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In the United States, sexually transmitted infections (STIs) disproportionately affect men who have sex with men (MSM) and transwomen of color. Partner services can prevent STI transmission by facilitating testing and treatment for partners of individuals diagnosed with an STI. Understanding client perspectives towards partner services is critical to their acceptance and uptake. This study examined perceptions, experiences, and preferences for partner services among Black and Latino MSM and transwomen in North Carolina. We conducted seven audio-recorded focus groups in English (n = 5) and Spanish (n = 2). The audio was transcribed verbatim and we inductively analyzed data using field notes, systematic coding, and thematic comparison. Black MSM reported the most exposure and experiences with partner services, and most perceived partner services negatively. Feeling supported and having flexibility characterized positive experiences with partner services among Black MSM; feeling judged or harassed characterized negative experiences. Black transwomen had less exposure to partner services and had a mix of positive reactions to the approach, along with concerns about client confidentiality. Most Latino participants were unaware of partner services and expressed openness to their potential. All participants preferred self-notifying and wanted flexible, discreet, supportive partner services with linkages to other wellness resources. Building off positive partner services experiences and responding to client preferences can enhance trust, acceptability, and service use. [ABSTRACT FROM AUTHOR]

Latinos are at a high risk of developing type 2 diabetes (T2D). Prediabetes is a major risk factor for T2D; however, progression to T2D can be slowed with engagement in healthy behaviors. Stress can hinder engagement with health behaviors. Qualitative methods were used to understand how Latinos with prediabetes attempted to modify their diet and physical activity behaviors to slow T2D progression and how stress affected their engagement in these behaviors. Semi-structured interviews were conducted with 20 Latinos with prediabetes in North Carolina. Participants were asked questions about types of stress they experienced and how stress affected their health. We generated codes on stress and stress responses and used content analysis to organize codes between and within participants. Behaviors changed after prediabetes diagnosis. Few participants reported changing their physical activity, however, all participants attempted to change their eating patterns by changing food types consumed and reducing portion sizes. The stress participants experienced impacted their ability to self-regulate their diet. They reported overeating or appetite suppression during stressful periods. Stress also affected cognitive responses by compromising healthy decision-making and instigating negative emotional reactions. Overall, stress complicated participants' ability to properly engage in recommended behaviors by negatively impacting participants' behavioral self-regulation and cognitive processes. Stress affects behavioral and cognitive progresses that adversely alters primarily dietary behaviors. Tailored plans acknowledging the impact of stress and providing coping and supportive help for dealing with stress may enhance engagement in healthy behaviors for Latinos with prediabetes. [ABSTRACT FROM AUTHOR]

Latino men who have sex with men (MSM) are disproportionately affected by HIV in the US and only half of Latinos diagnosed with HIV are virally suppressed. Little is known about the determinants of HIV care and treatment outcomes among Latinos. We used theories of intersectionality to assess the HIV testing, care and treatment experiences of gay Latino men living with HIV in a new immigrant destination. We conducted qualitative in-depth interviews with US and foreign-born gay Latino men living with HIV (n = 14) recruited through referrals from HIV care providers and case managers. We used Maxwell and Miller's theory of qualitative analysis to guide our approach to data analysis, integrating narrative techniques and thematic coding. We used theories of intersectionality – including both intersecting identities and structures – as an interpretive framework to understand participants' outcomes and experiences. All participants were engaged in HIV care at the time of the interviews. The mental health burden of diagnosis and managing life with HIV was a salient theme across all interviews. Most participants had experienced interruptions in their care due to both intersecting stigmatized identities (e.g. being gay, Latino, undocumented) and intersecting structures (healthcare, immigration policy, institutionalized homophobia). Undocumented participants directly connected their immigration status to their ability to get work, which then affected their retention in HIV care and treatment adherence. Examining the interplay between identities and structures provides a contextualized understanding of outcomes along the HIV care continuum among gay Latino men that goes beyond behavioral and cultural explanations. There is a need to assess long-term experiences of navigating HIV care and treatment given the intersecting structures of mobility, housing instability, and immigration policy. [ABSTRACT FROM AUTHOR]

