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ABSTRACT AMOLA, OLUWAKEMI. the Effects of Internalized Homophobia on HIV Risk Behaviors Among Black Men Who Have Sex with Men

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ABSTRACT AMOLA, OLUWAKEMI. the Effects of Internalized Homophobia on HIV Risk Behaviors Among Black Men Who Have Sex with Men ABSTRACT AMOLA, OLUWAKEMI. The Effects of Internalized Homophobia on HIV Risk Behaviors among Black Men Who Have Sex with Men. (Under the direction of Dr. Marc Grimmett). Background: African Americans, compared to other racial groups in the United States, have the highest HIV prevalence, the highest incidence of HIV/AIDS, the highest HIV mortality, and the greatest number of years of potential life lost. Although all segments of Black communities have been significantly impacted by this epidemic, Black men who have sex with men have disproportionately experienced the negative consequences. Internalized homophobia is a contributing factor to HIV infection and transmission in Black men who have sex with men. It is imperative to assess internalized homophobia in Black men who have sex with men in order to analyze the effects of internalized homophobia on HIV risk behaviors in order to adequately inform counseling interventions. Methods: A quantitative approach was utilized to study the effects of internalized homophobia on mental health and HIV risk behaviors in a sample of Black MSM. The variables of interest were explored with a Web-based survey design. A convenience sample of 202 Black men, who reported sex with a male in the prior 12 months, were recruited via the Internet. Participants ranged in age from eighteen to sixty-five. Results: The results revealed a direct relationship between age and religiosity and internalized homophobia and no significant relationship between relationship status and internalized homophobia. Participants who were HIV positive or were unaware of their status scored significantly higher on internalized homophobia than those who were HIV negative. In addition, men who identified as heterosexual or straight scored significantly higher on internalized homophobia than those who identified as homosexual or gay. Mental health measured by self-esteem and depression had a negative relationship with internalized homophobia; for example, mental health functioning decreased as internalized homophobia increased. Finally, as internalized homophobia increased, participants were significantly more likely to engage in HIV risk behaviors. Conclusions: The current study added to the limited data on the prevention needs of Black MSM. Overall, the results suggest that prevention efforts are not as effective among Black men experiencing internalized homophobia, which may influence these men to engage in HIV risk behaviors. When counselors are working with this population, it is important to understand how homophobia influences internalized homophobia and its effect on HIV risk behaviors. Future research efforts should be implemented in a manner that will be culturally competent and will minimize the negative consequences of HIV in African American communities. © Copyright 2012 by Oluwakemi Amola All Rights Reserved The Effects of Internalized Homophobia on HIV Risk Behaviors among Black Men Who Have Sex with Men by Oluwakemi Amola A dissertation submitted to the Graduate Faculty of North Carolina State University in partial fulfillment of the requirements for the degree of Doctor of Philosophy Counseling and Counselor Education Raleigh, North Carolina 2011 APPROVED BY: _______________________________ ______________________________ Marc A. Grimmett, Ph.D Angela Smith, PH.D Committee Chair ________________________________ ________________________________ Jessica T. DeCuir-Gunby, PH.D Pamela Martin, PH.D ________________________________ Sylvia Nassar-McMillan, PH.D DEDICATION This paper is dedicated to my husband, DeSean Hill, and my two sons, DeSean Jr. and DeWale. Thank you for all of your constant love and support. Additionally, I would like to thank my family, friends, and colleagues for their support and encouragement. ii BIOGRAPHY North Carolina State University Raleigh, NC PH.D Counselor Education, May 2012 North Carolina Central University Raleigh, NC Masters of Art Agency counseling, May 2007 The University of North Carolina at Chapel Hill, Chapel Hill, NC Bachelor of Arts, Psychology, December 2001 CERTIFICATIONS/ LICENSES: *Approved Clinical Supervisor, *Licensed Professional Counselor, *Nationally Certified counselor, *HIV Prevention Specialist, *North Carolina State HIV Counseling, Testing, and Referral Certification, *Centers for Disease Control Health Communications Certification RESEARCH / CLINICAL EXPERIENCE UNC School of Medicine IMPACT Study Chapel Hill, NC November 2010- Present Intervention team/Clinical Counselor Research Study Aim: IMPACT is a multi-component counseling intervention for prisoners in NC and TX targeting multiple levels