Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Behavioral Medicine, Boston, MA, 02114, USA; Department of Psychiatry, Harvard Medical School, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA; The Fenway Health Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA.
Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Behavioral Medicine, Boston, MA, 02114, USA; Department of Psychiatry, Harvard Medical School, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA.
Soc Sci Med. 2021 Apr;275:113824. doi: 10.1016/j.socscimed.2021.113824. Epub 2021 Mar 6.
Men who have sex with men (MSM) are disproportionately affected by HIV, substance use, and stigma related to co-existing or intersecting identities that are stigmatized or devalued by society (e.g., being a sexual minority male, a person living with HIV, or a person who uses substances). Evidence indicates that when stigma is internalized it may act as a barrier to engagement in self-care behaviors.
Gaining a better understanding of how intersecting internalized stigmas affect HIV self-care among MSM who use substances.
To investigate these relationships, we conducted semi-structured qualitative interviews until we reached thematic saturation (n = 33) with HIV + MSM who use substances and were sub-optimally engaged in HIV care. Interviews inquired about identity, internalized stigmas, substance use, HIV self-care behaviors, and interrelationships between concepts.
Our sample was 61% African American and 76% reported annual incomes of ≤$20,000. Approximately half of the participants explicitly described how intersecting internalized stigmas impacted their sense of self and their behavior. The overwhelming majority conveyed that internalized stigma related to substance use was the most burdensome and was considered a barrier to HIV self-care behaviors. Participants also described internalized stigmas related to HIV and sexual orientation, as well as race, effeminateness, poverty, and housing instability, which together impacted their psychological wellbeing and HIV self-care.
Our results indicate a need for clinicians to consider and address intersecting internalized stigmas, particularly internalized stigma related to substance use, to both reduce substance use and improve HIV self-care among MSM who use substances and are sub-optimally engaged in HIV care.
男男性行为者（MSM）不成比例地受到艾滋病毒、物质使用以及与共同存在或交叉的身份相关的污名化的影响，这些身份在社会上受到污名化或贬低（例如，作为性少数男性、艾滋病毒感染者或物质使用者）。有证据表明，当污名内化时，它可能成为参与自我保健行为的障碍。
更好地了解交叉的内化污名如何影响使用物质的 MSM 进行艾滋病毒自我保健。
为了研究这些关系，我们对 33 名 HIV 阳性且使用物质且未充分参与 HIV 护理的使用物质的 MSM 进行了半结构式定性访谈，直到达到主题饱和。访谈询问了身份、内化污名、物质使用、艾滋病毒自我保健行为以及概念之间的相互关系。
我们的样本中 61%是非洲裔美国人，76%报告的年收入≤$20,000。大约一半的参与者明确描述了交叉内化污名如何影响他们的自我意识和行为。绝大多数人表示，与物质使用相关的内化污名是最沉重的负担，被认为是进行艾滋病毒自我保健行为的障碍。参与者还描述了与 HIV 和性取向以及种族、女性化、贫困和住房不稳定相关的内化污名，这些共同影响了他们的心理健康和艾滋病毒自我保健。
我们的研究结果表明，临床医生需要考虑和解决交叉的内化污名，特别是与物质使用相关的内化污名，以减少使用物质并改善未充分参与 HIV 护理的使用物质的 MSM 的艾滋病毒自我保健。
