Accessing Medical Care After a Needlestick Injury: First Responders' Perception of HIV Risk and Attitudes Toward Syringe Service Programs.

First responders have an increased risk of occupational exposure to HIV as the result of a needlestick injury (NSI) because of the chaotic prehospital environment in which they provide care. Approximately 2.3 of every 1000 first responders (0.23%) who are exposed to HIV via a NSI risk seroconversion if left untreated. Participants completed a 28-question online survey examining level of concern about HIV, thoughts about injection drug use, number of accidental NSIs, and medical services received after a needlestick. First, all data were analyzed descriptively. Second, a multiple linear regression model was used to explore the level of concern about HIV as a function of the predictor variables. Nearly half of the respondents worked as paramedics (n = 141, 23.5%) or emergency medical technicians (n = 154, 25.7%), followed by 15.5% (n = 93) and 11.3% (n = 62) who indicated their primary first responder affiliation as "firefighter" or "police," respectively. The majority of the study population identified as male (75%, n = 450); 24.8% identified as female (n = 149). Slightly more first responders reported receiving no medical services after a needlestick (9.8%, n = 59) than received an HIV screening (9.5%, n = 57), and only 3.2% (n = 19) of those who experienced a needlestick reported receiving post-exposure prophylaxis. The results suggest that perceived risk of HIV infection via needlestick ultimately influences follow-up medical screening. Greater concern about HIV is significantly associated with HIV screening and willingness to obtain post-exposure prophylaxis. Future research should examine the impact of continued HIV education and policies outlining medical evaluation and other post-exposures procedures.

Characterizing Sexual Orientation Disclosure to Health Care Providers: Lesbian, Gay, and Bisexual Perspectives.

This study examines lesbian, gay, and bisexual patients' disclosure patterns of sexual orientation to health care providers. Using a semistructured interview format, researchers conducted interviews with 24 lesbian, gay, bisexual, and queer (LGBQ) adults about sexual orientation disclosure strategies. All interviews were transcribed and independently coded using thematic analysis. Results suggest that patient sexual orientation disclosure may be patient initiated and may occur to clarify or correct provider misinformation. Participants disclosed their orientation early in the medical visit during introductions, during small talk with the provider, and during the history-taking phase of the visit. Participants characterized sexual orientation disclosures as presented with minimal information, casually, and often indirectly. Practical and theoretical implications are discussed.

The Effects of Discrimination Are Associated With Cigarette Smoking Among Black Males.

Previous research has demonstrated that experiencing interpersonal discrimination is associated with cigarette smoking. Few studies have examined the relationship between the effects of physical and emotional discrimination and cigarette usage, and none have examined this relationship among Black men. The aim of this study was to examine the association between the effects of physical and emotional discrimination and cigarette smoking. METHODS: Data from the Indiana Black Men's Health Study, a community-based sample of adult Black men, was used to conduct multivariate logistic regression to examine the relationship between the physical and emotional effects of discrimination and smoking, net of healthcare and workplace discrimination, age, education, household income, and being married. RESULTS: After adjusting for having an emotional response to discrimination, health care and workplace discrimination, age, education, household income, and being married, males who had a physical response to discrimination (e.g., upset stomach or headache) had higher odds of cigarette use (odds ratio (OR): 1.95, 95% confidence interval (CI): 1.15-3.30) than men who did not have a physical response to discrimination. CONCLUSION: Findings from the study suggest that Black males may use cigarette smoking as a means to mitigate the stress associated with experiences of discrimination. Future research is needed further to explore if and how Black males use cigarette smoking to cope with unfair treatment.

Factors Associated With Black Men's Preference for Health Information.

Black men are less likely to seek routine health care examinations or preventative care compared with their racial/ethnic and gender counterparts. Because of Black men's limited engagement with the health system, Black men's preference to receive health information is unclear. Guided by a revised version of the Andersen Healthcare Utilization Model, the aim of the study is to examine factors associated with Black men's preference for informal or formal health information. Findings from the study demonstrate that financial barriers to care (odds ratio [OR] = 0.65, 95% confidence interval [CI] = 0.43-0.98) and higher income (OR = 2.44, 95% CI = 1.49-4.00) were most predictive of using a formal source for health information. Furthermore, age (OR = 1.02, 95% CI = 1.01-1.03) and having a college education (OR = 0.44, 95% CI = 0.26-0.76) were associated with using a formal place for health information. Interestingly, health care discrimination was not associated with preferred source or place for health information. Results from the study suggest that predisposing and enabling factors are most salient to the use of formal sources of health information among Black men.

