Racial and ethnic disparities in sexual risk behaviors and STDs during young men's transition to adulthood

CONTEXT: Racial and ethnic health disparities are an important issue in the United States. The extent to which racial and ethnic differences in STDs among youth are related to differences in socioeconomic characteristics and risky sexual behaviors requires investigation. METHODS: Data from three waves of the National Survey of Adolescent Males (1988, 1990–1991 and 1995) were used to examine 1,880 young men’s history of STDs and their patterns and trajectories of sexual risk behavior during adolescence and early adulthood. Multinomial and logistic regression analyses were conducted to test whether racial and ethnic differences in STDs are due to the lower socioeconomic status and higher levels of risky sexual behavior among minority groups. RESULTS: Young black men reported the highest rates of sexual risk and STDs at each wave and across waves. Compared with white men, black and Latino men had higher odds of maintaining high sexual risk and increasing sexual risk over time (odds ratios, 1.7–1.9). In multivariate analyses controlling for socioeconomic characteristics, black men were more likely than white men to have a history of STDs (3.2–5.0); disparities persisted in analyses controlling for level of risky sexual behavior. CONCLUSIONS: Race and ethnicity continue to differentiate young black and Latino men from their white peers in terms of STDs. Prevention programs that target different racial and ethnic subgroups of adolescent men and address both individual‐ and contextual‐level factors are needed to curb STD incidence.     

Racial disparities in health and health behaviors among gay,lesbian, bisexual and heterosexual men and women in the BRFSS-SOP

ABSTRACT

Objectives: Research on sexual minority health lack examinations of how sexual orientation intersects with other identities, including racial/ethnic identity, to shape health outcomes among U.S. adults. This study examines how health status and health behavior varies for gay, lesbian, and bisexual men and women who identify as non-Hispanic white, non-Hispanic black, Latino, Asian/Pacific Islander, and American Indian/Alaskan Native. By examining health and health behaviors within and across sexual minority subgroups, our study reports on race/ethnic, gender, and sexual orientation specific health risks.

Methods: We respond to shortcomings in current data by utilizing aggregated data from fourteen states from the Behavioral Risk Factor Surveillance System (BRFSS) collected between 2005 and 2010 (n?=?557,773). We investigated the odds of reporting poorer health, current cigarette smoking, and obesity by sexual orientation within race/ethnic and gender subgroups; all statistical analyses were performed in 2016.

Results: Results suggest persistent health and behavior disadvantages for lesbian and bisexual women of all racial and ethnic identities, relative to heterosexuals. Some of the heightened odds are extreme. Asian/Pacific Islander lesbian (OR?=?3.92) and bisexual (OR?=?4.61) women, for example, have 4.0 times higher odds of smoking than heterosexual A/PI women. Results for men are more variable. To illustrate, the odds of obesity for White and A/PI men are indistinguishable between bisexuals and heterosexuals, and Black and American Indian/Alaskan Native bisexuals have lower odds of obesity than their heterosexual counterparts.

Conclusion: These findings highlight the need for policy efforts aimed at improving health and health behaviors among lesbian and bisexual women across groups, and more targeted efforts among sexual minority men.     

Disparities in Sexually Transmitted Infection/HIV Testing,Contraception, and Emergency Contraception Care Among Adolescent Sexual Minority Women Who Are Racial/Ethnic Minorities

PurposeSexual minority women and racial/ethnic minority women in the United States are at increased risk for sexually transmitted infections (STIs) and unintended pregnancy. Yet, we know little about STI/HIV testing and contraceptive care among women who have sex with women only and women who have sex with both women and men, and who are racial/ethnic minorities. This study examined receipt of STI/HIV testing and contraceptive care among sexually active adolescent women by sex of sexual contact(s) and race/ethnicity.MethodsOur sample included 2,149 sexually active adolescent women from the National Survey of Family Growth (2011–2019). We examined receipt of sexual and reproductive health (SRH) services by sex of sexual contact(s) and race/ethnicity: STI and HIV testing, contraceptive counseling, contraceptive method, emergency contraception (EC) counseling, and EC method.ResultsService receipt was low for all adolescent women, with disparities by sex of sexual contact(s) and by race/ethnicity. Women who have sex with women only had the lowest rates across all services; women who have sex with both women and men had higher rates of STI and HIV testing and EC counseling than women who have sex with men only. Non-Hispanic Black women had higher rates of STI and HIV testing than non-Hispanic White peers, and non-Hispanic Black and Hispanic women had lower rates of contraception method receipt than their non-Hispanic White peers. Racial/ethnic disparities persisted when results were stratified by sex of sexual contact(s).DiscussionThere is an unmet need for improved SRH service delivery for all adolescent women and for services that are not biased by sex of sexual contact(s) and race/ethnicity.     

