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We evaluated the psychometric properties of a measure consisting of items that assess current HIV care continuum engagement based on established definitions in the United States. At baseline, participants in this longitudinal study, which included three time points from 2015 to 2020, were 331 young Black sexual minority men ages 18-29 living with HIV in the southern United States residing in two large southern cities. Self-report items reflected four aspects of HIV care continuum engagement as binary variables: seeing a healthcare provider for HIV care, being on antiretroviral treatment, being retained in HIV care, and being virally suppressed. Of these, the following three variables loaded onto a single factor in exploratory factor analysis: being on antiretroviral treatment, being retained in HIV care, and being virally suppressed. A one-dimensional factor structure was confirmed using confirmatory factor analyses at separate time points. Additionally, the three items collectively showed measurement invariance by age, education level, employment status, and income level. The three-item measure also showed reliability based on coefficient omega and convergent validity in its associations with indicators of socioeconomic distress, depression, resilience, and healthcare empowerment. In sum, the items performed well as a single scale. The study demonstrated the potential psychometric strength of simple, feasible, commonly administered items assessing engagement in the HIV care continuum.
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Infecções por HIV , Masculino , Humanos , Estados Unidos , Reprodutibilidade dos Testes , Estudos Longitudinais , Infecções por HIV/tratamento farmacológico , Antirretrovirais/uso terapêutico , Autorrelato , PsicometriaRESUMO
Young Black Sexual Minority Men with HIV (YBSMM+) in the US South encounter multiple socio-structural challenges that contribute to disproportionately poor HIV-related outcomes across the care continuum. Depression, anxiety, intimate partner violence (IPV), and alcohol use are prominent factors that negatively impact engagement with HIV care. Syndemic theory posits that these multiple factors interact synergistically to promote poor outcomes; however, depression itself is highly heterogeneous in presentation, which may pose issues when examining associations to HIV care engagement. This study sought to better understand the associations of specific depressive symptomology subtypes, generalized anxiety, experienced IPV, and alcohol use on HIV care engagement for YBSMM+. Results showed that interpersonally oriented depressive symptomatology was associated with increased HIV care engagement among YBSMM + who abstained from alcohol. On the other hand, among YBSMM + who frequently binge drank, combined negative affect and somatic components of depressive symptomatology and frequency of IPV experiences were associated with decreased HIV care engagement while generalized anxiety was associated with increased HIV care engagement. The findings suggest that the negative affect and somatic components of depression may be particularly salient for HIV care engagement among YBSMM + who binge drink frequently. Developing targeted interventions that address these specific conditions while accounting for the nuances of mood-based symptomatology could improve intervention efforts geared towards improving HIV care engagement among YBSMM+.
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Infecções por HIV , Violência por Parceiro Íntimo , Minorias Sexuais e de Gênero , Masculino , Humanos , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Consumo de Bebidas Alcoólicas/epidemiologia , Afeto , Fatores de RiscoRESUMO
OBJECTIVE: To study resilience and its association with HIV care engagement in a sample of young adult Black and Latinx people living with HIV (PLWH) in the United States and to test if a systems-level barrier, medical mistrust, would moderate the resilience-engagement association. METHOD: Between April and August 2021, we recruited participants through social media and dating apps (N = 212) and verified age and HIV status through a review process of digital text-messaged and emailed photos. Participants completed a one-time online survey consisting of the Connor-Davidson Resilience Scale, The Index of Engagement in HIV Care, and the Medical Mistrust Index. We ran a regression-based moderation analysis using the Johnson-Neyman Technique to estimate regions of significance. RESULTS: The sample (N = 212) was 80.5% Black and 19.5% Latinx with a mean age of 25.8 years (SD = 2.84). Higher resilience scores were associated with higher HIV care engagement scores (b = 0.72, p = .003), and medical mistrust moderated this relationship as evidenced by a mistrust by resilience interaction (b = -0.16, p = .01). Our regions of statistical significance showed that as mistrust increased, the size of the resilience-engagement association decreased. CONCLUSION: Resilience may be a protective factor associated with greater participation and sense of connection to HIV care, but is diminished by mistrust of the medical system at large. This suggest that systems-level changes, in addition to individual-level interventions, are needed to address medical mistrust to fully harness the resilience of young PLWH. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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HIV stigma negatively affects the social experiences of people living with HIV (PLWH) and remains a challenge to HIV prevention, treatment, and care. Research has overwhelmingly focused on individual cognitive measures of HIV stigma (e.g., internalized, anticipated, and experienced). However, little research explores the interactions and societal structures through which HIV stigma is produced. Data from qualitative interviews with 30 black gay and bisexual men living with HIV in the U.S. Deep South revealed an interconnected and interdependent set of processes that produce and reproduce HIV stigma. These included social interactions (silence, euphemism, and gossip), witnessed acts of marginalization, word-of-mouth transmission of HIV misinformation, and laws and policies carried out within the education and criminal justice systems. Efforts to reduce stigma that focus on individual beliefs and attitudes are critical to improving the well-being of PLWH. However, reducing HIV stigma requires intervening on the social interactions and structures through which HIV stigma is produced and reproduced.
