"Outness" as a Moderator of the Association Between Syndemic Conditions and HIV Risk-Taking Behavior Among Men Who Have Sex with Men in Tijuana, Mexico.
Multiple psychosocial conditions tend to co-occur and contribute to higher risk for HIV among men who have sex with men (MSM), a phenomenon known as syndemics. Less is known about moderating factors that may attenuate the relation between syndemic conditions and sexual risk-taking. We examined disclosure of same-sex sexual behavior or "outness" as a moderating factor of the syndemic effect. We recruited a sample of MSM (n = 191) using respondent-driven sampling in Tijuana, Mexico. Participants completed a survey of syndemic conditions (i.e., substance use, depression, violence, internalized homophobia, and sexual compulsivity), sexual risk-taking (i.e., condom unprotected anal sex with a stranger in the past 2 months), and the degree to which they are "out" about sex with men. Consistent with previous research, we found that men who report more syndemic conditions show a greater prevalence of sexual risk-taking. As predicted, men who were out to more people showed a weaker association between syndemic conditions and sexual risk-taking, whereas men who were out to fewer people showed the strongest association. This study is the first to provide evidence of "outness" as a moderating factor that attenuates syndemic effects on sexual risk-taking. Building upon previous research, the data suggest that "outness" may be a resilience factor for MSM in Tijuana. HIV prevention intervention implications are discussed.
Division of Global Public Health, Department of Medicine, University of California at San Diego, Mail Code 0507, 9500 Gilman Drive, La Jolla, CA, 92093-0680, USA. epitpitan@ucsd.edu.
Eileen V
EV
Pitpitan
Division of Global Public Health, Department of Medicine, University of California at San Diego, Mail Code 0507, 9500 Gilman Drive, La Jolla, CA, 92093-0680, USA.
Laramie R
LR
Smith
Division of Global Public Health, Department of Medicine, University of California at San Diego, Mail Code 0507, 9500 Gilman Drive, La Jolla, CA, 92093-0680, USA.
David
D
Goodman-Meza
Agencia Familiar Binacional, A.C., Tijuana, Mexico.
Karla
K
Torres
Division of Global Public Health, Department of Medicine, University of California at San Diego, Mail Code 0507, 9500 Gilman Drive, La Jolla, CA, 92093-0680, USA.
Shirley J
SJ
Semple
Division of Global Public Health, Department of Medicine, University of California at San Diego, Mail Code 0507, 9500 Gilman Drive, La Jolla, CA, 92093-0680, USA.
Steffanie A
SA
Strathdee
Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
Thomas L
TL
Patterson
D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D004192:Discrimination, Psychological; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology; D063509:Homophobia / Q000523:psychology; D018451:Homosexuality, Male / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008800:Mexico / Q000453:epidemiology; D015995:Prevalence; D012309:Risk-Taking; D012650:Self Disclosure; D012931:Social Environment; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology; D047568:Unsafe Sex / Q000706:statistics & numerical data*; D014754:Violence / Q000523:psychology / Q000706:statistics & numerical data; D055815:Young Adult
HIV; Internalized homophobia; MSM; Syndemics