Changes in Sexual Risk Behavior as Young Men Transition to Adulthood

CONTEXT: Understanding how young men’s sexual risk behaviors change during the transition from adolescence to early adulthood is important for the design and evaluation of effective strategies to reduce the transmission of HIV and other STDs. METHODS: Data from three waves of the National Survey of Adolescent Males (1988, 1991 and 1995) were used to categorize 1,880 respondents into clusters according to sexual risk behaviors. Univariate and bivariate analyses were conducted to assess associations between clusters and rates of self‐reported STD diagnoses and positive chlamydia tests. RESULTS: Two dimensions of sexual risk‐taking defined the clusters: partner characteristics and condom use. More than 50% of men remained in low‐risk groups over time. In the first two waves, 24–32% of men reported engaging in high‐risk behaviors (risky partners, condom nonuse); these behaviors were associated with elevated levels of STD outcomes. Nearly 40% of men who entered a high‐risk group in the first two waves transitioned to a lower risk group by the third wave. Nine percent of men either engaged in increasingly risky behaviors or maintained membership in high‐risk groups; elevated STD rates characterized both trajectories. Low condom use combined with having multiple partners during adolescence was associated with elevated STD rates in the year preceding the third wave; high condom use coupled with having risky partners was not. CONCLUSIONS: The prominence of low‐risk behaviors over time suggests that most young men avoid sexual risk‐taking. Effective strategies to reduce HIV and STD risk in young men must simultaneously address multiple dimensions of sexual behavior.     

Bacterial STDs and perceived risk among sexual minority young adults

CONTEXT: Most sexual health interventions focus on heterosexual sexual risk behavior. Health practitioners face a lack of information about the sexual health of sexual minority young adults (aged 18–26). METHODS: Three indicators of sexual minority status (identity, behavior and romantic attractions) were assessed in 10,986 young adults who participated in Wave 3 of the National Longitudinal Study of Adolescent Health (2001–2002). Logistic regression analyses examined associations between these indicators and individuals’ perceived risk for STDs and actual infection with STDs. Data from the 1,154 respondents who had current or recent bacterial STDs were investigated further to determine whether they had underestimated their risk. RESULTS: Outcomes varied by sexual minority status indicator and by sex. Bisexual females had significantly higher odds of STDs than heterosexual females (odds ratios, 1.4), and females attracted to both sexes had significantly higher odds of STDs than females attracted only to males (1.8). In contrast, none of the sexual minority status indicators predicted STDs for males. Among respondents who had an STD, females who reported only same‐sex sexual relationships were more likely to believe they were at very low risk for STDs than were females reporting only opposite‐sex sexual relationships (17.2); homosexual females had a higher likelihood of this outcome than heterosexual females (19.7). CONCLUSIONS: Health practitioners need to assist sexual minority young adults, particularly females, in under‐standing their risk for STDs and in taking safer‐sex precautions.     

Race, ethnicity and differences in contraception among low-income women: methods received by Family PACT Clients, California, 2001-2007

CONTEXT: The extent to which racial and ethnic differences in method choice are associated with financial barriers is unclear. Understanding these associations may provide insight into how to address racial and ethnic disparities in unintended pregnancy. METHODS: Claims data from the California Family PACT program, which provides free family planning services to low‐income residents, were used to determine the proportions of women receiving each type of contraceptive method in 2001–2007. Bivariate and multivariate analyses were performed to identify associations between women’s race and ethnicity and the primary contraceptive method they received in 2007. RESULTS: Compared with white women, blacks and Latinas were less likely to receive oral contraceptives (odds ratios, 0.4 and 0.6, respectively) and the contraceptive ring (0.7 and 0.5), and more likely to receive the injectable (1.6 and 1.4) and the patch (1.6 and 2.3). Black women were less likely than whites to receive the IUD (0.5), but more likely to receive barrier methods and emergency contraceptive pills (2.6); associations were similar, though weaker, for Latinas. Racial and ethnic disparities in receipt of effective methods declined between 2001 and 2005, largely because receipt of the patch (which was introduced in 2002) was higher among minority than white women. CONCLUSION: Although Family PACT eliminates financial barriers to method choice, the methods women received differed substantially by race and ethnicity in this low‐income population. The reduction in racial and ethnic disparities following introduction of the patch suggests that methods with novel characteristics may increase acceptability of contraceptives among minority women.     

