While stigma associated with human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) is well recognized, there remains relatively limited intervention data on effective stigma reduction strategies. This systematic review was conducted to highlight the mechanisms through which sexual and HIV stigma is reduced in relation to HIV prevention and care engagement. Search of PubMed and Scopus resulted in 11 tested interventions to include in our preliminary model constructed from programme frameworks and recommendations. We refined the preliminary programme theory to identify whether, why, or how mitigation strategies produce observed outcomes. Our review showed that the interventions produced stigma reduction through three groups of mechanisms: (1) Self-acceptance, leadership, and motivational activation for behaviour change from intrapersonal strategies, such as education and mobile health strategies, which intervene on internalized and anticipated stigma; (2) socialization, knowledge sharing, and social empowerment from interpersonal strategies, such as peer support and training for care providers; and (3) community introspection, self-reflection, and humanistic activation from structural strategies such as community leaders’ sensitization, which intervene on both anticipated and enacted stigma. Interventions mechanisms act complementarily and can be activated in different contexts in which MSM exposed to and infected with HIV are living.
BergRCRossMW.The second closet: a qualitative study of HIV stigma among seropositive gay men in a southern U.S. city. Int J Sex Health2014;
26: 186–199.
2.
LebouchéBEt LévyJJ.Récits de souffrance et VIH/sida: réflexions sur quelques enjeux anthropologiques et éthiques du témoignage . Alterstice2011;
1: 98–107.
3.
MahajanAPSaylesJNPatelVA, et al.
Stigma in the HIV/AIDS epidemic: a review of the literature and recommendations for the way forward. AIDS2008;
22: S67–S79.
4.
SmitPJBradyMCarterM, et al.
HIV-related stigma within communities of gay men: a literature review. AIDS Care2012;
24: 405–412.
5.
StanglALEarnshawVALogieCH, et al.
The health stigma and discrimination framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Med2019;
17: 31.
6.
WienerC (ed.) and SraussA (ed.). Where medicine fails.
New York:
Routledge, 1997.
7.
GoffmanE.Stigmate, les usages sociaux des handicaps.
Paris:
Les Éditions de Minuit, 1975.
8.
Fitzgerald-HusekAVan WertMJEwingWF, et al.
Measuring stigma affecting sex workers (SW) and men who have sex with men (MSM): a systematic review. PLoS One2017;
12: e0188393.
9.
Joint United Nations Program on HIV/AIDS. Stigma and discrimination: facts sheet on HIV/AIDS, 2003.
10.
AmirkhanianYA.Social networks, sexual networks and HIV risk in men who have sex with men. Curr HIV/AIDS Rep2014;
11: 81–92.
11.
CáceresCF.HIV among gay and other men who have sex with men in Latin America and the Caribbean: a hidden epidemic?AIDS2002;
16: S23–S33.
12.
PapworthECeesayNAnL, et al.
Epidemiology of HIV among female sex workers, their clients, men who have sex with men and people who inject drugs in West and Central Africa. J Int AIDS Soc2013;
16: 18751.
13.
GoffmanE.Stigma: notes on the management of spoiled identity.
Englewood Cliffs, NJ:
Prentice-Hall, 1963.
14.
WanyenzeRKMusinguziGMatovuJK, et al. “
If you tell people that you had sex with a fellow man, it is hard to be helped and treated”: barriers and opportunities for increasing access to HIV services among men who have sex with men in Uganda. PLoS One2016;
11: e0147714.
15.
BaralSSifakisFCleghornF, et al.
Elevated risk for HIV infection among men who have sex with men in low- and middle-income countries 2000–2006: a systematic review. PLoS Med2007;
4: e339.
16.
Hightow-WeidmanLLeGrandSChoiSK, et al.
Exploring the HIV continuum of care among young black MSM. PLoS One2017;
12: e0179688.
17.
PawsonRGreenhalghTHarveyG, et al.
Realist review – a new method of systematic review designed for complex policy interventions. J Health Serv Res Policy2005;
10: 21–34.
18.
PawsonR.Evidence-based policy: a realist perspective. In: CarterBNewC (eds) Making realism work: realist social theory and empirical research.
London:
Routledge, 2004, pp. 26–49.
19.
PawsonRTilleyN.Realistic evaluation bloodlines. Am J Eval2001;
22: 317–324.
20.
TrianaR.Evidence-based policy: a realist perspective, by Ray Pawson. J Policy Pract2008;
7: 321–323.
21.
de SouzaDE.Elaborating the context-mechanism-outcome configuration (CMOc) in realist evaluation: a critical realist perspective. Evaluation2013;
19: 141–154.
22.
MuzyambaCBroaddusECampbellC. “
You cannot eat rights”: a qualitative study of views by Zambian HIV-vulnerable women, youth and MSM on human rights as public health tools. BMC Int Health Hum Rights2015;
15: 26.
