Stigma, discrimination impede engagement in HIV prevention and treatment

Stigma and discrimination, such as homophobia and racism, impede engagement in HIV prevention and use of biomedical tools for treatment in both HIV-negative and HIV-positive gay and bisexual men, according to a Rutgers study.

The paper, published in AIDS and Behavior, examined the impact of stigma on HIV-related outcomes among gay and bisexual men in the U.S.

Despite recent advances in HIV prevention and treatment, and access to biomedical interventions that can hasten the end of the HIV epidemic, gay and bisexual men continue to be disproportionately affected by the virus.

Stigma, which has been associated with negative health outcomes, often impacts marginalized groups including gay and bisexual men and other high-risk populations.

Gay and bisexual men often embody more than one minority status, yielding experiences of intersectional stigma, for example, experiencing both racism and homophobia. These stigmas can prevent individuals from seeking information, getting tested, and seeking care or treatment.

The researchers, led by Rutgers School of Public Health doctoral students, reviewed 47 studies that examined stigma and HIV-related outcomes among gay and bisexual men over the past three decades.

They found that stigma influences an individual's decision to engage in HIV prevention, treatment, and care among both HIV-negative and HIV-positive gay and bisexual men. Specifically, HIV-positive gay and bisexual men were impacted predominantly by internalized stigma, which resulted in lower levels of engagement with treatment. For young gay and bisexual men of color, intersectional stigma intensified the social and structural barriers to care adherence.

These findings are important because the conclusions from this review can inform stigma reduction interventions or programs, and advance stigma research, to ultimately end this epidemic."

Riddhi A. Babel, lead author, doctoral student, Department of Biostatistics and Epidemiology, Rutgers School of Public Health

The study emphasizes critical intersectional efforts that must be made to address stigma, understand an individual's identity, and create and implement policy for community-based interventions.

"Although we now have the tools to end the HIV pandemic, stigma continues to stand in our way," said senior study author Chongyi Wei, an associate professor in the Department of Health Behavior, Society and Policy at the Rutgers School of Public Health. "Without systematically addressing it at all levels, whether homophobia, racism, or both, we will not prevail this virus."

Future research should evaluate how individual types of stigma, as well as intersectional stigma, impact viral suppression and treatment adherence, and PrEP uptake and adherence. Mixed-method studies should also be conducted in the future, to better understand the implications of intersecting stigma amongst men of color.