Advertisement

AIDS and Behavior

, Volume 23, Issue 11, pp 2992–3001 | Cite as

Age, Sex, Race, Ethnicity, Sexual Orientation: Intersectionality of Marginalized-Group Identities and Enacted HIV-Related Stigma Among People Living with HIV in Florida

  • Angel B. AlgarinEmail author
  • Zhi Zhou
  • Christa L. Cook
  • Robert L. Cook
  • Gladys E. Ibañez
Original Paper

Abstract

HIV-related stigma is associated with many negative health outcomes among people living with HIV (PLHIV). The theory of intersectionality suggests that the interactions of social identities affect PLHIV’s experiences of stigma. This study aims to identify individual and interactive marginalized-group identities correlated with enacted HIV-related stigma among PLHIV in Florida. The sample (n = 932) was majority male (66.6%), Black (58.5%), and non-Latino (80.2%) with 53% reporting experiences of HIV-related stigma. In multinomial regression models, the interaction between race and ethnicity was significant where non-White Latinos had higher odds of experiencing high levels of enacted stigma [AOR (CI) 7.71 (2.41, 24.73), p < 0.001] compared to white non-Latinos. Additionally, racial minorities were less likely to have experienced moderate or high levels of enacted stigma [AOR (CI) 0.47 (0.31, 0.72), p < 0.001; AOR (CI) 0.39 (0.22, 0.70), p = 0.002, respectively]. Moreover, women had higher odds of experiencing high levels of enacted stigma [AOR (CI) 2.04 (1.13, 3.67), p = 0.018]. The results suggest that intersectionality is important to consider in HIV-related stigma research and future interventions.

Keywords

Stigma HIV/AIDS Florida Intersectionality 

Abbreviations

PLHIV

People living with HIV/AIDS

HIV

Human immunodeficiency virus

AIDS

Acquired immunodeficiency syndrome

SHARC

Southern HIV & Alcohol Research Consortium

Resumen

El estigma relacionado con el VIH se asocia con muchos resultados de salud negativos entre las personas que viven con el VIH. La teoría de la interseccionalidad sugiere que las interacciones de las identidades sociales afectan las experiencias de estigma de las personas que viven con el VIH. Este estudio tiene como objetivo identificar las identidades individuales e interactivas de grupos marginados correlacionadas con el estigma promulgado relacionado con el VIH entre las personas que viven con el VIH en Florida. La muestra (n = 932) fue mayoritariamente masculina (66.6%), negra (58.5%) y no Latina (80.2%) con 53% reportando experiencias de estigma promulgado relacionado con el VIH. En los modelos de regresión multinomial, la interacción entre raza y etnicidad fue significativa donde los Latinos no blancos tenían mayores probabilidades de experimentar altos niveles de estigma promulgado (ORa(IC) = 7.71(2.41, 24.73), p < 0.001) comparado con los blancos no Latinos. Además, las minorías raciales tenían menos probabilidades de haber experimentado niveles moderados o altos de estigma promulgado (ORa(IC) = 0.47(0.31, 0.72), p < 0.001; ORa(IC) = 0.39(0.22, 0.70), p = 0.002, respectivamente). También, las mujeres tenían mayores probabilidades de experimentar altos niveles de estigma promulgado (ORa(IC) = 2.04(1.13, 3.67), p = 0.018). Los resultados sugieren que es importante considerar la interseccionalidad en la investigación del estigma relacionado con el VIH y en futuras intervenciones.

Notes

Acknowledgements

Research reported in this publication was supported by the National Institutes of Health (NIH) under Grant Numbers U24AA020002 (PI: Cook) and U24AA020003 (PI: Cook) and a contract from the Florida Department of Health (PI: Cook). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Florida Department of Health.

Compliance with Ethical Standards

Conflict of interests

The authors have no conflict of interests to report.