23.
AmonJJKasambalaT.Structural barriers and human rights related to HIV prevention and treatment in Zimbabwe. Glob Public Health2009;
4: 528–545.
NeedleRFuJBeyrerC, et al.
PEPFAR’s evolving HIV prevention approaches for key populations–people who inject drugs, men who have sex with men, and sex workers: progress, challenges, and opportunities. J Acquir Immune Defic Syndr2012;
60: S145–S151.
26.
van der ElstEMKomboBGichuruE, et al.
The green shoots of a novel training programme: progress and identified key actions to providing services to MSM at Kenyan health facilities. J Int AIDS Soc2015;
18: 20226.
27.
WirtzALTrapenceGJumbeV, et al.
Feasibility of a combination HIV prevention program for men who have sex with men in Blantyre, Malawi. J Acquir Immune Defic Syndr2015;
70: 155–162.
28.
RossMWNyoniJLarssonM, et al.
Health care in a homophobic climate: the SPEND model for providing sexual health services to men who have sex with men where their health and human rights are compromised. Glob Health Action2015;
8: 26096.
29.
GrahamSMMicheniMKomboB, et al.
Development and pilot testing of an intervention to promote care engagement and adherence among HIV-positive Kenyan MSM. AIDS2015;
29: S241–S249.
30.
TuckerAde SwardtGStruthersH, et al.
Understanding the needs of township men who have sex with men (MSM) health outreach workers: exploring the interplay between volunteer training, social capital and critical consciousness. AIDS Behav2013;
17: S33–S42.
31.
EarnshawVAChaudoirSR.From conceptualizing to measuring HIV stigma: a review of HIV stigma mechanism measures. AIDS Behav2009;
13: 1160–1177.
32.
EarnshawVASmithLRChaudoirSR, et al.
HIV stigma mechanisms and well-being among PLWH: a test of the HIV stigma framework. AIDS Behav2013;
17: 1785–1795.
33.
HosekSGLemosDHottonAL, et al.
An HIV intervention tailored for black young men who have sex with men in the House Ball Community. AIDS Care2015;
27: 355–362.
34.
ChristensenJLMillerLCApplebyPR, et al.
Reducing shame in a game that predicts HIV risk reduction for young adult MSM: a randomized trial delivered nationally over the Web. J Int AIDS Soc2013;
16: 18716.
35.
BauermeisterJAMuessigKELeGrandS, et al.
HIV and sexuality stigma reduction through engagement in online forums: results from the HealthMPowerment intervention. AIDS Behav2019;
23: 742–752.
36.
RongkavilitCWangBNaar-KingS, et al.
Motivational interviewing targeting risky sex in HIV-positive young Thai men who have sex with men. Arch Sex Behav2015;
44: 329–340.
37.
BatistEBrownBScheibeA, et al.
Outcomes of a community-based HIV-prevention pilot programme for township men who have sex with men in Cape Town, South Africa. J Int AIDS Soc2013;
16: 18754.
38.
MelendezRMZepedaJSamaniegoR, et al. “
La Familia” HIV prevention program: a focus on disclosure and family acceptance for Latino immigrant MSM to the USA. Salud Publica Mex2013;
55: S491–S497.
39.
LyonsCEKetendeSDioufD, et al.
Potential impact of integrated stigma mitigation interventions in improving HIV/AIDS service delivery and uptake for key populations in Senegal. J Acquir Immune Defic Syndr2017;
74: S52–S59.
40.
van der ElstEMSmithADGichuruE, et al.
Men who have sex with men sensitivity training reduces homoprejudice and increases knowledge among Kenyan healthcare providers in coastal Kenya. J Int AIDS Soc2013;
16: 18748.
41.
GeibelSHossainSMPulerwitzJ, et al.
Stigma reduction training improves healthcare provider attitudes toward, and experiences of, young marginalized people in Bangladesh. J Adolesc Health2017;
60: S35–S44.
42.
TuckerALihtJde SwardtG, et al.
Efficacy of tailored clinic trainings to improve knowledge of men who have sex with men health needs and reduce homoprejudicial attitudes in South Africa. LGBT Health2016;
3: 443–450.
43.
GichuruEKomboBMumbaN, et al.
Engaging religious leaders to support HIV prevention and care for gays, bisexual men, and other men who have sex with men in coastal Kenya. Crit Public Health2018;
28: 294–305.
44.
Watson D and Clark LA. Introduction to the special issue on personality and psychopathology. J Abnormal Psych 1994; 103: 3--5.
45.
Berger BE, Ferrans CE and Lashley FR. Measuring stigma in people with HIV: psychometric assessment of the HIV stigma scale. Res Nurs Health 2001; 24: 518--529.
46.
Wright LW, Adams HE and Bernat J. Development and Validation of the Homophobia Scale. J Psychopath and Behav Assess 1999; 21: 337--347.
