Citation
Culture and public health

Material Information

Title:
Culture and public health factors behind safer sex practices among men who have sex with men (msm)
Creator:
Pendygraft, Anne Laney
Publication Date:
Language:
English
Physical Description:
v, 50 leaves : ; 28 cm

Subjects

Subjects / Keywords:
Safe sex in AIDS prevention -- Cross-cultural studies -- United States ( lcsh )
Hispanic American gays -- Health and hygiene ( lcsh )
Public health -- United States ( lcsh )
Genre:
bibliography ( marcgt )
theses ( marcgt )
non-fiction ( marcgt )

Notes

Bibliography:
Includes bibliographical references (leaves 47-50).
General Note:
Department of Psychology
Statement of Responsibility:
by Anne Laney Pendygraft.

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Source Institution:
|University of Colorado Denver
Holding Location:
|Auraria Library
Rights Management:
All applicable rights reserved by the source institution and holding location.
Resource Identifier:
463292515 ( OCLC )
ocn463292515
Classification:
LD1193.L645 2009m P46 ( lcc )

Full Text
CULTURE AND PUBLIC HEALTH: FACTORS BEHIND SAFER SEX PRACTICES
AMONG MEN WHO HAVE SEX WITH MEN (MSM)
by
4
Anne Laney Pendygraft
B.A. -Transylvania University (2007)
A thesis submitted to the
University of Colorado Denver
in partial fulfillment
of the requirements for the degree of
Master of Arts
Psychology
2009


This thesis for the Masters of Art
degree by
Anne Pendygraft
has been approved
by
Eric Benofsch
7/14/2009
Date


Pendygraft, Anne L. (Masters of Art, Clinical Psychology)
CULTURE AND PUBLIC HEALTH: FACTORS BEHIND SAFER SEX PRACTICES
AMONG MEN WHO HAVE SEX WITH MEN (MSM)
Thesis directed by Eric Benotsch, PhD, Associate Professor, Department of Psychology
University of Colorado Denver
ABSTRACT
The purpose of the current study was to assess the cultural factors that comprise sexual
behaviors amongst Latino men who have sex with men (MSM) compared to other ethnic
groups. HIV rates are comparably higher among Latinos than White MSM. Therefore, more
research is needed to understand this public health trend. The study collected data on 268
MSM and looked at a variety of sexual behaviors including serosorting, strategic
positioning, disclosure rates, and rates of HIV testing. It compared these behaviors
between ethnicities and identified cultural trends. Overall, it was found that Latinos partake
in more public health risk behaviors such as getting tested less for HIV and disclosing their
HIV statuses less than non-Latinos. Such behaviors were correlated with traditional
masculine attitudes and lower rates of acculturation. Different approaches are needed to
target Latino MSM for prevention campaigns that may not identify with gay culture due to
high rates of Machismo.
This abstract accurately represents the content of the candidates thesis. I recommend its
publication.
Signed
Eric Benotsch


TABLE OF CONTENTS
Tables ..................................................v.
CHAPTERS
1. INTRODUCTION............................................1
2. METHOD..................................................8
4
3. RESULTS................................................12
4. DISCUSSION.............................................18
APPENDIX
A. ENGLISH SURVEY......................................26
B. SPANISH SURVEY......................................33
C. ENGLISH CONSENT.....................................39
D. SPANISH CONSENT................................... 42
E. TABLE 1.............................................44
F. TABLE 2.............................................45
G. TABLE 3.............................................46
BIBLIOGRAPHY .................................................45
IV.


TABLES
Table
1 Differences in sex practice, risk, and gay identification in Latino MSM and non-
Latino MSM.....................................................................44
2 Relationships between traditional masculine attitudes (TMA), public health risk
behaviors, and acculturation in Latino MSM.....................................45
3 Relationships between traditional masculine attitudes (TMA), public health risk
behaviors, and acculturation in Latino MSM controlling for insertive vs.
receptive tendencies...........................................................46
*
V.


CHAPTER 1
INTRODUCTION
Rise in HIV/'AIDS among minorities, specifically Latinos
The profile of the Human Immunodeficiency Virus (HIV) epidemic over the past two
decades has gone through many metamorphoses. Thanks to the increased attention to the
virus and its means of transmission, rates of new HIV cases have fallen over the past ten
years (Center for Disease Control [CDC], 2006). While this paints a nice image of the
general public health issue of HlV/AIDS, a micro view of the situation reveals a more
dismal picture. The rates of HIV/AIDS cases in minority populations are actually on the rise
and are higher in Latinos than in the dominant ethnic group (CDC, 2006).
Increased efforts at lowering the spread of HIV/AIDS have been targeted primarily
at white men who have sex with men (MSM) (Peterson & Marin, 1988; Eaton et al., 2007).
This population has benefited from trends in public health such as education, condom
distribution, and more available HIV testing (CDC, 2006). Yet, over 40,000 new cases of
HIV are reported in the United States every year and the number of Latinos infected is far
disproportionate to their overall percentage in the general population. Latinos constitute
approximately 14% of the US population but account for 21% of its AIDS cases (CDC,
2006). Clearly, there is a need for more specific research on the sexual practices of ethnic
minority populations. While the transmission of HIV/AIDS among the African American
population has been strongly linked to both high risk sex behaviors and injection drug use,
sexual contact with men accounts for the majority of HIV cases among Latinos (CDC,
2006). Furthermore, relative to Whites, Latino MSM are also more likely to also have sex
1


with women (Agronick et al., 2004; Wolitski, Jones, Wasserman, and Smith, 2006). This
poses a broader public health risk as it exposes a second population to the virus.
Trends in serosorting
Serosorting is defined as identifying ones sexual partner based on concordant HIV
statuses (CDC, 2006). The trend of serosorting is being endorsed by public health officials
and campaigns have been embraced by the white MSM population (Jarama, Kennamer,
Poppen, Hendricks, and Bradford, 2005; Peterson & Marin, 1988). Choosing ones sex
partners based on his HIV status has become a viable way of engaging in risk reduction
practices among MSM. The dislike o/ condoms seems to have driven this trend and many
men using this method believe they are taking a large step towards reducing their risks of
transmitting or being infected with HIV. However, a closer inspection of the use of
serosorting has shown that it is not as effective as individuals believe in reducing the
transmission of HIV (Eaton et al., 2007).
In order for serosorting to be an effective HIV risk reduction practice it requires
both parties involved to be honest and accurate in their disclosures. The accuracy of
someones disclosure can be affected by many things including sexual identification, self-
esteem, and influence of drugs and alcohol. Accurate disclosure also relies on the
individuals knowing his HIV status. This can be compromised by outdated test results or in
rare cases from false negative test results (Eaton et al., 2007; Lightfoot, Song, Rotheram-
Borus, and Newman, 2005). According to the Centers for Disease Control (2006), 20-25
percent of people in the US who have HIV are unaware of it. Therefore, at least some men
who are engaging in serosorting to protect their health or the health of their partners may
actually be compromising it.
2


