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IntroductionThe ability to objectively measure chronic stress has important implications for research, prevention, and treatment. Cortisol is currently the most used biological marker in the investigation of stress and can be measured via blood, saliva, and urine; however, these methods have disadvantages. The measurement of cortisol in hair is a more recently developed method that quantifies the cumulative production of cortisol over longer periods of time. Given the potential benefits of hair as a chronic stress biometric, research with this novel method is burgeoning, yet rarely involves transgender ("trans") populations, despite high levels of reported stress among trans people due to experiences of stigma and discrimination. Since hair is a key part of gender presentation, trans people might be less likely than cisgender people to donate hair for research. To explore the feasibility and acceptability of hair collection for use as a stress biometric with trans women, we nested a study into an ongoing clinical trial in São Paulo, Brazil, "Manas por Manas" (Sisters for Sisters). Here, we describe the hair biometric substudy protocol, as well as the feasibility and acceptability of collecting hair in the study cohort.MethodsWe randomly selected a subsample (n = 180) from the Manas por Manas cohort (n = 392), all of whom are trans women, age 18 or older. We messaged participants via phone, WhatsApp, or social media for at least three attempted contacts. Study visits included four components: (1) video introduction, including a demonstration of hair sampling; (2) informed consent; (3) a brief survey with the validated Short Stress Overload Scale (translated to Portuguese) and questions on hair care that could moderate stress hormone results; and (4) hair sample collection. Hair samples were collected and stored using validated protocols. Participants were reimbursed for travel costs.ResultsBetween April and December 2022, we messaged with 143 individuals out of the 180 sampled (79%) and invited them to participate in the study. Of those invited to participate, we scheduled study visits with 102 people (71.3% of those invited to participate), of whom 100 attended their study visits and completed all activities. Two people did not attend their study visits and stopped communication. Of those who were invited to participate and declined a study visit, four individuals declined due to the hair sample collection procedures (2.8% of those invited to participate). Other reasons for declining to participate included having moved (n = 7), lack of time (n = 11), not interested in research participation (n = 8), or unknown/stopped responding to messages (n = 11). Most participants reported that they chemically treated their hair to bleach, color, or straighten it, which could impact laboratory assays.ConclusionWe found hair sampling for stress measurement to be feasible and acceptable to our participants. We successfully completed all study activities for our desired sample size, and most recruited individuals volunteered to participate. Reasons provided for declining study participation reflected general barriers to research participation, with only four people declining due to hair sample collection procedures.

Introduction: Health disparities experienced by lesbian, gay, bisexual, and transgender (LGBT) individuals have been partially attributed to healthcare professionals' lack of cultural competence in addressing their specific needs. This study aimed to assess the differences in competencies and preparedness among health professionals from Poland and Spain when working with LGBT patients. Methodology: Data were collected between June and August 2024 through a cross-sectional survey involving 673 health professionals (Mage = 33.54, SD = 9.74; 61.5% female), including 273 participants from Spain and 400 from Poland. Participants completed a self-administered survey, which included sociodemographic questions and the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS). Multivariate linear regression was used to analyze predictors of clinical preparedness, attitudes, and knowledge regarding LGBT care. Clinical trial number: not applicable. Results: Spanish health professionals showed higher total LGBT-DOCSS scores compared to Polish participants (B = 0.503, p < 0.001). Gender was a significant predictor, with men scoring higher in clinical preparedness (B = 0.771, p = 0.002), while women scored higher in attitudes (B = -0.457, p < 0.001). In Poland, age was positively correlated with clinical preparedness (B = 0.034, p = 0.022), and physicians scored significantly higher in overall competency compared to nurses/midwives (B = 0.621, p = 0.005). Participation in LGBT-related training was associated with higher clinical preparedness in both countries, with those attending training 3 or more times scoring higher than those who never attended (B = 1.659, p < 0.001). Conclusion: The study revealed significant differences in LGBT competency between Polish and Spanish health professionals. Factors such as gender, age, profession, and participation in LGBT-related training were associated with these competencies. Results suggest that a more tailored approach in professional education and training may be necessary to ensure all health workers possess adequate skills and attitudes toward LGBT care. [ABSTRACT FROM AUTHOR]

