313P
What's in a Label? Differentiating Sociodemographic, Psychosocial, and Sexual Behavior Characteristics Among Black MSM By Sexual Identity
Black men who have sex with men (BMSM) in US urban settings are vastly overrepresented in HIV/AIDS epidemiology with rates surpassing populations among the world’s most affected countries. Although research consistently documents differences in risky sexual behavior among these men using behavioral classifications (behaviorally bisexual [MSMW] or homosexual [MSM]), there are mixed findings when disentangling MSM and MSMW by sexual identity (e.g., gay, down-low, straight, bisexual). Sexual identity is not a consistent predictor of unprotected sex or number of sex partners in the literature, but some studies indicate gay identity is generally related to more risky behavior than other categories of MSM. We explored differences among BMSM in sociodemographic, psychosocial, and sex behavior with men and women by sexual identity (gay, bisexual, straight, down low). Psychosocial characteristics included beliefs about ethnicity, sexuality, and masculinity that are postulated to influence sexual self-identity and risk behavior.
METHODS:
We used baseline data collected 2008-2011 from 595 participants in Being Responsible for Ourselves, an HIV prevention intervention for BMSM in Philadelphia. Descriptive statistics and difference tests (chi-square, ANOVA) were computed using SAS.
RESULTS:
Sociodemographics: Roughly equivalent numbers identified as gay (40.6%) and bisexual (41.3%) while fewer identified as straight (7.6%) or down-low (10.5%). Age ranged from 18 to 69 (mean=41.6); those identifying as gay were youngest (p<.0001). Participants were poor (73%) and many were unemployed (30%). More than half had been incarcerated; gay men reported a significantly lower rate. About 30% were HIV-positive: 42% were gay, 11% were straight, 23% were bisexual, 19% were down-low (p<.0001). Gay men reported fewest alcohol (p=.0240) and drug (.0016) problems. Fewer straight (8.9%) and down-low (14.5%) men considered themselves members of the gay community compared to bisexual (21%) or gay (58.1%) participants (p<.0001).
Psychosocial Characteristics: Participants differed significantly by sexual identity for measures reflecting masculinity (p<.0001), homophobia (p<.0001) and outness (p<.0001). Masculinity and homophobia scores increased from gay to bisexual to down-low to straight. The opposite pattern was observed for outness—a composite score of disclosure to friends, family and co-workers of being an MSM. Means on scales related to ethnicity postulated to vary by sexual identity—Black pride and religiosity—were not statistically different.
Sexual Behavior: Mean total intercourse (insertive and receptive anal with men, vaginal and anal with women) was highest among down-low and lowest among gay men. Mean proportions of types of intercourse varied by sexual identity. Gay men had less intercourse with women than the other identities. Bisexual and down-low men’s proportions of types of sex were similar. Straight men had little receptive anal sex. There were no significant differences by identity in frequency of unprotected insertive anal intercourse with men, but gay men had significantly more unprotected receptive anal intercourse (p<.0001). There were significant differences by identity for unprotected vaginal (p<.0001) and anal (p<.0001) intercourse with women.
CONCLUSIONS AND IMPLICATIONS:
This study demonstrates the importance of exploring differences in types of sexual activity for BMSM by considering sexual identity. HIV prevention should be tailored for relevance to subgroups of BMSM.