Archives of Sexual Behavior

, Volume 47, Issue 4, pp 1133–1144 | Cite as

Internalized Homophobia and Drug Use in a National Cohort of Gay and Bisexual Men: Examining Depression, Sexual Anxiety, and Gay Community Attachment as Mediating Factors

  • Raymond L. Moody
  • Tyrel J. Starks
  • Christian Grov
  • Jeffrey T. Parsons
Original Paper


The minority stress process of internalized homophobia (IH) has been associated with a range of adverse health outcomes among gay and bisexual men (GBM). However, evidence is mixed regarding the effect of IH on drug use, suggesting the potential role of multiple mediated pathways. Researchers have linked depression, sexual anxiety, and gay community attachment with IH. Depression, sexual anxiety, and gay community attachment have also been linked with drug use and drug-related problems suggesting potential mediating roles. A U.S. national sample of 1071 HIV-negative GBM completed at-home surveys, including measures of sociodemographic characteristics, IH, depression, sexual anxiety, gay community attachment, and drug use and associated problems. Adjusting for sociodemographic characteristics, depression mediated the association between IH and recent drug use. IH was positively associated with depression, and depression was positively associated with recent drug use. Gay community attachment partially mediated drug-related problems. IH had a positive direct association with drug-related problems and a negative direct association with gay community attachment. Gay community attachment had a positive association with drug-related problems. IH was positively associated with sexual anxiety, but sexual anxiety was not associated with either drug outcome. Efforts to reduce IH among HIV-negative GBM are likely to have a positive impact on mental health problems, as well as reduce risk for drug use and drug-related problems. Gay communities could provide the social support necessary for reducing IH; however, emphasis on community level interventions that address factors that increase risk for drug-related problems remains important.


Gay and bisexual men Internalized homophobia Depression Sexual anxiety Gay community Drug use 



The One Thousand Strong study was funded by a research Grant from the National Institute on Drug Abuse (R01 DA036466: Jeffrey T. Parsons and Christian Grov, MPIs). Raymond Moody’s effort was funded by a supplement to the parent Grant (R01 DA036466-S2). Special thanks to the other members of the One Thousand Strong study team (Tyrel Starks, Ana Ventuneac, H. Jonathon Rendina, Mark Pawson, Michael Castro, Ruben Jimenez, Chloe Mirzayi, Brett Millar, Thomas Whitfield, and Jonathan Lassiter) and other staff from the Center for HIV/AIDS Educational Studies and Training (Chris Hietikko, Andrew Cortopassi, Brian Salfas, Doug Keeler, Qurrat-Ul Ain, Chris Murphy, and Carlos Ponton). Thank you to the staff at Community Marketing, Inc. (David Paisley, Heather Torch, and Thomas Roth) as well as Patrick Sullivan, Jessica Ingersoll, Deborah Abdul-Ali, and Doris Igwe at the Emory Center for AIDS Research (P30 AI050409). Finally, a special thanks to Jeffrey Schulden and Pamela Goodlow at NIDA. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in this study.


