Discrimination and Rejection: The Effects of Ethnic and Sexuality-Based Discrimination Against Latino Gay and Bisexual Men

Latino gay and bisexual men (GBM) may experience discrimination attributed to their sexual orientation and ethnicity, necessitating an examination of their experiences from an intersectional lens. While relationships between discrimination and the internalization of those messages have been previously researched, less is known about experiencing discrimination attributed to different identities and its relationships with discrete attributions of internalized stigma. Understanding how different attributes of identity-based discrimination are related to different attributes of identity-based internalization of stigma among gay and bisexual men of color may be important in the design of interventions to help Latino GBM cope with discrimination and prevent negative mental health outcomes. In order to achieve this aim, the current study utilized data from the Latino MSM Community Involvement: HIV Protective Effects Study, which included 571 self-identified Latino GBM. Results demonstrate that experiences of external anti-Latino discrimination were significantly linked to both internalized ethnicity- and sexuality-based stigma, whereas experiences of external sexuality-based discrimination were not significantly linked with internalized ethnicity- or sexuality-based stigma. Results suggest a need for future research to further examine effects of external ethnic discrimination on the psychosocial health of Latino GBM.

Internalized Homonegativity and the Challenges of Having Same-Sex Desires in the Lebanese Context: A Study Examining Risk and Protective Factors

Internalized homonegativity (IH) has received increased attention in the literature on sexual minorities. Nevertheless, there is a lack of research on IH in conservative Arab cultures like Lebanon. The present study aimed to cover this gap by exploring risk and protective factors of IH in Lebanese sexual minorities. A hierarchical multiple regression (N = 210) revealed that religiosity, parental rejection (actual or anticipated), and legal discrimination were significant risk factors of IH, while sense of belonging to the LGBT community was a strong protective factor. Although self-compassion did not emerge as a predictor, it had interesting interactions on the bivariate level. Results, limitations, clinical implications, and recommendations for future research and policy making are discussed.

Exploring the role of trauma in underpinning sexualised drug use ('chemsex') among gay, bisexual and other men who have sex with men in Singapore

BACKGROUND

Sexualised drug use (SDU) has been identified as a major risk factor for HIV, as well as other mental health comorbidities among gay, bisexual and other men who have sex with men (GBMSM). While multiple studies have been conducted on the topic, few have explored the role of trauma in underpinning experiences of SDU among substance use treatment-experienced GBMSM. This qualitative study investigates life histories of trauma, and proposes a framework to better situate the factors driving SDU among treatment-experienced GBMSM.

METHODS

We conducted semi-structured in-depth interviews with 33 purposively-sampled GBMSM with a history of SDU, and seeking treatment for it in Singapore. Interview topics included participants' experiences and life histories of SDU, substance use, incarceration, trauma, as well as stories of resilience and ongoing recovery from SDU. Interviews were audio-recorded, transcribed, coded, and analysed using inductive thematic analysis, from which a trauma-informed framework was developed.

RESULTS

Participants firstly articulated the positive and desired aspects of SDU, such as its utility in allowing them to achieve positive emotional states, sexual enhancement, and feelings of connectedness and intimacy. Participants also described how SDU, in contrast, was used as a coping mechanism to deal with emotional and situational 'precipitants', including dealing with loneliness and a low self-esteem, sexual shame and social anxiety, as well as general stressful situations. Participants also articulated how such precipitants were underpinned by experiences of trauma, including those relating to HIV-related stigma, racism, sexual violence, death and loss, neglect, as well as internalised homophobia. Next, participants illustrated how such trauma were in turn reinforced by several 'preconditions', including the accessibility of substances, emphasis on sexual capital, and lack of access to mainstream support structures in the gay male community, alongside general sociolegal barriers to accessing care.

CONCLUSIONS

This study proposes the role of trauma and the preconditions underpinning them in motivating SDU among a sample of largely substance use treatment-experienced GBMSM in Singapore. Interventions that provide support for GBMSM seeking treatment for SDU should provide trauma-informed care to address the complex barriers to treatment effectiveness.

Association between sexual orientation acceptance and suicidal ideation, substance use, and internalised homophobia amongst the pink carpet Y cohort study of young gay, bisexual, and queer men in Singapore

Background

Gay, bisexual and queer (GBQ) men are frequently subjected to minority stressors that have negative impacts on their health. Milestones that include the acceptance and disclosure of sexual identity amongst GBQ men are hence key instruments in understanding the prevalence of internalised homophobia and predicting health outcomes. As such, this work takes a novel approach to deduce the correlates of delayed acceptance of sexual orientation in young GBQ men as a measure of internalised homophobia through retrospective self-reporting and age-based analysis.

