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OBJECTIVE: Physicians often feel they are not equipped to serve the lesbian, gay, bisexual, and queer (LGBTQ) community, but integrating education that incorporates LGBTQ content and perspective into an already-condensed medical school curriculum is challenging. We developed a preclinical active learning module on assisted reproductive technologies (ART) in LGBTQ care, integrating clinical and basic science content with patient perspective. METHODS: We created a module that combined a case-based small group discussion with a patient panel. We developed a case for discussion in collaboration with a female cis-gender same-sex couple who conceived through ART. A patient panel with the same couple followed the discussion. All first-year medical students attended both parts of the module. Prior to participation, students learned reproductive endocrinology and genetics concepts through lectures. After the module, students voluntarily completed an anonymous survey to evaluate self-perceived changes in familiarity and confidence with LGBTQ patients and satisfaction with the module. RESULTS: Of the 126 students who attended, 72 (57%) completed the survey. Of these, 69 (95.8%) felt the module gave them better perspectives on LGBTQ patient experiences, and 66 to 69 (92-96%) agreed the small group discussion achieved its learning objectives on LGBTQ health barriers and the application of ART. Students valued the patient panel (84.7%) and cited a better understanding of reproductive barriers for LGBTQ patients as its most valuable point. CONCLUSION: A preclerkship module combining a case-based small group discussion and patient panel on ART delivered in the context of a real-life LGBTQ patient experience provided an opportunity for the students to integrate basic science and clinical science knowledge to reflect on the healthcare needs of this patient population. Creating the case in collaboration with the same-sex couple and having them present their own experience provided an authentic perspective to students on reproductive healthcare issues and how they impact members of the LGBTQ community.

Objectives: Screening tools in which participants self-report sexual behaviors can identify people at risk of HIV acquisition for enrollment in preexposure prophylaxis (PrEP). We compared enrollment outcomes (ie, receiving PrEP vs being excluded by a counselor or declining PrEP) in Mexico's PrEP demonstration project and evaluated the validity of a 4-criteria PrEP eligibility tool in which participants self-reported risk behavior—having condomless anal sex, transactional sex, a partner living with HIV, or a sexually transmitted infection—as compared with PrEP eligibility assessed by a counselor. Methods: We recruited men who have sex with men and transwomen who were offered PrEP services in Mexico. We characterized participants according to enrollment outcome and identified underlying factors through logistic regression analyses. We calculated the sensitivity and specificity of the self-reported risk criteria, using the counselor's risk assessment as the point of reference. Results: Of 2460 participants, 2323 (94%) had risk criteria of HIV acquisition according to the 4-criteria tool; 1701 (73%) received PrEP, 247 (11%) were excluded by a counselor, and 351 (15%) declined PrEP despite being considered eligible by the counselor. Participants who were excluded or who declined PrEP were less likely to report HIV risk behaviors than those who received PrEP, and participants who declined PrEP were more likely to be transwomen (vs men who have sex with men) and aged ≤25 years (vs >25 y). The 4-criteria risk tool had high sensitivity (98.6%) and low specificity (29.8%). Conclusion: The screening tool identified most participants at risk of HIV acquisition, but counselors' assessment helped refine the decision for enrollment in PrEP by excluding those with low risk. Public health strategies are needed to enhance enrollment in PrEP among some groups. [ABSTRACT FROM AUTHOR]

Bisexuality in fatherhood is largely invisible, with very little known about the experiences of bisexual fathers. Conducted by researchers in the United Kingdom, this study is one of the first to explore the experiences of bisexual fathers, and, using an identify-focused approach, it aims to understand bisexual fathers' experiences of managing their bisexuality and role as a father. Twenty-four bisexual fathers in Europe and North America took part in qualitative, semistructured interviews that focused on their bisexual identity, becoming a parent, experiences of family life, and community involvement. Reflexive thematic analysis was conducted, and four themes were identified: valuing different types of authenticity, seeking safety in the community, reconciling bisexuality with the traditional family, and sharing and learning across age groups. Despite describing their identity as often invisible, fathers indicated that their personal identity had a significant impact on their social interactions as well as their individual parenting and family practices. Findings contrast stage models of LGBTQ+ identity development, as fathers' identity work practices were often more important for their identity development and integration than aspiring for full "outness." Findings expand our scholarly understanding of the role of identity in parenting and highlight the need to improve representation and support for bisexual fathers. [ABSTRACT FROM AUTHOR]

Lesbian, gay, bisexual, transgender, queer, and all sexually and gender diverse (LGBTQ+) youth with HIV face multiple barriers to progression along the HIV care continuum. We searched PubMed, PsycInfo, clinicaltrials.gov, and the Adolescent Medicine Trials Network for HIV/AIDS Interventions for interventions focused on improving linkage to care, retention in care, adherence to antiretroviral therapy, or viral suppression (VS) among LGBTQ+ youth with HIV in the United States. Included studies were published in English between January 1, 2017 and December 31, 2022, took place in the United States, and had samples with a minimum age of 12 years, a median or mean age of 24 years or less, and with ≥50% reporting an LGBTQ+ identity. Our search identified 11 interventions that met our criteria, of which only three were designed and tailored exclusively for LGBTQ+ populations. Interventions used a variety of modalities, including remote electronic delivery, in-person delivery, or both. Interventions most commonly aimed to enhance self-efficacy, HIV health knowledge, and medication self-management to facilitate improvements in HIV care continuum outcomes. Only two interventions showed statistically significant improvements in VS. More interventions tailored for LGBTQ+ youth are needed to end the HIV epidemic in the United States. [ABSTRACT FROM AUTHOR]

Research on the LGBTQ + community in the Caribbean is limited, a issue made all the more concerning because the people in that community do not have the same rights as their heterosexual counterparts. In Barbados, homosexual acts carried out in public or private were until recently (2022) punishable by law. This systematic literature review details information from 13 studies published between 2013 and 2022. The studies varied in methodological approach, study context and participant demographics, however four major themes arose from the research. These studies explored participants knowledge and understanding of the LGBT + community, the effects of homophobia, HIV, and the needs of the LGBT + community. Research focused more on the opinions of non-LGBTQ + participants than the experiences of that community, and it is noted that stigma, and discrimination still appears to be rife in the Barbadian population. This study reviews and analyses relevant research and provides recommendations for future practice and research. [ABSTRACT FROM AUTHOR]

