Sexual orientation identity and romantic relationship quality in same-sex couples

Sexual Minority Mothers: A Dyadic Exploration of Stigma, Identity, Support, and Parental Wellbeing

For all couples, regardless of sexual orientation, transition to parenthood often increases stress, although, according to minority stress theory (MST), same-sex couples often experience additional stressors specifically related to their sexual orientation. In this study of 34 same-sex female couples (68 sexual minority mothers) who conceived their children with the use of sperm donation, we explored the intrapersonal and interpersonal influences of sexuality-related stigma, sexual identity, sexuality disclosure ("outness"), and social support on the wellbeing of each partner among these couples. We found support for MST, although the process worked differently based on the mother's role. Among the pregnant (gestational) mothers, personal experiences of sexuality related stigma, social support, and sexual identity disclosure were all associated with their individual wellbeing. In contrast, among the non-pregnant (non-gestational) mothers, these associations were more interpersonal in nature. Specifically, the non-gestational mothers' wellbeing was unrelated to their personal experiences of sexuality stigma but was associated with their partner's (the gestational mother's) reports of sexual identity centrality and affirmation and support from friends. In all, we found support for MST, such that greater sexuality stigma was associated with poorer wellbeing, but this relationship functioned differently depending on the mother's role.

Romantic Attachment, Relationship Satisfaction, Internalized Sexual Stigma, and Motives for Parenthood in Italian Lesbian Women and Gay Men

This study examines romantic attachment, internalized sexual stigma, relationship satisfaction, and motives for parenthood in a sample of 313 Italian lesbian women (47.9%) and gay men (52.1%) aged 18-71 years (M = 36.2; SD = 11.9) and in same-sex relationships. The following hypotheses were tested: that romantic attachment is positively correlated with internalized stigma and motives to not have children, while it is negatively correlated with relationship satisfaction; that relationship satisfaction is negatively correlated with internalized stigma and motives for parenthood; that internalized stigma is negatively correlated with motives for parenthood; and that relationship satisfaction mediates the relationships between romantic attachment and motives for parenthood and between internalized stigma and motives for parenthood. The results strongly support the hypotheses. Furthermore, the results indicate that the lesbian participants reported lower levels of avoidance and internalized stigma and higher levels of relationship satisfaction and motives to not have children, and the participants in civil unions reported lower levels of anxiety and internalized stigma and higher levels of relationship satisfaction and motives to not have children. Taken together, our findings contribute to the growing body of research on LG parenthood and may inform social policy and psychological support for LG individuals pursuing parenthood.

Information, Motivation and Behavioral Skills as Mediators Between Sexual Minority Stigma and Condomless anal Sex Among Black South African Men Who have Sex with Men

We assessed pathways between sexual minority stigma and condomless anal intercourse (CAI) among two samples of Black South African men who have sex with other men (MSM). Two cross-sectional surveys were conducted in Tshwane, South Africa; one among 199 Black MSM and another among 480 Black MSM. Men reported on external and internalized experiences of sexual minority stigma, mental health, alcohol use, information-motivation-behavioral skills (IMB) model constructs, and CAI. Structural equation modeling was used to test whether external and internalized stigma were directly and indirectly associated with CAI. In both studies, external stigma and internalized stigma were associated with CAI through IMB model constructs. These results suggest a pathway through which stigma contributes to HIV risk. For HIV prevention efforts to be effective, strengthening safer sex motivation and thus decreasing sexual risk behavior likely requires reducing sexual minority stigma that MSM experience and internalize.

Internalized Homonegativity and Mental Health Among Chinese Gay and Bisexual Cisgender Men: Exploring the Moderating Influences of Psychosocial and Sexual Identity Factors

Much research on Chinese gay and bisexual men has focused on sexual health and, in particular, HIV-related issues. However, relatively little research has considered psychosocial aspects of being a gay or bisexual man in China. The present study was designed to address this gap by examining psychosocial predictors of mental health from a minority stress perspective. Results from an online survey of 1,786 Chinese gay and bisexual cisgender men revealed that higher levels of internalized homonegativity predicted greater psychological distress and a lower sense of positive well-being. Higher self-esteem, social support, and resilience were strong predictors of lower psychological distress and higher well-being, but these psychosocial factors mostly did not moderate associations between internalized homonegativity and mental health. A stronger sense of sexual identity superiority weakened the associations between internalized homonegativity and both mental health measures, but sexual identity centrality only moderated the association between internalized homonegativity and positive well-being. This study is among the first to examine minority stressors and psychosocial factors, distinct from the HIV-focussed literature, in a Chinese context. These findings may inform interventions targeting increased self-esteem, social support, and resilience, which could be beneficial for the mental health of Chinese gay and bisexual cisgender men.

The negative effects of internalized homonegativity on sexual satisfaction: dyadic effects and gender-based differences in Chile

Heterosexism is not only expressed through sexual prejudice as an external stressor, but also as an internalized rejection toward one's own (and others') sexually diverse identity. That is, lesbian women and gay men themselves internalize negative societal attitudes toward their sexual orientation and identity-a phenomenon called internalized homonegativity. A wealth of research shows that internalized homonegativity negatively affects the health and social adjustment of gay and lesbian people. However, the literature has documented this trend from an individual (over a dyadic) perspective, and largely among gay (over lesbian) samples. To address this oversight, we analyzed data from 210 gay and lesbian couples in Chile to examine both actor and partner effects of internalized homonegativity on their sexual satisfaction. Results from moderation analyses from an actor-partner interdependence model (APIM) approach show that partners' internalized homonegativity negatively affects actor sexual satisfaction, a pattern significantly moderated by gender; that is, only observed among lesbian couples. Our results further demonstrated that these effects hold above and beyond the actor and partner effects of age and relationship satisfaction, as well as relationship length. These results are consistent with the broader literature, which discusses the specific features of internalized homonegativity in lesbian women, characterized-among other aspects-by restrictive social demands over their sexuality. Accordingly, our findings highlight the deleterious relational consequences of internalized homonegativity and offer a relevant empirical contribution to the understanding of specific minority stress dynamics among lesbian women.

