Abstract
Objectives. To determine whether intersectional stigma is longitudinally associated with biopsychosocial outcomes. Methods. We measured experienced intersectional stigma (EIS; $ 2 identity-related attributions) among sexual minority men (SMM) in the United States participating in the Multicenter AIDS Cohort Study. We assessed longitudinal associations between EIS (2008–2009) and concurrent and future hypertension, diabetes, dyslipidemia, antiretroviral therapy adherence, HIV viremia, health care underutilization, and depression symptoms (2008–2019). We conducted causal mediation to assess the contribution of intersectional stigma to the relationship between self-identified Black race and persistently uncontrolled outcomes. Results. The mean age (n 5 1806) was 51.8 years (range 5 22–84 years). Of participants, 23.1% self-identified as Black; 48.3% were living with HIV. Participants reporting EIS (30.8%) had higher odds of hypertension, dyslipidemia, diabetes, depression symptoms, health care underutilization, and suboptimal antiretroviral therapy adherence compared with participants who did not report EIS. EIS mediated the relationship between self-identified Black race and uncontrolled outcomes. Conclusions. Our findings demonstrate that EIS is a durable driver of biopsychosocial health outcomes over the life course. Public Health Implications. There is a critical need for interventions to reduce intersectional stigma, help SMM cope with intersectional stigma, and enact policies protecting minoritized people from discriminatory acts.
| Original language | English (US) |
|---|---|
| Pages (from-to) | S452-S462 |
| Journal | American journal of public health |
| Volume | 112 |
| DOIs | |
| State | Published - Jun 2022 |
Funding
We acknowledge the following mechanisms and investigators: Multicenter AIDS Cohort Study (MACS) Aging and Resiliencies principal investigators (M. W. P. and M. R. F), R01-MD010680; MACS/WIHS Combined Cohort Study (MWCCS) Stigma and Non-Communicable Diseases Sub-Study (M. R. F.), R01-HL160326; MWCCS (principal investigators): Atlanta Clinical Research Site (CRS; Ighovwerha Ofotokun, Anandi Sheth, and Gina Wingood), U01-HL146241; Baltimore CRS (Todd Brown and Joseph Margolick), U01-HL146201; Bronx CRS (Kathryn Anastos and Anjali Sharma), U01-HL146204; Brooklyn CRS (Deborah Gustafson and Tracey Wilson), U01-HL146202; Data Analysis and Coordination Center (Gypsyamber D’Souza, Stephen Gange, and Elizabeth Golub), U01-HL146193; Chicago–Cook County CRS (Mardge Cohen and Audrey French), U01-HL146245; Chicago–Northwestern CRS (Steven Wolinsky), U01-HL146240; Northern California CRS (Bradley Aouizerat, Jennifer Price, and Phyllis Tien), U01-HL146242; Los Angeles CRS (Roger Detels and M. J. M.), U01-HL146333; Metropolitan Washington CRS (Seble Kassaye and Daniel Merenstein), U01-HL146205; Miami CRS (Maria Alcaide, Margaret Fischl, and Deborah Jones), U01-HL146203; Pittsburgh CRS (Jeremy Martin-son and Charles Rinaldo), U01-HL146208; Birmingham–Jackson CRS (Mirjam-Colette Kempf, Jodie Dionne-Odom, and Deborah Konkle-Parker), U01-HL146192; North Carolina CRS (Adaora Adimora), U01-HL146194. The MWCCS is funded primarily by the National Heart, Lung, and Blood Institute, with additional co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute on Aging, National Institute of Dental and Craniofacial Research, National Institute of Allergy and Infectious Diseases, National Institute of Neurologic Disorders and Stroke, National Institute of Mental Health, National Institute on Drug Abuse, National Institute of Nursing Research, National Cancer Institute, National Institute on Alcohol Abuse and Alcoholism, National Institute on Deafness and Other Communication