There is a current interest in implementing education programmes to reduce prejudice towards gay individuals. This study investigates how adolescents recognise gay stereotypes in characters and how video-on-demand series could be utilised to reduce bias in Spain and Mexico. Six focus groups (Spain: (1) gay, (2) heterosexual, (3) LBTQ+; Mexico: (4) gay, (5) heterosexual, (6) LBTQ+) are used to explore the main stereotypes, to analyse how they are perceived in serialised fiction and to investigate their potential use in education programmes. The thematic analysis reveals that the primary stereotypes identified by young Mexicans and Spaniards are associated with femininity and perversion, as well as the belief that the main factors that encourage these stereotypes are religion and politics. LBTQ+ participants are also more critical of the depictions than heterosexuals. Education programmes should not only target young people but also engage the individuals and institutions that are close to them. [ABSTRACT FROM AUTHOR]

Sexual minorities have higher rates of anxiety, depression, and binge eating compared to heterosexual peers. Internalized weight bias (IWB) is also higher for sexual minorities when compared to heterosexual peers. However, research has not examined whether the relationships between IWB and anxiety, depression, and binge eating differ among heterosexual and sexual minority adults pursuing bariatric surgery. To examine whether sexual orientation (heterosexual or sexual minority) moderated the relationships between IWB and anxiety, depression, and binge eating among adults pursuing bariatric surgery. University hospital, United States Participants included 811 adults who presented for bariatric surgery, 45 (5.5%) of which identified as a sexual minority. Self-reported data were collected as part of a standard preoperative psychological evaluation for surgical clearance. Three separate moderation models were run to test hypotheses. Sexual orientation did not moderate the association of IWB with anxiety or depression. The IWB by sexual orientation interaction was significant for binge eating (F 1856) = 4.84, P =.03, R2 =.27 such that the association between IWB and binge eating was significantly stronger for sexual minority patients (b =.54, 95% confidence interval {CI} [.36,.70]), compared to heterosexual patients (b =.33, 95% CI [.30,.38]). Minority stress from identifying as a sexual minority may increase vulnerability to binge eating from IWB among bariatric candidates. Future research examining the directionality of the relationship between IWB and binge eating among sexual minorities is warranted. • Internalized weight bias by sexual orientation was significant for binge eating. • This association was significantly stronger for sexual minority patients. • Minority stress may increase vulnerability to distress prior to bariatric surgery. [ABSTRACT FROM AUTHOR]

This study explores the perceptions of the Undetectable = Untransmittable (U = U) campaign among gay men with HIV in Japan who are part of the HIV community on Twitter. We conducted detailed semistructured interviews with 12 participants using a modified grounded theory approach. The analysis resulted in 31 concepts, 5 subcategories, 9 categories, and 2 core categories. The relationship between categories and core categories was examined in conjunction with the transcriptions, yielding a comprehensive category map depicting the process of understanding U = U. The three main processes emerged: participants expressed "expectations for improvement," underwent stages of "understanding U = U," and encountered "dilemmas" in forming their opinions. There are two routes to "understanding U = U": Route 1 involved a frictionless understanding of U = U, and Route 2 involved difficulty in understanding the slogan. In both routes, participants experienced the dilemma of "but I still have HIV" and regarding its ease of use. These dilemmas and difficulties in understanding U = U affected their "expectations for improvement." Efforts to promote U = U in Japan must address challenges in public understanding and related dilemmas. This entails reformulating the U = U message in simpler terms, leveraging professional explanations, disseminating it to a broader audience, and incorporating ideas from individuals living with HIV to enhance the message. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the self-perceived reasons of suicide attempts among sexual and gender minorities (SGM). We surveyed SGM living in Canada (n = 2778) and respondents who had attempted suicide answered open-ended questions about their perceived reason(s) of their first/only attempt (FOA) and last attempt (LA) (for those who attempted multiple times). Responses were double-coded and categorized as discrete findings. A quarter (25%, n = 695) of the total sample reported a history of suicide attempt, of whom 72% reported multiple attempts. Respondents described a wide variety of reasons for their suicide attempts, with an important number of individuals reporting multiple reasons (corresponding to 47.5% of FOA and 43% of LA). Emotional issues (FOA:42.1%, LA:44.0%) were the most prevalent category of reasons for suicide attempts followed by experience of mental illness (FOA:30.1%, LA:36.1%). Other common reasons included violence (FOA:23.2%, LA:10.2%), interpersonal conflict (FOA:13.4%, LA:6.0%), stress related to life circumstances (FOA:9.5%, LA:16.7%), relationship issues (FOA:7.9%, LA:13.3%), and minority stress related to sexuality (FOA:11.1%, LA:6.2%) and gender identity (FOA:5.0%, LA:6.8%). SGM assessments of the reasons underlying their suicide attempts yielded a variety of factors, many of which were absent from the literature on SGM suicide but amenable to tailored interventions. [ABSTRACT FROM AUTHOR]

This qualitative study was conducted to understand how gay and bisexual men (GBM) in Taiwan cope with childhood bullying because of their sexual orientation or gender nonconformity. We explored their journey from feeling disturbed to receiving social support, developing coping strategies, and achieving self-growth. Colaizzi’s phenomenological approach was used to investigate subject experiences. Semi-structured interviews were conducted with 21 GBM who had experienced high-level sexual bullying in childhood. Relevant data were collected to assess their experiences of sexual bullying, their coping strategies, and subjective effects of corresponding adjustments in interpersonal interactions. Subject experiences concentrated on six themes related to sexual bullying and coping strategies: bullying at developmental stages, bullying everywhere, facing bullying alone, various impacts of bullying, overcoming challenges of interpersonal relationships, and building a strong and carefree self. Our findings can provide mental health professionals with key insights into the contexts of sexual bullying and the associated psychological distress in GBM. This study further clarifies the coping responses of these individuals and their psychological growth following such adverse experiences. [ABSTRACT FROM AUTHOR]

