Safer Sex in Social Context: Individualistic and Relational Determinants of AIDS‐Preventive Behavior Among Gay Men1

This longitudinal study of gay men examined safer sex within steady relationships and assessed whether relationship quality influenced safer sex with casual partners. The theoretical frameworks of Rusbult's (1980) investment model of romantic relationships and of Ajzen's (1988, 1991) model of planned behavior were used. Unprotected intercourse with a steady partner was practiced significantly more often when both partners in a steady relationship were seronegative and had an explicit agreement to keep it safe with casual partners. However, there was no indication that explicit agreements reduced the occurrence of unsafe extrarelational sex. Both the investment model of romantic relationships and the model of planned behavior were successful in accounting for sexual risk behavior outside the relationship.     

Profiles of Resilience and Psychosocial Outcomes among Young Black Gay and Bisexual Men

Young Black gay/bisexual men (YBGBM) are affected by contextual stressors—namely syndemic conditions and minority stress—that threaten their health and well‐being. Resilience is a process through which YBGBM achieve positive psychosocial outcomes in the face of adverse conditions. Self‐efficacy, hardiness and adaptive coping, and social support may be important resilience factors for YBGBM. This study explores different profiles of these resilience factors in 228 YBGBM in New York City and compares profiles on psychological distress, mental health, and other psychosocial factors. Four profiles of resilience were identified: (a) Low self‐efficacy and hardiness/adaptive coping (23.5%); (b) Low peer and parental support (21.2%); (c) High peer support, low father support (34.5%); and (d) High father and mother support, self‐efficacy, and hardiness/adaptive coping (20.8%). YBGBM in profile 1 scored markedly higher on distress (d = .74) and lower on mental health functioning (d = .93) compared to men in the other profiles. Results suggest that self‐efficacy and hardiness/adaptive coping may play a more important role in protecting YBGBM from risks compared to social support and should be targeted in interventions. The findings show that resilience is a multidimensional construct and support the notion that there are different patterns of resilience among YBGBM.     

Thriving and Adapting: Resilience,Sense of Community,and Syndemics among Young Black Gay and Bisexual Men

We examined resilience associated with the avoidance of psychosocial health conditions (i.e., syndemics) that increase vulnerability for HIV among young Black gay and bisexual men. We used analytic induction to compare a sample of 23 men who showed no evidence of syndemic conditions to a sample of 23 men who experienced syndemic conditions. The men who avoided syndemics reported supportive relationships with people who helped them to develop a strong sense of identity, provided them with opportunities to give back to their communities, and promoted positive norms about health. In contrast, the men experiencing syndemic conditions described numerous instances of trauma and oppression that infringed upon their desire to form positive relationships. Among these men, experiences of oppression were associated with shame, identity incongruence, social isolation, relational disconnection, mistrust of men, and expectations of further marginalization. We examined participants’ experiences through the framework of the psychosocial sense of community. Results of this study provide evidence for using strength‐based intervention strategies to prevent syndemic conditions. Findings suggest that to attenuate socio‐structural barriers to health and comorbid psychosocial health concerns, interventions must address young men's social isolation and promote positive identity and sense of community.     

年轻男同性恋者内化同性恋嫌恶与主观幸福感的关系：自尊与孤独感的中介效应

通过网络抽样法,采用内化同性恋嫌恶量表、自尊量表、孤独感量表、主观幸福感量表对249名年轻男同性恋者进行调查,考察当代国内年轻男同性恋者内化同性恋嫌恶的现状,并探讨内化同性恋嫌恶与主观幸福感的关系及自尊与孤独感在其间的中介效应。结果表明：（1）总体上,国内年轻男同性恋者内化同性恋嫌恶处于中等偏低水平,且有较大比例年轻男同性恋者不存在内化同性恋嫌恶。（2）内化同性恋嫌恶与积极情感、生活满意度显著负相关,与消极情感显著正相关。（3）自尊与孤独感在内化同性恋嫌恶与主观幸福感间起完全中介作用。（4）内化同性恋嫌恶通过影响自尊间接影响孤独感,又通过影响孤独感作用于主观幸福感。     

