|
9
|
Ramos SR, Lardier DT, Opara I, Turpin RE, Boyd DT, Gutierrez JI, Williams CN, Nelson LE, Kershaw T. Intersectional Effects of Sexual Orientation Concealment, Internalized Homophobia, and Gender Expression on Sexual Identity and HIV Risk Among Sexual Minority Men of Color: A Path Analysis. J Assoc Nurses AIDS Care 2021; 32:495-511. [PMID: 34101701 PMCID: PMC8221709 DOI: 10.1097/jnc.0000000000000274] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT In the United States, 13 million people identify as sexual and gender minorities. The purposes of this article were to (a) examine the associations among sexual orientation concealment and internalized homophobia with HIV knowledge, health literacy, and transactional sex through sexual identity; and (b) assess whether gender expression moderates those relationships in sexual minority men of color. A multigroup mediation path model examined the association between sexual orientation concealment and internalized homophobia on HIV knowledge, health literacy, and transactional sex through sexual identity by gender expression. Results suggest that, among those with a masculine gender expression, as sexual concealment increased, health literacy decreased. The association between sexual orientation concealment and transactional sex varied by participant's gender expression as did the association between internalized homophobia and HIV knowledge. Multiple intersecting identities, when faced with anticipated discrimination and homophobia, can negatively affect health outcomes and increase HIV risk in sexual minority men of color.
Collapse
Affiliation(s)
- S. Raquel Ramos
- S. Raquel Ramos, PhD, MBA, MSN, FNP-BC, is an Assistant Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA. David T. Lardier, Jr., PhD, is an Assistant Professor, Department of Individual, Family, and Community Studies, and Affiliate Faculty, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA. Ijeoma Opara, PhD, MSW, MPH, is an Assistant Professor, Department of Social and Behavioral Sciences in the School of School of Public Health, Yale University, New Haven, Connecticut, USA. Rodman E. Turpin, PhD, MS, is a Research Assistant Professor, Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA. Donte T. Boyd, PhD, is an Assistant Professor, College of Social Work, The Ohio State University, Columbus, Ohio, USA. José I. Gutierrez, Jr., PhD, MSN, FNP-BC, is a National Clinician Scholar postdoctoral fellow, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA. Chase Nicole Williams, BSN(c), is a Nursing Student, Rory Meyers College of Nursing, New York University, New York, New York, USA. LaRon E. Nelson, PhD, RN, FNP, FNAP, FAAN, is the Associate Dean, Global Affairs & Planetary Health, and Independence Foundation Professor and Associate Professor of Nursing, Yale School of Nursing, Yale University, Orange, Connecticut, USA. Trace Kershaw, PhD, is the Department Chair of Social and Behavioral Sciences and Professor of Public Health and Director Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA
| | - David T. Lardier
- S. Raquel Ramos, PhD, MBA, MSN, FNP-BC, is an Assistant Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA. David T. Lardier, Jr., PhD, is an Assistant Professor, Department of Individual, Family, and Community Studies, and Affiliate Faculty, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA. Ijeoma Opara, PhD, MSW, MPH, is an Assistant Professor, Department of Social and Behavioral Sciences in the School of School of Public Health, Yale University, New Haven, Connecticut, USA. Rodman E. Turpin, PhD, MS, is a Research Assistant Professor, Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA. Donte T. Boyd, PhD, is an Assistant Professor, College of Social Work, The Ohio State University, Columbus, Ohio, USA. José I. Gutierrez, Jr., PhD, MSN, FNP-BC, is a National Clinician Scholar postdoctoral fellow, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA. Chase Nicole Williams, BSN(c), is a Nursing Student, Rory Meyers College of Nursing, New York University, New York, New York, USA. LaRon E. Nelson, PhD, RN, FNP, FNAP, FAAN, is the Associate Dean, Global Affairs & Planetary Health, and Independence Foundation Professor and Associate Professor of Nursing, Yale School of Nursing, Yale University, Orange, Connecticut, USA. Trace Kershaw, PhD, is the Department Chair of Social and Behavioral Sciences and Professor of Public Health and Director Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA
| | - Ijeoma Opara
