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Purpose:  We assessed how psychological distress and felt stigma (perceived sexual minority stigma in one's community) are associated with key HIV prevention outcomes in a U.S. national probability sample of sexually active, HIV-negative sexual minority men.  Methods:  Using data from the Generations study (2017-2018, N  = 285), the present study assessed the effects of psychological distress and felt stigma and their interaction on three HIV prevention outcomes: testing for HIV as per Centers for Disease Control and Prevention guidelines (once or more in the past year), use of latex barriers (e.g., condoms), and familiarity with pre-exposure prophylaxis (PrEP).  Results:  In main effects models, neither psychological distress nor felt stigma was associated with any of the screening and prevention outcomes. However, the interaction between psychological distress and felt stigma was associated with each outcome. Specifically, at higher levels of felt stigma, greater psychological distress was associated with lower odds of HIV testing (exponentiated coefficient = 0.93, confidence interval [95% CI] 0.87-1.00), use of latex barriers (exponentiated coefficient = 0.92, 95% CI 0.86-0.99), and familiarity with PrEP (exponentiated coefficient = 0.90, 95% CI 0.82-0.98).  Conclusion:  These findings highlight the importance of felt stigma in shaping the association between psychological distress and engagement in HIV screening and prevention and offer important considerations for future HIV prevention research and interventions.

Psychological Distress, Felt Stigma, and HIV Prevention in a National Probability Sample of Sexual Minority Men