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Structures of Sexuality: Sexual Stigma, Disclosure, and HIV Risk with Primary Female Partners Among Behaviorally Bisexual Black Men

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Abstract

HIV continues to disproportionately impact bisexual Black men, as well as their female partners, in the U.S. There is a need to better understand how stigma and disclosure affect sexual risk for men and their female partners. This article describes the relationship between sexual stigma and HIV risk with primary female partners among a sample of 121 behaviorally bisexual Black men of mixed HIV status in the San Francisco Bay Area. Multivariate analyses tested to see if each of three stigma measures (bisexual stigma, internalized homophobia, difficulty with bisexual identity) would have any effect on participants’ condom use. Quantitative analyses found that sexual stigma increased men’s sexual risk through inhibiting disclosure of their sexual activity with men to their female partners. Men who reported higher levels of bisexual stigma and internalized homophobia reported that it was harder to disclose having sex with men to their primary female partner, which was significantly related to lower levels of condom use. Stigma reduction HIV prevention interventions are needed that address bisexual stigma experienced by Black men. HIV prevention interventions, including stigma reduction programs, must target both men and women to effectively reduce bisexual stigma and address the structural and relationship contexts of HIV.

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References

  • Adimora, A. A., & Auerbach, J. D. (2010). Structural interventions for HIV prevention in the United States. Journal of Acquired Immune Deficiency Syndromes,55(Suppl. 2), S132–S135. https://doi.org/10.1097/QAI.0b013e3181fbcb38.

    Article  PubMed  Google Scholar 

  • Alameda County Public Health Department HIV Epidemiology and Surveillance Unit. (2018). HIV in Alameda County, 2014–2016. http://www.acphd.org/media/493885/hiv-report-2018.pdf.

  • Arnold, E. A., Weeks, J., Benjamin, M., Stewart, W. R., Pollack, L. M., Kegeles, S. M., & Operario, D. (2017). Identifying social and economic barriers to regular care and treatment for Black men who have sex with men and women (BMSMW) and who are living with HIV: A qualitative study from the Bruthas cohort. BMC Health Services Research,17(1), 90. https://doi.org/10.1186/s12913-017-2011-z.

    Article  PubMed  PubMed Central  Google Scholar 

  • Benoit, E., & Koken, J. A. (2012). Perspectives on substance use and disclosure among behaviorally bisexual Black men with female primary partners. Journal of Ethnicity in Substance Abuse,11(4), 294–317. https://doi.org/10.1080/15332640.2012.735165.

    Article  PubMed  PubMed Central  Google Scholar 

  • Benoit, E., Pass, M., Randolf, D., Murray, D., & Downing, M. J., Jr. (2012). Reaching and engaging non-gay identified, non-disclosing Black men who have sex with both men and women. Culture, Health, and Sexuality,14(9), 975–990.

    Article  Google Scholar 

  • Bingham, T. A., Harawa, N. T., & Williams, J. K. (2013). Gender role conflict among African American men who have sex with men and women: Associations With mental health and sexual risk and disclosure behaviors. American Journal of Public Health,103(1), 127–133.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bond, L., Wheeler, D. P., Millett, G. A., LaPollo, A. B., Carson, L. F., & Liau, A. (2009). Black men who have sex with men and the association of down-low identity with HIV risk behavior. American Journal of Public Health,99(Suppl. 1), S92–S95. https://doi.org/10.2105/AJPH.2007.127217.

    Article  PubMed  PubMed Central  Google Scholar 

  • Boone, M. R., Cook, S. H., & Wilson, P. A. (2016). Sexual identity and HIV status influence the relationship between internalized stigma and psychological distress in black gay and bisexual men. AIDS Care,28(6), 764–770. https://doi.org/10.1080/09540121.2016.1164801.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bowleg, L. (2012). The problem with the phrase women and minorities: Intersectionality—An important theoretical framework for public health. American Journal of Public Health,102(7), 1267–1273.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bowleg, L. (2013). “Once you’ve blended the cake, you can’t take the parts back to the main ingredients”: Black gay and bisexual men’s descriptions and experiences of intersectionality. Sex Roles,68(11–12), 754–767. https://doi.org/10.1007/s11199-012-0152-4.

