PrEP to Party: Exploring MSM's PrEP Use and Interest in the Context of Sexually Themed Events.

Sexually themed events present a unique opportunity for scaling up pre-exposure prophylaxis (PrEP) to men who have sex with men (MSM). This study descriptively explored PrEP uptake among MSM who anticipated attending a week-long major South Florida sexually themed event and examined potential facilitators and barriers to PrEP engagement among potential attendees. Of the participating HIV-negative MSM (n = 96), 66.7% were currently taking PrEP. Prior attendance at sexually themed events was significantly associated with current PrEP engagement and almost 75% of HIV-negative MSM not on PrEP reported high interest in taking PrEP if offered for free at future events.

PrEP and Behavioral Health Treatment Referral Among HIV Test Counselors in Miami-Dade County: A Rapid Qualitative Study Using the Consolidated Framework for Implementation Research.

HIV test counselors are well positioned to refer individuals to pre-exposure prophylaxis (PrEP) and behavioral health treatments. HIV test counselors in Miami-Dade County (N = 20), a priority jurisdiction for Ending the HIV Epidemic, completed interviews to assess determinants of PrEP and behavioral health treatment referrals. To identify determinants, we used a rapid deductive qualitative analysis approach and the Consolidated Framework for Implementation Research (CFIR). Identified determinants sometimes served as facilitators (e.g., relative priority, leadership importance) and sometimes as barriers (e.g., lack of access to knowledge and information, available resources for referrals) to making referrals. We also observed differences in determinants between PrEP and behavioral health referrals. For example, complexity (perceived difficulty of the referral) was a barrier to behavioral health more often than PrEP referral. Our findings suggest that determinants across many CFIR domains affect referral implementation, and the corresponding need for multiple implementation strategies to improve implementation of PrEP and behavioral health referrals in the context of HIV testing.

Peer ambassador stories: formative qualitative research to enhance the reach of PrEP, HIV testing, and behavioral health treatments to LMSM in South Florida.

Existing HIV prevention interventions, such as pre-exposure prophylaxis (PrEP), and behavioral health treatments inadequately reach Latino men who have sex with men (LMSM) in the US. This study involved formative research to inform the content, design, and implementation of a scalable, low resource implementation strategy - peer ambassador stories - stories from peers to normalize using PrEP, HIV testing, and behavioral health treatment. We conducted semi-structured interviews with 20 LMSM to elucidate their content, design, and implementation preferences for peer ambassador stories. Men were asked about story prompts, story contributor characteristics, story platform features, design preferences, and recommendations for enhancing the adoption and use of the peer ambassador technology platform among LMSM. Interviews were transcribed and analyzed via rapid qualitative analysis. Qualitative analyses identified 14 themes within 4 pre-specified domains. Collectively, the themes unified around the central concept that technology-delivered peer ambassador stories require a personalized, relational, culturally relevant touch to be acceptable and appropriate for LMSM. This study suggests that disseminating peer ambassador stories using electronic platforms and audio/video formats may enhance the reach of services and if they are personalized, relational, and culturally relevant. Findings have broad implications for informing other peer-based strategies to mitigate HIV disparities among LMSM.

Structural Determinants of Health and Markers of Immune Activation and Systemic Inflammation in Sexual Minority Men With and Without HIV.