  1. Barlow, D. H. (1986). Causes of sexual dysfunction: The role of anxiety and cognitive interference. Journal of Consulting and Clinical Psychology, 54(2), 140–148. doi: 10.1037/0022-006X.54.2.140.CrossRefPubMedGoogle Scholar
  2. Baron, R. M., & Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–1182. doi: 10.1037/0022-3514.51.6.1173.CrossRefPubMedGoogle Scholar
  3. Barrett, D. C., Bolan, G., Joy, D., Counts, K., Doll, L., & Harrison, J. (1995). Coping strategies, substance use, sexual activity, and HIV sexual risks in a sample of gay male STD patients. Journal of Applied Social Psychology, 25(12), 1058–1072. doi: 10.1111/j.1559-1816.1995.tb00617.x.CrossRefGoogle Scholar
  4. Brubaker, M. D., Garrett, M. T., & Dew, B. J. (2009). Examining the relationship between internalized heterosexism and substance abuse among lesbian, gay, and bisexual individuals: A critical review. Journal of LGBT Issues in Counseling, 3(1), 62–89. doi: 10.1080/15538600902754494.CrossRefGoogle Scholar
  5. Burns, M. N., Kamen, C., Lehman, K. A., & Beach, S. R. (2012). Minority stress and attributions for discriminatory events predict social anxiety in gay men. Cognitive Therapy and Research, 36(1), 25–35.CrossRefGoogle Scholar
  6. Cabaj, R. P. (2000). Substance abuse, internalized homophobia, and gay men and lesbians: Psychodynamic issues and clinical implications. Journal of Gay and Lesbian Psychotherapy, 3(3–4), 5–24. doi: 10.1300/J236v03n03_02.CrossRefGoogle Scholar
  7. Carpiano, R. M., Kelly, B. C., Easterbrook, A., & Parsons, J. T. (2011). Community and drug use among gay men the role of neighborhoods and networks. Journal of Health and Social Behavior, 52(1), 74–90.CrossRefPubMedGoogle Scholar
  8. Cheng, Z. (2003). Issues and standards in counseling lesbians and gay men with substance abuse concerns. Journal of Mental Health Counseling, 25(4), 323–336. doi: 10.17744/mehc.25.4.nb107j9cqdc5j7ld.CrossRefGoogle Scholar
  9. Cochran, S. D., Sullivan, J. G., & Mays, V. M. (2003). Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States. Journal of Consulting and Clinical Psychology, 71(1), 53.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Collins, R. L., Kanouse, D. E., Gifford, A. L., Senterfitt, J. W., Schuster, M. A., McCaffrey, D. F., … Wenger, N. S. (2001). Changes in health-promoting behavior following diagnosis with HIV: Prevalence and correlates in a national probability sample. Health Psychology, 20(5), 351–360. doi: 10.1037/0278-6133.20.5.351.CrossRefPubMedGoogle Scholar
  11. Coxe, S., West, S. G., & Aiken, L. S. (2009). The analysis of count data: A gentle introduction to Poisson Regression and its alternatives. Journal of Personality Assessment, 91(2), 121–136. doi: 10.1080/00223890802634175.CrossRefPubMedGoogle Scholar
  12. Cramer, R. J., Colbourn, S. L., Gemberling, T. M., Graham, J., & Stroud, C. H. (2015). Substance-related coping, HIV-related factors, and mental health among an HIV-positive sexual minority community sample. AIDS Care, 27, 1063–1068. doi: 10.1080/09540121.2015.1024097.CrossRefPubMedGoogle Scholar
  13. D’Augelli, A. R., Grossman, A. H., Hershberger, S. L., & O’Connell, T. S. (2001). Aspects of mental health among older lesbian, gay, and bisexual adults. Aging and Mental Health, 5(2), 149–158. doi: 10.1080/713650002.CrossRefPubMedGoogle Scholar
  14. Degenhardt, L., Hall, W., & Lynskey, M. (2001). Alcohol, cannabis and tobacco use among Australians: A comparison of their associations with other drug use and use disorders, affective and anxiety disorders, and psychosis. Addiction, 96(11), 1603–1614. doi: 10.1080/09652140120080732.CrossRefPubMedGoogle Scholar
  15. Dupras, A. (1994). Internalized homophobia and psychosexual adjustment among gay men. Psychological Reports, 75(1, Pt 1), 23–28. doi: 10.2466/pr0.1994.75.1.23.CrossRefPubMedGoogle Scholar