Routine HIV Testing in Indiana Community Health Centers.

Objectives. We assessed routine HIV testing in Indiana community health centers (CHCs). Methods. CHC medical directors reported HIV services, testing behaviors, barriers, and health center characteristics via survey from April to May 2013. Standard of care testing was measured by the extent to which CHCs complied with national guidelines for routine HIV testing in clinical settings. Results. Most (85.7%) CHCs reported HIV testing, primarily at patient request or if the patient was symptomatic. Routine HIV testing was provided for pregnant women by 60.7% of CHCs. Only 10.7% provided routine testing for adolescents to adults up to age 65 years. Routine testing was reported by 14.3% for gay and bisexual men, although 46.4% of CHCs reported asking patients about sexual orientation. Linkage to care services for HIV-positive patients, counseling for HIV treatment adherence, and partner testing generally was not provided. Conclusions. Most CHCs reported HIV testing, but such testing did not reflect the standard of care, because it depended on patient request or symptoms. One approach in future studies may be to allow respondents to compare current testing with standard of care and then reflect on barriers to and facilitators of adoption and implementation of routine HIV testing.

Adaptation of the Psychological-Behavioral Acculturation Scale to a Community of Urban-based Mexican Americans in the United States.

OBJECTIVE: To report the psychometric properties of the Psychological-Behavioral Acculturation Scale (P-BAS), a tool gauging behavioral and psychological acculturation after adapting it through formative research to people of Mexican origin in the United States. METHODS: We analyzed data from adapted P-BAS questionnaires in the TalaSurvey study, using standard methods to establish internal consistencies (Cronbach's alpha), construct validity, and ascertain if the value orientation profile differed by ethnic group. RESULTS: In 2012-13, 505 respondents (mean age 45.2 ± 14.1, 56% female) participated: 250 European Americans (EA) and 255 people of Mexican origin (MA). CONCLUSIONS: Although internal consistencies of 15 value orientation measures were occasionally low, overall results were encouraging. A weighted combination of value orientation scores strongly discriminated between EA and MA. Additionally, the pattern of relationships among MAs identified between acculturation scores and the validity contrasts supported the construct validity of the proposed dual framework. The trend was particularly evident for most behavioral variables.

Understanding sexually transmitted infection screening and management in Indiana community health centers.

BACKGROUND: The role of community health centers (CHCs) in preventive health care is central to health reform, yet little is known about how CHCs identify and manage sexually transmitted infections (STIs). METHODS: A survey of Indiana CHCs from April to May 2013 measured reported STI services, clinic expectations for STI testing and management, barriers to screening and management, and partner services. Reported practices were compared with current Centers for Disease Control and Prevention (CDC) guidelines for STI testing in clinical settings. RESULTS: Although most CHCs reported screening for syphilis (75.0%), chlamydia, and gonorrhea (85.7%), screening generally did not reflect CDC guidelines. Chlamydia and gonorrhea testing was provided primarily at patient request or when symptomatic by 67.9% of CHCs. Syphilis testing at 67.9% of CHCs reflected CDC guidelines for adults 65 years or younger and at 53.6% for first-trimester pregnant women. Chlamydia and gonorrhea screening reflected CDC guidelines for 17.9% of CHCs for gay/bisexual men and 60.9% for first-trimester pregnant women. One-third (35%) of CHCs reported not knowing the expectation for screening pregnant women and gay/bisexual men. CONCLUSIONS: It is likely that CHCs are not aware of patient sexual health risks because standard of care screening was observed only for gonorrhea and chlamydia during the first trimester and for syphilis testing when symptoms were present. As CHCs increase their role in preventive care with the implementation of the Affordable Care Act, focus must be upon clinician awareness of patient sexual health and training to identify and manage STIs in their patient populations.

The Influence of Health Care Provider-Initiated HIV Screening on the Rate of HIV Testing among Black and Latinx People in the Midwest.