Background: Clinical competence encompasses attitudes, skills, and knowledge regarding diverse client groups. Appropriate clinical competence requires an understanding of the cultural context in which healthcare is delivered. In conservative countries such as Israel, there is a noticeable scarcity of information regarding the clinical competency of physiotherapy students (PTSs) in effectively treating lesbian, gay, bisexual and transgender (LGBT) individuals. The objective of this study was to assess the level of LGBT clinical competence among PTSs in Israel. Methods: Conducted through an anonymous online self-report survey, this study gathered personal and academic background information and self-reported data on previous LGBT education during undergraduate studies of PTSs. It utilized the Hebrew version of the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS) questionnaire. Descriptive statistics were computed for all outcome measures. The internal reliability of the LGBT-DOCSS was assessed. Total scores of the LGBT-DOCSS, along with scores in each of the three subscales (clinical preparedness, knowledge, and attitudes), were compared across different levels of religiosity and gender. Results: The sample comprised of 251 PTSs, with an average age of 25.57 ± 3.07 years (34.7% men, 65.3% women). All students reported a lack of LGBT community-related courses during their undergraduate studies. The translated Hebrew version demonstrated good internal consistency, with Cronbach's alpha ranging from 0.65 to 0.83. The LGBT-DOCSS total score was 4.55 ± 0.61 out of 7, indicating a low level of clinical competency. The highest mean score was in the attitudes subscale (6.55 ± 0.87), which was significantly higher than the scores for the knowledge subscale (3.14 ± 1.46) and clinical preparedness subscale (3.36 ± 0.86). Religiousness was significantly associated with clinical preparedness and attitudes. Men exhibited higher self-reported levels of knowledge and clinical preparedness, albeit with more negative attitudes compare to women. Sexual orientation was significantly associated with clinical competency, with PTSs who identified as heterosexual demonstrating a lower level of clinical competency compared to participants who identified as non-heterosexual. Conclusions: In Israel, PTSs demonstrated a low level of clinical competency in terms of self-reported knowledge and self-reported clinical preparedness but contrasting positive attitudes toward the LGBT community. Religiousness, gender and sexual orientation had a significant influence on competency levels.These preliminary findings highlight the urgent necessity to enhance the knowledge of PTSs regarding the LGBT community to improve their clinical competence. Trial registration NR: Not applicable. [ABSTRACT FROM AUTHOR]

There is a long history of institutional and interpersonal stigma, violence, and oppression of sexual and gender minority (SGM) individuals in the United States and around the world. Structural and sociocultural factors have served to promote and justify criminalization, discrimination, and violence targeting SGM groups. This commentary provides a brief chronological summary of laws and policies that served to pathologize, oppress, and justify violence and discrimination; the evolution of academic study and understanding; activism aimed at changing laws, questioning pathologizing assumptions and practices, and protecting human rights; current challenges; and recommendations for policy, research, and practice. This commentary pays particular attention to the roles the Global Alliance for Behavioral Health and Social Justice and its journal, American Journal of Orthopsychiatry, have played to advocate for full recognition of the human rights of SGM individuals. Public Policy Relevance Statement: There is a long history of institutional and interpersonal stigma, violence, and oppression of sexual and gender minority (SGM) people. This commentary provides recommendations for promoting the rights and well-being of SGM individuals, with a particular focus on the Global Alliance and the American Journal of Orthopsychiatry. In particular, the commentary recommends strategies for countering anti-SGM propaganda, creating safe and supportive environments for SGM people, and accessing high-quality, culturally, and context appropriate services. [ABSTRACT FROM AUTHOR]

In this primer, following best practice recommendations and drawing upon their own expertise in psychometrics, the authors provide a step-by-step guide for developing measures relevant to sexual- and gender-marginalized persons (SGMPs). To ensure that readers operate from a uniform understanding, definitions for central elements of psychometric testing (e.g., reliability and validity) are provided. Then, detailed information is given about developing and refining scale items. Strategies designed to reduce a pool of items to a manageable number are also highlighted. The authors conclude this primer by discussing various forms of validation (e.g., convergent, discriminant, and known groups). To further readers' understanding, illustrative examples from measures designed for SGMPs are brought into focus throughout. [ABSTRACT FROM AUTHOR]

LGBTQ + people experience protective benefits from faith community participation, although some also experience minority stress from rejection and discrimination. Social workers, counselors, psychologists, nurse practitioners, and others can assist LGBTQ + people in looking for a faith community that fits their needs and desires. This study reveals how LGBTQ + people in this sample, most of whom identify as Christians, decided to attend their current faith community through an analysis methodology called Sort and Sift Think and Shift. Four contrasting themes were identified: welcoming versus inclusive, racial/ethnic versus LGBTQ+, inward versus outward, and role modeling versus blending. The authors explore the implications of these themes for helping professionals. [ABSTRACT FROM AUTHOR]

(1) Background: This paper presents an analysis of the associations between minority stressors and activism in the population of lesbian, gay, and bisexual individuals in Poland. (2) Methods: The cross-sectional online-based research was conducted among 192 lesbian, gay, and bisexual (LGB) people in two groups: activists (n = 51) and people not engaged in activism (n = 141). Four scales of the Sexual Minority Stress Scale were used: Internalized Homophobia, Expectation of Rejection, Concealment, and Sexual Minority Negative Events Scale. Activism was measured using the Activism Scale and a single item asking about belonging to an activist group. (3) Results: Activists, lesbians, and gays scored significantly higher in the Sexual Minority Negative Events than people not involved in activism and bisexual individuals. Attitude toward LGBT+ activism correlated weakly and positively with Sexual Minority Negative Events and Expectation of Rejection while negatively with Internalized Homophobia. The Network Analysis showed that positive attitudes toward LGBT+ activism, the expectation of rejection, and negative events in minority stress are the most influential variables in the network model, playing a crucial role in the interaction between particular dimensions of minority stress. (4) Conclusions: Prevention and intervention programs should focus on reducing minority stress, especially negative events and rejection, especially among lesbians, gays, and people engaged in LGBT+ activism. The cooperation of politicians, lawyers, social workers, and psychologists is required to decrease homophobia and the stigmatization of people representing sexual and gender minorities. [ABSTRACT FROM AUTHOR]

