“I Had No Idea about This:” A Mixed-Methods Exploration of Sexual Health and HIV Prevention Needs among Black Youth in a Southern City
Abstract
:1. Introduction
2. Methods
2.1. Recruitment and Eligibility
2.2. Study Procedures
2.3. Measures
2.4. Data Analysis
3. Results
3.1. Demographic Characteristics
3.2. Qualitative Categories and Quantitative Findings
3.3. The Impact of COVID-19 on Daily Life Experiences and Sexual Health Needs
Okay, so during COVID I was I guess more interactive because I had to show up for school and stuff… And then COVID hit…I’m inside the house most of the time anyway. But yeah COVID has been stressing me out. Not necessarily because of the amount of deaths …(Black/Female/17 years old)
…Although I did lose my job a couple of months ago, because of COVID. And it was in the service industry…it did mess up my job and my ability to work [and afford therapy]. But other than that, it’s just been me at home most of the time… my family is still safe, which is really good…(Black/Transgender/19 years old)
3.4. Health Information Seeking and Social Interactions
…I guess the counselors are there and stuff but I don’t honestly trust them…I could talk to [my mom], but I’m not sure what her reaction would be…one thing I do know is there is this app for women called—that helps us track our menstrual cycles and stuff and they have articles by very high-class healthcare professionals…(Black/Female/18 years old)
3.5. Barriers to Seeking Sexual Healthcare
It’s hey, can I afford this doctor appointment? Can I afford the medicine that I’ll need from this appointment? And just sending a message on my chart, first to talk to my doctor about it, would be the best bet and just doing my own self research. And if there’s something I can do at home, I’d probably seek this out first before I go to the doctor…it’s just not as accessible as it used to be for me. (African American/Nonbinary/18 years old)
…maybe it should be a different approach to where they ask, “Are you sexually active,”…Then, sometimes they do it in front of your parents and you’re not going to get the correct answer most of the times if you’re doing it in front of a parent [so time alone with a provider could be good]… start by giving information about it before they actually ask that question [to make it less awkward]… (Black/Female/22 years old)
3.6. HIV Knowledge and PrEP Awareness
Staying with each other [is how my partner and I prevent HIV]. Honestly, I don’t use condoms. I’ve never used condoms…I used to be a ho, so I’m not even going to lie…I have a pretty face. I can get dudes to do things for me without having to give up anything. And plus too, at the time, I guess this might be important, I didn’t want anymore bodies…(Black/Female/22 years old)
…I had no clue what you guys were talking about at first. I was like, “What’s this?” I did not know exactly what it is. It’s crazy. I feel like I’m pretty up to date on things but I had no idea…(Black/Male/18 years old)
3.7. Multilevel Stigma and Stigma Reduction
…even some of my family members who have just misgendered me on purpose, or just didn’t believe me, like those instances have caused me to be close off health care providers that I know aren’t going to support me, or I know who are going to judge me until I look a particular way they think I should look…(Black/Transgender/19 years old)
I know for me, I try to expand and not be … prejudice about people or all of that stuff… I know for my community, I guess one of the stigmas has been, I know even in history too, like the people in LBGTQ community, all of that stuff about HIV or people who are gay, it doesn’t make sense to me…(Black/Female/17 years old)
I believe everyone should get tested for having it, even if they haven’t had any sex with anybody… I believe it’ll bring a positive aspect into getting tested… [to reduce PrEP stigma]. The best way. I mean, we can at least, I guess, take it with them as showing support that you stand behind them… That they have support behind them. They’re not the only ones that feel like they’re going through it alone. (Black/Female/13 years old)
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Overview and Introduction |
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General Stressors |
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HIV-Related Experiences and Perceptions (less specific to PrEP) |
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PrEP Awareness and Experience |
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Barriers to HIV Prevention (not already discussed) |
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Conclusion |
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Demographic Characteristics | N (%) |
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Race | |
Black | 83 (100%) |
Age a | |
13–17 | 26 (32.5%) |
18–20 | 25 (31.3%) |
21–24 | 29 (36.3%) |
Gender | |
Male | 21 (25.3%) |
Female | 57 (68.7%) |
Transgender | 5 (6.0%) |
Sex Assigned at Birth | |
Male | 21 (25.3%) |
Female | 62 (74.7%) |
Sexual orientation | |
Homosexual | 10 (12.0%) |
Heterosexual | 47 (56.6%) |
Bisexual | 13 (15.6%) |
Queer | 2 (2.4%) |
Not sure | 1 (1.2%) |
Other | 8 (9.6%) |
Decline to respond | 2 (2.4%) |
Food insecurity (past 6 months) | |
