"A Community Sounds Like Communism": Notions of Gay Community and "Community Belonging Contradiction" Among Bulgarian Non-Heterosexual Males.

The term "gay community" has been criticized for its inability to explain the pluralities in a specific cultural and political context. Based on in-depth interviews with 63 non-heterosexual males in Bulgaria, this study aims to revisit the theories of gay communities in a non-Western, post-communist context. The data from this study suggest that (1) the idea of a "gay community" is often rejected due to anti-communist notions and explicit engagement with individualism as anti-communitarianism; (2) belonging to a gay community is subjective, and initial verbal detachment from gay communities does not indicate a lack of factual belonging to such communities; (3) the concepts of "personal communities" and "family of choice" remain relatively irrelevant in the Bulgarian context; (4) the most significant factor for attachment to a gay community is the notion of "gay culture" and "gay scene"; (5) recent forms of "sexual attachments" have led to a certain political involvement; and (6) the "anti-gender campaigns" have revitalized the importance of gay communities and have brought an increasing number of respondents to certain involvement in gay communities and networks, challenging the theories of "post-gay" societies.

Gay Community Stress in Sexual Minority Men and Women: A Validation Study in the Netherlands.

Intraminority gay community stress theory posits that social stressors within sexual minority communities of men may be risk factors for mental health problems in gay and bisexual men. The recently developed 20-item Gay Community Stress Scale (GCSS) is a valid and reliable measure of gay community stress, but was not yet validated in the Netherlands. This study developed a Dutch-translated version of the GCSS and validated this scale in sexual minority men and sexual minority women, as it was hypothesized that sexual minority women may also experience intraminority stress. Exploratory and confirmatory factor analyses were subsequently performed in independent samples of men and women, and produced a 16-item GCSS for men and a 12-item GCSS for women. The four-factor structure of the original GCSS was replicated in men and women, and encouraging support for discriminant and concurrent validity of the GCSS was found in both men and women. The total scale and subscales were internally consistent in men (α and ω ≥ .87) and in women (α and ω ≥ .78). The Dutch-translated GCSS seems to offer a valid and reliable way to assess intraminority stress in Dutch-speaking sexual minority men and sexual minority women, although further validation is warranted.

Status, sexual capital, and intraminority body stigma in a size-diverse sample of gay men.

Gay men are more likely than heterosexual men to experience social pressure based on body weight, shape, and muscularity, which may drive disparities in body image concerns and eating disorders. Utilizing a sample of 1723 gay men living in the United States, the present study examined whether sociodemographic factors (used as proxies for status and sexual capital) and frequency of attending gay-specific establishments or gatherings (community involvement) were associated with gay men's experiences of negative or discriminatory pressures based on body size and shape specifically from other gay men (intraminority body stigma). Experiences of intraminority body stigma were significantly more common among gay men who identified as higher-weight (r = 0.28), less masculine (r = -0.21), less wealthy (r = -0.21), younger (r = -0.21), or people of color (ds = 0.25-0.28). Furthermore, indicators of low status and sexual capital were indirectly associated with less frequent community involvement via more frequent experiences of intraminority body stigma. In addition to frequency, the valence of interactions between gay men should be considered when assessing body image and eating disorder risk in this population. Future research is encouraged to examine intraminority body stigma as an intersectional source of intraminority stress to inform prevention and treatment efforts for gay men.

Development and Validation of the Gay-Specific Intraminority Stigma Inventory (G-SISI): Initial Evidence Underpinned by Intraminority Stress Theory.

There is currently a lack of measures testing intraminority stress within gay men. Therefore, the current study sought to develop and psychometrically test the Gay-Specific Intraminority Stigma Inventory (G-SISI). Based on a content review of the literature and a panel of experts, a pool of items assessing gay men's perceived exposure to a range of discriminatory attitudes from other gay men was generated. Utilizing a randomly split sample of 1723 gay men between the ages of 19 and 79 years, an exploratory factor analysis was first performed (n = 861). The remaining unexamined data were then used to conduct a confirmatory factor analysis (n = 862). The results support a six-factor model: (1) Age Stigma, (2) Socioeconomic Stigma, (3) Gay Non-Conformity Stigma, (4) Racial Stigma, (5) Gender Expression Stigma, and (6) Body Stigma. Cronbach's alpha for the total scale was 0.90 and for the subscales ranged from 0.60 to 0.85. Sociodemographic factors and measures of community involvement were differentially associated with the G-SISI subscales, providing evidence of construct validity. The findings demonstrate initial support for the dimensionality and validity of the G-SISI, which targets modifiable factors (e.g., identity-based stigma) that may increase stress and reduce community coping resources among gay men with diverse identities.

