Moderators of the Relationship Between Internalized Homophobia and Risky Sexual Behavior in Men Who Have Sex with Men: A Meta-Analysis

Department of Psychology, University of Illinois at Chicago, 60607, USA.
Archives of Sexual Behavior (Impact Factor: 3.53). 11/2009; 40(1):189-99. DOI: 10.1007/s10508-009-9573-8
Source: PubMed


Research on internalized homophobia (IH) has consistently linked it to both mental and physical health outcomes, while research on its relationships with other variables has been inconsistent. Some research and theory support the association between IH and risky sexual behavior, but much of this research has been plagued by methodological issues, varying measures, and has produced inconsistent findings. Coming to a better understanding of the utility of IH as a potential mechanism or predictor of risky sex in men who have sex with men (MSM) may help to inform future studies of HIV risk in this population as well as the development of prevention interventions. The current study used hierarchical linear modeling to perform meta-analysis combining effect sizes across multiple studies of the relationships between IH and risky sexual behavior. Additionally, the use of multilevel modeling techniques allowed for the evaluation of the moderating effects of age, year of data collection, and publication type on this relationship. Sixteen studies were meta-analyzed for the relationship between IH and risky sexual behavior (N = 2,837), revealing a small overall effect size for this relationship. However, a significant moderating effect was found for the year of data collection, such that the correlation between these two variables has decreased over time. The current utility of this construct for understanding sexual risk taking of MSM is called into question.

