The Impact of Ingroup and Outgroup Exclusion on HIV-Risk Cognitions in Sexual Minority Men

Background Sexual minority men (SMM) face disproportionate rates of HIV/AIDS. Emerging evidence indicates that minority stress (e.g., discrimination) and stress from within the gay community itself (e.g., exclusion) may contribute to sexual orientation disparities in HIV prevalence and risk. Purpose This study investigated the impact of sexual orientation discrimination and exclusion by the gay community on SMM's intentions to engage in HIV-risk behavior. Methods We conducted an experiment in which we employed an exclusion manipulation to induce (a) perceived discrimination from the outgroup and (b) perceived exclusion by the ingroup in a community sample of 194 SMM. Participants completed a baseline assessment of previous discrimination, exposure to gay community stress, and HIV-risk behavior. Two days later, participants completed an experiment in which they were randomized to one of four conditions in the game Cyberball: (a) exclusion by straight men, (b) inclusion by straight men, (c) exclusion by gay men, or (d) inclusion by gay men. Risky sex intentions were then assessed. Results Discrimination and gay community stress were positively associated with HIV-risk behaviors at baseline. Participants who were excluded (vs. included) by straight men in the experimental task reported more risky sex intentions. This effect was mediated by decreases in state self-esteem. Risky sex intentions did not differ between participants who were included versus excluded by gay men. Conclusions This study provides the first experimental evidence that discrimination is associated with sexual risk taking in SMM, and elucidates a potential psychological mechanism through which this effect operates.