Journal of Behavioral Medicine

, Volume 41, Issue 4, pp 458–466 | Cite as

Experiences of stigma and health care engagement among Black MSM newly diagnosed with HIV/STI

  • Lisa A. Eaton
  • Valerie A. Earnshaw
  • Jessica L. Maksut
  • Katherine R. Thorson
  • Ryan J. Watson
  • Jose A. Bauermeister


Rates of HIV/STI transmission among Black men who have sex with men (BMSM) are alarmingly high and demand urgent public health attention. Stigma related concerns are a key barrier to accessing health care and prevention tools, yet limited research has been focused in this area. Experiences of stigma related to health care were evaluated among 151 BMSM residing in the Atlanta, GA area, both prior to and post HIV or STI diagnosis in a longitudinal study (data collected from 2014 to 2016). Findings demonstrated that inadequate health care engagement is associated with post-diagnosis anticipated stigma (b = − 0.38, SE  = 0.17 p  ≤ .05). Pre-diagnosis prejudice is a predictor of post-diagnosis enacted (b = 0.39, SE = 0.14, p < .01), anticipated (b = .28, SE = 0.14, p < .05), and internalized (b = .22, SE  = 0.06, p < .001) stigmas. This study is the first of its kind to assess experiences of stigma among BMSM during a critical time (i.e., before and after diagnosis) for HIV/STI prevention and treatment. Results provide a novel understanding of how stigma unfolds over-time and provide direction for stigma intervention development.


Stigma HIV/STI Black men who have sex with men 



This work was supported by National Institutes of Health Grants R01MH109409, R01MH094230 and R01NR013865.

Compliance with ethical standards

Conflict of interest

Lisa A. Eaton, Valerie A. Earnshaw, Jessica L. Maksut, Katherine R. Thorson, Ryan J. Watson, and Jose A. Bauermeister declare that they have no conflict of interest.

Human and animal rights and Informed consent

All procedures were in accordance with the ethical standards of the institutional research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.


