Unseen risks: HIV-related risk behaviors among ethnically diverse sexual minority adolescent females

Effects of sexual and gender minority stress on depressive symptoms among adolescents of color in the United States

OBJECTIVE

There is a need for more research on minority stress theory (MST) with sexual and gender minority (SGM) adolescents of color, because of their disproportionate risk for depression.

METHOD

We recruited 1,627 SGM adolescents of color in the United States to complete measures assessing lesbian, gay, bisexual, transgender, and queer (LGBTQ) climate, LGBTQ microaggressions within one's ethnoracial community, internalized LGBTQ stigma, stress management ability, and depressive symptoms. Using structural equation modeling, a hybrid measurement-structural model was tested, indicating good model fit.

RESULTS

Multiple significant indirect pathways linking LGBTQ climate and depressive symptoms emerged. A less positive LGBTQ climate was associated with more microaggression-related stress, more internalized LGBTQ stigma, and worse stress management ability, all of which were associated with greater depressive symptoms. A serial mediation with more microaggression-related stress being associated with greater internalized LGBTQ stigma approached significance.

CONCLUSIONS

Our findings generally support MST processes in terms of depressive symptoms in SGM adolescents of color, suggesting that psychosocial interventions targeting these processes may have meaningful implications for the mental health of this vulnerable group. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The lesbian, gay, bisexual and transgender movement: A systematic review with meta-analysis

BACKGROUND

To identify, through the conscientious, explicit and judicious use, the evidence about health behaviors and situations included in the decision making on individuals belonging to the lesbian, gay, bisexual and transgender (LGBT) group in the context of ethnic disparities and sexual minorities.

METHODS

A systematic review with meta-analysis meta-synthesis from searches in electronic databases SCOPUS and Virtual Health Library (VHL), portal that hosts databases such as MEDLINE, using the following descriptors MeSH (Medical Subject Headings): 'Sexual Minorities', 'Health', 'African Continental Ancestry Group' and 'Brazil'. To achieve safe and reproducible research, the authors decided to gather the descriptors using Boolean operators AND and OR, in the following manner: in the VHL, Sexual Minorities AND Health AND African Continental Ancestry Group OR Brazil; in SCOPUS, Sexual Minorities AND Health AND African Continental Ancestry Group. The selection of articles occurred in two stages.

RESULTS

Of the 52 results found, this study included 14 articles, according to the stages of screening and eligibility criteria. The research carried out proved to be scarce when related to Brazil, so that the review was constructed from studies carried out in international environment.

CONCLUSION

The scarcity of studies in this area suggested lack of knowledge on the health profiles of the LGBT Afro Population. The individualized attention proved to be insufficient and reveals the need for training health professionals aware of the aspects and health care for this population, with a view to implementing integral health policies that already exist.

An Affirmative Coping Skills Intervention to Improve the Mental and Sexual Health of Sexual and Gender Minority Youth (Project Youth AFFIRM): Protocol for an Implementation Study

BACKGROUND

Sexual and gender minority youth (SGMY, aged 14-29 years) face increased risks to their well-being, including rejection by family, exclusion from society, depression, substance use, elevated suicidality, and harassment, when compared with their cisgender, heterosexual peers. These perils and a lack of targeted programs for SGMY exacerbate their risk for HIV and other sexually transmitted infections. Cognitive behavioral therapy (CBT) interventions support clients by generating alternative ways of interpreting their problems and beliefs about themselves. CBT, tailored to the experiences of SGMY, may help SGMY improve their mood and coping skills by teaching them how to identify, challenge, and change maladaptive thoughts, beliefs, and behaviors. Based on the promising results of a pilot study, a CBT-informed group intervention, AFFIRM, is being tested in a pragmatic trial to assess its implementation potential.

OBJECTIVE

The aim of this study is to scale-up implementation and delivery of AFFIRM, an 8-session manualized group coping skills intervention focused on reducing sexual risk behaviors and psychosocial distress among SGMY. Our secondary aim is to decrease sexual risk taking, poor mental health, and internalized homophobia and to increase levels of sexual self-efficacy and proactive coping among SGMY.

METHODS

SGMY are recruited via flyers at community agencies and organizations, as well as through Web-based advertising. Potential participants are assessed for suitability for the group intervention via Web-based screening and are allocated in a 2:1 fashion to the AFFIRM intervention or a wait-listed control in a stepped wedge wait-list crossover design. The intervention groups are hosted by collaborating community agency sites (CCASs; eg, community health centers and family health teams) across Ontario, Canada. Participants are assessed at prewait (if applicable), preintervention, postintervention, 6-month follow-up, and 12-month follow-up for sexual health self-efficacy and capacity, mental health indicators, internalized homophobia, stress appraisal, proactive and active coping, and hope. Web-based data collection occurs either independently or at CCASs using tablets. Participants in crisis are assessed using an established distress protocol.

RESULTS

Data collection is ongoing; the target sample is 300 participants. It is anticipated that data analyses will use effect size estimates, paired sample t tests, and repeated measures linear mixed modeling in SPSS to test for differences pre- and postintervention. Descriptive analyses will summarize data and profile all variables, including internal consistency estimates. Distributional assumptions and univariate and multivariate normality of variables will be assessed.

CONCLUSIONS

AFFIRM is a potentially scalable intervention. Many existing community programs provide safe spaces for SGMY but do not provide skills-based training to deal with the increasingly complex lives of youth. This pragmatic trial could make a significant contribution to the field of intervention research by simultaneously moving AFFIRM into practice and evaluating its impact.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/13462.

