Syndemic factors associated with adult sexual HIV risk behaviors in a sample of Latino men who have sex with men in New York City

Abstract

Objective Syndemic theory has been proposed as a framework for understanding the role of multiple risk factors driving the HIV epidemic among sexual and gender minority individuals. As yet, the framework has been relatively absent in research on Latinos/as. Methods We used logistic regression to assess relationships among cumulative syndemic conditions – including clinically significant depression, high-risk alcohol consumption, discrimination, and childhood sexual abuse – engagement with multiple partners and condomless anal intercourse (CAI) in a sample of 176 Latino men who have sex with men (MSM) in New York City. Results In bivariate analyses, an increase in the number of syndemic factors experienced was associated with an increased likelihood of reporting multiple partners and CAI. In multivariable analyses, participants with 2, 3, and 4 factors were significantly more likely to report multiple partners than those with 0 (aOR=4.66, 95% CI [1.29, 16.85); aOR=7.28, 95% CI [1.94, 27.28] and aOR=8.25, 95% CI [1.74, 39.24] respectively; p<.05). Regarding CAI, only participants with 3 and 4 factors differed from those with 0 (aOR=7.35, 95% CI [1.64, 32.83] and OR=8.06, 95% CI [1.39, 46.73] respectively. Conclusions Comprehensive approaches that address syndemic factors, and capitalize on resiliency, are needed to address the sexual health needs of Latino MSM.

Promoting Pre-exposure Prophylaxis to Prevent HIV Infections Among Sexual and Gender Minority Hispanics/Latinxs

“…At the individual level, Latino MSM report concerns about side effects, mistrust of the medical establishment, hesitancy to discuss sexual health with their physicians, and fear that people will think they have HIV if they are seen taking a pill for PrEP (Bauermeister et al, 2013; Lelutiu-Weinberger & Golub, 2016; Martinez, Wu et al, 2016). In addition, many sexual and gender minority Latinxs face stressors that must be addressed as part of comprehensive HIV care and preventive services (Martinez et al, 2011; Palazzolo et al, 2016).…”

“…Latino MSM who migrate to gay epicenters often experience greater sexual freedom, but their limited English skills impede their ability to negotiate the conditions of sex placing them at risk for HIV infection (Bianchi et al, 2007). Many newly arrived sexual and gender minority Latinxs also experience poverty, discrimination, social isolation and marginalization, stigma, sexual trauma, violence, and substance abuse (Martinez et al, 2011; Martinez, Arreola et al, 2016). …”

“…Although data on the size of the undocumented sexual and minority Latinx population is limited (Martinez et al, 2011; Martinez, Arreola et al, 2016), it is estimated that there are approximately 190,000 undocumented adult LGBT Latinx immigrants in the U.S. (Gates, 2013). Because undocumented immigrants are specifically excluded from coverage under the Affordable Care Act (ACA), options for healthcare are limited for this population..…”

Co-occurring psychosocial problems predict HIV status and increased health care costs and utilization among sexual minority men

“…Syndemic indicators appear to be population-specific and, for sexual minority men, are thought to include victimization experiences, such as childhood sexual abuse (CSA) and intimate partner violence (IPV), as well as mental health problems, including depression and substance abuse. Factors such as sexual compulsivity, discrimination, concealment of sexual identity, and poverty, have also been identified as syndemic indicators among MSM but have not been as systematically evaluated (Parsons et al, 2012, 2015; Martinez et al, 2016; Oldenburg et al, 2014; Cole et al, 1996). …”

“…Various published studies have used a syndemics framework to examine the health of sexual minority men (Stall et al, 2003; Parsons et al, 2012, 2015; Martinez et al, 2016; Mimiaga et al, 2015; Mustanski et al, 2007, 2014). These studies consistently found that syndemic indicators were associated with one another, and that more syndemic indicators were associated with increased health risk behaviors (e.g., condomless anal sex; Stall et al, 2003; Mustanski et al, 2007).…”