Migration Experiences of HIV-Positive, English-Speaking, West Indian men who have sex with men in New York City

Background: West Indian men who have sex with men (WIMSM) often migrate to the US to escape the social injustices (stigma, homonegativity, heterosexism) sustained in their countries of origin. These social injustices often contribute to their inhibited pre-migration sexual experiences, which, in turn, may affect sexual risk behavior in their post-migration gay-friendly, social spaces.

Methods: We conducted in-depth, semi-structured interviews with 20 WIMSM recruited from 5 types of social spaces in NYC to explore their pre- and post-migration experiences. Data were analyzed using a modified grounded theory approach with QSR NVivo 8.

Results: WIMSM reported a heightened sense of stigma and homonegativity in their countries of origin, reinforced by religious beliefs. This led to sexual inhibition (sexual secrecy, masking of sexuality through heterosexual relationships, and periods of sexual abstinence) as a coping mechanism. Most men reported migrating to the US to escape homonegativity and heterosexism, and to achieve greater sexual freedom. Opportunities in the US to frequent gay-friendly social spaces were seen as liberating and conducive to exploring one's sexuality. However, men reported they were less likely to HIV disclose (fear of inciting physical violence) and initiate condom use (sign of being HIV+) in such settings.

Conclusion: We need to better understand the consequences of pre-migration experiences in planning effective interventions for WIMSM migrants. Because these pre-migration experiences often shape post-migration sexual risk behavior, we need to focus on the intersection of pre/post-migration experiences to reduce HIV acquisition and transmission in the US areas to which WIMSM migrate.