Health Implications of Internalized Homonegativity over the Life Course of Young Black Gay, Bisexual and other Men Who Have Sex With Men Living with HIV 公开

Abstract

Background: Minority stress theory posits that homonegativity, whether external to an individual or internalized, has the potential to negatively impact health. We sought to understand the mechanisms through which homonegativity experienced over the life course impacted mental and physical health for young Black gay, bisexual and other men who have sex with men (YB-GBMSM) living with HIV.

Methods: We conducted 30 in-depth interviews with HIV-positive YB-GBMSM ages 18-29 in Atlanta. Interview domains included adolescent experiences with sexuality and coming out, descriptions of social support, trauma history, and medication adherence. We conducted team-based coding and thematic analysis to identify patterns in the data.

Results: Stifling, and sometimes traumatic, environments encountered during adolescence led to internalized homonegativity, which in turn shaped sexual identity formation, risk behaviors, and mental health outcomes. Familial homonegativity led participants to engage with men in secret, and many acknowledged it as a facilitator of contracting HIV.  After HIV seroconversion, some participants expressed feelings of self-loathing and depression. The majority of participants distanced themselves from homophobic environments upon reaching adulthood. Although participants described new environments as freeing, distance from support systems sometimes led to homelessness and financial struggles, which often had an adverse impact on HIV medication adherence.  

Conclusions: Our analysis suggests that internalized homonegativity plays a significant role in mental and physical health outcomes for YB-GBMSM. In order to mitigate the adverse effects of these experiences, our focus should shift to increasing social support within this population during adolescence and young adulthood. Future interventions aimed at improving health outcomes should be culturally appropriate, identity-affirming, and utilize a trauma-informed approach.

 

Table of Contents

Chapter 1: Introduction ………………………………………………………….. 1

Introduction and Rationale………………………………………………………………….. 1

Problem Statement …………………………………………………………………..4

Statement of Purpose …………………………………………………………………..5

Research Questions ……………………………………………………………..6

Significance Statement ……………………………………………………………..6

Definition of Terms ……………………………………………………………..6

Chapter 2: Literature Review ……………………………………………………………..8

Epidemiology of HIV in the United States Among GBMSM…………………………8

Influences on HIV Risk for Black GBMSM …………………………………………………9

Sexual Identity ……………………………………………………………..10

Gender Role Strain ……………………………………………………………..12

Internalized Homonegativity ……………………………………………………………..14

Healthcare Experiences of Black GBMSM Living with HIV ………………………………17

Chapter 3: Manuscript ……………………………………………………………..20

Abstract ……………………………………………………………..20

Introduction ……………………………………………………………..21

Methods ……………………………………………………………..24

Context ……………………………………………………………..24

Participants ……………………………………………………………..25

Design ……………………………………………………………..26

Thematic Analysis ……………………………………………………………..27

Results ……………………………………………………………..27

        Figure 1: Conceptual Framework ……………………………………………28

Discussion ……………………………………………………………..39

Limitations ……………………………………………………………..42

Conclusions ……………………………………………………………..43

Table 1: Participant Demographics …………………………………………………..44

Chapter 4: Recommendations ……………………………………………………………45

References ……………………………………………………………..49

Appendix 1: In-Depth Interview Guide …………………………………………54

Appendix 2: IDI Demographic Questionnaire …………………………………………………59

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
关键词	MSM HIV Black sexual minority health
Committee Chair / Thesis Advisor	Hussen, Sophia, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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