Disorders, National Institute of Diabetes and Digestive and Kidney Diseases, and National Institute on Minority Health and Health Disparities, and in coordination and alignment with the research priorities of the National Institutes of Health, Office of AIDS Research. MWCCS data collection is also supported by UL1-TR000004 (University of California San Francisco Clinical and Translational Science Award), UL1-TR003098 (Johns Hopkins Institute for Clinical and Translational Research), UL1-TR001881 (University of California Los Angeles Clinical and Translational Science Institute), P30-AI-050409 (Atlanta Center for AIDS Research [CFAR]), P30-AI-073961 (Miami CFAR), P30-AI-050410 (University of North Carolina CFAR), P30-AI-027767 (University of Alabama at Birmingham CFAR), and P30-MH-116867 (Miami Center for HIV and Research in Mental Health). We acknowledge the following mechanisms and investigators: Multicenter AIDS Cohort Study (MACS) Aging and Resiliencies principal investigators (M. W. P. and M. R. F), R01-MD010680; MACS/WIHS Combined Cohort Study (MWCCS) Stigma and Non-Communicable Diseases Sub-Study (M. R. F.), R01-HL160326; MWCCS (principal investigators): Atlanta Clinical Research Site (CRS; Ighovwerha Ofo-tokun, Anandi Sheth, and Gina Wingood), U01-HL146241; Baltimore CRS (Todd Brown and Joseph Margolick), U01-HL146201; Bronx CRS (Kathryn Anastos and Anjali Sharma), U01-HL146204; Brooklyn CRS (Deborah Gustafson and Tracey Wilson), U01-HL146202; Data Analysis and Coordination Center (Gypsyamber D’Souza, Stephen Gange, and Elizabeth Golub), U01-HL146193; Chicago–Cook County CRS (Mardge Cohen and Audrey French), U01-HL146245; Chicago–Northwestern CRS (Steven Wolinsky), U01-HL146240; Northern California CRS (Bradley Aouizerat, Jennifer Price, and Phyllis Tien), U01-HL146242; Los Angeles CRS (Roger Detels and M. J. M.), U01-HL146333; Metropolitan Washington CRS (Seble Kassaye and Daniel Mer-enstein), U01-HL146205; Miami CRS (Maria Alcaide, Margaret Fischl, and Deborah Jones), U01-HL146203; Pittsburgh CRS (Jeremy Martin-son and Charles Rinaldo), U01-HL146208; Birmingham–Jackson CRS (Mirjam-Colette Kempf, Jodie Dionne-Odom, and Deborah Konkle-Parker), U01-HL146192; North Carolina CRS (Adaora Adimora), U01-HL146194. The MWCCS is funded primarily by the National Heart, Lung, and Blood Institute, with additional co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute on Aging, National Institute of Dental and Craniofacial Research, National Institute of Allergy and Infectious Diseases, National Institute of Neurologic Disorders and Stroke, National Institute of Mental Health, National Institute on Drug Abuse, National Institute of Nursing Research, National Cancer Institute, National Institute on Alcohol Abuse and Alcoholism, National Institute on Deafness and Other Communication Disorders, National Institute of Diabetes and Digestive and Kidney Diseases, and National Institute on Minority Health and Health Disparities, and in coordination and alignment with the research priorities of the National Institutes of Health, Office of AIDS Research. MWCCS data collection is also supported by UL1-TR000004 (University of California San Francisco Clinical and Translational Science Award), UL1-TR003098 (Johns Hopkins Institute for Clinical and Translational Research), UL1-TR001881 (University of California Los Angeles Clinical and Translational Science Institute), P30-AI-050409 (Atlanta Center for AIDS Research [CFAR]), P30-AI-073961 (Miami CFAR), P30-AI-050410 (University of North Carolina CFAR), P30-AI-027767 (University of Alabama at Birmingham CFAR), and P30-MH-116867 (Miami Center for HIV and Research in Mental Health).
ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health
