Social Support and Other Factors Associated with HIV Testing by Hispanic/Latino Gay, Bisexual, and Other Men Who Have Sex with Men in the U.S. South

  • Thomas M. PainterEmail author
  • Eunyoung Y. Song
  • Mary M. Mullins
  • Lilli Mann-Jackson
  • Jorge Alonzo
  • Beth A. Reboussin
  • Scott D. Rhodes
Original Paper


Cognitive-psychosocial and other factors may affect participation in HIV testing, particularly by Hispanic/Latino gay, bisexual, and other men who have sex with men (MSM) in the U.S. South, a region hard-hit by HIV. We used univariate and multivariable logistic regression analyses to examine the association between social support and other cognitive-psychosocial factors; sociodemographic characteristics; risk behaviors; and self-reported HIV testing in a sample of 304 Hispanic/Latino MSM in North Carolina. In the multivariable logistic regression analysis, general and HIV-related social support and HIV-related knowledge were associated with greater odds of testing; speaking only Spanish was associated with reduced odds of testing. Social support and aspects of social connectedness may constitute community-based resources for use in HIV prevention efforts with Hispanic/Latino MSM. However, harnessing these resources for HIV prevention will require a better understanding of how social support relationships and processes shape HIV risks and protective actions by these vulnerable MSM.


Hispanics/Latinos Men who have sex with men (MSM) Social support HIV testing U.S. South 


Factores cognitivos y psicosociales y otros, pueden afectar participación en pruebas de VIH, particularmente por parte de Hispanos/Latinos gay, bisexuales y otros hombres que tienen sexo con hombres (HSH) en el sur de los EE. UU., una región duramente afectada por el VIH. Usamos análisis de regresión logística univariable y multivariable para examinar la asociación entre apoyo social y otros factores cognitivos y psicosociales; características demográficas; comportamientos de riesgo y autorreportes de pruebas de VIH en una muestra de 304 HSH Hispanos/Latinos en Carolina del Norte. En el análisis de regresión logística multivariable, el apoyo social general y aquél relacionado con VIH y conocimiento relacionado con VIH, fueron asociados con mayores probabilidades de pruebas de VIH realizadas; hablar español solamente fue asociado con probabilidades reducidas de pruebas realizadas. Apoyo social y aspectos de conectividad social pueden constituir recursos comunitarios para ser usados en esfuerzos de prevención de VIH con HSH Hispanos/Latinos. Sin embargo, aprovechar estos recursos para prevención de VIH requerirá una mejor comprensión de cómo las relaciones y los procesos de apoyo social condicionan los riesgos de infección por VIH y acciones de protección efectuadas por estos vulnerables HSH.

Palabras Claves

Hispanos/Latinos Hombres que tienen sexo con hombres (HSH) Apoyo social Pruebas de VIH El sur de los EE. UU 



The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC).


