Relationship of Religiosity and Spirituality to Hazardous Drinking, Drug Use, and Depression Among Sexual Minority Women

Using data from Wave 3 of the Chicago Health and Life Experiences of Women (CHLEW) study (N = 699), we explored whether religiosity and spirituality were associated with risk of hazardous drinking, drug use, and depression among sexual minority women (SMW; i.e., lesbian, bisexual) and possible differences by race/ethnicity. Participants were more likely to endorse spirituality than religiosity, and endorsement of each was highest among African American SMW. We found no protective effect of religiosity or spirituality for hazardous drinking or drug use. An association initially found between identifying as very spiritual and past-year depression disappeared when controlling for help-seeking. Among SMW with high religiosity, African American SMW were more likely than White SMW to report hazardous drinking. Latina SMW with higher spirituality were more likely than White SMW to report drug use. Results suggest that religiosity and spirituality affect subgroups differently, which should be considered in future research on resiliency among SMW.

Imagined Rural/Regional Spaces: Non-Normative Sexualities in Small Towns and Rural Communities in Croatia

This research aims to critically examine how the complexity of the ongoing process of "coming out" in small towns and rural spaces in Croatia undermines the imagined hierarchical distinction between rural/urban spaces. The narratives of LGBQ individuals living in these spaces subvert imaginaries of their communities as homogeneously hostile and threatening. Some participants did, however, perceive other spaces as either "gay-friendly" or "deeply homophobic." As Croatia is transnationally perceived to be a part of a larger "homophobic region," the construction of the rural/urban hierarchical distinction is (re)produced and (re)configured within discourses that signify Western countries and so-called more developed regions within Croatia as "more open and liberal" as opposed to "more homophobic and backward" spaces. These distinctions between countries, regions, and the rural/urban spaces come into contradiction with each other and are undermined by my interviewees' own incongruous experiences.

Egalitarian: From Homophile to Helicophile in Post-World War II America

The presidency of gender in the Anglo-American taxonomy of sexualities historically has been haunted by the irruption of "other" parameters of medicalization, censure, and caesura, not in the least absolute and relative measures of age. Where today's clinical psychologists feel the need to age-specify adult homosexuality in such Hirschfeldian terms as androphilia, however, the felt need is indeed still essentially clinical. That cosmopolitan expressions such as homosexual, LGB, or queer rarely require such specifications relies on a protracted and today, arguably, complete disarticulation of sex/gender and age/maturity as parameters of sexual orientation, accreditation, and mobilization. Notably disconnected discursive frames gave voice to this Anglophone crystallization of "the normal homosexual" (circa 1950-1980): criminological, psychiatric, psychophysiological, and psychodynamic typologies of "sexual deviation" (variably tending to correlate, align, or subsume same-sex and age-disparate intimacies); territorializing apologias of gay, but also of "Greek," "pederast," and "man-boy," socialities; anthropological-historical exotification of "age-stratified homosexualities"; and mostly European, proto-queer critiques of all "bourgeois" sexual classification.

Religious anti-gay prejudice as a predictor of mental health, abuse, and substance use

Anti-gay, or homonegative, prejudice is generally considered harmful to the wellbeing of sexual minority individuals. However, the origins or nature of such prejudice may vary. Despite a sizable body of literature suggesting homonegative prejudice is frequently religious-based, the psychological impact of exposure to religious anti-gay prejudice remains largely undetermined. Addressing this research gap, the authors examined whether opposition to same-sex sexuality on religious grounds predicted detrimental outcomes among same- and both-sex attracted individuals, as well as their heterosexual counterparts. A nationwide U.S. sample of 1600 individuals-recruited using contemporary online crowd-sourcing techniques designed to limit selection bias-completed a novel inventory assessing interpersonal exposure to religious (as well as nonreligious) homonegative disapproval. Outcome variables assessed included a number of clinically relevant measures spanning general mental health, social support, suicidality, abuse, and substance use. Analyses revealed that greater exposure to religious anti-gay prejudice predicted higher levels of anxiety, stress, and shame; more instances of physical and verbal abuse; and more problematic alcohol use. Furthermore, while sexual minority individuals tended to fare more poorly than their heterosexual counterparts on almost every outcome measure assessed, homonegative prejudice predicted poorer outcomes among all respondents regardless of their sexual orientation or religious identification. Hence, results are among the first to demonstrate that anti-gay religious exposure is associated with substantial threats to wellbeing, and that such effects may be observed beyond religious sexual minorities. Overall, findings imply that homonegative religious social conditions may be of broader health and mental health concern than is conventionally recognized. (PsycINFO Database Record

The role of internalized homonegativity in the faith and psychological health of lesbians

Among lesbians, faith-based beliefs and behaviors may be associated with negative psychological health due to the interplay between religious and sexual identities. The present study examined health outcomes, faith-based beliefs (views of God as loving and controlling), faith-based behaviors (personal spiritual practices, religious activities), and internalized homonegativity in a sample of 225 self-identified lesbians. We hypothesized that internalized homonegativity would moderate the relationship between health outcomes and faith-based beliefs and behaviors among lesbians. Generally, results indicated that some faith-based beliefs and behaviors were related to negative health outcomes among lesbians with higher levels of internalized homonegativity, but among those with lower levels of internalized homonegativity, the negative associations with health were mitigated.

A genuine article: Intersectionality, Black lesbian gender expression, and the feminist pedagogical project

This article examines gender expression as central to the pedagogical projects of Black lesbian feminist pedagogues teaching interdisciplinary material related to race, gender, and sexuality. Participants discuss the ways in which their own masculinity, femme identity, and gendered performances influence instructive practices in the classroom and collegiality on campus. Being a "genuine article" of intersectionality theory plays a role in creative applications of the body as text and the institutional impediments to education as the practice of freedom for pedagogues whose marginalized gender, racial, sexual, and political identities closely align with their subject matter and influence campus roles and relationships.

Fear of a Black femme: The existential conundrum of embodying a Black femme identity while being a professor of Black, queer, and feminist studies

Although a Black femme identity has been defined and embodied by many as an identity with Black feminist roots and revolutionary potentials, Black femmes are still rendered hypervisible and invisible through racist and heteronormative politics. Similarly, embodying a Black femme identity as a professor in academia often engenders these same pretenses of hypervisibility and invisibility. This essay explores what this existential conundrum has been for me as both a Black femme and professor of Black queer and feminist studies, while illuminating the mix of forces within academia that have attempted to stifle my chosen sexual identity and gendered performance.

