Gaps in science and evidence-based interventions to respond to Intimate Partner Violence among Black gay and bisexual men in the U.S.: A Call for An Intersectional Social Justice Approach

Abstract

Intimate Partner Violence (IPV) is a prevalent, but underrecognized issue among sexual minorities (SM) broadly, but especially among Black Gay and Bisexual Men (BGBM). Over the last several years, acts of IPV among BGBM made national news, drawing attention to the unique ways that IPV plays out within this particular population. Yet, little research has examined the intersections between race and sexuality among BGBM, the lack of culturally responsive IPV services, their support needs, or the barriers that BGBM face when seeking IPV related services. When examined closely, the field of IPV has traditionally focused on cisgender heterosexual white woman as victims and cisgender white men as perpetrators, which has historically impacted the availability and quality of IPV services for other populations. This narrative critique of the IPV movement calls for an intersectional social justice and health equity approach to address the unique and intersectional needs of BGBM who experience IPV. By centering the intersectional needs of BGBM and the role that racism, homophobia, and heteronormative has played in shaping IPV-related services, this article challenges the IPV field to advance a social justice orientation in order to address the unmet needs of BGBM who experience IPV.

Introduction

Over the last several years, prominent news stories have emerged to shed light on the impact of Intimate Partner Violence (IPV) among Black gay and bisexual men (BGBM). In November 2017, a 27-year-old Black gay sociology graduate student who studied the criminalization of people of color was shot and killed in Texas by his partner after an altercation escalated (Edwards, 2017). In February 2019, a 24-year-old medical staff member was shot in the face in Baltimore City, MD at the University of Maryland Hospital by his former male partner. According to reports, the perpetrator shot him because the victim left him for a female partner. However, this display of violence was not the first sign of IPV; court records show that the perpetrator was under a peace order to stay away from another victim, 27, because the perpetrator stalked the victim, stole images from his Facebook page and posted them on dating apps claiming that the man was HIV positive, and threatened him with physical violence (Proctor, 2019). Finally, in April 2019, a 45-year-old Black gay man was shot and killed by his former partner for allegedly engaging in infidelity (Alberto, 2019). These examples are some of the most extreme forms of IPV. These stories highlight the need for greater research and evidence-based support services that address IPV within BGBM’s relationships that examines the intersecting social identities and systems of oppression that produce risk, as well as investigate the transgenerational production of IPV. These stories underscore the need for intentional discussion and research that examine the unique social and cultural context of IPV among BGBM as well as question the dearth of behavioral and psychosocial interventions currently available for this priority population. This narrative review examines IPV with an intersectional approach, discusses gaps in the scientific literature, and ultimately calls for an intersectional social justice approach to IPV research and practice to address the contextually situated needs of BGBM.

Background

Intimate Partner Violence (IPV) is a prevalent, but under-recognized epidemic among sexual minority populations broadly, but specifically among BGBM (Breiding et al., 2013; Edwards et al., 2015; Miller, 2016; Kubicek, 2016; Suarez et al., 2018; Kim & Schmuhl, 2019). While the definitions of IPV very, IPV can be understood as the pattern of controlling, abusive behavior within current or former intimate relationships and can include physical, psychological, emotional, verbal, or sexual abuse (Breiding et al., 2013). Emerging epidemiological research has found that sexual minorities have an estimated lifetime IPV prevalence as high as 66% (41% to 59% psychological/emotional, 23% to 66% physical, and 18%–50% sexual violence victimization)—which is comparable to levels reported by cisgender heterosexual women (CHW) in the United States. Additionally, IPV has also been associated with substance abuse, HIV risk, depression, and social dysregulation (Blosnich JR & Bossarte RM, 2009; Breiding et al., 2013; Buller et al., 2014; Edwards et al., 2015; Davis et al., 2016; Brown et al., 2016; Duncan et al., 2018; Kim & Schmuhl, 2019). While certainly some experiences of IPV are widely shared among those who experience IPV, it is not valid to assume that interventions and programs developed for CHW are sufficient or culturally appropriate to address IPV among sexual minority populations, particularly BGBM. Notably, the context in which BGBM experience IPV and the broader social and cultural context in which they navigate may function very differently.

