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      Development of a Black Caucus within the HIV Prevention Trials Network (HPTN): Representing the Perspectives of Black Men Who Have Sex with Men (MSM)

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          Abstract

          Black men who have sex with men (MSM) have disproportionate HIV disease burden in the United States. Black MSM have been underrepresented in biomedical research, including HIV clinical trials, due to a myriad of socio-structural, socio-cultural, and psychosocial factors. The HIV Prevention Trials Network (HPTN) 061, a feasibility study of a multi-component HIV prevention intervention for Black MSM in six US cities, incorporated the development and implementation of a Black Caucus as a culturally grounded model for the integration of Black MSM in clinical trials and research in HPTN. Based on a qualitative methodological approach, we describe the formation and implementation of the Black Caucus from the perspective of Black MSM key community stakeholders. Three major themes emerged from the qualitative narratives: (1) the role of the Black Caucus in shaping the HPTN, (2) how the Black Caucus addresses the needs of Black MSM communities pertaining to the influence of race and sexual identity, and (3) socio-cultural needs of Black MSM. These findings have implications for the provision of culturally congruent expertise, community engagement, cultural mistrust, recruitment and retention of Black MSM in HIV clinical trials, culturally-relevant study design and implementation, and the role of developing Black MSM prevention researchers.

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          Reducing Racial Inequities in Health: Using What We Already Know to Take Action

          This paper provides an overview of the scientific evidence pointing to critically needed steps to reduce racial inequities in health. First, it argues that communities of opportunity should be developed to minimize some of the adverse impacts of systemic racism. These are communities that provide early childhood development resources, implement policies to reduce childhood poverty, provide work and income support opportunities for adults, and ensure healthy housing and neighborhood conditions. Second, the healthcare system needs new emphases on ensuring access to high quality care for all, strengthening preventive health care approaches, addressing patients’ social needs as part of healthcare delivery, and diversifying the healthcare work force to more closely reflect the demographic composition of the patient population. Finally, new research is needed to identify the optimal strategies to build political will and support to address social inequities in health. This will include initiatives to raise awareness levels of the pervasiveness of inequities in health, build empathy and support for addressing inequities, enhance the capacity of individuals and communities to actively participate in intervention efforts and implement large scale efforts to reduce racial prejudice, ideologies, and stereotypes in the larger culture that undergird policy preferences that initiate and sustain inequities.
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            Stigma, medical mistrust, and perceived racism may affect PrEP awareness and uptake in black compared to white gay and bisexual men in Jackson, Mississippi and Boston, Massachusetts

            Gay and bisexual men and other men who have sex with men (MSM) account for more than two thirds of new HIV infections in the U.S., with Black MSM experiencing the greatest burden. Antiretroviral pre-exposure prophylaxis (PrEP) can reduce MSM's vulnerability to HIV infection. Uptake of PrEP has been limited, particularly among racial and ethnic minority MSM. Four semi-structured focus groups with gay and bisexual men and other MSM at risk for HIV infection were convened in Boston and Jackson in late 2013. The analysis plan utilized a within-case, across-case approach to code and analyze emerging themes, and to compare results across the two cities. Participants recruited in Jackson were primarily Black gay men, while Boston participants were mostly non-Hispanic White gay men. Participants in both sites shared concerns about medication side effects and culturally insensitive health care for gay men. Jackson participants described stronger medical mistrust, and more frequently described experiences of anti-gay and HIV related stigma. Multiple addressable barriers to PrEP uptake were described. Information about side effects should be explicitly addressed in PrEP education campaigns. Providers and health departments should address medical mistrust, especially among Black gay and bisexual men and other MSM, in part by training providers in how to provide affirming, culturally competent care. Medicaid should be expanded in Mississippi to cover low-income young Black gay and bisexual men and other MSM.
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              Understanding structural barriers to accessing HIV testing and prevention services among black men who have sex with men (BMSM) in the United States.

              Structural-level factors have contributed to the substantial disproportionate rates of HIV among Black men who have sex with men (BMSM) in the United States. Despite insufficient HIV testing patterns, however, there is a void in research investigating the relationship between structural factors and access to HIV testing and prevention services among BMSM. Building on previous scholarly work and incorporating a dynamic social systems conceptual framework, we conducted a comprehensive review of the literature on structural barriers to HIV testing and prevention services among BMSM across four domains: healthcare, stigma and discrimination, incarceration, and poverty. We found that BMSM experience inadequate access to culturally competent services, stigma and discrimination that impede access to services, a deficiency of services in correctional institutions, and limited services in areas where BMSM live. Structural interventions that eliminate barriers to HIV testing and prevention services and provide BMSM with core skills to navigate complex systems are needed.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                03 February 2020
                February 2020
                : 17
                : 3
                : 871
                Affiliations
                [1 ]Gilead Sciences, Foster City, CA 94404, USA; cclwat@ 123456gmail.com
                [2 ]Department of Human Development, State University of New York at Binghamton, Binghamton, NY 13902, USA
                [3 ]Faculty of Humanities, University of Johannesburg, Johannesburg 2006, South Africa
                [4 ]Science Facilitation Department, FHI 360, Durham, NC 27701, USA; JLucas@ 123456fhi360.org (J.P.L.); karadhya@ 123456gmail.com (K.A.)
                [5 ]Department of Health Administration, School of Nursing and Health Sciences, Capella University, Minneapolis, MN 55402, USA; oliver2387@ 123456bellsouth.net
                [6 ]David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90024, USA; gdvvoxx@ 123456aol.com
                [7 ]Invitae, San Francisco, CA 93103, USA
                [8 ]Harriet Rothkopf Heilbrunn School of Nursing, Long Island University-Brooklyn, Brooklyn, NY 11201, USA; sheldon.fields40@ 123456gmail.com
                [9 ]Iona College, New Rochelle, NY 10801, USA; dwheeler@ 123456iona.edu
                Author notes
                [* ]Correspondence: lwilton@ 123456binghamton.edu ; Tel.: +1-607-777-9215
                [†]

                Members are listed at the end of Acknowledgments.

                Author information
                https://orcid.org/0000-0003-0179-6824
                https://orcid.org/0000-0003-2087-6571
                Article
                ijerph-17-00871
                10.3390/ijerph17030871
                7037695
                32028553
                bfae1797-7cae-48e0-8d25-78ce76fba4fa
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 10 December 2019
                : 28 January 2020
                Categories
                Article

                Public health
                black men who have sex with men (msm),community-based participatory research,community engagement,qualitative,hiv

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