Skip to main content

Advertisement

SpringerLink
Log in

Interpersonal and Community-Level Influences Across the PrEP Cascade Among Young Adult Latinx Men who Have Sex with Men Living in a US-Mexico Border Region: A Qualitative Study

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Latinx men who have sex with men (MSM) are an at-risk population for new HIV diagnoses. Pre-exposure prophylaxis (PrEP) is a suite of biomedical approaches to prevent HIV infection. Latinx MSM are less likely to take PrEP compared to non-Latinx White MSM. This qualitative study identified interpersonal- and community-level barriers and facilitators of PrEP among young adult Latinx MSM. Using stratified purposeful sampling, 27 Latinx men, ages 19–29 years and living in a US-Mexico border region, completed self-report demographic surveys and participated in semi-structured in-depth interviews assessing barriers and facilitators to PrEP. Directed content analysis was used to identify both a priori and emerging themes. Most participants reported that other people, including peers, friends, partners, and health care providers were both supportive and discouraging of PrEP use. Participants’ intersectional identities as members of both Latinx and LGBTQ+ (Lesbian, Gay, Bisexual, Transgender, Queer) communities both hindered and facilitated PrEP use.

Resumen

Los hombres latinx que tienen sexo con hombres (latinx HSH) son una población en riesgo para nuevos diagnósticos de VIH. La profilaxis preexposición (PrEP) es un conjunto de propuestas biomédicas para prevenir la infección por VIH. Los latinx HSH son menos propensos a tomar PrEP en comparación con hombres blancos no latinx, que tiene sexo con hombres. Este estudio cualitativo identificó barreras interpersonales y comunitarias, así como facilitadores de la PrEP entre jóvenes latinx HSH. Usando un muestreo intencional estratificado, 27 hombres latinx, de 19 a 29 años y que viven en una región fronteriza de EE. UU. y México, completaron encuestas demográficas de autoinforme y participaron en entrevistas en profundidad, semiestructuradas, para evaluar las barreras y los facilitadores de PrEP. Se utilizó el análisis de contenido dirigido para identificar temas a priori y emergentes. La mayoría de los participantes informaron que otras personas, incluyendo compañeros, amigos, parejas y proveedores de atención médica, tanto apoyaban como desalentaban el uso de la PrEP. Las identidades interseccionales de los participantes como miembros de comunidades latinx y LGBTQ+ (lesbianas, gays, bisexuales, transgénero, queer) obstaculizaron y facilitaron el uso de PrEP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data Availability

Not applicable.

Code Availability

The study codebook is available upon request from the authors.

References

  1. Centers for Disease Control and Prevention. HIV among gay and bisexual men in the U.S. 2023. https://www.cdc.gov/nchhstp/newsroom/fact-sheets/hiv/HIV-gay-bisexual-men.html. Accessed 10 April 2023.

  2. Centers for Disease Control and Prevention. Diagnoses of HIV infection in the United States and dependent areas 2019: Special focus profiles. 2023. https://www.cdc.gov/hiv/library/reports/hiv-surveillance/vol-32/content/special-focus-profiles.html#:~:text=Hispanic%2FLatino%20MSM%20made%20up,Islander%20MSM%20(Table%205b). Accessed 10 April 2023.

  3. Hess KL, Hu X, Lansky A, Mermin J, Hall HI. Lifetime risk of a diagnosis of HIV infection in the United States. Ann Epidemiol. 2017;27(4):238–43.

    Article  PubMed  PubMed Central  Google Scholar 

  4. U.S General Services Administration. San Ysidro Land Port of Entry. 2023. https://www.gsa.gov/about-us/regions/welcome-to-the-pacific-rim-region-9/land-ports-of-entry/san-ysidro-land-port-of-entry. Accessed 4 August 2023.

  5. Raudenbush DT. We go to Tijuana to double check everything: the contemporaneous use of health services in the U.S. and Mexico by Mexican immigrants in a border region. Soc Sci Med. 2021;270:113584.

