Factors Associated with HIV Testing Among Spanish and English-Speaking Latino Adolescents Aged 13-18.

Adolescent Latino men who have sex with men (LMSM) in the U.S. are disproportionately impacted by HIV. However, there has been limited focus on their HIV prevention and risk behaviors. In this study, we examine the rates of HIV testing and explore the significant demographic and healthcare factors that influence HIV prevention among adolescent LMSM. The analysis for this study utilized data collected during the baseline assessment of SMART, a pragmatic trial aimed at evaluating the effectiveness of an online HIV prevention intervention for adolescent LMSM (N = 524). Only 35.5% of participants had ever had an HIV test in their lifetime. Rates of testing increased among adolescent LMSM who had a doctor with whom they spoke about their sexual health (odds ratio: 4.0; 95% confidence interval: 2.1-8.4; P < 0.001) or HIV testing (odds ratio: 5.8; 95% confidence interval: 3.1-10.7; P < 0.001). Out of the 61 participants who took part in the survey conducted in Spanish, only 26% reported ever having an HIV test. Additionally, 24.5% stated that they had discussed their sexual orientation with a doctor, and only 8.2% had undergone HIV testing. Spanish-speaking adolescents who completed the SMART survey were less likely to openly discuss their sexual orientation or sexual health with most people or have a doctor with whom they discussed these topics, compared to those who completed the survey in English. These findings suggest that Spanish-speaking adolescent LMSM may face obstacles in accessing HIV prevention services in the U.S.

RESUMEN: Los adolescentes latinos hombres que tienen sexo con otros hombres (LHSH) tienen mayor probabilidad de recibir tratamiento para el VIH más tarde en comparación con todos los casos nuevos del VIH en los Estados Unidos. Sin embargo, se ha estudiado muy poco sus prácticas de prevención de VIH o prácticas de riesgo, que similar a la de jóvenes no latinos, es determinada por múltiples factores. En este estudio describimos las tasas de pruebas para el VIH e identificamos los factores lingüísticos, individuales, familiares, escolares y de cuidado de salud que influencian a los adolescentes LHSH. Los datos provinieron de la evaluación inicial para SMART, un ensayo práctico de una intervención en línea para prevenir el VIH entre adolescentes LHSH (N = 524). Las medidas incluían la experiencia de hacerse la prueba del VIH a lo largo de la vida, factores de aculturación, datos demográficos, prácticas sexuales, educación sobre el VIH en la escuela y el hogar, comunicación sobre salud sexual con los médicos, conocimiento sobre el VIH y actitudes de riesgo. Solo 35.5% de los participantes se han realizado la prueba de VIH al menos una vez en su vida. La tasa de pruebas del VIH fue más alta entre los adolescentes LHSH que indicaron haber hablado con su médico sobre su salud sexual (odds ratio: 4.0; intervalo de confianza del 95%: 2.1­8.4; P < 0.001) o de la prueba del VIH (odds ratio: 5.8; intervalo de confianza del 95%: 3.1­10.7; P < 0.001). Más de 60 participantes completaron la encuesta en español. De estos, pocos reportaron alguna vez haberse hecho la prueba del HIV (26%), tener un médico con quien hablar sobre su orientación sexual (24.5%) o hablar sobre la prueba del VIH (8.2%). Estas cifras son significativamente más bajas que las obtenidas en la encuesta en inglés. Este estudio es uno de los primeros en evaluar los factores para hacerse la prueba del VIH entre adolescentes latinos que hablan inglés y español con edades entre 13 y 18 años. Los adolescentes latinos que completaron SMART en español tuvieron menos probabilidad de haber compartido sobre su orientación sexual con la mayoría de las personas o tener un médico con quien hablar sobre su orientación sexual o su salud sexual, en comparación con aquellos que completaron SMART en inglés, lo que sugiere que los jóvenes latinos que prefieren comunicarse en español pueden experimentar mayores barreras para acceder a los servicios de prevención del VIH en los Estados Unidos.

Experiences of Latinx sexual and gender minorities with access to healthcare during COVID-19 stay-at-home orders.

