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Bhattacharya G. Advancing Black Men's Type 2 Diabetes Healthcare Through Addressing Gender-centered Social Norms, Cognitive Scripts, and Manhood: An Integrated Public Health Approach for Reducing T2D Disparities. SOCIAL WORK IN PUBLIC HEALTH 2024; 39:666-677. [PMID: 38994694 DOI: 10.1080/19371918.2024.2376828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
In the United States, the burden of type 2 diabetes (T2D) health complications and outcomes is higher in Black men, and the diabetes disparities are escalating. Previous evidence-based research underscored the need to explore gender-specific experiences of chronic illness in social-cultural, historical, and clinical contexts. Our community-engaged qualitative study focused on learning from the live experiences of Black men (n = 15) in the Arkansas Delta area. Applying a narrative approach, we explored and learned from the participants about their perception of the consequences of T2D on manhood and the usefulness of T2D management instructions. Findings indicate that an integrated public health approach contextualizes social-cultural norms, cognitive scripts, and gender-centered expressions of manhood, a promising direction in T2D healthcare; social support is essential for emotional and physical help in continued T2D management; and connecting with Black men and their insights are vital to develop relevant and appropriate guidelines for T2D management care.
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Affiliation(s)
- Gauri Bhattacharya
- College of Health Sciences, School of Social Work, Jackson State University, Jackson, Mississippi, USA
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2
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James D. Initial Development and Validation of the Brief Internalized Heterosexist Racism Scale for Gay and Bisexual Black Men: A Measure of Internalized Heterosexist Racism. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1307-1325. [PMID: 38388762 PMCID: PMC10955034 DOI: 10.1007/s10508-023-02805-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 12/29/2023] [Accepted: 12/30/2023] [Indexed: 02/24/2024]
Abstract
We introduce internalized heterosexist racism (IHR), or the internalization of damaging stereotypes, harmful beliefs, and negative attitudes about being a sexual minority person of color. We also present the initial development and validation of the Brief Internalized Heterosexist Racism Scale for gay and bisexual Black men (IHR-GBBM), a unidimensional, 10-item measure of IHR. Exploratory factor analyses on an internet-obtained sample of gay and bisexual Black men (N = 312; Mean age = 30.36 years) show that the IHR-GBBM had evidence of good internal consistency, and good convergent, discriminant, concurrent, and incremental validity. The IHR-GBBM was positively correlated with internalized racism, internalized heterosexism, and discrimination (racist, heterosexist). IHR was also negatively correlated with race stigma consciousness, weakly positively correlated with sexual identity stigma consciousness, but not correlated with either race identity, sexual identity, or social desirability. Hierarchical regressions showed that the IHR-GBBM explained an additional variance of 2.8% and 3.1% in anxiety symptoms and substance use coping, respectively, after accounting for (1) sociodemographics, (2) internalized racism and internalized heterosexism, and (3) an interaction of internalized racism and internalized heterosexism. Older participants and those who were "out" about their sexual identity reported lower IHR. Those who did not know/want to report their HIV status reported greater IHR. Results revealed no sexual identity, sexual position, relationship status, income, education, or employment status differences in IHR. We hope the development of the IHR-GBBM spurs future research on predictors and consequences of IHR. We discuss limitations and implications for the future study of internalized heterosexist racism.
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Affiliation(s)
- Drexler James
- Department of Psychology, University of Minnesota, Twin Cities, 75 E River Rd, Minneapolis, MN, 55455-0366, USA.
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3
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Jiang L, Wang X, Cui S, Vasilenko SA. Time-varying associations between parental closeness, self-esteem, and sexual behavior across adolescence and emerging adulthood. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2024; 34:192-204. [PMID: 38287685 PMCID: PMC11437804 DOI: 10.1111/jora.12913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 12/13/2023] [Accepted: 01/09/2024] [Indexed: 01/31/2024]
Abstract
This study applied the time-varying effect model (TVEM) to data from the National Longitudinal Study of Adolescent to Adult Health to explore how self-esteem mediated age-varying associations of closeness to mother and father and their child's sexual behavior through adolescence and emerging adulthood. Paternal closeness is associated with lesser odds of sexual behaviors for both female and male adolescents until age 20, whereas maternal closeness only predicts for female adolescents between ages 13 and 15. Self-esteem mediated the association between mother closeness and multiple partners in male adolescents between ages 14.5 and 16.5. Fathers have an impact on adolescent sexual behavior across adolescence and emerging adulthood, while mothers' roles are more important for female adolescents in early adolescence.
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Affiliation(s)
- Linghua Jiang
- Department of Human Development and Family Science, David B. Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, New York, USA
| | - Xiafei Wang
- School of Social Work, David B. Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, New York, USA
| | - Shuangyue Cui
- Department of Human Development and Family Science, College of Family and Consumer Science, University of Georgia, Athens, Georgia, USA
| | - Sara A Vasilenko
- Department of Human Development and Family Science, David B. Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, New York, USA
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4
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Abubakar EO, Cunningham N. Small-area estimation and analysis of HIV/AIDS indicators for precise geographical targeting of health interventions in Nigeria. a spatial microsimulation approach. Int J Health Geogr 2023; 22:23. [PMID: 37730574 PMCID: PMC10510115 DOI: 10.1186/s12942-023-00341-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 07/25/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Precise geographical targeting is well recognised as an indispensable intervention strategy for achieving many Sustainable Development Goals (SDGs). This is more cogent for health-related goals such as the reduction of the HIV/AIDS pandemic, which exhibits substantial spatial heterogeneity at various spatial scales (including at microscale levels). Despite the dire data limitations in Low and Middle Income Countries (LMICs), it is essential to produce fine-scale estimates of health-related indicators such as HIV/AIDS. Existing small-area estimates (SAEs) incorporate limited synthesis of the spatial and socio-behavioural aspects of the HIV/AIDS pandemic and/or are not adequately grounded in international indicator frameworks for sustainable development initiatives. They are, therefore, of limited policy-relevance, not least because of their inability to provide necessary fine-scale socio-spatial disaggregation of relevant indicators. METHODS The current study attempts to overcome these challenges through innovative utilisation of gridded demographic datasets for SAEs as well as the mapping of standard HIV/AIDS indicators in LMICs using spatial microsimulation (SMS). RESULTS The result is a spatially enriched synthetic individual-level population of the study area as well as microscale estimates of four standard HIV/AIDS and sexual behaviour indicators. The analysis of these indicators follows similar studies with the added advantage of mapping fine-grained spatial patterns to facilitate precise geographical targeting of relevant interventions. In doing so, the need to explicate socio-spatial variations through proper socioeconomic disaggregation of data is reiterated. CONCLUSIONS In addition to creating SAEs of standard health-related indicators from disparate multivariate data, the outputs make it possible to establish more robust links (even at individual levels) with other mesoscale models, thereby enabling spatial analytics to be more responsive to evidence-based policymaking in LMICs. It is hoped that international organisations concerned with producing SDG-related indicators for LMICs move towards SAEs of such metrics using methods like SMS.
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Affiliation(s)
| | - Niall Cunningham
- School of Geography, Politics and Sociology, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
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5
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Persson T, Löve J, Tengelin E, Hensing G. Healthcare professionals discourses on men and masculinities in sexual healthcare: a focus group study. BMC Health Serv Res 2023; 23:535. [PMID: 37226171 DOI: 10.1186/s12913-023-09508-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 05/06/2023] [Indexed: 05/26/2023] Open
Abstract
Studies have reported that men's uptake of sexual health services is low, that these services make them feel vulnerable, and that they experience sexual healthcare (SHC) as stressful, heteronormative, potentially sexualised and "tailored for women". They also suggest that healthcare professionals (HCPs) working in SHC view masculinity as problematic, and situated in private relationships. This study aimed to explore how HCPs construct the gendered social location in SHC, specifically in terms of masculinity and a perception that masculinity is situated in relationships. Critical Discourse Analysis was used to analyse transcripts from seven focus group interviews with 35 HCPs working with men's sexual health in Sweden. The study found that gendered social locations were discursively constructed in four ways: (I) by problematising and opposing masculinity in society; (II) through discursive strategies where a professional discourse on men and masculinity is lacking; (III) by constructing SHC as a feminine arena where masculinity is a visible norm violation; (IV) by constructing men as reluctant patients and formulating a mission to change masculinity. The discourses of HCPs constructed the gendered social location of masculinity in society as incompatible with SHC, and saw masculinity in SHC as a violation of feminine norms. Men seeking SHC were constructed as reluctant patients, and HCPs were seen as agents of change with a mission to transform masculinity. The discourses of HCPs risk othering men in SHC, which could prevent care on equal terms. A shared professional discourse on masculinity could create a common foundation for a more consistent, knowledge-based approach to masculinity and men's sexual health in SHC.
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Affiliation(s)
- Tommy Persson
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 453, Gothenburg, SE-405 30, Sweden.
- Knowledge Center for Sexual Health, Region Västra Götaland, Gothenburg, Sweden.
| | - Jesper Löve
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 453, Gothenburg, SE-405 30, Sweden
| | - Ellinor Tengelin
- Department of Health Sciences, Rehabilitation Science, Mid Sweden University, Sundsvall, Sweden
| | - Gunnel Hensing
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 453, Gothenburg, SE-405 30, Sweden
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Bhushan NL, Shangase N, Kimaru LJ, Gomez-Olive FX, Kahn K, Pettifor AE. HIV Related Behaviors Among Male Partners of Adolescent Girls and Young Women in Rural South Africa. AIDS Behav 2023; 27:1469-1477. [PMID: 36318420 PMCID: PMC10485811 DOI: 10.1007/s10461-022-03882-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2022] [Indexed: 05/16/2023]
Abstract
Improving men's engagement in HIV prevention is not only essential for reducing their own HIV risk but also the risk of transmitting HIV to their female partners. We conducted a cross-sectional survey using a population-based sample of men (age 18-30) who reported being a partner of an adolescent girls and young women (AGYW) in South Africa (N = 2827). We used logit-binomial regression models to examine associations among men's partnership characteristics, HIV risk perceptions, and HIV-related behaviors and examine differences by male partner age (younger men (18-24) vs. older men (25-30)) and age difference between partners (age-concordant (< 5 years) vs. age-disparate (≥ 5 years)). Most men reported inconsistent condom use (85%) and nearly half reported engaging in transactional sex (48%). Older men were just as likely as younger men, and men with age-disparate and age-concordant partners, to inconsistently use condoms, engage in transactional sex, and perpetrate intimate partner violence. Most men also reported a very high interest in pre-exposure prophylaxis (PrEP) (77%) and half reported having an HIV test in the past year (50%). There were no differences by male partner age or age difference between partners in PrEP interest but older men and men in age-discordant relationships were more likely than younger men and men in age-concordant relationships to have an HIV test in the past year. Male partners of AGYW in South Africa are engaging in HIV-related behaviors and need HIV prevention interventions to reduce risk for themselves and their female partners.
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Affiliation(s)
- Nivedita L Bhushan
- RTI International, 3040 Cornwallis Road, 27709, Research Triangle Park, NC, USA.
| | - Nosipho Shangase
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Linda Jepkoech Kimaru
- University of Arizona, Tucson, AZ, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - F Xavier Gomez-Olive
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Audrey E Pettifor
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
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7
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Antabe R, McIntosh M, Lawson E, Husbands W, Wong JPH, Arku G, Luginaah I. Black heterosexual men's resilience in times of HIV adversity: findings from the "weSpeak" study. BMC Public Health 2023; 23:182. [PMID: 36707783 PMCID: PMC9880929 DOI: 10.1186/s12889-023-15103-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/13/2023] [Accepted: 01/20/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND In Canada, heterosexual African, Caribbean and Black (ACB) men tend to suffer a disproportionate burden of HIV. Consequently, studies have examined the underlying contributors to this disparity through the nexus of behavioral and structural factors. While findings from these studies have been helpful, their use of deficit and risk models only furthers our knowledge of why ACB men are more vulnerable to HIV infection. Thus far, there is a dearth of knowledge on how heterosexual ACB men mobilize protective assets to promote their resilience against HIV infection. METHODS As part of a larger Ontario-based project called weSpeak, this study examined how ACB men acquire protective assets to build their resilience to reduce their HIV vulnerability. We analyzed three focus group discussions (n = 17) and 13 in-depth interviews conducted with ACB men using NVivo and a mixed inductive-deductive thematic analyses approach. RESULTS The findings show that ACB men mostly relied on personal coping strategies, including sexual abstinence, to build resilience against HIV. Interpersonal resources such as family, friends, and religious communities also played an important role in constructing ACB men's resilience. ACB men bemoaned their lack of access to essential institutional resources, such as health services, that are important in managing HIV adversity. CONCLUSION Based on these findings, there is an urgent need for HIV policy stakeholders, including service providers, to engage the ACB community in the design of intervention programs. Additionally, addressing the socioeconomic disadvantages faced by ACB communities will increase the capacity of ACB men to develop resilience against HIV.
