Health equity for Black sexually minoritised men through status-neutral HIV care.

Current strategies (both biomedical and barrier methods) for HIV elimination in the USA do not best serve those who are most affected by HIV. Improving healthc are for individuals most affected by HIV requires restructuring of care delivery to improve their HIV outcomes. The transformation of clinical care delivery is crucial to address the needs of one of the most affected populations along the HIV care continuum: Black sexually minoritised men (BSMM). Status-neutral HIV care delivery systems might address social determinants of health of BSMM who are stigmatised and disenfranchised within the context of American society. Addressing the needs of BSMM will bring us closer to health-care equity, which benefits us all.

Population-Level Portal-Based Anxiety and Depression Screening Perspectives in HIV Care Clinicians: Qualitative Study Using the Consolidated Framework for Implementation Research.

BACKGROUND: Depression and anxiety are common among people with HIV and are associated with inadequate viral suppression, disease progression, and increased mortality. However, depression and anxiety are underdiagnosed and undertreated in people with HIV owing to inadequate visit time and personnel availability. Conducting population-level depression and anxiety screening via the patient portal is a promising intervention that has not been studied in HIV care settings. OBJECTIVE: We aimed to explore facilitators of and barriers to implementing population-level portal-based depression and anxiety screening for people with HIV. METHODS: We conducted semistructured hour-long qualitative interviews based on the Consolidated Framework for Implementation Research with clinicians at an HIV clinic. RESULTS: A total of 10 clinicians participated in interviews. In total, 10 facilitators and 7 barriers were identified across 5 Consolidated Framework for Implementation Research domains. Facilitators included advantages of systematic screening outside clinic visits; the expectation that assessment frequency could be tailored to patient needs; evidence from the literature and previous experience in other settings; respect for patient privacy; empowering patients and facilitating communication about mental health; compatibility with clinic culture, workflows, and systems; staff beliefs about the importance of mental health screening and benefits for HIV care; engaging all clinic staff and leveraging their strengths; and clear planning and communication with staff. Barriers included difficulty in ensuring prompt response to suicidal ideation; patient access, experience, and comfort using the portal; limited availability of mental health services; variations in how providers use the electronic health record and communicate with patients; limited capacity to address mental health concerns during HIV visits; staff knowledge and self-efficacy regarding the management of mental health conditions; and the impersonal approach to a sensitive topic. CONCLUSIONS: We proposed 13 strategies for implementing population-level portal-based screening for people with HIV. Before implementation, clinics can conduct local assessments of clinicians and clinic staff; engage clinicians and clinic staff with various roles and expertise to support the implementation; highlight advantages, relevance, and evidence for population-level portal-based mental health screening; make screening frequency adaptable based on patient history and symptoms; use user-centered design methods to refine results that are displayed and communicated in the electronic health record; make screening tools available for patients to use on demand in the portal; and create protocols for positive depression and anxiety screeners, including those indicating imminent risk. During implementation, clinics should communicate with clinicians and clinic staff and provide training on protocols; provide technical support and demonstrations for patients on how to use the portal; use multiple screening methods for broad reach; use patient-centered communication in portal messages; provide clinical decision support tools, training, and mentorship to help clinicians manage mental health concerns; and implement integrated behavioral health and increase mental health referral partnerships.

Applying an intersectionality framework to health services research.

Intersectionality is a transformative analytic tool for identifying and challenging how intersecting, systemic power relations generate differential outcomes in quality of life (P. Collins, 2019; Crenshaw, 1989). Intersectionality identifies how varied forms of power relations are interconnected and mutually constituted: simultaneously influencing and influenced by one another. As these power relations interact to shape social experiences, they result in social inequalities including unequal distributions of harm, violence, and neglect. Too often, social problems are approached through singular categories of experience (e.g., class, race, or gender) under the assumption that these categories are not mutually constituted. Intersectionality instead highlights the intersection and interactions between such categories, with close attention to the social power conferred or limited given inclusion in a given constellation of categories. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Transgender gender-affirming surgery consultation among patients seeking care in the Midwestern United States.

