The invisibility of Black and Latina women in sexual health care: shifting from biological individualism to intersectionality.

Black and Latinx women have long endured racist healthcare practices and policies that influence their sexual health outcomes. Despite having increased health care access, Black and Latina women continue to have higher rates of sexually transmitted infections compared to their white counterparts. We utilised Critical Race Theory to examine the myriad ways in which Black and Latina women and their unmet needs may be invisible to healthcare providers and to better understand the compounding factors that may affect Black and Latina women's engagement with sexual health services. Eighteen individual semi-structured interviews were conducted with healthcare providers, administrators and policy advocates working to address sexual health needs of Black and Latina women in California. Interviews were recorded and transcribed verbatim. Qualitative data were analysed using an inductive thematic approach. Two primary themes and subthemes were developed during our analysis. Within the healthcare system there is a lack of recognition of (1) intersectional identities of Black and Latina women, including intersectional oppressions and systemic vulnerabilities; and (2) structural barriers that mediate their sexual health treatment engagement. Recognition of intersectional identities and addressing structural barriers can potentially improve the sexual health of Black and Latina women and support efforts to address disparities in sexual health care.

Social Determinants of Disease: HIV and COVID-19 Experiences.

PURPOSE OF REVIEW: The differential impact of the COVID-19 and HIV pandemics on marginalized communities has renewed calls for more robust and deeper investigation into structural and social causes of health inequities contributing to these infections, including underlying factors related to systematic racism. Using the Social Determinants of Health (SDOH) framework, we analyzed parallel and divergent factors associated with COVID-19 and HIV/AIDS and the prevalence of disparate disease in diverse communities. We utilized PRISMA guidelines to identify relevant literature (N = 210 articles) that resulted in a review of 125 articles included in our synthesis. RECENT FINDINGS: With racial health inequities as a core contributor to disease vulnerability, we also identified other factors such as economic stability, social and community support, the neighborhood and built environment, healthcare access and quality, and education access and quality as important socioecological considerations toward achieving health equity. Our review identifies structural and systematic factors that drive HIV and COVID-19 transmission. Our review highlights the importance of not solely focusing on biomedical interventions as solutions to ending HIV and COVID-19, but rather call for building a more just public health and social service safety net that meets the needs of people at the intersection of multiple vulnerabilities.

Willingness of Pharmacists to Prescribe Medication Abortion in California.

Importance: Nearly half of US states have restricted abortion access. Policy makers are exploring pathways to increase access to abortion and reproductive health care more broadly. Since 2016, California pharmacists could prescribe hormonal birth control, providing an opportunity to learn about the implementation of pharmacist-provided reproductive health care. Objective: To explore the feasibility of broadening pharmacist scope of practice to include prescribing medication abortion. Design, Setting, and Participants: A cross-sectional online survey was conducted from October 11 to December 20, 2022, among a convenience sample of California licensed community pharmacists to examine their attitudes toward, knowledge of, and confidence in prescribing hormonal birth control and reports of pharmacy-level practices. Main Outcomes and Measures: Descriptive analyses and log-binomial regression models were used to compare medication abortion and contraceptive provision attitudes by pharmacist and pharmacy characteristics. Results: Among the 316 pharmacists included in the analysis who worked at community pharmacies across California (mean [SD] age, 40.9 [12.0] years; 169 of 285 [59.3%] cisgender women; and 159 of 272 [58.5%] non-Hispanic Asian individuals), most (193 of 280 [68.9%]) indicated willingness to prescribe medication abortion to pharmacy clients if allowed by law. However, less than half were confident in their knowledge of medication abortion (139 of 288 [48.3%]) or their ability to prescribe it (115 of 285 [40.4%]). Pharmacists who indicated that providing access to hormonal birth control as a prescribing provider was important (263 of 289 [91.0%]) and were confident in their ability to prescribe it (207 of 290 [71.4%]) were 3.96 (95% CI, 1.80-8.73) times and 2.44 (95% CI, 1.56-3.82) times more likely to be willing to prescribe medication abortion and to express confidence in doing so, respectively. Although most pharmacists held favorable attitudes toward hormonal birth control, less than half (144 of 308 [46.8%]) worked in a pharmacy that provided prescriptions for hormonal birth control, and 149 who did not reported barriers such as lack of knowledge or training (65 [43.6%]), insufficient staff or time to add new services (58 [38.9%]), and lack of coverage for services (50 [33.6%]). Conclusions and Relevance: The findings of this cross-sectional survey study of California pharmacists suggest that most pharmacists were willing to prescribe medication abortion. However, future efforts to expand pharmacists' scope of practice should include training to increase knowledge and confidence in prescribing medication abortion. Pharmacy-level barriers to hormonal birth control prescription, such as insurance coverage for pharmacist effort, should also be addressed, as they may serve as barriers to medication abortion access.

Factors Associated with COVID-19 Testing, Vaccination, and Use of Digital Contact Tracing Apps among Black and Latinx MSM (BLMSM) in Los Angeles.

