Factors predicting primary and booster COVID-19 vaccination in a community sample of African American men and women in the United States Midwest.

COVID-19 has disproportionately burdened impoverished minority communities. This study recruited an age- and gender-diverse community sample of 541 Black adults in a United States Midwestern city with large racial health disparities, with the aim of examining factors associated with COVID-19 vaccination. All participants completed measures assessing their COVID-19 vaccination status (unvaccinated, received primary vaccination, or received primary plus booster vaccination) as well as demographic characteristics, socioeconomic factors, health and health system factors, and health behavior theory constructs related to vaccination. In this predominantly low-income sample, 55% of participants had received primary COVID-19 vaccination and 31% of the sample had received a booster dose. Multiple regression analyses established that having primary vaccination was significantly predicted by older age, political identification as Democrat, education beyond high school, barriers to accessing health care, as well as higher trust of vaccine benefits, less preference for natural immunity, stronger social norms favoring vaccination, and perceiving higher levels of collective responsibility. Surprisingly, higher global medical mistrust and difficulty with healthcare access were associated with vaccination. The model explained 76% of the variance in primary COVID-19 vaccination. Having received a COVID-19 booster was predicted by older age, previous COVID-19 infection, higher trust in vaccine benefits, and fewer worries about unforeseen future effects of vaccination. Study findings identified factors associated with COVID-19 vaccine uptake in racial minority communities, and support the benefits of interventions that harness social network supports for vaccination, address community vaccine concerns, and appeal to collective responsibility to promote vaccine uptake.

Coronavirus Disease 2019 Vaccination by Gender and Age in a Sample of Black Adults in Chicago.

Although vaccine behaviors differ greatly by gender and age, few studies have examined vaccination at the intersection of gender and age within the Black community. We examined COVID-19 vaccination by gender and age using a survey of over 500 Black adults in Chicago, Illinois, fielded from September 2021 to March 2022. Although 54% had received at least one COVID-19 vaccine, the proportion vaccinated was considerably lower for Black men (28%) and women (37%) under 40 years old than Black men (92%) and women (86%) over 40 years (p < .001). Concern about vaccine side effects was the most reported barrier for unvaccinated women (56%) and men (38%) under 40 years. Our results suggest that targeted efforts to improve COVID-19 vaccine uptake in the Black community in Chicago after the initial rollout should have focused on young adults, particularly young Black men, with emphasis on addressing concern about vaccine side effects.

An exploratory study of community violence and HIV care engagement among Black gay and bisexual men.

This study examined the relationship between exposure to community violence and HIV care engagement among 107 Black gay or bisexual men living with HIV in Chicago. Measures assessed the importance of demographic covariates (age, annual income, health insurance status, and years living with HIV), community violence exposures, mental health, social support, in explaining variations in missed doses of antiretroviral therapy (ART) medication and missed HIV care appointments. Results showed that participants who reported higher rates of exposure to community violence were two times more likely to have missed ART doses and HIV care appointments. Participants who reported depression scores were two times more likely to have greater non-ART adherence. Finally, older participants were more likely to report fewer missed ART doses. More research is needed to clarify the mechanisms between age or depression and ART adherence given community violence exposure. Health care providers should screen for depression when attempting to promote better ART adherence and keeping HIV care appointments for Black gay and bisexual men living with HIV. Younger Black gay and bisexual men living with HIV may be more vulnerable than older men for missed ART doses and may require additional screening and follow-up.

Associations Between Religiosity and Medical Mistrust: An Age-Stratified Analysis of Survey Data from Black Adults in Chicago.

