Black men who have sex with
men (MSM) carry a disproportionate burden of HIV in the United States. Such
disparities cannot be attributed to individual behavioral risk factors alone,
prompting the exploration of social and contextual factors experienced by minority
MSM. Societal homonegativity and the internalization of those attitudes by
Black MSM may play an important role in understanding racial and ethnic
disparities in HIV incidence and prevalence. This study explores the correlates
of internalized homonegativity in a large multi-site sample of Black MSM.
Findings reveal a number of significant contextual and psychosocial factors
related to internalized homonegativity including religiosity, resilience, and
gay community acculturation, which have important implications for HIV risk,
HIV testing, and social and psychological wellbeing for Black MSM...
Given the complex nature of internalized homonegativity, it
was important to explore pathways by which internalized homonegativity may
affect Black MSM, and our results revealed a number of significant contextual
and psychosocial factors to consider. For example, given its prominence in the
Black community, the Black Church has played a significant role in defining
attitudes toward same-sex behavior and relationships, is often cited as a
source of homonegativity (Balaji et al., 2012), and is criticized for
perpetuating negative attitudes toward homosexuality (Fullilove & Fullilove, 1999; Woodyard, Peterson, & Stokes, 2000).
Research has previously demonstrated that LGBT individuals of color are less
likely to be open with their sexuality in religious environments than White
LGBT individuals (Moradi et al., 2010), although religious
environments are also a documented source of support and resilience for LGBT people
of color (Bowleg, Huang, Brooks, Black, & Burkholder, 2003; Gómez, Mason, & Alvarado, 2005; Miller, 2005). This perceived need to conceal
one’s sexuality within an environment that simultaneously provides support and
a sense of community can lead to significant internal turmoil and distress and
subsequently, to internalized homonegativity. It is not surprising, then, that
higher religiosity or church involvement significantly predicted internalized
homonegativity. The relationship between religious engagement and internalized
homonegativity is thought to begin in early life and is reinforced through
continued participation in non-affirming religious settings (Barnes, 2012). Homophobic messages and beliefs
acquired during childhood or emerging adolescence may become internalized when
individuals begin to identify as gay, even if they eventually disassociate from
such environments (Barnes, 2012). However, despite anti-gay
messages, some LGBT individuals may retain affiliations with non-affirming
religious settings because of the great personal benefit and connection with a
community, especially for Black Americans, for whom the Church has often been
viewed as central to racial identity and pride (Lincoln & Mamiya, 1990).
Real or perceived anti-gay attitudes from within the Black
community may also affect perceptions of masculinity and sexual identity among
Black MSM. Higher levels of masculinity and being an MSM who identifies as
bisexual or heterosexual were both significant predictors of internalized
homonegativity. The constructions of masculinity for Black men may be
influenced by experiences of racism and socioeconomic disparities, which may
affect the daily behaviors, attitudes, and perceptions of Black MSM (Mays et al., 2004). The social and cultural
environments of many Black men may inhibit their expression of non-heterosexual
behaviors and identities (Mays et al., 2004; G. Millett, Malebranche, Mason, & Spikes, 2005;Operario, Smith, & Kegeles, 2008), as
Black MSM may face cultural and community rejection when they openly identify
as gay (Dodge, Jeffries IV, & Sandfort, 2008; Malebranche, 2003). In response to societal
stigma and homonegativity, and as a strategy for self-preservation within the
Black community, some Black MSM report needing to conceal their sexual identity
(Choi, Han, Paul, & Ayala, 2011). Other men
may seek to portray a hypermasculine public image in an effort to conceal their
homosexuality, which is often viewed as inconsistent with traditional masculine
gender roles (E. L. Fields et al., 2014). Thus, individuals
with higher levels of internalized homonegativity may be more likely to attempt
to be perceived by others as masculine. It is possible that identifying as
bisexual may not be as stigmatizing as identifying as gay, and thus, Black MSM
who are more uncomfortable with their sexuality and have internalized negative
societal attitudes about their sexual orientation may feel more comfortable
identifying as bisexual or heterosexual. This is consistent with previous work
suggesting that more ‘closeted’ men tend to have higher levels of internalized
homonegativity (Berg, Ross, Weatherburn, & Schmidt, 2013).
