IntroductionLatino sexual minority men (SMM) represent 26% of new HIV diagnoses among sexual minority men, with lower PrEP utilization rates despite its effectiveness. Provider perceptions play a crucial role in effective PrEP delivery, necessitating coordination with Latino SMM.MethodsWe interviewed 10 providers from an LGBTQ health center in a major city using convenience sampling via clinic administrator emails until saturation. Interviews, conducted over Zoom, lasting 45-60 minutes. Data analysis was performed using NVivo, employing thematic analysis based on Levesque's healthcare access dimensions, along with cross-case analysis and analytical coding.ResultsAppropriateness and acceptability of services were the most salient topics discussed. Respondents reported inconsistent language accommodations for the Spanish speaking population, while others reported the utilization of an interpreter line. Participants commented on issues with the cultural representation across all departments at the clinic. Providers also noted specific barriers to care among Latino SMM, such as a lack of Latino representation in clinical and health care coordination positions.ConclusionOur study focused on provider perceptions of engaging Latino SMM. Findings highlight the significance of service appropriateness and acceptability, suggesting that cultural preferences and service adequacy may play a larger role in PrEP access for Latino SMM than traditional barriers like affordability and availability.

Long-acting injectable (LAI) Cabotegravir/Rilpivirine demonstrated trial superiority for PWH with adherence challenges; strategies to optimize therapy remain underexplored. We report implementation outcomes for the Mobile Outreach Retention and Engagement Program (MORE) and home injections for PWH on CAB+RPV LA at Whitman-Walker Health. MORE offers mobile care navigator support, transportation, text messaging, and optional home medical/phlebotomy/injection visits to PWH starting CAB+RPV LA with VL >200 copies/mL and/or no medical visit in the past six months. We conducted a baseline implementation assessment among 45 MORE participants, from 11/2024-2/2025, of MORE and home CAB+RPV LA injections using validated measures: Acceptability of Intervention Measure (AIM), Feasibility of Intervention Measure (FIM), and Intervention Appropriateness Measure (IAM). Each measure has 4 items rated on a 5-point Likert scale. Agreement is defined as the cumulative percentage of participants selecting “agree” or “strongly agree.” A subsample (n=25) participated in qualitative interviews. Participants had a median age of 44 years, 86% were Black/AA, 38% cis women, 13% transwomen, and 80% had public insurance. MORE acceptability was ≥77%, feasibility was ≥79%, and appropriateness was ≥65%. Home injection acceptability was ≥63%, feasibility was ≥70%, and appropriateness was ≥61%. Qualitative findings for MORE were that familiarity with care teams enhanced acceptability, program flexibility improved feasibility, and tailored services promoted appropriateness. Views about home injections varied, with perceptions of how privacy could be maintained, and the safety of medical procedures in the home influencing acceptability and appropriateness. Flexibility between home and clinic injections improved feasibility. Sixty-seven percent (30/45) of participants were willing to receive home injections and 31% (14/45) received at least one home visit. Home CAB+RPV LA injections delivered through a support program were acceptable, feasible, and appropriate among PWH with adherence challenges. Incorporating similar flexible, patient-centered home LAI interventions into health centers may help address unmet needs of PWH nationwide and globally. All Authors: No reported disclosures

Despite the disproportionate burden of HIV among sexual minority men (SMM), PrEP is underutilized among this population. This study used a discrete choice experiment (DCE) to examine preferences and concerns related to PrEP uptake among HIV-negative, PrEP-eligible SMM (n = 271). Participants evaluated hypothetical PrEP profiles based on administration method, side effects, provider language, and peer use. On-demand PrEP was preferred over daily and long-acting injectable regimens. Side effects, particularly headaches and nausea, were rated as more influential than other attributes. Participants who knew someone taking PrEP had increased odds of taking PrEP themselves. Language concordance with providers did not significantly affect preferences. These findings underscore the importance of flexible PrEP options and minimizing side effects to increase acceptability. Tailoring healthcare delivery and messaging to these preferences may improve PrEP uptake among SMM.

