Date Published: December 23, 2013
Publisher: Hindawi Publishing Corporation
Author(s): Rosa Solorio, Mark Forehand, Jane Simoni.
Latino immigrant men who have sex with men (MSM) are at risk for HIV and delayed diagnosis. An exploratory study using qualitative interviews that assess the beliefs and attitudes of 54 Latino immigrant MSM in Seattle, Washington, is presented. The goal of this research is to determine whether attitudinal differences exist between participants who had and had not been tested and to use any insight into the development of a media campaign to promote testing. Over one-third of the men have never been tested for HIV. Nontesters are more likely to be men who have sex with men and women, have less knowledge about HIV risks, perceive their sexual behaviors as less risky, and deflect HIV-related stigma. Testers are more likely to be self-identified as being gays. Both groups believe that fear of a positive result is the main barrier to testing. Both groups believe that family members have negative attitudes towards HIV testing and that having Latino staff at HIV testing sites hinders confidentiality. Financial concerns with regard to the cost of testing were also expressed by both groups. Based on these insights, recommended strategies for the development of HIV prevention and testing campaigns are made.
In the United States, Latino are disproportionately affected by HIV infection and have an HIV diagnosis rate that is three times that of non-Latino Whites . An important public health issue among Latinos is that they tend to be diagnosed later in the course of HIV infection than nonLatino Whites  and present with lower CD4 counts and more opportunistic infections [3, 4]. In a recent systematic review of delayed HIV/AIDS diagnosis in the United States, Latino males and Latino immigrants were found to have the highest risk for late diagnosis . Late HIV diagnosis has negative implications for individual morbidity and mortality and for public health. The HIV/AIDS epidemic can be lessened substantially by increasing the proportion of HIV positive persons who are aware of their status ; 70% of persons who find out that they are HIV positive stop having unsafe sex . Importantly, timely diagnosis and treatment of HIV benefit individuals through a reduction in morbidity and mortality and offer public health benefits through a lowering of the viral load across a population, potentially slowing down new infections .
We conducted in-depth qualitative interviews with Latino MSM from May 2009 to March 2010 in Seattle, Washington. This methodology provides an opportunity to investigate participant reaction to HIV testing more fully than do methodologies that collect data from participants using quantitative surveys with predefined response options. In addition, the use of individual interviews allows the participants to have more privacy and facilitates their sharing of sensitive information compared to group settings. We used a grounded theory approach with open coding to generate lists of emergent salient factors according to participant’s experiences and perspectives .
Most of the participants were of Mexican descent (80%), had an age range from 18 to 40 years with the median age of being 25 years, and had annual incomes below $20,000. All participants were monolingual Spanish speakers and most had resided in the USA. for less than 5 years and had less than a high school education; thus, the sample was a low-income one with low levels of acculturation to U.S. culture and low levels of education. Most of the men (60%) were clear about their self-described sexual orientation with 28 identifying themselves as gay, 2 as transgender, and 2 as bisexual; however, the other 40% explicitly stated that they were not gay and amongst these, 13 described a history of having sex with men and women and 9 described a history of having sex with men only. Some of these men asserted their male masculinity based on practicing only insertive anal sex with men. Among the 54 men, 35 had been tested for HIV (65%) and among these, 7 report positive results (20% of testers); 35% of the sample has never received HIV testing. Most men were aware about the existence of blood tests, but only a few were aware about rapid HIV tests that use saliva and that such testing may provide results within 20 minutes. About one-third of the sample could not identify a place for HIV testing in King County, WA.
This qualitative research identified important beliefs and attitudes towards HIV testing among Latino immigrant MSM. Important differences in attitudes and beliefs are found in comparing testers versus nontesters. Nontesters are more likely to be MSMW, to have less knowledge about HIV risks, to perceive their sexual behaviors as less risky, and to deflect HIV-related stigma. The main barrier for HIV testing for both groups, however, was the belief that if they undergo HIV testing and the result is positive, then they would face HIV-related stigma and rejection from friends and family members. The men reported that family members equate HIV testing with being gay and being promiscuous. Other significant barriers include confidentiality concerns and financial concerns about the cost of HIV testing. These findings may guide the future development of a mass media campaign to promote HIV testing among MSM and highlight the need for such a campaign to target MSM who are not identified as gays including MSMW and MSM who are not identified as gays.