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Rollins School of Public Health

Candler School of Theology

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Social Stressors, Risk Taking, and HIV Risk Perceptions among Men who have Sex with Men in Seven Countries

Chard, Anna Natalie (2013)
Master's Thesis (115 pages)
Committee Chair / Thesis Adviser: Stephenson, Robert
Committee Members:
Research Fields: Health Sciences, Public Health
Partnering Agencies: Emory University schools, faculty or affiliated programs
Keywords: MSM; social stress; minority stress; HIV/AIDS; homophobia
Program: Rollins School of Public Health, Hubert Department of Global Health
Permanent url:


Background: Men who have sex with men (MSM) continue to be disproportionally affected by the HIV/AIDS epidemic. Previous studies have focused on individual-level characteristics as drivers of risk behaviors, while little research has examined the role of the socio-cultural factors and social stressors that place MSM at a greater risk for negative health effects. Objective: To examine the relationships between social stresses, social networks, drug and alcohol use, HIV risk perceptions, and sexual risk taking among MSM in seven countries. Methods: Sexually active MSM aged over 18 and residing in Australia, Brazil, Canada, South Africa, Thailand, the United Kingdom, and the United States were recruited through Facebook. The study examined 7 outcomes, divided into three manuscripts: 1. Reporting experiences of external homophobic discrimination and reporting feelings of internalized homophobia were examined through linear regression. Covariates of interest included demographic characteristics, recent sexual behaviors,and social network size. 2. Reporting recent drug use and reporting intoxication at last intercourse were examined through logistic regression. Covariates of interest included demographic characteristics, measures of social stress, and social network size. 3. Perceived seriousness of HIV sero-conversion, perceived risk of contracting HIV, and perceived lifetime inability to remain HIV sero-negative were examined through linear regression. Covariates of interest included: demographic characteristics, measures of social stress, and recent sexual behavior. Results: Reporting of internal and external homophobic discrimination was widespread. Both self-reported drug use and participation in intoxicated sex were high. HIV infection was universally perceived as serious, but HIV risk perceptions were low despite participations in sexual risk-taking. Conclusion/Implications: Results demonstrate the ameliorative effect of social networks on experiencing homophobia and engaging in HIV risk behaviors, and highlight the need for inclusion of homophobia as a physical and mental health risk factor. Additional research should focus on incorporating experiences of homophobia in HIV/AIDS and STI counseling and testing tools.

Table of Contents

Table of Contents -- Chapter I: Introduction: p. 1 -- Objectives and Aims: p. 2 -- Homophobia: p. 3 -- Social Stress: p. 4 -- Social Networks: p. 5 -- Chapter II: Manuscript I: p. 7 -- Abstract: p. 9 -- Background: p. 10 -- Methods: p. 12 -- Results: p. 15 -- Discussion: p. 16 -- Conclusion: p. 20 -- Tables: p. 21 -- References: p. 26 -- Chapter III: Manuscript II: p. 29 -- Abstract: p. 31 -- Background: p. 32 -- Methods: p. 34 -- Results: p. 37 -- Discussion: p. 39 -- Conclusion: p. 42 -- Tables: p. 44 -- References: p. 53 -- Chapter IV: Manuscript III: p. 57 -- Abstract: p. 59 -- Background: p. 61 -- Methods: p. 62 -- Results: p. 66 -- Discussion: p. 70 -- Conclusion: p. 75 -- Tables: p. 76 -- References: p. 87 -- Chapter V: Public Health Recommendations: p. 90 -- Chapter VI: References: p. 97
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