Patient and Provider Perspectives on HIV Stigma in Healthcare Settings in Underserved Areas of the US South: A Mixed Methods Study.

Stigma experienced in healthcare settings is a barrier to ending the HIV epidemic. Using a convergent parallel mixed methods approach, we collected qualitative data from 14 focus groups with People with HIV (PWH) and Healthcare workers (HCW) and quantitative survey data (N = 762 PWH and N = 192 HCW) from seven HIV healthcare clinics outside of major urban areas in the southeastern US. Four key themes emerged: (1) HIV-related stigma and discrimination in healthcare settings; (2) experiences of intersectional stigma; (3) disclosure concerns in healthcare settings; and (4) impact of stigma on HIV-related health behavior. Implications for future stigma interventions in healthcare settings include the importance of engaging PWH in the development of interventions, the need for interventions in settings that do not specialize in HIV care, and the importance of engaging all staff when addressing HIV-related stigma.

RESUMEN: El estigma experimentado en los entornos de atención médica es una barrera para poner fin a la epidemia del VIH. Utilizando un enfoque convergente de métodos mixtosparalelos, recopilamos datos cualitativos de 14 grupos focales con personas con VIH y trabajadores de la salud y datos de encuestas cuantitativas (N = 762 personas con VIH y N = 192 trabajadores de la salud) de siete clínicas de atención médica de VIH fuera de las principales áreas urbanas en el sureste de los Estados Unidos. Surgieron cuatro temas clave: (1) el estigma y la discriminación relacionados con el VIH en los entornos de atención médica; (2) experiencias de estigma interseccional; (3) preocupaciones de divulgación en entornos de atención médica; y (4) el impacto del estigma en el comportamiento de salud relacionado con el VIH. Las implicaciones para futuras intervenciones de estigma en entornos de atención médica incluyen la importancia de involucrar a las personas con VIH en el desarrollo de intervenciones, la necesidad de intervenciones en entornos que no se especializan en la atención del VIH y la importancia de involucrar a todo el personal al abordar el estigma relacionado con el VIH.

Telehealth uptake among middle-aged and older Americans during COVID-19: chronic conditions, social media communication, and race/ethnicity.

OBJECTIVES: This study investigated whether and to what extent constructs of the protection motivation theory of health (PMT)-threat appraisal (perceived vulnerability/severity) and coping appraisal (response efficacy and self-efficacy)-are related to telehealth engagement during the COVID-19 pandemic, and how these associations differ by race/ethnicity among middle-aged and older Americans. METHODS: Data were from the 2020 Health and Retirement Study. Multivariable ordinary least-squares regression analyses were computed adjusting for health and sociodemographic factors. RESULTS: Some PMT constructs are useful in understanding telehealth uptake. Perceived vulnerability/severity, particularly comorbidity (b = 0.13, 95% confidence interval (CI) [0.11, 0.15], p < 0.001), and response efficacy, particularly participation in communication via social media (b = 0.24, 95% CI [0.21, 0.27], p < 0.001), were significantly and positively associated with higher telehealth uptake during the COVID-19 pandemic among middle-aged and older Americans. Non-Hispanic Black adults were more likely to engage in telehealth during the pandemic than their non-Hispanic White counterparts (b = 0.20, 95% CI [0.12, 0.28], p < 0.001). Multiple moderation analyses revealed the significant association between comorbidity and telehealth uptake was similar across racial/ethnic groups, whereas the significant association between social media communication and telehealth uptake varied by race/ethnicity. Specifically, the association was significantly less pronounced for Hispanic adults (b = -0.11, 95% CI [-0.19, -0.04], p < 0.01) and non-Hispanic Asian/other races adults (b = -0.13, 95% CI [-0.26, -0.01], p < 0.05) than it was for their non-Hispanic White counterparts. CONCLUSION: Results suggest the potential of using social media and telehealth to narrow health disparities, particularly serving as a bridge for members of underserved communities to telehealth uptake.