Researchers have identified very particular ways that IPV plays out among BGBM. For example, the tactics of abuse rely upon and leverage historical race and sexual orientation discrimination such as threatening to out someone or leveraging cultural norms and practices to silence or shame someone (identity-based abuse) (West, 2012; Geter et al., 2016; Goldenberg et al., 2016; Stephenson & Finneran, 2017; Woulfe & Goodman, 2019). More specifically, this may look like an abuser recognizing the vulnerable status of their partner and telling them that if they disclosed the abuse, they would not be believed, and their disclosure would subject them to greater community stigma because of their sexual orientation. This dynamic may be further exacerbated if the abuser is more traditionally masculine or hypermasculine and the person being abused is more feminine or gender-variant (Johns et al., 2012). This partnering dynamic among BGBM would privilege the abuser given his normative gender expression—even if his sexual partner is a man (Goldenberg et al., 2016). Additionally, this partnering dynamic would disadvantage the feminine or gender variant person in this relationship not only because of his sexual decision to partner with another man, but also their gender expression because it goes against “the strong Black man” narrative within the Black community (Malebranche et al., 2009; Fields et al., 2015; Mackenzie, 2019). In this way, the risk and consequences are not equal, a differential risk, which burdens the most marginalized in the relationship and therefore experience greater consequences. As a part of a broader research agenda, examining IPV among BGBM should interrogate the “victim-perpetrator” paradigm that is traditionally found within the IPV field regarding heterosexual couples to distil how normative gender roles and expression may influence mutual/reciprocal violence within BGBM’s relationships. Given that IPV unfolds within a particular social and cultural context, these unique and intersecting realities must be centered, interrogated, and attended to in order to address the root causes and cultural context in which IPV occurs among BGBM

Intersectionality

Intersectionality is a critically important theoretical framework to engage in order to understand the multiple historically marginalized social identities of BGBM as well as the social and cultural milieu in which they navigate IPV. The term intersectionality—coined by Kimberly Crenshaw—provides a theoretical framework that explains that people with multiple marginalized social identities (race, gender, sexuality, class, etc.) navigate and engage larger macro systems of oppression (racism, heteronormativity, homophobia, etc.) that intersect to impact an individual’s quality of life (Crenshaw, 1990). In IPV research and a health equity context, intersectionality serves as a critical analytic tool to analyze power dynamics, how it shapes social realities, and even health outcomes (Bowleg, 2012a; Bowleg, 2012b). More explicitly, this analytic tool asks one to consider how might homophobia and racism impact a BGBM’s ability to access quality IPV treatment and care services. For example, it would critically ask how might larger pervasive social issues shape and inform access to IPV prevention, treatment, or services for BGBM who experience IPV? It would not only ask who is delivering IPV services, but also where those services are delivered, as well as the quality of those services. Finally, it would require us to interrogate the absence of services and the fact that there are currently no behavioral interventions available for BGBM who experience IPV. In sum, Intersectionality offers a way to interrogate the absence of critical and life-saving services and research for BGBM who experience IPV. Intersectionality suggests that the field must move away from traditional heteronormative and a color-blind approaches to effectively address the cultural and contextually situated experiences of BGBM who experience IPV. The application of intersectionality as a key health equity framework would require IPV scholars and practitioners to consider how, and in what ways, do their research practices (e.g. the inclusion and retention of BGBM in their IPV research or disaggregating findings specific to this social and cultural context). It would also require service providers to address assumptions that men do not experience IPV as well as offering tailored supports, which have been reported as barriers to gay men receiving IPV services (only further marginalize BGBM and denies them access to potentially lifesaving services. In effect, intersectionality as a critical theoretical lens, challenges IPV scholars and practitioners to examine how BGBM have been left out of the IPV literature, and how that erasure reflects and operates as broader social function of systemic racism, heteronormative, and white supremacy within research and service provision. Critical social theories like Intersectionality, Critical Race, and Queer Theory, are among a few vital frameworks required to move away from decontextualized knowledge production in public health research into greater understanding of the deeply interconnected, nuanced, and contextual realities of historically marginalized BGBM who experience IPV (Delgado & Stafancic, 2001; Sullivan, 2003; Potvin et al., 2005; Ford & Airhihenbuwa, 2010).

