. Author manuscript; available in PMC: 2019 Jan 1.

Published in final edited form as: LGBT Health. 2017 Dec 22;5(1):6–32. doi: 10.1089/lgbt.2017.0053

Table 4.

Theorized Relationship-Level Protective Factors and Their Associations with Sexual Health Outcomes

Protective factor	Factor measure (as specified in articles)	Outcome	Type of association	Sexual minority population	Article	Summary
Peer relationships
Peer norms about safer sex	Peer condom norms/peer norms regarding condom use	Unprotected insertive anal sex	Protective	African American MSM	Bakeman et al.²⁴	Protective: 16; null: 11; risk: 0
	Peer condom norms/peer norms regarding condom use	Unprotected receptive anal sex	Protective	African American MSM	Hart et al.³¹
	Peer condom norms	UAI with main partners	Protective	African American MSM	Bakeman et al.²⁴
	Peer condom norms	UAI with casual partners	Protective	African American MSM	Bakeman et al.²⁴
	Peer norms about condoms	Avoidance of UAI	Protective	HIV+ YMSM	Forney et al.²⁹
	Peer norms about condoms	Avoidance of UAI	Protective	HIV − YMSM	Forney et al.²⁹
	Peer norms about condoms	HIV testing	Null	Young African American MSM	Mashburn et al.³⁹
	Peer norms about condom use	Ever having been tested for HIV	Null	YMSM	Sumartojo et al.⁵⁴
	Peer norms about condom use	HIV testing in the last 3 months	Null	YMSM	Sumartojo et al.⁵⁴
	Peer norms regarding condom use	UAI	Protective	Young African American MSM	Hart et al.³¹
	Peer norms regarding condom use—Strongly agree versus disagree/strongly disagree	Any UAI	Protective	Young Black MSM	Jones et al.³⁵
		Any UIAI	Protective
		Any URAI	Protective
	Peer norms regarding condom use—Agree versus disagree/strongly disagree	Any UAI	Null
		Any UIAI	Null
		Any URAI	Null
	Perceived norms around condom use and safer sex	Exchange of sex for money or valuables	Null	MSM	Kelly et al.³⁶
	Perceived condom norms	Sexual risk composite^a—No risk versus high risk	Protective Null	Young African American MSM	Peterson et al.⁴⁵
	Perceived condom norms	Sexual risk composite^a—Low risk versus high risk	Protective Null	Young African American MSM	Peterson et al.⁴⁵
	Safer sex peer norms	Number of sex partners (3 months)	Protective	YMSM in St. Petersburg and their social networks	Amirkhanian et al.²³
		Having unprotected vaginal or anal intercourse (3 months)	Protective
		Number of unprotected vaginal or anal sex acts (3 months)	Protective
		Paid or received money for sex (1 year)	Protective
		Testing positive for an STD at baseline	Null
	Safer sex peer norms	UAI in past 6 months among participants age 15–17	Protective	Young GB men	Waldo et al.⁵⁶
	Safer sex peer norms	UAI in past 6 months among participants age 18–22	Null	Young GB men	Waldo et al.⁵⁶
	Social support from friends for condoms	UAI	Null	YMSM in California	Molitor et al.⁴¹
Social network characteristics	Social network: number of sex partners (3 months)	Number of sex partners (3 months)	Protective	YMSM in St. Petersburg and their social networks	Amirkhanian et al.²³	Protective: 5; null: 6; risk: 0
	Social network: having unprotected vaginal or anal intercourse (3 months)	Having unprotected vaginal or anal intercourse (3 months)	Protective
	Social network: testing positive for an STD at baseline	Testing positive for an STD at baseline	Protective
	Social network: paid or received money for sex (1 year)	Paid or received money for sex (1 year)	Protective
	Social network: number of unprotected vaginal or anal sex acts (3 months)	Number of unprotected vaginal or anal sex acts (3 months)	Null
	How many friends are gay or bisexual	UAI	Protective	Young HIV − GB men	Hays et al. (1997a)³²
		UAI	Null	Young HIV+ GB men
		UAI	Null	Young untested GB men
	Friends sexual orientation— Mostly homosexual versus mostly heterosexual	Never having been tested for HIV	Null	MSM living in Douala, Cameroon	Lorente et al.³⁸
	Friends sexual orientation— Mostly homosexual versus mixed homosexual and heterosexual	Never having been tested for HIV	Null