A pilot study of prostate cancer knowledge among African American men and their health care advocates: implications for screening decisions.

PURPOSE: Prostate cancer (PCa) is the second leading cause of cancer death in U.S. men [American Cancer Society (ACS)], most often affecting men age 50 and older. The study provides information about factors that influence rural AA men in their decision to undergo screening for PCa with a specific focus on PCa knowledge among AA men and their health care advocates. METHODS: A longitudinal quantitative study included AA males and their health care advocates. Participants were from three Alabama rural counties. Measures included demographics, PCa knowledge, decisional conflict, and health literacy scales. RESULTS: Thirty-three men with a mean age of 54.61 and 35 health care advocates were included in the study. PROCASE Knowledge Index measure results indicate a lack of PCa knowledge among both male primary participants and their advocates. The knowledge of AA men in the study was somewhat low, with individuals correctly answering approximately six questions out of ten at multiple time points (baseline total M = 6.42, SD = 1.52). Decisional conflict responses at 12 months (38.64) were lower than at baseline (M = 62.88) and at 6 months (M = 58.33), p < .005. CONCLUSION: Health care advocates of the 33 male participants were usually women, spouses, or significant others, supporting the vital role women play in men's health specifically in rural underserved communities. Low overall PCa knowledge, including their risk for PCa, among these participants indicates a need for PCa and screening educational interventions and dialogue that include males and their significant others.

Testing our FAITHH: HIV stigma and knowledge after a faith-based HIV stigma reduction intervention in the Rural South.

Eliminating racial/ethnic HIV disparities requires HIV-related stigma reduction. African-American churches have a history of addressing community concerns, including health issues, but may also contribute to stigma. We developed and pilot tested a faith-based, anti-stigma intervention with 12 African-American churches in rural Alabama. We measured HIV-related stigma held by 199 adults who participated in the intervention (individual-level) and their perception of stigma among other congregants (congregational-level). Analyses of pre- and post-assessments using a linear mixed model showed the anti-stigma intervention group reported a significant reduction in individual-level stigma compared with the control group (mean difference: -.70 intervention vs. -.16 control, adjusted p < .05). Findings suggest African-American churches may be poised to aid HIV stigma-reduction efforts.

Developing FAITHH: Methods to Develop a Faith-Based HIV Stigma-Reduction Intervention in the Rural South.

Human immunodeficiency virus (HIV) disproportionately affects Blacks/African Americans, particularly those residing in the southern United States. HIV-related stigma adversely affects strategies to successfully engage people in HIV education, prevention, and care. Interventions targeting stigma reduction are vital as additional tools to move toward improved outcomes with HIV prevention and care, consistent with national goals. Faith institutions in the South have been understudied as partners in HIV stigma-reduction efforts, and some at-risk, Black/African American communities are involved with southern faith institutions. We describe the collaborative effort with rural, southern faith leaders from various denominations to develop and pilot test Project Faith-based Anti-stigma Initiative Towards Healing HIV/AIDS (FAITHH), an HIV stigma-reduction intervention that built on strategies previously used with other nonrural, Black/African American faith communities. The eight-module intervention included educational materials, myth-busting exercises to increase accurate HIV knowledge, role-playing, activities to confront stigma, and opportunities to develop and practice delivering a sermon about HIV that included scripture-based content and guidance. Engaging faith leaders facilitated the successful tailoring of the intervention, and congregation members were willing participants in the research process in support of increased HIV awareness, prevention, and care.

A Qualitative Study to Determine Barriers for Prostate Cancer Screening in Rural African-American Men.

