A study of social context within HIV prevention efforts

Héctor Carrillo, MPH, DrPH, is an Associate Professor of Sociology and Gender & Sexuality Studies at Northwestern University, where he also co-directs the Sexualities Project at Northwestern (SPAN). His talk, titled “Immigrants, Shifting Social Contexts, and the Social Production of HIV Risk,” was presented as part of the Institute for Public Health and Medicine (IPHAM) Speaker Series.

In a lecture presented at Northwestern University Feinberg School of Medicine on September 25, Héctor Carrillo, MPH, DrPH, presented research results that illustrate the importance of considering the social contexts of HIV risk and health-related behaviors. According to Carrillo, the interest in social factors surrounding HIV prevention programs has risen in recent years. Even now, however, “most efforts remain largely centered around individual behavior,” in spite of increasing recognition of social factors influencing those behaviors, including but not limited to gender inequality, sexual cultures, homophobia, racism, poverty, and access to services. Carrillo’s research aimed to show that an improved understanding of the social contexts in which behaviors take place, both pre- and post-migration, can lead to better prevention efforts.

Carrillo’s research was based in San Diego, California and made possible by a grant from the National Institutes of Health. The team conducted participant observation sessions, as well as in-depth interviews with a large qualitative sample of Mexican-born gay and bisexual men, US-born gay Latino men, and US-born partners of Latino/Mexican men. Carrillo’s goal was to identify patterns of change in the subjects’ sexual interpretations that result from their migration, as well as how in turn they affect their HIV risk. “Immigrant men should not be seen as a homogeneous group,” he says. Rather their sexual interpretations must be connected to the contexts and situations in which they participate. In his presentation, Carrillo showed a diversity of sexual identities among Mexican immigrants men who have sex with men—a diversity that challenges prevailing stereotypes about Mexican and American sexualities.

Carrillo has been conducting research with immigrants for the past decade. He indicates that during this time there has been growing critique of behavioral approaches to HIV prevention, as well as a new wave of biomedical strategies assumed to not have the same limitations as previous strategies. However, as he puts it, “we must recognize that the new biomedical strategies also greatly depend on individual motivations and behaviors, which in turn are affected by contextual factors.” This means that a focus on contextual and situational factors is very relevant. An important takeaway, says Carrillo, is recognizing the need for greater synergy between biomedical strategies and sociocultural approaches. Involved parties must “put social and contextual factors back in the picture of HIV prevention,” he says.

Carrillo’s research focused on the sexualities of Latino gay and bisexual immigrants. “There is a false notion that immigrants by definition leave culturally backward places to come to the US,” he says. He argues that it is just as important to learn about immigrants’ lives before migration, and that this helps understand the variety of paths that immigrants take once they arrive in the US. His conclusions showed that immigrants’ participation in American gay culture is highly influenced by their understandings and behaviors pre-migration. In order to gain a broad understanding of successful prevention efforts, compounding factors such as ethnic identity and social inequality must be understood.

With his findings, Carrillo is seeking to promote more comprehensive HIV prevention approaches—approaches that do take into consideration behavioral, cultural, social, structural, and biomedical strategies. In addition, he says he “hopes to engage in open discussions about vulnerability and larger structural issues.” It remains to be seen how the results of his research can be implemented in the healthcare realm, but, among other possible applications, Carrillo is interested in dialoguing with medical professionals to determine the applicability of his findings in biomedical and clinical settings.

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