Minority stress theory represents the most plausible conceptual framework for explaining health disparities for gay and bisexual men (GBM). However, little focus has been given to including the unique stressors experienced by HIV-positive GBM. We explored the role of HIV-related stress within a minority stress model of mental health and condomless anal sex. Longitudinal data were collected on a diverse convenience sample of 138 highly sexually active, HIV-positive GBM in NYC regarding sexual minority (internalized homonegativity and gay-related rejection sensitivity) and HIV-related stressors (internalized HIV stigma and HIV-related rejection sensitivity), emotion dysregulation, mental health (symptoms of depression, anxiety, sexual compulsivity, and hypersexuality), and sexual behavior (condomless anal sex with all male partners and with serodiscordant male partners). Across both sexual minority and HIV-related stressors, internalized stigma was significantly associated with mental health and sexual behavior outcomes while rejection sensitivity was not. Moreover, path analyses revealed that emotion dysregulation mediated the influence of both forms of internalized stigma on symptoms of depression/anxiety and sexual compulsivity/hypersexuality as well as serodiscordant condomless anal sex. We identified two targets of behavioral interventions that may lead to improvements in mental health and reductions in sexual transmission risk behaviors—maladaptive cognitions underlying negative self-schemas and difficulties with emotion regulation. Techniques for cognitive restructuring and emotion regulation may be particularly useful in the development of interventions that are sensitive to the needs of this population while also highlighting the important role that structural interventions can have in preventing these disparities for future generations.

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Extending the Minority Stress Model to Incorporate HIV-Positive Gay and Bisexual Men's Experiences: a Longitudinal Examination of Mental Health and Sexual Risk Behavior.

Acceptance and Compassion-Based Group Therapy to Reduce HIV Stigma

Body image dissatisfaction (BID) and weight self-stigma are prevalent and associated with physical and psychological ill-health. Acceptance and Commitment Therapy (ACT) is increasingly employed for both, yet little is known about its effectiveness. Searches of 12 databases identified six studies using online, face-to-face or self-help ACT interventions for BID or weight self-stigma, of varying duration and intensity. Their effectiveness and quality were evaluated. Two reported improved BID, three improved weight self-stigma, and one reported no impact on weight self-stigma. Methodological issues (small sample sizes, lack of allocation concealment, attention control and long-term follow up) impacted the validity of findings. Due to the small number of studies and poor study quality, the effectiveness of ACT for BID and weight self-stigma remains unclear. Nonetheless findings suggest psychological flexibility may facilitate reduction in BID and weight self-stigma and indicate that brief online as well as lengthy face-to-face delivery may be useful. Suggestions for further research are made.

/pdf/a-systematic-review-of-the-effectiveness-of-acceptance-and-58b1yyp2v4.pdf

A Systematic Review of the Effectiveness of Acceptance and Commitment Therapy (ACT) for Body Image Dissatisfaction and Weight Self-Stigma in Adults.

Stigma is an important topic in public health and has significant impact on psychological and physical well-being of stigmatized individuals. Emerging evidence has suggested that self-compassion, a self-caring and compassionate attitude in the face of hardship, may buffer the negative effects of stigma. However, little research has been conducted to investigate the underlying mechanisms through which self-compassion may buffer the effects of public stigma on self-stigma and the associated negative outcomes. The goal of this paper is to present a theoretical framework that integrates the existing body of literature in self-compassion and stigma. This framework postulates that (1) self-compassion may be related to adaptive cognitive, emotional, and social processes, and (2) these processes may, in turn, prevent individuals with stigmatized identity from developing self-stigma and other health outcomes. Theoretical and empirical support for this mediated-moderation model is reviewed. Future directions to empirically evaluate this model, as well the potential applications of this model for stigma reduction interventions are presented.

Hacking Stigma by Loving Yourself: a Mediated-Moderation Model of Self-Compassion and Stigma

Background:We evaluated attitudes toward treatment as prevention (TasP) among gay, bisexual, and other men who have sex with men (GBM) in Vancouver, Canada.Methods:Sexually active GBM, aged ≥16 years, were recruited between 2012 and 2015 using respondent-driven sampling. At each 6-month follow-up, p

Belief in Treatment as Prevention and Its Relationship to HIV Status and Behavioral Risk.

Objective: HIV-related stigma is a major driver of poor prognosis for the treatment and reduced spread of HIV. The present article provides a qualitative analysis surrounding various themes related to stigma and shame as a result HIV.Design: Eight gay men recruited from a community HIV clinic contacted the researchers in response to a study involving participation in a structured, eight-week group intervention for HIV-related stigma. Following this group, three men took part in open-ended interviews about their thoughts and experiences.Methods: Interpretative phenomenological analysis was used to examine the participants’ experiences surrounding shame and stigma related to living with HIV.Results: Three superordinate themes were identified: social support and the disclosure of serostatus, stigma associated with serosorting and attempts to negotiate a spoiled identity.Conclusion: In San Francisco, a city with a great deal of acceptance surrounding HIV and a large, politically active community of persons li...

William Collin Schenk

Papers

Shame, self-acceptance and disclosure in the lives of gay men living with HIV: an interpretative phenomenological analysis approach.

Sri Lanka's post-tsunami health system recovery: a qualitative analysis of physician perspectives.