Development and Validation of Two Abbreviated Intraminority Gay Community Stress Scales.

Social stressors stemming from within the gay community might render gay and bisexual men vulnerable to mental health problems. The 20-item intraminority Gay Community Stress Scale (GCSS) is a reliable measure of gay community stress, but the scale's length limits its widespread use in sexual minority mental health research. Using three independent samples of gay and bisexual men, the present research developed two abbreviated versions of the GCSS using nonparametric item response modeling and validated them. Results indicated that eight items provided maximal information about the gay community stress construct; these items were selected to form the eight-item GCSS. The eight-item GCSS reproduced the factor structure of the parent scale, and gay community stress scores obtained from it correlated with other identity-specific social stress constructs and mental health symptoms. Associations between gay community stress and mental health symptoms remained significant even after controlling for related identity-specific stressors, general life stress, and relevant demographics. A four-item version was also developed and assessed, showing good structural, convergent, criterion, and incremental validity and adequate reliability. The eight- and four-item versions of the GCSS offer efficient measures of gay community stress, an increasingly recognized source of stress for gay and bisexual men.

COVID-19 Testing in a Weekly Cohort Study of Gay and Bisexual Men: The Impact of Health-Seeking Behaviors and Social Connection.

Gay, bisexual, and other men who have sex with men (GBM) have developed community norms for regular HIV/STI testing. We investigated factors associated with self-reported COVID-19 testing in response to reported COVID-19 cases and public health restrictions. Participants responded to weekly cohort surveys between 10th May 2021 and 27th September 2021. We used the Andersen-Gill extensions to the Cox proportional hazards model for multivariable survival data to predict factors influencing COVID-19 testing. Mean age of the 942 study participants was 45.6 years (SD: 13.9). In multivariable analysis, GBM were more likely to report testing during periods of high COVID-19 caseload in their state of residence; if they were younger; university educated; close contact of someone with COVID-19; or reported coping with COVID-19 poorly. COVID-19 testing was higher among men who: were more socially engaged with other GBM; had a higher proportion of friends willing to vaccinate against COVID-19; and were willing to contact sexual partners for contact tracing. Social connection with other gay men was associated with COVID-19 testing, similar to what has been observed throughout the HIV epidemic, making community networks a potential focus for the promotion of COVID-19 safe practices.

Changing Levels of Social Engagement with Gay Men Is Associated with HIV Related Outcomes and Behaviors: Trends in Australian Behavioral Surveillance 1998-2020.

Changes to how gay, bisexual, and other men who have sex with men (GBM) connect with each other and with their communities have implications for HIV prevention. Social engagement with gay men (defined as having friends who are gay men and spending time with them) has been associated with HIV related outcomes over time among Australian GBM. Using data collected in national, repeated, cross-sectional surveys of GBM between 1998 and 2020 (N = 161,117), analyses of trends in the prevalence of gay social engagement (GSE) in Australia were conducted using linear regression. To assess changing associations with GSE at different time points in the HIV epidemic, three cross-sectional analyses were conducted on factors associated with high and low GSE in 1999/2000, 2009/2010, and 2019/2020 using bivariate and multivariable logistic regression. GSE (scored from 0 to 7) declined among all participants from 4.76 in 1998 to 4.04 in 2020 (p < 0.001) with a steeper decline among GBM aged under 25 years from 4.63 in 1998 to 3.40 in 2020 (p < 0.001). In all timepoints, high GSE was associated with older age, being university educated, full time employment, identifying as gay, recent HIV testing, and PrEP uptake. While mostly associated with protective behaviors, high GSE was also associated with some practices that may put GBM at risk of HIV infection such as drug-enhanced sex and group sex in the most recent timepoint. Changing levels of GSE have implications for health promotion among GBM, particularly how to engage GBM less connected to gay social networks.

