Sharing Culture and Management of Sex Work Information on Mobile Phones by Female Sex Workers in Nepal: Implications for mHealth Practice and Research.

Female sex workers (FSWs) in Nepal continue to be disproportionately at risk for Sexually Transmitted Infections (STIs), including HIV. Due to stigma related to sex work and HIV, FSWs keep their sex work information hidden, which poses a barrier to seeking health services. Emerging research indicates a high uptake of mobile phones among FSWs in Nepal. Mobile health (mHealth) interventions can provide health information and linkage to care. However, largely missing from the literature is FSWs' experience of managing the information about their involvement in sex work in a culture where sharing personal information and belongings is a part of the social norm, and maintaining privacy could have negative social repercussions. The current study aims to understand how FSWs perceive and manage privacy when they share their mobile phones. Using the Communication Privacy Management theory, we explore FSWs' perception of the threat to their privacy posed by mobile phones. We conducted 30 in-depth interviews among FSWs in Kathmandu, Nepal. Results showed that all participants owned mobile phones, and sharing devices was common. Mobile phones pose a considerable challenge in keeping sex work information private, and FSWs use various communication strategies to circumvent privacy threats. The findings highlight the mental and emotional burden FSWs face trying to conceal their private information in a sharing culture. The study discusses the importance of theorizing privacy in the cultural context of the Global South and the practical implications for developing mHealth interventions for this population.

An examination of the independent and intersectional effects of racial and heterosexist medical mistrust on timing of sexual/reproductive health care visits among Black sexual minority women in the USA.

Experiences of racism and heterosexism in medical settings are social and systemic barriers to 'on-time' receipt of sexual and reproductive health services among women with both racial and sexual minority identities. Medical mistrust based on experiences related to these dual identities is associated with avoidance and delays in care. However, investigators are just beginning to apply an intersectional lens to quantitatively understanding such barriers. The purpose of this study was to examine the independent and interaction effects of racial and heterosexist medical mistrust on timing of sexual/reproductive health care among Black sexual minority women who have sex with women and men. A total of 320 women participated in an online study of factors affecting sexual health in this population. Ordinal logistic regression was used to assess the independent and interaction effects of racial and heterosexist medical mistrust on self-reported time since last sexual/reproductive health visit. Results indicated an interaction between the two types of medical mistrust. Research on Black women who have sex with women and men's experiences of racism and heterosexism in the US healthcare system can lead to the development of the comprehensive training programmes needed to alleviate medical mistrust among women with racial and sexual minority identities.

"It didn't hurt me": patients' and providers' perspectives on unsupervised take-home doses, drug diversion, and overdose risks in the provision of medication for opioid use disorder during COVID-19 in San Juan, Puerto Rico.

BACKGROUND: During the COVID-19 pandemic, clinics offering medication for opioid use disorder (MOUD) needed to rapidly introduce unsupervised take-home dosing, while relapsing patients and patients unable to enter treatment faced increased risks of fentanyl-related overdose deaths and other drug-related harms. Based on a qualitative study of people who inject drugs (PWID) receiving MOUD treatment and MOUD staff in Puerto Rico, this paper documents the lived experiences of patients and providers during this period and the risk perceptions and management strategies to address substance misuse and drug diversion attributable to unsupervised take-home-dose delivery. METHODS: In-depth qualitative interviews were conducted with patients (N = 25) and staff (N = 25) in two clinics providing MOUD in San Juan, Puerto Rico, during 2022. Patients and staff were receiving or providing treatment during the pandemic, and patients reported injection drug use during the past thirty days. RESULTS: Patients were overwhelmingly male (84%), unmarried (72%), and unemployed (52%), with almost half (44%) injecting one to three times a day. Mean time in treatment was 7 years. Staff had a mean age of 46 years with more than half of the sample (63%) female. The majority of patients believed that unsupervised take-home dosing had no significant effect on their treatment adherence or engagement. In contrast, providers expressed concerns over the potential for drug diversion and possible increased risks of patient attrition, overdose episodes, and poor treatment outcomes. CONCLUSION: This study underscores the importance of insider perspectives on harm-reduction changes in policy implemented during a health crisis. Of note is the finding that staff disagreed among themselves regarding the potential harms of diversion and changes in drug testing protocols. These different perspectives are important to address so that future pandemic policies are successfully designed and implemented. Our study also illuminates disagreement in risk assessments between patients and providers. This suggests that preparation for emergency treatment plans requires enhanced communication with patients to match treatments to the context of lived experience.

