The Second Closet: A Qualitative Study of HIV Stigma Among Seropositive Gay Men in a Southern U.S. City

ABSTRACT

Objectives: Stigma connected with HIV/AIDS has decreased considerably since the early epidemic yet affects those living with HIV in many ways. Little research, particularly qualitative research, concerning HIV stigma from the perspective of gay men has emerged. The present qualitative study aimed to fill this evidence gap by examining how HIV stigma is perceived and experienced by gay men who have become HIV-infected and how they respond to this stigma. Methods: Thematic analysis of 19 gay men's narratives identified six main themes. Results: Encountering HIV stigmatization was common and was linked to the physical stigmata identifying respondents as HIV-positive. Overwhelmingly, they found stigmatization to be most intensely felt within gay communities. One profound theme was internalized HIV stigma, referring to respondents’ internalized negative feelings about their HIV status. A related theme was the closeted nature of HIV. Lastly, regarding how the men dealt with the HIV diagnosis and experiences of HIV stigma, a theme of adaptation became clear. Conclusions: Although exploratory, the results can serve as a beginning framework for understanding and assisting seropositive gay men who experience HIV stigma. The findings are important because it is realistic to expect that in a climate in which HIV has become increasingly invisible and closeted and in which infections are on the rise, gay and bisexual men will be increasingly affected and infected by HIV.     

Attitudes toward lesbians, gay men, bisexual women, and bisexual men in Germany

Attitudes toward lesbians, gay men, bisexual women, and bisexual men were assessed in a national representative sample of 2,006 self-identified heterosexual women and men living in Germany. Replicating previous findings, younger people held more favorable attitudes than older people; women held more favorable attitudes than men; and men held more favorable attitudes toward female than male homosexuality, whereas women did not differentiate. However, women held more favorable attitudes toward homosexuals than toward bisexuals, whereas men did not differentiate. Knowing a homosexual person was an important predictor of attitudes, as was political party preference. Both same-sex and opposite-sex sexual attraction were substantially related with attitudes. Our findings support the notion that attitudes toward lesbians, gay men, bisexual women, and bisexual men are related but distinct constructs.     

Attitudes toward lesbians,gay men,bisexual women,and bisexual men in Germany

Attitudes toward lesbians, gay men, bisexual women, and bisexual men were assessed in a national representative sample of 2,006 self‐identified heterosexual women and men living in Germany. Replicating previous findings, younger people held more favorable attitudes than older people; women held more favorable attitudes than men; and men held more favorable attitudes toward female than male homosexuality, whereas women did not differentiate. However, women held more favorable attitudes toward homosexuals than toward bisexuals, whereas men did not differentiate. Knowing a homosexual person was an important predictor of attitudes, as was political party preference. Both same‐sex and opposite‐sex sexual attraction were substantially related with attitudes. Our findings support the notion that attitudes toward lesbians, gay men, bisexual women, and bisexual men are related but distinct constructs.     

Sexual Assault Risks Among Gay and Bisexual Men

The goal of this study was to examine lifetime patterns of sexual assault and associated risks among a purposive sample of gay and bisexual men (N = 183; 18 to 35 years old, M = 24.3). Cross-sectional data were collected via written, self-administered questionnaires and face-to-face, event-based qualitative interviews. Alcohol severity scores indicated high rates of hazardous drinking (53.0%) and possible dependence (14.2%) among participants. One-half of men (50.8%) reported childhood sexual abuse (CSA), and 67.2% reported adult sexual assault (ASA). Average age at most recent ASA was 21 years. Most perpetrators (83.9%) of recent ASA incidents were male; 67.0% of participants reported consuming alcohol and/or drugs prior to the most recent incident. Regression findings indicated more severe CSA experiences and past alcohol-related problems predicted recent severe ASA. Although we found similarities between gay and bisexual men in lifetime sexual assault history, we found some distinct differences in ASA risk factors. Bisexual men reported higher alcohol severity scores, more female ASA perpetrators, higher internalized homophobia scores, and fewer male sexual partners than gay men. Findings suggest the need for interventions that reduce ASA risk among sexual minority men—and the potential benefits of focusing on alcohol consumption in risk reduction efforts.     

