Focus Groups

These reports outline the findings from two series of focus groups about experiences with Philadelphia's healthcare system among specific high-risk populations. The former HIV Prevention Planning Group requested that the Office of HIV Planning conduct these focus groups in order to better target HIV testing and prevention services in culturally competent and accessible ways.

One series of focus groups was held with high-risk heterosexuals of low socioeconomic status. The second series of focus groups was held with young gay and bisexual men. Each series resulted in a set of recommendations.

Recommendations

In order to address the healthcare and HIV prevention needs of Philadelphia’s YMSM, a combination of strategies, policies and programs are necessary.

1. Increasing access to and engagement with primary care for YMSM is essential. Engagement in primary care is an especially important tool in the HIV prevention “toolbox” in this age of biomedical interventions like pre-exposure prophylaxis and “treatment as prevention”. HIV-negative YMSM can be linked to appropriate interventions and have regular sexual health screenings. YMSM who are regularly tested and engaged in healthcare will have a better chance of being linked to HIV care and treatment, should they acquire HIV. Programs that engage YMSM in healthcare should address their complex needs, including mental health, substance use, chronic health conditions, and social needs, in developmentally appropriate ways.  
   
2. A combination of routine testing in all primary care settings and targeted community-based testing is necessary. Risk-based testing alone may miss high-risk individuals who are reluctant to disclose same-sex attraction and/or their sexual behaviors or substance use. 
   
3. Comprehensive evidence-based sexual health education, inclusive of all gender identities and sexual orientations, is needed in the Philadelphia school district. Young people need sexual health education that promotes not only their health but their well-being.
   
4. HIV testing protocols should address concerns about confidentiality. HIV testing programs ought to consider who provides the counselling and testing, where testing occurs, and how to address concerns about confidentiality and privacy. It may be beneficial to include information about privacy protections and confidential testing protocols in outreach and marketing materials, in order to address those concerns before they can become barriers to testing.  
   
5. Special attention should be paid to creating welcoming and accepting organizational cultures. Healthcare organizations need to prioritize the barriers, challenges and concerns of YMSM. YMSM want to go to providers who can relate to their experiences and accept them as they are. 
   
6. Relevant information about local services, sexual health, and HIV/STD testing should be online in the places YMSM are likely to find it. Reliable online content will help many YMSM, especially those who are reluctant or unable to access services in the “gay” community. More local research is needed to better understand how Philadelphia’s youth access online health information. 
   
7. Community level efforts are needed to address HIV stigma and discrimination of LGBTQ individuals, which persist and act as a barrier to open communication about the sexual health needs of YMSM.  
   
8. Public health programs and healthcare organizations must be sensitive to the effects of stigma and discrimination on YMSM; especially minority YMSM who face not only stigma because of their sexuality and/or gender expression, but also live in a society with pervasive structural racism.  
   

Recommendations

The following recommendations are based on the experiences and opinions of the focus group participants as well as the current literature and epidemiological data in Philadelphia. These recommendations seek to address health disparities and decrease HIV incidence and prevalence in Philadelphia.

1. Trauma-informed care should be the standard of care. Considering the pervasive experiences of trauma for men and women of low socio-economic status (childhood and adult), all healthcare settings should work towards a trauma-informed culture.
   
2. Sexual and reproductive health care must be trauma-informed. All women should be screened for current intimate partner violence, as well as childhood and past sexual and emotional abuse. Appropriate referrals should be made for mental health and social support services.
   
3. Honor and maintain a patient’s dignity in all care settings. Patients who feel they are treated with dignity and are active participants in healthcare decision-making are more likely to adhere to treatment and trust their medical provider.
   
4. Holistic care that includes services for mental and physical health is essential for long term health and continued engagement in primary and HIV care. Social support should be integrated into all healthcare settings, whether through case management, navigations services or peer support. Service providers should consider incorporation of childcare and respite services in services targeted to women, considering their caregiving responsibilities.
   
5. Continue and expand current efforts to make HIV testing routine in all primary care. Efforts should ensure routine screenings are happening in communities where HIV is most prevalent. Routine testing doesn’t rely on patient disclosure or recognition of HIV risk behaviors and will increase the likelihood that individuals are diagnosed and linked to care in a timely matter.
   
6. Include information about PrEP during pre- and/or post-test HIV counseling services. Individuals who test HIV-negative (for whom PrEP is appropriate) should receive information about where and how to access PrEP and provided with relevant referrals.
   
7. Community-level campaigns to raise awareness about HIV risk and prevention in the Black and Latino communities are needed. The campaigns should be broadly marketed to all members of the Black and Latino communities, not just to individuals of a certain risk profile or class. Local community leaders should be the messengers of the campaign.
   
8. Provide adult health education in community settings to raise health literacy to decrease health disparities. Programs should include information about sexual health and HIV/STI prevention, hygiene, nutrition, sleep, and the importance of health screenings. Specific interventions should focus on the health needs of Black men.