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Demeke J, Djiadeu P, Yusuf A, Whitfield DL, Lightfoot D, Worku F, Abu-Ba'are GR, Mbuagbaw L, Giwa S, Nelson LE. HIV Prevention and Treatment Interventions for Black Men Who Have Sex With Men in Canada: Scoping Systematic Review. JMIR Public Health Surveill 2024; 10:e40493. [PMID: 38236626 PMCID: PMC10835596 DOI: 10.2196/40493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 12/28/2022] [Accepted: 08/29/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Black men who have sex with men (MSM) experience disproportionately high HIV incidence globally. A comprehensive, intersectional approach (race, gender, and sexuality or sexual behavior) in understanding the experiences of Black MSM in Canada along the HIV prevention and care continuums has yet to be explored. OBJECTIVE This scoping review aims to examine the available evidence on the access, quality, gaps, facilitators, and barriers of engagement and identify interventions relevant to the HIV prevention and care continuum for Black MSM in Canada. METHODS We conducted a systematic database search, in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist, of the available studies on HIV health experience and epidemiology concerning Black MSM living with or without HIV in Canada and were published after 1983 in either English or French. Searched databases include MEDLINE, Excerpta, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, the NHUS Economic Development Database, Global Health, PsycInfo, PubMed, Scopus, and Web of Science. From the 3095 articles identified, 19 met the inclusion criteria and were analyzed. RESULTS Black MSM in Canada consistently report multiple forms of stigma and lack of community support contributing to an increased HIV burden. They experience discrimination based on their intersectional identities while accessing HIV preventative and treatment interventions. Available data demonstrate that Black MSM have higher HIV incidences than Black men who have sex with women (MSW) and White MSM, and low preexposure prophylaxis knowledge and HIV literacy. Black MSM experience significant disparities in HIV prevention and care knowledge, access, and use. Structural barriers, including anti-Black racism, homophobia, and xenophobia, are responsible for gaps in HIV prevention and care continuums, poor quality of care and linkage to HIV services, as well as a higher incidence of HIV. CONCLUSIONS Considering the lack of targeted interventions, there is a clear need for interventions that reduce HIV diagnoses among Black MSM, increase access and reduce structural barriers that significantly affect the ability of Black MSM to engage with HIV prevention and care, and address provider's capacity for care and the structural barriers. These findings can inform future interventions, programming, and tools that may alleviate this HIV inequity. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2020-043055.
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Affiliation(s)
- Jemal Demeke
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Pascal Djiadeu
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Abban Yusuf
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | | | - David Lightfoot
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Fiqir Worku
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Gamji Rabiu Abu-Ba'are
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, United States
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Sulaimon Giwa
- School of Social Work, St John's College, Memorial University of Newfoundland, St John's, NL, Canada
| | - LaRon E Nelson
- School of Nursing, Yale University, New Haven, CT, United States
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2
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Henningham M. Nowhere to bi: Barriers to belonging in the broader LGBTQ+ community for Aboriginal bi+ people in Australia. JOURNAL OF LESBIAN STUDIES 2023; 28:63-83. [PMID: 37652438 DOI: 10.1080/10894160.2023.2233339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Having a multiplicity of identities not only makes it difficult to find inclusive spaces for Aboriginal bisexual+ (bi) people but may often be a barrier to building connections and relationships with people who have other queer identities. Bi + identities alone are often rendered invisible, unintelligible or erased when it comes to inclusion and solidarity among their peers. An intersectional lens is used to reflexively investigate existing literature to explore how a lack of solidarity among lateral communities may impact Aboriginal bi + people in Australia who face an array of racism and queerphobia from both LGBTQ + and Aboriginal communities. These unique and multifaceted layers of discrimination greatly impact mental health and wellbeing. These experiences stem from the heterosexist and monosexist status quo from heteropatriarchal settler colonialism that is seen in both Aboriginal and LGBTQ + communities respectively. As a result, Aboriginal queer people are constantly surveying risks, policing their own identities and identity expression, often hiding parts of their identity as a survival strategy to avoid rejection and adhere to dominant cultural norms. When specifically considering Aboriginal bi + identities, there are added unique stressors of lateral violence with other LGBTQ + groups, antibisexual prejudice, and assumed monosexuality, adding additional layers of minority stress. The author explores these experiences by extending upon borderland theory and minority stress models. Whilst there is solace in the holistic celebration of intersecting identities in emerging intersectional Aboriginal queer spaces, there is still a great need for solidarity and celebration of Aboriginal bi + people within the broader LGBTQ + community.
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Affiliation(s)
- Mandy Henningham
- Department of Sociology and Social Policy, Faculty of Arts and Social Sciences, The University of Sydney, Camperdown, NSW, Australia
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3
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Silvestri F, Tilchin C, Wagner J, Hamill MM, Rompalo A, Ghanem KG, Schumacher C, Ruhs S, Greenbaum A, Latkin C, Jennings JM. Enacted Sexual Minority Stigma, Psychological Distress, and Sexual and Drug Risk Behaviors Among Urban Men Who Have Sex with Men (MSM). AIDS Behav 2023; 27:496-505. [PMID: 35831493 PMCID: PMC9908668 DOI: 10.1007/s10461-022-03784-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2022] [Indexed: 11/29/2022]
Abstract
Urban Black men who have sex with men (MSM) bear a disproportionate burden of HIV and syphilis in the U.S. Experiences of enacted sexual minority stigma and psychological distress among these men may be associated with HIV/STI sexual and drug risk behaviors. The objective was to determine the associations between enacted sexual minority stigma, psychological distress, and sexual and drug risk behaviors. In an urban prospective cohort study, survey measures assessed past 3-month exposure to enacted sexual minority stigma, psychological distress, and sexual and drug risk behaviors. Multivariable logistic regression models were utilized for hypothesis testing. The Black MSM (N = 140) reported the following: 22.1% experiences of enacted sexual minority stigma, 39% high levels of psychological distress, 48.6% > 1 sex partner, 8.6% transactional sex, and 6% injection drug use (IDU). In models adjusted for age and education, enacted sexual minority stigma significantly increased the odds of reporting > 1 sex partner, transactional sex, and IDU. Adjusting additionally for homelessness, the association between enacted sexual minority stigma and transactional sex remained significant. Adding psychological distress to this model showed a significant association between psychological distress and transactional sex, while the association was no longer significant for transactional sex. These findings highlight some of the complex psycho-social relationships that may be associated with sexual and drug risk behaviors among Black MSM placing them at increased risk for HIV and syphilis.