    Article  Google Scholar 

  • Bowleg, L., Fitz, C. C., Burkholder, G. J., Massie, J. S., Wahome, R., Teti, M., … Tschann, J. M. (2014). Racial discrimination and posttraumatic stress symptoms as pathways to sexual HIV risk behaviors among urban Black heterosexual men. AIDS Care,26(8), 1050–1057. https://doi.org/10.1080/09540121.2014.906548.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bowleg, L., & Raj, A. (2012). Shared communities, structural contexts, and HIV risk: Prioritizing the HIV risk and prevention needs of Black heterosexual men. American Journal of Public Health,102(Suppl. 2), S173–S177. https://doi.org/10.2105/AJPH.2011.300342.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bowleg, L., Teti, M., Massie, J. S., Patel, A., Malebranche, D. J., & Tschann, J. M. (2011). ‘What does it take to be a man? What is a real man?’ Ideologies of masculinity and HIV sexual risk among Black heterosexual men. Culture, Health & Sexuality,13(05), 545–559.

    Article  Google Scholar 

  • Brewer, R., Daunis, C., Ebaady, S., Wilton, L., Chrestman, S., Mukherjee, S., … Schneider, J. (2019). Implementation of a socio-structural demonstration project to improve HIV outcomes among young Black men in the deep south. Journal of Racial and Ethnic Health Disparities. https://doi.org/10.1007/s40615-019-00576-x.

    Article  PubMed  PubMed Central  Google Scholar 

  • Centers for Disease Control and Prevention. (2017). HIV among African Americans. https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/cdc-hiv-aa-508.pdf.

  • Crenshaw, K. (1995). Mapping the margins: Intersectionality, identity politics, and violence against women of color. In K. Crenshaw, N. Gotanda, G. Peller, & K. Thomas (Eds.), Critical race theory: The key writings that formed the movement (pp. 357–384). New York: NYU Press.

    Google Scholar 

  • Dodge, B., Jeffries, W. L., IV, & Sandfort, T. G. (2008). Beyond the down low: Sexual risk, protection, and disclosure among at-risk Black men who have sex with both men and women (MSMW). Archives of Sexual Behavior,37(5), 683–696.

    Article  PubMed  PubMed Central  Google Scholar 

  • Donald, C. A., DasGupta, S., Metzl, J. M., & Eckstrand, K. L. (2017). Queer frontiers in medicine: A structural competency approach. Academic Medicine: Journal of the Association of American Medical Colleges,92(3), 345–350. https://doi.org/10.1097/ACM.0000000000001533.

    Article  Google Scholar 

  • Dyer, T. V., Khan, M. R., Regan, R., Harawa, N. T., Nelson, L. E., Wilton, L., … Shoptaw, S. (2018). Differential patterns of risk and vulnerability suggest the need for novel prevention strategies for Black bisexual men in the HPTN 061 Study. Journal of Acquired Immune Deficiency Syndromes,78(5), 491–498. https://doi.org/10.1097/QAI.0000000000001716.

    Article  PubMed  Google Scholar 

  • Feinstein, B. A., Bettin, E., Swann, G., Macapagal, K., Whitton, S. W., & Newcomb, M. E. (2018). The influence of internalized stigma on the efficacy of an HIV prevention and relationship education program for young male couples. AIDS and Behavior, 22, 3847–3858. https://doi.org/10.1007/s10461-018-2093-6.

    Article  PubMed  PubMed Central  Google Scholar 

  • Feinstein, B. A., & Dyar, C. (2017). Bisexuality, minority stress, and health. Current Sexual Health Reports,9(1), 42–49. https://doi.org/10.1007/s11930-017-0096-3.

    Article  PubMed  PubMed Central  Google Scholar 

  • Fields, E. L., Bogart, L. M., Smith, K. C., Malebranche, D. J., Ellen, J., & Schuster, M. A. (2012). HIV risk and perceptions of masculinity among young black men who have sex with men. Journal of Adolescent Health,50(3), 296–303. https://doi.org/10.1016/j.jadohealth.2011.07.007.

    Article  Google Scholar 

  • Fields, E. L., Bogart, L. M., Smith, K. C., Malebranche, D. J., Ellen, J., & Schuster, M. A. (2015). “I always felt I had to prove my manhood”: Homosexuality, masculinity, gender role strain, and HIV risk among young black men who have sex with men. American Journal of Public Health,105(1), 122–131. https://doi.org/10.2105/AJPH.2013.301866.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ford, C. L., Whetten, K. D., Hall, S. A., Kaufman, J. S., & Thrasher, A. D. (2007). Black sexuality, social construction, and research targeting ‘The Down Low’(‘The DL’). Annals of Epidemiology,17(3), 209–216.

    Article  PubMed  Google Scholar 

  • Forenza, B., & Benoit, E. (2016). Exploring service provider perceptions of treatment barriers facing black, non-gay-identified MSMW. Journal of Ethnic & Cultural Diversity in Social Work,25(2), 114–129. https://doi.org/10.1080/15313204.2015.1071300.