  16. Feinstein, B. A., Goldfried, M. R., & Davila, J. (2012). The relationship between experiences of discrimination and mental health among lesbians and gay men: An examination of internalized homonegativity and rejection sensitivity as potential mechanisms. Journal of Consulting and Clinical Psychology, 80, 917–927.CrossRefPubMedGoogle Scholar
  17. Frost, D. M., & Meyer, I. H. (2009). Internalized homophobia and relationship quality among lesbians, gay men, and bisexuals. Journal of Counseling Psychology, 56(1), 97–109. doi: 10.1037/a0012844.CrossRefPubMedPubMedCentralGoogle Scholar
  18. Gold, S. D., Marx, B. P., & Lexington, J. M. (2007). Gay male sexual assault survivors: The relations among internalized homophobia, experiential avoidance, and psychological symptom severity. Behaviour Research and Therapy, 45(3), 549–562. doi: 10.1016/j.brat.2006.05.006.CrossRefPubMedGoogle Scholar
  19. Green, K. E., & Feinstein, B. A. (2012). Substance use in lesbian, gay, and bisexual populations: An update on empirical research and implications for treatment. Psychology of Addictive Behaviors, 26(2), 265–278. doi: 10.1037/a0025424.CrossRefPubMedGoogle Scholar
  20. Greenwald, A. G., McGhee, D. E., & Schwartz, J. L. K. (1998). Measuring individual differences in implicit cognition: The implicit association test. Journal of Personality and Social Psychology, 74(6), 1464–1480. doi: 10.1037/0022-3514.74.6.1464.CrossRefPubMedGoogle Scholar
  21. Greenwood, G. L., White, E. W., Page-Shafer, K., Bein, E., Osmond, D. H., Paul, J., & Stall, R. D. (2001). Correlates of heavy substance use among young gay and bisexual men: The San Francisco Young Men’s Health Study. Drug and Alcohol Dependence, 61, 105–112.CrossRefPubMedGoogle Scholar
  22. Grov, C., Bimbi, D. S., Nanin, J. E., & Parsons, J. T. (2006). Exploring racial and ethnic differences in recreational drug use among gay and bisexual men in New York City and Los Angeles. Journal of Drug Education, 36(2), 105–123.PubMedGoogle Scholar
  23. Grov, C., Cain, D., Whitfield, T. H., Rendina, H. J., Pawson, M., Ventuneac, A., & Parsons, J. T. (2016). Recruiting a US national sample of HIV-negative gay and bisexual men to complete at-home self-administered HIV/STI testing and surveys: Challenges and opportunities. Sexuality Research and Social Policy, 13(1), 1–21.CrossRefPubMedPubMedCentralGoogle Scholar
  24. Halkitis, P. N., Fischgrund, B. N., & Parsons, J. T. (2005). Explanations for methamphetamine use among gay and bisexual men in New York City. Substance Use and Misuse, 40(9–10), 1331–1345. doi: 10.1081/JA-200066900.CrossRefPubMedGoogle Scholar
  25. Hamilton, C. J., & Mahalik, J. R. (2009). Minority stress, masculinity, and social norms predicting gay men’s health risk behaviors. Journal of Counseling Psychology, 56(1), 132–141. doi: 10.1037/a0014440.CrossRefGoogle Scholar
  26. Hatzenbuehler, M. L. (2009). How does sexual minority stigma “get under the skin”? A psychological mediation framework. Psychological Bulletin, 135, 707–730.CrossRefPubMedPubMedCentralGoogle Scholar
  27. Hatzenbuehler, M. L., Corbin, W. R., & Fromme, K. (2008). Trajectories and determinants of alcohol use among LGB young adults and their heterosexual peers: Results from a prospective study. Developmental Psychology, 44(1), 81–90.CrossRefPubMedPubMedCentralGoogle Scholar
  28. Hatzenbuehler, M. L., Dovidio, J. F., Nolen-Hoeksema, S., & Phills, C. E. (2009). An implicit measure of anti-gay attitudes: Prospective associations with emotion regulation strategies and psychological distress. Journal of Experimental Social Psychology, 45(6), 1316–1320. doi: 10.1016/j.jesp.2009.08.005.CrossRefPubMedPubMedCentralGoogle Scholar