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Affiliation(s)
- Francesca Silvestri
- Center for Child and Community Health Research (CCHR), Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore City, MD USA ,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore City, MD USA
| | - Carla Tilchin
- Center for Child and Community Health Research (CCHR), Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore City, MD USA
| | - Jessica Wagner
- Center for Child and Community Health Research (CCHR), Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore City, MD USA
| | - Matthew M. Hamill
- Department of Infectious Disease, Johns Hopkins School of Medicine, Baltimore City, MD USA ,STI/HIV Program, Baltimore City Health Department, Baltimore City, MD USA
| | - Anne Rompalo
- Department of Infectious Disease, Johns Hopkins School of Medicine, Baltimore City, MD USA
| | - Khalil G. Ghanem
- Department of Infectious Disease, Johns Hopkins School of Medicine, Baltimore City, MD USA
| | - Christina Schumacher
- Center for Child and Community Health Research (CCHR), Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore City, MD USA
| | | | - Adena Greenbaum
- STI/HIV Program, Baltimore City Health Department, Baltimore City, MD USA
| | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore City, MD USA
| | - Jacky M. Jennings
- Center for Child and Community Health Research (CCHR), Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore City, MD USA ,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore City, MD USA
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4
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Reyes MES, Escote AMD, Ferrer AVC, Marpuri JKO, Santos ACDR, Torres RFE, Cayubit RFO, Bacaoco JRA. Suicidality among bisexual youths: the role of parental sexual orientation support and concealment. CURRENT PSYCHOLOGY 2022; 42:1-13. [PMID: 35967510 PMCID: PMC9358384 DOI: 10.1007/s12144-022-03474-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2022] [Indexed: 11/18/2022]
Abstract
Compared with the heterosexual population, the prevalence of mental health outcomes such as suicidality (suicidal ideation, suicide plans, and suicide attempts) is higher among sexual minority youth, particularly those who identify themselves as bisexuals. Bisexuals are at an even elevated risk within the LGB populations due to biphobia, monosexism, bisexual invisibility or erasure, and lack of support resources. These experiences may bring about issues regarding concealment of their sexual orientation linked to suicidality. Studies have also identified that parental support is a protective factor against suicidality among the youth, particularly their sexual orientation. The present study used a cross-sectional, predictive research design to examine parental sexual orientation support and concealment and their associations and predictive abilities in the suicidality of 151 Filipino bisexual youths aged 18-24 years old. The participants were recruited online within six months, from July 2021 to December 2021. As measured by the Parental Support for Sexual Orientation Scale, Sexual Orientation Concealment Scale, and Suicide Behaviors Questionnaire-Revised, results showed that among our bisexual participants, parental sexual orientation support and concealment did not have a significant relationship with and could not predict their risk for suicidality. Limitations and suggestions for further research were discussed, considering our findings.
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Affiliation(s)
- Marc Eric S. Reyes
- Department of Psychology, College of Science, University of Santo Tomas, 1008 Manila, Philippines
| | - Alyzza Meynell D. Escote
- Department of Psychology, College of Science, University of Santo Tomas, 1008 Manila, Philippines
| | | | - Judith Kate O. Marpuri
- Department of Psychology, College of Science, University of Santo Tomas, 1008 Manila, Philippines
| | | | | | - Ryan Francis O. Cayubit
- Department of Psychology, College of Science, University of Santo Tomas, 1008 Manila, Philippines
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A call for ACTion: A systematic review of empirical evidence for the use of Acceptance and Commitment Therapy (ACT) with LGBTQI+ individuals. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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6
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Tan KKH, Saw ATW. Prevalence and correlates of mental health difficulties amongst LGBTQ people in Southeast Asia: A systematic review. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2022. [DOI: 10.1080/19359705.2022.2089427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Kyle K. H. Tan
- Trans Health Research Lab, School of Psychology, University of Waikato, Hamilton, New Zealand
- Faculty of Māori and Indigenous Studies, University of Waikato, Hamilton, New Zealand
| | - Andrew T. W. Saw
- Labuan Faculty of International Finance, Univerisiti Malaysia Sabah, Sabah, Malaysia
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Metheny N, Stephenson R, Darbes LA, Chavanduka TMD, Essack Z, van Rooyen H. Correlates of Substance Misuse, Transactional Sex, and Depressive Symptomatology Among Partnered Gay, Bisexual and Other Men Who Have Sex with Men in South Africa and Namibia. AIDS Behav 2022; 26:2003-2014. [PMID: 34997385 DOI: 10.1007/s10461-021-03549-6] [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] [Accepted: 11/25/2021] [Indexed: 11/26/2022]
Abstract
Despite having some of the world's highest rates of HIV, there is a lack of knowledge on correlates of transmission risk among gay, bisexual and other men who have sex with men in Southern Africa. There is even less known about the factors that shape HIV risk in male-male couples. Using data from Together Tomorrow, a study of partnered GBMSM in South Africa and Namibia, this study assessed the individual and dyadic correlates of three major HIV risk factors in this population: substance misuse, transactional sex, and depressive symptomatology. Data were collected during November 2016-March 2017 via a quantitative survey conducted with 140 partnered MSM (70 couples) in Windohoek, Keetmanshoop, Walvis Bay, and Swakopmund, Namibia and 300 partnered MSM (150 couples) in Pietermaritzburg and Durban, KwaZulu-Natal, South Africa for a total sample size of 440 partnered MSM (220 couples). Results of multilevel modeling analyses show several significant factors present in partnered GBMSM that differ from studies of single GBMSM, with intimate partner violence being a significant correlate across all three risk factors. Future interventions should consider dyadic approaches and integrate IPV prevention and mitigation efforts to reduce HIV in this population as part of a multisectoral approach. To reduce rates of HIV in partnered GBMSM in Namibia and South Africa multilevel, multisectoral work is needed in policy, social norms change, and relationship-focused dyadic interventions to reduce the social and structural stigma facing male couples.
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Affiliation(s)
- Nicholas Metheny
- School of Nursing and Health Studies, University of Miami, 5030 Brunson Drive, Coral Gables, FL, 33146, USA.
| | - Rob Stephenson
- University of Michigan School of Nursing, Ann Arbor, MI, USA
- University of Michigan Center for Sexuality and Health Disparities, Ann Arbor, MI, USA
| | - Lynae A Darbes
- University of Michigan School of Nursing, Ann Arbor, MI, USA
- University of Michigan Center for Sexuality and Health Disparities, Ann Arbor, MI, USA
| | - Tanaka M D Chavanduka
- University of Michigan School of Nursing, Ann Arbor, MI, USA
- University of Michigan Center for Sexuality and Health Disparities, Ann Arbor, MI, USA
| | - Zaynab Essack
- Human Sciences Research Council of South Africa, Pretoria, Gauteng, South Africa
- School of Law, University of KwaZulu-Natal, KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Heidi van Rooyen
- Human Sciences Research Council of South Africa, Pretoria, Gauteng, South Africa
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
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8
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Korhonen CJ, Flaherty BP, Wahome E, Macharia P, Musyoki H, Battacharjee P, Kimani J, Doshi M, Mathenge J, Lorway RR, Sanders EJ, Graham SM. Validity and reliability of the Neilands sexual stigma scale among Kenyan gay, bisexual, and other men who have sex with men. BMC Public Health 2022; 22:754. [PMID: 35421967 PMCID: PMC9009048 DOI: 10.1186/s12889-022-13066-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 03/18/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
We evaluated the validity and reliability of the Neilands sexual stigma scale administered to 871 gay, bisexual, and other men who have sex with men (GBMSM) at two research locations in Kenya.
