Methods in HIV-Related Intersectional Stigma Research: Core Elements and Opportunities.

Researchers are increasingly recognizing the importance of studying and addressing intersectional stigma within the field of HIV. Yet, researchers have, arguably, struggled to operationalize intersectional stigma. To ensure that future research and methodological innovation is guided by frameworks from which this area of inquiry has arisen, we propose a series of core elements for future HIV-related intersectional stigma research. These core elements include multidimensional, multilevel, multidirectional, and action-oriented methods that sharpen focus on, and aim to transform, interlocking and reinforcing systems of oppression. We further identify opportunities for advancing HIV-related intersectional stigma research, including reducing barriers to and strengthening investments in resources, building capacity to engage in research and implementation of interventions, and creating meaningful pathways for HIV-related intersectional stigma research to produce structural change. Ultimately, the expected payoff for incorporating these core elements is a body of HIV-related intersectional stigma research that is both better aligned with the transformative potential of intersectionality and better positioned to achieve the goals of Ending the HIV Epidemic in the United States and globally. (Am J Public Health. 2022;112(S4):S413-S419. https://doi.org/10.2105/AJPH.2021.306710).

Lessons learned from use of social network strategy in HIV testing programs targeting African American men who have sex with men.

OBJECTIVES: We report lessons derived from implementation of the Social Network Strategy (SNS) into existing HIV counseling, testing, and referral services targeting 18- to 64-year-old Black gay, bisexual, and other men who have sex with men (MSM). METHODS: The SNS procedures used in this study were adapted from a Centers for Disease Control and Prevention-funded, 2-year demonstration project involving 9 community-based organizations (CBOs) in 7 cities. Under the SNS, HIV-positive and HIV-negative men at high risk for HIV (recruiters) were enlisted to identify and recruit persons from their social, sexual, or drug-using networks (network associates) for HIV testing. Sites maintained records of modified study protocols for ascertaining lessons learned. The study was conducted between April 2008 and May 2010 at CBOs in Washington, DC, and New York, New York, and at a health department in Baltimore, Maryland. RESULTS: Several common lessons regarding development of the plan, staffing, training, and use of incentives were identified across the sites. Collectively, these lessons indicate use of SNS is resource-intensive, requiring a detailed plan, dedicated staff, and continual input from clients and staff for successful implementation. CONCLUSIONS: SNS may provide a strategy for identifying and targeting clusters of high-risk Black MSM for HIV testing. Given the resources needed to implement the strategy, additional studies using an experimental design are needed to determine the cost-effectiveness of SNS compared with other testing strategies.

Development of culturally tailored educational brochures on HPV and pap tests for American Indian women.

PURPOSE: Participatory formative research guided the creation of a culturally tailored educational brochure about human papillomavirus (HPV) at an American Indian women's clinic. METHOD: A review of existing educational materials and in-depth interviews were conducted. Nine steps for creating health communications messages that were patterned after National Cancer Institute guidelines guided the brochure development process. RESULTS: Of 95 women tested for HPV, 41% were positive, 32 (34%) agreed to the in-depth interview, and 9 agreed to the pretesting interview. Mean age was 41 years. Interviews revealed key themes concerning emotional reactions to abnormal Pap test results and HPV; need for basic information about HPV, Pap tests, and results; concerns about HPV stigma, sexual transmission, and communication with sexual partner; and the preferred source and format for HPV educational materials. A literature review revealed 12 areas of basic HPV content. CONCLUSIONS: A participatory process successfully engaged nursing staff and patients in creating culturally appropriate brochures for clinic use. IMPLICATIONS: This article provides specific steps for creating culturally tailored patient education materials.

Patient-delivered partner therapy for sexually transmitted diseases as practiced by U.S. physicians.

OBJECTIVE: The objective of this study was to estimate how many U.S. physicians practice patient-delivered partner therapy (PDPT), which is the practice of giving patients diagnosed with curable sexually transmitted infections medication to give to their sex partners. STUDY: The authors conducted a national survey of physicians in specialties that diagnose the majority of sexually transmitted diseases in the United States. RESULTS: A total of 3011 physicians diagnosed at least 1 case of either gonorrhea or chlamydial infection in the preceding year. For gonorrhea and chlamydial infection, 50% to 56% reported ever using PDPT; 11% to 14% reported usually or always doing so. Obstetricians and gynecologists and family practice physicians more often used PDPT than internists, pediatricians, and emergency department physicians. Clinicians who collected sex partner information, as well as those who saw more female and white patients, used PDPT most often. CONCLUSIONS: PDPT is widely but inconsistently used throughout the United States and is typically provided to a minority of persons.

Knowledge and beliefs about abnormal pap test results and HPV among women with high-risk HPV: results from in-depth interviews.

The purpose of this qualitative study was to explore women's knowledge and understanding of abnormal Pap tests and HPV. Forty-four in-depth interviews were conducted with low-income, high-risk human papillomavirus (HPV) positive women (ages 18-64 years). Major themes regarding abnormal Pap test results were: (a) getting cancer; (b) need for repeat Pap testing; (c) need for additional tests/treatment; (d) low concern; (e) variety of causes; (f) sexual transmission; and (g) connection to HPV/other sexually transmitted disease (STD). Major themes related to HPV were: (a) getting follow-up care and (b) association of HPV with cancer. Findings indicate a need for clear, consistent educational messages.

Sexually transmitted disease screening by United States obstetricians and gynecologists.

OBJECTIVE: To assess compliance with practice guidelines and to determine the extent of missed opportunities for sexually transmitted disease (STD) prevention by describing screening practices of a national sample of obstetricians and gynecologists and comparing them to the practices of other specialists. METHODS: Physicians (n = 7300) in five specialties that diagnose 85% of STDs in the United States were surveyed. Obstetrics and gynecology (n = 647) was one of the five specialties. Besides providing demographic and practice characteristics, respondents answered questions about who they screen (nonpregnant females, pregnant females) and for which bacterial STDs (syphilis, gonorrhea, chlamydia). RESULTS: Responding obstetricians and gynecologists were most likely to be non-Hispanic white (75%), male (66%), and in their 40s (mode 43 years old). They saw an average of 90 patients per week during 47 hours of direct patient care. Approximately 95% practiced in private settings. Almost all (96%) screened some patients for at least one STD. Obstetricians and gynecologists screened women more frequently than other specialties, but no specialty screened all women or all pregnant women. CONCLUSION: Obstetricians and gynecologists screen women for STDs at a higher rate than other specialties represented in this study. Consistent with published guidelines, most obstetricians and gynecologists in our survey screened pregnant women for chlamydia, gonorrhea, and syphilis. Nonetheless, only about half of obstetricians and gynecologists screened nonpregnant women for gonorrhea or chlamydia, and fewer screen nonpregnant women for syphilis.