RESUMO
OBJECTIVES: We estimated HIV prevalence among men who have sex with men (MSM) and transgender women in Bogotá, Colombia, and explored differences between HIV-positive individuals who are aware and unaware of their serostatus. METHODS: In this cross-sectional 2011 study, we used respondent-driven sampling (RDS) to recruit 1000 MSM and transgender women, who completed a computerized questionnaire and received an HIV test. RESULTS: The RDS-adjusted prevalence was 12.1% (95% confidence interval [CI] = 8.7, 15.8), comparable to a previous RDS-derived estimate. Among HIV-positive participants, 39.7% (95% CI = 25.0, 54.8) were aware of their serostatus and 60.3% (95% CI = 45.2, 75.5) were unaware before this study. HIV-positive-unaware individuals were more likely to report inadequate insurance coverage, exchange sex (i.e., sexual intercourse in exchange for money, goods, or services), and substance use than other participants. HIV-positive-aware participants were least likely to have had condomless anal intercourse in the previous 3 months. Regardless of awareness, HIV-positive participants reported more violence and forced relocation experiences than HIV-negative participants. CONCLUSIONS: There is an urgent need to increase HIV detection among MSM and transgender women in Bogotá. HIV-positive-unaware group characteristics suggest an important role for structural, social, and individual interventions.
Assuntos
Infecções por HIV/epidemiologia , Soropositividade para HIV/psicologia , Homossexualidade/estatística & dados numéricos , Pessoas Transgênero/estatística & dados numéricos , Adolescente , Adulto , Colômbia/epidemiologia , Estudos Transversais , Feminino , Infecções por HIV/psicologia , Soropositividade para HIV/epidemiologia , Homossexualidade/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Comportamento Sexual/psicologia , Comportamento Sexual/estatística & dados numéricos , Inquéritos e Questionários , Pessoas Transgênero/psicologia , Adulto JovemRESUMO
This paper examined structural, social, and personal characteristics that shape the processes of gender affirmation and body modification among transgender persons (assigned male at birth) in Bogotá, Colombia. Qualitative data from life-history interviews (N=14) and a focus group (N=11) explored research questions concerning the ways in which the internal psychological and external contextual processes influence individuals' decisions and behaviors concerning hormonal treatment, injections, or surgery. Research questions concerning practices and consequences of treatment performed without medical supervision were addressed through qualitative data, as well as quantitative data from 58 transgender participants. Findings indicated variation in ways participants conceptualized gender (e.g., binary or fluid), but an increased feminine presentation was a strong personal desire expressed by many and often encouraged by romantic partners and transgender friends. Transgender individuals within participants' social networks were frequently instrumental not only in providing information about hormones and contouring injections, but also in carrying out procedures-sometimes with negative consequences. Body modification procedures occurred primarily outside the health care system, due to limited access to or awareness of medical care, societal stigma, social norms within the transgender community, and personal decision-making. Public health approaches to protect the health of transgender persons undergoing body modification were suggested.
RESUMO
This study used mixed methods to examine characteristics related to HIV testing among men who have sex with men (MSM) in Bogotá, Colombia. A sample of 890 MSM responded to a computerized quantitative survey. Follow-up qualitative data included 20 in-depth interviews with MSM and 12 key informant interviews. Hierarchical logistic set regression indicated that sequential sets of variables reflecting demographic characteristics, insurance coverage, risk appraisal, and social context each added to the explanation of HIV testing. Follow-up logistic regression showed that individuals who were older, had higher income, paid for their own insurance, had had a sexually transmitted infection, knew more people living with HIV, and had greater social support were more likely to have been tested for HIV at least once. Qualitative findings provided details of personal and structural barriers to testing, as well as inter-relationships among these factors. Recommendations to increase HIV testing among Colombian MSM are offered.
Assuntos
Infecções por HIV/diagnóstico , Homossexualidade Masculina/estatística & dados numéricos , Programas de Rastreamento/métodos , Comportamento Sexual/estatística & dados numéricos , Infecções Sexualmente Transmissíveis/diagnóstico , Adulto , Colômbia/epidemiologia , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Soropositividade para HIV , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Cobertura do Seguro/estatística & dados numéricos , Entrevistas como Assunto , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Assunção de Riscos , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Apoio Social , Fatores SocioeconômicosRESUMO
This qualitative study examined sex work among internally displaced male and transgender female sex workers in Bogotá, Colombia. Internal displacement has occurred in Colombia as a result of decades of conflict among armed groups and has created large-scale migration from rural to urban areas. Informed by the polymorphous model of sex work, which posits that contextual conditions shape the experience of sex work, we examined three main research questions. The first dealt with how internal displacement was related to the initiation of sex work; the second concerned the effect of agency on sex worker satisfaction; and the third examined how sex work in this context was related to HIV and other risks. Life history interviews were conducted with 26 displaced individuals who had done sex work: 14 were men who have sex with men and 12 were transgender women (natal males). Findings revealed that many participants began doing sex work in the period immediately after displacement, because of a lack of money, housing, and social support. HIV risk was greater during this time due to limited knowledge of HIV and inexperience negotiating safer sex with clients. Other findings indicated that sex workers who exerted more control and choice in the circumstances of their work reported greater satisfaction. In addition, we found that although many sex workers insisted on condom use with clients, several noted that they would sometimes have unprotected sex for additional money. Specific characteristics affecting the experience of sex work among the transgender women were also discussed.
