The ecology of sexual health of sexual minorities in Guatemala City

Abstract

Guatemalan gay and bisexual men, men who have sex with men (MSM), and transgender persons carry disproportionate burden of HIV and other sexually transmitted infections compared with other Guatemalan subgroups. However, little is known about the determinants of sexual health to inform health promotion and disease prevention interventions among these sexual minorities. We sought to explore sexual health and HIV risk among Guatemalan sexual minorities, using a community-based participatory research approach. We conducted 8 focus groups (n = 87 participants total) and 10 individual in-depth interviews with gay and bisexual men, MSM, and transgender persons. Using constant comparison, an approach to grounded theory, we analyzed verbatim transcripts and identified 24 themes that we organized into five ecological factors influencing sexual health: intrapersonal (e.g. misconceptions about HIV transmission, low perceived susceptibility and lack of condoms use skills); interpersonal (e.g. family rejection and condom use as a barrier to intimacy); community (e.g. discrimination and stigma); institutional (e.g. limited access to health promotion resources); and public policy (e.g. perceived lack of provider confidentiality and anti-gay rhetoric). There is profound need for multiple-level interventions to ensure that Guatemalan sexual minorities have the knowledge and skills needed to reduce sexual risk. Interventions are warranted to increase social support among sexual minorities, reduce negative perspectives about sexual minorities, develop institutional resources to meet the needs of sexual minorities and reduce harmful anti-gay rhetoric. Understanding and intervening on the identified factors is especially important given that the health of Guatemalan sexual minorities has been to-date neglected.

Gender-based discrimination and unprotected receptive anal intercourse among transgender women in Brazil: A mixed methods study

“…For example, the meaningful participation of TGW in the research process is critical to make sure that the right questions are asked, the appropriate methods are applied, and the interpretation of research findings are grounded. With respect to programs, there is ample evidence illustrating how GBD affects access to general health services in Brazil [ 67 , 68 ] and HIV counseling and testing [ 8 , 13 , 67 ] as well as other prevention services in particular [ 53 , 69 ]. Concrete steps are needed, such as training providers responsible for transgender-specific health care more broadly (e.g., knowing the appropriate dosage of hormones) as well as ensuring culturally competent care (e.g., understanding the importance of appropriate pronoun use), in addition to ensuring providers are prepared to screen TGW for experiences with GBD and connect them to the appropriate resources.…”

HIV Diagnosis, Linkage to Care, and Retention among Men Who Have Sex with Men and Transgender Women in Guatemala City

“…These findings echo previous findings of fear as a barrier to HIV testing MSM and transgender women in Guatemala City and highlight the salience of the debilitating impact of layered stigma. 6,7 As further evidence of the impact of stigma related to sexual orientation, in the most recent integrated behavioral and biological survey with MSM in Guatemala City, individuals who had not disclosed their sexual orientation to anyone were less likely to have been previously tested. 23 …”

“…5 In qualitative studies with MSM and transgender women in Guatemala City, the main barriers to HIV testing identified include fear, layered stigma and discrimination due to gender identity and/or sexual orientation and HIV, lack of social support, and lack of knowledge and access to HIV testing resources. 6,7 One consequence of these barriers to testing is that many MSM and transgender women are diagnosed with advanced cases of HIV, which has negative implications for their health as well as the opportunity for timely implementation and effectiveness of TasP.…”

Community-Engaged Research as an Approach to Expedite Advances in HIV Prevention, Care, and Treatment: A Call to Action

“…He also volunteered with a Guatemalan grassroots community organization that provides HIV prevention, care, and treatment. This ongoing relationship led to expanded partnerships with community members; representatives of organizations, agencies, and businesses; clinicians; and academic researchers within Guatemala as well as North Carolina (Rhodes et al, 2015).…”