In the United States, significant disparities in HIV/AIDS exist among Black men who have sex with men (MSM). For instance, in 2006, Black MSM comprised 63% of new HIV infections among Black men, and 35% of new HIV infections among all MSM (Centers for Disease Control and Prevention [CDC], 2010a). Further, Black MSM were the only risk group in the United States to experience statistically significant increases in new HIV infections between 2006 and 2009 (CDC, 2012a). To address such disparities, HIV prevention efforts that focus on reducing the stress associated with sociocultural factors, such as experiences and perceptions of racism and homophobia, have been proposed. Utilizing the minority stress model and the theory of Intersectionality as guiding theoretical frameworks, this study examined: the relationship between indicators of minority stress (events of racial/ethnic discrimination, internalized racism, and internalized homophobia) and HIV risk behavior; whether psychological distress and/or social support moderate this relationship; and whether a culturally congruent intervention was efficacious in reducing perceptions of internalized racism and internalized homophobia, and frequency of HIV risk behavior among a sample of HIV-positive non-gay identifying Black men who have sex with men and women and who have histories of childhood sexual abuse.
The full sample included 117 men who were administered a baseline survey, as well as a sub-sample of 88 men who were randomized into either the Enhanced Sexual Health Intervention for Men (ES-HIM) intervention or Health Promotion control condition as part of the ES-HIM Project. The original randomized control trial took place between 2007 and 2011.
Only perception of internalized racism was found to have a direct association with HIV risk behavior in this sample, though this relationship was negative meaning increased racial pride predicted more HIV risk behavior. The full model that included all indicators of minority stress, childhood sexual abuse, and social support explained HIV risk behavior better than each indicator of minority stress on its own. This supported the additive perspective of the theory of Intersectionality, but not the primary perspective of this theory. The interactionist perspective was also tested between internalized racism and internalized homophobia, but findings did not result in support for this perspective.
The role of psychological distress was inconclusive. While ample evidence supported the removal of psychological distress in order to test a direct relationship between indicators of minority stress and HIV risk behavior, some support for moderation was found.
Social support showed clear indication of a moderating effect between two indicators of minority stress and HIV risk behavior when controlling for other covariates. Further, the level of social support and the indicator of minority stress contributed to the overall effect of social support on HIV risk behavior.
In terms of intervention effects, internalized racism did not decrease over the four time points for either the group as a whole (n=88), or by intervention condition. Internalized homophobia, however, significantly diminished over the four time points for the group as a whole, but no differences between the ES-HIM intervention and Health Promotion control condition were found. Finally, frequency of HIV risk behavior (i.e., intercourse without a condom) also decreased from baseline to post-intervention assessment for the group as a whole, but no intervention effects were found.
Indicators of minority stress, namely internalized racism and internalized homophobia, appear to play an important role in the HIV risk behavior of this population. However, the relationship is nuanced among this highly marginalized sample. Finally, while the ES-HIM intervention was unsuccessful in effecting changes in internalized racism, internalized homophobia, and frequency of HIV risk behavior over time, significant reductions in internalized homophobia and HIV risk behavior for the group as a whole were achieved.
