Intersecting racism and homonegativism among sexual minority men of color: Latent class analysis of multidimensional stigma with subgroup differences in health and sociostructural burdens

https://doi.org/10.1016/j.socscimed.2021.114602Get rights and content

Highlights

  • Stigma experiences among Black and Latino sexual minority men are multidimensional and complex.

  • Latent class analysis uncovered subgroups experiencing unique patterns of intersecting stigma.

  • Mental and physical health differed by stigma subgroup for Black and Latino sexual minority men.

  • The most severe intersecting stigma pattern co-occurred with inordinate sociostructural burden.

Abstract

Rationale

Applying an intersectional framework to quantitative public health research among Black and Latino sexual minority men requires analysis that considers interlocking, multidimensional systems of racist and homonegative oppression that fundamentally subvert health. In this study, person-centered methods reflected the complexity of intersecting stigma and how subgroups experience that intersection differently.

Methods

Data were from a cohort of 435 Black and Latino sexual minority young men (mean age = 22.3 years) in the Healthy Young Men's Cohort Study in Los Angeles, United States. Participants provided data semiannually on five occasions spanning 24 months from 2016 to 2019. The marginal approach to longitudinal latent class analysis was used to identify latent classes indicated by multidimensional experiences of racism (e.g., police harassment, workplace discrimination, sexual objectification) and homonegativism (e.g., violence, family rejection, identity concealment) during the transition to adulthood. Associations between sociostructural burdens (e.g., socioeconomic status, food insecurity, unstable housing) and class incidents were investigated. Prevalence of mental health care needs, chronic health conditions, and overall self-reported health were compared among classes.

Results

Five latent classes were identified: Minimal Stigma (26% of person records), Select Social Stigma (22%), Homonegativism (17%), Multiform Racism (24%), and Compound Stigma (11%). Sociostructural burdens were generally associated with 1.69–3.75 times higher odds of Select Social Stigma, Homonegativism, Multiform Racism, and Compound Stigma class incidents relative to Minimal Stigma. The Compound Stigma class had the greatest sociostructural burden, highest mental health care needs, and highest odds of sleep and gastrointestinal disorders, but classes did not differ in overall self-reported health.

Conclusion

These results exemplify how sociostructural burdens are interconnected with intersectional stigma experiences that together erode the health of Black and Latino sexual minority young men.

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

References (68)

  • L. Bowleg

    The problem with the phrase women and minorities: intersectionality-an important theoretical framework for public health

    Am. J. Publ. Health

    (2012)
  • L. Bowleg

    When Black + lesbian + woman ≠ Black lesbian woman: the methodological challenges of qualitative and quantitative intersectionality research

    Sex. Roles

    (2008)
  • V.R. Brooks

    Minority Stress and Lesbian Women

    (1981)
  • R.K. Brunson

    “Police don't like Black people”: african-American young men's accumulated police experiences

    Criminol. Publ. Pol.

    (2007)
  • R. Clark et al.

    Racism as a stressor for african Americans

    Am. Psychol.

    (1999)
  • S.D. Cochran et al.

    Sexual orientation differences in functional limitations, disability, and mental health services use: results from the 2013-2014 national health interview survey

    J. Consult. Clin. Psychol.

    (2017)
  • L.M. Collins et al.

    Latent Class and Latent Transition Analysis: with Applications in the Social, Behavioral, and Health Sciences

    (2010)
  • K. Crenshaw

    Demarginalizing the intersection of race and sex: a Black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics

    Univ. Chicago Leg Forum

    (1989)
  • F.N. Denton et al.

    Stigma-related stressors, coping self-efficacy, and physical health in lesbian, gay, and bisexual individuals

    J. Counsel. Psychol.

    (2014)
  • L.M. Diamond

    New paradigms for research on heterosexual and sexual-minority development

    J. Clin. Child Adolesc. Psychol.

    (2003)
  • R.M. Diaz et al.

    The impact of homophobia, poverty, and racism on mental health of gay and bisexual Latino men: findings from 3 US cities

    Am. J. Publ. Health

    (2001)
  • P.J. Diggle et al.

    Analysis of Longitudinal Aata

    (2002)
  • C. Dyar et al.

    Physical health disparities across dimensions of sexual orientation, race/ethnicity, and sex: evidence for increased risk among bisexual adults

    Arch. Sex. Behav.

    (2019)
  • J.J. Dziak et al.

    Comparing the performance of improved classify-analyze approaches for distal outcomes in latent profile analysis

    Methodology

    (2016)
  • V.A. Earnshaw et al.

    Intersectional experiences of discrimination in a low-resource urban community: an exploratory latent class analysis

    J. Community Appl. Soc. Psychol.

    (2018)
  • C.L. Ford et al.

    Critical race theory, race equity, and public health: toward antiracism praxis

    Am. J. Publ. Health

    (2010)
  • M.P. Galupo et al.

    Experiences of LGBT microaggressions in the workplace: implications for policy

  • G.J. Gates

    Food Insecurity and SNAP ( Food Stamps ) Participation in LGBT Communities 12

    (2014)
  • W.P. Hammond

    Psychosocial correlates of medical mistrust among African American men

    Am. J. Community Psychol.

    (2010)
  • M.L. Hatzenbuehler et al.

    Stigma as a fundamental cause of population health inequalities

    Am. J. Publ. Health

    (2013)
  • G.M. Herek

    Beyond "homophobia": thinking about sexual prejudice and stigma in the twenty-first century

    Sex. Res. Soc. Pol.

    (2004)
  • G.M. Herek

    Hate crimes and stigma-related experiences among sexual minority adults in the United States: prevalence estimates from a national probability sample

    J. Interpers Violence

    (2009)
  • G.M. Herek et al.

    Internalized stigma among sexual minority adults: insights from a social psychological perspective

    J. Counsel. Psychol.

    (2009)
  • J. Heron et al.

    A comparison of approaches for assessing covariate effects in latent class analysis

    Longit. Life Course Stud.

    (2015)
  • Cited by (0)

    View full text