Stigma and HIV

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The stigma associated with homosexuality and HIV infection has affected the course of the epidemic in a number of different ways. It has caused people to focus on the epidemic among men who have sex with men (MSM) and ignore the risk to men and women who have sex with each other, even though worldwide they are at highest risk for infection. It has also made it difficult for people to seek out testing and treatment

Mostly, however, it has increased the long term health effects of the virus on MSM. There are a number of reasons why MSM are at particularly high risk for HIV - biological, social, and behavioral. However, research also suggests that stigma at the national level causes problematic effects on the HIV epidemic. It makes it harder for men to find partners, which the people who endorse the stigma may see as an advantage. But it also increases the odds of having unprotected sex, the difficulty of finding testing and getting other preventative care services, particularly since it makes MSM less likely to disclose their risky behaviors to their doctors.

Shame isn't healthy, and the stigma associated with not just homosexuality but gender minority status needs to be addressed at the individual, local, and national level in order to improve healthcare outcomes and access to quality, informed care.

Without it, all the inherent challenges of addressing the HIV epidemic are only confounded by invisibility, hostility, and a profound lack of reliable information about the best way for individuals to improve and maintain their health.

Ironically, technology is providing new ways for MSM to work around stigmatized identities to seek out new connections and partners...

but in a way that has the potential to increase their health risks even further. A number of studies have suggested that men who arrange hookups online are significantly more likely to have unprotected anal intercourse, despite the high risk of HIV and other STDs. The use of social-hookup tools such as Tindr and Grindr may increase sexual health risk beyond that of casual sex in physical venues by, among other things, interconnecting sexual networks and diffusing infections across communities. These tools may also further decrease individuals likelihood of having discussions about risk, testing, and safe sex, as well as increasing the temptation to serosort -- even though doing so is not a reliable method of prevention.


Beymer MR, Weiss RE, Bolan RK, Rudy ET, Bourque LB, Rodriguez JP, Morisky DE. Sex on demand: geosocial networking phone apps and risk of sexually transmitted infections among a cross-sectional sample of men who have sex with men in Los Angeles County. Sex Transm Infect. 2014 Nov;90(7):567-72.

Lewnard JA, Berrang-Ford L. Internet-based partner selection and risk for unprotected anal intercourse in sexual encounters among men who have sex with men: a meta-analysis of observational studies. Sex Transm Infect. 2014 Jun;90(4):290-6. doi: 10.1136/sextrans-2013-051332.

Pachankis JE, Hatzenbuehler ML, Hickson F, Weatherburn P, Berg RC, Marcus U, Schmidt AJ. Hidden from health: structural stigma, sexual orientation concealment, and HIV across 38 countries in the European MSM Internet Survey. AIDS. 2015 Jun 19;29(10):1239-46. doi: 10.1097/QAD.0000000000000724.

Winetrobe H, Rice E, Bauermeister J, Petering R, Holloway IW. Associations of unprotected anal intercourse with Grindr-met partners among Grindr-using young men who have sex with men in Los Angeles. AIDS Care. 2014;26(10):1303-8. doi: 10.1080/09540121.2014.911811.

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