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Correct and consistent condom use has been the primary method of HIV prevention until the FDA approve the use of PrEP in 2012. While strong evidence existing regarding the efficacy of PrEP, uptake has remained slower than anticipated. While work is underway to better understand the factors impacting uptake, the majority of this work as been focused on white gay, bisexual, and other men who have sex with men (GBMSM) living in metropolitan regions of the coastal U.S. The current study used a community-based framework to assess perceived social norms through a elicitation survey. A total of 104 GBMSM met inclusion criteria for the study. Several analytic categories emerged across questions and a number of differences were found across race and ethnicity such as who would approve or disapprove off PrEP and who would be likely to use PrEP. Further, we found differences between injunctive and descriptive norms. These findings suggest that there are unique factors contributing to PrEP uptake among racial and ethnic minority GBMSM and that to fully understand uptake a more robust measure of perceived norms may be needed.

Homelessness is a priority public health issue in the United States (U.S.) given its strong associations with multiple adverse health outcomes. While overall rates of homelessness have decreased over the last decade, some populations—such as sexual and gender minorities—have not seen equitable decreases. The present study explores the relationship between experiences of first-time homelessness with substance misuse (assessed via the DAST-10) and depression and anxiety (assessed via the PHQ-4) in an adult sample of SGM individuals in South Central Texas. The analytic sample (n = 907) was majority gay/lesbian or same-gender loving (55.8%) followed by bisexual or pansexual (34.7%) or another sexual identity (9.5%) and 12.5% were transgender. First-time homelessness was more common in childhood than adulthood. Multivariate logistic regression models were used to evaluate relationships between first-time homelessness and outcomes of interest. The odds of substance misuse (DAST > 3) were marginally higher for those experiencing first-time homelessness in childhood and significantly higher for those reporting first-time homelessness in adulthood. The odds of experiencing past 2-week depression were significantly greater for those reporting homelessness in childhood or adulthood. However, only first-time homelessness in adulthood was significantly associated with past two-week anxiety. These findings underscore the need to consider intersectionality when exploring solutions to existing health disparities, as this work suggests that both sexual and gender identity and homelessness are important factors in shaping mental and behavioral health outcomes. [ABSTRACT FROM AUTHOR]

The rates of intimate partner violence have been found to be higher among lesbian, gay, and bisexual (LGB) individuals when compared with heterosexual populations. However, lesser is known about the impact of specific minority stressors experienced by LGB populations on their face-to-face intimate partner violence (IPV) and cyber IPV experiences. Using a three-step latent class approach, the present study investigated (i) the latent classes of self-reported types of face-to-face IPV and cyber IPV perpetration and victimization and (ii) their associations with LGB distal and proximal minority stressors (i.e., vicarious trauma, discrimination, family rejection, and LGB-identity disclosure). Participants were 288 LGB emerging adults in the age range of 18–29 years (bisexual: n = 168, gay: n = 72, and lesbian: n = 48). Findings showed the presence of four latent classes, namely, face-to-face IPV (n = 32; 37.5% gay, 18.8% lesbian, and 43.8% bisexual individuals), cyber IPV (n = 66; 33.3% gay, 12.1% lesbian, and 54.5% bisexual individuals), psychological and stalking cyber IPV (n = 89; 15.7% gay, 15.7% lesbian, and 68.5% bisexual individuals), and low IPV (n = 101; 23.8% gay, 19.8% lesbian, and 56.4% bisexual individuals). Furthermore, multinomial logistic regressions indicated that greater exposure to the minority stressors such as exposure to heterosexism, namely, discrimination and harassment, rejection from one's family of origin, and exposure to vicarious trauma, as well as a lower degree of LGB-identity disclosure, largely predicted latent classes with greater probabilities of IPV exposure, namely, cyber IPV, face-to-face IPV classes, and psychological and stalking cyber IPV. Findings suggest the importance of addressing the role of minority stressors in IPV interventions and the creation of competent LGB-related services and training modules for clinicians. [ABSTRACT FROM AUTHOR]

