Participants were recruited online as well as via clinics and gay community events and organisations. They collect information on demographics, sexual behaviour, STI testing and diagnoses, and HIV prevention, testing, and treatment. These are annual repeated cross-sectional surveys of cis and trans gay and bisexual men over the age of 16 conducted across all of Australia’s states and territories (except the Northern Territory). Behavioural surveysĭata on STI and HIV outcomes used in the analysis came from the Gay Community Periodic Surveys held between 2015 to 2019. This is because respondents would be less likely to modify their response for fear of what others might think when they knew it would directly influence legislation. However, they believe the survey results were more likely to be an accurate reflection of public opinion than typical public attitude surveys. When assessing a complex social issue such as structural stigma, researchers will often use a combined measure of multiple indicators that capture different elements of structural stigma. The authors acknowledge that opposition to same-sex marriage is unlikely to provide a complete measure of the range of structural stigma experienced by gay and bisexual men. For example, the highest proportion of votes against same-sex marriage (55.4%) was found in Greater Sydney. Generally, more rural parts of Australia had a higher share of votes against same-sex marriage but, perhaps surprisingly, some of the highest percentages of votes against same-sex marriage were found in metropolitan areas.
Support for same-sex marriage varied significantly between these districts. The results of the vote can be broken down by electoral districts, which range in voter numbers from 65,752 (Lingiari) to 144,391 (Canberra). The results of the referendum showed that overall, 61.6% of voters thought same-sex marriage should be legalised. Although it wasn’t mandatory to vote, 79.5% of Australians eligible to vote took part. This survey was run by the Australian government as a referendum on the legalisation of same-sex marriage, with respondents only able to respond with “yes” or “no”. Saxby and her colleagues identified a useful measure of structural stigma expressed as opposition to same-sex marriage in the Australian Marriage Law Postal Survey, conducted in 2017. Therefore, Karinna Saxby from Monash University in Australia and colleagues sought to fill this gap by estimating the extent to which structural stigma was associated with STI and HIV testing awareness and use of PrEP and PEP and access to HIV care among gay and bisexual men in Australia. Individuals experiencing such stigma may experience mental distress, engage in risky health behaviours (such as substance use) to help them cope, and delay or avoid accessing healthcare for fear of being discriminated against by healthcare providers.Īlthough there is a growing body of evidence to support this theory, few researchers have evaluated how structural stigma specifically affects HIV and sexual health outcomes, and even fewer have measured the scale of its impact. Structural stigma increases gay and bisexual men’s exposure to discrimination and may lead to internalised stigma. For example, each case is matched individually with a control subject on variables such as age, sex and HIV status. In a case-control study, a process to make the cases and the controls comparable with respect to extraneous factors.