Influence of families and other adult support on HIV prevention outcomes among black men who have sex with men.

BACKGROUND: Prior research has consistently shown that the involvement of families plays a vital role in reducing risk behaviors, such as engaging in condomless sex, and promoting HIV prevention behaviors among young Black men who have sex with men (YBMSM). With the aim of expanding the existing knowledge, this study aimed to examine the specific influence of families and other supportive adults in facilitating casual condom use, partner condom use, HIV testing, and preexposure prophylaxis (PrEP) utilization among young Black MSM. METHODS: A sample of YBMSM aged 18-29 years (N = 400) was collected online. We used a path analysis to examine the influence of family factors on PrEP stigma and PrEP use. Respondents were recruited from December 1, 2021, to January 31, 2022. We used a path analysis to examine the direct and indirect effects of family factors on PrEP use through HIV testing and encouraging condom use. RESULTS: Among BMSM, other adult support was positive and directly associated with condom use by both casual partners (ß = 0.04, p < .05) and partners (ß = 0.17, p < .01). Condom use by casual partners was negative and was directly associated with HIV testing (ß = - 0.15, p < .01). CONCLUSION: The primary aim of this research was to examine the influence of family and adult support on HIV prevention behaviors among young Black MSM, including condom use, HIV testing, and PrEP use. Our findings highlight the significance of implementing interventions that incorporate families and other supportive adults to enhance the engagement of young Black MSM in HIV prevention behaviors.

Examining developmental assets of young Black sexual gender minority males in preventing suicidal behaviors.

Black gay and bisexual male adolescents and young adults (BGBMA/YA) are at higher risk for suicidal outcomes given their minoritized and stigmatized identities at the intersection of race and sexual orientation. This study explores key developmental assets, including family support and family communication, and their role in preventing depression symptoms and suicidal outcomes among BGBMA/YA. A cross-sectional survey was administered to participants (N = 400, Mage = 23.46, SD = 2.59) recruited through Amazon M-Turk, community-based organizations, and social media sites. A path analysis was conducted to examine associations among external assets (family support, communication about sex and drugs with parents, open family communication), depression symptoms, and suicidal attempts and plan to die by suicide. About 28 % of respondents reported a suicide attempt in the past 12 months. Depression symptoms and communication about sex and drugs with parents were positively associated with plan to die by suicide. Family support was negatively associated with depression symptoms. Depression symptoms were positively associated with suicide attempts. Family support was indirectly and negatively associated with suicide attempts. Suggestions for future research and policy implications are discussed.

Perspectives and thoughts of pregnant women and new mothers living with HIV receiving peer support: A mixed studies systematic review.

AIM: The aim of this study was to systematically consolidate evidence on perspectives and thoughts of women living with HIV regarding the peer support they have encountered during pregnancy and after childbirth. DESIGN: Mixed studies systematic review. DATA SOURCES: PubMed, EMBASE, Cochrane, PsycINFO, CINAHL, Scopus and ProQuest were sourced from 1981 to January 2022. METHODS: A convergent qualitative synthesis approach was used to analyse the data. Quality appraisal was performed using the Mixed Methods Appraisal Tool. RESULTS: A total of 12 studies were included, involving 1596 pregnant women and 1856 new mothers living with HIV. An overarching theme, 'From One Mother to Another: The Supportive Journey of Pregnant Women and New Mothers Living with HIV', and two themes were identified: (1) Emotional support buddies and extended networks and (2) Link bridge to healthcare support and self-empowerment. CONCLUSION: Peer support played an indispensable role in the lives of women living with HIV and served as a complementary support system to professional and family support. IMPACT: What problem did the study address? Pregnant women and new mothers living with HIV face preconceived stigma and discrimination. What were the main findings? Peer support was perceived to be beneficial in enhancing emotional support among women living with HIV and was well-accepted by them. Where and on whom will the research have an impact? Healthcare providers and community social workers could develop or enhance peer support educational programmes tailored to pregnant women and new mothers living with HIV. Policymakers and administrators can leverage public awareness, advocacy and political will to formulate and implement policies and campaigns aimed at fostering awareness and receptivity towards peer support interventions. REPORTING METHOD: Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Examining the Role of Autonomy Support, Goal Setting, and Care Coordination Quality on HIV PrEP Adherence in Black Men Who Have Sex with Men: HPTN 073.