Scholars theorize that the development of community is an important part of resilience. In this mixed‐methods study, we argue that race informs the experiences that transgender and non‐binary (TNB) people have in seeking community. Using the Strengthening Colors of Pride Phase I and Phase II research, we argue that in a Latino‐majority city, Latinx and Anglo TNB people connected with the transgender and broader lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community, although Anglo TNB people reported more transphobia in the LGBTQ+ community. Black and American Indian TNB people connected with LGBTQ+ communities of color specifically and struggled more to find in‐person community. Anglo TNB people used their own White racial networks to connect with supportive hobby and interest groups. In general, TNB people connected more with communities that resonated with the multiplicities of their own lives, such as commonalities of economic precarity and immigration status. This research is an important contribution to understanding the development of community for resilience, and the way race and gender identity inform community experiences for TNB people. [ABSTRACT FROM AUTHOR]

Research has shown that compared to younger individuals, older adults are at a similar risk for acquiring HIV. Additionally, screenings for HIV/STD tend to be lower among older adults, with this group seeing themselves at less risk for HIV/STD compared to their younger counterparts. Limited information exists concerning older bisexual men outside examining aggregated populations of sexual minority men (e.g., MSM). The purpose of this exploratory study was to examine the sexual health, behaviors, and evaluation of last sexual event among older (≥ 50 years old) compared to younger (< 50 years old) bisexual men. Data were collected in collaboration with a social and sexual networking website catering to men who have sex with men. Findings suggest that older bisexual men continue to be sexually active and that strategies need to be developed to better reach this population regarding HIV/STD prevention and education. [ABSTRACT FROM PUBLISHER]

Objective: Obesity is rising in people with HIV (PLWH) and Hispanics. Both HIV and obesity are associated with cardiovascular disease morbidity and mortality. Our goal is to understand perceptions of body image and lifestyle in Hispanics with HIV to adapt interventions appropriately. Methods: We conducted semi-structured interviews with 22 Hispanic PLWH and 6 providers. Purposive sampling selected patient participants across weights and genders. Interviews were coded and analyzed using grounded theory, comparing perspectives between patients with and without obesity, and patients and providers. Results: Participants felt obesity and diabetes were "normal" in the community. Patients exhibited understanding of healthy diet and lifestyle but felt incapable of maintaining either. Traditionally Hispanic foods were blamed for local obesity prevalence. Five patients equated weight with health and weight loss with illness, and four expressed concerns that weight loss could lead to unintentional disclosure of HIV status. Participants with overweight or obesity expressed awareness of their weight and felt shamed by providers. Providers found weight loss interventions to be ineffective. Conclusion: Interventions in this population must address identified barriers: overweight/obesity as a normative value, lack of self-efficacy, cultural beliefs surrounding food, fear of HIV-associated weight loss and stigma, and provider perspectives on intervention futility. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to assess the relationship between adverse childhood experiences (ACEs) exposure, perceived discrimination, and anxiety and depressive symptoms in sexual and gender minoritized (SGM) adults in the United States. Methods: Respondents ( n = 4445) from a national Qualtrics research panel completed a web-based survey. Guided by the stress proliferation (mediation model) and stress sensitization (moderation model) models, we examined the relationships between ACEs and perceived discrimination and the severity of anxiety and depressive symptoms in adulthood. Results: Cumulative ACEs exposure was positively associated with everyday discrimination scale (EDS) scores. ACEs and EDS scores had a significant direct association with anxiety and depressive symptoms. We found support for EDS as a mediator for anxiety ( β = 0.12, p < 0.001) and depressive symptoms ( β = 0.14, p < 0.001) and for ACEs as a moderator of the relationship between EDS and anxiety ( β = -0.04, p = 0.004) and depressive ( β = -0.05, p = 0.001) symptoms. Conclusions: These findings suggest that both stress proliferation and stress sensitization likely contribute to disparities in anxiety and depressive symptoms in SGM adults. This finding supports the integration of social safety and minority stress perspectives regarding health disparities in SGM populations. Exposure to early life adversity likely alters neurodevelopment, which in turn increases awareness of the lack of social safety in adulthood, reduces capacity to cope with minority stress exposure, and ultimately contributes to increased anxiety and depressive symptoms. Prevention efforts should focus on building positive and compensatory childhood experiences.

