Stigmatizing Policies Interact with Mental Health and Sexual Behaviours to Structurally Induce HIV Diagnoses Among European Men Who Have Sex with Men

Abstract

Structural stigma shapes men who have sex with men’s (MSM’s) mental health and sexual behaviours. The aim of this study was to examine how stigmatizing policies interact with downstream anxiety/depression and sexual behaviours to structurally pattern HIV disparities among European MSM. We conducted a secondary data analysis of the European Men-who-have-sex-with-men Internet Survey (EMIS) from 2017. We included a total of 98,600 participants living in 39 European countries. We used the Rainbow Index, a score given to countries based on their sexual and gender minority policies as the predictor of HIV diagnosis. We conducted adjusted random intercept and slope multi-level logistic regressions. In adjusted models, higher Rainbow Index scores was associated with lower predictive probabilities of diagnosed HIV, regardless of the number of condomless intercourse partners. The predictive probability of HIV diagnosis was also lower, regardless of severity of anxiety/depression, where the Rainbow Index score was better. Country-level policies interact with downstream sexual behaviours and anxiety/depression to structurally influence HIV diagnosis among MSM in Europe.

Global trends in depression among patients living with HIV: A bibliometric analysis

“…In addition to the development of scales to examine stigma among PLWH, several studies have also examined the effect of social support on stigma and depression. Previous studies have reported stigma is positive associated with depression ( Murphy et al, 2006 ; Kota et al, 2022 ; Stojanovski et al, 2022 ). A systematic review also reported PLWH living with HRS was 1.6 times more likely to suffer depression.…”

People Living with HIV and AIDS: Experiences towards Antiretroviral Therapy, Paradigm Changes, Coping, Stigma, and Discrimination—A Grounded Theory Study

“…It was confirmed that HIV has little relevance from a PLWH perspective, and for this reason, anonymity and discretion are preferred [ 45 ]. Gabbidon et al (2020) [ 46 ] escribe a decision-making and outing process with HIV self-disclosure. Studies confirmed relationship quality as a determinant of risk and resilience factors in the disclosure process of HIV infection.…”

“…Greater social acceptance makes it easier for PLWH to live openly with their disease [ 54 ]. Studies show that policies addressing stigma against LGBTQ+ people are significant structural determinants of the HIV risk in Europe [ 46 ].…”

Roles of Social Capital in the Association Between Internalized Homophobia and Condomless Sex Among Men Who Have Sex With Men in Southwest China: A Four-Way Decomposition

“…Second, we found that even attained a high level of SC, MSM with a high level of IH still had a higher risk of condomless sex than those with a low level of IH. For those with a high level of SC, structural stigma may still shape the fear of being stigmatized and crisis sense of support loss from social contacts (e.g., family members, colleagues) [56,57]. External prejudice events (i.e., distal stressors) and IH might further increase the risk of condomless sex.…”