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Souleymanov R, Star J, McLeod A, Amjad S, Moore S, Campbell C, Lorway R, Payne M, Ringaert L, Larcombe L, Restall G, Migliardi P, Magwood B, Lachowsky NJ, Brennan DJ, Sharma UN. Relationship between sociodemographics, healthcare providers' competence and healthcare access among two-spirit, gay, bisexual, queer and other men who have sex with men in Manitoba: results from a community-based cross-sectional study. BMJ Open 2022; 12:e054596. [PMID: 35105639 PMCID: PMC8804644 DOI: 10.1136/bmjopen-2021-054596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Little is known about barriers to healthcare access for two-spirit, gay, bisexual and queer (2SGBQ+) men in Manitoba. DESIGN Data were drawn from a community-based, cross-sectional survey designed to examine health and healthcare access among 2SGBQ+ men. SETTING Community-based cross-sectional study in Manitoba, Canada. PARTICIPANTS Community-based sample of 368 2SGBQ+ men. OUTCOMES Logistic regression analyses assessed the relationship between sociodemographics, healthcare discrimination, perceived healthcare providers' 2SGBQ+ competence/knowledge and two indicators of healthcare access (analytic outcome variables): (1) having a regular healthcare provider and (2) having had a healthcare visit in the past 12 months. RESULTS In multivariate analyses, living in Brandon (adjusted OR (AOR)=0.08, 95% CI 0.03 to 0.22), small cities (AOR=0.20, 95% CI 0.04 to 0.98) and smaller towns (AOR=0.26, 95% CI 0.08 o 0.81) in Manitoba (compared with living in Winnipeg), as well as having a healthcare provider with poor (AOR=0.19, 95% CI 0.04 to 0.90) or very poor competence/knowledge (AOR=0.03, 95% CI 0.03 to 0.25) of 2SGBQ+ men's issues (compared with very good competence) was associated with lower odds of having a regular healthcare provider. Living in Brandon (AOR=0.05, 95% CI 0.02 to 0.17) and smaller towns (AOR=0.25, 95% CI 0.67 to 0.90) in Manitoba (compared with living in Winnipeg) was associated with lower odds of having a healthcare visit in the past 12 months, while identifying as a gay man compared with bisexual (AOR=12.57, 95% CI 1.88 to 83.97) was associated with higher odds of having a healthcare visit in the past 12 months. CONCLUSIONS These findings underscore the importance of reducing the gap between the healthcare access of rural and urban 2SGBQ+ men, improving healthcare providers' cultural competence and addressing their lack of knowledge of 2SGBQ+ men's issues.
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Affiliation(s)
- Rusty Souleymanov
- Faculty of Social Work, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jared Star
- Department of Community Health Sciences, Rady Faculty of Health Sciences University of Manitoba, Winnipeg, Manitoba, Canada
| | - Albert McLeod
- Two-Spirited People of Manitoba, Winnipeg, Manitoba, Canada
| | - Sana Amjad
- Department of Community Health Sciences, Rady Faculty of Health Sciences University of Manitoba, Winnipeg, Manitoba, Canada
| | - Samantha Moore
- Department of Community Health Sciences, Rady Faculty of Health Sciences University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Robert Lorway
- Department of Community Health Sciences, Rady Faculty of Health Sciences University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael Payne
- Nine Circles Community Health Centre, Winnipeg, Manitoba, Canada
| | - Laurie Ringaert
- Manitoba HIV-STBBI Collective Impact Network, Winnipeg, Manitoba, Canada
| | - Linda Larcombe
- Department of Internal Medicine, Rady Faculty of Health Sciences University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gayle Restall
- Department of Occupational Therapy, Rady Faculty of Health Sciences University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paula Migliardi
- Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | | | - Nathan J Lachowsky
- Community-Based Research Centre, Victoria, British Columbia, Canada
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - David J Brennan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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Dangerfield DT, Johnson D, Hamlin-Palmer S, Browne DC, Mayer KH, Hickson DA. Prevalence and Correlates of Rectal Douching and Enema Use Among Black Sexual Minority Men and Black Transwomen in the Deep South. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:1915-1922. [PMID: 32086643 DOI: 10.1007/s10508-019-01605-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 11/30/2019] [Accepted: 12/03/2019] [Indexed: 06/10/2023]
Abstract
HIV/STI disparities are highest among Black sexual minority men (BSMM) and Black transwomen (BTW) in the Deep South. Exploring the prevalence and correlates of rectal douching and enema use could provide insights into risk factors and HIV/STI prevention opportunities among these groups. This study explored the prevalence and correlates of rectal douching and enema using Poisson regression models among 375 BSMM and BTW in Jackson, MS, and Atlanta GA. Approximately 95% reported their gender as male/man; 5.6% self-identified as transwomen. Most reported being single (73.1%) and were unemployed (56.0%); 36.1% were previously diagnosed with HIV. In multivariable models, BSMM and BTW who reported that their typical sexual position during anal sex was "bottom" (aPR = 2.39, 95% CI = 1.48, 3.84) or "versatile" (aPR = 2.46, 95% CI = 1.44, 4.17) had a higher prevalence of rectal douching and enema use than those who reported "top." Deeper understanding of the contexts of rectal douching, enema use, and sexual positioning practices is needed.