Methods

Participants were recruited as part of a cohort study exploring the syndemic risks associated with HIV acquisition among young GBQ men in Singapore. We examined their levels of internalised, perceived, experienced homophobia, as well as their health behaviours and suicidal tendencies. Two separate variables were also self-reported by the participants – the age of questioning of sexual orientation and the age of acceptance of sexual orientation. We subsequently recoded a new variable, delayed acceptance of sexual orientation, by taking the difference between these two variables, regressing it as an independent and dependent variable to deduce its psychosocial correlates, as well as its association with other measured instruments of health.

Results

As a dependent variable, delayed acceptance of sexual orientation is positively associated with an increase of age and internalised homophobia, while being negatively associated with reporting as being gay, compared to being bisexual or queer. As an independent variable, delayed acceptance of sexual orientation was associated with a delayed age of coming out to siblings and parents, suicide ideation, historical use of substances including smoking tobacco cigarettes and consuming marijuana, as well as reporting higher levels of experienced, internalised and perceived homophobia.

Conclusion

Greater levels of early intervention and efforts are required to reduce the heightened experience of minority stress resulting from communal and institutional hostilities. Areas of improvement may include community-based counselling and psychological support for GBQ men, while not forsaking greater education of the social and healthcare sectors. Most importantly, disrupting the stigma narrative of a GBQ ‘lifestyle’ is paramount in establishing an accepting social environment that reduces the health disparity faced by GBQ men.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10992-6.

Not in the Same Mental Drawer: Internalized Sexual Stigma, Dissociation, and the Role of Religion in a Sample of Italian Gay Men

Several studies have highlighted the relationship between internalized sexual stigma (ISS) and dissociation. The aim of the present study was to empirically investigate this relationship through a quantitative study. The Measure of Internalized Sexual Stigma for Lesbians and Gay Men (MISS-LG) and the Dissociation Scale (DIS) of the Trauma Symptom Inventory (TSI) were administered to 120 Caucasian participants who self-identified as gay men. Findings suggested that dissociative symptomatology, as measured by DIS-an estimation of the use of dissociation as a defense mechanism-was positively associated with MISS general index and all dimensions of MISS, especially the sexuality dimension (ISS-S). Moreover, the effect of the ISS-S on DIS was amplified in Catholic participants, suggesting a moderating role of religiosity. Implications for future research and clinical practice are discussed.

Several Common Bonds: Addressing the Needs of Gay and Bisexual Men in LGBT-Specific Recovery Housing

Recovery housing is a promising way to augment the substance use continuum of care, but we know little about the experiences of members of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community who live in them or about residences specifically for them. Within the LGBTQ community, gay, bisexual, and other men who have sex with men (MSM) often experience co-occurring syndemic conditions (e.g., trauma, depression, HIV) that present unique recovery challenges. Using qualitative data gathered from residents living in a recovery residence specifically for gay and bisexual men and from community key informants, we examine the experiences of men living in the home and factors that facilitate operating it. Findings highlight the need for residences that can address syndemic burden among gay and bisexual men in recovery and identify programmatic and community-level factors critical to operating residences for this population.

Internalized Homophobia and Drug Use in a National Cohort of Gay and Bisexual Men: Examining Depression, Sexual Anxiety, and Gay Community Attachment as Mediating Factors

The minority stress process of internalized homophobia (IH) has been associated with a range of adverse health outcomes among gay and bisexual men (GBM). However, evidence is mixed regarding the effect of IH on drug use, suggesting the potential role of multiple mediated pathways. Researchers have linked depression, sexual anxiety, and gay community attachment with IH. Depression, sexual anxiety, and gay community attachment have also been linked with drug use and drug-related problems suggesting potential mediating roles. A U.S. national sample of 1071 HIV-negative GBM completed at-home surveys, including measures of sociodemographic characteristics, IH, depression, sexual anxiety, gay community attachment, and drug use and associated problems. Adjusting for sociodemographic characteristics, depression mediated the association between IH and recent drug use. IH was positively associated with depression, and depression was positively associated with recent drug use. Gay community attachment partially mediated drug-related problems. IH had a positive direct association with drug-related problems and a negative direct association with gay community attachment. Gay community attachment had a positive association with drug-related problems. IH was positively associated with sexual anxiety, but sexual anxiety was not associated with either drug outcome. Efforts to reduce IH among HIV-negative GBM are likely to have a positive impact on mental health problems, as well as reduce risk for drug use and drug-related problems. Gay communities could provide the social support necessary for reducing IH; however, emphasis on community level interventions that address factors that increase risk for drug-related problems remains important.

