HIV health care teams increasingly utilize culturally-congruent peers to work in front-line outreach and linkage services, as they can more easily establish rapport with those who experience severe health inequities. This study evaluates a novel academic/community partnership based in Atlanta, GA -- the Linkage to Care Peer Navigation Training Program (LTC Program) -- that recruits and trains young black gay and bisexual men and black transgender women, all HIV positive, to serve as Peer Navigators. These two groups represent groups with the highest HIV prevalence rates in the southern U.S., where the epidemic is rampant. Few evaluations of peer training programs exist in the literature; this evaluation is further unique in its focus on the training experiences of HIV+ sexual and gender minorities, from their own perspectives. Moving from an emancipatory framework, this culturally-responsive qualitative evaluation analyzed in-depth interviews with program participants, reflections from program facilitators, interviews with collaborating agency representatives and multiple programmatic data sources to evaluate program effectiveness. Findings suggest that the program significantly expanded participants’ knowledge across key domains, and facilitated their entry into a network of professionals in HIV service and advocacy communities. LTC participants and facilitators agreed that increased communication between program facilitators and agency representatives would strengthen the quality of LTC participants' internship experiences.

Issue: The proposed presentation utilizes de-identified data collected during routine HIV testing at the largest community provider of HIV testing and counseling in Chicago, Illinois, comparing preliminary positive tests and linkage to care outcomes for clients who were referred by Northwestern University’s RADAR project, a longitudinal NIDA-funded cohort of YMSM and transgender women, and those who tested as part of the Center’s normal business operations. Setting: Center on Halsted is the Midwest's most comprehensive community center dedicated to advancing community and securing the health and well-being of the Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) people of Chicagoland. The Center’s Department of HIV/AIDS & STD Services is among Illinois’ largest community-based, HIV testing programs. The unique five year collaboration between the Center on Halsted and the RADAR project provides the unique opportunity to examine how ongoing, biannual retention in a longitudinal study has effects on linkage to care for participants who test HIV positive through the Center on Halsted’s high-volume HIV testing department. Project: From March 2015 through October 2018, 11,155 HIV tests were delivered through the Center on Halsted, 3,016 of which were delivered to members of the RADAR cohort (ages 16-29). Individuals who receive a reactive test result are linked to HIV care through a program of the Center on Halsted, and information about time to linkage, first medical visit, and other information is provided through medical record release. Results: The presentation will address demographic differences between the cohort and non-cohort testing populations, including age, race, and neighborhood. Outcomes from each step in the HIV care continuum will be compared, including time to confirmatory test receipt, time to first medical appointment, CD4 and viral load at first medical visit, and days until undetectable status. Lessons Learned: Ongoing rapport with longitudinal cohort participants and the provision of incentivized regular HIV testing has direct impacts on the efficacy of linkage to care. Implications for HIV testing providers and research projects relating to engagement in testing and linkage to care will be discussed.

