A scoping review of the integration of empowerment-based perspectives in quantitative intersectional stigma research

Figures & data

Figure 1. Flow diagram of the intersectional stigma quantitative scoping review.

Table 1. Studies addressing intersectional stigma included in scoping review (n=32).

Author(s)	Method	Sample Size	Study objective	Stigma and health/social identities assessed	Were empowerment-based factors measured
Algarin et al. (2019)	Quant	932	-examined associations between combinations of marginalised group identities and enacted HIV-related stigma	HIV-related stigma; marginalised group identity (age; sex; race; ethnicity; sexual orientation)	No
Bastos et al. (2018)	Quant	12,368	-examined associations between racial discrimination and health care barriers, and if racial discrimination effects varied by gender, sexual orientation and socio-economic status, and if other forms of discrimination impacted healthcare barriers	Racial discrimination; class, gender, and sexuality discrimination	No
Bouris and Hill (2017)	Quant	163	-examined associations between minority stressors (sexual orientation and gender identity stigma, racial discrimination), and protective factors (resilience, LGBT community connectedness, school-based social support, maternal resources) between sexual and gender minority (SGM) youth	Gender identity stigma; sexual orientation stigma; gender identity; sexual orientation; racial discrimination	Yes
Brown (2014)	Quant	376	-explored how gender and physical disability intersect to affect psychological distress -examined if the interaction between perceived devaluation and self/social approvals varied by gender, and examined if the interaction between functional limitation and self/social appraisal varied by gender	Disability; gender	Yes
Calabrese et al. (2018)	Quant	285	-examined sexual stereotypes associated with MSM, Black men, and white and Black MSM, including whether any unique stereotypes of Black MSM emerged	Racial stereotypes; sexual orientation stereotypes	No
DuPont-Reyes et al. (2020)	Quant	751	-co-examined effects of gender, race and ethnicity on mental illness stigma; also assessed familiarity with mental illness by level of contact with persons with mental illness	Mental illness stigma; race; ethnicity; gender	Yes
Dyar et al. (2020)	Quant	360	-examined within-group differences in stressors and health among non-monosexual persons by sexual, gender and ethnic/racial identities, also examined within group variation in associations between non-monosexual stressors and health by sex assigned at birth	Sexual orientation; gender identity; racial identity; non-monosexual stressors	No
Earnshaw et al. (2015)	Quant	85	-examined how internalized HIV stigma interacted with substance use internalized stigma and associations with depressive symptoms	HIV-related stigma; substance use stigma	No
Earnshaw et al. (2021)	Quant	151	-measured internalized stigma based on: race, sexual orientation, HIV/STI	Racial, sexual orientation and HIV/STI-related stigma	No
English et al. (2018)	Quant	376	-assessed racial discrimination and gay rejection sensitivity and their interaction with health outcomes (emotion regulation, depressive/anxiety symptoms, drug use, heavy drinking)	Racial discrimination; gay rejection sensitivity	No
Goodin et al. (2018)	Quant	60	-measured internalized HIV stigma and internalized chronic pain stigma, created a composite variable, and looked at associations with depressive symptoms	HIV stigma; chronic pain stigma	No
Haile et al. (2014)	Quant	2408	-measured differences in perceived racial inclusion, perceived racism, and positive affiliation with the gay community between Black and White MSM	Perceived racial inclusion; perceived racism	Yes
Himmelstein et al. (2017)	Quant	2378	-assessed weight stigma, weight bias internalisation, and maladaptive coping strategies (disordered eating) and racial differences	Weight stigma; weight bias internalisation; race	No*
Ion et al. (2017)	Quant	77	-examined associations between mental health, social support, and perceived racism on HIV-related stigma	HIV-related stigma; racism	Yes
Jackson et al. (2020)	Quant	131	-examined within-person associations between intersectional experiences based on race and sexual orientation and psychological wellbeing	Sexual minority stigma; racism	Yes
