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Background. Across settings, individuals from populations that are multiply stigmatized are at increased risk of HIV and experience worse HIV treatment outcomes. As evidence expands on how intersecting stigmatized identities and conditions influence HIV outcomes, researchers have used diverse quantitative approaches to measure HIV-related intersectional stigma and discrimination. To date, no clear consensus exists regarding how to best quantitatively measure and analyze intersectional stigma and discrimination. Objectives. To review and document existing quantitative measures of HIV-related intersectional stigma and discrimination to inform research, programmatic, and policy efforts. Search Methods. We searched 5 electronic databases for relevant studies. References of included articles were screened for possible inclusion. Additional articles were screened on the basis of consultations with experts in the field. Selection Criteria. We included peer-reviewed studies published between January 1, 2010, and May 12, 2021, that were HIV related and presented 1 or more quantitative measures of stigma and discrimination using an intersectional lens in measure design or analysis. Data Collection and Analysis. Systematic methods were used to screen citations and abstract data via a standardized coding form. Data were analyzed by coding categories stratified according to 2 subgroups: (1) studies incorporating a single intersectional measure and (2) studies that examined intersectional stigma through analytical approaches combining multiple measures. Main Results. Sixteen articles met the inclusion criteria, 7 of which explicitly referenced intersectionality. Ten studies were from the United States. All of the studies included participants living with HIV. Among the 4 studies incorporating a single intersectional stigma measure, 3 explored race and gender stigma and 1 explored gender and HIV stigma. Studies involving analytic approaches (n = 12) mostly examined intersectional stigma via interaction terms in multivariate regression models. Three studies employed structural equation modeling to examine interactive effects or latent constructs of intersectional stigma. Conclusions. Research on the measurement of HIV-related intersectional stigma and discrimination is currently concentrated in high-income settings and generally focuses on the intersection of 2 identities (e.g., race and gender). Efforts are needed to expand appropriate application of intersectionality in the development, adaptation, and use of measures of HIV-related intersectional stigma and discrimination. The use of context-, identity-, or condition-adaptable measures should be considered. Researchers should also carefully consider how to meaningfully engage communities in the process of measurement development. Public Health Implications. The measures and analytic approaches presented could significantly enhance public health efforts in assessing the impact of HIV-related intersectional stigma and discrimination on critical health outcomes. ( Am J Public Health . 2022;112(S4):S420-S432. https://doi.org/10.2105/AJPH.2021.306639).

Background: Black men who have sex with men (BMSM) remain at highest risk for HIV in the United States. Internalized HIV stigma and depression contribute to substance use and condomless anal intercourse (CAI). Religion and spirituality (R/S) are associated with decreased HIV-related risk behaviors for some groups, but their impact among BMSM is uncertain. We investigated the main and moderating roles of R/S on pathways from internalized HIV stigma to CAI while under the influence of drugs., Methods: We used baseline data from 1511 BMSM from the HIV Prevention Trials Network (HPTN) 061 study to examine the associations between internalized HIV stigma, depressive symptoms, alcohol use, and CAI while under the influence of drugs, adjusting for covariates in generalized structural equation models. We then tested whether R/S moderated the association between (1) internalized HIV stigma and depressive symptoms, (2) depressive symptoms and alcohol use, and (3) alcohol use and CAI while under the influence of drugs., Results: Spiritual beliefs [F(1,2) = 9.99, P < 0.001], spiritual activities [F(1,2) = 9.99, P < 0.001], and religious attendance [F(1,2) = 9.99, P < 0.001] moderated the pathway between internalized HIV stigma and depressive symptoms. As internalized HIV stigma increased, those with lower spiritual activity scores experienced significantly higher increases in depressive symptoms compared with those with higher spiritual activity scores whose depressive symptom scores remained unchanged [stigma × spiritual activities B = -0.18 (SE = 0.07), P < 0.001]., Conclusions: Religion and spirituality were protective against CAI among BMSM. Future intervention research should explore ways to incorporate religious and/or spiritual activities to reduce internalized HIV stigma as one way to reduce depressive symptoms among BMSM., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