Background: Black men who have sex with men (MSM) and transgender women (TW) comprise the most impacted groups by HIV infection in the U.S. Despite promising biomedical developments in HIV prevention (e.g., Pre-Exposure Prophylaxis, or PrEP), HIV diagnoses among young Black MSM (age 25-34) increased by almost one-third from 2011-2015, demonstrating unmet HIV prevention needs among this population. A fuller understanding of young Black MSM and TW’s conceptions of HIV risk is necessary to tailor HIV risk-reduction interventions. Methods: Data were derived from the attention-control arm of PrEP Chicago, a randomized controlled trial of a PrEP peer education and knowledge diffusion intervention. In the control arm, participants wrote three fictional narratives depicting encounters they considered low-, medium-, and high-risk for HIV transmission. Between March 2016 and February 2018, 425 Black MSM and TW (ages 18-35) participated. Narratives were each independently coded by two research staff. Results: Qualitative analysis of participants’ narratives revealed emergent themes related to HIV risk across three domains: behavioral, situational, and partner characteristics. Behavioral factors generally corresponded to varying story risk levels. Condomless anal sex and injection drug use were often included in high-risk stories. Anal sex with a condom appeared primarily in low- and medium-risk stories, though medium-risk stories often featured condom failure. Oral sex appeared across risk levels, mostly in low- and medium-risk stories in which no other types of sex occurred. In high-risk stories, oral often appeared alongside anal or vaginal sex. PrEP use most frequently appeared in low- and medium-risk stories; medium-risk stories including PrEP often featured non-adherence and/or lack of condom use. Situational characteristics (i.e. location/setting, group sex, violence, travel/special occasions, sex work, intoxication, and emotional state) and partner characteristics (i.e. type of relationship, number of partners, and communication/disclosure of HIV status) had a complex relationship to behavioral factors and risk. Some situational and partner characteristics corresponded to varying story risk levels only when paired with specific behavioral factors; e.g. friends/acquaintances as partners appeared in medium- and high-risk stories, but generally alongside condomless anal sex. However, other situational and partner characteristics corresponded to story risk levels regardless of behavior; e.g. mentions of sex work appeared primarily in high-risk stories. Discussion: These results suggest that Black MSM and transgender women’s perceptions of HIV risk are multidimensional and take into account interaction between behavioral, situational, and partner factors. Effective educational and risk-reduction interventions should be responsive to the needs and lived experiences of Black MSM and TW and address factors across these three domains to promote more accurate assessments of risk. Particularly, the prevalence of condom failures, PrEP non-adherence, and virally suppressed partners in medium-risk stories suggests a need to increase population knowledge about the efficacy and proper use of these prevention strategies. Further, lack of partner communication, and the prevalence of infidelity and intimate partner violence, suggest the need for interventions that promote healthy communication and partner trust.

Background: Bacterial sexually transmitted infections (STIs) maintain high prevalence among young men who have sex with men in the U.S. While significant research has been conducted to link bacterial STI infection with HIV infection, little work assesses effects of STI infection on later infection, and fewer works analyze the progression of STIs over years, especially in sexual minority youth. This analysis compares incidence rates of rectal Chlamydia trachomatis (RCT) and Neisseria gonorrhea (RNT) in a longitudinal cohort while exploring trends of persons testing positive for bacterial STIs over two years, as two years leads to a greater chance of reinfection. We hypothesize that having a positive screen for rectal STI at baseline will increase likelihood of retesting positive for an STI at follow-up and will be consistent from year to year. Methods: This study analyzes data from an on-going longitudinal cohort study of YMSM (aged 16 to 29) in Chicago (N=1078) during the period 2015-2018. Participants were recruited using venue-based, social media (e.g. Facebook), and incentivized snow ball sampling. All participants were between 16 and 29 years of age, assigned male at birth, spoke English, and had a sexual encounter with a man in the previous year or identified as gay, bisexual or transgender. Data were collected at baseline with continuing six-month follow-up visits. At odd-numbered visits, participants screened for RCT and RNG using self-administered testing kits. Those who tested positive were referred to clinics for treatment and to receive other sexual health resources. Results: Among 1078 participants at baseline, 174 (16%) tested positive for a rectal STI: 96 (9%) for RNG and 110 (10.5%) for RCT. At the one year follow-up, among 808 participants, 130 (16%) again tested positive for a rectal STI – suggesting no change in the incidence rate for infections (p>0.05). Participants who tested positive for rectal STIs at baseline, compared to those who tested negative at baseline, were three times more likely to have also tested positive for rectal STIs follow-up (p< 0.0001). Additionally, Black YMSM participants, compared to other YMSM, were 4 more likely to retest positive for RCT or RNG (p< 0.001) as compared to white participants. HIV-positive participants, compared to HIV-negative participants, were twice as likely to test positive for rectal STIs at follow up (p< 0.001). Data will be presented from the two year follow up to examine the persistence of trends and discuss the impact of treatment history. Discussion: These results suggest that participants who tested positive for rectal STIs at baseline are also those most likely to test positive again at follow-ups. Separately, Black and HIV positive YMSM are at greater risk of persistently testing positive. Future research should incorporate treatment history for STIs to develop a better understanding of whether these findings represent untreated infections or re-infections. Further research into the genetic makeup of specific rectal infections may be useful for determining if the infections at follow up are re-infections or new infections.

