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.16Among
people living with HIV, HIV and healthcare stigma has been associated with
decreased care-seeking behavior.9,12 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.17,18 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 team15 and
by others in other regions21 indicates
that MSM who engage in transactional sex are more likely to have a history of
HIV testing and of HIV diagnosis.22,23 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 distress7—which are major barriers to
linkage and continued engagement in care if diagnosed...
Full article at:
By:
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.
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