Reframing HIV prevention for gay men in the United States

The HIV epidemic in the United States has affected at least two generations of gay men. Despite numerous efforts to intervene on this public health crisis, HIV infections continue to escalate, especially among young men. This condition is compounded by an ever-growing number of gay men who are aging and living with HIV. We must enact an innovative and proactive vision and framework for HIV prevention that moves us beyond the undertakings rooted in social-cognitive paradigms that have informed this work for the past 25 years. A new framework for HIV prevention must give voice to gay men; must consider the totality of their lives; must delineate the underlying logic, which directs their relation to sex and HIV; and must concurrently respect their diverse life experiences. This approach should be rooted in a biopsychosocial paradigm, should be informed by both theory and practice, and should be directed by three theoretical lenses--a theory of syndemics, developmental theories, and contextual understandings of HIV disease. Taken together, these elements are a call to action for research and practice psychologists who are working to improve the lives of gay men.     

The Mpowerment Project: community-building with young gay and bisexual men to prevent HIV1

The Mpowerment Project is a community-level HIV prevention intervention for young gay and bisexual men ages 18–27. The program seeks to build a strong, supportive young gay and bisexual men's community where young gay and bisexual men nurture and protect each other, particularly with regard to HIV prevention. The program's theoretical framework draws from the areas of diffusion of innovations, community organizing, peer influence, and personal empowerment. The Mpowerment Project promotes a norm for safer sex through a variety of social, outreach and small group activities. The project is run by a Core Group of 12–15 young gay and bisexual men who, with volunteers, design and carry out all project activities. Implemented in 4 communities (Eugene, OR; Santa Barbara, CA; Albuquerque, NM; Austin, TX), the Mpowerment Project has proven to be effective in reducing high risk sex. This paper discusses the development and implementation of the program and various challenges encountered.     

A meta-analytic review of obesity prevention programs for children and adolescents: the skinny on interventions that work

This meta-analytic review summarizes obesity prevention programs and their effects and investigates participant, intervention, delivery, and design features associated with larger effects. A literature search identified 64 prevention programs seeking to produce weight gain prevention effects, of which 21% produced significant prevention effects that were typically pre- to post effects. Larger effects emerged for programs that targeted children and adolescents (vs. preadolescents) and females, programs that were relatively brief, programs that solely targeted weight control versus other health behaviors (e.g., smoking), programs evaluated in pilot trials, and programs wherein participants must have self-selected into the intervention. Other factors, including mandated improvements in diet and exercise, sedentary behavior reduction, delivery by trained interventionists, and parental involvement, were not associated with significantly larger effects.     

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.     

High-risk behavior among gay adolescents: implications for treatment and support

This article contrasts the experiences of most adolescents during social and psychological development with the special challenges faced by those developing an awareness of their homosexuality. Emphasis is placed upon the interplay between societal prejudices and discrimination toward homosexuality and personal development and risk-taking behavior in gay adolescents. The implications of these life stressors for gay adolescents are also discussed in terms of their consequences for mental health policy and treatment.     

Stress,coping, HIV status,psychosocial resources,and depressive mood in African American gay,bisexual, and heterosexual men

The associations between stress, physical health, psychosocial resources, coping, and depressive mood were examined in a community sample of African American gay, bisexual, and heterosexual men (N=139). Data were collected from physical exams and in-person interviews. In our theoretical framework, depressive mood scores were regressed first on stressors, next on psychosocial resources, and finally on coping strategy variables. Results revealed that psychosocial resources mediate the effects of stressors, including health symptoms, hassles, and life events, on depressive mood. There were no significant differences in depressive mood associated with HIV status or sexual orientation. Results are discussed in terms of community interventions needed to provide social support as a buffer between stress and psychological distress in African American men. The research was completed at the Center for AIDS Prevention Studies, University of California at San Francisco and was supported in part by National Institute of Mental Health Grants MH44045 and MH42459. The authors express their appreciation to the participants in this study.     

Intergroup relations in action: Questions asked about lesbian,gay and bisexual issues in diversity training

This paper focuses on the questions which heterosexual trainees ask about lesbian, gay and bisexual (LGB) experience within diversity training about LGB issues. Drawing on a data corpus of 162 questions asked by trainees in 13 tape‐recorded training sessions, questions were coded into six categories: (1) general ‘understanding’ questions; (2) questions about the trainer's life, experience and practices; (3) professional practice questions; (4) questions about lesbian and gay related legislation, policies and procedures; (5) questions about specific people and projects and (6) questions about the meanings, derivations and correct use of terms and symbols. ‘Real’ questions are compared with the decontexualized questions (and answers to them) that are provided in training manuals and it is demonstrated that these questions differ markedly from how questions actually get asked and how they actually get answered. Recommendations are provided for improving training and the argument made for turning towards analyses of the real world in action, especially when considering intergroup relations. Copyright © 2008 John Wiley & Sons, Ltd.     

