Homonegativity and Associated Factors among Men Who Have Sex with Men in Estonia

Men who have sex with men (MSM) continue to be at higher risk for negative health outcomes including HIV, STIs, depression, substance use, suicidality, and anxiety. Associative relationships between homonegativity (internal and external) and these outcomes are used to explain the observed disproportionate impact. 

The current study assessed associations between internalized homonegativity and high-risk behaviours, markers of substance use and symptoms of mental illness as well as openness and level of same sex attraction. A 2013 Internet-based survey was conducted among MSM, collecting data on socio-demographics, sexuality, drug and alcohol use, mental health, suicidality, and internalized homonegativity. 

The sample (n = 265) had a median age of 31 years, with 85 % employed at least part-time; at least a college-level education in 43 %; and 87 % lived in an urban setting. Sexual orientation was reported as: gay, 72 %; bisexual 23 %; other 5 %. Almost all men (97 %) reported ever having sex with a man, with more than one-third (36 %) having a steady male partner. 

Statistically significant higher homonegativity scores were detected among men reporting any level of opposite sex attraction compared to men attracted to only men; mostly men (p = 0.001), men and women equally (p = 0.002), and mostly women (p = 0.004), as well as less openness of same sex attraction to family and friends; >50 % family (p = 0.032), no family knowing (p = 0.042), and few friends knowing (p = 0.011). Anxiety risk and increased homonegativity also had a statistically significant increasing relationship. 

The identified associations between homonegativity and opposite sex attraction among MSM warrants further exploration as well as the relationship with increased anxiety risk.

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By:  Parker RD1, Lõhmus L2, Mangine C3, Rüütel K2.

• 1West Virginia University School of Public Health, 1 Medical Center Drive, Morgantown, WV, 26506, USA. rdparker@hsc.wvu.edu.
• 2Infectious Diseases and Drug Monitoring Department, National Institute for Health Development, Hiiu 42, 11619, Tallinn, Estonia.
• 3West Virginia University School of Public Health, 1 Medical Center Drive, Morgantown, WV, 26506, USA.
• J Community Health. 2016 Jan 4.  

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The Relationship of Internalized Homonegativity to Sexual Health and Well-Being among Men in 38 European Countries Who Have Sex With Men

The objective of this article is to examine internalized homonegativity (IH) in relation to aspects of well-being and several measures of clinical importance among men-who-have-sex-with-men (MSM) in 38 countries. The data were collected as part of the EMIS project. 

The multivariable regression analysis identified independent associations with IH for nongay identity, younger age, being closeted, limited gay social affiliation, and sexual unhappiness. IH was also positively associated with loneliness, inability to decline unwanted sex, and being less knowledgeable about HIV and HIV testing. 

These results provide evidence that homonegative internalization merits consideration as a predisposing factor in several aspects of ill health. There are also several clinical implications of this project, including: (1) Treatment of lesbian, gay, and bisexual (LGB) persons should address gay self-acceptance, as internalized homonegativity seems to be a predisposing factor in several aspects of ill health among this population, and (2) therapy that is used to help LGB persons accept and integrate a gay or lesbian identity seems particularly important for younger, nongay identified persons.

Full article at:   http://goo.gl/mMZFAC

By:   Rigmor C. Berg, PhD, a , * Peter Weatherburn, PhD, b Michael W. Ross, PhD, c and Axel J. Schmidt, MD b

aNorwegian Knowledge Center for the Health Services, Oslo, Norway

bDepartment of Social & Environmental Health ResearchLondon School of Hygiene and Tropical Medicine, London, England

cMalmö University, Sweden; and Department of Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota,USA

Address correspondence to Rigmor C. Berg, PhD, Norwegian Knowledge Center for the Health Services, PO Box 7004, St Olavsplass, OsloN-0130, Norway. E-mail:on.ckon@greb.romgir

 

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Resilience among Gay/Bisexual Young Men in Western Kenya: Psychosocial & Sexual Health Outcomes

OBJECTIVE:

To explore associations between intrapersonal and interpersonal factors and both sexual and psychosocial resilient outcomes among young gay, bisexual, and other men who have sex with men (GBMSM) in Western Kenya.