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic affected all social systems, but healthcare services were particularly disrupted. The pandemic also had a disproportionate impact on populations made socially vulnerable. In this study, we documented the experiences of Latinx sexual and gender minority (SGM) individuals with access to care during COVID-19 stay-at-home orders. METHODS: Semistructured qualitative interviews assessing experiences during the stay-at-home orders in response to the COVID-19 pandemic and patients' experiences accessing healthcare during this period were conducted with 21 Latinx SGM individuals from the Washington, DC, area. Data were analyzed using rapid qualitative analysis (RQA), and salient themes were identified. RESULTS: The RQA revealed 3 themes reflecting participants' experiences with pharmaceutical care during COVID-19 stay-at-home orders: (1) challenges in accessing HIV services; (2) community engagement; and (3) providers supporting access to care. Participants experienced problems with adherence to medication, transportation, and technology, as well as delays in care and miscommunication with providers. Latinx SGM individuals demonstrated engagement in response to this emergency as a community and valued their providers and their efforts to facilitate access to care. CONCLUSION: The COVID-19 pandemic strained healthcare services. Findings from this study show that the impact of the pandemic on the provision of care increased the vulnerability of Latinx SGM people. Future research should explore the impact of public health emergencies on the health of populations historically made socially vulnerable, and innovative solutions should be identified to eliminate these barriers to health equity.

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.

Reactions to Testing HIV Negative: An Assessment of Measurement Invariance and Associations with Condomless Anal Sex among English and Spanish-speaking Latinx Sexual Minority Men in the United States.

Among the many effective prevention strategies, frequent HIV testing continues to be promoted to reduce the risk of HIV transmission among sexual minority men (SMM). Testing negative for HIV can result in varied reactions that influence subsequent HIV transmission behaviors, yet the extant research has primarily been conducted in English. The current study examined measurement invariance of a Spanish-translated Inventory of Reactions to Testing HIV Negative (IRTHN). The study also examined whether the IRTHN was associated with subsequent condomless anal sex. Data were drawn from 2,170 Latinx SMM subsample of the UNITE Cohort Study. We conducted a multigroup confirmatory factor analysis to test for measurement invariance between participants who opted to take the survey in English (n = 2,024) and those who opted to take it in Spanish (n = 128). We also examined if the IRTHN is associated with subsequent CAS. The results were suggestive of partial invariance. The subscales of Luck and Invulernability were associated with CAS at the 12-month follow-up. Practice and research-based implications are discussed.

Critical Perspectives on Expanding Racial/Ethnic Diversity in the HIV Research Workforce: Comorbidities and Mentoring.

HIV-related comorbidities in underrepresented minority populations are reframed to include the co-occurring problems of systemic and structural barriers, within the mentoring context as a buffer and as action-oriented. This framework is discussed to improve racial and ethnic minority diversity in the research workforce from the perspectives of HIV comorbidities and mentoring. An integrated and coordinated approach to HIV-related comorbidities and inequities may be helpful when combined with research on the social-structural contributions as drivers to diversify the research workforce. We emphasize how these key research issues (a) provide a platform for training and retraining a highly motivated, diverse workforce and (b) facilitate the empowerment of these trained individuals to conduct rigorous scientific research on social-structural factors to mitigate the effects of these comorbidities. We conclude that a diverse research workforce is necessary but insufficient for improving training-related outcomes or reducing comorbidity effects. Additional considerations are warranted that include systemic approaches and changes at the structural and institutional levels.

HIV Disclosure Practices to Family Among Mexican and Puerto Rican Sexual Minority Men with HIV in the Continental USA: Intersections of Sexual Orientation and HIV Stigma.

Disclosing a seropositive HIV status still is a complex process of assessing the risks, benefits, and potential personal and interpersonal outcomes associated with disclosure, such as stigma, rejection, or emotional support. We examined HIV disclosure practices to family and intersectional stigma related to HIV and sexual orientation among Latino sexual minority men (LSMM) of Mexican and Puerto Rican origin with HIV in the continental USA. Guided by Framework Analysis, we present data from 54 interviews with 33 LSMM participants in HIV care engagement interventions, and 21 project staff implementing the interventions. LSMM disclosed their HIV status to family seeking support. They applied stigma management techniques to manage the information communicated to family about their HIV status, including selective disclosure to some family members, conveying strategic information about the significance of having HIV, non-disclosure, or partial disclosure, silence and deceptions. LSMM HIV disclosure practices to family encompassed appraisals of intersectional stigma related to their sexual orientation and HIV, assessing the potential outcomes of disclosure, and the preservation of family ties.

