Stigma, Concealment and Symptoms of Depression as Explanations for Sexually Transmitted Infections among Gay Men

Frost, David M.; Parsons, Jeffrey T.; Nanín, José E.

doi:10.1177/1359105307078170

Cited by 123HIV/AIDS Research and InterventionsLGBTQ Health, Identity, and PolicyHIV, Drug Use, Sexual Risk

Stigma, Concealment and Symptoms of Depression as Explanations for Sexually Transmitted Infections among Gay Men

Frost, David M., Parsons, Jeffrey T., Nanín, José E.·2007·Journal of Health Psychology

DOI 10.1177/1359105307078170

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Abstract

This study examined how perceived sociocultural factors influenced the relationship between psychosocial variables and sexually transmitted infections (STIs) among gay men. A cross-sectional brief street-intercept survey was administered to 594 gay men. Analyses examined how well stigma, concealment and symptoms of depression explained variation in participants' histories of STIs. Results suggested that concealment partially mediated the relationship between stigma and depression and depression partially mediated the relationship between concealment and STIs. Controlling for sociodemographic factors, symptoms of depression explained more varied histories of STIs; however, concealment was negatively related to STIs. Implications for STI and HIV interventions are discussed.

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Studies involving members of other stigmatized groups have demonstrated that concealment is associated with intrusive thoughts, increased psychological distress, anxiety, and depression.
“Studies involving members of other stigmatized groups have demonstrated that concealment is associated with intrusive thoughts, increased psychological distress, anxiety, and depression [59–61].”
From The Stigma of Suicide Survivorship and Related Consequences—A Systematic Review (2016) · cites this paper as [59]

