Gender,sexual orientation,and disordered eating

Abstract

While most patients with bulimia nervosa are heterosexual women, a significant number of men with bulimia nervosa are gay males, suggesting that gay men, more than heterosexual men, may be at risk for developing eating disorders. This study compared the food-related attitudes and behaviors of heterosexual men and women in contrast with those of lesbians and gay men, attempting to find whether one's sexual orientation may contribute to differential risk. Two thousand employees were randomly selected from a large health care corporation, of whom 805 returned a completed questionnaire including Stunkard and Messick's (1985) Dietary Restraint and Disinhibition Scales. A stratified random sample was drawn to include demographically comparable groups of 25 lesbians, 50 gay men, 75 heterosexual women, and 75 heterosexual men. Women were less satisfied with their appearance at their present weight and expressed more restraint and more negative feelings after bingeing than did men. Heterosexual women were most dissatisfied with their weight, although heterosexual men were more objectively overweight. Gay men and heterosexual women were similar in disordered eating patterns and disinhibition, contrasting with lesbians and heterosexual men.     

The nature of stress experienced by lesbians and gay men

Abstract

This study examined both the meanings and sources/causes of stress from the perspectives of lesbians and gay men (n=30), using a series of focus groups. The findings suggest that stress is considered a part of life itself, and is perceived to contain both negative (e.g. detrimental effects on health and overall functioning, unfairness, out-of-control), and positive (e.g. a motivator, growth-facilitator) elements. The sources/causes of stress (i.e. stressors) identified include stress experienced from the “coming out” process, stress in family relations and intimate relationships, conflict over one's sexuality given society's homophobic and heterosexist attitudes toward lesbians and gay men, as well as stress from financial and work-related issues. More importantly, this study suggests that culture/ethnicity, gender, and aging, which are interconnected with one's sexual identity, play an important role in shaping the experiences of stress among lesbians and gay men.     

Sexual Sensation Seeking and Sexual Compulsivity Scales: Validity,and Predicting HIV Risk Behavior

Two studies are presented that evaluate newly developed scales of sensation seeking and sexual compulsivity. Results showed that the scales were reliable and correlated with convergent and divergent measures in expected directions in samples of both gay men (N = 296) and inner city low-income men and women (N = 158). Consistent with theories of sensation seeking, the scales corresponded to an attraction toward a range of sexual practices, including increased frequencies of unprotected intercourse and a greater number of sexual partners. As expected, sexual compulsivity was not related to variety and novelty in sexual practices, but was associated with lower levels of self-esteem and resistance to adopting sexual risk-reducing strategies. However, important differences were observed between the gay men and heterosexual samples; scales correlated with substance use only among gay men, and sexual compulsivity was related to a range of sexual practices only among heterosexuals. The sensation seeking and Sexual Compulsivity Scales were therefore reliable, appeared valid, and useful in predicting sexual risk behaviors.     

Sexual Orientation and Developmental Challenges Experienced by Gay and Lesbian Youths

Youths with a homosexual orientation face different developmental challenges during adolescence than those faced by heterosexual youths or individuals who recognize their homosexual orientation later in life. We discuss the impact of “coming out,” or defining a homosexual orientation, on the development and identity formation of youths who come out during adolescence. The process of coming out is presented as entailing four broad dimensions: recognizing oneself as lesbian or gay; exploring one's sexual orientation through the gay and lesbian community; disclosing one's sexual orientation to others; and becoming more comfortable with one's sexual orientation. Some of the major challenges faced by these youths are described, and future directions for research efforts are discussed.     

‘Coming out’ and sexual debut: understanding the social context of HIV risk-related behaviour

This paper explores HIV risk-related behaviour in the context of men's entry into the gay community. It is an exploratory study which employed a qualitative approach to describe men's accounts of the process of acculturation. Twenty in-depth interviews were conducted with working-class gay men from Barnsley, UK. These were translated and analysed, using interpretative phenomenological analysis, for recurrent themes which reflect the way gay men thought about HIV risk-related behaviour, ‘coming out’ and their sexual debut. As men began to socialize with other gay men in their local community they had much to learn with regard to local gay culture, e.g. a distinct new vocabulary and local sexual mores. By virtue of their lack of experience and the personal impact of first sexual experiences, some men reported feelings of disempowerment with their initial sexual partners. Theoretical accounts relating to gay men's sexual health would benefit from a consideration of the way gay men report the process of acculturation. Sexual debut and the particular vulnerabilities of entry into the gay community highlight a temporal context in which affective experiences are privileged above considerations of sexual health. © 1998 John Wiley & Sons, Ltd.     