What happened when I invited students to see me? A Black queer professor's reflections on practicing embodied vulnerability in the classroom

What are the hesitations, dangers, and potentialities to inviting students to peruse my body? What possibilities arise from centering and leading with the body in the teaching/learning process? What risks and possibilities does this enactment pose to a Black lesbian educator? This auto/ethnography journeys through and reflects upon my experience enacting what I have coined "embodied vulnerability" as a pedagogical practice. Within this essay, I explore the interrelationship of race, gender, and embodiment (or, the performance of self). In addition, I reflect upon the pedagogical exercise-enacted over the last seven years-of asking students to see me and name what they see to illumine how social identities are read alongside context/location, as well as in relation to other assumed identities. Due to the historical and contemporary framing of Blackness and femininity-as paradoxical in popular culture and popular constructions of Blackness and queerness as antithesis-my queerness is undetectable in predominantly White classroom spaces. This essay documents my experience working through this contentious reality and offers the practice "embodied vulnerability" as a feminist practice and educative tool for mediating how the body is understood in the classroom, invoking identity and mobilizing the body in teaching/learning processes.

Brown queer compositionistas and the reflective practice of automythnography

Autoethnographic self-reflection is a strategy for teachers to examine their pedagogies and academic workspaces at large. In the process of moving from teaching composition at an institution in the Midwest to one in Southeast Queens, this author describes significant shifts in how she perceived herself as a Brown queer pedagogue. In order to analyze these shifts in ways that advance her pedagogical praxis, the author evaluates the research tools available to her and offers a hybrid method for reflection, which she calls "vulnerable automythnography." Applying this reflective practice to a specific classroom occurrence, the author considers some ways in which vulnerable automythnography offers underrepresented teachers and students an opportunity to examine the aggressions Black, Brown, and queer bodies face in academic settings. She posits this method of reflection as a tool for savvy resistance and intervention.

"She has a real connection with them": Reimagining and expanding our definitions of Black masculinity and mentoring in education through female masculinity

Through narrative inquiry, utilizing in-depth interviews and field observations, the goal of this research is to begin a dialogue within the field of education and mentoring scholarship that expands the mentoring of Black males beyond traditional norms of sex and gender identities/performances to reimagine the ways in which Black female masculinity can be a site of mentoring for Black and Brown boys.

Psychometric analysis of the Life Worries Scale for a new generation of sexual minority men: The P18 Cohort Study

OBJECTIVE

Sexual minority men (SMM) in the United States continue to experience adverse health problems and psychosocial burdens. However, there is limited psychometric research seeking to quantify the life worries of this population. Informed by syndemic theory, the Life Worries Scale (LWS) was developed to measure the concerns of young SMM.

METHOD

Analyses of the scale were undertaken using baseline data (n = 665) from an ongoing cohort study of emerging adult, SMM.

RESULTS

Exploratory factor analyses (EFA) of an initial set of 24 Likert-type items, followed by confirmatory factor analysis (CFA) and an exploratory structural equation model (ESEM), indicated a structure consisting of 6 domains of worries: financial stability, social stability, self esteem, loneliness, physical appearance, and physical health. These 6 subscales were highly correlated and also demonstrated high levels of internal consistency. Differences in life worries were noted across demographic states, specifically HIV serostatus, sexual attraction, housing status, and self-rated health. High levels of association were also detected between all 6 subscales with both depression and PTSD, while significant correlations were detected between suicidality and both self esteem and loneliness related worries.

CONCLUSIONS

The results of our analyses provide evidence for the strong psychometric characteristics of the LWS. This newly developed instrument should be utilized in research to examine the extent to which life worries explain health outcomes and risk behaviors in sexual minority males, and may be potentially extended for use in other populations. (PsycINFO Database Record

Promoting Pre-exposure Prophylaxis to Prevent HIV Infections Among Sexual and Gender Minority Hispanics/Latinxs

Sexual and gender minority Hispanics/Latinxs (henceforth: Latinxs) continue to be disproportionately impacted by HIV/AIDS in the U.S. Pre-exposure prophylaxis (PrEP) is a biomedical prevention approach which holds significant promise for at risk and vulnerable populations. We discuss barriers and facilitators to uptake of PrEP among sexual and gender minority Latinxs living in the U.S. through an ecosocial lens that takes into account structural, community, and individual contexts. The impact of immigration status on PrEP uptake emerges as a major and recurrent theme that must be understood and addressed by HIV prevention programs aiming to promote an inclusive strategy for sexual and gender minority Latinxs living in the U.S.

Promoting the wellbeing of lesbian, gay, bisexual and transgender forced migrants in Canada: providers' perspectives

Researchers are beginning to document the experiences of lesbian, gay, bisexual and transgender (LGBT) forced migrants in settlement. However, studies exploring the perceptions of service providers working with this vulnerable population are limited. These may shed light on the challenges of meeting the needs of LGBT forced migrants, especially mental health issues and problems. This qualitative study elicited the views of 22 Canadian service providers, including advocates, lawyers and mental health practitioners, who serve LGBT forced migrants. Grounded theory analysis revealed the following four themes: facilitating safety, buffering rejection; tracking avoidance patterns; interpreting mental health; and negotiating identity paradigms. Participants' accounts suggest that LGBT forced migrants may be best served by providers who understand the exigencies of establishing trust and safety for their clients; recognise their clients' nuanced social support needs; facilitate the refugee claims process; grasp the complexity of their clients' mental health challenges; and interrogate their own cultural biases regarding sexual orientations and gender identities.

Race, ethnicity, religious affiliation, and education are associated with gay and bisexual men's religious and spiritual participation and beliefs: Results from the One Thousand Strong cohort

OBJECTIVES

This study examined the rates of spirituality, religiosity, religious coping, and religious service attendance in addition to the sociodemographic correlates of those factors in a U.S. national cohort of 1,071 racially and ethnically diverse HIV-negative gay and bisexual men.

METHOD

Descriptive statistics were used to assess levels of spirituality, religiosity, religious coping, and religious service attendance. Multivariable regressions were used to determine the associations between sociodemographic characteristics, religious affiliation, and race/ethnicity with four outcome variables: (1) spirituality, (2) religiosity, (3) religious coping, and (4) current religious service attendance.

