Intersectional Stigma and Resilience among Young Latinx Gay, Bisexual and Other Men who have Sex with Men to Improve HIV Testing and PrEP Uptake

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PROJECT SUMMARY/ABSTRACT In this R21 application (PAR-20-150, NIMHD Exploratory/Developmental Research Grant Program), we propose to explore and describe experiences of intersectional stigma and sources of resilience to improve uptake of HIV testing and progression through the PrEP cascade among young (ages 18 to 24 years) Hispanic/Latinx gay, bisexual and other men who have sex with men (GBM). Young Latinx GBM are among the populations most heavily affected by HIV in the United States and have low rates of regular HIV testing and PrEP uptake, particularly among young Latinx in the South. Strategies to increase HIV testing and progression through the PrEP cascade have mostly focused on mitigating HIV-related stigma and have ignored its intersectionality with stigma related to sexual orientation, race, ethnicity, immigration status, or other stigmatized attributes affecting young Latinx GBM. The siloed approach to stigma reduction, focus on risk reduction, and preponderance of fear appeals in messaging may perpetuate stigma and contribute to HIV prevention fatigue by continuing to equate being GBM to sexual promiscuity and HIV as GBM’s disease. In this R21 application, we argue that in order to reduce the disproportionate burden of HIV and AIDS in the United States’ young Latinx GBM population, we need (a) to better understand how intersectional stigmas affect HIV risk and (b) to create culturally congruent services informed by this research. We will use a two-phase qualitative research approach to address our specific aims. First, we will conduct focus groups and individual interviews with young Latinx GBM to explore their experiences of intersectional stigma and resiliency to overcome barriers to HIV testing and PrEP uptake. We will also interview young Latinx GBM who demonstrate resilience-promoting factors that facilitate HIV testing and PrEP engagement, to learn more about how they overcome intersectional stigmas despite facing similar or worse adversities as others in the community. Findings from Aim 1 will be used to create intervention vignettes for inclusion in Aim 2 activities. Second, we will conduct FGD with young Latinx GBM and key informant interviews to formulate specific intervention content and to assess intervention delivery preferences based on hypothetical HIV testing and PrEP cascade scenarios illustrated in the intervention vignettes. Based on a Positive Youth Development framework, we will describe intervention efforts that foster resilience, build assets, and promote active engagement to address intersectional stigma and overcome barriers to testing and PrEP use in community and healthcare settings. Further, we will use Aim 2 findings to identify design attributes of a resilience-focused intervention, with a focus on implementation factors that affect uptake and acceptability. The findings from this study will provide the necessary groundwork to test and evaluate a resilience-focused and asset-based approach to mitigate intersectional stigma and enhance young Latinx GBM’s use of HIV testing and their progression through the PrEP cascade.