Background In the United States, sexual minority men (SMM) are disproportionately affected by HIV. For this population, intersecting sexual minority– and HIV-related stressors add to general life stress, increasing health risks. Stress is associated with HIV progression and is linked to transmission risk behaviors, such as medication nonadherence and substance use. Substance use is a particularly important risk factor for HIV transmission; beyond injection drug use, recreational use is associated with sexual transmission risk behaviors and an increased risk of HIV among SMM. Interventions targeting stress responses may be especially useful for HIV risk reduction among substance-using SMM (SUSMM) living with HIV (LWH). Positive affect interventions have shown promise in reducing stress in the context of chronic illness, including HIV. However, few studies have examined these interventions and their potential health benefits for SUSMM-LWH. Objective This protocol describes a project (R34DA053999) that builds on our pilot work exploring the induction of positive affect as a potential intervention to reduce stress and improve health outcomes among SMM-LWH. This protocol aims to employ a community-engaged research approach, using the multiphase optimization strategy, to iteratively tailor our app-based positive affect intervention, TeaTime, for SUSMM-LWH. Methods In phase 1, we enrolled 10 SUSMM-LWH into an open-phase pilot using our existing app-based ecological momentary intervention (EMI), which employs a just-in-time adaptive intervention design. We collaborated with a community advisory board to tailor our intervention content and app design using focus group feedback. In phase 2, we conducted a pilot factorial optimization trial to assess the acceptability and feasibility of adding 2 new features that may enhance intervention design and delivery. Specifically, we piloted a 2×2 factorial design, randomizing 80 SUSMM-LWH to receive either (1) random craving prompts or (2) smartwatch integration or both or neither. Analyses will examine group differences on feasibility and acceptability outcomes, as measured by the System Usability Scale and Mobile App Rating Scale, as well as retention and engagement. Results The project was funded in February 2022, and data collection for phase 1 was completed in December 2023. Phase 2 was launched in July 2024, with data collection completed by August 2025. Results from phase 1 are expected to be submitted for publication by December 2025. Conclusions In this protocol, we combine methods from social science, intervention science, and software development into a single innovative approach to enhance and optimize an app-based, just-in-time adaptive, EMI for SUSMM-LWH. Findings from this study will support the development of a fully optimized intervention ready for evaluation and implementation. In a future randomized controlled trial, the ecological momentary assessment design will also enable the collection of day-level data on intervention efficacy. International Registered Report Identifier (IRRID) DERR1-10.2196/76741

Objective: Adolescent men who have sex with men (AMSM) have high HIV incidence and low rates of HIV testing and pre-exposure prophylaxis (PrEP) use. There are few evidence-based HIV prevention programs that meet the unique needs of AMSM. The sequential, multiple assignment, randomized trial (SMART) program is a stepped care package of increasingly intensive eHealth interventions that were developed specifically for English- and Spanish-speaking AMSM. The sequence included universal sexuality education (SMART Sex Ed), an automated motivation and behavioral skills focused intervention (SMART Squad), and motivational interviewing via videoconferencing (SMART Sessions). Method: This SMART compared HIV testing, PrEP use, condomless anal sex (CAS), condom use intentions, and condom use self-efficacy outcomes for different embedded treatment sequences in the SMART program among a large sample of English- and Spanish-speaking AMSM (ages 13-18) in the U.S. states and territories (N = 1,306). Results: In most of the embedded treatment sequences, there were significant improvements across 12 months for most of the outcomes, including CAS with casual partners, HIV testing, PrEP use, and condom use self-efficacy. There were largely no changes in CAS inclusive of serious partnerships and condom use intentions declined in some regimes. Conclusion: Findings from 12 months of follow-up provide evidence of the SMART program's long-term effectiveness, with particular benefits for the important outcomes of HIV testing and PrEP use. Given the lack of effective interventions for this high HIV-incidence population coupled with the potential for high reach given the eHealth modality, funders should put in place the resources to enable rapid implementation.

Purpose:Sexual minority men (SMM) living with HIV experience significant mental health disparities. Studies show positive psychological interventions (PPI) and mindfulness-based interventions (MBI) can have a positive impact on people LWH, however, limited research has explored this among SMM LWH. The current study explores two MBIs (MBSR and yoga) as potential adjuncts to an app-based PPI, which was designed to reduce stress for SMM LWH. Methods:These data are from a sub-study of a proof-of-concept pilot. The pilot enrolled 22 SMM LWH, who used an app-based PPI for 90 days. Following completion of this initial study, participants were invited to participate in a focus group discussion, which explored SMM LWH's interest in MBSR vs. restorative yoga as adjunct programs to the app-based PPI. Results:A third of participants from the initial study attended the focus group (N=7). All focus group participants were racial minorities (71.4% Black, 14.3% Hispanic/Latino, 14.3% Multiracial), with an average age of 32.14yrs (SD=4.87). When asked about initial interest, most participants said they would prefer restorative yoga over MBSR. In the discussion that followed, three main themes and eleven subthemes emerged, which elucidated SMM LWH's attitudes toward MBI, as well as their perceived barriers and facilitators for both yoga and MBSR. Conclusions:The study provides insight into racial minority SMM LWH's comparative interest in two MBIs and suggests that yoga may be a feasible adjunct to the app-based PPI. However, inequities regarding access to yoga remain an important issue for SMM LWH and must be addressed.

