Karen A. Johnson

Despite efforts to end the HIV epidemic, new transmissions among Black women in the U.S.’ Deep South remain disproportionately high. This study exami

This study evaluated the impact of peer patient navigation compared to standard care in promoting PrEP treatment among individuals at high risk for HIV in Alabama. The study was conducted at an LGBTQ+-focused primary care clinic dedicated to culturally competent, affirming care. Longitudinal data from January 2016 to June 2022, covering 4,194 visits by 764 patients, were analyzed. Three service periods were compared: Standard of Care (SOC) (01/2016–05/2018), PrEP-Up! (06/2018–06/2021), and Enhanced PrEP-Up! (07/2021–06/2022). Segmentation regression was employed to analyze (1) the effects of PrEP-Up! and Enhanced PrEP-Up! on appointment persistence (versus “standard of care”); and (2) the effect of COVID-19. Participants were 71.5% White, 19.2% Black, 3.5% Other race, and 5.8% Unknown race. Regarding ethnicity, 10.6% disclosed as Not Hispanic/Latino, 3.6% as Hispanic/Latino, 2% as Central American/Chicano, and 84.9% had ethnicity unavailable. 93.5% identified as male, with 56.9% identifying as LGBTQ+. Persistence rates under SOC averaged 88%. PrEP-Up! improved persistence to 95% initially but declined slightly over time. COVID-19 significantly disrupted persistence during early 2020, though rates gradually improved with the easing of restrictions. During the Enhanced PrEP-Up! period, persistence increased more slowly, possibly reflecting residual pandemic effects. Peer patient navigation effectively enhanced PrEP persistence in a region disproportionately impacted by HIV. Despite challenges posed by COVID-19, these findings emphasize the importance of community-centered interventions in addressing health disparities. Rebuilding trust in public health among marginalized populations is essential to improving equitable health outcomes.

Background Despite encouraging declines in the overall rate of new transmission globally, HIV prevention efforts targeting individuals in the criminal legal system continue to significantly lag behind rates identified in the general population. Prevention efforts targeting this group worldwide remain geographically uneven and differ across the continuum of legal system involvement (diversion, arrests, community supervision, and post-release), which is attributed to social, structural, and systemic barriers. These gaps are noted to disproportionately impact minoritized and other transmission-burdened populations within the criminal legal system (e.g., men who have sex with men). Objective Given these challenges, this literature review examines HIV prevention efforts targeting individuals in the criminal legal system across the globe. Methods This review identifies current reach and gaps in prevention care and proposes strategies for improvement. Results Recommendations include updating and utilizing long-term platforms for sustained HIV prevention interventions, developing a global compendium for regions outside the U.S., enhancing targeted interventions in high-risk areas, and integrating HIV prevention with other health services while addressing stigma. Conclusions These actions are critical for ensuring that interventions remain up-to-date, sustainable, and culturally responsive, effectively addressing the unique needs of diverse populations and criminal legal system contexts. These measures are also vital for meeting the U.N. 95–95–95 targets for HIV testing, treatment, and viral suppression, ultimately contributing to the goal of ending the HIV epidemic among this high-need population.

This study examined retention and its relationship to mental health, substance use, and social determinants of health in a randomized clinical trial of a behavioral HIV/sexually transmitted infection prevention intervention with drug-involved Black women (N = 348) under community supervision programs in New York City. Using secondary analysis, we used logistic models to test the association between factors related to mental health, substance use, and social determinants of health and follow-up assessment completion (three, six, and 12 months). Participants who were diagnosed with schizophrenia or food insecure in the past 90 days had lower odds of retention. Participants who misused prescription opiates during their lifetime had higher odds of retention throughout the intervention.

This study examines cross-sectional clusters and longitudinal predictions using an expanded SAVA syndemic conceptual framework—SAVA MH + H (substance use, intimate partner violence, mental health, and homelessness leading to HIV/STI/HCV risks)—among women recently released from incarceration (WRRI) (n = 206) participating in the WORTH Transitions (WT) intervention. WT combines two evidence-based interventions: the Women on the Road to Health HIV intervention, and Transitions Clinic. Cluster analytic and logistic regression methods were utilized. For the cluster analyses, baseline SAVA MH + H variables were categorized into presence/absence. For logistic regression, baseline SAVA MH + H variables were examined on a composite HIV/STI/HCV outcome collected at 6-month follow-up, controlling for lifetime trauma and sociodemographic characteristics. Three SAVA MH + H clusters were identified, the first of which had women with the highest overall levels of SAVA MH + H variables, 47% of whom were unhoused. Hard drug use (HDU) was the only significant predictor of HIV/STI/HCV risks in the regression analyses. HDUs had 4.32-fold higher odds of HIV/STI/HCV outcomes than non-HDUs (p = 0.002). Interventions such as WORTH Transitions must differently target identified SAVA MH + H syndemic risk clusters and HDU to prevent HIV/HCV/STI outcomes among WRRI.

Purpose This study examines the HIV knowledge of people living with HIV (PLWH) and its implications for improved healthcare outcomes. Methods The study design was a descriptive cross-sectional study, and a total of 41 PLWH were recruited from a larger faith-based anti-stigma study. Data was collected using a semi-structured self-administered questionnaire and analyzed using SAS. In addition, a literature review was conducted using search engines to gauge existing literature from 2013 to 2022 in areas of HIV knowledge and healthcare outcomes among PLWH. Results The 41 PLWH enrolled consisted of 51% males and 49% females. Sixteen (39%) were aged ≥ 51 years, 17 (41%) had been living with HIV for > 10 years, 15 (37%) had < high school diploma, and 100% were currently in HIV care. HIV knowledge scores were below average for 20 (49%) of the PLWH. Substantial knowledge deficits were noted in areas of HIV transmission and risk reduction strategies. Lower scores were not significantly associated with the participant’s gender, education level, or length of time being HIV-infected. The results of the literature review showed limited research in this area. Conclusions The study and literature review results show that HIV knowledge and health literacy may contribute to racial disparities in retention in care leading to poor health outcomes. Healthcare providers and health facilities in rural areas should be equipped with culturally tailored HIV educational tools to strengthen ongoing care for PLWH, foster patient-provider relationships, and eliminate internalized stigma detrimental to improved healthcare outcomes among PLWH.

Objectives: This article describes the process used to adapt the only group-based, computer-assisted, HIV/sexually transmitted infections (STI) prevention intervention designed for drug-using Black women in community corrections using an integrated health equity ADAPT-ITT framework with a peer engagement lens. Methods: Key adaptation partners included cisgender, drug-using Black women in community corrections, and Black, female, community reentry providers slated to deliver the adapted intervention. Focus groups and a study pilot were held. Results: The resulting intervention, Empowering African-American Women on the Road to Health (E-WORTH), features HIV/STI-specific Afrocentric themes of risk and resiliency tailored for and by Black women in the criminal legal system. Evaluation of E-WORTH confirms its cultural resonance. Participants had a 54% lowered odds of testing positive for any STI and reported 38% fewer acts of condomless vaginal or anal intercourse at 12-month follow-up. Conclusions: Findings underscore the need to develop an adaptation model that is explicitly health equity in focus.