Structural Inequities, HIV Community-Based Organizations, and the End of the HIV Epidemic.

Community-based organizations (CBOs) are integral to achieving the goal of Ending the HIV epidemic (EHE). Their familiarity with and proximity to communities position them to effectively implement strategies necessary to address determinants of health through their formal and informal medical and social services. However, structural inequities have contributed to the demise of many organizations that were instrumental in early responses to the HIV epidemic. We define structural inequities for HIV CBOs as systems in which policies, institutional practices, organizational (mis)representations, and other norms work to produce and maintain inequities that affect CBOs' ability to survive and thrive. In this discussion, we describe the organizational threats to grassroots HIV CBOs and the risks to livelihood and longevity, including examples. The invaluable role of HIV CBOs in EHE and their role in responding to existing and novel infectious diseases like COVID-19 should not be overlooked. Recommendations to promote structural equity are offered. (Am J Public Health. 2022;112(3):417-425. https://doi.org/10.2105/AJPH.2021.306688).

From Practice to Publication: The Promise of Writing Workshops.

Practitioners in health departments, university extension programs, and nonprofit organizations working in public health face varied challenges to publishing in the peer-reviewed literature. These practitioners may lack time, support, skills, and efficacy needed for manuscript submission, which keeps them from sharing their wisdom and experience-based evidence. This exclusion can contribute to literature gaps, a failure of evidence-based practice to inform future research, reduced ability to educate partners, and delays in advancing public health practice. Our article describes the writing workshops offered to Division of Nutrition, Physical Activity, and Obesity (DNPAO), Centers for Disease Control and Prevention (CDC) funded programs in 2021. This project consisted of three 60-minute introductory writing webinars open to all recipients, followed by a Writing for Publications workshop, an 8- to 9-week virtual learning/writing intensive for selected writing team applicants. The Society for Public Health Education staff, consultants, and CDC/DNPAO staff developed, refined, and presented the curriculum. The workshop for public health practitioner writing teams was offered to two cohorts and included extensive coaching and focused on potential submission to a Health Promotion Practice supplement, "Reducing Chronic Disease through Physical Activity and Nutrition: Public Health Practice in the Field" (see Supplemental Material), which was supported by CDC/DNPAO. We describe the webinars, the workshop design, modifications, evaluation methods and results.

Working Against Gender-Based Violence in the American South: An Analysis of Race, Ethnicity, Gender, and Sexuality in Advocacy.

Non-profit organizations that address gender-based violence must create diverse, inclusive, and equitable workplaces for advocates so that they can adequately serve diverse survivors. Despite recent efforts, differential treatment and high turnover among minority advocates continue. Further strategies to eliminate discriminative organizational practices are needed. We interviewed 25 advocates employed by non-profit organizations in a Southeastern state to examine how race, ethnicity, gender, and sexuality shape their work experiences. Guided by constructivist grounded theory and intersectionality, data analysis yielded four major themes that covered white dominance in advocacy, essentialized womanhood and heteronormativity, serving communities of color, working in the Deep South. Patriarchal values, religious norms, and gender roles influenced how advocates' work was received by the communities. Racial/ethnic minority, and sexual and/or gender minority advocates faced discrimination, tokenism, and negative stereotypes. Transforming organizational climate and policies is necessary to support minority advocates' work engagement and ability to serve marginalized communities.

Advice for prevention from HIV-positive African-American women: 'My story is not just a story'.

Large disparities in HIV incidence, prevalence and mortality exist for African-American women, especially in the southern region of the USA. Based on the culture-centric health promotion model, HIV-positive African American women can use their stories to support primary prevention. The purpose of this study was to document advice from HIV-positive African-American women (n = 25) to young African-American women, as described in their own cultural narratives collected through qualitative interviews. Content analysis of women's advice identified five common themes revolving broadly around: (1) advice for prevention, (2) support systems for prevention, (3) education, (4) empowerment/self-care and (5) potential barriers to prevention. Advice reflected recommendations based on personal experience and highlighted social determinants linked to HIV, such as stigma, access to education and healthcare, social support, and gender and power dynamics. Women also offered advice for coping with an HIV-positive diagnosis. Communication with parents, family and friends regarding education and social support emerged as an important interpersonal factor for participants, as were interactions with sexual/romantic partners. Stigma, at the community level, was consistently discussed as a hindrance to prevention. Narratives of HIV-positive women as community health agents of change can enhance the effectiveness of HIV prevention interventions for young US African-American women.

Courtesy Stigma and HIV Professionals: A Brief Review of Implications for Psychosocial and Professional Well-Being.

