Introduction
Although evidence indicates that Black gay, bisexual, and other sexual minority men
experience vast psychological and behavioral health inequities, most research has
focused on individual rather than structural drivers of these inequities. This study
examines the associations between structural racism and anti–lesbian, gay, bisexual,
transgender, and queer policies and the psychological and behavioral health of Black
and White sexual minority men.
Methods
Participants were an Internet-based U.S. national sample of 1,379 Black and 5,537
White sexual minority men during 2017–2018. Analysis occurred in 2019–2020. Structural
equation modeling tested the associations from indicators of structural racism, anti‒lesbian,
gay, bisexual, transgender, and queer policies, and their interaction to anxiety symptoms,
depressive symptoms, perceived burdensomeness, heavy drinking, and HIV testing frequency.
Separate models for Black and White sexual minority men adjusted for contextual and
individual covariates.
Results
For Black participants, structural racism was positively associated with anxiety symptoms
(β=0.20, SE=0.10, p=0.04), perceived burdensomeness (β=0.42, SE=0.09, p<0.001), and heavy drinking (β=0.23, SE=0.10, p=0.01). Anti‒lesbian, gay, bisexual, transgender, and queer policies were positively
associated with anxiety symptoms (β=0.08, SE=0.04, p=0.03), perceived burdensomeness (β=0.20, SE=0.04, p<0.001), and heavy drinking (β=0.10, SE=0.04, p=0.01) and were negatively associated with HIV testing frequency (β= −0.14, SE=0.07,
p=0.04). Results showed significant interaction effects, such that the positive associations
between structural racism and both perceived burdensomeness (β=0.38, SE=0.08, p≤0.001) and heavy drinking (β=0.22, SE=0.07, p=0.003) were stronger for individuals living in states with high levels of anti‒lesbian,
gay, bisexual, transgender, and queer policies. Neither of the oppression variables
nor their interaction was significantly associated with outcomes for White sexual
minority men.
Conclusions
Results highlight the intersectional nature of structural oppression and suggest that
racist and anti–lesbian, gay, bisexual, transgender, and queer policies must be repealed
to rectify health inequities facing Black sexual minority men.
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REFERENCES
- Health disparities racial/ethnic and sexual minority boys and men.American Psychological Association, Washington, DC2018http://www.apa.org/pi/health-disparities/resources/race-sexuality-men.aspxDate accessed: September 28, 2019
- Lifetime risk of HIV diagnosis: half of Black gay men and a quarter of Latino gay men projected to be diagnosed within their lifetime.Centers for Disease Control and Prevention, 2016https://www.cdc.gov/nchhstp/newsroom/2016/croi-press-release-risk.htmlDate accessed: December 27, 2019
- HIV and African American gay and bisexual men.Centers for Disease Control and Prevention, 2020https://www.cdc.gov/hiv/group/msm/bmsm.htmlDate accessed: December 4, 2018
- Young Black gay/bisexual and other men who have sex with men: a review and content analysis of health-focused research between 1988 and 2013.Am J Mens Health. 2017; 11: 1388-1405https://doi.org/10.1177/1557988315606962
- Explaining disparities in HIV infection among black and white men who have sex with men: a meta-analysis of HIV risk behaviors.AIDS. 2007; 21: 2083-2091https://doi.org/10.1097/QAD.0b013e3282e9a64b
- Do men receive information required for shared decision making about PSA testing? Results from a National Survey.J Cancer Educ. 2016; 31: 693-701https://doi.org/10.1007/s13187-015-0870-8
- Racial/ethnic disparity in treatment for prostate cancer: does cancer severity matter?.Urology. 2017; 99: 76-83https://doi.org/10.1016/j.urology.2016.07.045
- Structural stigma: research evidence and implications for psychological science.Ann Psychol. 2016; 71: 742-751https://doi.org/10.1037/amp0000068
- Naming institutionalized racism in the public health literature: a systematic literature review.Public Health Rep. 2018; 133: 240-249https://doi.org/10.1177/0033354918760574
- Critical Race Theory: An Introduction.NYU Press, New York, NY2017
- “Once you've blended the cake, you can't take the parts back to the main ingredients”: Black gay and bisexual men's descriptions and experiences of intersectionality.Sex Roles. 2013; 68: 754-767https://doi.org/10.1007/s11199-012-0152-4
