Culturally Responsive Outreach and Peer Navigation to Improve HIV Prevention and Care for Latino Gay and Bisexual Men in Atlanta

Abstract

To evaluate the implementation outcomes of a culturally responsive social media outreach campaign and peer navigation program to improve access to HIV status-neutral sexual health services—which encompass both HIV prevention and care, regardless of HIV status—for Latino gay and bisexual men (LGBM) in metropolitan Atlanta. We designed and implemented a social media outreach campaign linked to a peer navigation program. The study included four stages: peer navigator recruitment/training, social media campaign development, program implementation, and exit interviews. Data from social media engagement, intake forms, follow-ups, and exit interviews evaluated reach, effectiveness, acceptability, usability, and patient-centeredness. A total of 70 participants, primarily young, foreign-born, Spanish-speaking, uninsured, and undocumented, enrolled in the study over 6 months. The program facilitated same-day service referrals, providing access to HIV/STI testing, PrEP, and care. Participants reported high acceptability, usability, and patient-centeredness. Factors impacting acceptability included ease of use, practical assistance, effective communication, and empathetic approach of the navigator. A community-informed social media outreach campaign connected with a culturally responsive peer navigation program was very well received by LGBM participants in the Atlanta area and led to successful linkage the HIV status-neutral services. Given the ongoing disparities in HIV prevention and care in this group, further intervention scale-up in the setting of a clinical trial is warranted, to assess its effectiveness in increasing uptake of PrEP and HIV treatment services in this population.

Introduction

Human immunodeficiency virus (HIV) remains a significant public health issue in the USA, particularly in the Southern region, which accounts for over half of new HIV diagnoses, primarily among racial and ethnic minorities and men who have sex with men (Centers for Disease Control and Prevention [CDC], 2024). According to a recent CDC report, 33% of new HIV diagnoses in 2022 were among Latinos (Centers for Disease Control and Prevention [CDC], 2024). Despite overall national progress in reducing HIV incidence (Gandhi et al., 2023), rates among Latino gay and bisexual men (LGBM) have stagnated from 2018 to 2022 (CDC, 2024). This concern is heightened in Georgia, where the Latino population has grown by 31.6% over the past decade, surpassing the national growth rate of 23% (Latino Community Fund Georgia, 2021). In Georgia, new HIV diagnoses among LGBM increased by 21% between 2014 and 2021, compared to a 4% rise among Black populations and stable rates among White populations (Georgia Department of Public Health [GDPH], 2023). Nationally, Georgia ranks third in new HIV diagnoses for LGBM, behind Mississippi and Florida (CDC, 2020). While most new diagnoses are concentrated in Fulton and DeKalb counties, Gwinnett County, where 23% of the population is Latino, has seen a sharp rise in diagnoses (GDPH, 2023; U.S. Census Bureau, 2024). Additionally, several HIV molecular clusters have been identified among LGBM in metropolitan Atlanta (Fulton, DeKalb, Cobb, Gwinnett counties). These occur primarily among adolescents and young adults aged 16–34, with a sizable proportion being foreign-born and underinsured, highlighting the urgent need for tailored, culturally responsive interventions to improve access to HIV prevention and care services. (Hassan et al., 2023).

Despite national progress in reducing HIV incidence, LGBM continue to face unique barriers to HIV prevention and care in Georgia, which our research group has examined in depth (Cantos et al., 2023; Hassan et al., 2023; Saldana et al., 2023). These barriers include low perceived eligibility for services, misinformation about PrEP, language barriers, perceived or actual cost, low rates of health insurance, and fear of deportation or incarceration when accessing services, particularly among undocumented individuals. Intersectional stigma—rooted in homophobia, HIV-related stigma, and anti-immigrant sentiment and policies—further deters engagement. Structural challenges such as inflexible work schedules, lack of transportation, ineligibility of undocumented individuals to obtain a driver’s license, and a shortage of Spanish-speaking providers create additional obstacles to care. Additionally, low self-efficacy in navigating the US healthcare system leads many to disengage before linking to services (Darrow et al., 2009; Guillamo-Ramos et al., 2020; Sandfort et al., 2007). Facilitators for accessing healthcare among LGBM included having Spanish-speaking Latina/o/x providers, engaging community members with lived experience, and offering compassionate, low-cost services that reduce stigma and structural barriers. Additionally, integrating HIV prevention (e.g., PrEP, PEP) and treatment services into a single, seamless continuum—a key principle of the HIV status-neutral approach—ensured that individuals could access care regardless of HIV status without experiencing categorization-based stigma (Cantos et al., 2023; Hassan et al., 2023; Saldana et al., 2023). The status-neutral approach prioritizes universal access to sexual health services, fosters continuity of care, and has been shown to increase engagement, retention, and linkage to both prevention and treatment (CDC, 2022; Myers et al., 2018).

