HIV prevention interventions to reduce sexual risk for African Americans: The influence of community-level stigma and psychological processes

Abstract

Interventions to improve public health may benefit from consideration of how environmental contexts can facilitate or hinder their success. We examined the extent to which efficacy of interventions to improve African Americans’ condom use practices was moderated by two indicators of structural stigma—Whites’ attitudes toward African Americans and residential segregation in the communities where interventions occurred. A previously published meta-analytic database was re-analyzed to examine the interplay of community-level stigma with the psychological processes implied by intervention content in influencing intervention efficacy. All studies were conducted in the United States and included samples that were at least 50% African American. Whites’ attitudes were drawn from the American National Election Studies, which collects data from nationally representative samples. Residential segregation was drawn from published reports. Results showed independent effects of Whites’ attitudes and residential segregation on condom use effect sizes. Interventions were most successful when Whites’ attitudes were more positive or when residential segregation was low. These two structural factors interacted: Interventions improved condom use only when communities had both relatively positive attitudes toward African Americans and lower levels of segregation. The effect of Whites’ attitudes was more pronounced at longer follow-up intervals and for younger samples and those samples with more African Americans. Tailoring content to participants’ values and needs, which may reduce African Americans’ mistrust of intervention providers, buffered against the negative influence of Whites’ attitudes on condom use. The structural factors uniquely accounted for variance in condom use effect sizes over and above intervention-level features and community-level education and poverty. Results highlight the interplay of social identity and environment in perpetuating intergroup disparities. Potential mechanisms for these effects are discussed along with public health implications.

Differential HIV Risk for Racial/Ethnic Minority Trans*female Youths and Socioeconomic Disparities in Housing, Residential Stability, and Education

“…Members of racial/ethnic minority groups have been found to cope with racism-related stressors like internalized racial stigma with substance use 20,31 . Racial stigma specifically has been found to affect condom use via the influence on decreased levels of self-control and subsequent substance use as has been demonstrated among African American adolescents 32,33 . Trans*female youth who experience racial stigma may use substances to cope and be less inclined to use condoms while under the influence 9,13,17,34 .…”

Stigma, gay men and biomedical prevention: the challenges and opportunities of a rapidly changing HIV prevention landscape

“…Similar results have been found in other studies in the USA and UK. 13,16,26 Projecting current rates of HIV infection, it has been estimated that~50% of black GMSM and 25% of Latino GMSM in the US will be diagnosed with HIV during their lifetime. 27 There is substantial evidence of the association between HIV stigma and downstream, negative impacts on the physical and mental health of people living with HIV, including delayed testing, reduced access to care, lower adherence to treatments and less social support, 20,22,28,29 resulting in both individual and social consequences.…”

“…The ways in which stigma may impact on the policy and health systems intended to support HIV responses has also been raised by several reviewers. 16,25,26,[32][33][34][35] For example, does stigma within policy circuits influence the focus of funded research into GMSM communities, the availability and sustainability of such services to meet the needs of GMSM in the first place, or the trust that community and policy have in GMSM community-led responses? Does HIV stigma within health services, such as excessive infection control measures, accentuate already existing race-related discrimination?…”

Factors Associated with African American Women’s Sexual Health and Risk Behavior: A Mixed Methods Study

“…Despite these efforts developed to address disparities in sexual and reproductive health, HIV and other STIs continue to be significant national health problems, particularly among specific subpopulations or social groups (Reid, Dovidio, Ballester, & Johnson, 2014). Although African American women (AAW) have experienced a 21% decline in HIV infection rates since 2008, this group continues to represent the highest proportion of infected women with rates 20 times higher than that of white women and nearly 5 times that of Latina women (Carter et al, 2013; Centers for Disease Control and Prevention, 2014c).…”

“…The identification of patterns of sexual risk behaviors and development of interventions to reduce or eliminate those behaviors has long since been the focus of research studies examining the sexual and reproductive health of AAW (McLellan-Lemal et al, 2012;Neblett et al, 2011;Reid et al, 2014). With heterosexual contact being attributed to most new HIV infections and other STIs in AAW, behavioral factors frequently identified in the examination of sexual risk for these women include: inconsistent condom use, having multiple or concurrent sexual partners, and the use of illicit drugs (Centers for Disease Control and Prevention, 2014b;McLellan-Lemal et al, 2013;Perkins, Stennis, Taylor Spriggs, Kwegyir-Afful, & Prather, 2014).…”