INTRODUCTION: African-American men have higher rates of prostate cancer and more advanced cancer when diagnosed than men of other ethnicities. PURPOSE: To explore the perspectives and shared experiences of rural African-American men when it comes to interactions with healthcare providers, shared decision-making, and information on prostate cancer and screening. METHODS: A convenience sample of African-American men in four rural counties in the southeastern United States agreed to participate. Semi-structured interviews of 43 men were conducted in patients' homes, classrooms, offices, and local churches. Lincoln and Guba's (1985) naturalistic approach was used. RESULTS: Analysis of the rich, in-depth narratives gleaned from these African-American men revealed three themes: 1) limitations in knowledge of prostate cancer, 2) poor patient/provider communication, and 3) deficient health literacy skills. CONCLUSIONS: Participants' perspectives about limited knowledge regarding PCa, variation in provider-patient communication and the finding of low health literacy skills expand knowledge, inform clinical practice, and provide evidence for further investigation to better provider communication and patient education concerning PCa and decision making in this population.

Community-Based Participatory Research-Speed Dating: An Innovative Model for Fostering Collaborations Between Community Leaders and Academic Researchers.

Developing meaningful community-based participatory relationships between researchers and the community can be challenging. The overall success of a community-based participatory relationship should be predicated on commitment and respect from empowered stakeholders. Prior to developing the technique discussed in this article, we hypothesized that the process of fostering relationships between researchers and the community was much like a social relationship: It has to develop organically and cannot be forced. To address this challenge, we developed a community-based participatory research-speed dating technique to foster relationships based on common interests, which we call CBPR-SD. This article describes the logistics of implementing CBPR-SD to foster scholarly collaborations. As part of a federally funded community-based research project, the speed dating technique was implemented for 10 researchers and 11 community leaders with a goal of developing scholarly collaborative groups who will submit applications for community-based research grants. In the end, four collaborative groups developed through CBPR-SD, three (75%) successfully submitted grant applications to fund pilot studies addressing obesity-related disparities in rural communities. Our preliminary findings suggest that CBPR-SD is a successful tool for promoting productive scholarly relationships between researchers and community leaders.

"Wake Up! HIV is at Your Door": African American Faith Leaders in the Rural South and HIV Perceptions: A Qualitative Analysis.

In Alabama, 70 % of new HIV cases are among African Americans. Because the Black Church plays an important role for many African Americans in the south, we conducted qualitative interviews with 10 African American pastors recruited for an HIV intervention study in rural Alabama. Two main themes emerged: (1) HIV stigma is prevalent and (2) the role of the Black Church in addressing HIV in the African American community. Our data suggest that pastors in rural Alabama are willing to be engaged in HIV prevention solutions; more formalized training is needed to decrease stigma, strengthen HIV prevention and support persons living with HIV/AIDS.

HIV Knowledge among African Americans Living with HIV in the Rural South: Implications for Improving HIV Prevention and Care Outcomes.

PURPOSE: This study examines the HIV knowledge of people living with HIV (PLWH) and its implications for improved healthcare outcomes. METHODS: The study design was a descriptive cross-sectional study, and a total of 41 PLWH were recruited from a larger faith-based anti-stigma study. Data was collected using a semi-structured self-administered questionnaire and analyzed using SAS. In addition, a literature review was conducted using search engines to gauge existing literature from 2013 to 2022 in areas of HIV knowledge and healthcare outcomes among PLWH. RESULTS: The 41 PLWH enrolled consisted of 51% males and 49% females. Sixteen (39%) were aged ≥ 51 years, 17 (41%) had been living with HIV for > 10 years, 15 (37%) had < high school diploma, and 100% were currently in HIV care. HIV knowledge scores were below average for 20 (49%) of the PLWH. Substantial knowledge deficits were noted in areas of HIV transmission and risk reduction strategies. Lower scores were not significantly associated with the participant's gender, education level, or length of time being HIV-infected. The results of the literature review showed limited research in this area. CONCLUSIONS: The study and literature review results show that HIV knowledge and health literacy may contribute to racial disparities in retention in care leading to poor health outcomes. Healthcare providers and health facilities in rural areas should be equipped with culturally tailored HIV educational tools to strengthen ongoing care for PLWH, foster patient-provider relationships, and eliminate internalized stigma detrimental to improved healthcare outcomes among PLWH.

