Seroadaptive Strategies of Vancouver Gay and Bisexual Men in a Treatment as Prevention Environment

British Columbia’s treatment as prevention policy has provided free access to highly active antiretroviral therapy (HAART) to all HIV-positive provincial residents since 1996. One outcome is an increase in HIV-positive gay and bisexual men (GBM) with suppressed viral loads. Previous cross-sectional analyses indicated that some Vancouver GBM now recognize condomless anal sex with men on HAART who report a suppressed viral load as a seroadaptive strategy. To test the hypothesis that this new strategy, termed viral load sorting (VLS), is recognized and used among by GBM in the Momentum Health Study, we analyzed longitudinal data for HIV-negative/unknown (n = 556) and HIV-positive (n = 218) serostatus participants. Analyses indicated that both groups reported VLS, and that serostatus and Treatment Optimism Scale scores were significant determinants in frequency and use. Results exemplify the medicalization of sex and Rogers’ Diffusion Of Preventative Innovations Model, and they have important implications for HIV research and GBM sexual decision-making.     

Gradients in Depressive Symptoms by Socioeconomic Position Among Men Who Have Sex With Men in the EXPLORE Study

ABSTRACT

This study examines gradients in depressive symptoms by socioeconomic position (SEP; i.e., income, education, employment) in a sample of men who have sex with men (MSM). Data were used from EXPLORE, a randomized, controlled behavioral HIV prevention trial for HIV-uninfected MSM in six U.S. cities (n = 4,277). Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression scale (short form). Multiple linear regressions were fitted with interaction terms to assess additive and multiplicative relationships between SEP and depressive symptoms. Depressive symptoms were more prevalent among MSM with lower income, lower educational attainment, and those in the unemployed/other employment category. Income, education, and employment made significant contributions in additive models after adjustment. The employment-income interaction was statistically significant, indicating a multiplicative effect. This study revealed gradients in depressive symptoms across SEP of MSM, pointing to income and employment status and, to a lesser extent, education as key factors for understanding heterogeneity of depressive symptoms.     

Predictors of Sports Motivation Among Gay and Bisexual Men

ABSTRACT

Athletic activities are associated with reduced levels of stress and negative mood states among heterosexuals; thus, examining this association among gay/bisexual men is warranted. The current study examined the relationship between sports motivation and mood states, self-esteem, body esteem, life satisfaction, perceptions of masculinity/femininity, and parental encouragement for athletic endeavors among 195 gay/bisexual men. The results were mixed, but suggest that sports participation among gay/bisexual men may relate to a desire to express their masculinity and maintain a positive body image. Gay/bisexual men may be more likely to participate in sports if they receive positive reinforcement from others.     

Predictors of sports motivation among gay and bisexual men

Athletic activities are associated with reduced levels of stress and negative mood states among heterosexuals; thus, examining this association among gay/bisexual men is warranted. The current study examined the relationship between sports motivation and mood states, self-esteem, body esteem, life satisfaction, perceptions of masculinity/femininity, and parental encouragement for athletic endeavors among 195 gay/bisexual men. The results were mixed, but suggest that sports participation among gay/bisexual men may relate to a desire to express their masculinity and maintain a positive body image. Gay/bisexual men may be more likely to participate in sports if they receive positive reinforcement from others.     

Cancer Screening Utilization Among U.S. Women: How Mammogram and Pap Test Use Varies Among Heterosexual,Lesbian, and Bisexual Women

Existing research on cancer screening utilization among sexual minority women in the U.S. has mostly relied on non-random samples that combine lesbian and bisexual women into a single group. We respond to these limitations by examining the relationship between sexual orientation and cancer screening among a sample of U.S. women from the Behavioral Risk Factor Surveillance System (BRFSS). Our analytic sample includes 2273 lesbian, 1689 bisexual, and 174,839 heterosexual women interviewed in 15 U.S. states between 2000 and 2010. We examine two cancer screening measures: timely mammogram and pap tests, defined as having had a mammogram in the past 2 years for women aged 40 and older, and having had a pap test in the past 3 years for women aged 21–65. For mammogram, results showed that rates of timely use did not significantly differ by sexual orientation. However, lesbian and bisexual women report significantly lower rates of timely pap testing than heterosexual women. Logistic regression results on timely pap testing showed that lower pap test use for bisexual women is primarily driven by their poorer socioeconomic status relative to heterosexual women, while the significantly lower odds of timely pap testing for lesbian women were unaffected by control measures. Better understanding of cancer screening utilization disparities among lesbian and bisexual women is necessary to address morbidity and mortality disparities by sexual orientation.     