Among sexual minority men (SMM), HIV and use of stimulants such as methamphetamine are linked with immune activation and systemic inflammation. Throughout the COVID-19 pandemic, SMM encountered financial challenges and structural obstacles that might have uniquely contributed to immune dysregulation and systemic inflammation, beyond the impacts of HIV and stimulant use. Between August 2020 and February 2022, 72 SMM with and without HIV residing in South Florida enrolled in a COVID-19 prospective cohort study. Multiple linear regression analyses examined unemployment, homelessness, and history of arrest as structural correlates of soluble markers of immune activation (i.e., sCD14 and sCD163) and inflammation (i.e., sTNF-α receptors I and II) at baseline after adjusting for HIV status, stimulant use, and recent SARS-CoV-2 infection. Enrolled participants were predominantly Latino (59%), gay-identified (85%), and with a mean age of 38 (SD, 12) years with approximately one-third (38%) of participants living with HIV. After adjusting for HIV status, SARS-CoV-2 infection, and recent stimulant use, unemployment independently predicted higher levels of sCD163 (ß = 0.24, p = 0.04) and sTNF-α receptor I (ß = 0.26, p = 0.02). Homelessness (ß = 0.25, p = 0.02) and history of arrest (ß = 0.24, p = 0.04) independently predicted higher levels of sCD14 after adjusting for HIV status, SARS-CoV-2 infection, and recent stimulant use. Independent associations exist between structural barriers and immune activation and systemic inflammation in SMM with and without HIV. Future longitudinal research should further elucidate complex bio-behavioral mechanisms linking structural factors with immune activation and inflammation.

Factors associated with meningitis vaccine awareness and engagement among Latino men who have sex with men in South Florida.

Awareness and uptake of the meningitis vaccine remains low among marginalized groups, such as Latino men who have sex with men (LMSM), potentially due to structural and psychosocial barriers in accessing preventative healthcare. The current study explored awareness and uptake of meningitis vaccines among a group of LMSM (N = 99) living in South Florida. A three-pronged variable selection approach was utilized prior to conducting regression models (linear and logistic). Overall, 48.5% of the participants reported little to no knowledge about meningitis vaccines, and 20.2% reported being vaccinated. Living with HIV (OR = 10.48) and time since outbreak (OR = 1.03) were significant predictors of meningitis vaccine uptake. No significant correlates of meningitis vaccine awareness were identified. More research is needed to identify other important factors associated with meningitis vaccine awareness and uptake among LMSM, a multiple marginalized group.

Longitudinal predictors of post-exposure prophylaxis awareness among latino sexual minority men in South Florida.

Biomedical tools for HIV prevention such as post-exposure prophylaxis (PEP) continue to be underutilized by subgroups experiencing significant HIV inequities. Specifically, factors associated with both PEP awareness and uptake both cross-sectionally and longitudinally are under-researched, despite PEP being a part of the United States' Plan for Ending the HIV Epidemic. The current study examined longitudinal predictors of PEP awareness among Latino sexual minority men (LSMM) living in South Florida. This current study (N = 290) employed hierarchal linear modeling across three timepoints (baseline, 4-months, 8-months) to assess within-person and between-person effects over time for several psychosocial and structural factors. Most participants (67.5%) reported little to no awareness of PEP at baseline with general PEP awareness growing slightly across the study (60.5% reporting little to no awareness of PEP at 8 months). Results of the final conditional model suggest significant within-person effects of PrEP knowledge (p = 0.02) and PrEP self-efficacy (p < 0.001), as well as a significant positive between-person effect of PrEP knowledge (p < 0.01) on PEP awareness. Between-person HIV knowledge was also a significant predictor in this model (p = 0.01). This longitudinal analysis of LSMM's PEP awareness indicates that more must be done to increase PEP awareness among this subgroup. Future studies should explore how to build on existing interventions focused on HIV and PrEP knowledge and PrEP self-efficacy to incorporate information about PEP to increase the reach of this effective biomedical HIV prevention tool.

Examining the Factor Structure and Correlates of Motives to Drink Before Attending a Virtual Social Event During COVID-19 Among University Students.