Latino MSM Sex Practices
Previous studies have shown that Latino and African American MSM are slightly
less likely to report using serosorting as a safer sex practice compared to White men
(Frost, Stirratt, and Ouellette, 2008; Zea, Reisen, Poppen, and Diaz; 2003). However, more
in-depth research is needed to clarify this relationship (Poppen et al., 2005). HIV status
disclosure is significantly lower among Latino MSM (Wolitski, Rietmeijer, Goldbaum, and
Wilson, 1998). This lack of disclosure has been linked to cultural factors such as low self-
acceptance of homosexuality and risks of stigmatization (Diaz and Ayala, 2001). Therefore,
serosorting for sexual partners in this population could be especially high risk if accurate
disclosures of HIV status are not being made. Given the higher rates of traditional
masculine attitudes among Latino men, it is not surprising that Latino MSM do not as often
openly identify as homosexual (Munoz-Laboy, 2004). Therefore, distancing themselves
from the gay community could affect Latino mens perception of serosorting practices. No
studies have examined perceptions of serosorting practices among Latino MSM. Without a
more in depth look at this situation it is unclear what the presence of serosorting is
amongst Latino MSM. It could be that serosorting practices are not necessarily lower
among Latino MSM but are simply not labeled as serosorting. Partaking in serosorting
requires disclosing HIV status which can become a part of the individuals identity, which
may be a step Latino MSM are not willing to take.
Another risk reduction practice commonly used as an alternative for condom use
among MSM is strategic positioning. Strategic positioning is where the HIV positive partner
is the receptive partner and the HIV negative partner is the insertive partner. Since HIV is
primarily transmitted through the blood stream, the receptive partner is thought to be at
3


more of a risk in contracting HIV because of anal tearing; whereas the insertive partner is
at much less of a risk (CDC, 2006; Pinkerton & Abramson, 1994; Pinkerton & Abramson,
1998). According to the CDC (2006), there is a 1 in 200 chance of contracting HIV as the
unprotected HIV negative receptive partner versus a 1 in 1538 chance of contracting HIV
as the unprotected HIV negative insertive partner. Strategic positioning takes less
identification and commitment to the homosexual lifestyle, resulting in less labeling and
stigmatization. Without having to disclose ones serostatus as being positive, a man can
choose to always position himself as the receiving partner in order to reduce risk of
transmission. Furthermore, sero-negative men do not have to know their partners statuses
but can always position themselves as the top partner in order to reduce the risk of
transmission. This indicates it could be a more common method of risk reduction among
Latino MSM. However, due to factors such as inaccurate disclosure, strategic positioning
also possesses the same vulnerabilities to become an ineffective risk reduction practice as
serosorting. For instance, if the insertive partner is HIV positive but does not know it and
therefore discloses as being HIV negative, this could be putting the receptive partner at risk
for contracting HIV.
One would expect that the higher rate of HIV in the Latino communities would
correspond to Latino MSM engaging in more high-risk sexual activity. However, the
research is mixed. Some studies have found that MSM do not report more engagement in
high risk sex behaviors compared to White MSM (Harawa et al., 2004; Mansergh et at.,
2002); while others have found that ethnic minority MSM do engage in more HIV risk
behaviors such as unprotected anal intercourse (Agronick et al., 2004; Remien, Wagner,
Dolezal, and Carbollo-Dieguez, 2001; Wolitski et al., 2006). Therefore, it is important to
4


take a closer look at the sex practices among these populations in order to determine risk
for HIV. Specifically, this study is interested in the relationship between machismo
attitude often found amongst Latino men and sexual behaviors. Machismo is basically
defined as how macho or masculine a male is. The manliness is often defined as
patriarchal, sexually promiscuous, and stoic (Meyer & Champion, 2008). This machismo
attitude could be affecting serosorting behaviors amongst Latino MSM. Machismo could
also be affecting how Latino MSM perceive and characterize their sex practices.
The cultural effects of machismo can be manifested in multiple ways. As already
mentioned, machismo may cultivate an atmosphere of promiscuity mixed with the need to
appear masculine and dominant to society (Meyer & Champion, 2008). This combination
could mean that Latino MSM who uphold machismo not only are engaging in high risk
sexual behavior but may not be disclosing their HIV statuses because of fear of being de-
masculinized. Therefore, safer sex practices among Latino men may look different than
they do amongst other ethnic groups, especially White MSM. Serosorting could occur even
if Latino MSM are not using that specific term to characterize their sex practices. If it is
present, it is important to fully understand the cultural factors surrounding the decision to
do so in order to target these behaviors for preventative education.
While sex practices of Latino MSM have been examined in the past (Jarama et al.,
2005; Meyer & Champion, 2008; Munoz-Laboy, 2004; Poppen, Reisen, Zea, Bianchi, &
Echeverry, 2005; Williams, Wyatt, Resell, Peterson, & OBrien, 2004), there have been few
explorations into the culturally sensitive factors behind HIV risk reduction practices such as
serosorting and strategic positioning. Understanding what else affects an individuals
decision to serosort and his perception of serosorting can give a clearer picture of Latino
5


MSMs sex practices. Cultural factors including masculine attitudes, attitudes towards HIV
testing, and sexual identity could all influence Latino MSMs decision in choosing sexual
partners and their disclosure patterns. Furthermore, one would expect these individuals
acculturation to have a direct effect on these patterns as well. As demonstrated in previous
studies, the less acculturated an individual is with the mainstream culture, the more likely
he/she is to demonstrate qualities of his/her country of origin, especially with Latino men
(Warren et al., 2007).
This Study
A significant public health issue for HIV prevention and treatment is the alignment
of perceived risk and actual risk of transmitting or contracting HIV. Lack of knowledge
about serosorting and strategic positioning, inaccurate disclosure or the absence of
disclosure and unawareness of one's HIV status can all threaten this alignment, especially
in a population with a higher proportion of HIV infection. This study aimed to examine the
serosorting and strategic positioning behaviors of Latino MSM in comparison to non-Latino
MSM. This study looked at psychosocial and cultural variables such as traditional
masculine attitudes behind sex practices and the decisions that go into engaging in those
practices/behaviors. The effects of traditional masculine attitudes on disclosure rates, HIV
testing practices, serosorting, and strategic positioning were examined.
The following hypotheses were made:
Hypothesis 1: Serosorting and strategic positioning behaviors will be present in all
ethnic groups; however, they will be lower in Latino MSM.
Hypothesis 2: Latino men will engage in higher rates of strategic positioning
compared to serosorting as this practice takes less commitment to disclosure.
6


Hypothesis 3: Latino men will have higher levels of traditional masculine attitudes,
more negative attitudes toward HIV testing, less knowledge of their HIV status, and
a lower likelihood of accurately disclosing their HIV statuses.
Hypothesis 4: Acculturation scores will be positively correlated with serosorting,
attitudes toward HIV testing, knowledge of HIV status, and HIV status disclosure
rates. Acculturation scores will be negatively correlated with traditional masculine
attitudes.
7


CHAPTER 2
METHOD
Participants and Setting
The sample consisted of 268 men over the age of 18 who identify as having sex
with men (MSM). All ethnicities were surveyed though Latinos were targeted more heavily:
approximately half of the participants were Latino and half were all other ethnicities. The
population surveyed was men visiting local gay bars and restaurants. The venues used for
interception were El Porteros, Old Tequila Roses, The Wrangler, JRs, Hamburger Marys,
Charlies, and The Compound. These places were selected using the venues universe list
and sampling frame generated by Denver Health for the 2008 National HIV Behavioral
Surveillance survey (Thrun et al., 2008). Since recruitment was done in locations that serve
alcohol, individuals that showed obvious signs of intoxication were not enrolled in the
study. Approximately 10% of the men approached were not enrolled because of signs of
intoxication.
This study used written surveys as its primary form of data collection, which were
distributed using common venue intercept procedures. Surveys were anonymous and took
no longer than 15 minutes to complete. Participants were offered a small monetary
compensation of $5 for completing the survey which they could opt to donate to a local
HIV/AIDS foundation. A total of $530 was accepted by participants and $810 was donated
to The Positive Project. Surveys were available in English and Spanish. Out of 268
surveys, 71 were completed in Spanish. Surveys were administered by this author and
other approved research assistants. At least one of the researchers present for the survey
administration was bilingual in both English and Spanish.
8