The purpose of this systematic review was twofold. First, we sought to summarize the literature on barriers and facilitators to successful healthcare transition for adolescents living with HIV from low- and middle-income countries (LMICs). Next, we assessed healthcare transition-related policies in countries from which we identified barriers and facilitators to determine the extent to which practice and policy meet to address the country-specific needs of adolescents living with HIV during healthcare transition. Ten studies met inclusion criteria. We identified four sub-themes of barriers to healthcare transition: emotional and psychological burden, effects of HIV disease, logistical and systemic impediments, and HIV stigma. We also identified five sub-themes of facilitators of healthcare transition: social support, skills development for adolescents and the adult treatment team, transition readiness, multidisciplinary teams, and transition coordination. Of the 12 countries from which we identified barriers and facilitators to healthcare transition among adolescents living with HIV, only five (Uganda, Kenya, Thailand, Brazil, and Cambodia) had healthcare transition-specific guidelines. Moreover, there was substantial variation across country-specific guidelines regarding the existence of protocols to monitor and enforce guidelines, and whether there were allocated funds to assist healthcare clinics with implementation. Our review has led to several recommendations to facilitate successful healthcare transition, including the development of surveillance systems to monitor and evaluate efforts to address adolescents' needs during healthcare transition, the development of guidelines specific to healthcare transition and based upon barrier and facilitators identified within target countries, and the incorporation of caregivers and training for the adult treatment team pre- and post-healthcare transition.

Background: Pre-exposure prophylaxis (PrEP) uptake has lagged among US women. PrEP stigma is a recognized barrier to uptake among men who have sex with men but remains largely unexplored among women. This study examined the pervasiveness of PrEP stigma among US women and its implications for uptake., Setting/methods: In a 2017 online survey of Planned Parenthood patients drawn from the 3 cities with the highest numbers of new HIV infections in Connecticut, 597 heterosexually active, HIV-negative, PrEP-inexperienced women reported background characteristics, 2 dimensions of anticipated PrEP stigma (PrEP-user stereotypes and PrEP disapproval by others), and 3 indicators of potential PrEP uptake (interest in learning more about PrEP, intention to use PrEP, and comfort discussing PrEP with a provider)., Results: Participants commonly perceived PrEP-user stereotypes, with many believing that others would regard them as promiscuous (37%), HIV-positive (32%), bad (14%), or gay (11%) if they used PrEP. Thirty percent would feel ashamed to disclose PrEP use. Many participants expected disapproval by family (36%), sex partners (34%), and friends (25%). In adjusted analyses, perception of PrEP-user stereotypes was uniquely associated with less comfort discussing PrEP with a provider. Expected PrEP disapproval by others was uniquely associated with less PrEP interest, less intention to use PrEP, and less comfort discussing PrEP with a provider. Exploratory moderation analyses suggested that intention to use PrEP was greatest when participants anticipated low levels of both PrEP-user stereotypes and PrEP disapproval by others., Conclusions: Findings highlight the need for positive messaging targeting potential PrEP users and their social networks to increase PrEP acceptance and uptake.

Researchers are increasingly recognizing the importance of studying and addressing intersectional stigma within the field of HIV. Yet, researchers have, arguably, struggled to operationalize intersectional stigma. To ensure that future research and methodological innovation is guided by frameworks from which this area of inquiry has arisen, we propose a series of core elements for future HIV-related intersectional stigma research. These core elements include multidimensional, multilevel, multidirectional, and action-oriented methods that sharpen focus on, and aim to transform, interlocking and reinforcing systems of oppression. We further identify opportunities for advancing HIV-related intersectional stigma research, including reducing barriers to and strengthening investments in resources, building capacity to engage in research and implementation of interventions, and creating meaningful pathways for HIV-related intersectional stigma research to produce structural change. Ultimately, the expected payoff for incorporating these core elements is a body of HIV-related intersectional stigma research that is both better aligned with the transformative potential of intersectionality and better positioned to achieve the goals of Ending the HIV Epidemic in the United States and globally. (Am J Public Health. 2022;112(S4):S413–S419. https://doi.org/10.2105/AJPH.2021.306710) [ABSTRACT FROM AUTHOR]

The authors suggest to expand intersectional stigma to include place as a level of measurement in HIV prevention research for sexual minority men (SMM) at marginalized intersectional positions. Topics include the use of the concept of spatial stigma in multidisciplinary research, how to fully assess the role of intersectional stigma as a driver of health inequities among SMM, and objectives that must be actualized to achieve the deconstructing and uprooting systems of power and privilege.