Several Common Bonds: Addressing the Needs of Gay and Bisexual Men in LGBT-Specific Recovery Housing

ABSTRACT

Recovery housing is a promising way to augment the substance use continuum of care, but we know little about the experiences of members of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community who live in them or about residences specifically for them. Within the LGBTQ community, gay, bisexual, and other men who have sex with men (MSM) often experience co-occurring syndemic conditions (e.g., trauma, depression, HIV) that present unique recovery challenges. Using qualitative data gathered from residents living in a recovery residence specifically for gay and bisexual men and from community key informants, we examine the experiences of men living in the home and factors that facilitate operating it. Findings highlight the need for residences that can address syndemic burden among gay and bisexual men in recovery and identify programmatic and community-level factors critical to operating residences for this population.     

High Rates of Access to Health Care,Disclosure of Sexuality and Gender Identity to Providers Among House and Ball Community Members in New York City

The House and Ball community is an important cultural manifestation of resiliency for Black and Latino gay and bisexual men and transgender women. Participants at the August 2013 House of Latex Ball in New York City were surveyed about insurance coverage, health care access, experiences in health care, and housing instability. The sample (n = 367) was 58% Black/African American and 20% Hispanic/Latino, with a mean age of 31. Fifty-five percent were gay and bisexual men. Although only 6% identified as transgender, nearly one half were gender nonconforming. Strong majorities had health insurance, were in regular medical care, and were “out” to their providers. Some were unstably housed and had recently exchanged sex for shelter or money. High rates of health care access and disclosure indicate resiliency and agency. Unstable housing and income insecurity may be structural drivers of vulnerability for this population to HIV infection and other health risks.     

Religiosity as a Protective Factor against Heavy Episodic Drinking (HED) in Heterosexual,Bisexual, Gay,and Lesbian Young Adults

Although religiosity has been shown to be associated with positive outcomes in studies of general population samples, few studies have considered the potential differential effect of religiosity on those who are consolidating gay, lesbian, or bisexual (GLB) identities. Logistic regression analyses using a sample of 13,038 emerging adults from the National Longitudinal Survey of Adolescent Health (Add Health) revealed main effects for religiosity and a significant religiosity × sexual identity interaction in women. Specifically, religiosity was protective against alcohol use and heavy episodic drinking (HED) in heterosexual women, but not lesbian women. In bisexual women, higher religiosity increased the odds of alcohol use and HED. Among men, religiosity was protective, with no differential effects based on sexual identity. Prevention efforts should consider that individual religiosity may be a risk, rather than protective factor for some young adults.     

The Relationship Between Body Image and Sexual Functioning Among Gay and Bisexual Men

ABSTRACT

Gay and bisexual men report high body dissatisfaction compared to heterosexual counterparts, but no studies to date have examined how this may impact their sexual functioning. The present study investigated body image domains as predictors of sexual functioning problems (inhibited desire, erectile dysfunction, and premature ejaculation) among an online community sample of 185 gay and bisexual men, ages 18–40. Participants reported moderate to high body image satisfaction and sexual functioning consistent with previous literature with nonclinical male samples. Overall, the total variance accounted for by regression models was low. Body image variables were not predictive of sexual desire. However, increased drive for muscularity and lower affective body esteem were predictive of erectile difficulties. Additionally, negative behavioral body image in sexual situations and evaluative body dissatisfaction were associated with premature ejaculation. Understanding this relationship may have implications for gay and bisexual men’s health and wellbeing. Future research directions are discussed.     

Internalized Homophobia,Coping, and Quality of Life Among Nigerian Gay and Bisexual Men

ABSTRACT

Despite high levels of homophobia in Nigeria, no studies have investigated the quality of life (QOL) of Nigerian gay and bisexual (GB) men. The associations between QOL and minority stress may differ from those reported in developed countries and may indicate alternative interventions. This study investigated internalized homophobia (IH) and coping strategies among gay and bisexual men in Nigeria and the relationships with overall QOL. Eighty-nine GB men were recruited with a snowball sampling technique. QOL (outcome), IH (predictor) and coping strategies (covariates) were assessed using standardized questionnaires. Relationships were investigated using linear regression analyses. Participants used adaptive more frequently than maladaptive coping strategies. The relationship between IH and QOL was nonlinear (β = ?0.27, 95% CI = ?0.48, ?0.06), and the positive component was attenuated by adaptive coping strategies. Adaptive strategies can be reinforced as a therapeutic intervention to improve wellbeing among gay and bisexual men in Nigeria.     

