扩展少数群体压力模型以纳入艾滋病毒呈阳性的男同性恋者和双性恋者的经历：对心理健康和性风险行为的纵向研究。
Extending the Minority Stress Model to Incorporate HIV-Positive Gay and Bisexual Men's Experiences: a Longitudinal Examination of Mental Health and Sexual Risk Behavior.
作者信息
Rendina H Jonathon, Gamarel Kristi E, Pachankis John E, Ventuneac Ana, Grov Christian, Parsons Jeffrey T
机构信息
Center for HIV/AIDS Educational Studies and Training (CHEST), Hunter College of the City University of New York (CUNY), New York, NY, USA.
Alpert Medical School of Brown University, Providence, RI, USA.
出版信息
Ann Behav Med. 2017 Apr;51(2):147-158. doi: 10.1007/s12160-016-9822-8.
BACKGROUND
Minority stress theory represents the most plausible conceptual framework for explaining health disparities for gay and bisexual men (GBM). However, little focus has been given to including the unique stressors experienced by HIV-positive GBM.
PURPOSE
We explored the role of HIV-related stress within a minority stress model of mental health and condomless anal sex.
METHODS
Longitudinal data were collected on a diverse convenience sample of 138 highly sexually active, HIV-positive GBM in NYC regarding sexual minority (internalized homonegativity and gay-related rejection sensitivity) and HIV-related stressors (internalized HIV stigma and HIV-related rejection sensitivity), emotion dysregulation, mental health (symptoms of depression, anxiety, sexual compulsivity, and hypersexuality), and sexual behavior (condomless anal sex with all male partners and with serodiscordant male partners).
RESULTS
Across both sexual minority and HIV-related stressors, internalized stigma was significantly associated with mental health and sexual behavior outcomes while rejection sensitivity was not. Moreover, path analyses revealed that emotion dysregulation mediated the influence of both forms of internalized stigma on symptoms of depression/anxiety and sexual compulsivity/hypersexuality as well as serodiscordant condomless anal sex.
CONCLUSIONS
We identified two targets of behavioral interventions that may lead to improvements in mental health and reductions in sexual transmission risk behaviors-maladaptive cognitions underlying negative self-schemas and difficulties with emotion regulation. Techniques for cognitive restructuring and emotion regulation may be particularly useful in the development of interventions that are sensitive to the needs of this population while also highlighting the important role that structural interventions can have in preventing these disparities for future generations.
背景
少数群体压力理论是解释男同性恋者和双性恋男性（GBM）健康差异最合理的概念框架。然而，对于HIV阳性的GBM所经历的独特压力源关注甚少。
目的
我们探讨了与HIV相关的压力在心理健康和无保护肛交的少数群体压力模型中的作用。
方法
收集了纽约市138名性活跃程度高、HIV阳性的GBM的纵向数据，这些数据来自一个多样化的便利样本，涉及性少数群体压力源（内化的同性恋消极态度和与同性恋相关的拒绝敏感性）、与HIV相关的压力源（内化的HIV污名和与HIV相关的拒绝敏感性）、情绪失调、心理健康（抑郁、焦虑、性强迫和性欲亢进症状）以及性行为（与所有男性伴侣和血清学不一致男性伴侣的无保护肛交）。
结果
在性少数群体压力源和与HIV相关的压力源中，内化污名都与心理健康和性行为结果显著相关，而拒绝敏感性则不然。此外，路径分析表明，情绪失调介导了两种内化污名形式对抑郁/焦虑症状、性强迫/性欲亢进以及血清学不一致的无保护肛交的影响。
结论
我们确定了行为干预的两个目标，这可能会改善心理健康并降低性传播风险行为——消极自我图式背后的适应不良认知以及情绪调节困难。认知重构和情绪调节技术在开发针对该人群需求的干预措施时可能特别有用，同时也凸显了结构性干预在为后代预防这些差异方面可以发挥的重要作用。
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