Search

Objectives: Treating gender identity as a fixed characteristic may contribute to considerable misclassification and hinder accurate characterization of health inequities and the design of effective preventive interventions for transgender and gender diverse (TGD) adolescents and young adults. We examined changes in how an ethnically and racially diverse sample of TGD adolescents and young adults reported their gender identity over time, the implications of this fluidity on public health, and the potential effects of misclassification of gender identity. Methods: We recruited 235 TGD adolescents and young adults (aged 15-24 y) in Los Angeles, California, and New Orleans, Louisiana, from May 2017 through August 2019 to participate in an HIV intervention study. We asked participants to self-report their gender identity and sex assigned at birth every 4 months for 24 months. We used a quantitative content analysis framework to catalog changes in responses over time and classified the changes into 3 main patterns: consistent, fluctuating, and moving in 1 direction. We then calculated the distribution of gender identity labels at baseline (initial assessment) and 12 and 24 months and described the overall sample by age, race, ethnicity, and study site. Results: Of 235 TGD participants, 162 (69%) were from Los Angeles, 89 (38%) were Latinx, and 80 (34%) were non-Latinx Black or African American. Changes in self-reported gender identity were common (n = 181; 77%); in fact, 39 (17%) changed gender identities more than twice. More than 50% (n = 131; 56%) showed a fluctuating pattern. Conclusions: Gender identity labels varied over time, suggesting that misclassification may occur if data from a single time point are used to define gender identity. Our study lays the foundation for launching studies to elucidate the associations between shifting gender identities and health outcomes. [ABSTRACT FROM AUTHOR]

Sexual minority men (SMM) face persistent stigma in Zambia. From a holistic perspective, we aim to explore its impacts within and between multiple socioecological levels, demonstrating how their interactions create a vicious cycle of barriers to the well-being of SMM. In-depth interviews were conducted with 20 purposively recruited SMM from Lusaka, Zambia. All interviews were audio-recorded, after written consent, transcribed verbatim, and iteratively coded employing inductive (i.e., data-driven) approaches for thematic analysis using NVivo. Results suggest three key themes: (1) interpersonal socially perpetuated sexual minority stigma (SMS); (2) multidirectional interactions between psychosocial well-being and risk-taking behaviors; and (3) institutionally perpetuated SMS as a barrier to seeking and receiving health care. SMS permeates across all levels of the socioecological model to negatively impact the psychosocial well-being of SMM while acting also as a barrier to accessing HIV prevention and care. Our study necessitates structural public health intervention to decrease stigma and discrimination against SMM in Zambia, in efforts to increase their psychosocial well-being as well as their access to and utilization of HIV care by breaking the vicious cycle of SMS that pervades through the intrapersonal, interpersonal, and institutional levels of the socioecological model. [ABSTRACT FROM AUTHOR]

Although transgender women of color, specifically Black and Latina experience gender-based violence in a variety of contexts, one of the most consistently reported is from a dating or romantic partner. This qualitative study sought to understand the manifestations and consequences of stigma experienced by transgender women of color in their dating or romantic relationships. Between January and February 2019, we purposively recruited 33 transgender women of color to participate in five focus group discussions and complete a brief survey. We employed both inductive and deductive approaches to coding and thematic analysis. We identified different forms of anti-transgender interpersonal stigma experienced by transgender women of color seeking romantic relationships and by those in romantic relationships. For those dating and seeking relationships, anti-transgender interpersonal stigma took the form of dehumanizing stereotypes and sexual objectification. While these manifestations of anti-transgender interpersonal stigma persisted for some within relationships, concealment behaviors from partners was the predominant type of anti-transgender interpersonal stigma. Each of these forms of anti-transgender interpersonal stigma had significant gender-based violence consequences, specifically encountering physical violence, experiencing psychological trauma, and engaging in survival strategies. In the current climate of COVID-19, which is exacerbating risks of gender-based violence, there is an urgent need to understand and address the nuanced manifestations of stigma in relationships and their consequences on the lives of transgender women of color. Culturally grounded gender-based violence prevention policies and programs with transgender women should address these forms of stigma and build on community strengths. Findings also highlight the importance of future research and gender-based violence prevention programming with cisgender men in/seeking partnerships with transgender women of color. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) realities have demanded that educators move swiftly to adopt new ways of teaching, advising, and mentoring. We suggest the centering of a trauma-informed approach to education and academic administration during the COVID-19 pandemic using the Substance Abuse and Mental Health Services Administration's (SAMHSA) guidance on trauma-informed approaches to care. In our model for trauma-informed education and administration (M-TIEA), SAMHSA's four key organizational assumptions are foundational, including a realization about trauma and its wide-ranging effects; a recognition of the basic signs and symptoms of trauma; a response that involves fully integrating knowledge into programs, policies, and practices; and an active process for resisting retraumatization. Since educators during the pandemic must follow new restrictions regarding how they teach, we have expanded the practice of teaching in M-TIEA to include both academic administrators' decision making about teaching, and educators' planning and implementation of teaching. In M-TIEA, SAMHSA's six guiding principles for a trauma-informed approach are infused into these two interrelated teaching processes, and include the following: safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; and cultural, historical, and gender issues. M-TIEA's organizational assumptions, processes, and principles are situated within an outer context that acknowledges the potential influences of four types of intersectional traumas and stressors that may occur at multiple socioecological levels: pandemic-related trauma and stressors; other forms of individual, group, community, or mass trauma and stressors; historical trauma; and current general life stressors. This acknowledges that all trauma-informed work is dynamic and may be influenced by contextual factors. [ABSTRACT FROM AUTHOR]