Assuntos
Infecções por HIV/prevenção & controle , Homossexualidade Masculina/psicologia , Profissionais do Sexo/estatística & dados numéricos , Pessoas Transgênero/psicologia , Sexo sem Proteção/estatística & dados numéricos , Adulto , Colômbia , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Assunção de Riscos , População Rural , Trabalho Sexual/psicologia , Trabalho Sexual/estatística & dados numéricos , Profissionais do Sexo/psicologia , Comportamento Sexual , Pessoas Transgênero/estatística & dados numéricos , Transexualidade , Adulto JovemRESUMO
Colombia has endured six decades of civil unrest, population displacement and violence. We examined the relationships between contextual conditions, displacement and HIV among gay, bisexual and transgender individuals in Bogotá, Colombia. A total of 19 key informants provided information about internal displacement of sexual minorities. Life-history interviews were conducted with 42 participants aged 18 to 48 years and included questions about displacement experiences, sexual behaviour, life prior to displacement and participants' economic and social situation in Bogotá. The interplay of a variety of factors - including internal conflict and violence, homonegativity and 'social cleansing', gender and sexual identity and poverty - strongly shaped the varied experiences of displacement. Migration, sexual violence, exchange sex and low rates of HIV testing were risk factors that increased vulnerability for HIV in this displaced sample. Although displacement and HIV in Colombia are major problems, both are understudied.
Assuntos
Infecções por HIV/diagnóstico , Homofobia/psicologia , Pobreza/psicologia , Sexualidade/psicologia , Pessoas Transgênero/psicologia , Violência/psicologia , Adolescente , Adulto , Bissexualidade/psicologia , Distúrbios Civis/psicologia , Colômbia , Feminino , Infecções por HIV/psicologia , Homossexualidade/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Refugiados/psicologia , Fatores de Risco , Discriminação Social/psicologia , Adulto JovemRESUMO
Male circumcision has received increased attention for its potential to reduce sexual transmission of HIV. Research on the acceptability of circumcision as a means of HIV prevention among men who have sex with men is limited. Men who have sex with men in Bogotá, Colombia, either participated in a focus group in which they shared information regarding their perceptions of circumcision or completed a survey that assessed circumcision experiences, attitudes, beliefs and willingness. Few participants reported they were circumcised, yet most participants reported knowing something about the procedure. Overall, attitudes towards circumcision were mixed: although circumcision was viewed as safe, it was also viewed as unnatural and cruel to babies. Beliefs that circumcision could improve sexual functioning and protect against STIs and HIV were not widely endorsed by survey participants, although focus-group participants discussed the potential impacts of circumcision on the availability of sexual partners and sexual performance. Some focus-group participants and many survey participants reported a hypothetical willingness to get circumcised if strong evidence of its effectiveness could be provided, barriers removed and recovery time minimised.
Assuntos
Circuncisão Masculina/psicologia , Infecções por HIV/transmissão , Conhecimentos, Atitudes e Prática em Saúde , Homossexualidade/psicologia , Comportamento Sexual/psicologia , Adulto , Colômbia , Coleta de Dados , Grupos Focais , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Pesquisa QualitativaRESUMO
Many men who have sex with men (MSM) have sexual encounters in public places, and some data suggest that this behavior is more common among Latino than non-Hispanic white MSM in the USA. In a sample of 482 Latino MSM born in Brazil, Colombia, and the Dominican Republic, and living in the New York City metropolitan area, we examined how demographic and psychosocial characteristics are related to having sex in public venues. Logistic regression was performed with the dichotomous outcome of sex in a public place in the previous six months. Demographic variables included education, HIV-positive serostatus, unknown HIV serostatus, and years in the USA; psychosocial variables included self-efficacy for safer sex, depression, and gay community involvement. Results indicated that those individuals with unknown serostatus were more likely than those with HIV-negative serostatus to have had sex in a public setting, as were men with lower self-efficacy for safer sex. These findings suggest that the partner pool may pose some risk to men who have sex in public sex venues, and therefore, low-risk sexual practices and condom use should be promoted in such settings. Contrary to expectations, higher education was related to sex in public settings, but neither depression nor more recent immigration was. Greater involvement in the gay community was also associated with having sex in public places, which may reflect the larger social function served by gay venues such as bathhouses and bars.