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Affiliation(s)
| | | | | | - Dorothy C Browne
- Department of Maternal and Child Health, University of North Carolina, Durham, NC, USA
| | - Kenneth H Mayer
- The Fenway Institute of Fenway Health and the Infectious Disease Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Apaydin KZ, Fontenot HB, Shtasel DL, Mayer KH, Keuroghlian AS. Primary Care Provider Practices and Perceptions Regarding HPV Vaccination and Anal Cancer Screening at a Boston Community Health Center. J Community Health 2018; 43:792-801. [PMID: 29480339 PMCID: PMC6033675 DOI: 10.1007/s10900-018-0486-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Human papillomavirus (HPV) vaccination and anal cancer screening are valuable, yet underutilized, tools in prevention of HPV-related cancers among sexual and gender minority (SGM) populations. The aim of this study was to characterize primary care providers' (PCPs) practices and perceptions pertaining to HPV vaccination and anal cancer screening. A survey assessing self-reported practice characteristics related to HPV vaccination and anal cancer screening, as well as perceived barriers to vaccination and anal cancer screening at the patient-, provider-, and system-level was distributed to PCPs at a Federally-Qualified Health Center that specializes in care for SGM populations in the greater Boston area. A total of 33 PCPs completed the survey. All PCPs strongly recommended HPV vaccination to their patients by emphasizing that the vaccine is extremely important or very important. Most PCPs told their patients that the HPV vaccine prevents cervical cancer (96.9%), anal cancer (96.9%), oropharyngeal cancer (72.7%), penile cancer (57.5%), and genital warts (63.6%). There is substantial variability among providers regarding recommendations for anal cancer screening and follow-up. Most PCPs perceived that patient-level factors such as poverty, mental illness, and substance use disorders were barriers to HPV vaccination and anal cancer screening. Systems-level barriers such as lack of clinical time with each patient and lack of staffing were also described as barriers to vaccination and screening. Patient-, provider- and systems-level improvements are important to increase HPV vaccination and anal cancer screening rates.
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Affiliation(s)
- Kaan Z Apaydin
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - Holly B Fontenot
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
- W.F. Connell School of Nursing, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA
| | - Derri L Shtasel
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, USA
| | - Alex S Keuroghlian
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA.
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
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4
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Vu NTT, Holt M, Phan HTT, La LT, Tran GM, Doan TT, Nguyen TNN, de Wit J. Amphetamine-Type-Stimulants (ATS) Use and Homosexuality-Related Enacted Stigma Are Associated With Depression Among Men Who Have Sex With Men (MSM) in Two Major Cities in Vietnam in 2014. Subst Use Misuse 2017; 52:1411-1419. [PMID: 28436758 DOI: 10.1080/10826084.2017.1284233] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Men who have sex with men (MSM) are disproportionately affected by mental health concerns, including depression. Amphetamine-type-stimulants (ATS) use and homosexuality-related stigma and discrimination have been found associated with depression among MSM. OBJECTIVES To assess the prevalence of depression and its associations with ATS use and homosexuality-related stigma and discrimination among MSM in Vietnam. METHODS 622 MSM were conveniently recruited in Hanoi and Ho Chi Minh city, Vietnam, from September to December 2014. We collected information on demographic characteristics, ATS, alcohol and other drug use, sexual behaviors, homosexuality-related and discrimination stigma, and sexual sensation-seeking. Depression and suicidal thoughts were assessed by the Patient Health Questionnaire (PHQ-9). We assessed associations of depression with ATS use and homosexuality-related stigma and discrimination using logistic regression. RESULTS Of 622 sampled MSM, 11.3% were classified as having major depression, 9.8% reported any suicidal thoughts in the last two weeks, 30.4% ever had used any ATS, 88.8% ever ad drank alcohol and 21.5% had ever used any other drugs. In multivariate analysis, depression was significantly associated with ATS use (Adjusted Odds Ratio [AOR: 2.20; (95% Confidence Interval (CI): 1.32-3.67], younger age of sexual debut with another man (AOR: 0.09; 95% CI: 0.02-0.50), and greater enacted homosexuality-related stigma (AOR: 1.97; 95% CI: 1.19-3.26). CONCLUSIONS We found a moderate prevalence of depression among sampled MSM, which was associated with ATS use and enacted homosexuality-related stigma. We recommend integrating assessment and interventions regarding depression and methamphetamine use into gay-friendly, culturally adapted holistic HIV prevention for MSM in Vietnam.
