Abstract
Sexual and gender identity have frequently been assessed in public health research as static states. However, a substantial and growing body of evidence indicates that both identities may have greater potential for change over time than once supposed. Despite this evidence, research into adult identity change remains relatively limited. Using longitudinal data from 1553 Black men who have sex with men (BMSM) aged 18–68 years and recruited from study locations in six major cities across the country, we examined changes in sexual and gender identities over a period of 12 months. The results showed that sexual and gender identity did indeed change among adult BMSM. Additionally, we explored internalized homophobia (IH) as a potential driver of identity change and found that IH significantly impacts the degree and direction of change, with individuals who reported higher baseline IH more likely to demonstrate a shift toward a heterosexual/straight identity at 6 and 12 months. The results are discussed in light of what is known and unknown regarding identity change, and potential avenues for future research are explored.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ansara, Y. G. (2015). Improving research methodology in adolescent sexual health research. Journal of Adolescent Health, 56(4), 367–369. https://doi.org/10.1016/j.jadohealth.2015.01.013.
Arnold, E. A., Rebchook, G. M., & Kegeles, S. M. (2014). ‘Triply cursed’: Racism, homophobia and HIV-related stigma are barriers to regular HIV testing, treatment adherence and disclosure among young Black gay men. Culture, Health & Sexuality, 16(6), 710–722. https://doi.org/10.1080/13691058.2014.905706.
Baral, S. D., Poteat, T., Stromdahl, S., Wirtz, A. L., Guadamuz, T. E., & Beyrer, C. (2013). Worldwide burden of HIV in transgender women: A systematic review and meta-analysis. The Lancet Infectious Diseases, 13(3), 214–222. https://doi.org/10.1016/S1473-3099(12)70315-8.
Bentler, P. M. (1990). Comparative fit indexes in structural models. Psychological Bulletin, 107(2), 238–246. https://doi.org/10.1037/0033-2909.107.2.238.
Burke, P. J. (2006). Identity change. School Psychology Quarterly, 69(1), 81–96. https://doi.org/10.1177/019027250606900106.
Cass, V. C. (1979). Homosexual identity formation: A rheoretical model. Journal of Homosexuality, 4(3), 219–235. https://doi.org/10.1300/J082v04n03_01.
Coleman, E. (1982). Developmental stages of the coming-out process. Journal of Homosexuality, 7(2–3), 31–43. https://doi.org/10.1300/J082v07n02_06.
Conron, K. J., Mimiaga, M. J., & Landers, S. J. (2010). A population-based study of sexual orientation identity and gender differences in adult health. American Journal of Public Health, 100(10), 1953–1960. https://doi.org/10.2105/AJPH.2009.174169.
Diamond, L. M. (1998). Development of sexual orientation among adolescent and young adult women. Developmental Psychology, 34(5), 1085–1095. https://doi.org/10.1037//0012-1649.34.5.1085.
Diamond, L. M. (2005). A new view of lesbian subtypes: Stable versus fluid identity trajectories over an 8-year period. Psychology of Women Quarterly, 29(2), 119–128. https://doi.org/10.1111/j.1471-6402.2005.00174.x.
Diamond, L. M. (2008). Female bisexuality from adolescence to adulthood: Results from a 10-year longitudinal study. Developmental Psychology, 44(1), 5–14. https://doi.org/10.1037/0012-1649.44.1.5.
Diamond, L. M. (2016). Sexual fluidity in males and females. Current Sexual Health Reports, 8(4), 249–256. https://doi.org/10.1007/s11930-016-0092-z.
Diamond, L. M., Dickenson, J. A., & Blair, K. L. (2017). Stability of sexual attractions across different timescales: The roles of bisexuality and gender. Archives of Sexual Behavior, 46(1), 193–204. https://doi.org/10.1007/s10508-016-0860-x.
Diamond, L. M., & Rosky, C. J. (2016). Scrutinizing immutability: Research on sexual orientation and U.S. legal advocacy for sexual minorities. Journal of Sex Research, 53(4–5), 363–391. https://doi.org/10.1080/00224499.2016.1139665.