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Affiliation(s)
- Roger Antabe
- Department of Health and Society, University of Toronto Scarborough, 1265 Military Trail, M1C 1A4, Toronto, ON, Canada.
| | - Martin McIntosh
- Regional HIV/AIDS Connections (RHAC), 30-186 King Street, N6A 1C7 London, ON Canada
| | - Erica Lawson
- grid.39381.300000 0004 1936 8884Department of Gender, Sexuality, and Women’s Studies, Western University, 1151 Richmond Street, Lawson Hall Room, 3260, N6A 5B8 London, ON Canada
| | - Winston Husbands
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M7 Toronto, ON Canada
| | - Josephine Pui-Hing Wong
- Daphne Cockwell School of Nursing, Faculty of Community Services, Toronto Metropolitan University, Podium Building, Room POD-481, 350 Victoria St, M5B 2K3 Toronto, ON Canada
| | - Godwin Arku
- grid.39381.300000 0004 1936 8884Department of Geography and Environment, Social Science Centre, Western University, 1151 Richmond St, N6A 5C2 London, ON Canada
| | - Isaac Luginaah
- grid.39381.300000 0004 1936 8884Department of Geography and Environment, Social Science Centre, Western University, 1151 Richmond St, N6A 5C2 London, ON Canada
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8
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Berner-Rodoreda A, Vandormael A, Bärnighausen K, Mavuso M, Dlamini P, Matse S, Hettema A, Bärnighausen T, McMahon SA. Cultural Repertoires and Situated Selections as an Alternative Framework to Hegemonic Masculinities: Findings From Eswatini. Am J Mens Health 2023; 17:15579883231152110. [PMID: 36823951 PMCID: PMC9969463 DOI: 10.1177/15579883231152110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/30/2022] [Accepted: 01/04/2023] [Indexed: 02/25/2023] Open
Abstract
Since the 1980s studies on men have frequently utilized Connell's framework of hegemonic masculinities. We critically appraise this framework in the context of a population-based HIV pre-exposure prophylaxis study in Eswatini. Our findings highlight that men confidently show variation in their behavior and choices, which manifest across different men and within the same men acting in particular situations and over the life course. This led us to interrogate the hegemonic masculinities framework on the following grounds: Men's choices and behavior do not seem to fit the model of aspiring to a hegemonic ideal; the delineation of masculine traits as hegemonic or subordinate remain vague in terms of "responsibility," "fidelity," and "consideration for others"; the binary gender concept underpinning hegemonic masculinities seems outdated. Building on the work of Hirsch and Kachtan, we propose cultural repertoires as an alternative framework which also bridges the gender divide.
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Affiliation(s)
| | - Alain Vandormael
- Heidelberg Institute of Global Health,
Heidelberg University, Heidelberg, Germany
| | - Kate Bärnighausen
- School of Public Health, University of
the Witwatersrand, Johannesburg, South Africa
| | | | | | - Sindy Matse
- Eswatini National AIDS Program,
Ministry of Health, Eswatini, Mbabane, Eswatini
| | - Anita Hettema
- Clinton Health Access Initiative
Eswatini, Mbabane, Eswatini
| | - Till Bärnighausen
- Heidelberg Institute of Global Health,
Heidelberg University, Heidelberg, Germany
| | - Shannon A. McMahon
- Heidelberg Institute of Global Health,
Heidelberg University, Heidelberg, Germany
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9
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Nwakoby C, Pierce LJ, Crawford R, Conserve D, Perkins J, Hurt S, Ahonkhai AA. Establishing an Academic-Community Partnership to Explore the Potential of Barbers and Barbershops in the Southern United States to Address Racial Disparities in HIV Care Outcomes for Black Men Living With HIV. Am J Mens Health 2023; 17:15579883231152114. [PMID: 36757054 PMCID: PMC9943967 DOI: 10.1177/15579883231152114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/14/2022] [Accepted: 01/03/2023] [Indexed: 02/10/2023] Open
Abstract
Black men comprise most new HIV infections in the Southern United States and have worse HIV outcomes than their non-Black counterparts. We developed an academic-community partnership in Nashville, Tennessee, to explore opportunities to improve HIV outcomes for Black men. We recruited barbers to an HIV training and focus group discussion about prevention and potential barber/barbershop-based strategies to address HIV-related needs for Black men. We assessed HIV knowledge and stigma with validated scales and conducted thematic analysis on discussion transcripts. HIV-related stigma was low (1.8 of 15 points [SD = 1.69]) among 13 participants of unknown HIV status (12 men and one woman). HIV knowledge increased among eight (67%) participants after receiving a brief HIV didactic. Participants described general health care barriers (e.g., the social norm that Black men do not go to the doctor until they are "damn near dead"), fears about unwanted HIV disclosure when seeking HIV testing or care, and community fears about negative stereotypes associated with HIV. Participants expressed enthusiasm about receiving more HIV-related training and utilizing communication skills and client/community relationships to serve as health educators and navigators. Barbers highlighted opportunities to disseminate HIV information in barbershops and combine HIV interventions with other health issues, such as COVID-19, and suggested that these interventions may help reduce HIV-related stigma. Our findings suggest that barbers and barbershops are an underutilized resource for disseminating HIV-related health information and engaging Black men in HIV and other important prevention and care activities such as COVID-19.
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Affiliation(s)
| | - Leslie J. Pierce
- Vanderbilt Institute of Global Health,
Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Donaldson Conserve
- Department of Prevention and Community
Health, Milken Institute School of Public Health, The George Washington University,
Washington, DC, USA
| | | | | | - Aima A. Ahonkhai
- Vanderbilt Institute of Global Health,
Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Infectious Diseases,
Vanderbilt University Medical Center, Nashville, TN, USA
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10
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Quinn KG, Dickson-Gomez J, Pearson B, Marion E, Amikrhanian Y, Kelly JA. Intersectional Resilience Among Black Gay, Bisexual, and Other Men Who Have Sex With Men, Wisconsin and Ohio, 2019. Am J Public Health 2022; 112:S405-S412. [PMID: 35763748 PMCID: PMC9241476 DOI: 10.2105/ajph.2021.306677] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To investigate resilience strategies used by Black gay, bisexual, and other men who have sex with men (MSM) to navigate racism and heterosexism. Methods. In 2019, we conducted in-depth interviews with 46 Black MSM in Milwaukee, Wisconsin, and Cleveland, Ohio. Thematic analysis, informed by intersectionality, was used to identify intersectional resilience within the context of participants' lives. Results. Our analyses revealed ways in which Black MSM respond to stigma and oppression. We identified the following themes that capture these experiences: pride in intersectional identities, perseverance, community advocacy, and social support. Our analyses reveal how men draw on these assets and resources to positively adapt despite experiences of racism and heterosexism. Conclusions. Intersectional resilience can support Black MSM in navigating racism and heterosexism. However, public health interventions at the institutional and system levels are needed to directly target the root causes of oppression and support resources that facilitate intersectional resilience. (Am J Public Health. 2022;112(S4):S405-S412. https://doi.org/10.2105/AJPH.2021.306677).
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Affiliation(s)
- Katherine G Quinn
- The authors are with the Medical College of Wisconsin, Milwaukee. Katherine G. Quinn, Broderick Pearson, Yuri Amirkhanian, and Jeffrey A. Kelly are with the Center for AIDS Intervention Research. Julia Dickson-Gomez and Erica Marion are with the Institute for Health and Equity
| | - Julia Dickson-Gomez
- The authors are with the Medical College of Wisconsin, Milwaukee. Katherine G. Quinn, Broderick Pearson, Yuri Amirkhanian, and Jeffrey A. Kelly are with the Center for AIDS Intervention Research. Julia Dickson-Gomez and Erica Marion are with the Institute for Health and Equity
| | - Broderick Pearson
- The authors are with the Medical College of Wisconsin, Milwaukee. Katherine G. Quinn, Broderick Pearson, Yuri Amirkhanian, and Jeffrey A. Kelly are with the Center for AIDS Intervention Research. Julia Dickson-Gomez and Erica Marion are with the Institute for Health and Equity
| | - Erica Marion
- The authors are with the Medical College of Wisconsin, Milwaukee. Katherine G. Quinn, Broderick Pearson, Yuri Amirkhanian, and Jeffrey A. Kelly are with the Center for AIDS Intervention Research. Julia Dickson-Gomez and Erica Marion are with the Institute for Health and Equity
| | - Yuri Amikrhanian
- The authors are with the Medical College of Wisconsin, Milwaukee. Katherine G. Quinn, Broderick Pearson, Yuri Amirkhanian, and Jeffrey A. Kelly are with the Center for AIDS Intervention Research. Julia Dickson-Gomez and Erica Marion are with the Institute for Health and Equity
| | - Jeffrey A Kelly
- The authors are with the Medical College of Wisconsin, Milwaukee. Katherine G. Quinn, Broderick Pearson, Yuri Amirkhanian, and Jeffrey A. Kelly are with the Center for AIDS Intervention Research. Julia Dickson-Gomez and Erica Marion are with the Institute for Health and Equity
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11
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Fuller TJ, Phillips NR, Lambert DN, DiClemente RJ, Wingood GM. Re-membering HIV in the Black Church: women's religious and social identity in relation to perceived risk and men on the down low. CULTURE, HEALTH & SEXUALITY 2022; 24:437-450. [PMID: 33651670 DOI: 10.1080/13691058.2020.1870000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 12/24/2020] [Indexed: 06/12/2023]
Abstract
This analysis of 84 interviews with female Black Church leaders and members from Atlanta, GA, examined how women in Black churches construct definitions of, and identities in relation to, HIV narratives about men on the down low. We analyse these narratives as collective memories, through the theoretical lens of memory and trauma studies, by identifying how women understand themselves as the victims of men on the down low transmitting HIV; describe this as a painful experience; make public claims about this experience; and draw on theological understandings to make these claims. The narratives articulate how Black communal modes of meaning making have been disrupted by the HIV epidemic and assign responsibility for HIV transmission to men on the down low, who are perceived to be engaged in risky sexual behaviour. We discuss these results in relation to HIV education and prevention and suggest health educators can engage Black church leaders by understanding these narratives as forms of countermemory.
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Affiliation(s)
- Tyler J Fuller
- Candler School of Theology, Emory University, Atlanta, GA, USA
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Danielle N Lambert
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ralph J DiClemente
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Gina M Wingood
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
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12
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Del Pino HE, Steers WN, Lee M, McCuller J, Hays RD, Harawa NT. Measuring Gender Role Conflict, Internalized Stigma, and Racial and Sexual Identity in Behaviorally Bisexual Black Men. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:1019-1030. [PMID: 34136991 PMCID: PMC8674384 DOI: 10.1007/s10508-021-01925-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/17/2020] [Accepted: 01/19/2021] [Indexed: 06/12/2023]
Abstract
Black men who have sex with men and women (BMSMW) experience pressure to fill hypermasculine ideals and may not identify with "gay" cultural norms. Existing measures of gender role expectations and internalized homophobia are not culturally appropriate for BMSMW. Researchers generally measure categorical identification with race, gender, and sexual orientation groups separately, whereas BMSMW may identify with multiple categories. We modified the Gender Role Conflict Scale to create the M-GRCS and the Internalized Homophobia Scale to include biphobia (Internalized Bi/Homophobia Scale, IBHS). To examine identification at the intersection of race, gender, and sexual orientation, we created 11 Integrated Race and Sexuality Scale (IRSS) items. With data from 429 BMSMW, we conducted exploratory factor analysis of the 59 items using categorical principal axis factoring with unweighted least squares extraction and Promax factor rotation. We created simple-summated multi-item scales and evaluated their construct validity. The rotated solution yielded four factors with 47 items and a simple factor structure: M-GRCS defined two factors (α = .93 for restricted emotionality/affection; .87 for success/power/competition); the IBHS (α = .89) and IRSS (α = .74) each defined a single factor. The IRSS factor was positively correlated with the Lukwago Racial Pride Scale, r(417) = .40. The IBHS factor was negatively correlated with the IRSS factor, r(414) = - .22. The two M-GRCS factors suggest that the construct of hypermasculinity impacts BMSMW. The high IBHS reliability indicates that homophobia and biphobia were positively correlated in this sample. These three scales have potential for future studies with BMSMW.