Gender-affirming surgery (GAS) is among the most rapidly growing and expanding subfields in plastic surgery due to increased awareness, decreased stigma, rising demand, and improved access for transgender and gender non-conforming individuals (TGNC). In order to address potential barriers and facilitators in GAS education and training, there is a need to explore the experiences of TGNC individuals. The purpose of this study was to qualitatively explore the factors that influence TGNC patient experiences in surgical consultation for GAS. Targeted recruitment was used to recruit and enroll participants who identified as TGNC and who had undergone consultation with a surgeon to discuss GAS. Semi-structured interviews were used to explore patient experiences with GAS. Recorded audio from these interviews was later transcribed verbatim. Open coding of these transcripts was then performed independently by 3 individual members of the research team using the consensual qualitative coding methods. Fifteen interviews were conducted (transmale, n = 7; transfemale, n = 4; gender non-conforming/non-binary, n = 4). Participants frequently expressed worry and frustration over insurance coverage and exorbitant out-of-pocket expense, whether actual or perceived. Logistical barriers were the most frequently cited category of barriers. The majority of participants made at least 1 reference to relying on others during the process of insurance pre-authorization. The majority of participants described their interactions with surgeons as positive, indicating that they felt comfortable during consultation and that their surgeons ensured their understanding. Our findings provide important insight into this often stressful and challenging process. Ensuring a welcoming, safe, and gender-affirming environment and experience for these individuals is essential. These findings may help to guide future education for medical students, trainees, clinic staff, and surgeons, as well as to direct changes necessary to improve the patient experience in clinics and hospitals for TGNC individuals undergoing consultation for GAS.

An mHealth Intervention to Improve Pre-Exposure Prophylaxis Knowledge Among Young Black Women in Family Planning Clinics: Development and Usability Study.

BACKGROUND: Young Black women between the ages of 18 and 24 years are disproportionately impacted by HIV, yet they have a low self-perception of HIV risk and limited exposure to prevention strategies. Pre-exposure prophylaxis (PrEP) is a safe and effective biomedical HIV prevention strategy for those at risk for HIV infection, but uptake has been slow among cisgender women. Family planning clinics are a primary source of health care access for young women, providing an ideal opportunity to integrate PrEP information and care into existing clinic practices. OBJECTIVE: The aim of this study was to use a multistage, community-engaged process to develop a mobile health app and to evaluate the feasibility and acceptability of the app. METHODS: Using user-centered design, the In the Loop app was developed in collaboration with a community advisory board of young Black women. This study employed a multistage design, which included community-engaged app development, user testing, and evaluation of the app's feasibility and acceptability. A pre- and postdesign was used to assess the impact of the app on PrEP knowledge immediately after app use. Descriptive statistics (eg, mean, SD, and percentage values) were used to describe the sample, and Wilcoxon matched-pairs signed-ranks test was used to detect changes in PrEP knowledge before and immediately after using the app. RESULTS: A total of 50 sexually active, young Black women, aged 18-24 (mean 21, SD 1.9) years, were enrolled in this study. Analysis comparing scores before and immediately after use of the app revealed a significant increase in PrEP content knowledge scores on a 7-item true or false scale (z=-6.04, P<.001). Overall, participants considered the In the Loop app feasible and acceptable to use while waiting for a family planning visit. The majority of participants (n=46, 92%) agreed that they would recommend In the Loop to friends to learn more about PrEP. Participants rated the overall quality of the app 4.3 on a 1-5 scale (1=very poor and 5=very good). Of 50 participants, 40 (80%) agreed that the app was easy to use, and 48 (96%) agreed that they found the information in the app easy to understand. Finally, 40 (80%) agreed that they had enjoyed using the app while waiting for their family planning visit. CONCLUSIONS: Our findings suggest that young Black women waiting for family planning visits found the In the Loop app to be feasible and acceptable. This study demonstrates the value of engaging young Black women in the app design process. As family planning clinics are a primary source of health care access for young women, they provide an ideal setting to integrate PrEP information and care into existing clinic practices. Next steps in the development of the In the Loop app include implementing user-suggested improvements and conducting efficacy testing in a randomized controlled trial to determine the app's impact on PrEP uptake.

Employment as HIV Prevention: An Employment Support Intervention for Adolescent Men Who Have Sex With Men and Adolescent Transgender Women of Color.

