The authors of this article are EHE-funded implementation researchers focused on reducing the burden of HIV in Latino/a/x communities. We conducted 3 formative meetings to formulate and answer the central question, “What are the key lessons learned from designing and conducting implementation research focused on ending the HIV epidemic among Latino/a/x populations in the US and Puerto Rico?” We initially met to share our scopes of work including population, geographical area, and specific focus within the EHE framework (diagnose, prevent, treat, and respond).⁷ We next identified common themes and contrasting findings, which we iteratively refined and consolidated in an article outline. Two authors (HSS and PAS) concurrently reviewed the 30 articles published by this group from 2014 to 2024, detailing EHE projects and their formative research to comprehensively incorporate results into the themes identified in discussion. Coauthors also provided illustrative examples of identified themes based on ongoing EHE projects that are not yet published. HSS and PAS then conducted a second literature search in PubMed for each identified theme to provide context and directions for future research. All coauthors reviewed and edited the themes, the outline, and the article itself.

There is no “one-size-fits-all” approach to addressing HIV disparities, because Latino/a/x communities differ significantly by region, immigration history, socioeconomic conditions, and sexual orientation and gender identity, among other factors. For instance, although all of these groups may be considered “Latino,” Dominican and Puerto Rican populations in New York have different health priorities and sociostructural contexts than Mexican or Salvadorean populations in Texas. Latino/x sexual minority men (SMM) and Latina transgender women are shown to be disproportionately affected by HIV on a national level, yet these disparities are driven by different factors depending on the intersectional identities they experience and the sociopolitical climate of where they live.¹ Community-engaged research is, therefore, key to assessing and addressing the needs of different Latino/a/x populations. The diversity within the Latino/a/x populations should not be considered a problem or challenge when providing HIV services or engaging with them in participatory research. The success of previous initiatives to address HIV disparities has stemmed precisely from the ability to provide services that are as tailored as possible.²⁶

In addition to the diversity of Latino/a/x individuals, our group has noted the critical importance of recognizing the diversity of place. Where a person lives has an inseparable impact on HIV vulnerability in terms of historical policies, local HIV prevalence, and local resources that affect access to care and sociostructural determinants of health.^13,27 Puerto Ricans in Puerto Rico have different health experiences when compared with Puerto Ricans in other US jurisdictions, as is true for people from other countries in Latin America.²⁸ Regions of the US that have had a long-standing presence of Latino/a/x populations are more likely to have developed infrastructure to serve those communities (eg, bilingual Latino/a/x workforce, Latino-centered community-based organizations and health centers) than emergent immigrant destinations. Implementation science and community-engaged research are thus essential to successfully adapting and scaling evidence-based interventions tailored to Latino/a/x communities.

The EHE initiative highlights that community engagement and partnerships are key to achieving the goal of reducing HIV infections by 90% by 2030.⁷ In our experience, academic institutions’ financial, administrative, and appointment processes often pose barriers to conducting community-engaged research and maintaining sustainable partnerships. In terms of financial processes, delayed payment schedules, inequitable payment amounts, and fee-for-service models can lead to community-based partners disengaging from research projects because it is not financially feasible for them to participate in such conditions. In addition, lengthy administrative processes such as institutional review board (IRB) approval and contractual agreements can further hinder community–academic partnerships. Finally, community members are often excluded from leadership roles in academic institutions because they often do not meet the institution’s eligibility criteria for such positions. Academic institutions participating in community-engaged research must reform their processes to support rather than obstruct equitable engagement with community members.

Academic institutions must also support and expand the pipeline of Latino/a/x trainees in medicine and public health research. Despite representing 19% of the US population, Latino/a/x individuals represent 4% of public health and 6% of medical school faculty in the nation, and this disparity increases with advances in career rank.^29–31 Latino/a/x researchers often have a deep understanding of the sociostructural factors affecting their communities’ health and can facilitate the trust and engagement of community members.³² Latino/a/x investigators are thus critical to developing and scaling sustainable HIV interventions in real-world settings. However, a history of structural racism has led to a shortage of Latino/a/x researchers and health professionals. We cannot effectively improve HIV outcomes among Latino/a/x populations when these same populations are excluded from leading solutions.^31,32 National programs such as the Centers for AIDS Research (CFAR) Diversity, Equity, and Inclusion Pathway Initiative and the Centers for Disease Control (CDC) Minority HIV Research Initiative offer robust national responses to address the shortage of trainees from backgrounds underrepresented in HIV research.^32,33 Such programs also illustrate the need for ongoing funding and support of Latino/a/x mentors throughout their careers. We advocate that federal and academic institutions must urgently expand efforts to address the shortage of Latino/a/x researchers, who are essential to advancing the field of HIV implementation research and promoting the health of Latino/a/x populations.^31–33