Why Girls Choose Not to Use Barriers to Prevent Sexually Transmitted Infection During Female-to-Female Sex

PURPOSE

Using data from a national qualitative study of lesbian, bisexual, and other sexual minority adolescent girls in the U.S., this study examined their awareness of the risk of sexually transmitted infection (STI) and opportunities for barrier use.

METHODS

Online asynchronous focus groups were conducted with lesbian and bisexual (LB) girls ages 14-18 years. Girls were assigned to online groups based on their self-identified sexual identity and whether they were sexually experienced or not. Two moderators posed questions and facilitated online discussions. Interpretive description analysis conducted by multiple members of the research team was used to categorize the results.

RESULTS

Key factors in girls' decisions not to use barriers with female partners concerned pleasure, sex of sexual partner, lack of knowledge of sexual risk or of barrier use for female-to-female sexual activities, and use of STI testing as a prevention tool.

CONCLUSIONS

Addressing knowledge and access gaps is an important first step for improving sexual health. Prevention priorities should focus on helping LB girls understand their risk of STI transmission in both opposite and same-sex relationships. Tailoring messaging to move beyond heteronormative scripts is critical to engaging LB girls and equipping them with the skills and knowledge to have safer sex regardless of the sex of their partner.

A National Study of Lesbian, Gay, Bisexual (LGB), and Non-LGB Youth Sexual Behavior Online and In-Person

Online and in-person sexual behaviors of cisgender lesbian, gay, queer, bisexual, heterosexual, questioning, unsure, and youth of other sexual identities were examined using data from the Teen Health and Technology study. Data were collected online between August 2010 and January 2011 from 5,078 youth 13-18 years old. Results suggested that, depending on sexual identity, between 4-35 % of youth had sexual conversations and 2-24 % shared sexual photos with someone online in the past year. Among the 22 % of youth who had oral, vaginal, and/or anal sex, between 5-30 % met one of their two most recent sexual partners online. Inconsistent condom use was associated with increased odds of meeting one's most recent partner online for heterosexual adolescent men. For gay and queer adolescent men, having an older partner, a partner with a lifetime history of sexually transmitted infections (STI), and concurrent sex partners were each significantly associated with increased odds of having met one's most recent sex partner online. None of the examined characteristics significantly predicted meeting one's most recent sexual partner online versus in-person for heterosexual; bisexual; or gay, lesbian, and queer women. The Internet is not replacing in-person exploration and expression of one's sexuality and meeting sexual partners online appears to be uncommon in adolescence across sexual identities. Healthy sexuality programming that acknowledges some youth are meeting partners online is warranted, but this should not be a main focal point. Instead, inclusive STI prevention programming that provides skills to reduce risk when engaging in all types of sex is critical.

Sexual Behaviors and Partner Characteristics by Sexual Identity Among Adolescent Girls

PURPOSE

Data suggest that lesbian and bisexual adolescents engage in risky sexual behaviors at higher rates than heterosexual girls. Whether these findings also apply to girls of other sexual identities is less well understood. Potential differences in risky sexual behaviors reported by lesbian versus bisexual adolescents are also underreported in the literature.

METHODS

Data were collected online in 2010-2011 among 2,823 girls, aged 13-18 years, in the United States. Multinomial logistic regression was used to quantify comparisons of sexual behaviors between (1) lesbian; (2) bisexual; and (3) questioning, unsure, or other (QUO) identity; and (0) heterosexual girls. Logistic regression compared lesbian and bisexual adolescents.

RESULTS

Lesbian and bisexual adolescents reported significantly more lifetime and past-year sexual partners than heterosexual girls. Bisexual girls were also more likely to report penile-anal and penile-vaginal sex, whereas lesbians were more likely to report earlier sexual debut for almost all types of sex, as compared to heterosexual girls. Lesbians also were more likely to report infrequent condom use and less likely to have conversations with partners about the use of barriers (e.g., dental dams) before first sex. Relative to lesbians, bisexual girls reported older age at first sex for almost all sexual behaviors and higher lifetime prevalence of recent male partners, penile-vaginal, and penile-anal sex. Few differences were noted between QUO and heterosexual girls.

CONCLUSIONS

Sexual minority adolescents are not identical in terms of sexual risk. Providers need to be sensitive to these differences and their implications for health and counseling of patients.

Health Risk Behaviors in a Representative Sample of Bisexual and Heterosexual Female High School Students in Massachusetts

BACKGROUND

Differences in sexual health-related outcomes by sexual behavior and identity remain underinvestigated among bisexual female adolescents.

METHODS

Data from girls (N = 875) who participated in the Massachusetts Youth Risk Behavior Surveillance survey were analyzed. Weighted logistic regression models were fit to examine sexual and psychosocial health by lifetime sexual behavior (behaviorally bisexual vs behaviorally heterosexual) and sexual identity (bisexual vs heterosexual) adjusting for grade and race/ethnicity.

RESULTS

Overall, 10.5% of girls reported lifetime bisexual behavior and 8.1% reported a bisexual identity. Behavior and identity were discordant for bisexual young women as 53.2% of behaviorally bisexual students had a bisexual identity and 46.8% had a heterosexual identity. Bisexual identity and behavior were associated with unprotected intercourse at last sexual encounter, early sexual debut, 4 or more lifetime partners, history of forced/unwanted sex, sexually transmitted infection testing history, past-year depression, and past-month drug use (all ps < .05).

CONCLUSION

Bisexuality, whether defined by identity or behavior, is associated with adverse sexual and psychosocial health outcomes in adolescent girls. Studies that explore wellness across the life span, and are designed to recognize developmental differences burgeoning in adolescence, may provide insights into the differential sexual risk outcomes observed among bisexual girls.