Similarities in the Sexual Behaviorand HIV Risk Factors

of Colombian, Dominican, Mexican,and Puerto Rican MSM

Residing in New York City

Alex Carballo-Diéguez, PhDCurtis Dolezal, PhD

Luis Nieves-Rosa, MSWFrancisco Díaz, MD

ABSTRACT. In a sample of Colombian, Dominican, Mexican, andPuerto Rican men who have sex with men (MSM) (n = 307) living inNew York City, we contrasted sexual behavior and a number of vari-ables related to it. The four groups were consistently similar in terms offrequency of partnership types (men with lovers, one-night-stands, oth-er partners), monogamy, types of sexual behaviors with men andwomen, number of occasions of different behaviors, condom use dur-ing sex, and history of childhood sexual abuse. The four groups alsohad similar scores in most of the psychosocial variables usually relatedto condom use. These similarities validate the clustering of these fourpopulations under a common category (Latino or Hispanic) for report-

Alex Carballo-Diéguez, Curtis Dolezal, Luis Nieves-Rosa and Francisco Díaz areaffiliated with the HIV Center for Clinical and Behavioral Studies, New York StatePsychiatric Institute and Columbia University, New York City, NY.

Address correspondence to Alex Carballo-Diéguez, 1051 Riverside Drive, Unit15, New York, NY 10032 (E-mail: <ac72@columbia.edu>).

The authors would like to acknowledge the review and input of their colleagues atthe HIV Center for Clinical and Behavioral Studies, and the administrative collabo-ration of Roberta Leftenant. Most of all, they are extremely grateful to the 307 menwho volunteered to discuss their intimate behaviors to make this study possible.

This study was funded by grant R01 MH52031 of the National Institutes ofHealth, Alex Carballo-Diéguez, PhD, Principal Investigator.

Journal of Psychology & Human Sexuality, Vol. 12(4) 2000� 2000 by The Haworth Press, Inc. All rights reserved. 49

JOURNAL OF PSYCHOLOGY & HUMAN SEXUALITY50

ing and prevention purposes. This does not imply, however, that smallscale interventions tailored to the specific cultural nuances of differentnational groups may not have an added strength. In the few cases whereintraethnic differences were found, Mexican MSM were more likely thanmen in the other groups to receive ejaculate both in the rectum and in themouth. These differences were not accounted for by the other variablesexamined and requires further investigation. [Article copies available for afee from The Haworth Document Delivery Service: 1-800-342-9678. E-mailaddress: <getinfo@haworthpressinc.com> Website: <http://www.HaworthPress.com>]

KEYWORDS. Latino, Hispanic, sexual behavior, HIV, AIDS, gay,homosexual, MSM

INTRODUCTION

Peoples of various Latin American backgrounds living in the U.S.are collectively referred to as Latinos or Hispanics. Although theselabels are useful, especially for epidemiological purposes, Hayes-Bau-tista and Chapa (1987), among others, have argued that, except for thecommon sociopolitical relationship to the U.S., there are more differ-ences than similarities among Latin Americans from different nations.These differences can be observed in the racial makeup of the popula-tion, music and food preferences, languages spoken, economical sta-tus, sociopolitical history, etc. However, when it comes to sexualbehavior or HIV sexual risk practices, no study known to us hasexplored whether significant differences among groups of differentLatin American origin demand separate focus or whether enough sim-ilarities exist to justify an aggregate of the data.

Our study focused on Colombian, Dominican, Mexican, and PuertoRican men who have sex with men (MSM) living in the New Yorkmetropolitan area. We chose Puerto Ricans and Dominicans becausethey have the highest demographic presence in NYC (CulturelincCorporation, 1991). Colombians and Mexicans are among the top fivegroups and provide interesting possibilities for comparison with theCaribbean groups. In this manuscript, we compare these four groupsin two ways: first, in terms of their reported sexual behavior; andsecond, in terms of condom-use related variables. Finally, we explorewhether the psycho-socio-cultural factors frequently postulated to be

Carballo-Diéguez et al. 51

correlates of sexual risk behavior account for some of the differencesobserved.

