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1.  A Model of Sexual Risk Behaviors Among Young Gay and Bisexual Men: Longitudinal Associations of Mental Health, Substance Abuse, Sexual Abuse, and the Coming-Out Process 
Sexual risk behaviors of young gay and bisexual men must be understood within the context of other health concerns (e.g., anxiety, substance abuse), population-specific factors (i.e., the coming-out process and gay-related stress), childhood sexual abuse, and other theoretical factors (e.g., safer sex intentions). The current report proposes and longitudinally examines a model of risk factors for subsequent sexual risk behaviors among young gay and bisexual men in New York City. As hypothesized, more negative attitudes toward homosexuality, more substance abuse symptoms, and poorer intentions for safer sex were directly associated with a greater likelihood of unprotected anal sex over the following year. Further, lower self-esteem, more anxious symptoms, and childhood sexual abuse were related to more unprotected anal sex indirectly through more sexual partners, sexual encounters, and substance abuse symptoms. These findings suggest that interventions targeting sexual risk behaviors of young gay and bisexual men may be more effective if they also address mental health concerns and aspects of the coming-out process.
PMCID: PMC3222951  PMID: 17067255
Sexual Risk Behaviors; Anal Sex; Child Sexual Abuse; Substance Abuse; Anxiety; Condom Use Intentions; Internalized Homophobia; Self-Disclosure
2.  Sexual Identity Development among Gay, Lesbian, and Bisexual Youths: Consistency and Change Over Time 
Journal of sex research  2006;43(1):46-58.
A longitudinal report of 156 gay, lesbian, and bisexual youths examined changes in sexual identity over time. Fifty-seven percent of the youths remained consistently self-identified as gay/lesbian, 18% transited from bisexual to gay/lesbian, and 15% consistently identified as bisexual over time. Although youths who consistently identified as gay/lesbian did not differ from other youths on time since experiencing sexual developmental milestones, they reported current sexual orientation and sexual behaviors that were more same-sex centered and they scored higher on aspects of the identity integration process (e.g., more certain, comfortable, and accepting of their same-sex sexuality, more involved in gay-related social activities, more possessing of positive attitudes toward homosexuality, and more comfortable with others knowing about their sexuality) than youths who transited to a gay/lesbian identity and youths who consistently identified as bisexual. Contrary to the hypothesis that females are more sexually fluid than males, female youths were less likely to change identities than male youths. The finding that youths who transited to a gay/lesbian identity differed from consistently gay/lesbian youths suggests that identity integration continues after the adoption of a gay/lesbian sexual identity.
PMCID: PMC3215279  PMID: 16817067
Coming-out process; sexual identity; sexual orientation; sexual behavior; internalized homophobia; gay; lesbian; bisexual; adolescents; longitudinal; gender differences
3.  Differences in African American and White Women’s Attitudes Toward Lesbians and Gay Men 
Sex roles  2009;61(9-10):599-606.
The aim of the present study was to examine racial differences in women’s attitudes toward lesbians and gay men and to offer an understanding of these differences. Participants were 224 18–30 year old heterosexual African American (64%) and White (36%) female undergraduates from a large urban university in the southeastern United States. Participants completed measures of social demographics, sexual orientation, and sexual prejudice. Results showed that African American, relative to White, women endorsed more negative attitudes toward lesbians and gay men. Also, unlike White women, African American women reported more negative attitudes toward gay men than lesbians. Implications are discussed regarding differences in cultural contexts that exist between African American and White women.
PMCID: PMC2778324  PMID: 20161368
Gender; Race; Attitudes Toward Homosexuality; Lesbians; Gay Men
4.  Stigma towards PLWHA: The Role of Internalized Homosexual Stigma in Latino Gay/Bisexual Male and Transgender Communities 
Stigma negatively affects the health of people living with HIV/AIDS (PLWHA). Negative attitudes and discriminatory actions towards PLWHA are thought to be based, among other factors, on stigma towards sexual minorities and beliefs about personal responsibility. Yet, there is little evidence to support these linkages and explain how they take place, especially among Latinos. This study analyzes attitudes towards PLWHA among 643 Latino gay/bisexual men and transgender (GBT) people. It examines whether discriminatory actions are predicted by beliefs about personal responsibility and internalized homosexual stigma. Results indicate that Discriminatory Actions towards PLWHA is associated with HIV/AIDS Personal Responsibility Beliefs and Internalized Homosexual Stigma. Further, HIV/AIDS Personal Responsibility Beliefs partially mediates the relationship between Internalized Homosexual Stigma and Discriminatory Actions towards PLWHA. Latino GBT persons who have internalized negative views about homosexuality may project those onto PLWHA. They may think PLWHA are responsible for their serostatus and, hence, deserving of rejection.