Internalized Sexual Stigma among Lesbian, Gay, and Bisexual Individuals in Taiwan: Its Related Factors and Association with Mental Health Problems

Internalized sexual stigma (ISS) is one of the major issues that can compromise the health of sexual minority populations. This quantitative study aimed to examine: (1) the relationships of individual factors (gender, age, education level, sexual orientation, and age of identification of sexual orientation) and perceived family support with ISS; and (2) the associations of ISS with mood problems and the moderating effects of gender on the associations among Taiwanese young adult lesbian, gay, and bisexual (LGB) individuals. In total, 500 male and 500 female young adult LGB individuals aged between 20 and 30 years participated in this study. The experience of ISS, individual (e.g., gender, age, education level, sexual orientation, and age of identification of sexual orientation) and environmental factors (perceived family), mood problems (e.g., anxiety and depression) were collected. The individual and environmental factors related to ISS and the associations of ISS with mood problems were examined using multivariate linear regression analysis. The results indicated that gender, sexual orientation, age of identification of sexual orientation, and perceived family support were significantly associated with all or some dimensions of ISS in LGB individuals. Various dimensions of ISS had different relationships with anxiety and depression. Gender had moderating effects on the association between the identity dimension of ISS and sexual orientation as well as between the social discomfort dimension of ISS and anxiety. Various dimensions of ISS among LGB individuals should be routinely assessed by mental health service units. Intervention programs should be provided for LGB individuals, especially those with factors related to ISS.

Trauma-Informed Care and Health Among LGBTQ Intimate Partner Violence Survivors

Intimate partner violence (IPV) and its health consequences occur among lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals at rates equal to or higher than cisgender heterosexual individuals. Trauma-informed care (TIC) is one service approach with emerging empirical support for use with IPV survivors, but without attention to the LGBTQ population. Structural equation modeling was used to assess associations between TIC and mental and physical health through several mechanisms among 239 LGBTQ adults who had experienced IPV and sought healthcare services within the past year (Mage = 27.66; 66.7% White; 43.9% cisgender women). Participants reported their perceptions of TIC in their services received; their sense of empowerment, emotion regulation, shame, and social withdrawal (all conceived as mobilizing mechanisms through which TIC could be associated with health); and their mental health (depression and posttraumatic stress disorder [PTSD]), and physical health (somatic symptoms and chronic health conditions). Those who perceived greater TIC in their services reported greater empowerment and emotion regulation, and lower social withdrawal. In turn, lower social withdrawal and shame were associated with better mental health, while lower shame also was associated with better physical health. Indirect associations between TIC and mental and physical health through the four mobilizing mechanisms were not significant, however, with the exception of a small indirect effect on mental health through lower social withdrawal. Results suggest that practitioners need to develop services to be used in conjunction with a general TIC approach to improve health and target shame among LGBTQ IPV survivors.

Internalized Consensual Non-Monogamy Negativity and Relationship Quality Among People Engaged in Polyamory, Swinging, and Open Relationships

Drawing on an internalized homonegativity and minority stress framework, the present study sought to address whether people engaged in consensual non-monogamy (CNM) internalize stigma toward their relationship style, and if internalized CNM negativity is associated with poorer relationship quality and functioning. We recruited a community sample of 339 people engaged in CNM (open, swinging, or polyamorous relationship) with at least two concurrent partners. Participants completed a newly developed measure of internalized CNM negativity (which assessed personal discomfort, social discomfort, and public identification) and four measures of relationship quality for each partner. Regression analyses showed that personal discomfort with CNM (e.g., wanting to change one's relationship style or endorsing CNM as unnatural) was associated with lower satisfaction with romantic and sexual relationship agreements, global relationship satisfaction, and commitment (but not sexual satisfaction) in both concurrent relationships. The other two dimensions of internalized CNM negativity, social discomfort and public identification, were not related to relationship quality with either partner. These findings provide support for the notion that prevailing mononormativity (idealization of monogamy in society) can become applied to the self and negatively impact relationship quality. Understanding the processes in which broader societal stigma toward CNM can become internalized and affect well-being provides a new direction for research at the intersection of public health, psychology, and sexuality.

Minority Stress and Relationship Well-Being in Sexual Minorities: The Varying Role of Outness on Relationship and Sexual Satisfaction

Objectives: Empirical inquiry has targeted how same-sex couples grapple with unique stressors in their romantic relationships. Meta-analyses demonstrate that the adverse link between minority stress and sexual and relationship well-being is contingent on the type of stressor and relationship component. Methods: We conducted a cross sectional study examining a sample of 238 individuals currently in same-sex relationships. Results: Outness predicted relationship satisfaction, sexual satisfaction, and sexual dissatisfaction relative to other stressors, and depressive symptomatology mediated the minority stressors and relationship well-being associations. Conclusions: The current findings offer practical applications for practitioners working with sexual minority clients and researchers who continue to reveal the boundaries in the minority stress process.

HIV incidence in a multinational cohort of men and transgender women who have sex with men in sub-Saharan Africa: Findings from HPTN 075

Few studies have assessed HIV incidence in men who have sex with men (MSM) and transgender women (TGW) in sub-Saharan Africa (SSA). We assessed HIV incidence and its correlates among MSM and TGW in SSA enrolled in the prospective, multi-country HIV Prevention Trials Network (HPTN) 075 study, conducted from 2015 to 2017. Participants were enrolled at four sites in SSA (Kisumu, Kenya; Blantyre, Malawi; Cape Town and Soweto, South Africa). Eligible participants reported male sex assignment at birth, were 18 to 44 years of age, and had engaged in anal intercourse with a man in the preceding three months. Participation involved five study visits over 12 months. Visits included behavioral assessments and testing for HIV and sexually transmitted infections. Twenty-one of 329 persons acquired HIV during the study [incidence rate: 6.96/100 person-years (PY) (95% CI: 4.3, 10.6)]. Among TGW, HIV incidence was estimated to be 8.4/100 PY (95% CI: 2.3, 21.5). Four participants were found to have acute HIV infection at their first HIV-positive visit. HIV incidence varied among the four study sites, ranging from 1.3/100 PY to 14.4/100 PY. In multivariate longitudinal analysis, factors significantly associated with HIV acquisition were engagement in unprotected receptive anal intercourse [adjusted hazard ratio (AHR) 5.8, 95% confidence interval (CI): 2.4, 14.4] and incident rectal gonorrhea and/or chlamydia (AHR: 2.7, 95% CI: 1.1, 6.8). The higher HIV incidence in Cape Town compared to Blantyre could be explained by the higher prevalence of several risk factors for HIV infection among participants in Cape Town. Annual HIV incidence observed in this study is substantially higher than reported HIV incidence in the general populations in the respective countries and among MSM in the United States. Intensification of HIV prevention efforts for MSM and TGW in SSA is urgently needed.

