Acceptability of daily pre-exposure prophylaxis among adolescent men who have sex with men, travestis and transgender women in Brazil: A qualitative study

BACKGROUND

Adolescents face socio-structural, personal and programmatic barriers to HIV prevention services, highlighting the importance of understanding knowledge and acceptability as essential aspects to promote their broader access to pre-exposure prophylaxis (PrEP). We analyzed the acceptability of PrEP among adolescent men who have sex with men (MSM), travestis and transgender women (TGW).

METHODS

A qualitative investigation was conducted as part of the formative research of the PrEP15-19 study, an ongoing demonstration study that analyzes the effectiveness of daily PrEP among adolescent MSM, travestis and TGW aged 15-19 in three Brazilian cities. A total of 37 semi-structured interviews and 6 focus groups were conducted. Building from thematic analysis focusing on participants' sexual encounters, perceptions about PrEP efficacy, and vulnerability contexts, we analyzed prospective acceptability of PrEP.

FINDINGS

Knowledge about PrEP was incipient and characterized by adolescents' frequent doubts about its prescription and efficacy. The 'ideal' use of PrEP appeared together with consistent condom use, especially in casual sex. PrEP use was also mentioned as depending on increased learning about prevention management over time. Main barriers to PrEP use included the incorporation of a daily medication into participants' routine and its impact on their social lives, especially related to stigma. Concerns over short- and long-term side effects were also reported as barriers to PrEP use. TGW and travestis contrasted using PrEP with the precarity of their life conditions, and some expressed a critical vision about PrEP by associating it with pharmaceuticalization and trans necropolitics.

CONCLUSIONS

Participants' low knowledge and acceptability of PrEP are circumscribed by a rigid perception of condom as the ideal prevention method and the context of their sexual relations. Prospective acceptability highlights that the successful uptake of PrEP depends on overcoming barriers of access to health services and confronting transphobia and homophobia as part of care.

LGBT workplace protections as an extension of the protected class framework

OBJECTIVES

Many corporations in the United States have enacted nondiscrimination policies for their LGBT employees, despite that the LGBT community has not been a legally protected class concerning employment discrimination at the national level. We examined whether progressive corporate LGBT-related policies may be an extension of policies and practices designed to foster diversity and create equality for existing legally protected classes (women, ethnic minorities, veterans, and those with disabilities). We also examined whether leadership level diversity (percentage of women and ethnic minorities on company boards of directors) predicted nondiscrimination policies for LGBT employees.

HYPOTHESES

We predicted companies that have been recognized and awarded for protected class diversity policies and that have a greater percentage of women and racial/ethnic minorities on their boards of directors would have more progressive LGBT-related corporate policies.

METHOD

Using a sample of Fortune 500 companies, we examined protected-class diversity awards and percentage of women and racial/ethnic minorities on boards of directors as predictors of LGBT-related policies. At the company-level, we controlled for the average age of board, company size, and company revenue. At the level of company headquarter location, we controlled for political climate, Christian religiosity, and LGBT employment nondiscrimination laws. We also controlled for U.S. region and industry sector.

RESULTS

Multilevel modeling results indicated that protected-class diversity awards and the percentage of women on company boards of directors significantly and independently predicted progressive LGBT policy scores, whereas the percentage of racial/ethnic minorities on boards of directors had less consistent results.

CONCLUSION

Companies that address issues of diversity and equality in the workplace have been likely to include the LGBT community among their groups of concern, even in the absence of legal pressures to do so. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Sexual orientation and mental health over the life course in a birth cohort

BACKGROUND

Sexual minority individuals consistently report higher rates of mental disorder than heterosexuals. However, much of the research has methodological limitations related to the classification of sexuality, the use of cross-sectional data and problematic sampling procedures such as using convenience samples.

METHODS

We used longitudinal data from a birth cohort enrolled in the Christchurch Health and Development Study (n = 1040). Latent class analysis was used to classify participants sexuality based on self-report data of sexual behaviour, attraction, identity and fantasy, gathered over five assessments between the ages of 18 and 35 years. Mental health and substance use outcome data were gathered at four assessments between the ages of 21 and 35 years. Potential covariate variables were collected during childhood.

