Mpox Diagnosis, Behavioral Risk Modification, and Vaccination Uptake among Gay, Bisexual, and Other Men Who Have Sex with Men, United Kingdom, 2022

During the 2022 multicountry mpox outbreak, the United Kingdom identified cases beginning in May. UK cases increased in June, peaked in July, then rapidly declined after September 2022. Public health responses included community-supported messaging and targeted mpox vaccination among eligible gay, bisexual, and other men who have sex with men (GBMSM). Using data from an online survey of GBMSM during November-December 2022, we examined self-reported mpox diagnoses, behavioral risk modification, and mpox vaccination offer and uptake. Among 1,333 participants, only 35 (2.6%) ever tested mpox-positive, but 707 (53%) reported behavior modification to avoid mpox. Among vaccine-eligible GBMSM, uptake was 69% (95% CI 65%-72%; 601/875) and was 92% (95% CI 89%-94%; 601/655) among those offered vaccine. GBMSM self-identifying as bisexual, reporting lower educational qualifications, or identifying as unemployed were less likely to be vaccinated. Equitable offer and provision of mpox vaccine are needed to minimize the risk for future outbreaks and mpox-related health inequalities.

Healthcare providers perspectives on digital, self-guided mental health programs for LGBTQIA+ individuals: A cross-sectional online survey

Digital, self-guided mental health programs are a promising avenue for mental health support for LGBTQIA+ (lesbian, gay, bisexual, trans, Queer, intersex, asexual plus additional sexuality, gender, and romantic identities) people - however, healthcare providers (HCPs) perspectives on programs are largely unknown. The aim of this study was to explore these perspectives. A cross-sectional online survey was distributed across Australia, with a final sample of 540 HCPs from a range of disciplines. Most respondents (419, 81.2 %), reported that digital, self-guided mental health programs would be useful, but 74.5 % (n = 380) also reported that they had concerns. Thematic analysis of open-text responses showed that HCPs believe programs may help overcome access barriers and could be useful as part of a wider care journey. Others were concerned about patient safety, and whether programs could be appropriately tailored to LGBTQIA+ experiences. Content analysis of open-text responses showed affirming language and imagery, content on LGBTQIA+ people's unique challenges, wider health information, and connections to community were important to include in programs. HCPs advocated for programs that offered broad and sub-population specific information. These findings show that HCPs are enthusiastic about digital, self-guided mental health programs, but care should be taken to address key concerns to facilitate future implementation.

Two New Strains of Drug-resistant Neisseria gonorrhoeae in a Bisexual Man having Sex with Men in Wroclaw, Poland

Abstract is missing (Short communication)

News media coverage of LGBT identities over 10 years in a 400-million-word corpus

BACKGROUND

This study is the first to analyze LGBT portrayals in a news media dataset over a decade (2010-2020). We selected Singapore as a country of interest, emblematic of a nation grappling with state-encouraged heteronormativity and a remnant colonial law against homosexuality (377A), fraught with calls for its repeal that was only enacted in 2022. Our study is interested in this period bookended by challenge and change, particularly in newspaper portrayals of LGBT narratives. Newspapers are an important source of current information and have the power to shape societal perceptions. We lay the groundwork and provide a framework to analyze news media narratives of other Commonwealth nations with colonial pasts and inherited laws criminalizing LGBT communities.

OBJECTIVES

This study analyzes LGBT portrayals in a 400-million-word news media dataset over a decade (2010-2020). First, we aimed to track the volume of LGBT media coverage over time and elucidate differences in coverage of different identity markers. Second, we aimed to track sentiments on LGBT portrayals. Third, we aimed to track salient narratives circulated about LGBT stories.

METHODS

The study leveraged a 400-million-word corpus from news media in Singapore, identifying the following target keywords: LGBT, Lesbian, Gay, Bisexual, Transgender, Pink Dot (a local Pride event), 377A. First, coverage volume was tracked using annual changes in keyword mentions per million, elucidating differences in coverage of different sub-groups. Second, sentiment analysis on a valence scale was conducted on LGBT collocates. Third, we distilled salient narratives about LGBT identities using thematic labelling of top-frequency collocates.

RESULTS

First, overall coverage of LGBT steadily increased over the decade, though Gay identities evidenced asymmetrical coverage-outstripping 'Bisexual' keywords by seven times, 'Lesbian' by four, 'Transgender' by two. Second, sentiment scores for Pink Dot (a local pride event) were most positive; Lesbian, Gay, LGBT, Transgender were neutral; Bisexual and 377A dipped slightly negative. Third, topics differed across the four identities: uniquely, 'Lesbian' collocates related to sensationalized cinema; 'Gay' about hate crimes; 'Bisexual' about population surveys; 'Transgender' about challenges (transitioning, alienation, suicide).

CONCLUSIONS

Practically, we presented a decade-long barometer of LGBT sentiments and themes on a national level, providing a framework to analyze media for more effective communication strategies-applicable to Commonwealth countries with similar inherited colonial laws. Salient repetition through media association may unwittingly frame certain issues negatively; caution is prudent in representing each sub-group adequately, rather than portraying the LGBT identity as monolithic.

Charles Silverstein (1935-2023)

Memorializes Charles Silverstein (1935-2023). One of Charles's most important contributions to the field of psychology and lesbian, gay, bisexual, and transgender rights in particular was his testimony in 1973 opposing the classification of homosexuality as a mental illness. His testimony, along with that of several others, led to the removal of homosexuality in the Diagnostic and Statistical Manual of Mental Disorders. He was also the founding editor of the Journal of Homosexuality, which began publication in 1976. Charles maintained a private practice in Manhattan for many years and was an advocate against conversion therapy. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Associations Between Structural Stigma and Allostatic Load Among Sexual Minorities: Results From a Population-Based Study

OBJECTIVE

Structural forms of stigma and discrimination are associated with adverse health outcomes across numerous stigmatized groups, including lesbian, gay, and bisexual (LGB) individuals. However, the biological consequences of structural stigma among LGB populations are understudied. To begin to address this gap, we assessed associations between indicators of structural stigma (i.e., state-level policies) targeting LGB individuals and allostatic load (AL) indices representing physiological dysregulations.

METHODS

Pooled data from the continuous 2001-2014 National Health and Nutritional Examination Survey were analyzed (LGB: n = 864; heterosexual: n = 20,310). Ten state-level LGB-related policies (e.g., employment nondiscrimination protections, same-sex marriage) were used to operationalize structural stigma. A sex-specific AL index representing 11 immune, metabolic, and cardiovascular biomarkers was estimated. Multilevel models were used to examine associations between structural stigma and AL, net of nine individual-level characteristics (e.g., education, race/ethnicity, age, and health behaviors).

RESULTS

Sexual minority men living in states with low levels of structural stigma experienced significantly lower AL ( β = -0.45, p = .02) compared with sexual minority men living in states with high structural stigma (i.e., fewer protective policies). There was no significant association between structural stigma and AL among sexual minority women.

CONCLUSIONS

By demonstrating direct associations between structural stigma and indices of physiological dysregulation, our findings provide a mechanistic understanding of how the social environment can "get under the skin and skull" for sexual minority men in the United States. Future research should explore whether these mechanisms generalize to other marginalized groups exposed to structural stigma.