Purpose of Review: To consolidate recent literature addressing eating disorders and disordered eating behaviors among sexual and gender minority (SGM) adolescents, including but not limited to lesbian, gay, bisexual, transgender, and queer (LGBTQ) adolescents. Recent Findings: Sexual and gender minority adolescents are at heightened vulnerability to eating disorders and disordered eating behaviors compared to their cisgender and heterosexual peers, potentially due to minority stress, gender norms, objectification, and the influence of the media, peers, and parents. We report findings from recent literature on the epidemiology and prevalence, assessment, mental health comorbidity, quality of life and psychosocial functioning, risk and protective factors, and treatment and interventions for eating disorders in sexual and gender minority adolescents. Summary: Addressing eating disorders in sexual and gender minority adolescents requires an integrated approach consisting of screening, tailored treatment, and comprehensive support to address intersectional challenges. Gender-affirming and trauma-informed care approaches may be considered. [ABSTRACT FROM AUTHOR]

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This article concerns Asian American queer masculinity and how the “coming out” process for gay Chinese men and their non-White immigrant families does not fit neatly within neat Western gender distinctions of public/private space. Using the film Ethan Mao as a primary text and case study, I argue for an intersectional approach to the coming out process for racialized sexual minorities. Ethan Mao is a film that tells the story of a Chinese American boy expunged from the home upon his family’s discovery of his homosexuality who returns to hold his family members hostage. The fictional story thematizes the indistinct spatial and symbolic boundaries of queer Asian American identity, masculinity, and domesticity. The film observes how gay men of color do not simply come out of the closet but break into it. Through an intersectional queer of color critique, I reconceptualize “the closet” as a synecdoche of the private home space, refiguring it as a contested site of belonging/exclusion to recognize the difficulties of “coming out” for certain queer racial male subjects.

Purpose: We sought to understand technology-based communication regarding mpox (monkeypox) among gay, bisexual, and other men who have sex with men (GBMSM) during the global outbreak in 2022. Methods: Forty-four GBMSM (Mage = 25.3 years, 68.2% cisgender, 43.2% non-White) living in the United States participated. From May 2022 to August 2022, all text data related to mpox (174 instances) were downloaded from the smartphones of GBMSM. Text data and smartphone app usage were analyzed. Results: Content analysis revealed 10 text-based themes and 7 app categories. GBMSM primarily used search and browser, texting, and gay dating apps to share vaccine updates, seek mpox vaccination, find general mpox information, share mpox information with other GBMSM, and discuss links between mpox and gay culture. Data visualizations revealed that changes in communication themes and app usage were responsive to major milestones in the mpox outbreak. Conclusion: GBMSM used apps to facilitate a community-driven mpox response.

Abstract Background Clinical competence encompasses attitudes, skills, and knowledge regarding diverse client groups. Appropriate clinical competence requires an understanding of the cultural context in which healthcare is delivered. In conservative countries such as Israel, there is a noticeable scarcity of information regarding the clinical competency of physiotherapy students (PTSs) in effectively treating lesbian, gay, bisexual and transgender (LGBT) individuals. The objective of this study was to assess the level of LGBT clinical competence among PTSs in Israel. Methods Conducted through an anonymous online self-report survey, this study gathered personal and academic background information and self-reported data on previous LGBT education during undergraduate studies of PTSs. It utilized the Hebrew version of the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS) questionnaire. Descriptive statistics were computed for all outcome measures. The internal reliability of the LGBT-DOCSS was assessed. Total scores of the LGBT-DOCSS, along with scores in each of the three subscales (clinical preparedness, knowledge, and attitudes), were compared across different levels of religiosity and gender. Results The sample comprised of 251 PTSs, with an average age of 25.57 ± 3.07 years (34.7% men, 65.3% women). All students reported a lack of LGBT community-related courses during their undergraduate studies. The translated Hebrew version demonstrated good internal consistency, with Cronbach’s alpha ranging from 0.65 to 0.83. The LGBT-DOCSS total score was 4.55 ± 0.61 out of 7, indicating a low level of clinical competency. The highest mean score was in the attitudes subscale (6.55 ± 0.87), which was significantly higher than the scores for the knowledge subscale (3.14 ± 1.46) and clinical preparedness subscale (3.36 ± 0.86). Religiousness was significantly associated with clinical preparedness and attitudes. Men exhibited higher self-reported levels of knowledge and clinical preparedness, albeit with more negative attitudes compare to women. Sexual orientation was significantly associated with clinical competency, with PTSs who identified as heterosexual demonstrating a lower level of clinical competency compared to participants who identified as non-heterosexual. Conclusions In Israel, PTSs demonstrated a low level of clinical competency in terms of self-reported knowledge and self-reported clinical preparedness but contrasting positive attitudes toward the LGBT community. Religiousness, gender and sexual orientation had a significant influence on competency levels.These preliminary findings highlight the urgent necessity to enhance the knowledge of PTSs regarding the LGBT community to improve their clinical competence. Trial registration NR Not applicable.

BackgroundMethamphetamine use disorder (MethUD) disproportionately affects men who have sex exclusively with men or with men and women (collectively MSM/W), compared to men who have sex with women (MSW). This study is the first MethUD medication trial to compare treatment effect for these groups, hypothesizing that extended-release injectable naltrexone 380mg every 3 weeks plus oral extended-release bupropion 450mg daily would be less effective for MSM/W than MSW.MethodsData come from men (N = 246) in a multi-site, double-blind, randomized, placebo-controlled trial with sequential parallel comparison design. In Stage 1 (6-weeks), participants were randomized to active treatment or placebo. In Stage 2 (6-weeks), Stage 1 placebo non-responders were rerandomized. Treatment response was ≥3 methamphetamine-negative urine samples, out of four obtained at the end of Stages 1 and 2. Treatment effect was the active-versus-placebo between-group difference in the weighted average Stages 1 and 2 responses.ResultsMSM/W (n = 151) were more likely than MSW (n = 95) to be Hispanic, college-educated, and living with HIV. Adjusting for demographics, among MSM/W, response rates were 13.95 % (active treatment) and 2.78 % (placebo) in Stage 1; 23.26 % (active treatment) and 4.26 % (placebo) in Stage 2. Among MSW, response rates were 7.69 % (active treatment) and 5.80 % (placebo) in Stage 1; 3.57 % (active treatment) and 0 % (placebo) in Stage 2. Treatment effect was significantly larger for MSM/W (h = 0.1479) than MSW (h = 0.0227) (p = 0.04).ConclusionsFindings suggest efficacy of extended-release naltrexone plus bupropion for MSM/W, a population heavily burdened by MethUD. While a secondary outcome, this intriguing finding merits testing in prospective trials.

