AIDS and Behavior

, Volume 19, Issue 2, pp 227–234 | Cite as

Sexual Stigma, Criminalization, Investment, and Access to HIV Services Among Men Who Have Sex with Men Worldwide

  • Sonya ArreolaEmail author
  • Glenn-Milo Santos
  • Jack Beck
  • Mohan Sundararaj
  • Patrick A. Wilson
  • Pato Hebert
  • Keletso Makofane
  • Tri D. Do
  • George Ayala
Original Paper


Globally, HIV disproportionately affects men who have sex with men (MSM). This study explored associations between access to HIV services and (1) individual-level perceived sexual stigma; (2) country-level criminalization of homosexuality; and (3) country-level investment in HIV services for MSM. 3,340 MSM completed an online survey assessing access to HIV services. MSM from over 115 countries were categorized according to criminalization of homosexuality policy and investment in HIV services targeting MSM. Lower access to condoms, lubricants, and HIV testing were each associated with greater perceived sexual stigma, existence of homosexuality criminalization policies, and less investment in HIV services. Lower access to HIV treatment was associated with greater perceived sexual stigma and criminalization. Criminalization of homosexuality and low investment in HIV services were both associated with greater perceived sexual stigma. Efforts to prevent and treat HIV among MSM should be coupled with structural interventions to reduce stigma, overturn homosexuality criminalization policies, and increase investment in MSM-specific HIV services.


Men who have sex with men (MSM) Sexual stigma Criminalization of homosexuality Country level investment in MSM–HIV services Access to HIV services 


Globalmente, el VIH afecta desproporcionadamente a los HSH. Este estudio exploró las asociaciones entre el acceso a servicios para el VIH y (1) la percepción del estigma sexual a nivel individual; (2) la criminalización de la homosexualidad en cada país; y (3) el nivel de inversión financiera por país en servicios para el VIH dirigidos a HSH. Un total de 3,340 HSH completaron una encuesta a través del internet sobre el acceso a servicios para el VIH. HSH de más de 115 países fueron clasificados según las legislaciones sobre la criminalización de la homosexualidad y el nivel de inversión en servicios para el VIH dirigido a HSH. Un menor acceso a condones, lubricantes y pruebas del VIH fueron asociados con una mayor percepción del estigma sexual, la existencia de legislación sobre la criminalización de la homosexualidad y menos inversión en servicios para el VIH. Menos acceso a tratamientos para el VIH, fue asociado con una mayor percepción de estigma sexual y la criminalización de la homosexualidad. A su vez, la criminalización de la homosexualidad y la baja inversión en servicios para el VIH, fueron asociados con una mayor percepción del estigma sexual. Los esfuerzos para prevenir y tratar el VIH entre HSH necesitan ser ligados a intervenciones estructurales para reducir el estigma, reformar legislaciones de criminalización de la homosexualidad y aumentar las inversiones en los servicios para el VIH específicamente diseñados para HSH.



We thank the participants who completed the GMHR online survey.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Sonya Arreola
    • 1
    Email author
  • Glenn-Milo Santos
    • 2
    • 3
  • Jack Beck
    • 1
  • Mohan Sundararaj
    • 1
  • Patrick A. Wilson
    • 4
  • Pato Hebert
    • 1
  • Keletso Makofane
    • 1
  • Tri D. Do
    • 5
  • George Ayala
    • 1
  1. 1.The Global Forum on MSM and HIV (MSMGF)OaklandUSA
  2. 2.Department of Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoUSA
  3. 3.San Francisco Department of Public HealthSan FranciscoUSA
  4. 4.Mailman School of Public HealthColumbia UniversityNew YorkUSA
  5. 5.Center for AIDS Prevention StudiesUniversity of California, San FranciscoSan FranciscoUSA

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