Trauma symptoms,internalized stigma,social support,and sexual risk behavior among HIV-positive gay and bisexual MSM who have sought sex partners online

Gay, bisexual, and other men who have sex with men (MSM) remain the highest risk group for HIV infection. One reason is the increased use of the Internet to meet potential sex partners, which is associated with greater sexual risk behavior. To date, few studies have investigated psychosocial predictors of sexual risk behavior among gay and bisexual men seeking sex partners online. The purpose of the current study was to test a conceptual model of the relationships between trauma symptoms indexed on the event of HIV diagnosis, internalized HIV stigma, and social support on sexual risk behavior among gay and bisexual MSM who seek sex partners online. A sample of 142 gay and bisexual MSM recruited on- and offline completed a comprehensive online assessment battery assessing the factors noted above. A number of associations emerged; most notably internalized HIV stigma mediated the relationship between trauma-related symptoms indexed on the event of HIV diagnosis and sexual risk behavior with HIV-negative and unknown serostatus sex partners. This suggests that gay and bisexual MSM who are in greater distress over their HIV diagnosis and who are more sensitive to HIV stigma engage in more HIV transmission risk behavior. As sexual risk environments expand with the increasing use of the Internet to connect with others for sex, it is important to understand the predictors of sexual risk behavior so that tailored interventions can promote sexual health for gay and bisexual MSM seeking sex online.     

The Psychological Cost of Anticipating HIV Stigma for HIV-Negative Gay and Bisexual Men

Much research has examined the impact of HIV-associated stigma on HIV-positive individuals, but little work has explored its impact on HIV-negative persons. However, many gay and bisexual men may imagine the stigma they would experience upon seroconverting, and this anticipated stigma may be associated with negative mental health. Such concerns may be exacerbated among men who identify with the receptive role during anal sex, because of greater risk for infection. This study examined the association between anticipated HIV stigma and negative affect among 683 HIV-negative gay and bisexual men living in New York City. Anticipated HIV stigma predicted negative affect over and above internalized homonegativity. Sexual role identity was associated directly with anticipated stigma and indirectly with negative affect. Results suggest that anticipated HIV stigma may be an important mental health issue for gay and bisexual men. Public health messaging discussing sexual positioning should be sensitive to the potential for exacerbating anticipated HIV stigma among bottom-identified men.     

Stigma,medical mistrust,and perceived racism may affect PrEP awareness and uptake in black compared to white gay and bisexual men in Jackson,Mississippi and Boston,Massachusetts

Gay and bisexual men and other men who have sex with men (MSM) account for more than two thirds of new HIV infections in the U.S., with Black MSM experiencing the greatest burden. Antiretroviral pre-exposure prophylaxis (PrEP) can reduce MSM’s vulnerability to HIV infection. Uptake of PrEP has been limited, particularly among racial and ethnic minority MSM. Four semi-structured focus groups with gay and bisexual men and other MSM at risk for HIV infection were convened in Boston and Jackson in late 2013. The analysis plan utilized a within-case, across-case approach to code and analyze emerging themes, and to compare results across the two cities. Participants recruited in Jackson were primarily Black gay men, while Boston participants were mostly non-Hispanic White gay men. Participants in both sites shared concerns about medication side effects and culturally insensitive health care for gay men. Jackson participants described stronger medical mistrust, and more frequently described experiences of anti-gay and HIV related stigma. Multiple addressable barriers to PrEP uptake were described. Information about side effects should be explicitly addressed in PrEP education campaigns. Providers and health departments should address medical mistrust, especially among Black gay and bisexual men and other MSM, in part by training providers in how to provide affirming, culturally competent care. Medicaid should be expanded in Mississippi to cover low-income young Black gay and bisexual men and other MSM.     

