Abstract
This article examined the associations between three forms of homosexuality-related stigma (enacted, perceived, and internalized homosexual stigmas) with risky sexual behaviors, and to describe the mechanisms of these associations, among men who have sex with men (MSM) in Hanoi, Vietnam. We used respondent-driven sampling (RDS) to recruit 451 MSM into a cross-sectional study conducted from August 2010 to January 2011. Data were adjusted for recruitment patterns due to the RDS approach; logistic regression and path analyses were performed. Participants were young and single; most had attended at least some college. Nine out of ten participants engaged in sexual behaviors at moderate to high risk levels. Compared to those who had no enacted homosexual stigma, men having low and high levels of enacted homosexual stigma, respectively, were 2.23 times (95 % CI 1.35–3.69) and 2.20 times (95 % CI 1.04–4.76) more likely to engage in high levels of sexual risk behaviors. In addition, there was an indirect effect of perceived homosexual stigma and internalized homosexual stigma on sexual risk behaviors through depression and drug and alcohol use. Our study provides valuable information to our understanding of homosexual stigma in Vietnam, highlighting the need for provision of coping skills against stigma to the gay community and addressing drinking and drug use among MSM, to improve the current HIV prevention interventions in Vietnam.
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References
Alvy, L. M., McKirnan, D. J., Mansergh, G., & Koblin, B. (2011). Depression is associated with sexual risk among men who have sex with men, but is mediated by cognitive escape and self-efficacy. AIDS and Behavior, 15, 1171–1179.
Bancroft, J., Janssen, E., Strong, D., Carnes, L., Vukadinovic, Z., & Long, J. S. (2003). Sexual risk-taking in gay men: The relevance of sexual arousability, mood, and sensation seeking. Archives of Sexual Behavior, 32, 555–572.
Beck, A., McNally, I., & Petrak, J. (2003). Psychosocial predictors of HIV/STI risk behaviors in a sample of homosexual men. Sexually Transmitted Infections, 79, 142–146.
Berlan, E. D., Corliss, H. L., Field, A. E., Goodman, E., & Austin, S. B. (2010). Sexual orientation and bullying among adolescents in the growing up today study. Journal of Adolescent Health, 46, 366–371.
Brimlow, D. L., Cook, J. S., & Seaton, R. (2003). Stigma and HIV/AIDS: A review of the literature. Washington, DC: US DHHS, Health Resources and Services Administration, HIV/AIDS Bureau.
Chesney, M. A., Koblin, B. A., Barresi, P. J., Husnik, M. J., Celum, C. L., Colfax, G., … EXPLORE Study Team. (2003). An individually tailored intervention for HIV prevention: Baseline data from the EXPLORE study. American Journal of Public Health, 93, 933–938.
Colby, D. J. (2010). Results of research on MSW in Ho Chi Minh city. Vietnam: Ho Chi Minh City.
Courtenay-Quick, C., Wolitski, R. J., Parsons, J. T., & Gomez, C. A. (2006). Is HIV/AIDS stigma diving the gay community? Perception of HIV-positive men who have sex with men. AIDS Education and Prevention, 18, 56–57.
Deacon, H. (2006). Towards a sustainable theory of health-related stigma: Lessons from the HIV/AIDS literature. Journal of Community & Applied Social Psychology, 16, 418–425.
Doll, L. S., & Beeker, C. (1996). Male bisexual behavior and HIV risk in the United States: Synthesis of research with implications for behavioral interventions. AIDS Education and Prevention, 8, 205–225.
Earnshaw, V. A., & Chaudoir, S. R. (2009). From conceptualizing to measuring HIV stigma: A review of HIV stigma mechanism measures. AIDS and Behavior, 13, 1160–1177.
Folkman, S., Chesney, M., Pollack, L., & Phillips, C. (1992). Stress, coping, and high-risk sexual behavior. Health Psychology, 11, 218–222.
