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Shame, internalized homonegativity, and religiosity: A comparison of the stigmatization associated with minority stress with gay men in Australia and Malaysia a

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Jac Brown Ph D , Wah Yun Low Ph D , Raymond Tai B Sc & Wen Ting Tong B Sc a

Dept of Psychology, Macquarie University, Sydney, Australia

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Medical Education and Research Development Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia, c

PT Foundation, Kuala Lumpur, Malaysia,

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Medical Education and Research Development Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia, Accepted author version posted online: 13 Jul 2015.

Click for updates To cite this article: Jac Brown Ph D, Wah Yun Low Ph D, Raymond Tai B Sc & Wen Ting Tong B Sc (2015): Shame, internalized homonegativity, and religiosity: A comparison of the stigmatization associated with minority stress with gay men in Australia and Malaysia, International Journal of Sexual Health, DOI: 10.1080/19317611.2015.1068902 To link to this article: http://dx.doi.org/10.1080/19317611.2015.1068902

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ACCEPTED MANUSCRIPT Shame, internalized homonegativity, and religiosity: A comparison of the stigmatization associated with minority stress with gay men in Australia and Malaysia Jac Brown, Ph D1,*, Wah Yun Low, Ph D2, Raymond Tai, B Sc3, Wen Ting Tong, B Sc4 1

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Dept of Psychology, Macquarie University, Sydney, Australia

Medical Education and Research Development Unit , Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia, [email protected]

Downloaded by [University of Malaya] at 02:13 14 July 2015

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PT Foundation, Kuala Lumpur, Malaysia, [email protected]

Medical Education and Research Development Unit, Faculty of Medicine, University of

Malaya, Kuala Lumpur, Malaysia , [email protected] *

Corresponding author: [email protected]

Abstract In this study we explore aspects of minority stress by comparing Malaysian (n = 234) and Australian (n = 123) gay men on internalized homonegativity (IH) and internalized shame (IS) in a 2 x 2 multivariate analysis (country x relationship status). Religious motivation (RM) was also included as a variable due to the importance of religion in Malaysia as compared to Australia. Malaysian gay men scored higher on IH, IS, and RM. Single men reported higher levels of IS than did those in relationships. These results are discussed in terms of the minority stress model (Meyer, 2003).

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ACCEPTED MANUSCRIPT Key Words


minority stress model, culture, stigmatization, gay men, shame, religiosity

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ACCEPTED MANUSCRIPT The effects of stigmatization on individuals have included interpersonal conflict, violence, and even wars, and the psychological impacts on the stigmatized have concerned sociologists and psychologists for many years. Allport (1954) wrote about prejudice and its consequences on those who were targeted resulting in defensive reactions such as self-hate, shyness, obsessive concern with the defining characteristic, and rebellion. Later, Goffman (1963) framed this discussion around stigmatization and how the attitudes of a dominant society


could have disastrous consequences on those who were defined as minorities and subsequently marginalized and stigmatized. In this study, stigmatization was explored through the minority stress model (Meyer, 2003). Minority Stress Model The stigmatizing aspect of being a minority was central to Meyer‘s (1995; 2003) minority stress model that he applied to lesbians, gay men, and bisexual and transgender (LGBT) people. He identified three stressors as contributing to minority stress in these populations: 1. Internalized homonegativity (IH) was related to a poor sense of self as LGBT people turned the societal disdain inward; 2. Stigmatization was the internalization of societal stigma resulting in feelings of rejection; and 3.

Discrimination, which could include violence against LGBT

people, was experienced at the hands of the dominant, often disapproving culture. Meyer concluded that these three factors had a negative impact on the mental health of LGBT people due to additional prolonged stress that these individuals felt when compared with others who are part of the dominant culture.

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ACCEPTED MANUSCRIPT Variables Related to Minority Stress ―Internalized homonegativity‖ was linked theoretically to minority stress by Meyer (2003), as indicated above. The term ―internalized homophobia‖ was previously coined, suggesting that the homophobia in society was internalized by gay people and directed towards them leading to self loathing, mirroring the prejudice focused on them by society. However, the term is somewhat pejorative in the sense that it attaches blame towards gay people instead of


society, and thus IH has thus been adopted as a more neutral term to refer to this process. Brown and Trevethan (2010) noted that there were higher scores on IH in Malaysian than in Australian gay men, providing some support for the link between IH and stigmatization that was assumed to be greater in Malaysia. Stigmatization and the resulting rejection may also be experienced as internalized shame (IS) when the cumulative effects of rejection lead to a rejection of self, similar to that associated with IH. However, while there may be overlap, there are also differences between a general sense of IS and IH with gay men, which implies that both are important variables to study (Brown & Trevethan, 2010). Shame is seen as the failure to meet an internalized ideal (Morrison, 1989). In a predominantly heterosexual society, any sexual deviation from the norm may provide a context for shame that may impact on the overall sense of self. IS is important to study in relation to gay identity development because the process of coming to terms with a gay identity is often difficult. In this process, judgmental parents and friends, and the broader heterosexual society provide repeated experiences of shame that may become internalized (Kaufman & Raphael, 1996). Wells (1996) reported that gay men, lesbians, and bisexual people had significantly higher levels of IS than did heterosexual people. Allen and Oleson (1999)