  29. Hatzenbuehler, M. L., Jun, H.-J., Corliss, H. L., & Austin, S. B. (2015). Structural stigma and sexual orientation disparities in adolescent drug use. Addictive Behaviors, 46, 14–18. doi: 10.1016/j.addbeh.2015.02.017.CrossRefPubMedPubMedCentralGoogle Scholar
  30. Hayes, A. F. (2009). Beyond Baron and Kenny: Statistical mediation analysis in the new millennium. Communication Monographs, 76(4), 408–420. doi: 10.1080/03637750903310360.CrossRefGoogle Scholar
  31. Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1–25. doi: 10.1016/j.brat.2005.06.006.CrossRefPubMedGoogle Scholar
  32. Hequembourg, A. L., & Dearing, R. L. (2013). Exploring shame, guilt, and risky substance use among sexual minority men and women. Journal of Homosexuality, 60(4), 615–638. doi: 10.1080/00918369.2013.760365.CrossRefPubMedPubMedCentralGoogle Scholar
  33. Herek, G. M., Gillis, J. R., & Cogan, J. C. (2009). Internalized stigma among sexual minority adults: Insights from a social psychological perspective. Journal of Counseling Psychology, 56(1), 32.CrossRefGoogle Scholar
  34. Hirshfield, S., Chiasson, M. A., Wagmiller, R. L., Jr., Remien, R. H., Humberstone, M., Scheinmann, R., & Grov, C. (2010). Sexual dysfunction in an Internet sample of U.S. men who have sex with men. Journal of Sexual Medicine, 7(9), 3104–3114. doi: 10.1111/j.1743-6109.2009.01636.x.CrossRefPubMedPubMedCentralGoogle Scholar
  35. Ibañez, G. E., Purcell, D. W., Stall, R., Parsons, J. T., & Gómez, C. A. (2005). Sexual risk, substance use, and psychological distress in HIV-positive gay and bisexual men who also inject drugs. AIDS, 19, S49–S55.CrossRefPubMedGoogle Scholar
  36. Igartua, K. J., Gill, K., & Montoro, R. (2003). Internalized homophobia: A factor in depression, anxiety, and suicide in the gay and lesbian population. Canadian Journal of Community Mental Health, 22(2), 15–30.CrossRefPubMedGoogle Scholar
  37. Johnson, A. S., Hall, H. I., Hu, X., Lansky, A., Holtgrave, D. R., & Mermin, J. (2014). Trends in diagnoses of HIV infection in the United States, 2002–2011. Journal of the American Medical Association, 312(4), 432–434.CrossRefPubMedGoogle Scholar
  38. Johnson, M. O., Carrico, A. W., Chesney, M. A., & Morin, S. F. (2008). Internalized heterosexism among HIV-positive, gay-identified men: Implications for HIV prevention and care. Journal of Consulting Clinical Psychology, 76(5), 829–839. doi: 10.1037/0022-006x.76.5.829.CrossRefPubMedPubMedCentralGoogle Scholar
  39. Kecojevic, A., Wong, C. F., Corliss, H. L., & Lankenau, S. E. (2015). Risk factors for high levels of prescription drug misuse and illicit drug use among substance-using young men who have sex with men (YMSM). Drug and Alcohol Dependence, 150, 156–163. doi: 10.1016/j.drugalcdep.2015.02.031.CrossRefPubMedGoogle Scholar
  40. Kerridge, B. T., Pickering, R. P., Saha, T. D., Ruan, W. J., Chou, S. P., Zhang, H., … Hasin, D. S. (2017). Prevalence, sociodemographic correlates and DSM-5 substance use disorders and other psychiatric disorders among sexual minorities in the United States. Drug and Alcohol Dependence, 170, 82–92. doi: 10.1016/j.drugalcdep.2016.10.038.CrossRefPubMedGoogle Scholar
  41. Kessler, R. (2003). The impairments caused by social phobia in the general population: Implications for intervention. Acta Psychiatrica Scandinavica, 108(s417), 19–27.CrossRefGoogle Scholar
  42. Klitzman, R. L., Greenberg, J. D., Pollack, L. M., & Dolezal, C. (2002). MDMA (‘ecstasy’) use, and its association with high risk behaviors, mental health, and other factors among gay/bisexual men in New York City. Drug and Alcohol Dependence, 66(2), 115–125.CrossRefPubMedGoogle Scholar
  43. Langdridge, D. (2007). Gay affirmative therapy: A theoretical framework and defence. Journal of Gay and Lesbian Psychotherapy, 11(1/2), 27–43. doi: 10.1300/J236v11n01_03.CrossRefGoogle Scholar