Background: Many university students pregame or drink before a social event. Pregaming carries some risk due to its link to heavy drinking. During the COVID-19 pandemic, there was limited access to many drinking venues (e.g., bars/clubs). Moreover, universities shifted to a virtual format and imposed restrictions on in-person gatherings resulting in the reliance on virtual platforms for class instruction, meetings, and social events. The pandemic facilitated changes in students' drinking behaviors, stress levels, and how they maintained social contact with others. Thus, it is conceivable that during an academic pandemic year, students may have engaged in the act of drinking before attending a virtual social event. Objectives: In the present study, we examined the factor structures/item loadings of the Pregaming Motives Measure-Virtual (PGMM-V) among students (N = 283; Mage = 21.38; women = 69.3%; White = 45.4%, Hispanic = 40.8%) from seven universities who completed an online questionnaire (Spring/Summer-2021). Items from the original Pregaming Motives Measure (Bachrach et al., 2012) were modified to reflect motives to drink before attending a virtual social event. Results: We found evidence for a 2-factor structure model of the PGMM-V which includes social/enhancement and social ease/stress. Bivariate correlations indicated that social/enhancement and social ease/stress were (a) positively associated with frequency of drinking and alcohol consumption prior to attending virtual social events, and (b) general drinking motives (social/enhancement/coping) that align with these motives. Conclusions: The PGMM-V is a promising instrument that could be used in future research designed to understand students' pregaming behaviors for virtual social events as the use of such platforms are increasingly relied upon for social engagement.

Does Problematic Substance Use Moderate Efficacy of Cognitive Behavioral Therapy for Adherence and Depression in HIV?

Problematic substance use may attenuate the effect of treating depression in people living with HIV (PLWH). We examined the potential moderating effect of problematic substance use on depression and adherence outcomes in PLWH (N = 143) who participated in a randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) and were randomized to either CBT-AD or enhanced treatment as usual (ETAU). Problematic substance use was operationalized as either having substance use-related diagnosis or current substance use in the past 30 days with a lifetime history of problematic use. Acute (baseline to 4-month) and follow up (4, 8, and 12-month) general linear modeling with time, condition, problematic baseline substance use, and corresponding interactions demonstrated that substance use did not significantly moderate the effects of CBT-AD on adherence or depression improvements. Therefore, CBT-AD was beneficial for PLWH with depression, regardless of problematic substance use when starting depression treatment. Based on these results, clinicians should not withhold CBT treatment for depression in patients with HIV and problematic substance use to attain reductions in depression and gains in adherence.

A Rapid Environmental Scan of South Florida HIV Organizations' Mpox Messaging During the August 2022 Peak of the U.S. Outbreak.

The 2022 outbreak of mpox disproportionately impacted men who have sex with men and people living with HIV. As such, HIV organizations were uniquely situated to reach populations affected by mpox. However, the extent to which these organizations pivoted to address mpox, and what form mpox messaging took, is unknown. We conducted a rapid environmental scan of 29 HIV or sexual health organizations to assess the frequency and content of mpox messaging in August 2022, the peak of the mpox outbreak in Miami, FL. Approximately half of the organizations provided mpox messaging, most of which was accurate. Only 5% of the messages were in Spanish and 4% in Spanish and Haitian Creole. Our findings suggest HIV organizations' pivot to mpox messaging may have been delayed overall and in reaching Spanish- and Haitian Creole-speaking communities. Results could inform modifications to mpox messaging campaigns and future outbreaks that disproportionately affect minoritized communities.

RESUMEN: El brote de la viruela del mono en 2022 afectó desproporcionadamente a hombres que tienen relaciones sexuales con hombres y personas que viven con el VIH. Como tal, las organizaciones dedicadas al VIH estaban en una posición única para llegar a las poblaciones afectadas por la viruela del mono. Sin embargo, no se sabe en qué medida estas organizaciones cambiaron su enfoque para abordar la viruela del mono y qué forma tomó la mensajería sobre a la viruela del mono. Realizamos un escaneo ambiental rápido de 29 organizaciones de VIH o salud sexual para evaluar la frecuencia y el contenido de la mensajería sobre la viruela del mono en agosto de 2022, en el pico del brote de la viruela del mono en Miami, Florida. Aproximadamente la mitad de las organizaciones proporcionaron mensajería sobre la viruela del mono, la mayoría de la cual era precisa. Solo el 5% de los mensajes estaban en español y el 4% en español y criollo haitiano. Nuestros hallazgos sugieren que el cambio de enfoque de las organizaciones de VIH hacia la mensajería sobre la viruela del mono puede haber sido en general demorado y que no llegó adecuadamente a las comunidades de habla hispana y criollo haitiano. Los resultados podrían informar modificaciones en las campañas de mensajería sobre la viruela del mono y en futuros brotes que afecten desproporcionadamente a comunidades minorizadas.

