Ethnicity and sex differences in university students' knowledge of AIDS, fear of AIDS, and homophobia

Explaining inequity in knowledge, attitude, and services related to HIV/AIDS: a systematic review

BACKGROUND

Equitable service provision and coverage are important responses to end the threat of the HIV/AIDS pandemic. Understanding inequity supports policies and programmes to deliver tailored interventions. There is continuous evidence generation on inequity in HIV/AIDS services. However, there was a lack of evidence on the global picture of inequity in behavioural and biomedical services related to HIV/AIDS. This systematic review assessed inequities in knowledge, attitude, HIV testing, and ART coverage across individual-level social groups and multiple (dis)advantage categories.

METHODS

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline, with a PROSPERO registration number CRD42024521247. The risk of bias was assessed by using Hoy et al's and Joanna Brigg's quality appraisal checklists for cross-sectional quantitative and qualitative studies, respectively. The search date was from inception to the final database search date (May 29, 2023). The included articles were either quantitative or qualitative studies. We used mixed-methods approach to analyse the data from the review articles. Quantitative descriptive analysis was conducted to estimate frequency of articles published from different countries around the world. Qualitative content analysis of the findings from the original studies was conducted using the PROGRESS plus framework which stands for: place of residence, occupation or employment status, gender, religion, education status, socioeconomic status, and social capital.

RESULTS

Out of 6,029 articles that were accessed and screened, only 72 articles met the inclusion criteria. More articles on HIV-related equity in knowledge, attitude, testing, and ART were published in developed countries than in developing countries. Individuals from higher-income households had better knowledge about HIV/AIDS. Unfavourable attitudes towards people living with HIV and HIV/AIDS-associated stigma were common among women. HIV/AIDS service coverage (HIV testing or ART coverage) was higher among richer and urban residents. HIV/AIDS-associated stigma and lower levels of knowledge about HIV/AIDS were observed among multiple disadvantageous groups due to the intersection of two or more identities.

CONCLUSIONS

The current review revealed that there have been disparities in HIV/AIDS services between social classes. Ending service disparity towards the global threat of HIV/AIDS demands tailored interventions based on socially disadvantaged groups (e.g., poor, rural dwellers, and women) and intersectional determinants. There is a need to understand the deep-rooted causes of inequity and the challenges that an equity-oriented system faces over time. More studies on inequity are needed, including intersectional inequity, which has been rarely studied in developing countries.

Gendered Trajectories to Tolerance: Men's and Women's Changing Attitudes toward Homosexuality in Japan, 1981-2019

Gender and sexuality are context-specific constructions. Yet, among the increasing volume of quantitative studies on changing attitudes toward homosexuality, scholars have failed to understand the role of gender in shaping attitudinal change. This study sheds light on the hitherto overlooked aspect of gender in analyzing changing attitudes toward homosexuality in a non-Western context. Drawing on Japanese data from the World Values Survey, I use a linear decomposition technique to estimate relative contributions of cohort replacement and intracohort change effects on overall change and examine the difference in changes between men and women. The results show clear gendered patterns in attitudinal change over the past four decades. Including the Japanese case in the literature allows for theoretical arguments on how persistent patriarchy and deeply embedded heteronormative practices perpetuate hegemonic masculinity and associated homophobia. Although the recent rapid liberalization of attitudes among men might shine a light on the emergence of inclusive masculinity, I argue that hegemonic masculinity is still at play, especially among older generations. Future research may address whether changing attitudes can be a catalyst for social change or merely a vestige of hegemonic masculinity that legitimizes a more subtle form of homophobia in the contemporary era.

Differences in Health Care Access and Satisfaction Across Intersections of Race/Ethnicity and Sexual Identity

PURPOSE

Racial/ethnic and sexual minorities experience numerous health disparities compared with their White and heterosexual counterparts, which may be exacerbated when these social identities intersect. The authors tested for differences in health care access and satisfaction across intersections of sexual identity and race/ethnicity.

