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Geographic Disparities in Availability of Spanish-Language PrEP Services Among Latino Sexual Minority Men in South Florida

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Abstract

Latino sexual minority men (LSMM) experience barriers in accessing HIV pre-exposure prophylaxis (PrEP), such as lack of proximate culturally-appropriate PrEP navigation services. We examined associations between LSMM’s immigration status and Spanish-language PrEP service availability. LSMM clinically indicated for PrEP were recruited from October 2018 to August 2019 in South Florida and completed an interviewer-administered questionnaire. PrEP service navigators in South Florida were identified using the CDC PrEP Directory. We constructed network service areas of 1-, 2-, and 5-miles from Spanish-speaking PrEP navigators. We used multilevel logistic regression to examine associations of individual (i.e., age, income, immigration status, network density) and zip code-level (i.e., population density, poverty, HIV risk) measures with availability of Spanish-language PrEP navigation services. A total of 131 participants clustered into 60 zip codes in South Florida. Latin American-born LSMM reported higher immigration and discrimination stress, and were 91% less likely to have PrEP navigation service availability, relative to LSMM born in the US. Zip code-level HIV incidence was associated with higher service availability within a 1-mile network of Spanish-speaking PrEP navigators. Spanish-language PrEP navigation services were available in high-HIV incidence zip codes; however, Latin American-born LSMM experienced reduced availability. Immigration and discrimination stress may explain lack of availability.

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References

  1. Fauci A: No more excuses. We have the tools to end the HIV/AIDS pandemic. Washington Post; 8 January 2016.

  2. Centers for Disease Control and Prevention: HIV Surveillance Report. 2019. Vol 32 2021. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2018-updated-vol-32.pdf.

  3. Pitasi MA, Beer L, Cha S, Lyons SJ, Hernandez AL, Prejean J, Valleroy L, Crim S, Trujillo L, Hardman D, Painter E, Petty J, Mermin J, Daskalakis D, Hall I. Vital signs: HIV infection, diagnosis, treatment, and prevention among gay, bisexual, and other men who have sex with men—United States, 2010–2019. Morb Mortal Wkly Rep. 2021;70(48):1669.

    Article  Google Scholar 

  4. Centers for Disease Control and Prevention. HIV Surveillance Report, 2018 (Updated); 2020.

  5. Gulliford M, Figueroa-Munoz J, Morgan M, Hughes D, Gibson B, Beech R, Hudson M. What does ‘access to health care’ mean? J Health Serv Res Policy. 2002;7(3):186–8.

    Article  PubMed  Google Scholar 

  6. Levesque JF, Harris MF, Russell G. Patient-centred access to health care: Conceptualising access at the interface of health systems and populations. Int J Equity Health. 2013;12:18. https://doi.org/10.1186/1475-9276-12-18.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Florida Department of Health Broward County: HIV/AIDS Epidemiological Profile, Florida, 2017; 2020.

  8. Valverde EE, Oster AM, Xu S, Wertheim JO, Hernandez AL. HIV transmission dynamics among foreign-born persons in the United States. JAIDS. 2017;76(5):445–52.

    PubMed  Google Scholar 

  9. Sheehan DM, Auf R, Cyrus E, Fennie KP, Maddox LM, Spencer EC, De La Rosa M, Trepka J. Changing demographic among Latino MSM diagnosed with HIV in Florida, 2007–2016. AIDS Care. 2019;31(12):1593–6.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Atlas Plus. 2022. https://gis.cdc.gov/grasp/nchhstpatlas/main.html.

  11. Harkness A, Satyanarayana S, Mayo D, Smith-Alvarez R, Rogers BG, Prado G, Safren S. Scaling up and out HIV prevention and behavioral health services to latino sexual minority men in South Florida: multi-level implementation barriers, facilitators, and strategies. AIDS Patient Care STDS. 2021;35(5):167–79.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Mugavero MJ, Amico KR, Horn T, Thompson MA. The state of engagement in HIV care in the United States: from cascade to continuum to control. Clin Infect Dis. 2013;57(8):1164–71.

    Article  PubMed  Google Scholar 

  13. Pinto RM, Berringer KR, Melendez R, Mmeje O. Improving PrEP implementation through multilevel interventions: a synthesis of the literature. AIDS Behav. 2018;22(11):3681–91.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Pathela P, Jamison K, Blank S, Daskalakis D, Hedberg T, Borges C. The HIV Pre-exposure Prophylaxis (PrEP) cascade at NYC sexual health clinics: navigation is the key to uptake. JAIDS J Acquir Immune Defic Syndr. 2020;83(4):357–64.