  1. Alonzo, A. A., & Reynolds, N. R. (1995). Stigma, HIV and AIDS: An exploration and elaboration of a stigma trajectory. Social Science and Medicine, 41, 303–315.CrossRefPubMedGoogle Scholar
  2. Baral, S., Logie, C. H., Grosso, A., Wirtz, A. L., & Beyrer, C. (2013). Modified social ecological model: A tool to guide the assessment of the risks and risk contexts of HIV epidemics. BMC Public Health, 13, 482. CrossRefPubMedPubMedCentralGoogle Scholar
  3. Cahill, S., Taylor, S. W., Elsesser, S. A., Mena, L., Hickson, D., & Mayer, K. H. (2017). Stigma, medical mistrust, and perceived racism may affect PrEP awareness and uptake in black compared to white gay and bisexual men in Jackson, Mississippi and Boston, Massachusetts. AIDS Care, 29, 1351–1358. CrossRefPubMedPubMedCentralGoogle Scholar
  4. Calabrese, S. K., Krakower, D. S., & Mayer, K. H. (2017). Integrating HIV preexposure prophylaxis (PrEP) into routine preventive health care to avoid exacerbating disparities. American Journal of Public Health, 107, 1883–1889.CrossRefPubMedGoogle Scholar
  5. CDC. (2010). The role of STD prevention and treatment in HIV prevention. Accessed 15 Aug 2017.
  6. CDC. (2015). STD & HIV screening recommendations. Accessed 15 Aug 2017.
  7. CDC. (2016). Half of black gay men and a quarter of Latino gay men projected to be diagnosed within their lifetime. Accessed 15 Aug 2017.
  8. Cohen, M. S., Chen, Y. Q., McCauley, M., Gamble, T., Hosseinipour, M. C., Kumarasamy, N., et al. (2011). Prevention of HIV-1 infection with early antiretroviral therapy. New England Journal of Medicine, 365, 493–505. CrossRefPubMedGoogle Scholar
  9. Dowshen, N., Binns, H. J., & Garofalo, R. (2009). Experiences of HIV-related stigma among young men who have sex with men. AIDS Patient Care STDS, 23, 371–376. CrossRefPubMedPubMedCentralGoogle Scholar
  10. Earnshaw, V. A., & Chaudoir, S. R. (2009). From conceptualizing to measuring HIV stigma: A review of HIV stigma mechanism measures. AIDS and Behavior, 13, 1160–1177. CrossRefPubMedPubMedCentralGoogle Scholar
  11. Earnshaw, V. A., Smith, L. R., Chaudoir, S. R., Amico, K. R., & Copenhaver, M. M. (2013). HIV stigma mechanisms and well-being among PLWH: A test of the HIV stigma framework. AIDS and Behavior, 17, 1785–1795. CrossRefPubMedPubMedCentralGoogle Scholar
  12. Eaton, L. A., Kalichman, S. C., Kalichman, M. O., Driffin, D. D., Baldwin, R., Zohren, L., et al. (2017). Randomised controlled trial of a sexual risk reduction intervention for STI prevention among men who have sex with men in the USA. Sexually Transmitted Infections. Google Scholar
  13. Fitzmaurice, G., Laird, N., & Ware, J. (2011). Applied longitudinal analysis (2nd ed.). New Jersey: Wiley.Google Scholar
  14. Garofalo, R., Hotton, A. L., Kuhns, L. M., Gratzer, B., & Mustanski, B. (2016). Incidence of HIV infection and sexually transmitted infections and related risk factors among very young men who have sex with men. Journal of Acquired Immune Deficiency Syndromes, 72, 79–86. CrossRefPubMedGoogle Scholar
  15. Golub, S. A., & Gamarel, K. E. (2013). The impact of anticipated HIV stigma on delays in HIV testing behaviors: Findings from a community-based sample of men who have sex with men and transgender women in New York City. AIDS Patient Care STDS, 27, 621–627. CrossRefPubMedPubMedCentralGoogle Scholar
  16. Goodreau, S. M., Rosenberg, E. S., Jenness, S. M., Luisi, N., Stansfield, S. E., Millett, G. A., et al. (2017). Sources of racial disparities in HIV prevalence in men who have sex with men in Atlanta, GA, USA: A modelling study. Lancet HIV. PubMedPubMedCentralGoogle Scholar
  17. Group, I. S. S., Lundgren, J. D., Babiker, A. G., Gordin, F., Emery, S., Grund, B., et al. (2015). Initiation of antiretroviral therapy in early asymptomatic HIV infection. New England Journal of Medicine, 373, 795–807. CrossRefGoogle Scholar
  18. Holzemer, W. L., Makoae, L. N., Greeff, M., Dlamini, P. S., Kohi, T. W., Chirwa, M. L., et al. (2009). Measuring HIV stigma for PLHAs and nurses over time in five African countries. SAHARA J, 6, 76–82.CrossRefPubMedPubMedCentralGoogle Scholar
  19. Koblin, B. A., Mayer, K. H., Eshleman, S. H., Wang, L., Mannheimer, S., del Rio, C., et al. (2013). Correlates of HIV acquisition in a cohort of Black men who have sex with men in the United States: HIV prevention trials network (HPTN) 061. PLoS ONE, 8, e70413. CrossRefPubMedPubMedCentralGoogle Scholar
