A lack of relatable messaging around HIV diagnoses and prevention could be a reason infection rates aren’t falling among young adults, despite dramatic decreases among all other demographics.
With a $4.9 million grant from the National Institute of Mental Health, Florida State University behavioral scientist Sylvie Naar hopes to change that.
“The No. 1 issue is that this is a population that is not accessing HIV testing as much as they should be,” said Naar, a professor in the FSU College of Medicine. “The question is, ‘Why?’ What we hear is there are a lot of factors, but one of the factors is stigma and their experience when they go get tested.”
Naar plans to learn more about those experiences through the eyes of the vulnerable population and to translate those lessons into more effective prevention and treatment strategies.
She and her research team at the FSU Center for Translational Behavioral Science (CTBS) are working with young sexual minority men — men who are members of the LGBTQ population — ages 18-29. They represent the ethnicities most affected by the epidemic in several Florida counties considered HIV hotspots. The men will visit HIV testing sites and provide assessments about their experiences.
“Observations from the perspective of the population are much more valid than researcher observations when it comes to understanding interactions with health care providers,” Naar said.
The assessments will help pinpoint training areas that need to be improved so public health professionals will better deliver evidence-based practices that are effective with the at-risk population.
“To end the epidemic, people need to be aware of their [HIV] status, and they need to have access to preventive services,” Naar said. “We’re trying to develop organizational-level interventions and implementation strategies to improve the care — preventive care — of young sexual minority men, with the ultimate goal of reducing and eliminating HIV.”
Gathering observations from the perspective of an at-risk population comes from the “mystery shopper” concept, where stores assess their workforce through private investigators who pose as customers.
The goal is to promote the delivery of evidence-based counseling, testing and referral services (CTR) for HIV diagnosis and prevention in a manner that is sensitive to a patient’s developmental level and appropriate to their culture. A 2019 study by the University of Pennsylvania, using mystery shoppers at CTR sites in three cities, found that providers were unprepared to deliver developmentally appropriate and culturally competent services to patients, including young men who have sex with men.
Following the six-month start-up phase that began in August, the rollout will involve 42 Florida Department of Health-contracted sites. Seven sites will be randomly selected to begin the intervention, with a rotation of seven new sites every three months.
In 2019, the U.S. Department of Health and Human Services developed the initiative Ending the HIV Epidemic in the U.S. The goal was a 90% reduction in new HIV infections by 2030. Focusing initially on 50 areas in the U.S. that account for more than half of new HIV diagnoses, plus seven states (including Florida) with a substantial 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 of the counties with high rates of HIV infections: Broward, Duval, Hillsborough, Miami-Dade, Orange, Palm Beach and Pinellas. Specifically, it examines young sexual minority men who constitute a portion of the only age group (20-29) that has not seen a decrease in HIV cases in a decade.
Naar’s lab has significant experience in implementation strategies. Tailored motivational interview training, an approach known to improve patient-provider interactions, reduce feelings of stigma and ultimately lead to better outcomes, will be central to the project.
“With my last big HIV grant, we learned a lot about organizational factors that can promote or interfere with evidence-based practice,” Naar said. “The health care providers will get some technical assistance at the agency level in terms of leadership 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 Iván Balán and Sara Green will work alongside Naar and research assistants hired for the project.