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Risk and Protective Factors for Sexual Health Outcomes Among Black Bisexual Men in the U.S.: Internalized Heterosexism, Sexual Orientation Disclosure, and Religiosity

Abstract

Bisexual individuals are oftentimes at higher risk for negative sexual health outcomes compared to their heterosexual, gay, and lesbian counterparts. Racial minorities, who may experience double minority stress, may be at particular risk for a sexually transmitted infection (STI) and HIV. Some studies have considered protective factors that ameliorate negative health outcomes; yet, few focus on especially vulnerable populations. We analyzed a sample of 225 Black bisexual men (Mage = 36 years, SD = 12) from Atlanta to explore how combinations of risk (internalized heterosexism) and protective (sexual identity disclosure to community, disclosure to family, and religiosity) factors were related to sexual health outcomes post-baseline during a 1-year follow-up period: any self-reported STI, chlamydia/gonorrhea diagnosis, and HIV diagnosis. We used probability profiling methodology to report the probabilities that a Black bisexual man would report an STI or HIV diagnosis with various combinations and profiles of risk/protective factors. We found that higher levels of internalized heterosexism were significantly related to higher odds of all sexual health outcomes. Disclosure to community was related to much lower risk of all outcomes, whereas disclosure to family was associated with lower odds of self-reported STIs over time. Religiosity was related to lower odds of diagnosis of STIs/HIV, but not self-reported STIs. Our findings have implications for interventions that address internalized heterosexism and protective factors, especially among racial and sexual minorities. Interventions are needed for Black bisexual men that will leverage specific strategies for support to reduce their risk of negative sexual health outcomes.

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Acknowledgments

The authors acknowledge funding support for this research from the National Institutes of Health, Grant: R01MH094230; R01MH109409; R01NR013865. In addition, the second author’s contribution to this paper was supported by a National Institutes of Mental Health Training Grant: T32MH074387. The third author acknowledges support from Grant P2CHD042849 and T32HD007081, awarded to the Population Research Center at The University of Texas at Austin. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Watson, R.J., Allen, A., Pollitt, A.M. et al. Risk and Protective Factors for Sexual Health Outcomes Among Black Bisexual Men in the U.S.: Internalized Heterosexism, Sexual Orientation Disclosure, and Religiosity. Arch Sex Behav 48, 243–253 (2019). https://doi.org/10.1007/s10508-018-1216-5

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Keywords

  • Sexual health
  • Sexuality disclosure
  • HIV
  • Sexual orientation
  • Black MSM