Medical mistrust is associated with poor health outcomes, ineffective disease management, lower utilization of preventive care, and lack of engagement in research. Mistrust of healthcare systems, providers, and institutions may be driven by previous negative experiences and discrimination, especially among communities of color, but religiosity may also influence the degree to which individuals develop trust with the healthcare system. The Black community has a particularly deep history of strong religious communities, and has been shown to have a stronger relationship with religion than any other racial or ethnic group. In order to address poor health outcomes in communities of color, it is important to understand the drivers of medical mistrust, which may include one's sense of religiosity. The current study used data from a cross-sectional survey of 537 Black individuals living in Chicago to understand the relationship between religiosity and medical mistrust, and how this differs by age group. Descriptive statistics were used to summarize data for our sample. Adjusted stratified linear regressions, including an interaction variable for age group and religiosity, were used to model the association between religiosity and medical mistrust for younger and older people. The results show a statistically significant relationship for younger individuals. Our findings provide evidence for the central role the faith-based community may play in shaping young peoples' perceptions of medical institutions.

Trusted Sources of Information and COVID-19 Vaccination Among Black Adults in Chicago.

PURPOSE: Examine trust in sources of COVID-19 information and vaccination status. DESIGN: Cross-sectional. SETTING: Chicago, Illinois. SUBJECTS: Convenience sample of 538 Black adults surveyed between September 2021 and March 2022. MEASURES: Trust in sources of COVID-19 information, COVID-19 vaccination. ANALYSIS: Using latent class analysis, we identified classes of trust in sources of COVID-19 information. We considered predictors of class membership using multinomial logistic regression and examined unadjusted and adjusted associations between trust class membership and COVID-19 vaccination while accounting for uncertainty in class assignment. RESULTS: Our analytic sample (n = 522) was predominantly aged 18-34 (52%) and female (71%). Results suggested a four-class solution: (1) low trust, (2) high trust in all sources, (3) high trust in doctor and government, and (4) high trust in doctor, faith leader, and family. Unadjusted odds of vaccination were greater in the high trust in all sources (OR 2.0, 95% CI 1.2-3.2), high trust in doctor and government (OR 2.7, 95% CI 1.4-5.3), and high trust in doctor, faith leader, and family classes (OR 2.1, 95% CI 1.2, 3.9) than the low trust class. However, these associations were not significant after adjustment for sociodemographic and health status factors. CONCLUSION: Although COVID-19 vaccination varied across trust classes, our adjusted findings do not suggest a direct association between trust and vaccination, reflecting complexities in the vaccine decision-making process.

Police Violence Experienced by Black Gay and Bisexual Men: The Effects on HIV Care Engagement and Medication Adherence.

Black men face high rates of police violence, including direct victimization and indirect exposure to or knowledge of harmful policing. This violence can result in death and physical harm, as well as in numerous poor mental health outcomes. There has been little research examining experiences of police violence experienced by Black gay and bisexual men or the effects of police brutality on HIV continuum of care outcomes. To address this important gap, in this exploratory study, we examined the effects of police brutality on engagement in HIV care and adherence to antiretroviral medications. Cross-sectional survey data were collected from 107 Black gay and bisexual men living with HIV. The path analysis showed that men with greater exposure to police violence had increased symptoms of post-traumatic stress disorder and were more likely to have missed HIV care appointments in the past year. Additionally, there was a significant indirect effect of exposure to police violence on missed medication doses via PTSD symptoms.

Factors associated with PrEP use in a community sample of African American men who have sex with men (MSM) and transgender women (TGW) in the United States Midwest.

Black sexual minority men who have sex with men (MSM) in the United States are at disparate risk for contracting HIV infection, but pre-exposure prophylaxis (PrEP) use is suboptimal. Social network methods were used to recruit a community sample of racial minority MSM and transgender women (TGW) in two Midwestern US cities. 250 PrEP-eligible (HIV-negative) participants completed measures assessing current and intended PrEP use; demographic characteristics; PrEP knowledge, attitudes, norms, stigma, and self-efficacy; and structural barriers to PrEP. Multivariate analyses established predictors of current and intended PrEP use. Only 12% of participants reported currently using PrEP, which was associated with greater PrEP knowledge and not having a main partner, with trends for greater PrEP use by younger participants and those with partners living with HIV. Among participants not currently on PrEP, strength of PrEP use intentions was associated with higher PrEP knowledge, PrEP descriptive social norms, and PrEP use self-efficacy. This study is among few to directly compare Black who have adopted PrEP with those who have not. Its findings underscore the potential benefits of employing social network approaches for strengthening PrEP use peer norms, increasing PrEP knowledge and self-efficacy, and optimizing PrEP uptake among racial minority MSM and TGW.

