Centre for Health Economics, Monash Business School, Monash University, Victoria, Australia ; and.
The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia .
J Acquir Immune Defic Syndr. 2022 Mar 1;89(3):241-250. doi: 10.1097/QAI.0000000000002851.
Discrimination and stigmatization at the institutional and sociocultural level (conceptualized as "structural stigma") has been associated with adverse health outcomes among sexual and gender minorities. However, few studies explore whether structural stigma is associated with sexual health outcomes. Addressing this gap, here, we explore this relationship among Australian gay, bisexual, and other men who have sex with men (GBM)-a population disproportionately affected by HIV.
Using responses from the 2017 Australian Marriage Law Postal Survey, we operationalized structural stigma related to sexual minority status as the regional percentage of votes against legalizing same-sex marriage. These responses were then linked to national HIV behavioral surveillance data from Australian GBM (43,811 responses between 2015 and 2019). Controlling for a rich set of individual and regional level confounders, regression analyses were used to estimate the extent to which structural stigma was associated with testing for, and diagnoses of, HIV and sexually transmitted infections (STIs), and awareness and use of HIV prevention and treatment interventions (pre-exposure and postexposure prophylaxis, combination therapy, and HIV-related clinical care).
Australian GBM living in regions with higher levels of structural stigma were less likely to undergo HIV/STI testing, receive HIV/STI diagnoses, and be taking, or aware of, biomedical prevention strategies. Among GBM living with HIV, structural stigma was associated with a reduced likelihood of being on combination therapy and fewer HIV-related clinical visits.
Altogether, these results suggest that structural stigma may undermine HIV prevention strategies as well as adequate management of HIV infection among GBM.
制度和社会文化层面的歧视和污名化（概念化为“结构性耻辱”）与性少数群体的不良健康结果有关。然而，很少有研究探讨结构性耻辱是否与性健康结果有关。为了解决这一差距，我们在此探讨了澳大利亚男同性恋、双性恋和其他与男性发生性关系的男性（GBM）群体中的这种关系，该群体受艾滋病毒影响不成比例。
使用 2017 年澳大利亚婚姻法邮政调查的答复，我们将与性少数群体地位有关的结构性耻辱操作化为反对同性婚姻合法化的地区百分比。然后，将这些答复与澳大利亚 GBM 的国家艾滋病毒行为监测数据（2015 年至 2019 年期间有 43811 名受访者）相关联。在控制了一系列丰富的个体和地区层面混杂因素后，使用回归分析来估计结构性耻辱与艾滋病毒和性传播感染（STI）检测和诊断、艾滋病毒预防和治疗干预措施（暴露前和暴露后预防、联合疗法和艾滋病毒相关临床护理）的意识和使用之间的关联程度。
生活在结构性耻辱程度较高地区的澳大利亚 GBM 进行艾滋病毒/性传播感染检测、接受艾滋病毒/性传播感染诊断以及接受或了解生物医学预防策略的可能性较小。在与艾滋病毒共存的 GBM 中，结构性耻辱与联合疗法的可能性降低以及艾滋病毒相关临床就诊次数减少有关。
总之，这些结果表明，结构性耻辱可能会破坏 GBM 的艾滋病毒预防策略以及艾滋病毒感染的充分管理。
