Everyday Discrimination and HIV Testing Among Partnered Latino/x Sexual Minority Men in the United States: A Stratified Analysis by Birth Location

We examined the association between everyday discrimination and HIV testing patterns-current (≤ 6 months), recent (7-12 months), and delayed (> 12 months or never tested)-among partnered Latino/x sexual minority men (SMM). Multinomial regression analyses revealed that in the full sample (N = 484) experiencing discrimination based on sexual orientation and race/ethnicity attributions concurrently (vs. no discrimination) was associated with higher odds of delayed (vs. current) HIV testing (AOR = 2.6, 95% CI [1.0, 6.7]). Similarly, in the subset of Latino/x SMM born outside the mainland U.S. (n = 209), experiencing concurrent sexual orientation- and race/ethnicity-based discrimination (vs. no discrimination) was associated with higher odds of recent (AOR = 12.4, 95% CI [1.3, 115.7]) and delayed HIV testing (AOR = 7.3, 95% CI [1.6, 33.0]), compared with current testing. Findings suggest that addressing discrimination may improve HIV testing uptake among partnered Latino/x SMM, particularly those born outside the U.S.

Intercategorical and Intracategorical Experiences of Discrimination and HIV Prevalence Among Transgender Women in San Francisco, CA: A Quantitative Intersectionality Analysis

Objectives. To examine differences in HIV prevalence and experiences of discrimination within the trans women community in California's San Francisco Bay Area.Methods. Intersectional positions were constructed on the basis of race/ethnicity (non-Hispanic White, non-Hispanic Black, Latina) and gender identity (female identifying, transgender identifying). We used baseline data from the Trans*National study (2016-2017) to construct regression models that estimated racial/ethnic differences in the attribution of discrimination experienced and, along with surrogate measures for intersectionality, estimated risk among those who were dually marginalized (racial/ethnic minority and transgender identifying). Margins plots were used to visually compare absolute risk across all intersectional positions.Results. Black and Latina trans women were more likely to be HIV positive than non-Hispanic White trans women. In several of the study domains, we estimated a lower risk of reporting discrimination among dually marginalized trans women than among White female-identifying trans women.Conclusions. Quantitative intersectionality methods highlight the diversity of experiences within the trans women community and reveal potential measurement challenges. Despite facing multiple forms of systemic marginalization, racial/ethnic minority trans women report less discrimination than White trans women. Subjective reporting of discrimination likely undercounts risks among racial/ethnic minorities.

Geographic Mobility, Place Attachment, and the Changing Geography of Sex among African American and Latinx MSM Who Use Substances in Los Angeles

The places that people go and interact with others, along with the characteristics of those places, determine degrees of sexual health risk and concomitant prevention opportunities for gay, bisexual, and other men who have sex with men (MSM). The objective of this paper is to use syndemic theory to guide analyses of 20 in-depth interviews with African American and Hispanic/Latinx MSM living in Los Angeles. We describe the places in which African American and Latinx MSM interviewees live and socialize, and how these places influence sexual behavior, drug use, and access to health care. We find common spatial patterns in mobility, incongruence in residential and sexual places, and differing geographic patterns of sex by men who use geo-social hook-up apps. Significant instability in home life and varying forms of mobility and risk-taking were a response to cumulative disadvantage and intersecting structural forces including poverty, racism, and homophobia. Our results strongly suggest that geographic mobility is a syndemic factor for HIV risk among MSM in Los Angeles, as mobility amplified negative impacts of other syndemic factors. Innovative place-interventions to reduce HIV incidence and disparities in HIV need to acknowledge the synergistic factors that drive higher HIV incidence among AA and Latinx MSM.

Internalized homophobia and sexual risk behavior among HIV-infected men who have sex with men in Israel

Sexual risk behaviors among men who have sex with men (MSM) have been linked to diverse demographic, psychosocial, and behavioral factors. This study assessed the association between internalized homophobia and sexual risk behavior among HIV-infected MSM and the mediating effects of safe-sex self-efficacy and depression on this association, using a theoretical framework based on the Theory of Social Action. Data were collected from 124 HIV-infected MSM attending an AIDS clinic in Israel. No significant association was found between internalized homophobia and sexual risk behavior (unprotected anal intercourse). Examination of mediation effects revealed full mediation by depression, but not by self-efficacy. Depression and self-efficacy were the only significant explanatory variables of sexual risk behavior. Diverse social work interventions with HIV-infected MSM aimed at reducing sexual risk behaviors should include routine screening of IH and its association with depression, and address depression and self-efficacy in CBT and other interventions.