Background: RADAR is a longitudinal cohort study of young transgender women (YTW) and young men who have sex with men (YMSM) that aims to understand the multilevel influences on HIV risk and substance use. Among factors investigated within these populations to better understand and prevent HIV infection is detection of sexually-transmitted infection (STI) agents. Increased sensitivity and specificity inherent to certain molecular diagnostic assays have facilitated off-label application of these tests to extra-urogenital specimens. The purpose of this investigation was to characterize detection rates of several STI agents and associated risk behaviors within this cohort. Methods: Study participants were required to be assigned male at birth, be between 16 and 29 years of age, and have had a sexual encounter with a male in the previous year or identify as gay, bisexual, or transgender. Within a nine-month interval, 1194 participants (89.1% YMSM) submitted first-void urine and rectal swab specimens. Urine specimens were processed with commercial transcription-mediated amplification (TMA)-based assays for Chlamydia trachomatis and Neisseria gonorrhoeae and with off-label TMA-based Trichomonas vaginalis and Mycoplasma genitalium testing. Rectal swabs were assessed for the four STI agents with off-label commercial TMA-based testing. Positive results were verified by repeat testing. Results: FDA-indicated C. trachomatis and N. gonorrhoeae screening of urine revealed 28 participants (2.3%) infected with one or both of these agents. Via C. trachomatis and N. gonorrhoeae screening that included rectal swab analysis, a cumulative 178 participants (14.9%) were infected with either (89 with C. trachomatis; 63 with N. gonorrhoeae) or both (26 participants) agents. Overall detection rates ranged from 0.8-1.6% (urine) and 7.3-8.8% (rectal) for these two agents. Detection of N. gonorrhoeae from rectal swabs was associated with both HIV-positive serostatus (X2=23.98; P< 0.0001) and black race (X2=5.21; P=0.02), while rectal C. trachomatis detection was associated with HIV-positive serostatus (X2=4.30; P=0.04). Off-label screening via TMA-based assays for T. vaginalis and M. genitalium identified 251 additional participants harboring STI agents (11 T. vaginalis; 240 M. genitalium). 82.5% of these novel identifications were generated from analysis of rectal swabs (10 participants with T. vaginalis; 197 participants with M. genitalium). Overall detection rates of T. vaginalis (0.2% urine; 1.2% rectal) and M. genitalium (9.0% urine; 21.9% rectal) were variable. Black participants yielded more rectal detection of M. genitalium (30.0%) than non-black participants (17.1%; X2=19.15; P< 0.0001). 42.1% of HIV-positive participants yielded rectal detection of M. genitalium in contrast to 16.0% of HIV-negative participants (X2=57.75; P< 0.0001). Participant age, cisgender/non-cisgender status, condomless insertive anal/vaginal sexual practice, and condomless receptive anal sexual practice were not associated with rectal detection of C. trachomatis (P≥0.10), N. gonorrhoeae (P≥0.14), T. vaginalis (P≥0.18), or M. genitalium (P≥0.30). Conclusions: Additive analyte testing, including that performed on extra-urogenital specimens, contributes to comprehensive STI screening. Additional studies may be warranted to determine the significance of rectal T. vaginalis and M. genitalium detection in the context of HIV infection.

