Date of Award


Document Type

Open Access Dissertation


Health Promotion, Education and Behavior

First Advisor

S. Melinda Spencer

Second Advisor

Lucy Annang


Background: African-American men who have sex with men (AAMSM) are at disproportionate risk for HIV infection. Although the disparities in infection rates between AAMSM and MSM of other groups have been well-documented, little is known about the factors that contribute to the disparity, particularly psychosocial factors. One such factor, internalized homonegativity (IH), has been identified as a potential predictor of AAMSM engagement in risky sexual behaviors. However, little has been known about the ways in which IH manifests itself in the lives of AAMSM, or the role that sociocultural institutions, such as African-American faith communities, play in the development of IH among AAMSM. To examine these phenomena, the Sexual Health in Faith Traditions (SHIFT) Study was developed to examine the relationships between religiosity, spirituality, IH, and engagement in risky sexual behaviors among AAMSM. Methods: Anonymous paper-and-pencil surveys were administered to 348 AAMSM living in the Deep South, recruited from Black Gay Pride celebration events, social media, and snowball sampling. First, the SHIFT Study examined the dimensional structure of IH among AAMSM as assessed by the Internalized Homonegativity Inventory (IHNI), a widely-used scale used to measure IH, using factor analysis. Second, regression analyses and structural equation models were used to investigate the relationships between the dimensions of IH, religiosity, spirituality, and sexual risk behaviors. Results: Whereas the original IHNI research showed evidence of a three-factor structure (Personal Homonegativity, Morality of Homosexuality, and Gay Affirmation), exploratory factor analysis showed evidence of a two-factor structure for this sample, with the "Personal Homonegativity" and "Morality of Homosexuality" items loading onto the same factor, and the "Gay Affirmation" subscale remaining intact. Subsequent regression analyses and structural equation models showed that both dimensions of IH were significantly positively associated with an increased frequency of condom use in the last 3 months. Results also showed that religiosity was significantly positively associated with IH, while spirituality was significantly negatively associated with IH. While there were no significant direct effects between religiosity and condom use or spirituality and condom use, there were significant indirect effects, suggesting that IH mediates the relationships between religiosity, spirituality, and condom use. Implications: the findings of the SHIFT Study provide insight for further investigation into the determinants of HIV risk for AAMSM. First, HIV prevention interventionists should explore the ways in which psychosocial factors, such as IH, may function differently among AAMSM, and take those differences into account in planning future interventions. Second, the influence of social, historical, and cultural aspects of the African-American experience, including the African-American faith experience, should also be considered in future intervention development.


© 2013, Stacy Whichard Smallwood