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BackgroundWe examined HIV prevalence and transmission dynamics among people who inject drugs in the U.S./Mexico border region during the COVID-19 pandemic.MethodsPeople who inject drugs aged ≥18 years from 3 groups were recruited: people who inject drugs who live in San Diego (SD) and engaged in cross-border drug use in Tijuana, Mexico (SD CBDUs), and people who inject drugs in SD and Tijuana (TJ) who did not engage in cross-border drug use (NCBDUs). We computed HIV prevalence at baseline and bivariate incidence-density rates (IR) at 18-month follow-up. Bayesian phylogenetic analysis was used to identify local transmission clusters, estimate their age, and effective reproductive number (Re) over time within the clusters.FindingsAt baseline (n = 612), 26% of participants were female, 9% engaged in sex work, and HIV prevalence was 8% (4% SD CBDU, 4% SD NCBDU, 16% TJ NCBDU). Nine HIV seroconversions occurred over 18 months, IR: 1.357 per 100 person-years (95% CI: 0.470, 2.243); 7 in TJ NCBDU and 2 in SD CBDU. Out of 16 identified phylogenetic clusters, 9 (56%) had sequences from both the U.S. and Mexico (mixed-country). The age of three youngest mixed-country dyads (2018-2021) overlapped with the COVID-related US-Mexico border closure in 2020. One large mixed-country cluster (N = 15) continued to grow during the border closure (Re = 4.8, 95% Highest Posterior Density (HPD) 1.5-9.1) with 47% engaging in sex work.InterpretationAmidst the COVID-19 pandemic and the border closure, cross-border HIV clusters grew. Efforts to end the HIV epidemic in the U.S. should take into account cross-border HIV-1 transmission from Tijuana. Mobile harm reduction services and coordination with municipal HIV programs to initiate anti-retroviral therapy and pre-exposure prophylaxisis are needed to reduce transmission.FundingThis research was supported by the James B. Pendleton Charitable Trust and the San Diego Center for AIDS Research.

Individual-level behavior can be influenced by injunctive and descriptive social network norms surrounding that behavior. There is a need to understand how the influence of social norms within an individuals social networks may influence individual-level sexual behavior. We aimed to typologize the network-level norms of sexual behaviors within the social networks of Black sexual and gender minoritized groups (SGM) assigned male at birth. Survey data were collected in Chicago, Illinois, USA, between 2018 and 2019 from Black SGM. A total of 371 participants provided individual-level information about sociodemographic characteristics and HIV vulnerability from sex (i.e., condomless sex, group sex, use of alcohol/drugs to enhance sex) and completed an egocentric network inventory assessing perceptions of their social network members (alters) injunctive and descriptive norms surrounding sexual behaviors with increased HIV vulnerability. We used Latent Profile Analysis (LPA) to identify network-level norms based on the proportion of alters approval of the participant engaging in condomless sex, group sex, and use of drugs to enhance sex (i.e., injunctive norms) and alters engagement in these behaviors (i.e., descriptive norms). We then used binomial regression analyses to examine associations between network-level norm profiles and individual-level HIV vulnerability from sex. The results of our LPA indicated that our sample experienced five distinct latent profiles of network-level norms: (1) low HIV vulnerability network norm, (2) moderately high HIV vulnerability network norm, (3) high HIV vulnerability network norm, (4) condomless sex dominant network norm, and (5) approval of drug use during sex dominant network norm. Condomless anal sex, group sex, and using drugs to enhance sex were positively and significantly associated with higher HIV vulnerability social network norm profiles, relative to low HIV vulnerability norm profiles. To mitigate Black SGMs HIV vulnerability, future HIV risk reduction strategies can consider using network-level intervention approaches such as opinion leaders, segmentation, induction, or alteration, through an intersectionality framework.

