UC San Diego

In resource-limited settings, like Tijuana, Mexico, cisgender men who have sex with men (MSM) and transgender women (TW) are disproportionately impacted by HIV. Among MSM and TW in Tijuana, HIV prevalence is 20% and 22%, respectively. To reduce HIV incidence there is an urgent need to identify novel HIV prevention strategies. The venues MSM and TW attend to meet sexual partners (e.g., bars, clubs, bath houses) have been successfully leveraged in high-income settings to implement venue-based HIV prevention strategies. In resource-limed settings, venue-based interventions are underutilized and may hold promise for increasing access to HIV prevention and care services (i.e., HIV services) among MSM and TW. However, these strategies will need to maximize limited resources available for HIV services among MSM and TW. Analyzing venue affiliation networks, a type of two-mode network connecting individuals to the venues they attend, could inform targeted venue-based HIV prevention strategies, and elucidate the mechanisms through which venue affiliation networks shape HIV transmission and acquisition risk and prevention behaviors among MSM and TW. The first chapter of this dissertation provides a summary of the HIV epidemics among MSM and TW in resource-limited settings and describes the HIV risk environment among MSM and TW in Tijuana. That chapter also describes the role that the venues MSM and TW attend to meet sexual partners play in shaping their HIV transmission and acquisition risk and prevention behaviors and introduces venue affiliation networks as a method to inform targeted venue-based HIV prevention strategies. The second chapter examines the association between characteristics associated with increased vulnerability to HIV and attending venues to meet sexual partners. The third chapter characterizes the global venue affiliation network among MSM and TW in Tijuana. The fourth chapter examines how MSM and TW’s personal venue affiliation networks influence their substance use and HIV transmission and acquisition risk and prevention behaviors. The final chapter of this dissertation summarizes the key findings from this dissertation and the potential impact of these findings to inform strategies to end the HIV epidemics among MSM and TW in Tijuana, and other resource-limited settings.