Stigma,Disclosure and Relationship Agency in Black Women’s Sexual Relationships with Behaviorally Bisexual Black Men

The health needs and relationships of Black women partnered with behaviorally bisexual Black men are under addressed in the public health literature. This paper explores the relationship dynamics of Black women’s sexual relationships with behaviorally bisexual Black men. We conducted thirty qualitative interviews with a group of HIV negative and HIV positive women partnered with behaviorally bisexual Black men in the San Francisco Bay Area. Women took part in a one-time qualitative interview that addressed relationships, bisexual partners, sexuality, HIV risk behaviors, and disclosure. Women described experiences of their own and their partner’s experiences of disclosure and sexual stigma, along with structural racism and masculine cultural norms that contribute to men’s non-disclosure of sex with men. The paper identifies the ways in which disclosure and stigma are experienced by a sample of women in relationships with behaviorally bisexual Black male partners, pointing to the ways in which these women demonstrate sexual agency in these relationships. These sexual narratives emphasize the ways in which Black women are at once agentic and also navigate gendered vulnerability in their relationships with bisexual men. These findings of Black women’s sexual agency present a call to develop health interventions resonant with Black women’s relationship experiences and structures of bisexual relationships.     

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.     

Sex isn't that simple: culture and context in HIV prevention interventions for gay and bisexual male adolescents

Gay and bisexual male adolescents and young adults in the United States have been disproportionately impacted by the HIV pandemic. Despite the steadily increasing rise in their HIV infection rates, there has not been a commensurate increase in HIV prevention programs targeted to the unique social and sexual lives of these youths. Programs that address cultural and contextual factors that influence sexual risk and protective behaviors need to be developed, implemented, and rigorously evaluated. These interventions should address the potential influences of sexual and gay culture on the HIV risk/protective behaviors of gay and bisexual adolescents, as well as the influence of more traditional cultural factors related to ethnicity. The influence of contextual developmental factors should also be addressed. This may include an incorporation into prevention programs of the societal-level influences of heterosexism and masculinity ideology and the individual-level influences of sexual identity and ethnic identity development. Researchers and interventionists need to be creative and innovative in their HIV prevention approaches and ensure that programs are grounded in the lives and realities of gay and bisexual adolescents and young adults.     

Application of a modified health belief model to hiv preventive behavioral intentions among gay and bisexual men

Abstract

The utility of a modified health belief model (Janz and Becker, 1984) for predicting the intention to use condoms was tested in a study among gay and bisexual men. The model explained a reasonable amount of variance. It was found that younger men's decision to have safe sex was guided by factors other than those that influenced older men. Among younger men, the intention to use a condom was positively related to the relative number of persons with AIDS in their social environment (cues to action) and to the perceived benefits of HIV preventive behavior. Among older men, this behavioral intention was much more determined by their perception of the prevalence of HIV and by their perception of their vulnerability to HIV infection. These findings are important because they may partly explain the recent increase in AIDS-risk behavior among young gay and bisexual men. The discussion focuses on these findings and on the implications for interventions aimed at promoting safe sex.     

Heterosexual behaviors and risk of exposure to HIV: Current status and prospects for change

Prevalence of HIV among heterosexuals is relatively low as compared to that of gay and bisexual males and intravenous drug users (IDUs). However, many heterosexuals engage in behavior that places them at risk for exposure to HIV. Changes in sexual behavior in response to HIV are reviewed for both high-prevalence groups such as gay and bisexual men and IDUs and lower prevalence heterosexual groups. Psychosocial factors contributing to behavior change are evaluated. The implications for future changes by heterosexuals, especially the adoption of self-protective behaviors such as condom use, are discussed.     

Racialized Sexual Discrimination (RSD) in the Age of Online Sexual Networking: Are Young Black Gay/Bisexual Men (YBGBM) at Elevated Risk for Adverse Psychological Health?

