Abstract
Latino sexual minority men (LSMM) experience sexual and behavioral health disparities. Yet, LSMM are underrepresented in sexual and behavioral health research, creating scientific inequity. There is, therefore, a need to identify the barriers and facilitators to LSMM’s participation in sexual and behavioral health research, which is the gap that the current study sought to fill. We interviewed LSMM (n = 28; age 18–40, 57% US born) and key informants (n = 10) regarding LSMM’s barriers and facilitators to participating in sexual and behavioral health research and suggestions for increasing participation. The research team coded the data via thematic analysis. We found that relational factors are central to understanding LSMM’s participation in sexual and behavioral health research. Some relational experiences (e.g., interpersonal stigma) interfered with participation, whereas others (e.g., altruistic desires to contribute to community well-being) facilitated participation. The findings are consolidated within a new relational framework for understanding LSMM’s participation in sexual and behavioral health research. Study findings highlight the centrality of relational factors in influencing LSMM’s participation in sexual and behavioral health research. Relational factors can be used to inform the development of culturally relevant recruitment strategies to improve representation of LSMM in sexual and behavioral health research. Implementing these recommendations may address scientific inequity, whereby LSMM are disproportionately impacted by sexual and behavioral health concerns yet underrepresented in related research.
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Notes
Note that we are using language regarding ethnicity recommended by del Río-González (2021), which is that when referring to the whole community, we use the term “Latino/a/x” whereas when we are referring to a specific gender (e.g., men), we use the corresponding gendered term (e.g., “Latino”).
References
Andrés-Hyman, R. C., Ortiz, J., Añez, L. M., Paris, M., & Davidson, L. (2006). Culture and clinical practice: Recommendations for working with Puerto Ricans and other Latinas(os) in the United States. Professional Psychology: Research and Practice, 37(6), 694–701. https://doi.org/10.1037/0735-7028.37.6.694
Añez, L. M., Paris Jr, M., Bedregal, L. E., Davidson, L., & Grilo, C. M. (2005). Application of cultural constructs in the care of first generation Latino clients in a community mental health setting. Journal of Psychiatric Practice, 11(4), 221–230.
Barrera, I., & Longoria, D. (2018). Examining cultural mental health care barriers among Latinos. CLEARvoz Journal, 4(1), 1–12.
Blair, I. V., Steiner, J. F., Fairclough, D. L., Hanratty, R., Price, D. W., Hirsh, H. K., Wright, L. A., Bronsert, M., Karimkhani, E., Magid, D. J., & Havranek, E. P. (2013). Clinicians’ implicit ethnic/racial bias and perceptions of care among black and Latino patients. Annals of Family Medicine, 11(1), 43–52. https://doi.org/10.1370/afm.1442
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa
Bruce, D., Ramirez-Valles, J., & Campbell, R. T. (2008). Stigmatization, substance use, and sexual risk behavior among latino gay and bisexual men and transgender persons. Journal of Drug Issues, 38(1), 235–260. https://doi.org/10.1177/002204260803800111
Castillo-Mancilla, J. R., Cohn, S. E., Krishnan, S., Cespedes, M., Floris-Moore, M., Schulte, G., Pavlov, G., Mildvan, D., Smith, K. Y., ACTG Underrepresented Populations Survey Group. (2014). Minorities remain underrepresented in HIV/AIDS research despite access to clinical trials. HIV Clinical Trials, 15(1), 14–26. https://doi.org/10.1310/hct1501-14