Social media outreach represents an innovative tool to promote sexual health services among Latina/o/x groups, with some campaigns reaching and engaging hundreds to thousands of users. Campaigns such PrEPárate, Tu Amigo Pepe, Sólo Se Vive Una Vez, and Proyecto Protégete have used multimedia platforms including websites, social marketing with mobile applications, and radio to increase awareness and linkage to sexual health services (Galvan et al., 2022; Shah et al., 2021, 2024; Solorio et al., 2016). These and other efforts have led to increased access to HIV testing and prevention strategies in multiple settings (Stafylis et al., 2022; Wray et al., 2023). Similarly, peer navigation interventions have been both acceptable and feasible for Latino individuals (Martinez-Donate et al., 2023), especially when utilizing community-engaged methods that prioritize collaboration between community members, stakeholders, and academic researchers to address local concerns and improve well-being. Programs such as HOLA and Enlaces Por LA Salud have successfully shown increases in HIV testing and care linkage among LGBM using peer navigators (Hightow-Weidman et al., 2025; Rhodes et al., 2020) Although social media outreach and peer navigation have independently increased access to sexual health services (Martinez-Donate et al., 2023; Rhodes et al., 2016; Stafylis et al., 2022; Wray et al., 2023), these strategies are often implemented separately and have rarely been integrated, studied, or evaluated as a combined method to improve access for LGBM to status-neutral HIV services in the Southern USA. A social media campaign can help with outreach and education, but without bilingual support on the receiving end, it may fall short in effectively reaching Spanish-speaking individuals. One example is weCare, a bilingual digital health intervention designed to use social media and peer navigation to support HIV care engagement (Rhodes et al., 2022). However, there remains a gap: Few interventions actively engage LGBM before they enter care or adopt a status-neutral approach that integrates both prevention and treatment. Expanding proactive, culturally tailored models like weCare is essential to ensuring equitable access to HIV services across the care continuum.

To address these gaps, we collaborated with local community-based organizations (CBOs) and health departments to develop a culturally responsive outreach campaign that integrated peer navigation services. This study adapts implementation science approaches based on RE-AIM framework to assess the real-world feasibility, acceptability, and effectiveness of integrating social media outreach with peer navigation (Glasgow et al., 1999). This initiative aimed to improve sexual health education and expand access to HIV status-neutral services for LGBM in metropolitan Atlanta, including tailored referrals for HIV/STI testing, PrEP, and treatment. Our study assessed the program’s reach, effectiveness, acceptability, usability, and patient-centeredness.

Method

Study Design and Overview

This is a multi-method, community-engaged pilot program guided by the RE-AIM framework, assessing implementation outcomes such as reach, effectiveness, timeliness, acceptability, along with usability and patient-centeredness (Glasgow et al., 1999).

Program Overview

The program ran for 6 months (May–October 2023) and combined a social media outreach campaign in Spanish with peer navigation to improve access to HIV status-neutral services for LGBM in metropolitan Atlanta. A bilingual Latino gay peer navigator was recruited through CBO support and underwent intensive training in HIV care and prevention, confidentiality, motivational interviewing, and service referrals. Fidelity to these trainings was assessed. The social media campaign (Meta, TikTok, Grindr) directed participants to the navigator via WhatsApp, text, or direct message via Facebook or Instagram. Examples of the social media campaign can be found on Appendix 1. Reach of the campaign was measured. The navigator provided culturally responsive referrals—defined as sexual health services that prioritized low-barrier organizations specializing in stigma-free, LGBTQ+ care, with Spanish-speaking, bicultural providers and staff at all levels whenever possible, ensuring accessibility for individuals facing immigration-related barriers and financial constraints—for HIV/STI testing, PrEP, and HIV care, with follow-ups varying from single interactions to weeks-long engagement. Implementation outcomes of the navigation program were assessed and included effectiveness, timeliness, acceptability, usability, and patient-centeredness (Fig. 1).

Fig. 1.

Highlights the study design and implementation outcomes of each phase on the right

Navigator Recruitment

We aimed to recruit one peer navigator in collaboration with Latino LinQ, our partnering community-based organization serving LGBTQ+ Latinos in metropolitan Atlanta, and we first delineated selection criteria for the navigator based on direct LGBM input and our previously identified facilitators and preferences for accessing care among LGBM. These criteria included: (1) being Latino, (2) fluency in both Spanish and English, (3) identifying as part of the LGBTQ+ community, and (4) having personal experience with immigration to the USA (Cantos et al., 2023; Hassan et al., 2023; Saldana et al., 2023). The selected navigator was identified by word of mouth. The selected navigator identified as a cisgender gay man, born in Mexico, bilingual in Spanish and English, and openly living with HIV. He also had lived experience in attempting to access HIV services in metropolitan Atlanta.

