An ecological framework for understanding HIV- and AIDS-related stigma among Asian American and Pacific Islander men who have sex with men living in the USA

Abstract

Despite the fact that HIV- and AIDS-related stigma is consistently identified as an impediment to HIV prevention, a multilevel conceptualisation of HIV- and AIDS-related stigma continues to be poorly understood. The role of multilevel HIV- and AIDS-related stigma in the HIV prevention and intervention behaviours of Asian American and Pacific Islander who have sex with men in the USA is particularly overlooked. Psychology has contributed significantly to the identification of individual or interpersonal level factors influencing HIV- and AIDS-related stigma, while sociology has contributed to a more societal perspective. This dichotomy has led to the absence of a multilevel conceptual framework for analysing the HIV- or AIDS-related stigma experienced by Asian American and Pacific Islander who have sex with men in the USA. In this paper, we argue for need to develop such a model which is culturally grounded and bridges the individual, interpersonal and societal conceptualisations of stigma prominent in the social science literature. To that end, we use Bronfenbrenner’s ecological systems theory to explore the manifestation of HIV stigma at the micro, meso and macro levels and how these might impact on HIV testing and HIV service utilisation among Asian American and Pacific Islander men who have sex with men. We conclude by identifying some practice and research implications.