Michael E. Newcomb

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.

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.

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

OBJECTIVEnYoung 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.nnnMETHODnOne 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.nnnRESULTSnThe 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.nnnCONCLUSIONSnThese 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.

Mental Health of Lesbian, Gay, and Bisexual Youths: A Developmental Resiliency Perspective

Research suggests that lesbian, gay, and bisexual (LGB) youths are at increased risk for both victimization and internalizing mental health problems, but limited research has studied their association or factors that increase resilience. The sample in this study included 425 LGBs between the ages of 16 and 24 years. The majority had disclosed their sexual orientation to family or friends (98%), and 97% had someone in their lives who was accepting of their orientation. Racial/ethnic minority and female participants in general reported lower levels of disclosure and acceptance. Most participants reported some form of sexual orientation-related victimization (94%). Victimization was associated with psychological distress, but a compensatory model indicated that in the context of this victimization both peer and family support had significant promotive effects. A test of a protective model found social support did not ameliorate negative effects of victimization. The positive effects of family support decreased with age. Peer and family support were particularly important, but they did not significantly dampen the negative effects of victimization. Findings suggest that mental health professionals working with LGB youths should address social support and that public health approaches are needed to reduce levels of victimization.

Moderators of the Relationship Between Internalized Homophobia and Risky Sexual Behavior in Men Who Have Sex with Men: A Meta-Analysis

Research on internalized homophobia (IH) has consistently linked it to both mental and physical health outcomes, while research on its relationships with other variables has been inconsistent. Some research and theory support the association between IH and risky sexual behavior, but much of this research has been plagued by methodological issues, varying measures, and has produced inconsistent findings. Coming to a better understanding of the utility of IH as a potential mechanism or predictor of risky sex in men who have sex with men (MSM) may help to inform future studies of HIV risk in this population as well as the development of prevention interventions. The current study used hierarchical linear modeling to perform meta-analysis combining effect sizes across multiple studies of the relationships between IH and risky sexual behavior. Additionally, the use of multilevel modeling techniques allowed for the evaluation of the moderating effects of age, year of data collection, and publication type on this relationship. Sixteen studies were meta-analyzed for the relationship between IH and risky sexual behavior (Nxa0=xa02,837), revealing a small overall effect size for this relationship. However, a significant moderating effect was found for the year of data collection, such that the correlation between these two variables has decreased over time. The current utility of this construct for understanding sexual risk taking of MSM is called into question.

Sensation Seeking Moderates the Effects of Alcohol and Drug Use Prior to Sex on Sexual Risk in Young Men Who Have Sex with Men

Men who have sex with men (MSM) account for more than half of all new HIV/AIDS diagnoses in the United States each year, and young MSM (ages 13–24) have the highest increases in new infections. Identifying which young MSM engage in sexual risk-taking in which contexts is critical in developing effective behavioral intervention strategies for this population. While studies have consistently found positive associations between the use of certain drugs and sexual risk, research on alcohol use as a predictor of risk has been less consistent. Participants included 114 young MSM from a longitudinal study of LGBT youth (ages 16–20 at baseline). Participants reported number of unprotected sex acts with up to nine partners across three waves of data collection spanning a reporting window of 18xa0months, for a total of 406 sexual partners. Sensation seeking was evaluated as a moderator of the effects of both alcohol and drug use prior to sex on sexual risk. Higher levels of sensation seeking were found to significantly increase the positive associations between frequency of unprotected sex and frequency of both alcohol use and drug use with partners. Follow-up analysis found that average rates of alcohol use moderated the association between alcohol use prior to sex and sexual risk, such that decreases in average alcohol use increased the positive association between these variables. Results suggest that while drug use with partners increased sexual risk for all young MSM, the effects of alcohol use prior to sex were limited in low sensation-seeking young MSM as well as those who are high alcohol consumers on average. Implications for future research and behavioral interventions are discussed.

Unpacking the racial disparity in HIV rates: the effect of race on risky sexual behavior among Black young men who have sex with men (YMSM)

The purpose of this study is to evaluate the large disparity in HIV prevalence rates between young Black and White Americans, including young men who have sex with men (YMSM). Research focusing on individual behaviors has proven insufficient to explain the disproportionately high rate of HIV among Black YMSM. The purpose of the present study was to gain a greater understanding of the pronounced racial disparity in HIV by evaluating whether YMSM are more likely to engage in risky sexual behaviors as a function of their partner’s race. Participants included 117 YMSM from a longitudinal study evaluating lesbian, gay, bisexual, and transgender youth (ages 16–20 at baseline), who reported characteristics and risk behaviors of up to 9 sexual partners over an 18-month period. Results indicated that participants were less likely to have unprotected sex with Black partners, and this finding was not driven by a response bias (i.e., Black YMSM did not appear to be minimizing their reports of unprotected sex). Furthermore, there was support for the hypothesis that participants’ sexual networks were partially determined by their race insofar as sexual partnerships were much more likely to be intra-racial (as opposed to interracial). It is possible that dyad- and sexual network-level factors may be needed to understand racial disparities in HIV among YMSM.