Homophobia and heteronormativity as dimensions of stigma that influence sexual risk behaviors among men who have sex with men (MSM) and women (MSMW) in Lima, Peru: a mixed-methods analysis

BMC Public Health

Jesse L. Clark¹  Jonathan Garcia²  Catherine E. Oldenburg³  Ryan C. Passaro⁴  Amaya G. Perez-Brumer⁵  Jorge Sanchez⁶  Javier R. Lama⁷  H. Javier Salvatierra⁷ 

[1] 0000 0000 9632 6718, grid.19006.3e, South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA;0000 0001 2112 1969, grid.4391.f, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA;0000 0001 2297 6811, grid.266102.1, Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA;0000 0004 0386 9246, grid.267301.1, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA;0000 0000 9632 6718, grid.19006.3e, South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA;0000000419368729, grid.21729.3f, Columbia Mailman School of Public Health, Department of Sociomedical Sciences, 722 West 168th St., 10032, New York, NY, USA;Centro de Investigaciones Tecnologicas y Biomedicas Universidad Nacional de San Marcos, Lima, Peru;grid.422949.0, Asociación Civil Impacta Salud y Educación, Lima, Peru;

关键词: Men who have sex with men and women (MSMW);    Sexually transmitted infections (STIs);    Human immunodeficiency virus (HIV);    Partner notification;    Social determinants of health;   

DOI  :  10.1186/s12889-019-6956-1

来源: publisher

【 摘 要 】

BackgroundStigma differentially influences HIV and STI care among MSM, especially regarding partner notification practices. Recognizing the heterogeneous behaviors/identities within the category “MSM,” we used mixed-methods to assess sexual risk behaviors among men who have sex with men only (MSMO) and behaviorally bisexual MSM (MSMW) with HIV and/or other STIs.MethodsMSMO/MSMW recently diagnosed (< 30 days) with HIV, syphilis, urethritis, or proctitis completed a cross-sectional survey assessing sexual risk behaviors, anticipated disclosure, and sexual partnership characteristics (n = 332). Multivariable generalized estimating equation models assessed characteristics associated with female compared to male partners in the last three partnerships. Follow-up qualitative interviews (n = 30) probed partner-specific experiences (e.g., acts and disclosure).ResultsAmong all participants, 13.9% (n = 46) described at least one of their last three sex partners as female (MSMW). MSMW (mean age of 31.8) reported a mean of 3.5 partners (SD = 4.5) in the past 3 months and MSMO (mean age 30.6) reported a mean of 4.6 partners (SD = 9.7) in the past 3 months. MSMW were more likely to report unprotected insertive anal sex (77.9%) than MSMO (43.1%; p < 0.01). Cisgender female partners were associated with condomless insertive sex in the last 3 months (aPR: 3.97, 95%CI: 1.98–8.00) and classification as a “primary” partnership (2.10, 1.34–3.31), and with lower prevalence of recent HIV diagnosis (0.26, 0.11–0.61). Planned notification of HIV/STI diagnoses was less common for female than for male partners (0.52, 0.31–0.85). Narratives illustrate internal (e.g., women as ‘true’ partners) and community-level processes (e.g., discrimination due to exposure of same-sex behavior) that position homosexual behavior and bisexual identity as divergent processes of deviance and generate vulnerability within sexual networks.ConclusionsMSMW recently diagnosed with HIV/STI in Peru report varying partnership characteristics, with different partner-specific risk contexts and prevention needs. Descriptions highlight how behaviorally bisexual partnerships cut across traditional risk group boundaries and suggest that HIV/STI prevention strategies must address diverse, partnership-specific risks.

【 授权许可】

CC BY