1
|
Psaros C, Hill-Rorie J, Quint M, Horvitz C, Dormitzer J, Biello KB, Krakower DS, Safren SA, Mimiaga MJ, Sullivan P, Hightow-Weidman LB, Mayer KH. A qualitative exploration of how to support PrEP adherence among young men who have sex with men. AIDS Care 2024; 36:732-743. [PMID: 37748111 PMCID: PMC10961251 DOI: 10.1080/09540121.2023.2240070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/18/2023] [Indexed: 09/27/2023]
Abstract
New HIV infections disproportionately affect young men who have sex with men (YMSM). PrEP is effective in preventing HIV acquisition; however, adherence is critical and is often suboptimal among YMSM. Interventions addressing the unique PrEP adherence challenges faced by YMSM are needed. We conducted qualitative interviews with 20 HIV-negative, YMSM (ages 15-24) with a PrEP indication and 11 healthcare professionals to inform adaption of a PrEP adherence intervention (Life-Steps for PrEP) for YMSM. We explored environmental, healthcare, and individual factors influencing uptake, adherence, attitudes, and perspectives (including desired modifications) on the Life-Steps intervention. Interviews were analyzed using content analysis. Of YMSM study participants (mean age 21.6) 55% were White, 15% Hispanic, and 5% Black. Most YMSM were PrEP-experienced (70%). Healthcare professionals (6 prescribers, 1 nurse, 2 health educators, 2 other/unspecified) averaged 6.9 years of experience caring for YMSM. All described stigma as a barrier to PrEP; YMSM expressed concern around being perceived as "risky" and concern about inadvertent PrEP disclosure if family/friends found their medication, or if parental insurance was used. Difficulty with planning for potential adherence challenges were identified by both groups. YMSM highlighted benefits of a nurse-led intervention (i.e., adding "legitimacy"), but stressed need for nonjudgmental, "savvy" interventionists. YMSM expressed a desire for comprehensive YMSM-specific sexual health information. These findings informed modification and expansion of Life-Steps content. Results highlight key potential barriers, many of which center around privacy. Content that addresses PrEP stigma, disclosing PrEP use, navigating insurance, and planning ahead in a nonjudgmental environment by trusted providers emerged as important components of a YMSM-focused delivery of Life-Steps for PrEP.
Collapse
Affiliation(s)
- Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States
- The Fenway Institute, Fenway Health, Boston, MA, United States
| | | | - Meg Quint
- The Fenway Institute, Fenway Health, Boston, MA, United States
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Boston, Massachusetts, United States
| | - Casey Horvitz
- Behavior and Technology Lab, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Katie B. Biello
- The Fenway Institute, Fenway Health, Boston, MA, United States
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, United States
- Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, RI, United States
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States
| | - Douglas S. Krakower
- The Fenway Institute, Fenway Health, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Steven A. Safren
- Department of Psychology, University of Miami, Coral Gables, FL, United States
| | - Matthew J. Mimiaga
- The Fenway Institute, Fenway Health, Boston, MA, United States
- UCLA Center for LGBTQ+ Advocacy, Research & Health, Los Angeles, CA, United States
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, United States
- Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, United States
| | - Patrick Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Lisa B. Hightow-Weidman
- Institute on Digital Health and Innovation, College of Nursing, Florida State University, Tallahassee, FL, United States
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, United States
| |
Collapse
|
2
|
Agor D, Knettel BA, Daici K, Meanley S. The Intersection of Mental Health and Sexual and Gender Minority Identities for Older Adults Living with Human Immunodeficiency Virus: A Narrative Review. Nurs Clin North Am 2024; 59:253-271. [PMID: 38670693 DOI: 10.1016/j.cnur.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
The transition of HIV into a chronic illness has brought to the forefront the pressing need to address the complex web of social determinants of HIV outcomes. A structured literature search and narrative review of studies describing intervention strategies for mental health among sexual/gender minority (SGM) older adults living with HIV (OALWH) published in the last decade identified 2 studies for inclusion. This narrative review identifies age-sensitive and culturally adapted therapies, mindfulness and meditation-based stress reduction, group therapy, digital mental health resources, and psilocybin-assisted group therapy as emerging intervention models tailored to meet the unique needs of SGM OALWH.
Collapse
Affiliation(s)
- David Agor
- Department of Family and Community Health, University of Pennsylvania, School of Nursing, 418 Curie Boulevard, 218L E, Philadelphia, PA 19104, USA; University of Pennsylvania Eidos Center, Philadelphia, PA, USA.
| | - Brandon A Knettel
- Duke School of Nursing, 307 Trent Drive, Durham, NC 27710, USA; Duke Global Health Institute, Duke University, Durham, NC, USA; Duke Global Mental Health Program, Duke University, Durham, NC, USA
| | - Kenneth Daici
- Brown University, 69 Brown Street, Box 9734, Providence, RI 02912, USA
| | - Steven Meanley
- University of Pennsylvania Eidos Center, Philadelphia, PA, USA; University of Pennsylvania School of Nursing, 418 Curie Boulevard, 231L, Philadelphia, PA 19104, USA
| |
Collapse
|
3
|
Aggarwal A, Zhang R, Qiao S, Wang B, Lwatula C, Menon A, Ostermann J, Li X, Harper G. Stigmatizing clinical setting erodes physician-patient interaction quality for sexual minority men through perceived HIV stigma and HIV infection concerns in Zambia. AIDS Care 2024; 36:797-806. [PMID: 38437705 DOI: 10.1080/09540121.2024.2324288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/22/2024] [Indexed: 03/06/2024]
Abstract
This study investigated whether perceived HIV stigma and HIV infection concerns among healthcare providers (HCPs) mediate the association between stigmatizing clinical setting and their interaction quality with sexual minority men (SMM) patients in Zambia. In 2021, a cross-sectional survey was conducted with 91 HCPs offering HIV-related services to SMM in Zambia. Path analysis was conducted to examine the potential mediation effect of "perceived HIV stigma" and "HIV infection concern" among HCPs in the association between "stigmatizing clinical setting" and their "interaction quality with SMM". Mediators i.e., "perceived HIV stigma" and "HIV infection concern" among HCPs, were associated positively with the stigmatizing clinical setting (β = 0.329, p < .01, β = 0.917, p < 0.01), and negatively with physician-patient interaction quality (β = -0.167, p = 0.051; β = -0.126, p < 0.05). Stigmatizing clinical setting had a significant and negative indirect effect on HCPs interaction quality with SMM through increased perceived HIV stigma (z = -1.966, p < 0.05) and increased HIV infection concern (z = -1.958, p = 0.050). To improve physician-patient interaction quality, stigma reduction interventions among HCPs, who serve SMM in Zambia, should target development of development of inclusive policies and the cultivation of cultural norms that are supportive and respectful to SMM, and protection of HCPs from enacted stigma due to offering care to SMM.
Collapse
Affiliation(s)
- Abhishek Aggarwal
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, USA
| | - Ran Zhang
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, USA
| | - Shan Qiao
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, USA
| | - Bo Wang
- Population and Quantitative Health Sciences, University of Massachusetts, Boston, USA
| | | | - Anitha Menon
- Department of Psychology, University of Zambia, Lusaka, Zambia
| | - Jan Ostermann
- Department of Health Service Policy and Management, University of South Carolina, Columbia, USA
| | - Xiaoming Li
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, USA
| | - Gary Harper
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, USA
| |
Collapse
|
4
|
Tan ASL, Chen JT, Keen R, Scout N, Gordon B, Applegate J, Machado A, Hanby E, Liu S, Zulkiewicz B, Ramanadhan S, Obedin-Maliver J, Lunn MR, Viswanath K, Potter J. Culturally Tailored Anti-Smoking Messages: A Randomized Trial With U.S. Sexual Minority Young Women. Am J Prev Med 2024; 66:840-849. [PMID: 38065403 PMCID: PMC11034759 DOI: 10.1016/j.amepre.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION This study evaluated effects of exposure to culturally tailored anti-smoking ads versus control ads on quitting intentions, cigarette purchase intentions, and tobacco industry perceptions among young adult, cisgender and transgender, sexual minority women (SMW). STUDY DESIGN An online randomized controlled experiment with 1-month longitudinal follow-up was conducted. SETTING AND PARTICIPANTS About 2,214 U.S. SMW ages 18-30 were recruited via online survey panels (The PRIDE Study and Prolific), social media ads and posts, and HER dating app ads. Data were collected in 2021-2022. INTERVENTION Participants were randomly assigned to receive up to 20 tailored ads containing LGBTQ+ branding versus 20 control ads without LGBTQ+ branding over 4 weeks. Both conditions used identical anti-smoking statements and photographs (including several photographs of individuals who self-identified as SMW). MAIN OUTCOME MEASURES One-month follow-up intention to purchase cigarettes, intention to quit, marketing receptivity, pro-industry attitudes, and pro-industry beliefs were measured. Analyses were conducted in 2022-2023. Linear regression models predicted outcomes at 1-month follow-up with the randomized arm, adjusted for baseline measures of each outcome and stratified by smoking status (those who currently smoked and those who did not smoke). RESULTS Among those who smoked, follow-up intention to quit increased and intention to purchase cigarettes, marketing receptivity, pro-industry attitudes, and pro-industry beliefs decreased versus baseline in both arms. Follow-up pro-industry beliefs were significantly lower (B=-0.331, 95% CI -0.652, -0.010, p=0.043) in the tailored versus control arm, adjusted for baseline beliefs. Among those who did not smoke, marketing receptivity, pro-industry attitudes, and pro-industry beliefs decreased versus baseline in both arms. Follow-up outcomes did not differ significantly between arms. CONCLUSIONS These findings can inform future anti-smoking campaign development to reduce cigarette smoking-related disparities among young adult, cisgender and transgender, sexual minority women and serve as the basis for developing similar ads for other LGBTQ+ audiences. TRIAL REGISTRATION This study was registered in ClinicalTrials.gov (NCT04812795).
Collapse
Affiliation(s)
- Andy S L Tan
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania; Abramson Cancer Center, Tobacco and Environmental Carcinogenesis Program, Philadelphia, Pennsylvania.
| | - Jarvis T Chen
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Ryan Keen
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Nfn Scout
- National LGBT Cancer Network, Providence, Rhode Island
| | - Bob Gordon
- California LGBT Tobacco Education Partnership, San Francisco, California
| | | | | | - Elaine Hanby
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sixiao Liu
- Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, Florida
| | - Brittany Zulkiewicz
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Juno Obedin-Maliver
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California; The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California; Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California; Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California; Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | | | - Jennifer Potter
- The Fenway Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Beth Israel Lahey Health, Boston, Massachusetts
| |
Collapse
|
5
|
Fergerson AK, Caulfield NM, Dworkin ER, Capron DW. Sexual Assault History May Moderate Posttraumatic Cognition and Posttraumatic Stress Among Trauma-Exposed Sexual Minority Women. Behav Ther 2024; 55:431-442. [PMID: 38670659 DOI: 10.1016/j.beth.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 06/21/2023] [Accepted: 07/03/2023] [Indexed: 04/28/2024]
Abstract
Sexual minority women (SMW) are highly vulnerable to trauma exposure and posttraumatic stress disorder (PTSD) symptoms following trauma exposure. Negative posttraumatic cognitions (i.e., negative cognitions about self, world, and self-blame following trauma exposure) are hypothesized to exacerbate and maintain the relationship between trauma exposure and PTSD symptoms. Posttraumatic cognitions are particularly important to examine in relation to PTSD symptoms among trauma-exposed SMW given their elevated risk for trauma exposure and PTSD. It is also important to understand whether the strength of this relationship differs as a function of trauma type to elucidate potentially differential pathways for risk by trauma type in this population. The current study explored whether trauma type (sexual assault vs. nonsexual trauma) moderated the relationship between negative posttraumatic cognitions and PTSD symptom severity among a sample of trauma-exposed SMW. Participants were SMW (n = 516) users of an online survey platform, Prolific. Data were collected via 20-minute online survey. Results indicated that trauma type moderated the relationship between negative posttraumatic cognitions and PTSD symptom severity, such that the relationship was stronger among those who had experienced at least one sexual assault in their lifetime. Results suggest that negative posttraumatic cognitions may be more strongly related to PTSD symptom severity among SMW who have experienced at least one sexual assault. Notably, this difference was in magnitude only, as the posttraumatic cognition-PTSD symptom relationship remained significant among nonsexual trauma survivors. Negative posttraumatic cognitions may be an especially relevant treatment target among SMW survivors of sexual assault.
