Association of Internalized and Social Network Level HIV Stigma with High-Risk Condomless Sex among HIV-Positive African American Men

We examined whether internalized HIV stigma and perceived HIV stigma from social network members (alters), including the most popular and most similar alter, predicted condomless intercourse with negative or unknown HIV status partners among 125 African American HIV-positive men. 

In a prospective, observational study, participants were administered surveys at baseline and months 6 and 12, with measures including sexual behavior, internalized HIV stigma, and an egocentric social network assessment that included several measures of perceived HIV stigma among alters. 

In longitudinal multivariable models comparing the relative predictive value of internalized stigma versus various measures of alter stigma, significant predictors of having had condomless intercourse included greater internalized HIV stigma (in all models), the perception that a popular (well-connected) alter or alter most like the participant agrees with an HIV stigma belief, and the interaction of network density with having any alter that agrees with a stigma belief. 

The interaction indicated that the protective effect of greater density (connectedness between alters) in terms of reduced risk behavior dissipated in the presence of perceived alter stigma. 

These findings call for interventions that help people living with HIV to cope with their diagnosis and reduce stigma, and inform the targets of social network-based and peer-driven HIV prevention interventions.

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By:   Wagner GJ¹, Bogart LM^2,3,4, Klein DJ^2,3, Green HD Jr², Mutchler MG^5,6, McDavitt B^5,6,7, Hilliard C⁸.

¹Health Unit, RAND Corporation (http://www.rand.org/health.html), 1776 Main St., Santa Monica, CA, 90407, USA. gwagner@rand.org.

²Health Unit, RAND Corporation, 1776 Main St., Santa Monica, CA, 90407, USA.

³Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, MA, USA.

⁴Department of Pediatrics, Harvard Medical School, Boston, MA, USA.

⁵Department of Sociology, California State University, Dominguez Hills, Carson, CA, USA.

⁶Community-Based Research, AIDS Project Los Angeles, Los Angeles, CA, USA.

⁷Clinical Psychology, Pacifica Graduate Institute, Carpinteria, CA, USA.

⁸Department of Psychiatry & Human Behavior, Charles Drew University of Medicine and Science, Los Angeles, CA, USA.

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