Background:
Young Black and Latinx men who have sex with men (MSM) and transgender women continue to face the heaviest burden of HIV infection in the United States. Previous research suggests that these disparities may be driven in part by economic inequality including high unemployment, lower rates of health insurance, and higher rates of poverty. Thus, the purpose of this study was to explore the early career experiences and economic stability of Black and Latinx sexual and gender minority youth as well as factors that influenced their career trajectories.
Methods:
As part of the Work2Prevent study (ATN-151), 21 interviews and 7 focus groups were conducted in Chicago with a total of 67 Black and Latinx men who have sex with men, transgender women, and gender non-conforming individuals who were assigned male at birth (ages 16-32). Interviews and focus groups centered on participants’ experiences navigating employment and managing finances. Transcripts were coded in Atlas.ti by two independent coders. Interrater reliability was moderately high (Kappa=0.76).
Results:
Qualitative analyses revealed that participants generally worked in both the formal economy (e.g. retail, fast food) and informal economy (e.g. sex work, cosmetology, domestic work) during their early careers. Participants’ formal work experiences were generally low-wage, short-term, unstable, and were often gig-based (e.g. rideshare, food delivery). Furthermore, participants cited engaging in informal work both as a supplementary source of income to a formal job as well as an alternative to formal work altogether. The types of informal labor participants engaged in included both survival-based work (e.g. sex work, peddling) and passion-based work (e.g. cosmetology, teaching dance). Those who engaged in sex work and other survival-based informal labor reported experiencing violence, arrest, instability, and exposure to HIV/STIs. Factors that influenced participants’ engagement in informal work included: a lack of social support; unstable housing; unreliable transportation; lower educational attainment; previous criminal-legal system involvement; financial insecurity; discrimination and harassment at jobs; poor pay and working conditions at jobs; flexibility and autonomy in informal work; and opportunities to pursue passions through informal work. Factors that facilitated participants’ sustained engagement with formal work included: support from family, friends, or partners; career assistance from schools and social services; higher educational attainment; stable housing; access to LGBTQ-inclusive jobs; access to jobs with benefits, higher pay, and pathways for promotion; and opportunities to pursue passions through formal work.
Discussion:
Black and Latinx sexual minority men and transgender youth often oscillated between formal and informal work during their early careers as well as used informal work to supplement their incomes. Ultimately, inconsistent work histories, adverse experiences, and structural challenges associated with these early career trajectories may present barriers to attaining financial security and career advancement for these populations. Structural-level interventions aimed at improving social support, economic opportunities, workplace inclusivity, and working conditions for Black and Latinx sexual minority men and transgender youth may improve financial stability and career progression for these populations. Ultimately, this may have positive downstream impacts on associated health outcomes including HIV prevention and viral suppression.

Background: An estimated 1.1 million people in the United States are living with HIV, including about 166,000 undiagnosed individuals. HIV testing helps to reduce undiagnosed HIV infection and prevent ongoing HIV transmission. Religiosity and homonegativity (i.e., negative attitude towards homosexuality) are factors that may contribute to HIV-related stigma resulting in the avoidance of HIV testing. Understanding associations that religiosity and homonegativity have with HIV testing may inform the development of interventions that promote HIV testing. Therefore, we assessed whether religiosity and homonegativity are associated with having ever tested for HIV among men and women in the United States. Methods: We analyzed data from the 2008–2016 General Social Surveys. We included the subsample of respondents who were aged 18 years or older and provided responses to questions regarding HIV testing, religiosity, and homonegativity (N=5,163). Respondents who reported that sexual relations between two men were always or almost always wrong (vs. sometimes wrong or not wrong at all) were classified as being homonegative. Religiosity was measured on a Likert scale of responses to the question “To what extent do you consider yourself a religious person?” Responses included very religious, moderately religious, slightly religious, and not religious. Study covariates included age, gender, race/ethnicity, marital status, income, sexual identity, condom use, and HIV-related risk behaviors (i.e., sex with a man, past 12 months [men only]; three or more opposite-sex partners, past 12 months; ever exchanged sex for money; ever injected drugs; or ever used crack/cocaine). A multivariable logistic regression model controlled for covariates and yielded adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) describing associations that religiosity and homonegativity had with ever testing for HIV. Results: Approximately 40% of respondents had ever tested for HIV. Respondents who perceived themselves as being very religious were less likely to have ever tested for HIV compared to respondents who were not religious (PR: 0.75; CI=0.66–0.86). Homonegative respondents were also less likely to test for HIV than respondents who were not homonegative (PR: 0.82; CI=0.76–0.88). After adjusting for study covariates, respondents who perceived themselves as being very religious were less likely to have ever tested for HIV compared to respondents who were not very religious (aPR: 0.86; CI=0.75–0.99). Homonegativity was not associated with having ever tested for HIV in the multivariable model. Conclusion: U.S. adults who are very religious are less likely than others to test for HIV. Given that being very religious was independently associated with never testing for HIV in the multivariable model, factors unique to being very religious may promote the avoidance of HIV testing. Future studies might determine mechanisms through which religiosity affects HIV testing behavior. Faith-based organizations need to be included in HIV prevention efforts in order to promote HIV testing to adults who may not perceive themselves at risk and, thereby, reduce the number of undiagnosed HIV infections in the United States.

