"That's My Girl; I love her": The Promise of Compassionate, Inclusive Healthcare for Black Transgender Women to Support PrEP Use.

There are significant disparities in HIV pre-exposure prophylaxis (PrEP) use that disproportionately impact Black transgender women. Medical mistrust and discriminatory experiences in healthcare settings have been identified as critical barriers to equitable PrEP implementation. This qualitative study examines Black transgender women's experiences in healthcare to better understand how patient-provider relationships can help overcome the challenges brought on by medical mistrust. We interviewed 42 Black transgender women about their experiences with healthcare and PrEP access. Data were analyzed using inductive thematic content analysis to develop the following themes: (1) historical and ongoing marginalization and exclusion from healthcare remains a barrier to PrEP use; (2) Many providers continue to be unprepared to prescribe PrEP; (3) Providers can act as important advocates and sources of support; and (4) Compassionate, trusting patient-provider relationships can facilitate PrEP use. Our results highlight the importance of supportive and positive patient-provider relationships and demonstrate how providers can build trusting relationships with Black transgender women to help overcome barriers to healthcare and PrEP use.

Stigma, serostatus disclosure, coping strategies, and the role of social capital resources among HIV care-nonadherent MSM in Russia: a qualitative analysis.

The HIV epidemic continues to expand in Russia, with suboptimal levels of care uptake. This qualitative study aimed to characterize social capital resources and lived stigma experiences, coping, and disclosure among care-nonadherent men who have sex with men (MSM) living with HIV in Russia. Twenty-five HIV-positive MSM - recruited online - completed in-depth interviews over Zoom, with data analyzed using MAXQDA software. Stigma was more likely to be encountered in interactions with persons with whom social ties were weaker such as medical providers and relatives, particularly males. Close friends - often other HIV-positive MSM and female relatives - were the most supportive and least stigmatizing. Similar persons were most often considered for HIV serostatus disclosure. Coping strategies to reduce the impact of stigma included ignoring stigmatizing experiences, seeking support from members of one's social circle, minimizing contact with stigmatizing persons, seeking new relationships with persons who are also HIV-positive, proactively reducing stigma through involvement in advocacy roles, and correcting myths and educating others about HIV infection. These findings underscore the need for interventions to assist HIV-positive MSM in building accepting social capital resources to reduce the impact of stigma and to build support within their social networks, often with other HIV-positive MSM.

Factors associated with PrEP use in a community sample of African American men who have sex with men (MSM) and transgender women (TGW) in the United States Midwest.

Black sexual minority men who have sex with men (MSM) in the United States are at disparate risk for contracting HIV infection, but pre-exposure prophylaxis (PrEP) use is suboptimal. Social network methods were used to recruit a community sample of racial minority MSM and transgender women (TGW) in two Midwestern US cities. 250 PrEP-eligible (HIV-negative) participants completed measures assessing current and intended PrEP use; demographic characteristics; PrEP knowledge, attitudes, norms, stigma, and self-efficacy; and structural barriers to PrEP. Multivariate analyses established predictors of current and intended PrEP use. Only 12% of participants reported currently using PrEP, which was associated with greater PrEP knowledge and not having a main partner, with trends for greater PrEP use by younger participants and those with partners living with HIV. Among participants not currently on PrEP, strength of PrEP use intentions was associated with higher PrEP knowledge, PrEP descriptive social norms, and PrEP use self-efficacy. This study is among few to directly compare Black who have adopted PrEP with those who have not. Its findings underscore the potential benefits of employing social network approaches for strengthening PrEP use peer norms, increasing PrEP knowledge and self-efficacy, and optimizing PrEP uptake among racial minority MSM and TGW.

Intersectional Resilience Among Black Gay, Bisexual, and Other Men Who Have Sex With Men, Wisconsin and Ohio, 2019.

Objectives. To investigate resilience strategies used by Black gay, bisexual, and other men who have sex with men (MSM) to navigate racism and heterosexism. Methods. In 2019, we conducted in-depth interviews with 46 Black MSM in Milwaukee, Wisconsin, and Cleveland, Ohio. Thematic analysis, informed by intersectionality, was used to identify intersectional resilience within the context of participants' lives. Results. Our analyses revealed ways in which Black MSM respond to stigma and oppression. We identified the following themes that capture these experiences: pride in intersectional identities, perseverance, community advocacy, and social support. Our analyses reveal how men draw on these assets and resources to positively adapt despite experiences of racism and heterosexism. Conclusions. Intersectional resilience can support Black MSM in navigating racism and heterosexism. However, public health interventions at the institutional and system levels are needed to directly target the root causes of oppression and support resources that facilitate intersectional resilience. (Am J Public Health. 2022;112(S4):S405-S412. https://doi.org/10.2105/AJPH.2021.306677).