Methods
Using cross-validation, exploratory factor analysis (EFA) was performed on a randomly selected subset of participants and validated using confirmatory factor analysis (CFA) on the remaining participants. Associations of the initial and final stigma scale factors with depressive symptoms, alcohol use, and other substance use were examined for the entire dataset.
Results
EFA produced a two-factor scale of perceived and enacted stigma. The CFA model fit to the two-factor scale was improved after removing three cross-loaded items and adding correlated errors (chi-squared = 26.5, df 17, p = 0.07). Perceived stigma was associated with depressive symptoms (beta = 0.34, 95% CI 0.24, 0.45), alcohol use (beta = 0.14, 95% CI 0.03, 0.25) and other substance use (beta = 0.19, 95% CI 0.07, 0.31), while enacted stigma was associated with alcohol use (beta = 0.17, 95% CI 0.06, 0.27).
Conclusions
Our findings suggest enacted and perceived sexual stigma are distinct yet closely related constructs among GBMSM in Kenya and are associated with poor mental health and substance use.
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Torres TS, Luz PM, Bezerra DRB, Almeida-Brasil CC, Marins LMS, Veloso VG, Grinsztejn B, Harel D, Thombs BD. Translation and validation in Brazilian Portuguese of the reactions to homosexuality scale. PSYCHOL HEALTH MED 2021; 26:20-36. [PMID: 34219572 DOI: 10.1080/13548506.2021.1936580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Internalized homonegativity results from the acceptance of negative attitudes about one's same-sex orientation, which has negative consequences for the health of gay, bisexual and other men who have sex with men (GBM). We translated the 7-item Reactions to Homosexuality Scale (RHS) to Brazilian Portuguese and assessed its factor structure, validity and reliability. The first step included the translation, back-translation, evaluation, peer review, and pre-testing of the scale. Then, we piloted the scale in two convenience samples of adult Brazilians recruited online during October 2019 and February to March 2020 through advertisements on Grindr and Hornet, respectively. The largest sample was randomly split into two groups for exploratory factor analysis (EFA) then confirmatory factor analysis (CFA). Criterion and construct validity were assessed via correlations between scale scores and study variables. A total of 5573 GBM (sample 1: 218; sample 2: 5355) completed the RHS. EFA (N = 2652) yielded two eigenvalues greater than one (Factor 1: 3.5 and Factor 2: 1.1). A one-factor solution provided the most interpretable model based on examination of scree plot and item factor loadings (χ2(14) = 1373.1, p < 0.001; CFI = 0.89; TLI = 0.84; RMSEA = 0.19; SRMS = 0.09). Though one-factor CFA showed moderate fit, freeing errors terms to covary, based on item content and interpretation, significantly improved model fit (χ2(12) = 309.1, p < .001; CFI = 0.97; TLI = 0.96; RMSEA = 0.09; SRMR = 0.02). As hypothesized, men who did not self-identify as gay (mean score 17.9 compared to those self-identifying as gay: 11.8) and men who reported no sex with men in the past 6 months (mean score 12.6 compared to those who reported sex with men: 10.6) scored higher reflecting higher internalized homonegativity. The RHS was effectively translated and validated in Brazilian Portuguese and can be used to evaluate the role of internalized homonegativity on GBM's health, as well as its impact on the uptake of HIV prevention technologies.
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Affiliation(s)
- Thiago S Torres
- Laboratório de Pesquisa Clínica em DST e AIDS (LAPCLIN-AIDS), Instituto Nacional De Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio De Janeiro, Brazil
| | - Paula M Luz
- Laboratório de Pesquisa Clínica em DST e AIDS (LAPCLIN-AIDS), Instituto Nacional De Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio De Janeiro, Brazil
| | - Daniel R B Bezerra
- Laboratório de Pesquisa Clínica em DST e AIDS (LAPCLIN-AIDS), Instituto Nacional De Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio De Janeiro, Brazil
| | - Celline C Almeida-Brasil
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Luana M S Marins
- Laboratório de Pesquisa Clínica em DST e AIDS (LAPCLIN-AIDS), Instituto Nacional De Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio De Janeiro, Brazil
| | - Valdilea G Veloso
- Laboratório de Pesquisa Clínica em DST e AIDS (LAPCLIN-AIDS), Instituto Nacional De Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio De Janeiro, Brazil
| | - Beatriz Grinsztejn
- Laboratório de Pesquisa Clínica em DST e AIDS (LAPCLIN-AIDS), Instituto Nacional De Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio De Janeiro, Brazil
| | - Daphna Harel
- Department of Applied Statistics, Social Science, and Humanities, New York University, New York, NY, USA.,Center for Practice and Research and the Intersection of Information, Society, and Methodology, New York University, New York, NY, USA
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Departments of Psychiatry; Epidemiology, Biostatistics and Occupational Health; Medicine; Psychology; Educational and Counselling Psychology, and Biomedical Ethics Unit, McGill University, Montréal, Québec, Canada
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Turpin R, Dyer T, Watson L, Mayer K. Classes of Sexual Identity, Homophobia, and Sexual Risk among Black Sexual Minorities in HPTN 061. JOURNAL OF SEX RESEARCH 2021; 58:638-647. [PMID: 33630695 PMCID: PMC8154646 DOI: 10.1080/00224499.2021.1886228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Homophobia is associated with sexual risk among sexual minorities, including Black sexual minority men, though experienced homophobia may differ across sexual identities. We conducted latent class analysis of sexual identities and experienced homophobia associated with sexual risk, and tested mediators of this association. We used longitudinal data from the HIV Prevention Trials Network Study 061 (n = 1,553). We generated rate ratios between baseline latent classes of experienced homophobia and sexual identity and 12-month outcomes: Condomless receptive anal intercourse (CRAI), number of partners, and transactional sex. Mediators included 6-month internalized homophobia, depression, social support, and substance use. We selected the following 7-class model: "Bisexual, rare homophobia" (reference), "Mixed identities, mixed homophobia", "Bisexual, frequent homophobia", "Heterosexual/Same-gender loving, frequent homophobia", "Gay, frequent homophobia", " Gay/Same-gender loving, frequent homophobia," and "Gay, rare homophobia." All other classes had greater CRAI than the reference. For bisexual/mixed/heterosexual classes, approximately 20% of this association was positively mediated through our mediators (p < .05). The Heterosexual/Same-gender loving class had the largest proportion mediated through internalized homophobia. For gay-identifying classes, mediation was marginally significant (.05 < p < .10). Classes of sexual identity and experienced homophobia were associated with CRAI among Black sexual minority men, partially mediated through internalized homophobia, depression, social support, and substance use.