The HIV epidemic negatively impacts the health of individuals, communities, and nations. With the ongoing HIV epidemic, effective HIV prevention strategies are needed that can be implemented in high-incidence settings. One critical prevention strategy is pre-exposure prophylaxis (PrEP), a biomedical intervention that involves daily administration of a fixed-dose combination of tenofovir disoproxil fumarate and emtricitabine to HIV-negative individuals to prevent infection. Although daily PrEP can reduce the risk of HIV infection in high-risk groups by up to 92%, clinical trials demonstrate low PrEP adherence (34% to 71%), resulting in reduced effectiveness for HIV prevention. To improve PrEP effectiveness, adherence to a daily PrEP regimen is essential. One strategy for improving PrEP adherence is use of cognitive behavioral therapy-(CBT) based interventions. CBT is a structured and present-oriented psychotherapy focusing on solving current problems and modifying dysfunctional thinking and behavior. This program was implemented in an urban neighborhood community that includes one of the largest LGBTQ communities in the U.S. The incidence of HIV infection in the program area is 66.8 per 100,000 population, exceeding the 40.7 per 100,000 incidences of the city as a whole. The audience for the presentation includes primary healthcare providers who manage the health of men having sex with men and the LGBTQ population. The program’s “Life-step” intervention consists of adherence counseling using CBT, motivational interviewing, and problem-solving therapy, all of which can be administered by primary care providers and nursing staff. This program explores patients’ adherence to PrEP, including the levels of PrEP knowledge, trust, and fear that they recognize in themselves. Furthermore, one-on-one discussion of these individual features helps to improve PrEP adherence among people at high risk of HIV. Of the program participants, 89% showed good PrEP adherence by taking PrEP medication daily. Their strategies for maintaining good adherence included establishing a routine such as setting a specific self-administration time and place. The patients with good PrEP adherence were those who started PrEP after requesting it from their healthcare providers. In contrast, 11% of patients missed taking their PrEP medication because of a busy schedule or forgetting to take it; these patients were those who started PrEP based on their healthcare provider’s recommendation. Both those showing good and poor adherence reported learning about PrEP through peer groups even before they started PrEP and exhibited a high level of knowledge and trust and a low level of fear of PrEP. Based on the “Life-Steps" intervention, patients’ perceptions of PrEP were mostly influenced by their peer groups. Patients’ identification of their own barriers and facilitators for PrEP adherence helped them to maintain their adherence. Among the patients, only 11% started PrEP due to a healthcare provider recommendation. Given this findings, healthcare providers should enlist the support of patients’ peer groups to promote PrEP use, should use an individualized patient approach to encourage self-identification of adherence barriers and facilitators, and should proactively recommend PrEP to patients based on a comprehensive medical history.

Issue: Black gay, bisexual, and other men who have sex with men (BGM) experience an exceptionally high prevalence of HIV. Contextual issues such as medical mistrust, societal and internalized homophobia and heterosexism, and social isolation have been shown to drive these HIV disparities. Tailored interventions are needed to address community-level stigma and discrimination that impact HIV among BGM. 

Setting: An immersive theatre intervention called As Much as I Can (AMAIC) was implemented in Baltimore, Maryland in September 2017 and aimed to shift community attitudes and understanding of the lived experiences of BGM living with or vulnerable to HIV.

Project: AMAIC was co-created by a New York-based creative studio and BGM, with funding from ViiV Healthcare. The script was based on in-depth interviews and listening sessions with BGM in Baltimore and Jackson, Mississippi. To facilitate story development and set design, playwrights collaborated with local BGM, several of whom were subsequently hired as actors. AMAIC placed viewers within each scene and used audience participation, an approach that has shown to be effective in changing how subject matter are perceived. 