Barriers and facilitators to PrEP use and HIV testing for subgroups of Latino sexual minority men.

Pre-exposure prophylaxis (PrEP) and HIV testing inadequately reach Latino sexual minority men (LSMM), fueling HIV disparities. This study identified determinants of LSMM's PrEP use and HIV testing and examined differences across subgroups (i.e., age and immigration history). First, we identified the most to least endorsed barriers and facilitators of PrEP use and HIV testing among LSMM (1) over vs. under 40 years old, and (2) across immigration histories (U.S. born, recent immigrant, established immigrant). Next, we examined differences in barrier/facilitator ratings across these age and immigration status groups. Key overall determinants were cost, knowledge, and perceived benefit/need. However, there was variation in determinants across age groups (i.e., cost, affordability, navigation support, and normalization) and immigration statuses (i.e., language, immigration concerns, and HIV knowledge). There were also differences across service types; mistrust and concerns was a barrier related to PrEP but not HIV testing. We found unique and common multilevel factors across prevention services and subgroups. Language, cost, and clinic/system issues are key barriers in accessing HIV prevention that should be considered when developing implementation strategies to enhance the reach of these services to LSMM.

Individual, Interpersonal, and Structural Factors That Influence Intentions to Use Pre-exposure Prophylaxis Among Sexual Minority Men in Miami.

Pre-exposure prophylaxis for HIV or "PrEP" holds great promise for reducing HIV incidence. However, in certain geographic settings, like Miami, a US HIV epicenter, uptake of PrEP has been paradoxically very low compared to other areas of the country. The goal of the current study was to examine factors associated with low uptake of PrEP in young sexual minority men in Miami. Qualitative data were extracted from conversations during voluntary HIV/STI counseling and testing sessions with 24 young sexual minority men, most of whom identified as racial/ethnic minorities. These sessions were completed as part of a baseline visit for a combined mental and sexual health intervention trial. Thematic analysis of transcripts revealed barriers and facilitators associated with PrEP uptake at multiple levels (individual, interpersonal, and economic and healthcare systems barriers). Individual-level themes included concerns about the safety of PrEP, risk compensation, and taking daily oral medication; and potential benefits of PrEP as a backup plan to condom use to reassure and reduce worry about HIV. Interpersonal-level themes included lack of knowledgeable and affirming medical providers, changing norms within the community around "safe sex," and PrEP use in serodiscordant partnerships. Economic and healthcare systems barriers included challenges to accessing PrEP because of a lack of insurance and high out-of-pocket cost. These data can be used to inform the development of interventions aligned with Ending the HIV Epidemic priorities to increase PrEP use among young sexual minority men living in an HIV epicenter.

Factors associated with latino sexual minority men's likelihood and motivation for obtaining a COVID-19 vaccine: a mixed-methods study.

Minoritized communities are underreached by biomedical interventions, such as the COVID-19 vaccine. This mixed-methods study identified factors associated with vaccine likelihood (VL) and uptake (VU) among 187 Latino sexual minority men (LSMM) in South Florida. Regression models with LASSO variable selection and Classification and Regression Trees (CART) assessed determinants of VL and VU while open-ended questions were evaluated using thematic content analysis. VL (range 1-7; M = 6.00, SD = 1.84) and VU (63.6%) was high. LASSO modeling identified being insured, worrying about others, fear of transmitting COVID-19, and financial stress as the most influential factors for VL; working remotely from home was important for VU. Time (weeks) since addition of COVID-19 vaccination-related questions (December 2nd, 2020) was associated with both outcomes across both modeling techniques. Convergence between data suggests capitalizing on altruistic motivations and improving accessibility to vaccine campaigns are valuable assets to increase LSMM's vaccine confidence.

Engaging Latino sexual minority men in PrEP and behavioral health care: multilevel barriers, facilitators, and potential implementation strategies.

