Improving Philadelphia Health Department Services to Prevent HIV Infection In Young Black Men Who Have Sex With Men (YBMSM): A Qualitative Study Open Access

Hoffman, Caitlin Elizabeth (2016)

Permanent URL: https://etd.library.emory.edu/concern/etds/cv43nx101?locale=en
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Abstract

Background: BMSM in Philadelphia face an HIV infection rate that is five times the national average. The highest incidence is found in BMSM 13-24 years old, which accounted for 44% of all new HIV infections in Philadelphia in 2014. There is little qualitative data available for YBMSM in Philadelphia. The purpose of this study is to explore the social and behavioral barriers that hinder HIV prevention efforts and to identify gaps in health care that could better prevent HIV in Philadelphia. A clearer understanding of the risk taking and sexual behaviors of YBMSM may help improve prevention programs.

Methods: In-depth interviews were conducted with 10 YBMSM living in Philadelphia. Participants were recruited from health department surveillance databases between January-November 2015. Eligibility was based on 1) negative laboratory-confirmed HIV test at the time of 2) positive rectal chlamydia/gonorrhea test reported to the health department in 2015 3) being between 18-24 years old and 4) identifying as a Black/African American male. A total of 114 young men were eligible for the study and saturation was reached after 10 interviews. Using NVivo qualitative software, a qualitative description approach was used within the Integrated Behavioral Model to guide analysis.

Results: Six main themes emerged from data analysis: 1) Partner Dynamics, 2) Improving Relationships with Providers and Health Messaging, 3) Perception of HIV, 4) Conflict of condomless anal intercourse (CAI), 5) STD/HIV Knowledge and Skepticism with Health Care and 6) Testing is Valued.

Conclusions: Perceived norms, attitudes and self-agency were influential in the participant's intentions to have CAI, condom negotiation and testing for HIV/STDs. Partner dynamics, especially age, may play a large role in the decision to use condoms, in defining sex roles, and in discussing sexual health, including HIV status and other protective heuristics. Participants identified friendship with health care providers and community role models as necessary elements of effective HIV prevention.

Table of Contents

Chapter 1: Introduction

Background and Significance............................................................................................. 1

YBMSM and Risk of HIV in Philadelphia....................................................................... 4

Problem Statement............................................................................................................ 7

Purpose Statement............................................................................................................ 8

Theoretical Framework..................................................................................................... 9

Research Questions........................................................................................................... 13

Significance Statement....................................................................................................... 14

Definition Term................................................................................................................ 15

Chapter 2: Literature Review

Introduction...................................................................................................................... 17

Overview of YBMSM HIV Epidemic.............................................................................. 17

National Intervention Strategies........................................................................................ 26

Philadelphia Intervention Strategies.................................................................................. 31

Chapter 3: Methodology

Introduction...................................................................................................................... 35

Study Setting..................................................................................................................... 35

Population and Sample..................................................................................................... 35

Procedures......................................................................................................................... 37

Protection of Human Subjects.......................................................................................... 39

Instrument......................................................................................................................... 39

Data Analysis Methodology............................................................................................ 41

Data Analysis Framework................................................................................................ 42

Data Quality..................................................................................................................... 43

Chapter 4: Results

Introduction...................................................................................................................... 45

Recruitment Results.......................................................................................................... 45

Description of Participants............................................................................................... 46

Themes.............................................................................................................................. 47

Theme I: Partner Dynamics ............................................................................................. 48

Theme II: Relationship with Provider & Health Messaging ............................................ 53

Theme III: Perception of HIV........................................................................................... 56

Theme IV Conflict During CAI........................................................................................ 58

Theme V: STD & HIV Knowledge is Low; Skepticism Exists......................................... 61

Theme VI: Testing is Valued............................................................................................. 63

Chapter 5: Discussion Introduction...................................................................................................................... 65

Partner Dynamics - Age and Sexual Role.................................................................. 66

Partner Dynamics - Communication and Condom Use............................................ 68

Perception of HIV........................................................................................................... 70

Health Care Providers and Health Messaging........................................................... 71

Implications for PrEP and nPEP................................................................................... 72 Testing is Valued............................................................................................................ 73 Limitations...................................................................................................................... 74 Future Direction............................................................................................................. 75 References................................................................................................................................... 78 Appendix A Consent Form........................................................................................................ 91

Appendix B Interview Guide..................................................................................................... 93

Appendix C Code Book............................................................................................................. .96

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