Abstract
The HIV burden for Black communities in Miami-Dade County is among the highest in the Nation, despite being a highly preventable condition through primary (i.e., medications, such as pre-exposure prophylaxis, or physical barriers, such as condoms), secondary (i.e., routine HIV testing), and tertiary (i.e., medication adherence to avert forward transmission) prevention strategies. While each of these approaches have shown encouraging outcomes, important gaps in HIV prevention persist for marginalized communities. Black residents of Miami-Dade County experience some of the worst HIV outcomes in the Nation. These disparities largely stem from social determinants that limit care continuity and impede optimal HIV outcomes. Equally important, prior research shows Black populations achieve better HIV outcomes when care delivery aligns with their sociocultural norms. Thus, to maximize the potential of prevention efforts, culturally-tailored approaches addressing the full spectrum of care in vulnerable minority communities must be employed. The three approaches discussed in this dissertation examine culturally-tailored primary, secondary, and tertiary HIV prevention interventions designed to reduce HIV disparities in Miami’s Black populations. Using data collected as part of a state-funded HIV testing program, the first study characterized underlying patterns of risk behavior among a cohort of over 1,000 residents within Miami’s historically Black communities. The second study utilized the same program data to examine characteristics associated with repeat HIV testing facilitated by Community Health Workers (CHWs). The third explored the feasibility of a clinic-based CHW intervention for Black adults living with an unsuppressed HIV viral load. The findings presented herein emphasize the value of developing interventions within the sociocultural context of high-risk communities and highlight CHW strategies as an effective tool in reducing HIV disparities for Black populations.