Health Care Stigma and HIV/Sexually Transmitted Infection Prevention Service Uptake Among Cisgender Men and Gender-Diverse Individuals Who Have Sex with Men in Five Asian Countries: Implications for Differentiated Service Delivery

Health care stigma remains a key barrier to HIV and sexually transmitted infection (STI) prevention, yet its effects may differ across health care systems. We examined associations between health care stigma and HIV/STI prevention service uptake across five Asian countries. A cross-sectional online survey was conducted in early 2020 among cisgender men and gender-diverse individuals who have sex with men in Japan, Malaysia, Indonesia, Thailand, and Vietnam. Outcomes were HIV testing and STI testing in the past 12 months, and pre-exposure prophylaxis (PrEP) initiation. Anticipated stigma was defined as health care avoidance due to fear of disclosing same-sex behavior: enacted stigma as experiences of poor treatment or provider ridicule related to same-sex behavior. Country-specific adjusted odds ratios (aORs) were estimated using pooled logistic regression models with country–stigma interaction terms. Among 10,274 participants who were HIV negative or had never been tested (median age 31 years; interquartile range 25–41), anticipated stigma was consistently associated with lower odds of HIV and STI testing across all five countries. Associations for enacted stigma varied by country. In Japan, enacted stigma was positively associated with STI testing [aOR = 1.74; 95% confidence interval (CI): 1.25–2.41], HIV testing (aOR = 1.66; 95% CI: 1.19–2.30), and PrEP initiation (aOR = 1.99; 95% CI: 1.20–3.29). In Thailand, enacted stigma was negatively associated with STI testing (aOR = 0.63; 95% CI: 0.44–0.88), HIV testing (aOR =0.54; 95% CI: 0.38–0.77), and PrEP initiation (aOR = 0.55; 95% CI: 0.33–0.90). In settings with more differentiated and community-based options, individuals engaged in prevention services may encounter less stigmatizing care. Expanding differentiated service delivery alongside stigma-reduction interventions may strengthen HIV and STI prevention across the Asia-Pacific region.