and supporting the test and treat (TNT) strategy objective: sustained HIV suppression after release. Intervention design: *Assisting with all aspects of intervention design *Informing and Developing research materials *Designing, Conducting, and Analyzing, qualitative interviews to gather data to inform study implementation *Setting up protocols and policies *Assuring compliance with IRB and HIPPA policies *providing guidance, Training and Instruction to collaborators and other study sites. Clinical Counselor *Providing MI style counseling to HIV+ participants in a prison setting *Delivering phone counseling once participants are released from prison *Coordinating and Implementing the logistics of recruitment, counseling, and follow-up *Training counselors on intervention protocol, *Providing Supervision to study counselors to ensure fidelity to study protocol, *Preparing written papers and reports for submission to professional meetings, journals, and funding agencies Duke University SLAM-DUNC study Durham, NC January 2011- Present Clinical Supervisor Research Study Aim: SLAM-DUNC is designed to test whether the integrated Measurement-Based Care depression management and adherence counseling intervention improves antiretroviral medication adherence and HIV clinical outcomes for PLWHA with iii depression. Study is conducted at Duke, UNC, and Lincoln community health center. Clinical Responsibilities: * Providing clinical supervision to counselors working on study *Ensuring fidelity to the techniques of Motivational Interviewing, *Developing and enhancing counselor skills related to MI and HIV Prevention, *Ensuring adherence to study protocol, *Addressing and working through counselor concerns. UNC Center for AIDS Research Chapel Hill, NC May 2007-Present Training Specialist Training Responsibilities: *Contributing to the development of training sessions designed to improve provider-patient communication and prevention practices related to risk reduction, medication adherence, compassion fatigue, and more. *Designing and conducting training for lay people, professionals, researchers, and others both nationally and internationally on Motivational Enhancement Techniques and other counseling techniques. *Providing consultation to HIV/AIDS research projects aimed at addressing behavioral or social risk factors in a participant population by utilizing formative research strategies, intervention development and design, and integrating counseling and Motivational Interviewing techniques. V.O.I.C.E. Therapeutic Solutions Raleigh, NC June 2008- Present Owner/Private Practice Clinical Responsibilities: *Responsible for clinical and operations management, *Provide training, clinical supervision and oversight of staff, *Manage and implement auditing systems, crisis response systems, and agency policies and procedures, *Program development, *Conducting in-home individual and group psychotherapy for children and adults, *Diagnostic assessments, *Provide clinical supervision for counselors,*Specialize in gang prevention, sexual health education. American Psychological Association, Office on AIDS May 2008 -Present Behavioral and Social Science Volunteer Technical Responsibilities : * Providing ongoing technical assistance to community-based organizations, health departments, and HIV-prevention community planning groups, *Assist with HIV prevention efforts in local community; *Capacity building, *Presenting trainings, *Providing assistance with identifying and designing intervention. HIV Prevention Trials Network ISIS study Chapel Hill, NC August 2008-2011 Project Manager Research Study Aim: *ISIS is a multi-site study whose goal is to estimate the overall HIV-1 incidence rate in women at risk for HIV acquisition in the US and to evaluate the feasibility iv of enrolling and following a cohort of these women. Qualitative components are also incorporated including semi-structured interviews of participants and focus group discussions. Research Responsibilities: *Managed day-to-day activities of project, *Conducted focus groups with men, Conducted one-on-one qualitative interviews and focus groups with women, *Created qualitative interview guides, *Analyzed qualitative data, *Conducted data collection and oversee research staff in the recruitment of participants, and collection of data, *Prepared written papers and reports for submission to professional meetings, journals, and funding agencies. Cecil G Sheps Center UNC-CH SAFETALK, Chapel Hill, NC April 2006- May 2009 Clinical Counselor/Assistant Project Manager Research Study Aim: Safe Talk, Prevention with Positive project, is a randomized controlled trial of a Motivational Interviewing (MI) intervention. This intervention addresses sexual risk behavior of HIV positive patients at UNC ID clinic, Wake County Health Department, and Lincoln Community Health Center. Clinical Research Responsibilities: *Provided counseling to HIV+
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