Dímelo (tell me about it) Project: Association of Access to Care, Engagement with Health Care Providers, and HIV Prevention Fatigue Among Latino MSM in San Juan, PR and San Antonio, TX.

Introduction: Texas (TX) and Puerto Rico (PR) are the top four areas of HIV prevalence for Latinos (CDC, 2016). Over half of HIV infections among Latinos in general are concentrated among Men who have Sex with Men (MSM; CDC, 2016). HIV prevention fatigue is a possible risk factor for MSM due to a lack of response to HIV prevention campaigns promoting safe sex (Chard, Metheny, & Stephenson, 2017). Research to date, however, has been limited in identifying the structural and social psychological factors related to HIV prevention fatigue for Latino MSM. This study is the first to examine the association between access to care, engagement with health care providers, and HIV prevention fatigue among Latino MSM living in PR and TX.

Methods: 239 HIV negative Latino MSM ages 21-30 ( age 25) completed a self-administered internet survey in Spanish for San Juan, PR (n = 112) and in English for San Antonio, TX (n = 127). Standardized measures for HIV prevention fatigue (Stockman, 2004), access to care (Sayles, Wong, Kinsler, Martins, & Cunningham, 2009), and engagement with health care providers (Bakken et al., 2000) were adapted for this study. Multiple regression analysis was employed to assess the relationships among these three key measures while controlling for individual sociodemographic characteristics.

Results: Access to care is significantly negatively correlated with HIV prevention fatigue (B = -0.26, t = -3.93, p < 0.001). The magnitude reduced about 22.6% when adding engagement with health care providers as a potential mediator. Mediation analysis with bias-corrected bootstrapping techniques showed a marginal significant indirect effect of access to care on HIV prevention fatigue through the pathway of engagement with health care providers, [B = -0.06, SE = 0.04, 90% CI: (-0.15, -0.01)]. Further, our data indicate that Latino MSM from San Antonio have significantly less access to care and marginally significantly higher rates of HIV prevention fatigue (B = 0.29, t = 1.69, p = 0.092) compared with San Juan participants.

Conclusions: This study demonstrates the important influences of structural and social psychological factors in health care such as access to care and engagement with health care providers on HIV prevention fatigue for Latino MSM—an underserved high-risk population. Our findings also indicate that access to care differs by locale, which explains the varying rates of HIV prevention fatigue for Latino MSM between cities. Recommendations for reducing HIV prevention fatigue for Latino MSM requires culturally informed services for sexual minorities to strengthen access to care and health care providers willingness to employ a patient-centered approach for promoting healthy sexual attitudes and safe sex behaviors.