Measures
Participants were asked to complete a survey measuring demographic information,
sexual practices including strategic positioning and serosorting, attitudes and behaviors
surrounding HIV testing and HIV status disclosure, traditional masculine attitudes, and
acculturation. The survey was composed of several different measures found to be
psychometrically sound in previous studies.
Demographics. Participants were asked their age; years of education; ethnicity;
yearly income; employment status; whether they self-identified as gay, bisexual, or
heterosexual; how out they are; relationship status; if they have been tested for HIV; and
the result of their most recent HIV test.
Sexual Practices. Sexual behavior was assessed by asking participants to report
their number of sex partners in the last 6 months and the HIV status of their current partner
or most recent partner. Serosorting behaviors were assessed by asking the participants to
answer whether or not they will only have sex with someone who is the same HIV status as
they are, and asking them to rank their likelihood of having sex with someone who has the
same HIV status as they have and their likelihood of having sex with someone who has a
different HIV status than they have. Strategic positioning was assessed by asking
participants to disclose whether their HIV status or their partners HIV status affects who is
top and who is bottom. The term strategic positioning was explained and participants were
asked to say how much they agree or disagree with the statement that strategic positioning
is a safer sex practice. Most of the questions from this portion of the measure were taken
from previous studies (Eaton et al., 2007; Poppen et al., 2005; Stall, 1999), though some
questions were added by the investigator to fully tap into all targeted sexual practices.
9


HIV Testing and Status Disclosure: Participants were asked to report how often
they get tested for HIV, how often they disclose their HIV status to their sexual partners, if
they know the HIV status of their most recent sexual partner, if their most recent sexual
partner knew his HIV status, how concerned the participants would be to tell their partner
about a positive HIV test result, and their likelihood to disclose information to the health
department as the result of positive HIV test.
Traditional Masculine Attitudes: Using a 5-point likert scale, participants were
asked to report how much they agree or disagree with different statements regarding
traditional masculine attitudes. Statements from this scale include It bothers me when a
man does something I consider feminine and Men are always ready for sex. These
questions were drawn from the Traditional Masculine Attitudes Scale derived by Thompson
and Pleck (1986). The scale was shown to be a reliable measure of traditional masculine
attitudes in this study with an alpha of .659.
Acculturation: Acculturation was measured using the Vancouver Index of
Acculturation (Ryder, Alden, and Paulhus, 2000). This index asked participants to say how
much they agree or disagree with different statements concerning heritage versus
mainstream culture. Statements are paired together so that one statement reflects
identification with the mainstream culture and one reflects maintenance of the participant's
culture of origin. Sample statements from the VIA include I often participate in mainstream
American cultural traditions and I often participate in my heritages cultural traditions.
Ryder et al. (2000) reported high internal consistency reliability of the VIA and provided
evidence for its validity. The internal consistency reliability of the VIA was alpha=0.86 for
heritage culture and 0.84 for mainstream culture (Ryder et al. 2000). A shortened version
10


of this scale was used in this study. Five items were used in the study but two items
pertaining to American traditions and cultures were removed to increase internal
consistency. Therefore, the scale measured only adherence to heritage culture. The alpha
was equal to .806. Acculturation was also gauged using language as a proxy variable.
Latino participants completing the survey in Spanish were considered to be less
assimilated with mainstream American culture.
11


CHAPTER 3
RESULTS
Demographics
Among the 268 participants, the mean age was 31.9 years (SD = 8.54) and the
average years of education was 14.4 years (SD = 2.7). Eighty-five percent of the
participants identified as homosexual, 12% as bisexual, 2 % as heterosexual, and less
than 1 % did not know. The five men who identified as heterosexual reported having sex
with men and were therefore included in the analyses. Sixty-nine percent reported their
sexuality as out, 26% reported as partially closeted, and 5% reported as closeted. The
sample was nearly evenly split between White (43%) and Latino (51%) with the remainder
being African American (2%), Asian American (2%), Native American (1%) or other (1%).
Forty percent reported having annual incomes over $40,000, 16% between $31,000-
$40,000, 19% between $21,000-$30,000, 13% between $11,000-$20,000, and 12%
$10,000 or below. Eighty-five percent reported being tested for HIV; of those 77% tested
HIV-negative, 9% tested HIV-positive, and 14% did not know their test results. Of those
who had been tested, 39% reported getting tested less than once a year, 27% reported
twice a year, 22% reported every 2-6 months, and 1 % reported getting tested once a
month or more.
Sexual Activity
In the present study, 89.6% of the respondents reported at least one sex partner in
the past six months. Of the men reporting sexual activity, 22% reported not knowing the
HIV status of their partners. Eighteen percent of men reported they never disclose their
HIV status, 15% reported they disclose some of the time, 15% reported they disclose
12


most of the time and 52% reported they always disclose HIV status to partners. Thirty-five
percent indicated they wouldnt be likely to give information to the health department for
partner notification if they were diagnosed with HIV.
Presence of Serosorting and Strategic Positioning in Entire Sample
Seventy-five percent of participants reported being unfamiliar with strategic
positioning. After reading a description of strategic positioning, 55% disagreed that it was a
safe way to have sex without a condom. Fifty-six percent of participants reported they
would be less likely to use a condom if their sex partners had the same HIV status. Sixty-
two percent of participants said they would worry less about HIV if their partners had the
same HIV status. Thirty-nine percent of all participants said they would only have sex with
someone with the same HIV status. Twenty-five percent of HIV positive participants said
they would have sex with only seroconcordant partners. Forty-five percent of HIV negative
participants said they would only have sex with seroconcordant partners. Of the HIV
positive, sexually active participants, 59% reported using strategic positioning behaviors
and 85% reported using serosorting behaviors. For HIV positive men, a strategic
positioning score was calculated by subtracting the number of times a man had sex with an
HIV negative man without a condom as the top from the number of times a man had sex
with an HIV negative man without a condom as the bottom. For HIV negative men, a
strategic positioning score was calculated by subtracting the number of times a man had
sex with an HIV positive man without a condom as the bottom from the number of times a
man had sex with an HIV positive man without a condom as the top. Positive scores were
considered a behavioral report of strategic positioning. If a man reported having sex with
no one that was serodiscordant this was considered a behavioral report of serosorting. Of
13


