Multiple Minority Stress and LGBT Community Resilience among Sexual Minority Men

The Importance of Social Support, Positive Identity, and Resilience in the Successful Aging of Older Sexual Minority Men

The aim of this study was to assess the relationship between social support, positive identity, and resilience and the successful aging of older sexual minority men. The study involved having 210 self-identified gay and bisexual men aged between 50 and 80 years complete a cross-sectional online survey comprised of sociodemographic information; the Portuguese version of the Multidimensional Scale of Perceived Social Support; the Lesbian, Gay, and multifactor Bisexual Positive Identity Measure; the Connor–Davidson Resilience Scale 10; and the Successful Aging Perceptions Scale. The results showed that self-identified gay participants showed higher levels of positive identity, while bisexual participants scored higher for resilience, mental health, and successful aging. Higher levels of social support, resilience, and positive identity were significant predictors of mental health (28%), physical health (18%), and successful aging (10%) in our sample. These results offer similarities with the growing body of literature on the positive factors of successful aging in the gay and bisexual men communities, which is an important step in the development of aging and health preventive initiatives among this population.

LGBTQ+ People's Mental Health and Pets: Novel Strategies of Coping and Resilience

Health disparities persist for lesbian, gay, bisexual, transgender, and/or queer (LGBTQ+)-identified people, often shaped by minority stress through anti-LGBTQ+ stigma. Resilience and coping are important for LGBTQ+ people widely, especially through social supports, but further examination is needed into more diverse, expansive mental health assets. Companion animals, or pets, have significant positive mental health benefits in the general population, but more understanding is needed to validate LGBTQ+ people's lived experiences of minority stress, mental health challenges, and pet-based sources of resilience. We employ the minority resilience framework to ask: What role do pets play in how LGBTQ+ people navigate and cope with stress? This U.S.-based study centers the voices of 45 LGBTQ+ people's qualitative interview narratives characterizing the diverse coping and resilience-building processes they develop through pet relationships. Findings demonstrate diverse processes surrounding pets as contributing to resilience, as participants emphasized the unique beneficial emotional connections pets provided. Second, pet family members were conceptualized as vital sources of support that promoted thriving. Finally, pet relationships fostered happiness and life enjoyment that augmented participants' life satisfaction. This study delineates more diverse understandings of how LGBTQ+ people manage stress through their pet relationships, which can provide vital information to service providers and policymakers in more holistically attending to marginalized communities' health needs.

Palliative care needs, concerns, and affirmative strategies for the LGBTQ population

The Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning population, also known as sexual and gender minorities, are an incredibly marginalized and vulnerable population that have been disproportionately affected by the provision, delivery, and optimal access to high-quality medical care including palliative, hospice, and end-of-life care. The long-standing and unique experiences shaped by positive and negative historical events have led to a better understanding of significant barriers and gaps in equitable healthcare for this population. The intersection of both internal and external stressors as well as minority identities in the context of discriminatory political and societal infrastructures have resulted in variable health outcomes that continues to be plagued by economic barriers, oppressive legislative policies, and undesirable societal practices. It could not be more urgent and timely to call upon the government and healthcare systems at large to execute reforms in policies and regulations, engage in cultural competency training, and promote cultural shifts in beliefs, attitudes, and practices that will ultimately recognize, prioritize, and address the needs of this population. After all, health care access is a universal right regardless of personal, social, political, and economic determinants of comprehensive medical care.

Elevated risk of substance use disorder and suicidal ideation among Black and Hispanic lesbian, gay, and bisexual adults

OBJECTIVE

Black and Hispanic persons who identify as lesbian, gay, or bisexual (LGB) experience health disparities relative to non-Hispanic White and heterosexual groups respectively, including higher rates of suicidal ideation (SI) and substance use disorder (SUD). To elucidate intersectional risk, we used a large national sample to examine rates of SI, SUD, and their co-occurrence (SI + SUD) at the intersection of sexual identity and race/ethnicity.

METHOD

Data were from five years (2015-2019) of the National Survey of Drug Use and Heath (unweighted N = 189,127). Multinomial logistic regressions with persons without SI and SUD as references were stratified by gender and controlled for survey year, age, education, marital status, and income.

RESULTS

Compared to same-race and same-gender heterosexual adults, White, Black, and Hispanic LGB men and women showed higher odds of SI (AOR = 2.86-4.45), SUD (AOR = 1.23-3.01), and SI + SUD (AOR = 2.72-6.85). Compared to same-gender White heterosexual adults, Black and Latinx heterosexual men and women showed lower odds of SI (AORs = .54-.65), SUD (AORs = .52-.78) and SI + SUD (AORs = .41-.57). Compared to same-gender White LGB adults, Black and Hispanic women, but not men, showed lower SI odds (AORs = .58-.72). Compared to same-gender White heterosexual adults, Black and Hispanic LGB men and women showed higher odds of SI (AORs = 1.71-2.51) and SI + SUD (AORs = 1.91-2.97).

CONCLUSIONS

Consistent with research showing effects of multiple minority stress on behavioral health, adults with intersecting racial/ethnic and sexual minority identities showed increased odds of SI, SUD, and SI + SUD relative to Non-Hispanic White heterosexual peers. Black, Hispanic, and White LGB adults may benefit from screening and intervention for SI and SUD.