- S. Raquel Ramos, PhD, MBA, MSN, FNP-BC, is an Assistant Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA. David T. Lardier, Jr., PhD, is an Assistant Professor, Department of Individual, Family, and Community Studies, and Affiliate Faculty, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA. Ijeoma Opara, PhD, MSW, MPH, is an Assistant Professor, Department of Social and Behavioral Sciences in the School of School of Public Health, Yale University, New Haven, Connecticut, USA. Rodman E. Turpin, PhD, MS, is a Research Assistant Professor, Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA. Donte T. Boyd, PhD, is an Assistant Professor, College of Social Work, The Ohio State University, Columbus, Ohio, USA. José I. Gutierrez, Jr., PhD, MSN, FNP-BC, is a National Clinician Scholar postdoctoral fellow, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA. Chase Nicole Williams, BSN(c), is a Nursing Student, Rory Meyers College of Nursing, New York University, New York, New York, USA. LaRon E. Nelson, PhD, RN, FNP, FNAP, FAAN, is the Associate Dean, Global Affairs & Planetary Health, and Independence Foundation Professor and Associate Professor of Nursing, Yale School of Nursing, Yale University, Orange, Connecticut, USA. Trace Kershaw, PhD, is the Department Chair of Social and Behavioral Sciences and Professor of Public Health and Director Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA
| | - Rodman E. Turpin
- S. Raquel Ramos, PhD, MBA, MSN, FNP-BC, is an Assistant Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA. David T. Lardier, Jr., PhD, is an Assistant Professor, Department of Individual, Family, and Community Studies, and Affiliate Faculty, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA. Ijeoma Opara, PhD, MSW, MPH, is an Assistant Professor, Department of Social and Behavioral Sciences in the School of School of Public Health, Yale University, New Haven, Connecticut, USA. Rodman E. Turpin, PhD, MS, is a Research Assistant Professor, Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA. Donte T. Boyd, PhD, is an Assistant Professor, College of Social Work, The Ohio State University, Columbus, Ohio, USA. José I. Gutierrez, Jr., PhD, MSN, FNP-BC, is a National Clinician Scholar postdoctoral fellow, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA. Chase Nicole Williams, BSN(c), is a Nursing Student, Rory Meyers College of Nursing, New York University, New York, New York, USA. LaRon E. Nelson, PhD, RN, FNP, FNAP, FAAN, is the Associate Dean, Global Affairs & Planetary Health, and Independence Foundation Professor and Associate Professor of Nursing, Yale School of Nursing, Yale University, Orange, Connecticut, USA. Trace Kershaw, PhD, is the Department Chair of Social and Behavioral Sciences and Professor of Public Health and Director Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA
| | - Donte T. Boyd
- S. Raquel Ramos, PhD, MBA, MSN, FNP-BC, is an Assistant Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA. David T. Lardier, Jr., PhD, is an Assistant Professor, Department of Individual, Family, and Community Studies, and Affiliate Faculty, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA. Ijeoma Opara, PhD, MSW, MPH, is an Assistant Professor, Department of Social and Behavioral Sciences in the School of School of Public Health, Yale University, New Haven, Connecticut, USA. Rodman E. Turpin, PhD, MS, is a Research Assistant Professor, Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA. Donte T. Boyd, PhD, is an Assistant Professor, College of Social Work, The Ohio State University, Columbus, Ohio, USA. José I. Gutierrez, Jr., PhD, MSN, FNP-BC, is a National Clinician Scholar postdoctoral fellow, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA. Chase Nicole Williams, BSN(c), is a Nursing Student, Rory Meyers College of Nursing, New York University, New York, New York, USA. LaRon E. Nelson, PhD, RN, FNP, FNAP, FAAN, is the Associate Dean, Global Affairs & Planetary Health, and Independence Foundation Professor and Associate Professor of Nursing, Yale School of Nursing, Yale University, Orange, Connecticut, USA. Trace Kershaw, PhD, is the Department Chair of Social and Behavioral Sciences and Professor of Public Health and Director Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA
| | - José I. Gutierrez
- S. Raquel Ramos, PhD, MBA, MSN, FNP-BC, is an Assistant Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA. David T. Lardier, Jr., PhD, is an Assistant Professor, Department of Individual, Family, and Community Studies, and Affiliate Faculty, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA. Ijeoma Opara, PhD, MSW, MPH, is an Assistant Professor, Department of Social and Behavioral Sciences in the School of School of Public Health, Yale University, New Haven, Connecticut, USA. Rodman E. Turpin, PhD, MS, is a Research Assistant Professor, Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA. Donte T. Boyd, PhD, is an Assistant Professor, College of Social Work, The Ohio State University, Columbus, Ohio, USA. José I. Gutierrez, Jr., PhD, MSN, FNP-BC, is a National Clinician Scholar postdoctoral fellow, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA. Chase Nicole Williams, BSN(c), is a Nursing Student, Rory Meyers College of Nursing, New York University, New York, New York, USA. LaRon E. Nelson, PhD, RN, FNP, FNAP, FAAN, is the Associate Dean, Global Affairs & Planetary Health, and Independence Foundation Professor and Associate Professor of Nursing, Yale School of Nursing, Yale University, Orange, Connecticut, USA. Trace Kershaw, PhD, is the Department Chair of Social and Behavioral Sciences and Professor of Public Health and Director Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA
