Program Structure, Group Dynamics Fundamental to HIV Intervention Success

An intervention created for Black women living with HIV in the United States was found to be successful due to how the program was structured and the group dynamics of peers in the intervention, according to a study published in International Journal of Environmental Research and Public Health.

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Black women are more vulnerable to HIV due to economic and social determinants of health. They are 5 times more likely to report HIV compared with other races. HIV prevention intervention design has started to integrate social and structural components and address economic determinants of health. Common Threads was an intervention created to help Black women understand the social, economic, and cultural factors that increase vulnerability to HIV. This qualitative study aimed to “explore the experience of the participants with a focus on evaluating the impact of this intervention through the framework of the client-focused considering work (CFCW) model.”

A grounded theory method was used to evaluate the experiences of women who participated in Common Threads. This intervention incorporated both trauma-informed care (TIC) and vocational rehabilitation. The study drew from both the TIC model and CFCW; TIC emphasizes the pervasiveness of trauma and advocates for service delivery to identify, prevent, and intervene in traumatic events whereas the CFCW acknowledges the domains of medical, psychological, financial, and vocational barriers to vocational development and decision-making.

Snowball sampling was used for to find study participants, and semi-structured interviewing techniques were used to collect perceptions of Common Threads’ outcomes. Further questions and probes were done afterward based on responses given. All participants took part in a 60 to 90 minute interview conducted either in person or via phone. Questions concerned participant experience regarding program satisfaction, effect of the program environment, and activities on development in physical, medical, psychosocial, financial, legal, and vocational areas.

There were 21 participants in this study aged 55 to 64 years, 10 of whom had received their diagnosis between ages 25 and 34 years. There were 20 participants who identified as Black and 1 who identified as Latina; 12 reported an annual household income less than $24,999. All participants had completed the first phase of the Common Threads training, with 17 continuing to the Microenterprise Circle and 14 participating in the Market Place.

Women spoke on key aspects of Common Threads that acted on components of TIC, including shared commonalities with other participants, gender-specific and peer-led programming, practicing storytelling skills, vocational rehabilitation options, building family trees and personal timelines, and gaining knowledge of HIV. These aspects, according to the women questioned, provided a safe environment. The women also felt protected against psychological and physical harm, as they felt others in the group would understand what they had gone through. This facilitated an environment where all participants had trust in each other. Some participants felt that being in a group of the same race was beneficial for this.

Participants also spoke on how the CFCW model worked in Common Threads. In terms of the health domain, Common Threads was found to encourage participants to continue behaviors that promoted and maintained health, such as medication adherence. Other participants said that they gained confidence and discovered ways to get information about their disease. The psychosocial domain involved building a community, which let the participants reconnect with others. Mental health had also improved after participating in the program.

Participants noted that they had been increasing their income by learning how to sell products that they had made. They also learned about their own health benefits through a flyer that Common Threads distributed. Participants also stated that Common Threads helped them understand the effect of trauma, gave them knowledge of HIV, and helped them with health management, self-care, storytelling, and psychosocial skills.

There were some limitations to the study. Women participated in different modifications of the program structure given the funding available. Also, not all participants of the study were involved in the second phase of the intervention, as participation in vocational training was not required. All research participants were also volunteers, which may have led to more positive engagements with Common Threads being included.

The researchers concluded that Common Threads was helpful for women in the 4 main domains of medical, psychosocial, information, and vocational aspects. Group dynamics and the way the program was structured were the contributing factors to success in women participating in the Common Threads intervention.

Reference

Chang HY, Johnson V, Conyers LM. Exploring the impact of an integrated trauma-informed HIV and vocational intervention for Black/African American women living with HIV. Int J Environ Res Public Health. 2023;20(17):6649. doi:10.3390/ijerph20176649