Acceptability, Feasibility, and Preliminary Impact of 4 Remotely-Delivered Interventions for Rural Older Adults Living with HIV.

People living with HIV (PLH) who live in rural areas of the United States (US) face more challenges to obtaining medical care and suffer higher mortality rates compared to non-rural PLH. Compared with younger PLH, older PLH (age 50+) also face additional challenges to maintaining their health and wellbeing. Despite the heightened barriers to receiving care and remaining adherent to treatment among older rural PLH, few interventions to increase viral suppression and improve quality of life exist for this population. We pilot-tested four remotely-delivered interventions-group-based social support, group-based stigma-reduction, individual strengths-based case management, and individual technology detailing-aimed to improve care engagement and quality of life in rural older PLH in the southern US. Participants (N = 61, Mage = 58, 75% male) completed surveys and self-collected blood specimens at baseline and 3 months; in between, they were randomized to 0-4 interventions. We assessed feasibility, acceptability, and preliminary impact on medication adherence, viral suppression, quality of life, depressive symptoms, and hypothesized mediating mechanisms. More than 80% participated in assigned intervention(s), and 84% completed the study. Interventions were highly acceptable to participants, with more than 80% reporting they would recommend interventions to peers. More than 80% found the social support and case management interventions to be relevant and enjoyable. We found promising preliminary impact of interventions on quality of life, medication adherence, depressive symptoms, internalized stigma, and loneliness. Remotely-delivered interventions targeting rural older PLH are feasible to conduct and acceptable to participants. Larger scale study of these interventions is warranted.

RESUMEN: A pesar de las múltiples barreras para la adherencia a la medicación y la recepción de atención entre las personas mayores de zonas rurales que viven con el VIH, existen pocas intervenciones para mejorar la supresión viral y la calidad de vida para esta población. Realizamos pruebas piloto de intervenciones realizadas de forma remota (grupos de apoyo social, grupos de reducción del estigma, manejo de casos basado en los puntos fuertes y "technology detailing") entre las personas que viven con el VIH en zonas rurales del sur de Estados Unidos. Los participantes (N = 61, Medad = 58, 75% hombres) completaron encuestas y recolectaron muestras de sangre al inicio y a los 3 meses; en el medio, fueron asignados al azar a 0­4 intervenciones. Evaluamos la viabilidad, la aceptabilidad y el impacto preliminar. Más del 80% participó en la(s) intervención(es) y el 84% completó el estudio. Las intervenciones fueron muy aceptables para los participantes; más del 80% consideró que las intervenciones de apoyo social y gestión de casos eran relevantes y agradables. Las intervenciones tuvieron un impacto preliminar prometedor sobre la calidad de vida, la adherencia a la medicación, los síntomas depresivos, el estigma y la soledad. Las intervenciones realizadas a distancia dirigidas a las personas que viven con el VIH en zonas rurales de edad avanzada son viables y aceptables, y se justifica un estudio a mayor escala.

The Inherent Violence of Anti-Black Racism and its Effects on HIV Care for Black Sexually Minoritized Men.

