Technology Platforms and Family Engagement for HIV/AIDS Prevention: Addressing the Needs of Minority Rural Youth

See Related Article on p.255In the U.S., cases of newly infected people with HIV/AIDS have substantially declined with HIV infections, levering off in the past 5 years to approximately 38,000–39,000 cases per year. Although adolescents represent only 13% of the entire U.S. population (42 million), youth aged 13–24 years accounted for 21% of the newly diagnosed HIV cases in 2017 [1Centers for Disease ControlU.S. Statistics. HIV.gov.https://www.hiv.gov/hiv-basics/overview/data-and-trends/statisticsDate: March 13, 2019Date accessed: April 10, 2019Google Scholar, 2Racial and ethnic composition of the child population.Child Trends. December 13, 2018; https://www.childtrends.org/indicators/racial-and-ethnic-composition-of-the-child-populationDate accessed: April 10, 2019Google Scholar]. They also comprised 8% of the total number of people diagnosed with AIDS (1473; one in every five cases) that same year [2Racial and ethnic composition of the child population.Child Trends. December 13, 2018; https://www.childtrends.org/indicators/racial-and-ethnic-composition-of-the-child-populationDate accessed: April 10, 2019Google Scholar, 3Centers for Disease Control and PreventionHIV/AIDS.https://www.cdc.gov/hiv/group/age/youth/index.htmlDate: April 20, 2018Date accessed: April 10, 2019Google Scholar]. See Related Article on p.255 The number of newly infected individuals with HIV are disproportionally higher in rural counties in the South and Southwest regions, comprising 52% of the total national cases in 2017 (19,968). Rural minority populations are largely affected by the HIV/AIDS epidemic with higher prevalence and risk among African American youth representing 61% of all the HIV infections among adolescent and young adults younger than 25 years [4Centers for Disease Control and PreventionHIV/AIDS.https://www.cdc.gov/hiv/statistics/overview/ataglance.htmlDate: January 29, 2019Date accessed: April 10, 2019Google Scholar, 5Centers for Disease Control and PreventionHIV Surveillance in Urban and Nonurban Areas. CDC - Slide Sets - Resource Library HIV/AIDS.http://www.cdc.gov/hiv/library/slideSets/index.htmlDate accessed: March 14, 2014Google Scholar]. Rural communities face several challenges that might hinder their opportunities for accessing prevention and treatment services for HIV/AIDS. For instance, restricted transportation services paired with scarce medical providers and facilities might limit accessibility to services and programs among rural residents. In addition, implementation of outreach programs among disperse communities in rural areas not only requires multisectoral collaborations but must also address issues related to continuance of services and sustainability [6Albritton T. Hodge-Sallah S. Akers A. et al.A process evaluation of an HIV/STI intervention for rural African American youth.Qual Health Res. 2014; 24: 969-982Crossref PubMed Scopus (5) Google Scholar, 7Corbie-Smith G. Adimora A.A. Youmans S. et al.Project GRACE: A staged approach to development of a community–academic partnership to address HIV in rural African American communities.Health Promotion Pract. 2011; 12: 293-302Crossref PubMed Scopus (35) Google Scholar]. The effectiveness of community-based programs to address the needs of HIV minority populations in rural communities has gained attention in the past decade, leading to the development of groundbreaking efforts using participatory research approaches to develop multilevel, interdisciplinary, culture-based, and sustainable interventions. This includes the GRACE project (Growing, Reaching, Advocating for Change and Empowerment, NC), the Rural HIV/AIDS Prevention and Treatment Toolkit (HIV.gov), and the Northern Colorado AIDS Project, to name a few [8Ellison A. Akers A. Black A. et al.HIV prevention in rural community: Project GRACE—a multigenerationl approach to community engagement.in: Rhodes S.D. Innovations in HIV Prevention Research and Practice through Community Engagement. Springer, New York2014: 11-26Crossref Scopus (3) Google Scholar, 9HIV.govNational Rural Health Day: Spotlight on HIV prevention and treatment in rural communities.https://www.hiv.gov/blog/national-rural-health-day-spotlight-hiv-prevention-and-treatment-rural-communitiesDate: November 14 2018Date accessed: April 10, 2019Google Scholar]. Less research has been done, however, on the effectiveness of HIV prevention programs for rural minority youth and their families, particularly among African Americans. In this issue of the Journal, a study by Murry et al. [[10]Murry V.M. Kettrey H.H. Berkel C. Inniss-Thompson M.N. The Pathways for African American Success (PAAS): Does delivery platform matter in the prevention of HIV risk vulnerability among youth?.J Adolesc Health. 2019; 65: 255-261Abstract Full Text Full Text PDF Scopus (1) Google Scholar] evaluates the effectiveness of a technology-delivered HIV risk prevention program named Pathways for African American Success (PAAS). Parent/youth dyads (n = 420) were randomly assigned to the following conditions: (1) small group in-person facilitator-led, (2) self-directed technology, and (3) home-mailed educational materials control group. Results from the study provided evidence of the efficacy of technology delivered HIV prevention components, yielding similar results as the in-person facilitator-led small-group modality. Furthermore, results showed that the technology-delivered PAAS program was significantly conducive to strengthening parent–child protective processes and lowering intentions to engage in risk-taking behaviors 6 months later. Murry et al. shed light on two very timely challenges on HIV/AIDS prevention efforts. First, they