Intersectional internalized stigma among Black gay and bisexual men: A longitudinal analysis spanning HIV/sexually transmitted infection diagnosis.

Internalized stigma undermines health among people diagnosed with HIV and other sexually transmitted infections (STI), yet limited research has examined how internalized stigma develops. Black gay and bisexual men (n = 151) reported their race and sexual orientation internalized stigma once before HIV/STI diagnosis and their HIV/STI internalized stigma monthly for 1 year after HIV/STI diagnosis. Multilevel analyses demonstrated that race and sexual orientation internalized stigma before diagnosis were associated with greater HIV/STI internalized stigma after diagnosis. More research is needed to understand how internalized stigma develops, including within the context of other identities and broader environmental characteristics to inform intervention efforts.

Masculine ideology and Black men who have sex with men's interest in HIV pre-exposure prophylaxis (PrEP).

We examined how traditional masculinity and stigma surrounding HIV pre-exposure prophylaxis (PrEP) affect PrEP interest among Black men who have sex with men (BMSM). One hundred twenty-three men attending a Black Gay Pride event completed measures assessing traditional masculinity, PrEP stigma, and PrEP interest along with two behavioral measures of interest in PrEP. Results demonstrated that avoidance of femininity directly related to interest in PrEP and indirectly through conformity to heterosexual self-presentation. Further, PrEP stigma differentially moderated both of these relationships. Interventions designed to improve engagement of PrEP for BMSM should be attentive to traditional masculinity as a barrier.

HIV microaggressions: a novel measure of stigma-related experiences among people living with HIV.

Since the beginning of the HIV epidemic stigma has served as a strong barrier to effectively delivering HIV prevention and treatment. Due in part to its complex nature, stigma is difficult to address and novel methods of understanding stigma are needed. Based on formative and empirical research with N = 236 primarily Black men living with HIV, a HIV microaggressions scale was developed and evaluated in order to assess this component of stigma. Factor analysis resulted in a 13-item scale (α = .83) with 3 subscales explaining 51% of the total variance. The microaggressions scale demonstrated convergent validity (with internalized, enacted, and anticipated stigmas) and discriminant validity (with social support). HIV microaggressions was associated with longer gaps since last care appointment and depressive symptoms, and subscales were associated with barriers to accessing health care, disclosure, and HIV care self-efficacy. The HIV microaggressions scale is a novel tool for assessing a critical subcomponent of stigma.

Risk and Protective Factors for Sexual Health Outcomes Among Black Bisexual Men in the U.S.: Internalized Heterosexism, Sexual Orientation Disclosure, and Religiosity.

Bisexual individuals are oftentimes at higher risk for negative sexual health outcomes compared to their heterosexual, gay, and lesbian counterparts. Racial minorities, who may experience double minority stress, may be at particular risk for a sexually transmitted infection (STI) and HIV. Some studies have considered protective factors that ameliorate negative health outcomes; yet, few focus on especially vulnerable populations. We analyzed a sample of 225 Black bisexual men (Mage = 36 years, SD = 12) from Atlanta to explore how combinations of risk (internalized heterosexism) and protective (sexual identity disclosure to community, disclosure to family, and religiosity) factors were related to sexual health outcomes post-baseline during a 1-year follow-up period: any self-reported STI, chlamydia/gonorrhea diagnosis, and HIV diagnosis. We used probability profiling methodology to report the probabilities that a Black bisexual man would report an STI or HIV diagnosis with various combinations and profiles of risk/protective factors. We found that higher levels of internalized heterosexism were significantly related to higher odds of all sexual health outcomes. Disclosure to community was related to much lower risk of all outcomes, whereas disclosure to family was associated with lower odds of self-reported STIs over time. Religiosity was related to lower odds of diagnosis of STIs/HIV, but not self-reported STIs. Our findings have implications for interventions that address internalized heterosexism and protective factors, especially among racial and sexual minorities. Interventions are needed for Black bisexual men that will leverage specific strategies for support to reduce their risk of negative sexual health outcomes.

Sexual Identity Disclosure and Awareness of HIV Prevention Methods Among Black Men Who Have Sex With Men.

Black men who have sex with men (BMSM) are disproportionately affected by the human immunodeficiency virus (HIV) epidemic, yet we know little about how HIV-negative BMSM of different sexual orientations access HIV prevention strategies. Identity development, minority stress, and disclosure theories suggest that for people of different sexual orientations, disclosure of sexual identity may be related to health behaviors. We performed a latent class analysis on a sample of 650 BMSM (Mage = 33.78, SD = 11.44) from Atlanta, Georgia, to explore whether sexual orientation, disclosure of sexual identity, and relationship status were related to HIV prevention strategies, including awareness of PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis) and frequency of HIV testing. We found three distinct BMSM classes referred to as (1) closeted bisexuals, (2) sexual identity managers, and (3) gay, out, and open; all classes primarily engaged in casual sex. Classes differed in their awareness and access to HIV prevention strategies. The closeted bisexual class was least aware of and least likely to access HIV prevention. Findings have important implications for future research, namely the consideration of sexual identity and disclosure among BMSM. With this knowledge, we may be able to engage BMSM in HIV/sexually transmitted infection (STI) prevention services.