Internalized Sexual Minority Stigma is Associated With HIV Testing Behavior Among Chinese Men Who Have Sex With Men: A Cross-Sectional Study

ABSTRACT

Although studies have examined the relationship between HIV-related stigma and HIV testing among men who have sex with men (MSM) in China, there is still a lack of knowledge regarding whether sexual minority stigma and HIV testing are associated. The purpose of this study was to identify the association between sexual minority- and HIV-related stigmas with HIV-testing behavior. A cross-sectional study was conducted in the Hunan Province of China. After controlling for covariates, the multivariate analyses showed that high internalized sexual minority stigma was negatively associated with HIV testing behavior in the previous year. However, anticipated sexual minority- and HIV-related stigmas were not associated with HIV-testing behavior. Findings suggest that internalized sexual minority stigma should be addressed in health care settings to encourage MSM to seek HIV testing services, especially considering the continuing HIV epidemic among MSM in China.

"We Faced Every Change Together". Couple's Intimacy and Sexuality Experiences from the Perspectives of Transgender and Non-Binary Individuals' Partners

In recent years, there has been a growing interest in the study of transgender and non-binary (TGNB) individuals' romantic and sexual relationships. The present study explored, from TGNB people's partners' perspective, how the couple experiences sexuality and intimacy, the effects from gender dysphoria in these relational domains, and how dysphoria is managed. For this purpose, 99 partners of TGNB individuals were recruited for an online study. Participants were asked to answer the following open-ended questions: "In the intimacy and sexuality with your partner, are there any parts of your or your partner's body that are/were off-limits?" "How did you manage this before, during, and after transition?" The data were analyzed through thematic analysis, and four overarching themes emerged: 1) Positive Aspects of the Relationship; (2) Challenges; (3) Strategies to Manage Dysphoria; and (4) Expected Improvement through Access to Medical Affirmation. The results suggest that gender dysphoria is one of the main challenges in experiencing intimacy and sexuality, but TGNB individuals and their partners can rely on several relational and practical resources to navigate it and enjoy positive experiences with intimacy and sexuality. The findings provide valuable information about how TGNB individuals and their partners build healthy and fulfilling relationships, and they can help clinicians better understand both members' perspectives in these romantic couples in the context of couples' therapy and sexual counseling.

How the COVID-19 Pandemic Affects Sexual Behavior of Hetero-, Homo-, and Bisexual Males in Germany

Introduction

The COVID-19 pandemic drastically altered the way of life around the world. Due to social distancing measures, contact restrictions and fears of infection, social life has changed significantly. These measures along with the stressors associated with the current worldwide situation, will inevitably have an effect on people's interpersonal and personal behaviors.

Aim

This study evaluates the effect the COVID-19 pandemic and nationwide German lockdown had on the sexual behavior of cis men.

Methods

An anonymous nationwide web-based questionnaire was conducted among cis men in Germany during the first COVID-19 home isolation (April 20, 2020–July 20, 2020). The questionnaire was distributed via e-mail, online chats and social-media platforms.

Main Outcome Measures

Data was collected on general characteristics including demographics and socio-economic backgrounds. To evaluate sexual health, questions from the Sexual Behavior Questionnaire were included.

Results

523 cis male participated. 414 met the inclusion criteria. Most were heterosexual (n = 248, 59.9%; vs homosexual n = 97, 23.4%; vs bisexual n = 69, 16.7%). 243 (59%) were employed, 153 (37.1%) were students and 16 (3.9%) were unemployed. Most of the participants reported an annual income lower than 75.000€. During the lockdown, average weekly frequency of sexual intercourse and masturbation was increased in all groups. Consistently, a significant rise of higher satisfaction with the frequency of sexual contacts during the quarantine was observed (P < .05). Furthermore, the level of sexual arousal increased significantly in all groups (P < .0005). Capability to enjoy sexual intercourse or masturbation increased significantly in heterosexual (P < .0005) and homosexual men (P < .005). Bisexual participants showed a significant increase in general satisfaction with sexual life (P < .05) and a significant decrease in satisfaction in relationship or single life (P < .05). Positive confounders in the changing of sexual behavior during the COVID-19 pandemic were: Being in a relationship or being single, parenthood and being employed.

Conclusion

Our study firstly describes how COVID-19 pandemic related restrictions and social distancing measurements altered sexual behavior amongst cis male in Germany. Further studies, including sexual minorities specifically, are needed to clarify if the behavior in the first German nationwide quarantine has persisted or transformed as the pandemic proceeded. Mumm J-N, Vilsmaier T, Schuetz JM, et al. How the COVID-19 Pandemic Affects Sexual Behavior of Hetero-, Homo-, and Bisexual Males in Germany. Sex Med 2021;9:100380.

“God Didn’t Make a Mistake in Creating Me”: Intrapersonal Resilience Processes among Gay and Bisexual Male Youth in Kenya

Gay and bisexual male youth in Kenya experience human rights violations, including pervasive stigma and discrimination, and these oppressive forces are associated with elevated rates of mental health concerns. Despite these challenges, many gay and bisexual male youth in Kenya are thriving during this critical developmental period. This study explored intrapersonal processes that gay and bisexual male youth in Kisumu, Kenya, highlight as important to developing, and demonstrating resilience in the face of adversity. We conducted qualitative in-depth interviews (IDIs) with 40 gay and bisexual male youth, ages 20–30 (mean = 26.4), and an additional 20 IDIs with gay and bisexual men, ages 22–45 (mean = 26.6), who were working as peer educators (total n = 60), all in Kisumu, Kenya. A total of nine primary themes emerged which describe various intrapersonal resilience processes enacted by gay and bisexual male youth, including sexual identity acceptance, self-confidence, self-love, religious/spiritual affirmation, adaptive coping, successful navigation, legal rights awareness, economic stability, and advocacy satisfaction. These data demonstrate the range of positive personal processes that promote mental health and wellbeing among gay and bisexual male youth in Kenya. We discuss implications of these findings for community-based interventions, and call for a research paradigm shift away from deficits and toward resilience.

