Stress and Coping with Racism and Their Role in Sexual Risk for HIV Among African American, Asian/Pacific Islander, and Latino Men Who Have Sex with Men

Abstract

The deleterious effects of racism on a wide range of health outcomes, including HIV risk, is well documented among racial/ethnic minority groups in the United States. However, little is known about how men of color who have sex with men (MSM) cope with stress from racism and whether the coping strategies they employ buffer against the impact of racism on sexual risk for HIV transmission. We examined associations of stress and coping with racism with unprotected anal intercourse (UAI) in a sample of African American (n = 403), Asian/Pacific Islander (n = 393), and Latino (n = 400) MSM recruited in Los Angeles County, CA during 2008–2009. Almost two-thirds (65%) of the sample reported being stressed as a consequence of racism experienced within the gay community. Overall, 51% of the sample reported having UAI in the prior six months. After controlling for race/ethnicity, age, nativity, marital status, sexual orientation, education, HIV serostatus, and lifetime history of incarceration, the multivariate analysis found statistically significant main effects of stress from racism and avoidance coping on UAI; no statistically significant main effects of dismissal, education/confrontation, and social-support seeking were observed. None of the interactions of stress with the four coping measures were statistically significant. Although stress from racism within the gay community increased the likelihood of engaging in UAI among MSM of color, we found little evidence that coping responses to racism buffered stress from racism. Instead, avoidance coping appears to suggest an increase in UAI.

Shared Decision Making Among Clinicians and Asian American and Pacific Islander Sexual and Gender Minorities: An Intersectional Approach to Address a Critical Care Gap

“…[19][20][21] Guided by a SDM conceptual model, 3 we identify common experiences of AAPI SGM that fall into three themes: (1) AAPI Heterogeneity, (2) SGM Stigma, and (3) Multiple Minority Group Identities and Sources of Discrimination (Table 1). [4][5][6][7][8]10,12,13,18,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] We created three case studies to illustrate the intersectional issues that can occur in reallife patient-provider encounters among AAPI SGM. We outline potential strategies for clinics and clinicians to improve cultural competency, communication, and SDM (Table 2).…”

“…Indeed, providers may see AAPI patients as being at lower risk for HIV infection due to the ''model minority'' stereotype of AAPIs engaging in ideal behavior despite evidence to the contrary. 9,[27][28][29] Because Dr. Mary did not solicit Amit's preferences, she referred him to a prominent HIV clinic without considering its location in relation to his distress of being ''outed'' (Table 1) and of disclosing serostatus, which would force him to contend with antigay sentiments and stigma within his racial/ethnic community. 47 SGM of color may avoid SGM communities because they do not openly identify as SGM or because these communities are often predominantly White.…”

“…He does not disclose his immigration status for fear of further antagonizing Dr. Molly and being denied treatment. Socioeconomic status, class Ethnicity and culture (e.g., role of non-western medicine, religion, and spirituality) 22,25,26 Language proficiency and health literacy 22,25,26 Racial stereotypes (e.g., ''model minorities'' against whom other racial minorities should be compared; ''perpetual foreigners'' who are never American enough) [27][28][29][30][31] Patients Lack of access to AAPI SGM-specific resources 32,33 Language barriers in communication with providers 7,33,34 Culturally specific norms, beliefs, and attitudes about privacy, family obligations and expectations, and relationships with authorities and experts 10 Fear of deportation or detention 12 Cultural fatalism and perceived lack of treatment efficacy 22 Providers Presumptions based on race or ethnicity (e.g., underestimation of risk in stereotyped model minority populations) [4][5][6]8 Aggregating AAPI instead of noting differing customs and experiences that may vary by ethnicity 10,13 Unconscious biases that lead to misinterpretation of health information [4][5][6]8 Communication barriers (e.g., limited English proficiency and health literacy) 7 AAPI SGM stigma Fear of prejudice and rejection [27][28][29] Internalized racial and anti-SGM prejudice [27][28][29] Fear of being outed [27]…”

“…Erroneous presumptions based on race/ethnicity, gender [4][5][6]33,36,37 Erroneous presumptions based on sexuality (e.g., overestimation of risk) 25 History of racial exclusion and discrimination (e.g., Chinese Exclusion Act, Page Act, Japanese internment, and Vincent Chin) 8 Conflict with cultural norms (e.g., continuation of blood lines, filial piety) 18,27,41 Patients Lack of trust leading to nondisclosure of health information, sexual orientation, and/or gender identity 22,25,26 Pessimism regarding treatment efficacy, self-efficacy due to SGM stigma Low engagement in care 22,25,26 Lack of health education and public health messaging targeting multiple minority identities 22,25,26,[38][39][40] …”

“…54 AAPI SGM face racism not only within larger society; racism within SGM spaces is well documented. 27,55 Within gay popular media, racial stereotypes have depicted Asian gay men as sexually desirable insofar as they ''fit'' stereotypic roles of the submissive and passive lover. 56 Likewise, Black gay men have been stereotyped to be animalistic and …”