Abstract
Stigma toward same-sex behaviors may be a structural driver of HIV epidemics among men who have sex with men (MSM) in Eastern Europe and has been linked to adverse HIV-outcomes elsewhere. We explored associations between sexual behavior stigma with HIV risk behaviors, testing, treatment, and infection. From November 2017-February 2018, MSM across 27 Ukrainian cities were recruited to cross-sectional surveys using respondent driven sampling. Eligible participants were cisgender males aged ≥14 years residing in participating cities that reported ≥1 sexual contact with another man in the prior six months. Participants self-reported experience of stigma (ever) and various HIV-outcomes and were tested for HIV antibodies. Regression models were used to explore associations between three sexual behavior stigma variables with demographic and HIV-related variables. Of 5,812 recruited cisgender MSM, 5,544 (95.4%) were included. 1,663 (30.0%) MSM reported having experienced stigma due to being MSM from family and friends, 698 (12.6%) reported anticipated healthcare stigma, and 1,805 (32.6%) reported general public/social stigma due to being MSM (enacted). All forms of stigma were associated with heightened HIV risk behaviors; those experiencing stigma (vs not) had more anal sex partners in the prior month and were less likely to have used condoms during their last anal intercourse. Stigma was not associated with HIV infection, testing, or treatment variables. A sizeable proportion of Ukrainian MSM reported ever experiencing stigma due to being MSM. MSM that had experienced stigma had higher odds of HIV sexual risk behaviors. Further study using longitudinal designs is required to determine causality.
| Original language | English |
|---|---|
| Journal | AIDS and Behavior |
| Early online date | 4 Oct 2023 |
| DOIs | |
| Publication status | E-pub ahead of print - 4 Oct 2023 |
Bibliographical note
Funding Information:This data collection activity has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of Cooperative Agreement GH 12 1228-GH000840. PV and JS acknowledge funding from NIAID and NIDA (R01AI147490) and NIDA (R01DA033679 and R21DA047902). AT acknowledges funding from the Wellcome Trust (222770/Z/21/Z). JS, TS, and PV acknowledge funding from the Wellcome Trust (226619/Z/22/Z). For the purpose of Open Access, the author has applied a CC BY public copyright license to any Author Accepted Manuscript version arising from this submission.
Funding Information:
JS reports nonfinancial support from Gilead Sciences, outside the submitted work. PV reports research grants from Gilead unrelated to this work. The other authors declare no conflict of interest.
Funding Information:
We would like to thank all those who participated in or were involved with carrying out the integrated biobehavioural survey used in this study. JS and PV acknowledge support from the NIHR Health Protection Research Unit in Behavioural Science and Evaluation at Unviersity of Bristol.
Publisher Copyright:
© 2023, The Author(s).
