Methods Used and Topics Addressed in Quantitative Health Research on Gay,Bisexual and Other Men Who Have Sex With Men: A Systematic Review of the Literature

Research on sexual minority men (gay, bisexual, and other men who have sex with men) was examined with regard to the measures of sexual orientation used, the methods of research, and the main health outcomes under study. A systematic review of English-language quantitative studies was conducted focused on the health of sexual minority men published in 2010 (n = 250). The results provide a snapshot of the literature and revealed that research on sexual minority men overwhelmingly focused on HIV, STIs, and sexual health for which sexual orientation was most commonly defined behaviorally. For topics of mental health or body/fitness outcomes, sexual orientation was most commonly defined by identity. Most study samples were venue-based, and only 8.8% of published papers drew data from population-based samples. The findings suggest that there exists a need for research on sexual minority men’s health beyond STIs and HIV that will examine mental and physical health outcomes beyond sexual risk, uses probability-based samples, and addresses intersectional concerns related to race/ethnicity and age.     

Sexual Orientation Stigmatization and Identity Work for Gays,Lesbians, and Bisexuals in the U.S. Military

ABSTRACT

This study examines communicative stigmatization processes and their influence on self-concept clarity for gays, lesbians, and bisexuals (GLB) in the United States military. In-depth interviews were conducted with GLB (N = 16) military service members and veterans, and data were analyzed using grounded theory analysis. Findings revealed that GLB identity repudiation incites feelings of identity incongruity for gays, lesbians, and bisexuals in the U.S. military. GLB identity repudiation was composed of three key communicative practices. Further, because non-heterosexuality was viewed as seemingly incompatible with the military identity, many participants struggled to integrate their two social identities effectively. As such, participants employed several strategies to manage their conflicting sexual and role identities.     

Quantifying Sexual Orientation Among Homeless and Unstably Housed Women in a Longitudinal Study: Identity,Behavior, and Fluctuations Over a Three-Year Period

ABSTRACT

Sexual orientation has been linked to certain health conditions, and yet quantifying sexual orientation in longitudinal studies is challenging. This study examined different methods of accounting for sexual orientation in a cohort study of 300 homeless and unstably housed women followed every 6 months over 3 years. Altogether, 39.7% (n = 119) could be considered sexual minority at one or more time points based on identity and/or behavior; 16.3% (n = 49) reported shifts in sexual identity. Only 24.0% (n = 72) were identified as sexual minority through a single measure of sexual identity, 27.0% (n = 81) were identified with a single measure of identity and behavior, 33.0% (n = 99) were identified through annual measures of identity and behavior, and 22.0%–22.3% (n = 66–67) were identified through latent class analysis including all identity/behavior measures. This study found that sexual fluidity is common in unstably housed women, and many sexual minority women would be missed in longitudinal studies with different methods of accounting for sexual orientation.     

“You Have to Keep Yourself Hidden”: Perspectives From Malaysian Malay-Muslim Men Who Have Sex With Men on Policy,Network, Community,and Individual Influences on HIV Risk

ABSTRACT

Malay-Muslim men who have sex with men (MSM) are marginalized and hidden in Malaysia, a predominantly Muslim country in southeast Asia. We explored the policy, network, community, and individual factors related to HIV infection among Malay-Muslim MSM through 26 in-depth interviews and one focus group discussion (n = 5) conducted in Kuala Lumpur and Kota Bharu between October 2013 and January 2014. As religion plays an important role in their lives, participants viewed homosexuality as a sin. Low risk perception and misconceptions about HIV/AIDS were common, and most participants expressed reluctance to consult a doctor unless they had symptoms. Additionally, buying condoms was embarrassing and anxiety-producing. Fear of discrimination by health care providers and community hindered participants from disclosing sexual behaviors and accessing health services. Homophobic comments and policies by the government and religious leaders were concerns of participants. A safe and enabling environment is needed to reduce HIV risks among Malay-Muslim MSM.     

“Hedge Your Bets”: Technology’s Role in Young Gay Men’s Relationship Challenges

Technology is playing an increasingly pervasive role among young gay men in the process of meeting potential romantic or sexual partners. We investigated challenges posed by technology related to young gay men’s relationships. Focus groups (n = 9) of young gay men aged 18–24 (n = 43) were transcribed verbatim, and thematic analysis was used to identify two major themes regarding challenges to relationship development and maintenance. Subthemes include unrealistic expectations of relationships, inauthentic self-presentation online, sexual primacy over romance, increased opportunities for infidelity, and jealousy. The implications of this study for sexual education and sexual health promotion are discussed.     