HIV continues to impact people of color disproportionately. In 2015, Black Americans accounted for 42% of those living with HIV, and Latinx individuals accounted for 30% of new diagnoses. Using a sample of 364 people of color, demographic data, HIV testing history, and interactions with health care providers were collected. Over half of the participants (59.3%) had never been offered an HIV test, and only 19% reported a provider had offered an HIV test once, followed by 14% who have had a provider offer an HIV test more than once. Participants who were offered an HIV test once were 13.23 times more likely to report a history of HIV screening, and those offered an HIV test more than once were 18.02 times more likely to report a history of HIV testing. Participants who reported feeling a "little" judged were 6.85 times less likely to report being screened for HIV.

Sexual Communication Self-Efficacy and PrEP Literacy Helps to Meet HIV Prevention Outcomes Among Black and Latinx Individuals.

BACKGROUND: Ending the HIV Epidemic is a campaign dedicated to reducing new HIV infections in the United States by 90% by 2030. Preexposure prophylaxis (PrEP) holds significant promise as a prevention tool. However, uptake has not improved much since then. As a result, this research looked at how PrEP literacy relates to sexual communication self-efficacy. METHODS: Between August 4 and 21, 2020, we performed a community-informed cross-sectional study of Black and Latino residents in Indiana. We collected demographic information as well as PrEP literacy, sexual communication self-efficacy, and awareness of HIV status. RESULTS: Being unaware of one's own HIV status and being unsure of one's sexual identity were both linked to reduced self-efficacy in the domain of sex communication. Those who had a greater level of PrEP literacy felt more confident in their ability to communicate with others about sexually related topics. People living in rural areas showed a significantly lower degree of sexual communication self-efficacy than participants in urban settings. CONCLUSION: Providing information about PrEP to those at risk of acquiring the virus may help them connect with treatment or prevention services. Healthcare professionals should take the time to understand their patients' levels of PrEP literacy and communication self-efficacy regarding sexual health.

Primary care providers as a critical access point to HIV information and services for African American and Latinx communities.

PURPOSE: This study aimed to examine the association between confidence in accessing HIV services, primary sources of HIV information, and primary care provider status for African American and Latinx individuals in Indiana. METHODS: An online survey was disseminated to African American and Latinx individuals using snowball and social media recruitment methods, resulting in a final sample size of n = 308. A multivariable linear regression analysis was performed to examine the relationships between confidence accessing HIV services, primary care provider status, sexual identification, and sources of HIV information. RESULTS: Of the total respondents, 62.5% (n = 193) identified as male and 36.9% (n = 114) identified as female. Most identified as African American (72.5%, n = 224), followed by 27.2% (n = 84) who identified as Latinx. Participants who used their primary care providers as a primary source of obtaining HIV information had a significantly higher level of comfort with accessing HIV services. Those who identified family members as a primary source of HIV information and those who identified as bisexual demonstrated a lower level of confidence in accessing HIV services. DISCUSSION: This study's results enhance our understanding of marginalization within minority groups regarding sexual identification and accessing HIV services. These results also offer insight into the importance of healthcare access because having a primary care provider was a strong predictor of increased confidence in accessing HIV services.

A Community-Led Partnership to Develop a Mental Health Promotion Curriculum with Minority Health Agencies.

BACKGROUND: Community-based mental health promotion programs for healthy people of color, without a diagnosed mental health condition are rare in public health literature. OBJECTIVES: A statewide minority health agency led a 4-year partnership in Indiana with researchers, community-based minority health affiliates, and people of color to design, pilot, and evaluate a mental health promotion program. METHODS: A participatory process was utilized to develop and test a group health promotion program designed with and for communities of color to improve knowledge, attitudes, and behaviors for handling life stresses in a healthy way. Activities included capacity building, two implementation cycles, and mixed-methods evaluation. RESULTS: The partnership revealed challenges and lessons learned such as recruiting skilled facilitators, effective communication about goals for cultural and linguistic appropriateness, maintaining fidelity, and realigning funding approaches for affiliates. CONCLUSIONS: Next steps include revisions based on lessons learned, additional cultural and linguistic tailoring of the program, and offering statewide access.

Discrimination in Health Care: Correlates of Health Care Discrimination Among Black Males.

