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

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Abstract

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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References

  • Auerbach, J. D. (2004). Principles of positive prevention. Journal of Acquired Immune Deficiency Syndromes, 37(Suppl. 2), S122–S125.

    Article  PubMed  Google Scholar 

  • Bell, D. C., Montoya, I. D., Atkinson, J. S., & Yang, S. J. (2002). Social networks and forecasting the spread of HIV infection. Journal of Acquired Immune Deficiency Syndrome, 31(2), 218–229.

    Article  Google Scholar 

  • Bogart, L. M., Chetty, S., Giddy, J., Sypek, A., Sticklor, L., Walensky, R. P., … Bassett, I. V. (2013). Barriers to care among people living with HIV in South Africa: Contrasts between patient and healthcare provider perspectives. AIDS Care, 25(7), 843–853.

  • Bogart, L. M., Cowgill, B. O., Kennedy, D., Ryan, G., Murphy, D. A., Elijah, J., & Schuster, M. A. (2008). HIV-related stigma among people with HIV and their families: A qualitative analysis. AIDS and Behavior, 12(2), 244–254.

    Article  PubMed  Google Scholar 

  • Broadhead, R. S., Heckathorn, D. D., Weakliem, D. L., Anthony, D. L., Madray, H., Mills, R. J., & Hughes, J. (1998). Harnessing peer networks as an instrument for AIDS prevention: Results from a peer-driven intervention. Public Health Reports, 113(S1), 42–47.

    PubMed  PubMed Central  Google Scholar 

  • Choi, K. H., Ayala, G., Paul, J., Boylan, R., & Gregorich, S. E. (2013). Social network characteristics and HIV risk among African American, Asian/Pacific Islander, and Latino men who have sex with men. Journal of Acquired Immune Deficiency Syndromes, 64, 496–501.

    Article  PubMed  Google Scholar 

  • Cohen, M. S., Chen, Y. Q., McCauley, M., Gamble, T., & HPTN 052 Study Team. (2011). Prevention of HIV-1 infection with early antiretroviral therapy. New England Journal of Medicine, 365, 493–505.

    Article  PubMed  PubMed Central  Google Scholar 

  • Earnshaw, V. A., Bogart, L. M., Dovidio, J. F., & Williams, D. R. (2013). Stigma and racial/ethnic HIV disparities: Moving toward resilience. American Psychologist, 68(4), 225–236.

    Article  PubMed  PubMed Central  Google Scholar 

  • Emlet, C. A. (2006). An examination of the social networks and social isolation in older and younger adults living with HIV/AIDS. Health and Social Work, 31(4), 299–308.

    Article  PubMed  Google Scholar 

  • Gordon, C. M., Stall, R., & Cheever, L. W. (2004). Prevention interventions with persons living with HIV/AIDS: Challenges, progress, and research priorities. Journal of Acquired Immune Deficiency Syndrome, 37, S53–S57.

    Article  Google Scholar 

  • Gore-Felton, C., Rotheram-Borus, M. J., Weinhardt, L. S., Kelly, J. A., Lightfoot, M., Kirshenbaum, S. B., … Project Team, N. H. L. (2005). The Healthy Living Project: An individually tailored, multidimensional intervention for HIV-infected persons. AIDS Education & Prevention, 17, 21–39.

  • Gower, J. C. (1971). A general coefficient of similarity and some of its properties. Biometrics, 27, 857–871.

    Article  Google Scholar 

  • Green, H. D., Hoover, M. A., Wagner, G. J., Ryan, G. W., & Ssegujja, E. (2014). Measuring agreement between egos and alters understanding informant accuracy in personal network studies. Field Methods, 26(2), 126–140.

    Article  Google Scholar 

  • Gyarmathy, V. A., & Neaigus, A. (2009). The relationship of sexual dyad and personal network characteristics and individual attributes to unprotected sex among young injecting drug users. AIDS and Behavior, 13(2), 196–206.

    Article  PubMed  Google Scholar 

  • Hatzenbuehler, M. L., O’Cleirigh, C., Mayer, K. H., Mimiaga, M. J., & Safren, S. A. (2011). Prospective associations between HIV-related stigma, transmission risk behaviors, and adverse mental health outcomes in men who have sex with men. Annals of Behavioral Medicine, 42(2), 227–234.

    Article  PubMed  PubMed Central  Google Scholar 

  • Healthy Living Project Team. (2007). Effects of a behavioral intervention to reduce risk of transmission among people living with HIV: The healthy living project randomized controlled study. Journal of Acquired Immune Deficiency Syndromes, 44(2), 213–221.

    Article  Google Scholar 

  • Herek, G. M., Capitanio, J. P., & Widaman, K. F. (2003). Stigma, social risk, and health policy: Public attitudes toward HIV surveillance policies and the social construction of illness. Health Psychology, 22(5), 533.

