A systematic review of stigma in sexual and gender minority health interventions

Cognitive behavioural therapy for internalizing symptoms in LGBTQ+ people: a preliminary meta-analysis

Internalizing disorders are common in lesbian, gay, bisexual, transgender, queer, questioning, and otherwise non-heterosexual or non-cisgender (LGBTQ+) people. Few studies have evaluated the efficacy of cognitive behavior therapy (CBT), a well-established treatment for internalizing disorders, in LGBTQ+ people. The current study quantitatively synthesized outcomes from existing trials of CBT for internalizing disorders in LGBTQ+ people. Seven databases were searched, identifying 14 relevant studies with a total of 414 participants. A medium within-group effect size was found for depressive symptoms from pre-treatment to post-treatment (k = 14; g = 0.60; 95% CI: 0.44-0.76; I2 = 71.59) and pre-treatment to 2-6-month follow-up (k = 7; g = 0.63; 95% CI: 0.40-0.86; I2 = 71.59). For anxiety and related disorder symptoms, a medium within-group effect size was found from both pre-treatment to post-treatment (k = 10; g = 0.73; 95% CI: 0.47-0.99; I2 = 71.59) and to 3-9-month follow-up (k = 5; g = 0.70; 95% CI: 0.54-0.87; I2 = 36.04). Exploratory analyses indicated small between-group effects at post-treatment between intervention and control groups. Effect sizes were comparable to those in the general population, indicating preliminary support for treating internalizing disorders in LGBTQ+ people with CBT.

Efficacy of videoconferencing-delivered cognitive behavioural therapy to reduce anxiety disorder severity in LGBTQ+ people: An exploratory trial protocol

OBJECTIVE

Cognitive behavior therapy (CBT) is a well-established treatment for anxiety disorders in the general population. However, the efficacy of CBT for lesbian, gay, bisexual, transgender, queer, questioning, and otherwise non-heterosexual or non-cisgender (LGBTQ+) people with anxiety disorders is still emerging in the literature. This protocol proposes an exploratory, two-group, randomized controlled trial comparing the efficacy of CBT for anxiety disorders against a waitlist control group.

METHODS

The trial will recruit 52 LGBTQ+ adults with a primary anxiety disorder diagnosis. The treatment will consist of videoconferencing-delivered CBT using the Unified Protocol (UP). The treatment will be provided in eight weekly individual sessions. Following treatment completion, the waitlist control participants will receive an LGBTQ+ adapted CBT intervention delivered via videoconferencing. The control group will receive the LGBTQ+ adapted UP in weekly sessions for eight weeks. Diagnostic status and symptom severity will be assessed at baseline, post-treatment, and three-month follow-up. Post-treatment qualitative exit interviews will collect participant perspectives on treatment acceptability.

RESULTS

Outcome measures will be compared across groups and benchmarked with existing literature to assess efficacy and feasibility, while qualitative analysis will explore intervention acceptability.

CONCLUSION

The results are anticipated to inform best-practice remote transdiagnostic treatment of anxiety disorders in LGBTQ+ people.

Sexual Minority Stress: Preliminary Evidence of Accelerated Pubertal Development in Early Adolescence

INTRODUCTION

Societal stressors place a tremendous burden on individuals who identify with a sexual minority identity. While minority stress experienced by racial/ethnic minority groups has been linked to accelerated aging, this link has yet to be examined among sexual minority youth. This study explores whether sexual minority youth who indicate experiencing stress at home or school (Minority Stress) due to their identity show evidence of accelerated aging (pubertal status or tempo) compared to those who do not report such experiences (No Minority Stress).

METHODS

Data are from the Adolescent Brain Cognitive Development (ABCD) Study. Participants were approximately 9-10 years old at baseline, 10-11 years old at Time 1, and 11-12 years old at Time 2. Measures included child-reports of sexual minority identity and stressors, and parent-reports of adolescent pubertal development.

RESULTS

Among 432 included participants who identified with a sexual minority identity, 83.6% were assigned female at birth and 24.8% were in the Minority Stress group. There were consistent results showing that sexual minority youth in the Minority Stress group showed accelerated pubertal status over time compared to those in the No Minority Stress group. Pubertal tempo (i.e., slope) was only accelerated for those who first identified as sexual minority at Time 2.

CONCLUSION

Our findings underscore that minority stress experienced by sexual minority youth may be linked to differences in pubertal development among these youth. The developmental and clinical implications of these patterns present critical lines for future research concerned with the wellbeing of sexual minority youth.

Assessing healthcare workers’ knowledge and confidence in the diagnosis, management and prevention of Monkeypox

BACKGROUND

Monkeypox (Mpox), is a disease of global public health concern, as it does not affect only countries in western and central Africa.

AIM

To assess Burundi healthcare workers (HCWs)s’ level of knowledge and confidence in the diagnosis and management of Mpox.

METHODS

We conducted a cross-sectional study via an online survey designed mainly from the World Health Organization course distributed among Burundi HCWs from June-July 2023. The questionnaire comprises 8 socioprofessional-related questions, 22 questions about Mpox disease knowledge, and 3 questions to assess confidence in Mpox diagnosis and management. The data were analyzed via SPSS software version 25.0. A P value < 0.05 was considered to indicate statistical significance.

RESULTS

The study sample comprised 471 HCWs who were mainly medical doctors (63.9%) and nurses (30.1%). None of the 22 questions concerning Mpox knowledge had at least 50% correct responses. A very low number of HCWs (17.4%) knew that Mpox has a vaccine. The confidence level to diagnose (21.20%), treat (18.00%) or prevent (23.30%) Mpox was low among HCWs. The confidence level in the diagnosis of Mpox was associated with the HCWs’ age (P value = 0.009), sex (P value < 0.001), work experience (P value = 0.002), and residence (P value < 0.001). The confidence level to treat Mpox was significantly associated with the HCWs’ age (P value = 0.050), sex (P value < 0.001), education (P value = 0.033) and occupation (P value = 0.005). The confidence level to prevent Mpox was associated with the HCWs’ education (P value < 0.001), work experience (P value = 0.002), residence (P value < 0.001) and type of work institution (P value = 0.003).

CONCLUSION

This study revealed that HCWs have the lowest level of knowledge regarding Mpox and a lack of confidence in the ability to diagnose, treat or prevent it. There is an urgent need to organize continuing medical education programs on Mpox epidemiology and preparedness for Burundi HCWs. We encourage future researchers to assess potential hesitancy toward Mpox vaccination and its associated factors.

Attitudes towards people living with HIV/AIDS through the EAPVVS-E: A descriptive analysis in nursing students

BACKGROUND

Despite advances in antiretroviral treatment, stigma towards people with HIV/AIDS continues to exist. Nursing students, as future key players in health care, must advocate for the elimination of stigma through education, empathy and the creation of a supportive environment. This holistic approach is crucial to improving their quality of life and moving towards the eradication of HIV/AIDS.

AIM

To identify nursing students' attitudes towards people living with HIV or AIDS and their relationship with sociodemographic and academic-cultural variables of the participants.

DESIGN

A cross-sectional study was performed.

SETTINGS

The research was carried out in the Nursing Degree of the Faculty of Health Sciences of the Ceuta Campus of the University of Granada.

PARTICIPANTS

Convenience sampling was used to recruit 284 students of the degree in Nursing.

METHODS

Data were collected voluntarily and on an anonymous basis, using the "Attitudes Towards People Living with HIV/AIDS Scale in Nursing Students". Bivariate and multivariate analyses were performed.

RESULTS

Factors 1 (Professional Practice), 2 (Social Integration) and 3 (Partner and Family) exhibited mean scores considered to be favourable attitudes (>4 points). In contrast, Factor 4, called Benevolent Stigma, had a mean score of 3.68 ± 0.97. Religious beliefs, academic year, sexual orientation, academic practices and age are considered influential variables in the different factors.

CONCLUSIONS

Nursing students present attitudes with favourable scores. However, these results highlight the importance of influencing the different factors, especially in the second year of the Bachelor's Degree in Nursing in our sample. Thus, an educational intervention in this area would be necessary to reinforce the values of humanised care.

Risk perception and mpox vaccine acceptability among people living with HIV in northern Nigeria

BACKGROUND

There is a dearth of information regarding mpox risk perception and vaccine acceptance among people living with human immunodeficiency virus (HIV), especially in countries with a dual burden of HIV and mpox, such as Nigeria.

METHODS

We used an explanatory mixed methods design and structured questionnaires administered to a clinic-based sample of people living with HIV (n=430), followed by in-depth interviews with a purposive subsample (n=20). Data were analysed using binary logistic regression and the framework approach.

