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. Author manuscript; available in PMC: 2024 Jan 1.
Published in final edited form as: J Gay Lesbian Ment Health. 2021 Aug 10;27(2):175–195. doi: 10.1080/19359705.2021.1957741

Associations between depressive esymptoms and identity-specific social support among Black men who have sex with men (BMSM) in Baltimore City, Maryland

Abigail K Winiker 1,§, Kristin E Schneider 2, Lauren Dayton 1, Carl A Latkin 1, Karin E Tobin 1
PMCID: PMC10281699  NIHMSID: NIHMS1761123  PMID: 37347093

Abstract

Introduction:

Depression and other adverse mental health outcomes are prevalent among Black men who have sex with men (BMSM). Social support can be protective against symptoms of depression, the effects of which may be amplified by experiences of a shared social identity.

Methods:

We explored the associations between BMSM-specific social support and depressive symptoms among a sample of 280 BMSM. We used chi-square and t-tests to examine bivariate associations between social support, depressive symptoms, and key correlates, and logistic regression to adjust the relationship between social support and depressive symptoms.

Results:

Most participants reported high (43.2%) or moderate (41.8%) levels of BMSM-specific social support, 38% reported depressive symptoms, and 47.6% were living with HIV. Adjusting for socioeconomic and structural vulnerabilities, health, and involvement in the gay community, high social support was associated with a marginal decrease in the odds of depressive symptoms compared to low social support.

Conclusions:

Results indicate that BMSM-specific social support is protective against depressive symptoms even in the context of other socioeconomic and structural vulnerabilities, suggesting that strengths-based interventions focused on building community and mutual support among BMSM may be valuable tools to prevent depression and promote positive mental health outcomes for members of this population.

Keywords: Black men who have sex with men, social support, depression, BMSM-specific social support

Introduction

Black men who have sex with men (BMSM) experience high levels of discrimination, homophobia, and stigmatization1,2, which are associated with disproportionately high rates of depression and other mental health conditions.3,4 A survey of 829 BMSM from 41 states across the US found rates of depression among participants to be as high as 33%, nearly five times that of the national rate for all adults.5–7 As members of racial and gender minority groups, BMSM experience the adverse impacts of both racism and homophobia, leading to greater disparities in mental health outcomes than those not at the intersection of multiple minority statuses.8,9 The mental health disparities experienced by BMSM are often exacerbated by societal prejudice, as homophobic attitudes in some Black communities contribute to increased social isolation, fear of rejection, discrimination, and violence.10–12 Depression among BMSM is correlated with increased HIV risk behaviors and transmission and greater rates of substance use, making it an important topic to address for both the physical and mental well-being of this population.5,13–15

Social support, operationalized as the frequency, duration, or type of supportive actions or resources one either perceives or receives from others, has been shown to mitigate experiences of depression.16 Within a diverse range of populations, social support has been associated with positive behavioral, social, and health outcomes, including reduced levels of depression and substance use, as well as greater psychological adaptation and improved clinical outcomes.16–23 Some researchers have further explored the role of shared social identity as it relates to social support. Shared social identity involves a perception of oneself as sharing an identity with others who possess similar traits or characteristics. Literature shows that individuals are more likely to be influenced by those with whom they share a social identity, and the experience of social support from people with a shared social identity has been linked to positive outcomes in health behaviors, clinical outcomes, and coping.24,25 Social support among people with a shared social identity may be particularly influential among sexual minority groups when mutually supportive, tight-knit communities are fostered. Research has demonstrated that community connectedness among sexual minority groups moderates the adverse impacts of stigmatization and prejudice on group members’ mental health outcomes.26,27 By evaluating and comparing oneself to similar others rather than members of the dominant culture, those in a minority group may be able to reappraise shared stressors and experience validation for their divergent identities and behaviors.28

Research has supported the positive role of community involvement among sexual minority groups. One study found that gay and bisexual men who reported higher levels of involvement in the gay community had better mental health outcomes.29 Another found that identification as a member of a gay community was protective against HIV risk.30 Among BMSM specifically, social support has been associated with positive behavioral and health outcomes. In one study, the presence of social support was associated with increased HIV testing and reductions in risky sexual behavior, such as engaging in unprotected anal intercourse.31 Scott and colleagues showed that social support among BMSM was associated with recency of HIV testing.32 Yet some studies report that BMSM may experience a lack of social support, even as compared with other racial groups of MSM.33,34 This can result in loneliness, social isolation, and depression,33,35,36 all of which in turn are associated with increased risky behavior, such as substance use or unprotected sexual activity.34,37

