Using Participatory Methods to Assess PrEP Interest and Uptake Among Young People Living in the Southeastern US: A Mixed Methods Assessment.

Adolescents and young adults (AYA; 13-24 years-old) comprise 22% of new HIV infections in the United States (US), most of whom live in the South. We used the situated-Information, Motivation, Behavioral skills (sIMB) model to identify priorities for intervention on multi-level factors that influence HIV preventive care among Black AYA in Durham, North Carolina. We conducted two participatory workshops (ages 13-17, N = 6; ages 18-24, N = 7) to engage youth about how to discuss HIV. We also assessed sIMB constructs from a separate quantitative sample of youth to contextualize the workshop findings (N = 80). HIV knowledge was low overall, but lower among younger Black AYA, suggesting a need for comprehensive sexual education. Trusted adults provided sexual health information, motivation for health maintenance, and behavioral skills support. HIV prevention interventions should provide comprehensive sexual health education to Black AYA, be age-specific, and include social supporters like parents, teachers, and community members.

Awareness of and attitudes toward pre-exposure prophylaxis among African American women living in low-income neighborhoods in a Southeastern city.

African American women in the South are disproportionately affected by HIV but have often been ignored in HIV prevention efforts, including in the rollout of pre-exposure prophylaxis (PrEP). To inform strategies to promote PrEP awareness and access in this population, we conducted a venue-based community survey with 53 African American women living in low-income neighborhoods of a Southeastern city to understand women's knowledge of and attitudes toward PrEP. Awareness of PrEP was very low (37%) with only 16% being aware that PrEP is used for HIV prevention. The vast majority of women (85%) reported that they would use or would consider using PrEP, most frequently citing a general interest in HIV prevention or a lack of awareness of their partners' HIV status as motivations for their interest. Some women expressed concerns about side effects or low perceived HIV risk as disincentives for PrEP use. Information regarding side effects and HIV risk assessments will be needed to ensure the acceptable delivery of PrEP in this population.

Engaging African American Faith-Based Organizations in Adolescent HIV Prevention.

To reduce current HIV disparities among African American youth, it is imperative to find effective ways to extend the reach of evidence-based HIV prevention. One promising community resource to support this effort is faith-based organizations (FBOs), a credible and respected resource in the African American community. This paper describes the experiences, perceptions, and challenges that African American FBOs and faith leaders face in engaging in adolescent HIV prevention and highlights facilitators and barriers to implementing HIV prevention in African American FBOs. The findings suggest that African American FBOs and faith-based leaders are uniquely positioned to be instrumental resources in reducing African American youth HIV disparities.

Where is the faith? Using a CBPR approach to propose adaptations to an evidence-based HIV prevention intervention for adolescents in African American faith settings.

African American adolescents are at increased risk for HIV/AIDS. Using a community-based participatory research approach, we engaged three black churches in adapting an evidence-based HIV prevention intervention, Focus on Youth (FOY)+ImPACT, for faith settings. To identify potential adaptations to increase FOY's relevance, utility, and efficacy for faith settings, we conducted eight focus groups pre- and post-intervention. Recommendations for maintaining FOY's core elements and enhancing its cultural authenticity include the following: incorporating faith tools, building pastor capacity, strengthening parent-child communication skills, and expanding social support for parents and youth. Engaging faith communities in adapting and implementing evidence-based HIV prevention programs could reduce HIV/AIDS disparities.

Faithful five: exploring African American faith leaders' perspectives on factors affecting childhood obesity.

This study used a community-based participatory research tool called photovoice to understand African American faith leaders' perspectives on the factors that influence childhood obesity in their communities. Five African American women, who self-identified as faith leaders, took photographs and discussed photographs and emergent themes in 5 meetings. Qualitative analysis involved identifying recurring themes from the transcriptions of the photograph discussions, as well as the photographs themselves. The results suggest that the cycle of stress related to family responsibilities influences childhood obesity in this community. The implications for further research and public health practice are discussed.

Lessons Learned From Conducting Community-Based Research on HIV Prevention With Youth During COVID-19.

Mitigating HIV burden among Black youth requires true community engagement. This brief report identifies challenges, strategies, and lessons learned from transitioning our three-phased, community-engaged HIV prevention project with Black youth to a remote format during COVID-19. The project involved (1) building a community-academic partnership on youth sexual health, (2) participatory youth workshops, and (3) youth surveys and interviews about HIV prevention. Feedback from community-academic partnership, pile sorting themes, and preliminary qualitative analyses guided this report. Challenges included a disruption to in-person engagement while strategies included relying heavily on pre-existing partnerships to recruit youth for interviews. We learned that pre-existing community engagement was essential for completing phase three remotely. More education is needed to support Pre-Exposure Prophylaxis (PrEP) awareness for HIV prevention and there is a need to address structural barriers to healthcare engagement such as community violence and mental illness. Community-engaged HIV research focused on youth can adapt if anchored in community relationships. Future studies must work to more fully center youth's voices and address the structural issues that may inhibit them from engaging in HIV prevention.