RESULTS

More than one-third (38.1% [n=164]) of the respondents self-perceived a high risk of mpox and 64.4% (n=277) indicated a willingness to receive the vaccine. Willingness to accept the mpox vaccine was positively associated with male sex, older age, non-Muslim faith, unmarried status, post-secondary education and current civil service employment. The odds of accepting the mpox vaccine was also higher among respondents who perceived mpox as a serious disease (adjusted odds ratio [aOR] 1.41 [95% confidence interval {CI} 1.12 to 2.35]), self-assessed a higher risk (aOR 1.66 [95% CI 1.19 to 3.06]) and were concerned about contracting the disease (aOR 1.78 [95% CI 1.12 to 3.94]). Reasons for hesitancy included anxiety about vaccine-antiretroviral drug interactions, low risk perception, perceived protection from antiretroviral treatment, the newness of the vaccine, mistrust of authorities and pharmaceutical companies and concerns regarding vaccine safety.

CONCLUSIONS

Mpox risk perception and vaccine acceptance were suboptimal. Vaccine acceptance was influenced by sociodemographic, perceived susceptibility and health behaviour-related factors. Targeted risk communication will enhance acceptance of mpox vaccination among people living with HIV in Nigeria.

Unveiling the landscape of antistigma interventions for individuals with substance use disorders: A scoping review

Background

Stigma against persons living with substance use disorders (PLSUD) fosters social and health inequities.

Aim

We aimed to map different populations targeted by antistigma interventions, analyze specific characteristics of these interventions, and identify and categorize the theoretical frameworks used in these interventions.

Methods

We examined randomized controlled trials and quasi or pre-experimental studies targeting stigma against PLSUD. Using two English databases, our analysis involved mapping study populations, antistigma interventions, and trial characteristics through a narrative synthesis. We adhered to the Workgroup for Intervention Development and Evaluation Research (WIDER) checklist for assessing reporting quality. The Theoretical Domain Framework (TDF) identified intervention domains and constructs of the interventions.

Results

Of 698 studies, 29 met eligibility, with three from low-middle-income countries: 12 studies addressed the public, 11 self, and 5 structural stigmas. Reduction in stigma or improvements in knowledge of and attitude toward PLSUD was observed in 23 studies. Eight used social contact-based interventions, and one used direct social contact. Other interventions were psychoeducation, collaborative community care and linkage to social services, acceptance and commitment therapy, and gatekeepers' training. Five focused on injection drug use stigma; others were not substance-specific. Most studies reported the characteristics of the recipients (n = 28), mode of delivery (n = 28), and delivery settings (n = 24). Adherence to delivery protocol was the least reported (n = 5). The number of theoretical domains varied: 18 studies had 1-5 domains, 3 studies had 10, and 8 studies had 6-9 domains.

Conclusion

Social contact-based interventions show promise for PLSUD; future research must improve the quality of reporting and design theory-informed interventions.

Sexual and gender minority university students in the wake of COVID-19: Unique risks and opportunities for intervention

Emerging adulthood is a critical period of development as individuals explore their identities and embark on developmental trajectories. Emerging adulthood may be an especially important period for sexual and gender minority (SGM) individuals as they explore, learn, and seek out communities related to their sexuality and gender identity. College is a unique setting in which SGM students may have access to physical and mental healthcare, secure food and housing, and affirming spaces and community related to their identity. However, the COVID-19 pandemic has interrupted or ended many of the services and resources provided by colleges and universities, potentially exacerbating challenges faced by sexual and gender minority students. This article provides recommendations for colleges and universities to improve access to and mitigate potentially negative outcomes among SGM students during and in the wake of the COVID-19 pandemic.

Meeting people where they are: Crowdsourcing goal-specific personalized wellness practices

OBJECTIVES

Despite the development of efficacious wellness interventions, sustainable wellness behavior change remains challenging. To optimize engagement, initiating small behaviors that build upon existing practices congruent with individuals' lifestyles may promote sustainable wellness behavior change. In this study, we crowd-sourced helpful, flexible, and engaging wellness practices to identify a list of those commonly used for improving sleep, productivity, and physical, emotional, and social wellness from participants who felt they had been successful in these dimensions.

METHOD

We recruited a representative sample of 992 U.S. residents to survey the wellness dimensions in which they had achieved success and their specific wellness practices.

RESULTS

Responses were aggregated across demographic, health, lifestyle factors, and wellness dimension. Exploration of these data revealed that there was little overlap in preferred practices across wellness dimensions. Within wellness dimensions, preferred practices were similar across demographic factors, especially within the top 3-4 most selected practices. Interestingly, daily wellness practices differ from those typically recommended as efficacious by research studies and seem to be impacted by health status (e.g., depression, cardiovascular disease). Additionally, we developed and provide for public use a web dashboard that visualizes and enables exploration of the study results.

CONCLUSIONS

Findings identify personalized, sustainable wellness practices targeted at specific wellness dimensions. Future studies could leverage tailored practices as recommendations for optimizing the development of healthier behaviors.

Minority Stressors, Social Provisions, and Past-Year Suicidal Ideation and Suicide Attempts in a Sample of Sexual Orientation and Gender Identity/Expression Minority People in Canada

Purpose: Mental health disparities in sexual orientation and/or gender identity and/or expression (SOGIE) minority groups are well-documented, with research consistently showing higher levels of suicidality, even in Canada, considered one of the world's most accepting countries of SOGIE minority groups. Adverse outcomes in these groups are often framed using minority stress theory, with social support frequently studied as an integral buffer to these outcomes. This analysis explores facets of minority stress and social support associated with past-year suicidal ideation and suicide attempts. Methods: A cross-sectional internet survey of SOGIE diverse people in Canada (n = 1542) was conducted. Binary logistic regression calculated bivariate and multivariate factors associated with past-year suicidal ideation and suicide attempts. Backward elimination (retaining sociodemographic factors and self-rated mental health) identified salient minority stress and social support (provisions) factors. Results: Over half (56.72%) of participants had ever thought of dying by suicide, with 24.84% having attempted suicide. During the past year, 26.80% had thought of dying by suicide, with 5.32% having attempted suicide. Victimization events, and guidance (e.g., someone to talk to about important decisions) and attachment (e.g., close relationships providing emotional security) social provision subscales remained salient after backward elimination procedures. Conclusion: Our findings emphasize that a fulsome, multilevel approach considering structural, community, and individual strategies to address overt discrimination, integrating social connections and guidance, is necessary to prevent dying by suicide.

'It's not a me thing': the role of transcendence and critical politics in Black LGBTQ wellness in Montreal

This study explores well-being strategies and challenges for Black LGBTQ individuals in Montreal, Canada. Semi-structured interviews were conducted between March and May 2023 with key informants, or advocates and service providers for LGBTQ communities in the Montreal metropolitan area. Thematic analysis was used and involved transcription, memo-writing and a multi-step, inductive coding process using MAXQDA. The findings highlight three areas of well-noted challenges for Black LGBTQ individuals: systemic barriers; lack of targeted support; and challenges to accessing services. Two strategic domains emerged as innovative approaches to support well-being: transcendental practices and intersectional sociopolitical awareness raising. Transcendental practices, ranging from fine arts and dance to reiki energy healing, offered avenues for healing and community-building. Intersectional sociopolitical awareness was described as crucial in informing and contributing to existing efforts to improve well-being such as therapeutic engagement with clients and facilitating mutual aid. The identified transcendental practices and political awareness offer promising avenues for holistic well-being and comprehensive approaches to challenges such as inequitable HIV burden. Recognising the convergence of identities and social power axes can inform future interventions to foster more inclusive and empowering health strategies for Black LGBTQ communities.

Perceptions of a Cardiovascular Risk Reduction Intervention for Sexual Minority Adults

Sexual minority (SM) adults have a higher prevalence of risk factors for cardiovascular disease (CVD), largely attributable to increased exposure to minority stressors. There are no evidence-based CVD risk reduction interventions tailored to the needs of SM adults. We conducted a qualitative descriptive study to explore SM adults' perceptions and preferences for a culturally tailored, minority stress-informed intervention for CVD risk reduction. SM adults without CVD were interviewed and presented with a 10-week proposed intervention that combined elements of existing interventions for minority stress and CVD risk reduction. Participants were asked about preferences regarding intervention delivery methods, setting, and duration. Interviews were deductively coded into cognitive, behavioral, and socio-environmental themes informed by the Social Cognitive Theory. Themes were also inductively coded based on participant responses. The sample included 22 SM adults with a mean age of 52 (±7.16) years; approximately 55% were female-identified and 59% were non-Latinx White. Cognitive themes included recognition of stress associated with minoritized identities and self-efficacy for behavior change. Behavioral themes included stress management skills and maintaining a healthy lifestyle (e.g., exercise). Socio-environmental themes included barriers (e.g., time commitment) and facilitators (e.g., financial incentives) for participating in the proposed intervention. All participants were interested in an intervention that would improve their cardiovascular health. A majority indicated they preferred a 12-week, virtual, synchronous, group intervention. All participants endorsed the proposed intervention with particular emphasis on stress-reduction components. This study provides important knowledge that should be considered in designing tailored interventions for CVD risk reduction among SM adults.