Given the high rates of stigma and discrimination experienced by BMSM, social support from individuals with whom a social identity is shared could be particularly impactful in improving mental health. Yet few studies of social support among BMSM have looked at the presence or absence of shared social identity to examine whether BMSM experience social support from other BMSM and if so, what the impacts may be. Accordingly, this study sought to examine the construct of BMSM-specific social support and explore its prevalence among a population of BMSM in Baltimore, Maryland as well as to assess the relationship between BMSM-specific social support and depressive symptoms, as measured by the CES-D.

Methods

The Social Networks and Prevention (SNAP) Study

Data for this analysis came from the six-month follow-up visit of the SNAP study, a prospective randomized control trial of a sexual health behavioral intervention focused on reducing HIV transmission behaviors among BMSM in Baltimore, Maryland. Participants were recruited from the community via posters/physical advertisements and online postings on MSM-specific listservs and social media sites. Interested participants were screened for eligibility. Participants were required to be at least 18 years old, identify as cis-gender Black or African American men, have had sex with at least one male partner in the past six months, and have had at least one episode of any type of condomless sex in the past six months. These criteria were established in accordance with the intervention aims to recruit a sample of sexually active men to reduce HIV transmission behaviors. Eligible individuals provided written informed consent. Study participants completed behavioral questionnaires at baseline, six months, and twelve months. Data used in this analysis comes from the six-month survey (85% retention from baseline). Participants received $40.00 for the completion of each survey. The SNAP study was approved by the Johns Hopkins Bloomberg School of Public Health Institutional Review Board.

Measures

BMSM-Specific Social Support.

BMSM-specific social support was measured via a six-item scale developed by the investigators with five response categories (1-strongly agree, 2-agree, 3-neither agree nor disagree, 4-disagree, 5-strongly disagree). The questions assessed both the presence of and satisfaction with social support from other BMSM (Table 1). The scale had high internal reliability (Cronbach’s alpha = 0.92). To examine the distribution of BMSM-specific social support in our sample, we averaged responses to the six items (range: 1–5). Figure 1 displays the distribution of these average scores. As these responses were not normally distributed and seemed to cluster, we selected two cut-points informed by the distribution and the interpretation of the scores. The “high support” category included participants with an average BMSM-specific social support score of less than 2.0, indicating an average score of more than ‘agree.’ The moderate support includes those with an average BMSM-specific social support score between 2.0 and 3.0 indicating that, on average, participants ranked their support on the six items included in the scale between ‘agree’ and ‘neither agree nor disagree.’ Participants in the low support category include those with scores greater than 3.0, meaning an average score between ‘neither agree nor disagree’ and ‘strongly disagree.’

Table 1.

BMSM-specific Social Support Questionnaire Response Distribution and Internal Reliability

Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Item-Test Correlation Item-Rest Correlation Scale Alpha with Item Removed
I am happy with the friendships I have with other Black MSM 107 (38.21%) 108 (38.57%) 36 (12.86%) 19 (6.79%) 10 (3.57%) 0.83 0.75 0.91
I have peers who are Black MSM that I can do social or fun activities with 100 (35.71%) 129 (46.07%) 20 (7.14%) 20 (7.14%) 11 (3.93%) 0.88 0.82 0.90
In a crisis, I would have the support I need from other Black MSM 82 (29.29%) 120 (42.86%) 41 (14.64%) 22 (7.86%) 15 (5.36%) 0.86 0.79 0.91
I know other Black MSM who will listen and understand me when I need to talk 95 (33.93%) 131 (46.79%) 24 (8.57%) 20 (7.14%) 10 (3.57%) 0.87 0.81 0.90
When I need help right away, I know other Black MSM that I can call on 90 (32.14%) 123 (43.93%) 30 (10.71%) 25 (8.93%) 12 (4.29%) 0.88 0.81 0.90
I have more than one friend who is a Black MSM 107 (38.21%) 129 (46.07%) 11 (3.93%) 20 (7.14%) 13 (4.64%) 0.77 0.67 0.92
Total Scale Alpha 0.92
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Figure 1.

