Role of Structural Marginalization, HIV Stigma, and Mistrust on HIV Prevention and Treatment Among Young Black Latinx Men Who Have Sex with Men and Transgender Women: Perspectives from Youth Service Providers

Abstract

Young black and Latinx men who have sex with men (YBLMSM) and transgender women (YBLTW) are disproportionately impacted by HIV. Structural and social marginalization, the social barriers, and structures that unevenly distribute benefits and burdens to different groups, may contribute to inability for youth to access prevention and treatment care services. Yet, few reports have examined the community and health care experiences of social marginalization among youth service providers who have multiple roles in the community (i.e., serve as a service provider and are a member or prior member of the YBLMSM and YBLTW population).Eighteen key informants (KIs), defined as youth, young adults, or adults who were members of or connected to the YBLMSM and young black and Latinx transgender (YBLTG) community, participated in a one-time, faceto-face, or telephone key informant interview (KII) lasting *45 min. KIs were defined as youth service providers because they described working with the target population and either being a member of or closely connected to the target population. KIs described key themes related to marginalization: lack of competent care among health care providers and both clinical and community spaces that left out key populations. HIV stigma and medical mistrust continues to create a barrier to care in this population and for interventions to be effective interventions will need to use an intersectional approach that simultaneously address all identities, and the social and structural needs of youth.

An evaluation of assumptions underlying respondent-driven sampling and the social contexts of sexual and gender minority youth participating in HIV clinical trials in the United States

“…Consistent with RDS recommendations and best practices,[24] RDS implementation was informed by formative research conducted among 18 key informants across the three cities. [18] Once PUSH launched, recruitment followed standard RDS procedures[2] with ongoing recruitment monitoring but added the following modifications for youth, based on prior studies. [13] Eligible and participating youth were offered electronic coupons (e-coupons) with which to recruit peers.…”

“…[16] The violation of these assumptions on population interferences has been explored in reviews and simulation studies,[17] though less is known about individual participant experiences and behaviors that may challenge these assumptions, particularly how the social context of limited disclosure, stigma, and racism experienced in Black and Latinx SGMY (BLSGMY) may impact RDS assumptions. [18]…”

Multilevel Barriers to HIV PrEP Uptake and Adherence Among Black and Hispanic/Latinx Transgender Women in Southern California

“…Experiences of social marginalization on the basis of gender, class, race, sexual identity, poverty, and the intersection of these identities and experiences may contribute to increased vulnerability to HIV infection among Black and Hispanic/Latinx transgender women [ 18 ]. Although several studies have investigated barriers and facilitators to PrEP uptake among transgender women, there is a dearth of research on multilevel barriers to PrEP uptake and adherence specifically among Black and Hispanic/Latinx transgender women.…”

Providing Unique Support for Health Study Among Young Black and Latinx Men Who Have Sex With Men and Young Black and Latinx Transgender Women Living in 3 Urban Cities in the United States: Protocol for a Coach-Based Mobile-Enhanced Randomized Control Trial

“…Focus group participants suggested that the app include the following components: (1) goal planning for ART adherence and substance use treatment, (2) time reminders, (3) adherence reminders, and (4) adherence support (rewards or points for achieving optimal adherence). Findings from key interviews have been described elsewhere [ 54 ]; however, KIs recommended that the study allow for a longer follow-up time (greater than 4 weeks) for coupons to ensure engagement around recruitment, and suggested that the app has rewards for achievement. KIs suggested that the intervention focused on values (health priorities and personal goals), medication initiation and adherence, medical appointments, alcohol or drug use, and sexual health.…”