JMIR Publications

ABSTRACT

Background:

In order to successfully implement treatment as prevention as a national strategy to end the U.S. HIV/AIDS epidemic., it is crucial to address and bridge gaps in the HIV care continuum. The majority of people living with HIV (PLWH) in the U.S. are men who have sex with men (MSM), with race and ethnicity-based disparities in HIV rates and care continuum. Lower care engagement and retention are influenced by factors that are often beyond the individual. In order to uncover the neighborhood and network-involved pathways that produce disparities in HIV care outcomes, systematic, theory-based investigation of the specific and intersecting neighborhood and network characteristics that relate to retention in care, antiretroviral therapy (ART) adherence, and viral suppression must be engaged.

Objective:

Using socioecological and intersectional conceptual frameworks, we identify individual, neighborhood- and network-level characteristics associated with HIV care continuum outcomes (viral suppression, retention in care, and ART adherence) among MSM living with HIV in New York City.

Methods:

We conduct a longitudinal cohort study among MSM living with HIV in New York City. We assess three neighborhoods of potential influence (residential, social, and healthcare access activity spaces) using Google Earth. We investigate the influence of neighborhood composition (e.g. concentrated poverty, racial segregation) and four neighborhood-level characteristics domains: (1) community violence, physical disorder, and social disorganization (e.g., crime rates, housing vacancy); (2) alcohol and other drug (AOD) use; (3) social norms (e.g., homophobia, HIV stigma, racial discrimination, health norms); and (4) community resources (e.g., HIV prevention services, social services, public transit access). We test theoretical pathways of influence, including stress/coping, stigma/resilience and access to resources, across the different neighborhoods in which MSM live, socialize, and receive HIV care. At each visit we locate each participant’s reported activity spaces (i.e., neighborhoods of potential influence) and collected individual-level data on relevant covariates (including perceptions of/exposure to neighborhoods) and social network inventory data on structure, composition, social support, and perceived social norms. The primary biological outcome of viral suppression is based on HIV viral load testing. The secondary behavioral outcomes are retention in care and ART adherence (self-reported data and pill count). These data are combined with an existing, extensive geospatial database of relevant area characteristics. Spatial analysis and multi-level modeling are used to test main theory-driven hypotheses and capture independent neighborhood-level and network-level effects and changes over time.

Results:

The study began enrollment in March 2019 and concluded visits in December 2023, with a total of 327 participants enrolled. The study has completed, with data analysis currently underway.

Conclusions:

This study will have direct implications for the design of multi-level interventions, addressing factors at the neighborhood, network, and individual levels. Results may inform urban planning and program design to improve HIV care outcomes for MSM, particularly for Black and Latino MSM living in urban areas.