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Publication Profiles

Intersectional Stigma and Prevention Among Gay, Bisexual, and Same Gender–Loving Men in New York City, 2020: System Dynamics Models

Citation

Lutete P, Matthews DW, Sabounchi NS, et al. Intersectional Stigma and Prevention Among Gay, Bisexual, and Same Gender-Loving Men in New York City, 2020: System Dynamics Models. Am J Public Health. 2022;112(S4):S444-S451. doi:10.2105/AJPH.2022.306725

Implementation stage:

Pre-Implementation

Implementation outcomes reported:

Not specified

Continuum target addressed:

HIV diagnosis, Linkage to HIV care, ART initiation, ART adherence, Engagement in treatment (including retention and re-engagement), Viral suppression, HIV testing, Linkage to preventative care, PrEP initation, PrEP adherence, PrEP persistence

Geography:

Bronx County-NY

Study Participant Classification:

Community member(s), Implementer(s)

Plain Language Objectives

The researchers worked with New York City experts to map how HIV stigma, racism, and homophobia reinforce one another for Black sexual minority men. They wanted to identify points where an intervention might interrupt these cycles and improve access to testing and prevention.

Plain Language Abstract

Black gay, bisexual, same-gender-loving, and other men who have sex with men can experience HIV stigma, racism, and homophobia at the same time. Researchers conducted focus groups and interviews with 80 expert informants in New York City between January and July 2020. They coded the discussions and repeatedly developed and validated causal loop diagrams, which show how factors may reinforce one another over time. Three major feedback loops involved medical mistrust and HIV transmission, sexual partner selection and marginalization, and family support and internalized homophobia. The team used these insights to design two components for an existing community intervention addressing HIV stigma and homophobia. The diagrams suggest possible ways that overlapping stigmas may reduce access to testing, prevention, and treatment. Because the model was built from qualitative accounts, it represents participants’ understanding of causal relationships rather than measured proof of cause and effect. The study developed intervention targets but did not test whether the new components reduced stigma or increased service use.

Key Takeaways

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