Optimizing the HIV Prevention and Care Continua in the United States

Subgroups within the House and Ballroom Community (HBC) account for at least half of all new HIV infections in the United States (U.S.). At the same time there is a significant disparity in knowledge of, access to and uptake of pre-exposure prophylaxis (PrEP) among these subgroups. Individuals in the HBC face stigma and individual, group, societal and structural challenges that put them at high risk of HIV, creating barriers to HIV prevention and care. This study will include a longitudinal qualitative phase, a longitudinal social epidemiologic phase, and an intensive longitudinal ecological momentary assessment phase. We propose to use an innovative and culturally relevant sampling strategy of web-based respondent driven sampling (webRDS) to recruit an online cohort of 900 people in the HBC. A subgroup of enrolled participants will participate in an ecological momentary assessment (EMA) phase to measure the immediate context of stigma and HIV prevention behaviors and HIV risk. These participants will receive short random ecological momentary assessments daily for 30 days via a mobile health application. Not only will this study examine stigma in context of the daily lives of individuals in the HBC, the EMA phase will also inform future development of a context aware, ecological momentary intervention to reduce HIV risk and optimize the HIV prevention and care continua.