PMCID: PMC3718259  PMID: 23631713
5.  Understanding Gender Differences in Early Adolescents’ Sexual Prejudice 
Drawing on social dominance theory and the contact hypothesis, we developed and tested a two-mediator model for explaining gender differences in early adolescents’ attitudes toward gay males and lesbians. Data from more than 400 ninth graders were analyzed. As predicted, gender differences in attitudes toward gay males were partially explained by social dominance orientation (SDO) and knowing a gay male. Gender differences in attitudes toward lesbians were partially mediated by SDO, while knowing a lesbian was not a mediating variable. Beyond their mediating roles, both SDO and knowing a member of the target group each significantly added to the prediction of attitudes toward each target group. Implications for policies to reduce victimization of sexual minorities in schools are discussed.
PMCID: PMC2828630  PMID: 20191095
gay/lesbian/bisexual; gender/gender differences; victimization; school context; social dominance; contact theory; adolescence
6.  The “Virtual” Panel: A Computerized Model for LGBT Speaker Panels 
American journal of sexuality education  2012;7(4):10.1080/15546128.2012.740948.
Recent societal trends indicate more tolerance for homosexuality, but prejudice remains on college campuses. Speaker panels are commonly used in classrooms as a way to educate students about sexual diversity and decrease negative attitudes toward sexual diversity. The advent of computer delivered instruction presents a unique opportunity to broaden the impact of traditional speaker panels. The current investigation examined the influence of an interactive “virtual” gay and lesbian speaker panel on cognitive, affective, and behavioral homonegativity. Findings suggest the computer-administered panel is lowers homonegativity, particularly for affective experiential homonegativity. The implications of these findings for research and practice are discussed.
PMCID: PMC3641703  PMID: 23646036
Homonegativity; Homophobia; LGBT; Gay; Lesbian; Speaker Panel; CMC; Personalization Model; Contact Theory; Contact Hypothesis
Journal of homosexuality  2009;56(8):1083-1100.
This internet-based study was designed to compare health risk behaviors of gay and non-gay university students from stratified random cross-sectional samples of undergraduate students. Mean age of the 4,167 male participants was 20.5 (±2.7) years. Of these, 206 (4.9%) self-identified as gay and 3,961 (95.1%) self-identified as heterosexual. After adjusting for selected characteristics and clustering within university, gay men had higher odds of reporting: multiple sexual partners; cigarette smoking; methamphetamine use; gamma-hydroxybutyrate (GHB) use; other illicit drug use within the past 30 days and during lifetime; and intimate partner violence (IPV). Understanding the health risk behaviors of gay and heterosexual men is crucial to identifying associated factors and intervening upon them using appropriate and tailored strategies to reduce behavioral risk disparities and improve health outcomes.
PMCID: PMC3715091  PMID: 19882428
gay men; sex; drug use; student; alcohol; intimate partner violence; methamphetamine; tobacco; condom; GHB
8.  Athletic Trainers' Attitudes Toward Lesbian, Gay, and Bisexual National Collegiate Athletic Association Student-Athletes 
Journal of Athletic Training  2011;46(1):69-75.
Researchers have investigated heterosexuals' attitudes toward homosexuals, focusing on factors such as sex, race, religion, education, and contact experiences. However, in the context of sport, this research is deficient. We found no published literature investigating athletic trainers (ATs') attitudes toward lesbian, gay, and bisexual student-athletes (LGB).
To determine heterosexual ATs' attitudes toward LGB student-athletes in the National Collegiate Athletic Association.
Cross-sectional study
E-mailed survey.
Patients or Other Participants:
A total of 964 ATs employed at member institutions.
Main Outcome Measure(s):
We measured attitudes using the Attitudes Toward Lesbian, Gay Men, and Bisexuals (ATLGB) Scale. To determine the extent to which sex, religion, and whether having an LGB friend or family member had an effect on ATs' attitudes, we performed analysis of variance. To establish the effect of age on ATs' attitudes, we calculated a Pearson correlation. We used an independent t test to identify differences between ATs who reported working with LGB student-athletes and ATs who did not.
