Stigma and sexual health – why where you live matters

Monash University

Monash University researchers have found that if you are a man identifying as a sexual minority, the postcode in which you live can have a surprising impact on your health.

A study from Monash Business School published in the Journal of Acquired Immune Deficiency Syndrome reveals that sexual health outcomes for Australian GBM (gay, bisexual and other men who have sex with men) is worse in areas where there is greater opposition to same-sex marriage.

It has long been believed that structural stigma, that is anti-LGBTIQA+ stigma institutionalised through laws, policies, practices and people’s opinions, may lead to poorer health outcomes for gay, bisexual men and other men who have sex with men.

Now, research confirms that Australian GBM living in regions with higher levels of structural stigma were less likely to undergo HIV/SI testing, receive HIV/STI diagnoses, and be taking or aware of biomedical prevention strategies.

“This is the first study to provide empirical evidence that structural stigma is associated with reduced use and awareness of HIV-related healthcare among this group,” says the paper’s lead researcher Karinna Saxby from the Monash Business School, Centre for Health Economics.

Monash researchers, working with co-authors from the Kirby Institute NSW found that;

  • A gay or bisexual man living in a district with the highest reported level of stigma was 7% less likely to have used PrEp (a preventative medicine people at risk of HIV).
  • HIV-positive men who have sex with men and who are living in districts most strongly opposed to same-sex marriage were 8% less likely to be on Antiretroviral Therapy than someone living in the district with the least opposition to same-sex marriage.

  • High stigma regions offered less access to healthcare with fewer medical practitioners per person and higher levels of socio economic disadvantage for Australian GBM.

“The results suggest that stigma may be undermining HIV prevention strategies as well as the provision of appropriate care and treatment for gay and bisexual men living with HIV,”

Ms Saxby says.

Using responses from the 2017 Australian Marriage Law Postal Survey and responses to behavioural surveys, researchers mapped the attitudes to same-sex marriage and determined the level of social stigma related to sexual minority status across Australia’s 150 electoral districts.

They categorised each district as;

  • Low stigma; less than 25.7 per cent votes against same sex-marriage

  • Low-medium stigma; 25.7-29.9 percent votes against

  • Medium-high stigma; 29.9 to 33.9 percent votes against

  • High stigma; more than 33.9 percent votes against

Although more rural parts of Australia generally had a higher share of votes against same-sex marriage, some of the highest percentage of votes against same-sex marriage were found in metropolitan areas—for example, the nation’s highest percentage of votes against same-sex marriage (55.4 per cent) was found in Greater Sydney.

“This work highlights the ongoing need to reduce the stigma of sexual minorities,” says Karinna Saxby. “While health care providers can play a role to promote acceptance of sexuality and gender diverse populations, there may also be scope for more innovative and flexible service models for men living in high stigma regions, such as at-home HIV/STI testing. To reach its goal of eliminating HIV transmission, Australia must improve its uptake of testing and HIV treatment among gay and bisexual men, particularly in high-stigma areas.”

-Ends –

Karinna Saxby

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