Navigator Training

The navigator training curriculum was adapted from the “Resource Linkages Peer Navigation Facilitator’s Guide” (FHI 360, 2024), a toolkit designed to train peer navigators. We used the core components of this guide—including HIV education, motivational interviewing, service linkage, confidentiality, addressing structural barriers, follow-up strategies, and self-care. These were adapted for cultural responsiveness and delivered in seven 2-h training sessions in English, developed by one of the authors (JYS), incorporating simplified language, and community-specific examples to enhance applicability for LGBM. The original guide was in English, and training sessions were conducted in English, as the navigator was fully bilingual. The sessions included (1) HIV basics (epidemiology, transmission, treatment, and care continuum), (2) HIV PrEP and post-exposure prophylaxis (PEP), (3) Roles and qualities of a peer navigator, (4) Social determinants of health, with special focus on key populations, (5) Confidentiality, (6) Implicit bias and motivational interviewing, and (7) Community resource database navigation. For this final session, we developed a detailed contact database of eight clinics, health departments, and CBOs providing culturally responsive sexual health services to LGBM, informed by prior research and community input (Cantos et al., 2023; Hassan et al., 2023; Saldana et al., 2023). The referral database outlined available services, Spanish-language options, referral, and enrollment processes, free or low-cost care for uninsured or undocumented individuals, hours of operation, after-hours/weekend availability, and direct contact information.

The navigator completed pre- and post-training assessments to ensure effective uptake of the curriculum (see Appendix 2 for details). Following the training, the navigator was virtually introduced to leaders from our partner referral organizations to expand his network and deepen his understanding of the referral process and service landscape in metropolitan Atlanta.

After the navigator completed the training sessions, we conducted three direct observations by a native Spanish-speaking, bilingual clinician, and study team member (CS), ensuring accurate assessment of communication, cultural responsiveness, and adherence to training protocols. First, we used patient simulations and defined high fidelity when he successfully completed over 90% of the required tasks (see Appendix 3 for fidelity checklists). Also, three direct observations of actual participant interactions were conducted at the program’s initiation.

Participants

The social media campaign was developed in close collaboration with our CBO partners, aiming to raise awareness about available sexual health services and connect individuals to our pilot peer navigation program. Based on input from our partners, we crafted culturally responsive messages originally written in Spanish, rather than translating directly from English. The campaign featured the navigator himself and emphasized that free or low-cost sexual health services were available regardless of insurance or immigration status. The campaign ran on Meta, TikTok, and Grindr platforms from May to October 2023. Interested individuals could click on the ad or scan a QR code and submit their contact information through a short bilingual (English/Spanish) eligibility form on REDCap, hosted on a secure University server, to be connected to the navigator for service referral. Alternatively, they could contact the navigator directly via WhatsApp (widely used messaging app among the Latino/a community), Meta direct messaging, text message, or phone call. For direct contacts, the navigator would then send a link to the REDCap eligibility form (Harris et al., 2009).

Participants were eligible for inclusion if they were 18 years or older, self-identified as Latino, male assigned at birth, identified as gay or bisexual, or reported male-to-male sexual contact in the past year, and resided in the metropolitan Atlanta area. Individuals who were ineligible for the program or resided outside of Georgia were still provided with publicly available resources, including CDC’s “Together TakeMeHome” HIV self-testing program (CDC, 2023), referrals to Ryan White clinics using the Ryan White Clinic Finder (Health Resources and Services Administration, n.d.), and educational materials on HIV prevention and care options.

Procedure

Service Navigation

Eligible participants verbally consented to peer navigation services. After consenting, they completed a baseline intake form that captured sociodemographic details such as age, sex assigned at birth, gender identity, sexual orientation, sexual partners, county of residence, country of birth, immigration status, insurance status, and the type of sexual health services needed The peer navigator conducted all activities remotely via phone, text, WhatsApp, or social media messaging, providing participants with service referrals, education on HIV prevention and care, assistance with scheduling, and follow-up support to ensure linkage to services. To illustrate the integration of social media outreach and peer navigation, a flowchart has been included to provide a visual representation of the intervention process (Fig. 2). Services included HIV/STI testing (either in-person or through a home HIV/STI self-test kit), PrEP, PEP, and HIV treatment. The navigator followed up with participants as needed until the service connection was made or the participant was lost to follow-up. Service connection included scheduling an appointment for in-person care (HIV care, PrEP, or testing) by the participant, or the navigator completing a home-test delivery form online on behalf of them. All navigator-participant interactions and service referral statuses were documented in REDCap.

Fig. 2.

Illustrates the integration of social media outreach and peer navigation, outlining the step from participant engagement to service linkage

Exit Interview

Once participants either self-reported the service was received, or one month had passed since enrollment, they were contacted to complete an exit interview. The interview consisted of 35 questions, including Likert-scale surveys and open-ended questions to assess the navigator program’s acceptability, usability, and patient-centeredness. Responses to the qualitative questions were transcribed directly into the REDCap form by the research staff conducting the interview. Exit interviews were offered in English or Spanish, based on the participant’s preference. Participants who completed the interview received a $50 Amazon gift card as compensation for their time (see Appendix 4 for the Exit Interview Guide).

Measures

The primary study outcomes were based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework’s implementation outcomes (Glasgow et al., 1999). Acceptability, usability, and patient-centeredness were assessed from the perspective of participants receiving peer navigation services, specifically evaluating their experience with referrals, communication, and overall support in accessing HIV-related services.

