Sexual minority men experience the largest portion of new HIV diagnoses in the United States. Among this group, Latino sexual minority men experience a disproportionate burden of HIV, accounting for 30% of new HIV diagnoses in 2018. Miami—an HIV epicenter—leads the U.S. in overall HIV incidence, including for Latino sexual minority men.

To further investigate the impact of HIV in this population, the National Institute on Minority Health and Health Disparities awarded Audrey Harkness, Ph.D., research assistant professor in the Miller School of Medicine’s Department of Public Health Sciences, a five-year grant to develop and pilot test a culturally tailored implementation strategy—Dime Más (Tell Me More)—to scale up and disseminate behavioral health and HIV-prevention services to Latino sexual minority men.

“The goal of this project is to develop a strategy that works within our local community in Miami and can address persistent HIV and behavioral health disparities affecting Latino sexual minority men in Miami and throughout the U.S.,” Dr. Harkness said. “One of the things I am most excited about with this project is that it is focused on working with the community to develop a strategy that’s feasible and useful.”

Latino sexual minority men show delayed HIV testing and underutilize pre-exposure prophylaxis (PrEP), as well as behavioral health treatment, compared to non-Latino White sexual minority men—according to Dr. Harkness’ NIH project summary. These differences, noted in the summary, are attributable to insufficient scale-up and dissemination of these needed services to Latino sexual minority men.

The implementation strategy that Dr. Harkness seeks to develop through this grant will seek to address the factors that drive suboptimal access to needed services among Latino sexual minority men.

Dr. Harkness began her work in this area with the Miller School's DÍMELO initiative—a study funded by the Miami Center for AIDS Research and the UM Center for Latino Health Research Opportunities. DÍMELO has explored the mechanisms that drive disparities in the utilization of PrEP, HIV testing, and behavioral health treatment among Latino sexual minority men.

Participants in this prior work, including Latino sexual minority men and key informants from the local community, described barriers, facilitators, and suggestions for addressing disparities in PrEP, HIV testing, and behavioral health service implementation.

Based on these findings, Dr. Harkness plans to develop Dime Más, a culturally tailored implementation strategy to scale up and disseminate services using the following approaches:

• Destigmatizing PrEP, HIV testing, and behavioral health services
• Ensuring that outreach staff reflect the community served
• Helping in exploring behavioral and sexual health needs
• Educating on services and navigating health systems
• Referring to affirming, trusted, and affordable organizations

Dr. Harkness’ new research project will refine Dime Más with multiple rounds of feedback from community members and service providers to ensure that the strategy fits well with both community needs and organizational capacity. As a career development award, the project will also build on Dr. Harkness’ expertise and career in utilizing implementation research to advance health disparities science.

“The findings will lay the foundation for a subsequent effectiveness-implementation trial, which will further advance scientific knowledge about the impact of a culturally tailored implementation strategy on Latino MSM health disparities,” noted Dr. Harkness.

Written by Amanda Torres

Published on November 3, 2020