An important distinction to make is that it is not an individual’s intersecting identities that contribute to marginalization, but rather the social positions, privileges, power, and oppression (e.g. HIV status, race, age, disability, sexual orientation Turan et al., 2017 Rice et al., 2018). Intersectional stigma can occur at multiple levels of influence (interpersonal, community, and structural levels), and is based upon co-occurring and intersecting identities or conditions (e.g. race, sexual orientation, economic status Logie et al., 2011). Intersectional stigma has emerged from intersectionality scholarship ( Crenshaw, 1991 Cole, 2009 Bowleg, 2012) to explain how persons can experience marginalization and discrimination due to multiple stigmatized identities (e.g. Stigma is best understood in relation to the social and structural conditions and institutions that contribute to social exclusion and disapproval ( Parker and Aggleton, 2003) as it represents broad social processes and power relations ( Herek, 2002). Initially described by sociologist Erving Goffman, stigma is the social identification and disapproval of a physical, behavioral, or social trait, which often manifests in marginalization or discrimination ( Goffman, 1963). Low PrEP awareness and uptake, particularly among young Black GBM, may be attributable to intersectional stigma. Additionally, young Black GBM have an 84% reduced odds of having ever used PrEP in comparison to young White GBM ( Kuhns et al., 2017). In 2016, just 11% of PrEP users were African American, compared to 13% Hispanic/Latino and 69% White ( Huang et al., 2018).
Yet, PrEP use is lowest among Black Americans ( Jenness et al., 2018 Smith, 2018) nearly six times as many White individuals than Black individuals have been prescribed PrEP. Of the 1.1 million persons estimated to be candidates for PrEP, 45% are Black ( Smith, 2018). In 2012, the Food and Drug Administration approved the use of Truvada for HIV pre-exposure prophylaxis (PrEP), yet there are disparities in PrEP use that reflect those seen in HIV incidence. Furthermore, despite having fewer sex partners and HIV-related risk behaviors than their White counterparts ( Friedman, Cooper and Osborne, 2009), half of Black GBM are projected to acquire HIV in their lifetime, compared to 25% of Latino GBM and just 9% of White GBM ( Hess et al., 2017). Between 20, HIV diagnoses among GBM remained stable overall, yet diagnoses among GBM aged 25 to 34 increased 30% ( Centers for Disease Control and prevention, 2018). In the United States, reducing new HIV infections will require a prioritization of HIV prevention among young Black gay, bisexual, or other men who have sex with men (GBM), a population that continues to carry a disproportionate burden of HIV ( Centers for Disease Control and Prevention, 2016).