Lesbian,gay, and bisexual youth in community settings: Personal challenges and mental health problems

Studied 194 lesbian, gay, and bisexual youth aged 21 and younger who attended programs in 14 community centers to determine the personal challenges they face due to their sexual orientation and their responses to these stresses. First awareness of sexual orientation typically occurred at age 10, but disclosure to another person did not occur until about age 16. There was much variability in sexual behavior, and many youths reported both same-sex and opposite-sex sexual experiences. Although most had told at least one family member about their sexual orientation, there remained much concern about family reactions. Suicide attempts were acknowledged by 42% of the sample. Attempters significantly differed from nonattempters on several milestones of sexual orientation development, social aspects of sexual orientation, parents' knowledge of sexual orientation, and mental health problems. The following organizations participated in this project and are thanked for their assistance: Affirmations (Detroit), the Atlanta Gay Center, Baltimore Gay and Lesbian Community Center, Boston Alliance of Gay and Lesbian Youth, Gay Alternative Youth (Pittsburgh), the Gay and Lesbian Youth Association of Dallas, Gay Youth Alliance — San Diego, the Gay and Lesbian Community Services Center of Los Angeles, Horizons Community Services (Chicago), the Indianapolis Youth Group, the Lesbian and Gay Community Services Center of Cleveland, Lavender Youth Recreation and Information Center (San Francisco), Outright (Denver), and Sexual Minority Youth Assistance League (Washington, DC). The following individuals associated with these groups are gratefully thanked for their help: Danny Barutta, Adriene Corbin, Tom Eversole, Chris Gonzalez, Bill Gripp, Rory Lopez, Phil Rector, Jamie Schield, Cheryl Schwartz, Jan Stephenson, Sterling Stowell, Amy Vitro, and Aubrey Wertheim. Gene Thomas is thanked for helping with data collection, as are Michael LaFlam, Patrick McNamara, and Mark Shiner, who processed the surveys. We also thank Rainer Silbereisen for his comments. This project was supported by funds from the Center for the Study of Child and Adolescent Development of the College of Health and Human Development at Pennsylvania State University.     

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.     

Lesbian,gay, bisexual,and transgender youth: Limited representation in school support personnel journals

Many lesbian, gay, bisexual, and transgender (LGBT) youth experience harassment and discrimination in schools and these experiences lead to increased negative social-emotional outcomes. Youth who can identify at least one supportive adult at school report better outcomes than youth who cannot identify a safe adult. Yet, many educators report feeling uncomfortable or unprepared to support LGBT youth. One reason for educators' discomfort may be that content related to issues unique to LGBT youth is sometimes missing or covered minimally in university training programs. We hypothesized that LGBT content may be covered minimally in school support personnel journals, as well. This study analyzed eight school support personnel journals across the disciplines of school counseling, school nursing, school psychology, and school social work for LGBT content published between 2000 and 2014 to gain a better understanding of the visibility of LGBT issues in the research. Results suggested that there has been a lack of presence of LGBT issues in journals across disciplines. These results also suggest a need for an intentional focus on issues relevant to LGBT youth in school support personnel journals. Thus, the article concludes with an introduction to two articles in this special topic section, including Russell, Day, Ioverno, and Toomey's (in this issue) study on teacher perceptions of bullying in the context of enumerated school policies and other supportive sexual orientation and gender identity related practices and Poteat and Vecho's (in this issue) study on characteristics of bystanders in homophobic bullying situations. The broad goal of these three studies is to increase visibility of critical LGBT issues in school support personnel journals.     

Oppression and discrimination among lesbian,gay, bisexual,and Transgendered people and communities: a challenge for community psychology

Lesbian, gay, bisexual, and transgendered (LGBT) people continue to experience various forms of oppression and discrimination in North America and throughout the world, despite the social, legal, and political advances that have been launched in an attempt to grant LGBT people basic human rights. Even though LGBT people and communities have been actively engaged in community organizing and social action efforts since the early twentieth century, research on LGBT issues has been, for the most part, conspicuously absent within the very field of psychology that is explicitly focused on community research and action–Community Psychology. The psychological and social impact of oppression, rejection, discrimination, harassment, and violence on LGBT people is reviewed, and recent advances in the areas of LGBT health, public policy, and research are detailed. Recent advances within the field of Community Psychology with regard to LGBT research and action are highlighted, and a call to action is offered to integrate the knowledge and skills within LGBT communities with Community Psychology's models of intervention, prevention, and social change in order to build better theory and intervention for LGBT people and communities.     

