Intersectional Stigma and Prevention Among Gay, Bisexual, and Same Gender-Loving Men in New York City, 2020: System Dynamics Models.

Objectives. To create causal loop diagrams that characterize intersectional stigma experiences among Black, gay, bisexual, same gender-loving, and other men who have sex with men and to identify intervention targets to reduce stigma and increase testing and prevention access. Methods. Between January and July 2020, we conducted focus groups and in-depth interviews with 80 expert informants in New York City, which were transcribed, coded, and analyzed. These qualitative insights were developed iteratively, visualized, and validated in a causal loop diagram (CLD) using Vensim software. Results. The CLD revealed 3 key feedback loops-medical mistrust and HIV transmission, serosorting and marginalization of Black and gay individuals, and family support and internalized homophobia-that contribute to intersectional HIV and related stigmas, homophobia, and systemic racism. On the basis of these results, we designed 2 novel intervention components to integrate into an existing community-level anti-HIV stigma and homophobia intervention. Conclusions. HIV stigma, systemic racism, and homophobia work via feedback loops to reduce access to and uptake of HIV testing, prevention, and treatment. Public Health Implications. The CLD method yielded unique insights into reciprocal feedback structures that, if broken, could interrupt stigmatization and discrimination cycles that impede testing and prevention uptake. (Am J Public Health. 2022;112(S4):S444-S451. https://doi.org/10.2105/AJPH.2022.306725).

TRUST: Assessing the Efficacy of an Intervention to Increase HIV Self-Testing Among Young Black Men Who have Sex with Men (MSM) and Transwomen.

HIV testing among young Black MSM and transwomen (YBMSM/TW) is the gateway to biomedical HIV prevention or treatment. HIV self-testing (HST) is a method that may increase consistent HIV testing. TRUST, a brief, peer-based behavioral intervention, was designed to increase uptake of consistent (every three months) HST among YBMSM/TW in New York City. To test the efficacy of the intervention, we randomized 200 friend pairs into either the intervention condition (TRUST) or a time and attention control condition. A modified intent-to-treat analysis found that self-reported HST at 3-month follow-up was statistically significantly higher (uOR 2.29; 95% CI 1.15, 4.58) and at 6-month follow-up was marginally statistically significantly higher (uOR 1.94; 95% CI 1.00, 3.75) in the intervention arm as compared with the control arm. There were no statistically significant differences by arm at 9- or 12-month follow-up. TRUST, a culturally-congruent intervention to increase HST among YBMSM/TW, had short-term impact on past-three month HST.Clinical Trials Registration ClinicalTrial.gov NCT04210271.

Knowledge, Stereotyped Beliefs and Attitudes Around HIV Chemoprophylaxis in Two High HIV Prevalence Neighborhoods in New York City.

HIV chemoprophylaxis (PrEP/PEP) has emerged as a transformative prevention tool to reduce infection rates and decrease disease burden. However, uptake is low, and efficacy depends upon adherence. To maximize impact, potential barriers to uptake and adherence must be identified and understood. Using univariate and logistic regression analytic methods, we assessed associations among potential barriers to uptake and adherence, including HIV chemoprophylaxis knowledge, negative stereotyped beliefs about people who use it and negative attitudes towards HIV chemoprophylaxis use by relatives among 583 residents of two high HIV prevalence neighborhoods in New York City. About a quarter of respondents knew about HIV chemoprophylaxis and over 50 % endorsed negative stereotyped beliefs about users; yet, approximately two-thirds had positive attitudes toward its use among a male or female relative. Young age, having lesbian or gay friends/family members and low levels of homophobia were associated with not endorsing negative stereotyped beliefs. Negative stereotyped beliefs were not associated with negative attitudes toward HIV chemoprophylaxis use among relatives. Implications for PrEP dissemination are discussed.

Who is Using the HIV Self-Test among Young Black Men Who Have Sex With Men (MSM) and Transwomen in New York City?