Cell Maps for Artificial Intelligence: AI-Ready Maps of Human Cell Architecture from Disease-Relevant Cell Lines.

This article describes the Cell Maps for Artificial Intelligence (CM4AI) project and its goals, methods, standards, current datasets, software tools , status, and future directions. CM4AI is the Functional Genomics Data Generation Project in the U.S. National Institute of Health's (NIH) Bridge2AI program. Its overarching mission is to produce ethical, AI-ready datasets of cell architecture, inferred from multimodal data collected for human cell lines, to enable transformative biomedical AI research.

Health Benefits of a 16-Week Whole Food, High Fiber, Plant Predominant Diet among U.S. Employees.

PURPOSE: To assess improvements in eating behaviors and health measures among adults participating in a whole food plant predominant diet, Full Plate Living (FPL) program. DESIGN: Retrospective, post hoc analysis of self-reported 16-week pre-post participant data obtained over a 3 year program period (2017-19). SETTING: Wellness offering for employees in Southwest U.S. SUBJECTS: Of 6,820 enrollees, 4,477 completed the program, further segmented by generational cohorts. INTERVENTION: FPL program materials and weekly online video lessons. MEASURES: Baseline and follow-up measures included eating behaviors, self-perceived health status and energy, body weight, and confidence in healthy eating and weight loss. ANALYSIS: Paired t-tests were used to examine changes in eating behaviors and health measures. Mixed-effects models were used to examine whether changes among generational cohorts differed. RESULTS: Significant pre-post improvements were demonstrated for all measures, including servings of fruits (1.54 to 2.34), vegetables (2.05 to 2.87), beans (.63 to .99), and weight loss (3.5) (P < .001). Self-perceived health and energy values, and confidence in making healthy food choices and losing weight improved (P < .001). Improvements were observed across generational cohorts (P < .001). CONCLUSION: The FPL healthy eating approach has a beneficial impact on health measures across generational cohorts, and may be an effective addition to lifestyle medicine and corporate wellness offerings. Longer-term program evaluation is warranted.

Increased dietary fiber is associated with weight loss among Full Plate Living program participants.

Introduction: Prior studies have demonstrated that an intake of foods rich in dietary fiber is associated with a favorable impact on health status and body weight. However, the association between fiber intake and weight loss has not been well-studied in employer settings. This research aimed to assess the relationship between dietary fiber and weight loss among individuals participating in the Full Plate Living (FPL) program. Methods: The 16-week plant-predominant fiber-rich eating program was delivered to 72 employers, primarily in the Southwest U.S., over 3 years (2017-2019). Participants received weekly video lessons, FPL materials, and additional online resources. A retrospective analysis of repeated measures was conducted using participant data obtained from 4,477 participants, of which 2,792 (62.5%) reduced body weight. Analysis of variance with post hoc analysis was used to assess the statistical significance of the changes between baseline and follow-up measures of dietary fiber intake in each of the food categories, specifically the relationship between changes in individual and combined (composite) daily servings of fruits, vegetables, whole grains, beans, and nuts on body weight measures among three groups at follow-up: those who lost, maintained, or gained weight. Multilevel modeling was used to test the hypothesis that increased intake of fiber was associated with greater weight loss. Results: The mean weight loss for the weight loss group was 3.28 kg. As compared to the two other groups, the intake of whole fiber-rich foods at follow-up was significantly higher among the weight loss group with fruits (2.45 servings), vegetables (2.99 servings), beans (1.03 servings), and total fiber composites (9.07 servings; P < 0.001). A significant increase in servings of grains was also noted (P < 0.05). Multilevel modeling demonstrated that a higher total fiber composite (Model 1), as well as higher intakes of either vegetables or fruits (Model 2), resulted in greater weight loss. Discussion: Our findings indicate that the FPL program can be a part of a lifestyle medicine approach to healthy eating and weight loss. Delivering the program in clinical, community, and workplace settings can increase its reach as an effective and low-cost offering.