The impact of HIV-related stigma on social workers, clinicians, counselors, and advocates working in organizations serving people living with HIV (PLWH), is rarely considered. Professionals experience "courtesy stigma" when working with or on behalf of PLWH, regardless of their personal HIV status. PubMed, Medline, and PsycInfo databases, along with a review of relevant reference lists and referrals, identified 13 studies addressing this phenomenon. Although limited, this brief review suggests that members of the HIV workforce do indeed face challenges that compromise their personal and professional well-being as a result of courtesy stigma. Addressing stigma among professionals is necessary to support the health of those working in the field, and to avoid undermining the efforts of this important workforce. More research is needed to understand the perceptions and experiences of courtesy stigma and how this stigma may adversely impact the psychological well-being, social functioning, and professional practice of HIV professionals.

Individual, Social, and Structural Vulnerability for Black Women in the South: Implications for PrEP.

Pre-exposure prophylaxis (PrEP) is an effective biomedical HIV prevention option, yet adoption among Black women, who are disproportionately impacted by HIV, is low. A nuanced understanding of the multi-level factors that contribute to elevated risk is necessary to better contextualize PrEP uptake. Qualitative data from Black women residing in the Southern U.S. who self-screened as HIV-negative, were collected via four focus groups (N = 27) to understand influences on HIV vulnerability and the potential role of PrEP in mitigating risk. Content analysis of transcribed data yielded multiple themes addressing: the pervasiveness of sexual partner sharing; lack of transparency regarding HIV status, disclosure, and testing; and social/cultural influences on HIV risk. Experiences with the health care system and providers were of particular concern. Findings demonstrate support for PrEP in this population and contribute to our understanding of individual, social, and structural factors to better inform PrEP promotion.

Pathways to sexual risk taking among female adolescent detainees.

Sexual risk taking among female delinquents represents a significant public health problem. Research is needed to understand the pathways leading to sexual risk taking among this population. This study sought to address this issue by identifying and testing two pathways from child maltreatment to non-condom use among 329 White and 484 African American female adolescent detainees: a relational pathway and a substance use coping pathway. The relational pathway indicated that child maltreatment would be related to non-condom use via depressive self-concept and condom use self-efficacy. The substance use coping pathway suggested that depressive self-concept and alcohol-based expectancies for sexual enhancement would mediate the relationship between child maltreatment and non-condom use. As hypothesized, the relational pathway variables were associated with one another in the expected directions; however, evidence of mediation was not found. Support for mediation was found for the substance use coping pathway. Exploratory across group comparison analysis indicated that the relational pathway was significant for White girls whereas the substance use coping pathway was significant for African American girls. Limitations and implications for future research are discussed.

Do family and parenting factors in adolescence influence condom use in early adulthood in a multiethnic sample of young adults?

Studies show that positive family factors help protect adolescents from engaging in risky sexual activities, but do they continue to protect adolescents as they transition to late adolescence/early adulthood? Using data from the National Longitudinal Study of Adolescent Health, we examined whether family support, parent-child closeness, parental control/monitoring of adolescent behaviors and parent-child communication about sex, assessed in adolescence, were related to condom use in late adolescence/early adulthood among African American (n = 1,986), Chinese American (n = 163), Mexican American (n = 1,011) and White (n = 6,971) youth. Controlling for demographic variables and number of sex partners, the results showed that family support was positively related and parent-child communication was negatively related to condom use for the sample as a whole and for the white sample, but not for the other groups. Parent-child communication about sex and parental control were negatively related to condom use in the Chinese American sample. None of the family factors was related to condom use in the African American or Mexican American samples. Overall, parents talked more with daughters than sons about sexual matters. Condom use was most common among African Americans and among males. Greater attention to cultural expectations regarding sex and gender roles, as well as the causal ordering of effects, are important directions for future research.

African American Women's Current Knowledge, Perceptions, and Willingness of PrEP Use for HIV Prevention in the South.

African American women accounted for approximately 60% of new HIV diagnoses among women in the United States, with the greatest burden occurring in the South. Past efforts to prevent HIV focused on behavioral interventions aimed at reducing sexual risk behavior. More recent HIV prevention methods have included oral pre-exposure prophylaxis (PrEP) with antiretroviral drugs. Although PrEP has been designated as an effective HIV prevention method since 2012, awareness and uptake of PrEP remains low among African American women. Our study explored African American women's knowledge, perceptions, and willingness of PrEP use. Four focus groups were held in April 2019, consisting of 27 women, who identified as African American and resided in South Carolina. Focus group topics focused on participants' awareness, perceptions, and potential use of PrEP. The majority of women had heard of PrEP; however, over half of the participants were in the HIV or health field. Overall, participants believed that the "lay woman" would be unaware of PrEP. Participants' perceptions of PrEP included stigma of PrEP use, benefits to non-monogamous couples, and experiences with PrEP clients. The majority of women were willing to use PrEP, but major concerns around short and long-term side effects were expressed. Participants provided recommendations to improve PrEP uptake among African American women that included targeted campaigns and spokespersons. African American women are interested and supportive of PrEP use for HIV prevention in the South, where HIV rates remain highest. Past PrEP implementation efforts have not been relatable to African American women; therefore, awareness and uptake rates remain low. Future efforts to increase PrEP awareness and uptake among African American women should be relevant, and should provide comprehensive information on potential side effects, purpose of use, and eligibility criteria.

