The Mediating Role of Emotion-Focused Coping between Adverse Experiences and Sexual Risk Behaviours Among Men Who Have Sex with Men in Taiwan

Background: Men who have sex with men (MSM) have been disproportionately affected by HIV since the beginning of the epidemic globally, including in Taiwan. Recent Taiwanese data suggest that MSM have accounted for more than 85% of new HIV infections since 2016 (TCDC, 2019). Previous research in Taiwan has found that MSM who have experienced adversity, such as intimate partner violence, were more likely to report condomless anal sex and mental health needs than MSM who have not experienced such adversity. Moreover, interventions using emotion-focused coping to reduce risk behaviours among ethno-racial people living with HIV have been supported by previous studies (Cramer et al., 2016). In order to address the intersection of adverse experiences and sexual risk behaviours among MSM in Taiwan, there is an urgent need to understand the pathways among multiple experiences of adversity, emotion-focused coping, HIV infection and condomless anal sex.

Methods

In a cross-sectional study through collaborative partnerships with five LGBTQ community-based organizations in three metropolitan cities and two rural cities in Taiwan, 1,000 MSM completed the online survey from August to October 2017. Path analysis in Mplus 8.0 was implemented to assess the mediation effects of six emotion-focused coping strategies (positive reframing, acceptance, humour, religion, emotional support and self-blame) on the association between adverse experiences (childhood physical abuse, childhood sexual abuse and intimate partner violence) and two outcome measures (HIV infection and condomless anal sex), controlling for socio-demographic characteristics. The model fit was assessed by checking Root Mean Square Error of Approximation (RMSEA), comparative fit index (CFI) and Standardized Root Mean Square Residual (SRMR).

Results

The prevalence of each adverse experience was: childhood physical abuse (18.6%), childhood sexual abuse (14.0%) and intimate partner violence (33.8%). Four coping strategies, namely active coping, positive reframing coping, acceptance coping and religion coping, showed a mediating role on the studied association. The four models fit the data well, as the RMSEA value was less than 0.06, the CFI value was greater than 0.97, and the SRMR value was less than 0.06 (Hu & Bentler, 1999). Tests of indirect associations suggested that positive reframing (B = -0.04, p < 0.01), acceptance (B = -0.02, p < 0.05) and religion (B = -0.02, p < 0.05) mediated the association between adverse experiences and HIV infection. Acceptance (B = -0.02, p < 0.05) and religion (B = -0.03, p < 0.01) coping also mediated the association between adverse experiences and condomless anal sex.

Conclusion:

Given the detrimental effect of adverse experiences on sexual risk behaviours among MSM, it is crucial to understand coping strategies that can reinforce or negate the negative impact of such experiences. These results may have implications for social work practice. In order to develop a tailored HIV prevention program, Taiwanese MSM living with adverse experiences would benefit from the trauma-informed counselling, which involves emotion-focused approaches with elements of positive reframing, acceptance and religion coping. Additionally, evidence-based research among MSM in Taiwan should further examine the effect of other coping strategies on HIV risk-taking behaviours.