RESULTS

Overall, participants endorsed low levels of spirituality, religiosity, and religious coping, as well as current religious service attendance. Education, religious affiliation, and race/ethnicity were associated with differences in endorsement of spirituality and religious beliefs and behaviors among gay and bisexual men. Men without a 4-year college education had significantly higher levels of religiosity and religious coping as well as higher odds of attending religious services than those with a 4-year college education. Gay and bisexual men who endorsed being religiously affiliated had higher levels of spirituality, religiosity, and religious coping as well as higher odds of religious service attendance than those who endorsed being atheist/agnostic. White men had significantly lower levels of spirituality, religiosity, and religious coping compared to Black men. Latino men also endorsed using religious coping significantly less than Black men.

CONCLUSIONS

The implications of these findings for future research and psychological interventions with gay and bisexual men are discussed. (PsycINFO Database Record

Suicide Acceptability and Sexual Orientation: Results from the General Social Survey 2008-2014

Lesbian, gay, and bisexual (LGB) individuals have higher prevalence of lifetime suicide ideation and attempt than their heterosexual peers, but less is known about differences in suicide acceptability (i.e., believing suicide is a viable answer to a problem). The purpose of this study was to examine if LGB adults had greater suicide acceptability than heterosexual adults. A total of 4 items in the General Social Surveys from 2008 to 2014 assessed whether a nationally representative sample of U.S. adult respondents (n = 5,037) thought it acceptable for individuals to kill themselves if one: goes bankrupt, dishonors their family, is tired of living, or has an incurable disease. Multiple logistic regression analyses were used to assess the association of sexual orientation with suicide acceptability items after adjusting for confounding factors. Compared with heterosexuals, lesbians/gays had higher odds of reporting suicide acceptability if one goes bankrupt (OR = 1.92; 95% CI: 1.06, 3.46), dishonors family (OR = 1.83; 95% CI: 1.01, 3.28), or is tired of living (OR = 2.25; 95% CI: 1.30, 3.90). Bisexual and heterosexual groups were largely similar across the 4 suicide acceptability items. No sexual orientation differences were observed for reporting acceptability of suicide in the instance of an incurable disease. Post hoc analyses revealed significant interactions between sex and sexual orientation, such that differences in suicide acceptability seemed to be driven by sexual minority women rather than by sexual minority men. Suicide acceptability differs by sexual orientation, and community-level interventions around changing norms about suicide may be a prevention strategy for sexual minority individuals.

Results of Gottman Method Couples Therapy with Gay and Lesbian Couples

The results of an uncontrolled study of Gottman Method Couples Therapy in changing relationship satisfaction with 106 gay and lesbian couples is reported in this paper. Measurement of relationship satisfaction was conducted at five separate time points. The data show significant improvements in relationship satisfaction following eleven sessions of therapy for both gay male and lesbian couples. Effect sizes suggest that this therapy was highly effective, compared to the usual 0.5 standard deviation effect size in couples therapy. Initial co-morbidities did not affect the size of the changes; in fact, some changes were significantly larger for three initial co-morbidities.

A Grounded Theory of Sexual Minority Women and Transgender Individuals' Social Justice Activism

Psychosocial benefits of activism include increased empowerment, social connectedness, and resilience. Yet sexual minority women (SMW) and transgender individuals with multiple oppressed statuses and identities are especially prone to oppression-based experiences, even within minority activist communities. This study sought to develop an empirical model to explain the diverse meanings of social justice activism situated in SMW and transgender individuals' social identities, values, and experiences of oppression and privilege. Using a grounded theory design, 20 SMW and transgender individuals participated in initial, follow-up, and feedback interviews. The most frequent demographic identities were queer or bisexual, White, middle-class women with advanced degrees. The results indicated that social justice activism was intensely relational, replete with multiple benefits, yet rife with experiences of oppression from within and outside of activist communities. The empirically derived model shows the complexity of SMW and transgender individuals' experiences, meanings, and benefits of social justice activism.

What Men Who Have Sex With Men in Peru Want in Internet-Based Sexual Health Information

We aimed to gather information among gay men regarding their preferences for online sexual health information; 1,160 Peruvian MSM, 18 years or older, completed an online survey hosted on www.tunexo.org . The mean age was 26.8 years. Around 90% had post-high school education. The self-reported HIV prevalence was 12.3%. The acceptability of sexual health content was greater in the most highly educated group. The highest rated topics and services of interest were those related to improving sexual and mental health. The least educated group was significantly more interested in "getting prevention messages on mobiles" compared to men with the highest level of education (71% vs. 52%; p < 0.001). Men's sexual health was of more interest to the 30-39-year-old group compared to the 18-24-year-old one (97% vs. 87%; p = 0.005). Future Web-based interventions related to sexual health among targeted groups of MSM in Peru can be tailored to meet their preferences.

Mental Health and Coping Patterns in Jewish Gay Men in Israel: The Role of Dual Identity Conflict, Religious Identity, and Partnership Status

This study examined the effects of dual-identity conflict, religious identity (religious/spiritual vs. sexual), and partnership status on the coping strategies and mental health of gay Jewish men in modern Israeli society. Participants were 73 religious and 71 secular gay men recruited via e-mail, social networking sites, and online resources targeting sexual minority men. Participants were assessed via measures of identity conflict, mental health, and coping strategies. Jewish gay men who reported more severe identity conflict also reported using less problem-focused and avoidance coping and more emotion-focused coping strategies and reported poorer mental health than their less identity-conflicted counterparts. Furthermore, gay men who self-identified as religious reported poorer mental health as well as less problem-focused coping and more emotion-focused coping compared to secular men. Religious gay men in romantic relationships reported lower intensities of dual-identity conflict and better mental health compared to their nonpartnered counterparts.

Who Adopts Queer and Pansexual Sexual Identities?

Some nonheterosexual individuals are eschewing lesbian/gay and bisexual identities for queer and pansexual identities. The present study aimed to examine the sexual and demographic characteristics of nonheterosexual individuals who adopt these labels. A convenience sample of 2,220 nonheterosexual (1,459 lesbian/gay, 413 bisexual, 168 queer, 146 pansexual, and 34 other "write-in") individuals were recruited for a cross-sectional online survey. In support of our hypotheses, those adopting pansexual identities were younger than those adopting lesbian, gay, and bisexual identities, and those adopting queer and pansexual identities were more likely to be noncisgender than cisgender, and more likely to be cisgender women than men. The majority of pansexual individuals demonstrated sexual orientation indices within the bisexual range, and showed equivalent patterns of sexual attraction, romantic attraction, sexual behavior, and partner gender as bisexual-identified men and women. In contrast, three-quarters of queer men, and more than half of queer women, reported sexual attraction in the homosexual range. This study found that rather than a general movement toward nontraditional sexual identities, queer and pansexual identities appear most appealing to nonheterosexual women and noncisgender individuals. These findings contribute important information regarding who adopts queer and pansexual identities in contemporary sexual minority populations.

