HIV in the United States disproportionately affects Black sexual minority men (BSMM), including disparities in HIV care engagement and outcomes. During public health emergencies, such as the COVID-19 pandemic, marginalized populations such as BSMM may face additional barriers to HIV care engagement. We examined associations between HIV care engagement (current antiretroviral therapy use, healthcare visits for HIV, viral load testing, viral load suppression) and experiencing COVID-19-related disruptions to HIV care in a sample of BSMM living with HIV in 2022 (n = 172). We then examined correlates of having experienced a COVID-19-related disruption to HIV care, spanning multiple variable groups: socioeconomic, substance use, mental health, social and structural, and strength and resilience. Social and structural variables, including transportation, intimate partner violence victimization, and experiences of discrimination showed the strongest associations with experiencing a COVID-19-related disruption to HIV care, followed closely by internalized HIV stigma, and strengths and resilience (treatment adherence self-efficacy, HIV social support). Socioeconomic variables and substance use variables, overall, had less robust associations with COVID-19-related care disruptions than these other variable groups. Lived experiences and resources that reflect social marginalization are associated with disruptions to HIV care during a period of intense social and economic upheaval. These findings point to important areas for future research, as well as considerations for building more robust, adaptable, accessible, and holistic HIV care systems that promote greater engagement and improved outcomes both during times of relative stability as well as during periods of significant upheaval.

Black sexual minority men living with HIV (BSMM+) in the Southern United States encounter multiple forms of discrimination, which are associated with decreased HIV care engagement. We analyzed data from 166 BSMM + in the South to assess direct associations between experiences of racism, heterosexism, and HIV-related discrimination with HIV care engagement. We further investigated indirect associations through three mediators: internalized racism, internalized heterosexism, and internalized HIV stigma. Experienced heterosexism was indirectly associated with HIV care engagement through internalized HIV stigma ( b indirect = −0.039, p = 0.098). HIV discrimination was associated with internalized heterosexism ( b direct = 0.577, p = 0.007) and internalized racism ( b direct = 0.253, p = 0.009). There were significant direct associations between internalized HIV stigma and HIV care engagement ( b direct = −0.040, p = 0.001) and experienced heterosexism and internalized HIV stigma ( b direct = 0.974, p = 0.050). These findings aim to understand the factors affecting HIV care engagement among this population to improve HIV care engagement.

“It Takes Two” is a couples-based HIV prevention program designed for transgender women and their partners. The aim of this project is to alleviate HIV vulnerability by enhancing communication, improving shared goals, and decreasing relationship stigma. From November 2019 to November 2022, we conducted a randomized controlled trial with 52 couples (104 individuals). Participants were randomized into one of two groups: the intervention group received four 1-hour counseling sessions, while the control group received educational videos. Due to the COVID-19 pandemic, 60

BACKGROUND:In 2023, the United States Food and Drug Administration revised its blood donor eligibility policy for men who have sex with men (MSM) from a 3-month deferral to individual assessment. Human Immunodeficiency Virus (HIV) pre-exposure prophylaxis (PrEP) use remains a reason for deferral, and nondisclosure is a concern. STUDY DESIGN AND METHODS:In a cross-sectional study of sexually active MSM from 8 U.S. cities who were interested in future blood donation, we assessed the performance of an enzyme-linked immunosorbent assay for detecting tenofovir (TFV) in whole blood (WB) and plasma and the correlation with self-reported PrEP use. RESULTS:Of 1548 individuals, 48% reported oral PrEP use. The WB assay identified 95% of PrEP users, while the plasma assay detected 88%. The WB assay performed well up to 14 days after the last reported dose. Receiver operating characteristics curve analysis showed an area under the curve of 0.96 (95% confidence interval [CI]: 0.95-0.97) using WB and 0.88 (95% CI: 0.86-0.90) using plasma. Specificity was 80% for WB and 66% for plasma. Detection rates for TFV disoproxil fumarate/emtricitabine (FTC) formulations were 99% in WB and 98% in plasma, compared to 93% and 86% for the TFV alafenamide/FTC formulation. DISCUSSION:High concordance between self-reported oral PrEP use and TFV detection was observed among PrEP users, suggesting the potential utility of WB as a biomatrix for TFV detection to support screening strategies. Given the expanded eligibility for MSM, who may be PrEP users, to donate blood, further examination of undisclosed PrEP use is important.