Objectives: This study examined research-related privacy and confidentiality concerns among adolescent sexual minority males (ASMM) and provides lessons learned to inform recruitment and enrollment strategies for this population. Methods: Participants were a 2017-2018 internet-based U.S. national sample of sexual minority adolescents who responded to self-report measures of privacy and confidentiality concerns. Results: Bivariate chi-square tests were used to identify participants' mean differences in worry and likelihood of privacy breach occurrences. Many participants reported privacy-related concerns within remote HIV prevention research. Conclusions: Study protocols were designed to ensure participants felt safe participating in online HIV prevention research. However, there are challenges to enroll participants with rigorous protocols for ensuring safety and privacy.

Background Most new HIV infections are attributed to male-to-male sexual contact in the United States. However, only two-thirds of sexual minority men living with HIV achieve an undetectable viral load (UVL). We tested a web-based antiretroviral therapy adherence intervention called Thrive with Me (TWM) with core features that included medication self-monitoring and feedback, HIV and antiretroviral therapy information, and a peer-to-peer exchange. Objective We assessed the efficacy of TWM on HIV UVL among adult (aged ≥18 years) sexual minority men. Moreover, we assessed the impact of overall engagement and engagement with specific intervention features on HIV UVL. Methods In total, 401 sexual minority men (mean age 39.1, SD 10.8 y; 230/384, 59.9% African American) in New York City were recruited between October 2016 and December 2019 and randomized to receive TWM (intervention) or a weekly email newsletter (control) for 5 months. Computerized assessments occurred at baseline and months 5, 11, and 17. The primary outcome was a dichotomous measure of HIV UVL (≤20 copies/μL). Generalized estimating equations with robust SEs were used to assess the effect of the TWM intervention on HIV UVL over the follow-up period in an unadjusted model and a model adjusted for baseline differences and then stratified by baseline recent drug use urinalysis. In secondary analyses, generalized linear models were used to estimate risk differences in the association of overall engagement with TWM (the sum of the number of days participants accessed ≥1 screen of the TWM intervention out of a possible 150 days) and engagement with specific TWM components on HIV UVL throughout the 17-month intervention period. Results Participant retention was 88.5% (355/401; month 5), 81.8% (328/401; month 11), and 80.3% (322/401; month 17). No consistent differences in HIV UVL were found between those randomized to receive TWM or the control at the 5- (difference-in-differences [DD]=–7.8, 95% CI –21.1 to 5.5), 11- (DD=–13.9, 95% CI –27.7 to 0.04), or 17-month (DD=–8.2, 95% CI –22.0 to 5.7) time points, or when stratified by baseline recent drug use. However, those TWM-assigned participants with high overall levels of engagement (in the upper 25th percentile) were more likely to have an HIV UVL at the end of the 5-month active intervention period compared to those with low engagement (below the 75th percentile; risk difference=17.8, 95% CI 2.5-33.0) or no engagement (risk difference=19.4, 95% CI 3.3-35.5) in the intervention. Moreover, high engagement with the peer-to-peer exchange was associated with HIV UVL over time in unadjusted models. Conclusions TWM did not have overall impacts on HIV UVL; however, it may assist some sexual minority men who are highly engaged with this web-based intervention in achieving HIV viral suppression. Trial Registration ClinicalTrials.gov NCT02704208; https://clinicaltrials.gov/study/NCT02704208