Adult Attachment, Differentiation of Self, and Relationship Satisfaction in Lesbians and Gay Men

We examined adult attachment styles, differentiation of self, and relationship satisfaction in a sample of 298 Italian lesbians (48%) and gay men (52%), all of whom were ages 19–71 years (M = 36.1; SD = 11.8) and in a couple relationship for at least six months. Participants were recruited via the Internet and completed a web-based survey. We tested the hypotheses that attachment insecurity and differentiation of self would predict relationship satisfaction, as well as that differentiation of self would mediate the relationship between adult attachment and relationship satisfaction. Results supported the hypotheses, thus indicating that attachment insecurity and differentiation of self were correlated with and predicted relationship satisfaction. Furthermore, results supported the hypothesized mediating role of differentiation of self. Finally, results indicated that younger participants, lesbians, and participants in civil unions reported higher levels of relationship satisfaction. Implications for counselors and therapists working with LG populations are discussed.

Single Bisexual Men's and Women's Perceptions of Acceptance in the LGBTQ Community

In recent years, sociocultural shifts in the U.S. have cast a positive light on the LGBTQ community, presumably providing benefits to sexual and gender minorities. Using a sample of single lesbian, gay, and bisexual men and women (N= 924) collected from a 2016 survey in the U.S., we assess bisexual people's attitudes about the "LGBTQ community", as well as how others in the community - gay men and lesbian women - view bisexuals. We also examine contexts in which bisexual people feel they are unable to share their sexual identities. Descriptive analyses revealed that while many bisexual people feel they need to hide their sexual identity in most contexts, the majority of bisexual men and women feel "mostly" to "near total acceptance" in the LGBTQ community. Thus, while bisexual people do experience stigma-related stress, findings suggest a promising shift for bisexual people's lives in terms of drawing resources and support from the larger LGBTQ community.

Lesbian and Gay Relationship Satisfaction Among Italians: Adult Attachment, Social Support, and Internalized Stigma

We examined adult attachment styles, perceived social support, internalized stigma, and relationship satisfaction in a sample of 305 lesbians (48.2%) and gay men (51.8%), ages 19-72 years (M = 36.4; SD = 11.8), and in a same-sex relationship for at least 6 months. Participants were recruited via the Internet and completed a web-based survey. We tested the hypotheses that attachment styles, perceived social support, and internalized stigma predicted relationship satisfaction, as well as that perceived social support would be correlated with internalized stigma. Results strongly supported the hypotheses, thus indicating that attachment styles, perceived support, and internalized stigma were negatively correlated with and predicted relationship satisfaction and that perceived social support was negatively correlated with internalized stigma. Furthermore, results indicated that lesbian participants had lower levels of anxious attachment style and reported higher levels of relationship satisfaction and lower levels of internalized stigma. Finally, results indicated that in the lesbian subsample, conservative political orientation and religious beliefs were correlated with higher levels of internalized stigma; participants coming from central Italy reported higher levels of perceived social support; and participants in civil unions reported higher levels of perceived social support and relationship satisfaction, and lower levels of internalized stigma. Implications for counselors and therapists working with lesbian and gay populations are discussed.

Healthcare-related stigma among men who have sex with men and transgender women in sub-Saharan Africa participating in HIV Prevention Trials Network (HPTN) 075 study

ABSTRACT The inability to access health services when needed is a critical barrier to HIV prevention, treatment and care among men who have sex with men (MSM) and transgender women (TGW). Using data collected in HPTN 075, we explored factors associated with any experienced healthcare-related stigma. HPTN 075 was a cohort study to assess the feasibility of recruiting and retaining MSM and TGW in clinical trials in sub-Saharan Africa. Of 401 MSM and TGW enrolled at four sites (Kisumu, Kenya; Blantyre, Malawi; Cape Town, Soweto, South Africa) 397 contributed to the analysis (79.9% cis-gender and 20.1% TGW). Of these, (45.3%; 180/397) reported one or more of healthcare-related stigma experiences. Most frequently reported experiences included fear to seek healthcare services (36.3%) and avoiding seeking such services because of the discovery of MSM status (29.2%). Few men and TGW (2.5%) reported having been denied health services because of having sex with men. In multivariable analysis, more participants in Soweto [adjusted odds ratio (AOR) = 2.60] and fewer participants in Blantyre (AOR = 0.27) reported any healthcare-related stigma experiences, in comparison to participants in Kisumu. MSM and TGW that did not have a supportive gay community to rely on were more likely to report any healthcare-related stigma experiences (AOR = 1.46), whereas MSM and TGW who reported high social support and who never had engaged in transactional sex were less likely to report such experiences (AOR = 0.76 and AOR = 0.43, respectively). Our results suggest that encouraging support groups for MSM and TGW as well as training and sensitizing healthcare staff, and the general community, on MSM and TGW health issues and cultural competence may reduce stigma, improve access to healthcare, which could ultimately reduce HIV transmission.

Self-Reported Mental and Physical Health Symptoms and Potentially Traumatic Events Among Lesbian, Gay, Bisexual, Transgender, and Queer Individuals: The Role of Shame

OBJECTIVE

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals disproportionately face exposure to potentially traumatic events-adverse experiences that may have a traumatizing effect-and experience shame as a common consequence. Previous research demonstrates associations between shame and psychological and physical health issues among those with exposure to potentially traumatic events in general, with limited attention among LGBTQ individuals specifically. This study determined whether shame partially mediated the relationship between potentially traumatic events exposure and self-reported mental and physical health symptoms among LGBTQ individuals.