Collapse
|
6
|
Strauss P, Marion L, Hill NT, Gilbey D, Waters Z, Moore JK, Costanza M, Lamblin M, Robinson J, Lin A, Perry Y. Development of best practice guidelines for clinical and community service providers to prevent suicide in LGBTQA+ young people: A Delphi expert consensus study. Aust N Z J Psychiatry 2024; 58:425-434. [PMID: 38217434 DOI: 10.1177/00048674231223697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Abstract
OBJECTIVE The aim of this study was to develop best practice guidelines for preventing suicide and reducing suicidal thoughts and behaviours in LGBTQA+ young people (lesbian, gay, bisexual, trans, queer/questioning, asexual, and those of other diverse sexualities and genders) within clinical and community service settings in Australia. METHODS We conducted a Delphi expert consensus study. A systematic literature search and interviews with key informants informed an initial 270-item questionnaire. Two expert panels completed the questionnaire, delivered over two rounds: (1) Australian professionals with expertise in LGBTQA+ mental health/suicide prevention and (2) Australian LGBTQA+ young people aged 14-25 with lived experience of suicidal thoughts and/or behaviours. Items endorsed as 'essential' or 'important' by >80% of both expert panels were included in the guidelines. RESULTS A total of 115 people participated in the Delphi process; n = 52 professionals completed Round 1, and n = 42 completed Round 2; n = 63 LGBTQA+ young people completed Round 1, and n = 50 completed Round 2. A total of 290 items were included in the guidelines and grouped into: (1) general principles for creating an affirming and inclusive environment for LGBTQA+ young people; (2) assessing suicide risk and working with suicidal LGBTQA+ young people; (3) considerations for specific LGBTQA+ populations; and (4) advocating for LGBTQA+ young people. CONCLUSION These guidelines are the first of their kind in Australia. They provide practical support to service providers regardless of prior training in LGBTQ+ identities or mental health, with the aim of reducing suicidal thoughts and behaviours, and preventing suicide, in LGBTQA+ young people.
Collapse
Affiliation(s)
- Penelope Strauss
- Telethon Kids Institute, Nedlands, WA, Australia
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | | | - Nicole Tm Hill
- Telethon Kids Institute, Nedlands, WA, Australia
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Dylan Gilbey
- Telethon Kids Institute, Nedlands, WA, Australia
| | - Zoe Waters
- Telethon Kids Institute, Nedlands, WA, Australia
| | - Julia K Moore
- The Gender Diversity Service, Child and Adolescent Health Service - Mental Health, Perth Children's Hospital, Perth, WA, Australia
| | - Marco Costanza
- Telethon Kids Institute, Nedlands, WA, Australia
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michelle Lamblin
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Jo Robinson
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, Nedlands, WA, Australia
| | - Yael Perry
- Telethon Kids Institute, Nedlands, WA, Australia
| |
Collapse
|
7
|
Birch L, Bindert A, Macias S, Luo E, Nwanah P, Green N, Stamps J, Crooks N, Singer RM, Johnson R, Singer RB. When Stigma, Disclosure, and Access to Care Collide: An Ethical Reflection of mpox Vaccination Outreach. Public Health Rep 2024; 139:379-384. [PMID: 37846098 PMCID: PMC11037228 DOI: 10.1177/00333549231201617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023] Open
Abstract
Experiences of stigma in health care encounters among LGBTQ+ populations (lesbian, gay, bisexual, transgender, and queer and questioning) have long been a barrier to care. Marginalization and historically grounded fears of stigmatization have contributed to a reluctance to disclose sexual behavior and/or gender identity to health care providers. We reflect on how student nurses grappled with the ethics of patient disclosure while providing mobile outreach in Chicago for mpox (formerly monkeypox) from fall 2022 to spring 2023. Student nurses addressed how requiring disclosure of sexual behavior or sexual orientation may serve as a barrier to accessing preventive care, such as mpox vaccination. Accounts of stigma and criminalization experienced by LGBTQ+ people provide insight on challenges historically associated with disclosure in health care.
Collapse
Affiliation(s)
- Lane Birch
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Adam Bindert
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Susy Macias
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Ellis Luo
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Patrick Nwanah
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Noel Green
- Department of Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | - Jahari Stamps
- Southside Health Advocacy Resource Partnership, Chicago, IL, USA
| | - Natasha Crooks
- Department of Human Development Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Rebecca M. Singer
- Department of Population Health Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Robin Johnson
- Department of Human Development Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Randi Beth Singer
- Department of Human Development Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
8
|
Friedman MR, Badri S, Bowleg L, Haberlen SA, Jones DL, Kempf MC, Konkle-Parker D, Kwait J, Martinson J, Mimiaga MJ, Plankey MW, Stosor V, Tsai AC, Turan JM, Ware D, Wu K. Intersectional stigma and the non-communicable disease syndemic in the context of HIV: protocol for a multisite, observational study in the USA. BMJ Open 2024; 14:e075368. [PMID: 38670612 DOI: 10.1136/bmjopen-2023-075368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION The increasing burden of non-communicable diseases, such as hypertension, diabetes and dyslipidaemia, presents key challenges to achieving optimal HIV care outcomes among ageing people living with HIV. These diseases are often comorbid and are exacerbated by psychosocial and structural inequities. This interaction among multiple health conditions and social factors is referred to as a syndemic. In the USA, there are substantial disparities by social position (ie, racial, ethnic and socioeconomic status) in the prevalence and/or control of non-communicable diseases and HIV. Intersecting stigmas, such as racism, classism and homophobia, may drive these health disparities by contributing to healthcare avoidance and by contributing to a psychosocial syndemic (stress, depression, violence victimisation and substance use), reducing success along the HIV and non-communicable disease continua of care. Our hypothesis is that marginalised populations experience disparities in non-communicable disease incidence, prevalence and control, mediated by intersectional stigma and the psychosocial syndemic. METHODS AND ANALYSIS Collecting data over a 4 year period, we will recruit sexual minority men (planned n=1800) enrolled in the MACS/WIHS Combined Cohort Study, a long-standing mixed-serostatus observational cohort in the USA, to investigate the following specific aims: (1) assess relationships between social position, intersectional stigma and the psychosocial syndemic among middle-aged and ageing sexual minority men, (2) assess relationships between social position and non-communicable disease incidence and prevalence and (3) assess relationships between social position and HIV and non-communicable disease continua of care outcomes, mediated by intersectional stigma and the psychosocial syndemic. Analyses will be conducted using generalised structural equation models using a cross-lagged panel model design. ETHICS AND DISSEMINATION This protocol is approved as a single-IRB study (Advarra Institutional Review Board: Protocol 00068335). We will disseminate results via peer-reviewed academic journals, scientific conferences, a dedicated website, site community advisory boards and forums hosted at participating sites.
Collapse
Affiliation(s)
- M Reuel Friedman
- Department of Urban-Global Public Health, Rutgers University, Newark, New Jersey, USA
| | - Sheila Badri
- Hektoen Institute of Medicine, Chicago, Illinois, USA
| | - Lisa Bowleg
- Department of Psychology, The George Washington University, Washington, District of Columbia, USA
| | - Sabina A Haberlen
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Deborah L Jones
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Coral Gables, Florida, USA
| | - Mirjam-Colette Kempf
- Schools of Nursing, Public Health, and Medicine, University of Albama, Birmingham, Alabama, USA
| | - Deborah Konkle-Parker
- Schools of Nursing, Medicine, and Population Health, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jenn Kwait
- Whitman-Walker Institute, Washington, District of Columbia, USA
| | - Jeremy Martinson
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Matthew J Mimiaga
- Center for LGBTQ+ Advocacy, Research & Health and Department of Epidemiology, University of California-Los Angeles, Los Angeles, California, USA
| | - Michael W Plankey
- Department of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Valentina Stosor
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
- School of Medicine and Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Janet M Turan
- Schools of Nursing, Public Health, and Medicine, University of Albama, Birmingham, Alabama, USA
| | - Deanna Ware
- Department of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Katherine Wu
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
9
|
Ni Y, Lu Y, Jing F, Wang Q, Xie Y, He X, Wu D, Tan RKJ, Tucker JD, Yan X, Ong JJ, Zhang Q, Jiang H, Dai W, Huang L, Mei W, Zhou Y, Tang W. A Machine Learning Model for Identifying Sexual Health Influencers to Promote the Secondary Distribution of HIV Self-Testing Among Gay, Bisexual, and Other Men Who Have Sex With Men in China: Quasi-Experimental Study. JMIR Public Health Surveill 2024; 10:e50656. [PMID: 38656769 DOI: 10.2196/50656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/27/2023] [Accepted: 02/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Sexual health influencers (SHIs) are individuals actively sharing sexual health information with their peers, and they play an important role in promoting HIV care services, including the secondary distribution of HIV self-testing (SD-HIVST). Previous studies used a 6-item empirical leadership scale to identify SHIs. However, this approach may be biased as it does not consider individuals' social networks. OBJECTIVE This study used a quasi-experimental study design to evaluate how well a newly developed machine learning (ML) model identifies SHIs in promoting SD-HIVST compared to SHIs identified by a scale whose validity had been tested before. METHODS We recruited participants from BlueD, the largest social networking app for gay men in China. Based on their responses to the baseline survey, the ML model and scale were used to identify SHIs, respectively. This study consisted of 2 rounds, differing in the upper limit of the number of HIVST kits and peer-referral links that SHIs could order and distribute (first round ≤5 and second round ≤10). Consented SHIs could order multiple HIV self-testing (HIVST) kits and generate personalized peer-referral links through a web-based platform managed by a partnered gay-friendly community-based organization. SHIs were encouraged to share additional kits and peer-referral links with their social contacts (defined as "alters"). SHIs would receive US $3 incentives when their corresponding alters uploaded valid photographic testing results to the same platform. Our primary outcomes included (1) the number of alters who conducted HIVST in each group and (2) the number of newly tested alters who conducted HIVST in each. We used negative binomial regression to examine group differences during the first round (February-June 2021), the second round (June-November 2021), and the combined first and second rounds, respectively. RESULTS In January 2021, a total of 1828 men who have sex with men (MSM) completed the survey. Overall, 393 SHIs (scale=195 and ML model=198) agreed to participate in SD-HIVST. Among them, 229 SHIs (scale=116 and ML model=113) ordered HIVST on the web. Compared with the scale group, SHIs in the ML model group motivated more alters to conduct HIVST (mean difference [MD] 0.88, 95% CI 0.02-2.22; adjusted incidence risk ratio [aIRR] 1.77, 95% CI 1.07-2.95) when we combined the first and second rounds. Although the mean number of newly tested alters was slightly higher in the ML model group than in the scale group, the group difference was insignificant (MD 0.35, 95% CI -0.17 to -0.99; aIRR 1.49, 95% CI 0.74-3.02). CONCLUSIONS Among Chinese MSM, SHIs identified by the ML model can motivate more individuals to conduct HIVST than those identified by the scale. Future research can focus on how to adapt the ML model to encourage newly tested individuals to conduct HIVST. TRIAL REGISTRATION Chinese Clinical Trials Registry ChiCTR2000039632; https://www.chictr.org.cn/showprojEN.html?proj=63068. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12889-021-11817-2.
Collapse
Affiliation(s)
- Yuxin Ni
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
| | - Ying Lu
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Fengshi Jing
- Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, Guangzhou, China
- Faculty of Data Science, City University of Macau, Macao SAR, China
| | - Qianyun Wang
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- Department of Social Welfare, University of California, Los Angeles, CA, United States
| | - Yewei Xie
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- Health Service and System Research Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Xi He
- Zhuhai Xutong Voluntary Services Center, Zhuhai, China
| | - Dan Wu
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Rayner Kay Jin Tan
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Joseph D Tucker
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Xumeng Yan
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA, United States
| | - Jason J Ong
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Central Clinical School, Monash University, Melbourne, Australia
| | - Qingpeng Zhang
- Musketeers Foundation Institute of Data Science, The University of Hong Kong, Hong Kong, China (Hong Kong)
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Hongbo Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Wencan Dai
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Liqun Huang
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Wenhua Mei
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Yi Zhou
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| |
Collapse
|
10
|
Kaneko N, Hill AO, Shiono S. Factors associated with help-seeking regarding sexual orientation concerns among Japanese gay and bisexual men: results from a cross-sectional survey. BMC Res Notes 2024; 17:117. [PMID: 38654279 DOI: 10.1186/s13104-024-06776-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 04/15/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE This study investigates Japanese gay and bisexual men's experiences of seeking help for emotional support from others regarding their sexual orientation concerns. It examines the relationship between their help-seeking and presence of gay and bisexual peers, duration between questioning their sexual orientation and accepting it, and experience of coming out to family members by multiple logistic regression analysis. RESULTS We conducted a cross-sectional survey using a self-reported paper questionnaire. There were 360 valid responses. Eighty-two respondents (22.8%) had experience of help-seeking for emotional support, and this was associated with age, occupation, presence of gay/bisexual friends, and experience of coming out to family members about their sexual orientation. Respondents sought the most help from their male friends (70.0%), followed by female friends (25.0%), mothers (17.5%), and the Internet (16.3%). Even after controlling for age and occupation, experience of help-seeking for emotional support was higher among participants who had gay/bisexual friends when they were aware of their sexual orientation, took < 1 year from questioning to realizing their sexual orientation, and had come out to their family about their sexual orientation.
