Multiple Minority Stress and LGBT Community Resilience among Sexual Minority Men

Piloting a Flexible Solicited Diary Study With Marginalized Latina Women During the COVID-19 Pandemic

Little is known about the experiences of minority stress among Latina women who have sex with both women and men (WSWM), a sexual and gender minority group situated at the intersection of multiple marginalized identities. The current article presents an exploratory study aimed at addressing this knowledge gap. The research utilized a flexible diary-interview method (DIM) to investigate stress-related experiences among Mexican American WSWM residing in an economically disadvantaged community in the U.S. during the third wave of the COVID-19 pandemic. A detailed description of the study is provided, including information on the background, methodology, participants' experiences, and how the project was managed remotely by a virtual research team. Twenty-one participants were asked to maintain a diary for a 6-week period spanning from March to September 2021. They submitted weekly entries in diverse formats (visual, audio, typed, and handwritten) through a user-friendly website or via mail while communicating regularly with researchers over the phone. Following the diarizing period, in-depth semi-structured interviews were conducted to clarify pertinent information within the entries and validate researchers' preliminary interpretations. Out of the initial 21 enrollees, 14 participants stopped diarizing at different stages, and nine completed the entire study. Despite facing challenges exacerbated by the pandemic, participants reported the diary-keeping process as a positive experience that offered an authentic outlet to share parts of their lives they seldom reveal. The implementation of this study highlights two significant methodological insights. Firstly, it emphasizes the value of employing a DIM to explore intersectional narratives. Secondly, it underscores the importance of adopting a flexible and sensitive approach in qualitative health research, particularly when engaging individuals from minoritized groups.

Exploring the intersectionality of stigma and substance use help-seeking behaviours among lesbian, gay, bisexual, transgender, queer, questioning or otherwise gender or sexuality minority (LGBTQ+) individuals in the United States: A scoping review

Problematic substance use (SU) is a significant issue among LGBTQ+ individuals, but rates of treatment/help-seeking in this population remain low. This review aimed to investigate literature about intersectional stigma of SU and LGBTQ+ identity and its impact on SU help-seeking behaviours in the U.S. Eligible studies from eight-database were included if peer-reviewed, in English, from the U.S., published between 2000 and 2022, focused on SU, stigma, SU help-seeking behaviours, among LGBTQ+ adults. Of 458 search results, 50 underwent full-text review, 12 were included in the final sample. Minority Stress Theory emerged as a relevant theoretical framework. Findings revealed that increased SU as a coping strategy was associated with minority stress. Intersectional stigma negatively impacted SU treatment experience among LGBTQ+ individuals, leading to avoidance of help-seeking or poor treatment outcomes. Patterns of SU and impact of stigma among LGBTQ+ individuals differ, wherein bisexual and transgender individuals reported significantly more treatment barriers and unique stressors. LGBTQ+ individuals reported earlier age of SU onset and were more likely to encounter opportunities for SU. This review highlights the impact of intersectional stigma on SU help-seeking behaviour among LGBTQ+ individuals in the U.S. Recommendations are provided for future clinical practice, research, and policy to better support LGBTQ+ individuals.

Experiences of COVID-19 among Chinese-speaking lesbian, gay and bisexual people in Hong Kong: an inductive thematic analysis of survey response data

As social inequalities during the COVID-19 pandemic have been recognised, emerging research showed that lesbian, gay and bisexual (LGB) people may be additionally affected during the pandemic. This paper adds to the understanding of the experiences of LGB people during the pandemic with a focus on Hong Kong, where issues of space significantly influence LGB people’s lives in this city with high population density. As part of a larger community study of LGB lives in Hong Kong, COVID-19-related impact on 434 Chinese-speaking LGB people was explored. Data collection was conducted from 20 May to 30 June 2020. Inductive thematic analysis of the open-text response survey data found that the LGB participants described both negative and positive impacts brought by COVID-19. Such impacts could be dimensionalised into those related to personal space and privacy, romantic and sexual space, and community space. It was also found that the experiences of COVID-19 among LGB people in Hong Kong were intersectional, along the lines of living arrangement and relationship status. Such findings make unique contributions to the emerging literature. First, there needs to be a more nuanced understanding of sexual minority individuals’ experiences during COVID-19 across cultural contexts. Second, COVID-19 was described as having brought positive impact in addition to its widely known negative impact.

Outness, Discrimination, and Psychological Distress Among LGBTQ+ People Living in the Southern United States

Purpose: Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) people face mental health disparities. These disparities are amplified in the Southern regions of the United States. This study assessed the role of outness, discrimination, and other demographic variables on possible serious mental illness (SMI) among LGBTQ+ Southerners. Methods: This study used data from the 2017 LGBT Institute Southern Survey, a cross-sectional convenience sample of 6502 LGBTQ+ adults living in 14 Southern states. Multivariable logistic regression was performed to examine differences between those with and without possible SMI. Results: Outness was associated with a lower likelihood of possible SMI (odds ratio [OR]: 0.696, 95% confidence interval [CI]: 0.574-0.844, p = 0.001), especially when controlling for discrimination in the past 12 months (OR: 0.693, 95% CI: 0.576-0.834, p ≤ 0.001) and lifetime discrimination (OR: 0.678, 95% CI: 0.554-0.829, p = 0.001). Lifetime discrimination was associated with a higher likelihood of possible SMI (OR: 1.413, 95% CI: 1.034-1.932, p = 0.033), as was discrimination experienced in the past 12 months (OR: 1.626, 95% CI: 1.408-1.877, p ≤ 0.001). Black/African American respondents had the lowest percentage of possible SMI (21.0%) compared with other races, despite having lower or comparable rates of outness. Conclusion: These results indicate a possible promotive effect of outness against possible SMI among LGBTQ+ Southerners, as well as possible promotive group-level factors among Black/African American LGBTQ+ Southerners. Policies and interventions that address discrimination against LGBTQ+ Southerners should be expanded, and future research should address how the relationships between outness, discrimination, and mental health outcomes may vary by subgroup.

A conditional embrace-Swedish LGBTQ+ spaces through the eyes of ethnic minority non-heterosexual individuals

Introduction

In research on sexuality, marginalized sub-groups within sexual minorities have often been overlooked. From the vantage point of Sweden, internationally ranked as an exemplary progressive nation in equality issues and LGBTQ+ rights, and with an increasingly diversified population, the lived experiences of ethnic minority non-heterosexual people are still very much lacking in voice and visibility. The present study aimed to examine experiences within Swedish non-heterosexual spaces, held by ethnic minority non-heterosexual individuals.

Method

A thematic analysis of in-depth interviews with 22 Swedish non-heterosexual individuals, 13 cis-men and nine cis-women, with diverse first- and second-generation immigration backgrounds, was conducted.

