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.

Structural Inequities, HIV Community-Based Organizations, and the End of the HIV Epidemic.

Community-based organizations (CBOs) are integral to achieving the goal of Ending the HIV epidemic (EHE). Their familiarity with and proximity to communities position them to effectively implement strategies necessary to address determinants of health through their formal and informal medical and social services. However, structural inequities have contributed to the demise of many organizations that were instrumental in early responses to the HIV epidemic. We define structural inequities for HIV CBOs as systems in which policies, institutional practices, organizational (mis)representations, and other norms work to produce and maintain inequities that affect CBOs' ability to survive and thrive. In this discussion, we describe the organizational threats to grassroots HIV CBOs and the risks to livelihood and longevity, including examples. The invaluable role of HIV CBOs in EHE and their role in responding to existing and novel infectious diseases like COVID-19 should not be overlooked. Recommendations to promote structural equity are offered. (Am J Public Health. 2022;112(3):417-425. https://doi.org/10.2105/AJPH.2021.306688).

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.

Understanding Community-based HIV/AIDS Service Organizations: An Invaluable Source of HPV-related Cancer Information for At-risk Populations.

To describe non-clinical HIV service providers (NCHSPs) as surrogate seekers and health information mavens for people living with HIV (PLWH), men who have sex with men (MSM), and other vulnerable populations.In May/June 2016, we recruited 30 NCHSPs from three community-based HIV/AIDS service organizations. NCHSPs completed a 118-item self-administered, paper-and-pencil survey about HPV, cancer, and health communication. Data were analyzed using Stata/SE 14.1.Almost all (97%) NCHSPs were surrogate seekers and had looked for HIV/AIDS (97%), STD (97%), and cancer (93%) information. Most (60%) cancer information seekers had looked for information about HPV. The Internet (97%) and healthcare providers (97%) were health information sources almost all NCHSPs trusted. Nearly all NCHSPs (93%) were completely or very confident about their ability to find health information. The mean health information mavenism score (17.4 ± 2.1) was significantly higher than the scale's high-score cutoff (15.0) (p < 0 .001).NCHSPs look for and share health information with the vulnerable populations (e.g., PLWH, MSM) they serve. More research is needed to understand what NCHSPs' know and think about the health information they are sharing with vulnerable populations.

Differential item functioning for items in Berger's HIV Stigma Scale: an analysis of cohorts from the Indian, Swedish, and US contexts.

PURPOSE: To examine whether items in Berger's HIV Stigma Scale function differently with persons of different age, gender, and cultural backgrounds. METHODS: Secondary data from cohorts, collected in South India (n = 250), Sweden (n = 193), and the US (n = 603) were reanalyzed to evaluate DIF within, between, and across these cohorts. All participants had answered the revised version of the HIV stigma scale consisting of 32 items forming the subscales Personalized stigma, Disclosure concerns, Concerns about public attitudes, and Negative self-image. Differential Item Functioning (DIF) for these items was assessed using hybrid ordinal regression-IRT technique. When DIF was detected, the cumulative impact of DIF on individual subscale scores was evaluated. RESULTS: DIF was detected for 9 items within, between, or across cohorts, but the DIF was negligible in general. Detected DIF between the Swedish and Indian cohorts had a cumulative salient impact on individual scores for the subscale Disclosure Concerns; Disclosure concerns were overestimated in the Swedish cohort and both over- and underestimated in the Indian cohort. CONCLUSIONS: The items in the 32-item version of the HIV stigma scale did not seem to be particularly prone to present DIF. The DIF between the Indian and Swedish cohort for items in the subscale Disclosure Concerns could, however, result in both type I and type II errors if scores should be compared between the Indian and Swedish cohort.

Social Determinants of HIV-Related Stigma in Faith-Based Organizations.

OBJECTIVES: To examine the association between social factors in faith-based settings (including religiosity and proximity to people living with HIV/AIDS) and HIV stigma. METHODS: A total of 1747 congregants from primarily African American faith-based organizations of Project FAITH (Fostering AIDS Initiatives That Heal), a South Carolina statewide initiative to address HIV-related stigma, completed a survey. RESULTS: Female gender (P = .001), higher education (P < .001), knowing someone with HIV/AIDS (P = .01), and knowing someone who is gay (P < .001), but not religiosity, were associated with lower levels of stigma and with lower odds of stigmatizing attitudes (P < .05). CONCLUSIONS: Opportunities for connection with people living with HIV/AIDS tailored to the social characteristics of faith-based organizations may address HIV stigma in African American communities.

Stigma as a Barrier to HIV-Related Activities Among African-American Churches in South Carolina.

South Carolina has one of the highest HIV/AIDS prevalence rates in the United States. More than 70% of those infected are African American. Traditionally, Black churches have been one of the primary sources of health outreach programs in Southern African-American communities. In this research, we explored the role of HIV-related stigma as a barrier to the acceptance of HIV-related activities in Black churches. A survey of African-American adults in South Carolina found that the overall level of stigma associated with HIV/AIDS was comparable to what has been found in a national probability sample of people in the United States. Consistent with the stigma-as-barrier hypothesis, the degree to which survey respondents endorsed HIV-related stigma was related to less positive attitudes concerning the involvement of Black churches in HIV-related activities.

