Understanding sociocultural influences in sexual health promotion and HIV protection among Latinx sexually minoritized men: A qualitative study.

Latinx sexually minoritized men (SMM) disproportionately represent 30% of new HIV diagnoses among all SMM in the United States, despite Latinx individuals comprising only 18% of the overall population.

• This disproportion highlights a significant epidemiological inequity within the Latinx SMM demographic.
• Highly effective HIV prevention strategies such as Pre-exposure Prophylaxis (PrEP) are available but show marked inequities in access and utilization among Latinx SMM.
• The study was motivated by the need to understand sociocultural factors shaping HIV self-protective behaviors in this group.

Five major sociocultural themes emerged from interviews with Latinx SMM that influence sexual health promotion and HIV self-protection.

• The five themes were: 1) prevention is better than to cure; 2) cultural and religious norms create a culture of silence around sexual health; 3) lack of information and misinformation leading to self-reliance for sexual health protection; 4) growing wiser: maturity's impact on sexual health and relationships; and 5) unjust and dehumanizing sexual health care.
• A convenience sample of 15 Latinx SMM was recruited from an ongoing longitudinal study and online for individual interviews conducted virtually between October 2020 and October 2021.
• A descriptive qualitative design using thematic analysis was employed.
• Interviews were conducted individually and virtually, allowing for in-depth exploration of personal sociocultural experiences.

Cultural and religious norms were identified as creating a 'culture of silence' around sexual health among Latinx SMM.

• This theme highlights how cultural and religious values discourage open discussion of sexual health topics.
• The culture of silence was identified as a barrier to accessing sexual health information and HIV prevention resources.
• This finding connects to broader sociocultural stigma surrounding sexuality within Latinx communities.

Lack of information and misinformation about sexual health led Latinx SMM to rely on themselves for sexual health protection.

• Participants described navigating sexual health decisions in the absence of adequate formal education or culturally appropriate resources.
• Self-reliance was identified as both a coping strategy and a potential risk factor due to the influence of misinformation.
• This theme underscores gaps in sexual health education as a structural barrier for this population.

Maturity and growing older were described as positively influencing sexual health behaviors and relationship decision-making among Latinx SMM.

• The theme 'growing wiser' captured how increased life experience and maturity led to more protective sexual health behaviors.
• Participants reported that with age came greater awareness of risk and more consistent engagement in HIV self-protection strategies such as condom use and HIV testing.
• This suggests a developmental trajectory in sexual health decision-making within this population.

Latinx SMM reported experiencing unjust and dehumanizing treatment within sexual health care settings.

• Healthcare provider bias was identified as a significant structural barrier to sexual health care engagement.
• Experiences of discrimination and dehumanization in clinical settings deterred participants from seeking sexual health services.
• This theme highlights the role of stigma at the institutional and provider level in shaping health-seeking behavior.
• The findings reinforce the need to address healthcare provider bias as a structural intervention target.

Stigma and structural factors were identified as the overarching forces shaping opportunities for Latinx SMM to engage in sexual health promotion and HIV self-protection.

• Structural barriers identified included inadequate sexual health education, limited access to care, and healthcare provider bias.
• Both internalized stigma related to sexual minority identity and externally imposed stigma from cultural, religious, and healthcare contexts were implicated.
• The study emphasized that addressing these structural barriers is necessary to improve sexual health outcomes among Latinx SMM.
• Participants were drawn from a qualitative sample of 15 individuals, limiting generalizability but providing depth of understanding.