Ceballos, R. M., Knerr, S., Scott, M. A., Hohl, S. D., Malen, R. C., Vilchis, H., & Thompson, B. (2014). Latino beliefs about biomedical research participation: A qualitative study on the US-Mexico border. Journal of Empirical Research on Human Research Ethics, 9(4), 10–21. https://doi.org/10.1177/1556264614544454
Centers for Disease Control and Prevention. (2018). Diagnoses of HIV Infection in the United States and Dependent Areas, 2017 (No. 29; HIV Surveillance Report, 2017). http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html
Centers for Disease Control and Prevention. (2019). Estimated HIV incidence and prevalence in the United States 2010–2016 (No. 24; HIV Surveillance Supplemental Report). http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html
Centers for Disease Control and Prevention. (2020). Diagnoses of HIV infection in the United States and dependent areas, 2018 (No. 31). Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2018-updated-vol-31.pdf
Chin, L. J., Berenson, J. A., & Klitzman, R. L. (2016). Typologies of altruistic and financial motivations for research participation: A Qualitative Study of MSM in HIV vaccine trials. Journal of Empirical Research on Human Research Ethics, 11(4), 299–310. https://doi.org/10.1177/1556264616679537
Cochran, S. D., Mays, V. M., Alegria, M., Ortega, A. N., & Takeuchi, D. (2007). Mental health and substance use disorders among Latino and Asian American lesbian, gay, and bisexual adults. Journal of Consulting and Clinical Psychology, 75(5), 785–794. https://doi.org/10.1037/0022-006X.75.5.785
Cowan, E. A., Calderon, Y., Gennis, P., Macklin, R., Ortiz, C., & Wall, S. P. (2007). Spanish and English video-assisted informed Consent for intravenous contrast administracion in the emergency department: A randomized controlled trial. Annals of Emergency Medicine, 49(2), 221-230.e3. https://doi.org/10.1016/j.annemergmed.2006.07.934
D’Angelo, A. B., Lopez-Rios, J., Flynn, A. W. P., Pantalone, D. W., Holloway, I. W., & Grov, C. (2019). What motivates gay and bisexual men to participate in PrEP-related research? International Journal of Sexual Health, 31(3), 283–290. https://doi.org/10.1080/19317611.2019.1634173
del Río-González, A. M. (2021). To Latinx or not to Latinx: A question of gender inclusivity versus gender neutrality. American Journal of Public Health, 111(6), 1018–1021. https://doi.org/10.2105/AJPH.2021.306238
Díaz, R. M., Ayala, G., Bein, E., Henne, J., & Marin, B. V. (2001). The impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: Findings from 3 US cities. American Journal of Public Health, 91(6), 927–932. https://doi.org/10.2105/ajph.91.6.927
Du Bois, S. N., Johnson, S. E., & Mustanski, B. (2012). Examining racial and ethnic minority differences among YMSM during recruitment for an online HIV prevention intervention study. AIDS and Behavior, 16(6), 1430–1435. https://doi.org/10.1007/s10461-011-0058-0
Fauci, A. S., Redfield, R. R., Sigounas, G., Weahkee, M. D., & Giroir, B. P. (2019). Ending the HIV epidemic: A plan for the United States. Journal of the American Medical Association, 321(9), 844–845. https://doi.org/10.1001/jama.2019.1343
Flores, G. (2000). Culture and the patient-physician relationship: Achieving cultural competency in health care. Journal of Pediatrics, 136(1), 14–23. https://doi.org/10.1016/S0022-3476(00)90043-X
Florida Department of Health in Miami-Dade. (2019). Epidemiology of HIV in Miami-Dade County, 2018. http://miamidade.floridahealth.gov/programs-and-services/infectious-disease-services/hiv-aids-services/_documents/2019/_documents/HIV-in-Miami-Dade-2018.pdf
