Gay Community Integration as Both a Source of Risk and Resilience for HIV Prevention in Beirut

Aspects of sexual identity development, including integration into gay community, have been found to be associated with sexual risk behavior among men who have sex with men (MSM), but not in the Middle East. Drawing on the minority stress model and integrated theory of health behavior, we examined the relationships between measures of sexual identity development and HIV protective behaviors (condomless anal sex and HIV testing) and the mediating roles of HIV knowledge, peer judgmentalism, and discrimination, in a sample of 226 young MSM in Beirut, Lebanon. A cross-sectional, mediation analysis was conducted using a bootstrapping approach and logistic regression models. Fifteen percent of the sample reported recent condomless anal sex with partners whose HIV status was positive or unknown, and 82.3% had ever been tested for HIV. Multivariate logistic regression analysis showed that greater integration into the gay community was significantly associated with having recent condomless anal sex with positive/unknown HIV status partners and having any history of HIV testing, after controlling for covariates. Knowledge of HIV risk was associated with gay integration as well as both condomless anal sex with positive or unknown HIV status partners and any history of HIV testing, but it only served as a (partial) mediator of HIV testing. Peer judgmental communication about sex and sexuality-related discrimination were related in bivariate analysis to gay integration and condomless anal sex, but they too did not prove to be significant mediators of the relationship between these two constructs. These findings highlight the potential sexual health benefits and vulnerabilities associated with increased integration into the gay community for young MSM in Beirut and the need to better understand how to increase HIV knowledge while limiting its potential to increase sexual risk behavior.