2018 was a big year for the HIV Organ Policy Equity Act (“HOPE”). Those diagnosed with HIV/AIDS have been barred from donating organs since 1988. Those with HIV/AIDS are, however, able to receive donated organs. As the lifespan of those affected has increased exponentially, so has the list of those with HIV/AIDS waiting for organs. In comes the HOPE Act, first introduced in 2013, offering a solution: HIV+ organs to HIV+ patients. A beautiful concept in theory, but it has been arduous to get off the ground. The first steps were to get clinical trials started, but many transplant centers refused, stating they didn’t have the necessary expertise or requisite experience. Small efforts began at large academic institutions, but failed to gain widespread traction. Thankfully, in 2018, large-scale clinical trials have launched. National Institutes of Health began a clinical trial in May introducing HIV-positive kidney transplantation. Participants in the NIH study can co-enroll in a National Institute of Allergy and Infectious Diseases study, which seeks to review data regarding the efficacy and safety of the CCR5 Blockade in HIV+ kidney transplant recipients. Additionally, a liver study has also been proposed with NIAID backing. The ban on HIV + organ donation is still only partially lifted, and comes behind a web of red tape. The criteria for research and participation were set forth by the Department of Health and Human Services and has been published in the Federal Register. This presentation seeks to explain the legislation, its current state, and the rights of those diagnosed with HIV/AIDS in both seeking and donating organs. HIV+ organ donation is currently limited to only kidneys and livers and those wishing to participate must be part of an approved study. Moreover, among other perquisites, those with HIV must have an undetectable viral load and a CD4 count over 200 to be considered for transplantation. The HOPE Act also permits HIV+ individuals to be living donors and participate in an IRB approved study. It’s vital that those living with HIV/AIDS understand their rights with respect to organ donation and transplantation. No longer legally considered “second-class” citizens in the organ-donation realm, HIV+ patients should understand the current regulatory landscape to best advocate for their rights in this new clinical territory.

In 2014 ViiV Healthcare (an HIV/AIDS pharmaceutical company) developed the ACCELERATE! Initiative—a 4-year, $10 million effort to address the critical needs of Black men who have sex with men. It began with commissioned ethnographic research, from which surfaced an expressed need for substantial health outreach to include whole life, sex-positive, comprehensive sexuality education. The Interdisciplinary Sexuality Research Collaborative at Widener University was ultimately called in to fulfill this imperative, with the goal of inspiring and supporting men to seek and maintain quality healthcare services. The ISRC has a long history of working with communities of color, specifically with Black gay men in Philadelphia as researchers and clinical and educational service providers. Using our experience, unique skillset, and social position as a resourced institution, researchers from the ISRC team developed a five-pronged approach to embracing and equipping project participants. The program was built using real-time participatory-action and community-based methodology, providing multi-variate access to sexuality education content and programming, and incorporating intersectional content responsiveness, anti-racist pedagogy, and eudaemonic sexual development into all developed materials. The fruit of this efforts includes 3 separate initiatives: a co-created collection of 21 lesson plans centered on Black male sexual health, a comprehensive needs assessment focused on unpacking and addressing stigma and cultural sensitivity challenges among sexual healthcare providers, and a virtual app through which Black MSM and other community members can access relevant community and education content in real time. All of these approaches are allowing us to dismantle historical barriers between the academy and public and build bridges in solidarity with both leadership of local community organizations and community members at large. At present, the ISRC’s efforts have been well-received among community members and are presently being prepared for distribution to a wider audience in an open-access online platform. Among other significant gains, what we’ve learned is that sex education, when effectively planned and executed, can be the cornerstone of solidarity for Black gay men to join and overcome deleterious health outcomes caused by systemic inequity, along with routine interpersonal barriers caused by the same. This session will offer an overview of the project, including the ISRC approach and its specific aspects, along with a presentation of our triumphs and challenges throughout the process. We will offer our insight into how this framework may be best used to enhance the work of sexual health service providers as a whole.