Arch Sex Behav (2007) 36:569–578
Minority Stress and Sexual Problems among African-American
Gay and Bisexual Men
Brian D. Zamboni · Isiaah Crawford
Received: 18 November 2005 / Revised: 5 April 2006 / Accepted: 28 May 2006 / Published online: 16 November 2006
C ?Springer Science+Business Media, Inc. 2006
ing, may be associated with sexual problems, but this notion
has not been examined in the literature. African-American
gay/bisexual men face a unique challenge in managing a
double minority status, putting them at high risk for stress
and sexual problems. This investigation examined ten pre-
dictors of sexual problems among 174 African-American
gay/bisexual men. Covarying for age, a forward multiple re-
gression analysis showed that the measures of self-esteem,
male gender role stress, HIV prevention self-efficacy, and
lifetime experiences with racial discrimination significantly
added to the prediction of sexual problems. Gay bashing,
psychiatric symptoms, low life satisfaction, and low social
support were significantly correlated with sexual problems,
but did not add to the prediction of sexual problems in the
regression analysis. Mediation analyses showed that stress
predicted psychiatric symptoms, which then predicted sex-
ual problems. Sexual problems were not significantly re-
lated to HIV status, racial/ethnic identity, or gay identity.
The findings from this study showed a relationship between
experiences with racial and sexual discrimination and sex-
ual problems while also providing support for mediation to
illustrate how stress might cause sexual problems. Address-
ing minority stress in therapy may help minimize and treat
sexual difficulties among minority gay/bisexual men.
Minority stress, such as racism and gay bash-
B. D. Zamboni (?)
Program in Human Sexuality, Department of Family Medicine
and Community Health, University of Minnesota,
1300 S 2nd St., Ste. 180, Minneapolis, Minnesota 55454
Department of Psychology, Loyola University Chicago,
gay/bisexual men or lesbian/bisexual women. The dearth
of literature in this area may reflect a heterosexual bias in
sex therapy research (Masters & Johnson, 1979; Sandfort
& de Keizer, 2001). Other reasons might include assumed
similarities between heterosexual and homosexual sexual
functioning and various barriers to accessing health care for
gay/bisexual individuals (e.g., fear of prejudice or discrimi-
nation; fear of social exposure during treatment).
As noted in Sandfort and de Keizer’s (2001) review,
past studies of sexual dysfunction among gay/bisexual men
lack strong empiricism, have variations in sample size and
composition, and use varying methodological approaches
(e.g., Everaerd et al., 1982; McWhirter & Mattison, 1984;
Paff, 1985; Reece, 1982). Consequently, summarizing the
literature is difficult. Similar to studies of heterosexual men
(see Rosen, 2000), early studies suggested that erectile
disorder was possibly the most common sexual dysfunc-
tion among gay/bisexual men (Bell & Weinberg, 1978;
McWhirter & Mattison, 1984; Paff, 1985; Reece, 1982). A
large, recent study supports the idea that erection difficulties
are common among gay/bisexual men (Bancroft, Carnes,
Janssen, Goodrich, & Long, 2005). A notable number of
gay/bisexual men reported orgasmic disorder (i.e., delayed
ejaculation) in the earlier studies, and this problem may be
more common among gay/bisexual men than heterosexual
men (Bell & Weinberg, 1978; McWhirter & Mattison, 1984;
Paff, 1985; Reece, 1982). The measurement and reported
frequency of premature ejaculation and hypoactive sexual
570 Arch Sex Behav (2007) 36:569–578
desire varied with each study, but generally the percentages
of gay/bisexual men complaining of these sexual dysfunc-
ejaculation difficulties. Premature ejaculation appears to be
more common than low sexual desire. Two separate, more
recent studies have highlighted the issue of painful receptive
anal sex as a frequent sexual problem among gay/bisexual
men (Rosser, Metz, Bockting, & Buroker, 1997; Rosser,
Short, Thurmes, & Coleman, 1998).
For example, gay/bisexual men may experience commu-
nication difficulties, performance concerns, psychopathol-
ogy, sexual knowledge deficits, and negative sexual attitudes
that contribute to sexual dysfunction (Bancroft et al., 2005;
McWhirter & Mattison, 1978; Paff, 1985; Reece, 1987).
