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1.  The associations of gender, sexual identity and competing needs with healthcare utilization among people with HIV/AIDS. 
Studies report gender differences in medical service utilization among persons with HIV, although most compare women to heterogeneous groups of men. Competing needs for medical care of women may contribute to those differences. We examined prospectively the role that competing social, economic and health needs, such as caring for others, play in gender differences in hospital, ambulatory and emergency room (ER) visits. We considered sexual identity to study women, gay/bisexual men and heterosexual men in the most recent wave (n = 1,385) of the HCSUS, a nationally representative sample of persons with HIV/AIDS in care in the United States. We considered gay/bisexual men and heterosexual men separately because their different resources and social networks may lead to disparate service utilization. Multivariate regression showed that women were more likely than gay/bisexual men to be hospitalized, while women and gay/bisexual men were more likely than heterosexual men to use the ER without subsequent hospitalization. Controlling for competing needs eliminated neither difference but predicted hospitalization and ER use. Findings suggest that addressing competing needs could reduce unnecessary hospitalization and ER use for both genders. Furthermore, examinations of gender differences in service use should include sexual identity.
PMCID: PMC2569651  PMID: 17444432
2.  Patterns and Correlates of Sexual Activity and Condom Use Behavior in Persons 50-Plus Years of Age Living with HIV/AIDS 
AIDS and behavior  2008;12(6):943-956.
This study characterized rates of sexual activity and identified psychosocial and behavioral correlates of sexual activity and condom use in a metropolitan sample of 290 HIV-infected adults 50-plus years of age. Thirty-eight percent of participants were sexually active in the past three months, 33% of whom had at least one occasion of anal or vaginal intercourse that was not condom protected. Rates and correlates of sexual activity and condom use differed between gay/bisexual men, heterosexual men, and heterosexual women. In the past three months, 72% of heterosexual men were sexually active compared to only 36% of gay/bisexual men and 21% of heterosexual women. However, among sexually active persons, only 27% of heterosexual men reported inconsistent condom use compared to 37% of gay/bisexual men and 35% of heterosexual women. As the number of older adults living with HIV/AIDS in the U.S. continues to increase, age-appropriate secondary risk-reduction interventions are urgently needed.
PMCID: PMC2575000  PMID: 18389361
HIV/AIDS; Older adults; Sexual activity; Condom use
3.  Tobacco, Marijuana Use and Sensation-seeking: Comparisons Across Gay, Lesbian, Bisexual and Heterosexual Groups 
This study examined patterns of smoked substances (cigarettes and marijuana) among heterosexuals, gays, lesbians, and bisexuals based on data from the 2000 National Alcohol Survey (NAS), a population-based telephone survey of adults in the United States. We also examined the effect of bar patronage and sensation-seeking/impulsivity (SSImp) on tobacco and marijuana use. Sexual orientation was defined as: lesbian or gay self-identified, bisexual self-identified, heterosexual self-identified with same-sex partners in the last five years, and exclusively heterosexual (heterosexual self-identified, reporting no same sex partners). Findings indicate that bisexual women and heterosexual women reporting same-sex partners had higher rates of cigarette smoking than exclusively heterosexual women. Bisexual women, lesbians and heterosexual women with same-sex partners also used marijuana at significantly higher rates than exclusively heterosexual women. Marijuana use was significantly greater and tobacco use was elevated among gay men compared to heterosexual men. SSImp was associated with greater use of both of these substances across nearly all groups. Bar patronage and SSImp did not buffer the relationship between sexual identity and smoking either cigarettes or marijuana. These findings suggest that marijuana and tobacco use differ by sexual identity, particularly among women, and underscore the importance of developing prevention and treatment services that are appropriate for sexual minorities.
PMCID: PMC2801062  PMID: 20025368
sexual orientation; tobacco use; marijuana use; sensation-seeking; bar patronage
4.  The health of people classified as lesbian, gay and bisexual attending family practitioners in London: a controlled study 
BMC Public Health  2006;6:127.
The morbidity of gay, lesbian or bisexual people attending family practice has not been previously assessed. We compared health measures of family practice attendees classified as lesbian, gay and bisexual.