    Article  PubMed  Google Scholar 

  6. Sullivan PS, Woodyatt C, Koski C, et al. 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;23(10):e23173.

    Article  Google Scholar 

  7. Pitpitan EV, Goodman-Meza D, Burgos JL, et al. Prevalence and correlates of HIV among men who have sex with men in Tijuana, Mexico. J Int AIDS Soc. 2015;18(1):19304.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Mehta SR, Wertheim JO, Brouwer KC, et al. HIV transmission networks in the San Diego-Tijuana border region. EBioMedicine. 2015;2(10):1456–63.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Healthy People 2020. 2020 Topics and objectives: HIV. 2023. https://wayback.archive-it.org/5774/20220414135449/https://www.healthypeople.gov/2020/topics-objectives/topic/hiv/objectives. Accessed 10 April 2023.

  10. Healthy People 2030. Reduce the number of new HIV infections - HIV-01. 2023. https://health.gov/healthypeople/objectives-and-data/browse-objectives/sexually-transmitted-infections/reduce-number-new-hiv-infections-hiv-01. Accessed 4 August 2023.

  11. The White House, National, HIV/AIDS Strategy For the United States. 2022–2025. 2021. https://www.whitehouse.gov/wp-content/uploads/2021/11/National-HIV-AIDS-Strategy.pdf. Accessed 4 August 2023.

  12. Owens DK, Davidson KW, Krist AH, et al. Preexposure prophylaxis for the prevention of HIV infection: US Preventive Services Task Force Recommendation Statement. JAMA. 2019;321(22):2203–13.

    Article  PubMed  Google Scholar 

  13. Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–99.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Grant R, Anderson P, McMahan V, Liu A, Amico K, Mehrotra M. Results of the iPrEx open-label extension (iPrEx OLE) in men and transgender women who have sex with men: PrEP uptake, sexual practices, and HIV incidence. AIDS. 2014:20–5.

  15. U.S. Food and Drug Administration. FDA approves first injectable treatment for HIV pre-exposure prevention [Press release]. 2021. https://www.fda.gov/news-events/press-announcements/fda-approves-first-injectable-treatment-hiv-pre-exposure-prevention. Accessed 11 April 2023.

  16. Landovitz RJ, Donnell D, Clement ME, et al. Cabotegravir for HIV prevention in cisgender men and transgender women. N Engl J Med. 2021;385(7):595–608.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Smith DK, Van Handel M, Wolitski RJ, et al. Vital signs: estimated percentages and numbers of adults with indications for preexposure prophylaxis to prevent HIV acquisition–United States, 2015. MMWR Morb Mortal Wkly Rep. 2015;64(46):1291–5.

    Article  PubMed  Google Scholar 

  18. The White House, National, HIV/AIDS Strategy for the United States: Updated to 2020. 2015. https://files.hiv.gov/s3fs-public/nhas-update.pdf. Accessed 10 April 2023.

  19. Blashill AJ, Brady JP, Rooney BM, et al. Syndemics and the PrEP cascade: results from a sample of young Latino men who have sex with men. Arch Sex Behav. 2020;49(1):125–35.

    Article  PubMed  Google Scholar 

  20. Kelley CF, Kahle E, Siegler A, et al. Applying a PrEP continuum of care for men who have sex with men in Atlanta, Georgia. Clin Infect Dis. 2015;61(10):1590–7.

    Article  PubMed  PubMed Central  Google Scholar 

  21. McNairy ML, El-Sadr WM. A paradigm shift: focus on the HIV prevention continuum. Clin Infect Dis. 2014;59(Suppl 1):12–5.

    Article  Google Scholar 

  22. Liu A, Colfax G, Cohen S, et al. The spectrum of engagement in HIV prevention: proposal for a PrEP cascade. Paper presented at: 7th International Conference on HIV Treatment and Prevention Adherence, 2012.