Autonomy support is a concept that is derived from self-determination theory. Autonomy refers to the freedom to act as one chooses. The current study aimed to examine if autonomy support was associated with dried blood spot validated pre-exposure prophylaxis (PrEP) adherence, and whether the association was mediated by PrEP adherence goal setting and progress toward PrEP adherence goals. Our sample was drawn from Black men who have sex with men (MSM) from across three cities (Chapel Hill, NC; Los Angeles, CA; and Washington, DC) in the United States between February 2013 and September 2014. We used logistic regression to evaluate associations between study variables and path analysis to test mediation effects. Participants were, on average, 28 [standard deviation (SD) = 1.12] years old and 25% were unemployed. We found that MSM who experienced high autonomy support were more likely to adhere to PrEP [odds ratio (OR) = 1.17; 95% confidence interval: 1.00-1.38]. MSM who set PrEP adherence goals were more likely to adhere to PrEP. Moreover, MSM who reported making progress toward their goals were also more likely to adhere to PrEP. Finally, client perception of coordination quality enhanced the magnitude of the association between goal setting and goal progress and the effect size of goal progress on PrEP adherence. Autonomy support, goal setting, goal monitoring/evaluation, and care coordination quality influenced PrEP adherence among Black MSM. Our findings indicate that while it is important to set goals for PrEP adherence, goal setting may need to be accompanied by progress monitoring to achieve the maximal effect.

A Longitudinal Study on the Influence of Sibling Support and HIV Testing Among Black Youth.

BACKGROUND: Healthy familial relationships have been noted as protective against HIV infection among the Black youth. Previous studies have indicated that sibling relationships are important over the life course and may have a significant influence on health behaviors and health promotion. However, the specific interaction between sibling relationships, HIV prevention, and HIV testing is underexplored. This longitudinal study aims to examine the role of sibling relationships, healthcare providers, and other contextual factors on HIV testing. METHODS: This study was conducted via the secondary analysis of data from the National Longitudinal Study of Adolescent to Adult Health evaluating the health of adolescents. The analysis included Black youth from Wave 1 and 3 (N = 509) with a mean age of 16 years. A multinomial analysis evaluated the association of sibling relationships on HIV testing. RESULTS: In Wave 1, youth who reported having love for their sibling were 1.90 (p < .001) times more likely to test for HIV infection than those who reported no love for their sibling. In Wave 1 and 3, the youth who reported no sibling support was 89% (p < .001) less likely to get tested for HIV more than once. CONCLUSION: This study's findings show that sibling relationships have a significant positive influence on HIV testing among Black youth, and they are a protective factor against HIV transmission. These findings are essential in structuring HIV testing programs and interventions tailored to Black youth.

Implementation of Client-Centered Care Coordination for HIV Prevention with Black Men Who Have Sex with Men: Activities, Personnel Costs, and Outcomes-HPTN 073.

BACKGROUND: Black men who have sex with men (MSM) experience disproportionate rates of HIV infection in the USA, despite being no more likely to engage in sexual risk behaviors than other MSM racial/ethnic groups. HIV pre-exposure prophylaxis (PrEP) has been shown to reduce risk of HIV acquisition; however, rates of PrEP use among Black MSM remain low. Clinical, psychosocial, and structural factors have been shown to impact PrEP use and adherence among Black MSM. Care coordination of HIV prevention services has the potential to improve PrEP use and adherence for Black MSM, as it has been shown to improve HIV-related care outcomes among people living with HIV. METHODS: Client-centered care coordination (C4) is a multi-level intervention designed to address clinical, psychosocial, and structural barriers to HIV prevention services for Black MSM within HPTN 073, a PrEP demonstration project among Black MSM in three cities in the USA. The current study examined the implementation process of C4, specifically investigating the activities, cost, time, and outcomes associated with the C4 intervention. RESULTS: On average, participants engaged in five care coordination encounters. The vast majority of care coordination activities were conducted by counselors, averaging 30 min per encounter. The cost of care coordination was relatively low with a mean cost of $8.70 per client encounter. CONCLUSION: Although client-centered care coordination was initially implemented in well-resourced communities with robust HIV research and service infrastructure, our findings suggest that C4 can be successfully implemented in resource constrained communities.