The goal of this study was to examine the effects of racial discrimination, depression, and Black LGBTQ community support on HIV care outcomes among a sample of Black sexually minoritized men living with HIV. We conducted a cross-sectional survey with 107 Black sexually minoritized men living with HIV in Chicago. A path model was used to test associations between racial discrimination, Black LGBTQ community support, depressive symptoms, and missed antiretroviral medication doses and HIV care appointments. Results of the path model showed that men who had experienced more racism had more depressive symptoms and subsequently, missed more doses of HIV antiretroviral medication and had missed more HIV care appointments. Greater Black LGBTQ community support was associated with fewer missed HIV care appointments in the past year. This research shows that anti-Black racism may be a pervasive and harmful determinant of HIV inequities and a critical driver of racial disparities in ART adherence and HIV care engagement experienced by Black SMM. Black LGBTQ community support may buffer against the effects of racial discrimination on HIV care outcomes by providing safe, inclusive, supportive spaces for Black SMM.

Community Cohesion, Social Support, and Mental Health among Black Individuals in Chicago: A Cross-Sectional Examination of the Effects on COVID-19 Vaccination.

The COVID-19 pandemic put a significant strain on communities, social resources, and personal relationships, disproportionately impacting Black and low-income communities in the United States. Community cohesion and social support are positively associated with numerous health outcomes and preventive health measures, yet were strained during the pandemic due to COVID mitigation measures. This study examined the relationships between social cohesion, social support, mental health, and COVID-19 vaccination to understand whether community cohesion and social support were associated with increased likelihood of receiving a COVID-19 vaccination. Data are from a cross-sectional survey of 537 Black Chicagoans that was disseminated between September 2021 and March 2022. Structural equation modeling was used to test associations between community cohesion, social support, loneliness, anxiety, stress, and having received a COVID-19 vaccination. Results demonstrated that social support mediated associations between community cohesion and loneliness, anxiety, and stress, but was not associated with COVID-19 vaccination. These results demonstrate the importance of community cohesion and social support on mental health and suggest there are other potential pathways that may link community cohesion and vaccination.

The Influence of Racism in Healthcare: COVID-19 Vaccine Hesitancy Among Black Mothers in Chicago.

Black mothers and children experience significant health disparities in the USA. These health disparities have been attributed, in part, to experiencing racism in healthcare. This study aimed to explore how experiences of healthcare discrimination and mistreatment experienced by Black mothers may influence COVID-19 vaccine beliefs and decision-making for themselves and their families. From April 2021 to November 2021, we conducted 50 semi-structured interviews among Chicago residents. Ten participants self-identified as female and with reported children; these data were extracted from the larger sample for data analysis. Interview content included perceptions and experiences with the COVID-19 vaccine and experiences with healthcare discrimination, mistreatment, and medical mistrust. Interview transcripts were transcribed verbatim and coded using the MAXQDA 2022 qualitative software. Themes were identified using a team-based thematic analysis to understand how experiences of racism in healthcare may influence COVID-19 vaccine decision-making. Four themes were generated from the data: (1) experiences of healthcare discrimination and mistreatment, (2) distrust and fears of experimentation, (3) the influence of discrimination and distrust on COVID-19 vaccine decision-making, and (4) overcoming vaccine hesitancy. The results of this study highlight the current literature; Black mothers experience racism and discrimination in healthcare when seeking care for themselves and their children. It is evident in their stories that medical racism and historical medical abuse influence vaccine decision-making. Therefore, healthcare and public health initiatives should be intentional in addressing past and present racism in healthcare to improve vaccine distrust.

Examining the Relationship between Anti-Black Racism, Community and Police Violence, and COVID-19 Vaccination.

In 2020, the COVID-19 pandemic emerged against a backdrop of long-standing racial inequities that contributed to significant disparities in COVID-19 mortality, morbidity, and eventually, vaccination rates. COVID-19 also converged with two social crises: anti-Black racism and community and police violence. The goal of this study was to examine the associations between community violence, police violence, anti-Black racism, and COVID-19 vaccination. Survey data were collected from a sample of 538 Black residents of Chicago between September 2021 and March 2022. Structural equation modeling was used to test associations between neighborhood violence, police violence, racism, medical mistrust, trust in COVID-related information, depressive symptoms, and having received a COVID-19 vaccination. In line with predictions, neighborhood violence had a significant indirect effect on vaccination via trust in COVID-related information from a personal doctor. Additionally, racism had a significant indirect effect on vaccination via trust in COVID-related information from a personal doctor, as well as via medical mistrust and trust in COVID-related information from a personal doctor. These findings add to the growing body of literature demonstrating the importance of medical mistrust when examining COVID-19 vaccination disparities. Furthermore, this study highlights the importance of considering how social and structural factors such as violence and racism can influence medical mistrust.

