Search

Video games are an understudied sport featuring social interactions both similar and dissimilar to those in offline sports. While anonymity in online video games could create a space where minoritized groups experience more equitable treatment, offline social inequalities are translated into online video game interactions. Drawing on 20 semistructured interviews and 2,694 survey responses from self-identified queer men, I build a framework for understanding gender, sexuality, and racial/ethnic harassment in online video games. I argue that nerd masculinity is a protest masculinity that uses symbolic harassment to reframe masculine hierarchy online and enforce hegemonic nerd masculinity. With this study, I illustrate the prevalence of symbolic harassment and the channels it may follow to become direct harassment. [ABSTRACT FROM AUTHOR]

Unhealthy alcohol use, which encompasses heavy episodic drinking to alcohol use disorder, has been identified as a modifiable barrier to optimal HIV care continuum outcomes. Despite the demonstrated efficacy of couples-based interventions for addressing unhealthy alcohol use, there are no existing couples-based alcohol interventions designed specifically for people living with HIV. This study presents the development and refinement of a three-session couples-based motivational intervention (ReACH2Gether) to address unhealthy alcohol use among a sample of 17 sexual minority men living with HIV and their partners living in the United States. To increase potential population reach, the intervention was delivered entirely remotely. Throughout an original and a modified version, results indicated that the ReACH2Gether intervention was acceptable and there were no reports of intimate partner violence or adverse events. Session engagement and retention were high. In pre-post-test analyses, the ReACH2Gether intervention showed trends in reducing Alcohol Use Disorder Identification Test scores and increasing relationship-promoting dynamics, such as positive support behaviors and goal congruence around alcohol use. Results support the need for continued work to evaluate the ReACH2Gether intervention.

Sexual and gender minority (SGM) cancer survivors face unmet care needs in accessing cancer health information and social support despite high satisfaction with treatment. SGM patients often delay care due to concerns of discrimination in healthcare settings, though the care experiences of SGM skin cancer survivors are less known. SGM individuals, particularly sexual minority men, report higher skin cancer prevalence and related risk behaviors than heterosexual men. This study aims to describe SGM skin cancer survivors' perceptions of the care environment and availability of SGM-specific survivorship resources. We conducted a secondary analysis of data from the OUT: National Cancer Survey conducted from September 2020 to March 2021. Among 2,528 survey respondents, 96 self-reported a history of skin cancer, with 33% having keratinocyte carcinomas (KC) only and 67% having melanoma. While 69% reported treatment in welcoming environments, 91% noted the absence of welcoming cues. Only 23% used social support specific to cancer survivorship, despite 62% valuing access to LGBTQI+-inclusive survivorship support. KC survivors reported less access to SGM-specific cancer information compared to melanoma survivors. These findings highlight gaps in dermatologic care for SGM skin cancer survivors. Dermatologists can address these needs by developing targeted health education resources, integrating identity-affirming information into care plans, and establishing inclusive environments through visible LGBTQI + cues and training staff in identity-affirming care. While limited by a small sample size, underrepresentation of gender and racial-ethnic minorities, and reliance on unvalidated survey tools, this study highlights the significant lack of data on SGM skin cancer survivors' experiences. We provide valuable insights into the unmet care needs of SGM skin cancer survivors. Future research should build on this foundational evidence to further examine differences in care experiences across skin cancer types and treatment settings, aiming to optimize support for SGM patients. [ABSTRACT FROM AUTHOR]

Although the use of geosocial networking (GSN) applications for relationship seeking is prevalent among sexual minority men (SMM), SMM of color may be vulnerable to sexual racism online. Little is known about how sexual racism relates to SMM of color's identity outness, which is integral to the minority stress model and the focus of this study. Eighty SMM, recruited through social media (53.7% racial/ethnic minority), reported their experiences of race-based discrimination on GSN apps and identity outness. Chi-squared and Fisher's tests examined differences in race-based discrimination online by participants' race/ethnicity. A factorial MANOVA was performed on outness to family, peers, and healthcare providers. Nearly one-third of participants experienced race-based discrimination online. Higher percentages of SMM of color experienced race-based discrimination than White SMM. SMM who experienced race-based discrimination online reported lower outness to family than those who had not. Post-hoc analyses revealed that Asian SMM reported consistently lower outness than other groups. Our findings resonated with the mediation framework of minority stress, suggesting that sexual racism online may be a distal stressor that contributes to the group-specific process of identity outness. This also illustrated the importance of addressing sexual racism on GSN apps to buffer existing stress with outness among SMM of color. [ABSTRACT FROM AUTHOR]

The precise nature of Horace Walpole's sexuality remains elusive, in spite of the extent of his surviving correspondence — which is vast but with notable and possibly strategic gaps. Walpole's reactions to two queer men he encountered in Italy, Cardinal Prince Henry Benedict and Baron Philipp von Stosch, nevertheless reveal some of his preoccupations and anxieties in relation to male‐male sexual desire. [ABSTRACT FROM AUTHOR]

Puppy play is a kink activity, in which people dress as, take on the role of, and mimic the physical and emotional behaviours of young canines or pups. We explore how the pup identity, depicted in cellphilms by queer men who are part of the pup community, influences men's body image perceptions using multimodal critical discourse analysis. Participants expressed feelings of dissonance, shame, and self-rejection when viewing themselves as humans, but conveyed excitement, pleasure, and self-celebration when viewing themselves as pups. Participants depicted their body images being transformed by way of puppy gear, puppy spaces, handlers, and playmates, which was said to foster more (self-)acceptance, playfulness, and freedom. This study highlights the potential for puppy play to provide a transformative experience for individuals, allowing participants to explore, re-signify, and embrace their bodies as pups. [ABSTRACT FROM AUTHOR]