Initial Development and Validation of the Brief Internalized Heterosexist Racism Scale for Gay and Bisexual Black Men: A Measure of Internalized Heterosexist Racism

We introduce internalized heterosexist racism (IHR), or the internalization of damaging stereotypes, harmful beliefs, and negative attitudes about being a sexual minority person of color. We also present the initial development and validation of the Brief Internalized Heterosexist Racism Scale for gay and bisexual Black men (IHR-GBBM), a unidimensional, 10-item measure of IHR. Exploratory factor analyses on an internet-obtained sample of gay and bisexual Black men (N = 312; Mean age = 30.36 years) show that the IHR-GBBM had evidence of good internal consistency, and good convergent, discriminant, concurrent, and incremental validity. The IHR-GBBM was positively correlated with internalized racism, internalized heterosexism, and discrimination (racist, heterosexist). IHR was also negatively correlated with race stigma consciousness, weakly positively correlated with sexual identity stigma consciousness, but not correlated with either race identity, sexual identity, or social desirability. Hierarchical regressions showed that the IHR-GBBM explained an additional variance of 2.8% and 3.1% in anxiety symptoms and substance use coping, respectively, after accounting for (1) sociodemographics, (2) internalized racism and internalized heterosexism, and (3) an interaction of internalized racism and internalized heterosexism. Older participants and those who were "out" about their sexual identity reported lower IHR. Those who did not know/want to report their HIV status reported greater IHR. Results revealed no sexual identity, sexual position, relationship status, income, education, or employment status differences in IHR. We hope the development of the IHR-GBBM spurs future research on predictors and consequences of IHR. We discuss limitations and implications for the future study of internalized heterosexist racism.

Outlining Individual and Contextual Factors Related to LGBTQ+ Bullying: A Systematic Review of Two Decades of Research

Scientific interest in lesbian, gay, bisexual, transgender, queer and any other sexual orientation, gender identity and/or expression (LGBTQ+) bullying in educational settings has grown exponentially in recent years. However, the varied ways of measuring its occurrence and associated factors have made it difficult to achieve a holistic understanding of this problem. Therefore, this systematic review aimed to provide an updated overview of individual and contextual factors related to LGBTQ+ bullying over the past two decades, based on the measurement approach to this phenomenon. Studies published from 2000 to 2020 were analyzed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses strategy. Inclusion and exclusion criteria were applied in a staggered process, and 111 articles met all the criteria. Studies focusing on LGBTQ+ bullying victimization or aggression were eligible for inclusion. Our analysis revealed LGBTQ+ bullying is usually examined by measures of general aggressions (47.8%) from the victims' perspective (87.3%). The best-represented factors across studies were individual characteristics (63.1%; n = 70), especially participants' sexual orientation and gender identity and expression (68.5%). Boys/males, from a binary gender perspective, and sexual and gender minority youth in general, were more at risk of being targeted for LGBTQ+ bullying. Although contextual factors were far less well-represented, the results revealed that gay-straight alliances, anti-homophobia policies, and social support act as protective factors. This review highlights the need to analyze LGBTQ+ bullying considering the full spectrum of sexual and gender diversity, to examine in more detail its contextual risk/protective factors, and to design public policies and psychoeducational programs in order to address the low effectiveness of generic interventions. Implications for future research and practice are discussed.

Unpacking the Drivers of LGBT+ Legislation

This paper stems from the hypothesis that there are various key factors rooted in economic, political, and social grounds which actively influence and determine the adoption and evolution of LGBT+ rights in the legal framework of any country. The goal of this research is to analyze these factors and understand how they channel the LGBT+ legislation in our present world. Assuming there is an asymmetry in this application and by extension in LGBT+ individuals' human rights, which are often ignored if not deprived in many parts of the world, this study seeks to understand the reasons behind that asymmetry. Based on a sample of 127 countries, a correlation analysis and a Panel data model were developed to analyze the real impact of these factors.

"I tried to appreciate it in a different way": Older lesbian, bisexual, and queer women's body image and embodiment across the life course

We examined the life histories of older lesbian, bisexual, and queer women, focusing on the stories they told about their bodies and sexuality from early to later life. Guided by a narrative constructionist approach, a series of two life history interviews were conducted with 17 lesbian, bisexual, and queer women aged 65-86. Two themes were constructed through a narrative thematic analysis: Queering the Corset: Negotiating Gender Expression and (Aspirational) Aging Body Acceptance. Participants experienced body-related freedom through 'tomboy' expressions of physicality as children. This body autonomy was constrained in adolescence and adulthood due to heterosexist messages surrounding idealized femininity relayed by family and (heterosexual) men, which disrupted self-care yet catalyzed attuned, queer desire and positive embodiment. Women worked to accept their bodies as they aged; they experienced some body dissatisfaction in relation to age-related body changes, yet gratitude and pride in their older queer identities. The findings highlight concurrent positive and negative body image, and breadth of body-related experiences ranging from attunement and agency to discomfort and disruption throughout the life course. This work contributes to body image and embodiment research by moving beyond dominant (youthful) heteronormative perspectives by illuminating how ageism and heterosexism can shape body-related experiences.

Implementing LGBTQ Culturally Appropriate Affirmation Training in the Southern United States: An Evidence-Based Practice Project

BACKGROUND

The lesbian, gay, bisexual, transgender, or queer (LGBTQ) community is diverse, and members have a shared need for culturally competent health care (CCH). Best practices show that culturally appropriate affirmation training (CAAT) bridges the sociocultural knowledge gap between patient and provider, resulting in increased access to CCH.

METHOD

The pre-/posttest project design used validated tools to measure group changes in knowledge, attitude, and skills before and after delivery of LGBTQ CAAT. The sample included staff interacting with or making decisions on behalf of patients (n = 11) at a nonprofit clinic in the southern United States.

RESULTS

A Wilcoxon signed-rank test showed an increase in health care team scores for knowledge, attitude, and skills (knowledge, p = .006, r = -.59; attitude, p = .123, r = -.33; skills, p = .005, r = -.60). Qualitative analysis (thematic analysis) (a) showed that participants explored sensitive subjects in a nonjudgmental way; (b) connected the dots between minority stress, bias, and patient-provider trust; and (c) showed increased staff confidence in providing care to LGBTQ patients.

CONCLUSION

As staff undergo LGBTQ CAAT, access to CCH will increase, health outcomes will improve, and LGBTQ health disparities will decrease. [J Contin Educ Nurs. 2024;55(3):121-129.].

Sexual orientation and experiences with police contact in Canada

PURPOSE

To investigate the relationship between sexual orientation and police contact-including police contact with intrusion (i.e., use of intrusive verbal or physical force) and police contact with harassment (i.e., actions making one feel inferior based on appearance, identity, or demographic background)-among a national sample in Canada.

METHODS

Logistic and multinomial logistic regression were used to assess the association between sexual orientation and experiences with police contact among a sample of 940 persons ages 16-30 across Canada.

RESULTS

Compared to heterosexual participants, persons identifying as bisexual were significantly more likely to report having any police contact in the past 12 months (OR = 1.72, 95% CI = 1.09, 2.70). Bisexual (RRR = 3.45, 95% CI = 1. 83, 6.50) and queer, questioning, and other (RRR = 2.33, 95% CI = 1.15, 4.73) identifying participants were more likely to report having experienced police contact with harassment relative to no police contact, compared to heterosexual individuals.

CONCLUSIONS

The current study provides the first analysis of the relationship between sexual minority identity and experiences with adverse police contact in Canada, revealing higher levels of police contact and police contact with harassment, especially among bisexual and queer, questioning, other individuals. Findings suggest that sexual minority persons in Canada experience potentially harmful police contact at elevated rates, which may have significant ramifications for health and traumatic stress responses.

Differences in the Prevalence of Adolescent Sexual Identity: Results of Expanding Survey Response Options

PURPOSE

To describe the prevalence of sexual identity by grade, racial and ethnic identities, and sex assigned at birth.

METHODS

Data came from the statewide 2022 Minnesota Student Survey of eighth, ninth, and 11th grade students (N = 99,688). Chi-square tests compared the prevalence of sexual identity across grades, racial/ethnic groups, and sex assigned at birth.

RESULTS

Over a fifth (22.2%) of students self-reported a minoritized sexual identity. Bisexual and pansexual were most common among Native+ (12.3%, 5.7%, respectively), multiracial (11.6%, 4.4%, respectively), and Latina/x/o (10.4%, 4.1%, respectively) youth. Asexuality was consistently reported across grades, and eighth graders reported gay/lesbian, bisexual, and queer identities less than 11th graders. Youth assigned female at birth were more likely to report gay/lesbian, bisexual, asexual, pansexual, queer, and questioning than youth assigned male at birth.