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Affiliation(s)
- Homero E Del Pino
- Department of Psychiatry and Human Behavior, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - W Neil Steers
- Department of Medicine, David Geffen School of Medicine at UCLA, Suite 850, 1100 Glendon Ave., Los Angeles, CA, 90024, USA
| | - Martin Lee
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Jason McCuller
- College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Ron D Hays
- Department of Medicine, David Geffen School of Medicine at UCLA, Suite 850, 1100 Glendon Ave., Los Angeles, CA, 90024, USA
| | - Nina T Harawa
- Department of Psychiatry and Human Behavior, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.
- Department of Medicine, David Geffen School of Medicine at UCLA, Suite 850, 1100 Glendon Ave., Los Angeles, CA, 90024, USA.
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Price DM, Gesselman AN, Fikslin RA, Goldberg AJ, Pervez O, Reinka MA, Franklin E. How Can I Get COVID?: Understanding Differences in American Heterosexual and Sexual Minority Men's Risk Perception. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:203-216. [PMID: 34779976 PMCID: PMC8592071 DOI: 10.1007/s10508-021-02123-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 07/09/2021] [Accepted: 08/01/2021] [Indexed: 05/30/2023]
Abstract
Men are more vulnerable to COVID-19 infections compared to women, but their risk perceptions around COVID-19 are persistently lower. Further, men often engage in less health promotion behavior because self-care in this capacity is seen as weak or less masculine. This combination has consequences for mortality; thus, a better understanding of men's COVID-19 cognitions and individual difference factors is critical. In a web-based survey conducted during the beginning stages of the pandemic in the U.S., we collected risk perceptions of various sexual and non-sexual behaviors from heterosexual (n = 137) and gay/bisexual men (n = 108). There were no significant sexual orientation differences for perceptions of COVID-19 risk from routine activities or in overall risk estimates. However, gay/bisexual men did report engaging in more precautionary behavior while socializing (i.e., masking, social distancing) and reported higher risk perceptions than did heterosexual men for nearly all intimate and sexual activities. A more nuanced understanding of cognitions around COVID-19 is needed to better understand motivation for-and especially motivation against-pursuing vaccinations and continuing precautionary behavior.
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Affiliation(s)
- Devon M Price
- Department of Psychology, Hunter College of the City University of New York, New York, NY, 10065, USA.
| | | | - Rachel A Fikslin
- Department of Psychology, Hunter College of the City University of New York, New York, NY, 10065, USA
- Department of Psychology, Graduate Center of the City, University of New York, New York, NY, USA
| | - Alison J Goldberg
- Department of Psychology, Hunter College of the City University of New York, New York, NY, 10065, USA
- Department of Psychology, Graduate Center of the City, University of New York, New York, NY, USA
| | - Omaima Pervez
- Department of Psychology, Hunter College of the City University of New York, New York, NY, 10065, USA
| | - Mora A Reinka
- Department of Psychology, Ursinus College, Collegeville, PA, USA
| | - Elissia Franklin
- Research Her, LLC, South Holland, IL, USA
- Purdue University, West Lafayette, IN, USA
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14
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Alexander KA, Sanders RA, Grace KT, Thorpe RJ, Doro E, Bowleg L. "Having a Child Meant I had a Real Life": Reproductive Coercion and Childbearing Motivations Among Young Black Men Living in Baltimore. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP9197-NP9225. [PMID: 31195889 PMCID: PMC6911027 DOI: 10.1177/0886260519853400] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Despite disproportionate health outcome disparities experienced by Black women, reproductive coercion (RC), a range of behaviors to promote unwanted pregnancy and childbearing motivations among poor young Black men are underexamined in current empirical literature. We aimed to describe perceptions of RC behaviors and childbearing motivations among poor young Black men in Baltimore City. We recruited a convenience sample of young Black men aged 18 to 25 (N = 25). Data were collected using semi-structured interviews and demographic surveys. Thematic analysis was guided by Miller's Traits-Desires-Intentions-Behaviors (TDIB) framework. According to survey data (N = 23), mean age was 22 (2.1). Majority of participants reported sexual relationships with one person (74%; n = 17), almost half (48%; n = 12) were biological fathers, and six (26%) participants reported using RC toward an intimate partner; three (13%) reported experiencing RC behaviors from a female partner. According to qualitative interviews (N = 25), participants described perceived women-partner motivations for RC as entrapment. Childbearing motivations were influenced by (a) legacies and bonding and (b) escaping/correcting the past. Childbearing desires included (a) love feelings and intimacy and (b) good father. Childbearing intentions included (a) resistance to medical interventions and (b) preparation. Perceptions of RC and childbearing motivations reflected desires from participants to fulfill cultural expectations for conventional masculinity and enhance personal dreams for fatherhood. Although some perceptions and behavior patterns aligned with previous studies, RC was relatively rare in this sample. Findings demonstrated nuanced antithesis to stereotypical notions of young Black men and fatherhood. Provision of reproductive care for young men and their sexual partners should include discussions about RC, pregnancy motivations, and healthy sexual communication strategies.
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Affiliation(s)
| | | | | | - Roland J. Thorpe
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior, and Society, Baltimore, Maryland, USA
| | - Elizabeth Doro
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Lisa Bowleg
- The George Washington University, Department of Psychology, Washington, D.C., USA
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15
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Alderson C, Hagiwara N, Green J. Perceptions of free will and self-control in a medically relevant treatment recommendation scenario. The Journal of Social Psychology 2021; 162:716-732. [PMID: 34315355 DOI: 10.1080/00224545.2021.1953956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Do provider perceptions of patient free will and treatment related self-control influence treatment recommendations and do such perceptions differ due to race? If so, such bias may be a mechanism for racial disparities in medical treatment recommendations. We hypothesized: (1) greater perceived patient free will would indirectly effect treatment recommendations for patients through increased perceived patient treatment related self-control; (2) participants would perceive greater free will for a hypothetical racial ingroup patient than outgroup patient; and (3) such effect would be exacerbated by greater levels of racial identity and racial bias. A 2 (Participant: Black vs. White) x 2 (Target: Black vs. White) x Continuous (Racial Identity/Racial Bias) between-subjects design supported hypothesis 1. Perceived patient free will predicted more rigorous treatment recommendations treatment related self-control. No evidence was found in support of hypotheses 2 and 3. Using a novel experimental design, this work demonstrates the importance of free will and self-control perceptions.
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16
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Watts KJ, Bentley KJ. Perceptions of gay black men on the social construction of masculinity and its role in mental health. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2021. [DOI: 10.1080/19359705.2021.1949422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Keith J. Watts
- School of Social Work, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kia J. Bentley
- School of Social Work, Virginia Commonwealth University, Richmond, Virginia, USA
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17
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A Structural Equation Model of the Effect of Masculinity and Avoidant Coping on Gay and Bisexual Men's Sexual Risk-Taking. AIDS Behav 2021; 25:1438-1453. [PMID: 32740828 DOI: 10.1007/s10461-020-02981-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study aims to extend the scientific knowledge base on the association between masculine norm adherence and sexual risk-taking, in the context of gay and bisexual men, by examining emotional suppression, social support seeking, and avoidant coping as potential mediating pathways. A sample of 482 gay and bisexual men was recruited. Structural equation modeling was used to assess for mediation. Findings revealed that although gender role conflict and conformity to masculine norms (i.e., the two masculine norm adherence predictor variables) did not have a direct effect on sexual risk-taking, a significant indirect effect was observed for gender role conflict on sexual risk-taking via increased avoidant coping. Accordingly, gender role conflict and avoidant coping may create a unique effect on sexual risk-taking whereby the effect of gender role conflict on sexual risk-taking is not transmitted directly but only indirectly through the mediating role of avoidant coping. Future research directions are discussed.
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18
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Pierce LJ, Rebeiro P, Brantley M, Fields EL, Jenkins CA, Griffith DM, Conserve D, Shepherd B, Wester C, Ahonkhai AA. Who Is Not Linking to HIV Care in Tennessee - the Benefits of an Intersectional Approach. J Racial Ethn Health Disparities 2021; 9:849-855. [PMID: 33876409 PMCID: PMC8523577 DOI: 10.1007/s40615-021-01023-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/17/2021] [Accepted: 03/14/2021] [Indexed: 11/21/2022]
Abstract
Introduction Guided by an intersectional approach, we assessed the association between social categories (individual and combined) on time to linkage to HIV care in Tennessee. Methods Tennessee residents diagnosed with HIV from 2012-2016 were included in the analysis (n=3750). Linkage was defined by the first CD4 or HIV RNA test date after HIV diagnosis. We used Cox proportional hazards models to assess the association of time to linkage with individual-level variables. We modeled interactions between race, age, gender, and HIV acquisition risk factor (RF), to understand how these variables jointly influence linkage to care. Results Age, race, and gender/RF weAima A. Ahonkhaire strong individual (p < 0.001 for each) and joint predictors of time to linkage to HIV care (p < 0.001 for interaction). Older individuals were more likely to link to care (aHR comparing 40 vs. 30 years, 1.20, 95%CI 1.11-1.29). Blacks were less likely to link to care than Whites (aHR= 0.73, 95% CI: 0.67-0.79). Men who have sex with men (MSM) (aHR = 1.18, 95%CI: 1.03-1.34) and heterosexually active females (females) (aHR = 1.32, 95%CI: 1.14-1.53) were more likely to link to care than heterosexually active males. The three-way interaction between age, race, and gender/RF showed that Black males overall and young, heterosexually active Black males in particular were least likely to establish care. Conclusions Racial disparities persist in establishing HIV care in Tennessee, but data highlighting the combined influence of age, race, gender, and sexual orientation suggest that heterosexually active Black males should be an important focus of targeted interventions for linkage to HIV care. Supplementary Information The online version contains supplementary material available at 10.1007/s40615-021-01023-6.
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Affiliation(s)
- Leslie J Pierce
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Ave, Suite 750, Nashville, TN, 37203, USA
| | - Peter Rebeiro
- Department of Medicine, Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Medicine, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Errol L Fields
- Division of Adolescent/Young Adult Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Cathy A Jenkins
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Derek M Griffith
- Center for Research on Men's Health, Vanderbilt University, Nashville, TN, USA
| | - Donaldson Conserve
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, SC, USA
| | - Bryan Shepherd
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Aima A Ahonkhai
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Ave, Suite 750, Nashville, TN, 37203, USA. .,Department of Medicine, Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA.
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19
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Black Resilience: A Strategic Asset for Engaging Heterosexual Black Canadian Men in Community Responses to HIV. J Racial Ethn Health Disparities 2021; 9:756-766. [PMID: 33686622 DOI: 10.1007/s40615-021-01011-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 11/25/2022]
Abstract
Black people's disproportionate burden of HIV in Canada has raised questions about whether they are sufficiently resilient to HIV, and how to promote resilience. In this paper, we critically examine the issue of resilience among heterosexual Black men in four large Canadian cities (Ottawa, Toronto, London, and Windsor). In 2016, a team of researchers engaged self-identified heterosexual Black men in critical reflection on HIV-related resilience and vulnerability, with the goal of identifying pathways to strengthen their involvement in community responses to HIV. In total, 56 men participated in in-depth interviews and 154 participated in 21 focus groups. The team also organized six focus groups (N = 41) with policymakers, service providers, and community leaders. All four cities participated in a multi-stage iterative process to identify the thematic content of the data. Three overarching sources of resilience emerged from our critical interpretive analysis: (1) bonding with other men, (2) strong commitment to family and community, and (3) demonstrating self-confidence and self-determination. These sources of resilience illustrate the value of love as a driving force for collective action on social justice, support for family and community, and self-determination. These expressions of love support heterosexual Black men to resist or negotiate the structural challenges and gendered ideologies that make them vulnerable to HIV. Based on our analysis, we propose the concept of Black resilience that transcends merely bouncing back from or accommodating to adversity; instead, we understand Black resilience as a predisposition that motivates strategic resistance to systemic disadvantage that undermines Black people's health and wellbeing.
