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Comprehensive Human Immunodeficiency Virus (HIV) services are seldom found within a single organisation. This motivates organisations to form partnerships to achieve optimal outcomes. However, the complexity of inter-organisational relationships can hinder the process of achieving an effective and coordinated response to the HIV epidemic. Understanding the evolution of these inter-organisational relationships can shed light on ways to improve the delivery of these service provisions. This study examines the organisational networks of the HIV care landscape in the Chicago area across 3 years (2015–17). The results of longitudinal analysis indicate that although most organisations still perceive this landscape to be moderately competitive, they have developed more formalised ties and increased their collaborations across 3 years. Further, with passage of time, this organisational network has become denser with no organisational isolation, indicating connection between all organisations in this landscape. Practical implications for organisations are discussed. [ABSTRACT FROM AUTHOR]

Although perception of stigma (PS) has been dubbed as a key barrier to the optimal uptake of PrEP, research on PS is sparse. More specifically, no scholarly work has explored factors associated with the expression of PS toward PrEP use. This study addresses the literature gap by investigating factors associated with PS toward PrEP use. Data were drawn from the baseline survey (2017–2019) of the "Keeping It LITE Study", involving a large cohort (n = 3330) of young sexual minority men, transgender men and women, and non-binary individuals in the US. Participants' ages ranged from 13 to 34 years, with the majority (87%) assigned male at birth. The racial composition of the sample was diverse, with 53.9% identifying as white, 19.8% as Latinx, 10.7% as Black or African American, and smaller proportions as Asian, American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, and another race/ethnicity. Logistic regression models were utilized to examine two common measures of PS in PrEP use: (1) the perception that PrEP users are seen as promiscuous and (2) the perception that PrEP users are assumed to be HIV-positive. Two sets of models were developed to account for the correlation between gender identity and sex assigned at birth. The results suggest strong PS among current PrEP users, which can explain the weak PrEP adherence reported among this group. The findings underscore the need for targeted interventions to mitigate PS and enhance PrEP uptake and adherence in vulnerable populations. Social and practical implications of the results and directions for future research are discussed. [ABSTRACT FROM AUTHOR]

Lesbian, Gay, Bisexual, Transgender, Queer, and other sexual and gender minority (LGBTQ+) youth and young adults (YYAs) have poorer mental health outcomes than their cisgender, heterosexual peers in large part due to multilevel stigmatization and minority stress. This was exacerbated by psychological stressors stemming from the COVID-19 pandemic; these experiences intersected with YYA unique developmental stage. Here we explored LGBTQ+ YYA's pandemic-related experiences, focusing on intersections between stigma and belonging, developmental processes, and their relationship to mental health. We conducted qualitative interviews from August to November 2021 with 34 LGBTQ+ YYA ages 14 to 24; interviews were nested within a quantitative study on YYA experiences during COVID-19. Interviews were transcribed and coded using thematic analysis. YYA described how pandemic impacts like quarantine and isolation directly impacted their mental health; these coalesced around four types of thematic shifts: shifts in (1) time, (2) living situations, (3) community supports, and (4) social and political climate. Multilevel stigmatization also created new mechanisms of norm enforcement for LGBTQ+ YYA. Interviews demonstrated how the pandemic also impacted key developmental processes including identity formation and autonomy seeking. The potential consequences of these pandemic-related shifts largely depended on YYA's experiences of stigma and/or belonging throughout the pandemic. Findings suggested that isolation from the COVID-19 pandemic intersected with existing socio-ecological structures in LGBTQ+ young people's lives. Efforts to investigate longitudinal impacts of the pandemic, as well as to intervene to reduce the stigmatization experienced by LGBTQ+ YYA, remain urgent. [ABSTRACT FROM AUTHOR]

Sexual and gender minorities (SGM) frequently experience depression and health care-related stigma. Health care satisfaction is important for seeking care, but little is known about SGM health care satisfaction, and especially as it relates to depression among rural SGM. From May 25 to July 2, 2021, we surveyed rural Illinois (IL) individuals aged ≥18 years on the topics of demographics, depression, health care satisfaction, past health care experiences, internalized stigma, and victimization. Among the 398 respondents, the gender identity distribution included cisgender males and females (171 and 203, respectively) and transgender males and females (8 and 7, respectively), while sexual orientation included heterosexuals (114), gay/lesbians (143), and other orientations (141). Analyses were conducted with respect to both identity and orientation (and their interaction). In univariate analysis, transgender individuals were more likely than cisgender to screen positive for depression and less likely to report feeling accepted by their medical provider. Compared to heterosexual respondents, gay/lesbians and other orientations were more likely to screen positive for depression. In logistic regression, factors associated with increased risk of depression included nonheterosexual orientation and past poor health care experiences. In linear regression, factors most commonly associated with the seven satisfaction subscales include: sexual orientation, past poor experiences, and employment. There were significant differences in depression across both sexual orientation and gender identity, and in health care satisfaction by sexual orientation. Rural SGMs are more vulnerable to depression and less likely to report satisfactory care. As health care engagement is critical for screening and care adherence, engaging rural SGM in a routine and satisfactory fashion is needed. [ABSTRACT FROM AUTHOR]

