Abstract
Individuals who disclose their sexual orientation are more likely to also disclose their HIV status. Disclosure of HIV-serostatus is associated with better health outcomes. The goal of this study was to build and test comprehensive models of sexual orientation that included 8 theory-informed predictors of disclosure to mothers, fathers, and closest friends in a sample of HIV-positive Latino gay and bisexual men. US acculturation, gender non-conformity to hegemonic masculinity in self-presentation, comfort with sexual orientation, gay community involvement, satisfaction with social support, sexual orientation and gender of the closest friend emerged as significant predictors of disclosure of sexual orientation.
Keywords: sexual orientation disclosure, Latino MSM, HIV-positive, acculturation
Background
Significant factors affecting disclosure of HIV-serostatus among HIV-positive Latino MSM have been identified (Padilla et al., 2008; Zea, Reisen, Poppen, Bianchi, & Echeverry, 2007). However, our understanding of factors that influence disclosure of sexual orientation has lagged behind (García, 2004). Understanding factors that influence the latter is important because HIV-positive Latino MSM who disclose their sexual orientation are also more likely to disclose their HIV status (Marks et al., 1992). Moreover, disclosure of HIV-serostatus is associated with better health outcomes (Ullrich, Lutgendorf, & Stapleton, 2002).
Factors related to gay identification, such as comfort with sexual orientation (Kertzner, Meyer, Frost, & Stirratt, 2009), involvement in the gay community (Zea et al., 2007), and gay-related victimization (Lasser, & Tharinger, 2003) are associated to disclosure of sexual orientation. Rosario, Schrimshaw, and Hunter (2008) found positive associations among comfort with sexual orientation, involvement in lesbian, gay, bisexual, and transgender (LGBT)-related social activities, and disclosure of sexual orientation among youth. However, experiences of gay-related victimization can negatively impact disclosure of sexual orientation (Day & Schoenrade, 2000). Garnets, Herek, and Levy (2003) suggest that LGBT individuals who have been victimized face double disclosure, being gay and a victim, which can push some back into the closet. While comfort with sexual orientation and involvement in the gay community may foster disclosure of sexual orientation, gay-related victimization may preclude it.
Cultural features (e.g., language, gender norms) may also influence disclosure of sexual orientation. Some Latino men with more hegemonic masculinity and who engage in insertive anal sex with other men may not even identify as gay (Carballo-Diéguez, & Dolezal, 1994), making disclosure of sexual orientation irrelevant. Thus, Latino notions of masculinity may preclude disclosure of sexual orientation. Conversely, affiliation with U.S. culture provides a new language, social context, and more flexible gender norms that foster disclosure of sexual orientation (García, 2004).
Characteristics of the targets of disclosure may also influence disclosure of sexual orientation. For instance, Beals, Peplau, and Gable (2009) found that gay and lesbian individuals disclose to a female friend before than to any other target. Gay friends are the most frequent target of disclosure, followed by heterosexual friends, and family members.
The purpose of this study was to examine factors associated with disclosure of sexual orientation to mothers, fathers, and friends among HIV positive Latino gay and bisexual men (GBM). In addition to the five factors previously discussed, time since HIV diagnosis (Zea et al., 2007), quality of life (Butler et al., 2009), and satisfaction with social support (Wohl et al., 2011; Zea, Reisen, Poppen, Bianchi, & Echeverry, 2005) were included in the analyses because they also predict disclosure of HIV status; a total of eight theory-informed predictors were considered.
Methods
We recruited 300 HIV-positive Latino GBM in New York City (66 %), Washington, DC (25%), and Boston (9%) from HIV/AIDS services, community organizations, hospitals, and from organizations that offered HIV testing; average time HIV+ was 7.6 years. To minimize researcher influence, participants completed the survey on a touch-screen laptop equipped with Audio-Computer Assisted Self-Interview technology (ACASI). The majority (81%) took the survey in Spanish. Inclusion criteria were being Latino/Hispanic, 18 years or older, HIV – positive, biologically male, and gay or bisexual. Participants were compensated $50 for their time. The George Washington University IRB approved the study.
Participants mean age was 40 years (SD = 8.8), range 22 to 62 years. Self-reported sexual orientation was 68% gay, 15% bisexual, 3% straight, and 3% transgender/transsexual. Table 1 includes additional demographic information.
Table 1.
