A Qualitative Investigation of Healthcare Engagement Among Young Adult Gay Men in New York City: A P18 Cohort Substudy

Vaccination uptake in LGBTQ adults in two US states: Findings from the QVax study

OBJECTIVES

Lesbian, gay, bisexual, transgender, queer and other (LGBTQ+) individuals face numerous health disparities, including higher rates of chronic diseases and sexually transmitted infections, partly due to marginalization, discrimination, and a healthcare system often unprepared to meet their specific needs. Despite the importance of vaccination in preventing these health issues, vaccination patterns in LGBTQ+ populations remain under-researched, with limited data available due to the absence of sexual orientation and gender identity information on most healthcare forms. As such, we sought to understand vaccine uptake among LGBTQ+ individuals living in New Jersey and New York for 7 primary adult vaccines.

METHODS

Participants were 768 LGBTQ+ adults living in New Jersey and New York, US. We recruited this convenience sample through community centers and events, social media, and listservs of local professional organizations. The online survey examined uptake for 7 adult vaccines.

RESULTS

Of the 7 adult vaccines, human papilloma virus (HPV) had the lowest proportion of participants who were fully/partially vaccinated (54.4 %), followed by hepatitis A (59.8 %), hepatitis B (63.0 %), meningitis B (63.7 %), seasonal influenza during the COVID-19 pandemic (70.2 %), seasonal influenza before the COVID-19 pandemic (70.3 %), and nearly all participants (99.2 %) received at least one dose of the COVID-19 vaccine. For Shingles virus, among participants age 50+, 63.8 % were fully/partially vaccinated. In adjusted models, age was the strongest predictor of vaccination uptake in HPV, hepatitis A, hepatitis B, meningitis B, and seasonal influenza before and during the COVID-19 pandemic. Younger participants were more likely to be vaccinated for 4 of the 6 vaccines, excluding Shingles (<0.001), whereas older adults were more likely to be vaccinated for seasonal influenza before and during the COVID-19 pandemic (<0.010).

CONCLUSIONS

This study highlights the differences in uptake across different vaccines. It also draws attention to differences within LGBTQ+ populations which is important to consider when ensuring more equitable vaccine access.

Fertility services for gay men: A website content analysis of US fertility clinics and sperm banks

BACKGROUND

Fertility preservation and subsequent third-party reproduction represents a principal pathway by which gay and bisexual cisgender men may have biologically related children. Previous studies of a similar design have commented on the availability of fertility services for sexually and gender diverse communities, but none have investigated access to the aforementioned services for this specific population.

OBJECTIVES

To assess the availability of fertility preservation and third-party reproduction services for gay and bisexual cisgender men across US fertility clinics and sperm banks.

MATERIALS AND METHODS

A content analysis was performed on a sample of fertility clinic and sperm bank websites compiled from three online sources. Sample construction and analysis were completed in 2023. Each website was systematically examined by two separate coders with a third coder deciding any discrepancies. Website coding followed a pre-constructed standardized questionnaire. Logistic regression analysis was used to identify statistically significant differences.

RESULTS

A total of 675 clinic and sperm bank websites (136 academic and 539 private) were analyzed. Five hundred and two (74.4%) offered third-party reproduction and 326 (48.3%) offered fertility preservation for gay and bisexual cisgender men. Furthermore, 248 websites (36.7%) featured some form of disqualifying language either directly communicating or implying exclusion of gay and bisexual cisgender men from these services. Private facilities were more likely to offer third-party reproduction (odds ratio [OR] = 1.88, p < 0.01) but less likely to offer fertility preservation (OR = 0.68, p < 0.05) compared with academic affiliated facilities. Lastly, states in the highest Human Rights Campaign Equality Index tier were significantly more likely to offer third-party reproduction (OR = 2.50, p < 0.01) than the lowest tier.

DISCUSSION AND CONCLUSION

These findings demonstrate great variability in access to fertility preservation and third-party reproduction services. Geography and ambiguity in facility-specific policies represent persistent barriers to family building for gay and bisexual cisgender men.