Reach was evaluated through several metrics, including the total number of unique individuals reached across social media platforms, the number of impressions (total times ads were displayed), the frequency (how often ads were shown to each individual), and the click-through rate (CTR), which proportion of people who click on the ad after seeing it, with higher CTRs indicating higher population engagement (Richardson et al., 2007). We also measured the number of unique individuals who filled out the eligibility form, and the proportion of those who were deemed eligible and subsequently consented.

Effectiveness was assessed during follow-up contacts and the exit interview and defined as the navigator’s ability to facilitate referrals to sexual health services, along the proportion of participants who reported receiving services successfully. Timeliness was also evaluated. We calculated the number of days from enrollment to referral (defined as the process of either connecting participants with service providers or requesting a home STI test kit on their behalf), from referral to receiving the service, and from enrollment to receiving the service.

Acceptability was evaluated during the exit interview using Sekhon et al.’s framework, which assesses the appropriateness of a healthcare intervention as perceived by the recipients, with questions such as “How satisfied were you with the navigation services?” (rated on a 5-point Likert scale) (Sekhon et al., 2017). This framework includes constructs such as affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, and self-efficacy, all measured by Likert scales. Open-ended questions were also used to further explore participants’ experiences and satisfaction with the peer navigation program.

Usability was measured during the exit interview using the System Usability Scale (SUS), a 10-item questionnaire that assesses the usability of a system or program on a five-point Likert scale ranging from “Strongly Disagree” to “Strongly Agree,” including items like “I found the navigation service easy to use” (Bangor et al., 2008).

Patient-Centeredness was assessed during the exit interview using an adapted version of Sidani et al.’s (2014) Patient-Centered Care (PCC) tool. The tool assesses the navigator’s ability to identify individual needs, provide tailored referrals, and offer culturally responsive support, while retaining core components of holistic, collaborative, and responsive care was designed to assess the degree to which care is holistic, collaborative, and responsive within the peer navigation program, with questions such as “Did the navigator consider your individual preferences when assisting you?”

Data Analysis

Quantitative Analysis

Descriptive statistics were used to summarize participant characteristics, social media engagement metrics, and navigation outcomes. For categorical variables, frequencies and percentages were reported, while means and standard deviations were calculated for continuous variables. Time-to-service measures (e.g., time from enrollment to referral, referral to service receipt) were analyzed using means, medians, and interquartile ranges to assess variation in service uptake speed. For acceptability, usability, and patient-centeredness, Likert-scale responses were summarized using means and standard deviations. The SUS scores were analyzed as continuous variables, with scores above 80 indicating high usability.

Qualitative Analysis

Qualitative data from exit interviews were analyzed using inductive content analysis. Three research team members (KG, LB, and CS) independently reviewed responses to open-ended questions, developed initial codes, and identified recurring patterns. Coders first independently analyzed a subset of interview responses, then met to compare interpretations, resolve discrepancies, and finalize a codebook. The remaining interviews were divided among the coders, with regular discussions to ensure consistency. Reflexivity was addressed through ongoing discussions of positionality, and researcher bias was mitigated by engaging bilingual, Latina/o/e coders, two of whom are LGBTQ+ (Glaser & Strauss, 1967).

Results

A total of 70 participants were enrolled, with a mean age of 31.9 years (range 18–52). The majority (95.7%) identified as cisgender men, and 97.1% identified as gay or bisexual. Nearly all participants (97.1%) were foreign-born, with Mexico (30%) being the most common country of origin. 47.1% were undocumented, while 14 (20%) reported being granted asylum or humanitarian parole, and 80% were uninsured. Participants were primarily from Fulton (28.6%), Gwinnett (25.7%), Cobb (18.6%), and DeKalb (8.6%) counties. Most reported recent sexual contact with cisgender men (94.3%), while 12.9% had partners who were cisgender women and 2.9% reported partners who were transgender men (Table 1).

Table 1.

Reach of Outreach Campaign per platform and participant enrollment cascade

META May 22, 2023 – August 31, 2023
Reacha	60,221
Impressionsb (times the ad was displayed)	350,378
Frequencyc (number of times each person saw the ad)	5.82
Clicks	4964
CTR	1.42%
Messages	343
Conversions	157
TikTok July 8, 2023 – August 1, 2023
Reacha	308,394
Impressionb	827,428
Video views	773,794
Frequencyc	2.68
CTR	0.25%
Grindr Sept 13, 2023 – Oct 13, 2023
Impressionsb	48,149
Clicks	28
CTR	0.06%
Contacted the Navigator	157
Completed eligibility survey	79
Eligible	70

^aReach: unique individuals who saw the ad at least once.

^bImpressions, times the ad was displayed.

^cFrequency, number of times each person saw the ad.

