Culturally Relevant Africultural Coping Moderates the Association Between Discrimination and Antiretroviral Adherence Among Sexual Minority Black Americans Living with HIV.

Exposure to discrimination has been linked to lower HIV antiretroviral therapy (ART) adherence and poor HIV care outcomes among Black Americans. Coping has been shown to mitigate the harmful effects of discrimination on health behaviors, but the use of cultural relevant Africultural coping strategies is understudied as a moderator of the association between intersectional discrimination and ART adherence among Black Americans. We used adjusted logistic regression to test whether Africultural coping strategies (cognitive/emotional debriefing; collective; spiritual-centered; ritual-centered) moderated associations between multiple forms of discrimination (HIV, sexual orientation, race) and good ART adherence (minimum of 75% or 85% of prescribed doses taken, as measured by electronic monitoring in separate analyses) among 92 sexual minority Black Americans living with HIV. Mean adherence was 66.5% in month 8 after baseline (36% ≥ 85% adherence; 49% ≥ 75% adherence). Ritual-centered coping moderated the relationship between each of the three types of discrimination at baseline and good ART adherence in month 8 (regardless of the minimum threshold for good adherence); when use of ritual coping was low, the association between discrimination and adherence was statistically significant. The other three coping scales each moderated the association between racial discrimination and good ART adherence (defined by the 75% threshold); cognitive/emotional debriefing was also a moderator for both HIV- and race-related discrimination at the 85% adherence threshold. These findings support the benefits of Africultural coping, particularly ritual-centered coping, to help sexual minority Black Americans manage stressors associated with discrimination and to adhere well to ART.

Everyday Discrimination and HIV Testing Among Partnered Latino/x Sexual Minority Men in the United States: A Stratified Analysis by Birth Location.

We examined the association between everyday discrimination and HIV testing patterns-current (≤ 6 months), recent (7-12 months), and delayed (> 12 months or never tested)-among partnered Latino/x sexual minority men (SMM). Multinomial regression analyses revealed that in the full sample (N = 484) experiencing discrimination based on sexual orientation and race/ethnicity attributions concurrently (vs. no discrimination) was associated with higher odds of delayed (vs. current) HIV testing (AOR = 2.6, 95% CI [1.0, 6.7]). Similarly, in the subset of Latino/x SMM born outside the mainland U.S. (n = 209), experiencing concurrent sexual orientation- and race/ethnicity-based discrimination (vs. no discrimination) was associated with higher odds of recent (AOR = 12.4, 95% CI [1.3, 115.7]) and delayed HIV testing (AOR = 7.3, 95% CI [1.6, 33.0]), compared with current testing. Findings suggest that addressing discrimination may improve HIV testing uptake among partnered Latino/x SMM, particularly those born outside the U.S.

Actitudes hacia las sexualidades periféricas en estudiantes universitarios de La Rioja, Argentina y Huancayo, Perú / Attitudes towards peripheral sexualities in university studentsof a Rioja, Argentina and Huancayo, Peru

El objetivo del estudio fue conocer las actitudes hacia la diversidad sexual en escenarios aca-démicos de dos universidades públicas: La Rioja Argentina y la Universidad Nacional del Centro del Perú. Se comparó las características de las actitudes hacia las sexualidades periféricas en estudiantes de ambas universidades. La investigación se desarrolló bajo el enfoque cuantitati-vo, de tipo observacional, prospectivo y transversal,de nivel exploratorio, descriptivo-relacional, con diseño comunitario, dado que la unidad de estudio es la población y se da una exploración con comparaciones múltiples. La población estuvo constituida por 150 estudiantes de las carreras profesionales de Trabajo Social en ambas universidades. Los resultados eviden-cian tendencias favorables hacia actitudes positivas respecto a las personas LGBTI+, con dife-rencias significativas en las dimensiones cognitiva y conductual según universidad. Se encontró tambiénrelación significativa de las actitudes con la religión y el género de los estudiantes. (AU)

The objective of the study was to know the attitudes towards sexual diversity in academic set-tings of two public universities: La Rioja Argentina and the National University of the Center of Peru. The characteristics of attitudes towards peripheral sexualities in students from both universities were compared. The research was developed under a quantitative, observational, prospective, and cross-sectional approach, exploratory, descriptive-relational, with communi-ty design, since the unit of study is the population and an exploration with multiple compari-sons is given. The population was constituted by 150 students of the professional careers of Social Work in both universities. The results show favorable trends towards positive attitudes towards LGBTI+ people, with significant differences in the cognitive and behavioral dimen-sions, according to the university. A significant relationship was also found between attitudes with religion and the gender of the students. (AU)

Lifetime Prevalence and Sociodemographic Correlates of Multifactorial Discrimination Among Middle-Aged and Older Adult Men Who Have Sex with Men.