Introduction: People who identify as lesbian, gay, bisexual, transgender, queer/questioning, intersex, and other sexual/gender minorities (LGBTQ+) may experience discrimination when seeking healthcare. Medical students should be trained in inclusive and affirming care for LGBTQ+ patients. This narrative literature review explores the landscape of interventions and evaluations related to LGBTQ+ health content taught in medical schools in the USA and suggests strategies for further curriculum development. Methods: PubMed, ERIC, and Education Research Complete databases were systematically searched for peer-reviewed articles on LGBTQ+ health in medical student education in the USA published between 1 January 2011–6 February 2023. Articles were screened for eligibility and data was abstracted from all eligible articles. Data abstraction included the type of intervention or evaluation, sample population and size, and key outcomes. Results: One hundred thirty-four articles met inclusion criteria and were reviewed. This includes 6 (4.5%) that evaluate existing curriculum, 77 (57.5%) study the impact of curriculum components and interventions, 36 (26.9%) evaluate student knowledge and learning experiences, and 15 (11.2%) describe the development of broad learning objectives and curriculum. Eight studies identified student knowledge gaps related to gender identity and affirming care and these topics were covered in 34 curriculum interventions. Conclusion: Medical student education is important to address health disparities faced by the LGBTQ+ community, and has been an increasingly studied topic in the USA. A variety of curriculum interventions at single institutions show promise in enhancing student knowledge and training in LGBTQ+ health. Despite this, multiple studies indicate that students report inadequate education on certain topics with limitations in their knowledge and preparedness to care for LGBTQ+ patients, particularly transgender and gender diverse patients. Additional integration of LGBTQ+ curriculum content in areas of perceived deficits could help better prepare future physicians to care for LGBTQ+ patients and populations. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Aim: To identify attitudes towards HIV/STI screening guidelines and explore the acceptability of assessing sexual positioning practices among Black sexual minority men (SMM). Background: Risks for HIV/STIs vary by sexual positioning practices. However, clinicians and Black SMM do not always discuss sexuality with each other. Therefore, HIV/STI screening and testing remain suboptimal. Design: Qualitative study using focus groups. Methods: Data were obtained from 12 focus groups and one in‐depth interview conducted in Baltimore, MD among HIV‐negative Black SMM between October 2019 and May 2020 (N = 39). Groups were stratified into three age categories: 18–24, 25–34 and 35+. Participants were given the "5 P's" from the CDC's 2015 Sexual History Screening Guidelines and asked to discuss attitudes towards existing questions regarding sexual positioning practices. Themes were identified using an electronic pile sorting approach. Results: Most identified as homosexual/gay/same gender‐loving (68%), were employed (69%) and single (66%). Additionally, 34% had ever been diagnosed with an STI, of whom 38% had a history of repeated STI acquisition in their lifetime. Participants across age groups said clinicians should use the words "top" and "bottom" to demonstrate cultural familiarity and build trust. Some said that screening for sexual positioning was unnecessary and intrusive; others said that questions should be justified. Younger men wanted clinicians to ask questions in ways that make them feel cared for. Discussion: Guidelines should include language for clinicians to use culturally specific language and better ways to prepare Black SMM patients for screening. Impact to Nursing Practice: Some Black SMM will not discuss sexual positioning practices without clinicians' demonstration of cultural understanding and respect. Screening should incorporate culturally responsive language, justification and convey care. Reporting Method: Consolidated criteria for reporting qualitative research (COREQ). No Patient or Public Contribution: There was no patient or public involvement in the design or drafting of this discursive paper. [ABSTRACT FROM AUTHOR]

Background: A growing number of men who have sex with men (MSM) utilise Grindr for seeking relationships and immediate/casual sexual encounters. Grindr and other mobile applications can be a valuable source of information on sociological predictors of health. One topic that is under reported is the use of Grindr by MSM with obesity. We described differences in Grindr use between MSM with and without obesity, and to use Grindr information to reveal trends which may serve as potential predictors of health. Methods: Data was collected from 3744 Grindr users (mean age [s.d.], 32.3 years [9.1]) from the largest 50 metropolitan centres in the USA between February and May 2018. Users were divided into two cohorts based on BMI: (1) MSM with obesity (BMI > 30), n = 253; and (2) MSM without obesity, n = 3491. Profile characteristics were compared. Results: When evaluating potential predictors for obesity, we found that black/African-American and older MSM were significantly more likely to have obesity. Further, we found that obesity among MSM was significantly inversely associated with the population percent lesbian, gay, bisexual, and transgender (LGBT) within a city. Additionally, we found that MSM with obesity were significantly more likely to indicate interest in immediate sexual encounters. Conclusions: These results highlight important trends that may serve as predictors of health in urban settings. Furthermore, our results suggest that MSM with obesity may be more likely to engage in risky sexual behaviours. These findings may be useful in informing providers and healthcare officials on when and how to provide outreach to this unique population. Men who have sex with men (MSM) suffer from health disparities at higher rates than men who have sex with women, which combined with the well understood association between obesity and poor health outcomes, calls attention to the unique health considerations of MSM with obesity. Mobile applications, such as Grindr, can be a valuable source of information on sociological predictors of health among MSM. We aimed to describe differences in the use of Grindr between MSM with and without obesity, and to use Grindr information to reveal trends that may serve as potential predictors of health. Our study highlights important trends that may serve as predictors of health in urban settings. These findings may be useful in informing providers and healthcare officials on when and how to provide outreach to this unique population. [ABSTRACT FROM AUTHOR]

We aimed to assess the probability of past-year DSM-5 alcohol use disorder (AUD) and past-year moderate-to-severe DSM-5 AUD as a function of past-year ethnic discrimination among U.S. Latino/Hispanic adults and as a function of past-year discrimination types among Latino/Hispanic sexual minorities (SM). We used data from the 2012–2013 National Epidemiological Survey on Alcohol and Related Conditions-III (n = 36,309 U.S. adults aged ≥18 years). Our sample consisted of 6,954 Latino/Hispanic adults. Multivariable logistic regression analyses estimated the association of past-year ethnic discrimination with past-year AUD and past-year moderate-to-severe AUD among the overall Latino/Hispanic population. We tested the association between discrimination types (i.e. none, ethnic or sexual orientation discrimination, both) with AUD and moderate-to-severe AUD among Latino/Hispanic SM adults. Among Latino/Hispanic adults, 13.4% met criteria for past-year AUD and 6.4% met criteria for past-year moderate-to-severe AUD. Ethnic discrimination was significantly associated with AUD (AOR = 1.09, 95% CI = 1.07–1.12) and moderate-to-severe AUD (AOR = 1.10, 95% CI = 1.06–1.13). Latino/Hispanic SMs who experienced both ethnic and sexual orientation discrimination were more likely to meet criteria for AUD (AOR = 3.44, 95% CI = 1.97–6.03) and moderate-to-severe AUD (AOR = 2.69, 95% CI = 1.25–5.82) compared to those who did not experience discrimination. Discrimination is a risk factor for AUD and moderate-to-severe AUD among Latino/Hispanic overall and SM populations. [ABSTRACT FROM AUTHOR]

