Identifying and Engaging Urban HIV infected and uninfected YSMSM in care

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ABSTRACT Current data suggest a disproportionate burden of COVID-19 illness and death among racial and ethnic minority groups.1,2 In multiple urban cities across the United States (U.S.) Black and Latinx persons are disproportionately impacted by COVID-19 illness and death.1,3-5 Disproportionate rates are likely the result of concomitant comorbidities, and adverse social determinants of health, including high rates of substance use (SU), mental health, structural racism, high population density, inadequate housing, and poor access to healthy foods.6,7 The same social determinants of health that predispose communities to COVID-19 illness, contribute to high rates of HIV in Black and Latinx sexual and gender minority youth (aged 15-24 ) (SGMY). COVID-19 will likely worsen social and economic inequalities, which predispose Black and Latinx SGMY to SU and to HIV. Exacerbated inequalities will also like result in further disruption of the HIV prevention and treatment cascades.8 The national strategy, Ending the HIV Epidemic (EHE), seeks to diagnose, treat and prevent onward infection in communities hardest hit by HIV, particularly Black and Latinx SGMY. High rates of substance use12 in BLSGMY has been identified as a key factor in treatment and prevention non-engagement, 13-15 and increased substance use may occur during the COVID-19 pandemic as a coping mechanism. SARS-CoV-2, which causes COVID-19, preferentially attacks the lungs, making YBLSGMY who smoke tobacco or marijuana, particularly at-risk.16-19 We will use a sequential explanatory mixed methods design, inclusive of cross-sectional surveys among 200 PUSH participants (both assigned male and female participants) (aim 1) and qualitative data of 48 participants and their service providers (aims 2-3), to understand potential ways in which the COVID-19 epidemic has affected personal life circumstances, risk behaviors, and health seeking behaviors; community barriers to COVID-19 prevention and treatment; and coping mechanisms to address psychosocial distressed experienced during this time. Specific Aim 1: Using a cross-sectional survey among 200 Black and Latinx SGMY enrolled in PUSH to characterize the psychosocial (including school closures, job loss, mental health and SU) disruptions and access barriers to HIV prevention, treatment and substance treatment services due to COVID-19. Specific Aim 2: Qualitatively describe how psychosocial disruptions due to COVID-19 alters BLSGMY’s access to HIV prevention, treatment and substance treatment services and the coping mechanisms used to address disruptions. Specific Aim 3: Identify potential community barriers to COVID-19 treatment and prevention among BLSGMY and their service providers and how such experiences of medical mistrust and misinformation impact experiences of social disruption in BLSGMY. Potential barriers will be explored using paired depth interviews of BLSGMY and their providers. This supplement allows the team to better understand how the COVID-19 pandemic contributes to limited access for HIV prevention, treatment and substance treatment services, and how potential community barriers and assigned sex at birth modifies this relationship.