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Study examines how stigma and resilience impact HIV prevention

Rainier Masa, Ph.D.
Rainier Masa, Ph.D.

UNC School of Social Work has been awarded a nearly $415,000 grant from the National Institute on Minority Health & Health Disparities to examine how intersectional stigma and resilience affect HIV prevention among young Latinx sexual minority men.

Rainier Masa, a social work assistant professor, is the principal investigator on the two-year project, which aims to better understand how discrimination based on multiple identities, such as those related to sexual orientation, race, ethnicity, immigration status, or other attributes may influence the healthy sexual behaviors of young Latino men, particularly in the prevention of HIV. In addition, the study will explore how stigma and discrimination may also affect this same population’s decision to take or adhere to a drug treatment plan for preventing HIV, commonly referred to as pre-exposure prophylaxis or PrEP.

Historically, research has generally focused on how HIV stigma alone confounds every single aspect of prevention and treatment, from not getting tested to not adhering to medication, Masa explained. However, a growing body of literature has found that other stigmatized identities, such as being a sexual minority and racial minority, may also affect young Latino men’s decision to get screened for HIV or to use PrEP, Masa said. This impact has been particularly significant in the southern United States, where the rate of new HIV infections among young sexual minority men of color is much higher than their white peers, Masa said.

“Ultimately, for the particular population we’re studying, we want to know how central being Latinx is to an individual’s identity and how often do they think of these things when getting tested or accessing PrEP,” Masa said. “What we’re really trying to learn is how a person’s intersecting identities and the stigmas associated with those identities matter or impact their daily lives and decisions, including when they are accessing care.”

For the UNC study, Masa is partnering with El Centro Hispano, an organization serving the Triangle Latinx community, to recruit participants from 11 counties in North Carolina, including Wake, Durham, Orange and Chatham. Because young Latinx men are particularly overrepresented in the number of people living with HIV in the United States, the study will focus on individuals, 18-24, who account for 20% of all new HIV infections, Masa said.

At the same time, Masa and his co-investigators – Natalia Villegas Rodriguez from UNC School of Nursing and Don Operario from Brown University, School of Public Health – are also interested in learning more about how some in the Latinx community have remained resilient and managed adversity despite facing stigma and discrimination because of their sexual minority identity or other stigmatized characteristics. In other words, they have managed their health in positive ways, testing for HIV regularly and adhering to PrEP as prescribed.

Although limited research exists on the topic, some studies have suggested that positive social support from family and friends can reduce the negative effects that individuals may experience as a result of their multiple minority identities.

“What we want to know,” Masa explained, “are what are these uncommon strategies that they have employed, and can we replicate those? What practices are these young men using to mitigate the negative impact of multiple layers of discrimination on their health and well-being, particularly when it comes to safer sex and HIV prevention behaviors, and can we scale up these practices and behaviors so that more young men in the community can attain this proven HIV prevention method despite their experiences of racism, homophobia and other stigma related to their health conditions.”

Based on their findings, researchers hope to develop an HIV-prevention model that incorporates these strengths-based practices, he said. Ultimately, the more answers they have about how stigma and discrimination impact decision-making around HIV prevention, the greater likelihood more tailored solutions can be developed, Masa said.

“HIV stigma and the racial ethnic minority stress that individuals experience have been shown to affect healthcare and health-seeking behaviors,” he said. “But we don’t know as much about what happens when all of these different identities intersect. Do they magnify or further exacerbate HIV prevention behaviors? Maybe it isn’t just one identity but this intersection of identities, including the fact that the individual may be undocumented combined with their racial ethnic and sexual minority status, that’s impacting their access to care. Yes, we know it’s stigma. But which of these stigmatized identities is having the most impact?

“Once we know these answers, we can target our interventions toward that type of stigma.”