García, A. A., Zuñiga, J. A., & Lagon, C. (2017). A personal touch: The most important strategy for recruiting Latino research participants. Journal of Transcultural Nursing, 28(4), 342–347. https://doi.org/10.1177/1043659616644958
Gattamorta, K. A., Salerno, J. P., & Castro, A. J. (2019). Intersectionality and health behaviors among US high school students: Examining race/ethnicity, sexual identity, and sex. Journal of School Health, 89, 800–808. https://doi.org/10.1111/josh.12817
George, S., Duran, N., & Norris, K. (2014). A systematic review of barriers and facilitators to minority research participation among African Americans, Latinos, Asian Americans, and Pacific Islanders. American Journal of Public Health, 104(2), e16-31. https://doi.org/10.2105/AJPH.2013.301706
Grov, C., Cain, D., Whitfield, T. H. F., Rendina, H. J., Pawson, M., Ventuneac, A., & Parsons, J. T. (2016). Recruiting a US national sample of HIV-negative gay and bisexual men to complete at-home self-administered HIV/STI testing and surveys: Challenges and opportunities. Sexuality Research and Social Policy, 13(1), 1–21. https://doi.org/10.1007/s13178-015-0212-y
Grov, C., Westmoreland, D. A., Carneiro, P. B., Stief, M., MacCrate, C., Mirzayi, C., Pantalone, D. W., Patel, V. V., & Nash, D. (2019). Recruiting vulnerable populations to participate in HIV prevention research: Findings from the Together 5,000 Cohort Study. Annals of Epidemiology, 35, 4–11. https://doi.org/10.1016/j.annepidem.2019.05.003
Guest, G., Bunce, A., & Johnson, L. (2006). How many interviews are enough? An experiment with data saturation and variability. Field Methods, 18, 69–92. https://doi.org/10.1177/1525822X05279903
Guilamo-Ramos, V., Thimm-Kaiser, M., Benzekri, A., Chacón, G., López, O. R., Scaccabarrozzi, L., & Rios, E. (2020). The invisible US Hispanic/Latino HIV crisis: Addressing gaps in the national response. American Journal of Public Health, 110(1), 27–31. https://doi.org/10.2105/AJPH.2019.305309
Harkness, A., Rogers, B. G., Mayo, D., Safren, S. A., & Pachankis, J. E. (2019). Engagement of young sexual minority men in hiv-prevention and behavioral health clinical research. 23rd Annual National Center for AIDS Research Meeting, Chapel Hill, NC.
Hendrickson, S. G. (2007). Video recruitment of non-English-speaking participants. Western Journal of Nursing Research, 29(2), 232–242. https://doi.org/10.1177/0193945906292558
Hildebrand, J. A., Billimek, J., Olshansky, E. F., Sorkin, D. H., Lee, J.-A., & Evangelista, L. S. (2018). Facilitators and barriers to research participation: Perspectives of Latinos with type 2 diabetes. European Journal of Cardiovascular Nursing, 17(8), 737–741. https://doi.org/10.1177/1474515118780895
Institute of Medicine Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. (2003). In B. D. Smedley, A. Y. Stith, & A. R. Nelson (Eds.), Unequal treatment: Confronting racial and ethnic disparities in health care. National Academies Press.
Kelley, E. G., Yarrington, C. D., Calderwood, L., Torrey Sosa, L., & Connors, P. D. (2020). The importance of personalismo: Navigating obstacles in recruitment strategies for Spanish speakers in marginalized communities. Journal of Genetic Counseling, 29(3), 391–398. https://doi.org/10.1002/jgc4.1240
Khosropour, C. M., & Sullivan, P. S. (2011). Predictors of retention in an online follow-up study of men who have sex with men. Journal of Medical Internet Research, 13(3), e47. https://doi.org/10.2196/jmir.1717
Kim, B. S. K., Soliz, A., Orellana, B., & Alamilla, S. G. (2009). Latino/a values scale: Development, reliability, and validity. Measurement and Evaluation in Counseling and Development, 42(2), 71–91. https://doi.org/10.1177/0748175609336861