Lack of Informed and Affirming Healthcare for Sexual Minority Men: A Call for Patient-Centered Care

BACKGROUND

Sexual minority men (SMM) face severe health inequities alongside negative experiences that drive avoidance of medical care. Understanding how SMM experience healthcare is paramount to improving this population's health. Patient-centered care, which emphasizes mutual respect and collaboration between patients and providers, may alleviate the disparaging effects of the homophobia that SMM face in healthcare settings.

OBJECTIVE

To explore how SMM perceive their experiences with healthcare providers and how care can most effectively meet their needs.

DESIGN

Semi-structured qualitative interviews focused on healthcare experiences, pre-exposure prophylaxis (PrEP), and HIV-related beliefs were conducted between July and November 2018.

PARTICIPANTS

The study included a sample of 43 young adult SMM (ages 25-27), representing diverse socioeconomic, racial, and ethnic backgrounds, in New York City.

APPROACH

Researchers utilized a multiphase, systematic coding method to identify salient themes in the interview transcripts.

KEY RESULTS

Analyses revealed three main themes: (1) SMM perceived that their clinicians often lack adequate skills and knowledge required to provide care that considers participants' identities and behaviors; (2) SMM desired patient-centered care as a way to regain agency and actively participate in making decisions about their health; and (3) SMM felt that patient-centered care was more common with providers who were LGBTQ-affirming, including many who felt that this was especially true for LGBTQ-identified providers.

CONCLUSIONS

SMM expressed a clear and strong desire for patient-centered approaches to care, often informed by experiences with healthcare providers who were unable to adequately meet their needs. However, widespread adoption of patient-centered care will require improving education and training for clinicians, with a focus on LGBTQ-specific clinical care and cultural humility. Through centering patients' preferences and experiences in the construction of care, patient-centered care can reduce health inequities among SMM and empower healthcare utilization in a population burdened by historic and ongoing stigmatization.

Estimate and needs of the transgender adult population: the SPoT study

BACKGROUND

Despite the increasing interest in transgender health research, to date little is known about the size of the transgender and gender diverse (TGD) population.

METHODS

A web-based questionnaire survey was developed, including a collection of socio-demographic characteristics and disseminated online through social media. Gender incongruence was evaluated by using a 2-item approach assessing gender recorded at birth and gender identity. The primary objective of the present population-based study was to estimate the proportion of TGD people across ages among a large sample of people who answered a web-based survey. The secondary endpoints were to identify gender-affirming needs and possible barriers to healthcare access.

RESULTS

A total of 19,572 individuals participated in the survey, of whom 7.7% reported a gender identity different from the sex recorded at birth. A significantly higher proportion of TGD people was observed in the youngest group of participants compared with older ones. Among TGD people who participated in the study, 58.4% were nonbinary, and 49.1% experienced discrimination in accessing health care services. Nonbinary TGD participants reported both the need for legal name and gender change, along with hormonal and surgical interventions less frequently compared to binary persons.

CONCLUSIONS

Being TGD is not a marginal condition In Italy. A large proportion of TGD persons may not need medical and surgical treatments. TGD people often experience barriers to healthcare access relating to gender identity.

The socio-ecological determinants of help-seeking practices and healthcare access among young men: a systematic review

Delayed engagement with health services is a key contributor to poorer health outcomes experienced by men. Patterns of health service usage which reduce the opportunity for disease prevention and health promotion appear to be especially prominent amongst young men. To identify the multiple and intersecting determinants of young men's help-seeking practices and health services usage, this review uses the social ecological model (SEM) to guide a critical synthesis of the literature on barriers and facilitators experienced by young men in accessing health services. A systematic review was conducted across five databases (MEDLINE, Embase, PsychINFO, CINAHL and Scopus). Included studies presented primary data regarding young men's (12-24 years) barriers and/or facilitators to seeking and accessing health care. Thirty-one studies (24 qualitative and 7 quantitative) underwent data extraction, quality appraisal and thematic analysis under the guiding framework of the SEM. Seven key themes were constructed, encapsulating the perceived barriers and facilitators to help-seeking and accessing health care experienced by young men, including masculine attitudes, health literacy, social pressure, service accessibility, economic factors, service characteristics and cultural attitudes. These findings highlight the complex interplay between the individual, interpersonal, organizational and societal factors impacting young men's healthcare engagement. They also illuminate avenues for multifaceted, context-specific interventions to enhance healthcare accessibility for this group, including addressing health literacy gaps, providing culturally sensitive care and reducing cost barriers.

