Dataset Information

Intersectional Effects of Sexual Orientation Concealment, Internalized Homophobia, and Gender Expression on Sexual Identity and HIV Risk Among Sexual Minority Men of Color: A Path Analysis.

ABSTRACT:

Abstract

In the United States, 13 million people identify as sexual and gender minorities. The purposes of this article were to (a) examine the associations among sexual orientation concealment and internalized homophobia with HIV knowledge, health literacy, and transactional sex through sexual identity; and (b) assess whether gender expression moderates those relationships in sexual minority men of color. A multigroup mediation path model examined the association between sexual orientation concealment and internalized homophobia on HIV knowledge, health literacy, and transactional sex through sexual identity by gender expression. Results suggest that, among those with a masculine gender expression, as sexual concealment increased, health literacy decreased. The association between sexual orientation concealment and transactional sex varied by participant's gender expression as did the association between internalized homophobia and HIV knowledge. Multiple intersecting identities, when faced with anticipated discrimination and homophobia, can negatively affect health outcomes and increase HIV risk in sexual minority men of color.

SUBMITTER: Ramos SR

PROVIDER: S-EPMC8221709 | biostudies-literature | 2021 Jul-Aug 01

REPOSITORIES: biostudies-literature

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Intersectional Effects of Sexual Orientation Concealment, Internalized Homophobia, and Gender Expression on Sexual Identity and HIV Risk Among Sexual Minority Men of Color: A Path Analysis.

Ramos S Raquel SR Lardier David T DT Opara Ijeoma I Turpin Rodman E RE Boyd Donte T DT Gutierrez José I JI Williams Chase Nicole CN Nelson LaRon E LE Kershaw Trace T

The Journal of the Association of Nurses in AIDS Care : JANAC 20210701 4

<h4>Abstract</h4>In the United States, 13 million people identify as sexual and gender minorities. The purposes of this article were to (a) examine the associations among sexual orientation concealment and internalized homophobia with HIV knowledge, health literacy, and transactional sex through sexual identity; and (b) assess whether gender expression moderates those relationships in sexual minority men of color. A multigroup mediation path model examined the association between sexual orientat ...[more]

PMID: 34101701

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Project description:Identity concealment affects all sexual minority individuals, with potentially complex mental health implications. Concealing a sexual minority identity can simultaneously generate the stress of hiding, protect against the stress of discrimination, and keep one apart from sexual minority communities and their norms and supports. Not surprisingly, existing studies of the association between sexual orientation concealment and mental health problems show contradictory associations-from positive to negative to null. This meta-analysis attempts to resolve these contradictions. Across 193 studies (n = 92,236) we find a small positive association between sexual orientation concealment and internalizing mental health problems (i.e., depression, anxiety, distress, problematic eating; ESr = 0.126; 95% CI [0.102, 0.151]) and a small negative association between concealment and substance use problems (ESr = -0.061; 95% CI [-0.096, -0.026]). The association between concealment and internalizing mental health problems was larger for those studies that assessed concealment as lack of open behavior, those conducted recently, and those with younger samples; it was smaller in exclusively bisexual samples. Year of data collection, study location, and sample gender, education, and racial/ethnic composition did not explain between-study heterogeneity. Results extend existing theories of stigma and sexual minority mental health, suggesting potentially distinct stress processes for internalizing problems versus substance use problems, life course fluctuations in the experience of concealment, distinct experiences of concealment for bisexual individuals, and measurement recommendations for future studies. Small overall effects, heavy reliance on cross-sectional designs, relatively few effects for substance use problems, and the necessarily coarse classification of effect moderators in this meta-analysis suggest future needed methodological advances to further understand the mental health of this still-increasingly visible population. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Project description:BackgroundThe healthcare disparities of sexual and gender minority (SGM) people are globally recognised. Research from the United States has advocated for sexual orientation and gender identity (SOGI) information capture via the electronic medical record (EMR) to support the generation of knowledge regarding SGM people's healthcare needs and the appropriate care for this population. In November 2022, The Royal Melbourne Hospital (RMH) enabled the SOGI capture EMR functionality. The purpose of this study is to understand how SOGI capture can inform the person-centred care of SGM people by way of interviews with SGM patients and RMH staff. It quantitatively describes RMH SOGI capture throughout the study period to provide additional insights.MethodsThis study uses an embedded mixed-methods design: qualitative data are primary and quantitative data are supplementary. SOGI capture uptake at RMH informed the recruitment of SGM patients (n = 11) and RMH staff (n = 13). Participants were engaged in in-depth semi-structured interviews that were then reflexively thematically analysed. SOGI capture throughout the study period (8th November 2022 to 23rd September 2024) was quantitatively described via frequency and percentage and then analysed in relation to the qualitative results to provide additional insights.ResultsInterviewed participants considered SOGI capture a significant step toward providing person-centred care for SGM people. However, participants shared problems in SGM healthcare and expressed that for SOGI capture to benefit SGM patients, staff must be aware of not only SOGI capture but also SGM healthcare issues. Other recommendations for SOGI capture included patient informed consent; patient preferences accurately captured; and mandatory SOGI questions to normalise this process. During the study period 272,672 patients were admitted to RMH, of which there were 2,174 (0.8%) SGM SOGI captures; 2,000 (0.7%) captured a gender identity that was not 'male' or 'female' and 1,113 captured a sexual orientation that was not 'straight' or 'not reported' (0.4%). These numbers demonstrate SGM patients' minority status and signal the need for more staff and patient awareness of SOGI capture and mandatory SOGI questions to increase the representation and knowledge of this population and ultimately improve its care provision. A diversity of identifiers for this population was captured (10 sexual orientation identifiers and 14 gender identity identifiers) which demonstrate the significance of recognising SGM patient preferences.ConclusionThis study presented an in-depth exploration of how SOGI capture can inform the person-centred care of SGM people if staff are aware of SGM healthcare issues, and if SOGI capture is done according to patient preference and consent and is normalised through mandatory questions. Insights and recommendations generated from this study can inform local and international policies and processes in the implementation of SOGI capture such that it can inform person-centred care for SGM people.

Dataset Information

Intersectional Effects of Sexual Orientation Concealment, Internalized Homophobia, and Gender Expression on Sexual Identity and HIV Risk Among Sexual Minority Men of Color: A Path Analysis.

Abstract

Publications

Intersectional Effects of Sexual Orientation Concealment, Internalized Homophobia, and Gender Expression on Sexual Identity and HIV Risk Among Sexual Minority Men of Color: A Path Analysis.

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