the HIV negative, sexually active participants, 52% reported using strategic positioning
behaviors and 75% reported using serosorting behaviors.
Serosorting and Strategic Positioning in Latinos
As seen in Table 1, Latino participants (34%) were significantly more likely to be
familiar with the term than other ethnicities (17%) (x2 (1) =6.9, p < .01). After receiving a
definition of strategic positioning, only 30% of Latino participants disagreed that it was a
safe way to have sex without a condom; which was significantly less than non-Latino
participants 0^(5) = 30.112, p < .001). Sixty-two percent of Latino participants reported that
*
they would be less likely to use condoms with someone of the same HIV status and 66%
said they would worry about HIV less if their partners were the same HIV status; indicating
a trend toward serosorting. Twenty-seven percent of Latino participants reported they
would only have sex with someone with the same HIV status. This was significantly lower
than in other ethnicities (52%) (x2 (2) = 18.259, p < .001). Of the HIV positive, sexually
active Latino men, 88% reported strategic positioning behaviors and 80% reported
serosorting behaviors. Neither serosorting nor strategic positioning was not significantly
different between HIV positive Latino participants and HIV positive non-Latino participants
(U (20J = 37, ns; U (20) = 45, ns). Furthermore, within Latinos, these behavioral reports
were not significantly different from one another (L/(10) = 208, ns; U = 25, ns). Of the HIV
negative, sexually active Latino men, 19% reported strategic positioning behaviors and
30% reported serosorting behaviors. There were no differences in serosorting or strategic
positioning between HIV negative Latino participants and HIV negative non-Latino
participants (f( 185) = 1.65, ns; f(184) = 1.23, ns). As well, within Latinos there were no
14


significant differences between these behavioral reports 0^(1) = 2.730, ns/x^l) = .329,
ns).
Trends in behaviors and cultural factors in Latinos
Overall, Latino participants reported significantly more public health risk behaviors
(see Table 1). Latinos reported significantly lower rates of HIV status disclosure than other
ethnicities; only 40% of Latinos reported they always disclose versus 66% of all other
ethnicities = 18.235, p < .001). Furthermore, 20% of Latino participants reported they
never disclose their HIV statuses versus 14% of all other ethnicities. Latino participants
reported significantly lower rates of HIV testing than other ethnicities 0f2(2) = 26.089, p <
.001). Twenty-five percent of Latino participants reported they had never been tested for
HIV versus three percent of other ethnicities. Out of the participants who had been tested
for HIV there were no significant differences between ethnicities on how often participants
were tested (x2(3) = 4.687, ns). Latino participants identifying as homosexual reported
being significantly more closeted than other ethnicities (x2(2) = 23.388, p < .001). Only 55%
of Latino participants reported they were out versus 82% of all other ethnicities. Latino
participants were significantly more likely to report being bisexual (x2^) = 17.051, p <
.001). Twenty percent of Latino participants reported being bisexual versus only 4% of all
other ethnicities. Furthermore, Latino participants (M = 20.69, SD = 4.36) were significantly
more likely to endorse traditional masculine attitudes than other ethnicities (M = 18.85, SD
= 3.51), f(266) = 3.79, p<.001.
Within group analyses of Latino participants showed that traditional masculine
attitudes correlated with several risk behaviors (see Table 2). Traditional masculine
attitudes negatively correlated with HIV status disclosure rates (r = -.323, p < .01). Also, the
15


more a participant endorsed traditional masculine attitudes the less likely he was to have
been tested for HIV (r = -.276, p < .01). There was no correlation between traditional
masculine attitudes and sexual orientation (r = .02, ns); how out a participant reported to
be (r = -.09, ns); and how often participants get tested for HIV (r = .09, ns). There was no
significance relationship between the amount of unprotected anal sex and traditional
masculine attitudes (r = .03, ns). Men expressing more traditional masculine attitudes were
less likely to give out information to the health department to inform sex partners of their
status (r= -.22, p < .05).
Role of Acculturation
Acculturation analyses were performed only on participants identifying as
Latino/Hispanic. Participants who were more acculturated endorsed fewer traditional
masculine attitudes (r = -.461, p < .01). Acculturation did not significantly correlate with
disclosure rates (r= .085, ns). More acculturated individuals did not report getting tested
for HIV more than less acculturated participants (r = -.157, ns). Acculturation negatively
correlated with strategic positioning in that participants who were less acculturated were
more likely to agree serosorting was a safe way to have sex without a condom (r = -.260, p
< .01). The less acculturated a participant reported being, the less likely he was to use a
condom when his partner reported having the same serostatus (r = .194, p < .05). The less
acculturated a participant reported being, the less likely he was to worry about contracting
HIV if his partner reported having the same serostatus (r = .230, p < .01).
Among Latino participants, 77 completed the questionnaire in Spanish and 66
completed the questionnaire in English. A proxy variable of language was also used to
gauge acculturation. Participants who took the questionnaire in Spanish (M = 21.90, SD =
16


4.17) were significantly more likely than participants who took the questionnaire in English
(M = 19.39, SD = 4.21) to endorse traditional masculine attitudes (f(135) = 3.498, p < .001).
Twenty-four percent of primarily Spanish speaking participants versus 16% of English
speaking participants reported never disclosing their HIV status. Twenty-eight percent of
primarily Spanish speaking participants versus fifty-three percent of English speaking
participants reported that they always disclose their HIV status. This was a significant
difference 0^(3)= 9-625, p< .05). There was not a significant difference in reported
serosorting and strategic positioning between Spanish and English speakers. Thirty-one
percent of Spanish speakers versus 18% of English speakers had not been tested for HIV.
This was not a statistically significant difference (x*(2) = 4.17, ns).
A partial correlation was also completed to control for the tendency for participants
to be the receptive partners or the insertive partner. A receptive/insertive score was
calculated by subtracting the number of times an individual was the receptive partner from
the number of times an individual was the insertive partners. Scores greater than 1 were
considered indicative of primarily insertive behaviors, scores between 1 and -1 were
considered indicative of no preference, and scores less than -1 were considered indicative
of primarily receptive behaviors. See Table 3 for correlations.
17


CHAPTER 4
DISCUSSION
Despite efforts targeted at reducing the spread of HIV/AIDS, the disease still poses
a significant health threat to society. The Center for Disease Control estimates that there
are over one million people living with HIV/AIDS in the United States. Furthermore, minority
populations are at an even greater risk for contracting the disease as it has been on the
rise in Latinos at an alarmingly disproportionate rate over the past ten years. Latino MSM
seem to be contracting HIV at a greater rate than MSM of other ethnicities (CDC, 2006).
Given Latino MSMs greater tendency to have sex with both males and females, this
statistic poses an even greater threat to public health. Some studies have found that
Latino MSM engage in more unprotected anal intercourse than any other ethnic group
(Agronick et al., 2004; Remien, Wagner et al., 2001; Wolitski et al., 2006). Therefore, more
attention is needed to better understand the decision making and behavioral patterns
behind Latino MSM sex behaviors. The results from this study will add to the existing
literature a more in-depth understanding of the behaviors and beliefs that put Latino MSM
at a higher risk for contracting HIV.
This study aimed to compare the sex behaviors, attitudes, and knowledge base of
Latino MSM with those of other ethnic groups. It specifically focused on how HIV testing,
disclosure rates, and condom-alternative sex practices (serosorting and strategic
positioning) differed between Latino participants and non-Latino participants. It was
hypothesized that because of cultural factors such as machismo and stigmatization around
homosexuality, Latino MSM would engage in more high risk sex behaviors. It was also
18


