Longitudinal associations of cannabis, depression, and anxiety in heterosexual and LGB adolescents

Cannabis use is linked to symptoms of depression and anxiety, particularly among sexual minorities. This study examines the relationships between cannabis, and depression and anxiety symptoms at 13, 15, and 17 years using cross-lagged models in a predominantly White (n = 1,430; 92%) subsample of 1,548 participants from the Quebec Longitudinal study of Child Development. Multigroup analyses were conducted to examine the models according to sexual orientation. Demographic covariates were included as control variables, as well as alcohol, cigarette, and other drug use to examine cannabis specificity. The full sample revealed small bidirectional associations, which remained significant once control variables were included in the model: cannabis at 13 and 15 years predicted anxiety symptoms at 15 and 17 years respectively, and depression symptoms at 15 years predicted cannabis at 17 years. The initial association between cannabis at 13 years and depression symptoms at 15 years was accounted for by other drug use at 13 years. Substantial differences were found between heterosexual participants and sexual minorities: LGB participants presented a substantially larger positive association between depression symptoms at 15 years and cannabis at 17 years, as well as a negative association between anxiety symptoms at 15 years and cannabis at 17 years. Both of these relationships remained significant when accounting for control variables. These results suggest that the relationships between cannabis, and depression and anxiety symptoms are bidirectional across adolescence, albeit small. Sexual minorities present particularly large associations that may represent self-medication efforts for depressive symptoms between 15 and 17 years. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Care During Pregnancy, Childbirth, Postpartum, and Human Milk Feeding for Individuals Who Identify as LGBTQ

The growing number of families that include members of sexual and/or gender minority (SGM) groups requires perinatal nurses to know how to provide respectful and affirming care to all people, including this population. Approximately 19% of adults who are members of SGM groups are raising 3 million children, with many hoping to become pregnant, foster, use surrogacy, or adopt in the future. Based on current literature, many nurses are not prepared to meet the clinical needs of patients who are members of SGM groups in the maternity setting. Likewise, patients and families of SGM groups often perceive that nurses are uncomfortable with providing care and are not always satisfied with their care. To meet these needs, it is important that nurses use strategies focused on promoting respectful, affirming care, reducing negative experiences, and eliminating marginalizing language and practices. Nurses must incorporate a holistic care focus for patients who are members of SGM minority groups that includes standardized strategic education; development of Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, or Plus (LGBTQ+) affirming and inclusive policies, practices, and language; flexibility, personal reflection of self-bias; and creating an environment of individualized compassionate care.

Outcomes for Youth Living in Canada's First LGBTQ2S Transitional Housing Program

This article offers descriptive and evaluative data for the first cohort of youth who lived in Canada's first transitional housing program for LGBTQ2S youth, operated by the YMCA of Greater Toronto. The purpose of this mixed-methods study was to report on how youth experienced living in an LGBTQ2S population-based housing program in relation to mental health, self-esteem, community participation and family connectedness, and how access to culturally competent services impact experiences of homelessness. The outcomes of this study are important for service providers, program managers, and policymakers to review in order to better understand how LGBTQ2S youth experience population-based housing programs and whether or not they positively impact their transition to adulthood. Although this study took place in Toronto, Canada, it has broader relevance nationally and internationally, and can be used to build the evidence base to guide the improvement, development, and evaluation of future LGBTQ2S housing services for youth.

My body. My politics. An exploration of body image and health in Barbadian sexual minority women

There is a dearth of research on how pervasive Western stereotypes of the ideal body affect non-heterosexual women, and this body of research shrinks even further when considering sexual minority women in the Caribbean. This study aimed to uncover how negotiations between identity, desire, and body politics are being navigated and experienced by sexual minority women in Barbados, along with examining concerns about body image, the impact of societal expectations, and the consequences of these expectations on physical and mental health. Using a qualitative methodology that employed a semi-structured guide, thirteen women were interviewed over the course of a year. Thematic analysis revealed three major themes that centered around the interconnectivity of desire and presentation as it related to body image; distancing from Western influences and grappling with local body ideals; and the ways in which layered events and identities have resulted in complicated relationships with food. A selection of identified community needs is also offered in conclusion.

How coming out and community involvement affects body image: An in-depth examination of lesbian women's personal experiences

Research on body image commonly focuses on the negative aspects of the construct, and the majority of findings related to body image in general arise from quantitative methods of investigation. Furthermore, little is known about the experiences lesbian women go through as they come out, and what consequence this has on their body image. In this study we examined the experiences of 12 lesbian women and explored how coming out affected their body image. Data were collected via face-to-face interviews and analyzed using thematic analysis. Participants' ages ranged from 20 to 33 (M = 25). The analysis revealed that all participants reported experiencing improved body image after coming out. Other changes related to the presentation of sexual identity in terms of how they dressed, i.e., presenting as either more masculine or feminine. Most participants reported feeling that the sexual and gender minority community was more accepting of different body shapes and sizes compared to the heteronormative society in which they resided. Negative feelings and experiences related to family situations, and occasionally from within themselves. The results are important in understanding how gender and sexual orientation are intertwined to create a distinct experience of body image in lesbian women, and also to illustrate the heterogeneity of body image within subgroups of women.

The effects of intimate relationship characteristics on unprotected anal intercourse among same-sex male couples in China: a dyadic analysis using the actor-partner interdependence model

BACKGROUND

Unprotected anal intercourse (UAI) within the context of concurrent sexual relationship are prevalent among men who have sex with men (MSM) who have regular male sex partners and it aggravates the risk of HIV infection among this community. The aim of this study was to assess the effect of intimate relationship characteristics on UAI among MSM couples at the dyadic level.

METHODS

Two hundred four MSM couples were recruited from a HIV testing clinic from April 2017 to April 2018 in Guangzhou, China. The actor-partner interdependence model (APIM) was applied for dyadic analysis. Each MSM couple was divided into the insertive role and the receptive role according to their regular anal sex role. In this context, actor effect is the impact of an MSM's intimate relationship characteristics on his own UAI, and partner effect is the impact of his partner's intimate relationship characteristics on his UAI.

RESULTS

Of the 408 participants, 58.82% had UAI with regular male sex partner (UAI-RP) and 8.09% had concurrent UAI. Intimate relationship characteristics were associated with concurrent UAI, but not associated with UAI-RP. For the receptive role, his relationship investment exerted significant actor and partner effects on concurrent UAI (AOR actor = 1.31, P < 0.001; AOR partner = 1.17, P < 0.001). Meanwhile, receptive role's violence experience within relationship exerted significant actor effects on his own concurrent UAI (AOR actor = 6.43, P = 0.044).

CONCLUSIONS

Relationship investment and violence experience influenced concurrent UAI among MSM couples and it varied in different sex roles. Additional assistance on empowerment, relationship therapy and sexual agreement is urgently needed to reduce their high possibility on engagement of HIV-related risk behaviors.

Intersectional experiences: A mixed methods experience sampling approach to studying an elusive phenomenon

Social scientists are increasingly interested in methodological advances that can illuminate the distinct experiences and health outcomes produced by various systems of inequality (e.g., race, gender, religion, sexual orientation). However, innovative methodological strategies are needed to (a) capture the breadth, complexity, and dynamic nature of moments co-constructed by multiple axes of power and oppression (i.e., intersectional experiences) and (b) keep pace with the increasing interest in testing links between such events and health among underresearched groups. Mixed methods designs may be particularly well suited for these needs, but are seldom adopted. In light of this, we describe a new mixed methods experience sampling approach that can aid researchers in detecting and understanding intersectional experiences, as well as testing their day-to-day associations with aspects of health. Drawn from two separate experience sampling studies examining day-to-day links between intersectional experiences and psychological health-one focusing on Black American LGBQ individuals and another on Muslim American LGBQ individuals-we provide quantitative and qualitative data examples to illustrate how mixed methods investigations can advance the assessment, interpretation, and analysis of everyday experiences constructed by multiple systems of power. Limitations, possible future adaptations, implications for research, and relevance to the clinical context are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Coming Home to One's Self: Butch Muslim Masculinities and Negotiations of Piety, Sex, and Parenthood in Singapore

In Singapore, discrimination toward LGBT citizens has been reinforced through a monolithic notion of the traditional Asian family. This ethnography focuses on the lived experiences of 7 ethnic minority Malay Muslim "butch" individuals and their journey to parenthood. Drawing upon frameworks of intersectionality and piety, I explore how butches negotiate and reconcile their queer practices and desires as Muslim daughters around "coming out," foster children with same-sex partners, being a biological parent and their perceptions of Assisted Reproductive Technologies (ART). Reproductive futures, enacted by Malay Muslim butches, disrupt yet reinforce the durability of "natural" life trajectories scripted through conventions of marriage, family and fatherhood that have, insofar, excluded them. Further, their experiences also offer alternatives to existing literature on same-sex families that tend to render other nonwhite and/or non-Western queer family practices invisible.