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20
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McCray N, Thompson L, Branch F, Porter N, Peterson J, Perry MJ. Talking About Public Health With African American Men: Perceptions of Environmental Health and Infertility. Am J Mens Health 2021; 14:1557988320901375. [PMID: 31973636 PMCID: PMC6984439 DOI: 10.1177/1557988320901375] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
While the past two decades have seen rapid advances in research demonstrating links between environmental health and reproductive capacity, African American men have largely been overlooked as study participants. To give voice to the perceptions of urban African American men, the present qualitative study conducted focus groups of men recruited from street- and internet-based advertisements in Washington, DC. Participants were asked for their perspectives on their environment, reproductive health and fertility, and factors that would influence their participation in public health research. Participants expressed concern about ubiquitous environmental exposures characteristic of their living environments, which they attributed in part to gentrification and urban development. Infertility was seen as a threat to masculinity and a taboo subject in the African American community and several participants shared personal stories describing a general code of silence about the subject. Each group offered multiple suggestions for recruiting African American men into research studies; facilitators for study participation included cultural relevance, incentives, transparent communication, internet- and community-based recruitment, and use of African Americans and/or recruiters of color as part of the research team. When asked whether participants would participate in a hypothetical study on fertility that involved providing a sperm sample, there was a mixed reaction, with some expressing concern about how such a sample would be used and others describing a few facilitators for participation in such a study. These are unique perspectives that are largely missing from current-day evidence on the inclusion of African American men in environmental health and reproductive health research.
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Affiliation(s)
- Nathan McCray
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Lance Thompson
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Francesca Branch
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Nicholas Porter
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - James Peterson
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Melissa J Perry
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
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21
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Berner-Rodoreda A, Geldsetzer P, Bärnighausen K, Hettema A, Bärnighausen T, Matse S, McMahon SA. "It's hard for us men to go to the clinic. We naturally have a fear of hospitals." Men's risk perceptions, experiences and program preferences for PrEP: A mixed methods study in Eswatini. PLoS One 2020; 15:e0237427. [PMID: 32966307 PMCID: PMC7510987 DOI: 10.1371/journal.pone.0237427] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 07/27/2020] [Indexed: 01/10/2023] Open
Abstract
Few studies on HIV Pre-Exposure Prophylaxis (PrEP) have focused on men who have sex with women. We present findings from a mixed-methods study in Eswatini, the country with the highest HIV prevalence in the world (27%). Our findings are based on risk assessments, in-depth interviews and focus-group discussions which describe men’s motivations for taking up or declining PrEP. Quantitatively, men self-reported starting PrEP because they had multiple or sero-discordant partners or did not know the partner’s HIV-status. Men’s self-perception of risk was echoed in the qualitative data, which revealed that the hope of facilitated sexual performance or relations, a preference for pills over condoms and the desire to protect themselves and others also played a role for men to initiate PrEP. Trust and mistrust and being able or unable to speak about PrEP with partner(s) were further considerations for initiating or declining PrEP. Once on PrEP, men’s sexual behavior varied in terms of number of partners and condom use. Men viewed daily pill-taking as an obstacle to starting PrEP. Side-effects were a major reason for men to discontinue PrEP. Men also worried that taking anti-retroviral drugs daily might leave them mistaken for a person living with HIV, and viewed clinic-based PrEP education and initiation processes as a further obstacle. Given that men comprise only 29% of all PrEP users in Eswatini, barriers to men’s uptake of PrEP will need to be addressed, in terms of more male-friendly services as well as trialing community-based PrEP education and service delivery.
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Affiliation(s)
| | - Pascal Geldsetzer
- Institute of Global Health, Ruprecht-Karls-Universität, Heidelberg, Germany
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California, United States of America
| | - Kate Bärnighausen
- Institute of Global Health, Ruprecht-Karls-Universität, Heidelberg, Germany
- University of the Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Anita Hettema
- Clinton Health Access Initiative Swaziland, Mbabane, Eswatini
| | - Till Bärnighausen
- Institute of Global Health, Ruprecht-Karls-Universität, Heidelberg, Germany
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Sindy Matse
- Eswatini Ministry of Health, Mbabane, Eswatini
| | - Shannon A. McMahon
- Institute of Global Health, Ruprecht-Karls-Universität, Heidelberg, Germany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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22
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Abdallah I, Conserve D, Burgess TL, Adegbite AH, Oraka E. Correlates of HIV-related risk behaviors among self-identified heterosexual men who have sex with men (HMSM): national survey of family growth (2002, 2006-2010, and 2011-2017). AIDS Care 2020; 32:1529-1537. [PMID: 32024380 DOI: 10.1080/09540121.2020.1724254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Self-identified heterosexual men who have sex with men (HMSM) have unique sexual behaviors that may increase their risk of HIV infection. We assessed the correlates of recent sex with other men and HIV-related risk behaviors among HMSM by sex of their sex partners. We analyzed data from the 2002 and 2006-2017 National Survey of Family Growth limited to men who self-identified as heterosexual and reported any anal/oral sex with another man (N = 787). Prevalence ratios based on logistic regression models determined the association between sociodemographic and behavior variables with reporting a same-sex partner or at least one HIV-related risk behavior with a female sex partner in the last 12 months. Approximately 17.7% and 42.5% of HMSM with recent same-sex partners reported HIV-related risk behaviors with male and female sex partners, respectively. HMSM who reported a recent same-sex partner and an HIV-related risk behavior reported more annual male (Ave = 2.6:95%CI;1.6-3.7) and female (Ave = 5.0:95%CI;3.3-6.8) sex partners than HMSM with a recent same-sex partner who did not report an HIV-related risk behavior [male (Ave = 1.7:95%CI;1.2-2.1) and female (Ave = 1.6:95%CI;1.1-2.1)]. HMSM with recent same-sex partners may engage in HIV-related risk behaviors with men and women concurrently. Further studies should assess gender-specific risk of infection.
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Taylor TN, DeHovitz J, Hirshfield S. Intersectional Stigma and Multi-Level Barriers to HIV Testing Among Foreign-Born Black Men From the Caribbean. Front Public Health 2020; 7:373. [PMID: 31998675 PMCID: PMC6965168 DOI: 10.3389/fpubh.2019.00373] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 11/21/2019] [Indexed: 01/08/2023] Open
Abstract
Testing is the entry point into the HIV care continuum that includes linkage to and retention in prevention services, and adherence to prevention strategies, including repeat HIV testing. Despite US policy approaches to expand HIV testing to diverse clinical care and community settings, disparities in HIV testing among Black populations persist. Foreign-born (FB) Black persons from the Caribbean have higher annual rates of HIV diagnosis and a higher percentage of late-stage HIV diagnosis, compared with US-born Black persons; and most HIV infections among FB Blacks are among men. In this article, we provide an overview of HIV testing barriers among FB Black men who engage in HIV risk-taking behaviors (e.g., condomless sex with male and/or female partners of unknown HIV serostatus). Barriers to HIV testing for both FB and US-born Black men, include HIV stigma (anticipated, perceived, internalized), low perceived HIV risk, medical or government mistrust, and perceived low access to testing resources. We examine beliefs about masculinity and gender roles that may perpetuate heteronormative stereotypes associated with perceptions of low HIV risk and barriers to HIV testing. We also discuss the impact of recent immigration policies on accessing HIV testing and treatment services and how intersectional stigmas and structural forms of oppression, such as racism, prejudice against select immigrant groups, and homophobia that may further amplify barriers to HIV testing among FB Black men. Finally, we review comprehensive prevention approaches, and suggest innovative approaches, that may improve the uptake of HIV testing among FB Black men.
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Affiliation(s)
- Tonya N. Taylor
- SUNY Downstate Health Sciences University, Brooklyn, NY, United States
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24
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Alexander KA, St. Vil NM, Braithwaite-Hall MA, Sanchez M, Baumann A, Callwood GB, Campbell JC, Campbell DW. 'Some men just don't want to get hurt': perspectives of U.S. Virgin Islands men toward partner violence and HIV risks. ETHNICITY & HEALTH 2020; 25:1-16. [PMID: 29088920 PMCID: PMC6768768 DOI: 10.1080/13557858.2017.1395816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 10/16/2017] [Indexed: 05/26/2023]
Abstract
Objectives: Global evidence suggests that individuals who experience intimate partner violence (IPV) can have accelerated risk for HIV transmission. The U.S. Virgin Islands (USVI) has high per capita rates of HIV and IPV that can have devastating effects on women's health. Catalysts for these health disparities may be shaped by cultural and social definitions of conventional masculinity. Thus, understanding USVI men's perceptions about HIV risks and IPV are a necessary component of developing strategies to improve women's health. This study aimed to describe perceptions of HIV risks and IPV among USVI men.Design: We conducted two focus groups with 14 men living on St. Thomas and St. Croix, USVI. The focus group interview guide was culturally relevant and developed using findings from research conducted about these issues on USVI. Thematic analysis was used to analyze focus group data. Transcripts were coded and categorized by four research team members and discrepancies were reconciled. Themes were developed based on the emerging data.Results: Focus group participants were all US citizens born on the USVI, had a median age range of 20-25, 86% (12) were of African descent and 14% (2) were Hispanic. Themes emerging from the data were: (1) validating status, (2) deflecting responsibility, and (3) evoking fear and distrust. These ideas underscored the ways that attitudes and beliefs informed by gender and social norms influence IPV and sexual behavior between intimate partners.Conclusion: USVI society could benefit from interventions that aim to transform norms, promote healthy relationships, and encourage health-seeking behavior to improve the health of women partners.
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Affiliation(s)
- Kamila A. Alexander
- Johns Hopkins School of Nursing, Department of Community-Public Health, Baltimore, Maryland, USA
| | - Noelle M. St. Vil
- University at Buffalo, School of Social Work, Buffalo, New York, USA
| | | | - Michael Sanchez
- Johns Hopkins School of Nursing, Department of Community-Public Health, Baltimore, Maryland, USA
| | - Aletha Baumann
- University of the Virgin Islands, Caribbean Exploratory Research Center, St. Thomas, U.S. Virgin Islands
| | - Gloria B. Callwood
- University of the Virgin Islands, Caribbean Exploratory Research Center, St. Thomas, U.S. Virgin Islands
| | - Jacquelyn C. Campbell
- Johns Hopkins School of Nursing, Department of Community-Public Health, Baltimore, Maryland, USA
| | - Doris W. Campbell
- University of the Virgin Islands, Caribbean Exploratory Research Center, St. Thomas, U.S. Virgin Islands
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Closson K, Hatcher A, Sikweyiya Y, Washington L, Mkhwanazi S, Jewkes R, Dunkle K, Gibbs A. Gender role conflict and sexual health and relationship practices amongst young men living in urban informal settlements in South Africa. CULTURE, HEALTH & SEXUALITY 2020; 22:31-47. [PMID: 30762491 DOI: 10.1080/13691058.2019.1568578] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 01/08/2019] [Indexed: 06/09/2023]
Abstract
Qualitative research suggests that men's inability to achieve dominant forms of masculinity may be related to HIV-risk behaviours and intimate partner violence (IPV) perpetration. Using clustered cross-sectional data, we assessed how young men's gender role conflict was associated with HIV-risk behaviours in urban informal settlements in KwaZulu-Natal, South Africa. Gender Role Conflict and Stress (GRC/S) was measured using a South African adaptation of the GRC/S scale comprising three sub-scales: subordination to women; restrictive emotionality; and success, power and competition. In random-effect models adjusting for socio-demographics, we tested the relationship with GRC/S sub-scales and sexual health behaviours (transactional sex, use of sex workers, ≥2 main partners and ≥2 casual/once off partners), and relationship practices (relationship satisfaction, relationship control, partnership type and perpetration of IPV). Overall, 449 young men (median age = 25, Q1, Q3 = 23-28) were included in the analysis. Higher GRC/S scores, denoting more GRC/S, were associated with increased relationship control and increased odds of having ≥2 casual or one-off partners and engaging in transactional sex. We found differences in associations between each sub-scale and sexual health and relationship practices, highlighting important implications for informing both theoretical understandings of masculinity and gender transformative efforts.