Intersectional minority stress and identity conflict among sexual and gender minority people of color assigned female at birth

Objective: Sexual and gender minority people of color (SGM-POC) experience intersectional forms of minority stress, including heterosexism within racial/ethnic minority communities, which can contribute to feelings of conflict between SGM and racial/ethnic identities. Internalized stigma may be a consequence of sexual orientation-based discrimination but has not been tested as a mechanism linking intersectional minority stress to identity conflict among SGM-POC. We hypothesized that the association between experiences of heterosexism in racial/ethnic minority communities and identity conflict would be mediated by internalized stigma among SGM assigned female at birth (SGM-AFAB). Method: Participants were 316 SGM-AFAB who identified as POC. Data were collected as a part of an ongoing longitudinal cohort study of young SGM-AFAB. We tested the longitudinal mediation using data from baseline, 6-month follow-up, and 1-year follow-up assessments. Results: Internalized stigma at 6-month follow-up partially mediated the association between experiences of heterosexism in racial/ethnic minority communities at baseline and identity conflict at 1-year follow-up. Conclusions: For SGM-POC, experiences of heterosexism within their racial/ethnic communities may lead to internalization of those negative attitudes. A consequence of internalizing heterosexist attitudes from one's racial/ethnic group could be a feeling that one's sexual orientation and racial/ethnic identities must remain separate, perhaps to maintain connection to one's racial/ethnic community. Identifying internalized stigma as a mediating process is critical to better understand identity development for SGM-POC, and has important clinical implications for working with this population. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Intersections of Racial Discrimination and LGB Victimization for Mental Health: A Prospective Study of Sexual Minority Youth of Color

Sexual minority youth (i.e., lesbian, gay, and bisexual youth; LGB) of color have multiple minoritized identities, and few studies examine the implications of intersectional minority stressors for their prospective mental health. The current study tested three intersectional hypotheses: the additive hypothesis-racial discrimination and LGB victimization are independently associated with mental health; the multiplicative hypothesis-racial discrimination and LGB victimization interact in to exacerbate their negative association with mental health, and the inuring hypothesis-only racial discrimination or LGB victimization is associated with mental health. Data come from a sample of lesbian, gay, and bisexual youth of color (36% Black, 30% Latino, 26% Multi-racial, 4% Native American, and 3% Asian, Hawaiian, and Pacific Islander) from two U.S. cities, one in the Northeast (77%) and one in the Southwest, who were between ages 15-24 (M = 19) and surveyed four times over three years spaced nine months apart (N = 476; 38% bisexual; 67% free and reduced lunch; and 49% assigned female at birth). The multiplicative hypothesis was supported for depression symptoms, and the additive hypothesis was supported for suicidal ideation. Intersectional minority stressors undermine the mental health of sexual minority youth of color and warrant further investigation.

Intersectional Effects of Sexual Orientation Concealment, Internalized Homophobia, and Gender Expression on Sexual Identity and HIV Risk Among Sexual Minority Men of Color: A Path Analysis

ABSTRACT

In the United States, 13 million people identify as sexual and gender minorities. The purposes of this article were to (a) examine the associations among sexual orientation concealment and internalized homophobia with HIV knowledge, health literacy, and transactional sex through sexual identity; and (b) assess whether gender expression moderates those relationships in sexual minority men of color. A multigroup mediation path model examined the association between sexual orientation concealment and internalized homophobia on HIV knowledge, health literacy, and transactional sex through sexual identity by gender expression. Results suggest that, among those with a masculine gender expression, as sexual concealment increased, health literacy decreased. The association between sexual orientation concealment and transactional sex varied by participant's gender expression as did the association between internalized homophobia and HIV knowledge. Multiple intersecting identities, when faced with anticipated discrimination and homophobia, can negatively affect health outcomes and increase HIV risk in sexual minority men of color.

Coping and healthcare utilization in LGBTQ older adults: A systematic review

PURPOSE

This systematic review was conducted to identify, synthesize, and elucidate the coping mechanisms described by aging lesbian, gay, bisexual, transgender, and queer (LGBTQ) adults (60+) when utilizing healthcare.

METHODS

A comprehensive literature search was conducted in Embase and Ovid databases to identify studies of aging LGBTQ adults using coping mechanisms during healthcare utilization. Qualitative and quantitative studies published in English between 1969 and 2020 were included and assessed with COREQ, STROBE Statement, and CASP instruments.

RESULTS

Of 227 articles identified, six were included in the review. The final synthesis revealed that coping mechanisms were associated with social support, social network size, provider competency, and disclosure management. Frequency of appointments varied when seeking healthcare, and one study indicated delay in treatment.

CONCLUSION

This systematic review highlights various coping mechanisms associated with healthcare utilization and supports the need to develop research uniquely focused on aging LGBTQ adults.

Psychosocial Impacts of COVID-19 Pandemic on Lesbian, Gay, and Bisexual People Living in Portugal and Brazil—A Qualitative Study

Introduction:

Not many studies have been reported from Portugal or Brazil to date, regarding the psychosocial impacts of COVID-19 on lesbian, gay, and bisexual (LGB) people, especially from a qualitative perspective.

Materials and Methods:

A convenience sample of 65 self-identified LGB individuals from Portugal and Brazil participated in this study. Thirty-two participants were from Portugal and 33 from Brazil. The average age was 34.48 years (standard deviation = 11.66), ranging from 19 to 67. We used an online interview approach in an asynchronous format. All study respondents completed a structured inquiry consisting of a short section of sociodemographic questions and a single open-ended question: “As a lesbian, gay, bisexual (or other) self-identified person, please elaborate on how the COVID-19 pandemic has impacted your life.”