With ATLGB score as the dependent factor, a main effect was noted for sex, religion, and having an LGB friend or family member (P < .01 for all comparisons). Age and total score were related (P < .01). A difference was seen in the ATLGB scores between ATs who were aware of LGB student-athletes on their teams and ATs who were not (P < .001).
Many ATs hold positive attitudes toward LGB student-athletes, especially females, those who have an LGB friend or family member, and those who are aware of LGB student-athletes. Still, it is important to provide an open environment in the athletic training room for all student-athletes.
PMCID: PMC3017492  PMID: 21214353
athletic training; diversity; sexual orientation
9.  Aggression Toward Gay Men as Gender Role Enforcement: Effects of Male Role Norms, Sexual Prejudice, and Masculine Gender Role Stress 
Journal of personality  2009;77(4):1137-1166.
This study examined sexual prejudice and masculine gender role stress as mediators of the relations between male gender norms and anger and aggression toward gay men. Participants were 150 self-identified heterosexual men who completed measures of adherence to male gender role norms, sexual prejudice, masculine gender role stress, and state anger. Participants then viewed a video depicting intimate relationship behavior between two gay men, reported state anger a second time, and competed in a laboratory aggression task against either a heterosexual or a gay male. Results indicated that adherence to the antifemininity norm exerted an indirect effect, primarily through sexual prejudice, on increases in anger. Adherence to the status and antifemininity norms exerted indirect effects, also through sexual prejudice, on physical aggression toward the gay, but not the heterosexual, male. Findings provide the first multivariate evidence for determinants of aggression toward gay men motivated by gender role enforcement.
PMCID: PMC2754233  PMID: 19558440
Aggressive Behavior; Homosexuality (Attitudes Toward); Male Homosexuality; Prejudice; Masculinity
10.  Effects of Traditional Gender Role Norms and Religious Fundamentalism on Self-Identified Heterosexual Men's Attitudes, Anger, and Aggression Toward Gay Men and Lesbians 
Psychology of men & masculinity  2011;12(4):383-400.
Sexual prejudice and antigay anger were examined as mediators of the associations between traditional male gender norms, religious fundamentalism, and aggression toward gay men and lesbians. Participants were 201 self-identified heterosexual men recruited from the community to complete computer-administered measures of adherence to traditional male gender norms (i.e., status, toughness, antifemininity), religious fundamentalism, sexual prejudice, and frequency of aggression toward gay men and lesbians. Additionally, participants completed a structured interview designed to assess anger in response to a vignette depicting a male-male intimate relationship (i.e., partners saying “I love you,” holding hands, kissing). Results showed that sexual prejudice and antigay anger partially mediated the effect of antifemininity on aggression and fully mediated the effect of religious fundamentalism on aggression. Sexual prejudice alone fully mediated the effect of status on aggression and neither sexual prejudice nor antigay anger mediated the effect of toughness on aggression. Further, results suggested that religious fundamentalism is a multifaceted construct of which some aspects increase risk for aggression toward gay men and lesbians, whereas other aspects decrease this risk. These data provide multivariate evidence from a nonprobability, community-based sample that extreme internalization of dominant cultural values can set the stage for violence toward marginalized groups. Implications for intervention programming and future research are reviewed.
PMCID: PMC3212102  PMID: 22081759
Culture; Religious Fundamentalism; Masculinity; Sexual Prejudice; Anger; Violence; Aggression; Lesbians; Gay Men
11.  Internalized Heterosexism among HIV-Positive Gay-Identified Men: Implications for HIV Prevention and Care 
Internalized heterosexism (IH), or the internalization of societal anti-homosexual attitudes, has been consistently linked to depression and low self-esteem among gay men, and inconclusively associated with substance use and sexual risk in gay and bisexual men. Using structural equation modeling, a model framed in Social Action Theory was tested in which IH is associated with HIV transmission risk and poor adherence to HIV antiretroviral therapy (ART) through the mechanisms of negative affect and stimulant use. Data from a sample of 465 gay-identified men interviewed as part of an HIV risk reduction behavioral trial were used to test the fit of the model. Results supported the hypothesized model in which IH was associated with unprotected receptive (but not insertive) anal intercourse with HIV-negative or unknown HIV status partners, and with ART non-adherence indirectly via increased negative affect and more regular stimulant use. The model accounted for 15% of the variance in unprotected receptive anal intercourse (URAI) and 17% of the variance in ART non-adherence. Findings support the potential utility of addressing IH in HIV prevention and treatment with HIV-positive gay men.