Mental healthcare for LGBTQIA+ populations in rural areas remains unequal, despite societal progress toward inclusivity. This review examines the specific obstacles faced in rural areas, such as limited services, workforce deficiencies, and travel burdens for treatment, which exacerbate existing mental health inequities. By following the Joanna Briggs Institute methodology, an exploration of SCOPUS, EBSCO Host (All), and Ovid databases yielded 2373 articles. After careful screening, 21 articles from five countries were selected, primarily using qualitative interviews and quantitative online surveys. Analysis through the Lévesque framework reveals the complex challenges faced by LGBTQIA+ individuals in rural mental healthcare. Discrepancies in approachability, acceptability, availability, affordability, and appropriateness were identified. Geographical isolation, discrimination, and a lack of LGBTQIA+-attuned professionals further compound these issues. Societal stigma, discrimination, and economic constraints hinder individuals from accessing and engaging in mental health services. This study highlights the need for purposeful interventions to improve rural mental health access for sexual and gender minorities. [ABSTRACT FROM AUTHOR]

Clinical education programs are positioned to train future health care professionals to provide excellent health care for transgender and gender-diverse patients. The purpose of this resource, Advancing Inclusion of Transgender and Gender-Diverse Identities in Clinical Education: A Toolkit for Clinical Educators, is to facilitate critical inquiry among clinical educators regarding their approach to teaching about sex, gender, the historical and sociopolitical context of transgender health, and how to prepare their students to apply standards of care and clinical care guidelines set forth by national and international professional organizations. [ABSTRACT FROM AUTHOR]

Chemsex refers to the use of psychoactive substances with sex. We carried out a systematic scoping review of methodological characteristics of chemsex research among men who have sex with men (MSM), published between 2010 and 2020. For inclusion, chemsex had to be the main focus, and studies had to specify GHB/GBL, stimulant (amphetamine, crystal meth, ecstasy/MDMA, cathinones, cocaine) and/or ketamine use with sex as a variable. From 7055 titles/abstracts, 108 studies were included, mostly cross-sectional, and from Western countries. About one-third of studies recruited exclusively from clinical settings. A majority of these recruited from sexually transmitted infection (STI) clinics. The included quantitative studies analyzed possible associations between chemsex and STI health (40%), mental health (15%), drug health (12%), sexological health (10%), and post-diagnostic HIV health (7%). Most studies included GHB/GBL and crystal meth in their operationalization of chemsex. Definitions and operationalizations of chemsex vary greatly in the literature, and researchers of chemsex among MSM should consider ways in which this variation impacts the validity of their results. More studies are needed among MSM in non-high income and non-Western countries, and examination of possible links between chemsex and post-diagnostic HIV health, sexological health, and mental health. [ABSTRACT FROM AUTHOR]

Enhancing healthcare professionals' education and training to effectively manage the healthcare needs of People Identifying as Lesbian, Gay, Bisexual, Transgender, Queer, and other Sexual and Gender Minorities (LGBTQ+) is imperative. Recognizing the importance of mitigating LGBTQ+ health disparities, healthcare associations have affirmed their commitment to providing inclusive and culturally competent healthcare. However, despite these efforts, there is still a gap in LGBTQ+-specific teaching within nursing and other healthcare professionals' schools, resulting in healthcare professionals being ill-equipped to meet the unique needs of LGBTQ+. To address this gap, we suggest integrating LGBTQ+ health content into healthcare training programs, focusing on the Philippine nursing curriculum. Drawing from various reports, including insights from discussions with the local LGBTQ+, the suggested topics include LGBTQ+ identities, sexual health, trans health, mental health, and social determinants of LGBTQ+ health. By fostering understanding and competence through education, equitable and inclusive healthcare practices for LGBTQ+ can be better cultivated, helping to ensure that the unique healthcare needs of LGBTQ+ are met effectively. Furthermore, it is necessary to share best practices for providing health services to LGBTQ+ people. Additionally, future studies can explore the median time allocated to LGBTQ+ teaching, the optimal number of teaching hours for LGBTQ+ content, and the specific contents of local nursing curricula that can better address their needs. By undertaking these steps, we can move toward effectively addressing the unique healthcare needs of LGBTQ+. [ABSTRACT FROM AUTHOR]

It is important to understand the differential impact of COVID-19 on the health of older lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, and people with other sexual orientations and forms of gender expression (LGBTQIA+). The objective of this study is to systematically review the impact of COVID-19 on LGBTQIA+ older adults' health including risk and protective factors. We reviewed a total of 167 records including LGBTQIA+ older adults published since 2019. Two independent reviewers screened titles and abstracts and extracted information of 21 full-text records meeting inclusion criteria using COVIDENCE software. The results show that the negative health consequences are exacerbated by personal risk (e.g., perceived homo/transphobia and ageism in LGBTQIA+ communities) and environmental factors (e.g., heterosexism within health services). The negative impact seems to be reduced by personal protective (e.g., resilience, spirituality, and hobbies) and environmental factors (e.g., technology use to increase social participation and social rituals). In conclusion, the health of LGBTQIA+ older adults has been disproportionately affected during the pandemic associated to the latest coronavirus (COVID-19). The experiences of LGBTQIA+ older adults during the pandemic are integrated in a Model of Health and Disease for LGBTQIA+ older adults. Specific strategies to promote health and well-being in this community are provided. [ABSTRACT FROM AUTHOR]

The Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Brief Form (PID-5-BF) was developed with an assumption of invariance across sexual and gender minority (SGM) individuals. This assumption has yet to be tested empirically. Using multigroup confirmatory factor analysis, we examined measurement invariance in the PID-5-BF across the SGM status in clinical (N = 1,174; n = 254 SGM) and nonclinical (N = 1,456; n = 151 SGM) samples. Measurement invariance was supported for the PID-5-BF structure, item thresholds, and factor loadings, but not at the item intercept level. SGM individuals endorsed higher negative affectivity, antagonism, disinhibition, and psychoticism domains in both samples. In the clinical sample, adjusting for partial invariance decreased detachment and antagonism levels for SGM persons. In the nonclinical sample, adjusting for partial invariance reduced antagonism disparities in the SGM group, even rendering original group differences null. Our results support the use of the PID-5-BF in SGM populations but indicate that some measurement bias may drive observed disparities in maladaptive trait domains and, in turn, personality disorder diagnosis. [ABSTRACT FROM AUTHOR]

