PI: Audrey Harkness, PhD
Primary Mentor: Steven A. Safren, PhD
Title: Research Assistant Professor, Department of Public Health Sciences, University of Miami Miller School of Medicine
Study Title: Syndemic barriers and facilitators to engagement in HIV-prevention and behavioral health services for Latino MSM in Miami
Abstract. This pilot study proposal, under Center for Latino Health Research Opportunities-CLaRO, examines syndemic barriers and facilitators of engagement in HIV-prevention (HIV testing, PrEP use) and behavioral health services among Latino men who have sex with men (MSM) in the Miami area. Miami leads the nation in new cases of HIV. Within Miami, Latino MSM had the highest rate of new infections from 2012-2016. Behavioral health problems co-occur as syndemics and are associated with higher risk of HIV infection among Latino MSM. Latino MSM face barriers to care, resulting in suboptimal access to needed HIV-prevention and behavioral health services. Identifying barriers and facilitators to engagement in care is important for conducting successful culturally relevant outreach that optimizes access to services for this population. Yet, Latino MSM are underrepresented in HIV-prevention research and have higher rates of unknown HIV-infection, lower PrEP utilization, and less access to health and mental health care than their white counterparts. In our work at the University of Miami (UM), we are recruiting young sexual minority men with depression or anxiety and sexual risk for a multisite clinical trial. Compared to the co-site in New York, the Miami site, majority Latino, is under enrolled in spite of augmented outreach. Thus, the proposed study will address Latino health disparities by examining factors that affect Latino MSM’s engagement in care. Methods. Formative qualitative research: Leveraging an ongoing R01 for HIV prevention in sexual minority men, we will interview (English and Spanish) Latino MSM who are HIV-prevention and behavioral health treatment engagers and non-engagers. We will also interview key informants who serve the local Latino MSM community. Following the NIMHD Research Framework and drawing upon syndemics theory, interviews will probe individual, interpersonal, and community/societal factors that together relate to accessing HIV-prevention and behavioral health services. Thematic content analysis will be used to identify barriers and facilitators. Findings from the qualitative study will inform the measure selection for the quantitative assessment. Quantitative community assessment to develop syndemic models: We will survey (English and Spanish) approximately 300 Latino MSM in the Miami area to identify factors associated with service engagement. We will disseminate our assessment through community collaborators who serve Latino MSM, venue-based recruitment, online/social media outreach, and utilizing our lab’s database of prospective research participants. Guided by the NIMHD Framework, the survey will include individual, interpersonal, and community/societal factors and will be modified based on the results of the formative qualitative research, pilot testing, and cognitive testing. The quantitative data will be used to test syndemic models of HIV testing, PrEP use, and willingness to use behavioral health services. Findings from this pilot study will be applied to develop an uptake and engagement intervention that addresses the identified barriers and facilitators for Latino MSM engaging in these needed services.