Sexual minority men (SMM) experience intimate partner violence (IPV) at a substantially high rate and also bear high burdens of adverse mental health outcomes. This systematic review and meta-analysis aimed to consolidate existing evidence on the associations between experiencing IPV and adverse mental health outcomes (depressive symptoms, anxiety, stress, etc.) among SMM. Following the Preferred Reporting Items For Systematic Reviews and Meta-Analyses guideline, we identified 22 published studies encompassing data from 18,454 individuals, all of which were cross-sectional in design and half of which were conducted in the U.S. We found that experiencing IPV was associated with an increased risk of depressive symptoms and anxiety with a pooled Adjusted Odds Ratios (AORs) of 1.71 (95% CI [1.43, 2.05]) and 1.89 (95% CI [1.46, 2.43]), respective. Studies also found that IPV was positively associated with suicide-related risk (AOR = 2.71, 95% CI [2.21, 3.32] and perceived loneliness. Studies varied in their IPV measures and recall periods and used diverse mental health measurement tools like PHQ-9/GAD-7, Perceived Stress Scale, and the Suicide Behaviors Questionnaire-Revised. This systematic review and meta-analysis revealed an urgent need to examine the effects of IPV on SMM's mental well-being in low- and middle-income countries using standardized IPV measurement tools. Future research should employ a longitudinal design to track the long-term effects of IPV on the mental well-being of SMM and explore potential interventions for mitigating these impacts over time. These insights are crucial for enhancing IPV screening within healthcare settings and identifying key intervention targets aimed at improving the mental health of SMM. [ABSTRACT FROM AUTHOR]

Partnership status among sexual minority men (SMM) is a potentially important yet underexplored predictor of cognitive functioning. Using data from the understanding patterns of healthy aging among men who have sex with men substudy of the Multicenter AIDS Cohort Study, we assessed the associations of partnership status and quality with cognitive performance in middle-aged and older SMM, adjusting for sociodemographic and clinical covariates. Partnership status was classified into four types: "only a primary partnership," "only a secondary partnership," "both a primary and secondary relationship," and "neither a primary nor secondary relationship." Partnership quality was assessed based on perceived support or strain from partners. Cognitive performance was evaluated using the z-scores on the Symbol Digit Modalities Test (SDMT), Trail Making Test Parts A (TMT-A) and B (TMT-B), and a composite Z-score that summed the SDMT, TMT-A, and TMT-B z-scores. Among 1067 participants (median age 60, 85.7% college educated), having a primary partner was associated with better cognitive performance (Z-score composite β ^ = 0.41 [95% CI 0.12–0.70]), TMT-A ( β ^ = 0.16 [95% CI 0.02–0.30]), and TMT-B ( β ^ = 0.19 [95% CI 0.06–0.33]). Support from secondary partners was also linked to better cognition. Additionally, there was a significant interaction between partnership and HIV status, indicating that SMM with HIV and both primary and secondary partners showed better cognitive outcomes than unpartnered SMM with HIV. These findings suggest that having a primary partner and receiving support from secondary partners may contribute to better cognitive health among middle-aged and older SMM, especially those with HIV. [ABSTRACT FROM AUTHOR]

Loneliness has reached epidemic proportions, affecting nearly one-in-two adults in the United States and is particularly potent in sexually minoritized men (SMM). Individual differences in optimism and pessimism may exert protective or maladaptive effects for the impact of discrimination on loneliness. This study investigated interrelationships between optimism/pessimism, discrimination, and loneliness within a sample of sexual minoritized men (SMM). Self-report data from 103 SMM were used from a six-month study from August 2020 to February 2022 in South Florida. A novel chronicity-based coding approach was used to determine whether associations of optimism/pessimism and loneliness vary based on different frequencies of exposure to discrimination. Hierarchical multivariable regression models were conducted to examine associations of optimism-pessimism and the moderating effect of chronicity-based discrimination on loneliness. SMM reporting higher pessimism and lower optimism reported greater levels of loneliness and exposure to discrimination, and chronicity-based discrimination was negatively associated with optimism, and positively associated with pessimism. Associations of optimism, but not pessimism, with loneliness were moderated by discrimination. Among the sample, optimism had a protective effect on loneliness for those experiencing moderate exposure to discrimination. Future research should consider the longitudinal impact of optimism/pessimism and discrimination on loneliness among SMM. [ABSTRACT FROM AUTHOR]

Introduction: This article describes the development and initial validation of a measure of implicit internalized stigma among queer people, the Implicit Internalized Sexual Orientation Stigma Affect Misattribution Procedure (Internal-SOS-AMP), a computer-administered sequential priming procedure. Methods: The creation of the Internal-SOS-AMP involved a mixed-methods approach, including a literature review, expert interviews, stimuli selection and pilot testing, data collection from a large sample, reliability testing, correlational analyses, and confirmatory factor analysis. Psychometric testing was conducted with a national sample of 500 queer adults who completed two waves of data collection. Confirmatory factor analysis was used to evaluate two models: a one-factor model with internalized stigma specified as one overall construct and a two-factor model with internalized stigma specified as two constructs based on binary conceptions of gender (stigma regarding queer women and stigma regarding queer men). Results: Results showed that the two-factor model best fit the data. This indicates that although implicit attitudes toward queer men and women are highly correlated, implicit internalized stigma differentiated by two gender stimuli groups (men and women) more accurately reflects the data. There was evidence of convergent validity as Internal-SOS-AMP scores showed small positive associations with explicit internalized stigma. Regarding divergent validity, Internal-SOS-AMP scores were inversely related to affirmation of a queer identity. Reliability results for the Internal-SOS-AMP showed good internal consistency and acceptable test–retest reliability. Discussion: The creation of the Internal-SOS-AMP used best practices for measurement development. Psychometric findings show strong evidence of content validity, convergent validity, divergent validity, and reliability of the Internal-SOS-AMP. [ABSTRACT FROM AUTHOR]