Spirituality and Religious Engagement, Community Involvement, Outness, and Family Support: Influence on LGBT+ Muslim Well-Being

The current study utilized data from the Social Justice Sexuality Project to investigate influences on psychological well-being of LGBT+ Muslims (N = 75) in the United States. Specifically, path analyses were used to examine the association between spiritual and religious engagement, LGBT community involvement, outness, and family support with psychological well-being. Control variables included lifespan Islam involvement, age, income, and the age at which the participant came out to themselves. Findings illustrate spiritual and religious engagement, outness, and income were all positively related to psychological well-being. Moreover, individuals who had converted to Islam but were not raised in the faith had significantly lower psychological well-being than those who had a consistent experience with Islam from their childhood until the time of the study. The present investigation provides critical contributions to the study of gender and sexual minorities in the United States and the experiences of currently practicing LGBT+ Muslims and those who were raised Muslim. Clinical implications and future research suggestions are discussed.

"I feel as if I'm lying to them": Exploring Lesbian Muslims' Experiences of Rejection, Support, and Depression

The current exploratory study utilized a mixed-methods design to study 18 lesbian Muslims' mental health in relation to familial and online social support (M Age = 24, Sd = 9). Due to the threat of familial rejection, the majority of participants (n = 11) selectively disclosed their sexual identity and four participants publicly disclosed. Half of participants scored as mildly to severely depressed on the Beck Depression Inventory (M = 15, Sd = 9). Participants reporting changes in their familial relationships due to their sexual orientation scored as the most highly depressed, F (2, 15) = 4.75, p = .025. Participants' depression scores varied significantly between those that belonged to online support groups addressing religion and sexuality (n = 8, M = 8.712, SD = 6.183) and those that did not (n = 10, M = 20.250, SD = 7.772), t(16) = 3.416, p = .004. Future research would benefit from exploring how therapeutic alliances and family of choice networks can help buffer lesbian Muslims' experiences of familial rejection.

Incorporating Transformative Intersectional Psychology (TIP) into Our Understanding of LGBTQ Muslims' Lived Experiences, Challenges, and Growth

This article serves as the first in a series of six articles providing a theoretically and empirically informed approach to understanding Muslim LGBTQ lives from an intersectional positive-growth framework, transformative intersectional psychology (TIP). Within this perspective, LGBTQ Muslims' religious, gender and sexual identities are mutually interactive and situated within the dynamic systems of power, privilege and oppression. This approach recognizes that LGBTQ individuals negotiate multiple minority identities as they navigate oppression and build pathways of resilience. In the present article, we provide an introduction to TIP and this theory's relevance to the distinct experiences of LGBTQ Muslims. We then conclude with an overview of the goals of this Special Issue, The LGBTQ Muslim Experience, and introduce the subsequent articles in the series. The articles in this Special Issue address the implications of transformative intersectional psychology for LGBTQ Muslim research, training and clinical practice.

Voices of Resistance and Agency: LBTQ Muslim Women Living Out Intersectional Lives in North America

This qualitative study critically examined, from an interpretive perspective, 14 life stories of LBTQ Muslim women across North America. This paper explored how LBTQ Muslim women navigated Muslim and LGBTQ hegemonic norms and exclusions as they negotiated and lived out identity intersections. Transnational and critical race feminisms, intersectionality, and critical Islamic liberationist approaches to gender and sexuality framed the project. The study findings suggested that LBTQ Muslim women resisted hegemonic norms by mapping out alternative paths grounded in Islam, and in living out lives in LGBTQ communities. Participants discussed their experiences of being "othered" within LGBTQ communities, how they challenged the notion of a monolithic Islam, how they expanded coming-out frameworks to include their own experiences, as well as how they asserted their own religious agency and resistance. Participants demonstrated that living out an intersectional identity was a complex task where constant negotiations of positionality were transpiring concurrently.

This Being is a Guest House: Embracing Humility, Liberation & Strengths in Therapy with Sexual and Gender Diverse Muslims

The complexity of the lives of sexual and gender diverse Muslims within the United States calls for mental health providers to own our power and privilege. Embracing cultural humility in service of aligning ourselves with liberation psychology, we call for an intersectionally informed, strengths-based approach to empowering/affirming clients whose diverse religious experiences intersect with their experiences of marginalization as sexual and gender diverse (SGD) Muslims. Drawing on extant personal narratives around mental health and therapy of this population, the authors offer critical reflections, processes and opportunities for clinicians to take responsibility in honoring the diverse journeys and experiences of SGD Muslims in serving them in journeys of healing.

Longitudinal effects of gender minority stressors on substance use and related risk and protective factors among gender minority adolescents

PURPOSE

Gender minority (GM) adolescents, who have a different gender identity than their sex assigned at birth, may use substances as a coping strategy in response to GM-related stressors. This study examined longitudinal effects of gender minority stressors on substance use in GM adolescents, and related risk factors (internalized transphobia, depressive symptoms, anxious symptoms) and protective factors (resilience, gender-related pride, family functioning, social support, gender-related community connectedness).

METHODS

Participants were 30 GM adolescents, ages 13-17 years, from the U.S. community-based longitudinal Trans Teen and Family Narratives Project. Participants completed an online survey every 6 months across 2 years (5 waves; data collected 2015-2019).

RESULTS

Exposure to gender minority stressors was associated with higher odds of alcohol use. Across models, internalized transphobia (risk factor), resilience (protective factor), and gender-related pride (protective factor) were the most significant mediators of associations between gender minority stressors and substance use. Family functioning and social support (protective factors) significantly moderated the association between gender minority stressors and alcohol use, such that family functioning and social support were protective for alcohol use at lower levels of gender minority stress, but not at higher levels.

CONCLUSION

Results suggest that GM adolescents engage in substance use as a coping strategy in response to gender minority stressors. A number of hypothesized risk and protective factors mediated or moderated these associations. Future interventions with GM adolescents should focus efforts on addressing internalized transphobia as a risk factor and strengthening resilience, gender-related pride, and family functioning as protective factors for substance use.

State-Level Structural Stigma and Smoking Among Sexual Minority Adults in the USA, 2012-2014

BACKGROUND

Exposure to structural stigma (i.e., societal norms and policies that constrain access to resources) may help explain poor health outcomes among sexual minority (SM) individuals in the USA.

PURPOSE

We examined the relationship between structural stigma and smoking prevalence among U.S. SM and heterosexual adults.

METHODS

We adapted an index to capture multiple state-level structural stigma indicators, including attitudes toward same-sex marriage; the geographical density of same-sex couples; and state-level policies toward SMs. The outcome variable was current smoking, derived from the National Adult Tobacco Survey (2012-2014). Poisson regression models stratified by SM status were used to assess the relationship between structural stigma and the prevalence ratio (PR) of current smoking. We included a squared term for stigma to explore nonlinear relationships between stigma and smoking. Interaction terms were used to examine effect modification by sex.

RESULTS

Adjusted models suggested a curvilinear PR relationship between stigma and smoking for both SM (linear PR = 1.03 [0.97-1.08]; quadratic PR = 0.98 [0.97-1.00]) and heterosexual (linear PR = 1.00 [0.99-1.02]; quadratic PR = 0.99 [0.988-0.995]) adults. The quadratic term was significant (p < .05) for both SM and heterosexual respondents, however, the change in probability of smoking associated with structural stigma was more pronounced among SM individuals. Specifically, the highest and lowest exposures to stigma were associated with the lowest probabilities of smoking. There was no apparent effect modification by sex.

CONCLUSIONS

Findings lend support to addressing SM structural stigma as a driver of smoking, particularly among SM adults.

