Human immunodeficiency virus (HIV) is a virus that attacks the immune system by decreasing the number of healthy white blood cells in the body (CDC, 2022a). In 2020, 30,636 people in the United States (US) were diagnosed with HIV (CDC, 2022b). In 2019, there were 34,800 new HIV diagnoses in the US, of which 70% or 24,500 were from same-gender-loving (SGL) men (CDC, 2022c, & HIV, 2022). Unfortunately, SGL men are disproportionally impacted by HIV, with black men being diagnosed at a higher rate (42.1) than any other racial and ethnic group (HIV, 2022). When assessing new HIV diagnoses by region, the southern region of the US reported 15,661 (51%) new HIV cases in 2020 (CDC, 2022d). With a population of 21.78 million people, the CDC (2022d) states that Florida has the second highest rate (18.2) of HIV diagnoses per 100,000 people in the South and the entire US. Per the Florida Department of Health (DOH), 4,708 people were diagnosed with HIV in the state of Florida in 2021(FDOH, 2022).
Understanding that HIV disproportionately impacts same-gender-loving (SGL) men and black men, the CHANGE program (Creating Hope and Affirming the Needs of Generational HIV Educators) was created to understand the role that structural racism, discrimination, and adverse childhood experiences (ACEs) play in the lives of adolescents and young adults (AYA) living with HIV (LWH).) The CHANGE program was created for black AYAs in the Tampa Bay area who are diagnosed with HIV and have experienced at least one ACE, including structural racism and discrimination. The CHANGE program aims to provide a safe space, a sense of community, and social support to black SGL AYA LWH. The CHANGE Program is a five-year intervention with multiple community-based activities taking place at the individual, interpersonal, and community levels of McLeroy’s Social-Ecological model.
Public Health Framework
By taking an intersectional approach to the public health framework, the CHANGE Program will assess the race, socioeconomic status, and community-level violence of participants to further understand experiences of racism and discrimination, race-based trauma, and ACE scores. The CHANGE Program intends to understand the primary, secondary, and tertiary levels of prevention by preventing, screening, and managing health outcomes related to HIV-related stigma and racial trauma (Philanthropy Network Greater Philadelphia, 2016). Overall, we intend to incorporate secondary and tertiary strategies to screen for ACEs and provide black AYAs with social support, resources, and knowledge to overcome race-based trauma and HIV-related stigma.
Focusing on the secondary level, we intend to screen all participants in the Tampa-Bay MSA for their ACE score and their lived experiences of racism, discrimination, and HIV-related stigma. While screening participants, we will take extra precautions by having a licensed therapist on site to provide trauma-informed care to any participants who feel triggered. Individuals who meet the criteria for participation will be allowed to enroll in the CHANGE program. Once enrolled, we will provide educational resources and training to combat experiences of racism, discrimination, race-based trauma, and HIV-related stigma. Additionally, participants will be placed in small groups, where they will have the opportunity to speak with other black AYA weekly to understand their lived experiences and, as a group—under the facilitation of a licensed mental health therapist—collaborate on how to combat negative experiences, and receive socioemotional support from each other, and clinical staff.
Level(s) of the Social Ecological Model
The CHANGE program will incorporate McLeroy’s Social-Ecological model to address the individual, interpersonal, and community levels (McLeroy et al, 1988).
The individual level will focus on providing social support and trauma-informed therapy to participations. Expanding upon this, HIV resources and one-on-one therapy will be provided to participants to ensure they are aware of ACEs and positive coping skills. At the individual level, special attention will be taken to focus on attitudes, knowledge, and awareness of trauma-informed therapy, ACEs, discrimination, racism, and stigma regarding HIV.
The interpersonal level will focus on small group sessions where all black AYAs will have the ability to collaborate, learn and grow with their peers under the guidance of a licensed therapist who has training in trauma-informed therapeutic approaches. Socioemotional support, trauma-informed care, and HIV care will be topics of discussion, with real-world examples being decided upon as a group to combat HIV-related stigma, race-based trauma, structural racism, and discrimination.
