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

Increasing Spiritual Beliefs are Associated With Lower HIV Incidence Among Black Men Who Have Sex With Men: Results From HPTN 061 Longitudinal Study

BACKGROUND

There is a limited understanding about the impact of spiritual beliefs and activities on HIV seroconversion among black men who have sex with men (BMSM), which we investigate in this study.

SETTING

United States.

METHODS

The HIV Prevention Trials Network Study 061 collected demographic and biomedical assessments among BMSM across 6 United States cities for longitudinal analysis. Spiritual beliefs and spiritual activities are constructed composite scales. Bivariate analyses among 894 who provided data at 12-month follow-up compared men who seroconverted to HIV between baseline and 6 months with those who remained uninfected with HIV at 12 months. Cox proportional hazard regression among 944 men tested spiritual beliefs and activities on the longitudinal risk of HIV seroconversion adjusting for age and any sexually transmitted infection (STI).

RESULTS

Among this sample, HIV incidence between baseline and 6 months was 1.69%, (95% confidence intervals [CI]: 1.04 to 2.77). Men who seroconverted to HIV were significantly younger than those who remained uninfected at the 12-month follow-up: (mean age 27, SD = 11 vs 37, SD = 12) and a higher proportion reported any STI (46.67% vs 11.39%, P < 0.01). A one-unit increase in spiritual beliefs was associated with lower hazard rate of seroconverting to HIV at follow-up [adjusted hazard ratio (aHR) = 0.37, 95% CI: = (0.16 to 0.87)]. Religious service attendance and spiritual activities were unrelated to seroconverting.

CONCLUSIONS

Spirituality is important in the lives of BMSM. Biomedical and behavioral HIV prevention interventions should consider assessing spiritual beliefs in HIV care among BMSM.

Religion/Spirituality, Stress, and Resilience Among Sexual and Gender Minorities: The Religious/Spiritual Stress and Resilience Model

Although many sexual and gender minorities (SGMs) consider themselves religious or spiritual, the impact of this religiousness or spirituality (RS) on their health is poorly understood. We introduce the religious/spiritual stress and resilience model (RSSR) to provide a robust framework for understanding the variegated ways that RS influences the health of SGMs. The RSSR bridges existing theorizing on minority stress, structural stigma, and RS-health pathways to articulate the circumstances under which SGMs likely experience RS as health promoting or health damaging. The RSSR makes five key propositions: (a) Minority stress and resilience processes influence health; (b) RS influences general resilience processes; (c) RS influences minority-specific stress and resilience processes; (d) these relationships are moderated by a number of variables uniquely relevant to RS among SGMs, such as congregational stances on same-sex sexual behavior and gender expression or an individual's degree of SGM and RS identity integration; and (e) relationships between minority stress and resilience, RS, and health are bidirectional. In this manuscript, we describe the empirical basis for each of the five propositions focusing on research examining the relationship between RS and health among SGMs. We conclude by describing how the RSSR may inform future research on RS and health among SGMs.

"They have their own people": Emotional connections, community belonging, and Chinese gay, bisexual and other men who have sex with men (GBMSM) college students' needs for sexual health support

Gay, bisexual and other men who have sex with men (GBMSM) college students in China have unique sexual health challenges, including a higher risk of HIV infection, stigma and discrimination against LGBTQ (lesbian, gay, bisexual, transgender, and queer) population, and limited access to LGBTQ-affirmative sexual health support. Nonetheless, previous research or policymaking has rarely addressed the students' needs for sexual health support from their perspectives. This study aims to explore GBMSM college students' perceptions and attitudes to current sexual health resources, the challenges they encounter, and their expectations to acquiring LGBTQ-affirmative sexual health information and services. The exploration was carried out through field visits and in-depth interviews with 26 GBMSM college students and eight relevant stakeholders in five cities in China. Qualitative thematic analysis was applied to the interview transcripts and fieldwork memos. Four themes emerged around the preference and needs of GBMSM students in dealing with their sexual health challenges: the association between tackling sexual health challenges and entering LGBTQ communities, the roles of emotional attachment in shaping the preference for HIV-related care and support, the desired modes of acquiring sexual health support, and the current unmet service needs. We discovered that the information-and-care-seeking behaviors of GBMSM college students are highly influenced by and connected to their participation in online and in-person LGBTQ communities. Due to the overall stigmatizing sociocultural environment of LGBTQ in China, GBMSM college students tend to rely on LGBTQ communities, seeking trust and a sense of belongingness for tackling their sexual health challenges. Conventional school-based sexual health educational programs, which often apply top-down, stigma-and-fear-based, and non-LGBTQ-inclusive teaching strategies, rarely help GBMSM college students to solve sexual health problems in real life. GBMSM college students are eager to have LGBTQ-affirmative "health managers" who can understand their emotional experiences and interpersonal contexts and assist them with sexual health issues. However, such support is generally perceived as limited by the students. Our study highlights these unmet needs of the GBMSM students and emphasizes the importance of developing future LGBTQ-affirmative sexual health programs among Chinese GBMSM college students and young GBMSM in general.