The Psychology of Martin Luther King Jr.'s "Creative Maladjustment" at Societal Injustice and Oppression.

Many theoretical frameworks in psychology are premised on the notion that people are hedonistic in nature-drawn to pleasure and avoidant of discomfort. In this essay, we argue that psychology's hedonism contrasts with Martin Luther King Jr's conception of creative maladjustment, wherein a feeling of "cosmic discontent" is focused on the ugly truth of societal injustice. After reviewing hedonistic assumptions in the psychology of coping, well-being, and views of societal inequality, we discuss MLK's conception of creative maladjustment and tie it to critical consciousness and the present-day idea of being "woke." We then use MLK's ideas as a lens on contemporary psychological research of views of societal injustice "from above" and "from below." We suggest that MLK's analysis continues to challenge psychology to develop an approach to cognition, emotion, and motivation at societal injustice that identifies the ethical value of a sustained discontent that illuminates truth and animates opposition.

The differences between medical trust and mistrust and their respective influences on medication beliefs and ART adherence among African-Americans living with HIV.

OBJECTIVE: The purpose of this study was to examine the relationships between medical mistrust and trust and to determine if these measures differentially predict antiretroviral therapy (ART) medication adherence for African-American adults living with HIV. DESIGN: A total of 458 HIV positive African-Americans completed a cross-sectional survey. MAIN OUTCOME MEASURES: Self-reported ART adherence was collected using the visual-analog scale. The Beliefs About Medicines Questionnaire was used to assess medication necessity and concern beliefs. RESULTS: All measures of medical mistrust and trust were significantly negatively correlated, ranging from r = -.339 to -.504. Race-based medical mistrust significantly predicted medication necessity and concern beliefs, whereas general medical mistrust only significantly predicted medication concerns. Both measures of trust significantly predicted medication necessity beliefs and medication concerns. Higher levels of race-based medical mistrust predicted lower medication adherence, whereas, neither trust in own physician nor trust in health care provider significantly predicted medication adherence. However, trust in own physician significantly predicted medication necessity beliefs, which predicted medication adherence. CONCLUSION: Trust and mistrust are not simply opposites of one another. These findings provide evidence for the complexity of understanding the relationship between health care trust, mistrust and patient-related health beliefs and behaviours.

Diminishing Perceived Threat of AIDS and Increasing Sexual Risks of HIV Among Men Who Have Sex with Men, 1997-2015.

Community-wide awareness that antiretroviral therapies (ART) provides protection against HIV has the potential to increase perceived safety and thereby increase condomless anal sex among men who have sex with men (MSM). Furthermore, reductions in condom use can increase exposure to sexually transmitted infections, which in turn can reduce the protective effects of ART on HIV transmission. The current study extends previous community-based behavioral surveillance research on beliefs regarding use of ART for HIV prevention and sexual practices among MSM. Anonymous cross-sectional community surveys were collected from 1831 men at the same gay pride event in Atlanta, GA four times over nearly two decades; 1997, 2005-2006 (the 2006 survey over-sampled African-Americans to diversify the study), and 2015. Results indicate clear and consistent trends of increasing beliefs that HIV treatments reduce HIV transmission risks, reflecting the dissemination of HIV prevention research findings. Changes in treatment beliefs coincide with increased rates of condomless anal intercourse. Increased beliefs that treatments prevent HIV and increased condomless anal sex were observed for both HIV positive men and men who had not tested HIV positive. Results illustrate the emergence of an era where ART is the focus of HIV prevention and community-held beliefs and behaviors regarding definitions of risk create a new and potentially problematic environment for HIV transmission.

Stigma and Conspiracy Beliefs Related to Pre-exposure Prophylaxis (PrEP) and Interest in Using PrEP Among Black and White Men and Transgender Women Who Have Sex with Men.

The HIV/AIDS epidemic in the US continues to persist, in particular, among race, sexual orientation, and gender minority populations. Pre-exposure prophylaxis (PrEP), or using antiretroviral medications for HIV prevention, is an effective option, but uptake of PrEP has been slow. Sociocultural barriers to using PrEP have been largely underemphasized, yet have the potential to stall uptake and, therefore, warrant further understanding. In order to assess the relationships between potential barriers to PrEP (i.e., PrEP stigma and conspiracy beliefs), and interest in PrEP, Black men and transgender women who have sex with men (BMTW, N = 85) and White MTW (WMTW, N = 179) were surveyed at a gay pride event in 2015 in a large southeastern US city. Bivariate and multivariate logistic regression analyses were completed to examine factors associated with PrEP interest. Among the full sample, moderate levels of PrEP awareness (63%) and low levels of use (9%) were observed. Believing that PrEP is for people who are promiscuous (stigma belief) was strongly associated with lack of interest in using PrEP, and individuals who endorsed this belief were more likely to report sexual risk taking behavior. Conspiracy beliefs related to PrEP were reported among a large minority of the sample (42%) and were more frequently reported among BMTW than WMTW. Given the strong emphasis on the use of biomedical strategies for HIV prevention, addressing sociocultural barriers to PrEP access is urgently needed and failure to do so will weaken the potential benefits of biomedical prevention.