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Examining Links of Racial and Sexual Identity Development EXAMINING LINKS OF RACIAL AND SEXUAL IDENTITY DEVELOPMENT, PSYCHOLOGICAL WELL-BEING, AND SEXUAL RISKS AMONG HIV- POSITIVE, SAME SEX ATTRACTED AFRICAN AMERICAN MEN A Dissertation Presented to The Graduate Faculty of The University of Akron In Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy Laura E. Kessler August 2008 EXAMINING LINKS OF RACIAL AND SEXUAL IDENTITY DEVELOPMENT, PSYCHOLOGICAL WELL-BEING, AND SEXUAL RISKS AMONG HIV- POSITIVE, SAME SEX ATTRACTED AFRICAN AMERICAN MEN Laura E. Kessler Dissertation Approved: Accepted: _____________________________ _____________________________ Charles A. Waehler Paul E. Levy Advisor Department Chair _____________________________ _____________________________ Rosalie J. Hall Ronald F. Levant Committee Member Dean of the College _____________________________ _____________________________ John E. Queener George R. Newkome Committee Member Dean of the Graduate School _____________________________ _____________________________ Robert C. Schwartz Date Committee Member _____________________________ Linda M. Subich Committee Member ii ABSTRACT 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, iii 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. iv ACKNOWLEDGMENTS I am so grateful for the help and support of so many people, without whom the successful completion of this work would not have been possible. First, thank you to the participants who volunteered to take part in this study, and shared a part of their lives. Thank you to Darrell Phillips, Toye Starver, Meghan Schwab, Jen McMillen-Smith, Melissa Kolenz, Kim Rodas, Patricia Smith, and Chris Esmurdoc, who donated their time and energy to this project. Also, thank you to my advisor Dr. Charles Waehler for his unconditional support and invaluable advice. Thanks to my committee members Professors Rosalie Hall, John Queener, Linda Subich, and Robert Schwartz, who provided wonderful feedback and guidance. Also, the following individuals (listed in alphabetical order) provided amazing support and always believed in this project and my ability to finish it. Thank you so much Susan Atkinson, Dahyun Chun, Michael Doman, Liz Gonda, Julie Harris, Suzanne Holt, James Kessler, Christine Larson, Melinda Lincoln-Richardson, Doug Masiroff, Patricia Millhoff, Rami Rao, Nick Warner, Bozena Zdaniuk, and my mentors at the University of Pittsburgh Counseling Center. v TABLE OF CONTENTS Page LIST OF TABLES………………………………………………………… xi CHAPTER I. INTRODUCTION .……………………………………………. 1 Challenges in Negotiating African American Male and Same Sex Attracted Identities………….….. 4 Connections between Racial and Sexual Identity and Psychological Well-being.……………………… 9 Associations between Fixed Minority Status and Psychological Well-being………………. 9 Associations between Racial and Sexual Identity Development and Psychological Well-being.……………………………… 10 Associations between Sociocultural Experiences Relevant to Racial and Sexual Identity Development and Psychological Well- being.…………………………………… 11 Connections between Racial and Sexual Identity and Sexual Risk Practices.……………………………… 13 Associations between Fixed Identity Status and Sexual Risk Practices……………………….. 13 Associations between Sexual and Racial Identity Development and Sexual Risk Practices …… 14 vi Associations between Sociocultural Factors Relevant to Racial and Sexual Identity Development and Sexual Risk Practices.………………………. 16 Associations between Psychological Well-being and Sexual Risk Practices.……………………………….……… 19 Application to Counseling Psychology ………………… 21 Research Questions.………………………………….… 22 II. A REVIEW OF THE LITERATURE.……………………….… 25 The Case for Positive Prevention ……………………… 26 African American Identity.…………………………….. 34 Same Sex Attracted Identity.…………………………… 45 Negotiating Racial and Sexual Minority Identities.……. 50 The “Down Low” and Popular Culture’s Portrayal of African American MSMs.…………… 58 Studies Exploring the Interplay among Same Sex Attracted and Racial Minority Identities... 63 Associations between Racial and Sexual Minority Identity and Mental Health…………………………………… 69 Associations between Identity as a Demographic Variable and Psychological Well-Being.… 69 Associations between Racial and Sexual Identity Development and Psychological Well-Being.………………….…………… 76 Associations between Relevant Sociocultural Experiences and Psychological Well-Being.… 82 Associations between Racial and Sexual Minority Identity and Sexual Risk Practices.…………………………… 86 vii Associations between Fixed Demographic Identity Components and Sexual Risk Practices.……… 87 Associations between Racial and Sexual Identity Development and Sexual Risk Practices.………………………………………. 96 Associations between Relevant Sociocultural Factors and Sexual Risk Practices.…………… 100 The Link between Psychological Well-being and Sexual Risk Practices.………………………………………… 109 Summary.…………………………………………………..114 Hypotheses ………………………………………………...115 III. METHODOLOGY ………………………………………………..119 Participants ………………………………………………..119 Procedure ………………………………………………….124 Instruments ………………………………………………..125 Personal Data Form ……………………………….125 Cross Racial Identity Scale…………..…………… 126 Lesbian and Gay Identity Scale.………………… 131 Brief Symptom Inventory 18.……………….……. 134 Difficult Sexual Situations.……………………… 138 Sexual Risk Practices…………………………… 139 Open Ended Commentary…………………………140 IV. RESULTS………………………………………………………… 141 Descriptive Statistics………………………………………142 Factor Analysis of the Difficult Sexual Situations Scale….148 viii Pearson Bivariate Correlations…………………………… 150 Tests of the Hypotheses…………………………………... 154 Hypothesis One: CRIS and LGIS Subscales Predicting Mental Health Symptoms (BSI 18)………………………. 156 Hypothesis Two: CRIS and LGIS Subscales Predicting Difficult Sexual Situations and Sexual Risk Practices…………………….. 160 Hypothesis Three: Psychological Well-being Predicting Difficult Sexual Situations and Sexual Risk Practices………………… 176 Hypothesis Four: Psychological Well-being Mediating a Relationship between Racial and Sexual Identities and Sexual Risk Practices…………………………………... 180 Qualitative Data Analysis………………………………… 180 Experiences of Being an African American Man and Same Sex Attracted…………………... 181 Challenges Associated with Being an African American Man and Same Sex Attracted….. 184 Rewards Associated with Being an African American Man and Same
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