Gay men may confront multiple layers of stigmatisation and discrimination based on their sexuality, behaviour and their HIV status from other HIV-negative and HIV-positive gay men. The consequences of this are wide-ranging and can negatively impact many aspects of an individual's daily life, social and sexual relationships, emotional and physical health. HIV-related stigma and discrimination have been associated with increased risk-taking behaviours in both HIV-positive and HIV-negative men, and a decrease in successful HIV prevention and testing in these men. When compounded by self-stigma, HIV stigma has been noted in a growing number of reports as a significant divisive influence between and among gay men at both a community and individual level.
Divergence is evolving between community and individual approaches to HIV prevention. For instance, studies have reported a reduction in condom use due to individual risk-assessment strategies, such as serosorting and viral load sorting (Prestage et al., 2009
), and changes in attitudes towards testing. These may in part be associated with HIV-related stigma and a wish to avoid discovery or disclosure of HIV status and the associated threat of rejection and reduced social support (Imrie & Macdonald, 2009
). Indeed, the issue of serosorting is complex. While some HIV-positive men may view serosorting as a means to cope with their anxiety about transmission, it has also been argued that men are more comfortable in relationships with men of the same status due to HIV-related stigma. Additionally, the practice of seroguessing conflates the issue; HIV risk-reduction messages should highlight the limitations of relying on assumed HIV status when making sexual risk decisions (Eaton et al., 2009
; Truong et al., 2006
In some countries, transmitting or exposing another person to HIV can be considered a criminal or unlawful act (UNAIDS, 2008
). This is a contentious topic and one that may be influenced by stigmatising attitudes (Dodds et al., 2009
). According to UNAIDS, criminalisation of HIV transmission may reinforce HIV-related stigma, spread misinformation about HIV, hinder HIV testing and counselling support and, importantly, create a false sense of security by encouraging HIV-negative men to indulge in risky behaviours, believing themselves legally protected from transmission (UNAIDS, 2008
More research is required to fully assess the extent, consequences and potential countermeasures in relation to HIV-related stigma within gay communities. In particular, much of the available literature is anecdotal, highlighting the need for empirical evaluations. The consequences of such missing data negatively affects individuals living with HIV, and may also threaten to further divide communities of gay men and present a significant barrier to efforts aimed at addressing the overall HIV epidemic.
While stigma-reduction programmes have been identified and shown to be effective in small-scale, short-term trials, none have been conducted specifically among gay men, and many gaps remain, especially in relation to the size, duration and impact of these initiatives (Brown, Macintyre, & Trujillo, 2003
). Increased efforts to raise awareness and to develop validated strategies to help reduce stigmatisation of HIV-positive gay men are urgently needed. Social cohesion in target groups of care and prevention are, from our understanding, important for mental and emotional well-being. Reducing the gaps between HIV-positive and HIV-negative men is therefore important not just for the well-being of HIV-positive men. Improving knowledge about HIV transmission and HIV prevention, and understanding about living with HIV, we believe, should help reduce the stigma that currently exists due to misunderstanding and lack of awareness, and hopefully increase the uptake of HIV testing and prevention measures. Indeed, UNAIDS has identified the reduction of stigma and discrimination as a central part of national HIV programmes (UNAIDS, 2007
). Such initiatives should foster a renewed dialogue about living with HIV as a gay man, create opportunities to share understanding and experience among HIV-positive and HIV-negative men, and aim to reunite gay communities by reducing stigma and offering integrated medical and social support.