  23. Blashill AJ, Gordon JR, Rojas SA, et al. Pilot randomised controlled trial of a patient navigation intervention to enhance engagement in the PrEP continuum among young Latino MSM: a protocol paper. BMJ Open. 2021;11(5):e040955.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Best A, Stokols D, Green LW, Leischow S, Holmes B, Buchholz K. An integrative framework for community partnering to translate theory into effective health promotion strategy. Am J Health Promot. 2003;18(2):168–76.

    Article  PubMed  Google Scholar 

  25. Stokols D. Translating social ecological theory into guidelines for community health promotion. Am J Health Promot. 1996;10(4):282–98.

    Article  CAS  PubMed  Google Scholar 

  26. McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Educ Q. 1988;15(4):351–77.

    Article  CAS  PubMed  Google Scholar 

  27. Brooks RA, Nieto O, Landrian A, Donohoe TJ. Persistent stigmatizing and negative perceptions of pre-exposure prophylaxis (PrEP) users: implications for PrEP adoption among Latino men who have sex with men. AIDS Care. 2019;31(4):427–35.

    Article  PubMed  Google Scholar 

  28. Brooks RA, Landrian A, Nieto O, Fehrenbacher A. Experiences of anticipated and enacted pre-exposure Prophylaxis (PrEP) stigma among Latino MSM in Los Angeles. AIDS Behav. 2019;23(7):1964–73.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Jaramillo J, Pagkas-Bather J, Waters K, et al. Perceptions of sexual risk, PrEP services, and peer Navigation Support among HIV-Negative latinx and black men who have sex with men (MSM) Residing in Western Washington. Sexuality Res Social Policy. 2022;19:1058–68.

    Article  Google Scholar 

  30. Pulsipher CA, Montoya JA, Plant A, Curtis P, Holloway I, Leibowitz A. Addressing PrEP disparities among young gay and bisexual men in California. 2016. https://www.chprc.org/climate-change-vital-signs-of-the-planet/. Accessed 11 April 2023.

  31. Golub SA, Gamarel KE, Rendina HJ, Surace A, Lelutiu-Weinberger CL. From efficacy to effectiveness: facilitators and barriers to PrEP acceptability and motivations for adherence among MSM and transgender women in New York City. AIDS Patient Care STDS. 2013;27(4):248–54.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Bauermeister JA, Meanley S, Pingel E, Soler JH, Harper GW. PrEP awareness and perceived barriers among single young men who have sex with men. Curr HIV Res. 2013;11(7):520–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Ayala G, Makofane K, Santos G-M, et al. Access to basic HIV-related services and PrEP acceptability among men who have sex with men worldwide: barriers, facilitators, and implications for combination prevention. J Sex Transm Dis. 2013;2013:953123.

    PubMed  PubMed Central  Google Scholar 

  34. Arnold T, Brinkley-Rubinstein L, Chan PA, et al. Social, structural, behavioral and clinical factors influencing retention in Pre-Exposure Prophylaxis (PrEP) care in Mississippi. PLoS ONE. 2017;12(2):e0172354.

    Article  PubMed  PubMed Central  Google Scholar 

  35. García M, Harris AL. PrEP awareness and decision-making for Latino MSM in San Antonio, Texas. PLoS One. 2017;12(9):e0184014.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Alcantar Heredia JL, Goldklank S. The relevance of pre-exposure prophylaxis in gay men’s lives and their motivations to use it: a qualitative study. BMC Public Health. 2021;21(1):1829.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Aidoo-Frimpong G, Wilson K, Przybyla S. Factors influencing pre-exposure prophylaxis uptake among current users: a qualitative study. J HIV AIDS Soc Serv. 2020;19(3):252–62.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Brooks RA, Nieto O, Landrian A, Fehrenbacher A, Cabral A. Experiences of pre-exposure prophylaxis (PrEP)-related stigma among black MSM PrEP users in Los Angeles. J Urban Health. 2020;97(5):679–91.

