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

Abstract

Background Stigma 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. Methods MSMO/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). Results Among 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. Conclusions MSMW 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.

Integrating HIV and mental health interventions to address a global syndemic among men who have sex with men

“…77,79 Studies in Latin America corroborate the negative consequences of minority stress for HIV and mental health outcomes. Exposure to anti-MSM stigma is associated with mental health problems among MSM in Chile, Mexico, Brazil, and Peru, [80][81][82][83] and with HIV risk and prevention behaviours among MSM in El Salvador, Belize, and Guatemala. 36,84,85 A few studies have applied syndemic theory to examine health inequities among MSM in Colombia, Mexico, and Brazil.…”

Homophobia and mental health: a scourge of modern era

“…( 2015 ), assessing LGB subjects in Belgium and Italy, found that social support is a protective mediator between IH and anxiety as well as depressive symptoms in their path-analysis model. Also, higher levels of IH and social heteronormativity have been associated with a significant increase of sexual risk behaviours and increased incidence of sexually transmitted diseases among LGBs (Perez-Brumer et al ., 2019 ).…”

Using an extended information-motivation-behavioral skills model to explain HPV vaccination intention among men who have sex with men only and men who have sex with men and women

“… 20–22 However, a systematic review and meta-analysis did not find a statistically significant relationship between the willingness to be vaccinated and gender identity. 11 Further, in other sexually transmitted disease-related studies, MSMW have demonstrated lower utilization rates of prevention and testing services relevant to the MSM population, 23 and have reported lower levels of sexual health knowledge and behavioral skills. 24 , 25 To our knowledge, few studies have revealed how underlying factors affect vaccination intention in these two populations and the variations among them, leading to a lack of appropriate recommendations for guidance.…”