Measuring the Impact of Racism on HIV

Principal Investigator:  Sean Arayasirikul, PhD, UC Irvine

Budget:  $321,204

Start Date: February 1, 2024        End Date: January 31, 2026

Project Abstract:  While literature evidencing racial disparities may be numerous, measurement that addresses the complex totalitizing nature of structural racism in relation to HIV-STI epidemics is conceptually thin. This study uses mixed-methods to examine how geographies and social spaces – as well as the policies and practices embedded therein - are racialized. All spaces are social; they involve people and practices; they hold meaning, carry history, transmit cultural norms and ideology, and provide critical context for understanding HIV-STI risk. This study seeks to understand how structural racism vis-à-vis communities’ racialized geographies are enacted through social spaces, driving structural vulnerability among sexual and gender minoritized people of color (SGMPoC) inequitably placed at risk for HIV-STI infection. This study is intentionally and explicitly intersectional, operating on the notion that all oppressions are linked in a matrix of domination. As a result, although our focus will be to measure geographic and spatial determinants of structural racism, we will account for other structural oppressions specifically structural homophobia, cissexism or transphobia, sexism, and xenophobia and their intersections. The House and Ball Community (HBC) emerged in the 1970s as an underground sub-culture of SGMPoC to combat structural racism. Because the HBC is at the confluence of intersectional oppression, this study will not only further our understanding of HIV-STI vulnerability and anti-Black racism, but also racism and xenophobia that Latine HBC members face, as well as homophobia, transphobia, and misogyny that SGMPoC face. SGMPoC in the HBC have not only navigated racialized spaces out of survival, they have created spaces out of resilience for their own liberation. This Public Health Critical Race praxis informed study uses diverse, critical, intersectional approaches and meaningful engagement through CBPR to center the experiential knowledge of minoritized communities. It examines structural racism in a multi-level, multi-faceted, interconnected, systemic, ecologically valid way. No studies have focused on spatial and geographical determinants of structural racism in this population in relation to HIV-STI epidemics. Further, the PI of this study is a member and national leader in the HBC; this study is not just community-based, but GROUNDED IN community.

Principal Investigator:  Nina Harawa, PhD MPH, UC Los Angeles

Budget:  $299,294

Start Date: February 1, 2024        End Date: January 31, 2026

Project Abstract:  Issue: Many people of color with and at risk for HIV legitimately mistrust health care systems and providers because of intersectional discrimination, including structural racism, yet still achieve and maintain positive outcomes in the face of such inequities. We seek to understand the nature of both protective and harmful medical mistrust and trust and the role of positive coping in helping sexual minority men (SMM) who are racialize navigate healthcare systems and prevent HIV or adhere to treatment and achieve viral suppression in spite of marginalization, stigmatization, and racism. For example, we will examine how Black and Latino SMM frame their experiences; communicate with care providers; and respond to having a condition that disproportionately affects their racial, ethnic, sexual, and gender groups. What strategies do they employ to overcome negative healthcare perceptions and experiences -- including lack of trustworthiness? What key support systems do they use and how? Despite the availability of several published measures on medical mistrust and positive coping, they do not fully capture the complexities of either for Black or Latino men.   Frameworks: Public Health Critical Race Praxis (PHCRP) and Positive Deviance.  Approach: Building on our established community partnerships with Bienestar Human Services and APLA Health, we propose a strengths-based, qualitative study to address this measurement limitation by examining positive coping strategies most relevant to HIV care engagement and delineating nuances related to mistrust among Black and Latino SMM. We will leverage existing data from approximately 160 audio recordings of the Still Climbin' and Siempre Seguire' group intervention sessions to identify, develop, and refine survey items for positive coping, hazardous medical mistrust (i.e., may impede healthcare engagement), and protective medical trust and mistrust (i.e., may promote patient self-advocacy and healthcare engagement). We propose to use the Positive Deviance Framework and PHCRP to underpin our research on the measurement of coping with intersectional stigma (particularly racism) and of medical mistrust. Positive Deviance refers to exhibiting good health-related outcomes in the face of extreme barriers. PHCRP illuminates the mechanisms by which racism contributes to health disparities and provides guidance for critical inquiry.

Budget:  $336,999

Start Date: February 1, 2024        End Date: January 31, 2026

Project Abstract:  In 2022, San Francisco AIDS Foundation (SFAF) tested 11,519 people and 93% of 2,906 identified as Latino/a/x sexual and gender minorities (LSGM). SFAF indicates that Latino/a/x are less likely to be virally suppressed and greater efforts are needed to increase PrEP enrollment. The plan to End the HIV Epidemic (EHE) must address Latino/a/x HIV disparities to achieve its goal of reducing new HIV diagnoses by 90% for 2030. EHE relies on Molecular HIV Surveillance (MHS) for Cluster Detection and Response (CDR) to reduce HIV transmission by facilitating access to HIV testing, preexposure prophylaxis (PrEP), and treatment as prevention (TasP). EHE has prioritized MHS without addressing structural racism or meaningful involvement of community stakeholders. MHS has fueled government mistrust among highly marginalized populations due to concerns about lack of informed consent, HIV criminalization, and persecution of immigrants. Public health staff have indicated that MHS will discourage people from getting tested because they are “afraid of being tracked.” We seek to explore: How does structural racism influence MHS/CDR interventions to enhance access to HIV services for Latino/a/x in the Bay Area? Project COMPA is innovative by taking a community-based approach on exploring how race, racism, and power influence government mistrust related to MHS activities for Latino/a/x.  A public health critical race (PHCR) methodology will be applied to understand how racial consciousness influence HIV disparities among Latino/a/x. We will administer a community based participatory research framework with SFAF to enhance research decision-making process to elevate PHCR. The investigators insider LSGM perspective will strengthen endeavors exploring the implications of racial consciousness, supplemented by their experience addressing HIV/AIDS among Latino/a/x. PHCR foci will guide the mixed methods approach: AIM 1, in-depth interviews with LSGMs and HIV service providers will enhance our understanding of racial relations (Focus 1) and knowledge production (Focus 2) for EHE. Qualitative findings on racial relations will increase knowledge production for AIM 2, the quantitative phase will develop standardized measures (Focus 3) to determine implications of structural racism for Latino/a/x and HIV. AIM 3, develop a community-centered action plan (Focus 4) to mitigate HIV outbreaks.