David M. Huebner

Family Rejection as a Predictor of Negative Health Outcomes in White and Latino Lesbian, Gay, and Bisexual Young Adults

OBJECTIVE. We examined specific family rejecting reactions to sexual orientation and gender expression during adolescence as predictors of current health problems in a sample of lesbian, gay, and bisexual young adults. METHODS. On the basis of previously collected in-depth interviews, we developed quantitative scales to assess retrospectively in young adults the frequency of parental and caregiver reactions to a lesbian, gay, or bisexual sexual orientation during adolescence. Our survey instrument also included measures of 9 negative health indicators, including mental health, substance abuse, and sexual risk. The survey was administered to a sample of 224 white and Latino self-identified lesbian, gay, and bisexual young adults, aged 21 to 25, recruited through diverse venues and organizations. Participants completed self-report questionnaires by using either computer-assisted or pencil-and-paper surveys. RESULTS. Higher rates of family rejection were significantly associated with poorer health outcomes. On the basis of odds ratios, lesbian, gay, and bisexual young adults who reported higher levels of family rejection during adolescence were 8.4 times more likely to report having attempted suicide, 5.9 times more likely to report high levels of depression, 3.4 times more likely to use illegal drugs, and 3.4 times more likely to report having engaged in unprotected sexual intercourse compared with peers from families that reported no or low levels of family rejection. Latino men reported the highest number of negative family reactions to their sexual orientation in adolescence. CONCLUSIONS. This study establishes a clear link between specific parental and caregiver rejecting behaviors and negative health problems in young lesbian, gay, and bisexual adults. Providers who serve this population should assess and help educate families about the impact of rejecting behaviors. Counseling families, providing anticipatory guidance, and referring families for counseling and support can help make a critical difference in helping decrease risk and increasing well-being for lesbian, gay, and bisexual youth.

Experiences of Harassment, Discrimination, and Physical Violence Among Young Gay and Bisexual Men

OBJECTIVES We examined the 6-month cumulative incidence of anti-gay harassment, discrimination, and violence among young gay/bisexual men and documented their associations with mental health. METHODS Gay/bisexual men from 3 cities in the southwestern United States completed self-administered questionnaires. RESULTS Thirty-seven percent of men reported experiencing anti-gay verbal harassment in the previous 6 months; 11.2% reported discrimination, and 4.8% reported physical violence. Men were more likely to report these experiences if they were younger, were more open in disclosing their sexual orientation to others, and were HIV positive. Reports of mistreatment were associated with lower self-esteem and increased suicidal ideation. CONCLUSIONS Absent policies preventing anti-gay mistreatment, empowerment and community-building programs are needed for young gay/bisexual men to both create safe social settings and help them cope with the psychological effects of these events.

The Impact of Internalized Homophobia on HIV Preventive Interventions

A growing body of research implicates internalized homophobia—the internalization of societys antihomosexual sentiments by gay and lesbian people—as a factor contributing to HIV-related sexual risk behavior in gay and bisexual men. Although accumulating evidence links internalized homophobia and sexual risk behavior, no study has explored the impact of internalized homophobia on efforts to prevent these behaviors. This paper examines the effect of internalized homophobia on gay and bisexual mens awareness of, participation in, and perceptions of programs offered by a community-based HIV prevention organization. In Study 1, 595 gay and bisexual men reported their levels of awareness of and participation in HIV prevention programming offered by one community organization. Internalized homophobia was negatively related to mens awareness of the services offered by the organization. However, among the men who were aware of at least one service, internalized homophobia did not further predict service utilization. Study 2 examined 89 gay and bisexual men who participated for a single session in a group-structured, community-based HIV preventive intervention. Pre- to immediate postintervention change in perceptions of condom use self-efficacy was inversely related to internalized homophobia. Internalized homophobia was also a significant negative predictor of the extent to which participants felt similar to and related well with other members of the group. Together, these findings suggest that internalized homophobia may pose multiple barriers to community-based HIV prevention efforts.

Perceived antigay discrimination and physical health outcomes.

OBJECTIVE Theories of minority stress posit that experiences of discrimination are stressful events with the potential to cause mental and physical illness. Although some empirical studies have demonstrated a positive linear association between perceived discrimination and a variety of health outcomes, 2 studies of African Americans have revealed that those of lower occupational status who report no discrimination have higher tonic blood pressure compared with those who report modest amounts of discrimination. The authors of the present study sought to determine if this provocative pattern of findings could be replicated using a different population and different health outcomes. DESIGN Gay and bisexual men (n = 361) were recruited through outreach to venues and community events and through advertising in local publications. They responded to survey questions using a self-administered paper questionnaire, the Internet, or a telephone. MAIN OUTCOME MEASURES Men self-reported their frequency of nonprescription medication use, number of physician visits, and number of sick days from work during the past year. RESULTS Perceived discrimination interacted with participant education, yielding an association between discrimination and health outcomes that was curvilinear (U-shaped) among men with lower education and an association that was positive among men with relatively higher education. CONCLUSION This unusual pattern of results in gay and bisexual men replicates the findings from previous research with African American men and suggests that failing to recognize or acknowledge discrimination can have negative health consequences for some individuals from marginalized groups.

A longitudinal study of the association between treatment optimism and sexual risk behavior in young adult gay and bisexual men.

