Date of Award

5-10-2018

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Public Health

First Advisor

Dr. Laura Salazar

Second Advisor

Dr. Monica Swahn

Abstract

INTRODUCTION: The HIV/AIDS epidemic has had a troubling affect across all racial/ethnic groups but has disproportionately exacted its greatest toll on African Americans, specifically, African American men who have sex with men (AAMSM), inclusive of any man who has had sexual contact with another man. In 2015, among all gay and bisexual men who received an HIV diagnosis in the U.S., African Americans accounted for the highest number (10,315; 39%), followed by whites (7,570; 29%) and Hispanics/Latinos (7,013; 27%)(CDC, 2017). Despite an overall decline in HIV diagnoses in African Americans between 2005-2014, conversely a 22% increase in HIV diagnosis was observed in African American gay and bisexual men during that same period, with HIV diagnoses among African American gay and bisexual men aged 13 to 24 increasing 87% (CDC, 2017). If current diagnosis rates continue, 1 in 6 gay and bisexual men will be diagnosed with HIV in their lifetime, including 1 in 2 black/African American gay and bisexual men, 1 in 4 Hispanic/Latino gay and bisexual men, and 1 in 11 white gay and bisexual men (CDC, 2017). Therefore, Black MSM (BMSM) in the United States are now experiencing rates of HIV infection that rival those among the general population in the developing world (Peterson & Jones, 2009). Studies to date have demonstrated that racial HIV disparities are not explained by individual behavioral factors alone, nor higher rates of substance use, or a higher number of sexual partners in BMSM, therefore these findings have prompted exploration into a broader array of social, structural, and contextual factors experienced by minority MSM that may explain HIV disparities (Quinn et al., 2015).

AIM: To examine the association between Internalized homophobia, stigma, racism, and religion and sexual risk behaviors, sexual identity and HIV testing frequency among young AAMSM in Jackson, MS.

METHODS: A total of 600 young MSM were eligible to participant in the study. Study participants were recruited from two federally funded clinics specializing in the diagnosis and treatment of STIs, including HIV. Participants were also recruited through social media, attending bars and nightclubs. Inclusion criteria included: (1) assigned male at birth; (2) self-identification as Black/African American; (3) 15-29 years of age; (4) attending the clinic to be tested for HIV or other STIs; (5) having engaged in anal sex with a male partner at least once in the past 6 months; and (6) the ability to speak and comprehend English. Study participants provided written informed consent and parental consent was obtained for participants under the age of 18. Participants completed an online questionnaire that collected sociodemographic characteristics, sexual risk behaviors, sexual experiences and experiences of homophobia, stigma and discrimination.

RESULTS: An increase in IH was associated with a .164(SD, .081) increase in the number of times having anal sex with a male partner as a top (p-value .02). An increase in stigma was associated with a .185(SD, .057) increase in the number of different male anal sex partners as a bottom (p-value .003). No statistically significant associations were found between daily racism. An increase in racism and life experiences was associated with a .051(SD, .021) increase in the number of different male anal sex partners as a bottom (p-value .027). No statistically significant association was found between religious support and the seven sexual risk behaviors. An increase in religious attendance was found to be associated with a .360 decrease in the number of different male anal sex partners as a bottom (p-value .03). And as religious attendance increased, the odds of engaging in condomless anal sex with a male as a bottom decreased (aOR 0.77, CI 0.64-0.92) at a p-value of .005. A statistically significant mean difference was found for IH across the sexual identity categories based on how an individual identified to male friends [F(6 ,581 )=7.0, p=

CONCLUSION: These study findings suggest that higher levels of IH, stigma, racism and life experiences are associated with an increase in sexual risk behaviors that can predispose young AAMSM in Jackson, MS. to HIV infection. Conversely, an increase in religious attendance was associated with a decrease in sexual risk behaviors. Additionally, the impact on mean levels of IH, stigma, religious attendance and support can differ across groups based on how individuals sexually identify to male friends, female friends and healthcare providers. These finding signify the importance of a need for HIV risk reduction interventions, at the individual, community, and structural level, that address socio-contextual factors that negatively impact sexual behaviors and increasing HIV risk, and these findings also signify the vital need for further research assessing socio-contextual factors and their role in driving the HIV/AIDS epidemic in AAMSM.

Available for download on Monday, April 22, 2019

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