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Artigos Originais • Rev. Saúde Pública 51 • 2017 • https://doi.org/10.11606/S1518-8787.2017051000016 linkcopy

Factors associated with self-reported discrimination against men who have sex with men in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE To estimate self-reported discrimination due to sexual orientation among men who have sex with men (MSM) in Brazil and to analyze associated factors.

METHODS A cross-sectional study of 3,859 MSM recruited in 2008–2009 with respondent driven sampling. Data collection conducted in health centers in 10 Brazilian cities. A face-to-face questionnaire was used and rapid HIV and syphilis tests conducted. Aggregated data were weighted and adjusted odds ratio estimated to measure the association between selected factors and self-reported discrimination due to sexual orientation.

RESULTS The sample was predominantly young, eight plus years of schooling, pardo (brown), single, low-income, and identified themselves as gay or homosexual. The prevalence of self-reported discrimination due to sexual orientation was 27.7% (95%CI 26.2–29.1). Discrimination was independently associated with: age < 30 years, more years of schooling, community involvement and support, history of sexual and physical violence, suicidal thoughts, and unprotected receptive anal intercourse.

CONCLUSIONS The prevalence of self-reported discrimination among MSM in Brazil is high. These results challenge the assumptions that MSM-specific prevention and support programs are not required or that health professionals do not need special training to address MSM needs.

Homosexuality, Male; Sexism; Risk Factors; Socioeconomic Factors; Gender and Health; Health Inequalities

Cities	Unadjusted (%)	95%CI	Weighted* (%)	95%CI	Homophily
Manaus	36.4	33.1–39.6	29.3	26.2–32.4	1.030
Recife	47.0	41.6–52.2	39.3	34.1–44.4	1.064
Salvador	34.1	29.3–38.9	26.6	22.1–31.0	1.019
Brasília	41.8	36.3–.47.2	39.3	33.8–44.7	0.992
Campo Grande	32.3	27.3–37.2	25.9	21.3–30.5	1.125
Belo Horizonte	40.8	34.8–46.7	34.0	28.2–39.7	1.046
Rio de Janeiro	31.4	26.3–36.4	23.3	18.6–27.9	1.041
Santos	23.2	17.6–28.7	20.4	15.0–25.6	1.043
Curitiba	33.2	28.0–38.4	23.9	19.2–28.6	0.955
Itajaí	21.5	16.6–26.2	12.5	8.6–16.3	1.086

Total	34.8	33.2–36.3	27.7	26.2–29.1	-

Characteristic	n^a	% Weighted^b
Self-reported discrimination in the last 12 months
Yes	1,266	27.7
No	2,369	72.3
Age
≤ 30 years	2,602	60.5
> 30 years	1,033	39.5
Years of education
0–7 years	727	28.4
8–14 years	2,338	57.4
≥ 15 years	570	14.2
Skin color/ethnicity
White	1,011	26.2
Black	458	12.6
Pardo (Brown)	2,047	53.84
Yellow/Indigenous	119	3.0
Conjugal situation
Married or lives with companion	592	16.3
Single/Widowed/Divorced/Separated	3,043	83.7
Monthly income
≤ 1 minimum wage	1,666	47.6
≥ 2 minimum wage	1,969	52.4
Sexual orientation
Heterosexual	281	7.7
Gay/Homosexual	1,836	50.5
Bisexual	1,103	30.3
MSM	415	11.4
URAI with casual male partners in the last 6 months
Yes	567	27.2
No	1,597	72.8
URAI with steady male partners in the last 6 months
Yes	828	47.5
No	884	52.5
Counseling about STD in health service
Yes	595	11.8
No	3,040	88.2
Verbal violence
Yes	1,652	42.3
No	1,983	57.7
Physical violence
Yes	539	15.9
No	3,096	84.1
Sexual violence
Yes	576	14.6
No	3,059	85.4
Felt sad or depressed in the last 6 months
No or infrequently	3,159	80.3
Frequently	475	19.7
Suicidal thoughts in the last 6 months
No or infrequently	3,094	80.1
Frequently	475	19.9
Use of alcohol
Low	1,461	36.1
Moderate	1,849	49.5
High	323	14.4
Community involvement and support
Yes	395	9.9
No	3,240	90.1

Variable	wOR*	95%CI	p
Age (years)
≤ 30	1.00
> 30	1.84	1.59–2.17	< 0.001
Years of education
0–7 years	1.00
8–14 years	2.68	2.21–3.25	< 0.001
≥ 15 years	2.86	2.23–3.67	< 0.001
Skin color/ethnicity
White	1.00
Black	0.79	0.63–1.00	0.06
Pardo (Brown)	0.92	0.77–1.09	0.3
Yellow/Indigenous	0.75	0.48–1.20	0.2
Conjugal situation
Married or lives with companion	1.00
Single/Widowed/Divorced/Separated	0.84	0.68–1.02	0.09
Monthly income
≤ 1 minimum wage	1.00
≥ 2 minimum wage	0.93	0.80–1.08	0.4
Sexual orientation
Heterosexual	1.00
Gay/Homosexual	14.70	9.02–23.97	< 0.001
Bisexual	3.82	2.30–6.34	< 0.001
MSM	3.39	1.99–5.76	< 0.001
URAI with casual male partners in the last 6 months
No	1.00
Yes	1.38	1.12–1.70	< 0.001
URAI with steady male partners in the last 6 months
No	1.00
Yes	1.97	1.58–2.45	< 0.001
Counseling about STD in health service
Yes	1.00
No	1.53	1.23–1.89	< 0.001
Verbal violence
No	1.00
Yes	6.62	5.62–7.80	< 0.001
Physical violence
No	1.00
Yes	3.98	3.26–4.86	< 0.001
Sexual violence
No	1.00
Yes	2.96	2.45–3.58	< 0.001
Felt sad or depressed in the last 6 months
No or infrequently	1.00
Frequently	1.47	1.23–1.75	< 0.001
Suicidal thoughts in the last 6 months
No or infrequently	1.00
Frequently	1.48	1.24–1.76	< 0.001
Use of alcohol
Low	1.00
Moderate	0.94	0.81–1.10	0.5
High	0.58	0.45–0.74	< 0.001
Community involvement and support
No	1.00
Yes	2.73	2.19–3.41	< 0.001

Variable	wOR (95%CI)*	p
Age (years)
≤ 30	1.00
> 30	2.45 (1.88–3.20)	< 0.001
Years of education
0–7 years	1.00
8–14 years	2.02 (1.41–2.88)	< 0.001
≥ 15 years	1.80 (1.19–2.72)	0.005
URAI with steady male partners in the last 6 months
No	1.00
Yes	1.89 (1.50–2.39)	< 0.001
Physical violence
No	1.00
Yes	2.97 (2.15–4.10)	< 0.001
Sexual violence
No	1.00
Yes	2.21 (1.63–3.00)	< 0.001
Suicidal thoughts in the last 6 months
No or infrequently	1.00
Frequently	1.42 (1.04–1.94)	0.02
Community involvement and support
No	1.00
Yes	1.70 (1.21–2.40)	< 0.001

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