Is HIV/AIDS Stigma Dividing the Gay Community? Perceptions of HIV–positive Men Who Have Sex With Men

Abstract

Stigma surrounding HIV/AIDS has existed since the beginning of the epidemic, but little is known about HIV/AIDS stigma within the gay community and how it affects men who have sex with men (MSM) living with HIV. A better understanding of the effects of stigma on this population is needed to reduce it and its harmful effects. Our study used quantitative data from 206 HIV-positive MSM and qualitative data from 250 to document beliefs about HIV/AIDS stigma within the gay community and to measure its effects on sexual risk behaviors, substance use behaviors, serostatus disclosure, and mental health. Stigma was associated with increased levels of anxiety, loneliness, depressive symptoms, engaging in avoidant coping strategies, and history of suicidal ideation. HIV/AIDS stigma exists within the gay community and has a negative effect on the mental health of people living with HIV. HIV/AIDS stigma should be monitored closely so that we may better understand how to address it.

The Effects of HIV Stigma on Health, Disclosure of HIV Status, and Risk Behavior of Homeless and Unstably Housed Persons Living with HIV

“…Perceived external, internal, and total HIV stigma were negatively associated with physical and mental health. These associations were strong and observed for all selfassessed measures employed in this study, confirming earlier findings (Courtenay-Quirk et al 2006;Lee et al 2002;Murphy et al 2006). Given this pattern of results, it was surprising that laboratory-based measures of physical health (CD4 and HIV viral load) were not associated with any HIV-stigma measure.…”

“…Overall, evidence regarding a direct association between HIV stigma and unprotected sex is limited and mixed (Courtenay-Quirk et al 2006;Preston et al 2004Preston et al , 2007Swendeman et al 2006). The finding that HIV stigma was associated with disclosure and not sexual risk behavior is consistent with prior research indicating that these behaviors are distinct, determined by different factors, and often not causally linked (i.e., disclosure of HIV status does not consistently lead to reduced sexual risk) (Crepaz and Marks 2003;Hart et al 2005;Marks and Crepaz 2001;Parsons et al 2005;Simoni and Pantalone 2005;Wolitski et al 1998).…”

“…Internal and external HIV stigma not only lead to social exclusion and discrimination, but also have the potential to affect individual and community health (Valdiserri 2002). For instance, stigma is associated with avoidance of HIV/STD testing, delayed seeking of HIV/STD medical care, reluctance to disclose seropositive HIV status to others, non-adherence to HIV treatment, and poorer self-assessed mental and physical health (Babalola 2007;Chesney and Smith 1999;Courtenay-Quirk et al 2006;Fortenberry 1997;Fortenberry et al 2002;Kang et al 2006;Lee et al 2002;Murphy et al 2006;Rintamaki et al 2006;Valdiserri 2002;Vanable et al 2006).…”

Formation of Personal HIV Disclosure Policies among HIV-Positive Men Who Have Sex with Men

“…13 Although discussing serostatus makes sense, it is unclear how well this strategy works among MSM, in part because of stigma, which is perceived by some MSM (particularly those who are HIV positive), as dividing the gay community by serostatus. 14 The development of HIV testing in 1985, the ''de-gaying'' of AIDS in the 1980s, 15 and dissemination of lifesaving highly active antiretroviral therapy (HAART) in the later 1990s may have contributed to erosion from a united gay community with a focus on community-inspired safer sex norms to a divided one with a focus on individual-level approaches based on serostatus. 16,17 Before testing was widely available, gay men and other MSM banded together to face AIDS, largely in part because of institutional homophobia and a delayed government response to the emerging epidemic, and were encouraged to have candid discussions about safer sex.…”

“…However, within gay communities, MSM do enact stigma upon one another, including judging one another for becoming HIV-positive. 14 However, perceptions of stigma within the gay community do not appear to be associated with risky behavior itself, but are linked to pursuit of anonymous sex as well as negative mental health.…”