Internalized Homophobia and Drug Use in a National Cohort of Gay and Bisexual Men: Examining Depression, Sexual Anxiety, and Gay Community Attachment as Mediating Factors
The minority stress process of internalized homophobia (IH) has been associated with a range of adverse health outcomes among gay and bisexual men (GBM). However, evidence is mixed regarding the effect of IH on drug use, suggesting the potential role of multiple mediated pathways. Researchers have linked depression, sexual anxiety, and gay community attachment with IH. Depression, sexual anxiety, and gay community attachment have also been linked with drug use and drug-related problems suggesting potential mediating roles. A U.S. national sample of 1071 HIV-negative GBM completed at-home surveys, including measures of sociodemographic characteristics, IH, depression, sexual anxiety, gay community attachment, and drug use and associated problems. Adjusting for sociodemographic characteristics, depression mediated the association between IH and recent drug use. IH was positively associated with depression, and depression was positively associated with recent drug use. Gay community attachment partially mediated drug-related problems. IH had a positive direct association with drug-related problems and a negative direct association with gay community attachment. Gay community attachment had a positive association with drug-related problems. IH was positively associated with sexual anxiety, but sexual anxiety was not associated with either drug outcome. Efforts to reduce IH among HIV-negative GBM are likely to have a positive impact on mental health problems, as well as reduce risk for drug use and drug-related problems. Gay communities could provide the social support necessary for reducing IH; however, emphasis on community level interventions that address factors that increase risk for drug-related problems remains important.
KeywordsGay and bisexual men Internalized homophobia Depression Sexual anxiety Gay community Drug use
The One Thousand Strong study was funded by a research Grant from the National Institute on Drug Abuse (R01 DA036466: Jeffrey T. Parsons and Christian Grov, MPIs). Raymond Moody’s effort was funded by a supplement to the parent Grant (R01 DA036466-S2). Special thanks to the other members of the One Thousand Strong study team (Tyrel Starks, Ana Ventuneac, H. Jonathon Rendina, Mark Pawson, Michael Castro, Ruben Jimenez, Chloe Mirzayi, Brett Millar, Thomas Whitfield, and Jonathan Lassiter) and other staff from the Center for HIV/AIDS Educational Studies and Training (Chris Hietikko, Andrew Cortopassi, Brian Salfas, Doug Keeler, Qurrat-Ul Ain, Chris Murphy, and Carlos Ponton). Thank you to the staff at Community Marketing, Inc. (David Paisley, Heather Torch, and Thomas Roth) as well as Patrick Sullivan, Jessica Ingersoll, Deborah Abdul-Ali, and Doris Igwe at the Emory Center for AIDS Research (P30 AI050409). Finally, a special thanks to Jeffrey Schulden and Pamela Goodlow at NIDA. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in this study.
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