Approaches to Engaging Men During Primary Healthcare Encounters: A scoping review

Gender-responsive healthcare is critical to advancing men's health given that masculinities intersect with other social determinants to impact help-seeking, engagement with primary healthcare, and patient outcomes. A scoping review was undertaken with the aim to synthesize gender-responsive approaches used by healthcare providers (HCPs) to engage men with primary healthcare. MEDLINE, PubMed, CINAHL, and PsycINFO databases were searched for articles published between 2000 and February 2024. Titles and abstracts for 15,659 citations were reviewed, and 97 articles met the inclusion criteria. Data were extracted and analyzed thematically. Thirty-three approaches were synthesized from across counseling/psychology, general practice, social work, nursing, psychiatry, pharmacy, and unspecified primary healthcare settings. These were organized into three interrelated themes: (a) tailoring communication to reach men; (b) purposefully structuring treatment to meet men's health needs, and (c) centering the therapeutic alliance to retain men in care. Strength-based and asset-building approaches focused on reading and responding to a diversity of masculinities was reinforced across the three findings. While these approaches are recommended for the judicious integration into health practitioner education and practice, this review highlighted that the evidence remains underdeveloped, particularly for men who experience health inequities. Critical priorities for further research include intersectional considerations and operationalizing gender-responsive healthcare approaches for men and its outcomes, particularly at first point-of-contact encounters.

"What if I get sick, where shall I go?": a qualitative investigation of healthcare engagement among young gay and bisexual men in Nairobi, Kenya

BACKGROUND

Globally, young gay, bisexual and other men who have sex with men (YMSM) experience a disproportionate burden of disease compared to young heterosexual men and older MSM. However, YMSM experience major inequities in access and use of health services. We sought to gain a detailed understanding of YMSM's healthcare engagement experiences across public, private, tertiary institution-based and MSM-friendly health facilities in Nairobi, Kenya, to inform development of interventions to improve access and use of health services by YMSM.

METHODS

In September 2021, in-person qualitative in-depths interviews were conducted among 22 YMSM purposively sampled from 248 YMSM who had previously participated in a respondent-driven sampling integrated bio-behavioral survey. Interviews were done in English, transcribed verbatim and analyzed descriptively using NVivo version 12.

RESULTS

Participants were 18-24 years old, all identified as cisgender male, three-quarters as gay and a quarter as bisexual. Themes that were defined from the analysis included: YMSM's experiences during healthcare seeking in various clinical settings, priority health needs, desired healthcare provider (HCP) characteristics, and the potential role of digital health interventions in improving access and use of health services. Participants relayed experiences of prejudice, stigma and discrimination when seeking services in public and institution-based health facilities, unlike in community pharmacies, private and MSM-friendly health facilities where they felt they were handled with dignity. Health needs prioritized by YMSM centered on prevention and control of HIV, sexually transmitted infections (STIs), depression and substance abuse. Participants desired HCPs who were empathetic, non-judgmental and knowledgeable about their unique health needs such as management of anorectal STIs. Participants highlighted the usefulness of digital media in offering telehealth consultations and health education on subjects such as HIV/STIs prevention.

CONCLUSION

During engagement with healthcare, YMSM experience various barriers that may cause them to postpone or avoid seeking care hence resulting in poor health outcomes. There is need to equip HCPs with knowledge, skills and cultural competencies to enable them offer equitable services to YMSM. Considerations should also be made for use of digital health interventions that may help YMSM circumvent some of the aforementioned barriers to service access and use.

