Qualitative research published in the July issue of Social Science Medicine by Dr Katherine Quinn and colleagues
at the Center for AIDS Intervention Research highlights how intersectional stigma
contributes to low pre-exposure prophylaxis (PrEP) uptake for black men who
have sex with men (MSM) in the US. Mistreatment in healthcare services, racism,
homophobia and structural inequalities all intersect to deter black MSM from
seeking out PrEP as a means of preventing HIV infection.

HIV
infection in the US continues to disproportionately affect black MSM when
compared to white and Hispanic MSM, despite black men consistently reporting
fewer sex partners and less risk behaviours. Half of all black MSM are
projected to acquire HIV in their lifetime, compared to 25% of Hispanic MSM and
9% of white MSM. There are major disparities in PrEP use: of the 1.1 million
estimated to benefit from PrEP, 45% are black MSM, yet of those currently using
PrEP, only 11% are black MSM, compared to 13% Latino men and 69% white men.

Low PrEP uptake among black MSM may be attributed to
intersectional stigma. This type of stigma is experienced as a result of
discrimination based on multiple identities, such as being black and gay.

As the authors explain, “Intersectional stigma can
occur at multiple levels of influence (interpersonal, community, and structural
levels), and is based upon co-occurring and intersecting identities or
conditions (e.g. HIV status, race, age, disability, sexual orientation). An
important distinction to make is that it is not an individual’s intersecting
identities that contribute to marginalization, but rather the social positions,
privileges, power, and oppression (e.g. racism, classism, heterosexism)
associated with those identities that contribute to inequalities.”

Intersectional stigma and PrEP use has not been widely
studied. However, it may have similarities to intersectional stigma and HIV
risk.