The study on which our analysis is based was supported by funding from the Centers for Disease Control and Prevention (Cooperative Agreement PS09-007, Award U01PS001570) to the Wake Forest University School of Medicine. The clinical trials protocol number for the study is NCT01626898.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Board of the Wake Forest School of Medicine and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Bonacci RA, Holtgrave DR. Unmet HIV service needs among Hispanic men who have sex with men in the United States. AIDS Behav. 2016;20(10):2444–51.Google Scholar
  2. 2.
    Purcell DW, Johnson CH, Lansky A, et al. Estimating the population size of men who have sex with men in the United States to obtain HIV and syphilis rates. Open AIDS J. 2012;6:98–107.Google Scholar
  3. 3.
    Centers for Disease Control and Prevention (CDC). CDC fact sheet: HIV among gay and bisexual men. February 2017; Accessed 1 Oct 2018.
  4. 4.
    Centers for Disease Control and Prevention (CDC). HIV and gay and bisexual men. Updated September 26, 2018. Accessed 2 Oct 2018.
  5. 5.
    Centers for Disease Control and Prevention (CDC). HIV among Hispanics/Latinos. Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention. Updated October 3, 2018. Accessed 4 Oct 2018.
  6. 6.
    Singh S, Song R, Johnson AS, McCray E, Hall HI. HIV incidence, prevalence, and undiagnosed infections in U.S. men who have sex with men. Ann Intern Med. 2018;168(10):685–94.Google Scholar
  7. 7.
    Hess K. Estimating the lifetime risk of a diagnosis of HIV infection in the United States. Conference on Retroviruses and Opportunitstic Infection (CROI). February 22–26, 2016; Abstract no. 52. Accessed 3 Oct 2018.
  8. 8.
    Rhodes SD, McCoy TP, Hergenrather KC, et al. Prevalence estimates of health risk behaviors of immigrant Latino men who have sex with men. J Rural Health. 2012;28(1):73–83.Google Scholar
  9. 9.
    Valverde EE, DiNenno EA, Schulden JD, Oster A, Painter T. Sexually transmitted infection diagnoses among Hispanic immigrant and migrant men who have sex with men in the United States. Int J STD AIDS. 2016;27(13):1162–9.Google Scholar
  10. 10.
    Centers for Disease Control and Prevention (CDC). HIV in the United States by geography. Updated June 25, 2018. Accessed 13 Sep 2018.
  11. 11.
    U. S. Census Bureau. Hispanic or Latino origin 2015 american community survey 1-year estimates 2015; Accessed 28 Oct 2016.
  12. 12.
    Massey D. New faces in new places: the changing geography of american immigration. New York: Russell Sage Found; 2008.Google Scholar
  13. 13.
    Painter TM. Connecting the dots: when the risks of HIV/STD infection appear high but the burden of infection is not known–the case of male Latino migrants in the Southern United States. AIDS Behav. 2008;12(2):213–26.Google Scholar
  14. 14.
    Rhodes SD, Hergenrather KC, Aronson RE, et al. Latino men who have sex with men and HIV in the rural south-eastern USA: findings from ethnographic in-depth interviews. Cult Health Sex. 2010;12(7):797–812.Google Scholar
  15. 15.
    Kochar R, Suro R, Tafoya S. The new Latino south: the context and consequences of rapid popuation growth. Pew Research Center. July 26, 2005; Accessed 17 Feb 2018.
  16. 16.
    Reif S, Safley D, McAllaster C, Wilson E, Whetten K. State of HIV in the US deep south. J Community Health. 2017;42(5):844–53.Google Scholar
  17. 17.
    Centers for Disease Control and Prevention (CDC). High-Impact Prevention (HIP). Updated February 22, 2018. Accessed 24 Aug 2018.
  18. 18.
    McCree DH, Walker T, DiNenno E, et al. A programmatic approach to address increasing HIV diagnoses among Hispanic/Latino MSM, 2010-2014. Prev Med. 2018;114:64–71.Google Scholar
  19. 19.
    Centers for Disease Control and Prevention (CDC). HIV infection risk, prevention, and testing behaviors among men who have sex with men national HIV behavioral surveillance, 20 U. S. cities, 2014. HIV Surveillance Special Report 15. January 2016; Accessed 8 Aug 2018.
  20. 20.
    Centers for Disease Control and Prevention (CDC). National HIV/AIDS strategy for the United States: Updated to 2020. July 30, 2015; Accessed 1 Oct 2018.
  21. 21.