Substance Use and Depression Among Recently Migrated African Gay and Bisexual Men Living in the United States

Immigrant African gay and bisexual men (GBM) are at risk for substance use and adverse mental health outcomes due to negative experiences in home and host countries. Little is known about correlates of substance use and mental health outcomes in this population. We explored pre- and post-migratory factors associated with substance use and depression in recently migrated African GBM. Participants (N = 70) were recruited between July and November 2015 in NYC. Eligible participants were administered a structured questionnaire. Correlates of substance use and depression were identified using bivariate and multivariable analyses. Factors independently associated with current substance use were age, openness about sexual orientation, homophobic experiences in home country, forced sex in home country, current housing instability, and internalized homophobia. Factors independently associated with depression were post-traumatic stress disorder symptoms and alcohol use. Substance use and depression were associated with negative experiences in home and host country.

Severity and Influencing Factors of Homophobia in Korean Nursing Students

Sexual minorities are people with non-cis and non-heterosexual gender identities, including LGBT (lesbian, gay, bisexual, and transgender) identities. Korean society is prejudiced against sexual minorities—in our study, we will broadly label this prejudice homophobia. It is possible that sexual minorities do not receive appropriate health management owing to such prejudices. Therefore, it is necessary to reduce homophobia in nursing students. This study aims to measure the degree of homophobia in Korean nursing students and identify the factors that affect homophobia. Our study is a cross-sectional study, which surveys attitudes of 265 nursing students toward homophobia in five Korean cities in January to March, 2019. The average homophobia score was 74.5 out of a possible 120; 92.9% of the participants were classified as homophobic, and 42.3% as highly homophobic. We found that participants who were male, religious, had low self-esteem, and had no family members or acquaintances who might belong to a sexual minority group, were more likely to be homophobic. Nursing students in Korea still exhibit high levels of homophobia. As high levels of homophobia can negatively affect health management and nursing, especially in the case of sexual minorities, we suggest that educational programs should be set up to reduce homophobia in nursing students.

Facilitating and Inhibiting Factors for Self-Reports of Same-Gender Attraction in Cisgender Heterosexual-Identifying Women and Men

We sought to identify psychosocial predictors of homoerotic motivations (viz., same-gender attraction) in heterosexual identifying cisgender women and men. We recruited participants from Amazon's Mechanical Turk to complete measures of (a) antipathy towards lesbians and gay men, (b) gender role beliefs, (c) felt-pressure to conform to gender stereotypes, and (d) openness to experience. In Study 1, we found that same-gender attraction was (a) negatively related to antipathy towards same-gender homosexual targets and (b) positively related to felt-pressure to conform to gender stereotypes for both women and men. In Study 2, both effects replicated for men at p < .05, but women only showed the antipathy effect at p < .05, even while the felt-pressure effect size was similar to that in Study 1. Additionally, men showed a significant negative relationship between openness and same-gender attraction. Thus, both anti-gay attitudes and felt-pressure to conform to gender stereotypes appear to be reliably associated with same-gender attraction.

Minority Stress, Activism, and Health in the Context of Economic Precarity: Results from a National Participatory Action Survey of Lesbian, Gay, Bisexual, Transgender, Queer, and Gender Non-Conforming Youth

Lesbian, gay, bisexual, transgender, queer, and gender non-conforming (LGBTQ & GNC) youth experience more economic hardship and social stress than their heterosexual and cisgender peers. However, the ways that LGBTQ & GNC youth resist these damaging social factors and the corresponding implications for their health have not been addressed. Data were analyzed from a national participatory survey of LGBTQ & GNC youth ages 14-24 (N = 5,860) living in the United States. Structural equation models indicated that economic precarity was associated with experiences of health problems. This association was mediated by the negative influence of minority stress on health as well as by activism, which had a positive association with health. Findings suggest that minority stress explanations of health inequalities among LGBTQ & GNC youth can benefit from including a focus on economic precarity; both in terms of its deleterious impact on health and its potential to provoke resistance to structural oppression in the form of activism.

Resilience, condom use self-efficacy, internalized homophobia, and condomless anal sex among black men who have sex with men, New York City

Background

Black men who have sex with men, who account for less than 1% of the U.S. population, account for approximately 25% of new HIV infections annually. Condomless anal sex contributes to HIV infection among black men who have sex with men. The capacity to recover quickly from difficulties (resilience) may be protective against condomless anal sex, but has been understudied among black men who have sex with men. Psychosocial factors related to resilience, i.e., condom use self-efficacy and internalized homophobia, may also affect condomless anal sex. We assessed the association between resilience, condom use self-efficacy, internalized homophobia and condomless anal sex among black men who have sex with men.

