Sunday, June 12, 2016

Is Involvement in Sex Work Associated with Engagement in HIV-Related Medical Care in Latin American Men Who Have Sex with Men? Results of a Large, Multinational Internet Survey

Men who have sex with men (MSM) who engage in transactional sex are at increased HIV risk, and face complex barriers to care seeking. Among 2,035 men recruited through an MSM social/sexual networking website in Latin America and who reported being HIV-infected, 186 (9.1%) reported being paid for sex with another man in the past year. Engagement in transactional sex was associated with decreased odds of receiving medical care for HIV (AOR=0.57, 95% CI=0.37–0.85). No significant differences were seen in being on antiretroviral therapy (ART) or ART adherence once in care. Interventions in this population should focus on reducing barriers to engagement in care.

...Results of this analysis suggest that there are disparities in receipt of HIV medical care associated with recent engagement in transactional sex among HIV-infected MSM in Latin America. The ability to access HIV-related medical care is related not only to availability of care facilities, but also barriers and facilitators to engagement and retention in care, and these factors may be compounded for MSM who engage in transactional sex. For example, stigma and discrimination may limit care seeking to a greater extent among men who engage in transactional sex, given multiple sources of stigma. Previous research suggests that MSM may face sexual stigma from multiple dimensions. Stigma from healthcare providers may limit disclosure of sexual orientation or sexual behaviors among MSM, if they anticipate discrimination following disclosure.Among people living with HIV, HIV and healthcare stigma has been associated with decreased care-seeking behavior., MSM who engage in transactional sex may experience additional stigma due to being involved in sex work, which is illegal and/or socially unacceptable across most of Latin America, and which has been described as a barrier to care seeking among female sex workers., Although experienced and/or perceived stigma could act as a mechanism through which MSM who engage in transactional sex in Latin America have decreased engagement in HIV care, we were unable to quantify experiences of stigma in this study. Future work should consider the role of experienced and/or perceived stigma specifically as a barrier to engaging in care in this population.

...Interestingly, although participants who engaged in transactional sex were less likely to be engaged in HIV-related medical care, prior research by this team and by others in other regions indicates that MSM who engage in transactional sex are more likely to have a history of HIV testing and of HIV diagnosis., This may indicate that men who engage in transactional sex are aware of their increased risk and thus are more likely to test for HIV, but that there are structural, interpersonal, and individual factors—including differential power dynamics due to social or economic position, physical or sexual violence, substance use, and/or psychological distress—which are major barriers to linkage and continued engagement in care if diagnosed...
  
Full article at:  http://goo.gl/5RWUOC

By: Katie B. Biello, PhD, MPH, 1,,2 Catherine E. Oldenburg, MPH,1 Joshua Rosenberger, PhD,3 Kenneth H. Mayer, MD,2,,4,,5 David Novak, MSW,6 and Matthew J. Mimiaga, ScD, MPH1,,2,,7,,8
1Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.
2The Fenway Institute, Fenway Health, Boston, Massachusetts.
3Department of Global and Community Health, George Mason University, Fairfax, Virginia.
4Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
5Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts.
6OLB Research Institute, Online Buddies, Inc., Cambridge, Massachusetts.
7Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
8Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.
1Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.
2The Fenway Institute, Fenway Health, Boston, Massachusetts.
3Department of Global and Community Health, George Mason University, Fairfax, Virginia.
4Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
5Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts.
6OLB Research Institute, Online Buddies, Inc., Cambridge, Massachusetts.
7Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
8Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.
LGBT Health. 2016 Jun 1; 3(3): 233–237. doi:  10.1089/lgbt.2015.0006




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