Intersecting Structural Oppression and Black Sexual Minority Men's Health

Abstract

Introduction: Although evidence indicates that Black gay, bisexual, and other sexual minority men experience vast psychological and behavioral health inequities, most research has focused on individual rather than structural drivers of these inequities. This study examines the associations between structural racism and anti-lesbian, gay, bisexual, transgender, and queer policies and the psychological and behavioral health of Black and White sexual minority men.

Methods: Participants were an Internet-based U.S. national sample of 1,379 Black and 5,537 White sexual minority men during 2017-2018. Analysis occurred in 2019-2020. Structural equation modeling tested the associations from indicators of structural racism, anti‒lesbian, gay, bisexual, transgender, and queer policies, and their interaction to anxiety symptoms, depressive symptoms, perceived burdensomeness, heavy drinking, and HIV testing frequency. Separate models for Black and White sexual minority men adjusted for contextual and individual covariates.

Results: For Black participants, structural racism was positively associated with anxiety symptoms (β=0.20, SE=0.10, p=0.04), perceived burdensomeness (β=0.42, SE=0.09, p<0.001), and heavy drinking (β=0.23, SE=0.10, p=0.01). Anti‒lesbian, gay, bisexual, transgender, and queer policies were positively associated with anxiety symptoms (β=0.08, SE=0.04, p=0.03), perceived burdensomeness (β=0.20, SE=0.04, p<0.001), and heavy drinking (β=0.10, SE=0.04, p=0.01) and were negatively associated with HIV testing frequency (β= -0.14, SE=0.07, p=0.04). Results showed significant interaction effects, such that the positive associations between structural racism and both perceived burdensomeness (β=0.38, SE=0.08, p≤0.001) and heavy drinking (β=0.22, SE=0.07, p=0.003) were stronger for individuals living in states with high levels of anti‒lesbian, gay, bisexual, transgender, and queer policies. Neither of the oppression variables nor their interaction was significantly associated with outcomes for White sexual minority men.

Conclusions: Results highlight the intersectional nature of structural oppression and suggest that racist and anti-lesbian, gay, bisexual, transgender, and queer policies must be repealed to rectify health inequities facing Black sexual minority men.

Figure 1.

National distribution of participants in the analytic sample. Note: Numbers within states correspond to the State Racism Index Score. Participants in Puerto Rico and Washington DC not included in the analytic sample. LGBTQ, lesbian, gay, bisexual, transgender, queer.

Figure 2.

Structural equation models with structural racism and anti-LGBTQ policies predicting psychological and behavioral outcomes for Black and White SMM. Note: ***p≤0.001; **p≤0.01; *p≤0.05; ^†p≤0.10. Standardized estimates. Depress symptom= Depressive symptoms. This model is adjusted for rural-urban classification, subjective SES, income, formal employment status, insurance status, housing instability, age, sexual identity, gender identity, relationship status, sexual activity (HIV testing), sexual identity outness (HIV testing), and sexual positioning (HIV testing). LGBTQ, lesbian, gay, bisexual, transgender, queer; SMM, sexual minority men.

Figure 2.

Structural equation models with structural racism and anti-LGBTQ policies predicting psychological and behavioral outcomes for Black and White SMM. Note: ***p≤0.001; **p≤0.01; *p≤0.05; ^†p≤0.10. Standardized estimates. Depress symptom= Depressive symptoms. This model is adjusted for rural-urban classification, subjective SES, income, formal employment status, insurance status, housing instability, age, sexual identity, gender identity, relationship status, sexual activity (HIV testing), sexual identity outness (HIV testing), and sexual positioning (HIV testing). LGBTQ, lesbian, gay, bisexual, transgender, queer; SMM, sexual minority men.

Figure 3.

Interactions between structural racism and anti-LGBTQ policies on heavy drinking and perceived burdensomeness among Black SMM. LGBTQ, lesbian, gay, bisexual, transgender, queer; SMM, sexual minority men.