Social oppression – homophobia and racism-and socioeconomic distress as determinants of unprotected anal intercourse among young U.S. black gay/bisexual men (YBG/BM)

Published: July 21, 2010

Social oppression – homophobia and racism-and socioeconomic distress as determinants of unprotected anal intercourse among young U.S. black gay/bisexual men (YBG/BM)

S. Kegeles1, G. Rebchook1, D. Huebner2, J. Peterson3, L. Pollack1, R. Williams1

1Center for AIDS Prevention Studies, University of California, San Francisco, United States, 2University of Utah, Salt Lake City, United States, 3Georgia State University, Atlanta, United States

Background: Black MSM are the group at highest risk for HIV in the U.S., with seroprevalence estimates as high as 46%. We examined if social/structural issues resulting from being part of a stigmatized sexual minority within a racial minority are related to sexual risk behavior.

Methods: YBG/BM (aged 18-29, mean=23 years) completed self-administered surveys on hand-held devices at venues in Houston and Dallas, Texas (N=666).
Scales assessed experiences of racism and homophobia in past year (alphas=91, .81), socioeconomic distress (count of 7 yes/no items), and frequency of participation in difficult sexual situations (e.g., at an adult bookstore; alpha=.90), and in difficult relationships (e.g., with someone supporting you financially; alpha=.78).

Results: 26% of YBG/BM engaged in unprotected anal intercourse (UAI) with casual, non-monogamous, or serodiscordant male partners in the past 2 months. Every variable was related to UAI at the bivariate level (p’s< .001). The figure displays multivariate path modeling results. Mediation analyses revealed that having sex in difficult sexual situations explained effects of homophobia, but not socioeconomic distress or racism, on UAI.[Path Model: Social Oppression Determinants of UAI ]

Conclusions: YBG/BM who are more socially marginalized and experience more social oppression are more likely to have sex in contexts that are conducive to unsafe sex, leading to increased sexual risk behavior. Their experiences of homophobia account for this effect and their vulnerability to HIV more than other sources of oppression and should be the target of intervention efforts. Additionally, developing men’s critical consciousness about responding to these sources of oppression is essential, as is building support for one another.

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