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“…published research with cisgender individuals strongly indicates that concealing a stigmatized identity is a negative and denigrating experience (Frost et al., 2007; Pachankis, 2007), our participants shared narratives that suggest that the assumptions T hi s do cu m en t is co py ri gh te d…”
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“The GRS is a 10-item scale (a = 0.93) that assesses perceived stigma from friends and family in relation to disclosing sexual orientation.”
MethodInfluential
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“A modified version of the HIV stigma scale (Berger et al., 2001; Frost et al., 2007; Kelly et al., 2009) was used to evaluate participants’ level of GRS.”
BackgroundMethodInfluential
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“A recent study of stigma and depression in MSM suggested that the relationship between stigma and depression was partially mediated by concealment of HIV status (Frost, Parsons, & Nanin, 2007 ), thus disclosure concerns should be included in further studies in this area.”
Background
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“International studies have shown that perception of stigma, discrimination, and comfort levels with individual sexual identity are important predictors of high-risk behaviors in HIV-infected MSM ( Frost, Parsons, & Nanin, 2007 ; Schiltz & Sandfort, 2000 ).”
Background
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“, ―I have been hurt by how people reacted to learning I‘m gay‖), respectively [25], having come out to their peers as measured by the proportion of friends who knew of the participant‘s same-sex sexual behavior (―About how many of your friends know that you have had sex with a man?‖ [26] (coded as no/―some, few, none,…”
Method
Sexual Minority Stigma, Sexual Orientation Concealment, Social Support and Depressive Symptoms Among Men Who have Sex with Men in China: A Moderated Mediation Modeling Analysis
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“Perceived transgender-related stigma was assessed using an adapted version of the HIV-related Stigma Scale [25] and stigma concealment was assessed using an adapted version of the Gay-related Stigma and Stigma Concealment Scale [26].”
Method
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“Being gay is considered to be a concealable stigma because it can be hidden from others (Frost, Parsons, & Nanin, 2007 ).”
Background
Mediating Effects of Social Support and Internalized Homonegativity on the Association Between Population Density and Mental Health Among Gay and Bisexual Men
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“GBM will often conceal their sexual identity when there is a threat of discrimination, 20,23 which may limit how they engage with others or seek supportive services.”
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“and Europe have documented substantial experiences of stigma and depression among MSM, especially among MSM living with HIV [19].”
Psychological Distress, Felt Stigma, and HIV Prevention in a National Probability Sample of Sexual Minority Men
Krueger, E. A., Holloway, I. W., Lightfoot, M. A., Lin, A., Hammack, P. L., & Meyer, I. H. (2020) · LGBT Health · doi:10.1089/lgbt.2019.0280 · Cited by 34 · see citing works
“7 17–23 Both mental health challenges and exposure to minority stressors have been directly associated with increased engagement in HIV risk behaviors among sexual minority men, including substance use, 24–27 and decreased engagement in HIV preventive behaviors, including use of condoms and/or PrEP.”
The Role of Stigma Concealment in the Retrospective High School Experiences of Gay, Lesbian, and Bisexual Individuals
Frost, D. M., & Bastone, L. (2008) · Journal of LGBT Youth · doi:10.1300/j524v05n01_04 · Cited by 32 · see citing works
Self-citation
Cigarette Smoking as Part of a Syndemic among Young Men Who Have Sex with Men Ages 13–29 in New York City
Storholm, E. D., Halkitis, P. N., Siconolfi, D. E., & Moeller, R. W. (2011) · Journal of Urban Health · doi:10.1007/s11524-011-9563-8 · Cited by 32 · see citing works
Surveillance systems for sexually transmitted infections
Mohammed, H. P., Hughes, G., & Fenton, K. A. (2015) · Current Opinion in Infectious Diseases · doi:10.1097/qco.0000000000000235 · Cited by 29 · see citing works
“In homophobic societies, it can be particularly difficult to engage MSM in screening and prevention activities [7].”
Background
Issue Introduction: Identity Concealment: Multilevel Predictors, Moderators, and Consequences
Quinn, D. M. (2017) · Journal of Social Issues · doi:10.1111/josi.12213 · Cited by 29 · see citing works
Sexual Victimization and Health-Related Indicators Among Sexual Minority Men
Hequembourg, A. L., Bimbi, D. S., & Parsons, J. T. (2011) · Journal of LGBTQ Issues in Counseling · doi:10.1080/15538605.2011.554603 · Cited by 29 · see citing works
“Stigma related to having a gay or bisexual identity was assessed using a 10-item version of the HIV Stigma Scale (Berger, Ferrans, & Lashley, 2001) with language modified to assess gay-related stigma (Frost et al., 2007).”
Identity cues influence sexual minorities’ anticipated treatment and disclosure intentions in healthcare settings: Exploring a multiple pathway model
Cipollina, R., & Sanchez, D. T. (2021) · Journal of Health Psychology · doi:10.1177/1359105321995984 · Cited by 26 · see citing works
“Further, identity concealment can reduce the quality of treatment that sexual minority patients receive (e.g. lack of proper preventative treatments or screenings; see Petroll and Mosack, 2011) and contributes indirectly to poorer health outcomes (Frost et al., 2007; Ruben and Fullerton, 2018).”
Background
The Syndemic of AIDS and STDS among MSM
O’Leary, D. (2014) · The Linacre Quarterly · doi:10.1179/2050854913y.0000000015 · Cited by 26 · see citing works
“…McKirnan and Peterson 1989; Stall et al. 2001; Stall and Purcell 2000), depression and HIV/AIDS (Sandfort et al. 2001; Ciesla and Roberts 2001; Frost, Parsons, and Nanin 2007), childhood sexual abuse and HIV/AIDS (Dilorio, Hartwell and Hansen 2002), and violence and HIV/ AIDS (Greenwood et…”
Background
