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Latino/x sexual minority men (SMM) in the U.S. are disproportionately affected by the HIV epidemic. In 2020, 80% of new HIV infections among Hispanic or Latino/x populations were attributed to male-to-male sexual transmission, and 30% of new infections among SMM occurred among those identifying as Hispanic or Latino. HIV testing is critical for linkage to HIV care, but its uptake among Latino/x SMM may be compromised by such psychosocial barriers as everyday discrimination. Further, the issue of HIV testing is particularly relevant for partnered SMM, with extant research illustrating lower likelihood of HIV testing among those in a monogamous relationship, compared with those who are single. We sought to examine the link between everyday discrimination and HIV testing among partnered Latino/x SMM and stratified the analysis by birth location.
METHODS
We used data from a national study of sexual health and intimate relationships among partnered Latino/x SMM. Between November 2018 and May 2019, Latino/x SMM were recruited online via advertisements on social media platforms and a geo-location-based dating/sexual networking application, and were administered structured online surveys assessing behavioral, cultural, and demographic characteristics. The parent study yielded a total of 625 index participants, which included 95 Latino/x SMM who successfully recruited their primary partner. For this study, we analyzed responses from index participants who reported HIV-negative or unknown status (N=484). Multinomial regression analyses were performed to examine the associations between everyday discrimination based on sexual orientation or race/ethnicity and HIV testing behaviors (past 6 months [current], past 7-11 months ago [recent], more than a year ago or never tested [delayed]) in the full sample as well as subpopulations of Latino/x SMM born in (n=275) and outside (n=209) the mainland U.S. (the 50 states and D.C.).
RESULTS
In the full sample, 95 (20%) Latino/x SMM reported delayed HIV testing. Most participants reported experiencing discrimination based on sexual orientation (79%) or race/ethnicity (79%); nearly 70% reported experiencing discrimination based on both attributions concurrently (i.e., concurrent discrimination). Participants who reported experiencing concurrent discrimination were more likely to report delayed (vs. current) HIV testing, compared with those reporting experiencing no discrimination (AOR=2.6, 95%CI=1.0, 6.7). Similar patterns emerged in the subset of Latino/x SMM born outside the mainland U.S.; in this group, the 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) were increased among those reporting experiencing concurrent discrimination relative to no discrimination. Statistical significance was not detected in the model examining the link between everyday discrimination and HIV testing among Latino/x SMM born in the mainland U.S.
CONCLUSIONS AND IMPLICATIONS
Study findings highlight salience of everyday discrimination based on sexual orientation, race/ethnicity, or both among Latino/x SMM. We also found support for the link between concurrent discrimination and delayed HIV testing in this sample, indicating the value and need for addressing concurrent discrimination in improving HIV testing uptake among Latino/x SMM, particularly those born outside the mainland U.S. One approach may be through incorporating culturally-relevant community-based strategies, especially ones attending to the unique challenges arising from migration.