Akua Gyamerah | University at Buffalo, State University of New York (original) (raw)

Papers by Akua Gyamerah

BMC Infectious Diseases, Nov 26, 2022

Background: Trans women face tremendous social inequities as well as disproportionate rates of HI... more Background: Trans women face tremendous social inequities as well as disproportionate rates of HIV and substance use, yet disaggregated substance use data specific to trans women remain limited. Methods: We conducted a secondary analysis of baseline data from the Trans*National Study (2016-2017) surveying trans women in the San Francisco Bay Area (n = 629). Multivariable logistic regression was used to analyze sociodemographic and environmental correlates of substance use, and bivariate associations between substance use and HIV-associated outcomes are presented alongside prevalence data. Results: Over half (52.9%) reported using substances in the prior year, most frequently marijuana, methamphetamine, and crack/cocaine. Those with unmet gender-affirming health care needs, lack of insurance, or a history of experiencing racial violence, transphobic violence, adult housing instability, or extreme poverty had higher odds of substance use. Sex work and condomless anal sex were also independently associated with substance use. Conclusions: Among this sample of trans women, substance use and substance use concurrent with sex were highly prevalent, and associated with a number of socioeconomic and health care needs. These findings corroborate the need for holistic and intersectional efforts to reduce substance use and HIV risk.

Social Aspects of HIV, 2021

In 2011, Ghana made a historic shift in its national HIV response by including men who have sex w... more In 2011, Ghana made a historic shift in its national HIV response by including men who have sex with men in the 2011–2015 HIV National Strategic Plan for the first time, marking a paradigm shift. This chapter examines how the criminalization and stigmatization of male same-sex sexual activities have shaped HIV prevention and care activities within this new paradigm. It explores how the legal and social context has informed and constrained HIV stakeholders’ response to the epidemic among men who have sex with men and discusses the unintended consequences of prevention and care activities within the new paradigm. Through an analysis of social, political and media developments, it demonstrates how approaches and initiatives to address HIV among men who have sex with men have contributed to the politicization of homosexuality in Ghana and reshaped the context in which stakeholders develop and implement HIV policies and programs for members of this population.

Introduction: The COVID-19 pandemic has compounded the global crisis of stress and burnout among ... more Introduction: The COVID-19 pandemic has compounded the global crisis of stress and burnout among healthcare workers (HCWs). But few studies have empirically examined the factors driving these outcomes. We examined the association between perceived preparedness to respond to the pandemic and HCW stress and burnout and identified potential mediating factors among HCWs in Ghana. Methods: Data are from HCWs in Ghana who completed a cross-sectional self-administered online survey; 414 and 409 HCWs completed stress and burnout questions, respectively. Perceived preparedness, stress, and burnout were measured using validated psychosocial measures. We assessed associations using linear regressions with robust standard errors. Results: The average score for preparedness was 24 (SD=8.8), 16.3 (SD=5.9) for stress, and 37.4 (SD=15.5) for burnout. In multivariate analysis, HCWs who felt somewhat prepared and prepared had lower stress (β=-1.89, 95%CI:-3.49 to -0.30 and β=-2.66, 95%CI:-4.48 to -0....

AIDS Care, 2020

LGBTQ populations experience human rights abuses worldwide; data need to document the health impa... more LGBTQ populations experience human rights abuses worldwide; data need to document the health impact of these experiences in Africa. In Ghana, we measured events of sexuality-based stigma, discrimination, and violence among men who have sex with men (MSM) and the impact on HIV testing behavior. Data are from respondent-driven sampling surveillance surveys in Accra/Tema, Kumasi, Cape Coast/Takoradi, and Koforidua. Discrimination was common among MSM: 6.2% −30.6% were refused services, 29.0%−48.9% experienced verbal/symbolic violence, 2.8%−12.8% experienced physical violence, 12.3%−30.0% experienced sexual violence due to their sexuality in the preceding year. MSM who experienced sexual violence in their first male sexual encounter were less likely to ever test for HIV in Accra/Tema and Cape Coast/Takoradi. Further studies are needed to examine the impact of stigma and violence on MSM's HIV health-seeking behavior in Ghana. Structural interventions are needed to mitigate the consequences of stigma and discrimination on MSM health and well-being.

