Integrating Biomedical Prevention Technologies: HIV/AIDS Focused CBOs Finding Their Way

Background and Purpose: Despite the emergence of highly effective biomedical HIV prevention technologies such as “treatment as prevention” and pre/post exposure prophylaxis (PrEP and PEP), people of color and men who have sex with men of all races continue to be disproportionately impacted by the virus. HIV/AIDS focused community-based organizations (CBOs) are well positioned to reach and engage individuals for whom these interventions could benefit most. However, little is known about the capacity of these organizations for integrating such complicated technologies into their routine prevention activities. The primary objectives of this study are 1) to understand the conditions under which HIV/AIDS focused CBOs integrate biomedical HIV prevention technologies into their existing prevention programming, 2) to learn about the various strategies being used by CBOs to incorporate such technologies, and 3) to understand the challenges that CBOs face as it relates to integration.

Methods: Thirteen (13) in-depth, semi-structured interviews were conducted with executive administrators from HIV/AIDS focused CBOs currently providing prevention services in the Midwest. Participants represented organizations that varied widely in terms of staff size, operating budget, and number of years in existence. Interviews elicited participants’ narratives about their organizations' thoughts, perceptions, and experiences with biomedical interventions, as well as the strategies used for integrating them into routine HIV prevention activities. Guided by the principles of phenomenological research methods, interviews were transcribed verbatim and coded thematically using Dedoose (a web-based qualitative analysis software package). 

Results: Data analysis reveals that, with the exception of “treatment as prevention,” very few of the HIV/AIDS focused CBOs represented in this study are integrating biomedical prevention technologies such as PrEP and PEP into their routine prevention activities (n=2). Participants from organizations not integrating these technologies cite lack of funder support, lack of staff knowledge, and ethical concerns regarding these interventions as reasons for not incorporating them. In CBOs where integration does occur, organizational leaders have recognized the value of making these prevention options available to their client population and sought out innovative ways to fund and deliver integrated prevention programming.

Conclusions and Implications: While biomedical HIV prevention technologies such as PrEP and PEP possess a great deal of potential for curbing the epidemic among the populations most affected, HIV/AIDS focused CBOs face a number of structural and ideological challenges that threaten to impede access. To maximize the potential of these emerging technologies, funders of HIV prevention programming must prioritize these interventions by supporting the development and dissemination of integrative models. Additionally, culturally sensitive technical assistance and capacity building opportunities must be made available to HIV/AIDS focused CBOs to increase staff knowledge and address the ethical concerns that exist as it relates to these interventions.