Methods: Data were collected from implementation focused qualitative interviews of participants in the POSSE Intervention; a study designed to decrease sexual risk, STIs, and HIV stigma within HBC communities in Chicago and Philadelphia. The intervention works in complement with Popular Opinion Leaders (POLs) who are trained to deliver HIV/STI prevention and treatment messages to members. Semi structured, in-depth interviews were conducted during follow-up assessments that occurred every 6 months, with each assessment point consisting of 45 interviews with POLs (n=15) and community participants (n=30). Interviews were recorded, transcribed verbatim, and analyzed using Dedoose 8.1.8. Minority stress theory, Stress and Coping theory, and Trauma Theory guided an iterative analysis during an open coding process used to create data driven codes. Illustrative quotes were identified in the coding process to support the thematic statements being made.
Results: Findings reveal that, despite the supportive and protective origins of the HBC, participating in these communities may create/exacerbate mental health symptoms, trauma/stress related factors, and substance abuse among participants. Specifically, participants reported symptoms of loneliness, sadness/hopelessness, anger, and suicidality related to their participation in the HBC. These symptoms, according to participants, resulted in and from a lack of social support within the HBC, violence, unhealthy relationships, homelessness, and sex work, among a host of other factors.
Conclusions and Implications: While Popular Opinion Leader intervention models may demonstrate efficacy with regard to disseminating HIV/STI prevention and treatment education within the HBC, community leaders involved with the POSSE project expressed the need for additional support to attend to mental health needs within the community. To remedy this, social workers can collaborate with the HBC to increase access to culturally appropriate mental health and substance abuse services by: 1) providing training to community leaders for supporting participants who present with these concerns; and 2) constructing and evaluating a mechanism for improving the pipeline of mental health/substance abuse professionals within HBC communities.