Stigma matters: HIV and HIV risk perception among men who have sex with men in Serbia; a qualitative study

Abstract

As a social determinant of health, stigma is a major barrier to health care access, illness management and completing the treatment. It is attributed both to HIV as a health condition and to the populations at risk of being infected with it. In Serbia, HIV is associated with men who have sex with men (MSM), with a noticeable stigma towards them. Drawing upon a qualitative cross-sectional study, conducted in three Serbian cities, we explore the MSM’s perception of HIV in the context of that social stigma. Using a respondent-driven sampling approach, 62 targeted MSM respondents participated in focus groups discussions and in-depth interviews. We found that the participants’ understandings of the HIV infection, risks and prevention are shaped by stigma. Those MSM who resisted stigma relativised the HIV risk, associating it with the general population and HIV-positive MSMs, believing that HIV, perceived as a chronical illness, was unjustly related to MSM. As one of the main preventive measures, serosorting was based on alleged HIV-positive statuses of potential sexual partners. HIV-negative participants described perceiving HIV-positive MSM as the ones responsible for spreading the virus, since they were concealing their positive status. As a response to stigma, MSM tended to challenge the HIV discourse, shifting it away from MSM onto the general (male) population and HIV positive MSM. Our analysis suggests that stigma resistance may make MSM more susceptible to taking risks. HIV prevention programmes should take the social context of MSM into account and target MSM-related stigma.

Keywords:

• HIV
• men who have sex with men
• stigma
• focus groups
• in-depth interviews
• risk

Acknowledgements

We would like to acknowledge funding support from the HIV project of the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM), led by Ministry of Health of the Republic of Serbia as the Primary Recipient for Round 8. We would also like to acknowledge the approval of the Ministry of Health and the ‘Dr Milan Jovanović Batut’ Institute of Public Health of Serbia, who implemented the survey, to explore the research data. We thank all individuals who participated in interviews or focus groups discussions, and especially the civil society organisations working on HIV prevention among MSM, which helped in study design and implementation: Association ‘Rainbow’ from Šabac, ‘Safe Pulse of Youth’ from Belgrade and Youth of JAZAS from Novi Sad. We are also grateful to the interviewer who conducted the in-depth interviews and acted as observer/recorder for the FGDs, Aleksandar Stojanović, Department of Ethnology and Anthropology, Faculty of Philosophy, Belgrade, and the interviewer Staša Plećaš, Association Against AIDS – JAZAS, Belgrade.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria through HIV project of Ministry of Health of Republic of Serbia [SER-809-G04-H]. All authors declare independence from these funding agencies.