This study investigates baseline differences in couples enrolled in the "It Takes Two" HIV prevention intervention for transgender women and their partners, comparing in-person participation pre-COVID-19 and digital participation during the pandemic. Among 52 couples (40% in-person, 60% digital), bivariate analyses revealed that in-person participants were more likely to be African American, have cisgender male partners, report higher unemployment, incarceration histories, greater relationship stigma, and lower relationship quality. The findings highlight the limitations of digital modalities in engaging transgender women of color and those with structural vulnerabilities. The study emphasizes that reliance on digital methods in HIV research jeopardizes the inclusion of those lacking technological access and literacy, especially communities disproportionately impacted by HIV. Researchers must incorporate hybrid or in-person options and engage communities to ensure equity and inclusion, thus overcoming barriers and ensuring comprehensive population reach in HIV prevention studies.

Background:Black sexual minority men (BSMM) in the Southern region of the United States experience a disproportionate burden of HIV. Research findings suggest that having supportive patient-provider relationships are critical for sustained HIV care engagement. The present study explores the role of supportive healthcare providers in the care engagement among BSMM living with HIV (BSMM+) in the US South. Methods:Semi-structured qualitative interviews were conducted with BSMM+ in Texas (n=27) to explore perceived barriers and facilitators of sustained care engagement. Interviews lasted 60 minutes on average, were transcribed, coded, and analyzed using applied thematic analysis. Findings:Participants described how important having relationships with engaged and supportive HIV care and service providers is to sustained engagement in care and positive HIV clinical outcomes. Supportive providers were characterized as non-judgmental, meeting patients' needs, and making patients feel "seen". Less supportive providers were described as making their patients "feel like a number" and having lack of follow through on proposed support and resources. Supportive providers were associated with increased care engagement of their patients while less supportive providers often led to patients switching providers, losing touch with services, and getting off track with their care. Discussion:We found that among BSMM+ an important facilitator of sustained care engagement was having positive, affirming, and knowledgeable healthcare providers, while negative and dismissive experiences with providers was a notable barrier to care engagement. This work highlights the need for a scale up of comprehensive, ongoing trainings in patient-centered and person-first communication for providers. Further, manageable provider caseloads can facilitate more thorough patient interactions where tailored HIV care and education can be provided in a safe and non-judgmental environment.

BACKGROUND Randomized controlled trials in Guinea-Bissau and Uganda have revealed that the intensive promotion of exclusive breastfeeding (EBF) impairs growth in early infancy. When newborn growth is impaired, small amounts of formula may be combined with breastfeeding to promote growth. METHODS To determine if breastfeeding combined with once-daily formula supplementation improves growth among at-risk newborns, we conducted a pilot randomized controlled trial in Bissau, Guinea-Bissau and Kampala, Uganda. We randomly assigned 324 healthy breastfeeding newborns who weighed 2000 g to 2499 g at birth or <2600 g at 4 days old to once-daily formula feeding through 30 days as a supplement to frequent breastfeeding followed by EBF from 31 days through 6 months, or to EBF through 6 months. The primary outcome was weight-for-age z score (WAZ) at 30 days. Other outcomes included weight-for-length z score (WLZ), length-for-age z score (LAZ), breastfeeding cessation, adverse events, and serious adverse events through 180 days. RESULTS Daily formula consumption in the intervention group was 31.9 ± 11.8 mL. The random assignment did not impact WAZ, WLZ, LAZ, breastfeeding cessation, adverse events, or serious adverse events through 180 days. In the intervention and control groups, 19 (12%) and 35 (21%) infants, respectively, reported nonformula supplementation in the first 30 days (P = .02). CONCLUSIONS Once-daily formula supplementation for 30 days was well-tolerated, but the small volume consumed did not alter growth through 180 days of age. Further research would be required to determine if larger formula volumes, longer duration of treatment, or more frequent feeding are effective at increasing growth for this at-risk population.

