This qualitative study explored the social experiences and HIV-related sexual practices of 30 young gay and bisexual men who moved to New York City in the past 3 years from other countries or elsewhere in the United States. Many recent arrivals migrated from places with small gay communities and low HIV prevalence, and some came with a practice of limited condom use.
Participants described encountering an abundance of sexual opportunity in New York City, accessible to even the newest arrivals through internet sex sites. Some migrants expressed surprise that few men they met were interested in dating or establishing trust before having sex. Although frequent HIV testing was common, HIV status, testing history, and condom use were seldom discussed with sex partners for some men even with new partners or before sex without condoms. This article suggests HIV prevention interventions for urban migrants and other men who have sex with men.
New York City has historically attracted great s of migrants, including men seeking the space to explore or celebrate same-sex attraction Chauncey, ; Kaiser, As these men encounter new urban, social, and sexual environments and navigate the challenges of getting established in an unfamiliar locale, they may be uniquely vulnerable to acquiring HIV and other sexually transmitted infections Bianchi et al. Research has identified a of ways where gay and bisexual urban migrants may be at an elevated risk of HIV.
Such opportunities, combined with social isolation, poverty, and limited knowledge of sexual disease transmission, can increase HIV risk Carrillo et al. Among Latino immigrants in New York City, the anonymity of living in a gay epicenter, often without social connections to home communities, can be conducive to active sex lives and sexual exploration, particularly soon after migrating Bianchi et al. Similarly, in a study of drug users who migrated to a gay resort area in Florida, mainly from elsewhere in the U.
However, we know of no research that directly measures whether incidence of HIV infection is greater among recent urban migrants. In the U. Younger men have a higher risk of HIV infection per sexual contact Scott et al. HIV acquisition may also be driven by social and economic considerations, particularly for men of color.
As our concern with HIV risk extended to all gay and bisexual new arrivals, we interviewed both international and in-country migrants. However, the small size of the sample did not allow for a formal comparison between types of migrants. Inthe 3 authors conducted in-person, semi-structured interviews with 30 young men living in New York City. To explore HIV risk among lower-income and unstably housed migrants, we actively recruited clients of homeless shelters and drop-in programs that serve gay and bisexual young men.
All eligible recruits were invited to participate. Interviews took place in spaces affording privacy. Below, all men are identified by pseudonyms. This guide was slightly modified during the study to deepen inquiry into emerging themes, such as the particular vulnerability of men who are effeminate or receptive partners in anal sex.
Interviews lasted between 1 and 2 h; three were conducted in Spanish. As in the anthropological tradition Bernard,each interview was described and analyzed by the interviewer in a detailed field note, rather than having distinct study team members conduct, transcribe, and code the interviews.
The interviewer reviewed each digital recording in its entirety. Each field note was annotated by the other two study authors.
New arrivals to new york city: vulnerability to hiv among urban migrant young gay men
Throughout the study period, field note content was cataloged into a master document, both by themes that corresponded to the main interview topics, and by an expanding set of sub-themes identified by the authors during field note writing and review. Linking interview content to themes was straightforward, thus no attempt was made at verifying inter-coder reliability. Below, findings are organized by major themes. Given this focus on HIV risk, findings highlight the experiences of new arrivals who did not consistently use condoms or were more sexually active.
Thirty new arrivals to New York City were diverse in age, ethnicity, and place of origin and where recruited Table 1. Participants were generally well-educated: all but one had graduated from high school and 18 had attended some college. Most migrants were engaged in HIV testing: six reported having been diagnosed with HIV, all in the past 3 years, while 19 of the other 24 had been tested for HIV within the past 3 months.
I always knew I was too gay for Jamaica. Also, it was too depressing for me. Because I knew I wanted to live my life openly.
I just wanted to be gay. You know: me. So I felt like if I had stayed I would probably be suicidal or something. So I felt like leaving would be the best thing for me. Roy identified as an effeminate man, unable to hide his sexuality, and was typically the receptive partner in anal sex.
They often kill gay people. If you act effeminate, they discriminate when you pass by in the street. I was discriminated against at school, since I was very young…I was discriminated against when I tried to get a job, at university, in school, by my mother. Translated from Spanish. Other men offered motives for migration not directly related to their sexuality, such as following the circuits of family or friends; escaping high unemployment in their home countries; pursuing higher education or a career in the arts; or moving to a new city after a difficult end to a relationship.
Social and medical services also attracted young men to New York City. Chuck was 21 and homeless when a case manager in New Jersey encouraged his move by telling him that there were more youth services in New York. The interview asked migrants to describe their sex lives back home.
Five migrants told of a violent childhood sexual initiation involving abuse by men or older boys. Some migrated from urban areas with sizeable gay communities, while others described coming of age in places where there were limited opportunities to express same-sex attraction or have sex with men. Alan, who grew up in a Catholic family in suburban Florida, tried to suppress his homosexual desire by becoming more involved in the church; he did not have sex until he moved to New York at age Nick, 22, recalled that neither he nor his first sex partner knew of other men gay men in their hometown in Siberia, and had little awareness of condoms or where to find them.
Ten migrants said they were typically the receptive partner in anal sex, 10 were typically insertive, 9 identified as versatile, and 1 only had oral sex.
Seven men—five of whom were typically the receptive partner in anal sex—described seldom using condoms while having sex with multiple partners during their first years of sexual activity. Mickey, 19, grew up in Houston, Texas, and faced intense familial rejection because of his effeminacy. He wanted to participate in the gay scene, but felt deeply conflicted.
When he began having receptive anal intercourse in the 10th grade, it was only when drunk and always without a condom.
He described his approach to sex:. Other participants were strategic about sex without condoms before they migrated. Before his HIV diagnosis, Silas routinely had unprotected receptive anal sex with other teens and only insisted on condoms if his partner was considerably older.
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Baby, 21, never used condoms in his small hometown in Puerto Rico. But later in the interview, he acknowledged continuing to routinely have sex without condoms after migrating. Thus, one basis of elevated HIV risk among urban migrants is the maintenance of sexual practices established in contexts where HIV prevalence may be lower.
Greater sexual opportunity in gay epicenters may also increase HIV risk. Three migrants noted the benefit of an efficient subway system linking a large concentration of potential partners. Others mentioned that the sheer of gay men in one city enabled having sex with many different men. Adam, 26, described himself, using a classic metaphor, as. Asked if they had become more or less sexually adventurous in New York, different migrants described novel experiences, including sex in front of other people, with a transgender woman, under the influence of marijuana, and engaging in a threesome.
Ben observed. In Jamaica, Roy worried that his harshly disapproving family would find out about his gay sex life and react violently. When he got to New York. It was definitely easier to access sex. I also feel like it was a lot more anonymous here.
Phil, 27, from Atlanta, said of using websites like Adam4Adam and Craigslist, or the Grindr mobile application.
In New York City there are a lot of guys always ready to have sex. You just jump in a cab or take the train and you can go anywhere…The sex websites are an easy and fast way to hook up and have fun. In the New York City internet scene, dating was seldom an option.
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Roy estimated that in his first year in New York he had anal sex with ten men and had sex without condoms with nine of them, always as the receptive partner. Mario also tied his high-volume sex life to the ease of meeting willing men.
He described his sex life in New York as. More promiscuous.