As rates of HIV transmission have accelerated in Kazakhstan over the past ten years, gay, bisexual, and other men who have sex with men (MSM) in Kazakhstan have experienced a disproportionate burden of the HIV epidemic, including a seven-fold increase in HIV prevalence. Earlier age of first sexual activity (i.e., earlier sexual debut) has been associated with long-term health trajectories among MSM at risk of HIV, however, no previous research has examined associations between earlier sexual debut and HIV-related risk factors among MSM in Kazakhstan. This dissertation tests hypotheses examining whether earlier sexual debut is associated with the following factors associated with HIV infection during adulthood among MSM in Kazakhstan: substance use, exchange sex, and experiences of anti-gay violence. Study data were obtained through a NIDA-funded clinical trial of a behavioral intervention seeking to increase the engagement of MSM who use substances in Kazakhstan in the HIV care continuum. Findings indicate that earlier sexual debut is significantly associated with increased risk of substance use, exchange sex behaviors, and experiences of anti-gay victimization among MSM in Kazakhstan. Future research should examine the contexts of MSM’s sexual debut, including whether this experience was consensual or involved other forms of adverse childhood events. Policy recommendations include increased access to sexual and gender expansive-inclusive comprehensive sexual education, and anti-discrimination policies. Clinical considerations include trauma-informed HIV prevention resources for MSM that recognizes that individuals seeking care may have complex, intersecting, and marginalized life histories, including experiences of violence across the life course.

The purpose of this study was a qualitative exploration of how gay men experienced the spiritual base of a substance abuse treatment program. The specific clientele are gay men who completed at least sixty days participation in an intensive LGBT outpatient treatment program and were living in a sober residence known as The Studios of Palm Springs, CA. The research question asked whether this program worked to develop spirituality for gay men.