We conducted a cross-sectional, controlled study conducted in 13 London family practices and compared the responses of 26 lesbian and 85 bisexual classified women, with that of 934 heterosexual classified women and 38 gay and 23 bisexual classified men with that of 373 heterosexual classified men. Our outcomes of interest were: General health questionnaire; CAGE questionnaire; short form12; smoking status; sexual experiences during childhood; number of sexual partners and sexual function and satisfaction.
In comparison to people classified as heterosexuals: men classified as gay reported higher levels of psychological symptoms (OR 2.48, CI 1.05–5.90); women classified as bisexual were more likely to misuse alcohol (OR 2.73, 1.70–4.40); women classified as bisexual (OR 2.53, 1.60–4.00) and lesbian (OR 3.13, 1.41–6.97) and men classified as bisexual (OR 2.48, 1,04, 5.86) were more likely to be smokers and women classified as bisexual (OR 3.27, 1.97–5.43) and men classified as gay (OR 4.86, 2.28–10.34) were much more likely to report childhood sexual experiences in childhood. Psychological distress was associated with reporting sexual experiences in childhood in men classified as gay and bisexual and women classified as heterosexual. Men classified as bisexual (OR 5.00, 1.73–14.51) and women classified as bisexual (OR 2.88, 1.24- 6.56) were more likely than heterosexuals to report more than one sexual partner in the preceding four weeks. Lesbian, gay and bisexual classified people encountered no more sexual function problems than heterosexuals but men classified as bisexual (OR 2.74, 1.12–6.70) were more dissatisfied with their sex lives.
Bisexual and lesbian classified people attending London general practices were more likely to be smokers and gay classified men were at increased risk of psychological distress in comparison to heterosexual classified people. Increased awareness of the sexuality of people seen in primary care can provide opportunities for health promotion.
PMCID: PMC1475848  PMID: 16681849
5.  Health Disparities Among Lesbian, Gay, and Bisexual Older Adults: Results From a Population-Based Study 
American journal of public health  2013;103(10):1802-1809.
We investigated health disparities among lesbian, gay, and bisexual (LGB) adults aged 50 years and older.
We analyzed data from the 2003–2010 Washington State Behavioral Risk Factor Surveillance System (n = 96 992) on health outcomes, chronic conditions, access to care, behaviors, and screening by gender and sexual orientation with adjusted logistic regressions.
LGB older adults had higher risk of disability, poor mental health, smoking, and excessive drinking than did heterosexuals. Lesbians and bisexual women had higher risk of cardiovascular disease and obesity, and gay and bisexual men had higher risk of poor physical health and living alone than did heterosexuals. Lesbians reported a higher rate of excessive drinking than did bisexual women; bisexual men reported a higher rate of diabetes and a lower rate of being tested for HIV than did gay men.
Tailored interventions are needed to address the health disparities and unique health needs of LGB older adults. Research across the life course is needed to better understand health disparities by sexual orientation and age, and to assess subgroup differences within these communities.
PMCID: PMC3770805  PMID: 23763391
6.  Protective Factors in the Lives of Bisexual Adolescents in North America 
American journal of public health  2008;99(1):110-117.
We compared protective factors among bisexual adolescents with those of heterosexual, mostly heterosexual, and gay or lesbian adolescents.
We analyzed 6 school-based surveys in Minnesota and British Columbia. Sexual orientation was measured by gender of sexual partners, attraction, or self-labeling. Protective factors included family connectedness, school connectedness, and religious involvement. General linear models, conducted separately by gender and adjusted for age, tested differences between orientation groups.
Bisexual adolescents reported significantly less family and school connectedness than did heterosexual and mostly heterosexual adolescents and higher or similar levels of religious involvement. In surveys that measured orientation by self-labeling or attraction, levels of protective factors were generally higher among bisexual than among gay and lesbian respondents. Adolescents with sexual partners of both genders reported levels of protective factors lower than or similar to those of adolescents with same-gender partners.
Bisexual adolescents had lower levels of most protective factors than did heterosexual adolescents, which may help explain their higher prevalence of risky behavior. Social connectedness should be monitored by including questions about protective factors in youth health surveys.