"We must help them despite who they are…": healthcare providers' attitudes and perspectives on care for young gay, bisexual and other men who have sex with men in Nairobi, Kenya

BACKGROUND

Compared to young heterosexual men, young gay, bisexual and other men who have sex with men (YMSM) face a disproportionate burden of sexual health conditions. This disparity is occasioned by factors such as criminalization and stigmatization of same-sex practices, YMSM's limited access to non-judgmental and non-discriminatory health services, and challenges associated with healthcare delivery. We explored the attitudes and perspectives of tertiary academic institution-based healthcare providers (HCPs) toward provision of services to YMSM in Nairobi, Kenya.

METHODS

In September 2021, six in-person focus group discussions (FGDs) were held with 36 HCPs drawn from six public tertiary academic institutions within the Nairobi metropolis. HCPs were drawn from six cadres: front office staff, nurses, clinicians, counsellors, laboratory technologists, and pharmaceutical technologists. Discussions were conducted in English, transcribed verbatim and analyzed thematically using NVivo version 12.

RESULTS

Analysis showed that despite expressing disapproval of same-sex practices, HCPs recognized their professional duty to provide care to YMSM, voiced challenges they experienced when providing care to YMSM, and suggested possible strategies for improving care for YMSM. Disapproval of same-sex practices mainly stemmed from HCPs' personal values, societal norms and religious beliefs, though some HCPs identified religious principles such as the golden rule of "treating others as one would want to be treated" as motivation to providing care to YMSM. HCPs did not perceive criminalization of same-sex practices as a barrier to providing care to YMSM. Healthcare delivery challenges included inadequate knowledge and skills, a desire to "convert" YMSM's perceived deviant homosexual to the normative heterosexual orientation, secondary stigma from other HCPs, and healthcare settings that did not support YMSM to disclose same-sex practices. Suggestions for improving care comprised sensitization and training of HCPs, encouraging more HCP-YMSM interaction, providing YMSM-friendly and inclusive services, and advocacy for YMSM services.

CONCLUSION

There is need for interventions to improve HCPs' knowledge of YMSM's health needs, build skills to respond to these needs, and foster affirming attitudes toward same-sex practices. By so doing, YMSM can hopefully be able to access services that meet their needs, and are non-discriminatory, non-stigmatizing and non-judgmental.

Intimate Partner Violence and the Sexual Health of Sexual Minority Men

Purpose: This qualitative study explores the pathways by which various forms of intimate partner violence (IPV) impact the sexual health behaviors of cisgender identified sexual minority men (SMM). Methods: Semi-structured interviews were conducted with 23 racially and ethnically diverse SMM who recently experienced IPV and 10 clinical and social service providers focused on how experiences of IPV directly or indirectly influences sexual risk as well as engagement in HIV prevention behaviors (e.g., pre-exposure prophylaxis [PrEP] use). Applied thematic analysis, including cycles of analytic memo writing and coding, aided the identification of patterns across the data. Results: Analyses yielded three overarching themes: use of condoms, use of PrEP, and HIV and sexually transmitted infections (STIs). Participants described different ways condom use or nonuse was a mechanism by which power and/or control might be asserted by one partner over the other partner. A range of responses to questions about PrEP were identified, including partners encouraging PrEP use, as well as avoidance of conversations about PrEP or actual PrEP use, to prevent experiencing aggression or IPV from partners. Responses regarding HIV/STIs included those ranging from a new diagnosis being a potential trigger for violence to the exploitation of status to control partners. Conclusion: These findings suggest that in relationships with IPV, HIV prevention strategies can be sources of relationship control and trigger abuse. Addressing IPV may help to prevent HIV/STI transmission and promote the health of SMM. In addition, long-acting formulations of PrEP may be a promising strategy for SMM experiencing IPV when oral PrEP medications may be a risk factor for violence.