Sexual and Gender Minority Individuals' Interest in Sexual Health Services at Collective Sex Venues in New York City.

Sexual and gender minority individuals who attend collective sex venues (CSVs; establishments where people can have sex in groups or the presence of others) are at elevated risk for HIV and STIs. On-site sexual health interventions have been attempted at CSVs, but attendees' interest in receiving such services is under-investigated. This paper presents results from a 2020 online cross-sectional survey completed by 342 sexual and gender minority individuals who attended CSVs in New York City. Interest in services such as on-site testing for STIs, testing vans near CSVs, and informational referrals was overall high, particularly among younger participants. Among participants who reported being HIV negative, those of younger age and those who were not using PrEP reported being more likely to take an HIV test if it would be offered at CSVs. In open-text survey responses, participants expressed interest in CSVs providing free prevention services such as HIV/STI testing, PEP, PrEP, and STI medications or vaccination, as well as in ways to improve norms surrounding condom use and consent at these venues. Some participants expressed barriers to on-site services such as privacy concerns, preexisting access to health services, an emphasis on personal responsibility, and negative reactions to the presence of service providers. However, some participants also felt that these services could be delivered in a positive, acceptable, and non-judgmental way, especially by involving CSV organizers and attendees in their implementation. Findings from this study can inform future initiatives to develop sexual health interventions at CSVs.

Differences in mental health and alcohol use across profiles of COVID-19 disruptions.

This study aimed to examine differences in mental health and alcohol use outcomes across distinct patterns of work, home, and social life disruptions associated with the COVID-19 pandemic. Data from 2093 adult participants were collected from September 2020 to April 2021 as a part of a larger study examining the impacts of the COVID-19 pandemic on substance use. Participants provided data on COVID-19 pandemic experiences, mental health outcomes, media consumption, and alcohol use at baseline. Alcohol use difficulties, including problems related to the use, desire to use alcohol, failure to cut down on alcohol use, and family/friend concern with alcohol use, were measured at 60-day follow-up. Factor mixture modeling followed by group comparisons, multiple linear regressions, and multiple logistic regressions was conducted. A four-profile model was selected. Results indicated that profile membership predicted differences in mental health and alcohol use outcomes above and beyond demographics. Individuals experiencing the most disruption reported the strongest daily impact of COVID-19 and significantly high levels of depression, anxiety, loneliness, overwhelm, alcohol use at baseline, and alcohol use difficulties measured at 60-day follow-up. The findings highlight the need for integrated mental health and/or alcohol services and social services targeting work, home, and social life during public health emergencies in order to respond effectively and comprehensively to the needs of those requiring different types of support.

The effects of COVID-19 victimization distress and racial bias on mental health among AIAN, Asian, Black, and Latinx young adults.

OBJECTIVE: U.S. young adult racial minorities have been disproportionately impacted by the coronavirus disease (COVID-19) pandemic in rates of infection and morbidity. Prepandemic racial discrimination has been associated with depression and general anxiety. However, the effect of coronavirus-specific forms of discrimination on mental health has not been examined. This study assessed the effect of social determinants of mental health and COVID-19-specific victimization and racial bias beliefs on depression and anxiety among young adults of color in the U.S. METHOD: A national online survey of 399 American Indian/Alaskan Natives, Asian, Black, and Latinx adults (18-25 years) included demographic variables, COVID-19-health risks, and standardized measures of depression, anxiety, coronavirus-related victimization distress and perceptions of coronavirus-related racial bias across a range of contexts. RESULTS: Employment, financial and prescription insecurity, COVID-19-health risks, coronavirus-victimization distress and coronavirus racial bias beliefs were positively correlated with depression and anxiety. Scores on the Coronavirus Racial Bias Scale were significantly higher among Asian and Black respondents. Structural equation modeling controlling for race/ethnicity and demographic variables indicated coronavirus racial bias mediated the effect of coronavirus victimization distress on both mental health indices. CONCLUSION: Results suggest the COVID-19 pandemic has created new pathways to mental health disparities among young adults of color by reversing formerly protective factors such as employment, and by exacerbating structural and societal inequities linked to race. Findings highlight the necessity of creating mental health services tailored to the specific needs of racial minorities during the current and future health crises. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Associations between sexting motivations and consequences among adolescent girls.

