Advancing behavioral interventions for African American/Black and Latino persons living with HIV using a new conceptual model that integrates 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, disparities among African American/Black and Latino PLWH are persistent, signaling the need for new conceptual approaches. To address gaps in services and research (e.g., insufficient attention to structural/systemic factors, inadequate harm reduction services and autonomy support) and improve behavioral interventions, we integrated critical race theory, harm reduction, and self-determination theory into a new conceptual model, then used the model to develop a set of six intervention components which were tested in a larger study. The present qualitative study explores participants’ perspectives on the study’s acceptability, feasibility, and impact, and the conceptual model’s contribution to these experiences. Methods Participants in the larger study were African American/Black and Latino PLWH poorly engaged in HIV care and with non-suppressed HIV viral load in New York City (N = 512). We randomly selected N = 46 for in-depth semi-structured interviews on their experiences with and perspectives on the study. 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, including poverty, poor quality/unstable housing, trauma histories exacerbated by current trauma, health comorbidities, and substance use. Participants found the study highly acceptable. We organized results into four themes focused on participants’ experiences of: 1) being understood as a whole person and in their structural/systemic 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. Themes reflected grounding in the conceptual model. Participants reported these characteristics were lacking in HIV care settings. Conclusions The new conceptual model emphasizes the salience of systemic/structural and social factors that drive health behavior and the resultant interventions foster trust, self-reflection, engagement, and behavior change. The model has potential to enhance intervention acceptability, feasibility, and effectiveness with African American/Black and Latino PLWH.

Behavioral intervention grounded in motivational interviewing and behavioral economics shows promise with Black and English-speaking Latino persons living with HIV with unsuppressed HIV viral load in New York City: A mixed methods pilot study

“…In particular, the intervention working group focused on the need for intrinsic motivation and personal goals pertaining to HIV viral suppression as fundamental to behavior change, and the need for participants who wished to achieve viral suppression to develop durable habits to take HIV antiretroviral therapy over time. The intervention working group drew on theories of behavioral economics (described in the Introduction) and selfdetermination theory (16). Self-determination theory is a macro theory of human motivation and personality that concerns the innate and fundamental needs for autonomy (people need to feel in control of their own behaviors and goals), competence (people need to gain mastery of tasks and learn different skills), and connection or relatedness (people need to experience a sense of belonging and attachment to other people) (48).…”

“…These serious and persistent racial/ethnic inequities in engagement along the HIV care continuum and in HIV health outcomes signal the need for evolution and improvements in effective behavioral intervention approaches for PWH, including for those with the greatest barriers to HIV viral suppression. Our team's past research has shed light on such behavioral interventions to address the constellation of barriers that African American/Black and Latino PWH experience to engagement along the HIV care continuum, primarily taking counseling approaches (16)(17)(18)(19). While the evidence base for the effectiveness and utility of counseling and other such behavioral interventions delivered by professional staff is robust (20,21), as technology evolves and cell phone and smartphone use increases, researchers are increasingly turning to technologyfacilitated interventions, including those that require little or no facilitation on the part of staff, called low-touch interventions (22)(23)(24)(25).…”

Correction: Advancing behavioral interventions for African American/Black and Latino persons living with HIV using a new conceptual model that integrates critical race theory, harm reduction, and self-determination theory: a qualitative exploratory study

“…After publication of this article [ 1 ], the authors reported that the caption to Fig. 2 (‘IIT-ICM core elements for ICM1’) should have read ‘Core elements and key characteristics of the Intervention Innovations Team integrated conceptual model (IIT-ICM) to guide behavioral intervention development’.…”