Abstract
Among men who have sex with men (MSM) populations, Black/African American (Black) and Hispanic/Latino (Latino) communities are disproportionately affected by HIV (human immunodeficiency virus) compared to other racial/ethnic groups. Pre-Exposure Prophylaxis (PrEP) is a biomedical HIV prevention strategy proven to reduce HIV transmission by 99% if used as prescribed. Significant associations exist between increases in PrEP coverage and a decrease in HIV diagnosis. While PrEP usage has significantly increased over the past few years in the United States, large discrepancy in PrEP use persist, particularly among those most affected by HIV: Latino and Black men and women. Barriers to PrEP for Black and Latino men and women need to be better understood to guide the development of targeted PrEP interventions. In order to address disparities in PrEP initiation, it is crucial to understand the overlapping and complex interactions between structural and psychosocial factors (e.g., substance abuse, violence, risk for HIV, and depression) and the social ecology in which these factors exist. This dissertation utilizes an expanded Syndemic Theory incorporating racial and sexual orientation discrimination to predict and examine PrEP use applying 1) seven machine learning environments and 2) exploratory factor analysis and partial polychoric network correlations.