The Journal of Sex Research, 2019

Although South Africa protects sexual orientation in its Constitution, homosexuality is sociocult... more Although South Africa protects sexual orientation in its Constitution, homosexuality is socioculturally contested and unaccepted. This lack of acceptance may impact the coming-out process of men who have sex with men (MSM). This study explored diverse factors that influenced whether Black South African MSM disclosed their sexual practices and identities to their families, how their families responded, and how family responses affected them. In-depth interviews were conducted with 81 Black MSM from four Tshwane townships about their sexual and gender identities, sexual practices, social networks, and familial relationships. Interview transcripts were analyzed with ATLAS.ti using a priori codes and inductive coding. Most participants disclosed their sexual identities to at least one person in their families or assumed their families knew despite no explicit disclosure about their sexual identity; a significant minority had not disclosed. Families of those who disclosed were either supportive, in denial, confused, or unsupportive in their responses. Whether or not family was supportive, silence around the participants' same-sex sexualities was prevalent within families. Family responses affected how participants perceived their sexuality and their confidence. Further studies are required to better understand the underlying processes of coming out for Black South African MSM and how these processes impact health outcomes and social well-being. 3 South Africa represents one of the world's most liberal countries in regard to the legal protection of lesbian, gay, bisexual, transgender, and queer (LGBTQ) rights. It was the world's first country to include sexual orientation as a ground for non-discrimination in its 1996 constitution (Equality Clause) and on 30 November 2006, it became the fifth country-and the first in Africa-to legalize same-sex marriage through the Civil Union Act (Cock, 2003; De Vos & Barnard, 2007). These legal protections were adopted in a broader context of social reform by the post-apartheid government after the successful organizing of LGBTQ rights activists, veterans of the anti-apartheid movement (Cock, 2003; Thoreson, 2008). Legal protections such as the Equality Clause and the Civil Union Act are important for millions of people across the world who identify with same-sex sexualities, desires, and intimacies because, as several studies indicate, the absence of such rights has a significantly negative impact on their health and other

BMC Public Health, 2021

Background Trans women experience high rates of gender-based violence (GBV)—a risk factor for adv... more Background Trans women experience high rates of gender-based violence (GBV)—a risk factor for adverse health outcomes. Transphobic hate crimes are one such form of GBV that affect trans women. However, little is understood about factors that shape transphobic hate crimes and racial/ethnic variation in these experiences. To contextualize GBV risk and police reporting, we examined self-reported types and correlates of transphobic hate crimes by racial/ethnic group of trans women in the San Francisco Bay Area. Methods From 2016 to 2018, trans women participated in a longitudinal cohort study of HIV. Secondary data analyses (N = 629) examined self-reported experiences of transphobic hate crimes (i.e., robbery, physical assault, sexual assault, and battery with weapon) by race/ethnicity, and whether hate crimes were reported to the police. Chi-square tests and simple logistic regression examined demographic, sociocultural, and gender identity factors associated with transphobic violence ...

The risk of acquiring sexually transmitted infections (STIs) among men who have sex with men (MSM... more The risk of acquiring sexually transmitted infections (STIs) among men who have sex with men (MSM) is driven by various socio-behavioral factors. From 2015-2017, 247 MSM ≥ 18 years-old who reported alcohol use in the past year, were recruited into a cross-sectional study in San Francisco. Participants completed a survey assessing socio-demographics, substance use and treatment, sexual behaviors, HIV status and self-reported STI diagnosis in the past 6 months. Multivariable logistic regression models stratified by HIV status were used to identify the correlates of STIs. Of 247 MSM, the prevalence of bacterial STIs were: gonorrhea (12.9%), chlamydia (9.3%) and syphilis (6.0%). Among 177 MSM living without HIV, factors significantly associated with recent STI diagnosis were: current pre-exposure prophylaxis (PrEP) use (aOR = 3.53, 95% CI: 1.42–8.75, p ≤ .01), popper use during sex in the past 6 months (aOR = 3.16, 95% CI = 1.34–7.47, p ≤ .01) and a history of alcohol treatment (aOR = 0...

Introduction: Healthcare workers' (HCWs) preparedness to respond to pandemics is critical to ... more Introduction: Healthcare workers' (HCWs) preparedness to respond to pandemics is critical to containing disease spread. Low-resource countries, however, experience barriers to preparedness due to limited resources. In Ghana, a country with a constrained healthcare system and high COVID-19 cases, we examined HCWs' perceived preparedness to respond to COVID-19 and associated factors. Methods: 472 HCWs completed questions in a cross-sectional self-administered online survey. Perceived preparedness was assessed using a 15-question scale (Cronbach alpha=0.91) and summative scores were created (range=0-45). Higher scores meant greater perceived preparedness. We used linear regression with robust standard errors to examine associations between perceived preparedness and potential predictors. Results: The average preparedness score was 24 (SD=8.9); 27.8% of HCWs felt prepared. In multivariate analysis, factors associated with higher perceived preparedness were: training (β=3.35, 95%...

