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Zhang ZM, Smith-Johnson M, Gorman BK. Who Cares? Unpaid Caregiving by Sexual Identity, Gender, and Partnership Status Among U.S. Adults. Demography 2024; 61:115-140. [PMID: 38206071 DOI: 10.1215/00703370-11145841] [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] [Indexed: 01/12/2024]
Abstract
Recent scholarship indicates that sexual minority adults have higher caregiving rates than heterosexuals and that women are more likely to be caregivers than men. However, little research has addressed how gender and sexuality intersect in shaping caregiving status. This study uses data from the Behavioral Risk Factor Surveillance System and aggregates a probability-based sample of adults living in 36 U.S. states between 2015 and 2021. We examine who provides care among adult heterosexual, lesbian, gay, and bisexual men and women. Results reveal that women are more likely to be caregivers than men, but only among heterosexuals. We find little variation in caregiving by sexuality among women, but bisexual men are more likely than heterosexual men to be caregivers; the latter result appears to be driven by unpartnered, bisexual men. Lastly, we contextualize caregivers' experiences and reveal selected descriptive differences in patterns of care recipient-caregiver relationships across gender and sexual identity groups. Our findings advance understanding of caregiving and changing family ties in an era of population aging and increasing diversity in sexual identities.
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Affiliation(s)
- Zhe Meredith Zhang
- Department of Sociology, California State University, Los Angeles, CA, USA
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2
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Chan RCH, Leung JSY. Monosexism as an Additional Dimension of Minority Stress Affecting Mental Health among Bisexual and Pansexual Individuals in Hong Kong: The Role of Gender and Sexual Identity Integration. JOURNAL OF SEX RESEARCH 2023; 60:704-717. [PMID: 36121683 DOI: 10.1080/00224499.2022.2119546] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Monosexism has been increasingly recognized as a minority stressor uniquely experienced by plurisexual individuals. The present study investigated the effects of monosexist discrimination on mental health and examined the moderating role of gender and sexual identity integration (i.e., negation, authenticity, and disclosure). In a sample of 314 bisexual and pansexual individuals in Hong Kong (73.9% women and 26.1% men), the results showed that monosexist discrimination was associated with higher levels of depression and anxiety symptoms, above and beyond heterosexist discrimination. The association between monosexist discrimination and depression symptoms was stronger among bisexual and pansexual men than women, despite there being no gender differences in vulnerability to monosexist discrimination. Moreover, sexual identity negation, authenticity, and disclosure moderated the associations of monosexist discrimination with depression and anxiety symptoms, such that the associations were not significant among those with more positive integration of sexual identity (i.e., lower levels of sexual identity negation as well as higher levels of sexual identity authenticity and disclosure). This study provides insight into the deleterious impact of monosexism and the protective role of sexual identity integration. Implications for plurisexual-affirming psychological intervention, public policy, and community practice are discussed.
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Affiliation(s)
- Randolph C H Chan
- Department of Special Education and Counselling, The Education University of Hong Kong
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3
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Krueger EA, Upchurch DM. Sexual orientation, social support, and mental health resilience in a U.S. national sample of adults. Behav Med 2022; 48:207-215. [PMID: 33052771 DOI: 10.1080/08964289.2020.1825922] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Sexual minority mental health disparities can be attributed, in large part, to chronic exposure to stress. There is growing interest in understanding the factors associated with psychological resilience, or the ability to positively cope with life's stressors. Using nationally representative data (2012-2013; N = 14,470), this study compared differences in resilience status (operationalized empirically using SF-12 mental health score among respondents reporting 2+ past-year stressful life events; respondents were categorized as "flourishing," "average," or "languishing") by sexual orientation and assessed whether social support mediated sexual minority disparities in resilience. Comparisons were made across four sexual orientation groups: heterosexuals and three sexual minority subgroups (lesbians/gay men, bisexual, heterosexual-identified sexual minorities [HSM]). Generally, heterosexual respondents were more likely to be flourishing, less likely to be languishing, and reported more social support, compared to sexual minority respondents. In multivariable analysis, bisexual women, HSM women, and gay men had lower odds of resilience than heterosexual women and men, respectively. In mediation models, lower social support was associated with reduced resilience for all sexual minority subgroups except lesbian/gay women. This study demonstrated that sexual orientation is an important determinant of resilience, and further, that social support contributes to sexual minority peoples' abilities to flourish when faced with stress.
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Affiliation(s)
- Evan A Krueger
- Department of Preventive Medicine, USC Keck School of Medicine
| | - Dawn M Upchurch
- Department of Community Health Sciences, UCLA Fielding School of Public Health
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4
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Chan C, Bavinton BR, Prestage GE, Broady TR, Mao L, Rule J, Wilcock B, Holt M. Changing Levels of Social Engagement with Gay Men Is Associated with HIV Related Outcomes and Behaviors: Trends in Australian Behavioral Surveillance 1998-2020. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2509-2521. [PMID: 35672592 PMCID: PMC9293873 DOI: 10.1007/s10508-022-02310-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 05/30/2023]
Abstract
Changes to how gay, bisexual, and other men who have sex with men (GBM) connect with each other and with their communities have implications for HIV prevention. Social engagement with gay men (defined as having friends who are gay men and spending time with them) has been associated with HIV related outcomes over time among Australian GBM. Using data collected in national, repeated, cross-sectional surveys of GBM between 1998 and 2020 (N = 161,117), analyses of trends in the prevalence of gay social engagement (GSE) in Australia were conducted using linear regression. To assess changing associations with GSE at different time points in the HIV epidemic, three cross-sectional analyses were conducted on factors associated with high and low GSE in 1999/2000, 2009/2010, and 2019/2020 using bivariate and multivariable logistic regression. GSE (scored from 0 to 7) declined among all participants from 4.76 in 1998 to 4.04 in 2020 (p < 0.001) with a steeper decline among GBM aged under 25 years from 4.63 in 1998 to 3.40 in 2020 (p < 0.001). In all timepoints, high GSE was associated with older age, being university educated, full time employment, identifying as gay, recent HIV testing, and PrEP uptake. While mostly associated with protective behaviors, high GSE was also associated with some practices that may put GBM at risk of HIV infection such as drug-enhanced sex and group sex in the most recent timepoint. Changing levels of GSE have implications for health promotion among GBM, particularly how to engage GBM less connected to gay social networks.
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Affiliation(s)
- Curtis Chan
- Kirby Institute, UNSW Sydney, Level 6 Wallace Wurth Building High Street, Kensington, Sydney, NSW, 2052, Australia.
| | - Benjamin R Bavinton
- Kirby Institute, UNSW Sydney, Level 6 Wallace Wurth Building High Street, Kensington, Sydney, NSW, 2052, Australia
| | - Garrett E Prestage
- Kirby Institute, UNSW Sydney, Level 6 Wallace Wurth Building High Street, Kensington, Sydney, NSW, 2052, Australia
| | - Timothy R Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - John Rule
- National Association of People with HIV Australia, Sydney, Australia
| | - Ben Wilcock
- Australia Federation of AIDS Organisations, Sydney, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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5
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Iott BE, Loveluck J, Benton A, Golson L, Kahle E, Lam J, Bauermeister JA, Veinot TC. The impact of stigma on HIV testing decisions for gay, bisexual, queer and other men who have sex with men: a qualitative study. BMC Public Health 2022; 22:471. [PMID: 35264132 PMCID: PMC8908600 DOI: 10.1186/s12889-022-12761-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 02/11/2022] [Indexed: 11/20/2022] Open
Abstract
Background Stigmatization may prompt gay, bisexual, queer and other men who have sex with men (GBQMSM) to avoid or delay HIV testing. There has been little attention to GBQMSMs’ perspectives about how stigma may influence their decisions about whether, where, and how often to get tested for HIV. Methods We conducted nine focus groups with 64 adult GBQMSM in Metropolitan Detroit, including HIV-negative men and people living with HIV (PLWH). Data were thematically analyzed deductively and inductively in three rounds. Results Three themes emerged regarding whether to get tested: (1) Perceived promiscuity, risk perceptions and HIV testing; (2) Fearing sexual rejection; and (3) Fearing friend and family member distancing and rejection. Themes concerning where to get tested included: (4) Conflating HIV testing and diagnosis; and (5) Seeking privacy and safety at specialized services. As for how often to get tested, themes included: (6) Reducing contact with healthcare providers due to intersectional stigma; (7) Responsibility and regular testing; and (8) HIV stigma and testing as routine care. Black participants articulated themes (3), (4), and (6) with greater frequency than other participants. Framing HIV testing as a personal responsibility may have created a “new stigma,” with unintended consequences not observed with “routine healthcare” messaging. Conclusions GBQMSMs’ perspectives indicate the potential for new foci for HIV testing promotion interventions based on stigma-related issues that they deem important. There is a need for interventions to challenge the “promiscuity” stereotype, and to reduce the sexual stigmatization of GBQMSM living with HIV/AIDS—especially online. Provider stigma requires both intervention and continued availability of specialized services. Future stigma-reduction interventions for Black GBQMSM could focus on building family support/acceptance, awareness of multiple testing options, and integrating LGBTQ-related issues into initiatives for racial justice in health care. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12761-5.
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Affiliation(s)
- Bradley E Iott
- School of Information, University of Michigan, Ann Arbor, MI, USA.,Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Akilah Benton
- Detroit Health Department, City of Detroit, Detroit, MI, USA
| | - Leon Golson
- Unified - HIV Health and Beyond, Ypsilanti, MI, USA
| | - Erin Kahle
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Jason Lam
- School of Information, University of Michigan, Ann Arbor, MI, USA
| | | | - Tiffany C Veinot
- School of Information, University of Michigan, Ann Arbor, MI, USA. .,Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
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6
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Wang AY, Feinstein BA. The perks of being bi+: Positive sexual orientation-related experiences among bisexual, pansexual, and queer male youth. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2022; 9:58-70. [PMID: 35755165 PMCID: PMC9231256 DOI: 10.1037/sgd0000459] [Citation(s) in RCA: 4] [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
Previous research on sexual minority health has largely focused on negative experiences related to one's sexual orientation with limited attention to the ways in which being a sexual minority can contribute to positive experiences. This is especially true of bisexual, pansexual, and queer (bi+) male youth, whose experiences have not been represented in the literature. To address these gaps, the goal of the current study was to characterize positive experiences related to one's sexual orientation in a sample of 46 bi+ male youth (ages 14-17) who were interviewed as part of a larger study. Interviews were transcribed and thematically analyzed. Almost all of the participants described at least one positive experience related to their bi+ identity. The positive experiences fell into six categories: (1) experiences with LGBTQ+ people in general; (2) experiences with other bi+ people; (3) experiences in LGBTQ+ environments; (4) experiences disclosing bi+ identities; (5) romantic and sexual experiences; and (6) experiences with allies. Participants described eight reasons for these experiences being positive: (1) feeling a sense of belonging in a community; (2) the normalization, acceptance, and visibility of one's identity or community; (3) providing or receiving support; (4) discussing shared experiences; (5) the promotion of authenticity; (6) celebrating one's identity or community; (7) experiencing personal growth; and (8) not feeling limited by gender when it came to romantic and sexual experiences. In sum, bi+ male youth report a range of positive experiences related to their sexual orientation, which may have important implications for promoting resilience and wellbeing.
