A review of research studies has identified a growing
division within gay communities, in which HIV-negative gay men associate mainly with other HIV-negative
men, and HIV-positive men mostly mix with other HIV-positive men. Moreover stigma has negative impacts on the health of both
HIV-positive and HIV-negative men, say the authors, writing in the online
edition of AIDS Care.
Stigma has been defined as ‘‘a process of devaluation of
people either living with, or associated with, HIV and AIDS’’. The majority of
the research literature on stigma deals with the attitudes of the general
population, but the authors wished to draw attention to and pull together
reports concerning the stigmatisation of HIV-positive men within communities of
They describe this literature as “fragmented and largely
anecdotal” – and call for more empirical research – but have identified
multiple references to stigma that affects gay and bisexual men.
- Seven out of ten gay male respondents to a Dutch survey had
experienced stigma on the gay scene.
- HIV-positive men perceive a ‘‘rift’’ based on HIV status
within their gay community.
- Fear of rejection by potential sexual partners is widely
reported and causes long-lasting harm to the self-confidence and self-esteem of
men with HIV.
- Older men with HIV feel particularly under-valued, believing
that they are at the “lowest rung” of the “gay social hierarchy”, resented for supposedly
being dependent on social benefits that are no longer available to younger men
- Body fat changes and other physical manifestations of HIV
and its treatment are regarded as unattractive. Men with such symptoms report a
loss of intimacy and the avoidance of particular social spaces because they
feel self-conscious or fear rejection.
- In the United States, black gay men are perceived to be at
higher risk of having HIV compared to men of other ethnicities, and are sometimes
avoided as sexual partners for that reason.
- Stigma has a considerable impact on mental and emotional
well-being, leading to anxiety, loneliness, depression, thoughts of suicide and
avoidance strategies such as social withdrawal.
- Men who only disclose their HIV-status to a limited support
network often feel socially isolated.
- Some gay men with HIV report keeping social and sexual
distance from other HIV-positive men, feeling that being associated with
HIV-positive sexual spaces (either online or offline) would compound stigma
directed against them.
- HIV-positive men who identify as ‘barebackers’ tend to
report greater stigma, gay-related stress, self-blame and substance abuse
- Men reporting discrimination from sexual partners and breaches
of confidentiality are less likely to adhere to their medication.
The authors note that stigma has negative effects on the
health of HIV-negative men too. HIV-negative men who rely on trying to avoid
sexual contact with HIV-positive men as a way of avoiding HIV infection put
themselves at risk – due to infrequent HIV testing, undiagnosed infection and non-disclosure
of HIV status. Moreover stigmatising beliefs are associated with lower rates of HIV testing
and poorer knowledge about HIV transmission.
They say that effective strategies, validated by research, to reduce stigma are
urgently needed. “Such initiatives should foster a renewed dialogue about living
with HIV as a gay man, create opportunities to share understanding and
experience among HIV positive and HIV-negative men, and aim to reunite gay
communities by reducing stigma and offering integrated medical and social