Few studies have examined sexual partnerships and HIV risk in diverse samples of African American/Black and Hispanic/Latino adolescent and young adult men who have sex with men (YMSM), a group that have a high burden of HIV in the United States. A community–venue recruitment approach was used, which identified significant differences in HIV risk by sexual partner type among 1,215 YMSM. Those with casual partners had a higher number of sexual partners, had more sexually transmitted infections (STIs), were more likely to engage in transactional sex, and to use alcohol, marijuana, or other substances compared with those with main partners only. Among those with female sexual partners, many used condoms "every time" when engaging in vaginal sex with casual partners, but a sizable proportion "never/rarely" used condoms with their main partners. Our findings demonstrate a need for tailored HIV prevention education and counseling with necessary skills regarding consistent and correct condom use with all sexual partnerships. [ABSTRACT FROM AUTHOR]

Although a growing number of psychosocial health promotion interventions use the critical analysis of media to facilitate behavior change, no specific guidelines exist to assist researchers and practitioners in the selection and evaluation of culturally relevant media stimuli for intervention development. Mobilizing Our Voices for Empowerment is a critical consciousness-based health enhancement intervention for HIV-positive Black young gay/bisexual men that employs the critical analysis of popular media. In the process of developing and testing this intervention, feedback on media stimuli was collected from youth advisory board members (n = 8), focus group participants (n = 19), intervention participants (n = 40), and intervention facilitators (n = 6). A thematic analysis of qualitative data resulted in the identification of four key attributes of media stimuli and participants’ responses to media stimuli that are important to consider when selecting and evaluating media stimuli for use in behavioral health interventions employing the critical analysis of media: comprehension, relevance, emotionality, and action. These four attributes are defined and presented as a framework for evaluating media, and adaptable tools are provided based on this framework to guide researchers and practitioners in the selection and evaluation of media for similar interventions. [ABSTRACT FROM AUTHOR]

Black young gay, bisexual, and other men who have sex with men (YGBMSM) are at high risk for negative health outcomes, though this population is underrepresented in the health literature. An extensive literature review and content analysis of health-related peer-reviewed articles (1988-2013) was conducted that targeted Black YGBMSM, examining five content areas: sexual health, health care, substance use, psychosocial functioning, and sociostructural factors. A coding sheet was created to collect information on all content areas and related subtopics and computed descriptive statistics. Out of 54 articles, most were published after 2004 (N = 49; 90.7%) and addressed some aspect of sexual health (N = 50; 92.6%). Few articles included content on psychosocial functioning, including bullying/harassment, suicide, and racial/ethnic identity. Data on health care delivery/receipt and health insurance were underrepresented; tobacco use and substance abuse were seldom addressed. Important sociostructural factors, including sexual networks and race-based discrimination, were poorly represented. Last, there was a noteworthy deficit of qualitative studies and research exploring intersectional identity and health. This review concludes that studies on Black YGBMSM health places sex at the forefront to the neglect of other critical health domains. More research is needed on the diverse health issues of a vulnerable and underexamined population. [ABSTRACT FROM AUTHOR]

