Publisher Correction To: Disclosure of same-sex practices and experiences of healthcare stigma among cisgender men who have sex with men in five sub-Saharan African countries

An amendment to this paper has been published and can be accessed via the original article

Disclosure of same-sex practices and experiences of healthcare stigma among cisgender men who have sex with men in five sub-Saharan African countries

Background For men who have sex with men (MSM) across sub-Saharan Africa (SSA), disclosure of same-sex practices to family and healthcare workers (HCWs) can facilitate access to HIV prevention services and support, but can also lead to experiences of stigma. Methods We performed mixed-effects regressions on pooled data from MSM in Cameroon, Senegal, Côte d’Ivoire, Lesotho, and eSwatini to assess associations between disclosure and sexual behavior stigma in healthcare contexts; we used logistic regressions to analyze country-specific data. Results Compared to participants who had not disclosed to either family or HCWs, those who had disclosed only to family were more likely to have been gossiped about by HCWs (aOR = 1.70, CI = 1.18, 2.45); the association between having disclosed to family and having felt mistreated in a health center approached, but did not achieve, statistical significance (aOR = 1.56, CI = 0.94, 2.59). Those who had disclosed only to HCWs were more likely to have feared to seek health services (aOR = 1.60, CI = 1.14, 2.25), avoided health services (aOR = 1.74, CI = 1.22, 2.50), and felt mistreated in a health center (aOR = 2.62, CI = 1.43, 4.81). Those who had disclosed to both were more likely to have feared to seek health services (aOR = 1.71, CI = 1.16, 2.52), avoided health services (aOR = 1.59, CI = 1.04, 2.42), been gossiped about by HCWs (aOR = 3.78, CI = 2.38, 5.99), and felt mistreated in a health center (aOR = 3.39, CI = 1.86, 6.20). Country-specific analyses suggested that data from Cameroon drove several of these associations. Conclusions Research to determine the factors driving disclosure’s differential effect on healthcare stigma across contexts is needed. Ultimately, supportive environments enabling safe disclosure is critical to understanding HIV-acquisition risks and informing differentiated HIV-prevention, treatment, and testing services for MSM across SSA

Predicting salivary cortisol and sexual behavior stigma among MSM in the American Men’s Internet Survey 2019

Abstract Physiological stress levels in response to sexual behavior stigma among men who have sex with men (MSM) in the United States (US) are understudied. The current study aims to explore the relationship between sexual behavior stigma and salivary cortisol both overall and stratified by race/ethnicity. If such an association exists, it may suggest that sexual behavior stigma can be physiologically measured or indicated by the presence of heightened salivary cortisol. A subsample of 667 MSM participants from the 2019 American Men’s Internet Survey (AMIS; N = 10,129) submitted morning (AM) and evening (PM) saliva cortisol samples using at-home mail-in collection kits. Average daily cortisol and daily cortisol change were calculated; simple linear regressions estimated associations between cortisol measures and sexual behavior stigma characterized in four different ways (ever and recent experience of individual stigma items; average ever and recent experience of three stigma scales: stigma from family and friends, anticipated healthcare stigma, general social stigma). Participants reported a mean age of 36.0 years (SD = 14.9), with most being non-Hispanic white (n = 480, 72.0%), Hispanic (n = 164, 12.3%), or Black/African American (n = 146, 10.9%), and identified as homosexual/gay (n = 562, 84.3%). Reporting ever experiencing healthcare providers gossiping was significantly associated with higher PM cortisol (β = 0.12, p = 0.001) and higher average daily cortisol (β = 0.11, p = 0.004), while reporting ever experiencing police refusing to protect was associated with higher AM cortisol (β = 0.08, p = 0.03) and higher average daily cortisol (β = 0.09, p = 0.02). Recent experiences of stigma were not significant predictors of any measure of cortisol. Measures of salivary cortisol may be used to characterize sexual behavior stigma among MSM populations, however more insight is needed to determine its exact relationship and strength

Characterizing Metrics of Sexual Behavior Stigmas Among Cisgender Men Who Have Sex with Men in Nine Cities Across the United States.

Men who have sex with men (MSM) in the United States (US) are stigmatized for same-sex practices, which can lead to risky sexual behavior, potentiating risk for HIV infection. Improved measurement is necessary for accurately reporting and mitigating sexual behavior stigma. We added 13 sexual behavior stigma items to the local surveys of 9 sites of the Centers for Disease Control and Prevention 2017 National HIV Behavioral Surveillance system, which used venue-based, time-sampling procedures to survey cisgender MSM in US metropolitan statistical areas. We performed exploratory factor analytic procedures on site-specific (Baltimore, Maryland; Denver, Colorado; Detroit, Michigan; Houston, Texas; Nassau-Suffolk, New York; Portland, Oregon; Los Angeles, California; San Diego, California; Virginia Beach-Norfolk, Virginia) and pooled responses to the items. A three-factor solution - stigma from family (α = 0.70), anticipated health-care stigma (α = 0.75), general social stigma (α = 0.66) - best fit the pooled data and was the best-fitting solution across sites. Findings demonstrate that MSM across the US experience sexual behavior stigma similarly. The results reflect the programmatic utility of enhanced stigma measurement, including tracking stigma trends over time, making regional comparisons of stigma burden, and supporting evaluation of stigma-mitigation interventions among MSM across the US

Additional file 3 of Associations between HIV testing and multilevel stigmas among gay men and other men who have sex with men in nine urban centers across the United States

Additional file 3: Appendix 3 Figure. Conceptual diagram of multivariable generalized hierarchical linear model combining individual and site factors

Additional file 1 of Associations between HIV testing and multilevel stigmas among gay men and other men who have sex with men in nine urban centers across the United States

Additional file 1: Appendix Table 1. Sexual behavior stigma scale items and responses by associated factors

Additional file 2 of Associations between HIV testing and multilevel stigmas among gay men and other men who have sex with men in nine urban centers across the United States

Additional file 2: Appendix Table 2. HIV-specific criminalization laws – National HIV Behavioral Surveillance, 9 U.S. sites, 2017