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Tatham C. Life and love under criminalization: The experiences of people living with HIV in Canada. PLoS One 2024; 19:e0306894. [PMID: 39052618 PMCID: PMC11271884 DOI: 10.1371/journal.pone.0306894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 06/23/2024] [Indexed: 07/27/2024] Open
Abstract
Based upon qualitative interviews with 54 women and men living with HIV across Ontario, Canada, this paper examines the impact of HIV criminalization on the sexual and romantic relationships of people living with HIV. This research highlights the navigation strategies people living with HIV create and employ to both navigate and protect themselves from the law. Through a thematic and intersectional analysis, this study shows how adoption of these strategies is unequal, with access to navigation strategies varying along lines of gender, race, and sexual orientation. As a result, women and racialized people living with HIV face more difficulties navigating the impact of the law. HIV criminalization in Canada fuels and validates HIV stigma and produces vulnerability both within and outside of the relationships of people living with HIV. This paper seeks to understand HIV criminalization from the perspective of those governed by the law, in hopes of producing knowledge which will contribute to legal reform, inform policy, and support the development of efficacious secondary prevention initiatives.
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Affiliation(s)
- Christopher Tatham
- Department of Sociology and Anthropology, University of Guelph, Guelph, Ontario, Canada
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Xu Y, Jiao K, Zhang Y, Huang S, Zhou J, Li Y, Xiao Y, Ma W, He L, Ren X, Dai Z, Sun J, Li Q, Cheng F, Liang W, Luo S. Behavioral intentions of self-isolation and informing close contacts after developing mpox-related symptoms among young men who have sex with men in China. J Med Virol 2024; 96:e29470. [PMID: 38362933 DOI: 10.1002/jmv.29470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 01/12/2024] [Accepted: 01/31/2024] [Indexed: 02/17/2024]
Abstract
The 2022 multi-country mpox outbreak raised public concern globally. Self-isolation and informing close contacts after developing mpox-related symptoms are critical measures in controlling the outbreak. This study investigated behavioral intentions of self-isolation and informing close contacts after developing mpox-related symptoms and associated factors among young men who have sex with men (YMSM) aged 18-29 years in China. The cross-sectional study was conducted among 2493 YMSM in six provincial regions in China from September 10th to 30th, 2022. Descriptive and logistic analyses were applied, using the intentions of self-isolation and informing close contacts after developing mpox-related symptoms as binary outcomes. The mean age of the participants was 24.6 (SD = 2.9) years. The prevalence of having intentions of self-isolation and informing close contacts after developing mpox-related symptoms was 88.6% (95% CI: 87.3%-89.9%) and 84.9% (95% CI: 83.5%-86.3%). Participants who were employed (adjusted odds ratio (AOR) = 1.474, 95% CI: 1.035-2.097; AOR = 1.371, 95% CI:1.002, 1.876), had higher mpox knowledge scores (AOR = 1.474, 95% CI: 1.035-2.097; AOR = 1.371, 95% CI: 1.002-1.876), and had higher perceived threats of mpox (AOR = 1.079, 95% CI: 1.030-1.130; AOR = 1.045, 95% CI: 1.002-1.090) were more likely to intend to self-isolate and inform close contacts. Participants who had MSM in-person gatherings in the past 6 months were more likely to intend to self-isolate (AOR = 1.392, 95% CI: 1.066-1.208). Participants with higher depression scores (AOR = 0.968, 95% CI: 0.948-0.989) and self-stigma (AOR = 0.975, 95% CI: 0.954-0.997) were less likely to intend to self-isolate and inform close contacts, respectively. Self-isolation and informing close contacts when developing disease-related symptoms are acceptable measures in response to mpox in China. Strengthening targeted risk communication and self-efficacy, raising disease knowledge, providing mental support, and reducing stigma toward the affected community are warranted.
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Affiliation(s)
- Yutong Xu
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Kedi Jiao
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Yuhang Zhang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Siwen Huang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Jingtao Zhou
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Yan Li
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Yongkang Xiao
- Department of Acute Infectious Diseases Control and Prevention, Anhui Provincial Center for Disease Control and Prevention, Hefei, Anhui, China
| | - Wei Ma
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Lin He
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Xianlong Ren
- Department of AIDS/STD Control and Prevention, Beijing Center for Disease Control and Prevention, Beijing, China
| | - Zhen Dai
- Department of AIDS/STD Control and Prevention, Chengdu Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Jiaruo Sun
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Qingyu Li
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Feng Cheng
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Wannian Liang
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Sitong Luo
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
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Campbell CK. The Ongoing Process of HIV-Stigma (Re)Production. SOCIOLOGICAL PERSPECTIVES : SP : OFFICIAL PUBLICATION OF THE PACIFIC SOCIOLOGICAL ASSOCIATION 2023; 66:355-374. [PMID: 38516303 PMCID: PMC10956429 DOI: 10.1177/07311214221117294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
HIV stigma negatively affects the social experiences of people living with HIV (PLWH) and remains a challenge to HIV prevention, treatment, and care. Research has overwhelmingly focused on individual cognitive measures of HIV stigma (e.g., internalized, anticipated, and experienced). However, little research explores the interactions and societal structures through which HIV stigma is produced. Data from qualitative interviews with 30 black gay and bisexual men living with HIV in the U.S. Deep South revealed an interconnected and interdependent set of processes that produce and reproduce HIV stigma. These included social interactions (silence, euphemism, and gossip), witnessed acts of marginalization, word-of-mouth transmission of HIV misinformation, and laws and policies carried out within the education and criminal justice systems. Efforts to reduce stigma that focus on individual beliefs and attitudes are critical to improving the well-being of PLWH. However, reducing HIV stigma requires intervening on the social interactions and structures through which HIV stigma is produced and reproduced.
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Affiliation(s)
- Chadwick K. Campbell
- Herbert Wertheim School of Public Health and Human Longevity, University of California, San Diego, La Jolla, CA, USA
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Li Y, Xiao X, Zhou Y, Su X, Wang H. The mediating role of executive function in the relationship between self-stigma and self-injury or suicidal ideation among men who have sex with men living with HIV. Front Public Health 2023; 10:1066781. [PMID: 36699888 PMCID: PMC9869120 DOI: 10.3389/fpubh.2022.1066781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Background Men who have sex with men (MSM) living with HIV suffer from psychosocial pressures and marginalization as a result of being HIV-positive and belonging to a sexual minority group, and self-injury or suicidal ideation are prevalent among this group. Studies have found that both perceived self-stigma and altered executive function is related to self-injury or suicidal ideation. However, the combined contribution of self-stigma and executive function to self-injury or suicidal ideation remains unclear, especially in MSM living with HIV. Therefore, this study is conducted to explore the mechanism of self-injury or suicidal ideation by hypothesizing that executive function plays a mediating role in the relationship between self-stigma and self-injury or suicidal ideation. Methods We conducted a cross-sectional survey among 448 MSM living with HIV who were recruited in the HIV clinic of a tertiary general hospital in Changsha, China, from November 2021 to February 2022. A questionnaires survey was adopted to collect sociodemographic and disease-related information and data related to executive function (including working memory, inhibition, and task monitoring), self-stigma, and self-injury or suicidal ideation. Structural equation modeling and bootstrap testing were used to investigate the potential mediating role of executive function in the relationship between self-stigma and suicidal ideation. Results The participants were aged 18-76 years. Those who had ever had self-injury or suicidal ideation accounted for 32.8% of the total. A higher level of self-stigma and poorer executive function were associated with more frequent self-injury or suicidal ideation (p < 0.01). The mediation model analysis showed a good fit (x 2/df = 1.07, p = 0.381). The direct effect of self-stigma on self-injury or suicidal ideation (β = 0.346, p < 0.001) and the indirect effect of self-stigma via executive function (β = 0.132, p < 0.001) were significant, with the indirect effect accounting for 27.6% of the total effect. Conclusions This study demonstrates that executive function mediates the relationship between self-stigma and self-injury or suicidal ideation among MSM living with HIV. It suggests that future studies targeting enhancing executive function and decreasing self-stigma may reduce self-injury or suicidal ideation among MSM living with HIV.
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Mi T, Lan G, Yang X, Li X, Qiao S, Shen Z, Zhou Y. HIV-Related Stigma, Sexual Identity, and Depressive Symptoms Among MSM Living With HIV in China: A Moderated Mediation Modeling Analysis. Am J Mens Health 2022; 16:15579883221087531. [PMID: 35343811 PMCID: PMC8966094 DOI: 10.1177/15579883221087531] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Depression is one of the biggest health issues among men who have sex with men (MSM) living with HIV, where sexual identity might play an intricate role. Yet, findings of the relationship between sexual identity and depression were mixed and few studies explored its underlying mechanisms. This study aimed to examine the association between sexual identity and depression, and the potential mediating role of HIV-related stigma and moderating role of age. A cross-sectional survey was conducted among 203 MSM living with HIV in Guangxi, China. Participants provided information on sexual identity, depression, HIV-related stigma, and background information. Descriptive statistics, bivariate analysis, and path analysis were applied to examine our hypotheses. Bivariate analysis demonstrated that participants who self-identified as gay reported a lower level of HIV-related stigma and depression. Path analysis revealed an insignificant direct effect of identifying as gay on depression. Yet, the indirect pathway was significant, with identifying as gay being associated with a lower level of HIV stigma and thus a lower level of depression. This indirect effect was moderated by age. The conditional indirect effect was significant in the younger group yet ceased in the older group. The study provided information to better understand the effect of sexual identity on mental health among stigmatized sexual and gender minorities by highlighting the mediating effect of HIV-related stigma and the protective effect of age. Interventions targeting mental health of MSM living with HIV might consider placing greater emphasis on addressing HIV-related stigma among younger MSM.
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Affiliation(s)
- Tianyue Mi
- Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Guanghua Lan
- Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Xueying Yang
- Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Shan Qiao
- Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Zhiyong Shen
- Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Yuejiao Zhou
- Guangxi Center for Disease Control and Prevention, Nanning, China
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Gunn JKL, Rooks-Peck C, Wichser ME, Denard C, McCree DH, Jeffries WL, DeLuca JB, Ross LW, Herron A, Barham T, Flores SA, Higa DH. Effectiveness of HIV Stigma Interventions for Men who have Sex with Men (MSM) With and Without HIV in the United States: A Systematic Review and Meta-Analyses. AIDS Behav 2022; 26:51-89. [PMID: 34263349 DOI: 10.1007/s10461-021-03358-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 02/08/2023]
Abstract
Stigma may contribute to HIV disparities for men who have sex with men (MSM). This systematic review quantified the effects of HIV stigma interventions for MSM on stigma and sex risk. We conducted a systematic search to identify US-based studies published between 2000 and June 2019 focused on HIV and MSM, and either measured stigma pre-post or included a stigma intervention component. Twenty-nine articles, representing 26 unique studies met inclusion criteria. Random effect models showed no intervention effect for reducing stigma and a non-significant increase in HIV testing. Significant decreases in condomless sex with males, condomless sex with females, and substance-influenced sex were found. Few intervention studies measured stigma pre-post. Findings suggest that including a stigma reduction component in interventions can improve HIV testing and reduce sex risk for MSM. Developing interventions to address stigma may be important in decreasing HIV infection among MSM and ending the HIV epidemic.
