Perceptions of bias in HIV prevention services, happiness with social support, and anticipated PrEP stigma among Black and Latine/x sexual and gender diverse individuals

Although pre-exposure prophylaxis (PrEP) is a highly effective preventive treatment for HIV, anticipated PrEP stigma can hinder uptake. Perceptions of bias in HIV prevention and evaluations (e.g., happiness) tied to social support among Black and Latine/x sexual and gender diverse (SGD) individuals could be important correlates of anticipated PrEP stigma. To further this line of inquiry, a national sample of 872 Black and Latine/x SGD individuals who had and had never taken PrEP (Mage = 25.1, SD = 2.8) reported how they perceived HIV prevention and how happy they were with their social support. Multivariable linear regressions revealed that greater perceptions of bias in HIV prevention services were associated with higher anticipated PrEP stigma among Black and Latine/x SGD individuals who have never taken PrEP. Greater happiness with friend support was associated with lower PrEP stigma, whereas greater happiness with family support was associated with higher PrEP stigma among individuals who have taken PrEP. Findings highlight the need for PrEP and HIV interventions to address the intersectional stigma attached to prevention and for researchers to understand how evaluations of social support may contribute to stigma among Black and Latine/x SGD individuals.

Measurement invariance of the LGBT People of Color Microaggressions Scale among LGBTQ+ youth

The LGBT People of Color Microaggressions Scale (LGBT-PCMS) is a widely used measure of intersectional microaggression experiences among sexual and gender minority people of color. Although it is widely used-and increasingly used in adolescent and young adult samples-it is unknown whether the LGBT-PCMS demonstrates similar measurement properties across subgroups of sexual and gender minority youth of color (SGMYOC). Among 4142 SGMYOC (ages 13-17) we found evidence for either partial or full scalar invariance (item loadings and intercepts were generally equal) across sexual orientation, race-ethnicity, and gender identity groups for all three subscales. Specific patterns of invariance and noninvariance across groups, as well as implications for the use of the LGBT-PCMS and its subscales among SGMYOC are discussed.

Sexual Identity Disclosure and Alcohol Experiences Among LGBTQ+ Adolescents

Sexual and gender minority youth (SGMY) report greater alcohol use in comparison to their heterosexual counterparts. Prior research has found that elevated alcohol use among SGMY can be explained by minority stress experiences. Sexual identity outness may be another factor that drives alcohol use among SGMY, given that outness is associated with alcohol use among older sexual and gender minority samples. We examined how patterns of sexual identity outness were associated with lifetime alcohol use, past-30-day alcohol use, and past-30-day heavy episodic drinking. Data were drawn from the LGBTQ National Teen Survey (N = 8884). Participants were SGMY aged 13 to 17 (mean age = 15.59) years living in the US. Latent class analysis was used to identify sexual identity outness patterns. Multinomial regressions were used to examine the probability of class membership by alcohol use. Six outness classes were identified: out to all but teachers (n = 1033), out to siblings and peers (n = 1808), out to siblings and LGBTQ+ peers (n = 1707), out to LGBTQ+ peers (n = 1376), mostly not out (n = 1653), and very much not out (n = 1307). SGMY in classes characterized by greater outness to peers, friends, and family had greater odds of lifetime alcohol use compared with SGMY in classes characterized by lower outness. These findings suggest that SGMY with greater sexual identity outness may be a target for alcohol use prevention programming. Differences in sexual identity outness may be explained by minority stress factors.

Chest Binding: Sociodemographic Characteristics Among a National Sample of Transgender and Gender Diverse Adolescents

PURPOSE

There is a paucity of national data documenting chest binding practices among transgender and gender diverse (TGD) adolescents, despite the possibility that adolescents chest bind at high rates due to gender identity exploration and/or structural barriers to accessing other gender affirmation strategies.

METHODS

We used data from the 2022 LGBTQ National Teen Survey to estimate the prevalence and sociodemographic characteristics of chest binding among TGD adolescents assigned female at birth (AFAB; n = 6,080), and, in supplementary analyses, a broader sample of AFAB and intersex LGBTQ+ adolescents (n = 7,622).