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Youth and young adults living with HIV (YLWH) have a high HIV infection rate and suboptimal oral medication adherence. Biomedical researchers hope that long-acting antiretroviral therapy (LAART) modalities can help those who struggle with daily oral adherence. While adults living with HIV have expressed interest in LAART, little research has explored perspectives of YLWH. This study explores ART experiences and perspectives on LAART through qualitative interviews with twenty diverse YLWH (18-29) in the United States. Data were analyzed using framework analysis. Most participants were satisfied with their current ART yet had experienced side effects or had struggled with daily adherence. Preferences for improving daily oral ART included making pills smaller and reformulating ART into flavored chewable gummies. Most expressed enthusiasm for LAART, although needle aversion and previous injection drug use were potential barriers for some. Approximately half were interested in an ART patch, though its visibility and fear of stigmatization was concerning. Few expressed interest in implantable ART, calling it unappealing. Although younger people are most likely to benefit from these advancements in HIV treatment, additional research is needed to identify gaps in uptake and to further explore perspectives of YLWH to improve the success of new treatment modalities.
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Infecções por HIV , Adolescente , Infecções por HIV/tratamento farmacológico , Humanos , Adesão à Medicação , Satisfação Pessoal , Inquéritos e Questionários , Estados Unidos , Adulto JovemRESUMO
In the United States, Black gay and bisexual men account for a quarter of HIV infections and face intersecting social and structural stigmas along the axes of race, sexuality and class. For those diagnosed with HIV, these inequities shape their lived experiences which include HIV disclosure. Public health has privileged HIV status disclosure as the appropriate moral and responsible choice to protect sex partners, reduce stigma and obtain social support. Though little is known about the emotional aspects of HIV disclosure for Black gay and bisexual men, or how they are shaped by social and structural contexts. Using the frameworks of healthism and emotion work, I explore HIV disclosure among a sample of 30 Black gay and bisexual men living with HIV in the Deep South. Drawing on in-depth, qualitative interviews, I identify the emotion work that men engaged in to manage their own emotions and protect the emotions of others before, during and after disclosure or nondisclosure. These findings challenge public health research that has explored disclosure as discrete measurable events by illustrating how HIV disclosure is embedded in ongoing social and structural relations and provide insights that can guide new approaches focused on structural inequities that constitute HIV disclosure.
