"It's like our own little world": resilience as a factor in participating in the Ballroom community subculture

The HIV Environmental Riskscape: The Roles of HIV Sexual Risk and Resilience Factors among Black Men Who Have Sex with Men: Findings from the Real Talk Project

Black and African American men who have sex with men (Black MSM) experience the greatest proportion of new HIV infections in the United States. To address this challenge, a better understanding of the HIV environment riskscape including both risk and resilience factors is warranted among Black MSM. Research indicates that stress is associated with increased HIV sexual risk behaviors. Further, behavioral factors such as serosorting and community level factors including social support and community connection are resilience factors that protect against risk behaviors. The present study examines whether everyday stress is associated with HIV sexual risk behavior, as well as the role of risk and resilience factors among 125 Black MSM recruited in the Real Talk study. The Real Talk project examined the relationships between resilience, HIV risk behaviors, and HIV prevention strategy among a sample of Black MSM. Using generalized estimating equations, our results indicate a positive association between everyday stress and engaging in condomless anal intercourse only after adjusting for risk, resilience, and correlate variables. Similarly, having multiple sex partners and using substances during sex also show positive associations with condomless anal intercourse. Resilience factors of engaging in serosorting and being connected to both the Black and gay communities were negatively associated with condomless anal intercourse. Future prevention research and programming should focus on both risk and resilience factors to mitigate new HIV infections among Black MSM.

"They're not feeling the love they need to feel": HIV stigma and other intersecting stigmas among Black gay and bisexual men and transgender women in House and Ball Communities

Introduction

Stigma negatively influences engagement in HIV prevention and care. This study explores how young Black gay and bisexual men and transgender women (GBT) in the House and Ball Community (HBC) experience HIV and other intersecting stigmas.

Method

We conducted phenomenological analysis of interviews with 60 young Black GBT HBC members and 30 older leaders of the HBC.

Result

Participants described experiences of enacted, perceived, and internalized HIV stigma and intersecting stigmas related to race, ethnicity, sexuality, gender identity, gender expression, and body size, as well as their responses to HIV stigma. Intersecting stigmas shaped and reinforced one another, leading to isolation and increased HIV vulnerability.

Conclusion

Interventions to ameliorate intersectional stigma and its effects are needed to improve primary and secondary HIV prevention in the HBC.

Pilot Trial of a Critical Consciousness-Based Intervention for Black Young Gay and Bisexual Men Living with HIV: Mobilizing Our Voices for Empowerment (MOVE)

HIV in the USA disproportionately affects Black young gay and bisexual men (Y-GBM). This article presents outcomes of a pilot randomized controlled trial comparing Mobilizing our Voices for Empowerment (MOVE), a culturally and developmentally tailored critical consciousness-based intervention for Black Y-GBM living with HIV (ages 16-24), with a comparison health promotion intervention. Black Y-GBM (n = 54) from four cities participated. Mixed effects models across four assessment points revealed participants in MOVE showed greater increases over time in perceived stress of HIV disclosure, self-efficacy for limiting HIV risk behavior, and condom use self-efficacy. Examining mean difference scores separately, participants in MOVE demonstrated increases in self-efficacy for HIV disclosure, perceived policy control, and self-efficacy for limiting HIV risk behavior. Immediately post-intervention, MOVE participants reported greater decreases in condomless intercourse with negative/unknown partners. MOVE may have potential to improve the health of Black Y-GBM living with HIV and reduce further transmission.

"Take It Out on the Floor": Experiences of Violence Among Black LGBT House and Ball Community Youth in a Rust Belt City

Black, lesbian, gay, bisexual, and transgender (LGBT), individuals experience higher rates of violent victimization compared to their cisgender heterosexual counterparts over their life course. Among Black LGBT people, witnessing and experiencing violence have been related to poor health outcomes, including depression, risky sexual behavior, substance use, and lower engagement in healthcare services. We engaged in research to better understand the effects of violence experienced by the Black LGBT youth community. We conducted a qualitative, phenomenological study focused on the causes of violence occurring in the lives of Black LGBT youth engaged in a recreation-based community health program. The study consisted of four focus groups with Black LGBT youth (N = 24) and in-depth individual interviews with medical and social service providers who work with Black LGBT youth (N = 4). Data analysis presented three themes: (1) causes of violence, (2) the context of intracommunity violence, and (3) solutions to violence. The first theme describes the reasoning, motivation, or explanation for violence experienced by the Black LGBT youth community. The second theme, the context of intracommunity violence, describes how violence occurs specifically within Black LGBT young adult communities. The third theme, solutions to violence, describes the recommendations for addressing, reducing, and/or eliminating violence within the Black LGBT youth community. Our findings highlight the need for safe spaces, culturally-relevant services, and trusted figures for Black LGBT young adults, which can serve as mechanisms for mitigating violence.

What affects timely linkage to HIV Care for Young Men of Color who have sex with Men? Young Men's Experiences Accessing HIV Care after Seroconverting

The HIV care continuum provides intervention points that should be addressed to optimally identify, engage, and retain populations in HIV care. This study addressed the lack of research into barriers and facilitators of linkage to care for HIV-positive young men who have sex with men (YMSM) of color. Data were collected using a qualitative timeline follow-back interview approach with YMSM who had seroconverted in the last 6 months. Interviews were conducted with 15 YMSM from April 2017 to April 2018. This study provides important information about what can delay linkage to care for YMSM of color. These delays include fractured referrals to care providers via mobile HIV testing vans, adapting to an HIV diagnosis and integrating it into their lives, and finding caring and competent providers that offer wraparound services, specifically mental health services, as soon as possible after an HIV diagnosis. Addressing these issues is imperative to optimize YMSM's engagement in the HIV care continuum and work toward ending the epidemic.

Feasibility and acceptability of B6: a social capital program for young Black gay, bisexual and other men who have sex with men living with HIV

Young Black gay, bisexual and other men who have sex with men (YB-GBMSM) are disproportionately burdened by HIV and often exhibit suboptimal engagement in HIV care. With the goal of increasing engagement in HIV care, we designed a culturally specific, theory-based group-level program, Brothers Building Brothers by Breaking Barriers (B6), which aimed to strengthen resilience and social capital among YB-GBMSM living with HIV. We conducted a pilot trial to evaluate the program's acceptability and feasibility. Through clinic-based recruitment and community outreach events, we recruited and enrolled 71 YB-GBMSM into the study. Participants were randomized to either the B6 program or a control comparison program. Post-session evaluation surveys and in-depth qualitative interviews showed B6 to have high levels of acceptability and satisfaction. Specifically, participants described benefits to interacting in a group with other YB-GBMSM, and several described increased comfort with their own gay identities after participation. No adverse events or safety concerns were reported. However, there were challenges to feasibility, as reflected in recruitment and retention rates. The B6 program was highly acceptable among YB-GBMSM living with HIV; however, innovative program delivery methods and implementation strategies will be needed to improve recruitment and retention in future implementation of B6.

Understanding social capital among young black gay and bisexual men living with HIV: a qualitative exploration

Social capital, defined as the sum of an individual's resource-containing, reciprocal and trustworthy social network connections, has been associated with improved engagement in care among people living with HIV globally. We conducted a qualitative interview study of social capital among 28 young Black gay, bisexual and other men who have sex with men ages 18-29 living with HIV in Atlanta, Georgia. We asked participants about bonding capital (relationships between individuals with similar demographic characteristics), bridging capital (relationships with individuals of different backgrounds), collective efficacy (involvement with community organisations) and satisfaction with their social networks. We found that participants described bonding capital from friends and family in depth, while more gaps were noted in bridging capital and collective efficacy. Bonding capital derived from families was especially critical to participants' satisfaction with their social capital. Findings suggest that interventions targeting young Black gay, bisexual and other men who have sex with men should build upon strong bonds with family and friends, and/or fill gaps in bridging capital and collective efficacy by connecting young men to mentors and organisations.

