; care engagement was determined by medical record data. Results support significant total indirect effects from perceived discrimination (due to HIV-serostatus, race, sexual orientation) to ART adherence through three types of medical mistrust (towards healthcare organizations, one's physician, and HIV-specific mistrust). The total indirect effects were also significant for care engagement and were largely driven by mistrust towards one's own physician. Findings suggest interventions at the provider or healthcare organization levels should address medical mistrust to improve the health and well-being of Black Americans living with HIV.
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HIV care continuum interventions for Black men who have sex with men in the USA. Lancet HIV 2021; 8:e776-e786. [PMID: 34695375 DOI: 10.1016/s2352-3018(21)00241-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 08/20/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
Disparities persist along the HIV care continuum among Black men who have sex with men (MSM) in the USA. As part of an initiative funded by the Health Resources and Services Administration's HIV/AIDS Bureau (US Department of Health and Human Services), we searched for recently published interventions focused on improving HIV care continuum outcomes among Black MSM with HIV in the USA. Our search identified 14 interventions, all of which were associated with at least one statistically significant outcome. Medication adherence was the most common outcome of interest, and linkage to care was the least common. More than half of the interventions focused on younger populations and took place in the US South. Interventions used a range of strategies to increase cultural relevance and address common barriers to optimal HIV outcomes for Black MSM. Several interventions harnessed social media, text messaging, and smartphone apps to facilitate social support, deliver HIV education, and encourage medication adherence. Interventions were delivered mostly at the individual or interpersonal level, although three made system-level changes to address structural barriers. Notably missing were interventions focused on minimising behavioural health barriers, and interventions directly addressing social determinants of health such as housing. To accelerate the pace of implementation and scale-up of interventions for Black MSM with HIV, public health entities can pilot emerging interventions in real-world settings, and use an implementation science approach to evaluate outcomes and assess the implementation strategies that drive or hinder effectiveness.
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The Treatment Ambassador Program: A Highly Acceptable and Feasible Community-Based Peer Intervention for South Africans Living with HIV Who Delay or Discontinue Antiretroviral Therapy. AIDS Behav 2021; 25:1129-1143. [PMID: 33125587 DOI: 10.1007/s10461-020-03063-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2020] [Indexed: 12/18/2022]
Abstract
We conducted a novel pilot randomized controlled trial of the Treatment Ambassador Program (TAP), an 8-session, peer-based, behavioral intervention for people with HIV (PWH) in South Africa not on antiretroviral therapy (ART). PWH (43 intervention, 41 controls) completed baseline, 3- and 6-month assessments. TAP was highly feasible (90% completion), with peer counselors demonstrating good intervention fidelity. Post-intervention interviews showed high acceptability of TAP and counselors, who supported autonomy, assisted with clinical navigation, and provided psychosocial support. Intention-to-treat analyses indicated increased ART initiation by 3 months in the intervention vs. control arm (12.2% [5/41] vs. 2.3% [1/43], Fisher exact p-value = 0.105; Cohen's h = 0.41). Among those previously on ART (off for > 6 months), 33.3% initiated ART by 3 months in the intervention vs. 14.3% in the control arm (Cohen's h = 0.45). Results suggest that TAP was highly acceptable and feasible among PWH not on ART.
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Sims OT, Chiu CY, Chandler R, Melton P, Wang K, Richey C, Odlum M. Alcohol Use and Ethnicity Independently Predict Antiretroviral Therapy Nonadherence Among Patients Living with HIV/HCV Coinfection. J Racial Ethn Health Disparities 2020; 7:28-35. [PMID: 31435855 PMCID: PMC6980421 DOI: 10.1007/s40615-019-00630-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/06/2019] [Accepted: 08/12/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Adherence to antiretroviral therapy (ART) is important to counter synergistic effects of HIV and hepatitis C (HCV) in patients living with coinfection. Predictors of ART nonadherence among patients living with HIV/HCV coinfection are not well established. This knowledge would be advantageous for clinicians and behavioral health specialists who provide care to patients living with HIV/HCV coinfection. OBJECTIVES The purpose of this study was to assess prevalence and predictors of ART nonadherence in a sample of patients living with HIV/HCV coinfection who were actively in HIV clinical care. METHOD A sample of patients living with HIV/HCV coinfection who received care at a university-affiliated HIV clinic (n = 137) between January 2013 and July 2017 were included in the study. Computerized patient-reported data or outcomes (PROs) and electronic medical record data of these respective patients were collected and analyzed. Binomial logistic regression was used to examine predictors of ART nonadherence. RESULTS The prevalence of ART nonadherence was 31%. In multivariate analysis, African American ethnicity (OR = 3.28, CI 1.241-8.653, p = 0.017) and a higher number of alcoholic drinks per drinking day (OR = 1.31, CI 1.054-1.639, p = 0.015) were positively associated with ART nonadherence. CONCLUSIONS Behavioral health providers are encouraged to incorporate alcohol use reduce interventions in HIV clinical settings to reduce ART nonadherence among patients living with HIV/HCV coinfection. Additionally, public health professionals and researchers, and clinicians are encouraged to use inductive methods to discover why ART nonadherence disproportionately impacts African American patients living with HIV/HCV coinfection and to develop approaches that are sensitive to those respective barriers.
