Promoting Reductions in Intersectional StigMa (PRISM) to Improve the HIV Prevention Continuum
NAMHC Concept Clearance •
Dianne Rausch, Ph.D.
Division of AIDS Research
The goals of this initiative are twofold: 1) to advance measurements of intersectional stigma (multiple stigmatized identities) and examine the mechanisms and pathways by which it is a barrier to HIV testing and linkage to prevention; and 2) to develop and test interventions to reduce intersectional stigma and improve the uptake of HIV testing and linkage to ongoing HIV prevention among key populations at substantial risk for HIV infection.
Despite many advances in HIV prevention, HIV-related stigma (at the individual, interpersonal and structural level) continues to be a critical barrier to HIV testing, as well as to the uptake of evidence-based prevention. The concept of intersectional stigma examines the juncture of multiple stigmatized identities that fall within or across several categories: 1) one or more co-existing health conditions such as HIV, mental illness or substance use disorder; 2) sociodemographic characteristics such as racial, ethnic, gender, and sexual orientation; and 3) behaviors/experiences such as substance use and sex work. Each stigmatized identity can be further differentiated by type, such as internalized (personal endorsement of prejudice and stereotypes), enacted (experiences of discrimination from others), and anticipated (expectations of discrimination from others in the future, even if one has not experienced discrimination in the past). Few studies have used the concept of intersectionality to understand the multiple stigmatized identities faced by the communities where HIV is most heavily concentrated. Furthermore, interventions designed to address intersectional stigma are notably absent from the literature.
Stigma has been associated with low uptake of HIV testing and poor linkage to ongoing HIV prevention such as Pre-Exposure Prophylaxis (PrEP) for high-risk, HIV-negative individuals. These findings are highly problematic because this phase represents initial entry into the HIV prevention continuum. HIV remains heavily stigmatized among key populations such as men who have sex with men and other sexual and gender minority sub groups, particularly those who are young, Black or Latino as well as those living in the Southern region of the U.S., in Sub-Saharan Africa or in other Low and Middle-Income Countries where stigma is strong. Scant research has linked successful stigma reduction efforts with improvements in outcomes such as HIV testing and uptake of PrEP. There is a need to understand the role of intersectional stigma and develop and test interventions designed to reduce intersectional stigma and improve HIV prevention outcomes. Stigma threatens to keep the “AIDS-free generation” out of reach.
This initiative would target a gap in the scientific knowledge on intersectional stigma and HIV prevention that may help to reduce the incidence of HIV and HIV disparities. Research related to this initiative may include studies to:
- Apply intersectional theory to measurements and analytical approaches of intersectional stigma to better understand the mechanisms and pathways by which it impacts HIV testing and HIV prevention uptake;
- Develop and validate measurements of intersectional stigma;
- Develop modeling approaches for assessing intersectional stigma;
- Develop interventions that will address the role of intersectional stigma in the uptake of HIV testing and linkage to HIV prevention services;
- Address the multi-level factors facilitating intersectional stigma to improve HIV prevention continuum outcomes;
- Determine the optimal combination of stigma reduction interventions to improve HIV prevention outcomes for those stigmatized populations at highest risk for HIV acquisition; and
- Compare the relative effects of stigma reduction interventions on HIV testing and linkage to HIV prevention outcomes.