METHODS

Participants

Participants were adult Latino men (aged 18 years or older) whohave sex with other men. We operationalized Latino national back-ground to mean having been born in Colombia, the Dominican Repub-lic, Mexico, or Puerto Rico, or having been born in the U.S. andself-identifying as ‘‘Latino’’ or ‘‘Hispanic’’ with at least one parent ortwo grandparents born in any of the aforementioned Latin Americancountries. In a few cases where national background was ambiguous(e.g., if the study candidate had been born in the U.S., the mother inPuerto Rico, and the father in the Dominican Republic), we asked theparticipant to chose the nationality that he felt had influenced hisdevelopment the most.

We operationalized ‘‘who have sex with other men’’ to mean havinghad at least ten sexual occasions with a man or men in the respondent’slifetime and one occasion in the year prior to the interview, thus rulingout individuals who had only occasional homosexual contact or whowere not sexually active.

Sampling and Recruitment

We broadly diversified our recruitment sources in an attempt tomaximize inclusion of potential study participants from gay-identifiedvenues–bars and discos, AIDS service organizations, the Gay and Les-bian Community Center, etc.,–as well as non gay-identified places–public parks, annual parades (Puerto Rican, Dominican, etc.), andtransportation terminals. We advertised the investigation by distribut-ing flyers and condoms wrapped in promotional material. The textindicated that our Center was conducting a study of Dominican,Colombian, Mexican, and Puerto Rican men who had sex with men orwith men and women. We did not use the words gay or bisexualbecause we wanted to include non gay-identified men who have sexwith other men. A compensation of $10 per hour was offered, and

JOURNAL OF PSYCHOLOGY & HUMAN SEXUALITY52

confidentiality was guaranteed. Interested parties were encouraged tocall to learn more about the study.

Recruitment took place between October, 1995, and November,1996. All study candidates were screened for eligibility, either byphone or in person. Those who qualified were invited to attend anassessment session. They signed consent forms, either in English orSpanish according to language dominance, that outlined the character-istics of the study, its confidentiality, the participants’ rights, the Insti-tutional Review Board’s authorization, and the phone numbers of thePI and an IRB representative who could be contacted if needed. Per-mission for audio taping was also obtained.

Instruments

The assessment consisted of two sections, one administered by aninterviewer and the other self-administered. All interviewers werebilingual and bicultural, and had been trained in general interviewingtechniques as well as in specific sexual assessment procedures. Allinterviews were audiotaped and monitored regularly followingMcKinnon et al. (1993).

Sexual Behavior

Our main interest was to assess and compare the sexual behavior ofthe four groups. To survey sexual behavior, we used the Sexual Prac-tices Assessment Schedule [SPAS] (Carballo-Diéguez, Dolezal,Nieves-Rosa, Díaz, 1995). The reliability of this instrument had beenpreviously established through test-retest of participants and comparisonsof main partners’ responses (Carballo-Diéguez, Remien, Dolezal, &Wagner, 1999). The SPAS explores number of occasions of differentsexual practices (insertive/receptive; protected/unprotected) with threedifferent types of male and female partners (lover/one-night-stand/other) over the year prior to the interview. (Lover is defined as aperson with whom the respondent is involved in a relationship ofmutual commitment and with whom he has sex; one-night-stand issomeone with whom the respondent had sex only once; other is any-body else.)

Condom Use Related Variables

In addition to sexual behavior, we explored factors theoreticallyrelated to condom use derived mainly from Fishbein et al. (1991).

