AIDS and Behavior

, Volume 22, Issue 2, pp 522–530 | Cite as

Anticipated HIV Stigma and Delays in Regular HIV Testing Behaviors Among Sexually-Active Young Gay, Bisexual, and Other Men Who Have Sex with Men and Transgender Women

  • Kristi E. GamarelEmail author
  • Kimberly M. Nelson
  • Rob Stephenson
  • Olga J. Santiago Rivera
  • Danielle Chiaramonte
  • Robin Lin Miller
  • the Adolescent Medicine Trials Network for HIV/AIDS Interventions
Original Paper


Young gay, bisexual and other men who have sex with men (YGBMSM) and young transgender women are disproportionately affected by HIV/AIDS. The success of biomedical prevention strategies is predicated on regular HIV testing; however, there has been limited uptake of testing among YGBMSM and young transgender women. Anticipated HIV stigma—expecting rejection as a result of seroconversion- may serve as a significant barrier to testing. A cross-sectional sample of YGBMSM (n = 719, 95.5%) and young transgender women (n = 33, 4.4%) ages 15–24 were recruited to participate in a one-time survey. Approximately one-third of youth had not tested within the last 6 months. In a multivariable model, anticipated HIV stigma and reporting a non-gay identity were associated with an increased odds of delaying regular HIV testing. Future research and interventions are warranted to address HIV stigma, in order to increase regular HIV testing among YGBMSM and transgender women.


Stigma HIV testing Youth Gay and bisexual men Young transgender women 


Los hombres jóvenes homosexuales, bisexuales o que tienen sexo con hombres (YGBMSM) y las mujeres jóvenes transgénero, son afectados desproporcionalmente por el VIH/SIDA. El éxito de las estrategias de prevención biomédicas se basa en pruebas de VIH frecuentes; sin embargo, entre los YGBMSM y las mujeres jóvenes transgéneros ha habido una aceptación limitada a hacerse la prueba de VIH. Esperar el rechazo como resultado de seroconversión a VIH es un estigma anticipado que puede servir como una barrera significativa para realizarse la prueba. Una muestra transversal de hombres YGBMSM (n = 719, 95.5%) y de mujeres jóvenes transgéneros (n = 33, 4.4%), entre las edades de 15 a 24 años, fueron reclutados para participar en una encuesta transversal. Aproximadamente un tercio no se habían realizado la prueba durante los pasados seis meses. En un modelo multivariado, el estigma anticipado de VIH y la identidad no-homosexual estuvieron asociados con un incremento en la probabilidad de posponer la prueba regular de VIH. Futuras investigaciones e intervenciones se necesitan para aumentar la frecuencia de la prueba de VIH entre los hombres YGBMSM y las mujeres transgéneros.



This work was supported by The Adolescent Trials Network for HIV/AIDS Interventions (ATN) from the National Institutes of Health [U01 HD 040533 and U01 HD 040474] through the National Institute of Child Health and Human Development (B. Kapogiannis), with supplemental funding from the National Institutes on Drug Abuse (S. Kahana) and Mental Health (P. Brouwers, S. Allison). The study was scientifically reviewed by the ATN’s Community Prevention Leadership Group. Network, scientific and logistical support was provided by the ATN Coordinating Center (C. Wilson, C. Partlow) at The University of Alabama at Birmingham. Network operations and analytic support was provided by the ATN Data and Operations Center at Westat, Inc. (B. Harris, B. Driver). Support was also provided to the first author by the Providence/Boston Center for AIDS Research (P30AI042853, PI: Cu-Uvin) and the second author was supported by Career Development Grant (K23MH109346, PI: Nelson). The comments and views of the authors do not necessarily represent the views of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. We acknowledge the contribution of the investigators and staff at the following sites that participated in this study: University of South Florida, Tampa (Emmanuel, Straub, Walker), Children’s Hospital of Los Angeles (Belzer, Smith), Children’s National Medical Center (D’Angelo, Trexler, Sinkfield), Children’s Hospital of Philadelphia (Douglas, Tanney), John H. Stroger Jr. Hospital of Cook County and the Ruth M. Rothstein CORE Center (Martinez, Henry-Reid, Holliman), Montefiore Medical Center (Futterman, Hinkson), Tulane University Health Sciences Center (Abdalian, Hayden, Jeanjacques), University of Miami School of Medicine (Friedman, Sanchez), St. Jude’s Children’s Research Hospital (Flynn, Stubbs), Baylor College of Medicine, Texas Children’s Hospital (Paul, Lopez); Wayne State University (Secord, Outlaw, Djalaj); Johns Hopkins University School of Medicine (Agwu, Sanders, Terreforte); The Fenway Institute (Mayer, Salomon); and University of Colorado (Reirden, Munoz). The investigators are grateful to the members of the local youth Community Advisory Boards for their insight and counsel and are indebted to the youth who participated in this study.

