THAD0502 - Oral Abstract
Homophobia and access to HIV services among young men who have sex with men (YMSM)
Presented by Glenn-Milo Santos (United States).
G.-M. Santos1,2, J. Beck3, P. Wilson4, P. Hebert3, G. Ayala3
1University of California, San Francisco, School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, United States, 2San Francisco Department of Public Health, HIV Prevention and Research Section, San Francisco, United States, 3Global Forum on MSM & HIV (MSMGF), Oakland, United States, 4Columbia University, Mailman School of Public Health, Department of Sociomedical Sciences, New York, United States
Background: Globally, YMSM are uniquely vulnerable to HIV. Many are dependent on family that may not understand or accept their sexuality, forcing them to hide their sexual behavior or risk losing housing and financial support. YMSM also may have limited access to information regarding sexual health and legal rights. Despite this vulnerability, YMSM's distinct needs are often overlooked by efforts to address HIV among general youth and general MSM.
Methods: In 2010, the Global Forum on MSM & HIV (MSMGF) conducted a global online survey of MSM and their service providers. Among 5,066 survey participants, 1,488 were YMSM (age 30/younger). YMSM respondents were from: Asia (65%), Latin America (10%), Australasia (9%), North America (6%), Europe (4%), and Africa (3%). Chi-square and Wilcoxon rank-sum were used to evaluate differences between YMSM and other MSM. Multivariable regression was used to identify predictors of access to HIV prevention services.
Results: HIV-prevalence among YMSM was 14%. Most YMSM (67%) had two or more sexual partners in the past year; 33% were homeless/unstably housed. Compared to other MSM, YMSM reported lower “easy access” to evidence-based HIV prevention strategies: free HIV testing (53% vs. 37%[p< 0.001]), condoms (47% vs. 36%[p< 0.001]), lubricants (33% vs. 21%[p< 0.001]), HIV behavioral interventions (38% vs. 21%[p< 0.001]). Compared to other MSM with HIV, YMSM with HIV reported lower “easy access” to antiretroviral medications (59% vs. 33%[p< 0.001]). YMSM also had significantly higher levels of perceived homophobia (p< 0.001) and internalized homophobia (p< 0.001) than other MSM. Perceived homophobia was the strongest predictor (0.38; 95% CI=0.3-0.4) of compromised access to HIV prevention services among YMSM.
Conclusions: YMSM are at increased risk for HIV due to a number of factors. Limited access to HIV services and high levels of homophobia may exacerbate vulnerability. Programs must be developed to address the unique needs of YMSM.
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