Understanding the sexual health of gay men and MSM in Guatemala City: Formative research findings blending focus groups and individual in-depth interviews

Background: Guatemala has a concentrated and rapidly accelerating HIV epidemic. Prevalence estimates of HIV infection among men who have sex with men (MSM) range from 11-18%. Because of limited resources, Central America countries, including Guatemala, focus on medical care of persons living with HIV rather than prevention.

Methods: Our community-based participatory research (CBPR) partnership in NC designed and implemented this study in partnership with Guatemalan leaders to explore HIV risk among Guatemalan MSM. Focus groups and in-depth interviews were conducted with Guatemalan MSM, audio recorded, and transcribed verbatim. Partners used open coding and organized data into themes and domains.

Results: Participants included 87 focus group and 10 in-depth interview participants. Mean age of participants was 27 years old (range 18-60). All reported sex with men within the past 3 months; 74% self-identified as gay; 22%, as bisexual; and 4%, as heterosexual.

We organized qualitative themes into 5 ecological domains: (1) intrapersonal (e.g., misconceptions about HIV transmission/prevention, negative perceptions about condoms, low perceived susceptibility, internalized homo-negativity); (2) interpersonal (e.g., family rejection, need for love, arousal associated with non-condom use); (3) community (e.g., intra- and intergroup discrimination, lack of accessible low-cost condoms); (4) institutional (e.g., lack of MSM-affirming clinics/providers, rejection by church); and (5) public policy (e.g., anti-homosexual political rhetoric, lack of perceived confidentiality).

Conclusions: This study provides preliminary data describing the factors that contribute to HIV risk among Guatemalan MSM, a vulnerable and neglected population. These results also inform future studies to better understand and promote sexual health among Guatemalan MSM.