Health Care and HIV Testing Experiences Among Black Men in the South: Implications for “Seek, Test, Treat, and Retain” HIV Prevention Strategies

Abstract

Few studies have explored how overall general health care and HIV/STI testing experiences may influence receipt of "Seek, Test, Treat, and Retain" (STTR) HIV prevention approaches among Black men in the southern United States. Using in-depth qualitative interviews with 78 HIV-negative/unknown Black men in Georgia, we explored factors influencing their general health care and HIV/STI testing experiences. The Andersen behavioral model of health care utilization (Andersen model) offers a useful framework through which to examine the general health care experiences and HIV testing practices of Black men. It has four primary domains: Environment, Population characteristics, Health behavior, and Outcomes. Within the Andersen model framework, participants described four main themes that influenced HIV testing: access to insurance, patient-provider communication, quality of services, and personal belief systems. If STTR is to be successful among Black men, improving access and quality of general health care, integrating HIV testing into general health care, promoting health empowerment, and consumer satisfaction should be addressed.

The Feasibility of Implementing the HIV Seek, Test, and Treat Strategy in Jails

“…Correctional facilities have been identified as important venues for reaching persons at risk for HIV, particularly for racial and ethnic minorities who face disparate rates of incarceration compared to nonminorities. 25 However, our findings reinforce other studies that have revealed the challenges of delivering HIV treatment and high quality HIV care to persons who cycle in and out of the criminal justice system. 26 This study demonstrates that new HIV diagnoses can be identified through routine opt-out testing in jail and those persons who remain incarcerated for at least 2 weeks can be considered for initiation of ART.…”

Sexually Transmitted Infection Related Stigma and Shame Among African American Male Youth: Implications for Testing Practices, Partner Notification, and Treatment

“…Isolating STI services and messages that produce negative and discriminatory perceptions may only contribute to STI stigma and shame. Integrated services 12 have been recommended, especially for people of color who experience major health disparities and barriers to accessing services 35,36 and for attracting and retaining young clients, especially by virtue of offering convenience and ''camouflaging'' services that carry stigma. 37 Integrated services in this context may lead to raised awareness, increased uptake and frequency of testing, less delay in care seeking, and greater uptake and success of partner notification and treatment programs.…”

Minimal Awareness and Stalled Uptake of Pre-Exposure Prophylaxis (PrEP) Among at Risk, HIV-Negative, Black Men Who Have Sex with Men

“…Strategies that provide direction on PrEP uptake have been defined and are well-articulated, 38,[40][41][42][43] however, public health agencies and primary care providers need to develop stronger ties in order to identify and link to ongoing care individuals who are at elevated risk for HIV. Although historically much of the HIV prevention and treatment efforts in the US have been carried out by community-based HIV/ AIDS organizations, many of these agencies are likely unequipped within their currently existing infrastructure to not only raise awareness of PrEP, but seek out, engage, and provide ongoing care for individuals who are on PrEP or candidates for PrEP.…”