Results: AMAIC performances (n=7) between 09/07/17 and 09/14/17 were attended by 268 viewers, including healthcare providers, educators, faith leaders, HIV activists, city officials, and community members. Viewers were asked to complete pre- and post-performance questionnaires. These assessed demographics, reactions and takeaways, and level of agreement (on a 4-point Likert scale, strongly disagree-strongly agree) with positive statements about health and acceptance of BGM (e.g., I understand the experiences of BGM). Between 7.1% and 46.8% of viewers increased their level of agreement with each positive statement, 17.7% on average. Viewers reported an appreciation for how realistically HIV-related issues were portrayed and reflected on relatable aspects of the play, including BGM viewers (e.g., “I remember being that guy when I was diagnosed”). In addition to increased awareness of HIV prevention options (e.g., pre-exposure prophylaxis), viewers described a newfound appreciation and empathy for social challenges BGM are facing in relation to HIV (e.g., discrimination within healthcare settings, rejection by family and church community, “how isolating it [HIV diagnosis] can be”). Viewers were inspired to take a range of actions following the performance: learn more about HIV, advocate for BGM by initiating conversations about HIV risk and stigma with others, convey support to BGM friends, and/or to listen to marginalized voices.

Lessons Learned: Community-engaged immersive theatre can be implemented as a public health communications tool for expanding awareness of HIV experiences and identity-based stigma. It may be an effective method for reaching diverse audiences that include people living with HIV. The commitment to co-creation with BGM (i.e, BGM inclusion and leadership at every stage of AMAIC development and implementation) was critical for ensuring authentic storytelling that reflects and affirms experiences of BGM. 
 
 

Background: The majority of pre-exposure prophylaxis (PrEP) research samples PrEP users who live in metropolitan cities and areas. Little is known about the PrEP adoption, adherence, and retention of care determinants among PrEP users living in nonurban areas. This study sought to explore the PrEP adoption, healthcare, and adherence experiences among men who have sex with men who live in nonurban areas of the Midwest. Methods: Nonurban MSM PrEP users participated in a semi-structured 1 hour telephone interview. The interview elicited PrEP, sexual health, and healthcare experiences. Interviews were transcribed verbatim. An inductive analysis approach was used with the first cycle of coding being open coding and the sequential cycles being axial coding. The analytical methods were inspired by Corbin's & Strauss's grounded theory analytical methods. Results: Participants became aware of PrEP via social and popular media; however, participants had to educate their primary care providers about PrEP. Participants perceived their primary care provider was unaware of PrEP, unwilling to prescribe PrEP, and expressed stigma-related behaviors (e.g., homophobia, HIV phobia). Due to this perception and experience, participants traveled outside of their county to the nearest metropolitan city for PrEP- and sexual health-related healthcare. Participants reported they had high adherence rates - rarely missing a dosage. This high levels of adherence rates may be due to participants having high levels of self-efficacy, having few adherence barriers, and having social support and conversations about PrEP with their social networks. When a dosage was missed, participants changed their behaviors (e.g., wear a condom, abstained from sex during a specific time period). Most participants indicated they received financial assistance from Gilead's Co-Payment Program and their employer-based insurance. Participants mentioned they educated and advocated for PrEP in their physical and electronic social networks, and few experienced PrEP stigma from their local MSM community. They did face aspects of PrEP stigma during their patient-provider interactions. Discussion: The determinants of PrEP adoption, adherence, and retention of care have primarily focused on MSM who live in large metropolitan cities. MSM who live in nonurban areas experience a different context, and this geographic and geo-cultural factor could impact PrEP-related outcomes. Overall, participants challenged current literature on the PrEP adoption, adherence, and retention of care experiences. Participants rarely experienced PrEP stigma in their local MSM community, faced little financial barriers, and had high levels of adherence and retention of care rates. More research is necessary to explore the PrEP experiences and determinants among nonurban populations, especially how geographic space could facilitate and hinder determinants such as LGBTQ+ culturally competent care.