Collapse
Affiliation(s)
- Noriyo Kaneko
- Department of Global and Community Health, Graduate School of Nursing, Nagoya City University, 1-4-7, Aoi, Higashi-ku, Nagoya, Aichi, Japan.
| | - Adam Orlando Hill
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Satoshi Shiono
- Faculty of Health Science, Osaka Aoyama University, Osaka, Japan
| |
Collapse
|
11
|
Latu I, Sălăgean N, Larsen TMB, Isbasoiu AB, Sava FA. Testing the Effectiveness of an Intervention to Improve Romanian Teachers' LGBT+-Related Attitudes, Cognitions, Behaviors, and Affect: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e54254. [PMID: 38652533 DOI: 10.2196/54254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/07/2024] [Accepted: 03/04/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Repeated stigmatization due to group membership constitutes a recurrent stressor with negative impact on physical and mental health (minority stress model). Among European countries, Romania ranks low on LGBT+ (lesbian, gay, bisexual, and transgender people. The "+" represents individuals whose identities do not fit typical binary notions of male and female [nonbinary]) inclusion, with 45% of Romanian LGBT+ respondents reporting discrimination in at least 1 area of life in the year preceding the survey. Importantly, while all LGBT+ people might experience minority stress, younger sexual minority individuals are more prone to the detrimental impacts of stigma on their mental and physical health. As such, interventions are necessary to improve the inclusion climate within schools, where young people spend most of their time. Until now, most interventions addressing this topic have been conducted on undergraduate students in Western countries, with no studies conducted in countries that have widespread anti-LGBT+ attitudes. OBJECTIVE This paper describes the research protocol for a randomized controlled trial investigating whether LGBT+ stigma and bias among Romanian school teachers can be reduced using an internet-based intervention focusing on education and contact as primary training elements. METHODS A sample of 175 school teachers will be randomly assigned to either the control or experimental group. The experimental group participants will receive the intervention first and then complete the outcome measures, whereas the control group will complete the outcome measures first and then receive the intervention. The 1-hour multimedia intervention is developed for internet-based delivery under controlled conditions. It includes 2 interactive exercises, 2 recorded presentations, animations, and testimonies from LGBT+ individuals. Data for attitudinal, behavioral, cognitive, and affective measures will be collected during the same session (before or after the intervention, depending on the condition). We also plan to conduct a brief mixed methods follow-up study at 6 to 8 months post participation to investigate potential long-term effects of training. However, due to attrition and lack of experimental control (all participants will have completed the intervention, regardless of the condition), these data will be analyzed and reported separately using a mixed methods approach. RESULTS This paper details the protocol for the teacher intervention study. Data collection began in December 2022 and was completed by February 2023. Data analysis will be performed upon protocol acceptance. Follow-up measures will be completed in 2024. Results are expected to be submitted for publication following analysis in the spring of 2024. CONCLUSIONS The findings of this study will establish the effectiveness of an internet-based intervention intended to lessen anti-LGBT stigma and sentiment in a nation where these views have long been prevalent. If successful, the intervention could end up serving as a resource for Romanian teachers and guidance counselors in high schools. TRIAL REGISTRATION ISRCTN 84290049; https://doi.org/10.1186/ISRCTN84290049. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54254.
Collapse
Affiliation(s)
- Ioana Latu
- Department of Psychology, Faculty of Sociology and Psychology, West University of Timisoara, Timisoara, Romania
- School of Psychology, Queen's University Beflast, Beflast, United Kingdom
| | - Nastasia Sălăgean
- Department of Scientific Research in Economy, Law and Human-Environment Interaction, Institute for Advanced Environmental Research, West University of Timișoara, Timisoara, Romania
| | - Torill M B Larsen
- Department of Health Promotion and Development, Faculty of Psychology at University of Bergen, Bergen, Norway
| | - Andreea Bogdana Isbasoiu
- Department of Psychology and Education Sciences, Transilvania University of Brasov, Brasov, Romania
| | - Florin Alin Sava
- Department of Psychology, Faculty of Sociology and Psychology, West University of Timisoara, Timisoara, Romania
| |
Collapse
|
12
|
Sönmez İ. How Does Sexual Identity-Attraction Discordance Influence Suicide Risk? A Study on Male and Female Adults in the U.S. Arch Suicide Res 2024; 28:686-700. [PMID: 37303190 DOI: 10.1080/13811118.2023.2220757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Suicide continues to be one of the main causes of death among adults in the U.S. Research showed an association between sexual identity-attraction discordance (IAD) and adverse health outcomes, including suicidal ideation. METHODS We sought to determine whether sexual IAD is associated with self-injurious thoughts and behaviors (SITBs), namely suicidal thoughts, plans, and suicide attempts, in the past year. We examined data from adults participating in the most recent six waves (2015-2020) of the National Survey on Drug Use and Health. RESULTS Men who report sexual identity-attraction discordance were at greater risk of reporting suicidal thoughts (aOR = 3.67, 95% CI: 2.24-6.00) and plans (aOR = 5.71, 95% CI: 3.32-9.81) in the past year. Stratified by sexual identity, results showed that gay (aOR = 5.92, 95% CI: 1.54-22.7) and bisexual men (aOR = 4.38, 95% CI: 2.17-8.83) had higher odds of reporting suicide plans and heterosexual (aOR = 2.66, 95% CI: 1.06-6.68), gay (aOR = 7.05, 95% CI: 1.88-26.4), and bisexual men (aOR = 5.30, 95% CI: 4.37-22.9) had higher odds of suicide attempts when compared to men with concordant sexual identity-attraction. We found that bisexual women who report sexual identity-attraction discordance had less odds of reporting suicidal thoughts (aOR = 0.36, 95% CI: 0.21-0.63) and suicide plans (aOR = 0.43, 95% CI: 0.20-0.89) than women with concordant sexual identity-attraction. Among bisexual-identified males, those who experience sexual identity-attraction discordance were at greater risk for past-year suicidal thoughts (aOR = 3.82, 95% CI: 2.12-6.91) and suicide attempts (aOR = 5.30, 95% CI: 2.13-13.1) when compared to bisexual men with concordant sexual identity-attraction. CONCLUSION Sexual IAD is associated with SITB and particularly concerning results emerged concerning bisexual-identified men.
Collapse
|
13
|
Cardoso PFG, Shimizu MA. Obstetric violence and LGBTQIA+phobia: interlaced oppressions and violations. Cien Saude Colet 2024; 29:e20072023. [PMID: 38655975 DOI: 10.1590/1413-81232024294.20072023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 12/27/2023] [Indexed: 04/26/2024] Open
Abstract
The cisheteropatriarchal capitalist system has developed by class, racial and sexual oppression and exploitation in establishing unequal, hierarchical power relations. One of these kinds of oppression involves the use of violence against bodies considered wayward and transgressive within this structure. Of the different types of violence, this study focused on obstetric violence, understood as patriarchal gender violence designed to remove the rights, autonomy and agency of trans women and men during the processes of pregnancy, childbirth, postpartum and abortion. This article reflects on obstetric violence and its impacts on homo-parenthood for lesbian women and trans men, on the understanding that the LGBTQIA+ population is one of the most vulnerable and removed from health services, mainly because of the institutional violence suffered by these bodies. Accordingly, the intention is to understand, through social and historical analysis, how these sexist, heteropatriarchal violations, interlacing and reflecting in health care for these people, generate even more forms of oppression against this population.
Collapse
Affiliation(s)
| | - Mariana Arissa Shimizu
- Universidade Federal de São Paulo (UNIFESP Baixada Santista). R. Silva Jardim 136, Vila Matias. 11015-020 Santos SP Brasil.
| |
Collapse
|
14
|
Oliveira CRS, Sousa CCVD, Torres JL. Who are the sexual and gender minorities who frequently interact with children and their association with healthcare. Cien Saude Colet 2024; 29:e19222023. [PMID: 38655963 DOI: 10.1590/1413-81232024294.19222023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 12/14/2023] [Indexed: 04/26/2024] Open
Abstract
This study aimed to examine the sociodemographic profile of sexual and gender minorities who regularly interact with children and investigate whether such frequent interactions are associated with healthcare factors. This cross-sectional study utilized data from the LGBT+ Health Survey in Brazil, conducted online and anonymously from August to November 2020 with 958 participants. Regular interaction with children was defined as living with children or engaging in bi-weekly face-to-face meetings with children residing in different households. Healthcare factors encompass having a professional or reference service, feeling comfortable in discussing personal issues, and receiving worse quality medical or hospital care. The statistical analysis used the Poisson regression with robust variance. The prevalence of interaction with children was 5.3%. We observed a statistically higher prevalence among cisgender women (13.4%) and Black/brown and other non-white people (7.9%) after adjusting for age. The results showed a positive association only between regular interaction with children and worse-quality medical or hospital care received (PR=6.00; 95%CI 1.22-29.67). These findings highlight a persistent stigma and prejudice within healthcare services.
Collapse
Affiliation(s)
- Claudia Rafaella Santos Oliveira
- Departamento de Medicina Preventiva e Social, Universidade Federal de Minas Gerais. Belo Horizonte, Brasil. Av. Professor Alfredo Balena 190, Santa Efigênia. 30130-100 Belo Horizonte MG Brasil.
| | - Carolina Campos Vieira de Sousa
- Departamento de Medicina Preventiva e Social, Universidade Federal de Minas Gerais. Belo Horizonte, Brasil. Av. Professor Alfredo Balena 190, Santa Efigênia. 30130-100 Belo Horizonte MG Brasil.
| | - Juliana Lustosa Torres
- Departamento de Medicina Preventiva e Social, Universidade Federal de Minas Gerais. Belo Horizonte, Brasil. Av. Professor Alfredo Balena 190, Santa Efigênia. 30130-100 Belo Horizonte MG Brasil.
| |
Collapse
|
15
|
Ril SY, Oliveira Junior JBD, Mello MMCE, Portes VDM, Moretti-Pires RO. "You only have one mother!": institutional violence in experiences of double motherhood in healthcare. Cien Saude Colet 2024; 29:e19802023. [PMID: 38655974 DOI: 10.1590/1413-81232024294.19802023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 12/21/2023] [Indexed: 04/26/2024] Open
Abstract
The objective was to understand experiences of double motherhood during antenatal, childbirth and postpartum healthcare, using a qualitative method involving individual online interviews and asynchronous, online focus groups of cisgender women, mostly in same-sex relationships. The results revealed how these women's experiences of parenting were marginalised, highlighting institutional violence in Brazilian healthcare services, which are presented here in two thematic dimensions: 1) Cisheteronormativity and its impact on experiences of double motherhood; and 2) Institutional violence in healthcare services: from curiosity to LGBTQIA+phobia. It was concluded that cisheteronormativity hinders healthcare for these experiences, especially by rendering the non-gestational mother invisible. This underscores the urgent need to train healthcare personnel, rethink and challenge cisgender and heterosexual norms and promote inclusive policies to ensure equitable care and combat institutional violence.
Collapse
Affiliation(s)
- Stephany Yolanda Ril
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal de Santa Catarina. R. Delfino Conti s/n, Trindade. 88040-370 Florianópolis SC Brasil.
| | - João Batista de Oliveira Junior
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal de Santa Catarina. R. Delfino Conti s/n, Trindade. 88040-370 Florianópolis SC Brasil.
| | - Mônica Machado Cunha E Mello
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal de Santa Catarina. R. Delfino Conti s/n, Trindade. 88040-370 Florianópolis SC Brasil.
| | - Virgínia de Menezes Portes
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal de Santa Catarina. R. Delfino Conti s/n, Trindade. 88040-370 Florianópolis SC Brasil.
| | - Rodrigo Otávio Moretti-Pires
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal de Santa Catarina. R. Delfino Conti s/n, Trindade. 88040-370 Florianópolis SC Brasil.
| |
Collapse
|
16
|
Santos MAD, Minari AB, Oliveira-Cardoso ÉAD. Lesbian and bisexual couples experiencing dual motherhood: (dis)encounters in the provision of healthcare. Cien Saude Colet 2024; 29:e19732023. [PMID: 38655971 DOI: 10.1590/1413-81232024294.19732023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 12/26/2023] [Indexed: 04/26/2024] Open
Abstract
The bond with healthcare services is a crucial dimension in facilitating the maternal journey of lesbian and bisexual women couples. This study aimed to analyze the culturally constructed meanings regarding the bond with healthcare services and professionals by lesbian and bisexual women who experienced dual motherhood. It is a qualitative investigation grounded in interpretative anthropology. The research corpus was built based on in-depth interviews with 10 lesbian and bisexual women, aged 30 to 39 years. The results indicate that access to parenthood, until its realization, involved a journey permeated by satisfactions and sufferings triggered by failed attempts and gestational losses. Challenges experienced in healthcare provision were also reported due to prejudices, lack of empathy, and unpreparedness of professionals in dealing with prenatal care for lesbian and bisexual women couples. Manifestations of discrimination were more pronounced concerning non-gestational mothers. The findings offer insights into implementing policies that prioritize humanization and planning programs and healthcare services based on culturally sensitive care for lesbian and bisexual women couples as they transition into dual motherhood.