Interaction of Religion/Spirituality With Internalized HIV Stigma, Depression, Alcohol Use, and Sexual Risk Among Black Men Who Have Sex With Men: The 6 City HPTN 061 Study

BACKGROUND

Black men who have sex with men (BMSM) remain at highest risk for HIV in the United States. Internalized HIV stigma and depression contribute to substance use and condomless anal intercourse (CAI). Religion and spirituality (R/S) are associated with decreased HIV-related risk behaviors for some groups, but their impact among BMSM is uncertain. We investigated the main and moderating roles of R/S on pathways from internalized HIV stigma to CAI while under the influence of drugs.

METHODS

We used baseline data from 1511 BMSM from the HIV Prevention Trials Network (HPTN) 061 study to examine the associations between internalized HIV stigma, depressive symptoms, alcohol use, and CAI while under the influence of drugs, adjusting for covariates in generalized structural equation models. We then tested whether R/S moderated the association between (1) internalized HIV stigma and depressive symptoms, (2) depressive symptoms and alcohol use, and (3) alcohol use and CAI while under the influence of drugs.

RESULTS

Spiritual beliefs [F(1,2) = 9.99, P < 0.001], spiritual activities [F(1,2) = 9.99, P < 0.001], and religious attendance [F(1,2) = 9.99, P < 0.001] moderated the pathway between internalized HIV stigma and depressive symptoms. As internalized HIV stigma increased, those with lower spiritual activity scores experienced significantly higher increases in depressive symptoms compared with those with higher spiritual activity scores whose depressive symptom scores remained unchanged [stigma × spiritual activities B = -0.18 (SE = 0.07), P < 0.001].

CONCLUSIONS

Religion and spirituality were protective against CAI among BMSM. Future intervention research should explore ways to incorporate religious and/or spiritual activities to reduce internalized HIV stigma as one way to reduce depressive symptoms among BMSM.

A mindfulness-based, stress and coping model of craving in methamphetamine users

There is increasing interest in the role of mindfulness and mindfulness-based interventions to optimize recovery from a substance use disorder (SUD). However, relatively little is known about the theory-based psychological and social pathways whereby mindfulness could have beneficial effects for managing a chronic, relapsing SUD. Informed by Revised Stress and Coping Theory, the present cross-sectional study examined affective, cognitive, and social pathways whereby mindfulness is associated with lower methamphetamine craving. A total of 161 HIV-positive, methamphetamine-using sexual minority men completed a screening visit for a randomized controlled trial. Using a hybrid structural equation model, we examined pathways whereby mindfulness is associated with lower methamphetamine craving. We found that greater mindfulness was directly associated with lower negative affect and higher positive affect as well as indirectly associated with less methamphetamine craving. Interestingly, the indirect association between mindfulness and methamphetamine craving appeared to be uniquely attributable to positive affect. Only positive affect was indirectly associated with lower methamphetamine craving via higher positive re-appraisal coping and greater self-efficacy for managing triggers for methamphetamine use. Methamphetamine craving was supported by moderate associations with greater substance use severity and more frequent methamphetamine use. These findings support the role of mindfulness in cultivating positive affect, which could be crucial to build the capacity of individuals to manage methamphetamine craving as a chronic stressor that threatens recovery from SUD.

Combining Global Positioning System (GPS) with saliva collection among sexual minority adults: A feasibility study

BACKGROUND

This is the first study, of which we are aware, to evaluate the feasibility and accessibility of simultaneous use of Global Positioning System (GPS) and saliva collection for biomarker assessment as an objective measure of stress physiology among sexual minority (lesbian, gay, bisexual, queer, and other non-heterosexual identities) individuals. The principal motivation for pairing GPS and saliva collection was to investigate how characteristics of the built and social environments along with participants' daily activity paths affect stress. This can contribute to a better understanding of health and health behaviors in the sexual minority community.

METHODS

A convenience sample of enrolled participants (N = 124) from Houston, Texas was asked to complete questionnaires, carry with them a GPS unit daily, and collect and store 6 samples of saliva at specific times across the span of a day prior to a second visit around one week later.

RESULTS

Of 124 participants, 16 participants (12.90%) provided no useable GPS data and 98 (79.03%) provided at least 4 days of data. More than three-fourths (n = 98, 79.03%) also provided complete saliva samples.

CONCLUSIONS

Our results show that the simultaneous use of GPS and saliva collection to assess sexual minority individuals' activity paths and stress level is feasible.

Acceptability of daily pre-exposure prophylaxis among adolescent men who have sex with men, travestis and transgender women in Brazil: A qualitative study

BACKGROUND

Adolescents face socio-structural, personal and programmatic barriers to HIV prevention services, highlighting the importance of understanding knowledge and acceptability as essential aspects to promote their broader access to pre-exposure prophylaxis (PrEP). We analyzed the acceptability of PrEP among adolescent men who have sex with men (MSM), travestis and transgender women (TGW).

METHODS

A qualitative investigation was conducted as part of the formative research of the PrEP15-19 study, an ongoing demonstration study that analyzes the effectiveness of daily PrEP among adolescent MSM, travestis and TGW aged 15-19 in three Brazilian cities. A total of 37 semi-structured interviews and 6 focus groups were conducted. Building from thematic analysis focusing on participants' sexual encounters, perceptions about PrEP efficacy, and vulnerability contexts, we analyzed prospective acceptability of PrEP.

FINDINGS

Knowledge about PrEP was incipient and characterized by adolescents' frequent doubts about its prescription and efficacy. The 'ideal' use of PrEP appeared together with consistent condom use, especially in casual sex. PrEP use was also mentioned as depending on increased learning about prevention management over time. Main barriers to PrEP use included the incorporation of a daily medication into participants' routine and its impact on their social lives, especially related to stigma. Concerns over short- and long-term side effects were also reported as barriers to PrEP use. TGW and travestis contrasted using PrEP with the precarity of their life conditions, and some expressed a critical vision about PrEP by associating it with pharmaceuticalization and trans necropolitics.

CONCLUSIONS

Participants' low knowledge and acceptability of PrEP are circumscribed by a rigid perception of condom as the ideal prevention method and the context of their sexual relations. Prospective acceptability highlights that the successful uptake of PrEP depends on overcoming barriers of access to health services and confronting transphobia and homophobia as part of care.

Positive and Negative Impacts of the COVID-19 Pandemic on Relationship Satisfaction in Male Couples

Little is known about the impact of the coronavirus pandemic and control measures on gay, bisexual, and other men who have sex with men (GBMSM) couples. The goal of this study was to investigate individual-level relationship satisfaction during the COVID-19 pandemic in a sample of 209 coupled GBMSM in the United States. We analyzed reported happiness and feelings about a relationship's future and assessed the odds of changing relationship happiness and investment associated with pandemic-related life changes (pandemic-related employment change; COVID-19 illness; high-risk of severe illness), using logistic and multinomial logit models. Fifty-five percent of participants (N = 114) reported that their relationship happiness had not changed during the pandemic, but 30% (N = 62) reported increased relationship happiness. 25% (N = 53) reported they had become more invested in their relationship's future during the pandemic, and only one participant reported decreased investment. The odds of increased relationship investment was significantly associated with pandemic-related employment change (adjusted odds ratio (aOR), 95% confidence interval (CI): 2.19 [1.04, 4.61]) and increased sex during the pandemic (aOR: 4.38 [1.55, 12.41]). Those with a pandemic-related employment change also had significantly higher odds of increased relationship happiness than those without a change (aOR: 2.10 [1.01, 4.35]). COVID-19 cases that reported being at higher risk of serious COVID-19 disease had higher odds of decreased relationship happiness than high-risk non-cases (aOR: 6.58 [1.10, 39.39]). Additional research in this area is warranted to minimize the long-term impacts of the pandemic on coupled GBMSM.

HIV Pre-Exposure Prophylaxis, Condoms, or Both? Insights on Risk Compensation Through a Discrete Choice Experiment and Latent Class Analysis Among Men Who Have Sex With Men

OBJECTIVES

We considered how decision making around human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) among gay, bisexual, and other men who have sex with men (GBMSM) is made in the context of one's perceived risk of HIV acquisition and the availability of condoms.