The health of rural Black communities during COVID: Some affirmations, some surprises.

Background and objective: There are overwhelming health disparities in the Deep South. It is important to include the voice of communities affected by these disparities when developing interventions. The goal of the current study was to develop an academic community engaged partnership to strengthen the ability to address priority health concerns of rural African American communities with a focus on health literacy and health advocacy. Methods: A community-based participatory research approach was used to administer a 15-item community health survey in five rural communities led by African American mayors in Alabama (N = 752). The survey assessed the health concerns and the potential behaviors that may be associated with those health concerns. Results: The five communities demonstrated similarities as well as differences in both the health concerns endorsed and the potential health behaviors that may contribute to those concerns. All five communities identified cardiovascular disease as a health concern with three endorsing mental health issues and 2 dental health. With respect to behaviors, all five communities identified either unhealthy eating/exercise and substance use as concerns with one community identifying racism as a risky behavior affecting health. Conclusion: The results presented replicate CBPR studies demonstrating that communities are important sources of information about local health priorities and concerns.

Church Leaders Share and Implement Solution-Focused Health Strategies During the COVID-19 Pandemic in Rural Alabama.

Bridging the healthcare access gap and addressing COVID-19 vaccine hesitancy among rural-dwelling Black American adults residing in the Deep South require involvement of faith-based leaders in the community. This study explored perceived barriers and resources to meeting community needs, including vaccination, during the COVID-19 pandemic as reported by 17 Black American church leaders in the rural West Alabama Black Belt geographic region in May 2022. The main themes that emerged included (1) attending to community impact of COVID-19 illness and death; (2) maximizing health literacy and diminishing vaccine hesitancy through engaging in preventive health practices and sharing public health information; (3) addressing challenges created or exacerbated by COVID-19, including reduction in in-person attendance (particularly among adolescents and young adults), limited access to and literacy with technology, and political perceptions influencing engagement in preventive health behaviors; (4) maximizing technological solutions to increase attendance in the church; and (5) engaging in solution-focused and innovative initiatives to meet the identified needs in the congregation and community. Church leaders in West Alabama rural areas facing economic, health, and technological disparities identified "silver linings" as well as challenges created or exacerbated during the pandemic. As the need for COVID-19 vaccination and booster vaccination continues, Black American church leaders play pivotal roles in meeting rural community needs.

Community Perspectives and Environmental Justice Issues in an Unincorporated Black Township.

Through each era, the southeastern United States was and continues to be an epicenter for industrial companies to establish factories and plants. Though this development attracts economic gain for the companies and surrounding areas, low-income and predominantly Black communities bear the brunt of the environmental consequences while frequently remaining stagnant economically. This qualitative, community-based participatory research study grew out of a larger study designed to recruit lay community advisors from communities labeled as hard to reach in research. We focus on Holt, Alabama, an unincorporated community in the southeastern United States region. The primary goal of this research inquiry is to thematically analyze community interviews stemming from a topic of research, practice, and policy interest to community members: the effects of industrial pollution on Holt citizens' daily lives. Content analysis of focus-group transcripts revealed four emergent themes, including: (1) how the pollution affects their water, soil, and air quality; (2) illness related to pollution; (3) community engagement and empowerment; and (4) suggestions regarding what government officials could do to address this area of need. Building upon the prior research regarding environmental justice, human flourishing, and the definition of nurturing environments, suggestions are made regarding the creation, implementation, and maintenance of project advisory councils focused on issues of environmental justice. Community advocacy and empowerment as well as community and scientific partnerships are imperative to alleviate problems associated with environmental justice.

Patient complexity and diabetes quality of care in rural settings.

