Jason D. P. Bird1, Dexter R. Voisin21 Assistant Professor in the Department of Social Work at Rutgers-   Newark, Newark, N...
“…You’re an open target for discrimination.          You’re an open target to be      abused...you’re an open target to be...
   Identified as a health crisis among African    Americans   African Americans account for nearly half of all    diagno...
   Prevention efforts are moving towards:     increased routine HIV testing     prevention interventions for HIV+ indiv...
   Grounded Theory approach – Semi-structured, one-    on-one interviews (avg. interview = 2.5hrs)   Eligible if: Previo...
 Mean age– 40 years Years positive – 9.2 years Majority of the participants identified as a sexual  minority (gay, bise...
1. Beliefs about HIV Stigma and the    Enforcement of Sexual Silence2. Transmission of HIV Information through    Sexual a...
   Multiple Sources of Stigma     Social and Ethnic Communities     Gay or Sexual Communities     Pre-HIV Personal Bel...
HIV as Punishment and Social Judgment: “…Black people see AIDS ...in a Church realm, like    you’re being punished by God....
“…I discriminated like everybody else did... thought that you   transfer the virus just by being in the same room – all th...
   Many potential consequences related to    disclosing an HIV+ status   Transmission of HIV information:     Primary c...
“…if the wrong person gets your information, you    know, they have power...They have power to wield it however they want ...
“…he got mad at me one day when he was on his binge  and I didn’t have money and put ‘Ted is HIV positive’     on white li...
What is important in deciding to Disclose?   Is it “Safe” to Tell   Controlling information   Partner assessment for tr...
Asking Probing Questions  “…you may mention...in a very...non-intrusive type of     way…"Wow, what do you think about this...
   An HIV status is a deeply private attribute   Fears about HIV stigma and the potential    transmission of HIV informa...
   Controlling to whom one discloses is seen as    both legitimate and imperative to self-    protection   These concern...
   Need to better account for the interpersonal    aspects of sexual negotiation   Focus on how individuals interpret is...
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The Impact of HIV-Stigma within Gay Communities on Disclosure to Sexual Partners for Black MSM

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The Impact of HIV-Stigma within Gay Communities on Disclosure to Sexual Partners for Black MSM

  1. 1. Jason D. P. Bird1, Dexter R. Voisin21 Assistant Professor in the Department of Social Work at Rutgers- Newark, Newark, NJ2Associate Professor at SSA, University of Chicago, Chicago IllinoisThis research was supported, in part, by Howard Brown Health Center, a grant from the Fahs-Beck Fund for Research and Experimentation, and a fellowship grant from the School of Social Service Administration at the University of Chicago.
  2. 2. “…You’re an open target for discrimination. You’re an open target to be abused...you’re an open target to be disrespected under any given point…you’re looked down upon – you’re discriminated against…there’s no support system...So if I say something – I’m gonna get talked about, I’m gonna get exiled -- that same stereotype...all those years ago, that still very much exists.” (Steve, age 51, 11yrs+)
  3. 3.  Identified as a health crisis among African Americans African Americans account for nearly half of all diagnosed cases of HIV Black MSM account for 63% of all cases of HIV infection among Black men
  4. 4.  Prevention efforts are moving towards:  increased routine HIV testing  prevention interventions for HIV+ individuals Literature is unclear about the relationship between disclosure and safer sex No established models regarding the interpersonal barriers to HIV disclosure
  5. 5.  Grounded Theory approach – Semi-structured, one- on-one interviews (avg. interview = 2.5hrs) Eligible if: Previously associated with research at Howard Brown Health Center; HIV+; African American aged 18 or older; and, reported engaging in Unprotected Anal Sex with an HIV- or unknown male sexual partner in the prior 6 months 20 HIV+, African American MSM were enrolled Data analysis based on Strauss and Corbin’s framework of Open-Coding, Axial Coding, and Selective Coding
  6. 6.  Mean age– 40 years Years positive – 9.2 years Majority of the participants identified as a sexual minority (gay, bisexual, SGL) Disclosure Patterns –  Always: 2  Never: 3  Conditional: 15
  7. 7. 1. Beliefs about HIV Stigma and the Enforcement of Sexual Silence2. Transmission of HIV Information through Sexual and Social Networks3. The Role of Trust Assessments in Sexual Relationships and Strategies for Disclosure
  8. 8.  Multiple Sources of Stigma  Social and Ethnic Communities  Gay or Sexual Communities  Pre-HIV Personal Beliefs Multiple Stigmatizing Messages  Lack of Empathy  Active Blame of people infected with HIV  Beliefs about moral failings
  9. 9. HIV as Punishment and Social Judgment: “…Black people see AIDS ...in a Church realm, like you’re being punished by God... you’ve been stricken…I really kept it hid ‘cause I didn’t want people to know.” (Tyrone, age 36, 10yrs+)Individuals as Diseased/Contagious:“…(they) consider you to be un-normal cause you’re HIV...The non AIDS people don’t like the AIDS people...because they figure they going around infecting everybody... They just feel like you’re dying...You’re going around to help people die…” (Ben, age 28, 3yrs+)
  10. 10. “…I discriminated like everybody else did... thought that you transfer the virus just by being in the same room – all the ignorant, paranoid...unsupported...thoughts that went along down the line, I was one of them people…once I found out, it was heartbreaking…All the stereotypes that were associated with HIV and AIDS were inside my head...” (Steve, age 51, 11yrs+)
  11. 11.  Many potential consequences related to disclosing an HIV+ status Transmission of HIV information:  Primary concern  Emerged from the data  Not in previous literature
  12. 12. “…if the wrong person gets your information, you know, they have power...They have power to wield it however they want to wield it, so you have to make sure that you empower yourself…I don’t wanna give that power – because to me, it’s like them having power over me…” (Jack, age 32, 10yrs+)“…really need to understand that you can’t unring a bell…You can’t un-tell someone, and you can’t control who they tell…you can’t control what someone does…It’s out there...” (David, age 23, 5yrs+)
  13. 13. “…he got mad at me one day when he was on his binge and I didn’t have money and put ‘Ted is HIV positive’ on white lined paper and hung it all over the apartment building where I was working…And I came home to find that...” (Ted, age 42, 3yrs+)
  14. 14. What is important in deciding to Disclose?  Is it “Safe” to Tell  Controlling information  Partner assessment for trust  Taking time to get to know someone
  15. 15. Asking Probing Questions “…you may mention...in a very...non-intrusive type of way…"Wow, what do you think about this whole epidemic?" or… things of that nature, and you kind of gauge their response…how he responds to that question...has a huge determining factor on if Im gonna disclose my status…” (Nick, age 27, 4yrs+)Time “…I’ve learned to have patience…because sometimes people, they know how to answer your questions right... they may have a mask on... you need to find the appropriate questions to ask...get these people to talk to you…Listen to everything…” (Jack, age 32, 10yrs+)
  16. 16.  An HIV status is a deeply private attribute Fears about HIV stigma and the potential transmission of HIV information serve as resilient barriers to disclosure Unintended consequence of stigma - facilitates silence and decreases communication
  17. 17.  Controlling to whom one discloses is seen as both legitimate and imperative to self- protection These concerns make people take a more cautious, thoughtful approach to disclosure HIV disclosure is not a simple, dichotomous choice – it is a “Conditional Process”
  18. 18.  Need to better account for the interpersonal aspects of sexual negotiation Focus on how individuals interpret issues of sexual safety and HIV transmission Interventions should emphasize the need to reduce HIV-related stigma

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