• Ask prostate cancer patients about sexual orientation, gender identity, and sexual behaviors. • Consider receptive anal intercourse at every stage in the cancer continuum. • Gender affirming hormone therapy can influence prostate specific antigen levels. • Consider patient interest in genital affirming surgery when recommending prostate cancer treatment. At every stage of the cancer continuum, the management of sexual and gender minorities with prostate cancer requires a thoughtful and multidisciplinary approach. For example, it is important to recognize that receptive anal intercourse, common among sexual minority men—i.e. gay and bisexual men—can potentially elevate prostate-specific antigen (PSA) leading to overdiagnosis and overtreatment. Additionally, it is important to understand that sexual minority men with prostate cancer might engage in insertive and/or receptive anal intercourse, as opposed to insertive vaginal intercourse, requiring a treatment conversation that expands beyond the usual discussion of sexual health in prostate cancer patients. For gender minorities—i.e. transgender women or trans feminine individuals (those recorded male at birth with feminine gender identities)—it is important to consider gender affirming hormones and pelvic surgeries as they can cause diagnostic and treatment challenges, including PSA suppression, more aggressive disease, and anatomical changes. Furthermore, it is essential to recognize that gender minorities are a diverse cohort and may or may not be on gender affirming hormone therapy and may or may not have received or intend to receive pelvic affirming surgery. In this seminar article, we highlight considerations for personalized management of prostate cancer in sexual and gender minorities to improve care for this understudied cohort and enhance health equity. [ABSTRACT FROM AUTHOR]

This article is an interview conducted by the author with Anwesh Sahoo who is a visual designer, technical and non-fungible token (NFT) artist, the first Indian recipient of the Troy Perry Medal of Pride for compassionate activism, the youngest winner of Mr Gay World India and the creator of The Effeminare. Through their conversation, the article touches upon a range of aspects of queer fashion, including cyber fashion, digital drag, representation of masculinity and femininity, and its varied significances within the cultural context of India. [ABSTRACT FROM AUTHOR]

(1) Background: This paper presents an analysis of the associations between minority stressors and activism in the population of lesbian, gay, and bisexual individuals in Poland. (2) Methods: The cross-sectional online-based research was conducted among 192 lesbian, gay, and bisexual (LGB) people in two groups: activists (n = 51) and people not engaged in activism (n = 141). Four scales of the Sexual Minority Stress Scale were used: Internalized Homophobia, Expectation of Rejection, Concealment, and Sexual Minority Negative Events Scale. Activism was measured using the Activism Scale and a single item asking about belonging to an activist group. (3) Results: Activists, lesbians, and gays scored significantly higher in the Sexual Minority Negative Events than people not involved in activism and bisexual individuals. Attitude toward LGBT+ activism correlated weakly and positively with Sexual Minority Negative Events and Expectation of Rejection while negatively with Internalized Homophobia. The Network Analysis showed that positive attitudes toward LGBT+ activism, the expectation of rejection, and negative events in minority stress are the most influential variables in the network model, playing a crucial role in the interaction between particular dimensions of minority stress. (4) Conclusions: Prevention and intervention programs should focus on reducing minority stress, especially negative events and rejection, especially among lesbians, gays, and people engaged in LGBT+ activism. The cooperation of politicians, lawyers, social workers, and psychologists is required to decrease homophobia and the stigmatization of people representing sexual and gender minorities.

Abstract Background The U.S. mpox outbreak in 2022 introduced new and exacerbated existing challenges that disproportionately stigmatize gay, bisexual, and other sexual minoritized men (GBSMM). This study contextualizes the perceptions, susceptibility, and lived experiences of the mpox outbreak among GBSMM in the U.S. using an intersectional framework. Methods Between September 2022 to February 2023, we conducted 33 semi-structured qualitative interviews with purposively sampled GBSMM in the Northeast and the South region of the United States on various aspects related to their experience during the mpox outbreak. Results We identified four themes: (1) understanding and conceptualizations of mpox, (2) mpox vaccine availability and accessibility, (3) mpox vaccine hesitancy and mistrust, and (4) call to action and recommendations. GBSMM collectively discussed the elevated mpox stigmatization and homophobic discourse from mainstream social media and news outlets. GBSMM also discussed the lack of availability of mpox vaccines, unclear procedures to receive the vaccine, and continued mistrust in government, non-government, and other institutions of health that were complicit in anti-LGBTQ + narratives related to mpox. However, they expressed that these challenges may be addressed through more LGTBQ + representation and leveraging ways to empower these communities. Conclusion GBSMM have mpox experiences that are distinct and multifaceted. Effectively addressing mpox and mitigating public health emergencies for GBSMM requires prioritizing destigmatizing communication channels and vaccine distribution strategies by centering their stories and lived experiences to advance health equity.

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.