Sexual Prejudice Among Heterosexual College Men as a Predictor of Condom Attitudes

Heterosexual male college students (N?=?100) (average age?=?19.7; 43% European American; 39% Christian) from the southwestern U.S. completed surveys in order to test a model predicting condom attitudes from religiosity, gender role attitudes, sexual prejudice, and the belief that “AIDS is a gay disease.” In the final model, those who reported more religiosity, more traditional gender role attitudes, and greater anxiety about interacting with gay men also reported feeling their core values and beliefs were threatened by gay men. In turn, men who felt strongly threatened in this way more strongly endorsed the belief that “AIDS is a gay disease,” and stronger endorsement of this belief was associated with more negative attitudes about condoms and condom use.     

Attitudinal and Normative Factors as Determinants of Gay Men's Intentions to Perform AIDS-Related Sexual Behaviors: A Multisite Analysis1

The purpose of this study was to test the applicability of the theory of reasoned action as a basis for understanding and predicting gay men's intentions to perform AIDS-related sexual behaviors. A total of 314 self-identified gay or bisexual men from Seattle, Denver, and Albany participated in the study. They were asked to indicate their intentions to perform 15 specific sexual behaviors chosen to represent different degrees of risk of contracting AIDS or other sexually transmitted diseases. In addition, they were asked to respond to items measuring the attitudinal and normative considerations regarding each behavior. As expected, the results showed that the gay men's intentions were significantly predicted by the two factors. More interesting, it was found that, although attitudes are consistently the more important determinants of intentions for all the respondents, the importance of normative considerations varies across cities. This difference in normative considerations is interpreted in light of the differences in the structure of the three gay communities. Implications for designing sample-specific intervention programs are discussed.     

Working class homosexuality and HIV/AIDS prevention some recent research from Sydney,Australia

Abstract

Surveys on gay and bisexual men in Sydney and non-metropolitan New South Wales (NSW) indicate uneven patterns of HIV/AIDS knowledge and sexual behaviour change. As a follow-up action-research study, the Class, Homosexuality and AIDS Prevention (CHAP) project pursued audio-recorded, semistructured interviews with men in western Sydney and Nullangardie, a provincial city in NSW, to investigate the relationship between homosexuality and class.

One-to-one interviews with working-class, homosexually active men revealed particular patterns of homosexual initiation and sexual relationships, and a distinct culture being slowly affected by notions of being “gay” and “gay community”. This impact of modern gay life on western Sydney was different from that in the provincial city. More prominent were the effects of class—unemployment, poor education, poverty, and cultural marginalisation—on the experience and elaboration of homosexuality. Group interviews confirmed an experience of “difference” from prominent gay communities, especially Sydney's “Oxford Street” gay quarter. Working-class men offered a critique of gay community-initiated HIV/AIDS prevention strategies, pointing toward different education initiatives involving local social networks.

Case studies are presented to argue the importance of the relation between sexuality and class, and its consequences for HIV/AIDS education.     

College Students Use Implicit Personality Theory Instead of Safer Sex1

Many college students engage in high levels of unsafe sexual behavior that puts them at risk for HIV infection. To better understand the dynamics underlying college students' unsafe behavior, focus group discussions were conducted with 308 students (146 men and 162 women). The results showed that, instead of consistently using condoms, many college students use implicit personality theories to judge the riskiness of potential sexual partners. Specifically, partners whom college students know and like are not perceived to be risky, even if what students know about these individuals is irrelevant to HIV status. The students determine the riskiness of partners they do not know well based on superficial characteristics that are also generally unrelated to HIV status. Therefore, AIDS prevention interventions for college students must expose the ineffectiveness of the students' use of implicit personality theories to determine potential partners' riskiness, and the “know your partner” safer sex guideline should be abandoned.     

Gay Identification and Psychological Health in HIV-Positive and HIV-Negative Gay Men1

This paper reports a study of HIV-positive and HIV-negative gay men focusing on comparisons between the HIV-positive and HIV-negative on gay identification, the interrelationships among gay identification variables, and the psychological correlates of gay identification. We hypothesized that better psychological health would be related to gay self-acceptance, participating in gay organizations and groups, socializing with other gay men, and parental disclosure and acceptance of being gay. The sample was composed of 169 gay men, including 98 asymptomatic HIV-positive and 71 HIV-negative men. The findings are largely consistent with our hypotheses. A strong and consistent relationship of the gay identification measures with psychological variables was observed, explaining up to one fifth of the variance in current level of mood and self-esteem. Among the HIV-positive subjects, participating in gay organizations and groups and having parents who accepted their sexual orientation were important correlates of psychological adaptation. Despite this, 36% of subjects had parents who disapproved of their sexual orientation, and 69% of HIV-positive subjects were not in any gay organizations or groups. Among the HIV-negative subjects, gay self-acceptance and disclosing their sexual orientation to parents were associated with better psychological adjustment. These results suggest that the psychological health and outlook of gay men may be influenced by gay self-acceptance, participation in gay groups, and parental disclosure and acceptance of their children's sexual orientation.     