Demographic Characteristics of the Sample (N = 300)
| Characteristic | N | (%) |
|---|---|---|
| Educational level (N= 298) | ||
| Did not finish grammar/elementary school | 25 | 8.4 |
| Less than high school degree | 42 | 14.1 |
| Completed high school or GED | 82 | 27.5 |
| Trade or vocational school | 14 | 4.7 |
| Some college | 59 | 19.8 |
| Completed college | 58 | 19.5 |
| Some graduate school or graduate degree | 18 | 6.0 |
| Monthly income (N = 298) | ||
| Less than $400 | 123 | 41.3 |
| Between $401and $800 | 88 | 29.5 |
| Between $801and $1600 | 57 | 19.1 |
| Between $1601 and $2400 | 20 | 6.7 |
| More than $2400 | 20 | 6.7 |
| Employment Status (N = 298) | ||
| Full-time | 64 | 21.5 |
| Part-time | 55 | 18.5 |
| Unemployed | 74 | 24.8 |
| Disabled | 84 | 28.2 |
| Retired | 6 | 2.0 |
| Self-employed | 15 | 5.0 |
| Region of Origin (N = 300) | ||
| Caribbean | 94 | 31.3 |
| Central America | 41 | 13.7 |
| Mexico | 32 | 10.7 |
| South America | 103 | 34.3 |
| Spain | 3 | 1.0 |
| USA | 27 | 9.0 |
Measures
Table 2 presents mean scale scores, response options ranges, and internal consistency reliabilities of measures used in final models.
Table 2.
Mean, standard deviation, and α-coefficient of scale for each independent variable
| Subscale | N | M | SD | Range | α |
|---|---|---|---|---|---|
| U. S. acculturation | 300 | 2.71 | 0.63 | 1 – 4 | 0.85 |
| Comfort with sexual orientation | 298 | 4.36 | 0.86 | 1 – 5 | - |
| Gender non-conformity | 300 | 3.55 | 0.90 | 1 – 4 | 0.75 |
| Gay community involvement | 300 | 3.71 | 0.81 | 1 – 5 | 0.78 |
| Gay-related victimization | 300 | 2.14 | 0.68 | 1 – 4 | 0.77 |
| Satisfaction with social support | 300 | 2.63 | 0.71 | 1 – 4 | 0.89 |
Acculturation was measured with an adapted 20-item version of the Abbreviated Multidimensional Acculturation Scales (AMAS) (Zea, Asner-Self, Birman, & Buki, 2003). The scale has two subscales, which assess U.S. and Latino acculturation.
Gender non-conformity in self-presentation was measured with a four-item scale of gender non-conformity to hegemonic masculinity in self-presentation (Reisen, Brooks, Zea, Poppen, & Bianchi, 2011) developed for the current study.
Comfort with sexual orientation was measured having participants choose an orientation from a list, then rate their comfort with it on a five-point Likert scale.
Gay community involvement was assessed with a seven-item scale that included items developed for the study and items based on Luhtanen and Crockers’s (1992) collective self-esteem scale, modified for gay males.
Gay discrimination was assessed with a seven-item scale (Díaz, Ayala, Bein, Henne, & Marín, 2001) that includes experiences of victimization due to sexual orientation.
Time since HIV diagnosis was calculated by subtracting date of HIV diagnosis from survey administration date.
Quality of life was assessed with an eleven-item scale with items adapted from the HIV/AIDS-Targeted Quality of Life (HAT-QoL) (Holmes, & Shea, 1993).
Satisfaction with social support was assessed with the quality of social support scale (QSSS) (Goodenow, Reisine, & Grady, 1990), a nine-item scale that assesses perceived support from members of the social network.
Gender and sexual orientation of closest friend included gender of closest friend and sexual orientation of the closest male friend. Closest friends were classified as “gay male,” “heterosexual male” or “female” friends.
Disclosure of sexual orientation was assessed with two questions per target of disclosure (i.e., father, mother, closest friend): “Does your (e.g., father) know that you have sex with other men?” Response options were ‘yes’ and ‘no’. Participants who answered ‘yes’ were asked a second question: “who told your (e.g., father) you have sex with men?” Response options “I told him” and “someone else told him with my permission” were assigned to the “disclosure” group. “No” responses to the first question and all other responses to the second (i.e., “someone else told him without my permission”, “someone else told him anonymously”, “he found out some other way”) were assigned to the “no disclosure” group.
Data Analysis
Statistical models for each target were tested using proc GLMSELECT set to a standard stepwise selection with “entry” and “removal” criteria set at p < .15 (Cohen, 2006). All models contained the same variables, except for the one to closest friends which also included the friend’s gender-sexual orientation variable. The resulting models were tested with multiple logistic regressions (see Table 3).
Table 3.