Compliance with Ethical Standards

Conflict of interest

Each of 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.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    CDC. HIV surveillance report. 2015.Google Scholar
  2. 2.
    Prejean J, et al. Estimated HIV incidence in the United States, 2006–2009. PLoS ONE. 2011;6:e17502.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Centers for Disease Control and Prevention. Estimated HIV incidence in the United States, 2007–2010. In: HIV Surveillance Supplemental Report. 2012.Google Scholar
  4. 4.
    Baral SD, et al. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13(3):214–22.CrossRefPubMedGoogle Scholar
  5. 5.
    Singh S., et al. HIV incidence, prevalence, and undiagnosed infections in men who have sex with men. In: Conference on Retroviruses and Opportunistic Infections, Boston, MA. 2017.Google Scholar
  6. 6.
    Miller RL, et al. Evaluating testing strategies for identifying youths with HIV infection and linking youths to biomedical and other prevention services. JAMA Pediatr. 2017;171(6):532–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Margolis AD, et al. Never testing for HIV’ among men who have sex with men recruited from a sexual networking website, United States. AIDS Behav. 2012;16(1):23–9.CrossRefPubMedGoogle Scholar
  8. 8.
    White House Office of National AIDS Policy. National HIV/AIDS strategy for the United States: updated to 2020. 2015. Accessed 11 Sept 2015.
  9. 9.
    DiNenno EA, et al. Recommendations for HIV screening of gay, bisexual, and other men who have sex with men—United States, 2017. MMWR Morb Mortal Wkly Rep. 2017;66:830–2.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    MacKellar DA, et al. Recent HIV testing among young men who have sex with men: correlates, contexts, and HIV seroconversion. Sex Transm Dis. 2006;33:183–92.CrossRefPubMedGoogle Scholar
  11. 11.
    Conway DP, et al. Barriers to HIV testing and characteristics associated with never testing among gay and bisexual men attending sexual health clinics in Sydney. J Int AIDS Soc. 2015;18:202–21.CrossRefGoogle Scholar
  12. 12.
    Metsh LR, et al. Implementing rapid HIV testing with or without risk-reduction counseling in drug treatment centers: results of a randomized trial. Am J Public Health. 2012;102(6):1160–7.CrossRefGoogle Scholar
  13. 13.
    Noble M, et al. HIV testing among Internet-using MSM in the United States: systematic review. AIDS Behav. 2017;21(2):561–75.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Herek GM, et al. Workshop report: AIDS and stigma: a conceptual framework and research agenda. AIDS Public Policy J. 1998;13:36–47.PubMedGoogle Scholar
  15. 15.
    Golub SA, Gamarel KE. The impact of anticpated HIV stigma on delays in HIV testing behaviors: findings from a community-based sample of men who have sex with men and transgender women. AIDS Patient Care STD. 2013;27(11):621–7.CrossRefGoogle Scholar
  16. 16.
    Earnshaw VA, Chaudoir SR. From conceptualizating to measuring HIV stigma: a review of HIV stigma mechanism measures. AIDS Behav. 2009;13(6):1160.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Kaplan AH, Scheyett A, Golin CE. HIV and stigma: analysis and research program. Curr HIV/AIDS Rep. 2005;2:184–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Young SD, Nussbaum AD, Monin B. Potential moral stigma and reactions to sexually transmitted diseases: evidence for a disjunction fallacy. Pers Soc Psychol Bull. 2007;33:789–99.CrossRefPubMedGoogle Scholar
  19. 19.
    Rutledge SE, et al. Measuring stigma among health care and social service providers: the HIV/AIDS provider stigma inventory. AIDS Patient Care STD. 2011;25:673–81.CrossRefGoogle Scholar
  20. 20.
    Kurth AE, et al. HIV testing and linkage to services for youth. J Int AIDS Soc. 2015;18(Suppl 1):19433.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Allen JP, Antonishak J. Understanding peer influence in children and adolescents. In: Prinstein MJ, Dodge KA, editors. Adolescent peer influences: beyond the dark side. New York: Guilford; 2008. p. 141–60.Google Scholar
