Minority stress and sexual problems among African-American gay and bisexual men.

Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota, 1300 S 2nd St., Ste. 180, Minneapolis, MN 55454, USA.
Archives of Sexual Behavior (Impact Factor: 3.53). 09/2007; 36(4):569-78. DOI: 10.1007/s10508-006-9081-z
Source: PubMed

ABSTRACT Minority stress, such as racism and gay bashing, 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 predictors of sexual problems among 174 African-American gay/bisexual men. Covarying for age, a forward multiple regression 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 sexual problems. Sexual problems were not significantly related 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 sexual problems while also providing support for mediation to illustrate how stress might cause sexual problems. Addressing minority stress in therapy may help minimize and treat sexual difficulties among minority gay/bisexual men.

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    ABSTRACT: The deleterious effects of racism on a wide range of health outcomes, including HIV risk, are well documented among racial/ethnic minority groups in the United States. However, little is known about how men of color who have sex with men (MSM) cope with stress from racism and whether the coping strategies they employ buffer against the impact of racism on sexual risk for HIV transmission. We examined associations of stress and coping with racism with unprotected anal intercourse (UAI) in a sample of African American (N = 403), Asian/Pacific Islander (N = 393), and Latino (N = 400) MSM recruited in Los Angeles County, CA during 2008-2009. Almost two-thirds (65 %) of the sample reported being stressed as a consequence of racism experienced within the gay community. Overall, 51 % of the sample reported having UAI in the prior 6 months. After controlling for race/ethnicity, age, nativity, marital status, sexual orientation, education, HIV serostatus, and lifetime history of incarceration, the multivariate analysis found statistically significant main effects of stress from racism and avoidance coping on UAI; no statistically significant main effects of dismissal, education/confrontation, and social-support seeking were observed. None of the interactions of stress with the four coping measures were statistically significant. Although stress from racism within the gay community increased the likelihood of engaging in UAI among MSM of color, we found little evidence that coping responses to racism buffered stress from racism. Instead, avoidance coping appears to suggest an increase in UAI.
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    ABSTRACT: Although research has shown a connection between minority stressors and internalizing mental health problems, the role of minority stress has mainly been neglected in the assessment of sexual problems among non-heterosexual men. Using online samples of heterosexual (n = 933) and non-heterosexual participants (n = 561) aged 18 to 50 years, this study aimed to comparatively assess sexual difficulties and problems and explore the role of minority stress in non-heterosexual men's sexual problems. Although the age-adjusted odds of reporting rapid ejaculation, delayed ejaculation, and sex-related anxiousness significantly differed between the two groups, the overall prevalence of sexual difficulties and the associated levels of distress did not significantly differ between the samples. In multivariate assessment, anxiety and depression significantly increased the odds of reporting distressing sexual difficulties among both heterosexual and non-heterosexual participants. In the non-heterosexual sample, positive body image significantly decreased the odds of experiencing sexual problems. Pointing to a role of minority stress, highest levels of victimization related to sexual orientation increased the risk of sexual problems. This association was partially mediated by negative emotions. Our findings offer some support for a recent call to include sexual orientation among the social determinants of health recognized by the World Health Organization.
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    ABSTRACT: IntroductionAlthough sexuality is a central feature that distinguishes nonheterosexual men from heterosexual men, little is known about how sexual orientation influences male sexual function and sexual problems. This presents a challenge for adequate healthcare for gay and bisexual men.AimThe aim of this article is to provide an overview of the literature on the prevalence and correlates of sexual health disturbances among heterosexual and nonheterosexual men.Methods PubMed and PsycINFO databases were searched for relevant studies published in English. Reference sections of selected papers were checked for additional studies of interest.Main Outcome MeasuresMain outcomes were comparative findings of the prevalence and correlates of sexual health disturbances in heterosexual and nonheterosexual men.ResultsIn total, we found nine studies of interest, five of which used a comparative design. Evidence regarding sexual orientation as a risk factor for male sexual difficulties is mixed, with more recent studies reporting nonsignificant associations. Heterogeneity of sampling strategies and indicators used to assess sexual orientation and sexual function in the studies, as well as the use of relatively small subsamples of nonheterosexual participants, preclude any conclusions about a comparative prevalence of male sexual disturbances. Several studies suggested that rapid ejaculation might be more prevalent among heterosexual than nonheterosexual men. However, a single study that controlled for frequency and patterns of male sexual activity failed to corroborate this finding. Two studies reported similar correlates of sexual dysfunction and sexual problems between heterosexual and nonheterosexual men (e.g., age and depression/anxiety symptoms), but also some sexual orientation-specific correlates (e.g., body image). Finally, significant but weak associations between minority stressors and sexual health disturbances among nonheterosexual men were reported in two studies.Conclusions There is a lack of comparative assessment of the relationship between sexual orientation and male sexual difficulties. Based on an analysis of the existing studies' limitations, we conclude with recommendations for future studies. Štulhofer A, Šević S, and Doyle DM. Comparing the prevalence and correlates of sexual health disturbances among heterosexual and nonheterosexual men: An overview of studies. Sex Med Rev **;**:**–**.
    10/2014; DOI:10.1002/smrj.31


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