    Article  PubMed  Google Scholar 

  15. Kim B, Chaix B, Chen Y-T, Callander D, Regan SD, Duncan DT. Geographic density and uptake of Pre-exposure Prophylaxis (PrEP) among young gay, bisexual and other sexual minority men: a Global Positioning System (GPS) study. AIDS Behav. 2021;25(2):155–64.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kanamori M, Shrader C-H, Stoler J, Aguilar de Santana S, Williams M. Geographic accessibility of HIV preventive services for young Latino men in Miami, florida: a cross-sectional study. J Assoc Nurses AIDS Care. 2021;32(1):68–78.

    Article  PubMed  Google Scholar 

  17. Kanamori MJ, Williams ML, Fujimoto K, Shrader CH, Schneider J, de La Rosa M. A social network analysis of cooperation and support in an HIV service delivery network for young latino MSM in Miami. J Homosex. 2021;68(6):887–900.

    Article  PubMed  Google Scholar 

  18. Siegler AJ, Bratcher A, Weiss KM, Mouhanna F, Ahlschlager L, Sullivan PS. Location location location: an exploration of disparities in access to publicly listed pre-exposure prophylaxis clinics in the United States. Ann Epidemiol. 2018;28(12):858–64.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Snijders TA, Bosker RJ. Multilevel analysis: an introduction to basic and advanced multilevel modeling. Thousand Oaks: Sage; 2011.

    Google Scholar 

  20. Centers for Disease Control and Prevention. Pre-exposure prophylaxis for the prevention of HIV infection in the United States- 2017 update: a clinical practice guideline US. Public Health Service. Atlanta: Centers for Disease Control and Prevention; 2018.

    Google Scholar 

  21. Kendall C, Kerr LR, Gondim RC, Werneck GL, Macena RHM, Pontes MK, Johnston L, Sabin K, McFarland W. An empirical comparison of respondent-driven sampling, time location sampling, and snowball sampling for behavioral surveillance in men who have sex with men, Fortaleza Brazil. AIDS Behav. 2008;12(1):97–104.

    Article  Google Scholar 

  22. Rhodes SD, McCoy TP. Condom use among immigrant Latino sexual minorities: multilevel analysis after respondent-driven sampling. AIDS Educ Prev. 2015;27(1):27–43.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Shrader CH, Arroyo-Flores J, Skvoretz J, Fallon S, Gonzalez V, Safren S, Algarin A, Johnson A, Doblecki-Lewis S, Kanamori M. PrEP use and PrEP use disclosure are associated with condom use during sex: a multilevel analysis of latino MSM egocentric sexual networks. AIDS Behav. 2021;25:1636–45.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kanamori M, Shrader C-H, Johnson A, Arroyo-Flores J, Rodriguez E, Skvoretz J, et al. The association between homophily on illicit drug use and PrEP conversations among latino men who have sex with men friends: a dyadic network and spatially explicit study. Arch Sex Behav. 2021;17:1–11.

    Google Scholar 

  25. Kanamori M, Shrader C-H, Flores-Arroyo J, Johnson A, Rodriguez E, Fallon S, Skvoretz J, Gonzalez V, Doblecki-Lewis S, Carrico A, Fujimoto K. The association between egocentric sexual networks and sexual meeting venues with PrEP conversation and encouragement for use among Latinx men who have sex with men. AIDS Care. 2022. https://doi.org/10.1080/09540121.2021.2023728.

    Article  PubMed  Google Scholar 

  26. Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, McLeod L, Delacqua G, Delacqua F, Kirby J, Duda SN. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Environmental Systems Research Institute. ArcGIS Online. Redlands, CA: Environmental Systems Research Institute; 2019.

    Google Scholar 

  28. Environmental Systems Research Institute. ArcGIS Pro. Redlands, CA: Environmental Systems Research Institute; 2019.

    Google Scholar 

  29. US Census Bureau. Population. 2021. https://www.census.gov/quickfacts/fact/table/sandiegocountycalifornia,CA/PST045219.