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Affiliation(s)
- Rodman Turpin
- Department of Epidemiology and Biostatistics, University of Maryland at College Park, School of Public Health, College Park, MD
| | - Typhanye Dyer
- Department of Epidemiology and Biostatistics, University of Maryland at College Park, School of Public Health, College Park, MD
| | - Lakeshia Watson
- Department of Epidemiology and Biostatistics, University of Maryland at College Park, School of Public Health, College Park, MD
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Torres TS, Luz PM, Marins LMS, Bezerra DRB, Almeida-Brasil CC, Veloso VG, Grinsztejn B, Harel D, Thombs BD. Cross-cultural adaptation of the Perceived Risk of HIV Scale in Brazilian Portuguese. Health Qual Life Outcomes 2021; 19:117. [PMID: 33836775 PMCID: PMC8033701 DOI: 10.1186/s12955-021-01760-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 03/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Valid and reliable instruments are needed to measure the multiple dimensions of perceived risk. The Perceived Risk of HIV Scale is an 8-item measure that assesses how people think and feel about their risk of infection. We set out to perform a cross-cultural adaptation of the scale to Brazilian Portuguese among key populations (gay, bisexual and other men who have sex with men and transgender/non-binary) and other populations (cisgender heterosexual men and cisgender women). METHODS Methodological study with cross-sectional design conducted online during October/2019 (key populations [sample 1] and other populations) and February-March/2020 (key populations not on pre-exposure prophylaxis [sample 2]). Cross-cultural adaptation of the Perceived Risk of HIV Scale followed Beaton et al. 2000 guidelines and included confirmatory factor analysis, differential item functioning (DIF) using the Multiple-Indicator Multiple-Cause model, and concurrent validity to verify if younger individuals, those ever testing for HIV, and engaging in high-risk behaviors had higher scores on the scale. RESULTS 4342 participants from key populations (sample 1 = 235; sample 2 = 4107) and 155 participants from other populations completed the measure. We confirmed the single-factor structure of the original measure (fit indices for sample 1 plus other populations: CFI = 0.98, TLI = 0.98, RMSEA = 0.07; sample 2 plus other populations: CFI = 0.97, TLI = 0.95, RMSEA = 0.09). For the comparisons between key populations and other populations, three items (item 2: "I worry about getting infected with HIV", item 4: "I am sure I will not get infected with HIV", and item 8: "Getting HIV is something I have") exhibited statistically significant DIF. Items 2 and 8 were endorsed at higher levels by key populations and item 4 by other populations. However, the effect of DIF on overall scores was negligible (0.10 and 0.02 standard deviations for the models with other populations plus sample 1 and 2, respectively). Those ever testing for HIV scored higher than those who never tested (p < .001); among key populations, those engaging in high-risk behaviors scored higher than those reporting low-risk. CONCLUSION The Perceived Risk of HIV Scale can be used among key populations and other populations from Brazil.
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Affiliation(s)
- Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil.
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Luana M S Marins
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Daniel R B Bezerra
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | | | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Daphna Harel
- Department of Applied Statistics, Social Science, and Humanities, New York University, New York, NY, USA
- Center for Practice and Research and the Intersection of Information, Society, and Methodology, New York University, New York, NY, USA
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Departments of Psychiatry; Epidemiology, Biostatistics and Occupational Health; Medicine; Psychology; Educational and Counselling Psychology, and Biomedical Ethics Unit, McGill University, Montréal, Québec, Canada
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12
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Jolley D, Jaspal R. Discrimination, HIV conspiracy theories and pre-exposure prophylaxis acceptability in gay men. Sex Health 2020; 17:525-533. [PMID: 33341121 DOI: 10.1071/sh20154] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/21/2020] [Indexed: 11/23/2022]
Abstract
Background Combination prevention, which includes pre-exposure prophylaxis (PrEP), is essential for achieving the zero HIV infections target in the UK by 2030. It is important to assess attitudes towards PrEP in at-risk populations. This study focuses on the effect of discrimination and HIV conspiracy theorising on attitudes towards PrEP in gay men in the UK. METHODS In total, 244 White British gay men completed a survey that included demographic questions and measures of sexual health screening, hypervigilance, sexual orientation discrimination, quality of contact with healthcare professionals, belief in conspiracy theories and attitudes towards PrEP. Data were analysed using multiple linear regression and mediation analysis. RESULTS Discrimination was positively correlated with HIV conspiracy beliefs and negatively correlated with PrEP acceptance. Mediation analyses demonstrated that the relationship between discrimination and attitudes towards PrEP was explained by HIV conspiracy theorising. Gay men who had attended a sexual health screening (vs never attended) reported higher belief in HIV conspiracy theories. A further mediation analysis showed that reported poor contact with a healthcare professional was associated with an increased belief in HIV conspiracy theories, which was associated with negative attitudes towards PrEP. Both perceived discrimination and poor contact with a healthcare professional were exacerbated by hypervigilance. CONCLUSIONS HIV conspiracy theorising is an important variable in understanding attitudes towards PrEP among gay men. Its roots are in adverse social experiences (e.g. discrimination, poor contact with healthcare professionals) and its consequences may be the rejection of PrEP. HIV prevention and PrEP campaigns must focus on prejudice reduction and on challenging conspiracy beliefs.
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Affiliation(s)
- Daniel Jolley
- Department of Psychology, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK; and Corresponding author.
| | - Rusi Jaspal
- School of Social Sciences, Nottingham Trent University, Nottingham, NG1 4FQ, UK
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13
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Sanchez C, Grzenda A, Varias A, Widge AS, Carpenter LL, McDonald WM, Nemeroff CB, Kalin NH, Martin G, Tohen M, Filippou-Frye M, Ramsey D, Linos E, Mangurian C, Rodriguez CI. Social media recruitment for mental health research: A systematic review. Compr Psychiatry 2020; 103:152197. [PMID: 32992073 PMCID: PMC7704547 DOI: 10.1016/j.comppsych.2020.152197] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/14/2020] [Accepted: 08/06/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Social media holds exciting promise for advancing mental health research recruitment, however, the extent and efficacy to which these platforms are currently in use are underexplored. OBJECTIVE A systematic review was conducted to characterize the current use and efficacy of social media in recruiting participants for mental health research. METHOD A literature review was performed using MEDLINE, EMBASE, and PsychINFO. Only non-duplicative manuscripts written in the English language and published between 1/1/2004-3/31/2019 were selected for further screening. Data extracted included study type and design, participant inclusion criteria, social media platform, advertising strategy, final recruited sample size, recruitment location, year, monetary incentives, comparison to other recruitment methods if performed, and final cost per participant. RESULTS A total of 176 unique studies that used social media for mental health research recruitment were reviewed. The majority of studies were cross-sectional (62.5%) in design and recruited adults. Facebook was overwhelmingly the recruitment platform of choice (92.6%), with the use of paid advertisements being the predominant strategy (60.8%). Of the reviewed studies, substance abuse (43.8%) and mood disorders (15.3%) were the primary subjects of investigation. In 68.3% of studies, social media recruitment performed as well as or better than traditional recruitment methods in the number and cost of final enrolled participants. The majority of studies used Facebook for recruitment at a median cost per final recruited study participant of $19.47. In 55.6% of the studies, social media recruitment was the more cost-effective recruitment method when compared to traditional methods (e.g., referrals, mailing). CONCLUSION Social media appears to be an effective and economical recruitment tool for mental health research. The platform raises methodological and privacy concerns not covered in current research regulations that warrant additional consideration.