    Article  Google Scholar 

  • Friedman, M., Dodge, B., Schick, V., Herbenick, D., Hubach, R., Bowling, J., … Reece, M. (2014a). From bias to bisexual health disparities: attitudes toward bisexual men and women in the United States. LGBT Health,1(4), 309–318.

    Article  PubMed  Google Scholar 

  • Friedman, M. R., Sang, J. M., Bukowski, L. A., Matthews, D. D., Eaton, L. A., Raymond, H. F., & Stall, R. (2018). HIV care continuum disparities among Black bisexual men and the mediating effect of psychosocial comorbidities. Journal of Acquired Immune Deficiency Syndromes,77(5), 451–458. https://doi.org/10.1097/QAI.0000000000001631.

    Article  PubMed  Google Scholar 

  • Friedman, M. R., Stall, R., Silvestre, A. J., Mustanski, B., Shoptaw, S., Surkan, P. J., … Plankey, M. W. (2014b). Stuck in the middle: Longitudinal HIV-related health disparities among men who have sex with men and women. Journal of Acquired Immune Deficiency Syndromes,66(2), 213–220. https://doi.org/10.1097/QAI.0000000000000143.

    Article  PubMed  Google Scholar 

  • Friedman, M. R., Wei, C., Klem, M. L., Silvestre, A. J., Markovic, N., & Stall, R. (2014c). HIV infection and sexual risk among men who have sex with men and women (MSMW): A systematic review and meta-analysis. PLoS ONE,9(1), e87139. https://doi.org/10.1371/journal.pone.0087139.

    Article  PubMed  PubMed Central  Google Scholar 

  • Grainger, C. (2017). Understanding disclosure behaviours in HIV-positive young people. Journal of Infection Prevention,18(1), 35–39. https://doi.org/10.1177/1757177416680871.

    Article  PubMed  Google Scholar 

  • Hall, H. I., Song, R., Rhodes, P., Prejean, J., An, Q., Lee, L. M., … Janssen, R. S. (2008). Estimation of HIV incidence in the United States. Journal of the American Medical Association,300(5), 520–529.

    Article  PubMed  Google Scholar 

  • Harawa, N., & Adimora, A. (2008). Incarceration, African Americans and HIV: Advancing a research agenda. Journal of the National Medical Association,100(1), 57–62.

    Article  PubMed  Google Scholar 

  • Harawa, N. T., McCuller, W. J., Chavers, C., & Janson, M. (2013). HIV risk behaviors among Black/African American and Hispanic/Latina female partners of men who have sex with men and women. AIDS and Behavior,17(3), 848–855. https://doi.org/10.1007/s10461-012-0138-9.

    Article  PubMed  PubMed Central  Google Scholar 

  • Harawa, N. T., Obregon, N. B., & McCuller, W. J. (2014a). Partnerships between Black women and behaviorally bisexual men: Implications for HIV risk and prevention. Sexuality and Culture,18(4), 570–891. https://doi.org/10.1007/s12119-014-9227-4.

    Article  PubMed  Google Scholar 

  • Harawa, N., Wilton, L., Wang, L., Mao, C., Kuo, I., Penniman, T., … Koblin, B. (2014b). Types of female partners reported by Black men who have sex with men and women (MSMW) and associations with intercourse frequency, unprotected sex and HIV and STI prevalence. AIDS and Behavior,18(8), 1548–1559.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hatzenbuehler, M. L., Phelan, J. C., & Link, B. G. (2013). Stigma as a fundamental cause of population health inequalities. American Journal of Public Health,103(5), 813–821.

    Article  PubMed  PubMed Central  Google Scholar 

  • Herek, G. M., Cogan, J. C., Gillis, J. R., & Glunt, E. K. (1998). Correlates of internalized homophobia in a community sample of lesbians and gay men. Journal of the Gay & Lesbian Medical Association,2(1), 17–25.

    Google Scholar 

  • Hubach, R. D., Dodge, B., Goncalves, G., Malebranche, D., Reece, M., Van Der Pol, B., … Fortenberry, J. D. (2014). Gender matters: Condom use and nonuse among behaviorally bisexual men. Archives of Sexual Behavior,43(4), 707–717. https://doi.org/10.1007/s10508-013-0147-4.

    Article  PubMed  Google Scholar 

  • Jeffries, W. L., Gelaude, D. J., Torrone, E. A., Gasiorowicz, M., Oster, A. M., Spikes, P. S., … Bertolli, J. (2017). Unhealthy environments, unhealthy consequences: Experienced homonegativity and HIV infection risk among young men who have sex with men. Global Public Health,12(1), 116–129. https://doi.org/10.1080/17441692.2015.1062120.

