Elevated alcohol and sexual risk behaviors among young Thai lesbian/bisexual women

Experiences of conflict, non-acceptance and discrimination are associated with poor mental well-being amongst LGBTQ-identified individuals in Singapore

Purpose

Health disparities affecting lesbian, gay, bisexual, transgender and queer (LGBTQ) populations have been reported in many countries. For Singapore, no large quantitative studies on mental health and well-being in the local LGBTQ community have been published. The authors conducted a community-based survey (National LGBT Census Singapore, 2013; NLCS2013) that covered a comprehensive set of demographic, social and health indicators. Here, the authors investigated mental health status and its correlates in 2,350 LGBTQ individuals within the NLCS2013 sample.

Design/methodology/approach

The NLCS2013 was an anonymous online survey conducted amongst self-identified LGBTQ adults (aged ≥ 21 years) residing in Singapore. The survey included the World Health Organisation Well-being Index (WHO-5) as a measure of mental well-being, with low WHO 5 scores (<13/25) indicating poor mental well-being. The authors analysed relationships between low WHO-5 score and a range of respondent characteristics using multivariate logistic regression.

Findings

Strikingly, 40.9% of 2,350 respondents analysed had low WHO-5 scores, indicating poor mental well-being. Parental non-acceptance, experience of conflict at home and bullying/discrimination in the workplace or educational environments were all significantly associated with poor mental well-being. Conversely, community participation appeared protective for mental well-being, as respondents who participated in LGBTQ community organisations or events were less likely to have poor mental well-being than non-participants.

Originality/value

The NLCS2013 represents one of the first broad-based efforts to comprehensively and quantitatively capture the sociodemographic and health profile, including mental health status, within Singapore’s resident LGBTQ population. These findings affirm the need to address the mental health needs of LGBTQ individuals in Singapore and to foster safe spaces and allyship.

An eHealth Intervention for Promoting COVID-19 Knowledge and Protective Behaviors and Reducing Pandemic Distress Among Sexual and Gender Minorities: Protocol for a Randomized Controlled Trial (#SafeHandsSafeHearts)

BACKGROUND

Existing data on COVID-19 disparities among vulnerable populations portend excess risk for lesbian, gay, bisexual, transgender (LGBT) and other persons outside of heteronormative and cisgender identities (ie, LGBT+). Owing to adverse social determinants of health, including pervasive HIV and sexual stigma, harassment, violence, barriers in access to health care, and existing health and mental health disparities, sexual and gender minorities in India and Thailand are at disproportionate risk for SARS-CoV-2 infection and severe disease. Despite global health disparities among LGBT+ populations, there is a lack of coordinated, community-engaged interventions to address the expected excess burden of COVID-19 and public health-recommended protective measures.

OBJECTIVE

We will implement a randomized controlled trial (RCT) to evaluate the effectiveness of a brief, peer-delivered eHealth intervention to increase COVID-19 knowledge and public health-recommended protective behaviors, and reduce psychological distress among LGBT+ people residing in Bangkok, Thailand, and Mumbai, India. Subsequent to the RCT, we will conduct exit interviews with purposively sampled subgroups, including those with no intervention effect.

METHODS

SafeHandsSafeHearts is a 2-site, parallel waitlist-controlled RCT to test the efficacy of a 3-session, peer counselor-delivered eHealth intervention based on motivational interviewing and psychoeducation. The study methods, online infrastructure, and content were pilot-tested with LGBT+ individuals in Toronto, Canada, before adaptation and rollout in the other contexts. The primary outcomes are COVID-19 knowledge (index based on US Centers for Disease Control and Prevention [CDC] items), protective behaviors (index based on World Health Organization and US CDC guidelines), depression (Patient Health Questionnaire-2), and anxiety (Generalized Anxiety Disorder-2). Secondary outcomes include loneliness, COVID-19 stress, and intended care-seeking. We will enroll 310 participants in each city aged 18 years and older. One-third of the participants will be cisgender gay, bisexual, and other men who have sex with men; one-third will be cisgender lesbian, bisexual, and other women who have sex with women; and one-third will be transfeminine, transmasculine, and gender nonbinary people. Participants will be equally stratified in the immediate intervention and waitlist control groups. Participants are mainly recruited from online social media accounts of community-based partner organizations. They can access the intervention on a computer, tablet, or mobile phone. SafeHandsSafeHearts involves 3 sessions delivered weekly over 3 successive weeks. Exit interviews will be conducted online with 3 subgroups (n=12 per group, n=36 in each city) of purposively selected participants to be informed by RCT outcomes and focal populations of concern.

RESULTS

The RCT was funded in 2020. The trials started recruitment as of August 1, 2021, and all RCT data collection will likely be completed by January 31, 2022.

