“You’re an Open Target to Be Abused”: A Qualitative Study of Stigma and HIV Self-Disclosure among Black Men Who Have Sex with Men

The HIV/AIDS epidemic is a health crisis among Black men who have sex with men (MSM). HIV-related stigma presents a primary barrier to sexual communication and effective HIV prevention. Using in-depth, qualitative interviews conducted with 20 HIV-positive Black MSM between 2007 and 2008 in Chicago, Illinois, we explored the themes related to HIV-related stigma and the underlying messages HIV-positive Black MSM receive regarding their status. Stigmatizing messages stem from family, churches, and the gay community and from negative, internalized, beliefs HIV-positive Black MSM held about infected individuals before their own infection. HIV stigma influences sexual silence around HIV disclosure, especially to sexual partners.

Black Americans, compared with Whites, are disproportionately affected by HIV, accounting for 44% versus 32% of the newly diagnosed cases in 20091,2 and comprising approximately 13% versus 65% of the US population.2,3 Furthermore, HIV is a serious health crisis among Black men who have sex with men (MSM), who represented 73% of the recorded new HIV diagnoses among Black men and 37% of new cases among MSM in 2009.1,4,5 One explanatory theory is that Black MSM are more likely than are White MSM to engage in sexual networks in which there is a higher prevalence of HIV-positive individuals,6–8 which increases the likelihood of HIV exposure. Additionally, national HIV surveillance data for the general population suggest that approximately 18% of those infected with HIV are unaware of their infection, with Black Americans less likely to know their HIV status than are Whites (19% vs 15%).9 Moreover, among MSM, studies indicate that MSM of color are less likely to know their HIV status (44% vs 54%)5 and may therefore be more likely to unknowingly transmit HIV to their sexual partners.4–6,8,10,11

Because of the high percentage of people who are unaware of their infection and persistent infection rates among MSM,1,5 prevention strategies have been shifting toward routine HIV testing12 and interventions aimed at HIV-positive individuals.13 Underlying many of these strategies is the belief that HIV is becoming less stigmatized and that infected individuals are now more likely to be out about their positive status with family, friends, and sexual partners. However, although there have been positive shifts toward reducing stigma in some medical and other health care settings, negative views of HIV-infected individuals continue to persist, especially in Black communities.14 Challenges to discussing one’s positive status arise from multiple sources, including direct and indirect experiences with HIV-related stigma and discrimination. These experiences may occur across various groups and settings (e.g., sexual networks, family, friends, churches). A better understanding of how these barriers develop and challenge HIV disclosure, especially with sexual partners, would greatly inform future HIV-prevention strategies. Consequently, we explored the beliefs about and experiences with HIV-related stigma in a cohort of HIV-positive Black MSM.

According to Goffman, stigma is a deeply discrediting attribute that marks an individual as both different and less desirable than are those without that attribute.15 Same-sex sexual activity remains highly stigmatized and strongly condemned in many Black communities in the United States. Therefore, Black HIV-positive MSM may experience a variety of stigmatizing messages from multiple sources, including community organizations, family, friends, and certain segments of the gay community.16–19 Both HIV stigma and stigma about homosexuality may increase mental and social stress and impair interpersonal interactions,16,17,20–22 creating a norm of silence around issues of sexuality and decreasing sexual communication before or during sexual encounters.6,8,19,21–25

Recent findings document that Black MSM were less likely than were their White counterparts to disclose their HIV status to sexual partners, regardless of their sexual partner’s HIV status.26 This finding may suggest that Black and White MSM experience being HIV positive differently and have varied challenges related to disclosure. For example, Wilson et al. found that gay-related stigma perpetuated through Black churches had the potential to increase silence around matters of sexuality and thereby negatively affect community response and HIV-prevention efforts for Black MSM.14 Therefore, community-based stigma related to homosexuality might be a more significant influencing factor in HIV disclosure for Black MSM than for White MSM.

We have had almost 30 years of concerted public health campaigns aimed at increasing HIV knowledge and decreasing HIV-related stigma. However, there is a dearth of recent studies on how HIV-related stigma may influence disclosure practices for Black MSM. In a qualitative study, we sought to better understand how beliefs about and experiences with HIV-related stigma among Black MSM influence HIV disclosure to sexual partners, family, and friends...

Full article at:  http://goo.gl/2PlWtv

By:  Jason D. P. Bird, PhD, MSW and Dexter R. Voisin, PhD, LCSW

Jason D. P. Bird is with the Department of Social Work, College of Arts and Sciences, Rutgers University, Newark, NJ. Dexter R. Voisin is with the School of Social Service Administration, University of Chicago, Chicago, IL, and the STI/HIV Intervention Network, Chicago.

Corresponding author.

Correspondence should be sent to Jason D. P. Bird, PhD, MSW, Rutgers-Newark, 360 Martin Luther King, Jr. Blvd., Hill Hall, Newark, NJ 07102-1801 (e-mail: ude.sregtur@drib.nosaj). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link.

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