Stigma consciousness concerns related to drug use and sexuality in a sample of street-based male sex workers

Measurement of, and response to, three different stigmas and their exposure (homosexual behavior, sex work, and drug use) were studied a group of 90 key-informant recruited male sex workers in Houston, Texas who were over 18 and had exchanged sex for money in the previous 7 days. Respondents reported on self-identified sexual orientation and were interviewed, including providing responses on a measure of perceived stigma relating to sexual behavior and drug use. Two thirds were white, almost all had used drugs (many in the past week), and half had ever injected. A fifth identified as heterosexual, with the remainder split between gay and bisexually-identified men. There was a high level of homelessness and contact with the criminal justice system for drug and property offences. Consciousness about drug-related stigma was moderately associated with concerns about drug-related exposure and sensitivity to rejection as a drug user, but not to exposure as homosexual or as a sex worker. Drug-using status is related to greater concern about exposure as a sex worker. Data suggest that stigma is domain-specific and that there are different patterns of response to different stigmata in the same individual. Measurement of stigmata and concern about exposure and rejection need to be specific to stigmatized behaviors, and not generalized to other stigmatized behaviors since the data suggest that they are minimally related.