Neighborhood Characteristics, Intersectional Discrimination, Mental Health, and HIV Outcomes Among Black Women Living With HIV, Southeastern United States, 2019‒2020.

Objectives. To examine the effects of within-neighborhood and neighboring characteristics on discrimination, stigma, mental health, and HIV outcomes among Black women living with HIV (BWLWH). Methods. A total of 151 BWLWH in a southeastern US city provided baseline data (October 2019‒January 2020) on experienced microaggressions and discrimination (race-, gender-, sexual orientation-, or HIV-related), mental health (e.g., depression, posttraumatic stress disorder), and HIV outcomes (e.g., viral load, antiretroviral therapy adherence). Neighborhood characteristics by census tract were gathered from the American Community Survey and the National Center for Charitable Statistics. Spatial econometrics guided the identification strategy, and we used the maximum likelihood technique to estimate relationships between a number of predictors and outcomes. Results. Within-neighborhood and neighboring characteristics (employment, education, crime, income, number of religious organizations, and low-income housing) were significantly related to intersectional stigma, discrimination, mental health, HIV viral load, and medication adherence. Conclusions. Policy, research, and interventions for BWLWH need to address the role of neighborhood characteristics to improve quality of life and HIV outcomes. (Am J Public Health. 2022;112(S4):S433-S443. https://doi.org/10.2105/AJPH.2021.306675).

Structural Life Instability and Factors Related to Latino Sexual Minority Men's Intention to Engage with Biomedical HIV-Prevention Services.

Latino sexual minority men (LSMM) experience high rates of HIV and co-occurring health inequities. Structural and psychosocial factors may lead to mental health problems and decreased engagement with biomedical HIV-prevention behaviors. This cross-sectional study assessed the extent to which structural life instability is related to biomedical HIV-prevention services engagement (HIV-testing and PrEP uptake) indirectly through psychological distress among 290 LSMM living in Greater Miami. Using hybrid structural equation modeling, significant direct effects from structural life instability to psychological distress emerged, as did effects from psychological distress (i.e., depression and anxiety) to HIV-prevention engagement. Structural life instability had a significant indirect effect to HIV-prevention engagement via psychological distress. Findings show a possible mechanism explaining the relationship between structural life instability and biomedical HIV-prevention engagement among a group of LSMM, a subpopulation at increased susceptibility for HIV acquisition in an U.S. HIV epicenter.

RESUMEN: Los hombres latinos de minorías sexuales (LHLMS) experimentan altos índices de VIH y disparidades de salud concurrentes. Los factores estructurales y psicosociales pueden provocar problemas de salud mental y, a su vez, reducir la participación con los comportamientos biomédicas de prevención del VIH. Este estudio transversal evaluó el grado en qué la inestabilidad estructural de la vida (IEV) está relacionada con la participación de los servicios de prevención del VIH (pruebas del VIH y uso de PrEP) indirectamente a través de la angustia psicológica entre 290 LHLMS que viven en el Gran Miami, un epicentro del VIH. Utilizando modelos de ecuaciones estructurales híbridas, surgieron efectos directos significativos de SLI a la angustia psicológica, al igual que los efectos de la angustia psicológica a la participación en la prevención del VIH. El SLI tuvo un efecto indirecto significativo en la participación en la prevención del VIH a través de la angustia psicológica. Los resultados muestran un posible mecanismo que explica la relación entre el SLI y la participación en la biomédica prevención del VIH.

The Association Between Financial Resources Strain and Self-Reported Antiretroviral Therapy (ART) Adherence among HIV-Positive Men Who Have Sex with Men.

The purpose of this study was to assess the relationship between financial resources strain and self-reported ART adherence among men who have sex with men (MSM) who are living with HIV. Secondary data analyses were conducted with a sample of HIV-positive MSM (N = 77) who participated in a daily diary study on substance use and sexual behavior. Logistic regression was used to model the odds of self-reported ART adherence associated with financial resources strain. The adjusted model revealed a significant association between financial resources strain and self-reported ART adherence such that financially strained participants were 78.4% less likely to have "excellent" self-reported adherence ability compared with non-financially strained participants (aOR = .216, 95% CI [.063, .749], p = .016). Financial resources strain may negatively influence ART adherence. Future research should consider objectively measuring ART adherence. Health care providers might consider assessing patients' financial situation to identify those at-risk for nonadherence.