Using data from the Indiana Black Men's Health Study ( N = 455), a community-based sample of adult Black men, the primary aim of this study was to explore factors of health care discrimination, and to examine if such reports differed by age and the frequency of race thoughts. Approximately one in four men reported experiencing discrimination in the health care setting. Results from the multivariable logistic regression models suggested that frequent race thoughts (odds ratio [ OR]: 1.89, p < .05), not having health insurance ( OR: 1.80, p < .05), and increased depressive symptomology ( OR: 1.06, p < .01) were positively associated with reports of health care discrimination. A multiplicative interaction coefficient of age and frequency of race thoughts was included to determine if health care discrimination differed by age and frequency of race thoughts ( OR: 1.03, p = .08). Results from the predicted probability plot suggested that the likelihood of experiencing health care discrimination decreases with age ( OR: 0.97, p < .05). In particular, results suggested that between the ages of 33 and 53 years, Black men who experienced frequent race thoughts were more likely to report experiences of discrimination in the health care setting than men of the same age that did not experience frequent race thoughts. These results highlight the need for empirical work to better understand the experiences of Black men, a group less likely to utilize health care services than most adult groups within the health care setting.

Correlates of past year dental health visits: findings from the Indiana black men's health study.

OBJECTIVES: To examine the role of social support and additional predisposing, enabling and need factors that may be associated with past year dental visits among adult Black men. METHODS: Data came from a 2011 study of 1,444 Black men from 12 Indiana counties. Based on Andersen's Behavioral Model of Health Service Utilization, we conducted multivariable logistic regression analyses examining predisposing (age, sex, marital status, education), enabling (income, employment, health insurance, place of sick care, social support) and need factors (self-reported smoking status, health status, mental health days, and fruit and vegetable consumption). RESULTS: Overall, 42% of African American males sought dental care in the past year. Several predisposing (being married, having a college degree), enabling (being unemployed, having higher income, having health insurance and reporting high levels of social support) and need (increased fruit consumption) factors were found to be positively associated (P < 0.05) with past year dental care utilization in the fully adjusted model. Vegetable consumption was not significantly associated with past year dental use. CONCLUSION: Adult black men in this sample underutilized dental services. Results suggest several factors that can be used to target Black men to increase utilization rates. In particular, social support may be a promising factor that should be explored in further studies.

Expanding HIV Testing in African American Communities Through Community-Based Distribution of Home-Test Vouchers.

We investigated the implementation feasibility and effectiveness of community-based HIV home-test voucher distribution in three Indianapolis African American communities. Community-based organizations augmented traditional outreach methods to distribute vouchers for home HIV tests redeemable at three pharmacies during three distribution waves from February to April 30, 2015. Voucher redemption served as a proxy indicator of intent to test for HIV. 315 vouchers were distributed and 47 vouchers were redeemed for a 14.9% redemption rate. Distribution was 46% of plan. Vouchers were redeemed at all three pharmacies, and 21% of visits involved redemption of more than one voucher. The original team of seven distributors in three organizations reduced to a remaining five distributors in two organizations by wave 2. This study suggests that outreach organizations could implement HIV home test voucher distribution, and that people would redeem the vouchers at a pharmacy for an HIV test. Future studies should explore how voucher distribution can expand the current HIV testing system.

Institutional and structural barriers to HIV testing: elements for a theoretical framework.

Stigma is a barrier to HIV health seeking, but little is known about institutional and structural expressions of stigma in HIV testing. This study examines evidence of institutional and structural stigma in the HIV testing process. A qualitative, grounded theory study was conducted using secondary data from a 2011 HIV test site evaluation data in a Midwestern, moderate HIV incidence state. Expressions of structural and institutional stigma were found with over half of the testing sites and at three stages of the HIV testing visit. Examples of structural stigma included social geography, organization, and staff behavior at first encounter and reception, and staff behavior when experiencing the actual HIV test. Institutional stigma was socially expressed through staff behavior at entry/reception and when experiencing the HIV test. The emerging elements demonstrate the potential compounding of stigma experiences with deleterious effect. Study findings may inform future development of a theoretical framework. In practice, findings can guide organizations seeking to reduce HIV testing barriers, as they provide a window into how test seekers experience HIV test sites at first encounter, entry/reception, and at testing stages; and can identify how stigma might be intensified by structural and institutional expressions.