Marya Gwadz

The Coming‐Out Process and Its Adaptational and Health‐Related Associations Among Gay, Lesbian, and Bisexual Youths: Stipulation and Exploration of a Model

A model is proposed and explored that links the coming-out process to the psychological functioning (i.e., self-esteem and distress) and sexual behaviors of gay, lesbian, and bisexual youths recruited from gay-focused community-based and college organizations in New York City. The coming-out process is multidimensional, consisting, as defined here, of involvement in gay/lesbian activities, attitudes toward homosexuality, comfort with homosexuality, self-disclosure of sexual identity to others, and sexual identity. The coming-out dimensions were related to self-esteem, distress, and unprotected sexual behaviors. In addition, the relations between the coming-out dimensions and unprotected sexual behaviors were explained by psychological functioning. In particular, limited involvement in gay/lesbian activities was associated with more unprotected sex. Negative attitudes toward homosexuality were related directly to more unprotected sex, and they were related indirectly to more unprotected sex by means of increasing emotional distress. These and other findings have implications for designing preventive interventions to increase the youths psychological functioning and reduce their unprotected sexual behaviors.

The psychosexual development of urban lesbian, gay, and bisexual youths

An examination of cognitive sexual orientation, sexual partner activity, and sexual identity was conducted among 76 lesbian/bisexual female youths and 80 gay/bisexual male youths (age range of 14–21 years) recruited from community‐based or college organizations for lesbian / gay youths in New York City. Self‐identification as lesbian / gay or bisexual changed over time; more than half the youths who identified as lesbian / gay at the interview had considered themselves bisexual in the past, and vice versa. A modal developmental sequence of cognitions and behaviors was found: Most youths first became aware of a cognitive sexual orientation (e.g., attractions and fantasies) toward the same or other sex, then considered a lesbian / gay or bisexual identity, and finally felt certain of a lesbian / gay or bisexual identity. Age at initiation of sexual activity with females or males was inconsistently related to this pattern. Significant gender differences indicated that females were older than males when they ...

Timing of HIV Interventions on Reductions in Sexual Risk Among Adolescents

Examined the effectiveness of an HIV intervention program among 151 adolescents ages 13 to 24 years who were randomly assigned to (a) seven sessions of 1.5 hr each (10.5 hr); (b) three sessions of 3.5 hr each (10.5 hr); or (c) a no-intervention condition. Using cognitive-behavioral intervention strategies, social skills and HIV-related beliefs, perceptions, and norms were targeted in both the three- and seven-session, small-group intervention conditions. Regression analysis indicated that over 3 months, the number of unprotected risk acts and the number of sexual partners were lower in the seven-session condition compared to the other conditions. Factors mediating risk acts changed in a complex manner: For example, perceived vulnerability increased for those with initially lower vulnerability scores among youths in the seven-session condition compared to others. Self-approval of condom use was also higher for those with initially low scores in the seven-session compared to the three-session condition. Self-efficacy for risk avoidance and condom use was significantly higher in the three-session condition for those with initially low scores compared to other groups. On the role-play measure, those with higher baseline scores in the low-pressure situation improved significantly only in the three-session intervention; in the high-pressure situation, the participants reported significantly higher scores in the seven-session intervention, and those with higher scores improved the most. Results suggest the importance of multisession HIV intervention programs to be delivered with fidelity in community settings.

HIV Testing, Behaviors, and Knowledge Among Adolescents at High Risk

PURPOSEnWe examined HIV testing behavior and its predictors among adolescents considered at high risk for HIV.nnnMETHODSnSelf-reports of HIV testing, knowledge, attitudes, and high-risk acts were examined among 272 adolescents aged 13-23 years (M = 18.7; SD = 2.3) attending community-based agencies that serve youth at high risk for HIV in Los Angeles, New York City, and San Francisco.nnnRESULTSnEvidence of adolescents risk for HIV is reflected in a rate of 4.8% seropositivity, 24% injecting drug use, a mean of 4.3 (SD = 11.6) sexual partners during the previous 3 months, and 71% condom use during vaginal/ anal sex. HIV testing was common (63%) and often repeated (M = 3.6, SD = 4.0). Knowledge of the meaning and consequences of testing was high (84% correct). Contrary to service providers expectations, youth were likely to return for their test results (90% returned). Youth who were older, labeled themselves gay or bisexual, lived in Los Angeles or San Francisco, and those who injected drugs were significantly more likely, compared to peers, to get tested for HIV.nnnCONCLUSIONSnThese results suggest a need for more detailed observational studies of HIV testing behavior that include evaluation of characteristics of the youth, the testing site, and the attitudes and beliefs of providers offering HIV testing.

Runaway and Homeless Youths

The number of youths who run away or are forced from their homes and become homeless is a growing and significant problem. Many of these young people have left or been forced from dysfunctional or abusive families only to face a life on the streets that can bring a variety of negative outcomes: poverty, substance abuse, physical and sexual assault, pregnancy, injury or illness, HIV infection, psychological and emotional problems, and suicide (Kennedy, 1991; Rotheram-Borus, Rosario, & Koopman, 1991; Rotheram-Borus & McDermott, 1995). Furthermore, their prospects for a healthy and productive adulthood are reduced by the health risks they face and the lack of educational and employment opportunities for homeless youths. Over the last 10 years, researchers have documented the breadth of these problems. The goals of this chapter are: to examine the extent and course of homelessness; to describe the health status of homeless youths; to identify the risk factors and potential strategies for prevention of the consequences of homelessness; to describe a model program for homeless youths; and to identify structural barriers to effective implementation of health care for homeless youths.

Understanding the unprotected sexual behaviors of gay, lesbian, and bisexual youths: an empirical test of the cognitive-environmental model.

The cognitive-environmental model (CEM; M. Fishbein et al., 1991) was used to understand the unprotected sexual behaviors of 156 gay, lesbian, and bisexual youths. Unprotected anal sex among the males was associated directly with poor protection skills (e.g., incorrect use of barrier methods, such as condoms), poor intentions to use barrier methods, and poor norms by sexual partners concerning barrier methods. Furthermore, the association between low self-efficacy and increasing unprotected anal sex was attributed to poor intentions. Direct associations of unprotected oral sex with poor intentions and poor partner norms also emerged, as did an indirect relation between unprotected oral sex and low self-efficacy via poor intentions. These last 3 findings were replicated when examining unprotected oral or vaginal-digital sex among the females. Relations among the CEM factors supported some CEM-theoretical propositions.

Beliefs and behavioral intentions regarding human immunodeficiency virus testing among New York city runaways

From 1988 to 1991, 139 runaways aged 11-19 years in the New York City area (n = 70 males, 69 females) were recruited from four shelters. Each runaway participated in a semistructured interview assessing beliefs and behavioral intentions regarding human immunodeficiency virus (HIV) testing. When asked how they would respond to being seropositive for HIV, 29% of runaways reported that they would engage in self-destructive acts and/or harm others (e.g., suicide, unprotected sex), 80% anticipated extreme distress, 47% expected difficulty securing housing and food, and 61% believed that friends were likely to avoid them. When presented with specific alternatives, fewer runaways anticipated self-destructive acts. Drug use, rather than sexual behaviors, would lead runaways to get tested for HIV. These results suggest that health-care providers must anticipate emotional distress and potential self-destructive behavior following receipt of documentation of HIV positive serostatus among runaways. Furthermore, prior to testing, youths access to food, shelter, medical care, and social support must be secured.