Original Research: Sexual Risk in Lesbians and Bisexual Women

Objective: To describe the frequency of human immunodeficiency virus (HIV)/sexually transmitted diseases (STDs) sexual risk behaviors in lesbian and bisexual women. Design: Cross-sectional anonymous self-administered questionnaire. Setting: Women's cultural events; HIV/STD service organizations; women's health collectives. Participants: 504 self-identified lesbian and bisexual women. The sample was composed of predominantly white, well-educated women with a mean age of 35 years. Results: Both lesbian and bisexual women engaged in behaviors that potentially lead to transmission of HIV and other STDs. Lesbians were more likely to have a single sexual partner than were bisexual women. Bisexual women were more likely to report a history of STD. Of those sexually active with male partners, one-third reported multiple male partners in the previous year. Significantly more bisexual women reported condom use. Women with multiple partners were more likely to consider themselves at risk for HIV/STD. Having unprotected sex or male partners was not associated with an increased risk perception. Conclusions: Lesbian and bisexual women are engaging in sexual behaviors that may increase their risk for HIV or STD infection. Culturally sensitive prevention programs are needed.     

Exploring Factors That Underlie Racial/Ethnic Disparities in HIV Risk among Young Men Who Have Sex with Men

Young men who have sex with men (YMSM) are among the highest risk groups for HIV, and the risk distribution varies by race/ethnicity. Prevalence rates are consistently higher for minority YMSM. Factors underlying these disparities are poorly understood. We examined disparities in HIV risk among a community-based sample of Black, Latino, and non-Hispanic Caucasian YMSM age 16–24. To address gaps in the literature, we examined factors between and within racial/ethnic groups across domains including: sexual and substance use behaviors, sexualized and other social contexts, psychological well-being, HIV attributes and prevention skills, and sexual minority stress.     

Sexual and behavioral health disparities among African American sexual minority men and women

ABSTRACT

Introduction: Sexual and behavioral health disparities have been consistently demonstrated between African American and White adults and between sexual minority and heterosexual communities in the United States; however, few studies using nationally representative samples have examined disparities between sexual minority and heterosexual adults within African American populations. The purpose of this study was to examine the prevalence of sexual and behavioral health outcomes between sexual minority and heterosexual African American adults and to examine whether there were different patterns of disparities for African American sexual minority men and women, respectively.

Methods: We analyzed data from 4502 African American adults who participated in the 2001–2015 waves of the National Health and Nutrition Examination Survey. Using multivariable analyses, we examined differences in HIV, sexually transmitted infections, mental health, and substance use among African American sexual minority and heterosexual men and women.

Results: After adjusting for sociodemographic variables, African American sexual minority men had significantly higher odds of HIV, sexually transmitted infections, and poor mental health compared to their heterosexual male counterparts, whereas African American sexual minority women had significantly higher odds of Hepatitis C, poor mental health, and substance use compared to their heterosexual female counterparts.

Conclusions: These findings demonstrate notable sexual orientation disparities among African American adults. Disparities persisted beyond the role of sociodemographic factors, suggesting that further research utilizing an intersectional approach is warranted to understand the social determinants of adverse health outcomes among African American sexual minority men and women.     

Original Research: Racial/Ethnic Patterns of HIV Sexual Risk Behaviors Among Young Men Who Have Sex with Men

Objectives: Not enough is known about the HIV high-risk sexual behaviors of young men who have sex with men (YMSM), and this is especially the case among ethnic minorities. This study examined racial/ethnic differences in the prevalence of HIV risk behaviors among YMSM across the United States. Design: Face-to-face interviews were conducted among randomly selected participants in venues identified with large samples of ethnic minority YMSM. Methods: Participants (N = 2612) were systematically sampled from venues in 13 U.S. cities representing four ethnic strata (African American, Asian/Pacific Islander, Hispanic, and mixed ethnicity). Results: Twenty-two percent of the sample reported that their last sexual contact with their main sexual partner, someone other than a main sexual partner, or both involved unprotected anal intercourse. Participants from Asian/Pacific Islander sites, mixed sites, and Hispanic sites were more likely than participants from African American sites to report unprotected anal intercourse. Moreover, within the mixed sites, Hispanic participants, followed by Asian/Pacific Islander and White participants, were more likely than African American participants to report unprotected anal intercourse. Conclusions: Interventions are needed that are responsive to the racial/ethnic differences in HIV risk behaviors of YMSM throughout urban American cities.     