A randomized trial of acceptance-based behavioral therapy to improve mental health outcomes for LGBTQ+ persons: Study protocol

BACKGROUND

During the COVID-19 pandemic, public health measures limited social interactions as an effective and protective intervention for all. For many, however, this social isolation exacerbated mental health symptoms. People who identify as lesbian, gay, bisexual, transgender, and queer (LGBTQ+) were already at elevated risk of anxiety and depression, relative to cisgender and heterosexual populations, and pandemic-related social isolation likely heightened these disparities. In our prior work with sexual and gender minorities, we developed and established feasibility and acceptability of a novel acceptance-based behavioral therapy (ABBT) intervention for HIV treatment. ABBT showed promise in improving social support and reducing mental health symptoms. In the current study, we investigate the efficacy of ABBT, compared to a treatment-as-usual control condition, in a full-scale randomized controlled trial to improve social support for LGBTQ+ persons living with anxiety and depression.

METHODS

Two hundred forty LGBTQ+ adults with anxiety and/or depressive symptoms will be recruited and equally randomized to receive: (a) the ABBT intervention, consisting of two 30-40 min sessions plus treatment-as-usual (TAU), or (b) TAU only. Primary outcomes are interviewer-assessed anxiety and depressive symptoms. Secondary outcomes are self-reported anxiety and depressive symptoms. Experiential avoidance and social support are hypothesized mediators and presence of an anxiety and/or depressive disorder is a hypothesized moderator.

CONCLUSIONS

ABBT represents a novel, identify-affirming real-world approach to promoting social support as a means of improving mental health among individuals who identify as LGBTQ+. This study will contribute actionable data establishing the impact, mediational mechanisms, and effect modifiers of ABBT.

CLINICALTRIALS

govregistration: NCT05540067.

Sexual health and treatment-related sexual dysfunction in sexual and gender minorities with prostate cancer

Prostate cancer treatment has substantial effects on sexual health and function. Sexual function is a vital aspect of human health and a critical component of cancer survivorship, and understanding the potential effects of different treatment modalities on sexual health is crucial. Existing research has extensively described the effects of treatment on male erectile tissues necessary for heterosexual intercourse; however, evidence regarding their effects on sexual health and function in sexual and gender minority populations is minimal. These groups include sexual minority - gay and bisexual - men, and transgender women or trans feminine people in general. Such unique effects in these groups might include altered sexual function in relation to receptive anal and neovaginal intercourse and changes to patients' role-in-sex. Sexual dysfunctions following prostate cancer treatment affecting quality of life in sexual minority men include climacturia, anejaculation, decreased penile length, erectile dysfunction, and problematic receptive anal intercourse, including anodyspareunia and altered pleasurable sensation. Notably, clinical trials investigating sexual outcomes after prostate cancer treatment do not collect sexual orientation and gender identity demographic data or outcomes specific to members of these populations, which perpetuates the uncertainty regarding optimal management. Providing clinicians with a solid evidence base is essential to communicate recommendations and tailor interventions for sexual and gender minority patients with prostate cancer.

Association of Affirming Care with Chronic Disease and Preventive Care Outcomes among Lesbian, Gay, Bisexual, Transgender, and Queer Older Adults

INTRODUCTION

Experiences of discrimination and bias in healthcare contribute to health disparities for lesbian, gay, bisexual, transgender, and queer populations. To avoid discrimination, many go to great lengths to find healthcare providers who they trust and who are knowledgeable about their health needs. This study examines whether access to an affirming provider improves health outcomes for lesbian, gay, bisexual, transgender, and queer populations across a range of preventive health and chronic disease management outcomes.

METHODS

This cross-sectional study uses Poisson regression models to examine original survey data (n=1,120) from Wave 1 of the Vanderbilt University Social Networks, Aging, and Policy Study, a panel study examining older (aged 50-76 years) lesbian, gay, bisexual, transgender, and queer adults' health and aging, collected between April 2020 and September 2021.

RESULTS

Overall, access to an affirming provider is associated with greater uptake of preventive health screenings and improved management of mental health conditions. Participants with an affirming provider are more likely to have ever and recently received several types of preventive care than participants reporting a usual source of care that is not affirming, including past year provider visit, influenza vaccination, colorectal cancer screening, and HIV test. Access to an affirming provider is also associated with better management of mental health conditions.

CONCLUSIONS

Inclusive care is essential for reducing health disparities among lesbian, gay, bisexual, transgender, and queer populations. Health systems can reduce disparities by expanding continuing education opportunities; adopting nondiscrimination policies for patients and employees; and ensuring that necessary care is covered by health insurance.