CTR click-through-rate

Reach

A total of 157 individuals contacted the navigator, of whom 79 completed the eligibility survey. Ultimately, 70 (45%) individuals were deemed eligible and consented, resulting in an approximate 2:1 contact-to-enrollment ratio. The most common reasons for ineligibility were residing outside the Atlanta metropolitan area, followed by not identifying as LGBTQ+ or not reporting male-to-male sexual contact. The online social media campaign promoting the peer navigator program generated over 1.2 million impressions across Meta, TikTok, and Grindr between May and October 2023. Specifically, the click-through rate for Meta was 1.42%. A detailed overview of the campaign’s overall reach is provided in Table 2.

Table 2.

Baseline characteristics

Characteristic	(N = 70) (%)
Age in years, Mean (range)	31.9 (18–52)
Sex assigned at birth, male	70 (100)
Current gender identity
Cisgender man	67 (95.7)
Gender non-binary	2 (2.9)
Other	1 (1.4)
Sexual orientation
Heterosexual	2 (2.9)
MSM	47 (67.1)
Bisexual person	20 (28.6)
Other	1 (1.4)
Sexual partners
Cisgender men	66 (94.3)
Cisgender women	9 (12.9)
Transgender women	1 (1.4)
Transgender men	2 (2.9)
I have not had sex in the last year	1 (1.4)
County of residence
Fulton	20 (28.6)
DeKalb	6 (8.6)
Gwinnett	18 (25.7)
Cobb	13 (18.6)
Other	13 (18.6)
Country of birth
U.S.	2 (2.9)
Mexico	21 (30)
Nicaragua	8 (11.4)
Venezuela	8 (11.4)
El Salvador	8 (11.4)
Other	23 (33)
Immigration status
U.S. citizen	5 (7.1)
Permanent resident	5 (7.1)
Visa	7 (10)
Undocumented	33 (47.1)
Asylum or humanitarian parole	14 (20)
Prefer not to answer	3 (4.3)
Other	3 (4.3)
Insurance status
Uninsured	56 (80)
Private insurance	7(10)
Unknown	3 (4.3)
Government insurance	2 (3)
Spouse’s employer insurance	1 (1.4)
Self-insured	1 (1.4)

Of the 70 participants enrolled, 20 (29%) were lost to follow-up, meaning they stopped responding to the navigator after receiving a referral. While it is unclear whether these participants successfully accessed services, the reasons for disengagement remain speculative. We conducted exit interviews with 50 (71%) of the 70 enrolled participants, all of which were conducted in Spanish, as it was the preferred language of all participants.

Effectiveness

Outcomes of service referrals for HIV/STI testing, PrEP, and HIV care are summarized in Table 3. Most participants requested more than one sexual health service, with an average of 1.7 services per participant (range 1–3). Since not all referral sites offer every service, the most requested service was HIV/STI testing, either through mail-home self-testing kits or in-person testing. A total of 53 referrals were made for HIV/STI testing, with 23 (43%) participants confirming service receipt. The average time from enrollment to referral was 0.3 days, and from referral to self-reported service receipt was 0.66 days, totaling an average of 0.96 days from enrollment to service.

Table 3.

Effectiveness outcomes (N = 70)

Service	Referrals	Confirmed receipt (%)	Days to referral (mean, range)	Days from referral to service (mean, range)	Days from enrollment to service (mean, range)
HIV/STI Test	53	23 (43%)	0.3 (0–5)	0.66 days (0–48)	0.96 days (0–48)
PrEP	51	35 (68%)	0.65 (0–1)	16.1 days (0–67)	16.75 days (0–67)
HIV Care	6	6 (100%)	Same day	19.25 days (2–64)	19.25 days (0–64)

For PrEP, 51 referrals were made, with 35 (68%) participants confirming service receipt. The average time from enrollment to referral was 0.65 days, and from referral to service receipt was 16.1 days, resulting in an overall average of 16.75 days from enrollment to service. For HIV care, 6 referrals were made, and all 6 participants confirmed receiving HIV primary care appointments. Referrals were made on the same day as enrollment, and the average time from referral to service receipt was 19.25 days. Some participants experienced significant delays. The longest wait times observed were 48 days for HIV/STI testing, 67 days for PrEP, and 64 days for HIV care.

Acceptability

The acceptability of the peer navigation program among the 50 participants who completed exit interviews is summarized in Table 4. Participants expressed high levels of satisfaction, with a mean satisfaction score of 4.80 (SD = 0.63). They reported feeling comfortable interacting with the navigator, (4.86, SD = 0.40). Accessing the navigation service was considered easy (4.53, SD = 0.92), and communication with the navigator was smooth (4.80, SD = 0.56). The assistance provided by the navigator was rated as highly helpful (4.96, SD = 0.20). Participants expressed complete confidence in their ability to reach out to the navigator again (5.0, SD = 0). Additionally, they indicated a strong likelihood of recommending the navigation services to others (4.76, SD = 0.62).

Table 4.

