Overcoming analytical and preanalytical challenges associated with extragenital home collected STI specimens.

Home sample collection for sexually transmitted infection (STI) screening options can improve access to sexual healthcare across communities. For Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), genital infections have classically been the focus for remote collection options. However, infections may go undiagnosed if sampling is limited to urogenital sites because some individuals only participate in oral and/or anal intercourse. Here we evaluated samples for CT/NG detection after several pre-analytical collection challenges. A paired provider to self-collection validation was performed on rectal [n = 162; 22 + for CT and 9 + for NG by provider-collected (PC)] and throat (N = 158; 2 + for CT and 11 + for NG by provider-collected) swabs. The positive percent agreement for CT and NG ranged from 90.9% to 100%. The discrepancies were more often positive on self-collected (SC) (n = 9 SC+/PC-; n = 1 PC+/SC-; n = 1 PC+/SC Equiv.; n = 2 PC-/SC Equiv.). An empirical limit of detection (LoD) lower than the manufacturer's claim (0.031 vs 2.5 IFU/mL for CT and 0.063 vs 124.8 CFU/ml for NG, respectively) was used to challenge additional variables. Common hand contaminants, including soap, hand sanitizer, lotion, and sunscreen were added to known positive (3× empirical LoD) or negative samples and did not influence detection. Samples at 2× and 10× the empirical LoD were challenged with extreme temperature cycling and extended room temperature storage. Detection was not affected by these conditions. These results indicate that remote self-collection is an appropriate method of sample acquisition for detecting extragenital CT/NG infections. Additionally, they provide a foundation towards meeting the regulatory standards for commercial testing of home collected extragenital samples. IMPORTANCE: There is a clinical need for expanded extragenital bacterial sexually transmitted infection (STI) testing options, but the current regulatory landscape limits the wide-spread promotion and adoption of such services. Improved access, particularly for the LGBTQ+ community, can be achieved by validating testing for specimens that are self-collected at a remote location and arrive at the laboratory via a postal carrier or other intermediary route. Here we provide valuable data showing that self-collected samples for anal and oropharyngeal STI testing are equally or increasingly sensitive compared with those collected by a provider. We systematically consider the effects of storage time, exposure to temperature extremes, and the addition of common toiletries on results.

Interventions, Barriers, and Facilitators to Address the Sexual Problems of Gay, Bisexual and Other Men Who Have Sex with Men Living with HIV: A Rapid Scoping Review.

Sexual problems are common among gay, bisexual, and other men who have sex with men (GBM) after diagnosis with HIV. However, these are often overlooked in care and research, where sexual risk reduction and biomedical aspects of sexual health tend to dominate. We conducted a rapid scoping review to investigate which sexual problems of GBM living with HIV are addressed by interventions, and the barriers and facilitators to their implementation. Literature from high-income countries published in English since 2010 was reviewed. Medline, Embase, PsycInfo, and Scopus databases were searched on July 4, 2022. Targeted sexual problems were categorized according to the ten dimensions of Robinson's Sexual Health Model, and barriers and facilitators, according to the five domains of the Consolidated Framework for Implementation Research (CFIR). Interventions focused solely on the dimension of Sexual Health Care/Safer Sex were excluded. Relevant information was extracted from the qualifying documents with NVivo 12 software for content analysis. Fifty-two documents were included, referring to 37 interventions which mainly took place in the United States (n = 29/37; 78%), were group-based (n = 16; 41%), and used counselling techniques (n = 23; 62%; e.g., motivational interviewing, cognitive-behavioral therapy). Their settings were mostly primary care (n = 15; 40%) or community-based (n = 16; 43%). On average, interventions addressed three sexual health dimensions (SD = 2; range: 1-10). The most targeted dimension was Sexual Health Care/Safer Sex (n = 26; 70%), which concerned sexual risk reduction. Next, Challenges (n = 23; 62%), included substance use (n = 7; 19%), sexual compulsivity (n = 6; 16%), sexual abuse (n = 6; 16%), and intimate partner violence (n = 4; 11%). Third was Talking About Sex (n = 22; 59%) which mostly concerned HIV disclosure. About a third of interventions addressed Culture/Sexual identity (n = 14; 38%), Intimacy/Relationships (n = 12; 33%), and Positive sexuality (n = 11; 30%). Finally, few targeted Body Image (n = 4; 11%), Spirituality (n = 3; 8%), Sexual Anatomy Functioning (n = 2; 5%) or Masturbation/Fantasy (n = 1; 3%). Forty-one documents (79%) mentioned implementation barriers or facilitators, particularly about the characteristics of the interventions (41% and 78%, respectively; e.g., cost, excessive duration, acceptability, feasibility) and of the individuals involved (37% and 46%; e.g., perceived stigmatization, provider expertise). The other three CFIR dimensions were less common (5%-17%). The search strategy of this review may not have captured all eligible documents, due to its limit to English-language publications. Overall, most interventions incorporated a focus on Sexual Health Care/Safer Sex, at the expenses of other prevalent sexual problems among GBM living with HIV, such as intimate partner violence (Challenges), erectile dysfunction (Sexual Anatomy Functioning), and Body Image dissatisfaction. These findings suggest they could receive more attention within clinical care and at the community level. They also highlight the importance of cost-effective and acceptable interventions conducted in non-stigmatizing environments, where patients' needs can be met by providers who are adequately trained on sexuality-related topics.

