Sayward E Harrison1,2, Kathryn Muessig3,4, Tonia Poteat5, Kimberly Koester6, Alyssa Vecchio3, Mariajosé Paton1, Sarah J Miller1, Nastacia Pereira5, Orlando Harris7, Janet Myers6, Chadwick Campbell6, Lisa Hightow-Weidman3,4. 1. Department of Psychology, University of South Carolina, Barnwell College, Columbia, SC. 2. South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC. 3. Institute of Global Health and Infectious Diseases, University of North Carolina, School of Medicine, Chapel Hill, NC. 4. Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC. 5. Center for Health Equity Research, University of North Carolina, School of Medicine, Chapel Hill, NC. 6. School of Medicine, University of California, San Francisco, CA; and. 7. Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA.
Abstract
BACKGROUND: Racist socio-political and economic systems in the United States are root causes of HIV disparities among minoritized individuals. However, within HIV implementation science literature, there is scarce empirical research on how to effectively counter racism. This article names racism and White supremacy as key challenges to the success of the Ending the HIV Epidemic (EHE) initiative and delineates opportunities to integrate anti-racism into HIV interventions. METHODS: Formative data were synthesized from 3 EHE studies in California, North Carolina, and South Carolina. Each study engaged with community stakeholders to inform pre-exposure prophylaxis interventions. Key informant interviews and focus groups were used to query individuals-including Black individuals-about implementation challenges. Although racism was not an a priori focus of included studies, discourse on race and racism emerged as key study findings from all projects. RESULTS: Across diverse stakeholder groups and EHE locales, participants described racism as a threat to the success of the EHE initiative. Institutional and structural racism, intersectional stigma, and maltreatment of minoritized individuals within healthcare systems were cited as challenges to pre-exposure prophylaxis scale-up. Some recommendations for addressing racism were given-yet these primarily focused on the individual level (eg, enhanced training, outreach). CONCLUSIONS: EHE implementation scientists should commit to measurable anti-racist actions. To this end, we present a series of recommendations to help investigators evaluate the extent to which they are taking actionable steps to counter racism to improve the adoption, implementation, and real-world impact of EHE interventions for people of color.
BACKGROUND: Racist socio-political and economic systems in the United States are root causes of HIV disparities among minoritized individuals. However, within HIV implementation science literature, there is scarce empirical research on how to effectively counter racism. This article names racism and White supremacy as key challenges to the success of the Ending the HIV Epidemic (EHE) initiative and delineates opportunities to integrate anti-racism into HIV interventions. METHODS: Formative data were synthesized from 3 EHE studies in California, North Carolina, and South Carolina. Each study engaged with community stakeholders to inform pre-exposure prophylaxis interventions. Key informant interviews and focus groups were used to query individuals-including Black individuals-about implementation challenges. Although racism was not an a priori focus of included studies, discourse on race and racism emerged as key study findings from all projects. RESULTS: Across diverse stakeholder groups and EHE locales, participants described racism as a threat to the success of the EHE initiative. Institutional and structural racism, intersectional stigma, and maltreatment of minoritized individuals within healthcare systems were cited as challenges to pre-exposure prophylaxis scale-up. Some recommendations for addressing racism were given-yet these primarily focused on the individual level (eg, enhanced training, outreach). CONCLUSIONS: EHE implementation scientists should commit to measurable anti-racist actions. To this end, we present a series of recommendations to help investigators evaluate the extent to which they are taking actionable steps to counter racism to improve the adoption, implementation, and real-world impact of EHE interventions for people of color.
Authors: Patrick S Sullivan; Justin Knox; Jeb Jones; Jennifer Taussig; Mariah Valentine Graves; Greg Millett; Nicole Luisi; Eric Hall; Travis H Sanchez; Carlos Del Rio; Colleen Kelley; Eli S Rosenberg; Jodie L Guest Journal: J Int AIDS Soc Date: 2021-04 Impact factor: 5.396