The influence of dual-identity development on the psychosocial functioning of African-American gay and bisexual men.

Research has been conducted concerning the identity development of homosexual males and racial-ethnic minorities as independent and mutually exclusive groups (Cass, 1979; Cross, 1971, Cross, Parham, & Helms, 1991; Troiden, 1979, 1993); however, only a few investigators have examined the issues that face gay/bisexual men who are African American (Cochran & Mays, 1994; Dube & Savin-Williams, 1999; Greene, 1997; Loiacano, 1993; Peterson, Folkman, & Bakeman, 1996; Stokes & Peterson, 1998; Stokes, Vanable, & McKirnan, 1996). Several recent epidemiological studies underlie the importance of considering the interface between racial-ethnic and sexual identity among African-American gay and bisexual men (AAGBM):

1. Higher rates of heavy substance use (i.e., alcohol and cocaine) have been found among AAGBM men in comparison to their heterosexual counterparts (Richardson, Meyers, Bing, & Satz, 1997).

2. The suicide rate among African-American boys and young men increased 105% between 1980 and 1995 (CDC, 1998).

3. Elevated levels of depressive mood and anxiety disorders have been found among AAGBM in comparison to European-American homosexual or heterosexual African-American men (Richardson et al., 1997).

4. While the incidence of Acquired Immune Deficiency Syndrome (AIDS) has decreased dramatically among European-American gay men, decreases among AAGBM have been minimal (CDC, 1999). Collectively, these data indicate that AAGBM living in the United States are at considerable risk for emotional and physical health problems.

Factors that may account for this elevated risk include heterosexist and race-based stress. Lesbians, gay men, and bisexuals represent a sexual minority, and like other minorities, they often face experiences of discrimination. Unfortunately, experiences of oppression and discrimination, including blocked access to resources, remain ongoing experiences in the lives of many African Americans. When the life experiences of AAGBM are closely examined, it becomes apparent these individuals must contend with the challenges of managing dual minority status (i.e., being African American and gay or bisexual).

Heterosexism in the United States

Although increasing numbers of Americans do not support discrimination based on sexual orientation, a significant number of people express negative attitudes toward homosexuality. Popular, media-based surveys (Lacayo, 1998) indicate that significant numbers of Americans believe homosexual relationships are not acceptable and are morally wrong, that homosexuality is a matter of choice, and that gay men and lesbians should not serve in the military, teach in schools, or parent children. Empirical survey research conducted by Michael, Gagnon, Laumann, and Kolata (1994) indicates that the vast majority of Americans view sexual relationships between two adults of the same sex as "always wrong." A national telephone survey conducted by Herek and Glunt (1993) revealed that 64% of their respondents agreed that "homosexual behavior between two men is just plain wrong," and 50% of the sample agreed with the statement "I believe homosexuals are disgusting."

Heterosexism in the African-American Community

The limited empirical research on the attitudes of African Americans toward homosexuality suggests that, as a group, most possess conservative religious views and consequently have a very negative outlook upon same-sex sexual activity (Greene, 1994, 1997; Herek & Capitanio, 1995; Michael et al., 1994). Homosexual behavior is conceptualized as sinful and unnatural, and individuals known to engage in this activity are urged to discontinue (Greene, 1994).

Tolerance or acceptance of homosexuality in African-American communities has been noted in many instances; however, this acceptance often comes with the implicit agreement that gay and bisexual African Americans must not disclose or display their sexual orientation (Dalton, 1989; Mays 1989; Peterson, 1992; Savin-Williams, 1996). As long as they do not make their lifestyles overly explicit, gay and bisexual African Americans will be tolerated within their communities.

Facing the threat of social and emotional abandonment, many AAGBM are compelled to maintain a dual existence that often has significant psychological consequences (Greene, 1994). For some, this means leading a compartmentalized existence. Recognizing that they are partially valued within the African-American community, AAGBM must monitor and measure what they reveal, while seeking out the European-American gay community to express the other aspects of their identity. However, this strategy is fraught with emotional hazards. Ethnic minority gay and lesbian people commonly report race-based discriminatory treatment in gay and lesbian-bars, clubs, and other social gatherings (Adams & Kimmel, 1997; Icard, 1986). As a consequence, many of these individuals report an intense sense of conflicting loyalties to two communities: They are marginalized in each community and are required to conceal important aspects of their identities to survive in each. Two factors believed to be important in this coping process are racial identity and sexual identity development (Adams & Kimmel, 1997; Greene, 1997).

Racial-Ethnic Identity Development

Several theorists have examined how the process of identity development for individuals of minority status differs from that of their majority counterparts (Cross, 1971, 1995; Cross et al., 1991; Helms, 1993; Phinney, 1989, 1993). The model of African-American identity development that has received the greatest amount of attention is one developed by Cross and his colleagues. The model posits that as African Americans become aware of themselves as objects of oppression, their attitudes toward themselves, their own minority group, other minority groups, and members of the dominant culture crystallize in a manner that leads to a core sense of identity (Cross, 1995).

African Americans are believed to progress through a sequence of stages, each of which comprises varying racial identity attitudes and corresponding states of psychological functioning. According to this model, the most psychologically healthy and integrated stage of functioning for the African American individual is labeled Integration. At this stage the individual develops a positive and personally relevant African-American identity that takes into consideration the unique attributes of the individual and the awareness that one's cultural heritage influences who one is (Helms, 1993). It is also an identity in which African Americans serve as the primary reference group to which one belongs (Helms, 1993). In addition, this stage of functioning also defends and protects a person from psychological insults and, when possible, warns of impending psychological attacks that stem from having to live in a racist society (Cross, 1997).

