Challenges of developing research on stigma among HIV-positive gay men and other men who have sex with men in Puerto Rico

Background: The estimated HIV incidence rate in Puerto Rico (PR) is 45.0 cases per 100,000 population, twice the rate for the 50 U.S. states and District of Columbia (DC). Socio-behavioral risks are significant contributors to the continuing HIV epidemic on the island. Despite the substantial prevalence of HIV men who have sex with men (MSM) in PR, there is very limited assessment of social and behavioral determinants of HIV risk in this group. Anecdotal data suggest that HIV-related stigma and gay/MSM-stigma affect both the provision of healthcare services for gay men and MSM, and the implementation of socio-behavioral research on the island. Methods: We conducted focus groups with two community advisory boards and interviews with eight key informants (4 MSM and 4 healthcare providers) at HIV clinical settings in PR to examine stigma. We reviewed the data using content and discourse analyses for common themes. Results: We found that different types of stigma were present based on individuals' sexual orientation/identity and HIV status. These forms of stigma create barriers for collaborations between institutions to implement HIV-related research activities. Stigma also affects the ability to recruit and retain both MSM and HIV-positive participants in research. Conclusions: Findings suggest that unique approaches, such as the use of stigma-reducing strategies to recruit gay-identified MSM and non-gay MSM, protect confidentiality, and foster institutional collaborations, are needed for HIV prevention research. Activities are needed to continue building culturally appropriate research capacity that is responsive to the needs of ethnic minority communities and researchers.