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Baugher AR, Whiteman A, Jeffries WL, Finlayson T, Lewis R, Wejnert C. Black men who have sex with men living in states with HIV criminalization laws report high stigma, 23 U.S. cities, 2017. AIDS 2021; 35:1637-1645. [PMID: 34270489 PMCID: PMC9030111 DOI: 10.1097/qad.0000000000002917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To examine the association between HIV laws, perceived community stigma, and behaviors and to compare differences between and within Black and White men who have sex with men (MSM). DESIGN/METHODS National HIV Behavioral Surveillance conducted interviews and HIV testing with MSM in 23 U.S. cities in 2017 using venue-based sampling methods. We used weighted cross-sectional data to compare MSM living in states with versus without HIV laws using Rao-Scott chi-square tests. We modeled the association between stigma and state HIV laws within racial groups to obtain adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs). RESULTS Among 7392 MSM, 56% lived in a state with HIV laws. In law states, Black MSM were more likely than White MSM to report their community would discriminate against persons with HIV (PWH) (59 versus 34%), not support the rights of PWH (20 versus 9%), not be friends with PWH (19 versus 10%), believe PWH 'got what they deserved' (27 versus 16%), and be intolerant of MSM (14 versus 5%). Adjusted for confounders, Black MSM in HIV law states were more likely to think their community would discriminate against PWH (aPR, 1.14; 95% CI, 1.02-1.29; P = 0.02) and be intolerant toward MSM (aPR, 2.02; 95% CI, 1.43-2.86; P < 0.001) than Black MSM in states without such laws. CONCLUSIONS HIV laws were related to higher stigma, but only for Black MSM. Future research regarding HIV-related laws should account for racial/ethnic disparities. Modernizing laws can delegitimize stigma and promote focusing on effective HIV prevention strategies.
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Affiliation(s)
- Amy R. Baugher
- Division of HIV/AIDS Prevention (DHAP), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ari Whiteman
- Division of HIV/AIDS Prevention (DHAP), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, assigned to DHAP, Oak Ridge, TN, USA
| | - William L. Jeffries
- Division of HIV/AIDS Prevention (DHAP), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Teresa Finlayson
- Division of HIV/AIDS Prevention (DHAP), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rashunda Lewis
- Division of HIV/AIDS Prevention (DHAP), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cyprian Wejnert
- Division of HIV/AIDS Prevention (DHAP), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Öztürk S, Şimşek Ç, Ardıç E, Ağalar C. Turkish validity and reliability of the Internalized AIDS-Related Stigma Scale. Perspect Psychiatr Care 2021; 57:1292-1298. [PMID: 33295019 DOI: 10.1111/ppc.12688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/25/2020] [Accepted: 10/31/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This study was conducted methodologically to adapt the Internalized AIDS-Related Stigma Scale (IA-RSS) to Turkish society. DESIGN AND METHODS: The universe of the study consisted of 250 people who were treated in the infectious diseases outpatient clinic. A total of 60 individuals living with human immunodeficiency virus (HIV) composed the sample. The Individual Information Form and IA-RSS were used for data collection. FINDINGS All the statistical procedures performed in the validity and reliability stages of the study show that the scale is a valid, reliable measurement tool for the Turkish culture. PRACTICE IMPLICATIONS: The Turkish version of the IA-RSS was determined as a valid and reliable screening tool that measures internal stigmatization in living with HIV.
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Affiliation(s)
- Servet Öztürk
- Infectious Diseases and Clinical Microbiology Clinic, Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Bostancı, Turkey
| | - Çağlar Şimşek
- Gaziosmanpaşa Taksim Training and Research Hospital, İstanbul, Taksim, Turkey
| | - Elif Ardıç
- Department of Nursing, Faculty of Health Sciences, Marmara University, İstanbul, Maltepe, Turkey
| | - Canan Ağalar
- Infectious Diseases and Clinical Microbiology Clinic, Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Bostancı, Turkey
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Taggart T, Mayer KH, Vermund SH, Huang S, Hayashi K, Ransome Y. Interaction of Religion/Spirituality With Internalized HIV Stigma, Depression, Alcohol Use, and Sexual Risk Among Black Men Who Have Sex With Men: The 6 City HPTN 061 Study. J Acquir Immune Defic Syndr 2021; 87:e188-e197. [PMID: 33633033 PMCID: PMC8131231 DOI: 10.1097/qai.0000000000002667] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/16/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Black men who have sex with men (BMSM) remain at highest risk for HIV in the United States. Internalized HIV stigma and depression contribute to substance use and condomless anal intercourse (CAI). Religion and spirituality (R/S) are associated with decreased HIV-related risk behaviors for some groups, but their impact among BMSM is uncertain. We investigated the main and moderating roles of R/S on pathways from internalized HIV stigma to CAI while under the influence of drugs. METHODS We used baseline data from 1511 BMSM from the HIV Prevention Trials Network (HPTN) 061 study to examine the associations between internalized HIV stigma, depressive symptoms, alcohol use, and CAI while under the influence of drugs, adjusting for covariates in generalized structural equation models. We then tested whether R/S moderated the association between (1) internalized HIV stigma and depressive symptoms, (2) depressive symptoms and alcohol use, and (3) alcohol use and CAI while under the influence of drugs. RESULTS Spiritual beliefs [F(1,2) = 9.99, P < 0.001], spiritual activities [F(1,2) = 9.99, P < 0.001], and religious attendance [F(1,2) = 9.99, P < 0.001] moderated the pathway between internalized HIV stigma and depressive symptoms. As internalized HIV stigma increased, those with lower spiritual activity scores experienced significantly higher increases in depressive symptoms compared with those with higher spiritual activity scores whose depressive symptom scores remained unchanged [stigma × spiritual activities B = -0.18 (SE = 0.07), P < 0.001]. CONCLUSIONS Religion and spirituality were protective against CAI among BMSM. Future intervention research should explore ways to incorporate religious and/or spiritual activities to reduce internalized HIV stigma as one way to reduce depressive symptoms among BMSM.
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Affiliation(s)
- Tamara Taggart
- Department of Prevention and Community Health, George Washington University, Milken Institute School of Public Health
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Shu Huang
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Kamden Hayashi
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
| | - Yusuf Ransome
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Campbell CK. Structural and intersectional biographical disruption: The case of HIV disclosure among a sample of black gay and bisexual men. Soc Sci Med 2021; 280:114046. [PMID: 34051554 DOI: 10.1016/j.socscimed.2021.114046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/06/2021] [Accepted: 05/17/2021] [Indexed: 01/18/2023]
Abstract
HIV disclosure has been considered key to prevention and privileged as a "healthy" behavior for people living with HIV. Although research has documented potential negative outcomes of disclosure, we know little about its potential of these consequences to disrupt one's biography, or the intersectional and structural inequities that shape disclosure/nondisclosure and its outcomes. Exploring HIV disclosure as a discrete, measurable event cannot account for the experience of the self in illness, and how disclosure can fundamentally shift everyday reality and social relationships. To fill this gap, I employed the framework of structural intersectionality, and the medical sociology theory of biographical disruption to explore HIV disclosure among a sample of Black gay and bisexual men living with HIV in the Deep South. Between June 2019 and June 2020, I conducted in-depth qualitative interviews with 30 Black gay and bisexual men living with HIV in the Baton Rouge, Louisiana metropolitan area. Interviews were recorded and transcribed verbatim and analyzed using a grounded theory approach. Disruptions as a result of HIV disclosure included: assaults on self; disturbance to social and familial networks; and socioeconomic impacts. Further, findings illustrate that disruptions were not discrete events, but evolved over time, and that the nature of disruption was constituted by previous traumatic disruptions, social and structural contexts, and men's social location at the intersections of race, class, sexuality, HIV-status, and geography. I highlight that consequences of HIV disclosure among a sample of Black gay and bisexual men, were shaped by their unique social location and the persistence of intersecting structural inequities. Future research should account for preceding and cumulative experiences, how intersecting inequities constitute disclosure experiences, and that disclosure is a complex process occurring in the context of ongoing social relations.
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Affiliation(s)
- Chadwick K Campbell
- Center for AIDS Prevention Studies, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94158, United States; Department of Social and Behavioral Sciences, University of California San Francisco, Box 0612, 490 Illinois Street, Floor 12, San Francisco, CA, 94143, United States.
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Fields EL, Hussen SA, Malebranche DJ. Mind the Gap: HIV Prevention Among Young Black Men Who Have Sex with Men. Curr HIV/AIDS Rep 2021; 17:632-642. [PMID: 32914329 PMCID: PMC7483045 DOI: 10.1007/s11904-020-00532-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW Young Black men who have sex with men (YBMSM) suffer profound health inequities in new HIV diagnoses and clinical outcomes. While the evolution of HIV prevention options has become increasingly biomedical, inequities in access and uptake of these modalities persist. RECENT FINDINGS Studies suggest that while YBMSM display interest and acceptability of varied HIV prevention options, uptake lags due to the lingering effects of intersectional oppression from racism and sexual prejudice, HIV stigma, institutional and provider bias, and unresolved health policy barriers. Promising avenues to address these barriers have yet to be fully explored. We have the tools to effectively prevent HIV transmission and acquisition among YBMSM, but we have not yet effectively implemented these tools for this priority population. To end the epidemic, we must tailor and adapt HIV prevention strategies to meet the unique intersecting needs, identities, and social contexts of YBMSM.
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Affiliation(s)
- Errol L Fields
- Division of Adolescent/Young Adult Medicine, Johns Hopkins School of Medicine, 200 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Sophia A Hussen
- Hubert Department of Global Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - David J Malebranche
- Department of General Medicine, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA, 30310, USA.
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da Silva LAV, Duarte FM, Magno L, Dourado I, Squire C. Moral barriers to HIV prevention and care for gay and bisexual men: Challenges in times of conservatism in Brazil. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:424-440. [PMID: 33432619 DOI: 10.1111/1467-9566.13230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 10/26/2020] [Accepted: 11/19/2020] [Indexed: 06/12/2023]
Abstract
This article examines narratives about promiscuity that are emphasized by some gay and bisexual men who are themselves living with HIV. We used semi-structured interviews to assess the processes, outcomes, and meanings of HIV diagnosis among 10 young gay and bisexual men aged between 18 and 30 years old. Interviews were conducted in health service settings for the diagnosis and treatment of HIV and AIDS in Salvador, Brazil. Based on a socioculturally oriented approach, the narratives suggest that discourse about promiscuity seems to persist, or is even strengthened, in order to explain HIV infection among young gays/bisexual men and to emphasize a more restrained sexual life following HIV diagnosis. Despite the biotechnologies and biomedical advances, some difficulties and tensions also persist in the daily life of young people living with HIV. Difficulties in starting new relationships, dilemmas around responsibility for infection/transmission, fear and guilt are elements that stand out in these narratives, demonstrating that HIV discourses and practices may produce greater stigma and discrimination in current times, individualizing and blaming certain people for the infection/transmission of the virus, and marginalizing practices that do not conform to hegemonic heteronormativity.
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Affiliation(s)
- Luís Augusto Vasconcelos da Silva
- Institute of Humanities, Arts and Sciences Professor Milton Santos, Federal University of Bahia (Universidade Federal da Bahia: UFBA), Salvador, Brazil
- Institute of Collective Health, UFBA, Salvador, Brazil
| | | | - Laio Magno
- Institute of Collective Health, UFBA, Salvador, Brazil
- Department of Life Sciences, Bahia State University, Salvador, Brazil
| | - Inês Dourado
- Institute of Collective Health, UFBA, Salvador, Brazil
| | - Corinne Squire
- Centre for Narrative Research, School of Social Sciences, University of East London, London, UK
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Meanley S, Chandler C, Jaiswal J, Flores DD, Stevens R, Connochie D, Bauermeister JA. Are Sexual Minority Stressors Associated with Young Men who Have Sex with Men's (YMSM) Level of Engagement in PrEP? Behav Med 2021; 47:225-235. [PMID: 32401184 PMCID: PMC7774673 DOI: 10.1080/08964289.2020.1731675] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Sexual minority stressors (community homophobia, sexuality-related discrimination, and internalized homonegativity) are negatively associated with accessing HIV prevention services among men who have sex with men (MSM). Few studies have tested minority stressors' associations with PrEP engagement among high-HIV risk young MSM (YMSM). Therefore, we assessed the associations between PrEP-indicated YMSM's progression along the PrEP continuum and their experiences of minority stress. N = 229 YMSM completed a web-survey on PrEP-related behaviors and minority stress. Adjusted for covariates, we developed two partial-proportional odds models examining the associations between PrEP continuum progression and minority stressors, as a composite, and community homophobia, sexuality-related discrimination, and internalized homonegativity, respectively. Our multivariable model demonstrated minority stress levels to be negatively associated with PrEP continuum location (AOR = 0.76, 95% CI: 0.58-0.99). Broken down, discrimination was positively associated with reporting being at an advanced location along the continuum (AOR = 1.39, 95% CI: 1.06-1.82). Internalized homonegativity was negatively associated with continuum location between PrEP-aware participants with no intention to initiate and participants who intended to initiate PrEP (AOR = 0.45, 95% CI: 0.27-0.77) and between those who intended to initiate and those who had ever used PrEP (AOR = 0.39, 95% CI: 0.22-0.69). Our findings suggest that minority stress, especially internalized homonegativity, remains a barrier to PrEP among PrEP-indicated YMSM. Sexuality-related discrimination was associated with PrEP continuum progression, suggesting potentially well-developed, adaptive coping skills (e.g., ability to locate sexuality-affirming providers). Coupled with stigma reduction efforts, HIV prevention services aiming to promote PrEP should incorporate internalized homonegativity screenings and referrals into sexuality-affirming resources for PrEP-indicated YMSM.
