GBQMSM of color may also face racism as an intersecting stigma along with homophobia, and this intersection has been linked to HIV testing behavior. įurthermore, GBQMSM living with HIV experience “intersectional stigma,” or the convergence of multiple stigmatized identities, in relation to both their sexual identities/practices and disease status. Perceptions of stigma towards GBQMSM may also interact with psychological distress to reduce HIV testing behavior. Reflecting this intertwinement, a recent survey of Australian GBQMSM found that 70% reported experiencing interpersonal stigma due to perceived HIV risk despite the fact that only 5% actually reported being that they were PLWH. Moreover, HIV-related stigma itself is intertwined with negative attitudes, often expressed interpersonally between people, towards same-sex sexual practices and identities (e.g., ). Importantly, GBQMSM who seek testing face stigma related not only to a possible HIV diagnosis, but also to same-sex sexual behaviors. In turn, stigma-related fears and expectations are associated with delays in, and infrequent, HIV testing -or it may be linked to non-testing and testing refusal. Results include fears of stigma, and cognitive expectations of negative consequences of living with HIV/AIDS, including negative treatment (“anticipated stigma”). This public stigma influences individuals’ feelings about, and perceptions of, the social environment. Moreover, 21% of GBQMSM in a recent survey believed that “most people” would discriminate against PLWH-with little change in the prevalence of this perception over time. Public HIV-related stigma remains prevalent in the US population a recent survey using a US national probability sample found that 17.5% of adults and 31.6% of adolescents feared casual contact with people with HIV/AIDS, and 12.5% expressed moral judgement towards them. However, HIV-related stigma-a social process characterized by the co-occurrence of labeling, stereotyping, separation, status loss, and discrimination -is a barrier to HIV testing. Thus, significant policy and program efforts aim to expand testing behavior among GBQMSM. HIV status awareness, which requires regular testing, may expand uptake of prevention options such as pre-exposure prophylaxis (PrEP), and facilitate early entry into care and treatment as prevention (TasP) for people living with HIV (PLWH). In Metropolitan Detroit, GBQMSM make up more than half of all reported HIV infections and Black GBQMSM experience a disproportionate share of this burden. Gay, bisexual, queer and other men who have sex with men (GBQMSM) in the United States (US) are disproportionally affected by HIV indeed, 69% of new HIV diagnoses in 2018 were among GBQMSM.
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Future stigma-reduction interventions for Black GBQMSM could focus on building family support/acceptance, awareness of multiple testing options, and integrating LGBTQ-related issues into initiatives for racial justice in health care. Provider stigma requires both intervention and continued availability of specialized services. There is a need for interventions to challenge the “promiscuity” stereotype, and to reduce the sexual stigmatization of GBQMSM living with HIV/AIDS-especially online. GBQMSMs’ perspectives indicate the potential for new foci for HIV testing promotion interventions based on stigma-related issues that they deem important. Framing HIV testing as a personal responsibility may have created a “new stigma,” with unintended consequences not observed with “routine healthcare” messaging. Black participants articulated themes (3), (4), and (6) with greater frequency than other participants. As for how often to get tested, themes included: (6) Reducing contact with healthcare providers due to intersectional stigma (7) Responsibility and regular testing and (8) HIV stigma and testing as routine care. Themes concerning where to get tested included: (4) Conflating HIV testing and diagnosis and (5) Seeking privacy and safety at specialized services.
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Three themes emerged regarding whether to get tested: (1) Perceived promiscuity, risk perceptions and HIV testing (2) Fearing sexual rejection and (3) Fearing friend and family member distancing and rejection. Data were thematically analyzed deductively and inductively in three rounds.
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We conducted nine focus groups with 64 adult GBQMSM in Metropolitan Detroit, including HIV-negative men and people living with HIV (PLWH). There has been little attention to GBQMSMs’ perspectives about how stigma may influence their decisions about whether, where, and how often to get tested for HIV. Stigmatization may prompt gay, bisexual, queer and other men who have sex with men (GBQMSM) to avoid or delay HIV testing.