Figure 1.

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Distribution of Average BMSM-Specific Social Support Scores.

Depressive Symptoms.

Depressive symptoms were measured by the twenty-item Center for Epidemiological Studies Depression Scale (CES-D) which assesses presence and frequency of depressive symptoms.38 We created a binary indicator variable, using the standard cutoff of scores ≥16 indicating risk of clinical depression.

Demographic Characteristics.

Participants reported their age (in years), level of education (<high school, high school equivalent, >high school; n=1 missing), and whether they were in a relationship (yes/no).

Socioeconomic and Structural Vulnerabilities.

Participants reported whether they had been unemployed in the past 6 months (yes/no), homeless in the past 6 months (yes/no), how often they worried about money in the past 6 months (never, once in a while, somewhat/fairly often), if they had been to prison/jail in the past 6 months (yes/no), and whether they had health insurance (yes/no).

Health Indicators.

Participants reported their self-rated overall health (poor/fair, good, very good/excellent). Participants also reported if they had been diagnosed with HIV (yes/no; n=7 missing). They also completed the 10-item Alcohol Use Disorders Identification Test (AUDIT).39,40 From the AUDIT scores, we created a binary indicator for probable hazardous drinking based on recommended AUDIT cutoffs (<8 vs ≥8).

Sexual Attraction.

We assessed sexual attraction by asking participants whether they were attracted to men, women, or both.

Involvement in the Gay Community.

Participants were asked about involvement in the gay community, including how often they had attended gay organizational activities or read gay-oriented publications (never, once a month or less, several times a month, about once a week, and several times a week/daily). These responses were condensed to never/ever due to small cell sizes.

Analysis

To assess associations between the correlates of interest, BMSM-specific social support, and depressive symptoms, chi-square statistics were used for categorical variables and ANOVA/t-tests were used for continuous ones. Then, using the correlates significantly associated with either BMSM-specific social support or depressive symptoms, we estimated bivariable logistic regression models assessing associations with depressive symptoms and a multivariable logistic regression model assessing the relationship between BMSM-specific social support and depressive symptoms, adjusting for other correlates. Any missing responses were removed listwise from the regression models. Stata 14 was used for all analyses.41

Results

Sample characteristics.

The sample included 280 participants, most of whom indicated having high (43.2%) or moderate (41.8%) levels of BMSM-specific social support (Table 2). A minority (15.0%) reported low BMSM-specific social support. About 38% were currently experiencing depressive symptoms. 29.6% were under age 30, 48.6% between 31–50, and 21.8% were between 51–60. One-fifth (20.1%) of participants had less than a high school education, 39.1% had a high school equivalent education, and 40.9% had attended some college or more. About one-quarter (27.5%) were currently in a relationship. Nearly three-quarters (72.5%) of the sample had been unemployed in the past six months, one fifth (18.2%) was currently experiencing homelessness, and 13.2% had been in prison or jail within the past six months. The majority of participants (86.4%) had health insurance. Most participants worried about money either once in a while (26.8%) or sometimes/often (40.7%). Self-rated health status was relatively evenly distributed across categories: 37.9% very good/excellent, 28.9% good, and 33.2% fair/poor. AUDIT scores indicated 22.1% of the sample engaged in hazardous alcohol use. Nearly 48% of the sample were HIV positive. Half of participants reported being attracted to men, 13.2% reported attraction to women, and 36.8% reported attraction to both men and women. About one-third (35.8%) of participants had ever attended gay-oriented organizational activities and half (49.5%) read gay-oriented publications.

Table 2.

Correlates of BMSM-specific social support and depressive symptoms among a sample of BMSM in Baltimore, Maryland; N=280.

