1. STIGMA AND HIV The Experience of African American Men Terrell J.A. Winder Charles Lea Shannon L. Dunlap

2. DEFINING STIGMA How do we define stigma? What are the first words that come to mind when we think of stigma?

3. DEFINING STIGMA Link and Phelan (2001, pg. 367), expand Goffman’s seminal work (Notes on a Spoiled Identity, 1963) further by developing four processes of stigma: 1) “human differences are labeled by others; 2) dominant culture stereotypes these labels; 3) categories of labels separate the labeled group from larger society; and 4) status loss and discrimination leads to unequal outcomes.”

4. TYPES OF STIGMA Enacted Stigma Negative reactions to stigma, especially in social settings” and “episodes of discrimination experienced by those with the stigmatizing attribute” Saewyc, E. M., Poon, C. S., Homma, Y., & Skay, C. L. (2008); Lekas, H. M., Siegel, K., & Leider, J. (2011) Internalized Stigma “self-directed prejudice in response to adapting one’s self-concept to be congruent with stigmatizing responses by society” Herek, Gillis, & Cogan, 2009 Anticipated Stigma “The degree to which individuals expect that others will stigmatize them in various settings” Quinn & Chaudoir, 2009

5. TYPES OF STIGMA Concealable Stigma “A stigma that can be kept hidden from others but carries with it a social devaluation” Quinn & Chaudoir, 2009 Associative Stigma “A stigma due to association (typically a caregiver, sibling, parent, partner, friend) of someone who carries a concealable stigmatized identity.” Quinn & Chaudoir, 2009

6. COMPONENTS OF STIGMA CentralitySalience

7. MINORITY STRESS THEORY Illan Meyer(1995, 2003), UCLA’s Williams Institute Combines stress theory (Lazarus and Folkman, 1984), social psychological theories, and social stress theories to understand both chronic and recent stress experiences of LGB people. Minority stress theory incorporates “(a) external, objective stressful events and conditions, (b) expectations of such events and the vigilance this expectation requires, and (c) the internalization of negative societal attitudes” (Meyer, 2003).

8. INTERSECTION OF STIGMA Institutional Individual Temporal Gender Race/ethnicity Sexual orientation Behavior Religion Geography Others? Compiling stigma – multiple stigmas, sometimes over many years

9. FINDING SELF, DEVELOPING COMMUNITY, AND BECOMING ADULTS: YOUTH DEVELOPMENT ORGANIZATIONS IN THE MAKING OF SEXUAL AND RACIAL MINORITY IDENTITY Terrell J.A. Winder (2013)

10. Some of the words used to describe their sexualities based in religious reasoning included: “abomination” “a sin” “[all gays are] going to hell” ”morally wrong” or “immoral” “against God” “[should be] prayed away” “damnation”

11. INTERVIEW EXCERPT Me: Ok. What are some of the messages you’ve received about being bisexual? Rahsaan: Well black and bisexual… the first message that I received was that I’m going to hell…um, and it was a sin, and it was a choice I made on my own…Um, my parents really didn’t approve, well they definitely didn’t approve of any homosexuality at all. The message I got after that would be that um…any gay man had HIV and that they were sick or disgusting…and that was pretty much the first two messages that I got…about that.

12. WHAT DOES THE RESEARCH SAY? Impact of stigma and on stigma...... Adherence (clinic appointments; HAART adherence within past week) Depression, anxiety, hopelessness Receipt of psychiatric care Greater HIV-related symptoms Those who reported HIV transmission likely due to IV drug use or sex with multiple partners reported significantly more stigma than those reporting HIV transmission due to sex with one partner.

13. SMALL GROUP ACTIVITY Billboards

14. STIGMA IN THE HEALTHCARE SETTING What are some ways that people with and affected by HIV experience stigma in the healthcare setting? How can stigma impact care? What can we do to mitigate stigma experienced within healthcare settings?

15. STIGMA INSTRUMENTS INSTRUMENT TITLE: STD Related Stigma and STD Related Shame SOURCE ARTICLE: Fortenberry, J. D., McFarlane, M., Bleakley, A., Bull, S., Fishbein, M., Grimley, D. M., et al. (2002). Relationships of stigma and shame to gonorrhea and HIV screening. American Journal of Public Health, 92, 378-381. INSTRUMENT TITLE: Visser HIV-related stigma SOURCE ARTICLE: Visser, M. J., Kershaw, T., Makin, J. D., & Forsyth, B. W. C. (2008). Development of parallel scales to measure HIV- related stigma. AIDS and Behavior, 12, 759-771. Berger HIV-Stigma Scale (40-items) Berger, B.E., Ferrans, C.E., & Lashley, F.R. (2001). Measuring stigma in people with HIV: Psychometric assessment of the HIV Stigma Scale. Research in Nursing and Health, 24, 518-529. Youth Stigma Scale (Revised Berger) Wright, K., Naar-King, S., Lam, P., Templin, T., & Frey, M (2007). Stigma Scale Revised: Reliability and validity of a brief measure of stigma for HIV+ youth. Journal of Adolescent Health, 40, 96-98.

16. REFERENCES Goffman, E. (1963). Stigma: Notes on a spoiled identity. New York: Simon and Schuster. Herek, Gillis, & Cogan (2009). Internalized stigma among sexual minority adults: Insights from a social psychological perspective. Journal of Counseling Psychology, 56, 32-43 Link, B. G., & Phelan, J. C. (2001). Conceptualizing stigma. Annual review of Sociology, 27, 363-385 Meyer, I.H (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697. doi: 10.1037/0033-2909.129.5.674 Meyer, I.H (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36, 38-56. Quinn, D.M. and Caudoir, S.R. (2009). Living with concealable stigmatized identity: The impact of anticipated stigma, centrality, salience, and cultural stigma on psychological distress and health. Journal of Personality and Social Psychology, 97, 634-651. Saewyc, E. M., Poon, C. S., Homma, Y., & Skay, C. L. (2008); Lekas, H. M., Siegel, K., & Leider, J. (2011). Stigma management? The links between enacted stigma and teen pregnancy trends among gay, lesbian and bisexual students in Brittish Columbia. Canadian Journal of Human Sexuality, 17, 123-139.