This study describes multifactorial discrimination (discrimination attributed to multiple social identities) among middle-aged and older adult MSM. MSM aged 40+ years (N = 1,193) enrolled in the Multicenter AIDS Cohort Study completed behavioral surveys ascertaining experiences of discrimination and their social identity attributions. Non-proportional odds regressions assessed multifactorial discrimination by age, race/ethnicity, HIV status, and covariates. Twenty-seven percent of participants reported multifactorial discrimination. Adjusted models indicated that middle-aged men were more likely to report multifactorial discrimination compared to older adult men. Racial/ethnic minorities were more likely to report multifactorial discrimination compared to non-Hispanic white participants. These same patterns emerged among the sub-sample of participants living with HIV. To our knowledge, this is the first assessment of multifactorial discrimination in middle-aged and older MSM. Our findings support the deleterious association between multiple-marginalization and multifactorial discrimination. Multilevel interventions targeting interconnected experiences of stigma may improve the health of MSM in transition to older age.

How to address the caveat of avoiding direct contact: Reducing prejudice towards gay and lesbian people in five Balkan countries.

In the Balkans, contact with gays and lesbians is typically hostile or avoided. Drawing from probability samples of young people from five Balkan countries (N = 1046), we examined whether it is possible to transfer the effects of contact with other marginalized outgroups (largest ethnic minority in every country, Roma, the extremely poor and physically disabled) to acceptance of gays and lesbians (secondary outgroup), and whether this relationship could be explained by attitude generalization and increased intergroup trust. Path analyses supported the secondary transfer effect: it confirmed that, while controlling for direct contact, contact with other marginalized groups was related to more acceptance of a secondary group; this relationship was mediated by trust. This was found across all primary groups in the combined samples, while the effect varied for different groups in country samples. The results add to the value of intergroup contact as a mean of prejudice-reduction.

Homofobia internalizada e satisfação sexual em casais homossexuais / Internalized Homophobia and sexual satisfaction on same-sex couples / Homofobia internalizada y satisfacción sexual en parejas homosexuales

Resumo Objetivo: O objetivo desta investigação foi observar a influência da religiosidade e da homofobia internalizada na satisfação sexual de casais do mesmo sexo. Method: Um estudo foi conduzido com 94 participantes, 49 homens e 45 mulheres, vivendo em um relacionamento estável com parceiro do mesmo sexo. A primeira hipótese é que altos níveis de homofobia internalizada e religiosidade influenciam negativamente na satisfação sexual de participantes em relacionamentos sexuais do mesmo sexo. Os dados foram coletados em pessoa com um instrumento auto-aplicável abordando: dados sociodemográficos, homofobia internalizada, experiência de homofobia externa, satisfação sexual e índice de religiosidade. Comparações de médias intragrupos foram realizada com análises unidirecionais ANOVA entre as variáveis estudadas. Em seguida, foi realizado o teste de correlação de Pearson entre as variáveis e, finalmente, uma análise de regressão linear tendo a Satisfação Sexual como variável de desfecho. Resultados: Os resultados indicaram níveis menores de satisfação sexual entre os grupos com maior homofobia internalizada, bem como uma diferença significante na satisfação de participantes com diferentes níveis de religiosidade, assim confirmando a hipótese prevista. Conclusão: Se discute que homofobia internalizada prevê negativamente a satisfação sexual de um sujeito, já que interfere com seu bem estar e que outras variáveis, como abertura e religiosidade, também se mostram relevantes neste contexto.

