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. Author manuscript; available in PMC: 2024 Oct 1.
Published in final edited form as: AIDS Educ Prev. 2023 Oct;35(5):376–389. doi: 10.1521/aeap.2023.35.5.376

Everyday discrimination and HIV testing among partnered Latino/x sexual minority men in the United States: A stratified analysis by birth location

Yong Gun Lee 1, Edward J Alessi 1, Matthew Lynn 1, Tyrel J Starks 2, Gabriel Robles 1,§
PMCID: PMC10701860  NIHMSID: NIHMS1943463  PMID: 37843904

Abstract

We examined the association between everyday discrimination and HIV testing patterns—current (≤ 6 months), recent (7–12 months), delayed (> 12 months or never tested)—among partnered Latino/x sexual minority men (SMM). Multinomial regression analyses revealed that, in the full sample (N = 484), experiencing discrimination based on sexual orientation and race/ethnicity attributions concurrently (vs. no discrimination) was associated with higher odds of delayed (vs. current) HIV testing (AOR = 2.6, 95% CI = 1.0, 6.7). Similarly, in the subset of Latino/x SMM born outside the mainland U.S. (n = 209), experiencing concurrent sexual orientation- and race/ethnicity-based discrimination (vs. no discrimination) was associated with higher odds of recent (AOR = 12.4, 95% CI = 1.3, 115.7) and delayed HIV testing (AOR = 7.3, 95% CI = 1.6, 33.0), compared with current testing. Findings suggest that addressing discrimination may improve HIV testing uptake among partnered Latino/x SMM, particularly those born outside the U.S.

Keywords: HIV testing, discrimination, Latino/x, sexual minority men, migrants

INTRODUCTION

Latino/x sexual minority men (SMM) in the U.S. experience disparities in HIV incidence when compared to the general population of SMM and compared to Hispanic or Latino/x individuals who are not sexual minorities. In 2021, 33% of new HIV infections among all SMM occurred in men who identified as Hispanic or Latino/x (CDC, 2023a). At the same time, 80% of new infections among Hispanic or Latino/x individuals are attributed to male-to-male sexual transmission (CDC, 2023a).

Test-and-treat is one of the foundational approaches of the national strategic plans to end the HIV epidemic by 2030 (OIDP, 2022); however, evidence suggests that between 17% and 20% of Latino/x SMM living with HIV were estimated to be unaware of their status (CDC, 2023b; Crepaz et al., 2021). Although annual or even more frequent (i.e., every 6 months) routine HIV testing has been recommended and made available for members of key populations (DiNenno et al., 2017), it may not be adequately reaching Latino/x SMM. Recent estimates of HIV testing rates among Latino/x SMM demonstrated suboptimal levels, ranging from 49% for lifetime (Nanin et al., 2020) to 21% and 32% for past-12-month and past-6-month periods, respectively (Eklund et al., 2020; Painter et al., 2019). Moreover, a survey of HIV testing frequency among sexually active Latino/x SMM in urban HIV epicenters found that less than one-third (31%) had been tested five or more times during lifetime (Joseph et al., 2014).

The issue of HIV testing is particularly relevant for SMM in main or primary relationships. Older research indicated as many as 68% of new HIV infections among SMM are transmitted between main partners (Sullivan et al., 2009). More recent work indicates that HIV risk may be elevated for partnered (vs. single) SMM and vary across patterns of sexual agreement (i.e., monogamous, non-monogamous). For instance, a national screening survey of sexual health and substance use among SMM aged 18 or older (Starks et al., 2020) demonstrated that, among those who did not use marijuana or club drugs (e.g., cocaine, crack, ecstasy/MDMA, GHB/GBL, ketamine, methamphetamine/“tina”), partnered SMM in open relationships had higher odds of any condomless anal sex (CAS) and those in non-monogamous relationships had more frequent CAS with casual partners, relative to single SMM. The same study found stronger links between club drug use and CAS with casual partners among SMM in non-monogamous relationships, relative to those in a monogamous relationship (Starks et al., 2020). Similar patterns have been documented among adolescent SMM, with a recent study illustrating lower odds of CAS occurrence and frequency among single SMM, compared with partnered SMM, particularly those in a non-monogamous relationship (Cain et al., 2023). A large body of existing evidence has now documented that, for SMM with main or primary relationship partners, characteristics of their relationships are associated with HIV prevention generally—and with HIV testing specifically. Extant research illustrates that being in a monogamous relationship, compared to being single, is associated with lower odds of HIV testing (Stephenson et al., 2015); this effect appears to be more salient among SMM aged 30 or older than younger age cohorts (Dellucci et al., 2022). Still, HIV testing among partnered Latino/x SMM has received relatively little attention.

A long line of minority stress research asserts that discrimination is a salient barrier to HIV prevention and care among SMM (Gyamerah et al., 2020; Maksut et al., 2018; Quinn et al., 2023). SMM, along with other minoritized identities, are subject to discrimination based on multiple social identities concurrently, or “multifactorial discrimination” (Khan et al., 2017), which in turn may compound their risk for HIV. For instance, research indicated that, among Latino/x SMM, exposure to discrimination based on racial/ethnic and sexual minority identities was prevalent (MacCarthy et al., 2021; Sun et al., 2016) and positively associated with reporting CAS, unhealthy drinking, and marijuana disorder symptoms (Layland et al., 2022; Mizuno et al., 2012). Still, the link between exposure to discrimination based on multiple attributions and HIV prevention and care among Latino/x SMM has not been extensively studied, with one qualitative analysis of in-depth interviews with Latino/x SMM living with HIV in the U.S. South illustrating disruptions to HIV care due to discrimination based on multiple stigmatized identities (Barrington et al., 2019).

