Protective Factors and Risk Factors of HIV Infection in Mexican-American Gay Men, Research Paper Example

In the Mexican-American community, there is a significant emphasis placed upon a culture which is grounded in core values and principles that are traditionally conservative and surround the family unit. For gay Mexican-American males, there is much stigma regarding these behaviors because they do not conform to familial and cultural expectations for males, who are typically destined to become married to females and have children. Therefore, it is likely that many gay males within this population group do not express their true identities and may engage in high risk or deviant behaviors due to lack of acceptance of their beliefs and sexual orientation. Some of these high risk behaviors may include unprotected sex with other males, thereby leading to a greater risk of HIV infection. It is necessary to identify some of the issues that are prevalent for this population and how their cultural values, norms, and expectations impact their behaviors and HIV risk. The following discussion will address the challenges associated with gay Mexican-American males and their risk of HIV as associated with cultural and other critical concerns that lead to negative and high risk behaviors for many men within this population group. The proposed qualitative research study will explore the psychosocial and cultural factors that may lead to high risk behaviors for HIV. A focus group method will be employed in order to identify patterns in beliefs and behaviors that may lead to an increased risk of HIV for this population.

Legal and Ethical Issues

In order to begin this type of study, human subject approval must be obtained to ensure that the study is safe and is without risk for its participants. Prior to study inception, an IRB protocol was written and approved by the IRB committee in order to ensure that the study is safe and does not pose any real risk or threat to its subjects. In addition, before the focus group began, it was necessary to obtain informed consent from each participant, which provide them with information regarding the study and how the information obtained would be managed. This ensured that study participants are fully aware of the study and any possible risks that might be imposed. In addition, the informed consent provides information regarding the data that will be collected and how each participant will be protected from being specifically identified in future research articles. The general nature of the proposed study is designed to reduce risks and to optimize benefits for its participants, and no participant will be coerced into participation. All subjects have the right to withdraw from the study at any time without penalty. The nature of this population is vulnerable; however, no participants who were at risk of additional harm were selected. Finally, the privacy of subjects will be protected at all times and in future research, subjects will be de-identified and will not be named.

Statement of the Phenomena of Interest

Mexican-American gay men face many critical challenges and a potentially high risk of HIV infection. This is due to the cultural and psychosocial issues that this population faces due to highly traditional cultural beliefs and backgrounds. These findings suggest that males in this group are likely to resort to high risk behaviors in spite of their culture and their beliefs, in spite of the risks that are likely to occur. Therefore, it is necessary to evaluate the conditions that drive these behaviors within the Mexican-American community.

The use of a qualitative method for a study of this nature is essential because it reflects a capacity to obtain greater insight through discussion-based approaches regarding the topic rather than to use quantitative statistics. The nature of the issue in question mandates a qualitative-based approach rather than a quantitative-based framework. The focus group is designed to encourage individuals to communicate within this setting and to share information with each other in order to generate information regarding specific experiences and the behaviors that they choose (Unknown Author, 1995). This is an important and meaningful tool in order to better represent the ideas and concepts associated with this population group and the common experiences that they share.

Purpose

The primary purpose of this qualitative research study is to evaluate the behaviors of gay Mexican-American males to determine their role in the risk of HIV infection for this population group. Within this community, there are many experiences associated with racial discrimination and other judgments that may lead to higher risk behaviors in some men (Ibanez et.al, 2012). It is believed that these racist attitudes have a significant impact on many gay males within this community that may lead to negative and high risk sexual behaviors (Ibanez et.al, 2012). In addition, it is perceived that “Despite intentions to practice safe sex and high levels of knowledge about HIV and safe sex, Latino gay/bisexual men engage in some of the highest levels of risky sexual behavior.(6, 7) Investigators attempting to explain these findings have examined possible determinants of increased risky sexual behavior and found that childhood sexual abuse increases HIV-risk” (Grant Arreola et.al, 2009, p. S432). Therefore, it is important to recognize the different issues that lead to higher risk behaviors for many Mexican-American gay men.

