African same-sex sexualities and gender diversity : a framing note

This article introduces the concept of African same-sex sexualities and gender diversity which refers to variation pertinent to gender expressions and identities, sexual expression and sexual orientation. The article describes the emerging and evolving African scholarly production evident in the last two decades and explains key underlying themes that bring together this special issue.The HIV Center for Clinical and Behavioral Researchhttps://journals.sagepub.com/home/sexhj2020Psycholog

Gender expression and mental health in Black South African men who have sex with men: further explorations of unexpected findings

Unlike studies conducted in Western countries, two studies among Black South African men who have sex with men (MSM) found no support for the association between gender nonconformity and mental distress, even though gender-nonconforming men experienced more discrimination and discrimination was associated with mental distress (Cook, Sandfort, Nel, & Rich, 2013; Sandfort, Bos, Knox, & Reddy, 2016). In Sandfort et al., gender nonconformity was assessed as a continuous variable, validated by comparing scores between a categorical assessment of gender presentation (masculine, feminine, no preference). Using the same dataset, we further explored this topic by (1) testing differences between gender expression groups in sexual minority stressors, resilience factors, and mental distress; (2) testing whether the impact of elevated discrimination in the feminine group was counterbalanced by lower scores on other stressors or higher scores on resilience factors; and (3) exploring whether relationships of stressors and resilience factors with mental distress varied between gender expression groups. Controlling for demographics, we found several differences between the gender expression groups in the stressors and resilience factors, but not in mental distress. We found no support for the idea that the lack of differences in mental distress between the gender expression groups was a consequence of factors working in opposite directions. However, internalized homophobia had a differential impact on depression in feminine men compared to masculine men. In our discussion of these findings, we explored the meaning of our participants’ self-categorization as it might relate to gender instead of sexual identities.A Grant from amfAR (106973; Principal Investigator: Theo Sandfort, Ph.D.) with additional support from a Grant from the National Institute of Mental Health (R01-MH083557; Principal Investigator: Theo Sandfort, Ph.D.).http://link.springer.com/journal/105082019-11-01hj2018Humanities EducationPsycholog

Gender nonconformity, discrimination, and mental health among Black South African men who have sex with men : a further exploration of unexpected findings

Using data from a study about HIV risk among Black South African MSM, we aimed to ascertain whether unexpected findings about the relationship between gender nonconformity, discrimination, and mental health in this population, as reported by Cook, Sandfort, Nel, and Rich (2013), could be replicated, and to explore more in-depth how gender nonconformity relates to health. Cook et al. found that feminine men were not more likely to be depressed despite the observation that they were more likely to be discriminated against and that discrimination increased the likelihood of depression. This is in contrast to what studies among gay and bisexual men in Western countries have consistently shown. In the current study, 196 Black South African MSM (ages between 18 and 40; mean age, 26.65 years) were surveyed. Assessments included stressors (identity confusion, internalized homophobia, and sexual orientation-based discrimination) and resilience factors (openness about one’s sexual orientation, social support, and identification with the gay community). We observed that gender-nonconforming men were not more likely to be depressed despite having experienced more discrimination, which was associated with depression. The same relationships were observed when considering anxiety as the mental health outcome. We found an indirect negative effect of gender nonconformity on depression through internalized homophobia, suggesting that, in this population, internalized homophobia masks the effect of discrimination on mental distress. Implications for the sexual minority stress model, used to guide our analyses, are discussed. Further research is needed to disentangle the complex relationship between gender nonconformity and mental health among MSM populations.The study was supported by a grant from amfAR (106973; Principal Investigator: Theo Sandfort, Ph.D.) with additional support from a grant from the National Institute of Mental Health (R01-MH083557; Principal Investigator: Theo Sandfort, Ph.D.). The HIV Center for Clinical and Behavioral Studies is supported by a center grant from the National Institute of Mental Health, P30 MH43520 (Principal Investigator: Robert Remien, Ph.D.).http://link.springer.com/journal/105082017-04-30hb2016School of Health Systems and Public Health (SHSPH

Forced sexual experiences as risk factor for self-reported HIV infection among southern African lesbian and bisexual women