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Affiliation(s)
- Omar T Sims
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA.
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
- Comprehensive Center for Healthy Aging, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
- Center for AIDS Research, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Franciso, CA, USA.
- The University of Alabama at Birmingham, Univesity Hall 3137, 1720 2nd AVE S, Birmingham, AL, 35294-1260, USA.
| | - Chia-Ying Chiu
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rasheeta Chandler
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Franciso, CA, USA
- School of Nursing, Emory University, Atlanta, GA, USA
| | - Pamela Melton
- Department of Social Work, College of Education, Humanities, and Behavioral Sciences, Alabama A&M University, 104 Bibb Graves Hall, Normal, AL, USA
| | - Kaiying Wang
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Caroline Richey
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michelle Odlum
- School of Nursing, Columbia University, 560 West 168th Street, New York, 10032, USA
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Du Bois SN, Guy AA, Manser KA, Thomas NN, Noble S, Lewis R, Toles J, Spivey C, Khan H, Tully T. Developing Prepare2Thrive, a community-based intervention targeting treatment engagement among African American individuals living with HIV and serious mental illness. AIDS Care 2020; 32:1102-1110. [PMID: 31992049 DOI: 10.1080/09540121.2020.1717420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
African American individuals living with HIV and serious mental illness (SMI) may report relatively low treatment engagement, despite treatment engagement being critical to managing both health conditions. Here, we have two aims: to describe the methodology we used to collect focus group data on treatment engagement with a sample of African American individuals living with HIV and SMI, and to describe the results of those focus groups in the context of intervention development. We conducted two focus groups (N = 15), integrating a social-ecological model for our theoretical framework, Community-Based Participatory Research for study design and execution, and group concept mapping for data analysis. Three thematic clusters relating to treatment engagement emerged from each group, with overlap across groups: Medication knowledge, Patient-provider relationships, and Barriers to treatment engagement. Items related to the Patient-provider relationship loaded onto all emergent clusters, demonstrating the pervasive impact of this variable. Findings informed the design of Prepare2Thrive, a community-based, culture-specific intervention aiming to increase treatment engagement among African American individuals living with HIV and SMI. Both our design and findings can be used in future collaborations aiming to maximize treatment engagement, and more broadly health, among individuals in this community.
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Affiliation(s)
- Steve N Du Bois
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | - Arryn A Guy
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | - Kelly A Manser
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | - Nicole Novie Thomas
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | - Scott Noble
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | - Rodney Lewis
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | - Jock Toles
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | - Craig Spivey
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | - Humza Khan
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | - Timothy Tully
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
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A Randomized Controlled Trial of Rise, a Community-Based Culturally Congruent Adherence Intervention for Black Americans Living with HIV. Ann Behav Med 2018; 51:868-878. [PMID: 28432578 DOI: 10.1007/s12160-017-9910-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Evidence-based HIV treatment adherence interventions have typically shown medium-sized effects on adherence. Prior evidence-based HIV treatment adherence interventions have not been culturally adapted specifically for Black/African Americans, the population most affected by HIV disparities in the USA, who exhibit lower adherence than do members of other racial/ethnic groups. PURPOSE We conducted a randomized controlled trial of Rise, a 6-month culturally congruent adherence counseling intervention for HIV-positive Black men and women. METHODS Rise was delivered by a trained peer counselor who used a problem-solving approach to address culturally congruent adherence barriers (e.g., medical mistrust, HIV stigma) and assisted with linkage to supportive services. A total of 215 participants were randomized to the intervention group (n = 107) or a wait-list control group (n = 108). Adherence was assessed daily via electronic monitoring. RESULTS In a repeated measures multivariate logistic regression model of dichotomous adherence (using a clinically significant cutoff of 85% of doses taken), adjusted for sociodemographic and medical covariates, adherence in the intervention group improved over time relative to the control group, (OR = 1.30 per month (95% CI = 1.12-1.51), p < 0.001), representing a large cumulative effect after 6 months (OR = 4.76, Cohen's d = 0.86). CONCLUSIONS Rise showed a larger effect on adherence than prior HIV adherence intervention studies. For greater effectiveness, interventions to improve adherence among Black people living with HIV may need to be customized to address culturally relevant barriers to adherence. ( ClinicalTrials.gov #NCT01350544).