Mobilizing individual social capital resources for HIV care support: results of a pilot intervention in St. Petersburg, Russia.

Half of HIV-positive persons in Russia are on antiretroviral therapy (ART), and only 27% are virally suppressed. A feasibility pilot intervention to mobilize social capital resources for HIV care support was conducted in St. Petersburg. Out-of-care or ART-nonadherent HIV-positive persons (n = 24) attended a five-session intervention to increase access social capital resources (i.e., family, friends, or providers) to mobilize supports for entering care, initiating care, and adhering to ART. HIV care indicators were assessed at baseline, an immediate followup (FU-1), and 6-month followup (FU-2) points. At FU-1, participants more frequently discussed their care experiences with others, verifying the intervention's mechanism of action. Participants increased in scales of medication taking adherence (p = 0.002, FU-1; p = 0.011, FU-2), self-efficacy (p = 0.042; FU-1), and outcome expectancies (p = 0.016, FU-2). Among persons not on ART, HIV Medication Readiness scale scores increased at FU-1 (p = 0.032) but became attenuated at FU-2. Participants tended to more frequently keep care appointments (79%, baseline to 90%, FU-1, p = 0.077); to have undetectable viral load (54%, baseline to 74%, FU-2; p = 0.063); and to have fewer past-month days with delayed or incomplete medication doses (7.8, baseline to 4.2, FU-1; p = 0.084). This novel social capital intervention is promising for improving HIV care-related outcomes and warrants a full-scale evaluation.

Social network intervention to increase pre-exposure prophylaxis (PrEP) awareness, interest, and use among African American men who have sex with men.

In the U.S., HIV incidence is highest among Black men who have sex with men (MSM) but PrEP uptake is low, in part due to lack of normative support for using PrEP. This research pilot tested a social network-level intervention designed to increase PrEP use willingness, interest, and peer supports among Black MSM in Milwaukee. Five community social networks (n = 40 participants) of racial minority MSM were assessed at baseline with measures of PrEP knowledge, interest, attitudes, and action taking. Persons most interconnected with others in each network attended an intervention that provided training to increase knowledge about PrEPbenefits, address PrEP concerns, endorse PrEP use as a symbol of pride and health, and deliver these messages to others in their social networks. All network members were re-administered the same measures at 3-month followup. Significant increases over time were found in network members' PrEP knowledge, attitudes, norm perceptions, self-efficacy, and willingness to use PrEP. Participants more often talked with friends about HIV and with their health care providers about PrEP. The percentage of participants who reported using PrEP increased from 3% to 11%. Larger-scale evaluations of this intervention model are needed.

The Influence of Peers on PrEP Perceptions and Use Among Young Black Gay, Bisexual, and Other Men Who Have Sex with Men: A Qualitative Examination.

Pre-exposure prophylaxis (PrEP) is a promising part of HIV prevention, yet racial disparities in PrEP uptake persist. Evidence indicates that Black gay, bisexual, and other men who have sex with men (GBM) face numerous social and structural barriers to PrEP, including stigma, medical mistrust, and exclusion from the healthcare system. However, little research has examined how social networks can influence PrEP use and help Black GBM overcome these identified barriers. To understand the influence of peers and social networks on Black GBM's perceptions of and decisions about PrEP use, we conducted in-depth interviews with 46 Black GBM in Milwaukee, WI and Cleveland, OH. Data were analyzed using multistage inductive coding and thematic content analysis, using MAXQDA software. Results indicate that participants' primary source of information on PrEP was other Black GBM in their communities. Peers and social networks served three primary functions with regard to PrEP: (1) filling informational gaps left by healthcare providers, (2) increasing trust of PrEP, and (3) reducing PrEP stigma. Participants described the "movers and shakers" in Black LGBT communities who have been influential in educating others and advocating for PrEP. Well-respected vocal advocates for PrEP have emerged in the Black LGBT community as PrEP champions who have successfully influenced young Black GBM's views on PrEP. Our results reveal the role social networks and peer groups can play in increasing PrEP use among Black GBM. Social network interventions may help overcome the stigma and mistrust that are contributing to PrEP disparities.

Predictors of HIV Care Engagement, Antiretroviral Medication Adherence, and Viral Suppression Among People Living with HIV Infection in St. Petersburg, Russia.