Food addiction among sexual minorities

Although sexual minorities represent a small proportion of the general population, this group has been observed to be at an increased risk of developing various pathologies, including substance use and eating disorders. Research suggests that foods high in added fat and refined carbohydrates may trigger an addictive response, especially in at-risk individuals. Consequently, food addiction is associated with elevated risk for obesity, diet-related disease, and psychological distress. However, there is limited research on whether food addiction, like substance use, may be elevated among sexual minorities, and whether self-compassion may be a protective factor. Thus, the current study aims to test whether food addiction is elevated in sexual minorities (relative to heterosexuals) and if discrimination and self-compassion may be related to food addiction among sexual minorities. In a community sample of 356 participants (43.3% sexual minority), sexual minorities had almost twice the prevalence of food addiction (16.9%) as heterosexuals (8.9%). Also, sexual minorities on average experienced more food addiction symptoms (M = 2.73, SD = 1.76) than heterosexuals (M = 1.95, SD = 1.59). For sexual minorities, heterosexist harassment was associated with increased food addiction, while self-compassion appeared to be a protective factor. Further research needs to examine between-group differences among sexual minorities for better treatment and interventions for food addiction.

Experiences of Discrimination and HIV Risk Among Men Who Have Sex With Men in New York City

The extent of gay-related discrimination in New York City (NYC) and the demographic and behavioral factors correlated with experiences of gay-related discrimination are not well understood. The Centers for Disease Control and Prevention-sponsored National HIV Behavioral Surveillance System, a cross-sectional study, was conducted in NYC in 2011. Men who have sex with men were venue-sampled, interviewed, and offered HIV testing. Frequencies of types of gay-related discrimination experienced in the past 12 months were calculated. Associations between types of discrimination and demographic and HIV risk variables were examined through the estimation of prevalence ratios (PRs) and 95% confidence intervals (CIs). More than half (53.2%) of all study participants reported having experienced any gay-related discrimination in the past 12 months; 45.0% reported that they had been called names or insulted; 23.6% reported receiving poorer services than other people in restaurants, stores, other businesses, or agencies; 22.0% reported being treated unfairly at work or school; 15.1% reported being physically attacked or injured; and 6.7% reported being denied or given lower quality health care. HIV-positive status (adjusted PR [aPR] = 2.9; 95% CI = 1.5, 5.6) and drug use in the past 12 months (aPR = 0.3; 95% CI = 0.1, 0.7) were independently associated with reports of having been denied or given lower quality health care. High rates of reported gay-related discrimination suggest that greater efforts are needed to reduce gay-related discrimination in affected communities. Future research is needed to better understand the extent of gay-related discrimination in NYC, particularly with regard to the relationship between HIV status and health care access.

Substance use by same sex attracted young people: Prevalence, perceptions and homophobia

INTRODUCTION AND AIMS

Research highlights that lesbian, gay, bisexual and transgender (LGBT) people use alcohol and drugs (AOD) more than heterosexual people; however, the incidence of AOD use by LGBT youth is less understood. The purpose of the current study was to ascertain AOD prevalence rates for LGBT youth compared with the Australian youth population; perceptions of AOD use within the LGBT community; and the impact of homophobia on AOD use.

DESIGN AND METHODS

The study surveyed a cross-sectional sample of LGBT youth (13-24 years) (n = 161) who attended a LGBT festival in Brisbane, Australia, in 2012. The Alcohol Use Disorders Identification Test-Consumption, Fagerström Test for Nicotine Dependence and Drug Check Assessment Tool were utilised to examine patterns of AOD use, with items developed to explore perceptions of AOD use and homophobia.

RESULTS

AOD use was common among the LGBT sample, with higher prevalence rates compared with the general Australian youth population (2010 National Drug Strategy Household Survey). AOD use by under 18-year-olds, and gender diverse youth was markedly higher. The majority misperceived AOD use to be the same in the LGBT and heterosexual communities. Those who believed homophobia impacted on AOD use were significantly more likely to use AOD.

DISCUSSION AND CONCLUSIONS

The higher prevalence of AOD use strongly suggests the need for AOD agencies to better respond to LGBT youth by not only screening sexuality and gender identity but also exploring young people's perceptions of AOD use in the LGBT community and their experiences of homophobia in order to provide effective AOD clinical treatment.