Collapse
Affiliation(s)
- Manoel Antônio Dos Santos
- Laboratório de Ensino e Pesquisa em Psicologia da Saúde, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo. Av. Bandeirantes 3900, Vila Monte Alegre. 14040-900 Ribeirão Preto SP Brasil.
| | - Amanda Brandane Minari
- Laboratório de Ensino e Pesquisa em Psicologia da Saúde, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo. Av. Bandeirantes 3900, Vila Monte Alegre. 14040-900 Ribeirão Preto SP Brasil.
| | - Érika Arantes de Oliveira-Cardoso
- Laboratório de Ensino e Pesquisa em Psicologia da Saúde, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo. Av. Bandeirantes 3900, Vila Monte Alegre. 14040-900 Ribeirão Preto SP Brasil.
| |
Collapse
|
17
|
Santana ADDS, Galdino AS, Araújo ECD. The overcoming of the monogamous family is through the community! Non-monogamous parenting of sex-gender-diverse people. Cien Saude Colet 2024; 29:e19692023. [PMID: 38655970 DOI: 10.1590/1413-81232024294.19692023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 12/20/2023] [Indexed: 04/26/2024] Open
Abstract
Sex-gender-diverse and non-monogamous strain cisnormativity and mononormativity. In scientific terms, the parenting arrangements of these people are uncertain. Thus, this ethnography aims to understand the perception of non-monogamous sex-gender-diverse people about parenting. The theoretical framework adopted is derived from non-monogamous studies, love and sexuality from the Social and Human Sciences in Public Health and the digital ethnography methodological framework. Fieldwork occurred from 2021 to 2022 through an online WhatsApp group. Participant observation was employed in the group, and semi-structured online interviews were held. Two categories emerged: a) The non-monogamous parenting nodes and b) Collective parenting. In the first, the importance of bonds in affective networks is explored, and the barriers to these family arrangements are exposed. The second describes the importance of living in a community, and Indigenous and Black ancestry is revived. The revived ancestry and ways of living in a community gain importance as we understand their relevance in the experience of parenting for sex-gender-diverse people who are non-monogamous.
Collapse
|
18
|
Dias FDS, Moreira MCN, Santos RDP. When disability and homoparenting meet: the adoption of children with disability by same sex couples. Cien Saude Colet 2024; 29:e19772023. [PMID: 38655973 DOI: 10.1590/1413-81232024294.19772023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 12/21/2023] [Indexed: 04/26/2024] Open
Abstract
The present theoretical essay is based on six reports concerning same-sex couples and gay and lesbian people in order to interconnect homoparenting and the adoption of children with disabilities, through the lenses of human and social sciences in public health. The reports were interpreted in light of studies on same-sex adoption and the adoption of children with disabilities. Feminist approaches related to care and disability were also included in the interpretative perspective, operating as expressive webs of grammars of ableism. It was found that media approaches endorse the right to family formation and the adoption of children with disabilities by homoparental families, but with little critical depth on the category of disability and without highlighting support for the adoption of all adoptee profiles. Moreover, the intersections between homophobia and ableism increase discriminatory and oppressive logics, with the union of social groups considered to be "undesirable" representing a strategy of governmentality that reveals the complexity of grammars of ableism, applied to the sexual and reproductive rights of LGBTQIA+ adopters and to the fundamental rights of children and adolescents with disabilities who are available for adoption.
Collapse
Affiliation(s)
- Francine de Souza Dias
- Instituto Gonçalo Moniz, Fiocruz Bahia. R. Waldemar Falcão, 121, Candeal. 40296710 Salvador BA Brasil.
| | - Martha Cristina Nunes Moreira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fiocruz Rio de Janeiro. Rio de Janeiro RJ Brasil
| | - Raul de Paiva Santos
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo. São Paulo SP Brasil
| |
Collapse
|
19
|
Mesquita JA, Nascimento MAFD. Digital activism about gay fatherhood on Instagram: male homoparenting in the picture. Cien Saude Colet 2024; 29:e19402023. [PMID: 38655966 DOI: 10.1590/1413-81232024294.19402023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 12/15/2023] [Indexed: 04/26/2024] Open
Abstract
In contemporary Brazil, the number of male fathers taking care of their sons and daughters and the initiatives to produce content about fatherhood on Instagram have been significant. This article aims to analyze the concepts that support the digital activism of homoparenting on Instagram, based on gender studies with men. To this end, a qualitative study was conducted using the life narrative method in a digital environment. The results were analyzed and divided into the following sections: parenting project, personal experience of fatherhood, articulation with LGBT political agenda when parenthood becomes a "business", and haters, criticism, and adverse reactions. It was concluded that the reflection on the experience of fatherhood/masculinity itself is crossed by the social marker of the difference in sexual orientation and the activism for rights that sustain content production. Thus, the uniqueness of each fatherhood is highlighted since the fact of being gay constructs the fatherhood experience for each man. Despite the initiatives brought forth in this study, changes are still in progress, as rights activism coexists with the advancement of conservative forces, which limit the expressions of sexual and gender otherness.
Collapse
Affiliation(s)
- Juliana Araujo Mesquita
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz. Av. Rui Barbosa 716, Flamengo. 22250-020 Rio de Janeiro RJ Brasil.
| | - Marcos Antonio Ferreira do Nascimento
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz. Av. Rui Barbosa 716, Flamengo. 22250-020 Rio de Janeiro RJ Brasil.
| |
Collapse
|
20
|
Ayala EV. ["We are families too": LGBT experiences and demands for access to Surrogacy in Argentina]. Cien Saude Colet 2024; 29:e15192023. [PMID: 38655953 DOI: 10.1590/1413-81232024294.15192023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 03/04/2024] [Indexed: 04/26/2024] Open
Abstract
Surrogacy (GS) has been established as a means of access to male homoparenting and, despite not being regulated in Argentina, it is negotiated in a "paralegal" scenario. For some time now, LGBT organizations have proposed regulation based on the argument that GS represents the only option available for a male homosexual couple to have a child with a genetic link, albeit with only one of them, and consecutively acknowledge the family ties of both. By means of ethnographic work carried out within the scope of a postgraduate research project, our objective is to ascertain the experiences of male homosexual couples who seek the legitimacy of GS processes and equal access to the healthcare system. With this in mind, we seek a reflection that articulates the construction of public health policies and the claims of sectors of the LGBT movement, focusing on the meanings of the collective experience, on the ways in which these actors organize their family demands, and on the conceptions and practices that articulate these claims with the production of public policies.
Collapse
Affiliation(s)
- Estefania Victoria Ayala
- Instituto de Ciencias Antropológicas, Facultad de Filosofía y Letras, Universidad de Buenos Aires. José Bonifacio 1337, 7mo piso, CABA. Buenos Aires Argentina.
| |
Collapse
|
21
|
Ghazal LV, Johnston H, Dodd E, Ramachandra Y, Giallourakis N, Fulginiti K, Kamen C. A Needs Assessment Approach for Adolescent and Young Adult Sexual and Gender Diverse Cancer Survivors. Int J Environ Res Public Health 2024; 21:424. [PMID: 38673335 DOI: 10.3390/ijerph21040424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 03/22/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024]
Abstract
Sexual and gender diverse (SGD) adolescent and young adult (AYA) cancer survivors are an increasing and vulnerable group with unique needs that often remain unmet in the healthcare system. This paper describes the conceptualization and development of a community-based organization dedicated to serving SGD AYAs, in addition to reporting on the results of a community-led needs assessment. A total of 56 SGD AYA community members completed the online survey. Most participants were between the ages of 26 to 33, identified as white, cisgender, bisexual women, and had hematologic malignancies. Identified unmet needs of SGD AYAs included the following: sexual health and family planning; gender affirmation; financial stability; and emotional support. Areas within the community organization were identified as gaps, areas of expansion, and assets. Results highlight the role of community and academic partnerships in improving cancer care delivery for SGD AYA cancer survivors.
Collapse
Affiliation(s)
- Lauren V Ghazal
- School of Nursing, University of Rochester, Rochester, NY 14642, USA
- Wilmot Cancer Institute, Rochester, NY 14642, USA
| | - Hailey Johnston
- Escape, Lansing, MI 48915, USA
- School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | | | | | | | | | - Charles Kamen
- Wilmot Cancer Institute, Rochester, NY 14642, USA
- Department of Surgery, Cancer Control, University of Rochester Medical Center, Rochester, NY 14642, USA
| |
Collapse
|
22
|
Tan KJ, Anderson JR. Internalized Sexual Stigma and Mental Health Outcomes for Gay, Lesbian, and Bisexual Asian Americans: The Moderating Role of Guilt and Shame. Int J Environ Res Public Health 2024; 21:384. [PMID: 38673297 DOI: 10.3390/ijerph21040384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/25/2024] [Accepted: 03/17/2024] [Indexed: 04/28/2024]
Abstract
The literature unequivocally demonstrates that lesbian, gay, and bisexual (LGB) individuals experience disproportionate mental health and social wellbeing impacts. Here, we respond to recent calls for research in the field of sexual minority health to better understand why various overlapping and intersecting identities can further drive health disparities. In this paper, we focus on the specific intersections of ethnicity and sexuality for Asian LGB individuals and the role of internalized stigma in driving poorer mental health outcomes for this group. We recruited 148 LGB Asian participants residing in the United States (Mage = 22.82 years, SD = 4.88) to participate in our online cross-sectional survey in which we collected data on their internalized stigma, levels of guilt and shame about their sexuality, and measures of depression, anxiety, and distress. Contrary to our predictions, there were no bivariate relationships between internalized sexual stigma and any of the mental health outcomes. However, a parallel mediation analysis revealed that guilt, but not shame, mediates the relationship between internalized sexual stigma and all mental health outcomes (depression, anxiety, and stress) for LGB Asian American individuals. This research highlights the important of exploring additional variables that may exacerbate of protect against poor mental health for individuals with multiple intersecting identities.
Collapse
Affiliation(s)
- Kian Jin Tan
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne Campus (St Patrick), Locked Bag 4115, Melbourne, VIC 3065, Australia
| | - Joel R Anderson
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne Campus (St Patrick), Locked Bag 4115, Melbourne, VIC 3065, Australia
- Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Melbourne, VIC 3086, Australia
| |
Collapse
|
23
|
Bush R, Staiger PK, McNeill IM, Brown R, Orellana L, Lubman D, McNair R. Evaluation of an SMS Based Alcohol Intervention for Same Sex Attracted Women: A Randomized Controlled Trial to Examine Feasibility, Acceptability, and Efficacy. Subst Use Misuse 2024; 59:1157-1166. [PMID: 38407160 DOI: 10.1080/10826084.2024.2321257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
PURPOSE The purpose of this randomized controlled trial (Trial registration ID: redacted) was to examine the feasibility, acceptability, and efficacy of the Step One program, an SMS-based alcohol intervention for same-sex attracted women (SSAW). METHODS Ninety-seven SSAW who scored ≥8 on the Alcohol Use Disorders Identification Test (AUDIT) were randomly allocated to receive the Step One program (n = 47; mean age = 36.79) or a weekly message containing a link to a website with health information and support services for LGBT individuals (n = 50; mean age = 34.08). Participants completed questionnaires on alcohol use, wellbeing, and help-seeking at baseline (T1), intervention completion (T2; 4 wk after baseline) and 12 wk post-intervention (T3). In addition, participants in the intervention condition completed feasibility and accessibility measures at T2, and a subsample (n = 10) was interviewed about acceptability at T3. RESULTS Across conditions, participants significantly reduced their alcohol intake and improved their wellbeing and help-seeking over time. However, there were no significant differences between the intervention and control condition. Furthermore, frequency of help-seeking was low; only four intervention group participants and three control group participants began accessing support between T1 and T3. Overall, our findings indicate the intervention would benefit from revision prior to implementation. CONCLUSIONS Our approach was consistent with best practice in the development of an ecologically valid intervention; however, this intervention, in its current form, lacks the complexity desired by its users to optimally facilitate alcohol reduction among SSAW. Keywords: Alcohol intervention; Intervention mapping framework; Randomized controlled trial (RCT); Same-sex attracted women; Short-message service (SMS).