Moreover, the link between discrimination and HIV prevention and care may vary by migration history. Migrants constitute a Latino/x SMM subgroup whose experiences of migration and/or acculturation interact with intersecting structures (e.g., immigration, employment, health care policies, prejudice, and discrimination) in the host country to produce unique HIV prevention needs (Alessi et al., 2022; Lee et al., 2020; Weinstein et al., 2022). For instance, studies with Latino/x SMM showed that those born outside the U.S. (vs. in the U.S.) and speakers of Spanish (vs. English) were less likely to have received an HIV test within the past 12 months (Joseph et al., 2014; Lee et al., 2022b; Oster et al., 2013). In addition to experiencing discrimination based on attributions shared by their non-migrant counterparts, such as sexual orientation and race/ethnicity, Latino/x SMM migrants contend with discrimination related to their migration backgrounds from both dominant and minority groups (Gray et al., 2015; MacCarthy et al., 2021). Efforts of promoting engagement of Latino/x SMM in HIV prevention and care necessitate ongoing investigation of their psychosocial contexts including exposure to discrimination based on multiple attributions while recognizing the heterogeneity of migration experiences.

The current study aimed to explore the relationship between discrimination and HIV testing among Latino/x SMM. First, we evaluated the contributions of everyday discrimination based on sexual orientation and race/ethnicity and HIV testing behaviors among a sample of Latino/x SMM in main or primary relationships. Subsequently, we stratified this analysis by birth location to describe the dynamics of everyday discrimination and HIV testing among partnered Latino/x SMM born in and born outside the U.S. We hypothesized that everyday discrimination based on sexual orientation and race/ethnicity concurrently would be associated with higher odds of delayed HIV testing among partnered Latino/x SMM. Additionally, we hypothesized that the association between everyday discrimination and delayed HIV testing would differ by birth location.

METHODS

PARTICIPANTS

The parent study, conducted from November 2018 to May 2019, was an online study of sexual health and intimate relationships among Latino/x SMM who have a main partner (Robles et al., 2022a, 2023a). Recruitment for the parent study primarily took place online via advertisements, in English, Spanish, or both, on social media platforms and a geo-location-based dating/sexual networking application. Study recruitment ads were created using stock images of diverse sexual minority men and their male partners with text denoting an opportunity to advance sexual and relationship science research. Participants who clicked on the online advertisements were directed to a brief screener for determining study eligibility.

Study eligibility requirements included: being 18 years old or older, residing in the mainland U.S. (i.e., the 50 states and District of Columbia) or Puerto Rico, identifying as Hispanic or Latino/x, identifying as a cis man, having reading proficiency in Spanish or English, and having a main partner who is 18 years old or older and identifies as a cis man. Although relationship length was not an eligibility criterion, the vast majority (98.8%) of participants in the study reported having been in a relationship for 3 months or longer. In the present study, participants were excluded if they indicated an HIV positive serostatus.

PROCEDURES

Participants who were determined eligible for the study were routed to a baseline survey. After selecting the preferred language of survey administration (i.e., English or Spanish) and providing informed consent, participants completed structured assessment of dyadic communication, cultural values, sexual and substance use behaviors, and demographics. At baseline survey completion, participants received a $10 e-gift card from Amazon and were provided with an e-invite to be forwarded to their main partner. The parent study yielded a total of 625 index participants, which included 95 Latino/x SMM who successfully recruited their partner and 530 Latino/x SMM who did not (Robles et al., 2022b). For this study, we restricted our analysis to include baseline responses from index participants who reported a negative or an unknown HIV status (N = 484). All study procedures were reviewed and approved by the Institutional Review Board of the City University of New York.

MEASURES

HIV Testing

HIV testing was assessed using a single item, “When was the last time you received an HIV test?”. Responses (3 months ago or less, 4–6 months ago, 7–11 months ago, 1 to 2 years ago, more than 2 years ago, never been tested) indicated the time frame of the most recent prior HIV testing.

We collapsed participant responses for the most recent prior HIV testing into three categories: current (‘3 months ago or less’ or ‘4–6 months ago’), recent (‘7–11 months’), and delayed (‘1 to 2 years ago’, ‘more than 2 years ago’ or ‘never been tested’).

Everyday Discrimination

Everyday discrimination based on race/ethnicity.

Experiences of everyday discrimination based on race/ethnicity were assessed using a modified version of the Everyday Discrimination Scale (EDS; Clark et al., 2004; Williams et al., 1997), a 9-item measure of unfair treatment in day-to-day life based on one’s racial or ethnic background (e.g., “You are treated with less courtesy than other people”, “You are threatened or harassed”). Participants were asked how often these forms of unfair treatment occurred because of their race/ethnicity. Responses were collected on a 6-point Likert scale illustrating the frequency of discrimination (1 = Never, 2 = Less than a year, 3 = A few times a year, 4 = A few times a month, 5 = At least once a week, 6 = Almost every day). Internal consistency was strong (α = .97).

Everyday discrimination based on sexual orientation.

The EDS was further adapted to assess the experiences of everyday discrimination based on sexual orientation. Participants were asked how often different forms of unfair treatment occurred because of their sexual orientation. Responses were collected on the same 6-point Likert scale as used in the EDS based on race/ethnicity. Internal consistency was strong (α = .95).

Discrimination attributions.