Young Black gay/bisexual men (YBGBM) are a highly marginalized population across multiple health outcomes. Most research on YBGBM health has focused on HIV/sexual health, but there is a demonstrable need for research examining racism and psychosocial functioning among this population. Racialized Sexual Discrimination (RSD), also known as sexual racism, is an important but under-investigated phenomenon that may have implications for the psychological health and well-being of YBGBM. This paper provides an overview of empirical research on RSD as experienced by gay/bisexual men of color in online partner-seeking venues. First, the researchers discuss how racialized experiences are a documented online phenomenon, with a variety of manifestations, and identify the potential effects that this phenomenon may have on the psychosocial health of YBGBM, and gay/bisexual men of color as a whole. Second, the researchers synthesize the RSD literature with a broader literature examining psychological well-being across race and sexual orientation. Third, the researchers present a theoretically grounded conceptual model detailing the pathways between RSD and psychological well-being using a stress and coping framework. The paper concludes with recommendations for future research on this topic, including scale development and hypothesis testing.     

The impact of internalized homophobia on HIV preventive interventions

A growing body of research implicates internalized homophobia—the internalization of society's antihomosexual sentiments by gay and lesbian people—as a factor contributing to HIV-related sexual risk behavior in gay and bisexual men. Although accumulating evidence links internalized homophobia and sexual risk behavior, no study has explored the impact of internalized homophobia on efforts to prevent these behaviors. This paper examines the effect of internalized homophobia on gay and bisexual men's awareness of, participation in, and perceptions of programs offered by a community-based HIV prevention organization. In Study 1, 595 gay and bisexual men reported their levels of awareness of and participation in HIV prevention programming offered by one community organization. Internalized homophobia was negatively related to men's awareness of the services offered by the organization. However, among the men who were aware of at least one service, internalized homophobia did not further predict service utilization. Study 2 examined 89 gay and bisexual men who participated for a single session in a group-structured, community-based HIV preventive intervention. Pre- to immediate postintervention change in perceptions of condom use self-efficacy was inversely related to internalized homophobia. Internalized homophobia was also a significant negative predictor of the extent to which participants felt similar to and related well with other members of the group. Together, these findings suggest that internalized homophobia may pose multiple barriers to community-based HIV prevention efforts.     

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.     

Protecting Sexual Minority Youth from Research Risks: Conflicting Perspectives

We describe the dilemmas we encountered in the informed consent process for an HIV prevention project targeting Black gay, bisexual, and non-gay identified young men. We highlight the complexities of applying informed parental consent procedures to sexual minority youth and identify some of the challenges that researchers who work with sexual minority youth face when they must balance the needs and rights of this population against the needs and rights accorded to parents by federal guidelines for protecting minor participants in research.     

Sexual Debut Ages in Heterosexual,Lesbian, Gay,and Bisexual Young Adults in Norway

This study estimates sexual debut ages in young heterosexual, lesbian, gay, and bisexual men and women in Norway. A questionnaire survey was completed online by 27.2 % of a representative national web sample of 2090 persons aged 18–29 years. Three self-selected samples of 924 respondents completed an extended version of the survey online. Lesbian and bisexual women reported earlier experience of orgasm through masturbation than heterosexual women (median 13.1 vs. 15.2 years), and heterosexual men (median 13.5) reported earlier debut than heterosexual women. There was a statistically significant difference between heterosexual and lesbian and bisexual women’s age at the first experience of receptive vaginal sex (median 16.8 vs. 15.4 years). As regards experience of insertive vaginal sex, a significantly higher percentage of heterosexual men than women, and of heterosexual and lesbian and bisexual women, reported experience. It was more common among lesbian and bisexual women than heterosexual women to have had oral sex with another woman, but in neither group did the cumulative percent reach 50 % by the age of 29 years and the median could not be estimated. Gay and bisexual men reported earlier receptive anal sex debut than heterosexual men. With regard to insertive anal sex, gay and bisexual men accumulated experience earlier than heterosexual men, and lesbian and bisexual women acquired this experience earlier than heterosexual women. Compared to heterosexuals, LGB persons of both genders engage in more varied sexual activities. Lesbian and gay persons have same-sex experiences at an earlier age than bisexuals.     

