Hidden from health

Structural stigma, sexual orientation concealment, and HIV across 38 countries in the European MSM Internet Survey

Dados Bibliográficos

ID23357280
AutoresJohn E Pachankis (0000-0002-2015-9225, Norwegian Institute of Public Health, autor correspondente), Mark L Hatzenbuehler (0000-0002-7430-0853, Columbia University), Ford Hickson (0000-0003-0395-374X, London School of Hygiene & Tropical Medicine), Peter Weatherburn (0000-0002-4950-6163, London School of Hygiene & Tropical Medicine), Rigmor C Berg (0000-0002-6915-0993, Nasjonalt Kunnskapssenter for Helsetjenesten), Ulrich Marcus (0000-0002-3143-2717, Robert Koch Institute), Alvin J Schmidt (0000-0002-6910-4399, London School of Hygiene & Tropical Medicine), Axel J Schmidt
Ano2015
Volume29
Fascículo10
Páginas1239-1246
Data de publicação2015-06-19
Peer ReviewedSim
Open AccessSim
TipoARTICLE
PeriódicoAIDS (JOURNAL)
Identificadores do periódicoISSN: 0269-9370 • E-ISSN: 1473-5571
EditoraOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/qad.0000000000000724
PMID26035323
OpenAlexW598269073
IdiomaEN
Citações recebidas113
Referências citadas28

OBJECTIVE: Substantial country-level variation exists in prejudiced attitudes towards male homosexuality and in the extent to which countries promote the unequal treatment of MSM through discriminatory laws. The impact and underlying mechanisms of country-level stigma on odds of diagnosed HIV, sexual opportunities, and experience of HIV-prevention services, needs and behaviours have rarely been examined, however. DESIGN: Data come from the European MSM Internet Survey (EMIS), which was administered between June and August 2010 across 38 European countries (N = 174 209). METHODS: Country-level stigma was assessed using a combination of national laws and policies affecting sexual minorities and a measure of attitudes held by the citizens of each country. We also assessed concealment, HIV status, number of past 12-month male sex partners, and eight HIV-preventive services, knowledge, and behavioural outcomes. RESULTS: MSM living in countries with higher levels of stigma had reduced odds of diagnosed HIV and fewer partners but higher odds of sexual risk behaviour, unmet prevention needs, not using testing services, and not discussing their sexuality in testing services. Sexual orientation concealment mediated associations between country-level stigma and these outcomes. CONCLUSION: Country-level stigma may have historically limited HIV transmission opportunities among MSM, but by restricting MSM's public visibility, it also reduces MSM's ability to access HIV-preventive services, knowledge and precautionary behaviours. These findings suggest that MSM in European countries with high levels of stigma are vulnerable to HIV infection. Although they have less opportunity to identify and contact other MSM, this might change with emerging technologies.

Environmental health · Family medicine · Homosexuality · Human immunodeficiency virus (HIV) · Human sexuality · Logistic regression · Men who have sex with men · Odds · Odds ratio · Psychiatry · Public health · Sexual orientation · Social stigma · Sociology · Stigma (botany) · Adolescent Sexual and Reproductive Health · Demography · Gender Studies · HIV/AIDS Research and Interventions · Medicine · Nursing · Psychology · Sex work and related issues · Social Psychology