Results

Two main themes were identified. The first theme, "Constantly contested identities," is composed of the sub-themes "Ingrained, intersecting ideals" and "Prejudiced spaces," and the second theme, "Effects and counteractions," of the sub-themes "Never fully human" and "Representation and separatism." The results, presented starting from a more theoretical level, moving to situated knowledge, and finally to psychological and practical implications, demonstrate that ethnic minority non-heterosexual people experience problematic and intersecting ideals, with related discrimination, in various Swedish non-heterosexual settings. Experiences of alienation, exotification, and tokenism were common among the participants and had negative psychological effects, including multiple-minority stress and a constant outsider feeling. Representation and participation in separatist forums were utilized as primary strategies to counteract the negative effects.

Discussion

The findings shed light on previously under-researched ideals and actions within Swedish LGBTQ+ spaces, and raises questions about how positive belonging can be achieved for multiple-minorities. Further research and continued critical discussions about ethnic minority non-heterosexual people's plight within non-heterosexual settings in Sweden, and beyond, is advocated.

Alday A, Jay J. Aurellano A, Raven R. Escala S, Ermelo V. Hernandez P, Esrom P. Matienzo J, Marian R. Panaguiton K, Charmaine C. Tan A, Zsila Á. Minority Stressors and Attitudes Toward Intimate Partner Violence Among Lesbian and Gay Individuals

Sexual minority individuals experience more intimate partner violence (IPV) than those in heterosexual relationships. Issues of mistrust, stigma, and anticipation of abuse contribute to these rates. Lesbian and gay IPV victims have distinct experiences from their abuses with exposure to homophobia, heterosexism, discrimination, and threats of sexual disclosure, among others. These unique and additive minority stressors can lead to adverse health concerns, increase vulnerability to victimization, and elevate abuse perpetration. This study aimed to investigate whether experiences of minority stressors are associated with attitudes toward intimate partner violence among a sample of 240 lesbian and gay Filipinos (155 lesbian and 85 gay participants) aged 20 to 40. Through convenience sampling, lesbian and gay Filipinos completed the Sexual Minority Stress Scale (SMSS) and Intimate Partner Violence Attitude Scale-Revised (IPVAS-Revised). Comparing the minority stressors levels among the participants, lesbians expressed higher expectations of rejection, while gay men experienced more sexual minority adverse events. Lesbians also reported higher satisfaction with outness. Regarding IPV, gay men expressed slightly more favorable attitudes toward abuse, which could make them at risk of becoming victims or perpetrators. Internalized homophobia was associated with more favorable attitudes toward abuse and control, indicating its contribution to more favorable IPV attitudes, although the explanatory power was modest.

Discrimination, identity connectedness and tobacco use in a sample of sexual and gender minority young adults

INTRODUCTION

Studies show that tobacco use among sexual and gender minority (SGM) populations is disproportionately higher than heterosexual or cisgender populations. However, few studies have examined tobacco use among SGM subgroups by race/ethnicity or associations between SGM-specific discrimination and connection to SGM identity and tobacco use.

METHODS

This study analysed survey data from 11 313 SGM (gay, lesbian, bisexual, other sexual minority or gender minority) young adults in the USA and reported current cigarette, e-cigarette, other tobacco (cigar, smokeless tobacco, hookah) and polytobacco use. We used multinomial logistic regression to estimate associations between (a) SGM subgroup, race/ethnicity, SGM-specific discrimination and SGM identity connection and (b) each tobacco use outcome (vs never use of tobacco). We conducted postestimation testing to assess predicted probabilities of tobacco use against the sample average.

RESULTS

Lesbian females (particularly black lesbian females) had higher-than-average probability of polytobacco use. White bisexual and lesbian participants had higher-than-average probability of cigarette and e-cigarette use, respectively. Higher levels of discrimination were associated with polytobacco use. Higher levels of identity connectedness were protective against certain tobacco use behaviours among gender minority participants and participants with high levels of discrimination experience.

CONCLUSIONS

We found variations in tobacco use by SGM subgroups overall and by race/ethnicity. Discrimination may be a risk factor for certain tobacco use behaviours. However, SGM identity connectedness may be protective against tobacco use among gender minority individuals and individuals experiencing SGM-specific discrimination. These findings can inform targeted approaches to reach SGM subgroups at greater risk of tobacco use.

Toward an Understanding of the Experiences of Deaf Gay Men: An Interpretative Phenomenological Analysis to an Intersectional View

Similarities between developing a deaf identity and a sexual minority identity have been postulated upon the parallel experience of oppressed minority positions. Sign language interviews with eight deaf gay British men explored their intersectional understanding of deaf-gay lived experiences, analyzed through Interpretative Phenomenological Analysis. During their adolescence deaf gay men sometimes experienced being in a position where they were trying hard to be something they were not: oral and heterosexual for hearing non-signing others (including heterosexual members of their family of origin). Participants spoke of increasingly being drawn toward a welcoming signing cultural world that supported them against deaf minority stress. Coming out as gay presented not only potential family of origin difficulties, but also threatened connection with the deaf community, leaving participants intensely fearful of gay visibility and stigma. Self-fulfillment and community building was sought through positions that ranged from oralist-heteronormativity through to the deaf-gay community. Along the way these journeys included experiences of pride and success alongside those of struggle. Our findings extend research on intersectionality by presenting a distinct set of obstacles, caveats, and nuances to identity conjunction.

Psychosocial and Culturally-Specific Factors Related to Intimate Partner Violence Victimization among a Sample of Latino Sexual Minority Cis Men in the U.S

A growing body of research illustrates that sexual minority men (SMM) experience elevated rates of intimate partner violence (IPV) compared to heterosexual individuals. Researchers have examined the relationship between minority stress and IPV victimization among sexual minority men. A majority of the IPV research identifying risk factors associated with IPV victimization among SMM have sampled predominately non-Hispanic White SMM, while Latino SMM are consistently under-represented in IPV research. This study examines the associations between (1) co-occurring psychosocial factors (e.g., depression, anxiety, childhood sexual abuse, drug use, and problematic drinking) and (2) Latino-specific minority stress factors (e.g., U.S.-born, language, race/ethnic identities, and discrimination) on IPV victimization in a nationwide sample of Latino SMM. Data were collected from Latino SMM aged 18 or older, identified as cis-male, and in a romantic relationship with a cis-male partner (N = 530). The participants were recruited through social media and geo-location-based dating mobile applications. A majority (72%) of the sample reported IPV victimization in their lifetime. Specific to forms of IPV, more than half (51.9%) of the sample reported monitoring behaviors, while 49.6% reported emotional IPV, 45.1% reported physical IPV, 31.5% reported controlling behaviors, and 22.3% reported HIV-related IPV. In multivariable models, psychosocial and Latino-specific factors were associated with the increased likelihood of IPV victimization. Regarding Latino-specific factors, being born in the U.S. and race-based discrimination predicted IPV victimization. These findings highlight the extent to which minority stress elevates the risk of IPV for Latino SMM and point to the need to address social factors in IPV prevention services. Further, work on SMM IPV victimization tends to focus on the potential role of sexual orientation-related discrimination, whereas the current study points to the importance of race-based discrimination.