Sexual Orientation Disparities in Mistimed and Unwanted Pregnancy Among Adult Women

CONTEXT

Many sexual minority women, regardless of sexual identity, engage in heterosexual behavior across the life course, which provides them opportunities to experience an unintended pregnancy. In addition, sexual minority women are more likely than others to report characteristics that may make them vulnerable to unintended pregnancy. Little research, however, has examined whether the risk of unintended pregnancy is elevated among these women.

METHODS

Using data from the 2006-2010 National Survey of Family Growth, logistic regression models were fitted to examine sexual orientation disparities in mistimed and unwanted pregnancies among 9,807 women aged 20-45; mixed-effects hazard models assessed disparities in the intention status of 5,238 pregnancies among these women by maternal sexual orientation.

RESULTS

Compared with heterosexual women reporting only male partners, heterosexual women who have sex with women had higher odds of reporting a mistimed pregnancy (odds ratio, 1.4), and bisexual women had higher odds of reporting an unwanted pregnancy (1.8). When compared with pregnancies reported by heterosexual women with only male partners, those reported by heterosexual women who have sex with women were more likely to be mistimed (hazard ratio, 1.7), and those reported by bisexual and lesbian women were more likely to be unwanted (1.7-4.4).

CONCLUSIONS

Compared with heterosexuals who have sex with men only, adult sexual minority women are at equal or greater risk of reporting an unintended pregnancy. More research addressing the reproductive health care needs of sexual minority women is needed to develop strategies to improve family planning for this population.

A Qualitative Exploration of the Premigration Victimization Experiences of Sexual and Gender Minority Refugees and Asylees in the United States and Canada

Progress in analyzing and interpreting the concepts of sexual orientation and gender identity in the context of refugee law has contributed to a rise in individuals seeking asylum in such countries as the United States and Canada. However, few studies have examined the victimization experiences of sexual- and gender-identity forced migrants prior to their arrival in North America. This qualitative study used thematic analysis to explore the premigration adult victimization experiences of 26 lesbian, gay, and transgender individuals who obtained refugee, asylee, or withholding-of-removal status in the United States or Canada based on persecution for their sexual orientation and/or gender identity. Participants originated from countries in Asia, Africa, the Caribbean, Eastern Europe, Latin America, and the Middle East. Analysis revealed the following themes: living on the edge, adopting concealment strategies, routine victimization, and protectors as perpetrators. Participants described living in a constant state of hypervigilance, and they adopted numerous strategies to protect themselves from victimization. Despite the use of such strategies, participants experienced victimization by community members and state actors, leaving them no choice but to flee to ensure their safety and well-being. Findings are discussed using the ecological framework outlined by the World Health Organization (WHO). The discussion concludes with implications for international policy and clinical practice.

Puerto Rican Latina Youth Coming Out to Talk About Sexuality and Identity

Public health efforts focused on Latina youth sexuality are most commonly framed by the syndemic of teen pregnancy and sexually transmitted infections, a narrow and often heteronormative focus that perpetuates silences that contribute to health inequities and overlooks the growing need for increased education, awareness, and support for lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth. This article presents findings from the project Let's Talk About Sex: Digital Storytelling for Puerto Rican Latina Youth, which used a culturally centered, narrative-based approach for analyzing participants' own specifications of sexual values and practices. The strength of digital storytelling lies in its utility as an innovative tool for community-based and culturally situated research, as well as in its capacity to open up new spaces for health communication. Here we present two "coming out" case studies to illustrate the value of digital storytelling in supporting the development of meaningful and culturally relevant health promotion efforts for LGBTQ-identified Puerto Rican Latina youth across the life span.

Associations of Bisexual-Specific Minority Stress and Health Among Cisgender and Transgender Adults with Bisexual Orientation

Among sexual minorities, bisexuals are at the greatest risk for poor health due in part to prejudice and stigma. This research examined associations of bisexual-specific minority stress and health among cisgender (non-transgender) and transgender adults with bisexual orientation. Participants were 488 adults (378 cisgender women, 49 cisgender men, 61 transgender individuals), age 18 to 66 years, with bisexual orientation based on identity and/or attractions to multiple genders. Participants completed an online survey. Hierarchical linear regression analyses were conducted with sexual minority stress and bisexual-specific minority stress as the predictors and physical health, measured by the 36-Item Short Form Survey (SF-36), as the outcome. Models controlled for demographic variables. Moderation analyses were conducted to test for gender differences. Greater bisexual-specific minority stress significantly predicted poorer overall physical health (β = -0.16), greater pain (β = -0.16), and poorer general health (β = -0.25) above and beyond the effects of sexual minority stress. Gender moderated the association between bisexual-specific minority stress and health, such that bisexual-specific minority stress predicted overall physical health and role limitations for transgender individuals but not for cisgender women. Addressing bisexual-specific minority stress is necessary to improve the health and well-being of bisexual individuals.

Partner abuse and its association with emotional distress: A study exploring LGBTI relationships

This study examines partner abuse in LBGTI relationships, with focus on the associations with emotional distress and protective factors. Two hundred and eighty-seven participants took part. Partner abuse (victimisation) comprised three factors; conflict orientated aggression; hostile ignorance and control of communication; and social control and possessiveness (including threats to possessions). Perpetration factors were similar. Significant differences across sexuality or gender were limited to the perpetration of abuse relating to suspicion and possessiveness, where men were more likely to report this than the other gender groups, and women were less likely to report this. Of those reporting abuse in their current relationship, over half reported experiencing abuse in a primary relationship previously, with 60% reporting exposure to abuse as a child. Partner abuse in their current relationship predicted current levels of increased emotional distress, with reduced satisfaction with the current relationship having an indirect impact on this association. Resilience traits were not a predictor or mediator. The results demonstrate the similarity in abuse across LGBTI communities despite the diversity of genders, sexualities and experiences within these groups. The results are discussed with regard to directions for future research and implications for practice.