	Friends sexual orientation— Mostly homosexual versus does not know/has no friends	Never having been tested for HIV	Null
Peer connectedness	Social isolation from friends (i.e., association interpreted as inverse of “connection to friends”)	Nonconcordant UAI in past 3 months	Protective	YMSM	Glick and Golden³⁰	Protective: 3; null: 2; risk: 0
		New HIV/STI diagnosis	Null	YMSM	Glick and Golden³⁰
	Peer connectedness—A little connected versus not at all connected	Inconsistent condom use	Protective	African American, Latino, and multiracial YMSM in Los Angeles and New York	Mutchler et al.⁴²
	Peer connectedness—Very connected versus not at all connected	Inconsistent condom use	Protective
	Peer connectedness— Somewhat connected versus not at all connected	Inconsistent condom use	Null
Friends’ support	Social support from friends	Sexual risk behaviors^b	Risk	Young LGBs	Shilo and Mor⁵¹	Protective: 1; null: 0; risk: 3
	Social support from friends	Internet use for seeking sex	Risk	Young GB men	Shilo and Mor⁵²
	Social support from friends	Sexual risk behaviors^b	Risk	Young GB men	Shilo and Mor⁵²
	Support received from Black gay/bisexual male friends	Delayed HIV testing	Protective	Young Black MSM	Scott et al.⁴⁹
Communication with peers	Communication about safer sex—told a friend about protecting self	UAI	Null	Young Black MSM	Jones et al.³⁵	Protective: 1; null: 8; risk: 0
		UIAI	Null
		URAI	Null
	Communication about safer sex—friend told participant about protecting self	UAI	Null
		UIAI	Null
		URAI	Null
	Disclosure of HIV+ serostatus status to friend/other person	UAI	Null	HIV+ YMSM (includes transgender women)	Cook et al.²⁷
	Disclosure of HIV+ serostatus status to friend/other person	UAI with serodiscordant partner	Null	HIV+ YMSM (includes transgender women)	Cook et al.²⁷
	Discussing condoms with friends	Condom use during last intercourse with a casual partner	Protective	Urban Tanzanian MSM	Nyoni and Ross⁴³
Disclosure	Peer knowledge of MSM behavior	UAI	Null	Urban Latino YMSM	O’Donnell et al.⁴⁴	Protective: 0; null: 4; risk: 0
		UAI at last sex with main partner	Null
		UAI at last sex with nonmain partner	Null
	Proportion of friends who knew of same-sex sexual behavior	Sexual health screening in the last 6 months for YMSM	Null	Young gay, bisexual, and other MSM	Siconolfi et al.⁵³
Family relationships
Support	General relationship quality composite^c	UAI in past 6 months	Null	YMSM	Thoma and Huebner⁵⁵	Protective:1; null: 12; risk: 0
	Maternal support: when first came out	Nonconcordant UAI in past 3 months	Null	YMSM	Glick and Golden³⁰
	Maternal support: when first came out	New HIV/STI diagnosis	Null
	Maternal support: current	Nonconcordant UAI in past 3 months	Null
	Maternal support: current	New HIV/STI diagnosis	Protective
	Paternal support: when first came out	Nonconcordant UAI in past 3 months	Null
	Paternal support: when first came out	New HIV/STI diagnosis	Null
	Paternal support: current	Nonconcordant UAI in past 3 months	Null
	Paternal support: current	New HIV/STI diagnosis	Null
	Social support from family	Sexual risk composite^b	Null	Young LGBs	Shilo and Mor⁵¹
	Social support from family	Internet use for seeking sex partners	Null	Young GB men	Shilo and Mor⁵²
		UAI in past 6 months	Null
		Sexual risk composite^b	Null
Disclosure	Disclosure of HIV-positive serostatus status to a family member	UAI	Protective	HIV+ YMSM (includes transgender women)	Cook et al.²⁷	Protective: 2; null: 7; risk: 1
	Ever came out to a mother or mother figure	Nonconcordant UAI in past 3 months	Null	YMSM	Glick and Golden³⁰
	Ever came out to a mother or mother figure	New HIV/STI diagnosis	Null
	Ever came out to a father or father figure	Nonconcordant UAI in past 3 months	Risk
	Ever came out to a father or father figure	New HIV/STI diagnosis	Null
	Outness to cohabitating parents	UAI in past 6 months	Null	YMSM	Thoma and Huebner⁵⁵
	Parental knowledge of MSM behavior	UAI	Null	Urban Latino YMSM	O’Donnell et al.⁴⁴
		UAI with main partner	Null
		UAI with nonmain partner	Null