BACKGROUND: The purpose of this study was to adapt and pilot-test an employment support, primary HIV intervention tailored to the needs of adolescent men who have sex with men and adolescent transgender women of color. SETTING: The intervention was implemented in 2 settings: controlled environment (Phase 1) and real-world community-based (Phase 2) setting in Chicago, IL. METHODS: Eighty-seven adolescent men who have sex with men and adolescent transgender women of color ages 16-24 participated in Work2Prevent , a 4-session employment and HIV prevention intervention, designed to increase job-readiness and reduce HIV risk. Intervention sessions consisted of group activities: educational games, roleplaying/modeling behavior, and self-regulation exercises. Participants were assessed at baseline, postintervention, and 8-month (Phase 1) or 3-month follow-up (Phase 2). RESULTS: Participants evaluated Work2Prevent as feasible and acceptable, rating intervention quality, usefulness, and satisfaction highly. Overall, 59.6% (Phase 1) and 85.0% (Phase 2) participants attended 2 or more sessions. At 8 months, Phase 1 participants reported a mean increase of 11.4 hours worked per week. Phase 2 participants reported a mean increase of 5.2 hours worked per week and an increase in job-seeking self-efficacy. Phase 2 participants also reported a decrease in transactional sex work. CONCLUSION: Work2Prevent is one of the first structural primary HIV interventions to specifically focus on adolescent employment readiness. Findings suggest Work2Prevent is feasible and acceptable, improved adolescent employment outcomes, and reduced HIV risk associated with transactional sex work. Our study underscores the need for alternative pathways, such as addressing socioeconomic determinants, to prevent adolescent HIV infection.

Moving toward equity: fostering transdisciplinary research between the social and behavioral sciences and implementation science to end the HIV epidemic.

PURPOSE OF REVIEW: Since the beginning of the HIV epidemic, social and behavioral scientists have developed interventions to stem the spread of the virus. The dissemination of these interventions has traditionally been a lengthy process; however, implementation science (IS) offers a route toward hastening delivery of effective interventions. A transdisciplinary approach, wherein IS informs and is informed by social and behavioral sciences (SBS) as well as community participation, offers a strategy for more efficiently moving toward health equity and ending the HIV epidemic. RECENT FINDINGS: There has been considerable growth in HIV research utilizing IS theories, methods and frameworks. Many of these studies have been multi or interdisciplinary in nature, demonstrating the ways that IS and SBS can strengthen one another. We also find areas for continued progress toward transdisciplinarity. SUMMARY: We review literature from 2020 to 2021, exploring the ways IS and SBS have been used in tandem to develop, evaluate and disseminate HIV interventions. We highlight the interplay between disciplines and make a case for moving toward transdisciplinarity, which would yield new, integrated frameworks that can improve prevention and treatment efforts, moving us closer to achieving health equity.

"We are just magic": A qualitative examination of self-love among Black same-gender loving men.

OBJECTIVES: Black same-gender loving men (BSGLM) represent a population with understudied lived experiences as both racial and sexual minority individuals. Most existing research among BSGLM focuses on sexual health outcomes in the context of minority stress, without consideration of the full experiences of BSGLM or strengths-based approaches. The present study aimed to address this gap in the literature by examining self-love among BSGLM using a phenomenological qualitative approach. METHOD: Adult BSGLM in the U.S. (n = 19; Mage = 31.79 years [SD = 8.88]) were recruited online and completed interviews via phone and video conferencing. Data were coded independently by two trained coders via an iterative approach that included in vivo coding and line-by-line comparative coding. Codes were grouped thematically, guided by sexual minority identity and positive psychology literature. RESULTS: Three major themes related to self-love among BSGLM emerged: (a) Freedom of identity, meaning participants' ability to construct an identity outside of societal expectations; (b) Community connection and pride, or participants' connection to and pride derived from the BSGLM community; and (c) Adversarial growth and resilience, or ways that adversity related to BSGLM identity generated personal growth. CONCLUSIONS: Current findings may have clinical implications. Using narrative therapy approach, facilitating connectedness to the BSGLM community, and implementing gratitude interventions in therapeutic settings may enhance self-love and positive self-regard among BSGLM. Future research should continue to give voice to the full lived experience of BSGLM. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Preliminary evidence for a race-based stress reduction intervention for Black women at risk for cardiovascular disease.