The Tsunamic Model of LGBTQ+ Deaths of Despair: A Systemic Review to Identify Risk Factors for Deaths of Despair Among LGBTQ+ People

The term Deaths of Despair (DOD) was introduced to capture the phenomenon of mortality associated with suicide, drug overdose, and alcoholic liver disease. The LGBTQ+ population consistently evidences disproportionately high rates of DOD. This study reviewed the literature on DOD within this community to create a conceptual model that identifies risk factors that work together to potentiate DOD in the LGBTQ+ community. Ten DOD-Related Factors were identified and used to create The Tsunamic Model of LGBTQ+ Deaths of Despair. DOD-Related Factors include: (1) Stigma, (2) Demographics, (3) Identity Development, (4) Internalized Homophobia, (5) Depression, (6) Victimization, (7) Isolation/Rejection, (8) Sensation Seeking, (9) Risky Behavior, and (10) Uninformed Care. Each factor is associated with increased risk for DOD among the LGBTQ+ community. This model can help health professionals by providing a framework for prevention and early intervention programs.

Moderating Effect of Community and Individual Resilience on Structural Stigma and Suicidal Ideation among Sexual and Gender Minority Adults in the United States

BACKGROUND

Structural stigma in the form of discriminatory laws and policies impacts the mental health of sexual and gender minorities, especially with regard to suicidality. However, this relationship could be moderated by resilience. The past two years has brought anti-SGM legislation, particularly transgender sports bans, at the state level in the United States into focus. This study aims to understand if the relationship between familiarity with transgender sports bans (proposed or enacted) and suicidality was moderated by individual or community resilience.

METHODS

This was a cross-sectional study of survey data collected from a national sample of 1033 SGM adults in the United States between 28 January and 7 February 2022. Univariate and multivariate moderation analyses were used.

RESULTS

In the univariate analyses and the final model, community resilience moderated the relationship between structural stigma and suicidality (p = 0.0002); however, individual resilience did not (p = 0.0664).

CONCLUSION

Interventions to bolster community resilience may attenuate the negative mental health impacts of structural stigma and are warranted, along with concerted efforts to minimize structural stigma in the form of discriminatory laws and policies targeting people who are SGM.

At-School Victimization and Alcohol Use Among Minoritized U.S. Youth, 2009-2017

INTRODUCTION

Sexual minority and/or racial/ethnic minority youth may use alcohol at school as a form of minority stress-based coping. Polyvictimization is particularly prevalent among sexual minority and/or racial/ethnic minority youth and may be a useful proxy measure for minority stressors.

METHODS

Data from local administrations of the Youth Risk Behavior Survey were pooled across 42 jurisdiction years (biennially, 2009-2017) and analyzed in 2022, resulting in a sample of 118,052 U.S. youth. The prevalence of alcohol use at school was examined by sexual identity, race/ethnicity, and their intersections, stratified by sex. Multivariable logistic regression models were built to examine the disparities in alcohol use at school and the impact of school-based polyvictimization.

RESULTS

At the intersections of race/ethnicity and sexual identity, 25 of 30 sexual minority and/or racial/ethnic minority subpopulations had greater odds of alcohol use at school than their White heterosexual same-sex peers. Hispanic/Latinx not-sure males (AOR=9.15; 95% CI=5.97, 14.03) and Hispanic/Latinx lesbian females (AOR=11.24; 95% CI=6.40, 19.77) were most likely to report alcohol use at school. After adjusting for polyvictimization, the magnitude of association was attenuated for most sexual minority and/or racial/ethnic minority subpopulations; however, all but 2 significant associations remained.

CONCLUSIONS

Sexual minority and/or racial/ethnic minority youth were more likely than White heterosexual peers to use alcohol at school, with the greatest odds among multiply marginalized and polyvictimized youth. Interventions should consider addressing more than school-based victimization alone because disparities persisted, although at a lower magnitude, after accounting for polyvictimization. Future longitudinal studies are warranted to further explore the associations between multiply marginalized identities, school-based polyvictimization, and alcohol use at school.

Suicidality, Sexual Orientation, and Race/Ethnicity: Results from a U.S. Representative Adolescent Sample

Objective: We examined sadness/hopelessness and suicide among racial/ethnic and sexual minority youth (SMY).Methods: 2017 Youth Risk Behavior Survey (YRBS) data on sadness/hopelessness and suicide were analyzed among White, Black, and Hispanic/Latino youth.Results: A main effect of sexual minority (SM) identity emerged for sadness/hopelessness, suicidal ideation, suicide plan, suicide attempts, and injurious attempts; SMY reported increased risk compared to their heterosexual peers. An interaction between Black race and SM identity emerged for sadness/hopelessness, suicidal ideation, and suicide plan; White SMY were at greater risk than Black SMY. A main effect of Black race on suicide attempts was found; Black youth reported increased risk of suicide attempts compared to White youth.Conclusions: Black SMY exhibited lower risk of sadness/hopelessness, suicide ideation, and suicide plans than their White SMY peers, whereas Black youth overall were more likely to report suicide attempts than their White peers.HIGHLIGHTSThere was an interaction of sexual minority identity and race (Black or White) for three outcomes.SM and Black identities were associated with higher risk for suicide attempts.Only SM identity was associated with increased risk of injurious suicide attempts.

Leveraging Resilience-supportive Strategies to Enhance Protective Factors in Young Sexual Minority Men: A Scoping Review of HIV Behavioral Interventions Implemented in High-income Countries

Behavioral HIV interventions focused on strengthening young sexual minority men's (SMM) internal (assets) and external (resources) protective factors are promising, yet their evaluation as resilience-supportive strategies to minimize or negate HIV-related risks remain understudied. The objective of this scoping review was to describe resilience-supportive intervention strategies that have been used to achieve desired HIV behavioral outcomes and to identify how these strategies have been evaluated using a resilience analytic framework. Our scoping review uncovered 271 peer-reviewed articles, of which 38 were eligible for inclusion based on our review criteria. The majority of interventions relied on social support strategies as their primary resilience-supportive strategy. A third of interventions reviewed analyzed their findings from a deficits-focused model, another third used compensatory resilience models, and the remaining interventions employed a hybrid (i.e., deficit and compensatory model) strategy. None of the interventions evaluated their intervention effects using a risk-protective model. From our synthesis regarding the current state of research around resilience-informed interventions, we propose strategies to inform the design of resilience-supportive approaches and make recommendations to move the field forward on how to develop, implement, and measure young SMM's resiliency processes.

