Skip to main content

Advertisement

Log in

A Structural Equation Model of the Effect of Masculinity and Avoidant Coping on Gay and Bisexual Men’s Sexual Risk-Taking

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

This study aims to extend the scientific knowledge base on the association between masculine norm adherence and sexual risk-taking, in the context of gay and bisexual men, by examining emotional suppression, social support seeking, and avoidant coping as potential mediating pathways. A sample of 482 gay and bisexual men was recruited. Structural equation modeling was used to assess for mediation. Findings revealed that although gender role conflict and conformity to masculine norms (i.e., the two masculine norm adherence predictor variables) did not have a direct effect on sexual risk-taking, a significant indirect effect was observed for gender role conflict on sexual risk-taking via increased avoidant coping. Accordingly, gender role conflict and avoidant coping may create a unique effect on sexual risk-taking whereby the effect of gender role conflict on sexual risk-taking is not transmitted directly but only indirectly through the mediating role of avoidant coping. Future research directions are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Public Health Agency of Canada. Summary: Estimates of HIV incidence, prevalence and Canada’s progress on meeting the 90-90-90 HIV target, 2016. Ottawa; 2018. https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/diseases-conditions/summary-estimates-hiv-incidence-prevalence-canadas-progress-90-90-90/pub-eng.pdf. Accessed 20 Dec 2018.

  2. Herek GM, Garnets LD. Sexual orientation and mental health. Annu Rev Clin Psychol. 2007;3(1):353–75.

    PubMed  Google Scholar 

  3. Meyer IH. Minority stress and mental health in gay men. J Health Soc Behav. 1995;36(1):38–56.

    CAS  PubMed  Google Scholar 

  4. Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674–97.

    PubMed  PubMed Central  Google Scholar 

  5. Dew BJ, Chaney MP. The relationship among sexual compulsivity, internalized homophobia, and HIV at-risk sexual behavior in gay and bisexual users of Internet chat rooms. Sex Addict Compulsivity. 2005;12(4):259–73.

    Google Scholar 

  6. Huebner DM, Davis MC, Nemeroff CJ, Aiken LS. The impact of internalized homophobia on HIV preventive interventions. Am J Community Psychol. 2002;30(3):327–48.

    PubMed  Google Scholar 

  7. Meyer IH, Dean L. Patterns of sexual behavior and risk taking among young New York City gay men. AIDS Educ Prev. 1995;7(5 Suppl):13–23.

    CAS  PubMed  Google Scholar 

  8. Ratti R, Bakeman R, Peterson JL. Correlates of high-risk sexual behaviour among Canadian men of South Asian and European origin who have sex with men. AIDS Care. 2000;12(2):193–202.

    CAS  PubMed  Google Scholar 

  9. Rosario M, Rotheram-Borus MJ, Reid H. Gay-related stress and its correlates among gay and bisexual male adolescents of predominantly Black and Hispanic background. J Community Psychol. 1996;24(2):136–59.

    Google Scholar 

  10. Rosario M, Hunter J, Maguen S, Gwadz M, Smith R. The coming-out process and its adaptational and health-related associations among gay, lesbian, and bisexual youths stipulation and exploration of a model. Am J Community Psychol. 2001;29(1):133–60.

    CAS  PubMed  Google Scholar 

  11. Dudley MG, Rostosky SS, Korfhage BA, Zimmerman RS. Correlates of high risk sexual behavior among young men who have sex with men. AIDS Educ Prev. 2004;16(4):328–40.

    PubMed  Google Scholar 

  12. Preston BP, D’Augelli AR, Cassab CD, Cain RE, Schulze FW, Starks MT. The influence of stigma on the sexual risk behavior of rural men who have sex with men. AIDS Educ Prev. 2004;16(4):291–303.

    PubMed  Google Scholar 

  13. Preston BP, D’Augelli AR, Cassab CD, Starks MT. The relationship of stigma to the sexual risk behavior of rural men who have sex with men. AIDS Educ Prev. 2007;19(3):218–30.

    PubMed  Google Scholar 

  14. Shidlo A. Internalized homophobia: conceptual and empirical issues in measurement. In: Green B, Herek G, editors. Lesbian and gay psychology: theory, research, and clinical applications. Thousand Oaks: Sage Publications; 1994. p. 176–205.

    Google Scholar 

  15. Newcomb ME, Mustanski BS. Moderators of the relationship between internalized homophobia and risky sexual behavior in men who have sex with men: a meta-analysis. Arch Sex Behav. 2011;40(1):189–98.