Over the last decade, several former Australian AIDS Councils (turned LGBT health organisations) have opened dedicated primary healthcare clinics for lesbian, gay, bisexual and transgender (LGBT) people. Operating at the intersection of medical practice and queer politics, these clinics try to enact a type of care that is attuned to the power relations between LGBT people and medicine. Drawing on the concepts of affective atmospheres (Anderson, 2009, “Affective Atmospheres.” Emotion, Space and Society 2 (2): 77–81. https://doi.org/10.1016/j.emospa.2009.08.005) and queer feelings (Ahmed 2014, The Cultural Politics of Emotion. Edinburgh University Press. https://www.jstor.org/stable/10.3366/j.ctt1g09 × 4q), this article argues that senses of the feelings and emotions of LGBT people evoked by mainstream medical spaces are central to the design of LGBT clinics. This analysisis based on situated interviews with practice managers which examined the affective intent of LGBT clinics. By examining how practice managers consider location, the curation of art and health promotion materials, and the employment of peer workers, this article argues that LGBT clinics are helping to make LGBT health a tangible and meaningful subcategory of public health by designing spaces in which medicine can be encountered within a ‘queer atmosphere’. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known about the subject?: The trans community perceives barriers to the mental health services in the form of professionals' transphobia, lack of knowledge, and cultural sensitivity in healthcare.The attitudes of health professionals are mediated by their social context, which can determine their behaviour or attitude towards users. What does the article add to existing knowledge?: The attitudes of mental health professionals towards trans people are related to variables such as the professional's age, gender, political ideology and religious beliefs.Mental health nursing, psychology and social work are the professions that present more favourable attitudes towards trans people. What are the implications for practice?: The inclusion of a professional perspective that understands sexual and gender diversity among mental health professionals is required.It is necessary to train professionals to promote socio‐healthcare based on respect and free from prejudice, discrimination and stigma. Introduction: The trans community perceives barriers to the mental health services in the form of professionals' transphobia, lack of knowledge and cultural sensitivity in healthcare. Aim: Evaluation of the attitudes towards trans people of the professionals who work in the different Spanish mental health services. Method: A cross‐sectional design was used with a sample of professionals from different professional groups working in mental health units, hospitals and outpatient settings throughout Spain. Results: Gender differences were found, with higher values in genderism and sexism among males. Negative attitudes and sexism have also been associated with age and religious beliefs. Mental health nursing, psychology and social work presented more favourable attitudes towards trans people than other mental health professionals. Discussion/Implications for Practice: The inclusion of a professional perspective that understands sexual and gender diversity and the acquisition of professional attitudes based on evidence and patient‐centred model are basic aspects to promote socio‐healthcare based on respect and free from prejudices, discrimination and stigma. [ABSTRACT FROM AUTHOR]

Relative to cisgender heterosexual persons, lesbian, gay, bisexual, and transgender (LGBT) people experience greater health inequities, thereby affecting their engagement in care. One strategy to address these disparities is to educate future healthcare professionals to provide nondiscriminatory care to LGBT people. The goal of this study was to explore the perceived coverage of LGBT health education topics in graduate-level medical (MD), pharmacy (PharmD) and nursing (DNP) curricula. Cross-sectional data were collected from web-based surveys (N = 733) completed by healthcare professional students enrolled at two universities in New York State. Of those who responded, 50.5% were MD, 38.9% were PharmD, and 10.6% were DNP students. Overall, mean scores indicated a dearth of perceived LGBT health coverage. Results demonstrated variations in coverage by degree program. Findings highlight the need to develop educational curricula inclusive of topics concerning LGBT patient health. Adequately educating the next generation of healthcare professionals can further promote healthcare engagement among LGBT persons and improve pedagogical practices in healthcare professional education programs. [ABSTRACT FROM AUTHOR]

There are approximately 90 000 lesbian, gay, bisexual, and transgender (LGBT) individuals in Orange County, California. LGBT individuals have significant health disparities, particularly if they are from racial or ethnic minority groups and/or have a disability. There are structural and access barriers in the health care system that increase these health disparities. These individuals experience discriminatory situations when accessing health care and mental health services, which may affect their health-seeking behaviors. The purpose of this pilot quantitative cross-sectional study was to gather information about the current health care experiences and needs of this LGBT population including priority health issues, physical and mental health care utilization, and perceived adequacy of LGBT-friendly physical and mental health care providers. These findings will inform organizational strategies for nursing administrators and other health care leaders when tailoring, planning, and redesigning structures that meaningfully address the service needs of this at-risk group. Seventy-five participants were recruited from 2 organizations serving the LGBT community to complete an online survey. Findings include trouble finding an LGBT competent provider, delays or being unable to access care, and worried about losing insurance. Most participants needed to visit multiple different locations to receive care and preferred a 1-stop shop. [ABSTRACT FROM AUTHOR]

Introduction: Cigarette smoking is disproportionately high among lesbian, gay, and bisexual (LGB) adults. Yet, collapsing these identities into a monolith can disguise important within group disparities (e.g., lesbian/gay versus bisexual female). The purpose of this study is to report recent national prevalence estimates and trends of cigarette smoking behaviors and nicotine dependence by sexual identity and sex. Methods: Data were from the 2015–2019 National Survey on Drug Use and Health (n = 210,392; adults 18+), a nationally representative, repeated cross-sectional study of substance use and mental health in the U.S. We examined bivariate and multivariable associations between sexual identity and cigarette smoking measures (i.e., former smoking, lifetime smoking, current smoking, current daily smoking, nicotine dependence) by sex. We also examined linear time trends in current and former smoking. Covariates included age, race/ethnicity, education, annual household income, and survey year. Results: Bisexual women had the highest unadjusted prevalence of current smoking (31 %) and lowest of former smoking (25 %). LGB females and males had higher adjusted prevalence of current smoking, daily smoking, and nicotine dependence than heterosexual adults. Bisexual females and gay and bisexual males had lower adjusted prevalence of former smoking (adjusted prevalence ratio range: 0.78–0.85) than heterosexual counterparts. Discussion: This is the first study to identify disproportionately low prevalence of former smoking among bisexual females. Paired with findings of high prevalence of current cigarette smoking and nicotine dependence, these data suggest that tobacco control interventions targeted toward bisexual females are urgently needed to reduce the burden of cigarette smoking among these individuals.

