Sociocultural Stigmas Provide Barriers to Sexual Health in Gay and Bisexual Latinos

Lucy Hicks

November 18, 2021

Religion and masculine ideology remain significant social cultural barriers to sexual health in Latino gay or bisexual men, according to new qualitative research presented at the 2021 Association of Nurses in AIDS Care (ANAC) conference. The pilot study also found that these men learned more sexual health information from friends and social networks than from their healthcare professionals.

Lisvel Matos

"There's still so much we do not know about cultural factors and the different levels of influence that shape sexual health promotion beliefs among Latinos, but moreover in Latino same-gender loving men," lead author Lisvel Matos, MSN, FNP-C, WHNP-BC, a PhD candidate at Duke University School of Nursing, in Durham, North Carolina, told Medscape Medical News. Matos prefers the term same-gender-loving men (SGLM) over men who have sex with men (MSM), as the latter term is more clinical and can be stigmatizing, she said.

In Matos' 10 years of working in nursing, she noticed that this lack of understanding about sexual health in Latino SGLM impeded culturally relevant interventions in this population. "When we don't have the evidence to show what's effective for these populations," she said, "then we're kind of working blind."

To get a better sense of social cultural barriers that influence sexual health, Matos and colleagues conducted 60- to 75-minute interviews with Latino SGLM through the secure web conferencing app WebEx from October 2020 to October 2021. The study used the World Health Organization's definition of sexual health: "a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity." The pilot study included 15 individuals, eight of whom were born outside of the United States. The mean age of participants was 31.4 years, and 47% reported being single and sexually active. 93% of participants said they were aware of pre-exposure prophylaxis (PrEP), and 47% reported using PrEP.

Matos identified three common themes in barriers to sexual health in these men: sexual silence, religion, and machismo, a term meaning aggressive masculine pride and patriarchal ideas of manhood. "Because of social constructs, because of what it meant to be a man, [sexual health] was a very difficult subject in adolescence," said one participant in a quote included on the poster. "I definitely believe in Christianity, and I think that has affected my sexual preference," said another quoted individual. "It came into that Catholic guilt where you always feel bad."

More than half of the study participants reported not having access to healthcare at one time in their life, because of lack of insurance or other factors such as feeling uncomfortable or even dehumanized by healthcare professionals. Most men said they learned about sexual health, including PrEP, from dating apps like Grindr or friend-based social media platforms rather than in care settings. Matos, who presented the study at the conference, received the Student Poster Research Award for her work.

Dr Dalmacio Flores

The findings are "a good reminder for providers" that these barriers, which have been identified for decades, are still major impediments to sexual health in Latino SGLM, both individually and at the clinic level, Dalmacio Dennis Flores, PhD, ACRN, an assistant professor at the University of Pennsylvania School of Nursing in Philadelphia, told Medscape. He was not involved with the work. "We need to be in a space to normalize their attractions, behaviors, and identities and then help them to be more confident about it," he noted. Self-confidence as well as trust in sexual partners and health providers were factors that helped these men overcome this negative messaging and sociocultural stigmas, Matos found.

Dr Kamila Alexander

"The fact that [the researchers] have individual level data about the experiences of this group of men can inform how we develop clinic-level structures that can, for example, promote trust with the provider," added Kamila Alexander, PHD, MPH, RN, an assistant professor and associate director of PhD and Postdoctoral Programs at the Johns Hopkins School of Nursing in Baltimore, Maryland.

Alexander, who was not involved with the research, added that the small study is a good starting point to better inform culturally relevant care for populations marginalized by society, like Latino SGLM, and to challenge engrained stereotypes around religion, masculinity, and sexuality. The researchers "highlighted these intersectional stigmas that have a lot to do with structural factors," she said, "and those things are really ripe for intervention."

Matos, Flores, and Alexander have disclosed no relevant financial relationships.

Association of Nurses in AIDS Care (ANAC) 2021. Presented
November 11, 2021.

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