Using an anti-racist research framework to design studies of oral human papillomavirus and oropharyngeal cancer in San Francisco - rationale and protocol for the Health Equity and Oral Health in People living with HIV (HEOHP) qualitative study

Sep 21, 2026

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The research programme aims to develop culturally appropriate, patient-specific interventions for primary and secondary prevention of HPV-related oropharyngeal cancer among people living with HIV (PLWH). PLWH face higher OPC risk, with race- and ethnicity-linked disparities in outcomes. The programme applies an anti-racist framework treating racism as a foundational system of ill health, extending it to biases from gender, sexual orientation, HIV status and other non-dominant identities. Grounded theory focus groups will generate and refine concepts during data collection.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Abstract

Introduction

Methods and analysis

Strengths and limitations of this study

Ethics and dissemination

Introduction

Background and rationale

Anti-racist/anti-intersectional bias research framework

Open access Protocol Using an anti-racist research framework to design studies of oral human papillomavirus and oropharyngeal cancer in San Francisco: rationale and protocol for the Health Equity and Oral Health in People living with HIV (HEOHP) qualitative study Alexandra L Hernandez ,1,2 Elena O Lingas,3 William Juarez,1 Alessandro Villa,4 Joel Palefsky1 To cite: Hernandez AL, Lingas EO, Juarez W, et al. Using an anti-racist research framework to design studies of oral human papillomavirus and oropharyngeal cancer in San Francisco: rationale and protocol for the Health Equity and Oral Health in People living with HIV (HEOHP) qualitative study. BMJ Open 2024;14:e091474 . doi:10 . 1136/ bmjopen-2024-091474 ► Prepublication history and additional supplemental material for this paper are available online. To view these files, please visit the journal online ([https://doi.org/10.1136/](https://doi.org/10.1136/)[ ](https://doi.org/10.1136/)[bmjopen-2024-091474](bmjopen-2024-091474)) . Received 22 July 2024 Accepted 14 August 2024 © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. For numbered affiliations see end of article. Correspondence to Dr Alexandra L Hernandez; [alexandra.hernandez@ucsf.edu](alexandra.hernandez@ucsf.edu) ABSTRACT Introduction The goal of our research programme is to develop culturally appropriate patient-specific interventions for primary and secondary prevention of human papillomavirus (HPV)-related oropharyngeal cancer (OPC) among people living with HIV (PLWH); PLWH are ata higher risk for OPC than the general population and, as with many cancers, there are disparities in OPC health outcomes by race and ethnicity. Our study incorporates an anti-racist research framework that proposes considering racism as a foundational sociocultural system that causes ill health. We expand the framework to include biases due to gender, sexual orientation, HIV status and membership in other non-dominant groups. Our research programme focuses on HPV-related OPC among people living with PLWH, and on how intersecting identities may impact an individual’s experience with oral health, obtaining regular and appropriate oral healthcare, knowledge and perceptions of oral HPV infection, risk factors for OPC and HPV vaccination. Methods and analysis We will follow a grounded theory (GT) qualitative research methodology using focus group discussions (FGDs) to collect data. We will invite PLWH with intersecting identities to participate in one of 12–18 FGDs with 5–8 participants per group. Focus groups will be formed based on self-reported domains, including race, ethnicity, gender identity, sexual orientation and other identities that could impact oral health, such as smoking status, experience with homelessness or experience with drug use disorders. We do not know which aspects of intersecting identities are most salient to accessing oral healthcare. Using FGDs will allow us to gain this knowledge in a setting where participants can build on and reinforce shared understandings about oral healthcare. Following our GT methodology, analysis will occur concurrently with data collection, and emerging concepts or theories may result in changes to focus group guide questions. Initial focus group questions will be organised around our main objectives: (1) to identify individual, STRENGTHS AND LIMITATIONS OF THIS STUDY ⇒ This study is the first step in a research programme using an anti-racist research framework that considers intersecting identities as factors in the oral health experiences of people living with HIV (PLWH) . ⇒ The study uses grounded theory as the qualitative research methodology, facilitating the emergence of theories from the study participants and the gathered data. ⇒ The study recruits participants from an established clinic with a diverse patient population, enabling a large number of foc

FAQs

What is the main objective of this HEOHP qualitative study?

To design culturally appropriate, patient-specific interventions for primary and secondary prevention of HPV-related oropharyngeal cancer among people living with HIV.

How does the study incorporate an anti-racist research framework?

It treats racism as a foundational sociocultural system causing ill health and expands the framework to include intersecting biases related to gender, sexual orientation, HIV status, and other non-dominant groups.

What qualitative method will the study use and how will focus groups be structured?

It will use grounded theory with focus group discussions (12–18 FGDs) of 5–8 participants each, grouped by self-reported domains such as race, ethnicity, gender identity, and sexual orientation, as well as other identities affecting oral health.

Sep 21, 2026

Upload by Riley