Stigma and sexual compulsivity in a community-based sample of HIV-positive gay and bisexual men

A better exploration of factors associated with sexual compulsivity (SC) among various subpopulations may help to explain its etiology, development, and course, as well as provide implications for treatment. Criticisms of SC highlight the need to have a better understanding of SC that takes into account both behavioral and psychosocial variables such as stigma, particularly stigma related to sexual orientation and HIV status. The purpose of this study was to investigate the association of SC with sexual behavior and stigma in a sample of HIV-positive gay and bisexual men. A cross-sectional, street-intercept method was adapted to survey a sample of 127 HIV-positive gay and bisexual males at two large-scale LGBT community events in the fall of 2008 and spring of 2009. We found that the number of recent male sexual partners (AOR = 1.05) and internalized HIV stigma (AOR = 8.20) were significantly associated with SC symptomology, while internalized homonegativity and interpersonal HIV stigma were not. These findings contradict many prominent criticisms of SC while highlighting the need to better understand the mechanisms related to the development of SC symptomology and the potential role stigma may have for the psychosexual well-being of HIV-positive gay and bisexual men.     

Correlates of sexual, ethnic, and dual identity: a study of young Asian and Pacific Islander men who have sex with men

Having a positive attitude toward one's own sexual and ethnic identity can improve psychological well-being and self-efficacy and may reduce vulnerability to HIV infection. We sought to understand factors associated with having greater self-worth about being Asian and Pacific Islander (API), being gay/bisexual, and being both gay/bisexual and API (dual identity). We conducted serial, cross-sectional surveys of 763 API men who have sex with men (MSM) annually from 1999 to 2002 in San Diego, California and Seattle, Washington. We found (a) sexual and ethnic identity were intertwined and mutually influential; (b) a positive attitude toward sexual identity was associated with higher socioeconomic status, greater social support, and self-identified homosexual orientation (as opposed to "straight/undecided"); (c) a positive dual identity was associated with higher socioeconomic status, greater social support, and levels of acculturation (being United States born and speaking English and another language equally); and (d) a positive sexual identity and dual identity were associated with HIV testing. The findings suggest that targeted programs should address cultural issues at the intersection of sexual and ethnic identity, promote social support and self-acceptance around homosexual identity, and help MSM build a positive sense of self to foster their self-esteem and HIV prevention self-efficacy.     

Correlates of high-risk sexual behaviour among Canadian men of South Asian and European origin who have sex with men

A sample of 98 Canadian homosexual and bisexual men, 46 of South Asian and 52 of European origin, who had sex with other than an exclusive primary partner were asked about their high-risk sexual behaviours during the previous six months. They were also queried about internalized homophobia, acculturation to the gay community, and for South Asians acculturation to the majority culture. Participants who reported more internalized homophobia were more likely to engage in both high-risk anal and oral sex. South Asian men exhibited significantly greater levels of homophobia. In addition, South Asian men who were less acculturated to the majority culture were more likely to engage in both types of high-risk sex. These data suggest a need to address internalized homophobia in HIV prevention programmes with homosexual and bisexual men generally, and further suggest the need to target less acculturated South Asian men in particular.     

Evidence of a Syndemic Among Young Canadian Gay and Bisexual Men: Uncovering the Associations Between Anti-gay Experiences,Psychosocial Issues,and HIV Risk

Syndemic has become an important theoretical model toward understanding how psychosocial issues may interact to increase HIV acquisition among gay and bisexual men. We measured the extent to which anti-gay experiences are associated with psychosocial issues, which in turn were hypothesized to have an additive effect on HIV risk, in a sample of Canadian young gay and bisexual men. Sixty-eight percent of men reported at least one form of anti-gay experience. For each additional form of anti-gay experience, our data demonstrated increased likelihood of psychosocial issues. Psychosocial issues had an additive effect, increasing the risk of unprotected intercourse in the last 12 months (doubling the risk for those with 3+ issues OR 1.95 [1.39–2.75]). Overall, our findings suggest that a syndemic is occurring among young Canadian gay and bisexual men, highlighting the need to expand HIV prevention efforts beyond sexual risk, to address stigma and gay men’s broader health concerns.     

Increasing incidence of HIV infections among young gay and bisexual men in Vancouver.