METHOD

Participants were 218 self-identified LGBTQ individuals who reported experiencing at least one potentially traumatic event (e.g., childhood sexual abuse). Online surveys assessed the type and frequency of potentially traumatic events exposure, shame, self-reported mental health (depression symptoms, posttraumatic stress disorder symptoms, and substance use), and physical health symptoms (sexual risk behavior, somatic symptoms, and chronic health conditions).

RESULTS

Greater potentially traumatic events exposure was associated with greater shame, and greater shame was associated with worse self-reported mental and physical health. Potentially traumatic events exposure had a direct effect on self-reported mental and physical health, and shame partially mediated this relationship.

CONCLUSION

Shame represents an important and modifiable factor that relates to poor health and may be amenable to change through psychosocial interventions. Given the prevalence of negative self-attribution stemming from potentially traumatic events exposure, in addition to the internalization of stigma among this population, practitioners need to uncover interventions specifically targeting shame when working with LGBTQ individuals.

The influence of stress on depression and substance use problems among young male same-sex couples: Relationship functioning as an underlying mechanism

Stress experienced by either partner in a couple can have a negative impact on each partner's health, but most dyadic research on stress and health focuses on different-sex couples. We examined relationship functioning as a mechanism underlying the longitudinal actor and partner effects of stress on depression and substance use problems among 109 young male same-sex couples. There were significant indirect actor effects of internalized stigma and microaggressions on depression and alcohol use problems through negative relationship interactions. Participants who reported higher levels of internalized stigma and microaggressions reported more negative relationship interactions, which in turn was associated with reporting greater depression and alcohol use problems. In contrast, none of the indirect partner effects were significant. Findings implicate negative relationship interactions as a mechanism linking minority stress to health, but raise questions about the influence of partner stress on individual health among young male same-sex couples.

Minority stress and relationship functioning among young male same-sex couples: An examination of actor-partner interdependence models

OBJECTIVE

In different-sex couples, individual and partner stress can both have a negative impact on relationship functioning (actor and partner effects). Gay and bisexual men experience unique stress (sexual minority stress), but few studies have examined the effects of this stress on relationship functioning among young male couples. The current study examined (a) actor and partner effects of general and minority stress (internalized stigma, microaggressions, victimization, and outness) on relationship functioning (relationship quality and negative relationship interactions), (b) interactions between individual and partner stress as predictors of relationship functioning, and (c) dyadic coping and relationship length as moderators of actor and partner effects.

METHOD

Actor-partner interdependence models were tested using data from 153 young male couples.

RESULTS

There was strong support for actor effects. Higher general stress and internalized stigma were associated with lower relationship quality, but only for those in longer relationships. Additionally, higher general stress, internalized stigma, and microaggressions, and lower outness, were associated with more negative relationship interactions. There was limited support for partner effects. Having a partner with higher internalized stigma was associated with more negative relationship interactions, but none of the other partner effects were significant. There was no support for individual and partner stress interacting to predict relationship functioning or for dyadic coping as a stress buffer.

CONCLUSIONS

Findings highlight the influence of one's own experiences of general and minority stress on relationship functioning, but raise questions about how partner stress influences relationship functioning among young male couples. (PsycINFO Database Record

Minority Stress and Same-Sex Relationship Satisfaction: The Role of Concealment Motivation

Most lesbian, gay, and bisexual (LGB) people want a stable, satisfying romantic relationship. Although many of the predictors of relationship outcomes are similar to those of heterosexual couples, same-sex couples face some additional challenges associated with minority stress that also impact upon relationship quality. Here, we investigate the association between minority stressors and relationship quality in a sample of 363 adults (M age = 30.37, SD = 10.78) currently in a same-sex romantic relationship. Internalized homophobia and difficulties accepting one's LGB identity were each negatively associated with relationship satisfaction via heightened concealment motivation. We also examined the protective role of identity affirmation on relationship quality, finding a direct positive relationship between the two variables. Minority stressors were negatively associated with couple relationship satisfaction via heightened concealment motivation. The finding that identity affirmation directly predicted increased couple satisfaction also highlights the important role of protective factors in same-sex couple relationships.

The Qualities of Same-Sex and Different-Sex Couples in Young Adulthood

OBJECTIVE

Recognition of sexual minorities in social science research is growing and this study contributes to knowledge on this population by comparing the qualities of same-sex and different-sex relationships among young adults.

BACKGROUND

The findings of studies on this topic cannot be generalized to young adults because they are limited to coresidential unions and based on convenience samples. This study extends prior research by examining multiple relationship qualities among a nationally-representative sample of males and females in "dating" and cohabiting relationships.

METHOD

The authors compare young adults in same-sex and different-sex relationships with respect to relationship quality (commitment, satisfaction, and emotional intimacy) and sexual behavior (sexual frequency and sexual exclusivity). Drawing on the fourth wave of data from the National Longitudinal Study of Adolescent to Adult Health (http://www.cpc.unc.edu/projects/addhealth), they use multiple regression to compare: male respondents with different-sex partners, male respondents with same-sex partners, female respondents with different-sex partners, and female respondents with same-sex partners.

RESULTS

Consistent with previous research, the authors find that respondents in same-sex relationships experience similar levels of commitment, satisfaction, and emotional intimacy as their counterparts in different-sex relationships. They also corroborate the finding that male respondents in same-sex relationships are less likely than other groups of respondents to indicate their relationship is sexually exclusive.

CONCLUSION

This study provides an empirical basis for understanding the relationships of sexual minority young adults.

Concordance in Reported Love, Trust, and Relationship Quality among Same-Sex Male Relationships

This paper examines concurrence of self-reported love, trust, and dyadic quality experiences between partners in 293 male couples. Significant yet poor concurrence was observed for all three self-reported relationship measures, but varied by relationship characteristics. Using an actor-partner interdependence model (APIM), actor and partner characteristics were shown to be associated with self-reported relationship concerns, such as satisfaction and intimate partner violence. This knowledge is important in the development and delivery of couples-based health interventions, such as couples HIV testing and counseling, for interventions that respect the unique relationship dynamics of each couple are needed to effectively address dyadic health.