Even though women who have sex with women are usually understood to be at no or very low risk for HIV infection, we explored whether lesbian and bisexual women in a geographical area with high HIV prevalence (Southern Africa) get tested for HIV and whether, among those women who get tested, there are women who live with HIV/AIDS. The study was conducted in collaboration with community-based organizations in Botswana, Namibia, South Africa and Zimbabwe. Data were collected via written surveys of women who in the preceding year had had sex with a woman (18 years and older; N = 591). Most participating women identified as lesbian and black. Almost half of the women (47.2%) reported ever having had consensual heterosexual sex. Engagement in transactional sex (lifetime) was reported by 18.6% of all women. Forced sex by men or women was reported by 31.1% of all women. A large proportion of the women reported to ever have been tested for HIV (78.3%); number of lifetime female and male partners was independently associated with having been tested; women who had engaged in transactional sex with women only or with women and men were less likely to have been tested. Self-reported HIV prevalence among tested women who knew their serostatus was 9.6%. Besides age, the sole independent predictor of a positive serostatus was having experienced forced sex by men, by women, or by both men and women. Study findings indicate that despite the image of invulnerability, HIV/AIDS is a reality for lesbian and bisexual women in Southern Africa. Surprisingly, it is not sex with men per se, but rather forced sex that is the important risk factor for self-reported HIV infection among the participating women. HIV/AIDS policy should also address the needs of lesbian, bisexual and other women who have sex with women

South African men who have sex with both men and women and how they differ from men who have sex with men exclusively

The label “men who have sex with men” (MSM) is used to categorize a diverse population exclusively on the basis of its sexual behavior. Understanding the diversity that this label comprises is critical for the development of health interventions that effectively reach the various populations subsumed under this label. In this cross-sectional study of South African MSM (N = 480) recruited through respondent-driven sampling (RDS), we explored differences between men who had sex with both men and women (MSMW) and men who had sex with men exclusively (MSME). We found significant differences between these two groups in terms of sexual attraction, sexual identity, sexual preferences, sexual histories, and current sexual practices. MSMW were more likely to be confused about their same-sex attraction, to experience internalized homophobia, and to have paid for sex in the previous year, while MSME were more gender nonconforming and more likely to have been forced to have sex in the previous year. These findings underscore that the MSM label comprises a diverse population and that exclusive sexual engagement with other men is a critical distinction to take into account in understanding this diversity and fully grasping the lived experiences of men who have sex with men.http://www.tandfonline.com/loi/hjsr202019-03-05hj2018Humanities EducationPsycholog

Sexual violence experiences among black gay, bisexual, and other men who have sex with men and transgender women in South African townships : contributing factors and implications for health

This study examined experiences with sexual violence among black African gay, bisexual, and other men who have sex with men and transgender women in townships surrounding Pretoria, South Africa. Of 81 gay, bisexual, and other men who have sex with men and transgender women interviewed, 17 reported to have experienced sexual violence perpetrated by other men. Qualitative analysis of interviews revealed the social and relational contexts of these experiences as well as their psychological and health consequences. The described context included single- and multiple-perpetrator attacks in private and public spaces, bias-motivated attacks, and violence from known partners. Several participants reported refusing propositions for sex as a reason for being victimized. HIV-positive individuals were overrepresented among survivors compared with the sample as a whole. Following victimization, participants described feelings of pain, fear, anger, and self-blame. The results demonstrate the need for interventions designed to (a) prevent sexual violence against gay, bisexual, and other men who have sex with men and transgender women in this population, and (b) reduce the negative psychological and health outcomes of sexual victimization. The discussion also highlights the need to examine more closely the link between experiences of sexual violence and the risk for HIV infection.An NIMH Grant (R01 MH083557; PI: Theo Sandfort, PhD) and an NIMH center Grant (P30 MH43520; PI: Robert Remien, PhD). Dr Kaighobadi was supported by an NIMH training Grant (T32 MH19139, Behavioral Sciences Research in HIV Infection; PI: Theo Sandfort, PhD).http://journals.sagepub.com/home/saphj2019Psycholog

HIV pre-exposure prophylaxis (PrEP)- knowledge and attitudes among a New York City emergency department patient population

HIV Pre-exposure Prophylaxis (PrEP), in which HIV-negative individuals receive antiretroviral medications to prevent HIV acquisition, has shown potential as a means to reduce HIV incidence among high-risk persons. The acceptability of PrEP among at-risk persons will strongly impact the effectiveness of PrEP. This study aimed to assess knowledge and attitudes towards PrEP within a demographically-mixed community with high HIV prevalence

HIV and sexually transmitted infection knowledge among women who have sex with women in four Southern African countries

