African-American, Latino, and White men who have sex with men and women (MSMW) may be a bridge of HIV transmission from men to women. Very little research has directly compared culturally specific correlates of the likelihood of unprotected sex among MSMW. The present study examined psychosocial correlates of unprotected sex without disclosure of HIV status with male and female partners among 50 African American, 50 Latino, and 50 White HIV-positive MSMW recruited from AIDS service organizations in Los Angeles County. Multivariate logistic regressions were conducted to examine relationships of race/ethnicity and psychosocial variables (e.g., condom attitudes, self-efficacy for HIV disclosure, sexual identification) to unprotected sex without disclosure of HIV status, for male and female partners separately. For female partners, different effects emerged by race/ethnicity. Among African-Americans, less exclusively homosexual identification and low self-efficacy for disclosure of HIV status to female partners were associated with unprotected sex without disclosure; among Latinos, less exclusively homosexual identification and negative attitudes about condoms were significant. Participants who were more exclusively homosexually identified, who held less positive condom attitudes, and who had low self-efficacy for disclosure to female partners were more likely to have unprotected sex without disclosure of HIV status to male partners. Culturally tailored community-level interventions may help to raise awareness about HIV and bisexuality, and decrease HIV and sexual orientation stigma, thereby increasing African-American and Latino MSMW’s comfort in communicating with their female partners about sexuality, HIV and condoms. Addressing norms for condom use and disclosure between male partners is recommended, especially for homosexually identified MSMW.
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Agronick, G., O’Donnell, L., Stueve, A., Doval, A. S., Duran, R., & Vargo, S. (2004). Sexual behaviors and risks among bisexually- and gay-identified young Latino men. AIDS and Behavior, 8, 185–197.
Almaguer, T. (1991). Chicano men: A cartography of homosexual identity and behavior. Differences, 3, 75–100.
Cargill, V. A., & Stone, V. E. (2005). HIV/AIDS: A minority health issue. Medical Clinics of North America, 89, 895–912.
Carrier, J. M. (1989). Sexual behavior and spread of AIDS in Mexico. Medical Anthropology, 20, 129–142.
Carrier, J. M., & Wolf, T. J. (1985). Mexican male bisexuality. Bisexualities: Theory and research. New York: Haworth Press.
Centers for Disease Control Prevention [CDC]. (2006). HIV/AIDS surveillance report, 2005. Atlanta, GA: Department of Health and Human Services.
Chu, S. Y., Peterman, T. A., Doll, L. S., Buehler, J. W., & Curran, J. W. (1992). AIDS in bisexual men in the United States: Epidemiology and transmission to women. American Journal of Public Health, 82, 220–224.
Department of Health Services [DHS]. (2000). HIV prevention plan. Los Angeles County: Department of Health Services.
Diaz, R. M. (1998). Latino gay men and HIV: Culture, sexuality and risk behavior. New York: Routledge.
Diaz, R. M., Ayala, G., Bein, E., Henne, J., & Marin, B. V. (2001). The impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: Findings from 3 US cities. American Journal of Public Health, 91, 927–932.
Diaz, T., Chu, S. Y., Frederick, M., Hermann, P., Levy, A., & Mokotoff, E. (1993). Sociodemographics and HIV risk behaviors of bisexual men with AIDS: Results from a multistate interview project. AIDS, 7, 1227–1232.
DiClemente, R., Boyer, C., & Morales, E. (1999). Minorities and AIDS: Knowledge, attitudes and misconceptions among Black and Latino adolescents. American Journal of Public Health, 78, 55–57.
Doll, L., Petersen, L. R., White, C. R., Johnson, E. S., & Ward, J. W. (1992). Homosexually and nonhomosexually identified men who have sex with men: A behavioral comparison. Journal of Sex Research, 29, 1–14.
Ekstrand, M. L., Coates, T. J., Guydish, J. R., Hauck, W. W., Collette, L. H., & Hulley, S. (1994). Are bisexually identified men in San Francisco a common vector for spreading HIV infection to women? American Journal of Public Health, 84, 915–919.
Ford, K., & Norris, A. E. (1995). Factors related to condom use with casual partners among urban African-American and Hispanic males. AIDS Education and Prevention, 7, 494–503.
Harawa, N. T., Greenland, S., Bingham, T. A., Johnson, D. F., Cochran, S. D., Cunningham, W., et al. (2004). Associations of race/ethnicity with HIV prevalence and HIV-related behaviors among young men who have sex with men in 7 urban centers in the United States. Journal of Acquired Immune Deficiency Syndromes, 35, 526–536.