We used the scoring procedures outlined in extant research that assessed additive effects of everyday discrimination based on multiple attributions on adverse health outcomes to create a composite discrimination variable (Kiekens et al., 2022; Meanley et al., 2021). First, for each of the two attribution-specific (i.e., sexual orientation-based, race/ethnicity-based) EDS measures, we dichotomized participant responses for the 9 items to denote the incidence of different forms of unfair treatment (0 = Never, 1 = Any). We subsequently summed and dichotomized these dummy variables to indicate endorsement of individual attributions for discrimination (0 = No, 1 = Yes). Then, we combined and summed two individual discrimination attribution variables to indicate the number of attributions endorsed, with the values of 0 (neither attribution), 1 (one attribution, i.e., sexual orientation or race/ethnicity), and 2 (both attributions, i.e., sexual orientation and race/ethnicity).

Sociodemographic and Behavioral Characteristics

Participants self-reported their birth location (i.e., whether they were born in the mainland U.S.). Regarding relationship factors, participants were asked relationship length, sexual agreement, partner HIV status, and any recent history (i.e., within past 30 days) of condomless anal sex (CAS). Participants also self-reported their race/ethnicity, age, sexual orientation, education level, income level, health insurance status, and current PrEP status.

ANALYSES

Data were inspected for mass and duplicate entries. Mass completions were flagged by Qualtrics fraud detection and duplicate cases were identified through comparing variants of names, email addresses, demographic information, and meta data (e.g., device and browser information); mass and duplicate entries were subsequently removed. We conducted frequency analyses to describe the distributions of sociodemographic and behavioral characteristics in the sample, and bivariate analyses—χ2 tests of independence for categorial variables and one-way ANOVA for continuous variables—to detect differences in these characteristics across HIV testing behaviors (current, recent, delayed).

We performed multinomial logistic regression analysis to examine the association of HIV testing behaviors (‘current’ as the reference category) with discrimination attributions in the full sample. This analysis was further stratified by birth location to examine the association in the subgroups of Latino/x SMM born in and born outside the mainland U.S. All models adjusted for sociodemographic and behavioral characteristics. We conducted Pearson χ2 tests to examine the model fit. We calculated the odds ratios and 95% confidence intervals to interpret the associations between discrimination types and HIV testing behaviors and adjusted for sociodemographic and behavioral characteristics in all regression models. Statistical significance was set at α = .05. All statistical analyses were performed using SPSS v.28 (IBM Corp., 2021).

RESULTS

Results of descriptive analyses are presented in Table 1. In the sample of 484 Latino/x SMM, 209 (43%) were born outside the mainland U.S. Of these participants, 164 (34.0%) reported living the West, followed by 131 (27.2%) in the Northeast, 120 (24.9%) in the South, and 58 (12.0%) in the Midwest. Nine individuals (1.9%) reported living Puerto Rico, and two did not report their region of residence. The most frequently reported race/ethnicity was White (63.6%), followed by multiracial (16.7%), not elsewhere identified (11.4%), and Black (8.3%). Participants were between the ages of 18 and 61; the average age was 30.4 (SD = 6.8). Most participants in the sample identified as gay (86.8%), had completed less than 4 years of higher education (61.2%), and earned $30,000 or less (60.1%). More than one-third (37.4%) reported either not having health insurance or being unsure about their health insurance status. The majority (78.1%) were not on PrEP at the time of assessment; 60.7% had not been prescribed PrEP, while 17.4% had been previously prescribed PrEP but had discontinued.

TABLE 1.

Sample Characteristics (N = 484)

Total
(N = 484)		 Current HIV Testinga
(n = 317, 65.5%)		 Recent HIV Testingb
(n = 72, 14.9%)		 Delayed HIV Testingc
(n = 95, 19.6%)		 Test Statistic
M (SD) M (SD) M (SD) M (SD)
Age (in years) 30.4 (6.8) 30.0 (6.5) 31.8 (7.8) 30.6 (6.6) F(2, 481) = 2.05
Relationship length (in months) 45.8 (46.5) 45.2 (46.5) 44.3 (52.3) 48.6 (42.1) F(2, 481) = 0.23
n (%) n (%) n (%) n (%)
Residence (n = 482)
 Northeast 131 (27.2) 80 (25.3) 22 (31.0) 29 (30.5) x2(8) = 15.55*
 Midwest 58 (12.0) 49 (15.5) 3 (4.2) 6 (6.3)
 South 120 (24.9) 83 (26.3) 14 (19.7) 23 (24.2)
 West 164 (34.0) 97 (30.7) 31 (43.7) 36 (37.9)
 Puerto Rico 9 (1.9) 7 (2.2) 1 (1.4) 1 (1.1)
Birth location
 Outside the mainland U.S.d 209 (43.2) 145 (45.7) 22 (30.6) 42 (44.2) x2(2) = 5.57
 Mainland U.S.d 275 (56.8) 172 (54.3) 50 (69.4) 53 (55.8)
Latino Race/Ethnicity
 White Latino 308 (63.6) 197 (62.1) 51 (70.8) 60 (63.2) x2(6) = 9.52
 Black/Afro-Latino 40 (8.3) 22 (6.9) 4 (5.6) 14 (14.7)
 Multiracial 81 (16.7) 59 (18.6) 10 (13.9) 12 (12.6)
 Not elsewhere identified 55 (11.4) 39 (12.3) 7 (9.7) 9 (9.5)
Sexual Orientation
 Gay 420 (86.8) 269 (84.9) 67 (93.1) 84 (88.4) x2(2) = 3.72
 Bisexual/Queer/Other 64 (13.2) 48 (15.1) 5 (6.9) 11 (11.6)
Educational Level
 Less than 4-year 296 (61.2) 171 (53.9) 53 (73.6) 72 (75.8) x2(2) = 20.21**
 4-year or more 188 (38.8) 146 (46.1) 19 (26.4) 23 (24.2)
Income Level
 $30,000 or less 291 (60.1) 168 (53.0) 55 (76.4) 68 (71.6) x2(2) = 19.86**
 More than $30,000 193 (39.9) 149 (47.0) 17 (23.6) 27 (28.4)
Health Insurance Status
 No/Unknown 181 (37.4) 94 (29.7) 39 (54.2) 48 (50.5) x2(2) = 23.76**
 Yes 303 (62.6) 223 (70.3) 33 (45.8) 47 (49.5)
PrEP Status
 Never been prescribed PrEP 294 (60.7) 170 (53.6) 53 (73.6) 71 (74.7) x2(4) = 65.39**
 Currently on PrEP 106 (21.9) 104 (32.8) 2 (2.8) 0 (0)
 Previously but not currently on PrEP 84 (17.4) 43 (13.6) 17 (23.6) 24 (25.3)
Sexual Agreement
 Monogamous 177 (36.6) 115 (36.3) 24 (33.3) 38 (40.0) x2(4) = 11.64**
 Monogamish 110 (22.7) 85 (26.8) 14 (19.4) 11 (11.6)
 Open 197 (40.7) 117 (36.9) 34 (47.2) 46 (48.4)
Partner HIV Status
 HIV positive 39 (8.1) 29 (9.1) 3 (4.2) 7 (7.4) x2(4) = 27.06**
 HIV negative 395 (81.6) 271 (85.5) 57 (79.2) 67 (70.5)
 Unsure/Don’t know 50 (10.3) 17 (5.4) 12 (16.7) 21 (22.1)
Condomless Anal Sex, Past 30 Days
 None 150 (31.0) 102 (32.2) 20 (27.8) 28 (29.5) x2(2) = 0.66
 At least once 334 (69.0) 215 (67.8) 52 (72.2) 67 (70.5)
Everyday Discrimination
 Sexual orientation-based 381 (78.7) 239 (75.4) 61 (84.7) 81 (85.3) x2(2) = 6.07*
 Race/ethnicity-based 383 (79.1) 243 (76.7) 58 (80.6) 82 (86.3) x2(2) = 4.23
 Number of attributions
 Neither 58 (12.0) 45 (14.2) 6 (8.3) 7 (7.4) x2(4) = 7.03
 One 88 (18.2) 62 (19.6) 13 (18.1) 13 (13.7)
 Both 338 (69.8) 210 (66.2) 53 (73.6) 75 (78.9)
Open in a new tab
a