INTRODUCTION: Approximately 15% of adolescent girls in the United States have engaged in sexting. Although sexting frequency is similar across genders, adolescent girls report more negative consequences. To date, the majority of sexting research focuses on demographic and behavioral predictors of sexting frequency or onset and there is limited research on the associations between different sexting motivations and consequences. This cross-sectional study draws upon approach-avoidance motivation theory to examine how different sexting motivations serve as risk and protective factors related to negative sexting consequences and which motivations promote more positive experiences. METHOD: A sample of 200 cisgender girls, 14-18 years, diverse with respect to race/ethnicity and geographical region, who had sexted a male recipient in the past year completed an online survey. RESULTS: Regression analyses indicated that avoidance motivations sexting in response to peer pressure and popularity and sexting in response to male coercion were risk factors for negative sexting consequences. Sexual subjectivity (sexual body-esteem, entitlement to sexual pleasure, and sexual self-reflection) was a protective factor against negative sexting consequences and, along with sexting for sexual or romantic reasons, an approach motivation, was associated with experiencing more positive sexting consequences. CONCLUSION: These findings support previous recommendations that schools incorporate ways to counter pressured sexting into existing cyberbullying or dating violence curricula and also align with a positive sexual development framework that acknowledges the importance of consensual and healthy sexual experiences during adolescence that minimize risks and vulnerabilities.

Attitudes Toward Peer-Delivered Sexual-Health Services Among New York City Sexual and Gender Minority Individuals Who Have Sex with Men and Attend Collective Sex Venues.

Collective sex venues such as sex clubs are strategic sites to promote sexual health among sexual and gender minority individuals. We present qualitative findings from a multiple-method study on the acceptability of sexual-health services at collective sex venues in New York City (NYC) among attendees who identified as men, transgender, or gender non-conforming. In a survey used for sample selection (n = 342), most respondents (82.7%) agreed that "having outreach workers at sex venues is a good thing." Interviewees (n = 30) appreciated how on-site services could promote sexual health in their community. They felt peer workers should be familiar with collective sex venues and share demographic characteristics with attendees. Some participants felt workers should keep some boundaries from attendees, while others felt they could be fully integrated in the environment, suggesting that either peer outreach or popular-opinion leader types of interventions could be feasible.

Profiles of Psychological Strengths on Symptom Distress, Recovery, and Quality of Life Among Young Adults with a History of Adolescent Psychiatric Hospitalization.

The current study surveyed 166 young adults (ages 20-35) with a history of adolescent psychiatric hospitalization to identify profiles of psychological strengths (self-determination, identity commitment, and low mental health self-stigma) and to examine their association with symptom distress, recovery, and quality of life in young adulthood. Over half of all participants (51%) reported a high quality of life, and over one-third (40%) were not experiencing clinically-significant psychiatric symptoms. k-means cluster analysis identified three distinct profiles: low psychological strengths, mixed, and high strengths. Multiple regression analyses indicated the high strengths profile was significantly associated with lower symptom distress, higher recovery, and higher quality of life after controlling for demographics, psychiatric history, treatment experience, and psychiatric interference in school and relationships during adolescence. Findings have implications for targeted support and services based on psychological profile, including family support, interventions to support medication management such as shared decision-making, and peer support.

