1
|
Blankenau A, Wax A, Auerbach L, Schuman ZD, Hopmeyer A. Queer Peer Crowds on Campus: LGBT Crowd Affiliation as a Critical Correlate of College Students' Loneliness, Academic Well-Being, & Stress. JOURNAL OF HOMOSEXUALITY 2023; 70:1411-1439. [PMID: 35112989 DOI: 10.1080/00918369.2022.2030616] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The current study explored whether affiliating with an LGBT peer crowd on a college campus differentially predicts college adjustment (including loneliness, college belongingness, academic well-being, and stress), as opposed to affiliating with a non-LGBT peer crowd. Based on a sample of 692 students from a small liberal arts college in Southern California, factor and path analyses were carried out. Results indicated that, of all the crowd affiliations, affiliating with an LGBT peer crowd was the strongest predictor of loneliness, academic well-being, and stress. However, affiliating with an LGBT peer crowd was not the strongest predictor of college belongingness. Implications and applications of these results are discussed.
Collapse
Affiliation(s)
| | - Amy Wax
- California State University, Long Beach, California, USA
| | | | | | | |
Collapse
|
2
|
Wei TH, Jiang Y. Mapping the Scientific Literature on Health Needs of Women with Same-Sex Attraction in Mainland China: A Scoping Review. LGBT Health 2023; 10:263-277. [PMID: 36595507 DOI: 10.1089/lgbt.2022.0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Purpose: This review study aimed to investigate how much and how well the unique health needs of women with same-sex attraction (WSSA) in mainland China have been studied. Methods: This review included published studies and gray reports between January 1, 1990, and March 31, 2022, regarding the health needs of Chinese WSSA. Chinese peer-reviewed journal articles, conference papers, theses, and dissertations were retrieved through the China National Knowledge Infrastructure. Studies with WSSA of mainland China as research participants were retrieved through PubMed, Embase, PsycInfo, LGBT Life, CINAHL, Web of Science, and International Bibliography of the Social Sciences. Gray reports were provided by two informaticists and eight Chinese WSSA who consented to be our stakeholders for consultation. Results: Of the 38 reviewed articles, unmet health needs of Chinese WSSA fell into three domains: mental health and substance abuse, sexual and reproductive health, and domestic, intimate partner, and dating violence, which were significantly associated with minority stress. Minority stigma was discovered to oppress Chinese WSSA by a covert and subtle pathway that makes Chinese WSSA culturally unintelligible and health care providers unprepared to provide them with respectful care. The barriers to the health care of Chinese WSSA were identified as health care providers' presumption of heterosexuality and Chinese WSSA's concealment of minority sexuality when discussing medical history. Conclusion: This scoping review is the first research effort to explore studies about the health needs of WSSA in mainland China. More research is needed with the guidance of minority stress theory to address the unique health needs of Chinese WSSA.
Collapse
Affiliation(s)
- Tao H Wei
- University of Oklahoma Health Science Center Hudson College of Public Health, Oklahoma City, Oklahoma, USA
| | - Yun Jiang
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| |
Collapse
|
3
|
Suen YT, Wong EMY, Chan RCH. Experiences of COVID-19 among Chinese-speaking lesbian, gay and bisexual people in Hong Kong: an inductive thematic analysis of survey response data. Sex Reprod Health Matters 2022; 30:2102537. [PMID: 36017871 PMCID: PMC9423823 DOI: 10.1080/26410397.2022.2102537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
As social inequalities during the COVID-19 pandemic have been recognised, emerging research showed that lesbian, gay and bisexual (LGB) people may be additionally affected during the pandemic. This paper adds to the understanding of the experiences of LGB people during the pandemic with a focus on Hong Kong, where issues of space significantly influence LGB people's lives in this city with high population density. As part of a larger community study of LGB lives in Hong Kong, COVID-19-related impact on 434 Chinese-speaking LGB people was explored. Data collection was conducted from 20 May to 30 June 2020. Inductive thematic analysis of the open-text response survey data found that the LGB participants described both negative and positive impacts brought by COVID-19. Such impacts could be dimensionalised into those related to personal space and privacy, romantic and sexual space, and community space. It was also found that the experiences of COVID-19 among LGB people in Hong Kong were intersectional, along the lines of living arrangement and relationship status. Such findings make unique contributions to the emerging literature. First, there needs to be a more nuanced understanding of sexual minority individuals' experiences during COVID-19 across cultural contexts. Second, COVID-19 was described as having brought positive impact in addition to its widely known negative impact.
Collapse
Affiliation(s)
- Yiu Tung Suen
- Associate Professor, Gender Studies Programme, Chinese University of Hong Kong, Room 250, 2/F, Sino Building, Shatin, Hong Kong. Correspondence:
| | - Eliz Miu Yin Wong
- PhD Candidate, Department of Social Policy, London School of Economics and Political Science, London, UK
| | - Randolph C H Chan
- Associate Professor, Department of Special Education and Counselling, The Education University of Hong Kong, Tai Po, Hong Kong
| |
Collapse
|
4
|
Li Y, Zhou D, Dai Y, Zhang J. Gender Differences in the Association Between Sexual Orientation and Risky Sexual Behavior Among College Students With Sexual Experience in Sichuan Province, Chinese. Sex Med 2022; 10:100547. [PMID: 35952614 PMCID: PMC9537270 DOI: 10.1016/j.esxm.2022.100547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/26/2022] [Accepted: 06/27/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Limited information is available regarding risky sexual behavior among college students with different sexual orientations. AIM The aim of this study was to examine the gender differences in the association between sexual orientation and risky sexual behavior among Chinese college students with sexual experience. METHODS With a self-assessment questionnaire, we conducted a cross-sectional survey among 73,800 students from 25 vocational colleges (3-year colleges) in the Sichuan province of China. Multivariate logistic regression models were used to examine the association between sexual orientation and risky sexual behavior among students with sexual experience. OUTCOMES The main outcome measures used regarding risky sexual behavior are the following: condom use in the last sexual intercourse, early sexual debut, and having multiple sexual partners. RESULTS 12,711 students with sexual experience were included. Sexual minority students were more likely to have an early sexual debut (For male students, homosexual: OR = 1.88, P < .001; bisexual: OR = 1.96, P < .001; unsure: OR = 1.68, P < .001. For female students, homosexual: OR = 1.87, P < .01; bisexual: OR = 2.07, P < .01; unsure: OR = 1.53, P < .05), and less likely to use condoms in their last sexual intercourse (except for homosexual male students) (For male students, bisexual: OR = 0.65, P < .01; unsure: OR = 0.60, P < .001. For female students, homosexual: OR = 0.21, P < .001; bisexual: OR = 0.54, P < .001; unsure: OR = 0.68, tP < .05). There are gender differences in the association between sexual orientation and having multiple sexual partners. Male sexual minorities were more likely to have multiple sexual partners than heterosexual students (homosexual: OR = 2.06, P < .001; bisexual: OR = 1.66, P < .001; unsure: OR = 1.31, P < .05), while the same result was only observed in bisexual female students (OR = 1.46, P < .01). CLINICAL IMPLICATIONS Sexual health education professionals should consider the sexual orientation of students when providing counseling services or educational intervention, especially for male students and LGBT ones. STRENGTHS & LIMITATIONS We examined gender differences in the association between sexual orientation and risky sexual behavior among college students with sexual experience. However, the ability for the cross-sectional survey to address causality is limited, and will be further tested in cohort studies. CONCLUSION Gender and sexual orientation affect the likelihood of risky sexual behavior among China's college students, and gender differences in the association between sexual orientation and risky sexual behavior should be noticed. Li Y, Zhou D, Dai Y, et al. Gender Differences of the Association Between Sexual Orientation and Risky Sexual Behavior Among College Students With Sexual Experience in Sichuan Province, Chinese. Sex Med 2022;10:100547.
