Measuring structural HIV stigma

Abstract

Despite the progress in pharmaceutical and epidemiological tools for combating HIV spread, HIV stigma remains a significant social barrier impeding treatment and prevention efforts, potentially reducing the effectiveness of interventions to reduce HIV transmission. In this paper, we propose a novel approach to defining and estimating HIV stigmatization through the structure of sexual relations, as opposed to attitudes. We conceptualize structural stigma as arising from two mechanisms: (1) a reduced propensity towards HIV serodiscordant partnerships (exclusion); and (2) a reduced propensity towards partnerships with seroconcordant individuals who themselves have serodiscordant partnerships (ostracism). Both mechanisms can be assessed from observed partnership network data using exponential family random graph models (ERGMs). We demonstrate our approach on a sexual contact network of black men who have sex with men in the South Side of Chicago. We find a tendency for serodiscordant sexual relationships to be suppressed in the network (θ = −0.69, p < .05), as well as a suppressive tendency for HIV negative YBMSM to have sex with other HIV negative people in serodiscordant relationships (θ = −0.96, p < .05) suggesting that structural HIV stigma is present in this network. Potential relationships with attitudinal stigma and implications for epidemiological strategies for reducing HIV stigma are discussed.