Abstract Objective This study investigates Japanese gay and bisexual men’s experiences of seeking help for emotional support from others regarding their sexual orientation concerns. It examines the relationship between their help-seeking and presence of gay and bisexual peers, duration between questioning their sexual orientation and accepting it, and experience of coming out to family members by multiple logistic regression analysis. Results We conducted a cross-sectional survey using a self-reported paper questionnaire. There were 360 valid responses. Eighty-two respondents (22.8%) had experience of help-seeking for emotional support, and this was associated with age, occupation, presence of gay/bisexual friends, and experience of coming out to family members about their sexual orientation. Respondents sought the most help from their male friends (70.0%), followed by female friends (25.0%), mothers (17.5%), and the Internet (16.3%). Even after controlling for age and occupation, experience of help-seeking for emotional support was higher among participants who had gay/bisexual friends when they were aware of their sexual orientation, took

Abstract Background Gay, bisexual, and cis-gender men who have sex with men (GBMSM) face severe consequences, especially within stigmatized environments. However, very little is known about the experiences of GBMSM living in slums in SSA and Ghana. This study investigates the experiences of stigma, victimization, and coping strategies and proposes some interventional approaches for combating stigma facing GBMSM in slum communities. Methods We engaged GBMSM living in slums in two major Ghanaian cities. We used a time-location sampling and collected data through in-depth individual interviews. Two major themes emerged from the study: (1) insecurities and criminalization of GBMSM activity, and (2) GBMSM coping strategies. Results Findings show GBMSM experienced negative attitudes from the community due to their sexual behavior/orientation. GBMSM also developed coping strategies to avert negative experiences, such as hiding their identities/behavior, avoiding gender non-conforming men, and having relationships with persons outside their communities. Conclusion We propose interventions such as HIV Education, Empathy, Empowerment, Acceptance, and Commitment Therapy as possible measures to improve the experiences of GBMSM living in Ghanaian slum communities.

Introduction Methods Results Discussion Intimate partner violence (IPV) involves an individual committing acts intended to harm or intimidate a current or former romantic partner. The COVID‐19 pandemic and subsequent stay‐at‐home orders often trapped victims with perpetrators and intensified IPV. Although sexual and gender diverse people disproportionately experience IPV compared to cisgender, heterosexual people, their experiences are not well documented in the Canadian context. This study aimed to explore the experiences of Two‐Spirit, lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexual and gender diverse (2S/LGBTQIA+) people with IPV in Ontario and how the COVID‐19 pandemic affected their IPV experiences.We conducted in‐depth, semi‐structured interviews with self‐identified 2S/LGBTQIA+ people who experienced IPV on/after March 15, 2020. We audio‐recorded and transcribed all interviews and coded the transcripts for content and themes using inductive and deductive techniques.Our 20 participants experienced physical, psychological, sexual, and financial abuse. Technology‐facilitated violence extended abuse geographically and temporally. IPV experiences were associated with negative mental health outcomes that were intensified by the COVID‐19 pandemic. Participants struggled to see themselves as legitimate victims of IPV. Although participants regretted being victims of violence, many saw their abusive relationship(s) as a learning experience to inform future relationships.Our findings suggest that 2S/LGBTQIA+ people may experience unique forms of identity abuse and may have difficulty recognizing their IPV experiences as abuse. Ensuring that comprehensive sexual health education is trauma‐informed, anti‐oppressive, and includes information about healthy relationship dynamics, 2S/LGBTQIA+ relationships, and IPV is critical. [ABSTRACT FROM AUTHOR]

This research tests whether self-labelling with a derogatory or reclaimed label is perceived as an act of reclamation. A pilot study (N = 102) identified English terms used to label lesbian women and gay men. The main study (N = 276) used a between-groups vignette design in which participants read about a woman/man self-labelling with a descriptive (lesbian/gay), reclaimed (queer), or derogatory group (dyke/fag) label. We assessed perceptions of the speaker (control/influence, agency, and efficacy) and group power, label offensiveness, and the likelihood of using the label in the future. Descriptive labels were perceived as less offensive and more likely to be used compared to reclaimed and derogatory labels. For gay men, using a derogatory label compared to other labels decreased perceived agency, but did not influence control/influence and efficacy. For lesbian women, there were no differences in perceptions of power depending on the label used. [ABSTRACT FROM AUTHOR]

In the United States, cultural forces have led to the stigmatization of lesbian, gay, bisexual, transgender, and queer (and additional identities) (LGBTQ+) parenthood. However, pushing back against this stigmatization, developing a positive LGBTQ+ identity, and investing in one's LGBTQ+ community may inform empowering narratives of future parenthood and related constructs, such as LGBTQ+ parent socialization. Perceived self-efficacy related to preparation for bias (i.e., discussions of discrimination, prejudice, or bias-based bullying) socialization is likely associated with an individual's own perceptions or experiences of stigmatization given the conceptual overlap of bias and stigma. However, other constructs related to stigmatization and socialization self-efficacy, such as positive LGBTQ+ identity or community connectedness, have yet to be simultaneously considered (to our knowledge). Further, previous research has rarely included different assessments of stigma (i.e., perceived and enacted) and/or dimensions of positive LGBTQ+ identity (i.e., authenticity and self-awareness). Thus, this study aimed to rectify these gaps and provide a greater understanding of sexual stigma and LGBTQ+ parent socialization self-efficacy. Using data from a survey-based, online, cross-sectional study of LGBTQ+ childfree adults (N = 433; Mage = 29.85 years old) in the United States, we found that experiences of enacted or perceived sexual stigma were differentially associated with LGBTQ+ parent socialization preparation for bias self-efficacy. Further, positive LGBTQ+ identity authenticity and self-awareness, as well as LGBTQ+ community connectedness played distinct roles as mediators of the relationships between sexual stigma and LGBTQ+ parent socialization self-efficacy. These findings have implications for how we might understand the role of stigma, identity, community, and socialization among future LGBTQ+ parents. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to introduce the Second Issue of our Double Special Edition on LGBTQIA+ Topics in Health, Wellbeing and Education. This special issue focuses on LGBTQIA+ Topics in Sport, Human Movement and Education. We introduce the issue by outlining the debate about the 'inclusivity' of queer bodies in sport. We then introduce each article and explain how they fit into these larger debates in sport and education. We conclude the paper by outlining key takeaways from the issue. We also provide recommendations for future LGBTQIA+ research in sport, human movement and education. [ABSTRACT FROM AUTHOR]