Collapse
Affiliation(s)
- Yajie Li
- Tibet Center for Disease Control and Prevention, Lhasa, China
| | - Dinglun Zhou
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yingxue Dai
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Jianxin Zhang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
5
|
Cooper RL, Ramesh A, Radix AE, Reuben JS, Juarez PD, Holder CL, Belton AS, Brown KY, Mena LA, Matthews-Juarez P. Affirming and Inclusive Care Training for Medical Students and Residents to Reducing Health Disparities Experienced by Sexual and Gender Minorities: A Systematic Review. Transgend Health 2022. [PMID: 37525832 PMCID: PMC10387161 DOI: 10.1089/trgh.2021.0148] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose Providing inclusive and comprehensive gender-affirming care is critical to reducing health disparities (gaps in care) experienced by sexual and gender minorities (SGM). Currently, little is known about how medical students and residents are being trained to address the health needs of SGM persons or of the most effective methods. Methods We conducted a systematic review of the research literature from 2000 to 2020 on the effectiveness of teaching medical students and residents on knowledge, attitudes, and skills in addressing the health of SGM persons and the strength of the research sample, design, and methods used. Results We identified a total of 36 articles that assessed the impact of medical student and resident education on knowledge, comfort, attitudes, confidence, and skills in working with SGM patients. All studies utilized quasi-experimental designs, and found efficacious results. No study examined the impact of training on patient outcomes. Conclusion Future studies will need to be powered and designed to assess the impact of training on patient outcomes.
Collapse
Affiliation(s)
- Robert Lyle Cooper
- Department of Family and Community Medicine, Cancer Biology, Neuroscience & Pharmacology, Meharry Medical College, Nashville, Tennessee, USA
| | - Aramandla Ramesh
- Department of Biochemistry, Cancer Biology, Neuroscience & Pharmacology, Meharry Medical College, Nashville, Tennessee, USA
- National Center for Medical Education Development and Research, Meharry Medical College, Nashville, Tennessee, USA
| | - Asa E. Radix
- Callen-Lorde Community Health Center in New York, New York, New York, USA
| | - Jayne S. Reuben
- Department of Biomedical Sciences, Texas Agricultural and Mechanical University College of Dentistry, Dallas, Texas, USA
| | - Paul D. Juarez
- Department of Family and Community Medicine, Cancer Biology, Neuroscience & Pharmacology, Meharry Medical College, Nashville, Tennessee, USA
- National Center for Medical Education Development and Research, Meharry Medical College, Nashville, Tennessee, USA
| | - Cheryl L. Holder
- Department of Family Medicine at Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Allyson S. Belton
- Satcher Health Leadership Institute at Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Katherine Y. Brown
- Department of Family and Community Medicine, Cancer Biology, Neuroscience & Pharmacology, Meharry Medical College, Nashville, Tennessee, USA
- National Center for Medical Education Development and Research, Meharry Medical College, Nashville, Tennessee, USA
| | - Leandro A. Mena
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Patricia Matthews-Juarez
- Department of Family and Community Medicine, Cancer Biology, Neuroscience & Pharmacology, Meharry Medical College, Nashville, Tennessee, USA
- National Center for Medical Education Development and Research, Meharry Medical College, Nashville, Tennessee, USA
| |
Collapse
|
6
|
Quinn GP, Tishelman AC, Chen D, Nahata L. Reproductive health risks and clinician practices with gender diverse adolescents and young adults. Andrology 2021; 9:1689-1697. [PMID: 33942552 PMCID: PMC8566321 DOI: 10.1111/andr.13026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reproductive health counseling is essential for adolescents and young adults (AYAs). Transgender and gender diverse (TGD) AYAs would benefit from tailored counseling given concerns about iatrogenic infertility and sexual dysfunction, and high rates of interpersonal violence, unplanned pregnancies and sexually transmitted infections, yet there are multiple obstacles to providing this care at the patient/family and clinician levels. OBJECTIVES This narrative review summarizes the literature on reproductive health considerations for TGD AYAs, current practices, and clinician barriers and facilitators to providing culturally sensitive reproductive care for TGD AYAs. Specific areas of focus include reproductive health goals, risks, and access barriers; clinician knowledge practices and challenges; and strategies for improving counseling practices. MATERIALS AND METHODS PubMed, Google Scholar, Medline, Web of Science, and PsycInfo databases were searched using the following terms: transgender, non-binary, gender expansive, gender non-conforming, reproductive health, sexual health, fertility, family planning/building, contraception, sexual dysfunction; gender-affirming hormones/surgery, clinician, physician or provider knowledge and attitudes; counseling. RESULTS Many TGD AYAs desire biological children and improved sexual experiences. TGD AYAs may experience infertility and sexual dysfunction associated with transition; have disproportionate HIV/STI risk; experience high rates of interpersonal/sexual violence and trauma; and encounter barriers to accessing competent medical care. Clinicians lack knowledge about reproductive health needs of TGD AYAs; inconsistently discuss family building options; perceive counseling challenges; and desire more training in this area. DISCUSSION Enriched communication training for medical/mental health clinicians is necessary to provide a skilled workforce for TGD AYAs. Web-based reproductive health training with other populations (eg oncology) demonstrates efficacy for improving communication skills and confidence in counseling, CONCLUSION: This review highlights barriers to adequate reproductive care encountered by TGD AYAs, exacerbated in underserved minority youth. Dedicated training for providers, and programs increasing access are important goals for improving care. The need for additional research is also emphasized.
Collapse
Affiliation(s)
- Gwendolyn P. Quinn
- Grossman School of Medicine, Departments of OB-GYN and Population Health, NY, NY, USA
| | - Amy C. Tishelman
- Boston Children’s Hospital, Departments of Psychiatry and Endocrinology, Boston, MA, USA
- Harvard Medical School, Departments of Psychiatry and Endocrinology, Boston, MA, USA
| | - Diane Chen
- Potocsnak Family Division of Adolescent and Young Adult Medicine, and Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Departments of Psychiatry and Behavioral Sciences, and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Leena Nahata
- Department of Pediatrics, The Ohio State University College of Medicine; Section of Endocrinology, Nationwide Children’s Hospital, Columbus, OH, USA
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Columbus, OH, USA
| |
Collapse
|
7
|
The Influence of Emerging Adulthood on the Risky and Dangerous Behaviors of LGBT Populations. SOCIAL SCIENCES-BASEL 2020. [DOI: 10.3390/socsci9120228] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
During emerging adulthood, traditional social bonds and turning points may be delayed, not present, or may not work in the same manner as they had for prior generations, leading many to engage in risky and dangerous behaviors. Lesbian, Gay, Bisexual and Transgendered emerging adults may be at particular risk for engaging in risky and dangerous behavior during emerging adulthood due to the lack of social bonds, reaching of turning points, as well as the historic stigmatization of these populations. Focusing on LGBT populations in the United States, the influence of emerging adulthood on risky and dangerous behaviors is presented; a theoretical examination of the relationship between LGBT populations and risky and dangerous behaviors is provided; the influence of emerging adulthood on LGBT populations is explored; research on the role of emerging adulthoods influence on the risky and dangerous behaviors of LGBT populations is presented; and theoretical and policy implications are offered.