Preexposure prophylaxis (PrEP)-related stigma is linked to inadequate PrEP uptake, yet there are no validated scales to test this association among Spanish-speaking Latino sexual minority men (SMM). The present study examined if the Spanish-translated PrEP Stigma Scale (PSS) was psychometrically appropriate for implementing in Spanish language-dominant Latino SMM. Recruitment was conducted using geosocial networking applications, social media sites, and email blasts (N = 3,049). First, we utilized item response theory (IRT) modeling to evaluate the reliability of the PSS items and the latent construct across both language groups (nEnglish = 2,844 and nSpanish = 205). Subsequently, we applied the PSS scale in a theoretical application by examining its association with key steps in the PrEP uptake cascade (i.e., perceived PrEP candidacy, PrEP willingness, PrEP intentions, and having spoken to provider about PrEP) stratified by language. Results of the IRT analyses provided evidence that the translated version of the PSS was appropriate for use among this sample. Further, among English respondents, PrEP stigma was negatively associated with perceived PrEP candidacy (B = -0.30, p < .001), PrEP willingness (B = -0.46, p < .001), and PrEP intentions (B = -0.23, p = .003). PrEP stigma, among Spanish respondents, was not significantly associated with any of the PrEP cascade steps. This study demonstrated that the PSS scale performs adequately for both English-and Spanish-speaking Latino SMM. However, researchers and health professionals alike should pay close attention to the nuanced effects in U.S.-based English-and Spanish language samples as PrEP stigma may impact the PrEP cascade for one language sample and not the other.

Research suggests that sexual minority individuals are at increased risk of suicide compared with the general population. As technology continues to develop in sophistication and accessibility, a growing number of research and therapeutic interventions utilize web-based assessments. To facilitate future research on assessing and responding to suicidal thoughts and behaviors, we describe the implementation of procedures for doing so in the context of a limited-interaction, remote cohort study. We describe factors associated with suicidal thoughts and behaviors among sexual minority men (SMM) that can guide risk/benefit assessments in future studies. Descriptive statistics were used to characterize the sample in terms of self-injury/suicidality. Bivariate χ2tests were conducted to explore differences in these indicators by age, race and ethnicity, sexual orientation, health insurance, region, education, and self-ranked socioeconomic status. Additionally, logistic regressions were used to examine associations between demographic characteristics, various psychosocial syndemic factors, and the four measures of self-injury/suicidality. In addition, we describe the experiences completing the suicidality follow-up protocol within the study. We conducted a nationwide study of 10,607 participants and found that 27.8% had a history of self-injury, 5.6% in the past year, 21.0% had attempted suicide, 18.2% experienced suicidal ideation, and 9.4% had thoughts of killing themselves. Logistic regressions revealed that depression, everyday discrimination based on sexual orientation, childhood sexual assault, and intimate partner violence were the strongest predictors of self-injury and suicidality. Study participants experienced high rates of self-injury and suicidality. Effective protocols can be developed to assess and respond to suicide risk in web-based SMM studies.

This study quantitatively and qualitatively examined prevalence, frequency, and content of discrimination exposure among gay, bisexual and other sexually minoritized men (SMM) within sexual minority contexts. Participants were an online, U.S. national sample of 14,133 SMM who reported discrimination exposure within sexual minority contexts targeting: body type, race, sexual behavior, HIV status, gender expression, age, and income/employment. Quantitative analyses included prevalence percentages and frequencies and ANOVAs, t-tests, and correlations to examine frequency of discrimination exposure type across participant race/ethnicity, sexual identity, gender identity, HIV status, age, and income. Qualitative analyses included conventional content analysis of responses to an open-ended discrimination exposure item. Results showed that discrimination exposure was nearly universal (99%). Discrimination exposure frequency was lowest among White men and, other than for income/employment discrimination exposure, highest among Asian/Pacific Islander men. For several discrimination types, exposure frequency was highest among groups targeted by group-specific negative stereotypes (e.g., Black men were exposed to the most income/employment discrimination). Qualitative analyses highlighted specific exposures to discrimination targeting body type, race/ethnicity, gender identity, attractiveness, education, and intersections between forms of discrimination. Over 69% of write-in responses were relevant to online/app-based discrimination. Findings underscore the importance of examining individual and intersectional discrimination exposure targeting marginalized social positions within sexual minority communities, particularly in online/app contexts.