Using the Meaningful Involvement of People Living with HIV/AIDS (MIPA) Framework to Assess the Engagement of Sexual Minority Men of Color in the US HIV Response: a Literature Review.

Black and Latino sexual minority men (SMM) continue to be disproportionately impacted by HIV. We utilized eight components of the Meaningful Involvement of People Living with HIV/AIDS (MIPA) framework to assess the engagement of Black and Latino SMM. Thirty-six (36) studies were included in the literature review. Forty-two percent of studies were Black SMM-specific, followed by Latino SMM-specific (31%) studies. Twenty-eight percent of studies were conducted among both groups. Most studies (72%) were intervention-related and focused on HIV prevention. The top five most common methods of community engagement were focus groups (39%), followed by interviews (36%), community-based participatory research (14%), the utilization of community advisory boards or peer mentorship (11%), and the establishment of multi-stakeholder coalitions, observations, or surveys (8%). We documented at least 7 MIPA components in 47% of the included studies. Community-based participatory research was more commonly utilized to engage Latino SMM. Researchers were more likely to initiate the engagement across all included studies. Few studies documented how Black and Latino SMM perceived the engagement. Engagement responsiveness was a well-documented MIPA component. In terms of engagement power dynamics, there were several examples of power imbalances, especially among Black SMM-specific studies. The inclusion of Black and Latino SMM had robust impacts on HIV research and interventions. There were limited examples of engagement capacity and maintenance. This is one of the first studies focused on utilizing MIPA to document the engagement of SMM of color. MIPA served as a useful framework for understanding the engagement of SMM of color in the US HIV response. The engagement of SMM of color is critical to reducing health inequities.

Applying Rapid Qualitative Analysis for Health Equity: Lessons Learned Using "EARS" With Latino Communities.

Qualitative research amplifies the voices of marginalized communities and thus plays a critical role in shaping our understanding of health inequities and their social determinants. Traditional qualitative approaches, such as grounded theory or thematic analysis, require extensive training and are time- and labor-intensive; as such, they may not be adequately suited to address healthy equity issues that require a swift response. Rapid qualitative analysis (RQA) is an action-oriented approach to qualitative data analysis that may be used when findings are needed to quickly inform practice. RQA capitalizes on using a team to summarize key points from qualitative data into matrices to explore relevant themes efficiently and systematically. In this paper, we provide case examples from our work applying RQA to health equity research with Latino communities to address community needs, such as responses to public health emergencies and the development of service delivery and technology interventions for infectious and chronic diseases. We draw from our collective experiences to share lessons learned and provide the following specific recommendations ("EARS") to researchers interested in applying RQA for health equity research: (1) Employ RQA to address rapidly evolving, urgent, health equity challenges; (2) Assure quality and rigor throughout the RQA process; (3) Respond to barriers and problem-solve as needed; and (4) Strengthen community relationships before, during, and after using RQA. Overall, we advocate for the use of RQA to promote health equity due to its ability to integrate the vital perspectives of marginalized communities and efficiently respond to their needs.

Refining an Implementation Strategy to Enhance the Reach of HIV-Prevention and Behavioral Health Treatments to Latino Men Who Have Sex with Men.