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Infecções por HIV , Minorias Sexuais e de Gênero , Bissexualidade , Revelação , Emoções , Infecções por HIV/psicologia , Homossexualidade Masculina/psicologia , Humanos , Masculino , Estados UnidosRESUMO
Few researchers have quantitatively explored the relationship power-HIV risk nexus in same-sex male couples. We developed and validated the Power Imbalance in Couples Scale (PICS) to measure relationship power among men in same-sex, committed relationships and its association with sexual risk behaviors. We recruited three independent and diverse samples of male couples in the greater San Francisco and New York City metropolitan areas and conducted qualitative interviews (N1 = 96) to inform item development, followed by two quantitative surveys (N2 = 341; N3 = 434) to assess the construct, predictive, convergent, and discriminant validity of the PICS. Exploratory factor analysis of the first survey's data yielded four factors-overtly controlling partner, supportive partner, conflict avoidant actor, and overtly controlling actor-that accounted for more than 50% of the shared variance among the PICS items. Confirmatory factor analysis (CFA) of the second survey's data supported these four factors: χ2(1823) = 2493.40, p < .001; CFI = .96, RMSEA = .03 and WRMR = 1.33. Strong interfactor correlations suggested the presence of a higher-order general perception of power imbalance factor; a higher-order factor CFA model was comparable in fit to the correlated lower-order factors' CFA: χ2(2) = 2.00, p = .37. Internal reliability of the PICS scale was strong: α = .94. Men perceiving greater power imbalances in their relationships had higher odds of engaging in condomless anal intercourse with outside partners of discordant or unknown HIV status (OR 1.27; 95% CI 1.01-1.60; p = .04). The PICS is an important contribution to measuring relationship power imbalance and its sequelae among male couples; it is applicable to research on relationships, sexuality, couples, and HIV prevention.
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Infecções por HIV/prevenção & controle , Relações Interpessoais , Comportamento Sexual/psicologia , Parceiros Sexuais/psicologia , Adulto , Homossexualidade Masculina , Humanos , Masculino , Reprodutibilidade dos Testes , Assunção de RiscosRESUMO
More than 30 years into the HIV epidemic, men who have sex with men (MSM) continue to be disproportionately impacted. It is estimated that worldwide nearly half of MSM infected with HIV are unaware of their status, making HIV testing along with early linkage to care crucial to HIV prevention efforts. However, there remain significant barriers to HIV testing among MSM, due largely to complex issues of layered stigma that deter MSM from accessing traditional, clinic-based testing. We conducted a review and synthesis of the literature on strategies to increase uptake of HIV testing among MSM. We found that social network-based strategies, community-based testing, HIV self-testing, and modifications to the traditional clinic-based model can effectively reach a subset of MSM, but success was often context-specific and there are significant gaps in evidence. We provide recommendations for increasing HIV testing rates and status awareness among MSM.
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Sorodiagnóstico da AIDS , Infecções por HIV/prevenção & controle , Comportamentos Relacionados com a Saúde , Homossexualidade Masculina/psicologia , Cooperação do Paciente/psicologia , Adulto , Técnicas de Apoio para a Decisão , Infecções por HIV/diagnóstico , Infecções por HIV/psicologia , Infecções por HIV/reabilitação , Humanos , MasculinoRESUMO
Among Black men who have sex with men (MSM), HIV incidence is disproportionately high and HIV care engagement is disproportionately low. There may be important opportunities to leverage the primary relationship to improve engagement in HIV care and treatment among Black MSM couples. Using dyadic qualitative analysis of semi-structured, one-on-one interviews, we explored dyadic aspects of HIV care engagement among 14 Black MSM couples in which at least one partner was HIV-positive and identified as a Black cisgender man. Findings showed that men varied in how involved they were in their HIV-positive partner's care and treatment, and in how they reciprocated their partner's involvement. Patterns of dyadic HIV care engagement supported a conceptual model of dyadic coordination that describes Black MSM relationships in terms of two conceptual dimensions of dyadic HIV care engagement, and guides future intervention designs with Black MSM couples.
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Negro ou Afro-Americano , Características da Família , Infecções por HIV/terapia , Participação do Paciente , Parceiros Sexuais , Minorias Sexuais e de Gênero , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Pesquisa Qualitativa , Adulto JovemRESUMO
This mixed-methods study used qualitative interviews to explore discrepancies between self-reported HIV care and treatment-related behaviors and the presence of antiretroviral medications (ARVs) in a population-based survey in South Africa. ARV analytes were identified among 18% of those reporting HIV-negative status and 18% of those reporting not being on ART. Among participants reporting diagnosis over a year prior, 19% reported multiple HIV tests in the past year. Qualitative results indicated that participant misunderstandings about their care and treatment played a substantial role in reporting inaccuracies. Participants conflated the term HIV test with CD4 and viral load testing, and confusion with terminology was compounded by recall difficulties. Data entry errors likely also played a role. Frequent discrepancies between biomarkers and self-reported data were more likely due to poor understanding of care and treatment and biomedical terminology than intentional misreporting. Results indicate a need for improving patient-provider communication, in addition to incorporating objective measures of treatment and care behaviors such as ARV analytes, to reduce inaccuracies.