Despite the high prevalence of low birth weight infants in sub-Saharan Africa and the associated poor outcomes, weight change during the newborn period has not been well characterized for this population. We prospectively assessed growth over the first 30 days among 120 infants born < 2000 g (g) in Guinea‐Bissau and Uganda, and compared it to a similar cohort of 420 infants born ≥ 2000 g. Among those born < 2000 g, mean birth weight was 1747 ± 164 g, and initial weight loss was 8.25 ± 4.40% of birth weight prior to the initiation of weight gain at a median of 3 (interquartile range 2, 4) days of age. This initial weight loss was more pronounced (8.25 vs 6.06%; p < 0.001) and lasted longer (median 3 vs 2 days; p < 0.001) than for infants born ≥ 2000 g. The initial period of weight loss was an important predictor of growth at 30 days in both cohorts. Infants born < 2000 g on average grew proportionately to their size at birth but did not experience catch-up growth; their weights at 30 days remained much lower than that of infants born ≥ 2000 g and most remained severely underweight. Targeted interventions to optimize early growth should be investigated.

Objectives: Low birth weight (LBW) and early feeding patterns impact neonatal growth, yet there< is little data examining the relationship between feeding patterns and growth among LBW infants in low- and middle-income countries (LMIC). We assess relationships between feeding patterns and weight in the neonatal period among newborns with birth weight < 2000 g in Guinea-Bissau (N=60) and Uganda (N=60). Methods: 120 singleton infants with birthweights < 2000 g were enrolled between March 2020 and January 2021. Feeding and weight were recorded at 1, 2, 3, 4, 5, 12, and 30 days of age. Among the 104 neonates followed to Day 30, we examined 4 feeding parameters: any feeding in the first 24 hours, number of breastfeedings in first 24 hours, any formula in the first 30 days, and supplemental feeding (anything other than breastmilk) in the first 30 days. We assessed the relationship between the feeding and weight change using chi-square statistics, student's t-tests, and Pearson correlation coefficients. Results: Mean birth weight was 1758 ± 159 g (range 1210-1995). All infants initially experienced weight loss; weight gain began at a median of 3 days of age. At 5 days and 30 days of age, mean weight was 1674.3± 196.8 g and 2332.62 ± 452.1 g, respectively. In this cohort, during the first 30 days, all infants were breastfed and 23% also received supplementation. Notably, 12% received no feedings at all in the first 24 hours (22% in Uganda and 2% in Guinea-Bissau (p=.001)). Neither timing of feeding initiation nor supplemental feeding were associated with weight change over the first 30 days. Number of breastfeedings in the first 24 hours correlated with weight (r=0.267, p=0.005) and with weight change (r=0.222, p=0.020) at 5 days of age, although not at 30 days of age (r=0.117 and r=0.095, respectively). Among Uganda infants only, the day 30 correlations were 0.277 (p=.043) and 0.267 (p=.051), respectively. Conclusions: Number of breastfeedings in the first 24 hours of life significantly correlated with weight at day 5 and, for Uganda infants, at day 30. Further research should describe how breastfeeding in the first 24 hours of life affects long-term growth and outcomes among LBW infants in LMIC. Funding Sources: Bill and Melinda Gates Foundation.