PMCID: PMC2636603  PMID: 19008523
7.  Drinking Patterns, Problems, and Motivations Among Collegiate Bisexual Women 
Objective and Participants
The authors compared the drinking behaviors, motivations, and problems of collegiate bisexual women with those of heterosexual women (N = 2,788; n = 86 bisexual women).
Data came from the 2003 Student Life Survey, a random population-based survey at a large midwestern university. The authors explored the hypothesis that bisexual women would be more likely than heterosexual women to report drinking motivations related to stress and coping as a result of sexual identity stigma.
They found that bisexual women drank significantly less than did heterosexual women. There were few differences between the 2 groups in drinking motivations and problems. Bisexual women reported a comparable number of problems related to their drinking but were significantly more likely to report contemplating suicide after drinking than were heterosexual women.
More research is needed to understand the finding that despite lower levels of alcohol consumption, bisexual women reported a comparable number of drinking problems. College health educators and health care providers need to be aware of findings related to heightened suicidal risk among bisexual women.
PMCID: PMC3733171  PMID: 18089511
bisexual women; college health; drinking motivations; drinking problems
8.  Reported condom use and condom use difficulties in street outreach samples of men of four racial and ethnic backgrounds. 
International journal of STD & AIDS  2005;16(11):739-743.
The epidemiology of the HIV/AIDS epidemic in the United States has focused research attention on lesbian, gay, bisexual and transgendered communities as well as on racial and ethnic minorities. Much of that attention has, however, been focused on specific racial and ethnic groups and specific sexual minorities. We report on the results of a study that examined the association between condom use and partnership types among men from four major racial/ethnic groups.
Self-reported data on sexual identity (homosexual, bisexual, and heterosexual) and condom use in the past three months were collected from 806 African American, Hispanic, Asian, and White men intercepted in public places in Houston, Texas. Data indicated that condom use was lowest in African American and Hispanic men, Bisexual men reported the highest levels of use, with heterosexual men reporting the lowest use. African American and Hispanic men reported generally that it was very difficult to use a condom during sexual contact, although the patterns for self-identified homosexual, heterosexual and bisexual men varied across race/ ethnicity. Homosexual African American men reported the least difficulty and White homosexual men the most difficulty compared with heterosexual and bisexual peers. For homosexually-identified men, there were considerable differences across race/ethnicity in the proportion of partners who never or rarely disagreed to use condoms, with Asians disagreeing least and African Americans most. Within racial/ethnic groups, the levels of condom use and difficulty were similar for male and female partners, suggesting that it is sexual identity, rather than partner gender, that has impacted condom use messages. These data suggest that racial/ethnic targeting of condom use is likely to be most efficacious in increasing condom use in men.
PMCID: PMC1343491  PMID: 16303069
HIV; AIDS; Condom use; Race; Ethnicity; Sexual identity
9.  Demographic, Psychological, and Social Characteristics of Self-Identified Lesbian, Gay, and Bisexual Adults in a US Probability Sample 
Using data from a US national probability sample of self-identified lesbian, gay, and bisexual adults (N = 662), this article reports population parameter estimates for a variety of demographic, psychological, and social variables. Special emphasis is given to information with relevance to public policy and law. Compared with the US adult population, respondents were younger, more highly educated, and less likely to be non-Hispanic White, but differences were observed between gender and sexual orientation groups on all of these variables. Overall, respondents tended to be politically liberal, not highly religious, and supportive of marriage equality for same-sex couples. Women were more likely than men to be in a committed relationship. Virtually all coupled gay men and lesbians had a same-sex partner, whereas the vast majority of coupled bisexuals were in a heterosexual relationship. Compared with bisexuals, gay men and lesbians reported stronger commitment to a sexual-minority identity, greater community identification and involvement, and more extensive disclosure of their sexual orientation to others. Most respondents reported experiencing little or no choice about their sexual orientation. The importance of distinguishing among lesbians, gay men, bisexual women, and bisexual men in behavioral and social research is discussed.
