Stigma, social inequity, and HIV risk disclosure among Dominican male sex workers

Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI 48109, USA.
Social Science & Medicine (Impact Factor: 2.89). 09/2008; 67(3):380-8. DOI: 10.1016/j.socscimed.2008.03.014
Source: PubMed


Some quantitative behavioral studies in the USA have concluded that bisexually behaving Latino men are less likely than White men to disclose to their female partners that they have engaged in same-sex risk behavior and/or are HIV-positive, presumably exposing female partners to elevated risk for HIV infection. Nevertheless, very little theoretical or empirical research has been conducted to understand the social factors that promote or inhibit sexual risk disclosure among Latino men who have sex with men (MSM), and much of the existing literature has neglected to contextualize disclosure patterns within broader experiences of stigma and social inequality. This paper examines decisions about disclosure of sex work, same-sex behavior, and sexual risk for HIV among male sex workers in two cities in the Dominican Republic. Data derive from long-term ethnography and qualitative in-depth interviews with 72 male sex workers were used to analyze the relationships among experiences of stigma, social inequality, and patterns of sexual risk disclosure. Thematic analysis of interviews and ethnographic evidence revealed a wide range of stigma management techniques utilized by sex workers to minimize the effects of marginality due to their engagement in homosexuality and sex work. These techniques imposed severe constraints on men's sexual risk disclosure, and potentially elevated their own and their female partners' vulnerability to HIV infection. Based on the study's findings, we conclude that future studies of sexual risk disclosure among ethnic minority MSM should avoid analyzing disclosure as a decontextualized variable, and should seek to examine sexual risk communication as a dynamic social process constrained by hierarchical systems of power and inequality.

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    • "This latter finding is notable as the stigma associated with sex work is associated with symptoms of both depression and anxiety among MSM (Hatzenbuehler, O'Cleirigh, Mayer, Mimiaga, & Safren, 2011). This stigma limits health-seeking behavior (Liu et al., 2011), and this may be especially true for male sex workers (Padilla et al., 2008), who are also stigmatized for homosexual sexual practices. Although there is growing attention to health disparities among MSM, research on the mental health characteristics of sex worker populations in nonindustrialized countries is limited . "
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    ABSTRACT: Objectives: This study assessed depression and anxiety symptoms, and their association with high-risk sexual and drug behaviors, among male sex workers in three Vietnamese cities. Methods: Male sex workers ages 16 to 35 completed an interview that included the CES-D to assess depressive symptoms and the BAI to assess anxiety symptoms, as well as questions assessing drug and sexual risk practices. Results: A majority of participants reported depressive symptomatology although fewer report symptoms of anxiety. Risky sexual and drug use practices predicted both types of symptoms. Conclusions: Mental distress is associated with drug and sexual risk among male sex workers.
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    • "Taken together, these studies suggest a need to broaden our understanding of sex workers' intimate relationships to encompass styles of disclosure, coping strategies, and consequences for HIV risk that engaging in sex work while pursuing an intimate relationship entails for both partners. As Padilla et al. (2008) have noted, " quantitative public health studies of HIV risk disclosure have generally failed to develop analyses that link the dynamics of disclosure to the social, cultural, and structural context of Latino and Latin American countries " (Padilla et al., 2008: 381). The dynamics surrounding intimate partners' perspectives on sex work are best understood within the broader political economic context in which the relationships are embedded. "
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    ABSTRACT: Partner communication about HIV sexual risk behaviors represents a key area of epidemiologic and social importance in terms of infection acquisition and potential for tailored interventions. Nevertheless, disclosing sexual risk behaviors often presents myriad challenges for marginalized couples who engage in stigmatized behaviors. Using qualitative data from a social epidemiology study of risk for HIV and other sexually transmitted infections (STIs) among female sex workers and their intimate, non-commercial male partners along the Mexico-U.S. border, we examined both partners' perspectives on sex work and the ways in which couples discussed associated HIV/STI risks in their relationship. Our thematic analysis of individual and joint interviews conducted in 2010 and 2011 with 44 couples suggested that broader contexts of social and economic inequalities profoundly shaped partner perspectives of sex work. Although couples accepted sex work as an economic contribution to the relationship in light of limited alternatives and drug addiction, it exacted an emotional toll on both partners. Couples employed multiple strategies to cope with sex work, including psychologically disconnecting from their situation, telling "little lies," avoiding the topic, and to a lesser extent, superficially discussing their risks. While such strategies served to protect both partners' emotional health by upholding illusions of fidelity and avoiding potential conflict, non-disclosure of risk behaviors may exacerbate the potential for HIV/STI acquisition. Our work has direct implications for designing multi-level, couple-based health interventions.
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    • "A good portion of the articles addressed the production of AIDS stigma from the perspective of how this stigma interacts with one or more of the axes of inequality. Some discussed how homophobia relates to the production of HIV/AIDS stigma, especially in contexts where material living conditions are unstable, traditional gender norms rule (patriarchalism), or violence and legal coercion are common in the face of sexual diversity (Andrinopoulos et al., 2011; Okal et al., 2009; Padilla et al., 2008; Wilson et al., 2011). These factors combined in different ways depending upon the conditions where the research was conducted, but they all fostered processes of social exclusion of sexual minorities such as challenges in finding employment, loss of family ties and increased vulnerability to HIV/AIDS. "
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    ABSTRACT: Abstract This study aimed to conduct a systematic literature review in order to identify how recent studies have addressed the interaction between social inequality and the processes of exclusion and marginalisation related to HIV/AIDS stigma and discrimination. The review was conducted using PubMed and Scopus databases and included publications from 2008 to 2011. Of 497 summaries found in the review, 42 were selected and classified based on topic, population, axes of inequality employed, conceptualisation of stigma and relationship between stigma and vulnerability. Results demonstrated that there is a predominance of research on stigma and discrimination towards people living with HIV/AIDS, sexual and racial/ethnic minorities and migrants. The axes of inequality examined in the literature were linked to specific cultural and socio-economic dimensions and analysed as factors that behave synergistically to increase social groups' vulnerability to HIV. Half of the 42 articles viewed expression of stigma/discrimination to be the result of power dynamics that reinforce the processes of social exclusion. The other half of the articles tended to describe stigma as intrinsic to social interaction. Some researchers are making a visible effort to devise consistent theoretical and methodological approaches in order to understand stigma as a complex social process produced at the intersection of different axes of inequality. These efforts provide vital information that can inform how best to address HIV/AIDS stigma.
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