Logistic regressions predicting disclosure of sexual orientation
| Overall Model | −2 log L
|
Wald’s χ2 | ||
|---|---|---|---|---|
| Intercept only | Intercept and covariates | |||
| Disclosure to the mother | 291.30 | 270.01 | 26.76d | |
| Disclosure to the father | 156.61 | 126.74 | 21.79c | |
| Disclosure to the closest friend | 341.72 | 282.44 | 46.58d | |
|
| ||||
| Parameters of the models | Odds ratio | Parameter Estimate | Wald’s χ2 | 95% CI |
|
| ||||
| Disclosure to the mother (N = 245) | ||||
| Intercept | −6.08 | 19.36d | ||
| U.S. acculturation | 1.94 | 0.66 | 7.09b | 1.19 – 3.15 |
| Gender non-conformity | 0.41 | 0.44 | 7.41b | 1.28 – 4.61 |
| Comfort with sexual orientation | 1.82 | 0.60 | 7.49b | 1.18 – 2.79 |
| Gay-related discrimination | 0.69 | −0.37 | 2.47 | 0.43 – 1.10 |
| Satisfaction with social support | 1.66 | 0.51 | 5.33a | 1.08 – 2.56 |
| Disclosure to the father (N = 183) | ||||
| Intercept | −10.79 | 21.39d | ||
| U.S. acculturation | 2.26 | 0.82 | 5.24a | 1.12 – 4.55 |
| Gender non-conformity | 0.32 | 0.58 | 5.59a | 0.12 – 0.82 |
| Comfort with sexual orientation | 2.21 | 0.79 | 3.68a | 0.98 – 4.97 |
| Satisfaction with social support | 2.90 | 1.07 | 9.27b | 1.46 – 5.76 |
| Disclosure to the closest friend (N = 300) | ||||
| Intercept | −4.76 | 17.25d | ||
| U.S. acculturation | 1.57 | 0.45 | 3.35+ | 0.97 – 2.54 |
| Gay community involvement | 2.23 | 0.80 | 17.50d | 1.53 – 3.25 |
| Satisfaction with social support | 1.58 | 0.46 | 4.44a | 1.03 – 2.43 |
| Closest Friend (CF) | ||||
| ◆CF: heterosexual male vs. female | 0.31 | −1.09 | 11.59c | 0.11 – 0.87 |
| ◆CF: gay male vs. female | 2.45 | 0.99 | 20.57d | 1.24 – 4.85 |
p < .1,
p < .05,
p < .01,
p < .001,
p < .0001
Findings
Most participants disclosed to closest friend (74%), followed by mother (28%) and father (15%), χ2 = 28.4, p < .0001. Men who disclosed to their mothers were more likely to disclose to their fathers, p < .0001.
Higher levels of U.S. acculturation, gender non-conformity to hegemonic masculinity in self-presentation, comfort with sexual orientation, and satisfaction with social support were associated with disclosure of sexual orientation to mother and father.
Greater involvement in the gay community, greater satisfaction with social support, and having a gay male friend were associated with disclosure to closest friend. Having a heterosexual male friend was negatively associated with disclosure. Higher levels of U.S. acculturation were only marginally associated with more disclosure to the closest friend
Discussion
This study investigated predictors of disclosure of sexual orientation to mother, father, and closest friend among HIV-positive Latino gay and bisexual men. Comfort with sexual orientation was related to disclosure to mother and father. Fostering comfort with sexual orientation may promote disclosure to parents but disclosure to parents may also increase comfort with sexual orientation. Comfort with sexual orientation, however, was not related to disclosure to closest friend. Gender non-conformity with hegemonic masculinity was associated to disclosure to mother and father. It is possible that men with masculine presentation do not feel the need to disclose as readily as those with lower levels of gender conformity and therefore may need assistance disclosing to certain members of their social network.
Higher level of U.S. acculturation was associated to disclosure of sexual orientation to both parents, and marginally associated to disclosure to closest friends. Acculturation to the U.S. may assist disclosure of sexual orientation by providing new resources such as positive terms to refer to homosexuality and more flexible gender roles.
Satisfaction with social support was also related to disclosure of sexual orientation to all three targets. Because communication is a two-way, dialectic activity, disclosing may invite provision of social support and facilitate further disclosure, whereas concealment of sexual orientation may preclude others from providing support. Involvement in the gay community only predicted disclosure to the closest friend, perhaps because this is a domain-specific factor; i.e., other gay men are involved with the gay community but parents are not. Participants were more likely to disclose to gay male friends than to female friends, but more to female friends than to heterosexual male friends. Gay male friends may be uniquely positioned to obtain and provide important health information about HIV that increases quality of life for those living with HIV and that can help prevent new infections.
The cross-sectional design is a limitation of the study. Another limitation was the way questions about disclosure of sexual orientation were formulated, e.g., intentional indirect disclosure was not considered. Future research using longitudinal design could further explore directionality and ascertain the order in which disclosure happened relative to variables such as satisfaction with social support.
Acknowledgments
The data for the current study was originally collected for R01 MH60545 (1999–2003), “Disclosure of HIV status among Latino gay and bisexual men,” M. C. Zea, principal investigator, P. J. Poppen, and C. A. Reisen, co-investigators. Preparation of this manuscript was supported, in part, by center grant P30-MH52776 from the National Institute of Mental Health and by NRSA postdoctoral training grant T32-MH19985 and F31 MH 078826 to Luis Garcia.
Contributor Information
Luis I. García, Email: lugarica@mcw.edu, Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N Summit Avenue, Milwaukee, WI 53202, (414) 955-7782 (phone), (414) 287-4206 (fax)
Julia Lechuga, Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N Summit Avenue, Milwaukee, WI 53202, (414) 955-7782 (phone), (414) 287-4206 (fax).
María Cecilia Zea, Department of Psychology, The George Washington University, Washington, DC.
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