Assuntos
Infecções por HIV/transmissão , Hispânico ou Latino/psicologia , Homossexualidade Masculina/psicologia , Logradouros Públicos , Adulto , Idoso , Brasil/etnologia , Colômbia/etnologia , República Dominicana/etnologia , Emigrantes e Imigrantes/psicologia , Soropositividade para HIV , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Assunção de Riscos , Sexo Seguro/psicologia , Índias OcidentaisRESUMO
This qualitative study explored partner selection in a sample of immigrant Latino men who have sex with men (MSM). In-depth interviews were conducted with men living in the greater New York metropolitan area who had been born in Brazil (n = 10), Colombia (n = 14), or the Dominican Republic (n = 9). One focus group was conducted with MSM from each of the three countries (9 Brazilian, 11 Colombian, and 5 Dominican participants). A grounded theory approach revealed three main themes relating to partner selection. The first concerned stereotypes of how Latino and Anglo-American men tend to behave in their sexual encounters and relationships. The participants perceived Latinos to be more affectionate and passionate, whereas they saw Anglo-American men as more independent and practical. These cultural discrepancies sometimes resulted in a preference for Latino partners. A second theme concerned stereotypes of the national groups, including expectations that Brazilians would be sexy and sensual and that Dominicans would have large penises. As found in other research on MSM of color, ethnic and national stereotypes were associated with experiences of sexual objectification. The third theme addressed the importance of masculine characteristics in sexual attraction and partner selection. Negative feelings towards effeminate men who did not conform to normative male physical or behavioral presentation reflect a stigma found inside and outside of the gay community. These findings suggest that gender and ethnic stereotypes play an important role in shaping partner choice and have implications for sexual risk and relationship formation.
Assuntos
Emigrantes e Imigrantes/psicologia , Hispânico ou Latino/psicologia , Homossexualidade Masculina/psicologia , Adulto , Brasil/etnologia , Colômbia/etnologia , República Dominicana/etnologia , Identidade de Gênero , Humanos , Entrevistas como Assunto , Masculino , Masculinidade , Pessoa de Meia-Idade , Cidade de Nova Iorque , Fatores Socioeconômicos , EstereotipagemRESUMO
Key informant interviews, in-depth interviews and focus groups were conducted to examine ways in which social context influenced the behavior of Brazilian, Colombian and Dominican men who have sex with men. First, we investigated how the social context in the home country affected motivation for migration. Findings suggest that Latino men who have sex with men frequently reported coming to the USA to escape homo-negativity and to achieve greater sexual freedom. The study also examined how the social context encountered in the early years after migration shaped sexual behavior and risk. A majority of the participants reported easy access to sex partners and frequent sexual encounters. The anonymity of living in a gay epicentre such as New York City, often without social connections from the past, was experienced as liberating and conducive to sexual exploration. Moreover, sex in public venues, such as parks and sex cabins, was readily available to those who do not speak English. The tendency to engage in high levels of sexual activity during the early period after arrival in New York City was particularly evident among younger men. Implications for future programme development are discussed alongside prevention efforts targeting migrants during this critical period.
Assuntos
Características Culturais , Emigração e Imigração , Liberdade , Homossexualidade Masculina/etnologia , Relações Interpessoais , Parceiros Sexuais , Adulto , Brasil/epidemiologia , Coito/psicologia , Colômbia/epidemiologia , República Dominicana/epidemiologia , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde , Homossexualidade Masculina/psicologia , Humanos , Masculino , Cidade de Nova Iorque/etnologia , Assunção de Riscos , Apoio Social , Inquéritos e Questionários , Saúde da População UrbanaRESUMO
This study investigated protective effects of circumcision in a sample of immigrant Latino men who have sex with men (MSM). A survey in Portuguese, Spanish, or English was administered with computer-assisted self-interview technology with audio enhancement (A-CASI) to 482 MSM from Brazil (n=146), Colombia (n=169), and the Dominican Republic (n=167), living in the New York metropolitan area. Logistic regression revealed that after controlling for age, income, education, having had syphilis, having done sex work, and preferring the receptive role in anal intercourse, uncircumcised men were almost twice as likely to be HIV-positive as circumcised men. Follow-up analyses revealed, however, that the protective effects occurred only among the group of Colombian men.