Project Summary Black and Latinx gay and bisexual men are at highest risk of comorbid conditions resulting from HIV. Cardiovascular disease has become the leading contributor to mortality among persons with HIV, as both conditions are often co-morbid. This is due to chronic inflammation, as a result of HIV, which increases CVD risk. As a result, prominent HIV comorbid conditions also include high blood pressure and type II diabetes mellitus. Compared to the general population, CVD risk is 1.5 to 2 times higher in people with HIV, and this risk increases with age. By the year 2030, an estimated 78% of persons with HIV will be 50 years old or older, and nearly 80% will have one or more chronic conditions. Increased risk of HIV-related comorbidities, such as heart disease are due to racism, discrimination, and homophobia, and inequitable social determinants that drive CVD risk (nicotine exposure, diet quality, low physical activity, insufficient sleep, high cholesterol levels, blood pressure, blood sugar, and body mass index). Even when HIV viral load is well-controlled, HIV-infection causes immune activation and chronic inflammation, which can cause a narrowing of blood vessels, and can result in high blood pressure, chest pain, and/or buildup of plaque in the heart, ultimately resulting in heart disease. The status quo as it pertains to traditional chronic illness prevention has been conventional patient teaching in the clinical setting. However, prevention efforts to thwart heart disease have not reached acceptable levels to have a population impact, and have mostly fared better in heterosexual, non-minoritized populations. The LEARN Study is a pilot waitlist control trial to test a virtual environment as prevention education in Black and Latinx sexual minority men with HIV. Our LEARN findings suggested that Black and Latinx sexual minority men with HIV are concerned about HTN, T2DM, CVA, and cancer. Cancer risk was due to the increased risk of cancers, other than AIDS-defining illnesses, among people with HIV as well as risk for cardiovascular-related comorbidities. We propose a follow-up study to these findings in LEARN 2 using an innovative clinical/community-based partnership, an equity-focused multidisciplinary team, with a culturally salient and tailored virtual environment to preemptively mitigate HIV-related comorbidities with shared risk factors that disproportionately affect Black and Latinx sexual minoritized men. Project objectives are to: 1) to utilize formative research to modify our intervention to address the social determinants of health that impact prevention of shared clinical risk factors for HIV-comorbidities; 2) determine the efficacy of LEARN2, as prevention education for HIV-comorbidities; and 3) to conduct a process evaluation of LEARN2 feasibility and acceptability and determine which intervention components are most successful in initiating change. This project represents a shift in the status quo and signifies a trailblazing effort that leverages a multidisciplinary team, virtual tools, and clinical/community-centeredness to advance health equity in diverse, sexual minority populations, while informing research, clinical practice, and policy.

Project Narrative Ethnic and racial sexual minority men from socioeconomic marginalization are disproportionately affected by HIV and HIV-related comorbidities. Efforts to mitigate risk in under-resourced communities remains a challenge. This proposal seeks to shift the traditional paradigm of patient education by using virtual technology to preemptively target interconnected HIV-related comorbidities uniquely affecting sexual minority men as a means to achieve health equity through prevention education and clinical/community-based, problem-solving research, which are NIMHD priority areas.