Alice Ma

Factors Influencing Health Care Access Perceptions and Care-seeking Behaviors of Immigrant Latino Sexual Minority Men and Transgender Individuals: Baseline Findings from the HOLA Intervention Study

Little is known about immigrant Latino sexual minorities’ health seeking behaviors. This study examined factors associated with perceptions of access and actual care behaviors among this population in North Carolina. Methods. A community-based participatory research partnership recruited 180 Latino sexual minority men and transgender individuals within preexisting social networks to participate in a sexual health intervention. Mixed-effects logistic regression models and GIS mapping examined factors influencing health care access perceptions and use of services (HIV testing and routine check-ups). Results. Results indicate that perceptions of access and actual care behaviors are low and affected by individual and structural factors, including: years living in NC, reported poor general health, perceptions of discrimination, micro-, meso-, and macro-level barriers, and residence in a Medically Underserved Area. Discussion. To improve Latino sexual minority health, focus must be placed on multiple levels, including: individual characteristics (e.g., demographics), clinic factors (e.g., provider competence and clinic environment), and structural factors (e.g., discrimination).

Transitioning HIV-infected adolescents to adult care at 14 clinics across the United States: using adolescent and adult providers’ insights to create multi-level solutions to address transition barriers

ABSTRACT HIV-infected adolescents have disproportionately low rates of care retention and viral suppression. Approximately half disengage from care while transitioning to adult clinics, in part due to fragmented care systems and lack of streamlined protocols. We conducted 58 qualitative interviews with social service and health care providers across 14 Adolescent Trials Network clinics (n = 28) and 20 adult clinics that receive transitioning adolescents (n = 30) from August 2015–June 2016. We used the constant comparative approach to examine processes, barriers, and facilitators of adult care transition. Transition barriers coalesced around three levels. Structural: insurance eligibility, transportation, and HIV-related stigma; Clinical: inter-clinic communication, differences in care cultures, and resource/personnel limitations; and Individual: adolescents’ transition readiness and developmental capacity. Staff-initiated solutions (e.g., grant-funded transportation) were often unsustainable and applied individual-level solutions to structural-level barriers. Comprehensive initiatives, which develop collaborative policies and protocols that support providers’ ability to match the solution and barrier level (i.e., structural-to-structural), are sorely needed. These initiatives should also support local systematic planning to facilitate inter-clinic structures and communication. Such approaches will help HIV-infected adolescents transition to adult care and improve long-term health outcomes.

Depressive Symptoms among Latino Sexual Minority Men and Latina Transgender Women in a New Settlement State: The Role of Perceived Discrimination

Background. Little is known about the role of discrimination on depression among Latino sexual and gender identity minorities. This manuscript examined the relationship between ethnic/racial discrimination and sexual discrimination on clinically significant depressive symptoms among Latino sexual minority men (i.e., gay and bisexual men and other men who have sex with men) and Latina transgender women. Methods. A community-based participatory research partnership recruited participants (N = 186; 80.6% cisgender men) in North Carolina to a social network-based HIV intervention. Using baseline data, we quantified the amount of perceived discrimination and conducted mixed-effects logistic regression analyses to examine correlates of clinically significant depressive symptoms. Results. A high percentage of participants reported ethnic/racial discrimination (73.7%) and sexual discrimination (53.8%). In the multivariable models, ethnic/racial discrimination, sexual discrimination, masculinity, fatalism, and social support were significantly associated with clinically significant depressive symptoms. Discussion. Improving mental health requires multilevel interventions that address pertinent individual, interpersonal, and system level factors.