The community level will focus on collaborative agreements with the City of Tampa to purchase a shared space and to host our annual Social Support Fair, free HIV testing, and TEDx Talks for residents living in the Tampa Bay MSA. Special interest will be taken to educate attendees on ACEs at all events. In addition to this, we intend to pair with Metro Inclusive Health (Metro Inclusive, 2023) and JASMYN (JASMYN, n.d.) to aid in our ability to take a community-based approach.
Should this program prove to be beneficial, we will intend to work with local, state, and national legislators to craft policies focused on trauma-informed care for AYA LWH.
Trauma-Informed Principles
Understanding the historical presence that structural racism and discrimination have had in the US, this program will utilize the safety, peer support, and cultural, historical, and gender issues of the trauma-informed principles as discussed by Substance Abuse and Mental Health Services Administration (SAMHSA, 2014). Throughout the implementation of the CHANGE program, the safety of staff and participants will be of the utmost importance. After securing a physical space, recruiting, hiring, and training staff—both administrative and clinical—on trauma-informed approaches and stigma will be our immediate focus. Special attention will be placed on ensuring the safety and the mental, social, emotional, and physical well-being of all who partake in the CHANGE program. Building on the principle of safety, we will also ensure peer support of our participants by holding one-on-one therapeutic sessions and peer support groups led by a licensed trauma-informed therapist. Each peer support group session will be led by a licensed therapist and will focus on providing support and education to all participants. To ensure participants receive the necessary support, feel safe, and are resilient, real-world examples focusing on trauma, racism, discrimination, and stigma related to an HIV diagnosis will be discussed. Lastly, special emphasis will be taken to conduct peer-based trust and support exercises for staff and participants to further ensure peer support and safety. In addition to this, cultural, historical, and gender issues will be addressed through culturally competent HIV-related training and cultural and historical training on racism and discrimination of black and SGL men LWH in the US.
References
Centers for Disease Control and Prevention. (2022a, December 1). HIV basics. Centers for Disease Control and Prevention. February 18, 2023, https://www.cdc.gov/hiv/basics/index.html
Centers for Disease Control and Prevention. (2022d, October 24). HIV diagnoses. Centers for Disease Control and Prevention. February 18, 2023, from https://www.cdc.gov/hiv/statis...rview/diagnoses.html
Centers for Disease Control and Prevention. (2022b, September 2). HIV in the US. Centers for Disease Control and Prevention. February 18, 2023, from https://www.cdc.gov/hiv/statis...rview/ataglance.html
Centers for Disease Control and Prevention. (2022c, September 2). HIV incidence. Centers for Disease Control and Prevention. February 18, 2023, from https://www.cdc.gov/hiv/statis...in-us/incidence.html
Florida Department of Health. (2022, November 7). HIV data center. HIV Data Center February 18, 2023, from https://www.floridahealth.gov/...veillance/index.html
HIV.gov. (2022, October 27). HIV & AIDS trends and U.S. Statistics Overview. Retrieved February 18, 2023, from https://www.hiv.gov/hiv-basics...nd-trends/statistics
JASMYN. (n.d.). March 25, 2023, from https://www.jasmyn.org/
McLeroy, Kenneth R., Daniel Bibeau, Allan Steckler, and Karen Glanz. "An ecological perspective on health promotion programs." Health education quarterly 15, no. 4 (1988): 351-377.
Metro Inclusive Health. (2023, March 9). March 10, 2023, from https://www.metrotampabay.org/
Philanthropy Network Greater Philadelphia, Thomas Scattergood Behavioral Health Foundation, and United Way of Greater Philadelphia and Southern New Jersey. (2016). Trauma Informed Philanthropy: A Funder’s Resource Guide for Supporting Trauma-Informed Practice in the Delaware Valley. https://philanthropynetwork.or...raumaGUIDE_Final.pdf
Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration.
Comments (0)