PMCID: PMC2801151  PMID: 18837600
HIV/AIDS; internalized heterosexism; homophobia; adherence; depression; methamphetamine; HIV transmission risk
12.  Sexual attitudes and practices of selected groups in Northern Ireland since the emergence of AIDS. 
The Ulster Medical Journal  1989;58(2):145-152.
One hundred and seventeen heterosexual males and females attending a sexually transmitted disease clinic and 57 homosexual males from a local "gay" club were asked to complete a questionnaire regarding their attitudes and sexual practices since the emergence of AIDS. The results show a trend towards increasing partner change rate among heterosexual males. There has been an increase in the practice of insertive anal intercourse by homosexual men with Northern Ireland contacts but no corresponding increase with contacts outside Northern Ireland. The practice of receptive anal intercourse has remained constant. Significant differences in attitudes between homosexual and heterosexual males were expressed with regard to testing of 'at risk groups' (p less than 0.001), in the uptake of testing (p less than 0.01), and in attitudes to sexual practices if they themselves became HIV positive. There was a low level of anxiety amongst heterosexuals regarding risk of HIV infection in the future. Less than 50% of the heterosexual patients attending this clinic use condoms, though more claim to intend to use them in future.
PMCID: PMC2448218  PMID: 2603264
13.  Intrasexual Competition and Eating Restriction in Heterosexual and Homosexual Individuals 
Restrictive eating attitudes and behaviors have been hypothesized to be related to processes of intrasexual competition. According to this perspective, within-sex competition for status serves the adaptive purpose of attracting mates. As such, status competition salience may lead to concerns of mating desirability. For heterosexual women and gay men, such concerns revolve around appearing youthful and thus, thinner. Following this logic, we examined how exposure to high-status and competitive (but not thin or highly attractive) same-sex individuals would influence body image and eating attitudes in heterosexual and in gay/lesbian individuals. Results indicated that for heterosexuals, intrasexual competition cues led to greater body image dissatisfaction and more restrictive eating attitudes for women, but not for men. In contrast, for homosexual individuals, intrasexual competition cues led to worse body image and eating attitudes for gay men, but not for lesbian women. These findings support the idea that the ultimate explanation for eating disorders is related to intrasexual competition.
PMCID: PMC2935594  PMID: 20835352
intrasexual competition; sex differences; sexual orientation; eating disorders; body image
14.  Effects of Disengagement Coping with HIV Risk on Unprotected Sex among HIV-Negative Gay Men in New York City 
This study examined how disengagement coping with HIV risk mediated the association between internalized homophobia and unprotected anal intercourse (UAI) and how sexual encounters in public venues (public sex) and drug use moderated the association between disengagement coping and UAI among HIV-negative gay men. Disengagement coping included fatalistic beliefs about maintaining HIV-negative seronegative serostatus (fatalism), optimistic attitudes toward medical seriousness of HIV infection and reduced concern about HIV risk due to HAART (optimism), and negative affective states associated with sexual risk (anxiety).
A survey was conducted among 285 HIV-negative gay men at an HIV prevention counseling program in New York City.
Main Outcome Measures
Sexual risk was defined as having had UAI with non-primary partners in the past six months.
In addition to the positive association between internalized homophobia, disengagement coping, and UAI, fatalism mediated the association between internalized homophobia and UAI; and optimism mediated the association between anxiety and UAI. A significant moderation effect of public sex was found between fatalism and UAI.
The findings highlight the importance of understanding disengagement coping as it affects sexual risk practices among HIV-negative gay men in the continuing epidemic.
PMCID: PMC2841324  PMID: 20230094
fatalism; optimism; internalized homophobia; gay men; coping; sexual risk
15.  Intergroup contact, attitudes toward homosexuality, and the role of acceptance of gender non-conformity in young adolescents 
Journal of Adolescence  2012;35(4):899-907.
