Intersectional Stigma and Prevention Among Gay, Bisexual, and Same Gender–Loving Men in New York City, 2020: System Dynamics Models

Abstract

Objectives. To create causal loop diagrams that characterize intersectional stigma experiences among Black, gay, bisexual, same gender–loving, and other men who have sex with men and to identify intervention targets to reduce stigma and increase testing and prevention access. Methods. Between January and July 2020, we conducted focus groups and in-depth interviews with 80 expert informants in New York City, which were transcribed, coded, and analyzed. These qualitative insights were developed iteratively, visualized, and validated in a causal loop diagram (CLD) using Vensim software. Results. The CLD revealed 3 key feedback loops—medical mistrust and HIV transmission, serosorting and marginalization of Black and gay individuals, and family support and internalized homophobia—that contribute to intersectional HIV and related stigmas, homophobia, and systemic racism. On the basis of these results, we designed 2 novel intervention components to integrate into an existing community-level anti-HIV stigma and homophobia intervention. Conclusions. HIV stigma, systemic racism, and homophobia work via feedback loops to reduce access to and uptake of HIV testing, prevention, and treatment. Public Health Implications. The CLD method yielded unique insights into reciprocal feedback structures that, if broken, could interrupt stigmatization and discrimination cycles that impede testing and prevention uptake. (Am J Public Health. 2022;112(S4):S444–S451. https://doi.org/10.2105/AJPH.2022.306725 )

The Application of Systems Thinking to the Prevention and Control of Sexually Transmissible Infections among Adolescents and Adults: A Scoping Review

“…Generally, studies examined STI prevention and control in the population at large; exceptions to this were studies concerned with people living with HIV (n = 22) [5,9,[34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53], people who inject drugs (n = 5) [54][55][56][57][58], women (n = 16) [5,11,[59][60][61][62][63][64][65][66][67][68][69][70][71][72], children and young people (n = 11) [43,49,57,[72][73][74][75]…”

“…Twenty-one studies had an HIV testing focus [5,37,42,43,[49][50][51]56,64,65,[69][70][71]74,85,87,[94][95][96][97][98], of which one was focused on home-or self-testing [85]. Twenty-five studies focused on issues related to HIV harm reduction, including intentional transmission [9], stigma [41], sexual behaviours and 'high risk' behaviours [38,39,58,59,61,[76][77][78][79]89,90], female condom use [11], PrEP [39,42,62,[81][82][83]98], injecting drug use [54,56,58], and general preventative measures [63,66].…”

Using an intersectionality-based approach to evaluate mental health services use among gay, bisexual and other men who have sex with men in Montreal, Toronto and Vancouver

“…Many studies on Black GBM in the US have leveraged intersectionality to better understand their disengagement from HIV care (Arnold et al , 2014; Arscott et al , 2020; Lutete et al , 2022). However, few studies have used an intersectionality-based framework to evaluate MHS use in GBM.…”

Use of geofencing interventions in population health research: a scoping review

“…Population health outcomes and health disparities result from multilevel factors beyond the individual. For example, poverty can lead to a lack of access to healthy food1 and medical care2; unstable housing can lead to inability to adhere to medications3 and exposures to unhealthy environments4; homophobia and racism leads to stigma and discrimination, and mistrust and avoidance of medical systems 5–7…”