Structural Stigma and Sexual Health Disparities Among Gay, Bisexual, and Other Men Who Have Sex With Men in Australia

Abstract

Background: Discrimination and stigmatization at the institutional and sociocultural level (conceptualized as "structural stigma") has been associated with adverse health outcomes among sexual and gender minorities. However, few studies explore whether structural stigma is associated with sexual health outcomes. Addressing this gap, here, we explore this relationship among Australian gay, bisexual, and other men who have sex with men (GBM)-a population disproportionately affected by HIV.Setting and Methods: Using responses from the 2017 Australian Marriage Law Postal Survey, we operationalized structural stigma related to sexual minority status as the regional percentage of votes against legalizing same-sex marriage. These responses were then linked to national HIV behavioral surveillance data from Australian GBM (43,811 responses between 2015 and. Controlling for a rich set of individual and regional level confounders, regression analyses were used to estimate the extent to which structural stigma was associated with testing for, and diagnoses of, HIV and sexually transmitted infections (STIs), and awareness and use of HIV prevention and treatment interventions (pre-exposure and postexposure prophylaxis, combination therapy, and HIV-related clinical care).Results: Australian GBM living in regions with higher levels of structural stigma were less likely to undergo HIV/STI testing, receive HIV/STI diagnoses, and be taking, or aware of, biomedical prevention strategies. Among GBM living with HIV, structural stigma was associated with a reduced likelihood of being on combination therapy and fewer HIV-related clinical visits.Conclusions: Altogether, these results suggest that structural stigma may undermine HIV prevention strategies as well as adequate management of HIV infection among GBM.

Physical and mental health of long-term users of HIV preexposure prophylaxis in Australia

“…The associations of depression with younger age, unemployment, and regular cannabis consumption have been broadly demonstrated [18][19][20]. GBMSM in regional or rural Australia were more likely than their metropolitan-based counterparts to have symptoms of depression, which may relate to GBMSM living in regional or rural Australia often reporting greater levels of stigma compared with their urban counterparts [21,22], and this stigma contributing to poorer mental health [23].…”

Measurement invariance and psychometric properties of a German-language Conformity to Masculine Norms Inventory among cisgender sexual minority and heterosexually identified women and men.

“…2 Second, important information about certain sexual minority groups can be missed if a common group for all persons who do not identify as heterosexual is formed. People with different sexual orientations (e.g., gay/lesbian, asexual, pansexual, queer, bisexual) might be affected by different forms of social pressure or discrimination (Saxby et al, 2022). Also, the endorsement and adherence to masculinity ideologies might differ depending on the specific sexual orientation (Winer, 2022).…”

Medicare and Priority Populations: Structural and Place‐based Considerations for Aboriginal and Torres Strait Islander Peoples and LGBTIQ+ Australians

“…Discrimination, both within and outside of the healthcare setting, continues to play an important role in predicting health outcomes and healthcare access among LGBTIQ+ Australians (Perales and Todd 2018; Ecker et al 2019; Saxby et al 2020; Saxby et al 2021). Recent research among samples of LGBTQ+ Australians has used exposure to marriage equality opposition to quantify the effects of stigma on healthcare use (Saxby et al 2020; Saxby et al 2021).…”