The Interrelations Between Internalized Homophobia,Depressive Symptoms,and Suicidal Ideation Among Australian Gay Men,Lesbians, and Bisexual Women

ABSTRACT

Internalized homophobia has been linked to depression among gay men, lesbians, and bisexuals. Relatively little research has investigated the link between internalized homophobia and suicidal thoughts and behaviors. The current research investigated the interrelations among internalized homophobia, depressive symptoms, and suicidal ideation by testing additive, mediation, and moderation models. Self-identified Australian gay men (n = 360), lesbians (n = 444), and bisexual women (n = 114) completed the Internalized Homophobia Scale, the Center for Epidemiological Studies Depression Scale, and the suicide subscale of the General Health Questionnaire. Results supported the additive and partial mediation models for gay men and the mediation and moderation models for lesbians. None of the models were supported for bisexual women. The findings imply that clinicians should focus on reducing internalized homophobia and depressive symptoms among gay men and lesbians, and depressive symptoms among bisexual women, to reduce suicidal ideation.     

Gender Role Identity in a Sample of Italian Male Homosexuals

ABSTRACT

Researchers have often considered the impact that online dating has had on gay communities; with some arguing that changes in social behavior may impact the spread of HIV. However, these conclusions are based on the premise that the Internet has fundamentally changed the way gay and bisexual men connect with their communities. Addressing this issue, we searched the PubMed and Web of Science databases for studies examining Internet use and interpersonal connectedness among gay and bisexual men to determine whether those who used the Internet to find sexual partners exhibited different patterns of community connectedness. Though sporadic, findings suggest that Internet use may be associated with lower gay identity, community attachment, and social embeddedness. However, recent reports have suggested that online sex seeking might be associated with greater, not less, interpersonal connectedness. We conclude that additional longitudinal analyses and consistent measurement of gay men’s social behavior are needed to draw more definite conclusions.     

Factors associated with 'feeling suicidal': the role of sexual identity

This paper examines factors associated with feeling suicidal in a large sample of urban men in Sydney and Melbourne, aged 18-50, including heterosexual, gay and bisexual men, HIV antibody positive and HIV antibody negative. As in previous research, sexuality (being homosexual or bisexual) was found to be a major predictor of suicidality. The research went some way towards explaining the close relationship between feeling suicidal and sexual orientation. Sexuality interacts with feeling bad in that, once men feel moderately bad/depressed, they are more likely to feel suicidal if they are homosexual or bisexual than if they are heterosexual. In addition, the research found that experience of verbal abuse and physical assault (harassment) increased feeling suicidal for both heterosexual and gay/bisexual men, not just for homosexual men as suggested by previous research, and that social isolation in the form of living alone is a further risk factor. Seeking counseling help and taking sexual risks were also independently associated with feeling suicidal. These actions may result from feeling suicidal rather than the reverse, and their association with feeling suicidal warrants further research. Many of the 46 independent variables examined in the research, including HIV antibody status and closeness to the HIV/ AIDS epidemic, were related to feeling suicidal only through their association with being gay/bisexual. Celibacy and general risk taking were not related to feeling suicidal in this study.     

Estimating Educational Differences in Low-Risk Cesarean Section Delivery: A Multilevel Modeling Approach

U.S. rates of cesarean section, and in particular, low-risk cesarean section (LRC) births rose dramatically across the late 1990s and early 2000s, and have since remained high. Although previous research explores how trends in LRC vary between states and across maternal characteristics, within-state heterogeneity has not yet been accounted for, nor has the extent to which maternal and county characteristics might interact to shape the likelihood of a LRC birth. Using U.S. county-level birth data for years 2008–2010 from the restricted National Vital Statistics Systems Cohort Linked Birth-Infant Death Files and the Area Health Resource Files, I conduct race-stratified multilevel analyses to explore the association between the mother’s education, the income of the county in which she gives birth, and the odds of LRC delivery. I find that regardless of race/ethnicity, less education at the individual level and lower income at the county level are associated with higher odds of LRC delivery. There are also persistent racial disparities in these relationships. Non-Hispanic black mothers have the highest overall odds of LRC delivery, yet the effect of both education and county income is greatest for non-Hispanic white mothers. The results highlight the importance of analyzing both individual resources and contextual effects of the county when assessing birthing processes, as both contribute to a mother’s access to and knowledge of natal care.     