Latino sexual minority men (LSMM) are affected by HIV and behavioral health disparities. Evidence-based HIV-prevention and behavioral health (BH) services are not sufficiently scaled up to LSMM. The current study identified multilevel barriers and facilitators to LSMM's use of HIV-prevention and BH services. LSMM (N = 290) in South Florida, a US HIV epicenter, completed a battery of measures potentially associated with pre-exposure prophylaxis (PrEP) and BH treatment use. Stochastic search variable selection (SSVS) followed by multiple linear regression analyses identified variables associated with engagement in PrEP and BH treatment. Multilevel determinants of PrEP and BH treatment engagement were identified, with most identified determinants being at the relational level (e.g., stigma, discrimination based on income and immigration status, personal recommendation for treatment). Individual (e.g., knowledge, self-efficacy) and structural (e.g., financial stress) determinants were also identified. Accordingly, modifiable leverage points to enhance the reach of PrEP and BH treatment to LSMM include educating and enhancing the perceived relevance of services, de-stigmatizing and normalizing via peer examples, bolstering self-efficacy, and building trust.

Life Instability Associated with Lower ART Adherence and Other Poor HIV-Related Care Outcomes in Older Adults with HIV.

BACKGROUND: Life instability may be an important factor for HIV-related care outcomes in older adults living with HIV (OALWH). This study examined the degree to which an 11-item life instability index (LII) composed of individual- and community-level indicators was associated with HIV-related care outcomes-viral load, antiretroviral (ART) medication adherence, rates of detectable viral load, and HIV care appointment non-adherence among OALWH in the Miami area. METHODS: Six hundred twenty-three OALWH completed an interviewer-administered assessment (English or Spanish), which was matched with medical record data. RESULTS: Participants reported about six LII indicators each (M = 6.08, SD = 1.44). Greater index scores were associated with worse self-reported ART adherence (b = - 1.14, p = 0.03), lower observed appointment adherence (b = 0.02, p < 0.01), higher viral load (b = 0.09, p = 0.02), and greater odds of viral detection (OR = 1.22, p = 0.01). Regarding health behaviors, life instability was significantly associated with increased illicit substance use among participants and not associated with depression or anxiety. The association of life instability to ART adherence remained significant (although attenuated) when controlling for the significant effects of substance use (b = - 0.40, BSTP [- 0.87, - 0.09]). CONCLUSION: This present study is the first to examine an additive life instability index and its association with HIV-related behavioral and biomedical health outcomes among a population of OALWH. Greater indicators of life instability among OALWH may lead to poorer HIV-related health outcomes above and beyond the net of the effects of depression, anxiety, and substance use.

"The familiar taste of poison": a qualitative study of multi-level motivations for stimulant use in sexual minority men living in South Florida.

BACKGROUND: In the US, stimulant use is associated with a 3-6 times greater rate of HIV seroconversion in sexual minority men (SMM) than in those who do not use stimulants. Annually, 1 in 3 SMM who HIV seroconvert will be persistent methamphetamine (meth) users. The primary objective of this qualitative study was to explore experiences of stimulant use in SMM living in South Florida, a high priority region for the Ending the HIV Epidemic initiative. METHODS: The sample included 25 SMM who use stimulants, recruited via targeted ads on social networking apps. Participants completed one-on-one semi-structured qualitative interviews, conducted from July 2019 through February 2020. A general inductive approach was used to identify themes relating to experiences, motivations, and overall relationship with stimulant use. RESULTS: Mean age of participants was 38.8, ranging from 20 to 61 years old. Participants were 44% White, 36% Latino, 16% Black and 4% Asian. Most participants were born in the US, self-identified as gay, and preferred meth as their stimulant of choice. Themes included: (1) stimulants as cognitive enhancements for focus or task completion, including transitioning to meth after first using prescription psychostimulants; (2) unique South Florida environment where participants could be open regarding their sexual minority status while also being influential on their stimulant use; (3) stimulant use as both stigmatizing and a coping mechanism for stigma. Participants anticipated stigma by family and potential sexual partners due to their stimulant use. They also reported using stimulants to cope with feelings of stigma due to their minoritized identities. CONCLUSION: This study is among the first to characterize motivations for stimulant use in SMM living in South Florida. Results highlight both the risk and protective factors of the South Florida environment, psychostimulant misuse as a risk for meth initiation, and the role of anticipated stigma on stimulant use in SMM. Understanding stimulant use motivations can help to shape intervention development. This includes developing interventions that address individual, interpersonal, and cultural factors that drive stimulant use and increase risk of HIV acquisition. Trial registration NCT04205487.