    Singh S, Mitsch A, Wu B. HIV care outcomes among men who have sex with men with diagnosed HIV infection—United States, 2015. MMWR Morb Mortal Wkly Rep. 2017;66(37):969–74.Google Scholar
  22. 22.
    O’Donnell L, Stueve A, Joseph HA, Flores S. Adapting the VOICES HIV behavioral intervention for Latino men who have sex with men. AIDS Behav. 2014;18(4):767–75.Google Scholar
  23. 23.
    Rhodes SD, Alonzo J, Mann L, et al. Small-group randomized controlled trial to increase condom use and HIV testing among Hispanic/Latino gay, bisexual, and other men who have sex with men. Am J Public Health. 2017;107(6):969–76.Google Scholar
  24. 24.
    Gwadz MV, Clatts MC, Yi H, Leonard NR, Goldsamt L, Lankenau S. Resilience among young men who have sex with men in New York City. Sex Res Social Policy. 2006;3(1):13–21.Google Scholar
  25. 25.
    Herrick AL, Lim SH, Wei C, et al. Resilience as an untapped resource in behavioral intervention design for gay men. AIDS Behav. 2011;15(Suppl 1):S25–9.Google Scholar
  26. 26.
    Herrick AL, Stall R, Chmiel JS, et al. It gets better: resolution of internalized homophobia over time and associations with positive health outcomes among MSM. AIDS Behav. 2013;17(4):1423–30.Google Scholar
  27. 27.
    Herrick AL, Stall R, Goldhammer H, Egan JE, Mayer KH. Resilience as a research framework and as a cornerstone of prevention research for gay and bisexual men: theory and evidence. AIDS Behav. 2014;18(1):1–9.Google Scholar
  28. 28.
    Kubicek K, McNeeley M, Holloway IW, Weiss G, Kipke MD. “It’s like our own little world”: resilience as a factor in participating in the ballroom community subculture. AIDS Behav. 2013;17(4):1524–39.Google Scholar
  29. 29.
    Schrager SM, Latkin CA, Weiss G, Kubicek K, Kipke MD. High-risk sexual activity in the House and Ball community: influence of social networks. Am J Public Health. 2014;104(2):326–31.Google Scholar
  30. 30.
    Harper GW, Bruce D, Hosek SG, Fernandez MI, Rood BA. Resilience processes demonstrated by young gay and bisexual men living with HIV: implications for intervention. AIDS Patient Care STDS. 2014;28(12):666–76.Google Scholar
  31. 31.
    Kurtz SP, Buttram ME, Surratt HL, Stall RD. Resilience, syndemic factors, and serosorting behaviors among HIV-positive and HIV-negative substance-using MSM. AIDS Educ Prev. 2012;24(3):193–205.Google Scholar
  32. 32.
    Carlos JA, Bingham TA, Stueve A, et al. The role of peer support on condom use among black and Latino MSM in three urban areas. AIDS Educ Prev. 2010;22(5):430–44.Google Scholar
  33. 33.
    Jeffries WL 4th, Townsend ES, Gelaude DJ, Torrone EA, Gasiorowicz M, Bertolli J. HIV stigma experienced by young men who have sex with men (MSM) living with HIV infection. AIDS Educ Prev. 2015;27(1):58–71.Google Scholar
  34. 34.
    Kapadia F, Siconolfi DE, Barton S, Olivieri B, Lombardo L, Halkitis PN. Social support network characteristics and sexual risk taking among a racially/ethnically diverse sample of young, urban men who have sex with men. AIDS Behav. 2013;17(5):1819–28.Google Scholar
  35. 35.
    Lauby JL, Marks G, Bingham T, et al. Having supportive social relationships is associated with reduced risk of unrecognized HIV infection among black and Latino men who have sex with men. AIDS Behav. 2012;16(3):508–15.Google Scholar
  36. 36.
    Scott HM, Pollack L, Rebchook GM, Huebner DM, Peterson J, Kegeles SM. Peer social support is associated with recent HIV testing among young black men who have sex with men. AIDS Behav. 2014;18(5):913–20.Google Scholar
  37. 37.
    Beougher SC, Gomez W, Hoff CC. The couple as context: latino gay male couples and HIV. Cult Health Sex. 2011;13(3):299–312.Google Scholar
  38. 38.
    Mitrani VB, De Santis JP, McCabe BE, Deleon DA, Gattamorta KA, Leblanc NM. The impact of parental reaction to sexual orientation on depressive symptoms and sexual risk behavior among Hispanic men who have sex with men. Arch Psychiatr Nurs. 2017;31(4):352–8.Google Scholar
  39. 39.
    Friedman MR, Coulter RW, Silvestre AJ, et al. Someone to count on: social support as an effect modifier of viral load suppression in a prospective cohort study. AIDS Care. 2017;29(4):469–80.Google Scholar
  40. 40.
    Solorio R, Forehand M, Simoni J. Attitudes towards and beliefs about HIV testing among Latino immigrant MSM: a comparison of testers and nontesters. AIDS Res Treat. 2013;2013:563537.Google Scholar