Sexual orientation, gender identity and virologic failure among people with HIV: a cohort study in all of US research program

BACKGROUND

Sexual and gender minorities (SGMs) are at higher risk of HIV incidence compared to their heterosexual cisgender counterparts. Despite the high HIV disease burden among SGMs, there was limited data on whether they are at higher risk of virologic failure, which may lead to potential disease progression and increased transmission risk. The All of Us (AoU) Research Program, a national community-engaged program aiming to improve health and facilitate health equity in the United States by partnering with one million participants, provides a promising resource for identifying a diverse and large volunteer TGD cohort. Leveraging various data sources available through AoU, the current study aims to explore the association between sexual orientation and gender identity (SOGI) and longitudinal virologic failure among adult people with HIV (PWH) in the US.

METHODS

This retrospective cohort study used integrated electronic health records (EHR) and self-reported survey data from the All of Us (AoU) controlled tier data, version 7, which includes participants enrolled in the AoU research program from May 31, 2017, to July 1, 2022. Based on participants' sexual orientation, gender identity, and sex assigned at birth, their SOGI were categorized into six groups, including cisgender heterosexual women, cisgender heterosexual men, cisgender sexual minority women, cisgender sexual minority men, gender minority people assigned female at birth of any sexual orientation, and gender minority people assigned male at birth of any sexual orientation. Yearly virologic failure was defined yearly after one's first viral load testing, and individuals with at least one viral load test > 50 copies/mL during a year were defined as having virologic failure at that year. Generalized linear mixed-effects models were used to explore the association between SOGI and longitudinal virologic failure while adjusting for potential confounders, including age, race, ethnicity, education attainment, income, and insurance type.

RESULTS

A total of 1,546 eligible PWH were extracted from the AoU database, among whom 1,196 (77.36%) had at least one viral failure and 773 (50.00%) belonged to SGMs. Compared to cisgender heterosexual women, cisgender sexual minority women (adjusted Odds Ratio [aOR] = 1.85, 95% CI: 1.05-3.27) were at higher risk of HIV virologic failure. Additionally, PWH who were Black vs. White (aOR = 2.15, 95% CI: 1.52-3.04) and whose insurance type was Medicaid vs. Private insurance (aOR = 2.07, 95% CI: 1.33-3.21) were more likely to experience virologic failure.

CONCLUSIONS

Maintaining frequent viral load monitoring among sexual minority women with HIV is warranted because it allows early detection of virologic failure, which could provide opportunities for interventions to strengthen treatment adherence and prevent HIV transmission. To understand the specific needs of subgroups of SGMs, future research needs to examine the mechanisms for SOGI-based disparities in virologic failure and the combined effects of multi-level psychosocial and health behavior characteristics.

Day-to-day associations of intersectional minority stressors with sleep health in sexual and gender minority people of color

OBJECTIVE

To determine the day-to-day associations between minority stressors (i.e., anticipated and experienced discrimination) and sleep health outcomes (i.e., total sleep time (TST), sleep disturbances, and sleep-related impairment) among sexual and gender minority (SGM) people of color.

METHOD

An online sample of SGM people of color living in the United States participated in a 30-day daily diary study. Daily anticipated and experienced discrimination as well as subjective sleep outcomes were assessed via electronic diaries using validated measures. Wrist-worn actigraphy was used to objectively assess TST. Multilevel linear models (MLMs) were used to estimate the independent associations of daily intersectional minority stressors with subsequent sleep outcomes, adjusted for demographic factors and lifetime discrimination.

RESULTS

The sample included 43 SGM people of color with a mean age of 27.0 years (± 7.7) of which 84% were Latinx, 47% were multiracial, and 37% were bisexual. Results of MLMs indicated that greater report of daily experienced discrimination was positively associated with same-night sleep disturbances, B (SE) = 0.45 (0.10), p < .001. Daily anticipated discrimination was positively associated with sleep-related impairment on the following day, B (SE) = 0.77 (0.17), p < .001. However, daily anticipated and experienced discrimination were not associated with same-night TST.

CONCLUSIONS

Findings highlight the importance of considering the differential effects of daily intersectional minority stressors on the sleep health of SGM people of color. Further research is needed to identify factors driving the link between daily minority stressors and sleep outcomes to inform sleep health interventions tailored to this population. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Impact of Stigma and Sexual Identity on PrEP Awareness and Use Among At-Risk Men Who Have Sex With Men in Four U.S. Cities (HPTN 078)

Persistent pre-exposure prophylaxis (PrEP) use reduces the risk of HIV infection, yet uptake lags among those with the greatest need. Sexual identity stigma may be a significant barrier to PrEP awareness and use among high-risk communities. The primary aim of this study was to determine whether sexual identity was related to PrEP awareness and use. This multi-site HIV Prevention Trials Network (HPTN) study (HPTN 078) focuses on men who have sex with men (MSM) (n=335) who were HIV-negative at screening. The majority of participants were non-white (62.1%), younger than 35 (57.9%), single (79.1%), and aware of PrEP, yet had never taken PrEP (52.5%). Participants completed questionnaires including sexual history and identity; lesbian, gay, bisexual, transgender, queer (LGBTQ) community engagement; PrEP awareness and use; and several measures of sexual identity stigma including family and friend stigma, general societal stigma, and anticipated healthcare stigma. Univariate and multinomial logistic regression models helped to determine factors associated with PrEP awareness and use. There were stark disparities in PrEP awareness comparing Black and White participants; 50% of Black participants reported being PrEP unaware vs 11.8% of White participants. In this sample, gay sexual identity (compared to bisexual identity) was associated with increased PrEP awareness (AOR 6.66) and use (AOR 16.9). Additionally, 29% of the association between sexual orientation and PrEP use was mediated through internalized stigma. Given low PrEP uptake among MSM, interventions that address sexual identity stigma may motivate greater PrEP uptake.

Men who have sex with men experience low anxiety and few barriers to performing anal self or companion examinations: a qualitative study of the Prevent Anal Cancer Palpation Study

While rare in the larger population, anal cancer incidence is significantly higher in groups such as sexual minority men and people living with HIV. This qualitative analysis examined participants' experiences and perceptions of barriers to anal self-examination and anal companion examination through interviews completed as a part of a larger clinical trial. Interviews were conducted online with participants (n = 131) within a week of their baseline appointment between January 2020 and October 2021. Content analysis denoted participants' thoughts and perceptions about anal self-examination and anal companion examinations. Of the 131 cisgender men interviewed (mean age 49.9 years, SD 12.7), 92.4% identified as gay, 54.9% identified as white, 22.1% identified as Black, 19.9% identified as Latino, and 44.3% of participants were living with HIV. Participants did not report feelings of excessive anxiety when an abnormality was detected. However, three salient themes emerged as to why participants may not perform an anal self-examination or anal companion examination: (1) physical limitation(s), (2) potential sexualisation of the examination, and (3) level of comfort discussing anal health. Future work must continue to explore methods that not only decrease stigma surrounding anal health but also bolster feelings of accessibility to perform self and couple examinations.

Stigma, Mental Health, and Health care Use Among Rural Sexual and Gender Minority Individuals

Sexual and gender minorities (SGM) frequently experience depression and health care-related stigma. Health care satisfaction is important for seeking care, but little is known about SGM health care satisfaction, and especially as it relates to depression among rural SGM. From May 25 to July 2, 2021, we surveyed rural Illinois (IL) individuals aged ≥18 years on the topics of demographics, depression, health care satisfaction, past health care experiences, internalized stigma, and victimization. Among the 398 respondents, the gender identity distribution included cisgender males and females (171 and 203, respectively) and transgender males and females (8 and 7, respectively), while sexual orientation included heterosexuals (114), gay/lesbians (143), and other orientations (141). Analyses were conducted with respect to both identity and orientation (and their interaction). In univariate analysis, transgender individuals were more likely than cisgender to screen positive for depression and less likely to report feeling accepted by their medical provider. Compared to heterosexual respondents, gay/lesbians and other orientations were more likely to screen positive for depression. In logistic regression, factors associated with increased risk of depression included nonheterosexual orientation and past poor health care experiences. In linear regression, factors most commonly associated with the seven satisfaction subscales include: sexual orientation, past poor experiences, and employment. There were significant differences in depression across both sexual orientation and gender identity, and in health care satisfaction by sexual orientation. Rural SGMs are more vulnerable to depression and less likely to report satisfactory care. As health care engagement is critical for screening and care adherence, engaging rural SGM in a routine and satisfactory fashion is needed.

Reducing stigma and promoting HIV wellness/mental health of sexual and gender minorities: RCT results from a group-based programme in Nigeria

INTRODUCTION

High levels of HIV stigma as well as stigma directed towards sexual and/or gender minorities (SGMs) are well documented in the African setting. These intersecting stigmas impede psychosocial wellbeing and HIV prevention and care. Yet, there are few if any evidence-based interventions that focus on reducing internalized stigma and promoting mental health and HIV wellness for SGMs in Africa. We developed and evaluated a group-based intervention drawing on cognitive behavioural therapy (CBT) strategies for men who have sex with men (MSM) and transgender women (TGW) at risk for or living with HIV in Lagos, Nigeria.

