Sexual Behavior Stigma Among Cisgender Gay, Bisexual, and Other Men Who Have Sex With Men in Nine NHBS Cities Across the United States: Burden and Associations With PrEP Continuum and HIV Care Continuum Outcomes

John Mark Wiginton, Sarah M. Murray, Bridget J. Anderson, Kwa Sey, Yingbo Ma, Colin P. Flynn, Danielle German, Emily Higgins, Timothy W. Menza, E. Roberto Orellana, Stephanie Sanz, Nabeeh A. Hasan, Alia Al-Tayyib, Jennifer Kienzle, Garrett Shields, Zaida Lopez, Paige Wermuth, Stefan D. Baral

Research output: Contribution to journalArticlepeer-review

Abstract

In the United States, sexuality-based stigma continues to undermine HIV prevention and care efforts. We assessed sexual behavior stigma burden across family, health care, and social domains and determined associations with HIV-related outcomes among cisgender gay, bisexual, and other men who have sex with men (MSM) in nine United States metropolitan statistical areas. MSM (N = 4,086) recruited at places of MSM social congregation via venue-based, time-sampling procedures completed a survey on sexual behavior stigma, preexposure prophylaxis (PrEP) continuum and HIV care continuum outcomes, sociodemographic characteristics, and other measures. We calculated prevalence and overall mean stigma subscale scores (range: 0.00–1.00) and used logistic and mixed-effects logistic regression to determine stigma-HIV outcome associations. Most participants identified as gay, were employed, and were from West Coast cities; roughly 40% were non-Hispanic White, aged 25–34 years, and had completed some college. One in five were living with HIV. Family stigma (prevalence = 47.5%; M = 0.36) was associated with greater odds of health care engagement, PrEP awareness, and PrEP use among HIV-negative MSM. Anticipated health care stigma (prevalence = 14.5%; M = 0.11) was associated with lower odds of health care engagement, current antiretroviral treatment (ART) use, and viral load undetectability among MSM living with HIV. General social stigma (prevalence = 49.9%; M = 0.20) was associated with greater odds of PrEP awareness and use among HIV-negative MSM and lower odds of current ART use among MSM living with HIV. Targeted stigma-mitigation in family, health care, and other social contexts remains paramount to ending the HIV epidemic in the United States.

Original languageEnglish (US)
JournalStigma and Health
DOIs
StateAccepted/In press - 2024

Keywords

  • HIV care continuum
  • men who have sex with men
  • preexposure prophylaxis continuum
  • sexual behavior stigma
  • stigma prevalence

ASJC Scopus subject areas

  • Social Psychology
  • Clinical Psychology
  • Health Policy
  • Public Health, Environmental and Occupational Health
  • Psychiatry and Mental health

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