Individual, Social, and Structural Vulnerability for Black Women in the South: Implications for PrEP.

Pre-exposure prophylaxis (PrEP) is an effective biomedical HIV prevention option, yet adoption among Black women, who are disproportionately impacted by HIV, is low. A nuanced understanding of the multi-level factors that contribute to elevated risk is necessary to better contextualize PrEP uptake. Qualitative data from Black women residing in the Southern U.S. who self-screened as HIV-negative, were collected via four focus groups (N = 27) to understand influences on HIV vulnerability and the potential role of PrEP in mitigating risk. Content analysis of transcribed data yielded multiple themes addressing: the pervasiveness of sexual partner sharing; lack of transparency regarding HIV status, disclosure, and testing; and social/cultural influences on HIV risk. Experiences with the health care system and providers were of particular concern. Findings demonstrate support for PrEP in this population and contribute to our understanding of individual, social, and structural factors to better inform PrEP promotion.

A qualitative study of health care access among African American older adults in a socio-demographically under-resourced region during the COVID-19 pandemic.

Background: In the U.S., health inequities experienced by the African American community, specifically among those ages 65 and older, have been well-documented in research literature. Alongside the findings regarding disparities in disease prevalence and management, researchers have also highlighted disparities in health care access. Despite recent evidence of health inequities experienced by African Americans during the COVID pandemic, there is little research on the lived experience of this group in this critical time, health care access challenges that may be exacerbated by the pandemic, and the community's outlook for the future in addressing health disparities. Methods: We conducted a qualitative study of African Americans to gather their perspectives about access to health care, particularly during the COVID-19 pandemic. Study participants consisted of African Americans, ages 50-85 years, who spoke English as their primary language, who resided in one of 17 counties in South Carolina that represent a region of the State known as the corridor of economic disadvantage. Results: Forty-seven telephone interviews were conducted. While research has shown that certain populations experienced health care access disparities during the early COVID pandemic, these disparities did not appear to be exacerbated in our sample. However, participants noted an increase in the use of telehealth, and identified challenges to using this technology. Participants made recommendations about how to address disparities in health care access in their communities. Conclusion: Our qualitative approach was useful in obtaining perspectives about access to health care during the COVID-19 pandemic from African American older adults. Continued research with older African Americans, particularly those in under-resourced communities are warranted to further elucidate these findings.

Responding to the Call: Building a Training Program to Diversify the Academy in Alzheimer's Disease Research.

Alzheimer's disease and related dementias (ADRD) are at the forefront of the United States (US) public health agenda due to their tremendous human and financial burden. Further, disproportionately high ADRD rates among racial/ethnic minorities require incorporating the unique perspectives of racially and ethnically diverse scientists, which will necessitate diversifying the scientific workforce that investigates disparities in aging. The purpose of this paper is to describe the training and mentorship initiatives of the National Institute on Aging (NIA)-funded Carolina Center on Alzheimer's Disease and Minority Research, emphasizing lessons learned from our engagement with underrepresented minority and minoritized (URM) Scientists. We highlight three aims of the Center's training and mentorship component: (1) Fund pilot projects for URM Scientists conducting research on sociocultural, behavioral, and environmental factors that influence ADRD-related health disparities; (2) Provide mentorship to build the research capacity of Center Scientists; and (3) Offer research education in Health Disparities and Minority Aging Research to Center Scientists and interested researchers at all partner institutions. Our experience may be a practical resource for others developing interdisciplinary training programs to increase the pipeline of URM Scientists conducting ADRD research.

Racial/ethnic differences in positive childhood experiences across a national sample.

