Jessica Mayson Perkins

Introduction: Black Americans and individuals in the Southern United States bear a disproportionate burden of HIV. To address stigma, a key contributor to these inequities, we developed Cutting Out Stigma ( COS ), a barbershop‐based education and multimedia intervention. Methods: We recruited and trained Tennessee (U.S.) barbers as COS Men's Health Ambassadors and invited them to participate in a 6‐month COS pilot implementation trial from September 2024 to March 2025. COS barbers provided sexual health education, referrals to HIV (and other ancillary) services for barbershop clients and shared relevant study and barber‐created social media posts. Using the RE‐AIM framework, we assessed reach (social media and barbershop‐based), preliminary effectiveness (barber‐level HIV knowledge improvement, role effectiveness and resource connection), intervention adoption and implementation (feasibility, acceptability, appropriateness at baseline and endline). Data sources included validated pre‐ and post‐implementation surveys, social media analytics, weekly self‐report forms and in‐depth interviews (IDIs). Quantitative data were summarized descriptively, with mixed‐effects models estimating change over time; IDI analyses helped interpret effectiveness outcomes. Results: Sixty‐seven barbers completed COS training. Among 57 successfully contacted post‐training, 50 barbers (87.7%) enrolled in the pilot trial across 26 barbershops. The pilot reached an estimated 4464 barbershop client encounters, with 62.0% of barbers engaging ≥6 clients weekly. Estimated social media reach averaged 57,462 users monthly. Implementation outcomes remained high: baseline/endline scores were 4.8/4.8 for feasibility, 4.9/4.9 for acceptability and 4.8/4.9 for appropriateness (each out of 5). HIV knowledge improved following training, and barbers reported high effectiveness as health ambassadors (median effectiveness 8 of 10; IQR: 7–9). Barbers facilitated an estimated 3096 referrals, primarily for HIV testing (71.0%) and pre‐exposure prophylaxis (PrEP) (70.0%). IDIs helped explain these patterns: barbers described moving from transmission myths towards actionable understanding of HIV prevention, reported shifts in personal attitudes as they grew in their new role, and perceived normalizing HIV discussion and making resource referrals as “shop talk” that could reduce community stigma. Barbers also described client‐level early prevention behaviours (e.g. condom uptake, PrEP inquiries), though they felt fear of judgement created intention−behaviour gaps for a few clients. Conclusions: COS demonstrated high feasibility, acceptability and suggested preliminary effectiveness in reducing HIV stigma and promoting prevention through trusted barbershop settings. Integrating community‐based and digital strategies offers a promising model to tackle HIV stigma and advance Ending the HIV Epidemic goals.

Background: HIV-related stigma remains a primary barrier to the elimination of the HIV epidemic worldwide. No studies have examined long-term changes in the distribution of stigmatizing attitudes within populations. Methods: We conducted a whole-population, open cohort study of adults in 8 villages in rural southwestern Uganda, with 5 biennial surveys spanning 2014-2024 (N=1,776 at baseline; 869 participated in all waves). We measured individual negative attitudes toward people with HIV (“public stigma”) and perceptions of negative attitudes among others (“perceived stigma”) using parallel 15-item scales. We estimated mean stigma scores, computed inequality measures at each wave, and decomposed inequality by sociodemographic characteristics. Leveraging the cohort design, we estimated intraclass correlation coefficients and rank-order stability over time. Results: Both public and perceived stigma declined substantially from baseline to endline and became concentrated in an increasingly smaller subgroup of the population. Theil decomposition failed to identify any stratifying variables that explained more than 3% of this variation: nearly all the inequality in HIV stigma occurred within population subgroups rather than between them. In longitudinal analyses, public stigma showed trait-like properties (intraclass correlation coefficient=0.35; 95% CI, 0.31-0.38) and meaningful rank-order stability (baseline-to-endline r=0.41). Perceived stigma showed no rank-order stability, no appreciable between-person variance, and universal convergence to low levels regardless of baseline. Conclusions: Both public and perceived HIV stigma declined substantially in this rural Ugandan population, but remaining public stigma has become concentrated within a persistent minority. Sociodemographic profiling to target individuals who carry persistently negative attitudes toward people with HIV is unlikely to succeed.