Psychosocial Factors and HIV Prevention for Gay,Bisexual, and Other Men Who Have Sex with Men

We are more than 30 years into the HIV epidemic, and, although we have made many important scientific advances, there remains much to understand and implement to prevent new infections. The science of HIV prevention, although interdisciplinary, has relied heavily on psychological theories and research methods to address many key questions. In this paper, we briefly review some historical and epidemiologic considerations about the U.S. HIV epidemic and then present some key psychological concepts from HIV prevention. We make the case for continuing to focus efforts on gay, bisexual, and other men who have sex with men, who represent the sociocultural group with the highest incidence and prevalence of HIV in the domestic epidemic. We present a summary of the research support for, and limitations of, the three major psychosocial models that predict HIV risk behaviors – the information–motivation–behavioral skills model, the minority stress model, and the syndemics framework. We discuss the use of these models in the development and testing of HIV prevention interventions and end by highlighting a few novel research areas, including bio‐behavioral approaches.     

Gay Identity and HIV Risk for Black and Latino Men Who Have Sex with Men

Strong gay identity among white men who have sex with men (MSM) has been associated with decreased HIV risk, but data for black and Latino MSM (BLMSM) are inconclusive. We examined gay identity and HIV risk among BLMSM to inform social and structural HIV intervention strategies. BLMSM were administered a computerized survey as part of an HIV research study during 2011–2012 conducted in New York City. We used a brief scale of Gay Identity Questionnaire. After data analysis, Stage I (not fully accepting) and Stage II (fully accepting) gay identity were determined based on participant responses. We used logistic regression to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for the association between gay identity with HIV risk and social determinant factors. Among 111 self-identified BLMSM (median age = 32 years, 68.4% with some college or higher education), 34.2% reported receptive anal sex without condoms in the previous three months. Gay Identity Questionnaire Scale assessment indicated that 22 (19.8%) were Stage I, and 85 (76.6%) were Stage II in this BLMSM sample. Stage II gay identity was more likely seen among BLMSM with high involvement in the gay community (aOR 3.2; CI 1.00, 10.26) and less likely among BLMSM who exchanged sex for food or shelter (aOR 0.15; CI 0.02, 0.98). Fully accepting gay identity may be protective for BLMSM as it relates to transactional sex; these factors warrant further research and consideration as part of HIV prevention strategies.     

Drugs,Sex, and Condoms: Identification and Interpretation of Race‐Specific Cultural Messages Influencing Black Gay and Bisexual Young Men Living with HIV

Black gay and bisexual young men carry a disproportionate burden of HIV in the United States. This study explored Black gay and bisexual young men living with HIV's identification and interpretation of race‐specific cultural messages regarding substance use, sexual activity, and condom use. A total of 36 Black gay and bisexual young men living with HIV (ages 16–24, mean = 20.6 years) from four geographically diverse regions of the United States participated in qualitative in‐depth interviews. Results from this study elucidate the ways in which these young men interpret various forms of race‐specific cultural messages and experiences regarding substance use, sexual activity, and condom use. Participants discussed cultural messages and experiences promoting and discouraging condoms and substance use. Regarding sexual activity, only messages and experiences promoting sex were reported. Across all three categories, messages and experiences promoting risk were predominant. Data further revealed that socially transmitted cultural messages received by young men emanated from multiple sources, such as family, peers, sexual partners, community/neighborhood, and the broader society. Race‐specific cultural messages and experiences should be addressed in interventions for this population, and programs should assist young men in developing a critical consciousness regarding these messages and experiences in order to promote health and well‐being.     