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Affiliation(s)
- Steven Meanley
- Department of Family and Community Health, University of Pennsylvania School of Nursing,Research Education Institute for Diverse Scholars, Yale University School of Public Health Center for Interdisciplinary Research on AIDS
| | - Cristian Chandler
- Research Education Institute for Diverse Scholars, Yale University School of Public Health Center for Interdisciplinary Research on AIDS
| | - Jessica Jaiswal
- Research Education Institute for Diverse Scholars, Yale University School of Public Health Center for Interdisciplinary Research on AIDS,Department of Health Sciences, University of Alabama
| | - Dalmacio D. Flores
- Department of Family and Community Health, University of Pennsylvania School of Nursing,Research Education Institute for Diverse Scholars, Yale University School of Public Health Center for Interdisciplinary Research on AIDS
| | - Robin Stevens
- Department of Family and Community Health, University of Pennsylvania School of Nursing
| | - Daniel Connochie
- Department of Family and Community Health, University of Pennsylvania School of Nursing
| | - José A. Bauermeister
- Department of Family and Community Health, University of Pennsylvania School of Nursing
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Muessig KE, Golinkoff JM, Hightow-Weidman LB, Rochelle AE, Mulawa MI, Hirshfield S, Rosengren AL, Aryal S, Buckner N, Wilson MS, Watson DL, Houang S, Bauermeister JA. Increasing HIV Testing and Viral Suppression via Stigma Reduction in a Social Networking Mobile Health Intervention Among Black and Latinx Young Men and Transgender Women Who Have Sex With Men (HealthMpowerment): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e24043. [PMID: 33325838 PMCID: PMC7773515 DOI: 10.2196/24043] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/03/2020] [Accepted: 11/03/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Stigma and discrimination related to sexuality, race, ethnicity, and HIV status negatively impact HIV testing, engagement in care, and consistent viral suppression (VS) among young Black and Latinx men who have sex with men and transgender women who have sex with men (YBLMT). Few interventions address the effects of intersectional stigma among youth living with HIV and those at risk for HIV within the same virtual space. OBJECTIVE Building on the success of the HealthMpowerment (HMP) mobile health (mHealth) intervention (HMP 1.0) and with the input of a youth advisory board, HMP 2.0 is an app-based intervention that promotes user-generated content and social support to reduce intersectional stigma and improve HIV-related outcomes among YBLMT. The primary objective of this study is to test whether participants randomized to HMP 2.0 report improvement in HIV prevention and care continuum outcomes compared with an information-only control arm. We will also explore whether participant engagement, as measured by paradata (data collected as users interact with an mHealth intervention, eg, time spent using the intervention), mediates stigma- and HIV care-related outcomes. Finally, we will assess whether changes in intersectional stigma and improvements in HIV care continuum outcomes vary across different types of social networks formed within the intervention study arms. METHODS We will enroll 1050 YBLMT aged 15 to 29 years affected by HIV across the United States. Using an HIV-status stratified, randomized trial design, participants will be randomly assigned to 1 of the 3 app-based conditions (information-only app-based control arm, a researcher-created network arm of HMP 2.0, or a peer-referred network arm of HMP 2.0). Behavioral assessments will occur at baseline, 3, 6, 9, and 12 months. For participants living with HIV, self-collected biomarkers (viral load) are scheduled for baseline, 6, and 12 months. For HIV-negative participants, up to 3 HIV self-testing kits will be available during the study period. RESULTS Research activities began in September 2018 and are ongoing. The University of Pennsylvania is the central institutional review board for this study (protocol #829805) with institutional reliance agreements with the University of North Carolina at Chapel Hill, Duke University, and SUNY Downstate Health Sciences University. Study recruitment began on July 20, 2020. A total of 205 participants have been enrolled as of November 20, 2020. CONCLUSIONS Among a large sample of US-based YBLMT, this study will assess whether HMP 2.0, an app-based intervention designed to ameliorate stigma and its negative sequelae, can increase routine HIV testing among HIV-negative participants and consistent VS among participants living with HIV. If efficacious and brought to scale, this intervention has the potential to significantly impact the disproportionate burden of HIV among YBLMT in the United States. TRIAL REGISTRATION ClinicalTrials.gov NCT03678181; https://clinicaltrials.gov/ct2/show/study/NCT03678181. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/24043.
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Affiliation(s)
- Kathryn Elizabeth Muessig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jesse M Golinkoff
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Lisa B Hightow-Weidman
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Aimee E Rochelle
- Behavior and Technology Lab, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Marta I Mulawa
- School of Nursing, Duke University, Durham, NC, United States
| | - Sabina Hirshfield
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, United States
| | - A Lina Rosengren
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Subhash Aryal
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | | | - M Skye Wilson
- Behavior and Technology Lab, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Dovie L Watson
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Steven Houang
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - José Arturo Bauermeister
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
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15
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Tieu HV, Koblin BA, Latkin C, Curriero FC, Greene ER, Rundle A, Frye V. Neighborhood and Network Characteristics and the HIV Care Continuum among Gay, Bisexual, and Other Men Who Have Sex with Men. J Urban Health 2020; 97:592-608. [PMID: 29845586 PMCID: PMC7560681 DOI: 10.1007/s11524-018-0266-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
In order for treatment as prevention to work as a national strategy to contain the HIV/AIDS epidemic in the United States (US), the HIV care continuum must become more robust, retaining more individuals at each step. The majority of people living with HIV/AIDS (PLWHA) in the US are gay, bisexual, and other men who have sex with men (MSM). Within this population, there are distinct race- and ethnicity-based disparities in rates of HIV infection, engagement, and retention in HIV care, and viral suppression. Compared with White MSM, HIV-infected Black MSM are less likely to be on anti-retroviral therapy (ART), adhere to ART, and achieve viral suppression. Among MSM living in urban areas, falling off the continuum may be influenced by factors beyond the individual level, with new research identifying key roles for network- and neighborhood-level characteristics. To inform multi-level and multi-component interventions, particularly to support Black MSM living in urban areas, a clearer understanding of the pathways of influence among factors at various levels of the social ecology is required. Here, we review and apply the empirical literature and relevant theoretical perspectives to develop a series of potential pathways of influence that may be further evaluated. Results of research based on these pathways may provide insights into the design of interventions, urban planning efforts, and assessments of program implementation, resulting in increased retention in care, ART adherence, and viral suppression among urban-dwelling, HIV-infected MSM.
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Affiliation(s)
- Hong-Van Tieu
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Beryl A Koblin
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Frank C Curriero
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emily R Greene
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Andrew Rundle
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Victoria Frye
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY, USA.
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Chen C, Huang J, Zhao J, Zhang Y, Xiaonan Yu N. Resilience Moderated the Predictive Effect of Dual Stigma on Distress Among Chinese Newly Diagnosed HIV-Positive Men Who Have Sex With Men. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2020; 32:403-415. [PMID: 33112678 DOI: 10.1521/aeap.2020.32.5.403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Previous studies have examined the distinct stigmas of people living with HIV or of men who have sex with men (MSM). To capture the composite stress of HIV-positive MSM and the mixed stigma they experience, we conceptualized a compound stigma combining HIV status and homosexual identity. At two waves with an interval of 6 months, the results of 112 Chinese newly diagnosed HIV-positive MSM showed that dual stigma at baseline increased distress symptoms 6 months later. Resilience moderated these effects, as the dual stigma increased, distress symptoms intensified more rapidly for individuals with lower resilience than they did for those with higher resilience. Our findings highlight that dual stigma, as an intensified risk factor, predicted distress among the Chinese newly diagnosed HIV-positive MSM, conditioned by the protective factor of resilience. The results have strong implications for developing resilience-based intervention programs in this population.
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Affiliation(s)
- Chen Chen
- Department of Social and Behavioural Sciences, City University of Hong Kong, China
| | - Jiasheng Huang
- Department of Social and Behavioural Sciences, City University of Hong Kong, China
- Department of Psychology, Sun Yat-Sen University, Guangdong, China
| | - Jin Zhao
- Shenzhen Center for Disease Control and Prevention, China
| | - Yan Zhang
- Shenzhen Center for Disease Control and Prevention, China
| | - Nancy Xiaonan Yu
- Department of Social and Behavioural Sciences, City University of Hong Kong, China
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17
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Mgbako O, Benoit E, Iyengar NS, Kuhner C, Brinker D, Duncan DT. "Like a ticking time bomb": the persistence of trauma in the HIV diagnosis experience among black men who have sex with men in New York City. BMC Public Health 2020; 20:1247. [PMID: 32807117 PMCID: PMC7433074 DOI: 10.1186/s12889-020-09342-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 08/04/2020] [Indexed: 11/18/2022] Open
Abstract
Background Black men who have sex with men (MSM) are disproportionately affected by HIV compared to almost every other demographic group in the country and have worse outcomes along the care continuum. Diagnosis is a critical juncture. This study aims to explore the impact and meaning of an HIV diagnosis for Black MSM, and how this has changed over time, both for the individual’s experience living with HIV as well as for Black MSM in general. Methods From 2017 to 2018, we conducted in-depth interviews with 16 black MSM living with HIV in New York City diagnosed between 1985 and 2016. Results Inductive analysis of the qualitative data allowed three major themes to emerge: diagnosis trauma, lack of patient -centeredness in the healthcare system, and acceptance of HIV diagnosis over time. Conclusions This small pilot study signals that an HIV diagnosis experience possibly remains traumatic for black MSM even in the era of highly effective ART, and they often perceive a lack of patient-centeredness in the delivery of a new diagnosis. This has persisted over time. In most cases, black MSM in our sample overcame this trauma due to self-motivation, social support and seeking out and fostering trusting relationships with their HIV provider and the healthcare system.