    PubMed  Google Scholar 

  16. Johnson MO, Carrico AW, Chesney MA, Morin SF. Internalized heterosexism among HIV-positive, gay-identified men: implications for HIV prevention and care. J Consult Clin Psychol. 2008;76(5):829–39.

    PubMed  PubMed Central  Google Scholar 

  17. Courtenay WH. Constructions of masculinity and their influence on men’s well-being: a theory of gender and health. Soc Sci Med. 2000;50(10):1385–401.

    CAS  PubMed  Google Scholar 

  18. Courtenay WH. Behavioral factors associated with disease, injury, and death among men: evidence and implications for prevention. J Mens Stud. 2000;9(1):81–142.

    Google Scholar 

  19. Courtenay WH. Engendering health: a social constructionist examination of men’s health beliefs and behaviors. Psychol Men Masc. 2000;1(1):4–15.

    Google Scholar 

  20. Creighton G, Oliffe JL. Theorizing masculinities and men’s health: a brief history with a view to practice. Health Sociol Rev. 2010;19(4):409–18.

    Google Scholar 

  21. Courtenay WH. Dying to be men: psychosocial, environmental, and biobehavioral directions in promoting the health of men and boys. New York: Routledge; 2011.

    Google Scholar 

  22. Helgeson VS. Gender and health: a social psychological perspective. In: Baum A, Revensson TA, Singer J, editors. Handbook of health psychology. 2nd ed. New York: Psychology Press; 2012. p. 519–37.

    Google Scholar 

  23. Dworkin SL. Men at risk: masculinity, heterosexuality and HIV prevention. New York: New York University Press; 2015.

    Google Scholar 

  24. Eisler RM. The relationship between masculine gender role stress and men’s health risk: the validation of a construct. In: Levant R, Pollack W, editors. A new psychology of men. New York: Basic Books; 1995. p. 207–25.

    Google Scholar 

  25. Griffith DM, Thorpe RJ Jr. Men’s physical health and health behavior. In: Wong YJ, Wester SR, editors. APA handbook of men and masculinities. Washington: American Psychological Association; 2016. p. 709–30.

    Google Scholar 

  26. Oliffe J. Health behaviors, prostate cancer, and masculinities. Men Masc. 2009;11(3):346–66.

    Google Scholar 

  27. Parent MC, Smiler AP. Metric invariance of the Conformity to Masculine Norms Inventory-46 among women and men. Psychol Men Masc. 2013;14(3):324–8.

    Google Scholar 

  28. Mahalik JR, Locke BD, Ludlow LH, et al. Development of the conformity to masculine norms inventory. Psychol Men Masc. 2003;4(1):3–25.

    Google Scholar 

  29. Bogaert AF, Fisher WA. Predictors of university men’s number of sexual partners. J Sex Res. 1995;32(2):119–30.

    Google Scholar 

  30. Knipper E, Rhodes SD, Lindstrom K, Bloom FR, Leichliter JS, Montaño J. Condom use among heterosexual immigrant Latino men in the southeastern United States. AIDS Educ Prev. 2007;19(5):436–47.

    PubMed  Google Scholar 

  31. Mahalik JR, Burns SM, Syzdek M. Masculinity and perceived normative health behaviors as predictors of men’s health behaviors. Soc Sci Med. 2007;64(11):2201–9.

    PubMed  Google Scholar 

  32. Marín BV, Gómez CA, Tschann JM, Gregorich SE. Condom use in unmarried Latino men: a test of cultural constructs. Health Psychol. 1997;16(5):458–67.

    PubMed  Google Scholar 

  33. Noar SM, Morokoff PJ. The relationship between masculinity ideology, condom attitudes, and condom use stage of change: a structural equation modeling approach. Int J Mens Health. 2002;1(1):43–58.

    Google Scholar 

  34. O’Sullivan LF, Hoffman S, Harrison A, Dolezal C. Men, multiple sexual partners, and young adults’ sexual relationships: understanding the role of gender in the study of risk. J Urban Health. 2006;83(4):695–708.

    PubMed  PubMed Central  Google Scholar 

  35. Pleck JH, Sonenstein FL, Ku LC. Masculinity ideology: its impact on adolescent males’ heterosexual relationships. J Soc Issues. 1993;49(3):11–29.

    Google Scholar 

  36. Santana MC, Raj A, Decker MR, La Marche A, Silverman JG. Masculine gender roles associated with increased sexual risk and intimate partner violence perpetration among young adult men. J Urban Health. 2006;83(4):575–85.

    PubMed  PubMed Central  Google Scholar 

  37. Shai NJ, Jewkes R, Nduna M, Dunkle K. Masculinities and condom use patterns among young rural South Africa men: a cross-sectional baseline survey. BMC Public Health. 2012;12(1):462–70.

