Race & Place: The Impacts of Racial Inequality on Substance Use and HIV Outcomes in Los Angeles

ABSTRACT It is well established that racial disparities in HIV care outcomes and use of substances among sexual minority men (SMM) of color persist because of structural racism in Los Angeles County (LAC). Furthermore, we know accessible, comprehensive, and culturally congruent healthcare is key to achieving racial equity in HIV and

substance use (SU) outcomes. Preliminary research, including our own studies, indicate major barriers to care include hard to reach locations of HIV and SU care, transportation challenges across large urban settings such as LAC, and lack of congruence with HIV care staff. While research shows that healthcare access is important,

there are mixed responses of where Black and Latinx SMM (BLSMM) prefer to receive care. These findings underscore the need for healthcare experiences that address geographic challenges and are culturally appropriate. Understanding how structural racism influences how BLSMM navigate the geography of LAC to

receive SU and HIV care and how peer case managers, with racial and SU congruence, may enhance access to care will provide novel insights into the relationship between racism and HIV and SU treatment. We propose research and adaptation of an evidence-based intervention LINK-LA built on an established NIDA-funded

cohort of BLSMM, The mSTUDY (U01DA036267), and preliminary findings of an R21 on spatial connections conducted by this multi-disciplinary research team (DA049643). Using intersectional anti-racism frameworks the Public Health Critical Race Praxis (PHCR) and the socio-ecological model of health and mixed methods,

we will interrogate how 1) historical racist practices influence unequal spatial patterns and how such unequal structural factors are associated with distinct patterns of movement across social and geographic space among BLSMM in LAC and how these patterns influence where people with HIV (PWH) elect to receive care; (2) and

how peer case managers who bring access to services and support to participants in the neighborhoods of their choice in LAC enhances use of services, their contextual outcomes, and HIV and SU outcomes by adapting an EBI Link-LA. Our proposed study directly fits with NIDA’s Racial Equity Initiative (REI). The

proposed study will extend ongoing collaborations between the University of California, Los Angeles (UCLA), the University of California, Santa Barbara (UCSB) team, and will be co-led by the Los Angeles LGBT Center resulting in a community-based research program design that is directly informed by and responsive to

community needs. This collaborative team of scientists includes MPIs across all three career levels and community-based practitioners that represent an intentionally interdisciplinary and comprehensive response to RFA-DA-23-061. Findings will be used to establish enhanced healthcare delivery models that improve racial

equity and reduce HIV care disparities.