Strategies That Promote Equity in COVID-19 Vaccine Uptake for Latinx Communities: a Review.

Latinx people in the USA have had a high burden of COVID-19 cases, hospitalizations, and death, yet rates of COVID-19 vaccine uptake among Latinx individuals were lower than other demographic groups. Effective strategies to promote vaccine uptake among Latinx communities are needed. We conducted a rapid review of information available between December 2020 and August 2021. Our search strategy used PUBMED, Google, and print media with a prescribed set of definitions and search terms for two reasons: there were limited peer-reviewed studies during early period of roll-out and real-time perspectives were crucially needed. Analyses included expert opinion, descriptions of project implementation and outcomes. We found that approaches varied. An integral component with all interventions was the use of local Latinx community leaders. They could understand the nuances of vaccine hesitancy, access issues, and structural inequities experienced by Latinx communities. The mechanisms for messaging included the use of social media, radio, and promotora outreach workers to disseminate information about COVID-19 vaccines and counter misinformation. Phone hotlines for scheduling were reported. Promoting access involved pop-up clinics at shopping malls, farmer's markets, and nearby grocery stores which were popularly used to vaccinate Latinx community members. Other practices included limited registration requirements, avoiding online-only communication, and training staff to provide specialized support to Latinx clients. This rapid review provides a basis for developing strategic implementation to increase COVID-19 vaccine uptake in this ongoing pandemic and planning to promote health equity for future bio-events and health crises.

Assessing the Influence of Child Sexual Behavior on Depression among Black SMM in the Southeastern United States.

Limited studies have examined the associations between child sexual abuse (CSA) and depression among Black sexual minority men (SMM) in the Southeastern United States (US). As, such, the current study examined the critical gap in understanding the impact of CSA on Black SMM's mental health. Specifically, we tested the associations between contextual CSA factors and depression among a large population-based sample of Black SMM living in two cities in the Southern US. Data were obtained from the MARI Study, a sample of Black SMM ages 18-66 years, recruited from the Jackson, MS and Atlanta, GA metropolitan areas (n = 507). Depression was assessed using the 9-item CES-D scale. We conducted multivariable regression analyses to examine the association between depression with history of CSA and other child sexual-related variables (i.e., age of perpetrator and age of sexual abuse), controlling for key confounders. Our results indicated that CSA (ß = 0.14, p < 0.001) was positively associated with depression. Our results also indicated that Black SMM who reported being sexually abused at the ages of 6 to 10 (ß = 0.30, p < 0.01) and 16 to 18 (ß = 0.25, p < 0.05) were positively associated with depression. These findings suggest that there is a need to provide culturally and safe mental health services in the Southeastern US for CSA survivors.

Community-Engaged Intervention Mapping for Cardiovascular Disease Prevention in Black and Latinx Sexual Minority Men With HIV in New York City: Protocol for a Web-Based Mixed Methods Study.

BACKGROUND: Approximately every 37 seconds, someone in the United States dies of cardiovascular disease (CVD). It has emerged as an important contributor to morbidity among persons with HIV. Black and Latinx sexual minority men are at higher risk of both HIV and CVD when compared to heterosexual, nonethnic or minority men. Persons with HIV have a 1.5 to 2-times risk of having CVD than do HIV-negative persons. Data suggest that by the year 2030, an estimated 78% of persons with HIV will have CVD. The relationship between HIV and CVD in marginalized populations is not well understood because overall awareness of HIV and CVD as comorbid conditions is low, which further heightens risk. This has created a critically pressing issue affecting underrepresented ethnic and racial populations with HIV and requires immediate efforts to mitigate risk. OBJECTIVE: The purpose of this formative, mixed methods study is to use a community-engaged approach to map a behavioral intervention for CVD prevention in Black and Latinx sexual minority men with HIV in New York City. METHODS: Literature reviews focused on behavioral prevention studies using intervention mapping. In Aim 1, we will use qualitative interviews with HIV program managers and community members to understand facilitators and barriers to CVD prevention, chronic illnesses of concern, and early design elements needed for a web-based CVD prevention intervention. In Aim 2, we will conduct qualitative interviews and administer cross-sectional validated surveys with 30 Black and Latinx sexual minority men with HIV. We will assess illness perceptions of chronic conditions, such as HIV, hypertension, and diabetes. A total of 40 participants (program managers and community members) for Aims 1 and 2 will be enrolled to participate. To develop the protocol, we will follow steps 1 through 3 (needs assessment, change objectives, implementation strategy) of intervention mapping, using mixed methods. RESULTS: The study was approved by New York University Institutional Review Board in February 2021 (IRB-FY2021-4772) and also by the Yale University Institutional Review Board in June 2022 (#2000031577). We anticipate completing data collection on or before December 2022. Early analyses suggested concerns about illnesses outside of HIV and associated comorbid conditions, such as COVID-19 and monkeypox. Additionally, we noted a strong interest in using a web-based platform for CVD prevention education. CONCLUSIONS: Web-based, behavioral, CVD prevention interventions may be promising modalities to closing the cardiovascular health disparities gap in Black and Latinx sexual minority men with HIV by extending the reach of prevention interventions using community-informed approaches and technological modalities that have been underused in this population. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/41602.

