Egocentric Sexual Network Characteristics that Facilitate PrEP Communication and Enrollment for Latino MSM in Miami
Mariano Kanamori, Cho Hee Shrader, John Skvoretz, Juan Arroyo-Flores, Susanne Doblecki-Lewis, Stephen Fallon, Victor Gonzales, Mark Williams, Ariana Johnson, Steve SafrenIntroduction: Miami-Dade County (MDC) has the highest HIV incidence, and the third highest HIV prevalence, of all U.S. metropolitan areas. Sixty-one percent of HIV diagnoses in MDC are attributed to Latinos, and Latino men who have sex with men (LMSM) account for 92% of new HIV diagnoses among Latino men in MDC. Pre-exposure prophylaxis (PrEP) is a pill that individuals at risk for HIV can take to prevent acquiring HIV. Many LMSM are unaware of PrEP’s existence and/or efficacy. This study applies a social network approach to LMSM and their sexual partners with the goal of finding dyadic characteristics that can increase PrEP conversation and encouragement for PrEP enrollment.
Methods: This is a cross-sectional study of 130 egocentric sexual networks with 507 alters. Data were collected from October 2018 to August 2019. Participants (egos) are LMSM ages 20–39 years who met criteria for PrEP use but did not necessarily use PrEP. Egos were randomly recruited from two locations of a community-based organization in MDC. Egos provided attribute and dyadic information for up to 13 sexual partners (alters). Analyses were performed using multi-level models in R.
Results: Ego characteristics: Ninety-five percent of egos self-identified as gay and 5% as bisexual. Egos reported an overall mean of 6.01 sexual partners (range 1-12). Thirty percent of egos reported currently using PrEP. Egos were more likely to report an intention of future ego-alter PrEP conversations if they: 1) were taking PrEP, 2) had larger numbers of sexual partners, or 3) valued the Latino cultural value “familism.” Alter characteristics: Egos reported that with the exception of one female alter, all of their sexual partners were male. Other reported alter characteristics include: 71% of alters were Latino, 8% were bisexual, and 4% were “heterosexual men who have sex with men.” Egos believed they would have less success convincing alters to use PrEP if the alter was a main sexual partner or older than them. Dyadic characteristics: The closer an ego felt to an alter, the more likely the ego was to talk with the alter about PrEP in the next six months or believe they could successfully encourage the alter to use PrEP. Dyadic formation and PrEP: Egos were more likely to talk about PrEP in the next six months or believe they would succeed in encouraging an alter to use PrEP, if they first met the alter through friends, at a mutual friend’s party, a gay-centric community event, or at school or work as compared to Grindr (a sexual networking app).
Discussion: Closeness between ego and alter and initial encounters at school, work or socially encourage PrEP promotion and enrollment. Future research and interventions should incorporate egocentric network components and structures to promote PrEP awareness and PrEP enrollment. Egocentric sexual networks can also be an effective tool for recruiting LMSM’s sexual partners who self-identify as bisexual or heterosexual.