The Role of Gay-Related Stigma in HIV-Risk Behavior Among Sexual Minority Men in Europe
Sexual orientation stigma stems from discriminatory social contexts and may ultimately impact the behavioral health of stigmatized individuals through stress-related pathways. Sexual minority stigma is of particular concern in Europe given the diversity of social contexts on the continent and sexual minority men’s rapidly increasing risk of HIV infection, especially in Central and Eastern Europe, potentially rooted in stigma. This study assesses whether stigma in the ubiquitous social contexts surrounding sexual minority men (e.g., family, workplace, government) may place them at higher risk for HIV contraction across six countries. We utilized a large cross-sectional survey sample of HIV-negative sexual minority men (N = 2087; mean age = 31.6, SD = 9.7) from six European countries to test whether those who reported sexual orientation stigma also engaged in more HIV risk-related behaviors, including condomless sex with casual partners (in the absence of PrEP) and substance use before and during sex. Regression analyses were performed in Mplus. We found that a one standard deviation increase in reported sexual orientation stigma was significantly associated with the following during the last sexual encounter: a 19% increase in odds of sex under the influence of alcohol, 27% increase in odds of sex under the influence of cannabis, 49% increase in odds of sex under the influence of illicit drugs, an 11% increase in odds of condomless sex with casual partners in the past 6 months, and a 26% increase in odds of knowing where to receive an HIV test. Sexual minority men who reported perceiving greater sexual orientation-related stigma within their ubiquitous social contexts were significantly more likely to report sexual risk and alcohol and drug use during their last sexual encounter, yet reported more knowledge of preventive services. Contextual stigma might serve as a precursor to behavioral risks of HIV infection, generating maladaptive stress responses capable of being modified through individually-focused interventions. Structural interventions are also needed to ultimately reduce stigma at its source.
KeywordsSexual minority men HIV risk Sexual orientation-related stigma Drug use Alcohol use
We gratefully acknowledge all the participants and project staff who have dedicated their time to this research.
This article is based on the findings from the SIALON project, co-funded by the European Commission under the Public Health Programme 2003–2008 (GA 2007309). The sole responsibility lies with the author of the publication, and the Commission is not responsible for any use that may be made of the information contained therein.
Compliance with Ethical Standards
Conflict of interest
The authors have no conflicts of interest to declare.
Research Involving Human Subjects
Informed consent was obtained from all individual participants included in the study. Study protocols were approved by each study site’s ethics committee, and are in compliance with the 1964 Declaration of Helsinki for ethical principles for conducting research with human subjects.
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