Since the beginning of the HIV epidemic in north America, the majority of HIV infections have occurred among men who engage in sexual relations with other men. As the HIV epidemic enters its third decade, gay and bisexual men continue to have among the highest rates of HIV infection. Previous studies have highlighted the decline in the incidence of HIV and risk behaviour among gay and bisexual men. However, several studies have suggested that young gay and bisexual men continue to engage in unprotected sexual behaviours and are at continued risk of HIV infection. Recent reports in the media and research literature have indicated an increase in the incidence of HIV among gay and bisexual individuals in many of the world's major cities. The purpose of this study was to determine trends in HIV incidence using data from a prospective cohort of young gay and bisexual men.     

'I count myself as being in a different world': African gay and bisexual men living with HIV in London. An exploratory study

The experiences of men from African backgrounds living with HIV who are gay/bisexual have so far been overlooked in the research on HIV in the UK. Little is known about the ways that HIV impacts on this population. We report on an exploratory qualitative study with 8 gay/bisexual men from 7 different African countries living with HIV in London, based on in depth semi structured interviews and a thematic analysis. HIV testing and diagnosis, disclosure to others, social and sexual networks, sexual relationships and practices, use of health services and coping mechanisms emerged as key themes. Men with insecure residency status in the UK and those without work had additional challenges to meet. Men described the constant juggling required to balance the complex and sometimes contradictory realities of life as a gay/bisexual man, an African and an HIV positive person. Actual and perceived stigma was a key barrier to accessing appropriate practical and emotional support from families, social network or religious organisations.     

Stigma and suicide among gay and bisexual men living with HIV

HIV positive gay and bisexual men (GBM) continue to struggle with the pervasiveness of HIV stigma, but little is known about the health effects of stigma. In this article, suicidal ideation and attempts are measured among GBM living with HIV, evaluating the extent to which these experiences are associated with stigma and suicide. Drawing from an online national survey of Canadian GBM completed by 7995 respondents, a sub-set of data provided by respondents self-reporting HIV-positive status was used for the current study. The associations between suicidal ideation (SI) and attempts (SA) and four measures of HIV stigma were measured: social exclusion, sexual rejection, verbal abuse and physical abuse. A total of 673 HIV-positive men completed the survey (8% of total sample). Among this group, 22% (n?=?150) reported SI and 5% (n?=?33) SA in the last 12 months. After adjusting for sociodemographic factors, SI and SA were associated with each of the four measures of HIV stigma: being excluded socially for being HIV positive (SI adjusted odds ratio, AOR 2.0 95% CI 1.4–3.1; SA AOR 3.8 95% CI 1.9–7.9), rejected as a sexual partner (SI AOR 1.6 95% CI 1.1–2.4; SA AOR 2.6 95% CI 1.1–6.0), verbally abused (SI AOR 2.9 95% CI 1.9–4.5; SA AOR 2.4 95% CI 1.1–5.1), and physically abused (SI AOR 4.5 95% CI 1.8–11.7; SA AOR 6.4 95% CI 2.0–20.1). Furthermore, experiencing multiple forms of stigma was associated with significantly increased risk of SI and SA. The authors conclude that HIV positive GBM experience significant levels of stigma that are associated with heightened risk for suicide. The findings affirm the need for targeted interventions to prevent suicide amid public health efforts to de-stigmatize HIV and mental illness.     

The relationship of stigma to the sexual risk behavior of rural men who have sex with men.

Most studies of risky sexual behaviors of men who have sex with men (MSM) have been conducted in cities. Few have documented risky sexual behavior of rural men despite increases in rural HIV. Fewer have addressed stigma and risk. This study explored the effects of stigma on sexual risk behavior among rural MSM. We hypothesized that stigma emanating from families, health care providers, and the communities of rural MSM would indirectly affect their sexual risk behavior through their mental health status, specifically self-esteem and internalized homophobia. A convenience sample of 414 rural MSM obtained through political, health service, and social organizations completed an anonymous self-administered questionnaire. Over half of the men reported high-risk sexual behavior. Sensation seeking directly affected levels of sexual risk while the effects of stigma on sexual risk behavior were mediated by mental health variables. Stigma related to respondents' low self-esteem, and low internalized homophobia increased risk behavior.     

