Promoting Health Equity in HIV Prevention and Sexual Health Promotion for Latinx Sexually Minoritized Men: PrEP, Sexual Health, and the Potential Threat of Online Bots

Abstract

Latinx sexually minoritized men (SMM) in the United States face a disproportionately high burden of HIV. Despite overall progress in reducing HIV infections among various groups, new HIV infections among Latinx SMM continue to rise. This increase persists even during a decade that has introduced highly effective HIV prevention tools, such as once-daily medication for HIV pre-exposure prophylaxis (PrEP), which is up to 99% effective at preventing HIV. Despite the availability of these prevention options, Latinx SMM are not equally benefiting from these strategies, exacerbating HIV inequities within this group. Individual behaviors do not fully account for the HIV inequities experienced by Latinx SMM, underscoring an urgent need to identify social and structural determinants of health such as socioeconomic status, access to care, and stigma that contribute to the burden of HIV in this group. To date, research focused on the unique experiences and determinants of health among Latinx SMM remains limited. Furthermore, the threat of fraud to online research by survey bots, potentially compromising the integrity of data collected through online research, presents a novel structural barrier to advancing HIV research.In this dissertation a health equity lens was applied to conduct three studies to explore the social and structural determinants of HIV prevention among Latinx SMM. A systematic review was conducted to explore barriers and facilitators of engagement in the PrEP continuum of care among Latinx SMM and transgender women (Chapter 2). This review demonstrated that social and structural factors such as PrEP stigma, access to healthcare, and xenophobic policies which have led to a widespread fear of deportation among Latinx groups influence engagement in the PrEP continuum of care among both groups. A qualitative descriptive study of 15 Latinx SMM revealed that participants viewed sexual health promotion as an integral part of their broader physical and emotional well-being, with a significant focus on protecting themselves from HIV (Chapter 3). Social and cultural stigma, driven by patriarchal stereotypes (i.e., Machismo) and heterosexism, acted as barriers to self-acceptance and HIV self-protection. Despite these challenges, participants overcame these barriers and took ownership of their sexual health and HIV self-protection. An online survey conducted to examine the relationships between intersecting oppression and HIV prevention behaviors, including PrEP use, was compromised by survey bots. In Chapter 4, an analysis of bot detection strategies revealed that 98% of the responses showed indications of being fraudulent and likely generated by survey bots. Findings from this dissertation underscore the need to expand the focus of interventions beyond individual behavior change to include social and structural determinants of health. Future research is needed to continue identifying effective strategies for mitigating these issues and ensuring the reliability of online data collection, as well as to further explore the social and structural determinants that impact HIV prevention among Latinx SMM. Addressing these challenges will be vital for developing equitable, structurally responsive HIV prevention interventions for Latinx SMM.