This study examines the factors associated with COVID-19 testing, vaccination intent (both individually and jointly), and willingness to use contact tracing digital apps among a cohort of Black and Latinx men who have sex with men (BLMSM) living in Los Angeles during the initial peak (July 2020) of the COVID-19 pandemic. A questionnaire detailing participants COVID-19 experiences was sent to 300 primarily BLMSM after the first state-wide COVID-19 lockdown. Logistic regression models with random cluster effects were used for analyses. Forty-two percent (42%) tested for COVID-19, 27% were willing to get vaccinated, and about 45% reported willingness to use contact tracing digital apps. Controlling for intervention participation, age, education, marital status, employment, health, tobacco, binge drinking, and self-reported anxiety, those who were depressed had 33% (95% CI: 0.13 to 0.82) odds of using a prevention strategy (either test for COVID-19 or vaccination intent) as the group who were not depressed. Those who had high school diploma or less had 23% (95% CI: 0.11 to 0.48) odds to use digital contact tracing apps as the group with education level of at least Associate's or Bachelor's degree. Without considering the format of the test kits, vaccine side effects, and ease of use for digital contact tracing apps, participants appeared to still be hesitant in using COVID-19 prevention strategies at the initial height of the pandemic. Our findings suggest the need for further investigation into this hesitancy to better inform and prepare for future epidemics.

Analysis of Smartphone Text Data Related to mpox from a U.S. Sample of Gay, Bisexual, and Other Men Who Have Sex with Men During the 2022 Outbreak.

Purpose: We sought to understand technology-based communication regarding mpox (monkeypox) among gay, bisexual, and other men who have sex with men (GBMSM) during the global outbreak in 2022. Methods: Forty-four GBMSM (Mage = 25.3 years, 68.2% cisgender, 43.2% non-White) living in the United States participated. From May 2022 to August 2022, all text data related to mpox (174 instances) were downloaded from the smartphones of GBMSM. Text data and smartphone app usage were analyzed. Results: Content analysis revealed 10 text-based themes and 7 app categories. GBMSM primarily used search and browser, texting, and gay dating apps to share vaccine updates, seek mpox vaccination, find general mpox information, share mpox information with other GBMSM, and discuss links between mpox and gay culture. Data visualizations revealed that changes in communication themes and app usage were responsive to major milestones in the mpox outbreak. Conclusion: GBMSM used apps to facilitate a community-driven mpox response.

"That's kind of like the big struggle right now is can we get PrEP?": Facilitators and Barriers to PrEP Uptake Among Active Duty Gay and Bisexual Men.

Introduction: The US Military is experiencing a rise in HIV infections among gay and bisexual men (GBM) serving on active duty, yet little is known about this population's uptake of pre-exposure prophylaxis (PrEP), an evidence-based intervention for HIV prevention. This mixed methods study examines the facilitators and barriers to PrEP access and uptake among active duty GBM. Methods: Active duty GBM were recruited using respondent-driven sampling (2017 and 2018). Participants (n = 93) answered quantitative survey questions on PrEP interest and accessibility. Another set of participants (n = 10) discussed their PrEP experiences in qualitative interviews. We conducted descriptive and bivariate analyses of quantitative data, while qualitative data were analyzed using structural and descriptive coding techniques. Results: Approximately 71% of active duty GBM indicated interest in accessing PrEP. A greater proportion of those who disclosed (vs. did not disclose) their sexual orientation to their military doctor discussed (p < 0.001) or accessed (p = 0.017) PrEP. The following qualitative themes emerged: (1) providers' negative views and knowledge gaps related to PrEP; (2) lack of a systems approach to PrEP access; (3) confidentiality concerns; and (4) reliance on peer networks for PrEP guidance and support. Conclusions: Study results indicate that active duty GBM are interested in and want to discuss PrEP with their military doctors, but gaps in providers' PrEP-related knowledge and skills, as well as mistrust in the military health care system, remain. Policy Implications: A system-wide approach that addresses confidentiality concerns and removes procedural barriers to PrEP access is recommended to improve PrEP uptake in this population.

Opportunities to Increase Access to HIV Prevention: Evaluating the Implementation of Pharmacist-Initiated Pre-exposure Prophylaxis in California.

Background: Pharmacies are a promising setting through which to expand access to human immunodeficiency virus (HIV) prevention, including pre-exposure and post-exposure prophylaxis (PrEP and PEP, respectively). We aimed to evaluate and inform the implementation of California's Senate Bill 159 (2019), allowing pharmacists to independently prescribe PrEP and PEP. Methods: From October through December 2022, we conducted a cross-sectional study of 919 California pharmacists and pharmacy students, primarily recruited via the email listservs of professional organizations. Participants completed an online survey assessing the implementation of pharmacist-initiated PrEP/PEP, including knowledge, attitudes, practices, perceived barriers, and implementation preferences elicited through a discrete choice experiment. Results: Among 919 participants (84% practicing pharmacists, 43% in community pharmacies), 11% and 13% reported that pharmacists at their pharmacy initiate PrEP and PEP, respectively. Most believed that pharmacist-initiated PrEP/PEP is important (96%) and were willing to provide PrEP (81%); fewer (27%) had PrEP/PEP training. Common implementation barriers were lack of staff/time and payment for pharmacist services. Participants preferred PrEP implementation models with in-pharmacy rapid oral HIV testing and pharmacists specifically hired to provide PrEP services. Conclusions: Despite pharmacists' supportive attitudes, Senate Bill 159 implementation in California pharmacies remains limited, in part due to policy-level and organizational-level barriers. Ensuring PrEP/PEP-related payment for services and sufficient workforce capacity is key to leveraging pharmacists' role in HIV prevention.