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Affiliation(s)
- Ofole Mgbako
- Division of Infectious Disease, Department of Internal Medicine, Columbia University Medical Center, 630 W. 168th St., P&S Box 82, New York, NY, 10032, USA.
| | - Ellen Benoit
- North Jersey Community Research Initiative, Newark, NJ, USA
| | | | | | | | - Dustin T Duncan
- Columbia Spatial Epidemiology Lab, Social and Spatial Epidemiology Unit, Department of Epidemiology, Columbia University Mailman School of Public Health, New York, USA
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18
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Brewer R, Hood KB, Moore M, Spieldenner A, Daunis C, Mukherjee S, Smith-Davis M, Brown G, Bowen B, Schneider JA. An Exploratory Study of Resilience, HIV-Related Stigma, and HIV Care Outcomes Among Men who have Sex with Men (MSM) Living with HIV in Louisiana. AIDS Behav 2020; 24:2119-2129. [PMID: 31916097 PMCID: PMC7319878 DOI: 10.1007/s10461-020-02778-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The various forms of HIV-related stigma continue to serve as major barriers to HIV care and treatment among men who have sex with men (MSM). The study of resilience within the context of HIV-related stigma among MSM living with HIV represents a promising area of research to inform the development of future HIV interventions for this population. We examined resilience within the context of HIV related stigma among MSM living with HIV in Louisiana with a particular interest in how resilience may be more relevant for Black MSM. We utilized Pearson's correlations and layered chi-square non-parametric tests to examine associations and racial differences in resilience, four HIV-related stigma measures/consequences (i.e., anticipated, internalized, enacted, and consequences of enacted HIV stigma), and HIV care outcomes (i.e., length of time since last HIV care visit, time since last HIV lab result, most recent HIV viral load result) among 110 MSM living with HIV in Louisiana who participated in the Louisiana HIV Stigma Index Project. The majority of MSM participants were Black (75%), lived in New Orleans (52%), and reported limited education (52%) and income (76%). MSM who reported higher levels of enacted HIV stigma, consequences of enacted HIV stigma, and internalized HIV stigma reported poorer HIV care outcomes. Both internalized and anticipated HIV stigma significantly negatively impacted Black MSM perceptions of their overall health compared with White MSM. Compared with White MSM, Black MSM who reported greater consequences of enacted HIV stigma had poorer HIV care outcomes. Resilience was associated with positive HIV care outcomes for both Black and White MSM. However, having higher levels of resilience may have been more protective for Black MSM such that higher levels of resilience were associated with less time since last HIV care visit for Black MSM than for White MSM. The current study provides preliminary information on the potential positive relationship between resilience and HIV care outcomes among MSM, particularly Black MSM. However, these findings need to be confirmed among a more representative sample of Black and White MSM in Louisiana.
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Affiliation(s)
- Russell Brewer
- Department of Medicine, University of Chicago, 5837 S. Maryland Avenue, MC 5065, Chicago, IL, 60637, USA.
- Chicago Center for HIV Elimination, Chicago, IL, USA.
| | | | - Mary Moore
- Dillard University, New Orleans, LA, USA
| | | | | | - Snigdha Mukherjee
- Educational Commission for Foreign Medical Graduates, Philadelphia, PA, USA
| | | | - Gina Brown
- Southern AIDS Coalition, New Orleans, LA, USA
| | - Brandi Bowen
- New Orleans Regional AIDS Planning Council, New Orleans, LA, USA
| | - John A Schneider
- Department of Medicine, University of Chicago, 5837 S. Maryland Avenue, MC 5065, Chicago, IL, 60637, USA
- Chicago Center for HIV Elimination, Chicago, IL, USA
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19
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Beer L, McCree DH, Jeffries WL, Lemons A, Sionean C. Recent US Centers for Disease Control and Prevention Activities to Reduce HIV Stigma. J Int Assoc Provid AIDS Care 2020; 18:2325958218823541. [PMID: 30798667 PMCID: PMC6748480 DOI: 10.1177/2325958218823541] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
HIV stigma affects many persons living with HIV in the United States, and reducing stigma is central to the US Centers for Disease Control and Prevention’s (CDC) mission to promote health and prevent HIV transmission. To this end, CDC funds and implements programmatic activities, research, communication campaigns, and monitoring through data collection and public health surveillance. Centers for Disease Control and Prevention-funded programs have developed promising interventions and educational materials for reducing HIV stigma. Research conducted by CDC staff and their collaborators have made important contributions to the scientific literature on stigma, which have informed current CDC programmatic efforts, including public education activities and social marketing campaigns. By monitoring HIV stigma in multiple populations, CDC can evaluate the population-level effectiveness of stigma-reduction efforts and identify key populations in need of support and intervention. This article describes these and other recent CDC efforts to address HIV stigma, and discusses new strategies with the potential to further reduce stigma.
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Affiliation(s)
- Linda Beer
- 1 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Donna Hubbard McCree
- 1 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - William L. Jeffries
- 1 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ansley Lemons
- 1 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Catlainn Sionean
- 1 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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20
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A centralized or decentralized approach when it comes to socially stigmatized health concerns in conservative social settings. AIDS 2020; 34:647-649. [PMID: 32108676 DOI: 10.1097/qad.0000000000002467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Currin JM, Giano Z, Hubach RD. Interface of Internalized Homophobia and Community Connectedness on Frequency of Doctor's Visits for Rural and Urban MSM in Oklahoma. J Rural Health 2020; 36:416-422. [PMID: 32057137 DOI: 10.1111/jrh.12416] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Men who have sex with men (MSM) face persistent risk of stigma, with past studies showing unequal treatments of MSM in health care settings. Contextual factors, such as internalized homophobia and connectedness to one's community, have shown to serve as a barrier or facilitator (respectively) with regard to MSM's decisions to seek preventative treatment. These studies, however, predominately feature urban populations, with less consideration given to rural MSM. The current study comparatively investigates these contextual factors between rural and urban MSM to detect differences in the frequency of doctor's visits. METHODS A 2-by-2 (rural/urban × doctor visit yes/no) multivariate analysis of variance (MANOVA) was conducted to investigate if significant differences and/or interactions existed for internalized homophobia and community connectedness. FINDINGS Results show a significant interaction between rurality and doctor's visits in our sample of predominantly white, self-identified gay men. Higher levels of internalized homophobia and lower levels of community connectedness were seen in rural individuals who had visited a doctor in the past 12 months and in urban individuals who had not seen a doctor in the past 12 months. CONCLUSIONS Study findings have implications for future public health research and for health promotion interventions, practices, and policies for MSM in rural areas. Social exclusion reinforces the invisibility of lesbian, gay, bisexual, and transgender (LGBT) populations, particularly in rural areas. Stigma and marginalization of MSM promote structural barriers inhibiting care. Our results give evidentiary support for programs which inform the work of clinicians on mechanisms to create LGBT-inclusive practice settings.
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Affiliation(s)
- Joseph M Currin
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas
| | - Zachary Giano
- Department of Rural Health, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Randolph D Hubach
- Department of Rural Health, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
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22
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Changes in Disparities in Estimated HIV Incidence Rates Among Black, Hispanic/Latino, and White Men Who Have Sex With Men (MSM) in the United States, 2010-2015. J Acquir Immune Defic Syndr 2019; 81:57-62. [PMID: 30964805 DOI: 10.1097/qai.0000000000001977] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND During 2008-2015, the estimated annual HIV incidence rate in the United States decreased for each transmission risk category, except for men who have sex with men (MSM). Racial/ethnic disparities exist, with higher incidence rates for Black and Hispanic/Latino MSM. SETTING This analysis examines changes, 2010-2015, in disparities of HIV incidence among Black, Hispanic/Latino and White MSM. METHODS We compared results from the rate ratio, rate difference, weighted and unweighted index of disparity, and population attributable proportion. We calculated incidence rates for MSM using HIV surveillance data and published estimates of the MSM population in the United States. We generated 95% confidence intervals for each measure and used the Z statistic and associated P values to assess statistical significance. FINDINGS Results from all but one measure, Black-to-White rate difference, indicate that racial/ethnic disparities increased during 2010-2015; not all results were statistically significant. There were statistically significant increases in the Hispanic/Latino-to-White MSM incidence rate ratio (29%, P < 0.05), weighted index of disparity with the rate for White MSM as the referent group (9%, P < 0.05), and the population attributable proportion index (10%, P < 0.05). If racial/ethnic disparities among MSM had been eliminated, a range of 55%-61% decrease in overall MSM HIV incidence would have been achieved during 2010-2015. CONCLUSIONS A large reduction in overall annual HIV incidence among MSM can be achieved by eliminating racial/ethnic disparities among MSM. Removing social and structural causes of racial/ethnic disparities among MSM can be effective in reducing overall annual HIV incidence among MSM.
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Ferraz D, Couto MT, Zucchi EM, Calazans GJ, dos Santos LA, Mathias A, Grangeiro A. AIDS- and sexuality-related stigmas underlying the use of post-exposure prophylaxis for HIV in Brazil: findings from a multicentric study. Sex Reprod Health Matters 2019; 27:1650587. [PMID: 31533555 PMCID: PMC7888039 DOI: 10.1080/26410397.2019.1650587] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
AIDS-related stigma is a major hurdle to care and it hinders people from accessing HIV prevention methods, such as post-exposure prophylaxis. This study was designed to explore how AIDS-related stigma impacts the experience of using non-occupational post-exposure prophylaxis (nPEP) for HIV after sexual contact. Data were gathered in in-depth interviews with 59 people who voluntarily sought out nPEP in five public healthcare facilities in Brazil between 2015 and 2016. Data were analysed into three thematic categories: fear of being mistaken for a person living with HIV and AIDS (PLWHA); desire to hide particular features of one's sexual life; and experiences of stigmatising behaviour due to nPEP use. Based on the Health Stigma and Discrimination Framework, predominant manifestations of AIDS-related stigma in each category were analysed, as well as their intersections with gender- and sexuality-related stigmas. Results show that experiences of using nPEP are permeated by AIDS-related stigma, intersecting with sexuality- and gender-related stigmas. Stigma experiences are mainly perceived, anticipated and internalised; stigma practices include prejudice and stigmatising behaviours. Taking antiretrovirals (ARVs) led participants to the fear of being discriminated against as a PLWHA and having particular features of their sexual identities disclosed. Thus, hiding nPEP was strategic to protect from stigmatising behaviour. As ARV-based prevention technologies are scaled-up, interventions designed to tackle AIDS- and sexuality-related stigmas must be expanded in Brazil. Required interventions include public campaigns about nPEP, educational programmes in healthcare settings to offer adequate support to nPEP users and investments in stigma research and monitoring.
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Affiliation(s)
- Dulce Ferraz
- Public Health Analyst, Escola de Governo em Saúde, Fundação Oswaldo Cruz, Brasília, Brazil
- PhD Candidate, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Eliana Miura Zucchi
- Assistant Professor at Programa de Pós-Graduação em Saúde Coletiva, Universidade Católica de Santos, Santos, Brazil
| | | | | | - Augusto Mathias
- PhD Candidate, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Alexandre Grangeiro
- Researcher, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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24
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Ha JH, Van Lith LM, Mallalieu EC, Chidassicua J, Pinho MD, Devos P, Wirtz AL. Gendered relationship between HIV stigma and HIV testing among men and women in Mozambique: a cross-sectional study to inform a stigma reduction and male-targeted HIV testing intervention. BMJ Open 2019; 9:e029748. [PMID: 31594877 PMCID: PMC6797434 DOI: 10.1136/bmjopen-2019-029748] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Increasing and sustaining engagement in HIV care for people living with HIV are critical to both individual therapeutic benefit and epidemic control. Men are less likely to test for HIV compared with women in sub-Saharan African countries, and ultimately have delayed entry to HIV care. Stigma is known to impede such engagement, placing an importance on understanding and addressing stigma to improve HIV testing and care outcomes. This study aimed to assess the gendered differences in the relationship between stigma and HIV testing. DESIGN AND SETTING A cross-sectional, household probability survey was implemented between November and December 2016 in the Sofala province of Mozambique. PARTICIPANTS Data were restricted to men and women participants who reported no prior diagnosis of HIV infection (N=2731). MEASURES Measures of sociodemographic characteristics, stigma and past exposure to HIV interventions were included in gender-stratified logistic regression models to estimate the relationship between stigma and recent testing for HIV, as well as to identify other relevant correlates. RESULTS Significantly fewer men (38.3%) than women (47.6%; p<0.001) had recently tested for HIV. Men who reported previous engagement in community group discussions about HIV had an increased odds of testing in the past 12 months compared to those who had not participated (adjusted OR (aOR)=1.92; 95% CI 1.51 to 2.44). Concerns about stigma were not a commonly reported barrier to HIV testing; however, men who expressed anticipated individual HIV stigma had a 35% lower odds of recent HIV testing (aOR=0.65; 95% CI 0.44 to 0.96). This association was not observed among women. CONCLUSIONS Men have lower uptake of HIV testing in Mozambique when compared to women. Even amidst the beneficial effects of HIV messaging, individual stigma is negatively associated with recent HIV testing among men. Intervention efforts that target the unique challenges and needs of men are essential in promoting men's engagement into the HIV care continuum in sub-Saharan Africa.
