A Sequential Mixed Methods Study Evaluating the Influence of Violence on HIV Care and Viral Suppression among Young Black and Latinx MSM

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Abstract Viral suppression is critical to the national HIV prevention strategy in the United States, where it is estimated that just about half of people living with HIV (PLWH) are virally suppressed. The vast majority of PLWH are men who have sex with men (MSM). There are marked race- and ethnicity-based disparities in HIV prevalence, care engagement, retention, and subsequent viral suppression among MSM. Compared with White MSM, HIV-infected Black and Latinx MSM are significantly less likely to achieve viral suppression. Relative to older Black and Latinx MSM living with HIV, Black and Latinx MSM aged 13-24 years have low rates of linkage to care, retention in care, and viral suppression. In addition to race- and sexual orientation-based discrimination, Black and Latinx MSM experience other forms of violence that may adversely impact HIV care-related outcomes, such as intimate partner violence and community violence. There are almost no studies that have simultaneously studied community violence (including stigma and discrimination) and intimate partner violence among young minority MSM. The overarching aim of the proposed sequential mixed methods research is to characterize, over time and space, experiences of violence (i.e., intimate partner and sexual, community, and race- and sexual orientation- based violence) and how these experiences influence HIV care among young Black and Latinx MSM living with HIV. These results will yield an empirical basis for interventions and policies to fill gaps in the care continuum among young Black and Latinx MSM. The Specific Aims of the study are: Aim 1: Geolocate the spaces where young Black and Latinx MSMLWH experience violence and characterize how they interpret and assess the impact of those experiences on health, well-being, and HIV care-related outcomes. Aim 2: Assess associations among violence experiences and HIV care-related outcomes over time and space. To achieve these aims, we will conduct a sequential mixed methods study. At baseline, 50 young Black and Latinx MSMLWH will complete a brief baseline computer-assisted survey instrument (CASI); a community asset and risk mapping using Google Earth; a blood draw; and a qualitative in-depth interview (IDI). Between the baseline visit and 3-month follow-up, participants will prospectively complete daily diaries and geospatial mapping, in real time, using a smartphone app, geolocating the precise times and locations of violence experiences and characterizing their emotional and other responses. At the 3-month follow-up, participants will complete another CASI, blood draw, and in-depth qualitative interview. With the CASI, diary, and app-based data, we will characterize statistical associations among participant-level violence experiences, subjective responses, area-level characteristics (via census data) and HIV care-related outcomes (self-reported ART adherence, medical appointment attendance, and HIV viral load, assessed via quantitative HIV-1 RNA by PCR). IDI data will contextualize mapping data, at baseline, and diary and app data, at follow-up. As an exploratory aim, we will ideate location-specific, visual- or social media-based messages to reduce exposure to violence and/or address the psychosocial impacts via a design charrette where preliminary results and exemplary campaigns are presented and novel ideas are generated and discussed.