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An Exploratory Study of Resilience, HIV-Related Stigma, and HIV Care Outcomes Among Men who have Sex with Men (MSM) Living with HIV in Louisiana

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Abstract

The various forms of HIV-related stigma continue to serve as major barriers to HIV care and treatment among men who have sex with men (MSM). The study of resilience within the context of HIV-related stigma among MSM living with HIV represents a promising area of research to inform the development of future HIV interventions for this population. We examined resilience within the context of HIV related stigma among MSM living with HIV in Louisiana with a particular interest in how resilience may be more relevant for Black MSM. We utilized Pearson’s correlations and layered chi-square non-parametric tests to examine associations and racial differences in resilience, four HIV-related stigma measures/consequences (i.e., anticipated, internalized, enacted, and consequences of enacted HIV stigma), and HIV care outcomes (i.e., length of time since last HIV care visit, time since last HIV lab result, most recent HIV viral load result) among 110 MSM living with HIV in Louisiana who participated in the Louisiana HIV Stigma Index Project. The majority of MSM participants were Black (75%), lived in New Orleans (52%), and reported limited education (52%) and income (76%). MSM who reported higher levels of enacted HIV stigma, consequences of enacted HIV stigma, and internalized HIV stigma reported poorer HIV care outcomes. Both internalized and anticipated HIV stigma significantly negatively impacted Black MSM perceptions of their overall health compared with White MSM. Compared with White MSM, Black MSM who reported greater consequences of enacted HIV stigma had poorer HIV care outcomes. Resilience was associated with positive HIV care outcomes for both Black and White MSM. However, having higher levels of resilience may have been more protective for Black MSM such that higher levels of resilience were associated with less time since last HIV care visit for Black MSM than for White MSM. The current study provides preliminary information on the potential positive relationship between resilience and HIV care outcomes among MSM, particularly Black MSM. However, these findings need to be confirmed among a more representative sample of Black and White MSM in Louisiana.

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Acknowledgements

We would like to thank all study participants; Louisiana People Living with HIV Stigma Index interviewers, core group, and allies; Laurel Sprague PhD; the Global Network of People Living with HIV; and the US People Living with HIV Caucus.

Funding

This project was supported with funds from AIDS United; the City of New Orleans Health Department, Office of Health Policy and AIDS Funding; and the Office of Minority Health Grant No. 6 CPIMP141066-03–01. R. Brewer’s time was supported by a grant from NIMH (R25MH067127) for the Visiting Professor Program at the University of California, San Francisco; the Centers for Disease Control and Prevention, NCHHSTP 5U01PS005122; and NIDA P30DA027828-08S1.

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Authors and Affiliations

  1. Department of Medicine, University of Chicago, 5837 S. Maryland Avenue, MC 5065, Chicago, IL, 60637, USA

    Russell Brewer & John A. Schneider

  2. Chicago Center for HIV Elimination, Chicago, IL, USA

    Russell Brewer & John A. Schneider

  3. Virginia Commonwealth University, Richmond, VA, USA

    Kristina B. Hood

  4. Dillard University, New Orleans, LA, USA

    Mary Moore

  5. California State University-San Marcos, San Marcos, CA, USA

    Andrew Spieldenner

  6. CrescentCare, New Orleans, LA, USA

    Chris Daunis

  7. Educational Commission for Foreign Medical Graduates, Philadelphia, PA, USA

    Snigdha Mukherjee

  8. HIV/AIDS Alliance for Region Two, Baton Rouge, LA, USA

    Meta Smith-Davis

  9. Southern AIDS Coalition, New Orleans, LA, USA

    Gina Brown

  10. New Orleans Regional AIDS Planning Council, New Orleans, LA, USA

    Brandi Bowen

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  1. Russell Brewer
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  10. John A. Schneider
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Contributions

RB created the initial concept and served as principal investigator for the study. KBH and MM conducted data analysis and contributed to the methods and results section. All other authors contributed to the introduction, methods, results, and discussion sections.

Corresponding author

Correspondence to Russell Brewer.

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Conflict of interest

Dr. Brewer currently serves as advisory to Gilead’s Implementation Science Group and ViiV Healthcare’s Accelerate Initiative.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Institutional Review Board approval was obtained for the study.

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Informed consent was obtained from all interviewed participants in the study.

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Brewer, R., Hood, K.B., Moore, M. et al. An Exploratory Study of Resilience, HIV-Related Stigma, and HIV Care Outcomes Among Men who have Sex with Men (MSM) Living with HIV in Louisiana. AIDS Behav 24, 2119–2129 (2020). https://doi.org/10.1007/s10461-020-02778-5

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