Interventions for Improving HIV Care Continuum Outcomes Among LGBTQ+ Youth in the United States: A Narrative Review.

Lesbian, gay, bisexual, transgender, queer, and all sexually and gender diverse (LGBTQ+) youth with HIV face multiple barriers to progression along the HIV care continuum. We searched PubMed, PsycInfo, clinicaltrials.gov, and the Adolescent Medicine Trials Network for HIV/AIDS Interventions for interventions focused on improving linkage to care, retention in care, adherence to antiretroviral therapy, or viral suppression (VS) among LGBTQ+ youth with HIV in the United States. Included studies were published in English between January 1, 2017 and December 31, 2022, took place in the United States, and had samples with a minimum age of 12 years, a median or mean age of 24 years or less, and with ≥50% reporting an LGBTQ+ identity. Our search identified 11 interventions that met our criteria, of which only three were designed and tailored exclusively for LGBTQ+ populations. Interventions used a variety of modalities, including remote electronic delivery, in-person delivery, or both. Interventions most commonly aimed to enhance self-efficacy, HIV health knowledge, and medication self-management to facilitate improvements in HIV care continuum outcomes. Only two interventions showed statistically significant improvements in VS. More interventions tailored for LGBTQ+ youth are needed to end the HIV epidemic in the United States.

"You put yourself at risk to keep the relationship:" African American women's perspectives on womanhood, relationships, sex and HIV.

Recent trends indicate that HIV and STI infection rates are rising among adults over the age of 50, and African American women have the highest rates of HIV infection across racial and ethnic groups of women in the USA. Limited research has examined factors that contribute to HIV risk among older African American women. The current study used Collins' Black Feminist Thought to examine and understand attitudes and perceptions around HIV and sexual risk behaviours among African American women aged 50 years and older. Participants were recruited from two faith-based organisations in the mid-Atlantic region of the USA. Overarching themes and subthemes included those of expectations among African American women (carry yourself as you were raised, and carry a big burden), risk factors (not at risk, sexual networks and loneliness) and protective factors (maintaining high standards and education). Findings from this study have implications for the development of future HIV prevention programmes involving older African American women, who have largely been overlooked by past and ongoing HIV prevention trials and safer sex promotion efforts.

Condom Use Efficacy and Sexual Communication Skills Among African American College Women.

Despite condom use being the most protective measure against the transmission of human immunodeficiency virus (HIV), little is known about the intermediary relationships between condom negotiation, assertive sexual communication, and condom use efficacy. The purpose of the current study was to examine the relationships between these constructs within the context of an HIV prevention intervention. We examined two samples of African American college women participating in two HIV prevention interventions, one of which was based on social learning theory ( N = 214). Data collected at intervention posttest and 3-month follow-up were analyzed. Findings revealed that condom use efficacy at posttest fully mediated the relationship between intervention effect and assertive sexual communication at 3-month follow-up. In addition, condom use efficacy at posttest fully mediated the relationship between intervention effect and condom negotiation at 3-month follow-up. Implications of the importance of experiential learning, in combination with behavior observance, on the maintenance of condom protective behaviors are discussed. Findings have the potential to inform clinic and community-based HIV prevention interventions conducted among African American women.

Ethnic Comparisons in HIV Testing Attitudes, HIV Testing, and Predictors of HIV Testing Among Black and White College Students.