It gets better with age: Resilience, stigma, and mental health among lesbian, gay, bisexual, transgender and queer persons from Poland

Lesbian, gay, bisexual, transgender, and queer populations are disproportionately affected by chronic stress associated with stigma which contributes to health adversities including depression. Negative impact of stigma on health can be alleviated by factors such as resilience. Little is known however on how exposure to stigma, protective factors and mental health change with age among gender and sexually diverse persons. Our study aimed at investigating this issue. Our sample consisted of (i) 245 sexually diverse cisgender women, (ii) 175 sexually diverse cisgender men, and (iii) 98 transgender and gender diverse persons. We collected data through a web-based survey. Linear regression models were performed to investigate the interactions of age and each group of participants for resilience, stigma exposure, and mental health indicators (depression and self-esteem). We hypothesized that resilience and mental health indicators will be positively associated with age in all distinguished groups despite the continued exposure to minority stress. The analysis yielded no significant relationships between stigma exposure and age among study participants. However, we observed significant interaction effects of distinguished groups of participants and age in case of self-esteem, depression, and resilience. Self-esteem and resilience were related positively, and depression was negatively associated with age in all study groups. Additionally, we observed that sexually diverse cisgender men demonstrated significantly increased resilience, reduced depression and higher self-esteem compared to other groups. Although the exposure to stigma did not decrease with age, resilience and self-esteem increased, suggesting that LGBTQ persons manage to thrive despite adversities.

Experiences of Community Resilience and Inequity among LGBTQ+ People: A Person-Centered Analysis

A diverse sample of LGBTQ+ people ( N = 527) was recruited to explore sexual and gender diverse peoples’ co-occurring experiences with community resilience resources and inequity within the LGBTQ+ community. Using latent profile analysis, four distinctive latent profiles emerged: Marginalized, Ambivalent, Disengaged, and Embedded. Beta regression analyses suggested that identity centrality played a pivotal role in a participants’ membership to a given profile. Additionally, plurisexual and gender diverse identities may be associated with less likelihood of membership in profiles that were high in LGBTQ+ community resilience resources. Profile membership was also associated with mental health, internalized minority stress, and LGBTQ+ identity affirmation. The present study assists in expanding the understanding of co-occurring processes (i.e., community resilience resources and inequity within the LGBTQ+ community) and how they link to mental health, internalized minority stress, and positive LGBTQ+ identity outcomes for sexual and gender diverse people. We discuss implications for practice, education, training, and research.

What does community resilience mean in the context of trauma-informed communities? A scoping review

Several communities are implementing trauma-informed, community-level approaches focused on addressing/preventing adverse childhood experiences (ACEs), yet most community resilience definitions from published articles are based on acute traumas. This scoping review aims to determine how community resilience is defined and operationalized within the context of chronic/complex traumas.

METHODS

We performed a rigorous, comprehensive literature search using multiple databases.

RESULTS

The 38 included articles addressed multiple types of chronic traumas, including historical trauma, poverty, minority stress, mass incarceration, and ACEs. A variety of definitions of community resilience were cited, several of which stressed the ability to thrive despite risk factors and the safety and wellbeing of residents. Few articles operationalized community resilience within the context of ACEs, suggesting significant gaps in the literature.

CONCLUSION

This review can serve as an important building block to develop expanded definitions of community resilience for chronic traumas and assist communities in promoting community-wide responses to ACEs.

Mental Health and Life Satisfaction on Chilean Gay Men and Lesbian Women: The Role of Perceived Sexual Stigma, Internalized Homophobia, and Community Connectedness

The Minority Stress Model has proposed that connectedness to a specific minority community may be a protective factor for stigmatized groups. This study evaluated the mediational role of connectedness with the gay men's and lesbian women's community on the relationship between two minority stressors (internalized homophobia and perceived sexual stigma) with anxiety-depressive symptomatology and life satisfaction. The sample consisted of 467 Chilean self-identified as gay men (57%) and lesbian women (43%). Results revealed that the two minority stressors were associated with anxiety-depressive symptomatology, but only internalized homophobia was associated with life satisfaction. The mediation hypothesis was partially supported by the relationship between internalized homophobia and life satisfaction. Unexpectedly, we found a negative association between connectedness with the gay men's and lesbian women's community and life satisfaction. This finding introduces a view that contrasts with the literature, which proposes that connectedness with the specific community would be a protective factor against sexual stigma.

Minority stress theory applied to conception, pregnancy, and pregnancy loss: A qualitative study examining LGBTQ+ people’s experiences

Many lesbian, gay, bisexual, transgender (trans), queer, and other sexual and gender minority (LGBTQ+) people desire to conceive children. Yet, LGBTQ+ peoples’ experiences are scant in reproductive health literature, particularly around pregnancy loss—a stigmatized and distressing pregnancy outcome. Informed by minority stress theory, this qualitative study aimed to explore the experiences of multi-level stigma and resilience among LGBTQ+ people in the context of conception, pregnancy, and loss. Seventeen semi-structured individual interviews (25–70 minutes) were conducted (2019) with a purposive sample of LGBTQ+ people in the United States (U.S.) who had experienced pregnancy loss (n = 14) or in an intimate partnership in which a pregnancy was lost (n = 3) in the last two years. Transcribed interviews were analyzed thematically. Participants described the profound sadness of pregnancy loss due to unique challenges of LGBTQ+ conception. Multiple types of stigma manifested at intrapersonal (e.g., anticipated sexual stigma upon disclosure), interpersonal (e.g., unsolicited advice about conception decisions), and structural levels (e.g., differential requirements to access conception compared to heterosexual/cisgender couples). Resilience was also seen individually (e.g., purposeful disclosure of conception, pregnancy, and loss), relationally (e.g., connecting with other LGBTQ+ community members), and collectively (e.g., creating/engaging in LGBTQ+-specific conception, pregnancy, and loss online spaces). LGBTQ+ people experience minority stressors of multi-level stigmatization throughout the pregnancy process, which limits their access to social support after experiencing pregnancy loss. However, individual, relational, and collective resilience strategies abound in response. Thus, minority stress theory can also be applied to recognize strengths-based and affirming approaches to reproductive healthcare for LGBTQ+ people.

"White, Tall, Top, Masculine, Muscular": Narratives of Intracommunity Stigma in Young Sexual Minority Men's Experience on Mobile Apps

What forms of intracommunity stigma do young sexual minority men narrate as they participate in communities through mobile apps? In a content analysis of 32 interviews with a racially diverse sample of young sexual minority men (ages 19-25; 84.4% non-White) from four regions of the USA, a majority of men (62.5%) spontaneously discussed mobile apps (e.g., Grindr, Scruff) when asked about their experience of community more broadly. Men's narratives revealed engagement with intracommunity stigma related to body size, race/ethnicity, gender expression, and sexual position (e.g., bottom). Stigma related to HIV status, substance use, and social class were not spontaneously narrated in response to questions about men's experience in communities. Expressions of stigma were frequently experienced intersectionally, particularly regarding racialized stereotype expectations (e.g., "Asian men are twinks, effeminate"). We discuss the ways in which sexual minority men reproduce dominant ideologies related to racism, misogyny, and masculine body ideals as they engage with one another on mobile apps. To the extent that many young men rely on mobile apps for community connection, their experiences of community might serve to exacerbate, rather than ameliorate, the deleterious impact of stigma.

