Guatemalan gay men and MSM identify what is needed to promote sexual health and prevent HIV: An ecological framework

Background: Guatemala has a concentrated and rapidly accelerating HIV epidemic. Prevalence estimates of HIV infection among MSM range from 11-18%.

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

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 identified 13 intervention approaches to target intra- and interpersonal factors identified as contributing to sexual risk, including programming based community-identified assets; filling knowledge gaps; and offering safe spaces for facilitated supportive MSM group dialogue around masculinity/machismo; sexual scripts; family, religious, and societal expectations; intimacy; and intragroup discrimination.

We also identified 5 intervention approaches to target community, institutional, and public policy factors, including the development of safe housing, vocational training, and educational opportunities. Finally, we identified 4 approaches to target all factors, including the incorporation of Mayan values.

Conclusions: Guatemalan MSM remain a neglected population in need of culturally congruent programming. We identified intervention approaches and characteristics that may be useful to guide intervention development to reduce sexual risk and promote sexual health, using an ecological perspective.