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Infecções por HIV/diagnóstico , Autorrelato , Desejabilidade Social , Adulto , Antirretrovirais/uso terapêutico , Terapia Comportamental , Viés , Compreensão , Aconselhamento , Feminino , Infecções por HIV/tratamento farmacológico , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pesquisa Qualitativa , Testes Sorológicos , África do Sul , Carga ViralRESUMO
Behavioral and epidemiological studies report high risk for HIV among MSM couples. Over the last decade, studies have examined relationship dynamics associated with sexual risk for HIV. It is important to examine the impact this research has had on HIV prevention and what is still needed. We conducted a review of the literature focusing on relationship dynamics associated with sexual risk for HIV among MSM couples. Procedures used for this review were guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses established to provide a framework for collecting, reviewing and reporting studies systematically (Mohler et al. in Ann Intern Med 151(4):264-269, 2009). We found that positive relationship dynamics are associated with less risk with partners outside the relationship, but were associated with greater odds of unprotected anal intercourse with primary partners. We also discuss other factors including sexual agreements about outside partners and make recommendations for next steps in HIV prevention research among MSM couples.
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Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Homossexualidade Masculina/psicologia , Comportamento de Redução do Risco , Parceiros Sexuais/psicologia , Sexo sem Proteção/prevenção & controle , Sexo sem Proteção/psicologia , Humanos , MasculinoRESUMO
Research has suggested that men who have sex with men and who have older sexual partners are at increased risk of HIV infection. However, while several studies have explored risk among men in age-discrepant non-primary partnerships, only two have explored age discrepancy and risk in primary same-sex male relationships. We used data from semi-structured in-depth interviews to explore sexual behaviour and HIV risk among 14 Black, white and interracial (Black/white) same-sex male couples with an age difference of 10 or more years. Most couples regularly used condoms, and sexual positioning tended to lead to lower risk for younger partners. Some serodiscordant couples abstained from anal sex, while others used seropositioning to avoid transmission within the relationship. Within some couples, older partners acted as mentors on HIV prevention and broader life lessons. Future studies should further explore the potential risks and benefits of large age differences in same-sex male primary relationships.
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Among gay and bisexual men, primary partners are a leading source of HIV infection. Trust, intimacy, and advancements in HIV treatment may impact same-sex male (SSM) couples' decisions to engage in unprotected anal intercourse (UAI). This qualitative study explored how Black, White and interracial couples discussed, and made decisions regarding condoms. Qualitative interviews were conducted with 48 SSM couples in the New York and San Francisco metropolitan areas. Stratified purposive sampling was used to include Black (n = 16), White (n = 17), and interracial (Black-White) (n = 15) couples. Twenty-six couples were concordant HIV-negative and 22 were HIV-discordant. Interviews were recorded, transcribed, coded, and analyzed using a grounded theory approach. Some couples described explicit processes, which involved active discussion, while others described implicit processes, where condom-use decisions occurred without any explicit discussion. These processes also differed by race and HIV status. Black couples tended to report condom-use as "just understood." White, HIV-discordant couples decided not to use condoms, with some identifying the HIV-positive partner's suppressed viral load and high CD4 count as deciding factors. After an unplanned episode of UAI, White, HIV-negative couples tended to discontinue condom use while Black HIV-negative couples decided to revert to using condoms. HIV prevention efforts focused on same-sex, male couples must consider the explicit/implicit nature of condom decision-making processes. Understanding differences in these processes and considering relationship dynamics, across race and HIV status, can promote the development of innovative couple-level, HIV prevention interventions.