Methods

Data are from a 2010–2011 study examining condomless anal sex (past 60 days) among black men who have sex with men in New York City. Validated scales assessed resilience (theoretical range = 0–100), condom use self-efficacy (theoretical range = 27–135), and internalized homophobia (theoretical range = 9–36). We described continuous variables using median and interquartile range (IQR). Univariable and multivariable Poisson regression models assuming a robust variance estimator were used to compute unadjusted and adjusted prevalence ratios, respectively, and their corresponding 95% confidence intervals (CI). Adjusted prevalence ratios (aPR) examined the association of resilience, condom use self-efficacy, and internalized homophobia with condomless anal sex, while controlling for potential confounders (e.g., having >1 sex partner).

Results

The median resilience score within our sample (N = 228) was 75 (IQR = 66–83). Many black men who have sex with men reported condomless anal sex (55.7%) and >1 sex partner (58.8%). Decreased condomless anal sex was associated with increased levels of condom use self-efficacy (aPR: 0.94 per 10-point increase in condom use self-efficacy score; CI: 0.90–0.97; p-value: 0.001). Condomless anal sex was not associated with resilience or internalized homophobia.

Conclusions

Within this sample of black men who have sex with men, condomless anal sex was prevalent. Greater resilience was not protective against condomless anal sex. Interventions that support condom use are warranted for black men who have sex with men.

Vulnerability, Harm, and Compromised Ethics Revealed by the Experiences of Queer Birthing Women in Rural Healthcare

Phenomenological interviews with queer women in rural Nova Scotia reveal significant forms of trauma experienced during labour and birth. Situating the accounts of participants within both phenomenological and intersectional analyses reveals harms enabled by structurally embedded heteronormative and homophobic healthcare practices and policies. Our account illustrates the breadth and depth of harm experienced and outlines how these violate core ethical principles and values in healthcare.

Latent Classes of Sexual Risk Among Black Men Who Have Sex with Men and Women

Black men who have sex with men and women (BMSMW) are at high risk for HIV and other sexually transmitted infections (STIs). Despite knowing that HIV/STI risk varies by sexual positioning practices, limited data have characterized the risk profiles of BSMW. This study utilized latent class analysis (LCA) to explore BMSMW's sexual risk profiles regarding condomless sexual positioning practices. Participants were BMSMW in intervention studies in Los Angeles, Chicago, and Philadelphia. LCA was used to characterize their sexual risk profiles. Age, study location, HIV status, social support, and internalized homophobia were used as covariates in a multinomial regression model predicting the likelihood of class membership. Among the 546 participants, three latent classes of risk were identified: Seropositive Serosorters, Seronegative/unknown Serosorters, and Main Partners Only. All groups had the greatest probabilities of condomless sex with main partners. Seropositive Serosorters had the highest probabilities of condomless sex with HIV-positive partners. Seronegative/unknown Serosorters had the highest probabilities of condomless sex with HIV-negative or unknown status partners. HIV-positive BMSMW had 87% lower odds of being classified as Seronegative/unknown Serosorters than Seropositive Serosorters than HIV-negative/unknown status BMSMW (AOR = 0.13, 95% CI 0.06, 0.28). HIV-positive BMSMW had 71% lower odds of being classified as Main Partners Only than Seropositive Serosorters than HIV-negative/unknown status BMSMW (AOR = 0.29, 95% CI 0.16, 0.51). Findings highlight opportunities for clinicians to promote condom use and risk reduction among BMSMW with differing sexual risk profiles. Increased understanding of sexual positioning practices among BMSMW might help address HIV/STIs among this group.

Sex Differences in School Safety and Bullying Experiences Among Sexual Minority Youth

Schools play an integral role in creating safe, supportive environments for students, especially for sexual minority youth (SMY). Using 2016 questionnaire data from seven high schools in a Florida school district, we obtained a sample of 1,364 SMY. Logistic regressions controlling for sex (as applicable), age, grade, race/ethnicity, and school explored differences between SMY and nonsexual minority youth (non-SMY). Sex differences related to school environment perceptions and experiences related to safety, bullying, and hearing homophobic remarks were also explored. SMY were more likely than non-SMY to report several negative school environment perceptions and experiences. Where differences existed within SMY, male SMY were more likely than female SMY to have missed school in the past 30 days (odds ratio [ OR] = 1.66, p = .03), report avoiding spaces at school due to safety concerns ( OR = 1.38, p = .02), and report hearing homophobic remarks from teachers ( OR = 2.00, p = .01). Implications for school nursing are discussed.