Social Media Communication and Network Correlates of HIV Infection and Transmission Risks Among Black Sexual Minority Men: Cross-sectional Digital Epidemiology Study

BACKGROUND

In the United States, HIV disproportionately affects Black cisgender sexual minority men (BSMM). Although epidemiological and behavioral surveillance are integral to identifying BSMM at risk of HIV infection and transmission, overreliance on self-reported data, inability to observe social contexts, and neglect of populations with limited engagement in health care systems limits their effectiveness. Digital epidemiological approaches drawing on social media data offer an opportunity to overcome these limitations by passively observing in organic settings activities, beliefs, behaviors, and moods that indicate health risks but are otherwise challenging to capture.

OBJECTIVE

The primary aim of this study was to determine whether features of Facebook communication and networks were associated with biological, behavioral, and psychological indicators of HIV infection and transmission risk.

METHODS

Facebook and survey data were collected from BSMM aged 18 to 35 years living in Chicago (N=310). Participants' Facebook posts were characterized using 4 culturally tailored topic dictionaries related to aspects of HIV protection and risk among BSMM (sexual health; substance use; sex behavior; and ballroom culture, a salient subculture in lesbian, gay, bisexual, transgender, and queer communities of color). Social network methods were used to capture structural features of BSMM's Facebook friendships (centrality, brokerage, and local clustering) and Facebook group affiliations. Multivariable regressions revealed relationships between these Facebook features and 5 ground truth indicators of HIV infection and transmission risk (sexually transmitted infection incidence, condomless sex, sex drug use, biomedical prevention, and depression).

RESULTS

Although analysis of participants' Facebook posts revealed that HIV-related topics occupied a small portion of the total messages posted by each participant, significant associations were found between the following HIV risk indicators and Facebook features: Condomless sex, including communication about sexual health (odds ratio [OR] 1.58, 95% CI 1.09-2.29), ballroom culture (OR 0.76, 95% CI 0.63-0.93), and friendship centrality (OR 0.69, 95% CI 0.52-0.92); Sex drug use, including communication about substance use (OR 1.81, 95% CI 1.17-2.79) and friendship centrality (OR 0.73, 95% CI 0.55-0.96) and brokerage (OR 0.71, 95% CI 0.51-0.99); Biomedical prevention, including communication about ballroom culture (OR 0.06, 95% CI 0.01-0.71); and Depression, including communication about sexual health (β=-0.72, 95% CI -1.42 to -0.02), ballroom culture (β=.80, 95% CI 0.27-1.34), friendship centrality (β=-0.90, 95% CI -1.60 to -0.21), and Facebook group affiliations (β=.84, 95% CI 0.25-1.43). Facebook features provided no significant explanatory value for sexually transmitted infection incidence.

CONCLUSIONS

Finding innovative strategies to detect BSMM at risk of contracting or transmitting HIV is critical to eliminating HIV disparities in this community. The findings suggest that social media data enable passive observance of social and communicative contexts that would otherwise go undetected using traditional HIV surveillance methods. As such, social media data are promising complements to more traditional data sources.

A pilot study of cognition and creativity among persons with HIV disease referred for neuropsychological evaluation

Creativity can help people to innovate, overcome obstacles, and successfully navigate challenges in daily life. Some aspects of creativity rely on the prefrontostriatal loops and executive functions, which can be compromised in persons with HIV (PWH). This pilot study examined whether neuropsychological functioning plays a role in creativity in PWH. A consecutive series of 41 PWH who were referred to an urban neuropsychology clinic in southeastern Texas were enrolled. Participants completed the Abbreviated Torrance Test for Adults (ATTA) to measure creativity, from which standardized creativity scores of fluency, originality, elaboration, and flexibility were derived. Participants also completed several measures of everyday functioning and a brief clinical neuropsychological battery measuring executive functions, motor skills, memory, and visuoconstruction. Global neuropsychological functioning showed a large, positive association with ATTA creativity performance that did not vary meaningfully by creativity domain and was independent of premorbid IQ. ATTA creativity scores were not associated with any measure of everyday functioning. Findings from this pilot study suggest that higher levels of neuropsychological functioning may support multiple dimensions of creativity in adults with HIV disease. Future studies might examine whether creativity moderates the association between HIV-associated neurocognitive impairment and various health behaviors (e.g., adherence, appointment attendance).

Thick trust, thin trust, social capital, and health outcomes among trans women of color in New York City

Introduction: Many trans women of color communities experience high HIV seroprevalence, extreme poverty, high rates of victimization and substance use, and poor mental health. Greater knowledge of trans women of color social capital may contribute toward more effective services for this marginalized population. Methods: These data come from a mixed-methods study that examined trans/gender-variant people of color who attended transgender support groups at harm reduction programs in NYC. The study was conducted from 2011 to 12, total N = 34. The qualitative portion was derived from six focus group interviews. Results: Two support groups stood out as exhibiting very strong alternative kinship structures. One group was comprised of immigrant trans Latinas, and the other group were trans women of African descent living with HIV. Both groups demonstrated ample cultivation of "trust capital" in the form of "thick trust" (bonding capital) and "thin trust" (bridging/linking capital) both inside and outside/beyond the support groups. Thick trust included the cultivation of intimacy, support in primary romantic relationships, and community leadership. Thin trust included networking with a variety of organizations, increased educational opportunities, and cultural production. Discussion: Participants "opened up to social capital" through the process of trusting as a series of (1) risks; (2) vulnerabilities; and (3) reciprocities. A solid foundation of thick trust resulted in a social, psychological, and emotional "base." Upon this foundation, thin trust was operationalized resulting in positive material, economic, and quality-of-life outcomes, leading to an expanded space of capabilities.

Internalised stigma as durable social determinant of HIV care for transnational patients of Puerto Rican ancestry

Intersectional stigmas have been contributing barriers to linkage and retention in HIV care for Latinx communities. Our analysis examines whether reductions in HIV-related and other stigmas were associated (or not) with progression on the HIV continuum of care for Puerto Ricans living with HIV, patients of the U.S. Special Projects of National Significance (SPNS) initiative: 'Culturally Appropriate Interventions of Outreach, Access and Retention among Latinx Populations from 2013 to 2018.' We conducted multivariate regression modelling to test our primary hypotheses. Internalised (HIV and racial/ethnic) stigma scores and age at baseline were predictors of ART adherence at six months assessment. Internalised stigma (HIV and racial/ethnic), depression, and resiliency scores were predictors of the likelihood of detectable HIV viral load at six months assessment. Our study confirms the importance of understanding internalised stigma on its own terms, as a durable construct that has implications for HIV treatment disparities for Puerto Ricans living with HIV.

Social-Environmental Resilience, PrEP Uptake, and Viral Suppression among Young Black Men Who Have Sex with Men and Young Black Transgender Women: the Neighborhoods and Networks (N2) Study in Chicago

Young black men who have sex with men (YBMSM) and young black transgender women (TGW) have experienced a stark disparity in HIV prevention and care. Resilience, collective resources to adapt stressors or adversities, may improve HIV prevention and care outcomes. The present study investigated the association of resilience-based factors with PrEP uptake and viral suppression from a socioecological perspective among YBMSM and young black TGW. Data were from the baseline cycle of the Neighborhoods and Networks (N2) Study, an ongoing cohort study of 16-34-year-old YBMSM and young black TGW in Chicago (n = 324). Confidant network-level and neighborhood affiliation variables were created to measure the social-environmental context of resilience. All analyses were stratified by participants' HIV status (184 HIV-negative participants and 140 HIV-positive participants). Among HIV-negative participants, having a parental figure within an individual's confidant network was significantly associated with a greater likelihood of PrEP use. Among HIV-positive participants, confidant network members' awareness of an individual's HIV status was associated with viral suppression. Social support resources from confidant networks could improve HIV prevention and care engagement among YBMSM and young black TGW. Understanding the social and environmental contexts of resilience resource is critical for HIV prevention and care engagement.