Madkins, K., Greene, G. J., Hall, E., Jimenez, R., Parsons, J. T., Sullivan, P. S., & Mustanski, B. (2018). Attrition and HIV risk behaviors: A comparison of young men who have sex with men recruited from online and offline venues for an online HIV prevention program. Archives of Sexual Behavior, 47(7), 2135–2148. https://doi.org/10.1007/s10508-018-1253-0
Martinez, C. R., McClure, H. H., Eddy, J. M., Ruth, B., & Hyers, M. J. (2012). Recruitment and retention of Latino immigrant families in prevention research. Prevention Science, 13(1), 15–26. https://doi.org/10.1007/s11121-011-0239-0
Martinez, O., Arreola, S. G., Wu, E., Muñoz-Laboy, M., Levine, E., Rutledge, S. E., Hausmann-Stabile, C., Icard, L., Rhodes, S. D., Carballo-Diéguez, A., Rodríguez-Díaz, C. E., Fernandez, M. I., & Sandfort, T. (2016). Syndemic factors associated with adult sexual HIV risk behaviors in a sample of Latino men who have sex with men in New York City. Drug and Alcohol Dependence, 166, 258–262. https://doi.org/10.1016/j.drugalcdep.2016.06.033
Martinez, O., Lee, J. H., Bandiera, F., Santamaria, E. K., Levine, E. C., & Operario, D. (2017). Sexual and behavioral health disparities among sexual minority Hispanics/Latinos: Findings from the National Health and Nutrition Examination Survey, 2001–2014. American Journal of Preventive Medicine, 53(2), 225–231. https://doi.org/10.1016/j.amepre.2017.01.037
McNulty, M., Smith, J. D., Villamar, J., Burnett-Zeigler, I., Vermeer, W., Benbow, N., Gallo, C., Wilensky, U., Hjorth, A., Mustanski, B., Schneider, J., & Brown, C. H. (2019). Implementation research methodologies for achieving scientific equity and health equity. Ethnicity & Disease, 29(1), 83–92. https://doi.org/10.18865/ed.29.S1.83
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. https://doi.org/10.1037/0033-2909.129.5.674
Mimiaga, M. J., Biello, K. B., Robertson, A. M., Oldenburg, C. E., Rosenberger, J. G., O’Cleirigh, C., Novak, D. S., Mayer, K. H., & Safren, S. A. (2015). High prevalence of multiple syndemic conditions associated with sexual risk behavior and HIV infection among a large sample of Spanish- and Portuguese-speaking men who have sex with men in Latin America. Archives of Sexual Behavior, 44(7), 1869–1878. https://doi.org/10.1007/s10508-015-0488-2
Mimiaga, M. J., Pantalone, D. W., Biello, K. B., Glynn, T. R., Santostefano, C. M., Olson, J., Pardee, D. J., Hughto, J. M. W., Garcia Valles, J., Carrico, A. W., Mayer, K. H., & Safren, S. A. (2018). A randomized controlled efficacy trial of behavioral activation for concurrent stimulant use and sexual risk for HIV acquisition among MSM: Project IMPACT study protocol. BMC Public Health. https://doi.org/10.1186/s12889-018-5856-0
Morrow, S. L. (2005). Quality and trustworthiness in qualitative research in counseling psychology. Journal of Counseling Psychology, 52(2), 250–260. https://doi.org/10.1037/0022-0167.52.2.250
Moua, M. (2010). Relationships matter: Volunteerism in immigrant communities. Minnesota Association for Volunteer Administration. https://www.yumpu.com/en/document/view/43174400/relationships-matter-volunteerism-in-immigrant-communities
Murray, A., Gaul, Z., Sutton, M. Y., & Nanin, J. (2018). “We hide…”: Perceptions of HIV risk among Black and Latino MSM in New York City. American Journal of Men’s Health, 12(2), 180–188. https://doi.org/10.1177/1557988317742231
National Center for Health Statistics (US). (2018). Health, United States, 2017: With special feature on mortality. National Center for Health Statistics (US). http://www.ncbi.nlm.nih.gov/books/NBK532685/