Bisexual and homosexual behavior and HIV risk among Chinese‐, Filipino‐, and Korean‐American men

Seventy bisexually or homosexually active men primarily of Chinese‐, Filipino‐, and Korean‐American backgrounds participated in extensive interviews focusing on acculturation and sexuality. Impressionistic data showed higher involvement in gay culture than Asian culture, a shift away from the complexity of bisexual lifestyles, and two patterns of exogenous selection of male partners. The findings suggest that Asian‐American men who had sex with men were more likely than comparison groups to comply with safer sex; acculturation to Asian society enhanced this compliance, but identification with Western Protestantism, or traditional Latin homosexual roles, was related to higher risk behavior. The reported behavior of the men who had sex with both men and women did not substantiate fears that bisexuals were a conduit for transmitting the virus from the gay to the heterosexual community. Impressionistic data suggested that a combination of inaccurate information about HIV transmission, unfounded trust of partners, poor assertiveness skills, and guilt may result in sexual risk taking. Suggestions for prevention included providing explicit information in ethnic and mainstream media, emphasizing risks of heterosexual transmission, providing electronic interactive learning situations that allow privacy rather than face‐to‐face interaction, and organizing support groups that affirm the men's dual identity as Asian‐American and gay or bisexual.     

Minority Stress Theory: An Examination of Factors Surrounding Sexual Risk Behavior Among Gay and Bisexual Men Who Use Club Drugs

Background: Few studies have examined the impact of minority stress theory (MST) upon sexual risk behavior among gay and bisexual men using club drugs. Similar studies have focused on ethnic minorities and women; however, gay and bisexual men demonstrate greater likelihood for risk behaviors leading to HIV/AIDS. Objective: This study examines sexual risk behavior from the perspective of minority stress theory upon substance-using gay and bisexual men and their partners. Methods: Multivariable logistic regression analysis examined minority stress associations with participant sexual risk behaviors, drug use, and partner type, controlling for demographics. Results: 396 gay and 54 bisexual respondents, ages 18–67, reported at least one-time drug use while engaging in sexual risk behavior. In the adjusted model, expectations of rejection associated with lower odds of sexual risk behavior, while older age approached significance. Conclusions: Theoretical origins for examining risk behavior among gay and bisexual men may underscore risk and protective factors, while ultimately holding implications for prevention and treatment interventions.     

The influence of dual‐identity development on the psychosocial functioning of African‐American gay and bisexual men

To examine the influence of racial‐ethnic and sexual identity development on the psychosocial functioning of African‐American gay and bisexual men (AAGBM), 174 AAGBM completed questionnaire packets designed to assess their levels of racial‐ethnic and sexual identity development, self‐esteem, social support, male gender role stress, HIV prevention self‐efficacy, psychological distress, and life satisfaction. The results indicate that AAGBM who possess more positive (i.e., integrated) seif‐identification as being African American and gay reported higher levels of self‐esteem, HIV prevention self‐efficacy, stronger social support networks, greater levels of life satisfaction, and lower levels of male gender role and psychological distress than their counterparts who reported less positive (i.e., less well integrated) African‐American and gay identity development. Although higher levels of racial‐ethnic identity development were associated with greater levels of life satisfaction, sexual identity development was not.     

The comparison of attachment styles among Iranian lesbian,gay, and bisexual and heterosexual people

This study was conducted in order to compare the attachment styles of sexual minorities and their heterosexual counterparts. The study participants consisted of a non-probability sample of 62 lesbians and gay men (LG) and 13 bisexual men and women (mean age = 25.50, SD = 5.09) living in various cities in Iran. There were also 75 heterosexuals selected from the general population and matched with the study group based on age, sex, and educational level. Each person completed the Revised Adult Attachment Scale (RAAS) and a demographic data sheet. In addition, the groups of sexual minorities were also asked to address additional items related to their status as sexual minorities. The results showed that, compared to heterosexual participants, lesbian, gay, and bisexual (LGB) people scored significantly higher on the anxiety subscale of RAAS. Among sexual minorities, there was no significant difference between bisexual and LG people's attachment styles. Also, those who were not satisfied with their orientation were less dependent and more anxious. Different developmental experiences and negative social attitudes toward LGB people could explain the more anxious attachment style in the LGB group.     

