Mechanisms of resilience and coping to intersectional HIV prevention and drug-use stigma among people who inject drugs in rural Appalachian Ohio

Harm Reduction Journal · 2025-02-19 · 7 citations

BACKGROUND: Intersectional stigma of drug-use and HIV hinders provision and utilization of HIV prevention services for people who inject drugs (PWID), particularly within rural US communities. Resilience and coping may be critical for PWID to counter pervasive stigma. METHODS: Between October 2021 and July 2022, 35 in-depth interviews were conducted in Appalachian Ohio to understand the intersection of drug-use and HIV prevention stigma and how resilience and coping processes are displayed, shared, and enacted. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was conducted, guided by Harper et al.'s four key resilience processes: (a) engaging in health-promoting cognitive processes, (b) enacting in health behavioral practices, (c) exchanging social support, and (d) empowering other PWID to engage in health behavior practices. RESULTS: Resilience processes aligned with the Harper framework with additional coping processes identified, including anticipation strategies and maladaptive coping. Empowering other PWID emerged as a prominent resiliency process, often supported by systems of support like syringe service programs (SSPs), which provided resources and helped reduce stigma. However, bidirectional social support was constrained, as PWID frequently acted as providers of resources and referrals for peers despite limited knowledge of HIV prevention strategies and feeling unsupported themselves. Anticipation strategies were employed to manage anticipated stigma, including accessing support or, conversely, avoiding healthcare and refraining from disclosing drug use. Maladaptive coping included behaviors such as social isolation and self-administered medical care, highlighting critical gaps in opportunities to foster resilience. CONCLUSIONS: Findings highlight that empowering peers and anticipation strategies can be key resilience processes, while maladaptive coping and limited bidirectional social support underscore the need for resilience-building and stigma-reduction interventions. Tailored systems of support for PWID in rural communities are critical to fostering adaptive coping and enhancing engagement with HIV prevention services.

Adapting a Sexual Health Intervention for Adolescents Exposed to Adversity: Feasibility Study

JMIR Formative Research · 2025-11-12

BACKGROUND: Although sexual exploration is normative during adolescence, sexual activities that are unprotected and occur under the influence of substances can pose significant risks to young people. Youth exposed to adversity are among the groups most vulnerable to sexual risk-taking in adolescence. Selective interventions that consider lived experiences and the local context may help reduce sexual risk-taking among this population. OBJECTIVE: This pilot study assessed the feasibility of participant recruitment and retention as well as participant engagement with an adapted version of Focus on Youth with Informed Parents and Children Together for Black youth exposed to household challenges. METHODS: Participants were recruited using school and community presentations, digital flyers, and referrals. A total of 121 youth from 3 sites in Baltimore, Maryland, were screened. Participants completed 3 assessments: baseline, posttest, and 3-month follow-up. Participant enrollment, session attendance, and assessment completion were used to determine feasibility and engagement. Sexual health knowledge, pregnancy intentions, partner communication, and sexual behaviors were explored as secondary outcomes. RESULTS: Funded by the National Institutes of Health, the data for this study were collected between January 2022 and April 2023. A total of 61 youth (aged 13-16 years) were recruited and randomized to either the intervention or the control condition (n=33 and n=28, respectively). In total, 87% (53/61) of the participants completed all 3 assessments. There was high engagement: 80% (48/61) of participants attended at least 3 sessions, and 75.2% (115/153) of after-session responses revealed they would recommend a session to a friend. Among the 18 participants who reported having any sex, all 18 (100%) abstained from alcohol use and 12 (67%) abstained from drug use before sex. The intervention group showed a significant increase in sexual health knowledge. No changes in sexual health behaviors or partner communication were observed. CONCLUSIONS: Findings suggest that recruiting, retaining, and engaging participants in the adapted Focus on Youth with Informed Parents and Children Together intervention is feasible. Additional research is needed to determine the extent to which this intervention can mitigate sexual risk-taking among youth exposed to adversity. The findings will inform the redesign of our assessments to capture additional factors that may affect sexual health behaviors. TRIAL REGISTRATION: ClinicalTrials.gov NCT05033821; https://clinicaltrials.gov/study/NCT05033821.