A Preliminary Examination of Sexual Orientation as a Social Vulnerability for Experiencing HIV/AIDS-related Stigma

This investigation is a preliminary examination of sexual orientation as a social vulnerability for experiencing HIV/AIDS-related stigma, specifically concerns about disclosure and public attitudes. Participants were 36 heterosexual men and 82 gay men with HIV/AIDS. Consistent with prediction, a heterosexual sexual orientation was significantly associated with HIV/AIDS disclosure concerns. This effect was evident after controlling for various demographic variables, CD4 T-cell count, time since HIV diagnosis, self-esteem, and coping styles. Also, as predicted, similar levels of enacted stigma were evident regardless of sexual orientation. Further work is needed to understand the process of HIV/AIDS disclosure for heterosexual men with this illness and to differentiate the experience of HIV/AIDS-related stigma among gay and straight men with HIV/AIDS.     

Membership in a Devalued Social Group and Emotional Well-Being: Developing a Model of Personal Self-Esteem,Collective Self-Esteem,and Group Socialization

We proposed and tested a theoretical model that links membership in a devalued social group to emotional health. People who identify with devalued social groups (e.g., ethnic minorities, gay men/lesbians, bisexuals, women) may be at increased risk for distress via 3 different pathways. First, some members of devalued groups may internalize negative stereotypes about their group, which negatively impact personal self-esteem. Second, being devalued simply on the basis of one's group membership could lead to emotional distress independent of one's own personal self-esteem. Third, some members of devalued groups may be socialized to develop attitudes and behaviors that increase their risk for emotional distress. Data were collected from a sample of White, middle-to-upper-class undergraduate women and men with respect to personal self-esteem, collective self-esteem on the basis of their gender group, attitudes and behaviors associated with female socialization, and emotional distress. Results supported the direct effect of each pathway in predicting concurrent depression and partially supported the prediction of concurrent anxiety. Each pathway fully accounted for women's greater levels of depression relative to men's. Implications for the study of devalued groups are discussed.     

Changes in HIV treatment beliefs and sexual risk behaviors among gay and bisexual men, 1997-2005.

OBJECTIVE: Beliefs about HIV treatment effectiveness and the impact of HIV treatments on HIV transmission risks were initially related to sexual risk-taking in the late 1990s when multidrug HIV treatments first became available. This study examined changes in beliefs about the effects of HIV treatment for preventing HIV transmission and their association to sexual risk behaviors between the years 1997 and 2005. DESIGN: Anonymous surveys were administered to a convenience sample of gay and bisexual men attending a large community event in Atlanta, Georgia in 1997 (N = 498) and again at the same community event in 2005 (N = 448). Analyses were performed for men living with HIV/AIDS and for men who have not been diagnosed with HIV/AIDS. MAIN OUTCOME MEASURES: Rates of unprotected anal intercourse in the previous 3 months. RESULTS: There were significant increases in high-risk sexual practices that coincided with increased beliefs that HIV treatments can reduce the chance of transmitting HIV. However, optimistic beliefs about the health benefits of HIV treatments decreased over the 8 years and were not related to risk behaviors. CONCLUSIONS: Beliefs about how HIV treatments impact HIV infectiousness remain associated with HIV transmission risk behavior and interventions targeting at-risk as well as HIV-positive men who have sex with men must directly address these beliefs and perceptions.     

Sex differences in the events that elicit jealousy among homosexuals

When individuals are asked which event would upset them more—a partner's emotional infidelity or a partner's sexual infidelity—among heterosexuals more men than women select a partner's sexual infidelity as the most distressing event, whereas more women than men select a partner's emotional infidelity as the most upsetting event. Because homosexuals’mating psychology is unlike that of heterosexuals, the present study examined which of these two events is more upsetting in a sample of 237 Dutch homosexuals. In support of our hypothesis it was found that, whereas gay men more often than lesbian women chose a mate's emotional infidelity as the most upsetting event, lesbians more often than gay men chose a mate's sexual infidelity as the most upsetting event. In addition, analyses showed that the effect of participant sex on infidelity choice was mediated by beliefs with regard to the co‐occurrence of sexual and emotional infidelity. Apparently, with respect to choosing the most upsetting type of infidelity of their partner, homosexuals resemble heterosexuals of the opposite sex. Several explanations are discussed for this finding.     