Dyar, C., Feinstein, B. A., Schick, V., & Davila, J. (2017). Minority stress, sexual identity uncertainty, and partner gender decision making among nonmonosexual individuals. Psychology of Sexual Orientation and Gender Diversity, 4(1), 87–104. https://doi.org/10.1037/sgd0000213.
Everett, B. (2015). Sexual orientation identity change and depressive symptoms: A longitudinal analysis. Journal of Health and Social Behavior, 56(1), 37–58. https://doi.org/10.1177/0022146514568349.
Everett, B. G., Talley, A. E., Hughes, T. L., Wilsnack, S. C., & Johnson, T. P. (2016). Sexual identity mobility and depressive symptoms: A longitudinal analysis of moderating factors among sexual minority women. Archives of Sexual Behavior, 45(7), 1731–1744. https://doi.org/10.1007/s10508-016-0755-x.
Flores, A. R., Herman, J. L., Gates, G. J., & Brown, T. N. T. (2016). How many adults identify as transgender in the United States? Los Angeles, CA: The Williams Institute. Retrieved September 3, 2018 from https://williamsinstitute.law.ucla.edu/wp-content/uploads/How-Many-Adults-Identify-as-Transgender-in-the-United-States.pdf.
Galupo, M. P., Mitchell, R. C., & Davis, K. S. (2015). Sexual minority self-identification: Multiple identities and complexity. Psychology of Sexual Orientation and Gender Diversity, 2(4), 355–364. https://doi.org/10.1037/sgd0000131.
Garofalo, R., Deleon, J., Osmer, E., Doll, M., & Harper, G. W. (2006). Overlooked, misunderstood and at-risk: Exploring the lives and HIV risk of ethnic minority male-to-female transgender youth. Journal of Adolescent Health, 38(3), 230–236. https://doi.org/10.1016/j.jadohealth.2005.03.023.
Gaston, G. B. (2013). African-Americans’ perceptions of health care provider cultural competence that promote HIV medical self-care and antiretroviral medication adherence. AIDS Care, 25(9), 1159–1165. https://doi.org/10.1080/09540121.2012.752783.
Gordon, L. E., & Silva, T. J. (2015). Inhabiting the sexual landscape: Toward an interpretive theory of the development of sexual orientation and identity. Journal of Homosexuality, 62(4), 495–530. https://doi.org/10.1080/00918369.2014.986417.
Herbst, J. H., Jacobs, E. D., Finlayson, T. J., McKleroy, V. S., Neumann, M. S., Crepaz, N., & HIV/AIDS Prevention Research Synthesis Team. (2008). Estimating HIV prevalence and risk behaviors of transgender persons in the United States: A systematic review. AIDS and Behavior, 12(1), 1–17. https://doi.org/10.1007/s10461-007-9299-3.
Herek, G. M., Gillis, J. R., & Cogan, J. C. (2009). Internalized stigma among sexual minority adults: Insights from a social psychological perspective. Journal of Counseling Psychology, 56(1), 32–43. https://doi.org/10.1037/A0014672.
Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55. https://doi.org/10.1080/10705519909540118.
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(3), 327–348. https://doi.org/10.1023/A:1015325303002.
Katz-Wise, S. L., & Hyde, J. S. (2017). Facilitative environments related to sexual orientation development and sexual fluidity in sexual minority young adults across different gender identities. Journal of Bisexuality, 17(2), 141–171. https://doi.org/10.1080/15299716.2016.1259138.
Katz-Wise, S. L., Rosario, M., Calzo, J. P., Scherer, E. A., Sarda, V., & Austin, S. B. (2017). Endorsement and timing of sexual orientation developmental milestones among sexual minority young adults in the growing up today study. Journal of Sex Research, 54(2), 172–185. https://doi.org/10.1080/00224499.2016.1170757.
Kenagy, G. P. (2005). Transgender health: Findings from two needs assessment studies in Philadelphia. Health and Social Work, 30(1), 19–26. https://doi.org/10.1093/hsw/30.1.19.
Koblin, B. A., Mayer, K. H., Eshleman, S. H., Wang, L., Mannheimer, S., del Rio, C., … for the HPTN 061 Protocol Team. (2013). Correlates of HIV acquisition in a cohort of Black men who have sex with men in the United States: HIV Prevention Trials Network (HPTN) 061. PLoS ONE, 8(7), e70413. https://doi.org/10.1371/journal.pone.0070413.