  44. Lea, T., de Wit, J., & Reynolds, R. (2014). Minority stress in lesbian, gay, and bisexual young adults in Australia: Associations with psychological distress, suicidality, and substance use. Archives of Sexual Behavior, 43(8), 1571–1578. doi: 10.1007/s10508-014-0266-6.CrossRefPubMedGoogle Scholar
  45. Lee, J. H., Gamarel, K. E., Kahler, C. W., Marshall, B. D. L., van den Berg, J. J., Bryant, K., … Operario, D. (2015). Co-occurring psychiatric and drug use disorders among sexual minority men with lifetime alcohol use disorders. Drug and Alcohol Dependence, 151, 167–172. doi: 10.1016/j.drugalcdep.2015.03.018.CrossRefPubMedPubMedCentralGoogle Scholar
  46. Lee, R. S., Kochman, A., & Sikkema, K. (2002). Internalized stigma among people living with HIV-AIDS. AIDS and Behavior, 6(4), 309–319. doi: 10.1023/A:1021144511957.CrossRefGoogle Scholar
  47. Lelutiu-Weinberger, C., Pachankis, J. E., Golub, S. A., Walker, J. N. J., Bamonte, A. J., & Parsons, J. T. (2013). Age cohort differences in the effects of gay-related stigma, anxiety and identification with the gay community on sexual risk and substance use. AIDS and Behavior, 17, 340–349.CrossRefPubMedPubMedCentralGoogle Scholar
  48. Lick, D. J., Durso, L. E., & Johnson, K. L. (2013). Minority stress and physical health among sexual minorities. Perspectives on Psychological Science, 8(5), 521–548. doi: 10.1177/1745691613497965.CrossRefPubMedGoogle Scholar
  49. Livingston, N. A., Oost, K. M., Heck, N. C., & Cochran, B. N. (2015). The role of personality in predicting drug and alcohol use among sexual minorities. Psychology of Addictive Behaviors, 29(2), 414–419. doi: 10.1037/adb0000034.CrossRefPubMedGoogle Scholar
  50. Martin, J. L., & Dean, L. L. (1988). The impact of AIDS on gay men: A research instrument, 1988. Unpublished technical report. New York: Columbia University.Google Scholar
  51. Maxwell, S. E., & Cole, D. A. (2007). Bias in cross-sectional analyses of longitudinal mediation. Psychological Methods, 12(1), 23–44. doi: 10.1037/1082-989X.12.1.23.CrossRefPubMedGoogle Scholar
  52. Mays, V. M., Cochran, S. D., & Zamudio, A. (2004). HIV prevention research: Are we meeting the needs of African American men who have sex with men? Journal of Black Psychology, 30(1), 78–105.CrossRefPubMedPubMedCentralGoogle Scholar
  53. McCabe, S. E., Bostwick, W. B., Hughes, T. L., West, B. T., & Boyd, C. J. (2010). The relationship between discrimination and substance use disorders among lesbian, gay, and bisexual adults in the United States. American Journal of Public Health, 100(10), 1946–1952. doi: 10.2105/AJPH.2009.163147.CrossRefPubMedPubMedCentralGoogle Scholar
  54. McKirnan, D. J., Ostrow, D. G., & Hope, B. (1996). Sex, drugs and escape: A psychological model of HIV-risk sexual behaviours. AIDS Care, 8(6), 655–669.CrossRefPubMedGoogle Scholar
  55. McKirnan, D. J., Vanable, P. A., Ostrow, D. G., & Hope, B. (2001). Expectancies of sexual “escape” and sexual risk among drug- and alcohol-involved gay and bisexual men. Journal of Substance Abuse, 13(1–2), 137–154. doi: 10.1016/S0899-3289(01)00063-3.CrossRefPubMedGoogle Scholar
  56. Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36, 38–56.CrossRefPubMedGoogle Scholar
  57. Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697.CrossRefPubMedPubMedCentralGoogle Scholar
  58. Meyer, I. H., & Dean, L. (1998). Internalized homophobia, intimacy and sexual behaviour among gay and bisexual men. In G. Herek (Ed.), Stigma and sexual orientation (pp. 160–186). Thousand Oaks, CA: Sage Publications.Google Scholar
  59. Miller, W. R., & Rollnick, S. (2012). Motivational interviewing: Helping people change. New York: Guilford press.Google Scholar