BACKGROUND:Online surveys can align with youth's increased use of the internet and can be a mechanism for expanding youth participation in research. This is particularly important during the coronavirus disease 2019 (COVID-19) pandemic, when in-person interactions are limited. However, the advantages and drawbacks of online systems used for research need to be carefully considered before utilizing such methodologies. AIM:To describe and discuss the strengths and limitations of an online system developed to recruit adolescent girls for a sexual health research study and conduct a three-month follow up survey. METHODS:This methodology paper examines the use of an online system to recruit and follow participants three months after their medical visit to evaluate a mobile sexual and reproductive health application, Health-E You/Salud iTuTM, for adolescent girls attending school-based health centers (SBHCs) across the United States. SBHC staff gave adolescent girls a web link to an online eligibility and consent survey. Participants were then asked to complete two online surveys (baseline and 3-month follow-up). Surveys, reminders, and incentives to complete them were distributed through short message service (SMS) text messages. Upon completing each survey, participants were also sent an email with a link to an electronic gift card as a thank-you for their participation. Barriers to implementing this system were discussed with clinicians and staff at each participating SBHC. RESULTS:This online recruitment and retention system enabled participant recruitment at 26 different SBHCs in seven states across the United States. Between September 2021 and June 2022, 415 adolescent girls were screened using the Qualtrics online survey platform, and 182 were eligible to participate. Of those eligible, 78.0% (n = 142) completed the baseline survey. Participants were racially, geographically, and linguistically diverse. Most of the participants (89.4%) were non-White, and 40.8% spoke Spanish. A total of 62.0% (n = 88) completed the 3-month follow-up survey. Limitations of this system included reliance on internet access (via Wi-Fi or cell service), which was not universally available or reliable. In addition, an individual unrelated to the study obtained the survey link, filled out multiple surveys, and received multiple gift cards before the research team discovered and stopped this activity. As a result, additional security protocols were instituted. CONCLUSION:Online systems for health research can increase the reach and diversity of study participants, reduce costs for research personnel time and travel, allow for continued study operation when in-person visits are limited (such as during the COVID-19 pandemic), and connect youth with research using technology. However, there are challenges and limitations to online systems, which include limited internet access, intermittent internet connection, data security concerns, and the potential for fraudulent users. These challenges should be considered prior to using online systems for research.

Importance Blood donor selection policies should be evidence-based. Individual risk assessment allows potential donors to be evaluated based on their own behaviors.Objective The Assessing Donor Variability and New Concepts in Eligibility (ADVANCE) study examined behavioral and biomarkers of HIV risk in sexually active men who have sex with men (MSM) to estimate the proportion of the study population who would not be deferred for higher risk HIV sexual behaviors and might be eligible to donate.Design A cross-sectional assessment of sexually active MSM interested in blood donation. Setting: An 8-city study of MSM aged 18 – 39 years assigned male sex at birth.Interventions or Exposures Participants completed surveys during 2 study visits to define eligibility, self-reported sexual and HIV prevention behaviors. Blood was drawn at study visit 1 and tested for HIV and the presence of tenofovir, 1 of the drugs in oral HIV pre-exposure prophylaxis (PrEP).Main Outcomes and Measures Associations between HIV infection status or HIV PrEP use and self-reported HIV risk behaviors, including number of male sex partners, new partners, and anal sex.Results Among 1788 screened MSM, 1593 were eligible and 1566 completed the visit 1 HIV risk questionnaire and blood draw. A median of 22 days later, 1197 completed the visit 2 follow-up questionnaire. Four individuals tested HIV positive (0.25%). Among HIV-negative participants, 789 (50.4%) reported no PrEP use in the past 3 months. The number of sex partners in the past 3 months was significantly higher among PrEP users versus non-users, as was the number reporting a new male sex partner in the same period. Among HIV-negative, non-PrEP using participants, 66.2% reported only 1 sexual partner or no anal sex and 69% reported no new sexual partners or no anal sex with a new partner in the past 3 months.Conclusion and Relevance Among sexually active MSM, there are subgroups who self-report no new sexual partners and only 1 sexual partner within the past 3 months. These individuals are likely at lower risk of HIV infection than other MSM and would meet proposed individual risk assessment criteria for blood donation in the U.S.Question Can a set of blood donor screening questions based on individual behaviors identify a population of lower HIV risk men who have sex with men (MSM) who wish to donate blood?Findings In this cross-sectional study of 1566 enrolled MSM, among 1562 persons without HIV, 789 (50.4%) were not taking pre-exposure prophylaxis (PrEP). Of those not taking PrEP, 66.2% reported only 1 sexual partner or no anal sex and 69% reported no new sexual partners or no anal sex with a new partner in the past 3 months.Meaning Potential blood donor history questions were able to identify sexually active MSM with lower-risk sexual behaviors who may be eligible to donate blood.### Competing Interest StatementThe authors have declared no competing interest.### Funding StatementThis study was funded by the U.S. Food and Drug Administration### Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:The Advarra Institutional Review Board (Columbia, MD) gave ethical approval for this work under protocol number 00043278.I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.YesData from this study are not openly available. Authors should be contacted to discuss data availability.