Background: In the United States, an estimated 4.5% of the population identifies as a sexual or gender minority (SGM). Efforts are underway to address this population's healthcare disparities. [A1] Objective: This review aims to highlight dermatologist's role in treating SGM patients, raise awareness about SGM-related stigma, and identify clinical interventions to improve SGM care. Methods: Articles were selected by review of literature from PubMed's database from 2000-2020. Results: The first intervention outlines methods to educate the healthcare team on the terminology used by the SGM community and how HIV epidemiology is a distinct topic through separate trainings. The second intervention emphasizes better communication with SGM patients in routine discussions, including the proper elicitation of a sexual history by avoiding heteronormative questioning. The last intervention discusses enhancing this population's clinical experience by updating clinical intake forms to include a fill-in-the-blank for patients' pronouns, refraining from gender-specific bathrooms, and advertising commitment to SGM care online. Conclusion: Our review article highlights a dermatologist's integral role in SGM care. The review emphasizes three distinct intervention areas that aim to destigmatize sexual/gender identity in the workplace, promote cultural humility, and improve the therapeutic alliance between SGM patients with dermatologists.

Two experimental studies, performed in Italy and Poland, showed that exposure to homophobic hate speech reduces well-being among LGBT+ people, particularly among those who highly identify with the LGBT+ community. Study 1 showed that exposure to homophobic words increases negative mood among highly identifying LGBT+ people, but it does not influence the negative affect of loosely identifying participants. Study 2 showed that exposure to homophobic statements reduces general life satisfaction among highly identifying LGBT+ people, as opposed to low-identifiers. [ABSTRACT FROM AUTHOR]

Drag queens are typically gay men who perform as caricature-like women. They thereby publicly challenge "naturally" binary gender role categories, though it remains unclear how that interplays with their private (e.g., sexual) lives. This study seeks to answer this question by exploring the sexuality and sexual practices of drag queens. Employing a critical realist approach, ten semi-structured interviews were conducted in Germany, with questions focusing on the drag queens' views on sexuality and sexual positioning. By adopting a thematic analysis, three main themes were identified: natural versus artificial identity; advocacy for sexuality; and rejection of heteronormativity. Results suggest that the primary intention of drag queens is to challenge heteronorms, while they regularly adhered to these privately. This illustrates the distinction made by the participants between their "public" persona, an artificial character that lacks sexuality, and their "private" life (e.g., sexual practices), shaped by an "inborn" sexuality. [ABSTRACT FROM AUTHOR]

Against the backdrop of the healthcare inequities and maltreatment facing LGBT patients, recommendations have been made for the inclusion of LGBT health topics in nursing curricula. Based on data collected in focus group discussions with South African nursing students, we complicate the assumption that training focused on health-specific knowledge will effectively reform providers' prejudicial practices. Findings reveal ambivalence: silence and discrimination versus inclusive humanism. Participants drew on discourses of ignorance, religion, and egalitarian treatment to justify their inadequacy regarding LGBT patients; while doing so, however, they deployed othering discourses in which homophobic and transphobic disregard is rendered acceptable, and "scientifically" supported through binary, deterministic views of sexuality and gender. Such "expert" views accord with Foucault's notion of "grotesque discourse." We conclude with a discussion of the findings' implications for nursing education; we call for the recognition and teaching of binary ideology as a form of discursive violence over LGBT lives. [ABSTRACT FROM AUTHOR]

A lifetime of disadvantages shapes how lesbians and gay men navigate healthcare as they age and their fears about end-of-life care. This paper investigates how a localized group of older white, college educated, and economically privileged gay men and lesbians conceptualize their approach to healthcare. Analyzing 23 in-depth interviews with gay men and lesbians over the age of 60 I consider how they utilize their advantages when aging and facing declining health. I pay particular attention to how discriminatory social and legal contexts shaped elders' current situations and ability to be "out" and engage with healthcare professionals. I utilize the theory of cumulative advantages and disadvantages as another way to understand literature on health inequalities and LGBTQ health work, finding that despite systemic inequalities some gay men and lesbian elders use their resources to find gay-friendly primary care physicians, age at home, and build social supports for caregiving as their health declines. [ABSTRACT FROM AUTHOR]

Transgender (trans) people face high rates of sexual assault and often encounter systemic barriers in accessing appropriate care and supports, including, among others, stigma, discrimination, and a lack of provider knowledge. Trans communities and allies in research and the service sector have emphasized the potential of advocacy as a tool to dismantle barriers for trans people; however, to date, few advocacy efforts have been undertaken in the sexual assault context. To address this gap, we developed and implemented #TRANSformativeKnowledge, a social media campaign to promote awareness among providers about the damaging attitudes, beliefs, and reactions that often impede trans survivors' access to appropriate services. Based on insights from a recorded consultation with trans community members and health and social service professionals, we designed seven posters for circulation on Twitter, each containing a representative quote, key message, and associated call to action. The campaign was launched May 17, 2021, with posters Tweeted twice weekly, including one final summary post on June 30, 2021. The campaign reached approximately 100,000 Twitter users, with almost 2,000 engagements. As demonstrated by these findings, our social media advocacy campaign represents a viable method for disseminating knowledge about sexual assault against trans people, which could be replicated by others aspiring to advance health equity through advocacy. [ABSTRACT FROM AUTHOR]