Acceptability of the Navigation Program (N = 50)

Variable	Mean	SD
How satisfied are you with the navigation service?	4.80	0.63
How comfortable did you feel while interacting with the navigator?	4.86	0.40
How difficult was it to access the navigation service?	4.53	0.92
How difficult was it to communicate with the navigator?	4.80	0.56
How helpful was the navigator’s assistance to help you to obtain the services you were looking for?	4.96	0.20
If you needed to contact the navigator again, how confident do you feel in being able to do it?	5.00	0
How likely are you to recommend the navigation services to someone you know?	4.76	0.62

Scored from a 5-point Likert scale, higher scores indicating higher acceptability

To further explore patient satisfaction within the affective attitude construct of Sekhon et al.’s acceptability framework, we employed open-ended questions during the exit interviews. All 50 participants provided additional qualitative data, which revealed five main themes: (1) ease of use, (2) effective communication, (3) empathetic approach, (4) practical assistance, and (5) remaining challenges in receiving services, as outlined in Table 5. Participants consistently highlighted the ease of accessing the navigator’s and particularly appreciated the availability of the service in Spanish. They also valued the prompt and accurate information provided about accessing services. Effective and frequent communication was another key theme, with many participants mentioning how the navigator sent appointment reminders. The navigator’s empathetic approach was often praised, with participants describing him as kind, “really caring,” and motivational. The practical assistance of the navigator was frequently mentioned, as he helped address unique barriers by recommending nearby or more accessible sexual health clinics. However, ten participants reported challenges in receiving sexual health services after being referred. Common barriers included scheduling conflicts and work commitments, with six individuals unable to attend appointments due to busy work schedules, though they planned to reschedule. Three participants expressed frustrations with external service providers (clinics, community-based organizations, and healthcare facilities where participants were referred for services), citing inefficiencies, lack of follow-up, and delays in receiving PrEP prescriptions. One participant chose not to fill out a PrEP prescription due to concerns about potential side effects after conducting personal research.

Table 5.

Themes on Navigator Program Participant Satisfaction (N = 50)

Theme	Description
Ease of Use	All clients commented on how straightforward it was to contact the navigator and keep in touch
Effective Communication	Many noted the navigator to give them accurate information on services they requested and other services they might need. The navigator was very quick to respond to messages, send them reminders, and could speak their preferred language
Empathetic Approach	Many participants praised the navigator’s kindness and motivational attitude. They felt, “like he really cared” about them, and could relate to their situation
Practical Assistance	The navigator helped them find sexual health services they could reach with the resources and time available
Remaining Challenges with receiving services	Some clients faced issues with referral organization, including prolonged waiting times for appointments, lack of follow up, and delayed PrEP prescriptions

Overall comments on navigation services N = 50

Usability

The average SUS score across participants for the peer navigation program was 89.6, with SUS scores ranging from 0 to 100, and scores above 80 indicating excellent perceived usability. Table 6 provides insights into participants’ perceptions of the peer navigation program’s usability. Participants consistently found the program easy to use and felt comfortable navigating it. They disagreed with statements suggesting the program was overly complex or difficult to manage. Most participants indicated that they would not require technical support to use the program and believed that others would be able to learn it quickly. Overall, participants viewed the program as well-integrated into their needs and expressed a willingness to use it frequently.

Table 6.

Usability of the Navigation Program N = 50

Variable (N = 50)	Mean	SD
1. I would use the navigation program frequently	4.45	0.60
2. The navigation program was unnecessarily complex	1.41	0.63
3. The navigation program was easy to use	4.73	0.43
4. I would need support from a technical person to be able to use the navigator program	1.65	0.88
5. Various function in the navigation program were well integrated	4.63	0.60
6. There was too much inconsistency in the navigation program	1.53	0.87
7. Most people would learn to use the navigation program very quickly	4.63	0.52
8. The navigator program was too complex to use	1.35	0.62
9. I felt very comfortable using the navigation program	4.78	0.41
10. I had to learn many things before I could get going with the navigation program	1.43	0.69

Scale of 1 (strongly disagree) to 5 (strongly agree). The odd-numbered items are positively phrased (higher scores are better), and the even-numbered items are negatively phrased (lower scores are better). The average SUS is: 89.6. The SUS score will be between 0 and 100. Generally, an SUS score above 68 is considered above average, and a score above 80 is considered excellent

Patient-Centeredness

Participants provided highly positive feedback regarding the navigator’s performance. All 50 participants reported that the navigator accurately identified their needs, gave clear instructions, ensured they had the necessary resources for their services, and offered sufficient support. Additionally, 47 (94%) participants mentioned that the navigator monitored or reassessed their needs over time, while 48 (96%) participants felt that the navigator considered their individual preferences. Furthermore, 42 (84%) participants noted that the navigator proactively provided information about other sexual health services, and 47 (94%) participants confirmed that the navigator took the time to answer their questions (Table 7).

Table 7.