Sexual minority women (e.g., lesbian, bisexual, pansexual) have increased risk of experiencing various mental health problems compared to sexual minority men and heterosexual individuals. Sexual minority women (SMW) have also been found to have lower self-esteem than heterosexual women, which could contribute to poorer mental health. Previous findings suggest that role models could potentially be used to improve LGBTQ+ wellbeing. The current exploratory study investigated SMW's experiences about the impact of role models or the lack of them and their views about how role models could be used to increase the self-esteem of SMW in potential interventions. Semi-structured qualitative interviews were conducted with 17 SMW. Using thematic analyses, four themes about characteristics of role models were developed: "Similar to me", "Self-confident about being different", "Strong and kind", and "Source of learning and support". Three themes about the impact of role models were identified: "Increased self-esteem", "Inspiring personal growth", and "Lack of role models: I don't belong". Content analyses indicated a wide range of ideas about how role models could be used within individual or group self-esteem interventions. Future research could apply these findings to develop or enhance interventions to increase the self-esteem of SMW. [ABSTRACT FROM AUTHOR]

Background: Skin cancer prevention relies on effective sun safety practices. Previous studies have shown that LGBTQ+ individuals exhibit lower sunscreen use and higher tanning bed usage compared to their non-LGBTQ+ counterparts. This study is the first to assess skin cancer risk factors, sun-protective behaviors, and skin cancer concerns among LGBTQ+ individuals across Canada. Methods: A national survey study was conducted between July 2020 and March 2024 and included LGBTQ+ respondents aged ≥ 16 years who had completed the survey. Responses were summarized using frequency counts/percentages for categorical variables and means/standard deviations for continuous variables. Logistic regression models were used to calculate age- and gender-adjusted odds ratios for subgroup analyses. Results: Of the 700 LGBTQ+ participants included (59.3% women; median age 38 years), the majority had a Fitzpatrick skin phototype (FSP) I–III (76.4%). Concerningly, 60% reported >10 lifetime sunburns, 58% reported ≥1 blistering sunburn, 34% had used a tanning bed ≥1 time in their lifetime, and 69% reported having a tan in the last 12 months. Sunscreen was worn regularly by only half of the respondents, and half of the participants agreed or strongly agreed with "I look better and/or healthier with a tan". Additional comparisons are presented based on gender, FSP, education, and income. Conclusion: The findings of this study highlight the need for public health campaigns tailored to the LGBTQ+ community, emphasizing culturally sensitive sun safety education, particularly for LGBTQ+ men, individuals with FSP IV–VI, and those with lower education levels, to help reduce future skin cancer risk. [ABSTRACT FROM AUTHOR]

Background: Pre-exposure prophylaxis (PrEP) use has been attributed to heightened rates of sexually transmitted infections (STIs), ostensibly due to increased condomless anal sex (CAS) and greater frequency of STI testing. Few qualitative studies have assessed how gay, bisexual and queer men (GBQM) who use PrEP perceive STIs and how these attitudes have evolved post-PrEP uptake. We investigated the perspectives of current and former PrEP users on STIs. Methods: Annual, in-depth longitudinal interviews were conducted with 38 current and former PrEP users in Ontario (n = 18) and British Columbia (n = 20), Canada, as part of a mixed-methods implementation science study (2020–2022). Over 3 years, 109 interviews were conducted. Data analysis included reflexive thematic coding and longitudinal recurrent cross-sectional analysis using NVivo 12. Results: Four STI-related themes emerged: (1) lack of STI-related concerns due to treatment and prevention optimism, (2) stigma-related concerns, (3) perceived risk among other PrEP users due to increased CAS, and (4) inconsistent testing concerns among non-PrEP users. Over time, some STI-related anxieties decreased with increased knowledge and reduced stigma. However, concerns persisted for other participants due to perceived risky sexual behaviours among other PrEP users and non-PrEP users. Both current and former PrEP users who expressed STI-related apprehensions consistently indicated adopting risk-reduction strategies, including condom use and having fewer sexual partners throughout the study. Conclusions: Findings show how varied STI perceptions and experiences among current and former PrEP users shaped sexual decision-making over time. Providers, public health experts, and policymakers should develop a more comprehensive strategy to address STI concerns among GBQM. PrEP has been attributed to increased rates of STIs due to condomless anal sex, but little is known about how gay, bisexual and queer men (GBQM) perceive PrEP and STIs and how these perceptions influence sexual behaviours. This study is the first longitudinal qualitative research that explores the experiences and attitudes of GBQM using PrEP in Canada. Understanding GBQM's perspectives can inform the development of more effective strategies to promote safer sexual practices and mitigate the spread of STIs within and beyond GBQM communities. [ABSTRACT FROM AUTHOR]

This clinical trial examined the individual and combined effects of three different approaches to reducing alcohol misuse among a sample of sexual minority men (SMM) with HIV. Specifically, we used a 2 × 2 × 2 randomized factorial design to compare: (a) behavioral intervention based in motivational interviewing (MI) vs. brief intervention (BI), (b) interactive text messaging (ITM) for alcohol use vs. no ITM, and (c) extended intervention (EI) length of nine months vs. a one-month intervention duration. Participants (N = 188) were SMM with HIV and alcohol misuse recruited in Miami, FL, and Boston, MA. Participants were randomized to one of eight intervention combinations and assessed at 6- and 12-month follow-ups. Large reductions of over 50% in drinks per week and heavy drinking days were observed in all conditions at follow-up. Those who received ITM, compared to those who did not, reported significantly lower drinks consumed per week at 6 and 12 months (incidence rate ratios = 0.73 [95% CI = 0.57, 0.90] and 0.72 [95% CI = 0.56, 0.87], respectively), and increased odds of cessation of alcohol misuse at 12 months, odds ratio = 1.46, 95% CI = 1.03, 2.08. Results provided no evidence of better alcohol use outcomes for either MI or EI relative to their comparison conditions, and no specific combination of intervention components demonstrated a notable benefit. This study suggests a two-session BI can effectuate substantial reductions in alcohol use in SMM with HIV and that adding one month of ITM can yield further improvements. Clinical Trials Number: NCT02709759 [ABSTRACT FROM AUTHOR]