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Affiliation(s)
- Catherine Sanchez
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Adrienne Grzenda
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Andrea Varias
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Alik S Widge
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, MN, USA
| | - Linda L Carpenter
- Department of Psychiatry and Human Behavior, Butler Hospital and Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - William M McDonald
- Department of Psychiatry and Human Behavior, Emory University School of Medicine, Atlanta, GA, USA
| | - Charles B Nemeroff
- Department of Psychiatry, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Ned H Kalin
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Glenn Martin
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mauricio Tohen
- Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Maria Filippou-Frye
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Drew Ramsey
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Eleni Linos
- Department of Dermatology, Stanford University, Stanford, CA, USA
| | - Christina Mangurian
- Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA; UCSF Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA; UCSF Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Carolyn I Rodriguez
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
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14
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Oginni OA, Mapayi BM, Afolabi OT, Obiajunwa C, Oloniniyi IO. Internalized Homophobia, Coping, and Quality of Life Among Nigerian Gay and Bisexual Men. JOURNAL OF HOMOSEXUALITY 2020; 67:1447-1470. [PMID: 30977714 DOI: 10.1080/00918369.2019.1600899] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Despite high levels of homophobia in Nigeria, no studies have investigated the quality of life (QOL) of Nigerian gay and bisexual (GB) men. The associations between QOL and minority stress may differ from those reported in developed countries and may indicate alternative interventions. This study investigated internalized homophobia (IH) and coping strategies among gay and bisexual men in Nigeria and the relationships with overall QOL. Eighty-nine GB men were recruited with a snowball sampling technique. QOL (outcome), IH (predictor) and coping strategies (covariates) were assessed using standardized questionnaires. Relationships were investigated using linear regression analyses. Participants used adaptive more frequently than maladaptive coping strategies. The relationship between IH and QOL was nonlinear (β = -0.27, 95% CI = -0.48, -0.06), and the positive component was attenuated by adaptive coping strategies. Adaptive strategies can be reinforced as a therapeutic intervention to improve wellbeing among gay and bisexual men in Nigeria.
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Affiliation(s)
- Olakunle A Oginni
- Departmental of Mental Health, Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University , Ile-Ife, Nigeria
- Mental Health Unit, Obafemi Awolowo University Teaching Hospitals Complex , Ile-Ife, Osun, Nigeria
| | - Boladale M Mapayi
- Departmental of Mental Health, Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University , Ile-Ife, Nigeria
- Mental Health Unit, Obafemi Awolowo University Teaching Hospitals Complex , Ile-Ife, Osun, Nigeria
| | - Olusegun T Afolabi
- Departmental of Community Health, Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University , Ile-Ife, Nigeria
| | - Chukwubueze Obiajunwa
- Departmental of Mental Health, Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University , Ile-Ife, Nigeria
| | - Ibidunni O Oloniniyi
- Departmental of Mental Health, Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University , Ile-Ife, Nigeria
- Mental Health Unit, Obafemi Awolowo University Teaching Hospitals Complex , Ile-Ife, Osun, Nigeria
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15
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McCann E, Brown M. Psychosocial Needs of Bisexual People: Findings from a Mixed-Methods Research Study. Issues Ment Health Nurs 2020; 41:691-699. [PMID: 32357305 DOI: 10.1080/01612840.2019.1710007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
More attention has recently been paid to the unique experiences and health needs of LGBTQ + people. To date, there has been a limited focus on the distinct psychosocial needs of bisexuals. A larger mixed-methods study explored the wider needs of a LGBTQ + cohort. The aim of this paper is to report the specific experiences of bisexuals and highlight their distinct psychosocial issues and concerns. The online survey instrument contained Likert-scale and qualitative questions and was completed by a total sample of LGBT people (n = 125), of which 19 participants self-identified as bisexual. The qualitative responses of the bisexuals were extracted and analyzed separately to identify emergent themes that were: accessing responsive services, culturally competent services, supports and interventions, and knowledge, skills and confidence. The study findings inform and enhance the understanding of the issues that impact upon the health and well-being of bisexuals, thereby contributing to promoting the wider social inclusion and human rights agenda by guiding mental health service developments, policy initiatives, education provision and future research.
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Affiliation(s)
- Edward McCann
- School of Nursing and Midwifery, University of Dublin, Trinity College, Dublin, Ireland
| | - Michael Brown
- School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland, UK
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16
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Nemoto T, Xie H, Iwamoto M, Sakata M. HIV Risk Behaviors in Relation to Psychosocial Factors and Internet Usage Among Asian and Pacific Islander (API) Men Who Had Sex With Men (MSM) in California. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2020; 32:117-136. [PMID: 32539477 DOI: 10.1521/aeap.2020.32.2.117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Very few studies have been conducted to investigate HIV risk and protective behaviors in relation to psychosocial factors among Asian and Pacific Islander (API) MSM whose HIV/AIDS prevalence is lower than those of other racial/ethnic groups. This study, based on an online survey targeting API MSM in California revealed that API MSM often met sex partners online and that psychosocial factors (e.g., homophobia and identity with API gay community) were correlated with condomless receptive anal sex (RAS) with casual partners. In particular, an Asian cultural construct, interdependency, was correlated with condom use for RAS; that is, those who consider sex partners' health and value harmony tend to engage in safe sex. This finding sheds light on re-thinking the current over-emphasis on assertiveness and self-responsibility to keep free from HIV/STIs during negotiation with partners. Future STI prevention programs for API MSM should incorporate Asian cultural constructs and target specific risk groups.
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17
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Robineau O, Gomes MFC, Kendall C, Kerr L, Périssé A, Boëlle PY. Model-based Respondent-driven sampling analysis for HIV prevalence in brazilian MSM. Sci Rep 2020; 10:2646. [PMID: 32060389 PMCID: PMC7021777 DOI: 10.1038/s41598-020-59567-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/17/2020] [Indexed: 11/09/2022] Open
Abstract
Respondent Driven Sampling study (RDS) is a population sampling method developed to study hard-to-reach populations. A sample is obtained by chain-referral recruitment in a network of contacts within the population of interest. Such self-selected samples are not representative of the target population and require weighing observations to reduce estimation bias. Recently, the Network Model-Assisted (NMA) method was described to compute the required weights. The NMA method relies on modeling the underlying contact network in the population where the RDS was conducted, in agreement with directly observable characteristics of the sample such as the number of contacts, but also with more difficult-to-measure characteristics such as homophily or differential characteristics according to the response variable. Here we investigated the use of the NMA method to estimate HIV prevalence from RDS data when information on homophily is limited. We show that an iterative procedure based on the NMA approach allows unbiased estimations even in the case of strong population homophily and differential activity and limits bias in case of preferential recruitment. We applied the methods to determine HIV prevalence in men having sex with men in Brazilian cities and confirmed a high prevalence of HIV in these populations from 3.8% to 22.1%.
