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Evidence of the Negative Effect of Sexual Minority Stigma on HIV Testing Among MSM and Transgender Women in San Salvador, El Salvador

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Abstract

A cross sectional survey was administered to 670 men who have sex with men (MSM) and transgender women (TW) in San Salvador through respondent driven sampling to identify determinants of ever testing for HIV using a minority stress framework. A positive association was found between ever testing and older age [adjusted odds ratio (aOR) 2.10], past experience of sexual assault (aOR 2.92), perceiving that most social acquaintances had tested (aOR 1.81), and knowing a PLHIV (aOR 1.94). A negative association was found between homelessness and ever testing (aOR 0.43). Among the MSM sub-sample (n = 506), similar results were found for older age (aOR 2.63), and past experience of sexual assault (aOR 2.56). Internalized homonegativity was negatively associated with ever testing for HIV among MSM (aOR 0.46), and HIV testing stigma and experienced provider discrimination further strengthened this relationship. It is important to mitigate sexual minority stigma in order to increase HIV testing among MSM. Future research should explore this construct among TW.

Resumen

Una encuesta transversal usando RDS, fue administrada a 670 hombres que tienen sexo con hombres (HSH) y mujeres trans (MT) en San Salvador para identificar los factores determinantes para la toma de la prueba de VIH a través de un marco de estrés de minorías. Se encontró una asociación positiva entre haberse hecho la prueba alguna vez y tener mayor edad [Odds Ratio ajustado (ORa) 2.10], abuso sexual previo (ORa 2.92), la percepción de que la mayoría de sus conocidos se la habían realizado (ORa 1.81), y conocer personas con VIH (ORa 1.94). Se encontró una asociación negativa entre la falta de vivienda y haberse hecho la prueba de VIH alguna vez (ORa 0.43). Entre la submuestra de HSH (n = 506), se encontraron resultados similares al tener mayor edad (ORa 2.63), y el abuso sexual previo (ORa 2.56). Entre los HSH, la homonegatividad internalizada se asoció negativamente con haberse hecho la prueba de VIH alguna vez (ORa 0.46), y esta relación se hizo más fuerte al relacionar el estigma de hacerse la prueba y haber sido discriminado por el proveedor. Es importante disminuir el estigma a las minorías sexuales con el fin de aumentar las pruebas de VIH entre los HSH. Las investigaciones futuras deberían explorar este construcción entre MT.

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Notes

  1. In this paper we use the term “transgender woman” to refer to a person who identifies their gender as female, but was assigned the male sex at birth [12, p. 12]. Within this group there are individuals who have undergone medical procedures to alter their sexual anatomy and physiology from male to female, or who plan to in the future, as well as people who do not wish to change physically but who identify as female. “Transgender” refers to the person’s gender identity, and is distinct from their sexual orientation.

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Acknowledgments

We are thankful to the people who participated in this study and contributed their time and knowledge to our understanding of this topic. We are also grateful to the dedicated field team, and local Transgender, MSM, and HIV advocacy organizations that supported this study. This study was funded by the United States Agency for International Development (USAID) through a cooperative agreement (GHA-A-00-08-00003-00) with the MEASURE Evaluation Project. The views expressed in this paper do not necessarily reflect those of USAID.

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Authors and Affiliations

  1. Department of Global Health Systems and Development, Tulane School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2200, New Orleans, LA, 70112, USA

    Katherine Andrinopoulos & John Hembling

  2. Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET) Inc., San Salvador, El Salvador

    Maria Elena Guardado & Flor de Maria Hernández

  3. National AIDS Control Program, Ministry of Health and Social Welfare, San Salvador, El Salvador

    Ana Isabel Nieto

  4. United States Agency for International Development, Guatemala City, Guatemala

    Giovanni Melendez

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  1. Katherine Andrinopoulos
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  2. John Hembling
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  3. Maria Elena Guardado
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  4. Flor de Maria Hernández
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  5. Ana Isabel Nieto
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  6. Giovanni Melendez
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Correspondence to Katherine Andrinopoulos.

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Andrinopoulos, K., Hembling, J., Guardado, M.E. et al. Evidence of the Negative Effect of Sexual Minority Stigma on HIV Testing Among MSM and Transgender Women in San Salvador, El Salvador. AIDS Behav 19, 60–71 (2015). https://doi.org/10.1007/s10461-014-0813-0

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