RESULTS

Nearly two-thirds (63.8%) of TGD AFAB adolescents in our sample reported chest binding. More than 80% of transgender boys reported chest binding. Chest binding varied by some sociodemographics but was prevalent across many characteristics.

DISCUSSION

Chest binding is a common gender exploration and affirmation strategy among TGD AFAB adolescents. Adolescent health providers require data to inform evidence-based healthcare related to chest binding.

Stress of being outed to parents, LGBTQ family support, and depressive symptoms among sexual and gender diverse youth

Limited scholarship has explored how a lack of agency in identity disclosure (being "outed") to parents is associated with mental health experiences of sexual and gender diverse youth (SGDY). With a national sample of SGDY (N = 9272; 66.8% White non-Hispanic) aged 13-17 (Mage  = 15.63, SD = 1.24), this study first compared social position differences between SGDY who were outed to their parents compared to those not outed, and second, investigated how the stress from being outed to parents was associated with LGBTQ family support and depressive symptoms. Results revealed that SGDY who were outed to their parents reported higher levels of depressive symptoms and lower amounts of LGBTQ family support than SGDY who were not outed to their parents. In addition, greater stress from being outed to parents was indirectly associated with higher depressive symptoms through lower LGBTQ family support. These relationships significantly varied across gender identity. Findings highlight the importance of instilling greater agency in disclosure experiences among SGDY.

Examining Mental Health and Bullying Concerns at the Intersection of Sexuality, Gender, Race, and Ethnicity Among a National Sample of Sexual and Gender Diverse Youth

Purpose: Most extant scholarship that examines the health experiences of sexual and gender diverse youth (SGDY) is limited in the ability to apply an intersectional framework due to small sample sizes and limitations in analytic methods that only analyze the independent contribution of social identities. To address this gap, this study explored the well-being of youth at the intersection of ethnic, racial, sexual, and gender identities in relation to mental health and bullying. Methods: Data were from a U.S. national survey of SGDY aged 13-18 years, collected in 2022 (N = 12,822). Exhaustive Chi-square Automatic Interaction Detection analysis identified intersectional social positions bearing the greatest burden of negative health-related experiences (depression, anxiety, and past 30-day in-person victimization). Results: Transgender boys were among those at the highest prevalence for compromised mental health and peer-based in-person victimization. Although the primary distinguishing factor was transgender identity for depression and anxiety, there were no racial/ethnic distinctions, corroborating some previous scholarship. Asian cisgender and transgender girl SGDY shared the lowest burden of peer-based in-person victimization in school. Conclusion: Our findings suggest a need for scholars, health professionals, and other stakeholders to better understand the mechanisms that drive negative health experiences and in-person victimization experiences at the intersections of sexual, gender, racial, and ethnic identities.

Co-occurring mental health and drug use experiences among Black and Hispanic/Latino sexual and gender diverse individuals

Black and Hispanic/Latino sexual and gender diverse individuals disproportionately experience overlapping health disparities, such as drug use and elevated depressive symptoms, which are often driven by minority stressors. We sought to better understand the interaction between drug use and mental health, as it may be fruitful in developing effective interventions to address co-occurring health disparities. In a longitudinal, 5-wave sample of 300 Black and Hispanic/Latino sexual and gender diverse (SGD) individuals collected between March 2020 and March 2022, we found a within-person association between greater than average levels of psychological distress (depression and anxiety) and more frequent extra-medical use of cannabis, inhalants, methamphetamines, and opioids over the span of two years. These associations held after adjusting for the direct, within-person association of internalized homonegativity with drug use frequency. These results suggest that psychological distress explains at least some variance in drug use among Black and Hispanic/Latino SGD individuals. This highlights the importance of interventions that focus on mental health among Black and Hispanic/Latino SGD individuals who report drug use.