Structural Barriers to HIV Prevention and Services: Perspectives of African American Women in Low-Income Communities.

BACKGROUND: African American women are at a disproportionate HIV risk compared with other U.S. women. Studies show that complex structural and social determinants, rather than individual behaviors, place African American women at greater risk of HIV infection; however, little is known about women's views of what puts them at risk. AIMS: This study sought to comprehend the perceptions of African American women living in low-income housing regarding the factors that influence both their personal sexual health behaviors and use of HIV prevention services. METHODS: We conducted seven focus groups with 48 African American women from 10 public housing communities in a small city in the southeastern United States. We analyzed the focus group transcripts using thematic data analysis to identify salient themes and points of interest related to the study aim. RESULTS: Women identified factors related to the health care system (trustworthiness of the health care system), the external environment (racism, classism, patriarchal structures, and violence/crime), as well as predisposing (health beliefs, stigma, and gender norms), enabling (agency to negotiate gendered power), and need (perceived HIV risk and perceptions of partner characteristics) features of individuals in the population. CONCLUSION: African American women living in public housing are especially vulnerable to HIV infection due to intersectional discrimination based on racism, classism, gender power dynamics, and community conditions. Our findings confirm the need to develop HIV intervention programming addressing intersectional identities of those making up the communities they plan to address, and being informed by those living in the communities they plan to act on.

Lessons Learned in Centering Youth Voices in HIV Prevention: The Adolescent Health Working Group.

BACKGROUND: There remains critical need for community-based approaches to HIV prevention which center youth voices and needs. OBJECTIVES: We established an adolescent health working group (AHWG) to convene youth, parents, providers, and advocates in agenda-setting for interventions to increase pre-exposure prophylaxis uptake in Durham. METHODS: Our three study phases included six AHWG meetings from 2019 to 2020, youth-only meetings guided by a participatory engagement framework (Youth Generate and Organize), and interviews (n=13) and surveys with youth in the community (N=87). We also developed materials such as an AHWG mission statement, a list of themes and informational needs, and documented strategies about pivoting the project during the onset of the COVID-19 global pandemic.Lessons Learned/Conclusions: Engaging adults in youth-focused HIV prevention differs greatly to engaging youth themselves. Creating spaces to promote adolescent sexual Health requires trust building, breaking down sensitivities and stigma to, and flexibility to navigate both virtual and in-person spaces to do so.

How Perceived Structural Racism and Discrimination and Medical Mistrust in the Health System Influences Participation in HIV Health Services for Black Women Living in the United States South: A Qualitative, Descriptive Study.

There are racial and geographic disparities for HIV in the United States; Black women have nearly 20 times the risk of White women in being infected with HIV, and lifetime HIV risk is greatest for people living in the southern United States. These disparities, layered with the structural racism and discrimination that is more prominent in the south, is a public health issue. The purpose of this article is to share Black women's perspectives of how perceived structural racism and discrimination, and medical mistrust in the health care system contribute to their participation in health services. In this formative study, we conducted seven focus groups among women living in 10 low-income housing communities. Results indicate that there are barriers to the utilization of health services that are grounded in personal experiences and historical mistrust for the health care system. Understanding these barriers is critical to combating the HIV epidemic for this population.

"In my house": laying the foundation for youth HIV prevention in the Black church.

BACKGROUND: This article describes the process our community-academic partnership used to lay the groundwork for successful implementation of an adolescent-focused, evidence-based HIV/AIDS prevention curriculum in two Black churches. OBJECTIVES: We highlight the challenges encountered and lessons learned in building a relationship with two churches, garnering the pastor's support, and implementing the curriculum within church youth groups. METHODS: We engaged a Community Advisory Board (CAB) made up of youth, parents, and diverse faith leaders to ensure community relevance and guide project development, implementation, and evaluation. LESSONS LEARNED: Using a community-based participatory research (CBPR) approach helped us to (1) engage diverse, intergenerational community members, (2) initiate a "culturally humble" process to build relationships with faith leaders, (3) remain responsive to stakeholder concerns, and (4) open the door to HIV prevention in the Black church. CONCLUSIONS: Finding effective and responsive ways to implement HIV/AIDS prevention in faith settings is facilitated by engaging diverse partners throughout the research process.