Collapse
Affiliation(s)
- Rachel Bush
- School of Psychology, Deakin University, Geelong, Australia
| | | | - Ilona M McNeill
- School of Psychology, Deakin University, Geelong, Australia
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, Australia
| | - Rhonda Brown
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
| | | | - Dan Lubman
- Turning Point, Monash University, Eastern Health, Richmond, Australia
| | - Ruth McNair
- Department of General Practice, The University of Melbourne, Carlton, Australia
| |
Collapse
|
24
|
Wagner GJ, Bogart LM, Klein DJ, Lawrence SJ, Goggin K, Gizaw M, Mutchler MG. Culturally Relevant Africultural Coping Moderates the Association Between Discrimination and Antiretroviral Adherence Among Sexual Minority Black Americans Living with HIV. AIDS Behav 2024; 28:408-420. [PMID: 38060112 PMCID: PMC10876751 DOI: 10.1007/s10461-023-04233-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 12/08/2023]
Abstract
Exposure to discrimination has been linked to lower HIV antiretroviral therapy (ART) adherence and poor HIV care outcomes among Black Americans. Coping has been shown to mitigate the harmful effects of discrimination on health behaviors, but the use of cultural relevant Africultural coping strategies is understudied as a moderator of the association between intersectional discrimination and ART adherence among Black Americans. We used adjusted logistic regression to test whether Africultural coping strategies (cognitive/emotional debriefing; collective; spiritual-centered; ritual-centered) moderated associations between multiple forms of discrimination (HIV, sexual orientation, race) and good ART adherence (minimum of 75% or 85% of prescribed doses taken, as measured by electronic monitoring in separate analyses) among 92 sexual minority Black Americans living with HIV. Mean adherence was 66.5% in month 8 after baseline (36% ≥ 85% adherence; 49% ≥ 75% adherence). Ritual-centered coping moderated the relationship between each of the three types of discrimination at baseline and good ART adherence in month 8 (regardless of the minimum threshold for good adherence); when use of ritual coping was low, the association between discrimination and adherence was statistically significant. The other three coping scales each moderated the association between racial discrimination and good ART adherence (defined by the 75% threshold); cognitive/emotional debriefing was also a moderator for both HIV- and race-related discrimination at the 85% adherence threshold. These findings support the benefits of Africultural coping, particularly ritual-centered coping, to help sexual minority Black Americans manage stressors associated with discrimination and to adhere well to ART.
Collapse
Affiliation(s)
- Glenn J Wagner
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA.
| | - Laura M Bogart
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA
| | - David J Klein
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA
| | | | - Kathy Goggin
- Children's Mercy Kansas City and University of Missouri - Kansas City Schools of Medicine and Pharmacy, Kansas City, MO, USA
| | - Mahlet Gizaw
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Matt G Mutchler
- APLA Health & Wellness, Los Angeles, CA, USA
- California State University Dominguez Hills, Carson, CA, USA
| |
Collapse
|
25
|
Burns PA, Klukas E, Sims-Gomillia C, Omondi A, Bender M, Poteat T. As Much As I Can - Utilizing Immersive Theatre to Reduce HIV-Related Stigma and Discrimination Toward Black Sexual Minority Men. Community Health Equity Res Policy 2024; 44:151-163. [PMID: 36189845 DOI: 10.1177/0272684x221115920] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Despite advances in biomedical HIV prevention modalities such as pre-exposure prophylaxis to prevent the transmission of HIV, racial/ethnic and sexual/gender minority populations are disproportionately impacted by HIV epidemic. Alarming rates of HIV have persisted among Black gay and bisexual men, particularly in Southern states. METHODS Utilizing data from the ViiV ACCELERATE! initiative, we explored the impact of As Much As I Can, an immersive theatre production, on HIV-related stigma behaviors. A self-administered post-performance survey was conducted with a cohort (n = 322) of randomly selected audience members. RESULTS Overall, the results showed participants had a highly favorable experience, rating the performance with a mean score of 9.77/10. Respondents indicated they intended to change behaviors to promote HIV prevention education and to reduce stigma and discrimination including: (1) Say something if I hear stigmatizing language against people living with HIV (75.4%), (2) Say something if I hear anti-gay language (69.7%) and (3) Tell others about HIV prevention options (e.g., PrEP, PEP, condoms (64.1%). The findings show there is an association between HIV-related behavior intention and linkage to HIV care. Respondents who reported they were more likely to say something about HIV stigma were almost three times (O.R. 2.77; 95% C.I. 0.98-7.8) more likely to indicate they would follow up with a healthcare professional. CONCLUSIONS This study suggests that immersive theatre is an effective method for communicating HIV prevention education and reducing HIV-related structural stigma and discrimination that increases HIV vulnerability for Black sexual minority men.
Collapse
Affiliation(s)
- Paul A Burns
- John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Courtney Sims-Gomillia
- John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | - Angela Omondi
- John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | - Melverta Bender
- Mississippi State Department of Health/Office of STD/HIV, Jackson, MS, USA
| | - Tonia Poteat
- School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
26
|
Kristensen Z, Drinkwater C, Johnson R, Menkes DB. Considerations in the assessment and management of ADHD within the TGDNB population. N Z Med J 2023; 136:46-51. [PMID: 38096434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
AIMS In this article we consider current literature around Attention Deficit Hyperactivity Disorder (ADHD) in the transgender, gender diverse and non-binary (TGDNB) population. METHODS Literature review. RESULTS N/A conclusions: We outline specific considerations pertaining to the assessment and treatment of ADHD in this group and highlight evidential gaps and avenues for future research. We conclude that TGDNB individuals should be considered a "special population" with regards to ADHD and encourage mental health practitioners to consider specific TGDNB mental health needs beyond capacity assessments and gender-affirming care.
Collapse
Affiliation(s)
- Zoe Kristensen
- Te Whatu Ora - Waitematā, Auckland; Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Caitlyn Drinkwater
- School of Psychology, Faculty of Science, The University of Auckland, Auckland, New Zealand
| | | | - David B Menkes
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
27
|
Barreras JL, Bogart LM, MacCarthy S, Klein DJ, Pantalone DW. Discrimination and adherence in a cross-sectional study of Latino sexual minority men with HIV: Coping with discrimination as a mediator and coping self-efficacy as a moderator. J Behav Med 2023; 46:1057-1067. [PMID: 37392342 PMCID: PMC10577103 DOI: 10.1007/s10865-023-00426-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 05/25/2023] [Indexed: 07/03/2023]
Abstract
Discrimination is associated with antiretroviral therapy non-adherence and reduced well-being among people with HIV. We examined the potential for coping to mediate the associations between intersectional discrimination and non-adherence and coping self-efficacy (confidence in one's ability to cope with discrimination) as a moderator that may buffer the negative effects of discrimination on non-adherence in a cross-sectional convenience sample of 82 Latino sexual minority men with HIV. In bivariate linear regressions, discrimination targeting Latino ethnic origin, undocumented residency status, and sexual orientation were each significantly associated with lower self-reported antiretroviral therapy non-adherence (percentage of prescribed doses taken in the last month) and greater use of disengagement coping (denial, substance use, venting, self-blame, behavioral disengagement). Associations between discrimination targeting Latino ethnicity and non-adherence, and discrimination targeting undocumented residency status and non-adherence, were each mediated by disengagement coping responses. Moderation analyses highlighted significant discrimination by coping self-efficacy interaction effects-both coping self-efficacy for problem solving and stopping unpleasant emotions/thoughts each moderated the associations between Latino discrimination and adherence, between undocumented residency status discrimination and adherence, and between HIV discrimination and adherence. Coping self-efficacy for getting social support moderated the association between undocumented residency status discrimination and adherence. Further, the interaction coefficients across models indicated that the negative effects of discrimination on adherence were attenuated at higher levels of coping self-efficacy. Findings highlight the need for structural interventions that reduce-and ultimately eliminate-discrimination, and interventions that address the harmful effects of discrimination and adherence improvement interventions to enhance coping skills among people faced with intersectional discrimination.
Collapse
Affiliation(s)
- Joanna L Barreras
- School of Social Work, California State University Long Beach, 1250 Bellflower Boulevard, Long Beach, CA, 90840, USA.
- Bienestar Human Services, Inc, 5326 East Beverly Blvd, Los Angeles, CA, 90022, USA.
| | - Laura M Bogart
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - Sarah MacCarthy
- Department of Health Behavior, University of Alabama, 1665 University Boulevard, Birmingham, AL, 35294, USA
| | - David J Klein
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - David W Pantalone
- Department of Psychology, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA, 02125, USA
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| |
Collapse
|
28
|
Watson RJ, Caba AE, Layland EK, Simon K, Morgan E, Edelman EJ, Chan PA, Eaton L. Co-occurring mental health and drug use experiences among Black and Hispanic/Latino sexual and gender diverse individuals. J Behav Med 2023; 46:986-995. [PMID: 37407904 DOI: 10.1007/s10865-023-00433-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 06/21/2023] [Indexed: 07/07/2023]
Abstract
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.
Collapse
Affiliation(s)
- Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Rd, Storrs, CT, 06269, USA.
| | - Antonia E Caba
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Rd, Storrs, CT, 06269, USA
| | - Eric K Layland
- College of Education & Human Development, University of Delaware, Newark, DE, USA
| | - Kay Simon
- College of Education and Human Development, University of Minnesota, Minneapolis, MN, USA
| | - Ethan Morgan
- College of Nursing, The Ohio State University, 1585 Neil Ave, Columbus, OH, 43210, USA
| | - E Jennifer Edelman
- Yale School of Medicine and Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | - Philip A Chan
- Department of Medicine, Brown University, Providence Rhode, Island
| | - Lisa Eaton
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Rd, Storrs, CT, 06269, USA
| |
Collapse
|
29
|
Affuso G, Picone N, Costa PA, Bacchini D, De Angelis G, Esposito C, Aparicio-García ME. Minority stress and mental health in gay and lesbian youth: A comparative study of Italy and Spain. Am J Orthopsychiatry 2023; 94:148-158. [PMID: 37883020 DOI: 10.1037/ort0000709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
The present study was carried out based on the minority stress model. The purpose was to compare Italian and Spanish gay and lesbian youth on minority stressors and mental health outcomes and test the minority stress model in Italy and Spain. The sample consisted of 490 participants (307 Italians, Mage = 25.30 and 183 Spanish, Mage = 27.57). They completed an online questionnaire measuring everyday discrimination, coming out to family members, coming out to friends/one's social network, internalized sexual stigma, depression, and anxiety. A multivariate analysis of covariance was performed to explore the effect of nationality on all measures. Structural equation modeling was applied to test the direct and indirect (through internalized sexual stigma) effects of stressors on mental health outcomes. The results demonstrate an impact of nationality on three dimensions: Spanish youth presented higher levels of everyday discrimination, while Italian youth had lower levels of both coming out to family members and coming out to friends/one's social network. Further, in both countries, all stressors had both direct and indirect (through internalized sexual stigma) associations with depression and anxiety. These findings have some social implications: studying the effect of nationality can be useful in suggesting changes in political and social macrosystems. Additionally, studying the associations among these variables is helpful for intervening more efficiently, for example, clinically, on the impact of minority stress. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Collapse
Affiliation(s)
- Gaetana Affuso
- Department of Psychology, University of Campania "Luigi Vanvitelli"
| | - Nicola Picone
- Department of Psychology, University of Campania "Luigi Vanvitelli"
| | | | - Dario Bacchini
- Department of Humanistic Studies, University of Naples "Federico II"
| | - Grazia De Angelis
- Department of Humanistic Studies, University of Naples "Federico II"
| | - Concetta Esposito
- Department of Humanistic Studies, University of Naples "Federico II"
| | | |
Collapse
|
30
|
Kerr L, Bourne A, Hill AO, McNair R, Wyatt K, Lyons A, Carman M, Amos N. Cervical screening among LGBTQ people: how affirming services may aid in achieving cervical cancer elimination targets. Women Health 2023; 63:736-746. [PMID: 37779316 DOI: 10.1080/03630242.2023.2263594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 09/17/2023] [Indexed: 10/03/2023]
Abstract
To reach cervical cancer elimination targets it is necessary to increase screening rates among underserved populations such as LGBTQ communities. This paper examines rates of attendance and associated factors of cervical screening in LGBTQ communities. Data from 2,424 people aged 25 to 74 years and assigned female at birth were drawn from an online national Australian survey of LGBTQ adults. Over half of the sample had accessed cervical screening in the past 2 years. Using a multivariable logistic regression analysis, significant associations were found between screening, sociodemographic traits and health-care access. Trans men were least likely to access cervical screening, while bisexual, pansexual and queer identified participants were most likely to access screening. People who lived outside inner-suburban areas and those who had a disability were less likely to have had screening. Evidence of trusting relationships with a general practitioner (having a regular GP and GP's knowledge of the individual's LGBTQ identity) increased the likelihood that participants had screened, as did recent access to a medical service that was LGBTQ-inclusive or catered specifically to LGBTQ communities. The findings suggest the importance of training health providers, as well as targeted public health messaging for increasing uptake of cervical screening among LGBTQ people.