When Stigma Is Concealable: The Costs and Benefits for Health
Quinn, D. M. (2017) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780190243470.013.19 · Cited by 26 · see citing works
Stigma Consciousness and Subjective Well-Being in Lesbians and Gays
Nouvilas-Pallejà, E., Silván-Ferrero, P., de Apodaca, M. R. D., & Molero, F. (2018) · Journal of Happiness Studies · doi:10.1007/s10902-017-9862-1 · Cited by 27 · see citing works
Depression care and prevalence in HIV-positive individuals
Ownby, R. L. (2010) · Neurobehavioral HIV Medicine · doi:10.2147/nbhiv.s7296 · Cited by 25 · see citing works
“50 Although the gay community can offer its members support, HIV-stigma exists within the gay community itself and is associated with increased levels of anxiety, loneliness, and depressive symptoms.”
Application of minority stress and the interpersonal theory of suicide in bisexual+ versus gay/lesbian young adults
Chang, C. J., Feinstein, B. A., Chu, B. C., & Selby, E. A. (2022) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12856 · Cited by 24 · see citing works
Race-based differentials in the impact of mental health and stigma on HIV risk among young men who have sex with men.
Lelutiu‐Weinberger, C., Gamarel, K. E., Golub, S. A., & Parsons, J. T. (2014) · Health Psychology · doi:10.1037/hea0000192 · Cited by 24 · see citing works
“The Gay-Related Stigma Scale (GRS; Frost et al., 2007) is a modified version of the HIV Stigma Scale (Berger et al., 2001).”
Background
Identity-Related Growth and Loss in a Sample of HIV-Positive Gay and Bisexual Men: Initial Scale Development and Psychometric Evaluation
Golub, S. A., Rendina, H. J., & Gamarel, K. E. (2012) · AIDS and Behavior · doi:10.1007/s10461-012-0338-3 · Cited by 20 · see citing works
“Participants completed the 10-item Personalized GayRelated Stigma Subscale [39] to examine stigma and other social consequences gay and bisexual men have faced as a result of their sexual orientation.”
Internalized Homophobia Influences Perceptions of Men’s Sexual Orientation from Photos of Their Faces
Tskhay, K. O., & Rule, N. O. (2015) · Archives of Sexual Behavior · doi:10.1007/s10508-015-0628-8 · Cited by 19 · see citing works
Age-related factors influence HIV testing within subpopulations: a cross-sectional survey of MSM within the Celtic nations
Dalrymple, J., McAloney‐Kocaman, K., Flowers, P., McDaid, L. M., & Frankis, J. S. (2019) · Sexually Transmitted Infections · doi:10.1136/sextrans-2018-053935 · Cited by 18 · see citing works
“[20, 24] The personalised Stigma Scale comprising 24 questions measured men’s ‘awareness of social attitudes about gay people’ and their perceptions of ‘the potential social consequences related to being gay’.[20, 25] The dataset excluded the 225 men who believed themselves to have HIV, due to the research question fo…”
Background
Psychological Symptoms Are Associated with Both Abstinence and Risky Sex Among Men with HIV
Miller, C. T., Solomon, S. E., Bunn, J. Y., Varni, S. E., & Hodge, J. J. (2015) · Archives of Sexual Behavior · doi:10.1007/s10508-014-0464-2 · Cited by 17 · see citing works
“…for men with HIV to include components that are designed not only to reduce risky sex, but alsotoaddresspsychologicalsymptomsandsupportbehaviors to effectively cope with HIV discrimination (Cook, Purdie-Vaughns, Meyer, & Busch, 2014; Frost et al., 2007; Safren, Blashill, & O’Cleirigh, 2011).”
Background
Mental health, potential minority stressors and resilience: evidence from a cross-sectional survey of gay, bisexual and other men who have sex with men within the Celtic nations
McGarty, A. M., McDaid, L. M., Flowers, P., Riddell, J., Pachankis, J. E., & Frankis, J. S. (2021) · BMC Public Health · doi:10.1186/s12889-021-12030-x · Cited by 15 · see citing works
“The Gay-Related Stigma Scale, a 20-item adaptation of the HIV stigma scale [21, 22], measures personalised stigma and concealment stigma (range 0– 80), with higher scores suggesting higher gay-related stigma.”
Method
Sexual fluidity and BMI, obesity, and physical activity
Fricke, J., & Sironi, M. (2020) · SSM - Population Health · doi:10.1016/j.ssmph.2020.100620 · Cited by 15 · see citing works
Examining the Correlates of Sexually Transmitted Infection Testing Among Men Who Have Sex With Men in Ouagadougou and Bobo-Dioulasso, Burkina Faso
Goodman, S. H., Grosso, A., Ketende, S. C., Ouedraogo, H. G., Kouanda, S., Ky‐Zerbo, O., Samadoulougou, B. C., & Baral, S. (2016) · Sexually Transmitted Diseases · doi:10.1097/olq.0000000000000437 · Cited by 14 · see citing works
Responding to Gender and Sexual Minority Stress With Functional Analytic Psychotherapy
Skinta, M., Hoeflein, B., Muñoz-Martínez, A., & Rincón, C. (2018) · Psychotherapy · doi:10.1037/pst0000157 · Cited by 11 · see citing works
Role of Social Support in the Relationship between Sexually Transmitted Infection and Depression among Young Women in Canada
Gao, Y., MacDonald, D., Collins, K. D., Alaghehbandan, R., & Chen, Y. (2010) · Journal of Epidemiology · doi:10.2188/jea.je20090133 · Cited by 14 · see citing works
A Structured Review and Critical Analysis of Male Perceptions of the Penis: A Comparison between Heterosexual Men and Men Who Have Sex with Men (MSM)
Simpson, P., & Adams, J. (2017) · Men and Masculinities · doi:10.1177/1097184x17715054 · Cited by 13 · see citing works
Associations Between Social Support Network Characteristics and Receipt of Emotional and Material Support Among a Sample of Male Sexual Minority Youths
Kapadia, F., Halkitis, P. N., Barton, S. C., Siconolfi, D. E., & Pérez‐Figueroa, R. (2014) · Sexual and Gender Diversity in Social Services · doi:10.1080/10538720.2014.924458 · Cited by 12 · see citing works
The role of STI-related attitudes on screening attendance in young adults
Shepherd, L., & Harwood, H. (2016) · Psychology Health & Medicine · doi:10.1080/13548506.2016.1234715 · Cited by 12 · see citing works
Falling through the cracks: the gap between evidence and policy in responding to depression in gay, lesbian and other homosexually active people in Australia
Carman, M., Corboz, J., & Dowsett, G. W. (2012) · Australian and New Zealand Journal of Public Health · doi:10.1111/j.1753-6405.2012.00828.x · Cited by 12 · see citing works