The extant data suggest that LGBT communities were disproportionately impacted by the economic ramifications of the pandemic and were more likely to report being uninsured throughout the first two years of the pandemic. Additionally, these groups are at heightened vulnerability for several health conditions that require insurance to manage or prevent. Thus, there is a need to assess changes in pandemic-era insurance coverage among these populations. This study uses data collected as part of the Together 5000 study, a U.S. national, internet-based cohort study of cisgender (cis) men, trans men, and trans women who have sex with men. We analyze insurance data across three different assessments between 2019 and 2021, exploring changes in insurance coverage and type. Among our sample, 6.4% lost their insurance in 2020 because of the pandemic. Insurance loss was associated with living in a state that had not expanded Medicaid, race/ethnicity, employment status, and income. Among those who lost their insurance in early 2020, most (59.2%) reported gaining insurance by 2021, with those living in nonexpanded states less likely to gain insurance. Finally, those who were uninsured prior to the pandemic were less likely to report gaining insurance by 2021 when compared with those uninsured as a result of the pandemic. This suggests that there are uninsured cis gay and bisexual men and transgender individuals (GBT) that continue to go unreached by policies to assuage uninsurance. Further policy intervention is needed to address uninsurance among LGBT individuals, which has important implications for addressing health disparities among these populations. [ABSTRACT FROM AUTHOR]

Lesbian, gay, bisexual, and transgender (LGBT) populations experience widespread disparities in health outcomes, health behaviors, and access to care compared to their non-LGBT counterparts. Moreover, very few studies have either studied the social determinants of health (SDoH) of LGBT populations or LGBT health in large cities located in the US South. This study uses novel, community-informed, and representative data to study the SDoH of LGBT adults in Nashville and Davidson County, Tennessee. Compared to non-LGBT adults (n = 1583), LGBT adults (n = 128) in Nashville, Tennessee, were more likely to report being dissatisfied with life and feeling emotionally upset or physical symptoms as a result of how they were treated based on their race/ethnicity compared to non-LGBT adults. LGBT adults in Nashville were also less likely to keep a firearm in the home than their non-LGBT peers. This study documents new disparities in the SDoH for LGBT adults living in one of the largest and fastest growing cities in the southeastern US. More research on LGBT populations in urban centers located in the US South is critically needed. Meanwhile, locally based community organizations and public health leaders may consider developing and testing innovative solutions to enhance social networks and social supports among LGBT populations. Addressing the SDoH among LGBT adults in southern cities will be essential for achieving health equity for all LGBT populations in the USA. [ABSTRACT FROM AUTHOR]

Religious spaces have proven to be effective sites of health intervention among Black Americans. Less is known about how religious environments impact the health of subgroups of Black Americans, specifically Black men who have sex with men (MSM). Using data from the Promoting Our Worth, Equality, and Resilience study, we explored the factor structure of a 10-item religious environment scale among Black MSM (N = 2,482). Exploratory factor analysis revealed three distinct factors: (1) visibility of MSM, (2) structural support, and (3) structural homonegativity. The relationship between Black MSM and their religious environments is complex and should be investigated using measures that accurately reflect their lived experiences. [ABSTRACT FROM AUTHOR]

Introduction: Pre-Exposure Prophylaxis (PrEP) use continues lag estimated need among gay and bisexual men in the United States. Studies report that challenges paying for PrEP may undermine continued use. Our study aimed to measure these challenges over time. Methods: Data were taken from a US national cohort study of cisgender gay and bisexual men and transgender individuals aged 16–49 years. We analyzed data from PrEP-using participants between 2019 and 2021 and observed cost-related and insurance-related challenges participants experienced while on PrEP across time points. We report McNemar and Cochrane Q test statistics to compare differences between groups by year(s). Results: In 2019, 16.5% (n = 828/5013) of participants were on PrEP; by 2020, 21% (n = 995/4727) were on PrEP, and by 2021, 24.5% (n = 1133/4617) were on PrEP. The proportion of those experiencing challenges paying for PrEP care decreased significantly across time points for clinical appointments, laboratory work, and prescriptions. Those experiencing insurance and copay approval issues did not change significantly. Although not statistically significant, the only proportion that increased over time was those reporting PrEP-related insurance approval issues. In a post hoc analysis, we found that those reporting PrEP use in the past year who were not currently on PrEP were significantly more likely to report experiencing most PrEP challenges, when compared with current PrEP users. Discussion: We found significant reductions in insurance and cost-related challenges between 2019 and 2021. However, those who discontinued PrEP within the past year reported greater challenges paying for PrEP, suggesting that cost and insurance issues may undermine PrEP persistence. [ABSTRACT FROM AUTHOR]

Transgender and gender diverse (TGD) youth, particularly transgender youth of color, experience barriers to most, if not all, types of care across the United States. Consequently, clinicians are concerned about the increase of anti-transgender policies in the United States, with many states now restricting gender-affirming care. In this manuscript, we suggest several empirically based techniques to provide quality clinical care. We also share resources to support TGD youth and their families, while accommodating for some of these newer restrictions on the care that clinicians are able to provide. Ongoing training and awareness in these techniques will allow clinicians and their health care institutions to more effectively and immediately respond to anti-transgender policies and be able to provide care. By continuing to advocate for some of these strategies, there is potential to reduce the health inequities that many TGD youth experience. Prioritizing screening for gender discrimination, creating a safe space for TGD youth, and providing immediate clinical strategies to reduce distress can reduce symptoms of depression and suicide. These changes, albeit small, will allow clinicians to feel more comfortable providing gender affirming care through holistic changes in clinical practices and care. [ABSTRACT FROM AUTHOR]

