Examining Stigmatizing Beliefs About PrEP Use Among Black Sexual Minority Men: A Test of Explanatory Mechanisms

摘要

Stigma often is cited as a barrier to the uptake and use of preexposure prophylaxis (PrEP) to prevent human immunodeficiency virus (HIV) among Black sexual minority men (SMM). Socialized gender norms (i.e., restrictive emotionality) are associated with experiences and manifestations of stigma in men. However, the association between restrictive emotionality and the stigma surrounding PrEP use has received little attention in previous research. The present study examines the association between restrictive emotionality and holding stigmatizing beliefs about PrEP use with a theoretically informed serial mediation model testing internalized homophobia (IHP) and lesbian, gay, bisexual, and transgender (LGBT) community connectedness as mediators among a sample of 455 Black SMM in the Southeastern U.S. Results indicate that restrictive emotionality is associated with stigmatizing beliefs about PrEP use. Further, IHP and LGBT community connectedness (LGBT CC) were found to partially mediate the proposed relationship serially. IHP, but not LGBT CC, also independently mediated the association between restrictive emotionality and stigmatizing beliefs about PrEP use. This study provides important insights into how aspects of masculinity influence the manifestation of stigmatizing beliefs about PrEP use among Black SMM. The present findings have implications for reducing these beliefs, which are known to negatively impact uptake and use of the HIV prevention tool among Black SMM at elevated risk for HIV. Public Significance Statement Restrictive emotionality was associated with stigmatizing beliefs about using PrEP to prevent HIV among Black sexual minority men. Internalized homophobia and LGBT community connectedness partially mediated the association serially. Addressing restrictive emotionality among this population may be an effective strategy to reduce stigmatizing beliefs about PrEP and increase the use of the prevention tool.