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Affiliation(s)
- Judy H Ha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lynn M Van Lith
- Johns Hopkins University Center for Communication Programs, Baltimore, Maryland, USA
| | - Elizabeth C Mallalieu
- Johns Hopkins University Center for Communication Programs, Baltimore, Maryland, USA
| | - Jose Chidassicua
- Johns Hopkins University Center for Communication Programs, Baltimore, Maryland, USA
| | - Maria Dirce Pinho
- Johns Hopkins University Center for Communication Programs, Baltimore, Maryland, USA
| | - Patrick Devos
- Johns Hopkins University Center for Communication Programs, Baltimore, Maryland, USA
| | - Andrea L Wirtz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Painter TM, Song EY, Mullins MM, Mann-Jackson L, Alonzo J, Reboussin BA, Rhodes SD. Social Support and Other Factors Associated with HIV Testing by Hispanic/Latino Gay, Bisexual, and Other Men Who Have Sex with Men in the U.S. South. AIDS Behav 2019; 23:251-265. [PMID: 31102108 PMCID: PMC6800592 DOI: 10.1007/s10461-019-02540-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Cognitive-psychosocial and other factors may affect participation in HIV testing, particularly by Hispanic/Latino gay, bisexual, and other men who have sex with men (MSM) in the U.S. South, a region hard-hit by HIV. We used univariate and multivariable logistic regression analyses to examine the association between social support and other cognitive-psychosocial factors; sociodemographic characteristics; risk behaviors; and self-reported HIV testing in a sample of 304 Hispanic/Latino MSM in North Carolina. In the multivariable logistic regression analysis, general and HIV-related social support and HIV-related knowledge were associated with greater odds of testing; speaking only Spanish was associated with reduced odds of testing. Social support and aspects of social connectedness may constitute community-based resources for use in HIV prevention efforts with Hispanic/Latino MSM. However, harnessing these resources for HIV prevention will require a better understanding of how social support relationships and processes shape HIV risks and protective actions by these vulnerable MSM.
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Affiliation(s)
- Thomas M Painter
- Prevention Research Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS E-37, Atlanta, GA, 30329, USA.
| | - Eunyoung Y Song
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mary M Mullins
- Prevention Research Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS E-37, Atlanta, GA, 30329, USA
| | - Lilli Mann-Jackson
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jorge Alonzo
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Scott D Rhodes
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Desyani NLJ, Waluyo A, Yona S. The relationship between stigma, religiosity, and the quality of life of HIV-positive MSM in Medan, Indonesia. ENFERMERIA CLINICA 2019. [PMID: 31300297 DOI: 10.1016/j.enfcli.2019.04.077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aims to determine the relationship between stigma, religiosity, and the quality of life of HIV-positive men who have sex with men (MSM) in Medan. METHODS This is an analytical observational study with a cross-sectional approach. Data in demographics, stigma, religiosity, and quality of life were obtained directly from the participants. Data were taken from April to May 2018. There were 175 subjects who met the criteria which; (i) HIV-positive MSM; (ii) aged≥18 y.o.; and (iii) able to read and write. RESULTS Bivariate analysis found that there is a negative relationship between stigma and quality of life (p-value=0.007), and there is a positive relationship between religiosity and quality of life (p-value=0.000). CONCLUSION These findings suggest that stigma is an indicator of poor quality of life, while higher religiosity is associated with better quality of life. An interdisciplinary approach is needed in health care planning and social services, to improve the quality of life of HIV-positive MSM.
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Affiliation(s)
- Ni Luh Jayanthi Desyani
- Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia; Health of Polytechnic Manado, North Sulawesi, Indonesia
| | - Agung Waluyo
- Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia.
| | - Sri Yona
- Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia
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The relationship between stigma, family acceptance, peer support and stress level among HIV-positive men who have sex with men (MSM) in Medan, North Sumatera, Indonesia. ENFERMERIA CLINICA 2019. [PMID: 31262678 DOI: 10.1016/j.enfcli.2019.04.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This present study investigates the level of stress and its relationship with stigma, family acceptance, and peer support among 176 HIV-positive MSM in Medan, Indonesia. METHOD This cross-sectional study with chi-square analysis was conducted April 2018 through May 2018 in Medan. The sample of this study were general HIV patients who identified themselves as MSM, were >18 years old, and were able to read and write in Indonesian. Data collection was conducted at Dr. H. Adam Malik Medan Hospital, Pirngadi General Hospital, Padang Bulan, and Teladan Kota Medan Health Center. RESULTS Findings show that 55.1% of the participants had severe stress. The results of this statistic showed that only stigma was positively associated with stress (p=0.049). CONCLUSIONS The results suggested that there is a need to reduce HIV stigma in reducing stress levels among HIV-positive MSM. Specific intervention should be designed for this population and integrated into programs to reduce stress levels.
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Chowdhury P, Beer L, Shouse RL, Bradley H. Brief Report: Clinical Outcomes of Young Black Men Receiving HIV Medical Care in the United States, 2009-2014. J Acquir Immune Defic Syndr 2019; 81:5-9. [PMID: 30789449 PMCID: PMC11307152 DOI: 10.1097/qai.0000000000001987] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND More than one-quarter of 2016 HIV diagnoses among blacks in the United States occurred among persons aged 15-24 years, and three-quarters were among men. Although the prevalence of viral suppression in all tests in the past 12 months (durable viral suppression) among persons receiving HIV care increased from 58% to 68% during 2009-2013, we do not know whether this same improvement was observed among young black men receiving care. METHODS We analyzed the 2009-2014 Medical Monitoring Project data collected from 336 black men aged 18-24 years. We estimated the proportion of young black men receiving HIV care who were prescribed antiretroviral therapy (ART), adherent to ART, and durably virally suppressed. We assessed changes in clinical outcomes over time and their association with patient characteristics, health behaviors, and depression. RESULTS During 2009-2014, 80% of young black men receiving HIV care were prescribed ART, 73% were adherent to ART, and 36% had durable viral suppression. There was no significant change in viral suppression over this period. ART prescription and durable viral suppression were significantly higher among those receiving the Ryan White HIV/AIDS Program assistance compared with those who did not. Durable viral suppression was significantly lower among those who used drugs compared with those who did not. CONCLUSIONS Viral suppression among young black men during 2009-2014 was lower than that among the overall population receiving HIV care in 2013 (36% vs. 68%). Increasing viral suppression is essential to improve health and reduce HIV transmissions in this key population.
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Affiliation(s)
- Pranesh Chowdhury
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Experienced HIV-Related Stigma and Psychological Distress in Peruvian Sexual and Gender Minorities: A Longitudinal Study to Explore Mediating Roles of Internalized HIV-Related Stigma and Coping Styles. AIDS Behav 2019; 23:661-674. [PMID: 30506474 DOI: 10.1007/s10461-018-2348-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Experiencing HIV-related stigma has important impacts on the mental health of people living with HIV, which has implications for treatment adherence, disease progression, and health outcomes. The impacts of stigma are particularly important to consider among sexual and gender minorities, who often face a disproportionate burden of HIV. To address the implications of stigma in these key populations, we leveraged a longitudinal study conducted among Peruvian sexual and gender minorities to compare the relative effects of multiple mediators affecting the relationship between experienced HIV-related stigma and psychological distress: internalized HIV-related stigma, adaptive coping, and maladaptive coping. HIV-related stigma, coping, and distress were measured, respectively, at 24 weeks, 36 weeks, and 48 weeks post-diagnosis for 145 participants from the Sabes Study. HIV-related maladaptive coping largely mediated the relationship between experienced HIV-related stigma and distress. Our findings suggest interventions targeting maladaptive coping may alleviate the mental health consequences of experiencing HIV-related stigma.
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Biello KB, Grinsztejn B, Fernandes NM, Edeza A, Kamel L, Salhaney P, Veloso V, Mimiaga MJ. Development of a Social Network-Based Intervention to Overcome Multilevel Barriers to ART Adherence Among Adolescents in Brazil. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2019; 31:111-126. [PMID: 30917013 DOI: 10.1521/aeap.2019.31.2.111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Brazil's comprehensive HIV treatment program does not specifically address ART adherence challenges for adolescents-a group accounting for the largest number of incident HIV infections in Brazil. We conducted three focus groups with 24 adolescents (age 15-24) living with HIV in Rio de Janeiro, separately for cisgender men who have sex with men, heterosexual-identified cisgender men and women, and transgender women of any sexual orientation, and key informant interviews (n = 7) with infectious disease specialists and HIV/AIDS service organization staff. Content analysis identified socioecological barriers and facilitators to adherence, including individual (e.g., low knowledge, side effects, and substance use), interpersonal (e.g., stigma from partners and health care providers) and structural (e.g., transportation and medication access) barriers. Overlapping and unique barriers emerged by sexual/gender identity. A community-informed, theory-driven ART adherence intervention for adolescents that is organized around identity and leverages social networks has the potential to improve HIV treatment and health outcomes for Brazilian adolescents.
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Affiliation(s)
- Katie B Biello
- Brown University School of Public Health, Providence, Rhode Island
- Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Beatriz Grinsztejn
- Evandro Chagas Clinical Research Institute (IPEC)- FIOCRUZ, Rio de Janeiro, Brazil
| | | | - Alberto Edeza
- Brown University School of Public Health, Providence, Rhode Island
| | - Luciana Kamel
- Evandro Chagas Clinical Research Institute (IPEC)- FIOCRUZ, Rio de Janeiro, Brazil
| | - Peter Salhaney
- Brown University School of Public Health, Providence, Rhode Island
| | - Valdiléa Veloso
- Evandro Chagas Clinical Research Institute (IPEC)- FIOCRUZ, Rio de Janeiro, Brazil
| | - Matthew J Mimiaga
- Brown University School of Public Health, Providence, Rhode Island
- Fenway Institute, Fenway Health, Boston, Massachusetts
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Sun CJ, Nall JL, Rhodes SD. Perceptions of Needs, Assets, and Priorities Among Black Men Who Have Sex With Men With HIV: Community-Driven Actions and Impacts of a Participatory Photovoice Process. Am J Mens Health 2018; 13:1557988318804901. [PMID: 30296869 PMCID: PMC6440064 DOI: 10.1177/1557988318804901] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Black men who have sex with men (MSM) with HIV experience significant health inequities and poorer health outcomes compared with other persons with HIV. The primary aims of this study were to describe the needs, assets, and priorities of Black MSM with HIV who live in the Southern United States and identify actions to improve their health using photovoice. Photovoice, a participatory, collaborative research methodology that combines documentary photography with group discussion, was conducted with six Black MSM with HIV. From the photographs and discussions, primary themes of discrimination and rejection, lack of mental health services, coping strategies to reduce stress, sources of acceptance and support, and future aspirations emerged. After the photographs were taken and discussed, the participants hosted a photo exhibition and community forum for the public. Here, 37 community attendees and influential advocates collaborated with the participants to identify 12 actions to address the men's identified needs, assets, and priorities. These included making structural changes in the legal and medical systems, encouraging dialogue to eliminate multiple forms of stigma and racism, and advocating for comprehensive care for persons with HIV. As a secondary aim, the impacts of photovoice were assessed. Participants reported enjoying photovoice and found it meaningful. Results suggest that in addition to cultivating rich community-based knowledge, photovoice may result in positive changes for Black MSM with HIV.
