Experienced Homophobia and HIV Infection Risk Among U.S. Gay, Bisexual, and Other Men Who Have Sex with Men: A Meta-Analysis

Abstract

Purpose: Experienced homophobia-negative treatment and perceptions that gay, bisexual, and other men who have sex with men ( MSM) encounter because of their sexual orientations-may promote HIV infection among MSM. We conducted a rapid review and meta-analysis to examine experienced homophobia in relation to HIV infection risk. Methods: We searched Embase, MEDLINE, PsycINFO, and Sociological Abstracts to acquire data from U.S. studies published during 1992-2017. Studies examined experienced homophobia in relation to sexual risk behavior, poor HIV care continuum engagement, and diagnosed HIV infection. Random-effects models yielded summary odds ratios (ORs) and 95% confidence intervals (CIs). Results: Experienced homophobia was associated with having any sexual risk behavior (

Latent profiles of stigma and HIV pre-exposure prophylaxis among Black sexual minority men: an exploratory study

“…We found that the profile characterized by the highest levels of both internalized and anticipated stigma was associated with the lowest PrEP use and acceptability. This is largely consistent with previous work demonstrating that stigma is associated with lower healthcare utilization, and more adverse HIV-related outcomes (Earnshaw et al 2019 , 2021 ; Cahill et al 2017 ; Jeffries 4th et al 2021 ; Quinn et al 2019 ). Internalized and experienced homophobia, as well as experienced racism, has been demonstrated as a barrier to HIV-related services in prior literature (Turpin et al 2021b ; Jeffries 4th et al 2021 ; Arnold et al 2014 ; Santos et al 2013 ).…”

“…This is largely consistent with previous work demonstrating that stigma is associated with lower healthcare utilization, and more adverse HIV-related outcomes (Earnshaw et al 2019 , 2021 ; Cahill et al 2017 ; Jeffries 4th et al 2021 ; Quinn et al 2019 ). Internalized and experienced homophobia, as well as experienced racism, has been demonstrated as a barrier to HIV-related services in prior literature (Turpin et al 2021b ; Jeffries 4th et al 2021 ; Arnold et al 2014 ; Santos et al 2013 ). While this was a small pilot study, the associations between stigmatized profiles and both PrEP use and acceptability were notably strong, with PrEP use three times as high among the reference profile compared to the most stigmatized profile.…”

“…Experiences of racism and homophobia may be internalized, resulting in greater distrust of medical services and development of more stigmatizing views towards HIV prevention utilization, including both HIV stigma and more specifically, PrEP stigma (Brooks et al 2020 ; Mustanski et al 2018 ; Cahill et al 2017 ; Arscott et al 2020 ). For instance, extant literature demonstrates strong associations between internalized homophobia and several adverse HIV-related outcomes, including greater difficulty engaging with HIV-related healthcare services (Arscott et al 2020 ; Turpin et al 2020 , 2021a , b ; Jeffries 4th et al 2021 ). Moreover, these forms of stigma may be heightened in the context of the COVID-19 pandemic, particularly given the greater social isolation, increased burden on mental health, and new challenges in navigating healthcare (Ramos et al 2021 ; Garcia et al 2021 ; Kamal et al 2021 ; Gato et al 2021 ).…”

Enacted Sexual Minority Stigma, Psychological Distress, and Sexual and Drug Risk Behaviors Among Urban Men Who Have Sex with Men (MSM)

“…These results suggest a positive and significant association between enacted sexual minority stigma and multiple sex and drug risk behaviors. While not directly comparable to our study, a meta-analysis including studies from 1992 to 2017 showed that Black MSM (compared to White and Latinos) who experienced homophobia were at significantly increased odds of reporting any sexual risk behavior (OR 1.55, 95% CI 1.28, 1.88) [15]. Black MSM bear a disproportionate burden of HIV and syphilis diagnoses and engagement in sexual and drug risk behaviors Table 3 Enacted stigma a in the past 3 months and the unadjusted and adjusted odds (OR, aOR) and 95% confidence interval (CI) b of three outcomes in the past 3 months-number of sex partners, transactional sex c and injection drug use (IDU)-as well as the association with psychological distress d among Black gay and bisexual men (MSM) participating in the nine-month study visit of the USHINE study using logistic regression, Baltimore City, MD, 2019-2020 (N = 140) a Enacted stigma-defined as 3-items each measuring whether the participant reported having experienced (yes, no) verbal harassment, physical violence, and/or discrimination in the past 3 months; the items were summed and any value > 1 was classified as enacted stigma compared to no report of enacted stigma b Statistical significance was defined as a 95% CI that did not cross 1.0, are indicated in bold, and adjusted models were adjusted for age and education c Transactional sex-defined as a self-report (yes, no) of giving or receiving sex in exchange for money, drugs, or something else in the past 3 months d Psychological distress-defined by a 5-item scale with each item measured on a 4-point frequency scale ranging from never, once or twice, a few times, to many times; the items were summed to create one cumulative ordinal scale such as transactional sex increases the risk.…”

Psychometric assessment of a homophobia management scale among cisgender sexual minority men in midlife and older adulthood.

“…Despite this trend, SMP remain susceptible to homophobic stigma over the life course (Meanley et al, 2021; Rice et al, 2021). Homophobic stigma includes negative attitudes, fears, and aggressive behaviors toward people who are, or are perceived to be, attracted to those of the same sex (Cheval et al, 2016) and has implications for long-term health (Austin et al, 2017; Frost et al, 2015; Jeffries et al, 2021; Meanley, Stall, et al, 2020; Meyer & Frost, 2013). Homophobic incidents are positively associated with psychosocial stress, serve as barriers to accessing health care, and exacerbate health disparities (e.g., mental health, substance use, and HIV/sexually transmitted infections) that burden SMP compared with heterosexual people (Hatzenbuehler et al, 2013; Williams & Mann, 2017).…”