A faith-based community partnership to address HIV/AIDS in the southern United States: implementation, challenges, and lessons learned.

Though race and region are not by themselves risk factors for HIV infection, regional and racial disparities exist in the burden of HIV/AIDS in the US. Specifically, African Americans in the southern US appear to bear the brunt of this burden due to a complex set of upstream factors like structural and cultural influences that do not facilitate HIV/AIDS awareness, HIV testing, or sexual risk-reduction techniques while perpetuating HIV/AIDS-related stigma. Strategies proposed to mitigate the burden among this population have included establishing partnerships and collaborations with non-traditional entities like African American churches and other faith-based organizations. Though efforts to partner with the African American church are not necessarily novel, most of these efforts do not present a model that focuses on building the capacity of the African American church to address these upstream factors and sustain these interventions. This article will describe Project Fostering AIDS Initiatives That Heal (F.A.I.T.H), a faith-based model for successfully developing, implementing, and sustaining locally developed HIV/AIDS prevention interventions in African American churches in South Carolina. This was achieved by engaging the faith community and the provision of technical assistance, grant funding and training for project personnel. Elements of success, challenges, and lessons learned during this process will also be discussed.

Development of a framework for HIV/AIDS prevention programs in African American churches.

Churches and other faith-based organizations (FBOs) are a vital resource for HIV prevention and education efforts in African American communities. Few models describe how churches and FBOs have implemented such efforts within their congregations or communities, the challenges they faced, or the changes that resulted from such efforts. This article presents a framework for implementing HIV/AIDS prevention programs in African American churches based upon a qualitative investigation of Project FAITH (Fostering AIDS Initiatives that Heal), an HIV education and stigma reduction demonstration project conducted in South Carolina. Between 2007-2008 in-depth interviews were conducted with 8 pastors, 4 technical assistance providers, and 2 project champions; 22 care team members also participated in focus groups to identify domains associated with project implementation. Data analysis was conducted using a grounded theory approach and inputs, enablers, inhibitors, mediators, and outputs associated with HIV/AIDS prevention programs conducted as part of Project FAITH were identified. Furthermore, the framework includes the influences of public policy and stigma on the faith-based HIV/AIDS prevention programs in this study. The framework calls for the identification of individuals (members of the congregation and church leadership) who are passionate about and devoted to addressing HIV/AIDS, and provides specific mechanisms (i.e., health ministries) through which these individuals can organize, strategies for HIV/AIDS implementation, and areas of technical assistance and capacity building to maximize effectiveness of such efforts.

Informing faith-based HIV/AIDS interventions: HIV-related knowledge and stigmatizing attitudes at Project F.A.I.T.H. churches in South Carolina.

OBJECTIVES: Project F.A.I.T.H. (Fostering AIDS Initiatives that Heal) was established in January 2006 to reduce the stigma of human immunodeficiency virus (HIV) among African American faith-based organizations in South Carolina. During its first year, Project F.A.I.T.H. funded 22 churches to provide HIV-related programs and services to their congregations and surrounding communities. To determine the baseline level of HIV-related knowledge and stigmatizing attitudes, we conducted a survey with parishioners, pastors, and care team members at Project F.A.I.T.H. churches. METHODS: During 2007, 20 Project F.A.I.T.H. churches conducted cross-sectional surveys with 1,445 parishioners, 61 pastors, and 109 care team members measuring their HIV-related knowledge and stigmatizing attitudes. RESULTS: While most parishioners were very knowledgeable about HIV transmission via unprotected sex and needle sharing during injection drug use, they were less knowledgeable about transmission via casual contact, mosquitoes, donating blood, and an HIV test. Overall, HIV-related stigma was low at Project F.A.I.T.H. churches. However, males and older parishioners (aged > or = 65 years) were significantly less knowledgeable and had greater HIV-related stigma than females and younger parishioners. Pastors and care team members at Project F.A.I.T.H. churches were significantly more knowledgeable and harbored significantly less stigma than their parishioners. CONCLUSIONS: To effectively address HIV-related stigma at African American churches, educational programs must reinforce the ways in which HIV can and cannot be transmitted, and pay particular attention to educating males and older populations. These findings may be helpful to HIV-prevention efforts targeting African American faith-based organizations in South Carolina and elsewhere.

Stigma, secrecy, and discrimination: ethnic/racial differences in the concerns of people living with HIV/AIDS.

The HIV Stigma Scale is a measure that assesses stigmatization perceived and experienced by people living with HIV/AIDS (PLWHA). Using Item Response Theory (IRT) methodologies, the present study examined HIV Stigma Scale responses from 224 Black and 317 White PLWHA to determine whether cross-cultural differences exist in responses to items of the scale. IRT analysis revealed that eleven out of forty items functioned differently across groups. Black respondents had a higher probability of indicating greater stigmatization on items that described situations in which others discriminated against them, and White respondents had a higher probability of indicating greater stigmatization on items that described a resolve to keep their status a secret and fears of interpersonal rejection. These differences suggest that PLWHA have different experiences of stigma based on their ethnic/racial background, either because of cultural differences or the ways in which the participants interpreted items of the HIV Stigma Scale.