Demographic and socioeconomic characteristics of Korean Americans in the United States in 1980

"Based on the analysis of 1980 [U.S. Census] Public-Use Microdata Samples, this article demonstrates that the Korean immigrant stream, particularly men, has been very selective even before the 1965 reform.... Despite the educational superiority and somewhat positive occupational position, Korean men in the U.S. are seriously disadvantaged in income regardless of nativity status. Korean Americans are not as successful as whites in translating their education into occupation and income; they are better educated for the same job, but experience a lower income return to the same education and the same occupation."     

Sexual Orientation and Quality of Life Among University Students from Cuba,Norway, India,and South Africa

This article explores quality-of-life aspects among gay, lesbian, bisexual, and straight male and female students in Havana (Cuba), Troms? (Norway), Hisar (India), and Cape Town (South Africa). In the period 2004–2005, a questionnaire survey on sexuality, happiness, and life satisfaction was undertaken among 339 students from the University of Havana, 144 students from the University of Troms?, 200 students from Guru Jambheswar University, and 189 students from the University of the Western Cape. The majority of the participants were straight and, in Hisar and Cape Town, few of those who regarded themselves as gay/lesbian/bisexual had engaged in sex with a person of the same gender. In all cities, straight men and women scored higher than gay, lesbian, and bisexual persons on the quality-of-life measures. Quality of life among gay/bisexual men and lesbian/bisexual women was higher in cultures with accepting attitudes toward homosexuality than in cultures with restrictive attitudes.     

Socio-demographic Correlates of Subjective Well-being in Urban India

This study aimed to explore subjective well-being (SWB) in an urban Indian sample. Adults (n = 1099) belonging to two wards in the city of Bangalore in South India, responded to a study-specific questionnaire. This paper is based on data generated as part of an ongoing larger study looking at correlates of SWB. Almost equal number of men and women responded to the study and their age ranged from 20 to 81 years (mean age 37 years). Majority of them were married, Hindus, from middle socio-economic status, had studied above pre-university level and more than half were earning. The mean scores on positive affect (40.9), negative affect (27.6) and life satisfaction (24) suggested above average levels of SWB. Higher age, being married, having higher education, higher income and working in a full time job seemed to improve life satisfaction and decrease negative affect. Religion was also significantly associated with negative affect. Step-wise regression analysis suggested that only education and income were important predictors of positive affect, while negative affect was better predicted by age, income, work status and religion. Life satisfaction was predicted by income, age and education. The important correlates of SWB for men and women were somewhat different. Overall, sociodemographic variables have minimal effect on SWB in urban India and research needs to explore other predictors of SWB.     

Exploring Shame,Guilt, and Risky Substance Use Among Sexual Minority Men and Women

This study examined the interrelations among shame-proneness, guilt-proneness, internalized heterosexism (IH), and problematic substance use among 389 gay, lesbian, and bisexual men and women. Problematic alcohol and drug use were positively related to shame-proneness and negatively related to guilt-proneness. Bisexuals reported riskier substance use behaviors, lower levels of guilt-proneness, and higher levels of IH than gay men and lesbians. Furthermore, study findings indicated that shame and IH are related. Additional investigations of these associations would supplement current understandings of sexual minority stress and advance the development of substance-related intervention and prevention efforts targeting sexual minorities.     

Lavender Islands: the New Zealand study

Lavender Islands: Portrait of the Whole Family is the first national strengths-based study of lesbian, gay, and bisexual (LGB) people in New Zealand. The 133-item survey was made available both by website and paper copy from April to July 2004. Multidisciplinary interest areas were developed by a community reference group, and included identity and self-definition, families of origin, relationships and sexuality, families of choice, immigration and internal migration, wellbeing, politics, income and spending, education, careers and leisure, community connections, challenges, and spirituality. A four-axis model of sexual identity was also tested; 2,269 responses were received. Of these 83% were from the website; 45% of responses were from women and 54% from men. Responses identified a robust, highly educated, relatively high-income, politically active LGB community. Male and female respondents experienced same-sex relationships and identity in significantly different ways.