OBJECTIVES: This study's primary aim was to examine ethnic differences in predictors of HIV testing among Black and White college students. We also examined ethnic differences in sexual risk behaviors and attitudes toward the importance of HIV testing. PARTICIPANTS/METHOD: An analytic sample of 126 Black and 617 White undergraduatestudents aged 18-24 were analyzed for a subset of responses on the American College Health Association-National College Health Assessment II (ACHA-NCHA II) (2012) pertaining to HIV testing, attitudes about the importance of HIV testing, and sexual risk behaviors. Predictors of HIV testing behavior were analyzed using logistic regression. t tests and chi-square tests were performed to access differences in HIV test history, testing attitudes, and sexual risk behaviors. RESULTS: Black students had more positive attitudes toward testing and were more likely to have been tested for HIV compared to White students. A greater number of sexual partners and more positive HIV testing attitudes were significant predictors of HIV testing among White students, whereas relationship status predicted testing among Black students. Older age and history of ever having sex were significant predictors of HIV testing for both groups. There were no significant differences between groups in number of sexual partners or self-reports in history of sexual experience (oral, vaginal, or anal). CONCLUSIONS: Factors that influence HIV testing may differ across racial/ethnic groups. Findings support the need to consider racial/ethnic differences in predictors of HIV testing during the development and tailoring of HIV testing prevention initiatives targeting college students.

Change in Risk Perceptions and Marijuana and Cigarette Use Among African American Young Adult Females in an HIV Prevention Intervention.

Cigarette smoking and marijuana use have been tied to increased risky sexual behaviors, which may exacerbate risk of HIV transmission and other STIs (sexually transmitted infections). Research suggests that change in general perceptions of risk is associated with change in non-domain-targeted behaviors. The goal of the current study was to determine whether change in general risk perceptions among African American college females enrolled in a culturally-tailored HIV prevention intervention would be associated with decreased cigarette and marijuana use over time. Data were collected from 108 women enrolled in the SISTA Project intervention at a large university at baseline, post-test, and 3-month follow-up. Results from moderation analyses indicated that change in risk perceptions moderated the relationship between past 30-day cigarette use at baseline and past 30-day cigarette use at both post-test and at 3-month follow-up. Change in risk-perceptions also moderated the relationship between past 30-day marijuana use at baseline and past 30-day marijuana use at 3-month follow-up. Implications of the study indicate that heightening risk perceptions in any one area may impact behavior via specific and general increases in self-efficacy and motivation to reduce health risks more generally.

Racial comparisons in perceptions of maternal and peer attitudes, body dissatisfaction, and eating disorders among African American and White women.

Although once thought primarily to affect White women, body dissatisfaction and disordered eating exist among all racial groups. In the current study, the authors determined whether the relationship between participants' perceived maternal/peer attitudes toward appearance and the outcomes of body dissatisfaction and eating pathology varied by race. Self-reported data, including measures of body dissatisfaction, disordered eating behaviors, body mass index (BMI), and perceptions of maternal/peer attitudes, were collected from December 2012 to May 2013 at a large Mid-Atlantic university. BMI (ß = 0.20, p = .01), perceptions of peers' attitudes toward appearance (ß = 0.23, p = .02), and White race (ß = 0.33, p < .001) were independently associated with body dissatisfaction. Additionally, race interacted with perceptions of peers' attitudes toward appearance such that at high perceptions, African American women reported high levels of body dissatisfaction (ß = -0.20, p = .04), but this was not true for White women. Higher perceived peer concern about weight and shape (ß = 0.32, p < .001), increased BMI (ß = 0.30, p < .001), and White race (ß = 0.21, p = .002), also were associated with disordered eating. The results of this study have implications for prevention programs that address disordered eating for racially diverse groups of women.

Development and Validation of a Preliminary Measure of African American Women's Gender Role Beliefs.

Gender role beliefs of African American women differ from those of women in other ethnic/racial groups and a culturally valid measure of their gender role beliefs is needed. Three studies were conducted to develop a preliminary measure. In Study 1, focus groups were conducted with a community and college sample of 44 African American women. Transcripts reviewed resulted in an initial pool of 40 items. These items were reviewed by an expert panel and 18 items were retained. In Study 2, an exploratory factor analysis was computed with data from 94 African American female college students. The 18 items were included along with measures to assess convergent and discriminant validity. Nine items were retained. These nine items comprised two subscales labeled Agency and Caretaking. The scales demonstrated good internal consistency and convergent and discriminant validity. In Study 3, a confirmatory factor analysis was computed with a different sample of 184 African American female college students. The confirmatory factor analysis showed acceptable fit for the two-factor structure of Agency and Caretaking.