METHOD

A cross-sectional secondary data analysis of the 2012-2018 waves of the Association of American Medical Colleges biannual online Consumer Survey of Health Care Access was conducted. This survey captures a national sample of U.S. adults who reported needing health care in the past 12 months. The analytic sample included 29,628 participants. Sixteen possible combinations of sexual identity and race/ethnicity were examined. Health care access and satisfaction were measured with 10 items and an index created from these items. Cumulative prevalence ratios (PRs) for the index and PRs across sexual identity, both individually and in combination with race/ethnicity, for each health care access and satisfaction item were generated.

RESULTS

Compared with White heterosexuals, all other groups had significantly more barriers to care before adjustment. The greatest barriers were observed among non-Hispanic Asian/Pacific Islander/Hawaiian gay/lesbian (unadjusted PR = 3.08; 95% confidence interval [CI]: 2.45, 3.88; adjusted PR = 2.01; 95% CI: 1.59, 2.53), non-Hispanic Black bisexual (unadjusted PR = 2.73; 95% CI: 2.28, 3.27; adjusted PR = 1.83; 95% CI: 1.52, 2.20), non-Hispanic Black other sexual identity (unadjusted PR = 2.27; 95% CI: 1.69, 3.06; adjusted PR = 2.07; 95% CI: 1.53, 2.78), and Hispanic/Latino other sexual identity (unadjusted PR = 2.06; 95% CI: 1.60, 2.65; adjusted PR = 1.39; 95% CI: 1.08, 1.79) participants.

CONCLUSIONS

Persons of both racial/ethnic and sexual minority status generally had less health care access and satisfaction than White heterosexuals. An intersectional perspective is critical to achieving equity in quality health care access.

The association between AIDS-related stigma and aggression toward gay men and lesbians

This study examined whether self-identified race and prior contact with a gay man or lesbian moderate the association between AIDS-related stigma and aggression toward gay men and lesbians when controlling for sexual prejudice. A regional, community-recruited sample of 194 heterosexual men (50% Black, 50% White) completed measures of AIDS-related stigma, sexual prejudice, and prior contact with gay men and lesbians. Regression analyses showed that AIDS-related stigma was positively associated with aggression toward gay men and lesbians among White men who reported no prior contact, but not among White men who endorsed prior contact and Black men regardless of prior contact. Findings suggest that intergroup contact may be a key component to reducing the effects of AIDS-related stigma towards stigmatized groups. Implications for aggression theory and intervention are discussed. Aggr. Behav. 42:542-554, 2016. © 2016 Wiley Periodicals, Inc.

Multiple Oppressions and the Mental Health of Sexual Minority Latina/o Individuals

This study investigated the additive and interactive relations of two forms of external oppression (racist discrimination and heterosexist discrimination) and internalized oppression (internalized racism and internalized heterosexism) with psychological distress, life satisfaction, and self-esteem in a sample of 173 sexual minority Latina/o adults. A combination of external and internalized oppressions was associated uniquely with psychological distress whereas the two internalized oppressions were linked uniquely with life satisfaction and self-esteem. The Racist discrimination × Internalized racism, Racist discrimination × Internalized heterosexism, and Heterosexist discrimination × Internalized racism interactions each accounted for unique variance in self-esteem. Specifically, low internalized racism protected self-esteem at low levels of racist discrimination, low internalized heterosexism protected self-esteem at high levels of racist discrimination, and low internalized racism protected self-esteem at high levels of heterosexist discrimination. Thus, multiple forms of oppression contribute additively and interactively to mental health in this population.

The interactive impacts of high school gay-straight alliances (GSAs) on college student attitudes toward LGBT individuals: an investigation of high school characteristics

Although gay-straight alliances (GSAs) are becoming more popular in high schools across the U.S., empirical studies investigating GSAs and their impact are sparse. Utilizing a sample of college students drawn from a large Southern university (N = 805; 78% White; 61% female; average age 22), the current study investigates the ways that the presence of high school GSAs affect college student attitudes toward LGBT individuals and how these relationships may vary by high school GSA location (South vs. non-South), town type (rural/small town, suburban, large city), and high school student population size. Overall, results from the current study show that the presence of a GSA in high school is a robust positive predictor of supportive attitudes toward LGBT individuals, even when considering many control variables. Such results suggest that the presence of GSAs in high schools may have significant positive and potentially long-lasting effects on college students' attitudes toward LGBT individuals.