METHODS

We recruited 648 GBMSM aged 18 years old and residing in Singapore through Grindr. Participants were given information on PrEP and participated in a discrete choice experiment requiring them to choose between 2 baskets of PrEP attributes and compare the chosen "PrEP only" option to default options of "condoms only" or "PrEP with condoms." Generalized multinomial logit model was used to examine the scaling effect and preference heterogeneity. Latent class analysis was conducted to examine preference heterogeneity in the sample.

RESULTS

Latent class analysis revealed 3 classes of GBMSM: PrEP conservatives (53.9%), moderates (31.1%), and liberals (14.9%). PrEP conservatives were more likely to report greater utility when using condoms only compared with PrEP only, as well as PrEP with condoms, compared with PrEP only, and more likely to report the lowest utility for PrEP as perceived HIV risk increased. PrEP liberals were more likely to report greatest utilities for PrEP only compared with condoms only, as well as PrEP only compared with PrEP with condoms. The utility for PrEP was not affected by perceived risk of HIV or sexually transmitted infections when risks were low.

CONCLUSION

This study provides some evidence for risk compensation among a class of GBMSM who already perceived themselves to be good candidates for PrEP before the discrete choice experiment.

HIV burden and correlates of infection among transfeminine people and cisgender men who have sex with men in Nairobi, Kenya: an observational study

BACKGROUND

Transgender people are disproportionately affected by HIV and other sexually transmitted infections (STIs) worldwide, and culturally competent prevention and treatment services are often unavailable or inaccessible. Despite recent improvements in national HIV responses for many key populations in east Africa, evidence of effective responses informed by transgender sexual health needs is sparse. We aimed to assess gender identity among men and transgender people who have sex with men in Kenya, and to explore its associations with sexual health-related outcomes, risk behaviours, and uptake of HIV prevention and care interventions.

METHODS

We did a cross-sectional study in Nairobi, Kenya, and recruited adult cisgender men and transfeminine people who reported having sex with men, through respondent-driven sampling. Inclusion criteria were possession of a valid study coupon, being aged 18 years or older, having male sex assignment at birth or male gender identification currently, living within 50 km of Nairobi, and having had consensual anal or oral sexual activity with a man in the previous 12 months. Seed participants were identified by three community organisations that provide targeted health-care services to gay, bisexual, or other men who have sex with men (MSM) communities in Nairobi. We assessed gender identity, sociodemographics, sexual behaviour, and HIV prevention and care uptake, by self-completed survey. Participants were tested for HIV, syphilis, and rectal and urethral gonorrhoea and chlamydia. We compared prevalence of sexual health outcomes, risk behaviour, and HIV prevention and care service uptake among transfeminine and cisgender participants, using multivariable robust Poisson regression models, with gender identity as the independent variable.

FINDINGS

Between May 4 and Dec 8, 2017, we enrolled 618 participants. Six participants did not answer the questions on sex assigned at birth and gender identity and so were excluded from the analyses. 522 (sample-weighted percentage 86%) of 612 participants were classified as cisgender men, 70 (11%) as transfeminine, and three (<1%) as transmasculine. 17 participants (2%) did not identify as male, female, or transgender. Compared with cisgender men, transfeminine people were more likely to be HIV-positive (28 [41%] of 70 transfeminine vs 151 [25%] of 521 cisgender men; p=0·0009) and to report current symptoms consistent with a rectal STI (eight [16%] of 67 vs 38 [7%] of 518; p=0·014). Transfeminine people reported higher numbers of recent male sexual partners (22 [27%] of 70 transfeminine people reported four or more male sexual partners in the past 3 months vs 112 [13%] of 522 cisgender men; p=0·042) and were more likely to report condomless anal intercourse with men (43 [62%] of 70 vs 208 [39%] of 522; p=0·0009) and receptive anal intercourse (54 [76%] of 70 vs 252 [46%] of 522; p<0·0001) in the past 3 months, and transactional sex with men (42 [57%] of 69 vs 240 [42%] of 518; p=0·023) and experience of sexual assault (16 [23%] of 69 vs 65 [11%] of 520; p=0·019) in the past 12 months. Use of pre-exposure prophylaxis and post-exposure prophylaxis was low in both groups.

INTERPRETATION

Transfeminine people who have sex with men have a higher burden of HIV and associated risk behaviours compared with cisgender MSM in the same context, yet their uptake of prevention and care services is poor. Policies should acknowledge the specific needs of transfeminine people as distinct from cisgender MSM, and support health-care providers to address these needs.

FUNDING

Evidence for HIV Prevention in Southern Africa (EHPSA), UK Aid.

Mental and Sexual Health Disparities Among Bisexual and Unsure Latino/a and Black Sexual Minority Youth

Purpose: Sexual minority youth (SMY), particularly bisexual youth and youth unsure of their sexual identity, are at greater risk of poor mental and sexual health outcomes than heterosexual youth. The purpose of this study was to examine disparities in intimate partner violence (IPV) and mental and sexual health for Black and Latino/a bisexual and unsure youth compared with their White bisexual and unsure and Black and Latino/a heterosexual peers. Methods: We used aggregated state and school district 2015 Youth Risk Behavior Survey data to demonstrate differences in mental health (e.g., depressive symptoms and suicidality), sexual health (e.g., number of sexual partners and contraceptive use), and physical and sexual IPV between Black and Latino/a bisexual and unsure youth, and their White bisexual and unsure and Black and Latino/a heterosexual peers. Results: Bisexual and unsure youth had higher odds of depressive symptoms, suicidal ideation and plans, and physical IPV than their same-race heterosexual peers. Black and Latina bisexual and unsure females were more likely to report sexual health risk behaviors than Black and Latina heterosexual females. There were few differences between bisexual and unsure youth of color and White youth. Conclusion: We add to a growing body of literature showing disparities in IPV and mental and sexual health among bisexual and unsure youth of color. Pronounced risk for poor health outcomes among bisexual and unsure females of color needs to be especially addressed by prevention and intervention efforts. We encourage further research on the health of SMY with multiple marginalized identities.

Now that They're Out: Experiences of College Athletics Teams with Openly LGBTQ Players

In recent years, more college athletes have publicly identified as lesbian, gay, bisexual, transgender, and/or queer (LGBTQ). Our study seeks to move past media celebrations and controversies of "coming out" and examine actual experiences of LGBTQ athletes and their teammates. A survey of 259 LGBTQ athletes and teammates of LGBTQ athletes was conducted. We examined concerns about being or playing with LGBTQ athletes, sources of homophobic language, experiences and observations of discrimination, and perceived impact of being or playing with an LGBTQ athlete. Findings indicate that many fears associated with college athletes coming out are likely overstated. All participants reported low levels of concern, homophobia, and negative impact of being or playing with an LGBTQ teammate. However, there were some differences between LGBTQ and non-LGBTQ athletes with non-LGBTQ athletes reporting fewer concerns, but also hearing less homophobic language than their LGBTQ counterparts. programs.

Protester, Partygoer, or Simply Playing It Down? The Impact of Crowd Affiliations on LGBT Emerging Adults' Socioemotional and Academic Adjustment to College

Although peer crowd affiliations have been studied among emerging adults in college, this work has yet to focus in on LGBT-identifying students. Accordingly, the current study a) surveyed the peer crowd landscape using a sample of 234 LGBT students (M_age = 19.89, SD = 1.55; 70.51% female, 18.38% male, 11.11% other) at a small, private, liberal arts college in Southern California, and b) explored the relationships between self-reported peer crowd affiliations and LGBT students' adjustment (i.e., loneliness, belongingness, and academic-, alcohol-, drug-, and sex-risk behaviors). Results point to the existence of four underlying peer crowd dimensions among LGBT students: protester, nonvocal, social, and athletic. Furthermore, affiliation with these peer crowds was found to relate to students' self-reported loneliness and academic-, drug-, and sex-risk behaviors.

Evaluation of Drug Abuse by Hair Analysis and Self-Reported Use Among MSM Under PrEP: Results From a French Substudy of the ANRS-IPERGAY Trial

BACKGROUND

We used the Agence nationale de Recherches sur le sida et les hépatites virales (ANRS)-IPERGAY trial to qualitatively and quantitatively measure drug use among men who have sex with men under preexposure prophylaxis using 2 different methods, to better understand and collectively respond to risky practices.