Introduction: HIV disproportionately affects sexual and gender minority men and transgender women. Pre-exposure prophylaxis (PrEP) is a highly effective method of primary HIV prevention, whereas post-exposure prophylaxis (PEP) reduces the risk of HIV-seroconversion when started within 72 hours of potential HIV exposure. We sought to determine past PEP use among current PrEP users and non-users to better understand the PEP-to-PrEP pathway to biomedical HIV prevention. Methods: HIV-negative cisgender men, transgender men, and transgender women who have sex with men (n=80,359) were recruited via geosocial sexual networking apps, social media, and other online venues between November 2017 and June 2018 to participate in a brief (~5 minute) eligibility screening survey administered in English and Spanish. Individuals were asked about past PEP use and current PrEP use. We examined associations of demographics (age, sexual orientation identity, gender, race/ethnicity), economic indicators (health insurance status, perceived socioeconomic status), recent club drug use, and current PrEP use on past PEP use using fully-adjusted logistic regression. Results: Prior PEP use (n=6,542, 8.1%) and current PrEP use (n=11,047, 13.8%) were relatively uncommon. Nearly half (n=2,743, 41.9%) of past PEP users were current PrEP users, representing 24.8% of all current PrEP users. In multivariable analysis, older age (>24 years old) was associated with higher odds of past PEP use compared to younger age (AOR=1.55, p< 0.001). Individuals who described themselves as bisexual (AOR=0.58, p< 0.001) or straight (AOR=0.47, p< 0.001) had lower odds of reporting past PEP use compared to those who identified as gay, lesbian, or queer. Transgender women had higher odds of reporting past PEP use than cisgender men (AOR=1.46, p< 0.01), but there was no difference between cis- and transgender men. Black, Latinx, and other/multiracial individuals had higher odds of reporting past PEP use compared to those who were White (AORs=1.38-1.47, all p< 0.001). While perceived socioeconomic status had no significant effect, those who had health insurance had higher odds of past PEP use compared to those uninsured (AOR=1.13, p< 0.01). Club drug users had higher odds of past PEP use compared to non-users (AOR=1.61, p< 0.001). Current PrEP users had 4.95 times higher odds (p< 0.001) of past PEP use compared to non-PrEP users. Discussion: PEP remains underutilized as an HIV prevention tool but is likely one mechanism that could have provided a cue to biomedical HIV primary prevention for a quarter of PrEP users. While PEP could be a “gateway” to PrEP, we do not know the time between PEP and PrEP, nor reasons for uptake. Promoting PEP-to-PrEP could support increasing PrEP uptake by capitalizing on perceived heightened HIV risk after potential exposure events, reducing immediate risk for HIV-seroconversion and future transmission risk. Results are promising for reducing HIV disparities among transgender women and racial/ethnic minorities, but further work is needed to support PEP uptake among younger at-risk groups and individuals who do not identify as gay, lesbian, or queer. Health insurance remains a structural barrier for PEP.