The effects of gender identity change efforts on Black, Latinx, and White transgender and gender nonbinary adults: Implications for ethical clinical practice

Gender identity change efforts (GICE) and sexual orientation change efforts (SOCE) continue to be practiced by mental health professionals and religious organizations. It is frequently sought out by families who are rejecting loved ones with marginalized sexual orientations and gender identities. This study explored the impact of religious and nonreligious GICE on the mental health of transgender and nonbinary adults through a secondary data analysis of the U.S. Transgender Survey. Results found that both nonreligious and religious GICE were associated with increased odds of suicidal ideation and attempts. Only nonreligious GICE was associated with severe psychological distress. Black individuals showed increased odds of binge alcohol consumption when exposed to nonreligious change efforts, while White individuals showed decreased odds with both nonreligious and religious GICE. This study supports ethical and legal bans on GICE.

Differences in the age-varying association of school belonging with socioemotional flourishing among minority and non-minority college and university students

Objective: This study aimed to assess the age-varying prevalence of and association between school belonging and flourishing among sexual or gender minority (SGM) and racial or ethnic minority (REM) students compared with non-minority students in the U.S. college setting. Participants: Data were drawn from a 2017-2018 national survey of U.S. college and university students ages 18-26. Method: Data were examined using varying-coefficients models to estimate the relation of school belonging and flourishing across ages 18-26. Results: SGM students (n = 6,718) and REM students (n = 10,539) reported significantly lower belonging and flourishing than cisgender heterosexual students (n = 19,492) and white students (n = 16,444), respectively, at several age points. The association of belonging with flourishing was significantly greater for SGM students than for cisgender heterosexual students across all ages. Conclusions: Findings of this study underline the important role of school belonging in socioemotional flourishing for SGM young adults.

Rethinking minority stress: A social safety perspective on the health effects of stigma in sexually-diverse and gender-diverse populations

For over two decades, the minority stress model has guided research on the health of sexually-diverse individuals (those who are not exclusively heterosexual) and gender-diverse individuals (those whose gender identity/expression differs from their birth-assigned sex/gender). According to this model, the cumulative stress caused by stigma and social marginalization fosters stress-related health problems. Yet studies linking minority stress to physical health outcomes have yielded mixed results, suggesting that something is missing from our understanding of stigma and health. Social safety may be the missing piece. Social safety refers to reliable social connection, inclusion, and protection, which are core human needs that are imperiled by stigma. The absence of social safety is just as health-consequential for stigmatized individuals as the presence of minority stress, because the chronic threat-vigilance fostered by insufficient safety has negative long-term effects on cognitive, emotional, and immunological functioning, even when exposure to minority stress is low. We argue that insufficient social safety is a primary cause of stigma-related health disparities and a key target for intervention.

Discomfort in LGBT Community and Psychological Wellbeing for LGBT Asian Americans: The Moderating Role of Racial/Ethnic Identity Importance

While past research has examined the deleterious effects of racism on Asian Americans, fewer studies have investigated lesbian, gay, bisexual, and transgender (LGBT) Asian Americans' unique experiences of oppression and unbelonging within the broader LGBT community. Guided by intersectionality and minority stress theoretical frameworks, the present study examined the effect of discomfort due to one's race/ethnicity within the LBGT community on psychological wellbeing in a national sample of 480 LGBT Asian Americans from the Social Justice Sexuality Project. The moderating role of how important one considered their race/ethnicity to their identity was also examined. Regression analyses revealed that greater discomfort due to one's race/ethnicity within the LGBT community was associated with reduced psychological wellbeing for LGBT Asian Americans who viewed their racial/ethnic identity as moderately or highly important, whereas this association was not significant for LGBT Asian Americans who considered their racial/ethnic identity as less important. These findings highlight the necessity of examining the role of racial/ethnic discomfort in relation to LGBT Asian Americans' psychological wellbeing, as well as the extent to which LGBT Asian Americans consider their race/ethnicity as important.

Spanish youth at the crossroads of gender and sexuality during the COVID-19 pandemic

This study examines some of the perceptions amongst Spanish LGBTQ+ youth during the first wave of the COVID-19 pandemic and the subsequent confinement and lockdown measures, between March and May 2020. During this time, many of these young people were forced to return to their family homes and restrict their social relations. This new situation often exposed them to forms of violence from which there was no escape, with negative consequences for their psychosocial health. The study evaluates the correlations between perceived social support, burdensomeness, thwarted belongingness and the people with whom LGBTQ+ youth lived during confinement. A descriptive and multivariate analysis of variance (MANOVA) and bivariate correlations is used to examine the responses of 394 LGBTQ+ youth, between 17 and 21 years of age, residing in Spain. Overall, the study finds that gender is key when explaining the differences between the experiences of LGBTQ+ youth, with women and non-binary individuals experiencing a greater perception of stigma in the places where they lived during the lockdown. Moreover, trans men and women and non-binary individuals reported receiving less support and a greater feeling of burdensomeness then the other participants. These results suggest that LGBTQ+ youth must be given special consideration during times of crisis, like the COVID-19 pandemic, and may benefit from intervention with an intersectional and transfeminist perspective.

Bisexual+ visibility attempts: Associations with minority stress, affect, and substance use in a daily diary study

The efforts of bisexual+ people to make their sexual orientation visible are associated with positive and negative outcomes, but little is known about the temporality or directionality of these associations. Using data from a 28-day diary study with 208 bi+ individuals, we found that bi+ visibility attempts were concurrently associated with more positive affect, higher identity affirmation, less depressed/anxious affect, as well as more anti-bisexual experiences and rejection sensitivity. Prospectively, the likelihood of consuming alcohol (but not marijuana) was higher the day after making a visibility attempt, and positive affect was higher the day before making an attempt. Making visibility attempts in contexts that may have been more supportive (e.g., with friends, partners, and lesbian/gay individuals) was associated with more positive outcomes (e.g., more positive affect), while making attempts in contexts that may have been less supportive (e.g., with family, strangers, people who are unaccepting of bi+ identities, and heterosexual people) was associated with more negative outcomes (e.g., higher rejection sensitivity and more discrimination). These findings suggest that the contexts in which visibility attempts are made may play an important role in the impact that bi+ visibility attempts have on stigma-related stress and wellbeing.

Behavioral Outcomes of Children with Same-Sex Parents in The Netherlands

Same-sex parents face substantial stressors due to their sexual orientation, such as experiences of prejudice and prohibitive legal environments. This added stress is likely to lead to reduced physical and mental health in same-sex parents that, in turn, may translate into problematic behavioral outcomes in their children. To date, there are only a few nationally representative studies that investigate the well-being of children with same-sex parents. The current study takes a closer look at children’s behavioral outcomes, reported by a parent, using an adapted version of the emotional, conduct, hyperactivity, pro-social, and peer problems subscales of the Strengths and Difficulties Questionnaire (SDQ). We take advantage of unique data from the Netherlands based on a probability sample from population registers, whereby findings can be inferred to same-sex and different-sex parent households with parents between the ages of 30 and 65, and with children between the ages of 6 and 16 years (62 children with same-sex, and 72 children with different-sex parents). The findings obtained by coarsened exact matching suggest no significant disadvantages for children with same-sex parents compared to different-sex parents. We contextualize these findings in their wider cultural context, and recommend a renewed focus in future research away from deficit-driven comparisons.