Background: Latino men who have sex with men (LMSM) experience HIV and behavioral health disparities. Yet, evidence-based interventions, such as pre-exposure prophylaxis (PrEP) and behavioral health treatments, have not been equitably scaled up to meet LMSM needs. To address quality of life and the public health importance of HIV prevention, implementation strategies to equitably scale up these interventions to LMSM need to be developed. This study identifies themes for developing culturally grounded implementation strategies to increase uptake of evidence-based HIV prevention and behavioral health treatments among LMSM. Methods: Participants included 13 LMSM and 12 stakeholders in Miami, an HIV epicenter. Feedback regarding the content, design, and format of an implementation strategy to scale up HIV-prevention and behavioral health services to LMSM were collected via focus groups (N=3) and individual interviews (N=3). Themes were inductively identified across the Health Equity Implementation Framework (HEIF) domains. Results: Analyses revealed five higher order themes regarding the design, content, and format of the implementation strategy: cultural context, relationships and networks, navigation of health information and systems, resources and models of service delivery, and motivation to engage. Themes were applicable across HEIF domains, meaning that the same theme could have implications for both the development and implementation of the implementation strategy. Conclusions: Findings highlight the importance of addressing culturally specific factors, leveraging relational networks, facilitating navigation of health systems, tailoring to available resources, and building consumer and implementer motivation in order to refine an implementation strategy for reducing mental health burden and achieving HIV health equity among LMSM.

The impact of Hurricane Maria on individuals living with non-communicable disease in Puerto Rico: the experience of 10 communities.

BACKGROUND: Coinciding with the rising non-communicable disease (NCD) prevalence worldwide is the increasing frequency and severity of natural hazards. Protecting populations with NCDs against natural hazards is ever more pressing given their increased risk of morbidity and mortality in disaster contexts. This investigation examined Hurricane Maria's impacts across ten lower SES municipalities in Puerto Rico with varying community characteristics and hurricane impacts to understand experiences of supporting individuals with NCD management in the six-month period following the hurricane. METHODS: We conducted 40 qualitative interviews with mayors, first responders, faith leaders, community leaders, and municipal employees from 10 municipalities in Puerto Rico. Using QSR NVivo software, we deductively and inductively coded interview transcripts and undertook thematic analysis to characterize community-level hurricane impact and consequences for NCD management, and to identify convergent and divergent themes. RESULTS: Damages to infrastructure, including healthcare facilities and roadways, complicated the provision of timely health care for NCDs, patient transport, and pharmaceutical/medical supply chain continuity. Lengthy power outages at both healthcare facilities and private residences were barriers to healthcare service delivery, use of medical equipment, and storage of prescription medications with refrigeration, and led to a widespread mental health crisis. Cascading failures such as fuel shortages further compounded these challenges. The consequences of these impacts included the reported exacerbation of health conditions and loss of life among NCD patients. CONCLUSIONS: Study findings identify contributors to morbidity and mortality among individuals with NCDs following Hurricane Maria. With the growing frequency of catastrophic disasters from natural hazards, the experiences of communities that endured these impacts offer important lessons regarding policies and practices to better support community disaster resilience and address the evolving preparedness needs of NCD patients.

Factors associated with individual and couple participation in online sexual health research with Latinx sexual minority men.

Latinx sexual minority men (LSMM) have higher rates of HIV incidence than most other ethnic and racial groups. Given that transmission risk is higher among primary partners, it is critical to identify factors that would facilitate partner recruitment into couples-based sexual health research studies. The present study utilizes a sample of index participants (n= 625), which includes 530 LSMM who did not recruit their partner and 95 LSMM who successfully did so (N = 625). Participants completed measures of communication styles and cultural values of masculinity. Findings suggest that caballerismo (chivalry/nurturing) and constructive communication were significantly and positively associated with the odds of recruiting one's partner in an interaction model. Consideration of cultural factors and communication style may enhance the efficiency of recruitment of LSMM and facilitate partner engagement.

Los hombres latinx de minorías sexuales (LSMM) tienen tasas más altas de incidencia del VIH que la mayoría de los otros grupos étnicos. Dado que el riesgo de transmisión es mayor entre las parejas principales, es fundamental identificar los factores que facilitarían el reclutamiento de la pareja en los estudios de investigación sobre salud sexual centrados en las parejas. El estudio actual utiliza una muestra "index partners" (los miembros principales de la pareja), que incluye 530 LSMM que no reclutaron a su pareja y 95 LSMM que pudieron reclutar exitosamente a su pareja (N = 625) en el estudio. Los participantes completaron medidas de estilos de comunicación y valores culturales. Los hallazgos sugieren que a medida que aumentaba el caballerismo y la comunicación constructiva, aumentaban las probabilidades de reclutar a la pareja en un modelo de interacción. La consideración de los factores culturales y el estilo de comunicación es fundamental para aumentar la contratación de LSMM y facilitar la participación de las parejas.

