Leveraging family-based assets for Black men who have sex with men in House Ball Communities: Protocol for a cluster randomized controlled trial.

Black men who have sex with men (MSM) continue to have the highest incidence of new human immunodeficiency virus (HIV) diagnoses in the United States but are least likely to be engaged in care or to be virally suppressed. Many Black MSM face multiple stigmas, but some have found refuge in the House Ball Community (HBC)-a national network of Black lesbian, gay, bisexual, and transgender kinship commitments that provide care-giving, affirmation, and survival skills-building for its members. We propose to modify a skills-building and HIV prevention best-evidence, group-level intervention for HIV- negative Black MSM (Many Men Many Voices) into a family-based intervention to focus on asset-building for both HIV-negative and HIV-positive Black MSM within HBC families. The adapted intervention will be re-branded as Our Family Our Voices (OFOV). We proposed a mixed-methods study to test the feasibility and preliminary efficacy of OFOV adapted for HIV status-neutral use with HBC families. First, we will develop the intervention protocol using the ADAPT-ITT model for modifying behavioral interventions. Then, we will conduct a cluster randomized controlled trial with six HBC families in New York City. Families will be randomized to the OFOV intervention or waitlist control arm. Primary outcomes will be HIV testing, HIV pre-exposure prophylaxis use, currently in HIV care and on HIV treatment. Secondary outcomes will be the number of family-based assets, resilience, number of sexual partners, and relative frequency of condomless anal intercourse. The results of the formative research, including the pilot trial, will contribute to the evidence-base regarding the development of HIV status-neutral interventions that respond to the diversity and complexities of HBC families and that recognize the importance of asset-building for facilitating HBC resilience to stigma as a part of the United States' domestic policy objective of ending the HIV epidemic by 2030.

An Innovative Adaptation of an HIV Status-Neutral, Community-Informed, Socioemotional Asset-Building Intervention With the House Ball Community.

Black men who have sex with men (MSM) have the highest incidence of new HIV diagnoses compared to other populations and face multiple stigmas. Some have found refuge in the House Ball Community (HBC)-a national network of Black lesbian, gay, bisexual, and transgender (LGBT) kinship commitments (families) that affirm gender expression(s) and sexualities and provide skills-building for its members. Internal and external socioemotional assets influence the health of young Black sexual and gender minorities; building these assets in the HBC is critical to facilitating engagement in health-promoting behaviors. To address this critical gap in HIV prevention, we describe an adaptation of 3MV, a best-evidence, group-level retreat-based risk reduction intervention developed for HIV-negative Black MSM. Clinicians, researchers, HBC members/leaders, and community experts collaborated to adapt 3MV for the HBC. Our Family, Our Voices (OFOV) is an HIV status-neutral, risk-reduction intervention that focuses on asset-building for young, gender-diverse Black HBC members, with the HBC family unit as the focus of the intervention. We describe the collaborative adaptation process and the development of HBC-relevant intervention topics. This novel adaptation and collaborative community model provides a framework for researchers and clinicians to follow when adapting evidence-based interventions for priority populations.

Impostor feelings as a moderator and mediator of the relationship between perceived discrimination and mental health among racial/ethnic minority college students.

This study investigated whether impostor feelings would both moderate and mediate the relationship between perceived discrimination and mental health in a sample of diverse ethnic minority college students (106 African Americans, 102 Asian Americans, 108 Latino/a Americans) at an urban public university. African American students reported higher perceived discrimination than Asian American and Latino/a American students, while no racial/ethnic group differences were reported for impostor feelings. Analyses revealed that among African American students, high levels of impostor feelings moderated the perceived discrimination and depression relationship and mediated the perceived discrimination and anxiety relationship. Among Asian American students, impostor feelings mediated the relationship between perceived discrimination and both depression and anxiety. Among Latino/a American students low levels of impostor feelings moderated the relationship between perceived discrimination and both depression and anxiety, and partially mediated the relationship between perceived discrimination and anxiety. Multigroup path analyses revealed a significantly stronger impact of impostor feelings on depression among African American students and a stronger impact of perceived discrimination on impostor feelings among African American and Latino/a American students. Clinical implications and future research directions are discussed. (PsycINFO Database Record

Institutional and structural barriers to HIV testing: elements for a theoretical framework.

Stigma is a barrier to HIV health seeking, but little is known about institutional and structural expressions of stigma in HIV testing. This study examines evidence of institutional and structural stigma in the HIV testing process. A qualitative, grounded theory study was conducted using secondary data from a 2011 HIV test site evaluation data in a Midwestern, moderate HIV incidence state. Expressions of structural and institutional stigma were found with over half of the testing sites and at three stages of the HIV testing visit. Examples of structural stigma included social geography, organization, and staff behavior at first encounter and reception, and staff behavior when experiencing the actual HIV test. Institutional stigma was socially expressed through staff behavior at entry/reception and when experiencing the HIV test. The emerging elements demonstrate the potential compounding of stigma experiences with deleterious effect. Study findings may inform future development of a theoretical framework. In practice, findings can guide organizations seeking to reduce HIV testing barriers, as they provide a window into how test seekers experience HIV test sites at first encounter, entry/reception, and at testing stages; and can identify how stigma might be intensified by structural and institutional expressions.

Preferences of Gay and Bisexual Men for Pharmacy-Based HIV Testing and Over-the-Counter HIV Tests.

A 2013 study among 169 Indiana men aged 18-45 who have sex with men assessed the acceptability of and preferences for pharmacy-based and over-the-counter (OTC) HIV testing. Rural men in general and men who did not know their HIV status were more likely to purchase an OTC HIV test. Men who did not know their HIV status also preferred an OTC HIV test to pharmacy-based testing. Pharmacies should enhance information around the sale of OTC HIV tests, particularly in rural areas. Information should include test results, opportunities for consultation, and linkage to care.

Constructing Home and Family: How the Ballroom Community Supports African American GLBTQ Youth in the Face of HIV/AIDS.

This article focuses on the construction of homes and families within the ballroom community, a prominent feature of urban GLBTQ communities of color in cities across the United States. Based on two ethnographic studies with ballroom communities in the San Francisco Bay Area, California, and Detroit, Michigan, we explore the importance of gender and sexual identity in informing community practice around HIV prevention and treatment. As a community, the ballroom scene provides African American queer youth with support for same-sex desire and identity, along with multiple forms of support for HIV prevention. Our study of the ballroom community documents current forms of "intravention" occurring within the community and the importance of the gender-sex system in organizing these practices. We also offer recommendations for community-based organizations to partner with the ballroom community, making use of existing social structures within the community and the salient concepts of home and family, to provide HIV-related services and support. We argue for HIV-prevention interventions to take a more culturally appropriate, nuanced approach to reaching African American youth at risk, utilizing community and family structures, in whatever forms these may take.