'Why aren't you on PrEP? You're a gay man': reification of HIV 'risk' influences perception and behaviour of young sexual minority men and medical providers

Public health models and medical interventions have often failed to consider the impact of reductionist HIV 'risk' discourse on how sexual minority men interpret, enact and embody biomedical knowledge in the context of sexual encounters. The aim of this study was to use an anthropological lens to examine sexual minority men's perception of HIV risk and experience within the medical system in order to examine the influence of risk discourse on their health, behaviour and social norms. In-depth interviews (n = 43) were conducted with a racially, ethnically and socioeconomically diverse sample of young sexual minority men and explored HIV-related beliefs and experiences, as well as their interactions with healthcare providers. Findings suggest that the stigmatisation of behaviours associated with HIV appears to be shaped by three key forces: healthcare provider perceptions of sexual minority men as inherently 'risky', community slut-shaming, and perceptions of risk related to anal sex positioning. Stigmatising notions of risk appear to be embodied through sexual health practices and identities vis-à-vis preferred anal sex positions and appear to influence condom use and PrEP initiation.

Barriers to COVID-19 Vaccine Uptake in the LGBTQIA Community

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).

A Qualitative Study of Intimate Partner Violence Among Young Gay and Bisexual Men

Intimate partner violence (IPV) is prevalent among young gay and bisexual men (YGBM) and is associated with physical and mental health problems, as well as deleterious psychosocial conditions. Most previous studies of IPV among YGBM have been quantitative in nature and have not examined the numerous subtypes of IPV, the chronicity of IPV experiences, and how is IPV manifested in the context of these same-sex relationships. Thus, a qualitative approach may be useful in exploring these multidimensional and understudied experiences. The present qualitative study sought to (a) explore dimensions of IPV victimization, perpetration, and bidirectional IPV among a sample of (n = 26) YGBM living in New York City and (b) explore the chronicity of IPV experiences among these YGBM. Participants were recruited from an ongoing cohort study of YGBM. Participants completed semistructured interviews that included questions about IPV victimization, perpetration, and bidirectional IPV. A modified version of the consensual qualitative research method was used to analyze the data. The YGBM in this study reported numerous forms of physical, psychological, sexual, and financial IPV victimization and perpetration. Bidirectional experiences of IPV were common. The various subtypes of IPV victimization and perpetration are explored in detail in this manuscript. In addition, many participants reported multiple experiences of abuse within the same relationship, and some participants experienced a pattern of abusive relationships over time. This study corroborates findings from quantitative studies, which indicate that IPV is a prevalent and significant health problem among YGBM, and one that warrants additional attention from researchers, practitioners, and policy-makers. Furthermore, this study adds rich qualitative data to the existing literature-data that can be used to help develop and refine future measures of IPV that are tailored for use with YGBM.

Employment Loss as a Result of COVID-19: a Nationwide Survey at the Onset of COVID-19 in US LGBTQ+ Populations

INTRODUCTION

The unemployment rate in the US reached record highs during the COVID-19 pandemic, but little is known about the job loss experiences of lesbian, gay, bisexual, transgender, and queer (LGBTQ+) individuals, who are already economically disadvantaged due to structural and social inequities.

METHODS

Cross-sectional data on unemployment due to COVID-19 were collected between May and July 2020 among 1090 individuals across the US through an online survey.

RESULTS

Respondents who had been employed prior to COVID-19 formed the analytic sample (n = 990). Of these, 298 (27.3%) reported job loss or being furloughed due to COVID-19. When controlling for all other factors, we found statistically significant higher rates of unemployment among younger participants, HIV-positive individuals, men, Black and White non-Hispanic participants, those with less educational attainment, and those in multi-person homes.

CONCLUSIONS

The employment of LGBTQ+ people has been undermined by COVID-19, but as with all populations, those with multiple minority identities, such as Black or HIV+ and LGBTQ+, have been most severely affected.