Latino sexual minority men's intersectional minority stress, general stress, and coping during COVID-19: A rapid qualitative study.

Introduction: Sexual minority men face mental health, substance use, and HIV disparities, all of which can be understood by minority stress and intersectionality theories. With the emergence of COVID-19 and considering its disproportionate impact on Latinx and sexual minority communities, Latino sexual minority men (LSMM) may be facing unique consequences of this new pandemic that intersect with pre-COVID disparities. The purpose of the current study is to explore the impact of the COVID-19 pandemic on LSMM's intersectional minority stress, general stress, and coping, filling a gap in the current literature. Methods: The current rapid qualitative study explores the impact of COVID-19 on LSMM in South Florida who reported being HIV-negative (N=10) or living with HIV (N=10). Results: The rapid analysis revealed themes of exacerbated intersectional minority stress and general stress in the context of COVID-19, some of which was related to the impact of pre-COVID-19 disparities in the LSMM community. Participants reported a variety of coping responses, some of which participants found helpful and others (e.g., substance use) which further exacerbated disparities. Conclusion: The findings underscore the need to scale up and disseminate behavioral health resources to LSMM to address the impact of the COVID-19 pandemic on this community's health and well-being.

HIV-Related Intersectional Stigma and Discrimination Measurement: State of the Science.

Background. Across settings, individuals from populations that are multiply stigmatized are at increased risk of HIV and experience worse HIV treatment outcomes. As evidence expands on how intersecting stigmatized identities and conditions influence HIV outcomes, researchers have used diverse quantitative approaches to measure HIV-related intersectional stigma and discrimination. To date, no clear consensus exists regarding how to best quantitatively measure and analyze intersectional stigma and discrimination. Objectives. To review and document existing quantitative measures of HIV-related intersectional stigma and discrimination to inform research, programmatic, and policy efforts. Search Methods. We searched 5 electronic databases for relevant studies. References of included articles were screened for possible inclusion. Additional articles were screened on the basis of consultations with experts in the field. Selection Criteria. We included peer-reviewed studies published between January 1, 2010, and May 12, 2021, that were HIV related and presented 1 or more quantitative measures of stigma and discrimination using an intersectional lens in measure design or analysis. Data Collection and Analysis. Systematic methods were used to screen citations and abstract data via a standardized coding form. Data were analyzed by coding categories stratified according to 2 subgroups: (1) studies incorporating a single intersectional measure and (2) studies that examined intersectional stigma through analytical approaches combining multiple measures. Main Results. Sixteen articles met the inclusion criteria, 7 of which explicitly referenced intersectionality. Ten studies were from the United States. All of the studies included participants living with HIV. Among the 4 studies incorporating a single intersectional stigma measure, 3 explored race and gender stigma and 1 explored gender and HIV stigma. Studies involving analytic approaches (n = 12) mostly examined intersectional stigma via interaction terms in multivariate regression models. Three studies employed structural equation modeling to examine interactive effects or latent constructs of intersectional stigma. Conclusions. Research on the measurement of HIV-related intersectional stigma and discrimination is currently concentrated in high-income settings and generally focuses on the intersection of 2 identities (e.g., race and gender). Efforts are needed to expand appropriate application of intersectionality in the development, adaptation, and use of measures of HIV-related intersectional stigma and discrimination. The use of context-, identity-, or condition-adaptable measures should be considered. Researchers should also carefully consider how to meaningfully engage communities in the process of measurement development. Public Health Implications. The measures and analytic approaches presented could significantly enhance public health efforts in assessing the impact of HIV-related intersectional stigma and discrimination on critical health outcomes. (Am J Public Health. 2022;112(S4):S420-S432. https://doi.org/10.2105/AJPH.2021.306639).

Awakening: The Unveiling of Historically Unaddressed Social Inequities During the COVID-19 Pandemic in the United States.

