Title: Contextualizing HIV risk among Latino men who have sex with men
Description: Latino men who have sex with men (MSM) in the United States experience a disproportionate and growing HIV burden. In spite of germinal studies and recent advances reported in the scientific literature, there is a noteworthy gap in our understanding of the factors that influence HIV transmission and acquisition among Latino MSM. The goal of this dissertation is to explore how cultural, spatial, and syndemic contexts influence two HIV-related risk behaviors among Latino MSM: serodiscordant condomless anal intercourse (SDCAI) and number of male causal partners. Specifically, I aimed to assess the how acculturation, neighborhood characteristics, and co-occurring epidemics may each contribute to HIV-related risk among Latino MSM. For this project, I utilized data from the NYCM2M study (R01 HD059729; PI: B. Koblin), a cross-sectional study of the relations among neighborhood environmental characteristics, sexual risk behaviors, anxiety and depression, and alcohol and substance use among urban MSM.

First, I examined the association between indices of acculturation and the two HIV-related risk behavior outcomes, in addition to assessing if acculturation moderates the influence of sexual minority stressors and peer condom use norms on those same outcomes. The results indicated that relationships between the two sexual minority stressors and SDCAI were strongest among two groups: English-speaking and foreign-born Latino MSM, groups considered to be high and low, respectively, on acculturation. Second, I examined the ethnicity- and gay-related neighborhood correlates of the HIV-related risk behavior outcomes. The results showed that living in areas with a higher proportion of men reporting experiences of ethnicity-based discrimination and higher levels of gay community connectedness were both associated with an increased likelihood of engaging with 5 or more casual sexual partners, while living in an area with a higher foreign-born population was associated with a lower likelihood of the same.

Third, I examined both established and population-relevant syndemic conditions to assess the association between syndemic burden and the HIV-related risk behavior outcomes among Latino MSM, and assessed if outness moderated these potential relationships. The results indicated a significant, positive association between the number of syndemic conditions and SDCAI, but, upon testing for moderation, this relationship only existed among men with high levels of outness about their sexual orientation. The results also showed that having any syndemic conditions, regardless of the number, was associated with having more casual sexual partners. Overall, this dissertation highlights the importance of studying HIV-related risk behaviors through multiple contextual lenses among Latino MSM. Specifically, the results suggest a strong need to attend to how cultural factors, spatial environments, and syndemic factors may shape HIV burden among Latino MSM. Taken together, these studies provide evidence for the development of multi-level, multicomponent HIV-reducing interventions that specifically target the differing needs among subgroups of Latino MSM, rather than treating them as a single, monolithic group for study and intervention.