Intersecting racism and homonegativism among sexual minority men of color: Latent class analysis of multidimensional stigma with subgroup differences in health and sociostructural burdens
Introduction
For Black and Latino sexual minorities, experiences at the intersection of racism and homonegativism reflect the pervasive reach of stigma across many contexts, levels, and relationships (Bowleg, 2013; Crenshaw, 1989). Myriad studies identify stigma as a fundamental cause of health disparities and demonstrate the connection of stigma with diverse physical health outcomes (e.g., asthma, sexually transmitted infections, sleep, gastrointestinal disorders) (Blosnich et al., 2013; Dyar et al., 2019; Jeffries and Johnson, 2015; Patterson and Potter, 2019) and elevated mental health care needs (Clark et al., 1999; Cochran et al., 2017; Denton et al., 2014; Meyer, 1995; Phelan and Link, 2015). Intersectionality provides a framework for understanding and analyzing how unique intersecting stigma experiences embedded in broader contexts of inequity converge to negatively impact the health of Black and Latino sexual minority men (Bauer, 2014; Bowleg, 2013; Crenshaw, 1989). Understanding how intersectional stigma impacts health is especially important during the transition to adulthood when the association between stigma and health disparities is especially strong (Layland et al., 2020b; Rice et al., 2021).
For Black and Latino young men, racism remains a fundamental cause of health disparities impacting physical and psychological health through numerous multilevel mechanisms (Phelan and Link, 2015; Priest and Williams, 2018; Williams et al., 2019). Acute stressful events and chronic experiences of racism contribute to shifts in behavioral patterns, emotional dysregulation, and physiological responses that directly impact health (Clark et al., 1999; Priest and Williams, 2018). Racism invades diverse contexts including health care settings (Hammond, 2010), the workplace (Allen, 2019), and gay bars (Diaz et al., 2001). Likewise, perpetrators are innumerable, including police (Brunson, 2007), potential romantic and sexual partners (Hidalgo et al., 2020), and employers (Allen, 2019). Racism is a multidimensional, insidious force that permeates diverse contexts, impacting individual health through many concurrent experiences.
Minority stress theory posits homonegativism as an underlying cause of health disparities among sexual minorities (Brooks, 1981; Meyer, 1995, 2003). Because sexual minorities often live within contexts defined by dominant heterosexual norms, minority stress is considered broad and chronic (Meyer, 1995). Sexual minorities may experience violent hate crimes (Herek, 2009), family rejection (Puckett et al., 2015), police harassment (Mallory et al., 2015), and workplace discrimination (Galupo and Resnick, 2016). To avoid perpetrators and contexts where homonegative stigma is expected, sexual minorities may adopt protective strategies (Herek et al., 2009). Examples of behavioral responses driven by anticipated homonegativism include concealing sexual orientation (Pachankis, 2007) and avoiding family and friends (Diaz et al., 2001). Anticipation of homonegativism can contribute to shame, emotional dysregulation, and social isolation that in turn impact health (Meyer, 2003; Pachankis, 2007). Additionally, sexual minority individuals experience internalized homonegativism when they accept and integrate societal messages about the inferiority of sexual minorities into their personal value systems (Herek et al., 2009), which is often related to mental health (Herek et al., 2009; Meyer, 2003; Puckett et al., 2015).
From an intersectional perspective, social identities cannot be divided into mutually exclusive, unidimensional categories wherein one identity (e.g., race/ethnicity, sexual orientation) fully explains disparities without considering other intersecting identities and stigma experiences (Bowleg, 2012). Unidimensional studies consistently find links of racism or homonegativism with mental health and diverse chronic health conditions (Hammond, 2010; Lick et al., 2013; Meyer, 2003; Puckett et al., 2015), but rarely is the intersection of racism and homonegativism considered when quantitatively investigating health disparities among Black and Latino sexual minority men.