For this community, the following was observed: “A probability sample of Latino gay/bisexual men found a high prevalence of psychological distress during the six months before the interview, including, anxiety, depression, and suicidal ideation. Furthermore, experiences of homophobia strongly predicted psychological distress” (Grant Arreola et.al, 2009, p. S432). Therefore, it is important to recognize these risks and how they impact Mexican-American gay men who are likely to also have a greater risk of HIV infection due to their prior experiences and current behaviors (Grant Arreola et.al, 2009). In addition, it is believed that the sources of psychosocial distress experienced by this population may also represent challenges to traditional cultural needs and expectations placed on these men by their families and peers, all of which may contribute to high risk or deviant behaviors that increase the risk of HIV infection for this group (Grant Arreola et.al, 2009).

For this population group, there is a greater tendency to engage in risk-taking behaviors that may lead to negative health outcomes (Stein et.al, 2011). Therefore, it is important to recognize the value of this study in promoting HIV prevention efforts through improved behaviors that do not condone risks (Stein et.al, 2011). In many cases, it is believed that there will be greater risks associated with those males who have been rejected by their families as a result of their sexual orientation, which is also likely to lead to negative behaviors and outcomes (Ryan et.al, 2009). In addition, the prevention of HIV infection is greatest when there are a number of key behaviors in place: “Analysis revealed participants engaging in four behaviours that may actively reduce their HIV risk: approaching sexual agreements from a practical standpoint, maintaining a high literacy around HIV, having exposure to social support groups for Latino gay men, and finding support in their relationship with another Latino gay man” (Beougher et.al, 2011, p. 299). Under these conditions, it is likely that there will be additional issues to consider; however, for those males in committed relationships with other males, there is likely to be a much lower risk associated with HIV because their behaviors indicate stability and knowledge regarding this condition (Beougher et.al, 2011).

Cultural identity and socialization also play a role in shaping HIV risk and infection in gay Mexican-American males, based upon the following premise: “HIV risk for gay men has been linked to the social environment. Gay men active in the bar scene have higher rates of HIV risk behaviors” (Vega et.al, 2012, p. 78). Under these conditions, many males are likely to engage in these behaviors when they are under the influence of alcohol; however, societal issues also play a significant role in these behaviors (Vega et.al, 2012). It is important to recognize these limitations and to address the issues associated with HIV infection for this group and to also consider how social awareness and identity could have a negative impact on this population group, particularly when they face challenges in the home environment, such as stigma or lack of acceptance (Vega et.al, 2012). Therefore, in a social context, there are likely to be significant risks associated with higher risk behaviors and the subsequent risk of HIV infection, and this issue must be addressed through educational interventions and other forms in order to accomplish the desired objectives in this manner (Rhodes et.al, 2010).

For Latino gay males, it is known that “Latino gay men are at increased risk for contracting HIV relative to the general population due to common risk behaviors, psychosocial factors and in particular a specific set of mental health vulnerabilities that are associated with various forms of social discrimination, either perceived or real. Latino gay men have identified homophobia, racism and poverty as key factors affecting their mental health and a study of Latino gay men’s mental health reported high prevalence of suicidal ideation, anxiety and depressed mood associated with feelings of social discrimination” (Vega et.al, 2011, p. 407). These findings suggest that the stigma associated with this culture may play a substantial role in HIV risk for many of these males because they do not feel that they have the support from their families, friends, and communities in this manner (Vega et.al, 2011). Therefore, negative and risky behaviors are likely to occur and may lead to significant challenges throughout this population group and may place them at greater risk of HIV infection over a period of time (Vega et.al, 2011).

For nurses, the prevention of HIV is of primary concern with all population groups. However, for a group with higher risks such as Mexican-American gay males, it is important to recognize the impact of nurses in providing effective education, testing, care and treatment as required to prevent the risk and spread of HIV infection. Nurses provide valuable insight, knowledge, and expertise in reducing the risks of HIV infection and in addressing HIV-related concerns for this group. Nurses also provide evidenced-based insight and information that will effectively contribute to the education of gay Mexican-American males who are at a greater risk for HIV infection.