PLOS Global Public Health

The COVID-19 pandemic has affected job satisfaction among healthcare workers; yet this has not be... more The COVID-19 pandemic has affected job satisfaction among healthcare workers; yet this has not been empirically examined in sub-Saharan Africa (SSA). We addressed this gap by examining job satisfaction and associated factors among healthcare workers in Ghana and Kenya during the COVID-19 pandemic. We conducted a cross-sectional study with healthcare workers (N = 1012). The two phased data collection included: (1) survey data collected in Ghana from April 17 to May 31, 2020, and (2) survey data collected in Ghana and Kenya from November 9, 2020, to March 8, 2021. We utilized a quantitative measure of job satisfaction, as well as validated psychosocial measures of perceived preparedness, stress, and burnout; and conducted descriptive, bivariable, and multivariable analysis using ordered logistic regression. We found high levels of job dissatisfaction (38.1%), low perceived preparedness (62.2%), stress (70.5%), and burnout (69.4%) among providers. High perceived preparedness was positi...

Think Global Health, 2022

AIDS Care, 2020

LGBTQ populations experience human rights abuses worldwide; data need to document the health impa... more LGBTQ populations experience human rights abuses worldwide; data need to document the health impact of these experiences in Africa. In Ghana, we measured events of sexuality-based stigma, discrimination, and violence among men who have sex with men (MSM) and the impact on HIV testing behavior. Data are from respondent-driven sampling surveillance surveys in Accra/Tema, Kumasi, Cape Coast/Takoradi, and Koforidua. Discrimination was common among MSM: 6.2%–30.6% were refused services, 29.0%–48.9% experienced verbal/symbolic violence, 2.8%–12.8% experienced physical violence, 12.3%-30.0% experienced sexual violence due to their sexuality in the preceding year. MSM who experienced sexual violence in their first male sexual encounter were less likely to ever test for HIV in Accra/Tema and Cape Coast/Takoradi. Further studies are needed to examine the impact of stigma and violence on MSM's HIV health-seeking behavior in Ghana. Structural interventions are needed to mitigate the consequences of stigma and discrimination on MSM health and well-being.

The Journal of Sex Research, 2019

Although South Africa protects sexual orientation in its Constitution, homosexuality is sociocult... more Although South Africa protects sexual orientation in its Constitution, homosexuality is socioculturally contested and unaccepted. This lack of acceptance may impact the coming-out process of men who have sex with men (MSM). This study explored diverse factors that influenced whether Black South African MSM disclosed their sexual practices and identities to their families, how their families responded, and how family responses affected them. In-depth interviews were conducted with 81 Black MSM from four Tshwane townships about their sexual and gender identities, sexual practices, social networks, and familial relationships. Interview transcripts were analyzed with ATLAS.ti using a priori codes and inductive coding. Most participants disclosed their sexual identities to at least one person in their families or assumed their families knew despite no explicit disclosure about their sexual identity; a significant minority had not disclosed. Families of those who disclosed were either supportive, in denial, confused, or unsupportive in their responses. Whether or not family was supportive, silence around the participants’ same-sex sexualities was prevalent within families. Family responses affected how participants perceived their sexuality and their confidence. Further studies are required to better understand the underlying processes of coming out for Black South African MSM and how these processes impact health outcomes and social well-being.

Journal of aggression, maltreatment & trauma, 2013

This mixed-methods study examined associations between prejudice events and post-traumatic stress... more This mixed-methods study examined associations between prejudice events and post-traumatic stress disorder (PTSD) among 382 lesbians, gays, and bisexuals (LGB) and 126 heterosexuals. Using the Composite International Diagnostic Interview, we assessed PTSD with a relaxed Criterion A1; that is, we allowed events that did not involve threat to life or physical integrity to also qualify as traumatic. We first assessed whether exposure to prejudice-related qualifying events differed with respect to participants' sexual orientation and race. We found that White LGBs were more likely than White heterosexuals to encounter a prejudice-related qualifying event, and among LGBs, Black and Latino LGBs were no more likely than White LGBs to experience this type of event. We then used qualitative analysis of participants' brief narratives to examine prejudice events that precipitated Relaxed Criterion A1 PTSD among 8 participants. Two themes emerged: (a) the need to make major changes, and (b) compromised sense of safety and security following exposure to the prejudice event.

