A group intervention to improve body image satisfaction and dietary habits in gay and bisexual men living with HIV/AIDS

Interventions, Barriers, and Facilitators to Address the Sexual Problems of Gay, Bisexual and Other Men Who Have Sex with Men Living with HIV: A Rapid Scoping Review

Sexual problems are common among gay, bisexual, and other men who have sex with men (GBM) after diagnosis with HIV. However, these are often overlooked in care and research, where sexual risk reduction and biomedical aspects of sexual health tend to dominate. We conducted a rapid scoping review to investigate which sexual problems of GBM living with HIV are addressed by interventions, and the barriers and facilitators to their implementation. Literature from high-income countries published in English since 2010 was reviewed. Medline, Embase, PsycInfo, and Scopus databases were searched on July 4, 2022. Targeted sexual problems were categorized according to the ten dimensions of Robinson's Sexual Health Model, and barriers and facilitators, according to the five domains of the Consolidated Framework for Implementation Research (CFIR). Interventions focused solely on the dimension of Sexual Health Care/Safer Sex were excluded. Relevant information was extracted from the qualifying documents with NVivo 12 software for content analysis. Fifty-two documents were included, referring to 37 interventions which mainly took place in the United States (n = 29/37; 78%), were group-based (n = 16; 41%), and used counselling techniques (n = 23; 62%; e.g., motivational interviewing, cognitive-behavioral therapy). Their settings were mostly primary care (n = 15; 40%) or community-based (n = 16; 43%). On average, interventions addressed three sexual health dimensions (SD = 2; range: 1-10). The most targeted dimension was Sexual Health Care/Safer Sex (n = 26; 70%), which concerned sexual risk reduction. Next, Challenges (n = 23; 62%), included substance use (n = 7; 19%), sexual compulsivity (n = 6; 16%), sexual abuse (n = 6; 16%), and intimate partner violence (n = 4; 11%). Third was Talking About Sex (n = 22; 59%) which mostly concerned HIV disclosure. About a third of interventions addressed Culture/Sexual identity (n = 14; 38%), Intimacy/Relationships (n = 12; 33%), and Positive sexuality (n = 11; 30%). Finally, few targeted Body Image (n = 4; 11%), Spirituality (n = 3; 8%), Sexual Anatomy Functioning (n = 2; 5%) or Masturbation/Fantasy (n = 1; 3%). Forty-one documents (79%) mentioned implementation barriers or facilitators, particularly about the characteristics of the interventions (41% and 78%, respectively; e.g., cost, excessive duration, acceptability, feasibility) and of the individuals involved (37% and 46%; e.g., perceived stigmatization, provider expertise). The other three CFIR dimensions were less common (5%-17%). The search strategy of this review may not have captured all eligible documents, due to its limit to English-language publications. Overall, most interventions incorporated a focus on Sexual Health Care/Safer Sex, at the expenses of other prevalent sexual problems among GBM living with HIV, such as intimate partner violence (Challenges), erectile dysfunction (Sexual Anatomy Functioning), and Body Image dissatisfaction. These findings suggest they could receive more attention within clinical care and at the community level. They also highlight the importance of cost-effective and acceptable interventions conducted in non-stigmatizing environments, where patients' needs can be met by providers who are adequately trained on sexuality-related topics.

Determinants of body image disturbance and disordered eating behaviors among self-identified LGBTQ individuals

It has been previously established that sexual minorities are more likely to suffer from mental health illnesses due to experiencing unique stressors such as fear, anxiety, stigma, harassment, and prejudice. Results revealed two noteworthy mental health disorders reported by lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals, disordered eating behaviors and disturbed body image. Yet, a-priori studies revealed inconsistent results with regards to body image concerns and eating disorder symptoms and attitudes among sexual minorities. Therefore, this cross-sectional study aimed at investigating the occurrence of disordered eating behaviors (DEB) and body image disturbance (BID) among sexual minorities in Lebanon. Additionally, the correlation between several determinants of DEB and BID including fear of negative evaluation, generalized anxiety, social support, and harassment levels have been examined. Generally, the present study revealed that LGBTQ population scored higher than cisgender and heterosexual individuals for the mean and global scores of the EDE-Q6.0 and BAS-2. Only generalized anxiety and fear of negative evaluation scales were significantly associated with DEB and BID among different sexual orientation and gender identity individuals. Therefore, it is very important that health professionals working with such vulnerable populations meticulously assess for disordered eating behaviors and body image disturbance for better communication and management.