Total (n = 280) High Support (n = 121) Moderate Support (n = 117) Low Support (n = 41) Chi2, p CESD <16 (n = 174) CESD ≥16 (n = 106) Chi2, p
Demographic Characteristics
Age, Mean (SD) 39.4 (11.8) 38.8 (12.0) 40.2 (11.8) 38.6 (11.4) 0.52, 0.598a 39.5 (12.1) 39.2 (11.3) 0.04, 0.841b
Education
 < high school 56 (20.1%) 18 (14.9%) 26 (22.2%) 12 (29.3%) 7.87, 0.097 28 (16.2%) 28 (26.4%) 6.82, 0.031
 High school or equivalent 109 (39.1%) 48 (39.7%) 42 (35.9%) 19 (46.3%) 65 (37.6%) 44 (41.5%)
 More than high school 114 (40.9%) 55 (45.4%) 49 (41.9%) 10 (24.4%) 80 (46.2%) 34 (32.1%)
In a Relationship 77 (27.5%) 37 (30.6%) 33 (28.2%) 7 (16.7%) 3.08, 0.215 49 (28.2%) 28 (26.4%) 0.10, 0.751
Socioeconomic and Structural Vulnerabilities
Experienced Unemployment 203 (72.5%) 82 (67.8%) 88 (75.2%) 33 (78.6%) 2.57, 0.277 115 (66.1%) 88 (83.0%) 9.47, 0.002
Experienced Homelessness 51 (18.2%) 21 (17.4%) 21 (18.0%) 9 (21.4%) 0.36, 0.837 19 (10.9%) 32 (30.2%) 16.42, <0.001
Has Health Insurance 242 (86.4%) 106 (87.6%) 101 (86.3%) 35 (83.3%) 0.49, 0.784 146 (83.9%) 96 (90.6%) 2.49, 0.115
Prison/Jail 37 (13.2%) 9 (7.4%) 22 (18.8%) 6 (14.3%) 6.75, 0.034 19 (10.9%) 18 (17.0%) 2.11, 0.146
Worried about Money
 Never 91 (32.5%) 47 (38.8%) 36 (30.8%) 8 (19.0%) 9.92, 0.042 68 (39.1%) 23 (21.7%) 14.99, 0.001
 Once in awhile 75 (26.8%) 36 (29.8%) 28 (23.9%) 11 (26.2%) 50 (28.7%) 25 (23.6%)
 Somewhat/fairly often 114 (40.7%) 38 (31.4%) 53 (45.3%) 23 (54.8%) 56 (32.2%) 58 (54.7%)
Health Variables
Self-Reported Overall Health
 Very good/ Excellent 106 (37.9%) 43 (35.5%) 50 (42.7%) 13 (31.0%) 2.48, 0.649 79 (45.4%) 27 (25.5%) 15.63, <0.001
 Good 81 (28.9%) 35 (28.9%) 32 (27.4%) 14 (33.3%) 51 (29.3%) 30 (28.3%)
 Poor/Fair 93 (33.2%) 43 (35.5%) 35 (29.9%) 15 (35.7%) 44 (25.3%) 49 (46.2%)
Hazardous Alcohol Use 62 (22.1%) 21 (17.4%) 25 (21.4%) 16 (38.1%) 7.85, 0.020 34 (19.5%) 28 (26.4%) 1.81, 0.179
HIV Positive 130 (47.6%) 68 (57.6%) 49 (43.0%) 13 (31.7%) 9.88, 0.007 85 (50.0%) 45 (43.7%) 1.02, 0.312
Sexual Attraction
 Men 140 (50.0%) 78 (64.5%) 53 (45.3%) 9 (21.4%) 42.46, <0.001 93 (53.5%) 47 (44.3%) 3.09, 0.213
 Women 37 (13.2%) 4 (3.3%) 17 (14.5%) 16 (38.1%) 19 (10.9%) 18 (17.0%)
 Both 103 (36.8%) 39 (32.2%) 47 (40.2%) 17 (40.5%) 62 (35.6%) 41 (38.7%)
Involvement in the Gay Community
Attended Organizational Activities 100 (35.8%) 60 (49.6%) 36 (30.8%) 4 (9.8%) 23.38, <0.001 66 (37.9%) 34 (32.4%) 0.99, 0.349
Read Gay-Oriented Publications 138 (49.5%) 77 (64.2%) 54 (46.2%) 7 (16.7%) 28.96, <0.001 88 (50.6%) 50 (47.6%) 0.23, 0.632
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a

Test statistics reported are F and p-value from a one-way ANOVA test.

b

Test statisics reported are t and p-value from t-test.

