AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #190 - Race-based differentials of the impact of mental health and stigma on HIV risk among young gay and bisexual men
Authors: Presenting Author: Dr. Corina Lelutiu-Weinberger - Center for HIV Educational Studies and Training, Hunter College
Additional Authors: Dr. Sarit Golub, Dr. Jeffrey Parsons, Ms. Kristi Gamarel,
Aim: Understanding independent and interactive effects of psychosocial and demographic characteristics on sexual risk poses urgency, especially for 18-29 year-old gay and bisexual men (GBM) of color, whose HIV incidence has shown drastic recent increases. This study accounts for how the confluence of adverse factors may impact risky behavior by asking whether established independent predictors of sexual risk would have an increased interactive effect on HIV risk. We analyzed baseline data from a randomized controlled trial aiming to reduce substance use and sexual risk in HIV-negative GBM, and hypothesized that being non-White, more marginalized (e.g., poorer, less educated), and presenting higher levels of gay-related stigma and depression/anxiety would be associated with increased sexual risk and drug use.
Method / Issue: The 206 participants were 18-29 years old, had ≥ 5 days of drug use and ≥ 1 incident of unsafe anal sex with a high risk partner in the last 90 days. Average age was 24.7 (2.7), and 65% were non-White. Our predictors were 1) Gay-Related Stigma and 2) BSI-Anxiety/Depression Scales, and 3) demographic characteristics (race/ethnicity, parental social class, employment, income and education). The outcomes were 1) sexual risk behavior (unprotected anal sex overall and under the influence of drugs/alcohol and number of sex partners in the past month) and 2) drug use and endorsement of pros of drug use. Significant bi-variate associations informed our selection of variables for multivariate analyses. Negative binomial regressions with interaction terms of mean centered predictors were employed when the amount of over-dispersion in behavioral outcomes exceeded the tolerance of Poisson distribution.
Results / Comments: All sexual risk indicators and number of drug use days in the past month increased in value for participants with higher levels of depression/anxiety and gay-related stigma. Of the demographic characteristics, only race and education significantly predicted HIV risk. Non-Whites reported higher numbers of risky sex acts and drugs per day, which was further exacerbated by high stigma and depression/anxiety. Only low levels of stigma and depression/anxiety were associated with non-significant differences in sexual risk between the two groups. Further, non-Whites with increased depression/anxiety and gay-related stigma held more favorable attitudes towards drug use than their White counterparts. Lastly, participants with an education of high school or less showed increased sexual risk and drug use.
Discussion: The interaction between high gay-related stigma and depression/anxiety predicted increased sexual risk and substance use for non-Whites compared to Whites. Similar risk patterns were observed for those with lower education, mostly characteristic of non-Whites. The cumulative impact of increased stigma based on sexual orientation and ethnicity, poorer mental health and lower levels of knowledge due to inadequate education place young GMB of color in a vulnerable position conducive of HIV risk behavior. These significant interactions should be considered when tailoring interventions for different groups in order to inform prevention models that may include community- and structural-level elements aimed at ameliorating multi-faceted adversities experienced by young GBM of color.
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