Recruiting an underserved, difficult to reach population into a cancer trial: Strategies from the Restore-2 Rehabilitation Trial for gay and bisexual prostate cancer patients.

BACKGROUND/AIMS: Sexual minorities are small and under-researched populations that are at disproportionate risk for cancer and poor cancer outcomes. Described as a "hidden population," the principal research challenge has been to develop effective methods to identify and recruit such cancer patients into cancer studies. Online recruitment strategies, as well as targeted clinic recruitment using patient-entered sexual orientation and gender identity data from electronic medical records have potential to transform recruitment, but studies testing the effects of how to recruit using these have not been published. METHODS: In 2019, we conducted a naturalistic, three-arm, stratified prospective study to compare three recruitment strategies: (a) clinic based recruitment of prostate cancer patients from gay health and urology clinics; (b) directly from the gay community; and (c) online recruitment (through cancer support, sex/dating, and social sites). For each strategy, we estimated time, workload, and direct costs involved. To study how recruitment strategy may affect sampling, we tested for retention rates, demographic and outcome differences across sites. Using these methods, we successfully recruited 401 gay and bisexual prostate cancer patients into a randomized, controlled, 24-month trial testing an online sexual and urinary rehabilitation curriculum tailored for this population. RESULTS: There were seven key results. First, it is possible to recruit substantial numbers of sexual minority men into prostate cancer studies provided online recruitment methods are used. Second, we observed big differences in dropout during study onboarding by recruitment source. Third, within online recruitment, the online sex/dating application (app) was the most successful and efficient, followed by the cancer support site, and then the social networking site. Fourth, while clinics were the cheapest source of recruitment, they were time intensive and low in yield. Fifth, the cancer support site and sex/dating app recruits differed by several characteristics, with the former being more rehabilitation-focused while the latter were younger and more sexually active. Sixth, we found almost no differences in outcomes across the three online recruitment sites. Seventh, because retention in online studies has been a concern, we confirm very low attrition at 3- and 6 months into the trial. CONCLUSION: For sexual minority cancer research, more research on how to use sexual orientation and gender identity electronic medical record data for clinic-based recruitment is needed. For other small or hard-to-reach populations, researchers should compare and publish online versus offline recruitment strategies.

Gearing up for PrEP in the Middle East and North Africa: An Initial Look at Willingness to Take PrEP among Young Men Who Have Sex with Men in Beirut, Lebanon.

The Middle East and North Africa (MENA) is one of only two global regions where rates of HIV are currently on the rise. In Lebanon, new HIV infections are increasing most rapidly among young men who have sex with men (YMSM). While, the majority of YMSM in Lebanon report having recently engaged in condomless anal intercourse, many report reluctance to seek HIV prevention services for fear of stigma and discrimination. Pre-exposure prophylaxis (PrEP) is an effective alternative HIV prevention strategy but there is a dearth of research looking at willingness to take PrEP among YMSM in MENA. This study is the first to delineate factors associated with willingness to take PrEP among a cohort of 218 YMSM recruited from Beirut, Lebanon. Over half (55.5%) reported willingness to take PrEP. At the bivariate level, knowledge of HIV risk, awareness of PrEP, being in a relationship, greater judgementalism about sex in communication with peers, greater number of types of gay-related discrimination experienced, sense of community among YMSM, having had recent condomless anal sex with positive or unknown status partner, and the use of substances just prior to or during sex were each associated with greater willingness to take PrEP. When entered into a linear regression analysis, use of substances just prior to or during sex and sense of community among YMSM remained significant predictors of PrEP willingness. Intervention efforts focused on increasing PrEP uptake among YMSM in MENA should consider the influence substance use and social factors on willingness to take PrEP.

Assessing the Role of Gay Community Attachment, Stigma, and PrEP Stereotypes on Young Men Who Have Sex with Men's PrEP Uptake.