  60. Mimiaga, M. J., Reisner, S. L., Fontaine, Y.-M., Bland, S. E., Driscoll, M. A., Isenberg, D., … Mayer, K. H. (2010). Walking the line: Stimulant use during sex and HIV risk behavior among Black urban MSM. Drug and Alcohol Dependence, 110(1–2), 30–37. doi: 10.1016/j.drugalcdep.2010.01.017.CrossRefPubMedPubMedCentralGoogle Scholar
  61. Morandini, J. S., Blaszczynski, A., Ross, M. W., Costa, D. S. J., & Dar-Nimrod, I. (2015). Essentialist beliefs, sexual identity uncertainty, internalized homonegativity and psychological wellbeing in gay men. Journal of Counseling Psychology, 62(3), 413–424. doi: 10.1037/cou0000072.CrossRefPubMedGoogle Scholar
  62. Mustanski, B., Andrews, R., Herrick, A., Stall, R., & Schnarrs, P. W. (2013). A syndemic of psychosocial health disparities and associations with risk for attempting suicide among young sexual minority men. American Journal of Public Health, 104(2), 287–294. doi: 10.2105/AJPH.2013.301744.CrossRefPubMedGoogle Scholar
  63. Newcomb, M. E., & Mustanski, B. (2010). Internalized homophobia and internalizing mental health problems: A meta-analytic review. Clinical Psychology Review, 30(20708315), 1019–1029.CrossRefPubMedGoogle Scholar
  64. Nicholson, W. D., & Long, B. C. (1990). Self-esteem, social support, internalized homophobia, and coping strategies of HIV + gay men. Journal of Consulting and Clinical Psychology, 58(6), 873–876. doi: 10.1037/0022-006X.58.6.873.CrossRefPubMedGoogle Scholar
  65. Pachankis, J. E. (2015). A transdiagnostic minority stress treatment approach for gay and bisexual men’s syndemic health conditions. Archives of Sexual Behavior, 44(7), 1843–1860. doi: 10.1007/s10508-015-0480-x.CrossRefPubMedPubMedCentralGoogle Scholar
  66. Pachankis, J. E., Hatzenbuehler, M. L., & Starks, T. J. (2014). The influence of structural stigma and rejection sensitivity on young sexual minority men’s daily tobacco and alcohol use. Social Science and Medicine, 103(24507912), 67–75.CrossRefPubMedPubMedCentralGoogle Scholar
  67. Parsons, J. T., Grov, C., & Golub, S. A. (2012). Sexual compulsivity, co-occurring psychosocial health problems, and HIV risk among gay and bisexual men: Further evidence of a syndemic. American Journal of Public Health, 102(1), 156–162.CrossRefPubMedPubMedCentralGoogle Scholar
  68. Parsons, J. T., Lelutiu-Weinberger, C., Botsko, M., & Golub, S. A. (2014). A randomized controlled trial utilizing motivational interviewing to reduce HIV risk and drug use in young gay and bisexual men. Journal of Consulting and Clinical Psychology, 82(1), 9–18. doi: 10.1037/a0035311.CrossRefPubMedGoogle Scholar
  69. Quinn, K., Dickson-Gomez, J., Di Franceisco, W., Kelly, J. A., St. Lawrence, J. S., Amirkhanian, Y. A., & Broaddus, M. (2015). Correlates of internalized homonegativity among black men who have sex with men. AIDS Education and Prevention, 27(3), 212–226. doi: 10.1521/aeap.2015.27.3.212.CrossRefPubMedPubMedCentralGoogle Scholar
  70. Radloff, L. S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401. doi: 10.1177/014662167700100306.CrossRefGoogle Scholar
  71. Reisner, S. L., Mimiaga, M. J., Bland, S., Skeer, M., Cranston, K., Isenberg, D., … Mayer, K. H. (2010). Problematic alcohol use and HIV risk among Black men who have sex with men in Massachusetts. AIDS Care, 22(5), 577–587. doi: 10.1080/09540120903311482.CrossRefPubMedGoogle Scholar
  72. Rosario, M., Schrimshaw, E. W., & Hunter, J. (2006). 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. AIDS Education and Prevention, 18, 444–460.CrossRefPubMedPubMedCentralGoogle Scholar
  73. Rosario, M., Schrimshaw, E. W., & Hunter, J. (2009). Disclosure of sexual orientation and subsequent substance use and abuse among lesbian, gay, and bisexual youths: Critical role of disclosure reactions. Psychology of Addictive Behaviors, 23, 175–184.CrossRefPubMedPubMedCentralGoogle Scholar