Latino men who have sex with transgender women: the influence of heteronormativity, homonegativity and transphobia on gender and sexual scripts

Latino men who have sex with transgender women make up an overlooked sector of the population that requires more attention than is currently given in sexuality and gender studies, particularly in regard to their non-commercial, long-term sexual and romantic relationships with transgender women. Sixty-one sexual histories were selected for this qualitative analysis from a larger study on Latino male bisexuality in the New York City metropolitan area. Findings suggest that participants' sexual and gender scripts with transgender women are strongly regulated by heteronormativity. Furthermore, homonegativity and transphobia often intersect in the lived experiences of men who have sex with transgender women, resulting in relationship conflicts over the control of transgender women's bodies, sexual behaviours and gender performance both in public and in private. Findings also suggest that low relationship conflict is more common among men who have sex with transgender women who exhibit diverse sexual roles (being both insertive and receptive during anal sex), or transgress heteronormative scripts through dialogue of desires and/or by embracing transgender women as human beings and not as hyperfeminised objects of desire. Stigma reduction and alternatives to heteronormative interventions are needed to improve relationship dynamics and potentially positively impact on the sexual health and overall wellbeing of Latino men who have sex with transgender women and their transgender partners.

Partner Abuse Among HIV-Positive Sexual Minority Men: "That Was All I Deserved . . ."

Living with HIV can be both a precipitant and a consequence of partner abuse (PA) across populations, including male-male partnerships. However, overlapping experiences of living with HIV and experiencing PA are not well characterized. We conducted 24 qualitative interviews with urban HIV-positive sexual minority men (SMM) recruited from a public hospital HIV clinic in Seattle, Washington, who reported lifetime PA histories, and analyzed them using content analysis. Participants reported psychological, physical, and sexual victimization from partners, varying in severity. Themes included (a) how HIV and minority stress (e.g., through self-stigma, serosorting) and (b) familial and repeated exposure to violence (e.g., through normalization or acceptance of PA, partnering as strategy for increasing one's own safety, esteem, or social status), independently and in combination, provided a context for the men's victimization. Our findings suggest that PA-related interventions might focus on coping with stigma, expanding social networks, and educating SMM about dysfunctional relationship dynamics.

Sexual orientation and future parenthood in a 2011-2013 nationally representative United States sample

Previous researchers have found evidence for differences in parenting goals between lesbian and gay people and their heterosexual peers. However, no previous research has quantified the parenting goals of bisexual people or evaluated parenting goals as a function of sexual partner gender. In addition, political and social climates for sexual minority people had improved rapidly since the last representative data on lesbian and gay peoples' plans for parenthood were collected. We analyzed data from 3,941 childless lesbian, gay, bisexual, and heterosexual participants from the 2011-2013 National Survey of Family Growth (NSFG; United States Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2014), a nationally representative sample of United States residents aged 15 to 44 years. We found that statistically significant, within-gender sexual orientation differences in parenting plans persist, despite social and legal changes. Consistent with hypotheses, bisexual men's parenting desires and intentions were similar to those of their heterosexual male peers and different from those of their gay male peers, while bisexual women's reports were more mixed. Also consistent with hypotheses, the gender of the most recent sexual partner was a strong predictor of parenting goals. We discuss implications for mental and reproductive health-care providers, attorneys, social workers, and others who interact with sexual minority adults. (PsycINFO Database Record

Sexual Behavior, Definitions of Sex, and the Role of Self-Partner Context Among Lesbian, Gay, and Bisexual Adults

Prior research has examined how heterosexual individuals define sex; however, these studies have rarely focused on sexual minority individuals or included a full range of applicable sexual behaviors. Participants were recruited from a local Pride Festival across two years. Study 1 (N = 329) was primarily descriptive and examined which physically intimate behaviors lesbian, gay, and bisexual (LGB) participants included in their definitions of sex and the behaviors in which they had previously engaged. Study 2 (N = 393) utilized a between-subjects design to assess differences in definitions of sex when judging one's own behavior compared with that of a partner outside of the relationship. The behaviors in which participants were most likely to have engaged were manual-genital (82%) and oral-genital stimulation (79%). Regarding definitions of sex, a clear "gold standard" emerged for men, with 90% endorsing penile-anal intercourse as sex. No equally clear standard existed for women. Participants who were asked to consider their partner's behavior outside of their relationship were more likely to endorse the behavior as "having sex" than participants asked to consider their own behavior. This study addressed a major limitation of prior research by investigating definitions of sex among a community sample of LGB adults, with implications for provision of health care and sexual agreements between same-sex couples.

Paving Pathways Through the Pain: A Grounded Theory of Resilience Among Lesbian, Gay, Bisexual, Trans, and Queer Youth

This grounded theory study utilized interviews with 16 service providers and 19 lesbian, gay, bisexual, trans, and queer (LGBTQ) youth to develop a substantive theory of resilience processes among LGBTQ youth. The core category, paving pathways through the pain, suggests that LGBTQ youth build on emotional pain inflicted by external adversities to carve out pathways to resilience. Youth employed the following resilience processes: (1) navigating safety across contexts, (2) asserting personal agency, (3) seeking and cultivating meaningful relationships, (4) un-silencing marginalized identities, and (5) engaging in collective healing and action. Youth focused on particularly painful adversities and engaged intentionally in one or more of the resilience processes related to the origins of their pain.

The Relationship Between Sexual Minority Stigma and Sexual Health Risk Behaviors Among HIV-Positive Older Gay and Bisexual Men

This study investigates how internalized sexual minority stigma and enacted sexual minority stigma in health care settings are associated with sexual health risk behaviors (SRBs) and the mediating role of infrequent routine health care and perceived stress among older gay and bisexual (G/B) men living with HIV disease. Survey responses from 135 sexually active older G/B men living with HIV were analyzed using hierarchical linear regression models. Results indicate that one fifth of G/B older adult men living with HIV are engaged in multiple SRBs. Internalized sexual minority stigma and enacted sexual minority stigma in health care settings are significantly associated with SRBs. The relationship between internalized sexual minority stigma and SRBs are mediated by infrequent routine health care and elevated levels of perceived stress. Improved primary and secondary prevention strategies are needed for the growing number of sexually active older G/B men.

The Relationship Between Sexual Minority Stigma and Sexual Health Risk Behaviors Among HIV-Positive Older Gay and Bisexual Men

This study investigates how internalized sexual minority stigma and enacted sexual minority stigma in health care settings are associated with sexual health risk behaviors (SRBs) and the mediating role of infrequent routine health care and perceived stress among older gay and bisexual (G/B) men living with HIV disease. Survey responses from 135 sexually active older G/B men living with HIV were analyzed using hierarchical linear regression models. Results indicate that one fifth of G/B older adult men living with HIV are engaged in multiple SRBs. Internalized sexual minority stigma and enacted sexual minority stigma in health care settings are significantly associated with SRBs. The relationship between internalized sexual minority stigma and SRBs are mediated by infrequent routine health care and elevated levels of perceived stress. Improved primary and secondary prevention strategies are needed for the growing number of sexually active older G/B men.

