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.

Factors Associated with Antiretroviral Therapy Adherence Among a Community-Based Sample of Sexual Minority Older Adults with HIV.

Older sexual minorities (e.g., gay, bisexual) living with HIV are at risk for poor HIV outcomes due to their frequent experience with both psychosocial challenges and structural barriers to care. This study utilized a stochastic search variable selection (SVSS) approach to explore potential psychosocial and structural factors associated with HIV-related health outcomes among a community-based sample of older sexual minorities (N = 150) in South Florida, an U.S. HIV-epidemic epicenter. After SVSS, a forward entry regression approach suggested unstable housing, illicit substance use, current nicotine use, and depression were all associated with poorer ART adherence among older sexual minority adults living with HIV. No associations between potential correlates and biological measures of HIV disease severity were observed. Findings highlight a need to focus on multiple levels of intervention that target a combination of psychosocial and structural factors to improve HIV-care outcomes among older sexual minorities and achieve Ending the HIV Epidemic goals.

Minorías sexuales mayores (p.ej., gay, bisexual) que viven con VIH están en riesgo de resultados negativos de VIH debido a sus experiencias con desafíos psicosociales y barreras estructurales. Este estudio uso selección de variables de búsqueda estocástica (SVSS) para explorar factores psicosociales y estructurales asociadas con resultados de salud relacionado a VIH entre una muestra comunitaria de minorías sexuales mayores (N = 150) el la Sur de la Florida, un epicentro de la epidemia de VIH en EE. UU. Después de SVSS, una regresión de entrada directa sugirió que vivienda inestable, uso de sustancias ilícitas, consumo actual de nicotina, y depresión eran asociados con menos adherencia de terapias antirretroviral entre adultos mayores de minorías sexuales que viven con el VIH. No se encontraron asociaciones entre correlatos potenciales y medidas biológicas de VIH. Recomendaciones destacan una necesidad de concentrarse en múltiples niveles de intervención que apuntan una combinación de factores psicosociales y estructurales para mejorar resultados de VIH entre las minorías sexuales mayores y lograr las metas de Finalizando la Epidemia del VIH.

The impact of syndemic burden, age, and sexual minority status on internalized HIV stigma among people living with HIV in South Florida.

Internalized HIV stigma has been associated with several poor mental and physical health outcomes among people living with HIV (PLWH); yet, little research has explored how internalized HIV stigma may be affected by syndemic burden. This study sought to examine the relationship between syndemic conditions and HIV stigma over and above the potential effects of two social determinants of health, age and sexual minority status, using a linear regression approach (N = 1343). Syndemic burden was significantly positively associated with internalized HIV stigma above and beyond the effects of age and sexual minority status (b = 0.23). Additionally, age (b = -0.02) and being a sexually minority (b = -0.31) were significantly negatively associated with internalized HIV stigma. Findings should inform future treatment targets for this population by specifically working to reduce internalized HIV stigma for people with a greater syndemic burden and, potentially, among young adults and heterosexual PLWH.

Factors Associated with Post-Exposure Prophylaxis Awareness Among Latino Sexual Minority Men in South Florida.

Despite their efficacy, biomedical HIV prevention tools such as post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP) have been insufficiently scaled up and disseminated, especially among marginalized subgroups that face substantial HIV disparities. Given the minimal literature available on PEP among Latino sexual minority men (LSMM), this cross-sectional secondary analysis explored factors associated with PEP awareness among a group of LSMM living in South Florida, a US HIV epicenter. The parent study examined patterns of engagement in PrEP and behavioral health treatment services among LSMM (N = 290). The current secondary analysis (N = 243) identified factors associated with PEP awareness using three methods: stochastic search variable selection, participatory data science, and literature review-before being modeled using linear regression. Most participants (67.5%) reported having little to no awareness about PEP before initiating our study. Simple linear regression models suggested that higher PrEP knowledge (B = 0.17, SE = 0.02, p < 0.001), HIV knowledge (B = 0.15, SE = 0.04, p < 0.001), PrEP self-efficacy (B = 0.37, SE = 0.13, p < 0.05), and high perceived community norms for HIV testing (B = 0.29, SE = 0.14, p < 0.05) were each associated with LSMM's greater PEP awareness, while identity affirmation was associated with less PEP awareness (B = -0.13, SE = 0.05, p < 0.01). Results suggest the utility of our three-pronged variable selection approach and address gaps in PEP awareness and use among LSMM living in a US HIV epicenter to support Ending the HIV Epidemic goals.

Dancing in the Rain: How Do Abiotic Conditions Influence Sexually Selected Behaviors in the White-Ruffed Manakin?

Tropical animals respond to rainfall in population-specific ways. In extremely wet regions, endotherms experience heavy rains as stressors with consequences for behavior and demography. Ultimately, such stressors can affect the relative strength of abiotic selection, reducing the scope for sexual selection, and other biotic sources of selection. We studied population-level differences in the response to rainfall of White-ruffed manakins (Corapipo altera) on the Caribbean slope of Costa Rica, a species having a lek mating system subject to strong sexual selection. Between 2008 and 2013, we studied reproductive behavior in a population inhabiting an extremely wet site; estimates of apparent survival were low, and the turnover of display courts and dominant males was high. Males also engaged in coordinated display, and sub-adult males practiced in the presence of adults. Over three breeding seasons (2017-2019), we studied a population of the same species at a site only 110 km away, but in a location receiving roughly half as much rain. We tested behavioral predictions of three alternative mechanisms-indirect abiotic effects, direct mortality effects, and direct behavioral effects-linking rainfall to sexual selection in these two populations. Data derived from over 4300 h of observations at 105 display sites revealed high interannual variation in nearly all response variables, including turnover of display sites, retention of alpha status, male display behavior, and time females spent assessing male display. Additionally, we detected spatial differences in drivers of display site turnover. Notably, age distribution of males was skewed toward older individuals at the drier location. Based on these findings, we infer that indirect abiotic effects on forest structure leading to display site transience and direct effects of mortality increasing turnover in the male population likely underlie links between rain and the spatial and temporal differences we documented. Our results are consistent with rain constituting an important source of abiotic selection for tropical endotherms and modulating the scope for sexual selection near the extremes of a species' hygric niche.