Over 1 million HIV infections have been diagnosed in Russia, and HIV care uptake and viral suppression are very low. 241 HIV-positive individuals in St. Petersburg were enrolled through social networks, provided blood for viral load testing, and completed measures of medication-taking adherence, readiness, and self-efficacy; psychosocial well-being; and substance use. Outcomes included attending an HIV care appointment in the past 6 months, >90% ART adherence, and undetectable viral load. 26% of participants had no recent care appointment, 18% had suboptimal adherence, and 56% had detectable viral load. Alcohol use consistently predicted all adverse health outcomes. Having no recent care visit was additionally associated with being single and greater past-month drug injection frequency. Poor adherence was additionally predicted by lower medication-taking self-efficacy and lower anxiety. Detectable viral load was additionally related to younger age. Comprehensive interventions to improve HIV care in Russia must address substance abuse, anxiety, and medication-taking self-efficacy.

The Health and Sociocultural Correlates of AIDS Genocidal Beliefs and Medical Mistrust Among African American MSM.

This study examined social and health-related correlates of AIDS conspiracy theories among 464 African American men who have sex with men (MSM). Exploratory factor analysis revealed two subscales within the AIDS conspiracy beliefs scale: medical mistrust and AIDS genocidal beliefs. Multiple regression analyses revealed medical mistrust and AIDS genocidal beliefs were both associated negative condom use attitudes and higher levels of internalized homonegativity. Medical mistrust was also associated with lower knowledge of HIV risk reduction strategies. Finally, we conducted bivariate regressions to examine the subsample of participants who reported being HIV-positive and currently taking HIV antiretroviral therapy (ART) to test associations between sexual behavior and HIV treatment and AIDS conspiracy theories. Among this subsample, medical mistrust was associated with having a detectable viral load and not disclosing HIV-status to all partners in the previous 3 months. Collectively, these findings have implications for HIV prevention and treatment for African American MSM.

An Exploration of Syndemic Factors That Influence Engagement in HIV Care Among Black Men.

Syndemic theory seeks to understand the interactions and clustering of disease and social conditions and explain racial disparities in HIV. Traditionally applied to HIV risk, this study characterizes the syndemic challenges of engagement in care among Black men living with HIV and provides insight into potential HIV treatment interventions to retain vulnerable individuals in care. Interviews were conducted with 23 HIV-positive men who were either out-of-care or nonadherent to antiretroviral therapy (ART). Interviews were audio recorded, transcribed verbatim, and coded using MAXQDA qualitative software. Researchers analyzed data using thematic content analysis to identify syndemic factors associated with disengagement in care or suboptimal ART adherence among Black men. Analyses revealed the syndemic nature of four themes: intersectional stigma, depression, substance use, and poverty. Findings from this study offer numerous opportunities for intervention including social and structural-level interventions to address syndemic processes and the influence of stigma and poverty on engagement in care.

PrEP Awareness, Familiarity, Comfort, and Prescribing Experience among US Primary Care Providers and HIV Specialists.

HIV pre-exposure prophylaxis (PrEP) was FDA approved in 2012, but uptake remains low. To characterize what would facilitate health care providers' increased PrEP prescribing, we conducted a 10-city, online survey of 525 primary care providers (PCPs) and HIV providers (HIVPs) to assess awareness, knowledge, and experience with prescribing PrEP; and, comfort with and barriers to PrEP-related activities. Fewer PCPs than HIVPs had heard of PrEP (76 vs 98%), felt familiar with prescribing PrEP (28 vs. 76%), or had prescribed it (17 vs. 64%). PCPs were less comfortable than HIVPs with PrEP-related activities such as discussing sexual activities (75 vs. 94%), testing for acute HIV (83 vs. 98%), or delivering a new HIV diagnosis (80 vs. 95%). PCPs most frequently identified limited knowledge about PrEP and concerns about insurance coverage as prescribing barriers. PCPs and HIVPs differ in needs that will facilitate their PrEP prescribing. Efforts to increase PrEP uptake will require interventions to increase the knowledge, comfort, and skills of providers to prescribe PrEP.

Correlates of Sexual HIV Risk Among African American Men Who Have Sex With Men.

