Low socioeconomic status is associated with self-reported HIV positive status among young MSM in Brazil and Peru

This was a cross-sectional, web-based survey targeting MSM from Brazil, Mexico, and Peru. Inclusion criteria were cisgender men, ≥18 years, resident of one of the three countries. For this secondary analysis, we included YMSM aged 18–24 years who self-reported their HIV status. Individuals who had never tested for HIV and were sexually attracted only to women were excluded. Details of the study design are described elsewhere [27]. Briefly, the questionnaire was developed in English (Additional file 1) by the researchers of the three countries and then translated to local languages (Portuguese in Brazil and Spanish in Mexico and Peru). Final versions were reviewed by two researchers fluent in Portuguese and Spanish. The questionnaire was programmed on Alchemer® in Brazil and SurveyMonkey® in Mexico and Peru. Then, each survey link was tested by the researchers and by members of MSM community as part of the validation process. The project was advertised on Hornet® and Grindr®, two geosocial networking (GSN) apps used by MSM, and Facebook®. Participants were not asked to refer friends to take the survey, but they could share the survey link if they wish.

The main outcome of interest was self-reported HIV status, which was assessed as follows: “Have you ever had a positive HIV result?”, with possible answers “yes” (self-reported HIV positive status) and “no” (self-reported HIV negative status). This question was only asked among individuals who reported a history of HIV testing, and as previously mentioned, individuals who reported never testing for HIV were excluded from the study.

Study recruitment was categorized into: Apps (Grindr and Hornet) and Facebook. Race was collected using the relevant categories for each country. In Brazil and Peru, race was stratified as “White”, “Black”, “Pardo or Mestizo”, “Indigenous” or “Asian”. Mexican participants were asked if they were indigenous (yes/no). Education was dichotomized by those who had less than or complete secondary education (≤ secondary education) versus those reporting any post-secondary education (> secondary education). Individuals were asked about their monthly income by the time of survey completion. Income was stratified in “low”, “middle” and “high” according to each country definition, which considered the minimum wage value per month in June 2018 (Brazil: 954 BRL or 250 USD; Mexico: 2686 MXN or 141 USD; Peru: 850 PEN or 265 USD). For Brazil, participants were stratified in “low” if the family monthly income was equivalent or inferior to three times the minimum wage (≤ 750 USD); in “middle” if between three and ten times the minimum wage (751–2500 USD); in “high” if superior to ten times the minimum wage (> 2500 USD) [20, 38, 39]. For Mexico, participants were stratified in “low” if individual monthly income was less than three times the minimum wage (< 423 USD); “middle” if between three and five times the minimum wage (423–704 USD); and high if equivalent or superior to five times the minimum wage (750 USD) [27, 40]. For Peru, participants were stratified in “low” if individual monthly income was less than the equivalent of three times the minimum wage (≤ 795 USD); “middle” if between three and five times the minimum wage (796–1060 USD); and “high” if greater than five times the minimum wage (> 1060 USD) [41]. Sexual attraction was dichotomized into those attracted only to men versus those attracted to both men and women. As previously mentioned, respondents reporting being attracted only to women were excluded from this analysis. Individuals were asked if they had a steady partner (yes/no) without further specification (i.e., if this was a long-term casual partner or a formal romantic relationship). They were also asked about their last HIV test with possible options as follows: last 3 months, last 6 months, last year and more than 1 year. As previously mentioned, those who responded that they had never tested for HIV were excluded from the analysis. We dichotomized this question in “≤ 1 year” versus “> 1 year”. Individuals were also asked about city of residence (data not shown).

For the logistic regression models, race was dichotomized into “white” vs. “non-white” (Black, Brown, Indigenous and Asian) following previous studies conducted among Brazilian and Peruvian MSM [20, 27, 42, 43] and income was dichotomized into “low” vs. “middle/high”.

Participant characteristics were described according to self-reported HIV status (negative or positive) per country (Brazil, Mexico, and Peru). Some survey questions included options such as “I do not want to answer” or “I do not know” for participant comfort, and these answers were considered missing for data analysis. We used logistic regression to assess the factors associated with self-reported HIV positive status separately for each country. Bivariate regression models were fitted for all explanatory variables and then a multivariable model was estimated including all of these variables regardless of statistical significance, based our a priori theoretical/conceptual model. We wanted to verify if sociodemographic characteristics measured by race, education and income were associated with HIV self-reported status after adjusting for behavior characteristics measured by sexual attraction and steady partner. These factors have been associated with HIV status among MSM from Latin America in previous studies [25]. All analyses were performed using Software R version 4.0.3 [44].