The association between religiosity and resilience among young trans women

INTRODUCTION

Young transgender women (trans women) experience poor health in part due to discrimination. Factors that promote resilience may help young trans women positively adapt to discrimination, resulting in attenuation of poor health outcomes. While religion is sometimes a source of stigma and transphobia, qualitative studies have identified religiosity as an important resilience resource for young trans women. The goals of this study were to quantitatively measure religiosity and resilience among young trans women and to assess whether they are associated.

METHODS

From 2012-2013, 300 young trans women between the ages of 16-24 years were enrolled in a longitudinal study; we examined the cross-sectional baseline data on demographics, religiosity, and resilience. Bivariate and multivariable logistic regression analysis examined the correlation between demographics (age, gender, race/ethnicity, education, income) and religiosity among young trans women. Additionally, bivariate and multivariable logistic regression analysis examined the association between religiosity and resilience among young trans women, controlling for age, gender, race/ethnicity, education, and income.

RESULTS

Participants who reported high religiosity had significantly greater odds (aOR 1.78, 95% CI 1.05-3.01, p = .03) of reporting high resilience compared to those reporting low religiosity. Black/African American participants had significantly higher odds (aOR 6.16, 95% CI 2.34-16.20, p = < .001) of reporting high religiosity compared to those who identified as White.

CONCLUSION

Religiosity may be an important resilience resource for young trans women. Gender affirming religious and spiritual interventions may promote resilience among some young trans women.

Media representation, perception and stigmatisation of race, sexuality and HIV among young black gay and bisexual men

Young Black gay and bisexual men who have sex with men experience stigma related to race, gender expression, sexuality and HIV status. Stigma impacts access to HIV care and prevention as well as interactions with healthcare providers. The amplification of stigma through popular media is under-researched in the health sciences. HealthMpowerment is a mobile phone optimised intervention to reduce sexual risk and support community-building for young Black gay and bisexual men (age 18-30). We analysed Forum conversations from 48 participants, 45.8% living with HIV. Of 322 stigma-relevant conversations, 18.9% referenced the media (e.g. television, news, social media) as a source of stigma. Forum conversations covered media representations of Black gay and bisexual men, media's influence on identity, and the creation of stigma by association with media representations. Cultural messages embedded in the media may accentuate stereotypes that influence perceptions of Black gay and bisexual men and disregard intersectional identities. HealthMpowerment provided a space to challenge stigmatising representations. Participants used HealthMpowerment to garner social support and celebrate positive media representations. Interventions for young Black gay and bisexual men should consider the influential role of media and include spaces for participants to process and address stigma.

Is it the Sermon or the Choir? Pastoral Support, Congregant Support, and Worshiper Mental Health

BACKGROUND

Although religious involvement tends to be associated with improved mental health, additional work is needed to identify the specific aspects of religious practice that are associated with positive mental health outcomes. Our study advances the literature by investigating how two unique forms of religious social support are associated with mental health.

PURPOSE

We explore whether support received in religious settings from fellow congregants or religious leaders is associated with participants' mental health. We address questions that are not only of interest to religion scholars, but that may also inform religious leaders and others whose work involves understanding connections between religious factors and psychological outcomes within religious communities.

METHODS

We test several hypotheses using original data from the "Mental Health in Congregations Study (2017-2019)", a survey of Christian and Jewish congregants from South Texas and the Washington DC area (N = 1882). Surveys were collected using both paper and online surveys and included an extensive battery of religious and mental health measures.

RESULTS

Congregant support has more robust direct associations with mental health outcomes than faith leader support. Increased congregant support is significantly associated (p < 0.001) with fewer symptoms of psychological distress (β = - 0.168), anxiety (β = - 0.159), and anger (β = - 0.190), as well as greater life satisfaction (β = 0.269) and optimism (β = 0.283). However, faith leader support moderates these associations such that congregant support is associated with better mental health only in cases where faith leader support is also high. When leader support is low, congregant support and mental health are not associated.