OBJECTIVE: Despite evidence that chronic stress, racism, and discrimination impact the well-being and the risk for cardiovascular disease (CVD) in Black women, there are few evidence-based interventions that improve well-being and reduce the risk for CVD in women of minority groups. The purpose of this pilot study was to evaluate the psychobehavioral and anti-inflammatory benefit of a race-based stress reduction program "Resilience, Stress, and Ethnicity (RiSE) for Black women at risk for CVD. METHODS: Black women were recruited from the Chicagoland community and randomized to either the 8-week RiSE intervention (n = 40) or control group (n = 34). Participants were assessed for coping strategies, psychological distress, and blood levels of TNF-alpha and high sensitivity C-reactive protein (hsCRP) at baseline and at 4 and 8 weeks after baseline. RESULTS: Participation in RiSE was associated with a more rapid decline in the use of avoidance coping (b = -0.3585, SE = 0.1705, p < .01). Reductions over time in TNF-alpha (b = -0.0163, SE = .0087, p = .08) and hsCRP (b= -0.4064, SE = 0.2270, p = .08) approached statistical significance. CONCLUSIONS: Findings provide preliminary evidence in Black women at risk for CVD that RiSE contributes to decreases in avoidance coping. Although preliminary, these results suggest RiSE to be an effective intervention to promote improved coping associated with racism and discrimination in minorities.

Psychosocial Support, Sexual Health, and HIV Risk among Older Men Who Have Sex with Younger Men.

This study examines the extent to which older males are willing to offer psychosocial and sexual health promoting support to their younger male partners, as well as the individual and relationship-level factors associated with this willingness to provide support. In total, 324 men over the age of 45, who currently or previously had younger male sexual partners, completed an anonymous online survey. Results show that participants were most willing to provide emotional support to their younger male partners, followed by health-related encouragement, HIV/STI testing support, and financial support. Of note, HIV positive status and being in a "main partnership" were associated with greater willingness to provide financial support. These results suggest that older men are willing to provide psychosocial and health promotive support to younger male partners, which could be leveraged in targeted interventions to reduce HIV transmission.

A Pragmatic Randomized Controlled Trial to Increase PrEP Uptake for HIV Prevention: 55-Week Results From PrEPChicago.

OBJECTIVES: We tested preliminary efficacy of a peer change agent type I network intervention to increase pre-exposure prophylaxis (PrEP) linkage to care among network members connected to young Black men who have sex with men. DESIGN: Parent study is a pragmatic randomized controlled trial with 110 weeks of total follow-up. Interim midpoint analyses are performed here using participant data before crossover assignment at 55 weeks. METHODS: We randomly assigned 423 participants in Chicago to receive the network intervention, an opinion leader workshop with telephonic booster sessions, versus a time-matched control from 2016 to 2018. The consolidated surrogate outcome was PrEP referral and linkage to clinical care among network members connected to study participants and was collected from independent administrative data. RESULTS: Each study participant in the trial (n = 423) had on average 1822 network contacts who could be eligible for PrEP referral and linkage. During the 55-week observation period, PrEP referral was most likely to occur within 3 days of an intervention session compared to control [odds ratio (OR) 0.07 (0.02-0.013); P = 0.007] resulting in 1-2 referrals of network members per session. Network members with referral or linkage were more likely to be connected to study participants in the intervention arm than the control condition [aOR 1.50 (1.09-2.06); P = 0.012]. CONCLUSIONS: A peer change agent type I network intervention is preliminarily effective at diffusing PrEP through a network of individuals highly susceptible to HIV over 55 weeks. This low-intensity intervention demonstrated network-level impact among populations that have experienced limited PrEP care engagement in the United States.

Work2Prevent, an Employment Intervention Program as HIV Prevention for Young Men Who Have Sex With Men and Transgender Youth of Color (Phase 3): Protocol for a Single-Arm Community-Based Trial to Assess Feasibility and Acceptability in a Real-World Setting.