Frequency, Nature, and Correlates of Hate Crime Victimization Experiences in an Urban Sample of Lesbian, Gay, and Bisexual Community Members

The present study examines two central research questions. First, we sought to add to current knowledge on the frequency and types of hate crime experiences in an urban sample. Also, drawing on existing frameworks for sexual minority specific (SMS) stress, we examined internalized SMS stress (defined by internalized homophobia and acceptance concerns regarding one's minority status) as a mediator of the association between hate crime victimization (i.e., objective or social SMS stress) and mental health symptoms (i.e., symptoms of depression, anxiety, and general stress). Participants were 336 self-identified lesbian, gay, and bisexual (LGB) community members who elected to participate in research at a community health agency in an urban southwestern United States jurisdiction. Results suggested (a) approximately one third of the sample reported lifetime hate crime victimization, with the most common types characterized by interpersonal, as opposed to property, crimes; (b) approximately half of participants reported their most recent victimization to law enforcement; and (c) internalized SMS stress mediated the relation between hate crime victimization and overall mental health symptoms. Findings are discussed with respect to implications of the unique nature of hate crimes in an urban setting, as well as theoretical and practical implications of SMS stress findings.

Beyond Homonegativity: Understanding Hong Kong People's Attitudes About Social Acceptance of Gay/Lesbian People, Sexual Orientation Discrimination Protection, and Same-Sex Marriage

This study examined attitudes about social acceptance, discrimination protection, and marriage equality for gay/lesbian people with a representative sample of 1,008 Hong Kong Chinese adults via a telephone survey. Despite majority endorsement of homosexuality (52.29% positive vs. 34.12% negative) and discrimination protection (50.72% favorable vs. 14.64% opposed), attitudes toward same-sex marriage diverged (32.79% favorable vs. 39.41% opposed). There was a sharp distinction in accepting gay/lesbian people as co-workers (83.57%) and friends (76.92%) versus relatives (40.19%). Having more homosexual/bisexual friends or co-workers contributed to greater endorsement of social acceptance and discrimination protection but not same-sex marriage. Age, religion, political orientation, and homonegativity consistently predicted attitudes toward social acceptance, discrimination protection, and same-sex marriage, whereas gender-role beliefs, conformity to norms, and cultural orientations had varying impacts. This article informs theory and advocacy by disentangling homonegativity from attitudes about gay/lesbian issues and highlighting the centrality of family-kinship and relative-outsider delineation in Chinese societies.

Paradoxes of an assimilation politics: media production of gay male belonging in the Canadian 'vital public' from the tainted blood scandal to the present

Canadian media discourses on gay men's sexuality and political inclusion serve as a rich site for understanding current tensions in debates on sexual citizenship under biopolitical regimes. This paper addresses how public health reporting in one health news media source, Canada's leading newspaper The Globe and Mail, discursively produced contiguous understandings of the moral, social and biological dimensions of gay male subjectivity and sexuality within the context of HIV risk discourses. Specifically, we critically examine the newspaper's coverage of what constitutes the public good when national blood supplies are at stake. Our analysis reveals a profound dichotomy in which gay men - as sexual subjects and subjects of rights - are recalibrated following the political and economic investments of bourgeoisie communities of interest. However encompassing the securing of legal social rights might be, gay men's sexuality is resistant to a reformatting under a heteronormative regulatory regime, as the social traumas caused by HIV continue to cast a shadow on sexual behaviours that purportedly risk leakage of contamination into the body politic.

The Whole Family Serves: Supporting Sexual Minority Youth in Military Families

Sexual minority youth in military families have a unique set of stressors that affect their mental, emotional, and physical health. There is a pronounced gap in data addressing the specific stressors of this population and how they interact to impact the health of the adolescent. The culture of the United States military has historically been heterosexist and homophobic, propelled primarily by policies that restricted the recruitment and service of lesbian, gay, bisexual, or transgender individuals, leading to a continued secrecy around sexual orientation that may affect how sexual minority youth within the community view themselves. Homophobia, social stigma, and victimization lead to significant health disparities among sexual minority youth, and youth connected to the military have additional stressors as a result of frequent moves, parental deployment, and general military culture. Primary care providers must be aware of these stressors to provide a safe environment, thorough screening, and competent care for these adolescents.

Gay-Straight Alliances are Associated with Lower Levels of School-Based Victimization of LGBTQ+ Youth: A Systematic Review and Meta-analysis

Gay-straight alliances (GSAs) are school-based organizations for lesbian, gay, bisexual, transgender, and queer (LGBTQ+) youth and their allies that often attempt to improve school climate for sexual and gender minority youth. This meta-analysis evaluates the association between school GSA presence and youth's self-reports of school-based victimization by quantitatively synthesizing 15 primary studies with 62,923 participants. Findings indicate GSA presence is associated with significantly lower levels of youth's self-reports of homophobic victimization, fear for safety, and hearing homophobic remarks, and these results are robust, controlling for a variety of study-level factors. The findings of this meta-analysis provide evidence to support GSAs as a means of protecting LGTBQ+ youth from school-based victimization.

