Family, Perceived Stigma, Prevention Fatigue, and Patient Engagement: Evaluating Factors Associated with Access to Medical Care for Latino MSM San Juan, Puerto Rico

Background: HIV continues to disproportionately affect Latino Men who have Sex with Men (MSM). The Latino MSM HIV incidence is greater in Puerto Rico (PR) than the United States mainland. Limited research, however, has explored determinants associated with access to medical care for Latino MSM in PR. Therefore, this study recruited Latino MSM in San Juan, PR to complete a self-administered Internet survey that explored possible determinants affecting access to medical care services.

Methods: A total of 141 Latino MSM (97.9% identified as PR; x̅ age = 25.5) completed a self-administered Internet survey in Spanish. The following measures are based on existing scales and applied to this study: familismo, perceived local stigma, HIV prevention fatigue, engagement with a health care provider, and access to medical care. Standardized measures were translated professionally from English to Spanish, except for the familismo scale, which was available in English and Spanish. All of the scales in Spanish had a Cronbach’s α of .82 or higher for this study.

Multiple linear regression was applied to test the following:

Hypothesis 1: Latino MSM with higher levels of familismo will have greater access to medical care.

Hypothesis 2: Latino MSM with lower levels of perceived local gay stigma will have higher levels of access to medical care. 

Hypothesis 3: Latino MSM with lower levels of HIV prevention fatigue will have higher levels of access to medical care.

Hypothesis 4: Latino MSM with greater levels of engagement to care will have higher levels of access to medical care.

Results: The multiple linear regression analysis revealed that familismo, was not significantly associated with access to medical care. However, the correlation results were positively associated as anticipated for access to medical care. Interpretation of the results must be perceived with caution, due to the scale measuring perceived support levels of familismo as a unit and not by individual family members. Consideration of individual family members is important due to the various roles reinforced by cultural norms and values such as the expectation of the mother being the nurturer and the father being the provider.

The relationship between HIV prevention fatigue (B = -0.27; SE = .09;P<.01), perceived local stigma for being gay (B = -.23; SE = .08;P<.05), and engagement with a health care provider (B = .32; SE = .04;P<.01) were significant predictors for access to medical care. 

Implications: People in general are less likely to access medical care services if they perceive themselves to be healthy (Marcell et al., 2017), which may be greater among younger adults. Additionally, HIV prevention campaigns targeting “high-risk” populations such as MSM may further alienate the intended population from seeking HIV prevention related services. MSM that reported higher levels of being concerned for being stigmatized as HIV positive were significantly less likely to get tested for HIV. Greater efforts should be explored on developing HIV prevention campaigns that raise awareness among the general public and de-stigmatize “high-risk” populations.