METHODS

The intervention comprised four weekly in-person group sessions facilitated by community health workers. We conducted a delayed intervention group randomized controlled trial (April-September 2022), with pre-post surveys plus 3-month follow-up (immediate group only), as well as qualitative research with participants and programme staff. Outcomes included internalized stigma related to SGM and HIV status, depression, resiliency/coping and pre-exposure prophylaxis (PrEP)/HIV treatment use.

RESULTS

Mean age of the 240 participants was 26 years (range 18-42). Seventy-seven percent self-identified as MSM and 23% TGW; 27% were people with HIV. Most (88%) participants attended all four sessions, and 98% expressed high intervention satisfaction. There was significant pre-post improvement in each psychosocial outcome, in both the immediate and delayed arms. There were further positive changes for the immediate intervention group by 3-month follow-up (e.g. in intersectional internalized stigma, depression). While baseline levels of ever-PrEP use were the same, 75% of immediate-group participants reported currently using PrEP at 3 months post-intervention versus 53% of delayed-group participants right after the intervention (p<0.01). Participants post-intervention described (in qualitative interviews) less self-blame, and enhanced social support and resilience when facing stigma, as well as motivation to use PrEP, and indicated that positive pre-intervention changes in psychosocial factors found in the delayed group mainly reflected perceived support from the study interviewers.

CONCLUSIONS

This study demonstrated the feasibility and acceptability of a group-based CBT model for MSM and TGW in Nigeria. There were also some indications of positive shifts related to stigma, mental health and PrEP, despite issues with maintaining the randomized design in this challenging environment.

Healthcare providers perspectives on digital, self-guided mental health programs for LGBTQIA+ individuals: A cross-sectional online survey

Digital, self-guided mental health programs are a promising avenue for mental health support for LGBTQIA+ (lesbian, gay, bisexual, trans, Queer, intersex, asexual plus additional sexuality, gender, and romantic identities) people - however, healthcare providers (HCPs) perspectives on programs are largely unknown. The aim of this study was to explore these perspectives. A cross-sectional online survey was distributed across Australia, with a final sample of 540 HCPs from a range of disciplines. Most respondents (419, 81.2 %), reported that digital, self-guided mental health programs would be useful, but 74.5 % (n = 380) also reported that they had concerns. Thematic analysis of open-text responses showed that HCPs believe programs may help overcome access barriers and could be useful as part of a wider care journey. Others were concerned about patient safety, and whether programs could be appropriately tailored to LGBTQIA+ experiences. Content analysis of open-text responses showed affirming language and imagery, content on LGBTQIA+ people's unique challenges, wider health information, and connections to community were important to include in programs. HCPs advocated for programs that offered broad and sub-population specific information. These findings show that HCPs are enthusiastic about digital, self-guided mental health programs, but care should be taken to address key concerns to facilitate future implementation.

Intersectional stigma and the non-communicable disease syndemic in the context of HIV: protocol for a multisite, observational study in the USA

INTRODUCTION

The increasing burden of non-communicable diseases, such as hypertension, diabetes and dyslipidaemia, presents key challenges to achieving optimal HIV care outcomes among ageing people living with HIV. These diseases are often comorbid and are exacerbated by psychosocial and structural inequities. This interaction among multiple health conditions and social factors is referred to as a syndemic. In the USA, there are substantial disparities by social position (ie, racial, ethnic and socioeconomic status) in the prevalence and/or control of non-communicable diseases and HIV. Intersecting stigmas, such as racism, classism and homophobia, may drive these health disparities by contributing to healthcare avoidance and by contributing to a psychosocial syndemic (stress, depression, violence victimisation and substance use), reducing success along the HIV and non-communicable disease continua of care. Our hypothesis is that marginalised populations experience disparities in non-communicable disease incidence, prevalence and control, mediated by intersectional stigma and the psychosocial syndemic.

METHODS AND ANALYSIS

Collecting data over a 4 year period, we will recruit sexual minority men (planned n=1800) enrolled in the MACS/WIHS Combined Cohort Study, a long-standing mixed-serostatus observational cohort in the USA, to investigate the following specific aims: (1) assess relationships between social position, intersectional stigma and the psychosocial syndemic among middle-aged and ageing sexual minority men, (2) assess relationships between social position and non-communicable disease incidence and prevalence and (3) assess relationships between social position and HIV and non-communicable disease continua of care outcomes, mediated by intersectional stigma and the psychosocial syndemic. Analyses will be conducted using generalised structural equation models using a cross-lagged panel model design.

ETHICS AND DISSEMINATION

This protocol is approved as a single-IRB study (Advarra Institutional Review Board: Protocol 00068335). We will disseminate results via peer-reviewed academic journals, scientific conferences, a dedicated website, site community advisory boards and forums hosted at participating sites.

Sexualized substance use among gbMSM: Their perspectives on their intervention needs and counsellor competencies

INTRODUCTION

Treatments for problematic substance use by gay, bisexual and other men who have sex with men (gbMSM) in sexualized contexts must be adapted to take sociocultural aspects of these sexual practices into account. When treatment programs factor in sexuality, they most commonly address it from a biological perspective (STTBIs, HIV). This article sets out to identify intervention needs related to sexualized substance use (SSU) from the perspective of gbMSM, taking into consideration different dimensions of sexuality to offer more effective support.

METHODS

Twenty adult gbMSM, each of whom had previously participated in addiction-related treatment programs, took part in this study. We recruited through medical clinics, community organizations, social media advertising and word of mouth. Through one-on-one semi-structured interviews, participants shared their perspectives on the treatment they had received, how their sexuality had been addressed during treatment, and their perceptions of their treatment-related needs and requirements. The study analyzed and interpreted the data gathered during these interviews using a conceptual framework of sexual health combined with The Competencies, a model for addiction counselling training.

RESULTS

When the study asked participants what they would consider beneficial in terms of SSU-related treatment, they identified certain key competencies. These can be broken down into three categories - knowledge, skills and attitudes - that, together, participants perceived as critical to the development of adequate programs and services. While participants reported addiction-related knowledge was important, so too was an understanding of sexuality (e.g., sexual practices, gbMSM communities, sociocultural norms). With regard to attitudes, the study identified respect, non-judgment, acceptance and empathy as themes for most participants. Lastly, the desired skills were those permitting counsellors and other treatment providers to better align programs and services with each individual's singular reality within the context of their substance use.

CONCLUSIONS

The results of this study suggest that, to provide treatment programs adapted to the needs of gbMSM in a context of SSU, knowledge must be consolidated and new skills developed. Furthermore, both knowledge and skills need to be placed within an overarching perspective of cultural humility. Overall, improving these various competencies should improve the continuum of care in addiction treatment.

The Role of Minority Stress in Psychological Distress and Hazardous Drinking Among Sexual Minority College Student Victims of Intimate Partner Violence

Sexual minority, individuals who are not heterosexual, college students experience high rates of intimate partner violence (IPV), which is linked to a myriad of deleterious outcomes. However, little work has evaluated whether there are differences in IPV outcomes among sexual minority college students as compared to heterosexual college students. Further, the extent to which minority stress at the institutional and individual level relates to IPV outcomes among sexual minority students is understudied. As such, the purpose of the current study was to evaluate IPV outcomes in a large sample of undergraduate students attending 18 medium- to large-sized universities across the contiguous U.S. Results supported that sexual minority victims of IPV had more anxious and depressive symptoms than heterosexual victims of IPV but were not more likely to engage in hazardous drinking. Further, analyses supported that several campus-level (but not individual-level) indicators of minority stress moderated the relation between IPV victimization and negative outcomes among sexual minority students, such that the association between IPV and negative outcomes was stronger among students embedded in campuses with higher levels of minority stressors. Results support the critical importance of interventions addressing campus-level minority stressors to reduce deleterious IPV outcomes among sexual minority college student victims.

A systematic review and research agenda of internalized sexual stigma in sexual minority individuals: Evidence from longitudinal and intervention studies

Internalized sexual stigma is a well-established risk factor for poor mental health among sexual minority individuals. However, there has been no synthesis of the literature pertaining to risk and protective factors that influence the development of internalized sexual stigma over time. This systematic review presents findings from 31 studies addressing this question (n = 9192); 23 studies examined psychosocial and sociodemographic predictors of internalized sexual stigma among sexual minority individuals, and eight studies tested the effects of psychological interventions on internalized sexual stigma. Longitudinal studies highlight the stability of internalized sexual stigma over time, and the role of stigma and discrimination, proximal minority stressors (e.g., outness, concealment), and psychological factors (e.g., depressive and anxious symptoms, coping styles, and demoralization) in predicting subsequent internalized sexual stigma. Demographic factors appear to play only a limited role in predicting subsequent internalized sexual stigma. Finally, most intervention studies found no significant effects in reducing internalized sexual stigma, with three exceptions finding significant intervention effects among young sexual minority individuals. We conclude by outlining a theory-driven model of internalized stigma and a research agenda to test more nuanced models of internalized stigma that include multifactorial risk indices.