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Anti-retroviral Status and HIV Transmission Risk Behaviors are Associated with Age, Time Since Diagnosis, and Psychosocial Factors Among Women Living with HIV/AIDS Enrolling in the WILLOW Intervention at Community-Based Organizations. AIDS Behav 2018; 22:358-366. [PMID: 29143162 DOI: 10.1007/s10461-017-1967-3] [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: 10/18/2022]
Abstract
Safe sexual behaviors and anti-retroviral use help prevent HIV transmission. In this cross-sectional study, we assessed correlates of anti-retroviral (ART) status and transmission risk (a constructed variable) among a convenience sample of n = 1041 HIV-positive women (pre-intervention) enrolled in an evidence-based intervention at four CBOs. Multinomial logistic regression models were used. Younger women and those diagnosed with HIV in the last 5 years more often reported that they had not been prescribed ART. Self-reported non-adherence to ART was less frequently reported among women who were older, had a higher HIV knowledge, and those with attitudes/beliefs supportive of condom use. The highest-risk transmission group (condomless sex with HIV-negative/unknown partner and not prescribed or non-adherent to ART) was associated with younger age, attitudes/beliefs less supportive of condom use, and low self-efficacy discussing condom use. Our findings inform HIV prevention efforts among similar populations of HIV-positive women enrolled in interventions at CBOs.
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Freeman R, Gwadz MV, Silverman E, Kutnick A, Leonard NR, Ritchie AS, Reed J, Martinez BY. Critical race theory as a tool for understanding poor engagement along the HIV care continuum among African American/Black and Hispanic persons living with HIV in the United States: a qualitative exploration. Int J Equity Health 2017. [DOI: http:/doi.org.10.1186/s12939-017-0549-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Freeman R, Gwadz MV, Silverman E, Kutnick A, Leonard NR, Ritchie AS, Reed J, Martinez BY. Critical race theory as a tool for understanding poor engagement along the HIV care continuum among African American/Black and Hispanic persons living with HIV in the United States: a qualitative exploration. Int J Equity Health 2017. [DOI: http://doi.org.10.1186/s12939-017-0549-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Freeman R, Gwadz MV, Silverman E, Kutnick A, Leonard NR, Ritchie AS, Reed J, Martinez BY. Critical race theory as a tool for understanding poor engagement along the HIV care continuum among African American/Black and Hispanic persons living with HIV in the United States: a qualitative exploration. Int J Equity Health 2017; 16:54. [PMID: 28340589 PMCID: PMC5364619 DOI: 10.1186/s12939-017-0549-3] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 03/13/2017] [Indexed: 11/12/2022] Open
Abstract
Background African American/Black and Hispanic persons living with HIV (AABH-PLWH) in the U.S. evidence insufficient engagement in HIV care and low uptake of HIV antiretroviral therapy, leading to suboptimal clinical outcomes. The present qualitative study used critical race theory, and incorporated intersectionality theory, to understand AABH-PLWH’s perspectives on the mechanisms by which structural racism; that is, the macro-level systems that reinforce inequities among racial/ethnic groups, influence health decisions and behaviors. Methods Participants were adult AABH-PLWH in New York City who were not taking antiretroviral therapy nor well engaged in HIV care (N = 37). Participants were purposively sampled for maximum variation from a larger study, and engaged in semi-structured in-depth interviews that were audio-recorded and professionally transcribed verbatim. Data were analyzed using a systematic content analysis approach. Results We found AABH-PLWH experienced HIV care and medication decisions through a historical and cultural lens incorporating knowledge of past and present structural racism. This contextual knowledge included awareness of past maltreatment of people of color in medical research. Further, these understandings were linked to the history of HIV antiretroviral therapy itself, including awareness of the first HIV antiretroviral regimen; namely, AZT (zidovudine) mono-therapy, which was initially prescribed in unacceptably high doses, causing serious side effects, but with only modest efficacy. In this historical/cultural context, aspects of structural racism negatively influenced health care decisions and behavior in four main ways: 1) via the extent to which healthcare settings were experienced as overly institutionalized and, therefore, dehumanizing; 2) distrust of medical institutions and healthcare providers, which led AABH-PLWH to feel pressured to take HIV antiretroviral therapy when it was offered; 3) perceptions that patients are excluded from the health decision-making process; and 4) an over-emphasis on antiretroviral therapy compared to other non-HIV related priorities. We found that although participants were located at the intersection of multiple social categories (e.g., gender, social class, AABH race/ethnicity), race/ethnicity and social class were described as primary factors. Conclusions Critical race theory proved useful in uncovering how macro-level structural racism affects individual-level health decisions and behaviors. HIV clinical settings can counter-balance the effects of structural racism by building “structural competency,” and interventions fostering core self-determination needs including autonomy may prove culturally appropriate and beneficial for AABH-PLWH.
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Affiliation(s)
| | - Marya Viorst Gwadz
- Center for Drug Use and HIV Research (CDUHR), Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY, 10010, USA.
| | - Elizabeth Silverman
- Center for Drug Use and HIV Research (CDUHR), Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY, 10010, USA
| | - Alexandra Kutnick
- Center for Drug Use and HIV Research (CDUHR), Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY, 10010, USA
| | - Noelle R Leonard
- Center for Drug Use and HIV Research (CDUHR), Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY, 10010, USA
| | - Amanda S Ritchie
- Center for Drug Use and HIV Research (CDUHR), Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY, 10010, USA
| | - Jennifer Reed
- Center for Drug Use and HIV Research (CDUHR), Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY, 10010, USA
| | - Belkis Y Martinez
- Center for Drug Use and HIV Research (CDUHR), Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY, 10010, USA
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