Sexual Minority Outness and HIV/STI Stigma Over First Year Post-HIV/STI Diagnosis among Black Sexual Minority Men

Abstract

Black sexual minority men in the southern United States continue to experience pronounced disparities related to the human immunodeficiency virus (HIV) and other sexually transmit- ted infections (STI). HIV/STI stigma undermines outcomes along the HIV and STI care continuums, and exacerbates HIV/STI disparities. Identifying who is at greater risk of experiencing HIV/STI stigma following diagnosis could inform targeted intervention efforts to address stigma and improve outcomes among vulnerable individuals. The current study therefore explored associations between sexual orientation outness and HIV/STI stigma in the first year post-HIV/STI diagnosis among Black sexual minority men in the southern United States. Data were drawn from a longitudinal study of 151 participants followed for the year following an HIV/STI diagnosis. Outness was measured before HIV/STI diagnosis, and HIV/STI stigma was measured monthly following diagnosis. Data were analyzed with multilevel models. Participants who were not fully out experienced greater internalized, enacted, and anticipated HIV/STI stigma immediately following their diagnosis than participants who were fully out. Moreover, outness moderated the trajectory of internalized HIV/STI stigma over the first year post-diagnosis: Participants who were not fully out initially experienced a faster decline in internalized HIV/STI stigma as compared to participants who were fully out. Findings suggest that Black sexual minority men who are not fully out may be particularly vulnerable to HIV/STI stigma following their diagnosis. Targeted intervention efforts could address HIV/STI stigma among vulnerable individuals during this time-period that is critical for linkage to and engagement in HIV/STI care.

Mpox stigma among men who have sex with men in the Netherlands: Underlying beliefs and comparisons across other commonly stigmatized infections

“…Stigma and its underlying beliefs have negative impacts on health and well‐being 29,34 . In the context of mpox, stigma is therefore likely to impede testing, reduce disclosure, and compromise vaccination willingness 2,38–40 .…”

“…For example, HIV is commonly associated with sex between men, commercial sex work, and substance use, all of which are considered norm‐violating to some, and research indeed shows that HIV stigma layers with homophobia, substance use stigma, and negative attitudes towards sex work 31–33 . Additionally, outness about sexual orientation is related to HIV and STI stigma and can result in greater internalized, enacted, and experienced stigma 34 . Stigma is also likely in contexts where prevalence is low and most people had limited contact with the stigmatized condition 35 .…”

“…[31][32][33] Additionally, outness about sexual orientation is related to HIV and STI stigma and can result in greater internalized, enacted, and experienced stigma. 34 Stigma is also likely in contexts where prevalence is low and most people had limited contact with the stigmatized condition. 35 Analogously, familiarity and contact with (a person with) a stigmatized condition have been found to reduce stigma endorsement and discrimination.…”

“…[35][36][37] Stigma and its underlying beliefs have negative impacts on health and well-being. 29,34 In the context of mpox, stigma is therefore likely to impede testing, reduce disclosure, and compromise vaccination willingness. 2,[38][39][40] Therefore, this study set out to investigate the endorsement of beliefs among MSM that have been shown to underlie HIV and STI stigma, including perceived severity and the extent to which people who acquire mpox are considered responsible for this infection.…”