Harawa, N. T., Williams, J. K., Ramamurthi, H. C., & Bingham, T. A. (2006). Perceptions towards condom use, sexual activity, and HIV disclosure among HIV-positive African American men who have sex with men: Implications for heterosexual transmission. Journal of Urban Health, 83, 682–694.
Hart, T. A., Wolitski, R. J., Purcell, D. W., Parsons, J. T., & Gomez, C. A. (2005). Partner awareness of the serostatus of HIV-seropositive men who have sex with men: Impact on unprotected sexual behavior. AIDS and Behavior, 9, 155–166.
Hays, R. B., Paul, J., Ekstrand, M., Kegeles, S. M., Stall, R., & Coates, T. J. (1997). Actual versus perceived HIV status, sexual behaviors and predictors of unprotected sex among young gay and bisexual men who identify as HIV-negative, HIV-positive and untested. AIDS, 11, 1495–1502.
Herek, G. M., & Capitanio, J. P. (1993). Public reactions to AIDS in the United States: A second decade of stigma. American Journal of Public Health, 83, 574–577.
Herek, G. M., Capitanio, J. P., & Widaman, K. F. (2002). HIV-related stigma and knowledge in the United States: Prevalence and trends, 1991–1999. American Journal of Public Health, 92, 371–377.
Herek, G. M., & Glunt, E. K. (1995). Identity and community among gay and bisexual men in the AIDS era: Preliminary findings from the Sacramento Men’s Health Study. In G. Herek & B. Greene (Eds.), AIDS, identity, and community: The HIV epidemic and lesbian and gay men (pp. 55–84). Thousand Oaks, CA: Sage.
Huebner, D. M., Davis, M. C., Nemeroff, C. J., & Aiken, L. S. (2002). The impact of internalized homophobia on HIV preventive interventions. American Journal of Community Psychology, 30, 327–348.
Jarama, S. L., Kennamer, J. D., Poppen, P. J., Hendricks, M., & Bradford, J. (2005). Psychosocial, behavioral, and cultural predictors of sexual risk for HIV infection among Latino men who have sex with men. AIDS and Behavior, 9, 513–523.
Jimenes, R. (1987). Educating minorities about AIDS: Challenges and strategies. Family and Community Health, 10, 70–73.
Kalichman, S. C. (2000). HIV risk behaviors of men and women living with HIV-AIDS: Prevalence, predictors, and emerging clinical interventions. Clinical Psychology: Science and Practice, 7, 32–47.
Kalichman, S. C., Kelly, J. A., & Rompa, D. (1997). Continued high-risk sex among HIV seropositive gay and bisexual men seeking HIV prevention services. Health Psychology, 16, 369–373.
Kalichman, S. C., & Nachimson, D. (1999). Self-efficacy and disclosure of HIV-positive serostatus to sex partners. Health Psychology, 18, 281–287.
Kelly, J. A., St. Lawrence, J. S., Diaz, Y. E., & Stevenson, L. Y. (1991). HIV risk behavior reduction following intervention with key opinion leaders of population: An experimental analysis. American Journal of Public Health, 81, 168–171.
Kelly, J. A., St. Lawrence, J. S., Stevenson, L. Y., & Hauth, A. C. (1992). Community AIDS/ HIV risk reduction: The effects of endorsements by popular people in three cities. American Journal of Public Health, 82, 1483–1489.
Klein, F., Sepekoff, B., & Wolf, T. J. (1990). Sexual orientation: A multi-variable dynamic process. In T. Geller (Ed.), Bisexuality: A reader and sourcebook (pp. 64–81). Ojai, CA: Times Change Press.
Kraft, J. M., Beeker, C., Stokes, J. P., & Peterson, J. L. (2000). Finding the “community” in community-level HIV/AIDS interventions: Formative research with young African American men who have sex with men. Health Education & Behavior, 27, 430–441.
Lichtenstein, B. (2000). Secret encounters: Black men, bisexuality, and AIDS in Alabama. Medical Anthropology Quarterly, 14, 374–393.
Mansergh, G., Marks, G., Colfax, G. N., Guzman, R., Rader, M., & Buchbinder, S. (2002). “Barebacking” in a diverse sample of men who have sex with men. AIDS, 16, 653–659.