Women who have sex with women in Southern Africa, where HIV prevalence is high, are often presumed to have minimal risk for sexually transmitted infections (STI) and HIV despite research documenting female-to-female transmission. This study examined the demographic and social factors contributing to female-to-female STI/HIV transmission knowledge among Southern African women who have sex with women using an integrated model of health literacy. In collaboration with community-based organisations in Botswana, Namibia, South Africa and Zimbabwe, data were collected through anonymous surveys (N = 591). Multivariable stepwise forward logistic regression assessed independent associations between participant characteristics and high vs. low knowledge using five items. Overall, 64.4% (n = 362) of women had high knowledge; 35.6% (n = 200) had low knowledge. Higher education (adjusted odds ratio [aOR]: 2.24, 95% confidence interval [CI]: 1.48, 3.40), regular income (aOR: 2.14, 95% CI: 1.43, 3.21), residence in Botswana (aOR: 3.12, 95% CI: 1.15, 8.48) and having ever received tailored STI/HIV information (aOR: 2.17, 95% CI: 1.41, 3.32) predicted significantly higher odds of high knowledge in the final multivariable model. Results suggest opportunities for peer-led sexual health programming and expanded HIV prevention campaigns addressing women who have sex with women.The Open Society Initiative for Southern Africa (PI: Vasu Reddy), with additional support from the United Nations Development Programme and the Open Society Foundations who also participated in the study. Margaret Paschen-Wolff was supported by a training grant (T32 MH019139; PI: Theodorus Sandfort) from the US National Institute of Mental Health at the HIV Center for Clinical and Behavioral Studies at the NY State Psychiatric Institute and Columbia University (P30-MH43520; PI: Robert Remien).http://www.tandfonline.com/loi/tchs202020-07-26hj2019Psycholog

Southern African lesbian and bisexual women responses to symptoms of sexually transmitted infections

Sexually transmitted infections (STI) in lesbian and bisexual women is a relatively unexplored topic, particularly for women from low and middle-income countries. Despite perceptions that women who have sex with women (WSW) are at negligible risk for contracting STI, existing research demonstrates that WSW do become infected with STI. Given the opposition between assumptions of invulnerability and the observed risks, we explored how WSW would respond to symptoms of STI (i.e., wait until symptoms passed, see a medical doctor, and inform sexual partners). We used data collected as part of a collaboration between academic researchers and community-based LGBTQ organizations in Botswana, Namibia, South Africa, and Zimbabwe. Chi-square tests were used to test whether participants’ responses to hypothetical STI symptoms varied in relation to several intrapersonal, interpersonal, and structural factors. Multivariable logistic regression (backward) was used to assess whether these variables were independently associated with women’s responses. Most women would be proactive in response to potential STI symptoms and would see a medical doctor. However, most women would not inform their sexual partner of symptoms of STI. Findings demonstrate several intrapersonal, interpersonal, and structural factors that influence WSW’s health agency, and show a clustering of high-risk factors among women who would not be proactive about their health. Our findings suggest the need for improved health and health care of WSW in Southern Africa.The Open Society Initiative for Southern Africa (PI: Vasu Reddy, Ph.D.), with additional support from the United Nations Development Programme, and Open Society Foundations; these organizations also participated in the study. Additional support came from a NIMH-center grant (P30-MH43520; PI: Robert Remien, Ph.D.) and a NIMH-training grant (T32-MH19139; PI: Theo Sandfort, Ph.D.).http://link.springer.com/journal/105082020-10-12hj2019Psycholog

The social and sexual lives of Black sexual minority men 30 years of age and older in South Africa

ADDITIONAL FILE 1. Quantitative survey.BACKGROUND : Black sexual minority men (SMM) ages 30 and older are under-represented in HIV studies in sub- Saharan Africa, despite being at increased risk of HIV infection and contributing to potential onward HIV transmission. To better understand the social and sexual lives of older Black South African SMM, we conducted in-depth interviews with SMM who were > 30 years old. METHODS : From March–September 2016, we recruited a convenience sample of 37 SMM ages 30 and older by partnering with an LGBTQ+ organization in Tshwane, Pretoria. Men were interviewed about various aspects of their lives, including their sexual orientation, social connectedness, experiences with stigma and perspectives on participating in research. RESULTS : Participants described their experiences with their sexual identities, cultural and social implications of disclosure, and their perspective on South Africa’s political perspectives on the LGBTQ+ community. Men described how these experiences influence their trust in research and comfort participating in studies. CONCLUSIONS : Inferences drawn from these findings provide direction on how to improve middle-aged SMM’s representation in research, such as recruiting a higher proportion of older and middle-aged SMM to serve as seed participants and building stronger community partnerships to disseminate study findings to settings where data collection is conducted.The Fulbright U.S. Student Program, NIMH and NIAAA.http://www.biomedcentral.com/bmcpublichealtham2023PsychologySociolog