1. Perceptions of Discrimination against Gay and Bisexual Men in South Carolina Matthew J. Page, PhD, MPP and Nicole L. Chapman, BS

2. Social Determinants of HIV US HIV transmission characterized by “low prevalence in general population [and] high prevalence among disenfranchised and socially marginalized populations.” What drives members of socially marginalized populations to partake in sexual risk behaviors? El-Sadr et al. 2010

3. Sexual Minority Stigma As of 2011, 55% of Americans felt homosexual behavior is always, almost always, or sometimes wrong. Types of sexual stigma: –Enacted stigma. –Felt stigma. –Internalized stigma (internalized homophobia). General Social Survey, Herek 2007

4. Sexual Stigma and HIV Risk Sexual risk is associated with actual and perceived discrimination against, and internalized stigma among, men who have sex with men (MSM). Enacted and felt stigma reduce self- acceptance and increase stress, anxiety, and depression among MSM. Actual/perceived discrimination: 21 references, 1992-2014 Internalized homophobia: 10 references, 1998-2014 Reduced self-acceptance: 7 references, 1995-2014

5. Structural Factors Individual Factors Societal Factors Based on work by Diaz et al. 2004, Herek 2007, Herek & Glunt 1995, Huebner 2002, Preston et al. 2007 Stigma External Felt Internalized Difficult Interpersonal or Sexual Situations Sexual Risk Taking Reduced Self-efficacy for Safe Sex Increased Interpersonal Barriers to Safe Sex

6. MSM is the only risk group in the US for whom HIV incidence has increased since 2000, part of a broader international trend. 62% of all new HIV diagnoses in US in 2011 were due to male-to-male sexual contact. HIV among MSM Hightow-Weidman et al. 2011, Beyrer et al., 2013; Morris & Little, 2011; Sullivan et al., 2009; CDC 2013

7. HIV in South Carolina Eight of 10 states with highest HIV diagnoses rates in 2011 are in Southern US. –South Carolina ranked ninth. In 2010, HIV prevalence exceeded national average in 57% of South Carolina counties. –Prevalence was more than twice the national average in 10 counties. CDC 2013; AIDSVu

8. Study Objective Efforts to increase tolerance of, and reduce discrimination against, MSM could be a viable alternative to behavioral interventions. Describe perceptions of discrimination among MSM in South Carolina.

9. Methods: Recruitment June 13-July 15, 2013. 12 banner ads. Facebook profiles: –18 years and older. –Male. –Reside in SC.

10. Methods: Survey Questionnaire Demographics Age. City of residence. Race/ethnicity. Main male partner (Y/N). –Status of relationship? STD diagnoses past year. Perceived Discrimination Degree of agreement with 16 positive negative and negative statements about discrimination against gay and bisexual men in city of residence. –Five-point Likert scale: “Strongly disagree” to “Strongly agree”

11. Methods: Analysis Likert scale responses coded so higher number reflected greater discrimination. –0=lowest to 4=highest Discrimination summary scales. –Overall: all 16 statements (score range: 0-64) –Partial: 9 statements (score range: 0-36) Descriptive statistics. Linear regression of discrimination scales.

12. Respondent Flowchart NOT Qualified or Consented 732 Impressions: 10,347,406 Reaches: 1,459,492 Clicks: 3,357 Surveys Initiated 985 (29.3% of clicks) Qualified or Consented 253 (7.5% of clicks)

13. Sample Characteristics Number (%) Age (n=253) 18 to 34 years113 (44.6%) 35 to 54 years95 (37.6%) 55 years and older45 (17.8%) Race (n=253) White209 (82.6%) African American18 (7.1%) Main Male Partner (n=250)110 (44.0%) Relationship Status (n=109) Married36 (33.1%) Boyfriend64 (58.7%) STD Diagnosis Past 12 Months (n=214)14 (6.5%)

14. Perceptions of Discrimination 66.7% agreed most people in their city/town think less of man who is gay or bisexual. 55.8% disagreed most people would treat gay/bisexual man same as anyone else. 67.3% felt most people would not hire gay/bisexual man to care for their children. 53.7% expressed desire to live someplace with stronger gay community.

15. Perceived Discrimination Scale Mean scores: –Overall scale: 34.79 (SD=±10.3) –Partial scale: 19.9 (SD=±7.5) Both overall and partial scores showed general decrease with age. –Prior findings show link between internalized stigma and sexual risk may wane over time. Newcomb & Mustanski, 2011

16. Linear Regression Results Coefficients (p-value) Covariates Overall Discrimination Score (n=177) Partial Discrimination Score (n=192) Intercept37.24 (p<0.05)20.45 (p<0.05) Age-1.19 (p<0.05)-0.22 (p=0.57) Race/Ethnicity0.38 (p=0.69)0.13 (p=0.85) STD Diagnosis Past 12 Months-6.46 (p<0.05)-3.57 (p=0.14) Race/Ethnicity x STD Past 12 Months1.94 (p=0.48)1.71 (p=0.41) R2R2 0.050.01 Adjusted R 2 0.03-0.01

17. Strengths and Limitations Strengths. –First research of its kind in South Carolina. –Recruitment method. Limitations. –Recruitment method. –Respondents restricted to only those sexually active in past 12 months.

18. Conclusions Levels of perceived discrimination against MSM in South Carolina indicate efforts to increase tolerance could be an effective alternative to behavioral interventions. Determining specific drivers of perceptions and leverage points for intervention require further study.

19. Acknowledgements Rob Stephenson, Associate Professor, and Patrick S. Sullivan, Professor, at Emory University Rollins School of Public Health. College of Charleston Department of Health and Human Performance. All survey respondents.

20. Presenter Disclosures Matthew J. Page, PhD, MPP (1)The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No relationships to disclose.

21. THANK YOU I can be reached at pagemj@cofc.edu.