CONCLUSIONS AND IMPLICATIONS

At the conceptual level, our study adds to an extensive literature on the relationship between religious social support and mental health. Additionally, our work may provide important insights to religious leadership in terms of communications strategies, services, and resources that might enhance overall congregant mental health and well-being.

Framing HIV and AIDS: how leaders of black religious institutions in New York City interpret and address sex and sexuality in their HIV interventions

This study explored how leaders of Black churches active in the fight against HIV conceptualised sex and sexuality when describing HIV interventions within their institutions. We analysed interviews with pastors and identified three frames through which leaders understood and communicated about sex and sexuality: (1) an evasive frame, in which participants avoided discussing behaviours and populations that have historically been disparaged within the church by emphasising involuntary risk exposure; (2) an agentic frame, which recognised sexual behaviour that differed from heteronormative conduct; and, (3) a pluralist frame, which allowed individuals to maintain their own beliefs about appropriate sexual conduct. Participants used frames to engage in a range of HIV interventions while upholding stigmatising beliefs about sexual behaviour and identity.

The Congregational Structure of Homonegativity: Why Place of Worship May Matter More than Frequency of Worship

Using 239 congregants from 14 randomly selected places of worship in the Southern United States-and a mega-analysis of 577 congregants from 34 similarly-located places of worship-we examined the relationship between religiousness and homonegativity. Multilevel models examining the effects of religiousness on homonegativity indicated that service attendance was more strongly related to homonegativity as a congregation-level variable than as an individual-level variable. Interaction effects between service attendance and the affirmativeness of a congregation were not significant, suggesting that the frequency of participation with a homonegative congregation is not related to homonegativity. These findings imply that the religiousness of a congregation is more closely related to homonegativity than the religiousness of an individual and that individuals may select a congregation that matches their views on same-sex sexuality. Homonegativity may serve a signaling function, enabling congregants to affiliate with a congregation with attitudes toward same-sex sexuality similar to their own.

Neighborhood social cohesion, religious participation and sexual risk behaviors among cisgender black sexual minority men in the southern United States

BACKGROUND

Few studies have examined associations between neighborhood social cohesion and sexual risk behaviors among gay, bisexual, and other sexual minority men (SMM), and none have among Black SMM in the southern U.S. The purpose of the current study is to examine associations between neighborhood social cohesion and sexual risk behaviors among Black SMM in the southern U.S., a population heavily impacted by HIV. We also examined whether these relationships are modified by religious participation for Black SMM in the southern U.S.

METHODS

Data was obtained from the MARI Study, a sample of Black SMM ages 18-66 years, recruited from the Jackson, MS and Atlanta, GA metropolitan areas (n = 354). Neighborhood social cohesion was assessed with a validated 5-item scale. We conducted multivariable regression analyses to examine the association between neighborhood social cohesion with each of the sexual risk behaviors (e.g., condomless sex and drug use before or during sex), controlling for key confounders. We then performed moderation analysis by religious participation (religious attendance and private religiosity).

RESULTS

Compared to Black SMM with higher perceived neighborhood social cohesion, Black SMM with lower neighborhood social cohesion had increased odds of alcohol use before or during sex (aPR = 1.56; 95% CI = 1.16-2.11) and condomless anal sex with casual partners (aPR = 1.55; 1.03-2.32). However, the magnitude of these associations varied by religious attendance and private religiosity. Black SMM with low religious service attendance had higher risk of alcohol use in the context of sex when perceived neighborhood social cohesion was low; those with high private religiosity had elevated alcohol use in the context of sex when perceived neighborhood social cohesion was low.

DISCUSSION

Interventions that target connectedness among neighborhood members through community education or mobilization efforts, including the involvement of religious organizations, should be considered for HIV prevention focused on alcohol and condomless sex among Black SMM.

A preliminary model of health regarding sexual and ethnic minority older adults

Older individuals with sexual/gender minority and minority racial/ethnic identities typically face unique challenges, along with opportunities to overcome these obstacles. Published studies on the difficulties faced by sexual and gender minorities are available; however, research on older adults with both racial/ethnic minority and sexual and gender minority identities is rarer. These individuals must confront various forms of discrimination related to ageism, homophobia and racism. Resilience likely plays a role in the ability to manage and survive multiple challenges and discriminatory experiences, yet targeted research on these populations is lacking. This paper offers a preliminary model that incorporates prevalent threats to these populations' well-being and their deleterious psychosocial correlates, especially, whenever available, the unique challenges that older individuals must face when age, sexual orientation and race/ethnicity intersect. Recommendations are made to optimise the expansion and empirical testing of this preliminary model.