Latino/Hispanic young men who have sex with men (YMSM) are disproportionally affected by the HIV epidemic in the US and Puerto Rico. National efforts to reduce new HIV cases and improve healthcare have been implemented. Yet, the success of these efforts depends on overcoming social determinants of health such as HIV and gay related stigma that act as barriers. HIV related stigma has been identified as a major obstacle to HIV prevention, treatment as well as a detriment to the quality of life of people with HIV. Previous studies have shown that HIV-positive Hispanic/Latino YMSM have had little participation or inclusion in HIV prevention interventions and programs. In Puerto Rico this is more evident, since effective interventions for this population are yet to be developed. As a stepping-stone, recent efforts have developed and proven feasible for an individual-level intervention (Contacto) for HIV-positive MSM in Puerto Rico. In order to fill the research gap aimed to understand and reduce the barriers to achieve optimal care among a high impacted group (HIV- positive YMSM) and in response to the call of the HIV National Strategy and HIV Care Continuum initiative, we propose the following aims: 1) Conduct a formative research for the development of a group-level intervention for Spanish-speaking HIV+ YMSM in Puerto Rico. 2) Develop and pilot-test a stigma- management group-level intervention, through the adaptation of Contacto intervention and formative research information (from Aim 1) to reduce HIV felt and gay stigma, increase levels of social support, improve access and retention in care, and improve adherence to care. 3) Assess the feasibility of implementing a stigma-management group-level intervention for Spanish-speaking HIV+ YMSM in Puerto Rico. 4) Conduct an interpretative policy analysis to address structural strengths and barriers that impact HIV services provision for HIV+ YMSM in Puerto Rico. To achieve these aims we have designed a combined strategies approach using group-level intervention and interpretative policy analysis. Findings will inform future research to evaluate the efficacy of the intervention to impact the HIV epidemic among groups of YMSM and develop strategies for policy agenda to improve HIV service provision at a structural level. 0925-0001/0002 (Rev. 08/12) Page Continuation Format Page
Consistent with the National HIV/AIDS Strategy's call to reduce HIV-related disparities and health inequities ? including stigma and discrimination based on HIV status, we propose to combine strategies to improve health outcomes among HIV-positive YMSM in Puerto Rico. The proposed combination of interventions will yield important information on developing and implementing a stigma-management group-level intervention among Spanish-speaking HIV-positive YMSM in Puerto Rico as well as of the participation of this group in adopting structural approaches to improve health outcomes in communities at increased risk.