The role of victimisation and sleep quality in self-harm and depression among sexual minority adolescents. A prospective cohort study.

Sexual minority adolescents (SMA) have a disproportionately high prevalence of victimisation, self-harm, and depressed mood, relative to the general population. Yet, the contributing and mechanistic factors are unclear. We aim to explore the directional relationship between victimisation and self-harm and depressed mood, with poor sleep quality as a possible mediator. A secondary data analysis was conducted using a nationally representative birth cohort in the United Kingdom, where participants self-identified as sexual minority (N = 1922, aged 11-13, 67.1% female) and their parents completed questionnaires and interviews when the participants were aged 11, 14 and 17. Logistic and linear regression were used to test whether victimisation prospectively predicted self-harm and depressed mood with mediation analyses conducted to assess if sleep onset latency and nocturnal awakening mediated their relationships. After adjusting for demographic factors and baseline self-harm and depressed mood, victimisation at age 11 significantly predicted self-harm (OR = 1.40, p < .01) and depressed mood (B = 0.024, SE = 0.01, p < .05) at age 17. In the mediation analyses, frequent nocturnal awakening at age 14, but not sleep onset latency, significantly mediated the effect of victimisation at age 11 on self-harm (indirect effect B = 0.008, SE = 0.004, 95%CI = 0.001-0.017) and depressed mood (indirect effect B = 0.005, SE = 0.002 95%CI = 0.001-0.010) at age 17. Our findings supported that victimisation contributed to negative mental health among SMA. Poor sleep quality could be an indicator of maladjustment with victimisation, which further increased vulnerability to negative mental health. Victimisation and sleep quality could be important assessment targets in mental health campaign among sexual minority adolescents.

Cultural acceptability of STI screening guidelines and sexual positioning assessments among black sexual minority men.

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.

From the bathroom to a national discussion of LGBTQ+ rights: a case of discrimination in the Philippines.

Despite the Philippines' progress in gender equality, contemporary evidence suggests that Filipinos continue to possess negative attitudes toward lesbian and gay individuals. Likewise, discrimination and violence toward bisexual, transgender, and queer Filipinos have been documented. Despite cases of sexual orientation and gender identity and expression (SOGIE) based discrimination, national-level anti-discrimination legislation remains unpassed in the Senate. This study explores the national discussions on the SOGIE Equality Bill triggered by a bathroom discrimination experienced by a Filipino transgender woman in 2019. Taking cues from Richardson's sexual citizenship framework, we investigate the diverse rights discourses among sectoral groups, such as local lesbian, gay, bisexual, transgender, queer, and other individuals of marginalized sexualities and genders (LGBTQ+) organizations and their allies, high-ranking Filipino politicians, and religious organizations. Analysis of local discourses showed that those supporting the SOGIE Equality Bill leverage identity-based rights discourses, while those opposed primarily navigate these debates using conduct-based rights discourses. Future policy and advocacy work must leverage the insights from these public proceedings to foster LGBTQ + solidarity in their campaigns for LGBTQ + rights in the country. Particularly, future work must (1) locate the middle ground between the LGBTQ + community and opposed legislators; (2) highlight essential values and common issues shared by all Filipinos; (3) surface how privilege can preclude and advance solidarity within the LGBTQ + community; (4) campaign for the passage of local anti-discrimination ordinances; (5) improve the SOGIE-related competencies of policy implementers; and (6) engage in research that explores public discourses and meanings assigned to sexual rights among Filipinos.