This study documented between-group differences in factors associated with lifetime sexual victimization in a sample of young sexual minority men. Diverse samples of gay (N = 205, ageM = 24.33 years) and bisexual (N = 201, ageM = 23.31 years) men were recruited using the CloudResearch platform to assess recent experiences of intimate partner violence (IPV). Participants were categorized into four groups, cross-classified by dichotomous self-reports of (a) childhood sexual abuse (CSA) and (b) sexual IPV. Principal components analysis was used to reduce the number of variables associated with sexual IPV in three domains: Past-year substance use involvement, minority stress, and relationship characteristics, separately for each sample. Gay men reporting both CSA and sexual IPV reported significantly higher mean factor scores for a principal component with high loadings for recent substance use, daily discrimination, relational aggression and relational victimization, compared to other groups of gay men. Bisexual men who experienced sexual IPV reported significantly higher mean factor scores for a principal component with high loadings for five measures of minority stress, compared to counterparts with no history of sexual victimization. Adult sexual IPV among gay men reporting CSA appears to occur in conditions that include harmful substance use, daily discrimination experiences, and relationship violence. Sexual IPV among bisexual men is associated with multiple minority stressors. Our findings highlighted different patterns of risk factors for sexual IPV among sexual minority men, providing information for tailored risk reduction initiatives, including the need for trauma-informed services and specialized training for service providers. [ABSTRACT FROM AUTHOR]

Background: Anabolic androgenic steroids (AAS) are synthetic forms of testosterone frequently used as performance enhancing drugs among gay, bisexual, and queer (GBQ) men. Despite widespread use, associated harms, and the likely existence of an AAS use disorder, there is no medical consensus on standards of care for people who use AAS, with most medical providers focusing exclusively on abstinence. Individuals using AAS have developed community-based harm reduction strategies to mitigate these harms. Methods: This paper is a sub-analysis of qualitative data obtained through semi-structured interviews with GBQ men using AAS for 8 or more weeks recruited through convenience and snowball sampling from clinical sites and LGBTQ + venues in New York City as well as through social media. Interviews were coded with themes developed using reflexive thematic analysis. Data related to harm reduction techniques were then re-analyzed through a prevention strategies framework lens of primary, secondary, and tertiary harm prevention. Results: Thematic saturation was reached at twelve interviews in the primary analysis, with men reporting frequent use of multiple harm reduction techniques. For primary prevention, men avoided oral steroids and simultaneous substance use, tried to obtain AAS from reputable sources, used "cycling" to dose steroids, and practiced sterile injection techniques. Secondary prevention methods included patient-directed lab testing for hematocrit, liver and kidney function, cholesterol, prostate specific antigen, testosterone, and self-performed blood pressure checks. Tertiary prevention included donating blood and the use of medications without a prescription, including aromatase inhibitors, selective estrogen receptor blockers, aspirin, statins, angiotensin receptor blockers, clomiphene, and human chorionic gonadotropin. Conclusions: Despite many GBQ men experiencing harms from anabolic androgenic steroids, community members have often sought harm reduction techniques in lieu of abstinence. Though many of these techniques embrace clinical reasoning and may be more broadly applicable, additional research is needed to understand the impact of each intervention on the overall health of individuals using AAS. [ABSTRACT FROM AUTHOR]

Background: In the United States, most (~ 70%) annual newly diagnosed HIV infections are among substance-using sexual minority men (SMM) and gender minority transgender women (trans women). Trans women and SMM are more likely to report or be diagnosed with a substance use disorder (SUD) than their cisgender or heterosexual counterparts and the presence of an SUD substantially increases the risk of HIV infection in both groups. Although Pre-Exposure Prophylaxis (PrEP) is highly effective, initiation, adherence, and persistence are exclusively behavioral outcomes; thus, the biomedical benefits of PrEP are abrogated by substance use. SUD is also associated with reduced quality-of-life, and increased overdose deaths, utilization of high-cost healthcare services, engagement in a street economy, and cycles of incarceration. Objective: To determine the optimal (considering efficacy and cost-effectiveness) strategy for advancement along the PrEP Care Continuum among trans women and SMM with an SUD. Methods: This study will implement a randomized controlled trial, evaluating two Stepped Care approaches involving A.S.K.-PrEP vs. standard of care (SOC) to determine optimal intervention strategies for trans women and SMM with an SUD (N = 250; n = 83 trans women; n = 167 SMM) for advancement along the PrEP Care Continuum. Participants will be randomized (3:1) to Stepped Care (n = 187) or SOC (n = 63). Participants in the Stepped Care arm will be assessed at 3-months for intervention response; responders will be maintained in A.S.K.-PrEP, while non-responders will receive added attention to their SUD via Contingency Management (CM). Non-responders will be re-randomized (1:1) to either (a) receive A.S.K.-PrEP + CM, or (b) shift the primary focus to their SUD (CM alone). Results: Recruitment and enrollment began in May 2023. Recruitment will span approximately 36 months. Data collection, including all follow-up assessments, is expected to be completed in April 2027. Discussion: Trans women and SMM with an SUD have the two highest HIV prevalence rates in the United States, which underscores the urgent need for effective measures to develop scalable behavioral interventions that can encourage advancement along the PrEP Care Continuum. To improve public health, researchers must identify scalable and cost-effective behavioral interventions to promote PrEP initiation, adherence, and persistence among trans women and SMM who use substances. Trial registration: This trial has been registered at ClinicalTrials.gov under the number NCT05934877. [ABSTRACT FROM AUTHOR]

Introduction: While research with sexual minority men (SMM) has focused on disparities related to HIV, substance use and mental health, synergistic psychosocial pathways driving these epidemics remain underexplored. We used syndemic theory to assess how psychosocial factors sustain methamphetamine use and hinder recovery efforts for SMM living with HIV. Methods: A triangulation of network analyses and constructivist grounded theory approaches is utilised to elucidate pathways through which psychosocial factors influence methamphetamine use among this population. Survey data (N = 129) are used for quantitative analyses and a purposive sub‐sample (n = 24) was recruited for semi‐structured interviews for qualitative analyses. Findings: The network analysis revealed two statistically significant bivariate associations: between post‐traumatic stress disorder and depression symptoms (b = 0.37, SD = 0.07, 95% confidence interval [0.23, 0.49]) and between depression symptoms and negative affect (b = 0.26, SD = 0.07, 95% confidence interval [0.12, 0.38]). Findings from the constructivist grounded theory analysis supplement the network analysis by offering a nuanced take on how negative affect, post‐traumatic stress disorder, and depression symptoms operate synergistically to promote methamphetamine use and impede recovery efforts. Discussion and Conclusions: Participants relay experiences of using methamphetamine to cope with these psychosocial factors through avoidance, escapism, mood elevation, and numbing of emotions. Findings suggest that centring these psychosocial factors may inform more effective, holistic interventions for this high‐priority population. [ABSTRACT FROM AUTHOR]