RESULTS

The latent class analysis identified four groups interpreted as: 'heterosexual' 82%, 'mostly heterosexual' 12.6%, 'bisexual' 3.5% and 'gay/lesbian' 1.9%. In the sexual minority groups, women outnumbered men by at least 2:1. Pooled rates for mental health disorders of depression, anxiety disorders, suicidal ideation, cannabis abuse and total disorders, after adjustment for childhood covariate variables, were significantly higher in the sexual minority groups (p < 0.01). The strength of association between sexuality group and mental health outcomes did not differ according to sex. Fluidity in sexuality reports appeared unrelated to risk of mental health outcomes.

CONCLUSIONS

Over the life course, membership of a sexual minority group is clearly associated with mental health problems of depression, anxiety and suicidal ideation regardless of the age when same-sex attraction, behaviour, identity or fantasy is expressed.

Are all LGBTQI+ patients white and male? Good practices and curriculum gaps in sexual and gender minority health issues in a Dutch medical curriculum

Objectives: People marginalized based on their sexual and gender identity face specific health risks and experience barriers to culturally competent care. Insight into how Dutch medical schools address LGBTQI+ health-related learning objectives is scarce. We therefore examined how LGBTQI+ health issues are integrated in the Amsterdam UMC-VUmc medical curriculum by evaluating the year-two course 'Sex, Sexuality and Relationships' for LGBTQI+ content. Methods/Design: We examined written course content (course syllabus, lecture notes, and course literature) of the 2016-2017 course. We used a framework for essential LGBTQI+ content in medical education and an intersectional approach to examine which LGBTQI+ themes and subthemes were addressed. Results: Several essential LGBTQI+ health issues were adequately addressed and integrated into the Amsterdam UMC-VUmc curriculum, but we also identified curriculum gaps. The needs of patients with lesbian, bisexual, or gender non-conforming identities were marginally addressed, and issues related to intersections of minoritized sexual and gender identities with other aspects of diversity such as ethnicity, age and class remained unexplored. The course discussed gender and sexuality as fixed and mainly binary constructs, and only addressed biomedical explanatory models of sex, gender and sexuality. Discussion and conclusion: The absence of complex patient identities in relation to sex, gender and sexuality does not adequately prepare students to provide LGBTQI+ responsive care. If not designed and taught competently, LGBTQI+-related curriculum content may reproduce bias and stereotypes, and contribute to a medical climate where both LGBTQI+ patients, students, and doctors conceal their identities. Further implementation of LGBTQI+ health issues is required in (continuing) medical education to secure culturally competent clinical environments. Educational research is needed to understand how medical education contributes to marginalization of LGBTQI+ identities and thus, to health disparities.

Suicide Acceptability and Sexual Orientation: Results from the General Social Survey 2008-2014

Lesbian, gay, and bisexual (LGB) individuals have higher prevalence of lifetime suicide ideation and attempt than their heterosexual peers, but less is known about differences in suicide acceptability (i.e., believing suicide is a viable answer to a problem). The purpose of this study was to examine if LGB adults had greater suicide acceptability than heterosexual adults. A total of 4 items in the General Social Surveys from 2008 to 2014 assessed whether a nationally representative sample of U.S. adult respondents (n = 5,037) thought it acceptable for individuals to kill themselves if one: goes bankrupt, dishonors their family, is tired of living, or has an incurable disease. Multiple logistic regression analyses were used to assess the association of sexual orientation with suicide acceptability items after adjusting for confounding factors. Compared with heterosexuals, lesbians/gays had higher odds of reporting suicide acceptability if one goes bankrupt (OR = 1.92; 95% CI: 1.06, 3.46), dishonors family (OR = 1.83; 95% CI: 1.01, 3.28), or is tired of living (OR = 2.25; 95% CI: 1.30, 3.90). Bisexual and heterosexual groups were largely similar across the 4 suicide acceptability items. No sexual orientation differences were observed for reporting acceptability of suicide in the instance of an incurable disease. Post hoc analyses revealed significant interactions between sex and sexual orientation, such that differences in suicide acceptability seemed to be driven by sexual minority women rather than by sexual minority men. Suicide acceptability differs by sexual orientation, and community-level interventions around changing norms about suicide may be a prevention strategy for sexual minority individuals.

