Stressors Based on Sexual Orientation and Mental Health Among Lesbian, Gay, and Bisexual Individuals in China: Minority Stress and Perceived Pressure to Get Married

Chinese Confucian filial piety posits that getting married and having children to maintain family bloodlines is a fundamental duty of children to their parents. Chinese lesbian, gay, and bisexual (LGB) individuals experience added stresses because of the pressure to get married from parents, social environments, and themselves. However, no research thus far has examined the influence of this added stressor, called "pressure to get married," on the mental health of LGB individuals in China. This study examined the influence of sexual orientation-based stresses (i.e., LGB minority stress and perceived pressure to get married) on mental health among 543 Chinese single LGB individuals (259 gay men, 161 lesbians, 68 bisexual men, and 55 bisexual women). We developed a new measure of stress based on perceived pressure to get married and found three factors based on pressure sources: social pressure, parental pressure, and internalized pressure. Both minority stress and perceived pressure to get married were associated with worse mental health. Minority stress and perceived external pressure (i.e., perceived social and parental pressure) were found to be components of a second-order latent variable, called sexual orientation-based stress, which was associated with worse mental health. Sexual orientation-based stress is associated with mental health through coping/emotion and cognitive, but not social, processes. The results indicate that the pressure to get married experienced by Chinese LGB individuals need to be examined further. The findings indicated that the perceived pressure to get married was another significant stressor based on sexual orientation and minority stress, and was associated with mental health among Chinese LGB individuals.</p

Integrated Cognitive-Behavioral Therapy for Social Anxiety and HIV/STI Prevention for Gay and Bisexual Men: A Pilot Intervention Trial

Given the alarmingly high HIV and sexually transmitted infection (STI) incidence among gay and bisexual men (GBM) worldwide, there is a critical need for HIV prevention interventions specifically for GBM. Social anxiety, or anxiety about being evaluated in interpersonal situations, is a risk factor for condomless anal sex (CAS) among GBM (e.g., Hart & Heimberg, 2005; Hart, James, Purcell, & Farber, 2008). Social anxiety may also increase substance use in sexual situations, which is another risk factor for HIV/STIs in this risk group (Semple, Strathdee, Zians, McQuaid, & Patterson, 2011). The goal of the Sexual Confidence Study was to provide initial evidence of efficacy for a 10-session integrated cognitive-behavioral therapy for social anxiety, substance use management in sexual situations, and HIV sexual risk reduction for HIV-negative GBM. Diagnostic and self-report assessments were completed at baseline, posttreatment, 3-month follow-up, and 6-month follow-up. In this open trial design, we observed a 50% reduction in engagement in HIV/STI sexual risk behavior at 6-month follow-up. We also observed large uncontrolled treatment effect sizes for reductions in social anxiety disorder and problematic alcohol use. These preliminary findings suggest that the present treatment may offer an efficient way of concurrently reducing social anxiety, problematic alcohol use, and the risk of contracting HIV and STIs via CAS with serodiscordant partners among HIV-negative GBM.</p

Scenes as Micro-Cultures: Examining Heterogeneity of HIV Risk Behavior Among Gay, Bisexual, and Other Men Who Have Sex with Men in Toronto, Canada

Using latent class analysis (LCA), we examined patterns of participation in multiple scenes, how sexual risk practices vary by scene, and psychosocial factors associated with these patterns among 470 gay, bisexual, and other men who have sex with men (GBM) recruited from Toronto. We calculated posterior probability of being in a class from participation in nine separate scenes. We used Entropy, the Bayesian information criterion and the Lo–Mendel–Rubin likelihood ratio test to identify the best fit model. Fit indices suggested a four-class solution. Half (50%) of the GBM reported no or minimal participation in any scene, 28% reported participating in the dance club scene, 16% reported participating in the BDSM, bear, and leather scenes, and 6% reported participating in circuit, party and play, and sex party scenes. Compared to GBM who did not participate in scenes, GBM participating in the BDSM-Bear-Leather scene were more likely to be older, white, to report higher sexual self-esteem, and to engage in condomless anal sex; Party and Play scene members were more likely to be of Asian origin, and to use drugs before and during sex, whereas Dance Club scene members were more likely to be younger and to report lower self-esteem but higher hope. LCA allowed us to identify distinct social niches or micro-cultures and factors characterizing these micro-cultures. GBM differ in their risk for HIV and STIs according to characteristics associated with participation in distinct micro-cultures associated with scenes. Tailored interventions may be needed that focus on reducing HIV risk and promoting sexual health in specific contexts such as the BDSM-Bear-Leather and Party and Play.</p

Integrated Cognitive Behavioral Therapy for Social Anxiety and HIV Prevention for Gay and Bisexual Men