BACKGROUND: Examination of racial/ethnic differences in positive childhood experiences (PCEs) is needed, as the absence of supportive factors may hinder children from healthy processing and mitigation of adversity. OBJECTIVE: The purpose of this study was to examine the prevalence of PCEs in a nationally representative sample of children and determine whether PCE exposure differed across race and ethnic groups. PARTICIPANTS AND SETTING: Data were drawn from the nationally representative 2017-2018 National Survey of Children's Health (NSCH) (n = 33,747). METHODS: Descriptive statistics and bivariate analyses were used in order to calculate frequencies, proportions, and unadjusted associations for each variable. Multivariable regression models were used to examine the association between race/ethnicity and PCEs. RESULTS: All racial-ethnic minority groups of children had a lower likelihood of mentorship, living in a safe neighborhood, or living in a supportive neighborhood, than their Non-Hispanic White counterparts. Non-Hispanic Black children had a lower likelihood of having a mentor for advice or guidance (aOR 0.50; 95 % CI 0.38-0.62), living in a safe neighborhood (aOR 0.62; 95 % CI 0.52-0.73), and living in a supportive neighborhood (aOR 0.75; 95 % CI 0.64-0.87) than Non-Hispanic white children. CONCLUSIONS: The information from this study highlights the negative disparities borne by racial/ethnic minority populations. Findings can be used to inform policymakers, program developers, and stakeholders on where to target interventions and how to bring together families and communities to not only confront adversity in childhood, but also to leverage community and family-level assets to create PCEs for all children.

African American Women's Current Knowledge, Perceptions, and Willingness of PrEP Use for HIV Prevention in the South.

African American women accounted for approximately 60% of new HIV diagnoses among women in the United States, with the greatest burden occurring in the South. Past efforts to prevent HIV focused on behavioral interventions aimed at reducing sexual risk behavior. More recent HIV prevention methods have included oral pre-exposure prophylaxis (PrEP) with antiretroviral drugs. Although PrEP has been designated as an effective HIV prevention method since 2012, awareness and uptake of PrEP remains low among African American women. Our study explored African American women's knowledge, perceptions, and willingness of PrEP use. Four focus groups were held in April 2019, consisting of 27 women, who identified as African American and resided in South Carolina. Focus group topics focused on participants' awareness, perceptions, and potential use of PrEP. The majority of women had heard of PrEP; however, over half of the participants were in the HIV or health field. Overall, participants believed that the "lay woman" would be unaware of PrEP. Participants' perceptions of PrEP included stigma of PrEP use, benefits to non-monogamous couples, and experiences with PrEP clients. The majority of women were willing to use PrEP, but major concerns around short and long-term side effects were expressed. Participants provided recommendations to improve PrEP uptake among African American women that included targeted campaigns and spokespersons. African American women are interested and supportive of PrEP use for HIV prevention in the South, where HIV rates remain highest. Past PrEP implementation efforts have not been relatable to African American women; therefore, awareness and uptake rates remain low. Future efforts to increase PrEP awareness and uptake among African American women should be relevant, and should provide comprehensive information on potential side effects, purpose of use, and eligibility criteria.

African American Emerging Adult Perspectives on Unintended Pregnancy and Meeting Their Needs With Mobile Technology: Mixed Methods Qualitative Study.

BACKGROUND: In the United States, a disproportionate number of unintended pregnancies occur among African Americans, particularly those in their later teenage years and early 20s. Mobile technology is becoming more ubiquitous as a method for health promotion; however, relatively little research has been done with this population to determine their perspectives about unintended pregnancy, the potential of successfully using mobile technology to prevent unintended pregnancy, and the content of such programs. OBJECTIVE: The purpose of this study was to obtain the perspectives of African American emerging adults about unintended pregnancy and the use of mobile technology to reduce unintended pregnancy rates. METHODS: Focus groups and interviews were conducted with 83 African Americans, aged 18-21 years. Data were analyzed using an open coding process. Emergent codes were then added as needed, and themes and subthemes were identified. RESULTS: Participants cited the social environment and lack of education as primary reasons for disproportionate rates of unintended pregnancy. They noted that unintended pregnancy is an important issue and that they desire more sexual health information. They enthusiastically supported mobile technology as a means to communicate unintended pregnancy prevention programming and offered many suggestions for program content, look, and feel. CONCLUSIONS: Young and emerging adult African Americans want and need sexual health resources, and a mobile-based platform could be widely accepted and address needs to lower disproportionate rates of unintended pregnancy. An essential next step is to use these findings to inform the development of a mobile-based unintended pregnancy prevention and sexual health program prototype to determine feasibility.

Community-Engaged Use of Cultural Narratives to Create HIV Prevention Stories for African American Women.