One emerging avenue for the exploration of adolescents’ sexual orientation identity development is the Internet, since it allows for varying degrees of anonymity and exploration. The purpose of this phenomenological study was to examine the role of the Internet in facilitating the sexual orientation identity development process of gay and bisexual male adolescents. Qualitative interviews were conducted with an ethnically diverse sample of 63 gay/bisexual male adolescents (ages 15-23). Participants reported using a range of Internet applications as they explored and came to accept their sexual orientation identity, with the intended purpose and degree of anonymity desired determining which applications were used. Youth reported that the Internet provided a range of functions with regard to the exploration and acceptance of their sexual orientation identity, including (1) increasing self-awareness of sexual orientation identity, (2) learning about gay/bisexual community life, (3) communicating with other gay/bisexual people, (4) meeting other gay/bisexual people, (5) finding comfort and acceptance with sexual orientation, and (6) facilitating the coming out process. Future research and practice may explore the Internet as a platform for promoting the healthy development of gay and bisexual male adolescents by providing a developmentally and culturally appropriate venue for the exploration and subsequent commitment to an integrated sexual orientation identity. [ABSTRACT FROM AUTHOR]

The present study examined the relationships between personality, coping strategies, and health ratings to extend past research to people living with chronic hepatitis C (HCV). Participants were 35 people (11 men, 24 women; M age=49.6 yr., SD=10.6) living with chronic hepatitis C for an average of 9.0 yr. (SD=6.0) since diagnosis. Participants provided descriptions of stressful situations and responded to a personality inventory, Ways of Coping Questionnaire scales (planful problem solving and escape=avoidance) and SF36 Health Survey scales measuring physical functioning and mental health. The stressful situations were judgmentally clustered into seven dimensions (diagnosis/mortality, disclosure, stigma, social and work role functioning, compounding problems, and no stress). Correlational analyses indicated strong negative relationships between escape-avoidance coping and health measures. Emotional Stability and Extraversion were positively related to both health variables, and Extraversion was negatively related to escape-avoidance coping. The results suggest that research from other contexts that has examined these relationships tended to generalize to people living with HCV. [ABSTRACT FROM AUTHOR]

Successful community partnerships for youth are based on the premise that reciprocity exists between all parties, but to what extent is equal power actually present? The current investigation examines the benefits and contributions associated with partnerships from community partners’ perspectives. Respondents from 15 different Connect to Protect® coalitions initiated by the Adolescent Medicine Trials Network for HIV/AIDS Interventions were interviewed at the onset of their partnerships. Community partners asserted that their contributions to partnerships are more varied than researchers’, yet they perceived that researchers acquire more kinds of benefits. Findings indicate nuances regarding reciprocity and power inequities between partners. Community partners’ insights have implications for defining best practices within partnerships that benefit youth. [ABSTRACT FROM AUTHOR]

Few studies have examined the relationship between young gay and bisexual men (YGBM) and their fathers. Based on a phenomenological framework, this study investigated the role of fathers in YGBM’s coming-out experience, focusing on how fathers responded to disclosure of same-sex attraction, how fathers’ responses compared with sons’ expectations, and what sons perceived as having influenced their fathers’ responses. Semistructured in-depth interviews with 30 gay and bisexual men aged 18 to 24 years were conducted as part of a larger study; topics explored in the interview included experiences coming out to family and others. Nineteen participants’ narratives included discussion about their fathers and were included in the current analyses. The YGBM who were interviewed perceived a complex range of responses upon coming out to their fathers, ranging from enthusiastic acceptance to physical violence. Participants spoke of fathers who were accepting in different manners and who often held contradictory attitudes about same-sex attraction. Fathers’ responses commonly differed from sons’ expectations, which were informed by homophobic talk and gendered expectations. Sons spoke about what informed their expectations as well as what they perceived as influencing their fathers’ responses, including gender norms, beliefs regarding the cause of same-sex attraction, religious and sociopolitical views, and concerns about HIV/AIDS. Particularly striking was the pervasive influence of hegemonic masculinity throughout the YGBM’s stories. The implications of these findings for future research and intervention development are discussed, as well as study strengths and limitations. [ABSTRACT FROM PUBLISHER]

Relationship dynamics develop early in life and are influenced by social environments. STI/HIV prevention programs need to consider romantic relationship dynamics that contribute to sexual health. The aim of this study was to examine monogamous patterns, commitment, and trust in African American adolescent romantic relationships. The authors also focused on the differences in these dynamics between and within gender. The way that such dynamics interplay in romantic relationships has the potential to influence STI/HIV acquisition risk. In-depth interviews were conducted with 28 African American adolescents aged 14 to 21 living in San Francisco. Our results discuss data related to monogamous behaviors, expectations, and values; trust and respect in romantic relationships; commitment to romantic relationships; and outcomes of mismatched relationship expectations. Incorporating gender-specific romantic relationships dynamics can enhance the effectiveness of prevention programs. [ABSTRACT FROM PUBLISHER]