Marin, B. V., Gomez, C. A., & Tschann, J. M. (1993). Condom use among Hispanic men with secondary female sex partners. Public Health Reports, 108, 742–750.
Mason, H. R., Marks, G., Simoni, J. M., Ruiz, M. S., & Richardson, J. L. (1995). Culturally sanctioned secrets? Latino men’s nondisclosure of HIV infection to family, friends, and lovers. Health Psychology, 14, 6–12.
Mays, V. M., Cochran, S. D., & Zamudio, A. (2004). HIV prevention research: Are we meeting the needs of African American men who have sex with men? Journal of Black Psychology, 30, 78–105.
Miller, M., Serner, M., & Wagner, M. (2005). Sexual diversity among black men who have sex with men in an inner-city community. Journal of Urban Health, 82, 26–34.
Millett, G. A., Malebranche, D., Mason, B., & Spikes, P. (2005). Focusing “down low”: Bisexual Black men, HIV risk and heterosexual transmission. Journal of the National Medical Association, 97, 52S–59S.
Millett, G. A., Peterson, J. L., Wolitski, R. J., & Stall, R. (2006). Greater risk for HIV infection of Black men who have sex with men: A critical literature review. American Journal of Public Health, 96, 1007–1019.
Montgomery, J. P., Mokotoff, E. D., Gentry, A. C., & Blair, J. M. (2003). The extent of bisexual behaviour in HIV-infected men and implications for transmission to their female sex partners. AIDS Care, 15, 829–837.
Mutchler, M. G., Chion, M., Tran, A., & Klosinki, L. E. (2001). Non-disclosure of HIV status and sexual risk behaviors among HIV+ bisexual men: Implications for prevention and interventions. Paper presented at the 4th Annual Conference on AIDS Research in California, Los Angeles, CA.
Norton, T. R., Bogart, L. M., Cecil, H., & Pinkerton, S. D. (2005). Primacy of affect over cognition in determining adult men’s condom-use behavior: A review. Journal of Applied Social Psychology, 35, 2493–2543.
O’Donnell, L., Agronick, G., San Doval, A., Duran, R., Myint-U, A., & Stueve, A. (2002). Ethnic and gay community attachments and sexual risk behaviors among urban Latino men who have sex with men. AIDS Education and Prevention, 14, 457–471.
Ortiz, Hernandez, L., & Torres, M. I. G. (2005). Internalized oppression and high-risk sexual practices among homosexual and bisexual males, Mexico. Revista de Saude Publica, 39, 956–964.
Parker, R., & Aggleton, P. (2003). HIV and AIDS-related stigma and discrimination: A conceptual framework and implications for action. Social Science & Medicine, 57, 13–24.
Parsons, J. T. (1999). Correlates of sexual HIV transmission risk behaviors among HIV+ men who have sex with men. Paper presented at the National HIV Prevention Conference, Atlanta, GA.
Parsons, J. T., Schrimshaw, E. W., Wolitski, R. J., Halkitis, P. N., Purcell, D. W., Hoff, C. C., et al. (2005). Sexual harm reduction practices of HIV-seropositive gay and bisexual men: Serosorting, strategic positioning, and withdrawal before ejaculation. AIDS, 19(Suppl. 1), S13–S25.
Poppen, P. J., Reisen, C. A., Zea, M. C., Bianchi, F. T., & Echeverry, J. J. (2004). Predictors of unprotected anal intercourse among HIV-positive Latino gay and bisexual men. AIDS and Behavior, 8, 379–389.
Reidpath, D. D., & Chan, K. Y. (2005). A method for the quantitative analysis of the layering of HIV-related stigma. AIDS Care, 17, 425–432.
San Doval, A., Duran, R., O’Donnell, L., & O’Donnell, C. R. (1995). Barriers to condom use in primary and nonprimary relationships among Hispanic STD clinic patients. Hispanic Journal of Behavioral Sciences, 17, 385–397.
Singer, M., & Marxuach-Rodriguez, L. (1996). Applying anthropology to the prevention of AIDS: The Latino gay men’s health project. Human Organization, 55, 141–148.
Somerville, G. G., Diaz, S., Davis, S., Coleman, K. D., & Taveras, S. (2006). Adapting the popular opinion leader intervention for Latino young migrant men who have sex with men. AIDS Education and Prevention, 18, 137–148.