Connecting the Dots: Interconnected Health Disparities

To center the voices and experiences of the most marginalized, is critically important to eliminate the interconnected disparities that are produced by social injustices. Research has found that BGBM have a 1 in 2 chance of becoming HIV positive in their lifetime when compared to 1 in 11 chance for white gay and bisexual men. Research suggests that this increased risk is not due to individual behaviors alone, but is due to larger historical and structural barriers that prevent BGBM from accessing quality care (Millett et al., 2012; Jeffries et al., 2013). For example, one of the first studies to explore IPV and HIV incidence with a sufficient number of BGBM to disaggregate the findings, reported that IPV was a significant partner-level predictor of HIV prevalence and incidence. They found that Individuals who reported experiencing IPV had 2.39 times higher odds of infection (CI 1.35–4.23) and 3.33 times higher hazard (CI 1.47–7.55) of HIV seroconversion (Beymer et al., 2017). Additionally, another study found that IPV victimization was associated with greater likelihood of condomless receptive anal sex, while IPV perpetration was associated with increased odds of condomless receptive and insertive (AOR= 2.21, 95% CI = 1.06, 4.59) anal sex (Stults et al). The use of alcohol also was significantly attributed to the high rates of IPV among gay and bisexual men broadly, with roughly 91% endorsing that alcohol or being drunk would lead to IPV among those who recently experienced IPV (Finneran & Stephenson, 2014) as well as higher levels of alcohol use being significantly associated with physical IPV and HIV related IPV victimization (Wu et al., 2015; Stults et al., 2016). And finally, Finnerman and Stephenson (2017) found in some of the most recent IPV research that when stratified by race, BGBM faced additional stressors related to race and homophobic based discrimination, which increased the odds that BGBM experiencing IPV and that homophobia and internalized homophobia were associated with perpetuating IPV. Additionally, the inability of many BGBM to negotiate condom usage, loss of sexual agency due to physical and sexual violence, gender norms and expectations, as well as economic dependences can also play a role in IPV risk. These data delineate the interconnections of IPV and various adverse sexual outcomes impacting BGBM along with a host of additional health issues similar to CHW including depression, substance abuse, unprotected sex, injuries, and even death in the most extreme cases (Geter et al., 2016).

Organizational Challenges in IPV Service Provision

Thoughtful and supportive services are critically important to ensure the safety of IPV survivors as well as ensuring they have the resources they need to heal. However, this cannot be accomplished without examining the role of larger pervasive social issues affecting access to quality and life-saving services for BGBM and the sexual and gender minority community more broadly. For example, The National Coalition of Anti-Violence Programs (2016a) found that sexual minority people of color were more likely to suffer from injuries, require medical attention, experience harassment, and face more anti-LGBT bias as a result of IPV (2016). The most frequent services that LGBTQ survivors sought were legal services (25%), housing assistance (18%), and mental health services (14%). While 40% did seek support services, the 60% of those who did not seek support services identified the actual or perceived sense that culturally competent and affirming IPV services were not available and cited pervasive issues such as racism, heteronormativity, homophobia, and transphobia that affected the quality of their care.

