Vitamin D Levels and SARS-CoV-2 Infection among Medically Underserved Populations in the Minority and Rural Coronavirus Insights Study.

BACKGROUND: Extant literature presents contradictory findings on the role of vitamin D on SARS-CoV-2 infection. Our study included an examination of the relationship between vitamin D levels and SARS-CoV-2 infection among the Minority and Rural Coronavirus Insights Study (MRCIS) cohort, a diverse population of medically underserved persons presenting at five Federally qualified health centers in the United States. METHODS: We conducted a descriptive analysis to explore the relationship between vitamin D levels and SARS-CoV-2 infection among medically underserved participants. A combined molecular and serologic assessment was used to determine the prevalence of SARS-CoV-2 infection. Vitamin D was examined as both a categorical (vitamin D status: deficient, insufficient, optimal) and continuous (vitamin D level) variable. Chi-squared testing, polynomial regression models, and logistic regression models were used to assess the relationship between vitamin D and SARS-CoV-2 infection. RESULTS: The overall SARS-CoV-2 infection rate among participants was 25.9%. Most participants were either vitamin D deficient (46.5%) or insufficient (29.7%), and 23.8% had an optimal level. Vitamin D status was significantly associated with key SARS-CoV-2 infection risk factors. As mean vitamin D levels increased, the proportion of participants with SARS-CoV-2 infection decreased. For every 10 ng/mL increase in vitamin D levels the odds of SARS-CoV-2 infection decreased by 12% when adjusting for race/ethnicity and age (main effect model). Participants who identified as Hispanic/Latino or Black non-Hispanic had approximately two times increased odds of SARS-CoV-2 infection when adjusting for age and vitamin D levels compared to white non-Hispanics. However, when additional factors were added to the main effect model, the relationship between vitamin D levels and SARS-CoV-2 infection did not remain significant. CONCLUSION: Vitamin D levels were associated with an increased risk of SARS-CoV-2 infection. Hispanic/Latino and Black, non-Hispanic compared to White, non-Hispanic participants were at increased odds for infection, after adjusting for race/ethnicity and age.

The Impact of HIV-Related Stigma on Racial/Ethnic Disparities in Retention in HIV Care Among Adults Living with HIV in Florida.

BACKGROUND: Our study examines the effects of distinct HIV stigma subtypes on retention in care and racial-ethnic differences among persons with HIV (PWH). METHODS: Using Florida Medical Monitoring Project 2015-2017 data, we analyzed patients' clinical and behavioral characteristics. We analyzed 89,889 PWH in Florida (50.0% non-Hispanic Blacks, 20.8% Hispanics, 29.2% non-Hispanic whites). HIV stigma subtypes, negative self-image, anticipated stigma, personalized stigma, and retention in care were examined with logistic regressions. RESULTS: People with high negative self-image and anticipated stigma were less likely to be retained (CI: 0.84-0.92; 0.47-0.53). The association between HIV-related stigma subtypes and retention in care differed between Black, White, and Hispanic participants. Negative self-image was associated with higher retention rates among Hispanics (CI: 5.64-9.26) and Whites (CI: 1.04-1.27), while low retention rates among Blacks (0.617-0.686). The likelihood of staying in care was lower across all racial-ethnic groups when the anticipated stigma was high or moderate. In contrast, personalized stigma increased retention across all racial-ethnic groups. CONCLUSION: Results showed that distinct types of HIV stigma differentially impact retention, and these associations differ by race and ethnicity. Future interventions should address the effect HIV stigma subtypes have on racially minoritized PWH retention.

Pre- and Post-immigration HIV Testing Behaviors among Young Adult Recent Latino Immigrants in Miami-Dade County, Florida.

