State-level structural sexual stigma and HIV prevention in a national online sample of HIV-uninfected MSM in the United States

Oldenburg, Catherine E.; Perez-Brumer, Amaya; Hatzenbuehler, Mark L.; Krakower, Douglas S.; Novak, David S.; Mimiaga, Matthew J.; Mayer, Kenneth H.

doi:10.1097/qad.0000000000000622

Cited by 152 publications

(125 citation statements)

References 39 publications

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“…They also found that concealment of sexual orientation mediated these associations with country-level stigma, in that concealment reduced opportunities to be exposed to HIV, but also reduced people's ability to access HIV prevention services, education and other health promotion programs. Similar results were found by Oldenburg et al 15 in their study comparing levels of structural stigma in different states in the USA and sexual risk behaviour and awareness of biomedical prevention such as PrEP. Looking at broader health impacts, data linkage work by Hatzenbuehler et al 25 found sexual minorities living in communities with high levels of anti-gay prejudice experienced a reduced life expectancy by~12 years (95% C.I.…”

Section: Impact Of Hiv and Gmsm Sexuality Stigma On Hiv Preventionsupporting

confidence: 79%

“…Strömdahl et al 17 in their systematic review of GMSM-focused HIV prevention programs for consideration in Europe, found that the need for programs to be implemented in combination and packaged together was undermined by structural barriers including human rights violations, homophobia, direct and indirect discrimination and obstructive policies and laws in Europe that limited the effectiveness and scope of HIV intervention programs and compromised the quality of services. Beyrer et al 16 and Oldenburg et al 15 have further argued that HIV prevention strategies with GMSM, such as TasP and PrEP, offer promise, but are limited by structural factors including, discrimination, criminalisation and barriers to health care, which impact on the social contexts in which people live their lives and their ability to access and adhere to such biomedical prevention.…”

Section: Impact Of Hiv and Gmsm Sexuality Stigma On Hiv Preventionmentioning

confidence: 99%

“…However, when communities experience high levels of widespread health and social challenges such as syndemics, we know this undermines the accessibility and effectiveness of prevention programs, testing services and access to treatment. 19 While most studies of GMSM-related stigma have focused on internal and interpersonal-level stigma, [20][21][22][23] there have been recent empirical investigations of the relationship between structural-level stigma and HIV prevention among GMSM in the USA 15 and in Europe. 24 Pachankis et al 24 reported on the European GMSM Internet Survey (EMIS), where a survey of 174 209 GMSM across 38 European countries enabled country-level analysis of the impact of stigma by comparing national laws and policies affecting sexual minorities, attitudes held by the citizens of each country, sexuality and HIV status concealment, and HIV-preventive services, knowledge and behavioural outcomes.…”

Section: Impact Of Hiv and Gmsm Sexuality Stigma On Hiv Preventionmentioning

confidence: 99%

“…[15][16][17][18] The relationship between syndemics and individual sexual risk behaviour is complex and contested. However, when communities experience high levels of widespread health and social challenges such as syndemics, we know this undermines the accessibility and effectiveness of prevention programs, testing services and access to treatment.…”

Section: Impact Of Hiv and Gmsm Sexuality Stigma On Hiv Preventionmentioning

confidence: 99%

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Stigma, gay men and biomedical prevention: the challenges and opportunities of a rapidly changing HIV prevention landscape

et al. 2017

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Abstract. Improvements in biomedical technologies, combined with changing social attitudes to sexual minorities, provide new opportunities for HIV prevention among gay and other men who have sex with men (GMSM). The potential of these new biomedical technologies (biotechnologies) to reduce HIV transmission and the impact of HIV among GMSM will depend, in part, on the degree to which they challenge prejudicial attitudes, practices and stigma directed against gay men and people living with HIV (PLHIV). At the structural level, stigma regarding gay men and HIV can influence the scale-up of new biotechnologies and negatively affect GMSM's access to and use of these technologies. At the personal level, stigma can affect individual gay men's sense of value and confidence as they negotiate serodiscordant relationships or access services. This paper argues that maximising the benefits of new biomedical technologies depends on reducing stigma directed at sexual minorities and people living with HIV and promoting positive social changes towards and within GMSM communities. HIV research, policy and programs will need to invest in: (1) responding to structural and institutional stigma; (2) health promotion and health services that recognise and work to address the impact of stigma on GMSM's incorporation of new HIV prevention biotechnologies; (3) enhanced mobilisation and participation of GMSM and PLHIV in new approaches to HIV prevention; and (4) expanded approaches to research and evaluation in stigma reduction and its relationship with HIV prevention. The HIV response must become bolder in resourcing, designing and evaluating programs that interact with and influence stigma at multiple levels, including structural-level stigma.Additional keywords: community mobilisation, health promotion, men who have sex with men, policy, social inequality.

