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Despite advances in HIV prevention and treatment, stigma remains an unleveraged and pervasive barrier to ending the epidemic. Stigma directly affects the use of HIV prevention methods and medication adherence. The southern US is particularly vulnerable to these issues. Black and Latin same-gender loving men (SGLM) are disproportionately affected by the epidemic because they often experience stigmas based on sexual orientation, racism, and other social determinants of health. Therefore, the purpose of this study is to contextualize the experiences of intersectional stigma and its outcomes to inform the cultural adaptation of a stigma-reduction intervention.
Methods
Using interpretive phenomenology, we aimed to catalog and contextualize the experiences of intersectional stigma, reactions to stigma, and ways to address stigma as outlined by young Black and Latin SGLM living in Central Florida. In-depth interviews were conducted with 7 participants (4 cis men, two cis men living with HIV, and one trans woman formally identifying as a same-gender loving man). Data were analyzed using interpretive phenomenological analysis that allows for an idiographic assessment of each relevant case and provides a rich and nuanced understanding of the lived experiences of the key population.
Results
Findings were organized into three themes (a) experiences of stigma, (b) reactions to stigma, and (c) community needs. As expected, participants experienced both public and internalized stigma; however, internalized may have a more direct connection to participants’ health behaviors and decision-making. Public stigma was seen at the systemic and interpersonal levels – wherein stigmatization within the family unit was particularly nuanced and prevalent. It was common for participants to experience family acceptance for some aspects of their identity (i.e., race/ethnicity) while experiencing rejection for other parts (i.e., sexual orientation and gender identity). Participants reported various immediate responses to stigma, including physiological and emotional reactions. Repeated exposure to stigma often resulted in identity conflict, namely when it occurred within their social networks (families, churches rather than workplaces). Other responses to stigma included long-term resilience and long-term disempowerment. Finally, participants reported their need for individual skill development in self-advocacy and other strategies for immediate response as well as community and systemic changes through policies.
Implications and Conclusions
Our findings highlight the need to address stigma from a two-pronged approach. While systemic change is critical for large-scale change, interventions focused on skill development to reduce internalized stigma and increase self-advocacy and resilience are warranted. Findings are being used to adapt an HIV stigma reduction intervention to one that reduces intersectional stigma (at the interpersonal and individual level) and increases resilience among young Black and Latin SGLM.