Document Type



Doctor of Philosophy (PhD)


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First Advisor's Name

Jessy G. Dévieux

First Advisor's Committee Title

Committee chair

Second Advisor's Name

Elena Bastida

Second Advisor's Committee Title

Committee member

Third Advisor's Name

David Forrest

Third Advisor's Committee Title

Committee member

Fourth Advisor's Name

Florence George

Fourth Advisor's Committee Title

Committee member

Fifth Advisor's Name

Mariana Sanchez

Fifth Advisor's Committee Title

Committee member


HIV, Florida, MSM, Enacted Stigma, Risk Behavior, Latent Class Analysis

Date of Defense



Crucial to ending the HIV epidemic is the prompt identification of HIV through testing services. National recommendations suggest everyone should test for HIV at least annually, and those with higher risk should test more often (for example, every 3 to 6 months). An estimated 66% of new HIV infections in 2018 occurred among men who have sex with men (MSM). Florida is third in the nation for HIV diagnoses among adults and adolescents (25.0 per 100,000 population) with an estimated 119,661 persons living with HIV; MSM account for 74% of the cases. This dissertation used the American Men’s Internet Survey (AMIS) 2014-2018 surveillance dataset with Florida MSM. The purpose was to assess annual behavioral trends using logistic regression to determine how enacted stigma would impact behaviors associated with HIV risk and apply latent class analysis (LCA) to classify HIV testing outcomes based on risk factors. There were significant changes in HIV risk behaviors from AMIS-2014 to 2018 among MSM reporting marijuana use (20.6% to 27.7%, p < 0.001), illicit drug use (28.4% to 33.0%, p = 0.02), and ever HIV tested (91.8% to 78.9%, p < 0.001). The second study found that MSM experienced enacted stigma due to sexual orientation, reporting verbal harassment (32.4%, n = 706), discrimination (26.0%, n=678), and physical assault (3.7%, n=78) in the preceding twelve months. LCA revealed four groups representing differences in HIV testing outcomes, whereby MSM who reported the lowest levels of HIV testing (Class 1 and 3) were more likely to report not seeing a healthcare provider, engage in condomless anal intercourse, condomless anal intercourse with a serodiscordant partner, and drug use. This dissertation adds to the literature about HIV risk and Florida's MSM, suggesting that some prevention strategies are still not reaching all including younger MSM, minorities, those with lower educational levels, and without health insurance. This is the first study that used the AMIS dataset to examine an MSM sample residing in Florida. The recommendations presented may be useful for researchers and Florida HIV providers to strengthen and target behavioral interventions for trends found in these studies.





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