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Affiliation(s)
- Olivier Robineau
- INSERM, Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique, F75012, Paris, France. .,Service Universitaire des Maladies Infectieuses et du Voyageur, Tourcoing, France.
| | - Marcelo F C Gomes
- Fundação Oswaldo Cruz (Fiocruz), Programa de Computação Cientifica, Rio de Janeiro, Brazil
| | - Carl Kendall
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Ligia Kerr
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - André Périssé
- Fundação Oswaldo Cruz (Fiocruz), Escola Nacional de Saúde Pública Sergio Arouca (ENSP), Departamento de Ciências Biológicas, Rio de Janeiro, RJ, Brazil
| | - Pierre-Yves Boëlle
- INSERM, Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique, F75012, Paris, France.,Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, Santé publique, F75012, Paris, France
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18
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Mann AJ, Patel TA, Elbogen EB, Calhoun PS, Kimbrel NA, Wilson SM. Sexual orientation, attraction and risk for deliberate self-harm: Findings from a nationally representative sample. Psychiatry Res 2020; 286:112863. [PMID: 32086030 PMCID: PMC7887939 DOI: 10.1016/j.psychres.2020.112863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/08/2020] [Accepted: 02/08/2020] [Indexed: 10/25/2022]
Abstract
To date, there has been limited investigation identifying predictors of deliberate self-harm (DSH) among sexual minority adults. The present study examined the likelihood of DSH by sexual minority status as measured by self-reported sexual identity and sexual attraction in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Among respondents who answered both the sexual identity and attraction items on the NESARC (N = 34,273), the link between sexual minority status and DSH was examined. Univariate analyses yielded greater risk of DSH for all sexual minority identities compared to heterosexual identity. Individuals with same-sex only attraction did not differ from those with different-sex only attraction. At the multivariate level, respondents reporting bisexual and unsure identity and bisexual attraction were at two to three times greater risk of DSH compared to their heterosexual/different-sex counterparts. Same-sex attracted and gay/lesbian individuals did not differ from different-sex attracted or heterosexual individuals in adjusted multivariate models. Findings from this nationally representative sample are consistent with previous research suggesting that sexual minority status is a risk factor for DSH. There is a vital need to incorporate varying measures of sexual minority status within research and in clinics, as well as to inquire about DSH among sexual minorities.
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Affiliation(s)
- Adam J Mann
- Durham Veterans Affairs Medical Center, Durham, NC, USA; Duke University Medical Center, Durham, NC, USA.
| | - Tapan A Patel
- Durham Veterans Affairs Medical Center, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA
| | - Eric B Elbogen
- Durham Veterans Affairs Medical Center, Durham, NC, USA; Duke University Medical Center, Durham, NC, USA
| | - Patrick S Calhoun
- Durham Veterans Affairs Medical Center, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA; Duke University Medical Center, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Nathan A Kimbrel
- Durham Veterans Affairs Medical Center, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA; Duke University Medical Center, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Sarah M Wilson
- Durham Veterans Affairs Medical Center, Durham, NC, USA; Duke University Medical Center, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
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19
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Cheung F, Chan W. Sexual Identity Management Strategies and Occupational Well-Being: A Latent Profile Analysis. JOURNAL OF CAREER DEVELOPMENT 2019. [DOI: 10.1177/0894845319856113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this study, we adopted the latent profile analysis (LPA) to examine whether the sexual identity management profiles relate to different occupational well-being including job satisfaction, emotional exhaustion, and depressive symptoms. A total of 225 Hong Kong Chinese full-time employees were recruited online. Four profiles were identified, namely, passive ( n = 31), integration dominant ( n = 81), hiding ( n = 21), and balanced ( n = 92). Results suggest that integration-dominant employees tended to report higher job satisfaction but lower emotional exhaustion and depressive symptoms. In contrast, employees with hiding profiles (i.e., high on counterfeiting and avoidance but low on integration) reported the lowest job satisfaction and highest emotional exhaustion and depressive symptoms. The limitations and implications of this study were also discussed.
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Affiliation(s)
- Francis Cheung
- Department of Applied Psychology, Lingnan University, Tuen Mun, Hong Kong
| | - Whywhy Chan
- Department of Applied Psychology, Lingnan University, Tuen Mun, Hong Kong
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20
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Marsack J, Stephenson R. Barriers to End-of-Life Care for LGBT Persons in the Absence of Legal Marriage or Adequate Legal Documentation. LGBT Health 2018; 5:273-283. [PMID: 29920158 DOI: 10.1089/lgbt.2016.0182] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
End-of-life care has attracted increased attention in recent years due to increases in both the number and mean age of the world's population; however, the experiences of LGBT persons during end-of-life care remain understudied. Given the health disparities and barriers to care experienced throughout the life course of LGBT persons, the frequent involvement of legal spouses in end-of-life care, and the recency of marriage equality, it can be surmised that LGBT persons might experience significantly different barriers to their desired end-of-life care compared to their heterosexual and cisgender counterparts. This article aims to synthesize what is known about these barriers, particularly in the absence of legal marriage or protective legal documentation. Of two hundred and twelve articles reviewed, twenty-three were included for analysis. Common barriers that emerged were discriminatory laws (e.g., prohibitions against same-sex marriage) and policies, lack of decision-making capacity, lack of knowledge regarding patient wishes, lack of visitation rights, challenges from biological next of kin, and discrimination and psychological distress. Recommendations for future research are provided based on gaps that were identified. These include increased research on transgender persons and bisexual persons, and on providers of end-of-life care. In addition, the recommendations take into account that important legislative and policy changes occurred after the period in which the studies reviewed here were published. The impact of those changes cannot be reported in this study and should be determined by future studies. This synthesis provides the contextual understanding necessary for research and improvement in this vastly understudied area.
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Affiliation(s)
- Jessica Marsack
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, and The Center for Sexuality and Health Disparities, University of Michigan , Ann Arbor, Michigan
| | - Rob Stephenson
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, and The Center for Sexuality and Health Disparities, University of Michigan , Ann Arbor, Michigan
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21
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Epstein FR, Fershtman CS. Emerging Narratives Affecting Gay Relationship Development and Commitment. JOURNAL OF HUMANISTIC PSYCHOLOGY 2018. [DOI: 10.1177/0022167818779507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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22
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Measurements of Sexuality-Based Stigma among Gay, Bisexual, and Other Men Who Have Sex with Men (GBMSM) in Resource-Poor Settings: A Review. AIDS Behav 2018; 22:1614-1638. [PMID: 29128941 DOI: 10.1007/s10461-017-1975-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Gay, bisexual, and other men who have sex with men (GBMSM) in resource-poor settings are disproportionately affected by the HIV/AIDS epidemic. GBMSM living in these settings may face unique barriers to HIV prevention, including legal barriers and increased sexuality-based stigma. It is therefore imperative to tailor HIV prevention and care resources to recognize the lived realities of GBMSM in these settings. Central to this is the accurate measurement of sexuality-based stigma. However, there is wide inconsistency in how sexuality-based stigma is measured among GBMSM in resource-poor settings. This paper reviews recent studies of sexuality-based stigma among GBMSM in resource-poor settings, finding great variability in measurements. The results of the review call for greater attention to the development of contextually and culturally specific measures of sexuality-based stigma for GBMSM living in resource-poor settings.