METHOD

We included 69 volunteers of the ANRS-IPERGAY trial. We measured drug use by 2 methods: (1) drug detection by hair analysis and (2) reported drug use by self-reported drug consumption.

RESULTS

New psychoactive substances (NPS) and conventional drugs were detected in 53 of the 69 (77%) volunteers by hair analysis and in 39 of the 69 (57%) volunteers by questionnaires. On the 219 hair segments analyzed, the most commonly used drugs were cocaine in 47 of the 69 (68%), 3,4-methylenedioxymethamphetamine/ecstasy in 31 of the 69 (45%), and NPS in 27 of the 69 (39%). On the 1061 collected questionnaires, the most commonly used drugs were cocaine in 31 of the 69 (45%), 3,4-methylenedioxymethamphetamine/ecstasy in 29 of the 69 (42%), and NPS in 16 of the 69 (23%). Hair analysis detects more conventional drugs and/or NPS use (P < 0.05). Drug use identified by hair was significantly associated with a higher number of sexual partners in the past 2 months (P ≤ 0.001), more often casual partners (P ≤ 0.001), condomless anal sex (P ≤ 0.005), hardcore sexual practices (P ≤ 0.001), a higher number of sexually transmitted infections, and chemsex (P ≤ 0.05).

CONCLUSIONS

Self-report drug use by questionnaires remains the reference tool for harm reduction at the individual level because of its feasibility and low cost. However, hair analysis is more sensitive, objectively assessing consumption, and interesting to understand uses and to be able to collectively respond to risky practices with adapted messages.

Cross-cultural adaptation of the Perceived Risk of HIV Scale in Brazilian Portuguese

BACKGROUND

Valid and reliable instruments are needed to measure the multiple dimensions of perceived risk. The Perceived Risk of HIV Scale is an 8-item measure that assesses how people think and feel about their risk of infection. We set out to perform a cross-cultural adaptation of the scale to Brazilian Portuguese among key populations (gay, bisexual and other men who have sex with men and transgender/non-binary) and other populations (cisgender heterosexual men and cisgender women).

METHODS

Methodological study with cross-sectional design conducted online during October/2019 (key populations [sample 1] and other populations) and February-March/2020 (key populations not on pre-exposure prophylaxis [sample 2]). Cross-cultural adaptation of the Perceived Risk of HIV Scale followed Beaton et al. 2000 guidelines and included confirmatory factor analysis, differential item functioning (DIF) using the Multiple-Indicator Multiple-Cause model, and concurrent validity to verify if younger individuals, those ever testing for HIV, and engaging in high-risk behaviors had higher scores on the scale.

RESULTS

4342 participants from key populations (sample 1 = 235; sample 2 = 4107) and 155 participants from other populations completed the measure. We confirmed the single-factor structure of the original measure (fit indices for sample 1 plus other populations: CFI = 0.98, TLI = 0.98, RMSEA = 0.07; sample 2 plus other populations: CFI = 0.97, TLI = 0.95, RMSEA = 0.09). For the comparisons between key populations and other populations, three items (item 2: "I worry about getting infected with HIV", item 4: "I am sure I will not get infected with HIV", and item 8: "Getting HIV is something I have") exhibited statistically significant DIF. Items 2 and 8 were endorsed at higher levels by key populations and item 4 by other populations. However, the effect of DIF on overall scores was negligible (0.10 and 0.02 standard deviations for the models with other populations plus sample 1 and 2, respectively). Those ever testing for HIV scored higher than those who never tested (p < .001); among key populations, those engaging in high-risk behaviors scored higher than those reporting low-risk.

CONCLUSION

The Perceived Risk of HIV Scale can be used among key populations and other populations from Brazil.

Evidence for the Confluence of Cigarette Smoking, Other Substance Use, and Psychosocial and Mental Health in a Sample of Urban Sexual Minority Young Adults: The P18 Cohort Study

BACKGROUND

Sexual minority men (SMM) and transgender women (TW) are more likely to smoke cigarettes than heterosexual and cisgender peers, which may exacerbate existing disparities in mental and psychosocial health and substance use.

PURPOSE

As few existing studies have examined the confluence of these factors, we sought to examine tobacco use in a diverse sample of SMM and TW and describe its relationship with other substance use and health.

METHODS

Data were drawn from a study of syndemic conditions among SMM and TW, which included measures assessing tobacco use, substance use, and mental, psychosocial, and general health.

RESULTS

A majority of the racially/ethnically and socioeconomically diverse sample (n = 665) reported ever smoking a cigarette, and more than half of them were current smokers. Current smoking was associated with more frequent recent substance use and poorer mental, psychosocial, and general health. In multivariable analyses, current smoking was predicted by more frequent substance use and more severe anxiety, when adjusting for demographic, substance use, and health factors.

CONCLUSIONS

A syndemic approach to health conditions such as substance use, mental health, and psychosocial burden dictates a framework of interrelation and mutual exacerbation. In doing so, we found that current cigarette use was associated with more frequent alcohol and marijuana use and more severe anxiety, suggesting a confluence of cigarette smoking, other substance use, and mental health burden. We recommend a holistic approach to treating tobacco use in sexual and gender minority populations that addresses both substance use and the myriad psychosocial burdens that sexual and gender minority communities experience.

Leveraging Technology to Blend Large-Scale Epidemiologic Surveillance With Social and Behavioral Science Methods: Successes, Challenges, and Lessons Learned Implementing the UNITE Longitudinal Cohort Study of HIV Risk Factors Among Sexual Minority Men in the United States

The use of digital technologies to conduct large-scale research with limited interaction (i.e., no in-person contact) and objective endpoints (i.e., biological testing) has significant potential for the field of epidemiology, but limited research to date has been published on the successes and challenges of such approaches. We analyzed data from a cohort study of sexual minority men across the United States, collected using digital strategies during a 10-month period from 2017 to 2018. Overall, 113,874 individuals were screened, of whom 26,000 were invited to the study, 10,691 joined the study, and 7,957 completed all enrollment steps, including return of a human immunodeficiency virus-negative sample. We examined group differences in completion of the steps towards enrollment to inform future research and found significant differences according to several factors, including age and race. This study adds to prior work to provide further proof-of-concept for this limited-interaction, technology-mediated methodology, highlighting some of its strengths and challenges, including rapid access to more diverse populations but also potential for bias due to differential enrollment. This method has strong promise, and future implementation research is needed to better understand the roles of burden, privacy, access, and compensation, to enhance representativeness and generalizability of the data generated.

Effects of the COVID-19 pandemic on the sexual and mental health of adolescent and adult men who have sex with men and transgender women participating in two PrEP cohort studies in Brazil: COBra study protocol

INTRODUCTION

The COVID-19 pandemic and its control measures have impacted health and healthcare provision in various levels. Physical distancing measures, for instance, may affect sexual health, impacting access to HIV prevention supplies and changing sexual behaviour, as well as mental health, increasing feelings of unsafety and weakening community support ties. These effects can be worsened among socially marginalised groups, such as men who have sex with men (MSM) and transgender women (TGW). Brazil is among the countries most affected by COVID-19 in the world, where control measures have been inconsistently implemented. We aim to investigate the effects of the COVID-19 pandemic on the sexual and mental health of adolescent and adult MSM and TGW in Brazil.

METHODS

Convergent mixed-method prospective cohort study, nested in two ongoing HIV pre-exposure prophylaxis (PrEP) cohorts in Brazil, named PrEP1519 and Combina. Participants will be invited to answer, at baseline and after 6 months, a questionnaire about the effects of the COVID-19 pandemic on sexual behaviour, HIV prevention and mental health. Data on HIV infection and sexually transmitted infections (STI) will be collected as part of routine follow-up from the cohorts. Main outcome measures (HIV infection, STI and depression symptoms) will be observed within 12 months after baseline. Sample size is estimated at 426 participants. Complementarily, 50 participants will be invited to in-depth interviews through video calls or interactive voice response, and 20 will be invited to chronicle their lives during the pandemic through digital diaries. Triangulation will be done across qualitative methods and with the quantitative data.

ETHICS AND DISSEMINATION

The study was approved by Research Ethics Committees from the Brazilian Universities coordinating the study. Findings will be published in scientific journals and presented at meetings. Informative flyers will be elaborated to communicate study findings to participants and key stakeholders.