This article presents findings from a qualitative evaluation of an HIV/STI (sexually transmitted infection) prevention intervention for urban African American youth (Project ÒRÉ), which was delivered to groups of 3 to 8 adolescents who were members of the same friendship network. Sixteen focus groups (N = 63) were conducted with youth following their participation in the intervention. Results demonstrate high acceptability of the intervention. Both males and females revealed multiple benefits of attending the intervention with friends including feeling more comfortable, experiencing general satisfaction with the program, experiencing greater ease in talking and expressing self, being able to reveal sensitive information, and being able to relate to each other’s experiences. Additional themes were presented only by males including feeling a sense of cohesion, the ability to protect each other from HIV/STIs in the future, and feeling safe. These results suggest that delivering HIV/STI and other prevention interventions within adolescents’ friendship networks may offer unique benefits not found with traditional programs that include random groupings of youth who are not familiar with each other. [ABSTRACT FROM AUTHOR]

Although interpersonal respect is considered an important quality in successful romantic relationships, limited attention has been paid to this concept. We examined the meaning of respect in romantic relationships as conceptualized by low-income, sexually active, heterosexually identified, African American adolescents aged 15 to 17 (N = 50). Qualitative analysis revealed meanings of respect within the romantic dyad that could be divided into three broad themes: (a) performance of pro-social behaviors within the dyad, (b) inhibition of antisocial behaviors (e.g., violence), and (c) showing respect in the community, either through avoidance of situations that might embarrass one’s romantic partner or performance of pro-social acts in public contexts (e.g., with friends or family). Gender, social class, and cultural differences in displays of respect and their interpersonal functions are discussed. A conceptual model is proposed both to understand the potential role that respect plays in adolescents’ lives and relationships and as a guide for future study. [ABSTRACT FROM AUTHOR]

This qualitative study explores the future life goals reported by a sample of HIV-positive gay/bisexual male emerging adults. Semi-structured interviews were conducted with 54 participants ages 17-24 at four geographically and demographically diverse adolescent HIV medicine programs to explore the content of participants’ goals, perceived obstacles and sources of resilience. We provide descriptive data on goals articulated by participants to begin to understand (1) how gay male emerging adults may differ from the heteronormative samples that have characterized most research on emerging adulthood to date, (2) how living with HIV/AIDS may impact the future life goals of this population, and (3) implications for HIV/AIDS service providers as HIV-positive emerging adults are transitioned from adolescent to adult care. [ABSTRACT FROM AUTHOR]

There is an urgent need for continued innovation in the design of HIV/STI prevention interventions for African American females, a group at high risk for STIs and HIV. In particular, attention to social development and to culture is needed. The present study reports on a group randomized controlled trial of a friendshipbased HIV/STI prevention intervention delivered at community-based centers in four San Francisco neighborhoods (n = 2, experimental; n = 2, control). This brief program focuses on youth and their friendship group (N = 264). Program outcomes vary by age at 3-month follow-up, evidencing decreases in risky sex in the oldest group (p ≤ .05), decreases in multiple partners in the middle age group (p ? .05), and increases in HIV testing in the youngest group (p = .05). Findings extend recent work on the efficacy of interventions to reduce sexual risk for racial and ethnic minority youth. [ABSTRACT FROM AUTHOR]

Transdisciplinary research and evaluation projects provide valuable opportunities to collaborate on interventions to improve the health and well-being of individuals and communities. Given team members' diverse backgrounds and roles or responsibilities in such projects, members' perspectives are significant in strengthening a project's infrastructure and improving its organizational functioning. This article presents an evaluation mechanism that allows team members to express the successes and challenges incurred throughout their involvement in a multisite transdisciplinary research project. Furthermore, their feedback is used to promote future sustainability and growth. Guided by a framework known as organizational development, the evaluative process was conducted by a neutral entity, the Quality Assurance Team. A mixed-methods approach was utilized to garner feedback and clarify how the research project goals could be achieved more effectively and efficiently. The multiple benefits gained by those involved in this evaluation and implications for utilizing transdisciplinary research and evaluation teams for health initiatives are detailed. [ABSTRACT FROM AUTHOR]