Known as the "Black-White mental health paradox," Black Americans typically report better mental health than White Americans, despite chronic exposure to the psychologically harmful effects of racism and discrimination. Yet, researchers rarely examine how mental health is experienced across racial groups in economically distressed rural regions where all residents have disproportionately less access to mental healthcare resources. The purpose of this study was to explore how the racialized social system potentially contributes to the mental health beliefs and attitudes of racially majoritized and minoritized rural residents. We conducted a secondary analysis of 29 health-focused oral history interviews from Black American (n = 16) and White American (n = 13) adults in rural North Carolina. Through critical discourse analysis, we found nuanced discourses linked to three mental-health-related topics: mental illness, stressors, and coping. White rural residents' condemning discourses illustrated how their beliefs about mental illnesses were rooted in meritocratic notions of individual choice and personal responsibility. Conversely, Black rural residents offered compassionate discourses toward those who experience mental illness, and they described how macro-level mechanisms can affect individual well-being. Stressors also differed along racial lines, such that White residents were primarily concerned about perceived social changes, and Black residents referenced experiences of interpersonal and structural racism. Related to coping, Black and White rural residents characterized the mental health benefits of social support from involvement in their respective religious organizations. Only Black residents signified that a personal relationship with a higher power was an essential positive coping mechanism. Our findings suggest that belief (or disbelief) in meritocratic ideology and specific religious components could be important factors to probe with Black-White patterning in mental health outcomes. This research also suggests that sociocultural factors can disparately contribute to mental health beliefs and attitudes among diverse rural populations. • Black and White rural adults received social support from religious organizations • Black rural adults articulated compassion for people who experience mental illness • White adults' beliefs about mental illness were rooted in meritocratic ideology • Perceived sociocultural changes were a source of stress for White rural adults • A relationship with a higher power was a positive coping mechanism for Black adults [ABSTRACT FROM AUTHOR]

District court judges who make final determinations in domestic violence protective order (DVPO) cases in North Carolina indicate often using heuristics, such as the presence of visible injury, to guide their assessment of violence severity. This approach is concerning as it minimizes nonphysical intimate partner violence. We conducted a thematic analysis of DVPO plaintiff complaints to identify the types of nonphysical vioence described and its effects on plaintiff health outcomes. Most case files included descriptions of nonphysical violence and plaintiffs described fear as a significant mental health outcome. Findings highlight the potentially deleterious impact of nonphysical violence on the well-being of DVPO plaintiffs. [ABSTRACT FROM AUTHOR]

Long-acting injectable antiretroviral therapy (LA-ART) expands treatment options for people living with HIV (PLWH). This qualitative study characterizes LA-ART awareness, perceptions, and preferences among PLWH engaged in HIV care. From 2019 through 2021, we conducted semistructured in-depth interviews with 71 PLWH sampled from three clinics in three U.S. settings (North Carolina, Washington, DC, Massachusetts). Transcripts were analyzed using narrative and thematic techniques. Participant mean age was 46 years (range 24–72); most were cisgender men (55%) and virally suppressed (73%). Most participants had not heard of LA-ART and reacted with a mix of excitement and cautiousness. Potential LA-ART benefits included easier adherence, privacy, and effectiveness; concerns included effectiveness, side effects, costs, and increased clinic visits. Participants appreciated that LA-ART could support achieving and sustaining viral suppression. To inform their decision, participants wanted more information and convenient access and administration. Findings indicated that a shared decision-making approach and economic and logistical support for PLWH could facilitate LA-ART uptake. [ABSTRACT FROM AUTHOR]

The promotor de salud, or community health worker (CHW) role, is highly feminized and little is known about how men view their participation in CHW programs. We conducted in-depth interviews with Latino men in North Carolina to explore this gap. We used systematic coding and display procedures informed by Grounded Theory to analyze the data. Men described their communities as lacking cohesion, making integration of Latino immigrants difficult. Most did not consider themselves leaders or feel they had leaders in their communities. Their perceptions of the feminized CHW role as well as the volunteer or low-paid nature of CHW work conflicted with men's provider role. They also did not think they could perform the CHW role because they lacked education, skills, and broad networks. Efforts to increase male participation in CHW programs in new Latino immigrant destinations will need to understand and address these gender and migration-related dynamics in order to engage both women and men in improving the health of their communities. [ABSTRACT FROM AUTHOR]