DESIGN:

Cross-sectional observational study.

METHODS:

Five hundred and eleven GBMSM ages 18-29 were recruited from nine communities in Western Kenya using community-based mobilization strategies. Participants completed an audio computer-assisted self-interview survey in English or Duhluo. We estimated four three-step hierarchical linear regression models to examine associations between predictors (intrapersonal and interpersonal factors) and four resilient outcomes (psychological well-being, self-esteem, condom use, HIV testing).

RESULTS:

Psychosocial well-being model (modeled conversely as depression/anxiety) was significant with loneliness, lesbian/gay/bisexual (LGB) difficult process, LGB identity superiority, and reactions to trauma as predictors. Self-esteem model was significant with known HIV-seropositivity, perceived social support, internalized homonegativity, and LGB difficult process as predictors. Condom use model was significant with perceived social support, self-esteem, and reactions to trauma as predictors. HIV testing model was significant with loneliness, LGB identity uncertainty, LGB difficult process, and LGB identity superiority as predictors.

CONCLUSION:

This study demonstrates the variety of ways in which intrapersonal and interpersonal factors are associated with HIV-related resilient outcomes for young GBMSM in Western Kenya. HIV prevention programs for this population should be developed in collaboration with GBMSM and include intervention components that promote resilience.

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By:  Harper GW1, Wade RM, Onyango DP, Abuor PA, Bauermeister JA, Odero WW, Bailey RC.

• 1aDepartment of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA bNyanza Rift Valley and Western Kenya (NYARWEK) Network cNyanza Reproductive Health Society, Kisumu, Kenya dSchool of Medicine, Maseno University eDivision of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health. 

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Beyond "Born This Way?" Reconsidering Sexual Orientation Beliefs and Attitudes

Previous research on heterosexuals' beliefs about sexual orientation (SO) has been limited in that it has generally examined heterosexuals' beliefs from an essentialist perspective. The recently developed Sexual Orientation Beliefs Scale (SOBS; Arseneau, Grzanka, Miles, & Fassinger, 2013) assesses multifarious "lay beliefs" about SO from essentialist, social constructionist, and constructivist perspectives. 

This study used the SOBS to explore latent group-based patterns in endorsement of these beliefs in 2 samples of undergraduate students: a mixed-gender sample (n = 379) and an all-women sample (n = 266). While previous research has posited that essentialist beliefs about the innateness of SO predict positive attitudes toward sexual minorities, our research contributes to a growing body of scholarship that suggests that biological essentialism should be considered in the context of other beliefs. 

Using a person-centered analytic strategy, we found that that college students fell into distinct patterns of SO beliefs that are more different on beliefs about the homogeneity, discreteness, and informativeness of SO categories than on beliefs about the naturalness of SO. Individuals with higher levels of endorsement on all 4 SOBS subscales (a group we named multidimensional essentialism) and those who were highest in discreteness, homogeneity, and informativeness beliefs (i.e., high-DHI) reported higher levels of homonegativity when compared with those who were high only in naturalness beliefs. 

We discuss the implications of these findings for counseling and psychotherapy about SO, as well educational and social interventions.

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By:  Grzanka PR, Zeiders KH, Miles JR.

 

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Correlates of Internalized Homonegativity among Black Men Who Have Sex with Men

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: http://goo.gl/ex45CC

By: Katherine Quinn, MA,1 Julia Dickson-Gomez, PhD,1 Wayne DiFranceisco, MA,1 Jeffrey A. Kelly, PhD,1 Janet S. Lawrence, St., PhD,2 Yuri A. Amirkhanian, PhD,1 and Michelle Broaddus, PhD1

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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The Role of the Black Church in the Lives of Young Black Men Who Have Sex with Men

In the USA, the Black Church is among the most important institutions in the Black community, offering numerous spiritual, social and health benefits. Yet, the presence of homonegativity in many Black Churches may mitigate those effects for gay Black youth. This research examines the role of the Church in the lives of gay and bisexual Black youth to understand how they reconcile any tension between their religious and sexual identities. Through interviews with pastors of Black churches (n = 21) and young Black men who have sex with men (n = 30), we explored homonegativity and young men's experiences within the Black Church. 