The Process of Sexual Identity Development

Troiden (1993) conceptualized the most well-received and accepted model of sexual identity formulation. He synthesized the work of many individuals over the last 25 years (Cass, 1979, 1984; Coleman, 1982; Lee 1977; Ponse, 1978; Schafer, 1976; Weinberg, 1978) with his own model (Troiden, 1979), which incorporates the results of research investigating the coming-out process of gay men and lesbians.

Troiden (1993) proposed a stage model that suggests the most psychologically healthy and integrated stage of functioning is the Committed stage of development. It is characterized by fusing sexuality and emotionality into a significant whole, perceiving a gay identity as legitimate and not secondary to a heterosexual identity, initiating and maintaining same-sex love relationships, and disclosing one's identity to the general public (Troiden, 1993).

Minority Stress

Brooks (1981) argues that sexual minorities experience proportionally more negative life events as a result of living in a sexist, racist, and heterosexist society. In the context of their double minority status, AAGBM experience heterosexism, racism, and stigmatization, which puts them at risk for experiencing negative life events (e.g., loss of employment, home, or custody of children; antigay violence and discrimination due to their sexual orientation and/or racial-ethnic background), as well as the more chronic daily hassles of hearing antigay or anti-Black jokes, or perceiving the need to be vigilant for verbal, physical or institutional assault or oppression (Brooks, 1981; Icard, 1986; Loicano, 1993).

Research examining minority stress on gay men indicates that discrimination and experiences of negative treatment in society are associated with greater mental health problems (Meyer, 1995) and emotional distress (Clark, Anderson, Clark, & Williams, 1999; Ross, 1990). As summarized by DiPlacido (1998, p. 142),

   Gay-related stressors are significantly more common among adolescent gay
   and bisexual males who have attempted suicide compared to those who have
   not (Rotheram-Borus, Hunter, & Rosario, 1994). Coping with high levels of
   stress has been related to high-risk sexual behavior among gay and bisexual
   youth (Folkman, Chesney, Pollack, & Phillips, 1992; Rotherman-Borus, Reid,
   Rosario & Kasen, 1995), and to delinquent behaviors among African American
   and Hispanic gay teenagers (Rotheram-Borus, Rosario, Van-Rossem, Reid, &
   Gillis, 1995). Verbal and physical abuse as stressors have been associated
   with school problems, substance abuse, running away, prostitution, and
   suicide among lesbian, gay, and bisexual youth (Garnets, Herek, & Levy,
   1992; Savin-Williams, 1994).

DiPlacido (1998, p. 148) goes on to suggest the following:

   Conceptualizing stress as life events and daily hassles may be particularly
   relevant to gay men and lesbians who are "out of the closet." Since others
   are aware of their sexual identity, their stigma is more evident. Being out
   exposes them to a greater number of negative life events, such as
   discrimination and rejection (Bradford, Ryan, & Rothblum, 1994) and
   violence (D'Augelli, 1989, Garnets, Herek, & Levy, 1992; Herek, 1991;
   Savin-Williams, 1994).

DiPlacido (1998) asserts that a major weakness of traditional research in this area has been its primary focus on external life events and daily hassles as stressors. To better comprehend the association of stress and health outcomes among sexual minorities, she suggests that a new conceptualization of stress must take place that includes the hidden nature of sexual orientation. Research examining sexual minorities demonstrates that the constructs of self-concealment and emotional inhibition can be conceptualized as salient internal stressors for this group of individuals. DiPlacido (1998; p. 148) notes the following:

   Jourard (1971) postulated that self-disclosure of one's true self leads to
   better psychological and physical health. Several studies conducted by
   Pennebaker and his colleagues have found that emotional inhibition (i.e.,
   the subjugation of feelings and cognition) is related to reports of
   physical symptoms, visits to the doctor, and distinctive physiological
   responses (Pennebaker & Chew, 1985; Pennebaker, Kiecolt-Glaser, & Glaser,
   1988; Pennebaker & O'Heeron, 1984). Larson and Chastain (1990) reported
   that the "keeping of secrets" is related to increased physical and
   psychological symptoms.

Diplacido (1998) concludes that this research suggests that the inhibition of feelings and thoughts produce strain on the body, which can be linked to psychological health. Because many gay men, lesbians, and bisexuals must constantly monitor situations to determine whether or not they can be open about their sexual orientation, they are placed at increased risk for psychosocial dysphoria due to this additional burden.

Rationale

The goal of this project was to examine how AAGBM manage their dual developmental processes, and how they may be associated with life satisfaction, psychosocial functioning, and engaging in risky sexual behaviors. To facilitate our theoretical approach to examining these questions, we utilized the work of Sedeno (1999), that offered a modified version of Berry, Kim, Minde, and Mok's (1987) conceptualization of Modes of Acculturation. Their work has primarily been used to conceptualize the process of acculturation among Latinos and Latinas. Acculturation refers to a dynamic process by which groups adapt to a new sociocultural environment depending on the power relationship between them (Berry et al., 1987). A mode is conceptualized as an adopted status one utilizes to do one of the following: (a) maintain one's cultural behaviors and participate in one's culture, or (b) establish and maintain new cultural behaviors and participate in the new culture (Sedeno, 1999). Within their formulation, as it would be applied to Latinos and Latinas, four modes of acculturation could occur: (a) Assimilation (no to ethnic, yes to mainstream)--this would entail relinquishing one's cultural behaviors and characteristics, and moving toward participation in the mainstream society; (b) Integration (yes to ethnic, yes to mainstream)--this would entail maintaining one's cultural traits and behaviors while becoming an integral part of the host culture; (c) Separation (yes to ethnic, no to mainstream)--this would involve maintaining one's cultural behaviors and characteristics while withdrawing from the host culture, done either by the discretion of the individual or imposed as segregation by the dominant culture; and (d) Marginalization (no to ethnic, no dominant culture)--this would involve a lack of participation or identification with either culture, often accompanied by feelings of loss and alienation.

