Background: People living with HIV (PLWH) are expected to go through the HIV care continuum – sequential steps of HIV care: diagnosis, linkage to care, taking HIV medicine, and viral suppression where the HIV virus cannot be sexually transmitted to others. We explored the lived experiences of 15 gay and bisexual men (GBM) living with HIV in a rural region of a Midwestern state to identify unique challenges that these men continue to face despite being undetectable.

Methods: This study was informed by interpretative phenomenological analysis. Participants were recruited via mail-based and snowball sampling. Participants participated in a one-hour semi-structured telephone interview about their experiences going through the rural HIV care continuum. Interpretive phenomenological analysis steps informed to create phenomenological analytical themes.

Results: Rural GBM who went through the rural HIV care continuum and are undetectable continue to face loneliness (e.g., interpersonal stigma, dating stigma), non-HIV issues (e.g., employment, affordable housing), and uncertainty (e.g., HIV social service polices).

Conclusions: Findings have implications that impact rural HIV care continuum conceptualization and implementation, especially moving beyond the rural HIV care continuum medical model to include social determinants of health (e.g., employment, affordable housing), chronic and mental health (e.g., diabetes, substance use), and interpersonal stigma (e.g., dating partners, family).

HIV-positive Black men who have sex with men (HIV+BMSM) report poor medication adherence and viral suppression rates. Extensive evidence describes men’s barriers to achieving adherence. The importance of these challenges notwithstanding, far fewer studies explore individual and community health resilience and its potential to support HIV+BMSM’s health and medication adherence.

The study team engaged 19 HIV+BMSM in a Photovoice process. Men explored barriers and facilitators to medication adherence via picture/video taking, group and individual discussions, and sharing their work with the medical community. Theme analysis of transcripts, videos, and images captured key findings.

On average, HIV+BMSM in the study were 34 years old and were HIV-positive for five years. Adherence challenge themes were largely institutional: insensitive medical care, incarceration fears (re HIV disclosure policies in Missouri), intersectional stigma (HIV/racism/ heterosexism), and community/familial isolation. Men described resilience on multiple levels: individual – persistence, self-love, action/advocacy; relational – chosen families; institutional – culturally competence care and strengths-based adherence messaging; and structural – laws to protect HIV+BMSM.

The challenges that HIV+BMSM described were largely not in their control but resulted from stigmatizing environments and policies that are potentially worse in conservative parts of the U.S. like Missouri. Many men are resourceful and resilient, however, and want recognition for these qualities in their relationships, medical care, adherence messaging, laws and policies. Men recognize that resilience promoting environments need to match their own personal health resilience. Both individual and community health resilience frameworks have potential to shape future adherence interventions.

background: HIV pre-exposure prophylaxis (PrEP) uptake is lagging in mid-sized, Midwestern cities compared to coastal areas. We sought to identify challenges to improving PrEP uptake and care delivery for young Black and Latinx sexual and gender minorities in two Midwestern cities.

methods: In 2018, we purposively sampled community leaders and known PrEP providers (n=36) in Cleveland and Milwaukee to participate in semi-structured interviews eliciting barriers and facilitators to increasing PrEP uptake locally. Community leaders were affiliated with local health departments, funding agencies, and community-based organizations providing HIV testing and prevention services. Data were analyzed using inductive and deductive thematic analysis with constant comparison.

results: We found community leaders to be highly knowledgeable of PrEP and their agencies frequently referred young Black and Latinx sexual and gender minorities to a limited number of known PrEP providers. Community leaders and PrEP providers believed PrEP referrals often failed for young Black and Latinx sexual and gender minorities because of social and structural barriers to PrEP care. We identified four key themes highlighting barriers to successful PrEP care referral, including stigma (e.g., HIV and PrEP stigma, homophobia), insurance cost barriers, logistics of PrEP maintenance care, and socio-contextual needs (e.g., poverty, housing).

conclusions: Health care systems often fail to engage young Black and Latinx sexual and gender minorities in PrEP-related care because of social and structural factors. Increasing holistic supportive services from PrEP navigators experienced in case management to combat social and structural barriers to PrEP are urgently needed to reduce PrEP uptake disparities.

Background: The continuum of care (e.g., prevention, screening, and linkage to care) for HIV and sexually transmitted infections (STIs) are unreliable in rural areas of the United States. Digital technology offers the opportunity to increase access to HIV prevention services. To address health inequities within rural communities telehealth and mobile health (mHealth) approaches have been advocated for; however, little research has evaluated the acceptability and effectiveness of such programs among rural populations.

Methods: Forty men who have sex with men (MSM) residing in rural Oklahoma were recruited to complete in-depth interviews related to the use of mHealth and telehealth technology for health care (e.g., HIV and STI screening, PrEP).

Results: Men described a resource-limited setting which hinders access to LGBT-affirming care providers. Instead, men described sanctioned stigma within clinical settings in their communities. In general, men described a willingness to use telehealth and mHealth technologies for the provision of health care. Men acknowledged these technologies would provide access to: 1) LGBT-affirming care providers and 2) knowledgeable providers with experience meeting the health care needs of MSM. Concurrently, such approaches would alleviate concerns with being inadvertently “outed” within their communities by providers.

Conclusions: Study findings suggest that mHealth and telemedicine is acceptable for use among rural MSM in the context of HIV and sexual health care. Because of the shortage of medical providers in rural communities and the further scarcity of LGBT-affirming providers, telemedicine and mHealth appears to be an ideal approach to enhance access to care for this patient population.

U.S. HIV incidence is 3-fold higher among Latinx individuals than non-Latinx Whites. While pre-exposure prophylaxis (PrEP) is a promising tool for HIV prevention, uptake remains low among Latinx men. Most HIV studies view Latinx communities as a monolithic group, ignoring diversity in racial and sexual identity known to affect PrEP-related outcomes. The current analysis examines PrEP-related outcomes including eligibility (based on CDC criteria), initiation, and at least 1 prescription refill across race (Black-Latinx, Latinx-only, and White-Latinx) and sexual identity (heterosexual, bisexual, and gay) in a sample of Latinx cisgender men (n=8,701) who sought services from a large healthcare network in Chicago, Illinois between 2012 and 2019. Logistic regression was used to calculate odds ratios (ORs) for PrEP outcomes, adjusted for age, clinic location, visit year, payment type, and language. Overall, 50.99% of the sample was PrEP eligible, 22.64% initiated PrEP, and 21.26% had at least 1 PrEP refill. Latinx-only participants had lower odds of PrEP eligibility (AOR= 0.73, 95% CI 0.66, 0.81) and PrEP initiation (AOR= 0.67. 95% CI 0.56, 0.80) compared to White-Latinx participants. No significant differences between Black-Latinx and White-Latinx participants were detected. While bisexual participants had equal odds of PrEP eligibility, they had lower odds of PrEP initiation (AOR=0.64, 95% CI 0.47, 0.85) and PrEP refill (AOR=0.51, 95% CI 0.28, 0.92) compared to gay participants. Heterosexual participants had lower odds of PrEP eligibility and initiation compared to gay participants. Future research should identify and address unique factors shaping PrEP-related outcomes among diverse Latinx populations.