PMCID: PMC2927737  PMID: 20835383
Lesbians; Gay men; Bisexuals; Public policy; Sampling; Survey research; Committed relationships; Politics and religion; Identity, community, and disclosure
10.  Men’s self-definitions of abusive childhood sexual experiences, and potentially related risky behavioral and psychiatric outcomes 
Child abuse & neglect  2007;32(1):83-97.
To estimate how many heterosexual and gay/bisexual men self-define abusive childhood sexual experiences (CSEs) to be childhood sexual abuse (CSA) and to assess whether CSA self-definition is associated with risky behavioral and psychiatric outcomes in adulthood.
In Philadelphia County, 197 (66%) of 298 recruited men participated in a telephone survey. They were screened for CSEs and then asked if they self-defined abusive CSEs to be CSA; they also were asked about risk behavior histories and posttraumatic stress disorder (PTSD) and depression symptoms.
Of 43 (22%) participants with abusive CSEs, 35% did not and 65% did self-define abusive CSEs to be CSA (“Non-Definers” and “Definers,” respectively). Heterosexual and gay/bisexual subgroups’ CSA self-definition rates did not significantly differ. When self-definition subgroups were compared to those without CSEs (“No-CSEs”), Non-Definers had lower perceived parental care (p = .007) and fewer siblings (p = .03), Definers had more Hispanics and fewer African Americans (p = .04), and No-CSEs had fewer gay/bisexual men (p = .002) and fewer reports of physical abuse histories (p = .02) than comparison groups. Non-Definers reported more sex under the influence (p = .001) and a higher mean number of all lifetime sex partners (p = .004) as well as (only) female sex partners (p = .05). More Non-Definers than Definers reported having experienced penetrative sex as part of their CSA (83% versus 35%, p = .006). Different explanations about self-definition were provided by subgroups.
Many men with abusive CSEs do not self-define these CSEs to be CSA, though not in a way that differs by sexual identity. The process by which men self-define their abusive CSEs to be CSA or not appears to be associated not only with self-explanations that differ by self-definition subgroup, but also with behavioral outcomes that impart risk to Non-Definers.
PMCID: PMC2253212  PMID: 18035415
Sexual abuse; Posttraumatic stress disorder; Depression; HIV risk behavior; Men
11.  Sexual orientation and demographic, cultural and psychological factors associated with the perpetration and victimization of intimate partner violence among Hispanic men 
Issues in mental health nursing  2013;34(2):103-109.
Hispanics are disproportionately affected by intimate partner violence. Most of the research describing factors associated with intimate partner violence among Hispanics has focused on Hispanic women or Hispanics in heterosexual relationships. The purpose of this study was to explore the relationship between sexual orientation (heterosexual, homosexual, and bisexual), and demographic, cultural and psychological factors and intimate partner violence among Hispanic men. A cross sectional questionnaire was administered to 160 Hispanic heterosexual and men who have sex with men. Demographic factors (age, education and income), acculturation, depressive symptoms and self-esteem were assessed using standardized instruments. Data was analyzed using ANOVA and simple and multiple logistical regression. Differences in education, income and self-esteem were noted across participants identifying as heterosexual, homosexual and bisexual. Bisexual Hispanic men were almost at 4 times greater odds of reporting the perpetration of IPV than homosexual Hispanic men, even when differences in education, income and self-esteem were controlled for (AOR = 3.92, 95%CI = 1.11, 14.19). This study suggest the importance of specifically targeting bisexual Hispanic men in IPV research and services.
PMCID: PMC3563281  PMID: 23369121
intimate partner violence; Hispanic men; sexual orientation; men who have sex with men; bisexual men
12.  Mental health and substance use disorders among Latino and Asian American lesbian, gay, and bisexual adults 
Growing evidence suggests that lesbian, gay, and bisexual adults may be at elevated risk for mental health and substance use disorders, possibly due to anti-gay stigma. Little of this work has examined putative excess morbidity among ethnic/racial minorities resulting from the experience of multiple sources of discrimination. We report findings from the National Latino and Asian American Survey (NLAAS), a national household probability psychiatric survey of 4,488 Latino and Asian American adults. Approximately 4.8% of persons interviewed identified as lesbian, gay, bisexual, and/or reported recent same-gender sexual experiences. Although few sexual orientation-related differences were observed, among men, gay/bisexual men were more likely than heterosexual men to report a recent suicide attempt. Among women, lesbian/bisexual women were more likely than heterosexual women to evidence positive 1-year and lifetime histories of depressive disorders. These findings suggest a small elevation in psychiatric morbidity risk among Latino and Asian American individuals with a minority sexual orientation. However, the level of morbidity among sexual orientation minorities in the NLAAS appears similar to or lower than that observed in population-based studies of lesbian, gay, and bisexual adults.
