Background: In the United States, 1 in every 2 people infected with HIV each year are African American. There is a large body of recent literature--both academic and popular--concerning the transmission of HIV from Black men who have sex with men and women (BMSMW). However, the mental health status, cognitions, motivations, and possible protective factors against sexual transmission of HIV in populations of BMSMW are relatively unknown. An understanding of sexual modes of HIV transmission among BMSMW is crucial to creating programming and interventions concerned with addressing HIV transmission within African American communities. Thus, the need to better understand the mental health status and sexual behaviors of this population is imperative. There has been a small body of literature that suggests that insecure attachment style is related to increased sexual risk behavior and decreased mental health (e.g., more depression). These studies have been primarily conducted with cohorts of heterosexual participants and have neglected to include sexual minorities. Understanding how attachment style relates to sexual behavior and mental health can help many facets of the health community (e.g., counseling, public health, social work, etc.) tailor HIV prevention efforts for those who may be at increased risk of transmission.
Aims : The current study is an exploratory study with two specific aims: 1) to describe the weekly levels of stress, depression, and sexual risk behavior among Black MSMW, and 2) using a mixed-methods approach, to understand what the relationships between attachment style, stress, depression and sexual risk behavior among BMSMW. Methods: 80 BMSMW will complete an online 12-week structured diary. The diary will include a depression inventory, stress inventory, adult attachment inventory, and sexual behavior questions. 1-hour open ended interviews will be conducted with 12 men drawn from the original sample of 80. The questions will mainly focus on assessing how participants'relationship with their primary childhood caregiver may have affected their mental health and sexual behavior as adults. Analysis: Growth Curve Modeling will be used to detect any existing relationships between attachment, stress, depression, and sexual risk from the structured diary data. A grounded theory approach will be used to analyze the qualitative interviews. The training program I have proposed in this application will allow me to not only develop the quantitative and qualitative research methodology skills to carry out my dissertation research but it also will help me obtain the necessary academic professional skills to become an academic researcher.
The proposed research will contribute to public health research and practice by informing secondary prevention interventions for HIV-positive and negative Black men who have sex with men and women - a potentially high-risk group for which there are few proven effective interventions. Therefore, it is important to develop interventions that target HIV-positive and negative BMSMW, particularly those who are non-gay identified and non-disclosing to their primary sexual partner, in order to effectively prevent the transmission of HIV disease. By elucidating the relationship between attachment, psychological well-being and sexual risk behavior among urban populations of Black MSMW, this study and the further research that will stem from it have great potential in contributing to the development of comprehensive, effective, multi-level (i.e., individual, couple, and setting level) interventions.