  30. US Census Bureau. Poverty. 2021. https://www.census.gov/quickfacts/fact/table/sandiegocountycalifornia,CA/PST045219.

  31. Sullivan PS, Woodyatt C, Koski C, Pembleton E, McGuinness P, Taussig J, Ricca A, Luisi N, Mokotoff E, Benbow N, Castel AD. A data visualization and dissemination resource to support HIV prevention and care at the local level: analysis and uses of the AIDSVu public data resource. J Med Internet Res. 2020;22(10):e23173.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Sullivan PS, Woodyatt C, Koski C, Pembleton E, McGuinness P, Taussig J, Ricca A, Luisi N, Mokotoff E, Benbow N, Castel AD. AIDSVu Datasets; 2019.

  33. Cervantes RC, Fisher DG, Padilla AM, Napper LE. The hispanic stress inventory version 2: improving the assessment of acculturation stress. Psychol Assess. 2016;28(5):509.

    Article  PubMed  Google Scholar 

  34. Siegler AJ, Wirtz S, Weber S, Sullivan PS. Developing a web-based geolocated directory of HIV pre-exposure prophylaxis-providing clinics: the PrEP locator protocol and operating procedures. JMIR Public Health Surveill. 2017;3(3):e58.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Centers for Disease Control and Prevention. PrEP Locator 2021.

  36. Musca S, Kamiejski R, Nugier A, Méot A, Er-rafiy A, Brauer M. Data with hierarchical structure: impact of intraclass correlation and sample Size on type-I error. Front Psychol. 2011;2:74.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Rendina HJ, Whitfield TH, Grov C, Starks TJ, Parsons JT. Distinguishing hypothetical willingness from behavioral intentions to initiate HIV pre-exposure prophylaxis (PrEP): Findings from a large cohort of gay and bisexual men in the US. Soc Sci Med. 2017;172:115–23.

    Article  PubMed  Google Scholar 

  38. Cassels S, Jenness SM, Khanna AS. Conceptual framework and research methods for migration and HIV transmission dynamics. AIDS Behav. 2014;18(12):2302–13.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Laumann EO, Youm Y. Racial/ethnic group differences in the prevalence of sexually transmitted diseases in the United States: a network explanation. Sex Transm Dis. 1999;26(5):250–61.

    Article  CAS  PubMed  Google Scholar 

  40. Glasman LR, Weinhardt LS, Hackl KL. Disparities in access to HIV prevention among men of Mexican descent living in the Midwestern United States. J Immigr Minor Health. 2011;13(6):1125–33.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Doblecki-Lewis S, Kobetz E, Butts JB, Stefani, Torrealba M, Klose K, Mcgaugh A, Shatz C, Scaramutti C, Baez Leon A, Narcisse G, Morel J, Whiteside P, Cardenas G, Feaster D, Stevenson M. PrEP On the Go! Implementation mobile PrEP, STI, and HIV prevention services in South Florida. Open Forum Infect Dis. 2019;6:S65.

    Article  PubMed Central  Google Scholar 

  42. Touger R, Wood BR. A review of telehealth innovations for HIV pre-exposure prophylaxis (PrEP). Curr HIV/AIDS Rep. 2019;16(1):113–9.

    Article  PubMed  Google Scholar 

  43. Kanamori M, Fallon S, Shrader C-H, Arroyo-Flores J, Johnson A, Rodriguez EL, et al. editors. Abstract of Distinction: Finishing HIV: A Social Network-Based Outreach Program to Encourage Utilization of HIV Protection, Diagnosis and Treatment Services, Customized for Latinos. SPR Virtual 29th Annual Meeting; 2021: Soceity for Prevention Research.

  44. Biello KB, Marrow E, Mimiaga MJ, Sullivan P, Hightow-Weidman L, Mayer KH. A mobile-based app (MyChoices) to increase uptake of HIV testing and pre-exposure prophylaxis by young men who have sex with men: protocol for a pilot randomized controlled trial. JMIR res protoc. 2019;8(1):e10694.

    Article  PubMed  PubMed Central  Google Scholar 

  45. LeGrand S, Muessig KE, Horvath KJ, Rosengren AL, Hightow-Weidman LB. Using technology to support HIV self-testing among men who have sex with men. Curr Opin HIV AIDS. 2017;12(5):425.

