Advancing behavioral interventions for African American/Black and Latino persons living with HIV by integrating critical race theory, harm reduction, and self-determination theory: A qualitative exploratory study

Abstract

Background . Rates of participation in HIV care, medication uptake, and viral suppression are improving among persons living with HIV (PLWH) in the United States. Yet, racial/ethnic disparities in engagement along this HIV care continuum are persistent, particularly among African American/Black and Latino PLWH, signaling the need for novel approaches. We created a new conceptual model that integrates critical race theory, harm reduction, and self-determination theory, which was used to plan an intervention optimization trial to test five behavioral intervention comcompponents. The present qualitative exploratory study describes the integrated conceptual model (ICM) and explores participants’ perspectives on contributions of the ICM to study acceptability, feasibility, and impact. Methods . Participants were African American/Black and Latino PLWH poorly engaged in HIV care and with non-suppressed HIV viral load in New York City. From the parent optimization trial (N=512), we randomly selected 46 for in-depth semi-structured interviews on experiences in the optimization trial. Interviews were audio-recorded and professionally transcribed verbatim, and data were analyzed using directed qualitative content analysis. Results . On average, participants were 49 years old (SD=9) and had lived with HIV for 19 years (SD=7). Most were male (78%) and African American/Black (76%). All had taken HIV medication previously. Challenging life contexts were the norm comprised of poverty, poor quality/unstable housing, trauma histories exacerbated by current trauma, medical and mental health comorbidities, and substance use. Participants found the optimization trial highly acceptable. We organized results into four themes focused on the importance of 1) being understood as a whole person and in context; 2) trustworthiness and trust; 3) opportunities for self-reflection; and 4) support of personal autonomy. The salience of nonjudgment was prominent in each theme. Their experiences and perspectives reflected the ICM. Participants reported these characteristics were generally lacking in HIV care settings. Conclusions . The ICM for is a new useful model for research with AABL-PLWH with potential to enhance study acceptability, feasibility, and intervention effectiveness. Future application of the ICM is warranted to reduce racial/ethnic disparities. In a future study, we will explore participants’ perspectives on the specific intervention components in which they engaged and ways components can be improved.