For sexual minority men (SMM), attachment anxiety and attachment avoidance are evidenced to predict poor mental health (e.g., depression and anxiety). While mindfulness is known to mediate this relationship among the general population, it has yet to be examined among SMM. This study examined the interaction of attachment anxiety and avoidance, and the mediating effect of mindfulness, in predicting symptoms of depression and anxiety among a sample of gay and bisexual men (GBM) in the U.S. We used regression-based path analyses to test the interaction of attachment anxiety and avoidance on symptoms of anxiety and depression. Attachment anxiety and avoidance were positively associated with mental health symptoms. In the model predicting anxiety, we found a significant interaction, indicating that individuals high in attachment anxiety and avoidance had the highest BSI scores. In model 2, direct effects for attachment anxiety and avoidance remained significant, and mindfulness was negatively associated with both mental health symptoms. Significant indirect effects from attachment anxiety and attachment avoidance, through mindfulness, to both depressive and anxiety symptoms were observed. No evidence of mediated moderation was found. Our findings show that attachment is an important predictor of mental health among GBM and support previous research on the mediating role of mindfulness in this association.

BACKGROUND:The HIV epidemic remains a major public health concern, particularly among youths living with HIV. While the availability of antiretroviral therapy has significantly improved the health outcomes of people living with HIV, there is growing evidence that youths living with HIV may be at increased risk of cardiovascular disease. However, the underlying mechanisms linking HIV and cardiovascular disease among youths living with HIV remain poorly understood. One potential explanation is that HIV-related biomarkers, including detectable viral load (VL) and low cluster of differentiation 4 (CD4) lymphocyte counts, may contribute to increased cardiovascular risk. Despite the potential importance of these biomarkers, the relationship between HIV-related biomarkers and cardiovascular risk among youths living with HIV has been understudied.OBJECTIVE:To address this gap, we examined whether detectable VL and low CD4 lymphocyte counts, both of which are indications of unsuppressed HIV, were associated with cardiovascular risk among youths living with HIV.METHODS:We analyzed electronic health record data from 7 adolescent HIV clinics in the United States (813 youths living with HIV). We used multivariable linear regression to examine the relationship between detectable VL and CD4 lymphocyte counts of ≤200 and cardiovascular risk scores, which were adapted from the gender-specific Framingham algorithm.RESULTS:In our study, nearly half of the participants (366/766, 47.8%) had detectable VL, indicating unsuppressed HIV, while 8.6% (51/593) of them had CD4 lymphocyte counts of ≤200, suggesting weakened immune function. We found that those with CD4 lymphocyte counts of ≤200 had significantly higher cardiovascular risk, as assessed by Cardiac Risk Score2, than those with CD4 lymphocyte counts of >200 (P=.002). After adjusting for demographic and clinical factors, we found that for every 1000-point increase in VL copies/mL, the probability of having cardiovascular risk (Cardiac Risk Score2) increased by 38%. When measuring the strength of this connection, we observed a minor effect of VL on increased cardiovascular risk (β=.134, SE 0.014; P=.006). We obtained similar results with Cardiac Risk Score1, but the effect of CD4 lymphocyte counts of ≤200 was no longer significant. Overall, our findings suggest that detectable VL is associated with increased cardiovascular risk among youths living with HIV, and that CD4 lymphocyte counts may play a role in this relationship as well.CONCLUSIONS:Our study highlights a significant association between unsuppressed HIV, indicated by detectable VL, and increased cardiovascular risk in youths living with HIV. These findings emphasize the importance of implementing interventions that address both VL suppression and cardiovascular risk reduction in this population. By tailoring interventions to meet the unique needs of youths, we can promote overall well-being throughout the HIV care continuum and across the life span. Ultimately, these efforts have the potential to improve the health outcomes and quality of life of youths living with HIV.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):RR2-10.2196/11185.

Among the many effective prevention strategies, frequent HIV testing continues to be promoted to reduce the risk of HIV transmission among sexual minority men (SMM). Testing negative for HIV can result in varied reactions that influence subsequent HIV transmission behaviors, yet the extant research has primarily been conducted in English. The current study examined measurement invariance of a Spanish-translated Inventory of Reactions to Testing HIV Negative (IRTHN). The study also examined whether the IRTHN was associated with subsequent condomless anal sex. Data were drawn from 2,170 Latinx SMM subsample of the UNITE Cohort Study. We conducted a multigroup confirmatory factor analysis to test for measurement invariance between participants who opted to take the survey in English (n = 2,024) and those who opted to take it in Spanish (n = 128). We also examined if the IRTHN is associated with subsequent CAS. The results were suggestive of partial invariance. The subscales of Luck and Invulernability were associated with CAS at the 12-month follow-up. Practice and research-based implications are discussed.