Exploring the role of LGBT-affirming churches in health promotion for Black sexual minority men

In the USA, Black sexual minority men (BSMM) remain disproportionately impacted upon by HIV and other sexual health issues. Individuals who attend church have lower rates of morbidity and mortality than those that do not; however, church attendance presents a paradox of being protective for some health outcomes and a risk for others among this population. Lesbian, gay, bisexual, and transgender (LGBT) affirming churches may offer support, but little is known about the role of LGBT-affirming churches in the lives of BSMM and how they may impact HIV and other health outcomes. This study explored the role of LGBT-affirming churches in the lives of BSMM. Nine focus groups (N = 52) were conducted in Baltimore City, Maryland between December 2017 and April 2018. Thematic analysis evaluated domains related to how men perceived, experienced, and engaged with LGBT-affirming churches. Three primary themes identified: (1) preferring traditional church environments over LGBT-affirming churches; (2) experiencing the LGBT-affirming church as a space of acceptance, emotional healing, and modelling loving same-sex relationships; and (3) perceiving LGBT-affirming churches as opportunities to engage community members to promote the well-being of BSMM. A secondary theme identified involvement in the house and ballroom community as an LGBT-affirming religious experience.

It's a Kiki!: Developmental benefits of the Kiki scene for Black gay/bisexual/transgender adolescents/emerging adults

Younger members of the House and Ball Community (HBC) have created an emerging social scene called "Kiki" that has shared elements with the HBC. Given the growing popularity of the Kiki scene in urban communities with large numbers of Black gay, bisexual, and transgender (GBT) adolescents and emerging adults, it is important to understand the developmental benefits of the Kiki scene. We conducted individual in-depth interviews with 30 GBT adolescents and emerging adults (ages 15-24) who attended Kiki-related events and 15 older opinion leaders affiliated with the HBC. Participants described how the Kiki scene provides them with a range of supportive and affirming functions and offers a place where they can achieve important developmental milestones. The results clustered into three primary thematic areas of development: Executive Functioning Development, Social-Emotional Development, and Physical and Emotional Safety during Development. Within each of these thematic areas are sub-themes that further explicate the ways in which these functions are supported. We believe this to be one of the first papers exclusively focused on the positive aspects of the Kiki scene for adolescent and emerging adult development, and we encourage other researchers to further explore this emerging socializing force and its potential benefits to development.

"We Are Powerful People": Health-Promoting Strengths of LGBTQ Communities of Color

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities of color experience intersecting systems of oppression that limit access to health care, safety, and other basic resources. Important research has documented these disparities, their antecedents, and consequences. However, little research has examined the strengths of multiply marginalized LGBTQ communities. Drawing from a health equity framework, this study is based on interviews with 38 LGBTQ-identified people of color in New York City. We used framework analysis to examine participants' perspectives on the role of community in enhancing health and well-being. Community strengths identified by participants included (a) safety, acceptance, and support; (b) interconnectedness and resource sharing; and (c) advocacy, collective action, and community potential. Recommendations for policy, practice, and future research are suggested, including efforts toward community power building.

The Social Environmental Context of Resilience Among Substance-Using African American/Black Men Who Have Sex With Men

Resilience theory has been suggested as a framework for research on HIV prevention among men who have sex with men. Among this population, literature indicates that African American/Black men who have sex with men experience additional health disparities including elevated HIV incidence rates, victimization, and poor physical health. Conceptualizing resilience as a part of one's social environment, this qualitative study investigates resilience processes and HIV transmission risk among a sample of 21 substance-using African American/Black men who have sex with men. Data from in-depth interviews describe the social environmental context in which resilience is exhibited and document the influence of homophobia, expressions of agency, and access to social, economic, and cultural capital on resilience processes. Central to this are expressions of hidden resilience, in which African American/Black men who have sex with men mitigate risk and experience their lives as subjectively successful, whether or not outsiders see it as such.

'I want the heart of fierceness to arise within us': maintaining public space to promote HIV-related health with House Ball Community members in an era of gentrification

The House Ball Community consists of sexual, gender and ethnic minority youth who form family-like houses and compete in balls. Many rely on community-based organisations as venues for socialising and accessing health-related resources. In recent years, urban gentrification has challenged the economic survival of the organisations that serve this community and its members. Between 2016 and 2017, we conducted 45 in-depth interviews with houses and gay families in the San Francisco Bay Area and regular participant observation at community events, including balls. In addition to forcing community organisations to close or move, rising rents have increased housing instability among Ballroom Community members, with some moving to distal locations. Participants felt nostalgia for organisations that provided HIV-related services and hosted balls in previous years, feeling the loss of space keenly. To maintain community and generate employment, the San Francisco Ballroom Community now offers Vogue classes at private dance studios. This allows participants to recruit new house members, welcoming a broader array of individuals into the community than those who have historically participated. However, accessing culturally appropriate sexual health services remains difficult. Health advocates should recognise that community organisations are necessary for diverse youth to build community and access sexual health services.

Identity as Resistance: Identity Formation at the Intersection of Race, Gender Identity, and Sexual Orientation

Although the concept of intersectionality has gained widespread attention in psychological research, there remains a significant gap related to the impact of intersectionality on identity formation for persons negotiating multiple minority statuses. This gap is especially pronounced among sexual and gender expansive women of Latinx and African American descent-two groups that face disparate personal and public health risks but are largely ignored in the research literature. In response to this gap, we carried out a qualitative study using constructivist grounded theory with 20 Latinx and African American sexual minority, gender expansive women to understand participants' experiences of forming an intersectional social identity. Following an exploration of identity formation related to the specific domains of race, gender identity, and sexual orientation, we prompted participants to consider how each of the specified identity domains impacted the formation and experience of an overall intersectional identity (e.g., how racial position impacted gender identity and/or sexual identity formation). Findings revealed four major themes that were critical in identity formation: (a) family and cultural expectations, (b) freedom to explore identity, (c) the constant negotiation of insider/outsider status, and (d) identity integration as an act of resistance. Implications for future research and psychological services are discussed.

"It Truly Does Get Better:" Young Sexual Minority Men's Resilient Responses to Sexual Minority Stress

Due to minority stress, sexual minority men experience mental health disparities. Sexual minority men who engaged in cognitive-behavioral therapy to address the minority stress underlying their distress completed an exercise eliciting their own resilience. This exercise involved writing an advice letter to a hypothetical peer about coping with minority stress. Qualitative analysis of these letters yielded 18 codes grouped into three categories reflecting resilience to minority stress. Categories included (1) cultivating internal affirmation strategies, (2) building supportive relationships and community, and (3) using cognitive and behavioral skills to cope with minority stress. Findings highlight this population's resilience and suggest building resilience through treatment.

