Stigmatization, Substance Use, and Sexual Risk Behavior among Latino Gay and Bisexual Men and Transgender Persons
Bruce, Douglas, Ramirez-Valles, Jesus, Campbell, Richard T., Journal of Drug Issues
Following the minority stress model as a framework, we examine the associations between racial and homosexual stigma, substance use, and sexual risk behavior among a respondent-driven sample of Latino gay and bisexual men and male-to-female transgender persons (GBT) in Chicago and San Francisco (N = 643). We use structural equations to test such a model and disentangle the possible effects of the different stigmas and their corresponding dimensions (i.e., perception, experience, internalization). Findings revealed distinct pathways to sexual risk. Two are typified by experienced homosexual stigma and internalized racial stigma via multiple drug use, and two are characterized by experienced racial stigma and internalized homosexual stigma via alcohol use.
Associations between substance use and sexual risk behavior among gay and bisexual men and male-to-female transgender persons (GBT) have been documented throughout the AIDS epidemic (Colfax et al., 2004; Ross, Mattison, & Franklin, 2003 ; Stall et al, 2001 ; Stall & Purcell, 2000; Valdiserri et al., 1988); however, the proximal factors which may predispose individuals to use substances and engage in sexual risk behavior are not well understood (Kalichman, Tannenbaum, & Nachimson, 1998; Stall & Purcell, 2000). Conceptually, substance use has been viewed as a coping mechanism to deal with stress (Pohorecky, 1991; Wills & Shiftman, 1985). Researchers have posited that GBT may engage in substance use and sexual risk behavior in response to stress created by stigmatization towards homosexuality or gender nonconformity (Marks, Bingman, & Duval, 1998; McKirnan, Ostrow, & Hope, 1996), yet empirically validating this position has proven difficult due to methodological limitations (Meyer, 2003a).
Racial discrimination is associated with a range of negative health and mental health outcomes among persons of color (Ramirez-Vallès, in press; Williams, Neighbors, & Jackson, 2003). Likewise, stigmatization towards homosexuality is associated with negative mental health outcomes among GBT (Diaz & Ayala, 2001 ; Mays & Cochran, 2001). Unfortunately, little is know about how discrimination and other dimensions of stigmatization towards race and homosexuality are associated with substance use and sexual risk behavior among ethnic minority GBT. Moreover, the measurement of stigmatization, either racial or homosexual, among GBT has been plagued by oversimplification, inconsistencies, and limited validity and reliability. Research to date has not disentangled the multiple processes associated with stigma (e.g., perception, experience, or internalization) or the simultaneous and differential effects of both racial and homosexual stigma. Our purpose in this paper is to model the associations among dimensions of racial and homosexual stigma, the use of drugs and alcohol, and sexual risk behavior among Latino GBT.
SUBSTANCE USE AMONG LATINO GBT
Drug use among GBT has been reported to be significantly higher than that of heterosexual men within household samples in Chicago and San Francisco (Fendrich, Wislar, Johnson, & Hubbell, 2003; Stall et al., 2001). A household-based sample of men who have sex with men (MSM) in New York, Los Angeles, Chicago, and San Francisco documented heavy drinking among 8% of the sample, but no racial differences among the heavy drinkers were reported (Stall et al., 2001). Some data point to elevated levels of substance use among Latino GBT compared to other GBT of color (Greenwood et al., 2001), but generalizations across studies are difficult to make due to diverse measurement methodologies utilized.
Previous research among Latino populations in the U.S. has documented higher rates of drug use among English-speaking Latinos than their Spanish-speaking counterparts (Amaro, Whitaker, Coffman, & Heeren, 1990). Also Latinos in the U.S., specifically Mexican-Americans, report some of the highest levels of alcohol use among ethnic groups in this country (Dawson, 1998). …