Carballo-Diéguez et al. 53

Anticipated Outcomes. To explore the respondent’s expectationsrelated to condoms use, Fishbein et al. (1991) recommended thedevelopment of items based on qualitative elicitation with the tar-get population. We had previously conducted a study of PuertoRican MSM where we asked participants to list the three mainreasons why they had not used a condom the last time they hadunprotected oral or anal sex. A qualitative analysis of the responsesallowed us to identify the most prevalent ones and to rank orderthem (Carballo-Diéguez & Dolezal, 1996). Based on these data, weconstructed 10 items, often taken verbatim from participant re-sponses, for example I may lose my erection if I try to put a condomon. Respondents are asked to express their agreement or disagree-ment with each statement by rating it on a 5-point Likert-type scalefrom ‘‘strongly disagree’’ to ‘‘strongly agree.’’ The alpha coeffi-cient for this 8-item scale is .82.

Beliefs. This instrument explores the beliefs that a respondent mayhave about different reasons that condom use is presumably unneces-sary. It was developed with the same procedures described for Antici-pated Outcomes, and is rated the same way. A sample item is I don’tneed to wear a condom if I won’t come up my partner’s ass. The alphacoefficient for this 12-item scale is .86.

Circumstantial Events. This questionnaire explores the frequencywith which incidental events prevent condom use. It was developedusing the same procedures described for Anticipated Outcomes and israted on a 5-point Likert scale from ‘‘never’’ to ‘‘always.’’ A sampleitem is The condom broke and we continued fucking. It comprises sixquestions related to sex with a lover and seven related to sex withone-night-stands (ONS). The respective alpha coefficients are .72 and.64. For this and other instruments that are separated into sections forlover and others (e.g., one-night-stands, or friends), the mean of thetwo scores is used in statistical analyses when respondents had bothlover and other partners.

Commitment. This scale explores the commitment of the respondentat the time of the interview to using condoms consistently for anal sexduring the following six months. We chose the word ‘‘commitment’’over ‘‘intention’’–both presented as alternatives in Fishbein et al.(1991)–because, among Spanish speakers, intención often means aweak statement of wish or desire, and this does not capture the theoret-ical construct postulated by the authors. The questionnaire consists of

JOURNAL OF PSYCHOLOGY & HUMAN SEXUALITY54

four items for Lover and four for ONS. Answers are rated on a 5-pointLikert type scale ranging from ‘‘not at all’’ to ‘‘extremely.’’ The alphacoefficients for the two scales were .69 and .67, respectively. Themean of the two scores was used when respondents had both lover andother partners.

Emotions. This scale assesses whether certain emotional statesmake a respondent less likely to use condoms. The development ofthis measure was similar to the one described for Anticipated Outcom-es, and its rating scale is identical. A sample item is I am more likely tohave sex without a condom when I am feeling depressed. The alphacoefficient for this 10-item measure is .93.

Pleasure. We measured the pleasure differential that a respondentexperiences using vs. not using condoms for anal sex. Using a 6-pointLikert-scale (‘‘dislike very much’’-‘‘like very much’’), he rates ques-tions such as, If it were not for AIDS, how much would you enjoy beingpenetrated with a condom? Then, using the same Likert scale, theparticipant rates how much he would enjoy the same behavior withouta condom. Two pairs of questions are asked for insertive and receptiveanal sex. The score of this scale is the difference between pleasureratings for unprotected minus protected sex for the four practices sothat positive scores indicate that the former was found more pleasur-able than the latter.

Risk Perception. Respondents are asked to use a 5-point scale, from‘‘not risky at all’’ to ‘‘extremely risky’’ to rate the amount of risk ofHIV transmission involved in (a) eight different behaviors involvingoral and anal sex, with and without protection, with and without ejacu-lation, between an HIV-positive and HIV-negative man, and (b) thebehavior that the respondent himself is having with his main partner(whose HIV status we also ask) if he has one.

Self Efficacy. This measure, developed with the same procedureemployed for Anticipated Outcomes, explores how confident the re-spondent is that he can consistently avoid unprotected sex with either alover or a one-night-stand under different circumstances. Responsesare given on a 6-point scale from ‘‘certainly can avoid’’ to ‘‘certainlycannot avoid.’’ The alpha coefficients for the 8-item lover measure is.90 and for the 8-item one-night-stand measure .92. The mean of thetwo scores was used when respondents had both lover and other part-ners.