Potentially unique etiological factors for sexual dysfunc-
tion among gay/bisexual male clients may include concerns
and concern about HIV prevention (McWhirter & Mattison,
1978; Paff, 1985; Reece, 1982, 1987; Rosser et al., 1998).
These etiological factors have been hypothesized, but not
examined. In one exception, Rosser et al. (1997) found that
high levels of sexual satisfaction were significantly associ-
same-sex attraction, and less sexual dysfunction in a sam-
ple of 197 predominantly (94%) white gay/bisexual men.
Bancroft et al. (2005) found that increases in age predicted
greater concerns about erection difficulties and rapid ejacu-
lation in a large sample of gay men (N=1, 196), but mood,
trait anxiety, and depression were not related to these sex-
ual concerns. Gender roles were not examined in either of
these studies. In their comprehensive review, Sandfort and
men, with attention to gender roles and sexual identity de-
Minority stress, sexual problems, and
African-American gay/bisexual men
Stress and trauma have been shown to predict sexual prob-
lems (Letourneau, Resnick, Kilpatrick, Saunders, & Best,
been examined in the literature. Brooks (1981) asserted that
stress among gay men has shown that discrimination and ex-
more mental health problems (Meyer, 1995) and emotional
distress (Clark, Anderson, Clark, & Williams, 1999; Ross,
1990). African-American gay/bisexual men face a unique
challenge in managing a double minority status (i.e., facing
racism and heterosexism), putting them at risk for nega-
tive life events (e.g., loss of employment, home, or custody
of children) and chronic daily hassles due to discrimina-
tion (Brooks, 1981; Crawford, Allison, Zamboni, & Soto,
2002; Icard, 1986; Loiacano, 1993). In the literature on sex-
gay/bisexual men have generally been neglected. Demo-
graphic details were not always specified by prior studies,
notable exception was Bell and Weinberg (1978), who stud-
ied 111 African-American and 575 Caucasian gay/bisexual
The notion that experiences of discrimination adversely
affect sexual functioning seems intuitive, but the process of
how this might occur has not been examined via any concep-
tual framework. Stress has been viewed as leading to psychi-
atric symptoms (Wheatley, 2000) and stress has been associ-
psychiatric symptoms may mediate the relationship between
stress and sexual dysfunction. More experiences of discrim-
ination based on sexual orientation and race would predict
higher levels of psychiatric symptoms which, in turn, should
predict higher levels of sexual problems among African-
American gay/bisexual men.
Sexual dysfunction and HIV
The current study does not aim to provide a thorough review
of sexual dysfunction and HIV-related issues, but no exami-
be complete without addressing this topic. Sexual dysfunc-
tion has been shown to be associated with HIV infection.
Gay/bisexual men who were HIV positive reported more
Jones, Klimes, & Catalan, 1994). Erectile dysfunction and
lack of sexual desire were some of the most common sexual
in the limited research on this topic (Catalan & Meadows,
with orgasmic disorder (i.e., delayed ejaculation) and, to a
lesser extent, premature ejaculation, have been reported with
other samples of HIV positive gay men (Dupras & Morisset,
1993; Jones et al., 1994).
Psychological and organic factors have been exam-
ined as causes of sexual dysfunction among HIV positive
gay/bisexual men. Psychological factors include reactions
to being HIV positive (e.g., shame, feeling a loss of sexu-
ality, fear of infecting others; Gochros, 1992). Dupras and
Morisset (1993) found that gay/bisexual men with sexual
dysfunction had greater fear of sexuality, greater sexual de-
pression and anxiety, lower sexual self-esteem, and lower
Arch Sex Behav (2007) 36:569–578571
sexual satisfaction when compared to men without sexual
dysfunction. Organic etiological factors include biological
predispositions toward sexual dysfunction prior to HIV in-
fection (e.g., low testosterone) and side effects from HIV
treatment (Catalan & Meadows, 2000).
The few existing studies on sexual dysfunction among
gay/bisexual men are largely descriptive, consist of small
describing frequencies of sexual problems, the current study
aimed to expand research in this area by examining predic-
tors of sexual problems among a large sample of African-
American gay/bisexual men. Understanding predictors of
sexual difficulties will help highlight possible etiological or
concomitant factors of sexual problems and provide guid-
ance in determining appropriate intervention strategies.