CONCLUSIONS

The SafeHandsSafeHearts RCT will provide evidence about the effectiveness of a brief, peer-delivered eHealth intervention developed for LGBT+ populations amid the COVID-19 pandemic. If the intervention proves effective, it will provide a basis for future scale-up in India and Thailand, and other low- and middle-income countries.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04870723; https://clinicaltrials.gov/ct2/show/NCT04870723.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/34381.

An intersectional burden: Gender and sexual stigma against toms in Thailand

Sexual stigma has deleterious effects on the health and wellbeing of sexual minority women. In low- and middle-income countries, theories and research on stigma against sexual minority women largely focus on sexuality-related stigma processes, such as internalized homophobia or perceived or enacted stigma due to sexual identity, attraction or practice. Yet, there is considerable gender diversity among sexual minority women. Further, sexuality and gender identity may intersect with broader gender inequalities to influence the experience of stigma among some groups. In this study, we conducted 21 qualitative life-history interviews with self-identified toms in Bangkok, the capital city of Thailand, to evaluate whether and how gender identity, independent of and together with same-sex sexuality, influences experiences of stigma among gender non-conforming sexual minority women. We find that the pervasive experiences of stigma against toms derive as much from their assumed masculinity in Thai society, as from their same-sex sexuality. Notably, coercive feminization (attempts by others to orient toms toward sexual and gendered expectations of Thai femininity) and boundary policing (expressed hostility toward tom gender performance and sexual intimacy with feminine Thai women) were manifestations of concurrent gender non-conformity and sexual stigma, shaped in turn by the unique location of toms within the Thai gender/sex system. We propose that research and theories on stigma and health among sexual minorities systematically integrate a gender perspective, to elucidate the effects of gender identity and location within the gender structure on sexual minority experiences of stigma.

Emotional and behavioral problems among sexual minority youth in Thailand

BACKGROUND

Sexual minority youth (SMY) had more risk behaviors and mental health problems than heterosexual youth. Relatively little research has differentiated among lesbian/gay, bisexual, and questioning (LGBQ) youth.

OBJECTIVE

To examine the differences in emotional and behavioral problems between LGBQ youth in the city of Northern Thailand.

METHODS

Data were from a school-based, cross-sectional study of grade 7-12 students in secondary and vocational schools. Five hundred and forty-three students who identified themselves as LGBQ and 3829 heterosexual peers completed the Youth Self-Report (YSR).

RESULTS

Of 12.4% of LGBQ participants, 4.1% identified themselves as lesbian/gay, 4.8% as bisexual, and 3.5% were unsure. SMY had significantly higher scores in internalizing problems (16.84 VS 13.99, 95% confidence interval [CI] 1.94-3.77, P < 0.001), externalizing problems (15.23 VS 13.51, 95% CI 0.97-2.45, P < 0.001), and total behavioral scores (55.26 VS 47.16, 95% CI 5.55-10.63, P < 0.001) than their heterosexual peers. In sexual minority subgroup analyses, all syndrome subscales were highest in the bisexual group followed by the lesbian/gay group, and the questioning group, respectively.

CONCLUSION

LGBQ high school students had greater psychosocial problems than their heterosexual counterparts. Bisexual students were at the greatest risks of emotional and behavioral problems. Pediatricians and school mental health providers should be aware of emotional and behavioral problems among LGBQ students.

Self-identified sexual orientations and high-risk sexual behaviours among Chinese youth

PURPOSE

High-risk sexual behaviour is a factor affecting the health of sexual minority students, yet few related studies have been completed among Chinese students. This article explores the distribution of sexual minority groups and its association with high-risk sexual behaviours and symptoms of sexually transmitted infections(STIs) among Chinese college students.

METHODS

An internet-based questionnaire was applied, and a sample of 17 966 surveys from 130 Chinese colleges was collected. Based on their self-reports, participants were classified into the following groups: homosexual male or female, heterosexual, bisexual, and sexual orientation unknown. High-risk sexual behaviours were defined as having sexual intercourse before the age of 18 years, having one's sexual debut with a non-regular partner, having had more than four sexual partners before investigation, and having mostly had sexual intercourse without using condoms. Logistic regression models were constructed to analyse the associations.

RESULTS

The proportions of the homosexual males and females, and the bisexual groups were 1.62%, 0.88% and 5.07%, respectively. Homosexual males were more likely to have their sexual debut with a non-regular partner (OR 4.79, 95% CI 3.38 to 6.78), having more than four sexual partners (OR 5.81, 95% CI 4.06 to 8.32), having their sexual debut before the age of 18 years (OR 1.92, 95% CI 1.34 to 2.76), and not using condoms for most episodes of sexual intercourse (OR 1.47, 95% CI 1.00 to 2.17). Similar associations also existed among homosexual females. A positive association between sexual orientation and having symptoms of STIs (OR 1.49, 95% CI 1.02 to 2.18) was found among homosexual males.