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.

A Relational Framework for Engaging Latino Sexual Minority Men in Sexual and Behavioral Health Research.

Latino sexual minority men (LSMM) experience sexual and behavioral health disparities. Yet, LSMM are underrepresented in sexual and behavioral health research, creating scientific inequity. There is, therefore, a need to identify the barriers and facilitators to LSMM's participation in sexual and behavioral health research, which is the gap that the current study sought to fill. We interviewed LSMM (n = 28; age 18-40, 57% US born) and key informants (n = 10) regarding LSMM's barriers and facilitators to participating in sexual and behavioral health research and suggestions for increasing participation. The research team coded the data via thematic analysis. We found that relational factors are central to understanding LSMM's participation in sexual and behavioral health research. Some relational experiences (e.g., interpersonal stigma) interfered with participation, whereas others (e.g., altruistic desires to contribute to community well-being) facilitated participation. The findings are consolidated within a new relational framework for understanding LSMM's participation in sexual and behavioral health research. Study findings highlight the centrality of relational factors in influencing LSMM's participation in sexual and behavioral health research. Relational factors can be used to inform the development of culturally relevant recruitment strategies to improve representation of LSMM in sexual and behavioral health research. Implementing these recommendations may address scientific inequity, whereby LSMM are disproportionately impacted by sexual and behavioral health concerns yet underrepresented in related research.

Impact of COVID-19 on HIV service delivery in Miami-Dade County: a mixed methods study.

BACKGROUND: Facilitating access to HIV prevention and treatment is imperative in Miami-Dade County (MDC), a U.S. HIV epicenter. With COVID-19, disruptions to these services have occurred, leading HIV organizations to innovate and demonstrate resilience. This study documented COVID-19 related disruptions and resilient innovations in HIV services within MDC. METHODS: This mixed methods cross-sectional study included HIV test counselors in MDC. In the quantitative component (N=106), participants reported COVID-19 impacts on HIV service delivery. Data visualization examined patterns within organizations and throughout the study period. Generalized estimating equation modeling examined differences in service disruptions and innovations. In the qualitative component, participants (N=20) completed interviews regarding COVID-19 impacts on HIV services. Rapid qualitative analysis was employed to analyze interviews. RESULTS: Quantitative data showed that innovations generally matched or outpaced disruptions, demonstrating resilience on HIV service delivery during COVID-19. HIV testing (36%, 95%CI[28%, 46%]) and STI testing (42%, 95%CI[33%, 52%]) were most likely to be disrupted. Sexual/reproductive health (45%, 95%CI[35%, 55%]), HIV testing (57%, 95%CI[47%,66%]), HIV case management (51%, 95%CI[41%, 60%]), PrEP initiation (47%, 95%CI[37%,57%]), and STI testing (47%, 95%CI[37%, 57%]) were most likely to be innovated. Qualitative analysis revealed three orthogonal themes related to 1) disruptions (with five sub-components), 2) resilient innovations (with four sub-components), and 3) emerging and ongoing health disparities. CONCLUSIONS: HIV organizations faced service disruptions during COVID-19 while also meaningfully innovating. Our findings point to potential changes in policy and practice that could be maintained beyond the immediate impacts of COVID-19 to enhance the resilience of HIV services. Aligning with the US Ending the HIV Epidemic Plan and the National Strategy for HIV/AIDS, capitalizing on the observed innovations would facilitate improved HIV-related health services for people living in MDC and beyond.