The Interaction of Same-Sex Marriage Access With Sexual Minority Identity on Mental Health and Subjective Wellbeing

Previous psychological and public health research has highlighted the impact of legal recognition of same-sex relationships on individual identity and mental health. Using a sample of U.S. sexual minority (N = 313) and heterosexual (N = 214) adults, participants completed a battery of mental health inventories prior to the nationwide legalization of same-sex marriage. Analyses of covariance (ANCOVAs) examining identity revealed sexual minority participants living in states where same-sex marriage was banned experienced significantly higher levels of internalized homonegativity than sexual minority participants living in states where same-sex marriage was legal, even after controlling for state-level political climate. Mental health ANCOVAs revealed sexual minority participants residing in states without same-sex marriage experienced greater anxiety and lower subjective wellbeing compared to sexual minority participants residing in states with same-sex marriage and heterosexual participants residing in states with or without same-sex marriage. Implications for public policy and future research directions are discussed.     

Mental Health Concerns of Gay and Bisexual Men Seeking Mental Health Services

ABSTRACT

Little data exist about the mental health needs of gay and bisexual men. This is due to limitations of existing studies such as small and nonrepresentative samples, failure to assess sexual orientation, and concerns about stigmatization, possibly causing sexual minority individuals to be reluctant to disclose their sexual orientation to researchers. Fenway Community Health is a large urban health center that serves the LGBT community. The large number of gay and bisexual men who present for mental health treatment allows for a unique opportunity to gain insight into mental health, prevention, and intervention needs for this group. The current study is a review of the mental health information from all of the gay and bisexual men who reported that they were HIV-negative during their mental health intake over a six-month period at Fenway Community Health (January to June 2000; N = 92). The most frequent presenting problems were depression, anxiety, and relationship issues. Additionally, presenting problems included current or past abuse, substance abuse, finance and employment, recent loss, and family issues. The most frequent diagnoses were depression, anxiety disorders, and adjustment disorders. These findings support the notion that presenting problems and mental health concerns among gay and bisexual men are similar to those frequently reported by individuals in other mental health facilities, however, specific psychosocial stressors are unique to this population.     

Social Responsibility,Substance Use,and Sexual Risk Behavior in Men Who Have Sex With Men

Considerable public health literature focuses on relationships between problematic human characteristics (e.g., psychopathology) and unhealthy behaviors. A recent movement termed positive psychology emphasizes the advantages of assessing relationships between human strengths (e.g., altruism) and beneficial health behaviors. The present study assessed social responsibility, an orientation to help or protect others even when there is nothing to be gained as an individual, and its relationship to HIV-relevant behaviors. In our sample of 350 men who have sex with men (MSM), social responsibility was negatively correlated with substance use and HIV risk behaviors. Men who had been tested for HIV and knew their HIV status—a behavior that helps men protect their partners but does not protect themselves from the virus—also scored higher in social responsibility. Interventions designed to reduce HIV risk behavior in MSM may benefit from efforts to promote human strengths.     

Difference in Condom Use Between Bear Concordant and Discordant Dyads During the Last Anal Sex Event

The purpose of this study was to understand how bear identity influenced condom use during the last anal sex event. Participants were recruited to complete an online, anonymous self-report survey through bear-related sexual and social networking websites. A total of 1,080 men who identified as gay or bisexual and as a member of the bear community and were 18 years or older completed the survey. Overall, fewer than a third of men reported condom use during the most recent receptive (28%) and insertive (30%) anal sex event. Men in bear concordant pairings were less likely to use a condom during receptive and insertive anal sex compared to those is discordant pairings (p < .05). Findings suggest that bear identity concordance influences condom use during anal sex after accounting for an individual’s relationship to their most recent partner as well as other confounding variables.     

Disclosing Lesbian and Gay Male Sexual Orientation in Later Life: Attitudes of Younger and Older Generations in Eight Latin American Countries

ABSTRACT

The purpose of this research was to explore attitudes toward older lesbians and gay men disclosing their sexual preferences in eight Latin American countries. The sample consisted of 1,539 participants belonging to three age groups (18–29 years, 60–69 years, and 70 years and over). Their answers to two open-ended questions were content-analyzed, and binary logistic regressions were run on the extreme attitudinal categories. Results showed that although most attitudes were positive, a solid percentage of participants still expressed different kinds of derogatory attitudes. Men (as compared to women) and participants who were more religious and less educated tended to hold more negative attitudes toward lesbians and gay men. Both older samples were more prejudiced than the younger one, and attitudes also varied according to country. There was a general trend showing more positive attitudes toward older lesbians and gay men in those countries where sexual minorities’ rights are better assured, which suggests that measures to protect sexual minorities and to make sexual diversity in older age visible could be advisable.     