(015) NAVIGATING SEXUAL AND REPRODUCTIVE HEALTH AMID POLITICAL UNCERTAINTY: QUALITATIVE INSIGHTS FROM BLACK WOMEN IN MARYLAND

The Journal of Sexual Medicine · 2025-04-01

Abstract Introduction Recent political shifts in the U.S., including restrictive policies on abortion and contraception, have created an uncertain landscape for sexual and reproductive healthcare (SRH). These changes disproportionately affect Black women (BW), who already experience systemic inequities and barriers to equitable SRH. Maryland, viewed as a “safe” state due to its progressive policies, provides a critical lens for examining how localized protections intersect with national restrictions, influencing BW’s engagement and comfort with SRH. BW’s SRH experiences offer an essential perspective on how systemic inequities and policy shifts intersect to influence access and engagement. Objective This study sought to investigate how BW perceive and navigate SRH in the current political climate. It focused on understanding how policy changes affect their confidence, trust in healthcare systems, and use of adaptive strategies to maintain access to essential SRH and information. Methods This qualitative study utilized semi-structured interviews with 40 cisgender BW residing in Maryland. The interviews explored how recent policy changes influenced their SRH engagement and confidence in accessing care. Thematic analysis was conducted using an abductive coding approach, integrating insights from Black feminist theory (BFT) and intersectionality with emergent themes from participant narratives. BFT provided a framework for examining how intersecting systems of oppression shape SRH experiences while centering participants’ voices and strategies of resilience. Data were analyzed iteratively to balance theoretical guidance with participant-driven insights, ensuring authenticity and depth. Results Four themes emerged: Access and Engagement Concerns: Many participants expressed fear and uncertainty about future restrictions on SRH services and concerns over autonomy and accessibility. Quote: “With policies constantly changing, I fear losing the ability to make decisions about my body.” Confidence and Mistrust in SRH: Historical distrust in healthcare systems was exacerbated by perceived caution among providers navigating restrictive policies. Quote: “I feel like the rug could be pulled out from under me at any moment. If they’re coming for one right, why not others?” Psychological and Emotional Toll: The national political climate induced health anxiety for some, while others expressed limited fear due to Maryland’s protections, empathizing with women in unsupportive states. Quote: “I feel safe. I don’t have the fear of someone maybe in Texas or another deep red state… but I feel for my sisters in places with abortion bans.” Adaptation and Resilience Strategies: Participants demonstrated resilience through self-advocacy, online resources, and peer networks. Quote: “I’m adamant about speaking up for myself… I started speaking up for myself now to the point where people don’t like it.” Conclusions This study underscores how national policy restrictions affect BW’s SRH experiences, even in relatively protective states like Maryland. While localized protections provided reassurance for some, the broader political climate amplified stress, mistrust, and barriers to care. These findings highlight the urgent need for clinical staff and providers to adopt culturally responsive, patient-centered approaches that address systemic inequities and build trust with marginalized communities. By fostering open communication, advocating for equitable policies, and integrating strategies to support resilience, healthcare professionals can better navigate the challenges posed by policy and ensure high-quality SRH for all patients. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: MyMD Pharmaceutical, Inc (unrelated minimal consultant support as admin staff).

Intimate Partner Violence in a Social Justice Framework

2025-11-20

Abstract Policymakers, practitioners, and researchers use social justice approaches to shed light on the complex dynamics of intimate partner violence (IPV) and uncover underlying structures that perpetuate it, including power imbalances, gender norms, economic disparities, and institutional biases. Approaches include comprehensive interventions that promote safety for all people and recognize that fairness in the distribution of resources to address IPV can challenge and dismantle oppressive systems that perpetuate violence and inhibit justice for survivors. This chapter uses principles of discursiveness, relationism, and reflectiveness to present social justice orientations as a set of practical assumptions that will benefit society’s collective efforts to minimize the effects of violence on health. It summarizes restorative and transformative justice, providing examples of their utility to address persistent health inequities. Finally, this chapter concludes with call for policy, practice, and research to move beyond merely promoting protection to the active removal of oppression.

Adapting a Sexual Health Intervention for Adolescents Exposed to Adversity: Feasibility Study (Preprint)