More than the Sum of Its Parts: Intersections of Sexual Orientation and Race as They Influence Perceptions of Group Similarity and Stereotype Content

Across two studies conducted in the United States, we apply an intersectional analysis to investigate how the interaction of sexual orientation (gay versus straight) and race (Black versus White) in male groups affect perceptions of inter-group similarity and stereotype content. The intersectionality hypothesis (Hypothesis 1) predicts that the interaction of race and sexual orientation will influence inter-group similarity perceptions and produce unique stereotype content that is not the result of simply adding race stereotypes to sexual orientation stereotypes. The related prototypicality hypothesis (Hypothesis 2) predicts that intersectional groups will generate more perceived dissimilarity and more unique attributes when they are non-prototypical with respect to race (Black) and sexual orientation (gay). We found strong support for intersectionality (Hypothesis 1); for Hypothesis 2, the prototypicality hypothesis, support was strongest with respect to the impact of non-prototypical sexual orientation (i.e., gayness). In Study 1, the group “Gay Black men” was viewed as most dissimilar to the group “Men,” and to its constituent ingroups. In Study 2, the group “Gay Black men” generated the most unique stereotype content. The addition of the label “gay” also reduced stereotype negativity, particularly in perceptions of Black men. The results contribute to research and theory by demonstrating that the intersection of ethnic and sexual orientation stereotypes is complex and produces meaningful differences in the perception of groups.

     

Finding Sunshine on a Cloudy Day: A Positive Affect Intervention for Co-Occurring Methamphetamine Use and HIV

Among sexual minority men (i.e., gay, bisexual, and other men who have sex with men) living with HIV, those who use methamphetamine experience profound health disparities. Affect Regulation Treatment to Enhance Methamphetamine Intervention Success (ARTEMIS) is an evidence-based, 5-session, individually delivered positive affect intervention adapted for sexual minority men living with HIV who use methamphetamine. ARTEMIS was designed to amplify the benefits of evidence-based substance use interventions such as contingency management (CM) with this high-priority population. Delivering ARTEMIS during CM has been shown to assist participants in reducing stimulant use, increasing positive affect, and achieving durable reductions in HIV viral load. We describe the theoretical underpinnings of the ARTEMIS intervention, provide details of the training and session protocols with a case example, and discuss implications for future applications in research and clinical settings.     

Predicting Self-Esteem, Well-Being, and Distress in a Cohort of Gay Men: The Importance of Cultural Stigma, Personal Visibility, Community Networks, and Positive Identity

ABSTRACT Homosexual and bisexual men (N= 825) enrolled in the Multi-center AIDS Cohort Study in Chicago completed a 90-minute self-administered questionnaire that included the Rosenberg Self-Esteem Scale, a Well-Being Index, and the Hopkins Symptom Checklist. Participants indicated their experiences with gay stigma, their visihility as gay men, their involvement in the gay community, and their commitment to a positive gay identity. Data from this predominantly white, young, educated, and tniddle-class cohort are consistent with a structural model in which cultural stigma is negatively asso-ciated with positive self-perceptions. This within-group result contrasts sharply with between group results that indicate our gay cohort was neither particularly low in global self-esteetn nor high in psychological distress when compared to nonstigmatized samples.     

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.     