expected that a Latino participants behaviors, attitudes, and beliefs would be affected by
how much he was acculturated with mainstream American society.
Overall, Latinos in the sample reported more public health risk behaviors, had less
knowledge about their HIV status, and had a lower perception of risk than other ethnic
groups. This is consistent with previous research that has shown that Latino MSM are
more likely to engage in sexual risk behaviors when they exhibit internalized homophobia
and attempt to distance themselves from the gay community (Diaz et al., 2000). Latino
participants were significantly less likely to know their HIV statuses, disclose their HIV
statuses, and identify as homosexual. Furthermore, Latinos in this sample were
significantly less likely to identify as having an open sexuality; significantly more Latino
participants were closeted or partially closeted compared to non-Latino participants. This
lack of gay identification could lead to these participants lack of knowledge around HIV. It
could also be affecting their attitudes about disclosing HIV status. The lower disclosure rate
could be linked to an absence of knowledge rather than an intentional carelessness. If
Latinos are attempting to distance themselves from the gay community, then they would
not be reached by HIV prevention education campaigns to the same extent as members of
the mainstream culture (Singer & Marxuach-Rodriquez, 1996). They may even intentionally
dismiss campaigns as being irrelevant to their lifestyles if they do not identify as
homosexual. This finding confirms the importance of tailoring HIV prevention campaigns to
this specific population.
Previous studies surveying the sexual risk behaviors of MSM ethnic minorities
have found mixed results on whether or not these men are actually engaging in more risky
behaviors than White MSM. Latino and African American men have been found not to
19


report any more HIV risk behaviors than other ethnic groups in some studies (Harawa et
al., 2004, Mansergh et al., 2002). These studies, however, focused primarily on perceived
risk versus actual risks. Other studies that focused more on behaviors versus perceived
risks found that Latino MSM are more likely to engage in HIV risk behaviors such as anal
sex with no condom (Agronick et al., 2004; Remien, Wagner, Dolezal, and Carbollo-
Dieguez, 2001; Wolitski et al., 2006). The findings from this study support previous
research that has identified the risks taken by Latino MSM who are less acculturated with
American mainstream society. Clearly, the large difference between Latino participants
likelihood to disclose than other ethnic groups is indicative of a pattern of HIV risk
behavior. This poses a risk not only for the individual but for the greater public health as
well. If Latino MSM are having just as much sex as other MSM ethnic groups but getting
tested less for HIV and disclosing their HIV statuses less, this points to a major area of
needed attention in the campaign against the spread of HIV/AIDS. While this study did not
specifically target perceived risk, it corroborates previous behavioraliy focused research
that Latinos are self-identifying as partaking in sexual risk behaviors and posing a public
health risk. This study did not, however, point to Latinos as partaking in significantly more
sexual risks behaviors such as unprotected anal sex. In fact, there were no differences
between ethnicities in the amount of unprotected anal sex being had. This indicates that
Latino MSMs behaviors encompass less personal risk for HIV contraction and more of a
public risk for transmitting HIV.
As predicted, risk behaviors were significantly correlated with the endorsement of
traditional masculine attitudes. This complements the findings from previous studies that
have found the cultural factor of machismo to be associated with increased risk for HIV
20


among Latino MSM population (Meyer & Champion, 2008). The more a participant
endorsed traditional masculine attitudes, the less likely he was to disclose his HIV status
and get tested for HIV. The traditional masculine attitude scale closely resembles traits
often associated with machismo. As defined by Thompson and Pleck (1986), the traditional
masculine attitudes scale represents status, anti-femininity, and toughness. Machista men
were found to have more sexual encounters, be more aggressive in sexual encounters, be
more likely to identify as straight or bisexual, and be more likely to discriminate against
homosexuality in previous research (Carballo-Dieguez, 1998). Considering the rate of
HIV/AIDS among Latino MSM, machismo attitudes among this population can result in a
serious public health threat. While this study did not find specific relationships between
traditional masculine attitudes and HIV risk behaviors such as unprotected anal sex, it did
find a relationship between traditional masculine attitudes and sexual behaviors that can
pose a public health risk such as disclosure rates and rates of HIV testing. This could point
to why there is a discrepancy between HIV rate among Latino MSM and reported risk
behaviors found in previous studies (Harawa et al., 2004, Mansergh et al., 2002).
Therefore, Latino MSM, specifically those who endorse traditional masculine attitudes, are
more likely to engage in behaviors that put the public at a higher risk for contracting HIV.
This study provides new information about the differences between Latino MSMs
sex practices and other ethnicities. Latino MSM are not necessarily having more
unprotected anal sex than other ethnicities. However, what unprotected sex they are
having is riskier as they get tested for HIV less and disclose their HIV status less than other
ethnic groups. While this finding is alarming, it also provides an avenue for education.
Among this population, not only should the importance of condom use be emphasized but
21


so should the importance of getting tested and disclosing one's HIV status. The other issue
in reaching and educating this group of individuals is targeting the large number of them
that endorse machismo or traditional masculine attitudes. Perhaps Latino MSM who
endorse traditional masculine attitudes disclose their HIV status less and get tested less
because they never hear the message that this can put them or their partners at risk for
HIV/AIDS. These men seem to distance themselves from the mainstream gay community
because of their engrained tendencies to discriminate against homosexuality (Singer &
Marxuach-Rodriquez, 1996). Reaching them will call for more creativity within the public
health education and outreach forum. Since a significantly larger amount of Latinos
identified as heterosexual or bisexual in this study, perhaps more resources can be put into
reaching out to all Latino MSM not just ones that would identify as homosexual. This would
help further disseminate information important to reducing the publics risk for HIV.
As predicted, Latino participants were more likely than other ethnic groups to be
familiar with and endorse strategic positioning as a safe alternative to condom use. As well,
they were less likely to endorse serosorting than other ethnic groups. Serosorting requires
more identification of HIV status and more acceptance of a gay lifestyle since it requires
testing, awareness of status, and accurate disclosure. While strategic positioning can
require these aspects as well, it does not necessarily (i.e., an HIV negative man will always
choose to be the insertive partner). Without a strong necessity of gay lifestyle
endorsement, proximity, and acceptance, strategic positioning allows Latino men
(especially Latino men with strong machismo attitudes) to practice aggressive, forceful sex
without using a condom while also guarding themselves against HIV.
22


However, Latino participants behavioral reports on serosorting and strategic
positioning did not differ. It seems that Latinos in the sample are not partaking in safer sex
practices not based on serosorting versus strategic positioning but based on HIV status.
Based on the differences in strategic positioning and serosorting between HIV negative
Latino MSM and HIV positive Latino MSM, it seems that HIV positive Latino MSM are
much more likely to use either strategic positioning or serosorting whereas HIV negative
Latino MSM are more likely to use neither method. Unlike what was predicted, Latino MSM
are no more likely to engage in serosorting versus strategic positioning. Yet they are more
likely to be aware of and report intentions to partake in strategic positioning versus
serosorting. HIV positive Latino MSMs high percentages of serosorting behaviors could be
indicative of their lack of knowledge and identification with the gay culture. The high rates
of serosorting in HIV positive Latino participants contradicted with the low rates of
knowledge about and intention to engage in serosorting indicates a discrepancy between
knowledge and practice. As mentioned in the introduction, it is possible that serosorting is
present in similar rates as strategic positioning in Latino MSM but it is simply not being
labeled that. The similar rates of serosorting versus strategic positioning could indicate that
this is the case.
Limitations
This study has several limitations that should be noted. Firstly, the VIA was
shortened to 5 items and shortened again to 3 for final calculations. While the scale was
found to be reliable for this study, there has been no other research to confirm this. As well,
23


