The Role of Multiple Identities in Adherence to Medical Appointments Among Gay/Bisexual Male Adolescents Living with HIV

Abstract

Adolescents living with HIV require engagement with care providers in order to access the critical medical and psychosocial services they need. The current study sought to explore developmental determinants of adherence to medical appointments as one aspect of engagement in care among a geographically diverse sample of 200 gay/bisexual male adolescents (16–24 years) living with HIV, with a specific focus on ethnic identity, sexual orientation identity, and identity as a young man living with HIV. Ethnic identity affirmation (OR = 0.6; 95% CI: 0.3, 0.9), morality of homosexuality (OR = 1.7; 95% CI: 1.2, 2.5), and HIV-positive identity salience (OR = 1.5; 95% CI: 0.9, 2.4) were associated with significantly higher risk for missed appointments in the past three months. These findings highlight the importance of attending to developmental factors, such as the development of multiple identities, when attempting to increase engagement in care for gay/bisexual male adolescents living with HIV.

Psychosocial Influences on Engagement in Care Among HIV-Positive Young Black Gay/Bisexual and Other Men Who Have Sex with Men

“…33 Affirmation, Belonging, and Commitment to one's ethnic group was associated with fewer missed appointments, consistent with a previously reported analysis in the larger ATN 070 cohort (which was not limited to black youth). 22 These results are also consistent with other literature in general adolescent and youth populations, where ethnic identity affirmation is associated with positive adjustment and healthy development, particularly for minority youth. 24,34 Employment status (working either full-time or part-time, compared to those participants who did not work at all) also had a positive effect on adherence to medical appointments.…”

“…21 Background contextual factors such as individuals' identity constructs were also salient in a previous analysis from our parent study (ATN 070), in which gay identity and ethnic identity influenced adherence to medical appointments, with some evidence that HIV-positive identity might also play a role. 22 Finally, a significant body of work has examined associations between SAT-related psychosocial factors and medication adherence, which is a health promoting behavior that is also a part of the continuum of engagement in care. Depression, stigma, and social support are among the factors that have most commonly been associated with adherence to ART, and these can similarly be viewed as background contextual factors (depression and stigma) and self-change processes (utilizing social support) consistent with the SAT model.…”

Cognitive and Behavioral Resilience Among Young Gay and Bisexual Men Living with HIV

“…Despite these significant challenges, we have observed Y-GBMSM living with HIV to display adaptive coping skills and achieve favorable health outcomes in our prior work. 8,9,15 Improving our understanding of resilience in these youth has the potential to inform effective interventions that enhance positive adaptation as opposed to simply mitigate risk.…”

“…18 A prior analysis from our parent study also highlighted associations between ethnic identity and engagement in HIV care among Y-GBMSM living with HIV. 15 Social support is another resilience resource that is highlighted in many youth populations, across a range of behaviors. 13 For example, peer and family support has been shown to mitigate the negative effects of violence.…”

Different Dimensions: Internalized Homonegativity Among African American Men Who Have Sex With Men in the Deep South

“…The IHNI has been used in a number of studies investigating IH and its associations with various physical and mental health outcomes (Graham et al, 2011;Harper, Fernandez, Bruce, Hosek, & Jacobs, 2013;Kappler, Hancock, & Plante, 2013;Kashubeck-West & Szymanski, 2008;Robinson & Brewster, 2014;Shoptaw et al, 2009;Slater et al, 2013;Szymanski & Carr, 2008;Young et al, 2011;). Higher total IHNI scores have been reported to be associated with increased age, lower educational levels, lower income, and lower quality of life (Shoptaw et al, 2009;Slater et al, 2013).…”