Abstract Objective: This research aimed to observe the influence of the following variables: internalized homophobia and religiosity related to sexual satisfaction on people who develop a relationship with those of the same sex. Method: 94 participants, 49 men and 45 women, living a stable relationship with a partner of the same sex, were sampled. The first hypothesis is that high levels of internalized homophobia and religiosity negatively impact on sexual satisfaction between people of same sex relationships. Data was collected by physical presence using a self-report questionaire focused on: socio-demographic, internalized homophobia, experience of external homophobia, sexual satisfaction and religiosity index. Comparisons with inter-groups mean through one-way analysis of variables ANOVA were considered. Then, Pearson's correlation test was performed between variables and, finally, an analysis of linear regression with sexual satisfaction as an outcome variable. Results: Showed lower levels of sexual satisfaction among groups with the highest internalized homophobia, as well as a significant difference in relation to satisfaction of people at different levels of religiosity, confirming in this way, the predicted hypothesis. Conclusion: It is discussed that internalized homophobia impacts negativetly on subject's sexual satisfaction as it interferes with their subjective well-being. Other variables, such as outness and religiosity, also show an impact on this context.

Resumen Objetivo: Observar la influencia de las variables homofobia internalizada y religiosidad en la satisfacción sexual de sujetos en relaciones con personas del mismo sexo. Método: Se realizó un estudio con 94 sujetos, 49 hombres y 45 mujeres, viviendo en una relación estable con pareja del mismo sexo. La hipótesis inicial es que altos niveles de homofobia internalizada y de religiosidad influencian de forma negativa la satisfacción sexual de sujetos en relaciones LGB. Los datos fueron recolectados de forma presencial con cuestionario auto-aplicable abordando aspectos sociodemográficos, homofobia internalizada, homofobia externa sufrida, satisfacción sexual e índice de religiosidad. Se realizaron comparaciones de media intergrupos con análisis unidireccional ANOVA entre variables estudiadas. Se realizó la prueba de correlaciones de Pearson entre las variables y, por fin, un análisis de regresión lineal teniendo como resultado la variable satisfacción sexual. Resultados: Estos apuntaron a menores niveles de satisfacción entre los grupos con mayor homofobia internalizada, así como para una diferencia significativa en la satisfacción de sujetos en niveles distintos de religiosidad, confirmando la hipótesis prevista. Conclusiones: Se discute que la homofobia internalizada prevé negativamente la satisfacción sexual del sujeto, a medida que interfiere en su bienestar subjetivo, y que otras variables, como apertura y religiosidad, también tienen una influencia relevante en este contexto.

HIV and Sexuality Stigma Reduction Through Engagement in Online Forums: Results from the HealthMPowerment Intervention.

HIV and sexuality stigma impede HIV prevention and care efforts. HealthMpowerment.org (HMP) is an interactive mobile phone- and web-based HIV prevention and care intervention for young Black men who have sex with men (YBMSM; ages 18-30) in the United States. HMP included three forums where participants could share their experiences. In this study, we explored whether engaging in stigma-related discussions was associated with changes in YBMSM's stigma-related scores throughout the trial. YBMSM (ages 18-30; N = 238) participating in HMP completed surveys at baseline, and 3 and 6 month follow-ups that included a series of scales focused on HIV and sexuality (internalized homophobia; sexual prejudice) stigma. Sixty-two participants contributed to the forums (1497 posts). We coded instances where YBMSM's conversations were stigma related (915 posts, 61.1%), including discussions of anticipated (74/915, 8.1%), experienced (125/915, 13.7%), internalized (410/915, 44.8%), and/or challenged (639/915, 69.8%) stigma regarding sexuality and HIV. Using a mixed methods approach, we examined whether changes in YBMSM's stigma scores were associated with stigma-related discussions within the forum. We controlled for age, HIV status, income, and educational attainment in these multivariable models. YBMSM who discussed experiencing HIV stigma in the forums reported decreases in perceived HIV stigma over time (b = - 0.37, p ≤ 0.05). YBMSM whose forum posts indicated anticipated HIV stigma reported increases in HIV stigma over time (b = 0.46, p ≤ 0.01). Participants who challenged sexuality-related stigma in forums had lower internalized homophobia (b = - 0.68, p ≤ 0.01) at baseline. YBMSM whose discussions focused on experiencing sexuality-related stigma reported increases in internalized homophobia (b = 0.39, p ≤ 0.01) and sexual prejudice (b = 0.87, p ≤ 0.05) over time. Developing strategies to combat stigma remains a key priority. HMP created an online space where YBMSM could discuss HIV and sexuality stigma. Although a limited number of HMP participants authored the majority of these forum discussions, the discussions were associated with changes in the sample's stigma scores over time. Online interventions (e.g., social media, apps) should consider the inclusion of forums to address stigma and test the efficacy of forums to improve YBMSM's HIV prevention and care continuum outcomes.

