Trauma symptoms, internalized stigma, social support, and sexual risk behavior among HIV-positive gay and bisexual MSM who have sought sex partners online

ABSTRACT Gay, bisexual, and other men who have sex with men (MSM) remain the highest risk group for HIV infection. One reason is the increased use of the Internet to meet potential sex partners, which is associated with greater sexual risk behavior. To date, few studies have investigated psychosocial predictors of sexual risk behavior among gay and bisexual men seeking sex partners online. The purpose of the current study was to test a conceptual model of the relationships between trauma symptoms indexed on the event of HIV diagnosis, internalized HIV stigma, and social support on sexual risk behavior among gay and bisexual MSM who seek sex partners online. A sample of 142 gay and bisexual MSM recruited on- and offline completed a comprehensive online assessment battery assessing the factors noted above. A number of associations emerged; most notably internalized HIV stigma mediated the relationship between trauma-related symptoms indexed on the event of HIV diagnosis and sexual risk behavior with HIV-negative and unknown serostatus sex partners. This suggests that gay and bisexual MSM who are in greater distress over their HIV diagnosis and who are more sensitive to HIV stigma engage in more HIV transmission risk behavior. As sexual risk environments expand with the increasing use of the Internet to connect with others for sex, it is important to understand the predictors of sexual risk behavior so that tailored interventions can promote sexual health for gay and bisexual MSM seeking sex online.

[1]  R. Beidas,et al.  Trauma and sexual risk among sexual minority african american HIV-positive young adults , 2011 .

[2]  S. Kalichman,et al.  Trauma Symptoms, Sexual Behaviors, and Substance Abuse: Correlates of Childhood Sexual Abuse and HIV Risks Among Men Who Have Sex with Men , 2004, Journal of child sexual abuse.

[3]  J. Nevid,et al.  Risk factors associated with posttraumatic stress disorder symptomatology in HIV-infected women. , 2005, AIDS patient care and STDs.

[4]  B. Mustanski,et al.  Are sexual partners met online associated with HIV/STI risk behaviours? Retrospective and daily diary data in conflict , 2007, AIDS care.

[5]  Stephenie R. Chaudoir,et al.  From Conceptualizing to Measuring HIV Stigma: A Review of HIV Stigma Mechanism Measures , 2009, AIDS and Behavior.

[6]  M. Mimiaga,et al.  Prospective Associations Between HIV-Related Stigma, Transmission Risk Behaviors, and Adverse Mental Health Outcomes in Men Who Have Sex with Men , 2011, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[7]  P N Halkitis,et al.  Intentional unsafe sex (barebacking) among HIV-positive gay men who seek sexual partners on the Internet , 2003, AIDS care.

[8]  J. Parsons,et al.  Stress and Coping Among HIV-Positive Barebackers , 2009, AIDS and Behavior.

[9]  R. Hays,et al.  Development and Psychometric Assessment of a Multidimensional Measure of Internalized HIV Stigma in a Sample of HIV-positive Adults , 2008, AIDS and Behavior.

[10]  Julie M. Turner-Cobb,et al.  Coping, Social Support, and Attachment Style as Psychosocial Correlates of Adjustment in Men and Women with HIV/AIDS , 2002, Journal of Behavioral Medicine.

[11]  C. Koopman,et al.  Traumatic Experiences: Harbinger of Risk Behavior Among HIV-Positive Adults , 2002 .

[12]  Kerstin E. E. Schroder,et al.  Methodological challenges in research on sexual risk behavior: II. Accuracy of self-reports , 2003, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[13]  C. Grov,et al.  Attitudes about and HIV risk related to the "most common place" MSM meet their sex partners: comparing men from bathhouses, bars/clubs, and Craigslist.org. , 2012, AIDS education and prevention : official publication of the International Society for AIDS Education.

[14]  A. Hayes Beyond Baron and Kenny: Statistical Mediation Analysis in the New Millennium , 2009 .

[15]  J. Bauermeister,et al.  Assessing motivations to engage in intentional condomless anal intercourse in HIV risk contexts ("Bareback Sex") among men who have sex with men. , 2009, AIDS education and prevention : official publication of the International Society for AIDS Education.

[16]  S. Kalichman,et al.  HIV-seropositive men who engage in high-risk sexual behaviour: psychological characteristics and implications for prevention. , 1997, AIDS care.

[17]  Sexual Risk Behaviors by Relationship Type and Trauma History Among HIV-Positive Men Who Have Sex with Men , 2013, Archives of sexual behavior.

[18]  S. Kalichman,et al.  Men Who Have Met Sex Partners via the Internet: Prevalence, Predictors, and Implications for HIV Prevention , 2002, Archives of sexual behavior.

[19]  S. West,et al.  A comparison of methods to test mediation and other intervening variable effects. , 2002, Psychological methods.

[20]  Ashley M. Fox,et al.  Psychosocial Predictors of Sexual HIV Transmission Risk Behavior among HIV-Positive Adults with a Sexual Abuse History in Childhood , 2009, Archives of sexual behavior.

[21]  Ruiguang Song,et al.  Estimated HIV Incidence in the United States, 2006–2009 , 2011, PloS one.

[22]  J. Serovich,et al.  The role of family and friend social support in reducing risk behaviors among HIV-positive Gay men. , 1999, AIDS education and prevention : official publication of the International Society for AIDS Education.

[23]  C. Koopman,et al.  Sexual minority status and trauma symptom severity in men living with HIV/AIDS , 2012, Journal of Behavioral Medicine.

[24]  S. Gibson,et al.  HIV-related posttraumatic stress disorder: investigating the traumatic events. , 2010, AIDS patient care and STDs.

[25]  A. Kagee,et al.  Lifetime and HIV-Related PTSD Among Persons Recently Diagnosed with HIV , 2008, AIDS and Behavior.

[26]  M. Carey,et al.  Impact of HIV-Related Stigma on Health Behaviors and Psychological Adjustment Among HIV-Positive Men and Women , 2006, AIDS and Behavior.

[27]  A. Hayes Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach , 2013 .

[28]  M. McFarlane,et al.  The process of seeking sex partners online and implications for STD/HIV prevention , 2004, AIDS care.

[29]  Graham Bolding,et al.  Web-Based Behavioral Surveillance Among Men Who Have Sex With Men: A Comparison of Online and Offline Samples in London, UK , 2004, Journal of acquired immune deficiency syndromes.

[30]  D. Preston,et al.  The relationship of stigma to the sexual risk behavior of rural men who have sex with men. , 2007, AIDS education and prevention : official publication of the International Society for AIDS Education.

[31]  D. Lee,et al.  The role of shame and guilt in traumatic events: a clinical model of shame-based and guilt-based PTSD. , 2001, The British journal of medical psychology.

[32]  D. Quinn,et al.  Internalized stigma and HIV status disclosure among HIV-positive black men who have sex with men , 2013, AIDS care.

[33]  Helena Motlagh,et al.  Impact of Event Scale-revised. , 2010, Journal of physiotherapy.

[34]  S. Kalichman,et al.  Psychosocial and behavioral correlates of seeking sex partners on the internet among hiv-positive men , 2005, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[35]  I. Sarason,et al.  Simultaneous Assessment of Perceived Global and Relationship-Specific Support , 1996 .

[36]  J. Parsons,et al.  Is HIV/AIDS stigma dividing the gay community? Perceptions of HIV-positive men who have sex with men. , 2006, AIDS education and prevention : official publication of the International Society for AIDS Education.