Collapse
|
8
|
Sok S, Hong R, Chhoun P, Chann N, Tuot S, Mun P, Brody C, Yi S. HIV risks and recent HIV testing among transgender women in Cambodia: Findings from a national survey. PLoS One 2020; 15:e0238314. [PMID: 32886693 PMCID: PMC7473569 DOI: 10.1371/journal.pone.0238314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 08/13/2020] [Indexed: 12/26/2022] Open
Abstract
Background Globally, the prevalence of HIV among transgender women remains much higher than that of the general population, and a large proportion of them are unaware of their HIV status. Transgender women are exposed to gender-based violence and social stigma and discrimination in different settings that may create significant barriers to receiving HIV prevention and care services. This study aimed to identify factors associated with recent HIV testing among transgender women in Cambodia. Methods We conducted a cross-sectional survey in 2016 among 1375 transgender women recruited from 13 provinces using a peer-based social network recruitment method. We used a structured questionnaire for face-to-face interviews and performed rapid HIV/syphilis testing onsite. We used a multiple logistic regression analysis to identify factors associated with recent HIV testing. Results Of the total, 49.2% of the participants reported having an HIV test in the past six months. After controlling for other covariates, the odds of having an HIV test in the past six months was significantly lower among students (AOR 0.36, 95% CI 0.20–0.65), participants who perceived that they were unlikely to be HIV infected (AOR 0.50, 95% CI 0.32–0.78), and participants who reported always using condoms with male non-commercial partners in the past three months (AOR 0.65, 95% CI 0.49–0.85) relative to their respective reference group. The odds of having an HIV test in the past six months was significantly higher among participants who had been reached by community-based HIV services (AOR 5.01, 95% CI 3.29–7.65) and received HIV education (AOR 1.65, 95% CI 1.06–2.58) in the past six months relative to their respective reference group. Conclusions Despite the widely available free HIV testing services, more than half of transgender women in this study had not received an HIV test in the past six months. Our findings suggest that a tailored and comprehensive combination prevention program, in which HIV testing is linked to care continuum and beyond, maybe an essential next step. Social media may have the potential to be promoted and utilized among transgender women populations in order to improve HIV testing and other prevention measures.
Collapse
Affiliation(s)
- Say Sok
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | | | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Navy Chann
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Phalkun Mun
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Carinne Brody
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Siyan Yi
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Saw Swee Hock School of Public Health, National University of Singapore & National University Health System, Singapore, Singapore
- Center for Global Health Research, Touro University California, Vallejo, California, United States of America
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
- * E-mail:
| |
Collapse
|
9
|
Ulanja MB, Lyons C, Ketende S, Stahlman S, Diouf D, Kouamé A, Ezouatchi R, Bamba A, Drame F, Liestman B, Baral S. The relationship between depression and sexual health service utilization among men who have sex with men (MSM) in Côte d'Ivoire, West Africa. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2019; 19:11. [PMID: 30832673 PMCID: PMC6399955 DOI: 10.1186/s12914-019-0186-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 01/09/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND In Cote D'Ivoire, there has been limited coverage of evidence-based sexual health services specifically supporting men who have sex with men (MSM). To date, there has been limited study of the determinants of engagement in these services including multiple intersecting stigmas and depression. METHODS 1301 MSM aged 18 years and older, were recruited using respondent-driven sampling in Abidjan, Yamoussoukro, Gagnoa and Bouake, Cote d'Ivoire from January 2015 to October 2015. Inclusion criteria included anal sex with another man in the past 12 months were to complete a structured questionnaire including the Patient Health Questionnaire (PHQ)-9 to screen for depression. Chi-Square tests were used to test difference in healthcare utilization across variables, and multiple logistic regression was used to test the association between depression and health care utilization represented by HIV and sexually transmittable infection testing and treatment. RESULTS Depression (aOR:1.40, 95% CI: 1.07-1.84), being aged 25-29 years (aOR:1.84, 95% CI: 1.11-3.03),unemployed (aOR:0.64, 95% CI: 0.42-0.98), being a student (aOR:0.67, 95% CI: 0.48-0.96), being identified as male (aOR:0.44, 95% CI: 0.29-0.67), and identifying as homosexual (aOR:0.74, 95% CI:0.56-0.99) were significantly associated with utilization of sexual health care services in the final multivariable model. Healthcare enacted stigma (aOR: 1.55, 95% CI: 1.03-2.33) was associated with utilizing sexual health care services, but perceived healthcare stigma, social stigma and family stigma were not. CONCLUSION Given higher levels of depressive symptomatology among those engaging in sexual health care services, this engagement represents an opportunity for service integration which may have synergistic benefits for both sexual and mental health. Moreover, MSM in Cote D'Ivoire who had engaged in sexual health services were more likely to report having experienced health-care enacted stigma. Taken together, these results reinforce the need for stigma mitigation interventions to support sustained engagement in HIV prevention, treatment and care services as a means of reducing health disparities among MSM in Cote d'Ivoire.
Collapse
Affiliation(s)
- Mark B Ulanja
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, E7146, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Carrie Lyons
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, E7146, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Sosthenes Ketende
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, E7146, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Shauna Stahlman
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, E7146, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | | | | | | | | | | | - Ben Liestman
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, E7146, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Stefan Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, E7146, 615 N. Wolfe Street, Baltimore, MD, 21205, USA. .,Programme National de Lutte contre le Sida, Ministère de la Santé et de la Lutte contre le Sida, Abidjan, Côte d'Ivoire.
| |
Collapse
|
10
|
Kuperberg A, Walker AM. Heterosexual College Students Who Hookup with Same-Sex Partners. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1387-1403. [PMID: 29671130 DOI: 10.1007/s10508-018-1194-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/13/2018] [Accepted: 03/14/2018] [Indexed: 06/08/2023]
Abstract
Individuals who identify as heterosexual but engage in same-sex sexual behavior fascinate both researchers and the media. We analyzed the Online College Social Life Survey dataset of over 24,000 undergraduate students to examine students whose last hookup was with a same-sex partner (N = 383 men and 312 women). The characteristics of a significant minority of these students (12% of men and 25% of women) who labelled their sexual orientation "heterosexual" differed from those who self-identified as "homosexual," "bisexual," or "uncertain." Differences among those who identified as heterosexual included more conservative attitudes, less prior homosexual and more prior heterosexual sexual experience, features of the hookups, and sentiments about the encounter after the fact. Latent class analysis revealed six distinctive "types" of heterosexually identified students whose last hookup was with a same-sex partner. Three types, comprising 60% of students, could be classified as mostly private sexual experimentation among those with little prior same-sex experience, including some who did not enjoy the encounter; the other two types in this group enjoyed the encounter, but differed on drunkenness and desire for a future relationship with their partner. Roughly, 12% could be classified as conforming to a "performative bisexuality" script of women publicly engaging in same-sex hookups at college parties, and the remaining 28% had strong religious practices and/or beliefs that may preclude a non-heterosexual identity, including 7% who exhibited "internalized heterosexism." Results indicate several distinctive motivations for a heterosexual identity among those who hooked up with same-sex partners; previous research focusing on selective "types" excludes many exhibiting this discordance.