After the fall from grace: negotiation of new identities among HIV‐positive women in Peru

Despite increasing rates of HIV infection among heterosexual women in Peru, married women remain virtually invisible as a group at risk of HIV or requiring treatment. This study analyzed the intersections of HIV with machismo and marianismo, the dominant discourses in Latin America that prescribe gender roles for men and women. Data sources include recent literature on machismo and marianismo and interviews conducted with 14 HIV‐positive women in Lima, Peru. Findings indicate how the stigma associated with HIV constructs a discourse that restricts the identities of HIV‐positive women to those of ‘fallen women’ whether or not they adhere to social codes that shape and inform their identities as faithful wives and devoted mothers. Lack of public discourse concerning HIV‐positive marianas silences women as wives and disenfranchises them as mothers, leaving them little room to negotiate identities that allow them to maintain their respected social positions. Efforts must be aimed at expanding the discourse of acceptable gender roles and behaviour for both men and women within the context of machismo and marianismo so that there can be better recognition of all persons at risk of, and living with, HIV infection.     

Demographic Correlates of HIV Testing,High-Risk Behaviors,and Condom/STD Consultation Among a Multi-Ethnic Sample of Women

ABSTRACT

Background: In the United States, HIV rates are disproportionately high among black women, with 78% of cases attributed to heterosexual transmission. This analysis examined HIV testing, high-risk behaviors and condom use consultation for the prevention of sexually transmitted diseases (STD) among a diverse sample of women.

Methods: Secondary analyses were conducted using data from the 2004 Behavioral Risk Factor Surveillance System (BRFSS). This dataset included a sample of 43,550 (12% black, 79% white, and 9% Hispanic) women aged 18 to 49 years, living in the United States. Both bivariate and multivariate statistical analyses were conducted.

Results: Multivariate logistic regression analyses revealed that ethnic group differences existed for past-year HIV test, high-risk behaviors, and condom use consultation even after we controlled for age, education, income, employment status, and region of residence. Black women were three times more likely than white women to report a past-year HIV test and Hispanic women were 50% more likely than white women and report a past-year HIV test. Women who reported receiving condom use consultations were most likely to be Hispanic, 30 to 34 years old, and residents of the northeast.

Conclusions: Initiatives to promote HIV testing appeared to have affected HIV testing behaviors among black women. However, increased HIV testing among black women was not associated with an increased likelihood of condom use counseling by a healthcare professional. More emphasis on HIV counseling is warranted to assist with HIV risk reduction and to complement HIV testing initiatives.     

Considering HIV risk and intimate partner violence among older women of color: a descriptive analysis

This study describes the types of intimate partner violence (IPV) and sexual HIV-risk factors reported by a sample of 139 African American and Latina women ages 50 and older receiving care in outpatient clinics of an urban medical center. Additionally, we obtained estimates of the associations between experiencing IPV in a primary heterosexual relationship and the following HIV-risk behaviors among our sample of older minority women: (a) having multiple sexual partners, (b) STD history, (c) partner-related risk (i.e., having a partner who has multiple sexual partners, is HIV-infected, injecting drugs, and/or has an STD), and (d) self-perception of risk for HIV infection. Results indicate that many of these women are engaged in sexual risk behaviors, and such behaviors are associated with increased likelihood of IPV for this cohort. Implications for health care professionals are discussed.     

Church ladies, good girls, and locas: stigma and the intersection of gender, ethnicity, mental illness, and sexuality in relation to HIV risk