PMCID: PMC2676845  PMID: 17907860
gay; lesbian; bisexual; Latino; Asian-American; psychiatric epidemiology
13.  Sexual Orientation and Testing for Prostate and Colorectal Cancers among Men in California 
Medical care  2008;46(12):1240-1248.
Previous quantitative studies have not compared the use of prostate and colorectal cancer testing between gay/bisexual and heterosexual men.
We analyzed cross-sectional data on 19,410 men in the California Health Interview Survey. The percentage of respondents age 50 and over who received prostate and colorectal cancer tests was calculated across subgroups defined by self-reported sexual orientation, race/ethnicity, and a combined variable on sexual orientation and race/ethnicity. Multivariate regression analysis was used to identify variables on respondent characteristics that were independently associated with testing.
In bivariate analyses, the percentage of gay/bisexual men receiving colorectal cancer tests was 6%-10% greater than that of heterosexuals. There were no overall differences in prostate-specific antigen test use between gay/bisexual and heterosexual men; however, use of these tests by gay/bisexual African Americans was 12%–14% lower than that of heterosexual African Americans and 15%–28% lower than that of gay/bisexual Whites. In multivariate analyses, gay/bisexual men had greater odds of ever receiving colorectal cancer tests (odds ratio [OR]=1.67; 95% confidence interval [CI]=1.06, 2.65), and lower odds of having an up-to-date prostate-specific antigen test than did heterosexuals (OR=0.61; CI=0.42, 0.89). However, interactions between sexual orientation and living situation showed that gay/bisexual men who lived alone had greater odds of receiving prostate-specific antigen tests than did other men (OR=1.93; CI=1.23, 3.03).
Sexual orientation is independently associated with cancer testing among men. Future work should investigate the differences in this association by race/ethnicity and living situation.
PMCID: PMC2659454  PMID: 19300314
Preventive services; prostate cancer; colorectal cancer; men; sexuality
14.  Sexual Minority-Related Victimization as a Mediator of Mental Health Disparities in Sexual Minority Youth: A Longitudinal Analysis 
Journal of youth and adolescence  2013;42(3):394-402.
Sexual minority youth (youth who are attracted to the same sex or endorse a gay/lesbian/bisexual identity) report significantly higher rates of depression and suicidality than heterosexual youth. The minority stress hypothesis contends that the stigma and discrimination experienced by sexual minority youth create a hostile social environment that can lead to chronic stress and mental health problems. The present study used longitudinal mediation models to directly test sexual minority-specific victimization as a potential explanatory mechanism of the mental health disparities of sexual minority youth. One hundred ninety seven adolescents (14–19 years old; 70% female; 29% sexual minority) completed measures of sexual minority-specific victimization, depressive symptoms, and suicidality at two time points six months apart. Compared to heterosexual youth, sexual minority youth reported higher levels of sexual minority-specific victimization, depressive symptoms, and suicidality. Sexual minority-specific victimization significantly mediated the effect of sexual minority status on depressive symptoms and suicidality. The results support the minority stress hypothesis that targeted harassment and victimization are partly responsible for the higher levels of depressive symptoms and suicidality found in sexual minority youth. This research lends support to public policy initiatives that reduce bullying and hate crimes because reducing victimization can have a significant impact on the health and well-being of sexual minority youth.
PMCID: PMC3570607  PMID: 23292751
sexual minority youth; victimization; depression; suicidality; minority stress
15.  Association of methamphetamine use during sex with risky sexual behaviors and HIV infection among non-injection drug users. 
Western Journal of Medicine  1998;168(2):93-97.
