Improving HIV and STI prevention and care for venezuelan sexual and gender minority migrants in lima, peru - the venezuelan refugee crisis is the largest recorded mass migration in latin america…

Improving HIV and STI prevention and care for venezuelan sexual and gender minority migrants in lima, peru - the venezuelan refugee crisis is the largest recorded mass migration in latin america with 20% of venezuela's population displaced, primarily to latin american countries. Venezuelan migrants face intersecting forms of socio-structural disadvantage that negatively impact their health-e.g., precarious employment, xenophobia and material deprivation. This displacement also strains chronically underfunded health care and public services; including in peru, a country of 33 million, which is the second largest host country in the region with over 1 million venezuelan migrants. These multi-level, systemic inequities perpetuate disadvantages among migrants and specifically among sexual and gender minorities (SGM). These unique biosocial stressors faced by venezuelan sexual and gender minority migrants (vsgmm) require an urgent and tailored response to prevention and care services for HIV and other sexually transmitted infections (stis); yet their needs remain understudied. SGM face individual and structural social conditions (e.g., high levels of violence, stigma, criminalization, and housing instability) and biomedical conditions (e.g., mental illness and substance use), can increase vulnerability to HIV/STI. Globally, SGM migrants are disproportionally at risk for HIV/stis compared to non- SGM migrants as they are at the nexus of migration and SGM health disparities. Migrant populations face barriers to health care and social services access including stigmatization, discrimination and identity documentation requirements; these barriers are compounded among migrants engaged in SEX work, who are frequently SGM. Venezuelan migrants living with HIV face heightened disparities; lower rates of viral suppression and higher rates of treatment non-adherence and abandonment compared to host countries' citizens living with HIV. There is urgent need to assess the multi-level social and biomedical vulnerabilities that place vsgmm at risk for HIV/STI. Thus, we will apply syndemic theory to assess the heightened risk of HIV/stis acquisition and lower care engagement among adult vsgmm living in peru and inform the future design and implementation of an integrated care and social prescribing intervention, providing for the HIV/STI needs of vsgmm and also linking them to with social services, to address both social and biomedical vulnerabilities. This two-year exploratory study will: aim 1. Apply syndemic theory to explore how social vulnerabilities related to migration and SGM status drive unique HIV/STI prevention and care needs among vsgmm in peru using qualitative research methods. Aim 2. Characterize the prevalence of HIV and stis and identify syndemic clusters of biomedical and social factors associated with HIV/STI among vsgmm using a BIO-behavioral survey and latent class analysis. Aim 3. Inform a novel intervention based on identified drivers of HIV/STI prevalence and care needs, migration, and social vulnerabilities including social prescribing and addressing their HIV/STI care needs.