"The Only Way We'll Be Successful": Organizational Factors That Influence Psychosocial Well-Being and Self-Care Among Advocates Working to Address Gender-Based Violence.

Advocates who work for nonprofit organizations (NPOs) that address gender-based violence (GBV) experience a wide range of psychosocial health and well-being risks due to the emotionally demanding nature of the work they engage in. Most recommendations for advocates' self-care focus on individual-level activities, failing to hold the NPOs accountable for creating workplace cultures and practices that foster psychosocial well-being, self-care, and resilience among the advocates. The aim of this qualitative research was to further our understanding of organizational-level factors that influence psychosocial well-being and self-care practices among advocates who work for GBV-specific NPOs in a metropolitan area in the southeastern United States. We conducted in-depth interviews with 25 GBV-specific advocates. Constructivist grounded theory methods were used in coding and analyzing the data. Sixteen advocates identified as White, followed by five Black, two Hispanic, and two mixed-race/ethnicity. Mean age was 36 years. Most participants had a master's degree (n = 16). Analysis of the data resulted in three major themes: (a) Management and Leadership Style, (b) Interpersonal Relationship Dynamics, and (c) Culture of Self-Care. The ways in which leaders established relationships with other advocates to accomplish organizational goals, how advocates developed a sense of camaraderie with their coworkers, and shared norms around self-care shaped advocates' willingness and ability to engage in individual and collective self-care. Findings of this study highlight the role of GBV-specific NPOs in creating workplace cultures and practices that are conducive to engaging in self-care and developing resilience among the advocates. By fulfilling this responsibility, organizations would enable the advocates to not only survive, but thrive in their work and make even greater strides in the overall mission of GBV prevention.

The Roles of Campus Ministry Leaders: Guiding Students through the Transition to Adulthood.

Despite historic existence of campus ministries at universities, little is known about the roles of campus ministry leaders. This research explored campus ministry leaders' engagement with students through interviews (n = 19). Analysis indicated interviewees' work includes building relationships with students, navigating the secular context of a public university, and tensions with others in campus ministry. Interviewees reported emotional strain resulting from extensive caring labor. Focused support for campus ministers would benefit both leaders and students.

Female sex workers and the social context of workplace violence in Tijuana, Mexico.

Gender-based violence in the workplace impacts the physical and emotional wellbeing of sex workers and may lead to other health problems, such as PTSD and depression, drug abuse, and a greater likelihood of sexually transmitted infections. This study examines the social context of workplace violence and risk avoidance in the context of legal regulations meant to reduce harms associated with the industry. Ethnographic research, including 18 months of extended field observations and interviews with 190 female sex workers, is used to illustrate how sex workers in Tijuana, Mexico, experience and manage workplace violence. Multiple subthemes emerge from this analysis, including deciding where to work, working with a third party, avoiding theft, and dealing with police. These findings support the idea that the risk of violence is part of a larger "hierarchy of risk" that can result in a "tradeoff" of harms.

Community-Engaged Use of Cultural Narratives to Create HIV Prevention Stories for African American Women.

BACKGROUND: Culture-specific interventions based on storytelling can address the social and cultural context of HIV that is unique to Southern African American women. METHODS: We describe a community-engaged process to construct scripted stories to promote HIV prevention based on cultural narratives from African American women living with HIV. Our process involved (1) the collection of cultural narratives, (2) establishment of a community advisory board (CAB), (3) identification of important intervention themes, (4) narrative analysis to identify stories, and (5) script writing/peer review to produce composite narrative HIV prevention messages. LESSONS LEARNED: Engaging community members is a strength; however, outreach should be strategic to individuals interested in a script writing creative process. This process is an adaptation of widely accepted methods to produce stories that incorporate culture organically in ways that allow for greater identification and engagement by the target audience. CONCLUSIONS: Authentic stories harvested and produced from and for a culture-specific population is a critical consideration for narrative health promotion.

Health disadvantages in colorectal cancer screening among African Americans: considering the cultural context of narrative health promotion.