POLICY IMPLICATIONS

LGBTQ+ populations in the US have experienced high levels of unemployment due to COVID-19. This study highlights the need for national data collection on sexual orientation and gender identity for unemployment as well as the need for substantive policies, such as expanding unemployment to assist in the economic recovery for populations most affected by COVID-19 and the Equality Act to offer further workplace protections.

A Nationwide Survey of COVID-19 Testing in LGBTQ+ Populations in the United States

OBJECTIVES

Lesbian, gay, bisexual, transgender, or queer and questioning (LGBTQ+) people and populations face myriad health disparities that are likely to be evident during the COVID-19 pandemic. The objectives of our study were to describe patterns of COVID-19 testing among LGBTQ+ people and to differentiate rates of COVID-19 testing and test results by sociodemographic characteristics.

METHODS

Participants residing in the United States and US territories (N = 1090) aged ≥18 completed an internet-based survey from May through July 2020 that assessed COVID-19 testing and test results and sociodemographic characteristics, including sexual orientation and gender identity (SOGI). We analyzed data on receipt and results of polymerase chain reaction (PCR) and antibody testing for SARS-CoV-2 and symptoms of COVID-19 in relation to sociodemographic characteristics.

RESULTS

Of the 1090 participants, 182 (16.7%) received a PCR test; of these, 16 (8.8%) had a positive test result. Of the 124 (11.4%) who received an antibody test, 45 (36.3%) had antibodies. Rates of PCR testing were higher among participants who were non-US-born (25.4%) versus US-born (16.3%) and employed full-time or part-time (18.5%) versus unemployed (10.8%). Antibody testing rates were higher among gay cisgender men (17.2%) versus other SOGI groups, non-US-born (25.4%) versus US-born participants, employed (12.6%) versus unemployed participants, and participants residing in the Northeast (20.0%) versus other regions. Among SOGI groups with sufficient cell sizes (n > 10), positive PCR results were highest among cisgender gay men (16.1%).

CONCLUSIONS

The differential patterns of testing and positivity, particularly among gay men in our sample, confirm the need to create COVID-19 public health messaging and programming that attend to the LGBTQ+ population.

A Qualitative Investigation of Engagement in Mental Health Services Among Black and Hispanic LGB Young Adults

OBJECTIVE

Little attention has been paid to engagement in mental health services among racially and ethnically diverse youths who identify as a sexual minority, despite research indicating that they face significant mental health disparities. In this study, the authors assessed the service use experiences of black and Hispanic lesbian, gay, and bisexual (LGB) young adults to identify factors that promoted or hindered their engagement.

METHODS

Semistructured interviews with 38 young adults regarding past and present experiences with mental health services were analyzed thematically for perceived challenges to and support for engagement. Participants' service use histories were reviewed for significant interruptions in services reported over the past year.

RESULTS

Seventeen participants (45%) reported disengagement despite continuing to need services. Factors that influenced engagement were identified across four domains: personal, social environment, accessibility, and provider characteristics. Stigma related to sexual orientation and cultural attitudes presented engagement barriers, whereas providers who were knowledgeable about sexual-minority issues were important engagement promoters. Additional barriers to engagement were ambivalence about treatment efficacy, lack of family support, and difficulty finding suitable and affordable care. Peers who identified as a sexual minority helped participants locate LGB-affirming services. Rapport with providers and health care autonomy assisted participants to manage barriers to engagement.

CONCLUSIONS

These findings offer insights about factors that can influence engagement with treatment among black and Hispanic LGB young adults. The findings reveal important provider competencies and can inform interventions to improve engagement and reduce mental health inequities among these youths.

The Health Challenges of Emerging Adult Gay Men: Effecting Change in Health Care

This article focuses on the health and health care challenges experienced by young and emerging adult gay men. Evidence is provided on the extent to which young and emerging adult gay men are disproportionally burdened by multidimensional health disparities, barriers to health care access, and inadequate provider-patient interactions. Recommendations are provided for health care providers and public health officials working with populations of emerging adult gay men that might have the greatest overall impact on improving this population's well-being and access to competent health care by increasing providers' awareness of the unique needs of young and emerging adult gay men.