Collapse
Affiliation(s)
- Lucille Kerr
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
- Department of Nursing Research, Cabrini Research, Malvern, Victoria, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
| | - Adam O Hill
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
- Graduate School of Public Health, St Luke's International University, Tokyo, Japan
| | - Ruth McNair
- Department of General Practice, The University of Melbourne, Parkville, Victoria, Australia
| | - Kerryann Wyatt
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
| | - Marina Carman
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
| | - Natalie Amos
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
| |
Collapse
|
31
|
López DJ, Yuan Y, Booth J, Wei K, Friedman MR. Discrimination and Rejection: The Effects of Ethnic and Sexuality-Based Discrimination Against Latino Gay and Bisexual Men. J Homosex 2023; 70:2828-2847. [PMID: 35801832 DOI: 10.1080/00918369.2022.2081105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Latino gay and bisexual men (GBM) may experience discrimination attributed to their sexual orientation and ethnicity, necessitating an examination of their experiences from an intersectional lens. While relationships between discrimination and the internalization of those messages have been previously researched, less is known about experiencing discrimination attributed to different identities and its relationships with discrete attributions of internalized stigma. Understanding how different attributes of identity-based discrimination are related to different attributes of identity-based internalization of stigma among gay and bisexual men of color may be important in the design of interventions to help Latino GBM cope with discrimination and prevent negative mental health outcomes. In order to achieve this aim, the current study utilized data from the Latino MSM Community Involvement: HIV Protective Effects Study, which included 571 self-identified Latino GBM. Results demonstrate that experiences of external anti-Latino discrimination were significantly linked to both internalized ethnicity- and sexuality-based stigma, whereas experiences of external sexuality-based discrimination were not significantly linked with internalized ethnicity- or sexuality-based stigma. Results suggest a need for future research to further examine effects of external ethnic discrimination on the psychosocial health of Latino GBM.
Collapse
Affiliation(s)
- Daniel Jacobson López
- School of Social Work, Boston University, Boston, Massachusetts, USA
- Yale University, School of Public Health, New Haven, CT, USA
| | - Yan Yuan
- School of Social Work, University of Pittsburgh, Pennsylvania, USA
| | - Jamie Booth
- School of Social Work, University of Pittsburgh, Pennsylvania, USA
| | - Kai Wei
- School of Social Work, University of Pittsburgh, Pennsylvania, USA
| | - M Reuel Friedman
- Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
32
|
Gamio Cuervo Á, Herrawi F, Horne SG, Wilkins-Yel KG. Recreating diasporic identity and community: Examination of transgender and nonbinary latinx healing from family rejection. J Couns Psychol 2023; 70:535-547. [PMID: 37384490 DOI: 10.1037/cou0000692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
The purpose of this study was to explore the experience of healing from family rejection among transgender and nonbinary Latinx individuals. Participants were asked how they navigated family dynamics related to gender identity and specific behaviors or resources that promoted their healing from experiences of family rejection. Data from 12 interviews with Latinx nonbinary and transgender adults were analyzed through a critical-constructivist grounded theory method resulting in a hierarchy composed of three clusters related to the core category (healing from family rejection leads to the recreation of diasporic identity and community as one learns to live authentically in their ethnic/racial gendered expression). These clusters included recreation of the family system, community-based cultural healing, and autonomy in trans identity and psychological well-being. Relevant contributions to research and implications for psychologists are reviewed: (a) Latinx diasporic identity formation is facilitated through the reconstruction of familial relationships and cultural healing, and (b) chosen family and supportive community networks may adopt the responsibility of ethnic-racial socialization after proximity to family of origin is lost. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Collapse
Affiliation(s)
- Álvaro Gamio Cuervo
- Department of Counseling and School Psychology, University of Massachusetts Boston
| | - Farahdeba Herrawi
- Department of Counseling and School Psychology, University of Massachusetts Boston
| | - Sharon G Horne
- Department of Counseling and School Psychology, University of Massachusetts Boston
| | - Kerrie G Wilkins-Yel
- Department of Counseling and School Psychology, University of Massachusetts Boston
| |
Collapse
|
33
|
Quinn KG, Edwards T, Johnson A, Takahashi L, Dakin A, Bouacha N, Voisin D. Understanding the impact of police brutality on Black sexually minoritized men. Soc Sci Med 2023; 334:116191. [PMID: 37666095 PMCID: PMC10565611 DOI: 10.1016/j.socscimed.2023.116191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/06/2023]
Abstract
Young Black gay, bisexual, and other sexually minoritized men (SMM) face high levels of police brutality and other negative, unwarranted encounters with the police. Such interactions have known health consequences. The purpose of this study was to understand the health, mental health, and social consequences of police brutality experienced by young Black SMM. We conducted in-depth interviews with 31 Black, cisgender men, ages of 16-30 and analyzed the data using thematic analysis. Our primary results are summarized in four themes: 1) Police brutality is built into the system and diminishes trust; 2) Videos and social media make visible violence that has long existed; 3) Police brutality contributes to anxiety and other psychosocial effects; and 4) Violence reduces feelings of safety and contributes to avoidance of police. Our results highlight the direct and vicarious police brutality participants are subjected to and sheds light on the effects of such violence on trust, perceived safety, anxiety, and trauma symptoms. Results from this study contribute to the needed public health conversation around police brutality against Black men, specifically shedding light on the experiences of Black SMM.
Collapse
Affiliation(s)
- Katherine G Quinn
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Travonne Edwards
- School of Child and Youth Care, Toronto Metropolitan University, Canada
| | - Anthony Johnson
- School of Social Work, Loyola University Chicago, Chicago, IL, USA
| | - Lois Takahashi
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
| | | | | | - Dexter Voisin
- School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
34
|
Metheny N, Scott D, Buch J, Fallon S, Chavez J. Trusted Sources of Information and COVID-19 Vaccine Uptake in a Sample of Latinx Sexual and Gender Minorities in South Florida. J Public Health Manag Pract 2023; 29:729-734. [PMID: 37104063 PMCID: PMC10524457 DOI: 10.1097/phh.0000000000001757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
OBJECTIVE To examine factors associated with COVID-19 vaccine uptake in a sample of Latino/a/x sexual and/or gender minority (SGM) individuals in South Florida. DESIGN Data were collected via an online survey from March 2021 to August 2022, as part of the Community Engagement Alliance Against COVID-19 Disparities. A multivariate regression analysis was fit using completion of a COVID-19 vaccine regimen as the outcome. Key covariates included trusted sources of information (eg, doctor, media), COVID-19-related challenges (eg, accessing medication, transportation), and dominant wave of SARS-CoV-2 at the time of data collection. SETTING Miami-Dade and Broward counties, Florida. RESULTS White Latino/a/x, bachelor's educated respondents, and those with high levels of trust in community organizations had significantly greater odds of vaccination. CONCLUSION Community organizations may be key to improving vaccine uptake among marginalized Latino/a/x SGM for COVID-19 and other emerging communicable diseases, such as meningitis and Mpox (monkeypox). The results of this study suggest that tailored public health messaging and additional funding for vaccine distribution are needed to better equip community organizations with the resources they need to serve this population.
Collapse
Affiliation(s)
- Nicholas Metheny
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida (Dr Metheny and Mr Scott); Latinos Salud, Miami, Florida (Mr Buch and Dr Fallon); and Miller School of Medicine, University of Miami, Miami, Florida (Ms Chavez)
| | | | | | | | | |
Collapse
|
35
|
Tran GM, Lachowsky N, Urbanoski KA, Scheim AI, Bauer GR. Correlates of hazardous alcohol drinking among trans and non-binary people in Canada: A community-based cross-sectional study. Drug Alcohol Depend 2023; 250:110872. [PMID: 37406573 DOI: 10.1016/j.drugalcdep.2023.110872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/30/2023] [Accepted: 06/20/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE Transgender and non-binary people (TGNB) have a higher rate of heavy episodic drinking than cisgender people; however, extant knowledge about predictors of hazardous alcohol drinking (HAD) among different TGNB groups is limited. This study examined predictors of HAD in a national sample of TGNB people in Canada. METHODS Logistic regression models were fit to examine the effects of 1) minority stressors and 2) stress-buffering factors on the likelihood of HAD, stratified by gender, among 2324 TGNB individuals from the Trans PULSE Canada survey, a cross-sectional survey conducted in 2019 among trans and non-binary people aged 14+ in Canada. RESULTS Almost 17% of participants reported past-year HAD. Lifetime day-to-day and lifetime major discrimination were associated with higher odds of HAD in the full sample [(AOR=1.37, 95% CI: 1.30, 1.44) and (AOR=1.69, 95% CI: 1.55, 1.86) respectively], and across all gender groups. Social support was associated with lower odds of HAD in trans men, non-binary people assigned female at birth (NB-AFAB), and non-binary people assigned male at birth (NB-AMAB) groups, but with higher odds of HAD in the trans women group. Misgendering was associated with lower odds of HAD in trans men and NB-AFAB, but higher odds of HAD in trans women and NB-AMAB. Mixed effects of gender distress, gender positivity, and gender-affirming medical care were also reported across groups. CONCLUSION The study provided a more detailed understanding of the predictors of HAD across four TGNB groups. Public health interventions should focus on structural discrimination and social support for TGNB people.
Collapse
Affiliation(s)
- Gioi Minh Tran
- School of Public Health and Social Policy, University of Victoria, 3800 Finnerty Road, Victoria, BC V8P 5C2, Canada; Center for Community Health Promotion, Suite 313-314, Block E1, Trung Tu Diplomatic Compound, Dong Da, Hanoi, Viet Nam.
| | - Nathan Lachowsky
- School of Public Health and Social Policy, University of Victoria, 3800 Finnerty Road, Victoria, BC V8P 5C2, Canada; Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility Room 273, 2300 McKenzie Avenue, Victoria, BCV8P 5C2, Canada
| | - Karen A Urbanoski
- School of Public Health and Social Policy, University of Victoria, 3800 Finnerty Road, Victoria, BC V8P 5C2, Canada; Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility Room 273, 2300 McKenzie Avenue, Victoria, BCV8P 5C2, Canada
| | - Ayden I Scheim
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA19104, United States; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada; Li Ka Shing Knowledge Institute, Unity Health Toronto, Canada
| | - Greta R Bauer
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada; Institute for Sexual and Gender Health, University of Minnesota Medical School, 1300 South 2nd Street, Minneapolis, MN55455, United States
| |
Collapse
|
36
|
Huynh J. "Family Is the Beginning but Not the End": Intergenerational LGBTQ Chosen Family, Social Support, and Health in a Vietnamese American Community Organization. J Homosex 2023; 70:1240-1262. [PMID: 35007487 DOI: 10.1080/00918369.2021.2018879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Homophobia and anti-LGBTQ (Lesbian, Gay, Bisexual, Transgender, and Queer) discrimination within ethnic communities can negatively impact the health of LGBTQ people. The formation of chosen families has been a source of social support that may have health benefits for LGBTQ people. This ethnographic study explores how participation in a LGBTQ Vietnamese American community organization reveals the salience of chosen family in informing individual members' perceptions of their health and well-being. Fifteen members were interviewed and over 30 were included in a 6-month participant-observation period. Three themes emerged: 1) queering family and kinship, 2) Vietnamese motherhood and the social reproduction of the family, 3) social ties and community connectedness as relational dimensions of health. Findings suggest that specific ethnic social support via chosen family formations for LGBTQ Vietnamese Americans can shape individuals' sense of self, sense of belonging, purpose in life, and consequently perceptions of well-being.
