Discrimination, HIV conspiracy theories and pre-exposure prophylaxis acceptability in gay men

Abstract

Background Combination prevention, which includes pre-exposure prophylaxis (PrEP), is essential for achieving the zero HIV infections target in the UK by 2030. It is important to assess attitudes towards PrEP in at-risk populations. This study focuses on the effect of discrimination and HIV conspiracy theorising on attitudes towards PrEP in gay men in the UK. Methods: In total, 244 White British gay men completed a survey that included demographic questions and measures of sexual health screening, hypervigilance, sexual orientation discrimination, quality of contact with healthcare professionals, belief in conspiracy theories and attitudes towards PrEP. Data were analysed using multiple linear regression and mediation analysis. Results: Discrimination was positively correlated with HIV conspiracy beliefs and negatively correlated with PrEP acceptance. Mediation analyses demonstrated that the relationship between discrimination and attitudes towards PrEP was explained by HIV conspiracy theorising. Gay men who had attended a sexual health screening (vs never attended) reported higher belief in HIV conspiracy theories. A further mediation analysis showed that reported poor contact with a healthcare professional was associated with an increased belief in HIV conspiracy theories, which was associated with negative attitudes towards PrEP. Both perceived discrimination and poor contact with a healthcare professional were exacerbated by hypervigilance. Conclusions: HIV conspiracy theorising is an important variable in understanding attitudes towards PrEP among gay men. Its roots are in adverse social experiences (e.g. discrimination, poor contact with healthcare professionals) and its consequences may be the rejection of PrEP. HIV prevention and PrEP campaigns must focus on prejudice reduction and on challenging conspiracy beliefs.

Identity resilience, social support and internalised homonegativity in gay men

“…Some may have long-term exposure to homonegativity due to dominant negative social representations in their social environment. Jolley and Jaspal (2020) found that gay men who are hypervigilant to discrimination are more likely to report its existence, possibly because previous experiences of discrimination have primed them to anticipate it in the future. Gay men who face discrimination may come to believe that people in their social context have negative and hostile views about their community (Castro et al, 2019).…”

“…H5: It has been found that the actual experience of discrimination is associated with the anticipation of further stigma in sexual minorities (Castro et al, 2019) due partly to a hypervigilance effect (Jolley & Jaspal, 2020). Therefore, everyday discrimination should be associated with perceived negative social representations of gay men.…”

“…Perceiving negative social representations of gay men in one's social context is itself psychologically harmful as this may increase the state of hypervigilance observed in some gay men (Jolley & Jaspal, 2020;Meyer, 2003). Perceived negative social representations of gay men is in turn likely to accentuate the psychological and emotional effects of challenging experiences, such as coming out as gay to a significant other (Berg et al, 2016;Calvo et al, 2020;Wang et al, 2021).…”

Coming Out, Distress and Identity Threat in Gay Men in the UK

“…This may be rooted in the perception that one's sexuality is not accepted by others (especially by significant others) and that one's value as a gay man is thus questionable and in the possible anticipation of negative experiences upon future sexual identity disclosure (Ryan et al, 2015;Weinstein et al, 2012). The latter has been referred to as hypervigilance and is characterized by negative psychological outcomes, such as avoidance behaviours (Jolley & Jaspal, 2020). Incidentally, this line of thinking is also consistent with the empirical observation in our study that internalized homonegativity is positively associated with both distress and identity threat.…”

“…However, to understand this relationship further, we examine the potential mediating role of an additional variable which taps into the perceived typicality of one's coming out experience of one's overall coming out experiences. After all, a negative coming out experience which is deemed to be more typical is likely to reinforce the view that opposition to one's sexuality is consensual and commonplace (Jolley & Jaspal, 2020); it may induce uncertainty and fear in relation to future and present, and therefore result in greater feelings of distress (Burgess et al, 2007). We therefore predict that the relationship between recalling a negative coming out experience and distress will be mediated by the perceived typicality of the recalled coming out experience, with greater typicality being associated with greater distress.…”