Open AccessHow Stigma Toward Anal Sexuality Promotes Concealment and Impedes Health-Seeking Behavior in the U.S. Among Cisgender Men Who Have Sex with Men
Author(s) -
Bryan A. Kutner,
Jane M. Simoni,
Frances M. Au,
Emma Creegan,
Ivan C. Balán
Publication year - 2020
Publication title -
archives of sexual behavior
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.288
H-Index - 111
eISSN - 1573-2800
pISSN - 0004-0002
DOI - 10.1007/s10508-019-01595-9
Subject(s) - men who have sex with men , psychology , human sexuality , stigma (botany) , reproductive health , social stigma , sexual minority , psychological intervention , public health , homosexuality , clinical psychology , sexual orientation , social psychology , medicine , human immunodeficiency virus (hiv) , population , psychiatry , environmental health , family medicine , syphilis , gender studies , sociology , psychoanalysis , nursing
Gay, bisexual, and other men who have sex with men (MSM) experience alarming HIV disparities alongside sub-optimal engagement in HIV interventions. Among MSM, stigma toward anal sexuality could interfere with engagement in HIV prevention, yet few studies have examined MSM perspectives on anal sex stigma or its health-related sequelae. Guided by theory, we aimed to characterize anal sex stigma, related sexual concerns, and barriers to health seeking, like concealment. We elicited community input by purposively interviewing 10 experts in MSM health and then 25 racially, ethnically, and geographically diverse cisgender MSM. Participants reported experienced, internalized, and anticipated forms of anal sex stigma that inhibited health seeking. Experienced stigma, including direct and observed experiences as well as the absence of sex education and information, contributed to internalized stigma and anticipation of future devaluation. This process produced psychological discomfort and concealment of health-related aspects of anal sexuality, even from potentially supportive sexual partners, social contacts, and health workers. Participants characterized stigma and discomfort with disclosure as normative, pervasive, and detrimental influences on health-seeking behavior both during sex and within healthcare interactions. Omission of information appears to be a particularly salient determinant of sexual behavior, inhibiting prevention of harm, like pain, and leading to adverse health outcomes. The development of measures of anal sex stigma and related sexual concerns, and testing their impact on comfort with disclosure, sexual practices, and engagement in health services could identify modifiable social pathways that contribute to health disparities among MSM, like those seen in the HIV epidemic.