Syndemic Conditions and Linkage to HIV Care among Men who have Sex with Men in Tijuana, Mexico

UCSD Center for AIDS RESEARCH (CFAR) Developmental Grant; PI: Eileen V. Pitpitan

Background: Recent research has demonstrated that HIV prevalence in Tijuana, Mexico is highest among men who have sex with men (MSM) (20%). The evidence also suggests that an overwhelming proportion of HIV+ MSM in Tijuana are not adequately engaged in HIV care. Thus, research to improve linkage and retention in HIV care among this population is critical to help curb the growing epidemic in this region. Whereas syndemics, or the co-occurrence of psychosocial and health problems (e.g., depression, substance abuse, violence) has been examined as it relates to sexual risk behavior among MSM in the primary prevention literature, scientists have yet to examine whether syndemics relates to HIV treatment behaviors among HIV+ MSM. The proposed research will bridge gaps in the extant literature by addressing the following aims:

  1. To pilot (examine the feasibility of) an intervention to improve linkage and retention in HIV care among medically vulnerable MSM in Tijuana, Mexico.
  2. To examine syndemic conditions as correlates of linkage to HIV care among MSM in Tijuana.
  3. To evaluate a potential interaction between the intervention and syndemic conditions on linkage to HIV care among MSM in Tijuana.

Methods: We propose to recruit 60 HIV+ MSM in Tijuana who have not linked to HIV care or who have not initiated ART if clinically indicated (CD4 <500) one-year post-diagnosis. This sample will help ensure that our intervention will be targeted to those who are among the highest-risk (e.g., not virally suppressed and likely reporting more psychosocial syndemic problems). Participants will be randomized to one of two conditions: a theory-based intervention using a Promotores model to improve linkage and retention in HIV care, or waitlist control. Our primary outcome will be linkage to care 3 months post-enrollment (initial visit to with an ART prescribing provider for medical monitoring and ART staging). We will also examine ART initiation within 6 months post-enrollment if/when clinically indicated as a secondary outcome Baseline and 6-month follow-up data on demographics, psychosocial conditions, substance use, stigma, and structural factors (e.g., negative interactions with police) will also be collected.

Implications for Future Research: Altogether, the findings from the proposed research will provide pilot data to test the intervention on HIV care behaviors along the entire care continuum (i.e., retention in care, ART adherence, viral suppression) in a larger and longer randomized controlled trial. The proposed study will also be the first to provide data on the association between syndemic conditions and HIV treatment behaviors.