Brian Mustanski

Psychosocial health problems increase risk for HIV among urban young men who have sex with men: preliminary evidence of a syndemic in need of attention.

Background: Young men who have sex with men (YMSM) experience disparities in HIV rates and potentially in mental health, substance abuse, and exposure to violence.Purpose: We assessed the extent to which these psychosocial health problems had an additive effect on increasing HIV risk among YMSM.Methods: An urban sample of 310 ethnically diverse YMSM reported on psychosocial health problems, sexual risk behaviors, and HIV status. A count of psychosocial health problems was calculated to test the additive relationship to HIV risk.Results: The prevalence of psychosocial health problems varied from 23% for regular binge drinking to 34% for experiencing partner violence. Rates of sexual risk behaviors were high and 14% of YMSM reported receiving a HIV + test result. Psychosocial health problems cooccurred, as evidenced by significant bivariate odds ratios (ORs) between 12 of the 15 associations tested. Number of psychosocial health problems significantly increased the odds of having multiple anal sex partners (OR=1.24), unprotected anal sex (OR=1.42), and an HIV-positive status (OR 1.42), after controlling for demographic factors.Conclusions: These data suggest the existence of cooccurring epidemics, or “syndemic,-of health problems among YMSM. Disparities exist not only in the prevalence of HIV among YMSM but also in research to combat the epidemic within this vulnerable population. Future research is needed to identify risk and resiliency factors across the range of health disparities and develop interventions that address this syndemic.

Internalized homophobia and internalizing mental health problems: A meta-analytic review

Research on internalized homophobia (IH) has linked it to both mental and physical health outcomes. Extant research indicates that IH and mental health are related in a variety of different subgroups of lesbian, gay and bisexual (LGB) persons. However, much of this research has suffered from methodological issues. Studies have frequently substituted distress-related constructs (e.g., self-esteem and general well-being) for measures of internalizing mental health problems. Furthermore, many studies have misapplied measures of IH designed for gay men with lesbian samples. The current study used Hierarchical Linear Modeling to perform meta-analysis. Effect sizes were combined across multiple studies that used dimensional measures of internalizing mental health problems (i.e., depression and anxiety). The use of multilevel modeling techniques allowed for the evaluation of moderating effects on these relationships, including those of gender, year of data collection, mean age of the sample, publication type, and type of symptomatology measured. Thirty-one studies were meta-analyzed for the relationship between IH and mental health (N=5831), revealing a small to moderate overall effect size for the relationship between the two variables. Higher levels of IH were associated with higher scores on dimensional measures of internalizing mental health problems. Significant moderating effects were also found for mean age of the sample and the type of symptomatology measured in each study. The relationship between IH and internalizing mental health problems was stronger in studies with a higher mean age. The relationship between IH and depressive symptomatology was stronger than the relationship between IH and symptoms of anxiety. Limitations and future research directions are discussed as well as implications for clinical practice.

Mental health disorders, psychological distress, and suicidality in a diverse sample of lesbian, gay, bisexual, and transgender youths.

OBJECTIVES We examined associations of race/ethnicity, gender, and sexual orientation with mental disorders among lesbian, gay, bisexual, and transgender (LGBT) youths. METHODS We assessed mental disorders by administering a structured diagnostic interview to a community sample of 246 LGBT youths aged 16 to 20 years. Participants also completed the Brief Symptom Inventory 18 (BSI 18). RESULTS One third of participants met criteria for any mental disorder, 17% for conduct disorder, 15% for major depression, and 9% for posttraumatic stress disorder. Anorexia and bulimia were rare. Lifetime suicide attempts were frequent (31%) but less so in the prior 12 months (7%). Few racial/ethnic and gender differences were statistically significant. Bisexually identified youths had lower prevalences of every diagnosis. The BSI 18 had high negative predictive power (90%) and low positive predictive power (25%) for major depression. CONCLUSIONS LGBT youths had higher prevalences of mental disorder diagnoses than youths in national samples, but were similar to representative samples of urban, racial/ethnic minority youths. Suicide behaviors were similar to those among representative youth samples in the same geographic area. Questionnaires measuring psychological distress may overestimate depression prevalence among this population.

