Abstract
Gay, bisexual, and other men who have sex with men (MSM) experience alarming HIV disparities alongside sub-optimal engagement in HIV interventions. Among MSM, stigma toward anal sexuality could interfere with engagement in HIV prevention, yet few studies have examined MSM perspectives on anal sex stigma or its health-related sequelae. Guided by theory, we aimed to characterize anal sex stigma, related sexual concerns, and barriers to health seeking, like concealment. We elicited community input by purposively interviewing 10 experts in MSM health and then 25 racially, ethnically, and geographically diverse cisgender MSM. Participants reported experienced, internalized, and anticipated forms of anal sex stigma that inhibited health seeking. Experienced stigma, including direct and observed experiences as well as the absence of sex education and information, contributed to internalized stigma and anticipation of future devaluation. This process produced psychological discomfort and concealment of health-related aspects of anal sexuality, even from potentially supportive sexual partners, social contacts, and health workers. Participants characterized stigma and discomfort with disclosure as normative, pervasive, and detrimental influences on health-seeking behavior both during sex and within healthcare interactions. Omission of information appears to be a particularly salient determinant of sexual behavior, inhibiting prevention of harm, like pain, and leading to adverse health outcomes. The development of measures of anal sex stigma and related sexual concerns, and testing their impact on comfort with disclosure, sexual practices, and engagement in health services could identify modifiable social pathways that contribute to health disparities among MSM, like those seen in the HIV epidemic.
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Acknowledgements
We are grateful to key informants and participants for their willingness to share their experiences and to colleagues in HIV services for their dedication to the mitigation of health disparities and, in this particular study, their essential contributions to recruitment of men of color. We thank the first author’s dissertation committee members Drs. Kevin King, Shannon Dorsey, and Steven Goodreau as well as research consultants Drs. B. R. Simon Rosser and Stefan Baral. We would also like to thank those who aided in project conception and implementation at the University of Washington, including Megan Ramaiya, Kira Brist, and Santino Camacho and Drs. Kimberly Nelson and Joyce Yang. Thanks to Dr. Susie Hoffman for extensive comments on earlier drafts of the manuscript. This research project was supported by the National Institutes of Health (T32AI07140, PI: Sheila Lukehart, Ph.D.; T32MH019139, PI: Theodorus Sandfort, Ph.D.; and P30MH43520, PI: Robert Remien, Ph.D.) and the Bolles Graduate Fellowship through the Department of Psychology at the University of Washington.
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Kutner, B.A., Simoni, J.M., Aunon, F.M. et al. How Stigma Toward Anal Sexuality Promotes Concealment and Impedes Health-Seeking Behavior in the U.S. Among Cisgender Men Who Have Sex with Men. Arch Sex Behav 50, 1651–1663 (2021). https://doi.org/10.1007/s10508-019-01595-9
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DOI: https://doi.org/10.1007/s10508-019-01595-9