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Pollard A, Nadarzynski T, Llewellyn C. Syndemics of stigma, minority-stress, maladaptive coping, risk environments and littoral spaces among men who have sex with men using chemsex. CULTURE, HEALTH & SEXUALITY 2018; 20:411-427. [PMID: 28741417 DOI: 10.1080/13691058.2017.1350751] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
There has been a steep rise in the use of drugs during sex (chemsex) by some men who have sex with men in economically developed countries, with associated increases in sexual risk for HIV and other STIs. This paper presents data from telephone interviews with 15 men attending sexual health clinics for post-exposure prophylaxis following a chemsex-related risk for HIV and discusses some of the theoretical approaches that have been employed to understand chemsex and inform interventions. Interviews were conducted as part of a larger intervention study, which used an adapted version of motivational Interviewing to explore risk behaviour and support change. Participants conceptualised their chemsex and HIV-related risks in a psycho-social context, highlighting the influences of psycho-socio-cultural challenges of homophobic marginalisation and the 'gay scene' on behaviour. Multiple influences of stigma, marginalisation, minority stress and maladaptive coping (including drug-use) contribute to syndemic 'risk-environments' and 'littoral spaces' in which chemsex and risk behaviours are played out.
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Affiliation(s)
- Alex Pollard
- a Department of Primary Care and Public Health, Brighton & Sussex Medical School , University of Sussex , Brighton , UK
| | - Tom Nadarzynski
- a Department of Primary Care and Public Health, Brighton & Sussex Medical School , University of Sussex , Brighton , UK
| | - Carrie Llewellyn
- a Department of Primary Care and Public Health, Brighton & Sussex Medical School , University of Sussex , Brighton , UK
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Abstract
Over the past two decades research has consistently found that bisexual people experience poorer mental health than their gay, lesbian or heterosexual counterparts. The reasons behind this high prevalence of poor mental health remain under-researched and largely unknown. In order to improve these outcomes, more research is critically needed with the aim of providing new knowledge upon which health care provision and policy development can be based. This article presents an analysis of the literature to date relating to bisexuality broadly and bisexual mental health specifically, with the aim of providing direction for future research projects.
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Affiliation(s)
- Julia Taylor
- a PhD Candidate, Australian Research Centre in Sex, Health and Society , La Trobe University , Melbourne , Victoria , Australia
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25
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Abstract
Many models of queer sexuality continue to depict a linear narrative of sexual development, beginning in repression/concealment and eventuating in coming out. The present study sought to challenge this by engaging in a hermeneutically informed thematic analysis of interviews with eight queer people living in Western Australia. Four themes were identified: "searching for identity," "society, stigma, and self," "sexual self-discovery," and "coming in." Interviewees discussed internalized homophobia and its impact on their life; experiences and implications of finding a community and achieving a sense of belonging; the concept of sexual self-discovery being a lifelong process; and sexuality as fluid, dynamic, and situational rather than static. The article concludes by suggesting that the idea of "coming in"-arriving at a place of acceptance of one's sexuality, regardless of its fluidity or how it is viewed by society-offers considerable analytic leverage for understanding the journeys of sexual self-discovery of queer-identified people.
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Affiliation(s)
- Shoshana Rosenberg
- a Department of Sexology, School of Public Health , Curtin University , Perth , Western Australia , Australia
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26
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Wolowic JM, Heston LV, Saewyc EM, Porta C, Eisenberg ME. Chasing the rainbow: lesbian, gay, bisexual, transgender and queer youth and pride semiotics. CULTURE, HEALTH & SEXUALITY 2017; 19:557-571. [PMID: 27829321 PMCID: PMC5378595 DOI: 10.1080/13691058.2016.1251613] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
While the pride rainbow has been part of political and social intervention for decades, few have researched how lesbian, gay, bisexual, transgender and queer young people perceive and use the symbol. How do lesbian, gay, bisexual, transgender and queer youth who experience greater feelings of isolation and discrimination than heterosexual youth recognise and deploy the symbol? As part of a larger study on supportive lesbian, gay, bisexual, transgender and queer youth environments, we conducted 66 go-along interviews with lesbian, gay, bisexual, transgender and queer youth people from Massachusetts, Minnesota and British Columbia. During interviews, young people identified visible symbols of support, including recognition and the use of the pride rainbow. A semiotic analysis reveals that young people use the rainbow to construct meanings related to affiliation and positive feelings about themselves, different communities and their futures. Constructed and shared meanings help make the symbol a useful tool for navigating social and physical surroundings. As part of this process, however, young people also recognize that there are limits to the symbolism; it is useful for navigation but its display does not always guarantee supportive places and people. Thus, the pride rainbow connotes safety and support, but using it as a tool for navigation is a learned activity that requires caution.
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Affiliation(s)
- Jennifer M. Wolowic
- School of Nursing, Stigma and Resilience Among Vulnerable Youth Centre, University of British Columbia, Vancouver, Canada
| | - Laura V. Heston
- Department of Sociology, University of Massachusetts, Amherst, USA
| | - Elizabeth M. Saewyc
- School of Nursing, Stigma and Resilience Among Vulnerable Youth Centre, University of British Columbia, Vancouver, Canada
| | - Carolyn Porta
- School of Nursing, University of Minnesota, Minneapolis, USA
| | - Marla E. Eisenberg
- Department of Pediatrics, Division of General Pediatrics and Adolescent Health, University of Minnesota, Minneapolis, USA
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27
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Hall EW, Sanchez TH, Stein AD, Stephenson R, Zlotorzynska M, Sineath RC, Sullivan PS. Use of Videos Improves Informed Consent Comprehension in Web-Based Surveys Among Internet-Using Men Who Have Sex With Men: A Randomized Controlled Trial. J Med Internet Res 2017; 19:e64. [PMID: 28264794 PMCID: PMC5359419 DOI: 10.2196/jmir.6710] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/07/2016] [Accepted: 02/08/2017] [Indexed: 11/23/2022] Open
Abstract
Background Web-based surveys are increasingly used to capture data essential for human immunodeficiency virus (HIV) prevention research. However, there are challenges in ensuring the informed consent of Web-based research participants. Objective The aim of our study was to develop and assess the efficacy of alternative methods of administering informed consent in Web-based HIV research with men who have sex with men (MSM). Methods From July to September 2014, paid advertisements on Facebook were used to recruit adult MSM living in the United States for a Web-based survey about risk and preventive behaviors. Participants were randomized to one of the 4 methods of delivering informed consent: a professionally produced video, a study staff-produced video, a frequently asked questions (FAQs) text page, and a standard informed consent text page. Following the behavior survey, participants answered 15 questions about comprehension of consent information. Correct responses to each question were given a score of 1, for a total possible scale score of 15. General linear regression and post-hoc Tukey comparisons were used to assess difference (P<.001) in mean consent comprehension scores. A mediation analysis was used to examine the relationship between time spent on consent page and consent comprehension. Results Of the 665 MSM participants who completed the comprehension questions, 24.2% (161/665) received the standard consent, 27.1% (180/665) received the FAQ consent, 26.8% (178/665) received the professional consent video, and 22.0% (146/665) received the staff video. The overall average consent comprehension score was 6.28 (SD=2.89). The average consent comprehension score differed significantly across consent type (P<.001), age (P=.04), race or ethnicity (P<.001), and highest level of education (P=.001). Compared with those who received the standard consent, comprehension was significantly higher for participants who received the professional video consent (score increase=1.79; 95% CI 1.02-2.55) and participants who received the staff video consent (score increase=1.79; 95% CI 0.99-2.59). There was no significant difference in comprehension for those who received the FAQ consent. Participants spent more time on the 2 video consents (staff video median time=117 seconds; professional video median time=115 seconds) than the FAQ (median=21 seconds) and standard consents (median=37 seconds). Mediation analysis showed that though time spent on the consent page was partially responsible for some of the differences in comprehension, the direct effects of the professional video (score increase=0.93; 95% CI 0.39-1.48) and the staff-produced video (score increase=0.99; 95% CI 0.42-1.56) were still significant. Conclusions Video-based consent methods improve consent comprehension of MSM participating in a Web-based HIV behavioral survey. This effect may be partially mediated through increased time spent reviewing the consent material; however, the video consent may still be superior to standard consent in improving participant comprehension of key study facts. Trail Registration Clinicaltrials.gov NCT02139566; https://clinicaltrials.gov/ct2/show/NCT02139566 (Archived by WebCite at http://www.webcitation.org/6oRnL261N).