Exploring Aromanticism Through an Online Qualitative Investigation With the Aromantic Community: "Freeing, Alienating, and Utterly Fantastic"

Objective

To explore what aromanticism is, common misconceptions about this identity, and the experiences people have connecting with an aromantic identity.

Methods

An online, international open-ended survey with a convenience sample of aromantic individuals (N = 1642) analyzed with thematic analysis.

Results

To identify as aromantic involves a spectrum of experiences with romance commonly tied to experiencing stigma. Connecting with an aromantic identity allows for a greater understanding of the self and a connection to a community.

Conclusions

Future research is needed to explore the experiences and perspectives of this community to gather better understanding of their needs and how to prevent/limit stigmatizing experiences.

Examination of the Sexual and Negative Dating Inventory (SANDI) Among Sexual and Gender Minorities: An Analysis of Psychometrics and Outcomes

ObjectiveAdverse sexual experiences (ASE), including sexual violence, sexual risk behaviors, and regretted sex, are highly prevalent among sexual and gender minorities (SGM) compared to cisgender and heterosexual individuals. Research indicates ASEs are associated with increased mental health symptomatology and decreased subsequent protective behavior use. The Sexual and Negative Dating Inventory (SANDI) measures dating and sexual protective strategies and includes five factors: Location Sharing, Assertiveness, Self-Protection, Risk Reduction and Privacy. SANDI total scores are linked to lower ASEs in heteronormative samples. Method: SANDI was previously validated in a sample of n = 1,289 college students. Data were examined from n = 313 (24.28%) SGM individuals at baseline, and n = 95 at one-month follow-up. Individuals were 19.70 (2.98 SD) years old, and 25% were non-white. Model fit was adequate for SGM: χ2(484) = 1729.621, p < .001, CFI = .947, RMSEA = .063 (90% CI = .060, .066), SRMR = .048. Results: Non-cisgender men and non-heterosexual individuals endorse using more of the SANDI at the factor level. Using logistic regression, SANDI was not associated with history of sexual violence or sexual violence over the next month. SANDI is inversely associated with history of sexual risk and prospectively associated with less sexual risk over the next month. Negative binomial regression analyses showed SANDI was not associated with a history of regretted sex; however, SANDI was moderately associated with decreased regretted sex over the next month. Conclusion: Findings highlight the importance of dating and sexual protective behaviors across dimensions of gender and sexual orientation.

Substance Use and Misuse among Sexual and Gender Minority Communities Living in Former Soviet Union Countries: A Scoping Review

Objectives

We reviewed literature examining substance use among sexual and gender minorities (SGM) living in the former Soviet Union (USSR) nations.

Methods

Searches were conducted across five databases (PubMed, SocINDEX, CINAHL, PscyInfo, LGBTQ + Source) to identify peer-reviewed literature.

Results

Across 19 studies, high hazardous substance use prevalence was documented. Substance use was correlated with (a) sexual health and behaviors and (b) mental wellbeing and the use of other substances.

Conclusion

We discuss minority stress implications and challenges presented by the paucity of evidence in the literature examining substance use among SGM women and SGM living in countries unrepresented in reviewed studies.

A 4-year prospective investigation of predictive effects of prepandemic sexual stigma, affective symptoms, and family support on fear of COVID-19 among lesbian, gay, and bisexual individuals

Aim

This prospective study examined whether prepandemic sexual stigma, affective symptoms, and family support can predict fear of coronavirus disease 2019 (COVID-19) among lesbian, gay, and bisexual (LGB) individuals.

Methods

Data of 1,000 LGB individual on prepandemic sociodemographic characteristics, sexual stigma (familial sexual stigma [FSS] measured by the Homosexuality-Related Stigma Scale, internalized sexual stigma [ISS] measured by the Measure of Internalized Sexual Stigma for Lesbians and Gay Men, and sexual orientation microaggression [SOM] measured by the Sexual Orientation Microaggression Inventory), affective symptoms (i.e., depression measured by the Center for Epidemiologic Studies-Depression Scale and anxiety measured by the State-Trait Anxiety Inventory-State version), and family support measured by the Adaptability, Partnership, Growth, Affection, and Resolve Index were collected. Four years later, the fear of COVID-19 was assessed using the Fear of COVID-19 Scale and the associations of prepandemic sexual stigma, affective symptoms, and perceived family support on fear of COVID-19 4 years later were analyzed using multiple linear regression analysis.

Results

In total, 670 (67.3%) participants agreed and completed the follow-up assessment. Greater prepandemic FSS, ISS, SOM, affective symptoms, and perceived family support were significantly associated with a greater fear of COVID-19 at follow-up.

Conclusion

The identified predictors should be considered when designing interventions aimed at preventing and reducing the fear of COVID-19 in LGB individuals.

Efficacy of psychosocial interventions to reduce affective symptoms in sexual and gender minorities: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) individuals are more likely than cisgender heterosexuals to experience mental, physical, and sexual health issues. A promising contemporary strategy to address the issue of affective symptoms in sexual and gender minorities (SGM) is psychosocial intervention.

OBJECTIVE

To systematically evaluate the effect of psychosocial interventions on the improvement of affective symptoms in SGM, and to provide a reference for the implementation of effective psychological interventions for SGM with affective symptoms.

METHODS

Between the date of database construction until December 10, 2022, a computerized search of the English-language literature published both nationally and worldwide was done. 8 literature databases and 3 additional gray databases were searched. We gathered randomized controlled trials that used psychological interventions for SGM. To evaluate risk bias in included papers in accordance with Cochrane cooperation criteria, we used Review Manager 5.4 software. In conjunction with post-test and follow-up data, mean differences were standardized using Stata 12.0 software. Subgroup analysis was used to investigate the cause of heterogeneity. The study was conducted strictly in accordance with PRISMA guidelines, and it was registered on the PROSPERO platform (CRD42023408610).

RESULTS

This review covered 18 research, and 14 studies were included in the meta-analysis. A total of 1194 study cases, including 706 cases from the control group and 488 cases from the experimental group, were included in these investigations. Compared to the control group, the psychosocial intervention group had significantly lower levels of depression (standardized mean difference (SMD) = -0.17;95% CI = [-0.30, -0.04]; p = 0.012) and anxiety (SMD = -0.22; 95% CI = [-0.41, -0.04]; p = 0.01), but no significant differences were found for distress (SMD = -0.19; 95% CI = [-0.45,0.07]; p = 0.021).

CONCLUSION

According to this study, psychosocial interventions helped lessen the symptoms of depression and anxiety in SGM but had no significant effect on their psychological distress. To assess the impact of psychological intervention on SGM, more randomized controlled trials with larger sample sizes and numerous follow-up times should be done.

Positive and Negative Social Consequences of Participating in a Sexual-Network Study

Assessment of risks and benefits of study participation is standard practice preceding the initiation of human subjects research. Although tracking adverse events during research participation is routine, collecting information from participants about what they perceive as benefits is less common. We longitudinally tracked social risks and benefits of participation among a cohort of 241 men who have sex with men participating in a sexual health study to improve participants' experiences and enhance understanding of participant motivations to enroll and attend follow-up. Of the participants who returned for at least one follow-up visit (n = 217, 90%), most (n = 185, 85%) reported positive consequences resulting from participation. Reporting of negative social consequences was rare, and all concerned a stigmatized reaction from someone learning about the participant's involvement in a sexual health study. Better identification of both positive and negative consequences resulting from research participation may improve how researchers design, recruit, and conduct research.

Cognitive and Developmental Profiles Associated with Self-Reported Sexual and Gender Minority Stigmatization Among Binary Transgender Adolescents

OBJECTIVE

Sexual and gender minority (SGM) stigmatization is a key factor related to transgender adolescent mental health. While previous research has focused on direct associations between stigmatization and mental health, the present study of transgender youth, equitably recruited across the autism spectrum, examines cognitive and developmental factors in relation to the self-report of experienced and perceived SGM stigmatization.

METHOD

65 binary transgender adolescents (43% transfeminine; ages 13-21 years) were intentionally recruited across the spectrum of autism traits from no traits to full criteria autism. Participants completed measures of autism-related social differences, cognitive abilities, and self-reported directly experienced and perceived SGM stigma. Autism-related social differences, cognitive abilities, and age were studied in relation to both SGM stigma factors.

RESULTS

Autism-related social differences were negatively associated with level of directly experienced SGM stigma but unassociated with perceived stigma. Greater cognitive ability was positively associated with level of perceived SGM stigma, but unassociated with report of directly experienced stigma. Older age was positively associated with level of perceived SGM stigma. There was a statistical trend toward older age positively associated with level of directly experienced stigma.

CONCLUSIONS

The present study identifies candidate cognitive and developmental influences on self-reported SGM stigmatization among transgender adolescents, evenly recruited across the autism spectrum. The factors which may impact the perception and experience of stigmatization have been notably under-explored in the mental health field. The examination of these individual characteristics may allow for more precise predictive models for research with transgender youth, and ultimately, in clinical care.