Culture, Health, and Sexuality

BMC Infectious Diseases, Nov 26, 2022

Background: Trans women face tremendous social inequities as well as disproportionate rates of HI... more Background: Trans women face tremendous social inequities as well as disproportionate rates of HIV and substance use, yet disaggregated substance use data specific to trans women remain limited. Methods: We conducted a secondary analysis of baseline data from the Trans*National Study (2016-2017) surveying trans women in the San Francisco Bay Area (n = 629). Multivariable logistic regression was used to analyze sociodemographic and environmental correlates of substance use, and bivariate associations between substance use and HIV-associated outcomes are presented alongside prevalence data. Results: Over half (52.9%) reported using substances in the prior year, most frequently marijuana, methamphetamine, and crack/cocaine. Those with unmet gender-affirming health care needs, lack of insurance, or a history of experiencing racial violence, transphobic violence, adult housing instability, or extreme poverty had higher odds of substance use. Sex work and condomless anal sex were also independently associated with substance use. Conclusions: Among this sample of trans women, substance use and substance use concurrent with sex were highly prevalent, and associated with a number of socioeconomic and health care needs. These findings corroborate the need for holistic and intersectional efforts to reduce substance use and HIV risk.

Social Aspects of HIV, 2021

In 2011, Ghana made a historic shift in its national HIV response by including men who have sex w... more In 2011, Ghana made a historic shift in its national HIV response by including men who have sex with men in the 2011–2015 HIV National Strategic Plan for the first time, marking a paradigm shift. This chapter examines how the criminalization and stigmatization of male same-sex sexual activities have shaped HIV prevention and care activities within this new paradigm. It explores how the legal and social context has informed and constrained HIV stakeholders’ response to the epidemic among men who have sex with men and discusses the unintended consequences of prevention and care activities within the new paradigm. Through an analysis of social, political and media developments, it demonstrates how approaches and initiatives to address HIV among men who have sex with men have contributed to the politicization of homosexuality in Ghana and reshaped the context in which stakeholders develop and implement HIV policies and programs for members of this population.

Introduction: The COVID-19 pandemic has compounded the global crisis of stress and burnout among ... more Introduction: The COVID-19 pandemic has compounded the global crisis of stress and burnout among healthcare workers (HCWs). But few studies have empirically examined the factors driving these outcomes. We examined the association between perceived preparedness to respond to the pandemic and HCW stress and burnout and identified potential mediating factors among HCWs in Ghana. Methods: Data are from HCWs in Ghana who completed a cross-sectional self-administered online survey; 414 and 409 HCWs completed stress and burnout questions, respectively. Perceived preparedness, stress, and burnout were measured using validated psychosocial measures. We assessed associations using linear regressions with robust standard errors. Results: The average score for preparedness was 24 (SD=8.8), 16.3 (SD=5.9) for stress, and 37.4 (SD=15.5) for burnout. In multivariate analysis, HCWs who felt somewhat prepared and prepared had lower stress (β=-1.89, 95%CI:-3.49 to -0.30 and β=-2.66, 95%CI:-4.48 to -0....

AIDS Care, 2020

LGBTQ populations experience human rights abuses worldwide; data need to document the health impa... more LGBTQ populations experience human rights abuses worldwide; data need to document the health impact of these experiences in Africa. In Ghana, we measured events of sexuality-based stigma, discrimination, and violence among men who have sex with men (MSM) and the impact on HIV testing behavior. Data are from respondent-driven sampling surveillance surveys in Accra/Tema, Kumasi, Cape Coast/Takoradi, and Koforidua. Discrimination was common among MSM: 6.2% −30.6% were refused services, 29.0%−48.9% experienced verbal/symbolic violence, 2.8%−12.8% experienced physical violence, 12.3%−30.0% experienced sexual violence due to their sexuality in the preceding year. MSM who experienced sexual violence in their first male sexual encounter were less likely to ever test for HIV in Accra/Tema and Cape Coast/Takoradi. Further studies are needed to examine the impact of stigma and violence on MSM's HIV health-seeking behavior in Ghana. Structural interventions are needed to mitigate the consequences of stigma and discrimination on MSM health and well-being.