BACKGROUND: In the United States, young cisgender men who have sex with men (YMSM), young transgender women (YTW), and gender nonconforming (GNC) youth face elevated rates of HIV infection. However, racial and ethnic disparities in adolescent HIV infection cannot be attributed to individual-level factors alone and are situated within larger social and structural contexts that marginalize and predispose sexual and gender minority youth of color to HIV. Addressing broader ecological factors that drive transmission requires interventions that focus on the distal drivers of HIV infection, including violence exposure, housing, food insecurity, educational attainment, and employment. Given the ways that economic instability may make YMSM, YTW, and GNC youth of color vulnerable to HIV exposure, this study focuses on employment as an HIV prevention intervention. More specifically, the intervention, called Work2Prevent (W2P), targets economic stability through job readiness and employment as a means of preventing behaviors and factors associated with adolescent and young adult HIV, such as transactional sex work and homelessness. The intervention was adapted from iFOUR, an evidence-based employment program for HIV-positive adults in phase 1 of this study, and pilot tested in a university-based setting in phase 2. OBJECTIVE: This paper aims to describe the protocol for the community-based test phase of W2P. The purpose of this phase was to pilot test a tailored, theoretically informed employment intervention program among YMSM, YTW, and GNC youth of color within a lesbian, gay, bisexual, transgender, and queer (LGBTQ) community setting. METHODS: The employment intervention was pilot tested using a single-arm pretest-posttest trial design implemented among a sample of vulnerable YMSM, YTW, and GNC youth of color using services within a community-based LGBTQ center. Assessments will examine intervention feasibility, acceptability, and preliminary estimates of efficacy. RESULTS: Phase 3 of W2P research activities began in May 2019 and was completed in December 2019. Overall, 41 participants were enrolled in the community-based pilot. CONCLUSIONS: This study will assess intervention feasibility and acceptability in the target populations and determine preliminary efficacy of the intervention to increase employment and reduce vulnerability to HIV when implemented in a community-based setting serving LGBTQ youth of color. Testing the intervention in a community setting is an opportunity to evaluate how recruitment, retention, and other outcomes are impacted by delivery in a venue akin to where this intervention could eventually be used by nonresearchers. If W2P demonstrates feasibility and acceptability, a larger multisite trial implemented in multiple community settings serving YMSM, YTW, and GNC youth of color is planned. TRIAL REGISTRATION: ClinicalTrials.gov NCT03313310; https://clinicaltrials.gov/ct2/show/NCT03313310. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/18051.

An Employment Intervention Program (Work2Prevent) for Young Men Who Have Sex With Men and Transgender Youth of Color (Phase 2): Protocol for a Single-Arm Mixed Methods Pilot Test to Assess Feasibility and Acceptability.

BACKGROUND: Young cisgender men who have sex with men (YMSM), young transgender women (YTW), and gender nonconforming (GNC) youth of color face substantial economic and health disparities. In particular, HIV risk and infection among these groups remains a significant public health issue. In 2017, 17% of all new HIV diagnoses were attributed to male-to-male sexual contact among adolescents and young adults aged 13 to 24 years. However, such disparities cannot be attributed to individual-level factors alone but rather are situated within larger social and structural contexts that marginalize and predispose YMSM, YTW, and GNC youth of color to increased HIV exposure. Addressing social and structural risk factors requires intervention on distal drivers of HIV risk, including employment and economic stability. The Work2Prevent (W2P) study aims to target economic stability through job readiness and employment as a structural-level intervention for preventing adolescent and young adult HIV among black and Latinx YMSM, YTW, and GNC youth. This study seeks to assess intervention feasibility and acceptability in the target populations and determine preliminary efficacy of the intervention to increase employment and reduce sexual risk behaviors. OBJECTIVE: The goal of the research is to pilot-test a tailored, theoretically informed employment intervention program among YMSM, YTW, and GNC youth of color. This intervention was adapted from Increased Individual Income and Independence, an existing evidence-based employment program for HIV-positive adults during phase 1 of the W2P study. METHODS: The employment intervention will be pilot-tested among vulnerable YMSM, YTW, and GNC youth of color in a single-arm pre-post trial to assess feasibility, acceptability, and preliminary estimates of efficacy. RESULTS: Research activities began in March 2018 and were completed in November 2019. Overall, 5 participants were enrolled in the pretest and 51 participants were enrolled in the pilot. CONCLUSIONS: Interventions that address the social and structural drivers of HIV exposure and infection are sorely needed in order to successfully bend the curve in the adolescent and young adult HIV epidemic. Employment as prevention has the potential to be a scalable intervention that can be deployed among this group. TRIAL REGISTRATION: ClinicalTrials.gov NCT03313310; https://clinicaltrials.gov/ct2/show/NCT03313310. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/16401.

