We sought to document the correlates of mental health and sexual behaviors of PrEP using and non-using gay, bisexual, and other MSM. Depression, anxiety and internalized homophobia scores were all significantly lower for PrEP users compared to HIV-negative non-PrEP users. PrEP use was found to moderate the relationship between anxiety and condomless anal intercourse (CAI), such that rates of anxiety were higher for non-PrEP users reporting greater numbers of CAI partners, while remaining stable for PrEP users. Use of PrEP was associated with lower levels of depression, anxiety, and internalized homophobia.

Examining sexual identity development—the process through which sexual minority individuals discover and disclose their sexual orientations—within a minority stress framework may help to contextualize sexual and mental health disparities among gay and bisexual men. Research on sexual identity development has typically focused on ages of achieving specific milestones (i.e., awareness, identification, sexual experience, and disclosure), though differences in onset and speed of the process and impact of these trajectories on healthy functioning in adulthood are understudied. We analyzed cross-sectional data from 374 highly sexually active gay and bisexual men in New York City. Using latent growth curve modeling, we examined trajectories of sexual identity development through the 4 afforementioned milestones. We next examined their associations with childhood and background characteristics, adult experiences of sexual minority stress, and adult mental health. Results showed that identifying as gay and greater childhood gender nonconformity were associated with earlier reported onset of sexual identity development, and younger age was significantly associated with faster progression through the developmental process. The model showed that faster progression through sexual identity development was associated with higher levels of sexual orientation–based discrimination, emotion dysregulation, sexual compulsivity, and anxiety and depression in adulthood, but not internalized homonegativity or sexual orientation-based rejection sensitivity. These findings support the need for a comprehensive and developmentally informed model of adulthood functioning among gay and bisexual men that considers trajectories of sexual identity development—including onset and duration—as potential precursors to mental health difficulties in adulthood. Given the early onset of sexual identity development and potential lifelong sequelae, early prevention programs promoting positive sexual identity development are warranted.