Background: HIV-related stigma impedes HIV prevention and care. HealthMpowerment.org (HMP) is an interactive online HIV prevention and care intervention for young Black men who have sex with men (YBMSM) in the United States. HMP included three forums where participants shared experiences. We explored whether engaging in stigma-related discussions was associated with changes in HIV-positive YBMSM care-related outcomes.
Methods: HIV-positive YBMSM (ages 18-30; N=107) in HMP completed surveys at baseline, three-
(end of intervention) and six- (3 month post intervention) months that included HIV care continuum items (e.g. retention in care, disclosure to partners). We also coded instances when HIV-positive YBMSM posted HIV-related stigma content on the site. We employed growth curve modeling to examine whether changes in HIV-positive YBMSM''s care-related outcomes were associated with stigma-related discussions in the site.
Results: Twenty percent of HIV-positive YBMSM (N=21; 19.6%) composed posts with HIV-related stigma content. HIV-positive YBMSM whose posts challenged HIV stigma were more likely over the 6-month follow-up to report greater provider communication (Cohen''s d=.51; p< .01), serostatus disclosure to partners (Cohen''s d=.38; p< .05), easier access to antiretroviral therapy (ART) (Cohen''s d=.42; p< .05), and more likely to be in care (Hazard Rate=2.92 [1.25,6.83]; p< .01). Conversely, participants whose posts reflected anticipated HIV stigma were less likely to be in care (Hazard Rate =.05 [.01, .20];
p< .001) and to have a viral load test in the prior 3 months (Hazard Rate =.05 [.01, .040]; p< .01). Participants whose posts reinforced HIV stigmatizing norms were less likely to report disclosing their serostatus to recent sexual partners over time (Cohen''s d=-.39; p< .05). Participants who shared experiences of HIV stigma were more likely to report lower ART adherence over time
(Cohen''s d=-.67; p< .001).
Conclusions: Developing online strategies to combat stigma remains a key priority. HMP created a space where YBMSM could discuss HIV-related stigma. These discussions were associated with changes in the sample''s HIV care continuum outcomes over time. Online interventions (e.g., social media, apps) should consider the inclusion of forums to address stigma, including resources to overcome anticipated stigma and leverage online peer support within their sites to improve YBMSM''s HIV care outcomes.