Freedom as Prevention: Mechanisms of Autonomy Support for Promoting HIV Pre-Exposure Prophylaxis Use and Condom Use among Black MSM in 3 US Cities-HPTN 073.

Healthcare providers who use controlling or coercive strategies may compel short-term enactment of HIV and sexually transmitted infection prevention behaviors but may inadvertently undermine their client's motivation to maintain those behaviors in the absence of external pressure. Autonomous motivation refers to the self-emanating and self-determined drive for engaging in health behaviors. It is associated with long-term maintenance of health behaviors. We used structural equation modeling to investigate whether autonomy support was associated with increased odds of therapeutic serum levels of pre-exposure prophylaxis, through a pathway that satisfies basic psychological needs for autonomous self-regulation and competence regarding pre-exposure prophylaxis use. We also investigated whether autonomy support was associated with decreased odds of condomless anal intercourse via the same psychological needs-satisfaction pathway of autonomous self-regulation and competence regarding condom use. We tested these two theorized pathways using secondary data from a longitudinal sample of Black men who have sex with men from across three cities in the US (N = 226). Data from the sample fit the theorized models regarding the pathways by which autonomy support leads to the presence of therapeutic PrEP levels in serum (χ2 = 0.56; RMSEA = 0.04; CFI = .99, TLI = 0.98) and how it also leads to decreased odds of condomless anal intercourse (χ2 = 0.58; RMSEA = 0.03; CFI = 0.99; TLI = 0.98). These findings provide scientific evidence for the utility of self-determination theory as a model to guide intervention approaches to optimize the implementation and impact of PrEP for Black men who have sex with men.

"Family before Anyone Else": A Qualitative Study on Family, Marginalization, and HIV among Hispanic or Latino/a/x Mexican Sexual Minority Males.

This study explored the influence family relationships have on HIV-related factors among Hispanic or Latino/a/x Mexican sexual minority cisgender males in San Antonio, TX, US. A total of 15 young adults (7 people living with HIV; PLWH) ages 21-30 completed a semi-structured interview. Data were transcribed verbatim and analyzed using thematic analysis. The following themes emerged: (1) family support; (2) mother-son relationships; (3) father-son relationships; (4) sibling support; (5) family marginalization of sexual minorities; and (6) internalized homophobia. People who reported being HIV negative were more likely to have a prominent mother-son relationship, strong sense of family, supportive siblings, and family acceptance as a sexual minority. PLWH were more likely to report a weak sense of family, being raised in a maternal-led household, and less likely to have a relationship with their father and siblings. Marginalization among participants regardless of HIV status included exposure to religious rhetoric stigmatizing sexual minorities and fathers' reinforcing Mexican traditional gender norms. In addition to encountering homophobia, PLWH were further marginalized by family members due to their HIV status. The findings suggest a need for greater attention to examining the impact of familial support of Hispanic or Latino/a/x Mexican sexual minority cisgender males as young adults with or at risk of HIV.

Cardiovascular Disease Prevention Education Using a Virtual Environment in Sexual-Minority Men of Color With HIV: Protocol for a Sequential, Mixed Method, Waitlist Randomized Controlled Trial.

