Examining the logic of risk among behaviorally bisexual Latino men

Background: Behaviorally bisexual men have been identified as critical nodes in the transmission of HIV between heterosexual and homosexual sexual networks, but have been underrepresented in prevention research. Studies focusing on behaviorally bisexual Latino men have been particularly lacking, despite data indicating that Latinos are disproportionately affected by HIV/AIDS. Methods: The Latino BiCultural Project is a four-year, mixed methods study of the determinants of HIV risk among behaviorally bisexual Latino men. The study includes: cross-sectional surveys and open-ended interviews with bisexual Latino men (n=160) in five urban communities; ethnographic observations of social spaces occupied by bisexual Latino men; key informant interviews (n=50); and group interviews with HIV/AIDS service providers (n=25). Results: Findings from the first year of the study suggest that socio-cultural factors intersect with structural inequalities to create determinants of HIV risk that are unique to bisexual Latino men. Cultural ideologies regarding the centrality of family and religion, as well as societal perceptions of Latino masculinity and bisexuality, facilitate risky sexual practices and inhibit access to prevention services, resulting in heightened HIV risk. Conclusions: Many of the previous HIV prevention studies and interventions derived from them focused largely on individual-level determinants of risk and behavior-based prevention strategies. Preliminary findings from this study, however, suggest that for behaviorally bisexual Latino men, the most salient determinants of risk operate at the environmental, rather than individual, level and thus are not likely to be affected by behavior-based interventions. Empirically-based structural interventions are needed to reduce HIV risk among this critical bridge population.