Individual and structural factors predicting HIV testing among Latinx MSM: substance use as a moderator

Sexual Identity Development and Social Ecological Facilitators and Barriers of PrEP Uptake and Adherence Among Latinx Men Who Have Sex with Men

Latinx gay, bisexual, and other men who have sex with men (LMSM) report lower pre-exposure prophylaxis (PrEP) use than their white, non-Latinx counterparts. We hypothesize that this disparity is partially attributable to social ecological factors that can be addressed via prevention interventions. In this retrospective study, we first examined data from 253 LMSM to determine whether theorized associations existed between acquisition of a PrEP prescription (uptake) in relation to several social ecological factors based on a conceptual framework of determinants of access to and uptake of PrEP for LMSM. We also explored relations between frequency of PrEP use (adherence) and social ecological factors with a subsample of 33 LMSM who had initiated PrEP 12 months prior to assessment. In this study, individual-level factors from this framework included age and socioeconomic status. Perceived access to medical care represented both individual- and community-level determinants of PrEP uptake and adherence. Interpersonal-level factors were social support and relationship status. Structural/cultural-level factors were sexual identity development status, the masculinity norm of heterosexual self-presentation, traditional Latinx masculine gender role beliefs of machismo and caballerismo, racial identity, and immigration status. Results indicated that older men and those who endorsed the synthesis/integration status of sexual identity development were more likely to acquire a PrEP prescription during their lifetime in comparison to peers. PrEP adherence was linked with being older, reporting higher socioeconomic status, reporting more appraisal social support, self-identifying as white-Latinx, being U.S.-born, and endorsing less sexual identity uncertainty and more heterosexual self-presentation. Results specify modifiable factors that may inform tailored, community-based prevention efforts to increase PrEP use and decrease existing HIV/AIDS disparities among LMSM.

Everyday Discrimination and HIV Testing Among Partnered Latino/x Sexual Minority Men in the United States: A Stratified Analysis by Birth Location

We examined the association between everyday discrimination and HIV testing patterns-current (≤ 6 months), recent (7-12 months), and delayed (> 12 months or never tested)-among partnered Latino/x sexual minority men (SMM). Multinomial regression analyses revealed that in the full sample (N = 484) experiencing discrimination based on sexual orientation and race/ethnicity attributions concurrently (vs. no discrimination) was associated with higher odds of delayed (vs. current) HIV testing (AOR = 2.6, 95% CI [1.0, 6.7]). Similarly, in the subset of Latino/x SMM born outside the mainland U.S. (n = 209), experiencing concurrent sexual orientation- and race/ethnicity-based discrimination (vs. no discrimination) was associated with higher odds of recent (AOR = 12.4, 95% CI [1.3, 115.7]) and delayed HIV testing (AOR = 7.3, 95% CI [1.6, 33.0]), compared with current testing. Findings suggest that addressing discrimination may improve HIV testing uptake among partnered Latino/x SMM, particularly those born outside the U.S.

Systematic Review of Social Determinants of Health Associated With HIV Testing Among Hispanic/Latino Gay, Bisexual, and Other Men Who Have Sex With Men in the United States

This systematic review synthesized published literature (January 2008-October 2021) about the association between social determinants of health (SDOH) and HIV testing among Hispanic/Latino gay, bisexual, and other men who have sex with men (HLMSM), a group disproportionally affected by HIV. Having higher education than a high school diploma, health insurance and access to health care services, and visiting a health care provider in the past 12 months were some of the determinants associated with HIV testing, while limited English proficiency was associated with reduced odds of HIV-testing among HLMSM. More research is needed to understand the relationship of SDOH (especially neighborhood) and HIV testing, how SDOH may affect HIV testing among different HLMSM groups, and how to increase self-testing and use of e-health in this priority population. Additionally, culturally and linguistically appropriate multilevel interventions and health services for HLMSM are urgently needed to diagnose HIV as early as possible after infection.

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.

Prevalence and Correlates of HIV Testing among Sexual Minorities

Objectives: We established baseline prevalence rates of HIV testing among adult, sexual minorities and identified the correlates of never being HIV tested. Methods: We used a 20-state sample of the 2017-2019 Behavioral Risk Factor Surveillance System to identify sexual minorities who responded to the HIV testing question (N=433,042). Using weighted multivariate logistic regression analysis, we identified the characteristics associated with never being HIV tested and the impact of state health departments' HIV testing messages on testing status. Results: Overall, 41.6% of sexual minorities reported never being HIV tested with statistically significant state-level variation. Being younger (18-24 years) or older (65+ years), not black, married, and in good health significantly increased the odds of never being HIV tested as did lacking regular healthcare access and reporting no high-risk HIV behaviors. States' HIV testing messages had no statistically significant effect on HIV testing status. Conclusions: Although sexual minorities were less likely than straight respondents to report never being HIV tested, a sizable population remained untested. Specific characteristics associated with sexual minorities' HIV testing status can be used to tailor public health messages and optimize testing rates.

A Rapid Review of Disparities in HIV Prevention and Care Outcomes Among Hispanic/Latino Men Who Have Sex With Men in the United States

In the United States, Hispanic/Latino men who have sex with men (HLMSM) are disproportionally affected by HIV. We conducted a rapid review of national surveillance data to examine disparities in HIV prevention and care outcomes among HLMSM. Thirteen reports provided relevant data from 2011 to 2018. Compared to White MSM, a higher percentage of HIV-negative HLMSM reported not taking PrEP and engaging in condomless sex; a lower percentage of HIV-negative HLMSM at risk for HIV reported PrEP awareness and use; and a lower percentage of HIV-positive HLMSM were aware of their status, linked to HIV care, and virally suppressed. Viral suppression rates in HLMSM were better among Ryan White clients than the national rates, suggesting that access to comprehensive care/services reduces disparities. Findings also call for identifying individual, social, and structural factors contributing to condomless sex without PrEP use and HIV status unawareness and identifying best approaches for scaling up comprehensive care/services.

Educational level and risk of sexually transmitted infections among clients of Dutch sexual health centres

This study aimed to assess whether educational level is an independent determinant for sexually transmitted infections (STIs) among clients consulting Dutch sexual health centres (SHCs). With data from the National STI surveillance database (2015-2017), generalized estimating equations corrected for (sexual) risk factors were used to estimate associations between educational level and chlamydia and gonorrhoea among women (n = 146,020), heterosexual men (n = 82,882) and men who have sex with men (MSM) (n = 52,149) and syphilis and HIV among MSM. Compared to the highest educational level (bachelor/master), all lower educational levels were associated with gonorrhoea among women (adjusted odds ratio 1.40; 95% CI 1.18-1.66 for higher general/pre-university level to 3.57; 95% CI 2.66-4.81 for no education/elementary school level) and heterosexual men (respectively 1.36; 1.06-1.74 to 3.84; 2.89-5.09). Women with no education/elementary school level (1.37; 1.17-1.62) and heterosexual clients with (pre-)vocational secondary educational level were more likely to test positive for chlamydia (women: 1.43; 1.39-1.48 and heterosexual men: 1.31; 1.26-1.37) than clients with higher general/pre-university level or bachelor/master level. In MSM, (pre-)vocational secondary educational level was associated with chlamydia (1.16; 1.11-1.22), gonorrhoea (1.15; 1.10-1.21) and syphilis (1.18; 1.08-1.29), and both (pre-)vocational secondary educational level (1.48; 1.25-1.76) and no education/elementary school level (1.81; 1.09-3.00) were associated with HIV. Lower educational levels were independent determinants of STI in SHC clients. Sexual health centres could facilitate STI testing and care among lower educated people by prioritizing their access.