Development of the Conceptual Future Parent Grief (CFPG) Scale for LGBTQ+ people

Parenthood is highly valued around the world. Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people, however, have faced a history of discrimination and challenges related to becoming parents (e.g., legal and/or practical barriers to adoption or biological parenthood). As such, LGBTQ+ youth may believe that certain pathways to parenthood (or parenthood itself) are unavailable to them. These feelings could prompt experiences of ambiguous loss related to a future idealized self. No quantitative research, however, has been conducted to capture these possible experiences; scale development is an important step to attempt to quantify them. Here, we report results from two studies using exploratory and confirmatory factor analysis to investigate the factor structure of a new scale reflecting conceptual future parent grief (CFPG) among LGBTQ+ individuals. Participants also responded to several measures to explore validity with the CFPG scale. Following model respecification, a 9-item one-factor solution resulted, reflecting ambiguous loss, complex grief, and sexual stigma-all of which could contribute to difficulties in reconciling one's LGBTQ+ and future parenthood identities. Significant associations with greater authenticity of LGBTQ+ identity, depressive symptoms, and sexual stigma provided evidence of convergent and divergent validity with the CFPG scale. Thus, ambiguous loss among LGBTQ+ people may connect to aspects of identity, mental health, and parenthood goals. Developing this scale represents a first step toward an assessment for LGBTQ+ individuals regarding future parenthood. Understanding more about CFPG among LGBTQ+ individuals could inform prevention efforts to reduce negative mental health symptoms and enhance positive LGBTQ+ identity development. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Health Care Satisfaction in Relation to Gender Identity: Behavioral Risk Factor Surveillance Survey, 20 States (2014-2018)

BACKGROUND

Health care satisfaction is a key component of patient-centered care. Prior research on transgender populations has been based on convenience samples, and/or grouped all gender minorities into a single category.

OBJECTIVE

The objective of this study was to quantify differences in health care satisfaction among transgender men, transgender women, gender nonconforming, and cisgender adults in a diverse multistate sample.

RESEARCH DESIGN

Cross-sectional analysis of 2014-2018 Behavioral Risk Factor Surveillance System data from 20 states, using multivariable logistic models.

SUBJECTS

We identified 167,468 transgender men, transgender women, gender-nonconforming people, cisgender women, and cisgender men and compared past year health care satisfaction across these groups.

RESULTS

Transgender men and women had the highest prevalence of being "not at all satisfied" with the health care they received (14.6% and 8.6%, respectively), and gender-nonconforming people had the lowest prevalence of being "very satisfied" with their health care (55.7%). After adjustment for sociodemographic characteristics, transgender men were more likely to report being "not at all satisfied" with health care than cisgender men (odds ratio: 4.45, 95% confidence interval: 1.72-11.5) and cisgender women (odds ratio: 3.40, 95% confidence interval: 1.31-8.80).

CONCLUSIONS

Findings indicate that transgender and gender-nonconforming adults report considerably less health care satisfaction relative to their cisgender peers. Interventions to address factors driving these differences are needed.

Use of HIV pre-exposure prophylaxis among urban Canadian gay, bisexual and other men who have sex with men: a cross-sectional analysis of the Engage cohort study

BACKGROUND

In Canada, gay, bisexual and other men who have sex with men (GBM) are disproportionately affected by HIV. Our objective was to describe access to HIV pre-exposure prophylaxis (PrEP) and identify factors associated with not using PrEP among self-reported HIV-negative or HIV-unknown GBM.

METHODS

This was a cross-sectional analysis of the Engage study cohort. Between 2017 and 2019, sexually active GBM aged 16 years or more in Montréal, Toronto and Vancouver were recruited via respondent-driven sampling (RDS). Participation included testing for HIV and sexually transmitted and blood-borne infections, and completion of a questionnaire. We examined PrEP access using a health care services model and fit RDS-adjusted logistic regressions to determine correlates of not using PrEP among those for whom PrEP was clinically recommended and who were aware of the intervention.

RESULTS

A total of 2449 GBM were recruited, of whom 2008 were HIV-negative or HIV-unknown; 1159 (511 in Montréal, 247 in Toronto and 401 in Vancouver) met clinical recommendations for PrEP. Of the 1159, 1100 were aware of PrEP (RDS-adjusted proportion: Montréal 84.6%, Toronto 94.2%, Vancouver 92.7%), 678 had felt the need for PrEP in the previous 6 months (RDS-adjusted proportion: Montréal 39.2%, Toronto 56.1%, Vancouver 49.0%), 406 had tried to access PrEP in the previous 6 months (RDS-adjusted proportion: Montréal 20.6%, Toronto 33.2%, Vancouver 29.6%) and 319 had used PrEP in the previous 6 months (RDS-adjusted proportion: Montréal 14.5%, Toronto 21.6%, Vancouver 21.8%). Not using PrEP was associated with several factors, including not feeling at high enough risk, viewing PrEP as not completely effective, not having a primary care provider and lacking medication insurance.

INTERPRETATION

Although half of GBM met clinical recommendations for PrEP, less than a quarter of them reported use. Despite high levels of awareness, a programmatic response that addresses PrEP-related perceptions and health care system barriers is needed to scale up PrEP access among GBM in Canada.

Risk and Protective Factors for Social Anxiety Among Sexual Minority Individuals

Minority stress processes represent clear determinants of social anxiety among sexual minority populations. Yet sources of resilience to social anxiety are less explored as are stressors experienced from within sexual minority communities (i.e., intraminority stress). Based on minority stress theory and the psychological mediation framework, we hypothesized that experiences of discrimination and intraminority stress would predict proximal minority stress processes, including internalized homonegativity, sexual concealment behavior, and rejection sensitivity, as well as two resilience factors-sense of coherence and LGBTQ community connectedness-to explain social anxiety among sexual minority individuals. Self-identified cisgender sexual minority women (n = 245) and men (n = 256) residing in the Republic of Ireland completed an online survey. Results from a structural equation modeling analysis indicated that the data fit the hypothesized model well for both women and men. For both sexual minority women and men, experiences of discrimination and intraminority stress were indirectly associated with social anxiety via two paths (1) increased rejection sensitivity and (2) reduced sense of coherence. Intraminority stress was indirectly associated with social anxiety via increased concealment behavior for sexual minority men only. Experiences of discrimination were indirectly associated with social anxiety via a sequential pathway through increased proximal minority stress (i.e., concealment behavior and internalized homonegativity), and reduced LGBTQ community connectedness solely among sexual minority women. Findings are discussed in terms of implications for future research and clinical practice with sexual minority individuals who suffer from social anxiety.

Sexual minority status, social adversity and risk for psychotic disorders-results from the GROUP study

BACKGROUND

Lesbian, bisexual, or gay individuals (LBGs) have an increased risk for mental health problems compared to heterosexuals, but this association has sparsely been investigated for psychotic disorders. The aim of this study was: (1) to examine whether LBG sexual orientation is more prevalent in individuals with a non-affective psychotic disorder (NAPD) than in people without a psychotic disorder; and if so, (2) to explore possible mediating pathways.

METHODS

Sexual orientation was assessed in the 6-year follow-up assessment of the Dutch Genetic Risk and Outcome of Psychosis study (GROUP), a case-control study with 1547 participants (582 patients with psychotic disorder, 604 siblings, and 361 controls). Binary logistic regression analyses were used to calculate the risk of patients with a psychotic disorder being LBG, compared to siblings and controls. Perceived discrimination, history of bullying, childhood trauma (CT), and sexual identity disclosure were investigated as potential mediating variables.

RESULTS

The proportion of individuals with LBG orientation was 6.8% in patients (n = 40), 4.3% in siblings (n = 26), and 2.5% in controls (n = 10). The age- and gender-adjusted odds ratio of LBG for patients was 1.57 (95% CI 1.08-2.27; p = 0.019), compared to siblings and controls. Discrimination, bullying, and CT all partially mediated this association.

CONCLUSIONS

Adverse social experiences related to sexual minority status may increase the risk for NAPD. Sexual identity, behavior, and difficulties need more attention in everyday clinical practice.