Collapse
Affiliation(s)
- James Huynh
- Department of Community Health Sciences, University of California, Los Angeles Fielding School of Public Health, Los Angeles, California, USA
| |
Collapse
|
37
|
Jagsi R, Griffith K, Krenz C, Jones RD, Cutter C, Feldman EL, Jacobson C, Kerr E, Paradis K, Singer K, Spector N, Stewart A, Telem D, Ubel P, Settles I. Workplace Harassment, Cyber Incivility, and Climate in Academic Medicine. JAMA 2023; 329:1848-1858. [PMID: 37278814 PMCID: PMC10245188 DOI: 10.1001/jama.2023.7232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/13/2023] [Indexed: 06/07/2023]
Abstract
Importance The culture of academic medicine may foster mistreatment that disproportionately affects individuals who have been marginalized within a given society (minoritized groups) and compromises workforce vitality. Existing research has been limited by a lack of comprehensive, validated measures, low response rates, and narrow samples as well as comparisons limited to the binary gender categories of male or female assigned at birth (cisgender). Objective To evaluate academic medical culture, faculty mental health, and their relationship. Design, Setting, and Participants A total of 830 faculty members in the US received National Institutes of Health career development awards from 2006-2009, remained in academia, and responded to a 2021 survey that had a response rate of 64%. Experiences were compared by gender, race and ethnicity (using the categories of Asian, underrepresented in medicine [defined as race and ethnicity other than Asian or non-Hispanic White], and White), and lesbian, gay, bisexual, transgender, queer (LGBTQ+) status. Multivariable models were used to explore associations between experiences of culture (climate, sexual harassment, and cyber incivility) with mental health. Exposures Minoritized identity based on gender, race and ethnicity, and LGBTQ+ status. Main Outcomes and Measures Three aspects of culture were measured as the primary outcomes: organizational climate, sexual harassment, and cyber incivility using previously developed instruments. The 5-item Mental Health Inventory (scored from 0 to 100 points with higher values indicating better mental health) was used to evaluate the secondary outcome of mental health. Results Of the 830 faculty members, there were 422 men, 385 women, 2 in nonbinary gender category, and 21 who did not identify gender; there were 169 Asian respondents, 66 respondents underrepresented in medicine, 572 White respondents, and 23 respondents who did not report their race and ethnicity; and there were 774 respondents who identified as cisgender and heterosexual, 31 as having LGBTQ+ status, and 25 who did not identify status. Women rated general climate (5-point scale) more negatively than men (mean, 3.68 [95% CI, 3.59-3.77] vs 3.96 [95% CI, 3.88-4.04], respectively, P < .001). Diversity climate ratings differed significantly by gender (mean, 3.72 [95% CI, 3.64-3.80] for women vs 4.16 [95% CI, 4.09-4.23] for men, P < .001) and by race and ethnicity (mean, 4.0 [95% CI, 3.88-4.12] for Asian respondents, 3.71 [95% CI, 3.50-3.92] for respondents underrepresented in medicine, and 3.96 [95% CI, 3.90-4.02] for White respondents, P = .04). Women were more likely than men to report experiencing gender harassment (sexist remarks and crude behaviors) (71.9% [95% CI, 67.1%-76.4%] vs 44.9% [95% CI, 40.1%-49.8%], respectively, P < .001). Respondents with LGBTQ+ status were more likely to report experiencing sexual harassment than cisgender and heterosexual respondents when using social media professionally (13.3% [95% CI, 1.7%-40.5%] vs 2.5% [95% CI, 1.2%-4.6%], respectively, P = .01). Each of the 3 aspects of culture and gender were significantly associated with the secondary outcome of mental health in the multivariable analysis. Conclusions and Relevance High rates of sexual harassment, cyber incivility, and negative organizational climate exist in academic medicine, disproportionately affecting minoritized groups and affecting mental health. Ongoing efforts to transform culture are necessary.
Collapse
Affiliation(s)
- Reshma Jagsi
- Medical School, University of Michigan, Ann Arbor
- Emory University, Atlanta, Georgia
| | | | - Chris Krenz
- Medical School, University of Michigan, Ann Arbor
| | | | | | | | | | - Eve Kerr
- Medical School, University of Michigan, Ann Arbor
| | | | | | - Nancy Spector
- College of Medicine, Drexel University, Philadelphia, Pennsylvania
| | - Abby Stewart
- Department of Psychology, University of Michigan, Ann Arbor, Michigan
| | - Dana Telem
- Medical School, University of Michigan, Ann Arbor
| | - Peter Ubel
- School of Medicine, Duke University, Durham, North Carolina
| | - Isis Settles
- Department of Psychology, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
38
|
Kim MJ, Wilkins K, Gorman B. Healthcare satisfaction at the intersections of sexual orientation and race/ethnicity. Ethn Health 2023; 28:601-618. [PMID: 35803900 DOI: 10.1080/13557858.2022.2096207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/26/2022] [Indexed: 05/05/2023]
Abstract
OBJECTIVES Existing scholarship has consistently demonstrated disparities in healthcare experience based on sexual identity. However, relatively little research has considered intersections with race/ethnicity, despite that intersection with other characteristics may complicate healthcare experiences and satisfaction among sexual minorities. This study aims to address such a gap by examining healthcare satisfaction across the intersections of sexual and racial/ethnic identity. DESIGN Utilizing data on U.S. adults included in the 2013-2018 Behavioral Risk Factor Surveillance System (BRFSS) (n = 372,766), we investigate levels of satisfaction with care among a range of groups simultaneously embodying two identities. RESULTS Findings from ordered logistic regression models show that among adults who identify as heterosexual, the odds of reporting high satisfaction with care are lower among Blacks, Asians, and Native Americans. Among sexual minority adults, the likelihood of reporting high satisfaction with care is consistently lower among Native American gay and lesbian adults compared to gays and lesbians of other race/ethnicity or Native American and White heterosexuals, indicating heightened vulnerability to poorer healthcare experience among this multiple minority group. CONCLUSION While levels of satisfaction with care tend to be generally high across groups, future research should endeavor to investigate the driving factors that lower the odds of high healthcare satisfaction among those with intersecting minority identities.
Collapse
Affiliation(s)
- Min Ju Kim
- Department of Sociology, Rice University, Houston, TX, USA
| | - Kiana Wilkins
- Department of Sociology, Rice University, Houston, TX, USA
| | - Bridget Gorman
- Department of Sociology, Rice University, Houston, TX, USA
| |
Collapse
|
39
|
Doucette C, Milano MT, Kamen C. Patient Perceptions of Sexual Orientation and Gender Identity Data Collection in an Outpatient Radiation Oncology Setting. Int J Radiat Oncol Biol Phys 2023; 116:68-78. [PMID: 36549346 DOI: 10.1016/j.ijrobp.2022.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/14/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Sexual and gender minority patients with cancer experience significant health disparities requiring tailored care. Collecting sexual orientation and gender identity (SOGI) data in the electronic medical record (EMR) could allow care to be tailored and is in line with radiation oncology's mission to better serve diverse patients. This article describes a systematic method for collecting SOGI data for all patients starting radiation treatment in a department of radiation oncology (DRO). METHODS AND MATERIALS During a 3-month experimental period, DRO staff administered a demographic questionnaire and attitude survey to new adult patients. SOGI demographic data, entered into the EMR by nursing staff, were extracted and analyzed for all patients from the experimental period and from the 3 months prior (control period). Descriptive and categorical data completion rates were compared between the experimental and control periods using independent-samples t tests and Pearson χ2 tests. RESULTS A total of 788 patients were included in this analysis: 368 in the control period and 420 in the experimental period. Of the 420 patients enrolled in the experimental period, 267 (63.6%) were offered a survey, of whom 211 (79.0%) completed the survey. There were higher rates of sexual orientation responses entered into the EMR for the experimental group compared with the control group (56.9% vs 27.1%; P <.001), with the highest response rates for patients who completed a survey (82.9%). Ten patients (2.9%) identified as gay or lesbian and 100% identified as cisgender. The majority of patients were not upset by the form, with only 11 patients (5.2%) stating that any specific question caused them distress. CONCLUSIONS Collecting SOGI data via a demographic form is feasible in an outpatient DRO. This approach was well received by the majority of patients and could lead to provision of higher-quality, tailored care.
Collapse
Affiliation(s)
| | | | - Charles Kamen
- Surgery, University of Rochester Medical Center, Rochester, New York.
| |
Collapse
|
40
|
Pico-Espinosa OJ, Hull M, MacPherson P, Grace D, Lachowsky N, Gaspar M, Mohammed S, Truong R, Tan DHS. Reasons for not using pre-exposure prophylaxis for HIV and strategies that may facilitate uptake in Ontario and British Columbia among gay, bisexual and other men who have sex with men: a cross-sectional survey. CMAJ Open 2023; 11:E560-E568. [PMID: 37369522 PMCID: PMC10310342 DOI: 10.9778/cmajo.20220113] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) for HIV is underutilized. We aimed to identify barriers to use of PrEP and strategies that may facilitate its uptake. METHODS Gay, bisexual and other men who have sex with men, aged 19 years or older and living in Ontario and British Columbia, Canada, completed a cross-sectional survey in 2019-2020. Participants who met Canadian PrEP guideline criteria and were not already using PrEP identified relevant barriers and which strategies would make them more likely to start PrEP. We described the barriers and strategies separately for Ontario and BC. RESULTS Of 1527 survey responses, 260 respondents who never used PrEP and met criteria for PrEP were included. In Ontario, the most common barriers were affordability (43%) and concern about adverse effects (42%). In BC, the most common reasons were concern about adverse effects (41%) and not feeling at high enough risk (36%). In Ontario, preferred strategies were short waiting time (63%), the health care provider informing about their HIV risk being higher than perceived (62%), and a written step-by-step guide (60%). In BC, strategies were short waiting time (68%), people speaking publicly about PrEP (68%), and the health care provider counselling about their HIV risk being higher than perceived (64%), adverse effects of PrEP (65%) and how well PrEP works (62%). INTERPRETATION Concern about adverse effects and not self-identifying as having high risk for HIV were common barriers, and shorter waiting times may increase PrEP uptake. In Ontario, the findings suggested lack of affordability, whereas in BC, strategies involving health care providers were valued.
Collapse
Affiliation(s)
- Oscar Javier Pico-Espinosa
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Mark Hull
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Paul MacPherson
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Daniel Grace
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Nathan Lachowsky
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Mark Gaspar
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Saira Mohammed
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Robinson Truong
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Darrell H S Tan
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| |
Collapse
|
41
|
Weinstein ER, Balise R, Metheny N, Jose Baeza Robba M, Mayo D, Michel C, Chan B, Safren SA, Harkness A. Factors associated with latino sexual minority men's likelihood and motivation for obtaining a COVID-19 vaccine: a mixed-methods study. J Behav Med 2023; 46:116-128. [PMID: 35476250 PMCID: PMC9043889 DOI: 10.1007/s10865-022-00315-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 03/29/2022] [Indexed: 01/01/2023]
Abstract
Minoritized communities are underreached by biomedical interventions, such as the COVID-19 vaccine. This mixed-methods study identified factors associated with vaccine likelihood (VL) and uptake (VU) among 187 Latino sexual minority men (LSMM) in South Florida. Regression models with LASSO variable selection and Classification and Regression Trees (CART) assessed determinants of VL and VU while open-ended questions were evaluated using thematic content analysis. VL (range 1-7; M = 6.00, SD = 1.84) and VU (63.6%) was high. LASSO modeling identified being insured, worrying about others, fear of transmitting COVID-19, and financial stress as the most influential factors for VL; working remotely from home was important for VU. Time (weeks) since addition of COVID-19 vaccination-related questions (December 2nd, 2020) was associated with both outcomes across both modeling techniques. Convergence between data suggests capitalizing on altruistic motivations and improving accessibility to vaccine campaigns are valuable assets to increase LSMM's vaccine confidence.
Collapse
Affiliation(s)
| | - Raymond Balise
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Nicholas Metheny
- School of Nursing and Health Studies, University of Miami, Miami, USA
| | | | - Daniel Mayo
- College of Public Health, National Taiwan University, Taipei, Taiwan
| | | | - Bill Chan
- Department of Psychology, University of Miami, Miami, USA
| | | | - Audrey Harkness
- School of Nursing and Health Studies, University of Miami, Miami, USA
| |
Collapse
|
42
|
Turpin RE, Dangerfield DT, Oke T, Hickson DA. Parental Sexuality Disclosure, Discrimination, and Depression Among Black Sexual Minority Men and Black Transgender Women. Fam Community Health 2023; 46:95-102. [PMID: 36799942 PMCID: PMC9942094 DOI: 10.1097/fch.0000000000000360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Racial and sexuality-based discrimination can induce depressive symptoms among Black sexual minority men and transgender women (BSMM/BTW). BSMM and BTW who disclose their sexuality to parents may be better prepared to cope with discrimination. We explored the relationship between discrimination and depression among BSMM and BTW and whether parental disclosure modified this relationship. Secondary analysis of The MARI Study was used to test the relationship between discrimination and depression modified by level of disclosure of sexuality to parents among 580 BSMM and BTW in Jackson, Mississippi, and Atlanta, Georgia. Bivariate tests and linear regression models were stratified by sexuality disclosure to parents. Discrimination was associated with greater depression, with significant dose-response modification across levels of disclosure. After adjustment, maximum discrimination scores were associated with depression scores 10.7 units higher among participants with very open disclosure (95% CI, 10.4-11.8), 15.3 units higher among participants with somewhat open disclosure (95% CI, 3.7-26.9), and 19.5 units higher among participants with no disclosure (95% CI, 10.2-26.8). Disclosure of sexuality to supportive parents can substantially benefit the mental health of BSMM and BTW. Future studies should explore intervention approaches to providing social support for BSMM and BTW in unsupportive families.