BACKGROUND: HIV self-testing (HST) is an important complement to existing testing approaches for young Black men who have sex with men (MSM) and transwomen. METHODS: In this formative research, we describe prevalence and perceptions of HST using qualitative in-depth interviews (n = 29) and baseline quantitative data (n = 302) from an HST intervention trial for young Black MSM and transwomen. RESULTS: In the qualitative analysis, participants preferred the privacy and flexibility of the HST but had concerns about its accuracy and being alone while testing. Quantitative results showed that 14% (44/302) had used an HST in their lifetime; of these, 64% (28/44) used it once and 23% (10/44) in the last 3 months. CONCLUSION: To increase consistent testing, HST may provide a new avenue for at-risk individuals that value privacy and control and could benefit from social support during testing.

Impact of a Community-level Intervention on HIV Stigma, Homophobia and HIV Testing in New York City: Results from Project CHHANGE.

Background: HIV stigma and homophobia are barriers to access to HIV prevention and treatment services. Project CHHANGE, Challenge HIV Stigma and Homophobia and Gain Empowerment, was a multicomponent intervention designed to reduce community-level HIV stigma and homophobia via workshops, space-based events and bus shelter ads delivered to community-based organizations and neighborhood residents in a high HIV prevalence, primarily African-American, Black and/or Afro-Caribbean, neighborhood in New York City (NYC). Methods: Serial cross-sectional, street intercept surveys among residents of the invention neighborhood and matched control neighborhood were conducted before and after the intervention. Propensity score matching and generalized estimating equation regression models assessed the impact of CHHANGE on HIV stigma and homophobia. HIV testing service utilization data were assessed and multivariable models of self-reported HIV testing among post-intervention street survey respondents were built. Results: We did not find a significant treatment effect on HIV stigma and homophobia among residents of the intervention neighborhood as compared with control community residents. However, HIV testing increased by 350% at the testing site in the intervention community after the intervention implementation. Further, lower HIV stigma, attending an HIV stigma workshop and having friends or family living with HIV were independently associated with past six-month HIV testing among post-intervention respondents in both neighborhoods. Conclusions: CHHANGE was feasible and acceptable to community residents. Evaluating community-level interventions is challenging. Our triangulated approach yielded somewhat conflicting results, which may be due to design limitations. Further research is needed to understand whether and how CHHANGE affected HIV testing.

Developing a community-level anti-HIV/AIDS stigma and homophobia intervention in new York city: The project CHHANGE model.

HIV/AIDS stigma and homophobia are associated with significant negative health and social outcomes among people living with HIV/AIDS (PLWHA) and those at risk of infection. Interventions to decrease HIV stigma have focused on providing information and education, changing attitudes and values, and increasing contact with people living with HIV/AIDS (PLWHA), activities that act to reduce stereotyped beliefs and prejudice, as well as acts of discrimination. Most anti-homophobia interventions have focused on bullying reduction and have been implemented at the secondary and post-secondary education levels. Few interventions address HIV stigma and homophobia and operate at the community level. Project CHHANGE, Challenge HIV Stigma and Homophobia and Gain Empowerment, was a community-level, multi-component anti-HIV/AIDS stigma and homophobia intervention designed to reduce HIV stigma and homophobia thus increasing access to HIV prevention and treatment access. The theory-based intervention included three primary components: workshops and trainings with local residents, businesses and community-based organizations (CBO); space-based events at a CBO-partner drop-in storefront and "pop-up" street-based events and outreach; and a bus shelter ad campaign. This paper describes the intervention design process, resultant intervention and the study team's experiences working with the community. We conclude that CHHANGE was feasible and acceptable to the community. Promoting the labeling of gay and/or HIV-related "space" as a non-stigmatized, community resource, as well as providing opportunities for residents to have contact with targeted groups and to understand how HIV stigma and homophobia relate to HIV/AIDS prevalence in their neighborhood may be crucial components of successful anti-stigma and discrimination programming.