The HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA.
Department of Psychology, University of Washington, Seattle, WA, USA.
Arch Sex Behav. 2021 May;50(4):1651-1663. doi: 10.1007/s10508-019-01595-9. Epub 2020 Feb 4.
Gay, bisexual, and other men who have sex with men (MSM) experience alarming HIV disparities alongside sub-optimal engagement in HIV interventions. Among MSM, stigma toward anal sexuality could interfere with engagement in HIV prevention, yet few studies have examined MSM perspectives on anal sex stigma or its health-related sequelae. Guided by theory, we aimed to characterize anal sex stigma, related sexual concerns, and barriers to health seeking, like concealment. We elicited community input by purposively interviewing 10 experts in MSM health and then 25 racially, ethnically, and geographically diverse cisgender MSM. Participants reported experienced, internalized, and anticipated forms of anal sex stigma that inhibited health seeking. Experienced stigma, including direct and observed experiences as well as the absence of sex education and information, contributed to internalized stigma and anticipation of future devaluation. This process produced psychological discomfort and concealment of health-related aspects of anal sexuality, even from potentially supportive sexual partners, social contacts, and health workers. Participants characterized stigma and discomfort with disclosure as normative, pervasive, and detrimental influences on health-seeking behavior both during sex and within healthcare interactions. Omission of information appears to be a particularly salient determinant of sexual behavior, inhibiting prevention of harm, like pain, and leading to adverse health outcomes. The development of measures of anal sex stigma and related sexual concerns, and testing their impact on comfort with disclosure, sexual practices, and engagement in health services could identify modifiable social pathways that contribute to health disparities among MSM, like those seen in the HIV epidemic.
男同性恋者、双性恋者和其他与男性发生性关系的男性（MSM）在艾滋病毒方面存在惊人的差异，同时参与艾滋病毒干预措施的情况也不理想。在 MSM 中，对肛交的污名可能会干扰艾滋病毒预防的参与，但很少有研究调查 MSM 对肛交污名的看法或其与健康相关的后果。本研究以理论为指导，旨在描述肛交污名、相关的性问题以及寻求健康的障碍，如隐瞒。我们通过有目的地采访 10 名 MSM 健康专家，然后采访 25 名不同种族、族裔和地理位置的顺性别 MSM，以征求社区意见。参与者报告了经历过、内化过和预期过的肛交污名，这些污名抑制了寻求健康的行为。经历过的污名，包括直接和观察到的经验以及缺乏性教育和信息，导致了内化的污名和对未来贬值的预期。这个过程产生了心理上的不适和对与肛交相关的健康方面的隐瞒，甚至对潜在的支持性伴侣、社会联系人以及卫生工作者也是如此。参与者将污名和对披露的不适描述为对性行为和医疗保健互动中寻求健康行为的规范性、普遍性和有害影响。信息的遗漏似乎是性行为的一个特别重要的决定因素，它抑制了伤害的预防，如疼痛，并导致不良的健康结果。开发肛交污名和相关性问题的测量工具，并测试它们对披露舒适度、性行为和参与卫生服务的影响，可能会发现可改变的社会途径，这些途径有助于 MSM 中存在的健康差异，就像在艾滋病毒流行中看到的那样。