While there is no current data regarding the services that BGBM men need explicitly, very few sexual minorities of color reported utilizing police as an intervention. In fact, of those reporting IPV to police, nearly a 1/3 reported that the survivor was arrested instead of the abuser and roughly 31% reported verbal abuse by police officers (NCAVP, 2013). Police encounters, particularly among Black men, have resulted in many high-profile deaths over the last several years, which also may fuel mistrust of police to address IPV. Additionally (Finneran & Stephenson, 2013), one of a very few articles that examines IPV among gay and bisexual men and police perceptions, found that roughly 60% perceived that contacting the police would be less helpful. Their perception of police helpfulness was corelated with past experiences of homophobia and stigma broadly. However, recent research among heterosexual black women suggest that low utilization of police for protection is due to a lack of confidence in the judicial process (Decker et al., 2019). This sentiment may be similarly shared among BGBM specifically because of contemporary and historical injustices Black men experience at the hands of police (Tyler, 2005; Owusu-Bempah, 2017). Also at the intersection of race, sexuality, and gender sexual minority men feared that IPV between men would be seen as merely “two men fighting,” which is a stark departure on how police responds to opposite-sex couples (Finneran & Stephenson, 2013). Critical gaps and disparate outcomes for this population in service provision has been well documented and some of the most common issues center on how organizations lack the capacity to acknowledge and address how racism, homophobia, and heteronormative operates, but also how those systemic issues seeps into organizational structures and policies that limit their ability to effectively serve all survivors of IPV and not just some.

In order to address the complex and intersecting issues that exacerbate risk for sexual minorities, and specifically BGBM who experience IPV, we must work to develop effective preventive interventions that are culturally affirming and relevant. Of particular interest, (Stephenson & Finneran, 2013) developed the first targeted IPV prevention screening tool for gay and bisexual men. Prior to this development, all of the other validated screening tools were designed specifically for heterosexual relationships. In addition, the validated measure also yielded additional domains that were unique to gay and bisexual men, which only further illustrates the need for tailored, culturally specific, and contextuality situated interventions that move away from one-size fit all approaches to IPV prevention. Also, there are several additional structural issues that must be addressed within the healthcare sector and with providers specifically. Healthcare providers (doctors, nurses, and behavioral health workers) play a critical role in potentially addressing IPV (Alvarez et al., 2017). Major medical associations such as the National Academy of Medicine and various nursing associations have recommended routine screening for IPV within the medical setting given its pervasive impact on the physical, psychological, emotional, and sexual wellbeing of survivors (Dicola & Spaar, 2016). The U.S. Preventative Services Taskforce (Curry et al., 2018) and Health Resources & Services Administration (2017) outline the importance of addressing IPV among women, men, and vulnerable populations including women, HIV positive people, and sexual and gender minority persons. Researchers have noted that service providers who primarily serve heterosexual survivors of IPV lacked critical knowledge about sexual and gender minority issues to provide adequate or appropriate care and drastically lacked the capacity to serve them. For example, Renner et al. (2019) conducted a study of healthcare providers (n=204) including doctors, nurses, and behavioral health workers and they found that of the providers surveyed, none of them felt adequately prepared to address to respond to IPV among heterosexual people, with medical providers scoring the lowest on preparedness compared to behavioral health workers. Unfortunately, this study did not include information regarding IPV among sexual and gender minorities. Without clear and intentional support, most IPV survivors’ needs will go unmeet, with BGBM and other sexual minority needs going unnoticed and, in many cases, erased. Continuing education and training are required to address the needs of BGBM and other sexual and gender minorities—but that training must address the intersecting issues of racism, heteronormativity, and homophobia at the organizational level as well as at the greater societal level to better meet the needs of this population (Ford et al., 2013; Furman et al., 2017). If these issues are not address, in practice this means that BGBM and other sexual and gender minorities will continue to experience disproportionate and adverse health outcomes because the system is not prepared to address their unique social and contextual realities.

Challenging Norms, Shifting Culture, & Expanding Paradigms to Address the Unmet IPV Needs of BGBM

Much of the discourse in the IPV literature has historically operated within and heteronormative and patriarchal paradigm (Cannon & Buttell, 2015). Born out of a need to address IPV perpetuated against women, feminists called attention to the ways in which patriarchy and male domination positioned women differently and systemically denied them access broadly within this country (Cannon et al., 2015). While at the same time, feminists of color were also drawing attention to the ways that racism was a contributing factor in the IPV movement, and yet that their needs were left unaddressed and systemically left out of the conversation (Crenshaw, 1990; Donnelly et al., 2005). More specifically, women of color contended that the intersections of racism and patriarchy made it increasingly difficult for them to access IPV care, which were available to white women seeking IPV services (Sokoloff & Dupont, 2005; Simpson & Helfrich, 2014; Subirana-Malaret et al., 2019). Unfortunately, the needs of women of color have not yet been fully realized and mainstream IPV providers continue to operate within a color-blind and heteronormative framework (Burman et al., 2004; Donnelly et al., 2005; Gillum, 2009; Nnawulezi & Sullivan, 2014). This paradigm provided the foundation on which laws and policies were built and created. Additionally, this paradigm also functioned in another way—it produced a normative model of care that codified heterosexual white men as perpetrators and heterosexual white woman as victims. This “model” not only erased the experiences and narratives of IPV among women of color, but would ultimately shape the field for decades to come.