    Article  PubMed  Google Scholar 

  39. Robles G, Hong C, Yu M, Starks TJ. Intersecting communities and PrEP uptake among US-based latinx sexual minority men. J Racial Ethn Health Disparities. 2022;9(6):2157–63.

    Article  PubMed  Google Scholar 

  40. Kanny D, Jeffries WL, Chapin-Bardales J, et al. Racial/ethnic disparities in HIV preexposure prophylaxis among men who have sex with men – 23 urban areas, 2017. MMWR Morb Mortal Wkly Rep. 2019;68(37):801–6.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Martinez O, Wu E, Levine EC, et al. Integration of social, cultural, and biomedical strategies into an existing couple-based behavioral HIV/STI prevention intervention: voices of Latino male couples. PLoS One. 2016;11(3):e0152361.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Quinn KG, Christenson E, Spector A, Amirkhanian Y, Kelly JA. The influence of peers on PrEP perceptions and use among young Black gay, bisexual, and other men who have sex with men: a qualitative examination. Arch Sex Behav. 2020;49(6):2129–43.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Schnarrs PW, Gordon D, Martin-Valenzuela R, et al. Perceived social norms about oral PrEP use: differences between African-American, Latino and white gay, bisexual and other men who have sex with men in Texas. AIDS Behav. 2018;22(11):3588–602.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Calabrese SK, Underhill K. How stigma surrounding the use of HIV preexposure prophylaxis undermines prevention and pleasure: a call to destigmatize Truvada Whores. Am J Public Health. 2015;105(10):1960–4.

    Article  Google Scholar 

  45. Booth A, Hannes K, Harden A, Noyes J, Harris J, Tong A. COREQ (consolidated criteria for reporting qualitative studies). In: Moher D, Altman DG, Schulz KF, Simera I, Wager E, editors. Guidelines for reporting health research: a user’s manual. Wiley;2014. p. 214–26.

  46. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57.

    Article  PubMed  Google Scholar 

  47. Spencer R, Pryce MJ, Walsh J. Philosophical approaches to qualitative research. In: Leavy P, editor. The Oxford handbook of qualitative research, 1st ed. New York: Oxford University Press;2014. p. 81–98.

    Google Scholar 

  48. US Public Health Service. Preexposure prophylaxis for the prevention of HIV infection in the United States–2014: a clinical practice guideline. 2014. https://www.sfdph.org/dph/files/newsMediadocs/2014PR/PrEPguidelines2014.pdf. Accessed 11 April 2023.

  49. Emmel N. Sampling and choosing cases in qualitative research: a realist approach. London: SAGE Publications Ltd;2013.

    Book  Google Scholar 

  50. Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Health. 2015;42:533–44.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Patton QM. Qualitative research and evaluation methods. London: Sage Publications, London;; 2002.

    Google Scholar 

  52. QSR International. NVivo for Windows. Version 10. 2014.

  53. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.

    Article  PubMed  Google Scholar 

  54. Cofie N, Braund H, Dalgarno N. Eight ways to get a grip on intercoder reliability using qualitative-based measures. Can Med Educ J. 2022;13(2):73–6.

    PubMed  PubMed Central  Google Scholar 

  55. San Diego Geographic Information Source. About SanGIS. 2023. https://www.sangis.org/pages/about. Accessed 4 August 2023.

  56. Galvan FH, Bogart LM, Wagner GJ, Klein DJ, Chen YT. Conceptualisations of masculinity and self-reported medication adherence among HIV-positive Latino men in Los Angeles, California, USA. Cult Health Sex. 2014;16(6):697–709.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Rivera DB, Brady JP, Blashill AJ. Traditional machismo, caballerismo, and the pre-exposure prophylaxis (PrEP) cascade among a sample of Latino sexual minority men. J Sex Res. 2021;58(1):21–8.

    Article  PubMed  Google Scholar 

  58. Meanley S, Connochie D, Choi SK, Bonett S, Flores DD, Bauermeister JA. Assessing the role of gay community attachment, stigma, and PrEP stereotypes on young men who have sex with Men’s PrEP uptake. AIDS Behav. 2021;25(6):1761–76.