To promote our conceptualization of the experiences of AAGBM, we modified Sedeno's (1999) formulation in the following manner: (a) Assimilation (low sexual identification/high racial-ethnic identification)--this would be the AAGBM who does not possess a strong sense of himself as a gay man, who has little or no association with the gay or lesbian community or its political or social agenda and concerns, but who does have a strong sense of himself as an African American and is invested and connected to the African-American community, its political or social agenda, and concerns; (b) Integration (high sexual identification/high ethnic-racial identification)--this would be the AAGBM who possesses a strong sense of himself as a gay man, who does associate with the gay or lesbian community and is involved and invested in the gay and lesbian political and social agenda, while simultaneously has a strong sense of himself as an African American and is invested and connected to the African-American community; (c) Separation (high sexual identification/low ethnic-racial identification)--this would be the AAGBM who possesses a strong sense of himself as a gay man, who associates with the gay or lesbian community and is involved and invested in the gay and lesbian political and social agenda, but is not involved or engaged in the African-American community or its political and social agenda; and d) Marginalization (low sexual identification/low ethnic-racial identification)--this would be the AAGBM who does not possess a strong sense of himself as a gay man, who has little or no association with the gay or lesbian community, and who has little or no investment in the gay and lesbian political agenda. In addition, he does not have a strong sense of himself as an African American and is not invested or connected to the African-American community.

Hypothesis

Collectively, ethnic-racial identity research suggests that individuals who are integrated or bicultural possess higher levels of self-esteem and life satisfaction because they experience the benefits of both aspects of their cultural identities (Chimezie, 1985; Phinney, 1990; Sanchez & Fernandez, 1993). The goal of this project was to determine if this was true for AAGBM who have to manage two aspects of their identity (i.e., sexuality and race/ethnicity). The specific hypothesis examined in this study is as follows:

   AAGBM who are identified to be in the Integration Mode of Sexual and
   Ethnic-Racial Acculturation will report less gender-role stress, greater
   life satisfaction, lower levels of psychosocial stress, engagement in fewer
   high-risk sexual behaviors, greater levels of self-esteem, and more racist
   and homophobic encounters than will AAGBM in the other Modes of Sexual and
   Ethnic-Racial Acculturation.

METHOD

Participants

AAGBM were recruited for participation in the study in Chicago, Illinois, and Richmond, Virginia, through print advertisement in weekly newspapers and periodicals, outreach by recruiters in community settings--including coffee shops and cafes, street fairs, public parks, and gay and "mixed" (i.e., gay and heterosexual) bars--and snowball sampling techniques (i.e., referrals from men who participated in the study). This sampling methodology has been successfully used by researchers sponsored by the National Institute on Drug Abuse, the National Institutes of Health, and the Centers for Disease Control and Prevention (e.g., Richardson et al., 1997; Stokes, Damon, & Mckirnan, 1997; Stokes, Vanable, & McKirnan, 1996). Print advertisements and field workers invited men to call a local university for more information about a confidential study being conducted investigating the social and sexual behaviors of African-American men who have sex with men. When respondents called, they were screened for eligibility (i.e., they had to be 18 years of age or older, had to identify themselves as engaging in sexual activity with men, had to have completed at least 8 years of formal education, and had to be in fair or good medical condition). Callers who met eligibility requirements were given an appointment. Upon arriving at a local university, participants were greeted by a research assistant and escorted to a testing room. They were told that all information gathered in the study would be held in the strictest confidence. A consent form was given to each participant, with a request to read and sign it, and participants were told they could discontinue their participation at anytime. Subjects (N = 174) were compensated $20 for their participation in the study. Table 1 presents a summary of the demographics of the participants.

Instruments

The respondents completed a demographics form adapted from an instrument developed by Johnson (1981) that included questions regarding the individual's lifetime number of male and female sex partners. Participants also completed a questionnaire packet that contained the following instruments.

The Life-Satisfaction Scale (LSS; Bryant & Veroff, 1984) is a 7-item scale that provides a measure of subjective mental health. The scale yields a single, global satisfaction score, although several aspects of individual functioning are assessed (e.g., leisure, work/school, home, romantic relationships, etc.). Factor loadings for items included in the LSS are high, and internal consistency measures lie consistently above .90 across various studies (Bryant & Veroff, 1984). The items are rated on a 1 = no satisfaction to 4 = great satisfaction scale. The following is an item from the LSS: "How much satisfaction have you gotten out of your work on the job or school?" Higher scores on the LSS indicate greater life-satisfaction. Cronbach's alpha equaled .73 for the LSS in this study.

The HIV Prevention Self-Efficacy Scale (HPSES; Smith, McGraw, Costa, & McKinley, 1996) is a 9-item measure that assesses the degree to which an individual feels he/she can engage in HIV preventive behaviors. Ratings are based on a Likert-type scale (1 = not at all sure; 5 = very sure). The following is an item from the HPSES: "How sure are you that you can ... buy condoms at a drug store?" This measure has demonstrated adequate internal reliability (e.g., Cronbach's alpha = .68 to .78) and validity (Smith et al., 1996). Higher scores on the HPSES indicate a greater degree of self-efficacy in preventing HIV infection. Cronbach's alpha equaled .79 for the HPSES in this study.