Early research has cited gender role stress, internalized
homophobia, and concern about HIV prevention as relevant
etiological factors for sexual problems among gay/bisexual
men (McWhirter & Mattison, 1978; Paff, 1985; Reece,
1982, 1987; see also Zilbergeld, 1992). African-American
gay/bisexual men have been disproportionately affected by
the HIV epidemic in the gay community (Centers for Dis-
ease Control and Prevention, 2001). Degree of racial/ethnic
identity and degree of gay identity have been shown to be
related to the psychosocial well-being of African-American
gay/bisexual men (Crawford et al., 2002) and these vari-
ables may be related to their sexual well-being (Rosser et al.,
Accordingly, this study included measures that assessed
experiences withdiscrimination based on racial/ethnic back-
ground and sexual orientation, measures of racial/ethnic
and HIV prevention self-efficacy. Measures of self-esteem,
life satisfaction, and psychiatric symptoms were included to
assess overall psychosocial functioning. A measure of so-
cial support was included to test the idea that social support
buffers the effect of stress on sexual problems.
1. Based on the previous literature, African-American
gay/bisexual men who were HIV positive were hypothe-
sized to report higher levels of sexual problems than men
who were HIV negative.
2. Higher levels of sexual problems were hypothesized to
be associated with lower levels of life satisfaction, self-
esteem, self-efficacy for HIV prevention, racial/ethnic
identity, and gay identity, as well as greater levels of
male gender role stress, more psychiatric symptoms, and
greater levels of experience with discrimination based on
race and sexual orientation.
3. Psychiatric symptoms were hypothesized to mediate the
relationship between minority stress variables and sexual
psychiatric symptoms which, in turn, predicts higher lev-
els of sexual problems).
ship between stress-related variables (e.g., racial discrim-
ination) and sexual problems (i.e., higher levels of racial
discrimination should predict more sexual problems, ex-
cept when high levels of social support exist).
gay/bisexual men. The study was approved by a university
IRB, and an informed consent procedure was followed. Par-
ticipants were recruited in Chicago, Illinois and Richmond,
outreach by recruiters in community settings (e.g., cafes or
techniques (i.e., referrals from men who participated in the
study). Prior studies sponsored by the National Institutes of
Health and the Centers for Disease Control and Prevention
have successfully used these methods (e.g., Stokes, Damon,
& McKirnan, 1997; Stokes, Vanable, & McKirnan, 1996).
Print advertisements and field workers invited men to call
a local university about a confidential study concerning the
social and sexual experiences of “African-American men
who have sex with men.” The advertisement stated that the
study would last about 60 min and that volunteers would be
paid $20. Men who called were screened for eligibility (i.e.,
activity with other men, have completed at least 8 years of
formal education, and be in fair or good medical condition).
assistant and escorted to a testing room. They were told that
all information gathered for the study would be held in strict
confidence and that they could discontinue participation at
any time. The research assistant checked each survey for
of incomplete or unreliable data. Of the 174 participants (M
age=35 years), most identified themselves as gay (71%),
Baptist (40%), and single (63%). Fifty-one percent were
HIV negative and 68% had never received alcohol or drug
treatment. Table 1 presents a summary of the demographic
characteristics of the participants.
572 Arch Sex Behav (2007) 36:569–578
Highest Level of Education
High school diploma or less
1 year or more of college
Junior College degree
4-year college degree
Type of Employment
Executive, doctor, lawyer
Manager/owner large business
Clerical, retail, technical
Self-defined Sexual Orientation
One or Both Parents
After completing a basic demographics form, participants
were asked to complete several scales. The Coopersmith
Self-Esteem Inventory (CSEI; Coopersmith, 1981) is a 25-
item questionnaire designed to measure evaluative attitudes
of experience. Participants were asked to respond “like me”
or “unlike me” to each item. Internal consistency estimates
have ranged from .87 to .92 (Maloney, Cheney, Spring, &
Kanusky, 1986). The number of self-esteem items answered
positively was summed. The following is an item from the
CSEI: “Things usually don’t bother me.” Higher scores of
the CSEI indicate more self-esteem. Cronbach’s alpha was
.80 in this study.
