Intersectional Effects of Sexual Orientation Concealment, Internalized Homophobia, and Gender Expression on Sexual Identity and HIV Risk Among Sexual Minority Men of Color: A Path Analysis

S Raquel Ramos, David T Lardier Jr, Ijeoma Opara, Rodman E Turpin, Donte T Boyd, José I Gutierrez Jr, Chase Nicole Williams, LaRon E Nelson, Trace Kershaw, S Raquel Ramos, David T Lardier Jr, Ijeoma Opara, Rodman E Turpin, Donte T Boyd, José I Gutierrez Jr, Chase Nicole Williams, LaRon E Nelson, Trace Kershaw

Abstract

In the United States, 13 million people identify as sexual and gender minorities. The purposes of this article were to (a) examine the associations among sexual orientation concealment and internalized homophobia with HIV knowledge, health literacy, and transactional sex through sexual identity; and (b) assess whether gender expression moderates those relationships in sexual minority men of color. A multigroup mediation path model examined the association between sexual orientation concealment and internalized homophobia on HIV knowledge, health literacy, and transactional sex through sexual identity by gender expression. Results suggest that, among those with a masculine gender expression, as sexual concealment increased, health literacy decreased. The association between sexual orientation concealment and transactional sex varied by participant's gender expression as did the association between internalized homophobia and HIV knowledge. Multiple intersecting identities, when faced with anticipated discrimination and homophobia, can negatively affect health outcomes and increase HIV risk in sexual minority men of color.

Trial registration: ClinicalTrials.gov NCT04061915.

Conflict of interest statement

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Copyright © 2021 Association of Nurses in AIDS Care.

Figures

Figure 1.
Figure 1.
Mediation path model predicting HIV knowledge, health literacy, and transactional sex. Note. Standardized path coefficients presented. *p < .05; **p < .01; ***p < .001.
Figure 2.
Figure 2.
Multigroup mediation path model predicting HIV knowledge, health literacy, and transactional sex. Note. Paths shown in bold are significantly different between groups. Standardized path coefficients presented. Order of standardized path coefficients between groups: masculine/both masculine and feminine/feminine gender expression. *p < .05; **p < .01; ***p < .001.

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