The Relationship Between Childhood Gender Nonconformity and Experiencing Diverse Types of Homophobic Violence

Experiences of homophobic violence seem to differ for various sexual-minority subgroups. Previous research has outlined that experiences differ for men and women, and for gender conforming and nonconforming lesbian, gay, and bisexual men and women (LGBs). In this article, these relationships are studied by making a distinction between four types of homophobic violence: verbal, physical, material, and sexual. In 2013, an online survey was designed to ask Flemish LGBs about their experiences of homophobic violence. The final sample consists of 1,402 Flemish sexual-minority individuals. The results show that gay and bisexual men experienced significantly more physical, material, and sexual violence during their lifetime than lesbian and bisexual women did. Moreover, LGBs who reported more childhood gender nonconformity also reported more homophobic violence, and this positive relationship is confirmed for the four forms of violence. For verbal and physical violence, however, the relationship between childhood gender nonconformity and violence varies according to the gender of the respondents. This relationship is much stronger for gay and bisexual men than for lesbian and bisexual women.

Factors Related to Homophobia Among Nursing Students

A convenience sample of 90 nursing students participated in an online survey measuring homophobia or sexual prejudice. Significantly higher scores were seen among those who endorsed the belief that being gay was a matter of personal choice, did not have a friend or family member who was gay or lesbian, and endorsed religiosity. A significantly higher level of sexual prejudice was seen among those who identified as non-Catholic Christians when compared to other religions. Asian/Pacific Islanders showed significantly higher scores on the scales compared to non-Hispanic Caucasian students. Nursing education should focus on those aspects of homophobia amenable to change.

Sex, violence and HIV on the inside: cultures of violence, denial, gender inequality and homophobia negatively influence the health outcomes of those in closed settings

To map the context of HIV in closed settings in Papua New Guinea (PNG), semi-structured interviews were undertaken with 56 prisoners and detainees and 60 key stakeholders. The nature of HIV-related risk differs for detained women and men, and reflects important gender-based issues present in PNG society more broadly. Women in detention are vulnerable to sexual violence and exploitation and at greatest risk of HIV while detained in police holding cells, where they are typically supervised by male officers, in contrast to prisons, where they have little contact with male staff. HIV risk for men in prison is associated with consensual and non-consensual sex; this risk is perpetuated by a pervasive culture of denial and institutionalised homophobia. The illegal nature of sodomy and male-to-male sex provides Correctional Services the legal grounds by which to refuse access to condoms for prisoners. Addressing HIV risk among detained men and women in PNG requires the reform of legislation, police and prison practices and an understanding of broader structural problems of gender-based violence and stigma and discrimination.

Religion-related stigma and discrimination experienced by lesbian, gay, bisexual and transgender students at a South African rural-based university

This paper reports on the stigma and discrimination experienced by lesbian, gay, bisexual and transgender students at a rural university in South Africa. Twenty lesbian, gay, bisexual and transgender students recruited through snowball sampling participated in this study. Interpretative Phenomenological Analysis was used as a framework for data analysis. Findings indicate that religion-related stigma and discrimination are common at a rural-based university in South Africa. Lesbian, gay, bisexual and transgender students are typically ascribed a range of labels, including 'sinners', 'devils' and 'demon possessed'. They are also exposed to a number of discriminatory acts, such as the denial of financial and healthcare services and threats of and/or actual rape. Study participants reported attempts to convert lesbian, gay, bisexual and transgender students' sexual orientation which involved the use of intervention in the form of prayers. Derogatory labelling and associated discriminatory acts, for example the threat of rape, led many students to conceal their sexual identity, not attend specific classes, terminate their studies and even attempt suicide. Universities should develop policies to promote greater social inclusion and the acceptance of lesbian, gay, bisexual and transgender students. Policies should also specify the steps or approaches to be taken in addressing discriminatory practices.

Experiences of homophobia among gay and bisexual men: results from a cross-sectional study in seven countries

Experiences of homophobic discrimination are associated with an increased prevalence of psychological disorders and increased odds of reporting suicidal ideation among gay and bisexual men. We examine two domains of homophobia--external homophobic discrimination and internalised homophobia--and their associations with sexual orientation, demographic characteristics, relationships and social support among a sample of gay and bisexual men from seven countries. Sexually active gay and bisexual men aged over 18 and residing in Australia, Brazil, Canada, South Africa, Thailand, the UK and the USA were recruited through banner advertisements on Facebook. Two outcomes were examined: reporting experiences of homophobic discrimination and reporting feelings of internalised homophobia. No covariates were consistently significantly associated with experiencing external homophobic discrimination across countries. Across all countries, bisexually identifying respondents reported significantly greater feelings of internalised homophobia. Respondents in Brazil and the UK reporting a main partner, and respondents in Australia, Brazil, Canada, South Africa, Thailand and the USA reporting a larger gay/bisexual social network, reported significantly fewer feelings of internalised homophobia. Results suggest an ameliorative effect of social networks on experiencing homophobia. Additional research should focus on the mechanisms through which social networks reduce feelings of internalised homophobia.

