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Homophobia and Access to HIV Services among Young Men Who Have Sex with Men (YMSM)

Homophobia and Access to HIV Services among Young Men Who Have Sex with Men (YMSM). Glenn-Milo Santos, PhD(c ), MPH HIV Prevention Section, San Francisco Department of Public Health Department of Epidemiology and Biostatistics, University of California, San Francisco Co-authors:

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Homophobia and Access to HIV Services among Young Men Who Have Sex with Men (YMSM)

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  1. Homophobia and Access to HIV Services among Young Men Who Have Sex with Men (YMSM) Glenn-Milo Santos, PhD(c), MPH HIV Prevention Section, San Francisco Department of Public Health Department of Epidemiology and Biostatistics, University of California, San Francisco Co-authors: Jack Beck(1), Pato Hebert(1), Patrick Wilson(2), George Ayala(1) Global Forum on MSM and HIV (MSMGF) Columbia University, Mailman School of Public Health, Department of Sociomedical Sciences XIX International AIDS Conference | Thursday, 26 July 2012 | AN: THAD0502

  2. Background Youth: Financial Dependence Limited legal rights Lower perception of risk Sexual Debut Limited access to sexual health info/services MSM: Homophobia Stigma Criminalization Violence YMSM

  3. HIV Prevalence Among Men who have Sex with Men (MSM) Compared with HIV Prevalence in the General Population (Aged 15 and over) in 36 Low- and Middle-Income Countries YMSM? Disaggregated data on MSM age-groups? -Beyrer C, Epidemiol Review. 2010

  4. Conceptual Model – Stigma, Homophobia and Increased Vulnerability to HIV - Ayala G et al, 2010

  5. Methods • In 2010, the Global Forum on MSM & HIV (MSMGF) conducted an online global survey of MSM and their service providers. • 12 constructs measured including: • Perceived stigma/external homophobia • Internalized homophobia • Self-esteem • Access to basic HIV prevention services • Chi-square and Wilcoxon rank-sum were used to examine differences between YMSM and other MSM. • Multivariable regression was used to identify predictors of access to HIV prevention services (e.g. condoms, lubricants, HIV testing and counseling). Patrick Wilson Glenn-Milo Santos Pato Hebert George Ayala

  6. Sample Characteristics • Among 5,066 survey participants, 1,488 were YMSM (age 30/younger). • Median age among YMSM: 25 (IQR: 22-28) • YMSM respondents were from: • Asia (65%) • Latin America (10%) • Australasia (9%) • North America (6%) • Europe (4%) • Africa (3%). • 14% HIV-prevalence • 67% had two or more sexual partners in the past year • 33% were homeless/unstably housed • 24% were from “low income” or impoverished backgrounds • 34% have never been tested for HIV (45% in the last 6 months) • 89% have sex with men only • 85% identify as gay

  7. YMSM vs. Other MSM (over 30) *All chi-square P<0.001

  8. YMSM: How would I describe the way MSM are treated in my country?

  9. YMSM: In the country I live in, most people think…

  10. YMSM: Internalized Homophobia

  11. Multivariable Regression ModelOutcome: Accessibility of HIV Prevention Services *increase in both internalized homophobia and externalized homophobia independently predict decreased access to HIV prevention services

  12. Conclusion • YMSM are at increased risk for HIV due to a number of factors. • have limited access to HIV services • access less widespread compared to older MSM • experience high levels of homophobia • combination of social factors and lack of access exacerbate vulnerability. • More tailored programs are needed to address the unique needs of YMSM • Internal and External Homophobia are both independent acts as barriers to HIV prevention among YMSM • Need to address homophobia to improve HIV prevention uptake

  13. Acknowledgements:The Global Forum on MSM and HIV (MSMGF)&MSMGF Youth Reference Group The Global Forum on MSM & HIV (MSMGF) is an expanding network of AIDS organizations, MSM networks, and advocates committed to ensuring robust coverage of and equitable access to effective HIV prevention, care, treatment, and support services tailored to the needs of gay men and other MSM. As part of the MSMGF’s commitment to young MSM, the MSMGF Secretariat supports a Youth Reference Group with YMSM advocates from Jamaica, Peru, Kenya, Guyana, Paraguay, Lebanon, Armenia, Singapore, Egypt, Nigeria, Ireland, and the United States. The Youth Reference Group works to advocate and empower YMSM through skills building, cross networking and meaningful participation in the decision-making processes that affect YMSM.

  14. Acknowledgements: • Co-authors: Jack Beck, Pato Hebert, Patrick Wilson, George Ayala • Funded by the Bill and Melinda Gates Foundation • MSMGF Youth Reference Group • MSMGF Scientific Writing Group members: • Sonya Arreola , George Ayala, Tri D. Do, Pato Hebert, Tom Pyun, Keletso Makofa, Patrick Wilson • Survey Respondents

  15. Strengths and Limitations • Convenience Sample • Selection Bias • Self-reported data • Adds to the body of literature on YMSM • Large, Diverse sample size of YMSM • Standardized Annonymous Questionnaire to reduce social desirability bias • Scales with high internal validity (alpha>0.9)

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