The Impact of Anticipated HIV Stigma on Delays in HIV Testing Behaviors: Findings from a Community-Based Sample of Men Who Have Sex with Men and Transgender Women in New York City

TLDR

Treatment as prevention relies on timely testing and linkage to care, yet while HIV‑associated stigma has been studied among positives, little is known about how anticipated stigma may deter testing among at‑risk populations. The study investigated how anticipated stigma relates to HIV testing behaviors in 305 MSM and transgender women in New York City. The cross‑sectional survey included 305 MSM and transgender women (mean age 33, 65.5 % minorities, 50.2 % earning <$20 k) to assess the link between anticipated stigma and testing behaviors. Among participants, 32 % had not tested in the past six months, and higher anticipated stigma, lower risk perception, and younger age were independently associated with reduced testing, suggesting that stigma‑focused campaigns could shift norms and improve testing uptake.

Abstract

Treatment as prevention (TaSP) is a critical component of biomedical interventions to prevent HIV transmission. However, its success is predicated on testing and identifying undiagnosed individuals to ensure linkage and retention in HIV care. Research has examined the impact of HIV-associated stigma on HIV-positive individuals, but little work has explored how anticipated HIV stigma-the expectation of rejection or discrimination against by others in the event of seroconversion-may serve as a barrier to HIV testing behaviors. This study examined the association between anticipated stigma and HIV testing behaviors among a sample of 305 men who have sex with men (MSM) and transgender women living in New York City. Participants' mean age was 33.0; 65.5% were racial/ethnic minority; and 50.2% earned <$20,000 per year. Overall, 32% of participants had not had an HIV test in the past 6 months. Anticipated stigma was negatively associated with risk perception. In multivariate models, anticipated stigma, risk perception, and younger age were significant predictors of HIV testing behaviors. Anti-HIV stigma campaigns targeting HIV-negative individuals may have the potential to significantly impact social norms around HIV testing and other biomedical strategies, such pre-exposure prophylaxis, at a critical moment for the redefinition of HIV prevention.