Lombardi, E. L., Wilchins, R. A., Priesing, D., & Malouf, D. (2001). Gender violence: Transgender experiences with violence and discrimination. Journal of Homosexuality, 42(1), 89–101.
Mayer, K. H., Wang, L., Koblin, B., Mannheimer, S., Magnus, M., del Rio, C., … for the HPTN 061 Protocol Team. (2014). Concomitant socioeconomic, behavioral, and biological factors associated with the disproportionate HIV infection burden among Black men who have sex with men in 6 U.S. cities. PLoS ONE, 9(1), e87298. https://doi.org/10.1371/journal.pone.0087298.
Meerwijk, E. L., & Sevelius, J. M. (2017). Transgender population size in the United States: A meta-regression of population-based probability samples. American Journal of Public Health, 107(2), 216. https://doi.org/10.2105/AJPH.2016.303578a.
Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36(1), 38–56. https://doi.org/10.2307/2137286.
Mock, S. E., & Eibach, R. P. (2012). Stability and change in sexual orientation identity over a 10-year period in adulthood. Archives of Sexual Behavior, 41(3), 641–648. https://doi.org/10.1007/s10508-011-9761-1.
Moreira, A. D., Halkitis, P. N., & Kapadia, F. (2015). Sexual identity development of a new generation of emerging adult men: The P18 Cohort Study. Psychology of Sexual Orientation and Gender Diversity, 2(2), 159–167. https://doi.org/10.1037/sgd0000099.
Nuttbrock, L., Hwahng, S., Bockting, W., Rosenblum, A., Mason, M., Macri, M., & Becker, J. (2010). Psychiatric impact of gender-related abuse across the life course of male-to-female fransgender persons. Journal of Sex Research, 47(1), 12–23. https://doi.org/10.1080/00224490903062258.
Oswalt, S. B., & Wyatt, T. J. (2011). Sexual orientation and differences in mental health, stress, and academic performance in a national sample of U.S. college students. Journal of Homosexuality, 58(9), 1255–1280. https://doi.org/10.1080/00918369.2011.605738.
Ott, M. Q., Corliss, H. L., Wypij, D., Rosario, M., & Austin, B. S. (2011). Stability and change in self-reported sexual orientation identity in young people: Application of mobility metrics. Archives of Sexual Behavior, 40(3), 519–532. https://doi.org/10.1007/s10508-010-9691-3.
Peplau, L. A., Spalding, L. R., Conley, T. D., & Veniegas, R. C. (1999). The development of sexual orientation in women. Annual Review of Sex Research, 10(1), 71–99. https://doi.org/10.1080/10532528.1999.10559775.
Phillips, G., II, Beach, L. B., Turner, B., Feinstein, B. A., Marro, R., Philbin, M. M., … Birkett, M. (2019a). Sexual identity and behavior among U.S. high school students, 2005–2015. Archives of Sexual Behavior, 48, 1463–1479. https://doi.org/10.1007/s10508-019-1404-y.
Phillips, G., II, Raman, A., Felt, D., Han, Y., & Mustanski, B. (2019b). Factors associated with PrEP support and disclosure among YMSM and transgender individuals assigned male at birth in Chicago. AIDS and Behavior, 23(10), 2749–2760. https://doi.org/10.1007/s10461-019-02561-1.
Poteat, T., German, D., & Flynn, C. P. (2016). The conflation of gender and sex: Gaps and opportunities in HIV data among transgender women and MSM. Global Public Health, 11(7–8), 835–848. https://doi.org/10.1080/17441692.2015.1134615.
Reisner, S. L., Biello, K., Rosenberger, J. G., Austin, S. B., Haneuse, S., Perez-Brumer, A., & Mimiaga, M. J. (2014). Using a two-step method to measure transgender identity in Latin America/the Caribbean, Portugal, and Spain. Archives of Sexual Behavior, 43(8), 1503–1514. https://doi.org/10.1007/s10508-014-0314-2.
