HIV stigma divides and fragments gay communities

A review of research studies has identified a growing division within gay communities, in which HIV-negative gay men associate mainly with other HIV-negative men, and HIV-positive men mostly mix with other HIV-positive men. Moreover stigma has negative impacts on the health of both HIV-positive and HIV-negative men, say the authors, writing in the online edition of AIDS Care.

Stigma has been defined as ‘‘a process of devaluation of people either living with, or associated with, HIV and AIDS’’. The majority of the research literature on stigma deals with the attitudes of the general population, but the authors wished to draw attention to and pull together reports concerning the stigmatisation of HIV-positive men within communities of gay men.

They describe this literature as “fragmented and largely anecdotal” – and call for more empirical research – but have identified multiple references to stigma that affects gay and bisexual men.

• Seven out of ten gay male respondents to a Dutch survey had experienced stigma on the gay scene.
• HIV-positive men perceive a ‘‘rift’’ based on HIV status within their gay community.
• Fear of rejection by potential sexual partners is widely reported and causes long-lasting harm to the self-confidence and self-esteem of men with HIV.
• Older men with HIV feel particularly under-valued, believing that they are at the “lowest rung” of the “gay social hierarchy”, resented for supposedly being dependent on social benefits that are no longer available to younger men with HIV.
• Body fat changes and other physical manifestations of HIV and its treatment are regarded as unattractive. Men with such symptoms report a loss of intimacy and the avoidance of particular social spaces because they feel self-conscious or fear rejection.
• In the United States, black gay men are perceived to be at higher risk of having HIV compared to men of other ethnicities, and are sometimes avoided as sexual partners for that reason.
• Stigma has a considerable impact on mental and emotional well-being, leading to anxiety, loneliness, depression, thoughts of suicide and avoidance strategies such as social withdrawal.
• Men who only disclose their HIV-status to a limited support network often feel socially isolated.
• Some gay men with HIV report keeping social and sexual distance from other HIV-positive men, feeling that being associated with HIV-positive sexual spaces (either online or offline) would compound stigma directed against them.
• HIV-positive men who identify as ‘barebackers’ tend to report greater stigma, gay-related stress, self-blame and substance abuse coping.
• Men reporting discrimination from sexual partners and breaches of confidentiality are less likely to adhere to their medication.

The authors note that stigma has negative effects on the health of HIV-negative men too. HIV-negative men who rely on trying to avoid sexual contact with HIV-positive men as a way of avoiding HIV infection put themselves at risk – due to infrequent HIV testing, undiagnosed infection and non-disclosure of HIV status. Moreover stigmatising beliefs are associated with lower rates of HIV testing and poorer knowledge about HIV transmission.

They say that effective strategies, validated by research, to reduce stigma are urgently needed. “Such initiatives should foster a renewed dialogue about living with HIV as a gay man, create opportunities to share understanding and experience among HIV positive and HIV-negative men, and aim to reunite gay communities by reducing stigma and offering integrated medical and social support.”