Background: Minimal uptake of daily oral combination tenofovir disoproxyl fumarate and emtricitabine (TDF/FTC) for pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) has prompted studies about patient-provider dynamics, prescription practices, and patient perceptions of healthcare. The use of PrEP has also stimulated qualitative and clinical research concerned with elements of sexuality while on PrEP such as sexual behaviors, perceptions of sexual identity, and sexual emotional contexts. There is a need to contextualize MSM patient continuation of PrEP with changes in sexuality while using the medication and, specifically, how healthcare providers consider sexuality in PrEP care. The purpose of this qualitative study is to examine potential impacts of provider sexual health care on MSM PrEP persistence in the context of evolving sexuality while using the medication. Methods: We conducted semi-structured interviews with 4 PrEP providers and 20 MSM adults in Atlanta, Georgia with current or past prescriptions for PrEP. Constructs from the information-motivation-behavioral skills (IMB) theory informed the development of interview guides exploring domains such as the impact of PrEP on sexuality, discussing sexuality with healthcare providers, and provider relationships affecting PrEP continuation. Data were analyzed with MAXQDA 2018 qualitative data analysis software using a thematic analysis approach to explore emergent patterns. Results: Data collection is complete and emergent themes found through preliminary coding include patient needs for tailored sexual health advice based on individual sexual preferences, increased PrEP provider interest in the sexual and emotional wellbeing of MSM patients, and improved access to PrEP providers who identify as gay men or who practice in LGBT-friendly settings. Themes emerging related to PrEP medication use include the motivation to continue PrEP due to HIV positive partners, frequent missed doses of PrEP due to impersonal healthcare, and more patient engagement with PrEP care when being treated by non-judgemental providers. Upon full analysis, changes in sexuality while on PrEP as well as needs for healthcare to incorporate sexual wellbeing will be compared with patterns of PrEP persistence to further explore the dynamic between sexuality, PrEP, medical care, and the continuation of PrEP among MSM patients. We will conduct subgroup analysis with data from MSM patients and PrEP providers to compare their perceptions of giving and receiving health care with attention to sexuality and how it is related to PrEP persistence. Discussion: Results from this study align with findings from existing exploratory research showing that discussions about sexual behaviors, identities, and emotions with a medical provider affects patient sexual health. Current study results indicate that the impact of healthcare provision on persistence of medication use is important to MSM sexual health and could inform LGBTQ medical education. Future research pertaining to the relationship between individualized sexual health care and continuation of PrEP along with feasibility of integrating sexual wellbeing into PrEP care is necessary to inform improvements to MSM patient health care.

Background Truvada, commonly known as PrEP (pre-exposure prophylaxis), is a daily medication that reduces the risk of HIV infection by up to 99% if taken as prescribed. Recent research has explored PrEP use in relation to health risk behaviors, but few studies have determined facilitative and detrimental psychosocial factors associated with PrEP uptake among LGBMSM. Guided by the Theory of Reasoned Action/Planned Behavior (Ajzen, 1985), the present study examined psychosocial factors associated with having a PrEP prescription among a sample of LGBMSM. Based on theory and extant research (e.g., Mimiaga et al., 2009), we hypothesized that several factors would relate with LGBMSM reporting having a PrEP prescription, including greater social support, more ethnic identity commitment, more sexual identity commitment, more sexual identity exploration, less sexual identity uncertainty, more sexual identity synthesis, less heterosexual self-presentation, less machismo, more caballerismo, and less sexual behavior while intoxicated. Methods Study recruitment announcements were circulated on social networking sites and in community agencies. Participants were 309 Latinx MSM (M age = 32.22 years, SD = 7.07 years) who responded to an online questionnaire a part of a larger study funded by the National Institutes of Health (MASKED FOR REVIEW). Participants identified as Mexican (46.9%), Cuban (16.2%), Colombian (13.6%), Puerto Rican (9.1%), Argentinian (3.9%), Dominican (3.6%), Costa Rican (1.9%), Venezuelan (1.0%), Bolivian (0.6%), Chilean (0.6%), Nicaraguan (0.6%), Ecuadorian (0.3%), El Salvadorian (0.3%), Peruvian (0.3%), and Uruguayan (0.3%). Seventy-nine percent of men identified as White/Latinx, while 19% identified as Black/Latinx. In terms of education, participants reported having a high school diploma (14.9%) up through a graduate degree (11.7%), with most participants reporting a bachelor’s or four-year degree (31.1%). Measures assessed social support (Interpersonal Support Evaluation List-12; Cohen et al., 1985), ethnic identity (Multigroup Ethnic Identity Measure; Phinney, 1992), aspects of sexual identity (Measure of Sexual Identity Exploration and Commitment; Worthington et al., 2008), heterosexual self-presentation (Conformity to Masculine Norms Inventory-46; Parent & Moradi, 2011), traditional masculine gender role beliefs (Traditional Machismo and Caballerismo Scale; Arciniega et al., 2008), and sex while intoxicated (4 items from the Risk Behavior Survey; National Institute on Drug Abuse, 1993). Results A logistic regression analysis tested hypothesized links between psychosocial factors and reporting obtaining a PrEP prescription within 12 months prior to assessment. Men who indicated more commitment to their Latinx ethnic identity had 2.39 times higher odds of having a PrEP prescription (p = .004). Men who indicated being in the Synthesis status of sexual identity had 3.39 times higher odds of having a PrEP prescription (p = .014). Men who indicated having more intoxicated sex during the 12 months prior to assessment had 4.22 times higher odds of having a PrEP prescription (p < .001). Discussion Findings supported several hypothesized psychosocial factors associated with PrEP uptake among LGBMSM. The present study extends past research and identifies multiple psychosocial factors that may be useful for health promotion interventions with LGBMSM to increase PrEP uptake. Biomedical prevention and counseling implications will be discussed.

