Faraway, so close :  HIV-related stigma among gay and other MSM  John BF de Wit, Dean A Murphy,  Simon Donohoe & Philippe ...
HIV-related stigma <ul><li>Perceived discrimination negatively affects health </li></ul><ul><ul><ul><li>Mental and physica...
HIV-Stigma Barometer Survey  <ul><li>To assess the extent to which people living with HIV in Australia experience HIV-rela...
Procedures and participants <ul><li>Online anonymous self-completion survey </li></ul><ul><ul><ul><li>1 December 2009 – 31...
Measurement of variables (1) <ul><li>HIV-related stigma: Thoughts, feelings and actions </li></ul><ul><ul><ul><li>Attribut...
Measurement of variables (2) <ul><li>Community engagement: Being and feeling connected </li></ul><ul><ul><ul><li>Gay and P...
Participant characteristics <ul><li>N=1,260 gay and other men who have sex with men </li></ul><ul><ul><ul><li>Mean age 37....
Sex, partners and relationships  <ul><li>Almost all men (95%) had sex with a man in past year </li></ul><ul><ul><ul><li>No...
Experienced and expressed stigma
Disclosure by HIV-positive men More sexual disclosure, in particular to regular partner(s), is significantly associated wi...
Stigma and partner HIV-status <ul><li>HIV-positive men </li></ul><ul><li>Experienced stigma unrelated to having HIV-negati...
Experienced HIV-related stigma <ul><li>HIV-positive men only </li></ul><ul><li>Higher when more engagement with PLHIV comm...
Expressed HIV-related stigma <ul><li>Non-positive men only </li></ul><ul><li>Lower when more engagement with gay and PLHIV...
Conclusions (1) <ul><li>HIV-related stigma is limited in this sample of gay men </li></ul><ul><li>Good correspondence betw...
Conclusions (2) <ul><li>More experienced stigma with higher PLHIV community engagement and stronger serostatus identity </...
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Faraway, so close: HIV-related stigma among gay and other men who have sex with men

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Presentation by John de Wit, from the National Centre in HIV Social Research, at the 2010 AFAO HIV Educators Conference.

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Faraway, so close: HIV-related stigma among gay and other men who have sex with men

  1. 1. Faraway, so close : HIV-related stigma among gay and other MSM John BF de Wit, Dean A Murphy, Simon Donohoe & Philippe CG Adam
  2. 2. HIV-related stigma <ul><li>Perceived discrimination negatively affects health </li></ul><ul><ul><ul><li>Mental and physical health; stress and health behaviours </li></ul></ul></ul><ul><li>HIV stigma is a major concern for affected communities </li></ul><ul><ul><ul><li>Outside but also within gay communities </li></ul></ul></ul><ul><ul><ul><li>Access to services, social support, sexual relationships </li></ul></ul></ul><ul><li>Research on HIV-related stigma is ‘patchy’ </li></ul><ul><ul><ul><li>Different ways of measuring; different actors and contexts </li></ul></ul></ul><ul><ul><ul><li>Different assessments of experienced and expressed stigma </li></ul></ul></ul><ul><li>Limited research from Australia </li></ul><ul><ul><ul><li>Informing adequate responses </li></ul></ul></ul><ul><li>Guiding principles for Barometer Survey </li></ul><ul><ul><ul><li>Conceptually comprehensive measurement </li></ul></ul></ul><ul><ul><ul><li>Comparison of expressed and experienced stigma </li></ul></ul></ul>
