Using the Implementation Research Logic Model as a Lens to View Experiences of Implementing HIV Prevention and Care Interventions with Adolescent Sexual Minority Men—A Global Perspective

Abstract

Adolescents and sexual minority men (SMM) are high priority groups in the United Nations’ 2021 − 2016 goals for HIV prevention and viral load suppression. Interventions aimed at optimizing HIV prevention, testing and viral load suppression for adolescents must also attend to the intersectional realities influencing key sub-populations of SMM. Consequently, there is not a robust evidence-base to guide researchers and program partners on optimal approaches to implementing interventions with adolescent SMM. Using a multiple case study design, we integrated the Implementation Research Logic Model with components of the Consolidated Framework for Implementation Research and applied it as a framework for a comparative description of ten HIV related interventions implemented across five countries (Ghana, Kenya, Nigeria, Tanzania and United States). Using self-reported qualitative survey data of project principal investigators, we identified 17 of the most influential implementation determinants as well as a range of 17 strategies that were used in 90 instances to support intervention implementation. We highlight lessons learned in the implementation research process and provide recommendations for researchers considering future HIV implementation science studies with adolescent SMM.

Family Support, Open Communication, and Black Gay and Bisexual Young Men’s Attitudes and Stigma Around Pre-Exposure Prophylaxis

“…Despite the underlying importance of family support in reducing PrEP stigma, our findings indicated communication about sex and drugs and open communication were both associated with an increase PrEP stigma, which did not support our hypotheses 26,27 . As shown in previous studies, although family bonds can reduce stigma and encourage PrEP uptake, some parents may also have stigmatizing attitudes that discourage PrEP initiation and use among young adults.…”

“…Previous studies argued that the effectiveness of PrEP usage is directly related to reduced stigma 24 . Many studies have documented that the stigma surrounding PrEP intake hinges on multiple levels that affect interest in, uptake of, and the continuation of medication, especially among young adults 1,25,26 . Beyond the individual level, our findings suggest that family-based interventions could provide an opportunity to leverage the family as a solid asset for lowering PrEP stigma among BMSM 25 .…”

“…Some young adults who access PrEP are likely to do so without their parents' consent, perceiving their parents as unsupportive of their PrEP use and fear their parents' subsequent expression of anger and unsolicited communication about sex 27 . In such cases, many young adults are likely to consider the use of PrEP as unimportant to them, to avoid family discrimination 26 . This is particularly true for young adults who, as in our sample, are from Black homes.…”

“…27 In such cases, many young adults are likely to consider the use of PrEP as unimportant to them, to avoid family discrimination. 26 This is particularly true for young adults who, as in our sample, are from Black homes. Traditionally, Black families have been more likely to stigmatize same-gender sex, HIV-seropositive status, and, to some extent, PrEP.…”

“…24 Many studies have documented that the stigma surrounding PrEP intake hinges on multiple levels that affect interest in, uptake of, and the continuation of medication, especially among young adults. 1,25,26 Beyond the individual level, our findings suggest that family-based interventions could provide an opportunity to leverage the family as a solid asset for lowering PrEP stigma among BMSM. 25 Consistent with previous findings, participants' responses showed that higher family support lowered PrEP stigma, which predicted our first hypotheses.…”