The Impact of Discrimination on Young Black Sexual Minority Men Living with HIV in the US South: Identifying Predictors of Internalized Stigma and Depressive Symptoms

Abstract

Young Black sexual minority men living with HIV (YBSMM+) consistently report reduced engagement in the HIV care continuum. YBSMM+ are also highly burdened by depressive symptoms, which are strongly associated with suboptimal HIV care outcomes. Yet, little is known about the processes that drive depression-related disparities among YBSMM+. Informed by Minority Stress Theory, we examined three indirect effects, assessing whether the associations between experiences of racism, heterosexism, and HIV-related discrimination and depressive symptoms were mediated by three corresponding forms of internalized stigma. Participants included 216 YBSMM+ from the Southern United States who were assessed at three consecutive time points (longitudinal analyses), as well as 172 YBSMM+ who completed a fourth assessment (cross-sectional analysis). Data were collected from November 2016 to October 2022. Multiple regression analyses revealed that more frequent HIV-related discrimination at baseline significantly predicted greater internalized HIV stigma at the subsequent assessment, and that greater internalized racism at the fourth visit was significantly associated with more frequent depressive symptoms. No indirect effects achieved statistical significance, although recall bias due to long follow-up intervals may have affected the findings. These results suggest that, compared with internalized heterosexism and HIV stigma, internalized racism may be uniquely related to depressive symptoms, emphasizing the importance of exploring the impact of distinct forms of stigma on mental health. Future research may benefit from employing shorter time intervals to capture more nuance, assessing how ingrained internalized stigma has become, and considering the salience of internalized negative attitudes to core self-conceptions in similar longitudinal models.