Sania Zia, Sabrina Benitez, Liesl Nydegger PhD, MPH
Background: Black and Latina women are disproportionately impacted by substance abuse, interpersonal violence, and HIV/AIDS syndemic along with structural barriers, such as healthcare access, employment, and access to social services. Pre-exposure prophylaxis (PrEP) is a preventative measure at-risk women can take to decrease their risk of contracting HIV.
Methods: We used data from a larger study that explored structural and syndemic barriers of PrEP adoption. Each participant completed three interviews over three months. There were 17 participants enrolled and the study was completed in January 2020. Data analysis explored how access to community resources affected attitudes toward PrEP and PrEP adoption among Black and Latina mothers at high risk for HIV.
Results: Emerging themes revealed that mothers who reported wanting to improve their lifestyles for their children used community resources to exit unhealthy relationships, seek employment, and seek physical/mental health treatment. Preliminary results revealed that participants who had access to community resources also had positive attitudes toward PrEP throughout the course of the study. Experiencing IPV was a barrier to accessing community resources and participants tended to have negative attitudes towards PrEP. Participants attributed their negative perceptions and attitudes toward PrEP to low perceived HIV risk and medical mistrust. Compounding structural inequities can contribute to lack of trust in medical interventions.
Conclusions: Our work to date suggests that more attention should be given to creating comprehensive community resources for Black and Latina mothers such as resources for employment, healthcare, leaving unhealthy relationships, and sexual health education. These resources should be culturally competent and focus on creating long term, quality relationships with trusted advocates. Giving women the opportunities to build resilience will also empower them to make informed decisions about their sexual health and mitigate their HIV risk.
Comments
As many others have said, this poster is really well designed. I’ve read some articles about communities where healthcare workers have combined HIV prevention education and care with communal spaces and events that are safe spaces for the people they’re working with, particularly Black communities in those articles. I’ve seen that clinics here in Austin are often at different queer events to promote and provide HIV care and education. The work in other cities that I’ve read about, though, also incorporated places like churches, community centers, as well as clubs, childcare centers, etc. into the areas where they have pop-up care available. Have you seen anything like that happening in Austin? Do you think that could be a potentially successful, and even possible, route to provide these kinds kinds of resources in spaces where people feel safe; or, do you think it would feel intrusive? I suppose that last one varies person-to-person or by community space. Thank you for doing this work and sharing it! —Anna Hornsby
Hi Anna, Thank you so much for your thoughtful questions and feedback! Because we coded for thematic analysis in the interviews, we were able to specifically look at how community resources were viewed by participants. A lot of the participants had used Lifeworks and SAFE, both of which are local community organizations that do a great job of serving with some of these integrated type of services – including counseling and childcare for example. We have some great organizations working towards HIV prevention in Austin, but a lot of times women are not targeted as potential users of PrEP. Dr. Nydegger and the rest of our lab are continuing to investigate different interventions, including involving social support for low income women. As far as I know, these wraparound prevention efforts are pretty limited so far in our area, so that’s definitely an important area of work to be done. However, mistrust was definitely a component of engaging with resources. Some participants didn’t trust that social workers or counselors cared, that CPS would do what was best for their families, or that doctors were treating them with high quality care. On the other hand, some really valued the relationships they formed with those working at these community organizations and viewed them as important resources. Part of this might be due to if it seems the “helpers” truly are invested in the progress of the communities they are working in. I think the kind of comprehensive initiative you mention is the best way to combat the barriers that can contribute to disproportionate HIV rates. Ensuring that these are successful and safe – not intrusive, requires that the community is involved in every aspect, from the bottom up. This might entail recruiting those who actively live and work in the target communities, instead of designing and imposing the intervention by an outside institution, like UT. And it would be vital to do the appropriate groundwork to have a deeper understanding of the plausibility and effectiveness of such a program. Sorry for the wordiness, but let me know if you have any other questions. we’d love to discuss! —Sania Zia
I agree this visual appeal of this poster is great! And very important findings about increasing community resources and building trust. —Keryn Pasch
Thank you for your feedback! —Sabrina Benitez
As many others have said, this poster is really well designed. I’ve read some articles about communities where healthcare workers have combined HIV prevention education and care with communal spaces and events that are safe spaces for the people they’re w —Avery Largent
Thank you for your question! Based on our study, a way to combat medical mistrust would be to improve access to quality health education that acknowledges the difficult history of medical mistrust in our healthcare system, as well as the creation of positive relationships between the providers of community resources and these communities. —Sabrina Benitez
I love how visually engaging this poster is! —Rebecca Wilcox
Thank you for reading! —Sania Zia
I was really impressed by the design of this poster. From the figures to the diagram of community resources to the illustrated pull-quotes from participants, y’all incorporated a lot of design elements that helped me understand this. —Rob Reichle
Thank you, I’m glad the design was conducive to your understanding of our work! —Sania Zia