    PubMed  PubMed Central  Google Scholar 

  38. Bowleg L, Teti M, Massie JS, Patel A, Malebranche DJ, Tschann JM. ‘What does it take to be a man? What is a real man?’: ideologies of masculinity and HIV sexual risk among Black heterosexual men. Cult Health Sex. 2011;13(5):545–59.

    PubMed  PubMed Central  Google Scholar 

  39. Kennedy DP, Brown RA, Golinelli D, Wenzel SL, Tucker JS, Wertheimer SR. Masculinity and HIV risk among homeless men in Los Angeles. Psychol Men Masc. 2013;14(2):156–67.

    PubMed  PubMed Central  Google Scholar 

  40. Brennan DJ, Souleymanov R, George C, et al. Masculinity, muscularity, and HIV sexual risk among gay and bisexual men of color. Psychol Men Masc. 2015;16(4):393–403.

    Google Scholar 

  41. Fields EL, Bogart LM, Smith KC, Malebranche DJ, Ellen J, Schuster MA. “I always felt I had to prove my manhood”: homosexuality, masculinity, gender role strain, and HIV risk among young black men who have sex with men. Am J Public Health. 2015;105(1):122–31.

    PubMed  PubMed Central  Google Scholar 

  42. Halkitis PN, Parsons JT. Intentional unsafe sex (barebacking) among HIV-positive gay men who seek sexual partners on the Internet. AIDS Care. 2003;15(3):367–78.

    CAS  PubMed  Google Scholar 

  43. Hamilton CJ, Mahalik JR. Minority stress, masculinity, and social norms predicting gay men’s health risk behaviors. J Couns Psychol. 2009;56(1):132–41.

    Google Scholar 

  44. Pool GJ, Schwegler AF, Theodore BR, Fuchs PN. Role of gender norms and group identification on hypothetical and experimental pain tolerance. Pain. 2007;129(1–2):122–9.

    PubMed  Google Scholar 

  45. Balswick J. The inexpressive male. Lexington: Lexington Books; 1988.

    Google Scholar 

  46. Brooks GR. A new psychotherapy for traditional men. San Francisco: Jossey-Bass; 1998.

    Google Scholar 

  47. Lynch JR, Kilmartin C. The pain behind the mask: overcoming masculine depression. Binghamton: The Hayworth Press, Inc; 1999.

    Google Scholar 

  48. Moore D, Haverkamp BE. Measured increases in male emotional expressiveness following a structured group intervention. J Couns Dev. 1989;67(9):513–7.

    Google Scholar 

  49. Pollack WS, Levant RF, editors. New psychotherapy for men. Hoboken: Wiley; 1998.

    Google Scholar 

  50. Scher M. Men in hiding: a challenge for the counselor. J Couns Dev. 1981;60(4):199–202.

    Google Scholar 

  51. Good G, Sherrod N. The psychology of men and masculinity: research status and future directions. In: Unger R, editor. Handbook of the psychology of women and gender. Hoboken: Wiley; 2001. p. 201–14.

    Google Scholar 

  52. O’Neil JM. Patterns of gender role conflict and strain: sexism and fear of femininity in men’s lives. Pers Guid J. 1981;60(4):203–10.

    Google Scholar 

  53. Stockard J. Gender socialization. In: Chafetz JS, editor. Handbook of the sociology of gender. New York: Kluwer Academic/Plenum Publishers; 1999. p. 215–46.

    Google Scholar 

  54. Kiselica MS, Benton-Wright S, Englar-Carlson M. Accentuating positive masculinity: a new foundation for the psychology of boys, men, and masculinity. In: Wong YJ, Wester SR, editors. APA handbook of men and masculinities. Washington: American Psychological Association; 2016. p. 123–43.

    Google Scholar 

  55. O’Neil JM, Good GE, Holmes S. Fifteen years of theory and research on men’s gender role conflict: new paradigms for empirical research. In: Levant RF, Pollack WS, editors. A new psychology of men. New York: Basic Books; 1995. p. 164–206.

    Google Scholar 

  56. Mahalik JR, Good GE, Englar-Carlson M. Masculinity scripts, presenting concerns, and help seeking: implications for practice and training. Prof Psychol Res Pract. 2003;34(2):123–31.

    Google Scholar 

  57. King LA, Emmons RA. Conflict over emotional expression: psychological and physical correlates. J Pers Soc Psychol. 1990;58(5):864–77.

