Violence Exposure, Affect and ART Use Among Young Black and Latinx Men Who have Sex with Men: An Ecological Momentary Assessment Analysis.

Black and Latinx gay, bisexual and other men who have sex with men (BLMSM) face disproportionate HIV burdens due to structural racism and homonegativity which manifest as multiple forms of violence that disrupt consistent HIV care engagement. This study examined pathways linking interpersonal, community and structural violence exposure to antiretroviral therapy (ART) use among young adult BLMSM and explored the mediating roles of substance use and negative affect. Participants (N = 41; ages 18-34) living with HIV in New York City completed a 90-day ecological momentary assessment (EMA) between May 2021 and March 2023. Multilevel logistic regression with Bayesian estimation assessed within- and between-person differences in ART use. Both witnessing and directly experiencing violence were associated with lower odds of same-day ART use, an effect mediated by negative affect. Violence exposure increased negative affect, which reduced same-day ART use by 50%, independent of race/ethnicity, violence exposure type, housing support and substance use. Cannabis use was linked to higher odds of same-day ART use but lower long-term maintenance. Non-Hispanic Black men and those receiving HIV/Services Administration (HASA) housing support demonstrated greater ART engagement, highlighting the critical role of housing stability in improving HIV-related health outcomes. Negative affect emerged as the strongest predictor of daily ART use, underscoring the need to integrate trauma-informed mental health support into HIV care for BLMSM. Additional research is needed to clarify the temporal and differential impacts of violence exposure and cannabis use on ART engagement.