# Structural Stigma and HIV Prevention Outcomes

> **NIH NIH R01** · HARVARD UNIVERSITY · 2020 · $692,703

## Abstract

PROJECT SUMMARY
Gay and bisexual men (GBM), and other men who have sex with men (MSM), represent the largest group of
individuals infected with HIV in the U.S. At current rates, 1 in 6 MSM will be diagnosed with HIV in their lifetime.
Extant research has largely focused on identifying individual- and interpersonal-level risk factors for HIV
infection among GBM; however, accumulating evidence also points to structural determinants of HIV outcomes
in this population. In particular, recent research has demonstrated that structural stigma—defined as societal-
level conditions, cultural norms, and institutional policies that constrain the resources and opportunities of
stigmatized individuals—is associated with adverse health outcomes, including HIV risk, among GBM. For
example, pilot data from our research group showed that 4,098 GBM living in states with high levels of
structural stigma—measured with a composite index of discriminatory state laws and negative social attitudes
towards homosexuality—had lower levels of post-exposure prophylaxis (PEP) and pre-exposure prophylaxis
(PrEP) knowledge and use, lower odds of HIV testing, and greater odds of condomless anal sex compared
with those living in low structural stigma states. While promising, the few existing studies of structural stigma
and HIV outcomes among GBM have been limited by a reliance on cross-sectional designs, a small number of
structural covariates, little attention to mediators/moderators of the structural stigma-HIV risk association, and
non-probability samples of GBM. To address these limitations, we will create a new, prospective, nationally
representative study of HIV-uninfected/unknown status GBM who will be followed for 5 waves of data collection
over a 24-month period (N=500). With a representative sample of participants from across the U.S., we will
have substantial variation in the social context surrounding GBM. This will be the first and largest prospective
study with a nationally representative sample of GBM specifically designed to: (1) examine whether structural
forms of stigma related to sexual identity increase vulnerability to adverse HIV prevention outcomes (e.g., less
HIV testing and PEP/PrEP use); (2) identify mutable mechanisms (e.g., self-stigma, depressive symptoms,
safer-sex self efficacy) through which structural stigma influences HIV outcomes; and (3) evaluate resilience
processes (e.g., LGB community connectedness) that may mitigate the negative effects of structural stigma on
HIV outcomes. In the final phase of the project, we will conduct qualitative interviews with 30 key informants
and 30 GBM. We will use data from these interviews, together with the quantitative results, to inform the
development of multi-level HIV intervention strategies that are maximally responsive to the structural conditions
in which GBM are embedded. We have assembled a team of experts in structural stigma, HIV prevention
among GBM, qualitative research, and survey research with ...

## Key facts

- **NIH application ID:** 10206432
- **Project number:** 7R01MH112384-05
- **Recipient organization:** HARVARD UNIVERSITY
- **Principal Investigator:** Brian Mark Dodge
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $692,703
- **Award type:** 7
- **Project period:** 2017-07-19 → 2022-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10206432

## Citation

> US National Institutes of Health, RePORTER application 10206432, Structural Stigma and HIV Prevention Outcomes (7R01MH112384-05). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10206432. Licensed CC0.

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