self-report data, in general, can be skewed by nature. Reporting accuracy may have been
compromised as data were collected primarily at bars and many participants were drinking
alcohol. While precautions were taken not to include any participants that appeared
intoxicated, it is possible that some participants were less capable of filling out the survey
accurately because of an intoxicated state. Lastly, the sample may have been skewed
because all data were collected at openly identified gay venues. Therefore, the sample
may be skewed towards a population that is more comfortable with the gay community and
not representative of the population as a whole. Completely closeted men would not have
been included in this sample. Future studies could use different data collection methods to
include MSM who do not identify as gay and who do not openly identity as having sex with
men. Possible methods include posting flyers at social services and health clinics that
serve the targeted population. Participants could be screened over the phone to determine
eligibility and respect confidentiality. Recruitment methods similar to those used by Siegal
et al. (2008) could also be used. This study targeted both gay identified and non-gay
identified men by randomly selecting venues from a list of straight, gay, and mixed
population venues and targeted all men at the site by giving them a card with recruitment
information. The card contained information of who to call, what the study was about, and
the reimbursement amount. This method targeted a wide range of participants and
preserved anonymity.
Future Directions
instead of focusing outreach education programs on gay men partaking in a gay
lifestyle, education for Latino MSM may be more effective if it targets gay, straight, and
24


bisexual individuals. Many of the Latino participants surveyed mentioned religion and
tradition being important aspects of their lives. More research is needed to tease out the
specific effects of these aspects on sex practices. As well, religion and traditional cultural
values such as dancing, family, and holidays can be incorporated in public health HIV
prevention campaigns. Country of origin was not assessed in this study because the
demographics of the selected city consist primarily of Latinos of Mexican descent.
However, future studies could incorporate country of origin to see what effect this variable
has on decision making and sex practices.
25


APPENDIX A
Measure-English
1. What is your age?
2. What is the highest grade or year of school that you have completed?
3. Which best describes you? (Circle one)
Hispanic/Latino White African American Asian American Native American
Other __________
4. Which of the following is closest to your current yearly income? (Circle one)
$0-$10,000 $11,000-$20,000 $21,000 $30,000 $31,000 $40,000 Over
$40,000
26


5. What is your current employment status? (Circle one)
Working Unemployed Student Receiving disability Other
6. How would you describe your sexual orientation? (Circle one)
Gay Bisexual Heterosexual Dont Know
7. How out are you? (Circle one)
Definitely "closeted" (not open about sexual orientation)
"Closeted" some of the time and "Out" some of the time
Definitely "Out" (open about sexual orientation all of the time)
8. Have you been tested for HIV?
Yes No Don't Know
9. If yes, how often do you get tested for HIV?
Less than once a year Twice a year Every 2-6 months Once a month or more
10. Do you know the results of your most recent HIV test? (Choose one)
Positive Negative Don't know
27


11. How many sex partners have you had in the past 6 months?
12. In the past 6 months, how often did you disclose your HIV status to your sex
partner?
Never Some of the time Most of the time Always
13. Are you currently in a significant intimate relationship?
Yes No
14. Is this relationship exclusive?
Yes No N/A
15. What is the HIV status of your partner?
Positive Negative Dont Know
16. Will you only have sex with someone who has the same HIV status as you?
Yes No Undecided
17. In the past 6 months how many of your sex partners were HIV positive?
18. Out of these, how many times did you have anal sex with no condom
where your partner inserted his penis into you (you were bottom)?
19. Out of these, how many times did you have anal sex with no condom
where you inserted your penis into your partner (you were top)?
28


20. In the past 6 months how many of your sex partners were HIV negative?
21. Out of these, how many times did you have anal sex with no condom
where your partner inserted his penis into you (you were bottom)?
22. Out of these, how many times did you have anal sex with no condom
where you inserted your penis into your partner (you were top)?
23. In the past 6 months, how many of your sex partners did you not know the HIV
status of?
24. Are you familiar with the term strategic positioning?
Yes No
25. Strategic positioning is sometimes used when one partner is HIV positive and
the other partner is HIV negative. The HIV positive man will be the bottom partner
during anal sex and the HIV negative man will be the top.
How much do you agree that the use of strategic positioning is a safer way to have
sex without a condom?
Strongly Agree Agree Neutral Disagree Strongly Disagree
Dont Know
29


26. If you were diagnosed with HIV/AIDS, on a scale of 1 to 10, how concerned
would you be to tell a partner about this diagnosis?
1 (Not Concerned) 2 3 456 7 8 910
(Extremely Concerned)
27. How likely would you be to give the health department contact information to
help notify your sex partners if you were diagnosed with HIV/AIDS?
1 Very likely 2 Somewhat likely 3 Somewhat not likely 4 Not at all likely
5 Dont know
28. Did your most recent sex partner know your HIV status?
Yes No
29. Did you know the HIV status of your most recent sex partner?
Yes No
30. If my partner tells me that his HIV status is the same as mine I am more likely
to have
unprotected sex with him.
Strongly Agree Agree Neutral Disagree Strongly Disagree
Dont Know
31. If my partner tells me his HIV status is the same as mine I worry less about
HIV
Strongly Agree Agree Neutral Disagree Strongly Disagree
Dont Know
30


32. It is essential for a guy to get respect from others. (Choose one)
Strongly Agree Agree Neutral Disagree Strongly Disagree
Dont Know
33. Men are always ready for sex. (Choose one)
Strongly Agree Agree Neutral Disagree Strongly Disagree
Dont Know
34-1 don't think a man should have to do housework. (Choose one)
Strongly Agree Agree Neutral Disagree Strongly Disagree
Dont Know
35. A man should never back down in the face of trouble. (Choose one)
Strongly Agree Agree Neutral Disagree Strongly Disagree
Dont Know
36. It bothers me when a man does something I consider feminine. (Choose one)
Strongly Agree Agree Neutral Disagree Strongly Disagree
Dont Know
37.1 often participate in my heritage cultural traditions.
Strongly Agree Agree Neutral Disagree Strongly Disagree
Dont Know
31


38. I often participate in mainstream American cultural traditions.
Strongly Agree Agree Neutral Disagree Strongly Disagree
Dont Know
39.1 am comfortable interacting with people of the same heritage culture as
myself.
Strongly Agree Agree Neutral Disagree Strongly Disagree
Dont Know

40. I often behave in ways that are typical of my heritage culture.
Strongly Agree Agree Neutral Disagree Strongly Disagree
Dont Know
41.1 often behave in ways that are 'typically American.'
Strongly Agree Agree Neutral Disagree Strongly Disagree
Dont Know
32


Measure (Spanish)
1. APPENDIX B
2. <*,Que es el grado o el ano mas maximo de la escuela que usted ha
completado?
3. <,Cual mejor le describe? (Decide uno)
Hispano/Latino Blanco Americano Africano Americano Asiatico Indio
Americano <
Otro__________
4. <<,Cual del siguiente es mas cercano a su corriente los ingresos anuales?
(Decide uno)
$0-$10,000 $11.000-$20,000 $21.000-$30,000 $31,000
- $40,000
mas de $40,000
5. ^Que es su estatus actual de empleo? (Decide uno)
Trabajando Sin trabajo Estudiante Recibe incapacidad
Otro
6. Homosexual Bisexual Heterosexual No Sabe
7. ^Corno gay es usted? (Decide uno)
Definitivamente "closeted" (no abre acerca de orientacion sexual)
Parte de "Closeted" del tiempo y "Gay" parte del tiempo
Definitivamente "Fuera" (abre acerca de orientacion sexual todo el tiempo)
33