Who Aren't We Reaching? Young Sexual Minority Men's Non-participation in an HIV-Prevention and Mental Health Clinical Trial.

Despite many successful clinical trials to test HIV-prevention interventions for sexual minority men (SMM), not all SMM are reached by these trials. Identifying factors associated with non-participation in these trials could help to ensure the benefits of research extend to all SMM. Prospective participants in New York City and Miami were screened to determine eligibility for a baseline assessment for a mental health/HIV-prevention trial (N = 633 eligible on screen). Logistic regression and classification and regression tree (CART) analysis identified predictors of non-participation in the baseline, among those who were screened as eligible and invited to participate. Individuals who reported unknown HIV status were more likely to be non-participators than those who reported being HIV-negative (OR = 2.39; 95% CI 1.41, 4.04). In New York City, Latinx SMM were more likely to be non-participators than non-Latinx white SMM (OR = 1.81; 95% CI, 1.09, 2.98). A CART model pruned two predictors of non-participation: knowledge of HIV status and age, such that SMM with unknown HIV status and SMM ages 18-19 were less likely to participate. Young SMM who did not know their HIV status, and thus are more likely to acquire and transmit HIV, were less likely to participate. Additionally, younger SMM (18-19 years) and Latinx SMM in New York City were less likely to participate. The findings suggest the importance of tailored recruitment to ensure HIV-prevention/mental health trials reach all SMM.

RESUMEN: A pesar de muchos ensayos clínicos exitosos para probar intervenciones de prevención del VIH para hombres de minorías sexuales (HMS), no todos los HMS son alcanzados por estos ensayos. La identificación de factores asociados con la no participación en estos ensayos podría ayudar a asegurar que los beneficios de la investigación se extiendan a todos los HMS. Se realizaron evaluaciones de teléfono para determinar la elegibilidad para la visita inicial para un ensayo de salud mental/prevención del VIH (N = 633 elegibles en las evaluaciones). La regresión logística y el análisis de arboles de regresión y clasificación (ARC) identificaron predictores de no participación en la visita inicial, entre aquellos que fueron evaluados como elegibles e invitados a participar. Los individuos que reportaron estado desconocido de VIH fueron más probables a ser no participantes que aquellos que reportaron ser VIH negativos (RP = 2.39; IC 95% 1.41, 4.04). En la ciudad de Nueva York, HMS latinx eran más probable a no participar que los HMS blancos no latinx (RP = 1.81; IC 95%, 1.09, 2.98). Un modelo de ARC podó dos predictores de no participación: el conocimiento del estado de VIH y la edad, tal que los HMS con estado desconocido del VIH y las HMS de 18­19 años eran menos probables a participar. Los HMS jóvenes que no conocían su estado de VIH, y por lo tanto eran más probables a adquirir y transmitir el VIH, tenían menos probabilidades de participar. Además, las HMS más jóvenes (18­19 años) y los HMS latinx en la ciudad de Nueva York eran menos probables a participar. Los resultados sugieren la importancia de un reclutamiento personalizado para garantizar que los ensayos de prevención del VIH y salud mental lleguen a todos los SMM.

Factors associated with barriers to engagement in HIV-prevention care among sexual minority men.

Engagement with HIV-prevention services varies among sexual minority men (SMM). 183 HIV-negative SMM completed a baseline assessment including sociodemographic, psychosocial, identity and stigma, and sexuality measures, as well as HIV-prevention behaviors: (1) date of most recent HIV test, (2) whether they discussed HIV or (3) sexual behavior with their provider, and (4) disclosure to provider about engaging in condomless anal sex (CAS). Factor analysis of these four items yielded an HIV-prevention engagement factor score. Stochastic search variable selection (SSVS) followed by multiple linear regression identified variables associated with HIV-prevention engagement. SSVS identified three variables for inclusion in a multiple linear regression model. Not disclosing sexual orientation to one's provider (p < 0.001), discomfort discussing sex with provider (p < 0.001) and lower education (p = 0.007) were associated with less HIV-prevention engagement. Findings suggest the importance of training providers in culturally competent care to mitigate observed barriers.