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Affiliation(s)
| | - Brian A. Feinstein
- Depatment of Psychology, Rosalind Franklin University of Medicine and Science
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7
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Kittle KR, Boerner K, Kim K, Fredriksen-Goldsen KI. Social Resource Variations Among LGBT Middle-Aged and Older Adults: The Intersections of Sociodemographic Characteristics. THE GERONTOLOGIST 2022; 62:1324-1335. [PMID: 35106592 PMCID: PMC9579464 DOI: 10.1093/geront/gnac021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Understanding the influence of social resources on health is crucial in gerontological research. However, access to social resources may differ by one's particular lesbian, gay, bisexual, and transgender (LGBT) identity and the intersection of LGBT identity with other sociodemographic characteristics, including age. RESEARCH DESIGN AND METHODS Using 2010 data from Caring and Aging With Pride (N = 2,536), this study examined how access to social resources varied by LGBT identity and whether the effect of LGBT identity was modified by additional sociodemographic characteristics among LGBT adults aged 50-95 years. RESULTS Lesbian respondents had larger social networks than gay male respondents, and gay male respondents had smaller networks than transgender respondents. Lesbian respondents reported more social support and community belonging than other identity groups. Bisexual male respondents and transgender respondents had less support than gay male respondents, and bisexual male respondents reported less community belonging than gay male respondents. Age and education moderated the association between LGBT identity and social support. DISCUSSION AND IMPLICATIONS This study demonstrated differences in access to social resources according to environmental circumstances that can intersect and govern access to social resources. Findings highlight the importance of considering social support separately from social network size; thus, large social networks do not necessarily provide ample social support. LGBT older adults had different perceptions of social support than their middle-aged counterparts. Health and human service professionals should not only consider the sexual and gender identity of their LGBT clients, but also education and age when assessing access to social resources.
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Affiliation(s)
- Krystal R Kittle
- Address correspondence to: Krystal R. Kittle, PhD, Department of Environmental and Occupational Health, Social & Behavioral Health Program, School of Public Health, University of Nevada, Las Vegas, 4700 S. Maryland Parkway, Suite #335, Las Vegas, NV 89119, USA. E-mail:
| | - Kathrin Boerner
- Department of Gerontology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Kyungmin Kim
- Department of Child Development and Family Studies, Research Institute of Human Ecology, Seoul National University, Seoul, Republic of Korea
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8
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Woulfe JM, Mereish EH, Katz-Wise SL. Social Support as a Mediator of Anti-Bisexual Prejudice and Posttraumatic Stress Disorder Symptoms. J Trauma Dissociation 2022; 23:124-139. [PMID: 34727837 PMCID: PMC9802679 DOI: 10.1080/15299732.2021.1989107] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Among sexual minorities, bisexual individuals experience higher rates of victimization and symptoms of PTSD than their lesbian and gay peers as well as heterosexual individuals. Despite these disparities, little work has examined factors contributing to PTSD symptoms among bisexual adults. The current study examined the associations between bisexual-specific minority stress and PTSD symptoms in a sample of adults with bisexual orientation and tested social support as a potential mediator of this association. Participants were 488 adults (378 cisgender women, 49 cisgender men, 61 transgender individuals), ages 18 to 66 years, with bisexual orientation based on identity and/or attraction to multiple genders. Greater anti-bisexual prejudice was associated with greater PTSD symptoms (β = 0.16) and lower social support (β = -.16), while accounting for sociodemographics and sexual identity-based victimization. Social support was associated with lower PTSD symptoms (β = -.25), while accounting for sociodemographics, sexual identity-based victimization, and anti-bisexual prejudice. Mediation analyses indicated that anti-bisexual prejudice was indirectly associated with greater PTSD symptoms through lower social support. Addressing bisexual-specific minority stress and its role in diminishing social support for bisexual individuals represents a critical component of trauma-informed research and intervention development in the bisexual community.
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Affiliation(s)
- Julie M Woulfe
- Syracuse University Barnes Center at the Arch, Syracuse, New York, USA
| | - Ethan H Mereish
- Department of Health studies, American University, Washington, DC, USA
| | - Sabra L Katz-Wise
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachussets, USA
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9
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Heiden-Rootes K, Hartwell E, Nedela M. Comparing the Partnering, Minority Stress, and Depression for Bisexual, Lesbian, and Gay Adults from Religious Upbringings. JOURNAL OF HOMOSEXUALITY 2021; 68:2323-2343. [PMID: 32748712 DOI: 10.1080/00918369.2020.1804255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Minority stress impacts the mental health of bi+ individuals (e.g., bisexual, pansexual, queer), similar to gay and lesbian individuals. Bi+ individuals may have difficulty accessing social supports for mitigating minority stress. A religious upbringing may complicate this process. This study sought to compare a survey sample of bi+ individuals (n = 153) and their gay/lesbian (n = 231) peers from religious families on minority stress factors, depression, and partnering. Results highlighted differences between gay/lesbian and bi+ individuals in partnering and LGB community connection with bi+ group reporting more minority stressors. Bi+ individuals in same-gender partnerships reported lower parent rejection and being more out than those who were single or in different-gender partnerships. Family religiosity was associated with family rejection; however, it did not directly predict minority stress factors or depression for bi+ individuals. Implications for future research are discussed in light of the distinctions emerging between gay/lesbian and bi+ adults.
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Affiliation(s)
- Katie Heiden-Rootes
- Department of Family & Community Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Erica Hartwell
- Marriage and Family Therapy, Fairfield University, Fairfield, Connecticut, USA
| | - Mary Nedela
- Marriage and Family Therapy, Virginia Tech, Blacksburg, Virginia, USA
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10
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Roth EA, Cui Z, Armstrong HL, Rich AJ, Lachowsky NJ, Sereda P, Card KG, Bacani N, Moore D, Hogg R. Longitudinal Analysis of HIV Risk and Substance Use Patterns for Men Who Have Sex with Men and Women and Men Who Have Sex with Men Only. JOURNAL OF BISEXUALITY 2021; 21:405-423. [PMID: 35935471 PMCID: PMC9355115 DOI: 10.1080/15299716.2021.1982102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Men Who Have Sex with Men and Women (MSMW) experience discrimination from same-sex and heterosexual communities partially because of perceptions they feature high-risk sexual behavior, elevated polysubstance use levels, and constitute an HIV bridge population. We used a longitudinal multivariate generalized linear mixed model comparing sexual risk and substance use patterns for Men Who Have Sex with Men Only (MSMO) with MSMW in the same cohort study. Data consisted of 771 men reporting 3,705 sexual partnerships from 2012-2017. For high-risk sexual behavior multivariate results showed non-significant (p>0.05) differences for partner number and commercial sex work, and significantly less (p<0.05) HIV prevalence and condomless anal sex. However, MSMW had significantly higher levels of hallucinogen and prescription opioid use, and substance treatment histories. Only one HIV-positive MSMW had a transmittable viral load, negating the concept of an HIV bridge population. Results indicate the need for additional longitudinal studies comparing MSMO and MSMW.
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Affiliation(s)
- Eric Abella Roth
- Department of Anthropology, University of Victoria, Victoria, British Columbia, Canada
| | - Zishan Cui
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Heather L Armstrong
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada, University of Southampton, Southampton, United Kingdom
| | - Ashleigh J Rich
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathan J Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Paul Sereda
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Kiffer G Card
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Nic Bacani
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - David Moore
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Robert Hogg
- Faculty of Health Sciences, Simon Fraser University, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
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11
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Sharma A, Paredes-Vincent A, Kahle EM. Awareness, Utilization, and Preferences for Traditional and Contemporary HIV Prevention Strategies Among Facebook and Instagram-Using MSM in the United States. J Int Assoc Provid AIDS Care 2021; 20:23259582211024770. [PMID: 34132144 PMCID: PMC8212379 DOI: 10.1177/23259582211024770] [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] [Indexed: 12/30/2022] Open
Abstract
HIV prevention research among men who have sex with men (MSM) has traditionally
focused on individual risk reduction strategies. Our study evaluated awareness,
utilization, and preferences for 10 complementary HIV prevention strategies
among 1,286 MSM recruited via Facebook and Instagram from June-August 2018. Ages
ranged from 18-85 years, and the majority were non-Hispanic white (n = 1,019,
79.24%), college-educated (n = 819, 63.69%), gay-identifying (n = 1,074,
83.51%), and partnered (n = 808, 62.83%). Post-exposure prophylaxis was the
least familiar option, and engaging in sexual activities other than anal sex was
the most utilized option. Progressively older and bisexual-identifying MSM were
less likely, but those with higher educational levels and easy access to local
HIV resources were more likely to be aware of and to be utilizing a greater
number of strategies. Additionally, Hispanic MSM were less likely to be aware
of, and those in a “closed” relationship were less likely to be utilizing a
greater number of strategies. In a subset of 775 multiple strategy users,
pre-exposure prophylaxis, regularly testing for HIV, and limiting the number of
sex partners emerged as the most preferred options. Combination intervention
packages for MSM should be tailored to personal circumstances, including sexual
orientation, relationship characteristics and access to local HIV resources.
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Affiliation(s)
- Akshay Sharma
- Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA.,Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Ariana Paredes-Vincent
- Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Erin M Kahle
- Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA.,Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, USA
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12
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Does Sexual Orientation Complicate the Relationship Between Marital Status and Gender With Self-rated Health and Cardiovascular Disease? Demography 2021; 57:599-626. [PMID: 32060742 DOI: 10.1007/s13524-020-00857-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
A substantial body of work has demonstrated the importance of marital status for health, yet the vast majority of this work has studied heterosexual marriages and relationships. To understand the role of marital status in shaping health among heterosexual, lesbian, gay, and bisexual men and women, we examine data from a probability-based sample of adults living in 40 U.S. states for selected years between 2011-2015. We test two physical health outcomes-poor-to-fair self-rated health and cardiovascular disease-and present predicted probabilities and pairwise comparisons from logistic regression models before and after adjustment for demographic characteristics, socioeconomic status, health behaviors, and depression. Overall, findings reveal some important similarities and differences in the relationships between marital status and health by sexual orientation and gender. First, the health benefits of marriage extend to sexual minority adults, relative to adults who are either formerly or never married. Among heterosexual adults, adjusted models also highlight the healthy status of never-married adults. Second, the health benefits associated with intimate relationships appear less dependent on legal marriage among sexual minorities than among heterosexual adults. Third, we document a persistent health disadvantage for bisexual adults compared with heterosexual adults, particularly among women who are formerly married, indicating some elevated health vulnerability among selected sexual minority women. Fourth, associations between sexual orientation and health are more similar across marital status groups for men than women. Altogether, these findings add much needed nuance to our understanding of the association between marital status and health in an era of increasing diversity in adult relationships.
