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Geographic disparities in availability of Spanish-language PrEP services among Latino sexual minority men in South Florida

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BACKGROUND: Despite pre-exposure prophylaxis (PrEP) being available in the US for 10 years, Latino sexual minority men (LSMM) continue to experience barriers in accessing PrEP, such as lack of proximate and accessible, culturally-sensitive navigation services. Little is known about disparities in the availability of PrEP navigation services in Spanish-language in the US HIV epicenter of South Florida's Miami-Dade County, where 83% of new HIV diagnoses among Latinos are among foreign-born Latinos. This study examined the relationship between LSMM's immigration and zip code-related characteristics and the availability of Spanish-language PrEP navigation services.
METHODS: From October 2018'August 2019, our community partner, an LSMM-centric HIV prevention organization, recruited 11 sociocentric networks of 13 LSMM, ages 20-39 years and clinically indicated for PrEP, in South Florida using respondent-driven sampling (n=143). Participants completed an interviewer-administered survey focused on demographic/address and immigration-related characteristics. PrEP services were identified using the CDC PrEP Provider Directory and stored in a geographic information system (GIS). We used bivariate analyses to assess the associations between demographic characteristics and immigration and discrimination stress using bivariate analyses. Hierarchical logistic modeling was used to examine associations of individual-level characteristics nested within zip codes, and the availability of PrEP navigation services in Spanish within 1, 2, and 5 miles from participants' home addresses. GIS was used to create maps of PrEP service availability.
RESULTS: A total of 130 participants were grouped into 60 zip codes (ICC=0.969). Of participants, 51% reported birth in the US and 49% in Latin America. Immigration and discrimination stress were significantly higher among LSMM born in Latin America. Latin American-born LSMM were 91% less likely to have Spanish PrEP navigation service availability within 1 mile relative to their US-born counterparts (OR=0.09,95%CI:0.01-0.68). Zip code-level HIV incidence was associated with higher Spanish PrEP service availability within 1 mile (OR=1.68,95%CI:1.17-2.42).
CONCLUSIONS: Spanish-language PrEP navigation services were in high HIV incidence zip codes where LSMM reside, signifying a geographically matched service need, particularly along Miami-Dade's eastern seaboard municipalities. However, LSMM may experience barriers preventing access, possibly related to immigration and discrimination stress. Opportunities to increase access to culturally-sensitive PrEP navigation services are discussed.