Examining HIV Organizational Structures and their Influence on Engagement with Young Black Gay, Bisexual, and other Men who have Sex with Men in Atlanta Open Access

Abstract

Background: Young black gay, bisexual, and other men who have sex with men (YB-GBMSM) are disproportionately impacted by HIV. Structural influences on these disparities, including characteristics of the various organizations that serve YB-GBMSM, are understudied to date. To gain insight into quality of services provided by organizations in Atlanta, we drew on Weick’s model of organizing, which defines “enactment” as the process by which organizations define problems and determine appropriate solutions. 

Methods: We conducted qualitative interviews with 28 HIV service providers (representing 20 healthcare and community-based organizations) in Atlanta. Participants responded to questions regarding their organizations’ strategies for meeting the needs of YB-GBMSM. Interview transcripts were coded thematically, grouped by type of enactment, and analyzed using a constant comparison approach. 

Results: Organizations’ enactment of HIV service provision could be described as following either simplified “rules”, or more nuanced “communication behavior cycles” (CBCs). Examples of rules included emphasis on patient quotas, one-time staff trainings, and limited hours of operation. Rules were often viewed as rigid, out-of-touch, and direct inhibitors of engagement with YB-GBMSM. Examples of CBCs included relationship-building, patient-feedback loops and rejection of traditional hierarchical structures. CBCs fostered a broader definition of HIV care, creative insights to combating the epidemic, and increased levels of cultural awareness and community buy-in.

Conclusion: HIV in YB-GBMSM is a multifaceted epidemic that requires an equally complex response. Organizations should strive to enact CBCs, to cultivate culturally conscious and innovative definitions of HIV care and foster new approaches to prevention and engagement by YB-GBMSM. 

Table of Contents

Introduction 1

Background and Rationale 1

Problem statement 1

Weick’s Model of Organizing 2

Purpose statement 3

Research question 3

Significance statement 3

Definition of terms 3

Literature Review 5

HIV in YB-GBMSM 5

Socio-contextual Determinants of HIV Incidence Among YB-GBMSM 7

Weick’s Theory of Organizing in Practice 8

Methods 11

Study Context 11

Participant Recruitment 11

Data Collection 12

Data Analysis 12

Ethical Considerations 13

Results 14

Rules 14

Communication Behavior Cycles 21

Discussion 30

Recommendations 30

Limitations 32

Conclusion 32

Public Health Implications 33

References 34

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Psychology, Social Health Sciences, Public Health Business Administration, Management
Keyword	YB-GBMSM Social Determinants of Health Health Systems HIV
Committee Chair / Thesis Advisor	Sophia Hussen, Emory University

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