PrEP Access Affected by COVID-19 Is Associated With Increased Odds of HIV Seroconversion

ABSTRACT

Black and Hispanic/Latino sexual minority men and gender diverse (SMMGD) individuals report lower uptake and adherence to pre-exposure prophylaxis (PrEP) compared with White SMMGD. For some, the COVID-19 pandemic has resulted in reduced access to PrEP prescriptions and related changes to PrEP use, yet little is known how pandemic-related changes to PrEP access and sexual activity might influence sexually transmitted infection (STI) status and HIV seroconversion among SMMGD of color. We used data from 4 waves of a national study of Black and Hispanic/Latino SMMGD's HIV, PrEP, and health experiences to assess whether self-reported changes to sexual activity were associated with STI status, and whether self-reported changes to PrEP access were associated with HIV seroconversion. Those who reported greater impact to their sexual activity during the pandemic [adjusted odds ratio (aOR) = 1.24; 95% confidence interval (CI): 1.10 to 1.40] and a greater number of sexual partners (aOR = 1.29; 95% CI: 1.21 to 1.38) were more likely to report a positive STI test. In addition, we found that compared with those who did not report pandemic-related changes to PrEP access, those who did report changes to PrEP access had significantly higher odds of HIV seroconversion during the study period (aOR = 2.80; 95% CI: 1.02 to 7.68). These findings have implications for HIV and STI prevention and highlight the importance of novel interventions to improve PrEP access among Black and Hispanic/Latino SMMGD. Importantly, these findings also demonstrate the need to stay focused on key populations at risk of HIV infection during emerging public health crises to avoid an increase in rates of new diagnoses.

Who is using PrEP on-demand? Factors associated with PrEP use modality among Black and Hispanic/Latino emerging adults

Pre-exposure prophylaxis (PrEP) is a highly efficacious HIV prevention medication, yet Black and Hispanic/Latino sexual minority men's and gender diverse individuals' (SMMGD) PrEP use is limited due to factors such as PrEP barriers and anticipated PrEP stigma. Although most individuals who use PrEP take it as a daily regimen, there is evidence that many SMMGD are interested in using "on-demand" (also known as event-driven or intermittent or 2-1-1) PrEP. We used stepwise multinomial logistic regression to explore factors associated with on-demand, daily, and no PrEP use among 820 Black and Hispanic/Latino SMMGD ages 18-29 in the United States. We found that greater reported PrEP barriers were associated with higher odds of using PrEP on-demand or not using PrEP compared to daily PrEP use. More past 3-month sex partners and greater comfort telling others about PrEP use were associated with lower odds of on-demand compared to daily PrEP use. In addition, compared to daily PrEP use, more past 3-month sex partners, greater comfort telling others about PrEP use, and higher anticipated PrEP stigma were associated with lower odds of no current PrEP use compared to daily PrEP use. Findings may inform clinical practices and interventions to promote PrEP uptake and adherence.

Complex Outness Patterns Among Sexual Minority Youth: A Latent Class Analysis

Prior scholarship has documented health-relevant consequences of sexual minority youth (SMY) sexual identity disclosure (i.e., "outness"), yet most of the extant work focuses on one social context at a time and/or measures outness as dichotomous: out or not out. However, SMY are out in some contexts (e.g., family, friends) and not in others, and to varying degrees (e.g., to some friends, but not to all). Using a national sample of 8884 SMY ages 13-17 (45% cisgender female, 67% White, 38% gay/lesbian and 34% bisexual, and 36% from the U.S. South), this study used latent class analysis to identify complex patterns of outness among SMY, as well differences in class membership by demographics, depression, family rejection, and bullying. The results indicated six distinct classes: out to all but teachers (n = 1033), out to siblings and peers (n = 1808), out to siblings and LGBTQ peers (n = 1707), out to LGBTQ peers (n = 1376), mostly not out (n = 1653), and very much not out (n = 1307). The findings reveal significant differences in class membership by age, sexual identity, gender identity, race and ethnicity, geography, and well-being outcomes. Moreover, these findings underscore the complex role of outness across social contexts in shaping health and well-being.