A systematic review of psychosocial challenges for MSM living with HIV among diverse and intersecting minorities

Abstract

Men who have sex with men (MSM) living with HIV have been studied extensively for stigmatization and inequitable factors affecting well-being. Although intersecting factors are acknowledged in some studies, they are rarely discussed in the context of health implications among multiple minority identities. This leaves psychosocial research outputs to focus their efforts among less stigmatized MSM groups, white men, while disregarding specific issues among historically marginalized MSM-related identities (e.g., racialized, Indigenous, and aging populations). As per the 95-95-95 goals set by the Joint United Nations Programme on HIV and AIDS, this systematic review covers psychosocial protective and risk factors experienced by HIV-positive MSM while also considering other intersecting identities. Following a standardized search inquiry, 2,139 records were identified and narrowed down to 24 peer-reviewed articles which were systematically reviewed. Psychological and social protective factors are contextually described. Some risk factors such as co-occurring stigmas, psychological distress, exposure to violence, and trauma among diverse MSM can potentiate greater risk-taking behaviours associated with HIV transmission among HIV-positive men. These findings highlight factors that contribute to resilient pathways among racialized minorities and other intersections among MSM while also examining specific psychological stressors. Tailored interventions and care for minorities with intersecting identities, with a focus on co-occurring stigmas, are crucial to ensure the well-being of diverse HIV-positive MSM and reduce HIV transmission. We propose an adaptation to the minority stress model to refine available tools and provide future studies with more accurate depictions of the lived experiences among diverse MSM.