HIV knowledge among Canadian-born and sub-Saharan African-born patients living with HIV

Research has revealed differences on scales measuring HIV knowledge between individuals from various ethnic backgrounds and cultures. Few studies have examined this knowledge with immigrant populations and persons living with HIV. This study examined HIV knowledge among persons living with HIV who were either born in Canada or in sub-Saharan Africa and, for comparison, in a sample of college students. All participants were residing in Canada. Participants completed questionnaires measuring demographic variables, sexual health behaviour, and HIV status, treatment, and knowledge. Canadian-born patients living with HIV were more likely to be older and male than the other groups. On average, patients living with HIV were diagnosed 6.4 years ago, and 80% reported having current or previous experience taking HIV medications. After adjusting for age and gender, significant differences were found between the groups on the Brief HIV Knowledge Questionnaire. Canadian-born persons living with HIV (n = 110) scored higher than sub-Saharan African-born patients (n = 23) and college students (n = 81); mean percentage correct was 86, 70, and 62%, respectively (P < .01). These results suggested that ongoing HIV education is needed for all groups, and that additional tailored and targeted educational interventions are needed to address important gaps in knowledge among persons living with HIV patients originating from Africa and among college students.

Student degree program and attitudes toward gays and lesbians in the military: is there a connection?

Individuals routinely experience discrimination based on sexual orientation. Since the implementation of Don't Ask, Don't Tell in 1994, over 13,000 military personnel have been discharged from the U.S. military on the basis of sexual orientation. As helping professionals, social workers will often provide services to returning gay and lesbian veterans. Therefore, social work programs must ensure that students develop positive attitudes toward and understanding of the needs presented by this population. Little is known about whether a specific degree program can be a predictor of student attitude toward gay and lesbian individuals in the military. Eighty-nine graduate students completed the Attitudes Toward Homosexuals in the Military (ATHM) scale, and scores were compared between two graduate degree programs: Social Work and Business Administration. A statistically significant relationship was found between degree program and ATHM scores. Implications for policy, practice and research related to gay and lesbian veterans are discussed.

“Hating the sin but not the sinner”: a study about heterosexism and religious experiences among black men

This article explored the religious experiences of nine Black men who are married (to a woman) and have sex with men (BMMSM). These men do not refer to themselves as men on the down low but self-identify as heterosexual. Using data collected in 2005 in South Carolina, the authors examined the complex relationship of homosexuality and the Black Church. Specifically, they examined the notion of coping with same-sex behavior, concealment, and its impact on BMMSM. Findings from the thematic analysis suggest that men found ways to manage their religious traditions and same-sex behaviors. This research presents an opportunity to locate and access a hidden population. The authors found a pervasive experience of growing up in social and family environments that expose them to heterosexism.

LGB of Color and White Individuals’ Perceptions of Heterosexist Stigma, Internalized Homophobia, and Outness: Comparisons of Levels and Links

Conceptual discussions about LGB people of color suggest that, compared with White LGB individuals, LGB people of color may be exposed to greater levels of heterosexist stigma and its deleterious correlates (greater risk) or may be more resilient to such stigma (resilience). This study tested tenets of these two perspectives with a sample of 178 LGB persons, about 50% of whom identified as White and 50% as people of color. Findings suggested similarities between LGB people of color and White LGB individuals in levels of perceived heterosexist stigma, internalized homophobia, and comfort with disclosure of sexual orientation and in relations of heterosexist stigma with sexual orientation disclosure variables. But, compared with data for White LGB participants, data for LGB people of color suggested lower levels of outness and a weaker relation between perceived heterosexist stigma and internalized homophobia. Implications of these findings for further research and practice are discussed.