A randomized controlled trial of a brief self-compassion intervention designed to improve the body image of sexual minority men

Self-compassion involves reflecting on shared human experiences, expressing self-kindness, and responding to feelings in a kind and non-judgmental way. Self-compassion interventions seem to be effective for women's body dissatisfaction, however, such interventions have not been trialed with men, including sexual minority men, who are particularly vulnerable. We conducted a randomized controlled trial of a brief self-compassion intervention designed to reduce body dissatisfaction among sexual minority men (N = 605). We used a 3 (condition: self-compassion, self-esteem, and a benign recollection control) × 5 (time) repeated measures design, whereby participants completed a brief writing task and completed body image measures at multiple time-points. Participants in both the self-compassion and self-esteem conditions showed improved body image and self-compassion following the intervention whereas participants in the control condition did not. Increases in self-compassion mediated body image measures for participants in the self-compassion but not self-esteem or control conditions. Participants in the self-compassion condition also showed increased self-compassion at three-weeks follow-up. While several caveats to our results were noted, our overall interpretation is that self-compassion and self-esteem interventions might be effective for sexual minority men's body image, and more research is necessary. The challenge of inculcating a self-compassionate mindset among men is also discussed.

Sexual orientation correlates with baseline characteristics but shows no moderating effects of dissonance-based eating disorder prevention programs for women

This study provided the first test of whether sexual orientation (categorized as heterosexual vs. sexual minority) is associated with baseline eating disorder risk factors and symptoms, moderated the intervention effects of variants of the dissonance-based Body Project, or moderated the relation of baseline risk factors to future change in eating disorder symptoms. A total of 680 women with body image concerns were randomized to clinician-or peer-led Body Project groups, the eBody Project, or educational video control and completed assessment of eating disorder risk factors and symptoms at pretest, posttest, and at six-, 12-, 24-, and 36-month follow-up. Results indicated that sexual minority women had significantly higher negative affect and impaired psychosocial functioning at baseline, but did not differ on other eating disorder risk factors or symptoms. We found no evidence that sexual orientation moderates the effects of the Body Project on risk factor or symptom change over follow-up or the relation of baseline risk factors to future change in eating disorder symptoms. Overall, sexual minority and heterosexual women differ on two, less specific eating disorder-related risk factors at baseline, but did not differ in response to different versions of the Body Project or the relations of risk factors to future symptom change.

Eating disorders and disordered eating behaviors in the LGBT population: a review of the literature

BACKGROUND

According to past research, lesbian, gay, bisexual, and transgender (LGBT) individuals experience a higher prevalence of psychopathology, which is attributable to the increased stress (i.e., stigma and prejudice) that they experience, as detailed by the minority stress model (MSM).

MAIN

This current literature review examined the empirical literature regarding the rates and types of, and risk factors for eating disorders and disordered eating behaviors in LGBT adults and adolescents, in addition to each individual subgroup (i.e., lesbians, gay males, bisexuals, transgender and gender-nonconforming individuals).

CONCLUSION

LGBT adults and adolescents experience greater incidence of eating disorders and disordered eating behaviors than their heterosexual and cisgender counterparts. Additionally, gay, bisexual, and transgender adults and adolescents were all at increased risk for eating disorders and disordered eating behaviors. Mixed results were found for lesbian adults and adolescents. Results are discussed within the framework of the MSM.

