Optimizing event-level measures of intersectional stigma for HIV prevention with young sexual minority men - Project Summary
Gay, bisexual, and other sexual minority men (SMM) are the group most impacted by the domestic HIV
epidemic. Critically, these rates are highest among young SMM (YSMM), with Black, Latino, and White YSMM
under age 35 being the three groups with the highest rates of new HIV diagnoses in 2016. Although more is
known about sexual minority stigma (i.e., internalized homonegativity), little quantitative work has focused on
intersectional experiences of stigma for diverse YSMM. Compared to White YSMM, intersectionality theory
suggests that increased HIV incidence among Black and Latino YSMM may due in part to the distinct effects of
stigma that occurs at the intersection of their multiple stigmatized identities. Researchers have consistently
found that exposure to sexual minority stigma at least partially explains the disproportionate experience of
adverse mental and physical health outcomes for SMM compared to the general population, though the
literature on intersectional stigma and HIV prevention for YSMM is less well developed. Experiences of stigma
occur regularly and are shaped by the context in which they occur, and event-level methodologies may be an
ideal way to collect such data. Although a few event-level studies of stigma have been published, few if any
have used rigorously developed, community-informed, and psychometrically validated items. To address these
limitations of the literature to date, the goal of this research is to conduct a three-phase study to generate,
refine, and optimize event-level measures of stigma for Black, Latino, and White YSMM aged 16-29 that focus
on the intersection of race, ethnicity, sexual minority identity, and gender performance (i.e., masculinity). The
first aim of the study is to generate and refine an item pool using the available literature and interviews with
expert researchers and community members (Phase 1) followed by an iterative process of cognitive
interviewing and pilot testing of the items with YSMM themselves (Phase 2). Having generated an item pool,
the second aim of the study is to use the items to conduct a 21-day daily diary study with 150 YSMM (Phase 3)
to examine the psychometric properties of the items, reduce the item pool, and test the predictive validity of the
items for three HIV prevention outcomes—HIV testing, STI testing, and rectal STI infection. To enroll YSMM for
Phases 2 and 3, we will leverage an existing cohort to rapidly recruit participants; in Phase 3, we will also
gather data collected during the cohort study both prior to and following the 21-day diary study. The proposed
study will address a notable gap in the literature by systematically developing and optimizing items to capture
event-level experiences of intersectional stigma for diverse YSMM across the U.S. Overall, the final item pool
developed will help to further research on intersectional stigma and health disparities; generating items with
greater cultural relevance and lower measurement error will enhance power to detect meaningful intervention
effects in future research aiming to reduce intersectional stigma and disparities in HIV incidence for YSMM.