discuss the rural/urban divide and its intersection with disparities in preventive medicine quality and the impact of health services for underserved populations, particularly rural youth of color. Despite the effectiveness of evidence-based programs (EBPs) in preventing risk behaviors associated with HIV transmission (e.g., unprotected and risky sex, substance use) among urban and rural youth, the authors discuss that rural families of color have limited access to EBPs, and thus, alternative delivery platforms need to be developed and adapted to alleviate their challenges. PAAS was found in the present study to successfully decrease risk engagement among African American rural youth using the self-directed technology platform compared with the youth attending a small group delivered program or the control group receiving only a literature package. Findings are consistent with previous studies documenting that technological platforms (e.g., telemedicine, social media) for HIV prevention, intervention, treatment, and support programs are generally well accepted and adopted by youth. More importantly, PASS represents a viable solution for rural African American youth, as it addresses many of the barriers presented by EBPs (e.g., transportation, location, accessibility) and might be a significant tool for raising awareness and educating rural communities about HIV/AIDS particularly among younger populations [11Taggart T. Grewe M.E. Conserve D.F. et al.Social media and HIV: A systematic review of uses of social media in HIV communication.J Med Internet Res. 2015; 17: e248Crossref PubMed Scopus (116) Google Scholar, 12Medich M. Swendeman D.T. Comulada W.S. et al.Promising approaches for engaging youth and young adults living with HIV in HIV primary care using social media and mobile technology interventions: Protocol for the SPNS Social Media Initiative (preprint).JMIR Preprints. 2018; https://doi.org/10.2196/preprints.10681Crossref Google Scholar]. This is especially relevant because approximately 51% of rural youth and young adults aged 13–24 years were living with HIV and did not know they were infected in 2015 [[2]Racial and ethnic composition of the child population.Child Trends. December 13, 2018; https://www.childtrends.org/indicators/racial-and-ethnic-composition-of-the-child-populationDate accessed: April 10, 2019Google Scholar]. Second, Murry et al. examined the significant role of caregivers and families as active agents in prevention efforts not only by buffering youth from engaging in HIV risk behaviors but also as the most important advocates of youth's health. This is a significant resource that has been underutilized, undermined, and that needs to be reempowered as a key asset in the current fight against HIV/AIDS epidemic in youth [[13]Richter L. Sherr L. Adata M. et al.Strengthening families to support children affected by HIV and AIDS.AIDS Care. 2009; 21: 3-12Crossref PubMed Scopus (106) Google Scholar]. The active participation of families and caregivers in HIV prevention programs for minority rural youth has been, however, less studied despite a robust body of evidence documenting their potential effectiveness in HIV prevention among adolescents. Murry et al. found that PAAS increased family engagement in discussions about values, norms, and expectations that might aid in influencing youth's decision-making and attitudes as well as their social cognitive abilities to avoid engaging in risky behaviors that could expose them to HIV infections and AIDS. Study findings extend current knowledge on the role of family members and caregivers who might be better positioned to provide guidance and monitor sexual development and behaviors, communicate values and expectations, and support children as they transition into adolescence and young adults. As prevention and intervention science expands and incorporates technology and additional delivery platforms, the need for developing culturally appropriate interventions remains a challenge. To be “culturally appropriate,” HIV/AIDS prevention and intervention programs targeting youth and their families must thoughtfully and purposefully examine the characteristics of the target population and incorporate elements that would make the programs flexible, desirable, and accessible. Furthermore, families represent a safe environment for developing healthy boundaries, building sexual confidence, communicating sexual values, and discussing difficult topics such as sexual minority stigmatization, HIV/AIDS risk behaviors, and risk reduction strategies to support the well-being of youth [[14]Sutton M.Y. Lasswell S.M. Lanier Y. Miller K.S. Impact of parent-child communication interventions on sex behaviors and cognitive outcomes for Black/African-American and Hispanic/Latino youth: A systematic review, 1988–2012.J Adolesc Health. 2014; 54: 369-384Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar]. A comprehensive prevention/intervention approach that caters to strengthen family relationships and empowers minority youth to become active agents in their health, is, therefore, warranted. The Pathways for African American Success: Does Delivery Platform Matter in the Prevention of HIV Risk Vulnerability Among Youth?Journal of Adolescent HealthVol. 65Issue 2PreviewTechnology provides new possibilities for disseminating effective prevention programming to underserved families, such as those residing in rural communities. The present study is an evaluation of a technology-delivered HIV risk prevention program designed for rural African-American families, Pathways for African American Success (PAAS), to determine its promise for increasing access to evidence-based youth risk prevention programs among those in the greatest need. Full-Text PDF