Promoting equity and decreasing disparities through optimizing prevention science: Power Differentials between Sexual Partners and Knowledge of HIV Status in Latino MSM

This abstract was presented at the 2018 Society for Prevention Research Annual Meeting which was held May 29 – June 1, 2018 in Washington, DC, US.

Ben Parchem George Washington University 

Ana Maria del Rio Gonzalez George Washington University; Andrew Barnett George Washington University; Paul J Poppen George Washington University; Maria Cecilia Zea George Washington University

Introduction: Power differentials among sex partners often result in negative health consequences for the lower status partner, including vulnerability to acquire HIV. Power differential is defined as differences in education level, socio-economic status, and financial stability, among others. Latino immigrant gay and bisexual men are a vulnerable population for being immigrant, Latino, and men who have sex with men (MSM). Due to their circumstances, they often resort to engaging in relationships of unequal power, which may account for a portion of the health disparities observed among Latino MSM. Power imbalances in their relationships also result in increased sexual risk behaviors for HIV (i.e. condomless anal intercourse, lower levels of communication about condom use). Using data from a sample of Latino immigrant MSM, our study examined power differentials between sexual partners and their associations with knowledge of partner’s serostatus, a known risk factor for HIV transmission. 

Methods: We used a subsample of 290 Latino immigrant MSM drawn from a larger study on Brazilian, Colombian, and Dominican immigrant MSM residing in New York City. Participants were included if they had engaged in receptive or insertive anal intercourse with a single male partner in their most recent sexual encounter. We estimated power differential using participants’ responses on sex partners education and income compared to their own by asking “What do you think this person’s income was? What do you think this person’s educational level was?” Response options included “Much higher than mine”, “More or less the same as mine”,“Much lower than mine”.We categorized power as held by the participant, the partner, or whether the power between partners was equal. To inquire about knowledge of HIV status we used questions such as “Did this person know your HIV status?”. Response options included Yesor No. 

Results: Regarding the power differentials, 23.5% of participants reported they had more power than their partner, 40.3% reported their partners had more power, and 36.2% reported equal levels of power. In terms of knowledge of HIV status, 68.3% reported their partner was aware of their HIV status. A logistic regression revealed that it was more likely that the partner knew the participant’s HIV status when the partner had more power, compared to partnerships where the participant had more power (b= 0.875, OR: 2.40, 95% CI: [1.26, 4.56]). Statistical analyses controlled for age of partner and HIV status of participant. 

Conclusions: These findings contribute to a more granular understanding of power imbalance which exacerbates already existing health disparities. Partners with more power are more likely to know the HIV status of the participant and participants with more power are less likely to share their HIV status with their partner. To reduce withholding HIV status, efforts to prevent HIV transmission should consider promoting bi-directional, open communication among partners of unequal power. Withholding communication may be a form of exerting power in a partnership. Preventative interventions that encourage the partner of lower status to inquire about his sexual partner’s serostatus can aide in ameliorating health disparities among Latino immigrant MSM.