References

  1. 1.
    Centers for Disease Control and Prevention. HIV surveillance report, 2017. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2017-vol-29.pdf. Accessed 15 Jan 2019.
  2. 2.
    Cloete A, Simbayi LC, Kalichman SC, Strebel A, Henda N. Stigma and discrimination experiences of HIV-positive men who have sex with men in Cape Town, South Africa. AIDS Care. 2008;20(9):1105–10.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Herek GM, Saha S, Burack J. Stigma and psychological distress in people with HIV/AIDS. Basic Appl Soc Psychol. 2013;35(1):41–54.Google Scholar
  4. 4.
    Liamputtong P, editor. Stigma, discrimination and living with HIV/AIDS: a cross-cultural perspective. New York: Springer; 2013.Google Scholar
  5. 5.
    Hatzenbuehler ML, O’cleirigh C, Mayer KH, Mimiaga MJ, Safren SA. Prospective associations between HIV-related stigma, transmission risk behaviors, and adverse mental health outcomes in men who have sex with men. Ann Behav Med. 2011;42(2):227–34.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Vanable PA, Carey MP, Blair DC, Littlewood RA. Impact of HIV-related stigma on health behaviors and psychological adjustment among HIV-positive men and women. AIDS Behav. 2006;10(5):473–82.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Varni SE, Miller CT, McCuin T, Solomon S. Disengagement and engagement coping with HIV/AIDS stigma and psychological well-being of people with HIV/AIDS. J Soc Clin Psychol. 2012;31(2):123–50.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Wohl AR, Galvan FH, Carlos JA, Myers HF, Garland W, Witt MD, Cadden J, Operskalski E, Jordan W, George S. A comparison of MSM stigma, HIV stigma and depression in HIV-positive Latino and African American men who have sex with men (MSM). AIDS Behav. 2013;17(4):1454–64.PubMedGoogle Scholar
  9. 9.
    Wolitski RJ, Pals SL, Kidder DP, Courtenay-Quirk C, Holtgrave DR. The effects of HIV stigma on health, disclosure of HIV status, and risk behavior of homeless and unstably housed persons living with HIV. AIDS Behav. 2009;13(6):1222–32.PubMedGoogle Scholar
  10. 10.
    Logie CH, Wang Y, Lacombe-Duncan A, Wagner AC, Kaida A, Conway T, Webster K, de Pokomandy A, Loutfy MR. HIV-related stigma, racial discrimination, and gender discrimination: Pathways to physical and mental health-related quality of life among a national cohort of women living with HIV. Prev Med. 2018;107:36–44.PubMedGoogle Scholar
  11. 11.
    Earnshaw VA, Lang SM, Lippitt M, Jin H, Chaudoir SR. HIV stigma and physical health symptoms: do social support, adaptive coping, and/or identity centrality act as resilience resources? AIDS Behav. 2015;19(1):41–9.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Arnold EA, Rebchook GM, Kegeles SM. ‘Triply cursed’: racism, homophobia and HIV-related stigma are barriers to regular HIV testing, treatment adherence and disclosure among young Black gay men. Cult Health Sex. 2014;16(6):710–22.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Katz IT, Ryu AE, Onuegbu AG, Psaros C, Weiser SD, Bangsberg DR, Tsai AC. Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis. J Int AIDS Soc. 2013;16:18640.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Sayles JN, Wong MD, Kinsler JJ, Martins D, Cunningham WE. The association of stigma with self-reported access to medical care and antiretroviral therapy adherence in persons living with HIV/AIDS. J Gen Intern Med. 2009;24(10):1101.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Bauman LJ, Braunstein S, Calderon Y, Chhabra R, Cutler B, Leider J, Rivera A, Sclafane J, Tsoi B, Watnick D. Barriers and facilitators of linkage to HIV primary care in New York City. J Acquir Immune Defic Syndr. 2013;64(01):S20.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Pollini RA, Blanco E, Crump C, Zúñiga ML. A community-based study of barriers to HIV care initiation. AIDS Patient Care STDs. 2011;25(10):601–9.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Florida Department of Health. HIV/AIDS surveillance program guides public health services. 2017. http://www.floridahealth.gov/diseases-and-conditions/aids/surveillance/index.html. Accessed 15 Jan 2019.