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Preservativos/estatística & dados numéricos , Tomada de Decisões , Soropositividade para HIV , Homossexualidade Masculina , Comportamento Sexual/psicologia , Adulto , Negro ou Afro-Americano/psicologia , Bissexualidade/psicologia , Infecções por HIV/prevenção & controle , Humanos , Masculino , New York , Sexo Seguro , São Francisco , Comportamento Sexual/etnologia , Parceiros Sexuais , Confiança , População Branca/psicologiaRESUMO
BACKGROUND: Health misinformation, which was particularly prevalent during the COVID-19 pandemic, hampers public health initiatives. Spanish-speaking communities in the San Francisco Bay Area may be especially affected due to low digital health literacy and skepticism towards science and healthcare experts. Our study aims to develop a checklist to counter misinformation, grounded in community insights. METHODS: We adopted a multistage approach to understanding barriers to COVID-19 vaccine uptake in Spanish-speaking populations in Alameda and San Francisco counties. Initial work included key informant and community interviews. Partnering with a community-based organization (CBO), we organized co-design workshops in July 2022 to develop a practical tool for identifying misinformation. Template analysis identified key themes for actionable steps, such as source evaluation and content assessment. From this, we developed a Spanish-language checklist. FINDINGS: During formative interviews, misinformation was identified as a major obstacle to vaccine uptake. Three co-design workshops with 15 Spanish-speaking women resulted in a 10-step checklist for tackling health misinformation. Participants highlighted the need for scrutinizing sources and assessing messenger credibility, and cues in visual content that could instill fear. The checklist offers a pragmatic approach to source verification and information assessment, supplemented by resources from local CBOs. CONCLUSION: We have co-created a targeted checklist for Spanish-speaking communities to identify and counter health misinformation. Such specialized tools are essential for populations that are more susceptible to misinformation, enabling them to differentiate between credible and non-credible information.
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Idioma , Pandemias , Humanos , Feminino , São Francisco , Vacinas contra COVID-19 , ComunicaçãoRESUMO
Black sexual minority men (BSMM) continue to bear a disproportionate burden of HIV in the United States, with the highest incidence and prevalence in the southern region of the country. In Texas, BSMM living with HIV (BSMM+) have the lowest rates of viral suppression of all SMM and have lower antiretroviral treatment (ART) adherence than white and Hispanic SMM. Long-acting injectable ART (LAI-ART) can potentially overcome several barriers to daily oral ART adherence (e.g., stigma, forgetfulness, pill fatigue). However, little is known about the knowledge, willingness, barriers, and facilitators regarding LAI-ART among BSMM+. From July 2022 to September 2023, we conducted in-depth, semi-structured interviews with 27 BSMM+ from the Houston and Dallas Metropolitan Areas, Texas. Data were analyzed using a thematic analysis approach. Most men knew about LAI-ART, but their understanding varied based on their existing sources of information. Some men were enthusiastic, some were cautious, and some reported no interest in LAI-ART. Barriers to LAI-ART included a lack of public insurance coverage of LAI-ART; fear of needles and side effects; the frequency of injection visits; the requirement of viral suppression before switching from oral ART to LAI-ART; and satisfaction with oral daily ART. Motivators of LAI-ART uptake included the eliminated burden of daily pills and reduced anxiety about possibly missing doses. BSMM+ may be among those who could most benefit from LAI-ART, though more research is needed to understand which factors influence their willingness and how the barriers to LAI-ART might be addressed, particularly among diverse communities of SMM of color.
