Ties That Bind: Community Attachment and Discriminations Among Black Men Who Have Sex With Men (MSM)

Purpose: The Centers for Disease Control and the US Department of Health and Human Services, Office of Minority Health reports that black Americans are more likely to report serious psychological distress (PD) than whites.This impact may be larger for black men who have sex with men (MSM)given that they may experience racial discrimination from white gay communities and discrimination due to sexual orientation within black communities. Both forms of discrimination are associated with negative outcomes, physically and mentally. Ajrouch and colleagues suggest that social support serves as a buffer between stressors and PD. Attachment is an important aspect of human interaction, source of group identity and community practices. This presentation seeks to contribute to the understanding of community affiliations, discrimination due to race and sexual orientation and PD. We identify and discuss the relationship between discrimination due to race and sexual orientation and psychological distress, describe the role of community attachment (i.e., black and/or black gay) in psychological distress and discuss the implication of finding to assessment, treatment and advocacy.

Methods: Black MSM (n=312) were recruited for a behavioral intervention trial through outreach at street and venue locations throughout New York City. Participants completed a baseline behavioral assessment using an audio computer-assisted self-interview (ACASI) and received a rapid HIV antibody test. Using baseline data, exploratory analyses were conducted using t-test and Chi square.PD was measured with the validated Kessler Psychological Distress Scale (K10). Discrimination due to race and sexual orientation was derived from two scales comprising 3-items assessing discrimination. Univariate and bivariate logistic regression analyses were performed to examine correlates of PD for black MSM using SPSS Version 20.

Results: The majority of participants (89%) reported racial and/or sexual orientation community attachment. Based on the PD scale, 185 participants (60%) did not report having distress. PD was significantly lower among men 40 years of age and older (31%). Nearly equal percent of younger men, those 18-29 (50%) and 30-39 years older (54%) reported PD. Greater PD also was associated with lower levels of educational attainment with 58% of men who completed less than the 12^thgradereporting PD compared to 37% among those with higher education. PD was significantly associated with exposure to discrimination due to race alone (OR= 2.13; 95% CI, .70, 12.95), discrimination due to sexual orientation alone (OR=3.80; 95% CI, 1.11, 12.95), exposure to both discrimination due to race and sexual orientation(OR=3.72; 95% CI, 1.39, 9.90) and having attachments to black/African American or black gay communities (OR=0.24; 95% CI 0.11, 0.54) was associated with lower level PD.

Implications: Our findings suggest that there is an association between PD and race, sexual orientation, and community attachment among black MSM. Susceptibility to disparate health outcomes must be understood in relation to social membership, including its particular norms, structures, and ecological milieu. It is incumbent upon future research to identify the factors that facilitate affiliation. Further practice methods would benefit greatly from knowledge of the specific resources exchange by means of affiliations.