Self-Standards. This scale, based on Fishbein et al. (1991) guide-

Carballo-Diéguez et al. 55

lines, explores whether the respondent sees himself as the kind ofperson who uses sexual protection. The respondents are asked to rateeight pairs of adjectives along a seven point semantic differential, firstfor themselves (e.g., I am . . . cautious � a risk-taker) and second fora condom user (e.g., In my opinion, a man who always uses a condomis . . . cautious � a risk-taker). The score is calculated as the sum ofthe absolute values of the discrepancies between the self-rating and therating for a condom user on each item. The alpha coefficient for theeight discrepancy items is .57.

Skills. To assess how skillful the respondent is using condoms, weuse a 9-item observational instrument (Cleghorn, 1991). The partici-pant is asked to put a condom on a plastic penis and then to remove itwhile the interviewer observes whether the condom package is openedwith care–not with nails or teeth, whether the condom is unrolledcorrectly, etc. Nine behaviors are rated either 0 if they are incorrect ormissing, or 1 if they take place correctly. The total score ranges from 0to 9.

Social Norms. The respondent is asked what he thinks his lover’sand his friends’ opinions are with respect to eight safer-sex circum-stances, six of which are specifically related to condom use. Subse-quently, the respondent is asked the degree to which he wants tobehave in agreement with his lover’ or friends’ opinions. The loverand friends’ sections are rated on a 4-point Likert scale (1 = ‘‘stronglydisagree’’ and 4 = ‘‘strongly agree’’), and the score is then multipliedby the score checked by the participant indicating his willingness tobehave accordingly (1= ‘‘not at all’’; 4 = ‘‘very much’’). The mean ofthe eight items in each section yields the partner-type specific scores.The alpha coefficient for lover is .95 and for friends .92. The averageof the two scores is the social norm total score that we used in ouranalyses.

Social Support. We adapted a scale authored by Funch (1986),developing four items for lover’s and four for friends’ support ofcondom use. A sample item is, My lover will listen to me if I want todiscuss my problems with condom use. It is rated on a 5-item Likertscale from ‘‘not at all’’ to ‘‘extremely.’’ The alpha coefficient for the4-item lover scale was .82, and for the 5-item friends scale was .88.The average of the two scores is the social support total score that weused in our analyses.

We conducted a post hoc factor analysis of the items included in the

JOURNAL OF PSYCHOLOGY & HUMAN SEXUALITY56

Anticipated Outcomes, Beliefs, and Emotions scales to verify that theywere distinct constructs. It produced seven factors, the last four withEigenvalues of less than two. The factors clearly distinguished be-tween the three scales with no factor containing items from more thanone scale.

Psycho-Socio-Cultural Variables

We also assessed other factors identified in the scientific literatureas potentially related to sexual behavior.

Acculturation. In its classic definition, ‘‘acculturation comprehendsthose phenomena which result when groups of individuals havingdifferent cultures come in continuous first-hand contact with subse-quent changes in the original culture patterns of either or both groups’’(Redfield, Linton & Herskovits, 1936, cited by Berry & Sam, 1997).We measured this variable with the 5-item Short Acculturation Scale(Marin, Sabogal, Marin, Otero-Sabogal, Pérez-Stable, 1987), whichfocuses mainly on language use. The respondent chooses one out offive possible answers from ‘‘only Spanish’’ to ‘‘only English.’’ Thealpha coefficient reported by the authors for this 5-item scale is .90,and its validity .65 or higher when compared to several validationcriteria.

Childhood Sexual Abuse. In a prior study conducted with PuertoRican MSM, we found an association between a history of childhoodsexual abuse and adult sexual risk behavior (Carballo-Diéguez & Do-lezal, 1995). For this study, once again we identified as abused anyrespondent who prior to age 13 had had sexual contact with someoneat least four years his senior, and felt physically or emotionally hurt bythe experience.