    Article  PubMed  Google Scholar 

  59. Pérez A, Santamaria EK, Operario D. A systematic review of behavioral interventions to reduce condomless sex and increase HIV testing for Latino MSM. J Immigr Minor Health. 2018;20(5):1261–76.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Vanessa Arellano, Guillermo Martin, Bethany Mendenhall, Hanna Moon, Sheldon Morris, Adoril Oshana, Sergio Velasquez, and Boyu Wei for their support and assistance. Research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under Award Number R34MH114699. Mr. Hernandez Mozo’s, Mr. Jones’s, and Mr. Rivera’s efforts on this research were supported by the National Institute of General Medical Sciences of the National Institutes of Health under Award Number R25GM058906. Mr. Lucido’s efforts on this research were supported by the National Cancer Institute of the National Institutes of Health under award numbers U54CA12384 and U54CA132379. The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health.

Funding

Research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under Award Number R34MH114699.

Author information

Authors and Affiliations

  1. Department of Psychology, San Diego State University, San Diego, CA, 92120, USA

    Kristen J. Wells, Eduardo Hernandez Mozo, Nicholas C. Lucido, Rosa A. Cobian Aguilar, Kalina M. L. Fahey, Isaiah J. Jones, David B. Rivera & Aaron J. Blashill

  2. SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, 92120, USA

    Kristen J. Wells, Janna R. Gordon, Rosa A. Cobian Aguilar, John P. Brady & Aaron J. Blashill

  3. San Diego State University Research Foundation, San Diego, CA, 92120, USA

    Claudia M. Carrizosa & Kelsey A. Nogg

  4. Laura Rodriguez Research Institute-Family Health Centers of San Diego, San Diego, CA, 92102, USA

    Sarah A. Rojas & Christian B. Ramers

Authors
  1. Kristen J. Wells
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Janna R. Gordon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Claudia M. Carrizosa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eduardo Hernandez Mozo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nicholas C. Lucido
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rosa A. Cobian Aguilar
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. John P. Brady
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sarah A. Rojas
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Christian B. Ramers
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kelsey A. Nogg
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Kalina M. L. Fahey
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Isaiah J. Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. David B. Rivera
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Aaron J. Blashill
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AJB, KJW, SAR, and CBR designed the study. CMC, RACB, JPB, KAN, KMLF, IJJ, and DBR, assisted with participant recruitment, data collection, data management, regulatory processes, and study coordination. AJB, KJW, JRG, NCL, RACA, and JRG conducted data analysis. AJB, KJW, JRG, NCL, and EHM wrote the first draft of the manuscript. All authors read, critically revised, and approved the manuscript.

Corresponding author

Correspondence to Kristen J. Wells.

Ethics declarations

Competing Interests

Research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under Award Number R34MH114699. The authors have no competing interests to declare that are relevant to the content of the article.

Ethics Approval

This study was approved by the San Diego State University Institutional Review Board (Protocol number: HS-2017-0187). All procedures performed in this study were in accordance with the ethical standards of the Institutional Review Board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Consent to Participate

All study participants engaged in an informed consent process with trained, bilingual study staff in either English or Spanish, according to the participants’ preference. Study staff obtained written informed consent from all participants prior to the commencement of data collection.

Consent for publication

All participants provided written consent for publication of the data obtained from this study.

Standards of Reporting

This study followed the COREQ standards of reporting for qualitative research.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Supplementary Material 2

Supplementary Material 3

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wells, K.J., Gordon, J.R., Carrizosa, C.M. et al. Interpersonal and Community-Level Influences Across the PrEP Cascade Among Young Adult Latinx Men who Have Sex with Men Living in a US-Mexico Border Region: A Qualitative Study. AIDS Behav 28, 759–773 (2024). https://doi.org/10.1007/s10461-023-04185-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-023-04185-y

Keywords

Search

Navigation