A latent class analyses of economic stability, medical mistrust, and barriers to care in relation to PrEP awareness in Black communities in Miami, FL.

In the U.S., Black communities are disproportionately impacted by HIV due to economic instability, racism, and structural inequities. Among Black residents who participated in a bundled implementation study from November 2019 through March 2020 in HIV high impact communities in Miami, FL this study examines (a) which latent classes are most prevalent based on indicators of economic stability (ES; income, work, housing, zip-code poverty thresholds), medical mistrust (MM), and barriers to care (BAC) and (b) the latent classes in relation to PrEP awareness and speaking with a doctor regarding HIV (e.g., testing, protection, treatment). Among 569 Black residents (mean = 42.4 years) 67% had never heard of PrEP, but 64% had spoken with a doctor about HIV. Four salient classes emerged: Class 1(34.8%) reported the second highest ES, lowest MM and least BAC. Class 2(18.7%) had the lowest ES, low MM and moderate BAC. Class 3(33.0%) exhibited the highest ES, high MM, and no BAC. Class 4(13.5%) had the third highest ES, highest MM, and highest probability for BAC. No significant differences between classes were found for PrEP awareness, but Class 1 had a higher likelihood of a provider conversation about HIV. Despite varying ES, MM levels and BAC, Black residents of HIV high impact communities are not being informed about PrEP. Interestingly, a significant percentage had provider conversations regarding HIV, especially Black residents with the highest ES, least BAC, and lowest MM. These findings also highlight the need for provider conversations with clients that discuss biomedical prevention tools such as PrEP.