Lisa Bowleg, PhD, MA (GW) has received an NIH CFAR Administrative Supplement entitled, “Addressing Intersectional and Social-Structural Barriers to Ending the HIV Epidemic in Black Sexual Minority Men and Black Heterosexual Women”.
The District of Columbia Department of Health HIV/AIDS (DC Health) has made many successful strides towards achieving its Ending the HIV Epidemic (EHE) goals. Yet, stark but predictable inequities in HIV incidence and time to viral suppression persist for two groups at historically marginalized intersections of race, gender, and sexual minority status: Black sexual minority men (BSMM) and Black heterosexual women (BHW). Informed by the Consolidated Framework for Implementation Research (CFIR), the goal of this implementation science research project is to advance empirical knowledge about how “economic, political and social contexts,” the outer setting domain of the CFIR, shape BSMM’s and BHW’s engagement with three EHE pillars: Diagnose, Treat, and Prevent. The project’s ultimate objective is to develop an implementation strategy to help DC Health achieve two implementation outcomes: reduce BSMM’s and BHW’s HIV incidence and time to viral suppression. To accomplish this objective, the proposed project has three aims. The first is to gain indepth, community-centered photographic and geospatial understandings of social-structural barriers and facilitators to HIV prevention and treatment based on the lived experiences of BSMM and BHW. The second is to understand, based on an institutional ethnographic analysis of local policies (e.g., DC EHE plan), interviews with key policymakers and community stakeholders, and ethnographic observations of key settings (e.g., clinic waiting rooms), the social-structural barriers to BSMM and BHW’s HIV prevention and treatment. Finally, the third aim is to revise the project’s implementation logic model (ILM), develop an implementation strategy for DC Health to help reduce BSMM’s and BHW’s HIV incidence and time to viral suppression, and disseminate project findings to DC Health, local policymakers and community leaders via a public exhibit and DC Health’s DCEndsHIV.org website. There are three phases to the proposed project. Phase I involves a collaboration with 80 (40 BSMM and 40 BHW) community co-researchers to document, using GIS-equipped digital cameras, social-structural barriers to HIV prevention and treatment. Phase II involves an IE analysis (using Rapid Ethnographic Assessment methods) of policies relevant to the Phase I-identified social-structural barriers; interviews with policymakers and community stakeholders; and ethnographic observations of the social structural barriers, and the synthesis of all project findings. Informed by Phase I and II findings, Phase III involves the revision of the ILM, the development of the implementation strategy, and the dissemination of project findings. The significance of the proposed research lies in the expected outcome of a community centered and intersectionally-specific implementation strategy to reduce social-structural barriers to BSMM’s and BHW’s HIV prevention/treatment, and bolster DC Health’s ongoing community-engaged EHE strategies.