"It's Our Superpower": A Mixed-Methods Study to Understand Motivation and Capabilities for HIV Management Among African American/Black and Latine Emerging Adults Living With HIV.

African American/Black and Latine (AABL) emerging adults living with HIV have insufficient engagement along the HIV care continuum, and lower rates than their White peers. Some subpopulations (e.g., those with unsuppressed HIV viral load, immigrants) and aspects of their experiences are understudied. This study uses a sequential explanatory mixed-methods design to explore motivational appraisals (e.g., core health goals), generative capabilities (e.g., self-efficacy, resilience), and their relationships to HIV management in a diverse cohort. Structured baseline assessments were conducted (N = 271). A subset of these was purposively sampled for maximum variability for qualitative interviews (N = 41). Quantitative data were analyzed with descriptive statistics and a structural equation model (SEM). Primary outcomes were HIV care engagement and viral suppression. Quantitative results informed qualitative research questions; qualitative data were analyzed with directed content analysis. We used the joint display method to integrate results. Participants were 25 years old (SD = 2), on average. The majority (59%) were Latine/Hispanic, 41% were African American/Black. Nearly all were assigned male sex at birth (96%) and sexual minorities (93%). Approximately half (49.1%) were immigrants. Almost a third (28%) were not well-engaged in care and 19% were not virally suppressed. Motivation, adherence self-efficacy, and medication outcome expectancies were high regardless of viral suppression. In the SEM, self-efficacy had a positive direct effect on motivation (B = 0.24, p < 0.01); and resilience (B = 0.02, p = 0.04) and self-efficacy (B = 0.23, p < 0.01) each had positive direct effects on outcome expectancies. Motivation (B = 0.26, p = 0.02) had a positive direct effect on care engagement. There were no statistically significant direct effects on viral suppression. In the qualitative results, participants focused on medication/viral suppression, but not HIV care. We organized qualitative results into four themes: (1) why participants took medication (e.g., desire for longevity, to be "normal" and attractive, and avoid transmitting HIV); (2) how they took medication (e.g., learning over time, creating routines and habits); (3) factors that interfered (e.g., structural barriers/disruptions could overwhelm motivation); and (4) issues salient to immigrants (e.g., moving to the US for better care, honoring family by taking medication). This study advances knowledge on HIV management among diverse AABL emerging adults living with HIV, and identifies intervention targets.