Substance Use and Depression Among Recently Migrated African Gay and Bisexual Men Living in the United States.

Immigrant African gay and bisexual men (GBM) are at risk for substance use and adverse mental health outcomes due to negative experiences in home and host countries. Little is known about correlates of substance use and mental health outcomes in this population. We explored pre- and post-migratory factors associated with substance use and depression in recently migrated African GBM. Participants (N = 70) were recruited between July and November 2015 in NYC. Eligible participants were administered a structured questionnaire. Correlates of substance use and depression were identified using bivariate and multivariable analyses. Factors independently associated with current substance use were age, openness about sexual orientation, homophobic experiences in home country, forced sex in home country, current housing instability, and internalized homophobia. Factors independently associated with depression were post-traumatic stress disorder symptoms and alcohol use. Substance use and depression were associated with negative experiences in home and host country.

Faith leaders' messaging is essential to enhance HIV prevention among black Americans: results from the 2016 National Survey on HIV in the black community (NSHBC).

BACKGROUND: To investigate whether religious service attendance and faith leaders' messages about HIV and same-sex relationships are associated with acceptance of HIV prevention strategies. METHODS: Multivariable Poisson regression assessed whether attending religious services, faith leaders' messages about HIV and same-sex relationships, and supportiveness of those messages were associated with HIV testing, as well as knowledge of and willingness to use pre-exposure prophylaxis (PrEP) among 868 Black Americans [45% men; M (SD) = 34 (9) years-old] in the 2016 National Survey on HIV in the Black Community, USA. RESULTS: Participants who reported attending services monthly and/or hearing faith leaders' messages that were supportive of same-sex relationships had a significantly higher likelihood of willingness to use PrEP (adjusted Rate Ratio[ARR] = 1.76; 95% confidence interval [CI] = 1.09, 2.48) and aRR = 2.19; 95% CI = 1.35, 3.55, respectively), independent of HIV risk. Homophobia was significantly associated with higher likelihood of being aware of PrEP and testing for HIV testing in the past 12 months. CONCLUSIONS: Faith leaders' messaging can influence Black Americans' perceptions and uptake of HIV prevention strategies. Faith institutions and faith leaders should be involved in designing and disseminating HIV prevention strategies.

A Critical Review and Commentary on the Challenges in Engaging HIV-Infected Latinos in the Continuum of HIV Care.

Antiretroviral therapy for treatment of HIV infection has become increasingly effective. Persistent poor HIV outcomes in racial and ethnic minority populations in the US call for a closer examination into why Latinos are at significant risk for acquiring and dying from HIV. To improve clinical outcomes and achieve an AIDS-free generation, HIV research must address disparities in HIV outcomes in Latinos, the largest ethnic/racial minority population in the US. Immigrant status as well as cultural factors influence HIV care utilization and are essential to highlight for effective intervention development in Latinos. A better understanding of these individual and contextual factors is critical to developing tailored approaches to engaging Latinos in HIV care. Based on a comprehensive literature review, we offer a framework for understanding what is needed from clinical practice and research to improve engagement in HIV care for US-based Latinos. These findings may have implications for other minority populations.

Beyond Homophobia: How Do Jamaican Men Who Have Sex with Men Build Communities, Affirm Identity, and Mitigate Homophobia?

Jamaican men who have sex with men (MSM) have experienced widespread stigma and discrimination. Much of the research on Jamaican MSM has focused on HIV risk behaviors. We examined the social and romantic relationships of Jamaican MSM and how these factors fostered a sense of community in an antihomosexual environment. Qualitative in-depth interviews were conducted with 30 MSM ages 18 to 29 years. Women and familial matriarchal figures were more likely to accept someone identified as homosexual and provide protection against homophobia. Jamaican MSM affirmed their identity by providing emotional support and safe spaces, which aided in building a sense of community. Relationships with friends and intimate partners were a source of love and validation as opposed to simply sexual gratification. The social and romantic relationships of Jamaican MSM transcended the social boundaries of homophobia, affirmed sexual identity and orientation, and served as facilitators across most general societal and cultural interactions.

