Exploring and Intervening on Multilevel Factors of Medical Mistrust among Hispanic/Latino Gay, Bisexual and Other Men Who Have Sex with Men (HLMSM) for HIV Prevention in a Priority Jurisdiction

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Hispanic/Latino gay, bisexual, and other men who have sex with men (HLMSM) are disproportionately affected by HIV. Medical mistrust is associated with these HIV disparities among HLMSM because mistrust may result in delayed or reduced use of needed HIV prevention (e.g., HIV testing and PrEP uptake) and care (e.g., antiretroviral therapy [ART]) services. A profound need exists for increased understanding of the drivers of medical mistrust and for effective multilevel interventions to address these drivers among HLMSM in the US. We propose a mixed-methods study to better understand the drivers of medical mistrust and to refine and test a multilevel intervention designed to address these drivers and increase the use of needed HIV prevention and care services among Spanish-speaking, English-speaking, and bilingual (including Spanish and English, or an indigenous language and Spanish and/or English) HLMSM in Mecklenburg County, NC, a jurisdiction prioritized by the Ending the HIV Epidemic in the US (EHE) initiative. In Aim 1, our community-based participatory research (CBPR) partnership will collect, analyze, and interpret qualitative and quantitative data to expand our understanding of the multilevel drivers of medical mistrust among Spanish-speaking, English-speaking, and bilingual HLMSM. In Aim 2, we will refine a status- neutral, culturally congruent, and bilingual multilevel intervention to address identified drivers of medical mistrust and increase HIV testing, PrEP uptake, and use of HIV care services among Spanish-speaking, English-speaking, and bilingual HLMSM. This intervention will be based on our partnership’s previous evidence-based interventions and will blend community-based peer navigation and mHealth. In Aim 3, we will implement and test the intervention through a longitudinal group-randomized design using a quantitative assessment collected at: (1) baseline, (2) immediate post-intervention, and (3) 6-month follow-up. Our hypothesis is that participants randomized to the intervention group, relative to their counterparts randomized to the delayed-intervention group, will demonstrate reduced medical mistrust and increased HIV testing, PrEP uptake, and use of HIV care services. We also will conduct in-depth interviews with a sample of participants and HIV prevention and care service providers at 6-month follow-up. This CBPR study aligns with strategies, goals, and objectives of the EHE initiative, the National HIV/AIDS Strategy, and Healthy People 2030. It will increase our understanding of the drivers of medical mistrust and will yield a tested status-neutral, culturally congruent, and bilingual multilevel intervention to intervene on these drivers and increase use of HIV prevention and care services, thus potentially increasing health equity and reducing disparities within a population disproportionately impacted by HIV – HLMSM. Findings will be broadly disseminated to inform public health practice, research, and policy to promote health equity and reduce HIV disparities among HLMSM in the US.