Collapse
Affiliation(s)
- Arielle Kuperberg
- Sociology Department, The University of North Carolina at Greensboro, PO Box 26170, Greensboro, NC, 27402-6170, USA.
| | - Alicia M Walker
- Department of Sociology and Anthropology, Missouri State University, Springfield, MO, USA
| |
Collapse
|
11
|
Noonan EJ, Sawning S, Combs R, Weingartner LA, Martin LJ, Jones VF, Holthouser A. Engaging the Transgender Community to Improve Medical Education and Prioritize Healthcare Initiatives. TEACHING AND LEARNING IN MEDICINE 2018; 30:119-132. [PMID: 29190167 DOI: 10.1080/10401334.2017.1365718] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
UNLABELLED Phenomenon: Transgender patients experience discrimination, limited access to care, and inadequate provider knowledge in healthcare settings. Medical education to address transgender-specific disparities is lacking. Research that engages transgender community members may help address health disparities by empowering patients, increasing trust, and informing medical curricula to increase competence. APPROACH A 2015 Community Forum on Transgender Health Care was hosted at the University of Louisville School of Medicine, which included healthcare professionals and transgender community members to facilitate dialogue among mixed-participant groups using a World Café model. Fifty-nine participants discussed the status of transgender healthcare and made recommendations for local improvements. A follow-up survey was administered to 100 individuals, including forum participants and their referrals. The forum discussion and survey responses were analyzed to determine common perceptions of transgender healthcare, priorities for improvement interventions, and themes to inform curriculum. FINDINGS The community forum discussion showed that local transgender care is overwhelmingly underdeveloped and unresponsive to the needs of the transgender community. The follow-up survey revealed that priorities to improve transgender care included a multidisciplinary clinic for lesbian, gay, bisexual, and transgender (LGBT) patients, an LGBT-friendly network of physicians, and more training for providers and support staff. This mutually constructive engagement experience influenced reform in undergraduate curricula and continuing education opportunities. Insights: Community engagement in healthcare disparities research can cultivate improbable discussions, yield innovative insight from marginalized populations, and build relationships with community members for future collaborations and interventions. Societal acceptance of transgender identities, which could be promoted through healthcare providers, could stimulate significant progress in transgender healthcare. Supplemental educational interventions for practicing physicians will improve the current conditions of transgender healthcare, but a comprehensive medical school curriculum specifically for transgender health that includes interactions between the transgender community and medical students could be particularly impactful.
Collapse
Affiliation(s)
- Emily J Noonan
- a Undergraduate Medical Education, University of Louisville School of Medicine , Louisville , Kentucky , USA
- b LGBT Center Satellite Office at the Health Sciences Center , University of Louisville , Louisville , Kentucky , USA
| | - Susan Sawning
- a Undergraduate Medical Education, University of Louisville School of Medicine , Louisville , Kentucky , USA
| | - Ryan Combs
- c Department of Health Promotion and Behavioral Sciences , University of Louisville School of Public Health and Information Sciences , Louisville , Kentucky , USA
| | - Laura A Weingartner
- a Undergraduate Medical Education, University of Louisville School of Medicine , Louisville , Kentucky , USA
| | - Leslee J Martin
- a Undergraduate Medical Education, University of Louisville School of Medicine , Louisville , Kentucky , USA
| | - V Faye Jones
- d Health Sciences Center Office of Diversity and Inclusion , University of Louisville , Louisville , Kentucky , USA
- e Department of Pediatrics , University of Louisville School of Medicine , Louisville , Kentucky , USA
| | - Amy Holthouser
- a Undergraduate Medical Education, University of Louisville School of Medicine , Louisville , Kentucky , USA
- e Department of Pediatrics , University of Louisville School of Medicine , Louisville , Kentucky , USA
| |
Collapse
|
12
|
Loza O, Alvarez CR, Peralta-Torres D. Healthcare and Social Services Providers Who Serve Sexual and Gender Minorities in a U.S.-Mexico Border City. J Immigr Minor Health 2018; 20:1537-1540. [PMID: 29335809 DOI: 10.1007/s10903-018-0688-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Sexual and gender minorities, including lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals, experience barriers to healthcare as a result of stigma, discrimination, and poor cultural competence by healthcare and social services providers (HCSSP). The purpose of the study is to increase access to care and services for the LGBTQ community in a U.S.-Mexico border city by identifying LGBTQ-friendly HCSSP. A survey, developed based on concerns voiced in a predominantly Hispanic LGBTQ community, was administered to HCSSP and used to create a referral list, "The Purple Pages of El Paso" (PPoEP). Overall, 77 HCSSP have responded and 43 are included in the most recent version of the PPoEP. This model for developing a referral list of providers can be adapted in areas where LGBTQ communities face similar barriers to care and services. To be effective in reducing barriers to care, PPoEP must be updatable and sustainable.
Collapse
Affiliation(s)
- Oralia Loza
- Department of Public Health Sciences, College of Health Sciences, The University of Texas at El Paso, 500 W. University Ave. (HSSN 405), El Paso, TX, 79968, USA.
| | - Carlos R Alvarez
- Texas Department of State Health Services, TB/HIV/STD Epidemiology and Surveillance Branch, Epidemiology and Supplemental Projects Group, MC 1873, P.O. Box 149347, Austin, TX, USA
| | - David Peralta-Torres
- HIV Prevention Program, City of El Paso Department of Public Health, 701 Montana Ave., El Paso, TX, USA
| |
Collapse
|
13
|
Lunn MR, Cui W, Zack MM, Thompson WW, Blank MB, Yehia BR. Sociodemographic Characteristics and Health Outcomes Among Lesbian, Gay, and Bisexual U.S. Adults Using Healthy People 2020 Leading Health Indicators. LGBT Health 2017; 4:283-294. [PMID: 28727950 DOI: 10.1089/lgbt.2016.0087] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
PURPOSE This study aimed to characterize the sociodemographic characteristics of sexual minority (i.e., gay, lesbian, bisexual) adults and compare sexual minority and heterosexual populations on nine Healthy People 2020 leading health indicators (LHIs). METHODS Using a nationally representative, cross-sectional survey (National Health Interview Survey 2013-2015) of the civilian, noninstitutionalized population (228,893,944 adults), nine Healthy People 2020 LHIs addressing health behaviors and access to care, stratified using a composite variable of sex (female, male) and sexual orientation (gay or lesbian, bisexual, heterosexual), were analyzed individually and in aggregate. RESULTS In 2013-2015, sexual minority adults represented 2.4% of the U.S. POPULATION Compared to heterosexuals, sexual minorities were more likely to be younger and to have never married. Gays and lesbians were more likely to have earned a graduate degree. Gay males were more likely to have a usual primary care provider, but gay/lesbian females were less likely than heterosexuals to have a usual primary care provider and health insurance. Gay males received more colorectal cancer screening than heterosexual males. Gay males, gay/lesbian females, and bisexual females were more likely to be current smokers than their sex-matched, heterosexual counterparts. Binge drinking was more common in bisexuals compared to heterosexuals. Sexual minority females were more likely to be obese than heterosexual females; the converse was true for gay males. Sexual minorities underwent more HIV testing than their heterosexual peers, but bisexual males were less likely than gay males to be tested. Gay males were more likely to meet all eligible LHIs than heterosexual males. Overall, more sexual minority adults met all eligible LHIs compared to heterosexual adults. Similar results were found regardless of HIV testing LHI inclusion. CONCLUSION Differences between sexual minorities and heterosexuals suggest the need for targeted health assessments and public health interventions aimed at reducing specific negative health behaviors.