Graded Structure in Sexual Definitions: Categorizations of Having "Had Sex" and Virginity Loss Among Homosexual and Heterosexual Men and Women

Definitions of sexual behavior display a robust hierarchy of agreement regarding whether or not acts should be classed as, for example, sex or virginity loss. The current research offers a theoretical explanation for this hierarchy, proposing that sexual definitions display graded categorical structure, arising from goodness of membership judgments. Moderation of this graded structure is also predicted, with the focus here on how sexual orientation identity affects sexual definitions. A total of 300 18- to 30-year-old participants completed an online survey, rating 18 behaviors for how far each constitutes having "had sex" and virginity loss. Participants fell into one of four groups: heterosexual male or female, gay male or lesbian. The predicted ratings hierarchy emerged, in which bidirectional genital acts were rated significantly higher than unidirectional or nonpenetrative contact, which was in turn rated significantly higher than acts involving no genital contact. Moderation of graded structure was also in line with predictions. Compared to the other groups, the lesbian group significantly upgraded ratings of genital contact that was either unidirectional or nonpenetrative. There was also evidence of upgrading by the gay male sample of anal intercourse ratings. These effects are theorized to reflect group-level variation in experience, contextual perspective, and identity-management. The implications of the findings in relation to previous research are discussed. It is suggested that a graded structure approach can greatly benefit future research into sexual definitions, by permitting variable definitions to be predicted and explained, rather than merely identified.

Patterns of Health Information Technology Use according to Sexual Orientation among US Adults Aged 50 and Older: Findings from a National Representative Sample-National Health Interview Survey 2013-2014

Health disparities among sexual minority adults ages 50 and older have been documented. Factors such as lifetime discrimination and internalized stigma may deter sexual minority individuals from seeking health services. Several studies suggest that health information technology may facilitate health education and outreach to populations whose health behaviors are affected by stigma such as older sexual minority people. This study examined the role of sexual minority identity as a factor that is associated with health information technology use. Data from the 2013-2014 National Health Interview Survey (NHIS) were analyzed. Multivariate logistic regressions were used to compare the odds of using technology as a resource for health information between sexual minority versus heterosexual US adults aged 50 and older. Adjusting for sociodemographic variables and health variables, sexual minority participants had increased odds of using computers to look up health information on the Internet (OR = 2.01, 95% CI 1.53-2.64), using computers to fill a prescription (OR = 1.97, 95% CI 1.36-2.85), and using computers to communicate with health-care provider by e-mail (OR = 2.13, 95% CI 1.55-2.92), compared with heterosexuals. Findings reveal greater use of health information technology among older sexual minority adults when compared to their heterosexual counterparts. While sensitive, competent providers and culturally appropriate prevention services are essential to meeting the needs of aging sexual minority populations, health information technology use may be an innovative means of reducing disparities in information access as structural changes are implemented.

"You just can't trust everybody": the impact of sexual risk, partner type and perceived partner trustworthiness on HIV-status disclosure decisions among HIV-positive black gay and bisexual men

HIV remains an intractable public health concern in the USA, with infection rates notably concentrated among Black gay and bisexual men. Status disclosure by HIV-positive individuals can be an important aspect of risk reduction but doing so poses dilemmas concerning privacy, stigma and self-protection, especially among populations subjected to multiple types of stigmatisation. Understanding the factors related to the disclosure process can help to inform prevention efforts. Using exploratory in-depth interviews, this qualitative study examines the disclosure process among a sample of twenty HIV-positive Black gay and bisexual men (mean age = 40) recruited through a non-profit health centre in a mid-western city in the USA. Data were analysed using a thematic analysis approach with HIV-disclosure as an a priori sensitising concept. Fears of stigma and secondary disclosure within social networks were critical barriers to talking about HIV with sexual partners and disclosure decisions involved a complex process centred on three primary themes: degree of sexual risk, partner type and perceived partner trustworthiness. The unique combinations of these contextual factors resulted in increased or decreased likelihood of disclosure. A conceptual model explicating a potential process by which these contextual factors influence disclosure decisions is presented.

Eating Disorders and Disordered Weight and Shape Control Behaviors in Sexual Minority Populations

PURPOSE OF REVIEW

This review summarized trends and key findings from empirical studies conducted between 2011 and 2017 regarding eating disorders and disordered weight and shape control behaviors among lesbian, gay, bisexual, and other sexual minority (i.e., non-heterosexual) populations.

RECENT FINDINGS

Recent research has examined disparities through sociocultural and minority stress approaches. Sexual minorities continue to demonstrate higher rates of disordered eating; disparities are more pronounced among males. Emerging data indicates elevated risk for disordered eating pathology among sexual minorities who are transgender or ethnic minorities. Dissonance-based eating disorder prevention programs may hold promise for sexual minority males. Continued research must examine the intersections of sexual orientation, gender, and ethnic identities, given emergent data that eating disorder risk may be most prominent among specific subgroups. More research is needed within sexual minorities across the lifespan. There is still a lack of eating disorder treatment and prevention studies for sexual minorities.

The effect of the promiscuity stereotype on opposition to gay rights

Opposition to gay rights is prevalent in countries around the world. Recent correlational research suggests that opposition to gay rights may be driven by an interaction between one’s own short-term mating orientation (i.e. willingness to engage in casual sex) and representations of gay people as sexually promiscuous. Here, we experimentally manipulated representations of gay men by randomly assigning participants to read one of two versions of a fictitious newspaper article, one of which contained faux scientific evidence confirming the stereotype that gay men are promiscuous, and the other containing faux scientific evidence refuting the stereotype. We found that the manipulation interacted with short-term mating orientation (STMO) to predict opposition to gay rights, such that low-STMO individuals (i.e. more averse to casual sex) exhibited more support for gay rights when assigned to read the stereotype-refuting article compared to the stereotype-confirming article, whereas high-STMO individuals (i.e. less averse to casual sex) were not significantly influenced by the manipulation. We discuss the implications of these findings for the study of antigay attitudes, as well as for recent societal changes in acceptance of homosexuality.