PURPOSE: Even though pay-for-performance programs are being rapidly implemented, little is known about how patient complexity affects practice-level performance assessment in rural settings. We sought to determine the association between patient complexity and practice-level performance in the rural United States. BASIC PROCEDURES: Using baseline data from a trial aimed at improving diabetes care, we determined factors associated with a practice's proportion of patients having controlled diabetes (hemoglobin A1c

Reasons for HIV disclosure and non-disclosure: an exploratory study of rural African American men.

Disclosure of one's HIV status to others is an important decision. There are benefits and risks to be considered. Also decisions must be made about the recipients of the disclosure. This study explored reasons for disclosure and non-disclosure among rural African American men in the south. Audiotaped interviews were conducted with 40 men. The most common reasons for disclosure were to relieve stress, satisfy the need to tell, help others, and to receive support. The most common reasons for non-disclosure were the fear of negative reaction or stigma, the fear of the disclosure recipient telling others, a belief that there was no need to tell, not being ready to tell, and not wanting to burden others with the disclosure.

Influence of Spirituality, HIV Stigma and Education on HIV Knowledge in Rural African American Congregants in the Deep South: Additional Findings from Project FAITHH.

HIV incidence has shifted racially and geographically in the United States and now represents higher proportions of African Americans living in the Rural South. Lower levels of HIV knowledge may be the culprit behind the increasing HIV rates observed in the Rural South. The purpose of this study was to investigate the individual and joint correlates of HIV knowledge in a sample of rural African Americans. Baseline data from a faith-based anti-stigma intervention (Project FAITHH, N= 210) was used to assess associations between sociodemographic characteristics, spirituality, stigma, and HIV knowledge scores. Associations were examined with recursive partitioning. Statistical significance was determined at P< 0.05 with a two-sided test. Recursive partitioning revealed five distinct groups based on the data. HIV knowledge scores were highest among participants who attended some college (P < 0.001) with lower levels of individual stigma (P < 0.001). HIV knowledge scores were lowest among less educated individuals (P < 0.001) who had lower levels of perceived community stigma (P = 0.002). Future interventions designed to improve HIV knowledge in rural African Americans should consider tailoring content to those who have the greatest deficits in HIV knowledge, which may be based on perceived community stigma and education levels.

Integrating Workforce Health Into Employer Diversity, Equity and Inclusion Efforts.

Our collective experience with COVID-19 and Black Lives Matter has heightened awareness of deeply embedded racial and socioeconomic disparities in American businesses. This time, perhaps, sustained change is within reach. As organizations advance diversity, equity and inclusion (DEI) initiatives, an often overlooked focus of is the health status of employees and their families, where equitable access to high-value health benefits offerings should be available to all. This commentary provides guidance for employers to expand their DEI initiatives to include employee and family health and well-being as a central outcome measure. Employers should ensure that DEI efforts incorporate equitable benefits design, and objectively assess benefit design impact on healthcare utilization and cost. Additionally, employers must appreciate the workplace as a significant determinant of health-for lower income workers, in particular-with review of policies and practices to mitigate any discriminatory negative health or well-being impact. Further, race and ethnicity data should be incorporated in health benefits data analysis to understand more clearly the differential outcomes of health management offerings on these different sub-populations. Finally, social needs data should be incorporated into strategic benefits planning to better understand gaps and opportunities to foster greater benefits equity. The provided recommendations can support employer goals of achieving greater equity and value in workforce health, measurably contributing to business success.

Nature-Based Therapies for Sleep Disorders in People Living with Human Immunodeficiency Virus.

Following diagnosis of human immunodeficiency virus (HIV), getting adequate sleep may be the farthest thing from the mind of patients or providers. Even further from mind are the potential benefits on both sleep and HIV from nature-based therapy. In developing and developed countries, access to high-quality natural spaces has the potential to support physical and mental health. This article provides a review of sleep disorders, conventional and nature-based therapies, and the potential of nature-based therapy to support the health of people living with HIV through increased restorative sleep and immune function.