  22. 22.
    Somerville LH. Special issue on the teenage brain: sensitivity to social evaluation. Curr Dir Psychol Sci. 2013;22(2):121–7.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Willard N, et al. Bridging the gap between individual level risk for HIV and structural determinants: using root cause analysis in strategic planning. J Prev Interv Community. 2012;40:103–17.CrossRefPubMedGoogle Scholar
  24. 24.
    Sevelius JM. Gender affirmation: a framework for conceptualizing risk behavior among transgender women of color. Sex Roles. 2013;68(11–12):675–89.CrossRefPubMedGoogle Scholar
  25. 25.
    Diaz RM, et al. The impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: findings from 3 US cities. Am J Public Health. 2001;91:927–32.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Miller RL, et al. Creating youth-supportive communities: outcomes from the Connect-to-Protect (C2P) structural change approach to youth HIV prevention. J Youth Adolesc. 2016;45:301–15.CrossRefPubMedGoogle Scholar
  27. 27.
    Harper GW, et al. Connect to Protect®: utilizing community mobilization and structural change to prevent HIV infection among youth. J Prev Interv Community. 2012;40(2):81–6.CrossRefPubMedGoogle Scholar
  28. 28.
    Ziff M, Harper GW, Chutuape KS. Laying the foundation for Connect to Protect: a multisite community mobilization intervention to reduce HIV/AIDS incidence and prevalence among urban youth. J Urban Health. 2006;83:506–22.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Williams K, et al. Standard 6: age groups for pediatric trials. Pediatrics. 2012;129(Suppl 3):S153–60.CrossRefPubMedGoogle Scholar
  30. 30.
    Smith D. The HIV epidemiology research study, HIV out-patient study and the spectrum of disease studies. J Acquir Immune Defic Syndr. 1998;17(Suppl 1):S17–9.CrossRefGoogle Scholar
  31. 31.
    National Institute on Alcohol Abuse and Alcoholism. Drinking levels defined. 2015.
  32. 32.
    Burton P, Gurrin L, Sly P. Tutorial in biostatistics: extending the simple linear regression model to account for correlated responses: an introduction to generalized estimating equations and multi-level mixed modeling. Stat Med. 1998;17:1261–91.CrossRefPubMedGoogle Scholar
  33. 33.
    Hubbard AE, et al. To GEE or not to GEE: comparing population average and mixed models for estimating the associaation between neighborhood risk factors and health. Epidemiology. 2010;21:467–74.CrossRefPubMedGoogle Scholar
  34. 34.
    Balaji AB, et al. Association between HIV-related risk behaviors and HIV testing among high school students in the United States, 2009. Arch Pediatr Adolesc Med. 2012;166(4):331–6.CrossRefPubMedGoogle Scholar
  35. 35.
    Peretti-Watel P, et al. Discrimination against HIV-infected people and the spread of HIV: some evidence from France. PLoS ONE. 2007;2:e411.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Peretti-Watel P, et al. Management of HIV-related stigma and adherence to HAART: evidence from a large representative sample of outpatients attending French hospitals (ANRSEN12-VESPA 2003). AIDS Care. 2006;18:254–61.CrossRefPubMedGoogle Scholar
  37. 37.
    Earnshaw VA, et al. Stereotypes about people living with HIV: implications for perceptions of HIV risk and testing frequency among at risk populations. AIDS Educ Prev. 2012;24:574–81.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Futterman DC, et al. The ACCESS (Adolescents Connected to Care, Evaluation, and Special Services) project: social marketing to promote HIV testing to adolescents, methods and first year results from a six city campaign. J Adolesc Health. 2001;29:19–29.CrossRefPubMedGoogle Scholar
  39. 39.
    Zanoni BC, Mayer KH. The adolescent and young adult HIV cascade of care in the United States: exaggerated health disparities. AIDS Patient Care STD. 2014;28(3):128–35.CrossRefGoogle Scholar
