Utilizing Community Based Participatory Research Methods in Black/African American and Hispanic/Latinx Communities in the US: The CDC Minority HIV Research Initiative (MARI-Round 4).

The Centers for Disease Control and Prevention Minority HIV Research Initiative (MARI) funded 8 investigators in 2016 to develop HIV prevention and treatment interventions in highly affected communities. We describe MARI studies who used community-based participatory research methods to inform the development of interventions in Black/African American and Hispanic/Latinx communities focused on sexual minority men (SMM) or heterosexual populations. Each study implemented best practice strategies for engaging with communities, informing recruitment strategies, navigating through the impacts of COVID-19, and disseminating findings. Best practice strategies common to all MARI studies included establishing community advisory boards, engaging community members in all stages of HIV research, and integrating technology to sustain interventions during the COVID-19 pandemic. Implementing community-informed approaches is crucial to intervention uptake and long-term sustainability in communities of color. MARI investigators' research studies provide a framework for developing effective programs tailored to reducing HIV-related racial/ethnic disparities.

Using a Structural-Ecological Model to Facilitate Adoption of Preexposure Prophylaxis Among Latinx Sexual Minority Men: A Systematic Literature Review.

Research has consistently shown that individual, interpersonal, community and structural factors influence the degree to which individuals' access and utilize health care services, and these factors may play a role in explaining racial and ethnic differences in health care outcomes. Differences in HIV prevalence and treatment between Latinx adults and white adults in the U.S. must be considered in the context of these factors. However, much of the existing research connecting these factors and HIV/AIDS outcomes in Latinxs remains disparate, limited in scope, and has yet not been applied to the use of biomedical HIV preventions. The following systematic literature review examined research related to PrEP in Latinx sexual minority men (SMM) to build a structural-ecological framework of the existing research, while identifying gaps in the literature and areas for future research. We searched two electronic databases using a systematic review protocol, screened 71 unique records, and identified 23 articles analyzing data from Latinx SMM and intended and/or actual PrEP-use in the United States. Based on the present review, disparities in PrEP uptake by Latinx SMM could be explained, in part, by examining how all levels of the structural-ecological framework uniquely contributes to how Latinx SMM engage with HIV prevention measures and come to understand PrEP. It is clear from the existing literature base that some of the most prominent barriers deterring Latinx SMM from seeking PrEP services are the lack of information surrounding PrEP and HIV/gay stigmas. However, higher order structural-level risks can facilitate or reduce access to PrEP. We propose a structural-ecological model to help visualize multi-level domains of unique stressors that limit the implementation of PrEP among Latinxs. At this stage, the available literature provides little guidance beyond suggesting that culturally adapted interventions can be effective in this population. The model developed here provides that needed specificity regarding targeted interventions that will fit the needs of this population.

Las investigaciones han demostrado sistemáticamente que los factores individuales, interpersonales, comunitarios y estructurales influyen en el grado en que las personas acceden y utilizan los servicios de atención médica. Estos factores pueden ayudar a explicar las consecuencias diferenciadas por raza y etnia. Las diferencias en la prevalencia y el tratamiento del VIH entre Latinxs y blancos en los Estados Unidos deben considerarse en el contexto de estos factores. Sin embargo, gran parte de la investigación existente que conecta estos factores y los resultados del VIH/SIDA en los Latinxs sigue siendo dispar, de alcance limitado y aún no se ha aplicado al uso de la prevención biomédica del VIH. La siguiente revisión sistemática de la literatura examinó la investigación relacionada con la PrEP en hombres Latinxs de minorías sexuales (SMM) para construir un marco estructural-ecológico de la investigación existente, al tiempo que identifica brechas en la literatura y áreas para futura investigación. Se realizaron búsquedas en dos bases de datos electrónicas mediante un protocolo de revisión sistemática, se seleccionaron 71 registros únicos y se identificaron 23 artículos que analizaban datos de Latinx SMM y el uso intencionado y/o real de la PrEP en los Estados Unidos. Según la presente revisión, las disparidades en la adopción de la PrEP por Latinx SMM podrían explicarse, en parte, examinando cómo todos los niveles del marco ecológico contribuyen de manera única a cómo los Latinx SMM se involucran con las medidas de prevención del VIH y llegan a comprender la PrEP. De la literatura existente, se desprende claramente que algunas de las barreras más importantes que disuaden a los Latinx SMM de buscar servicios de PrEP son la falta de información sobre la PrEP y los estigmas del VIH y por orientación sexual. Sin embargo, los riesgos de orden superior a nivel estructural pueden facilitar o reducir el acceso a la PrEP. Proponemos un modelo ecológico-estructural para ayudar a visualizar dominios multinivel de factores estresantes únicos que limitan la implementación de PrEP entre Latinxs. Hasta el momento, la literatura disponible proporciona poca orientación más allá de sugerir que las intervenciones para prevención adaptadas culturalmente pueden ser efectivas en esta población. El modelo desarrollado en el presente trabajo proporciona la especificidad necesaria con respecto a las intervenciones específicas que se ajustarán a las necesidades de esta población.

Factors Associated with Intention to Receive Vaccination against COVID-19 in Puerto Rico: An Online Survey of Adults.