年轻男同性恋者自我概念清晰性与生命意义感的关系及作用机制

通过网络抽样法对405名年轻男同性恋者进行问卷调查,考察年轻男同性恋者自我概念清晰性与生命意义感的关系,并探讨内化同性恋嫌恶和应对自我效能感在其间的作用机制。结果表明：（1）年轻男同性恋者自我概念清晰性与生命意义感呈显著正相关。（2）内化同性恋嫌恶、应对自我效能感在自我概念清晰性与生命意义感间起链式中介作用。（3）应对自我效能感在自我概念清晰性与生命意义感间起中介作用。     

Recognition,Desire, and Unjust Sex

In this article I will revisit the question of what I term the continuum of heteronormative sexual interactions, that is, the idea that purportedly ethically acceptable heterosexual interactions are conceptually, ethically, and politically associated with instances of sexual violence. Spurred by recent work by psychologist Nicola 11 , I conclude that some of my earlier critiques of Catharine MacKinnon's theoretical linkages between sexual violence and normative heterosex are wanting. In addition, neither MacKinnon's theory nor my critique of it seem up to the task of providing an ethical account of the examples of “unjust sex” that Gavey has described. I come to the conclusion that an ethical analysis of sexual interactions requires a focus on sexual desire, but that desire cannot take on the by now heavily criticized role of consent. Rather than looking for the presence or absence of sexual desire prior to sexual encounters as a kind of ethical certification of them, we ought instead to focus on the efficacy of that sexual desire, that is, its ability (or lack thereof) to shape an encounter in substantial and meaningful ways.     

Prejudice Events and Traumatic Stress among Heterosexuals and Lesbians,Gay Men,and Bisexuals

This mixed-methods study examined associations between prejudice events and post-traumatic stress disorder (PTSD) among 382 lesbians, gays, and bisexuals (LGB) and 126 heterosexuals. Using the Composite International Diagnostic Interview, we assessed PTSD with a relaxed Criterion A1; that is, we allowed events that did not involve threat to life or physical integrity to also qualify as traumatic. We first assessed whether exposure to prejudice-related qualifying events differed with respect to participants' sexual orientation and race. We found that White LGBs were more likely than White heterosexuals to encounter a prejudice-related qualifying event, and among LGBs, Black and Latino LGBs were no more likely than White LGBs to experience this type of event. We then used qualitative analysis of participants' brief narratives to examine prejudice events that precipitated Relaxed Criterion A1 PTSD among 8 participants. Two themes emerged: (a) the need to make major changes, and (b) compromised sense of safety and security following exposure to the prejudice event.     

Insert Discourse: Rectal Douching Among Young HIV-Positive and HIV-Negative Men Who Have Sex with Men in Vancouver,Canada

Douching is a common practice among certain groups of women and MSM, and it is conducted for the purpose of cleanliness as part of bodily hygiene maintenance. Although there has been considerable research about female vaginal douching, understandings of rectal douching (RD) for MSM are limited. In the epidemiological and medical literature, RD is presented as a behaviour that removes beneficial bacteria and the surface epithelium layer of the colon, which can, potentially, increase the risk of HIV transmission in MSM. The paucity of research on male douching practices is curious given the primacy of anal sex in HIV prevention initiatives and the widespread nature of rectal douching among this population. This paper provides preliminary data on RD and is intended to engender a dialogue about male douching and the need for additional research into the cultural construction of the body among MSM, namely with respect to the anus. Findings were derived from qualitative interviews with 12 young HIV-positive men who had recently become HIV-infected and 12 HIV-negative age-matched counterparts who were participating in a prospective cohort study. Beliefs about RD differed according to HIV serostatus; HIV-positive men discussed the practice much more openly than their counterparts did. Pre-coital RD is an embedded behaviour about which very little is known. However, it is a critical issue to include in the development of effective HIV prevention strategies and warrants an acknowledgement of importance of the anus in the lives, sexual practices, and identities among MSM.     

The Power of Prestige: Why Young Men Report Having more Sex Partners than Young Women

In a survey of 48 men and 61 women from a southwestern US college, the gender difference in reported number of sex partners was mediated by the degree to which individuals felt that men and women who had many sexual partners were prestigious. In addition, men cared about the quantity and quality of their sex partners more than women did and these two factors were also related to reported number of sexual partners. The gender difference in reported sex partners is not veridical; it can be accounted for with attitudinal measures related to status and sex that are more common in men than women. Results are discussed in terms of understanding biased reporting in young American men and women.     