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Affiliation(s)
- Christina J Sun
- 1 Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
| | - Jennifer L Nall
- 2 Forsyth County Department of Public Health, Winston-Salem, NC, USA
| | - Scott D Rhodes
- 3 Wake Forest School of Medicine, Department of Social Sciences and Health Policy, Division of Public Health Sciences, Winston-Salem, NC, USA
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Wu F, Zhang A, Babbitt A, Ma Q, Eyal N, Pan X, Cai W, Hu F, Cheng Y, Tucker JD. Overcoming HIV Stigma? A Qualitative Analysis of HIV Cure Research and Stigma Among Men Who Have Sex with Men Living with HIV. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:2061-2069. [PMID: 29149399 PMCID: PMC5957764 DOI: 10.1007/s10508-017-1062-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 06/07/2023]
Abstract
Despite global progress in HIV stigma reduction, persistent HIV stigma thwarts effective HIV service delivery. Advances in HIV biomedical research toward a cure may shift perceptions of people living with HIV and HIV stigma. The purpose of this study was to examine how men who have sex with men (MSM) living with HIV in Guangzhou, China perceive HIV cure research and its potential impact on MSM and HIV stigma. We conducted in-depth interviews with 26 MSM living with HIV about their perceptions of HIV cure research and the potential impact of an HIV cure on their lives. Thematic coding was used to identify themes and structure the analysis. Two overarching themes emerged. First, participants stated that an HIV cure may have a limited impact on MSM-related stigma. Men noted that most stigma toward MSM was linked to stereotypes of promiscuity and high rates of sexual transmitted diseases in the MSM community and might persist even after a cure. Second, participants believed that an HIV cure could substantially reduce enacted, anticipated, and internalized stigma associated with HIV. These findings suggest that a biomedical cure alone would not remove the layered stigma facing MSM living with HIV. Comprehensive measures to reduce stigma are needed.
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Affiliation(s)
- Feng Wu
- University of North Carolina Project-China, 2 Lujing Road, Guangzhou, Guangdong Province, China
| | - Alice Zhang
- University of North Carolina Project-China, 2 Lujing Road, Guangzhou, Guangdong Province, China
- Department of Family Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew Babbitt
- University of North Carolina Project-China, 2 Lujing Road, Guangzhou, Guangdong Province, China
| | - Qingyan Ma
- University of North Carolina Project-China, 2 Lujing Road, Guangzhou, Guangdong Province, China
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Nir Eyal
- Harvard University Program in Ethics and Health, Harvard University, Boston, MA, USA
| | - Xin Pan
- University of North Carolina Project-China, 2 Lujing Road, Guangzhou, Guangdong Province, China
| | - Weiping Cai
- Infectious Diseases Institute, Guangzhou Eighth People's Hospital, Guangzhou, China
| | - Fengyu Hu
- Infectious Diseases Institute, Guangzhou Eighth People's Hospital, Guangzhou, China
| | - Yu Cheng
- School of Sociology and Anthropology, Sun Yat-Sen University, Guangzhou, China
| | - Joseph D Tucker
- University of North Carolina Project-China, 2 Lujing Road, Guangzhou, Guangdong Province, China.
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
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Dubov A, Galbo P, Altice FL, Fraenkel L. Stigma and Shame Experiences by MSM Who Take PrEP for HIV Prevention: A Qualitative Study. Am J Mens Health 2018; 12:1843-1854. [PMID: 30160195 PMCID: PMC6199453 DOI: 10.1177/1557988318797437] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Pre-exposure prophylaxis (PrEP) uptake has been extremely low among key groups. PrEP-related stigma and shaming are potential barriers to uptake and retention in PrEP programs. There is a lack of literature describing PrEP stigma. In order to fill this gap, we recruited online 43 HIV-negative Men who have Sex with Men (MSM) who use PrEP. Semistructured interviews were conducted to explore their perceptions and experience of stigma related to PrEP use. Data were analyzed using Strauss and Corbin's grounded theory and constant comparison techniques to enhance understanding of the lived experiences of MSM who use PrEP. The participants experienced PrEP stigma as rejection by potential/actual partners, stereotypes of promiscuity or chemsex, and labeling of both the user and the medication. They connected PrEP stigma with HIV stigma, generational differences, moralization of condom use, and inability to embrace one's own sexuality. These findings point to a need to develop tailored interventions to address PrEP-related stigma and shaming for individuals, health-care professionals, and the MSM community-at-large.
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Affiliation(s)
- Alex Dubov
- 1 Assistant Professor, Loma Linda University School of Public Health, Sanitarium Dr. Loma Linda, CA, USA
| | - Phillip Galbo
- 2 Department of Neuro-Oncology, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, USA
| | - Frederick L Altice
- 3 Professor of Medicine and Public Health, Director of Clinical and Community Research, Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | - Liana Fraenkel
- 4 Professor of Medicine, Yale University School of Medicine, Section of Rheumatology, New Haven, CT, USA
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Bauermeister JA, Golinkoff JM, Horvath KJ, Hightow-Weidman LB, Sullivan PS, Stephenson R. A Multilevel Tailored Web App-Based Intervention for Linking Young Men Who Have Sex With Men to Quality Care (Get Connected): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e10444. [PMID: 30072358 PMCID: PMC6096165 DOI: 10.2196/10444] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 01/22/2023] Open
Abstract
Background HIV epidemic among young men who have sex with men (YMSM) is characterized by strong racial disparities and concerns about the availability and access to culturally appropriate HIV prevention and care service delivery. Get Connected, a Web-based intervention that employs individual- and system-level tailoring technology to reduce barriers to HIV prevention care (eg, HIV or sexually transmitted infection [STI] testing, pre-exposure prophylaxis [PrEP]), was developed for YMSM (age 15-24 years). This protocol details the design and procedures of a 2-phase project that includes mystery shopping and a randomized controlled trial (RCT) to test the efficacy of Get Connected among YMSM in Philadelphia, Atlanta, and Houston. Objective The objective of mystery shopping is to examine the quality of HIV test counseling and PrEP-related referrals for YMSM within local HIV or STI testing sites. The objective of the RCT is to test the efficacy of Get Connected for increasing HIV-negative or HIV-unknown YMSM’s successful uptake of HIV prevention services (eg, routine HIV or STI testing), PrEP awareness, and likelihood to start PrEP (PrEP willingness), compared with those in the control condition, over a 12-month period. Methods For Phase 1, we will create a master list of HIV and STI testing sites in each city. We will enroll and train 10-15 mystery shoppers per city; each testing site will be separately visited and assessed by 2 mystery shoppers. After each site visit, the mystery shoppers will complete a site evaluation to record their perceptions of various measures including lesbian, gay, bisexual, transgender, queer visibility and inclusivity, privacy and confidentiality, provider-patient interactions, and clinic environment. For Phase 2, we will enroll 480 YMSM for 12 months across the 3 iTech cities into a 2-arm prospective RCT. Participants randomized to the control condition are directed to the AIDSVu.org testing site locator. Participants randomized to the intervention condition will be granted access to a Web app with content tailored to their specific demographic characteristics (eg, age, race or ethnicity, location, and relationship status), HIV and STI risk behaviors (eg, HIV and STI testing history, substance use, communication with partners regarding status) and sociocultural context (eg, homelessness, incarceration). Study assessments will occur at enrollment and at 1, 3, 6, 9, and 12 months postenrollment. Results Get Connected research activities began in September 2016 and are ongoing. To date, institutional review board (IRB) submission is complete and IRB authorization agreements are pending at several other universities. Conclusions The deployment of Get Connected through a mobile-optimized Web app seeks to optimize the intervention’s acceptability, accessibility, availability, and long-term affordability among YMSM. Trial Registration ClinicalTrials.gov (NCT03132415); https://clinicaltrials.gov/ct2/show/NCT03132415 (Archived by WebCite at http://www.webcitation.org/70j4gSFbZ) Registered Report Identifier RR1-10.2196/10444
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Affiliation(s)
- José A Bauermeister
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Jesse M Golinkoff
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Keith J Horvath
- School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Lisa B Hightow-Weidman
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Patrick S Sullivan
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Rob Stephenson
- School of Nursing and the Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States
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Quinn K, Dickson-Gomez J, Broaddus M, Kelly JA. "It's Almost Like a Crab-in-a-Barrel Situation": Stigma, Social Support, and Engagement in Care Among Black Men Living With HIV. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:120-136. [PMID: 29688770 PMCID: PMC5921935 DOI: 10.1521/aeap.2018.30.2.120] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Social support is associated with improved health outcomes for people living with HIV (PLWH), including initiation and engagement in HIV care and antiretroviral therapy (ART) adherence. Yet, stigma may negatively affect the availability and utilization of social support networks, especially among African American PLWH, subsequently impacting HIV care and health out-comes. This qualitative study examines the relationship between stigma and social support relationships among African American PLWH. We conducted 23 interviews with Black men living with HIV who reported being out of care or non-adherent to ART. Thematic content analysis revealed three primary themes including variation in social support, experiences of stigma and discrimination, and coping mechanisms used to deal with stigma. Findings reveal that although social support may be protective for some men, many African American PLWH face challenges in harnessing and sustaining needed social support, partly due to stigma surrounding HIV and homo-sexuality.
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Affiliation(s)
| | | | | | - Jeffrey A Kelly
- Medical College of Wisconsin, Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Milwaukee Wisconsin
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Pereira H, Caldeira D, Monteiro S. Perceptions of HIV-Related Stigma in Portugal Among MSM With HIV Infection and an Undetectable Viral Load. J Assoc Nurses AIDS Care 2017; 29:439-453. [PMID: 29292083 DOI: 10.1016/j.jana.2017.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 12/12/2017] [Indexed: 10/18/2022]
Abstract
We explored perceptions of HIV-related stigma using a qualitative approach based on the findings of in-depth e-mail asynchronous interviews with 37 self-identified Portuguese men who have sex with men (MSM) with HIV infection and undetectable viral loads. Participants were asked to answer an online interview. Major findings concerned external perceptions of HIV-related stigma, HIV status disclosure, the impact of HIV on everyday life, the presence of double discrimination, and general perceptions of HIV-related stigma. Results revealed (a) stigmatizing and discriminatory behaviors and practices in psychosocial and inter-relational events, but not in accessing and receiving health care; (b) double exposure to stigma associated with being gay and having HIV; and (c) undetectability as an autonomous identity with important connections to social and interpersonal interactions. An important implication was related to multilevel risk perceptions and the psychosocial complexity and challenges of HIV infection. In Portugal, HIV is still a socially disabling disease.
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Magno L, Dourado I, da Silva LAV, Brignol S, Brito AMD, Guimarães MDC, Benzaken A, Pinho ADA, Kendall C, Kerr LRFS. Factors associated with self-reported discrimination against men who have sex with men in Brazil. Rev Saude Publica 2017; 51:102. [PMID: 29166436 PMCID: PMC5697921 DOI: 10.11606/s1518-8787.2017051000016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 10/24/2016] [Indexed: 11/29/2022] Open
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.