This article examines how Black gay men produce identities in correspondence with cultural scripts of Black manhood. I illustrate how these scripts organize a subjectivity shaped by white supremacy and signify racial consciousness, respectability, and commitment to Black antiracism. The script intentionally excludes queer men. Instead, Black queer men are "faggots," a subjectivity signifying weakness, wasted manhood, and capitulation to whiteness. Utilizing Muñoz's (1999, Disidentifications: Queers of Color and the Performance of Politics, University of Minnesota Press, Minneapolis) concept of disidentification, I track how participants engage in a reimagining of the conventional script of heteronormative Black masculinity to embody a subjectivity I call Super Black Man. This hybrid subjectivity responds to interlocking systems of race, sexuality, and gender in their lives by locating space in conventional Black male subjectivities for Black gay men. As Super Black Men, participants accomplished identities that did not compromise their self‐expression or affiliation with Black communities. I discuss how disidentification adds analytic complexity to this empirical investigation of Black gay men's identity work. What results is a more robust understanding of how race shapes the motives, trajectory, and outcomes of racialized sexual identities. [ABSTRACT FROM AUTHOR]

• 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 examines how Black gay men produce identities in correspondence with cultural scripts of Black manhood. I illustrate how these scripts organize a subjectivity shaped by white supremacy and signify racial consciousness, respectability, and commitment to Black antiracism. The script intentionally excludes queer men. Instead, Black queer men are "faggots," a subjectivity signifying weakness, wasted manhood, and capitulation to whiteness. Utilizing Muñoz's (1999, Disidentifications: Queers of Color and the Performance of Politics, University of Minnesota Press, Minneapolis) concept of disidentification, I track how participants engage in a reimagining of the conventional script of heteronormative Black masculinity to embody a subjectivity I call Super Black Man. This hybrid subjectivity responds to interlocking systems of race, sexuality, and gender in their lives by locating space in conventional Black male subjectivities for Black gay men. As Super Black Men, participants accomplished identities that did not compromise their self‐expression or affiliation with Black communities. I discuss how disidentification adds analytic complexity to this empirical investigation of Black gay men's identity work. What results is a more robust understanding of how race shapes the motives, trajectory, and outcomes of racialized sexual identities. [ABSTRACT FROM AUTHOR]

Esports, competitive video gaming, is an emerging media industry looking to legitimize itself on the global stage. Part of its efforts include addressing a culture widely perceived as toxic. Toxic gamer culture claims hegemonic masculinity by degrading any seen as feminine, such as women and queer men; while this problem is endemic to gaming, it is particularly virulent in esports due to its struggles to be recognized as a "real" sport. The methods esports authorities have deployed to combat patriarchal homophobia, however, are insufficient. They share much with an anti-queer respectability politics that reinscribes the market as the ultimate cultural authority. An alternative approach would be one based on the principles of transformative justice, which emphasizes the humanity of both perpetrators and victims while demanding perpetrators take responsibility for the harm they cause. Transformative justice has already proved viable in game live-streaming, as seen by AnyKey's GLHF initiative. [ABSTRACT FROM AUTHOR]

We examined how different patterns of crystal methamphetamine (CM) use are associated with different psychosocial and sexual health outcomes among gay, bisexual, and other men who have sex with men (GBM). We used latent class analysis to identify different patterns of CM use with the ASSIST scale for GBM who report using CM (n = 228), and examined how these classes differed from each other and from GBM who do not use CM (n = 2221). Results: We found four CM-use classes based on ASSIST responses. Classes defined by occasional use but few problems were more likely to test positive for STIs, while classes defined by more frequent use and problems were less likely to have STIs, but reported greater psychosocial problems. Interventions should focus on tailored substance use counselling and health promotion strategies to address the diversity of problems faced by GBM who use CM. [ABSTRACT FROM AUTHOR]

Copyright of AIDS & Behavior is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of AIDS & Behavior is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background In the United States, most (~ 70%) annual newly diagnosed HIV infections are among substance-using sexual minority men (SMM) and gender minority transgender women (trans women). Trans women and SMM are more likely to report or be diagnosed with a substance use disorder (SUD) than their cisgender or heterosexual counterparts and the presence of an SUD substantially increases the risk of HIV infection in both groups. Although Pre-Exposure Prophylaxis (PrEP) is highly effective, initiation, adherence, and persistence are exclusively behavioral outcomes; thus, the biomedical benefits of PrEP are abrogated by substance use. SUD is also associated with reduced quality-of-life, and increased overdose deaths, utilization of high-cost healthcare services, engagement in a street economy, and cycles of incarceration. Objective To determine the optimal (considering efficacy and cost-effectiveness) strategy for advancement along the PrEP Care Continuum among trans women and SMM with an SUD. Methods This study will implement a randomized controlled trial, evaluating two Stepped Care approaches involving A.S.K.-PrEP vs. standard of care (SOC) to determine optimal intervention strategies for trans women and SMM with an SUD (N = 250; n = 83 trans women; n = 167 SMM) for advancement along the PrEP Care Continuum. Participants will be randomized (3:1) to Stepped Care (n = 187) or SOC (n = 63). Participants in the Stepped Care arm will be assessed at 3-months for intervention response; responders will be maintained in A.S.K.-PrEP, while non-responders will receive added attention to their SUD via Contingency Management (CM). Non-responders will be re-randomized (1:1) to either (a) receive A.S.K.-PrEP + CM, or (b) shift the primary focus to their SUD (CM alone). Results Recruitment and enrollment began in May 2023. Recruitment will span approximately 36 months. Data collection, including all follow-up assessments, is expected to be completed in April 2027. Discussion Trans women and SMM with an SUD have the two highest HIV prevalence rates in the United States, which underscores the urgent need for effective measures to develop scalable behavioral interventions that can encourage advancement along the PrEP Care Continuum. To improve public health, researchers must identify scalable and cost-effective behavioral interventions to promote PrEP initiation, adherence, and persistence among trans women and SMM who use substances. Trial registration This trial has been registered at ClinicalTrials.gov under the number NCT05934877.