Method

The chosen method for the proposed research study is the focus group, which is designed to bring individuals with different experiences together in a unified setting to discuss topics of interest and to share experiences with others. This is an appropriate method for the study in question because it provides greater insight into the phenomena of HIV infection for gay Mexican-American males who may engage in behaviors that place them at a higher risk for this disease. It is important to recognize these concerns because this population group has a greater tendency to engage in negative behaviors that may impact their HIV risk over time. The focus group method will bring individuals together with common interests and behaviors so that they are provided with a framework for discussing HIV risk and their own behaviors. The focus group setting is also designed to be sensitive to key population variables and also to demonstrate the ability to garner trust among a group of individuals who share common behaviors and the same cultural identity.

The focus group is particularly instrumental in addressing the latter because it allows participants to share their experiences and to recognize where their behaviors might not be culturally appropriate, given the typical nature of the Mexican-American culture in modern society. In this capacity, it is expected that stigma will be addressed in great detail by focus group participants because it is primary experience of many gay males within this culture (Smit et.al, 2012). For example, “in a survey of HIV-negative gay Latino men, over 50% believed HIV-positive gay men were personally responsible for their HIV status and were more promiscuous than themselves… Additionally, in this study 64% and 82% of respondents respectively stated that their HIV status made it more difficult for them to trust people or worried that sexual partners would reject them” (Smit et.al, 2012, p. 406). This is a complicating factor in gay Mexican-American men and represents a challenge in reducing stigma against this group by friends, family members, and many heterosexuals throughout this community (Smit et.al, 2012). It is important to demonstrate these indicators and how they negatively impact Mexican-American gay men because of their status and to explore the tools that are required to ensure that these men are not stigmatized within their communities and beyond (Smit et.al, 2012).

The proposed inquiry into the psychosocial and cultural factors that lead to higher risk behaviors for HIV infection in Mexican-American gay males is necessary to further evaluate the level of stigma and discrimination that is evident within this segment of the population and in turn, is likely to promote negative and high risk behaviors for many of these men. It is important to address these findings and how they contribute to various outcomes for these males and how they might be contributing factors in increasing the HIV risk for this group. These elements are important indicators of the challenges that Mexican-American gay males face in their daily lives as a result of their status and the issues that they face from family, friends, and other members of their community.

Sample

In order to develop the desired population for a focus group-based study, it is important to determine the different elements and population characteristics that are desired. Most importantly, this population is not derived from a statistical method because there is a clear and concise group of subjects that the researchers are seeking for this type of study. For the sample that will be chosen for the proposed study, gay male participants will be recruited within smaller Mexican-American communities through advertising in local clinics and community-based settings where these men are likely to visit on a regular basis. It is expected that of those who are interested in the study, a smaller group of individuals will be selected to participate, based upon specific requirements and other factors that will contribute to the selection of the desired population. Those who are selected for the study must meet the following criteria: 1) They are of Mexican-American descent; 2) They are self-reporting homosexuals; 3) They are between the ages of 21-49; and 4) They are currently sexually active, either with one partner or several partners. Each of these criteria will lend to the development of the desired focus group environment in order to accomplish the tasks of the research study and to identify specific outcomes for future research studies.

Data Collection

The data collection component of the proposed qualitative study is based upon human and social factors that influence behavioral outcomes. The proposed study will involve a focus group setting, with the moderator asking the group a set of pre-determined questions in English, with a secondary interpreter in Spanish. These questions will focus on specific psychosocial and cultural indicators of the Mexican-American heritage and the relationship of this heritage to homosexuality and HIV infection. The focus group session will be recorded and the information will be evaluated in a separate setting in order to determine specific patterns of behaviors against a set of pre-determined criteria and how they are related to psychosocial and cultural values and beliefs within the Mexican-American population. This data collection technique is important because it reflects a means of understanding the specific challenges of this population and the risks that they face in their daily lives as a result of any stigma that they experience and its role in negative or high risk behaviors associated with HIV.

Data Analysis

The data analysis section of the study will utilize the evaluation of recordings derived during the focus group session and will consider some of the most important factors associated with Mexican-American gay men and their behaviors as related to the risk of HIV infection. The focus group dialogue will be transcribed and will provide additional insight regarding the risks associated with HIV infection for this group of males and how their behaviors are associated with cultural and psychosocial issues or stigma that they experience in their daily lives. All study participants will provide informed consent prior to their participation and will be provide with a framework for discussing their views in a protected fashion. This will demonstrate that the study is safe and does not pose any real risks to its participants. The data analysis will also associate specific concerns of this population group as related to cultural and psychosocial indicators that challenge this group because of their sexual orientation. This also reflects a capacity to develop new ideas and approaches that will determine the association between negative and risk-taking behaviors and cultural and psychosocial impact.