Exposure to Social Media Racial Discrimination and Mental Health among Adolescents of Color.

Offline and online racial discrimination has been associated with mental health problems among adolescents of color. Pandemic shelter-at-home policies and the reignited racial justice movement increased the use of social media among youth of color, potentially exposing them to social media racial discrimination. Yet, it is unclear which aspects of social media significantly contributed to youth exposure to racial discrimination and associated mental health issues during this period. This study assessed the relationships among social media use (hours, racial intergroup contact, and racial justice civic engagement), individual and vicarious social media discrimination (defined as personally directed versus observing discrimination directed at others), and mental health among 115 black, 112 East/Southeast Asian, 79 Indigenous, and 101 Latinx adolescents (N = 407, 82.31% female, aged 15-18 years, M = 16.47, SD = 0.93). Structural equation modeling (SEM) analyses indicate that hours of use and racial justice civic engagement were associated with increased social media racial discrimination, depressive symptoms, anxiety, alcohol use disorder, and drug use problems. Furthermore, individual social media racial discrimination fully mediated the relationship between racial justice civic publication and depressive and alcohol use disorder. Vicarious social media racial discrimination fully mediated the relationship between racial justice activity coordination with depressive symptoms, anxiety, and alcohol use disorder. Alternative SEM models indicate that exposure to individual and vicarious social media racial discrimination increased depressive symptoms and drug use problems among youth of color, further increasing their social media use frequency and racial justice civic publication. The findings call for strategies to mitigate the effects of social media racial discrimination in ways that support adolescents' racial justice civic engagement and mental health.

Employment, coronavirus victimization distress, and substance use disorders among black and non-Hispanic White young adults during the COVID-19 pandemic.

Substance abuse among young adults increased during the COVID-19 pandemic. Although pre-pandemic data indicate non-Hispanic White adults had higher levels of substance use disorder (SUD), Black adults suffered more serious consequences. The COVID-19 pandemic has introduced new stressors that may contribute to SUD, especially among Black young adults, including employment as essential workers, which may be related to victimization distress associated with the coronavirus (i.e., coronavirus victimization distress). The current study administered an anonymous, cross-sectional, online survey to a national sample of 132 Black and 141 non-Hispanic White adults 18 - 25 years to assess the relationship between health, economic disparities, employment, coronavirus victimization distress, and substance use during the first wave of the pandemic. Controlling for COVID-19 health risks and income, structural equation models indicated that coronavirus victimization distress fully accounted for the positive association between employment and SUD risk, and this association was more pronounced among Black young adults. Findings underscore the urgency of considering disease-related victimization in SUD interventions involving employed young adults during infectious disease pandemics.

Competence to Consent to Oral and Injectable PrEP Trials Among Adolescent Males Who Have Sex with Males.

Adherence to oral pre-exposure prophylaxis (PrEP) is challenging for adolescent males who have sex with males (AMSM). Once adult trials comparing oral to longer lasting injectable PrEP are completed, there will be a need for adolescent studies. However, lack of data on adolescent consent capacity may sustain guardian permission requirements identified as a barrier to AMSM participation in prior PrEP trials. This online study assessed AMSM's (14-17 years) consent capacity for these trials, comparing performance to MSM (18-19 years) for whom guardian permission is not required. Applying the MacCAT-CR, participants (N = 214) viewed a video and mock consent form followed by open-ended and yes/no items. Cognitive diagnostic models and means testing analyses supported AMSM capacity to consent to these trials: 16-17 and most 14-15 year-olds, demonstrated consent understanding, appreciation and reasoning at 18-19 year-old levels. Data also identified vulnerabilities requiring attention during informed consent.

Willingness to Attend Sex Venues in the Context of the COVID-19 Pandemic in New York City: Results from an Online Survey with Sexual and Gender Minority Individuals.