OBJECTIVES: We examined correlates of condomless anal intercourse with nonmain sexual partners among African American men who have sex with men (MSM). METHODS: We recruited social networks composed of 445 Black MSM from 2012 to 2014 in Milwaukee, Wisconsin; Cleveland, Ohio; and Miami Beach, Florida. Participants reported past-3-month sexual behavior, substance use, and background, psychosocial, and HIV-related characteristics. RESULTS: Condomless anal intercourse outside main concordant partnerships, reported by 34.4% of MSM, was less likely in the case of no alcohol and marijuana use in the past 30 days, and higher risk-reduction behavioral intentions. High frequency of condomless anal intercourse acts with nonmain partners was associated with high gay community participation, weak risk-reduction intentions, safer sex not being perceived as a peer norm, low condom-use self-efficacy, and longer time since most recent HIV testing. CONCLUSIONS: Condomless anal intercourse with nonmain partners among Black MSM was primarily associated with gay community participation, alcohol and marijuana use, and risk-reduction behavioral intentions.

Barriers and Facilitators of HIV Care Engagement: Results of a Qualitative Study in St. Petersburg, Russia.

Russia has a large HIV epidemic, but medical care engagement is low. Eighty HIV-positive persons in St. Petersburg completed in-depth interviews to identify barriers and facilitators of medical HIV care engagement. The most commonly-reported barriers involved difficulties accessing care providers, dissatisfaction with the quality of services, and negative attitudes of provider staff. Other barriers included not having illness symptoms, life stresses, low value placed on health, internalized stigma and wanting to hide one's HIV status, fears of learning about one's true health status, and substance abuse. Care facilitators were feeling responsible for one's health and one's family, care-related support from other HIV-positive persons, and the onset of health decline and fear of death. Substance use remission facilitated care engagement, as did good communication from providers and trust in one's doctor. Interventions are needed in Russia to address HIV care infrastructural barriers and integrate HIV, substance abuse, care, and psychosocial services.

The role of the Black Church in the lives of young Black men who have sex with men.

In the USA, the Black Church is among the most important institutions in the Black community, offering numerous spiritual, social and health benefits. Yet, the presence of homonegativity in many Black Churches may mitigate those effects for gay Black youth. This research examines the role of the Church in the lives of gay and bisexual Black youth to understand how they reconcile any tension between their religious and sexual identities. Through interviews with pastors of Black churches (n = 21) and young Black men who have sex with men (n = 30), we explored homonegativity and young men's experiences within the Black Church. Findings reveal that despite the prevalence of homonegativity within Black churches, religious involvement remains important for young men and many remain involved in non-affirming churches. The importance of the Church for young men stems from their significant involvement as youth and the integration of religion, family and community. Young men may not be able to leave their religious homes as readily as other gay youth given the cultural relevance of the Church. As a result, young men made attempts to conceal their sexuality in church to avoid shame and gossip and find opportunities to balance their sexuality and religiosity.

Social Media Use and High-Risk Sexual Behavior Among Black Men Who Have Sex with Men: A Three-City Study.

Black men who have sex with men (MSM) bear a disproportionate burden of human immunodeficiency (HIV) incidence in the United States. Little research has focused on the associations between social media use and sexual behavior among Black MSM. 205 Black MSM completed measures assessing social media use and sexual behaviors. Men spent an average of 34 h per week on social media sites. 53 % arranged sexual hookups online in the previous 3 months, and did so a mean of 10 times. Overall, users of social media and men who arranged sexual hookups online engaged in more risky behaviors than non-users and men who did not arrange sexual hookups online. However, partner-level data indicated that men engaged in fewer risky behaviors with partners met online compared to partners met in other ways such as at bars or through friends. Social media-based interventions designed to decrease HIV transmission among racial minority MSM are needed.

Situational, partner, and contextual factors associated with level of risk at most recent intercourse among Black men who have sex with men.

African American men who have sex with men (MSM) in the United States bear a disproportionate burden of HIV infection and disease incidence. 178 Black MSM provided detailed situational information concerning their most recent act of anal intercourse (AI) with a male partner including condom use, partner characteristics, serostatus disclosure, and substance use. Participants completed scales assessing AIDS-related as well as broader contextual domains. Most recent AI acts occurred with same-race partners outside of main relationships. Over one-third of AI acts were unprotected, and almost half of the unprotected acts were not between known HIV-concordant partners. Nearly half of men reported substance use before sex. In a multiple regression analysis, unprotected AI with a partner not known to be concordant was predicted by low risk reduction intentions and indicators of a casual relationship. The findings highlight issues and partner contexts associated with risk for contracting HIV infection among Black MSM.

Beyond the ball: implications for HIV risk and prevention among the constructed families of African American men who have sex with men.