DISCUSSION

Results support the continued use of further expanded sexual identities in epidemiologic surveys.

Adverse Childhood Experiences and Sexual Orientation: An Intersectional Analysis of Nationally Representative Data

INTRODUCTION

This study compared the prevalence of adverse childhood experiences across intersections of sexual orientation, gender, race/ethnicity, and economic status.

METHODS

Data collected between 1994 and 2018 from 12,519 participants in the National Longitudinal Study of Adolescent to Adult Health were analyzed in 2023 to generate adverse childhood experience prevalence estimates. Unadjusted 1-way ANOVAs and multivariate regressions were performed to compare differences in independent and cumulative adversity measures by sexual orientation, gender, race/ethnicity, and poverty status. A multilevel analysis of individual heterogeneity and discriminatory accuracy was conducted to estimate adversity scores across 24 groups that were stratified by sexual orientation, gender, race/ethnicity, and poverty status.

RESULTS

Adolescents with same-sex attractions and adults who identified with a sexual minority group reported more adverse childhood experiences overall than straight participants, although associations varied by type of adversity. Strikingly, adversity scores were higher among White youth with same-sex attractions than among Black youth with same-sex attractions, among more economically advantaged bisexual adults than among poorer ones, and among poor White participants than among poor Black and Hispanic participants, suggesting that the combination of disadvantaged and marginalized statuses does not necessarily correspond with greater childhood adversity. A multilevel analysis of individual heterogeneity and discriminatory accuracy interaction model showed that sexual orientation and poverty status contributed significant variance to cumulative adversity scores, whereas gender and race/ethnicity did not.

CONCLUSIONS

The results show that disparities in adverse experiences can be more fully and accurately represented when sexual orientation and other social identities are modeled as intersectional configurations. Given that adverse childhood experiences are linked to morbidity and mortality, the findings have salient implications for understanding health disparities that affect population subgroups.

Mental Health of Older Adults by Sexual Minority Status: Evidence From the 2021 National Health Interview Survey

This study explored differences among older adults in mental health by sexual minority status. Data came from the 2021 U.S. National Health Interview Survey. The study sample included older adults (or those aged ≥50 years, N = 15,559), and of those, two percent (n = 380) self-identified as lesbian, gay, or bisexual (LGB). Older LGB adults had significantly higher odds of reporting a diagnosis of depression and anxiety and experiencing serious psychological distress than older non-LGB adults. Additionally, older LGB adults reported higher odds of experiencing depression and anxiety more frequently than older non-LGB adults. Significant covariates included age, sex, housing, food security, and social support. Increased risk for mental illness may be long-term consequences of stigma and discrimination that this population has experienced over the life course. The combination of structural interventions and affirming mental healthcare that recognizes the cumulative negative experience among older LGB adults is necessary to achieve mental health equity.

A Qualitative Account of Coping Following Non-Consensual Sexual Experiences among Gay, Bisexual, and Other Men Who Have Sex with Men

Sexual consent among gay, bisexual, and other men who have sex with men (GBMSM) has not been thoroughly documented in the academic literature. Research has suggested that GBMSM incur a greater risk for experiencing non-consensual sexual experiences (NSEs) compared to heterosexual, cis-gendered men. Despite the high prevalence of NSEs impacting this population, little research has been conducted on how GBMSM cope after NSEs. The purpose of this study was to examine how GBMSM cope following NSEs. Responses were analyzed from 206 GBMSM, aged 18-77 (M = 31.84), recruited across Canada. Participants completed an online survey, answering open-ended questions on experiences of NSEs and how they coped afterward. Guidelines for thematic analysis were followed to analyze the responses, indicating that GBMSM cope both maladaptively (e.g., avoidance, withdrawal from social networks and sexual relationships) and adaptively (e.g., seeking therapy, social support) following NSEs. Some participants were affected by and needed to cope with their NSEs over a longer term (e.g., ongoing rumination, enjoying sexual and intimate relationships less). Participants used a range of coping skills and showed openness to reach out for help from formal and informal sources, but also noted that resources were not always accessible or culturally sensitive to GBMSM's needs. Responses are discussed in the context of barriers to effective coping, such as perceptions of masculinity and maladaptive sexual scripts.

Improving School Environments for Preventing Sexual Violence Among LGBTQ+ Youth

BACKGROUND

Sexual violence (SV) is a serious public health concern, and lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ+) youth report higher rates than their heterosexual and cisgender peers. This qualitative study aimed to understand LGBTQ+ students' perspectives on how middle and high school environments can better prevent and address SV.

METHODS

In partnership with a school-based LGBTQ+ support group in Washington State, we recruited 31 LGTBQ+ students ages 13-18 for virtual interviews (n = 24) and for providing text-based answers to interview questions (n = 7). We used inductive thematic analysis to analyze data and identify themes.

RESULTS

To prevent and respond to SV, students highlighted schools having: (1) access to gender-neutral spaces; (2) LGBTQ+ competency training for staff; (3) enforcement of school policies (eg, SV, anti-bullying) and accountability; (4) LGBTQ+-competent mental health support; and (5) comprehensive sexual health education that addresses LGBTQ+ relationships and SV.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

Students expressed the need for changes in school physical and social environments to address SV among LGBTQ+ youth.

CONCLUSIONS

Incorporating youth perspectives, particularly LGBTQ+ youth at high risk of SV, can help schools implement strategies that are supported by youth and thus potentially more sustainable and effective.

What Do Different People Look for in a Partner? Effects of Sex, Sexual Orientation, and Mating Strategies on Partner Preferences

Partner preferences are an important differential in relationship formation and evolutionary fitness, and vary according to individual, ecological, and social factors. In this study, we evaluated the variation in preference for intelligence, kindness, physical attractiveness, health, and socioeconomic level among individuals of different sexes and sexual orientations in a Brazilian sample. We analyzed the preference scores of 778 heterosexual, bisexual, and homosexual men and women in three budgeted mate design tasks (low vs. medium vs. high budget) and their association with sociosexuality, attachment styles, homogamy, and willingness to engage in short- and long-term relationships. Results indicated a global trait preference order, with intelligence ranking first, followed by kindness, physical attractiveness, health, and lastly by socioeconomic status. Typical sex differences were observed mostly within the heterosexual group, and specific combinations of sex and sexual orientation were linked to variation in preference for physical attractiveness, kindness, and socioeconomic status. We also found unique associations of the other variables with partner preferences and with willingness to engage in short- or long-term relationships. By exploring the partner preferences of non-heterosexual individuals from a Latin American country, an underrepresented group in evolutionary psychology research, our results help understand the universal and specific factors that guide partner preferences and human sexual behavior.

And how do LGB adults rate their orgasms in a relational context?

BACKGROUND

Subjective orgasm experience (SOE) refers to the perception, assessment, and/or sensation of orgasm on a psychological level, with the particularity that the study of SOE in nonheterosexual populations is currently very scarce.

AIM

The study sought to analyze differences in SOE dimensions, comparing the intensity of each adjective of the Orgasm Rating Scale (ORS) and creating a ranking of the adjectives that better represent it in LGB men and women.

METHODS

In a sample of 1475 adults organized into 4 groups according to the type of sexual relationships reported, comparisons were made using multivariate analysis of variance and chi-square tests.

OUTCOMES

Differences were obtained in the intensity of all the SOE dimensions, and in 23 of the 25 ORS adjectives.

RESULTS

Lesbians and bisexual women reported higher intensity in SOE compared with bisexual and gay men.

CLINICAL IMPLICATIONS

Because the ORS has been established as a good tool for detecting orgasmic difficulties in nonheterosexual populations, this study could provide LGBT affirmative psychotherapy with evidence on how these individuals evaluate their orgasms in a relational context.

STRENGTHS AND LIMITATIONS

This study extends prior limited knowledge about how LGB people evaluate their orgasmic experiences in the context of sexual relationships. Despite this, the study poses limitations such as nonprobability sampling or the inclusion of exclusively cisgender and young individuals, making it difficult to generalize the results.

