HIV-Related Stigma and HIV Prevention Uptake Among Men Who Have Sex with Men in Taiwan

Background:

HIV-related stigma encompasses a number of social and cultural phenomena, which function at the “intersection of culture, power, and difference” (Parker & Aggleton, 2003), and has been identified as a barrier to accessing HIV prevention, care, and treatment services for men who have sex with men (MSM). Previous studies have indicated that experiencing HIV-related stigma was associated with psychological distress and sexual risk behaviors among MSM, such as having condomless anal sex with partners of unknown HIV status (Hatzenbuehler et al. 2011). As a pervasive structural factor, however, little is known about the association between HIV-related stigma and HIV prevention uptake, such as condom use and rectal microbicide acceptability, among MSM in Taiwan. The present study hypothesized that a higher degree of HIV-related stigma is negatively correlated with HIV prevention uptake among MSM.

Methods:

From July-August 2014, we conducted a cross-sectional, self-administered paper-and-pencil (30-minute) survey among a convenience sample of MSM recruited from two LGBTQ community-based organizations in Taipei and Taichung, Taiwan. Survey items included HIV-related stigma, socio-demographic characteristics (age, educational attainment, employment status, and monthly income), number of sex partners, and two HIV prevention uptake outcome variables (condom use and rectal microbicide acceptability). Two multivariable logistic regression models were  built to assess the association between HIV-related stigma and two HIV prevention uptake strategies, adjusting for socio-demographic characteristics.

Results:

Participants’ (n=200) mean age was 27.6 years; 67% had a college degree or more. More than half of participants had a full-time job (57.5%) and had a monthly income less than < 30,000 TWD ($893 USD)(62.5%). The mean number of male sex partners in the past 3 months was 2.5. Nearly two-third (68.0%) reported consistent condom use. The majority (80.5%) would accept rectal microbicide if it became available in the future. The mean scores for HIV-related stigma was 1.55 (SD = 0.61, range = 0-3). In the multivariable logistic regression models, MSM who were older (AOR = 1.06, 95% CI = 1.00-1.12), had more male sex partners (AOR = 2.35, 95% CI = 1.22–4.51) and had a greater HIV-related stigma (AOR=0.50, 95% CI=0.29–0.85) had lower odds of consistent condom use (AOR=0.50, 95% CI=0.29–0.85). MSM who had greater HIV-related stigma had lower odds of rectal microbicide acceptability (AOR=0.53, 95% CI=0.29–0.96).

Conclusions:

Our findings suggest that HIV-related stigma remains a challenge to HIV prevention among MSM in Taiwan. Most MSM were aware of condom use and would accept rectal microbicide if it became available; however, experiencing HIV-related stigma may increase risk for sexual transmission risk behaviours and prevent accessing preventive technologies. These results may have implications for social work practice and future research among MSM in Taiwan: (1) In order to increase HIV prevention uptake, HIV stigma reduction programs targeting MSM should address HIV-related stigma as a correlate of structural barriers to accessing HIV prevention tools; (2) Future research should consider unpacking HIV-related stigma and searching for other factors that contribute to or counteract HIV prevention uptake for the MSM communities in Taiwan.