Stall, R. (1999). An agenda for gay men’s health: The Urban Men’s Health Study. Paper presented at the Center for HIV Identification, Prevention and Treatment Services, University of California Los Angeles.
Stokes, J. P., & Peterson, J. L. (1998). Homophobia, self-esteem, and risk for HIV among African American men who have sex with men. AIDS Education and Prevention, 10, 278–292.
Stokes, J. P., Taywaditep, K. J., Vanable, P. A., & McKirnan, D. J. (1996). Bisexual men, sexual behavior, and HIV/AIDS. In B. Firestein (Ed.), Bisexuality: The psychology and politics of an invisible minority (pp. 149–168). Thousand Oaks, CA: Sage Publications.
Stokes, J. P., Vanable, P. A., & McKirnan, D. J. (1996). Ethnic differences in sexual behavior, condom use, and psychological variables among Black and White men who have sex with men. Journal of Sex Research, 29, 1–14.
Weatherburn, P., Hickson, F., Reid, D. S., Davies, P. M., & Crosier, A. (1998). Sexual HIV risk behaviour among men who have sex with both men and women. AIDS Care, 10, 463–471.
Williams, J. K., Wyatt, G. E., Resell, J., Peterson, J., & Asuan-O’Brien, A. (2004). Psychosocial issues among gay- and non-gay-identifying HIV-seropositive African American and Latino MSM. Cultural Diversity and Ethnic Minority Psychology, 10, 268–286.
Wohl, A. R., Johnson, D. F., Lu, S., Frye, D., Bunch, G., & Simon, P. A. (2004). Recent increase in high-risk sexual behaviors among sexually active men who have sex with men living with AIDS in Los Angeles County. Journal of Acquired Immune Deficiency Syndromes, 35, 209–211.
Wohl, A. R., Johnson, D. F., Lu, S., Jordan, W., Beall, G., Currier, J., & Simon, P. A. (2002). HIV risk behaviors among African American men in Los Angeles County who self-identify as heterosexual. Journal of Acquired Immune Deficiency Syndromes, 31, 354–360.
Wold, C., Seage, G. R., Lenderking, W. R., Mayer, K. H., Cai, B., Heeren, T., & Goldstein, R. (1998). Unsafe sex in men who have sex with both men and women. Journal of Acquired Immune Deficiency Syndrome and Human Retrovirology, 17, 361–367.
Wolitski, R. J., Jones, K. T., Wasserman, J. L., & Smith, J. C. (2006). Self-identification as “down low” among men who have sex with men (MSM) from 12 US cities. AIDS and Behavior, 10, 519–529.
Wyatt, G. E., Tucker, B., Romero, G., Vargas, J., Newcomb, M., & Wayment, H. (1997). Adapting a comprehensive approach to African American women’s sexual risk taking. Journal of Health Education, 28, 52–60.
Zea, M. C., Reisen, C. A., & Diaz, R. M. (2003). Methodological issues in research on sexual behavior with Latino gay and bisexual men. American Journal of Community Psychology, 31, 281–291.
Zea, M. C., Reisen, C. A., Poppen, P. J., & Diaz, R. M. (2003). Asking and telling: Communication about HIV status among Latino HIV-positive gay men. AIDS and Behavior, 7, 143–152.
Zea, M. C., Reisen, C. A., Poppen, P. J., Echeverry, J. J., & Bianchi, F. T. (2004). Disclosure of HIV-positive status to Latino gay men’s social networks. American Journal of Community Psychology, 33, 107–116.
This research was supported by funds from the California HIV/AIDS Research Program (ID02-APLA-038, PI: Mutchler). This research was partially supported by the Centers for Disease Control and Prevention (U48/DP000056, PI: Schuster). Preparation of this article was partially supported by the National Institute of Mental Health (R01 MH072351; PI: Bogart) and the National Institute of Nursing Research (R21 R21NR010284; PI: Bogart). We would also like to acknowledge Leonardo Colemon for assistance coordinating the study, Miguel Chion for conducting interviews with the monolingual Spanish-speaking participants in the study, and Scott Stephenson and Kate Sommers-Dawes for their work on manuscript preparation for this article.
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Mutchler, M.G., Bogart, L.M., Elliott, M.N. et al. Psychosocial Correlates of Unprotected Sex Without Disclosure of HIV-Positivity among African-American, Latino, and White Men Who Have Sex with Men and Women. Arch Sex Behav 37, 736–747 (2008). https://doi.org/10.1007/s10508-008-9363-8
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