In general, it seems as though Black MSM face the potential loss of support
from the broader Black community if they disclose their sexual identity, yet
are likely to experience greater internalized heteronormativity and
psychological distress if they do not.
Two social and cultural factors were found to be negatively
correlated with internalized homonegativity for Black MSM in this study. First,
greater gay community acculturation was associated with lower levels of
internalized homonegativity, suggesting increased isolation from LGBT peers and
the gay community. This may present a unique challenge as Black MSM struggle
with the intersection of stigma due to sexual orientation and race and may face
racism from the White gay community (Choi et al., 2011), potentially leading to
exclusion and isolation from the broader gay community. Furthermore, higher
levels of societal homonegativity within the Black community (Fullilove & Fullilove, 1999) may
simultaneously result in isolation and stigma from the Black community. Black
MSM may feel a lack of support from the Black community and a simultaneous
disconnection from the largely White LGBT community, which may translate into
the internalization of more negative attitudes about themselves (Szymanski & Gupta, 2009).
Minority stress theory suggests that Black LGBT individuals
are exposed to greater stress, and subsequently worse health and mental health
outcomes, than White LGBT persons because of the stress related to both
homonegativity and racism, as well as more limited support and community
resources compared to White LGBT individuals (I. H. Meyer, 2010). Theories of resilience,
however, posit that because of negative experiences with racism experienced in
early life, Black MSM may be better able to guard against some of the
deleterious consequences of homonegativity as adolescents and adults (I. H. Meyer, 2010; Moradi et al., 2010). Resilience theories
suggest that despite increased stress exposure, Black MSM may actually have
higher levels of individual- and social-level resilience and resources need
counter some of the potential negative effects of stress and protect against
some of the negative consequences associated with homonegativity (I. H. Meyer, 2010). In our study, resiliency
was found to be negatively related with internalized homonegativity; higher
levels of resilience were associated with lower levels of internalized
homonegativity. As other researchers have pointed out (I. H. Meyer, 2003; I. H. Meyer, 2010), additional research
focusing on stress and resilience, especially among Black MSM, is needed to
fully understand the nuances and occasional inconsistencies in these theories
and understand how stress and resiliency affect internalized homonegativity.
These correlates of internalized homonegativity are
important not only to mental health and psychosocial coping among Black MSM,
but also have implications for HIV prevention interventions. Although this
study did not establish a direct link between sexual risk behaviors and
internalized homonegativity, many of the factors associated with internalized
homonegativity have been found in other studies to have an association with
sexual risk behaviors. For example, MSM with higher levels of internalized
homonegativity may invoke any number of maladaptive coping mechanisms to
minimize stress, including substance use, which increases the odds of engaging
in unprotected anal intercourse (Fendrich, Avci, Johnson, & Mackesy-Amiti, 2013).
Our findings support this, as internalized homonegativity was associated with
use of marijuana or other hard drugs in the previous 30 days. Black MSM may
turn to drug use as a coping mechanism for the stress related to internalized
homonegativity, which in turn, may lead to risky sexual behaviors or inhibit
safe sex negotiation. Similarly, isolation from the gay community or family and
community may also affect HIV risk behaviors (Mimiaga et al., 2009), suggesting an indirect
relationship between internalized homonegativity and sexual risky behaviors.
Furthermore, we found a significant association between internalized
homonegativity and either never receiving an HIV test or being tested more than
a year ago. This has important implications for HIV risk, as delays in testing
may result in unknowingly transmitting the virus to sexual partners. Other
researchers have suggested HIV disparities may be partially explained by late
HIV testing among Black MSM, and their likelihood of having undiagnosed and
untreated HIV infection (G. A. Millett et al., 2006)...
Full article
at:
By:
1 Center for AIDS Intervention Research,
Psychiatry and Behavioral Medicine, Medical College of Wisconsin
2 Mississippi State University
Corresponding author: Katherine Quinn, PhD, Center for AIDS
Intervention Research, Psychiatry and Behavioral Medicine, Medical College of
Wisconsin, 414-955-4909, Email: ude.wcm@nniuqak
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