The current study examined differences between gang-involved and non-gang-involved homeless African American male youth with regard to negative affect, substance use, and antisocial/violent behavior. A total of 69 homeless African American young men were recruited from community agencies and completed structured face-to-face interviews. Overall, gang members reported higher rates of negative mental and physical health outcomes than did non-gang members, with current gang members reporting higher levels of depression and anxiety, greater levels of antisocial and violent behavior, and higher levels of lifetime alcohol and marijuana use. Multiple linear regression analyses revealed that greater levels of gang involvement were associated with more frequent lifetime use of alcohol and marijuana and higher levels of participation in violent behaviors. Implications of these findings for interventions with homeless African American male youth and future research directions are discussed. [ABSTRACT FROM PUBLISHER]

The article examines an interactive and contextual model of community-university collaborations for research and action. The section proposes an interactive and contextual model for developing and sustaining community-university partnerships. The study explores on gaining entry into the community, developing and sustaining a mutual collaboration, and recognizing the benefits and outcomes of partnership work. It also offers the probable challenges that might threaten the partnership, such as resource inequality and time commitment.

Describes the development and maintenance of a successful university community-based organization (CBO) collaboration that was formed to explore HIV-related risk rates and prevention strategies for suburban street youth. Discussion on the benefits and challenges of including out-of-the-mainstream youth as full collaborative partners in the research; Formation of the collaboration; Criteria used to select the youth hired into the project; Conclusions.

Purpose: To examine health risk behaviors in distressed youth living with HIV (YLH) with problem substance use. Methods: Assessed distress, antiretroviral (ARV) adherence, and unprotected sex in a racially and geographically diverse sample of 122 YLH. Results: A total of 87% of distressed YLH reported significantly more past-month ARV non adherence (odds ratio [OR] = 7.15) and were more likely to have unprotected sex under the influence (OR = 5.14) than non distressed youth. Conclusions: Distressed YLH with problem substance use may benefit from interventions to improve adherence and to decrease sexual risk, especially while under the influence of drugs. [ABSTRACT FROM AUTHOR]

Background. Gay, bisexual, and transgender youth (GBTY) experience sexual health inequities and contend with intersectional oppression. The Michigan Forward in Enhancing Research and Community Equity (MFierce) Coalition formed as an intergenerational, collaborative, multisector partnership with a focus on implementing community-identified policy, systems, and environmental (PSE) change strategies to address inequities and injustices. Aims. We describe MFierce coalition development and structural change activities organized within Collaborating for Equity and Justice (CEJ) principles and provide empirical data supporting the utility of such principles. Method. We prioritized leadership by GBTY and created personal and professional capacity-building activities to support GBTY in being change agents. Our work was grounded in community-engaged scholarship and used a shared-power community development process. Our PSE change intervention, the Health Access Initiative (HAI), was a structural change program for health facilities aimed at improving the quality of and access to sexual health care for GBTY. Results. We evaluated coalition functioning and activities through multimethod assessments and evaluated PSE changes through HAI participant surveys. Data demonstrated positive and steady coalition dynamics, multiple benefits of participation for GBTY, and strategies for collaborative multigenerational community work. HAI outcome data revealed significant increases in PSE changes. Discussion. Centering life experiences of GBTY in collaborative partnerships and building opportunities for professional and personal development can support sustainable community change. We offer recommendations for developing future intergenerational, collaborative, multisector partnerships that prioritize youth leadership. Conclusion. Collaborative methods and careful consideration of adult–youth dynamics can inform future transformative efforts focused on health equity and justice for GBTY. [ABSTRACT FROM AUTHOR]

In the context of a U.S. dominant masculinity ideology, which devalues men who are not heterosexually identified, many gay, bisexual, and questioning (GBQ) adolescent males must develop their own affirming and health-promoting sense of masculinity. In order to promote the well-being of GBQ young men, exploration of their reactions and responses to dominant images of masculinity is needed. The authors qualitatively analyzed interviews with 39 GBQ African American, Latino, and European American male adolescents (15 to 23 years old). Participants reported a range of responses to traditional masculinity ideologies, most of which centered on balancing presentations of masculine and feminine characteristics. Negotiation strategies served a variety of functions, including avoiding antigay violence, living up to expected images of masculinity, and creating unique images of personhood free of gender role expectations. These data suggest a complex picture of GBQ male adolescents’ management of masculinity expectations and serve as a basis for culturally and developmentally specific HIV prevention programs. [ABSTRACT FROM AUTHOR]