8. iHa sido probado usted para VIH?
Si no No Sabe
9. Menos que una vez un ano Dos veces al ano Cada 2-6 meses Una vez al
mes o mas
10. ^Sabe usted los resultados de sus la mayorla de las pruebas recientes de
VIH? (Decide uno) >
Positivo Negativo No sabe
11. <-,Cuantas parejas ha tenido usted en los pasados 6 meses?
12. a su pareja?
Nunca Parte del tiempo Gran parte del tiempo Siempre
13. <-,Es usted actualmente en una relacion intima significativa?
Si no
14. ^Es esta relacion exclusiva?
Si no
15. es el estatus de VIH de su socio?
Positivo Negativo no Sabe
16. ^Solo tendra relaciones sexuales usted con alguien quien tiene el mismo
estatus de VIH como
usted?
34


Si no sin decidir
17. ^En los pasados 6 meses cuantos de sus parejas fue VIH positivo?
18. iFuera de estos, cuantas veces le hizo tiene sexo anal con ningun
condon donde su socio inserto el pene en usted (usted fue inferior)?
19. <,Fuera de estos, cuantas veces le hizo tiene sexo anal con ningun
condon donde usted inserto el pene en su socio (usted fue primero)?
20. <[,En los pasados 6 meses cuantos de sus parejas fue VIH negativo?
21. ^Fuera de estos, cuantas veces le hizo tiene sexo anal con ningun
condon donde su socio inserto el pene en usted (usted fue inferior)?
22. ^Fuera de estos, cuantas veces le hizo tiene sexo anal con ningun
condon donde usted inserto el pene en su socio (usted fue primero)?
23. VIH?_______
24. ^Corioce usted el termino posicionar estrategico?
Si no
25. Posicionar estrategico es utilizado a veces cuando un socio es VIH positivo y
el otro socio es VIH negativo. El
35


VIH hombre que positivo sera el socio inferior durante sexo anal y el VIH
hombre que negativo sera la cima.
^Cuanto concuerda usted que el uso de posicionar estrategico es una manera
mas segura tener relaciones sexuales sin un condon?
Concuerde totalmente Concuerda Neutral no Conviene no Conviene
Totalmente no Sabe
26. i,Si usted fue diagnosticado con VIH/AYUDAS, en una escala de 1 a 10, cuan
concernido le hace es
de decir a un socio acerca de este diagnostico?
1 (No Concernio) 2 3*4 5 6 7 8 9
10 (Concernio Muy)
27. ^Cuan probable le hace es de dar la information de contacto de departamento
de salud a ayudar a
notificar sus parejas si usted fue diagnosticado con VIH/AYUDAS?
1 Muy probable 2 Algo probable 3 Algo no probable 4 nada en absoluto
probable 5 no sabe
28. ^Supieron sus la mayoria de las parejas recientes su estatus de VIH?
Si no
29. <|,Supo usted el estatus de VIH de sus la mayoria de las parejas recientes?
Si no
30. Si mi socio me dice que su estatus de VIH es igual que mina soy mas
probable de tener sexo \
improtegido con el.
Concuerde totalmente Concuerda Neutral no Conviene no Conviene
Totalmente no Sabe
31. Si mi socio me dice que su estatus de VIH es igual que mina preocupo menos
acerca de VIH.
36


Concuerda Totalmente Concuerda Neutral no Conviene no Conviene
Totalmente no Sabe
32. Es esencial para un tipo consiga respeto de otros. (Decide uno)
Concuerda Totalmente Concuerda Neutral no Conviene no Conviene
Totalmente no Sabe
33. Los hombres estan siempre listos para el sexo. (Decide uno)
Concuerda Totalmente Concuerda Neutral no Conviene no Conviene
Totalmente no Sabe
34. Yo no pienso que un hombre debe tener que hacer tareas domesticas.
(Decide uno)
Concuerda Totalmente Concuerda Neutral no Conviene no Conviene
Totalmente no Sabe
35. Un hombre nunca debe echarse atras ante problema. (Decide uno)
Concuerda Totalmente Concuerda Neutral no Conviene no Conviene
Totalmente no Sabe
36. Me molesta cuando un hombre hace algo que considero femenino. (Decide
uno)
Concuerda Totalmente Concuerda Neutral no Conviene no Conviene
Totalmente no Sabe
37. Yo a menudo tomo parte en mi herencia tradiciones culturales.
Concuerde Totalmente Concuerda Neutral no Conviene no Conviene
Totalmente no Sabe
38. Yo a menudo tomo parte en las tradiciones culturales, norteamericanas y
convencionales.
Concuerde Totalmente Concuerda Neutral no Conviene no Conviene
Totalmente no Sabe
37


39. Soy interactuar comodo con personas de la misma cultura de herencia como
yo mismo.
Concuerde Totalmente Concuerda Neutral no Conviene no Conviene
Totalmente no Sabe
40. Yo a menudo me comporto en maneras que es tipico de mi cultura de
herencia.
Concuerde Totalmente Concuerda Neutral no Conviene no Conviene
Totalmente no Sabe
41. Yo a menudo me comporto en maneras que es 'tipicamente norteamericano'.
Concuerde Totalmente Concuerda Neutral no Conviene no Conviene
Totalmente no Sabe
38


APPENDIX C
Date: Valid for Use Through:
Study Title: Psychosocial decision making behind safer sex practices
among men who
have sex with men (MSM)
Principal Investigator: Anne Pendygraft, B.A.
HSRCNo: 09-0119
Version Date: 3/31/2009
Version No: 2
You are being asked to be in a research study. This form provides you with information
about the study. A member of the research team will describe this study to you and answer
all of your questions. Please read the information below and ask questions about anything
you don't understand before deciding whether or not to take part.
This research is being conducted by the University of Colorado at Denver.
Why is this study being done?
This study plans to learn more about decision making surrounding sexual behaviors among
men who has sex with men. This study wants to learn more about why men choose to
engage in some behaviors and not in others. It is specifically targeting the cultural factors
that surround these behaviors. The results from this study can benefit the gay community
by educating individuals about safer sex practices. The information you provide may help
us develop interventions to reduce health risks in the gay and bisexual community. You
are being asked to participate because you are a gay or bisexual man. Up to 300 men will
participate in the study. This research is being paid for by the University of Colorado
Denver.
What happens if I join this study?
39


If you join the study, you will be asked to complete a questionnaire that asks questions
about sexual behavior, attitudes about HIV status disclosure, HIV testing, and social and
cultural preferences. Most men complete the questionnaire in 15-20 minutes.
What are the possible discomforts or risks?
Some questions ask about personal information that may cause you some discomfort or
embarrassment or you may feel some concern about your own risk for sexually-transmitted
infections. If you would like to talk to someone about this discomfort or concern, you may
talk to the person conducting the survey. If we are not able to answer your questions, we
will make every effort to refer you to someone who can. The University of Colorado has no
plan to pay for psychological injury that could result from participation.
Will I be paid for being in the study?
We will pay you $5 for participating in the study. You will have the option of donating that
money to a local HIV/AIDS foundation.
Is my participation voluntary?
Taking part in this study is voluntary. You have the right to choose not to take part in this
study. If you choose to take part, you have the right to stop at any time. If you refuse or
decide to withdraw later, you will not lose any benefits or rights to which you are entitled.
Who do I talk to if I have questions?
The staff person who recruited you is available to answer any questions you have now.
The researcher carrying out this study is Anne Pendygraft. If you have questions later, you
may call her at 303-556-2794 or you may reach her by e-mail at
anne.pendygraft@email.ucdenver.edu
You may have questions about your rights as someone participating in this study. You can
call Anne Pendygraft with questions about your rights. You may also call the University of
Colorado at Denvers Human Subject Research Committee (HSRC) at 303-315-2732.
40


