Table 2.

Characteristics of studies (HIV negative MSM)

Author(s)	Year of publication	Location	Aims/purpose	Sample size	Methodology	Exposure (s)	Outcome (s)	Key findings
Quantitative studies
Kaston D. Anderson-Carpenter, et al. [36]	2019	All 50 US states, Washington, DC, and Puerto Rico	To examine associations between perceived homophobia, community connectedness, and having a health care provider among men who have sex with men (MSM)	2281 MSM	Cross-sectional	Perceived Homophobia	Having a regular health care provider	1. Greater level of perceived community level homophobia were associated with a lower likelihood of having a health care provider
Alexandra B. Balaji, et al. [37]	2017	Atlanta, Georgia; Baltimore, Maryland; Boston, Massachusetts; Chicago, Illinois; Dallas, Texas; Denver, Colorado; Detroit, Michigan; Houston, Texas; Los Angeles, California; Miami, Florida; Nassau, New York; Newark, New Jersey; New Orleans, Louisiana; New York City, New York; Philadelphia, Pennsylvania; San Diego, California; San Francisco, California; San Juan, Puerto Rico; Seattle, Washington; and Washington, District of Columbia	To examine the association between measures of enacted stigma (related to sexual minority) and HIV-related risk behaviors	9819 MSM	Cross-sectional; NHBS	Enacted Stigma: verbal harassment, discrimination, physical assault	HIV-related risk behaviors: CAI at last sex with a male partner of HIV discordant or unknown status and the past 12-month measures of CAI with a male partner, four or more male sexual partners, and exchange sex	1. A sizable proportion of participants had experienced some form of enacted stigma related to sexual minority status in the past 12 months; 2. Age was strongly related to the risk of victimization (more for younger ones); 3. No association between self-reported HIV status and any of the enacted stigma measures
Abigail W. Batcheldera, et al. [56]	2020	Boston, Massachusetts	To examine sexual orientation discrimination and HIV stigma in relation to condom less anal sex among MSM	382 MSM	Cross-sectional; NHBS	Sexual orientation discrimination, HIV related stigma	Sexual risk (number of condom less anal sex male partners in the past 12 months)	1. Substance use was associated with health care discrimination and physical assault; 2. Substance use and both forms of discrimination were associated with more condom less anal sex; 3. Hispanic MSM reported more workplace discrimination
Adolph Joseph Delgado, et al. [38]	2016	USA	To increase the body of knowledge on the sexual and behavioral health among gay and bisexual servicemen while investigating whether heteronormative roles and expectations led to discrimination and psychological stress. Further analyses were conducted to determine if stress and discrimination that negatively impacted negative health behaviors (i.e., using tobacco, drinking alcohol) and risky sexual behavior (i.e., having casual sex partners)	85 GB service men	Cross-sectional	Discrimination and psychological stress	Negative health behaviors (i.e., drugs, tobacco, and alcohol) and risky sexual behaviors	1. Gay and Bi servicemen reported experiencing discrimination more often than straight; 2. Sexual orientation is a significant predictor of tobacco use, alcohol use, and casual sex
Susan A. Fallon, et al. [24]	2017	Baltimore	To examine correlates of PrEP awareness and willingness to use PrEP	399 MSM	Cross-sectional	Discrimination and stigma	PrEP awareness and PrEP use	1. Black was associated with decreased awareness of PrEP; 2. People who perceived discrimination against HIV were less likely to hear of PrEP but more likely to take it; 3. Perception of HIV intolerance is a barrier for MSM to accessing HIV prevention; 4. HIV-related stigma influence PrEP use
Catherine Finneran, et al. [39]	2014	USA	To explore the associations between minority stress and both intimate partner violence and sexual risk-taking	1575 MSM	Cross-sectional	Internalized homophobia index, homophobic discrimination index, racist discrimination index	Experienced Physical Violence, experienced sexual violence, perpetrated physical violence, perpetrated sexual violence, unprotected anal sex	1. Minority stress has significant associations with sexual violence; 2. Non-white race, low education, HIV Positive have significant associations with violence and sexual risk; 3. The bidirectional association between perpetration of sexual intimate partner violence and unprotected anal intercourse at last sex; 4. No association of homophobia and HIV risk
