M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC.
Am J Public Health. 2022 Jun;112(S4):S452-S462. doi: 10.2105/AJPH.2022.306735.
To determine whether intersectional stigma is longitudinally associated with biopsychosocial outcomes. We measured experienced intersectional stigma (EIS; ≥ 2 identity-related attributions) among sexual minority men (SMM) in the United States participating in the Multicenter AIDS Cohort Study. We assessed longitudinal associations between EIS (2008‒2009) and concurrent and future hypertension, diabetes, dyslipidemia, antiretroviral therapy adherence, HIV viremia, health care underutilization, and depression symptoms (2008‒2019). We conducted causal mediation to assess the contribution of intersectional stigma to the relationship between self-identified Black race and persistently uncontrolled outcomes. The mean age (n = 1806) was 51.8 years (range = 22-84 years). Of participants, 23.1% self-identified as Black; 48.3% were living with HIV. Participants reporting EIS (30.8%) had higher odds of hypertension, dyslipidemia, diabetes, depression symptoms, health care underutilization, and suboptimal antiretroviral therapy adherence compared with participants who did not report EIS. EIS mediated the relationship between self-identified Black race and uncontrolled outcomes. Our findings demonstrate that EIS is a durable driver of biopsychosocial health outcomes over the life course. There is a critical need for interventions to reduce intersectional stigma, help SMM cope with intersectional stigma, and enact policies protecting minoritized people from discriminatory acts. (. 2022;112(S4):S452-S462. https://doi.org/10.2105/AJPH.2022.306735).
为了确定交叉污名是否与生物心理社会结局存在纵向关联。我们在美国参与多中心艾滋病队列研究的男同性恋者中测量了经历过的交叉污名（EIS；≥2 个与身份相关的归因）。我们评估了 EIS（2008-2009 年）与同期和未来高血压、糖尿病、血脂异常、抗逆转录病毒治疗依从性、HIV 病毒血症、卫生保健利用不足和抑郁症状（2008-2019 年）之间的纵向关联。我们进行了因果中介分析，以评估交叉污名对自我认同的黑人种族与持续未得到控制的结局之间关系的贡献。平均年龄（n=1806）为 51.8 岁（范围 22-84 岁）。参与者中，23.1%自我认同为黑人；48.3%携带 HIV。报告 EIS（30.8%）的参与者与未报告 EIS 的参与者相比，高血压、血脂异常、糖尿病、抑郁症状、卫生保健利用不足和抗逆转录病毒治疗依从性不理想的可能性更高。EIS 介导了自我认同的黑人种族与未得到控制的结局之间的关系。我们的研究结果表明，EIS 是贯穿整个生命过程中生物心理社会健康结局的持久驱动因素。迫切需要采取干预措施来减少交叉污名，帮助男同性恋者应对交叉污名，并制定政策保护少数族裔免受歧视行为。（。2022；112（S4）：S452-S462。https://doi.org/10.2105/AJPH.2022.306735）。