Youth involvement in anti-gay and anti-lesbian bias crimes

There is currently little information available about youth who commit bias crimes. This article contributes to the literature by highlighting the similarities and differences between sexual orientation-motivated bias crimes committed by adult and youth suspects. Among 894 reported sexual orientation-motivated incidents in Los Angeles County between 2002 and 2008, this study found that, when compared to adult suspects, youth suspects were more likely to target other youths, were more likely to be in mixed-gender groups, were less likely to commit crimes against person, and were most likely to be reported as committing the crime at school. These preliminary findings highlight the need for additional research into bias-motivation among youth and to clarify the links between bullying and bias crimes.

From navigation to negotiation: an examination of the lived experiences of Black gay male alumni of historically Black colleges and universities

This research presents an examination of Black gay men and their lived experiences while undergraduates at historically Black colleges and universities (HBCUs). Based on 10 in-depth interviews with self-identified Black gay men, the author presents four emergent themes, which reveal the complex ways in which Black gay men navigate and negotiate the intersections of their multiple identities as related to race, sexual orientation, and gender at HBCUs. The findings of this research have implications for larger discussions of community, Black masculinity, and gay identity in predominantly Black and non-Black contexts.

Exploring risk behaviors and vulnerability for HIV among men who have sex with men in Abidjan, Cote d'Ivoire: poor knowledge, homophobia and sexual violence

Men who have sex with men (MSM) are at high risk of HIV. Few data are available on MSM and HIV-related risk behaviors in West Africa. We aimed to describe risk behaviors and vulnerability among MSM in Abidjan, Cote d′Ivoire. We conducted a cross-sectional respondent-driven sampling survey with 601 MSM in 2011–2012. Sociodemographic and behavioural data as well as data related to emotional state and stigma were collected. Population estimates with 95% confidence intervals were produced. Survey weighted logistic regression was used to assess factors associated with inconsistent condom use in the prior 12 months. Most MSM were 24 years of age or younger (63.9%) and had attained at least primary education (84.4%). HIV risk behaviors such as low condom and water-based lubricant use, high numbers of male and female sex partners, and sex work were frequently reported as well as verbal, physical and sexual abuse. Inconsistent condom use during anal sex with a male partner in the prior 12 months was reported by 66.0% of the MSM and was positively associated with history of forced sex, alcohol consumption, having a regular partner and a casual partner, having bought sex, and self-perception of low HIV risk. MSM in Abidjan exhibit multiple and frequent HIV-related risk behaviors. To address those behaviours, a combination of individual but also structural interventions will be needed given the context of stigma, homophobia and violence.

Discomfort with homosexuality: a new measure captures differences in attitudes toward gay men and lesbians

This study describes a creative and psychometrically sound method that allows researchers to measure homonegativity at a lower threshold than existing measures and to differentiate between homonegativity toward gay men and lesbians. Four hundred and thirty-one undergraduate students at a Western comprehensive university were asked to respond to a series of vignettes describing situations in which heterosexuals sometimes experience discomfort in the presence of homosexuals, indicating the degree to which they would feel comfortable or uncomfortable. The 12-item Homonegativity as Discomfort Scale (HADS) has adequate alpha reliability (.92) as well as good criterion and construct validity. Suggestions are made as to how the measure could be employed in research. Testing on this sample shows greater discomfort with gay men than with lesbians and greater discomfort among men than among women.

Substance use and experienced stigmatization among ethnic minority men who have sex with men in the United States

Research has documented deleterious effects of racism among ethnic minorities and of homophobia among men who have sex with men (MSM). Less is known about the impact of multiple forms of stigmatization on ethnic minority MSM. This study examined substance use by African American, Asian/Pacific Islander and Latino MSM, and the associations of experienced racism and homophobia from various sources with polydrug use and stimulant drug use. Experienced racism within the general community was associated with higher levels of use; other forms of discrimination were either not associated with polydrug or stimulant use or had more complex relationships with use. Implications for further research and interventions are discussed.

University students' attitudes toward same-sex parenting and gay and lesbian rights in Portugal

The purpose of this study was to explore university students' attitudes toward same-sex parenting and toward gay and lesbian rights. A total of 292 participants, aged between 18 and 27 (M = 21) responded to a questionnaire measuring attitudes toward parenting by gay men and lesbians, gay and lesbian rights, and beliefs about the etiology of homosexuality. Results revealed that the majority of students were against gay and lesbian parenting, gay and lesbian equal rights, and believed that homosexuality has a social/environmental basis. It was found that sexual prejudice is highly prevalent in Portuguese university students, and implications of these findings are discussed.