IntroductionErectile dysfunction (ED) has been established as a comorbidity among men living with HIV, but comparisons by HIV serostatus of ED incidence in a longitudinal follow-up cohort of men are lacking. We sought to evaluate the incidence of ED spanning a period of 12 years in a longitudinal cohort of sexual minority men (SMM) living with and without HIV.MethodsWe analyzed ED incidence data for 625 participants in the longitudinal Multicenter AIDS Cohort Study from visits spanning October 2006 to April 2019.ResultsSMM living with HIV were more likely to have incident ED compared with those living without HIV (rate ratio: 1.41; 95% CI: 1.14-1.75). Older age, current diabetes, cumulative cigarette use, and cumulative antidepressant use were associated with increased incidence of ED in the entire sample. Self-identifying as Hispanic, current diabetes, and cumulative antidepressant use were positively associated with ED incidence among SMM living with HIV. Cumulative cigarette use was positively associated with greater ED incidence only among SMM living without HIV.DiscussionIn summary, age (full sample/ with HIV), current diabetes (full sample/with HIV), cumulative cigarette use (full sample/without HIV), and cumulative antidepressant use (full sample/with HIV) were associated with increased ED incidence. Skillful management of diabetes and careful titration of antidepressants, along with smoking cessation practices, are recommended to mitigate ED in this population.

Family rejection has negative health consequences for Latinx sexual minority men (LSMM). However, LSMM often reconcile with their families, a phenomenon cross-sectional studies miss. We analyzed longitudinal data from the Healthy Young Men's Study in Los Angeles. We used individual fixed-effects Poisson regression to model changes over time in the associations among family support, drug use, and depressive symptoms. We found that (1) the initiation of drug use was associated with a 7.2% (Ratio=1.072, 95% CI 1.006 - 1.142, p = 0.03) increase in family support among LSMM who reported high depressive symptoms (depression subscale T-score ≥ 63) in at least one data wave; (2) a 1-unit increase in family support was associated with a 4.7% (RR = ;0.953, 95% CI 0.931 - 0.976, p < 0.001) decrease in the probability of high depressive symptoms; and (3) no significant association between a change in drug use and a change in high depressive symptoms. Over time, LSMM appear to benefit from the health effects of family support associated with Latinx family structures.

Background and objectivesLoneliness is associated with frailty among older adults (60+), and there is evidence suggesting that this association may be bidirectional. However, there is limited evidence of this relationship over time among middle-aged and aging sexual minority men. We explored the bidirectional relationship between loneliness and frailty over 2 years among sexual minority men living with or without human immunodeficiency virus (HIV) from the Healthy Aging substudy of the Multicenter AIDS Cohort Study.Research design and methodsWe used data from 1 118 men (561 living with HIV; 557 living without HIV) aged 40 years or older with measurement of frailty or loneliness at Times 1 (September 2016 to March 2017) and 2 (September 2018 to March 2019). Descriptive statistics were generated. We used autoregressive cross-lagged panel analysis to examine the bidirectional association between frailty and loneliness at both time points while adjusting for time-stable and time-dependent covariates at Time 1. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were generated.ResultsThe estimated prevalence of loneliness at both time points was 35.5%. The estimated prevalence of frailty at Times 1 and 2 were 7.8% and 12.1%, respectively. Participants reporting loneliness at Time 1 had greater odds of being frail at Time 2 (aOR = 2.14; 95% CI: 1.23-3.73). Frailty at Time 1 was not associated with loneliness at Time 2 (aOR = 1.00; 95% CI: .44-2.25). The autoregressive effects of frailty (aOR = 23.43; 95% CI: 11.94-46) and loneliness (aOR = 13.94; 95% CI: 9.42-20.61) were large.Discussion and implicationsMen who felt lonely had higher odds of being frail 2 years later while the reciprocal association was not shown. This suggests that loneliness preceded frailty and not the other way around. Early and frequent assessments of loneliness may present opportunities for interventions that minimize the risk of frailty among sexual minority men living with and without HIV.

Sexual minority men (SMM) are disproportionately impacted by HIV and thus, HIV related-health complications. HIV has been linked to earlier onset of multi-morbid chronic diseases and declines in physical and cognitive functioning attributable to chronic HIV immune activation and resulting inflammation. Inflammation has been targeted with mindfulness-based interventions (MBIs); however, hypothesized negative associations between mindfulness and inflammation need to be confirmed in SMM with HIV. This is a secondary data analysis of baseline data from a randomized clinical trial (RCT) of SMM living with HIV with biologically confirmed recent methamphetamine use (ARTEMIS). Mindfulness was assessed with the Five Factor Mindfulness Questionnaire (FFMQ). Inflammation was assessed via cytokines interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α). Separate adjusted (for age, viral load, CD4 count, and methamphetamine use) regression models evaluated associations between four facets of mindfulness (description, awareness, non-judgement, and non-reactivity) with IL-6 and TNF-α. The average age of the participants was 43.86 (SD = 8.95). Both description (b =.54, se =.24) and awareness (b =.50, se=.23) were positively associated with IL-6. All other associations between mindfulness and inflammation were non-significant in adjusted models. There was also some evidence to suggest that engagement in care moderated associations between description and non-reactivity with IL-6 (ΔR2 =.03, F = 3.64), such that description and non-reactivity were each positively associated with inflammation among those who attended <100% of primary care appointments (b = 1.04, se=.34 and b = 1.23, se=.39, respectively), but was not associated with inflammation among those who attended 100% of appointments (b =.16, se=.32 and b=-.17, se=.40, respectively). There was also a significant interaction between 12-step program attendance and awareness with IL-6 (ΔR2=.03, F = 4.26), such that awareness was positively associated with inflammation among those who attended 12-step programming (b = 1.25, se =.41), but not associated with inflammation among those who did not (b =.22, se =.28). Further research is needed to understand how and under what circumstances mindfulness is associated with pro- versus anti-inflammatory processes.Trial Registration: NCT01926184. [ABSTRACT FROM AUTHOR]