Negative stereotypes about pre-exposure prophylaxis (PrEP) hinder PrEP uptake among young men who have sex with men (YMSM). Prior research suggests community homophobia may be linked to negative PrEP attitudes. Conversely, individuals with high gay community attachments (GCA) may have more access to credible PrEP information/resources. Among 285 YMSM recruited online, we estimated structural equation models to test competing conceptual models that inform pathways from perceived stigmas, GCA, and negative PrEP stereotype endorsements to PrEP uptake. In Model A, perceived stigma was directly associated with PrEP uptake, partially mediated by stereotype endorsement (ß = - 0.05; 95% CI [- 0.09, - 0.01]) and GCA (ß = - 0.06; 95% CI [- 0.11, 0.02]). In Model B, perceived stigma was associated with PrEP uptake (ß = - 0.07; 95% CI [- 0.14, - 0.01]) through stereotype endorsement among high GCA YMSM. Complemented by anti-stigma initiatives, PrEP outreach for YMSM should utilize sex-positive messaging and disentangle negative PrEP stereotypes within gay-centric social spaces.

RESUMEN: Los estereotipos negativos sobre la profilaxis pre-exposición (PrEP) dificultan su uso entre hombres jóvenes que tienen sexo con otros hombres (YMSM). Investigaciones anteriores sugieren que la homofobia comunitaria puede estar relacionada a las actitudes negativas sobre PrEP. En cambio, personas con alto apego a la comunidad gay (GCA) pueden tener más acceso a información y recursos creíbles sobre PrEP. Entre los 285 YMSM reclutados en línea, estimamos varios modelos de ecuaciones estructurales para contrastar las asociaciones entre los estigmas percibidos, la GCA, los estereotipos negativos sobre PrEP, y el uso de PrEP entre diversos modelos conceptuales. En el Modelo A, el estigma percibido se asoció directamente con el uso de PrEP, siendo parcialmente mediado por el endoso a estereotipos (ß = − 0.05; IC del 95% [− 0.09, − 0.01]) y GCA (ß = − 0.06; IC del 95% [− 0.11, 0.02]). En el Modelo B, el estigma percibido se asoció con el uso de PrEP (ß = − 0.07; IC del 95% [− 0.14, − 0.01]) a través de los estereotipos entre YMSM con puntajes altos en GCA. Complementado con iniciativas contra el estigma, el alcance de la PrEP para YMSM debe utilizar mensajes de sexo positivo y desenredar los estereotipos negativos de PrEP dentro de los espacios sociales centrados en la comunidad gay.

The Gay Community Involvement Index: An Exploratory Factor Analysis and Initial Validation of a New Measure of Gay Community Involvement.

This article details initial measure development, exploratory factor analysis, and preliminary validation of the Gay Community Involvement Index (GCII) across two studies. Previous research on gay community involvement has relied on measures that do not distinguish between distinct ways in which men may be involved in the gay community (e.g., going to bars and clubs vs. advocating for political issues). The GCII is a new multidimensional measure of the type and intensity of participation in a variety of activities within the gay community. Exploratory factor analysis suggested four subscales: Community Activities, Nightlife, Media, and Political Activism. We report strong evidence for internal consistency within subscale scores, as well as both convergent and discriminant validity for subscale scores. This measure may help those researching gay men's health and well-being better understand the impact of different types of community involvement on health and psychosocial outcomes.

Complex Intimacy: Theorizing Older Gay Men's Social Lives.

This qualitative study explores the social lives of older gay men. In-depth interviews were conducted with 10 gay men over the age of 65 to elicit details about their relationships with other people. Findings paint a complex picture of older gay social life that is compounded by significant events affecting gay men from a particular socio-historical period. Three overarching themes emerged that capture the social lives of the participants: (1) coming of age as a gay man in the 20th century; (2) dealing with the aging body; and (3) enduring loss and the consequent impact on social life. The participants reported that being in a gay environment and closing the gay generational divide helped them adjust to their changing social lives in later life. This study adds to the ongoing discussion about the experiences of older gay men and makes suggestions for future research and practice considerations.

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

BACKGROUND: 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. METHOD: 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. RESULTS: 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. CONCLUSION: 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.

Queer space and alternate queer geographies: LBQ women and the search for sexual partners at two LGBTQ-friendly U.S. universities.

