Neighborhoods, Networks, and the HIV Care Continuum among HIV-infected MSM in NYC

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Abstract Rapid HIV treatment and sustained viral suppression is one of the 4 strategies in the U.S. Department of Health and Human Services (HHS) plan to end the HIV epidemic in America. HIV disparities among Black men who have sex with men (BMSM) have been documented along all stages of the HIV care continuum, with BMSM having higher morbidity and mortality rate, less likely to engaged in HIV care and achieve viral suppression. While many factors influence engagement in HIV care, it is particularly important to understand psychosocial deterrents such as stigma and medical mistrust among BMSM, as this population often experience overlapping stigmas. Intersectional stigma, medical mistrust, and decreased likelihood of referral for HIV or COVID-19 testing and treatment have been shown to be associated with reduced engagement in care among minority populations and individuals living with HIV. Patient-provider relationship has been shown to negatively influence engagement in HIV care; however, this association is not well document among BMSM who are living with HIV especially in the context of a pandemic. The specific aims of the proposed research in this 1-year Diversity Supplement are to: Aim 1. Using the baseline and follow-up data from the CASI, determine the association between patient- provider interaction and perceived racism in healthcare and engagement in HIV care (medical appointment attendance, antiretroviral medical therapy adherence, and viral suppression) among BMSM; and examine the effect of the COVID-19 pandemic on BMSM’s ability to navigate the HIV care continuum. Aim 2. Conduct a qualitative sub-study involving in-depth interviews among 50 NNHIV participants who self-identify as Black using stratified random sampling based on viral load suppression to: (a) Characterize experiences of provider interaction and perceived racism in healthcare among BMSM; (b) Examine the ways in which patient-provider relationship influences navigation of the HIV care continuum, and how it has been impacted by the COVID-19 pandemic; (c) Characterize intersectional stigma associated with COVID-19 and HIV and how it impacts navigation of the HIV care continuum and overall health outcomes among Black MSM; (d) Identify strategies that participants believe should be implemented to improve patient- provider interaction, reduce racism in health care and help BMSM navigate the HIV care continuum. This work is a sub-study of the ongoing NIMH R01-funded longitudinal study called Neighborhoods, Networks and HIV Care (NNHIV) among BMSM living with HIV who reside in New York City. The findings of this study will help us elucidate the NNHIV quantitative data and advance our understanding of the ways in which the COVID-19 pandemic, patient-provider interaction and HIV and COVID-19 stigmas influence engagement in care and viral suppression among BMSM.