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13
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Brennan-Ing M, Haberlen S, Ware D, Egan JE, Brown AL, Meanley S, Palella FJ, Bolan R, Cook JA, Okafor CN, Friedman MR, Plankey MW. Psychological Connection to the Gay Community and Negative Self-Appraisals in Middle-Aged and Older Men Who Have Sex With Men: The Mediating Effects of Fitness Engagement. J Gerontol B Psychol Sci Soc Sci 2021; 77:39-49. [PMID: 33945614 PMCID: PMC8755915 DOI: 10.1093/geronb/gbab076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES Connections to the gay community may elicit negative self-appraisals among men who have sex with men (MSM), which may be exacerbated for people with HIV (PWH). Fitness engagement may mediate self-appraisals by maintaining or improving appearance and health. We hypothesized that gay community connections would be positively related to negative self-appraisal and explored whether this association would be mediated by fitness engagement and moderated by HIV status. METHOD Data were obtained from the Multicenter AIDS Cohort Healthy Aging study (N = 1,026; PWH n = 525; people without HIV [PWOH] n = 501). Structural equation modeling (SEM) examined associations between gay community connections, negative self-appraisal (body image dissatisfaction, self-perception of aging), and fitness engagement (physical activity, motivation to be fit). Multiple-group SEM tested the moderating effects of HIV serostatus. RESULTS The SEM fit the data well (root mean square error of approximation = 0.056; 90% CI: 0.046, 0.066). Connection to the gay community was inversely related to negative self-appraisals and positively related to fitness engagement. Fitness engagement mediated the association between community connections and negative self-appraisal and was inversely related to negative self-appraisals. Among PWH, the association between community connections and self-appraisal was weaker and the effect of fitness engagement on negative self-appraisal was stronger compared to PWOH. DISCUSSION Connection to the gay community may be a source of resilience for aging MSM by lessening negative self-appraisals and promoting strategies that address body image dissatisfaction and self-perceptions of aging. Interventions facilitating connections to the gay community may support healthy aging in this population.
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Affiliation(s)
- Mark Brennan-Ing
- Brookdale Center for Healthy Aging, Hunter College, The City University of New York, USA,Address correspondence to: Mark Brennan-Ing, PhD, Brookdale Center for Healthy Aging, Hunter College, the City University of New York, 2180 Third Avenue, 8th Floor, New York, NY 10035, USA. E-mail:
| | - Sabina Haberlen
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Deanna Ware
- Department of Medicine, Division of General Internal Medicine, Georgetown University, Washington, DC, USA
| | - James E Egan
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pennsylvania, USA
| | - Andre L Brown
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pennsylvania, USA
| | - Steven Meanley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, USA
| | - Frank J Palella
- Feinberg School of Medicine, Northwestern Medicine, Northwestern University, Chicago, Illinois, USA
| | - Robert Bolan
- Department of Family Medicine, University of Southern California, Los Angeles, USA
| | - Judith A Cook
- Center on Mental Health Services Research and Policy, University of Illinois at Chicago, USA
| | - Chukwuemeka N Okafor
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, USA
| | - M Reuel Friedman
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pennsylvania, USA
| | - Michael W Plankey
- Department of Medicine, Division of General Internal Medicine, Georgetown University, Washington, DC, USA
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Chan RCH, Huang YT. A Minority Stress Response Model of Health Behaviors in Gay and Bisexual Men: Results from a Taiwanese Sample. LGBT Health 2021; 8:209-221. [PMID: 33625267 DOI: 10.1089/lgbt.2020.0194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Health disparities among sexual minority men remain and continue to demand novel interventions. Other than risk reduction, a promising approach is to identify pathways to health-promoting behaviors. In this study, depressive symptoms, internalized homophobia, and sense of community connectedness were hypothesized to result from the experience of harassment and rejection, and in turn either promote or inhibit an individual's tendency toward health-promoting behaviors. We accounted for subgroup differences by examining the hypothesized model in gay and bisexual men separately. Methods: This was a cross-sectional survey study. One thousand three hundred eighty-one gay (81.5%) and bisexual (18.5%) Taiwanese men 18-49 years of age (mean = 26.56, standard deviation = 6) were recruited through a social media advertisement and completed an online survey. Structural equation modeling was employed to simultaneously examine multiple hypothesized paths. Results: Harassment and rejection were associated with greater depressive symptoms, internalized homophobia, and sense of community connectedness, which in turn yielded direct or indirect associations with health-promoting behavior among gay men. For bisexual men, depressive symptoms remained an important mechanism linking harassment and rejection and health-promoting behavior, whereas the roles of internalized homophobia and sense of community connectedness appeared less obvious. Conclusion: These findings cast new light on the behavioral implications of minority stress and elucidate the possible underlying mechanisms. The study suggests that more effort should be invested to understand and promote the drivers of health-promoting behavior to reduce health disparities in this population.
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Affiliation(s)
- Randolph Chun Ho Chan
- Department of Special Education and Counseling, The Education University of Hong Kong, Tai Po, New Territories, Hong Kong
| | - Yu-Te Huang
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong
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15
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Akré ERL, Boekeloo BO, Dyer T, Fenelon AT, Franzini L, Sehgal NJ, Roby DH. Disparities in Health Care Access and Utilization at the Intersections of Urbanicity and Sexual Identity in California. LGBT Health 2021; 8:231-239. [PMID: 33600724 DOI: 10.1089/lgbt.2020.0259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: The aim was to examine differences in health care access at the intersections of urbanicity and sexual identity in California. Methods: We used the 2014-2017 Adult California Health Interview Survey paired with the sexual orientation special use research file to create dummy groups representing each dimension of urbanicity and sexual identity to compare access to health care outcomes. We calculated unadjusted proportions and estimated adjusted odds ratios of each dimension relative to urban heterosexual people using logistic regressions. Results: Relative to urban heterosexual people, urban gay/lesbian people had 1.651 odds of using the emergency room (ER). Urban bisexual people had 1.429 odds of being uninsured, 1.575 odds of delaying prescriptions, and 1.907 odds of using the ER. Rural bisexual people experienced similar access barriers having 1.904 odds of uninsurance and 2.571 odds of using the ER. Conclusions: Our study findings demonstrated disparate access to health care across sexual orientation and rurality. The findings are consistent with literature that suggests urban and rural sexual minority people experience health care differently and demonstrate that bisexual people experience health care differently than gay/lesbian people. These findings warrant further study to examine how social identities, such as race/ethnicity, interact with sexual orientation to determine health care access. Furthermore, these findings demonstrate the need to emphasize the health care access needs of sexual minority people in both rural and urban areas to eliminate health care access disparities.
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Affiliation(s)
- Ellesse-Roselee L Akré
- Department of Health Policy and Management, School of Public Health, University of Maryland-College Park, College Park, Maryland, USA
| | - Bradley O Boekeloo
- University of Maryland Prevention Research Center, School of Public Health, University of Maryland-College Park, College Park, Maryland, USA
| | - Typhanye Dyer
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland-College Park, College Park, Maryland, USA
| | - Andrew T Fenelon
- Department of Sociology and Criminology, College of the Liberal Arts, Penn State University, University Park, Pennsylvania, USA
| | - Luisa Franzini
- Department of Health Policy and Management, School of Public Health, University of Maryland-College Park, College Park, Maryland, USA
| | - Neil J Sehgal
- Department of Health Policy and Management, School of Public Health, University of Maryland-College Park, College Park, Maryland, USA
| | - Dylan H Roby
- Department of Health Policy and Management, School of Public Health, University of Maryland-College Park, College Park, Maryland, USA
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16
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Tran A, Kaplan JA, Austin SB, Davison K, Lopez G, Agénor M. “It’s all outward appearance-based attractions”: A qualitative study of body image among a sample of young gay and bisexual men. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2020. [DOI: 10.1080/19359705.2019.1706683] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Alvin Tran
- Department of Health Administration and Policy, University of New Haven, West Haven, Connecticut, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Justin A. Kaplan
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - S. Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Kirsten Davison
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Gilberto Lopez
- Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Madina Agénor
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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17
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Feinstein BA, Dodge B. Meeting the Sexual Health Needs of Bisexual Men in the Age of Biomedical HIV Prevention: Gaps and Priorities. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:217-232. [PMID: 31691076 DOI: 10.1007/s10508-019-1428-3)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 05/09/2019] [Accepted: 05/14/2019] [Indexed: 05/24/2023]
Abstract
The field of HIV/STI prevention has primarily focused on gay men (or "men who have sex with men" [MSM] as a broad category) with limited attention to bisexual men in particular. Although bisexual men are also at increased risk for HIV and other STI, they are less likely to utilize HIV/STI prevention services than gay men, and very few interventions have been developed to address their unique needs. Further, while biomedical advances are changing the field of HIV prevention, bisexual men are also less likely to use biomedical HIV prevention strategies (e.g., pre-exposure prophylaxis [PrEP]) than gay men. In an effort to advance research on bisexual men and their sexual health needs, the goals of this commentary are: (1) to review the empirical literature on the prevalence of HIV/STI among bisexual men, the few existing HIV/STI prevention interventions developed for bisexual men, and the use of biomedical HIV prevention among bisexual men; (2) to describe the ways in which the field of HIV/STI prevention has largely overlooked bisexual men as a population in need of targeted services; and (3) to discuss how researchers can better address the sexual health needs of bisexual men in the age of biomedical HIV prevention.
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Affiliation(s)
- Brian A Feinstein
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., #14-047, Chicago, IL, 60611, USA.
| | - Brian Dodge
- Indiana University School of Public Health, Bloomington, IN, USA
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18
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Feinstein BA, Dodge B. Meeting the Sexual Health Needs of Bisexual Men in the Age of Biomedical HIV Prevention: Gaps and Priorities. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:217-232. [PMID: 31691076 PMCID: PMC7018582 DOI: 10.1007/s10508-019-01468-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 05/09/2019] [Accepted: 05/14/2019] [Indexed: 05/02/2023]
Abstract
The field of HIV/STI prevention has primarily focused on gay men (or "men who have sex with men" [MSM] as a broad category) with limited attention to bisexual men in particular. Although bisexual men are also at increased risk for HIV and other STI, they are less likely to utilize HIV/STI prevention services than gay men, and very few interventions have been developed to address their unique needs. Further, while biomedical advances are changing the field of HIV prevention, bisexual men are also less likely to use biomedical HIV prevention strategies (e.g., pre-exposure prophylaxis [PrEP]) than gay men. In an effort to advance research on bisexual men and their sexual health needs, the goals of this commentary are: (1) to review the empirical literature on the prevalence of HIV/STI among bisexual men, the few existing HIV/STI prevention interventions developed for bisexual men, and the use of biomedical HIV prevention among bisexual men; (2) to describe the ways in which the field of HIV/STI prevention has largely overlooked bisexual men as a population in need of targeted services; and (3) to discuss how researchers can better address the sexual health needs of bisexual men in the age of biomedical HIV prevention.
