JMIR Publications

ABSTRACT

Background:

Black youth with HIV (BYWH) endure higher rates of Post-Traumatic Stress Disorder, compared with White youth or youth without HIV. While trauma-informed approaches have been associated with improvements in health outcomes among marginalized communities, research infrequently includes cross-cutting practices for disrupting trauma driving care disengagement among BYWH. Greater attention is needed on methods for promoting inclusivity in HIV care spaces—such as building trust and safety by honoring patients’ values, beliefs, customs, and preferences—to mitigate psychological harm. In this study, we sought to assess a youth-focused HIV clinic’s capacity for providing trauma-sensitive, inclusive practices.

Objective:

In this study, we sought to assess a youth-focused HIV clinic’s capacity for providing trauma-sensitive, inclusive practices.

Methods:

A semi-structured interview guide was prepared via community-engaged discussions to evince implementation determinants relative to trauma-informed care with a specific focus on cross-cutting practices for disrupting trauma and promoting inclusivity. Personnel of the HIV clinic were invited to participate in one-on-one interviews, which were audio recorded, transcribed verbatim, and coded inductively via de novo themes and thematically via the Consolidated Framework for Implementation Research (CFIR).

Results:

Twenty clinic personnel participated, with 90% cisgender female, 40% (8) Black, and 40% (8) White, with a mean age of 46.58 (SD= 11.40) and length of employment 12 years (SD= 11.82). Three themes emerged: 1) Current efforts to promote inclusivity, which included staff attitudes, behaviors, conditions and culture, practices, and hospital-wide initiatives, 2) Stigma and bias as barriers, 3) General barriers and efforts needed to address, which included the CFIR domains of Informational and Engagement Barriers, Resource Availability and Relative Priority, Clinic and Organizational Setting Opinion, and Institutional Policies/ Leadership Make-Up, and 4) Facilitators to implementing further inclusive practices, which included CFIR domains of staff retention, collaboration, and communication and external resources.

Conclusions:

Findings indicated that while many conditions and practices exist, additional efforts are needed to promote inclusivity. Results contribute to the growing literature demonstrating explicitly how inclusivity is crucial to fostering a trauma-informed culture. Future interventions should address stigma and bias as barriers to the promotion and practice of inclusivity.