House Ball Community Leaders' Perceptions of HIV and HIV Vaccine Research

BACKGROUND OR OBJECTIVES

Worldwide, men who have sex with men (MSM) and Transgender persons are vulnerable to psychosocial factors associated with high risk for HIV, and suffer disproportionately high rates of HIV/AIDS. In the United States (US), the House Ball Community (HBC) is a social network comprised predominantly of Black and Hispanic MSM and Transgender persons who reside in communal settings. This study explores Western New York HBC leaders' perceptions of HIV in their communities and their knowledge of HIV prevention strategies, including HIV vaccine trials.

METHODS

The project was conducted using an exploratory approach based on the principles of Community-Based Participatory Research (CBPR) methods. An HIV behavioral risk assessment provided descriptive data, while qualitative measures explored psychosocial and behavioral factors.

RESULTS

Behavioral assessments indicated high levels of risky sexual behaviors and experiences of violence. Interviews with 14 HBC leaders revealed that knowledge of HIV and local HIV vaccines trials was limited. Barriers to HIV knowledge included fear of peer judgment, having inaccurate information, and lack of formal education. Experiencing violence was identified as barrier to positive health behavior. Nevertheless, the HBC was described as a safe and creative space for marginalized MSM and Transgender youth.

CONCLUSION AND GLOBAL HEALTH IMPLICATIONS

Findings suggest that the interrelation between health problems and social context amplify HIV risk in the HBC. The organizational structure and resources of the HBC, and MSM/Transgender communities worldwide can be instrumental in informing interventions to address HIV-related risk behaviors and create appropriate recruitment tools to ensure their representation in HIV research.

The Roles of Gender Affirmation and Discrimination in the Resilience of Transgender Individuals in the US

Transgender individuals face severe stigma-driven health inequities structurally, institutionally, and interpersonally, yielding poor individual-level outcomes. Gender affirmation, or being recognized based on one's gender identity, expression, and/or role, may be considered a manifestation of resilience. To provide intervention and policy guidelines, we examined latent constructs representative of gender affirmation (legal documentation changes, transition-related medical procedures, familial support) and discrimination (unequal treatment, harassment, and attacks), and tested their impact on mental, physical, and behavioral health outcomes among 17,188 binary-identified transgender participants in the 2015 US Transgender Survey. Confirmatory factor analyses revealed high standardized factor loadings for both latent variables, on which we regressed outcomes using structural equation modeling. Fit indices suggested good model fit. Affirmation was associated with lower odds of suicidal ideation and psychological distress, and higher odds of substance use, and past-year healthcare use and HIV-testing. Discrimination was associated with higher odds of suicidal ideation, psychological distress, substance use, and past-year HIV-testing. Affirmation and discrimination interaction analyses showed lower odds of past-year suicidal ideation, with affirmation having a significant moderating protective effect against discrimination. Gender affirmation is paramount in upholding transgender health. Clarification of affirmation procedures, and increases in its accessibility, equitably across racial/ethnic groups, should become a priority, from policy to the family unit. The impact of discrimination demands continued advocacy via education and policy.

Facebook group affiliation ties, group topics, and HIV behavioral characteristics among young Black men who have sex with men: Potential for public health intervention

•YBMSM were more likely to belong to personal/professional development groups.•YBMSM clustered around pairs of LGBTQ identity, sex, and nightlife groups.•Regular testers tended to belong to LGBTQ identity and nightlife groups.•Those who engaged in condomless sex tended to affiliate with LGBTQ identity groups.•Those who were aware of PrEP aware tended to affiliate with chat groups.

Social Support and Other Factors Associated with HIV Testing by Hispanic/Latino Gay, Bisexual, and Other Men Who Have Sex with Men in the U.S. South

Cognitive-psychosocial and other factors may affect participation in HIV testing, particularly by Hispanic/Latino gay, bisexual, and other men who have sex with men (MSM) in the U.S. South, a region hard-hit by HIV. We used univariate and multivariable logistic regression analyses to examine the association between social support and other cognitive-psychosocial factors; sociodemographic characteristics; risk behaviors; and self-reported HIV testing in a sample of 304 Hispanic/Latino MSM in North Carolina. In the multivariable logistic regression analysis, general and HIV-related social support and HIV-related knowledge were associated with greater odds of testing; speaking only Spanish was associated with reduced odds of testing. Social support and aspects of social connectedness may constitute community-based resources for use in HIV prevention efforts with Hispanic/Latino MSM. However, harnessing these resources for HIV prevention will require a better understanding of how social support relationships and processes shape HIV risks and protective actions by these vulnerable MSM.

The Social Context of HIV Prevention and Care among Black Men Who Have Sex with Men in Three U.S. Cities: The Neighborhoods and Networks (N2) Cohort Study

Background: In many parts of the world, stark racial disparities in human immunodeficiency virus (HIV) prevalence, incidence, prevention, and care outcomes persist among gay, bisexual, and other men who have sex with men (MSM), with Black MSM significantly impacted in the United States (U.S.). Individual-level characteristics, including sexual behaviors and socioeconomic status, do not fully account for racial/ethnic disparities in HIV among MSM. We hypothesize that neighborhood contexts and network characteristics influence risk for HIV infection as well as HIV-related prevention and care behaviors. As such, the study design includes the use of real-time geospatial methods and in-depth assessments of multiple network typologies to investigate the impact of neighborhood and network-level factors on HIV prevention and treatment among Black MSM residing in longstanding priority HIV elimination areas in the U.S., namely Chicago, Illinois and in the Deep South (Jackson, Mississippi and New Orleans, Louisiana) (n = 450, n = 50, and n = 100, respectively). We describe the design, sampling methods, data collection, data management methods, and preliminary findings of the ongoing 'Neighborhoods and Networks (N2) Cohort Study'. Methods/Design: N2 employs a prospective longitudinal design. The sample includes Black MSM participants in Chicago recruited via respondent-driven sampling and assessed every six months over two years of follow-up. Participants enrolled in Jackson and New Orleans are being recruited through existing health and community services and assessed every six months over one year of follow-up. Mobility within and between neighborhoods is being assessed using global positioning system (GPS) technology. Social and sexual networks among Black MSM are being studied through egocentric network inventories as well as newer methods of creating meso-level networks that involve social media (Facebook) and mobile phone contacts. Key HIV prevention outcomes such as pre-exposure prophylaxis (PrEP) care engagement, and HIV/STI (sexually transmitted infections) biomarkers will be examined at baseline and follow-up. Results: As of 31 December 2018, a total of 361 men were enrolled across all study sites: 259 in Chicago and 102 in the Deep South (75 in New Orleans and 27 in Jackson). At baseline, participants ranged in age from 17 to 65 years old (mean = 34.3, standard deviation = 5.1) with 123 men (34.1%) self-reported as HIV positive. While HIV treatment levels were similar between sites, men in the Deep South reported higher rates of adherence than men in Chicago (63.3% versus 49.4%, p = 0.03). Sexual risk profiles were mainly the same between men from different study sites, with 22.9% of men in Chicago and 28.9% in the Deep South reporting consistent condom use during vaginal and anal sex (p = 0.26). Regarding their home neighborhoods, men in the Deep South were more likely than those in Chicago to characterize theirs as having a good reputation (43.1% versus 24.7%, p < 0.001) and as being safe (37.3% versus 21.2%, p = 0.002). Conclusions: The focus on Black MSM in the N2 Study will allow for a nuanced exploration of the attitudes, beliefs, behaviors, and practices of a diverse group of Black MSM. The study is also positioned to provide novel insight about neighborhood and network characteristics that influence HIV-related behaviors. A health equity framework ensures that Black MSM are not explicitly or implicitly deemed as deviant, disordered, or the non-reference group. Findings from N2 will provide guidance for the implementation of more impactful HIV prevention interventions that engage a diverse population of Black MSM as we work toward HIV elimination in the U.S.