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Affiliation(s)
- Kalysha Closson
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Abigail Hatcher
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Yandisa Sikweyiya
- Gender and Health Research Unit, South Africa Medical Research Council
| | | | | | - Rachel Jewkes
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Gender and Health Research Unit, South Africa Medical Research Council
| | - Kristin Dunkle
- Gender and Health Research Unit, South Africa Medical Research Council
| | - Andrew Gibbs
- Gender and Health Research Unit, South Africa Medical Research Council
- Centre for Rural Health, School of Nursing and Public Health, University of Kwazulu-Natal, Durban, South Africa
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Mackenzie S, Michels C, Chang J. Structures of Sexuality: Sexual Stigma, Disclosure, and HIV Risk with Primary Female Partners Among Behaviorally Bisexual Black Men. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:299-310. [PMID: 31562582 DOI: 10.1007/s10508-019-1463-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 03/29/2019] [Accepted: 04/27/2019] [Indexed: 06/10/2023]
Abstract
HIV continues to disproportionately impact bisexual Black men, as well as their female partners, in the U.S. There is a need to better understand how stigma and disclosure affect sexual risk for men and their female partners. This article describes the relationship between sexual stigma and HIV risk with primary female partners among a sample of 121 behaviorally bisexual Black men of mixed HIV status in the San Francisco Bay Area. Multivariate analyses tested to see if each of three stigma measures (bisexual stigma, internalized homophobia, difficulty with bisexual identity) would have any effect on participants' condom use. Quantitative analyses found that sexual stigma increased men's sexual risk through inhibiting disclosure of their sexual activity with men to their female partners. Men who reported higher levels of bisexual stigma and internalized homophobia reported that it was harder to disclose having sex with men to their primary female partner, which was significantly related to lower levels of condom use. Stigma reduction HIV prevention interventions are needed that address bisexual stigma experienced by Black men. HIV prevention interventions, including stigma reduction programs, must target both men and women to effectively reduce bisexual stigma and address the structural and relationship contexts of HIV.
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Affiliation(s)
- Sonja Mackenzie
- Public Health Program, Santa Clara University, 500 El Camino Real, Santa Clara, CA, 95053, USA.
| | - Cameron Michels
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA, USA
| | - Jason Chang
- Health Equity Institute, San Francisco State University, San Francisco, CA, USA
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Reese N, Mincey KD, Felder K. Understanding What Influences Sexual Health Behaviors among Black Males in College. JOURNAL OF BLACK SEXUALITY AND RELATIONSHIPS 2020; 6:13-27. [PMID: 34337106 PMCID: PMC8323786 DOI: 10.1353/bsr.2020.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Using the Health Belief Model as a guide, focus groups and interviews (n=35) were conducted with Black males at a Historically Black College and University. Findings suggest that norms around the expectations of men and sex relates to their sexual behavior. The study also indicates that while Black college men know they should engage in protected sex (perceived benefits), they are inclined to engage in unprotected sex if their partner is on the pill (cues to action), they don't believe the consequences are immediate (perceived severity), and they like the feel of not using a condom (perceived barriers).
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Husbands W, Oakes W, Mbulaheni T, Ongoïba F, Pierre-Pierre V, Luyombya H. Resourceful masculinities: exploring heterosexual Black men's vulnerability to HIV in Ontario, Canada. ETHNICITY & HEALTH 2020; 25:17-33. [PMID: 29082777 DOI: 10.1080/13557858.2017.1395817] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 10/16/2017] [Indexed: 06/07/2023]
Abstract
Objectives: Heterosexually active Black men are alleged to endorse masculine norms that increase their and their female partners' vulnerability to HIV. These norms include Black men's inability or reluctance to productively engage their own health-related personal and interpersonal vulnerabilities. We draw on data from the iSpeak research study in Ontario, Canada, to assess whether and how heterosexual Black men cope with personal and inter-personal vulnerability, namely that heterosexual Black men: avoid emotionally supportive relationships with other men (and women), which diminishes their capacity to productively acknowledge and resolve their health-related challenges; are reticent to productively acknowledge and address HIV and health on a personal level; and are pathologically secretive about their health, which compounds their vulnerability and precipitates poor health outcomes.Design: iSpeak was implemented in 2011 to 2013, and included two focus groups with HIV-positive and HIV-negative self-identified heterosexual men (N = 14) in Toronto and London, a focus group with community-based health promotion practitioners who provide HIV-related services to Black communities in Ontario (N = 6), and one-on-one interviews with four researchers distinguished for their scholarship with/among Black communities in Toronto. Participants in the men's focus group were recruited discretely through word-of-mouth. Focus groups were audiotaped and transcribed verbatim. Team members independently read the transcripts, and then met to identify, discuss and agree on the emerging themes.Results: We demonstrate that iSpeak participants (a) engage their personal and interpersonal vulnerabilities creatively and strategically, (b) complicate and challenge familiar interpretations of Black men's allegedly transgressive masculinity through their emotional and practical investment in their health, and (c) demonstrate a form of resourceful masculinity that ambiguously aligns with patriarchy.Conclusion: We conclude with a range of actionable recommendations to strengthen the discursive framework for understanding heterosexual Black men in relation to HIV and health, and substantively engaging them in community responses to HIV.
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Affiliation(s)
| | - Wesley Oakes
- Africans in Partnership Against AIDS, Toronto, ON, Canada
| | - Tola Mbulaheni
- African and Caribbean Council on HIV/AIDS in Ontario, Toronto, ON, Canada
| | - Fanta Ongoïba
- Africans in Partnership Against AIDS, Toronto, ON, Canada
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Quinn KG. Applying an intersectional framework to understand syndemic conditions among young Black gay, bisexual, and other men who have sex with men. Soc Sci Med 2019; 295:112779. [PMID: 31898991 DOI: 10.1016/j.socscimed.2019.112779] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/16/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Abstract
Syndemic theory has been useful in illuminating the co-existence and reinforcing nature of multiple health and social conditions that contribute to HIV risk. However, little research has examined syndemics among young Black gay, bisexual, and other men who have sex with men (GBM) or situated syndemics within the context of racism, homonegativity, and other intersecting social inequities. Applying an intersectional framework to syndemics can help demonstrate how social and structural inequities and oppression facing young Black GBM contribute to and reinforce syndemic health conditions. In 2018, we conducted 45 in-depth qualitative interviews with young Black GBM in Milwaukee and Cleveland. Our analyses examined how intersectional stigma contributes to syndemics and HIV disparities facing young Black GBM. Our findings demonstrate that broader systems of oppression and disadvantage facing young Black GBM contribute to syndemic conditions. Future conceptualizations and measurements of syndemics must capture these experiences to strengthen our understanding of syndemics among young Black GBM.
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Affiliation(s)
- Katherine G Quinn
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA.
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Lindberg LD, Maddow-Zimet I, Marcell AV. Prevalence of Sexual Initiation Before Age 13 Years Among Male Adolescents and Young Adults in the United States. JAMA Pediatr 2019; 173:553-560. [PMID: 30958512 PMCID: PMC6547075 DOI: 10.1001/jamapediatrics.2019.0458] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Despite similar sexual activity rates among male and female adolescents, males are more likely to have their first sexual intercourse before age 13 years. The developmental needs and pathways to healthy trajectories for young males remain unknown. OBJECTIVE To examine the prevalence of sexual intercourse before age 13 years among male adolescents; the variation by race/ethnicity, location, and maternal educational level; and the wantedness of this first sexual experience. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional analysis was conducted from September 2017 to June 2018, using pooled 2011, 2013, and 2015 data from the school-based Youth Risk Behavior Surveillance System (YRBSS) and the 2006 to 2015 data of males aged 15 to 24 years from the household-based National Survey of Family Growth (NSFG). The percentage of males reporting sexual onset before age 13 years was estimated using survey-weighted logistic regression to test for differences by race/ethnicity within each national survey and within metropolitan areas (for YRBSS, high school and middle school samples). Among NSFG survey respondents, differences in wantedness of first sexual intercourse by age at first sexual intercourse were examined, along with the associations between sexual initiation and socioeconomic covariates. MAIN OUTCOMES AND MEASURES Sexual onset before age 13 years. RESULTS Data from a total of 19 916 male high school students (from YRBSS) and 7739 males aged 15 to 24 years (from NSFG) were included in the analysis. The sample was largely composed of non-Hispanic white males: 8789 (57.1%) from the YRBSS and 3737 (58.0%) from the NSFG. Sexual onset before age 13 years was reported nationally by 7.6% (95% CI, 6.8%-8.4%) of male high school students and 3.6% (95% CI, 3.0%-4.2%) of males aged 15 to 24 years. The proportion of male students who reported having sexual intercourse before age 13 years varied across metropolitan sites, from 5% (95% CI, 4%-7%) in San Francisco, California, to 25% (95% CI, 23%-28%) in Memphis, Tennessee, with elevated rates among non-Hispanic black and Hispanic males in most metropolitan areas. In the NSFG data set, respondents whose mothers had a college degree or higher educational level were statistically significantly less likely (OR, 0.31; 95% CI, 0.19-0.49) to report having sexual intercourse before age 13 years compared with those whose mothers did not have a college degree. Among males who reported having their first sexual experience before age 13 years, 8.5% (95% CI, 3.8%-17.8%) described their first sexual intercourse as unwanted. CONCLUSIONS AND RELEVANCE Rates of sexual onset before age 13 years among young males varied by race/ethnicity, location, and maternal educational level, presenting important implications for the provision of early, inclusive, and comprehensive sex education and sexual and reproductive health care to male children and adolescents.
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Affiliation(s)
| | | | - Arik V. Marcell
- Department of Pediatrics, School of Medicine, The Johns Hopkins University, Baltimore, Maryland,Department of Population, Family, and Reproductive Health, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland
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31
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Levitt HM. A Psychosocial Genealogy of LGBTQ+ Gender: An Empirically Based Theory of Gender and Gender Identity Cultures. PSYCHOLOGY OF WOMEN QUARTERLY 2019. [DOI: 10.1177/0361684319834641] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this invited article, I present an inclusive theory of gender that clarifies its interconnections with gender identity, gender expression, and sexuality. To support this functionalist theory, I summarize findings from an extensive body of mixed methods research on lesbian, gay, bisexual, transgender, queer, and other (LGBTQ+) genders in the United States. I use a feminist-intersectional lens to empirically base and historically situate a theory of gender that is grounded in research of LGBTQ+ communities (butch, femme, bear, leathermen, transgender, drag queens, and family/house systems). I define genders as either sets of personal qualities within a culture associated with physiological sex or sets of qualities that evolve in reaction to limitations of existing genders. The evolution of genders functions to meet needs in four domains: (1) psychological: an experience of fit between a core aspect of self and a gender construct; (2) cultural: the creation of an LGBTQ+ culture that asserts sets of gender characteristics, which were denied and stigmatized within preexisting cultural norms; (3) interpersonal: the communicating of affiliation and status to enhance safety; and (4) sexual: an erotic embodiment of signifiers of these needs via an aesthetic that structures sexual attraction. I detail how each function affects identity, security, belonging, and personal and social values. Online slides for instructors who want to use this article for teaching are available on PWQ's website at http://journals.sagepub.com/page/pwq/suppl/index
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Affiliation(s)
- Heidi M. Levitt
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
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32
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Neilands TB, Dworkin SL, Chakravarty D, Campbell CK, Wilson PA, Gomez AM, Grisham KK, Hoff CC. Development and Validation of the Power Imbalance in Couples Scale. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:763-779. [PMID: 29850977 PMCID: PMC6269212 DOI: 10.1007/s10508-018-1190-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 02/28/2018] [Accepted: 03/03/2018] [Indexed: 05/03/2023]
Abstract
Few researchers have quantitatively explored the relationship power-HIV risk nexus in same-sex male couples. We developed and validated the Power Imbalance in Couples Scale (PICS) to measure relationship power among men in same-sex, committed relationships and its association with sexual risk behaviors. We recruited three independent and diverse samples of male couples in the greater San Francisco and New York City metropolitan areas and conducted qualitative interviews (N1 = 96) to inform item development, followed by two quantitative surveys (N2 = 341; N3 = 434) to assess the construct, predictive, convergent, and discriminant validity of the PICS. Exploratory factor analysis of the first survey's data yielded four factors-overtly controlling partner, supportive partner, conflict avoidant actor, and overtly controlling actor-that accounted for more than 50% of the shared variance among the PICS items. Confirmatory factor analysis (CFA) of the second survey's data supported these four factors: χ2(1823) = 2493.40, p < .001; CFI = .96, RMSEA = .03 and WRMR = 1.33. Strong interfactor correlations suggested the presence of a higher-order general perception of power imbalance factor; a higher-order factor CFA model was comparable in fit to the correlated lower-order factors' CFA: χ2(2) = 2.00, p = .37. Internal reliability of the PICS scale was strong: α = .94. Men perceiving greater power imbalances in their relationships had higher odds of engaging in condomless anal intercourse with outside partners of discordant or unknown HIV status (OR 1.27; 95% CI 1.01-1.60; p = .04). The PICS is an important contribution to measuring relationship power imbalance and its sequelae among male couples; it is applicable to research on relationships, sexuality, couples, and HIV prevention.
