The lack of relevant messages about HIV diagnosis and prevention may be a reason why infection rates have not been low among young people, despite the significant decline among all other demographics.
Thanks to a $4.9 million grant from the National Institute of Mental Health, Florida State University behavioral scientist Sylvie Naar hopes to change that.
“The number one problem is that this population doesn’t have as much access to HIV testing as it should be,” said Nar, a professor at Fuso University School of Medicine. “The question is why?” What we hear is that there are a lot of factors, but one of those factors is stigma and their experience when they go to get tested.”
Naar plans to learn more about these experiences through the eyes of the at-risk population and translate these lessons into more effective prevention and treatment strategies.
She and her research team at the FSU Center for Translational Behavioral Science (CTBS) work with sexual minority youth — men from the LGBTQ community — ages 18 to 29. They represent the races most affected by the epidemic in many of Florida’s counties that are HIV hot spots. The men will visit HIV testing sites and provide feedback on their experiences.
“Observations from a population perspective are much more valid than the researchers’ observations when it comes to understanding interactions with health care providers,” Nar said.
The assessments will help identify areas of training that need improvement so that public health professionals can provide evidence-based practices that are effective with populations at risk.
To end the epidemic, people should be aware of their own [HIV] “They need access to preventive services,” Naar said. “We are trying to develop organizational-level interventions and implementation strategies to improve care – preventive care – for sexual minority men, with the ultimate goal of reducing and eliminating HIV.”
Collecting feedback from the perspective of the at-risk population comes from the concept of the “mystery shopper,” where stores assess their workforce through private investigators posing as customers.
The goal is to enhance the provision of evidence-based counseling, testing and referral services for HIV diagnosis and prevention in a manner that is developmentally sensitive and appropriate to the patient’s culture. A 2019 University of Pennsylvania study, using mystery shoppers at CTR sites in three cities, found that providers were unwilling to provide developmentally appropriate and culturally appropriate services to patients, including young men who have sex with men.
After a six-month start-up phase that began in August, the start-up will include 42 Florida Department of Health contract sites. Seven sites will be randomly selected to start the intervention, with seven new sites rotating every three months.
In 2019, the US Department of Health and Human Services developed the Initiative to End the HIV Epidemic in the US, with the goal being to reduce new HIV infections by 90% by 2030. Initially focusing on 50 US regions representing more than Half of the new HIV diagnoses, plus seven states (including Florida) with a significant rural burden, the initiative provided those 57 jurisdictions with additional resources, technology and expertise to expand HIV prevention and treatment activities.
In Florida, the project focuses on seven counties with high rates of HIV infection: Broward, Duval, Hillsborough, Miami-Dade, Orange, Palm Beach and Pinellas. Specifically, it examines men from sexual minorities who are part of the only age group (20-29) that has not seen a decline in HIV infection in a decade.
Nar Lab has extensive experience with implementation strategies. Tailor-made motivational interview training, a known approach to improving patient interactions with the service provider, reducing stigma and ultimately leading to better outcomes, will be central to the project.
“With my latest major grant from HIV, we have learned a lot about regulatory factors that can enhance or interfere with evidence-based practice,” Nar said. “Healthcare providers are going to get some agency-wide technical assistance with driving and other things that we know improve chronic stressors.”
The collaborative effort will include researchers from Nova Southeastern University and the University of Pennsylvania.
CTBS faculty members Evan Balan and Sarah Green will work alongside Nar and research assistants assigned to the project.