Findings

For the proposed study, it is expected that there will be a strong relationship between the risk of HIV for this population group and behavioral choices as a result of negative cultural and psychosocial experiences and stigma within the Mexican-American community. These efforts will demonstrate that it is necessary to provide positive influences to this group and to enhance educational efforts so that HIV prevention is optimized. It is also important to provide this group with a social environment that will offer support and encouragement to this group during difficult periods when they do not have the support of their families and friends as a result of stigma or other negative beliefs that are associated with traditional core values.

Conclusions, Implications, and Recommendations

The proposed qualitative research study will emphasize the relationship between negative and risk-taking behaviors in gay Mexican-American males and their impact on HIV risk as a product of psychosocial and cultural influences within the home community. It is important to identify this association because it determines how homosexuality remains a negative status in many communities and is not widely accepted when culture and traditions are of critical importance. The implications of this study will demonstrate that improved HIV education and support are necessary for many gay Mexican-American males because they are often unaware of the challenges that they face when they engage in negative behaviors that could place them at risk of HIV. These elements are important indicators of the appropriateness of HIV prevention and educational efforts for this population group and how to educate others within these communities regarding HIV and its risks. In addition, it is recommended that family members and other acquaintances of gay males within this community must be better educated regarding the risks of negative behaviors and HIV infection in the Mexican-American community because improved outreach and support of those with the highest risk may lead to better prevention efforts and a reduction in the number of HIV cases for this population group. These efforts are critical in shaping the lives of gay males and in reducing some of the stigma that they experience in their daily lives.

References

Boeugher, S.C., Gomez, W., and Hoff, C.C. (2012). The couple as context: Latino gay male couples and HIV. Culture of Health and Sex, 13(3), 299-312.

Grant Arreola, S., Neilands, T.B., and Diaz, R. (2009). Childhood sexual abuse and the sociocultural context of sexual risk among adult Latino gay and bisexual men. American Journal of Public Health, 99(Suppl 2), S432-S438.

Ibanez, G.E., Van Oss Marin, B., Flores, S.A., Millett, G., and Diaz, R.M. (2012). General and gay-related racism experienced by Latino gay men. Journal of Latina/o Psychology, 1(S1), 66-77.

Rhodes, S.D., Hergenrather, K.C., Aronson, R.E., Bloom, F.R., Felizzola, J., Wolfson, M., Vissman, A.T., Alonzo, J., Boeving Allen, A., Montano, J., and McGuire, J. (2010). Latino MSM and HIV in the rural south-eastern USA: findings from ethnographic in-depth interviews. Cultural Health and Sex, 12(7), 797-812.

Ryan, C., Huebner, D., Diaz, R.M., and Sanchez, J. (2009). Family rejection as a predictor of negative health outcomes in White and Latino lesbian, gay, and bisexual young adults. Pediatrics, 123(1), 346-352.

Smit, P.J., Brady, M., Carter, M., Fernandes, R., Lamore, L., Meulbroek, M., Ohayon, M., Platteau, T., Rehberg, P., Rockstroh, J.K., and Thompson, M. (2012). HIV-related stigma within communities of gay men: a literature review. AIDS Care, 24(3-4), 405-412.

Stein, T.R., Bonnano, G.A., and Gershefski, P.A. (2011). Trait self-enhancement, immune markers, and risk-reduction behaviors in HIV-positive gay men. Journal of HIV/AIDS & Social Services, 10(1), 22-41.

Unknown Author (1995). Qualitative research: introducing focus groups. BMJ, 311, 299.

Vega, M.Y., Spieldenner, A.R., DeLeon, D., Nieto, B.X., and Stroman, C.A. (2011). SOMOS: evaluation of an HIV prevention intervention for Latino gay men. Health Education Research, 26(3), 407-418.

Vega, M.Y., Spieldenner, A.R., and Tang, J. (2012). Sexo y la ciudad: sexual, ethnic, and social identity intersections of Latino gay men in New York City. Californian Journal of Health Promotion, 10, 78-87.