HIV in Young Men Who Have Sex with Men: A Review of Epidemiology, Risk and Protective Factors, and Interventions

Epidemiological studies have found that young men who have sex with men (YMSM) represent the majority of young people infected with HIV annually in the United States. Further, they are one of the few risk groups to show an increase in the rate of infections in recent years. In addition to these disparities in prevalence and infection rates, there is an inequity in prevention and intervention research on this population. The purpose of this article is to review the existing YMSM literature on HIV epidemiology, correlates of risk, and intervention research. The article concludes that promising future directions for basic research include a focus on multiple clustering health issues, processes that promote resiliency, the role of family influences, and the development of parsimonious models of risk. In terms of intervention research, the article suggests that promising future directions include Internet-based intervention delivery, integration of biomedical and behavioral approaches, and interventions that go beyond the individual level to address partnership, structural, community, and network factors.

Getting wired: Exploiting the internet for the collection of valid sexuality data

This paper explores the use of the Internet as a data collection method for sexuality research. Benefits, such as larger, more representative samples, and risks to validity, such as lying and sabotage, are discussed in the context of a large Internet‐based study of how “having sex” is defined by gay, lesbian, and bisexual college students. Suggestions for how to maximize utility as well as combat potential risks and ethical dilemmas are offered. Special attention is paid to the use of the Internet to collect data from traditionally underrepresented groups. The article ends with a look to the future of sex research over the Internet, exploring the collection of nonsurvey data.

Suicidal Ideation and Self-Harm in Lesbian, Gay, Bisexual, and Transgender Youth

BACKGROUND Suicide is the third-leading cause of death among adolescents and nonsuicidal self-harm occurs in 13%-45% of individuals within this age group, making these phenomena major public health concerns. Lesbian, gay, bisexual, and transgender (LGBT) youth particularly are at risk for engaging in these behaviors. Nevertheless, relatively little is known about the specific risk factors associated with suicidal ideation and self-harm behaviors in the population. PURPOSE This study provides a longitudinal evaluation of the relative contributions of general and LGBT-specific risk factors as well as protective factors to the occurrence of suicidal ideation and self-harm in an ethnically diverse sample of LGBT youth. METHODS A community sample of 246 LGBT youth (aged 16-20 years) was followed prospectively over five time points at regular 6-month intervals. Participants completed a baseline structured interview assessing suicide attempt history and questionnaires measuring gender nonconformity, impulsivity, and sensation-seeking. At follow-up assessments, participants completed a structured interview assessing self-harm and questionnaires for suicidal ideation, hopelessness, social support, and LGBT victimization. Data were collected from 2007 to 2011, and HLM analyses were conducted in 2011. RESULTS A history of attempted suicide (p=0.05); impulsivity (p=0.01); and prospective LGBT victimization (p=0.03) and low social support (p=0.02) were associated with increased risk for suicidal ideation. Suicide attempt history (p<0.01); sensation-seeking (p=0.04); female gender (p<0.01); childhood gender nonconformity (p<0.01); and prospective hopelessness (p<0.01) and victimization (p<0.01) were associated with greater self-harm. CONCLUSIONS General and LGBT-specific risk factors both uniquely contribute to likelihood of suicidal ideation and self-harm in LGBT youth, which may, in part, account for the higher risk of these phenomena observed in this population.

Tip of the Iceberg: Young Men Who Have Sex With Men, the Internet, and HIV Risk

OBJECTIVES We examined the prevalence of Internet use for meeting sexual partners (Internet partners) and HIV risk behaviors associated with this use among young men who have sex with men (aged 16-24 years). METHODS A sample of 270 young men who have sex with men completed a computer-assisted survey. We used bivariate chi(2) analyses and hierarchical logistic regression to assess factors associated with Internet-facilitated sexual encounters. RESULTS Using the Internet to meet sexual partners was common; 48% of our sample had sexual relations with a partner they met online. Of these, only 53% used condoms consistently, and 47% reported having sexual partners older (>4 years) than themselves. Regression analyses showed increased age, White race/ethnicity, history of unprotected anal intercourse, multiple anal intercourse partners, and engaging in sexual activity at a sex club or a bathhouse were associated with meeting sexual partners through the Internet. Only history of unprotected anal intercourse was associated with risky sexual behaviors with Internet partners (P<0.025). CONCLUSIONS Young men who have sex with men and who seek partners online also engage in other behaviors that place them at risk for HIV and other sexually transmitted infections.

