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Sexuality and Risk Behavior among Men Who have Sex with Men in León, Nicaragua: A Mixed Methods Approach
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). (International Maternal and Reproductive Health and Migration)
(Obstetrics and Gynecology, UNAN León)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). (International Maternal and Reproductive Health and Migration)
2012 (English)In: Journal of Sexual Medicine, ISSN 1743-6095, Vol. 9, no 6, 1634-1648 p.Article in journal (Refereed) Published
Abstract [en]


HIV prevalence among men who have sex with men (MSM) is 38 times higher than among the general population in Nicaragua. There are little data about the sexuality and sexual behaviors of MSM. It is essential to gain a better understanding of this understudied population.


The nature of sexual relationships among MSM, their reasons for engaging in risky sexual behaviors, and the sociocultural context in Leon, Nicaragua, were investigated through in-depth interviews. Our findings resulted in a structured overview of sociodemographic characteristics and HIV-related knowledge, attitudes, and risk behaviors.


Fifteen participants recruited by purposive sampling completed an in-depth interview that was then thematically analyzed. An additional 104 participants were surveyed by means of an interviewer-administered questionnaire.

Main Outcome Measures.

The in-depth interview guide and the survey covered topics related to sociodemographics, childhood, social and sexual relationships, knowledge and attitudes toward HIV and AIDS, identity, and networks.


The resulting ecological model explored sexuality and behaviors in four categories. It showed that despite a homophobic and heterosexist society, there is an increasing gay community and greater social acceptance of homosexuality. Nevertheless, interpersonal and intrapersonal factors continue to negatively influence MSM behavior. Quantitative findings demonstrate a satisfactory understanding of HIV transmission among this population, 75% of whom reported concerns of becoming infected with HIV in the future. Approximately one-half claimed that they always used condoms when having sex with men, but only one-third of the time with women, indicating inconsistent condom use. Negative attitudes toward HIV/AIDS were seldom heard.


This study is the first mixed methods approach in a Nicaraguan context that shows the interrelations among sex, sexuality, and identity at various levels of MSM life, and how they influence the sexual risk behaviors of individuals. Engaging in unprotected sex and postponing HIV testing are seen as cognitive dissonances.

Place, publisher, year, edition, pages
2012. Vol. 9, no 6, 1634-1648 p.
Keyword [en]
Sexuality, Sexual Behavior, MSM, HIV Vulnerability, Nicaragua
National Category
Medical and Health Sciences
Research subject
Social Medicine
URN: urn:nbn:se:uu:diva-177243DOI: 10.1111/j.1743-6109.2012.02713.xISI: 000304710400015OAI: oai:DiVA.org:uu-177243DiVA: diva2:539915
Available from: 2012-07-05 Created: 2012-07-04 Last updated: 2013-02-11Bibliographically approved
In thesis
1. Averting HIV and AIDS epidemic in Nicaragua: Studies of prevalence, knowledge, attitudes, and behavior
Open this publication in new window or tab >>Averting HIV and AIDS epidemic in Nicaragua: Studies of prevalence, knowledge, attitudes, and behavior
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to obtain an understanding of the dynamics of the HIV epidemic by estimating prevalence and exploring the relationship between HIV-related knowledge, attitudes, behavior, and HIV status in Nicaragua. Structured questionnaires were administered to adults from a health and demographic surveillance system in León, Nicaragua (Papers I–III). In-depth interviews and a survey were conducted among men who have sex with men (MSM, Paper IV). Blood sampling for HIV was carried out among 2,204 men and women (Paper I). Bivariate and multivariate analyses, including adjusted prevalence ratio (Papers I, II, IV), factor analysis, Cronbach’s alpha, and hierarchical regression analysis (Paper III) were performed. Thematic analysis was used with qualitative data (Paper IV).

The prevalence of HIV in the general population was 0.35% (95% CI, 0.17–0.73). Those who have taken a HIV test were more likely to be females, younger, living in an urban setting, have a higher level of education, be married or cohabiting, and have no religious affiliation. HIV-related knowledge was lower among members of the general population than among MSM. Unprotected sex was reported more times with regular partners than with casual partners. Findings suggested that consistency of condom use and emotional attachment (steady relations) were inversely related. Stigma and discrimination were reported high in the general population; they appeared to be negatively associated with HIV-related knowledge, self-perception of HIV risk, HIV testing, and willingness to disclose HIV status in the event of being HIV-positive. Findings demonstrated an increasing tolerance towards same-sex attractions. MSM have a better understanding of HIV transmission than men and women of the general population. Although seven out of ten MSM and six out of ten women were concerned about becoming infected with HIV, inconsistent condom use was common.

This study confirmed that Nicaragua has a low prevalence but high risk for HIV infection and transmission. Results underscore that social, behavioral, and cultural factors contribute to retard progress in achieving the Millennium Development Goals on reducing gender inequality and combating HIV/AIDS. Addressing these challenges depends not only on successful behavior change interventions, but requires a culturally gender-appropriate strategy.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. 67 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 847
HIV-related knowledge, vulnerability, risk behaviors, stigma, discrimination, men who have sex with men, gender, sexuality, Nicaragua
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Medical Science; Social Medicine
urn:nbn:se:uu:diva-186673 (URN)978-91-554-8553-5 (ISBN)
Public defence
2013-01-16, Room IX, plan 2, Uppsala University Main Building, Biskopsgatan 3, Uppsala, 09:15 (English)
Available from: 2012-12-21 Created: 2012-11-29 Last updated: 2013-04-02Bibliographically approved

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Publisher's full texthttp://onlinelibrary.wiley.com/doi/10.1111/j.1743-6109.2012.02713.x/abstract;jsessionid=2686D1F25F72B233F9EEF04CE63534E1.d04t01

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