How Stigma Toward Anal Sexuality Promotes Concealment and Impedes Health-Seeking Behavior in the US Among Cisgender Men Who Have Sex with Men
How Stigma Toward Anal Sexuality Promotes Concealment and Impedes Health-Seeking Behavior in the US Among Cisgender Men Who Have Sex with Men
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DOI：
10.1007/s10508-019-01595-9
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发表时间：
2020-02-04
影响因子：
3.8
通讯作者：
Balan, Ivan C.
中科院分区：
文献类型：
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作者：
Kutner, Bryan A.;Simoni, Jane M.;Balan, Ivan C.
男同性恋、双性恋和其他男男性行为者（MSM）在艾滋病毒干预措施方面的参与程度不佳，同时也经历了令人震惊的艾滋病毒差异。在男男性接触者中，对肛交的污名化可能会干扰艾滋病毒预防的参与，但很少有研究探讨男男性接触者对肛交污名化或其健康相关后遗症的看法。在理论的指导下，我们的目的是描述肛交耻辱，相关的性问题，以及寻求健康的障碍，如隐瞒。我们有目的地采访了10位MSM健康专家，然后采访了25位种族、民族和地理上不同的顺性别MSM，从而引发了社区的投入。参与者报告说，经验丰富，内化，和预期形式的肛交耻辱，抑制寻求健康。经历过的耻辱，包括直接和观察到的经历，以及缺乏性教育和信息，促成了内化的耻辱和未来贬值的预期。这个过程产生了心理上的不适，甚至对潜在的支持性伴侣、社会接触者和卫生工作者隐瞒了肛交的健康相关方面。参与者的特点是耻辱和不适与披露的规范，普遍和有害的影响，寻求健康的行为在性和医疗保健的互动。信息的遗漏似乎是性行为的一个特别突出的决定因素，抑制了对伤害的预防，比如疼痛，并导致不良的健康结果。制定肛交耻辱和相关性问题的措施，并测试其对披露舒适度的影响，性行为和参与卫生服务可以确定可改变的社会途径，这些途径有助于MSM之间的健康差异，如艾滋病毒流行病中所见。
Gay, bisexual, and other men who have sex with men (MSM) experience alarming HIV disparities alongside sub-optimal engagement in HIV interventions. Among MSM, stigma toward anal sexuality could interfere with engagement in HIV prevention, yet few studies have examined MSM perspectives on anal sex stigma or its health-related sequelae. Guided by theory, we aimed to characterize anal sex stigma, related sexual concerns, and barriers to health seeking, like concealment. We elicited community input by purposively interviewing 10 experts in MSM health and then 25 racially, ethnically, and geographically diverse cisgender MSM. Participants reported experienced, internalized, and anticipated forms of anal sex stigma that inhibited health seeking. Experienced stigma, including direct and observed experiences as well as the absence of sex education and information, contributed to internalized stigma and anticipation of future devaluation. This process produced psychological discomfort and concealment of health-related aspects of anal sexuality, even from potentially supportive sexual partners, social contacts, and health workers. Participants characterized stigma and discomfort with disclosure as normative, pervasive, and detrimental influences on health-seeking behavior both during sex and within healthcare interactions. Omission of information appears to be a particularly salient determinant of sexual behavior, inhibiting prevention of harm, like pain, and leading to adverse health outcomes. The development of measures of anal sex stigma and related sexual concerns, and testing their impact on comfort with disclosure, sexual practices, and engagement in health services could identify modifiable social pathways that contribute to health disparities among MSM, like those seen in the HIV epidemic.