Exploring the Correlates of Linkage to HIV Medical Care Among Persons Living with HIV Infection (PLWH) in the Deep South: Results and Lessons Learned from the Louisiana Positive Charge Initiative

We explored the correlates of linkage to HIV medical care and barriers to HIV care among PLWH in Louisiana. Of the 998 participants enrolled, 85.8% were successfully linked to HIV care within 3 months. The majority of participants were male (66.2%), African American (81.6%), and had limited education (74.4%). Approximately 22% of participants were Black gay and bisexual men. The most common reported barrier to care was lack of transportation (27.1%). Multivariable analysis revealed that compared with Black gay and bisexual men, White gay and bisexual men were significantly more likely to be linked to HIV care (adjusted prevalence ratio, aPR?1.08, 95% CI 1.02–1.13). Additionally, participants reporting moderate to high levels of stigma at intake (p?<?0.05) were significantly more likely to be linked to HIV care compared with those reporting low or no stigma at enrollment. Study findings highlight the continued importance of client-centered interventions and multi-sector collaborations to link PLWH to HIV medical care.     

Substance Use Disorders in Gay/Bisexual Men With HIV and AIDS

The authors conducted a longitudinal study of psychological adaptation to AIDS in subjects with and without lifetime and current substance use disorders (SUD), in a cohort of HIV+ gay/bisexual subjects. A sample of HIV+ gay/bisexual men (n = 183) and an HIV- comparison group (n = 84) were assessed for SUD, depression, and anxiety disorders. Among HIV+ men, combined lifetime (42%) but not current (11.5%) SUDs were more prevalent than in HIV- men (27% and 10%, respectively). HIV+ men with current SUD reported more depression, distress, and diminished quality of life than HIV+ men with no SUD, but HIV-illness severity did not differ. HIV+ men in recovery did not differ from men with no lifetime history. Most HIV+ gay/bisexual men with SUD discontinue or reduce substance use before or subsequent to knowledge of their HIV infection, probably in an attempt to adopt a healthier lifestyle. However, for some HIV+ men, persistent substance abuse/dependence is accompanied by higher levels of distress and diminished quality of life, underscoring their need for treatment intervention.     

Acceptability and HIV Prevention Benefits of a Peer-Based Model of Rapid Point of Care HIV Testing for Australian Gay,Bisexual and Other Men Who Have Sex with Men

Frequent HIV testing among gay, bisexual and other men who have sex with men (GBM) is a strategic priority for HIV prevention in Australia. To overcome barriers to testing in conventional clinical services, Australia recently introduced peer HIV rapid point of care (RPOC) testing services for GBM. This mixed methods evaluation describes client acceptability and HIV prevention benefits of a peer HIV testing model. Most aspects of the service model were overwhelmingly acceptable to clients. Two-thirds of survey participants reported preferring testing with peers rather than doctors or nurses and over half reported learning something new about reducing HIV risk. Focus group findings suggested peer-delivered HIV RPOC testing reduced stigma-related barriers to frequent testing and provided novel opportunities for GBM to openly discuss HIV prevention and sexual practices, enhancing their HIV risk-reduction knowledge. Analysis of survey data suggested knowledge transfer occurred particularly among younger and less gay community-attached GBM.     

Burden and Correlates of Mental Health Symptoms Among Young Black Gay,Bisexual, and Other Men Who Have Sex with Men Engaged in HIV Care in Atlanta

AIDS and Behavior - Mental health comorbidities are prevalent among young Black gay, bisexual, and other men who have sex with men (YB-GBMSM) living with HIV and can adversely impact HIV-related...     

Patterns of Online and Offline Connectedness Among Gay,Bisexual, and Other Men Who Have Sex with Men