Interrelationships between LGBT-based victimization, suicide, and substance use problems in a diverse sample of sexual and gender minorities

Research has documented significant relationships between sexual and gender minority stress and higher rates of suicidality (i.e. suicidal ideation and attempts) and substance use problems. We examined the potential mediating role of substance use problems on the relationship between sexual and gender minority stress (i.e. victimization based on lesbian, gay, bisexual, or transgender identity [LGBT]) and suicidality. A nonprobability sample of LGBT patients from a community health center (N = 1457) ranged in age from 19-70 years. Participants reported history of lifetime suicidal ideation and attempts, substance use problems, as well as experiences of LGBT-based verbal and physical attacks. Substance use problems were a significant partial mediator between LGBT-based victimization and suicidal ideation and between LGBT-based victimization and suicide attempts for sexual and gender minorities. Nuanced gender differences revealed that substance use problems did not significantly mediate the relationship between victimization and suicide attempts for sexual minority men. Substance use problems may be one insidious pathway that partially mediates the risk effects of sexual and gender minority stress on suicidality. Substances might be a temporary and deleterious coping resource in response to LGBT-based victimization, which have serious effects on suicidal ideation and behaviors.

Exploring shame, guilt, and risky substance use among sexual minority men and women

This study examined the interrelations among shame-proneness, guilt-proneness, internalized heterosexism (IH), and problematic substance use among 389 gay, lesbian, and bisexual men and women. Problematic alcohol and drug use were positively related to shame-proneness and negatively related to guilt-proneness. Bisexuals reported riskier substance use behaviors, lower levels of guilt-proneness, and higher levels of IH than gay men and lesbians. Furthermore, study findings indicated that shame and IH are related. Additional investigations of these associations would supplement current understandings of sexual minority stress and advance the development of substance-related intervention and prevention efforts targeting sexual minorities.

"It's one of the better drugs to use": perceptions of cocaine use among gay and bisexual Asian American men

Research on drug use among gay and bisexual men has primarily focused on examining the link between drug use- most notably, methamphetamine-sexual practices, and risk of HIV transmission. Drawing on in-depth qualitative data from 40 interviews with gay and bisexual Asian American men, we examine perceptions and meanings associated with cocaine use in the San Francisco Bay Area gay community. We found that the participants, in contrast to their negative perceptions of methamphetamine use, believed that cocaine enhanced sociability and was acceptable for use in most social situations. Furthermore, participants perceived little connection between cocaine use and risky sexual practices, emphasizing the drug's safety relative to other illicit substances. Based on these findings, we suggest that an increase in the favorability of cocaine use might be an unintended consequence of methamphetamine prevention campaigns targeting the gay community, with their emphasis on the harmful effects of drug use, unsafe sex, and HIV risk.

Are specialized LGBT program components helpful for gay and bisexual men in substance abuse treatment?

In the New York metropolitan area, a convenience sample of 187 men previously treated in substance abuse programs between 2000 and 2006 completed questionnaires regarding their reported outcomes, completion rates, and perceptions of treatment. The sample included 81 gay and bisexual ("gay/bisexual") men in "traditional" programs (with no specialized groups for gay/bisexual clients), 51 gay/bisexual men in "LGBT specialized treatment" (programs with specialized groups for gay/bisexual clients), and 55 heterosexual men. In bivariate and multivariate analyses, heterosexual men and gay/bisexual men in LGBT specialized treatment had more favorable results than did gay/bisexual men in traditional programs, suggesting the effectiveness of LGBT program components.

The effects of honesty and openness about sexual orientation on gay and bisexual clients in substance abuse programs

A convenience sample of 183 gay, lesbian, and bisexual participants who were previously treated in substance abuse programs, completed surveys that included questions regarding their honesty and openness about their sexual orientation with counselors and clients in their programs, as well as in their personal lives. It was found that levels of honesty and openness in treatment positively correlated with reported program completion, satisfaction with treatment, feelings of therapeutic support, and feelings of connection to the program. However, there were no correlations between honesty and openness and reported abstinence from substances at the end of treatment and at the time of survey completion.

The consequences of substance use among gay and bisexual men: A Consensual Qualitative Research analysis

Background: Substance use is common among gay/bisexual men and is associated with significant health risks (e.g. HIV transmission). The consequences of substance use, across the range of substances commonly used, have received little attention. The purpose of this study is to map participant’s beliefs about the effects of substance use to inform prevention, health promotion and clinical interventions. Methods: Participants were interviewed about experiences regarding their substance use and recruited through medical and sexual health clinics. Data were collected though a consumer panel and individual interviews. Responses regarding perceived consequences of substance use were coded using Consensual Qualitative Research (CQR) methodology. Results: Most participants reported lifetime use of alcohol, cannabis, stimulants and amyl nitrite, and recent alcohol and cannabis use. A wide range of themes were identified regarding participant’s thoughts, emotions and behaviours (including sexual behaviours) secondary to substance use, including: cognitive functioning, mood, social interaction, physical effects, sexual activity, sexual risk-taking, perception of sexual experience, arousal, sensation, relaxation, disinhibition, energy/activity level and numbing. Analyses indicated several consequences were consistent across substance types (e.g. cognitive impairment, enhanced mood), whereas others were highly specific to a given substance (e.g. heightened arousal post amyl nitrite use). Conclusions: Prevention and interventions need to consider the variety of effects of substance use in tailoring effective education programs to reduce harms. A diversity of consequences appear to have direct and indirect impacts on decision-making, sexual activity and risk-taking. Findings lend support for the role of specific beliefs (e.g. expectancies) related to substance use on risk-related cognitions, emotions and behaviours.