Resilience, condom use self-efficacy, internalized homophobia, and condomless anal sex among black men who have sex with men, New York City

Background

Black men who have sex with men, who account for less than 1% of the U.S. population, account for approximately 25% of new HIV infections annually. Condomless anal sex contributes to HIV infection among black men who have sex with men. The capacity to recover quickly from difficulties (resilience) may be protective against condomless anal sex, but has been understudied among black men who have sex with men. Psychosocial factors related to resilience, i.e., condom use self-efficacy and internalized homophobia, may also affect condomless anal sex. We assessed the association between resilience, condom use self-efficacy, internalized homophobia and condomless anal sex among black men who have sex with men.

Methods

Data are from a 2010–2011 study examining condomless anal sex (past 60 days) among black men who have sex with men in New York City. Validated scales assessed resilience (theoretical range = 0–100), condom use self-efficacy (theoretical range = 27–135), and internalized homophobia (theoretical range = 9–36). We described continuous variables using median and interquartile range (IQR). Univariable and multivariable Poisson regression models assuming a robust variance estimator were used to compute unadjusted and adjusted prevalence ratios, respectively, and their corresponding 95% confidence intervals (CI). Adjusted prevalence ratios (aPR) examined the association of resilience, condom use self-efficacy, and internalized homophobia with condomless anal sex, while controlling for potential confounders (e.g., having >1 sex partner).

Results

The median resilience score within our sample (N = 228) was 75 (IQR = 66–83). Many black men who have sex with men reported condomless anal sex (55.7%) and >1 sex partner (58.8%). Decreased condomless anal sex was associated with increased levels of condom use self-efficacy (aPR: 0.94 per 10-point increase in condom use self-efficacy score; CI: 0.90–0.97; p-value: 0.001). Condomless anal sex was not associated with resilience or internalized homophobia.

Conclusions

Within this sample of black men who have sex with men, condomless anal sex was prevalent. Greater resilience was not protective against condomless anal sex. Interventions that support condom use are warranted for black men who have sex with men.

Influences of health care access on resilience building among transgender and gender non-binary individuals

Background: Health care disparities between transgender/gender non-binary individuals and the general population are well-documented and related to both interpersonal and institutional discrimination. Resilience has been found to buffer the negative health effects of discrimination among gender diverse individuals as well as other stigmatized populations. Aims : The purpose of this study was to identify and understand resilience related to health and health care among a community sample of transgender and gender non-binary individuals in the southern United States. Methods: We conducted 35 longitudinal photo elicitation interviews with 21 participants among a community sample of transgender and gender non-binary individuals in the Southern US. Interview transcripts were coded using thematic analysis and themes were organized according to the Resilience Activation Framework. Results: Overall, individual and community-level resources within the domains of social and human capital were frequently activated to navigate challenges related to seeking and receiving health care. Lack of access to resources in economic and political capital domains constrained resilience. Discussion: This work demonstrates how stakeholders can identify target areas for interventions and policy change aimed at improving resilience in transgender and gender non-binary communities by utilizing the Resilience Activation Framework. In our sample, we found that resources should be directed toward building economic and political capital at the community level so participants have the ability and opportunity to marshal such resources.

Perceived social support, problematic drug use behaviors, and depression among prescription drugs-misusing young men who have sex with men

This study examined the relationship of perceived social support with problematic drug use behaviors and depression among young men who have sex with men (YMSM). A diverse sample of 191 substance-using YMSM (aged 18-29 years) reported on perceived social support, high-risk drug use behaviors (i.e., polydrug use and use of drugs before sex in the past 6 months, and lifetime injection drug use), and depression. Associations were examined using bivariate and multivariable logistic regression. Participants receiving higher levels of family social support were at lower odds of reporting polydrug use, drug use before sex, and depressive symptomology. Individuals with higher levels of friends' social support were at lower odds of reporting polydrug use, drug use before sex, and depression. Participants receiving higher levels of support from a special other were at lower odds of reporting depression. Intervention efforts should address YMSM's capacity to build supportive relationships and obtain adequate social support.

Brothers Building Brothers by Breaking Barriers: development of a resilience-building social capital intervention for young black gay and bisexual men living with HIV

Young Black gay/bisexual and other men who have sex with men (YB-GBMSM) are disproportionately impacted by HIV/AIDS. Novel intervention strategies are needed to optimize engagement in HIV care for this population. We sought to develop a group-level intervention to enhance resilience by augmenting social capital (defined as the sum of resources in an individual's social network) among YB-GBMSM living with HIV, with the ultimate goal of improving engagement in HIV care. Our multiphase, community-based participatory research (CBPR) intervention development process included: (1) Development and maintenance of a youth advisory board (YAB) comprised of YB-GBMSM living with HIV; (2) Qualitative in-depth interviews with YB-GBMSM living with HIV; (3) Qualitative in-depth interviews with care and service providers at clinics and community-based organizations; and (4) Collaborative development of intervention modules and activities with our YAB, informed by social capital theory and our formative research results. The result of this process is Brothers Building Brothers By Breaking Barriers, a two-day, 10-module group-level intervention. The intervention does not focus exclusively on HIV, but rather takes a holistic approach to supporting youth and enhancing resilience. Intervention modules aim to develop resilience at the individual level (exploration of black gay identity, development of critical self-reflection and coping skills), social network level (exploring strategies for navigating family and intimate relationships) and community level (developing strategies for navigating clinical spaces and plans for community participation). Most intervention activities are interactive, in order to facilitate new social network connections - and accompanying social capital - within intervention groups. In summary, our intensive CBPR approach resulted in a novel, culturally-specific intervention designed to enhance HIV care engagement by augmenting resilience and social capital among YB-GBMSM living with HIV.

Wilson, C. Partlow, G. Price. Transgender and Other Gender-Diverse Youth's Progression Through the HIV Continuum of Care: Socioecological System Barriers

Transgender and other gender-diverse youth (TGDY) are disproportionately affected by HIV and in need of developmentally and culturally appropriate services as they progress along the HIV continuum of care (CoC). We conducted a phenomenological analysis of 66 in-depth interviews with TGDY living with HIV (ages 16-24) from 14 cities across the United States about their experiences within the different stages of the HIV CoC. TGDY described experiencing a wide variety of barriers across each examined stage of the HIV CoC, including HIV testing, linkage to care, retention in care, initiation of antiretroviral therapy, and adherence to antiretroviral therapy. Within these CoC stages, TGDY experienced barriers to care across all socioecological systems, including the sociocultural systems, clinic/organizational systems, and interpersonal systems. Barrier themes remained relatively constant for all stages of the CoC, although the way each thematic category of barrier (e.g., the theme of societal oppression and discrimination within the sociocultural level) was experienced varied by stage. Although overall thematic categories were typically not focused solely on threats to participants' gender identity and expression, specific descriptions of the nature of the thematic barriers were related to gender identity and gender expression. Implications of the findings for future research and practice are discussed.

Alternative kinship structures, resilience and social support among immigrant trans Latinas in the USA

Latinas comprise the largest racial/ethnic group of trans women (male-to-female transgender people) in New York City, where HIV seroprevalence among trans Latinas has been found to be as high as 49%. Despite this population's high risk of HIV, little is known about resilience among trans Latinas that may provide protective health factors. Six focus groups and one in-depth interview were conducted with 34 low-income trans/gender-variant people of colour who attended transgender support groups at harm reduction programmes in New York City. This paper reports on data from 13 participants who identified as immigrant trans Latinas. Focus groups were coded and analysed using thematic qualitative methods. The majority of immigrants were undocumented but reported having robust social support. Unique characteristics of immigrant trans Latinas included alternative kinship structures and sources of income. Social creativity was used to develop achievable ways in which to improve their health outcomes. Resilience was evident in informal kinship dynamics, formal support groups, gender-transition, educational access and skills training and substance use reduction. Individual-level resilience increased as a result of strong community-level resilience.

