Identifying multilevel facilitators of care outcomes among Positive Deviants to design an intervention for Black sexual minority men living with HIV - Project Summary/Abstract The goal of this R01 is to build upon our sponsored Positive Deviance research by identifying how durably virally suppressed Black sexual minority men living with HIV (BSMM LWH) overcome racism and intersectional stigma on multiple socioecological levels. Only 62% of the 58% of BSMM LWH who adhere to treatment are virally suppressed and HIV care disparities have persisted for the past 15 years. Our preliminary studies suggest that the small proportion of virally suppressed BSMM LWH are “positive deviants” who consciously or unconsciously maintain their health despite adversity and could offer researchers effective solutions for the community. Identifying how exemplar men with successful HIV care outcomes overcome or withstand racism and intersectional stigma in high barrier contexts is significant and novel for intervention design because it shifts the HIV care research paradigm towards community-driven, strengths-based solutions. Therefore, the goal of this R01 is to identify novel strategies and multilevel facilitators that help BSMM LWH sustain durable viral suppression. Guided by Positive Deviance, this study will identify how BSMM LWH navigate racism and stigma to retain in care, adhere to treatment, and sustain viral suppression in two understudied, high-barrier contexts: Shelby County, TN and Prince George’s County, MD. Studying positive deviants in Shelby and Prince George’s Counties is significant because they are two of the largest majority- Black counties in the U.S. with well-documented inequities that could provide unidentified solutions for others who experience substantial barriers. We will begin by building upon our preliminary data using in-depth 60 qualitative interviews (Aim 1), then conduct ethnographic go-alongs to identify unconscious facilitators in their neighborhood and clinical contexts (Aim 2). Specifically, we will interview them in their neighborhoods and audio-record their follow-up HIV care visits to study how they overcome communication challenges with clinicians. Findings will be combined with publicly available data about neighborhood characteristics and clinic policies to design novel multi-dimensional figures called glyphs on county-wide maps. Glyphs will help us visualize and identify the key components needed in an intervention to support other BSMM LWH (Aim 3). Using Positive Deviance in HIV care research to identify existing community strengths for intervention design is highly significant and novel. This study aligns with NIH priorities to understand multilevel factors and design novel interventions to improve HIV care outcomes and is the next step needed in our work to support BSMM LWH. This study uses an innovative and significant strengths-based framework to discover, evaluate, and subsequently diffuse effective interventions for HIV outcomes, leading to high public health impact. Findings will allow us to design, refine, and implement at least one intervention in a subsequent R34 proposal that already exists in real-world contexts but remains unknown to researchers.