The postgay era - marked by decreased stigmatization of non-heterosexual identities and increasing assimilation of gays and lesbians into the heterosexual mainstream - may be indicative of a broader pluralization of queer geographies expanding the social and sexual opportunities of lesbian, gay, bisexual, transgender, and queer (LGBTQ)-identified individuals beyond queer spaces. Less is known, however, about how LBQ women experience these pluralized geographies in a postgay era in their search for sexual partners, and how the perceived accessibility of queer and heterosexual spaces informs the search process. Drawing upon twenty-six in-depth qualitative interviews, this study examines queer-identified undergraduate women's searches for same-sex sexual partners at two LGBTQ-friendly universities in the United States. The women in this study described experiences with dating, sex and relationships within three distinct campus "sexual geographies" - queer spaces, virtual communities and heteronormative campus parties - with entry to each of these sites negotiated in relationship to place-based gender and sexual dynamics. While women at both schools viewed their LGBTQ communities as viable spaces to both build community and meet potential sexual partners, this was paired with the understanding that one needed sufficient "queer capital" to stake a claim there. Counter to the notion that a postgay era has rendered queer space obsolete, or just one of many options, this study suggests that perceptions of queer community spaces as exclusionary or inaccessible may partially contribute to the production of alternative queer geographies beyond marked LGBTQ campus spaces.

Cognitive, Regulatory, and Interpersonal Mechanisms of HIV Stigma on the Mental and Social Health of Men Who Have Sex With Men Living With HIV.

Public stigma surrounding HIV is related to heightened emotional distress, poor psychological functioning, and reduced subjective well-being in people living with HIV. For men who have sex with men (MSM) living with HIV, they may also face stigmatizing attitudes within the gay community, which create an additional burden to their health. Grounded in the psychological mediation framework, the present study examined the underlying psychological processes through which HIV stigma from the public and within the gay community influences the mental and social health of MSM living with HIV. Findings from 206 Chinese MSM living with HIV in Hong Kong indicated that negative self-concept, maladaptive coping, and peer isolation mediated the effect of HIV stigma on mental and social health. The study revealed the cognitive, regulatory, and interpersonal processes underlying HIV stigma and health. Feeling intense HIV stigma from the public and within the gay community may render MSM living with HIV more vulnerable to negative self-concept, maladaptive coping, and peer isolation, which contribute to poor mental and social health. To combat prejudice and discrimination against people living HIV, stigma reduction initiatives should be implemented not only in the public, but also in the gay community. Cognitive-behavioral interventions can also be used to restructure negative self-beliefs and build adaptive emotion regulation skills, which can improve stigma-related health outcomes among MSM living with HIV.

What is the Role of the Community? Examining Minority Stress Processes among Gay and Bisexual Men.

Gay and bisexual men suffer from higher rates of mental health disorders than their heterosexual counterparts. Minority stress theory provides the framework for much research that seeks to explain this discrepancy. Recently, several studies have also examined the role of connection with the gay community with mixed results. Operationalizing gay community connectedness in terms of two separate constructs-community involvement and community identification-this study sought to examine and compare the role that each of these factors plays in affecting gay and bisexual men's mental health. We analyzed data from 371 gay and bisexual men in New York City, focusing on measures of minority stress factors, gay community connectedness, and mental health outcomes. As hypothesized, factor analysis showed that the community connectedness scale loaded onto two sub-factors corresponding to the theorized constructs of identification and involvement. Linear regression models adjusting for potential confounding factors showed that community involvement was significantly associated with better mental health outcomes. Community involvement also significantly moderated the impact of internalized homonegativity on mental health. This factor was not a significant moderator of the impact of sexual orientation discrimination on mental health, and community identification was not significantly associated with mental health outcomes. It also did not significantly moderate the effect of either minority stress factor. Future research would benefit from developing an updated and highly reliable measure of community involvement.

This is who we are: building community for HIV prevention with young gay and bisexual men in Beirut, Lebanon.