Cultural humility is essential to community-engaged research with diverse Latino/a/x populations, but it is often misunderstood. Although a diverse workforce is crucial for effective HIV research and care, diversity alone does not guarantee cultural humility. Cultural humility is an ongoing process of learning, reflection, and understanding of the sociostructural histories and realities faced by the communities being served.^34,35 The sociostructural histories of Latino/a/x populations profoundly affect health behaviors, trust in health care systems, and perspectives on research.²⁸ This history is marked by discrimination, racism, and stigmatization of migrants, people of color, and LGBTQ+ identities.³⁶ Acknowledging this history and planning for its ongoing impacts are essential for the success of community–academic partnerships and HIV implementation research. A lack of cultural humility can impede progress in HIV research by failing to evolve in response to community feedback and needs. Hence, cultural humility remains crucial for all research team members, regardless of background, because it ensures ongoing learning and responsiveness to the diverse needs of Latino/a/x populations.

Incorporating community members into all phases of research—planning, implementation, evaluation, and dissemination—is essential for the success of HIV interventions in Latino/a/x populations.³⁷ Community-based participatory research (CBPR), under the umbrella of community-engaged research, actively involves community members in all phases of research while striving for equal partnership and mutual empowerment.³⁷ Our group follows CBPR principles to develop and implement interventions that are culturally relevant, acceptable, and sustainable. In our experiences, we have found the following CBPR strategies to be effective:

For instance, in the Vive social marketing intervention to promote HIV testing among Latino/a/x immigrants in Maryland, the inclusion of community health workers and CBO leaders on the research team enabled the development of messages that resonated with local Latino/a/x populations.^39,40 Campaign messaging was tailored to address questions about obtaining HIV testing regardless of immigration status, insurance, and other concerns in a sensitive and culturally appropriate way. CBO partners were also instrumental in distributing messaging to the target audiences in a trusted manner. The Vive campaign was associated with increased HIV screening among Latino/a/x individuals at risk for HIV.⁴¹ By using CBPR strategies such as those described above, HIV researchers can improve recruitment, retention, and outcomes by leveraging community insights and belonging.

Beyond the study team and partnerships, community engagement is essential in the implementation research itself. In terms of study design, we often use mixed methods approaches, including surveys complemented by multilevel stakeholder interviews or focus groups, to obtain a breadth and depth of understanding of contextual determinants and implementation outcomes.^42,43 Given the lengthy timeline for traditional qualitative research, we have often incorporated rapid qualitative methods, designed to facilitate implementation science, and timely communication with community partners.^44,45 Interview questions and surveys should be tailored to the focus community. Questions should preserve anonymity whenever possible because identification can be a deterrent to participation for marginalized populations, such as undocumented immigrants or LGBTQ+ populations. The language and cultural adaptation of the data collection instruments should follow evidence-informed practices consistent with the participants, such as for race measures that are often not reflective of the identities experienced by Latino/a/x individuals.⁴⁶ In terms of recruitment, we recommend the following tailored strategies we have used to ensure engagement of underserved populations, including

By soliciting and synthesizing the input of community members while removing barriers to participation, research teams become well poised to design effective public health interventions.

Innovations in HIV prevention and care delivery are urgently needed to overcome barriers to traditional health care settings and expand access among Latino/a/x populations. Mobile health, telehealth, and social marketing interventions present opportunities for care expansion, because 91% of Latino/a/x individuals in the US own smartphones.⁵⁰ Informed by community engagement, our teams have piloted these interventions to promote PrEP uptake and virologic suppression among Latino/a/x populations.

Our work also highlights the limits of technological outreach for many Latino/a/x populations. In Maryland, where there are many recently arrived migrants in both urban and rural areas, peer referrals and community health worker outreach have proven to be more effective in promoting HIV testing, PrEP, and COVID-19 services than a social media campaign alone.^41,47 Thus, assessing local contexts and determining the most effective strategies for each population remain important.