Who will see my research information?
We will do everything we can to keep your records a secret. It cannot be guaranteed.
The data collected from this survey may be looked at by others. All of these data will be
anonymous. The people who could see the data are:
People at the Colorado Multiple Institutional Review Board (COMIRB)
Officials at the University of Colorado Denver who are in charge of making sure
that we follow all of the rules for research
We will NOT be asking your name at any point during the study. Because some of
the questions are sensitive, we want to protect the confidentiality of your answers.
You will be given a copy of this form to keep.
41


APPENDIX D
Fecha: Valido para el Uso Por:
Estudie Titulo: La toma de Decisiones Psycosocial detras de Practicas Mas
Seguras de Sexo Entre Hombres que Tienen Relaciones Sexuales con
Hombres.
Principal Investigador: Anne Pendygraft, B.A.
HSRC no: 09-0119
La Fecha de la version: 2/8/2009
Version no: 1
Usted es pedido estar en un estudio de investigacion. Esta forma le proporciona con <
informacidn sobre el estudio. Un miembro del equipo de investigacion le describira este
estudio a usted y contestara todas sus preguntas. Lea por favor la informacion debajo de y
haga preguntas acerca de algo usted no comprende antes decidir si ni no tomar parte.
Esta investigacion es realizada por la Universidad de Colorado en Denver.
i,Por que es hecho este estudio?
Este estudio planea aprender mas acerca de toma de decisiones conductas sexuales
circundantes entre hombres que tiene relaciones sexuales con hombres. Este estudio
quiere aprender mas acerca de por que hombres escoge entrar en algunas conductas y no
en otros. Concentra especificamente en los factores culturales que rodean estas
conductas. La informacion que usted proporciona nos puede ayudar desarrollamos
intervenciones para reducir peligros para la salud en la comunidad alegre y bisexual.
Usted es pedido participar porque usted es un hombre alegre o bisexual.
Hasta 300 hombres tomara parte en el estudio. Esta investigacion es pago por la
Universidad de Colorado Denver.
i,Que sucede si uno este estudio?
Si usted une el estudio, usted sera pedido completar un cuestionario que hace preguntas
acerca de conducta sexual, las actitudes acerca de revelation de estatus de VIH, VIH que
prueba, y preferencias sociales y culturales. La mayoria de los hombres completan el
cuestionario en 15-20 minutos.
i,Que es las molestias o los riesgos posibles?
Algunas preguntas preguntan por informacion personal que le puede causar alguna
molestia o desconcierto o usted pueden sentirse que algunos conciernen acerca de su
42


propio riesgo para infecciones sexualmente-transmitidos. Si usted querria hablar con
alguien acerca de esta molestia o concernir, usted puede hablar con la persona que
realiza la inspection. Si nosotros no podemos contestar sus preguntas, nosotros haremos
cada esfuerzo de referirsele a alguien que puede. La Universidad de Colorado no tiene
plan para pagar por herida psicolbgica que podrla resultar de la participation.
^Sere pague esta en el estudio?
Nosotros le pagaremos $5 para tomar parte en el estudio.
iEs mi participacion voiuntaria?
La parte que toma en este estudio es voiuntaria. Usted tiene el derecho de escoger no
tomar parte en este estudio. Si usted escoge tomar parte, usted tiene el derecho de parar
en tiempo. Si usted se niega o decide retirar mas tarde, usted no perdera ningun beneficio
o los derechos a que usted es permitido.
^Quien hablo yo con si tengo preguntas?
La persona del personal que alisto usted esta disponible contestar cualquier pregunta que
usted tiene ahora.
El investigador que llevando a cabo este estudio es Anne Pendygraft. Si usted tiene
preguntas mas tarde, usted la puede llamar en 303-556-2794 o usted la puede alcanzar
por email en anne.pendygraft@email.ucdenver.edu que Usted puede tener preguntas
acerca de sus derechos como alguien tomando parte en este estudio. Usted puede llamar
Anne Pendygraft con preguntas acerca de sus derechos. Usted
tambien puede llamar la Universidad de Colorado en el Comite Sujeto Humano de
Investigation de Denver (HSRC) en 303-315-2732.
i,Quien vera mi information de investigacion?
Haremos todo que podemos para llevar su registros un secreto. No puede ser garantizado.
Nosotros no estaremos preguntando su nombre en ningun punto durante el estudio.
Porque algunos de las preguntas son sensibles, queremos proteger la confidencialidad de
sus respuestas.
Usted sera dado una copia de esta forma a mantener.
43


APPENDIX E
Table 1 Differences in sex practices, risk, and gay identification in Latino MSM and
non-Latino MSM participants.
Latino Non-Latino Significance
Familiar with strategic positioning 34% 17% X2 (1) =6.9, p < .01
Agree that strategic positioning is a safe way to have sex without a condom 70% 40% X2(5) = 30.112,p<.001
Will only have sex with someone who is the same HIV status (serosorting) 27% 52% X2 (2) = 18.259, p< .001
Always disclose HIV status to sex partners 40% 66% X*(3) = 18.235, p< .001
Never disclose HIV status to sex partners 20% 14% Xz(3) = 18.235, p<.001
Has never been tested for HIV 25% 3% /(2) = 26.089, p < .001
Identify sexually as out (i.e. openly gay) 55% 82% /(2) = 23.388, p < .001
Identify as bisexual 20% 4% X2(3)= 17.051, p<.001
Traditional masculine attitudes rating (out of 25) 20.7 18.9 1(266) = 3.79, p < .001
44


Appendix F
Table 2 Relationships between traditional masculine attitudes (TMA), public health risk behaviors, and acculturation in Latino MSM
Variable Endorsement of TMA Rate of HIV disclosure HIV test rate Likelihood to Accult give info to health dept
1. Endorsement of TMA -
2. Rate of HIV disclosure -.323** --
3. HIV test rate -.276** ' .264** --
4. Likelihood to give out information to health department to inform sex partners of HIV status -.22* .323** -.027
5. Acculturation to mainstream culture -.461** . .085 -.157 .064
N = 143. Correlations represent Spearmans rho. *p< 05, **p<.01.


Appendix G
Table 3 Relationships between traditional masculine attitudes (TMA), public health risk behaviors, and acculturation in Latino MSM
controlling for insertive vs. receptive tendencies
Variable Endorsement of TMA Rate of HIV disclosure HIV test rate Likelihood to give information to health dept Acculturation
1. Endorsement of TMA -
2. Rate of HIV disclosure -.347** - -
3. HIV test rate -.123 .241* -
4. Likelihood to give out information to health department to inform sex partners of HIV status -.177 .33** -.038 --
5. Acculturation to mainstream culture -.516** .031 -.092 .064 -
N = 143. Correlations represent Spearmans rho. *p<.05, **p<01.


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