“Nobody wants to have conversation about HIV.” A thematic analysis of in-depth interviews with Black adolescent women and providers about strategies for discussing sexual health and HIV prevention

Abstract

Background Black adolescent girls and young women (AGYW) in the U.S. Southeast are disproportionately burdened by HIV. Infrequent assessment of sexual health in clinical encounters may contribute to low PrEP uptake for this population. This study explores Black AGYW and providers’ perspectives on engaging in discussions about sexual health, including PrEP. Methods In-depth interviews (IDIs) were conducted with Black AGYW ages 14-24 and healthcare providers (MD, DO, NP, PA) who self-reported caring for Black AGYWs in Alabama. IDIs were grounded in Andersen’s Behavioral Model of Health Service Utilization to explore barriers and facilitators to sexual health discussions. After separate analyses, AGYW and provider IDIs were aggregated and reanalyzed using thematic analysis to identify themes related to their views on ways to improve Black AGYW engagement in sexual health discussions while in clinical settings. Results Twelve Black AGYW and 11 providers completed IDIs. Client median age was 21, representing nine Alabama counties. Providers were predominately non-Hispanic White (82%), female (73%), and physicians (64%). Themes about ways to improve sexual health discussions included: 1) Improve sexual health education for providers and adolescents; 2) Normalize conversations in clinical settings; 3) Engage communities to continue these conversations outside of clinical settings. Conclusions Sexual health and HIV prevention discussions with Black AGYW are not occurring. This study is one of the first to to identify and highlight Black AGYW and provider-identified shared strategies for improving these discussions. Operationalizing these strategies is crucial to facilitating these discussions.