Correlates of suicide ideation among LGBT Nebraskans

The aim of this investigation is to outline correlates of suicide ideation among LGBT individuals living in Nebraska. A community-based participatory research approach was utilized to develop a 30-minute, online anonymous survey. Almost half of the sample had seriously considered suicide at some point in their lives. Significant correlates of increased likelihood of suicide ideation are age, gender, transgender identity, income, depression, and discrimination. Suicide ideation is a serious concern for the health of LGBT Nebraskans. Steps should be taken to incorporate individuals who fall into these high-risk categories in suicide outreach programs.

Office-based care for lesbian, gay, bisexual, transgender, and questioning youth

The American Academy of Pediatrics issued its last statement on homosexuality and adolescents in 2004. Although most lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth are quite resilient and emerge from adolescence as healthy adults, the effects of homophobia and heterosexism can contribute to health disparities in mental health with higher rates of depression and suicidal ideation, higher rates of substance abuse, and more sexually transmitted and HIV infections. Pediatricians should have offices that are teen-friendly and welcoming to sexual minority youth. Obtaining a comprehensive, confidential, developmentally appropriate adolescent psychosocial history allows for the discovery of strengths and assets as well as risks. Referrals for mental health or substance abuse may be warranted. Sexually active LGBTQ youth should have sexually transmitted infection/HIV testing according to recommendations of the Sexually Transmitted Diseases Treatment Guidelines of the Centers for Disease Control and Prevention based on sexual behaviors. With appropriate assistance and care, sexual minority youth should live healthy, productive lives while transitioning through adolescence and young adulthood.

Perceptions of campus climate by sexual minorities

Previous research has indicated that students who identify as lesbian, gay, bisexual, or transgender (LGBT) often have negative experiences on university campuses due to their sexual orientation or gender identity. Direct and indirect experiences contribute to an overall perception of the campus climate. This study used an online survey to assess students' perceptions of campus climate, their experiences confronting bias, support of family members and friends, and whether they had considered leaving campus. Multiple regression analysis indicated that perceptions of poorer campus climate were predicted by greater unfair treatment by instructors, more impact from anti-lesbian, gay, bisexual, transgender, or queer (LGBTQ) bias on friends' and families' emotional support, and having hidden one's LGBT identity from other students. Cluster analyses revealed four groups of participants distinguished by openness about their sexual orientation and negative experiences, with one group appearing to be at risk for poor retention. Results are discussed in terms of the needs of LGBTQ students on campus.

Psychological violence experienced by men who have sex with men in Puducherry, India: a qualitative study

Men who have sex with men are a hidden population in India. This study explores the psychological violence such men are exposed to in Puducherry, India. Eleven in-depth interviews probe experiences of blackmail, discrimination, and rejection. Some informants modified their behaviors or appearances to avoid harassment and safeguard their families' reputations. Others told how Indian men accepted their behaviors, but rejected their identities. Social pressure to marry was also a recurring theme. Understanding the factors behind these violent experiences may facilitate their amelioration.

Prevalence of internalized homophobia and HIV associated risks among men who have sex with men in Nigeria

This study assessed the level of internalized homophobia and associated factors among men who have sex with men (MSM) in Nigeria. Using respondent driven sampling, MSM were recruited in Lagos and Ibadan between July and September, 2006. Internalized homophobia was assessed as a negative composite score using an 11-item scale. A total of 1,125 MSM were interviewed. About 44.4% self-identified as homosexual or gay while 55% regarded themselves as bisexual. About a third of the respondents reported internalized homophobia. With homosexual/gay men as reference, respondents who self-identified as bisexual were two times more likely [AOR 2.1; 95 CI: 1.6 - 2.9, p < 0.001] to report internalized homophobia. Those who were HIV positive were also twice as likely to report internalized homophobia compared to those who were HIV negative [AOR 1.8; 95% CI: 1.2 - 2.7, p = 0.004]. As internalized homophobia impedes acceptance of HIV prevention programming, identifying MSM who experience internalized homophobia is integral to the success of HIV prevention programming in Nigeria.