We evaluated the psychometric properties of a measure consisting of items that assess current HIV care continuum engagement based on established definitions in the United States. At baseline, participants in this longitudinal study, which included three time points from 2015 to 2020, were 331 young Black sexual minority men ages 18–29 living with HIV in the southern United States residing in two large southern cities. Self-report items reflected four aspects of HIV care continuum engagement as binary variables: seeing a healthcare provider for HIV care, being on antiretroviral treatment, being retained in HIV care, and being virally suppressed. Of these, the following three variables loaded onto a single factor in exploratory factor analysis: being on antiretroviral treatment, being retained in HIV care, and being virally suppressed. A one-dimensional factor structure was confirmed using confirmatory factor analyses at separate time points. Additionally, the three items collectively showed measurement invariance by age, education level, employment status, and income level. The three-item measure also showed reliability based on coefficient omega and convergent validity in its associations with indicators of socioeconomic distress, depression, resilience, and healthcare empowerment. In sum, the items performed well as a single scale. The study demonstrated the potential psychometric strength of simple, feasible, commonly administered items assessing engagement in the HIV care continuum.

Young Black sexual minority men (YBSMM) living in the US South are among those most disproportionately impacted by HIV in the USA. This health inequity is, in part, due to lower rates of sustained engagement in the HIV care continuum, resulting in a lower prevalence of viral suppression and higher overall community-level viral load. Social, structural, and economic inequities have previously been linked with poorer HIV care engagement among YBSMM. HIV-related social support, individual-level resilience, and healthcare empowerment have been shown to be independently associated with improved HIV care engagement. The current study sought to assess the relative contribution of individual, structural, and economic factors on engagement in HIV care and to elucidate the potentially mediating role of healthcare empowerment. Data from 224 YBSMM with HIV in the US South indicated that greater levels of socioeconomic distress, intimate partner violence, and depressive symptoms were associated with lower levels of engagement in HIV care, while greater levels of individual-level resilience and healthcare empowerment were associated with higher levels of HIV care engagement. Importantly, healthcare empowerment mediated the association between resilience and engagement in HIV care and the association between social support and engagement in HIV care. Findings emphasize the critical role that HIV-related social support plays in fostering resilience and overcoming syndemic factors to promote empowerment and engagement in HIV care for YBSMM in the USA.

BACKGROUND:HIV disparities continue to be a significant challenge affecting Black sexual minority men in the United States. Inadequate engagement and retention of patients in HIV care has been associated with poor health outcomes. Interventions to improve sustained commitment to HIV care are needed. Mobile health interventions can help facilitate access to and use of HIV health services, particularly among individuals at risk for disengaging with care.OBJECTIVE:We designed the LetSync app wireframes for a mobile health intervention using a couple-centered design approach to improve HIV engagement and treatment among Black sexual minority men and their partners. The objective of this study was to gauge future app user interest and elicit feedback to improve the design, development, and usability of the LetSync app.METHODS:We conducted in-depth interviews with 24 Black sexual minority men to assess the acceptability of the LetSync app wireframes between May 2020 and January 2021. Participants reviewed the LetSync app wireframes and provided feedback regarding perceived usefulness and interest in future app use and suggestions for improvement.RESULTS:Participants indicated interest in the future LetSync app and noted that the wireframes' features were acceptable and usable. In our study, the future LetSync app was frequently referred to as a potential resource that could help facilitate users' engagement in HIV care through the following mechanisms: enable scheduling of appointments and timely reminders for clinic visits; help improve HIV medication adherence; encourage and motivate participants to ask questions to their health care provider and stay engaged in conversations during clinic visits; facilitate effective communication by assisting couples with planning, coordination, and management of daily routines; help participants understand their partner's health needs, including access to and use of health care services; and facilitate participants' ability to improve their relationship skills, partner support, and self-efficacy in managing conflict. In addition to near-universal interest in potential daily app use, study participants indicted that they would recommend the LetSync app to other family members, friends, and people in their social networks who are living with HIV.CONCLUSIONS:Our findings revealed considerable interest in future app use for HIV care management, which could possibly increase the chance of the LetSync app being successfully adopted by Black sexual minority men in couples. Owing to its interactive and couple-centered approach, the LetSync app could help improve communication between Black sexual minority men and their partners and health providers. In addition, the LetSync app could provide an acceptable modality for these men to receive support in accessing HIV care services.