An Employment Intervention Program (Work2Prevent) for Young Men Who Have Sex With Men and Transgender Youth of Color (Phase 1): Protocol for Determining Essential Intervention Components Using Qualitative Interviews and Focus Groups.

BACKGROUND: HIV continues to have a disparate impact on young cisgender men who have sex with men (YMSM), young trans women (YTW), and gender-nonconforming (GNC) youth who are assigned male at birth. Outcomes are generally worse among youth of color. Experiences of discrimination and marginalization often limit educational attainment and may even more directly limit access to gainful employment. Though seemingly distal, these experiences influence young people's proximity to HIV risk by limiting their access to health care and potentially moving them toward sex work as a means of income as well as increased substance use. Work2Prevent (W2P) aims to achieve economic stability through employment as a structural-level intervention for preventing adolescent and young adult HIV infection. The study will pilot-test an effective, theoretically driven employment program (increased individual income and independence [iFOUR]), for HIV-positive adults, and adapt it to the needs of black and Latinx YMSM, YTW, and GNC youth aged 16 to 24 years who are vulnerable to HIV exposure. OBJECTIVE: This paper aimed to describe the protocol for the exploratory phase of W2P. The purpose of this phase was to determine the essential components needed for a structural-level employment intervention aimed at increasing job-seeking self-efficacy and career readiness among black and Latinx YMSM, YTW, and GNC youth aged 16 to 24 years. METHODS: The exploratory phase of the W2P study consisted of in-depth interviews and focus groups with members of the target community as well as brief interviews with lesbian, gay, bisexual, transgender, and queer (LGBTQ)-inclusive employers. The study team will conduct in-depth interviews with up to 12 YMSM and 12 YTW and GNC youth, up to 10 focus groups with a maximum of 40 YMSM and 40 YTW and GNC youth, and up to 40 brief interviews with LGBTQ-inclusive employers. Participants will be recruited through a community-based recruiter, passive recruitment in community spaces and on social media, and active recruitment by research staff in community spaces serving LGBTQ youth. RESULTS: In-depth interviews were conducted with 21 participants, and 7 focus groups were conducted with 46 participants in total. In addition, 19 brief interviews with LGBTQ-inclusive employers were conducted. The analysis of the data is underway. CONCLUSIONS: Preliminary findings from the formative phase of the study will be used to inform the tailoring and refinement of the iFOUR adult-based intervention into the youth-focused W2P intervention curriculum. Perspectives from YMSM, YTW, GNC youth, and LGBTQ-inclusive employers offer a multidimensional view of the barriers and facilitators to adolescent and young adult LGBTQ employment. This information is critical to the development of a culturally appropriate and relevant youth-focused intervention. TRIAL REGISTRATION: ClinicalTrials.gov NCT03313310; https://clinicaltrials.gov/ct2/show/NCT03313310. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/16384.

Qualitative evidence for Resilience, Stress, and Ethnicity (RiSE): A program to address race-based stress among Black women at risk for cardiovascular disease.

OBJECTIVE: Growing evidence demonstrates that perceived discrimination and racism are significant contributing factors to psychological distress, low-grade chronic inflammation, and cardiovascular health disparities among minorities, particularly among Black women. Despite this evidence, there are no evidence-based complementary therapy interventions available to ameliorate chronic stress associated with racism and discrimination. The purpose of this study was to examine the feasibility and effectiveness of a novel, 8-week, group-based stress reduction program, Resilience, Stress and Ethnicity (RiSE), designed to help Black women at risk for cardiovascular disease (CVD) develop effective coping skills for dealing with chronic stress uniquely associated with being a minority. METHODS: We conducted two semi-structured focus groups with Black women (N = 22) following their participation in the 8-week RiSE program. We analyzed the data using constant comparative qualitative methods. RESULTS: Attrition rate was low (13%) with all participants attending at least 6 of the 8 classes. Participants reported high levels of satisfaction with the program and the majority (81%) reported practicing the skills that they learned in real-life stressful situations. In describing the participants' response to the program, four key categories emerged from the data: (1) Increasing awareness of stressors associated with perceived discrimination and racism; (2) Coping with race-based stressors; (3) Coping with other sources of stress; and (4) Increasing sense of empowerment and emotion regulation. CONCLUSIONS: Findings suggest that RiSE is feasible and effective in helping Black women at risk for CVD cope with chronic stress associated with being a minority. Given evidence that perceived discrimination and racism are underlying factors in many inflammatory-based chronic diseases, this research may have broader implications for reducing health disparities across a wide-spectrum of chronic illnesses in which women minorities are disproportionately affected.