Religious affiliation, internalized homophobia, and mental health in lesbians, gay men, and bisexuals

Most religious environments in the United States do not affirm homosexuality. The authors investigated the relationship between exposure to nonaffirming religious environments and internalized homophobia and mental health in a sample of lesbians, gay men, and bisexuals (LGBs) in New York City. Guided by minority stress theory, the authors hypothesized that exposure to nonaffirming religious settings would lead to higher internalized homophobia, more depressive symptoms, and less psychological well-being. The authors hypothesized that Black and Latino LGBs would be more likely than White LGBs to participate in nonaffirming religious settings and would therefore have higher internalized homophobia than White LGBs. Participants were 355 LGBs recruited through community-based venue sampling and evenly divided among Black, Latino, and White race or ethnic groups and among age groups within each race or ethnic group, as well as between women and men. Results supported the general hypothesis that nonaffirming religion was associated with higher internalized homophobia. There was no main effect of nonaffirming religion on mental health, an unexpected finding discussed in this article. Latinos, but not Blacks, had higher internalized homophobia than Whites, and as predicted, this was mediated by their greater exposure to nonaffirming religion.

Effects of gender-related domain violations and sexual orientation on perceptions of male and female targets: an analogue study

The current study examined factors that influenced heterosexual male and female raters' evaluations of male and female targets who were gay or heterosexual, and who displayed varying gender roles (i.e., typical vs. atypical) in multiple domains (i.e., activities, traits, and appearance). Participants were 305 undergraduate students from a private, midwestern Jesuit institution who read vignettes describing one of 24 target types and then rated the target on possession of positive and negative characteristics, psychological adjustment, and on measures reflecting the participants' anticipated behavior toward or comfort with the target. Results showed that gender atypical appearance and activity attributes (but not traits) were viewed more negatively than their gender typical counterparts. It was also found that male participants in particular viewed gay male targets as less desirable than lesbian and heterosexual male targets. These findings suggest a nuanced approach for understanding sexual prejudice, which incorporates a complex relationship among sex, gender, sexual orientation, and domain of gendered attributes.

Correlates of same-sex attractions and behaviors among self-identified heterosexual university students

Few studies have focused on intragroup variations in sexual orientation and fewer on self-identified heterosexuals with same-sex attractions, fantasies, and/or behaviors. Self-identified heterosexual students at a large public midwestern university (N = 263) completed measures of sexuality and gender, attitudes toward lesbian, gay, and bisexual (LGB) people, religious and political beliefs, emotional well-being, and demographics. The sample included 82 individuals (31%; labeled "H+") who endorsed same-sex attraction, fantasy, and/or behavior and 181 (69%; labeled "H") who did not. Women were more likely to be categorized as H+ than men. H+ participants had more positive attitudes toward lesbians and gay and bisexual men and reported more support for LGB-positive public policies than did H participants. H+ participants reported less literalistic beliefs about religious scripture than did H participants. H and H+ groups did not differ significantly on measures of emotional well-being. Results were discussed in the context of recent literature arguing for a more nuanced and gender-differentiated approach toward assessing sexual orientation, as well as literature on the flexibility of sexual orientation and on heterosexual identity development.

Medical students' attitudes toward gay men

BACKGROUND

Healthcare providers' attitudes toward sexual minorities influence patient comfort and outcomes. This study characterized medical student attitudes toward gay men, focusing on behavior, personhood, gay civil rights, and male toughness.

METHODS

A cross-sectional web-based anonymous survey was sent to medical students enrolled at the University of California, Davis (N = 371) with a response rate of 68%.

RESULTS

Few respondents expressed negative attitudes toward gay men or would deny them civil rights. More negative responses were seen with respect to aspects of intimate behavior and homosexuality as a natural form of sexual expression. Men and students younger than 25 years old were more likely to endorse negative attitudes toward behavior as well as more traditional views on male toughness.

CONCLUSIONS

We show that an important minority of students express discomfort with the behavior of gay men and hold to a narrow construction of male identity. These findings suggest that competency training must move beyond conceptual discussions and address attitudes toward behaviors through new pedagogical approaches.

Demographic predictors of consistency and change in heterosexuals' attitudes toward homosexual behavior over a two-year period

This study investigated demographic predictors of consistency and change in heterosexual people's attitudes toward homosexual behavior. A nationally representative sample of Australian men and women were recruited via random digit dialling in 2004 through 2005. Participants completed annual computer-assisted telephone interviews over the next five years. Questions about attitudes toward male and female homosexual behavior were assessed at Wave 1 (2004-2005) and Wave 3 (2006-2007) of the study. The majority of the sample reported tolerance of both male and female homosexual behavior (with women slightly more tolerant than men). Multivariate analyses showed that those who regularly attended religious services were more likely to consistently disapprove of homosexual behavior and more likely to change from tolerant to disapproving. Among those who were initially tolerant, younger respondents and those with higher educations were less likely to become homophobic. The results of this study show that individual attitudes toward homosexual behavior are open to change, particularly toward a more tolerant position. Religiosity appears to be consistently associated with the development and reinforcement of homophobic tendencies.