  20. Lifson, A. R., Grund, B., Gardner, E. M., Kaplan, R., Denning, E., & Engen, N. (2017). Improved quality of life with immediate versus deferred initiation of antiretroviral therapy in early asymptomatic HIV infection. AIDS, 31, 953–963. CrossRefPubMedPubMedCentralGoogle Scholar
  21. Link, B. G., & Phelan, J. C. (2006). Stigma and its public health implications. Lancet, 367, 528–529. CrossRefPubMedGoogle Scholar
  22. Matthews, D. D., Herrick, A. L., Coulter, R. W., Friedman, M. R., Mills, T. C., Eaton, L. A., et al. (2016). Running backwards: Consequences of current HIV incidence rates for the next generation of Black MSM in the United States. AIDS and Behavior, 20, 7–16. CrossRefPubMedPubMedCentralGoogle Scholar
  23. McNair, O. S., Gipson, J. A., Denson, D., Thompson, D. V., Sutton, M. Y., & Hickson, D. A. (2017). The associations of resilience and HIV risk behaviors among black gay, bisexual, other men who have sex with men (MSM) in the Deep South: The MARI study. AIDS and Behavior. Google Scholar
  24. Millett, G. A., Peterson, J. L., Flores, S. A., Hart, T. A., Jeffries, W. L., Wilson, P. A., et al. (2012). Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: A meta-analysis. Lancet, 380, 341–348. CrossRefPubMedGoogle Scholar
  25. Millett, G. A., Peterson, J. L., Wolitski, R. J., & Stall, R. (2006). Greater risk for HIV infection of black men who have sex with men: A critical literature review. American Journal of Public Health, 96, 1007–1019. CrossRefPubMedPubMedCentralGoogle Scholar
  26. Mugavero, M. J., Amico, K. R., Horn, T., & Thompson, M. A. (2013). The state of engagement in HIV care in the United States: From cascade to continuum to control. Clinical Infectious Diseases, 57, 1164–1171. CrossRefPubMedGoogle Scholar
  27. Nyblade, L., Stangl, A., Weiss, E., & Ashburn, K. (2009). Combating HIV stigma in health care settings: What works? Journal of the International AIDS Society, 12, 15.CrossRefPubMedPubMedCentralGoogle Scholar
  28. Quinn, K., Voisin, D. R., Bouris, A., Jaffe, K., Kuhns, L., Eavou, R., et al. (2017). Multiple dimensions of stigma and health related factors among young Black men who have sex with men. AIDS and Behavior, 21, 207–216. CrossRefPubMedPubMedCentralGoogle Scholar
  29. Scambler, G. (2009). Health-related stigma. Sociology of Health & Illness, 31, 441–455. CrossRefGoogle Scholar
  30. Sullivan, P. S., Peterson, J., Rosenberg, E. S., Kelley, C. F., Cooper, H., Vaughan, A., et al. (2014). Understanding racial HIV/STI disparities in Black and White men who have sex with men: A multilevel approach. PLoS ONE, 9, e90514. CrossRefPubMedPubMedCentralGoogle Scholar
  31. Sullivan, P. S., Rosenberg, E. S., Sanchez, T. H., Kelley, C. F., Luisi, N., Cooper, H. L., et al. (2015). Explaining racial disparities in HIV incidence in Black and White men who have sex with men in Atlanta, GA: A prospective observational cohort study. Annals of Epidemiology, 25, 445–454. CrossRefPubMedPubMedCentralGoogle Scholar
  32. Turan, B., Budhwani, H., Fazeli, P. L., Browning, W. R., Raper, J. L., Mugavero, M. J., et al. (2017a). How does stigma affect people living with HIV? The mediating roles of internalized and anticipated HIV stigma in the effects of perceived community stigma on health and psychosocial outcomes. AIDS and Behavior, 21, 283–291. CrossRefPubMedPubMedCentralGoogle Scholar
  33. Turan, B., Hatcher, A. M., Weiser, S. D., Johnson, M. O., Rice, W. S., & Turan, J. M. (2017b). Framing mechanisms linking HIV-related stigma, adherence to treatment, and health outcomes. American Journal of Public Health, 107, 863–869. CrossRefPubMedPubMedCentralGoogle Scholar
  34. Vanable, P. A., Carey, M. P., Blair, D. C., & Littlewood, R. A. (2006). Impact of HIV-related stigma on health behaviors and psychological adjustment among HIV-positive men and women. AIDS and Behavior, 10, 473–482. CrossRefPubMedPubMedCentralGoogle Scholar
  35. Villarosa, L. (2017). America’s hidden HIV epdidemic. New York Times. Accessed 10 June 2017.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Lisa A. Eaton
    • 1
  • Valerie A. Earnshaw
    • 2
  • Jessica L. Maksut
    • 1
  • Katherine R. Thorson
    • 3
  • Ryan J. Watson
    • 1
  • Jose A. Bauermeister
    • 4
  1. 1.Department of Human Development and Family Studies, Institute for Collaboration on Health, Intervention, and Policy (InCHIP)University of ConnecticutStorrsUSA
  2. 2.Department of Human Development and Family SciencesUniversity of DelawareNewarkUSA
  3. 3.Department of PsychologyNew York UniversityNew YorkUSA
  4. 4.School of NursingUniversity of PennsylvaniaPhiladelphiaUSA

Personalised recommendations