Social Capital, Depressive Symptoms, and HIV Viral Suppression Among Young Black, Gay, Bisexual and Other Men Who Have Sex with Men Living with HIV

Social capital, the sum of an individual's resource-containing social network connections, has been proposed as a facilitator of successful HIV care engagement. We explored relationships between social capital, psychological covariates (depression, stigma and internalized homonegativity), and viral suppression in a sample of young Black gay, bisexual and other men who have sex with men (YB-GBMSM). We recruited 81 HIV-positive YB-GBMSM 18-24 years of age from a clinic setting. Participants completed a cross-sectional survey, and HIV-1 viral load (VL) measurements were extracted from the medical record. Sixty-five percent (65%) were virally suppressed (HIV-1 VL ≤ 40 copies/ml). Forty-seven percent (47%) had a positive depression screen. Depressive symptoms affected viral suppression differently in YB-GBMSM with lower vs. higher social capital (p = 0.046, test for statistical interaction between depression and social capital). The odds of viral suppression among YB-GBMSM with lower social capital was 93% lower among those with depressive symptoms (OR 0.07, p = 0.002); however, there was no association between depressive symptoms and viral suppression among those with higher social capital. Our results suggest that social capital may buffer the strong negative effects of depressive symptoms on clinical outcomes in YB-GBMSM living with HIV. In addition to treating depression, there is a role for interventions to augment social capital among YB-GBMSM living with HIV as a strategy for enhancing care engagement.

Who counts as family? Family typologies, family support, and family undermining among young adult gay and bisexual men

Gay and bisexual men may form chosen families in addition to or in place of families of origin. However, the characteristics of these diverse families remain largely unexamined in the quantitative literature. The purpose of this study was to develop a family typology based on responses from a racially and ethnically diverse sample of young adult gay and bisexual men (YGBM) recruited from the Detroit Metropolitan Area (N=350; 18-29 years old). To explore the role of family, we then examined family social support and social undermining in relation to YGBM psychological distress within different family types. A series of multivariate regressions were used to examine associations between family social support and social undermining with depression and anxiety outcomes. The majority (88%) of YGBM included family of origin in their definitions of family and 63% indicated having chosen families. Associations between family social processes and psychological outcomes varied by type of family, suggesting that family composition shapes how perceptions of support and undermining relate to experiencing symptoms of depression and anxiety. Chosen families play a prominent role in the lives of YGBM and should not be overlooked in family research. Findings also highlight the importance of examining co-occurring family social support and social stress processes to further address psychological distress symptoms among YGBM.

Social networks and social support among ball-attending African American men who have sex with men and transgender women are associated with HIV-related outcomes

The House Ball Community (HBC) is an understudied network of African American men who have sex with men and transgender women, who join family-like houses that compete in elaborate balls in cities across the United States. From 2011 to 2012, we surveyed 274 recent attendees of balls in the San Francisco Bay Area, focusing on social networks, social support, and HIV-related behaviours. Participants with a high percentage of alters who were supportive of HIV testing were significantly more likely to have tested in the past six months (p = .02), and less likely to have engaged in unprotected anal intercourse (UAI) in the past three months (p = .003). Multivariate regression analyses of social network characteristics, and social support, revealed that testing in the past six months was significantly associated with social support for safer sex, instrumental social support, and age. Similarly, UAI in the past three months was significantly associated with social support for safer sex, homophily based on sexual identity and HIV status. HIV-related social support provided through the HBC networks was correlated with recent HIV testing and reduced UAI. Approaches utilising networks within alternative kinship systems, may increase HIV-related social support and improve HIV-related outcomes.

The relationship between Black and gay community involvement and HIV-related risk behaviors among Black men who have sex with men

Blackgay men must navigate identities and stigmas related to being gay and Black, and report higher HIV incidence relative to their white male counterparts although they report lower rates of drug use and risky sexual behaviors. This study examined whether closeness to the gay or Black community correlated with HIV related risk and protective behaviors. Data were drawn from uConnect, a population-based cohort study of YBMSM on Chicago's South Side. The sample consists of 618 Black MSM ranging in age from 16-29. Cross sectional measures for this study include Black and gay community closeness, drug use, sexual risk behaviors, HIV testing and health promotion behaviors. Closeness with the gay community was associated with greater PrEP knowledge as well as participating in health promotion programs along with higher rates of transactional sex and having sex under the influence of substances, and increased odds of self-reported HIV seropositivity. Involvement in the Black community was associated with lower odds of reporting being HIV positive. Findings suggest that programs and initiatives are needed to help promote the positive aspects of the Black and gay communities, while minimizing the negative correlates of such involvements.

HIV Prevention in Gay Family and House Networks: Fostering Self-Determination and Sexual Safety

Many gay, bisexual, and transgender (GBT) people of color (POC) join house and/or constructed family communities, which serve as support networks composed mostly of other non-biologically related GBT/POC. These networks can decrease or increase the risk of exposure to HIV via multiple mechanisms (e.g., providing informal sexual safety education versus stigmatizing family members with HIV, encouraging sexual safety practices versus unsafe escorting, teaching self-care versus substance use) but act to support family members in the face of social and economic hardship. Researchers interviewed ten members of these social networks in the Boston metro area of the US and produced a saturated grounded theory analysis to explore the role of gay family/house networks in HIV risk management. While network members utilized HIV prevention resources, interviewees described how their efficacy was related to the intentions of leadership and strength of kinship boundaries within their community, economic opportunities, and communication skills. Clinical and research implications are discussed.

Cognitive and Behavioral Resilience Among Young Gay and Bisexual Men Living with HIV

PURPOSE

HIV/AIDS disproportionately affects young gay, bisexual, and other men who have sex with men (Y-GBMSM). Resilience remains understudied among Y-GBMSM living with HIV, but represents a potentially important framework for improving HIV-related outcomes in this population. We sought to explore cognitive and behavioral dimensions of resilience and their correlates among Y-GBMSM to gain insights to inform future interventions.

METHODS

Our study sample consisted of 200 Y-GBMSM living with HIV enrolled in a multisite study of the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN). Participants completed a one-time, self-administered structured questionnaire, including validated scales capturing a range of cognitive, behavioral, demographic, and psychosocial data. Utilizing these data, we examined cognitive and behavioral dimensions of resilience and their potential psychosocial correlates using linear regression modeling.

RESULTS

Multiple regression analyses demonstrated that education, stigma, social support, ethnic identity, internalized homonegativity, and behavioral resilience were statistically significant predictors of cognitive resilience (P < 0.001, R² = 0.678). Social support satisfaction and cognitive resilience were significant predictors of behavioral resilience (P < 0.001, R² = 0.141).

CONCLUSIONS

Our findings point to potential strategies for incorporating resilience-promoting features into future interventions to support Y-GBMSM living with HIV. Specifically, strengths-based interventions in this population should seek to enhance social support, promote positive identity development, and encourage education. Future research can also seek to utilize and refine our measures of resilience among youth.