Lipperman-Kreda et al. (2019)	Quant	227	-examined perceptions of sexual and gender minority related discrimination and smoking-related stigma among SGM	Sexual minority; gender; smoking associated stigma	No
Logie et al. (2013)	Quant	173	-examined associations between HIV-related stigma, racial and gender discrimination, and depression, and social support and resilience coping as moderators and mediators of stigma effects on health	HIV-related stigma; racial discrimination; gender discrimination	Yes
Logie et al. (2016)	Quant	157	-examined associations between racial discrimination and: HIV-related stigma, housing insecurity, and social support	HIV-related stigma; racial discrimination; housing insecurity	Yes
Logie et al. (2018a)	Quant	556	-assessed if selling sex among MSM was associated with an increased likelihood of reporting sexual stigma or HIV-related stigma	Sex work; sexual stigma; HIV-related stigma	Yes
Logie et al. (2018b)	Quant	1425	-assessed associations between HIV-related stigma, racial discrimination and gender discrimination, and quality of life and mediating role of social support and economic insecurity	HIV-related stigma; racial discrimination; gender discrimination	Yes
Logie et al. (2019)	Quant	1422	-tested latent and observed variable approaches to an intersectional stigma construct (HIV-related stigma, racial and gender discrimination) via mediators of social support and women's centred HIV care to depressive symptoms	HIV-related stigma; racial discrimination; gender discrimination	Yes
Lyons et al. (2020)	Quant	375	-assessed longitudinal differences in stigma attributed to sex work or sexual and gender minority (SGM) status by HIV serostatus, and associations between viral suppression and stigma	Sex work stigma, sexual and gender minority stigma, stigma differences by HIV status	No
Makowski et al. (2019)	Quant	692	-assessed differences in fat phobia/obesity stigma vignettes based on the stigma target's gender and socio-economic status	Obesity stigma; gender; socioeconomic status	No
Moore et al. (2020)	Quant	185	-examined linkages between gender and multiple devalued identities (homelessness, sex work, illicit drug use) and internalized alcohol use stigma -examined associations between race, education, income, sex work, homelessness, and drug use with alcohol self-stigma	Alcohol use stigma; sex work; race, education, income, homelessness; drug use	No
Orza et al. (2015)	Mixed	832	-assessed associations between socially disadvantaged identities (e.g. sex work, drug use, incarceration history, disability, TB) and mental health outcomes	HIV; gender; mental health	No (only qualitative findings addressed strengths-based factors)
Rosengren et al. (2019)	Quant	324	-assessed HIV-related stigma and discrimination, sexual minority stigma, and racial discrimination and differences by HIV status and mobile app usage	HIV-related stigma; sexual minority stigma; racial discrimination	No
Sereda et al. (2020)	Quant	191	-examined differences in HIV stigma, substance use stigma, and/or an intersectional stigma variable that included both HIV and substance use stigma scores	HIV-related stigma; substance use stigma	Yes
Shangani et al. (2020)	Quant	396	-examined differences in minority stressors (sexual orientation stigma) by race, and the moderating impact of socio-economic status on the association between race and minority stressors	Race; socioeconomic status; sexual orientation stigma	No
Stewart et al. (2019)	Quant	729	-validated an anticipated sex work stigma scale and links to HIV and non-HIV service usage	Sex work stigma; HIV serostatus	No
Varas-Díaz et al. (2019)	Quant	237	-used standardised patients to explore intersectional stigma (HIV-related stigma, stigma towards people who use drugs, sexism, homophobia) in clinical interactions among medical students	HIV-related stigma; sexual minority stigma; substance use stigma; sexism	No
Weisz and Quinn (2018)	Quant	138	-examined independent and interactive effects of perceived homelessness stigma and perceived racial stigma and their associations with psychological distress, physical health, and service avoidance	Homelessness; race; gender; mental illness; addiction; criminal history; domestic violence history	No
Yang et al. (2020)	Quant	193	-examined main and interaction effects of HIV-related stigma and sexual and gender minority stigma on depression, anxiety, quality of life and resilience among MSM living with HIV	HIV-related stigma; sexual and gender-minority stigma	Yes