Exploring preferences and decision-making about long-acting injectable HIV pre-exposure prophylaxis (PrEP) among young sexual minority men 17-24 years old.

Intramuscular cabotegravir for long-acting injectable HIV pre-exposure prophylaxis (i.e., LAI-PrEP) was approved by the U.S. FDA in 2021. We sought to explore LAI-PrEP decision-making among a nationwide sample of young sexual minority men (YSMM) 17-24 years old. In 2020, HIV-negative/unknown YSMM (n = 41) who met CDC criteria for PrEP were recruited online to participate in synchronous online focus groups eliciting preferences and opinions about LAI-PrEP, as well as the impact of a potential self-administered option. Data were analyzed using inductive and deductive thematic analysis with constant comparison. Preferences and decision-making about LAI-PrEP varied widely among YSMM, with participants frequently comparing LAI-PrEP to oral PrEP regimens. We identified five key themes related to LAI-PrEP decision-making including concerns about adherence to PrEP dosing and clinic appointments, awareness and knowledge of PrEP safety and efficacy data, comfort with needles, minimizing PrEP stigma, and considerations of self-administration. YSMM acknowledged more PrEP options as beneficial to supporting uptake and persistence.

The COVID-19, racism, and violence syndemic: Evidence from a qualitative study with Black residents of Chicago.

The COVID-19 pandemic emerged in the United States in the shadows of a vast history of structural racism and community and police violence that disproportionately affect Black communities. Collectively, they have created a syndemic, wherein COVID-19, racism, and violence are mutually reinforcing to produce adverse health outcomes. The purpose of this study was to understand the COVID-19, racism, and violence syndemic and examine how structural racism and violence contributed to the disproportionate impact of COVID-19 on Black communities. In early 2021, we conducted phenomenological qualitative interviews with 50 Black residents of Chicago. Interview transcripts were coded and analyzed using thematic analysis. We identified four primary themes in our analyses: 1) the intersection of racism and violence in Chicago; 2) longstanding inequities were laid bare by COVID-19; 3) the pervasiveness of racism and violence contributes to poor mental health; 4) and COVID-19, racism and violence emerged as a syndemic. Our findings underscore the importance of addressing social and structural factors in remediating the health and social consequences brought about by COVID-19.

Intersectional Discrimination and PrEP uSe Among Young Black Sexual Minority Individuals: The Importance of Black LGBTQ Communities and Social Support.

Intersectional stigma and discrimination have increasingly been recognized as impediments to the health and well-being of young Black sexual minority men (YBSMM) and transgender women (TW). However, little research has examined the relationship between intersectional discrimination and HIV pre-exposure prophylaxis (PrEP) outcomes. This study with 283 YBSMM and TW examines the relationship between intersectional discrimination and current PrEP use and likelihood of future PrEP use. Path models were used to test associations between intersectional discrimination, resilience and social support, and PrEP use and intentions. Individuals with higher levels of anticipated discrimination were less likely to be current PrEP users (OR = 0.59, p = .013), and higher levels of daily discrimination were associated with increased likelihood of using PrEP in the future (B = 0.48 (0.16), p = .002). Greater discrimination was associated with higher levels of resilience, social support, and connection to the Black LGBTQ community. Social support mediated the effect of day-to-day discrimination on likelihood of future PrEP use. Additionally, there was a significant and negative indirect effect of PrEP social concerns on current PrEP use via Black LGBTQ community connectedness. The results of this study highlight the complexity of the relationships between discrimination, resilience, and health outcomes.