Collapse
Affiliation(s)
- Rodman E Turpin
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, Virginia (Dr Turpin); George Washington University, Milken Institute School of Public Health, Washington, District of Columbia (Dr Dangerfield); School of Social Work, University at Buffalo, Buffalo, New York (Mr Oke); and Us Helping Us, People Into Living Inc, Washington, District of Columbia (Drs Hickson and Dangerfield, and Mr Oke)
| | | | | | | |
Collapse
|
43
|
Ball TC, Molina LE, Branscombe NR. Consequences of interminority ingroup rejection for group identification and well-being. Cultur Divers Ethnic Minor Psychol 2023; 29:184-192. [PMID: 34472892 DOI: 10.1037/cdp0000380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The rejection-identification model (RIM; Branscombe et al. 1999) suggests group identification mitigates the negative effects of perceived discrimination on psychological well-being. The RIM has not been applied to instances of interminority ingroup rejection-discrimination by one's ingroup toward another of their ingroups (e.g., a gay Black American perceiving racial discrimination within his LGBTQ+ community). We address two questions: (a) do the predicted relationships between constructs in the RIM replicate for interminority ingroup rejection? (b) How does interminority ingroup rejection relate to identification with the discriminating ingroup? METHODS We test these questions using structural equation modeling (SEM) on a secondary dataset including respondents (N = 3,300) who identify as members of both a racial and sexual minority. RESULTS Our analysis produced two key findings. First, replicating past RIM research, we show that perceived discrimination-whether heterosexist or racist in nature-predicts worse well-being and higher identification with the target group. Furthermore, we demonstrate an indirect effect such that discrimination predicts higher group identification and this is positively related to well-being. Second, the interminority ingroup rejection-identification paths varied as a function of whether discrimination was heterosexist or racist. Greater heterosexism within one's racial community predicted greater racial ingroup identification; however, racism within one's sexual minority community was not a significant predictor of sexual minority group identification. CONCLUSIONS We discuss implications of interminority ingroup rejection for people who belong to intersecting minority groups and make recommendations for extending research on this issue. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Collapse
|
44
|
Feinstein BA, Mereish EH, Mamey MR, Chang CJ, Goldbach JT. Age Differences in the Associations Between Outness and Suicidality Among LGBTQ+ Youth. Arch Suicide Res 2023; 27:734-748. [PMID: 35506502 PMCID: PMC9719400 DOI: 10.1080/13811118.2022.2066493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) youth are at increased risk for suicidality compared to their heterosexual and cisgender peers, and outness (the extent to which an individual is open about their LGBTQ+ identity to others) is an important correlate of suicidality. However, previous research has led to mixed findings regarding whether outness functions as a risk or protective factor for suicidality, and the available evidence suggests that age may play an important role. As such, the goal of the current study was to examine whether the associations between outness and suicidality differed between LGBTQ+ adolescents (ages 12-17) and emerging adults (ages 18-24). METHOD The analytic sample included 475 LGBTQ+ youth who completed an online survey after contacting a national, LGBTQ+ crisis service provider. RESULTS Results indicated that age significantly moderated the association between outness and suicidal ideation, such that greater outness was significantly associated with greater suicidal ideation for adolescents, but not for emerging adults. In contrast, age did not significantly moderate the associations between outness and likelihood of a past suicide attempt or perceived likelihood of a future suicide attempt. However, the main effect of outness was significant in both models, such that greater outness was significantly associated with a greater likelihood of a past suicide attempt and a greater perceived likelihood of a future suicide attempt. CONCLUSIONS These findings suggest that the associations between outness and suicidality among LGBTQ+ youth may depend on age as well as the dimension of suicidality (ideation versus attempt). HighlightsBeing more open about one's LGBTQ+ identity may confer risk for suicidality.The influence of outness on suicidal ideation may be strongest during adolescence.There is a need for LGBTQ+ affirming policies and laws to reduce suicidality.
Collapse
Affiliation(s)
- Brian A. Feinstein
- Department of Psychology, Rosalind Franklin University of Medicine and Science
| | | | - Mary Rose Mamey
- Suzanne Dworak-Peck School of Social Work, University of Southern California
| | - Cindy J. Chang
- Graduate School of Applied and Professional Psychology, Rutgers University
| | - Jeremy T. Goldbach
- Suzanne Dworak-Peck School of Social Work, University of Southern California
| |
Collapse
|
45
|
Ünsal BC, Demetrovics Z, Reinhardt M. Stronger together: community participation, structural stigma, and depression among sexual and gender minority adults in 28 European countries. Soc Psychiatry Psychiatr Epidemiol 2023; 58:657-669. [PMID: 36434298 PMCID: PMC10066166 DOI: 10.1007/s00127-022-02385-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Although discriminatory laws, policies, and public attitudes (i.e., structural stigma) are linked to adverse mental health outcomes among sexual and gender minority (SGM) populations, little attention has been paid to protective factors, such as community participation, about which inconsistencies exist whether it ameliorates or exacerbates mental health burdens. Thus, we examined the mediator roles of identity disclosure and victimization and the moderator role of structural stigma in the association of community participation with depression. METHODS Data from the EU-LGBTI-II survey assessing community participation, identity disclosure, victimization, and depression among sexual minority men (n = 62,939), women (n = 38,976), and gender minority adults (n = 15,845) in 28 European countries were used. Structural stigma was measured as discriminatory legislation, policies, and societal attitudes using publicly available data. RESULTS Findings showed that community participation predicted lower and higher levels of depression through identity disclosure and victimization, respectively. For sexual minority men and women, structural stigma moderated the indirect effect through identity disclosure, with a larger effect in higher structural stigma countries. Only for sexual minority men, the indirect effect through victimization was also moderated, with a larger effect in high-stigma countries. For gender minorities, no moderation effect was found. CONCLUSIONS Community participation is differentially linked to depression through identity disclosure and victimization, and as a function of structural stigma. It can be a double-edged sword, especially for sexual minority men in high-stigma countries, who are expected to pay the price while enjoying its benefits, highlighting the targets and considerations for interventions.
Collapse
Affiliation(s)
- Berk C Ünsal
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar
| | - Melinda Reinhardt
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| |
Collapse
|
46
|
Jones SR, Mathews A, Colbert K, Jain M, Simon B, Usher D, McGoy SL. Popular Culture and Shaping HIV Perception. J Health Care Poor Underserved 2023; 34:27-36. [PMID: 38661914 DOI: 10.1353/hpu.2023.a903349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
The Gilead COMPASS Initiative® used celebrity partnerships to highlight HIV prevalence in the Southern U.S. and support Southern HIV and Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ) organizations. Using various media platforms, HIV organizations engaged with popular culture in collaboration with national media advocacy and public relations organizations to campaign against stigmatization and raise awareness about HIV.
Collapse
|
47
|
Stephens C, Smith JC, Hawkins DS. "When my Brother Fell, I Picked Up His Weapons": Collective Remembrance as Community Mobilization among Black Gay, Bisexual, and Queer Men. J Health Care Poor Underserved 2023; 34:1-6. [PMID: 38661910 DOI: 10.1353/hpu.2023.a903345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
The Counter Narrative Project (CNP) was founded to shift narratives and shatter stereotypes about Black gay, bisexual, and queer men to advance social justice. This paper describes three programs CNP implemented that were organized around collective memory as a strategy to respond to collective trauma experienced by this community.
Collapse
|
48
|
Wiginton JM, Eaton LA, Watson RJ, Maksut JL, Earnshaw VA, Berman M. Sex-Positivity, Medical Mistrust, and PrEP Conspiracy Beliefs Among HIV-Negative Cisgender Black Sexual Minority Men in Atlanta, Georgia. Arch Sex Behav 2022; 51:2571-2581. [PMID: 34761347 PMCID: PMC9085967 DOI: 10.1007/s10508-021-02174-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 08/18/2021] [Accepted: 10/05/2021] [Indexed: 06/13/2023]
Abstract
Because the public health response to the disproportionate HIV burden faced by Black sexual minority men (BSMMM) has focused on sexual risk reduction and disease prevention, other vital components of sexual health (e.g., intimacy, pleasure, benefits of sex) have been often overlooked. Sex-positive describes a more open, holistic approach toward sex and sexuality that prioritizes these other components, though such an approach is rarely applied to BSMM's sexual health. For sex-positive BSMM, risk/preventive discourse may foster or exacerbate medical mistrust as a reaction to the dissonance between how these men view sexual health and how the medical establishment views it, which may discourage sexual healthcare-seeking. We assessed sex-positivity and its association with medical mistrust and PrEP conspiracy beliefs among 206 HIV-negative cisgender BSMM in Atlanta, Georgia. We performed exploratory factor analytic procedures on responses to a sex-positivity scale, followed by multivariable linear regressions to determine sex-positivity's associations with medical mistrust and PrEP conspiracy beliefs. We extracted two sex-positivity factors: sexual freedom (α = 0.90), reflecting openness toward casual sex and rejection of sexual mores, and essence of sex (α = 0.77), reflecting the intimate, relational, and pleasurable qualities of sex. Sexual freedom was independently associated with perceived provider deception (β = 0.19, CI = 0.04, 0.34). Essence of sex was independently associated with PrEP conspiracy beliefs (β = 0.16, CI = 0.02, 0.31) and marginally associated with perceived provider deception (β = 0.14, CI = - 0.00, 0.29). Healthcare providers and public health practitioners may cultivate greater trust with BSMM by incorporating a sex-positive approach into patient/participant interactions, clinical decision-making, and interventions. Improving access to sexual pleasure acknowledges BSMM's right to optimal, holistic sexual health.
Collapse
Affiliation(s)
- John Mark Wiginton
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway Street, Baltimore, MD, 21205, USA.
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
| | - Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Jessica L Maksut
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Marcie Berman
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
| |
Collapse
|
49
|
Brooks BD, Kaniuka AR, Motley DN, Job SA, Williams SL. "We are just magic": A qualitative examination of self-love among Black same-gender loving men. Cultur Divers Ethnic Minor Psychol 2022; 28:280-289. [PMID: 35201796 DOI: 10.1037/cdp0000529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Black same-gender loving men (BSGLM) represent a population with understudied lived experiences as both racial and sexual minority individuals. Most existing research among BSGLM focuses on sexual health outcomes in the context of minority stress, without consideration of the full experiences of BSGLM or strengths-based approaches. The present study aimed to address this gap in the literature by examining self-love among BSGLM using a phenomenological qualitative approach. METHOD Adult BSGLM in the U.S. (n = 19; Mage = 31.79 years [SD = 8.88]) were recruited online and completed interviews via phone and video conferencing. Data were coded independently by two trained coders via an iterative approach that included in vivo coding and line-by-line comparative coding. Codes were grouped thematically, guided by sexual minority identity and positive psychology literature. RESULTS Three major themes related to self-love among BSGLM emerged: (a) Freedom of identity, meaning participants' ability to construct an identity outside of societal expectations; (b) Community connection and pride, or participants' connection to and pride derived from the BSGLM community; and (c) Adversarial growth and resilience, or ways that adversity related to BSGLM identity generated personal growth. CONCLUSIONS Current findings may have clinical implications. Using narrative therapy approach, facilitating connectedness to the BSGLM community, and implementing gratitude interventions in therapeutic settings may enhance self-love and positive self-regard among BSGLM. Future research should continue to give voice to the full lived experience of BSGLM. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Collapse
|
50
|
Abstract
Objectives. To report findings from qualitative research that describe sources of hesitancy and barriers to vaccine uptake among lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA) populations. Methods. In March 2021, we conducted focus groups with members of the Los Angeles, California LGBTQIA community to identify barriers to becoming vaccinated. Semistructured interviews were conducted with 32 individuals in 5 focus groups. Thematic analysis was conducted to identify themes. Results. Historical and ongoing medical trauma, including misgendering, and perceived emotional violence emerged as significant barriers to LGBTQIA individuals becoming vaccinated. Fear of violence was found to be a major barrier among transgender individuals, whereas fear of an unwelcoming vaccination site was a barrier for seniors. Finally, surviving was a higher priority than becoming vaccinated. Conclusions. Participants reported vaccine hesitancy and barriers that are unique to the life experiences of LGBTQIA individuals; these include medical trauma, violence, stigma, and discrimination. Our findings highlight the need to include LGBTQIA leaders and trusted individuals in the development of vaccination education and the delivery of vaccination services. (Am J Public Health. 2022;112(3):405-407. https://doi.org/10.2105/AJPH.2021.306599).
Collapse
Affiliation(s)
- Danny Azucar
- Danny Azucar, Lindsay Lee Slay, Damaris Garcia Valerio, and Michele D. Kipke are with the Division of Research on Children, Youth & Families, Department of Pediatrics, Children's Hospital, Los Angeles, CA. Michele D. Kipke is also with the Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
| | - Lindsay Slay
- Danny Azucar, Lindsay Lee Slay, Damaris Garcia Valerio, and Michele D. Kipke are with the Division of Research on Children, Youth & Families, Department of Pediatrics, Children's Hospital, Los Angeles, CA. Michele D. Kipke is also with the Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
| | - Damaris Garcia Valerio
- Danny Azucar, Lindsay Lee Slay, Damaris Garcia Valerio, and Michele D. Kipke are with the Division of Research on Children, Youth & Families, Department of Pediatrics, Children's Hospital, Los Angeles, CA. Michele D. Kipke is also with the Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
| | - Michele D Kipke
- Danny Azucar, Lindsay Lee Slay, Damaris Garcia Valerio, and Michele D. Kipke are with the Division of Research on Children, Youth & Families, Department of Pediatrics, Children's Hospital, Los Angeles, CA. Michele D. Kipke is also with the Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
| |
Collapse
|