“Some studies found that sexual risk was not associated with depressive symptoms, while others suggest a connection.(13,24,30)”
Background
Intimate Partner Violence and HIV Prevention Among Sexual Minority Men: Protocol for a Prospective Mixed Methods Cohort Study
Storholm, E. D., Siconolfi, D. E., Wagner, G., Huang, W.-J., Nacht, C. L., Sallabank, G., Felner, J. K., Wolf, J., Lee, S. D., & Stephenson, R. (2022) · JMIR Research Protocols · doi:10.2196/41453 · Cited by 10 · see citing works
Recent anxiety symptoms and drug use associated with sexually transmitted infection diagnosis among an online US sample of men who have sex with men
Downing, M. J., Chiasson, M. A., & Hirshfield, S. (2015) · Journal of Health Psychology · doi:10.1177/1359105315587135 · Cited by 10 · see citing works
“…other than HIV remains largely unexplored among MSM. Limited evidence from studies conducted in the United States suggest that depression and certain anxiety disorders are associated with a lifetime (Frost et al., 2007; Shoptaw et al., 2003) or recent STI diagnosis among MSM (Reisner et al., 2009).”
Background
Concealment as a moderator of anticipated stigma and psychiatric symptoms
Brooks, B. D., Job, S. A., Clark, E. A., Todd, E., & Williams, S. L. (2020) · Journal of Gay & Lesbian Mental Health · doi:10.1080/19359705.2020.1721037 · Cited by 10 · see citing works
“significant relationship between concealment and depressive symptoms (Frost et al., 2007).”
BackgroundResult
Perceived social support and mental health states in a clinic-based sample of older HIV positive adults
Kapadia, F., Lévy, M. D., Griffin-Tomas, M., Greene, R. E., Halkitis, S. N., Urbina, A., & Halkitis, P. N. (2016) · Journal of HIV/AIDS & Social Services · doi:10.1080/15381501.2016.1212295 · Cited by 8 · see citing works
Mental Health and Associated Sexual Health Behaviours in a Sample of Young People Attending a Music Festival in Melbourne, Victoria
Carrotte, E. R., Vella, A. M., Hellard, M. E., & Lim, M. S. C. (2016) · Community Mental Health Journal · doi:10.1007/s10597-015-9981-2 · Cited by 7 · see citing works
“Among young people who identify as a sexual minority (including those identifying as gay, lesbian, bisexual, transgender, intersex, or queer), factors such as stigma, concealment of sexual orientation and homophobic bullying can interact and influence the relationship between mental illness and sexual risk behaviours…”
Background
Applying resilience theory models to contextualize economic-dependent partnerships as a risk factor for HIV among young men who have sex with men
Meanley, S., Tingler, R. C., Chittamuru, D., & Bauermeister, J. A. (2018) · AIDS Care · doi:10.1080/09540121.2018.1493185 · Cited by 6 · see citing works
Factors Associated with Disclosure of Sexual Orientation Among Black Sexual Minority Men
Berman, M., Eaton, L. A., Watson, R. J., Earnshaw, V. A., Wiginton, J. M., & Layland, E. K. (2022) · LGBT Health · doi:10.1089/lgbt.2021.0446 · Cited by 6 · see citing works
Sexual Orientation Concealment, Hope, and Depressive Symptoms Among Sexual Minority Women: The Moderating Role of Sexual Orientation
Glynn, S. A., McLaren, S., & Goldie, P. D. (2023) · Journal of Homosexuality · doi:10.1080/00918369.2023.2250500 · Cited by 6 · see citing works
“…of research has found that concealment is associated with adverse mental health outcomes and indexes of well-being such as depression, low levels of life satisfaction (Frost et al., 2007; Jackson & Mohr, 2016), anxiety (Schrimshaw et al., 2013), and diminished social support (Ullrich et al., 2003).”
The Burden of Care of Gay Male Carers Caring for Men Living With HIV/AIDS
Munro, I., & Edward, K. (2009) · American Journal of Men s Health · doi:10.1177/1557988309331795 · Cited by 6 · see citing works
Factors Influencing Stigma to Lesbian, Gay, Bisexual, and Transgender (LGBT) Among Teenagers at Ngaran Village, Gamping, Sleman, Indonesia
Astuti, D. A., & Kurniati, N. (2018) · GHMJ (Global Health Management Journal) · doi:10.35898/ghmj-22192 · Cited by 6 · see citing works
“By the socio-cultural factor in the society, a gay man might be seen as a source of sexually transmitted infections among men who have sex with men [9].”
Background
Internalized Homophobia, Psychological Distress, and Resilience as Correlates of Substance Use During Sexual Encounters in Young Adult Black Men who have Sex with Men
Boone, M. R. (2014) · doi:10.7916/d89k48t8 · Cited by 4 · see citing works
The Double Bind of Communicating About Zoonotic Origins: Describing Exotic Animal Sources of COVID‐19 Increases Both Healthy and Discriminatory Avoidance Intentions
LaCour, M., Hughes, B., Goldwater, M. B., Ireland, M. E., Worthy, D. A., Allen, J. V., Gaylord, N., Van‐Hoosier, G., & Davis, T. H. (2021) · Risk Analysis · doi:10.1111/risa.13764 · Cited by 5 · see citing works
Differences in substance use, sexual behavior, and demographic factors by levels of ‘outness’ to friends and family about being a male-for-male escort
Grov, C., Moody, R. L., & Kinkaid, H. (2015) · International Journal of Sexual Health · doi:10.1080/19317611.2015.1034396 · Cited by 5 · see citing works
“Consistent with the literature on disclosure and health (Frost et al., 2007; Kadushin, 2000; Legate et al., 2011), we hypothesized that outness would be negatively associated with depression, substance use, and sexual risk behaviors.”
Ageing and Sexual Health in the UK
Hinchliff, S. (2009) · Journal of Health Psychology · doi:10.1177/1359105308101673 · Cited by 5 · see citing works
Relationship, Social, and Individual Well-Being in Italian Male Same-Sex Couples
Antonelli, P., & Dèttore, D. (2014) · Sexual and Gender Diversity in Social Services · doi:10.1080/10538720.2014.926231 · Cited by 4 · see citing works
The Mediating Effect of Post-Traumatic Growth on the Relationship between Adverse Childhood Experiences and Psychological Distress in Adults
Caetano, S., & Pereira, H. (2024) · Social Sciences · doi:10.3390/socsci13050262 · Cited by 4 · see citing works
Отношение к гомосексуалам в России: содержание, структура и предикторы
Gulevich, O. A., Осин, Е. Н., Isaenko, N. A., & Brainis, L. M. (2016) · Психология Журнал Высшей школы экономики · doi:10.17323/1813-8918-2016-1-79-110 · Cited by 3 · see citing works

