"Nobody Wants to Have Conversation About HIV." A Thematic Analysis of in-Depth Interviews With Black Adolescent Women and Providers About Strategies for Discussing Sexual Health and HIV Prevention

Abstract

Background: Black adolescent girls and young women (AGYW) in the US Southeast are disproportionately burdened by HIV. Infrequent assessment of sexual health in clinical encounters may contribute to low preexposure prophylaxis uptake for this population. This study explores Black AGYW and providers' perspectives on engaging in discussions about sexual health, including preexposure prophylaxis.

Methods: In-depth interviews (IDIs) were conducted with Black AGYW aged 14 to 24 years and health care providers (MD, DO, NP, PA) who self-reported caring for Black AGYWs in Alabama. In-depth interviews were grounded in Andersen's Behavioral Model of Health Service Utilization to explore barriers and facilitators to sexual health discussions. After separate analyses, AGYW and provider IDIs were aggregated and reanalyzed using thematic analysis to identify themes related to their views on ways to improve Black AGYW engagement in sexual health discussions while in clinical settings.

Results: Twelve Black AGYW and 11 providers completed IDIs. Client median age was 21 years, representing 9 Alabama counties. Providers were predominately non-Hispanic White (82%), female (73%), and physicians (64%). Themes about ways to improve sexual health discussions included the following: (1) improve sexual health education for providers and adolescents, (2) normalize conversations in clinical settings, and (3) engage communities to continue these conversations outside of clinical settings.

Conclusions: Sexual health and HIV prevention discussions with Black AGYW are not occurring. This study is one of the first to identify and highlight Black AGYW and provider-identified shared strategies for improving these discussions. Operationalizing these strategies is crucial to facilitating these discussions.

Figure 1:. Conceptual Framework grounded in Andersen’s Behavioral Model of Health Service Utilization and sIMB.

This figure illustrates the three constructs within Andersen’s Behavioral Model of Health Service Utilization (Environment (Green)), Client Characteristics (Orange), and Heath Behavior (Blue)), the components that impact each construct, and how the situated Information, Motivation, and Behavioral Skills (sIMB) model can influence intervention development able to impact the desired behavioral change, which for this study is PrEP uptake.

Figure 2:. Client and Provider Participant Alabama Zip Codes.

This map illustrates the distribution of Alabama counties where providers (blue), patients (yellow) and counties where both providers and patients (green) who completed the study resided.