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Affiliation(s)
- Torsten B Neilands
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Shari L Dworkin
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
- School of Nursing and Health Studies, University of Washington, Bothell, WA, USA
| | - Deepalika Chakravarty
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA
- Center for Research and Education on Gender and Sexuality, San Francisco State University, 835 Marker St., #523, San Francisco, CA, 94103, USA
| | - Chadwick K Campbell
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Patrick A Wilson
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, CA, USA
| | - Kirk K Grisham
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Colleen C Hoff
- Center for Research and Education on Gender and Sexuality, San Francisco State University, 835 Marker St., #523, San Francisco, CA, 94103, USA.
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Mackenzie S. Reframing masculinity: structural vulnerability and HIV among black men who have sex with men and women. CULTURE, HEALTH & SEXUALITY 2019; 21:175-187. [PMID: 29669484 DOI: 10.1080/13691058.2018.1459845] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 03/28/2018] [Indexed: 06/08/2023]
Abstract
This paper calls for a critical reframing of masculinity as an intersectional construct in the HIV epidemic and in public health. In-depth qualitative interviews were conducted with a sample of 56 Black men who have sex with men and women in the San Francisco Bay Area. Men described their sexual identities and practices via complex narratives of masculinity that drew on subordinated and resourceful adaptations to the structural effects of racism, economic marginalisation and homophobia. By focusing on men whose experience of masculinity operates outside fixed identity categories, the paper draws attention to the intersectionality that is, by necessity, constitutive of men's lived experiences. Findings suggest the value of an integrative framework for understanding Black masculinities as processes and practices simultaneously informed by structural inequalities (racism, economic marginalisation and/or homophobia, in particular) and cultural meanings of gender. By utilising an intersectional approach, public health and sociology can better understand the concurrent resilience and vulnerability of masculinities, while building an interdisciplinary understanding of the symbolic role of Black masculinities in the USA, as well as a means by which to promote health and well-being in and through these gendered contexts.
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Affiliation(s)
- Sonja Mackenzie
- a Public Health Program , Santa Clara University , Santa Clara , USA
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The Interaction of Sexual Validation, Criminal Justice Involvement, and Sexually Transmitted Infection Risk Among Adolescent and Young Adult Males. Sex Transm Dis 2019; 45:189-194. [PMID: 29420448 DOI: 10.1097/olq.0000000000000724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Young men who have been involved with the criminal justice system are more likely to have concurrent sexual partners, a key driver of sexually transmitted infections. The value men place on having sexual relationships to validate themselves may play an important role in understanding this association. METHODS Data were from a household survey. Young men (N = 132), aged 16 to 24 years, self-reported whether they ever spent time in jail or juvenile detention and if they had sexual partnerships that overlapped in time. A novel scale, "Validation through Sex and Sexual Relationships" (VTSSR) assessed the importance young men place on sex and sexual relationships (α = 0.91). Weighted logistic regression accounted for the sampling design. RESULTS The mean (SD) VTSSR score was 23.7 (8.8) with no differences by race. Both criminal justice involvement (CJI) (odds ratio [OR], 3.69; 95% confidence interval [CI], 1.12-12.1) and sexual validation (OR, 1.10; 95% CI, 1.04-1.16) were associated with an increased odds of concurrency; however, CJI did not remain associated with concurrency in the fully adjusted model. There was effect modification, CJI was associated with concurrency among those who scored high on sexual validation (OR, 9.18; 95% CI, 1.73-48.6]; however, there was no association among those who scored low on sexual validation. Racial differences were observed between CJI and concurrency, but not between sexual validation and concurrency. CONCLUSIONS Sexual validation may be an important driver of concurrency for men who have been involved with the criminal justice system. Study findings have important implications on how sexual validation may explain racial differences in rates of concurrency.
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Kenyon CR, Buyze J, Schwartz IS. Strong association between higher-risk sex and HIV prevalence at the regional level: an ecological study of 27 sub-Saharan African countries. F1000Res 2018; 7:1879. [PMID: 30800288 PMCID: PMC6367661 DOI: 10.12688/f1000research.17108.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2018] [Indexed: 11/20/2022] Open
Abstract
Background: It is unclear why HIV prevalence varies by nearly two orders of magnitude between regions within countries in sub-Saharan Africa. In this ecological study, we assess if HIV prevalence by region is associated with any of four markers of higher risk sexual behavior: lifetime number of partners, multiple partners in past year, higher risk sex (defined as sex with non-cohabiting, non-marital partners) and age at debut. Methods: We performed Pearson's correlation between the 4 behavioral risk factors and HIV prevalence by region in 47 nationally representative surveys from 27 sub-Saharan African countries, separately by gender. In addition, principal components analysis was used to reduce the eight risk factors (four for each gender) to two principal components (PCs). Mixed effects linear regression was used to assess the relationship between the resulting two PCs and HIV prevalence after controlling for the prevalence of male circumcision. Results: HIV prevalence varied by a median 3.7 fold (IQR 2.9-7.9) between regions within countries. HIV prevalence was strongly associated with higher risk sex and, to a lesser extent, the other risk factors evaluated. Both PCs were strongly associated with HIV prevalence when assessed via linear regression. Conclusions: Differences in sexual behavior may underpin the large differences in HIV-prevalence between subpopulation within sub-Saharan African countries.
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Affiliation(s)
- Chris R Kenyon
- Clinical Science, Institute of Tropical Medicine, Antwerp, 2000, Belgium
| | - Jozefien Buyze
- Clinical Science, Institute of Tropical Medicine, Antwerp, 2000, Belgium
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36
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Jones R, Hoover DR. Reduction in a high-risk sex script among young urban women in the Love, Sex, & Choices web video HIV prevention intervention study. Res Nurs Health 2018; 41:535-543. [PMID: 30281811 DOI: 10.1002/nur.21912] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 09/08/2018] [Indexed: 11/07/2022]
Abstract
For women, the high-risk sex script of condomless sex to maintain relationships with men is concerning, particularly in regard to heterosexual HIV acquisition. This secondary analysis of data from a clinical trial evaluated the effect of a 12-episode, web-based video series intervention, entitled Love, Sex, and Choices, versus a text message control on lowering the high-risk sex script. The sample comprised 238 predominately urban Black women, ages 18-29, having HIV sex risk behavior. Data were collected at baseline and 6 months post-intervention. The Sex Script Video Response score was used to measure a high-risk sex script. HIV sex risk behavior was measured by Vaginal Equivalent Episodes with high-risk partners. At baseline, lower education, younger age at first sexual intercourse, and alcohol/non-injection drug use before sex were positively associated with a high-risk sex script. At baseline, as the high-risk sex script increased by one log unit, sex risk behavior increased by 0.47 log units (p < 0.001), equivalent to a 60% increase in the geometric mean of sex risk behavior. ANCOVA analysis indicated that from baseline to 6-months post intervention, lowering the high-risk sex script by one unit was associated with an additional reduction of 0.26 units in sex risk behavior. Compared to the text messages, the LSC video series was associated with a 27% greater reduction in the geometric mean of the sex script (p = 0.03). Further investigation into the effect of lowering sex scripts to reduce sex risk behavior is recommended.
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Affiliation(s)
- Rachel Jones
- Bouvé College of Health Sciences, School of Nursing, Northeastern University, Boston, Massachusetts
| | - Donald R Hoover
- Department of Statistics and Biostatistics, Rutgers University, New Brunswick, New Jersey
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37
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Philbin MM, Parker CM, Parker RG, Wilson PA, Garcia J, Hirsch JS. Gendered Social Institutions and Preventive Healthcare Seeking for Black Men Who Have Sex with Men: The Promise of Biomedical HIV Prevention. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:2091-2100. [PMID: 29926263 PMCID: PMC6309278 DOI: 10.1007/s10508-018-1211-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 03/23/2018] [Accepted: 04/02/2018] [Indexed: 06/01/2023]
Abstract
Research on gender and health, including research conducted among Black men who have sex with men (BMSM), has primarily focused on how gender norms and roles shape healthcare engagement. Here we advance that work by demonstrating how a broader theorization of gender, particularly one that moves beyond gender norms and performance to incorporate structures such as the healthcare system and the labor market, can facilitate an understanding of how gender affects preventive healthcare seeking among BMSM, particularly the uptake of pre-exposure prophylaxis (PrEP), a promising approach to alleviate HIV disparities. This article is based on a year-long ethnographic study conducted in New York City with BMSM (n = 31; three interviews each) and community stakeholders (n = 17). Two primary findings emerged: (1) the labor market systematically excluded the men in our sample, which limited their ability to access employer-sponsored healthcare. Such discrimination may promote overt demonstrations of masculinity that increase their HIV vulnerability and decrease healthcare seeking, and (2) healthcare systems are not structured to promote preventive healthcare for men, particularly BMSM. In fact, they constrained men's access to primary providers and were usually tailored to women. Applying a structural, gendered lens to men's health-in addition to the more frequently researched individual or interpersonal levels-provides insight into factors that affect healthcare seeking and HIV prevention for BMSM. These findings have implications for the design of policies and institutional reforms that could enhance the impact of PrEP among BMSM. Findings are also relevant to the management of chronic disease among men more broadly.
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Affiliation(s)
- Morgan M Philbin
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, Floor 5, Room 536, New York, NY, 10032, USA.
| | - Caroline M Parker
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, Floor 5, Room 536, New York, NY, 10032, USA
| | - Richard G Parker
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, Floor 5, Room 536, New York, NY, 10032, USA
| | - Patrick A Wilson
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, Floor 5, Room 536, New York, NY, 10032, USA
| | - Jonathan Garcia
- College of Public Health and Human Science, Oregon State University, Corvallis, OR, USA
| | - Jennifer S Hirsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, Floor 5, Room 536, New York, NY, 10032, USA
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38
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Reidy DE, Smith-Darden JP, Vivolo-Kantor AM, Malone CA, Kernsmith PD. Masculine Discrepancy Stress and Psychosocial Maladjustment: Implications for Behavioral and Mental Health of Adolescent Boys. PSYCHOLOGY OF MEN & MASCULINITY 2018; 19:560-569. [PMID: 29599648 PMCID: PMC5868744 DOI: 10.1037/men0000132] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Gender role discrepancy (GRD), or nonconformity to socially prescribed gender roles, has been linked to a multitude of adverse mental and behavioral health outcomes. Masculine discrepancy stress (MDS), stress about being perceived not to conform to one's gender role, may explain the relationship between GRD and deleterious health outcomes. However, research on MDS has primarily been restricted to adult males. This leaves a critical gap pertaining to the potential effect of MDS on adolescent boys, who may be more malleable and susceptible to the influence and pressures of gender socialization. In the current study, data are drawn from a sample of adolescent male students (N = 592) who completed self-report questionnaires. We employed structural equation modeling to test the effects of GRD and MDS on psychosocial maladjustment measured via sexual behavior, substance use, violence, mood disorder symptoms, and hopelessness. In addition, we controlled for critical risk factors including sociodemographic characteristics, adverse childhood experiences, trauma symptoms, and neighborhood disorganization. Findings indicate significant potentiating effects of MDS on maladjustment while there were direct protective effects of GRD. These data suggest that developing prevention strategies that incorporate social norms pertaining to gender socialization may have an impact on multiple behavioral and mental health problems.