Social Support Provision to HIV-Infected Gay Men1

The study examined associations between attitudes toward homosexuality, fear of AIDS, blame of persons infected with the HIV-virus, and social support provision to these individuals. A sample of HIV-infected gay men reported on the support they receive from specific members of their social networks. These network members then completed questionnaires assessing the predictor variables. Homophobia, homosexual preference, and the interaction of these two variables were positively associated with blame. Blame, together with fear of AIDS and low levels of psychological well-being, were negatively associated with provision of emotional support. Fear of AIDS was also related to negative changes in the quality of recipients' and providers' relationships. Finally, emotional support was strongly related to adjustment to illness among support recipients. Results suggest important points for intervention to promote adjustment to HIV infection among gay men.     

The role of risk perception and efficacy cognitions in the prediction of HIV-related preventive behavior and condom use

Abstract

Based on empirical findings on the central model variables of the Protection Motivation Theory, the influence of perceived susceptibility, perceived severity of the threat of AIDS, communicative and sexual self-efficacy, and outcome expectancy on various aspects of HIV-preventive behavior was examined. The study was based on a sample of 468 heterosexual adults between the ages of 20 and 45 years. The data were obtained by means of questionnaires filled out at various vacation sites that draw mass tourism or in the subjects' home town. The most significant predictor of behavior was found to be self-efficacy expectancy as regards assertiveness and use of HIV-related preventive measures. A high communicative self-efficacy expectancy, on the other hand, is associated with a higher level of risk behavior among certain subgroups and under certain behavioral aspects. This confirms the necessity of acknowledging the different forms of self-efficacy expectancy in sexual interactions. Perceived personal threat is also associated with risk behavior with respect to certain behavioral operationalizations. From this it can be concluded that one's own behavior is used as the basis for appraising one's susceptibility. The results also show that distinctions must be made when analyzing HIV-related risk behavior. In particular, a difference must be made between absolute behavior (degree of the risk behavior) and relative behavior (change - especially reduction - in risk behavior due to the danger of AIDS).     

A short-term group treatment model for gay male survivors of childhood sexual abuse living with HIV/AIDS

HIV-positive gay male survivors of childhood sexual abuse (CSA) face three layers of trauma: childhood abuse, homophobic oppression, and HIV/AIDS. Additionally, CSA has been shown to increase HIV risk behavior among gay men, and the trauma of HIV infection often parallels the experience of CSA. Effective coping strategies are particularly important for people living with HIV/AIDS in order to adapt to physical, psychological, and social implications of infection. However, coping strategies once adaptive in the context of CSA may become maladaptive in adulthood. Interventions are needed that enhance coping and address CSA for survivors living with HIV/AIDS to protect their own health and to prevent new transmissions. This article presents a group model found to be efficacious for treating gay male survivors of CSA living with HIV/AIDS.     

Integrated Cognitive Behavioral Therapy for Social Anxiety and HIV Prevention for Gay and Bisexual Men

Little information is available to cognitive-behavioral therapists about how to integrate HIV prevention into standard cognitive behavioral (CBT) treatments among gay and bisexual men, especially for those gay and bisexual men who are at risk for contracting HIV due to their social anxiety. The purpose of the present paper is to assist cognitive behavioral therapists who are treating HIV-negative gay and bisexual men who have high social anxiety. This paper provides an overview of the extant research on social anxiety and its effects on sexual risk behaviors and how to integrate these two types of problems into a coherent treatment plan for gay and bisexual men. The treatment described here uses the framework of CBT for social anxiety (e.g., Hope, Heimberg, & Turk, 2010) and adapts it to include substance use management in interpersonal situations and to reduce sexual risk behavior. The application of empirically supported therapy techniques to reduce both social anxiety and HIV risk behavior for gay and bisexual men is illustrated using three case examples. The present treatment is potentially appropriate for HIV-negative gay and bisexual men who present with social anxiety and who wish to remain HIV-negative by decreasing their sexual risk behavior.     

Relations among media influence,body image,eating concerns,and sexual orientation in men: A preliminary investigation

The current study explored the relation between sexual orientation, media persuasion, and eating and body image concerns among 78 college men (39 gay; 39 straight). Participants completed measures of sexual orientation, eating disorder symptoms, appearance-related anxiety, perceived importance of physical attractiveness, perceptions of media influence, and media exposure. Gay men scored significantly higher on drive for thinness, body dissatisfaction, and body image-related anxiety than their straight counterparts. Additionally, perceptions of media influence were higher for gay men, and significantly mediated the relation between sexual orientation and eating and body image concerns. Sexual orientation also moderated the relation between perceived media influence and beliefs regarding the importance of physical attractiveness, as this relation was significant for gay men, but not straight men. The current findings suggest that gay men's increased vulnerability to media influence partially accounts for the relatively high rate of eating pathology observed in this population.