CONCLUSIONS

Sexual minority groups among Chinese college students had a greater risk of engaging in high-risk sexual behaviours and having STI symptoms. Future studies and interventions should focus on this population.

Validating a Hazardous Drinking Index in a Sample of Sexual Minority Women: Reliability, Validity, and Predictive Accuracy

BACKGROUND

Although sexual minority women (SMW) are at increased risk of hazardous drinking (HD), efforts to validate HD measures have yet to focus on this population.

OBJECTIVES

Validation of a 13-item Hazardous Drinking Index (HDI) in a large sample of SMW.

METHODS

Data were from 700 adult SMW (age 18-82) enrolled in the Chicago Health and Life Experiences of Women study. Criterion measures included counts of depressive symptoms and post-traumatic stress disorder (PTSD) symptoms, average daily and 30-day ethanol consumption, risky sexual behavior, and Diagnostic and Statistical Manual (DSM-IV) measures of alcohol abuse/dependence. Analyses included assessment of internal consistency, construction of receiver operating characteristic (ROC) curves to predict alcohol abuse/dependence, and correlations between HDI and criterion measures. We compared the psychometric properties (diagnostic accuracy and correlates of hazardous drinking) of the HDI to the commonly used CAGE instrument.

RESULTS

KR-20 reliability for the HDI was 0.80, compared to 0.74 for the CAGE. Predictive accuracy, as measured by the area under the receiver operating characteristic curve for alcohol abuse/dependence, was HDI: 0.89; CAGE: 0.84. The HDI evidenced the best predictive efficacy and tradeoff between sensitivity and specificity. Results supported the concurrent validity of the HDI measure.

CONCLUSIONS

The Hazardous Drinking Index is a reliable and valid measure of hazardous drinking for sexual minority women.

Prevalence of and disparities in HIV-related sexual risk behaviours among Chinese youth in relation to sexual orientation: a cross-sectional study

Background: The aim of this study was to calculate the prevalence rate of HIV-related sexual risk behaviours (HSRB) among Chinese youth and determine whether there was an association between sexual orientation and HSRB. Methods: This study used a nationally representative survey of youth aged 15-24 years in China. Population numbers, prevalence, and proportions were calculated where appropriate. χ2 tests were used to determine the difference within categorical variables. Multivariate logistic regression was used to calculate the adjusted odd ratios (AOR) and 95% confidence interval (CI). Results: The rate of any HSRB among sexually active youth was 79.43%, and the most common HSRB was lack of condom use during the first sexual experience (66.02%). After adjusting for demographic and socioeconomic variables (sex, age, residence, living with parents or not, father's education and annual family income), non-heterosexual orientation was found to significantly increase the odds of HSRB (AOR = 2.42, 95% CI: 1.16-5.05). Conclusions: Non-heterosexual youth are at a higher risk of partaking in HSRB. The high prevalence of HSRB indicates the insufficiency of sex education for Chinese youth, especially for non-heterosexual youth. Greater efforts should be made to increase reproductive and sexual health services for Chinese youth.

Women Who Have Sex with Women Living in Low- and Middle-Income Countries: A Systematic Review of Sexual Health and Risk Behaviors

Women who have sex with women (WSW) have long been considered at low risk of acquiring and transmitting HIV and other sexually transmitted infections (STIs). However, limited research has been conducted on WSW, especially those living in low-and middle-income countries (LMICs). We reviewed available research on sexual health and risk behaviors of WSW in LMICs. We searched CINAHL, Embase, and PubMed for studies of WSW in LMICs published between January 1, 1980, and December 31, 2013. Studies of any design and subject area that had at least two WSW participants were included. Data extraction was performed to report quantifiable WSW-specific results related to sexual health and risk behaviors, and key findings of all other studies on WSW in LMICs. Of 652 identified studies, 56 studies from 22 countries met inclusion criteria. Reported HIV prevalence among WSW ranged from 0% in East Asia and Pacific and 0%-2.9% in Latin America and the Caribbean to 7.7%-9.6% in Sub-Saharan Africa. Other regions did not report WSW HIV prevalence. Overall, many WSW reported risky sexual behaviors, including sex with men, men who have sex with men (MSM), and HIV-infected partners; transactional sex; and substance abuse. WSW are at risk for contracting HIV and STIs. While the number of research studies on WSW in LMICs continues to increase, data to address WSW sexual health needs remain limited.