Factors associated with lack of care engagement among older, rural-dwelling adults living with HIV in the United States.

PURPOSE: Most people living with HIV (PLH) in the United States are over age 50 and this sector of PLH continues to grow. Aging with HIV can be challenging due to comorbid medical conditions, mental health disorders, substance use, and lack of social and practical support. Additional challenges are faced by older PLH living in the rural United States, such as longer distances to health care, concerns over privacy and stigma, and social isolation. PLH in rural areas have higher mortality rates than urban PLH. We aimed to understand factors associated with HIV care engagement and quality of life in rural US adults over age 50. METHODS: We conducted a cross-sectional study to evaluate the association between patient-level factors and a combined outcome variable encompassing multiple aspects of care engagement. FINDINGS: Either online or on paper, 446 participants completed our survey. One-third of the participants (33%) were from the southern United States; one-third were women; one-third were non-White; and 24% completed the survey on paper. In multiple regression analysis, lower income, residing in the southern United States, lacking internet access at home, not having an HIV specialist provider, higher levels of stress, living alone, and longer distance to an HIV provider were all associated with lower engagement in HIV care. CONCLUSIONS: Our findings demonstrated multiple potential options for interventions that could improve care engagement, such as providing and enhancing access to technology for health care engagement and remotely delivering social support and mental health services. Research on such potential interventions is needed for older, rural PLH.

Factors associated with quality of life, depressive symptoms, and perceived stress among rural older adults living with HIV in the United States.

PURPOSE: Rural older people living with HIV (PLH) in the United States are a population of growing size and significance. A better understanding of factors associated with quality of life (QOL), depressive symptoms, and stress in this population-especially modifiable factors-could inform future interventions. METHODS: Online or on paper, we surveyed 446 PLH aged 50+ residing in rural counties across the United States (Mage = 56, 67% male, 67% White, and 23% Black). Associations between social support, HIV stigma, satisfaction with medical care, discrimination in health care settings, and structural barriers and health-related QOL, depressive symptoms, and perceived stress were assessed using multiple linear regressions. FINDINGS: Controlling for demographics, greater social support was associated with better QOL, fewer depressive symptoms, and less stress. Greater HIV stigma was associated with more depressive symptoms and stress. Satisfaction with care was associated with better QOL and less stress. Discrimination in medical settings was associated with lower QOL and more depressive symptoms and stress. Finally, experiencing more structural barriers was associated with lower QOL and more depressive symptoms and stress. CONCLUSIONS: In addition to engagement in care and viral suppression, QOL and mental health are also critical considerations for rural older PLH. Increasing social support, reducing or providing skills to cope with HIV stigma, improving quality of care, reducing discrimination and stigma in medical settings, and reducing or mitigating the impact of structural barriers present potential targets for interventions aiming to improve the well-being of older rural PLH.

Sources of Information about Pre-Exposure Prophylaxis (PrEP) and Associations with PrEP Stigma, Intentions, Provider Discussions, and Use in the United States.

The amount and type of information individuals receive about HIV pre-exposure prophylaxis (PrEP) may influence PrEP uptake. We surveyed 331 HIV-negative sexual and gender minorities who have sex with men at a Midwestern Pride festival in 2018 (Mage = 32, 68% White, 87% cisgender men) to assess sources and perceived tone of PrEP information and associated outcomes. Most participants (88%) had heard about PrEP. The most common sources were the internet (70%), social media (59%), and friends (54%). Messages from health campaigns were perceived as most positive and those from religious institutions as least positive. Sources differed based on demographics. Controlling for indications for PrEP use, those who heard about PrEP from health campaigns and those who heard more positive messages reported lower levels of PrEP stigma, ßs = -0.27--0.23, ps < .05. Non-users who heard about PrEP from the internet had stronger intentions to use PrEP, ß = 0.28, p < .05. Those who heard about PrEP from sexual partners and health campaigns were more likely to discuss PrEP with providers, PRs = 1.60-1.80, ps < .01. Finally, those who heard about PrEP from friends and partners were more likely to use PrEP, PRs = 2.01-2.24, ps < .05. Leveraging sexual partners, social network members, and health campaigns are promising avenues to advance PrEP implementation.