CONCLUSION

Although significant differences were found between LGB men and women, all groups agree on the adjectives they use to describe the subjective experience of orgasm in the context of sexual relationships; therefore, evidence is provided about how LGB people evaluate their orgasmic experiences in this context.

Sexualization of Children or Human Rights? Attitudes Toward Addressing Sexual-Orientation Diversity in School

Lesbian, gay, and bisexual (LGB) adolescents are more likely to experience mental health problems than their heterosexual peers because they are victimized more often or fear discrimination. Governmental plans to improve this situation by addressing sexual diversity in German schools have been accompanied by public resistance and misinformation, e.g., that they aim to sexualize children. The present study assessed how widespread negative attitudes toward such plans really are and how they can be explained. A random sample of 2,013 German residents was surveyed by phone. Only 10% opposed promoting acceptance of LGB in school. Approval of such plans was predominantly predicted by respondents' beliefs about sexual orientation and the plans' aim, and only marginally by societal values. Respondents who knew that the plans' aim was to promote acceptance of LGB and not to sexualize children and that children with same-sex parents are just as well off as those with heterosexual parents showed higher approval, whereas respondents who believed that homosexuality is affected by socialization showed higher opposition.

Asymptomatic transmission of human mpox

Monkeypox virus belongs to the genus Orthopoxvirus There was a worldwide mpox outbreak in 2022, with many cases reported in Europe in gay, bisexual and other men who have sex with men. Here, we report a case of mpox diagnosed in a heterosexual woman in her twenties without any known history of exposure. This is a very rare event. Despite lesions remaining for more than 1 month, she recovered fully with no sequelae. We highlight the diagnosis of mpox in a heterosexual woman without a known or suspected history of exposure or any risk factor for acquiring the infection.

Risk of chronic health conditions in lesbian, gay, and bisexual survivors of adolescent and young adult cancers

BACKGROUND

In the general population, individuals with minoritized sexual orientation and gender identity have a higher burden of chronic health conditions than heterosexual individuals. However, the extent to which sexual orientation is associated with excess burden of chronic conditions in adolescent and young adult cancer survivors (AYACS) is unknown.

METHODS

Lesbian, gay, and bisexual (LGB) AYACSs, LGB individuals without a history of cancer, and heterosexual AYACSs were identified by self-reported data from the cross-sectional National Health Interview Survey (2013-2020). Socioeconomic factors and the prevalence of chronic health conditions were compared between groups using χ2 tests. Logistic regression methods were used to determine the odds of chronic conditions by socioeconomic factors within and between survivor and comparison groups.

RESULTS

One hundred seventy LGB cancer survivors, 1700 LGB individuals without a history of cancer, and 1700 heterosexual cancer survivors were included. Compared with heterosexual survivors, LGB survivors were less likely to be married (p = .001) and more likely to have never been married (p < .001). LGB survivors were more likely to have incomes between 100% and 200% of the federal poverty level than LGB individuals without a history of cancer (p = .012) and heterosexual survivors (p = .021) and were less likely to report incomes >200% the federal poverty level. LGB survivors had higher odds of chronic health conditions than LGB individuals without a history of cancer (odds ratio, 2.45; p < .001) and heterosexual survivors (odds ratio, 2.16; p = .003).

CONCLUSIONS

LGB AYACSs are at increased risk of having chronic health conditions compared with both LGB individuals without a history of cancer and heterosexual AYACSs.

The Society of General Internal Medicine's Recommendations to Improve LGBTQ + Health

Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ +) individuals experience bias in healthcare with 1 in 6 LGBTQ + adults avoiding healthcare due to anticipated discrimination and overall report poorer health status compared to heterosexual and cisgendered peers. The Society of General Internal Medicine (SGIM) is a leading organization representing academic physicians and recognizes that significant physical and mental health inequities exist among LGBTQ + communities. As such, SGIM sees its role in improving LGBTQ + patient health through structural change, starting at the national policy level all the way to encouraging change in individual provider bias and personal actions. SGIM endorses a series of recommendations for policy priorities, research and data collection standards, and institutional policy changes as well as community engagement and individual practices to reduce bias and improve the well-being and health of LGBTQ + patients.

Higher Risk of Many Physical Health Conditions in Sexual Minority Men: Comprehensive Systematic Review and Meta-Analysis in Gay- and Bisexual-Identified Compared with Heterosexual-Identified Men

Purpose: The purpose of this study was to provide a systematic review and, where possible, meta-analysis on the prevalence of physical health conditions in sexual minority men (SMM, i.e., gay- and bisexual-identified men) compared with heterosexual-identified men. Methods: A systematic literature search in the databases MEDLINE, Embase, CENTRAL, CINAHL, and Web of Science was conducted on epidemiological studies on physical health conditions, classified in the Global Burden of Disease project and published between 2000 and 2021. Meta-analyses comparing odds ratios were calculated. Results: In total, 23,649 abstracts were screened, and 32 studies were included in the systematic review. Main findings were that (1) Largest differences in prevalence by sexual identity were found for chronic respiratory diseases, particularly asthma: overall, SMM were significantly almost 50% more likely to suffer from asthma than heterosexual men. (2) Evidence of higher prevalence was also found for chronic kidney diseases and headache disorders in gay men and for hepatitis B/C in both gay and bisexual men. (3) We found an overall trend that bisexual men were more affected by some of the physical health conditions compared with gay men (e.g., cardiovascular diseases, asthma). However, regarding cancer, headache disorders, and hepatitis, gay men were more affected. Conclusion: We found evidence of physical health disparities by sexual identity, suggesting more health issues in SMM. Since some of these findings rely on few comparisons or small samples of SMM only, this review is intended to be a vehement plea for routinely including sexual identity assessment in health research and clinical practice.

Trends in illicit drug use and their association with HIV transmission risks from behavioural surveillance of Australian gay and bisexual men

INTRODUCTION

Investigating drug trends among Australian gay and bisexual men (GBM) is crucial for understanding levels of use and the potential for harm, including HIV transmission risk.

METHOD

Using repeated, national, cross-sectional survey data collected between 2012 and 2021 (69,567 surveys), trends of recent (previous 6 months) and frequent (weekly) drug use were analysed, using logistic regression models. The last round of data from each jurisdiction (6709 surveys) was used to compare GBM who reported no use, infrequent (less than weekly) use and frequent (at least weekly) use of party drugs to investigate the association between party drug use and HIV transmission risk, using multinomial logistic regression models.

RESULTS

There was a significant upward trend in any recent drug use (from 58.4% in 2012 to 64.1% in 2021; p < 0.001). Frequent party drug use remained a minority practice over the period (consistently less than 3%). In cross-sectional analysis, frequent party drug users were more likely to report behaviours with HIV transmission risks, such as condomless anal intercourse without biomedical prevention strategies (30.0% vs. 13.1%; adjusted relative risk ratio [aRRR], 2.08; 95% CI, 1.24-3.47), weekly group sex (16.3% vs. 0.6%; aRRR, 12.36; 95% CI, 5.75-26.56) and more than 20 recent sexual partners (42.5% vs. 5.0%; aRRR, 21.44; 95% CI, 5.82-78.89), compared with GBM who did not use party drugs.

DISCUSSION AND CONCLUSION

Our findings suggest that the frequent use of party drugs remains a marker of HIV transmission risk among Australian GBM, despite the increased adoption of biomedical HIV prevention strategies over the past few years.

Mediation and interaction of problematic internet use in the relationship between sexual minority status and depressive symptoms: Gender-based analysis

BACKGROUND

Previous studies have demonstrated that sexual minorities are at a higher risk of experiencing depressive symptoms. However, few prior investigations have examined the potential mechanisms involved. This study aimed to employ the four-way decomposition approach that integrates the analysis of mediation and interaction to investigate the potential role of problematic internet use between sexual orientation and depressive symptoms.

METHODS

The participants were recruited through a multi-stage, stratified cluster, and random sampling method in China. Students who identified as "gay or lesbian" and "bisexual" were defined as "sexual minorities". The Young's Internet Addiction Test (IAT) was used to evaluate problematic internet use. The Center for Epidemiologic Studies Depression Scale (CESD-20) was used to evaluate depressive symptoms.