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Affiliation(s)
- Dennis E Reidy
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Enel P, Bonierbale M, Alexandre A, Guillet S, Cambau S, Brunel F, Chollier M, Baumstarck K, Auquier P. Sexual risk factors related to lack of HIV-screening in people attending erotic industry shows. AIDS Care 2018; 31:465-470. [PMID: 30149727 DOI: 10.1080/09540121.2018.1515468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The current aim of the fight against the HIV epidemic is to reduce the proportion of missed opportunities for HIV diagnosis. Erotic industry Shows (ES) were deemed to be appropriate events to organize awareness campaigns and to propose HIV Rapid Diagnostic Test (HIV-RDT) to people who are sexually active and likely to engage in unsafe sex practices. In 2015, a cross-sectional study in 4 ES was conducted to document the sexual risk factors associated with HIV-screening test approach and the proportion of positive HIV-RDT. Prevention booths were set up to offer HIV-screening to individuals ≥18 years volunteers for HIV-RDT and to respond to a validated anonymous self-reported questionnaire. In 4 ES, 943 participants were questioned and tested, mainly men (64%), young (mean age 30 years old), living as a couple (63.7%). A large majority (95.1%) reported sexual intercourse over the last year. The mean number of partners was 4.8. About 2/3 had unprotected sex. 37.5% had never been tested and had their first test during this campaign. The 430 participants who reported no previous HIV-testing during the last 5 years more frequently declared heterosexual intercourse (OR: 2.31), identifying as a male (OR: 1.82), having transactional sex (OR: 1.92), living as a couple (OR: 1.67), having fewer sexual partners (OR: 1.06) and being younger (OR = 1.02). Three people (0.32%) were tested positive for the HIV-RDT; linkage with care was ensured for confirmatory test. This innovative and original intervention showed for the first time the usefulness of HIV-screening and awareness campaigns, in fun and commercial backdrop event. Individuals who had never been HIV-tested and who had no intention of doing so before this campaign were reached and engaged. ES are potential new locations to get HIV information and screening, to tackle sexual health-related issues and reflect on sexual risk behaviors.
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Affiliation(s)
- Patricia Enel
- a Assistance Publique - Hôpitaux de Marseille , University Hospital Center , Marseille , France.,b Center for Studies and Research on Health Services and Quality of Life EA3279 , Aix-Marseille University , Marseille , France
| | - Mireille Bonierbale
- a Assistance Publique - Hôpitaux de Marseille , University Hospital Center , Marseille , France.,c University Interdisciplinary Association of Sexology, AIUS , Marseille , France
| | - Antonio Alexandre
- d Health Prevention National Association for Festive Venues , ENIPSE , Paris , France
| | - Sylvain Guillet
- d Health Prevention National Association for Festive Venues , ENIPSE , Paris , France
| | - Sébastien Cambau
- d Health Prevention National Association for Festive Venues , ENIPSE , Paris , France
| | - Florence Brunel
- e Infectious Diseases Unit , University Hospital of Edouard Herriot , Lyon , France
| | - Marie Chollier
- a Assistance Publique - Hôpitaux de Marseille , University Hospital Center , Marseille , France.,c University Interdisciplinary Association of Sexology, AIUS , Marseille , France.,f Interdisciplinary Studies , Manchester Metropolitan University , Manchester , UK
| | - Karine Baumstarck
- a Assistance Publique - Hôpitaux de Marseille , University Hospital Center , Marseille , France.,b Center for Studies and Research on Health Services and Quality of Life EA3279 , Aix-Marseille University , Marseille , France
| | - Pascal Auquier
- a Assistance Publique - Hôpitaux de Marseille , University Hospital Center , Marseille , France.,b Center for Studies and Research on Health Services and Quality of Life EA3279 , Aix-Marseille University , Marseille , France
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Abrams JA, Maxwell ML, Belgrave FZ. Circumstances Beyond Their Control: Black Women's Perceptions of Black Manhood. SEX ROLES 2018; 79:151-162. [PMID: 30034083 DOI: 10.1007/s11199-017-0870-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Insufficient empirical attention has been paid to Black women's perceptions of Black male gender roles and associated masculinity. Although constructions of Black masculinity have been speculated about in popular media and literature, no known published studies have specifically investigated Black women's perceptions of Black men or offered a conceptualization of Black masculinity informed by their voices. Because women's perceptions of and beliefs about men affect partnership decisions, quality of relationships, childrearing decisions, health behaviors, and other aspects of personal and psychosocial well-being, the purpose of the present exploratory qualitative study was to fill the noted gap in the literature while highlighting context related to these beliefs. Participants in eight focus groups were 44 Black women, ranging in age from 18 to 91, from the Mid-Atlantic region of the United States. Transcribed focus group data were coded via a qualitative data analysis software program. Thematic analysis of data revealed three main themes: (a) Strong Armed and Strong Minded, (b2) Challenges with Familial and Personal Connections, and (c) Circumstances Beyond Their Control: Impact of the Black Experience. Implications for research and practice related to Black marriage, family, and parenting relationships are discussed.
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Affiliation(s)
- Jasmine A Abrams
- University of Maryland, Baltimore County, Department of Psychology, 1000 Hilltop Road, Baltimore, MD 21250
| | - Morgan L Maxwell
- Virginia Commonwealth University, School of Medicine, Department of Health Behavior and Policy, 830 East Main Street, Richmond, VA 23219, iCubed: Institute Inclusion, Inquiry, and Innovation
| | - Faye Z Belgrave
- Virginia Commonwealth University, Psychology Department, Box 842018, Richmond, Virginia 23284-2018
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Jacques-Aviñó C, García de Olalla P, González Antelo A, Fernández Quevedo M, Romaní O, Caylà JA. The theory of masculinity in studies on HIV. A systematic review. Glob Public Health 2018; 14:601-620. [PMID: 29972098 DOI: 10.1080/17441692.2018.1493133] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study aimed to describe the methodological characteristics of publications on HIV and masculinity, to identify possible information gaps and determine the main thematic areas. A systematic review was conducted of gender, masculinity, HIV infection and other sexually-transmitted infections in original articles published between 1992 and 2015. Original studies published from Pubmed and Scopus were included. A total of 303 articles were identified, of which 187 were selected. Most of the studies were qualitative and the most widely used technique was the interview. Twenty-nine-point five percent of studies were performed in South Africa, 20.8% in the USA, and 3.2% in Europe. Fifteen percent of the studies were performed in heterosexuals, 12.8% in men who have sex with men, and 60% did not specify the sexual orientation of the population. Eight thematic areas were defined, the most frequent being sexuality and risk behaviours, defined by men's need to demonstrate they were sexually active and a breadwinner. Most studies on HIV and masculinity show a gender bias by not specifying the sexual identity of the population. Studies should consider diversity in sexual and cultural identity in different contexts, including in Europe, to carry out more effective HIV interventions from a masculinity perspective.
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Affiliation(s)
- Constanza Jacques-Aviñó
- a Servicio de Epidemiología , Agència de Salud Pública de Barcelona , Barcelona , Spain.,b Universitat Rovira i Virgili (URV) , Tarragona , Spain
| | - Patricia García de Olalla
- a Servicio de Epidemiología , Agència de Salud Pública de Barcelona , Barcelona , Spain.,c Epidemiología y Salud Pública , CIBER , Spain
| | - Alicia González Antelo
- d Servicio Medicina Preventiva y Epidemiología , Hospital Vall d'Hebrón , Barcelona , Spain
| | | | - Oriol Romaní
- c Epidemiología y Salud Pública , CIBER , Spain.,e Medical Anthropology Research Center (MARC- URV) , Tarragona , Spain
| | - Joan A Caylà
- a Servicio de Epidemiología , Agència de Salud Pública de Barcelona , Barcelona , Spain.,c Epidemiología y Salud Pública , CIBER , Spain
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Re-entry experiences of Black men living with HIV/AIDS after release from prison: Intersectionality and implications for care. Soc Sci Med 2018; 211:78-86. [PMID: 29913303 DOI: 10.1016/j.socscimed.2018.06.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 05/28/2018] [Accepted: 06/08/2018] [Indexed: 01/06/2023]
Abstract
RATIONALE Both the HIV epidemic and incarceration disproportionately affect Black men in the United States. A critical period for incarcerated Black men living with HIV/AIDS is re-entry into the community, which is often associated with adverse health outcomes. Additionally, Black men living with HIV/AIDS involved in the criminal justice system are burdened by multiple, intersecting disadvantaged identities and social positions. OBJECTIVE This study aimed to examine community re-entry experiences among Black men living with HIV/AIDS from an intersectional perspective. METHOD In-depth, semi-structured interviews were conducted with 16 incarcerated Black men in Wisconsin, at pre-release from prison and six months after re-entry. Thematic analysis guided by intersectionality theory was used to analyze interview transcripts. RESULTS Seven emerged themes included Intersectional Identities and Social Positions, Family Support, Neighborhood Violence, Relationship with Law Enforcement, Employment, Mental Health Concerns, and Medical Care and Medication Management. Intersecting identities and social positions interact with factors at multiple levels to inform health and HIV care. A conceptual framework was developed to illustrate relationships among themes. CONCLUSIONS Findings demonstrate the relevance of intersectionality theory in HIV care with Black men involved in criminal justice system. Incorporating a social-ecological perspective into intersectionality framework could be useful in theoretical and empirical research. Disenfranchised communities may particularly benefit from interventions that address community- and systemic-level issues.
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Randolph S, Coakley T, Shears J. Recruiting and engaging African-American men in health research. Nurse Res 2018; 26:8-12. [PMID: 29738190 DOI: 10.7748/nr.2018.e1569] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND Improving the health of black and minority ethnic (BME) men in the US continues to be a public health priority. Compared with men of other races and ethnicities, African-American men have higher rates of mortality and morbidity from chronic illness and diseases including cancer, heart disease, prostate cancer, diabetes and HIV/AIDS. One way to address these disparities is to include African-American men in health research, to elicit their perspectives on health risks and protective factors. These can then inform interventions aimed at reducing health disparities. However, challenges remain in recruiting and engaging African-American men in health research. AIM To provide strategies for recruiting African-American men in health research, using as an exemplar a qualitative study of fathers' perspectives of sexual health promotion with young African-American males. DISCUSSION Efforts are needed to increase the representation of African-American men in health research. Ensuring that researchers are aware of the cultural, social and environmental factors related to decisions to participate in research can lead to effective methods to recruit and engage them. CONCLUSION There are several essential strategies for increasing African-American men's participation in health research: ensuring the research team is culturally and gender-sensitive; recruiting in trusted environments; using respected gatekeepers; developing trust with participants; and being transparent. IMPLICATIONS FOR PRACTICE Implementing strategies to include African-American men in health research has the potential to improve health disparities in the US.
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Affiliation(s)
- Schenita Randolph
- Duke University School of Nursing, Durham, North Carolina, United States
| | - Tanya Coakley
- University of North Carolina at Greensboro, North Carolina, United States
| | - Jeffrey Shears
- North Carolina A&T State University/University of North Carolina at Greensboro, North Carolina, United States
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Kenyon CR, Wolfs K, Osbak K, van Lankveld J, Van Hal G. Implicit attitudes to sexual partner concurrency vary by sexual orientation but not by gender-A cross sectional study of Belgian students. PLoS One 2018; 13:e0196821. [PMID: 29738541 PMCID: PMC5940213 DOI: 10.1371/journal.pone.0196821] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 04/21/2018] [Indexed: 12/05/2022] Open
Abstract
High rates of sexual partner concurrency have been shown to facilitate the spread of various sexually transmitted infections. Assessments of explicit attitudes to concurrency have however found little difference between populations. Implicit attitudes to concurrency may vary between populations and play a role in generating differences in the prevalence of concurrency. We developed a concurrency implicit associations test (C-IAT) to assess if implicit attitudes towards concurrency may vary between individuals and populations and what the correlates of these variations are. A sample of 869 Belgian students (mean age 23, SD 5.1) completed an online version of the C-IAT together with a questionnaire concerning sexual behavior and explicit attitudes to concurrency. The study participants C-IATs demonstrated a strong preference for monogamy (-0.78, SD = 0.41). 93.2% of participants had a pro-monogamy C-IAT. There was no difference in this implicit preference for monogamy between heterosexual men and women. Men who have sex with men and women who have sex with women were more likely to exhibit implicit but not explicit preferences for concurrency compared to heterosexual men and women. Correlates of the C-IAT varied between men and women.