1000 Hometown Heroes: Mobilising community social influencers for COVID-19 prevention, care and coping.

Coronavirus disease 2019 (COVID-19) created life-disrupting stressors that disproportionately burden disadvantaged communities with devastating impacts that extend far beyond the burden of the disease itself, including joblessness, housing and food insecurity, educational system upheavals, isolation due to disrupted relationships, worsened mental health and substance use and violence. Socially interconnected community members are resources whose efforts can be mobilised to improve COVID-19 coping within their social networks. This research examined the feasibility, acceptability, and reach of a social media-based peer influencer intervention for COVID-19 coping. Over a 9-month period in 2020, the project enrolled 1253 social influencers in Milwaukee-primarily ethnic and racial minorities-who regularly received and passed along messages to members of their social networks that provided advice about COVID-19 pandemic coping, economic survival, health protection, mental health, family needs, social justice and other impacts. Messages were shared by influencers with others over social media and also text messages, phone calls and conversations. Facebook social media tracking metrics objectively measured the community reach of social influencers' messages. Quantitative surveys and qualitative follow-up interviews with a subset of influencers also measured the feasibility and acceptability of the intervention. Social media monitoring metrics showed that, by the end of the project, influencers' messages reached an average of 7978 unique individuals per week and had an average of 13,894 total views per week, with more than 140,000 total cumulative organic impressions. More than half of social influencers indicated that-beyond Facebook message sharing-they shared COVID-19 prevention, care, and coping messages with social network members in conversations, phone calls and text messages. Social influencers reported that they valued having the opportunity to help community members to cope with pandemic stressors by conveying practical COVID-19 coping advice.

Sexually Transmitted Infections Diagnosed Among Sexual and Gender Minority Communities During the First 11 Months of the COVID-19 Pandemic in Midwest and Southern Cities in the United States.

BACKGROUND: The COVID-19 pandemic adversely affected sexual health services. Given the burden of sexually transmitted infections (STIs) on sexual and gender minorities (SGMs), we estimated incidence of self-reported STI diagnoses and factors associated with STI diagnoses among SGMs during the pandemic's first year. METHODS: A cohort of 426 SGM persons, 25 years or older, recruited in Chicago, Milwaukee, Detroit, Minneapolis, and Houston completed 5 online surveys from April 2020 to February 2021. Persons self-reported on each survey all health care provider STI diagnoses. Kaplan-Meier was used to estimate the cumulative risk of STI diagnoses, stratified by human immunodeficiency virus (HIV) status. Factors associated with STI diagnoses were assessed with a longitudinal negative binomial regression. RESULTS: Median age was 37 years, and 27.0% were persons living with HIV (PLH). Participants reported 63 STIs for a cumulative incidence for PLH and HIV-negative persons of 0.19 (95% confidence interval [CI], 0.13-0.29) and 0.12 (95% CI, 0.09-0.17), respectively. Regardless of HIV, a younger age and changes in health care use were associated with STI diagnoses. Among HIV-negative persons, the rate of STI diagnoses was higher in Houston than the Midwest cities (adjusted relative risk, 2.37; 95% CI, 1.08-5.20). Among PLH, a decrease in health care use was also associated with STI diagnoses (adjusted relative risk, 3.53; 95% CI, 1.01-12.32 vs no change in health care services), as was Hispanic ethnicity and using a dating app to meet a sex partner. CONCLUSIONS: Factors associated with STI diagnoses during the COVID-19 pandemic generally reflected factors associated with STI incidence before the pandemic like geography, HIV, age, and ethnicity.