Black Edens, country Eves: Listening, performance, and black queer longing in country music

This article explores Black queer country music listening, performance, and fandom as a source of pleasure, nostalgia, and longing for Black listeners. Country music can be a space for alliance and community, as well as a way of accessing sometimes repressed cultural and personal histories of violence: lynching and other forms of racial terror, gender surveillance and disciplining, and continued racial and economic segregation. For many Black country music listeners and performers, the experience of being a closeted fan also fosters an experience of ideological hailing, as well as queer world-making. Royster suggests that through Black queer country music fandom and performance, fans construct risky and soulful identities. The article uses Tina Turner's solo album, Tina Turns the Country On! (1974) as an example of country music's power as a tool for resistance to racial, sexual, and class disciplining.

Event-Level Associations Among Drinking Motives, Alcohol Consumption, and Condomless Anal Sex in a Sample of Young Men Who Have Sex With Men

Young men who have sex with men (YMSM) are at increased risk for HIV and problematic alcohol use. Drinking motives are associated with alcohol use in cross-sectional studies, but their associations with alcohol use and condomless anal sex (CAS) at the event-level remain unclear. The current study examined these event-level associations in a sample of 189 YMSM who completed self-report measures on a daily or weekly basis for two months. Participants were recruited between August 2014 and April 2015 for a randomized trial designed to study behavioral reactivity in diary studies. YMSM consumed more alcohol on days when they drank to cope, to enhance pleasure, or to be more social. CAS with casual partners was more likely on days when they consumed more alcohol. Drinking motives were not associated with CAS. Interventions may benefit from addressing drinking motives and the influence of alcohol use on CAS in different types of relationships.

LGBTQ Youth's Views on Gay-Straight Alliances: Building Community, Providing Gateways, and Representing Safety and Support

BACKGROUND

Gay-Straight Alliances (GSAs) are school-based clubs that can contribute to a healthy school climate for lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth. While positive associations between health behaviors and GSAs have been documented, less is known about how youth perceive GSAs.

METHODS

A total of 58 LGBTQ youth (14-19 years old) mentioned GSAs during go-along interviews in 3 states/provinces in North America. These 446 comments about GSAs were thematically coded and organized using Atlas.ti software by a multidisciplinary research team.

RESULTS

A total of 3 themes describe youth-perceived attributes of GSAs. First, youth identified GSAs as an opportunity to be members of a community, evidenced by their sense of emotional connection, support and belonging, opportunities for leadership, and fulfillment of needs. Second, GSAs served as a gateway to resources outside of the GSA, such as supportive adults and informal social locations. Third, GSAs represented safety.

CONCLUSIONS

GSAs positively influence the physical, social, emotional, and academic well-being of LGBTQ young people and their allies. School administrators and staff are positioned to advocate for comprehensive GSAs. Study findings offer insights about the mechanisms by which GSAs benefit youth health and well-being.

Personality and its Relation to Mental and Psychosocial Health in Emerging Adult Sexual Minority Men: The P18 Cohort Study

Personality disorder and personality pathology encompass a dimension of psychological dysfunction known to severely impact multiple domains of functioning. However, there is a notable dearth of research regarding both the pervasiveness and correlates of personality pathology among young sexual minority males who themselves experience heightened mental health burdens. Using the self-report version of the Standardized Assessment of Personality-Abbreviated Scale we tested associations between distinct personality characteristics with sociodemographic and psychosocial factors as well as mental health states in a sample of 528 young (aged 21-25 years) sexual minority men. In multivariate analysis, personality traits varied significantly by race/ethnicity. Personality traits were also positively associated with psychosocial states, specifically, internalized anti-homosexual bias, level of connection with the gay community, and male body dissatisfaction, as well as mental health in the form of recent depressive and anxious symptomatology. These findings support the complex synergy which exists between personality characteristics, psychosocial conditions, and mental health burdens present among sexual minority men and support the need for an all-encompassing approach to both the study and care of this population that addresses the influences of both internal and external factors on well-being.

The Mental Health Impact of Physical Appearance Concerns in the Context of Other Life Domains Among Australian Gay Men

Previous studies have identified gay men as a high-risk population for body image disturbances. However, little research has examined the mental health impact of gay men's physical appearance concerns in the context of other major life domains. The present study addressed this gap by investigating how mental health outcomes (satisfaction with life, self-esteem, positive well-being, and psychological distress) were associated with satisfaction with and importance of physical appearance, work, family relationships, friendships, health and fitness, and sex life among Australian gay men aged 18-39. The possible moderating role of intimate relationship status was also examined. Results from an online survey revealed that greater satisfaction with physical appearance, work, family, and friendships all had similar positive associations with mental health. However, more importance placed on physical appearance was more consistently associated with poorer mental health compared with the subjective importance of other domains. Findings also indicated the associations between physical appearance satisfaction and life satisfaction, and between physical appearance importance and positive well-being, were weaker for those in relationships. Thus, physical appearance matters in gay men's lives, but was only one factor when considered in the broader context of other life areas that contributed to overall well-being. These findings suggest the need for a nuanced and contextualized understanding of how physical appearance concerns fit into gay men's lives.

"Knowing Your Status and Knowing Your Partner's Status Is Really Where It Starts": A Qualitative Exploration of the Process by Which a Sexual Partner's HIV Status Can Influence Sexual Decision Making

Gay and bisexual men are at disproportionate risk for human immunodeficiency virus (HIV) infection. While prevention efforts often emphasize consistent condom use, there is growing evidence that men are using seroadaptive safer-sex strategies, such as serosorting and seropositioning. This qualitative analysis of 204 HIV-negative and HIV-positive gay and bisexual men explored the ways that a sexual partner's HIV status can influence safer-sex strategies and sexual decisions. The majority of the respondents reported that they were influenced by their partners' HIV status. Those respondents who reported no influence discussed adhering to safer-sex rules that were not dependent on partner status and a lack of concern about HIV. Conversely, respondents who reported influence identified three primary areas of influence: psychological impacts, partner preference and selection, and specific behavioral intentions and strategies. A conceptual model explicating a potential process by which respondents use partner serostatus information in shaping sexual decisions is presented.

Disproportionality and Disparities among Sexual Minority Youth in Custody

Research indicates that sexual minority youth are disproportionately criminalized in the U.S. and subjected to abusive treatment while in correctional facilities. However, the scope and extent of disparities based on sexual orientation remains largely overlooked in the juvenile justice literature. This study, based on a nationally representative federal agency survey conducted in 2012 (N = 8785; 9.9% girls), reveals that 39.4% of girls and 3.2% of boys in juvenile correctional facilities identified as lesbian, gay, or bisexual. These youth, particularly gay and bisexual boys, report higher rates of sexual victimization compared to their heterosexual peers. Sexual minority youth, defined as both lesbian, gay, and bisexual identified youth as well as youth who identified as straight and reported some same-sex attraction, were also 2-3 times more likely than heterosexual youth to report prior episodes of detention lasting a year or more. Implications for future research and public policy are discussed.

