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

Abstract

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.

Stigma, prejudice, discrimination and health

“…Their findings highlight that efforts to combat stigma and prejudice will be ineffective if they do not account for multiple and interlocking identities (Crenshaw, 1996). The paper by Padilla et al (2008) is also illustrative of why attention to multiple disadvantaged statuses is important to identifying the root causes of health disparities. In their work on bisexual Dominican male sex workers they find multiple disadvantaged statuses have important consequences for HIV risk.…”

Social-ecological factors associated with selling sex among men who have sex with men in Jamaica: results from a cross-sectional tablet-based survey

“…In Jamaica, cross-sectional surveys conducted with MSM in 2007 (n = 201) [12] and 2011 (n = 449) [2] identified the prevalence of sex-selling as 35.9% overall [2], and 30.5% and 39.4% among HIV negative and positive persons, respectively [12]. In contexts with pervasive sexual stigma and discrimination, MSM may experience limited access to education and employment, and may lose familial support; this may contribute to poverty, homelessness, and engagement in survival sex work for money in addition to food, rent, shelter, drugs, and/or alcohol [5,6,20,25]. …”

“…Significant knowledge gaps remain, however, regarding factors associated with selling sex, including multivariable analyses that identify independent effects of multi-level factors, and the possible association between sexual stigma and sex-selling among MSM in Jamaica [2]. Stigma is a particularly important area to examine among MSM who sell sex, who may face intersecting stigma, including sexual stigma, and HIV-related stigma, in addition to sex work stigma [4,5,34–38]. Stigma has been identified as a barrier for male sex workers in accessing HIV prevention services [3].…”

“…Internalized homophobia , feelings of shame and self-blame [40–43], may contribute to mental health challenges. Sexual stigma may limit access to education and employment, threatening economic security [5]. In addition, sexual stigma, sex work, and HIV-related stigma may limit access to sexual health and HIV information, prevention, and testing and care services [44,45].…”

Masculinity and the Occupational Experience of Male Independent Escorts Who Seek Male Clients

“…This process may be a coping strategy by which participants managed the stigma from non-conformance with masculine norms (Kong 2009). Kong (2009) participants spoke about stigma arising from morality and subordination, among other factors, and escorts in other studies indicated stigma arising from homosexuality (Koken et al 2004;Padilla et al 2008). However, none of the participants in this study reported stigma arising from any of these sources.…”