Correlates of BMSM-specific Social Support and Depressive Symptoms

The correlates of BMSM-specific social support and depressive symptoms are summarized in Table 2. A greater proportion of men with moderate and high BMSM-specific social support reported higher education status, being in a relationship, being HIV positive, being attracted to men only, attending gay-oriented organizational events, and reading gay-oriented publications. A greater proportion of men who scored low in BMSM-specific social support reported having been to jail in the past six months, worrying about money, and engaging in hazardous alcohol use. Depressive symptoms were associated with less education, unemployment, homelessness, worrying about money, and worse self-rated health.

Regression Results

In the unadjusted model, high (OR: 0.34, 95% CI: 0.17, 0.71) and moderate (OR: 0.45, 95% CI: 0.22, 0.93) BMSM-specific social support were associated with decreased odds of depressive symptoms (Table 3). Having more than a high school education (compared to less than high school) was also protective against depressive symptoms (OR: 0.43, 95% CI: 0.22, 0.82). Also in unadjusted models, unemployment (OR: 2.51, 95% CI: 1.38, 4.55), homelessness (OR: 3.53, 95% CI: 1.88, 6.63), worrying about money often (OR: 3.06, 95% CI: 1.68, 5.57), being in good (OR: 1.72, 95% CI: 0.92, 3.22) or fair/poor (OR: 3.26, 95% CI: 1.79, 5.92) compared to excellent health, and being attracted to women (OR: 1.87, 95% CI: 0.90, 3.91) compared to only men were all associated with increased odds of depressive symptoms. In the multivariable model, high BMSM-specific social support was associated with a marginal decrease in the odds of depressive symptoms (aOR: 0.43, 95% CI: 0.17, 1.05) compared to low BMSM-specific social support. Homelessness (aOR: 2.29, 95% CI: 1.09, 4.82), worrying about money often (aOR: 2.03, 95% CI: 1.02, 4.06), and fair/poor self-rated health (aOR: 2.82, 95% CI: 1.44, 5.52) all remained associated with increased odds of depressive symptoms in the adjusted model.

Table 3.

Bivariate and multivariate logistic regression results for correlates of depressive symptoms among BMSM in Baltimore, Maryland (N=280)

Bivariable Models Multivariable Model
OR 95% CI p-value aOR 95% CI p-value
BMSM Social Support
 High 0.34 0.17, 0.71 0.004 0.43 0.17, 1.05 0.064
 Moderate 0.45 0.22, 0.93 0.030 0.54 0.24, 1.26 0.154
 Low REF -- -- REF -- --
Education
 Less than high school REF -- -- REF -- --
 High school or equivalent 0.68 0.35, 1.29 0.238 0.68 0.32, 1.44 0.311
 More than high school 0.43 0.22, 0.82 0.011 0.60 0.28, 1.31 0.199
Experienced Unemployment 2.51 1.38, 4.55 0.003 1.62 0.82, 3.22 0.168
Experienced Homelessness 3.53 1.88, 6.63 <0.001 2.29 1.09, 4.82 0.028
Prison/Jail 1.67 0.83, 3.35 0.149 1.31 0.57, 2.97 0.526
Worried About Money
 Never REF -- -- REF -- --
 Once in awhile 1.48 0.75, 2.90 0.256 1.50 0.71, 3.16 0.283
 Somewhat/fairly often 3.06 1.68, 5.57 <0.001 2.03 1.02, 4.06 0.045
Self-Reported Overall Health
 Very good/ Excellent REF -- -- REF -- --
 Good 1.72 0.92, 3.22 0.090 1.48 0.72, 3.04 0.284
 Poor/Fair 3.26 1.79, 5.92 <0.001 2.82 1.44, 5.52 0.003
Hazardous Alcohol Use 1.48 0.83, 2.62 0.180 1.16 0.59, 2.27 0.663
HIV Positive 0.78 0.47, 1.27 0.312 0.80 0.43, 1.50 0.487
Attraction
 Men REF -- -- REF -- --
 Women 1.87 0.90, 3.91 0.093 0.92 0.35, 2.42 0.860
 Both 1.31 0.77, 2.22 0.318 0.90 0.45, 1.77 0.751
Attended Gay Organizational Activities 0.78 0.47, 1.31 0.349 1.11 0.57, 2.17 0.759
Read Gay-Oriented Publications 0.89 0.55, 1.44 0.632 1.02 0.52, 1.97 0.959
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Discussion