RESULTS

A total of 59,859 adolescents were included in this study, with 30,180 (53.25 %) boys and 29,679 (46.75 %) girls. Of these, 7263 (12.13 %) were identified as sexual minorities. Gender differences were observed in the association between sexual orientation, problematic internet use, and depressive symptoms. The mediating effect of problematic internet use was 28.80 % for boys and 36.84 % for girls, respectively. The interaction effect between problematic internet use and sexual minority status on depressive symptoms was 21.19 % and 9.65 % for boys and girls, respectively.

LIMITATIONS

The current study was limited by the cross-sectional design.

CONCLUSION

These findings suggest that prevention and intervention programs aimed at improving mental health outcomes among sexual minority adolescents should prioritize considering the impact of problematic internet use and potential gender differences.

Interventions, Barriers, and Facilitators to Address the Sexual Problems of Gay, Bisexual and Other Men Who Have Sex with Men Living with HIV: A Rapid Scoping Review

Sexual problems are common among gay, bisexual, and other men who have sex with men (GBM) after diagnosis with HIV. However, these are often overlooked in care and research, where sexual risk reduction and biomedical aspects of sexual health tend to dominate. We conducted a rapid scoping review to investigate which sexual problems of GBM living with HIV are addressed by interventions, and the barriers and facilitators to their implementation. Literature from high-income countries published in English since 2010 was reviewed. Medline, Embase, PsycInfo, and Scopus databases were searched on July 4, 2022. Targeted sexual problems were categorized according to the ten dimensions of Robinson's Sexual Health Model, and barriers and facilitators, according to the five domains of the Consolidated Framework for Implementation Research (CFIR). Interventions focused solely on the dimension of Sexual Health Care/Safer Sex were excluded. Relevant information was extracted from the qualifying documents with NVivo 12 software for content analysis. Fifty-two documents were included, referring to 37 interventions which mainly took place in the United States (n = 29/37; 78%), were group-based (n = 16; 41%), and used counselling techniques (n = 23; 62%; e.g., motivational interviewing, cognitive-behavioral therapy). Their settings were mostly primary care (n = 15; 40%) or community-based (n = 16; 43%). On average, interventions addressed three sexual health dimensions (SD = 2; range: 1-10). The most targeted dimension was Sexual Health Care/Safer Sex (n = 26; 70%), which concerned sexual risk reduction. Next, Challenges (n = 23; 62%), included substance use (n = 7; 19%), sexual compulsivity (n = 6; 16%), sexual abuse (n = 6; 16%), and intimate partner violence (n = 4; 11%). Third was Talking About Sex (n = 22; 59%) which mostly concerned HIV disclosure. About a third of interventions addressed Culture/Sexual identity (n = 14; 38%), Intimacy/Relationships (n = 12; 33%), and Positive sexuality (n = 11; 30%). Finally, few targeted Body Image (n = 4; 11%), Spirituality (n = 3; 8%), Sexual Anatomy Functioning (n = 2; 5%) or Masturbation/Fantasy (n = 1; 3%). Forty-one documents (79%) mentioned implementation barriers or facilitators, particularly about the characteristics of the interventions (41% and 78%, respectively; e.g., cost, excessive duration, acceptability, feasibility) and of the individuals involved (37% and 46%; e.g., perceived stigmatization, provider expertise). The other three CFIR dimensions were less common (5%-17%). The search strategy of this review may not have captured all eligible documents, due to its limit to English-language publications. Overall, most interventions incorporated a focus on Sexual Health Care/Safer Sex, at the expenses of other prevalent sexual problems among GBM living with HIV, such as intimate partner violence (Challenges), erectile dysfunction (Sexual Anatomy Functioning), and Body Image dissatisfaction. These findings suggest they could receive more attention within clinical care and at the community level. They also highlight the importance of cost-effective and acceptable interventions conducted in non-stigmatizing environments, where patients' needs can be met by providers who are adequately trained on sexuality-related topics.

(Mis)Perceiving Sexual Intent: A Mixed-Method Approach Investigating Sexual Overperception Across Diverse Sexual Identities

Research on perceptions of sexual interest has documented the tendency for men to overperceive sexual interest (i.e., to perceive a social signal as indicating more sexual intent than the actor intended). However, this work has almost exclusively focused upon these dynamics among heterosexual individuals. Thus, the current set of studies aimed to understand how perceptions of sexual interest manifest among lesbian, gay, and bisexual (LGB) women and men. In Study 1 (N = 85), LGB women and men nominated behaviors that signal sexual intent. Using an act nomination approach, LGB women and men tended to nominate behaviors similar to those nominated by heterosexual women and men. In Study 2 (N = 43), gay men reported acts that were representative of their own and other gay men's sexual interest. Consistent with previous work-by comparing perceived self-reported versus others' sexual intent when engaging in specific behaviors-we found no evidence for a sexual overperception bias in gay men, albeit in a small field study. In Study 3 (N = 307), using a gender-by-sexual orientation design, heterosexual and LGB women and men reported previous experiences in which their friendliness was sexually misperceived. Bisexual women were less likely than other groups to report their friendliness being misinterpreted as sexual by other bisexual women and/or lesbians. Additionally, across all genders and sexual orientations, participants reported feelings of indifference, awkwardness and embarrassment when being misperceived. Ultimately, the current studies' results provide broader insight into the nature of sexual overperception among LGB populations.

Typologies of alcohol and other drug-related risk among lesbian, gay, bisexual, transgender (trans) and queer adults

INTRODUCTION

Prevalence and patterns of alcohol and other drug (AOD) use among specific lesbian, gay, bisexual, transgender (trans) and queer (LGBTQ+) subpopulations are well established. However, patterns of substance-related risk have been less thoroughly explored. This study aimed to determine typologies AOD risk among LGBTQ+ adults in Australia.

METHOD

Latent class analyses were performed to determine distinct patterns of AOD risk (n = 6835), as measured by the Alcohol Use Disorder Identification Test and Drug Abuse Screening Tool. Demographic characteristics, experience of harassment, assault and/or threats, mental wellbeing and LGBTQ+ connectedness were compared across emergent classes.

RESULTS

AOD risk was characterised as 'no risk' (13.3% of sample), 'low risk' (15.1%), 'moderate risk' (alcohol + other drugs; 30.1%), or 'moderate alcohol only risk' (41.5%). The 'moderate risk' class was the most likely class to report recent sexual assault, verbal abuse, harassment and physical threats compared to other classes, while those in the 'moderate alcohol only risk' group were least likely to report these experiences of all classes. However, both the 'moderate risk' and 'moderate alcohol risk only' classes reported greater mental wellbeing and LGBTQ+ connectedness compared to the 'no risk' and 'low risk' classes.

DISCUSSION AND CONCLUSIONS

Our findings indicate that level of AOD risk is not uniform among some LGBTQ+ adults, nor is the distribution of harms experienced by them. Tailored harm-reduction interventions may be fruitful in attenuating harms based on risk profile; most specifically, LGBTQ+ individuals engaging in moderately risky concurrent AOD use.

Normalising intolerance: the efforts of Christian Right groups to block LGBTIQ+ inclusion in South African schools

Post-apartheid, South Africa has come a long way in making the inclusion of gender and sexuality equality explicit in its Constitution. To make schools more inclusive for lesbian, gay, bisexual, transgender, intersex and queer (LGBTIQ+) identifying learners, the Department of Basic Education has developed what it claims are South Africa's first guidelines regarding sexual orientation, gender identity and sex characteristics (SOGIESC). Despite the emphasis on equality in South Africa's post-apartheid policies, which set out to protect the rights of LGBTIQ+ individuals, there has been a backlash from conservative advocacy groups, many with links to the US Christian Right. This paper argues that contrary to the disinformation being propagated by anti-LGBTIQ + groups, it is queer and transgender individuals who experience extreme levels of violence and marginalisation in schools. The empirical research makes explicit the bullying and exclusion that transgender and gender-diverse youth experience in school; however, this evidence is neglected in conservative claims that SOGIESC (SOGIESC) guidelines and Comprehensive Sexuality Education (CSE) endanger other learners. Notably, and in stark contrast to those advocating for measures to make schools safer for LGBTIQ + learners, far-right advocacy groups have no empirical basis to support their claims.