O’Dell, B. L., Rosser, B. R. S., Miner, M. H., & Jacoby, S. M. (2008). HIV prevention altruism and sexual risk behavior in HIV-positive men who have sex with men. AIDS and Behavior, 12(5), 713–720. https://doi.org/10.1007/s10461-007-9321-9
Oakley, L. P., López-Cevallos, D. F., & Harvey, S. M. (2019). The association of cultural and structural factors with perceived medical mistrust among young adult Latinos in rural Oregon. Behavioral Medicine, 45(2), 118–127. https://doi.org/10.1080/08964289.2019.1590799
Pachankis, J. E., McConocha, E. M., Reynolds, J. S., Winston, R., Adeyinka, O., Harkness, A., Burton, C. L., Behari, K., Sullivan, T. J., Eldahan, A. I., Esserman, D. A., Hatzenbuehler, M. L., & Safren, S. A. (2019). Project ESTEEM protocol: A randomized controlled trial of an LGBTQ-affirmative treatment for young adult sexual minority men’s mental and sexual health. BMC Public Health, 19(1), 1086. https://doi.org/10.1186/s12889-019-7346-4
Perrino, T., Beardslee, W., Bernal, G., Brincks, A., Cruden, G., Howe, G., Murry, V., Pantin, H., Prado, G., Sandler, I., & Brown, C. H. (2015). Toward scientific equity for the prevention of depression and depressive symptoms in vulnerable youth. Prevention Science, 16(5), 642–651. https://doi.org/10.1007/s11121-014-0518-7
Reidy, M. C., Orpinas, P., & Davis, M. (2012). Successful recruitment and retention of Latino study participants. Health Promotion Practice, 13(6), 779–787. https://doi.org/10.1177/1524839911405842
Rhodes, S. D., Hergenrather, K. C., Aronson, R. E., Bloom, F. R., Felizzola, J., Wolfson, M., Vissman, A. T., Alonzo, J., Boeving Allen, A., Montaño, J., & McGuire, J. (2010). Latino men who have sex with men and HIV in the rural south-eastern USA: Findings from ethnographic in-depth interviews. Culture, Health & Sexuality, 12(7), 797–812. https://doi.org/10.1080/13691058.2010.492432
Rodriguez-Seijas, C., Eaton, N. R., & Pachankis, J. E. (2019). Prevalence of psychiatric disorders at the intersection of race and sexual orientation: Results from the National Epidemiologic Survey of Alcohol and Related Conditions-III. Journal of Consulting and Clinical Psychology, 87(4), 321–331. https://doi.org/10.1037/ccp0000377
Sage, R., Benavides-Vaello, S., Flores, E., LaValley, S., & Martyak, P. (2018). Strategies for conducting health research with Latinos during times of political incivility. Nursing Open, 5(3), 261–266. https://doi.org/10.1002/nop2.166
Sandfort, T. G. M., Melendez, R. M., & Diaz, R. M. (2007). Gender nonconformity, homophobia, and mental distress in Latino gay and bisexual men. Journal of Sex Research, 44(2), 181–189. https://doi.org/10.1080/00224490701263819
Schmitz, R. M., Robinson, B. A., Tabler, J., Welch, B., & Rafaqut, S. (2019). LGBTQ+ Latino/a young people’s interpretations of stigma and mental health: An intersectional minority stress perspective. Society and Mental Health, 10(2), 2156869319847248. https://doi.org/10.1177/2156869319847248
Segal, E. A., Gerdes, K. E., Mullins, J., Wagaman, M. A., & Androff, D. (2011). Social empathy attitudes: Do Latino students have more? Journal of Human Behavior in the Social Environment, 21(4), 438–454. https://doi.org/10.1080/10911359.2011.566445
Sewell, A. A. (2015). Disaggregating ethnoracial disparities in physician trust. Social Science Research, 54, 1–20. https://doi.org/10.1016/j.ssresearch.2015.06.020
Shah, P. P., & Diaz, A. A. (2021). Creating multilingual COVID-19–related material expanding health literacy in vulnerable populations. ATS Scholar, 2(1), 9–12. https://doi.org/10.34197/ats-scholar.2020-0131CM
