Gay Community Integration as Both a Source of Risk and Resilience for HIV Prevention in Beirut
Tóm tắt
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.
Tài liệu tham khảo
Wohl AR, Galvan FH, Myers HF, et al. Do social support, stress, disclosure and stigma influence retention in HIV care for Latino and African American men who have sex with men and women? AIDS Behav. 2010;15(6):1098–110. https://doi.org/10.1007/s10461-010-9833-6.
Ryan P. Integrated theory of health behavior change. Clin Nurse Spec. 2009;23(3):161–70. https://doi.org/10.1097/nur.0b013e3181a423733.
Fergus S, Lewis MA, Darbes L, Butterfield RM. HIV risk and protection among gay male couples: the role of gay community integration. Health Educ Behav. 2005;32:151–71.
Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674–97. https://doi.org/10.1037/0033-2909.129.5.674.
Meyer IH. Minority stress and mental health in gay men. J Health Soc Behav. 1995;36(1):38. https://doi.org/10.2307/2137286.
Bogart LM, Wagner GJ, Galvan FH, Landrine H, Klein DJ, Sticklor LA. Perceived discrimination and mental health symptoms among Black men with HIV. Cult Divers Ethn Minor Psychol. 2011;17(3):295–302. https://doi.org/10.1037/a0024056.
Tao J, Wang L, Kipp AM, et al. Relationship of stigma and depression among newly HIV-diagnosed Chinese men who have sex with men. AIDS Behav. 2016;21(1):292–9. https://doi.org/10.1007/s10461-016-1477-8.
Preston DB, D’Augelli AR, Kassab CD, Starks MT. The relationship of stigma to the sexual risk behavior of rural men who have sex with men. AIDS Educ Prev. 2007;19(3):218–30. https://doi.org/10.1521/aeap.2007.19.3.218.
Hays RB, Paul J, Ekstrand M, Kegeles SM, Stall R, Coates TJ. Actual versus perceived HIV status, sexual behaviors and predictors of unprotected sex among young gay and bisexual men who identify as HIV-negative, HIV-positive and untested. AIDS. 1997;11(12):1495–502. https://doi.org/10.1097/00002030-199712000-00014.
Harper GW. Sex isn’t that simple: culture and context in HIV prevention interventions for gay and bisexual male adolescents. Am Psychol. 2007;62(8):806–19. https://doi.org/10.1037/0003-066x.62.8.806.
Walker JNJ, Longmire-Avital B, Golub S. Racial and sexual identities as potential buffers to risky sexual behavior for Black gay and bisexual emerging adult men. Health Psychol. 2015;34(8):841–6. https://doi.org/10.1037/hea0000187.
Mutchler MG, McDavitt BW, Tran TN, et al. This is who we are: building community for HIV prevention with young gay and bisexual men in Beirut, Lebanon. Cult Health Sex. 2017;20(6):690–703. https://doi.org/10.1080/13691058.2017.1371334.
Kippax S, Connell RW, Dowsett GW, Crawford J. Sustaining safe sex: gay communities respond to AIDS. London: Falmer Press; 1993.
Fergus S, Lewis MA, Darbes LA, Kral AH. Social support moderates the relationship between gay community integration and sexual risk behavior among gay male couples. Health Educ Behav. 2009;36(5):846–59.
McDavitt B, Mutchler MG. “Dude, you’re such a slut!” barriers and facilitators of sexual communication among young gay men and their best friends. J Adolesc Res. 2014;29(4):464–98. https://doi.org/10.1177/0743558414528974.
United Nations. The Joint United Nations Programme on HIV/AIDS. Regional report: Middle East and North Africa. Geneva, Switzerland. 2016.
Mahfoud Z, Afifi R, Ramia S, et al. HIV/AIDS among female sex workers, injecting drug users and men who have sex with men in Lebanon: results of the first biobehavioral surveys. AIDS. 2010;24(Suppl 2):S45–54. https://doi.org/10.1097/01.aids.0000386733.02425.98.
Heimer R, Barbour R, Khouri D, et al. HIV risk, prevalence, and access to care among men who have sex with men in Lebanon. AIDS Res Hum Retrovir. 2017;33(11):1149–54. https://doi.org/10.1089/aid.2016.0326.
O'Brien K, Wortman CB, Kessler RC, Joseph JG. Social relationships of men at risk for AIDS. Soc Sci Med. 1993;36(9):1161–7. https://doi.org/10.1016/0277-9536(93)90236-w.
Bingham T. Questionnaire from MyLife MyStyle Evaluation Study. Los Angeles: County Health Department; 2011.
Mutchler MG, McDavitt B. ‘Gay boy talk’ meets ‘girl talk’: HIV risk assessment assumptions in young gay men’s sexual health communication with best friends. Health Educ Res. 2010;26(3):489–505. https://doi.org/10.1093/her/cyq069.
Kegeles SM, Hays RB, Coates TJ. The Mpowerment Project: a community-level HIV prevention intervention for young gay men. Am J Publ Health. 1996;86(8_Pt_1):1129–36. https://doi.org/10.2105/ajph.86.8_pt_1.1129.
Hayes AF, Preacher KJ. Statistical mediation analysis with a multicategorical independent variable. Br J Math Stat Psychol. 2013;67(3):451–70. https://doi.org/10.1111/bmsp.12028.
Lohr SL. Sampling: design and analysis. Second ed. Boston: Brooks / Cole; 2010.
Institute SAS. The SAS System Version 9.4. [Computer Software]. 2013.
Crepaz N, Hart TA, Marks G. Highly active antiretroviral therapy and sexual risk behavior. JAMA. 2004;292(2):224. https://doi.org/10.1001/jama.292.2.224.
Peterson JL, Bakeman R. Impact of beliefs about HIV treatment and peer condom norms on risky sexual behavior among gay and bisexual men. J Commun Psychol. 2005;34(1):37–46. https://doi.org/10.1002/jcop.20082.