AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #214 - Stigma, coping, and HIV risk: Examining the Psychological Mediation Framework
Authors: Presenting Author: Dr. Sarit Golub - Hunter College of the City University of New York
Additional Authors: Dr. Tyrel Starks, Dr. Corina Weinberger, Dr. Jeffrey Parsons,
Aim: Past research suggests significant mental health disparities among sexual minorities, including increases in both internalizing outcomes (i.e. anxiety and depression) and externalizing behaviors (i.e. substance use). According to Minority Stress Theory (Meyer, 2003), coping strategies moderate the relationship between stress and mental health outcomes. According to the Psychological Mediation Framework (Hatzenbuehler, 2009), coping strategies mediate this relationship: minority stress may lead to rumination and preoccupation with a stigmatized identity, as well as coping motives for substance use and other negative health behavior. The present study was designed to examine the extent to which gay-related stigma and anxiety increase the association between substance use and high-risk sex among a sample of substance using gay and bisexual men (GBM), providing support for the existence of such coping motives.
Method / Issue: Analyses used baseline data from an RCT aiming to reduce substance use and sexual risk in HIV-negative GBM. Eligible participants reported ¡İ 5 drug days and ¡İ 1 high-risk sex act (i.e., unprotected anal intercourse with an HIV serodiscordant or status-unknown partner) in the past month. The analytic sample included 245 men between the ages of 18 and 50 (M = 30.0, SD = 7.5), and was 41% White, 28% Latino, 20% Black, and 11% Other/Multiracial. Participants reported an average of 5.6 drug use days (SD = 6.7, range 0-30) and an average of 2.7 high-risk sex acts (SD = 3.6, range 0-26) in the past 30. Multilevel path modeling was used to estimate the day-level impact of substance use on high-risk sex, as well as the direct and indirect effects of gay-related stigma and anxiety on substance use, high-risk sex, and their day-level relationship.
Results / Comments: Substance use on a given day increased the odds of high risk sex on that day by more than 4 times (expB = 4.5, p < .01). As gay-related stigma increased, so did the likelihood of high-risk sex on any given day (expB = 1.03, p < .05). However, the impact of stigma on high-risk sex was fully mediated through anxiety. Higher levels of stigma were associated with higher levels of anxiety (B = .20, p < .01), and anxiety was associated with both: a) a greater likelihood of substance use (expB = 1.1, p < .01); and b) a strengthened association between substance use and high-risk sex (expB = 1.09, p < .05). In the full path model, the direct effect of stigma on high-risk sex disappeared, suggesting that stigma leads to anxiety, which in turn leads to increased substance use and increased likelihood of high-risk sex under the influence.
Discussion: Findings lend support for the Psychological Mediation Framework in which minority stigma may lead to anxiety and coping motives for substance use, increasing the likelihood of HIV risk. Although casual claims cannot be made from these correlational data, findings suggest the importance of examining links among these critical variables, as wells as the extent to which some GBM may use substances to cope with the stigma and anxiety associated with minority sexual expression.
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