Collective sex venues (places where people have sex in groups or in the presence of others, such as bathhouses or sex clubs) are locations where SARS-CoV-2 transmission is likely to occur. We conducted an online survey to examine the impact of the COVID-19 pandemic among 342 sexual and gender minority (SGM) individuals who had attended collective sex venues (CSV) in New York City (NYC) in the prior year. Almost 1 in 10 (9.9%) participants reported having received a positive test for SARS-CoV-2 infection or antibodies. Although a minority (27.5%) of participants reported being comfortable attending a CSV during the COVID-19 pandemic, multivariable ordinal logistic regression found that willingness was higher among participants who had taken the survey later in the pandemic (aOR = 2.90, CI95% 1.90 to 4.43), who attended CSV at higher frequencies (aOR = 1.94, CI95% 1.26 to 2.99), who used substances at CSV (aOR = 1.98, CI95% 1.22 to 3.23), and who had tested positive for SARS-CoV-2 infection or antibodies (aOR = 2.27, CI95% 1.17 to 4.39). In open survey answers, participants described reasons for or against attending CSV during the pandemic, as well as risk reduction strategies that would make them more comfortable attending (e.g., screening for test results, doing temperature checks, holding outdoor events, or restricting events to lower risk sexual practices). SGM individuals who attend CSV might be at increased risk for COVID-19. Public health officials should provide CSV organizers and attendees with guidelines on how to prevent or minimize transmission risk in the context of pandemics such as COVID-19.

Risks and Benefits of Adolescent Girls' Participation in Online Sexting Survey Research.

The increasingly ubiquitous use of sexting among adolescent girls underscores the importance of empirical data on their sexting behaviors, motivations, and outcomes. To date, the majority of sexting studies have been conducted online; however, little is known about the extent to which responding to such socially sensitive questions may cause participant discomfort or distress. Research on this question is critical since in the absence of empirical data, institutional review boards (IRBs) may permit or place restrictions on online sexting studies based on an under- or overestimation of adolescent participation risk. The current online study asked 210 girls (aged 14-18 years, 55% non-Hispanic White, with sexting experience in the past 12 months) who previously registered to take online surveys on (1) their anticipated comfort in responding to a sexting survey include items on sexting motivations, positive and negative sexting consequences, and related sexual behaviors; (2) their perceptions of sexting research benefits/harms; and (3) comfort discussing similar topics in everyday life and with health professionals. Overall, participants were comfortable responding to sexting survey questions, rated sexting research as high benefits and low risks, and felt about the same as or more comfortable completing a sexting survey than discussing similar topics with peers, parents, or healthcare professionals. Findings suggest that anonymous online sexting studies can be classified as minimal risk research for adolescent girls and provide empirical support for IRB decisions to waive guardian permission for participation in such studies.

Perceived Confidentiality Risks of Mobile Technology-Based Ecologic Momentary Assessment to Assess High-Risk Behaviors Among Rural Men Who Have Sex with Men.

Although men who have sex with men (MSM) within rural communities are disproportionately impacted by HIV, limited HIV research and programmatic resources are directed to these communities within the U.S. There is a need for improved behavioral data collection methods to obtain more detailed information on the relationship between rural environments, sexual behavior, and substance use. Utilization of mobile health (mHealth) technologies, such as ecologic momentary assessment (EMA), has been advocated for; however, limited research has evaluated its utility among rural MSM. Forty MSM residing in rural Oklahoma were recruited to complete in-depth interviews related to participating online/mobile-based HIV prevention research. Men described a willingness to participate in HIV and substance use studies that use EMA methodologies for data collection; however, they raised various research-related concerns. In particular, participants indicated potential privacy and confidentiality concerns related to the use of the mobile technology-based EMA in public and the storage of data by researchers. Given the varying degree of sexual orientation and substance use disclosure by participants, rural MSM were largely concerned with being inadvertently "outed" within their communities. Men described the various strategies they could employ to protect private information and methods to minimize research risk. Study findings suggest that EMA is an acceptable research methodology for use among rural MSM in the context of HIV and sexual health information, when privacy and confidentiality concerns are adequately addressed. Input from community members and stakeholders is necessary to identify potential areas of concerns for participants prior to data collection.