HIV testing early in the immigration process can facilitate timely linkage to HIV prevention and treatment services for immigrants. This study aims to determine the prevalence of self-report HIV testing pre- and post-immigration and the associations between pre-immigration HIV sexual risk behaviors, access to healthcare post-immigration, and HIV testing post-immigration among young adult recent Latino immigrants. Cross-sectional data from 504 recent Latino immigrants aged 18 to 34 who immigrated to Miami-Dade County, Florida during the 12 months before assessment were analyzed using robust Poisson regression models. We found that 23.8% of participants reported HIV testing post-immigration and 56.7% reported HIV testing pre-immigration. The prevalence ratio for post-immigration HIV testing was higher for participants that had health insurance (adjusted prevalence ratio [aPR]: 1.70, 95% confidence interval [CI]: 1.21-2.38) and a regular doctor or healthcare provider after immigration (aPR: 1.43, 95% CI 1.03-2.00), and post-immigration HIV testing was higher for participants that had ever been tested for HIV before immigration (aPR: 2.41, 95% CI 1.68-3.45). Also, the prevalence ratio was lower for those who engaged in condomless sex in the three months prior to immigration (aPR: 0.65, 95% 0.47-0.90). These findings suggest that addressing barriers to healthcare and prevention services for young adult recent Latino immigrants is needed to scale-up HIV testing in this population early in the immigration process.

RESUMEN: Obtener una prueba del VIH al inicio del proceso de inmigración puede facilitar una conexión inmediata con los servicios de prevención y tratamiento del VIH. Este estudio tiene como propósito determinar la prevalencia auto informada de las pruebas de VIH antes y después de la inmigración, y las asociaciones entre las conductas sexuales de riesgo antes de la inmigración, el acceso a los servicios médicos después de la inmigración y las pruebas de VIH realizadas después de la inmigración en Latinos jóvenes adultos recién llegados a los Estados Unidos. Los datos transversales de 504 inmigrantes Latinos recién llegados entre los 18 y 34 años, que inmigraron al condado de Miami-Dade, Florida, durante los 12 meses anteriores a la evaluación, se analizaron utilizando modelos de regresión de Poisson robustos. Encontramos que 23.8% de los participantes informaron haberse realizado la prueba del VIH después de la inmigración y 56.7% informaron haberse realizado la prueba del VIH antes de la inmigración. El índice de prevalencia para las pruebas del VIH después de la inmigración fue mayor para los participantes que tenían seguro médico [índice de prevalencia ajustado (IPa): 1.70, intervalo de confianza (IC) del 95%: 1.21-2.38] y un médico o proveedor regular de atención médica después de la inmigración [IPa: 1.43, IC del 95%: 1.03-2.00], y para los participantes que se habían hecho la prueba del VIH antes de la inmigración [IPa: 2.41, IC de 95%: 1.68-3.45]. Además, el índice de prevalencia fue menor para aquellos participantes que tuvieron relaciones sexuales sin condón en los tres meses previos a la inmigración [IPa: 0.65, IC del 95%: 0.47-0.90]. Estos resultados sugieren que es necesario abordar las barreras a los servicios médicos y de prevención en los inmigrantes Latinos jóvenes adultos recién llegados a los Estados Unidos para ampliar las pruebas del VIH en esta población al inicio del proceso de inmigración.

Psychosocial stress, bicultural identity integration, and bicultural self-efficacy among Hispanic emerging adults.

Most studies on psychosocial stress among Hispanics have focused on risk factors. To better understand psychosocial stress among this population, this study aimed to examine components of bicultural identity integration and bicultural self-efficacy, that may be associated with lower psychosocial stress among Hispanic emerging adults (ages 18-25). This aim was tested on a cross-sectional sample of Hispanic emerging adults (Mage = 21.30, SD = 2.09) that included 200 participants (Arizona n = 99, Florida n = 101). The sample included men (n = 98) and women (n = 102). Most participants were US-born (70%), college students (69.5%), and of Mexican heritage (44%). Standardized coefficients from a hierarchical multiple regression model indicate that higher levels of the bicultural harmony component of bicultural identity integration (ß = -0.26, p < 0.001) and the social groundedness component of bicultural self-efficacy (ß = -0.23, p < 0.01) were associated with lower levels of psychosocial stress. To our knowledge, this is the first study to examine components of bicultural identity integration and bicultural self-efficacy and their respective associations with psychosocial stress among any racial/ethnic group. Thus, more studies are needed to replicate our findings to determine if bicultural identity integration and bicultural self-efficacy should be considered in psychosocial stress interventions for Hispanics.