Young gay men in Beirut are at significantly elevated risk of HIV infection compared with the general Lebanese population. Despite nascent HIV prevention efforts in the region, there is a need for effective community-level HIV prevention interventions tailored for young gay men. This qualitative study examined internal dynamics within Beirut's gay community as a basis for developing community-level interventions. Peer ethnographers were trained to collect field notes on conversations between young gay men in public spaces in Beirut, and conducted follow-up focus groups with young gay men. Analyses revealed three major themes: (1) the need for safe spaces in which to socialise, (2) the importance of being able to locate and connect with other young gay men, and (3) ambivalence regarding a gay community that was supportive in some ways but also fragmented and often judgemental. Study findings also confirm the existence of external threats to community such as stigma, cultural and familial norms regarding heterosexuality and criminalisation of refugee status. Understanding such community dynamics and the environmental context is central to designing effective community-based HIV prevention programmes.

The rush to risk when interrogating the relationship between methamphetamine use and sexual practice among gay and bisexual men.

Much research concerning drug use in the context of sexual activity among gay and bisexual men derives from public health scholarship. In this paper, we critically examine how the relationship between methamphetamine use and sexual risk practice is treated and understood in this body of research. While public health has made important contributions to establishing the link between methamphetamine use and sexual risk-taking, the precise nature of the relationship is not well defined. This creates space for ungrounded assumptions about methamphetamine use to take hold. We outline what appear to be two dominant interpretations of the methamphetamine/sexual practice relationship: the first proposes that methamphetamine has specific pharmacological properties which lead to sexual disinhibition, risky behaviour and poor health outcomes; the second proposes that methamphetamine attracts men who are already inclined toward highly sexualised interactions and risky practice, and that such men are likely to engage in these practices with or without drugs. We suggest that both interpretations are problematic in that they individualise and cast drug and sex practices as inherently risky and biopsychologically determined. We outline a more historically, socially and politically engaged way to understand methamphetamine use in the context of sexual activity by drawing on the concept of sex-based sociality and the ways in which gay and bisexual men may use methamphetamine and sex as social resources around which to build identities, establish relationships, participate in gay communities, and maximise pleasure while protecting themselves and others from harm.

Ambivalently post-lesbian: LBQ friendships in the rural Midwest.

Using data from friendship interviews with lesbian, bisexual, and queer women in a small Midwestern city, I argue that non-urban communities might be characterized as ambivalently post-lesbian, as participants explain that shared identities "don't matter" in their friendships, while continuing to insist on the relevance of lesbian identity in their community. This research highlights three sets of concerns about lesbian communities, identities, and friendships. First, given the theoretical purchase of the concept of "post-gay" communities, there is a parallel need to develop the concept of "post-lesbian" as uniquely ambivalent and distinct from post-gay discourses, as the case of LBQ friendship demonstrates. Second, the appearance of post-lesbian narratives beyond major cities suggests a need to reassess the presumably progressive post-gay narrative that gay identities are becoming less central to gay lives. Finally, a focus on close lesbian friendships highlights the central role such relationships continue to play in constituting, and perhaps dismantling, lesbian identities and communities.

Internalized Homophobia and Drug Use in a National Cohort of Gay and Bisexual Men: Examining Depression, Sexual Anxiety, and Gay Community Attachment as Mediating Factors.

The minority stress process of internalized homophobia (IH) has been associated with a range of adverse health outcomes among gay and bisexual men (GBM). However, evidence is mixed regarding the effect of IH on drug use, suggesting the potential role of multiple mediated pathways. Researchers have linked depression, sexual anxiety, and gay community attachment with IH. Depression, sexual anxiety, and gay community attachment have also been linked with drug use and drug-related problems suggesting potential mediating roles. A U.S. national sample of 1071 HIV-negative GBM completed at-home surveys, including measures of sociodemographic characteristics, IH, depression, sexual anxiety, gay community attachment, and drug use and associated problems. Adjusting for sociodemographic characteristics, depression mediated the association between IH and recent drug use. IH was positively associated with depression, and depression was positively associated with recent drug use. Gay community attachment partially mediated drug-related problems. IH had a positive direct association with drug-related problems and a negative direct association with gay community attachment. Gay community attachment had a positive association with drug-related problems. IH was positively associated with sexual anxiety, but sexual anxiety was not associated with either drug outcome. Efforts to reduce IH among HIV-negative GBM are likely to have a positive impact on mental health problems, as well as reduce risk for drug use and drug-related problems. Gay communities could provide the social support necessary for reducing IH; however, emphasis on community level interventions that address factors that increase risk for drug-related problems remains important.