  18. 18.
    Turan B, Hatcher AM, Weiser SD, Johnson MO, Rice WS, Turan JM. Framing mechanisms linking HIV-related stigma, adherence to treatment, and health outcomes. Am J Public Health. 2017;107(6):863–9.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Lovato LV. Intersectionality of identity and HIV-related stigma. Doctoral dissertation, The University of North Carolina at Charlotte.Google Scholar
  20. 20.
    Purdie-Vaughns V, Eibach RP. Intersectional invisibility: the distinctive advantages and disadvantages of multiple subordinate-group identities. Sex Roles. 2008;59(5–6):377–91.Google Scholar
  21. 21.
    Dubrow JK. How can we account for intersectionality in quantitative analysis of survey data? Empirical illustration for Central and Eastern Europe. Res Methods. 2008;17:85–100.Google Scholar
  22. 22.
    Bowleg L. When Black + lesbian + woman ≠ Black lesbian woman: the methodological challenges of qualitative and quantitative intersectionality research. Sex Roles. 2008;59(5–6):312–25.Google Scholar
  23. 23.
    Loutfy MR, Logie CH, Zhang Y, Blitz SL, Margolese SL, Tharao WE, Rourke SB, Rueda S, Raboud JM. Gender and ethnicity differences in HIV-related stigma experienced by people living with HIV in Ontario, Canada. PLoS ONE. 2012;7(12):e48168.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Mays VM, Cochran SD. Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United States. Am J Public Health. 2001;91(11):1869–76.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Semple SJ, Strathdee SA, Zians J, Patterson TL. Factors associated with experiences of stigma in a sample of HIV-positive, methamphetamine-using men who have sex with men. Drug Alcohol Depend. 2012;125(1–2):154–9.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Young M, Stuber J, Ahern J, Galea S. Interpersonal discrimination and the health of illicit drug users. Am J Drug Alcohol Abuse. 2005;31(3):371–91.PubMedGoogle Scholar
  27. 27.
    Caiola C, Docherty S, Relf M, Barroso J. Using an intersectional approach to study the impact of social determinants of health for African-American mothers living with HIV. Adv Nurs Sci. 2014;37(4):287.Google Scholar
  28. 28.
    Collins PY, von Unger H, Armbrister A. Church ladies, good girls, and locas: stigma and the intersection of gender, ethnicity, mental illness, and sexuality in relation to HIV risk. Soc Sci Med. 2008;67(3):389–97.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Earnshaw VA, Bogart LM, Dovidio JF, Williams DR. Stigma and racial/ethnic HIV disparities: moving toward resilience. Am Psychol. 2015;68(4):60.Google Scholar
  30. 30.
    Simien EM. Doing intersectionality research: from conceptual issues to practical examples. Politics Gend. 2007;3(2):264–71.Google Scholar
  31. 31.
    Logie C, James L, Tharao W, Loutfy M. Associations between HIV-related stigma, racial discrimination, gender discrimination, and depression among HIV-positive African, Caribbean, and Black women in Ontario, Canada. AIDS Patient Care STDs. 2013;27(2):114–22.PubMedGoogle Scholar
  32. 32.
    Florida Department of Health (FDOH). State of Florida Integrated HIV Prevention and Care Plan 2017–2021; 2016. http://aidsnet.org/wp-content/uploads/2016/11/State-of-Florida-Integrated-HIV-Prevention-and-Care-Plan-09-29-16_FINAL-Combined.pdf. Accessed 15 Jan 2019.
  33. 33.
    National Institute of Health (NIH). RFA-MH-19-412: promoting reductions in intersectional StigMa (PRISM) to improve the HIV prevention continuum (R01 clinical trial optional). 2018.Google Scholar
  34. 34.
    Lucero RJ, Frimpong JA, Fehlberg EA, Bjarnadottir RI, Weaver MT, Cook C, Modave F, Rathore MH, Morano JP, Ibanez G, Cook RL. The relationship between individual characteristics and interest in using a mobile phone app for HIV self-management: observational cohort study of people living with HIV. JMIR mHealth uHealth. 2017;5(7):e100.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Sharpe JD, Zhou Z, Escobar-Viera CG, Morano JP, Lucero RJ, Ibañez GE, Hart M, Cook CL, Cook RL. Interest in using mobile technology to help self-manage alcohol use among persons living with the human immunodeficiency virus: a Florida Cohort cross-sectional study. Subst Abuse. 2018;39(1):77–82.Google Scholar