Results:

The thematic analysis of participants’ responses revealed 9 recurring themes, encompassing 18 subcategories to occur: mental health (depression, anxiety, fear, anger, and loneliness), isolation (social distancing and leisure impediments), relationships (family and friends), work-related problems, education-related problems, financial problems, changes (behavioral changes and opportunity to grow), coping (seeking support, accessing information and physical activities), and LGBTQI (lesbian, gay, bisexual, transgender, queer and intersex) topics (health barriers, going back into the closet, pride celebration events, and online dating).

Conclusions:

Our results provide voice to LGB Portuguese and Brazilian people during the COVID-19 pandemic demonstrating specific challenges exacerbated by stigma and sexual discrimination amplified by preexistent social inequalities.

Neighborhood social cohesion, religious participation and sexual risk behaviors among cisgender black sexual minority men in the southern United States

BACKGROUND

Few studies have examined associations between neighborhood social cohesion and sexual risk behaviors among gay, bisexual, and other sexual minority men (SMM), and none have among Black SMM in the southern U.S. The purpose of the current study is to examine associations between neighborhood social cohesion and sexual risk behaviors among Black SMM in the southern U.S., a population heavily impacted by HIV. We also examined whether these relationships are modified by religious participation for Black SMM in the southern U.S.

METHODS

Data was obtained from the MARI Study, a sample of Black SMM ages 18-66 years, recruited from the Jackson, MS and Atlanta, GA metropolitan areas (n = 354). Neighborhood social cohesion was assessed with a validated 5-item scale. We conducted multivariable regression analyses to examine the association between neighborhood social cohesion with each of the sexual risk behaviors (e.g., condomless sex and drug use before or during sex), controlling for key confounders. We then performed moderation analysis by religious participation (religious attendance and private religiosity).

RESULTS

Compared to Black SMM with higher perceived neighborhood social cohesion, Black SMM with lower neighborhood social cohesion had increased odds of alcohol use before or during sex (aPR = 1.56; 95% CI = 1.16-2.11) and condomless anal sex with casual partners (aPR = 1.55; 1.03-2.32). However, the magnitude of these associations varied by religious attendance and private religiosity. Black SMM with low religious service attendance had higher risk of alcohol use in the context of sex when perceived neighborhood social cohesion was low; those with high private religiosity had elevated alcohol use in the context of sex when perceived neighborhood social cohesion was low.

DISCUSSION

Interventions that target connectedness among neighborhood members through community education or mobilization efforts, including the involvement of religious organizations, should be considered for HIV prevention focused on alcohol and condomless sex among Black SMM.

Influence of Stress, Gender, and Minority Status on Cardiovascular Disease Risk in the Hispanic/Latino Community: Protocol for a Longitudinal Observational Cohort Study

BACKGROUND

Hispanic/Latino sexual and gender minorities (SGM) are the fastest growing ethnic group of SGM in the United States. Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among Hispanics/Latinos. SGM inequities in CVD risk have been identified as early as young adulthood, and minority stress has been identified as a potential mediator. Yet, the small number of ethnic or racial minority participants in SGM studies have precluded the examination of the intersections of sexual orientation, gender identity, and race and ethnicity.

OBJECTIVE

Minority stress models conceptualize relationships between stressors in minority groups and health outcomes. In this study, we will (1) examine the influence of sexual orientation and gender identity on CVD risk among all Hispanic Community Health Study/Study of Latinos (HCHS/SOL) participants at visit 3 (2021-2024; N~9300); (2) model pathways from sexual orientation and gender identity to CVD risk through stigma, discrimination, and stress in a 1:2 matched subcohort of SGM and non-SGM participants at visit 3 (n~1680); and (3) examine the influence of resilience factors on sexual orientation or gender identity and CVD risk relationships among subcohort participants at visit 3 (n~1680).

METHODS

This study will leverage existing data from the parent HCHS/SOL study (collected since 2008) while collecting new data on sexual orientation, gender identity, stigma, discrimination, stress, coping, social support, and CVD risk. Data analysis will follow the SGM minority stress model, which states that excess stigma against SGM populations leads to minority stress that increases CVD risk. In this model, coping and social support serve as resilience factors that can mitigate the impact of minority stress on CVD risk. Cross-sectional and longitudinal regression models as well as structural equation models will be used to test these relationships.

RESULTS

This study was funded by the National Heart, Lung, and Blood Institute in March 2020. Recruitment is scheduled to begin in the first quarter of 2021 and continue through 2024.

CONCLUSIONS

Understanding the influence of stigma-induced stress on CVD risk among Hispanic/Latino SGM has significant implications for the development of culturally specific CVD risk reduction strategies. Study findings will be used to build on identified Hispanic/Latino cultural strengths to inform adaptation and testing of family and community acceptance interventions.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/28997.

Classes of Sexual Identity, Homophobia, and Sexual Risk among Black Sexual Minorities in HPTN 061

Homophobia is associated with sexual risk among sexual minorities, including Black sexual minority men, though experienced homophobia may differ across sexual identities. We conducted latent class analysis of sexual identities and experienced homophobia associated with sexual risk, and tested mediators of this association. We used longitudinal data from the HIV Prevention Trials Network Study 061 (n = 1,553). We generated rate ratios between baseline latent classes of experienced homophobia and sexual identity and 12-month outcomes: Condomless receptive anal intercourse (CRAI), number of partners, and transactional sex. Mediators included 6-month internalized homophobia, depression, social support, and substance use. We selected the following 7-class model: "Bisexual, rare homophobia" (reference), "Mixed identities, mixed homophobia", "Bisexual, frequent homophobia", "Heterosexual/Same-gender loving, frequent homophobia", "Gay, frequent homophobia", " Gay/Same-gender loving, frequent homophobia," and "Gay, rare homophobia." All other classes had greater CRAI than the reference. For bisexual/mixed/heterosexual classes, approximately 20% of this association was positively mediated through our mediators (p < .05). The Heterosexual/Same-gender loving class had the largest proportion mediated through internalized homophobia. For gay-identifying classes, mediation was marginally significant (.05 < p < .10). Classes of sexual identity and experienced homophobia were associated with CRAI among Black sexual minority men, partially mediated through internalized homophobia, depression, social support, and substance use.