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Infecções por HIV , Conhecimentos, Atitudes e Prática em Saúde , Minorias Sexuais e de Gênero , Humanos , Masculino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Texas , Adulto , Minorias Sexuais e de Gênero/psicologia , Minorias Sexuais e de Gênero/estatística & dados numéricos , Pessoa de Meia-Idade , Negro ou Afro-Americano/psicologia , Fármacos Anti-HIV/uso terapêutico , Adulto Jovem , Adesão à Medicação/psicologiaRESUMO
Background: Black sexual minority men (BSMM) in the Southern region of the United States experience a disproportionate burden of HIV. Research findings suggest that having supportive patient-provider relationships are critical for sustained HIV care engagement. The present study explores the role of supportive healthcare providers in the care engagement among BSMM living with HIV (BSMM+) in the US South. Methods: Semi-structured qualitative interviews were conducted with BSMM+ in Texas (n=27) to explore perceived barriers and facilitators of sustained care engagement. Interviews lasted 60 minutes on average, were transcribed, coded, and analyzed using applied thematic analysis. Findings: Participants described how important having relationships with engaged and supportive HIV care and service providers is to sustained engagement in care and positive HIV clinical outcomes. Supportive providers were characterized as non-judgmental, meeting patients' needs, and making patients feel "seen". Less supportive providers were described as making their patients "feel like a number" and having lack of follow through on proposed support and resources. Supportive providers were associated with increased care engagement of their patients while less supportive providers often led to patients switching providers, losing touch with services, and getting off track with their care. Discussion: We found that among BSMM+ an important facilitator of sustained care engagement was having positive, affirming, and knowledgeable healthcare providers, while negative and dismissive experiences with providers was a notable barrier to care engagement. This work highlights the need for a scale up of comprehensive, ongoing trainings in patient-centered and person-first communication for providers. Further, manageable provider caseloads can facilitate more thorough patient interactions where tailored HIV care and education can be provided in a safe and non-judgmental environment.
Black sexual minority men in the Southern region of the United States experience a disproportionate burden of HIV. While the role of patient-provider relationships for HIV care engagement has been shown in some contexts, less is known about the specific role of supportive healthcare providers in the care engagement among Black sexual minority men living with HIV in the United States South.Semi-structured qualitative interviews were conducted among Black sexual minority men living with HIV in Texas (n=27) to explore perceived barriers and facilitators of sustained care engagement.We found that supportive providers were associated with increased care engagement of their patients while less supportive providers often led to patients switching providers, losing touch with services, and getting off track with their care. Our findings suggest the need for a scale up of comprehensive, ongoing trainings in patient-centered and person-first communication for providers.
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Recognizing the historical grounding of sexual identity development, we examined the spontaneous narration of the internet's significance among a diverse sample of three distinct birth cohorts of sexual minority adults (n = 36, ages 18-59) in the United States. Thematic analysis revealed two structural barriers and four roles of the internet in sexual identity development. Structural barriers were being in a heterosexual marriage (exclusive to members of the older cohort), and (2) growing up in a conservative family, religion, or community (which cut across cohorts). Roles of the internet included: learning about LGBQ+ identities and sex; watching pornography (which appeared only in narratives of the younger cohort); finding affirming community; and facilitating initial LGBQ+ romantic and sexual experiences (which appeared mostly in narratives of the younger cohort). Most participants who described the internet as playing a role in sexual identity development were members of the younger (ages 18-25) and middle (ages 34-41) cohorts. We discuss how the internet has assumed a unique role in history in the development of sexual minority people. Further, our findings highlight that sexual identity development occurs across the lifespan, and how that process and the roles of the internet vary by generation and structural realities.
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Homossexualidade Feminina , Minorias Sexuais e de Gênero , Adulto , Feminino , Humanos , Estados Unidos , Adolescente , Adulto Jovem , Comportamento Sexual , Bissexualidade , InternetRESUMO
BACKGROUND: Whereas national attention has been paid to the ongoing mental health crises among young people triggered by the COVID-19 pandemic, less is known about the social, physical and psychological impacts of COVID-19 on young people living with HIV, especially racial/ethnic minorities. SETTING: Online survey of participants across the U.S. METHOD: A national cross-sectional survey of non-Latinx Black and Latinx young adults (18-29) living with HIV. Between April and August 2021, participants answered survey questions about several domains (eg, stress, anxiety, relationships, work, quality of life) that were worsened, improved, or unchanged during the pandemic. We ran a logistic regression estimating the self-reported impact of the pandemic on these domains between 2 age groups (ages 18-24 versus 25-29). RESULTS: The sample size was 231 (186 non-Latinx Black, 45 Latinx) and mainly male (84.4%) and gay identified (62.2%). Nearly 20% of participants were 18-24 years old and 80% were ages 25-29. Participants who were 18-24 years old reported 2-3 times the odds for having worse sleep quality and mood and greater stress, anxiety, and weight gain compared with those 25-29 years old. CONCLUSION: Our data provide a nuanced picture of the negative impacts that COVID-19 had on non-Latinx Black and Latinx young adults living with HIV in the U.S. Given that these adults represent a priority population for HIV treatment outcomes, it is critical to better understand the ongoing toll that these dual pandemics have on their lives.
