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.

HIV Stigma and Health Care Discrimination Experienced by Hispanic or Latino Persons with HIV - United States, 2018-2020.

Hispanic or Latino (Hispanic) persons with HIV experience disparities in HIV health outcomes compared with some other racial and ethnic groups. A previous report found that the percentages of Hispanic persons who received HIV care, were retained in care, and were virally suppressed were lower than those among non-Hispanic White persons with HIV (1). HIV stigma and discrimination are human rights issues associated with adverse HIV outcomes; eliminating stigma and discrimination among persons with HIV is a national priority*,†,§ (2,3). CDC analyzed data from the Medical Monitoring Project (MMP), an annual, cross-sectional study designed to report nationally representative estimates of experiences and outcomes among adults with diagnosed HIV. Data from the 2018-2020 cycles were analyzed to assess self-reported stigma and health care discrimination using adapted versions of validated multi-component scales among 2,690 adult Hispanic persons with HIV in the United States overall and by six characteristics.¶ The median HIV stigma score on a scale of 0-100 was 31.7, with women (35.6) and American Indian or Alaska Native (AI/AN) persons (38.9) reporting the highest scores among Hispanic persons with HIV. HIV stigma was primarily attributed to disclosure concerns (e.g., fearing others will disclose one's HIV status and being careful about who one tells about one's HIV status). Nearly one in four (23%) Hispanic persons with HIV experienced health care discrimination. Health care discrimination was experienced more frequently by Hispanic men (23%) than by Hispanic women (18%) and by Black or African American (Black) Hispanic persons (28%) than by White Hispanic persons (21%). Understanding disparities in experiences of stigma and discrimination is important when designing culturally appropriate interventions to reduce stigma and discrimination.

Evaluating for health equity among a cluster of health departments implementing PrEP services.

African American/Black and Hispanic/Latino sexual and gender minority populations are disproportionately affected by HIV in the United States and continue to experience HIV-related disparities. CDC funded project PrIDE to support 12 health departments (HD) with implementing pre-exposure prophylaxis (PrEP) strategies for men who have sex with men (MSM) and transgender persons, with a health-equity focus established by HDs. Each HD conducted mixed-methods evaluation of at least one local strategy. CDC employed a cluster evaluation approach to maximize cross validation. As a result, this cluster evaluation focused on three HDs that evaluated health equity-focused PrEP implementation strategies. Findings suggest that integrating health equity strategies such as storytelling and healthcare worker (HCW) trainings can help reduce HIV-related disparities. Storytelling improved HCW's understanding of clients' experiences of stigma due to racial, gender, and sexual identities. Provider training increased competencies on culturally appropriate care and the use of clinic services by Black and Hispanic MSM and transgender persons. Good practices included community engagement, seeking leadership buy-in, and integration of programmatic staff in health equity and evaluation activities. Evaluating strategies and training policies addressing social determinants of health that adversely affect HIV outcomes may help mitigate barriers Black and Hispanic MSM and transgender populations encounter in their HIV prevention seeking efforts.

The utility of evaluation in optimizing implementation and improvement of HIV prevention programming.

The objective of this article is to describe Project PrIDE (PrEP Implementation, Data to Care, and Evaluation) through the lens of Evaluation Utilization and provide examples of how twelve funded health departments (HD) utilized evaluation findings to make decisions related to improving PrEP awareness and uptake, and/or enhancing capacity for data to care (D2C) activities. Each HD conducted a local evaluation (LE) and reported ongoing and planned utilization of evaluation findings in the final LE reports. Information from all reports was abstracted for qualitative analysis to identify main evaluation utilization themes. Findings showed that program evaluation was incorporated as early as the project development phase and designed with the goal of improving, and not just demonstrating the efficacy of the programs. Evaluation data were effectively utilized to improve PrEP and D2C activities, for example, by increasing community engagement throughout LEs, enhancing social media implementation, prioritizing the most effective referral sources at re-linking clients into HIV care, reducing client wait time between receiving PrEP referral and obtaining appointment with provider, and incorporating evaluation findings into program planning and development. Project PrIDE highlights the importance of a planned evaluation in providing ongoing improvements to HIV prevention services to better serve priority populations.

Informing the future of PrEP navigation: Findings from a five-site cluster evaluation.

The PrEP (pre-exposure prophylaxis) Implementation, Data to Care and Evaluation (PrIDE) demonstration project funded 12 health departments (HD) (2016-2019) to scale up PrEP among sexual minorities at risk for HIV. Each health department (HD) conducted an evaluation of at least one local strategy, and, to maximize crossvalidation, an adapted cluster evaluation approach was employed. As a result, five HDs with similar evaluation questions regarding PrEP navigation were identified. Overall, PrEP navigation fit in well with HD clinics and community-based organizations. A hybrid model of patient, peer, and systems navigation linking clients to PrEP and social services was commonly used. Although there were no differences by setting regarding linking clients to PrEP providers, one HD demonstrated that having all PrEP services in the same location contributed the most to PrEP uptake. Navigator skill for case management and rapport building facilitated navigation, whereas staff turnover and lack of client health insurance were challenges. While one HD in a non-Medicaid expansion state was affected by health insurance issues the most, another HD demonstrated that providing payment assistance increased client PrEP use. The findings pinpoint PrEP navigation hybrid modality and having health insurance as promising strategies to increase PrEP uptake among priority groups.