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.

Intersecting minority statuses and tryptophan degradation among stimulant-using, sexual minority men living with HIV

BACKGROUND

Disclosure of one's sexual orientation as a sexual-minority (SM) person (i.e., being "out") may affect HIV-related health outcomes. This longitudinal study examined whether race/ethnicity moderated effects of outness on the plasma kynurenine/tryptophan (KT) ratio, a marker of dysregulated serotonin metabolism due to immune activation that predicts clinical HIV progression.

METHODS

Participants were African American, Hispanic/Latino, and non-Hispanic White, methamphetamine-using SM men living with HIV (N = 97) who completed self-report scales of outness and SM stress at baseline for a randomized controlled trial of a positive affect intervention. Linear mixed modeling was used to test whether race/ethnicity and experimental condition moderated the association of baseline outness with the KT ratio at baseline, 6, 12, and 15 months controlling for SM stress, sociodemographics, HIV disease markers, and recent stimulant use.

RESULTS

The interactions of outness by race/ethnicity and outness by experimental condition on the KT ratio were significant. Greater outness predicted a lower KT ratio over time in non-Hispanic White SM men, but not among SM men of color (MOC). Greater outness predicted a lower KT ratio over time for SM men in the control, but not among those in the intervention arm.

CONCLUSION

Being more out may be protective for non-Hispanic White SM men, but not for their SM MOC peers. Outness mattered for participants who did not receive the positive affect intervention. Findings underscore the potentially different contexts and consequences of outness depending on SM men's race/ethnicity and whether they received a positive affect intervention. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

COVID-19 Vaccine Acceptance among an Online Sample of Sexual and Gender Minority Men and Transgender Women

Sexual and gender minority (SGM) populations are particularly vulnerable to poor COVID-19 outcomes and are more likely to experience stigma and medical mistrust that may impact COVID-19 vaccine acceptance. This study examined the prevalence of COVID testing and diagnosis and assessed COVID-19 vaccine acceptance among a large sample of SGM. Participants were recruited as part of an online cross-sectional study focused on an HIV biomedical prevention technology willingness in the United States at increased risk for HIV sero-conversion. Multivariate linear analysis was conducted to examine COVID-19 vaccine acceptance. The study sample included 1350 predominately gay (61.6%), Black (57.9%), cis-gender (95.7%) males with a mean age of 32.9 years. Medical mistrust and social concern regarding COVID-19 vaccine stigma were significantly associated with decreased COVID-19 vaccine acceptance, and altruism was significantly associated with increased vaccine acceptance. Black participants were significantly less likely to accept a COVID-19 vaccine, and Asian participants were significantly more likely to accept a vaccine, compared to White peers. As the planning of COVID-19 vaccine rollout efforts is conceptualized and designed, these data may inform equitable implementation strategies and prevent worsening health inequities among SGM populations.

Conceptualizing the Effects of Continuous Traumatic Violence on HIV Continuum of Care Outcomes for Young Black Men Who Have Sex with Men in the United States

The United States (US) is on track to achieve the 90-90-90 targets set forth by UNAIDS and the National HIV/AIDS strategy, yet significant racial disparities in HIV care outcomes remain, particularly for young Black men who have sex with men (YBMSM). Research has demonstrated that various types of violence are key aspects of syndemics that contribute to disparities in HIV risk. However, little research has looked collectively at cumulative violent experiences and how those might affect HIV treatment and care outcomes. Drawing on extant literature and theoretical underpinnings of syndemics, we provide a conceptual model that highlights how continuous traumatic violence experienced by YBMSM may affect HIV outcomes and contribute to racial disparities in HIV outcomes. The findings of this focused review suggest a need for research on how continuous exposure to various types of violence influence HIV prevention and treatment outcomes for young Black MSM.

Substance Use, General Health and Health Literacy as Predictors of Oral Health in Emerging Adult Sexual Minority Men of Color: A Secondary Data Analysis

There is limited evidence surrounding oral health in emerging adult, sexual minority men of color. This study examined the association between sociodemographic factors, health literacy, cigarette, e-cigarette, and alcohol use on oral health outcomes. Secondary data analysis was conducted with 322 sexual minority men ages 18-34 in the United States. Between-group, mean-level, and multivariable logistic regression analyses examined differences on oral health outcomes. Increased cigarette (aOR = 1.84, p = 0.03), e-cigarette (aOR = 1.40, p = 0.03), and alcohol use (aOR = 2.07, p = 0.05) were associated with extended time away from the dentist. Health literacy (aOR = 0.93, p = 0.05) was negatively associated. Increased cigarette (aOR = 1.17, p = 0.04) and cigarette use (aOR = 1.26, p = 0.04) were associated with tooth loss. Health literacy was negatively associated (aOR = 0.65, p = 0.03). Increased e-cigarette (aOR = 1.74, p = 0.04) and cigarette use (aOR = 4.37, p < 0.001) were associated with dental affordability issues. Lower health literacy and racial identification as Black were associated with dental affordability issues; demonstrating an urgent need to address these factors to improve oral health in emerging adult sexual minority men of color.

Experiences of educators who identify as lesbian, gay, and bisexual

The focus of the phenomenological qualitative study was on the lived experiences of U.S. educators who identified as lesbian, gay, and bisexual (LGB). Life story data regarding stress, coping, and identity were gathered, triangulated, and analyzed from 24 U.S. educators who identified as LGB teachers, mentors, and coaches. Four themes resulted: (a) subscribing to a helping identity, (b) being effective as an educator, (c) experiencing different levels of support, and (d) being out about sexual orientation to different degrees. Recommendations for future research are provided.