This research is the first to provide insights into the experiences of gay men studying a university degree in Physical Activity and Sport Science (PASS) in Spain. Drawing on Bourdieu's categories, one-to-one semi-structured interviews were conducted with 11 PASS students and ex-students that were subsequently studied through deductive-inductive thematic analysis. Our findings show the PASS context to be a heteronormative, masculinised and cisgender social field. Male homosexuality was almost invisible except when antigay language was used. Considering this environment, most of our interviewees chose to remain in the closet, which contributed to low levels of wellbeing and high levels of stress and anxiety. However, the few students that chose to come out experienced relief and felt included by some of their classmates and by staff. Discussed are key aspects of the dominant culture in PASS faculties and the repercussions for the mental health and wellbeing of gay students. Our research also provides new insights into the nature and prevalence of microaggressions regarding sexual orientation that will help PASS and university management develop specific strategies and programmes to foster inclusivity. [ABSTRACT FROM AUTHOR]

A growing body of literature has found that sexual orientation and gender impact labor market outcomes, including earnings. This literature generally finds that gay and bisexual men earn less than heterosexual men. Despite being the highest earners among women, lesbians earn less than heterosexual men, and bisexual women earn the least. Far less research has explored intersectional disadvantages/advantages of being a lesbian, gay, or bisexual (LGB) individual and belonging to other minority groups. Using data from the 2013 to 2018 US National Health Interview Survey, this paper explores whether being an LGB racial minority or LGB immigrant results in cumulative earning disadvantages/advantages. This study finds that regardless of race or immigrant status, gay men’s earnings did not statistically differ from white/US-born heterosexual men’s earnings. For white and US-born women, their earnings followed the same pattern, with lesbians earning the most, followed by heterosexual women, then bisexuals; however, for nonwhite women, bisexuals earned the most and lesbians earned the least. The results for immigrant sexual minorities were not statistically significant. These findings suggest that disadvantage/advantage is multilayered—sexual minorities who occupy multiple minority positions may experience different levels of disadvantage/advantage. [ABSTRACT FROM AUTHOR]

The internalization of ageist stereotypes or messages based on the framework of an aging gay man is known as internalized gay ageism. Internalized gay ageism may influence an older gay man’s sexual satisfaction. The aim of this study was to examine the relationship between internalized gay ageism and sexual satisfaction and determine if body image was a potential mediator. A cross-sectional online survey collected data on sexual satisfaction and other variables related to sexual health and well-being among older gay men. Inclusion criteria included: aged 50 or older, identified as gay, identified as male, assigned male at birth, and resided in the Midwestern region of the United States. Descriptive, bivariate, and mediation analyses were conducted. A complete mediation effect was found between internalized gay ageism and sexual satisfaction when mediated by body image. Older gay men who were in open relationships were more sexually satisfied than single/widowed older gay men. Future research should continue to explore internalized gay ageism, relationship status, body image, and sexual satisfaction among older gay men. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Physicians often feel they are not equipped to serve the lesbian, gay, bisexual, and queer (LGBTQ) community, but integrating education that incorporates LGBTQ content and perspective into an already-condensed medical school curriculum is challenging. We developed a preclinical active learning module on assisted reproductive technologies (ART) in LGBTQ care, integrating clinical and basic science content with patient perspective. METHODS: We created a module that combined a case-based small group discussion with a patient panel. We developed a case for discussion in collaboration with a female cis-gender same-sex couple who conceived through ART. A patient panel with the same couple followed the discussion. All first-year medical students attended both parts of the module. Prior to participation, students learned reproductive endocrinology and genetics concepts through lectures. After the module, students voluntarily completed an anonymous survey to evaluate self-perceived changes in familiarity and confidence with LGBTQ patients and satisfaction with the module. RESULTS: Of the 126 students who attended, 72 (57%) completed the survey. Of these, 69 (95.8%) felt the module gave them better perspectives on LGBTQ patient experiences, and 66 to 69 (92-96%) agreed the small group discussion achieved its learning objectives on LGBTQ health barriers and the application of ART. Students valued the patient panel (84.7%) and cited a better understanding of reproductive barriers for LGBTQ patients as its most valuable point. CONCLUSION: A preclerkship module combining a case-based small group discussion and patient panel on ART delivered in the context of a real-life LGBTQ patient experience provided an opportunity for the students to integrate basic science and clinical science knowledge to reflect on the healthcare needs of this patient population. Creating the case in collaboration with the same-sex couple and having them present their own experience provided an authentic perspective to students on reproductive healthcare issues and how they impact members of the LGBTQ community. [ABSTRACT FROM AUTHOR]

AbstractDespite the web’s revolutionary impact on LGBTQ communities, the preservation and study of LGBTQ web histories have been largely overlooked by archives and scholars. This neglect has contributed to a “queer digital dark age,” perpetuating the symbolic annihilation of LGBTQ people in the historical record. Drawing on an extensive review of queer archive and library studies literature, as well as a survey of curators of queer web archives, this article argues for urgent intervention. Specific actions are needed: heritage institutions should prioritise creating queer web collections, and scholars must begin consulting existing collections. Failure to address this undermines the representation of LGBTQ experiences and hinders our understanding of online LGBTQ life. By examining extant initiatives, specifically the LGBT + web archive of the National Library of the Netherlands, this article demonstrates the potential of studying queer internet histories through web archives. Such endeavours enable diachronic research and the application of computational methods like hyperlink analyses, revealing the interconnected nature of queer online cultures. Ultimately, this article advocates a collaborative dialogue between queer archival and librarian studies, web archive studies, and LGBTQ internet studies—which must lead to pressing steps to preserve and comprehensively examine LGBTQ online heritage. [ABSTRACT FROM AUTHOR]

Objective Background Methods Results Conclusion This study examines how marriage‐cohabitation gaps in household specialization (labor supply and earnings) vary across institutional contexts for same‐sex couples (SSCs) and different‐sex couples (DSCs) in Canada.Prior research suggests that marriage‐cohabitation gaps are smaller in contexts where cohabitation is more prevalent, but it has overlooked how legal protections (at the contextual level) and gender composition (at the couple level) moderate this association. As a result, little is known about whether differences in household specialization stem from heightened gendered expectations attached to marriage or stronger legal protections for married couples. This study posits that marriage‐cohabitation gaps will be larger in contexts where legal protections for cohabitors are less marriage‐like.Using the 2006 and 2016 Canadian Census and the 2011 National Household Survey, I estimate ordinal and fractional logit models to examine marriage‐cohabitation gaps in specialization among all couples (N = 2,788,055) and couples with young children (N = 826,305).Among DSCs, marriage‐cohabitation gaps were larger in Québec than in English Canada vis‐à‐vis earnings but not labor supply. Patterns among SSCs were more heterogeneous: gaps in labor supply were larger in English Canada for female couples but larger in Québec for male couples. Gaps in earnings were generally larger in Québec, with few exceptions. However, DSCs consistently specialized more than SSCs.While existing research suggests marriage‐cohabitation gaps in household specialization are largely explained by the prevalence of cohabitation, my results indicate that legal protections (at the contextual level) and gender composition (at the couple level) play a more decisive role. [ABSTRACT FROM AUTHOR]

