BACKGROUND: HIV incidence in the US has increased for Hispanic, stabilized for Black, and decreased for White men who have sex with men (MSM). The US government''s plan to end the HIV epidemic has emphasized molecular HIV surveillance (MHS) as a strategy to detect and respond to growing HIV transmission clusters. However, existing medical advances to treat and prevent HIV have not successfully engaged communities of color.
DESCRIPTION: The Houston Health Department was one of four CDC demonstration sites throughout the US to utilize MHS for cluster detection and response for Hispanic MSM and transgender communities. MHS data was based on HIV genetic sequences collected from HIV drug resistance tests. An HIV molecular cluster consists of people living with HIV (PLWH) with a highly similar HIV strain that meets a .05% HIV genetic distance threshold. January 2019, a total of 28 molecular clusters were identified among 126 PLWH. Project PODER''s goal was to identify, monitor, and respond to HIV molecular clusters among Hispanic MSM and transgender communities. Strategic Framework: 1. establish partnerships and capacity building stakeholders; 2. monitor and prioritize molecular clusters for investigation; 3. increase HIV testing, treatment as prevention, and PrEP; and 4. address socio-structural HIV-related factors.
LESSONS LEARNED: Historically oppressed and highly marginalized populations were more likely to mistrust the government and significant concerns were raised about the government taking HIV genetic sequences without their consent. The community was alarmed that associating PLWH with a molecular cluster may further stigmatize and result in HIV criminalization or deportation.
Community stakeholders played a critical role in addressing the concerns of the community. A community advisory board (CAB) was established and members were instrumental in developing resources that were culturally informed and linguistically appropriate for Hispanic sexual and gender minorities. A community-based approach supported Social Network Strategy as a peer-based intervention to inform and engage the Hispanic community to access HIV related services.
CONCLUSIONS: Structural level outcomes resulted in the health department retraining staff and enhancing access to care for highly marginalized populations. The health department reframed MHS through a strengths-based approach and encouraged people in the community to promote HIV testing.