Characterizing Cross-Culturally Relevant Metrics of Stigma Among Men Who Have Sex With Men Across 8 Sub-Saharan African Countries and the United States

Abstract

Overcoming stigma affecting gay, bisexual, and other men who have sex with men (MSM) is a foundational element of an effective response to the human immunodeficiency virus (HIV) pandemic. Quantifying the impact of stigma mitigation interventions necessitates improved measurement of stigma for MSM around the world. In this study, we explored the underlying factor structure and psychometric properties of 13 sexual behavior stigma items among 10,396 MSM across 8 sub-Saharan African countries and the United States using cross-sectional data collected between 2012 and 2016. Exploratory factor analyses were used to examine the number and composition of underlying stigma factors. A 3-factor model was found to be an adequate fit in all countries (root mean square error of approximation = 0.02–0.05; comparative fit index/Tucker-Lewis index = 0.97–1.00/0.94–1.00; standardized root mean square residual = 0.04–0.08), consisting of “stigma from family and friends,” “anticipated health-care stigma,” and “general social stigma,” with internal consistency estimates across countries of α = 0.36–0.80, α = 0.72–0.93, and α = 0.51–0.79, respectively. The 3-factor model of sexual behavior stigma cut across social contexts among MSM in the 9 countries. These findings indicate commonalities in sexual behavior stigma affecting MSM across sub-Saharan Africa and the United States, which can facilitate efforts to track progress on global stigma mitigation interventions.

HIV infection and engagement in HIV care cascade among men who have sex with men and transgender women in Kigali, Rwanda: a cross‐sectional study

“…Individual HIV risks are contextualized by community‐level and structural factors including stigma, sexual and physical violence and exposure to human rights violations, which influence individual HIV risk factors (2,3). Furthermore, structural determinants increase HIV risk by limiting the uptake and provision of HIV prevention and treatment services for MSM (9). Consequently, MSM generally have lower engagement in HIV prevention and treatment services and poorer outcomes compared to other adults in SSA (10,11).…”

Retention of a cohort of men who have sex with men and transgender women at risk for and living with HIV in Abuja and Lagos, Nigeria: a longitudinal analysis

“…For sexual and gender minorities, sexual behaviour stigma further impedes access and retention in healthcare facilities [7]. Sexual behaviour stigma as a multifaceted construct includes enacted stigma (behavioural expressions including physical violence); internalized stigma (feelings of stigma) and anticipated stigma (expectations of stigma) [7,8].…”

Project BESPOKE (Integrated Bio-Behavioral Assessment of HIV and STI Among Young Tertiary Student Men Who Have Sex With Men in Nairobi, Kenya): A Respondent-Driven Sampling Survey Protocol

“…The questionnaire that will be used in the behavioral assessment was developed for this study, with modifications from various sources, including: Integrated HIV Bio-behavioral Surveillance Toolbox by University of California, San Francisco (60), Rectal Douching and Enema Survey by International Rectal Microbicide Advocates-University of California, Los Angeles (61), MSM Stigma Metrics by Johns Hopkins University (62), and American Men's Internet Survey by Emory University (63). In addition, the Alcohol Use Disorders Identification Test (AUDIT) (64), Perceived Stress Scale-10 (PSS-10) (65), Patient Health Questionnaire-9 (PHQ-9) (66), and Generalized Anxiety Disorder-7 (GAD-7) (67) tools were included in the IBBA questionnaire.…”