Marginalized communities have been disproportionately affected by COVID-19, including both racial/ethnic minority and sexual minority populations. To date, there has been little research examining the impact of the COVID-19 pandemic at the intersections of marginalized identities. Furthermore, available national data on COVID-19 outcomes may obscure our understanding of region-specific outcomes, particularly in the U.S. South. Using an intersectional approach, we explore differences in worries over COVID-19, preventative behaviors, and COVID-19 outcomes in the early months of the pandemic in a diverse sample of LGBTQ people ( N  = 1076) living in Texas. Our findings indicated that LGBTQ Latinx people in Texas reported more COVID-19 related worries and adverse outcomes than non-Latinx LGBTQ people. These findings are in line with previous research that found that the increased risk to Latinx and LGBTQ populations in public health crises is often overlooked and can be attributed to many factors such as socioeconomic status, occupational propensity, disparities in physical health, and barriers to healthcare access. Furthermore, our findings suggest the necessity of utilizing an intersectional approach when examining the disproportionate burden marginalized communities face in public health crises.

Introduction: The manifold consequences of adverse childhood experiences (ACEs) are well-documented. Recent research has demonstrated that sexual and gender minorities (SGMs) typically encounter ACEs more often than cisgender heterosexual individuals. Given the higher exposure rate, the measurement of frequency of exposure to traumatic events may be relevant for SGMs., Methods: We changed the response options of the ACEs index from dichotomous to a five-point Likert scale that described frequency of exposure. As part of a larger community-based participatory research study, the Likert ACEs measure was distributed to a large and diverse sample of SGM participants in San Antonio., Results: A cross-validation design demonstrated that the Likert ACEs scores outperformed the traditional ACEs index in predicting self-reported anxiety and post-traumatic stress disorder. Half of the SGMs in this sample experienced 3 or more ACEs, compared to only 10% of Americans in a nationally representative sample., Limitations: These analyses were based on retrospective self-report data instead of structured clinical interviews. Since only the Likert ACEs was administered, we had to assume that any response other than "never" on Likert ACEs corresponded to "yes" on the ACEs Index., Conclusions: Future research may assess the utility of the Likert ACEs approach with other minoritized or intersectional populations. For clinical practitioners, these results suggest that a better way to measure ACEs for SGMs is to ask them how often they were exposed, rather than asking whether they were exposed., (Copyright © 2020. Published by Elsevier B.V.)

Objective: Obesity is rising in people with HIV (PLWH) and Hispanics. Both HIV and obesity are associated with cardiovascular disease morbidity and mortality. Our goal is to understand perceptions of body image and lifestyle in Hispanics with HIV to adapt interventions appropriately., Methods: We conducted semi-structured interviews with 22 Hispanic PLWH and 6 providers. Purposive sampling selected patient participants across weights and genders. Interviews were coded and analyzed using grounded theory, comparing perspectives between patients with and without obesity, and patients and providers., Results: Participants felt obesity and diabetes were "normal" in the community. Patients exhibited understanding of healthy diet and lifestyle but felt incapable of maintaining either. Traditionally Hispanic foods were blamed for local obesity prevalence. Five patients equated weight with health and weight loss with illness, and four expressed concerns that weight loss could lead to unintentional disclosure of HIV status. Participants with overweight or obesity expressed awareness of their weight and felt shamed by providers. Providers found weight loss interventions to be ineffective., Conclusion: Interventions in this population must address identified barriers: overweight/obesity as a normative value, lack of self-efficacy, cultural beliefs surrounding food, fear of HIV-associated weight loss and stigma, and provider perspectives on intervention futility.

The purpose of this study was to understand how bear identity influenced condom use during the last anal sex event. Participants were recruited to complete an online, anonymous self-report survey through bear-related sexual and social networking websites. A total of 1,080 men who identified as gay or bisexual and as a member of the bear community and were 18 years or older completed the survey. Overall, fewer than a third of men reported condom use during the most recent receptive (28%) and insertive (30%) anal sex event. Men in bear concordant pairings were less likely to use a condom during receptive and insertive anal sex compared to those is discordant pairings (p < .05). Findings suggest that bear identity concordance influences condom use during anal sex after accounting for an individual's relationship to their most recent partner as well as other confounding variables.