To determine whether optimism about highly active antiretroviral therapy is associated with sexual risk behavior among young adult HIV-negative gay and bisexual men, and to test 2 alternative explanations for this association: that treatment optimism leads to increased sexual risk or that treatment optimism is the result of previous sexual risk. Data on sexual risk behavior, treatment optimism, and perceived susceptibility to HIV infection were obtained from a sample of 538 HIV-negative or untested gay and bisexual men (ages 18-30) who were not in monogamous relationships. Follow-up data were collected 18 months later. In the cross-sectional data, treatment optimism was associated with the 2-month cumulative incidence of unprotected anal intercourse (UAI) with nonprimary partners; however, this effect was observed only among men who felt highly susceptible to HIV infection. Longitudinal analyses revealed that treatment optimism did not predict subsequent UAI, but UAI did predict later treatment optimism. Treatment optimism is associated with sexual risk behavior among young adult gay and bisexual men. However, these data suggest that optimism may result from, rather than precede, sexual risk.

The relation between beliefs about drug treatments for HIV and sexual risk behavior in gay and bisexual men

This study examined the relation between gay and bisexual men’s (N = 575) beliefs about highly active antiretroviral therapy (HAART) and other HIV-related beliefs, intentions, and risk behaviors. Confirmatory factor analysis verified three belief factors: the extent to which HAART improves health among HIV-infected individuals, decreases the risk of HIV transmission, and is complicated and of limited efficacy. Men who endorsed the belief that HAART decreases HIV transmission risk expressed lower intentions to use condoms for anal sex and were more likely to have engaged in unprotected anal intercourse with a casual partner. HIV-negative men who believed that HAART decreases transmission risk also perceived themselves to be more susceptible to HIV infection. Statistical evidence indicated that perceptions of susceptibility partially mediate the relation between sexual risk behavior and beliefs about HAART, suggesting that beliefs may result from, rather than cause, increased risk behavior.

Is Being Out About Sexual Orientation Uniformly Healthy? The Moderating Role of Socioeconomic Status in a Prospective Study of Gay and Bisexual Men

BackgroundStress associated with concealing sexual orientation is a possible mechanism for health disparities among lesbian, gay, bisexual (LGB) individuals. However, disclosing one’s sexual orientation might not be uniformly healthy across social contexts.PurposeThe present study tested whether being out is less healthy for gay and bisexual men of lower socioeconomic status (SES) relative to higher SES men.MethodsUsing longitudinal data on gay and bisexual men (N = 564, ages 18–72), we examined whether the association between outness and physical health differs by SES.ResultsSES significantly moderated associations between outness and physician visits, nonprescription medication use, and physical symptoms. Outness predicted physical health benefits for higher SES men but health problems for lower SES men.ConclusionsThe common assumption that disclosing one’s sexual orientation is uniformly healthy may be less accurate (or inaccurate) for lower status groups. Future research should explore SES as context for minority stress and LGB health disparities.

Sampling in Surveys of Lesbian, Gay, and Bisexual People

One purpose of this volume is to provide methodological tools for conducting public health research for lesbian, gay, and bisexual (LGB) populations. Among the most fundamental methodological considerations in any kind of research is how best to sample the population of interest. The importance of sampling in health research among LGB people can be seen in how the medical profession initially came to consider homosexuality a mental disorder. The “evidence” supporting such judgments came from studies of psychiatrists’ patients and inmates in mental hospitals and prisons. The possibility that such samples might be biased—that is, that these individuals might not be representative of homosexuals who were not in treatment or institutionalized—was not considered seriously, in large part due to prevailing attitudes about homosexuality. Nevertheless, the historical lesson of how poor sampling can create significant problems for the health and well-being of LGB people should be enough to make all of us ardent promoters of the use of sound sampling procedures in public health research.

Bathhouse-based voluntary counseling and testing is feasible and shows preliminary evidence of effectiveness

Summary:The goal of this study was to provide evidence for the feasibility and effectiveness of conducting voluntary counseling and testing (VCT) for HIV in a bathhouse setting. Four hundred ninety-two men participated in bathhouse-based VCT offered at a single venue over a 13-month period. A convenience sample of 133 of these testers was assessed at 2 points: immediately before and 3 months after testing. Thirty-eight percent of men in the sample reported unprotected anal intercourse (UAI) with 1 of their 2 most recent partners in the 3 months before testing, and 48% of those men had not otherwise been tested for HIV in the previous 12 months. Results showed that in the months after VCT, men were less likely to engage in UAI, decreased their frequency of engaging in sex while drunk or high, and were more likely to communicate about HIV with their sexual partners. Bathhouse-based VCT seems to be a feasible approach for reaching significant numbers of men at risk for HIV and shows preliminary evidence of effectiveness in changing some specific HIV-related risk and precautionary behaviors.

Sorting Through Chickens and Eggs: A Longitudinal Examination of the Associations Between Attitudes, Norms, and Sexual Risk Behavior

OBJECTIVE Health behavior theories posit that health-relevant attitudes, beliefs, and behavioral skills drive subsequent actions people take to protect themselves from health threats. Within the realm of HIV-related sexual risk behavior, much of the research in support of this notion is cross-sectional, rather than longitudinal, particularly in studies of gay and bisexual men. Other psychological theories (e.g., self-perception or cognitive dissonance theories) suggest that the opposite could be true--that health-relevant attitudes and beliefs might change as a function of previous risk or precautionary behavior. Appreciating the complex nature of these associations is essential for modifying theory and developing appropriate interventions. DESIGN Using longitudinal data from gay and bisexual men (n = 1465), we used structural equation modeling to examine three possibilities--that perceived norms and attitudes about sexual risk would be (a) related to unprotected anal intercourse cross-sectionally, (b) related to unprotected anal intercourse at a subsequent time point, and/or (c) predicted from previous instances of unprotected anal intercourse. RESULTS Safe-sex norms and attitudes were related to unprotected anal intercourse cross-sectionally, but did not predict unprotected sex longitudinally. Rather, perceived norms and attitudes changed as a function of previous risk behavior. CONCLUSIONS These results raise the possibility that modified theoretical models might be necessary to adequately describe sexual risk behavior among gay and bisexual men.