BACKGROUND:Individual risk assessment allows donors to be evaluated based on their own behaviors. Study objectives were to assess human immunodeficiency virus (HIV) risk behaviors in men who have sex with men (MSM) and estimate the proportion of the study population who would not be deferred for higher risk HIV sexual behaviors. STUDY DESIGN AND METHODS:Cross-sectional survey and biomarker assessment were conducted in eight U.S. cities. Participants were sexually active MSM interested in blood donation aged 18-39 years, assigned male sex at birth. Participants completed surveys during two study visits to define eligibility, and self-reported sexual and HIV prevention behaviors. Blood was drawn at study visit 1 and tested for HIV and the presence of tenofovir, one of the drugs in oral HIV pre-exposure prophylaxis (PrEP). Associations were assessed between HIV infection status or HIV PrEP use and behaviors, including sex partners, new partners, and anal sex. RESULTS:A total of 1566 MSM completed the visit 1 questionnaire and blood draw and 1197 completed the visit 2 questionnaire. Among 1562 persons without HIV, 789 (50.4%) were not taking PrEP. Of those not taking PrEP, 66.2% reported one sexual partner or no anal sex and 69% reported no new sexual partners or no anal sex with a new partner in the past 3 months. CONCLUSION:The study found that questions were able to identify sexually active, HIV-negative MSM who report lower risk sexual behaviors. About a quarter of enrolled study participants would be potentially eligible blood donors using individual risk assessment questions.

There is limited research examining depression and contraceptive use among adolescent females. To address this gap, this study assessed the relationship between depression and non-barrier contraceptive practices, contraceptive self-efficacy, and sexual behaviors among sexually active adolescent females. It was hypothesized that a positive depression screen would be associated with lower use and inconsistent use of non-barrier contraception in the last three months, and with lower contraceptive self-efficacy. Sexually active adolescent females from 32 school-based health centers (SBHCs) in seven states were recruited as part of a study to assess an intervention designed to promote patient-centered contraceptive care. We assessed the cross-sectional associations of a positive screening for depressive symptoms (sum score >3 on the Patient Health Questionnaire-2 or PHQ-2) with non-barrier contraception practices, sexual health behaviors (number of partners, frequency of sex), and self-efficacy for using contraception (three item scale, range 0-30, α=0.76). Chi-square statistics and t-test were used to assess the bivariate relationships. A total of 142 sexually active adolescent females completed the baseline survey. The mean age was 16.7 and nearly half (49.3%) were Hispanic/Latina. Most (85.9%) indicated it was very important to avoid becoming pregnant, although 50.0% were not using any form of non-barrier contraception at the time of their SBHC visit and another 11.3% participants were not using non-barrier contraception method as prescribed. On the PHQ-2, 23.2% screened positive for depressive symptoms. Compared to their negative counterparts, participants who screened positive for depressive symptoms reported less non-barrier contraceptive use in the past three months (39.4% vs. 53.8%, p=0.149), a lower mean contraceptive self-efficacy score (22.6 vs. 24.8, p=0.65), and a lower mean frequency of vaginal sex in the last three months (7.7 vs. 11.9, p=0.060); however, the associations did not reach statistical significance. Results from this preliminary data indicate that many adolescents, who are coming in for care at SBHCs, are both at risk of unintended pregnancy and have mental health needs. Further, data suggests a relationship between depressive symptoms and lower rates of contraception use and lower self-efficacy. While the associations only approached significance, this is likely due to the small sample size and the limitations of a two-question mental health assessment. The mental health crisis in a post-pandemic world has significant implications across multiple domains of adolescent health; however, these relationships have not been adequately explored. This study suggests that the risk of unintended pregnancy in adolescence may be related to depression. This and future research can inform interventions to address both depression and contraceptive use among adolescents which can ultimately lead to reducing rates of unintended pregnancy.

