Lessons learned from syndemic HIV research in an immigrant, latinx sexual and gender minority community.

The HIV incidence rate in Miami-Dade County is among the highest in the United States, with Latinx sexual and gender minority (SGM) groups experiencing a disproportionate burden. Despite extensive efforts by both private and public sectors to curb transmission and improve pre-exposure prophylaxis (PrEP) uptake, Latinx SGM groups continue to have high rates of HIV and low PrEP uptake compared to SGM groups overall. Using data collected from a biobehavioral study of the socio-structural factors affecting HIV susceptibility and PrEP uptake among Latinx SGM subgroups in Miami-Dade County, this paper shares lessons learned and provides concrete recommendations for tailoring survey research and biospecimen collection among a largely immigrant, socioeconomically disadvantaged community that is especially vulnerable to HIV. By drawing inferences from study data and contextualizing these with community partners, we learned: (1) Large parts of the target community may be unfamiliar with the underlying constructs captured in important HIV-related measures; (2) Cash incentives may shift motivation from intrinsic to extrinsic and lead to poorer data quality; (3) Deviations in Spanish go beyond vocabulary used in different Latin American countries, and more formal Spanish may relay concepts in unfamiliar ways that are unapproachable; and (4) community members may be unfamiliar with survey data collection processes and the protections in place to ensure confidentiality. These lessons and associated recommendations may help improve recruitment, study design, analysis, and community engagement in future studies, building trust and ultimately reducing the burden of HIV in these communities.