"You've Gotta be Careful": Familial Messages Regarding Sexual Behavior and Sexual Relationships among African American Adolescents.

BACKGROUND: Research on the sexual behaviors of African American youth has primarily focused on associated risks, with a dearth of studies examining a fuller representation of African American adolescents' sexual lives. This study explored the range of messages African American adolescents receive from family members regarding sexual behavior and sexual relationships. METHODS: Participants were 52 sexually experienced African American youth (male = 32, female = 20) between the ages of 15 and 17 recruited from community-based organizations in the United States. Youth participated in individual in-depth qualitative interviews, and data were analyzed using a phenomenological framework. RESULTS: Participants received a variety of messages about sexual behavior and sexual relationships from a range of family members including parents, siblings, grandmothers, aunts/uncles, and cousins. Types of messages clustered into three domains: sexual decision-making, quantity and quality of sexual activity, and sexual health promotion; with themes and sub-themes emerging within each area. CONCLUSION: Gender differences in the types of messages received are explored, and applications of the findings to the development of family-involved community interventions that promote sexual and reproductive health are discussed.

Parents' Perspectives About Adolescent Boys' Involvement in Biomedical HIV Prevention Research.

Research on the use of pre-exposure prophylaxis (PrEP) among adolescents at high risk for HIV is urgently needed, and parents' perspectives on these studies are essential for guiding the responsible conduct of adolescent PrEP research. We conducted interviews with 30 parents of adolescent boys (50% known/presumed heterosexual; 50% sexual minority) to understand their views of research risks and benefits and parental permission regarding their son's involvement in a hypothetical PrEP adherence trial. Parents identified several health and educational benefits of the study and expressed that waiving parental permission would overcome barriers to accessing PrEP, particularly for youth who may benefit most. Among their concerns were medication non-adherence and risk compensation. Parents provided suggestions to facilitate informed, rational, and voluntary participation decisions and protect youth's safety if parental permission was waived. These findings can inform ways to increase parental trust in PrEP research and create adequate protections for adolescent participants.

Strategies Chosen by YMSM During Goal Setting to Reduce Risk for HIV and Other Sexually Transmitted Infections: Results From the Keep It Up! 2.0 Prevention Trial.

Although there have been great advances in the prevention of HIV in the last two decades, young men who have sex with men (YMSM) continue to be disproportionately impacted. Utilizing qualitative data from a sample of YMSM (N = 292) engaged in a randomized controlled trial testing the efficacy of an internet-based HIV prevention program, we examined YMSM's goals for sexual risk reduction. Goals tended to focus on strategies used to prepare for safer sex or strategies to be used during sex. In both areas, five categories of strategies were identified: skill-related, intrapersonal, social, contextual, and instrumental. Findings suggest opportunities for more tailored eHealth intervention by focusing on strategies in domains of most use to the individual. Future research should include longitudinal assessment of barriers and facilitators to goal adherence, utility of goals in increasing safer sex behaviors, and changes to goals over time.

Self-implemented HIV testing: perspectives on improving dissemination among urban African American youths.

We examined the potential for increasing the reach of HIV testing to African American youths through the dissemination of oral-HIV testing. From 2012 through 2013 we examined the perceptions of alternatives to pharmacy dissemination of SITs in African American youths (5 focus groups) and service providers (4 focus groups), and conducted an ethnographic study of pharmacies (n = 10). Participants perceived significant advantages to delivering SITs through community health and services for adolescents (e.g., increased confidentiality, reduced stigma) over pharmacy dissemination. Given proper attention to fit, SIT dissemination could be facilitated through distribution by health and social service sites, and by improving elements of pharmacy dissemination.