Living and Loving: A Qualitative Exploration of the Dating and Sexual Relationships of HIV-Positive Young Black Gay, Bisexual, and Other Men Who Have Sex with Men

Infection with HIV is a global pandemic that continues to have particular impacts on Black men who have sex with men. Accordingly, researchers have examined risk behaviors in order to inform interventions that seek to decrease transmission. However, there has been relatively little research that has examined the dating and sexual experiences of Black GBMSM living with HIV absent a particular focus on sexual risk and potential transmission. The present study seeks to better understand the dating and sexual experiences of a sample of young Black GBMSM living with HIV. Twenty young Black GBMSM living with HIV were interviewed using a semi-structured interview guide meant to explore their dating and sexual experiences since diagnosis. Using thematic analysis, the author identified salient aspects of the broad identity-related experiences, dating experiences, and sexual experiences for young Black GBMSM living with HIV. Salient themes related to identity were: (1) broad experiences as young Black GBMSM living with HIV, (2) experiences related to Black identity, (3) experiences related to sexual orientation, and (4) experiences related to HIV. Salient themes related to dating were: (1) broad dating experiences as related to Blackness, (2) impacts of HIV on new relationships, (3) impacts of HIV on existing relationships, and (4) qualities of healthy dating relationships. Salient themes related to sexual relationships were: (1) sexual experiences as related to Blackness, (2) relationship between HIV and sexual desire, (3) impacts of HIV on sexual intercourse, (4) fear of hurt if partner becomes HIV-positive, (5) sexual risk negotiation, and (6) qualities of healthy sexual relationships. Salient themes that related to both dating and sex were: (1) selecting partners and (2) navigating disclosure in relationships. Findings suggest that HIV is the most salient factor HIV-positive young Black GBMSM consider when exploring their experiences in intimate relationships. Given the primacy of HIV and the negative trend of participants’ experiences related to others’ perception of HIV, suggestions for improving sexual health education and public health campaigns are offered

Ideal Dating and Sexual Partners for Low-Income Heterosexual African American Adolescents

Dating and sexual relationships among adolescents have been identified as both normative and beneficial. However, the research examining the dating and sexual relationships of African American adolescents has been narrow in scope, focusing primarily on risks of intimate partner violence, pregnancy, and STI/HIV transmission. This myopic focus has left a gap in the literature as it relates to the normative aspects of dating and sexual relationships for these youth. The present study sought to better understand the dating and sexual partner preferences of 51 African American adolescents (male = 32, female = 19) recruited from Chicago and San Francisco. The adolescents were interviewed by study personnel using a semi-structured interview guide meant to explore gender ideologies. While the interview had a wide scope, it also included questions that specifically query respondents’ ideal dating and sexual partners. These questions served as the core of the present analysis, though the entirety of the interviews was analyzed. The study utilized qualitative analysis guided by a psychological phenomenological framework. The study found that there were eight primary domains of relevance in the selection of an ideal dating and/or sexual partner: physical characteristics, self-presentation characteristics, interpersonal characteristics, intrapersonal characteristics, financial resources, age, preferred race, and similarity to celebrities. Contrary to expectations based on exchange theory, both young men and young women considered characteristics across the spectrum when selecting their partners. In general, both young men and young women had a great deal of similarity between their ideal dating and ideal sexual partners. However, there were some characteristics that were unique to a dating partner or sexual partner. In general, young men’s ideal dating partners had all the characteristics required of an ideal sexual partner, but they also had additional qualities related to the increased seriousness and potential length of a dating relationship. Young women’s ideal dating and sexual partners both had unique characteristics, despite sharing a large number of qualities. Young women’s ideal dating partners had qualities necessary due to the seriousness of the relationship, the amount of time which would be spent together, and the potential length of the relationship. Young women’s ideal sexual partners had qualities more related to minimizing the risk of embarrassment resulting from the primarily sexual focus of the relationship

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

“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

“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&#8217; 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

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.</p

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

Patient Perspectives on Portal-Based Anxiety and Depression Screening in HIV Care: A Qualitative Study Using the Consolidated Framework for Implementation Research

Electronic patient portals represent a promising means of integrating mental health assessments into HIV care where anxiety and depression are highly prevalent. Patient attitudes toward portal-based mental health screening within HIV clinics have not been well described. The aim of this formative qualitative study is to characterize the patient-perceived facilitators and barriers to portal-based anxiety and depression screening within HIV care in order to inform implementation strategies for mental health screening. Twelve adult HIV clinic patients participated in semi-structured interviews that were audio recorded and transcribed. The transcripts were coded using constructs from the Consolidated Framework for Implementation Research and analyzed thematically to identify the barriers to and facilitators of portal-based anxiety and depression screening. Facilitators included an absence of alternative screening methods, an approachable design, perceived adaptability, high compatibility with HIV care, the potential for linkage to treatment, an increased self-awareness of mental health conditions, the ability to bundle screening with clinic visits, and communicating an action plan for results. The barriers included difficulty navigating the patient portal system, a lack of technical support, stigmatization from the healthcare system, care team response times, and the novelty of using patient portals for communication. The patients in the HIV clinic viewed the use of a portal-based anxiety and depression screening tool as highly compatible with routine HIV care. Technical difficulties, follow-up concerns, and a fear of stigmatization were commonly perceived as barriers to portal use. The results of this study can be used to inform implementation strategies when designing or incorporating portal-based mental health screening into other HIV care settings