Legislation, policy and programming are moving in the direction of greater inclusivity. Thirty years after inception, the Violence Against Women Act was reauthorized in 2013 and included provisions for LGBT people broadly, though reauthorization in 2019/2020 is uncertain (The Violence Against Women Act, 2019). Marriage equality was also passed in 2015 ensuring same-sex marriage was recognized across the US, creating an environment in which nationally LGBT acceptance was at an all-time high. The time is now to expand our efforts to ensure that all people live without fear of IPV. In order to achieve this vision, it is imperative to attend to the ways that race, gender-identity, and sexual orientation intersect to produce unique social and cultural dynamics that influence IPV. For too long, many sexual minorities broadly, and BGBM specifically, have gone without IPV support services. The idea that two men cannot experience IPV is a pervasive cultural myth that must be overcome with research and programming to ensure that support services are in place to meet the contextual needs of IPV survivors as well as address the intersections of racism, heteronormativity, and homophobia in their role in structuring and reproducing health disparities.

Advancing the Field: A Call for An Intersectional Social Justice Approach to Addressing IPV

The need for the mainstream IPV movement to shift and change toward greater inclusion is critical to save lives, and promote health and well-being, especially among those who have been historically marginalized. For that shift to occur, social justice which requires the “full and equal participation of all groups in a society that is mutually shaped to meet their needs”—must be foundational (Adams et al., 1997). This value of full and equal participation as well as mutually shaping access and opportunities to meet the needs of people are particularly important in a society that is still struggling to address issues of racism, homophobia, and heteronormativity. IPV does not occur in a vacuum, and therefore the field must address how issues such as racism, homophobia, and heteronormativity manifests within programs, policies, as well as with service provision to ensure that BGBM receive the best quality IPV services and support. Additionally, research, programs, and policy must grapple with how power, privilege, and oppression functions to further marginalize already vulnerable populations. Broadly, communities are calling for more survivor centered and community driven approaches to address IPV (Shugrue dos Santos, 2012; Kulkarni, 2019). More specifically for BGBM, currently there are no existing evidenced-based interventions to address IPV and the interconnected health disparities that IPV exacerbate and/or produces. To advance the field and become more inclusive, we must:

• Move away from a color-blind heteronormative framework and adopt an Intersectional Social Justice approach that addresses racism, homophobia, and heteronormativity in order to effectively meet the IPV needs of BGBM

• Systematically collect qualitative data on the IPV needs of BGBM and other sexual and gender minorities to understand the unique social and cultural contexts in which IPV is occurring

• Increase funding and opportunities for integrating IPV into substance use, mental health, and HIV prevention and treatment programs

• Create culturally responsive programs and interventions along with increasing the capacity of providers to serve this key population

• Create community level campaigns and mobilization efforts to address the interconnections of IPV other health disparities

• Intentionally create policies that address the unique needs of this subgroup

Conclusion

The need for increased IPV prevention programs for BGBM and other sexual and gender minorities is critical. Now more than ever, the need to address historic and systemic discrimination that has prevented the development of culturally affirming IPV prevention interventions must be addressed to ensure that everyone gets quality access to treatment, care, and prevention services. Intentionally adopting an intersectional social justice and health equity approach in the field broadly and within the development of programs, polices, and practices will begin to move the field forward and ensure that all people, especially BGBM and other sexual and gender minorities who experience IPV, have an opportunity to live full and productive lives.