This study explored how contact with gay and lesbian persons affects adolescents' attitudes toward them, and whether this association is mediated or moderated by one's acceptance of gender non-conformity. We analyzed survey responses from 456 Dutch adolescents aged 12 to 15 who reported having no same-sex attractions. Data were collected in 2008 at 8 schools in Amsterdam, the Netherlands. Preliminary analyses showed that contact with lesbian/gay persons outside of school was positively associated with attitudes toward lesbians and gay men. Multilevel analyses showed that acceptance of gender non-conformity mediated rather than moderated the relationship between intergroup contact and sexual prejudice in males. The effect of intergroup contact on females' attitudes toward lesbian women was no longer significant in multilevel analyses. The findings suggest that attention to both intergroup contact and acceptance of gender non-conformity would enhance our understanding of attitudes toward homosexuality in adolescents.
PMCID: PMC3341517  PMID: 22243627
Intergroup contact; Homosexuality; Gender non-conformity; Adolescence; Sexual prejudice
16.  Masculine Gender Role Conflict and Negative Feelings about Being Gay 
Professional psychologists who work with gay men have noted that traditional masculine ideals play a prominent role in the gay community whereby some endorse these traditional ideals and stigmatize effeminate behavior by other gay men. One hypothesis is that this behavior reflects negative feelings about being gay. This article examined this hypothesis by reporting the results of an online survey of 622 self-identified gay men. Participants completed the Gender Role Conflict Scale, Lesbian and Gay Identity Scale, the Social Desirability Scale, and questions related to the importance of masculinity. Results showed that most participants valued the public appearance of masculinity; and they ideally wished to be more masculine than they felt they were (Cohen’s d = 0.42). A multiple regression analysis showed that the degree to which they valued masculinity and were concerned with violating masculine ideals was positively related with negative feelings about being gay (Cohen’s f2 = .67). These findings highlight the importance of exploring the role that masculine ideals play in gay client’s lives given that negative feelings about oneself can adversely affect psychological well-being.
PMCID: PMC2860327  PMID: 20428323
Anti-femininity; Straight-acting; Internalized homophobia; Internalized heterosexism; Self-esteem
17.  Homophobia among doctors. 
BMJ : British Medical Journal  1994;308(6928):586-587.
Homophobia creates stress for gay men and women. An interview study of 28 doctors, 20 gay and eight non-gay, was performed to assess whether homophobia is strong among the medical profession, the stress it causes, and whether the advent of AIDS and HIV infection has increased the stress. The doctors, recruited by word of mouth and by a letter in the medical and gay press, were asked about their own attitudes to homosexuality and AIDS. Only one (non-gay) doctor thought that there was no prejudice against gay doctors in the medical profession. The gay doctors certainly perceived prejudice, which they claimed caused them extra stress; the advent of AIDS had increased this stress to an extent. Doctors who had not openly declared themselves to be gay feared doing so because of the effect on their job prospects, but those who had declared themselves openly reported less stress than previously. Homophobia clearly exists within the medical profession. Non-gay doctors should use the power of the profession to challenge homophobia in the profession and in society. HIV infection could then be treated as a purely medical condition; sufferers would receive wider understanding and the pressures of extra workload could be more equally shared.
PMCID: PMC2539594  PMID: 8148685
18.  The Critical Role of Intimacy in the Sexual Risk Behaviors of Gay and Bisexual Men 
AIDS and Behavior  2012;16(3):626-632.
Research indicates that high numbers of gay and bisexual men report infrequent or inconsistent condom use, placing them at risk for HIV and other STDs. The present study examined positive and negative condom-related attitudes along three dimensions—risk reduction, pleasure reduction, and intimacy interference—and examined their relative predictive power in determining condom use among a sample of sexually risky gay and bisexual men in New York City. In a multivariate model, both risk reduction and intimacy interference attitudes emerged as significant predictors of unprotected sex; however, the variance accounted for by a model including intimacy interference was almost three times that accounted for by a model including risk reduction alone. These data suggest a pivotal role for intimacy in shaping condom attitudes and behavior among gay and bisexual men. HIV prevention interventions should consider incorporating intimacy as a motivating factor for sexual behavior and a potential barrier to condom use.
PMCID: PMC3376348  PMID: 21630012
MSM; HIV; Risk; Intimacy; Condom use
19.  Human Papillomavirus Infection: Knowledge, Attitudes, and Behaviors among Lesbian, Gay Men, and Bisexual in Italy 
PLoS ONE  2012;7(8):e42856.