"We are in this together:" dyadic-level influence and decision-making among HIV serodiscordant couples in Tanzania receiving access to PrEP.

BACKGROUND: A substantial number of new HIV infections in sub-Saharan Africa occur within stable couples. Biomedical prevention (pre-exposure prophylaxis, PrEP) and treatment (antiretroviral therapy, ART) can provide benefits to sexual partners and can be used to prevent infection within HIV serodiscordant couples. However, research is typically focused on individuals, not dyads, even when the intervention may directly or indirectly impact sexual partners. Gaps remain in understanding best practices for recruitment, informed consent, and intervention implementation in studies involving HIV prevention and treatment among heterosexual serodiscordant couples. This qualitative study was undertaken to understand and describe decision-making and dyadic-level influence among members of serodiscordant couples regarding (1) participation in a dyadic-based research study involving HIV self-testing and access to PrEP, and (2) utilization of PrEP and ART. METHODS: This qualitative study was nested within an observational cohort study assessing the acceptability of home-based couples' HIV self-testing and uptake of dyadic care for serodiscordant couples involving facilitated referral for HIV-positive partners and access to PrEP for HIV-negative partners. Semi-structured in-depth interviews were conducted among a subset of study participants (n = 22) as well as individuals involved in serodiscordant relationships who chose not to participate (n = 9). Interviews focused on couples' decision-making regarding study participation and dyadic-level influence on medication use. Interviews were transcribed verbatim and translated from Kiswahili into English. Data were analyzed using thematic analysis. RESULTS: Three major themes were identified: (1) HIV as "two people's secret" and the elevated role of partner support in serodiscordant relationships; (2) the intersectional role of HIV-status and gender on decision-making; (3) the relational benefits of PrEP, including psychosocial benefits for the couple that extend beyond prevention. CONCLUSIONS: The study found that couples made joint decisions regarding study participation and uptake of HIV-related medication. Relational autonomy and dyadic-level influence should be considered within research and programs involving HIV serodiscordant couples.

"Because all mothers is not the same": The development and implementation of an in loco parentis informed consent procedure to enroll adolescent girls and young women to participate in HIV research.

INTRODUCTION: South Africa has one of the highest incidences of HIV among adolescent girls and young women (AGW), ages 15-24, and recent research has focused on developing interventions for HIV prevention. However, the South African National Health Act requires those under 18 years of age to obtain a guardian's permission to participate in research. Limiting research enrolment to AGYW who can obtain guardian consent may lead to non-representative findings. Therefore, innovative, inclusive consent approaches that protect AGYW from the risks of research are needed. METHODS: This report details the development and implementation of an approach called the in loco parentis (in place of parent) consent procedure. In loco parentis consent provides a vehicle for adolescent participation that protects adolescents from potential social harms. The in loco parentis consent procedure does not seek to obtain independent minor consent but seeks to obtain permission for the minor to participate in research from a trusted adult who is not a minor's parent or legal guardian. This report also qualitatively explores the experiences of 31 AGYW who were recruited into a behavioral HIV prevention study using this method. RESULTS: Findings suggest that the in loco parentis consent procedure is a feasible and acceptable method to inclusively AGYW in HIV research. CONCLUSIONS: The in loco parentis procedure may provide a more inclusive strategy to recruit AGYW for HIV research to increase the generalizability of findings.

Ethical Considerations in HIV eHealth Intervention Research: Implications for Informational Risk in Recruitment, Data Maintenance, and Consent Procedures.

PURPOSE OF REVIEW: Along with the benefits of eHealth HIV interventions are challenges to participant privacy and confidentiality inherent in the use of online strategies. This paper reviews current guidelines and recent publications to identify ethical issues and suggested solutions in recruitment, data management, and informed consent. RECENT FINDINGS: Across eHealth HIV research, recruitment, data collection, and storage efforts to protect informational risk highlight the tension between the investigators' ability to protect participant confidentiality and the evolving informational risk posed by the online platforms on which they are operating. Adequately addressing these challenges requires updating technical competencies and educating participants on their own responsibilities to guard against privacy violations. Additional protections are required when interventions involve peer or community support, especially with minors. The rapid progression of technology presents challenges in solidifying best practices for future interventions. This article draws on published works describing investigator experiences to contribute to the ongoing development of guidance in this area.