Patient centeredness of the Navigation Program

Question	Yes N (%)
Did the Navigator correctly identify your needs and/or concerns?	50 (100.0)
Did the Navigator monitor or reassess your needs as time went by?	47 (94)
Did the Navigator provide information about other sexual health services you may be eligible for, without you needing to ask?	42 (84)
Did the Navigator assess your individual preferences when recommending a service?	48 (96)
Did the Navigator provide clear instructions on how to receive the requested service?	50 (100)
Did the Navigator provide adequate support, as needed, when recommending a service?	50 (100)
Did the Navigator take time to answer your questions?	43 (94)
Did the Navigator make sure you had what you needed for your services?	50 (100)

Discussion

In this study, we launched a social media outreach campaign to raise awareness about sexual health among Spanish-speaking LGBM and promoted a peer navigation program to help them access these services. The social media campaign was developed with direct input from CBOs to ensure linguistic and cultural relevance. Rather than translating existing materials, campaign messages were originally created in Spanish, incorporating visuals and narratives that normalized HIV prevention behaviors and addressed stigma and misinformation. By leveraging Meta, TikTok, and Grindr, the campaign effectively reached this vulnerable population. Additionally, the peer navigator’s shared lived experiences, bilingual support, and flexible communication methods (e.g., WhatsApp, text, direct messaging) fostered trust and engagement, contributing to high program acceptability. These elements highlight the importance of culturally responsive, community-informed approaches in improving HIV service access.

Advertising sexual health services, such as HIV testing, via social media has proven effective in other settings (Stafylis et al., 2022; Wray et al., 2023). In our study, participants showed high engagement with the campaign, reflected by a 1.42% CTR, which is nearly double the average CTR for healthcare ads on META platforms (0.73%) (Hootsuite, 2023). This success demonstrates that these populations can be effectively reached when strategies are developed with direct community input, utilize culturally concordant language, and are distributed across diverse social media platforms. It is important to note that Meta, TikTok, and Grindr do not standardly report all these metrics, making it difficult to compare performance and user engagement across platforms.

Among the platforms used, Meta achieved the highest CTR compared to TikTok and Grindr (1.42% vs. 0.25% vs. 0.06%, respectively), indicating better user engagement on Meta, making it particularly suitable for campaigns designed to prompt specific actions, such as entering contact information to connect with the navigator. Although TikTok had a lower CTR during our campaign, it generated the most impressions, suggesting its potential for broad dissemination of educational content prioritizing LGBM without necessarily driving user interaction. This aligns with findings from Lewis-Torres et al. 2024, which highlighted TikTok’s effectiveness in normalizing PrEP use and raising sexual health awareness within marginalized communities (Lewis & Melendez-Torres, 2024).

Grindr, despite its popularity within the LGBTQ+ community, had the lowest CTR. This may be due to advertising fatigue and privacy concerns specific to the platform, suggesting that refreshed ad content and trust-building measures could be needed to sustain user engagement (Criddle & Murphy, 2024; McDonald, 2018).

In contrast to our findings, Zlotorzynska et al. (2021) evaluated the effectiveness of social media in recruiting young gay and bisexual men (YGBM) for HIV prevention services across 10 U.S. cities (excluding Atlanta). Their study used Meta, Snapchat, Twitter, and Grindr for recruitment. Interestingly, they found that Grindr and Snapchat had the highest CTRs, though fewer YGBM completed eligibility screeners on these platforms. Meta platforms consistently provided the lowest cost per eligible contact and were more effective in reaching communities of color and younger demographics (Criddle & Murphy, 2024).

These findings underscore the variability in performance across social media platforms, depending on the priority population and campaign goals. Understanding these differences is key to optimizing outreach strategies, improving engagement, education, and cost-effectiveness in health intervention campaigns (Parker et al., 2021; Zlotorzynska et al., 2021). In terms of study enrollment, 45% of individuals who responded to the online ads and contacted the navigator successfully enrolled, resulting in an approximate 2:1 contact-to-enrollment ratio. This low enrollment rate may be attributed to mistrust, scheduling conflicts, or competing priorities, highlighting the need for ongoing efforts to build trust and effectively address stigma (Cantos et al., 2023; Hassan et al., 2023; Saldana et al., 2023).

Once enrolled, the navigator provided same-day service referrals for all participants, regardless of the type of service requested. While most participants received services within days, some experienced significant delays—up to 48, 67, and 64 days for HIV/STI testing, PrEP, and HIV care, respectively. Additionally, 30 (57%) referrals for HIV/STI testing and 16 (32%) for PrEP were unconfirmed after the initial referral. It remains unclear whether these participants successfully accessed services and chose not to report back, encountered further barriers, or decided against pursuing care. Despite the navigator’s ongoing communication with participants and clinics, these prolonged wait times and loss of follow-up highlight the need for improved referral-to-linkage processes. To address these challenges, several strategies could enhance trust and streamline access to care, such as expanding the Spanish-speaking Latina/o/x workforce in clinics, implementing low-barrier enrollment processes regardless of immigration or insurance status, and scaling up interventions that improve flexibility, such as telemedicine, convenient transportation options for provider and laboratory visits, and/or weekend or after-hours appointments. These efforts would reduce barriers and improve access to care for this vulnerable population.

