Research shows that Black communities continue to experience disproportionate rates of human immunodeficiency virus (HIV) and opioid overdose. Yet traditional outreach strategies don’t always translate into meaningful engagement. Improving outcomes will require culturally responsive interventions that build trust and meet Black communities where they are.
A recent study published in the Journal of Racial and Ethnic Health Disparities examined how a community advisory board (CAB) helped a syringe program redesign its approach to improve HIV testing, overdose prevention, and pre-exposure prophylaxis (PrEP) linkage among Black residents in Shelby County, Tennessee.
For providers, improving outcomes will require not only evidence-based interventions but also trust, accessibility, and community alignment.
Despite advances in HIV prevention and treatment, disparities continue to persist among Black communities — particularly in the South. In 2022, 52 percent of Black Americans newly diagnosed with HIV lived in the South, underscoring the region’s disproportionate burden. The study’s researchers found that Black residents in Shelby County experienced a disproportionate HIV burden while also facing barriers to harm reduction services, including social determinants of health (SDOH), stigma, and long-standing health inequities. They also identified a disconnect — the HIV prevention services were available, but they weren’t reaching the populations most affected.
Simply offering services is not enough. Communities most affected by HIV and substance use often face structural, cultural, and logistical barriers that prevent them from accessing care.
When recommending preventive care, clinicians should consider barriers such as:
Understanding the barriers that can keep patients from accessing potentially life-saving care can help close the gaps in disparities — especially for Black communities.
To find more effective ways to encourage engagement in preventive services, researchers used a community-based participatory research (CBPR) approach. A 12-member community advisory board was created, which included people with lived and professional experience with HIV prevention, substance use, and overdose response. The CAB worked together for over one year to identify barriers to access and develop strategies tailored to the Black Shelby County community.
CBPR shifts community members from being recipients of care to active partners in designing interventions. This collaborative approach can improve trust, cultural relevance, and long-term sustainability — particularly in Black communities, where historical and ongoing inequities have contributed to medical mistrust.
The study’s findings revealed four key approaches that helped Shelby County residents better access HIV and opioid overdose preventive care.
The CAB identified racial discordance between program staff and the community as a potential barrier to care. The researchers recommended regular “Lunch-and-Learn” sessions to strengthen relationships, increase cultural awareness, and foster collaboration among organizations serving Black communities.
For clinicians, it’s important to understand that cultural humility is an ongoing practice, not a one-time training.
The CAB recommended making the services feel relevant and holistic. The researchers used strategies, such as updated resource guides, broader wellness messaging, and resources that reflected Black community needs.
Mobile clinics, partnerships with trusted community organizations, and outreach efforts can help reduce transportation barriers while bringing preventive services directly into neighborhoods where they’re needed most.
The community advisory board also suggested using a discreet mobile health unit in a predominantly Black neighborhood to improve geographic access. For providers, meeting patients where they are — through mobile clinics, community partnerships, and outreach programs — can reduce access barriers.
Changing the programs’ service delivery model and branding to make it feel safer and more welcoming to the Black community was another recommendation from the CAB. Researchers emphasized that stigma surrounding HIV, drug use, and prevention services can prevent people from seeking care.
Long before a patient enters the exam room, stigma, fear, and distrust may already influence whether they seek care at all. Thoughtful messaging, welcoming environments, and culturally responsive outreach can all help reduce those barriers.
Clinicians should recognize that disparities are often driven by structural barriers — not patient willingness alone.
Providers can help strengthen engagement by:
While individual clinicians play an important role, improving access ultimately requires systems-level change. Health systems, public health agencies, and community organizations must work together to expand culturally responsive outreach and reduce structural barriers to care.
The research demonstrates that community partnership can help identify barriers traditional healthcare models may miss. For clinicians, the lesson extends beyond HIV or overdose prevention — culturally responsive care requires listening to the communities healthcare systems aim to serve. Integrating community voices into program design may help improve trust, increase engagement, and ultimately advance health equity for Black patients.
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