We aimed to examine the relationship between BMSM-specific social support and depressive symptoms among a sample of BMSM in Baltimore, Maryland. Among the 280 participants surveyed, most reported high or moderate levels of BMSM-specific social support. In the unadjusted model, having high or moderate BMSM-specific social support was protective against depressive symptoms compared to low support. When adjusting for socioeconomic and structural vulnerabilities and health characteristics, high but not moderate support remained marginally significant. Our findings indicate that BMSM-specific social support is a protective factor against depressive symptoms in this population, even in the face of substantial structural disadvantage. Thus, strengths-based interventions to promote mutual support and group identification among BMSM may be a valuable public health tool to reduce the high burden of depression among BMSM.

Within our sample, high BMSM-specific social support was common. This is noteworthy, as research has found rates of social isolation to be high within the BMSM community.34,42,43 The Social Stress Theory posits that members of marginalized groups such as BMSM face greater stressors yet have access to fewer support systems and resources than those who do not experience discrimination and stigma.44 We therefore anticipated relatively low rates of BMSM-specific social support in our sample. However, these expectations were not borne out by our data. The high level of BMSM-specific social support observed could in part be due to sampling bias: we recruited participants through flyers posted at locations where BMSM are known to frequent, used word of mouth/network recruitment, and distributed study materials at sexual minority-centric locations. These methods likely disproportionally reached individuals who are connected with other BMSM and who participate actively in the gay/queer community over those who do not. While many BMSM may be associated with similar others, future studies should utilize recruitment techniques that do not rely on participants being socially connected to the gay community.

While social support has been previously associated with improved mental health in many contexts, it is important to think about the added component of identity-specific social support measured in this study. Extensive research shows ties between individuals’ physical and mental health and their social identities.45 Feeling like a part of a group can facilitate resilience and adaptive psychological functioning, increasing individuals’ experiences of belonging, self-esteem, purpose, and meaning.46–48 However, for members of minority groups, access to social support can be limited by societal exclusion or rejection. The Minority Stress Theory provides a framework to conceptualize how cumulative experiences of prejudice and discrimination in response to one’s identity are associated with an increase in adverse psychological and physical health outcomes.27,49 Research exploring pathways from minority stress to health posit that the disproportionately high burden of stigma and discrimination faced by many members of marginalized minority groups impact psychological processes, leading to emotional dysregulation, increased shame, and lowered self-esteem.50 This, in turn, is associated with increased levels of depression, anxiety, substance use, and HIV risk behaviors.27,50,51 Further, research on intersectionality has demonstrated that those at the intersection of multiple stigmatized identities may face even greater disparities in mental and physical health outcomes due to the compounding experiences of discrimination and stigma they may face in response to these multiple minority statuses.52–54 Accordingly, BMSM may be at a uniquely high risk of minority stress-related outcomes as members of both sexual and racial minority groups, facing the additive adverse impacts of racism and homophobia.55 Minority stress can be additionally harmful by reducing access to resources or coping mechanisms, such as social connectedness or support seeking behaviors, that have been shown to help buffer against the negative impacts of those stressors.56–59 Yet given that minority identification can be as a source of strength if associated with opportunities to build group membership, understanding the presence of social support among members of intersecting minority groups may be a key means through which to foster coping, strength, and resilience within highly marginalized populations.

Among those vulnerable communities who experience high rates of stigma and discrimination due to these intersecting minority identities, a sense of shared social identity, or identity-specific support, may therefore be an important mechanism through which to promote positive mental health. Studies have shown that the strength with which a person experiences group membership is associated with improvements in well-being.47,60,61 A review of studies on diverse social groups demonstrated that, in all cases, higher levels of social identification were associated with lower levels of depression.45,62 This reflects the findings in this study that participation in the gay community was not alone associated with reduced depressive symptoms: simply participating in a community without commensurate support or an accompanying sense of identification may be insufficient to benefit mental health. Given these findings, it is important to consider ways in which a sense of group identification can be both fostered and strengthened among vulnerable groups such as BMSM.