2025-03-19

<sec> <title>BACKGROUND</title> Although sexual exploration is normative during adolescence, sexual activities that are unprotected and occur under the influence of substances can pose significant risks to young people. Youth exposed to adversity are among the groups most vulnerable to sexual risk-taking in adolescence. Selective interventions that consider lived experiences and the local context may help reduce sexual risk-taking among this population. </sec> <sec> <title>OBJECTIVE</title> This pilot study assessed the feasibility of participant recruitment and retention as well as participant engagement with an adapted version of Focus on Youth with Informed Parents and Children Together for Black youth exposed to household challenges. </sec> <sec> <title>METHODS</title> Participants were recruited using school and community presentations, digital flyers, and referrals. A total of 121 youth from 3 sites in Baltimore, Maryland, were screened. Participants completed 3 assessments: baseline, posttest, and 3-month follow-up. Participant enrollment, session attendance, and assessment completion were used to determine feasibility and engagement. Sexual health knowledge, pregnancy intentions, partner communication, and sexual behaviors were explored as secondary outcomes. </sec> <sec> <title>RESULTS</title> Funded by the National Institutes of Health, the data for this study were collected between January 2022 and April 2023. A total of 61 youth (aged 13-16 years) were recruited and randomized to either the intervention or the control condition (n=33 and n=28, respectively). In total, 87% (53/61) of the participants completed all 3 assessments. There was high engagement: 80% (48/61) of participants attended at least 3 sessions, and 75.2% (115/153) of after-session responses revealed they would recommend a session to a friend. Among the 18 participants who reported having any sex, all 18 (100%) abstained from alcohol use and 12 (67%) abstained from drug use before sex. The intervention group showed a significant increase in sexual health knowledge. No changes in sexual health behaviors or partner communication were observed. </sec> <sec> <title>CONCLUSIONS</title> Findings suggest that recruiting, retaining, and engaging participants in the adapted Focus on Youth with Informed Parents and Children Together intervention is feasible. Additional research is needed to determine the extent to which this intervention can mitigate sexual risk-taking among youth exposed to adversity. The findings will inform the redesign of our assessments to capture additional factors that may affect sexual health behaviors. </sec> <sec> <title>CLINICALTRIAL</title> ClinicalTrials.gov NCT05033821; https://clinicaltrials.gov/study/NCT05033821 </sec>

A Comparison of Intimate Partner Violence Victimization and Perpetration, Adverse Childhood Experiences, and Mental Health Among Men in Same-Gender and Different-Gender Relationships

Partner Abuse · 2024-07-22 · 1 citations

Is Resilience Enough? Resilience Processes to Intersectional Stigma Among People who Inject Drugs (PWID) in Appalachia Ohio

Drug and Alcohol Dependence · 2024-07-01

21. Creating Hope and Ending Stigma: A Holistic Approach to HIV/AIDS

American Public Health Association eBooks · 2023-01-01

Using the intervention mapping for adaption framework to adapt an evidence-based sexual health intervention for youth affected by trauma

BMC Public Health · 2023-06-01 · 8 citations

BACKGROUND: Children exposed to household challenges (i.e., parental substance use, incarceration, and mental illness) are among the groups most vulnerable to sexual risk-taking in adolescence. These behaviors have been associated with a range of negative outcomes later in life, including substance abuse, low educational attainment, and incarceration. Adapting an evidence-based intervention (EBI) to be suitable for this population is one strategy to address the needs of this group. METHODS: In this study, we describe the use of the Intervention Mapping for Adaption (IM-Adapt) framework to adapt an evidence-based, sexual health intervention (Focus on Youth with Informed Children and Parents). We describe the actions taken at each step of the IM-Adapt process which are to assess needs, search for EBIs, assess fit and plan adaptions, make adaptions, plan for implementation and plan for evaluation. RESULTS: Key changes of the adapted intervention include the incorporation of trauma-informed principles and gender inclusive language, standardization of the session length, and modernization of the content to be more appropriate for our priority population. CONCLUSIONS: The adapted intervention shows promise toward meeting the behavioral health needs of Black youth exposed to household challenges. Our process and approach can serve as a model for researchers and practitioners aiming to extend the reach of EBIs.

Examining Associations Between Resilience and Sexual Health Among South African Girls and Young Women Living With and Without HIV

AIDS Education and Prevention · 2023-02-01 · 1 citations

Resilience, or multilevel processes related to thriving, offers a strengths-based approach to reducing HIV and sexual risk behaviors among girls and young women. Processes of resilience may change based on the experience of living with HIV. However, little is known about how resilience and serologically verified HIV status influence sexual health. Using weighted cross-sectional data collected during 2017–2018 from South African girls and young women aged 15–24 (N = 7237), this article examines associations between resilience and three sexual risk behaviors among those living with and without HIV. Logistic regression models indicated greater resilience scores were associated with reduced odds of engaging in transactional sex and early sexual debut. Results also identified differing associations between resilience and sexual risk behaviors by HIV status. Findings provide implications for programming to prevent HIV and improve sexual health while underscoring the need for tailored resilience-promoting interventions for South African girls and young women living with HIV.