by Jordan Wingate
This article originally appeared in the School of Social Work 2024 Spring Impact Report.
“What keeps high-risk people from accessing proven HIV treatments?” asks University of North Carolina at Chapel Hill School of Social Work associate professor Rainier Masa. “For Latino sexual minority men, a big factor is stigma.”
So how to reduce stigma’s impact on HIV prevention and testing among Latino sexual minority men?
A research team led by Masa (PI) is pursuing an answer through Gay Latinos Organizando Resiliencia Interseccional en Acción (GLORIA): an NIH-funded study (R21MD016356; $414,553) that combines community expertise with rigorous analysis to learn about experiences of and protective factors against the stigma faced by young Latino sexual minority men in central North Carolina.
This timely study is racing to address the disproportionately high rate of HIV infection today among Latino sexual minority men (e.g., gay, bisexual, men who have sex with men), who in 2021 accounted for 23% of all new HIV diagnoses in the United States and 33% of new diagnoses among all sexual minority men.
Facing the prospect of intersectional stigma (e.g., related to race, sexual identity, or health conditions such as HIV and substance use disorder), many may choose to reduce or avoid using biomedical preventions (e.g., PrEP) for HIV, a choice which, beyond increasing their chances of contracting HIV, can also have consequences for their mental and behavioral health.
“This project will tell us for the first time what strengths-based behaviors and practices young Latino sexual minority men use to adhere to HIV preventive behaviors, and how we can harness those strategies,” Masa said. “This alone should tell you that, despite their disproportionate HIV burden, few studies have sought to understand their experiences.”
One reason why the U.S.’s Latino sexual minority male community remains understudied is that it is difficult to recruit community members into studies in the first place, due in part to concerns about immigration status and confidentiality. Driving outreach through the networks of the research team’s community partner, El Centro Hispano, the state’s oldest Latino-serving organization, proved pivotal.
“At fairs, churches, nightclubs, and every time we had any event with the community, I was recruiting,” said Orlando Martinez, El Centro’s LBGTQ+ Community Specialist.
Successful recruitment allowed Masa’s team to convene eight focus group discussions with 25 participants (18-24 years old) about common contexts and effects of stigma. After these discussions, the team identified and individually interviewed 15 “positive deviants” — those who exhibited adaptive strategies for overcoming stigma, remaining resilient and maintaining HIV prevention behaviors — to learn what behaviors and resources build resilience and improve the health of young Latino sexual minority men.
With input from a Youth Advisory Board and El Centro representatives, the research team developed multiple video vignettes illustrating common themes from the focus groups and interviews. Pivoting to the project’s next phase, the research team is using the vignettes in new focus groups to spark conversations about what young Latino sexual minority men need to overcome challenges related to stigma and discrimination.
“We’re harnessing the strategies positive deviant youth use to protect their wellness in face of multiple stigmatizing experiences,” said Masa. “Ending the U.S.’s HIV epidemic means we have to learn how to address stigma and its impact, and these youth are helping us do that.”
To do so, the project team plans to pilot an intervention built on learning from positive deviant interviews, group discussions, and service provider input. Planned testing sites include central N.C. and metro Atlanta, as both areas’ Latino immigrant populations continue to increase despite the relative scarcity of culturally and linguistically trained health and social providers compared to other areas of the country.
“Many of the young men in our study have only been in the U.S. for a few years,” Masa said. “Their need for information is even greater because they’re often not familiar with the medical system and the service system.”