Substance use in lesbian, gay, and bisexual populations: an update on empirical research and implications for treatment

Historically, substance use problems were thought to be more prevalent in lesbian, gay, and bisexual (LGB) populations, and correcting skewed perceptions about substance abuse among LGB individuals is critically important. This review provides an update on empirical evidence on LGB substance use patterns and treatment outcome, with specific focus on clinical implications of findings. Compared to earlier studies, the recent research included in this review has used more sophisticated methodologies and more representative samples, and also has investigated multiple dimensions of sexual orientation in relation to substance use patterns. Findings from recent research suggest that lesbians and bisexual women are at greater risk for alcohol and drug use disorders and related problems, and that gay and bisexual men are at greater risk for illicit drug use and related problems. Several sociocultural factors have emerged as correlates of substance use patterns in LGB populations (e.g., affiliation with gay culture, HIV status), and several demographic characteristics (e.g., female, older age) do not appear to be as robust of protective factors against substance abuse for LGB individuals compared to heterosexual populations. Bisexual identity and/or behavior in particular seem to be related to increased risk for substance abuse. In terms of treatment outcome, limitations of extant research prevent conclusions about the relative impact of LGB-specific interventions, and further research that includes women and uses more equivalent comparison interventions is needed. Clinical implications of research findings are discussed for case identification, selection of treatment goals (e.g., moderation vs. abstinence), targets for intervention, and specific treatment modalities.     

Achieving Safety: Safer Sex, Communication, and Desire among Young Gay Men

Conceptualizations of safer sex practices among young gay men (YGM) are frequently structured around communication between partners and the subsequent utilization or absence of condoms in a sexual encounter. Drawing on a sample of 34 in-depth interviews with YGM, ages 18 to 24, we explore the ways in which conceptualizations and definitions of safer sex are discussed and enacted. Placing attention on their safer sex practices, we analyze the conversations that do and do not occur among YGM and their partners, including the strategies (e.g., negotiated safety, condom communication and negotiation) that are commonly perceived as most useful by YGM. We provide recommendations regarding how to craft safer sex messages for YGM by considering their competing demands.     

The importance of feeling sexually attractive: Can it predict an individual's experience of their sexuality and sexual relationships across gender and sexual orientation?

Limited research exists on the implications of feeling sexually attractive for various aspects of sexuality and sexual relationships. This article examined associations between self‐perceived sexual attractiveness and sexual esteem, sexual satisfaction and amount of sexual experience, among both men and women who identified as heterosexual (n = 1017), gay or lesbian (n = 1225) or bisexual (n = 651). Results of the study demonstrated that positive self‐perceptions of sexual attractiveness predicted greater sexual esteem, greater sexual satisfaction, a higher frequency of sexual activity with others and a larger number of sexual partners among both men and women who identified as heterosexual, gay, lesbian or bisexual. The findings suggest that feeling sexually attractive may have implications for how an individual experiences their sexuality and sexual relationships regardless of their gender or sexual orientation. The importance of considering an individual's self‐perceptions of sexual attractiveness when they present with concerns related to their sexual experiences or relationships, and the potential benefits of educational and therapeutic interventions designed to enhance self‐perceptions of sexual attractiveness are discussed.     

Self-Assessed Risk of HIV and Other STIs Among Young Adults in Norway and Croatia

The purpose of the present study is to explore how sexually active young Norwegian and Croatian adults assess the risk of being infected with HIV and other STIs. Study results are based on a 2009–2010 large-scale national probability survey of young adults aged 18–24 in Croatia (n = 1,005) and Norway (n = 871). A majority of sexually active young adults in Croatia and Norway assessed the risk of becoming infected with HIV or other STIs as low or negligible. Among non-condom users, 85–98% determined they had low or no risk of getting infected with HIV. The corresponding figures for STIs were 77–79%. In both countries a higher HIV risk self-assessment was observed among those who had had same-sex sexual experience, those who reported a higher number of sex partners during the past year, and those who were single. When investigating the patterns of HIV/STI risk assessment, gender and country-related differences appeared. Condom use associated with higher risk assessment was significant only among Croatian men. The strong perception of condom use as being a male responsibility in Croatia may be the reason for a higher risk assessment for unwanted pregnancy and HIV/STIs when protection fails. The risk assessment for HIV/STIs was not associated with partner turnover in Croatian men. New campaigns need to develop gender-sensitive messages, particularly targeting men who believe that a great number of sexual partners is a sign of manliness and women who shy away from their responsibility to use protection.