Background
Cisgender sexual minority men (SMM) in the United States (US) are disproportionately burdened by trauma and posttraumatic stress disorder (PTSD). Limited but growing research has linked PTSD symptoms to sexual risk behaviors among SMM but minimally accounted for PTSD symptomology’s heterogeneity. Moreover, resilience processes in response to trauma remain poorly understood and understudied among SMM. This dissertation aimed to identify latent classes of posttraumatic stress symptoms, assess associations between class membership and serodiscordant condomless anal sex, and explore trauma’s impact and associated resilience processes among SMM.
Methods
Trauma-exposed SMM’s responses (6,319/11,069) to a PTSD symptom scale in the American Men’s Internet Survey were subjected to latent class analysis; latent classes were then regressed on sociodemographic and other variables. In a subsample of non-Hispanic Black and white SMM (N=4,286), associations between latent classes and serodiscordant condomless anal sex were determined via the manual three-step Bolck, Croon, and Hagenaars method; moderation by race and social cohesion was also examined. An interpretative phenomenological analysis (IPA) approach with multiple in-depth interviews and photo/image-elicitation was used to explore trauma’s impact and resilience processes among Black SMM (N=9).
Results
Four latent classes of posttraumatic stress symptoms emerged: “Intrusive-Avoidant”; “Dysphoric-Inattentive”; “Pervasive”; and “Resistant.” Relative to white participants, non-Hispanic Black participants were overrepresented in the Intrusive-Avoidant class. Relative to HIV-negative participants, those living with HIV were overrepresented in the Pervasive class. Higher prevalence of serodiscordant condomless anal sex was associated with Pervasive and Dysphoric-Inattentive class membership relative to Resistant class membership, as was higher prevalence of serodiscordant condomless anal sex with a high-risk partner. There were no significant moderation effects. Black SMM perceived trauma as transformative, experiencing a sense of depletion/disconnection, encumbrance/fixation, and pain/turmoil. Participants overcame trauma’s impact via resilience processes involving purpose-giving/meaning-making, restoring self-worth/belief in goodness in the world, and reconstituting/cultivating self.
Conclusions
Posttraumatic stress symptoms emerge in diverse patterns among trauma-exposed SMM in the US, necessitating nuanced assessment and intervention approaches. As patterns are differentially linked to HIV transmission risk behaviors, integrated trauma-focused, sexual risk-reduction interventions tailored to each pattern may be warranted. Engaging Black SMM and leveraging their inherent resilience may improve psychosocial wellness