Abstracts of the Scientific Programs of the American College Health Association Fifty-Eighth Annual Meeting April 9-12, 1980, San Diego,California

Abstract

Gay male university students less than 25 years old were studied to determine whether they had changed their sexual activity patterns to reduce the risk of HIV infection. Most had not established sexual behavior patterns typical of the older gay men who had been studied in earlier research. Although most of the participants surveyed were concerned about HIV infection, some did engage in risky sexual behavior. The riskreduction strategies most often used were having fewer sexual partners and being more selective in choosing partners. Future HIV-prevention interventions must be designed to address the needs of this generation of gay men.     

Anti-Effeminacy Moderates the Relationship Between Masculinity and Internalized Heterosexism Among Gay Men

Internalized heterosexism (IH) is linked to negative mental health outcomes among people who are lesbian, gay, and bisexual. This study examined whether anti-effeminacy moderates the relationship between masculinity and IH among gay men in the United States. The participants were 239 gay men who completed measures of masculinity, anti-effeminacy, and IH. Results indicated that anti-effeminacy and masculinity predicted IH and that anti-effeminacy moderated the relationship between masculinity and IH. These findings suggest that, to reduce IH and its deleterious mental health effects, counselors should work with their male clients who are gay to reduce their anti-effeminacy and sexism.     

Gay, Straight, or Somewhere in Between: Accuracy and Bias in the Perception of Bisexual Faces

Sexual orientation can be accurately identified from photos of faces, but previous work has focused exclusively on straight versus gay and lesbian individuals. Across three studies, the current work investigated the facial perception of bisexual men and women, a less socially salient category. Although participants could identify straight and gay men at above-chance levels in a trichotomous categorization task, bisexual men were categorized only at chance (Study 1). Participants perceived bisexual men to be significantly different from straight men, but not gay men (Study 2). Similarly, whereas bisexual and lesbian women were not rated differently, both groups were distinguishable from straight female targets (Study 3). These findings suggest a straight-non straight dichotomy in the categorization of sexual orientation.     

Sexual behavior patterns of gay university men: implications for preventing HIV infection.

Gay male university students less than 25 years old were studied to determine whether they had changed their sexual activity patterns to reduce the risk of HIV infection. Most had not established sexual behavior patterns typical of the older gay men who had been studied in earlier research. Although most of the participants surveyed were concerned about HIV infection, some did engage in risky sexual behavior. The risk-reduction strategies most often used were having fewer sexual partners and being more selective in choosing partners. Future HIV-prevention interventions must be designed to address the needs of this generation of gay men.     

Gay Men

Summary

This report presents the findings from four ethnographic studies of older gay men (Brown, 1997; Brown, Sarosy, Cook & Quarto, 1997; Cook, 1991; Quarto, 1996; Sarosy, 1996). There were 69 total participants who ranged in age from 36 to 79 years; most were from 50 to 65 years of age. The purpose of these studies was to examine how older gay men have adjusted, psychologically and socially, to their sexual orientation and aging process. Participants reported that they spend 50% time or more with gay friends within their own age cohorts. Many reported being involved with the gay community in some capacity, while about 15% had no involvement with the gay community. Most participants were in regular contact with their families. Most stated that their families were aware of their sexual orientation. Most of the participants reported experiencing discrimination due to sexual orientation, and one third had experienced discrimination within the gay community based on age or ethnicity. With regard to sex life, the studies found an overall lowered frequency of sexual activity. Participants felt that HIV/AIDS has had a devastating impact on older gay men, interrupting the normal aging process for those who have contracted it and prematurely aging those who care for them. The studies' findings identified the qualities of healthy adaptation to aging for older gay males: having satisfying relationship, self-acceptance as one ages, good health, an active life with a variety of interests, and financial security.     