The aim of this study is to gauge the current social climate in neurosurgical residency training and attitudes regarding sexual orientation and gender identity. We conducted a cross-sectional study through a 35-question questionnaire distributed to roughly 1700 residents at all U.S. neurosurgical residency programs. A total of 107 responses were obtained. Seventeen residents (16%) identified as being an LGBTQ+ individual. The majority (76%) of LGBTQ+ residents were concerned about how their sexual orientation would be perceived while applying to programs, and 47% endorsed purposefully concealing sexual orientation at work for fear of rejection or reprisal. More than half (56%) of those surveyed have witnessed homophobic/transphobic remarks by patients. While at work, 29% of LGBTQ+ individuals stated they are uncomfortable being open with their sexual orientation, and 3 LGBTQ+ individuals admitted being the target of direct homophobic/transphobic comments. This is the first study to our knowledge that has been conducted assessing the presence, perception, and treatment of LGBTQ+ trainees in neurosurgical residency. Our study outlines the challenges LGBTQ+ individuals face when applying to neurosurgical programs, which involves the perception of their sexual orientation, their witnessed instances of homophobic and transphobic comments by coworkers and patients, and their hesitation with discussing their social lives compared with their non-LGBTQ+ peers at work for fear of judgment or reprisal. Ongoing research is needed to address these issues to obtain workplace respect and fairness in this population and thus create an accepting atmosphere and achieve social justice in neurosurgery training. [ABSTRACT FROM AUTHOR]

This article introduces the multidimensional properties of social connectedness among sexual and gender minority (SGM) midlife and older adults and examines the relationship between these properties and general health. Data were analyzed from Aging With Pride: National, Aging, and Sexuality/Gender Study, including 2,450 SGM adults aged 50 and older in the United States. The structure, function, and quality of interpersonal relations as well as community-level activities and engagement were measured through a self-administered survey and an in-person interview. Findings indicated that SGM midlife and older adults, on average, had a large social network with high bridging potential and low density, consisting of more nonrelative family members than immediate family members. They also showed frequent availability of social support, moderate or higher satisfaction with interpersonal relations, and moderate SGM community engagement. Properties of social connectedness differed by gender, sexual identity, and gender identity, with SGM men, sexually diverse women, and transgender people showing distinct challenges in interpersonal relations. All aspects of social connectedness were positively associated with good general health, particularly network diversity, outdoor leisure activity engagement, and access to health-related decision support, controlling for age and chronic conditions. Care receiving and loneliness were negatively associated with good general health. Intervention development can target these factors to promote social and community connectivity and reduce the negative health effects of persistent social stressors. This study underscores the necessity of addressing all facets (i.e., structure, function, and quality) of interpersonal relations encompassing both immediate and chosen family as well as community-level social connectedness. Public Policy Relevance Statement: Limited knowledge exists regarding the multidimensional aspects of social connectedness of sexual and gender minority older adults. This study delineates the distinct nature of their interpersonal relationships and community engagement and identifies social connectedness factors that can contribute to health equity. By addressing these factors, culturally tailored programs and policies could foster resilience and mitigate the negative health consequences of ongoing social stressors. [ABSTRACT FROM AUTHOR]

Disparities in youth homelessness by racial/ethnic, sexual, and gender identities are well documented, though this literature lacks specificity regarding intersectional social identities of youth who are most likely to experience homelessness. Population-based cross-sectional data on youth from the 2019 Minnesota Student Survey (N = 80,456) were used to examine the relationship between parent caring and intersections of minoritized identities that experience the highest prevalence of two distinct types of unaccompanied unstable housing with expanded categories of sexual and gender identities. Exhaustive chi-square automatic interaction detection models revealed that low parent caring was the most common predictor of unaccompanied homelessness and running away, but there was important variation among youth of color at the intersection of sexual and gender identities. The findings reveal a more complex story of disparities in unaccompanied unstable housing among youth with multiple marginalized social identities and highlight the need to create culturally informed prevention and intervention strategies for parents of LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and questioning) youth of color. The implications for prevention and intervention among subgroups with the highest prevalence are discussed in the context of interlocking systems of power and oppression. Public Policy Relevance Statement: Having caring and supportive parents may buffer against unaccompanied unstable housing for youth across racial, ethnic, sexual, and gender identities. Our findings suggest the need for increased use of intersectional frameworks and methods in health disparities research and specifically point to certain intersectional populations that need support to improve parent caring and reduce unaccompanied unstable housing, building on efforts focused on a single minoritized identity. Such strategies would center and work alongside affected communities in the interpretation and application of research findings and partner with existing parent education programs in those communities to build culturally informed awareness and understanding of diverse sexual and gender identities. [ABSTRACT FROM AUTHOR]

Although their intimate lives are often adversely affected by homonegative laws and conservative religio-cultural attitudes, many Malaysian gay men formulate affirming materialist-discursive strategies to pursue personal happiness. Some Christian gay men, for instance, challenge conservative ecclesiastical notions of same-sex attraction as iniquitous and generate life-giving spiritualities for themselves that contribute to a sense of inner joy and equanimity. In this article, aided primarily by Sara Ahmed's provocative ideas on happiness, I analyse the lived experiences of a Malaysian Christian gay man, and theorise the notion of deviant happiness, which I suggest is a pathway to queer spiritual well-being. Then, drawing on the Catechism of the Catholic Church 's exposition of the beatitudes, I theologically propose that his active pursuit of happiness and well-being as a gay man participates in God's own beatitude. [ABSTRACT FROM AUTHOR]