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Affiliation(s)
- Nga Thi Thu Vu
- a Centre for Social Research in Health, University of New South Wales , Sydney , Australia.,b Institute of Preventive Medicine and Public Health, Hanoi Medical University , Hanoi , Vietnam
| | - Martin Holt
- a Centre for Social Research in Health, University of New South Wales , Sydney , Australia
| | - Huong Thi Thu Phan
- c Vietnam Administration for HIV/AIDS Prevention and Control, Ministry of Health , Hanoi , Vietnam
| | - Lan Thi La
- d Hanoi Centre of HIV/AIDS Prevention and Control , Hanoi , Vietnam
| | - Gioi Minh Tran
- e Center for Community Health Promotion , Hanoi , Vietnam
| | | | | | - John de Wit
- a Centre for Social Research in Health, University of New South Wales , Sydney , Australia
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5
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Russo S, Mccaffery K, Ellard J, Poynten M, Prestage G, Templeton DJ, Hillman R, Law C, Grulich AE. Experience and psychological impact of anal cancer screening in gay, bisexual and other men who have sex with men: a qualitative study. Psychooncology 2017. [PMID: 28635044 DOI: 10.1002/pon.4480] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Human papillomavirus-related anal cancer rates are increasing and are particularly high in gay, bisexual and other men who have sex with men (GBM/MSM), especially HIV-positive individuals. Although screening programs for high-risk populations have been advocated, concerns about possible adverse psychological consequences exist. This study aimed to investigate GBM/MSM's experience, understanding and emotional response to screening techniques for anal cancer to determine how best to minimise psychological distress in future programs. METHODS In-depth qualitative face-to-face interviews were conducted with 21 GBM/MSM participating in the "Study of the Prevention of Anal Cancer" in Sydney, Australia, between June 2013 and June 2014. Nonrandom, purposive sampling was used to ensure heterogeneity with respect to HIV status and screening test results. Framework analysis method was used to organise the data and identify emerging themes. RESULTS Knowledge about anal cancer, human papillomavirus and the link between them was limited. Abnormal screening results affected participants' sense of well-being and were associated with anxiety and concern about developing anal cancer. HIV-negative men receiving abnormal results showed higher levels of distress compared to their HIV-positive counterparts. Consultations with general practitioners about abnormal results had an important role in increasing participants' understanding and in moderating their anxiety. CONCLUSION Anal cancer screening should be accompanied by health education around anal cancer, its aetiology and the meaning of associated test results. Simple and effective communication strategies should be encouraged. Collaboration with general practitioners could assist the process of education and reporting test results.
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Affiliation(s)
- S Russo
- Behavioural Sciences Unit, School of Women's and Children's Health, UNSW, Sydney, Australia
| | - K Mccaffery
- School of Public Health, University of Sydney, Sydney, Australia
| | - J Ellard
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - M Poynten
- The Kirby Institute, UNSW, Sydney, Australia
| | - G Prestage
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia.,The Kirby Institute, UNSW, Sydney, Australia
| | - D J Templeton
- The Kirby Institute, UNSW, Sydney, Australia.,RPA Sexual Health, Sydney Local Health District, Sydney, Australia.,Central Clinical School, University of Sydney, Australia
| | - R Hillman
- The Kirby Institute, UNSW, Sydney, Australia.,St Vincent's Hospital, Sydney, Australia
| | - C Law
- St Vincent's Hospital, Sydney, Australia
| | - A E Grulich
- The Kirby Institute, UNSW, Sydney, Australia
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Lee C, Oliffe JL, Kelly MT, Ferlatte O. Depression and Suicidality in Gay Men: Implications for Health Care Providers. Am J Mens Health 2017; 11:910-919. [PMID: 28103765 PMCID: PMC5675322 DOI: 10.1177/1557988316685492] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/07/2016] [Accepted: 11/22/2016] [Indexed: 01/18/2023] Open
Abstract
Gay men are a subgroup vulnerable to depression and suicidality. The prevalence of depression among gay men is three times higher than the general adult population. Because depression is a known risk factor for suicide, gay men are also at high risk for suicidality. Despite the high prevalence of depression and suicidality, health researchers and health care providers have tended to focus on sexual health issues, most often human immunodeficiency virus in gay men. Related to this, gay men's health has often been defined by sexual practices, and poorly understood are the intersections of gay men's physical and mental health with social determinants of health including ethnicity, locale, education level, and socioeconomic status. In the current article summated is literature addressing risk factors for depression and suicidality among gay men including family acceptance of their sexual identities, social cohesion and belonging, internalized stigma, and victimization. Barriers to gay men's help seeking are also discussed in detailing how health care providers might advance the well-being of this underserved subgroup by effectively addressing depression and suicidality.