Health disparities in one of the world's most progressive countries: a scoping review of mental health and substance use among sexual and gender minority people in the Netherlands

BACKGROUND

Evidence from many parts of the world shows that sexual and gender minority (SGM) people have poorer health than their cisgender heterosexual counterparts. Minority stressors, particularly stigma and discrimination, have been identified as major contributors to sexual orientation- and gender identity-related health disparities, particularly negative mental health and behavioral health outcomes. To better understand factors that contribute to these disparities, we conducted a scoping review of SGM mental health and substance use research in the Netherlands-a country with a long-standing reputation as a pioneer in SGM equality.

METHODS

Using Joanna Briggs Institute guidelines and the PRISMA-ScR protocol, we searched seven databases to identify studies published between 2010 and 2022 that focused on substance use and/or mental health of SGM youth and adults in the Netherlands.

RESULTS

Although there was some evidence that SGM people in the Netherlands report fewer substance use and mental health concerns than those in less progressive countries, with very few exceptions studies found poorer outcomes among SGM participants than cisgender, heterosexual participants. However, this observation must be considered cautiously given major gaps in the literature. For example, only one study focused exclusively on adult sexual minority women, two focused on older SGM adults, and very little attention was given to nonbinary individuals. Most studies used non-probability samples that were quite homogenous. Many studies, especially those with youth, assessed sexual orientation based on sexual attraction; some studies of adults operationalized SGM status as having a same-sex partner. Importantly, we found no studies that directly assessed associations between structural-level stigma and health outcomes. Studies were mostly focused at the individual level and on health problems; very little attention was given to strengths or resilience.

CONCLUSIONS

Findings of persistent health disparities-despite the relatively long history of SGM supportive policies in the Netherlands-highlight the need for more research and greater attention to population groups that have been underrepresented. Such research would not only provide guidance on strategies to improve the health of SGM people in the Netherlands, but also in other countries that are seeking to reduce health inequities. Addressing SGM health disparities in the Netherlands and elsewhere is complex and requires a multifaceted approach that addresses individual, interpersonal and structural factors.

Discrimination and adherence in a cross-sectional study of Latino sexual minority men with HIV: Coping with discrimination as a mediator and coping self-efficacy as a moderator

Discrimination is associated with antiretroviral therapy non-adherence and reduced well-being among people with HIV. We examined the potential for coping to mediate the associations between intersectional discrimination and non-adherence and coping self-efficacy (confidence in one's ability to cope with discrimination) as a moderator that may buffer the negative effects of discrimination on non-adherence in a cross-sectional convenience sample of 82 Latino sexual minority men with HIV. In bivariate linear regressions, discrimination targeting Latino ethnic origin, undocumented residency status, and sexual orientation were each significantly associated with lower self-reported antiretroviral therapy non-adherence (percentage of prescribed doses taken in the last month) and greater use of disengagement coping (denial, substance use, venting, self-blame, behavioral disengagement). Associations between discrimination targeting Latino ethnicity and non-adherence, and discrimination targeting undocumented residency status and non-adherence, were each mediated by disengagement coping responses. Moderation analyses highlighted significant discrimination by coping self-efficacy interaction effects-both coping self-efficacy for problem solving and stopping unpleasant emotions/thoughts each moderated the associations between Latino discrimination and adherence, between undocumented residency status discrimination and adherence, and between HIV discrimination and adherence. Coping self-efficacy for getting social support moderated the association between undocumented residency status discrimination and adherence. Further, the interaction coefficients across models indicated that the negative effects of discrimination on adherence were attenuated at higher levels of coping self-efficacy. Findings highlight the need for structural interventions that reduce-and ultimately eliminate-discrimination, and interventions that address the harmful effects of discrimination and adherence improvement interventions to enhance coping skills among people faced with intersectional discrimination.

iTHRIVE 365: A Community-Led, Multicomponent Health Promotion Intervention for Black Same Gender Loving Men

Although health inequities among Black same gender loving men (SGLM) are well documented (e.g., chronic psychological disorders, HIV, suicide), there are few accessible, culturally affirming, and community-led interventions designed to reduce these inequities. The present manuscript describes the process through which we developed iTHRIVE 365, a multicomponent health-promotion intervention designed by Black SGLM for Black SGLM. We utilized a community-based participatory research approach (CBPR) that included collaboration between THRIVE SS, a Black SGLM-run community-based organization, and a multisectoral team of public health, research, and digital design professionals to develop the intervention. A five-phase development process included four phases of focus groups and a technical pilot to assess community priorities and incorporate input on each feature of the intervention. Directed content analysis indicated that participants wanted a multicomponent and technology-mediated intervention that promotes health knowledge and motivation, Black SGLM social support, access to affirming healthcare, and housing and economic resources. iTHRIVE 365 combines multilevel and culturally affirming intervention features to combat the effects of oppression and ultimately promote Black SGLM's biopsychosocial health.

Indigenous gender and wellness: a scoping review of Canadian research

This scoping review examined research publications related to health and/or wellness along with gender among Canadian Indigenous populations. The intent was to explore the range of articles on this topic and to identify methods for improving gender-related health and wellness research among Indigenous peoples. Six research databases were searched up to 1 February 2021. The final selection of 155 publications represented empirical research conducted in Canada, included Indigenous populations, investigated health and/or wellness topics and focused on gender. Among the diverse range of health and wellness topics, most publications focused on physical health issues, primarily regarding perinatal care and HIV- and HPV-related issues. Gender diverse people were seldom included in the reviewed publications. Sex and gender were typically used interchangeably. Most authors recommended that Indigenous knowledge and culture be integrated into health programmes and further research. More health research with Indigenous peoples must be conducted in ways that discern sex from gender, uplift the strengths of Indigenous peoples and communities, privilege community perspectives, and attend to gender diversity; using methods that avoid replicating colonialism, promote action, change stories of deficit, and build on what we already know about gender as a critical social determinant of health.

Investigating the Associations of Sexual Minority Stressors and Incident Hypertension in a Community Sample of Sexual Minority Adults

BACKGROUND

Sexual minority adults are at higher risk of hypertension than their heterosexual counterparts. Sexual minority stressors (i.e., unique stressors attributed to sexual minority identity) are associated with a variety of poor mental and physical health outcomes. Previous research has not tested associations between sexual minority stressors and incident hypertension among sexual minority adults.

PURPOSE

To examine the associations between sexual minority stressors and incident hypertension among sexual minority adults assigned female sex at birth.

METHODS

Using data from a longitudinal study, we examined associations between three sexual minority stressors and self-reported hypertension. We ran multiple logistic regression models to estimate the associations between sexual minority stressors and hypertension. We conducted exploratory analyses to determine whether these associations differed by race/ethnicity and sexual identity (e.g., lesbian/gay vs. bisexual).

RESULTS

The sample included 380 adults, mean age 38.4 (± 12.81) years. Approximately 54.5% were people of color and 93.9% were female-identified. Mean follow-up was 7.0 (± 0.6) years; during which 12.4% were diagnosed with hypertension. We found that a 1-standard deviation increase in internalized homophobia was associated with higher odds of developing hypertension (AOR 1.48, 95% Cl: 1.06-2.07). Stigma consciousness (AOR 0.85, 95% CI: 0.56-1.26) and experiences of discrimination (AOR 1.07, 95% CI: 0.72-1.52) were not associated with hypertension. The associations of sexual minority stressors with hypertension did not differ by race/ethnicity or sexual identity.

CONCLUSIONS

This is the first study to examine the associations between sexual minority stressors and incident hypertension in sexual minority adults. Implications for future studies are highlighted.

Digital mental health interventions: A narrative review of what is important from the perspective of LGBTQIA+ people

OBJECTIVES

Digital mental health interventions are a promising therapeutic modality to provide psychological support to LGBTQIA+ (lesbian, gay, bisexual, trans, Queer, intersex, asexual, plus other gender, sexual, and romantic minority identities) people. The aim of this narrative review is to explore how the LGBTQIA+ community has been engaged in the design of digital mental health interventions, how content has been tailored to the LGBTQIA+ community, and features identified as important by LGBTQIA+ participants.

METHODS

A total of 33 studies were included in this review from a larger yield of 1933 identified from systematic searches of five databases (PsycINFO, PubMed, Scopus, CINAHAL, and Medline). Data were analyzed narratively and using content analysis.

RESULTS

Only half of the studies reported engaging the LGBTQIA+ community in intervention designs. Interventions have been tailored in a variety of ways to support LGBTQIA+ individuals-such as through affirming imagery, recruitment through LGBTQIA+ networks, and designing content to focus specifically on LGBTQIA+ issues. A range of features were identified as important for participants, namely how content was tailored to LGBTQIA+ experiences, providing connection to community, and links to other relevant LGBTQIA+ resources. While not a primary aim, results also showed that a wide range of digital modalities can significantly improve a range of mental health problems.

CONCLUSION

Digital interventions are an acceptable and effective form of therapeutic intervention, but future research needs to focus on meaningful engagement of community members to inform design and implementation.

