Multi-level Risk Factors for HIV Prevention and Care Among Black Sexual Minority Men: The N2 Cohort Study
Associate Professor, Epidemiology
Co-Director, Social and Spatial Epidemiology Unit
Columbia University Mailman School of Public Health
Decades of research (and the interventions that followed) have focused on a broad range of individual-level risk factors, including sexual behaviors and socioeconomic status, to address the HIV epidemic. However, stark racial disparities in HIV prevention and care (including in pre-exposure prophylaxis [PrEP] and antiretroviral therapy [ART] uptake and adherence) persist among gay, bisexual and other sexual minority men (SMM). These disparities disproportionately impact Black SMM.
Moving beyond studies of individual-level factors, a focus on social and contextual factors, including neighborhood environments and network characteristics (highly linked social contextual factors), may help to explain disparities in HIV prevention and care among subsets of SMM. However, little work has been conducted on neighborhood and network determinants of HIV prevention and care in Black SMM, and significant methodological limitations exist in the current published research.
This talk will describe the design, sampling methods, data collection, and main findings to-date of the ongoing 'Neighborhoods and Networks (N2) Cohort Study' including the recently launched follow-up study to the Neighborhoods and Networks (N2) study, which we refer to as N2 Part 2 (N2P2). N2 employs a prospective longitudinal design. The original sample includes Black SMM participants in Chicago recruited via respondent-driven sampling and assessed every six months over two years of follow-up. Participants enrolled in Jackson, New Orleans and Baton Rouge were originally recruited through existing health and community services and assessed every six months over one year of follow-up. Mobility within and between neighborhoods was assessed using global positioning system (GPS) technology, making the N2 study is the largest GPS-based study of HIV disparities in any SMM population. Social and sexual networks among Black SMM were studied through egocentric network inventories as well as newer methods of creating meso-level networks that involve social media (Facebook) and mobile phone contacts.
We also discuss how the N2P2 study will apply an observational-implementation hybrid design in order to help us achieve findings that support rapid translation, a critical priority among populations such as Black SMM that experience long-standing inequities, with regards to HIV and other health-related outcomes.
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Jorge Salazar, MD
Infectious Diseases Fellow, Division of HIV, Infectious Disease, and Global Medicine
University of California San Francisco
Early-stage investigator presentation