Barriers to Condom Use and Safer Sex Talk among College Dating Couples

Using an open-ended questionnaire response format, this study examined self-generated barriers to condom use and safer sex talk among 119 heterosexual college dating couples at the University of New Mexico (total N=238). Data were collected from both members of these dyads. Reasons for abstaining from intercourse were also elicited. Several general response categories emerged including no perceived risk; spontaneity; deliberate choice; negative attitudes; and a lack of perceived self-efficacy for enacting condom use and safer sex discussion. Explanations for abstinence included religious/moral prohibitions; lack of readiness for intercourse; and a fear of being emotionally hurt. Few differences emerged across gender, ethnicity (Caucasian vs Hispanic), and prior sexual experience (participant had intercourse prior to current relationship vs did not). Selected reasons for not using a condom and/or discussing safer sex (e.g. partner is monogamous) were cross-validated with the self-reported behavior of the respondent's dating partner. In general, participants reasons for perceived non-risk were not supported by their partner's reported behavior. Implications of these findings for sexual risk reduction programs include: establishing realistic goals for safer sex behavior and talk within committed relationships, acknowledging the impact of passion on safer sex, and addressing knowledge gaps in risk perception.     

The Impact of Social Media on Body Image Perceptions and Bodily Practices among Gay,Bisexual, and Other Men Who Have Sex with Men: A Critical Review of the Literature and Extension of Theory

Sex Roles - Recent evidence indicates that interactive media-based web technologies, such as social networking sites, have an appreciable effect on users’ perceptions of and attitudes toward...     

Safer Sex Behavior: The Role of Attitudes, Norms, and Control Factors

A study was undertaken to assess the utility of revisions to the theories of reasoned action/planned behavior in the context of HIV-preventive behaviors. Revisions to the models incorporated the addition of group norm (behavioral norm and group attitude) to the nonnative component of the reasoned action model and the distinction among three aspects (self-efficacy, perceived behavioral control, and planning) of the control component of the theory of planned behavior. Respondents were 211 sexually experienced heterosexual undergraduates. The study employed a longitudinal design, with the proposed predictors of performing the behaviors under consideration (using a condom every time you have sexual intercourse during the next month and discussing whether to use a condom with any new partners during the next month) assessed prior to the measures of reported behavior. Consistent with expectations, group norm emerged as a distinctive predictor (in addition to attitude and subjective norm) of intentions to practice both safer sex behaviors. The data also revealed some support for the distinction among the different measures of control. The results of the study suggest that the normative component of the theories of reasoned action and planned behavior should be revised to incorporate more subtle influences of the referent group and that tests of theory of planned behavior should distinguish among the different aspects of behavioral control.     

Sexual Compulsivity in Gay Men: Controversy and Treatment

Compulsive sex among some gay men has been made a more significant issue by the AIDS epidemic. There is controversy as to whether or not compulsive sex is a disorder or if it should be thought of as addiction. The clinical usefulness of the addictive model is discussed, along with the commonalities between the two most prevalent and successful approaches used to treat this disorder: namely, group treatment and the self-help Twelve Step addictive model.     

Understanding and Counseling Gay Men: A Developmental Perspective

The author reviews current concepts and research concerning homosexuality with emphasis on understanding gay men and their relationship behaviors. Because the current focus is on homosexuality as a developmental process, counseling considerations are presented from a developmental perspective and a case example is included.     

Counseling Gay Men with AIDS: Human Dimensions

As the incidence of acquired immunodeficiency syndrome (AIDS) becomes more widespread, individuals with AIDS will present themselves for counseling in both public and private settings, and counselors will need to become familiar with the psychological manifestations of the AIDS virus. This article provides case material that demonstrates the emotional responses of gay men to AIDS. Specifically, denial, anger, rage, guilt, and shame are discussed with an emphasis on the human dimensions of AIDS.