African Americans are more likely than any other racial or ethnic group to develop colorectal cancer (CRC) and to die as a result. Factors such as age, family history, income, knowledge, attitudes and beliefs regarding screening are important predictors of risk, and multiple factors may contribute to poor CRC outcomes for African Americans. Although screening is not the only factor associated with CRC outcomes, it may be one of the more important and modifiable risk factors for African Americans. Few programs have utilized narrative approaches to promote cancer screening among African Americans. None have focused on CRC screening. The purpose of this discussion is to review factors associated with CRC incidence, late detection and mortality among African Americans with emphasis on screening to improve CRC-related outcomes, and to discuss narrative health promotion as a culturally appropriate means for eliminating the disparities in CRC-related outcomes between African Americans and other racial/ethnic groups.

Sexual Behaviors, Mobile Technology Use, and Sexting Among College Students in the American South.

PURPOSE: To examine sexual, mobile technology, and sexting behaviors of college students. DESIGN: A cross-sectional study design was employed. SETTING: Study sites were 2 universities in the southern United States. SUBJECTS: Data were collected from 254 participants via online survey of college students. MEASURES: The survey included 268 items inclusive of measures from previously validated sources. Variables for this study included technology ownership/use, online/mobile dating site use, sexting behaviors/attitudes, and sexual behaviors. In particular, the Sexting Attitudes Scale has been previously validated with other researchers providing comparative data. ANALYSIS: Chi-square and Mann-Whitney tests were used for group comparisons. Logistic regression analysis was used to examine predictors of sexting behavior. RESULTS: Of the 254 participants, over 80% had ever had sex, and participants were more likely to use condoms with partners who they were not in a committed relationship compared to those to whom they were committed (χ2 = 27.324, P = .0001). Seventy percent had ever sexted, and sexting attitudes ranged from approximately 80% agreeing that sexting is "risky" or can leave one "vulnerable" compared to 43% agreeing that sexting is "fun." Sexting was associated with having multiple sexual partners (odds ratio [OR] = 2.47, 95% confidence interval [CI]: 1.36-4.47) and sexually transmitted infection testing history (OR = 2.08, 95% CI: 1.03-4.18). CONCLUSION: Study findings should be considered as interventionists plan sexual health and risk prevention programs for college students.

Differential perceptions of a hypothetical sexual assault survivor based on race and ethnicity: Exploring victim responsibility, trauma, and need for social support.

Objective: Explore the ways in which a sample of college women interpret racially/ethnically coded vignettes to understand their perceptions of responsibility and trauma experienced by a hypothetical female sexual assault survivor and her need for social support. Participants: Convenience sample of college women (N = 51) attending a large, predominately white university in the Southeastern United States recruited between January and March 2013. Methods: Participants were randomly assigned one of three vignettes describing a hypothetical date rape scenario. Vignette scenarios were identical except for discrete statements coded to signify either an African American, Latina, or white female student. Participants responded to open-ended questions that gauged their interpretations of responsibility, trauma, and social support. Results: Qualitative analysis of open-ended responses revealed six overarching themes, including overt victim blaming/shaming, justification of the sexual assault, and perceived need for social support. Conclusions: Findings point to the significance of including race in discussions about and programs that address sexual assault on college campuses to ensure that all women who experience sexual violence receive the support that they need.

A Systematic Mixed Studies Review of the Intersections of Social-Ecological Factors and HIV Stigma in People Living With HIV in the U.S. South.

The role of stigma on psychological wellness and treatment outcomes in people living with HIV (PLWH) has been well documented. However, within the context of the southern United States, the intersection between HIV-related stigma and social-ecological factors has been understudied. Thus, a results-based convergent, mixed synthesis design was used to examine the manifestations of HIV-related stigma in PLWH in the U.S. South. A literature search was conducted using PsycINFO, PubMed (includes MEDLINE), and CINAHL. The first level of screening by title and abstract was administered on 1,829 articles. A full-text screening of 169 studies was completed, and a total of 30 relevant articles were extracted. The mixed synthesis highlighted intervention strategies that can reduce HIV-related stigma while promoting positive health-behavior change. The findings of this review underscored the uniqueness of PLWH in the south and demonstrated the crucial role of intersectionality in investigating HIV-related stigma in treating and preventing HIV.

An Exploratory Study Examining Risk Communication among Adolescent Children, Their Incarcerated Mothers, and Their Caregivers.

Adolescent children of incarcerated mothers (ACIM) are typically left in the care of adults (primary caregivers) who play a crucial role in children's care and guidance, as well as in the facilitation of contact and communication with incarcerated mothers. The purpose of this study was to explore the nature of relationships and communication among adolescent children of incarcerated mothers, primary caregivers, and incarcerated mothers using pilot data. Semi-structured individual interviews were conducted with youth aged 12-17 (n=7) and caregivers (n=6) recruited through a non-profit organization working with incarcerated mothers and their children. Incarcerated mothers and primary caregivers represent an important family unit for ACIMs and may play a role in preventing risk behavior. A conceptual framework is offered for further consideration of mother and caregiver communication with youth and youth risk.