Within the past 6 months

b

Within the past 7–11 months

c

Within the past 12 or more months

d

The 50 states and District of Columbia

Significance levels:

*

p<.05,

**

p<.01

Latino/x SMM in the sample had been in a relationship, on average, for 46 months (SD = 46). While one-third (36.6%) were in a monogamous relationship, the remainder were in a monogamish (22.7%) or an open (40.7%) relationship. With respect to their partner’s HIV status, most participants (81.6%) self-reported a negative HIV status and 8.1% reported a positive HIV status, while 10.3% did not know their partner’s HIV status. Sixty-nine percent had engaged in condomless anal sex at least once within the past 30 days.

Most participants reported experiencing discrimination based on sexual orientation (78.7%) and race/ethnicity (79.1%). Nearly 70% of participants reported experiencing discrimination based on both sexual orientation and race/ethnicity attributions concurrently, 18.2% based on either of the two attributions, and 12.0% experienced neither. While the majority (65.5%) reported current HIV testing, 14.9% and 19.6% reported recent and delayed HIV testing, respectively.

Bivariate analyses illustrated differences in sociodemographic characteristics and discrimination experiences across HIV testing behaviors. Specifically, HIV testing behaviors differed significantly across education level, income level, and health insurance status. Furthermore, proportions of participants experiencing sexual orientation-based discrimination and both sexual orientation-based and race/ethnicity-based discrimination were the highest among those who reported delayed HIV testing.

Results of multivariable regression analyses are presented in Table 2. The full model was statistically significant, x2(38) = 170.69, p < .001. In the full sample, experiencing discrimination based on both sexual orientation and race/ethnicity attributions concurrently, compared with neither discrimination attribution, was associated with higher odds of delayed HIV testing (AOR = 2.6, 95% CI = 1.0, 6.7), relative to current testing. Similar patterns emerged in one of the subgroup models. Specifically, among Latino/x SMM born outside the mainland U.S., experiencing discrimination based on both sexual orientation and race/ethnicity attributions concurrently, compared with neither attribution, was associated with higher odds of recent (AOR = 12.4, 95% CI = 1.3, 115.7) as well as delayed HIV testing (AOR = 7.3, 95% CI = 1.6, 33.0), relative to current testing. These relationships, although also positive, were not statistically significant among Latino/x SMM born in the mainland U.S.

TABLE 2.

Results of Multivariable Regression Analyses (Reference: Current HIV Testing) (N = 484): Total and Stratified by Birth Location

Full Sample
(N = 484)		 Born Outside the Mainland U.S.a
(n = 209)		 Born in the Mainland U.S.a
(n = 275)
Recent HIV Testingb Delayed HIV Testingc Recent HIV Testingb Delayed HIV Testingc Recent HIV Testingb Delayed HIV Testingc
AORd (95% CI) AORd (95% CI) AORd (95% CI) AORd (95% CI) AORd (95% CI) AORd (95% CI)
Discrimination Attributionsf
 Neither Ref. Ref. Ref. Ref. Ref. Ref.
 One 2.0 (0.7, 6.3) 1.6 (0.5, 4.7) 9.3 (0.9, 100.2) 2.5 (0.4, 14.5) 1.4 (0.3, 6.0) 1.2 (0.3, 5.6)
 Both 2.2 (0.8, 5.9) 2.6 (1.0, 6.7)* 12.4 (1.3, 115.7)* 7.3 (1.6, 33.0)* 1.3 (0.4, 4.5) 1.4 (0.4, 5.1)
Open in a new tab
a

