The family is the principal source of socialization and protection against racism for many Blacks. Transmitting values, norms, morals, and beliefs (i.e., racial socialization) to successive generations is done to promote racial awareness and to prepare an individual to survive in racist environments. Further, developing a sense of security, resiliency, and cultural pride provides psychological protection against racial prejudice and discrimination. Protective socialization is even more critical when it becomes the difference between life and death at the hands of law enforcement—a fate faced by too many Black males as a result of racist policing practices, including the over-patrolling of Black communities. Because discriminatory surveillance and over-patrolling can incite a number of social, physical, and mental health issues, a holistic approach to understanding the interaction between Blacks and law enforcement is critical. This article reviews the Mundane Extreme Environmental Stress (MEES) model, racial socialization theory, and Family Stress Model in the development of a theoretical framework for understanding the patterns of interactions between Blacks and law enforcement, the immediate and long-term effects of unjustified shootings on Black families and communities, and the response of sociopolitical systems. The new theoretical framework will be used to inform the work of human service providers and practitioners by identifying targets for interventions to improve relations and trust between Black communities and law enforcement institutions.
Background: HIV prevention is the primary goal of preexposure prophylaxis (PrEP); however, ancillary benefits may exist, including PrEP as an entry point to primary care. Objective: To explore PrEP users' perspectives on how PrEP use relates to broader engagement in health care. Design: In-depth qualitative interviews. Participants: We recruited PrEP users aged 18 years or older from a social media group for people interested in PrEP information and a Boston community health center specializing in health care for sexual and gender minorities. Approach: Inductive content analysis to identify emergent themes. Key results: All 25 participants were men who have sex with men, whose mean age was 34 years, and 84% were White. Three major themes emerged: (1) accessing PrEP was a strong motivator for initial and continued engagement in health care, which for some evolved over time into accessing comprehensive primary care; (2) provider awareness and attitudes about PrEP influenced participants' ongoing engagement in health care; and (3) PrEP engendered a positive sense of control over users' personal health, giving them agency in reducing their risk of HIV and engaging in other aspects of their health. Quarterly PrEP visits helped participants establish and maintain a relationship with a primary care provider, access non–HIV-related care services, and feel empowered to keep themselves healthy. Conclusions: The benefits of PrEP extend beyond HIV prevention to broader engagement in health care, including new relationships with primary care providers and use of other preventive health care services. To maximize those benefits, efforts are needed to ensure that providers are aware, nonjudgmental, and supportive of PrEP use.