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Affiliation(s)
- Laio Magno
- Universidade do Estado da Bahia. Departamento de Ciências da Vida. Salvador, BA, Brasil.,Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil
| | - Inês Dourado
- Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil
| | - Luís Augusto V da Silva
- Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil.,Universidade Federal da Bahia. Instituto de Humanidades, Artes & Ciências Professor Milton Santos. Salvador, BA, Brasil
| | - Sandra Brignol
- Universidade Federal Fluminense. Instituto de Saúde Coletiva. Niterói, RJ, Brasil
| | | | - Mark Drew Crosland Guimarães
- Universidade Federal de Minas Gerais. Faculdade de Medicina. Departamento de Medicina Preventiva e Social. Belo Horizonte, MG, Brasil
| | - Adele Benzaken
- Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de IST, Aids e Hepatites Virais. Brasília, DF, Brasil
| | - Adriana de A Pinho
- Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Carl Kendall
- Center for Global Health Equit. Tulane School of Public Health and Tropical Medicine. New Orleans, Louisiana, USA
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Arístegui I, Radusky PD, Zalazar V, Lucas M, Sued O. Resources to cope with stigma related to HIV status, gender identity, and sexual orientation in gay men and transgender women. J Health Psychol 2017; 23:320-331. [PMID: 29069922 DOI: 10.1177/1359105317736782] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The stigma related to HIV status, gender identity, and sexual orientation has negative implications for the quality of life of individuals. A qualitative study was conducted to explore the resources that these stigmatized groups recognize as tools to cope with stigma and maintain their psychological well-being. Four focus groups were conducted with gay men and transgender women divided by HIV status. A thematic analysis revealed that individual, interpersonal, and institutional resources are commonly recognized as coping resources. This article discusses the importance of enhancing self-acceptance, social support, and a legal framework that legitimizes these groups as right holders.
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Affiliation(s)
- Inés Arístegui
- 1 Fundación Huésped, Argentina.,2 University of Palermo, Argentina
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40
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Characteristics and Risk Behaviors of Men Who Have Sex With Men and Women Compared With Men Who Have Sex With Men-20 US Cities, 2011 and 2014. J Acquir Immune Defic Syndr 2017; 75 Suppl 3:S281-S287. [PMID: 28604429 DOI: 10.1097/qai.0000000000001403] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Men who have sex with men (MSM) are heterogeneous with respect to sexual behavior. We examined differences in sex behaviors between men who have sex with men and women (MSMW) and men who have sex with men only (MSMO). METHODS Data for this analysis were from MSM who participated in National HIV Behavioral Surveillance in 2011 and 2014. We used the combined years to evaluate demographic and behavioral differences between MSMW and MSMO. Using log-linked Poisson regression models, adjusted prevalence ratios (aPR) were calculated for behavioral outcomes. RESULTS Overall, 2042 (11.9%) participants were classified as MSMW. MSMW were less likely than MSMO to have condomless sex with male partners [aPR 0.77; 95% confidence interval (CI): 0.74 to 0.81] and to have been diagnosed with another sexually transmitted disease (aPR 0.83; 95% CI: 0.72 to 0.95). MSMW were more likely than MSMO to have given money or drugs for sex (aPR 2.85; 95% CI: 2.52 to 3.24) or received money or drugs for sex (aPR 2.64; 95% CI: 2.37 to 2.93) and to ever have injected drugs (aPR 2.05; 95% CI: 1.80 to 2.34). MSMW had more total sex partners (median 6, interquartile range: 4-11 vs. 3, 2-8), casual sex partners (5, 2-10 vs. 3, 1-7), and condomless sex partners (2, 1-4 vs. 1, 0-2) in the last 12 months (P < 0.01 for all comparisons). CONCLUSIONS MSMW have distinct sexual risk behaviors from MSMO and may contribute to HIV transmission among women. MSMW could benefit from tailored interventions to reduce HIV risk behaviors.
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Bird JDP, Eversman M, Voisin DR. "You just can't trust everybody": the impact of sexual risk, partner type and perceived partner trustworthiness on HIV-status disclosure decisions among HIV-positive black gay and bisexual men. CULTURE, HEALTH & SEXUALITY 2017; 19:829-843. [PMID: 28050947 DOI: 10.1080/13691058.2016.1267408] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
HIV remains an intractable public health concern in the USA, with infection rates notably concentrated among Black gay and bisexual men. Status disclosure by HIV-positive individuals can be an important aspect of risk reduction but doing so poses dilemmas concerning privacy, stigma and self-protection, especially among populations subjected to multiple types of stigmatisation. Understanding the factors related to the disclosure process can help to inform prevention efforts. Using exploratory in-depth interviews, this qualitative study examines the disclosure process among a sample of twenty HIV-positive Black gay and bisexual men (mean age = 40) recruited through a non-profit health centre in a mid-western city in the USA. Data were analysed using a thematic analysis approach with HIV-disclosure as an a priori sensitising concept. Fears of stigma and secondary disclosure within social networks were critical barriers to talking about HIV with sexual partners and disclosure decisions involved a complex process centred on three primary themes: degree of sexual risk, partner type and perceived partner trustworthiness. The unique combinations of these contextual factors resulted in increased or decreased likelihood of disclosure. A conceptual model explicating a potential process by which these contextual factors influence disclosure decisions is presented.
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Affiliation(s)
- Jason D P Bird
- a Department of Social Work , College of Arts and Sciences, Rutgers University-Newark , Newark , USA
| | - Michael Eversman
- a Department of Social Work , College of Arts and Sciences, Rutgers University-Newark , Newark , USA
| | - Dexter R Voisin
- b School of Social Service Administration , University of Chicago , Chicago , USA
- c School of Social Service Administration , STI/HIV Intervention Network , Chicago , USA
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Bogart LM, Dale SK, Christian J, Patel K, Daffin GK, Mayer KH, Pantalone DW. Coping with discrimination among HIV-positive Black men who have sex with men. CULTURE, HEALTH & SEXUALITY 2017; 19:723-737. [PMID: 27885963 PMCID: PMC5445012 DOI: 10.1080/13691058.2016.1258492] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
In the USA, HIV-positive Black men who have sex with men show large disparities in disease outcomes compared to other racial/ethnic and risk groups. This study examined the strategies that HIV-positive Black men who have sex with men use to cope with different types of discrimination. A total of 27 HIV-positive Black men who have sex with men participated in semi-structured interviews, which were transcribed verbatim and coded using thematic analysis by multiple raters. Major coping themes included reactive avoidance (using behaviours, cognitions and emotions to escape from discrimination), a common reaction to racism; proactive avoidance (avoiding situations in which discrimination is anticipated), manifested as selective disclosure of HIV-serostatus; external attribution for discrimination (versus self-blame), used more for sexual orientation and HIV discrimination; and social support-seeking, which most often emerged in response to racism. Active coping strategies, such as self-advocacy (countering discrimination directly or indirectly), were infrequently reported. Findings suggest a need for structural anti-discrimination interventions, in tandem with culturally congruent individual- or group-level interventions that aim to enhance men's existing adaptive coping strategies.
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Affiliation(s)
- Laura M. Bogart
- Health Unit, RAND Corporation, Santa Monica, CA, USA
- Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Corresponding author. Laura M. Bogart.
| | - Sannisha K. Dale
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Jana Christian
- Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Kinjal Patel
- Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, Boston, MA, USA
| | | | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Medicine, Division of Infectious Disease, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - David W. Pantalone
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
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Jeffries WL, Sutton MY, Eke AN. On the Battlefield: The Black Church, Public Health, and the Fight against HIV among African American Gay and Bisexual Men. J Urban Health 2017; 94:384-398. [PMID: 28409359 PMCID: PMC5481215 DOI: 10.1007/s11524-017-0147-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
HIV affects African American gay and bisexual men (AAGBM) more disproportionately than any other group in the USA. The Black Church, which has been a historic mainstay for African American empowerment and well-being, has the potential to be a public health partner for HIV prevention with AAGBM. Public health partnerships with the Black Church can strengthen HIV prevention efforts with AAGBM by [1] adapting church-based prevention strategies developed for other African American subgroups [2], providing prevention and referral services [3], considering how scripture supports prevention efforts, and [4] emphasizing the tenets of liberation theology. Public health should consider how thoughtful engagement, research, and interventions can support these approaches. Developing partnerships with the Black Church and African American clergy can promote effective HIV prevention efforts for AAGBM.
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Affiliation(s)
- William L Jeffries
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA.
| | - Madeline Y Sutton
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
| | - Agatha N Eke
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
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Quinn K, Voisin DR, Bouris A, Jaffe K, Kuhns L, Eavou R, Schneider J. Multiple Dimensions of Stigma and Health Related Factors Among Young Black Men Who Have Sex with Men. AIDS Behav 2017; 21:207-216. [PMID: 27233249 PMCID: PMC5124546 DOI: 10.1007/s10461-016-1439-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study is among the first to examine the association between multiple domains of HIV-related stigma and health-related correlates including viral load and medication adherence among young Black men who have sex with men (N = 92). Individual logistic regressions were done to examine the hypothesized relationships between HIV-related stigma and various health and psychosocial outcomes. In addition to examining total stigma, we also examined four domains of HIV stigma. Findings revealed the various domains of stigma had differential effects on health-related outcomes. Individuals who reported higher levels of total stigma and personalized stigma were less likely to be virally suppressed (OR 0.96, 95 % CI 0.91-1.00 and OR 0.50, 95 % CI 0.25-1.02, respectively). Concerns about public attitudes toward HIV were positively related to medication adherence (OR 2.18, 95 % CI 1.20-3.94) and psychological distress (OR 5.02, 95 % CI 1.54-16.34). The various domains of HIV stigma differentially affected health and psychosocial outcomes, and our findings suggest that some forms of HIV stigma may significantly affect viral load and medication adherence among this population. Stigma-informed approaches to care and treatment are needed, along with incorporated psychological and social supports.
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Affiliation(s)
- Katherine Quinn
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit, Milwaukee, WI, 53202, USA.
| | - Dexter R Voisin
- School of Social Service Administration, University of Chicago, Chicago, IL, USA
- STI/HIV Intervention Network, University of Chicago, Chicago, IL, USA
| | - Alida Bouris
- School of Social Service Administration, University of Chicago, Chicago, IL, USA
- STI/HIV Intervention Network, University of Chicago, Chicago, IL, USA
| | - Kate Jaffe
- STI/HIV Intervention Network, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Lisa Kuhns
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Rebecca Eavou
- STI/HIV Intervention Network, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - John Schneider
- STI/HIV Intervention Network, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
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45
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Balaji AB, Bowles KE, Hess KL, Smith JC, Paz-Bailey G. Association Between Enacted Stigma and HIV-Related Risk Behavior Among MSM, National HIV Behavioral Surveillance System, 2011. AIDS Behav 2017; 21:227-237. [PMID: 27830344 DOI: 10.1007/s10461-016-1599-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
MSM bear a disproportionate burden of the HIV epidemic. Enacted stigma (overt negative actions) against sexual minorities may play an important role in increasing HIV risk among this population. Using data from the 2011 National HIV Behavioral Surveillance system, MSM cycle, we examined the independent associations between three measures of enacted stigma (verbal harassment, discrimination, physical assault) and engagement in each of four HIV-related risk behaviors as outcomes: condomless anal intercourse (CAI) at last sex with a male partner of HIV discordant or unknown status and, in the past 12 months, CAI with a male partner, ≥4 male sex partners, and exchange sex. Of 9819 MSM, 32% experienced verbal harassment in the past 12 months, 23% experienced discrimination, and 8% experienced physical assault. Discordant CAI at last sex with a male partner was associated with previous discrimination and physical assault. Past 12 month CAI with a male partner, ≥4 male sex partners, and exchange sex were each associated with verbal harassment, discrimination, and physical assault. These findings indicate that a sizable proportion of MSM report occurrences of past 12 month enacted stigma and suggest that these experiences may be associated with HIV-related risk behavior. Addressing stigma towards sexual minorities must involve an integrated, multi-faceted approach, including interventions at the individual, community, and societal level.
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46
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Aholou TM, Cooks E, Murray A, Sutton MY, Gaul Z, Gaskins S, Payne-Foster P. "Wake Up! HIV is at Your Door": African American Faith Leaders in the Rural South and HIV Perceptions: A Qualitative Analysis. JOURNAL OF RELIGION AND HEALTH 2016; 55:1968-1979. [PMID: 26883229 DOI: 10.1007/s10943-016-0193-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In Alabama, 70 % of new HIV cases are among African Americans. Because the Black Church plays an important role for many African Americans in the south, we conducted qualitative interviews with 10 African American pastors recruited for an HIV intervention study in rural Alabama. Two main themes emerged: (1) HIV stigma is prevalent and (2) the role of the Black Church in addressing HIV in the African American community. Our data suggest that pastors in rural Alabama are willing to be engaged in HIV prevention solutions; more formalized training is needed to decrease stigma, strengthen HIV prevention and support persons living with HIV/AIDS.