Eudaimonic Well-Being for Lesbian and Bisexual Women: The Roles of Religion and Social Connectedness

Understanding how religion and well-being are related for lesbian and bisexual women provides important context for clinical interventions. Current literature in the field diverges on whether the relationship between religious commitment and well-being is positive for those in the queer community. The current study examines whether an independent or interdependent self-construal explains the relationship between religious commitment and eudaimonic well-being (EWB) for lesbian and bisexual women. This empirical study used data from the Multi-Site University Study on Identity and Culture, a research collaboration amongst 30 colleges and universities in the United States. Findings suggest that although self-construal does not mediate the relationship between religious commitment and well-being, there are significant effects between religious commitment and EWB as well as an independent self-construal and EWB. These findings provide a deeper understanding of variables associated with greater well-being and are important for the advancement of research and practice with queer women.

Black sexual minority women's social well-being and psychological distress

Black sexual minority women (SMW), the largest racial group among the sexual minority community, often report high psychological distress and decreased psychological health and social well-being. Strong, positive, social relationships positive within group identities, and support networks are a key component in coping with minority stressors and promoting overall well-being. This study explored the association between minority stressors, social support, and Black SMW's social well-being and psychological distress. Participants consisted of individuals identifying as Black (including biracial identities, n = 48) cisgender women (N = 149) who responded to the Generations Study's initial round of surveys collected in 2016-2017. Participants were between the ages of 18-60, with a mean of 29.3 years old. Descriptive and bivariate correlations were conducted for lesbian, gay, and bisexual (LGB) stigma, internalized homophobia, gender presentation, ethnic identity affiliation, LGB community connectedness, and social support. Multiple regression models were conducted to analyze correlates of social well-being and psychological distress, controlling for age and education level. LGB stigma and internalized homophobia were significant predictors of social well-being and psychological distress. Low internalized homophobia, distress, and stigma were associated with higher social well-being as were high connection to LGB and ethnic communities. Implications for therapy are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Racial/Ethnic Differences in Health-Related Quality of Life Among Gay and Bisexual Prostate Cancer Survivors

Introduction

Prostate cancer treatment has established effects on the health-related quality of life (HRQOL) of patients. While racial/ethnic differences in HRQOL have been explored in heterosexual patients, this is the first study to examine racial/ethnic differences in a cohort of sexual minority prostate cancer survivors.

Methods

We used data from the Restore-1 study, an online cross-sectional survey of sexual and gender minority (SGM) prostate cancer survivors in North America, to explore the association between race/ethnicity and HRQOL. General mental and physical HRQOL was assessed using the Short-Form Health Survey version 2 (SF-12). The frequency and distress of prostate cancer specific symptoms was assessed using the Expanded Prostate Cancer Composite (EPIC) scale. Multivariable linear regression was used to estimate mean differences in HRQOL between sexual minority men of color and their white, non-Hispanic counterparts after adjustment for pertinent demographic and medical characteristics.

Results

Among 190 participants, 23 (12%) self-identified as non-white and/or Hispanic. In unadjusted analysis, sexual minority men of color compared to their white counterparts reported worse HRQOL scores in the EPIC hormonal summary (73.8 vs. 81.8) and hormonal function (70.9 vs 80.5) domains. Clinically important differences between men of color and their white counterparts were seen in the EPIC bowel function (mean difference (MD): -4.5, 95% CI: -9.9, 0.8), hormonal summary (MD: -8.0, 95% CI: -15.6, -0.4), hormonal function (MD: -9.6, 95% CI: -17.6, -1.6), and hormonal bother (MD: -6.7, 95% CI: -14.4, 1.1) domains. After adjustment for covariates, clinically important differences persisted between men of color and white, non-Hispanic men on the hormonal summary (74.4 vs. 81.7), hormonal function (71.3 vs. 80.3), and hormonal bother (77.0 vs. 82.7) domains.

Conclusions

This exploratory study provides the first evidence that sexual minority men of color may have worse HRQOL outcomes compared to white, non-Hispanic sexual minority men following prostate cancer treatment.

Mental health and well-being of LGBTQ+ people during the COVID-19 pandemic

The COVID-19 pandemic has had a profound negative impact on the mental health of the general population. The COVID-19 pandemic and its related containment measures have increased structural disadvantages faced by marginalized communities, such as LGBTQ+ people. LGBTQ+ is an acronym used to identify lesbian, gay, bisexual, transgender and queer people plus all community members using different terms to describe their sexual orientation or gender identity. It is likely that the COVID-19 pandemic has exposed them to increased minority stress, which can also affect their physical health. Since the beginning of the pandemic, the few available studies on the mental health of LGBTQ+ have reported frequent worries about the future, negative emotions, and feelings of uncertainty. Moreover, they have faced further difficulties such as undertaking hormone therapy, accessing to health facilities or living with family members not accepting their condition. The COVID-19 pandemic has added a significant burden to the well-being of LGBTQ+ people, and therefore there is the need to provide them with dedicated supportive interventions in order to promote the early detection of mental health problems or of full-blown mental disorders.

Body Image Concerns, Correlates, and Community Connection Among Black and Latinx Sexual Minority Cisgender Men and Transgender/Gender Nonconforming Young Adults

AbstractPurpose: We extended the focus on body image research beyond cisgender, White sexual minority men (SMM) by describing body image concerns among Black and Latinx SMM and transgender/gender nonconforming (TGNC) adults and by examining protective effects of community connection. Methods: From 2016 to 2020, 447 Black and Latinx SMM (94%) and TGNC (6%) individuals in Los Angeles provided data semiannually. Participant endorsement of any body image concerns was determined by five body image codes (weight, fitness, appearance, body area dissatisfaction, and general body image) applied to participants' open-ended lists of health and body concerns. Fixed effects multivariable logistic regression was performed to examine the association between gay and racial/ethnic community connection and odds of any body image concerns, accounting for multiple records per person. An interaction term between gay and racial/ethnic community connection approximated the protective effect of connection to multiple, intersecting communities. Results: The majority of participants (51%) reported a body image concern, most commonly weight concerns, at least once across three years. Body image concerns were more common among Latinx participants (χ² = 17.79, p < 0.001) and participants experiencing food insecurity (χ² = 4.11, p = 0.04) and unmet basic financial needs (χ² = 10.56, p = 0.001). Gay community connection was protective against body image concerns, but only for participants who had high racial/ethnic community connection (adjusted odds ratio = 0.87, p = 0.05). Conclusion: Body image concerns were notable, especially among those with low community connection and higher socioeconomic burden. These findings suggest that building connections within SMM/TGNC and racial/ethnic communities may aid in building a support network that buffers against body image concerns.