BACKGROUND: It is estimated that 70% of all deaths each year in the United States are due to chronic conditions. Cardiovascular disease (CVD), a chronic condition, is the leading cause of death in ethnic and racial minority males. It has been identified as the second most common cause of death in persons with HIV. By the year 2030, it is estimated that 78% of persons with HIV will be diagnosed with CVD. OBJECTIVE: We propose the first technology-based virtual environment intervention to address behavioral, modifiable risk factors associated with cardiovascular and metabolic comorbidities in sexual-minority men of color with HIV. METHODS: This study will be guided using social cognitive theory and the Technology Acceptance Model. A sequential, mixed method, waitlist controlled randomized control feasibility trial will be conducted. Aim 1 is to qualitatively explore perceptions of cardiovascular risk in 15 participants. Aim 2 is to conduct a waitlist controlled comparison to test if a virtual environment is feasible and acceptable for CVD prevention, based on web-based, self-assessed, behavioral, and psychosocial outcomes in 80 sexual-minority men of color with HIV. RESULTS: The study was approved by the New York University Institutional Review Board in 2019, University of Texas Health Science Center at Houston in 2020, and by the Yale University Institutional Review Board in February 2022. As of April 2022, aim 1 data collection is 87% completed. We expect to complete data collection for aim 1 by April 30, 2022. Recruitment for aim 2 will begin mid-May 2022. CONCLUSIONS: This study will be the first online virtual environment intervention for CVD prevention in sexual-minority men of color with HIV. We anticipate that the intervention will be beneficial for CVD prevention education and building peer social supports, resulting in change or modification over time in risk behaviors for CVD. TRIAL REGISTRATION: ClinicalTrials.gov NCT05242952; https://clinicaltrials.gov/ct2/show/NCT05242952. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/38348.

Optimizing PrEP Continuance: A Secondary Analysis Examining Perceived Autonomy Support and Care Coordination Quality among Black MSM in HPTN 073.

At the end of year 2018, it was estimated that in the United States over 1 million people were living with HIV. Although Black/African American individuals comprise an estimated 13.4% of the US population, as of 2019, they represented an estimated 42% of all new HIV diagnoses in 2018. PrEP use among Black men who have sex with men has not reached levels sufficient to have a population impact on HIV incidence. The purpose of this study was to examine whether high perceived autonomy support and care coordination quality were associated with PrEP continuation. Secondary analyses were conducted on data with 226 Black MSM in three US cities. Participants who were PrEP users and scored higher on autonomy support at week 8 were significantly more likely to continue PrEP (OR 1.48; 95% CI 1.04-2.11). Perception of coordination quality did not differ between PrEP users and non-users at any of the visits. Although coordination quality was not statistically significant, greater than half of PrEP users and non-PrEP users utilized the C4 services. Addressing social, individual, and structural barriers to PrEP may benefit Black MSM irrespective of their PrEP use.

The Influence of Family Bonding, Support, Engagement in Healthcare, on PrEP Stigma among Young Black and Latino Men Who Have Sex with Men: A Path Analysis.

This study employs the ecodevelopmental theory to examine the influence of mother and father bonding, family engagement in healthcare, and family support on PrEP stigma among BLMSM. We used a cross-sectional sample from wave five of the Healthy Young Men (HYM) study, with a survey sample of 399 participants aged 16−24 years. We conducted two-path analyses to test multiple hypotheses: (1) mother/father bonding is associated with an increase in family engagement in healthcare; (2) family engagement in healthcare is associated with family social support; and (3) family social support is associated with PrEP stigma. Family social support was negatively correlated with PrEP stigma (r = −0.15; p < 0.001). The findings show that families either led by a Black/Latino father or mother have a significant impact on the sexual health-seeking behavior of BLMSM and their perception of HIV and PrEP.

Assessing Different Types of HIV Communication and Sociocultural Factors on Perceived HIV Stigma and Testing among a National Sample of Youth and Young Adults.