'Ballroom itself can either make you or break you' - Black GBT Youths' psychosocial development in the House Ball Community

Social context plays a significant role in adolescent identity development, particularly for youth lacking traditional systems of support. Using ecological and symbolic interactionism perspectives, this study qualitatively explored the psychosocial identity development of Black gay, bisexual, or transgendered youth participating in the House Ball Community (HBC). The HBC is a diverse network of family-like structures called 'houses', as well as a glamorous social outlet via pageant-like 'balls' in which participants compete. A series of focus groups were conducted with youth and leaders from the HBC (n = 37; age range = 17-24). Via cross-case and comparative analyses, specific motivating factors related to entry into and continued involvement in the community were identified. Factors related to entry into the community included lack of safe spaces, opportunities for acceptance, means of subsistence, and allure of the scene. Factors related to continued involvement included resilience and coping skills development, sexual identity acceptance and pride, prevalence of risky behaviour, and risk of exploitation. Discussion of these factors provides insight on how self-constructed, supplementary social contexts may provide both unique supports and risks to members, allowing for more focused and well-informed interventions and policies to enhance healthy development in such communities while mitigating risk.

Network dynamics of HIV risk and prevention in a population-based cohort of young Black men who have sex with men

Critical to the development of improved HIV elimination efforts is a greater understanding of how social networks and their dynamics are related to HIV risk and prevention. In this paper, we examine network stability of confidant and sexual networks among young black men who have sex with men (YBMSM). We use data from uConnect (2013–2016), a population-based, longitudinal cohort study. We use an innovative approach to measure both sexual and confidant network stability at three time points, and examine the relationship between each type of stability and HIV risk and prevention behaviors. This approach is consistent with a co-evolutionary perspective in which behavior is not only affected by static properties of an individual's network, but may also be associated with changes in the topology of his or her egocentric network. Our results indicate that although confidant and sexual network stability are moderately correlated, their dynamics are distinct with different predictors and differing associations with behavior. Both types of stability are associated with lower rates of risk behaviors, and both are reduced among those who have spent time in jail. Public health awareness and engagement with both types of networks may provide new opportunities for HIV prevention interventions.

Social-structural properties and HIV prevention among young men who have sex with men in the ballroom house and independent gay family communities

The endogenous social support systems of young Black men who have sex with men (YBMSM), like surrogate families and social networks, are considered crucial assets for HIV prevention in this population. Yet, the extent to which these social systems foster sexual health protections or risks remains unclear. We examine the networked patterns of membership in ballroom houses and independent gay families, both Black gay subcultures in the United States, and how these memberships are related to HIV protective and risk traits of members. Drawing from a population-based sample of 618 YBMSM living in Chicago between June 2013 and July 2014, we observe a suite of protective and risk traits and perform bivariate analyses to assess each of their associations with being a member of a house or family. We then present an analysis of the homophilous and heterophilous mixing on these traits that structures the patterns of house and family affiliations among members. The bivariate analyses show that members of the house and family communities were more likely than non-members to report protective traits like being aware of PrEP, having health coverage, having a primary care doctor, and discouraging sex drug use among peers. However, members were also more likely to engage in the use of sex drugs. With respect to how these traits inform specific house/family affiliations, results show that members who had a recent HIV test, who were PrEP aware, or who engaged in exchange sex were more likely to belong to the same house or family, while HIV positive individuals were less likely to cluster within houses or families. These findings provide insights regarding the strengths and vulnerabilities of the house and gay family communities that can inform more culturally specific interventions that build on the existing human and social capital in this milieu.

"I feel like I am surviving the health care system": understanding LGBTQ health in Nova Scotia, Canada

Background

Currently, there is a dearth of baseline data on the health of lesbian, gay, bisexual, transgender, and queer (LGBTQ) populations in the province of Nova Scotia, Canada. Historically, LGBTQ health research has tended to focus on individual-level health risks associated with poor health outcomes among these populations, which has served to obscure the ways in which they maintain their own health and wellness across the life course. As such, there is an urgent need to shift the focus of LGBTQ health research towards strengths-based perspectives that explore the complex and resilient ways in which LGBTQ populations promote their health.

Methods

This paper discusses the findings of our recent scoping review as well as the qualitative data to emerge from community consultations aimed at developing strengths-based approaches to understanding and advancing LGBTQ pathways to health across Nova Scotia.

Results

Our scoping review findings demonstrated the lack of strengths-based research on LGBTQ health in Nova Scotia. Specifically, the studies examined in our scoping review identified a number of health-promoting factors and a wide variety of measurement tools, some of which may prove useful for future strengths-based health research with LGBTQ populations. In addition, our community consultations revealed that many participants had negative experiences with health care systems and services in Nova Scotia. However, participants also shared a number of factors that contribute to LGBTQ health and suggestions for how LGBTQ pathways to health in Nova Scotia can be improved.

Conclusions

There is an urgent need to conduct research on the health needs, lived experiences, and outcomes of LGBTQ populations in Nova Scotia to address gaps in our knowledge of their unique health needs. In moving forward, it is important that future health research take an intersectional, strengths-based perspective in an effort to highlight the factors that promote LGBTQ health and wellness across the life course, while taking into account the social determinants of health.

The utility of resilience as a conceptual framework for understanding and measuring LGBTQ health

BACKGROUND

Historically, lesbian, gay, bisexual, transgender and queer (LGBTQ) health research has focused heavily on the risks for poor health outcomes, obscuring the ways in which LGBTQ populations maintain and improve their health across the life course. In this paper we argue that informing culturally competent health policy and systems requires shifting the LGBTQ health research evidence base away from deficit-focused approaches toward strengths-based approaches to understanding and measuring LGBTQ health.

METHODS

We recently conducted a scoping review with the aim of exploring strengths-based approaches to LGBTQ health research. Our team found that the concept of resilience emerged as a key conceptual framework. This paper discusses a subset of our scoping review findings on the utility of resilience as a conceptual framework in understanding and measuring LGBTQ health.

RESULTS

The findings of our scoping review suggest that the ways in which resilience is defined and measured in relation to LGBTQ populations remains contested. Given that LGBTQ populations have unique lived experiences of adversity and discrimination, and may also have unique factors that contribute to their resilience, the utility of heteronormative and cis-normative models of resilience is questionable. Our findings suggest that there is a need to consider further exploration and development of LGBTQ-specific models and measures of resilience that take into account structural, social, and individual determinants of health and incorporate an intersectional lens.

CONCLUSIONS

While we fully acknowledge that the resilience of LGBTQ populations is central to advancing LGBTQ health, there remains much work to be done before the concept of resilience can be truly useful in measuring LGBTQ health.

Resilience among gay/bisexual young men in Western Kenya: psychosocial and sexual health outcomes

OBJECTIVE

To explore associations between intrapersonal and interpersonal factors and both sexual and psychosocial resilient outcomes among young gay, bisexual, and other men who have sex with men (GBMSM) in Western Kenya.

DESIGN

Cross-sectional observational study.

METHODS

Five hundred and eleven GBMSM ages 18-29 were recruited from nine communities in Western Kenya using community-based mobilization strategies. Participants completed an audio computer-assisted self-interview survey in English or Duhluo. We estimated four three-step hierarchical linear regression models to examine associations between predictors (intrapersonal and interpersonal factors) and four resilient outcomes (psychological well-being, self-esteem, condom use, HIV testing).

RESULTS

Psychosocial well-being model (modeled conversely as depression/anxiety) was significant (F(13,424) = 106.41, P < 0.001, R = 0.765) with loneliness, lesbian/gay/bisexual (LGB) difficult process, LGB identity superiority, and reactions to trauma as predictors. Self-esteem model was significant (F(12,425) = 6.40, P < 0.001, R = 0.153) with known HIV-seropositivity, perceived social support, internalized homonegativity, and LGB difficult process as predictors. Condom use model was significant (F(13,379) = 4.30, P < 0.001, R = 0.128) with perceived social support, self-esteem, and reactions to trauma as predictors. HIV testing model was significant (F(12,377) = 4.75, P < 0.001, R = 0.131) with loneliness, LGB identity uncertainty, LGB difficult process, and LGB identity superiority as predictors.

