(see Poster Gallery) The Intersecting Self-Stigma of Young Chinese Men Who Have Sex with Men Living with HIV/AIDS

Background and purpose: Community participation is vital for the recovery and empowerment of men who have sex with men (MSM) living with HIV. Intersectionality also provides an important lens that inequalities operate in an intersectional manner and pose compound challenges to the lives of minority individuals. However, the association between intersecting stigma towards HIV-positive MSM and their community participation has been underexplored. This study aims to investigate the associations among perceived stigma against sexual minorities and people living with HIV/AIDS (PLWHA), HIV/AIDS self-stigma, and HIV/AIDS community participation. The indirect effect of self-stigma and the statistical interaction between perceived homosexual stigma and perceived HIV/AIDS stigma were further examined.

Methods: The study drew on a sample of young Chinese MSM living with HIV/AIDS from a large community-based online survey that recruited respondents using non-probability purposive sampling (n = 1,004). The mean age of the sample was 25.21 years (SD = 3.18), and nearly 80% had a bachelor or higher degree. Over 65% were in full- or part-time employment. The average length of HIV diagnosis was 2.83 years (SD = 2.45). Most respondents had undergone antiretroviral treatment. Structural equation modeling was performed to investigate the associations among perceived stigma against sexual minorities and people living with HIV, HIV-related self-stigma, and HIV/AIDS community participation. The indirect effect of self-stigma and the statistical interaction between perceived homosexual stigma and perceived HIV/AIDS stigma were further examined.

Results: Results show that total direct effect was significant (B(SE)=0.859 (0.233); 95% CI=0.402, 1.316). Perceived HIV/AIDS stigma was positively correlated with HIV/AIDS community participation, while HIV/AIDS self-stigma was negatively correlated. The mediating role of HIV/AIDS self-stigma was significant in both types of perceived stigma (total indirect effect: B(SE)=– 0.935 (0.175); 95% CI=– 1.277, – 0.593). The interaction effect was also significant and negative (B(SE)=– 0.117 (0.056), p < .001), showing that perceived homosexual stigma could offset the effect of perceived HIV/AIDS stigma on HIV/AIDS self-stigma.

Conclusions and Implications: The findings indicate how intersecting stigma impacts on self-stigma of young Chinese MSM living with HIV/AIDS. In terms of theoretical contributions, this study enriches the psychological mediation framework by revealing that public stigma could hinder stigmatized individuals’ community engagement as well as causing psychopathological outcomes. The study findings also resonate with intersectionality theory insofar as the multiple forms of stigma simultaneously contribute to stigma internalization among MSM living with HIV. This study makes policy implications for improving community health and well-being among PLWHA. Meanwhile, it identifies a pressing need to eliminate the intersecting stigma that HIV-positive MSM may confront and internalize. Moreover, the study also advocates the non-government organizations to strengthen community building and encourage PLWHA to engage in their services and activities.