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Affiliation(s)
- Chris R. Kenyon
- HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium
- Division of Infectious Diseases and HIV Medicine, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - Kenny Wolfs
- Faculty of Psychology, Open University of the Netherlands, Heerlen, The Netherlands
| | - Kara Osbak
- HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jacques van Lankveld
- Faculty of Psychology, Open University of the Netherlands, Heerlen, The Netherlands
| | - Guido Van Hal
- University of Antwerp, Medical Sociology and Health Policy, Antwerp, Belgium
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Willie TC, Khondkaryan E, Callands T, Kershaw T. "Think Like a Man": How Sexual Cultural Scripting and Masculinity Influence Changes in Men's Use of Intimate Partner Violence. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2018; 61:240-250. [PMID: 29377159 PMCID: PMC5837937 DOI: 10.1002/ajcp.12224] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The purpose of the study was to (a) explore the relationship between sexual cultural scripting and traditional masculine norms on changes in intimate partner violence (IPV) perpetration, and (b) examine traditional masculine norms as an effect modifier among young heterosexual men. This study is a secondary data analysis of a prospective cohort study of 119 young heterosexual men who were followed for 6 months. The adjusted logistic regression results revealed that sexual cultural scripting norms were associated with an increased odds of emotional IPV perpetration and traditional masculine norms were associated with an increased odds of physical IPV perpetration in the past 6 months. There were no significant interaction effects between sexual cultural scripting and traditional masculine norms on IPV perpetration. These findings suggest that socially constructed norms and beliefs surrounding masculinity, femininity, and how women and men interact in sexual relationships are important constructs for understanding the etiology of young men's use of violence against a female partner. While primary IPV interventions targeting young men do address masculinity, sexual cultural scripting is an additional concept that should also be addressed.
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Affiliation(s)
- Tiara C Willie
- School of Public Health, Yale University, New Haven, CT, USA
- Yale Center for Interdisciplinary Research on AIDS, New Haven, CT, USA
| | | | - Tamora Callands
- Department of Health Promotion and Behavior, University of Georgia, Athens, GA, USA
| | - Trace Kershaw
- School of Public Health, Yale University, New Haven, CT, USA
- Yale Center for Interdisciplinary Research on AIDS, New Haven, CT, USA
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Downing MJ, Brown D, Steen J, Benoit E. Understanding the Impact of Childhood Sexual Abuse on Men's Risk Behavior: Protocol for a Mixed-Methods Study. JMIR Res Protoc 2018; 7:e62. [PMID: 29483063 PMCID: PMC5847822 DOI: 10.2196/resprot.9071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 12/19/2017] [Accepted: 12/19/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Childhood sexual abuse (CSA) remains a critical public health issue among black and Latino men who have sex with men (MSM), as it is associated with multiple negative outcomes including substance misuse, poor mental health, revictimization, and high-risk sexual behavior. Most CSA research with MSM relies on quantitative assessment that often precludes consideration of cultural variations in how formative sexual experiences are understood and is based on inconsistent or overly restrictive definitions of abuse, and therefore may fail to detect certain abusive experiences (eg, those involving female perpetrators), which can have harmful health consequences if they remain unrecognized. OBJECTIVE The objective of this study is to overcome existing limitations in the literature by drawing on perspectives of black and Latino MSM and men who have sex with men and women (MSMW), as well as relevant service providers to better understand the role of, and the need to include, sexual abuse histories (eg, CSA) in treatment and counseling settings, with the long-term goal of improving assessment and health outcomes. METHODS We will conduct mixed-methods interviews, framed by an intersectionality approach, with 80 black and Latino men (40 MSM and 40 MSMW) in New York City (NYC), exploring appraisals of their formative sexual experiences, including those described as consensual but meeting criteria for CSA. We will also interview 30 local service providers representing substance abuse treatment, mental health care, and HIV prevention and outreach. RESULTS The study was launched in May 2017. CONCLUSIONS This formative research will inform testable approaches to assessing and incorporating sexual abuse history into substance abuse treatment and other health and mental health services used by men with such histories.
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Affiliation(s)
| | - Dominique Brown
- National Development and Research Institutes, Inc, New York, NY, United States
| | - Jeffrey Steen
- School of Social Work, Bridgewater State University, Bridgewater, MA, United States
| | - Ellen Benoit
- National Development and Research Institutes, Inc, New York, NY, United States
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Fleming PJ, Barrington C, Powell W, Gottert A, Lerebours L, Donastorg Y, Brito MO. The Association Between Men's Concern About Demonstrating Masculine Characteristics and Their Sexual Risk Behaviors: Findings from the Dominican Republic. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:507-515. [PMID: 27844313 PMCID: PMC5429985 DOI: 10.1007/s10508-016-0880-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 10/08/2016] [Accepted: 10/12/2016] [Indexed: 06/06/2023]
Abstract
Quantitative analyses exploring the relationship between masculinities and men's sexual risk behaviors have most commonly used one dimension of masculinities: men's gender ideology. Examining other dimensions may enhance our understanding of and ability to intervene upon this relationship. In this article, we examined the association between gender role conflict/stress (GRC/S)-men's concern about demonstrating masculine characteristics-and three different sexual risk behaviors (having two or more sex partners in the last 30 days; never/inconsistent condom use with non-steady partners; and drinking alcohol at last sex) among a sample of heterosexual men in the Dominican Republic who were participating in an HIV prevention intervention (n = 293). The GRC/S Scale we used was adapted for this specific cultural context and has 17 items (α = 0.75). We used logistic regression to assess the relationship between GRC/S and each sexual behavior, controlling for sociodemographic characteristics. In adjusted models, a higher GRC/S score was significantly associated with increased odds of having two or more sex partners in the past 30 days (AOR 1.33, 95 % CI 1.01-1.74), never/inconsistent condom use with non-steady partners (AOR 1.45, 95 % CI 1.04-2.01), and drinking alcohol at last sex (AOR 1.56, 95 % CI 1.13-2.17). These results highlight the importance of expanding beyond gender ideology to understanding the influence of GRC/S on men's sexual risk behaviors. Interventions should address men's concern about demonstrating masculine characteristics to reduce the social and internalized pressure men feel to engage in sexual risk behaviors.
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Affiliation(s)
- Paul J Fleming
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA.
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Wizdom Powell
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | | | | | - Yeycy Donastorg
- HIV Vaccine Trials Unit, Instituto Dermatológico y Cirugía de Piel, Santo Domingo, Dominican Republic
| | - Maximo O Brito
- Division of Infectious Diseases, University of Illinois at Chicago, Chicago, IL, USA
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Calabrese SK, Earnshaw VA, Magnus M, Hansen NB, Krakower DS, Underhill K, Mayer KH, Kershaw TS, Betancourt JR, Dovidio JF. Sexual Stereotypes Ascribed to Black Men Who Have Sex with Men: An Intersectional Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:143-156. [PMID: 28224313 PMCID: PMC5565715 DOI: 10.1007/s10508-016-0911-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 10/11/2016] [Accepted: 11/25/2016] [Indexed: 05/15/2023]
Abstract
Sexual stereotypes may adversely affect the health of Black men who have sex with men (MSM). Greater understanding of the nature and nuances of these stereotypes is needed. This online, survey-based study used an inductive, intersectional approach to characterize the sexual stereotypes ascribed to Black MSM by the U.S. general public, their distinctiveness from those ascribed to Black men and MSM in general, and their relative prototypicality as compared to dominant subgroups. Members of the public, recruited in 2014-2015, were randomly assigned to survey conditions that varied systematically by race (Black, White, or unspecified) and sexual orientation (gay, heterosexual, or unspecified) of a designated social group. Participants (n = 285) reported stereotypes of their assigned group that they perceived to exist in U.S. culture in an open-response format. Cross-condition comparisons revealed that, overall, Black gay male stereotypes were non-prototypical of Black men or gay men. Rather, stereotypes of Black men were more similar to Black heterosexual men and stereotypes of gay men were more similar to White gay men. Nonetheless, 11 of the 15 most frequently reported Black gay male stereotypes overlapped with stereotypes of Black men (e.g., large penis), gay men (e.g., deviant), or both (e.g., promiscuous). Four stereotypes were unique relative to both Black men and gay men: down low, diseased, loud, and dirty. Findings suggest that Black MSM face multiple derogatory sexual stereotypes, several of which are group-specific. These stereotypes are consistent with cultural (mis)representations of Black MSM and suggest a need for more accurate portrayals of existing sexual diversity within this group.
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Affiliation(s)
- Sarah K Calabrese
- Department of Psychology, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA.
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA.
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA.
| | - Valerie A Earnshaw
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Department of Human Development and Family Studies, University of Delaware, Newark, DE, USA
| | - Manya Magnus
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Nathan B Hansen
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA, USA
| | - Douglas S Krakower
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Kristen Underhill
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Columbia Law School, New York, NY, USA
| | - Kenneth H Mayer
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Trace S Kershaw
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
| | - Joseph R Betancourt
- Disparities Solutions Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John F Dovidio
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
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Dogan J, Hargons C, Meiller C, Oluokun J, Montique C, Malone N. Catchin' Feelings: Experiences of Intimacy During Black College Students' Sexual Encounters. ACTA ACUST UNITED AC 2018; 5:81-107. [PMID: 32258245 DOI: 10.1353/bsr.2018.0021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Research regarding intimacy within Black relationships is often deficiency-focused, reinforcing negative stereotypes about Black people's capacity to relate in sexual and romantic relationships. Utilizing social exchange theory and social learning theory as a combined framework, we examined intimacy-related narratives of 18 Black college students during their first and last sexual encounters. A thematic analysis constructed five themes: (a) limited knowledge of intimacy, (b) internal barriers to non-sexual intimacy, (c) external barriers to non-sexual intimacy, (d) seeking an emotional connection, and (e) experiencing intimacy. Findings suggest varying perspectives and experiences related to intimacy. Intimacy barriers and facilitators are discussed.
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Fields JC, King KM, Alexander KA, Smith KC, Sherman SG, Knowlton A. Recently released Black men's perceptions of the impact of incarceration on sexual partnering. CULTURE, HEALTH & SEXUALITY 2018; 20:55-68. [PMID: 28532296 DOI: 10.1080/13691058.2017.1325009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Evidence suggests that men with recent histories of incarceration are more likely to engage in high-risk sexual activity, however there is limited research exploring how having been recently released from prison might impact men's sexual risk behaviours or sexual partnering. This qualitative study explores the ways in which exposure to incarceration impacts the dynamics of sexual partnering among recently released Black men in Baltimore, USA. In-depth interviews were conducted with 19 recently released Black men between 21-45 years of age living in the city. Data were analysed using a combination of inductive and deductive approaches. Participants reported that women living in the neighbourhoods to which they returned found recently released men to be highly desirable sexual partners because they offered increased potential for sexual gratification, were perceived as healthier than other sexual partners in their communities and represented opportunities for attaining financial stability and the potential for establishing romantic partnerships. As a result, men reported they had more opportunities for sex and more power to negotiate sex with women. Recently released Black men's perceptions of their own sexual desirability among women raise important implications regarding power in the sexual relationships of recently released men that may increase HIV- and sexually transmitted infection-related risk for recently released men and their sexual partners.
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Affiliation(s)
- Julie C Fields
- a Department of Health, Behaviour and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , USA
| | - Kelly M King
- b Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , USA
| | - Kamila A Alexander
- c School of Nursing , Johns Hopkins Bloomberg School of Public Health , Baltimore , USA
| | - Katherine C Smith
- a Department of Health, Behaviour and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , USA
| | - Susan G Sherman
- a Department of Health, Behaviour and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , USA
| | - Amy Knowlton
- a Department of Health, Behaviour and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , USA
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