Social inequalities contribute to racial/ethnic disparities in depressive symptomology among men who have sex with men

PURPOSE

Racial/ethnic minorities experience disproportionate rates of depressive symptoms in the United States. The magnitude that underlying factors-such as social inequalities-contribute to these symptoms is unknown. We sought to identify exposures that explain racial/ethnic differences in clinically significant depressive symptomology among men who have sex with men (MSM).

METHODS

Data from the Multicenter AIDS Cohort Study (MACS), a prospective cohort study, were used to examine clinically significant symptoms of depression (Center for Epidemiologic Studies Depression Scale score ≥ 20) among non-Latinx White, non-Latinx Black, and Latinx MSM. We included 44,823 person-visits by 1729 MSM seen in the study sites of Baltimore/Washington, DC; Chicago; Pittsburgh/Columbus; and Los Angeles from 2000 to 2017. Regression models estimated the percentage of depressive symptom risk explained by social, treatment, and health-related variables related to race/ethnicity. Machine-learning methods were used to predict the impact of mitigating differences in determinants of depressive symptoms by race/ethnicity.

RESULTS

At the most recent non-missing MACS visit, 16% of non-Latinx White MSM reported clinically significant depressive symptoms, compared to 22% of non-Latinx Black and 25% of Latinx men. We found that income and social-environmental stress were the largest contributors to racial/ethnic disparities in risk for depressive symptoms. Similarly, setting the prevalence of these two exposures to be equal across racial/ethnic groups was estimated to be most effective at reducing levels of clinically significant depressive symptoms.

CONCLUSION

Results suggested that reducing socioeconomic inequalities and stressful experiences may be effective public health targets to decrease racial/ethnic disparities in depressive symptoms among MSM.

Disparities in health behaviors and outcomes at the intersection of race and sexual identity among women: Results from the 2011-2016 National Health and Nutrition Examination Survey

The purpose of this study was to explore potential differences in health behaviors and outcomes of sexual minority women (SMW) of color compared to White SMW, heterosexual women of color, and White heterosexual women. Data from 4878 women were extracted from the 2011 to 2016 National Health and Nutritional Examination Survey. The four-category independent variable (SMW of color, White SMW, heterosexual women of color, and White heterosexual women) was included in binary and multinomial logistic regression models predicting fair/poor self-reported health status, depression, cigarette smoking, alcohol, cannabis, and illicit drug use. Compared to White heterosexual women, SMW of color and heterosexual women of color had significantly higher odds of fair/poor self-reported health and lower odds of being a current or former smoker, binge drinking or using alcohol in the past year, being a former cannabis user, and ever using illicit drugs. In contrast, White SMW had significantly greater odds of depression, current smoking and cannabis and illicit drug use. Results of post-hoc tests indicated that the adjusted ORs for SMW of color differed significantly from those of White SMW for all outcomes, and did not differ significantly from those for heterosexual women of color for any outcome other than no binge drinking (OR = 0.34 vs. 0.67, p < 0.01) and current cannabis use (OR = 0.93 vs. 0.44, p < 0.01). SMW of color are more similar to heterosexual women of color than to White SMW in terms of depression, substance use, and self-reported health.

Health Care Experiences of Black Transgender Women and Men Who Have Sex With Men: A Qualitative Study

Black sexual and gender minorities (SGM) are at greater risk for HIV compared to their White, cisgender, heterosexual counterparts. Linkage to culturally sensitive health care is, therefore, pivotal for HIV prevention and treatment of Black SGM. Unfortunately, social and structural challenges undermine Black SGM individuals' abilities to obtain adequate health care services, indicating a need to understand Black SGM perceptions of health care. To address this gap, we interviewed Black men who have sex with men and transwomen about their experiences with health care providers. Participants discussed needs and concerns, including provider SGM identity diversity and education; assumptions, judgment, stigma, and discrimination; and ability to establish a personal bond, trust, and familiarity. Black SGM indicated that providers often did not meet their needs in different ways regarding their SGM identities. Findings suggest a need for provider cultural sensitivity education programs that address the needs of Black SGM in health care.

Experiences of LGBTIQA+ People with Disability in Healthcare and Community Services: Towards Embracing Multiple Identities

Healthcare and disability support services are increasing their efforts towards inclusion and recognising the needs of different groups. This research project was conducted by academic and peer researchers (LGBTIQA+ people with disability) in Victoria, Australia using four focus groups with LGBTIQA+ people with disability. We report on two overarching themes relating to participants’ experiences of accessing health services as LGBTIQA+ people with disability: difficulties in managing multiple identities and the impacts of community services and supports. Participants described having to repeatedly ‘come out’ in a range of ways and contexts as complex and layered processes in which it was difficult to present their full range of needs and experiences to services. We also found that the role of community in promoting a sense of belonging and resilience increased capacity to manage health service use and advocacy. Services and communities aiming to be inclusive to all have the opportunity to recognise and respond to the issues faced by LGBTIQA+ people with disability as a way to pay attention to how overt and subtle practices of discrimination continue to operate despite repeated attempts at or claims of being ‘inclusive.’ Our research suggests actual inclusive, accessible services can be achieved in part through policy and practice that actively responds to the specific needs of LGBTIQA+ people with disability, in addition to LGBTIQA+ education for disability services and disability and accessibility education for LGBTIQA+ focused services. As we do in this article, we argue that this work must be done by prioritising authentic participation of LGBTIQA+ people with disability in the services and research that is about them.

