HIV testing is a critical strategy to addressing the disproportionate impact of HIV among Black transgender and nonbinary (TNB) individuals in the Southern U.S. We conducted 12 semi-structured qualitative interviews with Black TNB young adults in New Orleans to explore factors influencing HIV testing experiences and perceptions. We used a socioecological framework to guide analysis and identified themes across intrapersonal, interpersonal, organizational, and community levels. At the intrapersonal level, HIV anxiety shaped testing experiences and perceptions. Peer influence and patient-provider interactions emerged at the interpersonal level, and clinic operations at the organizational level. Community-level factors included stigma, medical mistrust, and confidentiality concerns. Participants provided actionable recommendations, emphasizing the need for instrumental support (e.g., transportation), hiring and training Black TNB clinic staff, and creating culturally resonant HIV testing programs. Community-informed strategies centering Black TNB voices are critical for designing effective HIV prevention programs that honor their identities and lived experiences.
Stigma remains a significant barrier to health care and well-being for people living with HIV (PLWH), especially when compounded by racial identity and sexual orientation. Most existing studies address stigma in isolation, overlooking its compounded effects. Guided by the socioecological model, intersectionality theory, and resilience theory, this qualitative study explored how intersectional stigma (perceived, internalized, enacted) related to HIV status, race/ethnicity, and sexual orientation. Semi-structured interviews were conducted with 11 PLWH from diverse backgrounds until thematic saturation was reached. Analysis identified intersecting stigma forms resulting in social rejection, anticipatory discrimination, and internalized shame. Resilience emerged across individual (self-advocacy), interpersonal (peer support), and community (solidarity) levels, mitigating emotional, social, and healthcare-related impacts. Family and community simultaneously served as sources of harm and resilience. Findings indicate the need for multilevel, culturally responsive interventions addressing structural and relational stigma while enhancing supportive networks to promote health care engagement among PLWH.
Black residents of Miami-Dade County experience among the worst HIV outcomes in the United States. Research suggests tailoring strategies to reflect population-specific patterns of risk may improve intervention impact. Yet HIV interventions often prioritize the factors of greatest risk regardless of their prevalence within a given population. To better inform the reach and effectiveness of a community-based HIV intervention for diverse Black communities, we used latent class analysis (LCA) to empirically identify behavioral subgroups within a cohort of over 1,000 predominantly Black South Florida residents. From December 2016 to April 2019, a community health worker-led HIV prevention program collected demographic and HIV risk data. LCA was performed using 12 risk indicators, resulting in five classes: Minimal Engagement (31%), Substance Use (4%), Condomless Engagement (43%), Impaired-Condomless Engagement (18%), and Syndemic Risk (4%). Findings support the value of LCA for designing efficient, context-aware, and resource-conscience HIV interventions.
Holistic approaches to HIV care aim to improve the lives of people living with HIV (PLWH) by shifting focus toward health systems that are more people-orientated and less disease-orientated. Social prescribing is one such approach that refers individuals to co-design non-clinical social prescriptions to improve their health and well-being. This qualitative study aimed to explore PLWH and support personnel preferences for the content and delivery of a socially prescribed psychoeducation model for PLWH in Ireland. Individual interviews were conducted with five PLWH and eight support personnel. Content analysis identified six superordinate categories with thirteen subcategories, identifying opportunities to empower PLWH through shared decision-making with trusted service providers and improved access to community resources, potential for peer support to combat social isolation and improve well-being, methods to overcome barriers to participation and improve cultural competency, and rationale to promote integrated social support that promotes a multidisciplinary approach and continuum of care.
In a secondary analysis from a randomized controlled trial of a peer advocacy training intervention for people living with HIV (PLWH), we examined effects on advocacy targeting specific HIV protective behaviors among enrolled social network members (alters), and whether alter behaviors were predicted by advocacy receipt and tone of delivery. 210 PLWH and 599 alters enrolled and were followed over 18 months. Repeated measures logistic regressions showed that PLWH in the intervention group targeted more alters with advocacy for HIV testing, condom use, pre-exposure prophylaxis, and HIV care, compared to those in the control group. Alters targeted with HIV testing advocacy were more likely to report increased HIV testing at the subsequent assessment. Among alters with HIV-negative main partners, receipt of condom use advocacy predicted increased consistent condom use at the subsequent assessment. Advocacy training for PLWH can increase targeted HIV prevention advocacy, which then promotes HIV testing and condom use.