	Sexual orientation known by family members	HIV status	Protective	MSM in NE China	Xu et al.⁵⁸
Acceptance	Family acceptance	UAI or UVI in past 6 months with casual partner or a steady partner who was nonmonogamous or serodiscordant for HIV	Null	LGBT adolescents	Ryan et al.⁴⁸	Protective: 1; null: 9; risk: 0
	Family expressed disapproval of sex with men (i.e., association interpreted as inverse of “family approval”)	UAI	Null	Young Black MSM	Jones et al.³⁵
		UAI with main partner	Null
		UAI with nonmain partner	Null
	Family rejection (i.e., association interpreted as lack of family rejection)— Low family acceptance versus high family acceptance	UAI with casual partner in past 6 months	Protective	White and Latino LGB young adults	Ryan et al.⁴⁷
		UAI with casual partner at last intercourse	Null
		STD diagnosis	Null
	Family rejection (i.e., association interpreted as lack of family rejection)— Low family acceptance versus medium family acceptance	UAI with casual partner in past 6 months	Null
		UAI with casual partner at last intercourse	Null
		STD diagnosis	Null
Connectedness	Social isolation from family (i.e., association interpreted as inverse of “connection to family”)	Nonconcordant UAI in past 3 months	Protective	YMSM	Glick and Golden³⁰	Protective: 1; null: 1; risk: 0
Connectedness		New HIV/STI diagnosis	Null	YMSM	Glick and Golden³⁰	Protective: 1; null: 1; risk: 0
Communication	Sexual communication scale^d	UAI in past 6 months	Risk	YMSM	Thoma and Huebner⁵⁵	Protective: 0; null: 0; risk: 1
Monitoring	Parental monitoring	UAI in past 6 months	Null	YMSM	Thoma and Huebner⁵⁵	Protective: 0; null: 1; risk: 0
Romantic/Sexual partners
Communication about safer sex with partners	Asking partner to disclose their HIV status	Condom use at last intercourse with casual partner	Protective	Urban Tanzanian MSM	Nyoni and Ross⁴³	Protective: 12; null: 21; risk: 0
	Disclosed HIV status to sex partners/boyfriends	Condom use during oral sex within last 3 months	Protective	HIV+ MSM	Hightow-Weidman et al.³⁴
		Condom use during insertive anal intercourse within last 3 months	Protective
		Condom use during receptive anal intercourse within last 3 months	Protective
	Disclosure of HIV-positive serostatus to a sex partner/romantic partner	UAI in last 3 months	Null	HIV+ YMSM (study includes transgender women)	Cook et al.²⁷
		UAI with serodiscordant partner	Null	HIV+ YMSM (study includes transgender women)	Cook et al.²⁷
	Ever asked by a partner about HIV testing	History of HIV testing	Protective	Young men of color who have sex with men (study includes transgender women)	Cohall et al.²⁶
	Ever asked partner about partner’s HIV test	History of HIV testing	Protective		Cohall et al.²⁶
	New partner asked for HIV testing	Frequency of testing	Null (P < .10)	Urban YMSM of color	Leonard et al.³⁷
	Sexual communication about condom use with casual partners	Lifetime consistent condom use during oral or anal sex with regular partner	Null	Chinese MSM in Beijing	Xiao et al.⁵⁷
		Consistent condom use with regular partner in last three episodes of oral or anal sex	Null
		Lifetime consistent condom use during oral or anal sex with casual partner	Null
		Consistent condom use with casual partner in last three episodes of oral or anal sex	Null
	Sexual communication about condom use with regular partners	Lifetime consistent condom use during oral or anal sex with regular partner	Protective
		Consistent condom use with regular partner in last three episodes of oral or anal sex	Protective
		Lifetime consistent condom use during oral or anal sex with casual partner	Null
		Consistent condom use with casual partner in last three episodes of oral or anal sex	Null
	Sexual communication about HIV/STDs with casual partners	Lifetime consistent condom use during oral or anal sex with regular partner	Null
		Consistent condom use with regular partner in last three episodes of oral or anal sex	Null
		Lifetime consistent condom use during oral or anal sex with casual partner	Null