Demographic and social factors associated with homophobia and fear of AIDS in a community sample

Examinations of demographic and social factors associated with homophobia and fear of AIDS are limited by the frequent use of homogeneous, college student samples and limited examination of interrelationships among variables. The present study examined community attitudes toward homosexuality and fear of HIV/AIDS as a function of age, education, race/ethnicity, religious affiliation, political party affiliation, and personal contact with homosexual individuals and persons living with HIV/AIDS. A community sample of 463 adults completed standardized measures of homophobia and fear of AIDS as well as demographic and social background items. When examined separately, each demographic and social factor assessed, with the exception of race/ethnicity, was associated with homophobia and all but race/ethnicity and political party affiliation were associated with fear of AIDS. However, when entered into multiple regression analyses, 24% of the variance in homophobia was predicted by a single variable, including only personal contact with homosexual individuals, while 18% of the variance in fear of AIDS was accounted for by five variables, including personal contact with homosexual individuals, religious affiliation, political affiliation, education, and personal contact with someone living with HIV/AIDS. Findings suggest that it is important to consider intercorrelations among social and demographic factors, particularly when considering homophobia.

John Amaechi: changing the way sport reporters examine gay athletes

In 2007, John Amaechi became the first former National Basketball Association (NBA) player to publicly announce he was gay. Former NBA star Tim Hardaway made a series of homophobic remarks a week later. A textual analysis was used to analyze narratives on Amaechi's revelation and/or Hardaway's comments published in 50 international newspapers. Four dominant themes emerged from the data. While most of these themes supported narratives that gay males remain unwelcome in men's team sports, all were challenged consistently, thus, showing the fluidity of hegemonic masculinity and the increasing societal acceptance of gays and gay lifestyles. Moreover, print media writers exhibited little homophobia and frequently called for more acceptance of gays, particularly within sport.

Gender nonconformity, homophobia, and mental distress in latino gay and bisexual men

This study explored whether gender nonconformity in gay and bisexual men is related to mental distress and if so, whether this relationship is mediated by negative experiences that are likely associated with gender nonconformity, including abuse and harassment. To study this question, data were analyzed from face-to face interviews with 912 self-identified gay and bisexual Latino men in three major U.S. cities collected by Diaz and colleagues (2001). Gay and bisexual Latino men who considered themselves to be effeminate had higher levels of mental distress and more frequently reported various negative experiences, compared with gay and bisexual Latino men who did not identify as effeminate. Higher levels of mental distress in effeminate men seemed to primarily result from more experiences of homophobia. Findings suggest the need for more attention to gender in research as well as counseling of sexual minority men.

The urban environment and sexual risk behavior among men who have sex with men

Increasingly, studies show that characteristics of the urban environment influence a wide variety of health behaviors and disease outcomes, yet few studies have focused on the sexual risk behaviors of men who have sex with men (MSM). This focus is important as many gay men reside in or move to urban areas, and sexual risk behaviors and associated outcomes have increased among some urban MSM in recent years. As interventions aimed at changing individual-level risk behaviors have shown mainly short-term effects, consideration of broader environmental influences is needed. Previous efforts to assess the influence of environmental characteristics on sexual behaviors and related health outcomes among the general population have generally applied three theories as explanatory models: physical disorder, social disorganization and social norms theories. In these models, the intervening mechanisms specified to link environmental characteristics to individual-level outcomes include stress, collective efficacy, and social influence processes, respectively. Whether these models can be empirically supported in generating inferences about the sexual behavior of urban MSM is underdeveloped. Conceptualizing sexual risk among MSM to include social and physical environmental characteristics provides a basis for generating novel and holistic disease prevention and health promotion interventions.

College students' views on gay and lesbian issues: does education make a difference

Many in academia believe that higher education leads to an increase in tolerance towards individuals who are different. There are some empirical findings to support this premise; however, the impact of higher education on acceptance of homosexuality has not been adequately explored. Gays and lesbians in society face many negative attitudes. Based upon the survey results of 364 students at a Midwestern university, juniors and seniors had statistically significant more positive attitudes towards gays and lesbians than did freshmen and sophomores. Even in multi-variate analysis, upper-level students had more positive views on many of the attitudinal measures.

