Rutgers Biomedical and Health Sciences, School of Nursing and François-Xavier Bagnoud Center, Rutgers, State University of New Jersey, 65 Bergen Street, Rm 846 North, Newark, NJ, 07101, USA.
Department of Psychology and the Center for HIV Educational Studies and Training (CHEST), Hunter College, City University of New York, New York, NY, USA.
AIDS Behav. 2019 Mar;23(3):684-694. doi: 10.1007/s10461-018-2306-z.
Sexual orientation stigma stems from discriminatory social contexts and may ultimately impact the behavioral health of stigmatized individuals through stress-related pathways. Sexual minority stigma is of particular concern in Europe given the diversity of social contexts on the continent and sexual minority men's rapidly increasing risk of HIV infection, especially in Central and Eastern Europe, potentially rooted in stigma. This study assesses whether stigma in the ubiquitous social contexts surrounding sexual minority men (e.g., family, workplace, government) may place them at higher risk for HIV contraction across six countries. We utilized a large cross-sectional survey sample of HIV-negative sexual minority men (N = 2087; mean age = 31.6, SD = 9.7) from six European countries to test whether those who reported sexual orientation stigma also engaged in more HIV risk-related behaviors, including condomless sex with casual partners (in the absence of PrEP) and substance use before and during sex. Regression analyses were performed in Mplus. We found that a one standard deviation increase in reported sexual orientation stigma was significantly associated with the following during the last sexual encounter: a 19% increase in odds of sex under the influence of alcohol, 27% increase in odds of sex under the influence of cannabis, 49% increase in odds of sex under the influence of illicit drugs, an 11% increase in odds of condomless sex with casual partners in the past 6 months, and a 26% increase in odds of knowing where to receive an HIV test. Sexual minority men who reported perceiving greater sexual orientation-related stigma within their ubiquitous social contexts were significantly more likely to report sexual risk and alcohol and drug use during their last sexual encounter, yet reported more knowledge of preventive services. Contextual stigma might serve as a precursor to behavioral risks of HIV infection, generating maladaptive stress responses capable of being modified through individually-focused interventions. Structural interventions are also needed to ultimately reduce stigma at its source.
性取向污名源于歧视性的社会环境,可能通过与压力相关的途径最终影响被污名化个体的行为健康。鉴于欧洲大陆社会环境的多样性,以及性少数群体男性感染艾滋病毒的风险迅速上升,尤其是在中欧和东欧,性少数群体污名问题尤其令人关注,这可能植根于污名。本研究评估了普遍存在于性少数群体男性周围的社会环境(例如家庭、工作场所、政府)中的污名是否会使他们在六个国家面临更高的艾滋病毒感染风险。我们利用来自六个欧洲国家的 2087 名 HIV 阴性性少数群体男性的大型横断面调查样本(平均年龄 31.6,标准差 9.7),测试了那些报告性取向污名的人是否也会更多地从事与艾滋病毒相关的风险行为,包括与偶然伴侣发生无保护性行为(在没有 PrEP 的情况下)以及在性行为前后使用药物。回归分析在 Mplus 中进行。我们发现,报告的性取向污名增加一个标准差与以下方面在最近一次性接触中显著相关:受酒精影响发生性行为的几率增加 19%,受大麻影响发生性行为的几率增加 27%,受非法药物影响发生性行为的几率增加 49%,过去 6 个月中与偶然伴侣发生无保护性行为的几率增加 11%,以及知道在哪里可以接受艾滋病毒检测的几率增加 26%。报告在其普遍社会环境中感知到更大的性取向相关污名的男同性恋、双性恋和其他男男性行为者更有可能报告最近一次性行为中的性风险以及酒精和药物使用,但报告对预防服务的了解更多。背景污名可能是感染艾滋病毒的行为风险的前兆,产生能够通过以个体为中心的干预措施来改变的适应不良的应激反应。还需要结构性干预措施来最终从源头上减少污名。