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Affiliation(s)
- Carrie Lee
- University of British Columbia, Vancouver, British Columbia, Canada
| | - John L. Oliffe
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary T. Kelly
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Olivier Ferlatte
- University of British Columbia, Vancouver, British Columbia, Canada
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7
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Coleman TA, Bauer GR, Pugh D, Aykroyd G, Powell L, Newman R. Sexual Orientation Disclosure in Primary Care Settings by Gay, Bisexual, and Other Men Who Have Sex with Men in a Canadian City. LGBT Health 2016; 4:42-54. [PMID: 27996376 DOI: 10.1089/lgbt.2016.0004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Sexual orientation affects individuals' health histories and is fundamental to providers' understanding of patients as a whole. Gay, bisexual, and other men who have sex with men (GB-MSM) are vulnerable to certain health conditions, including HIV. The aim of this exploratory analysis was to examine factors associated with sexual orientation disclosure and communication with providers about GB-MSM health issues and to discuss implications. METHODS We conducted a cross-sectional internet survey of GB-MSM (n = 202) in London-Middlesex, Ontario, Canada; analyses were limited to those with a regular primary care provider (n = 173). Blockwise regression models explored demographic, psychosocial, and healthcare-related factors associated with sexual orientation disclosure and physician-patient communication about GB-MSM-related health. RESULTS Just over seventy-one percent (71.1%) of participants reported that their primary care provider (PCP) knew their sexual orientation, and 44.5% had talked to them about GB-MSM health. Overt negative comments or being refused care based on sexual orientation occurred infrequently, although 26.6% reported their provider had assumed they were heterosexual. Being married to or living common-law with another man, more frequent experiences of homosexual prejudice, and higher quality assessment of provider's communication skills were associated with the PCP knowing respondents' sexual orientation. Greater internalized homonegativity was associated with not talking to a PCP about GB-MSM-related health issues. More frequent experiences of homosexual prejudice, higher assessment of provider communication, and having prior negative experiences with a PCP were significantly associated with talking to a PCP about GB-MSM health. CONCLUSION The majority of our sample disclosed their sexual orientation; however, not all patients voluntarily disclose. Medical training and education in Canada, where specific rights protections exist for sexual orientation minority populations, should emphasize awareness of essential patient health information. Training should include information about GB-MSM health and building a foundation on how to speak with GB-MSM patients nonjudgmentally.
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Affiliation(s)
- Todd A Coleman
- 1 Department of Psychology, Ryerson University , Toronto, Canada .,2 Department of Epidemiology and Biostatistics, University of Western Ontario , London, Canada
| | - Greta R Bauer
- 2 Department of Epidemiology and Biostatistics, University of Western Ontario , London, Canada
| | - Daniel Pugh
- 3 Gay Men's Sexual Health Alliance , Toronto, Canada
| | - Gloria Aykroyd
- 4 St. Joseph's Infectious Diseases Care Program , London, Canada
| | | | - Rob Newman
- 6 Regional HIV/AIDS Connection , London, Canada
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Vu NTT, Holt M, Phan HTT, La LT, Tran GM, Doan TT, de Wit J. The Prevalence and Correlates of HIV and Undiagnosed Infection among Men Who Have Sex with Men in Hanoi, Vietnam: Findings from a Cross-sectional, Biobehavioral Study. Front Public Health 2016; 4:275. [PMID: 28066754 PMCID: PMC5165257 DOI: 10.3389/fpubh.2016.00275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 12/02/2016] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Men who have sex with men (MSM) are a key population for HIV infection in Vietnam, and the use of amphetamine type substances (ATS) is prevalent and possibly increasing in this population. The reported analysis examines the association between ATS use before or during sex and HIV infection among MSM in Hanoi, Vietnam. METHODS This cross-sectional study of 210 MSM was conducted in Hanoi, Vietnam, in late 2014. Men tested for HIV and answered questions about demographic characteristics, sexual sensation seeking, depression, belief in HIV prevention strategies, homosexuality-related stigma and discrimination, recent accessing of HIV prevention services, sexual behaviors and ATS, and other drug use behaviors. We performed logistic regression to assess correlates of HIV infection. RESULTS HIV prevalence was 6.7% (14/210), and 85.7% (12/14) of HIV-positive men were not aware of their HIV status. Of the 210 participants, 10.5, 2.9, and 3.8% of men had used methamphetamine, amphetamine, and ecstasy before or during sex in the last 3 months. In multivariable analysis, HIV infection was associated with recent sex-related methamphetamine use [adjusted odds ratio (AOR): 5.03, 95% confidence interval (CI): 1.35-18.68], engaging in recent sex work (AOR: 3.55, 95% CI: 1.07-11.75), and homosexuality-related perceived stigma (AOR: 2.32, 95% CI: 0.98-5.47). CONCLUSION Findings underscore the importance of integrating methamphetamine use interventions into HIV prevention services and scaling-up of gay-friendly, non-stigmatizing HIV testing services for MSM in Hanoi. We recommend the routine assessment of ATS use and undiagnosed infection in this population.
