This application is being submitted in response to RFA-MH-14-140 (R01): "Revision Applications for Research on Assessing the Role of Stigma in HIV Prevention and Care." The proposed project will examine the role of stigma as a social-structural barrier to accessing STI/HIV linkage and retention in care among African American men who have sex with men (AAMSM) who are recently diagnosed with STI/HIV. AAMSM represent 70% of all new HIV infections among AA men and comprise a disproportionately high 36% of the incident HIV infections among all MSM. Likewise, we observe disproportionately high rates of non-HIV STI among AAMSM and evidence suggests a surge in primary and secondary syphilis infection among these men. Experiences with stigma have been identified as a critical and important deterrent to seeking health care for STI/HIV related treatment, yet littleis understood about how the mechanisms of stigma manifest themselves during the course of accessing health care. Using a contemporary model of stigma, STI/HIV Stigma Framework, we propose to better understand the effects of stigma -including factors thought to drive stigma, i.e. prejudice, stereotypes, and discrimination;and stigma mechanisms, i.e., internalized, enacted, and anticipated stigma- as AAMSM with recent STI/HIV diagnosis are linked and retained in health care. Framing the study around the STI/HIV Stigma Framework will allow us to test the concepts of stigma intersectionality - how stigma associated with STI/HIV diagnosis, racism, and homophobia simultaneously impact healthcare engagement;and stigma in transition - how stigma experienced pre-diagnosis of STI/HIV relate to stigma experienced post-diagnosis. The proposed study will take place at a community-based research site in downtown Atlanta, GA.
The aims of this project are consistent with the RFA in that we will (a) validate measures of stigma across multiple groups (i.e. HIV positive persons and persons at risk for HIV [recently STI diagnosed]), (b) investigate how stigma impacts HIV prevention and care, and (c) use study findings to inform a pilot intervention for reducing stigma as a barrier to care. We propose the following aims:
Specific Aim 1 : Guided by the STI/HIV Stigma Framework, examine the relative strength of each stigma mechanism as a predictor of linkage and retention to care.
Specific Aim 2 : Examine how pre-diagnosis drivers of STI/HIV stigma affect post-diagnosis experiences of STI/HIV stigma.
Specific Aim 3 : Assess stigma mechanisms longitudinally, including pre- and post-STI/HIV positive diagnosis and during retention in care, and examine how stigma mechanisms associated with STI/HIV, race, and sexual orientation develop and evolve during this critical period of transition.

Public Health Relevance

African American men who have sex with men (AAMSM) are disproportionately infected with STI/HIV and little is understood about how the role of stigma impacts their linkage and retention to health care during treatment. Effective strategies for reducing social barriers to health care treatment rely on a comprehensive and thorough investigation into social barriers that affect AAMSM to effectively engage in medical care. The proposed research will follow recently STI/HIV diagnosed AAMSM as they navigate treatment and retention to care and will focus on how stigma affects this process.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Special Emphasis Panel (ZRG1-AARR-G (50))
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Grossman, Cynthia I
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University of Connecticut
Other Health Professions
Schools of Arts and Sciences
United States
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