Aging with HIV: Historical and Intra-Community Differences in Experience of Aging with HIV

Gay men living with HIV/AIDS face a complex of health issues, including those associated with the aging process, long-term HIV infection (25 years or more), and side effects from Highly Active Anti-Retroviral Therapy (HAART). If aging can increase marginalization, this is more likely for the aging HIV positive gay man, who is already marginalized for being queer and living with a stigmatizing disease. This article presents findings from a study of a long-running HIV support group. It locates the members, all gay men living with HIV, in a specific historical and political context to explore how feelings of loss and the struggle to sustain community affect long-term survivors and other older HIV+ gay men. We identify specific challenges presented by aging for men who contracted HIV early in the epidemic, contrasting them with those faced by men infected with the virus later in life. While both groups appear to struggle with a vision of what life could have been, had AIDS not forced loss and change, they also celebrate the community their shared plight has enabled.     

Changing Directions in HIV Prevention: The Move Toward a Psychosocial Model

ABSTRACT

Although some HIV prevention programs have been successful in helping gay and bisexual men change their sexual behaviors, rates of HIV infection continue to increase. In an attempt to address this problem, social workers need to move beyond traditional HIV prevention approaches to a psychosocial model of HIV prevention. Based on the work of previous researchers, this approach assumes that a combination of individual, psychological, and social factors contribute to risky sex in gay and bisexual men. Because social workers are trained to view problems from a psychosocial framework, they are already in a position to develop programs incorporating the psychosocial model. This article examines the psychosocial model of HIV prevention and the various psychosocial factors that may contribute to high-risk sexual behavior and concludes with examples of prevention research that have already incorporated the model.     

Influence of Social Support on Gay Men Living with HIV

This article examines the social support networks of gay men living with HIV. Many people do not realize that HIV is still a significant health concern. The rate of HIV infection has not decreased substantially in over 15 years, and in the United States alone health care practitioners see approximately 40,000 cases per year. Some of the literature on this topic suggests that gay men with HIV receive more social support from friends than from family members. Research also suggests that these men sometimes experience losses of social support after they are diagnosed as HIV positive. Five gay men with HIV participated in in-depth interviews for this study. During these interviews 14 open-ended questions were posed with several of these questions having follow-up probes/questions. The questions focused on specific aspects of the participant's support network. Participants' responses to the interview questions were transcribed and content analyzed for relevant themes. Results indicated that whereas many of the men maintained their supportive contacts with family members and friends, others experienced changes in their support networks after they were diagnosed as HIV positive. Further results revealed that all men interviewed were satisfied with the level of support they received from the people in their support networks.     

The influence of dual-identity development on the psychosocial functioning of African-American gay and bisexual men

To examine the influence of racial-ethnic and sexual identity development on the psychosocial functioning of African-American gay and bisexual men (AAGBM), 174 AAGBM completed questionnaire packets designed to assess their levels of racial-ethnic and sexual identity development, self-esteem, social support, male gender role stress, HIV prevention self-efficacy, psychological distress, and life satisfaction. The results indicate that AAGBM who possess more positive (i.e., integrated) self-identification as being African American and gay reported higher levels of self-esteem, HIV prevention self-efficacy, stronger social support networks, greater levels of life satisfaction, and lower levels of male gender role and psychological distress than their counterparts who reported less positive (i.e., less well integrated) African American and gay identity development. Although higher levels of racial-ethnic identity development were associated with greater levels of life satisfaction, sexual identity development was not.     

Hidden dangers among circuit parties—A systematic review of HIV prevalence,sexual behaviors and drug abuse during the biggest gay events

ABSTRACT

Circuit parties (CP) are extended celebrations, lasting from a day to a week, primarily attended by gay and bisexual men in their thirties and forties. The increasing popularity of circuit parties may play a significant role in the epidemiology of HIV and other sexually transmitted diseases. We performed a systematic literature search in MEDLINE, without any temporal limit, using the term “circuit party”. Only articles reporting cross-sectional studies were analyzed. Ten articles, published in the period from 2001 to 2015 were included in our systematic review and reported data on samples ranging from 173 to 13,883 gay/bisexual men. The HIV prevalence among men who attended the CPs was very high, ranging from 6% to 40.8%. Sexual risk behaviors (e.g. unsafe sex or multiple partners) and drug use were particularly frequent. It wo'uld be useful to promote efficient strategies with the cooperation of party planners, catching the participants before nightlife activities in order to prevent HIV transmission and the use of recreational drugs.