Addressing Racism's Role in the US HIV Epidemic: Qualitative Findings From Three Ending the HIV Epidemic Prevention Projects.
Journal
Journal of acquired immune deficiency syndromes (1999)
ISSN: 1944-7884
Titre abrégé: J Acquir Immune Defic Syndr
Pays: United States
ID NLM: 100892005
Informations de publication
Date de publication:
01 07 2022
01 07 2022
Historique:
entrez:
15
6
2022
pubmed:
16
6
2022
medline:
18
6
2022
Statut:
ppublish
Résumé
Racist socio-political and economic systems in the United States are root causes of HIV disparities among minoritized individuals. However, within HIV implementation science literature, there is scarce empirical research on how to effectively counter racism. This article names racism and White supremacy as key challenges to the success of the Ending the HIV Epidemic (EHE) initiative and delineates opportunities to integrate anti-racism into HIV interventions. Formative data were synthesized from 3 EHE studies in California, North Carolina, and South Carolina. Each study engaged with community stakeholders to inform pre-exposure prophylaxis interventions. Key informant interviews and focus groups were used to query individuals-including Black individuals-about implementation challenges. Although racism was not an a priori focus of included studies, discourse on race and racism emerged as key study findings from all projects. Across diverse stakeholder groups and EHE locales, participants described racism as a threat to the success of the EHE initiative. Institutional and structural racism, intersectional stigma, and maltreatment of minoritized individuals within healthcare systems were cited as challenges to pre-exposure prophylaxis scale-up. Some recommendations for addressing racism were given-yet these primarily focused on the individual level (eg, enhanced training, outreach). EHE implementation scientists should commit to measurable anti-racist actions. To this end, we present a series of recommendations to help investigators evaluate the extent to which they are taking actionable steps to counter racism to improve the adoption, implementation, and real-world impact of EHE interventions for people of color.
Sections du résumé
BACKGROUND
Racist socio-political and economic systems in the United States are root causes of HIV disparities among minoritized individuals. However, within HIV implementation science literature, there is scarce empirical research on how to effectively counter racism. This article names racism and White supremacy as key challenges to the success of the Ending the HIV Epidemic (EHE) initiative and delineates opportunities to integrate anti-racism into HIV interventions.
METHODS
Formative data were synthesized from 3 EHE studies in California, North Carolina, and South Carolina. Each study engaged with community stakeholders to inform pre-exposure prophylaxis interventions. Key informant interviews and focus groups were used to query individuals-including Black individuals-about implementation challenges. Although racism was not an a priori focus of included studies, discourse on race and racism emerged as key study findings from all projects.
RESULTS
Across diverse stakeholder groups and EHE locales, participants described racism as a threat to the success of the EHE initiative. Institutional and structural racism, intersectional stigma, and maltreatment of minoritized individuals within healthcare systems were cited as challenges to pre-exposure prophylaxis scale-up. Some recommendations for addressing racism were given-yet these primarily focused on the individual level (eg, enhanced training, outreach).
CONCLUSIONS
EHE implementation scientists should commit to measurable anti-racist actions. To this end, we present a series of recommendations to help investigators evaluate the extent to which they are taking actionable steps to counter racism to improve the adoption, implementation, and real-world impact of EHE interventions for people of color.
Identifiants
pubmed: 35703755
doi: 10.1097/QAI.0000000000002965
pii: 00126334-202206001-00007
pmc: PMC9204779
mid: NIHMS1791050
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
S46-S55Subventions
Organisme : NIMH NIH HHS
ID : K01 MH118073
Pays : United States
Organisme : NICHD NIH HHS
ID : P2C HD050924
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI050410
Pays : United States
Organisme : NIMH NIH HHS
ID : R25 MH067127
Pays : United States
Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors have no conflicts of interest to disclose.
Références
Fauci AS, Redfield RR, Sigounas G, et al. Ending the HIV epidemic: a plan for the United States. JAMA. 2019;321:844–845.
Bradley H, Rosenberg ES, Holtgrave DR. Data-driven goals for curbing the U.S. HIV epidemic by 2030. AIDS Behav. 2019;23:557–563.
US Center for Disease Control and Prevention. CDC 2020 in review: press release. 2020. Available at: https://www.cdc.gov/media/releases/2020/p1229-cdc-2020-review.html . Accessed May 26, 2021.
US Center for Disease Control and Prevention. Ending the HIV epidemic: community involvement. 2021. Available at: https://www.cdc.gov/endhiv/action/community.html . Accessed May 26, 2021.
US Center for Disease Control and Prevention. HIV: African American people. 2021. Available at: https://www.cdc.gov/hiv/group/racialethnic/africanamericans/index.html . Accessed May 27, 2021.
US Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States 2014–2018. HIV Surveill Suppl Rep. 2020;25. Available at: https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-supplemental-report-vol-25-1.pdf . Accessed May 28, 2021.
US Centers for Disease Control and Prevention. HIV among African Americans. Published date unknown. Available at: https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/cdc-hiv-aa-508.pdf . Accessed May 27, 2021.
Guilamo-Ramos V, Thimm-Kaiser M, Benzekri A, et al. The invisible US hispanic/latino HIV crisis: addressing gaps in the national response. Am J Public Health. 2020;110:27–31.
Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States 2010–2016. HIV Surveill Suppl Rep. 2019;24. Available at: https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-supplemental-report-vol-24-1.pdf . Accessed May 28, 2021.
Centers for Disease Control and Prevention. HIV infection, risk, prevention, and testing behaviors among transgender women—national HIV behavioral surveillance, 7 U.S. Cities, 2019–2020. HIV Surveill Spec Rep. 2021;27. Available at: http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html . Accessed June 1, 2021.