Effects of general and sexual minority-specific COVID-19-related stressors on the mental health of lesbian, gay, and bisexual people in Hong Kong

The impact of COVID-19 on mental health has begun to be widely recognized, but there is an absence of studies on how the mental health of lesbian, gay, and bisexual (LGB) people have been affected by the COVID-19 pandemic. A total of 857 LGB people in Hong Kong participated in a community-based survey study. Over one-fourth of them met the criteria for probable clinical depression (31.5%) and generalized anxiety disorder (27.9%). Besides general stressors, we identified sexual minority-specific stressors during the pandemic. 4.2% of the participants indicated that they had frequently experienced family conflict related to sexual orientation. One-third responded that they had largely reduced connection to the lesbian, gay, bisexual, and transgender plus (LGBT+) community (34.7%). The results showed that sexual minority-specific COVID-19-related stressors explained significant variance in depressive and anxiety symptoms, above and beyond the contribution of general COVID-19-related stressors. Since LGB people are particularly vulnerable to poor mental health during the COVID-19 pandemic, LGB people-targeting organizations need to understand more about family, space, and privacy concerns in order to provide better support, and LGB safe spaces and shelters may be needed as a policy response.

Resilience Moderated the Predictive Effect of Dual Stigma on Distress Among Chinese Newly Diagnosed HIV-Positive Men Who Have Sex With Men

Previous studies have examined the distinct stigmas of people living with HIV or of men who have sex with men (MSM). To capture the composite stress of HIV-positive MSM and the mixed stigma they experience, we conceptualized a compound stigma combining HIV status and homosexual identity. At two waves with an interval of 6 months, the results of 112 Chinese newly diagnosed HIV-positive MSM showed that dual stigma at baseline increased distress symptoms 6 months later. Resilience moderated these effects, as the dual stigma increased, distress symptoms intensified more rapidly for individuals with lower resilience than they did for those with higher resilience. Our findings highlight that dual stigma, as an intensified risk factor, predicted distress among the Chinese newly diagnosed HIV-positive MSM, conditioned by the protective factor of resilience. The results have strong implications for developing resilience-based intervention programs in this population.

Depression in High School: Lesbian, Gay, and Bisexual Identity as a Moderator of Sexual Assault

BACKGROUND

Depression continues to be a public health crisis for young adults. For high school students, past research has identified trauma as a significant predictor of depression. Congruent with the theory of cumulative stress, the present study hypothesized that the effect of sexual assault on depression would be stronger among lesbian, gay, and bisexual (LGB) students than among their straight peers.

METHODS

Using the Youth Risk Behavior Survey completed by students attending Duval County Public Schools in Florida (N = 3053), this study used secondary data analysis to conduct 2 regression analyses, one for boys and one for girls.

RESULTS

LGB status was associated with 3-fold increase in the odds of reporting depression for both boys and girls. History of sexual assault was associated with a significant increase in reporting depression. There was also a significant interaction effect between sexual orientation and history of sexual assault among male students only (p < .05). Contrary to the hypothesis, the effect was stronger among straight boys than among LGB boys.

CONCLUSION

Minority students continue to evidence greater risks for depression. Opportunities for systemic changes to address these include training teachers, banning conversion therapy, and implementing comprehensive sex education.

"It's the nature of the beast": Community resilience among gender diverse individuals

Marginalization causes gender diverse individuals to experience increased stress compared with cisgender individuals, such as social stigma and discrimination, which can lead to poor physical and mental health outcomes. This population uses various resources to cope with these challenges, including community social support. This qualitative research aimed to understand how gender diverse individuals perceive their community resilience. Supported by a community partner organization, we recruited N = 20 gender diverse participants for semi-structured interviews analyzed through inductive thematic qualitative analysis. The data revealed similarities with community resilience factors observed among other minority groups as well as novelty. Themes emerged on both individual and group levels and include strengths (e.g., opening to the group, role modeling for resilience, and group resources) and threats to community resilience (e.g., social anxiety, physical health conditions, and stigma). This paper informs the development of community resilience interventions in the context of gender diversity.

Engagement with LGBTQ community moderates the association between victimization and substance use among a cohort of sexual and gender minority individuals assigned female at birth

BACKGROUND

Research has documented higher levels of substance use among sexual and gender minority (SGM) individuals - particularly sexual minority women (SMW) and transgender people - than among their heterosexual and cisgender peers. Because SGM substance use is linked to stigma-based victimization, it is crucial to identify social contexts that may buffer the association between victimization and substance use among SGM.

METHODS

We explored how engagement with LGBTQ-specific community influences victimization experiences and substance use among 488 SGM individuals assigned female at birth (FAB-SGM; ages 16-32; 26% White) in a large Midwestern city. We tested whether participants who used LGBTQ community spaces differed from those who do not in levels of victimization and substance use, and whether use of LGBTQ spaces buffered SGM from the negative effects of victimization on substance use.

RESULTS

Results demonstrated significant associations between victimization and alcohol and use of specific drugs. Contrary to expectations, participants who used LGBTQ spaces reported more victimization and more use of certain substances; however, when controlling for being out about non-heterosexual identity, this association remained only for LGBTQ community centers and school groups. Evidence was mixed for community engagement as a moderator of the association between victimization and substance use.

CONCLUSIONS

Overall, results indicated that LGBTQ spaces may be associated with adaptive and maladaptive coping functions and should be considered a potential target for health interventions. Findings emphasize the need for increased research on FAB-SGM, including SMW and transgender individuals, and provide actionable recommendations to reduce incidence of victimization and substance use.