Explaining comfort with homosexuality in rural america

While recent research has explored the determinants of homophobia in urban settings, few have looked at the perception of homosexuals in rural communities. This research fills this gap by exploring the ways in which Central Appalachians feel about homosexuality. In doing so, the impact of interpersonal contact with a homosexual as well as the factors of gender, age, religious beliefs, gender role prescriptions and fear of AIDS are identified through a multivariate analysis of 123 college students. In the end, the role of homosexual peers is emphasized, as are the effects of the perceived cause of homosexuality, and the anxieties over AIDS. Finally after some stipulations about methodological limitations, this work offers some suggestions as to how practitioners and social work educators can use this study to counter the homophobic ideas that are prevalent in rural Americans.

A comparison of African American and white college students' affective and attitudinal reactions to lesbian, gay, and bisexual individuals: an exploratory study

African American (n = 70) university students were compared with White students (n = 140) on their affective (homophobia) and attitudinal (homonegativity) reactions to lesbian, gay, and bisexual individuals. The results initially suggested that African Americans had modestly higher homophobia and homonegativity scores than Whites. However, those ethnic differences vanished after controlling for frequency of church attendance, religious commitment, and socioeconomic status. For both ethnic groups, gender and religiosity variables significantly predicted homophobia and homonegativity. Men in both ethnic groups had significantly higher homophobia and homonegativity scores than their female counterparts. Lastly, additional regression analyses revealed that one aspect of African American culture--family practices--significantly predicted homophobia, but not homonegativity, above the predictive ability of religiosity. Implications of the results are discussed.

Black masculinity matters in attitudes toward gay males

Recent work on attitudes toward homosexuals promotes the view that males typically have more negative attitudes than females; and African Americans have more negative attitudes than their white counterparts. However, among African Americans, women are thought to have the greatest negative attitudes because they perceive themselves as competing for a limited pool of black male partners. This study uses the National Black Politics Study to examine African American gender differences in attitudes toward homosexual men. Multivariate findings show that of the variables analyzed: (1) Among African American females, age, income, education, and urban residence are statistically significant; and (2) among African American males, frequency of religious attendance was the only statistically significant variable. It is, therefore, argued that black masculinity explains the gendered differences and that negative attitudes within the African American community toward gay men contribute to debilitating both the physical and mental health of the entire black community.

Knowledge of HIV/AIDS transmission and screening in United States blood donors

BACKGROUND

Increased knowledge of HIV transmission and behavioral and test screening may encourage high-risk blood donors to self-defer.

STUDY DESIGN AND METHODS

Knowledge of HIV transmission and screening and the association with demographics, screening test reactivity, and unreported deferrable risks (UDRs) was assessed by a 1998 anonymous mail survey sent to 92,581 blood donors, of whom 57 percent responded. Groups were compared by using weighted chi-square tests and logistic regression analysis.

RESULTS

Four percent of the donors thought that it was very likely or somewhat likely for a person to contract HIV from donating blood, and 20 percent perceived a similar risk from blood transfusion. Only 60 percent of the donors knew that the available screening tests may not detect a recent infection. Thirty-seven percent either did not know or felt it was acceptable to donate blood to obtain HIV testing. Those most likely to answer knowledge questions incorrectly were more likely to have a higher prevalence of test reactivity or UDRs and to be <or=25 years old, members of a minority, less educated, non-US-born, or first-time donors.

CONCLUSION

Innovative ways to increase donor understanding of the implications of risk behaviors and the limitations of current screening procedures should be developed. They might prevent high-risk individuals from donating blood.

Attributions and emotional reactions to the identity disclosure ("coming out") of a homosexual child

This study examined factors that contribute to parental rejection of gay and lesbian youth. College students (N = 356) were asked to imagine being the parent of an adolescent son who recently disclosed that he was gay. Consistent with study hypotheses and based on attribution and moral affect theory, results of regression analyses indicated that greater perceptions of control over homosexuality, higher proneness to experience shame, and lower proneness to experience guilt were associated with increasing negative reactions toward an imagined homosexual child. Also in line with study hypotheses, greater willingness to offer help to the hypothetical child was predicted by lower perceptions of control over homosexuality, less intensely unfavorable emotional reactions, less proneness to experience guilt, and greater reported likelihood of experiencing affection toward him. Theoretical and clinical implications of this research are discussed.