Experiences of Stigma in American Men Who Have Sex With Men Pre and Post Federal Same Sex Marriage Legalization Open Access

Grill, Emilia (Spring 2022)

Permanent URL: https://etd.library.emory.edu/concern/etds/79407z54k?locale=en


Background: Most research related to men who have sex with men (MSM) and stigma has focused on the impact of stigma on health outcomes. Little is known about the effect of policies like same sex marriage legalization on stigma experienced by MSM.

Objective: The objective of this analysis is to determine how experiences of stigma have changed for American MSM from 2013 to 2019, focused on the impact of federal same-sex marriage legalization in 2015.

Methods: Data were obtained from the 2013, 2016, 2017, 2018, and 2019 cycles of the American Men's Internet Survey (AMIS). Respondents who answered at least one of six stigma questions were included. Stigma questions were combined to create a composite stigma variable, and the prevalence of stigma was calculated for each year. Log binomial regression was used to examine the effect of several exposures on experiences of stigma and to calculate adjusted prevalence ratios and 95% confidence intervals.

Results: Pre and post legalization, experience of stigma was reported by approximately half of participants. The most common form of stigma was verbal harassment (20.9 – 40.2%), followed by unfair treatment at work/school and worse service (12.5 – 17.7%), then assault and healthcare stigma (2.4 – 4.7%). Between 14.7% and 16.7% of participants disagreed or strongly disagreed their community is tolerant of gays and bisexuals. Composite stigma decreased in 2016 (46.6%) and 2017 (44.1%) compared to 2013 (48.0%), but increased substantially in 2018 (50.4%) and 2019 (52.3%). Post same sex marriage legalization, experiences of stigma decreased by 5% (adjusted prevalence ratio [aPR] = 1.05, 95% CI 1.02, 10.9) compared to pre legalization, after adjusting for age, sexuality, race/ethnicity, region, and state same sex marriage.

Conclusions: Stigma based on sexual identity remained common over time as roughly half of MSM have at least one stigmatizing experience per year. While there was only a small decrease in stigma following legalization of same sex marriage, MSM and other members of the LGBTQ community continue to be affected by changes in legislation. Given the negative mental and physical health impacts of stigma, there is a need to fully understand the impact of policy to further mitigate stigma.

Table of Contents

Introduction                     1

Methods                            4

Results                              6

Discussion                        8

Tables and Figures        12

References                      16

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