    CAS  PubMed  Google Scholar 

  58. Kennedy-Moore E, Watson JC. How and when does emotional expression help? Rev Gen Psychol. 2001;5(3):187–212.

    Google Scholar 

  59. Folkman S, Lazarus RS. An analysis of coping in a middle-aged community sample. J Health Soc Behav. 1980;21(3):219–39.

    CAS  PubMed  Google Scholar 

  60. Folkman S, Chesney MA, Pollack L, Phillips C. Stress, coping, and high-risk sexual behavior. Health Psychol. 1992;11(4):218–22.

    CAS  PubMed  Google Scholar 

  61. Dowsett GW, Williams H, Ventuneac A, Carballo-Dieguez A. ‘Taking it like a man’: masculinity and barebacking online. Sexualities. 2008;11(1–2):121–41.

    Google Scholar 

  62. Halkitis PN, Parsons JT, Wilton L. Barebacking among gay and bisexual men in New York City: explanations for the emergence of intentional unsafe behavior. Arch Sex Behav. 2003;32(4):351–7.

    PubMed  Google Scholar 

  63. Koblin BA, Husnik MJ, Colfax G, et al. Risk factors for HIV infection among men who have sex with men. AIDS. 2006;20(5):731–9.

    PubMed  Google Scholar 

  64. Spendelow JS. Men’s self-reported coping strategies for depression: a systematic review of qualitative studies. Psychol Men Masc. 2015;16(4):439–47.

    Google Scholar 

  65. Tamres LK, Janicki D, Helgeson VS. Sex differences in coping behavior: a meta-analytic review and an examination of relative coping. Pers Soc Psychol Rev. 2002;6(1):2–30.

    Google Scholar 

  66. Martin JI, Pryce JG, Leeper JD. Avoidance coping and HIV risk behavior among gay men. Health Soc Work. 2005;30(3):193–201.

    PubMed  Google Scholar 

  67. Robins AG, Dew MA, Davidson S, Penkower L, Becker JA, Kingsley L. Psychosocial factors associated with risky sexual behavior among HIV-seropositive gay men. AIDS Educ Prev. 1994;6(6):483–92.

    CAS  PubMed  Google Scholar 

  68. Semple SJ, Patterson TL, Grant I. Psychosocial predictors of unprotected anal intercourse in a sample of HIV positive gay men who volunteer for a sexual risk reduction intervention. AIDS Educ Prev. 2000;12(5):416–30.

    CAS  PubMed  Google Scholar 

  69. Williams ML, Elwood WN, Bowen AM. Escape from risk: a qualitative exploration of relapse to unprotected anal sex among men who have sex with men. J Psychol Hum Sex. 2000;11(4):25–49.

    Google Scholar 

  70. O’Neil JM. Summarizing 25 years of research on men’s gender role conflict using the gender role conflict scale: new research paradigms and clinical implications. Couns Psychol. 2008;36(3):358–445.

    Google Scholar 

  71. Lambert G, Cox J, Miangotar Y, et al. ARGUS 2008–2009: a survey on HIV, viral hepatitis and sexually transmitted infections (STI) as well as associated risk behaviours among Quebec men who have sex with men (MSM). Direction de santé publique de l’Agence de la santé et des services sociaux de Montréal, Institut national de santé publique du Québec and the Public Health Agency of Canada; 2011.

  72. Public Health Agency of Canada. M-Track: Enhanced surveillance of HIV, sexually transmitted and blood-borne infections, and associated risk behaviours among men who have sex with men in Canada. Phase 1 Report (internet). Ottawa; 2011. http://librarypdf.catie.ca/PDF/ATI-20000s/26403.pdf. Accessed 20 Dec 2018.

  73. Wester SR, Vogel DL, O’Neil JM, Danforth L. Development and evaluation of the Gender Role Conflict Scale Short Form (GRCS-SF). Psychol Men Masc. 2012;13(2):199–210.

    Google Scholar 

  74. Parent MC, Moradi B. Confirmatory factor analysis of the conformity to masculine norms inventory and development of the conformity to masculine norms inventory-46. Psychol Men Masc. 2009;10(3):175–89.

    Google Scholar 

  75. Larson DG, Chastain RL. Self-concealment: conceptualization, measurement, and health implications. J Soc Clin Psychol. 1990;9(4):439–55.

    Google Scholar 

  76. Amirkhan JH. A factor analytically derived measure of coping: the coping strategy indicator. J Pers Soc Psychol. 1990;59(5):1066–74.

    Google Scholar 

  77. Tobin DL, Holroyd KA, Reynolds RV. User’s manual for the Coping Strategies Inventory. Athens: Ohio University, Department of Psychology; 1984.