Given the alarmingly high HIV and sexually transmitted infection (STI) incidence among gay and bisexual men (GBM) worldwide, there is a critical need for HIV prevention interventions specifically for GBM. Social anxiety, or anxiety about being evaluated in interpersonal situations, is a risk factor for condomless anal sex (CAS) among GBM (e.g., Hart & Heimberg, 2005; Hart, James, Purcell, & Farber, 2008). Social anxiety may also increase substance use in sexual situations, which is another risk factor for HIV/STIs in this risk group (Semple, Strathdee, Zians, McQuaid, & Patterson, 2011). The goal of the Sexual Confidence Study was to provide initial evidence of efficacy for a 10-session integrated cognitive-behavioral therapy for social anxiety, substance use management in sexual situations, and HIV sexual risk reduction for HIV-negative GBM. Diagnostic and self-report assessments were completed at baseline, posttreatment, 3-month follow-up, and 6-month follow-up. In this open trial design, we observed a 50% reduction in engagement in HIV/STI sexual risk behavior at 6-month follow-up. We also observed large uncontrolled treatment effect sizes for reductions in social anxiety disorder and problematic alcohol use. These preliminary findings suggest that the present treatment may offer an efficient way of concurrently reducing social anxiety, problematic alcohol use, and the risk of contracting HIV and STIs via CAS with serodiscordant partners among HIV-negative GBM.</p

Measuring Adverse Childhood Experiences: Comparing Individual, Composite, Score‑based and Latent Profile‑based Scoring Schemas Among Gay, Bisexual, and Other Men Who Have Sex with Men

Adverse childhood experiences (ACEs; e.g., neglect, sexual abuse) among gay, bisexual, and other men who have sex with men (GBM) may not occur in isolation, but may be connected and occur in clusters. Most studies have measured ACEs individually, hierarchically, additively, or in a binary fashion (presence or absence of ACEs), rather than treating them as connected and clustered. This study examined these competing approaches of scoring ACEs and their relative power at predicting health outcomes. We examined abuse (sexual, physical, and emotional) and neglect (physical and emotional) experiences among a non-random sample of 470 Toronto GBM using the Childhood Trauma Questionnaire Short Form subscales. We compared five scoring schemas: (1) five individual scores for each form of maltreatment; (2) a composite score summing all of the maltreatment scores; (3) a hierarchical regression model with sexual abuse entered first then followed by physical abuse, emotional abuse, physical neglect, and emotional neglect; (4) a severity-based categorization; and (5) a latent profile-based categorization. Experiences of abuse and neglect were not uncommon (22-33%) and some participants experienced multiple forms of abuse and neglect (r = .33-.65, df = 464-467; p < .001; shared variance, r2 = 11-43%). Results show the dose-response effects of ACEs and highlight the importance of examining ACEs in clusters rather than individually. Latent profile analysis identified GBM who experienced multiple and frequent ACEs, and also identified the types of ACEs they experienced: crucial information that was obscured in score-based or severity-based approaches.</p

Childhood Maltreatment, Bullying Victimization, and Psychological Distress Among Gay and Bisexual Men

Sexual minority men report higher psychological distress than heterosexual men, including depression and anxiety. Research suggests that these health disparities may be due to the heightened stressors that gay, lesbian, and bisexual individuals experience. Some of these stressors occur early on in life, such as childhood abuse and bullying, and may include stressors that are topically related to sexual minority status, such as anti-gay bullying and teasing for gender nonconformity to masculine gender norms. We tested a structural equation model on the association between negative childhood experiences and adult psychological distress among 304 gay and bisexual men. The model fit the data well, and demonstrated an indirect effect of negative childhood experiences on adult psychological distress via dysfunctional thoughts toward oneself. The results integrate the childhood abuse and anti-gay bullying victimization literatures by showing that both forms of adverse childhood experiences are associated with adult psychological distress. The findings suggest the benefit of treatments to reduce negative, dysfunctional thoughts among gay and bisexual men who have experienced adverse childhood events.</p

Number of Psychosocial Strengths Predicts Reduced HIV Sexual Risk Behaviors Above and Beyond Syndemic Problems Among Gay and Bisexual Men

Syndemics research shows the additive effect of psychosocial problems on high-risk sexual behavior among gay and bisexual men (GBM). Psychosocial strengths may predict less engagement in high-risk sexual behavior. In a study of 470 ethnically diverse HIV-negative GBM, regression models were computed using number of syndemic psychosocial problems, number of psychosocial strengths, and serodiscordant condomless anal sex (CAS). The number of syndemic psychosocial problems correlated with serodiscordant CAS (RR = 1.51, 95% CI 1.18-1.92; p = 0.001). When adding the number of psychosocial strengths to the model, the effect of syndemic psychosocial problems became non-significant, but the number of strengths-based factors remained significant (RR = 0.67, 95% CI 0.53-0.86; p = 0.002). Psychosocial strengths may operate additively in the same way as syndemic psychosocial problems, but in the opposite direction. Consistent with theories of resilience, psychosocial strengths may be an important set of variables predicting sexual risk behavior that is largely missing from the current HIV behavioral literature.</p