Rosario, M., Hunter, J., Maguen, S., Gwadz, M., & Smith, R. (2001). The coming-out process and its adaptational and health-related associations among gay, lesbian, and bisexual youths: Stipulation and exploration of a model. American Journal of Community Psychology, 29(1), 133–160. https://doi.org/10.1023/A:1005205630978.
Rosario, M., Schrimshaw, E. W., Hunter, J., & Braun, L. (2006). Sexual identity development among gay, lesbian, and bisexual youths: Consistency and change over time. Journal of Sex Research, 43(1), 46–58. https://doi.org/10.1080/00224490609552298.
Rust, P. C. (2000). Two many and not enough: The meanings of bisexual identities. Journal of Bisexuality, 1(1), 31–68. https://doi.org/10.1300/J159v01n01_04.
Saha, S., Korthuis, P. T., Cohn, J. A., Sharp, V. L., Moore, R. D., & Beach, M. C. (2013). Primary care provider cultural competence and racial disparities in HIV care and outcomes. Journal of General Internal Medicine, 28(5), 622–629. https://doi.org/10.1007/s11606-012-2298-8.
Savin-Williams, R. C., Joyner, K., & Rieger, G. (2012). Prevalence and stability of self-reported sexual orientation identity during young adulthood. Archives of Sexual Behavior, 41(1), 103–110. https://doi.org/10.1007/s10508-012-9913-y.
Steensma, T. D., Kreukels, B. P., de Vries, A. L. C., & Cohen-Kettenis, P. T. (2013). Gender identity development in adolescence. Hormones and Behavior, 64(2), 288–297. https://doi.org/10.1016/j.yhbeh.2013.02.020.
Su, D., Irwin, J. A., Fisher, C., Ramos, A., Kelley, M., Mendoza, D. A. R., & Coleman, J. D. (2016). Mental health disparities within the LGBT population: A comparison between transgender and nontransgender individuals. Transgender Health, 1(1), 12–21. https://doi.org/10.1089/trgh.2015.0001.
Tate, C. C., Ledbetter, J. N., & Youssef, C. P. (2013). A two-question method for assessing gender categories in the social and medical sciences. Journal of Sex Research, 50(8), 767–776. https://doi.org/10.1080/00224499.2012.690110.
Troiden, R. R. (1988). Homosexual identity development. Journal of Adolescent Health Care, 9(2), 105–113. https://doi.org/10.1016/0197-0070(88)90056-3.
Tucker, L. R., & Lewis, C. (1973). A reliability coefficient for maximum likelihood factor analysis. Psychometrika, 38(1), 1–10. https://doi.org/10.1007/BF02291170.
Funding
HPTN 061 Grant support provided by the National Institute of Allergy and Infectious Disease (NIAID), National Institute on Drug Abuse (NIDA) and National Institute of Mental Health (NIMH): Cooperative Agreements UM1 AI068619, UM1 AI068617, and UM1 AI068613. Additional site funding—Fenway Institute CRS: Harvard University CFAR (P30 AI060354) and CTU for HIV Prevention and Microbicide Research (UM1 AI069480); George Washington University CRS (UM1 AI069503): District of Columbia CFAR (P30 AI117970); Harlem Prevention Center CRS and NY Blood Center/Union Square CRS: Columbia University CTU (5U01 AI069466) and ARRA funding (3U01 AI069466-03S1); Hope Clinic of the Emory Vaccine Center CRS and The Ponce de Leon Center CRS: Emory University HIV/AIDS CTU (5U01 AI069418), CFAR (P30 AI050409) and CTSA (UL1 RR025008); San Francisco Vaccine and Prevention CRS: ARRA funding (3U01 AI069496-03S1, 3U01 AI069496-03S2); UCLA Vine Street CRS: UCLA Department of Medicine, Division of Infectious Diseases CTU (U01 AI069424).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical Approval
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
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Phillips, G., Feinstein, B.A., Levy, M. et al. Changes in Sexual and Gender Identity and Their Associations with Internalized Homophobia Among Black Men Who Have Sex with Men in the HPTN 061 BROTHERS Cohort. Arch Sex Behav 49, 2375–2387 (2020). https://doi.org/10.1007/s10508-019-01618-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10508-019-01618-5