“Cutting Out Stigma” Intervention – Barbershops Link Black Men in Tennessee to HIV Care
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Summary:
Led by Aima Ahonkhai, MD, MPH, the Tennessee Department of Health, one of three Phase 3 winners of the Innovative Community Engagement Strategies to Reduce HIV-related Stigma and Disparities Challenge, implements “Cutting out Stigma,” an intervention focused on increasing linkage to HIV care for Black men in the state.
Sponsored by the HHS Office of Minority Health, in partnership with the Office of the Assistant Secretary for Health (OASH) Office of Infectious Disease and HIV/AIDS Policy (OIDP), the Innovative Community Engagement Strategies to Reduce HIV-related Stigma and Disparities Challenge (the Challenge) sought innovative and effective approaches for community engagement and mobilization to reduce HIV stigma and improve pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) utilization among racial and ethnic minority individuals who are at increased risk for HIV infection or are people with HIV. The Challenge advanced through three phases and awarded a total of $760,000. It received more than 80 submissions and selected three winners, awarding each of the Phase 3 winners a $60,000 prize to advance their work.
HIV.gov is sharing the work of the Tennessee Department of Health, in collaboration with Aima Ahonkhai, MD, MPH, an infectious diseases physician and researcher specializing in HIV medicine, one of the Phase 3 winners.
The Intervention
“I’m very proud of this work because it came out of a community-partnered approach. As an HIV physician, I’ve had first-hand experiences with the devastating impact of stigma on the lives of people living with HIV. These experiences have fueled my efforts to address HIV stigma.”
Dr. Ahonkhai shared this sentiment with HIV.gov as we discussed her work with the Tennessee Department of Health as a Phase 3 winner. Currently, Dr. Ahonkhai is a faculty member in the Division of Infectious Diseases at Massachusetts General Hospital in Boston, and the Director of the Community Engaged Research Program for the Harvard University Center for AIDS Research.
As part of this collaboration, Dr. Ahonkhai and her team analyzed the rates and predictors of linkage to HIV care in Tennessee—a measure for which Tennessee lagged behind other states in the nation. The team’s findings showed the rates of linkage to HIV care had not improved over time (despite many focused public health efforts). In addition, the team found that young Black men were the least likely of any demographic group to be linked to HIV care.
After identifying this population of focus, Dr. Ahonkhai noted that the next question became, “if young Black men aren’t getting linked to and engaging in care, how can we find them, and how can we engage them in HIV care?”
Dr. Ahonkhai and the team decided to explore reaching Black men by partnering with barbers and their barbershops—as barbershops often serve as “a trusted and safe space for Black men where they can go to cut their hair and talk about anything and everything,” said Dr. Ahonkhai. An additional grant from Vanderbilt University School of Medicine and Meharry Medical College to establish a partnership with a Nashville community-based organization enabled Dr. Ahonkhai to partner with Street WorksExit Disclaimer, an HIV Service Organization that provides education, prevention, and treatment services for people with and affected by HIV, to develop the “Cutting out Stigma” intervention.
The Impact
Dr. Ahonkhai and Street Works brought together a cohort of barbers to discuss how they could assist with improving health-related HIV outcomes for young Black men in the area. The team ultimately decided to focus on stigma—where most of the conversation with the barbers ultimately focused. “Cutting out Stigma” was born out of these conversations.
The “Cutting out Stigma” intervention trains barbers to become health ambassadors, providing education and connection and sparking critical conversations to ultimately help reduce HIV stigma. In addition to training the barbers, “Cutting out Stigma” created multimedia educational programs and a campaign around HIV stigma reduction that includes posters in barbershops and social media reels.
“We had to value what the community was saying. We met Black men where they are, which is an important part of community-engaged research,” noted Dr. Ahonkhai. She also highlighted the team’s effectiveness in reaching Black men due to the team’s makeup. “On our research team, we have our community partners, including Street Works, MOJO marketing and PR (a Black-owned media company with expertise in health interventions), barbers, content experts in behavioral science, and people with lived experience which are very important, as it makes the work more relevant,” she shared.
Next Steps
As the implementation of “Cutting out Stigma” continues, Dr. Ahonkhai shared that the intervention’s potential impact inspires her. She noted that “Black barbers on our study team have shared how being involved in this intervention has allowed them to see their value to the community beyond their profession. It provides avenues for further development. Our barber investigators presented at national conferences and are getting certified as community health workers.” Dr. Ahonkhai added that “how you approach solutions, collaboration, and a community is the most important thing, and doing it in a way where you form a partnership whereby you recognize the mutual benefits being brought to the table creates value which is worthy of replicating.”
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