Perceived risks and amelioration of harm in research using mobile technology to support antiretroviral therapy adherence in the context of methamphetamine use: a focus group study among minorities living with HIV.

BACKGROUND: Methamphetamine use poses a barrier to antiretroviral therapy (ART) adherence. Black and Hispanic men who have sex with men living with HIV (PLWH) shoulder much of the health burden resulting from the methamphetamine and HIV syndemic. Smartphones are nearly ubiquitous in the USA and may be promising vehicles for delivering interventions for ART adherence and drug use cessation. However, the acceptability of using applications to collect sensitive information and deliver feedback in this population has not been adequately explored. OBJECTIVE: This study examined minority PLWH's appraisals of the risks of participating in smartphone-based research to promote ART adherence in the context of methamphetamine use and explored their views on appropriate steps to mitigate perceived risks of participation. METHODS: Three focus groups were conducted among Black and Hispanic PLWH who use methamphetamine. Of the 13 participants, 5 had previously participated in a smartphone-based observational study of ART adherence and substance use. Discussants provided feedback on smartphone-based research, including receiving probes for HIV medication adherence, mood, and substance use as well as feedback on passive location-tracking for personalized messages. Transcribed audio-recordings were thematically coded and analyzed using the qualitative software MAXQDA. RESULTS: Participants expressed confidentiality concerns related to potential unintentional disclosure of their HIV status and methamphetamine use and to possible legal consequences. They additionally expressed concerns around the invasiveness of daily assessments and the potential of methamphetamine use questions to trigger cravings. To mitigate these concerns, they suggested maintaining participant privacy by indirectly asking sensitive questions, focusing on positive behaviors (e.g., number of days sober), allowing user-initiated reporting of location to tailor messages, and ensuring adequate data protections. In addition to financial compensation, participants cited altruism (specifically, continuing a tradition of volunteerism in HIV research) as a motivator for potentially engaging in such research. CONCLUSIONS: Minority PLWH have concerns regarding the use of smartphones for ART adherence and methamphetamine sobriety intervention research. However, minority PLWH are likely to participate if studies include appropriate protections against risks to confidentiality and experimental harm and are designed to offer future benefit to themselves and other PLWH.

Beyond the Belmont Principles: A Community-Based Approach to Developing an Indigenous Ethics Model and Curriculum for Training Health Researchers Working with American Indian and Alaska Native Communities.

Individuals responsible for carrying out research within their diverse communities experience a critical need for research ethics training materials that align with community values. To improve the capacity to meet local human subject protections, we created the research Ethics Training for Health in Indigenous Communities (rETHICS), a training curriculum aligned within American Indian and Alaska Native (AI/AN) context, culture, and community-level ethical values and principles. Beginning with the Belmont Report and the Common Rule that defines research with human subjects (46 CFR 45), the authors convened three different expert panels (N = 37) to identify Indigenous research values and principles common across tribal communities. The resulting culturally grounded curriculum was then tested with 48 AI/AN individuals, 39 who also had recorded debriefing interviews. Using a thematic analysis, we coded the qualitative feedback from the expert panel discussions and the participant debriefings to assess content validity. Participants identified five foundational constructs needed to ensure cultural-grounding of the AI/AN-specific research training curriculum. These included ensuring that the module was: (a) framed within an AI/AN historical context; (b) reflected Indigenous moral values; (c) specifically linked AI/AN cultural considerations to ethical procedures; (d) contributed to a growing Indigenous ethics; and (e) provided Indigenous-based ethics tools for decision making. Using community-based consultation and feedback from participants led to a culturally grounded training curriculum that teaches research ethical principles and procedures for conducting research with AI/ANs. The curriculum is available for free and the community-based process used can be adapted for other cultural groups.