Understanding and Reducing Sexual Prejudice in Jamaica: Theoretical and Practical Insights From a Severely Anti-Gay Society.

Jamaica has earned an international reputation for severe sexual prejudice-perhaps disproportionately so compared to other severely anti-LGBT (lesbian, gay, bisexual, and transgender) societies. Until recently, however, no quantitative empirical research had investigated Jamaica's sexual prejudice, leaving the prejudice poorly understood and methods of reducing it unclear. This article reviews empirical research on Jamaican anti-LGBT prejudice from the past 15 years. It situates Jamaica within the global context, explains the current understanding of the severity and nature of the problem, evaluates solutions currently being explored, and suggests promising strategies based on available evidence. Importantly, this article also reflects on lessons learned from Jamaica that are relevant for other severely anti-LGBT societies.

Challenging the Black Church Narrative: Race, Class, and Homosexual Attitudes.

In recent years, scholars have pointed to the Black church as the driving force behind Blacks' more conservative lesbian, gay, bisexual, and transgendered (LGBT) attitudes. Although evidence suggests a robust association between religiosity and LGBT attitudes, contemporary scholarship has not examined the role of class or the extent to which religiosity actually explains these trends. Using the 2004-2014 waves of the General Social Survey, we find that class moderates in the effect of race on negative LGBT attitudes, resulting in a noticeably larger gap between middle-class Blacks and Whites than in the top or the bottom of the class distribution. Although religiosity and moralization explain a portion of racial differences in homosexual attitudes across class groups, we find that neither fully accounts for the more conservative attitudes of the Black middle class. We conclude by discussing the shortcomings of these narratives for understanding Blacks' more conservative LGBT attitudes.

HIV Testing, Stigma, and Risk: A Comparison of Church Leaders and Their Congregants.

The involvement of African American churches in HIV testing and prevention is a viable community-based strategy in efforts to reduce rates of HIV among African Americans; however, church members' beliefs and attitudes are often barriers to successful implementation. This study aimed to compare church leaders and congregants regarding HIV testing behaviors, HIV-related stigma, HIV knowledge, and perceived risk. This comparative, cross-sectional study used self-reporting questionnaires across six churches in Baltimore, Maryland. Of the 173 participants (68 leaders, 105 congregants), leaders and congregants had equally high levels of HIV knowledge and equally low levels of HIV stigma, but leaders had higher homosexuality stigma than congregants t(169) = 1.773, p = .039. Congregants had higher perceived HIV risk t(170) = 3.814, p < .001, and were more likely to be tested annually for HIV than leaders, c2(1) = 8.940, p = .002. Given the higher rates of stigma, lower perceived risk and lower likelihood to be tested, interventions should focus on changing the beliefs and behaviors of church leadership to promote implementation of HIV efforts.

Latino men who have sex with transgender women: the influence of heteronormativity, homonegativity and transphobia on gender and sexual scripts.

Latino men who have sex with transgender women make up an overlooked sector of the population that requires more attention than is currently given in sexuality and gender studies, particularly in regard to their non-commercial, long-term sexual and romantic relationships with transgender women. Sixty-one sexual histories were selected for this qualitative analysis from a larger study on Latino male bisexuality in the New York City metropolitan area. Findings suggest that participants' sexual and gender scripts with transgender women are strongly regulated by heteronormativity. Furthermore, homonegativity and transphobia often intersect in the lived experiences of men who have sex with transgender women, resulting in relationship conflicts over the control of transgender women's bodies, sexual behaviours and gender performance both in public and in private. Findings also suggest that low relationship conflict is more common among men who have sex with transgender women who exhibit diverse sexual roles (being both insertive and receptive during anal sex), or transgress heteronormative scripts through dialogue of desires and/or by embracing transgender women as human beings and not as hyperfeminised objects of desire. Stigma reduction and alternatives to heteronormative interventions are needed to improve relationship dynamics and potentially positively impact on the sexual health and overall wellbeing of Latino men who have sex with transgender women and their transgender partners.

Contextualising family microaggressions and strategies of resilience among young gay and bisexual men of Latino heritage.

