Bringing the Community to the Table: Implications for Ending the HIV Epidemic and Molecular HIV Surveillance

Background: Sexual and gender minorities (SGM) of color have a higher life time risk of HIV and are less likely to utilize HIV related services, despite having prominent behavioral and biomedical interventions to treat and prevent HIV transmission. The US government’s plan for Ending the HIV Epidemic has promoted Molecular HIV Surveillance (MHS) as a prominent strategy to detect and prevent HIV transmission networks from growing. The Houston Health Department (HHD) in 2018 was one of four CDC demonstration projects to implement MHS for HIV cluster detection and prevention among Hispanic SGMs and their social networks. In 2020, the CDC has funded health departments nationwide to utilize MHS for detecting and responding to HIV transmission networks. However, the community has protested that people living with HIV (PLWH) have not consented to be part of an MHS database that collects their blood samples for HIV genetic sequencing to identify HIV molecular clusters, which further marginalizes and discourages highly vulnerable populations from accessing HIV related services.

Methods: This case study places an emphasis on the Houston Health Department’s (HHD) initiative to establish a community advisory board (CAB) and develop culturally informed approaches to detect and prevent HIV molecular clusters from spreading among Hispanic SGMs and their social networks. MHS related data was collected from HIV drug-resistance tests, submitted to a laboratory for HIV genetic sequencing, reported to the local/state health department, and deidentified for submission to the CDC. An emphasis will be placed on HHD’s model partnership with CAB members towards implementing Social Network Strategy as an evidence-based HIV peer intervention to enhance access to HIV related services (testing, treatment, and PrEP) among Hispanic SGMs and their social networks.

Results: As of January 2019, a total of 28 HIV molecular clusters with a total of 126 PLWH have been identified throughout Houston/Harris County; 70% among sexual minorities and 47% of sexual minorities identified as Hispanic. The CAB assisted HHD in overcoming obstacles such as government mistrust through an MHS community-based model for detecting and preventing HIV transmission among Hispanic SGMs and their social networks. HHD was responsible for identifying people associated with the molecular cluster and supporting their role as peer recruiters to educate their community to promote HIV related services. Peer recruiters referred people to CAB agencies addressing the needs of the Hispanic community and provided a warm-handoff to HHD.

Conclusion/Implications: Community stake holders emphasized the significance of structural inequities at the government, state, and local level reinforcing health disparities among SGM’s of color. Hispanic related factors raised concerns over limited public health resources tailored for undocumented and monolingual Spanish speakers. Recommendations focused on people first language and reconceptualization of interventions from a deficit to a strengths-based approach for culturally and linguistically informed services provided by the community for the community. HHD and CAB members hosted community forums and presented in multiple venues to disseminate information related to MHS endeavors, address concerns, and provide resources to the community. Peer recruiters were essential in encouraging highly marginalized populations to access HIV services.