    Article  PubMed  Google Scholar 

  • Jeffries, W. L., Marks, G., Lauby, J., Murrill, C. S., & Millett, G. A. (2013). Homophobia is associated with sexual behavior that increases risk of acquiring and transmitting HIV infection among Black men who have sex with men. AIDS and Behavior,17, 1442–1453.

    Article  PubMed  Google Scholar 

  • Joseph, H. A., Pan, Y., Mendoza, M., Harawa, N. T., Lauby, J., Hosek, S. G., … Millett, G. A. (2017). HIV acquisition and transmission potential among African American men who have sex with men and women in three U.S. cities. Archives of Sexual Behavior. https://doi.org/10.1007/s10508-017-1052-z.

    Article  PubMed  PubMed Central  Google Scholar 

  • LaPollo, A. B., Bond, L., & Lauby, J. L. (2014). Hypermasculinity and sexual risk among Black and White Men who have sex with men and women. American Journal of Men’s Health,8(5), 362–372. https://doi.org/10.1177/1557988313512861.

    Article  PubMed  Google Scholar 

  • Link, B. G., & Phelan, J. C. (2001). Conceptualizing stigma. Annual Review of Sociology,27, 363–385.

    Article  Google Scholar 

  • Mackenzie, S. (2013). Structural intimacies: Sexual stories in the Black AIDS epidemic. New Brunswick, NJ: Rutgers University Press.

    Google Scholar 

  • Mackenzie, S. (2018). Reframing masculinity: Structural vulnerability and HIV among black men who have sex with men and women. Culture, Health & Sexuality,21, 175–187. https://doi.org/10.1080/13691058.2018.1459845.

    Article  Google Scholar 

  • Mackenzie, S., & Brooks, D. (2018). Stigma, disclosure and relationship agency in Black women’s sexual relationships with behaviorally bisexual Black men. Sexuality and Culture,22(3), 837–848. https://doi.org/10.1007/s12119-017-9493-z.

    Article  Google Scholar 

  • Mackenzie, S., & Jenkins Barnes, T. (2014). Project WAMERU: Knowing and disclosing in relationships of behaviorally bisexual African American men and their female partners. Presented at the meeting of the American Public Health Association, New Orleans, LA.

  • Mackenzie, S., Rubin, E., & Gómez, C. (2016). ‘Prison is one place you don’t want your sexuality:’ Sexuality, desire and survival among incarcerated bisexual Black men in the United States. Penal Field (Champ Penal). https://doi.org/10.4000/champpenal.9364.

  • MacKinnon, D. P. (2008). Multivariate applications series. Introduction to statistical mediation analysis. New York, NY: Taylor and Francis Group/Lawrence Erlbaum Associates.

    Google Scholar 

  • Malebranche, D. J. (2008). Bisexually active Black men in the United States and HIV: Acknowledging more than the “down low”. Archives of Sexual Behavior,37(5), 810–816.

    Article  PubMed  Google Scholar 

  • Malebranche, D. J., Arriola, K. J., Jenkins, T. R., Dauria, E., & Patel, S. N. (2010). Exploring the “bisexual bridge”: A qualitative study of risk behavior and disclosure of same-sex behavior among Black bisexual men. American Journal of Public Health, 100, 159–164. https://doi.org/10.2105/AJPH.2008.158725.

    Article  PubMed  PubMed Central  Google Scholar 

  • Malebranche, D. J., Fields, E. L., Bryant, L. O., & Harper, S. R. (2009). Masculine socialization and sexual risk behaviors among Black men who have sex with men: A qualitative exploration. Men and Masculinities,12(1), 90–112. https://doi.org/10.1177/1097184X07309504.

    Article  Google Scholar 

  • Matthews, D. D., Herrick, A. L., Coulter, R. W. S., Friedman, M. R., Mills, T. C., Eaton, L. A., … POWER Study Team. (2016). Running backwards: Consequences of current HIV incidence rates for the next generation of Black MSM in the United States. AIDS and Behavior,20(1), 7–16. https://doi.org/10.1007/s10461-015-1158-z.

    Article  PubMed  PubMed Central  Google Scholar 

  • Metzl, J. M. (2013). Structural health and the politics of African American masculinity. American Journal of Men’s Health,7(4 Suppl.), 68S–72S. https://doi.org/10.1177/1557988313486512.

    Article  PubMed  Google Scholar 

  • Metzl, J. M., & Hansen, H. (2014). Structural competency: Theorizing a new medical engagement with stigma and inequality. Social Science and Medicine,1982(103), 126–133. https://doi.org/10.1016/j.socscimed.2013.06.032.

