Metrics of sexual behavior stigma among cisgender men who have sex with men in Mexico: exploratory and confirmatory factor analyses

• Type of Material: Article
• Authors: John Mark Wiginton, San Diego State University; Sarah M Murray, Johns Hopkins Bloomberg School of Public Health; Angel B Algarin, University of California, San Diego; Stefan D Baral, Johns Hopkins Bloomberg School of Public Health; Travis Sanchez, Emory University; Laramie R Smith, University of California, San Diego
• Language: English
• Date: 2022-12-01
• Publisher: BMC
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2022
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12879-022-07672-0
• Title of Journal or Parent Work: BMC Infectious Diseases
• Volume: 22
• Issue: 1
• Start Page: 690
• End Page: 690
• Grant/Funding Information: This research was supported by the San Diego Center for AIDS Research (SD CFAR), an NIH-funded program (P30 AI036214), which is supported by the following NIH Institutes and Centers: NIAID, NCI, NHLBI, NIA, NICHD, NIDA, NIDCR, NIDDK, NIGMS, NIMH, NIMHD, FIC, and OAR.; LRS acknowledges support from the NIDA under Grant number K01DA039767 and the NIMH under Grant number R01MH123282.; ABA acknowledges support from NIDA under Grant number T32DA023356.
• Keywords: Sexual and Gender Minorities; HIV Infections; Homosexuality, Male; Factor analysis; Humans; Mexico; Men who have sex with men; Social Stigma; Sexual Behavior; Factor Analysis, Statistical; Benchmarking; Sexual behavior stigma; Male; Construct validity
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

Cisgender gay, bisexual, and other men who have sex with men (MSM) in Mexico experience disparities in sexual health outcomes, perhaps most notably in HIV prevalence, HIV testing and status awareness, and condom use. Sexual behavior stigma, underpinned by socio-structural factors specific to Mexico (e.g., machismo), uniquely shapes these sexual health disparities. However, few reliable, valid measures are available to document, track, and ultimately mitigate sexual behavior stigma in this context. Exploratory and confirmatory factor analyses were performed on responses to a 13-item sexual behavior stigma scale from 15,681 MSM recruited online across Mexico. Associations with extracted factors were tested to assess construct validity. Three subscales were identified in exploratory factor analysis and validated in confirmatory factor analysis: “stigma from family and friends” (α = 0.65), “anticipated healthcare stigma” (α = 0.84), and “general social stigma” (α = 0.70). External construct validity was indicated through each subscale’s strong association (all p < 0.001) with perceived community intolerance of MSM and perceived community discrimination toward people living with HIV. These subscales show promise as reliable, valid measures for assessing sexual behavior stigma among MSM in Mexico, and as tools for documenting and tracking sexual behavior stigma trends, comparing regional burdens of sexual behavior stigma, and tracking the progress of stigma-mitigation interventions among MSM in Mexico. Future research is needed to understand the extent to which each subscale is differentially associated with sexual (and other) health outcomes, which can inform the development and implementation of uniquely tailored stigma-mitigation, HIV-prevention, HIV-care, and other needed interventions for MSM in Mexico.