Victoria Frye, et al. [40]	2015	NYC	To assess the relationship between sexual orientation and race-based experiences of discrimination and sexual HIV risk behavior	1369 MSM	Cross-sectional	Experience of race- and sexual orientation-based discrimination	HIV acquisition risk behavior, HIV transmission risk behavior	1. self-reported experience of sexual orientation-based discrimination only within the past 3 months that was significantly associated with sexual HIV acquisition risk behavior; 2. Psychological distress and alcohol and/or drug use before/during last sex, were associated with the outcome, but not internalized homophobia
Tamar Goldenberg, et al. [41]	2018	Detroit	To understand and address the social and structural factors influencing HIV/AIDS among Black and Latino YMSM	334 YMSM	Cross-sectional survey	Perceived community prejudice, internalized homonegativity (IH), experience of sexuality-related discrimination	Three outcomes for HIV testing were examined: testing for HIV in 2012; previously testing for HIV, but not in 2012; and never testing for HIV	1. Higher perceived sexuality prejudice with higher odds of HIV testing, but not associated with timing since last test; 2. IH was negatively associated with likelihood of testing for HIV; 3. No association between stigma and recency of HIV testing among YMSM who had tested in the past
Michael A. Hoyt, et al. [42]	2012	Central Arizona	To investigate relationships between institutional mistrust, HIV risk behaviors, and HIV testing	394 MSM	Longitudinal study	Institutional Mistrust (systematic discrimination, organizational suspicion, conspiracy beliefs), perceived susceptibility to HIV	Sexual risk behaviors	1. Perceptions of systematic discrimination were related to lower likelihood of having received HIV testing; 2. Among minority, conspiracy beliefs impact HIV risk behaviors; 3. Higher levels of mistrust are more detrimental to minority MSM, resulting in increased risk-taking behavior, less testing
William L. Jeffries 4th, et al. [43]	2013	NYC and Philadelphia	To examine the association of the experience of homophobic and whether social integration level affects the association	1140 Black MSM	Cross-sectional	Homophobia; social integration	Sexual risk behaviors such as unprotected anal sex	1. People experienced homophobic events are more likely to have UAI than people did not; 2. For people not diagnosed of HIV positive before, being bullied increases their UAI; 3. For people diagnosed of HIV positive before, all type of homophobic events increase their HIV transmission; 4. Social integration cannot mitigate the association of homophobia and UAI
Leslie E. Kooyman [44]	2008	South USA-Charlotte, North Carolina; Columbia, South Carolina; and, Nashville, Tennessee	To examine the predictive value of peer norms, self-efficacy, stigma, social support, age, and recreational drug use on high-risk sexual behavior	576 gay and MSM	Cross-sectional	Stigma	High-risk sexual behaviors	1. Low peers’ norms for safer sex, low self-efficacy, greater family, and community stigma, being younger in age, and greater drug use do predict higher risk sexual behavior; 2. Predictors might be interrelated
Jessica L. Maksut, et al. [45]	2018	Southeast USA	1. To determine the extent of PrEP awareness among BMSM; 2. to examine whether perceived healthcare-related discrimination, disclosure of same-sex sex behavior to a healthcare provider, and participants’ age were related to PrEP awareness among BMSM; and whether age moderated the relationship between perceived healthcare-related discrimination and PrEP awareness	147 BMSM	Cross-sectional	Perceived healthcare related discrimination, disclosure of same-sex behavior	PrEP awareness	1. Perceived healthcare related discrimination was significantly negatively associated with PrEP awareness; 2. Same sex behavior disclosure was significantly positively associated with PrEP awareness; 3. Older BMSM were significantly less aware of PrEP as an HIV prevention strategy than were their younger counterparts; 4. Age moderated the relationship between perceived healthcare related discrimination and PrEP awareness