Morbidity, mortality, and drug treatment data suggest that methamphetamine use is on the rise. Based on research findings of the sexual behaviors of methamphetamine-using injection drug users, we chose to examine the relationship between methamphetamine use during sex and risky sexual behaviors and human immunodeficiency virus (HIV) seropositivity among clients of publicly funded HIV testing sites in California who reported never injecting drugs. We found that among gay, bisexual, and heterosexual men and heterosexual women, users of methamphetamines reported more sexual partners than non-methamphetamine users. Among heterosexuals, a greater percentage of methamphetamine users than nonusers participated in anal intercourse. Methamphetamine use was independently related to decreased condom use during vaginal and anal intercourse, prostitution, and sex with known injection drug users. In addition, methamphetamine users were more likely to have had a sexually transmitted disease. When controlling for race or ethnicity; age; exposure to possibly infected blood or blood products; and the use of cocaine, alcohol, or marijuana during sex, methamphetamine-using bisexual men were more likely to test positive for HIV than those reporting no history of methamphetamine use. Our data suggest that noninjection methamphetamine use is related to increased, unprotected sexual activity and the risk of contracting sexually transmitted diseases, including HIV.
PMCID: PMC1304836  PMID: 9499742
16.  Differences in club drug use between heterosexual and lesbian/bisexual females 
Addictive behaviors  2006;31(12):2344-2349.
Although there has been much empirical research documenting current trends in club drug use among gay and bisexual men, little research has addressed the variance among lesbian, bisexual, or heterosexual women. Using data collected through time—space sampling from dance clubs in New York City during 2005 (N=1104), this study explored sexual identity variance among women in the reported use of six club drugs: methamphetamine, cocaine, MDMA, ketamine, GHB, and LSD. Significant differences were found in that younger women were more likely to be active club drug users. Lesbian and bisexual women reported significantly higher lifetime rates of ecstasy, cocaine, methamphetamine, and LSD use compared to heterosexual women. These data suggest a need to better understand the influence of sexual orientation and sexual culture in relation to club drug use and to tailor health promotion efforts to meet the needs of various groups of club drug using women.
PMCID: PMC2688448  PMID: 16632210
Club drugs; Gender; Sexual orientation
17.  Gender, Sexual Orientation, and Adolescent HIV Testing: A Qualitative Analysis 
Using qualitative data, this article explored the circumstances leading to HIV testing among 59 HIV-infected adolescents recruited from New York City HIV clinics. Results showed differences between the heterosexual women and the gay and bisexual men. Most of the young women were tested during routine health care or self-initiated tests, and most were asymptomatic when they tested positive. Their testing decisions were sometimes based on assessments of their boyfriends’ risk behaviors, rather than their own. Many males were experiencing symptoms of illness when they tested positive, and about half of these recognized their symptoms as related to HIV and sought tests. Some young men expressed fear of learning about positive test results, which delayed their testing, and some providers did not initially recommend HIV testing for males who presented with symptoms. The article concludes that consideration of these gender and sexual orientation-related concerns can facilitate HIV testing among adolescents.
PMCID: PMC2902626  PMID: 20303793
adolescents; gender; HIV infection; HIV testing
18.  Racial disparities in sexual risk behaviors and drug use among older gay/bisexual and heterosexual men living with HIV/AIDS. 
Adults over age 50 comprise 11% of yearly AIDS cases, yet little is known about their sexual risk behaviors and drug use following diagnosis with HIV/AIDS. The present questionnaire study examines potential racial differences in sexual risk and drug use behaviors among 59 HIV-infected gay/bisexual and heterosexual men over age 50 who were recruited from HIV-related organizations in New York City between 1996-1998. The majority (59%) of older men reported unprotected sex since diagnosis, and 36% had done so in the past six months. African-American gay/bisexual men (n=12) were significantly more likely than white gay/bisexual men (n=32) to report unprotected vaginal/anal sex in the past six months (67% versus 22%, p<0.01), since diagnosis (42% versus 9%, p<0.05), and to report a history of intravenous drug use (50% versus 3%, p<0.01), but did not differ from heterosexual African-American men (n=15). No differences were found in reports of unprotected oral sex or recent use of hard drugs (i.e., crack, cocaine, heroin). These findings suggest that interventions targeting older African-American men (both gay/bisexual and heterosexual) with HIV/AIDS are needed to reduce risk behaviors and prevent HIV transmission in this population.