Associations of past-year overall trauma, sexual assault and PTSD with social support for young adult sexual minority women

Background: Young adult sexual minority women (SMW) are at elevated risk for sexual assault (SA), posttraumatic stress disorder (PTSD), and inadequate social support. While SA and PTSD can lead to reductions in social support from close significant others, the impact of SA and PTSD on SMWs' social support has not previously been assessed.Objective: This study examined the associations of past year SA and PTSD with SMW's social support from intimate partners, family, and friends. It was hypothesized that SA and PTSD would be negatively associated with support from partners, family and friends, and that PTSD would moderate the effect of SA on support in early adulthood.Method: Young adult SMW in the United States (N = 235) who were M = 23.93 (SD = 2.15) years old, primarily lesbian or bisexual (n = 186, 79.1%) and White (n = 176, 74.9%) completed measures on past year exposure to SA and non-SA trauma, PTSD, and social support from intimate partners, family and friends.Results: PTSD was associated with less social support from partners, (b  = -0.06, SE = 0.02, p = .010, R2change = .02), family, (b  = -0.06, SE = 0.03, p = .025, R2change = .02), and friends, (b  = -0.07, SE = 0.02, p = .008, R2change = .02). There was a significant interaction between PTSD and SA on social support from partners (b  = -0.01, SE = 0.01, p = .047, R2change = .01). Neither non-SA nor SA trauma was associated with support from family or friends.Conclusions: Results underscore the potential impact of recent SA on intimate partnerships for young adult SMW with more severe PTSD. Future work should explore how addressing PTSD and improving social support quality may help SMW recover from traumatic experiences and ameliorate the effects of SA on intimate partnerships.

Ethno-racial variations in mental health symptoms among sexually-active gay, bisexual, and other men who have sex with men in Vancouver, Canada: a longitudinal analysis

BACKGROUND

Minority stress from racism and heterosexism may uniquely interact to impact the mental health of racialized sexual minorities. We examined variations in anxiety and depressive symptoms by reported by ethno-racial identity among gay, bisexual, and other men who have sex with men (gbMSM) in Vancouver, Canada.

METHODS

We recruited gbMSM aged ≥ 16 years from February 2012 to February 2015 using respondent-driven sampling (RDS). Participants completed computer assisted self-interviews (CASI) at enrollment and every 6 months until February 2017. We examined factors associated with moderate/severe anxiety and depression scores (> 10) on the Hospital Anxiety and Depression Scale (HADS) and differences in key explanatory variables including sociodemographic, psychosocial, and substance use factors. We used multivariable mixed effects models to assess whether moderate/severe scores were associated with ethno-racial identity across all visits.

RESULTS

After RDS-adjustment, of 774 participants, 79.9% of participants identified as gay. 68.6% identified as white, 9.2% as Asian, 9.8% as Indigenous, 7.3% as Latin American, and 5.1% as other ethno-racial identities. Participants contributed a median of 6 follow-up visits (Q1-Q3: 4-7). In the multivariable analysis, Asian participants had decreased odds of moderate/severe anxiety scores compared to white participants (aOR = 0.39; 95% CI: 0.18-0.86), and Latin American participants had decreased odds of moderate/severe depression scores compared to both white (aOR = 0.17; 95% CI: 0.08-0.36) and Asian (aOR = 0.07; 95% CI: 0.02-0.20) participants.

CONCLUSION

Asian and Latino gbMSM reported decreased mental health symptoms compared to white participants. Asian and Latino gbMSM in Vancouver appear to manage multiple minority stressors without adversely affecting their mental health.

Reciprocal expression of MADS-box genes and DNA methylation reconfiguration initiate bisexual cones in spruce

The naturally occurring bisexual cone of gymnosperms has long been considered a possible intermediate stage in the origin of flowers, but the mechanisms governing bisexual cone formation remain largely elusive. Here, we employed transcriptomic and DNA methylomic analyses, together with hormone measurement, to investigate the molecular mechanisms underlying bisexual cone development in the conifer Picea crassifolia. Our study reveals a "bisexual" expression profile in bisexual cones, especially in expression patterns of B-class, C-class and LEAFY genes, supporting the out of male model. GGM7 could be essential for initiating bisexual cones. DNA methylation reconfiguration in bisexual cones affects the expression of key genes in cone development, including PcDAL12, PcDAL10, PcNEEDLY, and PcHDG5. Auxin likely plays an important role in the development of female structures of bisexual cones. This study unveils the potential mechanisms responsible for bisexual cone formation in conifers and may shed light on the evolution of bisexuality.

Normative Perceptions of Sexual Behavior and Alcohol Use among Bisexual Women

Background: As compared to heterosexual and lesbian women, bisexual women report higher rates of alcohol, other substance use, and risky sexual behavior, and they experience more negative outcomes from these behaviors. Descriptive norms (i.e., perceptions of others' behavior) are an important predictor of risky behaviors, but scant research has examined whether bisexual women's perceptions of other bisexual women's alcohol use and sexual behavior are associated with their own alcohol or drug use during sex. Objectives: Consequently, the present study examined (1) whether perceived sex norms were related to engagement in sex and (2) the relative influence of drinking and sex norms on engaging in sex while drinking among bisexual women. Method: Data were collected from 225 self-identified bisexual women who completed an online survey about their typical weekly alcohol use, engagement in alcohol or drug use during sex in the past 30 days, and normative perceptions of drinking and sexual behavior. Results: Regression models demonstrated both sexual norms and drinking frequency norms were positively associated with alcohol or drug use during sex. In addition, only perceived norms of other bisexual women, compared to perceived norms of lesbian and heterosexual women, predicted engagement in sex. Conclusions: Bisexual women may be susceptible to normative perceptions, given their connectedness to a marginalized social group. Thus, alcohol prevention and intervention efforts aimed at reducing risky consequences among bisexual women should specifically consider drinking and sexual norms of other bisexual women.

Genetic variants underlying human bisexual behavior are reproductively advantageous

Because human same-sex sexual behavior (SSB) is heritable and leads to fewer offspring, how SSB-associated alleles have persisted and whether they will remain in human populations are of interest. Using the UK Biobank, we address these questions separately for bisexual behavior (BSB) and exclusive SSB (eSSB) after confirming their genetic distinction. We discover that male BSB is genetically positively correlated with the number of offspring. This unexpected phenomenon is attributable to the horizontal pleiotropy of male risk-taking behavior-associated alleles because male risk-taking behavior is genetically positively correlated with both BSB and the number of offspring and because genetically controlling male risk-taking behavior abolishes the genetic correlation between male BSB and the number of offspring. By contrast, eSSB is genetically negatively correlated with the number of offspring. Our results suggest that male BSB-associated alleles are likely reproductively advantageous, which may explain their past persistence and predict their future maintenance, and that eSSB-associated alleles are likely being selected against at present.

Emerging Adult LGB+ Romantic Relationships: Narratives about Met and Unmet Relationship Needs

Although emerging adulthood is recognized as a pivotal time for relationship development, most studies concern heterosexual youth or older sexual minority partners. Using narratives from 40 college student emerging adults, we sought to understand the particularities and generalities of lesbian, gay, bisexual and other sexual minority (LGB+) relationship experiences. Positive experiences particular to being in a LGB+ relationship concerned partner support for coming and being out; support from family members for the relationship was rarely mentioned. Negative experiences were twice as likely to be mentioned as positive ones. They concerned how partners being at different levels of outness and problems with family support stressed the relationship. Generalities pertaining to positive relationship factors included meeting needs for support and using perspective taking to deal with conflict. Negative factors included unmet needs for companionship and intimacy and breakup anxiety about whether the relationship had a future. Our findings suggest the importance of developing strength-based LGB+ affirmative education for emerging adults to promote core relationship processes and strengthen skills to cope with stressors specific to sexual minority romantic partnerships.

