Structural competency training provides guidance to healthcare providers on recognizing and addressing structural factors leading to health inequities. To inform the evidence-based progression of structural competency curriculum development, this study was designed to map the current state of the literature on structural competency training with pre-health students, healthcare professional students, and/or healthcare professionals. We performed a scoping review and identified peer-reviewed, primary research articles assessing structural competency training interventions. The category of learners, timing of the structural competency training, types of teaching and learning activities used, instruments used to measure training outcomes, and evaluation criteria were examined. Eleven (n = 11) articles met inclusion criteria, addressing all training levels, and largely focused on medical education. Active learning strategies and researcher-developed instruments to measure training outcomes were most used. Evaluation criteria largely focused on trainees’ affective reactions, utility assessments, and direct measure of the trainee learning. We suggest designing interprofessional structural competency education with an emphasis on active learning strategies and standardized training curricula. Evaluation instruments integrated at different points in the health professional learning trajectory are important for evidence-based progression in curriculum development focused on achieving structural competency.

HIV care engagement and antiretroviral therapy (ART) adherence interventions aimed at decreasing viral suppression disparities for women living with HIV (WLWH) in the Southern United States (i.e., the South) are few and seldom consider diverse social locations. These refer broadly and dynamically to contextual factors and the position people occupy in a social hierarchy based on intersecting systems of oppression and social determinants of health like gender, race/ethnic, and class inequities; geographic location; and HIV-related stigma. Using an intersectional approach, we conducted in-depth interviews and used a phased approach to directed content analysis to describe women’s perceptions of their social location and how it impacts their decision-making about HIV care engagement and ART adherence. Participants were recruited to participate from a broad geographic area and represented the diverse social locations occupied by WLWH in the South. Findings from 40 in-depth interviews include descriptions of how geographic context impacts HIV care engagement and medication adherence through access to care, quality of care, and the place-based context of day-to-day experiences of living with HIV. Participants spoke of multilevel power relationships based on their gender and racial identities, and how social determinants and intersecting identities occur simultaneously and vary as a function of one another to impact health and HIV care decision-making. The findings offer a nuanced understanding of how WLWH perceive their contextually specific social locations and make critical decisions about their HIV care engagement and medication adherence.

Background: Women living with HIV in the Southern United States, or the South, face persistent and overlapping challenges to care engagement and antiretroviral therapy adherence, including HIV-related stigma, poverty, and inequitable access to health care. While mobile health (mHealth) interventions show promise for enhancing self-management and care engagement among people living with HIV, interventions tailored to women living with HIV remain limited, particularly those developed through participatory approaches that center their lived experiences. Objective: This study sought to evaluate the acceptability, comprehensibility, and personal relevance of targeted health messages developed for a proposed mHealth app tailored to women living with HIV in the South. In addition, it explored participants’ perceptions of the feasibility and desirability of the proposed intervention. Methods: This study represents phase 3 of a multistage, mixed methods project. Message content was informed by earlier phases, which included individual interviews, surveys, perceptual mapping with women living with HIV, and input from a community and clinician advisory board. In this phase, 3 focus groups (2 virtual and 1 in person) were conducted with 30 women living with HIV recruited from Southern HIV clinics and community organizations. Participants reviewed prototype wireframes and health messages, including SMS text message–style content, and provided feedback on all content. Data were analyzed using conventional content analysis. Results: Participants expressed strong interest in the proposed mHealth app and emphasized the importance of health messaging that is clear, supportive, and personally meaningful. Four key categories emerged: (1) acceptability of a tailored mHealth app, with participants noting the value of privacy, accessibility, and convenience; (2) acceptability of message content, including preferences for affirming, uplifting language and images; (3) personal relevance, particularly for messages addressing stigma, spirituality, family, and empowerment; and (4) comprehensibility, highlighting the need for plain language and visual clarity. Conclusions: These findings support the development of a tailored mHealth intervention for women living with HIV in the South. Co-designed messages that center affirmation, spirituality, and real-life challenges were perceived as acceptable, comprehensible, and highly relevant. Future work will focus on refining the content and prototype testing.

The purpose of our integrative review was to synthesize the literature examining relationships between depressive symptoms, silencing the self (STS), sexual relationship power (SRP), and HIV vulnerability among women in the United States. Literature searches were conducted through CINAHL, MEDLINE, PsycINFO, SCOPUS, Sociological Abstracts, and SocINDEX. Integrative review methodology of Whittemore and Knafl guided the review process, and 37 articles met inclusion criteria. The Theory of Gender and Power, modified by Wingood and DiClemente, was the guiding framework to organize and synthesize findings. Primary findings suggest that depressive symptoms, STS, and SRP in relationships may individually influence women's vulnerability for acquiring HIV, yet research lags behind. Evidence documenting relationships between these factors is insufficient to draw generalizable conclusions. Findings suggest that the current literature on this topic does not reflect those women most highly affected by HIV and those who identify as African American or Black in the Southeast region of the United States.

Black/African American women continue to be disproportionately affected by HIV, facing multiple intersecting challenges that influence how they age and effectively manage their health. Supportive social relationships have been shown to help mitigate challenges and improve health in women with HIV, but little is known about Black/African American women's perceptions of social relationships. Guided by Life Course Theory, in-depth life history interviews were conducted with 18 Black/African American women aged 50+ years. In older adulthood, most important relationships among Black/African American women were with their adult children and grandchildren, intimate partners, God, and friends from the community. Factors that influenced relationships over time included: (a) a desire to build a community; (b) a need to empower oneself and give back; (c) yearning to engage the younger generation; and (d) battling HIV stigma. Older Black/African American women with HIV played a critical role in the education of the younger generation.