Gay, bisexual and other men who have sex with men (MSM) often are motivated to embark on new lives in supportive countries to escape oppression and experience freedoms unavailable in their home countries. However, a recent study addressing the MSM migrant community shows that structural stigma (e.g., laws and policies promoting the unequal treatment of oppressed populations) may put this intersectional population at a higher risk of HIV exposure.
These analyses led by the Yale School of Public Health offer the first evidence to show stigma toward sexual minorities and immigrants is associated with a lack of HIV-prevention knowledge, service coverage and precautionary behaviors among MSM migrants. The findings are published in the Journal of Acquired Immune Deficiency Syndromes.
"MSM migrants are potentially affected by stigmas directed toward sexual minorities and toward immigrants," said John E. Pachankis, Ph.D., associate professor at the Yale School of Public Health, who collaborated with European colleagues on the research project. "Yet, previous research has only examined these stigma influences in isolation."
Based on data from 23,000 participants who had moved to or within38 European countries, researchers found that discriminatory laws, institutional policies and biased national attitudes present risk factors underlying the global HIV epidemic among MSM. For example, MSM living in more structurally stigmatizing locales experience critical gaps in HIV-prevention, service coverage, knowledge and behavior.
Immigration poses its own set of challenges related to fitting into a culture and accessing appropriate health care services – MSM migrants in unwelcoming societies are particularly vulnerable to structural disadvantages given that they may not possess the political, social or economic status necessary to access health-promoting resources.
"We looked at the LGBT stigma in a person's previous country and in their current country and found that both are relevant to MSM migrants' HIV risk. We found that LGBT stigma in one's current country had the strongest effects on HIV-risk outcomes, although having previously lived in a country with a supportive climate seemed to protect against some of those risks upon migrating," Pachankis said.
He noted that the support, or lack therefore, that MSM receive in their home countries might continue to influence their risk even if they move to a different country. Pachankis also notes that MSM living at the intersection of high anti-LGBT stigma and anti-immigrant stigma are at particular risk of outcomes like not disclosing their sexual orientation during testing.
The authors hope that this study will bring attention to LGBT immigrants as a vulnerable population, and that health officials need to engage laws and policies to protect the health of this community. They advise modifying the structural contexts surrounding MSM migrants through legislation (e.g., enacting laws that recognize the equality of sexual minorities), so that countries may ensure more equitable access to health-promotion interventions among MSM migrants and ultimately curb the HIV epidemic among this population.
The study was based on data from European MSM Internet Survey.
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John E. Pachankis et al. Anti-LGBT and Anti-Immigrant Structural Stigma, JAIDS Journal of Acquired Immune Deficiency Syndromes (2017). DOI: 10.1097/QAI.0000000000001519