Pathways to Inequities: Understanding Stigma

In Greek, the word stigma refers to a mark; in today’s English, stigma refers to a mark of disgrace or shame that is applied to a person, group or behaviour. There is no shortage of connections between our work in gay men’s health, gay men’s lives, and stigma: it is connected to the ways we express our gender and sexuality and come out about our identities; it impacts the conversations we have or avoid having about the sex we want, our bodies, our mental health, and our HIV status.

Stigma also creates many direct and indirect barriers to peer support, health services and information, and advocacy efforts to shift laws and policies. In our work and in our lives, stigma associated with identity (e.g. sexuality, gender, religion), behaviour (e.g. sex, substance use), and health (HIV, mental health) are layered on top of each other. In fact, it was the HIV/AIDS epidemic that first led researchers (Bayer & Stuber, 2006) to link stigma and public health.

Stigma is also connected to experiences of prejudice and discrimination: these concepts consider societal and structural attitudes towards specific groups, and how these negative attitudes get enacted in day-to-day experiences. Ina review of the research related to these concepts, Stuber, Meyer & Link (2008) identified five specific pathways through which stigma, prejudice, and discrimination adversely impact our health: 1) stress processes, 2) denial of resources and services, 3) prejudicial and discriminatory interpersonal interactions, 4) the internalization of negative attitudes, and 5) anticipation of negative reactions. In this blog, I will review these pathways and link them to current scholarship within gay men’s health and HIV.

Experiences of stigma and discrimination activate stress processes among those of us in stigmatized groups, often when we interact with people from non-stigmatized groups. Stress specific to the experiences of sexual minorities accounts for part of the elevated rates of adverse mental health outcomes among our communities (Meyer, 2003). Known as “minority stress” (Meyer, 2003), these experiences activate general psychological processes which increase the possibility of depression and/or anxiety (Hatzenbuehler, 2009).

Second, stigma and prejudice often go unnoticed by people in non-marginalized groups. As a result, stigmatized groups are unconsciously denied resources and services designed by non-marginalized groups. For example, the experiences of people living with HIV and sexual minorities are often not included in sex education curriculum. As discussed elsewhere in this blog series, multiple systems of oppression[SC1] , including heterosexism, [SC2] shape and create many experiences of exclusion and stress for gay men.

Third, non-stigmatized individuals learn and absorb stigma through no effort of their own, which leads to prejudicial and discriminatory interpersonal actions. Many of these actions are not intentional. This is demonstrative of the effectiveness of stigma as it is unconsciously perpetuated in day-to-day interactions. Through these interactions, those of us who are part of stigmatized groups experience victimization, bullying, and exclusion.

Stigmatized individuals often internalize negative stereotypes and attitudes common in mainstream society about the groups they are a part of. Internalizing these beliefs can impact the way we respond to stress, how we feel about ourselves, and the ways we interact with our peers. One example is internalized homophobia, which has been shown to minimize people’s social networks and quality of life.

Lastly, as stigmatized groups often expend significant amounts of energy anticipating stigma, and consciously acting to reduce stigmatizing interactions. For example, coming out processes[SC3] , whether related to sexual or gender identity, HIV status, or a mental health condition, often involve much anticipation and avoidance of stigma. Many stigma researchers have shown that this process means those of us who anticipate stigma may have less energy available to enact healthy coping resources, and thus are more likely to experience mental health outcomes such as depression and anxiety.

These are five ways stigma manifests in our communities: taken together, they produce profound inequalities. Hatzenbuehler, Phelan, and Link (2013) argue that stigma is a fundamental cause of population health inequalities, when we look at disability, HIV, mental health, obesity, race, and sexual and gender identity. In each of these cases, the association between an attribute (e.g. obesity, race) and negative traits limits access to resources. This happens by impacting how individuals cope with stress, and the ways our health and education systems provide services.

Undeniably, both HIV stigma, and stigma relating to HIV, have impacted our work in gay men’s health and the HIV sector since the beginning of the epidemic. For example, one of the factors that contributed to the coining of the term ‘men who have sex with men’ was trying to avoid the stigma associated with identifying as ‘gay’. HIV-related stigma continues to impact our health, and was the theme of the 2014 British Columbia’s Provincial Health Officer’s report. This report, which emphasized the ways stigma helps to create the sexual risk environments [SC4] gay men navigate.

Stigma is a crucial driver of our health. To accept this research is to recognize that resisting stigma is an essential part of our work to build healthier, stronger, gay men’s communities. This research on stigma further emphasizes the need for broad, collaborative approaches to HIV prevention. We need to interrupt the cyclical ways through which stigma is reproduced, and this requires stopping people within and beyond gay men’s communities from internalizing stigma, and providing tailored supports to reduce and/or reverse the impact of stress processes on our overall health and wellbeing. Join us on Facebook in our efforts to Resist Stigma[SC5]!


The Pacific AIDS Network produced this video about stigma as part of Speaking My Truth: The Canadian People Living with HIV Stigma Index in BC (the Stigma Index). This is a dynamic research project born out of a community-identified need to turn the tide against persistent HIV stigma and discrimination.

Further Reading

Hatzenbuehler, Mark – 2009. How Does Sexual Minority Stigma “Get Under the Skin”? A Psychological Mediation Framework. Available online via

Hatzenbuehler, Mark, Phelan, Jo, and Link, Bruce - 2013. Stigma as a fundamental cause of population health inequalities. Available online via

Meyer, Ilan - 2003. Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual Populations: Conceptual Issues and Research Evidence. Available online via

British Columbia Provincial Health Officer – 2014. HIV, Stigma and Society: Tackling a Complex Epidemic and Renewing HIV Prevention for Gay and Bisexual Men in British Columbia. Provincial Health Officer’s 2010 Annual Report. Available online via

Stuber, Jennifer, Meyer, Ilan, and Link, Bruce - 2008. Stigma, prejudice, discrimination, and health. Available online via



About CBRC

Community-Based Research Centre (CBRC) promotes the health of people of diverse sexualities and genders through research and intervention development.
Pathways to Inequities: Understanding Stigma
Pathways to Inequities: Understanding Stigma
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