Predator, Pet Lesbian, or Just The Nanny? LGBTQ Parents of Children With Disabilities Describe Categorization

How are lesbian/gay/bisexual/trans/queer (LGBTQ) parents of children with disabilities categorized by service providers, and how do parents anticipate, interpret, and respond to such categorizations? This intersectional study investigated the experiences of LGBTQ parents of children with disabilities with service providers in Toronto, Canada. Parents described pressures to "fit" into providers' limited understanding of family. Some parents described facing overt discrimination, including one parent who was seen as a possible sexual predator. Some described being perceived as representatives of "diversity" for organizations, or "pet lesbians" in the words of one couple. Others described being misread as a non-parent, as in "just the nanny," particularly in conjunction with their racial minority status. Parents described how their experiences of being "outside the mainstream" helped them challenge systems and normative beliefs. Findings suggest that a context of scarce disability resources shapes parents' experiences of how LGBTQ identity comes to matter.

Acoustic correlates of sexual orientation and gender-role self-concept in women's speech

Compared to studies of male speakers, relatively few studies have investigated acoustic correlates of sexual orientation in women. The present investigation focuses on shedding more light on intra-group variability in lesbians and straight women by using a fine-grained analysis of sexual orientation and collecting data on psychological characteristics (e.g., gender-role self-concept). For a large-scale women's sample (overall n = 108), recordings of spontaneous and read speech were analyzed for median fundamental frequency and acoustic vowel space features. Two studies showed no acoustic differences between lesbians and straight women, but there was evidence of acoustic differences within sexual orientation groups. Intra-group variability in median f0 was found to depend on the exclusivity of sexual orientation; F1 and F2 in /iː/ (study 1) and median f0 (study 2) were acoustic correlates of gender-role self-concept, at least for lesbians. Other psychological characteristics (e.g., sexual orientation of female friends) were also reflected in lesbians' speech. Findings suggest that acoustic features indexicalizing sexual orientation can only be successfully interpreted in combination with a fine-grained analysis of psychological characteristics.

"All of My Lovers Fit Into This Scale": Sexual Minority Individuals' Responses to Two Novel Measures of Sexual Orientation

Previous qualitative research on traditional measures of sexual orientation raise concerns regarding how well these scales capture sexual minority individuals' experience of sexuality. The present research focused on the critique of two novel scales developed to better capture the way sexual and gender minority individuals conceptualize sexuality. Participants were 179 sexual minority (i.e., gay, lesbian, bisexual, pansexual, queer, asexual) individuals who identified as cisgender (n = 122) and transgender (n = 57). Participants first completed the new scales, then provided qualitative responses regarding how well each scale captured their sexuality. The Sexual-Romantic Scale enabled the measurement of sexual and romantic attraction to each sex independently (same-sex and other-sex). Participants resonated with the way the Sexual-Romantic scale disaggregated sexual and romantic attraction. Although cisgender monosexual (lesbian/gay) individuals positively responded to the separation of same- and other-sex attraction, individuals with either plurisexual (bisexual, pansexual, or fluid) or transgender identities found the binary conceptualization of sex/gender problematic. The Gender-Inclusive Scale incorporated same- and other-sex attraction as well as dimensions of attraction beyond those based on sex (attraction to masculine, feminine, androgynous, and gender non-conforming individuals). The incorporation of dimensions of sexual attraction outside of sex in the Gender-Inclusive Scale was positively regarded by participants of all identities. Findings indicate that the Sexual-Romantic and Gender-Inclusive scales appear to address some of the concerns raised in previous research regarding the measurement of sexual orientation among sexual minority individuals.

When identities collide: Conflicts in allegiances among LGB people of color

Little research has examined the management of multiple minority identities among lesbian, gay, and bisexual (LGB) people of color, despite a growing theoretical literature on such identity intersections. The present study focused on the intersectional construct of conflicts in allegiances (CIA), defined as perceived incompatibility between one's racial/ethnic and sexual orientation identities. CIA was investigated in relation to experiences of parental heterosexism, racism in LGB communities, outness, and racial/ethnic and sexual orientation group identity. Participants were 124 LGB people of color (main sample) and 124 LGB White people (comparison sample) who completed self-report measures of the main variables as part of a larger survey of same-sex couples. CIA was positively correlated with experiences of racism within LGB communities and perceived heterosexism in one's mother (but not one's father), and negatively correlated with outness to family (but not outness to others in one's everyday life). An interaction was found between racial/ethnic and LGB group identity with respect to behavioral engagement: CIA levels were highest among participants with high racial/ethnic behavioral engagement and low sexual orientation behavioral engagement. Results highlight the role of minority and family contexts in CIA among LGB people of color, and, more broadly, the potential value of studying intersectional variables using quantitative methods. Longitudinal and experimental studies are needed to address questions about direction of influence raised by findings.