The 50 states and District of Columbia

b

Within the past 7–11 months

c

Within the past 12 or more months

d

Adjusted for birth location, race/ethnicity, age, sexual orientation, education level, income level, health insurance status, PrEP status, relationship length, sexual agreement, partner HIV status, condomless anal sex (past 30 days)

e

Adjusted for race/ethnicity, age, sexual orientation, education level, income level, health insurance status, PrEP status, relationship length, sexual agreement, partner HIV status, condomless anal sex (past 30 days)

f

Sexual orientation, race/ethnicity

AOR: Adjusted odds ratio

CI: Confidence interval

Significance levels:

*

p<.05,

**

p<.01

DISCUSSION

This study explored the relationship between everyday discrimination and HIV testing among Latino/x SMM in main or primary relationships. We found that most participants had received their most recent prior HIV test within the past 12 months, demonstrating adherence to the CDC recommendations of annual testing for members of key populations (CDC, 2023c). In line with the national survey showing common experiences of discrimination among LGBTQ people in the U.S., rates of everyday discrimination were high among participants in our study (Casey et al., 2019). In the full sample, HIV testing was significantly associated with everyday discrimination. Specifically, compared with participants who were most recently tested within the past 6 months (i.e., current HIV testing), those tested longer than 12 months ago (i.e., delayed HIV testing) were significantly more likely to have experienced discrimination based on both sexual orientation and race/ethnicity attributions concurrently, relative to those who experienced no discrimination. We also found support for a correlation between HIV testing and concurrent discrimination among Latino/x SMM born outside the mainland U.S. In this subgroup, compared with those reporting current HIV testing, those reporting recent and delayed testing were significantly more likely to have experienced concurrent discrimination, relative to those who experienced no discrimination.

Our findings are consistent with minority stress literature demonstrating the adverse impact of discrimination on engagement in HIV prevention methods among members of multiple minoritized communities (Kimball et al., 2020; Quinn et al., 2023). Research illustrates that Latino/x SMM frequently experience discrimination in healthcare settings and strategically employ such coping mechanisms as avoidance and nondisclosure, which in turn may hamper linkage to HIV prevention (Gilbert et al., 2016; Lee et al., 2020; MacCarthy et al., 2021; Tanner et al., 2014). It is reasonable to posit that any prior exposure to concurrent discrimination in health care settings had reinforced decisions to avoid seeking routine HIV testing among Latino/x SMM in the study.

Alternatives to direct contact with medical institutions, such as culturally relevant community-based strategies (Lee et al., 2022a; Robles et al., 2022b) or home-based or self-testing (Lightfoot et al,. 2018; Young et al., 2022), should be incorporated in the efforts of promoting HIV testing uptake among Latino/x SMM. This may further help to buffer the negative effects of health care-related discrimination experienced in their countries of origin. It is also possible that structural factors causing delays in HIV testing, such as unemployment, immigration proceedings, limited health care coverage, and language barriers (Galeucia et al., 2016; Horridge et al., 2019), had reinforced concurrent discrimination among Latino/x SMM born outside the mainland U.S.

Emerging research with Latino/x SMM couples has demonstrated the utility of considering dyadic factors in promoting HIV prevention and buffering against psychosocial adversities known to exacerbate the HIV risk. A recent study guided by the interdependence theory found that relationship functioning buffered against the link between adverse childhood experiences and intimate partner violence among partnered Latino/x SMM (Robles et al., 2023b), highlighting relationships as a potentially important avenue for promoting HIV preventive behaviors such as testing through facilitating awareness of impacts of their actions on their partners. Moreover, a pilot study of a couples-based HIV preventive intervention for partnered Latino/x SMM indicated high feasibility and acceptability, as well as a significant increase in relationship functioning (conceptualized as a key mechanism of change in HIV protective behaviors) among those in the intervention group (Martinez et al., 2023). Thus, utilizing and strengthening key functions of a relationship could help partnered Latino/x SMM overcome psychosocial and structural barriers to HIV testing. Further investigation of the structural and psychosocial contexts of HIV testing among Latino/x SMM from diverse migration backgrounds is warranted.

LIMITATIONS

One major limitation of this study is the use of internet-enhanced recruitment strategies, resulting in a convenience sample of Latino/x SMM who had been using web- or app-based social media and networking services. Although this approach limits generalizability of study findings, when used in culturally relevant ways, it can serve as a viable avenue for reaching and recruiting diverse Latino/x SMM (Lee et al., 2022a; Martinez et al., 2014). Furthermore, although the study assessed several relationship factors, we limited our analyses to participants in main or primary relationships. Therefore, the study is not representative of the larger population of Latino/x SMM. Another limitation is the conflation of individual identities and experiences, particularly with respect to race and ethnicity and migration history. Latino/x SMM represent a racially and ethnically diverse group whose experiences of race-based discrimination may preclude dimensions of ethnicity (and vice versa); these nuances were not examined in our sample of predominantly White Latino/x SMM. Additionally, the stratified analysis by birth location limits detection of potential effect size differences across lengths of stay, levels of language proficiency/preference, and other acculturation factors across migrant subgroups. Finally, the composite measure of dual discrimination may not adequately capture the experiences of Latino/x SMM. Future endeavors of fully capturing the experiences of discrimination based on multiple intersecting identities held by Latino/x SMM and their influence on HIV testing would benefit from incorporating the lens and more appropriate measures of intersectionality (Earnshaw et al., 2022).