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ACCEPTED MANUSCRIPT identified a positive relationship between IS and IH, suggesting that there was probably a connection between shame and the struggle for identity, and that IS is one of the central aspects related to IH and clearly linked to stigmatization. Thus, both IS and IH will be explored as dependent variables in this study. A further societal influence on LGBT people that is frequently stigmatizing is religion (Barton, 2010; Sowe, Brown, & Taylor, 2014). The effects of religion contribute towards


stigmatization in the wider society, and particularly for those who have some religious faith. In a recent study, the link between gay people‘s perceptions of support from religious environments and IH was explored. In this study Barnes & Meyer (2012) concluded that gay people attending gay-affirming religious groups had less IH than did those attending non-gay-affirming religious groups. Thus, religious beliefs are likely to be related to stigmatization, IS, and IH, and will also be explored in this research as a dependent variable. Country, Culture and Minority Stress The first independent variable in this study will be Country, as it is argued that there are differences in the level of stigmatization between the two countries and their cultures that we surveyed. The relationship between culture and the minority stress model has begun to receive some attention in the literature with most of the studies have been conducted in the USA (e.g., Chen & Tryon, 2012; Dunn, Gonzalez, Costa, & Narid, 2014; Sandil, Robinson, Brewster, Szymanski, & Gupta, 2009; Wong & Geiger, 2014; Yoshikawa, Wilson, Ghae, & Cheng, 2004). However, studies that have identified minority stress are now appearing elsewhere such as Europe (Kuyper & Fokkema, 2011) and Australia (Lea, de Wit, & Reynolds, 2014). Much of the data about stigmatization in non-Western countries have been reported in qualitative studies

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ACCEPTED MANUSCRIPT (e.g., Chapman, Cai, Hillier, & Estcourt, 2009; Han, 2008; Tadele, 2011; Wang, Bih, & Brennan, 2009). However, quantitative research in which minority stress was confirmed was reported from a study in Brazil (Dunn et al., 2014). While not framed in terms of the minority stress model, Manalastas (2014) identified the link between a gay sexual identity and suicide risk in the Philippines. A few other studies have focused on race and sexuality of Asian Americans in relation to minority stress (Szymanski & Gupta, 2009; Yoshikawa, Wilson, Ghae, & Cheng,


2004). Other researchers have focused on the additive effects of race and sexuality in determining minority stress in a south Asian sample living in the USA (Sandil, Robinson, Brewster, Wong, & Geiger, 2014) and in a more general Asian sample in the USA (Chen & Tryon, 2012). These researchers concluded in both of these studies that there was no additive effect due to race, but that sexuality was the key ingredient in minority stress when race was involved. These results are contrary to the findings of other research (Szymanski & Gupta, 2009; Szymanski & Sung, 2010), where it was concluded that the cumulative effects of two minority identities contributed to IH. Thus there is conflicting evidence related to the additive effects of culture and sexuality contributing to minority stress. While research on minority stress has been carried out in many countries, there are no reported cross-cultural studies on this topic, which is the focus of this study.

A stark contrast is provided by the two countries of Australia and Malaysia in terms of the level of stigmatization of LGBT people. Homosexuality is illegal in Malaysia (one of 76 countries around the world where homosexuality is illegal), strongly influenced by the dominant Muslim population and the accompanying oppressive laws. In Malaysia, while there are gay

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ACCEPTED MANUSCRIPT clubs, police regularly raid these premises and harass those attending. There are some sexual health services related to a harm-reduction program provided by the Ministry of Health as well as non-government organizations, but they are relatively covert and discretely funded, frequently from private donations (Low, Ng, Tai, & Wong, 2006). A further example relating to the societal view of homosexuality comes from a recent newspaper story reporting on the Film Censorship Board of Malaysia announcing that gay characters would be allowed on film only if


they repented or died (Bolcer, 2010). In the World Values Survey Wave 6 (2010-2014), 60.5% of Malaysians surveyed indicated that homosexuality is never justifiable. Thus, there is substantial opposition to same-sex attracted people in Malaysia, which should be associated with greater stigmatization than in Australia. By contrast, in Australia homosexuality is legal and public opinion ranges from tolerance for the most part, to complete acceptance of minority sexualities. There is no oppression at any of the many gay clubs, and liaison police officers are appointed to support gay people in key gay precincts. There is a very well funded government sexual health service for LGBT people and same-sex attracted people are allowed to form civil unions, with considerable public discourse about the possibility of legalizing gay marriage. The gay and lesbian Mardi gras are publically supported by government funds, as it is a widely accepted and attended event every year. In the World Values Survey Wave 6 (2010-2014), 13.1% of Australians surveyed indicated that homosexuality is never justifiable. Thus, there is a very broad acceptance of diverse sexuality in Australia when compared with Malaysia, and this should be associated with less stigmatization. Relationship Status and Minority Stress