In 2021, Canada Health Infoway and the University of Victoria's Gender, Sex, and Sexual Orientation Research Team hosted a series of discussions to successfully and safely modernize gender, sex, and sexual orientation information practices within digital health systems. Five main topic areas were covered: (1) terminology standards; (2) digital health and electronic health record functions; (3) policy and practice implications; (4) primary care settings; and (5) acute and tertiary care settings. In this viewpoint paper, we provide priorities for future research and implementation projects and recommendations that emerged from these discussions. [ABSTRACT FROM AUTHOR]

Introduction: Chemsex refers to using illicit substances to facilitate sexual experiences in men who have sex with men. Chemsex has been linked to significant negative impacts on psychological, social, and physical wellbeing. Little is known about information-seeking behaviours in this population. This study aims to provide an in-depth understanding of seeking and engaging with health information. Methods: Self-identified Australian sexual minority men who engage in chemsex (N = 184) participated in an anonymous cross-sectional survey. Variables included chemsex engagement, knowledge, perception and use of harm-reduction information, and associated health and support services. Pearson correlation and ANOVAs were conducted. Wilcoxon-Signed-Rank and Friedman tests were applied to analyse the perceived trustworthiness of information sources. Results: Chemsex represented a meaningful part of sexual events. Most participants knew where to access professional help and harm-reduction information but worried about being judged. Most did not feel comfortable discussing chemsex with health professionals except with sexual health doctors/counsellors. Few users discussed health risks with a professional. Information on chemsex was received through multiple sources with significant differences in perceived relevance and trustworthiness, with sexual health doctors/nurses ranked the most trustworthy information. Interest in non-traditional sources of information was low except for formal peer networks and anonymous personal expert advice. Conclusion: Engagement with health professionals and harm-reduction information is limited in this population, despite high risk and potentially significant adverse health outcomes. Results suggest that new and combined approaches are necessary to reach this population, including peer support networks, anonymous personal advice and changing community attitudes towards chemsex.

Transgender (trans) persons are sexually assaulted at high rates and often encounter barriers to equitable services and supports. The receipt of timely and appropriate postassault care, provided increasingly by specialized forensic nurses around the world, is critical in ameliorating the harms that accompany sexual assault. In order to adequately respond to the acute health care needs of trans clients and attend to longer term psychosocial difficulties that some experience, forensic nurses not only require specialized training but must also cultivate collaborative relationships with trans-positive health and social services in their communities. To meet this need, we describe our strategy to advance trans-affirming practice in the sexual assault context. We outline the design and evaluation of a trans-affirming care curriculum for forensic nurses. We also discuss the planning, formation, and maturation of an intersectoral network through which to disseminate our curriculum, foster collaboration, and promote trans-affirming practice across health care and social services in Ontario, Canada. Our approach to advancing trans-affirming practice holds the potential to address systemic barriers experienced by trans survivors and transform the response to sexual assault across other sectors and jurisdictions. [ABSTRACT FROM AUTHOR]

We used data from the 2014-2017 Medical Expenditure Panel Survey to compare health care expenditures and financial burden between adults in same-sex couples (n = 514) and adults in different-sex couples (n = 41,043). Compared with men in different-sex couples ($3,994), men in same-sex couples ($6,896) were more likely to spend more on health care, especially on prescription medications ($2,745 vs. $1,050), which was primarily driven by antiviral medications ($1,061 vs. $35). Women in same-sex couples ($5,886) reported similar health care expenditures compared with women in different-sex couples ($5,619). However, women in same-sex couples were significantly more likely to experience financial burden compared with women in different-sex couples (25.7% vs. 11.3%). We speculate that the disparities reported here are due to a variety of issues, including elevated health needs requiring prescriptions for lesbian, gay, bisexual, and transgender (LGBT) men and lower incomes for LGBT women. More research is needed to understand health services utilization and expenditure patterns among LGBT populations. [ABSTRACT FROM AUTHOR]

Disparities in health insurance coverage and access to care are well documented between sexual minority adults and their heterosexual peers. Much less research has examined whether marital status affects access to care by sexual orientation identity. This study used data on nonelderly gay/lesbian adults (n = 1740), bisexual adults (n = 1138), and their heterosexual counterparts (n = 80,329) from the 2015–2018 National Health Interview Survey. Multivariable logistic regression models estimated the differences in health insurance status and access to care between married and cohabiting adults to single adults by sexual orientation. Compared to single adults, married adults were more likely to have private health insurance and less likely to have public health insurance regardless of sexual orientation. Married heterosexual and gay/lesbian adults were more likely to have a usual source of care and less likely to experience delayed or unmet medical care and mental health care due to cost compared to their single counterparts. We found fewer statistically significant differences between married and single bisexual adults and between married and cohabiting adults of all sexual orientations. Our study demonstrates that married gay, lesbian, and bisexual adults are more likely to have private health insurance and fewer financial barriers to care compared to their single counterparts. Given the recent recognition of legal same-sex marriage for sexual minorities, much more research is needed to document if and how marriage affects access to care and health outcomes by sexual orientation. [ABSTRACT FROM AUTHOR]

