A Mixed-Methods Study of the Social Ecological and Integration Factors Associated with HIV Prevention Behaviors Among Latino/x Sexual Minority Migrant Men in the U.S.

Project Summary
HIV remains the most pressing public health issue for Latino/x sexual minority men (SMM) in the U.S. Although
Latino/x SMM comprise a small percentage of the U.S. population, they make up a majority of new HIV
infections. To effectively address minority health disparities, research should target overlooked Latino/x SMM
migrant subgroups, the largest segment of foreign-born sexual minorities in the U.S. who tend to move for
better economic opportunities and to escape victimization. Although research consistently shows that SMM
migrants experience alarmingly high rates of HIV infection following migration, studies have yet to examine
how social ecological factors magnify this risk among Latino/x SMM migrants. Guided by the NIMHD research
framework and employing a mixed-methods sequential exploratory study design, the proposed study will
advance science by providing rich description of social ecological and social integration factors associated with
sexual risk, HIV testing, and PrEP use among Latino/x SMM migrants. Therefore, the aims of the proposed
study are to: (1A) identify the social ecological (structural, community, interpersonal, individual) factors
associated with sexual risk, HIV testing, and PrEP use among Latino/x SMM migrants living in the mainland
U.S., (1B) empirically derive, using latent class analysis, subgroups of Latino/x SMM migrants living in the U.S.
based on social integration indicators (immigration status, length of time in the U.S., language use, social
connections, healthcare access and utilization), and examine their moderating role in the association between
social ecological factors and sexual risk, HIV testing, and PrEP use, and subsequently (2) examine, using in-
depth qualitative interviews, sexual risk, HIV testing, and PrEP decision-making processes involved in,
including facilitators of and barriers to, PrEP use among Latino/x SMM migrants living in the U.S. To achieve
Aims 1A and 1B, an online survey will be used to collect and analyze data and investigate the role of
integration in the association between social ecological factors and sexual risk, HIV testing, and PrEP by
empirically deriving, using latent class analysis, subgroups of Latino/x SMM migrants based on their integration
experiences. This phase (Phase 1) of the study will include 300 Latino/x SMM migrants recruited online via
geo-location dating apps. To achieve Aim 2, we will administer in-depth qualitative interviews to examine how
sexual risk, HIV testing, and PrEP decision-making processes, including facilitators and barriers, shape PrEP
use among Latino/x SMM migrants. This phase (Phase 2) of the study a total of 30 Latino/x SMM migrants,
recruited among those who completed Phase 1. At least 5 of the 30 will be on PrEP. The proposed study will
further establish the empirical foundation for future research with this exceptionally vulnerable subgroup of
Latino/x, SMM, and migrant populations; that is, protocol development for and pilot testing of a multi-level
intervention designed to promote PrEP use among Latino/x SMM migrants.

Grant Number: 5R21MD019227-02
NIH Institute/Center: NIH
Principal Investigator: Edward Alessi