The Journal of Sex Research, 2019

Although South Africa protects sexual orientation in its Constitution, homosexuality is sociocult... more Although South Africa protects sexual orientation in its Constitution, homosexuality is socioculturally contested and unaccepted. This lack of acceptance may impact the coming-out process of men who have sex with men (MSM). This study explored diverse factors that influenced whether Black South African MSM disclosed their sexual practices and identities to their families, how their families responded, and how family responses affected them. In-depth interviews were conducted with 81 Black MSM from four Tshwane townships about their sexual and gender identities, sexual practices, social networks, and familial relationships. Interview transcripts were analyzed with ATLAS.ti using a priori codes and inductive coding. Most participants disclosed their sexual identities to at least one person in their families or assumed their families knew despite no explicit disclosure about their sexual identity; a significant minority had not disclosed. Families of those who disclosed were either supportive, in denial, confused, or unsupportive in their responses. Whether or not family was supportive, silence around the participants' same-sex sexualities was prevalent within families. Family responses affected how participants perceived their sexuality and their confidence. Further studies are required to better understand the underlying processes of coming out for Black South African MSM and how these processes impact health outcomes and social well-being. 3 South Africa represents one of the world's most liberal countries in regard to the legal protection of lesbian, gay, bisexual, transgender, and queer (LGBTQ) rights. It was the world's first country to include sexual orientation as a ground for non-discrimination in its 1996 constitution (Equality Clause) and on 30 November 2006, it became the fifth country-and the first in Africa-to legalize same-sex marriage through the Civil Union Act (Cock, 2003; De Vos & Barnard, 2007). These legal protections were adopted in a broader context of social reform by the post-apartheid government after the successful organizing of LGBTQ rights activists, veterans of the anti-apartheid movement (Cock, 2003; Thoreson, 2008). Legal protections such as the Equality Clause and the Civil Union Act are important for millions of people across the world who identify with same-sex sexualities, desires, and intimacies because, as several studies indicate, the absence of such rights has a significantly negative impact on their health and other

BMC Public Health, 2021

Background Trans women experience high rates of gender-based violence (GBV)—a risk factor for adv... more Background Trans women experience high rates of gender-based violence (GBV)—a risk factor for adverse health outcomes. Transphobic hate crimes are one such form of GBV that affect trans women. However, little is understood about factors that shape transphobic hate crimes and racial/ethnic variation in these experiences. To contextualize GBV risk and police reporting, we examined self-reported types and correlates of transphobic hate crimes by racial/ethnic group of trans women in the San Francisco Bay Area. Methods From 2016 to 2018, trans women participated in a longitudinal cohort study of HIV. Secondary data analyses (N = 629) examined self-reported experiences of transphobic hate crimes (i.e., robbery, physical assault, sexual assault, and battery with weapon) by race/ethnicity, and whether hate crimes were reported to the police. Chi-square tests and simple logistic regression examined demographic, sociocultural, and gender identity factors associated with transphobic violence ...

The risk of acquiring sexually transmitted infections (STIs) among men who have sex with men (MSM... more The risk of acquiring sexually transmitted infections (STIs) among men who have sex with men (MSM) is driven by various socio-behavioral factors. From 2015-2017, 247 MSM ≥ 18 years-old who reported alcohol use in the past year, were recruited into a cross-sectional study in San Francisco. Participants completed a survey assessing socio-demographics, substance use and treatment, sexual behaviors, HIV status and self-reported STI diagnosis in the past 6 months. Multivariable logistic regression models stratified by HIV status were used to identify the correlates of STIs. Of 247 MSM, the prevalence of bacterial STIs were: gonorrhea (12.9%), chlamydia (9.3%) and syphilis (6.0%). Among 177 MSM living without HIV, factors significantly associated with recent STI diagnosis were: current pre-exposure prophylaxis (PrEP) use (aOR = 3.53, 95% CI: 1.42–8.75, p ≤ .01), popper use during sex in the past 6 months (aOR = 3.16, 95% CI = 1.34–7.47, p ≤ .01) and a history of alcohol treatment (aOR = 0...

Introduction: Healthcare workers' (HCWs) preparedness to respond to pandemics is critical to ... more Introduction: Healthcare workers' (HCWs) preparedness to respond to pandemics is critical to containing disease spread. Low-resource countries, however, experience barriers to preparedness due to limited resources. In Ghana, a country with a constrained healthcare system and high COVID-19 cases, we examined HCWs' perceived preparedness to respond to COVID-19 and associated factors. Methods: 472 HCWs completed questions in a cross-sectional self-administered online survey. Perceived preparedness was assessed using a 15-question scale (Cronbach alpha=0.91) and summative scores were created (range=0-45). Higher scores meant greater perceived preparedness. We used linear regression with robust standard errors to examine associations between perceived preparedness and potential predictors. Results: The average preparedness score was 24 (SD=8.9); 27.8% of HCWs felt prepared. In multivariate analysis, factors associated with higher perceived preparedness were: training (β=3.35, 95%...