  3. 3. HIV-Stigma Barometer Survey <ul><li>To assess the extent to which people living with HIV in Australia experience HIV-related stigma and the extent to which people not living with HIV express HIV stigma </li></ul><ul><ul><ul><li>All PLHIV; non-HIV positive MSM </li></ul></ul></ul><ul><li>To develop and use a conceptually sound stigma assessment tool that captures key dimensions of experienced and expressed stigma </li></ul><ul><ul><ul><li>Direct comparison between experienced and expressed stigma </li></ul></ul></ul><ul><li>To explore some of the personal and social factors that may contribute to expressed HIV-related stigma </li></ul><ul><ul><ul><li>Community engagement, perceived risk of HIV transmission, serostatus identity, reliance on serostatus disclosure </li></ul></ul></ul>
  4. 4. Procedures and participants <ul><li>Online anonymous self-completion survey </li></ul><ul><ul><ul><li>1 December 2009 – 31 January 2010 </li></ul></ul></ul><ul><ul><ul><li>Ads on gaydar and facebook, and email lists of organisations </li></ul></ul></ul><ul><ul><ul><li>Netq software; secure off-site electronic storage of data </li></ul></ul></ul><ul><li>In total 1,855 click-throughs to survey website </li></ul><ul><li>Final sample only gay and other MSM (N=1,260) </li></ul>
  5. 5. Measurement of variables (1) <ul><li>HIV-related stigma: Thoughts, feelings and actions </li></ul><ul><ul><ul><li>Attributions of responsibility (6 items; e.g., blame; alpha=.88) </li></ul></ul></ul><ul><ul><ul><li>Negative emotional reactions (5 items; e.g., disgust; alpha=.84) </li></ul></ul></ul><ul><ul><ul><li>Social distancing (9 items; e.g., avoidance; alpha=.88) </li></ul></ul></ul><ul><ul><ul><li>Sexual exclusion (2 items; e.g., will not have sex; alpha=.90) </li></ul></ul></ul><ul><li>Disclosure of HIV status (HIV-positive men only) </li></ul><ul><ul><ul><li>No - all individuals in specific categories </li></ul></ul></ul><ul><ul><ul><li>Sexual disclosure: Regular partner(s), casual partners (alpha=.70) </li></ul></ul></ul><ul><ul><ul><li>Social disclosure: Family, female/straight male/gay male friends, acquaintances, neighbours, work colleagues (alpha=.86) </li></ul></ul></ul>
  6. 6. Measurement of variables (2) <ul><li>Community engagement: Being and feeling connected </li></ul><ul><ul><ul><li>Gay and PLHIV community (3 items each; alpha=.76 & .77) </li></ul></ul></ul><ul><li>Perceived risk of HIV transmission </li></ul><ul><ul><ul><li>21 practices with positive partner of unknown VL (alpha=.93) </li></ul></ul></ul><ul><li>Serostatus identity </li></ul><ul><ul><ul><li>4 items; actual, future, ideal and ought self (alpha=.94) </li></ul></ul></ul><ul><li>Reliance on disclosure: Expectations and practices </li></ul><ul><ul><ul><li>7 items (e.g., will only have sex if I know HIV status; alpha=.89) </li></ul></ul></ul>
  7. 7. Participant characteristics <ul><li>N=1,260 gay and other men who have sex with men </li></ul><ul><ul><ul><li>Mean age 37.9; 3.3% ATSI origin; 75.1% tertiary education </li></ul></ul></ul><ul><li>Jurisdiction </li></ul><ul><ul><ul><li>NSW 42.6%; Vic 20.8%; QLD 19.6% </li></ul></ul></ul><ul><ul><ul><li>SA 5.4%; ACT 2.9%; TAS 2.6%; WA 2.5%; NT 1.5% </li></ul></ul></ul><ul><li>Self-labeling </li></ul><ul><ul><ul><li>Gay 88.9%; bisexual 8.9%; queer 1.4%; other 1.4% </li></ul></ul></ul><ul><li>HIV status </li></ul><ul><ul><ul><li>HIV positive: n=214 (17.0%) </li></ul></ul></ul><ul><ul><ul><li>HIV negative: n=915 (72.6%) </li></ul></ul></ul><ul><ul><ul><li>Untested/status unknown: n=131 (10.4%) </li></ul></ul></ul>