    Article  PubMed  Google Scholar 

  • Janssen, R. S., Holtgrave, D. R., Valdiserri, R. O., Shepherd, M., Gayle, H. D., & De Cock, K. M. (2001). The serostatus approach to fighting the HIV epidemic: Prevention strategies for infected individuals. American Journal of Public Health, 91(7), 1019.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kalichman, S. C., Simbayi, L. C., Jooste, S., Toefy, Y., Cain, D., Cherry, C., & Kagee, A. (2005). Development of a brief scale to measure AIDS-related stigma in South Africa. AIDS and Behavior, 9(2), 135–143.

    Article  PubMed  Google Scholar 

  • Kelly, J. A. (2004). Popular opinion leaders and HIV prevention peer education: Resolving discrepant findings, and implications for the development of effective community programmes. AIDS Care, 16(2), 139–150.

    Article  PubMed  Google Scholar 

  • Latkin, C. A., Forman, V., Knowlton, A., & Sherman, S. (2003). Norms, social networks, and HIV-related risk behaviors among urban disadvantaged drug users. Social Science and Medicine, 56(3), 465–476.

    Article  PubMed  Google Scholar 

  • Liu, H., Feng, T., Liu, H., Feng, H., Cai, Y., Rhodes, A. G., & Grusky, O. (2009). Egocentric networks of Chinese men who have sex with men: Network components, condom use norms, and safer sex. AIDS Patient Care and STDs, 23(10), 885–893.

    Article  PubMed  Google Scholar 

  • Maiorana, A., Kegeles, S., Fernandez, P., Salazar, X., Caceres, C., Sandoval, C., … Coates, T. (2007). Implementation and evaluation of an HIV/STD intervention in Peru. Evaluation and Program Planning, 30(1), 82–93.

  • McCarty, C. (2002). Structure in personal networks. Journal of Social Structure, 3(1), 20–26.

    Google Scholar 

  • McCarty, C., Bernard, H. R., Killworth, P. D., Shelley, G. A., & Johnsen, E. C. (1997). Eliciting representative samples of personal networks. Social Networks, 19(4), 303–323.

    Article  Google Scholar 

  • Medley, A., Kennedy, C., O’Reilly, K., & Sweat, M. (2009). Effectiveness of peer education interventions for HIV prevention in developing countries: A systematic review and meta-analysis. AIDS Education and Prevention, 21(3), 181–206.

    Article  PubMed  PubMed Central  Google Scholar 

  • Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36, 38–56.

    Article  PubMed  Google Scholar 

  • Moskowitz, G. B. (2005). Social cognition: Understanding self and others. New York: Guilford Press.

    Google Scholar 

  • Pinel, E. C. (1999). Stigma consciousness: The psychological legacy of social stereotypes. Journal of Personality and Social Psychology, 76(1), 114.

    Article  PubMed  Google Scholar 

  • Radcliffe, J., Doty, N., Hawkins, L. A., Gaskins, C. S., Beidas, R., & Rudy, B. J. (2010). Stigma and sexual health risk in HIV-positive African American young men who have sex with men. AIDS Patient Care and STDs, 24(8), 493–499.

    Article  PubMed  Google Scholar 

  • Reece, M., Herbenick, D., Schick, V., Sanders, S. A., Dodge, B., & Fortenberry, J. D. (2010). Condom use rates in a national probability sample of males and females ages 14–94 in the United States. Journal of Sexual Medicine, 7(s5), 266–276.

    Article  PubMed  Google Scholar 

  • Tsai, A. C., Bangsberg, D. R., Kegeles, S. M., Katz, I. T., Haberer, J. E., Muzoora, C., … Weiser, S. D. (2013). Internalized stigma, social distance, and disclosure of HIV seropositivity in rural Uganda. Annals of Behavioral Medicine, 46(3), 285–294.

  • Wolitski, R. J., Pals, S. L., Kidder, D. P., Courtenay-Quirk, C., & Holtgrave, D. R. (2009). The effects of HIV stigma on health, disclosure of HIV status, and risk behavior of homeless and unstably housed persons living with HIV. AIDS and Behavior, 13(6), 1222–1232.

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was funded by National Institute of Minority Health and Health Disparities (Grant R01MD003964).

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Authors and Affiliations

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

    Glenn J. Wagner, Laura M. Bogart, David J. Klein & Harold D. Green Jr.

  2. Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, Boston, MA, USA

    Laura M. Bogart & David J. Klein

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

    Laura M. Bogart

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

    Matt G. Mutchler & Bryce McDavitt

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

    Matt G. Mutchler & Bryce McDavitt

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

    Bryce McDavitt

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

    Charles Hilliard

Authors
  1. Glenn J. Wagner
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  2. Laura M. Bogart
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  3. David J. Klein
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  4. Harold D. Green Jr.
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  5. Matt G. Mutchler
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  6. Bryce McDavitt
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  7. Charles Hilliard
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Correspondence to Glenn J. Wagner.

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Wagner, G.J., Bogart, L.M., Klein, D.J. et al. Association of Internalized and Social Network Level HIV Stigma With High-Risk Condomless Sex Among HIV-Positive African American Men. Arch Sex Behav 45, 1347–1355 (2016). https://doi.org/10.1007/s10508-015-0641-y

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  • DOI: https://doi.org/10.1007/s10508-015-0641-y

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