Table 2. Quantitative intersectional stigma studies that included empowerment-based factors (n=13).

Author(s)	Empowerment-based and Protective Factors Measured, Level of factor	Empowerment-based and Protective Factors Findings
Bouris and Hill (2017)	Resilience, LGBT community connectedness, school-based social support, maternal resources; intrapersonal, interpersonal, community and institutional levels	For sexual minority youth, resilience was associated with increased condomless anal sex, while mother-to-son communication about sex was associated with reduced condomless anal sex
		For gender minority youth, maternal warmth was related to improved mental health outcomes and maternal acceptance was related to reduced condomless anal sex
Brown (2014)	Self-esteem; mastery; intrapersonal level	Self-esteem and mastery were associated with reduced depressive symptoms among men
DuPont-Reyes et al. (2020)	Familiarity with mental illness (contact with persons with mental illness); interpersonal level	Familiarity with mental illness did not interact with intersectional groupings to impact stigma outcomes
Haile et al. (2014)	Positive affiliation with the gay community, racial inclusivity within the gay community; community level	Black MSM reported less racial inclusivity, and less positive affiliation, in the gay community than white MSM
Ion et al. (2017)	Social support; interpersonal level	HIV-related stigma was associated with reduced social support in pregnancy
Jackson et al. (2020)	Positive intersectional experiences; interpersonal and intrapersonal levels	Positive intersectional experiences were associated with positive rumination and positive affect within and between persons
Logie et al. (2013)	Social support; resilient coping; interpersonal and intrapersonal levels	Social support and resilient coping did not significantly moderate depression scores and only partially mediated effects of HIV-related stigma, racial discrimination, and gender discrimination
Logie et al. (2016)	Social support; interpersonal level	Racial discrimination, HIV-related stigma, and housing insecurity were associated with reduced social support
Logie et al. (2018a)	Social support; interpersonal level	Sex work was associated with increased sexual stigma and higher needs for social support
Logie et al. (2018b)	Social support; interpersonal level	Social support mediated the relationship between gender discrimination and HIV-related stigma and mental health-related quality of life
Logie et al. (2019)	Resilience; social support; women-centred HIV care; intrapersonal, interpersonal and institutional levels	Women-centred care mediated the relationship between (a) a latent intersectional stigma construct, and (b) gender discrimination, and depression
Sereda et al. (2020)	Co-located HIV and opiod agonist treatment; institutional level	Co-located HIV and substance use treatment were not significantly associated with reduced HIV or substance use stigma
Yang et al. (2020)	Psychological resilience; intrapersonal level	There was an interaction where high levels of both SGM stigma and HIV-related stigma resulted in significantly lower psychological resilience

Algarin, A. B., Zhou, Z., Cook, C. L., Cook, R. L., & Ibañez, G. E. (2019). Age, sex, race, ethnicity, sexual orientation: Intersectionality of marginalized-group identities and enacted HIV-related stigma among people living with HIV in Florida. AIDS and Behavior, 23(11), 2992–3001. https://doi.org/10.1007/s10461-019-02629-y

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Bastos, J. L., Harnois, C. E., & Paradies, Y. C. (2018). Health care barriers, racism, and intersectionality in Australia. Social Science & Medicine, 199, 209–218. https://doi.org/10.1016/j.socscimed.2017.05.010

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Bouris, A., & Hill, B. J. (2017). Exploring the mother-adolescent relationship as a promotive resource for sexual and gender minority youth. Journal of Social Issues, 73(3), 618–636. https://doi.org/10.1111/josi.12234

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Brown, R. L. (2014). Psychological distress and the intersection of gender and physical disability: Considering gender and disability-related risk factors. Sex Roles, 71(3), 171–181. https://doi.org/10.1007/s11199-014-0385-5

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Calabrese, S. K., Earnshaw, V. A., Magnus, M., Hansen, N. B., Krakower, D. S., Underhill, K., Underhill, K., Mayer, K. H., Kershaw, T. S., Betancourt, J. R., & Dovidio, J. F. (2018). Sexual stereotypes ascribed to black men who have sex with men: An intersectional analysis. Archives of Sexual Behavior, 47(1), 143–156. https://doi.org/10.1007/s10508-016-0911-3

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DuPont-Reyes, M. J., Villatoro, A. P., Phelan, J. C., Painter, K., & Link, B. G. (2020). Adolescent views of mental illness stigma: An intersectional lens. American Journal of Orthopsychiatry, 90(2), 201–211. https://doi.org/10.1037/ort0000425

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Dyar, C. E., Feinstein, B., Stephens, J., Zimmerman, A. R., Newcomb, M., & Whitton, S. W. (2020). Nonmonosexual stress and dimensions of health: Within-group variation by sexual, gender, and racial/ethnic identities. Psychology of Sexual Orientation and Gender Diversity, 7(1), 12–25. https://doi.org/10.1037/sgd0000348

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Earnshaw, V. A., Smith, L. R., Cunningham, C. O., & Copenhaver, M. M. (2015). Intersectionality of internalized HIV stigma and internalized substance use stigma: Implications for depressive symptoms. Journal of Health Psychology, 20(8), 1083–1089. https://doi.org/10.1177/1359105313507964

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Earnshaw, V. A., Reed, N. M., Watson, R. J., Maksut, J. L., Allen, A. M., & Eaton, L. A. (2021). Intersectional internalized stigma among Black gay and bisexual men: A longitudinal analysis spanning HIV/sexually transmitted infection diagnosis. Journal of Health Psychology, 26(3), 465–476. https://doi.org/10.1177/1359105318820101

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