PMCID: PMC2594963  PMID: 14977281
19.  Disability Among Lesbian, Gay, and Bisexual Adults: Disparities in Prevalence and Risk 
American journal of public health  2011;102(1):e16-e21.
We used population-based data to comprehensively examine disability among lesbian, gay, and bisexual adults.
We estimated prevalence of disability and its covariates and compared by sexual orientation by utilizing data from the Washington State Behavioral Risk Factor Surveillance System (n=82531) collected in 2003, 2005, 2007, and 2009. We used multivariate logistic regression to examine the relationship between disability and sexual orientation, after we controlled for covariates of disability.
Findings indicated that the prevalence of disability is higher among lesbian, gay, and bisexual adults compared with their heterosexual counterparts; lesbian, gay, and bisexual adults with disabilities are significantly younger than heterosexual adults with disabilities. Higher disability prevalence among lesbians and among bisexual women and men remained significant after we controlled for covariates of disability.
Higher rates of disability among lesbian, gay, and bisexual adults are of major concern. Efforts are needed to prevent, delay, and reduce disabilities as well as to improve the quality of life for lesbian, gay, and bisexual adults with disabilities. Future prevention and intervention efforts need to address the unique concerns of these groups.
PMCID: PMC3490559  PMID: 22095356
20.  Predictors of HIV-related Stigma among Young People Living with HIV 
Enacted and perceived HIV-stigma was examined among substance using young people living with HIV (YPLH) in Los Angeles, San Francisco, and New York City (N = 147). Almost all YPLH (89%) reported perceived stigma and 31% report enacted experiences in the past three months; 64% reported experiences during their lifetime. The HIV-stigma questions were characterized by factors of avoidance, social rejections, abuse and shame. In multivariate models enacted stigma was associated with gay/bisexual identity, symptomatic HIV or AIDS, and bartering sex. Perceived stigma was associated with female gender, symptomatic HIV or AIDS, bartering sex, lower injection drug use, and fewer friends and family knowing serostatus. Gay/bisexual YPLH who were also HIV symptomatic or AIDS diagnosed experienced more HIV-stigma than their heterosexual peers.
PMCID: PMC2392891  PMID: 16846325
Stigma; HIV; AIDS; Youth
21.  Searching for Love in all the “Write” Places: Exploring Internet Personals Use by Sexual Orientation, Gender, and Age 
Few researchers of Internet sexual exploration have systematically compared variance of use across sexual orientations, with even fewer surveying bisexual respondents. In 2004, 15,246 individuals responded to an online survey of their use of Internet personals and adult websites. Gay men, lesbians, and bisexuals (GLBs) were more likely than heterosexuals to have exchanged correspondence, met others offline, and had sex with someone they met through personal ads. Whereas gay men and lesbians of all ages were most likely to have established a long-term relationship as a result of personals, heterosexuals over age 40 were more likely to have established a long-term relationship than younger heterosexuals. Further, compared to men, women were approximately two times as likely to have established a serious relationship as a result of personals. Qualitative findings suggest that the Internet functions not only as a means of screening for desired characteristics, but also as a shield against prejudice in real life encounters. GLBs and heterosexuals alike used online venues as a means of sexual identity development, sexual exploration, and community building.
PMCID: PMC2874906  PMID: 20502618
Internet; online dating; gender; personals; age; gay; lesbian; bisexual
22.  Sexual Orientation Disparities in Sexually Transmitted Infections: Examining the Intersection Between Sexual Identity and Sexual Behavior 
Archives of sexual behavior  2012;42(2):225-236.