Ambient Discrimination, Victimization, and Suicidality in a Non-Probability U.S. Sample of LGBTQ Adults

Individuals who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) are at a higher risk for suicidality compared to the general population. A growing body of research has investigated this risk, particularly with attention to systemic factors such as discrimination and harassment. Unfortunately, research has only examined the impact of direct discrimination on suicidality and has neglected to examine how ambient discrimination (i.e., witnessing or being made aware of discriminatory behaviors directed at someone other than yourself in your group) relates to suicidality. Additionally, although some links exist between discrimination and suicidality, the mechanisms by which these are related are understudied. This study aimed to address these gaps by exploring the effect of ambient discrimination on suicidal ideation and examining psychological pain as a mediator in this relationship. Data were collected from a sample of 200 LGBTQ-identified individuals (M age = 35 years; 53.5% female; 86% White). Results of independent t tests and a one-way multivariate ANOVA revealed greater vulnerability for ambient/direct discrimination and psychache among individuals identifying as transgender, queer, and other. Regression and mediation analyses revealed that while both ambient and direct discrimination predicted suicidal ideation, only direct discrimination accounted for unique variance in the outcome; however, both ambient and direct discrimination contributed unique variance to psychological pain, which fully mediated their relationships to suicidal ideation. Results of this study may begin to provide insight into the pathways of risk and points of intervention for suicidality in the LGBTQ community.

"Being Talked to Like I Was a Sex Toy, Like Being Transgender Was Simply for the Enjoyment of Someone Else": Fetishization and Sexualization of Transgender and Nonbinary Individuals

Despite the growing interest in the experiences of transgender individuals, the phenomenon of fetishization of transgender bodies and identities has been overlooked. The present study was aimed at investigating the experiences of fetishization of transgender and nonbinary (TGNB) people. Participants in the current study represent a sample of 142 TGNB volunteers from the community who answered the prompt: "If you feel comfortable, could you describe your experience of being fetishized?" Using thematic analysis, we developed three overarching themes relevant to the experiences of fetishization of TGNB participants: (1) context of fetishization; (2) negative experiences of fetishization; and (3) positive or ambiguous experiences of fetishization. The results demonstrated that, in most cases, fetishization was understood by TGNB people as a negative experience of sexual objectification, although some individuals experienced fetishization as a positive experience, perceiving the sexual desire of the other person or living it as a kink. Consistent with the integrated theory of dehumanization, the results demonstrated that both sexual objectification and minority stress contributed to participants' understanding of fetishization for TGNB individuals. Implications for clinical work with TGNB individuals are discussed.

A Scoping Review of Intimate Partner Violence as It Relates to the Experiences of Gay and Bisexual Men

Intimate partner violence (IPV) is a global health issue that encroaches beyond parameters of age, gender, sexual orientation and is the subject of extensive scholarly inquiry. Research on IPV in heterosexual couples, in particular on heterosexual women, has been prolific. However, there is a dearth of literature to document the distinct experiences of gay and bisexual men, despite the evidence of prevalence of IPV as reported equal or higher to heterosexual women. Studies have found that one in four gay men and four in 10 bisexual men have experienced IPV in their lifetime. This scoping review examines studies between 1931 and 2019 that had a predominant focus on violence among gay and bisexual men. Four electronic databases were searched in 2019. Arksey and O'Malley's framework was utilized to extract 28 studies using a range of research designs that represented 13,224 sexual minority male participants. Across studies, gay and bisexual men were observed to experience IPV similarly to heterosexual couples involving psychological, physical, and sexual violence. However, as a marginalized and sexual minority group, they experience distinctive features of violence including sexual orientation outing, unprotected sexual intercourse, homophobia, internalized homophobia, and difficulties accessing minority men-focused services. Minority stress theory is posited as a useful lens in understanding the above features. In keeping with previous scholarship, a paucity of knowledge on gay and bisexual men's experience of IPV was observed, and additional research is recommended.

Physical and Emotional Satisfaction at First Same-Sex Anal Sex in Young Gay and Bisexual Men

Research has focused on adolescents' feelings about their first sexual experiences, but little research has examined this topic in sexual minority adolescents. In this study, we examined how experiencing emotional and physical satisfaction at first same-sex anal sex differed by age of first sex for young gay and bisexual men. We applied the time-varying effect model to data from an Internet survey of men who initiated first sex between ages 14-26 (n = 6401) to examine emotional and physical satisfaction at first same-sex anal sex across continuous age of onset and by partner factors. The majority of men reported satisfaction across all ages; however, satisfaction was generally less likely for men who had first anal sex with a non-relationship partner, an older partner, or a partner they had sex with only once and this was particularly true at earlier ages. Findings suggest that many young gay and bisexual men report satisfaction with their first anal sex and that relationship context can be important in predicting satisfaction, particularly at younger ages.

Family Belongingness Attenuates Entrapment and Buffers Its Association with Suicidal Ideation in a Sample of Dutch Sexual Minority Emerging Adults

Sexual minority emerging adults are more likely to engage in suicidal ideation than their heterosexual counterparts. Experiences of homophobic violence are associated with suicidal ideation. Yet, the specific mechanisms linking homophobic violence to suicidal ideation remain unclear. Entrapment and social belongingness were tested to determine their relevance for understanding the link between homophobic violence and suicidal ideation. A sample of sexual minority Dutch emerging adults (N = 675; ages 18-29, M = 21.93 years, SD = 3.20) were recruited through online platforms and flyers. Homophobic violence was expected to be positively associated with suicidal ideation and entrapment. The association between homophobic violence and suicidal ideation was expected to be indirectly linked through entrapment. We explored whether various sources of social belongingness moderated the path between entrapment and suicidal ideation and whether those sources of social belongingness moderated the indirect effect of homophobic violence on suicidal ideation through entrapment. Results showed that homophobic violence and entrapment were positively associated with suicidal ideation and that family belongingness was negatively associated with suicidal ideation. Homophobic violence and suicidal ideation were not indirectly linked through entrapment. The interaction effect between entrapment and family belongingness was significant, suggesting that, on average, the effect of entrapment on suicidal ideation decreased when family belongingness was high. These results suggest that family belongingness may reduce the association between entrapment and suicidal ideation while adjusting for homophonic violence. Reducing entrapment and improving family belongingness may be useful targets for programs aimed at preventing suicidal ideation among sexual minority emerging adults.

Strengthening resilience to reduce HIV risk in Indian MSM: a multicity, randomised, clinical efficacy trial

BACKGROUND

Men who have sex with men (MSM) in India are extremely marginalised and stigmatised, and therefore experience immense psychosocial stress. As current HIV prevention interventions in India do not address mental health or resilience to these stressors, we aimed to evaluate a resilience-based psychosocial intervention in the context of HIV and sexually transmitted infection (STI) prevention.

METHODS

We did a multicity, randomised, clinical efficacy trial in Chennai (governmental tuberculosis research institute) and Mumbai (non-governmental organisation for MSM), India. Inclusion criteria were MSM, aged 18 years or older, who were at risk of HIV acquisition or transmission, defined as having any of the following in the 4 months before screening: anal sex with four or more male partners (protected or unprotected), diagnosis of an STI, history of transactional sex activity, or condomless anal sex with a man who was of unknown HIV status or serodiscordant. Participants were required to speak English, Tamil (in Chennai), or Hindi (in Mumbai) fluently. Eligible individuals were randomly assigned (1:1) to either a resilience-based psychosocial HIV prevention intervention, consisting of group (four sessions) and individual (six sessions) counselling alongside HIV and STI voluntary counselling and testing, or a standard-of-care control comprising voluntary counselling and testing alone. The primary outcomes were number of condomless anal sex acts with male partners during the past month (at baseline and 4 months, 8 months, and 12 months after randomisation), and incident bacterial STIs (at 12 months after randomisation). Resilience-related mediators included self-esteem, self-acceptance, and depression. Recruitment is now closed. This trial is registered with ClinicalTrials.gov, NCT02556294.

