Stigma as an impediment to access and uptake of HIV prevention services: A global survey of men who have sex with men

Background: Public health and advocacy organizations have called for heightened prevention and treatment efforts targeting MSM around the globe. As new prevention technologies are rolled out, it is important to examine access to existing prevention services among MSM. This study sought to examine the relationship between perceived stigma and access to HIV prevention among MSM.

Methods: In 2010 the Global Forum on MSM & HIV (MSMGF) conducted an online survey of 5,066 MSM and their providers. Surveys were completed in five languages and respondents were represented from diverse countries in the global north and south. Respondents were assessed on perceived stigma/external homophobia, internalized homophobia, and access to/uptake of HIV prevention strategies. Regression analysis was performed to examine relationships among variables.

Results: Access to basic HIV prevention services—including free condoms, water-based lubricants, and HIV behavioral and education interventions—is not widespread among MSM. External and internalized stigma independently predicted lower access to basic and emerging HIV prevention strategies. Stigma accounted for 21% and 10% of the variation in access to HIV prevention and uptake of prevention services, respectively. Regional variation in levels of perceived stigma was observed, with the highest levels documented by participants from Africa, the Middle East, and Asia.

Conclusions: Findings highlight the important roles that external and internalized stigma play in impeding HIV prevention efforts targeting MSM. Stigma surrounding homosexuality must be addressed in order to promote unfettered access to HIV prevention services that can increase the health of communities of MSM worldwide.