    Google Scholar 

  78. Muthén LK, Muthén BO. Mplus user’s guide. 7th ed. Los Angeles: Author; 2012.

    Google Scholar 

  79. Kline RB. Principles and practice of structural equation modeling. 4th ed. New York: Guilford Press; 2016.

    Google Scholar 

  80. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Mahwah: Lawrence Erlbaum Associates; 1988.

    Google Scholar 

  81. Steiger JH. Structural model evaluation and modification: an interval estimation approach. Multivariate Behav Res. 1990;25(2):173–80.

    CAS  PubMed  Google Scholar 

  82. Bentler PM. Comparative fit indexes in structural models. Psychol Bull. 1990;107(2):238–46.

    CAS  PubMed  Google Scholar 

  83. Herbst JH, Jacobs ED, Finlayson TJ, McKleroy VS, Neumann MS, Crepaz N, HIV/AIDS Prevention Research Synthesis Team. Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review. AIDS Behav. 2008;12:1–7.

    PubMed  Google Scholar 

  84. Hayes AF. Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. New York: Guilford Press; 2013.

    Google Scholar 

  85. Baron RM, Kenny DA. The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51(6):1173–82.

    CAS  Google Scholar 

  86. Hayes AF. Beyond Baron and Kenny: statistical mediation analysis in the new millennium. Commun Monogr. 2009;76(4):408–20.

    Google Scholar 

  87. Preacher KJ, Hayes AF. SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behav Res Methods. 2004;36(4):717–31.

    Google Scholar 

  88. Rucker DD, Preacher KJ, Tormala ZL, Petty RE. Mediation analysis in social psychology: current practice and new recommendations. Soc Personal Psychol Compass. 2011;5(6):359–71.

    Google Scholar 

  89. Shrout PE, Bolger N. Mediation in experimental and nonexperimental studies: new procedures and recommendations. Psychol Methods. 2002;7(4):422–45.

    PubMed  Google Scholar 

  90. Zhao X, Lynch JG Jr, Chen Q. Reconsidering Baron and Kenny: myths and truths about mediation analysis. J Consum Res. 2010;37(2):197–206.

    Google Scholar 

  91. Wells S, Flynn A, Tremblay PF, Dumas T, Miller P, Graham K. Linking masculinity to negative drinking consequences: the mediating roles of heavy episodic drinking and alcohol expectancies. J Stud Alcohol Drugs. 2014;75(3):510–9.

    PubMed  Google Scholar 

  92. Stall R, Paul JP, Greenwood G, et al. Alcohol use, drug use and alcohol-related problems among men who have sex with men: the Urban Men’s Health Study. Addiction. 2001;96(11):1589–601.

    CAS  PubMed  Google Scholar 

  93. Kiselica MS, Englar-Carlson M. Identifying, affirming, and building upon male strengths: the positive psychology/positive masculinity model of psychotherapy with boys and men. Psychotherapy. 2010;47(3):276–87.

    PubMed  Google Scholar 

  94. De Ridder DT, Lensvelt-Mulders G, Finkenauer C, Stok FM, Baumeister RF. Taking stock of self-control: a meta-analysis of how trait self-control relates to a wide range of behaviors. Pers Soc Psychol Rev. 2012;16(1):76–99.

    PubMed  Google Scholar 

  95. Gailliot MT, Baumeister RF. Self-regulation and sexual restraint: dispositionally and temporarily poor self-regulatory abilities contribute to failures at restraining sexual behavior. Pers Soc Psychol Bull. 2007;33(2):173–86.

    PubMed  Google Scholar 

  96. Rochefort C, Baldwin AS, Chmielewski M. Experiential avoidance: an examination of the construct validity of the AAQ-II and MEAQ. Behav Ther. 2018;49(3):435–49.

    PubMed  Google Scholar 

  97. Dobson DJ, Dobson KS. Avoidance in the clinic: strategies to conceptualize and reduce avoidant thoughts, emotions, and behaviors with cognitive-behavioral therapy. Pract Innov. 2018;3(1):32–42.

    Google Scholar 

Download references

Acknowledgements

Canadian Institutes of Health Research and Canadian Association of HIV Research funded the present study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Tyler L. Brown.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Brown, T.L., Smith, N.G. & Cox, J. A Structural Equation Model of the Effect of Masculinity and Avoidant Coping on Gay and Bisexual Men’s Sexual Risk-Taking. AIDS Behav 25, 1438–1453 (2021). https://doi.org/10.1007/s10461-020-02981-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-020-02981-4

Keywords

Navigation