Comparing prevalence and correlates of sexuality-related stigmas among men who have sex with men in the United States versus Mexico, AMIS-2018 Pubblico

Abstract

Introduction:

Stigma is a fundamental cause of health disparities and sexuality-related stigma, especially, drives poor health outcomes among sexual minority populations. Studies have shown that experiencing sexual behavior stigma is associated with increased risk behaviors for HIV transmission and creates barriers to accessing sexual health services. Variation in sexual minorities’ stigma experiences in different countries is rooted in the unique sociopolitical context, although it has been difficult to empirically compare these experiences previously due to a lack of consistent stigma measurement metrics. This analysis sought to describe and compare the prevalence of sexuality-related stigma between the United States (US) and Mexico among men who have sex with men (MSM). 

Methods:

Data was obtained from the 2018 American Men’s Internet Survey, conducted separately in the US and Mexico. Log-binomial regression was used to examine the association between variables of interest and 13 stigma items. Bivariate analyses were conducted on the entire study sample, and used to perform country-specific analyses. Crude and adjusted multivariate models were used to compare the prevalence of stigma in the US versus Mexico. 

Results:

Overall, the highest prevalence stigma items were family gossip (47%), verbal harassment (47%), and family exclusion (27%). Family exclusion and gossip, friend rejection, fear of seeking healthcare, healthcare avoidance, fear being in public, physical harm, and rape were reported more commonly among US MSM. Healthcare worker gossip, police refusal to protect, verbal harassment, and blackmail were more common among Mexican MSM. Adjusted prevalence ratios (aPR) for all stigma items were statistically significant, but measures of association were typically small with the exception of family exclusion (aPR = 0.67), healthcare worker gossip (aPR = 1.94), police refusing to protect (aPR = 1.89), and blackmail (aPR = 1.66). 

Discussion:

In this analysis, sexuality-related stigma was common amongst MSM regardless of country. These findings indicate that despite the existence of protective policies for LGBTQ people in both countries, variation in enforcement and adoption of these policies have fostered sociopolitical landscapes that are damaging to the health of MSM. The ubiquity of these experiences indicates the need for intersectional, context-specific stigma mitigation interventions to reduce the harms caused by structural stigma. 

Table of Contents

Table of Contents

1. Introduction .......................................................................................1

2. Methods ............................................................................................4

i. AMIS.......................................................................................4

ii. Dataset Creation .........................................................................5

iii. Sexual Behavior Stigma ...............................................................7

iv. Statistical Analysis .......................................................................7 

3. Results ..............................................................................................8

i. Sample Demographics ..................................................................8

ii. Sexual Behavior Stigma in AMIS-2018 .............................................10

iii. Comparison of Stigma Prevalence Across United States and Mexico .........13

iv. Multivariable Adjusted Associations of United States/Mexico With Sexual Behavior Stigma Items ....................................................................14 

4. Discussion ........................................................................................14

i. Key Findings .............................................................................14

ii. Interpretation of Findings .............................................................15

iii. Limitations ..............................................................................19

iv. Conclusions .............................................................................21 

5. Tables and Figures ..............................................................................23

Table 1. Breakdown of Mexico regions by states .....................................23

Table 2. Sexual behavior stigma items .................................................24

Table 3. Characteristics of 2018 participants in the American Men's Internet Survey (AMIS) .............................................................................25

Table 3a. Characteristics of US AMIS-2018 Participants ...........................26

Table 3b. Characteristics Mexico AMIS-2018 Participants .........................26

Table 4. Crude prevalence and correlates of sexuality-related stigma among AMIS 2018 survey ........................................................................27

Table 5. Bivariate analyses of age, disclosure status, education level, and community tolerance with stigma types, cPR (95% CI) ..............................28

Table 6. Prevalence of sexual behavior stigma among MSM in US AMIS-2018 by region .......................................................................................29

Table 7. Prevalence of sexual behavior stigma among MSM in US AMIS-2018 by race/ethnicity ...............................................................................30

Table 8. Prevalence of sexual behavior stigma among MSM in US AMIS-2018 by urbanicity ...................................................................................31

Table 9. Prevalence of sexual behavior stigma among MSM in Mexico AMIS- 2018 by region .............................................................................32

Table 10. Adjusted prevalence and correlates of sexuality-related stigma among AMIS 2018 Survey ........................................................................33

Figure 1. Prevalence of sexual behavior stigma among MSM in the US versus Mexico ......................................................................................34

Figure 2. Prevalence of sexual behavior stigma among US MSM by region.......34

Figure 3. Prevalence of sexual behavior stigma among US MSM by race and ethnicity .....................................................................................34

Figure 4. Prevalence of sexual behavior stigma among US MSM by urbanicity..35

Figure 5. Prevalence of sexual behavior stigma among Mexican MSM by region........................................................................................35

6. References ........................................................................................36 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology
Parola chiave	sexuality-related stigma sexual behavior stigma
Committee Chair / Thesis Advisor	Guest, Jodie, Emory University

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