  41. 41.
    Sun CJ, Ma A, Tanner AE, et al. Depressive symptoms among Latino sexual minority men and Latina transgender women in a new settlement state: the role of perceived discrimination. Depress Res Treat. 2016;2016:4972854.Google Scholar
  42. 42.
    Mizuno Y, Borkowf CB, Ayala G, Carballo-Dieguez A, Millett GA. Correlates of sexual risk for HIV among US-born and foreign-born Latino men who have sex with men (MSM): an analysis from the Brothers y Hermanos study. J Immigr Minor Health. 2015;17(1):47–55.Google Scholar
  43. 43.
    Hirsch JS, Munoz-Laboy M, Nyhus CM, Yount KM, Bauermeister JA. They “miss more than anything their normal life back home”: masculinity and extramarital sex among Mexican migrants in Atlanta. Perspect Sex Reprod Health. 2009;41(1):23–32.Google Scholar
  44. 44.
    Kissinger P, Kovacs S, Anderson-Smits C, et al. Patterns and predictors of HIV/STI risk among Latino migrant men in a new receiving community. AIDS Behav. 2012;16(1):199–213.Google Scholar
  45. 45.
    Martinez-Donate A, Zhang X, Rangel G, Hovell M, Rhoads N. Discrimination, social support and stress: association with sexual risk behaviors and HIV testing rates among male Mexican migrants. Presentation at the 2015 National HIV Prevention Conference, Atlanta [abstract LB-17].Google Scholar
  46. 46.
    Painter TM. Social support networks: an underutilized resource for the prevention of HIV and other sexually transmitted diseases among Hispanic/Latino migrants and immigrants. J Health Care Poor Underserved. 2018;29(1):44–57.Google Scholar
  47. 47.
    Flores-Yeffal N. Migration-trust networks: social cohesion in Mexican U.S. bound emigration. College Station: Texas A&M University Press; 2013.Google Scholar
  48. 48.
    O’Donnell L, Agronick G, San Doval A, Duran R, Myint UA, Stueve A. Ethnic and gay community attachments and sexual risk behaviors among urban Latino young men who have sex with men. AIDS Educ Prev. 2002;14(6):457–71.Google Scholar
  49. 49.
    Gray NN, Mendelsohn DM, Omoto AM. Community connectedness, challenges, and resilience among gay Latino immigrants. Am J Community Psychol. 2015;55(1–2):202–14.Google Scholar
  50. 50.
    Rhodes SD, Hergenrather KC, Vissman AT, et al. Boys must be men, and men must have sex with women: a qualitative CBPR study to explore sexual risk among African American, Latino, and White gay men and MSM. Am J Mens Health. 2011;5(2):140–51.Google Scholar
  51. 51.
    DeLuca JB, Mullins MM, Lyles CM, Crepaz N, Kay L, Thadiparthi S. Developing a comprehensive search strategy for evidence based systematic reviews. Evid Based Libr Inf Pract. 2008;3:3–32.Google Scholar
  52. 52.
    Pew Research Center. Demographic profile of Hispanics in North Carolina, 2014. Pew Research Center, Hispanic Trends. 2014; Accessed 3 Oct 2018.
  53. 53.
    Tippett R. The Hispanic/Latino community in North Carolina. UNC Carolina Population Center. Accessed 4 Oct 2018.
  54. 54.
    Centers for Disease Control and Prevention (CDC). Diagnoses of HIV infection in the United States and dependent areas, 2016. HIV Surveillance Report, 2016. November 2017;vol. 28. Accessed 19 Sep 2018.
  55. 55.
    North Carolina HIV/STD/Hepatitis Surveillance Unit. 2017 North Carolina HIV/STD/Hepatitis surveillance report. North Carolina Department of Health and Human Services, Division of Public Health, Communicable Disease Branch. 2018; Accessed 3 Oct 2018.
  56. 56.
    Centers for Disease Control and Prevention (CDC). Evaluating locally-developed (homegrown) HIV prevention interventions for African-American and Hispanic/Latino men who have sex with men (MSM), funding opportunity announcement (FOA) number PA 09-007. Federal Register. 2009;74(58)13436. Accessed 1 Oct 2018.
  57. 57.
    Rhodes SD, Alonzo J, Mann L, et al. Enhancement of a locally developed HIV prevention intervention for Hispanic/Latino MSM: a partnership of community-based organizations, a university, and the Centers for Disease Control and Prevention. AIDS Educ Prev. 2015;27(4):312–32.Google Scholar
  58. 58.
    Gilbert P, Rhodes S. Psychometric performance of a novel measure of social support among Spanish-speaking immigrant Latino gay men. Hisp J Behav Sci. 2012;34(3):491–504.Google Scholar
