Impact of geographic mobility on PrEP and HIV care outcomes among Latino gay, bisexual and other men who have sex with men - Abstract HIV continues to be a major public health concern for Hispanic/Latino gay, bisexual and other men who have sex with men (GBMSM) in the U.S. Immigrant/migrant Latino GBMSM make up the largest proportion of foreign-born sexual minority population and are a key group vulnerable to HIV acquisition and transmission, yet are rarely the focus of funded research. Immigrant/migrant Latino GBMSM are more likely to receive delayed HIV diagnoses and to be uninsured/underinsured than U.S.-born Latinos, in addition to facing immigration- related barriers to care. Spatial segregation among immigrant/migrant Latino GBMSM is linked to diminished proximity to Spanish-language pre-exposure prophylaxis (PrEP) and HIV service navigation services and reduced access to culturally competent PrEP and HIV care, creating an increasingly invisible HIV burden. Rates of new HIV diagnoses and HIV viral suppression vary dramatically between countries of origin for immigrant/migrant Latino GBMSM. Geographic mobility has been shown to enhance HIV vulnerability and adversely impact HIV care and treatment in people living with HIV, yet there is limited data on how geographic mobility impacts PrEP and HIV care outcomes among Latino GBMSM in the U.S. Further, geographic mobility may lead to positive outcomes, as people may travel for better access to HIV prevention and care services, or move toward better support networks or away from HIV and PrEP stigma prevalent in their communities. To address the knowledge gap regarding the impact of geographic mobility for Latino GBMSM on PrEP and HIV care outcomes and to inform future interventions, the Specific Aims for this exploratory proposal are: Aim 1: To characterize patterns of geographic mobility in the past 3 years, including destinations, temporality (including duration, frequency, or seasonality), purpose, and level of planning over travel among 40 Latino GBMSM not living with HIV (on/not on PrEP) and 40 Latino GBMSM living with HIV (on/not on ART) in NYC using qualitative in-depth interviews and mobility maps. Aim 2: To determine how past-year geographic mobility impacts PrEP care outcomes (PrEP initiation/adherence, retention and persistence in PrEP care) and HIV care outcomes (ART initiation/adherence, retention in care, and viral suppression) longitudinally over 12 months. We will ensure a range of Latino GBMSM experiences are included, by purposive sampling by: living with and without HIV, region of birth (Dominican Republic, Puerto Rico, Mexico/Central America, and South America), and recent vs. non-recent immigrant/migrant to the U.S. Our approach is innovative, as it examines the impact of geographic mobility on PrEP and HIV care outcomes among Latino GBMSM who have been disproportionately affected by HIV and have been understudied, applies mobility maps in a novel way, and has potential to inform future design of interventions to improve PrEP and HIV care outcomes in this population.