No | 59 (71.9%) |
Yes | 23 (28.1%) |
Employment status a | |
Unemployed | 39 (46.9%) |
Part-time employment | 24 (28.9%) |
Full-time employment | 14 (16.9%) |
Preferred health information resource a | |
Parent | 28 (33.7%) |
Friend | 2 (2.4%) |
Sibling/family member | 1 (1.2%) |
Internet | 20 (24.1%) |
Healthcare provider | 31 (37.4%) |
Have needed sexual health services and did not receive them | |
No | 60 (72.3%) |
Yes | 23 (27.7%) |
Ever received an HIV test | |
No | 52 (62.7%) |
Yes | 31 (37.4%) |
Lifetime perceived HIV diagnosis likelihood | |
Not at all likely | 44 (53.0%) |
A little likely | 26 (31.3%) |
Somewhat likely | 9 (10.8%) |
Very likely | 4 (4.8%) |
PrEP awareness prior to study enrollment | |
No | 37 (44.6%) |
Yes | 46 (55.4%) |
If aware of PrEP, where learned of PrEP | |
A friend or a sex partner | 4 (8.7%) |
An advertisement/commercial | 27 (58.7%) |
Student health clinic | 2 (3.3%) |
A student organization at school | 3 (6.5%) |
Social media | 2 (3.3%) |
Other | 8 (17.4%) |
Decline to answer | 0 (0%) |
PrEP taken previously | |
Yes | 3 (3.7%) |
No | 80 (96.3%) |
PrEP taken currently | |
Yes | 1 (1.2%) |
No | 82 (98.8%) |
Willing to tell others I’m on PrEP | |
Yes, only sexual partners | 23 (27.7%) |
Yes, close friends or sexual partners | 14 (16.9%) |
Yes, anyone who asks | 27 (32.5%) |
Yes, I’d spread the word | 15 (18.1) |
No | 4 (4.8%) |
If people knew I took PrEP, they’d see me | |
Negatively | 26 (31.3%) |
The same | 5 (6.0%) |
Positively | 52 (62.7%) |
Demographic Characteristic | N(%) |
---|---|
Age (years) a | |
13–17 | 5 (38%) |
18–22 | 8 (62%) |
Race | |
Black | 13 (100%) |
Sex Assigned at birth | |
Male | 2 (15%) |
Female | 11 (85%) |
Gender b | |
Male | 2 (15%) |
Female | 8 (62%) |
Transgender | 2 (15%) |
Genderqueer/non-binary | 1 (8%) |
Sexual orientation c | |
Heterosexual | 9 (69%) |
Bisexual | 1 (8%) |
Queer | 1 (8%) |
Other d | 2 (15%) |
Current grade in school e | |
6th–8th grade | 1 (8%) |
9th–12th grade | 5 (39%) |
Community college | 2 (15%) |
Four-year university | 3 (23%) |
Graduate school | 1 (8%) |
Not in school | 1 (8%) |
Employment | |
Full-time | 2 (15%) |
Part-time | 1 (8%) |
Unemployed | 9 (69%) |
Other (write-in option) f | 1 (8%) |
Qualitative Theme | Exemplar Quote | Relevant Quantitative Descriptive Results |
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Impact of COVID-19 on daily life experiences Participants described daily stress of early life during lockdown, such as mental health challenges and/or financial hardship | So we lost our car and so I haven’t really been going out that much because I really don’t understand the transit system in—… before COVID I was seeing my niece a lot more because she has special needs and I love seeing her…that—was really, really hard for me … (African American/Nonbinary/18 years old) Just the fact that COVID is around, that’s a stress … keeping the mask on you at all times and just having to be clean, when I come home to my baby, no viruses, no infections, nothing comes home with me… For me, it affects me mentally because I get irritated, and then I just shut down, don’t want to talk to nobody, just want to be alone. (African American/Female/20 years old) | Among our quantitative sample (N = 83), nearly 50% were unemployed. Among those who were young adults aged 18 and up (e.g., of definite working age), unemployment rates ranged from 30% to 44% depending on age category. Similarly, nearly 30% overall reported experiences of food insecurity; the rates were marginally significantly higher among young adults aged 21 and up (41%; p < 0.08) |
Health information seeking, social interactions Participants described what sexual health information they have sought, sources they consult, and social interactions they have had in their personal lives around sexual health | [if I had questions] Probably my primary care doctor and then also people that look like me and share the same identities as me and ask about their experiences with using PrEP. (African American/Nonbinary/18 years old) I definitely do [have trusted sources of sexual health information]. I don’t really talk to my family about it…But I do talk to my girlfriend about it… my close friends about my experience…sometimes I’ll ask my clinician, “Oh, can you tell me more about genital warts,” because that’s something that I have. But I’ve yet to actually go to my health care providers…based off of something like that … (African American/Transgender/19 years old) … I don’t think they [my family] would be mad [if I asked about this] but I think they would feel some type of way about it… they’ll probably think, “Why is she asking this type of thing?” (African American/Female/15 years old) | Across all survey respondents, roughly one-third preferred their parents or guardian as a resource for health information (33.7%). Nearly 40% preferred a healthcare provider (37.4%); roughly one-fourth preferred the internet (24.1%). |