  59. 59.
    Ong ASJ, Ward C. The construction and validation of a social support measure for sojourners: the index of sojourner social support (ISSS) scale. J Cross Cult Psychol. 2005;36(6):637–61.Google Scholar
  60. 60.
    Phinney J. The multigroup ethnic identity measure: a new scale for use with diverse groups. J Adolesc Res. 1992;7(2):156–76.Google Scholar
  61. 61.
    Plante TG, Boccaccini M. Reliability and validity of the Santa Clara strength of religious faith questionnaire. Pastoral Psychol. 1997;45(6):429–37.Google Scholar
  62. 62.
    Marin G, Sabogal F, Marin BV, Otero-Sabogal R, Perez-Stable EJ. Development of a short acculturation scale for Hispanics. Hisp J Behav Sci. 1987;9(2):183–205.Google Scholar
  63. 63.
    Rhodes SD, McCoy TP, Vissman AT, et al. A randomized controlled trial of a culturally congruent intervention to increase condom use and HIV testing among heterosexually active immigrant Latino men. AIDS Behav. 2011;15(8):1764–75.Google Scholar
  64. 64.
    Mahalik JR, Burns SM, Syzdek M. Masculinity and perceived normative health behaviors as predictors of men’s health behaviors. Soc Sci Med. 2007;64(11):2201–9.Google Scholar
  65. 65.
    De Vogli R, Ferrie JE, Chandola T, Kivimaki M, Marmot MG. Unfairness and health: evidence from the Whitehall II Study. J Epidemiol Community Health. 2007;61(6):513–8.Google Scholar
  66. 66.
    Daniel-Ulloa J, Reboussin BA, Gilbert PA, et al. Predictors of heavy episodic drinking and weekly drunkenness among immigrant Latinos in North Carolina. Am J Mens Health. 2014;8(4):339–48.Google Scholar
  67. 67.
    Joseph HA, Belcher L, O’Donnell L, Fernandez MI, Spikes PS, Flores SA. HIV testing among sexually active Hispanic/Latino MSM in Miami-Dade County and New York City: opportunities for increasing acceptance and frequency of testing. Health Promot Pract. 2014;15(6):867–80.Google Scholar
  68. 68.
    Oster AM, Russell K, Wiegand RE, et al. HIV infection and testing among Latino men who have sex with men in the United States: the role of location of birth and other social determinants. PLoS ONE. 2013;8(9):e73779.Google Scholar
  69. 69.
    Neme S, Goldenberg T, Stekler JD, Sullivan PS, Stephenson R. Attitudes towards couples HIV testing and counseling among Latino men who have sex with men in the Seattle area. AIDS Care. 2015;27(10):1354–9.Google Scholar
  70. 70.
    Villalonga-Olives E, Kawachi I. The dark side of social capital: a systematic review of the negative health effects of social capital. Soc Sci Med. 2017;194:105–27.Google Scholar
  71. 71.
    Woolf SE, Maisto SA. Alcohol use and risk of HIV infection among men who have sex with men. AIDS Behav. 2009;13(4):757–82.Google Scholar
  72. 72.
    Organista KC, Worby PA, Quesada J, Arreola SG, Kral AH, Khoury S. Sexual health of Latino migrant day labourers under conditions of structural vulnerability. Cult Health Sex. 2013;15(1):58–72.Google Scholar
  73. 73.
    Herbst JH, Glassman M, Carey JW, et al. Operational research to improve HIV prevention in the United States. J Acquir Immune Defic Syndr. 2012;59(5):530–6.Google Scholar
  74. 74.
    Rhodes SD, Mann L, Alonzo J, et al. CBPR to prevent HIV within racial/ethnic, sexual, and gender minority communities: successes with long-term sustainability. In: Rhodes SD, editor. Innovations in HIV prevention research and practice through community engagement. New York: Springer; 2014. p. 135–60.Google Scholar
  75. 75.
    Rhodes SD, Hergenrather KC, Bloom FR, Leichliter JS, Montano J. Outcomes from a community-based, participatory lay health adviser HIV/STD prevention intervention for recently arrived immigrant Latino men in rural North Carolina. AIDS Educ Prev. 2009;21(Suppl. 5):103–8.Google Scholar

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Authors and Affiliations

  1. 1.Prevention Research Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB PreventionCenters for Disease Control and PreventionAtlantaUSA
  2. 2.Department of Social Sciences and Health Policy, Division of Public Health SciencesWake Forest School of MedicineWinston-SalemUSA
  3. 3.Department of Biostatistics and Data Science, Division of Public Health SciencesWake Forest School of MedicineWinston-SalemUSA

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