Double Disparity of Sexual Minority Status and Rurality in Cardiometabolic Hospitalization Risk: A Secondary Analysis Using Linked Population-Based Data

Studies have shown separately that sexual minority populations generally experience poorer chronic health outcomes compared with those who identify as heterosexual, as do rural populations compared with urban dwellers. This Canadian national observational study explored healthcare patterns at the little-understood intersections of lesbian, gay, or bisexual (LGB) identity with residence in rural and remote communities, beyond chronic disease status. The secondary analysis applied logistic regressions on multiple linked datasets from representative health surveys, administrative hospital records, and a geocoded index of community remoteness to examine differences in the risk of potentially avoidable cardiometabolic-related hospitalization among adults of working age. Among those with an underlying cardiometabolic condition and residing in more rural and remote communities, a significantly higher hospitalization risk was found for LGB-identified persons compared with their heterosexual peers (odds ratio: 4.2; 95% confidence interval: 1.5-11.7), adjusting for sociodemographic characteristics, behavioral risk factors, and primary healthcare access. In models stratified by sex, the association remained significant among gay and bisexual men (5.6; CI: 1.3-24.4) but not among lesbian and bisexual women (3.5; CI: 0.9-13.6). More research is needed leveraging linkable datasets to better understand the complex and multiplicative influences of sexual minority status and rurality on cardiometabolic health to inform equity-enhancing preventive healthcare interventions.

Randomized evaluation of an online single-session intervention for minority stress in LGBTQ+ adolescents

Background

LGBTQ+ youth face myriad adverse health outcomes due to minority stress, creating a need for accessible, mechanism-targeted interventions to mitigate these minority stress-related risk factors. We tested the effectiveness and acceptability of Project RISE, an online single-session intervention designed to ameliorate internalized stigma and improve other outcomes among LGBTQ+ youth. We hypothesized that youth assigned to RISE (versus a control) would report significantly reduced internalized stigma and increased identity pride at post-intervention and at two-week follow-up and would find RISE acceptable.

Methods

We recruited adolescents nationally through Instagram advertisements in May 2022 (N = 538; M age = 15.06, SD age = 0.97). Participants were randomly assigned to RISE or an information-only control and completed questionnaires pre-intervention, immediately post-intervention, and two weeks post-intervention. Inclusion criteria included endorsing: (1) LGBTQ+ identity, (2) age 13-16, (3) English fluency (4) Internet access, and (5) subjective negative impact of LGBTQ+ stigma.

Results

Relative to participants in the control condition, participants who completed RISE reported significant decreases in internalized stigma (d = -0.49) and increases in identity pride (d = 0.25) from pre- to immediately post-intervention, along with decreased internalized stigma (d = -0.26) from baseline to two-week follow-up. Participants rated both RISE and the information-only control as highly, equivalently acceptable.

Conclusions

RISE appears to be an acceptable and useful online SSI for LGBTQ+ adolescents, with potential to reduce internalized stigma in both the short- and longer-term. Future directions include evaluating effects of Project RISE over longer follow-ups and in conjunction with other mental health supports.

Understanding why racial/ethnic inequities along the HIV care continuum persist in the United States: a qualitative exploration of systemic barriers from the perspectives of African American/Black and Latino persons living with HIV

BACKGROUND

Racial/ethnic inequities along the HIV care continuum persist in the United States despite substantial federal investment. Numerous studies highlight individual and social-level impediments in HIV, but fewer foreground systemic barriers. The present qualitative study sought to uncover and describe systemic barriers to the HIV care continuum from the perspectives of African American/Black and Latino persons living with HIV (PLWH) with unsuppressed HIV viral load, including how barriers operated and their effects.

METHODS

Participants were African American/Black and Latino PLWH with unsuppressed HIV viral load (N = 41). They were purposively sampled for maximum variability on key indices from a larger study. They engaged in semi-structured in-depth interviews that were audio-recorded and professionally transcribed. Data were analyzed using directed content analysis.

RESULTS

Participants were 49 years old, on average (SD = 9), 76% were assigned male sex at birth, 83% were African American/Black and 17% Latino, 34% were sexual minorities (i.e., non-heterosexual), and 22% were transgender/gender-nonbinary. All had indications of chronic poverty. Participants had been diagnosed with HIV 19 years prior to the study, on average (SD = 9). The majority (76%) had taken HIV medication in the six weeks before enrollment, but at levels insufficient to reach HIV viral suppression. Findings underscored a primary theme describing chronic poverty as a fundamental cause of poor engagement. Related subthemes were: negative aspects of congregate versus private housing settings (e.g., triggering substance use and social isolation); generally positive experiences with health care providers, although structural and cultural competency appeared insufficient and managing health care systems was difficult; pharmacies illegally purchased HIV medication from PLWH; and COVID-19 exacerbated barriers. Participants described mitigation strategies and evidenced resilience.

CONCLUSIONS

To reduce racial/ethnic inequities and end the HIV epidemic, it is necessary to understand African American/Black and Latino PLWH's perspectives on the systemic impediments they experience throughout the HIV care continuum. This study uncovers and describes a number of salient barriers and how they operate, including unexpected findings regarding drug diversion and negative aspects of congregate housing. There is growing awareness that systemic racism is a core determinant of systemic barriers to HIV care continuum engagement. Findings are interpreted in this context.

Predicting the Influences of Depression and Sexual Stigma on Motivation to Get Vaccinated against COVID-19 in Lesbian, Gay, and Bisexual Young Adults: A 4-Year Follow-Up Study

Vaccination is a crucial preventive measure against COVID-19. However, limited research has focused on identifying the factors predicting motivation to get vaccinated against COVID-19 (MoVAC-19) among lesbian, gay, and bisexual (LGB) individuals. This study examined the predictive effects of depression and sexual stigma (i.e., perceived sexual stigma from family members, perceived sexual orientation microaggression, and internalized sexual stigma) before the COVID-19 pandemic on MoVAC-19 among LGB individuals 4 years later during the COVID-19 pandemic in Taiwan. Baseline data related to depression and sexual stigma were collected in 2018 and 2019. Depression was assessed using the 20-item Mandarin Chinese version of the Center for Epidemiologic Studies Depression Scale. Perceived sexual stigma from family members was assessed using the Homosexuality-Related Stigma Scale. Internalized sexual stigma was assessed using the Measure of Internalized Sexual Stigma for Lesbians and Gay Men. Perceived sexual orientation microaggression was assessed using the Sexual Orientation Microaggression Inventory. Participant MoVAC-19 during the pandemic was assessed using the nine-item Motors of COVID-19 Vaccination Acceptance Scale. The associations of depression and sexual stigma at baseline with MoVAC-19 at follow-up were examined through multivariate linear regression analysis. Internalized sexual stigma was negatively associated with MoVAC-19, whereas perceived sexual orientation microaggression was positively associated with MoVAC-19. Depression and perceived sexual stigma from family members were not significantly associated with MoVAC-19. Although male sex and older age were positively associated with increased MoVAC-19, sex and age did not moderate the relationship between sexual stigma and motivation to get vaccinated. Among LGB individuals, sexual stigma experiences should be considered when developing intervention strategies aimed at enhancing MoVAC-19.

Toward Cognitive-Behavioral Therapy for Sexual Minority Women: Voices From Stakeholders and Community Members

Sexual minority women (SMW) experience an elevated risk of mental health problems compared to heterosexual women. However, knowledge gaps remain regarding whether cognitive-behavioral therapy (CBT) interventions meet SMW's mental health needs. Further, virtually no studies have integrated stakeholder (i.e., researchers with content expertise in SMW's health and clinical providers who work with SMW) and community member (i.e., SMW) perspectives to identify CBT approaches that address SMW-specific issues. This study used qualitative data gathered from 39 SMW who reported depression, anxiety, suicidality, and heavy drinking in the past 3 months and 16 content experts and clinical providers to obtain information relevant to enhancing CBT for SMW. In addition, we used thematic analysis to identify themes related to the adaptation and delivery of CBT for SMW. Building on prior literature, this study's findings revealed seven considerations for delivering mental health services to SMW: (1) attending to SMW's diverse gender identities and expressions; (2) focusing on SMW's nonbinary stressors; (3) formulating SMW's gender-based stressors within a feminist framework; (4) applying intersectionality frameworks; (5) incorporating issues of diversity, multiculturalism, and social justice; (6) addressing the role of trauma exposure; and (7) addressing the role of alcohol use in SMW's lives. These considerations are reviewed in terms of their implications for clinical practice, with a focus on enhancing applications of existing CBT interventions, to best respond to the unique needs of this population.

Barriers and facilitators of HPV vaccination in sub-saharan Africa: a systematic review

BACKGROUND

Human Papilloma Virus (HPV) is the most common sexually transmitted infection worldwide. Globally, both men and women have a 50% risk of being infected at least once in their life. HPV prevalence is among the highest in sub-Saharan Africa (SSA), at an average of 24%. HPV causes different types of cancers, including cervical cancer (CC), which is the leading cause of cancer deaths among women in SSA. HPV-vaccination has been proven to be effective in reducing HPV induced cancers. SSA countries are delayed in reaching the WHO's target of fully vaccinating 90% of girls within the age of 15 by 2030. Our systematic review aims to identify barriers and facilitators of HPV-vaccination in SSA to inform national implementation strategies in the region.

