The role of discrimination in alcohol-related problems in samples of heavy drinking HIV-negative and positive men who have sex with men (MSM)

Abstract

Background Heavy drinking is a major public health concern among men who have sex with men (MSM), as it is in many other populations. However, the consequences of heavy drinking among MSM may be particularly severe, especially for sexual risk behavior, due to the relatively high prevalence of HIV. Minority stress models suggest that, among members of marginalized groups, discrimination may be associated with heavier alcohol use as these individuals increasingly drink to cope with such experiences. Past studies have provided some support for this association. However, they have not explored the role other drinking motives play, how these relationships might differ across MSM who are HIV-positive versus HIV-negative, or how this relationship extends to alcohol-related problems. Methods In this study, we used path modeling to explore associations between perceived discrimination experiences, drinking motives, alcohol use, and alcohol-related problems in samples of heavy drinking MSM with and without HIV. Results In both HIV-negative and positive MSM, perceived discrimination was significantly positively associated with alcohol problems. Drinking to cope appears to play an important role in this relationship in both samples. Reporting more discrimination experiences was associated with drinking more frequently for sexual reasons among both groups. While the total effect of drinking to facilitate sex was positively associated with alcohol-related problems, sex motives did not mediate associations between discrimination and either drinking outcome. Conclusion These results suggest that interventions addressing discrimination and specific drinking motivations may be useful in helping reduce alcohol use of heavy drinking MSM.

Stigma, Coping, and Alcohol Use Severity Among People Living With HIV: A Prospective Analysis of Bidirectional and Mediated Associations

“…Our prospective data provided partial support for this hypothesis, as we observed a small but statistically significant indirect association from HIV-related stigma at W2 to increased alcohol use severity at W4 mediated by increased maladaptive coping at W3. This finding is consistent with previous studies demonstrating that maladaptive coping mediates the associations of stigma and discrimination with problematic drinking behavior [13,50] although this study is the first to provide a fully longitudinal examination of this pathway and to focus on HIV stigma specifically. Thus, findings suggest that maladaptive coping may be one mechanism linking HIV stigma with alcohol outcomes.…”

“…Further, people living with HIV often endorse using alcohol to cope as one of several motivations for alcohol use, and greater endorsement of using alcohol as a coping strategy correlates uniquely with alcohol problems above and beyond other motives for drinking [34,35]. Moreover, a recent study by Wray et al [13] found that drinking alcohol to cope mediated the relationship between perceived discrimination based on sexual orientation and alcohol problems in a sample of HIV-positive men who have sex with men, suggesting that maladaptive coping plays a role in the link between stigma and alcohol problems in this population. Importantly, this study found that the coping-related pathway from discrimination to alcohol problems was distinct from other motivational pathways such as social or sexual reasons for drinking.…”

“…Although receiving less attention than other health outcomes associated with HIV stigma, a small but growing number of studies have found that alcohol use and problems are elevated among people living with HIV who report experiencing greater stigma [12][13][14]. Alcohol misuse is a particularly concerning correlate of HIVrelated stigma given that heavy drinking among people living with HIV is associated with a wide range of deleterious outcomes.…”

Sexual Victimization and Sex-Related Drinking Motives: How Protective is Emotion Regulation?

“…In the same study, SRDM were positively associated with an increased frequency of pre-sex drinking over and above general drinking motives (coping, enhancement, and social motives) and sexual alcohol expectancies. Finally, experiencing discrimination among men who have sex with men is associated with SRDM even when coping and enhancement motives were included in the model (Wray et al, 2016). Given the nascent stage of the literature on SRDM, these studies make important first steps in understanding correlates of SRDM and supporting incremental predictive validity.…”

“…Only three studies that we are aware of have examined SRDM (Kahler et al, 2015;Tubman, Wagner, & Langer, 2003;Wray, Pantalone, Kahler, Monti, & Mayer, 2016). One study found that drinking motives to cope with sex-related distress and to enhance sex were associated with alcohol problems and heavy episodic drinking (Tubman et al, 2003).…”