Gender Expression and Mental Health in Black South African Men Who Have Sex with Men: Further Explorations of Unexpected Findings

Unlike studies conducted in Western countries, two studies among Black South African men who have sex with men (MSM) found no support for the association between gender nonconformity and mental distress, even though gender-nonconforming men experienced more discrimination and discrimination was associated with mental distress (Cook, Sandfort, Nel, & Rich, 2013; Sandfort, Bos, Knox, & Reddy, 2016). In Sandfort et al., gender nonconformity was assessed as a continuous variable, validated by comparing scores between a categorical assessment of gender presentation (masculine, feminine, no preference). Using the same dataset, we further explored this topic by (1) testing differences between gender expression groups in sexual minority stressors, resilience factors, and mental distress; (2) testing whether the impact of elevated discrimination in the feminine group was counterbalanced by lower scores on other stressors or higher scores on resilience factors; and (3) exploring whether relationships of stressors and resilience factors with mental distress varied between gender expression groups. Controlling for demographics, we found several differences between the gender expression groups in the stressors and resilience factors, but not in mental distress. We found no support for the idea that the lack of differences in mental distress between the gender expression groups was a consequence of factors working in opposite directions. However, internalized homophobia had a differential impact on depression in feminine men compared to masculine men. In our discussion of these findings, we explored the meaning of our participants' self-categorization as it might relate to gender instead of sexual identities.

South African Men Who Have Sex With Both Men and Women and How They Differ From Men Who Have Sex With Men Exclusively

The label "men who have sex with men" (MSM) is used to categorize a diverse population exclusively on the basis of its sexual behavior. Understanding the diversity that this label comprises is critical for the development of health interventions that effectively reach the various populations subsumed under this label. In this cross-sectional study of South African MSM (N = 480) recruited through respondent-driven sampling (RDS), we explored differences between men who had sex with both men and women (MSMW) and men who had sex with men exclusively (MSME). We found significant differences between these two groups in terms of sexual attraction, sexual identity, sexual preferences, sexual histories, and current sexual practices. MSMW were more likely to be confused about their same-sex attraction, to experience internalized homophobia, and to have paid for sex in the previous year, while MSME were more gender nonconforming and more likely to have been forced to have sex in the previous year. These findings underscore that the MSM label comprises a diverse population and that exclusive sexual engagement with other men is a critical distinction to take into account in understanding this diversity and fully grasping the lived experiences of men who have sex with men.

Measurements of Sexuality-Based Stigma among Gay, Bisexual, and Other Men Who Have Sex with Men (GBMSM) in Resource-Poor Settings: A Review

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.

Internalized Sexual Stigma in Italian Lesbians and Gay Men: The Roles of Outness, Connectedness to the LGBT Community, and Relationship Satisfaction

The authors examined the extent to which outness, connectedness to the LGBT community, and relationship satisfaction could be used to predict internalized sexual stigma scores. A total of 279 Italian lesbians (47%) and gay men (53%) in a same-sex relationship for at least six months completed the web-based survey. Significant correlations were found between outness, connectedness, relationship satisfaction, and internalized stigma. Analyses of variance were conducted on demographic variables to explore group differences. Multivariate regression analysis suggests that demographic variables, outness, connectedness, and relationship satisfaction combined accounted for 32.8% of the variance in overall internalized sexual stigma. Clinical implications are discussed.

Monosexual and Nonmonosexual Women in Same-Sex Couples' Relationship Quality During the First Five Years of Parenthood

Research on relationship quality in same-sex couples has rarely focused on (a) couples who are parents, who likely experience additional stressors, or (b) couples in which partners differ in sexual identity. Insomuch as nonmonosexual women (i.e., women with non-exclusive sexual orientations) experience unique challenges due to monosexism, relationship quality may be influenced by whether partners share a monosexual or nonmonosexual identity. The current study is a longitudinal, dyadic analysis of 118 female parents within 63 same-sex couples whose relationship quality (relationship maintenance, conflict, love, ambivalence) was assessed at five time points across the first 5 years of adoptive parenthood. Monosexual women were those who identified as exclusively lesbian/gay (n = 68); nonmonosexual women were those who identified as mostly lesbian/gay, bisexual, queer, pansexual, or mostly heterosexual (n = 50). Analyses revealed both actor and partner effects on maintenance and conflict, such that nonmonosexual women reported more maintenance and conflict than monosexual women, and women with nonmonosexual partners reported more maintenance and conflict than women with monosexual partners. Depression was related to greater conflict and ambivalence and less love; internalized sexual stigma was related to greater conflict and ambivalence. In terms of change over time, maintenance and love declined whereas ambivalence increased during early parenthood.

Couple-level Minority Stress: An Examination of Same-sex Couples' Unique Experiences

Social stress resulting from stigma, prejudice, and discrimination-"minority stress"-negatively impacts sexual minority individuals' health and relational well-being. The present study examined how being in a same-sex couple can result in exposure to unique minority stressors not accounted for at the individual level. Relationship timeline interviews were conducted with 120 same-sex couples equally distributed across two study sites (Atlanta and San Francisco), gender (male and female), and relationship duration (at least six months but less than three years, at least three years but less than seven years, and seven or more years). Directed content analyses identified 17 unique couple-level minority stressors experienced within nine distinct social contexts. Analyses also revealed experiences of dyadic minority stress processes (stress discrepancies and stress contagion). These findings can be useful in future efforts to better understand and address the cumulative impact of minority stress on relational well-being and individual health.

Social Network Types and Mental Health Among LGBT Older Adults

PURPOSE OF THE STUDY

This study was designed to identify social network types among lesbian, gay, bisexual, and transgender (LGBT) older adults and examine the relationship between social network type and mental health.

DESIGN AND METHODS

We analyzed the 2014 survey data of LGBT adults aged 50 and older (N = 2,450) from Aging with Pride: National Health, Aging, and Sexuality/Gender Study. Latent profile analyses were conducted to identify clusters of social network ties based on 11 indicators. Multiple regression analysis was performed to examine the association between social network types and mental health.