Inner city women with severe mental illness may carry multiple stigmatized statuses. In some contexts these include having a mental illness, being a member of an ethnic minority group, being an immigrant, being poor, and being a woman who does not live up to gendered expectations. These potentially stigmatizing identities influence both the way women's sexuality is viewed and their risk for HIV infection. This qualitative study applies the concept of intersectionality to facilitate understanding of how these multiple identities intersect to influence women's sexuality and HIV risk. We report the firsthand accounts of 24 Latina women living with severe mental illness in New York City. In examining the interlocking domains of these women's sexual lives, we find that the women seek identities that define them in opposition to the stigmatizing label of "loca" (Spanish for crazy) and bestow respect and dignity. These identities have unfolded through the additional themes of "good girls" and "church ladies". Therefore, in spite of their association with the "loca", the women also identify with faith and religion ("church ladies") and uphold more traditional gender norms ("good girls") that are often undermined by the realities of life with a severe mental illness and the stigma attached to it. However, the participants fall short of their gender ideals and engage in sexual relationships that they experience as disempowering and unsatisfying. The effects of their multiple identities as poor Latina women living with severe mental illness in an urban ethnic minority community are not always additive, but the interlocking effects can facilitate increased HIV risks. Interventions should acknowledge women's multiple layers of vulnerability, both individual and structural, and stress women's empowerment in and beyond the sexual realm.     

HIV infection, genital ulcer disease, and crack cocaine use among patients attending a clinic for sexually transmitted diseases.

BACKGROUND. Recently there has been a rise in genital ulcer disease (GUD) in urban minority heterosexuals in the United States. The impact of these increased GUD rates on HIV transmission patterns in this population is unknown. METHODS. Sexually transmitted disease (STD) diagnoses were correlated with HIV antibody status and risk factor history in 194 patients who consented to HIV testing at an STD clinic in central Brooklyn. RESULTS. Of 36 HIV-positive patients, 23 (64%) denied HIV risk factors other than heterosexual contact with persons of unknown HIV status. HIV antibody was associated with GUD (odds radio [OR] = 2.72, 95% confidence interval [CI] = 1.20-6.24), multiple concurrent STDs (OR = 2.51, 95% CI = 1.08-5.81), and a history of crack cocaine use (OR = 2.98, 95% CI = inexact-9.61). Crack use was also associated with GUD (OR = 15.15, 95% CI = 3.27-inexact) and multiple simultaneous STDs (OR = 13.87, 95% CI = 4.62-inexact). In a log-linear model analysis, HIV infection was independently associated with GUD and crack use. HIV infection, genital ulcer disease, and crack cocaine use were more common in women than men. CONCLUSIONS. The association between HIV infection and GUD seen here may be secondary to high-risk sexual behavior, which in turn may be partially attributable to crack cocaine use and drug-related prostitution. The high rate of coinfection with HIV and GUD raises a concern about the increased efficiency of sexual transmission of HIV in this population.     

Heterogeneity of health disparities among African American, Hispanic, and Asian American women: unrecognized influences of sexual orientation

OBJECTIVES: This study compared health indicators among self-identified lesbians/bisexual women and heterosexual women residing in Los Angeles County. METHODS: Respondents were English-speaking Hispanic, African American, and Asian American women. Health status, behavioral risks, access barriers, and indicators of health care were assessed. RESULTS: Prevalence rates of chronic health conditions were similar among women in the 3 racial/ethnic groups. However, lesbians and bisexual women evidenced higher behavioral risks and lower rates of preventive care than heterosexual women. CONCLUSIONS: Among racial/ethnic minority women, minority sexual orientation is associated with increased health risks. The effects of sexual minority status need to be considered in addressing health disparities affecting this population.     

Original Research: AIDS Educational Videos for Gay and Bisexual Men: A Content Analysis

Objective: To systematically describe the content of AIDS educational videos targeting gay and bisexual men, and to compare it to the content of videos for heterosexual African American and Latino audiences. Design: AIDS videos targeting gay/bisexual men (n = 35), heterosexual African Americans (n = 14), and heterosexual Latinos (n = 25) were coded for the presence or absence of messages identified by various theoretical models as relevant to HIV education and risk reduction. Results and Conclusions: Videos targeting gay and bisexual men typically emphasized sexual risk reduction techniques, whereas videos for heterosexual minority viewers were more likely to provide information about HIV transmission and audience members' vulnerability to AIDS. Despite their focus on reducing personal risk, most gay/bisexual videos did not depict partner negotiation for safer sex, reinforce the perception that social norms favor sexual risk reduction, or eroticize safer sex practices. Suggestions are offered for future research and for production of AIDS educational videos.     