African American men who have sex with men (AAMSM) are disproportionately burdened by new and existing HIV infections. In spite of this, few HIV prevention interventions have been developed that meet the specific needs of AAMSM and that are culturally appropriate and build on strengths and resources. In this paper, we examine constructed families, including those who belong to houses and those who do not, from a three city sample of 196 AAMSM. Results show that the majority of AAMSM who belong to constructed families do not participate in houses or balls. Both house and non-house affiliated constructed families are important sources of social support among AAMSM. Participants reported limited success in spreading HIV messages at ball events, but talk about HIV within their constructed families. Social network approaches to HIV prevention may capitalize on existing social ties within constructed families to promote safer sexual behaviors.

Factors predicting primary and booster COVID-19 vaccination in a community sample of African American men and women in the United States Midwest.

COVID-19 has disproportionately burdened impoverished minority communities. This study recruited an age- and gender-diverse community sample of 541 Black adults in a United States Midwestern city with large racial health disparities, with the aim of examining factors associated with COVID-19 vaccination. All participants completed measures assessing their COVID-19 vaccination status (unvaccinated, received primary vaccination, or received primary plus booster vaccination) as well as demographic characteristics, socioeconomic factors, health and health system factors, and health behavior theory constructs related to vaccination. In this predominantly low-income sample, 55% of participants had received primary COVID-19 vaccination and 31% of the sample had received a booster dose. Multiple regression analyses established that having primary vaccination was significantly predicted by older age, political identification as Democrat, education beyond high school, barriers to accessing health care, as well as higher trust of vaccine benefits, less preference for natural immunity, stronger social norms favoring vaccination, and perceiving higher levels of collective responsibility. Surprisingly, higher global medical mistrust and difficulty with healthcare access were associated with vaccination. The model explained 76% of the variance in primary COVID-19 vaccination. Having received a COVID-19 booster was predicted by older age, previous COVID-19 infection, higher trust in vaccine benefits, and fewer worries about unforeseen future effects of vaccination. Study findings identified factors associated with COVID-19 vaccine uptake in racial minority communities, and support the benefits of interventions that harness social network supports for vaccination, address community vaccine concerns, and appeal to collective responsibility to promote vaccine uptake.

Strategies to reduce COVID-19 vaccine hesitancy among pregnant individuals: Data from a prospective survey of unvaccinated pregnant women.

OBJECTIVE: To explore strategies that could reduce coronavirus disease 2019 (COVID-19) vaccine hesitancy in pregnancy. METHODS: In 2021, the authors conducted a survey of pregnant women assessing attitudes and beliefs regarding COVID-19 vaccination. The present analysis reviewed trusted sources of information about COVID-19 vaccination that could reduce vaccine hesitancy among pregnant respondents. RESULTS: A total of 295 surveys were analyzed. Using 10-point Likert scales, intentions to accept COVID-19 vaccine were split between individuals with low (n = 126, 43%) and high (n = 141, 48%) intentions to receive the vaccine, with only a small percentage of women having midrange vaccination intentions (n = 28, 10%). When asked what would reduce their COVID-19 vaccine concerns, published data was the leading answer in both low (46.2%) and medium (35.7%) intention groups followed by personally knowing someone who got vaccinated during pregnancy (21.0% and 28.6% for low and medium groups, respectively). In contrast, an obstetrician's recommendation was the most common answer in the group with high intention to vaccinate (37.2%). Knowing someone who received the vaccine in pregnancy was the leading response for reducing concerns of COVID-19 vaccination among Black respondents. CONCLUSION: The survey identified several innovative and culturally specific approaches to address vaccine confidence and complacency and improve vaccine uptake in pregnant people.

People Living With HIV in St. Petersburg, Russia: Gender and Exposure Group Differences in HIV Care Engagement, Psychosocial Health, Substance Use, and Transmission Risk Behavior.

This study examined psychosocial and health needs of persons living with HIV (PLWH) in Russia. The study combined baseline datasets from two social network samples of PLWH in St. Petersburg (N = 872). Samples were recruited between 2014 and 2018 by enrolling a PLWH seed who was either out-of-care or treatment nonadherent as well as network members surrounding each seed, assessing each participant's HIV care, transmission risk, substance use, and mental health characteristics. Almost one-quarter of participants said they were never offered antiretroviral therapy (ART), and-among those offered ART-one-quarter refused or discontinued therapy and 45% were <95% ART-adherent. Almost half of participants had detectable viral load, and many reported continued condomless intercourse with potentially nonconcordant serostatus partners or needle sharing. Over 46% of participants had elevated scores on measures of depression, hopelessness, state anxiety, or poor social support. Study findings illustrate unmet needs of PLWH in Russia.