Collapse
Affiliation(s)
- Mitchell R Lunn
- 1 Division of Nephrology, Department of Medicine, University of California , San Francisco, San Francisco, California.,2 The PRIDE Study/PRIDEnet, University of California , San Francisco, San Francisco, California.,3 Lesbian, Gay, Bisexual, and Transgender Medical Education Research Group, Stanford University School of Medicine , Stanford, California
| | - Wanjun Cui
- 4 Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, U.S. Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Matthew M Zack
- 4 Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, U.S. Centers for Disease Control and Prevention , Atlanta, Georgia
| | - William W Thompson
- 5 Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, U.S. Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Michael B Blank
- 6 Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania.,7 Leonard Davis Institute of Health Economics, University of Pennsylvania , Philadelphia, Pennsylvania.,8 Annenberg Public Policy Center, Annenberg School for Communication, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Baligh R Yehia
- 9 Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania.,10 Penn Medicine Program for LGBT Health, University of Pennsylvania , Philadelphia, Pennsylvania
| |
Collapse
|
14
|
White Hughto JM, Biello KB, Reisner SL, Perez-Brumer A, Heflin KJ, Mimiaga MJ. Health Risk Behaviors in a Representative Sample of Bisexual and Heterosexual Female High School Students in Massachusetts. THE JOURNAL OF SCHOOL HEALTH 2016; 86:61-71. [PMID: 26645422 PMCID: PMC4675046 DOI: 10.1111/josh.12353] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 05/08/2015] [Accepted: 05/10/2015] [Indexed: 05/29/2023]
Abstract
BACKGROUND Differences in sexual health-related outcomes by sexual behavior and identity remain underinvestigated among bisexual female adolescents. METHODS Data from girls (N = 875) who participated in the Massachusetts Youth Risk Behavior Surveillance survey were analyzed. Weighted logistic regression models were fit to examine sexual and psychosocial health by lifetime sexual behavior (behaviorally bisexual vs behaviorally heterosexual) and sexual identity (bisexual vs heterosexual) adjusting for grade and race/ethnicity. RESULTS Overall, 10.5% of girls reported lifetime bisexual behavior and 8.1% reported a bisexual identity. Behavior and identity were discordant for bisexual young women as 53.2% of behaviorally bisexual students had a bisexual identity and 46.8% had a heterosexual identity. Bisexual identity and behavior were associated with unprotected intercourse at last sexual encounter, early sexual debut, 4 or more lifetime partners, history of forced/unwanted sex, sexually transmitted infection testing history, past-year depression, and past-month drug use (all ps < .05). CONCLUSION Bisexuality, whether defined by identity or behavior, is associated with adverse sexual and psychosocial health outcomes in adolescent girls. Studies that explore wellness across the life span, and are designed to recognize developmental differences burgeoning in adolescence, may provide insights into the differential sexual risk outcomes observed among bisexual girls.
Collapse
Affiliation(s)
- Jaclyn M White Hughto
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA 02215.
- Department of Chronic Disease Epidemiology, Yale School of Public Health.
| | - Katie B Biello
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA 02215.
- Departments of Behavioral & Social Sciences and Epidemiology, Institute for Community Health Promotion, Brown University School of Public Health.
| | - Sari L Reisner
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA 02215.
- Division of General Pediatrics, Boston Children's Hospital/Harvard Medical School.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health.
| | - Amaya Perez-Brumer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032.
| | - Katherine J Heflin
- Center for Health Care Strategies, 200 American Metro Blvd., Hamilton, New Jersey 08619.
| | - Matthew J Mimiaga
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA 02215.
- Institute for Community Health Promotion, Brown University School of Public Health.
- Harvard T.H. Chan School of Public Health.
| |
Collapse
|
15
|
Roller CG, Sedlak C, Draucker CB. Navigating the System: How Transgender Individuals Engage in Health Care Services. J Nurs Scholarsh 2015; 47:417-24. [PMID: 26243380 DOI: 10.1111/jnu.12160] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Transgender individuals (TIs) experience a number of healthcare disparities that result in compromised access to health care, placing them at high risk for poor health outcomes. Despite their unique health concerns, there is little known about how they engage in health care. The purpose of this grounded theory study was to construct a theoretical framework that depicts the process by which transgender individuals engage in health care. METHODS In this grounded theory study, data from interviews with 25 individuals who self-identified as transgender were used to develop a theoretical framework that depicts the process by which TIs engage in health care. Data analysis included open coding, category formation, and theoretical coding. Constant comparative analysis was used to facilitate theory generation. CONCLUSIONS The central phenomenon of how TIs engage in health care was the core process of navigating the system. The core process involves four subprocesses: needing to move forward, doing due diligence, finding loopholes, and making it work. CLINICAL RELEVANCE The theoretical framework of navigating the system can provide healthcare providers with a way to understand how TIs engage in health care as they move through the subprocesses of moving forward, doing due diligence, finding loopholes, and making it work in order to get their healthcare needs met. With a better understanding of the healthcare journeys of TIs, healthcare providers can provide better care for this population and advocate for change in policies that contribute to the health disparities TIs experience.
Collapse
Affiliation(s)
- Cyndi Gale Roller
- Associate Professor of Nursing, American Nurses Foundation Scholar, Kent State University - College of Nursing, Kent, OH, USA
| | - Carol Sedlak
- Professor of Nursing, Kent State University - College of Nursing, Kent, OH, USA
| | | |
Collapse
|
16
|
Brittain DR, Dinger MK. An Examination of Health Inequities among College Students by Sexual Orientation Identity and Sex. J Public Health Res 2015; 4:414. [PMID: 25918696 PMCID: PMC4407041 DOI: 10.4081/jphr.2015.414] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 12/05/2014] [Indexed: 11/24/2022] Open
Abstract
Background Lesbian, gay, and bisexual (LGB) college students may have an increased number of health inequities compared to their heterosexual counterparts. However, to date, no research has provided a comprehensive examination of health-related factors by sexual orientation identity and sex among a national sample of college students. Thus, the purpose of this study was to examine physical, sexual, interpersonal relations/safety, and mental health inequities by sexual orientation identity and sex among a national sample of college students. Design and methods Participants (n=39,767) completed the National College Health Assessment II during the fall 2008/spring 2009 academic year. Hierarchical binary logistic regression analyses were used to examine health inequities by sexual orientation identity and sex. Results LGB students compared to heterosexual students, experienced multiple health inequities including higher rates of being verbally threatened and lower rates of physical activity and condom use. Conclusions An understanding of health inequities experienced by LGB college students is critical as during these years of transition, students engage in protective (e.g., physical activity) and risky (e.g., lack of condom use) health behaviours, establishing habits that could last a lifetime. Future research should be used to design and implement targeted public health strategies and policies to reduce health inequities and improve health-related quality of life among LGB college students. Significance for public health Health inequities based on sexual orientation identity and sex among college students is a critical public health concern. Based on the results of the current study, lesbian, gay, and bisexual (LGB) college students experienced multiple physical, sexual, interpersonal relations and safety, and mental health inequities. This understanding of health inequities experienced by LGB college students is critical as during these years of transition, students engage in protective (e.g., physical activity) and risky (e.g., lack of condom use) health behaviours, establishing habits that could last a lifetime. By intervening during the college years, targeted public health strategies and policies can be designed and implemented to reduce health inequities and improve health-related quality of life among LGB individuals during mid-to-later adulthood.