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Affiliation(s)
- Brian A Feinstein
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., #14-047, Chicago, IL, 60611, USA.
| | - Brian Dodge
- Indiana University School of Public Health, Bloomington, IN, USA
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19
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Martos AJ, Fingerhut A, Wilson PA, Meyer IH. Utilization of LGBT-Specific clinics and providers across three cohorts of lesbian, gay, and bisexual people in the United States. SSM Popul Health 2019; 9:100505. [PMID: 31993490 PMCID: PMC6978477 DOI: 10.1016/j.ssmph.2019.100505] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 07/30/2019] [Accepted: 10/18/2019] [Indexed: 11/24/2022] Open
Abstract
Lesbian, gay, and bisexual (LGB) people navigate issues of stigma, discrimination, structural barriers, and a history of medical mistrust when seeking healthcare services. Lesbian, gay, bisexual, and transgender (LGBT)-specific clinics and providers offer alternative spaces where these issues may be avoided, but limited research is available on how LGB people utilize these resources. The current study analyzes data from a nationally-representative survey of 1534 LGB people across three age cohorts. Gender, sexual identity, income, proximity to LGBT community health centers, perceived health status, and the total number of lifetime diagnoses are each associated with past utilization of LGBT-specific clinics and providers; interest in future utilization is associated with sexual identity, race/ethnicity, several psychosocial factors, income, a usual source of care, and mental distress. We conclude that LGBT-specific clinics and providers represent an important piece of the healthcare landscape for LGB people but access remains an important barrier to utilization.
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Affiliation(s)
- Alexander J. Martos
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
- The Williams Institute, UCLA School of Law, Los Angeles, CA, USA
| | - Adam Fingerhut
- Department of Psychology, Loyola Marymount University, Los Angeles, CA, USA
| | - Patrick A. Wilson
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Ilan H. Meyer
- The Williams Institute, UCLA School of Law, Los Angeles, CA, USA
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20
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Abstract
HealthMpowerment.org (HMP), is a mobile optimized, online intervention to reduce sexual risk behaviors among HIV-positive and HIV-negative young Black men who have sex with men (BMSM) by providing information and resources, fostering social support, and including game-based elements. A randomized controlled trial with 474 young BMSM compared HMP to an information-only control website. The rate of self-reported condomless anal intercourse (CAI) at 3-months was 32% lower in the intervention group compared to the control group (IRR 0.68, 95% CI 0.43, 0.93), however this effect was not sustained at 12 months. Among HIV-positive participants, the rate of CAI at 3-month follow-up was 82% lower among participants with detectable viral loads in the intervention group compared to the control group (IRR 0.18, 95% CI 0.04, 0.32). In a secondary analysis, when we limited to those who used HMP for over 60 min during the 3-month intervention period (n = 50, 25.8%), we estimated 4.85 (95% CI 2.15, 7.53) fewer CAI events than we would have expected in control participants, had they used the intervention at the same rate as the intervention group. Findings suggest that exposure to an online intervention can reduce the rate of CAI among young BMSM, at least in the short term. Given the stronger effect seen among those participants who complied with HMP, additional intervention engagement strategies are warranted.
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21
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Friedman MR, Bukowski L, Eaton LA, Matthews DD, Dyer TV, Siconolfi D, Stall R. Psychosocial Health Disparities Among Black Bisexual Men in the U.S.: Effects of Sexuality Nondisclosure and Gay Community Support. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:213-224. [PMID: 29623533 PMCID: PMC6173653 DOI: 10.1007/s10508-018-1162-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 01/02/2018] [Accepted: 01/25/2018] [Indexed: 05/04/2023]
Abstract
Compared with Black gay men, Black bisexual men experience psychosocial health disparities, including depression, polydrug use, physical assault, and intimate partner violence (IPV). Black bisexual men are also less likely to disclose their sexuality, which may result in them receiving less sexual minority community support, exacerbating psychosocial health disparities. We assessed relationships between bisexual behavior, bisexual identity, sexuality nondisclosure, gay community support, and psychosocial morbidities among Black men who have sex with men (MSM). Between 2014 and 2017, survey data were collected from Black MSM ≥ 18 years old (n = 4430) at Black Pride events in six U.S. cities. We differentiated between bisexual-identified men reporting past-year sex with men and women (bisexual MSMW, 8.4%); gay-identified men reporting sex with men only (gay MSMO, 73.1%); gay MSMW (8.0%); and bisexual MSMO (8.4%). Multivariable regressions contrasted these groups by psychosocial morbidities, sexuality nondisclosure, and gay community support. Structural equation models assessed total, direct, and indirect effects. Compared with gay MSMO, bisexual MSMW and gay MSMW were significantly more likely to report polydrug use, depression symptoms, IPV, physical assault, sexuality nondisclosure, and lack of gay community support. Lack of gay community support had significant indirect effects on the relationships between bisexual behavior and psychosocial morbidity (p < .001) and between bisexual identity and psychosocial morbidity (p < .001). Sexuality nondisclosure had significant indirect effects on relationships between bisexual behavior (p < .001), bisexual identity (p < .001), and lack of gay community support. Psychosocial health disparities experienced by Black bisexual men are associated with both bisexual behavior and bisexual identity. Interventions decreasing biphobia will facilitate opportunities for protective sexuality disclosure and access to sexual minority community support.
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Affiliation(s)
- M Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, PO Box 7319, Pittsburgh, PA, 15213, USA.
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Leigh Bukowski
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lisa A Eaton
- Department of Human Development and Family Studies, University of Connecticut, Hartford, CT, USA
| | - Derrick D Matthews
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, PO Box 7319, Pittsburgh, PA, 15213, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Typhanye V Dyer
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA
| | | | - Ron Stall
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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22
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Banik S, Dodge B, Schmidt-Sane M, Sivasubramanian M, Bowling J, Rawat SM, Dange A, Anand V. Humanizing an Invisible Population in India: Voices from Bisexual Men Concerning Identity, Life Experiences, and Sexual Health. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:305-316. [PMID: 30511146 PMCID: PMC6349550 DOI: 10.1007/s10508-018-1361-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/22/2018] [Accepted: 11/26/2018] [Indexed: 06/09/2023]
Abstract
Research examining the sexual identities, behaviors, and experiences of bisexual men outside of Western contexts (including in India) is limited. Individuals who self-identify as bisexual due to their orientation toward partners of more than one gender face distinct psychosocial challenges relative to exclusively heterosexual, gay/lesbian, or other individuals. We conducted four focus group discussions (n = 22) and in-depth interviews (n = 50) with self-identified bisexual men (age 18 years and older) who were recruited from the metropolitan area of Mumbai, India, between June and August 2013. We triangulated and analyzed focus group and interview data using standard qualitative research techniques. Findings from our study suggest that multiple factors influence the sexual experiences of self-identified bisexual men in Mumbai, including contexts of sexual interactions, sexual positioning, and the gender of sexual partners. Participants described cultural meaning systems and psychosocial dynamics that regulate bisexual identity development, disclosure, and sexual decision making with male, female, and other partners. Secrecy, discretion, and sexual pleasure also influenced sexual behaviors and relationships. Although Western sexual identity categories are not necessarily equivalent in the Indian context, it is interesting and important to note that a number of individuals in India continue to use the identity label of "bisexual." Before developing interventions to meet unique sexual health needs of bisexual men, it is crucial to understand how these men perceive themselves, reconcile the ordinary aspects of their lives with their sexuality, and structure their relationships with partners.
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Affiliation(s)
- Swagata Banik
- Department of Public Health and Prevention Sciences, Baldwin Wallace University, Berea, OH, USA
| | - Brian Dodge
- Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, IN, 47405, USA.
| | - Megan Schmidt-Sane
- Department of Anthropology, Case Western Reserve University, Cleveland, OH, USA
| | | | - Jessamyn Bowling
- Department of Public Health Sciences, University of North Carolina, Charlotte, NC, USA
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Rich AJ, Armstrong HL, Cui Z, Sereda P, Lachowsky NJ, Moore DM, Hogg RS, Roth EA. Sexual orientation measurement, bisexuality, and mental health in a sample of men who have sex with men in Vancouver, Canada. JOURNAL OF BISEXUALITY 2018; 18:299-317. [PMID: 31462896 PMCID: PMC6713462 DOI: 10.1080/15299716.2018.1518181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/22/2018] [Accepted: 08/28/2018] [Indexed: 05/24/2023]
Abstract
This cross-sectional study used a validated index (i.e., Hospital Anxiety and Depression Scale) to measure anxiety and depression (caseness score: ≥8) among men who have sex with men recruited via respondent-driven sampling in Vancouver, Canada (n=774), and investigated whether differences in mental health outcomes varied by sexual orientation measure (i.e., identity, attraction, behavior). Of the sample, 15.5% identified as bisexual, 33.4% reported any bisexual attraction, and 22.7% reported any bisexual sexual activity. More bisexual than gay men met the case definition for anxiety and depression, across all sexual orientation measures. In adjusted multivariable models, bisexual men had higher odds of anxiety by attraction and identity and higher odds of depression by identity. Findings highlight the value of measuring multiple sexual orientation dimensions in surveys and routine surveillance, and the need to ensure sexual minority groups and sexual orientation dimensions are not considered commensurate for mental health prevention and treatment.
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Affiliation(s)
- Ashleigh J. Rich
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Epidemiology & Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Heather L. Armstrong
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Epidemiology & Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Zishan Cui
- Epidemiology & Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Paul Sereda
- Epidemiology & Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Nathan J. Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - David M. Moore
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Epidemiology & Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Robert S. Hogg
- Epidemiology & Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Eric A. Roth
- Department of Anthropology, University of Victoria, Victoria, Canada
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Roth EA, Cui Z, Wang L, Armstrong HL, Rich AJ, Lachowsky NJ, Sereda P, Card KG, Jollimore J, Howard T, Olarewaju G, Moore DM, Hogg RS. Substance Use Patterns of Gay and Bisexual Men in the Momentum Health Study. Am J Mens Health 2018; 12:1759-1773. [PMID: 30024296 PMCID: PMC6142133 DOI: 10.1177/1557988318786872] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 05/23/2018] [Accepted: 06/07/2018] [Indexed: 01/25/2023] Open
Abstract
Research with male sexual minorities frequently combines gay and bisexual men as Men Who Have Sex with Men or Gay and Bisexual Men. When analyzed separately, bisexual men consistently feature negative health differentials, exemplified by higher substance use levels. This interpretation is not clear-cut because studies may combine bisexual men and women, use different dimensions of sexual orientation to define bisexuality, and/or not consider number of sexual partners as a possible confounding factor. This study conducted separate bivariate and multivariate analyses comparing gay to bisexual Momentum Study participants based on self-identity, sexual attraction, and sexual behavior, while controlling for number of sexual partners and sociodemographic, psychosocial, and sexual behavior measures. The study hypothesized that, regardless of definition, bisexual men feature higher substance use levels compared to gay men. Bivariate analyses revealed significantly higher ( p < .05) use among bisexual men for multiple substances in all samples. Nonprescription stimulants and heroin were significant in all multivariate logistic regression models. In contrast, all bisexual samples reported lower use of erectile dysfunction drugs and poppers, substances associated with anal sex among gay men. Subsequent analysis linked these results to lower levels of anal sex in all bisexual samples. Bivariate analyses also revealed that bisexual men featured significantly lower educational levels, annual incomes, and Social Support Scales scores and higher Anxiety and Depression Sub-Scale Scores. In summary, findings revealed bisexual men's distinctive substance use, sexual behavior, psychosocial, and sociodemographic profiles, and are important for tailoring specific health programs for bisexual men.