BACKGROUND: Culture-specific interventions based on storytelling can address the social and cultural context of HIV that is unique to Southern African American women. METHODS: We describe a community-engaged process to construct scripted stories to promote HIV prevention based on cultural narratives from African American women living with HIV. Our process involved (1) the collection of cultural narratives, (2) establishment of a community advisory board (CAB), (3) identification of important intervention themes, (4) narrative analysis to identify stories, and (5) script writing/peer review to produce composite narrative HIV prevention messages. LESSONS LEARNED: Engaging community members is a strength; however, outreach should be strategic to individuals interested in a script writing creative process. This process is an adaptation of widely accepted methods to produce stories that incorporate culture organically in ways that allow for greater identification and engagement by the target audience. CONCLUSIONS: Authentic stories harvested and produced from and for a culture-specific population is a critical consideration for narrative health promotion.

Understanding Conceptualizations of Pregnancy and Planning for Pregnancy Among Adolescent Girls and Young Women in Harare, Zimbabwe.

Zimbabwe has one of the highest rates of maternal mortality, yet little is understood about adolescent girls' and young women's perspectives on pregnancy or planning for pregnancy. The research study took an emic approach to understand and describe how adolescent girls and young women (14-24 years) in Harare, Zimbabwe, conceptualize pregnancy and planning for pregnancy and how these conceptualizations inform pregnancy decisions. Semi-structured, in-depth, qualitative interviews were conducted with adolescent girls and young women ( N = 48) and data were analyzed thematically using NVivo 10. Pregnancy was conceptualized across nine themes: carrying a child and oneself, growing a family, motherhood, the best time for pregnancy, pregnancy decision makers, who is responsible for the pregnancy, pregnancy burden, pregnancy dangers, and increase in social status with pregnancy. Planning for pregnancy was conceptualized during the prepregnancy, pregnancy, and postpregnancy phases. Findings emphasize considering sociocultural views concerning pregnancy and including social networks in maternal health efforts.

Examining Long-Term Mental Health in a Rural Community Post-Disaster: A Mixed Methods Approach.

Psychological stressors have been observed immediately following disasters, yet less is known about the long-term effects on the mental health of vulnerable communities. In 2005, Graniteville, S.C. was ravaged by a train derailment that leaked approximately 60 tons of chlorine gas and left several people dead in the small community. The purpose of this study was to examine the mental health of Graniteville-area residents in the nine years following the train disaster using a mixed methods approach. Using the photovoice method, participants reported compromised mental health with symptoms consistent with depression, post-traumatic stress disorder, fear, and anxiety. Medical records analysis indicated that mental health-related hospital encounters generally increased post-disaster. Mental health concerns should be anticipated in the long-term aftermath of disasters. Addressing these concerns is particularly vital in resource-poor communities. Our findings can be useful in developing mental health disaster management protocols and policies for communities in the long-term post-disaster period.

Examining the Relationships Between Religiosity, Spirituality, Internalized Homonegativity, and Condom Use Among African American Men Who Have Sex With Men in the Deep South.

The Sexual Health in Faith Traditions Study evaluated the relationships between religiosity, spirituality, internalized homonegativity, and sexual risk behaviors among a sample of African American men who have sex with men living in the Deep South. Participants were recruited primarily from Black Gay Pride celebrations to complete a self-administered, paper-and-pencil survey. Structural equation modeling was used to determine relationships between key constructs and condom use for insertive ( n = 285) and receptive ( n = 263) anal intercourse in the past 3 months. Almost half of respondents reported using condoms "every time" when engaging in insertive (48.3%) or receptive (45.1%) anal intercourse. Religiosity and spirituality were differentially associated with dimensions of internalized homonegativity. While no significant direct relationships were reported between either religiosity or spirituality and condom use, dimensions of internalized homonegativity mediated significant indirect relationships. Findings suggest that religiosity and spirituality influence African American men who have sex with men's internalized homonegativity and, subsequently, engagement in safer sex behaviors.

Different Dimensions: Internalized Homonegativity Among African American Men Who Have Sex With Men in the Deep South.