Machismo. (Lara-Cantú, 1989). This 60-item instrument was devel-oped based on the Bem Sex Role Inventory (Bem, 1974). It consists offour scales: Assertive Masculinity, Affective Femininity, AggressiveMasculinity, and Submissive Femininity. The respondent chooses oneout of five possible answers from ‘‘not at all like me’’ to ‘‘extremelylike me.’’ Our alpha coefficients for the four subscales ranged from.73 to .85.

Finally, we asked respondents’ demographic information (includingnational background), history of STDs, involvement in commercialsex, and HIV status.

Carballo-Diéguez et al. 57

Statistical Analyses

A variety of statistical methods were employed as appropriate. Theprimary analyses contrasting the four groups on prevalence of sexualbehaviors involved chi-square tests of 4 � 2 tables. The four groupswere also contrasted using ANOVAs on the log-transformed(log10[x+1]) frequencies of sexual practices. When group differenceswere detected, multiple 2-group tests were done with a Scheffe adjust-ment for post-hoc comparisons. When other factors required twogroup comparisons, chi-square tests were used for categorical vari-ables and t-tests for continuous variables.

RESULTS

The sample consisted of 307 Latino MSM: 80 each Colombians,Dominicans, and Puerto Ricans, and 67 Mexicans (the recruitment ofthe latter fell short from the target number within the allotted time).Ninety-five percent of the respondents resided in New York City at thetime of the assessment, the rest in its surrounding areas. Most respon-dents (188, 61%) chose to be interviewed in Spanish; 100 (33%)preferred English, and 19(6%) used both languages. The participants’average age was 31(range 18-55) and their average education 14 years(3-20), i.e., two years of college–similarly high levels of educationwere reported by the randomly selected sample of New York City’sgay Latinos participating in the Urban Men’s Health Study (Binson etal. 1996), and by a New York City probabilistic sample of Latino barpatrons (Rafael Díaz, personal communication, 9-17-99). The partici-pant’s average yearly income was $16,236 with a median of $14,000(range 0-95,000). Fifty two percent considered themselves Catholics.Eighty percent self-identified as gay, 8.5% as bisexual, 7.5% asstraight, and 4.0% as transgender. The four ethnic subgroups did notdiffer significantly in education, income, or religion, but there weresignificant age differences (p = .000) among the groups, with Domini-cans being younger, on average, than both Colombians and PuertoRicans (28.8 vs. 31.9 and 33.4 years, respectively); Mexican’s averageage was 30.4 years. There were also significant differences in sexualself-identity, with Puerto Ricans having the lowest numbers of gays(68%) and highest of straights (18%), while Dominicans had the high-est numbers of bisexuals (19%; p < .001).

JOURNAL OF PSYCHOLOGY & HUMAN SEXUALITY58

Sexual Behavior

Sexual Behavior with Men

At the time of the assessment, 132 (43%) of the respondents hadlovers. During the year prior to the interview, 239 (78%) had hadone-night-stands, and 199 (65%) had had other male partners. Sepa-rate analyses showed no significant intraethnic differences in terms ofpartnership types. Only 57 (43%) of those who had lovers had beensexually monogamous during the course of the relationship–but wehave no way to ascertain how many of their partners were monoga-mous as well. The monogamous men reported shorter relationshiplength (mean, 8.29 months) than the rest of the men involved with aprimary partner who were not monogamous (N = 75; mean relation-ship length, 9.97 months; t = 2.50, df = 94, p = .014). There were nointraethnic differences in terms of monogamy.