There is a dearth of research on incarceration among young Black sexual minority men (SMM). The current study aimed to assess the prevalence and association between unmet socioeconomic and structural needs and history of incarceration among young Black SMM. Between 2009 and 2015, young Black SMM (N = 1,774) in Dallas and Houston Texas were recruited to participate in an annual, venue-based, cross-sectional survey. We found that 26% of the sample reported any lifetime history of incarceration. Additionally, participants with unmet socioeconomic and structural needs (unemployment, homelessness, financial insecurity and limited educational attainment) were more likely to have a history of incarceration. It is imperative that interventions are developed to address the basic, social, and economic needs of young Black SMM with a history of incarceration or who are at risk for incarceration.

Young Black Sexual Minority Men with HIV (YBSMM+) in the US South encounter multiple socio-structural challenges that contribute to disproportionately poor HIV-related outcomes across the care continuum. Depression, anxiety, intimate partner violence (IPV), and alcohol use are prominent factors that negatively impact engagement with HIV care. Syndemic theory posits that these multiple factors interact synergistically to promote poor outcomes; however, depression itself is highly heterogeneous in presentation, which may pose issues when examining associations to HIV care engagement. This study sought to better understand the associations of specific depressive symptomology subtypes, generalized anxiety, experienced IPV, and alcohol use on HIV care engagement for YBSMM+. Results showed that interpersonally oriented depressive symptomatology was associated with increased HIV care engagement among YBSMM + who abstained from alcohol. On the other hand, among YBSMM + who frequently binge drank, combined negative affect and somatic components of depressive symptomatology and frequency of IPV experiences were associated with decreased HIV care engagement while generalized anxiety was associated with increased HIV care engagement. The findings suggest that the negative affect and somatic components of depression may be particularly salient for HIV care engagement among YBSMM + who binge drink frequently. Developing targeted interventions that address these specific conditions while accounting for the nuances of mood-based symptomatology could improve intervention efforts geared towards improving HIV care engagement among YBSMM+. Los jovenes afroamericanos de minorias sexuales con VIH en el sur de Estados Unidos enfrentan diversos desafios socioestructurales que contribuyen a resultados desfavorables, de manera desproporcionada, en lo que respecta a su atencion medica relacionada con el VIH. La depresion, la ansiedad, la violencia en las relaciones intimas, y el consumo de alcohol son factores destacados que afectan negativamente su involucramiento en el cuidado del VIH. La teoria sindemica sugiere que estos multiples factores interactuan de manera sinergica para promover resultados deficientes; sin embargo, la depresion, en si misma, se presenta de manera muy variada, lo que puede plantear desafios al examinar las conexiones con la atencion medica del VIH. Este estudio tuvo como objetivo mejorar la comprension de como los subtipos especificos de sintomas depresivos, la ansiedad generalizada, la experiencia de violencia en relaciones intimas, y el consumo de alcohol se relacionan con la atencion medica del VIH en estos jovenes. Los resultados revelaron que los sintomas depresivos relacionados con las relaciones personales se asociaron con un mayor involucramiento en la atencion medica del VIH en aquellos que no consumian alcohol. Por otro lado, entre aquellos que consumian alcohol en exceso con frecuencia, la combinacion de afecto negativo y aspectos fisicos de los sintomas depresivos, asi como la frecuencia de experiencias de violencia en relaciones intimas, se relacionaron con un menor involucramiento en la atencion medica del VIH, mientras que la ansiedad generalizada se asocio con un mayor involucramiento en la atencion medica del VIH. Estos hallazgos sugieren que los aspectos negativos y fisicos de la depresion pueden ser especialmente relevantes para el involucramiento en la atencion medica del VIH en aquellos jovenes que consumen alcohol en exceso con frecuencia. Desarrollar intervenciones dirigidas que aborden estas condiciones especificas, teniendo en cuenta las complejidades de los sintomas relacionados con el estado de animo, podria mejorar los esfuerzos de intervencion destinados a mejorar el involucramiento en la atencion medica del VIH en este grupo.