Background: In recent years, social media has emerged as a pivotal tool in implementation science efforts to address the HIV epidemic. Engaging community partners is essential to ensure the successful and equitable implementation of social media strategies. There is a notable lack of scholarship addressing the operational considerations for studies using social media strategies in community-partnered HIV research. This article seeks to bridge this gap by consolidating field notes and practical considerations derived from 3 ongoing NIH-supported studies focused on Ending the HIV Epidemic in the United States. Objective: This article aims to inform the design, planning, and implementation of operationally effective community-partnered social media strategies in HIV research, ultimately contributing to enhancements in HIV practice and improved outcomes across the HIV prevention and care continua. Methods: Supported by the University of California, Los Angeles Rapid, Rigorous, Relevant (3R) Implementation Science Hub, the 3 Ending the HIV Epidemic projects convened to form the community-partnered social media campaigns working group. The working group used the Consolidated Framework for Implementation Research to help identify and organize key barriers and facilitators of relevance to implementation of the projects’ social media strategies. Given the high degree of interrelatedness across reported factors, the working group thematically synthesized the content into 5 practical considerations to inform use of community-partnered social media strategies in HIV research. Results: The practical considerations identified by the community-partnered social media campaigns working group include the following: (1) the power and pitfalls of social media platforms (ie, opportunities and challenges inherent to social media platforms that may affect use of social media strategies in HIV research), (2) messengers and messages matter (ie, ensuring the appropriateness, acceptability, and quality of social media messengers and content), (3) the significance of the sociopolitical environment (ie, characterizing the sociopolitical environment surrounding HIV and its potential impact on implementing social media strategies to reach priority populations), (4) investing in academic-community partnerships (ie, cultivating positive and productive academic-community partnerships to support implementation of social media strategies in HIV research), and (5) the alignment of the institutional environment and research approach (ie, assessing and working to address features of institutional environments that may impact implementation of social media strategies in community-partnered HIV research). Conclusions: As use of social media in HIV research and practice continues to grow, the practical considerations presented in this paper can help research teams anticipate factors that may impact implementation of community-partnered social media strategies and take early action to mitigate potential challenges. By understanding and addressing the unique challenges and opportunities of social media in community-partnered HIV research, we can leverage these platforms to accelerate progress toward ending the HIV epidemic.

BACKGROUND In recent years, social media has emerged as a pivotal tool in implementation science efforts to address the HIV epidemic. Engaging community partners is essential to ensure the successful and equitable implementation of social media strategies. There is a notable lack of scholarship addressing the operational considerations for studies using social media strategies in community-partnered HIV research. This article seeks to bridge this gap by consolidating field notes and practical considerations derived from 3 ongoing NIH-supported studies focused on Ending the HIV Epidemic in the United States. OBJECTIVE This article aims to inform the design, planning, and implementation of operationally effective community-partnered social media strategies in HIV research, ultimately contributing to enhancements in HIV practice and improved outcomes across the HIV prevention and care continua. METHODS Supported by the University of California, Los Angeles Rapid, Rigorous, Relevant (3R) Implementation Science Hub, the 3 Ending the HIV Epidemic projects convened to form the community-partnered social media campaigns working group. The working group used the Consolidated Framework for Implementation Research to help identify and organize key barriers and facilitators of relevance to implementation of the projects’ social media strategies. Given the high degree of interrelatedness across reported factors, the working group thematically synthesized the content into 5 practical considerations to inform use of community-partnered social media strategies in HIV research. RESULTS The practical considerations identified by the community-partnered social media campaigns working group include the following: (1) the power and pitfalls of social media platforms (ie, opportunities and challenges inherent to social media platforms that may affect use of social media strategies in HIV research), (2) messengers and messages matter (ie, ensuring the appropriateness, acceptability, and quality of social media messengers and content), (3) the significance of the sociopolitical environment (ie, characterizing the sociopolitical environment surrounding HIV and its potential impact on implementing social media strategies to reach priority populations), (4) investing in academic-community partnerships (ie, cultivating positive and productive academic-community partnerships to support implementation of social media strategies in HIV research), and (5) the alignment of the institutional environment and research approach (ie, assessing and working to address features of institutional environments that may impact implementation of social media strategies in community-partnered HIV research). CONCLUSIONS As use of social media in HIV research and practice continues to grow, the practical considerations presented in this paper can help research teams anticipate factors that may impact implementation of community-partnered social media strategies and take early action to mitigate potential challenges. By understanding and addressing the unique challenges and opportunities of social media in community-partnered HIV research, we can leverage these platforms to accelerate progress toward ending the HIV epidemic.