  40. 40.
    Phillips G, et al. Low rates of human immunodeficiency virus testing among adolescent gay, bisexual, and queer men. J Adolesc Health. 2015;57(4):407–12.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Gamarel KE, et al. Prevalence and correlates of substance use among youth living with HIV in clinical settings. Drug Alcohol Depend. 2016;169:11–8.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Huebner DM, Thoma BC, Neilands TB. School victimization and substance use among lesbian, gay, bisexual, and transgender adolescents. Prev Sci. 2015;16(5):734–43.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Reisner SL, et al. Gender minority social stress in adolescence: disparities in adolescent bullying and substance use by gender identity. J Sex Res. 2015;52(3):243–56.CrossRefPubMedGoogle Scholar
  44. 44.
    Marshal MP, et al. Sexual orientation and adolescent substance use: a meta-analysis and methodological review. Addiction. 2008;103(4):546–56.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Hughto JMW, Reisner SL, Packankis JE. Transgender stigma and health: A critical review of stigma determinant, mechanisms, and interventions. Soc Sci Med. 2015;147:222–31.CrossRefGoogle Scholar
  46. 46.
    Kami K, et al. Transgender patient perceptions of stigma in health care contexts. Med Care. 2013;51:819–22.CrossRefGoogle Scholar
  47. 47.
    Sevelius JM, et al. Barriers and facilitators to engagement and retention in care among transgender women living with human immunodeficiency virus. Ann Behav Med. 2014;47(1):5–16.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Garofalo R, et al. Behavioral interventions to prevent HIV transmission and acquisition for transgender women: a critical review. J Acquir Immune Defic Syndr. 2016;72(Suppl 3):S220–5.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Millett GA, et al. Common roots: a contextual review of HIV epidemics in black men who have sex with men across the African diaspora. Lancet. 2012;380(9839):411–32.CrossRefPubMedGoogle Scholar
  50. 50.
    Ransome Y, et al. Structural inequalities drive late HIV diagnosis: the role of Black racial concentration, income inequality, socioeconomic deprivation, and HIV testing. Health Place. 2016;42:148–58.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Arnold EA, Rebchook GM. ‘Triply cursed’: racism, homophobia, and HIV-related stigma are barriers to regular HIV testing, treatment adherence, and disclosure among young Black gay men. Cult Health Sex. 2014;16(4):710–22.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    MacKellar DA, et al. Unrecognized HIV infection, risk behaviors, and perceptions of risk among young men who have sex with men: opportunities for advancing HIV prevention in the third decade of HIV/AIDS. JAIDS J Acquir Immune Defic Syndr. 2005;38(5):603–14.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Kristi E. Gamarel
    • 1
    • 2
    • 3
    Email author
  • Kimberly M. Nelson
    • 3
    • 4
    • 5
  • Rob Stephenson
    • 1
    • 2
    • 6
  • Olga J. Santiago Rivera
    • 7
  • Danielle Chiaramonte
    • 7
  • Robin Lin Miller
    • 7
  • the Adolescent Medicine Trials Network for HIV/AIDS Interventions
  1. 1.Department of Health Behavior and Health EducationUniversity of Michigan School of Public HealthAnn ArborUSA
  2. 2.The Center for Sexuality and Health DisparitiesUniversity of MichiganAnn ArborUSA
  3. 3.Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceUSA
  4. 4.Centers for Behavioral and Preventative MedicineThe Miriam HospitalProvidenceUSA
  5. 5.Department of Psychiatry and Human BehaviorAlpert Medical School of Brown UniversityProvidenceUSA
  6. 6.Department of Health Behavior and Biological Sciences, School of NursingUniversity of MichiganAnn ArborUSA
  7. 7.Department of PsychologyMichigan State UniversityEast LansingUSA

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