Gottlieb MS, Schanker HM, Fan PT, et al. Pneumocystis pneumonia–los angeles. MMWR Morb Mortal Wkly Rep. 1981;30:250–252.
Centers for Disease Control and Prevention. HIV and AIDS --- United States, 1981–2000. MMWR Morb Mortal Wkly Rep. 2001;50:430–434. Available at: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5021a2.htm . Accessed May 1, 2021.
Millett GA, Peterson JL, Flores SA, et al. Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: a meta-analysis. Lancet. 2012;380:341–348.
Alvidrez J, Tabor DC. Now is the time to incorporate the construct of structural racism and discrimination into health research. Ethn Dis. 2021;31(suppl):283–284.
Jeffries WL, Henny KD. From epidemiology to action: the case for addressing social determinants of health to end HIV in the southern United States. AIDS Behav. 2019;23:340–346.
Bailey ZD, Krieger N, Agénor M, et al. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017;389:1453–1463.
Dennis AC, Chung EO, Lodge EK, et al. Looking back to leap forward: a framework for operationalizing the structural racism construct in minority and immigrant health research. Ethn Dis. 2021;31(suppl):301–310.
Krieger N. Discrimination and health inequities. Int J Health Serv. 2014;44:643–710.
Randolph SD, Golin C, Welgus H, et al. How perceived structural racism and discrimination and medical mistrust in the health system influences participation in HIV health services for black women living in the United States South: a qualitative, descriptive study. J Assoc Nurses AIDS Care. 2020;31:598–605.
Sullivan PS, Knox J, Jones J, et al. Understanding disparities in viral suppression among Black MSM living with HIV in Atlanta Georgia. J Int AIDS Soc. 2021;24:e25689.
Bazargan M, Cobb S, Assari S. Discrimination and medical mistrust in a racially and ethnically diverse sample of California adults. Ann Fam Med. 2021;19:4–15.
Jaiswal J, Halkitis PN. Towards a more inclusive and dynamic understanding of medical mistrust informed by science. Behav Med. 2019;45:79–85.
Quinn K, Dickson-Gomez J, Zarwell M, et al. “A gay man and a doctor are just like, a recipe for destruction”: how racism and homonegativity in healthcare settings influence PrEP uptake among young Black MSM. AIDS Behav. 2019;23:1951–1963.
Freeman R, Gwadz MV, Silverman E, et al. Critical race theory as a tool for understanding poor engagement along the HIV care continuum among African American/Black and Hispanic persons living with HIV in the United States: a qualitative exploration. Int J Equity Health. 2017;16:54–14.
Arnold EA, Rebchook GM, Kegeles SM. Triply cursed: racism, homophobia, and HIV-related stigma are barriers to regular HIV testing, treatment adherence, and disclosure among young Black gay men. Cult Health Sex. 2014;16:710–722.
Aarons GA, Hurlburt M, Horwitz SM. Advancing a conceptual model of evidence-based practice implementation in public service sectors. Adm Pol Ment Health. 2011;38:4–23.
Ford CL, Daniel M, Earp JA, et al. Perceived everyday racism, residential segregation, and HIV testing among patients at a sexually transmitted disease clinic. Am J Public Health. 2009;99(suppl 1):S137–S143.
Mizuno Y, Borkowf C, Millett GA, et al. Homophobia and racism experienced by latino men who have sex with men in the United States: correlates of exposure and associations with HIV risk behaviors. AIDS Behav. 2012;16:724–735.
Crenshaw K. Demarginalizing the intersection of race and sex: a black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. Univ Chic Leg Forum. 1989;1:139–167.
Rice WS, Logie CH, Napoles TM, et al. Perceptions of intersectional stigma among diverse women living with HIV in the United States. Soc Sci Med. 2018;208:9–17.
Beyrer C, Adimora AA, Hodder SL, et al. Call to action: how can the US Ending the HIV Epidemic initiative succeed? The Lancet. 2021;397:1151–1156.
Loutfy M, Tharao W, Logie C, et al. Systematic review of stigma reducing interventions for African/Black diasporic women. J Int AIDS Soc. 2015;18:19835.
Rao D, Desmond M, Andrasik M, et al. Feasibility, acceptability, and preliminary efficacy of the unity workshop: an internalized stigma reduction intervention for African American women living with HIV. AIDS Patient Care STDS. 2012;26:614–620.
Miles MS, Holditch-Davis D, Eron J, et al. An HIV self-care symptom management intervention for African American mothers. Nurs Res. 2003;52:350–360.
Hill Collins P. Black Feminist Thought: Knowledge, Consciousness, and the Politics of Empowerment. New York: Unwin Hyman; 1990.
hooks b. Killing Rage: Ending Racism. 1st ed. New York: H. Holt and Co; 1995.
Kendi IX. How to Be an Antiracist. New York; 2019. Accessed June 7, 2021.
Davis AY. Women, Culture & Politics. New York: Vintage Books; 1990.
Woodward EN, Singh RS, Ndebele-Ngwenya P, et al. A more practical guide to incorporating health equity domains in implementation determinant frameworks. Implementat Sci. 2021;2:61.
Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89:1322–1327.
Glasgow RE, Harden SM, Gaglio B, et al. RE-AIM planning and evaluation framework: adapting to new science and practice with a 20-year review. Front Public Health. 2019;7:64.
Smith JD, Li DH, Rafferty MR. The Implementation Research Logic Model: a method for planning, executing, reporting, and synthesizing implementation projects. Implement Sci. 2020;15:84.
Li D, Audet C, Schwartz S. A proposed set of standard implementation outcome measures for HIV interventions. 2020. Available at: https://isc3i.isgmh.northwestern.edu/hivoutcomes/ . Accessed June 10, 2021.