CONCLUSION

This study demonstrates the variety of ways in which intrapersonal and interpersonal factors are associated with HIV-related resilient outcomes for young GBMSM in Western Kenya. HIV prevention programs for this population should be developed in collaboration with GBMSM and include intervention components that promote resilience.

Correlates of Sexual HIV Risk Among African American Men Who Have Sex With Men

OBJECTIVES

We examined correlates of condomless anal intercourse with nonmain sexual partners among African American men who have sex with men (MSM).

METHODS

We recruited social networks composed of 445 Black MSM from 2012 to 2014 in Milwaukee, Wisconsin; Cleveland, Ohio; and Miami Beach, Florida. Participants reported past-3-month sexual behavior, substance use, and background, psychosocial, and HIV-related characteristics.

RESULTS

Condomless anal intercourse outside main concordant partnerships, reported by 34.4% of MSM, was less likely in the case of no alcohol and marijuana use in the past 30 days, and higher risk-reduction behavioral intentions. High frequency of condomless anal intercourse acts with nonmain partners was associated with high gay community participation, weak risk-reduction intentions, safer sex not being perceived as a peer norm, low condom-use self-efficacy, and longer time since most recent HIV testing.

CONCLUSIONS

Condomless anal intercourse with nonmain partners among Black MSM was primarily associated with gay community participation, alcohol and marijuana use, and risk-reduction behavioral intentions.

MINORITY STRESS, POSITIVE IDENTITY DEVELOPMENT, AND DEPRESSIVE SYMPTOMS: IMPLICATIONS FOR RESILIENCE AMONG SEXUAL MINORITY MALE YOUTH

INTRODUCTION

Minority stress processes have been shown to have significant associations with negative mental health outcomes among sexual minority populations. Given that adversity may be experienced growing up as a sexual minority in heteronormative, if not heterosexist, environments, our research on resilience among sexual minority male youth proposes that positive identity development may buffer the effects of a range of minority stress processes.

METHODS

An ethnically diverse sample of 200 sexual minority males ages 16-24 (mean age, 20.9 years) was recruited using mixed recruitment methods. We developed and tested two new measures: concealment stress during adolescence and sexual minority-related positive identity development. We then tested a path model that assessed the effects of minority stressors, positive identity development, and social support on major depressive symptoms.

RESULTS

Experience of stigma was associated with internalized homophobia (β=.138, p<.05) and major depressive symptoms (β=1.076, OR=2.933, p<.001), and internalized homophobia partially mediated experience's effects on major depression (β=.773, OR=2.167, p<.001). Concealment stress was associated with positive identity development (β=.155, p<.05) and internalized homophobia (β=.418, p<.001), and positive identity development partially mediated concealment stress's effects on internalized homophobia (β=-.527, p<.001). Concealment stress demonstrated a direct effect on major depression (β=1.400, OR=4.056, p<.001), and indirect paths to social support through positive identity development.

CONCLUSIONS

With these results, we offer an exploratory model that empirically identifies significant paths among minority stress dimensions, positive identity development, and major depressive symptoms. This study helps further our understanding of minority stress, identity development, and resources of resilience among sexual minority male youth.

Reconciling Reality with Fantasy: Exploration of the Sociocultural Factors influencing HIV Transmission among Black Young Men who have Sex with Men (BYMSM) within the House Ball Community: A Chicago Study

Studies involving the House Ball Community (HBC) have found high rates of HIV prevalence and undiagnosed HIV infection, as well as unique social and sexual network-related HIV risk and protective behaviors (Murrill et al., 2008; Sanchez et al., 2010). Efforts to understand culturally-appropriate and effective methods of HIV prevention services within the relatively understudied HBC are scarce (Phillips et al., 2011). This qualitative study, utilizing a Diffusion of Innovation Theoretical framework, aimed to explore social norms regarding HIV and accessibility of HIV prevention services within the HBC. Thirty-seven participants (16 community leaders and 21 youth) engaged in focus group discussions. Participants discussed the perceptions of HIV and stigmatization within the HBC, general and HBC-specific risk factors for HIV transmission, as well as HIV prevention needs and strategies for culturally-appropriate HIV interventions. Findings from this qualitative study highlight both the vulnerability of the HBC to HIV transmission and the corresponding support for HIV prevention interventions.

The Social Environmental Elements of Resilience among Vulnerable African American/Black Men Who Have Sex with Men

Resilience theory has been suggested as a strong framework for research on HIV prevention among men who have sex with men (MSM). Among this population, literature indicates that African American/Black MSM are particularly vulnerable to health and social disparities associated with HIV transmission risk. Conceptualizing resilience as a part of one's social environment, this qualitative study investigates the specific elements of resilience, and the associated contexts and relationships, among a sample of 21 substance-using African American/Black MSM. Data indicate that: 1) elements contributing to resilience are multiple and co-occurring, including inner strengths, social relationships, diversity of experience, religion/spirituality, altruism, and creativity; 2) as an element of resilience, social support was experienced differently among men who did and did not have supportive relationships with other gay and bisexual men, which has implications for social service provision and intervention approaches; and 3) diversity of experiences and relationships is an important influencing factor on expressions of resilience. Social services or interventions that facilitate the development of these elements of resilience will likely be especially beneficial for vulnerable African American/Black MSM.

Minority stress experiences and psychological well-being: the impact of support from and connection to social networks within the Los Angeles House and Ball communities

African American young men who have sex with men (AAYMSM) from the House and Ball communities are at high risk for HIV infection. Because these communities are not only sources of risk but also support for AAYMSM, researchers must also consider the resources these communities possess. This knowledge will assist in the formulation of more effective prevention strategies and intervention approaches. Using minority stress theory as a framework, the current study illustrates the impact minority stress has on the psychological well-being of a sample of MSM from the Los Angeles House and Ball communities and investigates how these factors affect the relationship between minority stress and psychological well-being. Surveys were administered to participants over the course of a year. Structural equation modeling was used to estimate a model of the associations between minority stressors, support, connection to social network, and psychological well-being/distress (N = 233). The results indicated significant associations between different sources of minority stress, including distal minority stress (e.g., racism, homophobia), gay identification, and internalized homophobia. Minority stressors were in turn significantly associated with greater distress. However, greater instrumental support significantly reduced the effects of distal minority stress on distress. Greater connection to social network also significantly reduced stress associated with gay identification on distress. The findings captured the diverse sources of minority stress faced by this population and how these stressors are interrelated to impact mental health. The results also illustrate how support from and connection to social networks can reduce the negative impact of minority stress experiences.

African American Gay Family Networks: An Entry Point for HIV Prevention

Gay families are constructed support networks that gay, bisexual, and transgender individuals of color form, often in response to societal marginalization and rejection from biological families. Research on these family structures has been scarce, with little focus on the experience of African American gay family networks in the South. The current grounded theory qualitative study focused on the experiences of 10 African American male and transgender individuals between the ages of 18 and 29 from gay families in the Mid-South, and explored the ways these families addressed safe-sex issues and human immunodeficiency virus (HIV) risk prevention. Results revealed that families can play a role in either increasing HIV risk (e.g., ignoring HIV issues, encouraging such unsafe behaviors as exchanging sex for money or drugs, stigmatizing HIV-positive people) or decreasing it (e.g., intensive, family-level prevention efforts at safe-sex practices and family support for HIV treatment adherence). The potential of these family networks for HIV prevention and adherence efforts is considered.