Factors Influencing Engagement Across the Motivational PrEP Cascade Among Latino SMM: A Mixed-Methods Analysis from the Perspectives of Community Providers and Latino SMM.

Latino sexual minority men (SMM) are a highly vulnerable population to HIV, and while pre-exposure prophylaxis (PrEP) has emerged as a promising biomedical tool for HIV prevention among them, its utilization remains disproportionately low in this community despite its potential. Understanding the barriers along the PrEP continuum of care, known as the "PrEP cascade," is crucial for effectively implementing PrEP interventions. Therefore, the objective of our study was twofold: first, to explore the stage of Latino SMM in the PrEP cascade by examining disparities in demographics, social factors, and healthcare aspects; second, to gain insights from healthcare providers who have direct clinical experience with our population regarding the challenges faced by Latino SMM in accessing and adhering to PrEP. Based on the study findings, the majority of participants (n = 74; 49%) were in the contemplation stage, and only one in ten Latino SMM (10.6%) were currently adherent to PrEP. Compared to those who were at least second-generation, first-generation status had a positive association (B = 0.699, SE = 0.208, ß = 0.351, p < .001) with engagement along the PrEP Contemplation Ladder. Conversely, having at least one parent who did not have legal residency, relative to those whose parents were both U.S. citizens or held legal residency documentation, was found to have a negative association (B = - 0.689, SE = 0.245, ß = 0.245, p = .006) with engagement along the PrEP Contemplation Ladder. Additionally, discussing PrEP with a healthcare provider had a positive association (B = 0.374, SE = 0.179, ß = 0.185, p = .038) with engagement along the PrEP Contemplation Ladder. Qualitative results from our study suggest that some Latinos who initially agreed to start using PrEP ended up getting lost in the care pipeline and failed to attend their scheduled appointments. Providers also noted that many patients lacked access to a pharmacy where they felt comfortable obtaining their PrEP prescription, leading them to discontinue use after only a few months. These findings emphasize the importance of considering the unique needs, culture, and background of Latinos, including care delivery and provider attitudes that can facilitate progress through the PrEP cascade.

Stakeholders' Perspectives About Cultural Strategies to Support PrEP for Latino Sexual Minority Men.

Compared with non-Latino White sexual minority men, Latino sexual minority men (LSMM) have lower engagement with HIV pre-exposure prophylaxis (PrEP) and likelihood of discussing PrEP with a health care provider. The overall goal of the current study was to collect data from community stakeholders to inform the integration of culturally relevant factors into an empirically supported PrEP prevention program. Between December 2020 and August 2021, 18 interviews were conducted with 18 stakeholders with experience delivering health and social services. Themes identified are: (1) stakeholders' perspectives of new HIV infections among LSMM; (2) stakeholders' perspectives of general cultural variables; and (3) the development of culturally tailored programs. Our findings demonstrate how culturally competent stakeholders can leverage their established rapport and trust to reduce the negative effects of machismo and/or homophobia in the Latinx community to promote HIV prevention.

Perspectives on Social Support and Stigma in PrEP-related Care among Gay and Bisexual Men: A Qualitative Investigation.

Despite its effectiveness at preventing HIV, uptake of PrEP has been slow. PrEP-related stigma is a potential barrier to uptake. Social support has been found to buffer against some PrEP stigma. Unfortunately, little research has investigated the relationship between social support and PrEP-related care. In 2018, we conducted 20 semistructured interviews with MSM who use PrEP (ages 22-70). Interview questions explored social support and PrEP-related stigma, and how these and other psychosocial factors affected PrEP use and continuation. Data were analyzed using grounded theory. Social support was important in PrEP-related care and promoted adaptive behavioral responses, such as adherence to PrEP-related medical care and enhancing resilience to stress. Participants described psychosocial benefits of PrEP, such as reduced HIV-related anxiety, but some also reported that PrEP-related stigma was an additional stressor. Findings suggest that social support has significant impacts within PrEP-related care and may help buffer against stigma.

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.

The role of internalized homonegativity in the faith and psychological health of lesbians.

Among lesbians, faith-based beliefs and behaviors may be associated with negative psychological health due to the interplay between religious and sexual identities. The present study examined health outcomes, faith-based beliefs (views of God as loving and controlling), faith-based behaviors (personal spiritual practices, religious activities), and internalized homonegativity in a sample of 225 self-identified lesbians. We hypothesized that internalized homonegativity would moderate the relationship between health outcomes and faith-based beliefs and behaviors among lesbians. Generally, results indicated that some faith-based beliefs and behaviors were related to negative health outcomes among lesbians with higher levels of internalized homonegativity, but among those with lower levels of internalized homonegativity, the negative associations with health were mitigated.

Meaning-making appraisals relevant to adjustment for veterans with spinal cord injury.

The purpose of the present study was to conduct a mixed-methods investigation of meaning-making appraisals generated from spinal cord injury survivors' narratives of their injury experience. The sample consisted of 79 participants from an urban midwestern Veterans Affairs facility. The study design was cross-sectional and incorporated semistructured, face-to-face interviews, taking approximately 1 hr to complete. Measures of posttraumatic stress disorder, depression, psychological well-being, and purpose in life were completed as part of the interview. A data analytic approach based on grounded theory that allowed qualitative themes to be transformed to quantitative data was employed. Seven salient meaning-making themes were identified. Significant relationships were identified between certain meaning-making themes (e.g., identity integration positively related to positive growth), and certain themes were also significantly related to postinjury psychological health and distress separately (e.g., perceived burden on others was significantly related to greater depression scores). Findings are discussed within the context of clinical interventions that foster positive posttrauma outcomes.

Psychological well-being after spinal cord injury: perception of loss and meaning making.

OBJECTIVE: This study examined the influence of medical injury severity, perceived loss of physical functioning (conceptualized as physical resource loss), and global meaning making on psychological well-being among 79 veterans living with a spinal cord injury. MEASURES: Structured interviews were completed to assess perceived loss of physical abilities using the Conservation of Resources-Evaluation and SF-36 Health Survey, global meaning making (Purpose in Life scale), and psychological well-being (Sense of Well-Being Inventory). Medical injury severity was calculated from medical records. RESULTS: Medical injury severity was not related to psychological well-being, whereas perceived loss of physical functioning was inversely associated. Global meaning making was significantly related to and accounted for a large portion of the variance in psychological well-being. Results suggest that global meaning making partially mediates perceived loss of physical resources and psychological well-being. CONCLUSION: The perceived loss of physical abilities and the generation of meaning and purpose in life are important variables that relate to positive adaptation following spinal cord injury. Treatment implications related to factors that increase quality of life following spinal cord injury are discussed.