Concealment as a moderator of anticipated stigma and psychiatric symptoms
Brooks, B. D., Job, S. A., Clark, E. A., Todd, E., & Williams, S. L. (2020) · Journal of Gay & Lesbian Mental Health · doi:10.1080/19359705.2020.1721037 · Cited by 10 · see citing works
Depression and Social Stigma Among MSM in Lesotho: Implications for HIV and Sexually Transmitted Infection Prevention
Stahlman, S. L., Grosso, A., Ketende, S. C., Sweitzer, S., Mothopeng, T., Taruberekera, N., Nkonyana, J., & Baral, S. (2015) · AIDS and Behavior · doi:10.1007/s10461-015-1094-y · Cited by 114 · see citing works
Association of Enacted Stigma with Depressive Symptoms Among Gay and Bisexual Men Who Have Sex with Men: Baltimore, 2011 and 2014
Marti-Pastor, M., Ferrer, M., Alonso, J., Garín, O., Pont, À., Flynn, C. P., & German, D. (2019) · LGBT Health · doi:10.1089/lgbt.2018.0230 · Cited by 18 · see citing works
The Intersectional Influence of Experienced Stigma on Clinically Significant Depressive Symptoms Among Gay, Bisexual, and Other Men Who Have Sex with Men
Barrett, B. W., Abraham, A. G., Friedman, M. R., Turan, J. M., Mimiaga, M. J., Stosor, V., & Surkan, P. J. (2025) · Journal of Homosexuality · doi:10.1080/00918369.2025.2475026 · Cited by 1 · see citing works
What triggers depressive symptoms among gay and bisexual men? A sequential mediation model of sexual minority‐related stigma and self‐criticism
He, A., Bu, H., Liao, A., & Mu, W. (2023) · British Journal of Social Psychology · doi:10.1111/bjso.12621 · Cited by 9 · see citing works