CONCLUSIONS

This study extends previous research illustrating discrimination impeding engagement in HIV prevention and care among Latino/x SMM. The findings showed high rates of everyday discrimination based on sexual orientation, race/ethnicity, or both attributions among partnered Latino/x SMM, and highlight benefits of culturally tailored interventions addressing concurrent discrimination in promoting HIV testing in this population.

Acknowledgements

The authors would like to thank Latino/x SMM for their time in sharing their experiences.

Funding

This study was funded by a Research Supplement to Promote Diversity in Health-Related Research funded by the National Institute on Drug Abuse (R01DA045613–01S).

References

  1. Alessi EJ, Cheung SP, Sarna V, Dentato MP, Eaton A, & Craig SL (2022). Experiences of COVID-19 pandemic-related stress among sexual and gender minority emerging adult migrants in the United States. Stress and Health : Journal of the International Society for the Investigation of Stress, 10.1002/smi.3198. Advance online publication. 10.1002/smi.3198 [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Barrington C, Davis DA, Villa-Torres L, Carcano J, & Hightow-Weidman L (2021). Intersectionalities and the HIV continuum of care among gay Latino men living with HIV in North Carolina. Ethnicity & Health, 26(7), 1098–1113. 10.1080/13557858.2019.1620177 [DOI] [PubMed] [Google Scholar]
  3. Cain D, Salsabilian B, Jones SS, & Starks TJ (2023). 55. Substance use, sexual agreements, and sexual risk taking among adolescent sexual minority men (Aged 13–17) in the USA. Journal of Adolescent Health, 72(3), S35. 10.1016/j.jadohealth.2022.11.076 [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Casey LS, Reisner SL, Findling MG, Blendon RJ, Benson JM, Sayde JM, & Miller C (2019). Discrimination in the United States: Experiences of lesbian, gay, bisexual, transgender, and queer Americans. Health Services Research, 54 Suppl 2(Suppl 2), 1454–1466. 10.1111/1475-6773.13229 [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Centers for Disease Control and Prevention (CDC). (2023a). Diagnoses of HIV infection in the United States and dependent areas, 2021. HIV Surveillance Report, 2021, 34. https://www.cdc.gov/hiv/library/reports/hiv-surveillance/vol-34/index.html [Google Scholar]
  6. Centers for Disease Control and Prevention (CDC). (2023b). Estimated HIV incidence and prevalence in the United States, 2017–2021. HIV Surveillance Supplemental Report, 2023, 28. https://www.cdc.gov/hiv/library/reports/hiv-surveillance/vol-28-no-3/index.html [Google Scholar]
  7. Centers for Disease Control and Prevention (CDC). (2023c). HIV infection risk, prevention, and testing behaviors among men who have sex with men—National HIV Behavioral Surveillance, 13 U.S. cities, 2021. HIV Surveillance Special Report, 2023, 31. https://www.cdc.gov/hiv/library/reports/hiv-surveillance-special-reports/no-31/index.html [Google Scholar]
  8. Clark R, Coleman AP, & Novak JD (2004). Brief report: Initial psychometric properties of the everyday discrimination scale in black adolescents. Journal of Adolescence, 27(3), 363–368. 10.1016/j.adolescence.2003.09.004 [DOI] [PubMed] [Google Scholar]
  9. Crepaz N, Mullins MM, Higa D, Gunn JKL, & Salabarría-Peña Y (2021). A rapid review of disparities in HIV prevention and care outcomes among Hispanic/Latino men who have sex with men in the United States. AIDS Education and Prevention : Official Publication of the International Society for AIDS Education, 33(4), 276–289. 10.1521/aeap.2021.33.4.276 [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Dellucci TV, Jones SS, Adhemar C, Feldstein Ewing SW, Lovejoy TI, & Starks TJ (2022). Correlates of HIV testing across the lifespan - adolescence through later adulthood - among sexual minority men in the US who are not on PrEP. Journal of Behavioral Medicine, 45(6), 975–982. 10.1007/s10865-022-00341-2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. DiNenno EA, Prejean J, Irwin K, Delaney KP, Bowles K, Martin T, Tailor A, Dumitru G, Mullins MM, Hutchinson AB, & Lansky A (2017). Recommendations for HIV screening of gay, bisexual, and other men who have sex with men - United States, 2017. MMWR. Morbidity and Mortality Weekly Report, 66(31), 830–832. 10.15585/mmwr.mm6631a3 [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Earnshaw VA, Jonathon Rendina H, Bauer GR, Bonett S, Bowleg L, Carter J, English D, Friedman MR, Hatzenbuehler ML, Johnson MO, McCree DH, Neilands TB, Quinn KG, Robles G, Scheim AI, Smith JC, Smith LR, Sprague L, Taggart T, Tsai AC, … Kerrigan DL (2022). Methods in HIV-related intersectional stigma research: Core elements and opportunities. American Journal of Public Health, 112(S4), S413–S419. 10.2105/AJPH.2021.306710 [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Eklund AC, Dillon FR, & Ebersole RC (2020). Individual and structural factors predicting HIV testing among Latinx MSM: Substance use as a moderator. AIDS Care, 32(2), 193–201. 10.1080/09540121.2019.1619664 [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Galeucia M, & Hirsch JS (2016). State and local policies as a structural and modifiable determinant of HIV vulnerability among Latino migrants in the United States. American Journal of Public Health, 106(5), 800–807. 10.2105/AJPH.2016.303081 [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Gilbert PA, Barrington C, Rhodes SD, & Eng E (2016). Saliendo Adelante: Stressors and coping strategies among immigrant Latino men who have sex with men in a nontraditional settlement state. American Journal of Men’s Health, 10(6), 515–525. 