The COVID-19 related U.S.-Mexico border-crossing restrictions disrupted social networks and HIV harm reduction services among people who inject drugs (PWID) in San Diego and Tijuana. We assessed associations of descriptive network norms on PWID's HIV vulnerability during this period. Between 10/2020 and 10/2021, 399 PWID completed a behavioral and egocentric questionnaire. We used Latent Profile Analysis to categorize PWID into network norm risk profiles based on proportions of their network (n = 924 drug use alters) who injected drugs and engaged in cross-border drug use (CBDU), among other vulnerabilities. We used logistic and linear regressions to assess network profile associations with individual-level index of HIV vulnerability and harm reduction behaviors. Fit indices specified a 4-latent profile solution of descriptive network risk norms: lower (n = 178), moderate with (n = 34) and without (n = 94) CBDU and obtainment, and higher (n = 93). Participants in higher risk profiles reported more HIV vulnerability behaviors and fewer harm reduction behaviors. PWID's gradient of HIV risk was associated with network norms, warranting intervention on high-vulnerability networks when services are limited.

Despite the availability of pre-exposure prophylaxis (PrEP), Latino sexual minority men (LSMM) continue to experience disparities in PrEP uptake and subsequently, HIV vulnerability. Social network norms are an underutilized solution to increase PrEP uptake. We used a peer influence model (network autocorrelation model) to examine the role of social network descriptive norms (i.e., actual behaviors) surrounding PrEP use. A total of 11 sociocentric networks of 13 friends (n = 143 LSMM) were recruited into our study from 2018 to 2019 in South Florida. Most participants were in PrEP pre-contemplation (n = 44), and almost one-third of our sample were using PrEP (n = 38). Three network autocorrelation models were estimated using an empirically informed Bayesian analysis. We found a positive association between participants' Motivational PrEP Cascade (MPC) position and their network members' (friends') cascade position based on three different measures of connection even when accounting for PrEP knowledge: friendship (ρ = 0.22; 95% CI = 0.01–0.42), emotional closeness (ρ = 0.24; 95% CI = 0.03–0.44), and frequency of interaction (ρ = 0.22; CI = 0.03–0.42). Our findings highlight that an individual's progress in the MPC may be influenced by their network members' progress in the MPC, suggesting that LSMM using PrEP may serve as role models to their peers for PrEP use due to descriptive norms. Our findings further suggest that PrEP interventions for LSMM along the MPC can be implemented at the social network level. [ABSTRACT FROM AUTHOR]

To examine the associations between COVID-19-related living arrangements and sexual and gender minority (SGM)-related stressors (ie, identity concealment and familial rejection). N = 478 SGM university students (Mage = 22 years, SD = 4.00). SGM university students were surveyed cross-sectionally between May and August 2020 regarding SGM-related stressors and living arrangements since the start of COVID-19. Approximately half (48.7%) of the sample reported a living rearrangement to their parents' home due to COVID-19. Living rearrangement to parents' homes was associated with an increased degree of identity concealment (β [95% C.I.] = 0.62 [0.10, 1.15]; p =.020) and familial rejection (β [95% C.I.] = 1.56 [0.72, 2.41]; p <.001) since the start of COVID-19 compared to stably living without parents (34.3%). Stably living with parents (17.0%) was not associated with increased degree of SGM-related stressors compared to experiencing a living rearrangement. Stakeholders must consider the unique identity-related vulnerabilities of SGM students living with parents and who experience living rearrangements due to COVID-19. [ABSTRACT FROM AUTHOR]

Latina Seasonal Farmworkers (LSFW) in South Florida are a community affected by human immunodeficiency virus (HIV) due to cultural barriers, stigma, and lack of awareness of pre-exposure prophylaxis (PrEP). Building on the PROGRESO study, this study sought to: (1) develop and pre-test scientifically supported and culturally tailored PrEP materials for PROGRESO and (2) assess the acceptability of these PrEP materials by LSFW who use alcohol and/or drugs. PrEP messages were selected based on a literature review, feedback from experts working on PrEP programs, and recommendations from a four-member scientific expert panel through a two-level Delphi method. A culturally tailored PrEP presentation was developed and presented to sixteen LSFW, who engaged in four focus groups. Materials were modified based on participants' suggestions. Thematic analysis was used to assess the acceptability and usability of these materials in the LSFW community. Participants responded positively to the PrEP messages and understood their importance for Latinx communities. Participants felt empowered and comfortable enough with the information to distribute the messages to partners, children, and friends with the aid of a physical pamphlet or flyer. A strong cultural context of familialismo and confianza was present in comments made by our participants. This study has the potential to increase LSFW's PrEP awareness and initiation. Future studies may implement a hybrid-interview approach, allowing individuals to self-select into a virtual or in-person focus group. Such flexibility may increase participation and discussion by allowing participants to attend in a format they are most comfortable with, as noted by participants in this study. [ABSTRACT FROM AUTHOR]

