Meininger E, Saewyc E, Skay C, Clark T, Poon C, Robinson E, Pettingell S, & Homma Y. (2007). Enacted stigma and HIV risk behaviors in sexual minority youth of European heritage across three countries. [abstract]. Journal of Adolescent Health, Volume 40, Issue 2 Supplement, page S27.

Purpose: Lesbian, gay, and bisexual (LGB) adolescents are stigmatized at home, at school, and in communities. They can be targeted for exclusion, discrimination, harassment, bullying, or physical assault (enacted stigma). LGB teens also have higher rates of HIV risk behaviors than heterosexual (HET) peers. Does experiencing enacted stigma help explain higher HIV risk?

Methods: International study in 3 countries: Canada, New Zealand, & USA. Design: Secondary analyses of existing school-based surveys: 2001Minnesota Student Survey (MN), 2003 British Columbia Adolescent Health Survey (BC), and 2001 New Zealand Youth Health Survey (NZ).

Participants: European heritage or White students in each survey who responded to a sexual orientation item: MN (sexually experienced only) grades 9 & 12 N = 18,757, 49.3% female, 9% LGB; BC grades 7 to 12 (weighted) N = 120,767, 52.7% female, 3% LGB; NZ ages 12 to 18 N = 4,977, 54.0% female, 6% LGB. Other ethnic groups’ results were reported elsewhere.

Outcome Measures: Enacted Stigma and Safety in School scales were developed in BC and MN, individual items and a Bullying scale in NZ. HIV risk / sexual risk behavior measures include a Sexual Risk Score for MN and NZ, and an HIV Risk Score for BC (included injection drug use).

Analyses: Cross tabulation with χ2 for individual enacted stigma and HIV risk behaviors by orientation, and age-adjusted general linear models (GLM) of HIV or Sexual Risk Scores with orientation, enacted stigma, and interactions (separately by gender where needed).

Results: In all 3 surveys, LGB students were significantly more likely to experience enacted stigma and to feel less safe in school than heterosexual peers (p < 0.001). In all 3 surveys, LGB youth had significantly higher HIV risk scores than HET youth (except girls in NZ, p = 0.058). In both MN and BC enacted stigma had a significant effect on risk score regardless of sexual orientation. With enacted stigma in the GLM model, sexual orientation no longer explained the differences between LGB and heterosexual students in HIV risk scores for boys in BC; however orientation remained significant for boys in MN, NZ, and girls in BC and MN (all p < 0.01).

Conclusions: Our research suggests preventing sexual minority youth from being targeted for enacted stigma may help reduce the disparities in HIV or sexual risk behaviors by orientation.

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