Dissertations, Theses, and Capstone Projects

Date of Degree

9-2023

Document Type

Dissertation

Degree Name

Ph.D.

Program

Psychology

Advisor

Jennifer S. Ford

Committee Members

H. Jonathon Rendina

Tracy Dennis-Tiwari

Christopher Stults

Carlos Rodriguez-Diaz

Keywords

Intersectional stigma, latino, black, multiracial, social anxiety

Abstract

Black, Latino, and Multiracial YSMM are at disproportionate risk of acquiring HIV despite engaging in similar or less HIV risk behaviors when compared to their White YSMM counterparts. While over two decades of research have highlighted minority stress theory as a potential explanation as to why this disparity exists, increased efforts are being made to infuse this body of work with an intersectional framework. Intersectionality posits that individuals with multiple, interlocking social identities that are continuously affected and impacted by various forms of marginalization and stigmatization are at an increased risk of negative psychological and physical health outcomes. Current data on intersectional stigma is limited in several ways: experiences of stigma are often examined separately, commonly at the individual level, with constructs often treated as additive, with no potential mechanisms being explored, and with no validated measures of intersectionality created for the specific populations being studied. Utilizing an event-level approach in tandem with a measure of intersectional stigma created specifically for Black, Latino, and Multiracial YSMM is crucial to understand how stigma impacts HIV risk for these men on a daily level and to lend further support to existing research examining health disparities among this subpopulation.

Therefore, the aims of this dissertation broadly focused examining within-person associations between daily intersectional stigma and daily HIV risk behaviors (e.g., condomless anal sex, substance use); examining potential mechanisms in these associations; and finally, examining impact of daily intersectional stigma among a subsample of YSMM who reported clinically significant levels of individual-level social anxiety. To achieve these aims, event-level data were collected from PRISM, a three-phase study designed to generate event-level measures of intersectional stigma for YSMM of color aged 18-29. Individual-level data were collected from UNITE, a nationwide cohort study following nearly 8,000 HIV-negative sexual minority men at risk for HIV to examine individual-level psychosocial predictors of seroconversion. All participants from PRISM were recruited from UNITE, allowing for individual- and event-level data to be linked. Using multilevel modeling, I tested a series of hypotheses regarding the within-person roles of daily intersectional stigma on daily social anxiety, daily substance use, and daily condomless anal sex.

Results of the first aim supported my first set of hypotheses: the factor structure of the daily social anxiety items was confirmed, and individual-level social anxiety significantly predicted daily social anxiety. For the second aim, results did not support either within-person hypothesis: the passing of time was not positively associated with daily social anxiety, and period of the week (e.g., weekend vs. week) was not associated with higher reports of daily social anxiety. Results supported the hypothesis of the third aim: participants who reported higher than average daily intersectional stigma were likely to report higher daily social anxiety on a given day. Examining individual-level social anxiety as a potential mechanism of the association between daily intersectional stigma and daily HIV risk behaviors for the fourth aim, results did not support my hypotheses. Individual-level social anxiety did not moderate (i.e., cross-level moderation) the within-person association between daily intersectional stigma and both daily condomless anal sex and daily substance use. For the fifth and final aim, I focused on participants who reported clinically significant individual-level social anxiety and hypothesized within-person daily social anxiety would mediate the association between daily intersectional stigma and daily substance use. The data did not support this hypothesis among this subsample. Taken together, findings suggest that when individuals experience higher than average daily intersectional stigma, they are also at risk of experiencing higher social anxiety on a given day. Theoretical and clinical impactions of the findings as well as directions for future research are discussed.

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