Gill, B. (2002). China’s HIV/AIDS crisis: Implications for human rights, the Rule of Law and U.S.–China relations. Testimony before the Congressional-Executive Commission on China, Roundtable on HIV/AIDS.
Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. New York: Simon & Schuster.
Ha, H., Ross, M. W., Risser, J. M. H., & Nguyen, H. T. M. (2013). Measurement of stigma in men who have sex with men in Hanoi, Vietnam: Assessment of a Homosexuality-related Stigma Scale. Journal of Sexually Transmitted Diseases. http://dx.doi.org/10.1155/2013/174506.
Heckathorn, D. (2002). Respondent-driven sampling II: Deriving valid population estimates from chain-referral samples of hidden populations. Social Problems, 49, 11–34.
Herek, G. M., Gillis, J. R., & Ogan, J. C. (2009). Internalized stigma among sexual minority adults: insights from a social psychological perspective. Journal of Counseling Psychology, 56, 32–43.
Hirshfield, S., Remien, R. H., Humberstone, M., & Walavalkar, I. (2004). Substance use and high-risk sex among men who have sex with men: A national online study in the USA. AIDS Care, 16, 1036–1047.
Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55.
King, M., Semlyen, J., Tai, S. S., Killaspy, H., & Nazareth, I. (2008). A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay, and bisexual people. BMC Psychiatry, 8, 70. doi:10.1186/1471-244X-8-70.
Koblin, B. A., Husnik, M. J., Colfax, G., & Huang, Y. (2006). Risk factors for HIV infection among men who have sex with men. AIDS, 20, 731–739.
Liu, H., Feng, T., & Rhodes, G. A. (2009). Assessment of the Chinese version of HIV and homosexuality related stigma scales. Sexually Transmitted Infections, 85, 65–69.
Lleras, C. (2005). Path analysis. Encyclopedia of social measurement (pp. 25–30). New York: Academic Press.
Marshal, M. P., Friedman, M. S., Stall, R., King, K. M., & Morse, J. Q. (2008). Sexual orientation and adolescent substance use: A meta-analysis and methodological review. Addiction, 103, 546–556.
McKusick, L., Hoff, C. C., Stall, R., & Coates, T. J. (1991). Tailoring AIDS prevention: Differences in behavioral strategies among hetero-sexual and gay bar patrons in San Francisco. AIDS Education and Prevention, 3, 1–9.
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697.
Mimiaga, M. J., Noonan, E., Donnell, D., Safren, S. A., & Mayer, K. H. (2009). Childhood sexual abuse is highly associated with HIV risk taking behavior and infection among MSM in the EXPLORE Study. Journal of Acquired Immune Deficiency Syndromes, 51, 340–348.
Neilands, B. T., Steward, W. T., & Choi, H. K. (2008). Assessment of stigma towards homosexuality in China: A study of men who have sex with men. Archives of Sexual Behavior, 37, 838–844.
Ostrow, D. G., DiFranceisco, W., & Wagstaff, D. (1998). The Coping and Change Study of Men at Risk of AIDS: Sexual Behavior and Behavior Change Questionnaire. In C. M. Davis, W. L. Yarber, R. Bauserman, G. Sheer, & L. Davis (Eds.), Handbook of sexuality-related measures (pp. 547–553). Thousand Oaks, CA: Sage.
Preston, D. B., Cain, R. E., Schulze, F. W., & Starks, M. T. (2004). The influence of stigma on the sexual risk behavior of rural men who have sex with men. AIDS Education and Prevention, 16, 291–303.
Preston, D. B., D’Augelli, A. R., Kassab, C. D., & Starks, M. T. (2007). The relationship of stigma to the sexual risk behavior of rural men who have sex with men. AIDS Education and Prevention, 19, 218–230.
Radloff, L. S. (1977). The CES-D scale: A self report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.
