Bisexual people's utilization of sexual health services at an LGBTQ Community Center in Chicago

Sexual health and wellbeing and the menopause: An EMAS clinical guide

INTRODUCTION

Sexual health and wellbeing are significant aspects of quality of life. However, taking a sexual history is often avoided in medical practice, leaving a void in management and awareness. As the menopause can have a major impact on sexual health, it is imperative that healthcare providers are appropriately trained in sexual health and wellbeing and the aligned disciplines in order to achieve optimal care.

AIM

To provide an evidence-based clinical guide for the assessment and management of sexual problems at the menopause and beyond.

MATERIALS AND METHODS

Review of the literature and consensus of expert opinion.

RESULTS AND CONCLUSION

The assessment of sexual problems includes history taking, examination and laboratory investigation (if indicated), and occasionally the use of specific validated questionnaires. Management of sexual problems requires a multidimensional approach using biopsychosocial measures. Medical management and psychosexual counselling include pharmacological and non-pharmacological interventions, and sex therapy and psychoeducation. Furthermore, perimenopausal women should be advised about the need for contraception if they wish to avoid pregnancy. Also, sexually transmitted diseases can be acquired at any age. To conclude, taking a sexual history should be incorporated into medical practice and healthcare providers should be appropriately trained to assess and manage sexual problems at the menopause and beyond.

Pre-exposure prophylaxis (PrEP) use, anticipated PrEP stigma, and bisexual identity among a Black and Hispanic/Latino sexual and gender diverse sample

Black and Hispanic/Latino sexual minority men and gender diverse (SMMGD) individuals are disproportionately impacted by the HIV epidemic. Uptake and adherence to pre-exposure prophylaxis (PrEP) is suboptimal among SMMGD Black and Hispanic/Latino individuals, but most research has approached this population as homogenous (e.g., a group operationalized as men who have sex with men). Bisexual men are less likely to disclose their sexual identity and report more mental health problems than their gay counterparts, but there is less attention to the impact of different sexual identities on PrEP use over time. We utilized data from three waves of a national longitudinal study (2020-2021) to characterize Black and Hispanic/Latino SMMGD participants' PrEP use including: 1) PrEP uptake during the study; 2) consistent PrEP use across the study; and 3) discontinuation of PrEP use since study baseline. We found bisexual men were significantly less likely than gay men to be consistent PrEP users and were more likely to discontinue PrEP use over the course of the study. Of the sample who reported PrEP use across surveys, 10% initiated PrEP during the study period, 0% of whom were bisexual. Additionally, bisexual participants reported statistically significantly higher anticipated PrEP stigma relative to gay participants. These findings have implications for HIV prevention interventions. Given the differences in PrEP experiences as a function of sexual identity, researchers and clinicians should consider the disruptive role of stigma (both biphobia and anticipated PrEP stigma) in PrEP care and adherence.

Nowhere to go? A study of marginalization, social connection, and mental health outcomes among young adults experiencing the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic onset necessitated large-scale closures of third places, potentially exacerbating social barriers experienced by young adults in the United States. To better understand the role of urban form in facilitating socialization, we examine the effects of pandemic-based third place closures on mental health outcomes as mediated by changes in social connection. Because identifying as a racial, gender, or sexual minority can compound baseline disadvantages rooted in systemic inequities, we investigate outcome differences for non-white, woman/nonbinary, and LGBTQ+ young adults to disentangle identity-based nuances of the pandemic experience.

METHODS

In February 2021, we administered a web-based survey with retrospective name and place generators to 313 18-to-34-year-olds in California, Illinois, and Texas. A structural equation model is estimated showing the direct and indirect effects of physical and virtual mobility constraints on mental health.

RESULTS

Both the closure of third places and dissatisfaction with alternative social spaces are associated with the deterioration of social connections and mental health. The strongest direct predictor of mental health decline is dissatisfaction with virtual socialization (more significant for women and nonbinary respondents). Surprisingly, two distinct categories of third places (i.e., 'civic' and 'commercial') reveal different relationships with social connections and mental health outcomes. Asian, other non-white, and non-heterosexual young adults experienced greater 'civic' visit reduction, while those with intersecting identities of low income and woman/nonbinary or Black experienced greater 'commercial' visit reduction.

CONCLUSIONS

Physical and virtual mobility reductions contributed to the inequitable mental health outcomes experienced by young adults during the pandemic. This highlights the potential for a careful redesign of physical and virtual social spaces to support feelings of belonging/safety and spontaneous 'weak tie' interactions, encourages further investigation of social infrastructure's role in facilitating the maintenance of social connections and mental health, and reveals the value of examining differences in mobility-related experiences across social identities.

Knowing the unknown: The underestimation of monkeypox cases. Insights and implications from an integrative review of the literature

Monkeypox is an emerging zoonotic disease caused by the monkeypox virus, which is an infectious agent belonging to the genus Orthopoxvirus. Currently, commencing from the end of April 2022, an outbreak of monkeypox is ongoing, with more than 43,000 cases reported as of 23 August 2022, involving 99 countries and territories across all the six World Health Organization (WHO) regions. On 23 July 2022, the Director-General of the WHO declared monkeypox a global public health emergency of international concern (PHEIC), since the outbreak represents an extraordinary, unusual, and unexpected event that poses a significant risk for international spread, requiring an immediate, coordinated international response. However, the real magnitude of the burden of disease could be masked by failures in ascertainment and under-detection. As such, underestimation affects the efficiency and reliability of surveillance and notification systems and compromises the possibility of making informed and evidence-based policy decisions in terms of the adoption and implementation of ad hoc adequate preventive measures. In this review, synthesizing 53 papers, we summarize the determinants of the underestimation of sexually transmitted diseases, in general, and, in particular, monkeypox, in terms of all their various components and dimensions (under-ascertainment, underreporting, under-detection, under-diagnosis, misdiagnosis/misclassification, and under-notification).

Bi Us, For Us: Articulating foundational principles for research in partnership with bisexual communities

Bisexual people comprise over half of all adults who identify as sexual minorities within the United States. Increasingly, population level health research has revealed that bisexual people face striking and broad-ranging health disparities compared not only to heterosexual people, but also often compared to their gay and lesbian peers. Despite the fact that bisexual people comprise an 'invisible majority' of LGBTQ people and are disproportionately impacted by poor health, the vast majority of funding dedicated to LGBTQ community organizing and to sexual and gender minority health research does not address the needs of bisexual people. Within this three-part article, we first describe how manifestations of systematic biphobia have led to the current situation where bisexual community organizations and bisexual health researchers are not granted adequate resources to address the health and health promotion of bisexual populations. In the second section, we articulate foundational ethical guiding principles and propose Bi Us, For Us, a new model to inform the design, evaluation, and implementation of intersectional bisexual community engaged research to inform the development of structural bisexual-specific health equity interventions. In the last section of this paper, we present the Chicago Bisexual Health Task Force as a case study of the model in action to illustrate a real-life approach that community engaged research and advocacy initiatives can take to promote bisexual health equity. We view this article as an invitation for dialogue about how to develop best practices to advance bisexual health equity and hope that it inspires additional bisexual people, organizers, and researchers to join in these pursuits.