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ACCEPTED MANUSCRIPT The second independent variable in this study will be Relationship Status, as it is argued that there are differences in the level of stigmatization and the resulting stress due to the buffering effects of being in a relationship. Meyer (2003) stated that psychological stress was not automatic, but could be modified by a range of variables including an intimate relationship. Researchers have demonstrated that those in relationships tended to experience less stress than those who were single (Hudson & O‘Regan, 1994; Lewis, Derlega, Berndt, Moris, & Rose,


2001). Furthermore, those in relationships appear to have better mental and physical health than do those who are single (Umberson & Montez, 2010). Thus, there is evidence to support the importance of relationships in managing stress. Thus, our two independent variables of Country and Relationship Status will be used to explore the minority stress model. It is acknowledged that sexuality can be somewhat fluid, but because this study explored men who were closer to the gay end of the sexuality spectrum, the word ―gay‖ will be used to describe survey participants. However it must be pointed out that the term ―gay‖ in this study includes men who have sex with men.

Current Study The major objective of this research was to explore the minority stress model through the independent variables of Country and Relationship Status, and their connection with the dependent variables of IS and IH as discussed by Meyer (2003). A further dependent variable was added to this exploration of minority stress as we argued that religious motivation would be related to stigmatization as explored through the independent variable of Country, particularly since religion plays a larger part in Malaysia than it does in Australia.

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These variables will be

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ACCEPTED MANUSCRIPT analyzed using a multivariate analysis of covariance to determine the unique contribution of each variable. Thus, this research is designed to address three major questions, together with their accompanying hypotheses: 1. Relationship between country and minority stress: What variables are related to stigmatization, and is a more stigmatizing environment (Malaysia when compared to Australia)


associated with higher levels of IH and IS? As predicted by minority stress, gay men in Malaysia should report higher scores on IH and IS than Australian gay men. 2. Association between relationship status and minority stress: Is the minority stress associated with stigmatization modified by relationship status? For those in relationships, there should be a soothing effect associated with less minority stress which should lead to lower IH and IS than for those who are single, a result that should be more pronounced for Malaysian than for Australian gay men because of the predicted greater minority stress. 3. Relationship between religious motivation and minority stress: Does religious motivation lead to greater minority stress and the associated IH and IS as predicted by Meyer (2003) in his minority stress model? Because of the differences of minority stress in the two countries, religious motivation should contribute to minority stress leading to higher scores where stigmatization is greater (Malaysia).

Method

Participants

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There were initially 438 respondents to an online survey. A number of these were from countries other than Australia and Malaysia, and consequently were removed from the data set. As Chinese and Malays represent the majority of the Malaysian population, the small number of other ethnic groups was removed. Respondents who were not Caucasian in the Australian data set were also removed. When respondents from other countries and other ethnicities were


removed, there were 123 (37% were single; 63% were in a relationship) respondents from Australia and 234 (44% were single; 56% were in a relationship) from Malaysia. Thus, we retained 69.9% of the surveys attempted. For the Malaysian sample, religion was reported by respondents as: Buddhist: 37.2% (n=87); Christian: 14.5% (n=34); Islam: 10.7% (n=25); None/Other: 22.6% (n=46). For the Australian sample, religion was reported by respondents as: Buddhist: 3.3% (n=4); Christian: 44.7% (n=55); Islam: 1.6% (n=2); None/Other: 37.4% (n=46). Measures A questionnaire was designed that included demographic variables; a number of questions related to relationship status, sexual practices, and condom usage; and a number of standardized scales with the relevant ones used in this study detailed below. Sexual orientation was assessed on the mean of five items. Respondents were asked to rate their preference for males or females on sexual attraction, sexual behavior, sexual fantasies, emotional preference, and social preference. These were rated on a 7-point scale from 1 (Opposite sex only) to 7 (Same sex only). This approach was used to ensure that a broader spectrum of gay male behavior was considered as two quite different cultures were used in the

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ACCEPTED MANUSCRIPT analysis. Cronbach‘s alpha for this scale was .88 for the combined data, .87 for Malaysian participants and .86 for Australian participants. Participants were also asked to describe themselves as ―Heterosexual‖, ―Bisexual‖, or ―Homosexual‖. Asking participants if they were in a relationship at the time of completing the survey assessed relationship status. If they reported not being in a relationship, they were classified as single.