Youth and young adults (YYA) have been uniquely affected by COVID-19. Behavioral models have not yet been applied to understand YYA's preventive behavior, though the Information–Motivation–Behavior (IMB) model may be appropriate. We used data from a national, diverse survey of COVID-19 effects and prevention behaviors in YYA ages 14–24 (n = 1026) and conducted an exploratory factor analysis and bivariate linear regressions to assess the association between demographics and IMB measures. Significant differences by sexual identity were identified, with bisexual/pansexual, gay/lesbian, and queer populations reporting significantly lower prevention stigma, in comparison to their straight respondents. Non-binary respondents (vs. women/girls) and transgender and gender diverse individuals (vs. cisgender) had significantly higher intentions to social distance. Racial/ethnicity differences were also found in lower prevention efficacy beliefs (Latinx and multiracial vs. white), and lower motivation norms (Black and Latinx vs. white). Our findings about critical disparities in IMB measures provide recommendations for future prevention research, practice, and policy development in response to the pandemic, particularly related to highly marginalized communities. [ABSTRACT FROM AUTHOR]

This study aims to determine the prevalence of suicidality among American Indian and Alaskan Native (AI/AN) adolescents. Additionally, we measured suicidality, stratified by sex, and its association with sexual identity, sexual violence, and binge drinking. We pooled data from the Youth Risk Behavior Survey from 2005 to 2019 to analyze the prevalence of sexual minorities, forced sex, and binge drinking, and their association with suicidality using basic descriptive statistics followed by adjusted odds ratios stratified by sex among AI/AN youth. 19% of AI/AN participants reported having suicidal thoughts and 14% reported having a previous suicide attempt. More than 17% of AI/AN participants identified as sexual minority youth (SMY). Compared to AI/AN heterosexual youth, AI/AN bisexual youth had significantly higher odds of reporting suicidal thoughts (aOR = 16.01), planning (aOR = 12.4), and previous attempts (aOR = 7.73). This pattern was also significantly demonstrated for AI/AN gay/lesbian youth. 43% of all AI/AN participants reported being forced into sexual intercourse. The presence of binge drinking was associated with higher odds of suicidal thoughts for both females and males compared to those who did not binge drink. At the intersection of multiple marginalization, AI/AN SMY have a high mental health burden, demonstrating the need for culturally informed, community-led, and targeted mental health support focused on SMY AI/AN. Though this study fails to capture the heterogeneity within the AI/AN community, as nuances exist at the tribal level, these results demonstrate work needs to be done to support the health burden that AI/AN youth carry. [ABSTRACT FROM AUTHOR]

Multiple rural states and communities experience elevated rates of human immunodeficiency virus (HIV), often associated with diminished healthcare access and increased drug use. Though a substantial proportion of rural populations are sexual and gender minorities (SGM), little is known of this group regarding substance use, healthcare utilization, and HIV transmission behaviors. During May–July 2021, we surveyed 398 individuals across 22 rural Illinois counties. Participants included cisgender heterosexual males (CHm) and females (CHf) (n = 110); cisgender non-heterosexual males and females (C-MSM and C-WSW; n = 264); and transgender individuals (TG; n = 24). C-MSM participants were more likely to report daily-to-weekly alcohol and illicit drug use prescription medication misuse (versus CHf; aOR = 5.64 [2.37–13.41], 4.42 [1.56–12.53], and 29.13 [3.80–223.20], respectively), and C-MSM participants more frequently reported traveling to meet with romantic/sex partners. Further, more C-MSM and TG than C-WSW reported healthcare avoidance and denial due to their orientation/identity (p < 0.001 and p = 0.011, respectively); 47.6% of C-MSM and 58.3% of TG had not informed their provider about their orientation/identity; and only 8.6% of C-MSM reported ever receiving a pre-exposure prophylaxis (PrEP) recommendation. More work is needed to explore the substance use and sexual behaviors of rural SGM, as well as their healthcare interactions, to better target health and PrEP engagement campaigns. [ABSTRACT FROM AUTHOR]