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Affiliation(s)
- Eric Abella Roth
- Department of Anthropology, University of Victoria, Victoria, BC, Canada
| | - Zishan Cui
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Heather L. Armstrong
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ashleigh J. Rich
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Nathan J. Lachowsky
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
| | - Paul Sereda
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Kiffer G. Card
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Jody Jollimore
- Executive Director, Community Based Research Centre for Gay Men’s Health, Vancouver, BC, Canada
| | - Terry Howard
- Community Advisory Board, Momentum Health Study, Vancouver, BC, Canada
| | - Gbolahan Olarewaju
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - David M. Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Robert S. Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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25
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Friedman MR, Sang JM, Bukowski LA, Matthews DD, Eaton LA, Raymond HF, Stall R. HIV Care Continuum Disparities Among Black Bisexual Men and the Mediating Effect of Psychosocial Comorbidities. J Acquir Immune Defic Syndr 2018; 77:451-458. [PMID: 29337847 PMCID: PMC5844845 DOI: 10.1097/qai.0000000000001631] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Differences across the HIV care continuum between men who have sex with men and women (MSMW) and men who have sex with men only (MSMO) are emerging in recent literature but have not been comprehensively documented among black MSM. Although MSMW have lower HIV prevalence than MSMO, they are more likely to be HIV-positive unaware and be virally unsuppressed. Explanatory factors for these differences have not previously been assessed. METHODS Between 2014 and 2016, we surveyed sexually active black MSM 18 years or older at Black Gay Pride events in 6 U.S. cities (n = 3881), 1229 of whom either self-reported HIV-positive status or tested HIV-positive onsite. We compared HIV-positive MSMW (n = 196) with HIV-positive MSMO (n = 1033) by HIV-positive unaware status, HIV care uptake, and viral load suppression. We conducted multivariable logistic regressions and built a structural equation model assessing mediating effects of psychosocial comorbidities (violence victimization, depression, and polydrug use) on the relationship between MSMW status and unsuppressed virus. RESULTS MSMW were more likely than MSMO to be HIV-positive unaware [adjusted odds ratio (aOR) = 2.17; 95% confidence interval (CI): 1.58 to 3.00]. Among those who were HIV-positive aware (n = 720), MSMW were more likely to report never receiving HIV care (aOR = 2.74; 95% CI: 1.05 to 7.16) and to report detectable viral loads (aOR = 2.34; 95% CI: 1.31 to 4.19). Psychosocial comorbidities significantly mediated (P = 0.01) the relationship between MSMW status and unsuppressed virus. DISCUSSION Black MSMW were less likely than black MSMO to uptake biomedical care and secondary prevention. Biobehavioral intervention development specific to HIV-positive black MSMW will be most successful if psychosocial comorbidities are also addressed.
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Affiliation(s)
- M. Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jordan M. Sang
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Leigh A. Bukowski
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Derrick D. Matthews
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lisa A. Eaton
- Department of Human Development and Family Studies, University of Connecticut, Hartford, CT, USA
| | - H. Fisher Raymond
- Department of Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Ron Stall
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Hammack PL, Frost DM, Meyer IH, Pletta DR. Gay Men's Health and Identity: Social Change and the Life Course. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:59-74. [PMID: 28585157 PMCID: PMC5903851 DOI: 10.1007/s10508-017-0990-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 03/17/2017] [Accepted: 04/05/2017] [Indexed: 05/19/2023]
Abstract
Due to significant historical change in the late 20th and early 21st century related to both health and cultural attitudes toward homosexuality, gay men of distinct birth cohorts may diverge considerably in their health and identity development. We argue that research on gay men's health has not adequately considered the significance of membership in distinct generation-cohorts, and we present a life course paradigm to address this problem. Focusing on the U.S. as an exemplar that can be adapted to other cultural contexts, we identify five generations of gay men alive today and review unique issues related to health and identity development for each. Implications for research, practice, and advocacy on gay men's health and development are discussed.
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Affiliation(s)
- Phillip L Hammack
- Department of Psychology, University of California, Santa Cruz, 1156 High Street, Santa Cruz, CA, 95064, USA.
| | - David M Frost
- Department of Psychology, University of Surrey, Guildford, UK
| | - Ilan H Meyer
- William Institute, School of Law, University of California, Los Angeles, Los Angeles, CA, USA
| | - David R Pletta
- Department of Psychology, University of California, Santa Cruz, 1156 High Street, Santa Cruz, CA, 95064, USA
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Dodge B, Herbenick D, Friedman MR, Schick V, Fu TC(J, Bostwick W, Bartelt E, Muñoz-Laboy M, Pletta D, Reece M, Sandfort TGM. Attitudes toward Bisexual Men and Women among a Nationally Representative Probability Sample of Adults in the United States. PLoS One 2016; 11:e0164430. [PMID: 27783644 PMCID: PMC5082634 DOI: 10.1371/journal.pone.0164430] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 09/26/2016] [Indexed: 11/18/2022] Open
Abstract
As bisexual individuals in the United States (U.S.) face significant health disparities, researchers have posited that these differences may be fueled, at least in part, by negative attitudes, prejudice, stigma, and discrimination toward bisexual individuals from heterosexual and gay/lesbian individuals. Previous studies of individual and social attitudes toward bisexual men and women have been conducted almost exclusively with convenience samples, with limited generalizability to the broader U.S. POPULATION Our study provides an assessment of attitudes toward bisexual men and women among a nationally representative probability sample of heterosexual, gay, lesbian, and other-identified adults in the U.S. Data were collected from the 2015 National Survey of Sexual Health and Behavior (NSSHB), via an online questionnaire with a probability sample of adults (18 years and over) from throughout the U.S. We included two modified 5-item versions of the Bisexualities: Indiana Attitudes Scale (BIAS), validated sub-scales that were developed to measure attitudes toward bisexual men and women. Data were analyzed using descriptive statistics, gamma regression, and paired t-tests. Gender, sexual identity, age, race/ethnicity, income, and educational attainment were all significantly associated with participants' attitudes toward bisexual individuals. In terms of responses to individual scale items, participants were most likely to "neither agree nor disagree" with all attitudinal statements. Across sexual identities, self-identified other participants reported the most positive attitudes, while heterosexual male participants reported the least positive attitudes. As in previous research on convenience samples, we found a wide range of demographic characteristics were related with attitudes toward bisexual individuals in our nationally-representative study of heterosexual, gay/lesbian, and other-identified adults in the U.S. In particular, gender emerged as a significant characteristic; female participants' attitudes were more positive than male participants' attitudes, and all participants' attitudes were generally more positive toward bisexual women than bisexual men. While recent population data suggest a marked shift in more positive attitudes toward gay men and lesbian women in the general population of the U.S., the largest proportions of participants in our study reported a relative lack of agreement or disagreement with all affective-evaluative statements in the BIAS scales. Findings document the relative lack of positive attitudes toward bisexual individuals among the general population of adults in the U.S. and highlight the need for developing intervention approaches to promote more positive attitudes toward bisexual individuals, targeted toward not only heterosexual but also gay/lesbian individuals and communities.
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Affiliation(s)
- Brian Dodge
- Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, Indiana, United States of America
| | - Debby Herbenick
- Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, Indiana, United States of America
| | - M. Reuel Friedman
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Vanessa Schick
- University of Texas Health Science Center, Houston, Texas, United States of America
| | - Tsung-Chieh (Jane) Fu
- Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, Indiana, United States of America
| | - Wendy Bostwick
- Department of Health Systems Science, School of Nursing, University of Illinois, Chicago, Illinois, United States of America
| | - Elizabeth Bartelt
- Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, Indiana, United States of America
| | - Miguel Muñoz-Laboy
- School of Social Work, Temple University, Philadelphia. Pennsylvania, United States of America
| | - David Pletta
- Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, Indiana, United States of America
| | - Michael Reece
- Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, Indiana, United States of America
| | - Theo G. M. Sandfort
- Department of Psychiatry, College of Physicians & Surgeons, Columbia University, New York, New York, United States of America
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Mor Z, Davidovich U. Sexual Orientation and Behavior of Adult Jews in Israel and the Association With Risk Behavior. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:1563-1571. [PMID: 26754157 DOI: 10.1007/s10508-015-0631-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 09/05/2015] [Accepted: 09/15/2015] [Indexed: 06/05/2023]
Abstract
Estimating the size of key risk groups susceptible to HIV/sexually transmitted diseases (STI) is necessary for establishment of interventions and budget allocation. This study aimed to identify various dimensions of sexual orientation and practices in Israel, and correlate the findings with sexual risk behavior (SRB). It used a random representative sample of the Jewish population aged 18-44 years who completed online questionnaires regarding their self-identified sexual orientation, attraction and practices, and SRB. Concordant heterosexuals were those who self-reported heterosexual identity, were attracted and had sex only with the opposite gender. National estimates regarding prevalence of gay, lesbian, and bisexual men and women were based on the civil census. The sample included 997 men and 1005 women, of whom 11.3 and 15.2 % were attracted to the same-gender, 10.2 and 8.7 % reported lifetime same-gender encounters, while 8.2 and 4.8 % self-identified as gay or bisexual men and lesbian or bisexual women, respectively. The estimated population of self-identified Jewish gay or bisexual men and lesbian or bisexual women aged 18-44 in Israel was 94,176, and 57,671, respectively. SRB was more common among self-identified gays or bisexual men and among discordant heterosexual men and women. Those who reported same-gender sexual practices reported greater SRB than those who only had opposite-gender encounters. Interestingly, SRB among discordant heterosexuals was associated with same-sex behavior rather than attraction. Health practitioners should increase their awareness of sexual diversity among their clientele, and should recognize that risk for HIV/STI may exist among self-identified heterosexuals, who may not disclose their actual sexual attraction or practices.
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Affiliation(s)
- Zohar Mor
- Ramla Department of Health, Ministry of Health, 3 Danny Mass St., 72100, Ramla, Israel.
| | - Udi Davidovich
- Geneeskundige en Gezondheidsdienst, Amsterdam, The Netherlands
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Bowling J, Dodge B, Banik S, Rodriguez I, Mengele SR, Herbenick D, Guerra-Reyes L, Sanders S, Dange A, Anand V. Perceived health concerns among sexual minority women in Mumbai, India: an exploratory qualitative study. CULTURE, HEALTH & SEXUALITY 2016; 18:826-840. [PMID: 26873141 DOI: 10.1080/13691058.2015.1134812] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The experiences of sexual minority women (i.e., women who do not identify as 'heterosexual') in India have largely been absent in scientific literature. In partnership with India's oldest and largest sexual and gender minority-advocacy organisation, the Humsafar Trust, our study used community-based participatory research principles to explore the lived experiences and health concerns of sexual minority women in Mumbai. Study methodologies included interviews with key informants, a focus group comprised of six women, and an additional 12 in-person interviews with sexual minority women to identify important physical, mental, social and other health priorities from these women's perspectives. Thematic data are organised within the framework offered by the social ecological model, including individual, interpersonal, micro and macro levels. Findings from this study are important in providing the groundwork for future research and intervention involving sexual minority women in India, a dramatically underserved population.