RESULTS

We found five social network types. Ordered from greatest to least access to family, friend, and other non-family network ties, they were diverse, diverse/no children, immediate family-focused, friend-centered/restricted, and fully restricted. The friend-centered/restricted (33%) and diverse/no children network types (31%) were the most prevalent. Among individuals with the friend-centered/restricted type, access to social networks was limited to friends, and across both types children were not present. The least prevalent type was the fully restricted network type (6%). Social network type was significantly associated with mental health, after controlling for background characteristics and total social network size; those with the fully restricted type showed the poorest mental health.

IMPLICATIONS

Unique social network types (diverse/no children and friend-centered/restricted) emerge among LGBT older adults. Moreover, individuals with fully restricted social networks are at particular risk due to heightened health needs and limited social resources. This study highlights the importance of understanding heterogeneous social relations and developing tailored interventions to promote social connectedness and mental health in LGBT older adults.

Determinants of hazardous drinking among black South African men who have sex with men

BACKGROUND

There is a known heavy burden of hazardous drinking and its associated health risks among black South African MSM; however, no study to date has identified risk factors for hazardous drinking among this nor any other African MSM population.

METHODS

A cross-sectional survey was conducted among 480 black South African MSM recruited using respondent-driven sampling. All analyses were adjusted using an RDS II estimator. Multivariable logistic regression was used to assess the relationship between demographic characteristics, psychosocial factors, behavioral attributes and hazardous drinking.

RESULTS

More than half of the men (62%, 95%CI=56%-68%) screened positive as hazardous drinkers. In multivariable analyses, living in a township (versus the city of Pretoria) (aOR=1.9, 95%CI=1.2-3.1, p<.01), more gender dysphoria (aOR=1.4, 95%CI=1.0-1.8, p=.03), having ever received money or other incentives in return for sex (aOR=2.4, 95%CI=1.3-4.3, p<.01), having been sexually abused as a child (aOR=2.6, 95%CI=1.1-6.4, p=.03), having anxiety (aOR=5.4, 95%CI=1.2-24.3, p=.03), and social network drinking behavior (aOR=5.4, 95%CI=1.2-24.3, p=.03) were positively associated with hazardous drinking. Being sexually attracted only to men (aOR=0.3, 95%CI=0.1-0.8, p=.01) was negatively associated with hazardous drinking.

DISCUSSION

Hazardous drinking is highly prevalent among black South African MSM. Multiple indicators of social vulnerability were identified as independent determinants of hazardous drinking. These findings are of heightened concern because these health problems often work synergistically to increase risk of HIV infection and should be taken into consideration by efforts aimed at reducing hazardous drinking among this critical population.

Sexual Minority Stress and Same-Sex Relationship Well-Being: A Meta-Analysis of Research Prior to the U.S. Nationwide Legalization of Same-Sex Marriage

Meta-analytic methods were used to analyze 179 effect sizes retrieved from 32 research reports on the implications that sexual minority stress may have for same-sex relationship well-being. Sexual minority stress (aggregated across different types of stress) was moderately and negatively associated with same-sex relationship well-being (aggregated across different dimensions of relationship well-being). Internalized homophobia was significantly and negatively associated with same-sex relationship well-being, whereas heterosexist discrimination and sexual orientation visibility management were not. Moreover, the effect size for internalized homophobia was significantly larger than those for heterosexist discrimination and sexual orientation visibility management. Sexual minority stress was significantly and negatively associated with same-sex relationship quality but not associated with closeness or stability. Sexual minority stress was significantly and negatively associated with relationship well-being among same-sex female couples but not among same-sex male couples. The current status of research approaches in this field was also summarized and discussed.

Sexual Minority Stress and Same-Sex Relationship Well-Being: A Meta-Analysis of Research Prior to the U.S. Nationwide Legalization of Same-Sex Marriage

Meta-analytic methods were used to analyze 179 effect sizes retrieved from 32 research reports on the implications that sexual minority stress may have for same-sex relationship well-being. Sexual minority stress (aggregated across different types of stress) was moderately and negatively associated with same-sex relationship well-being (aggregated across different dimensions of relationship well-being). Internalized homophobia was significantly and negatively associated with same-sex relationship well-being, whereas heterosexist discrimination and sexual orientation visibility management were not. Moreover, the effect size for internalized homophobia was significantly larger than those for heterosexist discrimination and sexual orientation visibility management. Sexual minority stress was significantly and negatively associated with same-sex relationship quality but not associated with closeness or stability. Sexual minority stress was significantly and negatively associated with relationship well-being among same-sex female couples but not among same-sex male couples. The current status of research approaches in this field was also summarized and discussed.

Correlates of Sexual Risk among Recent Gay and Bisexual Immigrants from Western and Eastern Africa to the USA

We examined correlates of sexual risk among gay and bisexual men, who recently migrated from western and eastern African countries to the USA and lived in New York City and who are HIV negative or of unknown status. These men migrate from countries where same-sex sexuality is socially rejected and mostly illegal contributing to the motivation to migrate. Their background might predispose these men to engagement in sexual risk practices, while they are not specifically addressed in HIV prevention programming. Participants (N = 62) reported in face-to-face interviews on pre- and postmigration experiences, psychosocial determinants of sexual risk, and current sexual practices. Operationalization of sexual risk was based on the number of men with whom they had condomless receptive and/or insertive anal sex. Over a third of the men reported always having used condoms in the past year; among the other men, sexual risk varied. Multivariate analyses showed that sexual risk was lower among men with a stronger motivation to avoid HIV infection and higher among men who currently engaged in transactional sex. Further analyses indicated that housing instability was independently associated with reduced motivation to avoid HIV infection and with engagement in transactional sex in the USA. In recent western and eastern African gay and bisexual immigrants to the USA, structural factors, including housing instability, are strongly associated with sexual risk.