The Coopersmith Self-Esteem Inventory (CSEI; Coopersmith, 1981) is a 25-item questionnaire designed to measure evaluative attitudes toward the self in social, academic, family, and personal areas of experience. Respondents are asked to respond like me or unlike me to each item. Internal consistency estimates have ranged from .87 to .92 (Maloney, Cheney, Spring, & Kanusky, 1986). The number of self-esteem items answered correctly is summed. The following is an item from the CSEI: "Things usually don't bother me." Higher scores on the CSEI indicate more self-esteem. Cronbach's alpha equaled .80 for the CSEI in this study.

The Social Support Questionnaire (SSQ; Sarason, Levine, Basham, & Sarason, 1982) is a 15-item (abbreviated version of the original questionnaire) instrument that asks respondents to list the people to whom they can turn for support in various situations, and to indicate their perceived level of satisfaction with the social support received in each case. The measure yields two scores: the average number of persons listed as supportive and the average degree of satisfaction (1 = very dissatisfied to 6 = very satisfied) with received social support. The following is an example of an item from the SSQ: "Whom can you count on to be dependable when you need help? How Satisfied?" Sarason et al. (1982) report a reliability index of .94 for the SSQ. Higher scores indicate more social supports and more satisfaction with the support the individual receives. The degree of social support satisfaction was the only index utilized in this study. Cronbach's alpha equaled .95 for both measures in this study.

The Symptom CheckList 90-Revised (SCL 90-R; Derogatis, 1993) is a 90-item self-report symptom inventory designed to reflect the psychological symptom patterns of community, medical, and psychiatric respondents. Each item is rated on a 5-point scale of distress (0-4) ranging from not at all to extremely. Nine primary symptom dimensions and three global indices of distress are provided: Somatization, Obsessive-Compulsive, Interpersonal Sensitivity, Depression, Anxiety, Hostility, Phobic Anxiety, Paranoid Ideation, Psychoticism--Global Severity Index, Positive Symptom Distress Index, and Positive Symptom Total. The following is an example of an item from the SCL-90: "How much were you distressed by: heart pounding or racing?" Internal consistency estimates in clinical samples have ranged from .77 to .90, and test-retest estimates have ranged from .78 to .90 (Derogatis, 1993). The Global Severity Index was the only component of the measure utilized for this study. Cronbach's alpha equaled .99 for the SCL 90-R in this study.

The Minority Multi-Group Ethnic Identity Measure (MEIM; Phinney, 1992) is a 20-item, Likert-type scale which assesses four aspects of ethnic identity: (a) positive ethnic attitudes and sense of belonging (5 items), (b) ethnic behaviors and practices (2 items), (c) ethnic identity achievement (7 items), and (d) other-group orientation (7 items). Each item is rated on a 5-point scale, ranging from strongly agree (5) to strongly disagree (1). Internal consistency estimates have ranged from .81 to .90 (Phinney, 1992). For the purpose of this study, the items were summed to produce a Total Minority Ethnic Identity Score, such that higher scores indicate more positive ethnic attitudes and ties to one's ethnic group. The following is an item from the MEIM: "I am active in organizations or groups that include mostly members of my own ethnic group." Cronbach's alpha equaled .85 for the MEIM in this study.

The Schedule of Racist Events (SRE; Landrine & Klonoff, 1996) is an 18-item self-report inventory that assesses the frequency of racist discrimination an individual has experienced in the past year, in one's entire life, and the extent to which this discrimination was evaluated as stressful. Each of the 18 items is completed 3 times (on a 6-point scale, 1 = not at all and 6 = extremely) with reference to the aforementioned constructs. Landrine and Klonoff (1996) report the following reliability coefficients for the three subscales: .95 (recent racist events), .95 (lifetime racist events), and .94 (appraised racist events). Higher scores indicate more frequent encounters with racism and experiencing these events as stressful. The following is an item from the SRE: "How many times have you been treated unfairly by your employers, bosses, or supervisors because you are Black?" Cronbach's alpha equaled .95 for the SRE in this study.

The Male Gender Role Stress Scale (MGRS; Eisler & Skidmore, 1987) is a 40-item self-report scale designed to measure the level of male gender role stress an individual experiences in his day-to-day existence. Respondents are asked to rate each item in terms of the impact it has on them. Items are rated on a 7-point Likert-type scale (0 = not stressful; 6 = extremely stressful). The MGRS provides a total score and five subscale scores, with higher scores reflecting more male gender role stress. For the purpose of this study, only total scores on the MGRS were computed. The following is an item from the MGRS: "Please rate the following according to how stressful the situation would be for you--telling your significant other that you love him/her." The MGRS has adequate reliability (e.g., Cronbach's alpha = .90) and validity (Copenhaver, Lash, Eisler, 2000; Eisler, Skidmore, & Ward, 1988). Cronbach's alpha equaled .93 for the MGRS in this study.

The Gay Identity Scale (GIS) is a 15-item, Likert-type scale developed specifically for this study based on previous research by Waldo, Hesson-McInnis, and D'Augelli (1998) to assess several aspects of gay sexual identity: (a) positive gay/lesbian attitudes, (b) disclosure of gay identity to others, and (c) participation in gay/lesbian organizations. Respondents were asked to rate each item on a Liken-type scale (1 = not at all comfortable to 4 = very comfortable). The following is an item from the GIS: "How comfortable do you feel disclosing your sexual orientation to the majority of the people in your community?" Higher scores on the GIS indicate a more positive adjustment to one's sexual identity. Cronbach's alpha equaled .81 for the GIS in this study.

The Sexual Risk-Taking Scale (SRS) is a 9-item, Likert-type scale (1 = all the time; 7 = never) developed specifically for this study to assess the frequency in which respondents engage in unsafe sexual activity (e.g., engage in receptive anal intercourse without the use of a condom). Higher scores on the SRS indicate participation in more frequent episodes of unsafe sexual activity. Cronbach's alpha equaled .78 for the SRS in this study.