  74. Safren, S. A., O’Cleirigh, C. M., Bullis, J. R., Otto, M. W., Stein, M. D., & Pollack, M. H. (2012). Cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected injection drug users: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 80(3), 404–415. doi: 10.1037/a0028208.CrossRefPubMedPubMedCentralGoogle Scholar
  75. Schrimshaw, E. W., Siegel, K., Downing, M. J., Jr., & Parsons, J. T. (2013). Disclosure and concealment of sexual orientation and the mental health of non-gay-identified, behaviorally bisexual men. Journal of Consulting and Clinical Psychology, 81(1), 141–153. doi: 10.1037/a0031272.CrossRefPubMedGoogle Scholar
  76. Shoptaw, S., Weiss, R. E., Munjas, B., Hucks-Ortiz, C., Young, S. D., Larkins, S., … Gorbach, P. M. (2009). Homonegativity, substance use, sexual risk behaviors, and HIV status in poor and ethnic men who have sex with men in Los Angeles. Journal of Urban Health, 86(Suppl. 1), 77–92.CrossRefPubMedPubMedCentralGoogle Scholar
  77. Skinner, H. A. (1982). The Drug Abuse Screening Test. Addictive Behaviors, 7(4), 363–371.CrossRefPubMedGoogle Scholar
  78. Snell, W. E. (1998). The multidimensional sexual self-concept questionnaire. In C. M. Davis, W. L. Yarber, R. Bauseman, G. Schreer, & S. L. Davis (Eds.), Handbook of sexuality-related measures (pp. 521–524). Newbury Park, CA: Sage.Google Scholar
  79. Stall, R., Paul, J. P., Greenwood, G., Pollack, L. M., Bein, E., Crosby, G. M., … Catania, J. A. (2001). Alcohol use, drug use and alcohol-related problems among men who have sex with men: The Urban Men’s Health Study. Addiction, 96(11), 1589–1601. doi: 10.1046/j.1360-0443.2001.961115896.x.CrossRefPubMedGoogle Scholar
  80. Starks, T. J., Millar, B. M., Tuck, A. N., & Wells, B. E. (2015). The role of sexual expectancies of substance use as a mediator between adult attachment and drug use among gay and bisexual men. Drug and Alcohol Dependence, 153, 187–193.CrossRefPubMedPubMedCentralGoogle Scholar
  81. Traube, D. E., Schrager, S. M., Holloway, I. W., Weiss, G., & Kipke, M. D. (2013). Environmental risk, social cognition, and drug use among young men who have sex with men: Longitudinal effects of minority status on health processes and outcomes. Drug and Alcohol Dependence, 127(1–3), 1–7. doi: 10.1016/j.drugalcdep.2012.06.007.CrossRefPubMedGoogle Scholar
  82. Wagner, G., Brondolo, E., & Rabkin, J. (1997). Internalized homophobia in a sample of HIV + gay men, and its relationship to psychological distress, coping, and illness progression. Journal of Homosexuality, 32(2), 91–106. doi: 10.1300/J082v32n02_06.CrossRefGoogle Scholar
  83. Weber, G. N. (2008). Using to numb the pain: Substance use and abuse among lesbian, gay and bisexual individuals. Journal of Mental Health Counseling, 30(1), 31–48.CrossRefGoogle Scholar
  84. Weiss, B. J., & Hope, D. A. (2011). A preliminary investigation of worry content in sexual minorities. Journal of Anxiety Disorders, 25(2), 244–250. doi: 10.1016/j.janxdis.2010.09.009.CrossRefPubMedGoogle Scholar
  85. Wolitski, R., Jones, K., Wasserman, J., & Smith, J. (2006). Self-identification as “down low” among men who have sex with men (MSM) from 12 US cities. AIDS and Behavior, 10(5), 519–529. doi: 10.1007/s10461-006-9095-5.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Raymond L. Moody
    • 1
    • 2
  • Tyrel J. Starks
    • 1
    • 2
    • 3
  • Christian Grov
    • 1
    • 4
  • Jeffrey T. Parsons
    • 1
    • 2
    • 3
  1. 1.Center for HIV/AIDS Educational Studies and TrainingHunter College of the City University of New YorkNew YorkUSA
  2. 2.Health Psychology and Clinical Sciences Doctoral ProgramThe Graduate Center of the City University of New YorkNew YorkUSA
  3. 3.Department of PsychologyHunter College of the City University of New YorkNew YorkUSA
  4. 4.City University of New York School of Public HealthNew YorkUSA

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