    Article  Google Scholar 

  • Millett, G. A., & Peterson, J. L. (2007). The known hidden epidemic HIV/AIDS among Black men who have sex with men in the United States. American Journal of Preventive Medicine,32(4 Suppl.), S31–S33.

    Article  PubMed  Google Scholar 

  • 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(6), 1007–1019.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mohr, J. J., & Kendra, M. S. (2011). Revision and extension of a multidimensional measure of sexual minority identity: The Lesbian, Gay, and Bisexual Identity Scale. Journal of Counseling Psychology,58(2), 234–245.

    Article  PubMed  Google Scholar 

  • Nelson, L. E., Wilton, L., Moineddin, R., Zhang, N., Siddiqi, A., Sa, T., … HPTN 061 Study Team. (2016). Economic, legal, and social hardships associated with HIV risk among Black men who have sex with men in six US cities. Journal of Urban Health,93(1), 170–188. https://doi.org/10.1007/s11524-015-0020-y.

    Article  PubMed  PubMed Central  Google Scholar 

  • Parker, C. M., Garcia, J., Philbin, M. M., Wilson, P. A., Parker, R. G., & Hirsch, J. S. (2017). Social risk, stigma and space: Key concepts for understanding HIV vulnerability among Black men who have sex with men in New York City. Culture, Health & Sexuality,19(3), 323–337. https://doi.org/10.1080/13691058.2016.1216604.

    Article  Google Scholar 

  • Parker, R. G., Easton, D., & Klein, C. H. (2000). Structural barriers and facilitators in HIV prevention: A review of international research. AIDS,14(Suppl. 1), S22–S32.

    Article  PubMed  Google Scholar 

  • Pinel, E. C. (1999). Stigma consciousness: The psychological legacy of social stereotypes. Journal of Personality and Social Psychology,76(1), 114–128.

    Article  PubMed  Google Scholar 

  • Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods,40, 879–891. https://doi.org/10.3758/BRM.40.3.879.

    Article  PubMed  Google Scholar 

  • Reback, C. J., Kaplan, R., & Larkins, S. (2015). Disclosure of male sexual partnering and HIV serostatus among a sample of heterosexually identified men who have sex with men and women. AIDS Education and Prevention,27(3), 227–239.

    Article  PubMed  Google Scholar 

  • Reddy, C. (2016). Race and the critique of marriage. South Atlantic Quarterly,115(2), 424–432. https://doi.org/10.1215/00382876-3488524.

    Article  Google Scholar 

  • San Francisco Department of Public Health Population Health Division. (2018). HIV Epidemiology: Annual Report 2017. San Francisco, CA: Author.

    Google Scholar 

  • Schrimshaw, E. W., Downing, M. J., & Cohn, D. J. (2016). Reasons for non-disclosure of sexual orientation among behaviorally bisexual men: Non-disclosure as stigma management. Archives of Sexual Behavior. https://doi.org/10.1007/s10508-016-0762-y.

    Article  PubMed  PubMed Central  Google Scholar 

  • Shearer, K., Khosropour, C., Stephenson, R., & Sullivan, P. S. (2012). Do bisexual men tell their female partners about having male partners? Results from a National Online HIV Prevention Survey in the United States. International Journal of Sexual Health,24(3), 195–204.

    Article  Google Scholar 

  • Stokes, J., McKirnan, D., Doll, L., & Burzette, R. (1996). Female partners of bisexual men: What they don’t know might hurt them. Psychology of Women Quarterly,20(2), 267–284.

    Article  Google Scholar 

  • Ward, E. G. (2005). Homophobia, hypermasculinity and the US black church. Culture, Health & Sexuality,7(5), 493–504.

    Article  Google Scholar 

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Acknowledgements

Funding was provided by National Institute of Mental Health (Grant No. K01MH096608-01).

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Authors and Affiliations

  1. Public Health Program, Santa Clara University, 500 El Camino Real, Santa Clara, CA, 95053, USA

    Sonja Mackenzie

  2. Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA, USA

    Cameron Michels

  3. Health Equity Institute, San Francisco State University, San Francisco, CA, USA

    Jason Chang

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  1. Sonja Mackenzie
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  2. Cameron Michels
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Correspondence to Sonja Mackenzie.

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Mackenzie, S., Michels, C. & Chang, J. Structures of Sexuality: Sexual Stigma, Disclosure, and HIV Risk with Primary Female Partners Among Behaviorally Bisexual Black Men. Arch Sex Behav 49, 299–310 (2020). https://doi.org/10.1007/s10508-019-1463-0

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