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.     

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.     

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, 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.     

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.     

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?     

A crucible for murder: the social context of violent children and adolescents

The author describes aspects of social context that are of importance in the genesis of murderous violence in children and adolescents. Case presentations illustrate the effects of family attachment pathology, differing outcomes in destructive children, and the copycat phenomenon. The author concludes by summarizing the continuum of responses of children and adolescents to various forms of threat: real attack, unconscious threat, kindled threat, suppressed threat, bully-victim-bystander sadomasochistic ritual attack, and peer-group-validated threat.     

Prejudice,social stress,and mental health in lesbian,gay, and bisexual populations: conceptual issues and research evidence

In this article the author reviews research evidence on the prevalence of mental disorders in lesbians, gay men, and bisexuals (LGBs) and shows, using meta-analyses, that LGBs have a higher prevalence of mental disorders than heterosexuals. The author offers a conceptual framework for understanding this excess in prevalence of disorder in terms of minority stress--explaining that stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems. The model describes stress processes, including the experience of prejudice events, expectations of rejection, hiding and concealing, internalized homophobia, and ameliorative coping processes. This conceptual framework is the basis for the review of research evidence, suggestions for future research directions, and exploration of public policy implications.     

Coming of age in a heterosexist world: the development of gay and lesbian adolescents.

The general developmental struggles of gay and lesbian adolescents are described as delineated in recent research. Three developmental areas were selected as a focus: the consolidation of sexual identity and the effects of both parental and peer relationships on gay adolescents' development. Weaknesses are noted in current research and theory, and suggestions are offered which could facilitate the development of both homosexual and heterosexual youth.     

Heterosexual, lesbian, and gay male relationships: a comparison of couples in 1975 and 2000

This study examined the differences among lesbians, gay men, and heterosexuals at two points in time (1975 and 2000) using responses of 6,864 participants from two archival data sets. Groups were compared on variables representing equality of behaviors between partners in seven realms: traditionally "feminine" housework, traditionally "masculine" housework, finances, support, communication, requesting/refusing sex, and decision-making. In addition, the current study compared monogamy agreements and monogamy behaviors reported by the two cohorts of couple types. Overall, the results indicate that on the equality variables, there have been many statistically significant behavioral shifts among the different sexual orientations across 25 years. In addition, all couple types reported substantially greater rates of monogamy in the year 2000 than in 1975. The present study has important clinical implications for therapists working with couples because it provides new baseline evidence regarding how couples now interact with one another (especially about monogamy) and how this has shifted over time. In addition, it elucidates the differences that still exist between different couple types, which could serve to inform couple therapists as they strive to become more culturally competent working with same-sex couples.     

Sex differences in self-concept and self-esteem of late adolescents: A time-lag analysis

The presence of historical change in the self-concept and self-esteem of male and female late adolescents was studied using a time-lag design. Five cohorts of students enrolled in the same university and course, consecutively from 1973 to 1977 (total N=1,141), gave self-ratings to 16 evaluative items relating to traits traditionally associated with sex differences. Mean score across items was the self-esteem index, and the vector of ratings for item content was the self-concept index. Historical continuity in self-esteem was found. Males and females did not differ in mean self-esteem, within or between cohorts, and cohort differences accounted for less than 2% of the variance. Cross-cohort similarity in within-cohort sex differences in self-concept was found also. These differences were minimal, accounting for small proportions of the variance and involving no more than 5 items in any cohort. Late adolescents from recent historical eras thus rated themselves in ways inconsistent with societal stereotypes, and showed minimal differences in their self-appraisals. Results are discussed in relation to (1) theoretical positions with which they are inconsistent and (2) an emerging interactionist view, which they appear to support.A shortened version of this paper was presented at the annual meeting of the American Association for the Advancement of Science, Houston, January 1978. The authors thank Stuart A. Karabenick, John R. Knapp, James B. Orlos, and Joyce L. Stuart for collaborating on portions of the project from which the present report is derived.