Gay Community Integration as Both a Source of Risk and Resilience for HIV Prevention in Beirut

  • Carol Abi GhanemEmail author
  • Cynthia El Khoury
  • Matt G. Mutchler
  • Bonnie Ghosh-Dastidar
  • Susan Kegeles
  • Elie Balan
  • Jacques E. Mokhbat
  • Glenn J. Wagner
Full length manuscript



Aspects of sexual identity development, including integration into gay community, have been found to be associated with sexual risk behavior among men who have sex with men (MSM), but not in the Middle East.


Drawing on the minority stress model and integrated theory of health behavior, we examined the relationships between measures of sexual identity development and HIV protective behaviors (condomless anal sex and HIV testing) and the mediating roles of HIV knowledge, peer judgmentalism, and discrimination, in a sample of 226 young MSM in Beirut, Lebanon.

A cross-sectional, mediation analysis was conducted using a bootstrapping approach and logistic regression models.


Fifteen percent of the sample reported recent condomless anal sex with partners whose HIV status was positive or unknown, and 82.3% had ever been tested for HIV. Multivariate logistic regression analysis showed that greater integration into the gay community was significantly associated with having recent condomless anal sex with positive/unknown HIV status partners and having any history of HIV testing, after controlling for covariates. Knowledge of HIV risk was associated with gay integration as well as both condomless anal sex with positive or unknown HIV status partners and any history of HIV testing, but it only served as a (partial) mediator of HIV testing. Peer judgmental communication about sex and sexuality-related discrimination were related in bivariate analysis to gay integration and condomless anal sex, but they too did not prove to be significant mediators of the relationship between these two constructs.


These findings highlight the potential sexual health benefits and vulnerabilities associated with increased integration into the gay community for young MSM in Beirut and the need to better understand how to increase HIV knowledge while limiting its potential to increase sexual risk behavior.


Discrimination HIV knowledge Social support Condomless anal sex HIV testing Gay community integration 


Funding Information

Research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under Award Number R01MH107272 (PI: G. Wagner).

Compliance with Ethical Standards


The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Conflict of Interest

The authors declare that they have no conflict of interest.

Informed Consent

All participants provided informed consent.

Ethical Approval

Ethics approval was provided by institution review boards at RAND and the Lebanese American University.


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Copyright information

© International Society of Behavioral Medicine 2019

Authors and Affiliations

  1. 1.The Lebanese Center for Policy StudiesBeirutLebanon
  2. 2.BeirutLebanon
  3. 3.California State University Dominguez HillsCarsonUSA
  4. 4.AIDS Project Los Angeles HealthLos AngelesUSA
  5. 5.RAND CorporationSanta MonicaUSA
  6. 6.Center for AIDS Prevention StudiesUniversity of California at San FranciscoSan FranciscoUSA
  7. 7.Arab Foundation for Freedom and EqualityBeirutLebanon
  8. 8.Lebanese AIDS SocietyBeirutLebanon
  9. 9.Department of MedicineLebanese American University School of MedicineBeirutLebanon
  10. 10.RAND CorporationSanta MonicaUSA

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