This cross-sectional study assess knowledge, attitudes, and behavior towards the human papillomavirus (HPV) and the vaccination among a random sample of 1000 lesbian, gay men, and bisexual women and men.
A face-to-face interview sought information about: socio-demographic characteristics, knowledge about HPV infection, perception of risk towards HPV infection and/or cervical, anal, and oropharyngeal cancers, perception of the benefits of a vaccination to prevent cervical, anal, and oropharyngeal cancers, sexual behaviors, health-promoting behaviors, and willingness to receive the HPV vaccine.
Only 60.6% had heard about the HPV infection and this knowledge was significantly higher in female, in those being a member of a homosexual association, in those having had the first sexual experience at a younger age, in those having received information about the HPV infection from physicians, and in those having no need of information about HPV infection. A higher perceived risk of contracting HPV infection has been observed in those younger, lesbian and gay men, who have heard of HPV infection and knew the risk factors and its related diseases, who have received information about HPV infection from physicians, and who need information about HPV infection. Only 1.7% have undergone HPV immunization and 73.3% professed intent to obtain it in the future. The significant predictors of the willingness to receive this vaccine were belief that the vaccination is useful, perception to be at higher risk of contracting HPV infection, and perception to be at higher risk of developing cervical, anal, and oropharyngeal cancers.
Information and interventions are strongly needed in order to overcome the lack of knowledge about HPV infection and its vaccination. Inclusion of boys in the national vaccination program and initiate a catch-up program for men who have sex with men up to 26 years may reduce their burden of HPV-related disease.
PMCID: PMC3414511  PMID: 22905178
20.  Ethnicity, gender socialization, and children’s attitudes towards gay men and lesbian women 
Journal of cross-cultural psychology  2011;43(7):1082-1094.
The aim of the present study was to assess whether children’s attitudes towards gay men and lesbian women differ in relation to their ethnic backgrounds, and whether ethnic differences are a result of perceived differential gender socialization practices. Data were collected from children in eight Dutch elementary schools by means of a paper-and-pencil questionnaire administered in the classroom. All children (mean age 11.47; N = 229) lived in the Netherlands; 50.2% had non-Western and 49.8% Western ethnic backgrounds. Children with non-Western ethnic backgrounds reported more negative attitudes towards gays and lesbians. These children perceived more parental pressure to behave in accordance with their gender and showed more negative attitudes towards gender-nonconforming behaviour by peers. Hierarchical regression analyses revealed that cultural differences in attitudes towards gay men and lesbian women are partly mediated by differentially perceived parental pressure to behave in accordance with their gender.
PMCID: PMC3496397  PMID: 23162164
Children; Ethnicity; Attitudes towards homosexuality; Gender role beliefs
21.  HIV/AIDS Awareness, Attitudes and Risk Behavior Among University Students in Wuhan, China 
The Open AIDS Journal  2009;3:55-62.
In China, the estimated number of HIV positives in 2007 was 700,000 and the epidemic continues to expand. Because of their attitudes towards sexual behavior, young people are considered to be a group at high risk.
Eight hundred sixty-eight undergraduate students at Wuhan University were selected through stratified cluster sampling, to answer a questionnaire. They were divided into three main groups: Chinese medical students, foreign medical students and Chinese students from other faculties. Fourteen interviews were conducted in addition.
Ninety-nine percent of the students had heard of HIV/AIDS and 76% of the students could distinguish HIV from AIDS. The main route of transmission was believed by the Chinese students to be blood transfusion and sexual intercourse by the foreign medical students. The female students knew more about the routes of transmission than the male students. Medical students had a higher level of knowledge than non-medical students, and among the medical students, the foreign students were more knowledgeable than the Chinese students. Only 8 % of the students were sexually active.
The students had an accepting attitude towards people living with HIV and no extensive risk behavior. Overall, the knowledge level was found to be moderate.
PMCID: PMC2775123  PMID: 19911068
HIV; AIDS; information; epidemic; ethnic.
22.  The attitude of patients towards medical students in a sexual health clinic 
Sexually Transmitted Infections  2005;81(5):437-439.
Objectives: To determine patient attitudes toward medical students in the sexual health clinic, and to describe factors associated with patient refusal of medical student involvement.
