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HIV Stigma, Homophobia, Sexual and Gender Minority Community Connectedness and HIV Testing Among Gay, Bisexual, and Other Men and Transgender People Who Have Sex with Men in Kazakhstan

Abstract

Although HIV incidence is rising among gay, bisexual, and other men (MSM) and transgender people who have sex with men (TSM) in Kazakhstan, whether stigmatizing attitudes and connectedness are associated with HIV testing in this region is not known. We analyzed data from one-time interviews with 304 adult MSM and TSM conducted 2018–2019 in three cities in Kazakhstan. Logistic regression determined whether HIV stigma, internalized homophobia, sexual and gender minority (SGM) connectedness predicted HIV testing (within the lifetime, past year, and past 6 months) before and after adjustment for sociodemographic characteristics. 80% of participants reported ever receiving an HIV test. Gay-identified participants reported less HIV stigma and internalized homophobia as well as greater connectedness relative to those with bisexual or other identities. In adjusted models, those who had ever tested reported lower HIV stigma (aOR 0.83, 95% CI 0.76–0.91, P < .001) and higher connectedness (aOR 1.17, 95% CI 1.06–1.29, P = .003) than those who had not; those who had ever tested reported lower internalized homophobia in the unadjusted model only (OR 0.95, 95% CI 0.91–0.99, P = .01). Similar differences and trends were found in models examining testing in the past year and past 6 months. Addressing stigmatizing attitudes and connectedness may improve uptake of HIV testing among MSM and TSM in Kazakhstan.

Resumen

Aunque la incidencia del VIH está aumentando entre homosexuales, bisexuales y otros hombres (HSH) y entre personas transgénero que tienen sexo con hombres (TSM) en Kazajistán, se desconoce si las actitudes estigmatizantes y la conexión están asociadas con las pruebas del VIH en esta región. Analizamos datos de entrevistas únicas con 304 HSH adultos y TSM realizadas en 2018-2019 en tres ciudades de Kazajistán. La regresión logística determinó si el estigma del VIH, la homofobia internalizada, la conexión de las minorías sexuales y de género (SGM) predijeron la prueba del VIH (durante la vida, el año pasado y los últimos 6 meses) antes y después del ajuste por características sociodemográficas. El 80% de los participantes informaron haber recibido alguna vez una prueba de VIH. Los participantes identificados como homosexuales informaron menos estigma del VIH y homofobia internalizada, así como una mayor conexión en relación con aquellos con identidades bisexuales u otras. En modelos ajustados, aquellos que alguna vez se habían hecho la prueba informaron un menor estigma del VIH (ORa 0,83, IC del 95% 0,76-0,91, P <0,001) y una mayor conectividad (OR 1,17, IC del 95% 1,06-1,29, P = 0,003) que aquellos quien no lo había hecho; aquellos que alguna vez habían realizado la prueba informaron una menor homofobia internalizada solo en el modelo no ajustado (OR 0,95; IC del 95%: 0,91-0,99; p = 0,01). Se encontraron diferencias y tendencias similares en modelos que examinaron las pruebas en el último año y los últimos 6 meses. Abordar las actitudes estigmatizantes y la conexión pueden mejorar la aceptación de las pruebas del VIH entre los HSH y TSM en Kazajistán.

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Acknowledgements

This research was supported by grants R01DA040513 (PI: Wu) from the National Institute on Drug Abuse and P30MH43520 (PI: Remien) and T32MH019139 (PI: Sandfort) from the National Institute of Mental Health. We would like to thank the participants who made this possible. We would also like to thank Susie Hoffman, Curtis Dolezal, and Jagadīśa-devaśrī Dācus for their helpful comments on early drafts of this manuscript.

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Authors

Contributions

All authors contributed to the study conception and design. Data analyses were performed by: EAP, YGL, and EW. The first draft of the manuscript was written by EAP and all authors assisted with the writing of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Emily Allen Paine.

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The authors have no relevant financial or non-financial interests to disclose.

Ethical Approval

Approval was obtained from the Columbia University Human Subjects Review Committee and the Kazakhstan School of Public Health in Almaty, Kazakhstan.

Informed Consent

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

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Paine, E.A., Lee, Y.G., Vinogradov, V. et al. HIV Stigma, Homophobia, Sexual and Gender Minority Community Connectedness and HIV Testing Among Gay, Bisexual, and Other Men and Transgender People Who Have Sex with Men in Kazakhstan. AIDS Behav 25, 2568–2577 (2021). https://doi.org/10.1007/s10461-021-03217-9

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Keywords

  • Kazakhstan
  • HIV testing
  • MSM
  • Transgender populations
  • HIV stigma
  • Homophobia
  • Social connectedness