Barriers to seeking sexual healthcare Participants described cost and fear of awkward interactions with providers as barriers to seeking sexual healthcare services | …So I go to—because I am trans, I get testosterone from there … the last time I went, they asked if I wanted to pee in a cup to check for any…I have access to it. But I also sometimes I’m not open to getting it, just because insurance won’t always cover my me going to—(African American/Transgender/19 years old) … [It would help to have providers] especially when they can relate to what I’m going through…there’s been times where I’ve had doctors, they really understood my problems, and really understood what it’s like to be in my shoes… It makes me want to be more honest with them. (African American/Male/18 years old) | Nearly 30% of respondents reported a time they needed sexual health services and did not receive them. Of these individuals, reasons included the following:
|
HIV knowledge, PrEP familiarity Participants described their knowledge of HIV, PrEP, outstanding questions, and sexual health needs around them | Perceptions of HIV: … with me having a gay brother, I really get concerned about him and I make sure that… “Have you been tested for HIV”. It’s uncomfortable to ask that because I feel like he should already [be doing it] … (African American/Female/21 years old) People who didn’t take the right precaution to prevent it, I just feel maybe they weren’t careful enough. But yeah, I just really am a strong advocate for people getting tested early because one thing I do know is that when you get tested earlier… people can stop being afraid and actually go get tested to protect their health and stuff … There’s different ways it can be spread … (African American/Female/18 years old) Preventing HIV:… the people I’ve been with, I know them and they haven’t been with that many people or they haven’t been with people at all… I can see if I was active every week or twice a week I would, but I’ve only been with two other people, so I don’t feel like it’s that big of a deal to me [to be tested]…(African American/Male/18 years old) PrEP: I already said this but definitely pushing the PrEP pill because I had no clue what you guys were talking about at first. I was like, “What’s this?” I did not know exactly what it is. I thought it was a two or three year thing, nah, [PrEP has been around] ten years?… For someone my age not knowing about it is kind of crazy… I feel like a lot of the questions I can have, I’ll do research..(African American/Male/18 years old) | Over half of young adults aged 18–20 reported never receiving an HIV test. Sixty percent of young adults aged 21+ had never had an HIV test. Only half of males and half of females overall knew about PrEP. Of those sexually active overall, only 51.7% had been tested for HIV. |
Multilevel stigma and stigma reduction Participants described multiple dimensions of stigma, and gave recommendations for addressing some forms | Transphobia/Queer discrimination:…this [my high] school is kind of not being fair to trans folks and kind of dealing with that. But that was kind of a thing for a lot of my high school years, and then switching to another high school having to deal with that same battle again. (African American/Nonbinary/18 years old) …I originally was very open to it more so when it came to health care providers. But after those instances, and even some of my family members who have just misgendered me on purpose, or just didn’t believe me, like those instances have caused me to be close off health care providers that I know aren’t going to support me…(African American/Transgender/19 years old) Community perceptions (HIV stigma)…Depends on who you talk to you. Everybody has their own opinion…Negative ones I heard was people saying, “Oh, they’re dirty, that they got HIV and stuff”. (African American/Male/15 years old) Stigma comes from because people aren’t educated about it. And since you’re not educated it’s probably rare that you’ll go get tested as well. And so, that means your transferring more stuff because you didn’t know you was carrying it…. (African American/Female/22 years old) | Over 60% of survey respondents reported being viewed positively if people know they were taking PrEP, yet nearly one-third reported being viewed negatively (31.3%). When asked who they were willing to tell that they were on PrEP, responses varied by who would be told (though most reported willingness to do so):
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Share and Cite
Maragh-Bass, A.C.; Mitchell, J.T.; Stoner, M.C.D.; Bhushan, N.L.; Riggins, L.; Lightfoot, A.; Corneli, A. “I Had No Idea about This:” A Mixed-Methods Exploration of Sexual Health and HIV Prevention Needs among Black Youth in a Southern City. Adolescents 2024, 4, 278-296. https://doi.org/10.3390/adolescents4020020
Maragh-Bass AC, Mitchell JT, Stoner MCD, Bhushan NL, Riggins L, Lightfoot A, Corneli A. “I Had No Idea about This:” A Mixed-Methods Exploration of Sexual Health and HIV Prevention Needs among Black Youth in a Southern City. Adolescents. 2024; 4(2):278-296. https://doi.org/10.3390/adolescents4020020
Chicago/Turabian StyleMaragh-Bass, Allysha C., John T. Mitchell, Marie C. D. Stoner, Nivedita L. Bhushan, Linda Riggins, Alexandra Lightfoot, and Amy Corneli. 2024. "“I Had No Idea about This:” A Mixed-Methods Exploration of Sexual Health and HIV Prevention Needs among Black Youth in a Southern City" Adolescents 4, no. 2: 278-296. https://doi.org/10.3390/adolescents4020020