Project Summary

Background and Rationale: In 2021, a Centers for Disease Control and Prevention HIV surveillance report indicated that Latinx communities accounted for 29% of new HIV diagnoses but comprised only 19% of the US population. In that same year, male-to-male sexual contact accounted for 67% of all new HIV diagnoses. These disparities in HIV cases have led to the designation of Latinx sexual and gender minority (LSGM) groups as priority populations in the Ending the HIV Epidemic (EHE) Plans, both nationally and locally, and in the Getting to Zero-Illinois Plan.

Barriers to HIV Prevention in LSGM Communities: Reasons for high HIV incidence and prevalence within LSGM communities are multifaceted and compounded by intersecting sexual and ethnic/racial identities. Preliminary work by our team and others has shown that a lack of trust in health systems may reduce engagement and retention in HIV care and prevention services, including uptake and adherence to HIV pre-exposure prophylaxis (PrEP). Furthermore, social and structural factors, such as racism, homophobia, and stigma, may reinforce and perpetuate medical mistrust and misinformation within LSGM communities.

Gaps in Research on Medical Mistrust and Misinformation: Unfortunately, little is known about the mechanisms of medical mistrust and misinformation, particularly from the perspective of LSGM community members, and most research has focused on individual-level behavioral interventions. This has led to a gap in addressing medical mistrust as a social determinant of health. We propose that community- and structural-level interventions are necessary to dismantle medical mistrust and misinformation, especially to improve engagement in PrEP healthcare among LSGM.

Research Objective and Long-term Goal: Leveraging our longstanding collaborations with local leaders in Latinx-focused research and service provision, including partnerships with our local health department, the long-term goal of this research is to prevent new HIV transmissions among LSGM by improving engagement in HIV prevention services, including PrEP.

Research Aims: To accomplish this goal, we propose the following mixed-methods research aims:

1. Aim 1: Understand medical mistrust and misinformation and their impact on PrEP healthcare engagement (i.e., PrEP Stages of Change) from the perspectives of LSGM, HIV healthcare providers, and social service providers through interviews and a community-level survey.

2. Aim 2: Utilize the ADAPT-ITT framework to select and tailor a CDC-designated, evidence-based intervention (EBI) for LSGM, focusing on medical mistrust, medical misinformation, and PrEP healthcare engagement through formative research, focus groups with LSGM, input from our community advisory board (Chicago Queer Latine Collaborative), and feedback from expert consultants.

3. Aim 3: Conduct an implementation feasibility trial by leveraging implementation science frameworks (e.g., CFIR) to optimize intervention delivery, assess the acceptability of the adapted EBI for LSGM, and explore our capacity to collect preliminary outcomes using the RE-AIM framework.

Alignment with National HIV Prevention Goals: This research aligns with the US EHE Plan, and study activities will be conducted in Chicago and Cook County, IL - one of the 50 EHE jurisdictions.