Henry F Raymond, et al. [28]	2011	San Francisco	To examine the association of negative life factors during adolescence and adult HIV status	521 MSM	Cross-sectional	Adolescent life course negative factors: disconnected, discriminated, harassed, uncomfortable	Adult HIV status	1. There were high level of ever being harassed, ever being discriminated, and ever feeling disconnected from community and being uncomfortable with sexuality [12-18yrs]; 2. Higher harassment experiences, higher discrimination, and higher discomfort at ages 12–18 are associated with HIV Neg status as adult; 3. Black MSM do not experience more negative life course factors that others
John E. Pachankis, et al. [47]	2016	NYC	To investigate migration-related motivations, experiences, health risks	273 YGBM	Cross-sectional	Hometown characteristics (size, USA or not, structural stigma, discrimination), experiences upon arrival (income, gay density, knew no one in NYC, recently arrived), migration motivations (escape, opportunity, work/school)	HIV transmission risk behavior; heavy drug use; alcohol use; mental health problems	1. Hometown interpersonal discrimination was strongly related to all assessed health risks, including HIV transmission risk, heavy substance use, alcohol use problems, and mental health problems, although hometown structural stigma climate was associated with lower odds of heavy drug use; 2. There is an inverse association between hometown structural stigma and substance use
Catherine E. Oldenburg, et al. [46]	2016	Boston	To assess PrEP awareness, use, and intent to use among those who reported engaging in condom less anal intercourse in the context of stimulant and/or alcohol use	254 MSM	Cross-sectional	Substance use	PrEP awareness and use	1. Stimulant-using MSM reported engaging in higher risk sex more often than alcohol-using MSM; 2. For alcohol users, HIV stigma is a limiting factor in PrEP use; 3. Significant association between type of substance used and concern about HIV stigma; 5. Black MSM are more concerned of HIV stigma
Kellie Schueler, et al. [48]	2019	Chicago	1. To characterize HIV-positive index participants and the members of their potential transmission networks; 2. To understand how behavioral factors, PrEP use within networks, and experiences of stigma and community support are associated with awareness and use of PrEP among transmission network members	218 MSM	Cross-sectional	Stigma, support, HIV status, HIV test, HIV knowledge	PrEP awareness and PrEP use	1. Individuals who were aware of PrEP were more likely to identify as gay, be highly educated, engaged in health care, and have HIV-related social support; 2. PrEP users were more likely to know other PrEP users
Ja’Nina J. Walker, et al. [49]	2015	NYC	To understand the ways in which racial and sexual identities may serve as buffers to risky sexual behavior	120 Black GBM	Cross-sectional	Racial identities, sexual identities	Risky sexual behavior	1. Racial identity was associated with sexual risk behavior; 2. There is no association of sexual identity and sexual risk behavior
Jennifer L. Walsh [50]	2019	Midwestern US	To explore factors associated with PrEP intentions and use	476 MSM	Cross-sectional	PrEP knowledge, PrEP attitudes, PrEP stigma, PrEP descriptive norms, PrEP subjective norms, PrEP self-efficacy	PrEP intention and use	1. Information (PrEP knowledge); motivation (PrEP attitudes, PrEP stigma, and PrEP descriptive norms); and behavioral skills (PrEP self-efficacy) all had associations with PrEP use; 2. PrEP knowledge was directly associated with PrEP use; 3. Latino MSM were less knowledgeable about PrEP than White and Black MSM; 4. Self-efficacy for PrEP use was positively associated with PrEP use and PrEP intention