Socio-structural Factors Associated with Mental Health, Substance Use, and HIV Risk Among Black Sexual and Gender Minorities in the House and Ball Community

The House and Ball Community (HBC), a tight-knit social and cultural network comprised primarily of Black sexual and gender minorities (SGM), offers unique opportunities for HIV prevention that leverage naturally occurring social support networks. However, experiences of socioeconomic marginalization, stigma, violence, and trauma may impede HIV prevention efforts. This study analyzed data from 551 Black SGM recruited at HBC events in 2 cities over 24 months. Logistic regression with generalized estimating equations examined associations between socio-structural stressors, mental health, substance use, and sexual behavior among HBC participants. Findings indicated high prevalence of depressive symptoms, history of trauma, intimate partner violence, and substance use, and significant associations between socioeconomic marginalization and depressive symptoms, substance use, and condomless anal sex. Future research is needed to better elucidate the temporal relationships between socioeconomic marginalization, mental health and substance use, and HIV transmission dynamics. Results highlight a need for integration of mental health services, substance use treatment, and HIV prevention for this community.

Chubby, Hairy and Fearless. Subcultural Identities and Predictors of Self-Esteem in a Sample of Polish Members of Bear Community

Bear subculture exists within a larger gay community, which has been recognized by public health experts as disproportionately burdened with stigma and related health adversities. Bears are distinguished by a particular body look—body hirsuteness and heavy-set physique. Previous research documented the various health risks, and the exposure to both sexual minority and weight stigma, of this population. In this study we focused on the determinants of self-esteem in Bears. We explored the significance of such predictors as: perceived sexual minority and weight stigma, age, resilience, and physique as reflected by the BMI. Our sample consisted of 60 men from the Polish Bear community (i.e., Bears, Cubs, Otters, Wolves). Linear regression models were performed for the entire sample (N = 60) and for Bear-identified men (N = 31). Perceived sexual minority stigma negatively, and resilience positively, predicted self-esteem. In the case of Bear-identified men, age, perceived exposure to weight discrimination, and BMI were also significant predictors of self-esteem. Higher BMI in the case of Bear-identified men predicted higher self-esteem. Our results suggest that although Bear-identified men are characterized by their similarities to other gay men, subcultural identities create unique social contexts that are important for health and health interventions in this population.

Loneliness and self-rated physical health among gay, bisexual and other men who have sex with men in Vancouver, Canada

BACKGROUND

Due to stigma and discrimination, gay, bisexual and other men who have sex with men (gbMSM) potentially carry a heightened burden of loneliness. This analysis investigates loneliness among gbMSM and its relationship with self-rated physical health, along with the mediating effect of depression.

METHODS

Participants were recruited using respondent-driven sampling into the Momentum Health Study (February 2012-February 2015) with follow-up visits occurring every 6 months till February 2018. Using computer-assisted self-interviews, measures of loneliness were assessed using a 6-item Loneliness Scale for Emotional and Social Loneliness (lonely vs not lonely). Current physical health was self-assessed (poor, fair, good, very good or excellent). A multivariable generalised linear-mixed model with a logit link function was used to examine the relationship between loneliness and self-rated physical health. We further investigated the mediating effect of depressive symptomatology on this relationship via the Hospital Anxiety and Depression Scale.

RESULTS

Of the 770 participants included, we found that 61% (n=471) experienced loneliness at baseline. Of the 674 (88%) who reported good/very good/excellent physical health, 59% (n=391) reported loneliness, compared with 87% (n=80) of those in poor/fair self-rated physical health who reported feeling lonely. After adjustment for confounding, loneliness was associated with poor self-rated physical health (adjusted OR 1.71; 95% CI 1.13 to 2.60). Depressive symptomatology was found to partially mediate this relationship.

CONCLUSION

There may be a need for the integration of social, mental and physical health programming, targeted towards gbMSM, to alleviate the degree of loneliness experienced and its co-occurrence with poor self-rated physical health.

Intersectional stigma and psychosocial well-being among MSM living with HIV in Guangxi, China

The existing literature suggests a negative impact of intersectional stigma on multiple aspects of psychosocial well-being among individuals with multiple stigmatized identities. However, such impact remains poorly understood. This study aims to investigate the association between intersectional stigma and psychosocial well-being among 193 men who have sex with men (MSM) living with HIV. Based on their responses to measures of HIV-related stigma and sexual and gender minority (SGM) stigma, the participants were grouped into "high" vs "low" on each type of stigma. The General Linear Model (GLM) was used to analyze the main and interaction effect of two types of stigma on multiple psychosocial measures. Our results indicated a significant interaction effect of two types of stigma on depression, anxiety, quality of life, and psychological resilience after controlling for key socio-demographic covariates. The findings suggest that experiencing both HIV-related stigma and SGM stigma may synergistically lead to poor psychosocial well-being among MSM in a more profound manner than experiencing only one type of stigma. It is critical for researchers and clinicians to consider the patients' multiple stigmatized identities, develop effective intervention strategies, and improve the psychosocial well-being of MSM living with HIV in China and other cultural settings.

Impact of Status-Based Rejection Sensitivity on Depression and Anxiety Symptoms in Gay Men

Status-based rejection sensitivity refers to the anxious expectation and tendency to perceive rejection in ambiguous social scenarios based on one's minority identification. This study evaluates the implications of sensitivity to rejection based on sexual orientation identity on negative mental health outcomes. Current minority stress models include rejection sensitivity as a factor that may contribute to adverse negative psychosocial outcomes in LGBT persons. This study evaluates the role of rejection sensitivity alongside demographically relevant predictors such as age, race, education, and level of sexuality disclosure in predicting the presence of significant depression and anxiety scores among a sample of gay men. Results indicate that rejection sensitivity, sexuality openness, and anxiety were significant predictors of depression symptoms, whereas age and depression were significant predictors of anxiety symptoms. This study supports the role of rejection sensitivity as a contributor to negative mental health outcomes among gay men, particularly as it pertains to internalizing mental health disorders.