# Validation of Stigma Metrics for Marginalized Men

> **NIH NIH R01** · JOHNS HOPKINS UNIVERSITY · 2020 · $675,256

## Abstract

The overarching goal of this proposed study is to leverage existing and ongoing data to examine the role of
sexual behavior stigma on access to HIV healthcare as well as sexual and mental health outcomes among
men who have sex with men (MSM). Worldwide MSM are a key population that bear a disproportionate burden
of HIV with high prevalence and incidence yet they have low uptake and/or access to treatment and
prevention. Consistent with NIH HIV/AIDS research priorities, the proposed project aims to reduce health
disparities in HIV infection and treatment outcomes by addressing stigma towards MSM in the context of
intersecting stigmas and potentially modifiable mediators (e.g., depression). In particular, validated measures
of sexual behavior stigma are needed to effectively measure stigma-related interventions and to better
understand the mechanisms of how stigma potentiates HIV risks among this key population. We propose to
leverage existing data collected from over 15,000 MSM across 7 different Sub-Saharan African nations, the
American Men's Internet Survey (AMIS), the UCLA mSTUDY, and the HIV Prevention Trials Network (HPTN)
078 study on Enhancing Recruitment, Linkage to Care and Treatment for HIV-Infected MSM in the US. The
specific aims of the work are: Aim 1) Develop validated measures used to assess sexual behavior stigma
among MSM using factor analysis and validity and reliability testing. This will result in finalized stigma metrics
and recommendations for integration of MSM stigma items that can be used in future studies. Aim 2) Identify
specific mediated associations between stigma and HIV-related outcomes using structural equation modeling.
In addition, test for intersectionality of multiple forms of stigma (e.g., gender, HIV status, race/ethnicity) using
an inter- and intra-categorical approach. The delivered outcomes will include quantified associations of sexual
behavior stigma with HIV-related outcomes that can be used to inform HIV intervention planning by setting
feasible targets for stigma mitigation interventions. Aim 3) Include final validated stigma metrics in an
upcoming cycle of AMIS and bio-validate the stigma metrics. Bio-validation will consist of testing associations
of sexual behavior stigma with testing positive for sexually transmitted infections (chlamydia and gonorrhea),
and with chronic stress measured using telomere DNA length. Participants will self-collect urine, rectal, and
saliva specimens using home-based STI test kits. Overall, the proposed study will result in a thorough
assessment of a sexual behavior stigma scale for MSM and how it operates comparatively with other types of
stigma. The validated stigma metrics will provide recommendations for future studies that seek to measure
stigma and its relation to HIV among this key population.

## Key facts

- **NIH application ID:** 9867747
- **Project number:** 5R01MH110358-04
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Stefan David Baral
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $675,256
- **Award type:** 5
- **Project period:** 2017-05-05 → 2022-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9867747

## Citation

> US National Institutes of Health, RePORTER application 9867747, Validation of Stigma Metrics for Marginalized Men (5R01MH110358-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9867747. Licensed CC0.

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