"You Have to Humanize Your feelings:" Black fathers' Reflections on How Youth Violence Prevention and Perpetration Influence Their Overall Health and Fathering Practices.

In Baton Rouge, LA, and nationally, youth violence is a serious public health problem affecting the lives of community members. Fortunately, Black fathers have responded to the urgent call to prevent youth violence in Louisiana. In 2021, the SUPPORT project was launched to unearth stories of Black fathers' prevention practices and interventions. Since relationships are embedded within and across various systems, the Social-Ecological Model for Violence Prevention was applied to a semi-structured interview approach to investigate two aims with 12 Black fathers from Baton Rouge: (1) how their experiences with youth violence influence their mental and social health, and their children's violence exposure, and (2) the benefits of addressing youth violence. Using Braun and Clarke's (2021) thematic analysis, the three major themes that emerged related to Black fathers' history with violence were: (1) self-reflexive moments on lessons learned, (2) the impacts of victimization and bullying, and (3) socioemotional responses to youth violence. Related to the second aim, the salutary impact on the neighborhood and improvement of the school community were the major themes that emerged regarding the perceived benefits of addressing youth violence. These findings demonstrate that interviewees are cognizant of how their history of violence led to maladaptive coping mechanisms in response to youth violence and influenced their fathering ideologies; moreover, they were concerned with familial betterment. Further research is needed to deepen understanding of how Black fathers' socioemotional responses to youth violence impact their wellness and fathering practices as their children mature.

Redlining and Time to Viral Suppression Among Persons With HIV.

Importance: Structural racism in the US is evidenced in the discriminatory practice of historical racial redlining when neighborhoods were valued, in part, based on the community's racial and ethnic compositions. However, the influence of these systemic practices in the context of the HIV epidemic is not well understood. Objective: To assess the effect of redlining on time to viral suppression among people newly diagnosed with HIV. Design, Setting, and Participants: Observational study that included individuals diagnosed with HIV from January 1, 2011, to December 31, 2019, in New Orleans, Louisiana. At the time of their HIV diagnosis, these individuals lived in neighborhoods historically mapped by the Home Owners' Loan Corporation (HOLC). The HOLC lending risk maps classified neighborhoods into 1 of 4 color-coded grades: A (best), B (still desirable), C (definitely declining), and D (hazardous). Main Outcome and Measures: The primary outcome of interest was time to viral suppression (estimated as the time from the diagnosis date to the date of the first recorded viral load that was <200 copies/mL). Individual-level demographic factors were used to evaluate time to viral suppression along with a neighborhood measure of gentrification (based on US census tract-level characteristics for educational attainment, housing development and value, and household income) and a Cox gamma frailty model with census tract used as the frailty term. Results: Of 1132 individuals newly diagnosed with HIV, 871 (76.9%) were men and 620 (54.8%) were 25 to 44 years of age. Of the 697 individuals living in historically redlined neighborhoods (HOLC grade D), 100 (14.6%) were living in neighborhoods that were gentrifying. The median time to viral suppression was 193 days (95% CI, 167-223 days) for persons with HIV living in redlined neighborhoods compared with 164 days (95% CI, 143-185 days) for the 435 persons with HIV living in HOLC grade A, B, or C (nonredlined) neighborhoods. Among persons with HIV living in gentrifying neighborhoods, those living in redlined neighborhoods had a longer time to viral suppression compared with persons living in nonredlined neighborhoods (hazard ratio, 0.54 [95% CI, 0.36-0.82]). Conclusions and Relevance: These findings suggest the enduring effects of systemic racism on present-day health outcomes among persons with HIV. Regardless of their neighborhood's contemporary level of gentrification, individuals diagnosed with HIV while living in historically redlined neighborhoods may experience a significantly longer time to viral suppression.