The Gay Bashing Scale (GBS) is a 9-item scale developed specifically for this study that assesses lifetime discrimination based on sexual orientation. Respondents are asked how often they have experienced 9 events (e.g., verbal insults) because someone knew or assumed the individual was gay or bisexual. A Likert-type scale (1 = never; 7 = more than three times) response format is used. Higher scores on the GBS indicate more frequent encounters of discrimination based on sexual orientation. Cronbach's alpha equaled .86 for the SRS in this study.

RESULTS

To control for Type I error, the level of significance was set at .025 for all analyses. To determine the four Modes of Sexual and Ethnic-Racial Acculturation, median splits were performed on participants' scores on the GIS and MEIM. As a consequence, participants scoring below the median on the GIS and above the median on the MEIM were categorized as being in the Assimilation Mode (N = 45), while individuals scoring above the median on both measures were categorized as being in the Integration Mode (N = 41). Participants scoring above the median on the GIS and below the median on the MEIM were placed in the Separation Mode category (N = 45), and subjects scoring below the median on each measure were categorized as being in the Marginalization Mode (N = 40).

We performed preliminary analyses to determine if there were significant demographic variable differences across the four groups. These analyses revealed no differences across the groups related to age, level of education, employment status, religious preference, or region of the U.S. (i.e., Richmond, N = 26, versus Chicago, N = 145).

To evaluate our primary hypothesis, we used multivariate analyses of variance (MANOVA) with Mode of Sexual and Ethnic-racial Acculturation to assess differences on the LSS, MGRS, SCL-90-R, HPSES, and the CSEI. A significant multivariate effect was evident, Pillai's trace = .37, F(15,489) = 4.58, p < .01, [[eta].sup.2] = .12. Univariate analyses of variance (ANOVA) with Tukey post hoc tests indicated that AAGBM in the Integration Mode of Sexual Ethnic-Racial Acculturation reported experiencing lower levels of psychological distress than AAGBM in the Marginalization Mode, F(3, 167) = 2.29, p < .01, [[eta].sup.2] = .07. The mean differences are shown in Table 2. Individuals in the Integration Mode also reported lower levels of male gender-role stress than participants in the Assimilation and Marginalization Modes of Acculturation, F(3, 167) = 6.56, p < .01, [[eta].sup.2] = .11. Subjects in the Integration Mode also reported greater levels of life satisfaction, F(3, 167) = 8.90, p < .01, [[eta].sup.2] = .14, and self-esteem, F(3, 168) = 12.67, p < .01, [[eta].sup.2] = .19, than individuals in the Marginalization and Separation Modes of Acculturation. Participants in the Integration Mode expressed more confidence in preventing HIV infection than participants in the Separation Mode of Sexual and Ethnic-Racial Acculturation, F(3, 168) = 5.34, p < .01, [[eta].sup.2] = .09. A summary of these results is presented in Table 2.

We also used MANOVA to determine if differences existed between the groups on their perceived levels of social support and level of social support satisfaction, which was measured by the SSQ. A significant multivariate effect was evident, Pillai's trace = .12, F(6, 334) = 3.51, p < .01, [[eta].sub.2] = .06. Univariate ANOVA revealed individuals in the Integration Mode of Sexual and Ethnic-Racial Acculturation reported more people being a part of their social support system than individuals in the Marginalization or Assimilation Modes of Acculturation, F(3, 167) = 5.38, p < .01, [[eta].sup.2] = .09 (see Table 2). No significant group differences were found on level of social support satisfaction.

MANOVA was also used to determine if there were significant group differences related to sexual risk-taking and the number of lifetime opposite and same-sex sexual partners. A significant multivariate effect was evident, Pillai's trace = .21, F(9, 504) = 4.17, p < .01, [[eta].sup.2] = .07. AAGBM in the Assimilation Mode of Sexual Ethnic-Racial Acculturation reported having had more opposite-sex lifetime sexual partners than their counterparts in the Separation and Integration Modes of Sexual Ethnic-Racial Acculturation, F(3, 168) = 7.73, p < .01, [[eta].sup.2] = .12 (see Table 2). No significant group differences were found regarding sexual risk-taking and lifetime number of same-sex sexual partners. A final MANOVA with experiences of racism and heterosexism as dependent variables was not significant.

Using median splits in the current study provides a conceptually clear picture and matches the theoretical foundation upon which this study is based. Yet, the median split procedure may involve a loss of information in the data and may create arbitrary groups (Maxwell & Delaney, 1990). The median is dependent upon the characteristics of any sample, but using a set cut-off score to differentiate high versus low scores on a measure is an alternative to median splits that can be replicated in other samples. As a check to the median split procedure used in this study, a cut-off score of 3.75 was used for both the gay identity and ethnic identity measures (i.e., mean scores of 3.75 and above denotes higher levels of the given identity), and the prior MANOVAs were repeated with this new set of four modes of sexual and ethnic-racial acculturation. The general pattern of the results was replicated. Thus, the results are in the hypothesized direction across several dependent variables using two different categorical procedures, which suggest the disparity among the groups reflects true and valid differences.

We used forward multiple regression analyses to assess and compare the degree to which racial identity, sexual identity, male gender-role stress, lifetime encounters with racism and heterosexism, and self-esteem predicted life satisfaction. Self-esteem accounted for nearly 29% of the variance in life satisfaction. Higher levels of self esteem were associated with greater levels of life satisfaction, F(1, 167) = 70.1, p < .001. Higher levels of racial identity development and lower levels of racism were also significantly associated with greater levels of life satisfaction, although the latter relationship is statistically marginal. Racial identity and levels of racism accounted for an additional 3% and 2% of variance in the prediction of life satisfaction, respectively (see Table 3).

