title: The ecology of sexual health of sexual minorities in Guatemala City.
abstract: Guatemalan gay and bisexual men, men who have sex with men (MSM), and transgender persons carry disproportionate burden of HIV and other sexually transmitted infections compared with other Guatemalan subgroups. However, little is known about the determinants of sexual health to inform health promotion and disease prevention interventions among these sexual minorities. We sought to explore sexual health and HIV risk among Guatemalan sexual minorities, using a community-based participatory research approach. We conducted 8 focus groups (n = 87 participants total) and 10 individual in-depth interviews with gay and bisexual men, MSM, and transgender persons. Using constant comparison, an approach to grounded theory, we analyzed verbatim transcripts and identified 24 themes that we organized into five ecological factors influencing sexual health: intrapersonal (e.g. misconceptions about HIV transmission, low perceived susceptibility and lack of condoms use skills); interpersonal (e.g. family rejection and condom use as a barrier to intimacy); community (e.g. discrimination and stigma); institutional (e.g. limited access to health promotion resources); and public policy (e.g. perceived lack of provider confidentiality and anti-gay rhetoric). There is profound need for multiple-level interventions to ensure that Guatemalan sexual minorities have the knowledge and skills needed to reduce sexual risk. Interventions are warranted to increase social support among sexual minorities, reduce negative perspectives about sexual minorities, develop institutional resources to meet the needs of sexual minorities and reduce harmful anti-gay rhetoric. Understanding and intervening on the identified factors is especially important given that the health of Guatemalan sexual minorities has been to-date neglected.
authors.affiliation: Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA Section on Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC, USA srhodes@wakehealth.edu.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Rhodes
authors.affiliation: Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Jorge
authors.initials: J
authors.lastname: Alonzo
authors.affiliation: Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Lilli
authors.initials: L
authors.lastname: Mann
authors.affiliation: Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Mario
authors.initials: M
authors.lastname: Downs
authors.affiliation: APAES-Solidaridad, Guatemala City, Guatemala.
authors.forename: Mario
authors.initials: M
authors.lastname: Andrade
authors.affiliation: Miami, FL, USA.
authors.forename: Cindy
authors.initials: C
authors.lastname: Wilks
authors.affiliation: Health Programs/Programas de Salud, El Pueblo, Inc, Raleigh, NC, USA.
authors.forename: Florence M
authors.initials: FM
authors.lastname: Simán
authors.affiliation: HIV Center for Clinical and Behavioral Studies, Columbia University, New York, NY, USA.
authors.forename: Omar
authors.initials: O
authors.lastname: Martinez
authors.affiliation: Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Claire
authors.initials: C
authors.lastname: Abraham
authors.affiliation: Unidad de Epidemiologia, Hospital Roosevelt, Guatemala City, Guatemala.
authors.forename: Guillermo R
authors.initials: GR
authors.lastname: Villatoro
authors.affiliation: Section on Infectious Diseases, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Laura H
authors.initials: LH
authors.lastname: Bachmann
mesh_terms: D000293:Adolescent; D000328:Adult; D055812:Community-Based Participatory Research; D017144:Focus Groups; D066296:Grounded Theory; D006166:Guatemala; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D060728:Reproductive Health; D012307:Risk Factors; D012725:Sexual Behavior / Q000523:psychology; D063106:Transgender Persons; D055815:Young Adult; D005260:Female
keywords: HIV/AIDS; community based participatory research; condom use; sexual health