Term of Award

Fall 2023

Degree Name

Doctor of Public Health in Public Health Leadership (Dr.P.H.)

Document Type and Release Option

Dissertation (open access)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

Department

College of Public Health

Committee Chair

Stacy Smallwood

Committee Member 1

Bettye Apenteng

Committee Member 2

William Mase

Abstract

Background. Effective HIV treatment and pre-exposure prophylaxis can drastically reduce the risk of acquiring HIV and prevent most future transmission, but these advances are not accessible to many who could most benefit from them. Advances in use of molecular sequence data to inform prevention efforts, paired with supportive interventions, have the potential to identify clusters of rapid HIV transmission and focus prevention resources toward areas of highest need. Although molecular cluster detection has been successfully used in other areas of public health, advocates for people with HIV have raised concerns about the application of this approach because of HIV criminalization, stigma and marginalization, and consent issues.

Purpose. The primary purpose of this study was to describe the perspectives of Black and Hispanic/Latino same gender-loving men and genderqueer persons with experience in the field of HIV prevention about molecular HIV cluster detection. Additional goals aim to understand the ethical frameworks underlying these perceptions, and to document participants’ suggestions to improve implementation of molecular HIV cluster detection and response.

Methods. This qualitative research study gathered information from ten key informants via semi-structured individual interviews, using a standard interview tool, to better understand existing opinions and beliefs in HIV prevention and advocacy communities. Data were coded using an inductive thematic analysis with Dedoose version 9.0.

Results. Participants had varied levels of experience with this work, but all understood basic concepts including the potential value of this work to focus HIV prevention to communities with the greatest needs. Participants expressed a variety of perspectives. Concerns included HIV criminalization, stigma and marginalization, and informed consent. Suggestions included increasing transparency through additional community engagement and communication, and addressing HIV criminalization, stigma, and marginalization.

Conclusions. Public health agencies need to better understand and address concerns about molecular HIV detection. Increased community engagement and communication around this work can help address issues of perceived lack of transparency and mistrust. Communication should include the rationale for conducting public health surveillance activities in the absence of informed consent, as well as health department data protections and local criminalization policies and practices.

Research Data and Supplementary Material

No

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