Validating the Anal Sex Stigma Scale among Black Sexual Minority Men Living with HIV

Anal sex stigma substantially affects sexual minority men (SMM), particularly regarding sexual roles and the implications of identifying as a "top" or "bottom." The intersection of negative perceptions regarding race, sexuality, and health status could intensify anal sex stigma effects among Black SMM living with HIV. However, there are few validated tools to measure this form of stigma among this demographic. Therefore, this study tested the psychometric properties of the Anal Sex Stigma Scale (ASSS) among 650 Black SMM living with HIV. Using exploratory and confirmatory factor analyses, a two-factor model was generated: "Self & Provider Anal Sex Stigma" and "Peer & Knowledge-Based Anal Sex Stigma." Both subscales showed excellent internal consistency (Cronbach's α > 0.90). Results revealed a strong correlation between higher anal sex stigma and negative mental health outcomes, including internalized homophobia, depression, and HIV stigma, as well as lower social support and LGBT community connectedness. Findings suggest that the ASSS is a reliable measure to assess anal sex stigma among Black SMM living with HIV and provide novel insights into how it manifests in this population.