Shangani, S., Gamarel, K. E., Ogunbajo, A., Cai, J., & Operario, D. (2020). Intersectional minority stress disparities among sexual minority adults in the USA: The role of race/ethnicity and socioeconomic status. Culture, Health & Sexuality, 22, 398-412. https://doi.org/10.1080/13691058.2019.1604994
Singer, M., & Clair, S. (2003). Syndemics and public health: Reconceptualizing disease in bio-social context. Medical Anthropology Quarterly, 17(4), 423–441. https://doi.org/10.1525/maq.2003.17.4.423
Singer, M. C., Erickson, P. I., Badiane, L., Diaz, R., Ortiz, D., Abraham, T., & Nicolaysen, A. M. (2006). Syndemics, sex and the city: Understanding sexually transmitted diseases in social and cultural context. Social Science & Medicine, 63(8), 2010–2021. https://doi.org/10.1016/j.socscimed.2006.05.012
Sullivan, P. S., Khosropour, C. M., Luisi, N., Amsden, M., Coggia, T., Wingood, G. M., & DiClemente, R. J. (2011). Bias in online recruitment and retention of racial and ethnic minority men who have sex with men. Journal of Medical Internet Research, 13(2), e38. https://doi.org/10.2196/jmir.1797
Svensson, K., Ramírez, O. F., Peres, F., Barnett, M., & Claudio, L. (2012). Socioeconomic determinants associated with willingness to participate in medical research among a diverse population. Contemporary Clinical Trials, 33(6), 1197–1205. https://doi.org/10.1016/j.cct.2012.07.014
Villarruel, A. M., Jemmott, L. S., Jemmott, J. B., & Eakin, B. L. (2006). Recruitment and retention of Latino adolescents to a research study: Lessons learned from a randomized clinical trial. Journal for Specialists in Pediatric Nursing, 11(4), 244–250. https://doi.org/10.1111/j.1744-6155.2006.00076.x
Vincent, D., McEwen, M. M., Hepworth, J. T., & Stump, C. S. (2013). Challenges and success of recruiting and retention for a culturally tailored diabetes prevention program for adults of Mexican descent. The Diabetes Educator, 39(2), 222–230. https://doi.org/10.1177/0145721713475842
Woodall, A., Morgan, C., Sloan, C., & Howard, L. (2010). Barriers to participation in mental health research: Are there specific gender, ethnicity and age related barriers? BMC Psychiatry, 10(1), 103. https://doi.org/10.1186/1471-244X-10-103
Zea, M. C., Reisen, C. A., & Díaz, R. M. (2003). Methodological issues in research on sexual behavior with Latino gay and bisexual men. American Journal of Community Psychology, 31(3–4), 281–291.
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Data collection for this study was supported by P30 AI073961 (Pahwa). Additional research support was provided by U54 MD002266 (Behar-Zusman), P30 MH116867 (Safren), and R01 MH109413 (Pachankis). Some of the author time was supported by K24DA040489 (Safren) and K23MD015690 (Harkness). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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AH was involved in conceptualization, AH, DM, RSA contributed to data curation and project administration, AH, BGR, DM, RSA were involved in formal analysis, AH, SS contributed to funding acquisition and methodology, AH, DM, RSA, SS were involved in investigation, AH, JEP, SAS contributed to supervision, AH, BGR, DM were involved in writing—original draft, AH, BGR, JEP, SAS contributed to writing—review and editing.
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Harkness, A., Rogers, B.G., Mayo, D. et al. A Relational Framework for Engaging Latino Sexual Minority Men in Sexual and Behavioral Health Research. Arch Sex Behav 51, 2399–2412 (2022). https://doi.org/10.1007/s10508-021-02237-9
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DOI: https://doi.org/10.1007/s10508-021-02237-9