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Anti-LGBT and Anti-immigrant Structural Stigma: An Intersectional Analysis of Sexual Minority Men's HIV Risk When Migrating to or Within Europe

Pachankis, John E. PhD*; Hatzenbuehler, Mark L. PhD; Berg, Rigmor C. PhD; Fernández-Dávila, Percy PhD§; Mirandola, Massimo PhD; Marcus, Ulrich MD; Weatherburn, Peter MSc#; Schmidt, Axel J. MD#,**

JAIDS Journal of Acquired Immune Deficiency Syndromes: December 1, 2017 - Volume 76 - Issue 4 - p 356–366
doi: 10.1097/QAI.0000000000001519
Epidemiology

Objective: Gay, bisexual, and other men who have sex with men (MSM) might be particularly likely to migrate to experience freedoms unavailable in their home countries. Structural stigma (eg, laws and policies promoting the unequal treatment of oppressed populations) in MSM migrants' sending and receiving countries represent potential barriers to HIV prevention among this intersectional population. This study represents the first investigation of structural determinants of HIV risk in a large, geographically diverse sample of MSM migrants.

Design: The 2010 European MSM Internet Survey (n = 23,371 migrants) was administered across 38 European countries.

Methods: Structural stigma was assessed using (1) national laws and policies promoting unequal treatment of sexual minorities across 181 countries worldwide and (2) national attitudes against immigrants in the 38 receiving countries. We also assessed linguistic status, time since migrating, and 5 HIV-prevention outcomes.

Results: Structural stigma toward sexual minorities (in sending and receiving countries) and toward immigrants (in receiving countries) was associated with a lack of HIV-prevention knowledge, service coverage, and precautionary behaviors among MSM migrants. Linguistic status and time since migrating moderated some associations between structural stigma and lack of HIV prevention.

Conclusions: Structural stigma toward MSM and immigrants represents a modifiable structural determinant of the global HIV epidemic.

*Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT;

Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY;

Department of Community Medicine, University of Tromso, Tromso, Norway;

§Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya, Stop Sida, Barcelona, Spain;

Department of Pathology, Infectious Diseases Section, Verona University Hospital, Verona, Italy;

Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany;

#Sigma Research, Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, United Kingdom; and

**Infectious Diseases Division, Swiss Federal Office of Public Health, Bern, Switzerland.

Correspondence to: John E. Pachankis, PhD, Yale University, New Haven, CT 06520 (e-mail: john.pachankis@yale.edu).

The 2010 European MSM Internet Survey was funded by grants from the Executive Agency for Health and Consumers (EU Health Programme 2008–2013); Centre d'Estudis Epidemiológics sobre les ITS HIV/SIDA de Catalunya (CEEISCat); Terrence Higgins Trust for the CHAPS partnership; Regione de Veneto; Robert Koch Institute; Maastricht University; German Ministry of Health; Finnish Ministry of Health; Norwegian Institute of Public Health; Swedish Board of Health and Welfare; and, for M.L.H. contribution, the National Institute on Drug Abuse (K01DA032558).

The authors have no conflicts of interest to disclose.

The survey was designed and executed by A.J.S., U.M., and P.W. in association with The 2010 European MSM Internet Survey Network (see Acknowledgements). A.J.S. coordinated the study, P.W. coordinated the survey promotion, U.M. initiated the study. Data were prepared and coded by A.J.S., J.E.P., and M.H. designed the analysis. J.E.P. conducted the statistical analyses. The manuscript was drafted by J.E.P. and M.L.H. and co-authored by all other authors. All authors approved the final manuscript.

Received April 20, 2017

Accepted July 24, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.