Exploring Resilience Among Midlife and Older Sexual Minority and Heterosexual Adults: A Multidimensional Analysis

Research on resilience in sexual minority midlife and older adults is limited. Using a multidimensional approach, this study examined trait resilience (optimism), resilience as a dynamic process (perceived control), and relational resilience (social support), analyzing their roles in physical and mental health among sexual minority adults. Analyzing data from MIDUS 2 and MIDUS Refresher, we examined a sample of 492 participants, comprising 164 sexual minority and 328 propensity-matched heterosexual individuals. Among sexual minority participants, perceived control was associated with fewer chronic conditions and optimism with lower depressed affect. Among heterosexual participants, perceived control was associated with both outcomes. Subgroup analyses found variations, particularly among lesbian and bisexual women. Resilience measures were not associated with the health outcomes for gay or bisexual men. This study highlighted the complex roles of trait resilience and dynamic resilience processes in association with health outcomes among sexual minority midlife and older adults across diverse subgroups.

Sexual minority status modifies the association between HIV risk behavior and prevalent mood or anxiety disorders in British Columbia, Canada

PURPOSE

This study aimed at determining to what extent sexual minority status modifies the association between HIV risk behavior and prevalent mood or anxiety disorder diagnosis in British Columbia (BC), Canada, using a population-based survey.

METHODS

This analysis was based on the cross-sectional 2013-2014 Canadian Community Health Survey. The sample was restricted to respondents in BC with valid responses to the survey items considered. A multivariable logistic model, where the behavioral HIV risk score exposure was nested into the sexual minority status modifier, estimated the odds of having a prevalent mood or an anxiety disorder. The behavioral HIV risk score (0, 1, 2, ≥ 3) included the following five measures: (1) age at first intercourse < 14 years, (2) condom use during last intercourse, (3) history of sexually transmitted infections, (5) number of sexual partners in the past 12 months (< 4, ≥ 4), and substance use in the past 12 months.

RESULTS

Of the weighted sample (2,521,252), 97% (95% confidence interval (CI) 97-98) were heterosexual, while 3% (95% CI 2-3) were lesbian, gay, and bisexual (LGB). The prevalence of a mood or anxiety disorder diagnosis was 12% (95% CI 11-13). For every 1-level increment in the behavioral HIV risk score, the adjusted odds ratio of having a prevalent mood or anxiety disorder diagnosis was 1.29 (95% CI 1.03-1.54) for heterosexual respondents and 2.37 (95% CI 1.84-2.90) for LGB respondents.

CONCLUSION

Sexual minority status modified the relationship between HIV risk behavior and prevalent mood or anxiety disorders, with a stronger association among LGB respondents. Healthcare providers should prioritize integrated care that addresses the intersectionality between sexual risk, substance use, and mood or anxiety disorders.

LGBTQ+ Aging Research in Canada: A 30-Year Scoping Review of the Literature

Canada has a unique socio-political history concerning the inclusion of lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people. With aging populations, understanding diverse groups of older adults is paramount. We completed a systematic search and scoping review of research in Canada to quantify and articulate the scale and scope of research on LGBTQ+ aging. Our search identified over 4000 results and, after screening for relevance, our review focused on 70 articles. Five major themes in the literature on LGBTQ+ aging in Canada were identified: (1) risk, (2) HIV, (3) stigma, and discrimination as barriers to care, (4) navigating care and identity, (5) documenting the history and changing policy landscapes. Most of the articles were not focused on the aging, yet the findings are relevant when considering the lived experiences of current older adults within LGBTQ+ communities. Advancing the evidence on LGBTQ+ aging involves improving the quality of life and aging experiences for LGBTQ+ older adults through research.

Development and reliability of metrics to characterize types and sources of stigma among men who have sex with men and female sex workers in Togo and Burkina Faso

Background

Stigma is a multifaceted concept that potentiates Human Immunodeficiency Virus and sexually transmitted infection acquisition and transmission risks among key populations, including men who have sex with men (MSM) and female sex workers (FSW). Despite extensive stigma literature, limited research has characterized the types and sources of stigma reported by key populations in Sub-Saharan Africa.

Methods

This study leveraged data collected from 1356 MSM and 1383 FSW in Togo and Burkina Faso, recruited via respondent-driven sampling. Participants completed a survey instrument including stigma items developed through systematic reviews and synthesis of existing metrics. Using exploratory factor analysis with promax oblique rotation, 16 items were retained in a stigma metric for MSM and 20 in an FSW stigma metric. To assess the measures’ convergent validity, their correlations with expected variables were examined through bivariate logistic regression models.

Results

One factor, experienced stigma, included actions that were carried out by multiple types of perpetrators and included being arrested, verbally harassed, blackmailed, physically abused, tortured, or forced to have sex. Other factors were differentiated by source of stigma including healthcare workers, family and friends, or police. Specifically, stigma from healthcare workers loaded on two factors: experienced healthcare stigma included being denied care, not treated well, or gossiped about by healthcare workers and anticipated healthcare stigma included fear of or avoiding seeking healthcare. Stigma from family and friends included feeling excluded from family gatherings, gossiped about by family, or rejected by friends. Stigma from police included being refused police protection and items related to police confiscation of condoms. The Cronbach’s alpha ranged from 0.71–0.82. Median stigma scores, created for each participant by summing the number of affirmative responses to each stigma item, among MSM were highest in Ouagadougou and among FSW were highest in both Ouagadougou and Bobo-Dioulasso. Validation analyses demonstrated higher stigma was generally significantly associated with suicidal ideation, disclosure of involvement in sex work or same-sex practices, and involvement in organizations for MSM or FSW.