Authors: Frost, D. M., Parsons, J. T., & Nanín, J. E.
Affiliations: The Graduate Center, CUNY (US)
City University of New York (US)
Corresponding author: Parsons, Jeffrey T.
ORCID: Frost, David M.
Parsons, Jeffrey T.
Venue: Journal of Health Psychology
Publisher: SAGE Publications
Published: 2007-07
Volume: 12
Issue: 4
Pages: 636-640
ISSN: 1359-1053 (ISSN-L)
1461-7277
DOI: 10.1177/1359105307078170
OpenAlex: W1963645227
Cited by: 123
References: 18
Citations by year: 2024: 3 · 2023: 3 · 2022: 4 · 2021: 6 · 2020: 8 · 2019: 7 · 2018: 7 · 2017: 8 · 2016: 12 · 2015: 13 · 2014: 10 · 2013: 12 · 2012: 12
FWCI: 2.96
Type: journal article
Language: en
Open access: closed
Licence: journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: Journal of Health Psychology (publishedVersion)
PubMed (publishedVersion)
UCL Discovery (University College London) (submittedVersion)
Topics: Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
Keywords: sexually transmitted infections, gay men, stigma, concealment, depression, HIV, psychosocial risk factors, mediation, sociocultural factors, HIV prevention
MeSH terms: Adolescent, Adult, Aged, Data Collection, Depression, Humans, Interpersonal Relations, Male, Middle Aged, New York City, Prejudice, Sexually Transmitted Diseases, Truth Disclosure, Homosexuality, Male

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Stigma, Concealment and Symptoms of Depression as Explanations for Sexually Transmitted Infections among Gay Men

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