The Role of Minority Stressors in Lesbian Relationship Commitment and Persistence over Time

The Investment Model of relationship commitment uses interpersonal investment, relationship satisfaction, quality of alternatives, and commitment to predict relationship longevity (Rusbult, 1980, 1983). Although ample support for the Investment Model has been found in heterosexual couples, it appears to be less powerful in predicting stability in same-sex relationships (Beals, Impett, & Peplau, 2002), potentially because the model does not account for factors unique to same-sex relationships, such as anti-gay discrimination. However, no research has tested the nature and power of sexual minority stress factors in predicting same-sex relationship stability over time. Using secondary, longitudinal data collected from a diverse sample of lesbian women in relationships (N = 211), we examined how internalized homonegativity, sexual identity disclosure, and workplace discrimination affected the Investment Model antecedents of relationship persistence: satisfaction, quality of alternatives, and investment. We tested the influence of sexual minority stressors on Investment Model processes using structural equations modeling and found that sexual identity disclosure was positively associated with satisfaction and investment, internalized homonegativity was only negatively associated with satisfaction and investment, while workplace discrimination was negatively associated with alternatives. Moreover, both relationship satisfaction and investment influenced commitment which predicted persistence in these relationships over about seven years' time, demonstrating support for the Investment Model. Our findings support the addition of sexual minority stress variables to the Investment Model when examining same-sex relationships and implications are discussed.

Health Equity and Aging of Bisexual Older Adults: Pathways of Risk and Resilience

OBJECTIVES

Bisexual older adults are a growing yet largely invisible, underserved, and understudied population. Utilizing the Health Equity Promotion Model, we examined hypothesized mechanisms accounting for health disparities between bisexual older adults and lesbian and gay older adults.

METHOD

Based on data from Caring and Aging with Pride, the largest national survey of LGBT older adults, this study (N = 2,463) utilized structural equation modeling to investigate direct and indirect associations between sexual identity (bisexual vs. lesbian and gay) and health via sexual identity factors (identity disclosure and internalized stigma), social resources, and socioeconomic status (SES).

RESULTS

Bisexual older adults reported significantly poorer health compared with lesbian and gay older adults. Indirect effects involving sexual identity factors, social resources, and SES explained the association between bisexual identity and poorer health. A potentially protective pathway was also identified wherein bisexuals had larger social networks after adjusting for other factors.

DISCUSSION

Bisexual older adults face distinct challenges and health risks relative to other older adults, likely because of the accumulation of socioeconomic and psychosocial disadvantages across the life course. Interventions taking into account older bisexuals' unique risk and protective factors may be helpful in reducing health inequities.

Older Gay Men and Their Support Convoys

Objective

We used the convoy model and the network type construct to identify the relationship quality profiles found among older gay men and to examine how they define a satisfactory network.

Method

We used a network mapping strategy and in-depth qualitative interviews with 20 participants in Atlanta. During the interviews, all network members were discussed, regardless of relationship or map position.

Results

For participants, having people in their lives with whom they could fully be "out" as gay men (authenticity) was at the root of a quality network. This allowed them to develop emotional closeness (intimacy), which, in part, provided a foundation of social support. Participants' discussion of network quality, which reflected authenticity, intimacy, and social support, revealed high, moderate, and low quality network types.

Discussion

Our findings diversify knowledge of the network type construct, provide a deeper understanding of its qualitative features, and give voice to this often-invisible group, situating meaning within their social-historical context. The findings suggest that the meaning of a quality network is contextual and culturally specific, varying across groups of older adults.

Relationship satisfaction in lesbian couples: Review, methodological critique, and research agenda

There has been increased interest in and attention to understanding the characteristics associated with relationship satisfaction among same-sex couples. This review examines the individual, couple, and external factors associated with relationship satisfaction among contemporary lesbian couples, highlighting domains such as internalized homophobia, personality, communication, conflict, sex, stress, and social support. I discuss methodological concerns and future directions to advance research in this area.

Emotional Intimacy Among Coupled Heterosexual and Gay/Bisexual Croatian Men: Assessing the Role of Minority Stress

Emotional intimacy cuts across contexts as diverse as sexual motivation and satisfaction, psychological and physical health, and relational well-being. Although the experience of intimacy and its effects on sex life may be gender and sexual orientation-specific, the role of intimacy in personal and sexual relationships has been studied mostly among heterosexual individuals and couples. Using the minority stress framework (Meyer, 2003) to address this gap in knowledge, the present study comparatively explored levels and predictors/correlates of emotional intimacy, and its association with sexual satisfaction among coupled heterosexual and gay/bisexual men sampled online in a predominantly homonegative country (Croatia). Heterosexual participants (n = 860; M age = 36.4, SD = 9.09) were recruited in 2011 and gay/bisexual participants (n = 250; M age = 29.4, SD = 7.13) in 2013. Controlling for age and relationship duration, gay/bisexual men reported higher levels of emotional intimacy than heterosexual men. Suggesting that the role of emotional intimacy in sexual satisfaction is not sexual orientation-specific, the strength of the association between these two constructs was similar in both samples. However, internalized homonegativity, which was negatively associated with emotional intimacy in this study, remains a challenge to creating and maintaining intimacy in male same-sex relationships.

Comparing Heterosexuals' and Gay Men/Lesbians' Responses to Relationship Problems and the Effects of Internalized Homophobia on Gay Men/Lesbians' Responses to Relationship Problems in Turkey

The purpose of the present study was twofold: (1) to investigate the effects of sexual orientation (heterosexuals and gay men/lesbians) and gender difference on responses to romantic relationship problems (Exit, Voice, Loyalty, and Neglect [EVLN] responses) and of perceived partner's EVLN responses in Turkey, and (2) to examine whether internalized homophobia was associated with EVLN responses and perceived partner's EVLN responses for gay men and lesbians. Responses to Dissatisfaction Scale-Accommodation Instrument, Internalized Homophobia, and Demographics Information were administered to 187 participants (44 lesbians, 44 gay men, 53 heterosexual women, 46 heterosexual men).The MANCOVA results showed that men reported higher loyalty than women, whereas women presented more exit responses than men. Further, the interactions between gender and sexual orientation on the participants' EVLN responses and on the perceived partner's EVLN responses were significant. With respect to heterosexual women, heterosexual men displayed more loyalty responses. Lesbians had higher scores on loyalty than did heterosexual women. Lesbians also had higher scores on perceived partner's exit response than did heterosexual women and gay men. On the contrary, heterosexual women reported more perceived partner's voice response than lesbians. In addition, lesbians reported higher perceived partner's neglect responses than heterosexual women. Compared to heterosexual women, heterosexual men reported higher perceived partner's exit response. Finally, internalized homophobia was associated with destructive responses for both lesbians and gay men.