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Affiliation(s)
- Jessamyn Bowling
- a Center for Sexual Health Promotion , Indiana University , Bloomington, USA
| | - Brian Dodge
- a Center for Sexual Health Promotion , Indiana University , Bloomington, USA
| | - Swagata Banik
- b Public Health Program , Baldwin Wallace University , Berea, USA
| | - Israel Rodriguez
- a Center for Sexual Health Promotion , Indiana University , Bloomington, USA
| | | | - Debby Herbenick
- a Center for Sexual Health Promotion , Indiana University , Bloomington, USA
| | - Lucia Guerra-Reyes
- a Center for Sexual Health Promotion , Indiana University , Bloomington, USA
| | - Stephanie Sanders
- d The Kinsey Institute for Research in Sex, Gender and Reproduction , Indiana University , Indiana , USA
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Intimate Partner Violence and Correlates With Risk Behaviors and HIV/STI Diagnoses Among Men Who Have Sex With Men and Men Who Have Sex With Men and Women in China: A Hidden Epidemic. Sex Transm Dis 2016. [PMID: 26222752 DOI: 10.1097/olq.0000000000000302] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Intimate partner violence (IPV) research has primarily focused on heterosexual couples but has largely ignored IPV among men who have sex with men (MSM). We examined IPV prevalence among MSM and men who have sex with men and women (MSMW) in China. METHODS Men who have sex with men older than 16 years were recruited through 3 MSM-focused Web sites in China. An online survey containing items on sociodemographics, risk behaviors, IPV, and self-reported HIV or sexually transmitted infection diagnosis was completed. Multivariate regression was used to examine associations between IPV and risk behaviors and an HIV or sexually transmitted infection diagnosis. RESULTS Among 610 participants, 182 (29.8%) reported experiencing at least 1 type of IPV. Men who have sex with both men and women were at significantly greater risk for IPV (adjusted odds ratio [AOR], 1.65; 95% confidence interval [CI], 1.08-2.53) compared with MSM. Men who had experienced IPV were more likely to have participated in group sex (AOR, 1.86; 95% CI, 1.08-3.21), to have had sex in exchange for gifts or money (AOR, 5.06; 95% CI, 2.47-10.35), and to report a positive HIV diagnosis (AOR, 2.59; 95% CI, 1.22-5.51). CONCLUSIONS There is a hidden epidemic of IPV among MSM in China, especially among MSMW. The hidden nature of MSM and MSMW suggests the need for a clinical environment more conducive to disclosure. Research is needed to understand the pathways linking IPV and HIV risk among MSM to optimize the design of effective interventions.
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Dodge B, Herbenick D, Fu TCJ, Schick V, Reece M, Sanders S, Fortenberry JD. Sexual Behaviors of U.S. Men by Self-Identified Sexual Orientation: Results From the 2012 National Survey of Sexual Health and Behavior. J Sex Med 2016; 13:637-49. [PMID: 26936073 DOI: 10.1016/j.jsxm.2016.01.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/27/2016] [Accepted: 01/30/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Although a large body of previous research has examined sexual behavior and its relation to risk in men of diverse sexual identities, most studies have relied on convenience sampling. As such, the vast majority of research on the sexual behaviors of gay and bisexual men, in particular, might not be generalizable to the general population of these men in the United States. This is of particular concern because many studies are based on samples of men recruited from relatively "high-risk" venues and environments. AIMS To provide nationally representative baseline rates for sexual behavior in heterosexual, gay, and bisexual men in the United States and compare findings on sexual behaviors, relationships, and other variables across subgroups. METHODS Data were obtained from the 2012 National Survey of Sexual Health and Behavior, which involved the administration of an online questionnaire to a nationally representative probability sample of women and men at least 18 years old in the United States, with oversampling of self-identified gay and bisexual men and women. Results from the male participants are included in this article. MAIN OUTCOME MEASURES Measurements include demographic characteristics, particularly sexual identity, and their relations to diverse sexual behaviors, including masturbation, mutual masturbation, oral sex, vaginal sex, and anal sex. Behaviors with male and female partners were examined. RESULTS Men of all self-identified sexual identities reported engaging in a range of sexual behaviors (solo and partnered). As in previous studies, sexual identity was not always congruent for gender of lifetime and recent sexual partners. CONCLUSION Patterns of sexual behaviors and relationships vary among heterosexual, gay, and bisexual men. Several demographic characteristics, including age, were related to men's sexual behaviors. The results from this probability study highlight the diversity in men's sexual behaviors across sexual identities, and these data allow generalizability to the broader population of gay and bisexual men, in particular, in the United States, which is a major advancement in research focused on individuals in a sexual minority.
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Affiliation(s)
- Brian Dodge
- Center for Sexual Health Promotion, Indiana University, Bloomington, IN, USA.
| | - Debby Herbenick
- Center for Sexual Health Promotion, Indiana University, Bloomington, IN, USA
| | - Tsung-Chieh Jane Fu
- Center for Sexual Health Promotion, Indiana University, Bloomington, IN, USA
| | | | - Michael Reece
- Center for Sexual Health Promotion, Indiana University, Bloomington, IN, USA
| | - Stephanie Sanders
- The Kinsey Institute for Research on Sex, Gender and Reproduction, Indiana University, Bloomington, IN, USA; Department of Gender Studies, Indiana University, Bloomington, IN, USA
| | - J Dennis Fortenberry
- Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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White Hughto JM, Biello KB, Reisner SL, Perez-Brumer A, Heflin KJ, Mimiaga MJ. Health Risk Behaviors in a Representative Sample of Bisexual and Heterosexual Female High School Students in Massachusetts. THE JOURNAL OF SCHOOL HEALTH 2016; 86:61-71. [PMID: 26645422 PMCID: PMC4675046 DOI: 10.1111/josh.12353] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 05/08/2015] [Accepted: 05/10/2015] [Indexed: 05/29/2023]
Abstract
BACKGROUND Differences in sexual health-related outcomes by sexual behavior and identity remain underinvestigated among bisexual female adolescents. METHODS Data from girls (N = 875) who participated in the Massachusetts Youth Risk Behavior Surveillance survey were analyzed. Weighted logistic regression models were fit to examine sexual and psychosocial health by lifetime sexual behavior (behaviorally bisexual vs behaviorally heterosexual) and sexual identity (bisexual vs heterosexual) adjusting for grade and race/ethnicity. RESULTS Overall, 10.5% of girls reported lifetime bisexual behavior and 8.1% reported a bisexual identity. Behavior and identity were discordant for bisexual young women as 53.2% of behaviorally bisexual students had a bisexual identity and 46.8% had a heterosexual identity. Bisexual identity and behavior were associated with unprotected intercourse at last sexual encounter, early sexual debut, 4 or more lifetime partners, history of forced/unwanted sex, sexually transmitted infection testing history, past-year depression, and past-month drug use (all ps < .05). CONCLUSION Bisexuality, whether defined by identity or behavior, is associated with adverse sexual and psychosocial health outcomes in adolescent girls. Studies that explore wellness across the life span, and are designed to recognize developmental differences burgeoning in adolescence, may provide insights into the differential sexual risk outcomes observed among bisexual girls.
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Affiliation(s)
- Jaclyn M White Hughto
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA 02215.
- Department of Chronic Disease Epidemiology, Yale School of Public Health.
| | - Katie B Biello
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA 02215.
- Departments of Behavioral & Social Sciences and Epidemiology, Institute for Community Health Promotion, Brown University School of Public Health.
| | - Sari L Reisner
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA 02215.
- Division of General Pediatrics, Boston Children's Hospital/Harvard Medical School.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health.
| | - Amaya Perez-Brumer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032.
| | - Katherine J Heflin
- Center for Health Care Strategies, 200 American Metro Blvd., Hamilton, New Jersey 08619.
| | - Matthew J Mimiaga
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA 02215.
- Institute for Community Health Promotion, Brown University School of Public Health.
- Harvard T.H. Chan School of Public Health.
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The Role of Syndemic in Explaining Health Disparities Among Bisexual Men: A Blueprint for a Theoretically Informed Perspective. SOCIAL DISPARITIES IN HEALTH AND HEALTH CARE 2016. [DOI: 10.1007/978-3-319-34004-3_4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Brown TA, Keel PK. A randomized controlled trial of a peer co-led dissonance-based eating disorder prevention program for gay men. Behav Res Ther 2015; 74:1-10. [PMID: 26342904 DOI: 10.1016/j.brat.2015.08.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 08/20/2015] [Accepted: 08/24/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Gay males have increased risk for eating disorders compared to heterosexual males, establishing a need to develop and empirically evaluate programs to reduce risk for this population. The present study investigated the acceptability and efficacy of a cognitive dissonance-based (DB) intervention (The PRIDE Body Project(©)) in reducing eating disorder risk factors among gay males in a university-based setting. METHOD Eighty-seven gay males were randomized to either a 2-session DB intervention (n = 47) or a waitlist control condition (n = 40). Participants completed eating disorder risk factor assessments pre-intervention, post-intervention, and at 4-week follow-up, and those receiving the intervention completed post-treatment acceptability measures. RESULTS Acceptability ratings were highly favorable. Regarding efficacy, the DB condition was associated with significantly greater decreases in body dissatisfaction, drive for muscularity, self-objectification, partner-objectification, body-ideal internalization, dietary restraint, and bulimic symptoms compared to waitlist control from pre- to post-intervention. Improvements in the DB group were maintained at 4-week follow-up, with the exception of body-ideal internalization. Body-ideal internalization mediated treatment effects on bulimic symptoms. CONCLUSION Results support the acceptability and efficacy of The PRIDE Body Project(©) and provide support for theoretical models of eating pathology in gay men.
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Affiliation(s)
- Tiffany A Brown
- Florida State University, Department of Psychology, 1107 W. Call St., Tallahassee, FL 32304, USA.
| | - Pamela K Keel
- Florida State University, Department of Psychology, 1107 W. Call St., Tallahassee, FL 32304, USA.