HIV antiretroviral therapy (ART) allows people living with HIV (PLWH) to achieve an undetectable viral load (Flynn et al., 2004), decreasing HIV transmission (Outlaw et al., 2010). ART adherence is correlated with slowed HIV disease progression (Benator et al., 2015) and improved quality of life (Burman et al., 2008). Many PLWH, however, do not achieve optimal ART adherence (MacDonell, Jacques-Tiura, Naar, & Fernandez, 2016). Depression is associated with decreased ART adherence (Uthman, Magidson, Safren, & Nachega, 2014). Racial disparities also exist in ART adherence. Black PLWH, the highest proportion of PLWH in the U.S. (CDC, 2018), show lower adherence than other groups (Simoni et al., 2012). Depression is common among PLWH (Kong et al., 2012), but less prevalent among Black individuals (Erving, Thomas, & Frazier, 2018), meaning that its association with ART adherence may differ for Black PLWH. The present longitudinal study examined race (Black vs. non-Black) as a moderator of the association between depressive symptoms and ART adherence among young men who have sex with men (YMSM) and transgender women (TW). Method Participants were 210 PLWH. Average age was 26.13 years. Participants' gender was as male (88.6%) or transgender (assigned male at birth; 11.4%). Participants identified their race/ethnicity as Asian (0.5%), Black or African American (63.8%), Hispanic/Latino(a) (22.4%), White (4.3%), Multi-racial (8.1%), or Other (1%). Participants’ sexual orientations were: gay (79%), bisexual (8.6%), queer (2.4%), unsure/questioning (2.4%), straight/heterosexual (4.8%), or an orientation not listed (2.9%). Data were collected as part of RADAR, an ongoing longitudinal cohort study of YMSM and TW. Participants completed measures of number of missed doses of HIV medications and depressive symptoms, both in the past seven days, every six months between February 2015 and August 2018. Data were analyzed using Mplus software with robust maximum likelihood estimation (Muthén & Muthén, 1998-2015). Longitudinal within-persons analyses were conducted using a multilevel latent covariate model (Lüdtke et al., 2008), with depressive symptoms predicting concurrent ART adherence (zero missed doses was Adherent; at least one missed dose was Not Adherent). Race was a between-persons moderator of the within-person relation between ART adherence and depressive symptoms. Results At the within-persons level, depressive symptoms had a negative association with ART adherence (B = -0.06, SE = 0.02, p = .001), which was moderated by race. Black participants had a stronger within-persons association between depression and ART adherence (B = -0.06, SE = 0.01, p < .001) than non-Black participants (B = -0.02, SE = 0.01, p = .004). Discussion Depressive symptoms may be a more significant barrier to ART adherence for Black than for non-Black PLWH. Because Black YMSM/TW have lower rates of depression, they may not have developed coping skills to buffer the effects of depressive symptoms on functioning. Thus, when Black YMSM/TW do experience depressive symptoms, they have a stronger impact on ART adherence. These results indicate a need to increase access to psychiatric treatment for Black PLWH, which can greatly increase ART adherence (Kong et al., 2012).