Abstract Background Pre-exposure prophylaxis (PrEP) to prevent HIV is severely underutilized among sexually minoritized men (SMM). Inequitable access to PrEP-prescribing facilities and providers is a critical barrier to PrEP uptake among SMM. Integrating HIV prevention services, such as PrEP screening, into pharmacy-based settings is a viable solution to addressing HIV inequities in the US. We aimed to examine willingness to obtain PrEP screening in a pharmacy and its associated correlates, leveraging Andersen’s Healthcare Utilization Model (AHUM), among a national sample of SMM in the U.S. Methods Data from the 2020 American Men’s Internet Survey, an annual online survey among SMM, were analyzed. Drawing on AHUM-related constructs, we used a modified stepwise Poisson regression with robust variance estimates to examine differences in willingness to screen for PrEP in a pharmacy. Estimated prevalence ratios (PR) were calculated with 95% confidence intervals (CI95%). Results Out of 10,816 men, most (76%) were willing to screen for PrEP in a pharmacy. Participants were more willing to screen for PrEP in a pharmacy if they (1) had a general willingness to use PrEP (PR = 1.52; CI95% =1.45, 1.59); (2) felt comfortable speaking with pharmacy staff about PrEP (PR = 2.71; CI95% =2.47, 2.98); and (3) had HIV-related concerns (PR = 1.04; CI95% =1.02, 1.06). There were no observed differences in men’s willingness to screen for PrEP in a pharmacy by race/ethnicity, education level, annual household income, nor insurance status. Conclusions Strategically offering PrEP screening in pharmacies could mitigate access-related barriers to HIV prevention services among SMM, particularly across various sociodemographic domains. Importantly, this approach has vitally important implications for addressing broader inequities in HIV prevention. Future studies should examine strategies to successfully integrate PrEP screenings in pharmacies among diverse populations, especially among those at elevated risk for HIV.

Intimacy and relationships are important to sexual minority men, yet traditional sex and relationship education from sources such as schools and families may lack perceived usefulness. Consequently, sexual minority men may seek information from alternative sources, but little research has explored the usefulness of these alternatives. A national survey of sexual minority men in Australia (n = 936, Mage = 38.9) evaluated the usefulness of seven sources of information: school programmes, family, peers and friends, social media and the Internet, popular culture, pornography, and official information sources. Five topics were examined for each source: sexual and reproductive physiology, HIV/STI prevention, relationship skills, consent and needs negotiation, and sexual and intimate behaviours. Participants rated the sources as minimally to moderately useful. Official information sources were rated most useful, followed by peers and friends, social media and the Internet, popular culture, pornography, school, and family. Older men found most sources less useful than younger participants. Perceived usefulness varied across topics (e.g. popular culture and peers and friends rated most useful for relationship skills). These findings underscore the limited relevance of conventional sex and relationship education for sexual minority men and highlight the need for enhanced education programmes. [ABSTRACT FROM AUTHOR]

This study quantitatively and qualitatively examined the prevalence, frequency, and content of discrimination exposure among gay, bisexual, and other sexually minoritized men (SMM) within sexual minority contexts. Participants were an online, U.S. national sample of 14,133 SMM who reported discrimination exposure within sexual minority contexts targeting: body type, race, sexual behavior, HIV status, gender expression, age, and income/employment. Quantitative analyses included prevalence percentages and frequencies and ANOVAs, t-tests, and correlations to examine the frequency of discrimination exposure type across participant race/ethnicity, sexual identity, gender identity, HIV status, age, and income. Qualitative analyses included conventional content analysis of responses to an open-ended discrimination exposure item. Results showed that discrimination exposure was nearly universal (99%). Discrimination exposure frequency was lowest among White men and, other than for income/employment discrimination exposure, highest among Asian/Pacific Islander men. For several discrimination types, exposure frequency was highest among groups targeted by group-specific negative stereotypes (e.g., Black men were exposed to the most income/employment discrimination). Qualitative analyses highlighted specific exposures to discrimination targeting body type, race/ethnicity, gender identity, attractiveness, education, and intersections between forms of discrimination. Over 69% of write-in responses were relevant to online/app-based discrimination. Findings underscore the importance of examining individual and intersectional discrimination exposure targeting marginalized social positions within sexual minority communities, particularly in online/app contexts. [ABSTRACT FROM AUTHOR]

Psychosocial and structural stressors and low engagement in medical care likely contribute to the disproportionate burden of chronic disease among sexual minority men (SMM) across the life course. However, how these stressors impact engagement in medical care among young SMM (YSMM) across racial identities remains understudied. The association of psychosocial and structural stressors with forgoing care among YSMM across racial identities was examined using race-stratified adjusted logistic regression of cross-sectional data. Among 737 HIV-negative SMM aged 16–24 years, nearly all (93%) experienced discrimination in their daily lives. Non-Hispanic/Latinx Black participants reported significantly higher levels of discrimination, exposure to community violence, and food insecurity. Medical mistrust and mental health were not significantly different across racial groups. In the full sample model, education, food insecurity, and discrimination were associated with forgoing care. Among the non-Hispanic/Latinx White sample, medical mistrust and discrimination were associated with forgoing care. Among the non-Hispanic/Latinx Black sample, discrimination was associated with forgoing care. Among the Hispanic/Latinx sample, food insecurity was associated with forgoing care. Psychosocial and structural stressors were common in this YSMM cohort, and significantly different across racial/ethnic identities. Race-stratified analysis revealed differences in the association of stressors with forgoing care among YSMM across racial identities, not appreciated in the analysis limited to the total study population. Our findings may support efforts to address health inequity and improve engagement in medical care among SMM. [ABSTRACT FROM AUTHOR]