Identifying HIV PrEP Attributes to Increase PrEP Use Among Different Groups of Gay, Bisexual, and Other Men Who Have Sex with Men: A Latent Class Analysis of a Discrete Choice Experiment

Daily pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV among gay, bisexual, and other men who have sex with men (GBMSM), although uptake remains suboptimal. By identifying the features of PrEP that appeal to various subgroups of GBMSM, this study aimed to improve PrEP uptake by examining preferences for PrEP use. Adults ≥ 18 years old in six New England states completed an online discrete choice experiment survey. A latent class analysis (LCA) was conducted to identify groups of GBMSM based on four attributes of choices for PrEP (cost, time, side effects, and mode of administration). Multinominal logistic regression was conducted to compare the association between sociodemographic and behavioral characteristics and class memberships. Data from 675 GBMSM were analyzed. A 3-Class model was selected as the best fit model. Class 1 (47.7% of individuals) was identified as having "no specific preferences". Class 2 (18.5% of individuals) were "Cost- and time-conscious" and were significantly more likely to be older, have prior sexually transmitted infection (STI) testing, have low household income, private insurance, and have extreme concerns about HIV risk than those with no specific preference (Class 1). Finally, Class 3 (34.1% of individuals) were "Side effects-conscious" and were more likely to have low income, private insurance, and have moderate and extreme concerns about HIV risk than those with no specific preference (Class 1). Findings indicate that outreach to GBMSM who have never used PrEP should emphasize low cost and short travel times to increase potential PrEP use.

Health Disparities Among Older Adults: An Introduction to the Special Issue

The problem of health disparities across the lifespan and in older adulthood has gained recent attention by the National Institute on Aging (NIA) and other organizations and researchers. These disparities are of significant interest as they greatly impact health, life span, and quality-of-life for countless individuals and create economic burden on societies. Given the critical nature of this problem, this special issue will focus on health disparities for older adults across the lifespan. This introductory article will lay the groundwork for subsequent works on disparities among older ethnic minorities, women, lesbian, gay, bisexual, and trans, as well as rural elders. Concepts critical to an understanding of the topic such as social determinants of health, marginalization, and intersectionality will also be discussed.

Disparities in alcohol- and substance-related hospitalizations and deaths across sexual orientations in Canada: a longitudinal study

OBJECTIVES

We aim to quantify disparities in substance-related acute events (i.e. hospitalizations and deaths for substances, including alcohol, cannabis, opioids, narcotics, and/or illicit drugs) across sexual orientations based on health administrative data.

STUDY DESIGN

This was a longitudinal analysis from six waves of the Canadian Community Health Survey (2009-2014) linked to hospitalization/mortality data in Ontario, Canada.

METHODS

The study sample consisted of survey respondents aged ≥15 (weighted n = 15,406,000) who provided a valid response to the question about sexual orientation. The primary outcome was substance-related acute events, including hospitalizations and deaths due to alcohol, cannabis, opioids, narcotics, and/or illicit drugs. Disparities in substance-related acute events across sexual orientation and gender were examined using flexible parametric survival analysis.

RESULTS

Bisexual women had hazard ratios of 2.46 (95% confidence interval: 1.46-4.15) for any substance-related acute event and 2.67 (95% confidence interval: 1.42-5.00) for non-alcohol substance acute events compared to heterosexual women. Lesbian women did not exhibit significant differences in acute event risk compared to heterosexual women. Gay and bisexual men demonstrated elevated but not statistically significant risks compared to heterosexual men.

CONCLUSIONS

Bisexual women face higher risks of substance-related acute events, potentially due to self-medication of unique stressors brought on by discrimination and isolation. Enhanced education and training for healthcare professionals are essential to increase awareness and sensitivity toward the heightened substance use risk among lesbian, gay, and bisexual individuals. Targeted interventions aimed at reducing substance use problems among bisexual individuals warrant increased funding and research.

Intersexual and Intrasexual Differences in Mate Selection Preferences Among Lesbian Women, Gay Men, and Bisexual Women and Men

Sex differences in mating strategies and partner preferences are well established. However, most research solely focused on heterosexual women and men. We examined the mate selection, marriage, and age preferences of a sample of lesbian women, gay men, and bisexual women and men (LGB) who took part in an online dating survey. Additionally, we analyzed inter- and intrasexual differences in these preferences. A total of 710 participants rated the importance of 82 mate selection criteria and 10 marriage criteria, and they also indicated their age preferences and short-term and long-term relationship orientation. An exploratory factor analysis suggested 11 relevant domains of mate selection in the LGB sample, with sex, age, and long-term relationship orientation being relevant predictors of differences in these domains. We compared the LGB data with data collected from 21,245 heterosexual women and men on the same mate selection criteria. Results showed that the participants' sex was the most important predictor of differences in mate selection and marriage preferences, while intrasexual variables (sexual orientation and relationship orientation) explained only a small part of the variance. We incorporated the results into the current discussion about partner preferences and sexual orientation.

Prenatal Substance Use Among Young Pregnant Sexual Minority People

Purpose: Sexual minority (SM) youth have higher rates of substance use and pregnancy but are absent from the prenatal substance use literature. We modeled the impact of SM identity and syndemic factors on prenatal substance use among 14- to 21-year-olds. Methods: Pregnant people completed an online survey (n = 357). Prenatal substance use was regressed on SM identity, controlling for other syndemic factors (e.g., depressive symptoms, intimate partner violence) and household substance use. Results: Pregnant SM participants (n = 125) were primarily bisexual and were more likely to use tobacco and illicit drugs than heterosexual participants (n = 232). The association between SM identity and prenatal tobacco use was not attenuated by syndemic factors, prenatal cannabis use, or household tobacco use. Conclusion: SM people need increased support for smoking cessation to redress health inequities in tobacco use, prevent prenatal exposures to tobacco, and limit the long-term consequences of tobacco use on health.

Parenting Desire Among Sexual Minority Women in China: From the Stigma Perspective

In China, women who are childless or have children outside of heterosexual marriage are generally stigmatized. Consequently, Chinese sexual minority women are challenged for their willingness to have children. This study explored how multiple (structural-interpersonal-individual) levels of sexual minority stigma are related to parenting desire among Chinese sexual minority women. Furthermore, it examined the mediation mechanism of individual stigma and the moderation effect of outness to one's family in the link between structural/interpersonal stigma and parenting desire. Participants (265 lesbian and 193 bisexual women) completed online measures of structural stigma (adherence to Confucianism), interpersonal stigma (discrimination events), individual stigma (internalized homophobia and rejection sensitivity), outness to one's family, and parenting desire. Lesbian women reported lower structural and individual stigma and parenting desire levels than bisexual women. Sexual minority women's high adherence to Confucianism, internalized homophobia, and rejection sensitivity were positively associated with their increased parenting desires. Notably, adherence to Confucianism and discrimination events were associated with parenting desire through internalized homophobia, but not rejection sensitivity; moreover, outness to one's family buffered the direct link between adherence to Confucianism and parenting desire and strengthened the direct link between discrimination events and internalized homophobia and the indirect link between discrimination events and parenting desire. This study contributes to a robust understanding of how sexual minority stigma is connected to parenting desire among sexual minority women in Chinese sociocultural contexts, providing cultural-specific evidence to support theories of stigma and minority stress.

Assessing HIV risk and the social and behavioural characteristics of gay and bisexual men who have recently migrated to Australia: an analysis of national, behavioural surveillance data 2019-2021

INTRODUCTION

Overseas-born gay and bisexual men (GBM) are overrepresented in HIV diagnoses in Australia. We assessed social and sexual behaviours, and the use of HIV prevention and testing, by region of birth and length of residence in Australia. We sought to identify similarities and differences between recently arrived and non-recently arrived GBM from non-English-speaking countries to improve targeting and engagement with HIV testing and prevention.