Section snippets
An intersectional perspective
Intersectionality provides a framework for understanding how multiple identities (e.g., race, sexual identity) converge in personal, individual experiences—including interpersonal experiences of stigma—that reflect multiple interlocking systems of oppression (Bowleg, 2012; Crenshaw, 1989). Systems of oppression refers to the far-reaching ways in which racism and homonegativism are normalized, legalized, and institutionalized to ensure maintenance of power and unequal distribution of resources
Methods
Data were from the Healthy Young Men's Cohort Study (n = 448), a 2-year longitudinal study beginning in 2016 (Kipke et al., 2019). The study utilized venue-based recruitment, social media, and participant and health clinic referrals to identify eligible individuals who (1) were aged 16–24 years; (2) were assigned male sex at birth; (3) self-identified as gay, bisexual, or uncertain about their sexual orientation; (4) reported sex with a man within the past year; (5) self-identified as Black or
Stigma
Stigma measurement followed the intracategorical approach to intersectional research (McCall, 2005) and reflected in-depth exploration of diverse experiences of racist and homonegative stigma forms, perpetrators, contexts, severity, and frequency rather than limited measures of stigma compared across many different identities (i.e., intercategorical). Stigma was measured with 16 items from the Diaz et al. (2001) indices of racism and homonegativity and one shortened scale score from Ross and
Results
Across five occasions, 435 participants (n) provided 2003 person records (i) comprising a 92.1% global participation rate with 90.3% of participants providing data on four or more occasions. Records with no stigma data were excluded (i = 8), reducing person records to i=1995. Across person records, 24.8% had a high school education or less, 22.4% reported unemployment, 11.7% engaged in sex exchange, 49.3% had unmet basic needs (i.e., unmet basic needs>1), 33.7% experienced food insecurity,
Model selection
Latent class models with one to eight classes were well-identified (Table 1). Because most information criteria continued to decrease as classes were added and improvements to model fit diminished after six classes, models with two to six classes were considered for conceptual interpretability and stability. In the 5-class model, all classes from previous models (two to four classes) replicated and demonstrated structural stability (i.e., item-response probabilities). In the 6-class model,
Discussion
Adopting a person-centered methodological approach (Collins and Lanza, 2010) for modeling stigma, this study is grounded in an intersectional framework reflecting pervasive, myriad forms of racism and homonegativism experienced in diverse patterns associated with mental and physical health. Consideration of sociostructural burdens together with classification of racist and homonegative experiences quantified how intersectional stigma experiences converge with individuals’ experiences of social,
Conclusions
Ultimately, this study demonstrates how sociostructural burdens interlock with intersecting experiences of stigma to together erode the health of Black and Latino sexual minority young men during the transition to adulthood. On occasions when young men belonged to the Compound Stigma class—characterized by diverse racist and homonegative stigma—sociostructural burden (unemployment, food insecurity, unmet basic needs, unstable housing) was most severe, odds of sleep and gastrointestinal
Credit author statement
Eric K. Layland: Conceptualization, Methodology, Formal analysis, Data curation, Writing – original draft Preparation, Visualization Jennifer L. Maggs: Conceptualization, Writing – review & editing, Supervision Michele D. Kipke: Investigation, Writing – review & editing, Project administration, Funding acquisition Bethany C. Bray: Conceptualization, Methodology, Software, Validation, Writing – review & editing, Supervision
Funding
This research was supported by the National Institute on Drug Abuse (U01 DA036926; P50 DA039838; T32 DA017629) and the National Institute of Mental Health (T32 MH020031) of the National Institutes of Health. The views expressed are solely those of the authors and do not necessarily reflect the views of the National Institutes of Health. The National Institutes of Health had no involvement in the collection, analysis and interpretation of data, the writing of this article, or the decision to
Acknowledgements
The authors acknowledge the contributions of the many staff members who contributed to collection, management, analysis, and review of this data: James Aboagye, Alex Aldana, Stacy Alford, Ali Johnson, Nicole Pereira, Aracely Rodriguez, and Su Wu. The authors would also like to acknowledge the insightful and practical commentary of the members of the Community Advisory Board - Daniel Nguyen: Asian Pacific AIDS Intervention Team; Ivan Daniels III: Los Angeles Black Pride; Steven Campa: Los
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