Where’s the “Everyday Black Woman”? An intersectional qualitative analysis of Black Women’s decision-making regarding HIV pre-exposure prophylaxis (PrEP) in Mississippi

Background: Black cisgender women in the U.S. South bear a disproportionate burden of HIV compared to cisgender women in other racial and ethnic groups and in any other part of the US. Critical to decreasing new HIV infections is the improved delivery of pre-exposure prophylaxis (PrEP) for Black cisgender women as it remains underutilized in 2021. Informed by intersectionality, the study sought to characterize the sociostructural influences on Black cisgender women’s deliberations about PrEP within the context of interlocking systems of oppression including racism, sexism, and classism. Methods: Six focus groups were conducted with 37 Black women residing in Jackson, Mississippi. This sample was purposively recruited to include Black cisgender women who were eligible for PrEP but had never received a PrEP prescription. Results: Six themes were identified as concerns during PrEP deliberation among Black women: 1) limited PrEP awareness, 2) low perceived HIV risk, 3) concerns about side effects, 4) concerns about costs, 5) limited marketing, and 6) distrust in the healthcare system. Three themes were identified as facilitators during PrEP deliberations: 1) women’s empowerment and advocacy, 2) need for increased PrEP-specific education, and 3) the positive influence of PrEP-engaged women’s testimonials. Black women shared a limited awareness of PrEP exacerbated by the lack of Black women-specific marketing. Opportunities to support Black women-specific social marketing could increase awareness and knowledge regarding PrEP’s benefits and costs. Black women also shared their concerns about discrimination in healthcare and distrust, but they felt that these barriers may be addressed by patient testimonials from PrEP-engaged Black women, empowerment strategies, and directly addressing provider biases. Conclusions: An effective response to PrEP implementation among Black women in the South requires developing programs to center the needs of Black women and carry out active strategies that prioritize peer advocacy while reinforcing positive and mitigating negative influences from broader social and historical contexts

“PrEP’s just to secure you like insurance”: a qualitative study on HIV pre-exposure prophylaxis (PrEP) adherence and retention among black cisgender women in Mississippi

Background: Pre-exposure prophylaxis (PrEP) has the potential to reduce transmission of HIV among Black cisgender women in the Southern United States (U.S.); however, national data suggests that PrEP initiation is lowest in the South and among Black women compared to other U.S. regions and white women. This study applied intersectionality and PrEP multilevel resilience frameworks to assess how socio-structural and clinical contexts shaped PrEP persistence among Black cisgender women in Mississippi. Methods: Semi-structured interviews were conducted with eight Black cisgender women in Jackson, Mississippi. This sample was purposively recruited to include PrEP-initiated Black cisgender women. Results: Six themes identified that shaped PrEP care among Black cisgender women: (1) internal assets, (2) sole responsibility to HIV prevention, (3) added protection in HIV serodifferent relationships, (4) financial issues, (5) trust and distrust in the medical system, and (6) side effects. Black cisgender women reported that PrEP persistence increased control over their sexual health, reduced anxiety about HIV, and promoted self-care. Black cisgender women also indicated that medication assistance programs increased PrEP affordability resulting in continued persistence. Conclusions: In addition to preventing HIV, PrEP may yield secondary positive impacts on the health and relationships of Black cisgender women. However, very few Black cisgender women in the South are using PrEP given intersectional barriers and thus necessitates adaptive strategies to support PrEP initiation and persistence. Efforts aimed at increasing the coverage of PrEP among Black cisgender women should consider implementation strategies responsive to lived realities of Black women

Disentangling the Effects of Multiple Fires on Spatially Interspersed Sagebrush (\u3ci\u3eArtemisia\u3c/i\u3e spp.) Communities

Questions: Relative to a landscape with a mosaic of two sagebrush community types and increasing fire frequency, we asked (a) do vegetation characteristics very significantly with number of times burned for each sagebrush community; (b) how do vegetation responses to different fire frequencies compare between the two sagebrush communities? Location: Columbia Plateau Ecoregion, Washington, USA. Methods: We sampled vegetation across a landscape that burned three times over a 10-year period in two sagebrush community types that are interspersed on unique landforms: big sagebrush (Artemisia tridentata) communities that occur on small “mounds” and scabland sagebrush (A. rigida) communities that occur on surrounding “flats.” Spatially overlapping fires permitted a balanced sampling design to assess unburned and once-, twice-, and thrice-burned locations for each land form/community type. We utilized a suite of statistical analyses to determine differences among plant functional groups and biomass among unburned/burned strata by land form and compared results between land forms. Results: Big sagebrush and scabland sagebrush communities responded uniquely to multiple fires, due to different fuel loadings, fire severities, succession and invasion dynamics. Big sagebrush experienced nearly complete shrub loss and conversion from exotic-invaded shrubland to exotic annual grassland after only one fire. In contrast, scabland sagebrush retained a minor shrub component and higher relative cover of native herbaceous species, even after three fires. Both communities retained cover of native perennial grasses, including shallow- and deep-rooted species, likely reflecting decreasing fire intensity with number of times burned. Conclusions: Despite different community-level responses, increasing fire frequency is transforming the entire landscape to a non-native/native grassland mix. Quantifying unique ecosystem responses to altered wildfire regimes is critical to understanding the relative resilience of communities to disturbance and their resistance to exotic species invasion (and community type conversion). Management actions may help to maintain spatial heterogeneity of ecosystems and fire-tolerant native species