Official websites use. Share sensitive information only on official, secure websites. Author for Correspondence: Catherine E. Keywords: men who have sex with men, HIV, pre-exposure prophylaxis, structural stigma, post-exposure prophylaxis. Public health researchers and practitioners have increasingly highlighted the importance of structural determinants on the HIV epidemic, building on a long tradition of research and practice in social and behavioral sciences.
Although scientific advances have demonstrated the efficacy of biomedical HIV prevention interventions, including pre- and post-exposure prophylaxis PrEP and PEP, respectively , to protect against HIV transmission,[ 2 — 4 ] social contexts affect environments in which people live and can present barriers to implementation and adherence to this individual-level intervention. Recently, research among sexual minority populations has increasingly considered the role of stigma related to sexual orientation at the individual, interpersonal and structural level in affecting risk for adverse health outcomes.
Among MSM, individual and interpersonal forms of stigma have been associated with decreased access to healthcare in diverse settings[ 20 , 21 ], with increased HIV risk, and adverse mental health conditions. We hypothesized that individuals living in areas with higher structural stigma increased anti-gay prejudicial social environments at the state level would have decreased awareness and utilization of PEP and PrEP, decreased condom use, and reduced ability to discuss sexual risk and HIV prevention strategies with primary care providers.
In August , an anonymous survey was conducted among members of one of the largest Internet sites for men seeking social or sexual interactions with other men in the United States.
An electronic email recruitment message was sent to all users of the site who resided in the United States at the time of the study, including a description of the study purpose and included a link to the study website.