The violence and victimization brought by colonization and slavery and justified for over a century by race-based science have resulted in enduring inequities for black, Indigenous and people of color (BIPOC) across the United States. This is particularly true if BIPOC individuals have other intersecting devalued identities. We highlight how such longstanding inequities paved the way for the disproportionate burdens of coronavirus disease 2019 (COVID-19) among the BIPOC populations across the country and provide recommendations on how to improve COVID-19 mitigation strategies with the goal of eliminating disparities.

How Is Colonialism a Sociostructural Determinant of Health in Puerto Rico?

Puerto Rico is experiencing a public health crisis driven by effects and processes of US colonialism in the archipelago, such as the exclusionary application of federal health policy, an exodus of health care professionals, and the long-term effects of unequal distribution of health care funding in the unincorporated territories. Compound effects of multiple disasters, including Hurricane María, repeated earthquakes, and the COVID-19 pandemic, as well as relentless privatization and fragmentation of the health care system, have led to very poor health outcomes. Puerto Rico's case clearly shows the negative effects of colonialism on public health. This article specifies what decolonization requires from a public health standpoint to promote health equity.

Puerto Rico atraviesa una crisis de salud pública debido a los efectos y procesos del colonialismo estadounidense en el archipiélago, como la aplicación excluyente de la política sanitaria federal, el éxodo de los profesionales de la salud y los efectos a largo plazo de la distribución desigual de la financiación sanitaria en los territorios no incorporados. Los efectos combinados de múltiples catástrofes, como el huracán María, los repetidos terremotos y la pandemia del COVID-19, así como la constante privatización y fragmentación del sistema de atención médica, han propiciado resultados de salud muy deficientes. El caso de Puerto Rico muestra claramente los efectos negativos del colonialismo en la salud pública. Este artículo especifica lo que requiere la descolonización desde el punto de vista de la salud pública para promover la equidad sanitaria.

Disparities in traditional and alternative tobacco product use across sexual orientation groups of young adult men and women in the US.

Background: Despite literature documenting disparities in tobacco use among sexual minority young adults, research is just emerging regarding alternative tobacco product (ATP) use among specific sexual minority men versus women. The current study examined associations between sexual orientation and traditional and ATP use among young adult men and women. Methods: We analyzed survey data (September-December 2018) from 2,809 young adults (ages 18-34) recruited via social media. Multivariable regression models were used to examine the binary outcomes of any past 30-day use of cigarettes, e-cigarettes, cigars, hookah, and any tobacco product (logistic regression), and the continuous outcome of number of categories of tobacco products used (linear regression), in relation to sexual orientation (bisexual, gay/lesbian, heterosexual) among men versus women, controlling for age and race/ethnicity. Results: In this sample (Mage = 24.60, SD = 4.73; 56.0% women, 71.5% White, 5.4% Black, 12.6% Asian, 11.5% Hispanic), 9.3% of participants identified as gay/lesbian (13.1% of men, 6.2% of women) and 17.6% bisexual (8.3% of men, 25.0% of women). Gay men were less likely to use e-cigarettes, cigars, and any tobacco product, and used fewer products relative to heterosexual men. Bisexual women were more likely to use each tobacco product and any tobacco product, and used more categories of products relative to heterosexual women. Conclusions: Specific tobacco use disparities differ with respect to type of product, gender, and sexual orientation, underscoring the need to better understand the underlying mechanisms of these differences (e.g., marketing, social influences) and developing interventions to address them.

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.

Differences in HIV Risk and Prevention Among Cisgender Latino Sexual Minority Men by Language of Online Survey Completion: Analysis of National and Washington State Data.

Internet-based surveys can be programmed and advertised in multiple languages to reach non-English-speaking individuals, but it is unclear the extent to which this enhances the diversity of participants and supports inclusion of individuals at higher risk for HIV. We sought to examine how language of survey completion (English or Spanish) was associated with sociodemographic characteristics and indicators of HIV risk and prevention among cisgender Latino sexual minority men (SMM). We analyzed national and Washington State data using the Understanding New Infections through Targeted Epidemiology (UNITE) Cohort Study (2017 and 2018) and the Washington HIV/STI Prevention Project (WHSPP) survey (2017 and 2018/2019), respectively. Latino SMM who completed online surveys in Spanish differed from those who completed surveys in English across several sociodemographic characteristics including age, education, and income. After adjusting for sociodemographic characteristics and HIV-related risk factors, Spanish language respondents in UNITE were less likely to have tested for HIV in the past year, and those in WHSPP were more likely to report a recent STI diagnosis. Findings suggest that Latino SMM who complete surveys in Spanish comprise a unique subgroup that may have a specific HIV health and risk behavior profile. Our results suggest a need for increased and tailored efforts to recruit and include Spanish-speaking Latino SMM for local and national research and public health programming.