Sari L Reisner, et al. [52]	2019	US	To assess PrEP indication and uptake as a means of primary HIV prevention	857 trans MSM	Cross-sectional	PrEP awareness, uptake, and persistence	PrEP indications	1. Majority heard of PrEP, but PrEP uptake was low and PrEP indications were high; 2. Higher perceived HIV risk was found to be associated with increased odds of PrEP indication; 3. Higher partner stigma was associated with increased odds of PrEP indications
Katie Wang, et al. [54]	2016	NYC	To investigate associations among gay-related rejection sensitivity, condom use self-efficacy, and condom less anal sex	63 MSM	Cross-sectional	Gay-related rejection sensitivity, safer sex self-efficacy	Condom less anal sex	1. Gay related rejection were positively associated with the number of condom less anal sex acts with casual partners; 2. Gay-related rejection sensitivity was associated with lower self-efficacy for condom use, which in turn predicted a higher number of condom less anal sex acts
Erik D. Storholm, et al. [53]	2019	Dallas and Houston	To assess the mediating effects of gay pride/self-esteem, resilience, and social support on the relationship between stressful experiences of racism and homophobia, stimulant use, and sexual risk behavior	1817 YBMSM	Cross-sectional	Minority stress (experienced homophobia, experienced racism, internalized homophobia)	Sexual risk behavior	1. Minority stress was significantly and directly associated with sexual risk behavior; 2. Stimulant use was associated with sexual risk behavior; 3. There is no association between minority stress and stimulant use; 4. Minority stress was found to be negatively associated with sources of resilience
Hirokazu Yoshikawa, et al. [55]	2004	Northeastern city, USA	To examine the influence of experiences of racism, homophobia, and anti-immigrant discrimination on depressive symptoms and HIV risk	192 Asian and Pacific Islander MSM	Cross-sectional	Experience of discrimination (racism, homophobia, anti-immigrant discrimination)	Depressive symptoms, HIV risk (UAI)	1. Experiences of discrimination and conversations about discrimination with family members were somewhat associated with both depression and HIV risk; 2. Conversations with gay friends and with family members about discrimination were associated with lower levels of UAI with primary partners; 3. High levels of discrimination + low levels of conversations with family about discrimination was associated with the highest levels of UAI; 4. Low levels of racism + low levels of family discussions was related to highest levels of secondary-partner UAI
Sharon Mannheimer, et al. [51]	2014	Atlanta, GA; Boston, MA; New York, NY; Los Angeles, CA; San Francisco, CA; and Washington, D.C	To assess frequency and correlates of infrequent HIV testing and late diagnosis	1301 Black MSM	Cross-sectional	Internalized HIV stigma, employment status, housing status, seeing a health care provider	Late HIV diagnosis	1. Infrequent testing was associated with higher frequency of newly diagnosed HIV infection compared to that among BMSM tested in the prior 12 months and was not associated with lower CD4 or late diagnosis; 2. Unemployment, not seeing health care provider, high internalized HIV stigma are independently associated with infrequent testing
Qualitative studies
Derek T. Dangerfield li, et al. [61]	2018	LA	To inform the development of an intervention for promoting HIV and STI testing, prevention, and treatment	24 Black MSM	5 Focus groups	Barriers and facilitators	HIV testing	1. Fear, stigma and drug use are barriers to HIV testing; 2. Symptoms, new relationships, perceptions of risk, community HIV prevalence and peer navigators are motivations to HIV testing
Joseph P. De Santis, et al. [62]	2014	Florida	To describe the relationship of risky sexual behavior, substance abuse, and violence within the cultural context	20 Latino MSM	Focus group	Roots of risk: acculturation, culture, discrimination, economics, immigration issues, peer influences, unstable intimate relationships	Burden of violence, substance abusers as a buffer, negation of sexual risk	1. Acculturation to mainstream U.S. culture could be both a risk and protective factor for the acquisition of HIV infection; 2. Internal and external sources of discrimination resulted in stress that was mitigated by high-risk sexual behaviors and substance abuse, and sometimes IPV; 3. Economic factors, unstable intimate relationships and access to psychological support contributed to high-risk sex, substance abuse, and violence