  8. 8. Sex, partners and relationships <ul><li>Almost all men (95%) had sex with a man in past year </li></ul><ul><ul><ul><li>No significant difference by HIV status </li></ul></ul></ul><ul><li>Average of 21 male partners in past year </li></ul><ul><ul><ul><li>HIV-positive men (M=35) had more male partners than HIV-negative men (M=18) and serostatus unknown men (M=20) </li></ul></ul></ul><ul><li>Majority of men had one or more regular male partners </li></ul><ul><ul><ul><li>HIV-positive men: 64% </li></ul></ul></ul><ul><ul><ul><li>HIV-negative men: 68% </li></ul></ul></ul><ul><ul><ul><li>Serostatus unknown men: 58% </li></ul></ul></ul><ul><li>Some men had dis/noncordant regular partner(s) </li></ul><ul><ul><ul><li>HIV-positive men: 54%/15% </li></ul></ul></ul><ul><ul><ul><li>HIV-negative men: 9%/12% </li></ul></ul></ul>
  9. 9. Experienced and expressed stigma
  10. 10. Disclosure by HIV-positive men More sexual disclosure, in particular to regular partner(s), is significantly associated with more experienced stigma. Social disclosure is not significantly associated with experienced stigma.
  11. 11. Stigma and partner HIV-status <ul><li>HIV-positive men </li></ul><ul><li>Experienced stigma unrelated to having HIV-negative regular partner(s); higher when having serostatus unknown regular partner(s) </li></ul><ul><li>Experienced stigma lower with more HIV-negative casual partners and higher with more serostatus unknown casual partners </li></ul><ul><li>Non-positive men </li></ul><ul><li>Expressed stigma lower when HIV-positive regular partner(s); unrelated to number of HIV-positive casual partners </li></ul>
  12. 12. Experienced HIV-related stigma <ul><li>HIV-positive men only </li></ul><ul><li>Higher when more engagement with PLHIV community and when serostatus more important for identity </li></ul><ul><li>No association with gay community engagement, perceived transmission risk or reliance on serostatus disclosure </li></ul><ul><li>Replicated in multivariate analyses; also replicated when controlling for recruitment and biographic characteristics </li></ul><ul><li>No multivariate associations for having HIV-negative or status unknown regular or casual partners </li></ul>
  13. 13. Expressed HIV-related stigma <ul><li>Non-positive men only </li></ul><ul><li>Lower when more engagement with gay and PLHIV communities </li></ul><ul><li>Higher when more perceived transmission risk, when serostatus more important for identity and when more reliance on serostatus disclosure </li></ul><ul><li>Multivariate associations for PLHIV engagement, HIV status identity and perceived transmission risk; also when controlling for recruitment and biographic characteristics </li></ul><ul><li>No multivariate associations for having HIV-positive regular or casual partners </li></ul>
  14. 14. Conclusions (1) <ul><li>HIV-related stigma is limited in this sample of gay men </li></ul><ul><li>Good correspondence between experienced and expressed stigma </li></ul><ul><li>HIV-related stigma is highest in the sexual domain </li></ul><ul><li>Serostatus divide promoted by risk reduction strategies? </li></ul><ul><li>Among HIV-positive men more disclosure to regular partners is associated with more experienced stigma </li></ul><ul><li>Sexual rejection in particular as relationship partner? </li></ul>
  15. 15. Conclusions (2) <ul><li>More experienced stigma with higher PLHIV community engagement and stronger serostatus identity </li></ul><ul><li>Cause (vigilance) or effect (support)? </li></ul><ul><li>More expressed stigma with less PLHIV engagement, stronger serostatus identity and higher perceived sex risk </li></ul><ul><li>Stigma promotes avoidance as a simple self-protection heuristic grounded in misconceptions? </li></ul><ul><li>There are other ways to prevent HIV infection than avoiding PLHIV as sex partners </li></ul>

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