One of the most important shifts in gender scholarship is the attention now being paid to discourses and practices of masculinity in the Global South. This issue of Men and Masculinities contributes to this growing field in three important ways. First, we foreground scholarship on masculinities in two interconnected, but understudied regions of the world, specifically the Middle East, which is also known as South West Asia and North Africa (SWANA), and its neighbor to the east, South Asia. In particular, we demonstrate the ways in which queer identities and communities are being formed across these two regions, connected as they are by historic trade routes, migration pathways, and transregional cultural flows. Second, we point to the vibrant masculinities scholarship that is emerging from these regions. But we focus specifically on non-normative masculinities—or the queer, trans, and other genderqueer masculinities—which have been historically present in these two regions, but which have been much less represented in masculinities literature. Third, we look to identity formation, or the ways in which young cis-gender, trans, and queer men come out in their communities and seek authentic lives of desire, pleasure, and participation. At the same time, we highlight the ever-present precarity within queer communities in the Middle East/SWANA and South Asia, especially given postcolonial nationalist and ethno-nationalist agendas, which promote normative heteropatriarchal masculinities and concomitant homophobia and transphobia. [ABSTRACT FROM AUTHOR]

Blued is the most popular gay dating app among Chinese sexual minority men. This study explored the textual self-presentation of the profiles on Blued in terms of motivation, appearance focus, and exclusion. A total of 10,000 profiles were randomly selected from a dataset of 197,516 profiles using an interval sampling method. A total of 230 features were developed, and six themes were extracted from 4,881 profiles based on content analysis. The themes were motivation, personal information, partner preference, partner non-preference, sexual preference, and communication preference. Body and age were the most commonly mentioned self-presentations, followed by attractiveness and masculinity. Self-presentations largely focused on the users' photos are prominent on Blued. Exclusion against those who were "overweight," "elderly," "unattractive," and "effeminate" was common. Network analysis was used to analyze and visualize the co-occurrence of these features. Appearance focus and exclusion features were linked with both "hookup" and "no hookup" motivations. Photo-focused communication was linked to the exclusion of others. "No hookup" motivation was associated with more social motivation (e.g., making friends and chatting) and trait-focused communication (e.g., being polite and permanent). "Hookup" motivation was associated with genital presentations (i.e., "big penis" and "like big penis"). Most self-presentation features of sexual preference were sexual role-specific. The results indicate a widespread focus on appearance and exclusion on Blued, which may negatively affect the mental health of Chinese sexual minority men. [ABSTRACT FROM AUTHOR]

The literature differentiates between two domains of machismo: traditional machismo and caballerismo. Research has largely focused on measuring machismo among English speakers. We evaluated whether Estrada's (2011) 2-factor model of machismo was invariant across language (English vs. a direct Spanish translation). A series of multigroup confirmatory factor analyses were conducted between respondents who completed the survey in English (n = 428) and Spanish (n = 102). Analyses suggested the hypothesized 2-factor model did not fit across language groups. While the traditional 2-factor structure emerged in the English language data, exploratory factor analysis indicated a 3-factor structure of machismo among Spanish-speaking respondents. One of the new factors (inherent machismo), among Spanish-speaking respondents, was associated with internalized heterosexism, suggesting that the new factor structure may capture the belief that masculine men are superior. These findings suggest there is a need for the development of culturally appropriate Spanish language assessment. [ABSTRACT FROM AUTHOR]

This study investigated the relationship between pornography use and men's body image, utilizing the social comparison theory as the theoretical framework. The research focused on a moderated mediation model, examining the role of social body comparison as a mediator between pornography use (frequency and problematic use) and men's body image. The sample consisted of 726 men aged 18–68, with 223 (30.7%) identifying as sexual minorities. Sexual minority men reported higher levels of pornography use frequency, problematic use, perceived realism, social body comparison, negative body image, and psychological distress compared to heterosexual men. Findings revealed that problematic pornography use (but not frequency of use) was related to higher levels of social body comparison, which, in turn, were related to higher levels of negative body image. The perceived realism in pornography did not moderate the examined associations. Clinicians should consider the impact of the relationship between pornography and body image among men. [ABSTRACT FROM AUTHOR]

AbstractThis study addresses a gap in the labour market and occupational health literatures among sexual and gender minority workers by exploring the relationship between precarious employment and mental health through a political economy framework. Narratives from 20 cisgender and transgender sexual minority men were analysed to uncover the production of employment and mental health inequities. Results are presented temporally, including employment readiness, looking for work, and on the job, illuminating the social and structural processes that underly participants’ stories of precarious employment and mental health. A cyclical pattern was identified whereby participants’ mental ill-health resulted in separation from the labour market and increased employment precarity that subsequently further impacted their mental health. Interventions and programmes must consider multipronged approaches that address all aspects of this syndemic, including social stigma and discrimination towards sexual and gender minority people and improved access to stable employment, mental healthcare, and adequate social welfare systems. [ABSTRACT FROM AUTHOR]

AbstractExisting research on Latino cultural factors mainly focuses on gender and nationality, often overlooking sexual orientation and giving limited attention to the experiences of Latino sexual minority men in the United States of America (USA). This study addressed this gap by exploring how sexual minority men identify, describe and experience Latino cultural factors. Between April and December 2019, semi-structured interviews were conducted with 28 men (ages 18–40, 43% non-US-born) in the greater Miami, Florida area to explore their engagement in HIV prevention and behavioural health services. Secondary qualitative analysis examined five Latino cultural factors (personalismo, machismo, familismo, fatalismo and curanderismo), informed by the existing literature for initial coding and supplemented by the use of an inductive approach, yielding 14 subthemes. Findings revealed that although participants often described cultural factors in their traditional interpretations within the Latino community at large, they also highlighted unique experiences, particularly for relationship-oriented factors like personalismo, machismo and familismo. Sexual orientation stigma shaped participants’ experiences of these cultural factors. Study findings enhance knowledge about Latino sexual minority men’s lived experiences in the USA, underscoring how cultural factors are perceived both traditionally and uniquely, and emphasises the need for nuanced, culturally tailored assessments in future research. [ABSTRACT FROM AUTHOR]