Sexual Orientation as a Peripheral Cue in Advertising: Effects of Models’ Sexual Orientation,Argument Strength,and Involvement on Responses to Magazine Ads

This study examines how sexual orientation of couples featured in magazine advertisements affects heterosexual viewers’ responses using the elaboration likelihood model as a framework. A 3 × 2 × 2 × 3 experiment tested effects of sexual orientation, argument strength, involvement, and attitudes toward homosexuality on heterosexuals’ attitudes toward the couple, advertisement, brand, and product, purchase intentions, and recall. Results indicate that consumers were accepting of ads with lesbian portrayals. Participants showed more negative attitudes toward gay male portrayals, but attitudes toward heterosexual and lesbian ads were similar. This effect was moderated by participants’ attitudes toward homosexuals. Low-involvement consumers showed more negative attitudes toward homosexual portrayals than toward heterosexual portrayals, indicating that sexual orientation may have served as a peripheral cue negatively impacting attitudes toward the couple and ad under low elaboration. These effects were not observed for attitudes toward the brand and product, purchase intentions, or recall.     

When “They” Become “Us”: The Effect of Time and Ingroup Identity on Perceptions of Gay and Lesbian Group Members

ABSTRACT

Prejudice change manipulations rarely produce the expected attitude change effects. Our research suggests that attitude change depends on time-dependent memory consolidation processes. This study tested the effects of group information and time on perceptions of gays and lesbians. Heterosexual participants (N = 90) were randomly assigned to a condition where their ingroup, or an outgroup, included gay and lesbian individuals. We measured participants’ gay and lesbian political attitudes and evaluations of the groups’ members at a short or long delay. Results showed no effect of our manipulations on political attitudes, F(1, 86) = 0.14, p = .72. Contrary to predictions, participants evaluated gay and lesbian ingroup members less positively at the long versus short delay, t(49) = 3.72, p = .0004, d = 1.01. Results suggest that members of stigmatized groups are perceived more negatively when associated with one’s ingroup.     

Risk Behaviors Among Young Men Who Have Sex With Men in Bangkok: A Qualitative Study to Understand and Contextualize High HIV Incidence

ABSTRACT

The Bangkok Men Who Have Sex With Men (MSM) Cohort Study has shown high HIV incidence (8–12/100 person-years) among 18–21-year-old MSM. These data led to a further study using qualitative methods among young (18–24 years old) MSM in order to understand the factors driving the HIV epidemic among YMSM. We conducted eight focus group discussions and 10 key informant interviews among YMSM in Bangkok, Thailand. Sociodemographic and behavioral data were collected using a questionnaire. We audio-recorded, transcribed, and analyzed qualitative and questionnaire data using computer software. The categories relating to risk behavior were (1) the use of social networks for seeking sexual partners and the marketing promotions of MSM entertainment venues, (2) social influence by peers and older MSM, (3) easy access to high parties and group sex, (4) easy access to club drugs, (5) conceptions related to HIV risk, and (6) sexual preferences of YMSM. Increased HIV testing, same-sex education, and YMSM-specific HIV prevention efforts are urgently needed for YMSM in Bangkok.     

When Heterosexuality is Questioned: Stifling Suspicion Through Public Displays of Heterosexual Identity

This study examined public heterosexual identity management practices of heterosexual-identified young adults in the United States. Analysis of 415 participants’ written narratives indicated that 41% (n = 169) described consciously engaging in public displays of their heterosexual status in relation to suspicion about their sexual orientation. This article describes our findings regarding five aspects of these narratives of suspicion: types of suspicion, causes of suspicion, reasons for concern about suspicion, the types of public displays of heterosexual status employed to quell suspicion, and intended audiences for these displays. Overall, the results indicated that heterosexual identity suspicion is multifaceted, this suspicion serves as a catalyst for public displays of heterosexual status, and the climate of suspicion described by our participants reflects and reinforces contemporary heterosexism.     

Is the Lack of Specific Lesbian,Gay, Bisexual,Transgender and Queer/Questioning (LGBTQ) Health Care Education in Medical School a Cause for Concern? Evidence From a Survey of Knowledge and Practice Among UK Medical Students

Lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ) people frequently report negative health care encounters. Medical professionals may inadequately manage LGBTQ persons’ health if they have not received training in this area. An anonymous survey measuring efficacy in health situations among LGBTQ persons was answered by 166 medical students across all years of a UK university. Results show that 84.9% of participants reported a lack of LGBTQ health care education, with deficits in confidence clarifying unfamiliar sexual and gender terms, deciding the ward in which to nurse transgender patients, finding support resources, and discussing domestic abuse with LGBTQ patients. Most participants reported that they would not clarify gender pronouns or ask about gender or sexual identity in mental health or reproductive health settings. Participants reported infrequently observing doctors making similar inquiries. Participants held positive attitudes toward LGBTQ patients, with attitude scores positively correlating with LGBTQ terminology knowledge scores (r_s = 0.5052, p < .01). Addressing gender identity and sexuality issues within medical curricula may remove barriers to accessing health care and improve encounters for LGBTQ patients.     