Method: A self administered questionnaire was given to 259 consecutive patients attending the general genitourinary medicine clinic. Participants were asked to indicate their attitude to questioning and/or examination by medical students. Information was also collected on sex, age, ethnicity, and previous visits to sexual health clinics and previous exposure to medical students. The proportion of patients reporting comfort with student involvement, and association with age, sex, country of birth, language spoken, and previous experience of student and/or genitourinary medicine clinics are reported.
Results: 82.6% of patients agreed to participate. The proportion reporting feeling comfortable with students ranged from 64% for female students questioning them with a doctor present to 35% for a male student questioning them alone. Comfort levels were associated with the sex of the student and previous exposure to medical students, but not age, country of birth, language spoken, or previous attendance at a sexual health clinic. The most common reasons for feeling uncomfortable with students were privacy concerns and poorer quality of care.
Conclusion: Many patients feel uncomfortable with medical student involvement in a sexual health clinic consultation; particularly patients with no previous contact with medical students. Privacy and standard of care were the most common concerns, which are potentially amenable to change through better explanation of the students' role in the clinic.
PMCID: PMC1745034  PMID: 16199748
23.  Genetic and Environmental Influences on Individual Differences in Attitudes Toward Homosexuality: An Australian Twin Study 
Behavior Genetics  2008;38(3):257-265.
Previous research has shown that many heterosexuals hold negative attitudes toward homosexuals and homosexuality (homophobia). Although a great deal of research has focused on the profile of homophobic individuals, this research provides little theoretical insight into the aetiology of homophobia. To examine genetic and environmental influences on variation in attitudes toward homophobia, we analysed data from 4,688 twins who completed a questionnaire concerning sexual behaviour and attitudes, including attitudes toward homosexuality. Results show that, in accordance with literature, males have significantly more negative attitudes toward homosexuality than females and non-heterosexuals are less homophobic than heterosexuals. In contrast with some earlier findings, age had no significant effect on the homophobia scores in this study. Genetic modelling showed that variation in homophobia scores could be explained by additive genetic (36%), shared environmental (18%) and unique environmental factors (46%). However, corrections based on previous findings show that the shared environmental estimate may be almost entirely accounted for as extra additive genetic variance arising from assortative mating for homophobic attitudes. The results suggest that variation in attitudes toward homosexuality is substantially inherited, and that social environmental influences are relatively minor.
PMCID: PMC2292426  PMID: 18347968
Attitudes; Genetics; Heritability; Homophobia; Twin study; Homosexuality
24.  Medical schools seek to overcome "invisibility" of gay patients, gay issues in curriculum. 
Dr. Gary Gibson of Cambridge, Ont., went many years without identifying a single gay patient in his practice. When he "came out" about his homosexuality in 1981, about 15 of his patients revealed they were gay. Gibson, a professor of family medicine at the University of Western Ontario who is active in the College of Family Physicians of Canada, says such information is useful, because "if they don't identify, they may not get the medical advice they need." He wants medical students to receive more education in gay and lesbian issues, and recently drafted a gay and lesbian curriculum for postgraduate family medicine, which has been endorsed by the CMA.
PMCID: PMC1335250  PMID: 8823221
25.  Methamphetamine Use, Attitudes About Condoms, and Sexual Risk Behavior Among HIV-Positive Men Who Have Sex with Men 
Archives of Sexual Behavior  2009;40(2):267-272.
This study examined attitudes about condoms as a moderator of the relationship between methamphetamine use and sexual risk behavior in a sample of 297 HIV-positive, methamphetamine-using men who have sex with men (MSM). To test for a moderating effect of attitudes towards condoms, an interaction term was included in multiple regression analysis along with age, income, negative condom attitudes, frequency of methamphetamine use, and Beck depression score. A post hoc analysis was conducted to determine the relations between methamphetamine use and unprotected sex for persons with more vs. less negative attitudes toward condoms. These analyses indicated that when individuals had more negative attitudes toward condoms, the relation between methamphetamine frequency and unprotected sex was significant, while among participants with less negative attitudes toward condoms, no significant association was found. Addressing methamphetamine-using MSM’s attitudes about condoms can serve as a form of harm reduction for those who are not yet ready or willing to discontinue methamphetamine use.
PMCID: PMC2891784  PMID: 19856091
Methamphetamine; Attitudes; Condoms; Sexual risk; Men who have sex with men

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