The success of the social media campaign and the peer navigation program is related to partnering with CBOs, the language and cultural relevance of our program and comprehensive navigator training. These findings align with studies specifically related to LGBM, highlighting the impact of culturally responsive and personalized support on engagement and satisfaction. Pagkas-Bather et al. (2020) found higher acceptability for peer navigation programs among Black Gay and Bisexual Men (BGBM) and LGBM in Seattle when navigators matched participants’ sexual orientation, race, age, and culture (Pagkas-Bather et al., 2020). McKetchnie et al. (2023) emphasized the importance of consistent and tailored follow-up from peer navigators for YGBM regarding PrEP adherence (McKetchnie et al., 2023). These studies underscore the value of culturally responsive support. Research shows that GBM are significantly more likely to access HIV testing and prevention services with navigator programs (Kimball et al., 2023). In San Francisco, navigation services led to quicker PrEP initiation (Spinelli et al., 2018), and in North Carolina, a peer “navegante” program increased HIV testing and condom use among LGBM (Rhodes et al., 2020). In terms of HIV care, peer navigation services have been widely effective in linking and re-engaging people living with HIV to care by leveraging shared experiences, trust, and support (Krulic et al., 2022); however, the weCare intervention, which similarly to our approach leveraged social media and peer navigation to improve HIV care engagement among young YGBM and transgender women, demonstrated feasibility and acceptability, although a randomized trial found no significant difference in care outcomes compared to usual care—highlighting the need for ongoing refinement and evaluation of combined digital and peer strategies (Rhodes et al., 2022).

Our study has several limitations. First, participation in the navigator program was limited to individuals who completed both the eligibility and baseline intake forms. This requirement may have discouraged potential participants, particularly those with high levels of mistrust in healthcare systems, from enrolling. Second, since the sample primarily consisted of younger participants, who may be more likely to engage with social media outreach, the findings may not fully represent the experiences of older LGBM, who may have different healthcare access patterns. Future research should explore alternative engagement strategies to assess the effectiveness of peer navigation in aging populations. Third, as this was a 3-month pilot study, our sample size is small and only enrolled LGBM living in metropolitan Atlanta, limiting the generalizability of our findings to other regions in the USA. Our program evaluation did not include a comparison group (i.e., group of LGBM who were not enrolled in the program), which is an intrinsic limitation to research design outside of controlled trials or cohort studies. Fourth, we only obtained data on successful linkage to services by participants’ self-report, which may have introduced recall or social desirability biases, affecting the accuracy of the results. This issue is compounded by the 29% loss to follow-up after service referral. The reasons for loss of follow-up are unclear, as participants stopped communicating with the navigator. Factors include receiving the service without reporting back, dissatisfaction, competing priorities, or other barriers, though this remains speculative. Furthermore, confirmation of service linkage and retention in care through electronic medical data was out of this study’s scope. Future research should explore contributors to attrition and explore direct service engagement and retention. Fifth, the effectiveness of the navigator program may be influenced by the unique skills, training, and experiences of the single navigator used in this study, which impacts the potential replicability of the program. Finally, another peer navigator may not carry the same social influence as the individuals recruited and trained in this study, which may hinder future programs’ success and highlights the need for standardized training strategies for navigators. We recognize that economic and logistical challenges may emerge during scale-up of similar programs.

Our study represents the first to integrate a community-informed social media campaign with a peer navigation program specifically addressing LGBM’s barriers and facilitators to sexual health services access. Our findings provide meaningful insights when viewed through an implementation lens. In terms of Reach, we demonstrated substantial engagement with a young, foreign-born, and often uninsured Latino community—frequently underserved due to systemic barriers—by using culturally tailored social media strategies better aligned with their communication preferences. For Effectiveness, we observed high satisfaction, timely service linkage, and reported successful linkage to HIV-related services. Adoption was evidenced by the local health department integrating the program into its outreach strategies in late 2023. Regarding Implementation, we consider that assessing for fidelity to training and culturally responsive delivery supported the program’s success. While long-term Maintenance was outside this study’s scope, initial results offer a strong foundation for scale-up. These findings highlight the importance of embedding community-informed, status-neutral, and language-accessible interventions in implementation strategies aimed at reducing HIV disparities.

Future studies should focus on scaling up combined tailored social media campaigns with peer navigation assessing its longitudinal impact on HIV among LGBM which are needed. Future studies should assess the implementation of standardized yet adaptable peer training, clear role definitions, and expanded evaluation metrics—including peer navigator satisfaction, workload sustainability, cost-effectiveness, and systematically collect results and outcomes of referrals (i.e., home-test result, PrEP, and HIV care retention)—to enhance the scalability and impact of peer-led interventions.

Conclusion

A community-informed social media campaign integrated with a culturally responsive peer navigation program represents a promising strategy to improve HIV-related service accessibility for LGBM. This approach showed high rates of acceptability and offers an effective means to curb the rising HIV incidence within this group. Scaling up these strategies across metropolitan Atlanta, along with further optimization of service delivery, is urgently needed to improve outcomes for this population.

Supplementary Material

Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s10508-025-03231-1.