METHODS

This is a mixed method systematic review based on the PRISMA statement and The Joanna Briggs Institute Reviewers' Manual. Search strategies were adapted to each selected database: PubMed/MEDLINE, Livivo, Google Scholar, Science Direct, and African Journals Online for papers published in English, Italian, German, French and Spanish between 1 December 2011 and 31 December 2021. Zotero and Rayyan were the software used for data management. The appraisal was conducted by three independent reviewers.

RESULTS

A total of 20 articles were selected for appraisal from an initial 536 articles. Barriers included: limited health system capacities, socio-economic status, stigma, fear and costs of vaccines, negative experience with vaccinations, COVID-19 pandemic, lack of correct information, health education (HE) and consent. Additionally, we found that boys are scarcely considered for HPV-vaccination by parents and stakeholders. Facilitators included: information and knowledge, policy implementation, positive experience with vaccinations, HE, stakeholders' engagement, women's empowerment, community engagement, seasonality, and target-oriented vaccination campaigns.

CONCLUSIONS

This review synthesizes barriers and facilitators of HPV-vaccinations in SSA. Addressing these can contribute to the implementation of more effective HPV immunization programs targeted at eliminating CC in line with the WHO 90/70/90 strategy.

REGISTRATION AND FUNDING

Protocol ID: CRD42022338609 registered in the International Prospective Register of Systematic Reviews (PROSPERO). Partial funds: German Centre for Infection research (DZIF) project NAMASTE: 8,008,803,819.

Program Evaluation: exploring health disparities that impact chronic pain referrals within a VA Health Care System

Introduction

The present Program Evaluation study examines sociodemographic characteristics of Veterans in the Phoenix VA Health Care System who have back pain, and specifically the likelihood of those characteristics being associated with a referral to the Chronic Pain Wellness Center (CPWC) in the year 2021. We examined the following characteristics: Race/ethnicity, gender, age, mental health diagnosis, substance use disorder diagnosis, and service-connected diagnosis.

Methods

Our study used cross sectional data from the Corporate Data Warehouse for 2021. 13624 records had complete data for the variables of interest. Univariate and multivariate logistic regression was used to determine the likelihood of patients' being referred to the Chronic Pain Wellness Center.

Results

The multivariate model found under-referral to be significant for younger adults and for patients who identified as Hispanic/Latinx, Black/African American, or Native American/Alaskan. Those with depressive disorders and opioid use disorders, on the other hand, were found to be more likely to be referred to the pain clinic. Other sociodemographic characteristics were not found to be significant.

Discussion

Study limitations include the use of cross-sectional data, which cannot determine causality, and the inclusion of patients only if the ICD-10 codes of interest were recorded for an encounter in 2021 (i.e., a prior history of a particular diagnosis was not captured). In future efforts, we plan to examine, implement, and track the impact of interventions designed to mitigate these identified disparities in access to chronic pain specialty care.

A Scoping Review on COVID-19 Vaccine Hesitancy among the Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual (LGBTQIA+) Community and Factors Fostering Its Refusal

BACKGROUND

The ramifications of the existing crisis caused by the coronavirus pandemic are sensed in all walks of life. Among the various efforts made to curb the spread of this novel infection, the development of COVID-19 vaccines had a profound role in flattening the pandemic curve. Even though the rapid vaccine drive received a highly welcoming response among people, the reluctance and ignorance of a part of the population towards available safe vaccines stand as impediments to achieving the desired outcome. The LGBTQIA+ (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual) communities are the least studied groups in this regard.

OBJECTIVE

The purpose of this study is to extensively review and report on COVID-19 vaccine uptake and refusal among the LGBTQIA+ population and enumerate the factors contributing to vaccine hesitancy. The study extends further to outline a conceptual framework for interventions to enhance COVID-19 vaccine acceptance among the LGBTQIA+ population.

METHODS

We performed a systematic search using key terms on Google Scholar and PubMed. The obtained results were filtered using the eligibility criteria framed for this study. The initial search provided an extensive result of 4510 articles which were later screened at various levels to arrive at the final inclusive collection of manuscripts adding to 17. The studies were analyzed by the authors individually, and the data were categorized using variables. The results are interpreted using charts and graphs. The whole manuscript has been structured in accordance with the PRISMA extension for scoping reviews.

RESULT

The comprehensive search yielded 17 eligible articles for this review. Most of the studies were conducted in the United States (n = 17), and predominantly cross-sectional studies have been conducted. The major comparative factor was the HIV status of the LGBTQIA+ population. HIV-affected patients were more willing to take up COVID-19 vaccination. However, social stigma, discrimination, lack of access and non-prioritization in vaccine drives were found to be the major factors contributing to vaccine hesitancy among this population.

CONCLUSION

The invention of the COVID-19 vaccination revolutionized the healthcare systems burdened with COVID-19. Although this is a breakthrough scientific contribution, many factors are associated with the rate of vaccine acceptance, especially among sexual and gender minorities. The reviewed studies have revealed numerous factors that influence vaccine uptake and refusal with the commonest being concerns on discrimination, social stigma, inequitable access to healthcare, vaccine safety, efficacy, potency, side effects and lack of trust in medical workers. These impediments in vaccine coverage should be meticulously addressed to ensure optimum LGBTQIA+ physical and mental health as well as for providing non-discriminative, equitable and quality healthcare service regardless of the gender or sexual orientation of individuals.

Intersectional stigma subgroup differences in unhealthy drinking and disordered marijuana use among Black and Latino cisgender sexual minority young men

BACKGROUND

We investigated associations of intersectional stigma subgroups with alcohol and marijuana use among Black and Latino sexual minority young men. Subgroups included Minimal Stigma (low to no stigma), Select Social Stigma (occasional stigma in social relationships), Multiform Heterosexism (internalized and interpersonal heterosexism from family/friends), Multiform Racism (racism across diverse contexts), Compound Stigma (frequent, ubiquitous racism and heterosexism).

METHODS

Cohort of Black and Latino cisgender sexual minority young men (n = 414; baseline ages 16-25) surveyed semiannually 2016-2019. Generalized estimating equations integrated with latent class analysis modeled linear and quadratic age effects and association of stigma subgroups with past 6-month alcohol use, marijuana use, unhealthy drinking, and marijuana use disorder symptoms.

RESULTS

All past 6-month substance use peaked between ages 21-23 years old. Across all ages and relative to Minimal Stigma, odds of drinking were higher in every subgroup and highest in Compound Stigma (OR=2.72, 95% CI 1.17-6.35); unhealthy drinking was higher in every subgroup and highest in Multiform Heterosexism (β = 3.31, 95% CI 1.92-3.89); marijuana use disorder symptoms were higher in most subgroups and highest in Compound Stigma (β = 1.30, 95% CI 0.76-1.85). Marijuana use odds did not differ among groups.

CONCLUSION

By examining intersectional stigma subgroups, we identified subgroups for whom substance use was elevated during a development period when use tends to be highest. Young men experiencing stigma patterns characterized primarily by heterosexism or heterosexism together with racism may be especially at risk for developing unhealthy drinking behaviors and marijuana use disorder symptoms.

Examining the role of problematic drug use in the relationship between discrimination and sleep disturbance in transgender and nonbinary individuals

OBJECTIVE

Transgender and nonbinary (TGNB) individuals are a health disparity population at high risk for sleep disturbance (e.g., insomnia). Recent evidence suggests minority stress (e.g., discrimination) is associated with sleep disturbance in TGNB adults. However, investigators have yet to identify factors that might explain this relationship. In this study, we investigated the role of problematic drug use (PDU) in the relationship between discrimination and sleep disturbance in TGNB individuals.

METHODS

The study sample included 194 TGNB participants from Wave 5 (2021) of Project AFFIRM, a multi-site longitudinal study of transgender health. Discrimination, PDU, and sleep disturbance were measured using the Everyday Discrimination Scale, Drug Use Disorders Identification Test (DUDIT), and PROMIS Sleep Disturbance measures, respectively. Individuals were classified as having PDU using established DUDIT criteria that were applied based on sex assigned at birth. Regression analyses were used to estimate the associations of study variables, and subsequently, mediation analysis was used to determine whether PDU partially mediated the association between discrimination and sleep disturbance.

RESULTS

Nearly half of participants reported PDU, of which 83.2% reported cannabis use. Higher levels of discrimination were associated with worse self-reported sleep disturbance scores. Additionally, participants with greater discrimination were more likely to have PDU. Surprisingly, participants with PDU had lower sleep disturbance scores.

CONCLUSIONS

Our cross-sectional findings suggest that PDU partially suppressed the association between discrimination and sleep disturbance in TGNB people. Efforts to address PDU in TGNB adults may consider assessing sleep disturbance as a motivating factor for drug use and the potential role of discrimination in perpetuating PDU.