A second forward multiple regression analysis was conducted with sexual risk-taking as the dependent variable and several independent variables: self-esteem, male gender-role stress, SCL-90-R scores, gay identity, life satisfaction, HIV prevention self-efficacy, lifetime experience with racism, and gay bashing. Psychological distress accounted for 2% of the variance in sexual risk-taking. Higher levels of psychological distress were associated with greater levels of sexual risk-taking, F, (1, 167) = 4.74, p < .032. Higher levels of gay identity and higher levels of life satisfaction accounted for an additional 3% and 2% of variance in the prediction of sexual risk-taking, respectively (see Table 4). Because the simple bivariate correlation between life satisfaction and sexual risk-taking was not significant (see Table 5), one of the independent variables in this regression analysis functioned as a suppressor variable (i.e., suppressing irrelevant variance and enhancing the relationship between life satisfaction and sexual risk-taking).

DISCUSSION

The results of this study help to further clarify the complex relationship between racial-ethnic identity and sexual identity among AAGBM, and the subsequent impact these dual identities have on these individuals' psychosocial functioning. The findings of this study have implications regarding the inclusion of affirmative conceptualizations of sexual diversity in contemporary theories of African-American manhood and social development and health promotion. The following discussion will summarize and synthesize the main findings from this study.

The results of this study indicate that AAGBM identified in the Integration Mode of Racial-Ethnic Sexual Identity Acculturation (i.e., individuals possessing very positive self-identification as being African American and gay) reported experiencing higher levels of self-esteem, HIV prevention self-efficacy, stronger social support networks, greater levels of life satisfaction, and lower levels of male gender-role and psychosocial distress than their counterparts in the other Modes of Racial-Ethnic Sexual Identity Acculturation. Participants identified in the Marginalization Mode of Racial-Ethnic Sexual Identity Acculturation (i.e., individuals possessing negative self-identification as being African American and gay) reported experiencing the greatest amount of psychosocial distress and the lowest levels of self-esteem, social support, and life satisfaction. Higher levels of self-esteem were associated with greater levels of life satisfaction for the entire sample, followed by higher levels of racial identity development and lower levels of experienced racism. Sexual identity development and experiences with heterosexism were not significant predictors of life satisfaction for this sample of AAGBM.

The aforementioned pattern of results support our hypothesis that the more AAGBM are able to integrate and hold positive self-attitudes toward their racial-ethnic and sexual identities, the more likely they are to value themselves, protect their health, and experience greater levels of personal contentment. These findings affirm how important the successful integration and simultaneous validation of these various identities are to the overall psychosocial health of AAGBM. Overcoming the social pressure to view identity as a singular construct that requires the renunciation or devaluation of one's race/ethnicity or sexuality appears to be associated with the most psychological benefit for AAGBM. The fusion of ethnic and sexual identity into an integrated whole that is characterized by holding positive attitudes toward one's ethnic group, homosexuals and homosexuality, and engaging in social participation and cultural practice in the African-American and gay subcultures appear to be key to this process. Moreover, our findings suggest that to whatever degree AAGBM are not able or allowed to simultaneously value their dual identities and be a part of both the African-American and gay and lesbian subcultures, their levels of life satisfaction and self-esteem are diminished. The most extreme form of this is seen among the AAGBM in this study who were identified in the Marginalization Mode of Racial-Ethnic Sexual Identity Development; These participants reported the highest levels of psychosocial distress.

Although the results of this study suggest that the integration of ethnic and sexual identity is associated with optimal psychosocial functioning for AAGBM, attachment to cultural heritage and identity as an African American are the most important factors to the emotional health of AAGBM (see Table 3). These findings lend support to the theoretical research on ethnic minority gay men and lesbians that suggest sexual identity must be integrated with and accepted within the context of one's racial-ethnic identity (Greene, 1997; Icard, 1986, Loicano, 1993, Manalansan, 1996). The primacy of racial-ethnic identity may result from it serving to provide a sense of kinship with a group of people who have successfully endured a history of oppression in this country. As a consequence, this cultural connectedness provides a shield from the emotional invective that results from living in a racist society. Race continues to be the most defining social characteristic in the U.S., and although AAGBM possess dual or multiple identities, their primary social identity is that of an African-American man. Within this context, an afrocentric orientation may be essential to manage the race-conscious social milieu of this country.

Findings from this study clearly demonstrate that the successful integration of sexual and racial-ethnic identity is associated with healthy psychosocial functioning among AAGBM. Current theories and interventions to facilitate African-American manhood and social development do not adequately address sexual orientation (Boykin & Ellison, 1995; Dei, 1994; Gilmore, 1990; Hay, Castle, Jewett, 1994; Jagers & Watts, 1997; Nobles, 1991). AAGBM face myriad health concerns that jeopardize their quality of life and existence. To buttress the health of AAGBM, it is imperative that broader constructions of African-American male gender roles and more affirmative conceptualization of sexual diversity are promoted within the African-American community. A more expansive afrocultural ethos, similar to that espoused by Jagers (1996), will allow AAGBM to experience greater levels of social support and acceptance from the African-American community, which could make the process of integrating their racial-ethnic and sexual identities a more benign experience. As a consequence, this may lead to lower rates of heavy substance use, suicide, depression and anxiety, and HIV infection among AAGBM.

Results from this study reveal that higher levels of psychosocial distress and gay identity, as well as lower levels of life satisfaction, are associated with higher levels of sexual risk-taking among this sample of AAGBM. These findings appear to be consistent with findings reported by Adams, Sears, and Schellenberg (2000) and Hospers, Molenar, and Kok (1994) that suggest gay men sometimes use sex as a way to escape negative mood and affect and the pressures of everyday life. Rotheram-Borus, Rosario, Reid, and Koopman (1995) reported that unprotected anal sex was associated with high levels of anxiety and depression among gay and bisexual male adolescents. Stokes and Peterson (1998) reported that the AAGBM participating in their study believed psychological distress was an important factor linked to engaging in risky sexual behaviors.