We conducted an online survey among adults in Puerto Rico to identify factors associated with the intention to receive vaccination against COVID-19. Sociodemographic variables were analyzed independently for association with intent to receive vaccination. Significant associations were included in the multivariate logistic regression analysis. A total of 1016 responses were available for analysis. In the bivariate analysis, younger age, higher education, pre-COVID-19 employment, male sex, gay/bisexual identity, and single marital status were associated with increased intent to receive the vaccination. In the multivariate logistic regression, younger, male respondents, and those with higher educational attainment reported higher intent to receive the vaccination. Lower-income and living outside the San Juan metro region were associated with lower intent to receive the vaccination. National and international health organizations were identified as the most reliable sources of information, followed by healthcare professionals. These findings highlight the importance of considering sociodemographic characteristics and using trusted sources of information when designing COVID-19 vaccination public messaging.

Vital Voices: HIV Prevention and Care Interventions Developed for Disproportionately Affected Communities by Historically Underrepresented, Early-Career Scientists.

BACKGROUND: HIV prevention interventions which support engagement in care and increased awareness of biomedical options, including pre-exposure prophylaxis (PrEP), are highly desired for disproportionately affected Black/African American, Hispanic/Latinx and gay, bisexual, and other men who have sex with men (GBMSM) populations in the United States (US). However, in almost 40 years of HIV research, few interventions have been developed directly by and for these priority populations in domestic counties most at risk. We submit that interventions developed by early-career scientists who identify with and work directly with affected subgroups, and which include social and structural determinants of health, are vital as culturally tailored HIV prevention and care tools. METHODS: We reviewed and summarized interventions developed from 2007 to 2020 by historically underrepresented early-career HIV prevention scientists in a federally funded research mentoring program. We mapped these interventions to determine which were in jurisdictions deemed as high priority (based on HIV burden) by national prevention strategies. RESULTS: We summarized 11 HIV interventions; 10 (91%) of the 11 interventions are in geographic areas where HIV disparities are most concentrated and where new HIV prevention and care activities are focused. Each intervention addresses critical social and structural determinants of health disparities, and successfully reaches priority populations. CONCLUSION: Focused funding that supports historically underrepresented scientists and their HIV prevention and care intervention research can help facilitate reaching national goals to reduce HIV-related disparities and end the HIV epidemic. Maintaining these funding streams should remain a priority as one of the tools for national HIV prevention.

Zika virus epidemic in Puerto Rico: Health justice too long delayed.

Over the course of 16 months, more than 35400 cases of Zika virus infection have been confirmed in Puerto Rico. This represents 85% of all cases reported in the USA and its territories. The Zika epidemic is exposing the profound failure of socioeconomic policies, as well as the failure to protect sexual and reproductive health rights in Puerto Rico. Considering the high poverty rates, high levels of sexuality-related stigma, poor quality sex education, limited access to contraception, and limited participation in the allocation of resources for prevention, it is unreasonable to focus public health efforts to prevent Zika virus infection on vector control. The allocation and equitable management of resources for research and intervention are required in order to understand and address the barriers to and facilitators of prevention at the individual, social, and structural levels. Further, the impact of efforts to tackle the social determinants of the Zika virus epidemic on the island should be assessed.

Knowledge of legal rights among persons living with HIV/AIDS in Puerto Rico: implications for stigma management.

OBJECTIVE: To determine the level of understanding that people living with HIV/ AIDS (PLWHA) in Puerto Rico have in terms of their own legal rights; to ascertain how the members of this population manage the violation/s of these rights in the event that such violations occurred. METHODS: A mixed-method design was used to accomplish our objectives. One hundred and three participants completed a questionnaire; an in-depth interview was also conducted with 10 members of the sample group. RESULTS: Quantitative results show that the most recognized rights among the participants were the right to have sex (n = 98; 95%) and the right to marry (n = 90; 87%). Most participants inaccurately indicated that PLWHA are forced by law to disclose their HIV serostatus both to their partners (n = 69; 67%) and to their physicians (n = 70; 68%). The results from qualitative analysis indicate that most of the participants had experienced discrimination, though none reported these occurrences to the legal authorities. CONCLUSION: Findings suggest that there is a need to improve the implementation of the public policy that protects PLWHA who live in Puerto Rico from discrimination. Future interventions aimed at reducing HIV-related stigma should consider providing information about legal rights and strategies for managing stigma and discrimination. Healthcare professionals play an important role in the promotion of the rights of PLWHA in Puerto Rico.

Stigmatization of illicit drug use among Puerto Rican health professionals in training.

Social stigma continues to be a barrier for health promotion in our society. One of the most stigmatized health conditions in our time continues to be addiction to illicit drug use. Although it has been widely recognized as a health concern, criminalizing approaches continue to be common in Puerto Rico. Health professionals need to engage in challenging the stigma of illicit drug use in order to foster policies and government efforts with health-oriented approaches. Still, personal stigmatizing attitudes among them continue to be a barrier for the implementation of this agenda. Therefore, the main objectives of this study were to document stigma towards illicit drug use among a sample of health professionals in training, and explore differences in such attitudes among participants from different areas of training. In order to achieve this objective we carried out a sequential mixed method approach with a sample of 501 health professionals in training or practice from the disciplines of medicine, nursing, psychology and social work. Results evidence the continued existence of stigmatizing attitudes among this population. We discuss some of the implications for public health and potential strategies for action.