Collapse
Affiliation(s)
- Danielle R Brittain
- Community Health Program, Colorado School of Public Health at the University of Northern Colorado , Greeley, CO, USA
| | - Mary K Dinger
- Community Health Program, Colorado School of Public Health at the University of Northern Colorado , Greeley, CO, USA
| |
Collapse
|
17
|
Patel N, Rana A, Thomas A, Barnhart JC, Flanigan TP, van den Berg JJ, Chan PA. HIV testing practices among New England college health centers. AIDS Res Ther 2013; 10:8. [PMID: 23496891 PMCID: PMC3606211 DOI: 10.1186/1742-6405-10-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 03/12/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of human immunodeficiency virus (HIV) continues to increase among certain populations including young men who have sex with men (MSM). College campuses represent a potential setting to engage young adults and institute prevention interventions including HIV testing. The purpose of this study was to evaluate testing practices for HIV and other sexually transmitted infections (STIs) on college campuses. METHODS Medical directors at four-year residential baccalaureate college health centers in New England were surveyed from June, 2011 to September, 2011. Thirty-one interviews were completed regarding experiences with HIV testing, acute HIV infection, other STI testing, and outreach efforts targeting specific at-risk groups such as MSM. RESULTS Among schools that responded to the survey, less than five percent of students were tested for HIV at their local college health center in the past academic year (2010-2011). Significant barriers to HIV testing included cost and availability of rapid antibody testing. One-third of college health medical directors reported that their practitioners may not feel comfortable recognizing acute HIV infection. CONCLUSIONS Improved HIV testing practices are needed on college campuses. Programs should focus on outreach efforts targeting MSM and other at-risk populations.
Collapse
|
18
|
Heywood W, Smith AMA. Anal sex practices in heterosexual and male homosexual populations: a review of population-based data. Sex Health 2013; 9:517-26. [PMID: 22951046 DOI: 10.1071/sh12014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 03/19/2012] [Indexed: 01/23/2023]
Abstract
Anal sex is known to be an important risk factor for anal cancer. Yet compared with vaginal intercourse, little is known about anal sex practices in either heterosexual or male homosexual populations. Of the data that are available, it appears a significant and increasing minority of heterosexuals have ever practised anal intercourse. Among homosexual men, most, but not all, report anal sex, with large proportions of men engaging in both insertive and receptive anal intercourse. The most significant finding of the review was the dearth of population-based data, particularly relating to homosexual men.
Collapse
Affiliation(s)
- Wendy Heywood
- Australian Research Centre in Sex, Health & Society, La Trobe University, Melbourne, Australia
| | | |
Collapse
|
19
|
Schick V, Herbenick D, Rosenberger JG, Reece M. Prevalence and Characteristics of Vibrator Use among Women who have Sex with Women. J Sex Med 2011; 8:3306-15. [DOI: 10.1111/j.1743-6109.2011.02503.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
20
|
Reproductive health screening disparities and sexual orientation in a cohort study of U.S. adolescent and young adult females. J Adolesc Health 2011; 49:505-10. [PMID: 22018565 PMCID: PMC3200536 DOI: 10.1016/j.jadohealth.2011.03.013] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 03/27/2011] [Accepted: 03/29/2011] [Indexed: 11/23/2022]
Abstract
PURPOSE To examine sexual orientation group disparities in the Papanicolaou (Pap) and sexually transmitted infection (STI)/human papillomavirus (HPV) tests among adolescents and young adult females. METHODS Survey data from 4,224 adolescents and young adults aged 17-25 years who responded to the 2005 wave questionnaire of the Growing Up Today Study were cross-sectionally examined with multivariate generalized estimating equations regression. We examined associations between sexual orientation and reproductive healthcare utilization as well as abnormal results with completely heterosexual as the referent group, controlling for age, race/ethnicity, geographic region, and sexual history. RESULTS After accounting for sociodemographics and sexual history, mostly heterosexual/bisexual females had 30% lower odds of having a Pap test within the last year and almost 40% higher odds of being diagnosed with an STI, as compared with the completely heterosexual group. Additionally, lesbians had very low odds of having a Pap test in their lifetime (odds ratio = .13, p ≤ .0001) and having a Pap test within the last year (odds ratio = .25, p = .0002), as compared with completely heterosexuals. CONCLUSIONS Our study demonstrates that sexual minority adolescent and young adult women underutilize routine reproductive health screenings, including Pap smears and STI tests. Providers and health educators should be aware of these disparities so that they can provide appropriate care to young women and their families and ensure that all young women receive reproductive health screening. Further research is needed to explore reasons sexual minority females are not accessing care as recommended because this may suggest opportunities to improve reproductive health screenings as well as broader healthcare access issues.
Collapse
|
21
|
HIV infection and STI in the trans population: A critical review. Rev Epidemiol Sante Publique 2011; 59:259-68. [DOI: 10.1016/j.respe.2011.02.102] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 01/24/2011] [Accepted: 02/02/2011] [Indexed: 11/20/2022] Open
|
22
|
Fisher CM. Adapting the information-motivation-behavioral skills model: predicting HIV-related sexual risk among sexual minority youth. HEALTH EDUCATION & BEHAVIOR 2011; 39:290-302. [PMID: 21693648 DOI: 10.1177/1090198111406537] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Young sexual minority males are among those at highest risk for HIV infection, yet we know relatively little about the impact of sexual identity development on HIV risk. This study used cross-sectional data to investigate factors associated with HIV-related sexual risk among a sample of sexual minority males (n = 156), ages 14 to 21 years, using an extended version of the information-motivation-behavioral skills (IMB) model tailored for this population. Path analysis results indicated that the extended model predicted a sizable amount of primary and secondary sexual risk (r (2) = .35 and .42). In addition to increasing HIV prevention information and motivation and decreasing substance use, study findings suggest that interventions with young sexual minority males should focus on sexual identity development factors including youths' attitudes toward LBGT people, sex-centered versus identity-centered development, and with specific emphasis on youth with non-male exclusive sexual orientations.