PLOS Global Public Health

The COVID-19 pandemic has affected job satisfaction among healthcare workers; yet this has not be... more The COVID-19 pandemic has affected job satisfaction among healthcare workers; yet this has not been empirically examined in sub-Saharan Africa (SSA). We addressed this gap by examining job satisfaction and associated factors among healthcare workers in Ghana and Kenya during the COVID-19 pandemic. We conducted a cross-sectional study with healthcare workers (N = 1012). The two phased data collection included: (1) survey data collected in Ghana from April 17 to May 31, 2020, and (2) survey data collected in Ghana and Kenya from November 9, 2020, to March 8, 2021. We utilized a quantitative measure of job satisfaction, as well as validated psychosocial measures of perceived preparedness, stress, and burnout; and conducted descriptive, bivariable, and multivariable analysis using ordered logistic regression. We found high levels of job dissatisfaction (38.1%), low perceived preparedness (62.2%), stress (70.5%), and burnout (69.4%) among providers. High perceived preparedness was positi...

Think Global Health, 2022

AIDS Care, 2020

LGBTQ populations experience human rights abuses worldwide; data need to document the health impa... more LGBTQ populations experience human rights abuses worldwide; data need to document the health impact of these experiences in Africa. In Ghana, we measured events of sexuality-based stigma, discrimination, and violence among men who have sex with men (MSM) and the impact on HIV testing behavior. Data are from respondent-driven sampling surveillance surveys in Accra/Tema, Kumasi, Cape Coast/Takoradi, and Koforidua. Discrimination was common among MSM: 6.2%–30.6% were refused services, 29.0%–48.9% experienced verbal/symbolic violence, 2.8%–12.8% experienced physical violence, 12.3%-30.0% experienced sexual violence due to their sexuality in the preceding year. MSM who experienced sexual violence in their first male sexual encounter were less likely to ever test for HIV in Accra/Tema and Cape Coast/Takoradi. Further studies are needed to examine the impact of stigma and violence on MSM's HIV health-seeking behavior in Ghana. Structural interventions are needed to mitigate the consequences of stigma and discrimination on MSM health and well-being.

The Journal of Sex Research, 2019

Although South Africa protects sexual orientation in its Constitution, homosexuality is sociocult... more Although South Africa protects sexual orientation in its Constitution, homosexuality is socioculturally contested and unaccepted. This lack of acceptance may impact the coming-out process of men who have sex with men (MSM). This study explored diverse factors that influenced whether Black South African MSM disclosed their sexual practices and identities to their families, how their families responded, and how family responses affected them. In-depth interviews were conducted with 81 Black MSM from four Tshwane townships about their sexual and gender identities, sexual practices, social networks, and familial relationships. Interview transcripts were analyzed with ATLAS.ti using a priori codes and inductive coding. Most participants disclosed their sexual identities to at least one person in their families or assumed their families knew despite no explicit disclosure about their sexual identity; a significant minority had not disclosed. Families of those who disclosed were either supportive, in denial, confused, or unsupportive in their responses. Whether or not family was supportive, silence around the participants’ same-sex sexualities was prevalent within families. Family responses affected how participants perceived their sexuality and their confidence. Further studies are required to better understand the underlying processes of coming out for Black South African MSM and how these processes impact health outcomes and social well-being.

Journal of aggression, maltreatment & trauma, 2013

This mixed-methods study examined associations between prejudice events and post-traumatic stress... more This mixed-methods study examined associations between prejudice events and post-traumatic stress disorder (PTSD) among 382 lesbians, gays, and bisexuals (LGB) and 126 heterosexuals. Using the Composite International Diagnostic Interview, we assessed PTSD with a relaxed Criterion A1; that is, we allowed events that did not involve threat to life or physical integrity to also qualify as traumatic. We first assessed whether exposure to prejudice-related qualifying events differed with respect to participants' sexual orientation and race. We found that White LGBs were more likely than White heterosexuals to encounter a prejudice-related qualifying event, and among LGBs, Black and Latino LGBs were no more likely than White LGBs to experience this type of event. We then used qualitative analysis of participants' brief narratives to examine prejudice events that precipitated Relaxed Criterion A1 PTSD among 8 participants. Two themes emerged: (a) the need to make major changes, and (b) compromised sense of safety and security following exposure to the prejudice event.

Culture, Health, and Sexuality