| | - Chase Nicole Williams
- S. Raquel Ramos, PhD, MBA, MSN, FNP-BC, is an Assistant Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA. David T. Lardier, Jr., PhD, is an Assistant Professor, Department of Individual, Family, and Community Studies, and Affiliate Faculty, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA. Ijeoma Opara, PhD, MSW, MPH, is an Assistant Professor, Department of Social and Behavioral Sciences in the School of School of Public Health, Yale University, New Haven, Connecticut, USA. Rodman E. Turpin, PhD, MS, is a Research Assistant Professor, Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA. Donte T. Boyd, PhD, is an Assistant Professor, College of Social Work, The Ohio State University, Columbus, Ohio, USA. José I. Gutierrez, Jr., PhD, MSN, FNP-BC, is a National Clinician Scholar postdoctoral fellow, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA. Chase Nicole Williams, BSN(c), is a Nursing Student, Rory Meyers College of Nursing, New York University, New York, New York, USA. LaRon E. Nelson, PhD, RN, FNP, FNAP, FAAN, is the Associate Dean, Global Affairs & Planetary Health, and Independence Foundation Professor and Associate Professor of Nursing, Yale School of Nursing, Yale University, Orange, Connecticut, USA. Trace Kershaw, PhD, is the Department Chair of Social and Behavioral Sciences and Professor of Public Health and Director Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA
| | - LaRon E. Nelson
- S. Raquel Ramos, PhD, MBA, MSN, FNP-BC, is an Assistant Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA. David T. Lardier, Jr., PhD, is an Assistant Professor, Department of Individual, Family, and Community Studies, and Affiliate Faculty, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA. Ijeoma Opara, PhD, MSW, MPH, is an Assistant Professor, Department of Social and Behavioral Sciences in the School of School of Public Health, Yale University, New Haven, Connecticut, USA. Rodman E. Turpin, PhD, MS, is a Research Assistant Professor, Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA. Donte T. Boyd, PhD, is an Assistant Professor, College of Social Work, The Ohio State University, Columbus, Ohio, USA. José I. Gutierrez, Jr., PhD, MSN, FNP-BC, is a National Clinician Scholar postdoctoral fellow, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA. Chase Nicole Williams, BSN(c), is a Nursing Student, Rory Meyers College of Nursing, New York University, New York, New York, USA. LaRon E. Nelson, PhD, RN, FNP, FNAP, FAAN, is the Associate Dean, Global Affairs & Planetary Health, and Independence Foundation Professor and Associate Professor of Nursing, Yale School of Nursing, Yale University, Orange, Connecticut, USA. Trace Kershaw, PhD, is the Department Chair of Social and Behavioral Sciences and Professor of Public Health and Director Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA
| | - Trace Kershaw
- S. Raquel Ramos, PhD, MBA, MSN, FNP-BC, is an Assistant Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA. David T. Lardier, Jr., PhD, is an Assistant Professor, Department of Individual, Family, and Community Studies, and Affiliate Faculty, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA. Ijeoma Opara, PhD, MSW, MPH, is an Assistant Professor, Department of Social and Behavioral Sciences in the School of School of Public Health, Yale University, New Haven, Connecticut, USA. Rodman E. Turpin, PhD, MS, is a Research Assistant Professor, Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA. Donte T. Boyd, PhD, is an Assistant Professor, College of Social Work, The Ohio State University, Columbus, Ohio, USA. José I. Gutierrez, Jr., PhD, MSN, FNP-BC, is a National Clinician Scholar postdoctoral fellow, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA. Chase Nicole Williams, BSN(c), is a Nursing Student, Rory Meyers College of Nursing, New York University, New York, New York, USA. LaRon E. Nelson, PhD, RN, FNP, FNAP, FAAN, is the Associate Dean, Global Affairs & Planetary Health, and Independence Foundation Professor and Associate Professor of Nursing, Yale School of Nursing, Yale University, Orange, Connecticut, USA. Trace Kershaw, PhD, is the Department Chair of Social and Behavioral Sciences and Professor of Public Health and Director Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA
| |
Collapse
|