Collapse
|
23
|
Stieglitz KA. Development, Risk, and Resilience of Transgender Youth. J Assoc Nurses AIDS Care 2010; 21:192-206. [DOI: 10.1016/j.jana.2009.08.004] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Accepted: 08/25/2009] [Indexed: 11/28/2022]
|
24
|
Lindley LL, Barnett CL, Brandt HM, Hardin JW, Burcin M. STDs among sexually active female college students: does sexual orientation make a difference? PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2008; 40:212-217. [PMID: 19067934 DOI: 10.1363/4021208] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
CONTEXT Research addressing sexual health or STD risk among lesbian and bisexual college women is scarce. METHODS Data on 29,952 sexually active females aged 18-24 who completed the 2006 National College Health Assessment were examined to assess differences in sexual risk factors and recent STD incidence by sexual orientation. Comparisons were analyzed at the bivariate level and through multivariate logistic regression. RESULTS Bisexual students were the most likely to have had an STD during the past year (9%); lesbians were the least likely (2%). However, lesbians were also the least likely to have had a routine gynecologic examination (46%, compared with 64-73% of others). Among students who had had multiple partners in the past year, those who had had partners of both sexes were more likely to have had an STD (16%) than were students who had had only male partners (9%) or only female partners (6%). Students who had binged on alcohol the last time they partied, had had multiple partners or had had a routine gynecologic examination in the past year, had been tested for HIV or had not used condoms at last vaginal intercourse were at increased odds of having had an STD (odds ratios, 1.3-4.0). CONCLUSIONS Sexual health programs targeting female college students, regardless of sexual orientation, must focus on behavioral risks associated with STDs. In addition, the importance of regular gynecologic exams should be emphasized, especially among lesbians. Further research is needed on risk-taking among female college students who are sexually active with both sexes.
Collapse
Affiliation(s)
- Lisa L Lindley
- Department of Health Promotion, Education and Behavior, Arnold School of Public health, University of South Carolina, Columbia, USA.
| | | | | | | | | |
Collapse
|
25
|
Evans AR, Wiggins RD, Bolding G, Elford J. Characteristics of gay and bisexual men who drop out of a web survey of sexual behaviour in the UK. AIDS Behav 2008; 12:957-63. [PMID: 18481166 DOI: 10.1007/s10461-008-9400-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Accepted: 04/28/2008] [Indexed: 11/26/2022]
Abstract
An invitation to take part in a web survey of sexual behaviour appeared on two popular websites for gay men in the UK in May and June 2003. As soon as men began the survey, their responses were recorded. If they quit before the end, the point at which they stopped was identified. Men clicked into the survey a total of 4,271 times and 2,752 (64%) respondents completed it. The median last question reached by respondents who dropped out was question number 20 out of 158. Multivariate analysis indicated that drop out was related to ethnic group, openness about sexual orientation and age. The results suggest that MSM who use the Internet to seek sexual partners may be younger, more likely to be from an ethnic minority and less open about their sexuality than web surveys indicate. This has implications for the development of online HIV and STI interventions.
Collapse
|
26
|
Malebranche DJ. Bisexually active Black men in the United States and HIV: acknowledging more than the "Down Low". ARCHIVES OF SEXUAL BEHAVIOR 2008; 37:810-6. [PMID: 18506612 DOI: 10.1007/s10508-008-9364-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
HIV is disproportionately impacting Black men who have sex with men and heterosexual women in the United States. Current speculation posits a "bisexual bridge" of HIV transmission connecting these two subpopulations of the Black community. Specifically, bisexually active Black men who identify as heterosexual but do not disclose their same-sex behavior, or "down low" (DL) men, have received the most attention and blame as the primary group fueling this epidemic. This essay explores the current knowledge and limitations of public health research on bisexually active Black men. Implications for future research initiatives are discussed.
Collapse
Affiliation(s)
- David J Malebranche
- Division of General Medicine, Emory University School of Medicine, 49 Jesse Hill Jr. Drive, Suite 413, Atlanta, GA 30303, USA.
| |
Collapse
|
27
|
Abstract
Cities are now the major sites of human habitation worldwide, a trend that will continue for the foreseeable future, not only in the developed world but in developing countries. Urban residence impacts health and health prospects both positively and negatively through a complex mix of exposures and mechanisms. In addition, cities concentrate population subsets of various demographic, economic, and social characteristics, some with particular health risks and vulnerabilities. Looking at health through the urban lens allows increased understanding of disparate risks and emphasizes the essentiality of collaborative efforts in protecting and enhancing the health of populations, especially those living in cities.
Collapse
|
28
|
Valente TW, Murphy S, Huang G, Gusek J, Greene J, Beck V. Evaluating a Minor Storyline on ER About Teen Obesity, Hypertension, and 5 A Day. JOURNAL OF HEALTH COMMUNICATION 2007; 12:551-66. [PMID: 17763052 DOI: 10.1080/10810730701508385] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
This study evaluates the effects of an ER (NBC) storyline about teen obesity, hypertension, and 5 A Day on knowledge, attitudes, and behavior. The storyline depicted an African American teen who presented at the emergency room with burns from a workplace injury. Upon diagnosis, the teen was discovered to have hypertension and counseled to eat more fruits and vegetables and get more exercise. The evaluation was conducted using three separate datasets, one of which provided data on a sample of primetime viewers before and after the storyline aired. Results showed that the storyline affected self-reported behavior change and had modest impacts on knowledge, attitudes, and practices. Interestingly, these effects were stronger for men than for women, possibly due to men's lower knowledge levels at baseline. Issues including identification with characters and the value of even modest effects on large audiences and the implications of our findings for future evaluations of entertainment education (EE) and other health communication programs are discussed.
Collapse
Affiliation(s)
- Thomas W Valente
- Department of Preventive Medicine, School of Medicine, University of Southern California, Alhambra, California 91803, USA.
| | | | | | | | | | | |
Collapse
|
29
|
Abstract
PURPOSE OF REVIEW The goal of this article is to provide an overview of up-to-date health information about sexual minority female youth so that healthcare practitioners can better serve their healthcare needs. RECENT FINDINGS Sexual minority adolescent girls may follow diverse sexual developmental trajectories. Many in this population are quite healthy, but some may be disproportionately vulnerable to health risks, perhaps because of the stigma associated with minority sexuality in society. If sexually active, girls in this population often have sex with boys as well as girls and confront risks attendant with sex with both genders. They may demonstrate fluidity in their sexual identity as they move through adolescence. Data suggest that sexual minority adolescent girls are more likely to smoke cigarettes, drink alcohol, or use illicit drugs compared with girls who are heterosexual. They may be more likely to be victims of violence or victimization or to be depressed or suicidal. SUMMARY Sexual minority adolescent girls may be quite resilient, but they face a range of possible adverse health risks. Healthcare practitioners should keep their health issues in mind so they can offer healthcare and counseling that is sensitive, comprehensive, and appropriate.
