Minority Stress Predictors of Substance Use & Sexual Risk Behavior Among MSM

Background/Purpose: Research surrounding minority stress factors associated with risk behaviors typically centers on women and ethnic populations (Meyer, 2003). However, men who have sex with men (MSM) have a greater likelihood (Cochran, Mays & Sullivan, 2003) for poly-substance use (Kashubeck-West & Szymanski, 2008), sex with multiple partners (Bimbi, Nanin, Parsons, et al., 2006) and risk for sexually transmitted infections including HIV (Halkitis, Green & Carragher, 2006). This study examined the impact of three stress factors: external prejudice, expectations of rejection and internalized homophobia upon MSM. Hypotheses: 1. Minority stress is related to greater probability of MSM engaging in sexual risk behavior; 2. Minority stress is correlated differentially with regard to sexual risk behavior with primary vs. non-primary partners whether on drugs or not on drugs.

Methods: This study analyzed baseline data from Club Drug Use and Men's Health: A Community Study (n = 450), which examined MSM club drug usage (Halkitis, Green & Mourgues, 2005). Participants ranged in age from 18-67 (33 M) (SD = 7.93). Half were men of color, 88% identified as gay and 12% as bisexual. Participants were HIV positive (n = 150), HIV negative (n = 274) or unknown status (n = 26). To explore the correlation of stress factors and risk behaviors, multivariable regression analysis and binary logistic regressions were conducted using generalized estimating equations. Models were tested to examine which stress factors explained the likelihood of engaging in sexual risk behavior with primary partner and non-primary partners, whether on drugs, or not on drugs and controlled with sociodemographic factors.

Results: To determine the level of association with minority stress, scores were added for for each stress factor and reliability checked using Cronbach's Alpha: external prejudice (0.65); expectations of rejection (0.40) and internalized homophobia (0.74). Correlations among all three factors were between .24 and .43 illustrating no collinearity problems. Participants reporting stronger associations with expectations of rejection had decreased likelihood for engaging in unprotected insertive anal sex while not using drugs (OR = .54, p = .002) as well as when using drugs (OR = .56, p = .002) with non-primary partners. Expectations of rejection held slight relevance with both unprotected insertive and receptive anal sex with primary partner (OR = .70, p = .031). As age increased in the study sample, there was less likelihood of unprotected receptive anal sex while not on drugs (OR = .96, p = .015) and while on drugs (OR = .97, p = .067) with non-primary partners.

Conclusions/Implications: Significant relationships existed between expectations of rejection as a protective factor with sexual risk behavior with non-primary and primary partners, while age progression was slightly correlated with less risk for unprotected anal sex. The role of rejection requires further analysis as a protective factor regarding implications for the decision-making process and MSM risk behavior attitudes. Continued analysis may result in more effective HIV and substance abuse education, prevention and treatment strategies. Ongoing investigation of other stress factors on MSM substance use and sexual risk behavior is suggested.