The Gender Nonconformity Teasing Scale for Gay and Bisexual Men

Sexual minority youth experience more bullying than their heterosexual peers, and antigay bullying is positively associated with psychological distress. Antigay bullying can also involve being verbally bullied for gender nonconformity, which is common among sexual minority youth. Despite its relevance for the mental health of gay and bisexual men (GBM), no scales with established psychometric properties exist to assess childhood verbal bullying based on gender nonconformity. In this study, we tested the psychometric properties of the Gender Nonconformity Teasing Scale (GeNTS). In this cross-sectional study, we enrolled 304 participants (median age 44, 91% gay identified) who responded to 13 items, using a 5-point Likert-type scale. Sample items include “I was teased because I played with girls” and “I was teased for being ‘too feminine.’” Fit indices, in an exploratory factor analysis with oblique rotation, suggested a nine-item, two-factor solution: (a) teasing pertaining to the choice of social activities and (b) teasing based on gender expression. The scale correlated positively with self-reports of childhood teasing and bullying frequency, and adult loneliness, depression, and anxiety. The GeNTS is a reliable scale that demonstrates medium to strong associations with psychological distress among GBM. This scale will enable researchers to investigate retrospective reports of bullying based on gender nonconformity among GBM and its effects on psychological distress. The GeNTS may also be helpful as a screening tool in clinical settings for clinicians working with GBM. (PsycInfo Database Record (c) 2022 APA, all rights reserved)</p

High HIV risk and syndemic burden regardless of referral source among MSM screening for a PrEP demonstration project in Toronto, Canada

Background: To maximize public health impact and cost-effectiveness, HIV pre-exposure prophylaxis (PrEP) must reach individuals at high HIV risk. Referrals for PrEP can be self- or provider-initiated, but there are several challenges to both. We assessed whether HIV risk differed by referral source among gay, bisexual and other men who have sex (gbMSM) screening for an HIV PrEP demonstration project. Methods: PREPARATORY-5 was an open-label PrEP demonstration project enrolling gbMSM at high risk of HIV acquisition in Toronto, Canada. Study eligibility criteria related to high risk was defined as scoring ≥10 on the HIV Incidence Risk Index for MSM (HIRI-MSM) and engaging in at least 1 act of condomless receptive anal sex within the past 6 months. Recruitment was promoted through self-referrals (ads in a sexual networking app and gay newspaper/website) and provider-referrals (10 community-based organizations, CBOs). HIV risk score (HIRI-MSM) and syndemic health burden were measured among gbMSM screened for study participation and compared according to referral source. Results: Between October 16 and December 30, 2014, online ads generated 1518 click-throughs and CBOs referred 115 individuals. Overall, 165 men inquired about the trial, of which 86 underwent screening. The majority of screened men were self-referrals (60.5%), scored ≥10 on HIRI-MSM (96.5%), and reported condomless receptive anal sex in the past 6 months (74.2%). Self- and provider-referrals had similarly high HIV risk profiles, with a median (IQR) HIRI-MSM score of 26.0 (19.0-32.5) and 28.5 (20.0-34.0) (p = 0.3), and 75.0% and 73.5% reporting condomless receptive anal sex (p = 0.9), respectively. The overall burden of syndemic health problems was also high, with approximately one-third overall identified as having depressive symptoms (39.5%), alcohol-related problems (39.5%), multiple drug use (31.4%), or sexual compulsivity (31.4%). There were no significant differences in syndemic health problems by referral source. Conclusions: HIV risk and syndemic burden were high among gbMSM presenting for this PrEP demonstration project regardless of referral source. Self-referral may be a useful and efficient strategy for identifying individuals suitable for PrEP use. Online strategies and CBOs working in gay men's health may play important roles in connecting individuals at high HIV risk to PrEP services.</p

The relevance of communal altruism for sexual minority men in contemporary contexts

There are many reasons why individuals engage in prosocial behavior; communal sexual altruism is based on the notion that some practice safer sex in the interest of promoting the well-being of their community/in-group. Given that definitions of what constitutes "safer sex" have changed with advances in human immunodeficiency virus (HIV) prevention, we investigated the importance of communal sexual altruism (herein "altruism") among urban gay, bisexual, and other sexual minority men (GBM) in the contemporary context. Using a sample of 2449 GBM we examined the association of both safer-sex-related attitudes (e.g., HIV treatment optimism-skepticism) and behaviors (e.g., condomless anal sex [CAS]) with altruism scores. Higher altruism scores were associated with a lower likelihood of CAS and a greater frequency of discussing HIV status with new partners. These findings demonstrate that many GBM are motivated to engage in several kinds of behaviors that improve the well-being of their in-group (i.e., the GBM community).</p