Collapse
Affiliation(s)
- Joanna D Brown
- Division of Adolescent/Young Adult Medicine, Department of Medicine, Children's Hospital Boston, MA 02115, USA.
| | | |
Collapse
|
30
|
Noar SM, Cole C, Carlyle K. Condom use measurement in 56 studies of sexual risk behavior: review and recommendations. ARCHIVES OF SEXUAL BEHAVIOR 2006; 35:327-45. [PMID: 16799837 DOI: 10.1007/s10508-006-9028-4] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2004] [Revised: 02/24/2005] [Accepted: 05/01/2005] [Indexed: 05/08/2023]
Abstract
Despite numerous studies that measure self-reported condom use, there is currently no agreed upon "gold standard" in terms of the best way to assess condom use. The purpose of the current study was to review measures of self-reported condom use within correlational studies of sexual risk behavior, and to evaluate such measures on the basis of suggestions from the methodological literature. An additional purpose was to examine specifically whether measures published in the correlational literature have improved over time. A systematic review of studies was undertaken and specific review criteria were used to guide the inclusion of studies. A final set of 56 studies that contained 72 measures of self-reported condom use were included in the review. These measures were coded and evaluated on 12 dimensions, including measure type, number of response categories, recall period, sex partner specificity, and sex act specificity. Results indicated a great amount of diversity in terms of how condom use has been measured in the literature. Although results indicated that measures published between 1996 and 2003 were of higher quality on a number of dimensions as compared to 1989-1995, a number of these gains were minimal and in some cases measures have decreased in quality. The overall conclusion is that the sexual risk behavior literature should implement more of the recommendations made by methodological scholars in this area. Specific recommendations are summarized and presented in a way that may be helpful in guiding the development of future measures of self-reported condom use.
Collapse
Affiliation(s)
- Seth M Noar
- Department of Communication, University of Kentucky, Lexington, Kentucky 40506-0042, USA.
| | | | | |
Collapse
|
31
|
Abstract
Adolescence is the period of life in which issues of sexuality come to the fore. This article describes the concept of sexuality, teens' expression of sexuality, and various consequences of sexual behaviors. Issues of sexual preference and identity are described,and a brief discussion of sex education is presented. Primary care clinicians should use this article as a basis for further exploration of these important issues for their adolescent patients.
Collapse
Affiliation(s)
- Robert T Brown
- Clinical Pediatrics/Obstetrics-Gynecology, The Ohio State University College of Medicine and Public Health, Columbus, USA.
| | | |
Collapse
|
32
|
Alexander B, Schrauben S. Outside the Margins: Youth Who Are Different and Their Special Health Care Needs. Prim Care 2006; 33:285-303. [PMID: 16713763 DOI: 10.1016/j.pop.2006.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Some adolescents have differences, not of their own choosing, that require different approaches to clinical assessment and care. These adolescents are often marginalized from their peer group, and of-ten isolated in general. Awareness of the differences in health risks that these youth face, and their challenges in the successful mastery of developmental tasks is important to the clinician who serves them. Health care professionals must avoid three things in their efforts to help these groups of young people: judging, preaching, or becoming an agent of social control, even though such efforts maybe well meaning. This article addresses some of the unique needs of gay, lesbian, and bisexual youth; homeless adolescents; foster care youth; and youth who have disabilities.
Collapse
Affiliation(s)
- Beth Alexander
- Department of Family Practice, College of Human Medicine, Michigan State University, East Lansing, 48824, USA.
| | | |
Collapse
|
33
|
Are Transgender Persons at Higher Risk for HIV Than Other Sexual Minorities? A Comparison of HIV Prevalence and Risks. Int J Transgend 2005. [DOI: 10.1300/j485v08n02_11] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
34
|
Hightow LB, MacDonald PDM, Pilcher CD, Kaplan AH, Foust E, Nguyen TQ, Leone PA. The unexpected movement of the HIV epidemic in the Southeastern United States: transmission among college students. J Acquir Immune Defic Syndr 2005; 38:531-7. [PMID: 15793362 DOI: 10.1097/01.qai.0000155037.10628.cb] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Approximately 16 million people are enrolled in institutions of higher learning in the United States. However, college students have not been perceived as at high risk for HIV infection. In early 2003, acute HIV infection was diagnosed in 2 men attending college in North Carolina. We describe an epidemiologic investigation of newly diagnosed HIV infection in men attending college in North Carolina. METHODS We reviewed state surveillance records examining new HIV diagnoses in men 18-30 years old between January 1, 2000 and December 31, 2003, living in 69 North Carolina counties. Risk behavior and demographic information for HIV-infected men enrolled in college were compared with HIV-infected male nonenrollees. RESULTS Of the 735 records available for review, 84 (11%) were college men. Eighty-seven percent of college men were African American and 92% were men who have sex with men (MSM) or men who have sex with men and women (MSM/W). Compared with noncollege men, college men were more likely to be African American (odds ratio 3.70, 95% CI = 1.86-7.54), to report meeting sex partners at bars or dance clubs (odds ratio 3.01, 95% CI = 1.77-5.10) or on the Internet/chat lines (odds ratio 4.95, 95% CI = 2.53-9.64), or to report use of "ecstasy" or club drugs (odds ratio 4.51, 95% CI = 1.15-15.40). Newly diagnosed HIV infection was found in men in 37 colleges located in North Carolina or surrounding states and a sexual partner network investigation linked 21 colleges, 61 students, and 8 partners of students. CONCLUSION We describe an epidemic of HIV infection occurring in North Carolina college students, primarily involving African American MSM and MSM/W. College students represent an at-risk, accessible population, which deserves further HIV prevention interventions.
Collapse
Affiliation(s)
- Lisa B Hightow
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | | | | | | | | | | | | |
Collapse
|
35
|
Crosby RA, Miller KH, Staten RR, Noland M. Prevalence and correlates of HIV testing among college students: an exploratory study. Sex Health 2005; 2:19-22. [PMID: 16334708 DOI: 10.1071/sh04047] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objectives: Whether college students who are most at-risk of HIV infection are being tested is unknown. This exploratory study identified the prevalence and correlates of ever having an HIV test among college students. Methods: A cross-sectional survey was conducted among a probability sample of 903 college students. Measures of sexual risk behaviour were assessed. Results: Of the students surveyed, 22.5% reported they had been tested for HIV. Testing was more likely among those 20 years of age or older (27.8% v. 14.7%; P = 0.0001), females (25.4% v. 17.8%; P = 0.01), and members of racial/ethnic minorities (42.7% v. 20.3%; P = 0.0001). After adjusting for these covariates, those who reported ever having vaginal sex (AOR = 5.5; 95% CI = 3.1–9.6); anal sex (AOR = 2.4; 95% CI = 1.6–3.6), and oral sex (AOR = 6.3; 95% CI = 3.0–13.3) were significantly more likely to report being tested. Students having vaginal sex in the past 12 months were significantly more likely to report testing (AOR = 5.3; 95% CI = 3.1–9.1). Those reporting vaginal sexual debut (AOR = 1.9; 95% CI = 1.2–3.1) or oral sexual debut (AOR = 1.7; 95% CI = 1.1–2.5) ≤age 15 were significantly more likely to be tested. Students reporting four or more sex partners were significantly more likely to be tested than sexually experienced students reporting fewer partners (AOR = 3.2; 95% CI = 2.2–4.6). Finally, those reporting at least one episode of forced vaginal sex (AOR = 3.9; 95% CI = 2.1–7.2) and reporting at least one episode of any forced sex (vaginal, anal, oral) (AOR = 3.0; 95% CI = 1.8–5.0) were significantly more likely to report being tested. Conclusions: Within this population, demographically controlled findings suggest that those most at-risk of HIV infection are indeed being tested for the virus.
Collapse
Affiliation(s)
- Richard A Crosby
- College of Public Health, University of Kentucky, 121 Washington Ave, Room 11 C, Lexington, KY 40506-0003, USA.
| | | | | | | |
Collapse
|