A critical review of recent biological research on human sexual orientation.

Abstract This article provides a comprehensive review and critique of biological research on sexual orientation published over the last decade. We cover research investigating (a) the neurohormonal theory of sexual orientation (psychoneuroendocrinology, prenatal stress, cerebral asymmetry, neuroanatomy, otoacoustic emissions, anthropometrics), (b) genetic influences, (c) fraternal birth-order effects, and (d) a putative role for developmental instability. Despite inconsistent results across both studies and traits, some support for the neurohormonal theory is garnered, but mostly in men. Genetic research using family and twin methodologies has produced consistent evidence that genes influence sexual orientation, but molecular research has not yet produced compelling evidence for specific genes. Although it has been well established that older brothers increase the odds of homosexuality in men, the route by which this occurs has not been resolved. We conclude with an examination of the limitations of biological research on sexual orientation, including measurement issues (paper and pencil, cognitive, and psychophysiological), and lack of research on women.

Exploring the Diversity of Gender and Sexual Orientation Identities in an Online Sample of Transgender Individuals

Although the term transgender is increasingly used to refer to those whose gender identity or expression diverges from culturally defined categories of sex and gender, less is known about the self-identities of those who fall within this category. Historically, recruitment of transgender populations has also been limited to specialized clinics and support groups. This study was conducted online, with the aim of exploring the gender identities, sexual orientation identities, and surgery and hormonal statuses of those who identify with a gender identity other than, or in addition to, that associated with their birth sex (n = 292). Genderqueer was the most commonly endorsed gender identity, and pansexual and queer were the most commonly endorsed sexual orientation identities. Participants indentified with a mean of 2.5 current gender identities, 1.4 past gender identities, and 2 past sexual orientation identities. The majority of participants either did not desire or were unsure of their desire to take hormones or undergo sexual reassignment surgery. However, birth sex and age were significant predictors of “bottom” surgery and hormone status/desire, along with several identities and orientations. This study explores explanations and implications for these patterns of identification, along with the potential distinctiveness of this sample.

Relationship characteristics and sexual risk-taking in young men who have sex with men.

OBJECTIVE Young men who have sex with men (MSM), particularly young men of color, are experiencing the largest increase in HIV incidence of any risk group in the United States Epidemiological research suggests that the majority of transmissions among MSM are occurring in the context of primary partnerships, but little research has been done on the processes within these dyads that increase HIV risk behaviors. The aim of this study was to use longitudinal partnership-level data to explore the effects of partner and relationship characteristics on the frequency of unprotected sex within young MSM relationships. METHOD One hundred twenty-two young MSM (age 16-20 at baseline) were assessed at three time-points six months apart, with 91% retention at the 12-month follow-up wave. Over 80% were racial/ethnic minorities. At each wave, participants reported on characteristics of the relationships and partners for up to three sexual partners. Hierarchical linear modeling was used for analyses. RESULTS The largest effect was for considering the relationship to be serious, which was associated with nearly an eightfold increase in the rate of unprotected sex. Other factors that increased risk behaviors included older partners, drug use prior to sex, physical violence, forced sex, and partnership lasting more than six months. Partners met online were not associated with significantly more sexual risk. CONCLUSIONS These data provide insight into the relationship processes that should be addressed in prevention programs targeted at young MSM. Relationships may serve as a promising unit for HIV prevention interventions, although more formative research will be required to address potential logistical obstacles to implementing such interventions. The partner-by-partner analytic approach (i.e., evaluating situational variables associated with several partners for a given participant) holds promise for future HIV behavioral research.