The Burden of Intersecting Internalized Homophobia and Internalized HIV Stigma Can Exacerbate Depression Symptoms...

Gay men with HIV face stigma associated with both their sexual orientation and their HIV status. The intersectional stigma framework suggests that the co-occurrence and internalization of multiple stigmas may harm mental health. In the context of Türkiye, limited public discussion about HIV and sexual diversity may contribute to intersectional stigma experiences. In total, 255 Turkish gay men with HIV completed validated measures of internalized HIV stigma, internalized homophobia, and depression symptoms. Two analytic techniques recommended for intersectional effects were conducted: multiple regression with moderation analysis and multidimensional latent class item response analysis (MLCIRT). Regression analysis suggested independent, positive associations of both internalized HIV stigma and internalized homophobia with depression symptoms. Furthermore, a significant interaction effect between internalized HIV stigma and internalized homophobia suggested that higher levels of internalized homophobia were associated with higher depression symptoms when internalized HIV stigma was low. However, when internalized HIV stigma was high, depression symptoms remained high, irrespective of internalized homophobia levels. MLCIRT identified four subgroups: low on both internalized stigmas, high internalized HIV stigma, high internalized homophobia, and high on both internalized stigmas. Depression symptoms differed among classes, especially those characterized by higher internalized HIV stigma had higher depression symptoms. Findings from both analyses suggest the important role of internalized HIV stigma in depression symptoms of gay men with HIV, but internalized homophobia is also important when internalized HIV stigma is low. Mental health interventions may address the intersection of stigmatized conditions to cater to the needs of key populations.