Factor influencing suicide intent in gay and bisexual suicide ideators: differing models for men with and without human immunodeficiency virus.

Of 778 gay and bisexual men (none with acquired immunodeficiency syndrome [AIDS]), 27% (n = 212) reported suicidal ideation over the previous 6 months. Covariance structure models were used to explore predictors of suicide intent among (n = 112) suicide ideators with (n = 100) and without (n = 112) human immunodeficiency virus (HIV). Current AIDS-related stressors (deaths and illnesses and perceived AIDS risk) and past levels of adaptive functioning (social isolation and depression) were significantly more powerful predictors of suicide intent among HIV-positive than among HIV-negative ideators. Biological AIDS risk predicted neither suicide intent, current distress, nor perceived AIDS risk. Pathways to suicide intent appear to be psychologically, rather than biologically, mediated. Among HIV-positive ideators, AIDS-related death and illness events predicted suicide intent but not current distress symptoms. Some suicidal ideation in response to AIDS-related events may be an effort to cope rather than a manifestation of psychological distress.     

Minority stress and health: Implications for lesbian,gay, bisexual,transgender, and questioning (LGBTQ) young people

Historically, the pathologization of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) orientations shaped research and professional practice, while the impact of stigma was not considered. Within a minority stress conceptualization however, stigma-related prejudice and discrimination experienced by LGBTQ people constitute chronically stressful events that can lead to negative health outcomes. Minority stress has been linked to psychological distress among gay men and lesbians and may contribute to elevated rates of distress frequently observed among LGBTQ youth. This study explored the impact of minority stress on psychological distress among LGBTQ youth in Ireland. Measures assessing three components of minority stress (sexual identity distress, stigma consciousness, and heterosexist experiences) were administered online to LGBTQ youth aged 16–24 years (N = 301). Each minority stressor had a significant independent association with distress. Stepwise regression analyses identified the linear combination of minority stressors as significantly predictive of distress [F(3,201) = 30.80, p ≤ 0.001]. Results suggest that the oppressive social environment created through sexual/transgender identity-related stigma negatively impacts on the well-being of LGBTQ youth. These findings have implications for health professionals and policy makers interested in the concerns of LGBTQ youth experiencing difficulties related to minority status and will facilitate the development and tailoring of interventions aimed at reaching those most at risk.     

Relational aggression and victimization in gay male relationships: the role of internalized homophobia

This article presents two studies that are the first to examine relational aggression and relational victimization in gay male peer relationships. A qualitative pilot study provides a strong rationale for a subsequent empirical investigation of 100 young adult, self-identified gay males. Results of both studies demonstrate that relational aggression and relational victimization are common experiences in gay male relationships. They also reveal forms of relational aggression and victimization that appear to be unique to gay males (e.g., outing). Results of the empirical study found significant relations between engaging in relational aggression against gay males and experiencing relational victimization and between experiencing relational victimization and internalized homophobia. However, there was no significant correlation between internalized homophobia and engaging in relational aggression. A multiple regression analysis found that experiencing relational victimization was correlated more strongly with the combination of engaging in relational aggression and internalized homophobia together than with relational aggression alone. Results are discussed within the framework of Allport's "traits due to victimization" theory and Meyer's theory of "minority stress." Implications for the prevention of relational aggression/victimization in gay male relationships are offered.     

Sexual ethics, marriage, and sexual autonomy: the landscapes for Muslimat and lesbian, gay, bisexual, and transgendered Muslims

Muslims today are increasingly re-examining gender and human rights in the light of Qur’anic teachings, and these issues crucially intersect in the terrain of sexual autonomy. The Qur’an insists that men and women are spiritually equal, yet dominant interpretations of sexual rights in Islam are not gender symmetrical. This paper asks whether Islam’s depiction of sexuality and marriage allows a space for female, and non-heterosexual, sexual autonomy. It also explores current interpretations of Islam, sexuality and same-sex relationships amongst British Muslims who identify as Lesbian, Gay, Bisexual and Transgendered. Large issues are at stake for contemporary Muslims re-examining their institutions and identity. Does marriage remain authoritative when paradigms of sexuality shift, and what does this mean for sexual autonomy in the wider Muslim consciousness?