    Article  PubMed  PubMed Central  Google Scholar 

  46. MacCarthy S, Barreras JL, Mendoza-Graf A, Galvan F, Linnemayr S. Strategies for improving mobile technology-based HIV prevention interventions with latino men who have sex with men and latina transgender women. AIDS Educ Prev. 2019;31(5):407–20.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Johnson A. KM: A Discussion of DiversiPrEP: Multi-Level Variables Influencing Implementation Success of a Client-Centered PrEP Service Model for Telehealth University of Miami Staying Focused: High Priority Areas for HIV/AIDS Prevention in the Era of COVID-19 In celebration of World AIDS Day 2021; Miami, FL.

  48. Sullivan PS, Purcell DW, Grey JA, Bernstein KT, Gift TL, Wimbly TA, Hall E, Rosenberg ES. Patterns of racial/ethnic disparities and prevalence in HIV and syphilis diagnoses among men who have sex with men, 2016: a novel data visualization. Am J Public Health. 2018;108(S4):S266–73.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Landovitz RJ, Li S, Grinsztejn B, Dawood H, Liu AY, Magnus M, Hosseinipour MC, Panchia R, Cottle L, Chau G. Safety, tolerability, and pharmacokinetics of long-acting injectable cabotegravir in low-risk HIV-uninfected individuals: HPTN 077, a phase 2a randomized controlled trial. PLoS Med. 2018;15(11):e1002690.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Sharfstein JM, Killelea A, Dangerfield D. Long-acting cabotegravir for HIV prevention: issues of access, cost, and equity. JAMA. 2022;327(10):921–2.

    Article  CAS  PubMed  Google Scholar 

  51. US Food & Drug Administration. FDA Approves First Injectable Treatment for HIV Pre-Exposure Prevention. 2022. https://www.fda.gov/news-events/press-announcements/fda-approves-first-injectable-treatment-hiv-pre-exposure-prevention

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Acknowledgements

We would like to thank the staff of our community partner, Latinos Salud, for their efforts. We would also like to thank our participants and mentors. We disclose funding from the following institutions: National Institute of Minority Health and Health Disparities (PI: Shrader #F31MD015988), National Institute of Drug Abuse (PI: Kanamori #K99DA041494, #R00DA041494; PI: Valdez #R25DA050687), National Institute of Mental Health (PI: Kanamori #R01MH125727), National Institute of Allergy and Infectious Diseases (PI: Howard #T32AI114398), and University of Miami CFAR (Parent study PI: Safren, Project PI: Kanamori #AI050409).

Funding

We disclose funding from the following institutions: National Institute of Minority Health and Health Disparities (PI: Shrader #F31MD015988), National Institute of Drug Abuse (PI: Kanamori #K99DA041494, #R00DA041494; PI: Valdez #R25DA050687), National Institute of Mental Health (PI: Kanamori #R01MH125727), National Institute of Allergy and Infectious Diseases (PI: Howard #T32AI114398), and University of Miami CFAR (Parent study PI: Safren, Project PI: Kanamori #AI050409).

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Authors and Affiliations

  1. Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA

    Justin Stoler, Adam Carrico & Mariano Kanamori

  2. ICAP, Columbia University, New York, NY, USA

    Cho-Hee Shrader

  3. Department of Geography and Sustainable Development, College of Arts and Sciences, University of Miami, Coral Gables, FL, USA

    Justin Stoler

  4. Fors Marsh Group, Arlington, VA, USA

    Juan Arroyo-Flores

  5. Department of Medicine, University of Miami, Miller School of Medicine, Miami, FL, USA

    Susanne Doblecki-Lewis

  6. Department of Psychology, College of Arts and Sciences, University of Miami, Coral Gables, FL, USA

    Steven Safren

  7. Latinos Salud, Wilton Manor, FL, USA

    Stephen Fallon

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  1. Cho-Hee Shrader
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  8. Mariano Kanamori
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Correspondence to Cho-Hee Shrader.

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Conflict of interest

Drs. Mariano Kanamori and Susanne Doblecki-Lewis disclose having been recipients of funding from Gilead Sciences for their research. All other authors disclose having no potential conflicts of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Approval was obtained by the University of Miami ethics committee.

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Shrader, CH., Stoler, J., Arroyo-Flores, J. et al. Geographic Disparities in Availability of Spanish-Language PrEP Services Among Latino Sexual Minority Men in South Florida. J Immigrant Minority Health 25, 374–381 (2023). https://doi.org/10.1007/s10903-022-01412-x

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