  36. 36.
    Rueda S, Mitra S, Chen S, Gogolishvili D, Globerman J, Chambers L, Wilson M, Logie CH, Shi Q, Morassaei S, Rourke SB. Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: a series of meta-analyses. BMJ Open. 2016;6(7):e011453.PubMedPubMedCentralGoogle Scholar
  37. 37.
    Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med. 1991;32(6):705–14.PubMedGoogle Scholar
  38. 38.
    Sheehan D, Trepka M, Fennie K, Prado G, Cano M, Maddox L. Black-White Latino racial disparities in HIV survival, Florida, 2000–2011. Int J Environ Res Public Health. 2016;13(1):9.Google Scholar
  39. 39.
    López G, Gonzalez-Barrera A. Afro-latino: a deeply rooted identity among US hispanics. Waxhington, DC: Pew Research Center; 2016.Google Scholar
  40. 40.
    Florida Department of Health. HIV/AIDS Epidemiologic Profile: Florida, 2017. 2018. http://www.floridahealth.gov/diseases-and-conditions/aids/surveillance/epi-profiles/index.html. Accessed 15 Jan 2019.
  41. 41.
    Cuevas AG, Dawson BA, Williams DR. Race and skin color in Latino health: an analytic review. Am J Public Health. 2016;106(12):2131–6.PubMedPubMedCentralGoogle Scholar
  42. 42.
    Garcia JA, Sanchez GR, Sanchez-Youngman S, Vargas ED, Ybarra VD. Race as lived experience: the impact of multi-dimensional measures of race/ethnicity on the self-reported health status of Latinos. Du Bois Rev. 2015;12(2):349–73.PubMedPubMedCentralGoogle Scholar
  43. 43.
    Chavez-Dueñas NY, Adames HY, Organista KC. Skin-color prejudice and within-group racial discrimination: historical and current impact on Latino/a populations. Hisp J Behav Sci. 2014;36(1):3–26.Google Scholar
  44. 44.
    Florida Department of Health. HIV prevention program launches new statewide minority media campaign. 2017. http://www.floridahealth.gov/diseases-and-conditions/aids/. Accessed 15 Jan 2019.
  45. 45.
    Kerr JC, Valois RF, DiClemente RJ, Carey MP, Stanton B, Romer D, Fletcher F, Farber N, Brown LK, Vanable PA, Salazar LF. The effects of a mass media HIV-risk reduction strategy on HIV-related stigma and knowledge among African American adolescents. AIDS Patient Care STDs. 2015;29(3):150–6.PubMedPubMedCentralGoogle Scholar
  46. 46.
    LaVeist-Ramos TA, Galarraga J, Thorpe RJ, Bell CN, Austin CJ. Are black Hispanics black or Hispanic? Exploring disparities at the intersection of race and ethnicity. J Epidemiol Community Health. 2012;66(7):e21.PubMedGoogle Scholar
  47. 47.
    Washington Post. Survey of Americans on HIV/AIDS. Kaiser family foundation. 2012. https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8334-f.pdf. Accessed 15 Jan 2019.
  48. 48.
    Darlington CK, Hutson SP. Understanding HIV-related stigma among women in the Southern United States: a literature review. AIDS Behav. 2017;21(1):12–26.PubMedGoogle Scholar
  49. 49.
    Melton ML. Sex, lies, and stereotypes: HIV positive black women’s perspectives on HIV stigma and the need for public policy as HIV/AIDS prevention intervention. Race Gend Class. 2011;18:295–313.Google Scholar
  50. 50.
    Moneyham L, Seals B, Demi A, Sowell R, Cohen L, Guillory J. Perceptions of stigma in women infected with HIV. AIDS Patient Care STDs. 1996;10(3):162–7.PubMedGoogle Scholar
  51. 51.
    Vyavaharkar MV, Moneyham L, Corwin S. Health care utilization: the experiences of rural HIV-positive African American women. J Health Care Poor Underserved. 2008;19(1):294–306.PubMedGoogle Scholar
  52. 52.
    Sengupta S, Banks B, Jonas D, Miles MS, Smith GC. HIV interventions to reduce HIV/AIDS stigma: a systematic review. AIDS Behav. 2011;15(6):1075–87.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of EpidemiologyFlorida International UniversityMiamiUSA
  2. 2.Department of EpidemiologyUniversity of FloridaGainesvilleUSA
  3. 3.College of NursingUniversity of Central FloridaOrlandoUSA

Personalised recommendations