10.1177/1557988316647704 [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Gray NN, Mendelsohn DM, & Omoto AM (2015). Community connectedness, challenges, and resilience among gay Latino immigrants. American Journal of Community Psychology, 55(1–2), 202–214. 10.1007/s10464-014-9697-4 [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Gyamerah AO, Taylor KD, Atuahene K, Anarfi JK, Fletcher M, Raymond HF, McFarland W, & Dodoo FN (2020). Stigma, discrimination, violence, and HIV testing among men who have sex with men in four major cities in Ghana. AIDS Care, 32(8), 1036–1044. 10.1080/09540121.2020.1757020 [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Horridge DN, Oh TS, Alonzo J, Mann-Jackson L, Tanner AE, Song EY, Smart BD, Van Dam CN, Baker LS, & Rhodes SD (2019). Barriers to HIV testing within a sample of Spanish-speaking Latinx gay, bisexual, and other men who have sex with men: Implications for HIV prevention and care. Health Behavior Research, 2(3), 10.4148/2572-1836.1069. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Joseph HA, Belcher L, O’Donnell L, Fernandez MI, Spikes PS, & Flores SA (2014). 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 Promotion Practice, 15(6), 867–880. 10.1177/1524839914537493 [DOI] [PubMed] [Google Scholar]
  20. Khan M, Ilcisin M, & Saxton K (2017). Multifactorial discrimination as a fundamental cause of mental health inequities. International Journal for Equity in Health, 16(1), 43. 10.1186/s12939-017-0532-z [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Kiekens WJ, Fish JN, Gordon AR, & Russell ST (2022). Everyday discrimination and alcohol use among sexual minority adults in a U.S. national probability sample. Substance Use & Misuse, 57(9), 1383–1391. 10.1080/10826084.2022.2083172 [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Kimball D, Rivera D, Gonzales M 4th, & Blashill AJ (2020). Medical mistrust and the PrEP cascade among Latino sexual minority men. AIDS and Behavior, 24(12), 3456–3461. 10.1007/s10461-020-02916-z [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Layland EK, Bray BC, Kipke MD, & Maggs JL (2022). Intersectional stigma subgroup differences in unhealthy drinking and disordered marijuana use among Black and Latino cisgender sexual minority young men. Drug and Alcohol Dependence, 241, 109652. 10.1016/j.drugalcdep.2022.109652 [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Lee JJ, Aguirre Herrera J, Cardona J, Cruz LY, Munguía L, Leyva Vera CA, & Robles G (2022a). Culturally tailored social media content to reach Latinx immigrant sexual minority men for HIV prevention: Web-based feasibility study. JMIR Formative Research, 6(3), e36446. 10.2196/36446 [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Lee JJ, Katz DA, Glick SN, Moreno C, & Kerani RP (2020). Immigrant status and sexual orientation disclosure: Implications for HIV/STD prevention among men who have sex with men in Seattle, Washington. AIDS and Behavior, 24(10), 2819–2828. 10.1007/s10461-020-02831-3 [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Lee JJ, Rao DW, Robles G, Kerani RP, Naismith K, Rodriguez-Díaz CE, Rendina HJ, & Katz DA (2022b). Differences in HIV risk and prevention among cisgender Latino sexual minority men by language of online survey completion: Analysis of national and Washington State data. AIDS and Behavior, 26(3), 662–673. 10.1007/s10461-021-03426-2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Lightfoot M, Campbell C, Moss N, Treves-Kagan S, Agnew E, Kang Dufour M, Scott H, Sa’id A, & Lippman S (2018). Using a social network strategy to distribute HIV self-test kits to African American and Latino MSM. JAIDS Journal of Acquired Immune Deficiency Syndromes, 79(1), 38–45. 10.1097/QAI.0000000000001726 [DOI] [PubMed] [Google Scholar]
  28. MacCarthy S, Bogart LM, Galvan FH, & Pantalone DW (2021). Inter-group and intraminority-group discrimination experiences and the coping responses of Latino sexual minority men living with HIV. Annals of LGBTQ Public and Population Health, 2(1), 1–21. 10.1891/lgbtq-2020-0028 [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Maksut JL, Eaton LA, Siembida EJ, Fabius CD, & Bradley AM (2018). Health care discrimination, sexual behavior disclosure, and awareness of pre-exposure prophylaxis among Black men who have sex with men. Stigma and Health, 3(4), 330–337. 10.1037/sah0000102 [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Martinez O, Fernandez MI, Yang C, Wu E, Valentin O, & Johnson M (2023). Feasibility and acceptability pilot test of Connecting Latinos en Parejas: A couples-based HIV prevention intervention for Latino male couples. American Journal of Men’s Health, 17(2), 15579883231167106. 10.1177/15579883231167106 [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Martinez O, Wu E, Shultz AZ, Capote J, López Rios J, Sandfort T, Manusov J, Ovejero H, Carballo-Dieguez A, Chavez Baray S, Moya E, López Matos J, DelaCruz JJ, Remien RH, & Rhodes SD (2014). Still a hard-to-reach population? Using social media to recruit Latino gay couples for an HIV intervention adaptation study. Journal of Medical Internet Research, 16(4), e113. 10.2196/jmir.3311 [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Meanley SP, Plankey MW, Matthews DD, Hawk ME, Egan JE, Teplin LA, Shoptaw SJ, Surkan PJ, & Stall RD (2021). Lifetime prevalence and sociodemographic correlates of multifactorial discrimination among middle-aged and older adult men who have sex with men. Journal of Homosexuality, 68(10), 1591–1608. 10.1080/00918369.2019.1702353 [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Mizuno Y, Borkowf C, Millett GA, Bingham T, Ayala G, & Stueve A (2012). Homophobia and racism experienced by Latino men who have sex with men in the United States: Correlates of exposure and associations with HIV risk behaviors. AIDS and Behavior, 16(3), 724–735. 10.1007/s10461-011-9967-1 [DOI] [PubMed] [Google Scholar]