Table 1 presents the number of reported male partners and sexualoccasions in the prior year as well as the number of sexual encountersper partner type. The distributions are highly skewed, mainly due tothe presence of some individuals with a large number of partners andsexual occasions (some, but not all of these were involved in com-mercial sex). For this reason, we report median values–rather thanmeans–as better indicators of central tendency, as well as the 25thand 75th percentile values. The analyses involving ANOVAs usinglog-transformed frequencies showed no statistically significant dif-ferences by groups in terms of number of partners or sexual occa-sions.

Table 2 summarizes the proportion of men in the sample who hadany oral or anal sex in the prior year (regardless of whether it wasinsertive or receptive, discussed later) and who did it unprotected atleast once, as well as the proportion who had both insertive andreceptive oral or anal sex (with same or different partners), and whodid it unprotected. Anal sex was very popular in this sample ofLatino MSM, being practiced by nine out of ten men. Almost half ofthose having anal sex report at least one episode that was unpro-tected.

Table 3 presents in more detail the percentages of individuals whoreported engaging in particular sexual practices the year prior to as-sessment, broken down by national background. We used Chi-squaretests to check for differences between the groups. The Chi Square p

Carballo-Diéguez et al. 59

TABLE 1. Number of male partners and sexual occasions in the year prior toassessment in a sample of Latino MSM (N = 307).

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column of Table 3 shows that significant intraethnic differences couldbe found in only three of the 24 behaviors. Only two of these behav-iors–swallowing semen and receiving ejaculate in the rectum–are con-sidered to carry high risk for HIV transmission.

We also explored how frequently men had performed each of thereported behaviors in the year prior to the interview. Since these dis-tributions were very skewed due to outliers with high frequencies, welog-transformed all frequency data. We then used ANOVAs to test fordifferences among the four groups. There were five statistically signif-icant results (data not shown) on the following behaviors: swallowingsemen, receptive anal sex, unprotected receptive anal sex, receivingejaculation in rectum, and sharing dildos. Mexicans and Puerto Ricanshad an almost identical mean frequency with respect to swallowing

JOURNAL OF PSYCHOLOGY & HUMAN SEXUALITY60

TABLE 3. Intraethnic differences in the sexual behavior of Latino MSM over oneyear.

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Carballo-Diéguez et al. 61

semen, which was higher than that of the other two groups–althoughpost hoc 2-group comparisons were no longer significant after Scheffeadjustment; Mexicans had significantly higher frequencies of recep-tive anal sex and unprotected receptive anal sex than Colombians;Mexicans received ejaculate in the rectum with significantly morefrequency than the other three groups; and Puerto Ricans shared dildoswith significantly more frequency than the other three groups.

Sexual Behavior with Women

Two hundred and fourteen respondents (70%) had had sex with awoman at least once in their lives, and 54 (18%) had sex with a womanin the year prior to the interview. The median number of femalepartners in the past year was 2, ranging from 1 to 70. All but one of the54 men had had vaginal sex with a female partner in the previous year,31 (57% of 54) having done so unprotected. Sixteen (30% of 54) alsoreported anal sex with women, nine having done so unprotected.There were no intraethnic differences on these variables. A McNemartest, restricted to the 54 men who had had sex with both men andwomen, contrasted any unprotected anal sex (receptive or insertive)with a male partner and any unprotected vaginal or anal sex with afemale partner. It showed that a greater number of men have unpro-tected sex with women than with men (p = .021).

In parallel fashion to our prior analysis of sex with men, we ex-plored how frequently the men performed each of the reported behav-iors with women during the year prior to the interview. None of theseanalyses showed significant intraethnic differences.

Condom-Use Related Variables

No intraethnic differences were found in Anticipated Outcomes,Beliefs, Circumstantial Events, Commitment (to practice protectedanal sex), Emotions, Pleasure (associated with anal sex), Risk Percep-tion (in general or personally), Self Standards, Skills, or Social Sup-port. The overall ANOVA showed group differences on Self-Efficacywith highest scores among Dominicans and lowest among Mexicans.However, no 2-group comparisons were significant after Scheffe ad-justment. The only other condom use related variable to show signifi-cant intraethnic differences was Social Norms, with Puerto Ricans

JOURNAL OF PSYCHOLOGY & HUMAN SEXUALITY62

reporting significantly higher pro-condom norms than Colombiansand Mexicans, and Dominicans reporting significantly higher normsthan Colombians. The four groups differed in acculturation, withPuerto Ricans scoring higher. After adjusting for acculturation, therewas still a significant ANOVA result for Social Norms.