This study examined patterns of connectedness among 774 sexually-active gay, bisexual, and other men who have sex with men (GBM), aged ≥ 16 years, recruited using respondent-driven sampling in Metro Vancouver. Latent class analysis examined patterns of connectedness including: attendance at gay venues/events (i.e., bars/clubs, community groups, pride parades), social time spent with GBM, use of online social and sex seeking apps/websites, and consumption of gay media. Multinomial regression identified correlates of class membership. A three-class LCA solution was specified: Class 1 “Socialites” (38.8%) were highly connected across all indicators. Class 2 “Traditionalists” (25.7%) were moderately connected, with little app/website-use. Class 3 “Techies” (35.4%) had high online connectedness and relatively lower in-person connectedness. In multivariable modelling, Socialites had higher collectivism than Traditionalists, who had higher collectivism than Techies. Socialites also had higher annual incomes than other classes. Techies were more likely than Traditionalists to report recent serodiscordant or unknown condomless anal sex and HIV risk management practices (e.g., ask their partner’s HIV status, get tested for HIV). Traditionalists on the other hand were less likely to practice HIV risk management and had lower HIV/AIDS stigma scores than Socialites. Further, Traditionalists were older, more likely to be partnered, and reported fewer male sex partners than men in other groups. These findings highlight how patterns of connectedness relate to GBM’s risk management.     

Sexual sensation seeking,sexual compulsivity,and high-risk sexual behaviours among gay/bisexual men in Southwest China

High-risk sexual behaviours (HRSBs), such as having male casual sexual partners (MCSPs) and unprotected anal intercourse (UAI), are combined with a high prevalence of HIV infection among gay/bisexual men. Sexual sensation seeking (SSS) and sexual compulsivity (SC), which are intrapersonal factors, were observed to have associations with HRSB among gay/bisexual men in Western nations. The aim of the study was to examine the relationships between SSS, SC, socio-demographic factors, and HRSB (defined as having MCSP and UAI with MCSP) among self-identified gay and bisexual men in Southwest China. The study was cross-sectional, with a sample of 436 respondents. And their mean age was 24.5 years. The results confirmed that SSS, SC, and sexual attitude are associated with both having MCSP and UAI with MCSP in the Chinese cultural context, among the subgroup of men who have sex with men. Being older, not a student, and having transactional sex in the last 6 months were independently associated with having MCSP. Lower educational level, unemployed, having a relationship with a man, and an unsure HIV status were independently associated with UAI with MCSP. This study indicates that SSS and SC are cross-cultural personality traits related to HRSB. The results of this study may shed light on HIV prevention among gay/bisexual men in China.     

Sexual sensation seeking, reduced concern about HIV and sexual risk behaviour among gay men in primary relationships

Gay and bisexual men who indicated they were currently in a primary relationship with another man (N = 230) completed measures of HIV treatment attitudes, sexual risk behaviour and sexual sensation seeking. Results indicate non-primary partner sexual activity is common in many gay relationships and men in non-exclusive relationships possessed greater levels of sexual sensation seeking and treatment-related reduced concern about the dangerousness of HIV than men in exclusive relationships. Results also suggest that individuals who were members of HIV-seroconcordant relationships were more likely to engage in unprotected sexual activity with their primary sexual partners than gay men who were members of HIV-discordant couples. A series of regression analyses revealed that reduced concern about HIV mediated the relationship between sexual sensation seeking and sexual risk behaviour. The next generation of HIV prevention interventions must address the attitudinal shifts that have occurred among some gay men regarding the seriousness of HIV and should be sensitive to the dynamics of gay relationships.     

Preventing HIV among Latino and African American gay and bisexual men in a context of HIV-related stigma, discrimination, and homophobia: perspectives of providers

HIV-related stigma, discrimination, and homophobia impede community-based efforts to combat HIV disease among Latino and African American gay and bisexual men. This commentary highlights ways to address these social biases in communities of color in Los Angeles, California, from the perspectives of staff from HIV prevention programs. Information was collected from HIV prevention program staff participating in a 2-day symposium. The outcomes from the symposium offer strategies for developing and implementing HIV prevention services for Latino and African American gay and bisexual men, which include: (1) addressing social biases present in a community that can hinder, and even prohibit, utilization of effective HIV prevention programs; (2) recasting HIV prevention messages in a broader social or health context; (3) developing culturally appropriate HIV prevention messages; (4) exploring new modalities and venues for delivering HIV prevention messages that are appropriate for gay and bisexual men of color and the communities in which they live; and (5) broadening the target of HIV prevention services to include service providers, local institutions and agencies, and the community at-large. These strategies underscore the need to consider the social and contextual factors of a community when designing and implementing HIV prevention programs.