(WITHDRAWN) Is This a "Safe Space" or Not?: Exploring Mental Health within House and Ballroom Communities

Background and Purpose: House and Ballroom communities (HBC) across the country provide a “safe space” for Black gay, bisexual, and transgender (GBT) individuals to escape from societal stigma related to their sexual orientation and/or gender expression. Despite the supportive and protective factors associated with HBC culture, these communities are not without their challenges. Extensive histories of stigma and rejection from families of origin, religious institutions, and society-at-large experienced by community members has resulted in increased rates of sex work and illicit substance abuse within the HBC. Moreover, the importance placed on image and status within the HBC has been shown to increase HIV-related stigma, resulting in lower rates of testing and engagement in medical care among members. While much has been written about elevated HIV risk and stigma within the HBC, little is known about the impact of these factors on the mental health of participants. Specifically, there is limited understanding of how “othering” in spaces designed to be safe for Black GBT individuals create and/or exacerbate mental health issues within the HBC. This paper explores mental health within the HBC and offers recommendations for “intravention” strategies.

Methods: Data were collected from implementation focused qualitative interviews of participants in the POSSE Intervention; a study designed to decrease sexual risk, STIs, and HIV stigma within HBC communities in Chicago and Philadelphia. The intervention works in complement with Popular Opinion Leaders (POLs) who are trained to deliver HIV/STI prevention and treatment messages to members. Semi structured, in-depth interviews were conducted during follow-up assessments that occurred every 6 months, with each assessment point consisting of 45 interviews with POLs (n=15) and community participants (n=30). Interviews were recorded, transcribed verbatim, and analyzed using Dedoose 8.1.8. Minority stress theory, Stress and Coping theory, and Trauma Theory guided an iterative analysis during an open coding process used to create data driven codes. Illustrative quotes were identified in the coding process to support the thematic statements being made.

Results: Findings reveal that, despite the supportive and protective origins of the HBC, participating in these communities may create/exacerbate mental health symptoms, trauma/stress related factors, and substance abuse among participants. Specifically, participants reported symptoms of loneliness, sadness/hopelessness, anger, and suicidality related to their participation in the HBC. These symptoms, according to participants, resulted in and from a lack of social support within the HBC, violence, unhealthy relationships, homelessness, and sex work, among a host of other factors.

Conclusions and Implications: While Popular Opinion Leader intervention models may demonstrate efficacy with regard to disseminating HIV/STI prevention and treatment education within the HBC, community leaders involved with the POSSE project expressed the need for additional support to attend to mental health needs within the community. To remedy this, social workers can collaborate with the HBC to increase access to culturally appropriate mental health and substance abuse services by: 1) providing training to community leaders for supporting participants who present with these concerns; and 2) constructing and evaluating a mechanism for improving the pipeline of mental health/substance abuse professionals within HBC communities.