Discrimination's Influence on HIV Risk Behavior Among American Indian and Alaska Native Men Who Have Sex with Men: Does LGBT and Native Community Participation Play a Role?

Introduction: The recent literature on racial minority men who have sex with men (MSM) indicates that exposure to racial and heterosexist discrimination are positively associated with increased incidence of unprotected receptive anal intercourse (URAI). However, the same literature indicates that LGBT- and racial minority group- participation protect against URAI. In an effort to better understand this association among AIAN MSM, an analysis was conducted to explore the associations of lifetime exposure to racial and heterosexist discrimination on self-reported URAI in the past 12 months and whether or not LGBT- and Native- community participation mediated this association.

Methods: Using a sample of Native MSM (N=221) drawn from the HONOR Project, this study use and multivariate logistic regression analysis.

Results: After controlling for demographic factors, socio-economic status, and alcohol- and substance use, Native MSM reporting higher mean levels of distress from heterosexist discrimination had higher odds of reporting URAI (OR = 1.68, SE = 0.43, p < .05) compared to AIAN MSM reporting lower levels of distress. This analysis found no association between racial discrimination and URAI. Native MSM reporting higher levels of LGBT community participation had lower odds of reporting URAI (OR = 0.80, SE = 0.09, p < .05) compared to those with lower levels of participation. This analysis found no association between Native community participation and URAI. Lastly, adjusting for LGBT community participation explained away the association between heterosexist discrimination and URAI (OR = 1.51, SE = 0.40, ns) suggesting a partial mediation effect of LGBT community participation.  

Conclusions: Future HIV prevention research and behavioral interventions should address heterosexist discrimination and focus on increasing LGBT community participation as a means of preventing HIV transmission among racial minority MSM, and specifically Native MSM.