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Unique service needs exist for expectant or parenting youth with foster care histories (EPY) and their families. Informed by Critical Ecological Systems Theory (CEST), this exploratory qualitative study presents findings from an inductive content analysis of in‐depth interviews and focus groups with EPY and service providers. The study included nine in‐depth face‐to‐face interviews with service providers (n = 5) and EPY (n = 4) as well as five focus groups with service providers (n = 23) and three with EPY (n = 7) to identify the characteristics of service providers, agencies and systems that may act as barriers to service utilization among EPY with a foster care history (n = 10) or juvenile justice history (n = 1). Service provider characteristics included negative attitudes towards EPY and/or those with child welfare experiences. Agency characteristics included a lack of workforce diversity, employee turnover, lack of training about diverse communities, restrictive enrolment processes and eligibility requirements, lack of childcare and transportation and limited accessibility of services. System characteristics included a lack of up‐to‐date information about existing services, territorialism, funding sources that do not prioritize interagency collaboration and a lack of communication/coordination among agencies. Implications include hiring and retaining a diverse workforce, providing training about diverse communities and implicit biases concerning young parents, developing navigation services specifically for EPY and developing processes for sharing data and communicating across systems that interact with EPY. [ABSTRACT FROM AUTHOR]

HIV stigma is a critical barrier to HIV prevention and care. This study evaluates the psychometric properties of the HIV Stigma Mechanisms Scale (HIV-SMS) among people living with HIV (PLHIV) in central Uganda and tests the underlying framework. Using data from the PATH/Ekkubo study, (n = 804 PLHIV), we assessed the HIV-SMS' reliability and validity (face, content, construct, and convergent). We used multiple regression analyses to test the HIV-SMS' association with health and well-being outcomes. Findings revealed a more specific (5-factor) stigma structure than the original model, splitting anticipated and enacted stigmas into two subconstructs: family and healthcare workers (HW). The 5-factor model had high reliability (α = 0.92–0.98) and supported the convergent validity (r = 0.12–0.42, p < 0.01). The expected relationship between HIV stigma mechanisms and health outcomes was particularly strong for internalized stigma. Anticipated-family and enacted-family stigma mechanisms showed partial agreement with the hypothesized health outcomes. Anticipated-HW and enacted-HW mechanisms showed no significant association with health outcomes. The 5-factor HIV-SMS yielded a proper and nuanced measurement of HIV stigma in central Uganda, reflecting the importance of family-related stigma mechanisms and showing associations with health outcomes similar to and beyond the seminal study. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) is associated with poor HIV care linkage and retention, medication adherence, and viral suppression. However, limited knowledge exists regarding potential mechanisms linking IPV to these outcomes. We aimed to (a) identify the top barriers to accessing HIV care experienced by women living with HIV (WLHIV) who report a history of IPV and have suppressed viral load (VL) versus unsuppressed VL and (b) understand how these barriers influence VL, comparing WLHIV with a history of IPV to WLHIV without a history of IPV. Study data come from newly diagnosed WLHIV in rural Uganda participating in the standard-of-care control arm of a randomized trial (n = 152). Descriptive results ranking mean scores from highest to lowest showed that, among women with a history of IPV, irrespective of viral suppression status, paying for transportation to come to clinic, having to wait at the clinic for long periods of time, and finding a clinic within reasonable travel distance were the top three barriers to accessing HIV care. WLHIV with a history of IPV were significantly more likely to have unsuppressed VL versus suppressed VL if they reported higher levels of difficulty finding a clinic within reasonable travel distance (RRR = 1.7, 95% CI [1.1–2.7]), getting permission to take time off from work (RRR = 1.5, 95% CI [1.0–2.9]), and finding time to come to the clinic for an appointment (RRR = 1.6, 95% CI [1.0–2.6]). The same relationships were not present among WLHIV without a history of IPV, suggesting these barriers and their effect on VL may be uniquely related to IPV. Interventions should address IPV and HIV care continuum outcomes in tandem, targeting barriers to accessing HIV care likely associated with IPV. Additional research is necessary to better understand how IPV relates to HIV care barriers and VL. [ABSTRACT FROM AUTHOR]

This practice note presents findings from a statewide survey of domestic violence and sexual assault agency directors (n = 80; 77% response rate), regarding their opinions about the outcome information that should be collected from victims during evaluations of five commonly provided services: legal advocacy, medical advocacy, group services, individual counseling, and shelter. The findings showed that four information types were repeatedly ranked among the most important to collect to understand whether services helped victims including victims’ satisfaction with services, victims’ progress toward meeting their goals, changes in the extent of violence and/or trauma that victims experienced, and changes in victims’ knowledge. [ABSTRACT FROM AUTHOR]