Abstract
In the US, most new HIV infections are in sexual minority men (SMM). Black and Latino SMM experience profound HIV-related disparities. The CDC estimates that 1 in 2 Black SMM and 1 in 4 Latino SMM will be diagnosed with HIV in their lifetime. The HIV epidemic also disproportionately impacts South Florida, a priority jurisdiction in the national Ending the HIV Epidemic plan to guide the implementation of biomedical approaches to HIV prevention.
Advancing our understanding of multi-level determinants is essential to optimize the effectiveness of biomedical approaches. Regular HIV testing supports timely identification of HIV for immediate treatment to dramatically reduce the risk of onward transmission. Similarly, HIV testing facilitates linkage to PrEP, which when taken as prescribed nearly eliminates risk for HIV acquisition. Although we have the tools to end the HIV epidemic, marginalized and underserved populations continue to display higher HIV incidence. For example, 1 in 3 new HIV infections are estimated to be among SMM who use methamphetamine. The consequences of stimulant use are often compounded by multiple structural factors such as racism, heterosexism and incarceration that could potentiate HIV incidence in SMM. Research is needed to examine the intersection of structural factors, substance use, and outcomes relevant to HIV in SMM.
The goal of this dissertation was to examine the multi-level determinants of substance use and HIV in SMM who are managing multiple minoritized identities relevant to race/ethnicity, substance use, and HIV. Findings underscore the central importance of structural barriers such as incarceration, perceived stigma related to substance use and HIV, and the burden of depressive symptoms in SMM. Results also provided evidence that the South Florida is comprised of unique risk and protective factors relevant to substance use and HIV in SMM. These results will guide the development of scalable, tailored HIV prevention interventions to optimize the benefits of biomedical approaches to HIV prevention in diverse communities of SMM in South Florida.