SYNDEMICS AND HIV TESTING AMONG HISPANIC/LATINO GAY AND BISEXUAL MEN
MetadataShow full item record
Hispanic/Latino gay and bisexual men (HLGBM) are especially vulnerable to HIV acquisition compared to their heterosexual counterparts. In an era of treatment as prevention, HIV testing is a crucial point to link individuals with HIV infection to treatment and healthcare services. In this dissertation, I addressed three specific aims: 1) to assess the prevalence of mental health conditions and socioeconomic risk factors among HLGBM comparing those who have and have not been tested for HIV; 2) to examine the applicability of syndemic theory to HIV testing among HLGBM; and, 3) to assess whether race/ethnicity modifies the association between health care access and socioeconomic factors with HIV testing in gay and bisexual men (GBM). In Aim 1, bivariate associations indicated that depression (prevalence ratio [PR]=1.36; 95% CI: 1.12, 1.64) and frequent high stress (PR=1.23; 95% CI: 1.02, 1.49) were associated with a higher prevalence of HIV testing, whereas poverty was associated with a lower prevalence of HIV testing (PR=0.64, 9% CI: 0.55, 0.75). In an adjusted model that included all mental health and demographic variables including age, marital status, health insurance status, access to a personal doctor, and education, only poverty status maintained an association with HIV testing at p<.05 (PR=0.77, 95% CI:0.65, 0.92). In Aim2, results from interaction tests supported the application of syndemic theory to HIV testing (p-values <.05 for all pair-wise interactions between risk factors). We used strata-specific estimates to display the synergistic relationships between combinations of risk factors, adjusted for demographic characteristics. For example, individuals who were poor and had a mental health condition (i.e., depressive disorder, heavy alcohol consumption, frequent high stress) had a lower prevalence of HIV testing relative to those with poverty or a mental health condition alone (e.g. among HLGBM living in poverty, those who were heavy drinkers had 0.16 (95% CI: 0.05, 0.54) times the prevalence of having an HIV test compared to those were not in poverty and not heavy drinkers). In Aim 3, analyses revealed that race/ethnicity modified the associations between health care access and socioeconomic factors with HIV testing (all p-values <.05). In adjusted models stratified by race/ethnicity, poverty was associated with HIV testing among Black GBM (PR=1.21; 95%CI 1.06, 1.38) and White GBM (PR=0.86; 95% CI: 0.80, 0.93) in opposite directions; and, having a personal doctor was associated with a higher prevalence of HIV test among Hispanic/Latino GBM only (PR=1.30; 95% CI: 1.10, 1.53). Taken together, results from these studies suggest that sociodemographic factors and mental health conditions facing HLGBM work in tandem and contribute to syndemic conditions; being White and having insurance, having a personal doctor, as well as higher household income were protective, which advance knowledge about HIV testing among GBM. Findings from this study further support addressing racial disparities in health care access and improving socioeconomic conditions, which together may promote HIV testing uptake among high-risk populations.