This study examined the psychometric properties of the Internalized Homonegativity Inventory (IHNI) among African American men who have sex with men (AAMSM) in the southeastern United States. Data from 261 AAMSM were analyzed using exploratory factor analysis. Results showed evidence of a two-factor solution: personal and moral homonegativity and gay affirmation. Internal consistencies were greater than .80, and correlations with other variables (e.g., sociodemographics, religiosity, masculinity) provided evidence of validity. Findings suggesting a two-factor instead of a three-factor solution may indicate that the IHNI manifests differently for AAMSM in the Deep South than for predominantly White MSM. Further research should examine how incorporating new conceptions of internalized homonegativity into culturally specific health-promotion interventions for AAMSM might enhance effectiveness.

"She Told Them, Oh That Bitch Got AIDS": Experiences of Multilevel HIV/AIDS-Related Stigma Among African American Women Living with HIV/AIDS in the South.

African American women bear a disproportionate burden of HIV/AIDS in the United States. Although they constitute only 13% of the US population, African Americans account for nearly 65% of all new HIV infections among American women. In addition, this population suffers comparatively greater adverse health outcomes related to HIV status. African American women living with HIV in the South may be further burdened by HIV/AIDS stigma, which is comparatively more pronounced in this region. To further explore this burden, we used narrative data and the Social Ecological Model to explore how African American women living with HIV in the US South recount, conceptualize, and cope with HIV/AIDS stigma at interpersonal, community, and institutional levels. Our narrative analysis suggests that HIV-positive African American women living in the South are vulnerable to experiences of multilevel HIV stigma in various settings and contexts across multiple domains of life. Stigma subsequently complicated disclosure decisions and made it difficult for women to feel supported in particular social, professional and medical settings that are generally regarded as safe spaces for noninfected individuals. Findings suggest that the debilitating and compounded effect of multilevel HIV/AIDS stigma on HIV-positive African American women in the South warrants closer examination to tailor approaches that effectively address the unique needs of this population.

"Out of All of this Mess, I Got a Blessing": Perceptions and Experiences of Reproduction and Motherhood in African American Women Living With HIV.

HIV disproportionately impacts African American women of childbearing age residing in the southern United States. Antiretroviral therapy has increased the quantity and quality of life for people living with HIV and produced viable and safe reproduction possibilities for women living with HIV. However, little is known about reproductive decision-making processes for African American women living with HIV. The overall goal of our study was to qualitatively explore perspectives related to reproduction and motherhood in HIV-infected African American women of childbearing capacity. HIV-infected African American women of childbearing capacity in South Carolina (N = 42) participated in in-depth interviews. Our respondents held positive views about pregnancy and motherhood, despite nonsupportive pregnancy messages from interpersonal influences, including health care providers. Study findings uncovered the need for programs and interventions to support women's reproductive autonomy and focus on reducing conception- and pregnancy-related transmission risks to infants and uninfected sexual partners.

Exploring perceptions of cancer risk, neighborhood environmental risks, and health behaviors of blacks.

Cancer risk perceptions and cancer worry are shaped by race/ethnicity, and social, economic, and environmental factors, which in turn shape health decision-making. A paucity of studies has explored risk perceptions and worry in metropolitan areas with disparate environmental conditions and cancer outcomes. This study examined perceptions of cancer risk, neighborhood environmental health risks, and risk-reducing health behaviors among Blacks. A 59-item survey was administered to respondents in Metropolitan Charleston, South Carolina from March to September 2013. A convenience sample of males and females was recruited at local venues and community events. Descriptive statistics, bivariate analyses (Chi square tests), and logistic regression models were estimated using SAS 9.3 software. Respondents (N = 405) were 100% Black, 81% female (n = 323), and ranged from 18 to 87 years of age (M = 49.55, SD = 15.27). Most respondents reported lower perceptions of cancer risk (37%) and equated their cancer beliefs to direct or indirect (i.e. personal or family) experiences. Low perceived cancer risk (absolute risk) was significantly associated (p < .05) with non-alcohol consumption, having a colon cancer screening test, being female, and being age 25-44 or 45-64. Cancer worry was significantly associated (p < .05) with being a current smoker, having a "fair" diet, non-alcohol consumption, and having any colon cancer screening test. Perceived cancer risk is an important indicator of health behaviors among Blacks. Direct or indirect experiences with cancer and/or the environment and awareness of family history of cancer may explain cancer risk perceptions.