Experiencias de homofobia y adherencia al tratamiento antirretroviral (TAR) en hombres que tienen sexo con hombres (HSH)

Abstract

Resumen El objetivo del estudio fue conocer la relación de las experiencias de homofobia con la adherencia al tratamiento anti-retroviral (TAR) en hombres que tienen sexo con hombres (HSH). Para ello, se realizó una encuesta transversal con una muestra por conveniencia de HSH que vivían con VIH (n=340) atendidos en dos instituciones públicas de salud de la Ciudad de México. La información sobre la adherencia al TAR en el mes previo de los participantes y sus experiencias de violencia, discriminación y homofobia internalizada se recopiló mediante un cuestionario. Entre 14% y 33% de los HSH reportaron alguna experiencia de discriminación y entre 41% y 60% experimentaron violencia. Cuando los HSH habían experimentado ambos tipos de estresores, el riesgo de baja adherencia TAR fue mayor (RP=6.49 para mes previo) que cuando habían experimentado sólo una de ellas (RP=4.36 para violencia y RP=5.67 para discriminación). Los profesionales de la salud deben ser sensibles a cómo el ambiente sociocultural puede afectar las prácticas de autocuidado de HSH, incluyendo la adherencia al TAR.

Metrics of sexual behavior stigma among cisgender men who have sex with men in Mexico: exploratory and confirmatory factor analyses

“…HIV testing and status awareness remain low at 40%, while roughly 1 in 3 do not use condoms [ 25 ]. Consistent with findings from other regions [ 27 – 33 ], sexual behavior stigma has been linked to risk factors for HIV infection and transmission among MSM in Mexico, including sexual risk behavior [ 11 ], low uptake of HIV prevention tools [ 34 , 35 ], poor HIV care and treatment outcomes [ 11 , 36 ], and psychosocial risk factors for HIV [ 11 , 37 , 38 ]. Sexual behavior stigma may also underlie infrequent/delayed HIV testing, late HIV diagnosis, and suboptimal linkage to HIV care and treatment services for MSM in Mexico, resulting in late initiation of universally-available antiretroviral treatment (ART) [ 39 – 41 ].…”

“…“Anticipated healthcare stigma” could be tapping into participants’ tendency to refrain from disclosing their sexuality to their healthcare provider, as nondisclosure has been linked to anticipated stigma among MSM in Mexico and other contexts [ 4 , 11 , 35 , 82 ]. However, this subscale may also be tapping into participants’ rejection sensitivities [ 80 ], as sexuality-based stigmatization by healthcare providers [ 35 , 64 ] and others in one’s social network or community is not uncommon in Mexico [ 15 , 16 , 36 ].…”

“…In Mexico, stigma among MSM has been explored qualitatively [ 11 , 13 ] or been restricted to one type of stigma, such as internalized (e.g., assessed with the Internalized Homophobia scale) [ 34 , 37 , 48 – 51 ] or enacted stigma (e.g., via Experiences of Homophobia or other scales) [ 36 – 38 , 48 , 52 ], with stigma often being an incidental rather than primary focus of inquiry. Moreover, there is minimal evidence that any sexuality-based stigma scale has been thoroughly validated among MSM in Mexico.…”

“…Moreover, assorted forms of stigma have been shown to be differentially associated with HIV outcomes and related vulnerabilities among MSM in diverse contexts worldwide [44][45][46][47]. Among MSM in Mexico specifically, enacted stigma has been associated with limited HIV care access and decreased ART adherence, psychological distress, and sexual violence [11,[36][37][38]; internalized stigma has been associated with low uptake of HIV testing [34]; and perceived/anticipated stigma has been associated with decreased uptake of HIV pre-exposure prophylaxis (PrEP) and constrained access to sexual health knowledge [11,35]. These findings illustrate the need for comprehensive measures that distinguish between and separately assess diverse stigma manifestations.…”