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    • "Thus, outness and internalized homonegativity are of interest to researchers studying the health of lesbian, gay, or bisexual populations. This includes HIV prevention researchers focused on studying how individual factors might influence sexual risk (Kubicek et al., 2009; Newcomb & Mustanski, 2011; Ross et al., 2001; Rostosky, Danner, & Riggle, 2007; Shoptaw et al., 2009), as well as some developmental researchers. There is some evidence that outness increases with age among MSM (Ross & Rosser, 1996; Ross et al., 2008). "
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    ABSTRACT: In this study, we investigated if a single-item indicator measured the degree to which people were open about their same-sex attraction (“out”) as accurately as a multi-item scale. For the multi-item scale, we used the Outness Inventory, which includes three subscales: family, world, and religion. We examined correlations between the single- and multi-item measures; between the single-item indicator and the subscales of the multi-item scale; and between the measures and internalized homonegativity, social attitudes towards homosexuality, and depressive symptoms. In addition, we calculated Tjur’s R 2 as a measure of predictive power of the single-item indicator, multi-item scale, and subscales of the multi-item scale in predicting two health-related outcomes: depressive symptoms and condomless anal sex with multiple partners. There was a strong correlation between the single- and multi-item measures (r = 0.73). Furthermore, there were strong correlations between the single-item indicator and each subscale of the multi-item scale: family (r = 0.70), world (r = 0.77), and religion (r = 0.50). In addition, the correlations between the single-item indicator and internalized homonegativity (r = −0.63), social attitudes towards homosexuality (r = −0.38), and depression (r = −0.14) were higher than those between the multi-item scale and internalized homonegativity (r = −0.55), social attitudes towards homosexuality (r = −0.21), and depression (r = −0.13). Contrary to the premise that multi-item measures are superior to single-item measures, our collective findings indicate that the single-item indicator of outness performs better than the multi-item scale of outness.
    Archives of Sexual Behavior 08/2015; DOI:10.1007/s10508-015-0605-2 · 3.53 Impact Factor
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    • "Several authors have studied the concept of internalized homophobia as a predictor of risky behavior and psychological issues among MSM [60-62]. These theories are far from disentangling the multiple components related to risky behavior, and there is a debate on their real impact on health [63], but they certainly reinforce the need for a comprehensive approach on treating and preventing HIV among MSM. "
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    ABSTRACT: Many countries are facing concentrated HIV epidemics among vulnerable populations, including men who have sex with men (MSM). Unprotected anal intercourse (UAI) is the main HIV transmission route among them and its understanding in the different cultures and how it relates to HIV transmission, re-infection and development of HIV antiretroviral resistance has important public health implications. Data on UAI among Brazilian MSM are scarce. This study aims to evaluate the prevalence and associated factors of UAI among HIV-infected MSM who had sex with seronegative or male partners with an unknown serostatus. A cross-sectional study nested in a cohort was conducted in Rio de Janeiro, Brazil. The one hundred and fifty five MSM included in the study answered an ACASI interview and provided biological samples. Generalized linear models were used to identify variables associated with UAI. Overall, UAI with an HIV-negative or unknown serostatus male partner was reported by 40.6% (63/155) of MSM. Lifetime sexual abuse or domestic violence was reported by 35.9%, being more frequent among MSM who reported UAI compared to those who did not (P = 0.001). Use of stimulants before sex was reported by 20% of the MSM, being slightly higher among those who reported UAI (27.0% vs. 15.2%; P = 0.072). Commercial sex was frequent among all MSM (48.4%). After multivariate modeling, the report of sexual abuse or domestic violence (OR = 2.70; 95%CI: 1.08-7.01), commercial sex (OR = 2.28; 95%CI: 1.04- 5.10), the number of male sexual partners (p = 0.039) and exclusively receptive anal intercourse (OR = 0.21; 95%CI: 0.06-0.75) remained associated with UAI. CD4 levels, HIV viral load and antiretroviral therapy were not associated with UAI. The UAI prevalence found with negative or unknown HIV status partners points out that other interventions are needed as additional prevention tools to vulnerable MSM. The main factors associated with UAI were a lifetime history of violence, commercial sex and the number of male sexual partners. This clustering of different behavioral, health and social problems in this population reinforce the need of a comprehensive approach on treating and preventing HIV among MSM.
    BMC Public Health 04/2014; 14(1):379. DOI:10.1186/1471-2458-14-379 · 2.26 Impact Factor
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    • "For example, recovering alcoholics’ displays of shame (e.g., humped shoulders) when describing their last drink predicted subsequent relapse severity [14]. States of shame differ from trait-like constructs (e.g., internalized homophobia that inconsistently predicts sexual risk-taking [15]) in that they involve specific situational contexts (e.g., before an attractive partner). For example, participants given misleading feedback – suggesting their responses conflicted with their self-standards – felt shame [16]. "
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    ABSTRACT: IntroductionMen who have sex with men (MSM) often face socially sanctioned disapproval of sexual deviance from the heterosexual “normal.” Such sexual stigma can be internalized producing a painful affective state (i.e., shame). Although shame (e.g., addiction) can predict risk-taking (e.g., alcohol abuse), sexual shame's link to sexual risk-taking is unclear. Socially Optimized Learning in Virtual Environments (SOLVE) was designed to reduce MSM's sexual shame, but whether it does so, and if that reduction predicts HIV risk reduction, is unclear. To test if at baseline, MSM's reported past unprotected anal intercourse (UAI) is related to shame; MSM's exposure to SOLVE compared to a wait-list control (WLC) condition reduces MSM's shame; and shame-reduction mediates the link between WLC condition and UAI risk reduction.MethodsHIV-negative, self-identified African American, Latino or White MSM, aged 18–24 years, who had had UAI with a non-primary/casual partner in the past three months were recruited for a national online study. Eligible MSM were computer randomized to either WLC or a web-delivered SOLVE. Retained MSM completed baseline measures (e.g., UAI in the past three months; current level of shame) and, in the SOLVE group, viewed at least one level of the game. At the end of the first session, shame was measured again. MSM completed follow-up UAI measures three months later. All data from 921 retained MSM (WLC condition, 484; SOLVE condition, 437) were analyzed, with missing data multiply imputed.ResultsAt baseline, MSM reporting more risky sexual behaviour reported more shame (r s=0.21; p<0.001). MSM in the SOLVE intervention reported more shame reduction (M=−0.08) than MSM in the control condition (M=0.07; t(919)=4.24; p<0.001). As predicted, the indirect effect was significant (point estimate −0.10, 95% bias-corrected CI [−0.01 to −0.23] such that participants in the SOLVE treatment condition reported greater reductions in shame, which in turn predicted reductions in risky sexual behaviour at follow-up. The direct effect, however, was not significant.ConclusionsSOLVE is the first intervention to: (1) significantly reduce shame for MSM; and (2) demonstrate that shame-reduction, due to an intervention, is predictive of risk (UAI) reduction over time.
    Journal of the International AIDS Society 11/2013; 16(Supplement 2). DOI:10.7448/IAS.16.3.18716 · 5.09 Impact Factor
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