Derogatis, 1993) is a 90-item self-report symptom inventory
ical distress, was used in this study. Each item was rated on
a 5-point Likert-type scale (0=not at all to 4=extremely).
Higher scores reflect greater levels of psychiatric symptoms.
Internal consistency estimates have ranged from .78 to .90
and test-retest reliability estimates have ranged from .78 to
The Sexual Problems Scale (SPS) is a 12-item instrument
in an individual’s current sex life. To minimize heterosexual
biases, sexual dysfunction was conceptualized as traditional
sexual disorders as well as sexual problems important to
gay men (Sandfort & de Keizer, 2001). Thus, items on the
scale covered a variety of sexual problems, including insuf-
ficient frequency of sex, responding to and receiving sexual
for a sex partner, being good enough sexually, and engag-
ing in activities that seem wrong or sinful based on one’s
upbringing. The SPS also included concerns about sexual
desire, arousal, premature ejaculation, and lack of orgasm
(for self and partner). Participants were asked, “To what ex-
tent are the following problems for you in your sex life?”
Ratings were based on a Likert-type scale (from 1=not at
all to 4=very much). Higher scores indicate greater levels
of sexual problems. Cronbach’s alpha was .77 in this study.
The Life Satisfaction Scale (LSS; Bryant & Veroff, 1984)
health. The scale yields a single, global satisfaction score,
although several aspects of individual functioning were as-
sessed (e.g., leisure, work/school, home, romantic relation-
ships, etc.) Factor loadings for items on the LSS were high,
and internal consistency measures lie consistently above .90
across several studies (Bryant & Veroff, 1984). The items
were rated on a Likert-type scale in which 1=no satisfac-
work on the job or school?” Higher scores indicate greater
life satisfaction. Cronbach’s alpha equaled .73 in this study.
The HIV Prevention Self-Efficacy Scale (HPSES; Smith,
McGraw, Costa, & McKinley, 1996) is a 9-item measure
that assesses the degree to which an individual feels he can
engage in HIV preventive behaviors. Ratings were based
on a Likert-type scale (1=not at all sure; 5=very sure).
An example item from the HPSES is, “How sure were you
that you can...buy condoms at a drug store?” This measure
has demonstrated adequate internal reliability (Cronbach’s
alpha=.68 to .78) and validity (Smith et al., 1996). High
scores on the HPSES indicate a greater level of self-efficacy
Arch Sex Behav (2007) 36:569–578573
in preventing HIV infection. Cronbach’s alpha was .73 in
1987) is a 40-item self-report scale designed to measure the
level of male gender role stress an individual experiences in
a 7-point Likert-type scale (0=not stressful; 6=extremely
scores, with higher scores reflecting more male gender role
stress. For the purpose of this study, only total scores on the
MGRS were computed. The following is an item from the
MGRS: “Please rate the following according to how stress-
ful the situation would be for you—telling your significant
other that you love him/her.” The MGRS has adequate relia-
bility (Cronbach’s α =.90) and validity (Copenhaver, Lash,
alpha was .93 in this study.
in the past year, in one’s lifetime, and the extent to which
this discrimination was evaluated as stressful. Each of the 18
items was completed 3 times (on a 6-point scale, 1=not at
all and 6=extremely) with reference to the aforementioned
ing reliability coefficients for the three subscales: .95 (recent
racist events), .95 (lifetime racist events), and .94 (appraised
racist events). Higher scores indicate more frequent encoun-
ters with racism and experiencing these events as stressful.
The following is an item from the SRE: “How many times
have you been treated unfairly by your employers, bosses,
or supervisors because you were Black?” Cronbach’s alpha
was .95 in this study.
specifically for this study and assesses lifetime discrimina-
often they had experienced 9 events (e.g., verbal insults) be-
cause someone knew or assumed the individual was gay or
times) response format was used. Higher scores of the GBS
sexual orientation. Cronbach’s alpha was .86 in this study.
