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Stigma, gay men and biomedical prevention: the challenges and opportunities of a rapidly changing HIV prevention landscape

Graham Brown A H , William Leonard B , Anthony Lyons A , Jennifer Power A , Dirk Sander C , William McColl D , Ronald Johnson D , Cary James E , Matthew Hodson F G and Marina Carman A

A La Trobe University, Australian Research Centre in Sex, Health and Society, 215 Franklin Street, Melbourne, Vic. 3000, Australia.

B La Trobe University – Gay and Lesbian Health Victoria, 215 Franklin Street, Melbourne, Vic. 3000, Australia.

C Deutsche AIDS-Hilfe e.V, Wilhelmstraße 138, 10963 Berlin, Germany.

D AIDS United, 1424 K Street, N.W., Suite 200, Washington, DC 20005, USA.

E Terrence Higgins Trust, 314–320 Gray’s Inn Road, London, WC1X 8DP, UK.

F GMFA, Unit 22, Eurolink Business Centre, 49 Effra Road, London SW2 1BZ, UK.

G Present address: NAM, Acorn House, 314--320 Gray’s Inn Road, London, WCIX 8DP, UK.

H Corresponding author. Email: graham.brown@latrobe.edu.au

Sexual Health 14(1) 111-118 http://dx.doi.org/10.1071/SH16052
Submitted: 29 March 2016  Accepted: 26 September 2016   Published: 16 December 2016

Abstract

Improvements in biomedical technologies, combined with changing social attitudes to sexual minorities, provide new opportunities for HIV prevention among gay and other men who have sex with men (GMSM). The potential of these new biomedical technologies (biotechnologies) to reduce HIV transmission and the impact of HIV among GMSM will depend, in part, on the degree to which they challenge prejudicial attitudes, practices and stigma directed against gay men and people living with HIV (PLHIV). At the structural level, stigma regarding gay men and HIV can influence the scale-up of new biotechnologies and negatively affect GMSM’s access to and use of these technologies. At the personal level, stigma can affect individual gay men’s sense of value and confidence as they negotiate serodiscordant relationships or access services. This paper argues that maximising the benefits of new biomedical technologies depends on reducing stigma directed at sexual minorities and people living with HIV and promoting positive social changes towards and within GMSM communities. HIV research, policy and programs will need to invest in: (1) responding to structural and institutional stigma; (2) health promotion and health services that recognise and work to address the impact of stigma on GMSM’s incorporation of new HIV prevention biotechnologies; (3) enhanced mobilisation and participation of GMSM and PLHIV in new approaches to HIV prevention; and (4) expanded approaches to research and evaluation in stigma reduction and its relationship with HIV prevention. The HIV response must become bolder in resourcing, designing and evaluating programs that interact with and influence stigma at multiple levels, including structural-level stigma.

Additional keywords: community mobilisation, health promotion, men who have sex with men, policy, social inequality.


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