A pilot controlled trial of a cognitive dissonance-based body dissatisfaction intervention with young British men

This pilot study evaluated a body image intervention for men, Body Project M. Seventy-four British undergraduate men took part in two 90-min intervention sessions, and completed standardised assessments of body image, bulimic pathology, and related outcomes at baseline, post-intervention, and 3-month follow-up. Fifty-three other men completed the questionnaires as an assessment-only control group. Per-protocol analysis showed that Body Project M improved men's dissatisfaction with body fat and muscularity, body appreciation, muscularity enhancing behaviours, appearance comparisons, and internalization (ds=0.46-0.80) at post-intervention. All except dissatisfaction with muscularity and internalization were sustained at 3-month follow-up. No effects were found for bulimic pathology. Post-intervention effects for dissatisfaction with muscularity and internalization only were retained under intention-to-treat analysis. Participants were favourable towards the intervention. This study provides preliminary evidence for the acceptability and post-intervention efficacy of Body Project M. Further development of the intervention is required to improve and sustain effects.

Eating Disorders and Disordered Weight and Shape Control Behaviors in Sexual Minority Populations

PURPOSE OF REVIEW

This review summarized trends and key findings from empirical studies conducted between 2011 and 2017 regarding eating disorders and disordered weight and shape control behaviors among lesbian, gay, bisexual, and other sexual minority (i.e., non-heterosexual) populations.

RECENT FINDINGS

Recent research has examined disparities through sociocultural and minority stress approaches. Sexual minorities continue to demonstrate higher rates of disordered eating; disparities are more pronounced among males. Emerging data indicates elevated risk for disordered eating pathology among sexual minorities who are transgender or ethnic minorities. Dissonance-based eating disorder prevention programs may hold promise for sexual minority males. Continued research must examine the intersections of sexual orientation, gender, and ethnic identities, given emergent data that eating disorder risk may be most prominent among specific subgroups. More research is needed within sexual minorities across the lifespan. There is still a lack of eating disorder treatment and prevention studies for sexual minorities.

Perceived importance of five different health issues for gay and bisexual men: implications for new directions in health education and prevention

This study assessed the perceived importance of five health issues for gay and bisexual men (N = 660) using time-space sampling in gay bars/clubs and bathhouses in New York City: "HIV & STDs," "Drugs & Alcohol," "Body Image," "Mental Health," and "Smoking." This study compared ratings based on demographic differences, recent substance use, recent sexual risk behavior, and whether or not participants owned a smart device (e.g., "smart" phone, iPad, iPod touch). Contrary to research indicating that gay and bisexual men may be experiencing HIV prevention fatigue, this study identified that HIV and STIs were perceived as most important. Drugs and alcohol and mental health were also rated high, suggesting that providers may be well served to include mental health and drugs and alcohol as part of their comprehensive approach to HIV prevention. A majority of participants (72%) owned a smart device. Smart device owners rated health issues similarly to those who did not, suggesting that such devices may be a useful platform to reach gay and bisexual men for health education and prevention.

Intimacy and sexual decision making: exploring the perspective of HIV positive women over 50

Due to advances made in HIV treatment, the population of individuals with HIV over the age of 50 is growing. Aging women face many developmental challenges and some of these challenges, including having or maintaining intimate partner relationships, may be particularly pronounced for aging women living with HIV. However, research exploring the psychosocial needs of aging women with HIV is limited. Thus, the aim of this study was to explore factors that impact intimate partner relationships for older women with HIV. Nineteen women (mean age=56.79, SD=4.63 years) referred from Boston-area community organizations and hospitals completed in-depth individual interviews. Forty-seven percent of participants identified themselves as Black/African American, and 37% as White/Caucasian. Average time since diagnosis was 16.32 years (SD=5.70). Interviews continued until saturation of content was reached. Inclusion criteria included: biologically born female; aged 50 years or older; diagnosis of HIV/AIDS; and English speaking. Qualitative interviews were coded by two raters and content analyses were conducted using NVivo 9 software. The findings are described across the following three main themes: (1) stigma; (2) body image concerns; and (3) the disclosure dilemma. The themes and issues identified by this study may help guide sexual health-related interventions for older HIV-infected women.