title: 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.
abstract: BACKGROUND
  In the United States, Latino men who have sex with men (MSM) are disproportionately affected by HIV. Latino MSM are a diverse group who differ culturally based on their countries or regions of birth and their time in the United States. We assessed differences in HIV prevalence and testing among Latino MSM by location of birth, time since arrival, and other social determinants of health.
  
  
  METHODS
  For the 2008 National HIV Behavioral Surveillance System, a cross-sectional survey conducted in large US cities, MSM were interviewed and tested for HIV infection. We used generalized estimating equations to test associations between various factors and 1) prevalent HIV infection and 2) being tested for HIV infection in the past 12 months.
  
  
  RESULTS
  Among 1734 Latino MSM, HIV prevalence was 19%. In multivariable analysis, increasing age, low income, and gay identity were associated with HIV infection. Moreover, men who were U.S.-born or who arrived ≥5 years ago had significantly higher HIV prevalence than recent immigrants. Among men not reporting a previous positive HIV test, 63% had been tested for HIV infection in the past 12 months; recent testing was most strongly associated with having seen a health care provider and disclosing male-male attraction/sexual behavior to a health care provider.
  
  
  CONCLUSIONS
  We identified several social determinants of health associated with HIV infection and testing among Latino MSM. Lower HIV prevalence among recent immigrants contrasts with higher prevalence among established immigrants and suggests a critical window of opportunity for HIV prevention, which should prioritize those with low income, who are at particular risk for HIV infection. Expanding health care utilization and encouraging communication with health care providers about sexual orientation may increase testing.
authors.affiliation: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Alexandra M
authors.initials: AM
authors.lastname: Oster
authors.forename: Kate
authors.initials: K
authors.lastname: Russell
authors.forename: Ryan E
authors.initials: RE
authors.lastname: Wiegand
authors.forename: Eduardo
authors.initials: E
authors.lastname: Valverde
authors.forename: David W
authors.initials: DW
authors.lastname: Forrest
authors.forename: Melissa
authors.initials: M
authors.lastname: Cribbin
authors.forename: Binh C
authors.initials: BC
authors.lastname: Le
authors.forename: Gabriela
authors.initials: G
authors.lastname: Paz-Bailey
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology*; D006679:HIV Seropositivity; D006630:Hispanic or Latino; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D062486:Public Health Surveillance; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult