Official websites use. Share sensitive information only on official, secure websites. We conducted a series of studies to validate a new scale of stigma toward anal sex, culturally tailored to cisgender men who have sex with men MSM. We developed a item measure, grounded in the lived experience of cisgender MSM. Future work should examine associations with health-seeking behavior. Keywords: anal sexuality, anal sex stigma, sexual stigma, men who have sex with men, concealable stigmatized identities.
Anal sex is a prevalent behavior, depicted since antiquity [ 1 β 3 ], and reported across populations and the globe [ 4 β 9 ]. However, anal sex is also under-reported depending on data collection methods and social context [ 4 ], likely due to stigma [ 2 , 10 , 11 ]. Stigma refers to a social process that labels some people, for example those who engage in anal sex, as less valuable than others [ 12 β 15 ].
In the United States, anal sex was illegal in many jurisdictions until , likely inhibiting both research and health policy on the topic [ 16 β 18 ].
Stigma toward anal sexuality may relate to important health outcomes. Sexual education tends to omit anal sexuality, leaving those who engage in anal sex uninformed, anxious, and at risk for embarrassment and physical harm during sex [ 11 , 19 β 21 ]. Among gay, bisexual and other men who have sex with men MSM , anal intercourse, under certain conditions, is the most proximate risk factor for HIV [ 4 , 6 ] and a precursor, if disclosed, to enrollment in promising interventions, like pre-exposure prophylaxis PrEP [ 33 ].
However, for sexual and gender minority SGM populations, stigma toward their sexual identity and behavior is generally a deterrent to health-seeking behavior [ 34 ]. Among MSM, stigma toward sexual orientation is associated with acquisition of sexually transmitted infections [ 35 ], diminished social support [ 36 ], compromised life satisfaction [ 37 ], and concealment of sexuality and delayed and intermittent engagement in medical care [ 38 , 39 ] including biomedical interventions like PrEP [ 23 ].