Maria Knight Lapinski, et al. [67]	2010	Michigan	To addresses the functional role of stigma in human social systems and the nature of the Down Low phenomenon	32 for Interviews, Black MSM, 24 for focus group, BMSM,	Interview, focus groups	Stigma	Down low (closet), sexual risk	1. Organized religion was viewed as a source of expressing stigma around sex and sexuality; 2. Stigma and discrimination are linked to sexual risk behaviors, mainly in health information and information seeking
David J. Malebranche, et al. [68]	2004	NY State; Atlanta	To assess healthcare experiences of BMSM and the perceived influence of their race and sexuality on these experiences; (2) perceived barriers to healthcare utilization and (3) factors affecting adherence in this population	81 BMSM	8 Focus groups	Racial and sexual prejudice; external barriers (money, insurance, lack confidentiality, impersonal medical system); internal barriers (distrust, fear, discrimination)	Access to medical care	1. Experiences with societal and institutional racism, and the subsequent expectation of medical racism, impacts how open BMSM are with providers about their sexuality; 2. Internalized displacement makes healthcare access difficult
José Nanín, et al. [63]	2009	NYC	To identify participants’ experiences with and attitudes and other factors toward HIV testing	29 BMSM	Focus group	Fear, stigma, universality of messages, responsibility, sexuality, religion, race and class, knowledge, media influences	HIV Testing	1. How to overcome barriers to HIV testing: hiring and retention of competent testing personnel, use of more focused, competent, community relevant messages in HIV testing
Jennifer R. Pharr, et al. [64]	2015	Nevada	To identify barriers as well as facilitators to HIV testing so as to inform future interventions to increase testing among this group	11 YMSM	Semi-structured focus group	Barriers: lack of awareness and knowledge, fear, lack of self-esteem, access problems, stigma, unfriendly environment; Facilitators: fear about having HIV, access, friendly environment	HIV Testing	1. The greatest barrier is lack of awareness and knowledge and the perception of stigma is a major barrier; 2. Friendly environment is important facilitator
Whitney S. Rice, et al. [65]	2019	Birmingham, Alabama	To explore perceptions of PrEP access among current and potential PrEP users; to assess the effects of stigma on PrEP uptake an adherence	44 MSM	Semi-structured interviews	Barriers and facilitators (approachability, acceptability, availability and accommodation, affordability, appropriateness)	PrEP use	1. Barriers: lack of awareness particularly within communities of color; 2. Facilitators: PrEP-related information gathering and sharing, making PrEP more approachable, social support networks, cost assistance programs, and clinical support staff
Karolynn Siegel, et al. [66]	1989	NYC	To explore the motives of gay men for taking or not taking HIV test	120 MSM	Unstructured focused interviews	Motives	HIV Testing	To test: 1. To enable medical treatment for HIV infection and to inform sexual decision making; 2. to relieve the psychological distress associated with not knowing HIV status; To not test: 1. To avoid the adverse psychological impact of being positive and to avoid social discrimination
Thomas Alex Washington, et al. [25]	2015	LA	To explore the barriers and challenges to HIV testing uptake behavior	36 Black YMSM	Focus group	Barriers to HIV testing (lack of knowledge for HIV testing; anxiety and substance use; lack of peer support; stigma; perceptions about HIV testing and treatment facilities	HIV testing	1. Young BMSM are drinking alcohol before and during sex, and as a result having condom less sex; thus, increasing their risk for HIV
Joseph P. Stokes, et al. [69]	1998	Atlanta and Chicago	To examine the relationship of negative attitudes toward homosexuality, self-esteem, and risk for HIV	76 Black MSM	Interview	Homophobia	HIV risk	1. Fear of being perceived as gay or bisexual can lead some men to avoid showing interest in information about HIV and AIDS or to avoid discussing using condoms