Can perceived homophobia be protective? Correlates of lower likelihood of HIV positive status among bisexual MSM
Background: Among men who have sex with men (MSM), having sex with women and concealing homosexual preferences are sometimes believed to reflect perceived homophobia and may influence HIV risk. In 2005 and 2006, we conducted a venue-based survey to determine HIV prevalence, sexual practices, and perceived discrimination among (MSM) in four Mexican cities. For those testing HIV positive, access to public health-care services for treatment was guaranteed. The paper’s objectives are to examine the relationships between HIV status, bisexual history and disclosure of sexual preference to close relatives.
Methods: A random sample of 1,111 MSM, obtained through venue-based time-location sampling (TLS), underwent HIV testing (Determine® or Orasure®) and answered a questionnaire about sexual behavior and perceived discrimination. We used SPSS 15.1 to compute tests of mean group differences, associations (LR Chi-square), and multivariate logistic regressions.
Results: HIV prevalence was 10%. Of all participants, 42.2% reported sex with women in their lifetime. There was a strong association between this variable and HIV status (p=.007). In a logistic regression, participants reporting lifetime bisexuality were significantly less likely to be HIV positive (OR .56; 95% CI .368-.886). Adjusting for age, parental awareness of sexual preferences and years of MSM sex strengthened the relationship (AOR .406; 95% CI .207-.633, p=.003). These effects were not present for reported recent sex with women (p=.328). The two groups differed slightly in mean years of homosexual activity, but not in mean number of recent male partners.
Conclusions: Adjusting for significant correlates, randomly selected MSM who report lifetime bisexual activity were 60% less likely to be HIV positive than those consistently homosexual. These groups did not differ greatly in several other main behavioral risk-factors. This relationship deserves further research as does the influence of homophobia in observed increased risk for consistent MSM.
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