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Affiliation(s)
- Nga Thi Thu Vu
- Centre for Social Research in Health, UNSW Australia, Sydney, NSW, Australia; Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Martin Holt
- Centre for Social Research in Health, UNSW Australia , Sydney, NSW , Australia
| | - Huong Thi Thu Phan
- Vietnam Administration for HIV/AIDS Prevention and Control, Ministry of Health , Hanoi , Vietnam
| | - Lan Thi La
- Hanoi Centre of HIV/AIDS Prevention and Control , Hanoi , Vietnam
| | | | | | - John de Wit
- Centre for Social Research in Health, UNSW Australia, Sydney, NSW, Australia; Utrecht University, Utrecht, Netherlands
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9
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Swartz JA. A Multi-Group Latent Class Analysis of Chronic Medical Conditions Among Men Who Have Sex with Men. AIDS Behav 2016; 20:2418-2432. [PMID: 27037547 DOI: 10.1007/s10461-016-1381-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Until recently, research on the health of gay and other men who have sex with men (MSM) has focused on risk for and the health consequences of HIV and other sexually transmitted infections. A multigroup latent class analysis examined a range of lifetime chronic medical conditions (CMCs) among MSM. Covariates included sociodemographics, substance use, psychological distress, and HIV serostatus. A two-class model best fit the medical condition data: a low probabilities class for most CMCs and a moderate to high probabilities (MHP) class. HIV serostatus was associated with increased within-class probabilities for some CMCs, particularly gastrointestinal and skin disorders. Only increasing age and use of erectile dysfunction drugs were directly associated with increased odds of being in the MHP class whereas methamphetamine use, identifying as gay, and lower alcohol use were indirectly associated. Implications of the findings for future research and the health care needs of MSM are discussed.
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Affiliation(s)
- James A Swartz
- Jane Addams College of Social Work, University of Illinois at Chicago, 1040 W. Harrison Street, (M/C 309), Chicago, IL, 60607, USA.
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10
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Diesterheft R, Brady JP, Shattell M. Risk behaviours of an interrelated syphilis-infected sexual network of men who have sex with men. J Clin Nurs 2016; 25:3597-3604. [PMID: 27104302 DOI: 10.1111/jocn.13209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2015] [Indexed: 12/17/2022]
Abstract
AIMS AND OBJECTIVES We examined the risk behaviours in an interrelated sexual network of 33 syphilis-infected men who have sex with men on the use of condoms, substances and websites to meet sexual partners. Our study used a descriptive exploratory design to investigate co-occurring high-risk behaviours in this interrelated sexual network to inform future health interventions and research directions. BACKGROUND Although the risk behaviours for human immunodeficiency virus transmission in men who have sex with men have been studied, few have studied the high-risk population of men who already have syphilis, and even fewer have studied the risk behaviours in sexual networks of syphilis-infected men who have sex with men who were identified using contact tracing. DESIGN/METHODS The data were collected from semi-structured, individual interviews at a not-for-profit lesbian, gay, bisexual and transgender health centre in a large city in the Midwestern USA. RESULTS Inconsistent condom use was substantial during both insertive (92%) and receptive (88%) anal intercourse. Most participants (97%) reported using one or more substances prior to or during anal intercourse, and Internet websites were the most common place to meet sexual partners (88%). CONCLUSIONS High-risk behaviours were significant within this syphilis-infected sexual network of men who have sex with men. The majority of our 33 participants were non-Hispanic Whites (n = 27, 82%), possessed a baccalaureate degree or higher (n = 23, 70%), and actively sought out unprotected anal intercourse [21 participants (64%) used BareBackRT.com, a website to seek out unprotected anal intercourse]. RELEVANCE TO CLINICAL PRACTICE Nurses should be more informed about the risk factors of a high-risk sexual network of syphilis-infected men who have sex with men. Interrelated sexual networks have high levels of similarity among participants' high-risk behaviours; contact tracing may be used to identify individual participants for relevant risk-reduction interventions.
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Affiliation(s)
| | - John P Brady
- Department of Psychology, DePaul University, Chicago, IL, USA
| | - Mona Shattell
- School of Nursing, DePaul University, Chicago, IL, USA.,Department of Community, Systems, and Mental Health Nursing, Rush University, DePaul University, Chicago, IL, USA
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11
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Quidley-Rodriguez N, De Santis JP. A Literature Review of Health Risks in the Bear Community, a Gay Subculture. Am J Mens Health 2015; 11:1673-1679. [PMID: 26718773 DOI: 10.1177/1557988315624507] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Gay men's subcultural identifications may help explain why certain groups of gay men are more at risk than other groups. One such subculture is the Bear community, a group that espouses that large-framed, hirsute men are attractive. To understand current health risks among the Bear community, a literature search was conducted using Medline, Psychinfo, CINAHL, and LGBT Life. A total of eight articles were found addressing health risks in the Bear community. There is a dearth of literature that focuses on the Bear community, but the current literature indicates that Bears are more likely to have a higher body mass index, lower self-esteem, and engage in risky sexual behaviors than other gay men. Suggestions for engaging and conducting research with the Bear community are provided. Last, clinical implications offer guidance for health care providers working with the Bear community to ensure that appropriate care is delivered to these men.
