Variations in Substance Use and Disorders Among Sexual Minorities by Race/Ethnicity

Double Jeopardy: Does Intersectional Discrimination Moderate the Relationship Between Acculturation and Cigarette Dependence Among Latinx Sexual Minority Men Current Smokers?

INTRODUCTION

The Double Jeopardy Hypothesis posits that sexual minority people of color may have a greater risk of substance use because of dealing with heterosexism and racism. We sought to test this hypothesis by examining whether appraisal of intersectional forms of discrimination predict greater cigarette dependence and whether acculturation attenuates that relationship among Latinx sexual minority men (SMM) who smoke.

METHODS

Participants were 258 Latinx SMM who identified as current smokers recruited via Amazon Mechanical Turk (MTurk). OLS regressions tested (1) the relationship between appraisal of intersectional forms of discrimination (total and subscales) and Hispanic/non-Hispanic acculturation on cigarette dependence, and (2) the moderating effects of appraisal of intersectional discrimination (total and subscales) on the relationship between Hispanic/non-Hispanic acculturation and cigarette dependence.

RESULTS

In line with our hypotheses, non-Hispanic acculturation was associated with lower cigarette dependence. Appraisal of intersectional discrimination and subscales moderated the relationship between non-Hispanic acculturation and cigarette dependence. Simple slopes tests showed that the effects of non-Hispanic acculturation on cigarette dependence were strongest for those who experience lower intersectional discrimination.

CONCLUSION

Our findings suggest that Latinx SMM may have resilience that helps them deal with the negative effects of discrimination on cigarette dependence, especially for those who are more acculturated to the U.S. These findings may point to Latinx SMM taking on U.S. negative views towards smoking. However, future studies should use a more nuanced assessment of acculturation that does not rely on a language-based acculturation measure.

Intracommunity intersectional discrimination and its impact on psychological distress and smoking behavior among sexual minority men from minority ethnic backgrounds

Despite growing awareness of the experiences of LGBTQ+ communities, there has been relatively little attention given to the issues of exclusion and marginalization that occur within these communities. This gap is particularly significant given the health disparities faced by LGBTQ+ individuals from minority ethnic backgrounds. To address this gap, this paper examines the experiences of intracommunity intersectional discrimination among sexual minority men from minority ethnic backgrounds. Additionally, it proposes an intracommunity stress-coping model that explains how individuals may turn to smoking as a coping mechanism to manage the psychological impact of discrimination within LGBTQ+ communities. This paper is based on data collected from a national behavioral surveillance study in Australia, which included 1056 cisgender sexual minority men of Asian backgrounds. A substantial proportion of participants reported experiencing discrimination based on body size (39.9%) or skin color (36.3%) within LGBTQ+ communities. While the severity of discrimination was found to be positively related to psychological distress, the analysis also revealed the cumulative effects of discrimination based on intersecting identities. Specifically, individuals who experienced discrimination across multiple intersecting identities reported higher rates of psychological distress and smoking behavior. The positive associations between intracommunity intersectional discrimination and smoking behavior were mediated by psychological distress. Given the detrimental impact of intracommunity intersectional discrimination, it is crucial to raise awareness about the stressors within LGBTQ+ communities. Practitioners in mental health services and smoking cessation programs should be equipped with the knowledge and skills to effectively address the intracommunity stress experienced by Asian sexual minority men with multiple marginalized identities.

Police Harassment and Psychiatric, Sexual, and Substance Use Risk Among Black Sexual Minority Men and Black Transgender Women in the HIV Prevention Trials 061 Cohort

BACKGROUND

Black sexual minority men and Black transgender women (BSMM/BTW) experience disproportionate levels of HIV/STI-related risk factors as well as police harassment (PH). PH is linked to psychiatric risk and could play a role in substance use, sexual risk behavior, and HIV/STI risk.

METHODS

We used data from the HIV Prevention Trials Network 061(HPTN 061) study to examine associations between PH and HIV/STI-related outcomes. Using PH exposure measured at baseline and 6-month study visits, we examined an ordinal exposure (PH reported at both visits, PH reported at either visit, versus PH reported at neither baseline nor 6 months) and a binary exposure of persistent PH reported at both visits (yes versus no). We estimate risk ratios (RR) for associations between PH and depression, use of alcohol and methamphetamine, multiple partnerships, condomless sex, and syphilis.

RESULTS

Persistent PH (binary) was associated with a 20% or greater increase in the risk of depression (RR, 1.26 (1.07, 1.47)) and multiple partnerships (RR, 1.20 (1.05, 1.39)). There was evidence that ordinal PH was associated with elevated risk of alcohol use (RR, 1.17 (1.00, 1.36)); the point estimate for the association between persistent PH and alcohol use was similar but the imprecision was greater (RR, 1.16 (0.95, 1.42)).

CONCLUSION

PH may influence not only mental health but also behavioral risks that contribute to HIV/STI among BSMM/BTW, highlighting the potential wide-ranging and downstream effects of PH on health. Further research is required to confirm associations and elucidate pathways through which PH may influence HIV/STI among BSMM/BTW.

Use of poppers (nitrite inhalants) among young men who have sex with men with HIV: A clinic-based qualitative study

Nitrite inhalants (poppers) are associated with HIV transmission and commonly used among young men who have sex with men (YMSM), a group at increased risk for HIV. Significant research gaps exist in understanding the context in which YMSM use poppers. Qualitative interviews were conducted with 15 YMSM (22-31 years) with HIV to better understand the context in which poppers are used and their impacts on HIV care outcomes, such as care retention and antiretroviral adherence. The Social Ecological Model was applied to understand intrapersonal, interpersonal, community, and system level influences on popper use. Factors influencing popper use included: ubiquity of popper use in sexual settings, introduction to poppers by casual sexual partners, patient-HIV provider communication surrounding poppers, neighborhood, substance use and HIV care systems, and the legal status of poppers. Implications for clinical care, public health, policy, and future research are discussed.

Facets of Gender Expression and Discrimination in Relation to Alcohol and Other Drug Use Severity Among Sexual Minority Women and Gender Diverse Individuals Assigned Female at Birth

Purpose: Sexual minority women and gender diverse individuals assigned female at birth (SMW+) consistently report more alcohol and other drug (AOD) use severity than heterosexual women, with greater disparities reported among bisexual plus (bi+) SMW (including bisexual, pansexual, queer, and those with attractions to more than one gender regardless of identity). Furthermore, emerging evidence suggests that SMW with masculine gender expression (e.g., SMW with masculine gender appearance) disproportionately experience problematic AOD use compared to those with feminine gender expression. The minority stress model, which has predominantly been investigated in relation to internalized homonegativity and sexuality-based discrimination, may also account for these AOD use disparities. This study examined gender expression, related discrimination, and AOD use severity among SMW+. Methods: In a 2020 sample of SMW+ (n = 236), we investigated AOD use severity in relation to gender expression (appearance, emotional expression, and gender roles) and gender expression-based discrimination after controlling for internalized homonegativity and sexuality-based discrimination through an online survey. Results: Masculine gender roles were associated with AOD use severity, whereas masculine appearance and emotional expression were not. In multivariable models, gender identity was inconsistently associated with alcohol use severity, sexuality-based discrimination was consistently associated with alcohol use severity and inconsistently associated with other drug use severity, and gender expression-based discrimination was associated with neither. Conclusion: This study emphasizes the importance of examining intersecting aspects of minority identity among SMW+, including facets of gender expression, in relation to AOD use severity.