Little is known about polydrug use among Latino seasonal farmworkers. This cross-sectional study with male Latino seasonal workers (LSWs) living in South Florida categorized distinct classes of drug use and then characterized each drug use typology by demographic, structural, and psychological factors. One hundred and twenty-five male LSWs were recruited during community events using convenience sampling between July 2019-March 2020. Latent class analysis was conducted by leveraging measures of self-reported use of nine drugs in the past year (sedatives, cannabis, stimulants, heroin, opioids, cocaine, PCP, hallucinogens, and inhalants). Correlates of latent class membership were examined using 3-step categorical latent variable logistic regression. Analyses were performed using Mplus version 8 and SAS 9.4. Four drug use classes were identified, male LSWs who exhibited: 1) use of illegal opioids only (n = 32); 2) concurrent cannabis and cocaine use (n = 75); 3) concurrent sedative and cannabis use (n = 13); and 4) high concurrent drug use (n = 5). About 84.7% of the sample reported use of at least one drug in the past 12 months. LSWs who identified as White and were married or in a stable relationship were likely to only use illegal opioids. LSWs with less than high school education and self-reported good to excellent health were more likely to use cannabis and cocaine. Men with moderate to severe anxiety and self-reported bad health were classified as engaging in sedative and cannabis co-use. Survivors of physical abuse were more commonly classified as people using high concurrent substances relative to non-abused men among the four classes. This pilot study suggests the presence of heterogeneity in polydrug use classes among LSWs in South Florida. [ABSTRACT FROM AUTHOR]

US female Latina seasonal farm workers (LSW) are a medically underserved community experiencing severe health disparities. We explored the relationship between alcohol and prescription medication, and LSW social networks using a qualitative approach. In 2015, this study used convenience sampling to recruit 28 LSWs in South Florida for three focus group discussions in Spanish. Focus groups were translated to English for analysis, which employed a general inductive approach. Themes included prescription medication distribution within networks, spirituality/religion practice with friends and family, and alcohol use with friends. Substance abuse prevention and treatment interventions should account for the unique needs of LSW. [ABSTRACT FROM AUTHOR]

Despite the development of targeted interventions for men who have sex with men, this population continues to comprise the majority of new HIV diagnoses. Though condoms are highly efficacious, some sexually active MSM use sero-sorting as a method of HIV prevention. This study aimed to characterize: (1) differences between partner sero-status and condom use likelihood, and (2) demographic, behavioral, and knowledge-related factors influencing condom use likelihood with varying sero-status partners. Using convenience sampling, 150 sexual and gender minority men completed a survey on PrEP and sexual behaviors. The majority of participants identified as racial/ethnic minorities (51.7%), having 4 years of college or more (52.0%), and being HIV-negative (not on PrEP) (68.8%). Our sample reported the lowest average condom use likelihood with a partner on PrEP (2.93 ± 1.39) and the highest average likelihood with an HIV-positive partner (unknown VL) (4.57 ± 0.98). Age, race/ethnicity, education, HIV-status, and HIV and PrEP knowledge were significantly associated with differences in condom use likelihood. Our findings elucidate the complexity of sero-sorting scenarios and decision-making processes in the context of biomedical HIV prevention. These results may provide insight for future condom use and sero-sorting interventions in the context of biomedical HIV prevention. [ABSTRACT FROM AUTHOR]