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Davis A, Best J, Luo J, Van Der Pol B, Dodge B, Meyerson B, Aalsma M, Wei C, Tucker JD. Differences in risk behaviours, HIV/STI testing and HIV/STI prevalence between men who have sex with men and men who have sex with both men and women in China. Int J STD AIDS 2015; 27:840-9. [PMID: 26185041 DOI: 10.1177/0956462415596302] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/18/2015] [Indexed: 11/17/2022]
Abstract
Differences in risk behaviours between men who have sex with men (MSM) and men who have sex with both men and women (MSMW) have important implications for HIV and sexually transmitted infection (STI) transmission. We examined differences in risk behaviours, HIV/STI testing, self-reported HIV/STI diagnoses, and linkage to HIV care between MSM and MSMW across China. Participants were recruited through three MSM-focused websites in China. An online survey containing items on socio-demographics, risk behaviours, testing history, self-reported HIV/STI diagnosis, and linkage to and retention in HIV care was completed from September to October 2014. Chi square tests and logistic regression analyses were conducted. MSMW were less likely to use a condom during last anal sex (p ≤ 0.01) and more likely to engage in group sex (p ≤ 0.01) and transactional sex (p ≤ 0.01) compared to MSM. Self-reported HIV/STI testing and positivity rates between MSM and MSMW were similar. Among HIV-infected MSM, there was no difference in rates of linkage to or retention in antiretroviral therapy when comparing MSM and MSMW. Chinese MSM and MSMW may benefit from different HIV and STI intervention and prevention strategies. Achieving a successful decrease in HIV/STI epidemics among Chinese MSM and MSMW will depend on the ability of targeted and culturally congruent HIV/STI control programmes to facilitate a reduction in risk behaviours.
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Affiliation(s)
- Alissa Davis
- Department of Epidemiology & Biostatistics, Indiana University School of Public Health, Bloomington, IN, USA UNC-Project China, Guangzhou, China Rural Center for AIDS/STD Prevention, Indiana University School of Public Health, Bloomington, IN, USA
| | - John Best
- UNC-Project China, Guangzhou, China School of Medicine, University of California, San Francisco, CA, USA
| | - Juhua Luo
- Department of Epidemiology & Biostatistics, Indiana University School of Public Health, Bloomington, IN, USA
| | | | - Brian Dodge
- Center for Sexual Health Promotion, Indiana University School of Public Health, Bloomington, IN, USA
| | - Beth Meyerson
- Rural Center for AIDS/STD Prevention, Indiana University School of Public Health, Bloomington, IN, USA Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN, USA
| | - Matthew Aalsma
- Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Chongyi Wei
- Department of Epidemiology & Biostatistics and Global Health Sciences, University of California, San Francisco, CA, USA
| | - Joseph D Tucker
- UNC-Project China, Guangzhou, China School of Medicine, University of North Carolina-Chapel Hill, NC, USA
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Davis A, Best J, Wei C, Luo J, Van Der Pol B, Meyerson B, Dodge B, Aalsma M, Tucker J. Intimate Partner Violence and Correlates With Risk Behaviors and HIV/STI Diagnoses Among Men Who Have Sex With Men and Men Who Have Sex With Men and Women in China: A Hidden Epidemic. Sex Transm Dis 2015. [PMID: 26222752 DOI: 10.1097/olq.00000000000003022017.03.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
BACKGROUND Intimate partner violence (IPV) research has primarily focused on heterosexual couples but has largely ignored IPV among men who have sex with men (MSM). We examined IPV prevalence among MSM and men who have sex with men and women (MSMW) in China. METHODS Men who have sex with men older than 16 years were recruited through 3 MSM-focused Web sites in China. An online survey containing items on sociodemographics, risk behaviors, IPV, and self-reported HIV or sexually transmitted infection diagnosis was completed. Multivariate regression was used to examine associations between IPV and risk behaviors and an HIV or sexually transmitted infection diagnosis. RESULTS Among 610 participants, 182 (29.8%) reported experiencing at least 1 type of IPV. Men who have sex with both men and women were at significantly greater risk for IPV (adjusted odds ratio [AOR], 1.65; 95% confidence interval [CI], 1.08-2.53) compared with MSM. Men who had experienced IPV were more likely to have participated in group sex (AOR, 1.86; 95% CI, 1.08-3.21), to have had sex in exchange for gifts or money (AOR, 5.06; 95% CI, 2.47-10.35), and to report a positive HIV diagnosis (AOR, 2.59; 95% CI, 1.22-5.51). CONCLUSIONS There is a hidden epidemic of IPV among MSM in China, especially among MSMW. The hidden nature of MSM and MSMW suggests the need for a clinical environment more conducive to disclosure. Research is needed to understand the pathways linking IPV and HIV risk among MSM to optimize the design of effective interventions.
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Affiliation(s)
- Alissa Davis
- From the *Department of Epidemiology & Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN; †UNC-Project China, Guangzhou, China; ‡Rural Center for AIDS/STD Prevention, Indiana University School of Public Health-Bloomington, Bloomington, IN; §School of Medicine and ¶Department of Epidemiology & Biostatistics and Global Health Sciences, University of California-San Francisco, San Francisco, CA; ∥School of Medicine, University of Alabama-Birmingham, Birmingham, AL; **Department of Applied Health Science and ††Center for Sexual Health Promotion, Indiana University School of Public Health-Bloomington, Bloomington, IN; ‡‡Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN; §§School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, CA; and ¶¶Social Entrepreneurship for Sexual Health Research Group, University of North Carolina and Guangdong Provincial Center for Skin Diseases & STI Control, Guangzhou, China
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Molina Y, Marquez JH, Logan DE, Leeson CJ, Balsam KF, Kaysen DL. Current intimate relationship status, depression, and alcohol use among bisexual women: The mediating roles of bisexual-specific minority stressors. SEX ROLES 2015; 73:43-57. [PMID: 26456995 PMCID: PMC4594946 DOI: 10.1007/s11199-015-0483-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Current intimate relationship characteristics, including gender and number of partner(s), may affect one's visibility as a bisexual individual and the minority stressors they experience, which may in turn influence their health. The current study tested four hypotheses: 1) minority stressors vary by current intimate relationship status; 2) higher minority stressors are associated with higher depressive symptoms and alcohol-related outcomes; 3) depressive symptoms and alcohol-related outcomes vary by current intimate relationship status; and 4) minority stressors will mediate differences in these outcomes. Participants included 470 self-identified bisexual women (65% Caucasian, mean age: 21) from a sample of sexual minority women recruited from different geographic regions in the United States through advertisements on social networking sites and Craigslist. Participants completed a 45 minute survey. Respondents with single partners were first grouped by partner gender (male partner: n=282; female partner: n=56). Second, women were grouped by partner gender/number (single female/male partner: n = 338; women with multiple female and male partners: n=132). Women with single male partners and women with multiple male and female partners exhibited elevated experienced bi-negativity and differences in outness (H1). Experienced and internalized bi-negativity were associated with health outcomes, but not outness (H2). Differences in outcomes emerged by partner number and partner number/gender (H3); these differences were mediated by experienced bi-negativity (H4). These results suggest that experiences of discrimination may underlie differences in health related to bisexual women's relationship structure and highlight the importance of evaluating women's relational context as well as sexual identification in understanding health risk behaviors.
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Affiliation(s)
- Yamile Molina
- University of Washington, Seattle, WA
- Fred Hutchinson Cancer Research Center, Seattle, WA
- University of Illinois-Chicago, Chicago, IL
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Friedman MR, Dodge B, Schick V, Herbenick D, Hubach R, Bowling J, Goncalves G, Krier S, Reece M. FROM BIAS TO BISEXUAL HEALTH DISPARITIES: ATTITUDES TOWARD BISEXUAL MEN AND WOMEN IN THE UNITED STATES. LGBT Health 2014; 1:309-318. [PMID: 25568885 DOI: 10.1089/lgbt.2014.0005] [Citation(s) in RCA: 187] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PUROPSE A newly emergent literature suggest that bisexual men and women face profound health disparities in comparison to both heterosexual and homosexual individuals. Additionally, bisexual individuals often experience prejudice, stigma, and discrimination from both gay/lesbian and straight communities, termed "biphobia." However, only limited research exists that empirically tests the extent and predictors of this double discrimination. The Bisexualities: Indiana Attitudes Survey (BIAS) was developed to test associations between biphobia and sexual identity. METHODS Using standard techniques, we developed and administered a scale to a purposive online sample of adults from a wide range of social networking websites. We conducted exploratory factor analysis to refine scales assessing attitudes toward bisexual men and bisexual women, respectively. Using generalized linear modeling, we assessed relationships between BIAS scores and sexual identity, adjusting for covariates. RESULTS Two separately gendered scales were developed, administered, and refined: BIAS-m (n=645), focusing on attitudes toward bisexual men; and BIAS-f (n=631), focusing on attitudes toward bisexual women. Across scales, sexual identity significantly predicted response variance. Lesbian/gay respondents had lower levels of bi-negative attitudes than their heterosexual counterparts (all p-values <.05); bisexual respondents had lower levels of bi-negative attitudes than their straight counterparts (all p-values <.001); and bisexual respondents had lower levels of bi-negative attitudes than their lesbian/gay counterparts (all p-values <.05). Within racial/ethnic minority respondents, biracial/multiracial status was associated with lower bi-negativity scores (all p-values <.05). CONCLUSION This study provides important quantitative support for theories related to biphobia and double discrimination. Our findings provide strong evidence for understanding how stereotypes and stigma may lead to dramatic disparities in depression, anxiety, stress, and other health outcomes among bisexual individuals in comparison to their heterosexual and homosexual counterparts. Our results yield valuable data for informing social awareness and intervention efforts that aim to decrease bi-negative attitudes within both straight and gay/lesbian communities, with the ultimate goal of alleviating health disparities among bisexual men and women.
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Affiliation(s)
- M Reuel Friedman
- University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania, USA,
| | - Brian Dodge
- Indiana University - Bloomington, Center for Sexual Health Promotion, Bloomington, Indiana, USA,
| | - Vanessa Schick
- University of Texas, Health Science Center, Houston, Texas, USA,
| | - Debby Herbenick
- Indiana University - Bloomington, Center for Sexual Health Promotion, Bloomington, Indiana. USA,
| | - Randolph Hubach
- Indiana University - Bloomington, Center for Sexual Health Promotion, Bloomington, Indiana, USA,
| | - Jessamyn Bowling
- Indiana University - Bloomington, Center for Sexual Health Promotion, Bloomington, Indiana, USA,
| | - Gabriel Goncalves
- Indiana University - Bloomington, Center for Sexual Health Promotion, Bloomington, Indiana, USA,
| | - Sarah Krier
- University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania, USA,
| | - Michael Reece
- Indiana University - Bloomington, Center for Sexual Health Promotion, Bloomington, Indiana, USA,
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Dodge B, Schick V, Herbenick D, Reece M, Sanders SA, Fortenberry JD. Frequency, reasons for, and perceptions of lubricant use among a nationally representative sample of self-identified gay and bisexual men in the United States. J Sex Med 2014; 11:2396-405. [PMID: 25088090 DOI: 10.1111/jsm.12640] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Few previous studies have examined lubricant use among gay and bisexual men outside the context of human immunodeficiency virus risk reduction associated with condom use during penile-anal intercourse and the potential use of lubricants to deliver rectal microbicides. The vast majority of studies examining lubricant use among gay and bisexual men have employed convenience sampling strategies for participant recruitment. Additionally, most studies have collapsed gay men and bisexual men into one category of "gay and bisexual men." AIMS This study aimed to provide overall rates of lubricant use and related factors among a nationally representative sample of self-identified gay and bisexual men. Frequencies of lubricant use, reasons for using lubricant, and perceptions of lubricant use were examined separately for subsamples of both gay and bisexual men. METHODS Data were from the 2012 National Survey of Sexual Health and Behavior, which involved the administration of an online questionnaire to a nationally representative probability sample of women and men in the United States aged 18 and older, and we oversampled self-identified gay and bisexual men and women; the results from male participants are included in this article. MAIN OUTCOME MEASURES Measure included demographic characteristics, recent and lifetime commercial lubricant use, lubricant use during specific sexual behaviors, frequency of lubricant use, and reasons for lubricant use during sexual activity. RESULTS Over 90% of both gay and bisexual male participants reported lifetime lubricant use. Use was most common during partnered sexual activities, particularly among men aged 25-29 years old. The most commonly reported reasons for lubricant use included to increase comfort during anal intercourse, curiosity, and to make sex more comfortable. CONCLUSIONS Most gay and bisexual men in the United States have used lubricant to enhance a wide range of sexual activities, including but not limited to anal intercourse. Findings from this study will be of utility to clinicians and other health practitioners who seek to understand and promote sexual health among gay and bisexual men and other traditionally underserved public health populations.