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Affiliation(s)
- Tiffiany M Aholou
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
| | - Eric Cooks
- University of Alabama, Tuscaloosa, AL, USA
| | - Ashley Murray
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Madeline Y Sutton
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Zaneta Gaul
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
- ICF International, Atlanta, GA, USA
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47
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Beer L, Bradley H, Mattson CL, Johnson CH, Hoots B, Shouse RL. Trends in Racial and Ethnic Disparities in Antiretroviral Therapy Prescription and Viral Suppression in the United States, 2009-2013. J Acquir Immune Defic Syndr 2016; 73:446-453. [PMID: 27391389 PMCID: PMC5085853 DOI: 10.1097/qai.0000000000001125] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To examine trends in racial/ethnic disparities in antiretroviral therapy (ART) prescription and viral suppression among HIV-infected persons in care, overall and among men who have sex with men (MSM), from 2009 to 2013. DESIGN The Medical Monitoring Project (MMP) is a complex sample survey of HIV-infected adults receiving medical care in the United States. METHODS We used weighted interview and medical record data collected June 2009-May 2014 to estimate the prevalence of ART prescription and viral suppression among racial/ethnic groups overall and among MSM. RESULTS We found significant increases in ART prescription and viral suppression among all racial/ethnic groups from 2009 to 2013, both overall and among MSM. By 2013, overall and among MSM, the Hispanic-white disparity in ART prescription was nonexistent, and the black-white disparity was not significant after accounting for differences between blacks and whites in age and length of HIV diagnosis. Despite reductions in racial/ethnic disparities in viral suppression over the time period, significant disparities remained among the total population, even after adjusting for differences in racial/ethnic group characteristics. Encouragingly, however, there was no significant Hispanic-white disparity in viral suppression among MSM by 2013. CONCLUSIONS Despite significant improvements in ART prescription and viral suppression in recent years, racial and ethnic disparities persist, particularly for black persons. If the United States is to achieve the National HIV/AIDS Strategy goal of reducing HIV-related health disparities, continued efforts to accelerate the rate of improvement in ART prescription and viral suppression among Hispanic and black persons may need to be prioritized.
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Affiliation(s)
- Linda Beer
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Heather Bradley
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christine L. Mattson
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christopher H. Johnson
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brooke Hoots
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - R. Luke Shouse
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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48
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Hull SJ, Davis CR, Hollander G, Gasiorowicz M, Jeffries WL, Gray S, Bertolli J, Mohr A. Evaluation of the Acceptance Journeys Social Marketing Campaign to Reduce Homophobia. Am J Public Health 2016; 107:173-179. [PMID: 27854527 DOI: 10.2105/ajph.2016.303528] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of the Acceptance Journeys social marketing campaign to reduce homophobia in the Black community in Milwaukee, Wisconsin. METHODS We assessed the campaign's effectiveness using a rolling cross-sectional survey. Data were collected annually online between 2011 and 2015. Each year, a unique sample of Black and White adults, aged 30 years and older, were surveyed in the treatment city (Milwaukee) and in 2 comparison cities that did not have antihomophobia campaigns (St. Louis, MO, and Cleveland, OH; for total sample, n = 3592). RESULTS Black self-identification and Milwaukee residence were significantly associated with exposure to the campaign, suggesting successful message targeting. The relationship between exposure and acceptance of gay men was significantly mediated through attitudes toward gay men, perceptions of community acceptance, and perceptions of the impact of stigma on gay men, but not through rejection of stereotypes. This model accounted for 39% of variance in acceptance. CONCLUSIONS This evidence suggests that the Acceptance Journeys model of social marketing may be a promising strategy for addressing homophobia in US Black communities.
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Affiliation(s)
- Shawnika J Hull
- Shawnika J. Hull is with the Department of Prevention and Community Health, George Washington University, Washington, DC. Catasha R. Davis is with the School of Journalism and Mass Communication, University of Wisconsin, Madison. Gary Hollander is with Diverse & Resilient Inc, Milwaukee, WI. Mari Gasiorowicz and Anneke Mohr are with with the Wisconsin Division of Public Health, Madison. William L. Jeffries IV, Simone Gray, and Jeanne Bertolli are with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Catasha R Davis
- Shawnika J. Hull is with the Department of Prevention and Community Health, George Washington University, Washington, DC. Catasha R. Davis is with the School of Journalism and Mass Communication, University of Wisconsin, Madison. Gary Hollander is with Diverse & Resilient Inc, Milwaukee, WI. Mari Gasiorowicz and Anneke Mohr are with with the Wisconsin Division of Public Health, Madison. William L. Jeffries IV, Simone Gray, and Jeanne Bertolli are with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Gary Hollander
- Shawnika J. Hull is with the Department of Prevention and Community Health, George Washington University, Washington, DC. Catasha R. Davis is with the School of Journalism and Mass Communication, University of Wisconsin, Madison. Gary Hollander is with Diverse & Resilient Inc, Milwaukee, WI. Mari Gasiorowicz and Anneke Mohr are with with the Wisconsin Division of Public Health, Madison. William L. Jeffries IV, Simone Gray, and Jeanne Bertolli are with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Mari Gasiorowicz
- Shawnika J. Hull is with the Department of Prevention and Community Health, George Washington University, Washington, DC. Catasha R. Davis is with the School of Journalism and Mass Communication, University of Wisconsin, Madison. Gary Hollander is with Diverse & Resilient Inc, Milwaukee, WI. Mari Gasiorowicz and Anneke Mohr are with with the Wisconsin Division of Public Health, Madison. William L. Jeffries IV, Simone Gray, and Jeanne Bertolli are with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - William L Jeffries
- Shawnika J. Hull is with the Department of Prevention and Community Health, George Washington University, Washington, DC. Catasha R. Davis is with the School of Journalism and Mass Communication, University of Wisconsin, Madison. Gary Hollander is with Diverse & Resilient Inc, Milwaukee, WI. Mari Gasiorowicz and Anneke Mohr are with with the Wisconsin Division of Public Health, Madison. William L. Jeffries IV, Simone Gray, and Jeanne Bertolli are with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Simone Gray
- Shawnika J. Hull is with the Department of Prevention and Community Health, George Washington University, Washington, DC. Catasha R. Davis is with the School of Journalism and Mass Communication, University of Wisconsin, Madison. Gary Hollander is with Diverse & Resilient Inc, Milwaukee, WI. Mari Gasiorowicz and Anneke Mohr are with with the Wisconsin Division of Public Health, Madison. William L. Jeffries IV, Simone Gray, and Jeanne Bertolli are with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jeanne Bertolli
- Shawnika J. Hull is with the Department of Prevention and Community Health, George Washington University, Washington, DC. Catasha R. Davis is with the School of Journalism and Mass Communication, University of Wisconsin, Madison. Gary Hollander is with Diverse & Resilient Inc, Milwaukee, WI. Mari Gasiorowicz and Anneke Mohr are with with the Wisconsin Division of Public Health, Madison. William L. Jeffries IV, Simone Gray, and Jeanne Bertolli are with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Anneke Mohr
- Shawnika J. Hull is with the Department of Prevention and Community Health, George Washington University, Washington, DC. Catasha R. Davis is with the School of Journalism and Mass Communication, University of Wisconsin, Madison. Gary Hollander is with Diverse & Resilient Inc, Milwaukee, WI. Mari Gasiorowicz and Anneke Mohr are with with the Wisconsin Division of Public Health, Madison. William L. Jeffries IV, Simone Gray, and Jeanne Bertolli are with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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49
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Goldenberg T, Vansia D, Stephenson R. Intragroup Stigma Among Men Who Have Sex with Men: Data Extraction from Craigslist Ads in 11 Cities in the United States. JMIR Public Health Surveill 2016; 2:e4. [PMID: 27227158 PMCID: PMC4869222 DOI: 10.2196/publichealth.4742] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 08/13/2015] [Accepted: 10/14/2015] [Indexed: 11/13/2022] Open
Abstract
Background Gay, bisexual, and other men who have sex with men (MSM) regularly experience homophobic discrimination and stigma. While previous research has examined homophobic and HIV-related intergroup stigma originating from non-MSM directed at MSM, less is known about intragroup stigma originating from within MSM communities. While some research has examined intragroup stigma, this research has focused mostly on HIV-related stigma. Intragroup stigma may have a unique influence on sexual risk-taking behaviors as it occurs between sexual partners. Online sexual networking venues provide a unique opportunity to examine this type of stigma. Objective The purpose of this study is to examine the presence and patterns of various types of intragroup stigma represented in Men Seeking Men Craigslist sex ads. Methods Data were collected from ads on Craigslist sites from 11 of the 12 US metropolitan statistical areas with the highest HIV/AIDS prevalence. Two categories of data were collected: self-reported characteristics of the authors and reported biases in the ads. Chi-square tests were used to examine patterns of biases across cities and author characteristics. Results Biases were rarely reported in the ads. The most commonly reported biases were against men who were not “disease and drug free (DDF),” representing stigma against men living with HIV or a sexually transmitted infection. Patterns in bias reporting occurred across cities and author characteristics. There were no variations based on race, but ageism (mostly against older men) varied based on the ad author’s age and self-reported DDF status; bias against feminine gender expression varied based on self-reported sexual orientation; bias against “fat” men varied by self-reported DDF status; bias against “ugly” men varied by a self-report of being good-looking; and bias against people who do not have a DDF status varied based on self-reported HIV status and self-reported DDF status. Conclusions Despite an overall low reporting of biases in ads, these findings suggest that there is a need to address intragroup stigma within MSM communities. The representation of biases and intragroup stigma on Craigslist may result from internalized stigma among MSM while also perpetuating further internalization of stigma for men who read the sex ads. Understanding patterns in the perpetuation of intragroup stigma can help to better target messages aimed at making cultural and behavioral shifts in the perpetration of intragroup stigma within MSM communities.
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Affiliation(s)
- Tamar Goldenberg
- School of Nursing Department of Health Behavior and Biological Sciences and the Center for Sexuality and Health Disparities University of Michigan Ann Arbor, MI United States
| | - Dhrutika Vansia
- Rollins School of Public Health Hubert Department of Global Health Emory University Atlanta, GA United States
| | - Rob Stephenson
- School of Nursing Department of Health Behavior and Biological Sciences and the Center for Sexuality and Health Disparities University of Michigan Ann Arbor, MI United States
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50
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Xiaonan Yu N, Chow AYM, Chan CLW, Zhang J, Stewart SM. Stigma never dies: Mourning a spouse who died of AIDS in China. Psychiatry Res 2015; 230:968-70. [PMID: 26553145 DOI: 10.1016/j.psychres.2015.10.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 10/29/2015] [Indexed: 11/16/2022]
Abstract
Stigma towards people with HIV (PHIV) can affect their family members. In this study of 68 HIV seronegative participants in China whose spouse died of AIDS, 35.3% reported prolonged grief. Stigma beliefs towards PHIV (i.e., belief that PHIV's death leaves the deceased, the family and society better off) predicted grief symptoms. Social campaigns to combat stigma and grief therapy to reconstruct the meaning of HIV-related death may be helpful to reduce suffering in HIV bereaved.
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Affiliation(s)
- Nancy Xiaonan Yu
- Department of Applied Social Sciences, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong Special Administrative Region.
| | - Amy Y M Chow
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Cecilia L W Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China; Center on Behavioral Health, The University of Hong Kong, Hong Kong, China
| | - Jianxin Zhang
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Sunita M Stewart
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
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