Living with HIV was associated with higher BMSM-specific support. While Black citizens comprise 62% of Baltimore City’s population, they represent 82% of those infected with HIV in the city.63 The Baltimore City Health Department has engaged in a wide range of HIV prevention initiatives targeting at-risk community members. Multidisciplinary, community-based health education and behavior change campaigns initiated by the Baltimore City Health Department have focused upon addressing the multifactorial barriers to HIV prevention and care, including stigma and discrimination. Because of the disproportionate burden of HIV among Black community members and MSM in Baltimore City, BMSM are considered a key population for many such programs.64 Greater community-level programming to address HIV risk factors and stigma may foster a sense of unity and social support among some BMSM. However, those living with HIV may therefore have more opportunities to develop social support and friendships among other BMSM than those who are HIV negative through these city initiatives, underscoring the importance of providing these resources to all BMSM regardless of HIV status.

Multiple strategies have been used, and should be expanded upon, to promote community and social support among BMSM. Safe spaces are environments designed specifically to allow members of minority or at-risk groups to feel comfortable being themselves.65 They offer group members a physical place in which to spend time together without facing external stressors such as discrimination, racism, or aggression. Safe spaces promote empowerment and mobilization against stigma and discrimination, encouraging strengths-based personal growth and promoting the development of supportive, mutually reinforcing peer networks.66 Safe spaces can be used to facilitate an exploration among BMSM of the many complex self and societal perceptions of their racial and gender identities, which has been shown to foster both social support and a sense of community.66 Thus, safe spaces have immense potential in improving health outcomes and reducing HIV risk among BMSM.67 Another means of fostering community is through mentorship programs. Among minority communities, mentorship has been shown to promote academic achievement, resilience, self-esteem, and social skills and reduce delinquency and substance use.68,69 Mentors can provide an important source of social support and promote positive identity and self-esteem development, which may be particularly meaningful among members of racial and sexual/gender minority groups.70 These findings support the importance of expanding upon current evidence-based models for health prevention among BMSM, broadening their reach to promote mentorship and the fostering of social support.

Researchers have also begun exploring internet-based strategies to build social support in BMSM communities. Social media platforms have been used to promote HIV testing, linkage to care, and other health behaviors among vulnerable communities,71,72 but these platforms can also provide opportunities for individuals to seek emotional support, comfort, and friendship from other members of their identity-specific communities.73–76 Such forums provide people with a place in which they can connect with peers, gain self-acceptance, discuss community issues, access resources, and solidify a sense of identity.77–80 Research has demonstrated the potential for an internet-based social media platform to address social isolation and build community among BMSM while simultaneously promoting HIV prevention and reducing risky sexual behavior.37 Further exploration of online strategies holds potential for benefitting social connectedness and mental health among BMSM.

This study explored BMSM-specific social support and depressive symptoms, highlighting the important role of social support among BMSM in improving mental health outcomes. However, there are some study limitations to consider. These results are cross-sectional, and thus no assumptions about directional causality can be made. Further, the majority of Baltimore City’s population is Black: thus, the experiences of this population of BMSM may not represent those residing in other settings in which Black communities are less prevalent. Additionally, the city of Baltimore has a long history of programs established to address disparities in HIV transmission, many of which target the BMSM community. It may therefore be that members of our sample had more opportunities through which to foster social support than those residing in other cities or communities. Finally, future research should explore more nuanced and comprehensive measures of involvement in the gay community, as our measurement of this concept was limited to two binary indicators that likely do not capture its full scope. Nonetheless, it is important to recognize the potential role of BMSM-specific social support in reducing depressive symptoms among this population and consider ways to foster and strengthen friendship and community between members of this highly stigmatized group.

Acknowledgements:

We would like to acknowledge the participants of the SNAP study and thank the members of the Lighthouse team; Marlesha Whittington, Charles Moore, Denise Mitchell, Tonya Johnson, and Gelores Moore for their dedication and hard work. This work was supported by the National Institute on Drug Abuse under grant numbers R01DA031030 and R01DA040488. All research activities were reviewed and approved by the Johns Hopkins School of Public Health Institutional Review Board.

Footnotes

Author Disclosure Statement:

No competing financial interests exist.

References

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