- Queer Theory: an Introduction.NYU Press, New York, NY1996
- Conceptualizing stigma.Annu Rev Sociol. 2001; 27: 363-385https://doi.org/10.1146/annurev.soc.27.1.363
- Racism and mental health: the African American experience.Ethn Health. 2000; 5: 243-268https://doi.org/10.1080/713667453
- Black Power: the Politics of Liberation in America.Vintage, New York, NY1992
- Systemic Racism: A Theory of Oppression.Routledge, New York, NY2013
- The problem with the phrase women and minorities: intersectionality-an important theoretical framework for public health.Am J Public Health. 2012; 102: 1267-1273https://doi.org/10.2105/AJPH.2012.300750
- Demarginalizing the intersection of race and sex: a Black feminist critique of antidiscrimination doctrine, feminist theory, and antiracist politics.University of Chicago Legal Forum. 1989; 102: 139-167
- Black Feminist Thought: Knowledge, Consciousness, and the Politics of Empowerment.Routledge, New York, NY2002
- Unjust: how the broken criminal justice system fails LGBT people of color.Movement Advancement Project, Center for American Progress, Boulder, CO2016http://www.lgbtmap.org/policy-and-issue-analysis/criminal-justice-pocDate accessed: March 3, 2019
- Racism as a stressor for African Americans: a biopsychosocial model.Ann Psychol. 1999; 54: 805-816https://doi.org/10.1037//0003-066x.54.10.805
- Intersectionality and why it matters to global health.Lancet. 2018; 391: 2589-2591https://doi.org/10.1016/S0140-6736(18)31431-4
- Modeling the intersectionality of processes in the social production of health inequalities.Soc Sci Med. 2019; 226: 249-253https://doi.org/10.1016/j.socscimed.2019.01.017
- The relationship between structural racism and Black–White disparities in fatal police shootings at the state level.J Natl Med Assoc. 2018; 110: 106-116https://doi.org/10.1016/j.jnma.2017.12.002
- Blacks’ death rate due to circulatory diseases is positively related to whites’ explicit racial bias: a nationwide investigation using Project Implicit.Psychol Sci. 2016; 27: 1299-1311https://doi.org/10.1177/0956797616658450
- Structural racism and myocardial infarction in the United States.Soc Sci Med. 2014; 103: 42-50https://doi.org/10.1016/j.socscimed.2013.07.021
- Joint effects of structural racism and income inequality on small-for-gestational-age birth.Am J Public Health. 2015; 105: 1681-1688https://doi.org/10.2105/AJPH.2015.302613
- Measuring structural racism and its association with BMI.Am J Prev Med. 2020; 59: 530-537https://doi.org/10.1016/j.amepre.2020.05.019
- Association of state laws permitting denial of services to same-sex couples with mental distress in sexual minority adults: a difference-in-difference-in-differences analysis.JAMA Psychiatry. 2018; 75: 671-677https://doi.org/10.1001/jamapsychiatry.2018.0757
- State-level policies and psychiatric morbidity in lesbian, gay, and bisexual populations.Am J Public Health. 2009; 99: 2275-2281https://doi.org/10.2105/AJPH.2008.153510
- Structural stigma and sexual orientation disparities in adolescent drug use.Addict Behav. 2015; 46: 14-18https://doi.org/10.1016/j.addbeh.2015.02.017
- The influence of structural stigma and rejection sensitivity on young sexual minority men's daily tobacco and alcohol use.Soc Sci Med. 2014; 103: 67-75https://doi.org/10.1016/j.socscimed.2013.10.005
- State-level structural sexual stigma and HIV prevention in a national online sample of HIV-uninfected MSM in the United States.AIDS. 2015; 29: 837-845https://doi.org/10.1097/QAD.0000000000000622
- Inclusive anti-bullying policies and reduced risk of suicide attempts in lesbian and gay youth.J Adolesc Health. 2013; 53 (suppl): S21-S26https://doi.org/10.1016/j.jadohealth.2012.08.010
- Difference-in-differences analysis of the association between state same-sex marriage policies and adolescent suicide attempts [published correction appears in JAMA Pediatr. 2017;171(4):399] [published correction appears in JAMA Pediatr. 2017;171(6):602].JAMA Pediatr. 2017; 171: 350-356https://doi.org/10.1001/jamapediatrics.2016.4529
- Anti-LGBT and anti-immigrant structural stigma: an intersectional analysis of sexual minority men's HIV risk when migrating to or within Europe.J Acquir Immune Defic Syndr. 2017; 76: 356-366https://doi.org/10.1097/QAI.0000000000001519
- Thwarted belongingness and perceived burdensomeness: construct validity and psychometric properties of the Interpersonal Needs Questionnaire.Psychol Assess. 2012; 24: 197-215https://doi.org/10.1037/a0025358
