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HIV and Sexuality Stigma Reduction Through Engagement in Online Forums: Results from the HealthMPowerment Intervention

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Abstract

HIV and sexuality stigma impede HIV prevention and care efforts. HealthMpowerment.org (HMP) is an interactive mobile phone- and web-based HIV prevention and care intervention for young Black men who have sex with men (YBMSM; ages 18–30) in the United States. HMP included three forums where participants could share their experiences. In this study, we explored whether engaging in stigma-related discussions was associated with changes in YBMSM’s stigma-related scores throughout the trial. YBMSM (ages 18–30; N = 238) participating in HMP completed surveys at baseline, and 3 and 6 month follow-ups that included a series of scales focused on HIV and sexuality (internalized homophobia; sexual prejudice) stigma. Sixty-two participants contributed to the forums (1497 posts). We coded instances where YBMSM’s conversations were stigma related (915 posts, 61.1%), including discussions of anticipated (74/915, 8.1%), experienced (125/915, 13.7%), internalized (410/915, 44.8%), and/or challenged (639/915, 69.8%) stigma regarding sexuality and HIV. Using a mixed methods approach, we examined whether changes in YBMSM’s stigma scores were associated with stigma-related discussions within the forum. We controlled for age, HIV status, income, and educational attainment in these multivariable models. YBMSM who discussed experiencing HIV stigma in the forums reported decreases in perceived HIV stigma over time (b = − 0.37, p ≤ 0.05). YBMSM whose forum posts indicated anticipated HIV stigma reported increases in HIV stigma over time (b = 0.46, p ≤ 0.01). Participants who challenged sexuality-related stigma in forums had lower internalized homophobia (b = − 0.68, p ≤ 0.01) at baseline. YBMSM whose discussions focused on experiencing sexuality-related stigma reported increases in internalized homophobia (b = 0.39, p ≤ 0.01) and sexual prejudice (b = 0.87, p ≤ 0.05) over time. Developing strategies to combat stigma remains a key priority. HMP created an online space where YBMSM could discuss HIV and sexuality stigma. Although a limited number of HMP participants authored the majority of these forum discussions, the discussions were associated with changes in the sample’s stigma scores over time. Online interventions (e.g., social media, apps) should consider the inclusion of forums to address stigma and test the efficacy of forums to improve YBMSM’s HIV prevention and care continuum outcomes.

Resumen

El estigma atribuido al VIH y a la sexualidad obstaculizan los esfuerzos de prevención y manejo del VIH. HealthMpowerment.org (HMP) es una intervención interactiva y en línea enfocada en la prevención y manejo del VIH para jóvenes negros que tienen relaciones sexuales con otros hombres (YBMSM, entre 18 y 30 años) en los Estados Unidos. HMP incluyó tres foros donde los participantes pudieron compartir sus experiencias. En este estudio, exploramos si la participación de YBMSM en discusiones relacionadas con el estigma estuvo asociado con cambios en los puntajes relacionados con el estigma a lo largo del estudio. YBMSM (edades 18–30; N = 238) que participaron en HMP completaron encuestas al inicio del estudio y en seguimientos a los tres y seis meses. Las encuestas incluyeron una serie de escalas enfocadas en el estigma de VIH y la sexualidad (homofobia internalizada, prejuicio sexual). Sesenta y dos participantes contribuyeron a los foros (1497 publicaciones). Codificamos instancias donde las conversaciones entre YBMSM estaban relacionadas con el estigma (915 publicaciones, 61.1%), incluyendo discusiones de estigma anticipado (74/915, 8.1%), experiencial (125/915, 13.7%), internalizado (410/915, 44.8%), y/o impugnado (639/915, 69.8%). Usando un enfoque de métodos mixtos, examinamos si los cambios en los puntajes de estigma de YBMSM se asociaron con las discusiones relacionadas con el estigma dentro de los foros. Controlamos por la edad, el estado de VIH, los ingresos y el logro educativo de los participantes en estos modelos multivariables. Los YBMSM que discutieron experiencias de estigma relacionada con el VIH en los foros reportaron disminuciones en el estigma del VIH percibido a través del tiempo (b = − 0.37, p ≤ 0.05). YBMSM cuyas publicaciones en los foros indicaron temáticas de estigma anticipado acerca del VIH tuvieron aumentos en el estigma del VIH a lo largo del tiempo (b = 0.46, p ≤ 0.01). Los participantes que desafiaron el estigma relacionado con la sexualidad en los foros reportaron menor puntaje de homofobia internaliza (b = − 0.68, p ≤ 0.01) al inicio del estudio. YBMSM cuyas discusiones se centraron en experiencias del estigma relacionado con la sexualidad informaron aumentos en la homofobia internalizada (b = 0.39, p ≤ 0.01) y prejuicio sexual (b = 0.87, p ≤ 0.05) a través del tiempo. El desarrollo de estrategias para combatir el estigma sigue siendo una prioridad clave. HMP creó un espacio en línea donde YBMSM pudieron hablar sobre el VIH y el estigma sexual. Aunque un número limitado de participantes de HMP redactó la mayoría de estas discusiones en el foro, las discusiones se asociaron con cambios a lo largo del tiempo en los puntajes de estigma de la muestra. Las intervenciones en línea (por ejemplo, redes sociales, aplicaciones) deben considerar la inclusión de foros para abordar el estigma y evaluar la eficacia de los foros para mejorar la prevención y manejo del VIH entre YBMSM.

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Acknowledgements

We greatly appreciate the hard work of the study staff and are indebted to the study participants for volunteering their time.

Funding

This research was sponsored by the US National Institutes of Health (NIH), under R21 MH105292 (Muessig & Bauermeister) and R01 MH093275 (Hightow-Weidman), and a Center for AIDS Research award from the National Institute of Allergy and Infectious Diseases (Grant No. P30 AI 045008). The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH.

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Authors and Affiliations

  1. University of Pennsylvania, 418 Curie Blvd, Suite 222L, Philadelphia, PA, 19104, USA

    J. A. Bauermeister & D. D. Flores

  2. University of North Carolina, Chapel Hill, NC, USA

    K. E. Muessig, S. K. Choi, W. Dong & L. B. Hightow-Weidman

  3. Duke University, Durham, NC, USA

    S. LeGrand

  4. University of Michigan, Ann Arbor, MI, USA

    G. Sallabank

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  1. J. A. Bauermeister
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  8. L. B. Hightow-Weidman
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Correspondence to J. A. Bauermeister.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Bauermeister, J.A., Muessig, K.E., LeGrand, S. et al. HIV and Sexuality Stigma Reduction Through Engagement in Online Forums: Results from the HealthMPowerment Intervention. AIDS Behav 23, 742–752 (2019). https://doi.org/10.1007/s10461-018-2256-5

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