  34. Nanin J, Drumhiller K, Gaul Z, & Sutton MY (2020). HIV testing among Black and Hispanic/Latino men who have sex with men in New York City: A mixed-methods study. Archives of Sexual Behavior, 49(6), 2019–2027. 10.1007/s10508-019-01610-z [DOI] [PubMed] [Google Scholar]
  35. Office of Infectious Disease and HIV/AIDS Policy (OIDP). (2022). About Ending the HIV Epidemic in the U.S https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview
  36. Oster AM, Russell K, Wiegand RE, Valverde E, Forrest DW, Cribbin M, Le BC, Paz-Bailey G, & NHBS Study Group (2013). 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, 8(9), e73779. 10.1371/journal.pone.0073779 [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Painter TM, Song EY, Mullins MM, Mann-Jackson L, Alonzo J, Reboussin BA, & Rhodes SD (2019). 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. AIDS and Behavior, 23(Suppl 3), 251–265. 10.1007/s10461-019-02540-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Quinn KG, Dickson-Gomez J, Craig A, John SA, & Walsh JL (2023). Intersectional discrimination and PrEP use among young Black sexual minority individuals: The importance of Black LGBTQ communities and social support. AIDS and Behavior, 1–13. Advance online publication. 10.1007/s10461-022-03763-w [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Robles G, Bosco SC, Cardenas I, Hostetter J, & Starks TJ (2022a). Psychosocial and culturally-specific factors related to intimate partner violence victimization among a sample of Latino sexual minority cis men in the U.S. Journal of Interpersonal Violence, 37(23–24), NP22501–NP22527. 10.1177/08862605211072167 [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Robles G, Dellucci TV, Del Rosario B, Jimenez RH, Rodríguez-Díaz CE, & Starks TJ (2022b). Factors associated with individual and couple participation in online sexual health research with Latinx sexual minority men. Journal of Latina/o Psychology, 10(3), 241–252. 10.1037/lat0000169 [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Robles G, Lee JJ, Yu M, & Starks TJ (2023a). Multilevel analysis of sociopolitical contexts, social support, mental health, and alcohol use among partnered sexual minority Latino men in the U.S. Journal of Racial and Ethnic Health Disparities. Advance online publication. 10.1007/s40615-023-01637-y [DOI] [PubMed] [Google Scholar]
  42. Robles G, Reynolds A, Cardenas I, & Starks TJ (2023b). Relationship functioning buffers the impact of adverse childhood experiences on intimate partner violence among Latino sexual minority male couples. Journal of Family Violence (2023). 10.1007/s10896-023-00618-3 [DOI] [Google Scholar]
  43. Starks TJ, Jones SS, Kyre K, Robles G, Cain D, Jimenez R, Stephenson R, & Sullivan PS (2020). Testing the drug use and condomless anal sex link among sexual minority men: the predictive utility of marijuana and interactions with relationship status. Drug and Alcohol Dependence, 216, 108318. 10.1016/j.drugalcdep.2020.108318 [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Stephenson R, White D, Darbes L, Hoff C, & Sullivan P (2015). HIV testing behaviors and perceptions of risk of HIV infection among MSM with main partners. AIDS and Behavior, 19(3), 553–560. 10.1007/s10461-014-0862-4 [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Sullivan PS, Salazar L, Buchbinder S, & Sanchez TH (2009). Estimating the proportion of HIV transmissions from main sex partners among men who have sex with men in five US cities. AIDS (London, England), 23(9), 1153–1162. 10.1097/QAD.0b013e32832baa34 [DOI] [PubMed] [Google Scholar]
  46. Sun CJ, Ma A, Tanner AE, Mann L, Reboussin BA, Garcia M, Alonzo J, & Rhodes SD (2016). Depressive symptoms among Latino sexual minority men and Latina transgender women in a new settlement state: The Role of perceived discrimination. Depression Research and Treatment, 2016, 4972854. 10.1155/2016/4972854 [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Tanner AE, Reboussin BA, Mann L, Ma A, Song E, Alonzo J, & Rhodes SD (2014). Factors influencing health care access perceptions and care-seeking behaviors of immigrant Latino sexual minority men and transgender individuals: Baseline findings from the HOLA intervention study. Journal of Health Care for the Poor and Underserved, 25(4), 1679–1697. 10.1353/hpu.2014.0156 [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Weinstein ER, Glynn TR, Simmons EM, Safren SA, & Harkness A (2022). Structural life instability and factors related to Latino sexual minority men’s intention to engage with biomedical HIV-prevention services. AIDS and Behavior, 26(12), 3914–3924. 10.1007/s10461-022-03718-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Williams DR, Yan Yu, Jackson JS, & Anderson NB (1997). Racial differences in physical and mental health: Socio-economic status, stress and discrimination. Journal of Health Psychology, 2(3), 335–351. 10.1177/135910539700200305 [DOI] [PubMed] [Google Scholar]
  50. Young S, Cumberland W, Singh P, & Coates T (2022). A peer-led online community to increase HIV self-testing among African American and Latinx MSM: A randomized controlled trial. JAIDS Journal of Acquired Immune Deficiency Syndromes, 90(1), 20–26. 10.1097/QAI.0000000000002919 [DOI] [PMC free article] [PubMed] [Google Scholar]

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