HIV Prevention Interventions with Adolescents: Innovations and Challenges in Partnerships across the Integrated Transitions Model

In the USA, the incidence of HIV is rapidly increasing among young people. To increase the effectiveness of HIV prevention and care, efforts for adolescents should consist of interdisciplinary partnerships that address the complexity of the population and co-occurring physical and mental health issues. Partnerships among academic researchers; representatives from educational and testing organizations, health departments, clinics, and other community-based organizations (including youth-serving organizations); and adolescents themselves are essential. These partnerships can produce innovative strategies that address adolescent-specific issues related to HIV prevention, diagnosis, and care, as well as cultural norms and gender-role expectations particular to adolescents, their developmental stage, and their local communities. Such partnerships can also increase understanding during exploratory and formative evaluation phases, inform the development of interventions and programs that are most relevant to adolescents, and increase the likelihood that these interventions and programs will be implemented, found to be effective, and sustained (if warranted) by communities. Some academic researchers, clinicians, and other providers partner directly with adolescents, while others partner with youth-serving organizations to engage and work with adolescents.

Using the Multiphase Optimization Strategy (MOST) to Develop an Optimized Online STI Preventive Intervention Aimed at College Students: Description of Conceptual Model and Iterative Approach to Optimization

This chapter describes some aspects of an application of the multiphase optimization strategy (MOST) to optimize and evaluate itMatters, an online intervention that targets the intersection of alcohol use and sexual behaviors to reduce sexually transmitted infections (STIs) among college students. The chapter emphasizes two aspects of this application. First, we describe the development of a detailed conceptual model during the preparation phase of MOST. This conceptual model guided decisions such as the choice of outcome variables. Second, we describe an iterative approach to experimentation during the optimization phase of MOST. The objective of the iterative approach is to build a highly effective intervention by using repeated optimization trials to evaluate which intervention components meet a given criterion for effectiveness and which do not. Revisions are undertaken to improve the components that do not meet the criterion, and then a subsequent optimization trial is used to reevaluate the components. This iterative approach has the potential to enable the investigator to develop more effective, efficient, economical, and scalable interventions.

The “kaleidoscope” of factors influencing urban adolescent pregnancy in Baltimore, Maryland

Existing intervention and prevention efforts for adolescent pregnancy focus primarily on individual-level approaches; however, there is an emerging expectation to include a more contextually based social-ecological approach. This approach is salient in urban communities like Baltimore, Maryland, with one of the nation’s highest adolescent pregnancy and birth rates. Poverty, community violence, and compromised school systems further complicate the precursors and consequences of adolescent pregnancy. In this mixed methods study, we conducted interviews with key informants (n = 16) from community-based organizations, health departments, foundations, the public school system, clinics, and the faith community who worked with youth in Baltimore to gain a more comprehensive perspective on factors affecting adolescent pregnancy. Interviews were digitally recorded, transcribed verbatim, and analyzed using the constant comparative method. Geographic maps of select socio-demographic variables were created to examine the community context. Results highlighted contributing multi-level factors that emerged across the social-ecological model. Key informants described community- (e.g., environment, community norms, public policy; “Teen pregnancy is norm in many communities”), interpersonal- (e.g., peer social norms; “If you don’t perceive that you have a whole lot of options, you might just kind-of do what everybody else does”), and intrapersonal-level (e.g., specific developmental phase, self-esteem; “You need somebody to love and somebody to love you back”) influences on adolescent pregnancy and birth. GIS maps further illustrated disparities in adolescent birth rates, poverty level, and available community resources. Key informants recommended institutional and structural changes in the community, such as improving sexuality education and school-based health centers and increasing inter-organizational collaboration. These findings underscore the importance of considering creative community partnerships that address key social determinants of reproductive health in developing interventions to address adolescent pregnancy.

Individual and structural factors influencing HIV care linkage and engagement: Perceived barriers and solutions among HIV-positive persons

ABSTRACT To meet the National HIV/AIDS Strategy’s goals of reducing and preventing HIV transmission, understanding factors that shape HIV-positive persons’ care-seeking behaviors is critical. Accordingly, this study examined factors that affect HIV care linkage and engagement. Six focus groups were conducted with 33 HIV-positive persons living in North Carolina. A variety of factors influenced care behaviors, including: structural and policy factors, relationship with HIV care systems, and individuals’ personal characteristics. Participants also provided solutions for addressing specific factors to care. Improving clinical services and utilizing context-specific strategies can help facilitate greater care linkage and engagement.