FINDINGS

Between Sept 4, 2015, and June 28, 2018, we enrolled 608 participants; 305 (50%) were assigned to the psychosocial intervention condition and 303 (50%) were assigned to the control condition. 510 (84%) of 608 men completed an assessment at 4 months after randomisation, 483 (79%) at 8 months, and 515 (85%) at 12 months. 512 (99%) of 515 men had STI data from the 12-month assessment. The intervention condition had a 56% larger reduction in condomless anal sex acts (95% CI 35-71; p<0·0001) from baseline to 4-month follow-up, 72% larger reduction (56-82; p<0·0001) from baseline to 8-month follow-up, and 72% larger reduction (53-83; p<0·0001) from baseline to 12-month follow-up, compared with the standard-of-care control condition (condition by time interaction; χ2=40·29, 3 df; p<0·0001). Improvements in self-esteem and depressive symptoms both mediated 9% of the intervention effect on condomless anal sex acts. Bacterial STI incidence did not differ between study conditions at 12-month follow-up.

INTERPRETATION

A resilience-based psychosocial intervention for MSM at risk of HIV acquisition or transmission in India was efficacious in reducing condomless anal sex acts, with evidence for mediation effects in two key target resilience variables. HIV prevention programmes for MSM in India should address mental health resilience to augment reductions in the risk of sexually transmitted HIV.

FUNDING

National Institute of Mental Health.

Community-Based Resistance Strategies among a Group of Trans Women in Lima, Peru during the COVID-19 Pandemic

This study explores the community-based strategies that a group of trans women living in Lima, Peru, employed to resist the negative impact of the COVID-19 pandemic on their wellbeing. Data was collected through participant observation and focus group discussions during the implementation of a social aid campaign targeted to this population and analyzed through reflexive theoretical thematic analysis. Resistance strategies were understood as forms of social capital grounded in relations of support and connectedness. Results underscored the importance of social cohesion to ameliorate increasing levels of precarity, community leaders as key for linking trans women across different networks, and unified efforts of social groups who share values to influence institutional power. The analysis also captured barriers and challenges that could hinder the development and articulation of social capital. Fostering trust relations and community-organization should be fundamental components for advocacy programs that seek to support the trans women community.

Associations Between Physical Distancing and Mental Health, Sexual Health and Technology Use Among Gay, Bisexual and Other Men Who Have Sex With Men During the COVID-19 Pandemic

Physical distancing measures, designed to limit the spread of COVID-19, have been implemented globally. We sought to understand how physical distancing impacts gay, bisexual and other men who have sex with men (GBMSM), a group disproportionately affected by poor health outcomes. A cross-sectional online survey on Hornet, a networking application (N = 10,079), measured sociodemographics, physical distancing, mental health outcomes, and sexual behavior. Nearly two-thirds of participants (63%) reported only leaving their home for essentials. Those who practiced physical distancing were more likely to feel anxious (aOR = 1.37), feel lonely (aOR = 1.36), to report their sex life being impacted (aOR = 2.95), and less likely to be satisfied with their current sex life (aOR = 0.76). Those who practiced physical distancing were more likely to use social technologies to stay in touch with others. Risk reduction and telehealth opportunities may alleviate health challenges for GBMSM in the COVID-19 era.

The Spatial Impacts of COVID-19 Restrictions on LGBTIQ Wellbeing, Visibility, and Belonging in Tasmania, Australia

International emergency management and disaster risk reduction policies and planning have rarely included lesbian, gay, bisexual, transgender, intersex, and queer (LGBTIQ) people's specific health and wellbeing concerns, despite increasing research showing that these groups face some specific vulnerabilities and additional challenges. Emerging studies in the US and UK noted increased feelings of loneliness, minority stress, and vulnerability to family violence since the outbreak of COVID-19. However, little is known about LGBTIQ people's experiences of COVID-19 in Australia. This article explores the effects of COVID-19 on LGBTIQ mental health and wellbeing in Tasmania, Australia. Drawing on a survey of 231 LGBTIQ respondents aged 14-78, we use the spaces of wellbeing framework to examine the impacts of COVID-19 restrictions on LGBTIQ (in)visibility in relation to the public, private, and online spaces, arguing that COVID-19 restrictions affected LGBTIQ Tasmanians' experiences and use of spaces in ways that detracted from wellbeing, visibility, and belonging.

The persistent and evolving HIV epidemic in American men who have sex with men

Men who have sex with men (MSM) in the USA were the first population to be identified with AIDS and continue to be at very high risk of HIV acquisition. We did a systematic literature search to identify the factors that explain the reasons for the ongoing epidemic in this population, using a social-ecological perspective. Common features of the HIV epidemic in American MSM include role versatility and biological, individual, and social and structural factors. The high-prevalence networks of some racial and ethnic minority men are further concentrated because of assortative mixing, adverse life experiences (including high rates of incarceration), and avoidant behaviour because of negative interactions with the health-care system. Young MSM have additional risks for HIV because their impulse control is less developed and they are less familiar with serostatus and other risk mitigation discussions. They might benefit from prevention efforts that use digital technologies, which they often use to meet partners and obtain health-related information. Older MSM remain at risk of HIV and are the largest population of US residents with chronic HIV, requiring culturally responsive programmes that address longer-term comorbidities. Transgender MSM are an understudied population, but emerging data suggest that some are at great risk of HIV and require specifically tailored information on HIV prevention. In the current era of pre-exposure prophylaxis and the undetectable equals untransmittable campaign, training of health-care providers to create culturally competent programmes for all MSM is crucial, since the use of antiretrovirals is foundational to optimising HIV care and prevention. Effective control of the HIV epidemic among all American MSM will require scaling up programmes that address their common vulnerabilities, but are sufficiently nuanced to address the specific sociocultural, structural, and behavioural issues of diverse subgroups.

Nonsuicidal self-injury, suicide ideation, and suicide attempts among sexual minority children

OBJECTIVES

Sexual minority adolescents have previously been found to experience disparities in self-injurious thoughts and behaviors (SITBs) compared to heterosexual adolescents. However, there is a paucity of data on SITBs amongst children. Thus, the aim of the current study is to assess the prevalence of SITBs in a large sample of U.S. children and to test whether rates vary by sexual orientation.

METHODS

Data were drawn from the 2.0 baseline release of the Adolescent Brain Cognitive Development (ABCD) study. The full sample included 11,777_raw 9-10-year-old children (sexual minority n = 150_raw). Children completed a computerized version of the youth Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS-5), including items assessing suicide ideation, suicide attempts, and nonsuicidal self-injury (NSSI). Unadjusted and adjusted models compared the prevalence of outcomes by sexual orientation. Models also compared the co-occurrence of NSSI and suicide ideation by sexual orientation.

RESULTS

Across all outcomes, sexual minority children reported elevated prevalence rates compared to heterosexual children, with odds ratios ranging from 4.4 to 6.5. Among children who reported NSSI, a greater proportion of sexual minority versus heterosexual children reported co-occurring suicide ideation (OR = 3.8).

CONCLUSIONS

In a large sample of 9-10-year-old U.S. children, sexual orientation disparities emerged across NSSI, suicide ideation, and suicide attempts. Results indicate that sexual minority children are a vulnerable population for SITBs. Inclusion of children in prevention programs is encouraged. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Minority stress, distress, and suicide attempts in three cohorts of sexual minority adults: A U.S. probability sample

During the past 50 years, there have been marked improvement in the social and legal environment of sexual minorities in the United States. Minority stress theory predicts that health of sexual minorities is predicated on the social environment. As the social environment improves, exposure to stress would decline and health outcomes would improve. We assessed how stress, identity, connectedness with the LGBT community, and psychological distress and suicide behavior varied across three distinct cohorts of sexual minority people in the United States. Using a national probability sample recruited in 2016 and 2017, we assessed three a priori defined cohorts of sexual minorities we labeled the pride (born 1956-1963), visibility (born 1974-1981), and equality (born 1990-1997) cohorts. We found significant and impressive cohort differences in coming out milestones, with members of the younger cohort coming out much earlier than members of the two older cohorts. But we found no signs that the improved social environment attenuated their exposure to minority stressors-both distal stressors, such as violence and discrimination, and proximal stressors, such as internalized homophobia and expectations of rejection. Psychological distress and suicide behavior also were not improved, and indeed were worse for the younger than the older cohorts. These findings suggest that changes in the social environment had limited impact on stress processes and mental health for sexual minority people. They speak to the endurance of cultural ideologies such as homophobia and heterosexism and accompanying rejection of and violence toward sexual minorities.