AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #279 - The role of racism and homophobia in explaining racial/ethnic disparities in HIV infection among U.S. ethnic minority men who have sex with men (MSM)
Authors: Presenting Author: Prof Kyung-Hee Choi - University of California, San Francisco
Additional Authors: Dr. George Ayala, Dr. Jay Paul, Dr. Ross Boylan, Dr. Steven Gregorich,
Aim: Researchers have suggested that discrimination may help explain racial/ethnic disparities in HIV infection. However, few studies have examined the associations between various forms of discrimination and HIV infection and identified which forms of discrimination may contribute to such racial/ethnic disparities among U.S. MSM of color.
Method / Issue: A chain-referral sample of 403 African American, 393 Asian and Pacific Islander (API), and 400 Latino MSM (aged 18+) was recruited in Los Angeles County, CA from May 2008 to October 2009. Participants were asked about their HIV serostatus, lifetime experiences of racism and homophobia within the general community, perceived racism within the gay community, and perceived homophobia among heterosexual friends and within the family, using an audio computer-assisted self-interview (ACASI) system. We conducted GEE logistic regressions pooled across all three ethnic groups to examine associations of racism and homophobia with self-reported HIV serostatus, controlling for age, nativity, marital status, sexual orientation, education, and lifetime history of incarceration, sexually transmitted infection and injection drug use.
Results / Comments: In our sample, self-reported HIV prevalence was 51% among African Americans, 43% among Latinos, and 14% among APIs. HIV infection was positively associated with perceived racism within the gay community (OR = 1.32, 95% CI, 1.12-1.55) and lifetime experiences of homophobia within the general community (OR = 1.20, 95% CI, 1.06-1.35), but was negatively associated with experiences of racism within the general community (OR = 0.79, 95% CI, 0.72-0.88). No statistically significant association was observed for perceived homophobia among heterosexual friends (OR = 0.87, 95% CI, 0.73-1.04) and within the family (OR = 0.85, 95% CI, 0.69-1.05). In corresponding models including covariates, but excluding discrimination measures, we observed a statistically significant association between race/ethnicity and HIV infection: the odds ratio for HIV infection of African Americans relative to APIs was 1.72 (95% CI, 1.35-2.20), for Latinos relative to APIs was 1.37 (95% CI, 1.07-1.77), and for African Americans relative to Latino was 1.25 (95% CI, 0.83-1.90). After adding all five discrimination measures, the odds ratio for HIV infection of African Americans relative to APIs was 1.87 (95% CI, 1.47-2.42), for Latinos relative to APIs was 1.38 (95% CI, 1.05-1.81), and for African Americans relative to Latinos was 1.37 (95% CI, 0.87-2.14).
Discussion: Racial/ethnic differences in HIV infection rates were not explained by experienced discrimination. Our data do indicate that the associations between discrimination and HIV infection vary depending upon type: higher levels of perceived racism within the gay community and experiences of homophobia within the general community appear to heighten risk for HIV infection, but higher levels of experienced racism in the general community appear to lower risk for HIV infection. More research is needed to better understand the mechanisms through which various forms of discrimination may augment or diminish the risk of HIV infection among MSM of color in the U.S.
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