Basham, & Sarason, 1982) is a 15-item abbreviated version
of the original questionnaire that asks participants to list the
people to whom they can turn for support in various situ-
ations, and to indicate their perceived level of satisfaction
with the social support received in each case. The measure
yields two scores: the average number of persons listed as
supportive and the average degree of satisfaction (1=very
dissatisfied to 6=very satisfied) with received social sup-
port: “Whom can you count on to be dependable when you
need help? How satisfied?” Sarason et al. (1982) reported a
reliability index of .94 for the SSQ. Higher scores indicate
more social supports and more satisfaction with the support
the individual receives. The degree of social support satis-
faction was the only index utilized in this study. Cronbach’s
alpha was .95 in this study.
The Multigroup Ethnic Identity Measure (MEIM;
Phinney, 1992) was employed to assess ethnic identity. The
tity: Affirmation and belonging, Ethnic Identity Achieve-
ment, Ethnic Behaviors, and other-group orientation.
Participants were asked to indicate their level of agree-
ment with a series of statements (1=strongly disagree to
5=strongly agree). An example item is “I am active in or-
ganizations or groups that include mostly members of my
own ethnic group.” The overall MEIM has shown good in-
ternal reliability (Cronbach’s alpha=.90; Cuellar, Nyberg,
Maldonado, & Roberts, 1997). Cronbach’s alpha was .85 in
for this study based on prior research (see Waldo, Hesson-
McInnis, & D-Augelli, 1998). Participants were asked to
rate a series of statements using a Likert-type response for-
mat (1=not all comfortable to 4=very comfortable). Items
on the GIS address positive gay/lesbian attitudes, disclosure
of one’s gay identity, and participation in gay/lesbian or-
ganizations. An example item is “How comfortable do you
feel disclosing your sexual orientation to the majority of the
people in your community?” Higher scores reflect a more
positive adjustment to one’s sexual identity. Cronbach’s al-
pha was .81 in this study.
Distributions of the data for each measure were examined
to detect skewness that may violate statistical assumptions.
The data were normally distributed for all measures. To con-
trol for Type I error, the level for significance was set at
.01 for all analyses. When grouped by region of recruitment
(Richmond vs. Chicago), there were no significant differ-
ences between groups on any demographic variables. There
were no significant relationships between sexual problems
and the demographic variables, except for a significant cor-
relation with age (r= .28, p < .01). Thus, age was covaried
in subsequent analyses. Means and SDs for each measure
are listed in Table 2. According to the SCL-90-R manual
(Derogatis, 1993), the mean Global Severity Index score in
this study was more than one SD above the mean, indicating
a notable level of psychiatric symptoms in this sample.
To test Hypothesis 1, a one-way analysis of covariance
in level of sexual problems based on HIV status, covarying
574 Arch Sex Behav (2007) 36:569–578
and correlations with the Sexual
r with SPS
HIV Prevention Self-Efficacy
Male Gender Role Stress
Note:∗∗p < .01. Range refers to
the possible range of scores.
SPS=Sexual Problems Scale.
Higher scores on each scale
reflect higher levels of the
construct being measured.
for age. Participants who did not know their HIV status
(N=18) were excluded from this analysis. There was no
statistically significant difference in levels of sexual prob-
lems between individuals who were HIV positive (N=68)
versus individuals who were HIV negative (N=89), F(1,
153)=.29, p=.59, ES=.01.
Correlations and forward multiple regression
Hypothesis 2. Of the 10 correlations, 8 were statistically sig-
nificant. These correlations are displayed in Table 2. As the
table indicates, the correlations were generally significant,
but modest in magnitude. All of the significant correlations
were in the hypothesized direction at the .01 level. Higher
levels of sexual problems were significantly associated with
lower levels of self-esteem, life satisfaction, and HIV pre-
vention self-efficacy. Higher levels of social support were
associated with lower levels of sexual problems. In addition,
higher levels of sexual problems were significantly corre-
lated with more experiences of lifetime racial discrimination
greater male gender role stress. In contrast to these results,
sexual problems were not related to level of gay identity or
level of racial/ethnic identity.
A forward multiple regression analysis was conducted in
which the independent variables with prior significant corre-
Accordingly, the predictors in the regression included self-
esteem, life satisfaction, HIV prevention self-efficacy, social
support, lifetime racial discrimination, gay bashing, psychi-
atric symptoms, and male gender role stress. The sexual
problems scale was the dependent variable. The results of
this analysis are shown in Table 3.