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Affiliation(s)
| | - Joseph P De Santis
- 1 University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
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12
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Halkitis PN, Kapadia F, Ompad DC, Perez-Figueroa R. Moving toward a holistic conceptual framework for understanding healthy aging among gay men. JOURNAL OF HOMOSEXUALITY 2015; 62:571-587. [PMID: 25492304 DOI: 10.1080/00918369.2014.987567] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In the last four decades, we have witnessed vast and important transitions in the social, economic, political, and health contexts of the lived experiences of gay men in the United States. This dynamic period, as evidenced most prominently by the transition of the gay rights movement to a civil rights movement, has shifted the exploration of gay men's health from one focusing primarily on HIV/AIDS into a mainstream consideration of the overall health and wellbeing of gay men. Against this backdrop, aging gay men in the United States constitute a growing population, for whom further investigations of health states and health-related disparities are warranted. In order to advance our understanding of the health and wellbeing of aging gay men, we outline here a multilevel, ecosocial conceptual framework that integrates salient environmental, social, psychosocial, and sociodeomgraphic factors into sets of macro-, meso-, and micro-level constructs that can be applied to comprehensively study health states and health care utilization in older gay men.
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Affiliation(s)
- Perry N Halkitis
- a Center for Health, Identity, Behavior and Prevention Studies , New York University , New York , New York , USA
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Swartz JA. The Relative Odds of Lifetime Health Conditions and Infectious Diseases Among Men Who Have Sex With Men Compared With a Matched General Population Sample. Am J Mens Health 2014; 9:150-62. [DOI: 10.1177/1557988314533379] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To address the understudy of health conditions and infectious diseases that are not strictly related to sexual transmission among men who have sex with men (MSM), this study examined the relative odds of 10 health conditions and two infectious diseases in a sample of MSM compared with a matched general population sample. MSM ( N = 653) living mainly in Chicago were sampled through successive administrations of an Internet-based survey (2008-2010) that assessed physical and mental health, substance use, and HIV status. Propensity score matching was used to obtain a demographically comparable sample of men ( N = 653) from aggregated administrations (2008-2012) of the National Survey on Drug Use and Health. Multivariate Firth logistic regressions compared the odds of ever having been diagnosed with each condition or disease, controlling for demographics, substance use, psychological distress, and HIV/AIDS status. MSM were more likely ( p < .01) to have experienced: ulcers (odds ratio [OR] = 2.3), hypertension (OR = 2.1), liver disease (OR = 5.7), and sexually transmitted infections other than HIV/AIDS (OR = 8.9). Two other conditions, pneumonia and pancreatitis, as well as tuberculosis, were significant at p < .05 but below the statistical threshold used to reduce alpha error. The findings suggest that relative to non-sexual-minority men, MSM are more likely to experience a range of health conditions not specifically attributable to HIV/AIDS, sexual behavior, psychological distress, or substance use. The implications for research on the health status and provision of health care to MSM in light of the study findings are considered.
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Boehmer U, Miao X, Linkletter C, Clark MA. Health Conditions in Younger, Middle, and Older Ages: Are There Differences by Sexual Orientation? LGBT Health 2014; 1:168-76. [PMID: 26789710 DOI: 10.1089/lgbt.2013.0033] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Sexual minorities engage in more risk behaviors at a younger age than heterosexuals and many are subject to minority stress from a young age, which raises questions about the age at which sexual minorities' experience morbidities. Our objective was to estimate the prevalence of health conditions among young, middle age, and older age groups to examine sexual orientation differences while stratifying by gender. METHODS We pooled 4 years of data from the California Health Interview Survey to obtain a representative sample of the male and female population in California, allowing us to examine health conditions by sexual orientation in three age strata, age 20-39, age 40-59, and age 60 and older. RESULTS Compared with same-gender heterosexuals, sexual minority women had a higher likelihood of physical morbidities (disability: adjusted odds ratio [AOR] 2.66 for lesbians and AOR 2.21 for bisexuals; arthritis: AOR 2.12 for lesbians) at a young age, whereas gay men had a higher likelihood of heart disease (AOR 2.78) and cancer (AOR 4.75) at a young age. Across the life span, sexual minorities had higher likelihoods of poor mental health than heterosexuals. CONCLUSION These findings suggest that at a young age, sexual minorities experience more morbidities than heterosexual individuals. Consideration should be given to early detection, identification, and treatment of these conditions among sexual minorities particularly at younger ages.
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Affiliation(s)
- Ulrike Boehmer
- 1 Department of Community Health Sciences, Boston University School of Public Health , Boston, Massachusetts
| | - Xiaopeng Miao
- 2 Department of Biostatistics, Boston University School of Public Health , Boston, Massachusetts
| | | | - Melissa A Clark
- 4 Warren Alpert School of Medicine and School of Public Health, Brown University , Providence, Rhode Island
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Sexual healthcare preferences among gay and bisexual men: a qualitative study in San Francisco, California. PLoS One 2013; 8:e71546. [PMID: 23977073 PMCID: PMC3747218 DOI: 10.1371/journal.pone.0071546] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 06/29/2013] [Indexed: 01/22/2023] Open
Abstract
Background Research on gay and other men who have sex with men's (G/MSM) preferences for sexual healthcare services focuses largely on HIV testing and to some extent on sexually transmitted infections (STI). This research illustrates the frequency and location of where G/MSM interface with the healthcare system, but it does not speak to why men seek care in those locations. As HIV and STI prevention strategies evolve, evidence about G/MSM's motivations and decision-making can inform future plans to optimize models of HIV/STI prevention and primary care. Methods We conducted a phenomenological study of gay men's sexual health seeking experiences, which included 32 in-depth interviews with gay and bisexual men. Interviews were transcribed verbatim and entered into Atlas.ti. We conducted a Framework Analysis. Findings We identified a continuum of sexual healthcare seeking practices and their associated drivers. Men differed in their preferences for separating sexual healthcare from other forms of healthcare (“fragmentation”) versus combining all care into one location (“consolidation”). Fragmentation drivers included: fear of being monitored by insurance companies, a desire to seek non-judgmental providers with expertise in sexual health, a desire for rapid HIV testing, perceiving sexual health services as more convenient than primary care services, and a lack of healthcare coverage. Consolidation drivers included: a comfortable and trusting relationship with a provider, a desire for one provider to oversee overall health and those with access to public or private health insurance. Conclusions Men in this study were likely to separate sexual healthcare from primary care. Based on this finding, we recommend placing new combination HIV/STI prevention interventions within sexual health clinics. Furthermore, given the evolution of the financing and delivery of healthcare services and in HIV prevention, policymakers and clinicians should consider including more primary care services within sexual healthcare settings.
