Examing Links of Racial and Sexual Identity Development, Psychological Well-Being, and Sexual Risks Among HIV-Positive, Same Sex Attracted African American Men

The present study investigated associations among African American and same sex attracted identity developmental components, psychological well-being, difficult sexual situations, and sexual risk practices among a sample (N = 73) of HIV-positive African American men who have sex with men (MSMs). The current study responds to Mays, Cochran, and Zamudio’s (2004) call for empirical investigations of culturally specific determinants impacting psychological health and sexual risk behaviors among African American MSMs. The current study parallels the methodology of Diaz, Ayala, and Bein (2004) and Diaz, Bein, and Ayala (2006), linking experiences of homophobia, racism, and poverty to psychological health and sexual risk practices among gay identified Latino men. Using a similar framework, the current study investigated the impact of African American and same sex attracted identity development on psychological health and sexual risk practices within a sample of African American HIV-positive MSMs. The current study’s sample reported a diverse range of sexual identities (e.g., gay, heterosexual, “on the down low;”), with all participants having engaged in consensual sex with other men. Results indicated that higher endorsement of the Anti-White African American identity (as measured by the Cross Racial Identity Scale [CRIS, Vandiver et al., 2000]), as well as lower levels of psychological well-being, and younger ages, predicted circumstances promoting unsafe sex. Higher endorsements of the African American identities of Multiculturalist Inclusive and Miseducation, as well as the same sex attracted identity of Superiority (as measured by the Lesbian and Gay Identity Scale [LGIS; Mohr & Fassinger, 2000]), predicted interpersonal barriers to unsafe sex. Additional exploratory analyses showed higher endorsements of the same sex identity of Homonegativity to predict lower levels of psychological well-being; higher endorsements of the African American identity of Assimilation, and same sex attracted identity of Need for Acceptance, to predict circumstances predicting unsafe sex; higher endorsements of the African American identities of Anti-White and Afrocentric to predict interpersonal barriers to unsafe sex; and higher endorsements of the Anti-White identity to predict sexual risk practices outside of a committed relationship. Descriptive data suggested that participants endorsed African American and same sex attracted identities differently than scale development samples. An exploratory factor analysis showed that the six-factor structure of the CRIS generally replicated within the current sample. However, there was an insufficient sample size to investigate the LGIS factor structure within the current sample. Qualitative data also suggested that participants are experiencing racial and sexual identity challenges, but also engaging in effective ways of coping with and resolving these challenges. Qualitative data also highlighted the importance of social support that is accepting of African American and same sex attracted male identities. Results imply that interventions highlighting issues around effectively managing racial and sexual identity challenges, and psychological distress, while providing social support, could help promote sexual health among HIV-positive African American MSMs.