BackgroundBlack cisgender gay, bisexual, and other sexual minority men (SMM) and transgender women (TW) continue to be heavily affected by HIV. Further research is needed to better understand HIV prevention and care outcomes in this population. In particular, there is a need for research examining the impact of substance use and sleep health on HIV prevention and treatment outcomes among Black SMM and TW. ObjectiveThis paper outlines the study methods being used in the recently launched follow-up study to the Neighborhoods and Networks (N2) study, which we refer to as N2 Part 2 (N2P2). N2P2 aims to address this gap in the literature, build off the findings of the original N2 study, and identify socioenvironmental determinants of health, including whether neighborhood and network factors mediate and moderate these relationships. MethodsBuilding on the N2 cohort study in Chicago from 2018 to 2022, N2P2 used a prospective longitudinal cohort design and an observational-implementation hybrid approach. With sustained high levels of community engagement, we aim to recruit a new sample of 600 Black SMM and TW participants residing in the Chicago metropolitan statistical area. Participants are asked to participate in 3 study visits across an 18-month study period (1 visit every 9 months). Four different forms of data are collected per wave: (1) an in-person survey, (2) biological specimen collection, (3) a daily remote ecological momentary assessment for 14 days after each study visit, and (4) data from electronic health records. These forms of data collection continue to assess neighborhood and network factors and specifically explore substance use, sleep, immune function, obesity, and the implementation of potential interventions that address relevant constructs (eg, alcohol use and pre-exposure prophylaxis adherence). ResultsThe N2P2 study was funded in August 2021 by the National Institute of Drug Abuse (R01DA054553 and R21DA053156) and National Heart, Lung, and Blood Institute (R01HL160325). This study was launched in November 2022. Recruitment and enrollment for the first wave of data collection are currently ongoing. ConclusionsThe N2P2 study is applying innovative methods to comprehensively explore the impacts of substance use and sleep health on HIV-related outcomes among an HIV status–neutral cohort of Black SMM and TW in Chicago. This study is applying an observational-implementation hybrid design to help us achieve findings that support rapid translation, a critical priority among populations such as Black SMM and TW that experience long-standing inequities with regard to HIV and other health-related outcomes. N2P2 will directly build off the findings that have resulted from the original N2 study among Black SMM and TW in Chicago. These findings provide a better understanding of multilevel (eg, individual, network, and neighborhood) factors that contribute to HIV-related outcomes and viral suppression among Black SMM and TW. International Registered Report Identifier (IRRID)DERR1-10.2196/48548

Although sexual minority men experience elevated rates of childhood sexual abuse (CSA) and equal or greater rates of intimate partner violence (IPV) victimization compared to heterosexual individuals, little research has examined mechanisms linking these forms of victimization in this high-need population. We examined general (i.e., emotion regulation difficulties) and sexual minority specific (i.e., internalized homophobia) mediational pathways between CSA and IPV victimization in a longitudinal sample of 940 sexual minority men. Path analyses revealed significant associations between CSA and internalized homophobia, between internalized homophobia and emotion regulation difficulties, and between emotion regulation difficulties and IPV victimization. No indirect effects of CSA on IPV via general or minority specific pathways were observed. Findings suggest that minority stress specific (i.e., internalized homophobia) and general psychological risk factors (i.e., emotion regulation difficulties) co-occur and may function along independent pathways to link CSA to IPV revictimization. Future work is needed to investigate how mitigation of these modifiable pathways may be targeted to inform violence prevention interventions for sexual minority men.

Background and Objective Research related to anxiety among sexual minority men (SMM) typically focuses on risk factors. It has seldom examined factors that may be associated with lower levels of anxiety. This gap in the literature represents an opportunity to explore positive psychological factors that may be related to lower levels of anxiety among this group. Spirituality and self-compassion are two positive psychological factors that have been associated with reduced anxiety in general samples but have been understudied among SMM. This study aimed to determine the longitudinal associations between spirituality, self-compassion, and anxiety.Design and Methods Guided by an Afrocentric psychological framework, we conducted a secondary quantitative analysis with data from a racially and ethnically diverse sample of 697 U.S. SMM.Results Utilizing Hayes PROCESS Macro Model 4, we found that spirituality at baseline was positively associated with self-compassion at baseline, which in turn was inversely associated with anxiety at 12-month follow-up.Conclusions Overall, our findings provide evidence that spirituality and self-compassion are two positive psychological factors that are inversely associated with anxiety among SMM.