Findings reveal that despite the prevalence of homonegativity within Black churches, religious involvement remains important for young men and many remain involved in non-affirming churches. The importance of the Church for young men stems from their significant involvement as youth and the integration of religion, family and community. Young men may not be able to leave their religious homes as readily as other gay youth given the cultural relevance of the Church. 

As a result, young men made attempts to conceal their sexuality in church to avoid shame and gossip and find opportunities to balance their sexuality and religiosity.

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By: Quinn K1, Dickson-Gomez J1, Kelly JA1.

• 1a Department of Psychiatry and Behavioral Medicine , Medical College of Wisconsin, Center for AIDS Intervention Research , Milwaukee , USA.  

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Essentialist Beliefs, Sexual Identity Uncertainty, Internalized Homonegativity & Psychological Wellbeing in Gay Men

The present study examined essentialist beliefs about sexual orientation and their implications for sexual identity uncertainty, internalized homonegativity and psychological wellbeing in a sample of gay men. 

A combination of targeted sampling and snowball strategies were used to recruit 639 gay identifying men for a cross-sectional online survey. Participants completed a questionnaire assessing sexual orientation beliefs, sexual identity uncertainty, internalized homonegativity, and psychological wellbeing outcomes. Structural equation modeling was used to test whether essentialist beliefs were associated with psychological wellbeing indirectly via their effect on sexual identity uncertainty and internalized homonegativity. 

A unique pattern of direct and indirect effects was observed in which facets of essentialism predicted sexual identity uncertainty, internalized homonegativity and psychological wellbeing. Of note, viewing sexual orientation as immutable/biologically based and as existing in discrete categories, were associated with less sexual identity uncertainty. On the other hand, these beliefs had divergent relationships with internalized homonegativity, with immutability/biological beliefs associated with lower, and discreteness beliefs associated with greater internalized homonegativity. 

Of interest, although sexual identity uncertainty was associated with poorer psychological wellbeing via its contribution to internalized homophobia, there was no direct relationship between identity uncertainty and psychological wellbeing. 

Findings indicate that essentializing sexual orientation has mixed implications for sexual identity uncertainty and internalized homonegativity and wellbeing in gay men. Those undertaking educational and clinical interventions with gay men should be aware of the benefits and of caveats of essentialist theories of homosexuality for this population.

Via: http://goo.gl/5clQ94 Purchase full article at: http://goo.gl/j1atTV

By: Morandini JS1, Blaszczynski A1, Ross MW2, Costa DS1, Dar-Nimrod I1.

• 1School of Psychology, The University of Sydney.
• 2Department of Family Medicine and Community Health, The University of Minnesota Medical School.

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Examining the Relationships Between Religiosity, Spirituality, Internalized Homonegativity, and Condom Use among African American Men Who Have Sex with Men in the Deep South

The Sexual Health in Faith Traditions Study evaluated the relationships between religiosity, spirituality, internalized homonegativity, and sexual risk behaviors among a sample of African American men who have sex with men living in the Deep South. 

Participants were recruited primarily from Black Gay Pride celebrations to complete a self-administered, paper-and-pencil survey. Structural equation modeling was used to determine relationships between key constructs and condom use for insertive (n = 285) and receptive (n = 263) anal intercourse in the past 3 months. 

• Almost half of respondents reported using condoms "every time" when engaging in insertive (48.3%) or receptive (45.1%) anal intercourse. 
• Religiosity and spirituality were differentially associated with dimensions of internalized homonegativity. 
• While no significant direct relationships were reported between either religiosity or spirituality and condom use, dimensions of internalized homonegativity mediated significant indirect relationships. 

