Tashuna Albritton

In Their Own Voices: Rural African American Youth Speak Out About Community-Based HIV Prevention Interventions

Background: The HIV epidemic is a major public health problem in the United States, particularly among rural African American adolescents and young adults. Objectives: We sought to explore young, rural African American’s perspectives about key programmatic components to consider when designing youth-targeted, community- based HIV prevention interventions. Methods: We report data from four focus groups with adolescents and young adults aged 16 to 24 (n = 38) conducted as part of a community-based participatory research (CBPR) project designed to develop multilevel HIV risk reduction interventions in two rural North Carolina communities with high HIV rates. Analysis was performed by academic and community partners using a modified grounded theory approach to content analysis. Results: Interventions should target preadolescents and early adolescents rather than older adolescents and young adults in an effort to “catch them while they’re young.” Intervention developers should obtain input from local young people regarding critical programmatic components, such as whom to employ as study recruiters and intervention leaders; intervention format and delivery options, acceptable recruitment and intervention locations, and incentive structures. Participants believe selecting community collaborators representing varied community sectors is critical. Important barriers to address included limited transportation, discomfort communicating about sexual issues, lack of community interest in HIV prevention, and unwillingness to acknowledge and address sexual activity among adolescents. Conclusion: When designing HIV/AIDS prevention interventions, targeting young people, it is important to form academic–community partnerships that ensure young people’s perspectives are integral to the intervention development process.

Exploring Social Networking Technologies as Tools for HIV Prevention for Men Who Have Sex With Men.

Social networking technologies are influential among men who have sex with men (MSM) and may be an important strategy for HIV prevention. We conducted focus groups with HIV positive and negative participants. Almost all participants used social networking sites to meet new friends and sexual partners. The main obstacle to effective HIV prevention campaigns in social networking platforms was stigmatization based on homosexuality as well as HIV status. Persistent stigma associated with HIV status and disclosure was cited as a top reason for avoiding HIV-related conversations while meeting new partners using social technologies. Further, social networking sites have different social etiquettes and rules that may increase HIV risk by discouraging HIV status disclosure. Overall, successful interventions for MSM using social networking technologies must consider aspects of privacy, stigma, and social norms in order to enact HIV reduction among MSM.

Condom Use Self-Efficacy Among Younger Rural Adolescents The Influence of Parent-Teen Communication, and Knowledge of and Attitudes Toward Condoms

This study examines the role of condom use knowledge and attitudes, and parent-teen communication about sex and relationship quality on reports of condom use self-efficacy among rural, African American youth. Participants were 465 North Carolinian youth (10-14 years). Results indicated that greater condom use self-efficacy was predicted by greater knowledge of condom use (β = .206; p < .001), more favorable attitudes toward condom use (β = −.20; p < .0001) and parent-teen communication about sex (β = .13; p < .05), and actual parent-teen communication about sex and dating (β = .14; p < .05). There was low agreement between parents and youth on measures related to parent-teen communication about sex. Findings call for interventions targeting improvement of condom use knowledge among early adolescents, as well as parent-teen communication about sex. In addition, given the low parent-teen agreement regarding sexual communication, parent-teen sexual communication is an important point of intervention.

Who's asking the important questions? Sexual topics discussed among young pregnant couples

The aim was to examine gender differences in sexual risk communication among young couples and factors influencing communication. Sample consisted of 296 young pregnant couples. We assessed individual, interpersonal, and community factors on sexual risk communication. The Actor–Partner Independence Model was used to assess actor and partner effects on sexual risk communication. For actor effects, being female, older, not being Hispanic, and higher condom use self-efficacy was associated with sexual risk communication. The significant partner effect was avoidant romantic attachment. Gender interactions were significant for high risk behaviors and family functioning. High risk behaviors and family functioning were associated with sexual risk communication for females but not for males. The study emphasizes the need to promote sexual risk communication among young high risk couples, particularly for males. Family support could serve as a catalyst for sexual risk communication and other sexual protective behaviors among young couples.

What about Us? Economic and Policy Changes Affecting Rural HIV/AIDS Services and Care

ABSTRACT Health care budgets and policies are chief drivers in the delivery and access to health services. Place is also a factor that affects patient and provider experiences within the health care system. We examine the impact of policy changes and subsequent budget cuts on rural HIV/AIDS care, support services, and prevention. We interviewed 11 social workers, case managers, and outreach workers who serve rural people living with HIV/AIDS. We conducted telephone interviews inquiring about the effect of economics and policies on direct practice with rural clients. We analyzed data using a content analysis approach. We found several themes from the data. Ryan White funding and policy changes shifted direct practice to a medical case management model. Changes in federal and state poverty levels affected client eligibility for the AIDS Drugs Assistance Program. Policy banning financial support for syringe service programs hindered prevention efforts to reduce HIV/AIDS transmission. Ancillary services were reduced, such as housing assistance, transportation, and emergency financial assistance. In conclusion, we highlight the importance of place-based policies to improve access to healthcare and services. We also provide recommendations for greater inclusion in HIV/AIDS-related policy development, care, and service planning for rural workers.

A Process Evaluation of an HIV/STI Intervention for Rural African American Youth:

We evaluated the fidelity and implementation of an HIV/AIDS and sexually transmitted infections intervention for rural African American youth. Using a community-based evaluation approach, community partners and researchers monitored four core process-evaluation components: reach, fidelity, dose delivered, and dose received. Researchers collected evaluation data through session observations, facilitator debriefing interviews, a youth focus group, and a satisfaction survey. For reach, more than half of the participants attended the 13 sessions. Participation varied between 62% and 100%. For fidelity, not all sessions were implemented as intended; multiple modifications occurred across sessions. For dose delivered, some lessons were missing materials and content was omitted; facilitators omitted content when there was insufficient time to complete a lesson. For dose received, engagement varied across lessons but youth reported high levels of satisfaction with the intervention. This formative process evaluation enabled us to identify and address multiple challenges to implementation.

Intimate Partner Violence Among Low-Income Fathers: Testing a Stress-Coping Model

This research used a stress-coping conceptual framework to examine intimate partner violence (IPV) among men who are fathers. The current study examined how perceived stress explained associations between stressors (e.g., employment status, psychological and physical female-to-male partner violence [FMPV], substance use, criminal justice system involvement) and male-perpetrated physical and psychological IPV. Participants were 1,971 low-income, ethnically diverse fathers involved in a statewide fatherhood program. Findings indicated that, across African American, White, and Hispanic/Latino men, male-reported FMPV and criminal justice involvement were associated with psychological and/or physical IPV via perceived stress. Employment status and alcohol use were associated with psychological IPV via perceived stress among African American men only. Implications for community-based fatherhood programs are discussed.

HIV Prevention in a Rural Community: Project GRACE—A Multigenerational Approach to Community Engagement

The burden of HIV and sexually transmitted infections (STIs) is disproportionate for the African-American community. The Project GRACE (Growing, Reaching, Advocating for Change and Empowerment) Consortium is an ongoing community–academic partnership based in eastern North Carolina that was established to address the disproportionately high rates of HIV among the African-American/black population in two eastern North Carolina counties. In this chapter, we explore the impact that the HIV and STI epidemics have had on African-American communities in the southeastern USA in general and within rural communities in North Carolina specifically. We highlight the unique ways in which community members were engaged in the formation of the Project GRACE Consortium; the development, implementation, and evaluation of the multigenerational HIV-prevention intervention known as Teach One Reach One (TORO) that was born out of this community–academic partnership; the lessons learned throughout the community engagement process; and recommendations for future research. We also describe research needs and priorities in terms of prevention and community engagement.