Psycho-Socio-Cultural Variables

We wondered whether some of the minor intraethnic differencesobserved in sexual behavior were associated with demographic vari-ables. To explore this, we reanalyzed the three sexual behaviors thatshowed differences in the ANOVAs by running ANCOVAs with age,education, acculturation, and generation (immigrant, first-generation-,or second-generation-U.S. born) as covariates. Intraethnic differenceswere still present after this adjustment except for the variable ‘‘respon-dent swallows semen,’’ which only showed a statistical trend (p =.087).

Since the items in Marin et al. (1987) acculturation scale dealmainly with language use, we looked for other possible indicators ofacculturation. We found that Mexican MSM had spent fewer years inthe U.S. than the rest of the sample, had spent more years in LatinAmerica prior to age 18–an important formative period in one’s life–,but had fewer friends of their same ethnicity among their closest fivefriends. For each of the receptive anal sex variables (overall, unpro-tected, and unprotected with ejaculation) we ran the ANCOVAs witheach one of these variables entered as a covariate. The intraethnicdifferences persisted. It is important to note that, although significantgroup differences were found at the .05 level, the associations weretypically very modest. Since these analyses were exploratory, weaddress all findings that were at that conventional level of signifi-cance and have made no adjustment for multiple comparisons. How-ever, even a moderate adjustment of the acceptable p value for multi-ple comparisons would render a majority of the findingsnon-significant. For example, using the standard adjustment for mul-tiple comparisons of the 24 tests in Table 3 would require a p value of.002 (.05/24). None of the significance levels in Table 3 meet thiscriterion.

We had asked men whether they had exchanged sex for drugs,money, food, clothes, or a place to stay during the year prior to theinterview. Twenty-four percent had either given or been given some-

Carballo-Diéguez et al. 63

thing in exchange for sex (16% had received something). However,only 13 men (4%) had received money or goods in exchange for sexmore than ten times in the prior year. We concluded that the number ofcommercial sex workers in the sample was too small to significantlyaffect the results.

Reportedly, 28 % of the men had had an STD. In terms of childhoodsexual abuse, 18% of the men reported having had sex prior to age 13with an adult at least four years their senior and being physically orpsychologically hurt by the experience; an additional 14% met our agecriteria for abuse but did not report feeling hurt. There were no ethnicdifferences along any of these variables. We only found significantintraethnic differences in three out of four Machismo subscales, withPuerto Ricans scoring significantly higher than Mexicans on the Mas-culine Aggressive subscale, and Mexicans scoring lower than the oth-er three groups in Masculine Assertive scales. Against expectations,Mexicans scored lower in the Female Affective scale than the otherthree groups.

DISCUSSION

The results of this study should be interpreted with caution giventhe non-random selection of the sample and the use of volunteers.Furthermore, the participants were living in New York City, and theirbehavior may be different from that of Latinos in other regions of theUnited States.

Within those constraints, the primary outcome of our study is thatColombian, Dominican, Mexican, and Puerto Rican MSM living inNew York City behave similarly, on average, when it comes to sex.Over the course of one year, they have a similar number of sexualpartners and sexual occasions. Similar proportions in each ethnicgroup are likely to have lovers, one-night-stands, or other partners; tobe sexually monogamous; to have sex with women; and to be involvedin commercial sex. Furthermore, MSM in the four groups do notsignificantly differ in terms of the specific sexual acts in which theyengage or their frequency with a few exceptions that have limitedsignificance from the point of view of HIV transmission.