METHODS

Data were collected in national repeated, behavioural surveillance surveys conducted across Australia during 2019-2021. Logistic regression was used to identify factors that differentiated between recently arrived (<2 years) and non-recently arrived (≥2 years in Australia) GBM from non-English-speaking countries.

RESULTS

Among 24,707 participants in 2019-21, 2811 (11.4%) were from high-income English-speaking countries, 714 (2.9%) were recently arrived overseas-born GBM and 3833 (15.5%) were non-recently arrived migrants. Recently arrived GBM were most likely to be born in Asia (36.1%) and Europe (21.1%). Compared with non-recently arrived GBM, recently arrived GBM from non-English-speaking countries were younger (aOR = 0.95, 95% CI = 0.94-0.96, p<0.001), more likely to be students (aOR = 1.43, 95% CI = 1.11-1.85, p = 0.005), less likely to be in full-time employment (aOR = 0.56, 95% CI = 0.46-0.69, p <0.001), more likely to report consistent condom use (aOR = 1.30, 95% CI = 1.01-1.66, p = 0.039), but had lower awareness (aOR = 0.62, 95% CI = 0.48-0.80, p<0.001) and use of pre-exposure prophylaxis (PrEP) (22.8%, vs. 32.3%, χ2 (1, 4185) = 23.78, p<0.001), and similar levels of casual sex with a risk of HIV acquisition or transmission (aOR = 1.29, 95% CI = 0.98-1.69, p = 0.066). Recently arrived GBM reported similar levels of lifetime HIV testing (aOR = 0.97, 95% CI = 0.54-1.74, p = 0.915) and recent HIV testing (OR = 1.03, 95% CI = 0.86-1.22, p = 0.779), but were much less likely to have tested at general practitioners (aOR = 0.53, 95% CI = 0.41-0.68, p<0.001) and more likely to report testing at hospitals (aOR = 3.35, 95% CI = 2.53-4.43, p<0.001), at home (aOR = 2.85, 95% CI = 1.63-4.99, p<0.001), or community-based services (aOR = 1.36, 95% CI = 1.01-1.84, p = 0.043).

CONCLUSIONS

Recently arrived GBM from non-English-speaking countries reported similar levels of risk of HIV acquisition to longer-term residents in Australia, but lower levels of PrEP awareness and use, and more reliance on HIV testing services which are free or low cost. It is necessary to enhance access to HIV testing and prevention among recently arrived GBM in Australia.

Disparities in cannabis use outcomes, perceived risks and social norms across sexual orientation groups of US young adult women and men

Little research has examined mechanisms driving cannabis use disparities among sexual minority (SM; versus heterosexual) young adults (YAs). Participants were US YA women (N = 1345; 24.8% bisexual, 6.1% lesbian) and men (N = 998: 8.9% bisexual, 13.8% gay). Bivariate analyses examined associations between sexual orientation (heterosexual, gay/lesbian, bisexual) and cannabis use outcomes (past 30-day [current] use, use frequency, cannabis-tobacco dual use, use intentions), perceived risks (harm, addictiveness) and social norms (social acceptability, peer use). Regressions examined sexual orientation, perceived risks and social norms as correlates of cannabis outcomes. Bisexual and lesbian (versus heterosexual) women reported lower cannabis-related perceived risks, greater social norms and higher odds of current use. Bisexual (versus heterosexual) women reported more days of use, higher odds of cannabis-tobacco dual use and greater use intentions. Gay (versus heterosexual) men reported lower perceived addictiveness, greater social norms and higher odds of current use. Lower perceived risks and greater social norms predicted greater use outcomes for women and men. Bisexual women displayed higher odds of several cannabis use outcomes, whereas lesbian women and gay men displayed higher odds of current cannabis use only. Cannabis-related perceptions and social norms may be important targets for public health messaging for SMYAs.

Polysubstance use by sexual identity among US adults, 2021

OBJECTIVE

Understanding polysubstance use among US sexual minority adults is important to serve as a population-level baseline to promote health equity around substance use prevention and public health strategies. This study quantifies the number of substances used by sexual identity among US adults.

METHODS

We used the 2021 National Survey on Drug Use and Health and included adults (aged ≥18) (unweighted n = 47,291). We conducted multivariable Poisson regression models to examine the number of substances used in the past year (count variable; range: 0-18) by sexual identity ("heterosexual", "gay/lesbian", "bisexual", "unknown" [don't know, refused, blank]), after adjusting for covariates (i.e., age, sex, race/ethnicity, income level, education level, having insurance status, living in urban area, past-year distress level (Kessler-6), any drug or alcohol use disorder in the past year, and sexual attraction).

RESULTS

Of the total sample (51.4% were female, 12.1% were non-Hispanic Black and 17.0% were Hispanic adults), 88.3% were heterosexual, 2.4% were gay/lesbian, 5.0% were bisexual adults, and 4.3% reported "unknown" sexual identity. After adjusting for covariates, a greater number of substances were used in the past year among gay/lesbian individuals (aIRR = 1.44, 95% CI = 1.09, 1.75), bisexual individuals (aIRR =1.34, 95% CI = 1.26, 1.41), and individuals reporting an "unknown" sexual identity (aIRR = 1.22, 95% CI = 1.09, 1.36) (vs. heterosexual adults).

CONCLUSIONS

Tailored substance use prevention and public health strategies specializing in sexual minority populations are warranted.

Sexual minority youth in romantic relationships: Associations with youth well-being

This study investigated differences in depressive symptoms, loneliness, and self-esteem for monosexual (lesbian, gay) and plurisexual (bisexual, pansexual, queer) sexual minority youth (SMY) by relationship status (single, partnered) and relationship configuration (same-gender partner, different-gender partner). Participants included 338 SMY (Mage  = 19.10 years) who reported on their relationship status, partner's gender identity, well-being, and ability to confide in partner about LGBTQ issues. Results indicated that for plurisexual youth, single status was associated with greater loneliness; plurisexual youth with same-gender partners reported fewer depressive symptoms and marginally greater ability to confide in their partner about LGBTQ issues than those with different-gender partners. Findings reveal similarities across SMY while also highlighting some unique challenges among plurisexual youth with different-gender partners.

The Epidemiology of Violence Exposure in Children

Exposure to violence remains a significant issue for children in the United States. The COVID-19 pandemic exacerbated many of these exposures. Violence unequally impacts children of color and lesbian, gay, bisexual, transgender, and questioning youth. Pediatricians can and must continue to advocate and intervene to decrease pediatric violence exposure and its effects.

Attachment-based family therapy versus nondirective supportive therapy for lesbian, gay, bisexual and questioning adolescents with depression, and suicidal ideation: An exploratory study

INTRODUCTION

Lesbian, gay, bisexual, and questioning (LGBQ) adolescents are particularly at risk for suicidal ideation; however, little clinical research is focused on treating this population. Attachment-based family therapy (ABFT) is among the few empirically supported youth suicide treatments adapted for LGBQ adolescents. The purpose of this exploratory study is to determine the differential treatment effects and rates of change for LGBQ and heterosexual adolescents with depression and suicidal ideation receiving either ABFT or family enhanced nondirective supportive therapy (FE-NST).

METHOD

The sample included 129 adolescents (31% LGBQ), ages 12-18 randomized to the two treatment groups. Multilevel modeling was used to examine individual changes in depression and suicidal ideation over the 16-week treatment.

RESULTS

Results revealed that LGBQ adolescents in the ABFT condition showed a greater rate of reduction in depressive symptoms over treatment, slope = -0.94, p < 0.001, than did LGBQ adolescents in the NST condition, slope = -0.41, p = 0.12. Heterosexual adolescents showed symptom reduction in both treatment conditions (ABFT slope = -0.47, p < 0.001; NST slope = -0.79, t (113) = -7.48, p < 0.001). Changes in suicidal ideation were found across time, but not across conditions.

CONCLUSION

LGBQ adolescents in the ABFT condition had a sharper decrease in depressive symptoms and better outcomes at week 16.