Self-esteem was the strongest predictor of sexual prob-
lems, accounting for 14% of the variance in sexual prob-
lems, F(2, 163)=22.97, p < .001, ES=.15. Male gender
role stress, HIV prevention self-efficacy, and lifetime racial
discrimination were additional significant predictors, in that
order. Each independent variable accounted for a significant
amount of additional variance in overall sexual problems
beyond self-esteem, although the change in R2for HIV pre-
vention self-efficacy was marginal (p=.021). With age as a
covariate, these four predictors explained 32.8% of the vari-
ES=.04. The change in R2was not significant for any of the
subsequent predictors, indicating that no other independent
variableaccounted foradditional variance above andbeyond
the other predictors (see Table 3).
Mediation and moderation analyses
Multiple regression was used to explore the hypothesis that
psychiatric symptoms would mediate the relationship be-
tween lifetime racial discrimination and sexual problems.
To examine mediation via regression, each pair of variables
must have a statistically significant relationship (Baron &
Kenny, 1986; Holmbeck, 1997). The simple bivariate corre-
lation between psychiatric symptoms and lifetime racial dis-
crimination was significant (r=.27, p < .01, df=173), and
The latter two relationships can also be shown via regres-
sion analyses with age as a covariate. Racial discrimination
significantly predicted sexual problems, F(2, 169)=13.13,
p < .001, and psychiatric symptoms significantly predicted
sexual problems, F(2, 169)=19.68, p < .001. In the final
step, for full mediation, lifetime racial discrimination should
no longer predict sexual problems when psychiatric symp-
toms were covaried with age. This was the case (p=.042),
and there was a drop in the beta-weight for lifetime racial
discrimination from Step 1 (.24) to Step 4 (.16). Thus, life-
time experiences with discrimination predicted psychiatric
symptoms which, in turn, predicted sexual problems, and
psychiatric symptoms mediated the relationship. This medi-
ation analysis is illustrated in Fig. 1.
A second analysis examined psychiatric symptoms as a
mediator of gay bashing and sexual problems. The simple
Arch Sex Behav (2007) 36:569–578 575
multiple regression of variables
predicting sexual problems
Summary of forward
B SE B
Male Gender Role Stress
HIV Prevention Self-Efficacy
Note. R2=total variance
explained by the predictor and
any preceding predictors. The p
value shows the significance of
the change in R2with each
bivariate correlation between psychiatric symptoms and gay
bashing was significant (r=.30, p < .01, df=173), and
Table 2 shows that the other two correlations were signif-
icant. Gay bashing significantly predicted sexual problems
sociated with sexual problems with age as a covariate. When
the psychiatric symptoms variable was covaried with age,
gay bashing was no longer a significant predictor of sexual
Experiences of gay bashing predicted psychiatric symptoms
which, in turn, predicted sexual problems, and psychiatric
symptoms fully mediated the relationship. Figure 1 illus-
trates this analysis of mediation.
The final analysis of mediation examined psychiatric
problems. The simple bivariate correlation between psychi-
atric symptoms and male gender role stress was significant
(r=.44, p < .01, df=172), and Table 2 shows that the other
two correlations were significant. Male gender role stress
significantly predicted sexual problems with age as a covari-
ate, F(2, 168)=21.97, p < .001. Male gender role stress
still predicted sexual problems when psychiatric symptoms
were covaried (p=.001). The drop in the beta-weight for
.33 (.001) .27 (.001)
.30 (.001) .33 (.001)
Illustration of Statistically Significant Mediation Analyses
male gender role stress from Step 1 (.37) to Step 4 (.27)
and the Sobel test indicated a partial mediation effect (Baron
& Kenny, 1986). Male gender role stress predicted psychi-
atric symptoms which, in turn, predicted sexual problems,
but psychiatric symptoms only partially mediated the rela-
Additional regression analyses were conducted to de-
termine if social support moderated the relationship be-
tween stress-related variables (i.e., racial discrimination,
gay-bashing, and male gender role stress) and sexual prob-
lems. This hypothesis was tested by conducting a series of
regression analyses in which each moderator-predictor in-
teraction term was an independent predictor entered after
the moderator and the stress-related main effects (Baron &
Kenny, 1986; Holmbeck, 1997). None of the analyses exam-
ining social support as a moderator were significant.