"I Won't Out Myself Just to Do a Survey": Sexual and Gender Minority Adolescents' Perspectives on the Risks and Benefits of Sex Research

Sexual and gender minority (SGM) adolescents under age 18 are underrepresented in sexual health research. Exclusion of SGM minors from these studies has resulted in a lack of knowledge about the risks and benefits youth experience from sexual health research participation. Institutional Review Boards' (IRB) overprotective stances toward research risks and requirements for guardian consent for SGM research are significant barriers to participation, though few have investigated SGM youth's perspectives on these topics. This study aimed to empirically inform decisions about guardian consent for sexuality survey studies involving SGM youth. A total of 74 SGM youth aged 14-17 completed an online survey of sexual behavior and SGM identity, and a new measure that compared the discomfort of sexual health survey completion to everyday events and exemplars of minimal risk research (e.g., behavioral observation). Youth described survey benefits and drawbacks and perspectives on guardian permission during an online focus group. Participants felt about the same as or more comfortable completing the survey compared to other research procedures, and indicated that direct and indirect participation benefits outweighed concerns about privacy and emotional discomfort. Most would not have participated if guardian permission was required, citing negative parental attitudes about adolescent sexuality and SGM issues and not being "out" about their SGM identity. Findings suggest that sexual health survey studies meet minimal risk criteria, are appropriate for SGM youth, and that recruitment would not be possible without waivers of guardian consent. Decreasing barriers to research participation would dramatically improve our understanding of sexual health among SGM youth.

Variation in Sexual Identification Among Behaviorally Bisexual Women in the Midwestern United States: Challenging the Established Methods for Collecting Data on Sexual Identity and Orientation

Collecting information on sexual identity is critical to ensuring the visibility of minority populations who face stigmatization and discrimination related to sexual identities. However, it is challenging to capture the nuances of sexual identity with traditional survey research methods. Using a mixed-methods approach, we gathered data on the sexual identities of 80 behaviorally bisexual women in the Midwestern United States through an online survey. When provided different types of measures (e.g., open ended and fixed response) and different contexts in which to identify (e.g., private and public), participants varied in how they reported their sexual identities. Qualitative analysis of participant narratives around identity change finds partitioning and ranking of attraction is a key component in understanding behaviorally bisexual women's identities. We further identify a division regarding the desired outcomes of identity development processes. Given the multiple ways in which participants identified depending upon the type of measure and the context specified, and the variation in identification over time, results support reconsidering the capability of typical measures and methods used in survey research to capture sexual identity information. Additionally, findings highlight the utility of including multiple, context-specific measures of sexual identities in future research.

Sexual Orientation Self-Presentation Among Bisexual-Identified Women and Men: Patterns and Predictors

Writing on the experiences of bisexual-identified people has highlighted the potential complexity of the ongoing process of deciding when and how to present one's sexual orientation identity to others (Rust, 2002). The two studies presented here were designed to contribute basic knowledge regarding self-presentation of sexual orientation among bisexual people. In Study 1, bisexual participants (N = 147) were less likely than their lesbian and gay (LG) peers (N = 191) to present their actual orientation to others, and more likely to present themselves as having a sexual orientation different from their actual orientation. These sexual orientation differences were explained by gender of romantic partner and uncertainty about one's sexual orientation. Sexual orientation differences also emerged in links between self-presentation and outness level. For example, bisexual participants who presented themselves as LG had relatively high everyday outness levels; in contrast, LG participants who presented themselves as bisexual had relatively low everyday outness levels. In Study 2, 240 bisexual women and men indicated their levels of outness as a sexual minority person (potentially including identification as gay, lesbian, queer) and specifically as bisexual. Outness was higher with respect to status as a sexual minority compared to status as bisexual; the magnitude of this difference was predicted by gender of romantic partner and uncertainty about one's sexual orientation. Moreover, even controlling for outness as a sexual minority person, well-being was predicted by outness as bisexual to family members.

Qualitative Comparison of Barriers to Antiretroviral Medication Adherence Among Perinatally and Behaviorally HIV-Infected Youth

Medication adherence among youth living with HIV (28%-69%) is often insufficient for viral suppression. The psychosocial context of adherence barriers is complex. We sought to qualitatively understand adherence barriers among behaviorally infected and perinatally infected youth and develop an intervention specific to their needs. We conducted in-depth interviews with 30 youth living with HIV (aged 14-24 years) and analyzed transcripts using the constant comparative method. Barriers were influenced by clinical and psychosocial factors. Perinatally infected youth barriers included reactance, complicated regimens, HIV fatigue, and difficulty transitioning to autonomous care. Behaviorally infected youth barriers included HIV-related shame and difficulty initiating medication. Both groups reported low risk perception, medication as a reminder of HIV, and nondisclosure, but described different contexts to these common barriers. Common and unique barriers emerged for behaviorally infected and perinatally infected youth reflecting varying HIV experiences and psychosocial contexts. We developed a customizable intervention addressing identified barriers and their psychosocial antecedents.

Substance Use and Sexual Risk Behavior Among Black South African Men Who Have Sex With Men: The Moderating Effects of Reasons for Drinking and Safer Sex Intentions

Research studies suggest an association between substance use and sexual risk behavior, but are not completely consistent. The moderating effects of other psychosocial factors might help explain these inconsistencies. The current study therefore assessed whether substance use is associated with sexual risk behavior, and whether this relationship is modified by expectancies about the effects of alcohol, reasons for consuming alcohol, or intentions to engage in safe sex. A cross-sectional survey was conducted among 480 black South African men who have sex with men recruited using respondent-driven sampling. In multivariable analyses, the effect of alcohol use on unprotected receptive anal intercourse (URAI) was modified by drinking to enhance social interaction (R² change = 0.03, p < 0.01). The effect of drug use on URAI was modified by safe sex intentions (R² change = 0.03, p < 0.001). Alcohol use was positively associated with URAI only among those who drink to enhance social interaction (β = 0.08, p < 0.05). Drug use was positively associated with URAI only among those with high safe sex intentions (β = 0.30, p < 0.001). Our findings suggest that efforts to minimize the impact of substance use on HIV risk behavior should target men who drink to enhance social interaction and men who intend to engage in safer sex. Efforts made to increase safer sex intentions as a way to reduce HIV risk behavior should additionally consider the effects of substance use.