“¡Ponte el Condón!”: Sociocultural Barriers to Timely HIV Testing in the Spanish MSM Community

Abstract

In 2015, 46.5% of new HIV cases in Spain were diagnosed late, with 38.4% of these late diagnoses attributed to men who have sex with men (MSM).1 While very few studies have investigated the factors that contribute to late diagnosis among this group, the consequences of late diagnosis are detrimental on both individual and population levels. The infected individual’s risk of morbidity increases as they cannot benefit from treatment, and, simultaneously, they are at risk of unknowingly infecting others. This study aims to identify the sociocultural barriers to timely HIV diagnostic testing among the Spanish MSM community and offers recommendations to refocus prevention efforts.The methods implemented include interviews with HIV-positive and -negative Spanish MSM, interviews with caregivers who work in HIV/AIDS non-governmental organizations, and ethnographic studies of patient-caregiver interactions during testing. Results indicate that barriers to early diagnosis are low perception of risk; invisibility of the virus in the public sphere, in primary school education, and in physician training; fear of discrimination and stigmatization, particularly in the medical field; and lack of quality care. Discrimination and stigma were partly attributed to moral connotations of sexuality and further exacerbated these other sociocultural barriers. This moralization reportedly stemmed from Spanish sociocultural values reflecting the historical influence of the Catholic Church. These findings support the need to reform prevention efforts to curb sociocultural-related stigma faced by the Spanish MSM community, in both the social and medical sphere, in order to promote timely diagnostic testing.