Collectively, our findings provide additional empirical support for the importance of developing and implementing population-specific and subculture-specific HIV/AIDS prevention interventions. Our results suggest that more "out" AAGBM may be in need of HIV/AIDS prevention programs that will not only assist them in gaining condom self-efficacy, but will also provide them with effective coping strategies that will facilitate their ability to contend with negative mood states that develop as a result of their dual minority status. Components of an intervention of this nature would need to include strategies for managing racism and heterosexism both within and outside the African-American community, and should also focus on elevating self-esteem and promoting positive life experiences.

There are several limitations associated with this research. First, the findings presented here should not be generalized to African-American men who have sex with men who have not self-identified or revealed their same-sex attractions. Second, the current sample consists of primarily educated, middle-class, urban, Midwestern African-American men. By including African-American men who have sex with men from varying geographic, economic, and educational backgrounds, researchers can examine whether these variables contribute to our understanding of racial/ethnic and sexual identity development (Dube & Savin-Williams, 1999). All data for the study come from a single source with a single method. As a consequence, common method variance interpretations of the findings cannot be ruled out. Participants in the study were also self-selected and not randomly drawn. As a result, the internal validity of the study is threatened (Shaugnnessy & Zechmeister, 1994). Extensive psychometric validation of the measures developed specifically for this study (i.e., the GID and SRS) was not undertaken; consequently, conclusions regarding sexual identity development and sexual risk-taking behavior should be drawn cautiously. Nonetheless, the study provides an important empirical investigation into the influence of dual identity development on the psychosocial functioning of AAGBM and offers recommendations on intervention strategies to address the challenges that confront this understudied population.

Table 1. Demographics

Highest of level of education                       N      %

   [less than or equal to] High school diploma     36     20.7
   1 year or more of college                       65     37.4
   Junior college degree                           18     10.3
   4-year college degree                           42     24.1
   Professional degree                             13      7.5
Type of employment
   Executive, doctor, lawyer                       13      7.5
   Manager/owner large business                    12      6.9
   Administrator                                   57     32.8
   Clerical, retail, technical                     59     33.9
   Semi-skilled laborer                            13      7.5
   Unskilled laborer                               15      8.6
Self-Defined sexual orientation
   Gay                                            124     71.3
   Bisexual/mostly homosexual                      23     13.2
   Bisexual/equally homosexual/heterosexual        14      8.0
   Bisexual/mostly heterosexual                     4      2.3
   Heterosexual                                     5      2.9
   Uncertain/don't know                             4      2.3
Living arrangement
   Alone                                           65     37.4
   With partner/lover                              43     24.7
   Same-sex roommate                               22     12.6
   Opposite-sex roommate                           22     12.6
   Mother only                                     10      5.7
   Father only                                      7      4.0
   Both parents                                     2      1.1
   Wife                                             2      1.1
Religious preference
   Baptist                                         70     40.2
   Other                                           55     31.6
   Catholic                                        17      9.8
   Inactive                                         9      5.2
   Agnostic                                         8      4.6
   Methodist                                        7      4.0
   Muslim                                           4      2.3
   Other (Protestant)                               1       .6
Current stable love relationship
   Yes                                             64     37
   No                                             109     63
Received alcohol/drug treatment
   Yes                                             56     32.2
   No                                             118     67.8
HIV Status
   Positive                                        67     38.5
   Negative                                        89     51.1
   Don't know                                      18     10.3

Note. N = 174. Age range = 19-55 years. Mean age = 34.66 years.

Table 2. Mean Scores and Standard Deviations of the Modes of Sexual
and Ethnic-Racial Acculturation

Analysis Measure              Integration          Assimilation

                                N = 41                N = 45
#1    LSS                    3.26 (.40) (a)         3.13 (.48)
      SCL-90-R                .57 (.60) (a)          .88 (.79)
      MGRS                  72.33 (36.04) (a)     106.41 (37.78) (b)
      HPSES                 42.38 (4.62) (a)       40.62 (5.31)
      CSEI                  76.85 (17.05) (a)      68.88 (16.76)
#2    SSQ                    3.18 (2.00) (a)        2.13 (1.55) (b) **
      SSQ Satisfaction       5.28 (1.19)            4.65 (1.60)
#3    SRS                   19.07 (9.23)           17.00 (11.66)
     Female sex partners     3.05 (2.32) (a)        4.64 (2.83) (b)
     Male sex partners       8.57 (1.99)            7.47 (2.24)

Analysis Measure              Separation         Marginalization

                                N = 45                N = 40
#1    LSS                    2.95 (.48) (b) *       2.74 (.55) (b)
      SCL-90-R                .88 (.75)             1.15 (.83) (b)
      MGRS                  87.99 (38.01)         100.58 (42.34) (b)
      HPSES                 37.71 (6.34) (b)       39.57 (5.84)
      CSEI                  62.31 (16.78) (b)      54.20 (17.95) (b)
#2    SSQ                    2.44 (1.44)            1.86 (1.22) (b)
      SSQ Satisfaction       5.17 (0.96)            5.06 (1.07)
#3    SRS                   18.24 (10.58)          13.68 (7.42)
     Female sex partners     2.29 (1.75) (a)        3.48 (2.47)
     Male sex partners       7.44 (2.52)            7.55 (2.47)

Note. CSEI = Coopersmith Self-Esteem Inventory; LSS = Life
Satisfaction Survey; MGRS = Male Gender Role Stress; SCL90-R = SCL
90-R Symptom Checklist; HPSES = HIV Prevention Self-Efficacy Scale;
SRS = Sexual Risk-Taking Scale. Means in each row that do not share
common subscripts are significantly different (p < .01). Means without
subscripts in each row are not significantly different from one
another.