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Sirota T. Attitudes Among Nurse Educators Toward Homosexuality. J Nurs Educ 2013; 52:219-27. [DOI: 10.3928/01484834-20130320-01] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 08/29/2012] [Indexed: 11/20/2022]
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Lesbian, Gay, Bisexual, Transgendered, or Intersexed Content for Nursing Curricula. J Prof Nurs 2012; 28:96-104. [DOI: 10.1016/j.profnurs.2011.11.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Indexed: 11/21/2022]
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18
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Shindel AW, Vittinghoff E, Breyer BN. Erectile dysfunction and premature ejaculation in men who have sex with men. J Sex Med 2012; 9:576-84. [PMID: 22214402 PMCID: PMC3271132 DOI: 10.1111/j.1743-6109.2011.02585.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Quantitative research into sexual function and dysfunction in men who have sex with men (MSM) has been sparse due in large part to a lack of validated, quantitative instruments for the assessment of sexuality in this population. AIM To assess prevalence and associations of erectile problems and premature ejaculation in MSM. METHODS MSM were invited to complete an online survey of sexual function. Ethnodemographic, sexuality, and health-related factors were assessed. MAIN OUTCOME MEASURE Participants completed a version of the International Index of Erectile Function modified for use in MSM (IIEF-MSM) and the Premature Ejaculation Diagnostic Tool (PEDT). Total score on the erectile function (EF) domain of the IIEF-EF (IIEF-MSM-EF) was used to stratify erectile dysfunction (ED) severity (25-30 = no ED, 16-24 mild or mild moderate ED, 11-15 moderate ED, and ≤10 severe ED). PEDT scores were used to stratify risk of premature ejaculation (PE, diagnosed as PEDT score ≥9). RESULTS Nearly 80% of the study cohort of 2,640 men resided in North America. The prevalence of ED was higher in older men whereas the prevalence of PE was relatively constant across age groups. Multivariate logistic regression revealed that increasing age, HIV seropositivity, prior use of erectogenic therapy, lower urinary tract symptoms (LUTS), and lack of a stable sexual partner were associated with greater odds of ED. A separate multivariate analysis revealed that younger age, LUTS, and lower number of lifetime sexual partners were associated with greater odds of PE. CONCLUSIONS Risk factors for sexual problems in MSM are similar to what has been observed in quantitative studies of non-MSM males. Urinary symptoms are associated with poorer sexual function in MSM.
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Affiliation(s)
- Alan W Shindel
- Department of Urology, University of California, Davis, Sacramento, CA 95817, USA.
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Lindley LL, Walsemann KM, Carter JW. The association of sexual orientation measures with young adults' health-related outcomes. Am J Public Health 2011; 102:1177-85. [PMID: 22021310 DOI: 10.2105/ajph.2011.300262] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined associations among 3 dimensions of sexual orientation (identity, behavior, and attraction) and key health-related indicators commonly studied among sexual minority populations: depressive symptoms, perceived stress, smoking, binge drinking, and victimization. METHODS We analyzed data from the National Longitudinal Study of Adolescent Health, Wave IV (2007-2008) when respondents were aged 24 to 32 years (n=14,412). We used multivariate linear and logistic regressions to examine consistency of associations between sexual orientation measures and health-related indicators. RESULTS Strength of associations differed by gender and sexual orientation measure. Among women, being attracted to both sexes, identifying as "mostly straight" or "bisexual," and having mostly opposite-sex sexual partners was associated with greater risk for all indicators. Among men, sexual attraction was unrelated to health indicators. Men who were "mostly straight" were at greater risk for some, but not all, indicators. Men who had sexual partners of the same-sex or both sexes were at lower risk for binge drinking. CONCLUSIONS Using all 3 dimensions of sexual orientation provides a more complete picture of the association between sexual orientation and health among young adults than does using any 1 dimension alone.
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Affiliation(s)
- Lisa L Lindley
- Department of Global and Community Health, George Mason University, Fairfax, VA 22030, USA.