Which Psychological Factors are Related to HIV Testing? A Quantitative Systematic Review of Global Studies

Deciding to test for HIV is necessary for receiving HIV treatment and care among those who are HIV-positive. This article presents a systematic review of quantitative studies on relationships between psychological (cognitive and affective) variables and HIV testing. Sixty two studies were included (fifty six cross sectional). Most measured lifetime testing. HIV knowledge, risk perception and stigma were the most commonly measured psychological variables. Meta-analysis was carried out on the relationships between HIV knowledge and testing, and HIV risk perception and testing. Both relationships were positive and significant, representing small effects (HIV knowledge, d = 0.22, 95 % CI 0.14-0.31, p < 0.001; HIV risk perception, OR 1.47, 95 % CI 1.26-1.67, p < 0.001). Other variables with a majority of studies showing a relationship with HIV testing included: perceived testing benefits, testing fear, perceived behavioural control/self-efficacy, knowledge of testing sites, prejudiced attitudes towards people living with HIV, and knowing someone with HIV. Research and practice implications are outlined.

Gender Nonconformity, Discrimination, and Mental Health Among Black South African Men Who Have Sex with Men: A Further Exploration of Unexpected Findings

Using data from a study about HIV risk among Black South African MSM, we aimed to ascertain whether unexpected findings about the relationship between gender nonconformity, discrimination, and mental health in this population, as reported by Cook, Sandfort, Nel, and Rich (2013), could be replicated, and to explore more in-depth how gender nonconformity relates to health. Cook et al. found that feminine men were not more likely to be depressed despite the observation that they were more likely to be discriminated against and that discrimination increased the likelihood of depression. This is in contrast to what studies among gay and bisexual men in Western countries have consistently shown. In the current study, 196 Black South African MSM (ages between 18 and 40; M age, 26.65 years) were surveyed. Assessments included stressors (identity confusion, internalized homophobia, and sexual orientation-based discrimination) and resilience factors (openness about one's sexual orientation, social support, and identification with the gay community). We observed that gender-nonconforming men were not more likely to be depressed despite having experienced more discrimination, which was associated with depression. The same relationships were observed when considering anxiety as the mental health outcome. We found an indirect negative effect of gender nonconformity on depression through internalized homophobia, suggesting that, in this population, internalized homophobia masks the effect of discrimination on mental distress. Implications for the sexual minority stress model, used to guide our analyses, are discussed. Further research is needed to disentangle the complex relationship between gender nonconformity and mental health among MSM populations.

When Parents Separate and One Parent 'Comes Out' as Lesbian, Gay or Bisexual: Sons and Daughters Engage with the Tension that Occurs When Their Family Unit Changes

The experiences of Irish sons and daughters born into heterosexually-organised parental partnerships/unions whose parents have separated and one has come out as Lesbian, Gay or Bisexual (LGB) were explored through a grounded theory approach. 15 adult children (over the age of 18 years), who varied in age when their parents separated and one disclosed as LGB, were interviewed. The primary concern that emerged centred on participants having to adjust to their parents’ being separated, as opposed to their parent being LGB. This involved engaging with the tension that arose from the loss of the parental union, which involved changes to the home environment and adapting to new parental partners and family units. Heightened reflection on sexual orientation and an increased sensitivity to societal LGB prejudice were specifically associated with a parent coming out as LGB. How parents negotiated disclosing the changes to others, the level of support available to parents, and how capable parents were at maintaining the parent-child relationship had an impact on the tension experienced by sons and daughters. Participants moved from initially avoiding and resisting the family changes that were occurring to gradual consonance with their altered family environments. Concluding directions for research and clinical considerations are suggested.

Identity, Relationship Satisfaction, and Disclosure

We tested the usefulness of combining the Interpersonal–Psychological Theory of Suicide and minority stress models in studying suicidality among sexual minority women. According to the Interpersonal–Psychological Theory of Suicide, perceptions of being a burden on others and feelings of failed belongingness predict suicidal ideation. In a sample of sexual minority women ( n = 51), we tested first, if the interaction of perceived burdensomeness and failed belongingness predicted lifetime suicidal behavior; second, if identity affirmation was negatively related to perceived burdensomeness and if this relation was moderated by disclosure; and third, if relationship satisfaction was negatively related to failed belongingness and if this relation was moderated by acceptance concerns. The proposed interaction of perceived burdensomeness and failed belongingness predicted lifetime suicide attempts. Moreover, among sexual minority women with greater disclosure of their sexual minority identities, low identity affirmation was related to higher perceived burdensomeness. For sexual minority women with high acceptance concerns, relationship satisfaction did not relate to lower feelings of failed belongingness. These findings suggest that sexual minority related stressors moderate risk factors for suicidality—in particular, perceptions of burdensomeness and failed belongingness. We suggest clinicians and others encourage sexual minority individuals to engage in activities that promote effectiveness and interpersonal closeness. Online slides for instructors who want to use this article for teaching are available to PWQ subscribers on PWQ's website at http://pwq.sagepub.com/supplemental

Lesbian, Gay, and Bisexual Identity as a Moderator of Relationship Functioning After Sexual Assault

Sexual assault is unfortunately common, especially among lesbian, gay, and bisexual (LGB) individuals. Yet, the associations of such victimization have not yet been extensively established in the areas of sexual identity and romantic relationship functioning. Accordingly, the present study examined the associations between lifetime sexual assault, LGB identity, and romantic relationship functioning in a sample of 336 LGB individuals. A history of sexual assault was associated with attachment anxiety and several sexual identity components (i.e., higher levels of acceptance concerns, identity uncertainty, internalized homonegativity, and identity superiority). Furthermore, an association of sexual assault and attachment avoidance was moderated by internalized homonegativity. Finally, a more secure LGB identity was associated with healthier romantic relationship functioning. Collectively, these findings are applicable to services for LGB sexual assault victims, suggesting the incorporation of treatment that bolsters LGB identity and couple functioning. Limitations and future directions are discussed.