Use of a Telephone Screener to Identify a Probability Sample of Gays,Lesbians, and Bisexuals

Abstract

Objectives. To examine public response to a telephone screener used to identify a probability sample of lesbians, gays, and bisexuals.

Methods.A telephone screener was designed to provide a representative sample of self-identified lesbians, gays, and bisexuals (LGB) in the 30 central cities of the 15 largest Consolidated Metropolitan Areas.

Results. Of 14,458 households contacted, 11,612 completed at least part of the survey. Of these, only 2.6% refused or responded “don't know” to the sexual orientation screener question. Respondents from the northeast were more reluctant to answer than respondents from the west.

Conclusions. The use of a screener on a national telephone survey to screen households for self-identified lesbian, gay, and bisexual adults was a successful way to generate a representative sample.     

Is Gaydar Affected by Attitudes Toward Homosexuality? Confidence,Labeling Bias,and Accuracy

Previous research has largely ignored the relationship between sexual orientation judgement accuracy, confidence, and attitudes toward homosexuality. In an online study, participants (N = 269) judged the sexual orientation of homosexual and heterosexual targets presented via a series of facial photographs. Participants also indicated their confidence in each judgment and completed the Modern Homonegativity Scale (Morrison & Morrison, 2002). We found that (1) homosexual men and heterosexual women were more accurate when judging photographs of women as opposed to photographs of men, and (2) in heterosexual men, negative attitudes toward homosexual men predicted confidence and bias when rating men’s photographs. Findings indicate that homosexual men and heterosexual women are similar in terms of accuracy in judging women’s sexuality. Further, especially in men, homophobia is associated with cognitive biases in labeling other men but does not have a relationship with increased accuracy.     

Is It Facebook Official? Coming Out and Passing Strategies of Young Adult Gay Men on Social Media

The rapid proliferation of social media, mobile applications, and Internet technologies has shifted a wide variety of social interaction from physical spaces to an online environment. Drawing from 42 semistructured, in-depth interviews with gay college-aged men between the ages of 18 and 27, this article explores these changing patterns of social interaction among gay men. I discuss three strategies of identity management college-aged gay men use to disclose or conceal their sexual identity to others. The first group of men, “Out and Proud,” uses Facebook as a way to celebrate and reaffirm their sexual identity, in addition to actively coming out to others on the social media Web site. The second group, “Out and Discreet,” uses Facebook to indirectly come out to some of their friends while hiding this information from others. The men in the last group I identify, “Facebook Closeted,” actively manage their online profiles to ensure their sexual identity is not exposed. Facebook is both transformative and risky for college-aged gay men, as it represents a new platform for them to come out as gay to friends and family, as well as other areas of their lives where they must actively manage the presentation of their sexual identity.     

Parents' supportive reactions to sexual orientation disclosure associated with better health: results from a population-based survey of LGB adults in Massachusetts

This study investigated associations between coming out to parents, experiences of parental support, and self-reported health behaviors and conditions among a population-based sample of LGB individuals using data collected via the 2002 Massachusetts Behavioral Risk Factor Surveillance System (BRFSS; N = 177). We explored the following two hypotheses: 1) Lesbian, gay, and bisexual (LGB) individuals who had never disclosed their sexual orientation to a parent would report higher levels of risk behaviors and poorer health conditions than those who had come out; and 2) among LGB respondents who had come out to their parents, the individuals whose parents had reacted unsupportively would report higher levels of risk behaviors and poorer health conditions than those who had come out to parents who were supportive. Approximately two thirds of gay and bisexual (GB) males and lesbian and bisexual (LB) females reported receiving adequate social and emotional support from the parent to whom they first disclosed their sexual orientation. Among LB females, no disclosure of sexual orientation to a parent was associated with significantly elevated levels of past-month illicit drug use (AOR 12.16, 95% CI 2.87-51.54), fair or poor self-reported health status (AOR 5.71, 95% CI 1.45-22.51), and >15 days of depression in the past month (AOR 5.95, 95% CI 1.78-19.90), controlling for potential confounders. However, nondisclosure to a parent by GB males was not associated with greater odds of any of the health indicators assessed. Among GB males, those with unsupportive parents were significantly more likely to report current binge drinking (AOR 6.94, 95% CI 1.70-28.35) and >15 days depression in the past month (AOR 6.08, 95% CI 1.15-32.15), and among LB females, those with unsupportive parents were significantly more likely to report lifetime illicit drug use (AOR 11.43, 95% CI 2.50-52.30), and >15 days depression in the past month (AOR 5.51, 95% CI 1.36-22.36). We conclude that coming out may be associated with better health for LB women, and that parents who react nonsupportively when their children disclose LGB sexual orientation may contribute to children's increased odds of depression and hazardous substance use.