		Consistent condom use with casual partner in last three episodes of oral or anal sex	Null
	Sexual communication about HIV/STDs with regular partners	Lifetime consistent condom use during oral or anal sex with regular partner	Protective
		Consistent condom use with regular partner in last three episodes of oral or anal sex	Protective
		Lifetime consistent condom use during oral or anal sex with casual partner	Null
		Consistent condom use with casual partner in last three episodes of oral or anal sex	Null
	Sexual communication about sexual history with casual partners	Lifetime consistent condom use during oral or anal sex with regular partner	Null
		Consistent condom use with regular partner in last three episodes of oral or anal sex	Null
		Lifetime consistent condom use during oral or anal sex with casual partner	Null
		Consistent condom use with casual partner in last three episodes of oral or anal sex	Null
	Sexual communication about sexual history with regular partners	Lifetime consistent condom use during oral or anal sex with regular partner	Protective
		Consistent condom use with regular partner in last three episodes of oral or anal sex	Protective
		Lifetime consistent condom use during oral or anal sex with casual partner	Null
		Consistent condom use with casual partner in last three episodes of oral or anal sex	Null
Quality of communication with partners	Feel embarrassed or find it difficult discussing condom use with sexual partners	Condom use at last intercourse with casual partner	Protective	Urban Tanzanian MSM	Nyoni and Ross⁴³	Protective: 2; null: 5; risk: 0
	Safer sex communication (i.e., comfort with)	Sexual risk composite^e	Null	Asian MSM	Shapiro and Vives⁵⁰
	Safer sex communication scale^f	UAI within last 6 months	Protective	YMSM in California	Molitor et al.⁴¹
	Sexual communication skills	UAI	Null (P < .10)	Young GB men (HIV+)	Hays et al. (1997a)³²
		UAI	Null (P < .10)	Young GB men (HIV−)
		UAI	Null (P < .10)	Young GB men (untested)
	Sexual communication skills	UAI with a boyfriend	Null (P < .10)	Young gay men in a boyfriend relationship	Hays et al. (1997b)³³
Medical providers
Communication with medical providers	Counselor or other professional suggested (HIV testing)	HIV testing—High frequency versus low frequency	Null	Urban YMSM of color	Leonard et al.³⁷	Protective: 4; null: 3; risk: 0
	Offered as part of my regular medical care	HIV testing—High frequency versus low frequency	Null (P > .1)	Urban YMSM of color	Leonard et al.³⁷
	Healthcare provider communication	Hepatitis A vaccination	Protective	African American MSM	Rhodes et al.⁴⁶
	No advice on HIV or STD prevention or testing (association interpreted as inverse of received advice)	HIV+	Protective	African American MSM	Dorell et al.²⁸
	Sexual identity disclosed to health provider (yes, disclosed)	HIV+	Protective	African American MSM	Dorell et al.²⁸
	Provider prevention discussions	No testing/HIV testing/HIV and STD testing	Protective	YMSM	Meanley et al.⁴⁰
	Source of HIV/AIDS knowledge—clinical doctors	HIV infection	Null	MSM in NE China	Xu et al.⁵⁸
Quality of communication with medical providers	Provider comfort	No testing/HIV testing/HIV and STD testing	Null	YMSM	Meanley et al.⁴⁰	Protective: 0; null: 1; risk: 0

Number of times participants had anal sex as a top and as a bottom in last 3 months and how often a condom was used for both behaviors.

UAI, use of drugs and alcohol before or during sex.

Maternal and paternal warmth, support, and attachment.

Composite of issues discussed with parents such as HIV/AIDS, condoms, choosing partners.

Multiple/anonymous partners, inconsistent condom use, no HIV test, unprotected alcohol-related sex.

Perceived efficacy and experience with communication with partners.

GB, gay or bisexual; HIV, human immunodeficiency virus; LGB, lesbian, gay, or bisexual; STD, sexually transmitted disease; UAI, unprotected anal intercourse; UIAI, unprotected insertive anal intercourse; URAI, unprotected receptive anal intercourse. UVI, unprotected vaginal intercourse.