Conclusions

Taken together, these data suggest promising reliability and validity of metrics for measuring stigma affecting MSM and FSW in multiple urban centers across West Africa.

Affective Responses to Gay Men Using Facial Electromyography: Is There a Psychophysiological "Look" of Anti-Gay Bias

Despite a wealth of attitudinal studies that elucidate the psychological correlates of anti-gay bias, studies that provide evidence of the physiological correlates of anti-gay bias remain relatively scarce. The present study addresses the under-representation of physiological research in the area of homonegativity by examining psychophysiological markers, namely the affective manifestations of anti-gay prejudice, and their correspondence with anti-gay behavior. Facial electromyography (EMG) was the technique used to acquire the psychophysiological markers via recordings from two facial muscle sites. Whether heterosexual men's implicit affective reactions to gay male couples best predicted their overt and covert discriminatory behavior toward a presumed gay male confederate was determined. The strength of the implicit affective reactions to predict anti-gay discrimination was then tested against the strength of participants' implicit cognitive reactions acquired via the Implicit Association Test (IAT). Results indicated that the affective reactions recorded via facial EMG emerged as the strongest predictor of discrimination toward gay men compared to the cognitive reactions recorded using the IAT. Findings support the contention that emotional reactions to gay men using implicit techniques such as facial EMG are potentially valuable pathways toward understanding the nature and sequelae of anti-gay behavior.

Discrimination des minorités sexuelles et de genre au travail : quelles implications pour la santé mentale ?

Malgré les avancées législatives en matière d’égalité au travail pour les minorités sexuelles et de genre (MSG), les données disponibles permettent de constater la persistance des discriminations en milieu de travail envers les personnes lesbiennes, gaies et bisexuelles, et surtout, envers les personnes transsexuelles/transgenres. Cet article, basé sur une revue de la littérature, explore les liens entre les différents vécus de discrimination en milieu de travail et leurs impacts sur la santé mentale chez les MSG et chez différentes sous-populations : hommes ayant des relations sexuelles avec d’autres hommes, femmes non hétérosexuelles, parents lesbiennes et gais, et personnes trans. De plus, l’article explore certains facteurs de protection et de risque individuels et systémiques qui interviennent dans cette relation, entre autres le dévoilement de l’orientation sexuelle ou de l’identité de genre et le soutien organisationnel. Finalement, la littérature sur la discrimination en milieu de travail et la santé mentale des MSG met en lumière l’importance, dans le contexte actuel, des approches intersectionnelles et des études sur les micro-agressions. Pour terminer, l’article discute les implications pour les milieux de pratique, de recherche et de travail tout en formulant plusieurs recommandations.

[Homophobia, coping strategies, and sexual identity formation among LGBT youths]

Sexual minority youths (SMY) face challenges in consolidating their sexual identity because of heterosexism. The role of homophobic bullying and coping strategies in the formation of sexual identity has been explored within a convenient sample of 262 sexual minority youths. Six dimensions of sexual identity formation have been tested, independent variables being: homophobic bullying, coping strategies (avoidance and problem-solving), age, gender, migration trajectory, residency, sexual attraction and time elapsed since the realization of the sexual identity difference. Homophobic bullying was associated with a lower score of sexual identity affirmation and higher scores of identity concealment, internalized homo/bi-phobia, acceptance concern, identity uncertainty and process difficulty. Problem-solving coping strategies were associated with acceptance concerns. Avoidance coping strategies were associated with higher scores of acceptance concern and process difficulty in accepting non-heterosexual identity. Results confirm the importance of homo/bi-phobia prevention in order to help SMY in sexual identity consolidation.

Sexual orientation- and race-based discrimination and sexual HIV risk behavior among urban MSM

Understanding what social factors are associated with risk of HIV acquisition and transmission among gay, bisexual and other men who have sex with men (MSM) is a critical public health goal. Experiencing discrimination may increase risk of HIV infection among MSM. This analysis assessed relations between experiences of sexual orientation- and race-based discrimination and sexual HIV risk behavior among MSM in New York City. 1,369 MSM completed a self-administered computerized assessment of past 3-month sexual behavior, experience of social discrimination and other covariates. Regression models assessed relations between recent experience of discrimination and sexual HIV risk behavior. Mean age was 32 years; 32 % were white; 32 % Latino/Hispanic; 25 % African American/Black. Of MSM who self-reported HIV-positive or unknown status (377), 7 % (N = 27) reported having unprotected insertive anal intercourse with an HIV-negative or unknown status partner ("HIV transmission risk"). Of MSM who self-reported HIV-negative status (992), 11 % (110) reported unprotected receptive anal intercourse with an HIV-positive or unknown status partner ("HIV acquisition risk"). HIV acquisition risk was positively associated with sexual orientation-based discrimination in home or social neighborhoods, but not race-based discrimination. We observed that sexual orientation-based discrimination was associated with sexual HIV risk behavior among urban-dwelling MSM. Addressing environmental sources of this form of discrimination, as well as the psychological distress that may result, should be prioritized in HIV prevention efforts.