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Affiliation(s)
- Brian Dodge
- Center for Sexual Health Promotion, Indiana University, Bloomington, IN, USA
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Friedman MR, Stall R, Silvestre AJ, Mustanski B, Shoptaw S, Surkan PJ, Rinaldo CR, Plankey MW. Stuck in the middle: longitudinal HIV-related health disparities among men who have sex with men and women. J Acquir Immune Defic Syndr 2014; 66:213-20. [PMID: 24662298 PMCID: PMC4030741 DOI: 10.1097/qai.0000000000000143] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Men who have sex with men and women (MSMW) have been shown in cross-sectional studies to suffer HIV-related health disparities above and beyond those found among men who have sex with men only (MSMO). We conducted a secondary data analysis over a 7-year time frame of participants in the Multicenter AIDS Cohort Study, a long-standing prospective cohort study, to examine whether MSMW had persistently higher rates of depression symptoms, polydrug use, and (among HIV-positive men who have sex with men) HIV viral load levels compared with MSMO. METHODS Men were behaviorally defined as bisexual if they reported sexual activity with at least 1 male and 1 female partner between study waves 38 and 50. We used generalized mixed modeling with repeated measures to test differences in CES-D score, polydrug use, and viral load between sexually active MSMO (n = 1514) and MSMW (n = 111), adjusting for age, income, race/ethnicity, and recent seroconversion. RESULTS MSMW were significantly more likely than MSMO to have higher CES-D scores, polydrug use, and viral load levels (all P < 0.01). Outcome trajectories did not differ significantly over time between these groups. Black and Hispanic HIV-positive MSMW had higher viral load levels relative to white HIV-positive MSMW (P < 0.01). DISCUSSION Compared with MSMO, MSMW in the Multicenter AIDS Cohort Study suffer from profound and persistent HIV-related health disparities across biological, behavioral, and psychosocial domains. Further qualitative and quantitative research contextualizing the pathways underlying these disparities is recommended for intervention development targeting MSMW at risk for HIV acquisition and transmission.
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Affiliation(s)
- M. Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ron Stall
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anthony J. Silvestre
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Steve Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Pamela J. Surkan
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Charles R. Rinaldo
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael W. Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, D.C., USA
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Hubach RD, Dodge B, Goncalves G, Malebranche D, Reece M, Van Der Pol B, Martinez O, Schnarrs PW, Nix R, Fortenberry JD. Gender matters: condom use and nonuse among behaviorally bisexual men. ARCHIVES OF SEXUAL BEHAVIOR 2014; 43:707-17. [PMID: 23912775 PMCID: PMC3912218 DOI: 10.1007/s10508-013-0147-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Revised: 04/29/2013] [Accepted: 04/30/2013] [Indexed: 05/12/2023]
Abstract
Although frequently cited as being at high risk for HIV/STI transmission, little is known about behaviorally bisexual men's patterns and experiences of condom use and nonuse with male and female sexual partners. Using a variety of recruitment techniques informed by a Community Advisory Committee, a total of 77 behaviorally bisexual men were recruited from Indianapolis, Indiana to participate in semi-structured interviews focused on sexual health. Qualitative data were collected containing detailed information on their patterns and experiences of condom use and nonuse with both male and female partners. Participants described numerous commonly reported barriers for consistent condom use, as well as distinct bisexual-specific barriers. The majority reported consistent condom use with male and female casual partners, but many who did not use condoms described doing so in the context of ongoing relationships. In addition, participants provided reasons for condom use and nonuse that varied based on the gender of the partner and the type of relationship with the partner. Future interventions focused on increasing condom use among behaviorally bisexual men should take into account the unique complexities of gender and relationship configurations in this distinct population.
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Affiliation(s)
- Randolph D. Hubach
- Center for Sexual Health Promotion, Department of Applied Health Science, SPH 116, School of Public Health-Bloomington, Indiana University, Bloomington, IN 47405
| | - Brian Dodge
- Center for Sexual Health Promotion, Department of Applied Health Science, SPH 116, School of Public Health-Bloomington, Indiana University, Bloomington, IN 47405
| | - Gabriel Goncalves
- Center for Sexual Health Promotion, Department of Applied Health Science, SPH 116, School of Public Health-Bloomington, Indiana University, Bloomington, IN 47405
| | | | - Michael Reece
- Center for Sexual Health Promotion, Department of Applied Health Science, SPH 116, School of Public Health-Bloomington, Indiana University, Bloomington, IN 47405
| | - Barbara Van Der Pol
- Center for Sexual Health Promotion, Department of Applied Health Science, SPH 116, School of Public Health-Bloomington, Indiana University, Bloomington, IN 47405
- Department of Epidemiology & Biostatistics, Indiana University, Bloomington, IN
| | - Omar Martinez
- HIV Center for Clinical and Behavioral Studies, Columbia University/New York State Psychiatric Institute, New York, NY
| | | | | | - J. Dennis Fortenberry
- Center for Sexual Health Promotion, Department of Applied Health Science, SPH 116, School of Public Health-Bloomington, Indiana University, Bloomington, IN 47405
- Division of Adolescent Medicine, Indiana University, Indianapolis, IN
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Martinez O, Wu E, Shultz AZ, Capote J, López Rios J, Sandfort T, Manusov J, Ovejero H, Carballo-Dieguez A, Chavez Baray S, Moya E, López Matos J, DelaCruz JJ, Remien RH, Rhodes SD. Still a hard-to-reach population? Using social media to recruit Latino gay couples for an HIV intervention adaptation study. J Med Internet Res 2014; 16:e113. [PMID: 24763130 PMCID: PMC4019772 DOI: 10.2196/jmir.3311] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 03/17/2014] [Accepted: 04/13/2014] [Indexed: 11/13/2022] Open
Abstract
Background Online social networking use has increased rapidly among African American and Latino men who have sex with men (MSM), making it important to understand how these technologies can be used to reach, retain, and maintain individuals in care and promote health wellness. In particular, the Internet is increasingly recognized as a platform for health communication and education. However, little is known about how primarily Spanish-speaking populations use and engage with each other through social media platforms. Objective We aimed to recruit eligible couples for a study to adapt “Connect ‘n Unite” (an HIV prevention intervention initially created for black gay couples) for Spanish-speaking Latino gay couples living in New York City. Methods In order to successfully design and implement an effective social media recruitment campaign to reach Spanish-speaking Latino gay couples for our ongoing “Latinos en Pareja” study, our community stakeholders and research team used McGuire’s communication/persuasion matrix. The matrix guided our research, specifically each marketing “channel”, targeted “message”, and target population or “receiver”. We developed a social media recruitment protocol and trained our research staff and stakeholders to conduct social media recruitment. Results As a result, in just 1 month, we recruited all of our subjects (N=14 couples, that is, N=28 participants) and reached more than 35,658 participants through different channels. One of the major successes of our social media recruitment campaign was to build a strong stakeholder base that became involved early on in all aspects of the research process—from pilot study writing and development to recruitment and retention. In addition, the variety of “messages” used across different social media platforms (including Facebook, the “Latinos en Pareja” study website, Craigslist, and various smartphone applications such as Grindr, SCRUFF, and Jack’d) helped recruit Latino gay couples. We also relied on a wide range of community-based organizations across New York City to promote the study and build in the social media components. Conclusions Our findings highlight the importance of incorporating communication technologies into the recruitment and engagement of participants in HIV interventions. Particularly, the success of our social media recruitment strategy with Spanish-speaking Latino MSM shows that this population is not particularly “hard to reach”, as it is often characterized within public health literature.
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Affiliation(s)
- Omar Martinez
- Columbia University, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, United States.
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Friedman MR, Kurtz SP, Buttram ME, Wei C, Silvestre AJ, Stall R. HIV risk among substance-using men who have sex with men and women (MSMW): findings from South Florida. AIDS Behav 2014; 18:111-9. [PMID: 23653091 DOI: 10.1007/s10461-013-0495-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Compared with men who have sex with men only (MSMO), men who have sex with men and women (MSMW) consistently report higher rates of two HIV risk behaviors: transactional sex (TS) and concurrent substance use and sex (CSS). Within MSMW, little is known about how synergistic epidemics ("syndemics") affect TS and CSS. Using a sample of substance-using MSM (n = 515) in South Florida, we compared TS and CSS among MSMO and MSMW; examined whether, within MSMW (n = 86), TS and CSS predict unprotected anal intercourse with partners of serodiscordant/unknown HIV status (SU-UAI); and tested whether syndemics predict TS and CSS. MSMW reported higher rates of engaging in both TS and CSS (AOR = 1.7; 95 % CI 1.0-3.0). Within MSMW, engagement in both TS and CSS predicted SU-UAI (AOR = 3.3; 95 % CI 1.2-9.6); and syndemics predicted TS and CSS involvement (p < 0.01). Substance-using MSMW may benefit from interventions targeting TS, CSS, and background syndemics.
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Affiliation(s)
- M Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, P.O. Box 7319, Pittsburgh, PA, 15213, USA,
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Herrick AL, Egan JE, Coulter RWS, Friedman MR, Stall R. Raising sexual minority youths' health levels by incorporating resiliencies into health promotion efforts. Am J Public Health 2013; 104:206-10. [PMID: 24328652 DOI: 10.2105/ajph.2013.301546] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Myriad health inequities that sexual minority youths (SMYs) experience have been documented over the past several decades. Evidence demonstrates that these are not a result of intrinsic characteristics; rather, they result from high levels of adversity that SMYs experience. Despite the pervasive marginalization that SMYs face, there is also evidence of great resilience within this population. It seems likely that if a culture of marginalization produces health inequities in SMYs, a culture of acceptance and integration can work to produce resiliencies. We have described how promoting forms of acceptance and integration could work to promote resilient SMYs despite an overarching culture of marginalization. Building on SMYs' resiliencies may potentiate the effectiveness of health promotion interventions to reduce health disparities within this population.
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Affiliation(s)
- Amy L Herrick
- All authors are with the Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
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