Dissertation

Cashing in on HIV Prevention: An Exploratory Mixed Methods Study Assessing the Preferences and Acceptability of a Pre-Exposure Prophylaxis-Based Conditional Cash Transfer Among Black and Latino Men Who Have Sex with Men in Los Angeles County

Trujillo, Dillon Wesley

2026

Overview

Black and Latino men who have sex with men (MSM) face disproportionately high rates of HIV in the United States, yet uptake of pre-exposure prophylaxis (PrEP), a highly effective HIV prevention medication, remains critically low in these communities. Paying people money or rewards to take PrEP, is a strategy called conditional cash transfers (CCTs), and they have shown promise in HIV prevention globally, but no research has asked Black and Latino MSM what kind of CCT interventions they would actually want, or whether their sexual health history and life circumstances shape those preferences.Data were drawn from the Incentives and Prevention Study (TIPS), a pilot study conducted in Los Angeles County with 133 Black and Latino MSM. Three interconnected studies are presented. Study One used in-depth interviews with 20 participants to explore how Black and Latino MSM felt about the idea of a PrEP-based CCT, whether it felt worth it, burdensome, or likely to work. Studies Two and Three used a discrete choice experiment (DCE), a method in which participants repeatedly chose between hypothetical CCT intervention designs to reveal which features mattered most, examining whether participant’s PrEP use status and housing stability shaped those preferences.Study One found broad support for PrEP-based CCTs and identified specific burdens to participating in a PrEP-based CCT such as stigma, access barriers, and medical mistrust that varied by race/ethnicity and PrEP experience. Study Two found that Black and Latino MSM regardless of whether they were currently using PrEP or not strongly preferred higher payment amounts, more frequent payments, and cash over gift cards, with PrEP type playing a minimal role in their choices. The one stand out difference was that current PrEP users placed a stronger preference for higher payment amounts compared to non-PrEP users, suggesting that Black and Latino MSM already engaged in HIV prevention may respond more strongly to financial incentives to further sustain their engagement with HIV prevention. Study Three found that housing stability did not change these preferences, with Black and Latino MSM in both stable and unstable housing wanting the same program design.These findings challenge a common assumption in HIV prevention — that programs must be extensively tailored by subgroups to be effective. The data show that when it comes to CCT intervention design for increasing PrEP use, Black and Latino MSM want the same things regardless of their PrEP history or housing situation. What requires consideration and tailoring is the implementation itself — accessible locations to participate, flexible hours, transportation support, and culturally grounded outreach. This dissertation is among the first to rigorously explore CCT intervention acceptability and examine CCT design preferences among this population, and its findings provide direct evidence how to design CCT interventions that improve PrEP use. That evidence is essential for HIV prevention organizations, programs, and local jurisdictions considering utilizing financial incentives as a strategy to improve HIV prevention outcomes. To be effective, these programs must be financially meaningful, accessible, and built with the community at the center. Limitations include a relatively small sample from Los Angeles County, which constrains the generalizability to other geographic settings and broader communities at risk for HIV. The sample size also limits the statistical power for the quantitative analyses, meaning that some real differences in CCT design preference across subgroups may exist but were too small to detect with the number of participants enrolled. Therefore, these findings should be interpreted as initial and exploratory evidence.

• Publisher: ProQuest Dissertations & Theses
• Subject: Black studies / Gender studies / Latin American Studies / Public health
• ISBN: 9798244885767