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COVID-19 , Infecções por HIV , Adulto Jovem , Humanos , Masculino , Adolescente , Adulto , Feminino , Estudos Transversais , Saúde Mental , Pandemias , Qualidade de VidaRESUMO
BACKGROUND: We implemented a mentored research education and training program for underrepresented minorities (URMs) and Black, Indigenous, and People of Color (BIPOC) predoctoral and postdoctoral fellows called San Diego SUN (SD SUN): Supporting and Uplifting New and Diverse Scientists in HIV Research. The SD SUN program aimed to prepare fellows for an academic career trajectory in HIV science focused on ameliorating HIV-related disparities in communities of color. SETTING: The program leveraged a strong interinstitutional collaboration between San Diego State University and the University of California, San Diego, that share commitments to diversity, equity, and inclusion and an established history of training programs for URM/BIPOC investigators. METHODS: During a 9-month training period, launched in February 2022, fellows supported by a mentoring team completed ten 3-hour training sessions (core curriculum) and a mentored research project. The curriculum included seminars on building skills for a productive academic research career and reflective discussions around issues uniquely faced by URM/BIPOC investigators. Standardized measures developed for Center for AIDS Research Diversity, Equity, and Inclusion Pipeline Initiative (eg, around benefits gained) were used to evaluate the program. RESULTS: Six fellows participated in the SD SUN program. The results demonstrated a successful first year. Fellows were highly engaged and reported positive experiences, satisfaction with their mentor(s), various benefits gained from the program, and gains in numerous skillsets. CONCLUSIONS: Challenges were faced during implementation (eg, teaching grant writing to fellows at different skill levels). Time constraints were reported by some faculty mentors with limited bandwidth. We describe insights and solutions to the major challenges to sustaining the successful SD SUN program.
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Infecções por HIV , Médicos , Humanos , Pigmentação da Pele , Infecções por HIV/prevenção & controle , Escolaridade , Pessoal de SaúdeRESUMO
Nearly half of new HIV cases in the United States are among youth. Little is known about the willingness of young adults living with HIV (YLWH) to participate in HIV cure-related research. In 2021, we recruited 271 YLWH aged 18-29 for an online survey. We asked questions about willingness to participate in HIV cure research, perceived risks and benefits, acceptable trade-offs, and perceptions on analytical treatment interruptions. We conducted descriptive analyses to summarize data and bivariate analyses to explore correlations by demographics. Most respondents (mean age = 26) identified as men (86%) and Black Americans (69%). YLWH expressed high willingness to consider participating in cell- and gene-based approaches (75%) and immune-based approaches (71%). Approximately 45% would be willing to let their viral load become detectable for a period of time during an HIV cure study, 27% would not be willing, and 28% did not know. The social risk most likely to deter participation was the possibility of transmitting HIV to sex partners while off HIV medications (65% of respondents would be deterred a great deal or a lot). Compared to the 25-29 age group (n = 192), the 18-24 age group (n = 79) was more likely to indicate that having to disclose HIV status would matter a great deal in considering participation in HIV cure research (38% vs. 21%, p = .003). Inclusion and engagement of YLWH are critical for advancing novel HIV curative agents. Our article concludes with possible considerations for engaging YLWH in HIV cure research. Physical, clinical, and social risks will need to be kept to a minimum, and research teams will need to proactively mitigate the possibility of transmitting HIV to sex partners while off HIV medications.