Congruence across Sexual Orientation Dimensions and Risk for Unintended Pregnancy among Adult U.S. Women

ObjectivesTo date, no studies have investigated whether sexual minority women (SMW) are more likely to experience unintended pregnancies compared with their heterosexual peers. The aim of this study was to explore whether adult SMW were more likely to have unintended pregnancies compared with heterosexual women, to examine the role of identity–attraction congruence in unintended pregnancy risk, and to evaluate possible mediators.MethodsData on pregnancies to women ages 18 to 44 were drawn from the 2006 through 2013 National Survey of Family Growth (n = 25,403). Weighted logistic regression models estimated the likelihood of reporting an unintended (rather than intended) pregnancy by identity–attraction congruence and the extent to which this association was mediated by sexual experiences with men, including age at first sex and number of sexual partners. Supplementary analyses addressed the issue of abortion underreporting.ResultsPregnancies to SMW were more likely to be unintended compared with pregnancies to heterosexual women (adjusted odds ratio, 1.26; 95% confidence interval, 1.08–1.46). This was driven by the elevated risk experienced by heterosexual-identified women with same-sex attractions, specifically (adjusted odds ratio, 1.28; 95% confidence interval, 1.08–1.51). Greater unintended pregnancy risk among these women was mediated by a greater number of male sex partners compared with heterosexual women.ConclusionsUnintended pregnancy risk among SMW has historically received little attention from scholars and clinicians. Future research should explore the specific conditions that put heterosexual-identified women with same sex attractions at increased risk for unintended pregnancy. Clinicians should consider these dynamics when screening patients for contraceptive counseling.     

The number of recent sex partners among bisexual men in the United States

CONTEXT: Little is known regarding bisexual men’s number of recent sex partners, a risk factor for HIV and other STDs. Furthermore, it is unclear if bisexual men have more partners than heterosexual or homosexual men, and whether partner number varies by measures of sexual behavior, identity and attraction. METHODs: Sexual orientation—defined separately by sexual behavior during the past year, identity and attraction—was assessed for 3,875 sexually active men aged 15–44 who had participated in the 2002 National Survey of Family Growth. Chi‐square and t tests examined differences in background characteristics, behavioral risk factors and number of past‐year sex partners by sexual orientation according to each definition. Multivariate ordinary least‐squares regression was used to assess predictors of the number of partners. RESULTS: When sexual identity and attraction were controlled for, behaviorally bisexual men were predicted to have had 3.1 more past‐year partners than behaviorally heterosexual men and 2.6 more than behaviorally homosexual men. After controlling for sexual identity and behavior, bisexual‐attracted men had had 0.7 fewer partners than homosexual‐attracted men. In a model including background characteristics and behavioral risk factors, behaviorally bisexual men were predicted to have had 2.5–2.6 more partners than others. Neither bisexual identity nor bisexual attraction independently predicted the number of recent partners. CONCLUSION: The way in which bisexuality relates to men’s number of recent sex partners depends on how sexual orientation is measured. Interventions to reduce behaviorally bisexual men’s number of partners will likely lessen their risk for HIV and other STDs.     

Ethnicity and HIV risk behaviour,testing and knowledge in Guatemala

Objectives. To describe levels of risky sexual behaviour, HIV testing and HIV knowledge among men and women in Guatemala by ethnic group and to identify adjusted associations between ethnicity and these outcomes.

Design. Data on 16,205 women aged 15–49 and 6822 men aged 15–59 from the 2008–2009 Encuesta Nacional de Salud Materno Infantil were used to describe ethnic group differences in sexual behaviour, HIV knowledge and testing. We then controlled for age, education, wealth and other socio-demographic factors in a multivariate logistic regression model to examine the effects of ethnicity on outcomes related to age at sexual debut, number of lifetime sex partners, comprehensive HIV knowledge, HIV testing and lifetime sex worker patronage (men only).

Results. The data show low levels of risky sexual behaviour and low levels of HIV knowledge among indigenous women and men, compared to other respondents. Controlling for demographic factors, indigenous women were more likely than other women never to have been tested for HIV and to lack comprehensive HIV knowledge. They were less likely to report early sexual debut and three or more lifetime sexual partners. Indigenous men were more likely than other men to lack comprehensive HIV knowledge and demonstrated lower odds of early sexual debut, 10 or more lifetime sexual partners and sex worker patronage.

Conclusions. The Mayan indigenous population in Guatemala, while broadly socially vulnerable, does not appear to be at elevated risk for HIV based on this analysis of selected risk factors. Nonetheless, low rates of HIV knowledge and testing may be cause for concern. Programmes working in indigenous communities should focus on HIV education and reducing barriers to testing. Further research into the factors that underlie ethnic self-identity and perceived ethnicity could help clarify the relative significance of these measures for HIV risk and other health outcomes.