perceptions of discrimination against gay and bisexual men in south carolina matthew j. page, phd,...
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![Page 1: Perceptions of Discrimination against Gay and Bisexual Men in South Carolina Matthew J. Page, PhD, MPP and Nicole L. Chapman, BS](https://reader031.vdocuments.us/reader031/viewer/2022022216/5697c0131a28abf838cccf7b/html5/thumbnails/1.jpg)
Perceptions of Discrimination against Gay and Bisexual Men in
South Carolina
Matthew J. Page, PhD, MPP and Nicole L. Chapman, BS
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Social Determinants of HIV• US HIV transmission characterized by “low
prevalence in general population [and] high prevalence among disenfranchised and socially marginalized populations.”
• What drives members of socially marginalized populations to partake in sexual risk behaviors?
El-Sadr et al. 2010
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Sexual Minority Stigma
• As of 2011, 55% of Americans felt homosexual behavior is always, almost always, or sometimes wrong.
• Types of sexual stigma:– Enacted stigma.– Felt stigma.– Internalized stigma (internalized homophobia).
General Social Survey, Herek 2007
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Sexual Stigma and HIV Risk• Sexual risk is associated with actual and
perceived discrimination against, and internalized stigma among, men who have sex with men (MSM).
• Enacted and felt stigma reduce self-acceptance and increase stress, anxiety, and depression among MSM.
Actual/perceived discrimination: 21 references, 1992-2014
Internalized homophobia: 10 references, 1998-2014 Reduced self-acceptance: 7 references, 1995-2014
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Structural Factors
Individual Factors
Societal Factors
Based on work by Diaz et al. 2004, Herek 2007, Herek & Glunt 1995, Huebner 2002, Preston et al. 2007
StigmaExternal
FeltInternalized
Difficult Interpersonal
or Sexual Situations
Sexual Risk Taking
Reduced Self-efficacy for Safe Sex
Increased Interpersonal
Barriers to Safe Sex
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• MSM is the only risk group in the US for whom HIV incidence has increased since 2000, part of a broader international trend.
• 62% of all new HIV diagnoses in US in 2011 were due to male-to-male sexual contact.
HIV among MSM
Hightow-Weidman et al. 2011, Beyrer et al., 2013; Morris & Little, 2011; Sullivan et al., 2009; CDC 2013
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HIV in South Carolina• Eight of 10 states with highest HIV
diagnoses rates in 2011 are in Southern US.– South Carolina ranked ninth.
• In 2010, HIV prevalence exceeded national average in 57% of South Carolina counties. – Prevalence was more than twice the national
average in 10 counties.
CDC 2013; AIDSVu
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Study Objective
• Efforts to increase tolerance of, and reduce discrimination against, MSM could be a viable alternative to behavioral interventions.
• Describe perceptions of discrimination among MSM in South Carolina.
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Methods: Recruitment
• June 13-July 15, 2013.
• 12 banner ads.
• Facebook profiles:– 18 years and older.– Male.– Reside in SC.
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Methods: Survey Questionnaire
Demographics• Age.• City of residence.• Race/ethnicity.• Main male partner (Y/N).
– Status of relationship?
• STD diagnoses past year.
Perceived Discrimination• Degree of agreement with
16 positive negative and negative statements about discrimination against gay and bisexual men in city of residence.– Five-point Likert scale:
“Strongly disagree” to “Strongly agree”
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Methods: Analysis
• Likert scale responses coded so higher number reflected greater discrimination.– 0=lowest to 4=highest
• Discrimination summary scales.– Overall: all 16 statements (score range: 0-64)– Partial: 9 statements (score range: 0-36)
• Descriptive statistics.• Linear regression of discrimination scales.
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Respondent Flowchart
NOT Qualified or Consented
732
Impressions: 10,347,406Reaches: 1,459,492
Clicks: 3,357
Surveys Initiated985 (29.3% of clicks)
Qualified or Consented
253 (7.5% of clicks)
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Sample CharacteristicsNumber (%)
Age (n=253) 18 to 34 years 113 (44.6%)35 to 54 years 95 (37.6%)55 years and older 45 (17.8%)
Race (n=253) White 209 (82.6%)African American 18 (7.1%)
Main Male Partner (n=250) 110 (44.0%)Relationship Status (n=109) Married 36 (33.1%)Boyfriend 64 (58.7%)
STD Diagnosis Past 12 Months (n=214) 14 (6.5%)
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Perceptions of Discrimination
• 66.7% agreed most people in their city/town think less of man who is gay or bisexual.
• 55.8% disagreed most people would treat gay/bisexual man same as anyone else.
• 67.3% felt most people would not hire gay/bisexual man to care for their children.
• 53.7% expressed desire to live someplace with stronger gay community.
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Perceived Discrimination Scale• Mean scores:
– Overall scale: 34.79 (SD=±10.3)– Partial scale: 19.9 (SD=±7.5)
• Both overall and partial scores showed general decrease with age. – Prior findings show link between internalized
stigma and sexual risk may wane over time.
Newcomb & Mustanski, 2011
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Linear Regression Results Coefficients (p-value)
CovariatesOverall
Discrimination Score (n=177)
Partial Discrimination Score (n=192)
Intercept 37.24 (p<0.05) 20.45 (p<0.05)Age -1.19 (p<0.05) -0.22 (p=0.57)Race/Ethnicity 0.38 (p=0.69) 0.13 (p=0.85)STD Diagnosis Past 12 Months -6.46 (p<0.05) -3.57 (p=0.14)Race/Ethnicity x STD Past 12 Months 1.94 (p=0.48) 1.71 (p=0.41)R2 0.05 0.01Adjusted R2 0.03 -0.01
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Strengths and Limitations
• Strengths.– First research of its kind in South Carolina.– Recruitment method.
• Limitations.– Recruitment method.– Respondents restricted to only those sexually
active in past 12 months.
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Conclusions• Levels of perceived discrimination against
MSM in South Carolina indicate efforts to increase tolerance could be an effective alternative to behavioral interventions.
• Determining specific drivers of perceptions and leverage points for intervention require further study.
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Acknowledgements
• Rob Stephenson, Associate Professor, and Patrick S. Sullivan, Professor, at Emory University Rollins School of Public Health.
• College of Charleston Department of Health and Human Performance.
• All survey respondents.
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Presenter Disclosures
Matthew J. Page, PhD, MPP
(1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:
No relationships to disclose.