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Association Between Enacted Stigma and HIV-Related Risk Behavior Among MSM, National HIV Behavioral Surveillance System, 2011

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Abstract

MSM bear a disproportionate burden of the HIV epidemic. Enacted stigma (overt negative actions) against sexual minorities may play an important role in increasing HIV risk among this population. Using data from the 2011 National HIV Behavioral Surveillance system, MSM cycle, we examined the independent associations between three measures of enacted stigma (verbal harassment, discrimination, physical assault) and engagement in each of four HIV-related risk behaviors as outcomes: condomless anal intercourse (CAI) at last sex with a male partner of HIV discordant or unknown status and, in the past 12 months, CAI with a male partner, ≥4 male sex partners, and exchange sex. Of 9819 MSM, 32% experienced verbal harassment in the past 12 months, 23% experienced discrimination, and 8% experienced physical assault. Discordant CAI at last sex with a male partner was associated with previous discrimination and physical assault. Past 12 month CAI with a male partner, ≥4 male sex partners, and exchange sex were each associated with verbal harassment, discrimination, and physical assault. These findings indicate that a sizable proportion of MSM report occurrences of past 12 month enacted stigma and suggest that these experiences may be associated with HIV-related risk behavior. Addressing stigma towards sexual minorities must involve an integrated, multi-faceted approach, including interventions at the individual, community, and societal level.

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  1. Atlanta, Georgia; Baltimore, Maryland; Boston, Massachusetts; Chicago, Illinois; Dallas, Texas; Denver, Colorado; Detroit, Michigan; Houston, Texas; Los Angeles, California; Miami, Florida; Nassau, New York; Newark, New Jersey; New Orleans, Louisiana; New York City, New York; Philadelphia, Pennsylvania; San Diego, California; San Francisco, California; San Juan, Puerto Rico; Seattle, Washington; and Washington, District of Columbia.

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Acknowledgements

We would like to thank all of the NHBS 2011 participants. We would also like to thank members of the NHBS Study Group: Atlanta, GA: Jianglan White, Jeff Todd, Greg Bautista; Baltimore, MD: Colin Flynn, Danielle German; Boston, MA: Maura Miminos, Rose Doherty, Chris Wittke; Chicago, IL: Nikhil Prachand, Nanette Benbow; Dallas, TX: Sharon Melville, Shane Sheu, Alicia Novoa; Denver, CO: Mark Thrun, Alia Al-Tayyib, Ralph Wilmoth; Detroit, MI: Emily Higgins, Vivian Griffin, Karen MacMaster; Houston, TX: Marcia Wolverton, Hafeez Rehman, Paige Padgett; Los Angeles, CA: Trista Bingham, Ekow Kwa Sey; Miami, FL: Marlene LaLota, Lisa Metsch, David Forrest; Nassau-Suffolk, NY: Bridget J. Anderson, Carol-Ann Watson, Lou Smith; New Orleans, LA: William T. Robinson, DeAnn Gruber, Narquis Barak; New York City, NY: Alan Neaigus, Kathleen H. Reilly, Travis Wendel; Newark, NJ: Barbara Bolden, Afework Wogayehu, Henry Godette; Philadelphia, PA: Kathleen A. Brady, Andrea Sifferman; San Diego, CA: Vanessa Miguelino-Keasling, Al Velasco, Veronica Tovar; San Francisco, CA: H. Fisher Raymond; San Juan, PR: Sandra Miranda De Leo’n, Yadira Rolo’n-Colo’n, Melissa Marzan; Seattle, WA: Tom Jaenicke, Hanne Thiede, Richard Burt; Washington, DC: Tiffany West, Manya Magnus, Irene Kuo; CDC: Behavioral Surveillance Team, Division of HIV/AIDS Prevention, CDC.

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Authors and Affiliations

  1. Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, N.E. MS E-46, Atlanta, GA, USA

    Alexandra B. Balaji, Kristina E. Bowles, Kristen L. Hess & Gabriela Paz-Bailey

  2. Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA

    Justin C. Smith

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  1. Alexandra B. Balaji
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  2. Kristina E. Bowles
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  3. Kristen L. Hess
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Consortia

for the NHBS study group

  • Jennifer Taussig
  • , Robert Gern
  • , Tamika Hoyte
  • , Laura Salazar
  • , Jianglan White
  • , Jeff Todd
  • , Greg Bautista
  • , Colin Flynn
  • , Frangiscos Sifakis
  • , Danielle German
  • , Debbie Isenberg
  • , Maura Driscoll
  • , Elizabeth Hurwitz
  • ,  Miminos
  • , Rose Doherty
  • , Chris Wittke
  • , Nikhil Prachand
  • , Nanette Benbow
  • , Sharon Melville
  • , Praveen Pannala
  • , Richard Yeager
  • , Aaron Sayegh
  • , Jim Dyer
  • , Shane Sheu
  • , Alicia Novoa
  • , Mark Thrun
  • , Alia Al-Tayyib
  • , Ralph Wilmoth
  • , Emily Higgins
  • , Vivian Griffin
  • , Eve Mokotoff
  • , Karen MacMaster
  • , Marcia Wolverton
  • , Jan Risser
  • , Hafeez Rehman
  • , Paige Padgett
  • , Trista Bingham
  • , EkowKwa Sey
  • , Marlene LaLota
  • , Lisa Metsch
  • , David Forrest
  • , Dano Beck
  • , Gabriel Cardenas
  • , Chris Nemeth
  • , Bridget J. Anderson
  • , Carol-Ann Watson
  • , Lou Smith
  • , William T. Robinson
  • , DeAnn Gruber
  • , Narquis Barak
  • , Chris Murrill
  • , Alan Neaigus
  • , Samuel Jenness
  • , Holly Hagan
  • , Kathleen H. Reilly
  • , Travis Wendel
  • , Helene Cross
  • , Barbara Bolden
  • , Sally D’Errico
  • , Afework Wogayehu
  • , Henry Godette
  • , Kathleen A. Brady
  • , Althea Kirkland
  • , Andrea Sifferman
  • , Vanessa Miguelino-Keasling
  • , Al Velasco
  • , Veronica Tovar
  • , Sandra Miranda De Leo’n
  • , Yadira Rolo’n-Colo’n
  • , Melissa Marzan
  • , Maria Courogen
  • , Tom Jaenicke
  • , Hanne Thiede
  • , Richard Burt
  • , Yujiang Jia
  • , Jenevieve Opoku
  • , Marie Sansone
  • , Tiffany West
  • , Manya Magnus
  •  & Irene Kuo

Corresponding author

Correspondence to Alexandra B. Balaji.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. Informed consent was obtained from all individual participants included in the study.

Additional information

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. This research was supported in part by an appointment to the Research Participation Program at the Centers for Disease Control and Prevention administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the U.S. Department of Energy and CDC.

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Balaji, A.B., Bowles, K.E., Hess, K.L. et al. Association Between Enacted Stigma and HIV-Related Risk Behavior Among MSM, National HIV Behavioral Surveillance System, 2011. AIDS Behav 21, 227–237 (2017). https://doi.org/10.1007/s10461-016-1599-z

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