Rogers, G., Curry, M., Oddy, J., & Pratt, N. (2003). Depressive disorders and unprotected casual anal sex among Australian homosexually active men in primary care. HIV Medicine, 4, 271–275.
Ross, M. W., Berg, R. C., Schmidt, A. J., & Hospers, H. J. (2013). Internalized homonegativity predicts HIV-associated risk behavior in European men who have sex with men in a 38-country across-sectional study: Some public health implications of homophobia. BMJ Open, 3, e001928.
Safren, S. A., Raisner, S. L., Herrick, A., & Mimiaga, M. J. (2010). Mental health and HIV risk in men who have sex with men. Journal of Acquired Immune Deficiency Syndromes, 55, S74–S77.
Salganik, M. J. (2006). Variance estimation, design effects, and sample size calculations for respondent-driven sampling. Journal of Urban Health, 83(6 Suppl.), i98–112.
Songwathana, P., & Manderson, L. (2001). Stigma and rejection: Living with AIDS in villages in southern Thailand. Medical Anthropology, 20, 1–23.
Stall, R., Mills, T. C., Williamson, J., Hart, T., & Catania, J. A. (2003). Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. American Journal of Public Health, 93, 939–942.
Stall, R., Paul, J., Greenwood, G., Pollack, L. M., & Catania, J. A. (2001). Alcohol use, drug use, and alcohol related problems among men who have sex with men: The Urban Men’s Health Study. Addiction, 96, 1589–1601.
Strathdee, S. A., Hogg, R. S., Martindale, S. L., Cornelisse, P. G., & Schechter, M. T. (1998). Determinants of sexual risk-taking among young HIV-negative gay and bisexual men. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 19, 61–66.
The EXPLORE Study Team. (2004). Effects of a behavioral intervention to reduce acquisition of HIV infection among men who have sex with men: The EXPLORE randomized controlled study. Lancet, 364, 41–50.
Thiede, H., Valleroy, L. A., MacKellar, D. A., & Celentano, D. D. (2003). Regional patterns and correlates of substance use among young men who have sex with men in 7 US urban areas. American Journal of Public Health, 93, 1915–1921.
UNAIDS. (2007). Men who have sex with men, the missing piece in national response to AIDS in Asia and the Pacific. Available at: http://www.wisdomofwhores.com/wp-content/uploads/2010/12/MSM-the-missing-piece-Aug-2007.pdf. Accessed on August 30, 2013.
USAID and Horizons Program/Population Councill. (2008). Assessment of risk factors for HIV infection among men who have sex with men in the metropolitan area of Campinas City, Brazil, using respondent-driven sampling. Population Council.
World Health Organization. (2001). The Alcohol Use Disorders Identification Test: Guidelines for use in primary care. Available at: http://whqlibdoc.who.int/hq/2001/who_msd_msb_01.6a.pdf. Accessed on August 30, 2013.
Acknowledgments
This research was supported by Research to Prevention (R2P) Small Grants Program funded by United States Agency for International Development, awarded to Dr. Le Minh Giang at the Center for Community Health Research and Development (CCRD). The John Hopkins Bloomberg School of Public Health/Center for Communication Program is the prime contractor for R2P. Authors would like to thank Dr. Giang for his supports and CCRD’s staffs, especially Mr. Nguyen Tri Trung and Ms. Le Mai Phuong for data collection. Additional support was provided by Fogarty International Center through grant D43TW007669. The content of this study is solely the responsibility of the authors and does not necessarily represent the official views of the Fogarty International Center or the National Institutes of Health.
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Ha, H., Risser, J.M.H., Ross, M.W. et al. Homosexuality-Related Stigma and Sexual Risk Behaviors Among Men Who Have Sex With Men in Hanoi, Vietnam. Arch Sex Behav 44, 349–356 (2015). https://doi.org/10.1007/s10508-014-0450-8
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DOI: https://doi.org/10.1007/s10508-014-0450-8