- Stigma and intersectionality: a systematic review of systematic reviews across HIV/AIDS, mental illness, and physical disability.BMC Public Health. 2018; 18: 919https://doi.org/10.1186/s12889-018-5861-3
- “The fear of being Black plus the fear of being gay”: the effects of intersectional stigma on PrEP use among young Black gay, bisexual, and other men who have sex with men.Soc Sci Med. 2019; 232: 86-93https://doi.org/10.1016/j.socscimed.2019.04.042
- Leveraging technology to blend large-scale epidemiologic surveillance with social and behavioral science methods: successes, challenges, and lessons learned implementing the UNITE longitudinal cohort study of sexual minority men at risk for HIV in the U.S.Am J Epidemiol. 2020; (In Press. Online October 15)https://doi.org/10.1093/aje/kwaa226
- Marcoulides GA Schumacker RE Advanced Structural Equation Modeling: Issues and Techniques. 1st ed. Psychology Press, New York, NY1996
- The MacArthur scale of subjective social status.University of California San Francisco, MacArthur, Research Network on SES & Health, San Francisco, CA2007https://macses.ucsf.edu/research/psychosocial/subjective.phpDate accessed: September 28, 2019
- Rural-urban commuting area codes.U.S. Department of Agriculture, Economic Research Service, 2019 (Updated July 3. Accessed September 28, 2019)
- 2018 State equality index.Human Rights Campaign Foundation, Washington, DC2018https://assets2.hrc.org/files/assets/resources/SEI-2018-Report.pdfDate accessed: September 28, 2019
- The Brief Symptom Inventory: an introductory report.Psychol Med. 1983; 13: 595-605https://doi.org/10.1017/s0033291700048017
- Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale).Am J Prev Med. 1994; 10: 77-84https://doi.org/10.1016/s0749-3797(18)30622-6
- Validating a shortened depression scale (10 item CES-D) among HIV-positive people in British Columbia, Canada.PLoS One. 2012; 7: e40793https://doi.org/10.1371/journal.pone.0040793
- The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test.Arch Intern Med. 1998; 158: 1789-1795https://doi.org/10.1001/archinte.158.16.1789
- AUDIT-C scores as a scaled marker of mean daily drinking, alcohol use disorder severity, and probability of alcohol dependence in a U.S. general population sample of drinkers.Alcohol Clin Exp Res. 2013; 37: 1380-1390https://doi.org/10.1111/acer.12092
- Structural equation modeling.in: Smelser NJ Baltes PB International Encyclopedia of the Social & Behavioral Science. Pergamon, Oxford, United Kingdom2001: 15215-15222https://doi.org/10.1016/b0-08-043076-7/00776-2
- Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives.Struct Equ Modeling. 1999; 6: 1-55https://doi.org/10.1080/10705519909540118
- Advanced Structural Equation Modeling Techniques.1st ed. Psychology Press, New York, NY1996
- What is the difference between missing completely at random and missing at random?.Int J Epidemiol. 2014; 43: 1336-1339https://doi.org/10.1093/ije/dyu080
- LGBT demographic data interactive.The Williams Institute, UCLA School of Law, Los Angeles, CA2019https://williamsinstitute.law.ucla.edu/visualization/lgbt-statsDate accessed: September 28, 2019
- Reconciling epidemiology and social justice in the public health discourse around the sexual networks of Black men who have sex with men.Am J Public Health. 2016; 106: 808-814https://doi.org/10.2105/AJPH.2015.303031
- Intersectional stigma and multi-level barriers to HIV testing among foreign-born Black men from the Caribbean.Front Public Health. 2020; 7: 373https://doi.org/10.3389/fpubh.2019.00373
- Intersectional internalized stigma among Black gay and bisexual men: a longitudinal analysis spanning HIV/sexually transmitted infection diagnosis.J Health Psychol. 2021; 26: 465-476
- Measuring the pros and cons of what it means to be a Black man: development and validation of the Black Men's Experiences Scale (BMES).Psychol Men Masc. 2016; 17: 177-188https://doi.org/10.1037/men0000026
- Follins LD Lassiter JM Black LGBT Health in the United States: The Intersection of Race, Gender, and Sexual Orientation. 1st ed. Lexington Books, Lanham, MD2016
Decrimny. https://www.decrimny.org/. Accessed July 24, 2020.
- Reparations as a public health priority — a strategy for ending Black–White health disparities.N Engl J Med. 2020; 383: 2101-2103https://doi.org/10.1056/NEJMp2026170
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Published online: April 08, 2021
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