AVENIDA DE DISEÑO

Summary

Young African American and Hispanic MSM, especially in Louisville, Lexington, and Northern Kentucky, are at the highest risk for concurrent HIV/AIDS diagnoses in the state of Kentucky. Forty-six percent of MSM in Kentucky are diagnosed with HIV and AIDS within 30 days of the initial HIV diagnosis, which puts the rest of the population at higher risk for

transmission of HIV (Kentucky CHFS, 2014). The HIV/AIDS epidemic among African

American and Hispanic MSM in Kentucky continues to be a significant public health problem. Surveys and focus groups were utilized in this study to discover HIV testing barriers within these communities in Kentucky.

Thirty-three African American MSM, six Hispanic MSM, and ten Multiracial MSM participated in this study. All 49 participants completed surveys and eight participants discussed HIV/AIDS testing barriers in focus group settings. Although the majority of all participants who completed the survey understood HIV risk factors, safe sex, and had accessed HIV testing at some point in their lifetime, many of them also expressed concern over HIV testing barriers. These HIV testing barriers included denial of being at risk for HIV/AIDS, fear of finding out positive status, fear of no support with positive diagnosis, and fear of seeing someone they know when getting tested. Additionally, they do not want to worry or upset family and/or friends and they do not want anyone to find out their HIV status.

African American MSM expressed great concern over the lack of knowledge of

more education in schools and on the streets. A recurring theme highlighted the importance of parents educating their children regarding HIV/AIDS facts and testing. Families are the center of African American communities and HIV/AIDS education for children needs to start with early elementary-aged children in the home, rather than from peers at school.

Hispanic and Multiracial MSM are more likely to avoid HIV testing due to confidentiality and privacy issues. They are very fearful of others finding out that they participate in high-risk behavior, or even finding out their sexual orientation and HIV status. Before interventions are implemented by public health professionals to improve HIV testing among Hispanic and Multiracial MSM, time must be spent on building relationships and building trust with these groups.

Limitations

There are several limitations to this study. While the sample of young minority MSM in Kentucky provided some relevant themes focused on the barriers to early HIV testing, the sample was too small to make results generalizable to the target population as a whole. Using focus groups is an appropriate methodology to identify barriers to early HIV testing, however, the researchers were limited because participants who had committed to participate did not keep their appointments.

Multiracial MSM were not in the target population of interest, however, 20.4% of participants identified themselves as Multiracial in this group. It would be beneficial to conduct focus groups that only include Multiracial MSM to better understand the barriers to early HIV testing and identify if they differ from African-American MSM. Additionally, the absence of any Hispanic MSM in the focus groups significantly limited the researchers in understanding their experience with barriers to early HIV testing.

Conclusions and Recommendations

Young African American and Hispanic MSM in Kentucky are at high risk for concurrent diagnoses due to multi-faceted barriers, to include lack of knowledge, fear of dying, fear of discrimination, fear of no support, fear of rejection, and fear of intrusion on privacy, as determined from the pencil and paper surveys. In addition, these young minority MSM are largely concerned over privacy and confidentiality, and the need for the education of parents prior to the education of young children. Goals are very similar; however different strategies will be needed for each ethnic group.

When targeting young African American MSM to increase rates of early HIV testing and decrease rates of concurrent diagnoses, public health professionals must focus on the lack of knowledge that exists within this community. In order to gain trust with this community, going to neighborhoods and building relationships will largely improve efficiency and effectiveness of interventions. Two separate African American focus groups voiced the need for education to be started in the home at an early age. Because young children are frequently influenced by their peers, it is important that this education begin with early elementary-aged children. Public health professionals should focus their interventions on parents. If parents learn to let go of the fear and stigma, then these negative values will no longer be instilled in their children. Once parents feel that they are adequately equipped with the facts and social reality of HIV/AIDS, then they can begin to bring this up as a normal topic of conversation in their home.

To improve rates of early HIV testing and concurrent diagnoses among young Hispanic MSM, public health professionals must focus on the lack of trust that exists within this

community. These young MSM are often unwilling to discuss HIV/AIDS with public health professionals due to fear associated with this epidemic. Public health professionals should

develop interventions that begin with meeting these young MSM in their homes and building relationships over a significant period of time. Although this is not an intervention that may immediately increase rates of early testing and decrease rates of concurrent diagnoses, this will ensure that later interventions target this population effectively.

Additional research with a broader scope is needed to ensure that these results are generalizable to young minority MSM communities in Kentucky, and in the United States as a whole. Researchers who wish to study HIV testing barriers among minority MSM should conduct this research over a longer period of time. Before implementing research methods, researchers should spend time building relationships with gatekeepers and with their target communities in order to build a potential larger sample size. Surveys and focus groups are effective methods; however, it is necessary that these methods be conducted with a larger sample of each target ethnicity group. Data should be analyzed utilizing a more sophisticated program that can provide confidence levels, probability values and quantitatively significant results.

To break down HIV testing barriers and decrease rates of concurrent diagnoses among young African American and Hispanic MSM in high-risk areas in Kentucky, public health professionals must be willing to spend a sufficient amount of time building relationships with these populations. Interventions need to largely focus on lack of knowledge and the endemic fear and stigma that resides within these communities. If these steps are taken carefully and