Young Latino gay and bisexual men experience discrimination due to heterosexism and racism from within and beyond their communities. Although most research has emphasised overt forms of discrimination, a growing body of research is examining the effects of microaggressions, or indirect forms of discrimination, on racial and sexual minorities. The purpose of this study was to explore the contexts of various types of microaggressions, as well as describe the resilience strategies used by young adult Latino gay and bisexual men living in Los Angeles, California. A sample of 21 young Latino gay and bisexual men aged 18 to 29 years were recruited to complete qualitative, in-depth, semi-structured interviews following a phenomenological approach. Three contextual themes relevant to microaggressions emerged: (1) microassaults, (2) microinsults and (3) microinvalidations. Three themes emerged around the resilience strategies to overcome these experiences: (1) self-discovery, (2) adaptive socialisation and (3) self-advocacy. Family and community-based efforts to reinforce and expand resilience repertoires are needed to help young Latino gay and bisexual men.

"Homophobia hurts": Mourning as resistance to violence in South Africa.

Much has been written on the successful lesbian, gay, bisexual, transgender, and intersex movement in South Africa, and the resulting institutionalization of sexual minority rights. Comparatively less has been written about the forms of activism undertaken specifically by Black lesbians that are not oriented toward legal change. In this article, I assert the need to examine public demonstrations of mourning as an act of Black lesbian resistance to violence in South Africa. Based on in-depth interviews with members of Free Gender, a Black lesbian organization, I argue that members' conceptualizations of mourning as providing community support force a reconsideration of what it means to be human. In order to grasp the decolonial potential of Free Gender's activism, I draw on Sylvia Wynter's argument that a singular Western bourgeois conception of human has come to dominate globally.

"Lesbian"/female same-sex sexualities in Africa.

Understandings of African lesbian sexualities have been affected by silence, repression, and uncertainty. The subject of lesbian experiences and sexualities in Africa constitutes an opportunity for feminist scholars to address the transnational politics of knowledge production about African lesbians' lives and the contours of lesbian art, activism, and relationships in African nations. This article contextualizes the state of research on African lesbian sexualities and introduces the special issue.

Associations Between Internalized Homophobia and Sexual Risk Behaviors Among Young Black Men Who Have Sex With Men.

OBJECTIVE: To assess internalized homophobia (IH) and its relationship to sexual risk behaviors and prevalence of sexually transmitted infection (STIs) in a clinic-based sample of young black men who have sex with men (YBMSM). METHODS: Six hundred YBMSM completed a self-interview and provided specimens for testing. A 7-item scale assessed IH, and 19 sexual risk behaviors were assessed. RESULTS: In adjusted models, compared with men with less IH, those with greater IH were more likely to report: any condomless anal receptive sex (P = 0.01) and sex with women (P < 0.001). Alternatively, men with greater IH were less likely to: discuss acquired immune deficiency syndrome prevention with sex partners (P = 0.009), disclose their same sex sexual behavior to providers (P = 0.01), be tested for human immunodeficiency virus in the past 12 months (P = 0.04), report condomless oral sex (P = 0.049), and test RPR positive (P = 0.01). CONCLUSIONS: With some exceptions, IH among YBMSM attending STI clinics may influence their sexual risk behaviors; however, STI prevalence was not associated with this construct.

Jamaica, Three Years Later: Effects of Intensified Pro-Gay Activism on Severe Prejudice Against Lesbians and Gay Men.

Jamaica has developed an international reputation for severe anti-gay prejudice. However, in the past few years, between 2012 and 2015, intensified waves of activism have increased the visibility of lesbian, gay, bisexual, and transgender (LGBT) Jamaicans, and supported their social and legal inclusion in Jamaican society. This research investigated the effects of that activism by taking advantage of two large, representative surveys of Jamaicans' attitudes toward lesbians and gay men: one in 2012 and one in 2015. Over the three-year period there were significant reductions in desire for social distance and opposition to gay rights. However, there was no significant change in anti-gay attitudes, and there was evidence of an increase in anti-gay behaviors. There was also no evidence of polarization of responses to gay men and lesbians; rather, the most prejudiced Jamaicans showed the largest reductions in bias. Implications of these findings for activism in Jamaica and other anti-gay countries are discussed.