Innovative Interventions to Improve Health Outcomes Across the HIV Prevention and Care Continuum Among Hispanic People Living in the United States and Puerto Rico

According to the US Census Bureau, individuals who identify as Latino, Hispanic, or of Latino descent account for approximately 19.5% of the US population as of July 2023¹ and the largest ethnic minority group in the United States. Hispanics continue to experience poor health outcomes compared with other groups.^2–4 These disparate health outcomes are rooted in social determinants of health including receiving inadequate health care because of language barriers, rising medical costs, socioeconomic status, being uninsured or underinsured, and fears related to stigma and discrimination.^5–9 Notably, these barriers continue to fuel the ongoing HIV epidemic among Hispanic communities.^3,10

Innovative strategies to increase awareness of and access to effective biomedical strategies including preexposure prophylaxis (PrEP) for HIV prevention and antiretroviral therapy for HIV care are needed. This need is emphasized for Hispanics living in geographic regions with high HIV incidence, such as Puerto Rico and counties throughout Florida and California.^10,11 Furthermore, Hispanic sexual minority men continue to account for a disproportionate number of new HIV diagnoses each year,³ highlighting an ongoing disparity that exists within the Hispanic community.

In this supplement of AJPH, sponsored by the Center for Latino Health Research Opportunities (CLaRO), the authors offer a comprehensive and timely exploration of innovative approaches to improving HIV outcomes among Hispanics. By addressing systemic challenges and presenting novel, community-driven solutions, this supplement aims to advance effective strategies that improve public health outcomes across the HIV prevention and care continuum. These articles provide innovative and practical lessons learned from community-engaged research, complementing existing epidemiological studies by offering grounded, real-world insights into interventions designed to improve HIV outcomes in Hispanics.

The special supplement begins with an editorial by De La Rosa et al. (p. S4), which highlights CLaRO’s founding mission and accomplishments, including details about their training and mentoring program designed to strengthen the career development of fellows and early stage investigators working in the field of preventing the syndemic of substance abuse, violence/trauma, and HIV/AIDS (SAVA).

Studies in this supplement span the HIV continuum—from prevention to care—and employ creative strategies to engage families, friendship networks, and communities in critical HIV services. By using a community-based participatory approach and implementation science frameworks, these projects ensure community members play an integral role in program design, implementation, and evaluation, and contribute to strengthening program sustainability, scalability, and long-term impact.

Lozano et al. (p. S22) describe lessons learned from the implementation of eHealth Familias Unidas, a family-based program for Hispanic parents and adolescents to support the prevention of substance use, sexual risk behaviors, and sexually transmitted infections. The article contributes innovative strategies to effectively implement family-based programs in pediatric primary care settings for the prevention of substance use, sexual risk behaviors, and sexually transmitted infections.

Johnson et al. (p. S28) presents the implementation of a community-developed and -implemented HIV prevention program for men in South Florida. This study adds to the current implementation science literature by offering one of the first mixed-methods evaluations of a community-based PrEP navigation program tailored for Hispanic and non-Hispanic men in South Florida, a region with persistently high HIV incidence. This study also advances the field by providing actionable, context-specific guidance for scaling and sustaining equitable PrEP programs in high-need, underrepresented communities.

Simchick et al. (p. S32) shared the lessons learned from implementing a social network strategy to disseminate HIV self-test kits, PrEP, and HIV resources through peer delivery. By engaging community members via people with HIV who are already in care, the intervention leverages existing relationships and the lived experiences of people with HIV in combination with the accessibility and privacy of self-test kits, to reach individuals who otherwise may not seek prevention services. This article shows the potential impact of community-based, social network‒based strategies in delivering essential resources for HIV prevention and engagement in care.

Despres et al. (p. S10) present preliminary insights into the acceptability of using game-based strategies to improve HIV and PrEP knowledge among Hispanic men who qualify for PrEP use. This article shows how multicomponent game-based PrEP and HIV prevention interventions may address implementation gaps related to PrEP and HIV prevention engagement among this priority population.

Yonko et al. (p. S36) examined whether the effect size of Positive STEPS, an intervention to improve antiretroviral therapy adherence and viral suppression among adolescents and young adults with HIV, was moderated for participants who self-identified as Hispanic compared with those who did not identify as Hispanic. This article contributes novel evidence on the use of a stepped-care behavioral intervention to improve HIV treatment outcomes among Hispanic adolescents and young adults with HIV.

Finally, the Rodriguez et al. report (p. S7) outlines the development of the PrEParados Model, a spatially explicit, social network–based approach designed to engage priority populations in PrEP. The model has proven effective at engaging priority communities in HIV programs. This article shows how this model is adaptable to other teams working to address the HIV epidemic when implementing it using community-engaged approaches.

CLaRO represents a collaborative effort between the University of Miami School of Nursing and Health Studies and Florida International University to advance interdisciplinary research addressing the interrelated conditions of the SAVA syndemic along with associated mental health challenges.

The purpose of this AJPH supplement is to highlight selected innovative, community-centered strategies that show promising results in improving HIV outcomes among Hispanics living in the United States and Puerto Rico. Aligned with CLaRO’s mission, we hope this supplement inspires researchers, practitioners, policymakers, and community leaders and organizations to build upon these lessons to cocreate culturally grounded and sustainable HIV prevention and care services.

17 Years Ago

Barriers to Research and Capacity Building at Hispanic-Serving Institutions: The Case of HIV/AIDS Research at the University of Puerto Rico

Latino researchers face structural, institutional, and cultural barriers to HIV/AIDS research, such as the nature and history of Hispanic-serving institutions, lack of access to research-intensive institutions, limited language and cultural diversity, and methodological limitations to conducting culturally sensitive research. Hispanic-serving institutions have evolved primarily as teaching institutions with the mission of training and educating future professionals who share a language and a cultural heritage and who will become mentors to future generations… Conducting culturally sensitive research places a greater burden on Latino investigators because itis more expensive, labor-intensive, time-consuming, and complex, and it is often not well understood. Risky HIV/AIDS– related behaviors are strongly influenced by cultural factors that must be incorporated as central variables of interest rather than as background or demographic information. Culturally informed research is scarce, which results in a limited knowledge base on Latinos… There is a critical need to expand and enhance research development programs that support racial/ethnic minorities in their pursuit of careers in HIV and mental health research.

From AJPH, Supplement 1 2009, pp. S60, S63

22 Years Ago

Sociodemographic Differences in Access to Care Among Hispanic Patients Who Are HIV Infected in the United States

Hispanic patients who are HIV infected have worse access to care than do White patients. Strategies to remedy this problem necessitate learning the extent to which access to care varies among Hispanic subgroups, so that interventions can be tailored and the most vulnerable population prioritized…. In contrast to prior findings, women in this study reported better access to care than did men. Women had a 67% lower adjusted odds ratio than men of not having a usual source of care at HIV diagnosis. Not having a usual source of care at HIV diagnosis has been associated with delays in care, subsequent hospitalizations, and decreased use of antiretrovirals. Hispanic persons exposed to HIV by drug use and heterosexual sex also were at increased risk for not having had a usual source of care at HIV diagnosis. These results suggest that Hispanic men and Hispanic patients exposed to HIV by drug use and heterosexual sex should receive special attention when interventions to improve access to care for Hispanic patients who are HIV infected are considered.

From AJPH, July 2004, p. 1119–1120