The rise of Black maternal mortality rates throughout the country demonstrates a great need to utilize innovative frameworks to craft solutions that improve health outcomes for Black birthing people. Previous research and interventions have examined individual- and policy-level factors to reduce maternal mortality; however, these methods may lack a true community-centered approach to understanding the experiences of Black birthing people in local communities that have been disproportionately impacted. In addition, certain research methods may not recognize other marginalized intersectional identities (e.g., Black transgender men) who experience inequities in Black maternal health. This commentary aims to provide recommendations for utilizing community-centered strategies on Black maternal mortality informed by community-based participatory research principles.
Introduction: Black and Latinx sexual minority men are disproportionately impacted by chronic conditions, such as HIV. Persons with HIV have a 1.5 to 2 times risk of cardiovascular disease (CVD) when compared to White, HIV-negative persons. By the year 2030, it is estimated that 78% of persons with HIV will have CVD. Patient teaching in the clinical setting has been the traditional modality for prevention education. However, persons at the highest risk, and who are based in the community, may not have access to clinic-based prevention education. Objective: To use mixed methods to assess HIV illness perceptions, HIV-related comorbid conditions of concern, and understand perspectives on the use of an online virtual environment (VE) for CVD prevention education. Methods: The Gaming Protocol Study is a mixed methods study that used Life’s Simple 7 as a framework to map an intervention to support cardiovascular health in sexual minority men of color with HIV, ages 30-65. Data were collected in English, Spanish, and Creole. Using validated measures, HIV illness perceptions, nicotine exposure, and physical activity were assessed. Qualitative interviews explored chronic illnesses of concern outside of HIV and also perceptions about the use of an online VE for CVD prevention education. Results: Thirty participants completed the validated measures and interviews. Quantitative findings suggested that greater than 90% of participants had a strong understanding of their HIV status. More than 50% of participants reported they experienced feelings of anxiety or fear by having HIV. Close to 30% reported having used nicotine and/or e-cigarettes. Less than half of participants met the criteria for engaging in vigorous or moderate physical activity. Qualitative findings suggested concerns about existing and potential future conditions, such as hypertension, diabetes, asthma, obesity, and mental health. Additionally, COVID-19 and Monkeypox were highlighted as important considerations because they pose high risk in the community. Perceptions about using a VE were mostly positive. Concerns were focused on online engagement and digital privacy. Conclusions: Sexual minority men of color are concerned about health conditions beyond HIV. They desire accessible, culturally relevant information to manage their health. Findings provide early evidence about health communication and education preferences for technology tools so they are meaningful and actionable as CVD prevention education.
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