Chemsex is the use of methamphetamine or other substances to enhance sexual experiences, and is most often associated with sexual minority men. Within the chemsex literature, questions of sexual violence emerge due, in part, to ambiguity about what constitutes consent within sexualized environments with co-occurring substance use. To understand the context in which sexual violence occurs, data from an online survey of sexual and gender minority Texans were analyzed using bivariate and logistic regression (N = 1273), and qualitative interviews with substance-using sexual minority men from a separate sample were thematically analyzed (N = 22). Among survey participants, 12.8% experienced a form of sexual violence (10.1% experienced intimate partner violence and 7.6% experienced sexual assault). When participants were categorized based on past year substance use and sex party attendance, 48.0% of participants who used drugs and attended sex parties (a proxy for chemsex) experienced sexual violence (41.6% experienced intimate partner violence and 41.0% experienced sexual assault). When variables statistically significant at the bivariate-level were entered into logistic regression models, participants in the chemsex category were 12.5 [95% CI: 6.9, 22.8] times more likely to experience sexual violence. Substance-using sexual minority men experiencing sexual violence describe situations in which consent is difficult to revoke and sexual exploitation is likely to occur. Studies which more deeply explore the relationship between sexual and relationship violence and chemsex among sexual and gender minorities are needed. Particularly, the notion of consent needs further conceptualization in the context of drug use and sex parties. Measures of recent substance use and sex party attendance were combined to create a proxy measure for chemsex, which is the use of substances to enhance sexual experiences. Substance-using sexual and gender minorities engaging in chemsex were at increased risk of sexual violence. In addition to engaging in chemsex, variables associated with an increased odds of sexual violence among sexual and gender minorities were younger age, having a non-monosexual sexual identity, and receiving a mental health diagnoses. Studies on sexual and gender minorities engaging in chemsex should be developed to further explore sexual exploitation. [ABSTRACT FROM AUTHOR]

Lesbian, gay, bisexual, and transgender (LGBT) older adults are at particular risk for receiving inequitable end-of-life care. Their health care wishes may be ignored or disregarded, their families of choice are less likely to be included in their decision making, and they may experience increased isolation, bullying, mistreatment, or abuse, which ultimately contribute to receipt of poor-quality health care. This is particularly important during sensitive transitions along the care continuum to end-of-life settings; 43% of respondents of a 2018 survey of 865 hospice professionals reported having directly observed discriminatory behavior toward LGBT patients. Lack of visibility and accountability perpetuates vulnerabilities and the potential for discriminatory treatment. Unfortunately, while other areas of health care have prioritized and normalized collecting sexual orientation and gender identity (SOGI) data, hospices do not routinely assess patients' SOGI in the context of end-of-life wishes and decisions. Drawing insight from a sample of 31 in-depth interviews with older LGBT adults, this paper focuses on one participant's story—Esther's. We chose her story to illustrate how care can be compromised at the end of life if an open discussion with patients about what and who matters most to them at the end of life, is avoided. [ABSTRACT FROM AUTHOR]

Introduction. the objectives were to determine doctor of physical therapy (DPT) student comfort level, attitudes, and preparedness to address lesbian, gay, bisexual, transgender, and queer (LGBTQ+) health in the United States. Methods. the research design was a cross-sectional nonexperimental national survey of DPT students in the United States the survey was administered online using SurveyGizmo. Participants included 1,015 DPT students. Results. Most respondents (91.7%, n = 931) reported that they felt comfortable treating patients who identify as lesbian, gay, and bisexual and 75.7% (n = 768) indicated that they felt comfortable treating patients who identify as transgender. An overwhelming majority (96.7%, n = 982) agreed that it was the responsibility of all health care providers to care for patients who identify as LGBTQ+. Conversely, only 20.6% (n = 209) agreed that their entry-level DPT programs had prepared them to care for patients who identify as LGBTQ+. About two-thirds of the respondents (66.0%, n = 670) indicated that they were interested in receiving further education about LGBTQ+ health. Ordinal logistic regression analysis indicated that some demographical factors, including age, gender, number of years in a physical therapy program, and respondent's sexual orientation, had impacts on some of the responses with statistical significance. Discussion. Doctor of physical therapy students reported high comfort level and positive attitudes toward patients who identify as LGBTQ+ but feel underprepared by their entry-level DPT programs to treat this population and demonstrate an interest in more training. Conclusion. Improvements in education on LGBTQ+ health are needed in entry-level DPT programs to provide high-quality graduates as workforce in the health care system. [ABSTRACT FROM AUTHOR]

HPV, a sexually transmitted viral infection, is the etiological agent of significant dermatologic disease including benign anogenital warts and invasive cancers. Sexual and gender minority individuals are particularly vulnerable to HPV‐associated disease due to reduced vaccination rates in these cohorts, low awareness of HPV, lack of provider recommendation, and inadequate consensus guidelines on screening and prevention in these individuals. A targeted approach is needed with regards to vaccination in all children —especially those from racial, ethnic, sexual, and gender minorities; provider recommendation, especially from pediatric dermatologists, is crucial. Effort must also be made to use transgender and non‐binary affirming language as dividing vaccination programs by anatomic sex and sexuality reinforces problematic notions of gender identity and sexuality, isolating the most vulnerable. [ABSTRACT FROM AUTHOR]

Objective: Microaggressions, a concept originally introduced for ethnic minorities, represent subtle day‐to‐day discrimination, damaging the psychological health and well‐being of lesbian, gay, bisexual, and transgender individuals as well. This study aimed to assess whether microaggressions occur in psychotherapists' assessments of clients who identify as either lesbian or transgender woman when compared with those identifying as heterosexual woman. Methods: The study included a sample of 135 licensed psychotherapists (110 cisgender women and 25 cisgender men). Participants were presented with an audio file of a woman introducing herself during her first therapy session. Three versions were presented: a transgender, a lesbian, and a heterosexual client. Participants were asked to assess the clinical relevance of 10 questions defined as neutral (N = 5) and microaggressive (N = 5), used to determine a clinical impression of the client. A repeated measure analysis of variance was conducted to understand the likelihood of clients of different gender identity and sexual orientation receiving microaggressions. Results: Participants were more prone to consider microaggressive questions relevant where the client identified as either lesbian or transgender. Conclusions: The findings highlighted a bias against lesbian and trans women in evaluating the relevance and usefulness of clinical information while making a psychological assessment of a case. [ABSTRACT FROM AUTHOR]