* p < .018. ** p < .012.

Table 3. Summary of Multiple Regression Analysis for
Predicting Life Satisfaction

Variable    Step      R      [R.sup.2]    [DELTA][R.sup.2]
CSEI         1       .54        .29             .29
MEIM         2       .57        .32             .03
SRE          3       .58        .34             .01
MGRS         4       .59        .34             .00
GIS          5       .59        .34             .00
GBS          6       .59        .34             .00

Variable    [beta]    Sig. [DELTA][R.sup.2]
CSEI         .41                 .00
MEIM         .24                 .00
SRE          .12                 .03
MGRS         .06                 .39
GIS          .02                 .78
GBS          .00                 .89

Note. MEIM = Minority Multi-group Ethnic Identity Measures;
GIS = Gay Identity Scale; CSEI = Coopersmith Self-Esteem Inventory;
MGRS = Male Gender-Role Stress; SRE = Schedule of Racist Events;
GBS = Gay Bashing Scale. [DELTA][R.sup.2] = the change in the multiple
[R.sup.2]; Sig. [DELTA][R.sup.2] = significance of the change in
[R.sup.2]. The Beta listed is the standardized value in the last step.

Table 4. Summary of Multiple Regression Analysis for
Predicting Sexual Risk-Taking

Variable    Step     R     [R.sup.2]    [DELTA][R.sup.2]

SCL 90-R     1      .16       .02             .02
GIS          2      .25       .06             .03
LSS          3      .30       .09             .02
MGRS         4      .33       .11             .01
CSEI         5      .35       .12             .01
HPSES        6      .37       .13             .01
GBS          7      .38       .14             .00
SRE          8      .38       .14             .00
MEIM         9      .38       .14             .00

Variable    [beta]    Sig. [DELTA][R.sup.2]

SCL 90-R     .26               .03
GIS          .24               .01
LSS          .13               .02
MGRS         .18               .07
CSEI         .16               .09
HPSES       -.13               .11
GBS         -.09               .21
SRE         -.01               .87
MEIM         .01               .86

Note. MEIM = Minority Multi-group Ethnic Identity Measures;
GIS = Gay Identity Scale; CSEI = Coopersmith Self-Esteem Inventory;
LSS = Life Satisfaction Survey; MGRS = Male Gender Role Stress; SCL90-R
= SCL 90-R Symptom Checklist; SRE = Schedule of Racist Events; GBS
= Gay Bashing Scale; HPSES = HIV Prevention Self-Efficacy Scale.
[DELTA][R.sup.2] = the change in the multiple [R.sup.2]; Sig.
[DELTA][R.sup.2] = significance of the change in [R.sup.2].
The Beta listed is the standardized value in the last step.

Table 5. Correlation Matrix Containing Dependent Variables

                       MEIM          GIS       CSEI        LSS

GIS                  -.00          --
CSEI                  .40 (a)     .18 (b)      --
LSS                   .39 (a)     .09         .52 (a)      --
SSQ                   .20 (b)     .30 (a)     .32 (a)     .26 (a)
MGRS                 -.10        -.35 (a)    -.40 (a)    -.28 (a)
SCL90-R              -.17 (b)     .13        -.51 (a)    -.40 (a)
SRE                   .23 (a)    -.16 (b)     .09        -.13
GBS                  -.06         .16 (b)    -.23 (a)    -.16 (b)
HPES                  .31 (a)    -.02         .27 (a)     .17 (b)
SRS                   .04         .17 (b)     .06         .11
Same-Sex partners     .13         .14         .12         .04

                       SSQ         MGRS      SCL90-R       SRE

GIS
CSEI
LSS
SSQ                    --
MGRS                 -.21 (a)      --
SCL90-R              -.16 (b)     .44 (a)      --
SRE                  -.14         .32 (a)     .27 (a)      --
GBS                  -.11         .16 (b)     .30 (a)     .27
HPES                  .18 (b)    -.18 (b)    -.28 (a)     .03
SRS                   .04         .12         .17 (b)     .03
Same-Sex partners     .05         .05        -.04         .04

                      GBS        HPSES       SRS

GIS
CSEI
LSS
SSQ
MGRS
SCL90-R
SRE
GBS                   --
HPES                 .17 (b)      --
SRS                  .00         -.18 (b)     --
Same-Sex partners    .17 (b)     -.03        .13

Note. MEIM = Minority Multi-group Ethnic Identity Measures;
GIS = Gay Identity Scale; CSEI = Coopersmith Self-Esteem Inventory;
LSS = Life Satisfaction Survey; MGRS = Male Gender Role Stress;
SCL90-R = SCL 90-R Symptom Checklist; SRE = Schedule of Racist Events;
GBS = Gay Bashing Scale; HPSES = HIV Prevention Self-Efficacy Scale;
SRS = Sexual Risk-Taking Scale. (a) = Significant at the .01 level,
(b) = Significant at the .05 level.

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Manuscript accepted February 18, 2002

Isiaah Crawford Loyola University of Chicago

Kevin W. Allison Virginia Commonwealth University

Brian D. Zamboni Loyola University of Chicago

Tomas Soto The CORE Center, Chicago, Illinois

Address correspondence to Isiaah Crawford, Ph.D., Department of Psychology, Loyola University of Chicago, 6525 N. Sheridan Road, Chicago, IL 60626; e-mail: [e-mail].