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.

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 (e.g., desires/ commitments), behaviors (e.g., practice changes to assure anonymity of diagnosis), conditions (e.g., human-equity centered culture) and practices (e.g., promotion of patient choice, demonstrated allyship, prioritization of hiring staff attuned to intersectional stigma, removal of HIV visibility, and normalization of HIV. Organizational-level identity campaigns and ally-ship based groups were also discussed. 2) Efforts needed to address barriers to inclusivity, which included general barriers and those related to perceived stigma and bias, and 3) 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.