Objective: Stigma is a known barrier to seeking behavioral health support and treatment. This study assesses college students' stigma toward students seeking help for alcohol use. Participants: 237 students from a diverse major at a private university in the southeastern United States. Method: Respondents reported personal stigma and public stigma (i.e., the estimated prevalence of personal stigma among peers). We compared public stigma estimates with the prevalence of respondents' personal stigma. Logistic regression models were fit to estimate correlates of overestimating public stigma. Results: More than 70% overestimated public stigma. Estimates from regression models indicated that consuming alcohol 3+ days per week (aOR = 4.63; 95% CI 1.39-15.41; p = 0.012) and personal stigma (aOR = 14.06; 95% CI 3.64-54.36; p < 0.001) were associated with overestimating public stigma. Conclusions: Students overestimated public stigma toward students seeking help for alcohol use. Future research should assess whether correcting overestimates increases help-seeking for alcohol use.

: Access to water safe for consumption is critical for health and well-being, yet substantial structural barriers often necessitate household action to make water safer. Social norms about water treatment practices are understudied as a driver of personal water treatment practice. This study assesses reported and perceived water treatment practices among women in a rural, water insecure setting. We used cross-sectional data from a population-based study of women living with children under 5 years old across eight villages in southwest Uganda. Participants reported their typical household water treatment practices and what they perceived to be the common practices among most other women with young children in their own village. Modified multivariable Poisson regression models estimated the association between individual behavior and perceptions. Of 274 participants (78% response rate), 221 (81%) reported boiling water and 228 (83%) reported taking at least one action to make water safer. However, 135 (49%) misperceived most women with young children in their village not to boil their water, and 119 (43%) misperceived most to take no action. Participants who misperceived these norms were less likely to practice safe water treatment (e.g., for boiling water, adjusted relative risk = 0.80; 95% CI 0.69–0.92, P = 0.002), adjusting for other factors. Future research should assess whether making actual descriptive norms about local water treatment practices visible and salient (e.g., with messages such as “most women in this village boil their drinking water”) corrects misperceived norms and increases safe water treatment practices by some and supports consistent safe practices by others.

Intimate partner violence (IPV) against women is a global public health problem. Conceptual frameworks suggest misperceived norms around IPV might drive perpetration of violence against women in southern and eastern Africa. We conducted a cross-sectional, population-based survey of all men residing in a rural parish in southwest Uganda, eliciting their endorsement of IPV in five hypothetical scenarios and their reported frequency of perpetration of violence against their wife/main partner. They also reported their perceptions about the extent to which most other men in their villages endorsed and/or perpetrated IPV, which we compared against the population data to measure the primary explanatory variable of interest: whether individuals misperceived norms around IPV. We fitted multivariable Poisson regression models specifying personal IPV endorsement and IPV perpetration as the outcomes. Overall, 765 men participated in the study (90% response rate): 182 (24%) personally endorsed IPV, and 78 of 456 partnered men (17%) reported perpetrating one or more acts of IPV at least once per month. Although most men neither endorsed nor reported perpetrating IPV, 342 (45%) men mistakenly thought that most other men in their villages endorsed IPV and 365 (48%) men mistakenly thought that most other men perpetrate IPV at least monthly. In multivariable regression models, men who misperceived most men to endorse IPV were more likely to endorse IPV themselves (adjusted relative risk [aRR] = 2.44; 95% CI [1.66, 3.59]; p < .001). Among partnered men, those who misperceived IPV perpetration to be normative were more likely to perpetrate IPV themselves (aRR = 4.38; [2.53, 7.59]; p < .001). Interventions to correct misperceived norms about IPV may be a promising method for reducing violence against women in rural Uganda.

In 2007, the World Health Organization (WHO) and the Joint United Nations Programme on human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) recommended increasing voluntary medical male circumcision (VMMC) uptake in populations at high risk of HIV infection, especially in HIV-endemic countries [1]. Studies had indicated that VMMC uptake was associated with reduced HIV acquisition risk […]