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Affiliation(s)
- Eric William Hall
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Travis H Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Aryeh D Stein
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Rob Stephenson
- Department of Health Behavior and Biological Sciences, School of Nursing and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, GA, United States
| | - Maria Zlotorzynska
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Robert Craig Sineath
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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Schwitters A, Sondag KA. The lives and sexual risk behaviours of rural, closeted men who have sex with men living in Montana. CULTURE, HEALTH & SEXUALITY 2017; 19:121-134. [PMID: 27684113 DOI: 10.1080/13691058.2016.1211739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The current study investigated the role of the rural environment in shaping men's decisions to remain closeted about their same-sex sexual activity and the cognitive, affective and behavioural consequences of that decision. In-depth qualitative interviews were conducted with 45 self-identified closeted men who have sex with men living in Montana. Because of the difficulty of finding closeted men, recruitment occurred using the Internet. Interviews were analysed to elicit overall themes influencing men's lives. An Outness Inventory was administered to determine men's perceived level of being 'out' to others. Men reported high levels of stress related to their need to live a double life in an attempt to conform to perceptions of masculinity within the rural cultural environment. Fear of being outed led men to seek out-of-town or out-of-state sexual partners indicating widespread sexual networks and increased risk for HIV infection. While men felt they were able to interact with their communities on a superficial level, many stressed their desire for a deeper sense of connection and social support. The majority of men in this study dreamed of a day when they could express their whole identity without fear.
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Affiliation(s)
- Amee Schwitters
- a Department of Anthropology , University of Montana , Missoula , USA
| | - K Ann Sondag
- b Department of Health and Human Performance , University of Montana , Missoula , USA
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Wakefield JRH, Kalinauskaite M, Hopkins N. The Nation and the Family: The Impact of National Identification and Perceived Importance of Family Values on Homophobic Attitudes in Lithuania and Scotland. SEX ROLES 2016; 75:448-458. [PMID: 27909383 PMCID: PMC5112283 DOI: 10.1007/s11199-016-0641-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The meanings attached to the nation can be consequential for group members' attitudes and beliefs. We examined how national identity definition can influence the extent of individuals' homophobia with 159 Lithuanian and 176 Scottish university students who completed a questionnaire which measured their national identification, homophobia, and the extent to which they felt traditional family values were central to their nation's identity. Consistent with nation-wide differences in the significance given to the family, Lithuanian participants perceived family values to be more important for their national identity and expressed higher levels of homophobia than did Scottish participants. Moreover, the relationship between level of national identification and homophobia was stronger in Lithuania than in Scotland. Analyses revealed that the perceived importance of family values helped explain the difference between homophobia levels in Lithuania and Scotland. In both sites we found an indirect effect of national identification on homophobia via the perceived importance of family values, but this effect was significantly stronger for Lithuanian participants. These findings illustrate the ways in which identification with the nation is relevant to attitudes concerning sexuality, and how this varies according to national context. Our work indicates that LGBT rights campaigns should be informed by the knowledge that homophobia may be perpetuated by national valorisation of the family.
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Affiliation(s)
- Juliet R H Wakefield
- Division of Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, NG1 4BU UK
| | | | - Nick Hopkins
- Psychology, School of Social Sciences, University of Dundee, Dundee, DD1 4HN UK
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Ntozini A, Ngqangweni H. Gay Xhosa men's experiences of ulwaluko (traditional male initiation). CULTURE, HEALTH & SEXUALITY 2016; 18:1309-1318. [PMID: 27232591 PMCID: PMC5062045 DOI: 10.1080/13691058.2016.1182213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 04/20/2016] [Indexed: 06/05/2023]
Abstract
This paper explores the lives of gay men undergoing traditional initiation in the Eastern Cape. Nine participants aged between 18 and 26 reported their reasons for becoming traditionally circumcised, which included personal validation of cultural manhood, the desire to conform to societal norms and expectations, and pressure from family members to 'convert' them to heterosexuality. While homosexuality remains a target for vilification and abuse both in Southern Africa and across the African continent, practices such as ulwaluko (traditional male initiation) must surely be among the most threatening to a young gay Xhosa man's self-esteem.
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Affiliation(s)
- Anathi Ntozini
- Department of Psychology, University of Fort Hare, East London, South Africa
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Marsack J, Stephenson R. Sexuality-based stigma and depression among sexual minority individuals in rural United States. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2016. [DOI: 10.1080/19359705.2016.1233164] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Eslen-Ziya H, Koc Y. Being a gay man in Turkey: internalised sexual prejudice as a function of prevalent hegemonic masculinity perceptions. CULTURE, HEALTH & SEXUALITY 2016; 18:799-811. [PMID: 26873280 DOI: 10.1080/13691058.2015.1133846] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This paper examines expressions and experiences of internalised sexual stigma with respect to definitions of masculinity and identity conflicts through a thematic analysis of life-history narratives of 14 self-identified gay men living in Turkey. The analysis reveals that internalised sexual prejudice emerges when widely accepted hegemonic masculinity ideology is 'violated' by being gay. Participants' narratives indicate that their construction of masculinity is a vigorous process established via encounters with hegemonic masculinity. Findings are discussed in the context of the relevant literature and in relation to Turkish culture's traditional understanding of gender and gender roles.
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Affiliation(s)
- Hande Eslen-Ziya
- a School of Applied Human Sciences College of Humanities , University of KwaZulu Natal , Durban , South Africa
| | - Yasin Koc
- b School of Psychology , University of Sussex , Sussex , UK
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