Causal inferences cannot be made based on this study, but
the results suggest possible antecedents of sexual problems.
Racial discrimination, gay bashing, and male gender role
among African-American gay/bisexual men or these factors
may occur in conjunction with other life stressors faced by
to show statistically significant relationships among these
variables, the findings fit with recent research that empha-
sizes the importance of mental health and cultural factors
among minority groups when examining the etiology of sex-
& Marin, 2006).
The mediational analyses suggested that perceived ex-
periences with discrimination based on race/ethnicity and
sexual orientation create stress as evidenced by psychiatric
symptoms which, in turn, adversely affect sexual function-
tioning in a similar fashion. Because full mediation was
not evident in that analysis, there were clearly other vari-
ables unspecified by this study that predict both psychiatric
576 Arch Sex Behav (2007) 36:569–578
symptoms and also sexual problems. For example, problems
in one’s romantic relationship may predict sexual problems
or psychiatric symptoms (Heiman, 2002). Moreover, social
support did not moderate the relationship between stress-
related variables and sexual problems. These results indicate
that the etiology of sexual problems cannot be oversimpli-
fied. Despite the significance of the current study, any given
predictor may not have a direct effect on sexual problems.
Addressing minority stress in the treatment of sexual prob-
lems among African-American gay/bisexual men may be
important in therapy, but not sufficient for the amelioration
of any sexual difficulties they experience. Other risk fac-
tors must be identified so that appropriate preventative and
therapeutic measures can be taken.
It is important to note that experiencing sexual problems
could lead to psychiatric symptoms (e.g., a man might feel
depressed in response to erection difficulties), rather than
specific conceptual framework and corresponding hypothe-
ses (Baron & Kenny, 1986; Holmbeck, 1997). Although the
current study followed these tenants of inquiry, clearly the
relationship between sexual problems and psychiatric symp-
toms can be more complex. Reverse causal effects could be
explored in future studies (Smith, 1982) or structural equa-
more complex model of relationships between sexual prob-
lems, psychiatric symptoms, and other variables.
Sexual problems were not related to level of racial/ethnic
and gay identity, possibly because these constructs were not
proximal influences on an African American’s sexual func-
tioning. Extensive psychometric validation of the gay iden-
tity measure used in this study has not been undertaken.
Thus, the gay identity instrument may lack sufficient con-
struct validity and therefore it could mask a possible existing
relationship between gay identity and sexual problems.
There was not a significant difference in sexual problems
between participant groups based on HIV status (positive
versus negative). This was surprising, given that HIV posi-
than gay/bisexual men without HIV (e.g., Jones et al., 1994).
This finding suggests one’s HIV status is not necessarily
associated with disturbances in sexual functioning. Support
for individuals who were HIV positive has increased over
time, and more people were living longer with HIV due
to advanced treatments for the infection, possibly leading
to reduced concerns about HIV infection (Vanable, Ostrow,
McKirnan, Taywaditep, & Hope, 2000) and decreasing its
impact on sexual functioning. The current study did not as-
sess how long each individual had been HIV positive. It was
possible that more sexual problems were evident among in-
Participants in the current study who were HIV positive may
have had sufficient timetoadjusttotheirHIVstatus,eroding
any relationship between HIV status and sexual problems.
HIV status and sexual functioning. Older gay/bisexual men
may be more likely to experience sexual problems (Bancroft
et al., 2005) because of hypertension or other health condi-
tions, regardless of when they became HIV positive. Future
ings of stigmatization associated with HIV infection to see
if these factors are associated with sexual problems.
of participants’ self-serving biases, demand characteristics,
and the artificial nature of the research setting. The partici-
pants were urban African-American gay/bisexual men who
were comfortable enough to complete a survey at a major
university in their city. Many participants may have been
motivated by the monetary compensation. In short, the par-
ticipants may not be representative of all African-American
men who have sex with men. Finally, the data were self-
reported and therefore subject to retrospective bias and com-
mon method error.
Despite these limitations, the current investigation pro-
vides an important empirical investigation into a ne-
glected topic. Sexual difficulties among African-American
gay/bisexual men occur in the context of the minority stress
they experience in their lives. Researchers and clinicians
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