Project Summary HIV remains the most pressing public health issue for Latino/x sexual minority men (SMM) in the U.S. Although Latino/x SMM comprise a small percentage of the U.S. population, they make up a majority of new HIV infections. To effectively address minority health disparities, research should target overlooked Latino/x SMM migrant subgroups, the largest segment of foreign-born sexual minorities in the U.S. who tend to move for better economic opportunities and to escape victimization. Although research consistently shows that SMM migrants experience alarmingly high rates of HIV infection following migration, studies have yet to examine how social ecological factors magnify this risk among Latino/x SMM migrants. Guided by the NIMHD research framework and employing a mixed-methods sequential exploratory study design, the proposed study will advance science by providing rich description of social ecological and social integration factors associated with sexual risk, HIV testing, and PrEP use among Latino/x SMM migrants. Therefore, the aims of the proposed study are to: (1A) identify the social ecological (structural, community, interpersonal, individual) factors associated with sexual risk, HIV testing, and PrEP use among Latino/x SMM migrants living in the mainland U.S., (1B) empirically derive, using latent class analysis, subgroups of Latino/x SMM migrants living in the U.S. based on social integration indicators (immigration status, length of time in the U.S., language use, social connections, healthcare access and utilization), and examine their moderating role in the association between social ecological factors and sexual risk, HIV testing, and PrEP use, and subsequently (2) examine, using in- depth qualitative interviews, sexual risk, HIV testing, and PrEP decision-making processes involved in, including facilitators of and barriers to, PrEP use among Latino/x SMM migrants living in the U.S. To achieve Aims 1A and 1B, an online survey will be used to collect and analyze data and investigate the role of integration in the association between social ecological factors and sexual risk, HIV testing, and PrEP by empirically deriving, using latent class analysis, subgroups of Latino/x SMM migrants based on their integration experiences. This phase (Phase 1) of the study will include 300 Latino/x SMM migrants recruited online via geo-location dating apps. To achieve Aim 2, we will administer in-depth qualitative interviews to examine how sexual risk, HIV testing, and PrEP decision-making processes, including facilitators and barriers, shape PrEP use among Latino/x SMM migrants. This phase (Phase 2) of the study a total of 30 Latino/x SMM migrants, recruited among those who completed Phase 1. At least 5 of the 30 will be on PrEP. The proposed study will further establish the empirical foundation for future research with this exceptionally vulnerable subgroup of Latino/x, SMM, and migrant populations; that is, protocol development for and pilot testing of a multi-level intervention designed to promote PrEP use among Latino/x SMM migrants.

Project Narrative This mixed-methods sequential exploratory/developmental study, which is guided by the NIMHD research framework adapted for sexual and gender minority health research, is relevant to public health for several reasons. The study will (a) describe how social ecological factors facilitate or impede sexual risk, HIV testing, and PrEP use among Latino/x sexual minority men (SMM) migrants, (b) investigate the role of social integration factors (immigration status, length of time in the U.S., language use, social connections, healthcare access and utilization) in the association between social ecological factors and sexual risk, HIV testing, and PrEP use among Latino/x SMM migrants, and (c) illustrate sexual risk, HIV testing, and PrEP decision-making processes as it relates to PrEP use disparities among Latino/x SMM migrants. This research will further establish the empirical foundation for future research with this exceptionally vulnerable subgroup of Latino/x, SMM, and migrant populations; that is, a longitudinal examination of PrEP uptake and promotion.