": Exploring Intersectional Stigma and Other Social and Structural Determinants of Health for Indigenous Gay and Bisexual Men in Guatemala.

Although nearly half of Guatemalans identify as Indigenous, little is known about the unique health experiences of Indigenous sexual minority individuals. We sought to explore how intersectional stigma impacts the health of Indigenous gay and bisexual men (GBM) in Guatemala. Between February and May 2021, we conducted in-depth qualitative interviews via Zoom with key stakeholders ( = 12) working with Indigenous GBM throughout Guatemala. We coded thematically and conducted narrative analysis to identify the most salient themes. We found that Indigenous GBM experience intersectional stigma based on multiple marginalized identities, primarily their Indigenous and sexual identities, but also based on gender expression, level of education, and whether they were from a rural setting. Intersectional stigma had a direct impact on the mental and physical health of Indigenous GBM but also impacted social and structural determinants of health, including access to education, stable employment, and quality health care. The compounding effect of low education and employment and chronic stress from multiple marginalized identities often led to mental and physical health problems. Multilevel policies and culturally congruent public health interventions that target individual, community, institutional, and societal levels are needed to mitigate the effects of intersectional stigma and improve the overall health of Indigenous GBM.