HIV prevalence and associated risk behaviors in New York City's house ball community

OBJECTIVES

We measured HIV seroprevalence and associated risk factors among persons in New York City's house ball community.

METHODS

In 2004 we conducted a venue-based risk-behavior survey and HIV testing in the house ball community.

RESULTS

Of the 504 study participants, 67% were male, 14% female, and 18% transgender. Mean age was 24 years (range=15-52 years); 55% were Black, and 40% were Latino. More than 85% of participants had previously been tested for HIV, although only 60% had been tested in the previous 12 months. Of the 84 (17%) persons who tested positive for HIV in our study, 61 (73%) were unaware of their HIV status. A logistic regression analysis on data from 371 participants who had had a male sexual partner in the previous 12 months showed that HIV-infected participants were more likely than were HIV-negative participants to be Black, to be older than 29 years, and not to have been tested for HIV in the previous 12 months.

CONCLUSIONS

Culturally specific community-level prevention efforts are warranted to reduce risk behaviors and increase the frequency of HIV testing in New York City's house ball community.

The Cognitive Escape Scale: measuring HIV-related thought avoidance

Cognitive escape provides a model for examining the cognitive processes involved in escaping from thoughts of HIV/AIDS in a population of men who have sex with men (MSM). This investigation presents psychometric information and validation data on the Cognitive Escape Scale (CES), a measure of HIV-related cognitive avoidance. This study also examined the associations between the CES and self-report measures of theoretically related constructs, including HIV-related worry, sensation-seeking, depressive symptoms, perceived stress, and risky sexual behaviors. Participants were 709 MSM (71% White, 13% Latino, 8% African-American, 6% Native American; M age = 35). The CES measured HIV-related thought avoidance. Exploratory and confirmatory factor analyses supported a 3-factor structure to the CES, suggesting three strategies of cognitive escape: fatalism/short-term thinking, thought suppression/distraction, and alcohol/drug use. These factors are differentially related to several variables of interest including risky sexual behaviors. Although the CES is designed for use with both HIV negative and positive men, correlates differed between groups.

Multi-level modeling to explain methamphetamine use among gay and bisexual men

AIM

The popularity of methamphetamine among gay men has been documented; however, few studies have examined the complex behavioral and psychological motivations behind methamphetamine use, particularly over time. This study aimed to (i) identify the trajectories for methamphetamine use; (ii) explore factors related to methamphetamine use; and (iii) determine factors which predict changes in usage over a year.

DESIGN

This analysis utilized hierarchical linear modeling to identify the trajectories for methamphetamine use and explore factors related to patterns of methamphetamine use.

PARTICIPANTS

A sample of 293 gay and bisexual men who indicated methamphetamine use at baseline were drawn from Project BUMPS (Boys Using Multiple Party Substances), which was a longitudinal, mixed-methodologies study of 450 club drug-using gay and bisexual men.

MEASUREMENTS

Participants were assessed via quantitative measures in four waves of data collection over the course of a year (baseline, 4, 8 and 12 months post-baseline).

FINDINGS

Frequency of methamphetamine use is related to reliance on the drug to avoid unpleasant emotions and physical discomfort, outcome expectancies for use and combining the drug with Viagra. Those with higher levels of drug-related sensation-seeking and those who combine use with Viagra show more consistent use over time, although a decrease in use is noted for most of the sample.

CONCLUSIONS

Longitudinal analyses support the idea that methamphetamine is used by gay men to mask feelings of discomfort and to enhance sensations as well as sexual pleasure. Longitudinal non-intervention studies of drug use may have intervention-like effects.

Treatment Experiences of Gays and Lesbians In Recovery from Addiction: A Qualitative Inquiry

The literature has suggested that addiction treatment programs are not addressing the unique recovery needs of gays and lesbians. This qualitative study examined gay men's and lesbian women's experiences with addiction treatment and recovery. Ten themes emerged to define their experiences. These themes are described, along with implications for mental health counselors working with this population.