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Section: Impact Of Hiv and Gmsm Sexuality Stigma On Hiv Preventionsupporting

confidence: 79%

Section: Impact Of Hiv and Gmsm Sexuality Stigma On Hiv Preventionmentioning

confidence: 99%

Section: Impact Of Hiv and Gmsm Sexuality Stigma On Hiv Preventionmentioning

confidence: 99%

Section: Impact Of Hiv and Gmsm Sexuality Stigma On Hiv Preventionmentioning

confidence: 99%

See 2 more Smart Citations

Stigma, gay men and biomedical prevention: the challenges and opportunities of a rapidly changing HIV prevention landscape

et al. 2017

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“…[77][78][79] Exposure to stigma including culturally insensitive health workers can result in MSM avoiding HIV testing and other prevention services, limiting diagnosis and awareness of status. 78,[80][81][82] Even more acute, men who are aware of living with HIV may avoid HIV treatment altogether. 83 Reduced utilisation of health and HIV services by MSM, due to enacted or perceived discrimination, limits knowledge of the risks of condomless anal intercourse and opportunities for access to prevention services.…”

Section: -69mentioning

confidence: 99%

HIV incidence among gay men and other men who have sex with men in 2020: where is the epidemic heading?

et al. 2017

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Abstract. The goal to effectively prevent new HIV infections among gay, bisexual, and other men who have sex with men (MSM) is more challenging now than ever before. Despite declines in the late 1990s and early 2000s, HIV incidence among MSM is now increasing in many low-and high-income settings including the US, with young, adolescent, and racial/ethnic minority MSM being among those at highest risk. Potentiating HIV risks across all settings are individual-, network-, and structural-level factors such as stigma and lack of access to pre-exposure prophylaxis (PrEP) and antiretroviral treatment as prevention. To make a sustained impact on the epidemic, a concerted effort must integrate all evidence-based interventions that will most proximally decrease HIV acquisition and transmission risks, together with structural interventions that will support improved coverage and retention in care. Universal HIV treatment, increased access to HIV testing, and daily oral PrEP have emerged as integral to the prevention of HIV transmission, and such efforts should be immediately expanded for MSM and other populations disproportionately affected by HIV. Respect for human rights and efforts to combat stigma and improve access to prevention services are needed to change the trajectory of the HIV pandemic among MSM.

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Regional Disparities in Qualified Health Plans’ Prior Authorization Requirements for HIV Pre-exposure Prophylaxis in the United States

et al. 2020

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IMPORTANCE With the goal of ending the HIV epidemic in the United States, access to HIV pre-exposure prophylaxis (PrEP) is essential to help curb new HIV infections. There has been differential uptake of PrEP by region, with the South lagging behind other regions. Discriminatory benefit design (benefit design that prevents or delays people with complex or expensive conditions from obtaining appropriate treatment) through prior authorization requirements could be a systemic barrier that contributes to the decreased PrEP uptake in the South.OBJECTIVES To investigate whether there are regional disparities in prior authorization requirements for combined tenofovir disoproxil fumarate and emtricitabine for qualified health plans (QHPs) and to assess whether any QHP characteristics explain the disparities. DESIGN, SETTING, AND PARTICIPANTSThis design was a cross-sectional study of QHPs offered in the 2019 Affordable Care Act Marketplace. The QHPs studied included all Affordable Care Act-compliant individual and small-group market plans in the United States. EXPOSURES The primary exposure was the 4 census regions (Northeast, West, Midwest, and South). Additional covariates included other plan characteristics. MAIN OUTCOMES AND MEASURES Prior authorization requirement for combined tenofovir disoproxil fumarate and emtricitabine at the QHP level. RESULTSIn total, 16 853 QHPs were analyzed (18.2% in the Northeast, 19.5% in the West, 25.0% in the Midwest, and 37.3% in the South). Overall, 18.9% of QHPs required prior authorization for combined tenofovir disoproxil fumarate and emtricitabine. This percentage varied by region, with 2.3%, 6.2%, 13.3%, and 37.3% of plans requiring prior authorization in the Northeast, West, Midwest, and South, respectively. Compared with QHPs in the Northeast, QHPs in the South were 15.89 (95% CI, 12.57-20.09) times as likely to require prior authorization, whereas the Midwest and West were 5.69 (95% CI, 4.45-7.27) and 2.65 (95% CI, 2.02-3.47) times as likely, respectively. Other plan characteristics did not account for the regional variation. CONCLUSIONS AND RELEVANCECompared with QHPs in the Northeast, QHPs in the South were almost 16 times as likely to require prior authorization for PrEP, and the reasons for these disparities are unknown. The prior authorization requirement is a possible barrier to PrEP access in the South, which is the region of the United States with the most annual new HIV diagnoses. There is limited regulation of QHPs' prior authorization requirements. Federal-or state-level health policy laws may be necessary to remove this system-level barrier to ending the HIV epidemic in the United States.

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State-level structural sexual stigma and HIV prevention in a national online sample of HIV-uninfected MSM in the United States

Cited by 152 publications

References 39 publications

Stigma, gay men and biomedical prevention: the challenges and opportunities of a rapidly changing HIV prevention landscape

Stigma, gay men and biomedical prevention: the challenges and opportunities of a rapidly changing HIV prevention landscape

HIV incidence among gay men and other men who have sex with men in 2020: where is the epidemic heading?

Regional Disparities in Qualified Health Plans’ Prior Authorization Requirements for HIV Pre-exposure Prophylaxis in the United States

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