Engagement in Care and Housing Instability Influence HIV Screening Among Transgender Individuals in South Florida

Purpose: HIV screening is a critical step in the HIV care continuum to lowering incidence and achieving viral load suppression among at-risk populations. Few studies assess factors associated with HIV screening among transgender individuals living in the southeast region of the United States. This study was conducted to determine factors that influence HIV screening among transgender individuals in South Florida. Methods: During Fall 2016, 68 participants were recruited to complete a questionnaire as part of a pilot pre-exposure prophylaxis study. Correlations were examined between sociodemographic factors, HIV risk, and access to and engagement in care. Significant correlations were entered into one logistic regression model to estimate predictors of HIV screening and knowledge of HIV status. Results: Almost half (48.5%) of the respondents were Latinx, 38.2% Black, 10.3% non-Latinx White, and 3% other. Seventy-eight percent reported access and routine engagement in care within the past year, 25% had not screened for HIV in the past year, and of those who knew their status, 16.7% reported living with HIV. Regression analysis revealed that participants with routine engagement in care were twice as likely to screen for HIV (p=0.02). Unstable housing was associated with no HIV screening in the past year (p=0.05). Conclusion: Stable housing is linked to engagement in routine care that can increase the likelihood of an at-risk transgender individual screening for HIV. Further research is needed to develop interventions to improve engagement in care among transgender individuals who do not have adequate housing or access to care.

Pre-Exposure Prophylaxis Interventions among Black Sexual Minority Men: A Systematic Literature Review

Background: Interventions to promote HIV pre-exposure prophylaxis (PrEP) among Black sexual minority men (BSMM) are especially important, given the disproportionate HIV incidence and relatively low uptake of PrEP among BSMM. Methods: We conducted a systematic literature review to identify the characteristics of interventions between 2016 and 2021 promoting PrEP use among BSMM. We synthesized these studies based on sample size, location, the use of peer-based delivery, and key intervention targets. Results: Of the starting total 198 articles, 10 were included in the final review, with the majority of included studies being randomized controlled trials. We identified providing PrEP access, PrEP counseling, HIV and PrEP education, linkage to general health care, and peer-based support as key successful intervention components. The starkest difference between interventions with and without demonstrated PrEP improvements was the outcome: all interventions focused on PrEP initiation led to large improvements, but those focused on PrEP adherence did not. No other factors demonstrated distinct differences between successful and unsuccessful interventions. Conclusion: We identified notable differences in intervention efficacy between PrEP initiation and PrEP adherence outcomes; PrEP adherence is necessary for optimal HIV prevention. Future interventions promoting and measuring PrEP adherence, with a focus on cultural competence and peer components, are recommended.

The Effect of Discrimination and Resilience on Depressive Symptoms among Middle-Aged and Older Men who have Sex with Men

This study investigated if homophobic and racist discrimination increased depressive symptoms among 960 middle-aged and older men who have sex with men (MSM) and how resilience moderated these relationships. We used five waves of longitudinal data from the Healthy Aging sub-study of the Multicenter AIDS Cohort Study (MACS). We used linear regression analyses to model depressive symptoms as a function of discrimination. We used linear mixed analyses to model changes in mean resilience scores across visits. We used linear regression analyses to model depressive symptoms as a function of changes in resilience and to test the moderation effects of resilience on the relationship between discrimination and depressive symptoms. The models accounted for repeated measures of resilience. Men who experienced external and internal homophobia had greater depressive symptoms (β: 2.08; 95% Confidence Interval: 0.65, 3.51; β: 1.60; 95% Confidence Interval: 0.76, 2.44). Men experienced significant changes in mean resilience levels across visits (F = 2.84, p = 0.02). Men with a greater positive change in resilience had lower depressive symptoms (β: -0.95; 95% Confidence Interval: -1.47, -0.43). Men with higher average resilience levels had lower depressive symptoms (β: -5.08; 95% Confidence Interval: -5.68, -4.49). Men's resilience did not moderate the relationship between homophobia and depressive symptoms. Significant associations of external and internal homophobia with greater depressive symptoms present targets for future research and interventions among middle-aged and older MSM. Significant associations of average and positive changes in resilience with lower depressive symptoms provide aims for future research and interventions with this population.

Psychological Issues among Spanish Adolescents and Young People when Coming out of the Closet to Their Families

Some social settings may make the process of 'coming out' more difficult for gay males and lesbian females, and the decision to do so may be even more problematic for adolescents and young people. As a result, some may choose to hide their sexual orientation, leading to emotional suffering. This study aims to analyse the differences in perceived stress, life satisfaction, happiness, and psychological distress experienced by both coming out and closeted young people and teens. The sample included a total of 228 Spanish young people aged 16-23 years old (M = 19.69, S.D. = 1.81) who identified themselves as gay or lesbian (73.2% women). The results of this study show that people in the closet show greater psychological distress (anxiety and depressive symptomatology) and perceived stress. Although perceived stress is positively related to psychological distress in both groups, the correlation is higher in the closeted group. This suggests that perceived stress has more serious consequences on the mental health of the closeted group than of the 'coming out' group. To sum up, the results show the importance of family support for gay and lesbian young people.

Latino sexual minority men's intersectional minority stress, general stress, and coping during COVID-19: A rapid qualitative study

Introduction

Sexual minority men face mental health, substance use, and HIV disparities, all of which can be understood by minority stress and intersectionality theories. With the emergence of COVID-19 and considering its disproportionate impact on Latinx and sexual minority communities, Latino sexual minority men (LSMM) may be facing unique consequences of this new pandemic that intersect with pre-COVID disparities. The purpose of the current study is to explore the impact of the COVID-19 pandemic on LSMM's intersectional minority stress, general stress, and coping, filling a gap in the current literature.

Methods

The current rapid qualitative study explores the impact of COVID-19 on LSMM in South Florida who reported being HIV-negative (N=10) or living with HIV (N=10).

Results

The rapid analysis revealed themes of exacerbated intersectional minority stress and general stress in the context of COVID-19, some of which was related to the impact of pre-COVID-19 disparities in the LSMM community. Participants reported a variety of coping responses, some of which participants found helpful and others (e.g., substance use) which further exacerbated disparities.

Conclusion

The findings underscore the need to scale up and disseminate behavioral health resources to LSMM to address the impact of the COVID-19 pandemic on this community's health and well-being.

Associations between minority stress, depression, and suicidal ideation and attempts in transgender and gender diverse (TGD) individuals: Systematic review and meta-analysis

Minority stress theory posits that transgender and gender diverse (TGD) individuals exhibit greater rates of depression and suicidality due to internal (proximal) and external (distal) stressors related to their TGD identity. Yet, the magnitude of the relationship between minority stress processes and mental health outcomes has not been quantitatively summarized. The current research meta-analyzed the relationship between minority stress constructs and depression, suicidal ideation, and suicide attempt. Results from 85 cross-sectional quantitative studies indicate that distal stress, expectations of rejection, internalized transphobia, and concealment are significantly associated with increased depression, suicidal ideation, and suicide attempt. Greater effect sizes were observed for expectations of rejection and internalized transphobia when compared to distal stress and concealment. Future research on the relationship between minority stress, depression, and suicide would benefit from longitudinal designs and more diverse and representative samples of TGD individuals.

