Untangling Discrimination: The Impact of Internalizing Oppression on HIV Treatment Engagement Among Young Black Sexual Minority Men in the Southern US.

Black sexual minority men living with HIV (BSMM+) in the Southern United States encounter multiple forms of discrimination, which are associated with decreased HIV care engagement. We analyzed data from 166 BSMM + in the South to assess direct associations between experiences of racism, heterosexism, and HIV-related discrimination with HIV care engagement. We further investigated indirect associations through three mediators: internalized racism, internalized heterosexism, and internalized HIV stigma. Experienced heterosexism was indirectly associated with HIV care engagement through internalized HIV stigma (bindirect = -0.039, p = 0.098). HIV discrimination was associated with internalized heterosexism (bdirect = 0.577, p = 0.007) and internalized racism (bdirect = 0.253, p = 0.009). There were significant direct associations between internalized HIV stigma and HIV care engagement (bdirect = -0.040, p = 0.001) and experienced heterosexism and internalized HIV stigma (bdirect = 0.974, p = 0.050). These findings aim to understand the factors affecting HIV care engagement among this population to improve HIV care engagement.