The morbidity and mortality of Latino immigrants in the United States ( US) stem from a complex mix of policy, culture, discrimination and economics. Immigrants working as day labourers may be particularly vulnerable to the negative influences of these social factors due to limited access to social, financial and legal resources. We aimed to understand how the health of male Latino day labourers in North Carolina, US is influenced by their experiences interacting with their community and perceptions of their social environment. To respond to our research questions, we conducted three focus groups ( n = 9, n = 10, n = 10) and a photovoice project ( n = 5) with Latino male immigrants between October 2013 and March 2014. We conducted a thematic analysis of transcripts from the discussions in the focus groups and the group discussions with Photovoice participants. We found that men's health and well-being were primarily shaped by their experiences and feelings of discrimination and marginalisation. We identified three main links between discrimination/marginalisation and poor health: (i) dangerous work resulted in workplace injuries or illnesses; (ii) unsteady employment caused stress, anxiety and insufficient funds for healthcare; and (iii) exclusionary policies and treatment resulted in limited healthcare accessibility. Health promotion with Latino immigrant men in new settlement areas could benefit from community-building activities, addressing discrimination, augmenting the reach of formal healthcare and building upon the informal mechanisms that immigrants rely on to meet their health needs. Reforms to immigration and labour policies are also essential to addressing these structural barriers to health for these men. [ABSTRACT FROM AUTHOR]

Latino men in the Southeastern USA are disproportionately affected by HIV, but little is known about how the migration process influences HIV-related risk. In North Carolina, a relatively new immigrant destination, Latino men are predominantly young and from Mexico. We conducted 31 iterative life history interviews with 15 Mexican-born men living with HIV. We used holistic content narrative analysis methods to examine HIV vulnerability in the context of migration and to identify important turning points. Major themes included the prominence of traumatic early-life experiences, migration as an ongoing process rather than a finite event, and HIV diagnosis as a final turning point in migration trajectories. Findings provide a nuanced understanding of HIV vulnerability throughout the migration process and have implications including the need for bi-national HIV-prevention approaches, improved outreach around early testing and linkage to care, and attention to mental health. [ABSTRACT FROM PUBLISHER]

The Southeastern United States (US) has a rapidly growing Latino population, yet little is known about HIV-infected Latinos in the region. To help inform future prevention studies, we compared sociodemographic, clinical, and behavioral characteristics between immigrant and US-born HIV-infected Latinos using face-to-face interviews conducted at three clinics in North Carolina. Questions encompassed HIV testing, acculturation, sexual- and substance-related behaviors, and migration history. Behavioral data were compared with 451 black and white clinic patients. Differences were tested using Pearson's and Kruskal–Wallis tests. Participants (n=127) were primarily male (74%) and immigrants (82%). Most immigrants were Mexican (67%), had low acculturation scores (92%), and were diagnosed a median of 8 years (IQR 0–12) following immigration. Compared with US-born Latinos, immigrants had lower CD4 counts at clinic entry (median 187 vs. 371 cells/mm3) and were less likely to have graduated high school (49% vs. 78%) or have insurance (9% vs. 52%; allP <0.05). Most immigrants identified as heterosexual (60%) and reported fewer lifetime partners than US-born Latinos (median 6 vs. 20;P=0.001). Immigrant men were less likely to report sex with men than US-born men (43% vs. 81%;P=0.005). Immigrant men also had similar risk behaviors to black men, and US-born Latino men exhibited behaviors that were more similar to white men in our clinic. At the time of survey, >90% of participants were receiving antiretroviral therapy (ART) and most had achieved HIV RNA <50 copies/mL (62% immigrants vs. 76% US-born;P=0.32). In conclusion, Latino immigrants were more likely to present with advanced disease, identify as heterosexual, and report different risk behaviors than US-born Latinos, yet receipt and response to ART were similar between the two groups. Prevention strategies should prioritize finding innovative methods to reach Latino immigrants for routine early testing regardless of risk stratification and include programs targeted toward the different needs of immigrant and US-born Latinos. [ABSTRACT FROM PUBLISHER]

Substance abuse continues to greatly impact the US population. The purpose of this study is to improve understanding of the reasons why individuals seek substance user treatment. Qualitative interviews were conducted with 50 men ( n = 25) and women ( n = 25) across eight substance user treatment programs in Durham, North Carolina, in 2010. We identify six motivating themes regarding reasons for seeking treatment and explore how these themes vary by the participants' mode of entry into treatment. Findings provide a holistic understanding of how and why individuals come into treatment that can enhance the quality and impact of substance user services. [ABSTRACT FROM AUTHOR]