In the United States, racial/ethnic and sexual youth and young adults (YYA) of color are disproportionately affected by HIV. Subsequently, YYA experience HIV stigma and engage in increased risk behaviors and reduced HIV testing. HIV communication has been identified as a potential buffer to HIV stigma, resulting in health-seeking behaviors, such as HIV testing. In this study, we respond to a meaningful gap in the literature by examining different types of HIV communication and their impact on HIV stigma and HIV testing in a diverse sample of YYA. We analyzed secondary data from the Kaiser Family Foundation National Survey of Teens and Young Adults on HIV/AIDS. A 40-question, web-based survey was conducted with 1437 youth (ages 15-24). Recruitment included a dual sampling method from households with: (1) listed phone numbers, (2) unlisted phone numbers, (3) telephones, (4) no telephone, and (5) only cell phone access. The purpose of the survey was to establish participants' HIV knowledge, communication, experiences, and testing behaviors. Findings suggested an association between intimate-partner HIV communication, increased HIV testing, and reduced HIV stigma. We also identified differentials in HIV testing and stigma based on gender, income, age, and sexual minority status, explained by HIV communication. Further research is needed that examines ways to use intimate-partner HIV communication to reduce stigma and increase HIV testing among YYA of different sociodemographic characteristics and sexual orientations.

Participatory Design of a Web-Based HIV Oral Self-Testing Infographic Experiment (HOTIE) for Emerging Adult Sexual Minority Men of Color: A Mixed Methods Randomized Control Trial.

Health communication is a key health promotion approach for translating research findings into actionable information. The purpose of this study was to use participatory design to create and then test the usability and comprehension of an HIV self-testing infographic in a sample of 322 emerging adult, sexual minority men of color. Our study objectives addressed three challenges to HIV self-testing: (1) correct usage of the test stick, (2) understanding the number of minutes to wait before reading the result, and (3) how to correctly interpret a negative or a positive HIV result. This study was a two-phase, sequential, mixed methods, pilot, online, randomized controlled trial. Results suggested a significant mean difference between the control and intervention groups on HIV self-testing knowledge, with the control group outperforming the intervention group. However, two-thirds or better of the participants in the intervention group were able to comprehend the three critical steps to HIV self-testing. This was a promising finding that has resulted in the authors' development of additional recommendations for using participatory design for visual aid development in HIV prevention research. Participatory design of an HIV self-testing infographic is a rigorous approach, as a health communication strategy, to address public health priorities.

Training Underrepresented Early-Career Faculty in Cardiovascular Health Research during COVID-19: Structural Inequities and Health Disparity.

The COVID-19 pandemic has highlighted race-based health disparities and structural racism in the United States. Enhancing the training of early-career academic and health scientists from underrepresented minority groups (URM) is critical to reduce disparities affecting underserved population groups. A dedicated training program that has been proven to support URM can facilitate career development for junior faculty during the pandemic. This critical support ensures the retention of talented, racially diverse junior faculty who are poised to mitigate structural racism, rather than perpetuate it. We describe how the Cardiovascular Disease Programs to Increase Diversity Among Individuals Engaged in Health-Related Research (PRIDE-CVD) summer institute successfully transitioned from a face-to-face format to a virtual format during the COVID-19 pandemic. As a result, early-career faculty continued to receive the PRIDE-CVD training on research methodology, grantsmanship, career development, and CVD health disparities, especially as related to the pandemic. In addition, the virtual format facilitated networking, promoted mental wellness, and allowed continual mentorship. Collectively, the program provided timely and relevant career development in the COVID-19 era and helped participants navigate the psychosocial challenges of being a URM in cardiovascular health research.

Family Support and Sociocultural Factors on Depression among Black and Latinx Sexual Minority Men.

Family-based approaches are critical for improving health outcomes in sexual minority men (SMM) of color. Yet, it is unclear how family context, internalized homophobia, and stress influence mental health outcomes among sexual minority men of color. From a cross-sectional sample of 448 participants, aged 16-24 years, survey data were analyzed to examine rates of family social support, the perception of sexuality by family, the stressfulness of life events, internalized homophobia, and other contextual variables on depression using linear regression. Our results indicated that an 86% increase in family social support was related to a -0.14 decrease in depression (ß = -0.14, p = 0.004). In addition, SMM who were separated by family and friends because of their sexuality were statistically significant and positively associated with depression (ß = 0.09, p < 0.001). Findings from our study suggest that the influence from the microsystem is salient in modifying mental health outcomes for SMM of color.