RESUMEN: Encuestas por internet pueden ser programadas y anunciadas para alcanzar a personas que no hablan inglés, pero no queda claro si esto pueda mejorar la diversidad de los participantes de investigación y apoyar la inclusión de los individuos de alto riesgo a infección con el VIH. En este estudio examinamos la relación del idioma de completar la encuesta en línea (inglés o español) entre hombres Latinos de minorías sexuales (HLMS) cisgénero con características sociodemográficas y determinantes para el riesgo y prevención del VIH. Analizamos los datos nacionales y estatales con el estudio de cohorte de Understanding New Infections through Targeted Epidemiology (UNITE) (2017 y 2018) y El Proyecto de Washington para la Prevención del VIH/Infecciones de Transmisión Sexual (WHSPP) (2017 y 2018/2019), respectivamente. Los HLSM quienes completaron las encuestas por internet en español fueron diferentes a los que completaron las encuestas en inglés por varias características sociodemográficas incluso la edad, la educación, y el ingreso. Después de ajustar por las características sociodemográficas y los factores de riesgo asociados con el VIH, los participantes de UNITE que respondieron en español tuvieron menos probabilidad de haberse hecho la prueba de VIH en el año pasado y los que participaron en el WHSPP eran más probable que reportaran un diagnóstico de ITS. Los resultados indican que los HLSM quienes completan las encuestas en español representan un subgrupo distinto que tiene un perfil específico de comportamiento de riesgo y salud respecto al VIH. Los resultados demuestran la necesidad de mayores esfuerzos especializados para reclutar e incluir los HLSM quienes hablan español para que participen en las investigaciones en línea a nivel local y nacional y la programación de la salud pública.

Examining inequities in rates of undiagnosed HIV and rectal STIs in a large nationwide cohort study of sexual minority men.

OBJECTIVE: Sexual minority men (SMM) of colour are disproportionately impacted by HIV and bacterial STIs (bSTIs). To better understand within-group heterogeneity and differential risk factors by race and ethnicity, we sought to examine rates of undiagnosed HIV and rectal bSTI at the intersection of racial and ethnic identity with other sociodemographic factors. METHODS: We examined data from 8105 SMM conducting home-based self-testing at enrolment in a nationwide cohort study collected from November 2017 to August 2018. We conducted analyses stratified by racial and ethnic groups to examine within-group (ie, subgroup) unadjusted rates of HIV and rectal bSTI infection across a range of characteristics. RESULTS: Rates of undiagnosed HIV were highest among Black (4.3%, n=39) and Latino (2.4%, n=38) SMM, with lower rates among those identified as multiracial (1.6%, n=15), white (1.3%, n=56) and other races (1.3%, n=6). Across the stratified analyses of HIV infection, 15 significant associations emerged showing that age, region, insurance type, sexual positioning and incarceration history had differential impacts across racial and ethnic groups. In particular, private and public insurance were protective against HIV for white but not Black and Latino SMM, and incarceration was associated with substantially higher rates of HIV infection for Black and Latino SMM relative to white SMM. We found significant co-occurrence of HIV and bSTI rates for participants who identified as Latino (OR=7.5, 95% CI 2.12 to 26.54), white (OR=3.19, 95% CI 1.14 to 8.98) and multiracial (OR=5.5, 95% CI 1.08 to 27.90), but not those who identified as Black (OR=0.82, 95% CI 0.10 to 6.56) or other races (OR=3.56 95% CI 0.31 to 40.80). CONCLUSIONS: Stratified analyses showed differential rates of HIV infection at the intersection of racial and ethnic groups with other characteristics, particularly insurance status and incarceration history, pointing to structural inequities rather than individual behaviours underlying disproportionately high rates of HIV for Black and Latino SMM.