The terms MSM (men who have sex with men) and WSW (women who have sex with women) have been used with increasing frequency in the public health literature to examine sexual orientation disparities in sexual health. These categories, however, do not allow researchers to examine potential differences in sexually transmitted infection (STI) risk by sexual orientation identity. Using data from the National Longitudinal Survey of Adolescent Health, this study investigated the relationship between self-reported STIs and both sexual orientation identity and sexual behaviors. Additionally, this study examined the mediating role of victimization and STI risk behaviors on the relationship between sexual orientation and self-reported STIs. STI risk was found to be elevated among heterosexual-WSW and bisexual women, whether they report same-sex partners or not, whereas gay-identified WSW were less likely to report an STI compared to heterosexual women with opposite sex relationships only. Among males, heterosexual-identified MSM did not have a greater likelihood of reporting an STI diagnosis; rather, STI risk was concentrated among gay and bisexual identified men who reported both male and female sexual partners. STI risk behaviors mediated the STI disparities among both males and females, and victimization partially mediated STI disparities among female participants. These results suggest that relying solely on behavior-based categories, such as MSM and WSW, may mischaracterize STI disparities by sexual orientation.
PMCID: PMC3575167  PMID: 22350122
Sexual orientation identity; same-sex behavior; STIs; victimization; gender
23.  A Preliminary Examination of Sexual Orientation as a Social Vulnerability for Experiencing HIV/AIDS-related Stigma 
Journal of applied social psychology  2011;41(5):1258-1274.
This investigation is a preliminary examination of sexual orientation as a social vulnerability for experiencing HIV/AIDS-related stigma, specifically concerns about disclosure and public attitudes. Participants were 36 heterosexual men and 82 gay men with HIV/AIDS. Consistent with prediction, a heterosexual sexual orientation was significantly associated with HIV/AIDS disclosure concerns. This effect was evident after controlling for various demographic variables, CD4 T-cell count, time since HIV diagnosis, self-esteem, and coping styles. Also, as predicted, similar levels of enacted stigma were evident regardless of sexual orientation. Further work is needed to understand the process of HIV/AIDS disclosure for heterosexual men with this illness and to differentiate the experience of HIV/AIDS-related stigma among gay and straight men with HIV/AIDS.
PMCID: PMC3366341  PMID: 22675233
Social Vulnerability; Stigma; HIV/AIDS; Sexual Orientation; Risk
24.  Implicit Sexual Attitude of Heterosexual, Gay and Bisexual Individuals: Disentangling the Contribution of Specific Associations to the Overall Measure 
PLoS ONE  2013;8(11):e78990.
The article aims to measure implicit sexual attitude in heterosexual, gay and bisexual individuals. A Many-Facet Rasch Measurement analysis was used to disentangle the contribution of specific associations to the overall IAT measure. A preference for heterosexuals relative to homosexuals is observed in heterosexual respondents, driven most by associating positive attributes with heterosexuals rather than negative attributes with homosexuals. Differently, neither the negative nor the positive evaluation of any of the target groups play a prominent role in driving the preference for homosexuals observed in gay respondents. A preference for heterosexuals relative to homosexuals is observed in bisexual respondents, that results most from ascribing negative attributes to homosexuals rather than positive attributes to heterosexuals. The results are consistent with the expression of the need for achieving a positive self-image and with the influence of shared social norms concerning sexuality.
PMCID: PMC3832517  PMID: 24260142
25.  “What Does it Take to be a Man? What is a Real Man?”: Ideologies of masculinity and HIV sexual risk among Black heterosexual men 
Culture, health & sexuality  2011;13(5):545-559.
Research documents the link between traditional ideologies of masculinity and sexual risk among multi-ethnic male adolescents and White male college students, but similar research with Black heterosexual men is scarce. This exploratory study addressed this gap through six focus groups with 41 Black, low to middle income heterosexual men aged 19 to 51 years in Philadelphia, PA. Analyses highlighted two explicit ideologies of masculinity: that Black men should have sex with multiple women, often concurrently; and that Black men should not be gay or bisexual. Analyses also identified two implicit masculinity ideologies: the perception that Black heterosexual men cannot decline sex, even risky sex; and that women are primarily responsible for condom use. The study’s implications for HIV prevention with Black heterosexual men are discussed.
PMCID: PMC3077673  PMID: 21390949
Masculinity, HIV/AIDS; Black heterosexual men; Condom use: USA

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