Findings suggest that religiosity and spirituality influence African American men who have sex with men's internalized homonegativity and, subsequently, engagement in safer sex behaviors.

Via: http://ht.ly/SOktt  Purchase full article at: http://goo.gl/kaJc13

By: Smallwood SW1, Spencer SM2, Ingram LA2, Thrasher JF2, Thompson-Robinson MV3.

• 1Georgia Southern University, Statesboro, GA, USA
• 2University of South Carolina, Columbia, SC, USA.
• 3University of Nevada-Las Vegas, Las Vegas, NV, USA.

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Homonegativity, Religiosity, and the Intersecting Identities of Young Black Men Who Have Sex with Men

Young, Black men who have sex with men (YBMSM) are disproportionately affected by HIV. Homonegativity, or the stigma associated with homosexuality, may be an important social factor influencing racial disparities in HIV. 

This research, conducted using an intersectional framework, examines experiences of homonegativity among YBMSM with a particular emphasis on the influence of the Black Church. We conducted 30 semi-structured interviews with YBMSM ages 16-24. Interview transcripts were analyzed in MAXQDA using thematic content analysis, guided by principles of grounded theory and constant comparative method. 

The Black Church is an integral aspect of YBMSM's identity, history, family, and community life. As such, the Church's construction of homosexuality dominated throughout YBMSM's lives. The expectations of masculinity facing YBMSM emphasize expectations of physical and sexual dominance, which are viewed as incompatible with homosexuality. Participants describe complex decision-making around whether to disclose their sexuality and to whom, and weigh the consequences of disclosure and non-disclosure. For many YBMSM, their multiple, intersecting identities significantly influenced their experiences with homonegativity and their decisions about disclosing their sexual orientation. 

Findings lend support for the need to develop community-, family-, and church-based stigma reduction interventions that address homonegativity among YBMSM.

Via: http://ht.ly/SxeJa  Purchase full article at: http://goo.gl/5PVlhp

By: Quinn K1, Dickson-Gomez J2.

• 1Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Center for AIDS Intervention Research, 2071 N. Summit, Milwaukee, WI, 53202, USA
• 2Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Center for AIDS Intervention Research, 2071 N. Summit, Milwaukee, WI, 53202, USA.
• 
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Relationships between Religion and Two Forms of Homonegativity in Europe—A Multilevel Analysis of Effects of Believing, Belonging and Religious Practice

Below:  The Variation of the Statistical Effect of Belief in a Personal God on Moralistic Homonegativity (‘Homosexuality is never justifiable’)

Below:  The Variation of the Statistical Effect of Belief in a Spirit/Life Force on Moralistic Homonegativity (‘Homosexuality is never justifiable’).

Below:  The Variation of the Statistical Effect of Attendance at Religious Services on Moralistic Homonegativity (‘Homosexuality is never justifiable’)

Below:  Two Indicators of Homonegativity in Cross-National Comparison.  Cross-Country-Percentages,

This paper examines relationships between religion and two forms of homonegativity across 43 European countries using a bivariate response binary logistic multilevel model. The model analyzes effects of religious believing, belonging and practice on two response variables: a) a moral rejection of homosexuality as a practice and b) intolerance toward homosexuals as a group. The findings indicate that both forms of homonegativity are prevalent in Europe. Traditional doctrinal religious believing (belief in a personal God) is positively related to a moral rejection of homosexuality but to a much lesser extent associated with intolerance toward homosexuals as a group. Members of religious denominations are more likely than non-members to reject homosexuality as morally wrong and to reject homosexuals as neighbors. The analysis found significant differences between denominations that are likely context-dependent. Attendance at religious services is positively related to homonegativity in a majority of countries. The findings vary considerably across countries: Religion is more strongly related to homonegativity in Western than in Eastern Europe. In the post-soviet countries homonegativity appears to be largely a secular phenomenon. National contexts of high religiosity, high perceived government corruption, high income inequality and shortcomings in the implementation of gay rights in the countries’ legislations are statistically related to higher levels of both moralistic homonegativity and intolerance toward homosexuals as a group.

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