Going beyond performance measures in HIV-prevention: A funder-recipient expedition.

Project PrIDE (PrEP Implementation, Data to Care, and Evaluation) was a multi-site demonstration project implemented in 12 health departments (HDs) from 2016 to 2019. In Project PrIDE, there were two monitoring and evaluation components: crossjurisdictional performance monitoring (CJPM) and local program evaluation (LE). Project PrIDE was innovative in that a portion of funds were allocated for LE in order to support robust process and outcome evaluations. The purpose of this article is threefold: to describe Project PrIDE LE conceptualization, to share lessons learned about LE development and implementation processes that may benefit other programs and evaluation initiatives, and to introduce the Special Issue. This experience highlights the importance of using a health equity lens in future evaluation efforts in HIV prevention involving historically marginalized populations to ensure that priority groups are treated as equal partners of and benefit from the evaluations.

Reaching racial/ethnic and sexual and gender minorities with HIV prevention information via social marketing.

The Pre-exposure Prophylaxis, Data to Care, Implementation, and Evaluation (PrIDE) multi-site demonstration project utilized a cluster evaluation approach and identified six funding recipients that evaluated similar media evaluation questions (Baltimore, Los Angeles County, Lousiana, Michigan, New York City, and Virginia). All of the evaluated social marketing campaigns were developed in collaboration with health department staff, external marketing firms, and community advisory boards (CAB) aiming to produce changes in PrEP outcomes by reaching racial/ethnic and sexual and gender minorities. Jurisdictions demonstrated changes in PrEP awareness, knowledge, willingness to take PrEP, and/or PrEP literacy following initiation of the campaigns. In data from four sites, PrEP awareness significantly increased from 72 % at baseline to 86 % at mid-project, and to 90 % post-campaigns. The campaigns illustrate the importance of partnerships and stakeholder engagement, audience segmentation, and intentional evaluation planning. As PrEP services mature, evaluating PrEP demand and PrEP use resulting from campaigns, will be necessary. Also, future campaigns for racial/ethnic and sexual and gender minorities should identify the best channels to reach each group based on their input, disaggregate data by priority group, and determine campaign effectiveness.

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.

Weight, diet, and physical activity-related beliefs and practices among pregnant and postpartum Latino women: the role of social support.

OBJECTIVES: Eating and physical activity patterns may contribute to excessive pregnancy weight gain and postpartum retention that increase the risks of obesity and diabetes for both Latino mothers and their children. Social support is an important health determinant and may affect health-related beliefs and behaviors. The objective of this study was to investigate the influence of social support on weight, diet, and physical activity-related beliefs and behaviors among pregnant and postpartum Latinas. METHODS: A community-based participatory project, Promoting Healthy Lifestyles among Women, was conducted in southwest Detroit to plan interventions aimed at reducing risks of obesity and type 2 diabetes. Qualitative analyses of in-depth semistructured interviews with dyads of 10 pregnant and postpartum Latinas, and 10 people who influenced them were conducted. RESULTS: Husbands and some female relatives were primary sources of emotional, instrumental, and informational support for weight, diet, and physical activity-related beliefs and behaviors for Latina participants. Holistic health beliefs and the opinions of others consistently influenced Latinas' motivation and beliefs about the need to remain healthy and the links between behavior and health. Absence of mothers, other female relatives, and friends to provide childcare, companionship for exercise, and advice about food were prominent barriers that limited women's ability to maintain healthy practices during and after pregnancy. CONCLUSION: The findings support evidence that low-income, recently immigrated pregnant and postpartum Latinas could benefit from community-based, family-oriented interventions that provide social support necessary to promote and sustain healthy lifestyles.

Determinants of female and male condom use among immigrant women of Central American descent.

This study was designed to determine factors that influence female and male condom use among Central American women, applying the theory of planned behavior. A cross-sectional design was employed and a sample of 175 Central American women, 18-50 years old, was recruited from a community-based clinic in Los Angeles County. Participants in this study were interviewed face-to-face. Attitude, subjective norm, and perceived behavioral control explained 41% and 45% of the variation in the intention to use male and female condoms, respectively. Respondents' friends and mothers influenced their subjective norms. Beliefs regarding sexual sensation and sexually transmitted infection/pregnancy prevention affected respondents' attitudes toward condoms. Trust issues were also a major factor affecting attitudes toward female condoms. Condom use and sex negotiation skills predicted control over condoms. Results of this study can be used to design HIV/AIDS prevention programs that help women feel control over condom use and their sexual behavior.