Identifying Subgroups of Intersectional Stigma, Discrimination, and the Association with Mental Health Outcomes Among HIV-Positive Men Who Have Sex with Men: A Latent Class Analysis.

Abstract

This study aimed to (1) identify latent classes of stigma and discrimination experiences among men who have sex with men (MSM) living with HIV; (2) examine the associations between class membership and mental health outcomes, and (3) investigate the moderating effects of social support and resilience. The study used the baseline (N = 224) and six-month follow-up data (N = 118) from a longitudinal cohort study on HIV and hypertension among African American and Asian Pacific American MSM in Hawai'i and Philadelphia from 2019 to 2023. Latent class analysis was conducted to characterize the patterns of stigma and discrimination experience. Multivariable regression was conducted to examine the association between class membership and mental health outcomes. Interaction terms were added to examine the moderation effects of social support and resilience on the association between class memberships and mental health outcomes. A five-class model was identified: Class (1) high on internalized homophobia and low on all discrimination experiences; Class (2) high on racial discrimination; Class (3) high on sexual identity discrimination; Class (4) low on internalized homophobia and all discrimination experiences; Class (5) high on physical disability discrimination and internalized homophobia. Class 5 consistently predicted worse mental health outcomes, compared to Class 4. The association between Class 2 (high racial discrimination) and depression was moderated by perceived social support. The study reveals complex experiences of intersectional stigma and discrimination among MSM living with HIV, highlighting the need for further research on the intersecting effects of multiple disadvantages among aging sexual minorities.