Demographic and psychosocial factors associated with recent suicidal ideation and suicide attempts among lesbian, gay, bisexual, pansexual, queer, and asexual (LGBQ) people in Australia: Correlates of suicidality among LGBQ Australians

INTRODUCTION

To examine demographic and psychosocial correlates of suicidal ideation and suicide attempts among a large cross-section of sexual orientation populations in Australia, including lesbian, gay, bisexual, pansexual, queer, and asexual (LGBQ) people.

METHODS

A national survey was conducted involving 5,174 cisgender LGBQ participants aged 18+ years. Multivariable regressions identified factors associated with recent suicidal ideation and suicide attempts.

RESULTS

In all, 37.2% reported suicidal ideation and 3.9% a suicide attempt in the past 12 months. The likelihood of suicidal ideation was greater for those who identified as queer or felt treated unfairly or socially excluded due to their sexual orientation, and lower for those in a committed relationship, who felt part of LGBTIQ communities, or felt accepted in family, work, and health services. The likelihood of suicide attempts was greater for those aged younger or had recently experienced verbal abuse or social exclusion, and lower for those in a committed relationship or who felt part of LGBTIQ communities.

LIMITATIONS

Participants were recruited largely through paid Facebook advertising and the sample may therefore not be representative of all LGBQ adults in Australia. However, a representative population-level study would require the collection of population demographic data to provide the necessary and sexual identity is not included in the Australian Census.

CONCLUSION

These findings highlight an urgent need for supporting LGBQ people and may help inform tailored support services, including culturally-safe suicide prevention programs. These could involve peer support, trauma-informed counselling, supporting committed relationships, and addressing marginalization in the wider community.

Mental Health Symptoms Associated with Sexualized Drug Use (Chemsex) among Men Who Have Sex with Men: A Systematic Review

Background: Sexualized drug use (SDU), also known as chemsex, refers to the use of psychoactive substances for sexual purposes among men who have sex with men (MSM), which has been associated with mental health symptoms. The objective of this review is to systematically review the available evidence on mental health outcomes in MSM who use sexualized drugs. Methods: To prepare this systematic review, search strategies were developed and applied to the Web of Science, Science Direct, PubMed, and Scopus databases. A total of 117 articles were found, of which 12 were selected for the final review. Results: Those MSM who practiced SDU were more likely to experience from depression, anxiety, or a substance dependence, although these results were not found in all the studies analyzed. Among those who practiced the administration of intravenous drugs (referred to as slamsex), the mental health symptoms were more severe. Conclusions: This systematic review contributes to a fuller understanding of the mental health symptoms present in MSM who consume drugs for sexual purposes. Greater uniformity in data collection instruments is required, as well as the need to conduct a more in-depth assessment of the psychosocial adjustment of people who practice chemsex.

Multiple Minority Stress and Behavioral Health Among Young Black and Latino Sexual Minority Men

Purpose: Young Black and Latino sexual minority men may experience multiple minority stressors, which may negatively impact behavioral health. To investigate this, longitudinal associations between multiple minority stressors and behavioral health outcomes were examined over a 2-year period. Methods: Data were from the Healthy Young Men's Cohort Study. The present study used five waves of data collected every 6 months from 2016 to 2019. Participants were young Black and/or Latino sexual minority men in Los Angeles, California (n = 448; aged 16-24). Participants self-reported their experiences of racial and homonegative discrimination, internalized homonegativity, alcohol use, and depressive symptoms. Latent growth curve models with time-varying covariates examined contemporaneous associations between minority stressors as well as general life stress and behavioral health measures. Results: After accounting for general life stress and demographic characteristics, racial discrimination was persistently associated with unhealthy alcohol use. Internalized homonegativity was associated with unhealthy alcohol use initially, but this association became non-significant over time. In models predicting depressive symptoms, racial discrimination was a significant predictor at early waves, and homonegative discrimination and internalized homonegativity emerged as significant predictors at later waves. Conclusion: These results help clarify which multiple minority stressors are more prominent in their relationship to young Black and Latino sexual minority men's unhealthy alcohol use and depressive symptoms. Interventions targeting multiple minority stressors may be needed at different times during young adulthood.

Out of the Closet, Not Yet Out of the House: Gay Men's Experiences of Homonegativity and Internalized Homonegativity

This paper explores how Australian gay men experience gender and sexuality in relation to heteronormative gender norms, specifically masculinity. A sample of 32 gay men 22-72 years of age participated in an online interview, using a videoconferencing software, on masculinity and homosexuality. Thematic analyses revealed that gay men experience gender and sexuality-related strain across all levels of their socioecological environment through social regulation, homophobic discrimination/harassment, and anti-effeminacy prejudice. The gay men expressed feelings of self-loathing, shame, internalized homonegativity, and isolation as a result. In examining interactions at each level of the socioecological environment, future research and practice may gain understanding in the social phenomena and how to ameliorate such strain.

It Might Take Time: A Study on the Evolution of Quality of Life in Individuals With Gender Incongruence During Gender-Affirming Care

INTRODUCTION

The distress caused by gender incongruence has been shown to be reduced with gender-affirming care. The current study follows a cohort of patients that requested gender-affirming care at Ghent University Hospital and examines the outcome of the procedures.

METHODS

The prospective design with 4 assessment times allows the study to assess the evolution of self-reported quality of life (QoL) and gender incongruence throughout a medical transition process. All the participants (N = 119) received hormone therapy, 52% underwent a separate gonadectomy (N = 62), and 41% vaginoplasty or phalloplasty (N = 49).

RESULTS

The results suggest that gender incongruence improves after surgery. QoL has slightly different trends for the different gender groups: compared to people who were assigned male at birth (AMAB), people who were assigned female at birth (AFAB) report lower QoL after gonadectomy. Meeting other transgender people facilitate QoL after starting hormone therapy. A higher number of friends after genital surgery are predictive of a better QoL.

CLINICAL IMPLICATIONS

These results may be useful for clinicians working with transgender patients, as they provide information collected assessing patients soon after surgery and may raise awareness regarding the specific clinical attention that postsurgery patients need.

CONCLUSIONS

QoL can be compromised after the invasive surgery, while gender incongruence is alleviated throughout the transition. Our results should be confirmed with other prospective study designs that include a longer follow-up period. Pavanello Decaro S, Van Gils S, Van Hoorde B, et al. It Might Take Time: A Study on the Evolution of Quality of Life in Individuals With Gender Incongruence During Gender-Affirming Care. J Sex Med 2021;18:2045-2055.