"Outness" as a Moderator of the Association Between Syndemic Conditions and HIV Risk-Taking Behavior among Men Who Have Sex with Men in Tijuana, Mexico

Multiple psychosocial conditions tend to co-occur and contribute to higher risk for HIV among men who have sex with men (MSM), a phenomenon known as syndemics. Less is known about moderating factors that may attenuate the relation between syndemic conditions and sexual risk-taking. 

We examined disclosure of same-sex sexual behavior or "outness" as a moderating factor of the syndemic effect. We recruited a sample of MSM (n = 191) using respondent-driven sampling in Tijuana, Mexico. Participants completed a survey of syndemic conditions (i.e., substance use, depression, violence, internalized homophobia, and sexual compulsivity), sexual risk-taking (i.e., condom unprotected anal sex with a stranger in the past 2 months), and the degree to which they are "out" about sex with men. 

Consistent with previous research, we found that men who report more syndemic conditions show a greater prevalence of sexual risk-taking. As predicted, men who were out to more people showed a weaker association between syndemic conditions and sexual risk-taking, whereas men who were out to fewer people showed the strongest association. 

This study is the first to provide evidence of "outness" as a moderating factor that attenuates syndemic effects on sexual risk-taking. Building upon previous research, the data suggest that "outness" may be a resilience factor for MSM in Tijuana. HIV prevention intervention implications are discussed.

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By:  Pitpitan EV1, Smith LR, Goodman-Meza D, Torres K, Semple SJ, Strathdee SA, Patterson TL.

• 1Division of Global Public Health, Department of Medicine, University of California at San Diego, Mail Code 0507, 9500 Gilman Drive, La Jolla, CA, 92093-0680, USA, epitpitan@ucsd.edu. 

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