First, a significant difference appears in terms of swallowing ejacu-late. Here, the highest proportion of men reporting this behavior areMexican and the lowest, Dominican. However, only 8% of the total

JOURNAL OF PSYCHOLOGY & HUMAN SEXUALITY64

sample swallows, there are no significant differences between groupsin terms of frequency of this behavior, and the intraethnic differencewith respect to receiving ejaculate in the mouth–regardless of swallo-wing–does not quite reach significance. Although it is popularly as-sumed that swallowing infected semen may present a higher risk thanspitting it, no definitive data exist on this issue.

The second significant difference refers to receiving ejaculate in therectum. Although there are no intraethnic differences in the proportionof men who are penetrated or who are penetrated without condoms,Mexicans engage in these behaviors significantly more frequentlythan Colombians, but no more than Dominicans or Puerto Ricans.When it comes to receiving ejaculate in the rectum, more Mexicans doso and more frequently than the three other groups. This last differ-ence is probably the most consistent one that we have found in all theintraethnic comparisons of sexual behaviors, and it has relevance fromthe point of view of HIV transmission. Throughout these analyses, itappears that Mexicans tend to play a more ‘‘passive’’ sexual role.Furthermore, Mexicans score lower than the other three groups in theMasculine Assertive subscale of the Machismo measurement. Yet,none of the condom-use related variables or the rest of the psycho-so-cio-cultural factors considered account for the difference, thus leavingthe issue open to further study.

In terms of sharing dildos, Puerto Ricans reported it more fre-quently than the three other groups. Again, there is no hard data onthe relevance of this behavior in terms of HIV transmission, but onecould postulate some risk if no condoms are used to cover the dildo,no appropriate washing takes place before sharing, and the partnersare of serodiscordant HIV status. Except for Puerto Ricans, the threeother groups had very low proportions of men engaging in this be-havior.

Finally, except for social norms, none of the theoretically derivedcondom use related variables appeared significantly different in theintraethnic comparison. The four groups shared similar positive andnegative anticipations concerning condom use, had comparable be-liefs about circumstances that made condom use unnecessary, hadexperienced to a similar degree circumstantial events that preventedcondom use, shared a comparable commitment to use condoms, wereno significantly different from each other in terms of emotions thatmight interfere with condom use, experienced parallel levels of de-

Carballo-Diéguez et al. 65

crease in pleasure when they used condoms, shared perceptions onthe risk involved in unprotected sex, held similar self-standards con-cerning condom use, and had similar skills to put on and remove acondom. The difference in social norms, on which Puerto Ricansscored highest, was not explained by acculturation per se; yet, beingmore acculturated, this group may be more exposed to EuropeanAmerican groups in which social norms fostering condom use maybe stronger.

In sum, the overall sexual behavior of these four groups of LatinoMSM shows more similarities than differences. The groups are alsosimilar on a number of parameters usually associated with condomuse. Therefore, collapsing data concerning their sexual behaviorseems justified, as well as implementing mass media prevention cam-paigns directed to Latino MSM of different national backgrounds.This does not imply, however, that small scale interventions tailored tothe specific cultural nuances of different national groups may not havean added strength.

Another important finding was that, over the course of one year,anal sex is practiced almost universally among Latino MSM, thisreplicating the results of our prior study that was restricted to Puer-to Rican MSM (Carballo-Diéguez & Dolezal, 1994). We have alsoestablished that most Latino MSM have multiple sexual partners inthe course of one year and that monogamy is not the norm amongpartnered Latino MSM. Not surprisingly, longer relationships areless likely to be monogamous than shorter ones, and men who areinvolved in relationships have more sexual occasions than thosewho are not. The small ratio of ejaculation in mouth or anuscompared to the proportion of individuals practicing unprotectedpenetration may indicate that ‘‘coitus interruptus’’ is being used asa form of safer sex. Finally, of those men who engage in bisexualbehavior, fewer use protection with their female partners than withtheir male partners.

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