Using a Positive Deviance Approach to Stigma Reduction and HIV Prevention Among Young Latino Sexual Minority Men

Background and Purpose

Young Latino sexual minority men (YLSMM) bear a disproportionate burden of the HIV and AIDS epidemic relative to their population size. Intersectional stigma may contribute to HIV disparities. While there are efforts to increase HIV testing and PrEP uptake to prevent transmission, they may not resonate with YLSMM in the South, as illustrated by their low rates of regular testing and PrEP uptake. HIV prevention approaches may benefit from focusing on resilience and recognizing the assets, agency, and lived experiences of YLSMM. This study aims to characterize the implementation of a Positive Deviance Approach to identify health-promotive assets and resilience-enabling practices.

Methods

We used a Positive Deviance Approach to identify 15 YLSMM whose uncommon behaviors and practices enable them to find better solutions to overcome stigma experiences than their peers while facing similar or worse adversities due to their multiple stigmatized identities. Through collaboration with our community partner, eligible YLSMM were identified through community outreach, focus groups, and individual interviews. Interview transcripts and notes were analyzed thematically to characterize YLSMM, who demonstrated resilience-enabling behaviors and practices to overcome their experiences of multiple co-occurring stigmas. A final group discussion with the research and community partners was conducted to verify the accuracy of the findings.

Results

Findings were classified into three descriptive themes: challenges faced by YLSMM, characteristics of YLSMM who were “positive deviant” (PD), and multilevel strategies used by PD youth. Challenges included experiences of multiple stigmas due to youth’s multiple minoritized (i.e., race/ethnicity, sexual orientation, and immigration). Stigma has contributed to other health issues such as mental ill-health and substance use disorder. Language barriers, lack of health insurance, and sociocultural norms were identified as facilitators of stigmatizing experiences. PD youth were knowledgeable of PrEP and had discussed it with peers and health providers. PD youth openly discussed their sexual identity and regularly engaged in LGBTQ+ activities, including support groups for other YLSMM. Individual resilience strategies included building a strong sense of self and creating possible future selves. Resilience-promoting strategies at the community level included social connectedness and a sense of group belonging enabled through LGBT+ support groups. PD youth’s connection with LGBT+ groups facilitated their link to HIV testing and PrEP services.

Conclusions and Implications

Using a Positive Deviance Approach allowed us to shift our focus on discovering and determining uncommon practices or behaviors that some YLSMM have been using to overcome stigma and discrimination. A PD approach also enabled YLSMM to join in the social construction of knowledge and actions to reduce stigma and its adverse effect on HIV prevention. Further, a PD approach is a feasible and acceptable tool to identify and incorporate existing practices and behaviors used by marginalized populations to overcome their experiences of intersectional stigmas. Knowledge generated through a PD approach can inform the development of interventions that recognize the lived experiences and assets of YLSMM, further increasing the contribution of YLSMM in creating solutions that are meaningful to them.