Internalized Homonegativity Inventory (Mayfield, 2001). This inventory consists of 23 items distributed over the following three factors: Personal homonegativity (IH Personal) (11 items), Gay affirmation (Gay Affirm) (7 items), and Morality of homosexuality (IH Moral) (5 items). Each item is rated on 5-point Likert responses ranging from 1 (Strongly Disagree) to 5 (Strongly Agree). IH Personal was a measure of personal emotions and attitudes that participants had toward their own sexual practices. Higher scores indicated a higher level of personal homonegativity. Gay Affirm was a measure of the positive feelings participants had about their own homosexuality as a normalizing and validating part of their personal lives. Higher scores indicated higher levels of affirmation. IH Moral was a measure of the negative attitudes regarding morality and same-sex attraction and behavior. Higher scores indicated higher IH related to issues of morality. The alpha coefficients for the three subscales were .91 for IH Personal (.92 for the current study, Malaysian participants: .91; Australian participants: .91), .82 for Gay Affirm (.79 for the current study; Malaysian participants: .81; Australian participants: .67) and .70 for IH Moral (.76 for the current study; Malaysian participants: .80; Australian participants: .64) (Mayfield, 2001). The scale was translated into Chinese and Malay but was not altered in any other way for Malaysian participants. As the website hosting the

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ACCEPTED MANUSCRIPT survey was an English language website, the language was assumed to be familiar to Malaysian participants. Internalized Shame Scale: The Internalized Shame Scale (Cook, 1996) consists of 30 items measured on 5-point Likert responses ranging from 0 (Never) to 4 (Almost Always). It contains the two subscales of shame and self-esteem. Alpha reliability for the shame scale was .95 (Cook, 1996). In the current study, the alpha for the shame scale was .98 (Malaysian


participants: .96; Australian participants: .97). This scale was not adapted for Malaysian participants. Religious Orientation Scale: The Religious Orientation Scale (Allport & Ross, 1967) consists of 21 items designed to provide a measure of extrinsic (EXTREL) and intrinsic (INTREL) religious motivation. Brewczynski subsequently revised the scale and McDonald (2006) that was the version used for this research. We further modified the scale to include nonChristian religions and used this version both in Australia and in Malaysia. For example, items where ―church‖ was used were modified to include ―mosques‖. Items were rated on 5-point Likert response scales ranging from 1 (Strongly Disagree) to 5 (Strongly Agree). Alpha reliabilities for the current study were .93 for INTREL (Malaysian Participants: .91; Australian Participants: .93) and .88 for EXTREL (Malaysian Participants: .82; Australian Participants: .87). Procedure Following university ethics approval, a description of the research, and the link to a secure online facility at Macquarie University, Australia, was posted on a number of gay social

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ACCEPTED MANUSCRIPT networking Internet sites easily accessible in Australia. In Malaysia a local website designed for gay men to meet other gay men was used to recruit potential respondents to the survey. Although Malaysian males who use the Internet require some English language proficiency, we provided two forms of the questionnaire in Malaysia that participants could choose to complete: an English-Malay version and an English-Chinese version, both of which were presented with the English and an immediate translation into the other language for each question. While we


endeavored to find a website in Australia that was similar to the website used in Malaysia, this was not possible. Dating websites in most Western countries simply do not permit research to take place with their clients. Thus, we attempted to get the next best alternative which was a gay social networking site, realizing that there could be differences in the gay male samples accessed in Australia and Malaysia that could possibly affect the comparability of the two samples and the conclusions that could be reached. Gay men, who were invited to participate, completed an anonymous survey that was confidential. Participants were not paid for their involvement in this study. In terms of informed consent, when accessing the survey web-link, a description of the study and potential risks was provided. If potential participants agreed to participate, they were required to click ―accept‖ to access the actual survey. In line with ethics approval, participants were not coerced in any way to complete the survey and could stop at any point, skip any questions, decide not to submit the survey once they had started, or submit a partially completed survey. Results Preliminary analysis with independent samples t tests revealed a number of differences between the Australian and Malaysian samples. These are presented in Table 1. The Malaysian

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ACCEPTED MANUSCRIPT sample was younger than the Australian sample and reported being slightly less gay than was the Australian sample. Malaysians reported higher scores on most of the dependent variables than Australians including (INTREL, EXTREL, IH Personal, and IH Moral). Most of these differences were explored for unique variance in the multivariate analysis, while age and sexuality were entered as covariates. These data were then analyzed using a multivariate analysis of covariance with two


independent variables (Country and Relationship Status) to determine the differences in stigmatization. Estimated marginal means were used to indicate the nature of the differences where they were significant. When compared with Australians (Aus), Malaysian (Mal) respondents reported higher levels of IS: (F(1,241)=89.49, p