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20
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Chavez KR. Identifying the needs of LGBTQ immigrants and refugees in Southern Arizona. JOURNAL OF HOMOSEXUALITY 2011; 58:189-218. [PMID: 21294025 DOI: 10.1080/00918369.2011.540175] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
This article reports on the results of a needs assessment conducted for lesbian, gay, bisexual, transgender, and queer (LGBTQ) immigrants, asylees, refugees, and their allies in Southern Arizona, and it is the first study of its kind in the United States. Utilizing interview data collected with migrants, allies, and service providers in Tucson, Arizona, this article presents findings on the quality of service provision provided to this very underserved community pertaining to health care, housing, and legal services. The assessment shows that no services are provided specifically for LGBTQ migrants, and most LGBTQ migrants turn to family and friends when they have needs. The most significant result of this study pertains to the lack of cultural competence and an overall deficiency in terms of cultural awareness when it comes to the specific needs of LGBTQ migrants.
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Affiliation(s)
- Karma R Chavez
- Department of Communication Arts, University of Wisconsin, Madison, WI 53706, USA.
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22
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Online and offline sexual health-seeking patterns of HIV-negative men who have sex with men. AIDS Behav 2010; 14:1362-70. [PMID: 20799060 DOI: 10.1007/s10461-010-9794-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
To inform health information targeting, we used cross-sectional data from 2577 HIV-negative MSM to identify groups of men who access similar sources. Offline, more men reported talking to a physician about HIV than about having sex with men; fewer than half attended a safer sex workshop. Online, men sought information primarily through Internet search engines, GLBT websites, or health websites. A latent class analysis identified four groups of health seekers: minimal health seekers, those who accessed online sources only, those who sought information mostly from health professionals, and those who sought information from diverse sources. Minimal health seekers, 9% of the sample, were the group of greatest concern. They engaged in unprotected anal sex with multiple partners but infrequently testing for HIV or sought sexual health information. By encouraging health seeking from diverse sources, opportunities exist to increase men's knowledge of HIV/STI prevention and, when necessary, access to medical care.
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Keyes SM, Rothman EF, Zhang Z. Sexual orientation and sexual behavior: results from the Massachusetts Behavioral Risk Factor Surveillance System, 2002-2006. ACTA ACUST UNITED AC 2009; 3:1-10. [PMID: 19042901 DOI: 10.1080/15574090802092614] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Few population-based surveys in the United States include sexual orientation as a demographic variable. As a result, estimating the proportion of the U.S. population that is gay, lesbian, or bisexual (GLB) is a substantial challenge. Prior estimates vary widely, from 1-21%. In 2001, questions on sexual orientation and sexual behavior were added to the Massachusetts Behavioral Risk Factor Surveillance System (MA BRFSS) and have been asked continually since that time. The purpose of this study was to determine the prevalence of adults in Massachusetts identifying as GLB and providing a demographic description of this group. The study also examined the correlation of reported sexual behavior and sexual identity within this group. Overall, 1.9% of Massachusetts adults identified as gay or lesbian and 1.0% of Massachusetts adults identified as bisexual. Of those identifying as gay or lesbian, 95.4% reported sexual behavior concordant with this identification, and 99.4% of respondents identifying as heterosexual reported behavior concordant with heterosexual sexual orientation. Among those reporting a GLB sexual orientation, men were more likely than women to identify as gay, and women were more likely than men to identify as bisexual. Younger adults (18-25 years old) were more likely than people in other age groups to identify as bisexual. Respondents with 4 or more years of education were more likely to identify as gay or lesbian than those in all other education categories. The addition of sexual orientation to population-based surveys will allow for research on the health of GLB adults and provide critical information for those charged with the creation of public policy regarding sexual orientation.
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Affiliation(s)
- Susan M Keyes
- Health Survey Program, Massachusetts Department of Public Health, Boston, MA 02108, USA.
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Rhodes SD, McCoy TP, Wilkin AM, Wolfson M. Behavioral risk disparities in a random sample of self-identifying gay and non-gay male university students. JOURNAL OF HOMOSEXUALITY 2009; 56:1083-100. [PMID: 19882428 PMCID: PMC3715091 DOI: 10.1080/00918360903275500] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This Internet-based study was designed to compare health risk behaviors of gay and non-gay university students from stratified random cross-sectional samples of undergraduate students. Mean age of the 4,167 male participants was 20.5 (+/-2.7) years. Of these, 206 (4.9%) self-identified as gay and 3,961 (95.1%) self-identified as heterosexual. After adjusting for selected characteristics and clustering within university, gay men had higher odds of reporting: multiple sexual partners; cigarette smoking; methamphetamine use; gamma-hydroxybutyrate (GHB) use; other illicit drug use within the past 30 days and during lifetime; and intimate partner violence (IPV). Understanding the health risk behaviors of gay and heterosexual men is crucial to identifying associated factors and intervening upon them using appropriate and tailored strategies to reduce behavioral risk disparities and improve health outcomes.
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Affiliation(s)
- Scott D Rhodes
- Section on Society and Health, Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27158-1063, USA.
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