Perceived Discrimination Experiences and Social Well-Being Among Midlife and Older Adult Men Who Have Sex with Men from the Multicenter AIDS Cohort Stud

Many men who have sex with men (MSM) in midlife (40-64 years) and older adulthood (65+ years) have survived a lifetime fighting and advocating for equality given exposures to social discrimination attributed to stigmatized social identities (e.g., sexual orientation, racial/ethnic minority, and HIV-positive status). Few public health research efforts have given attention to how MSM's exposure and salience of social discrimination across the life course have shaped social well-being in midlife and older age. Three studies were conducted using a cross-sectional healthy aging sub-study of the Multicenter AIDS Cohort Study (MACS). Study 1 explored whether older adulthood, racial/ethnic minorities, and HIV+ serostatus were associated with higher prevalence of any lifetime, any sexuality-related, and multifactorial (number of discrimination types) discrimination. Non-Hispanic Blacks were associated with greater any lifetime discrimination ( aOR=1.42, p<0.001) and associated with less sexuality-related discrimination (aOR=0.56, p=0.001) compared to Non-Hispanic Whites. There was a statistically significant interaction associated to multifactorial discrimination between Non-Hispanic Black identity and HIV serostatus (aOR=0.46, p=0.019). Interestingly, no statistically significant differences in discrimination were observed by age cohort. Study 2 examined current internalized homophobia by discrimination exposure and salience. We observed no statistically significant differences in internalized homophobia by any discrimination or salience variables. Study 3 assessed differences in six indicators of social well-being ( attachment, social integration, guidance, reassurance of worth, reliable alliance, and opportunity for nurturance) by discrimination exposure and salience. Though the mean scores for social well-being indicators were high overall, both any lifetime discrimination and multifactorial discrimination were negatively associated with indicator scores except opportunity for nurturance . Sexuality-related discrimination was negatively associated with social integration only. Across all discrimination salience variables, participants who reported discrimination and no/low salience exhibited lower scores on social well-being indicators than participants who reported no discrimination. Study 3 extended the public health literature on aging MSM, elucidating the role of salience on discrimination's relationship to social well-being and that despite social adversity, these men have been able to maintain or achieve high social well-being. Future research should continue exploring midlife and older adult MSM's resiliencies to identify factors that interrupt the deleterious impact of discrimination on health.