Getting through the Door: The Role of HIV Stigma on Screening for HIV
A Conversation with Dr. Kristi Gamarel on the role of HIV Stigma on Screening for HIV among Young Gay, Bisexual and Other MSM and Trans Women
Written by: Tanaka Chavanduka
Tanaka is a Graduate Research Assistant with The Center for Sexuality and Health Disparities.
Dr. Kristi Gamarel is an Assistant Professor at the University of Michigan (U-M) School of Public Health and a Core Faculty Member at the U-M Center for Sexuality and Health Disparities. I interviewed her to explore some of her key findings in a recently published manuscript entitled
“Anticipated HIV Stigma and Delays in Regular HIV Testing Behaviors Among Sexually-Active Young Gay, Bisexual, and Other Men Who Have Sex with Men and Transgender Women.”
While completing her doctoral studies at the Graduate Center of the City University of New York, Dr. Gamarel worked on a similar study where she and her colleagues found anticipated stigma was associated with delayed HIV testing among adult gay and bisexual men living in New York City. As she explained,
“What motivated me [to conduct this study] was to understand whether anticipated stigma was a barrier, and if we see that as a replication of what we found before but whether it was also something that we could see among young people [beyond New York City]. Particularly as there are developmental and cohort differences around experiencing stigma with young people. There is this whole idea in the literature that there is HIV fatigue with young people and they’re not as worried about HIV.”
Her research on barriers to HIV testing comes at time in the United States when observed HIV testing among young people ages 15-24 has significantly diminished. Despite this reduced rate of screening, young gay bi men and trans people remain at elevated risk for acquiring HIV. In 2015, gay and bisexual men ages 13-24 accounted for 92% of new HIV diagnoses within their age group in the United States and in 2013 trans people received new diagnoses three times the rate of national average. For Dr. Gamarel anticipated stigma was one possible reason why these young people weren’t coming in.
“Measuring anticipated stigma is getting at anticipating negative interactions from other people if you were to become HIV positive. It is how people forecast into the future thinking negative things like, “If I had HIV people would think bad things about me, or that I was hanging out with the wrong crowd, or that I’m unclean in some way.”
Among her cross-sectional sample (meaning the data were collected only at one point in time) of young gay, bisexual men and other men who have sex with men (719 individuals) and young transgender women (33 individuals) ages 15–24, Dr. Gamarel found that anticipated HIV stigma and reporting a non-gay identity increased the odds of delayed HIV testing.
“I think it’s significant that we found anticipated stigma held up as a barrier in this diverse sample [i.e. 90% of participants reported a non-white racial-ethnic identity] of young people across different sites in the U.S. Another interesting finding was that non-gay identified youth were experiencing bigger delays in HIV testing than their gay identified peers. I think a lot of our testing efforts and campaigns are geared towards the LGBTQ community or are very gay-identified so we may not be sending the right messages to young people who do not identify with the LGBTQ community…Non-identified men who have sex with men or heterosexual identified men engaging in same sex behaviors may have different needs in what would make HIV testing appealing.”
When reflecting on how her findings on anticipated stigma could inform current prevention efforts, Dr. Gamarel spoke to how messaging around undetectable equals untransmittable may help in reducing HIV stigma,
“One thing I think is paramount is to have anti-stigma campaigns become a part of our HIV screening campaigns. Right now in the field of HIV there’s an understanding that if you are on HIV treatment to the point of becoming virally suppressed or undetectable, the risk of passing HIV on to your partner is effectively zero. So if we can spread that message in a way to help destigmatize HIV and take away that fear we may be able to better motivate people into care.”
When addressing some of the study’s limitations, Dr. Gameral reflected on the difficulty of handling such small numbers of trans identified research participants in an analysis,
“There was a very small number of transgender women in the study and then there is always the question if you should include them in the analysis or not. Since there were so few, you cannot generalize that the processes we found for young gay and bisexual men work in the same way for young trans women. At the same time, I don’t want to remove their responses entirely because these young people took the time to provide us this data. So I think that’s a limitation and we need more research specifically addressing how young trans women experience stigma in relation to getting tested for HIV.”
In addition to targeted studies of the role stigma may play in the HIV testing behavior of young trans women, Dr. Gamarel sees future directions in exploring how different forms of stigma may impact HIV testing in different ways.
“There are a lot of reasons why people aren’t testing and there are a lot of different forms of stigma that might serve as alternative barriers. The interplay of racism in people’s communities, heterosexism, sexism, and all these things get complicated with HIV. I wasn’t able to look at different forms of stigma and how HIV stigma might be different or play less of a role than other forms of stigma as a barrier to testing.”
You can view this December 2017 article and others at https://www.sexualityandhealth.org/2017publications