Androgenetic alopecia in transgender and gender diverse populations: A review of therapeutics.

Androgenetic alopecia (AGA) management is a significant clinical and therapeutic challenge for transgender and gender-diverse (TGD) patients. Although gender-affirming hormone therapies affect hair growth, there is little research about AGA in TGD populations. After reviewing the literature on approved treatments, off-label medication usages, and procedures for treating AGA, we present treatment options for AGA in TGD patients. The first-line treatments for any TGD patient include topical minoxidil 5% applied to the scalp once or twice daily, finasteride 1 mg oral daily, and/or low-level laser light therapy. Spironolactone 200 mg daily is also first-line for transfeminine patients. Second-line options include daily oral minoxidil dosed at 1.25 or 2.5 mg for transfeminine and transmasculine patients, respectively. Topical finasteride 0.25% monotherapy or in combination with minoxidil 2% solution are second-line options for transmasculine and transfeminine patients, respectively. Other second-line treatments for any TGD patient include oral dutasteride 0.5 mg daily, platelet-rich plasma, or hair restoration procedures. After 6-12 months of treatment, AGA severity and treatment progress should be assessed via scales not based on sex; eg, the Basic and Specific Classification or the Bouhanna scales. Dermatologists should coordinate care with the patient's primary gender-affirming clinician(s) so that shared knowledge of all medications exists across the care team.

Perceptions and practices of the Brazilian LGBT+ population toward blood donation.

In May 2020, after years of demands by activists and in light of COVID-19-related blood shortages, the Brazilian Federal Supreme Court abolished the rules that demanded a 12-month celibacy period for men who have sex with men (MSM) to donate blood. The objective of this open web survey was to assess the perceptions and practices regarding blood donation and blood donation rules among members of the Brazilian LGBT+ community. The data collection was conducted between October 2019 and March 2020, before the changes in the rules for blood donation and before the onset of the COVID-19 pandemic in Brazil. A total of 1639 adult individuals, self-declared as LGBT+ , participated (54.3 % MSM, 2.2 non-MSM, 43.5 % women). As expected, most of the study participants did not agree with the 12-month deferral period for MSM donate blood. Blood donation was already practiced by MSM, even before the abolition of the restrictions on donation. Among MSM and women, 38.7 % and 41.0 % have already donated blood, respectively. A significant number of participants reported lying in screening interviews at blood banks in order to be able to donate, and many said they knew people who were MSM and disobeyed the rules for donation, even though they knew them. Therefore, the practice of blood donation was already present among these people, even before the restriction policy change, confirming the need for revised rules for blood donation.

Addressing discrimination and violence against Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) persons from Brazil: a mobile health intervention.

BACKGROUND: Sexual and gender minorities (SGM) experience higher rates of discrimination and violence when compared to cis, heterosexual peers. However, violent crimes and other hate incidents against SGM persons are consistently not reported and prosecuted because of chronic distrust between the SGM community and police. Brazil is one of the most dangerous countries for SGM persons globally. Herein, we describe the development of a mobile health intervention to address the rampant violence against this population, the Rainbow Resistance-Dandarah app. METHODS: We conducted community-based participatory research (CBPR) between 2019 and 2020. The study started with in-depth interviews (IDIs) and focus group discussions (FGDs) with representatives of the SGM community from Brazil. Descriptive qualitative data analysis included the plotting of a 'word cloud', to visually represent word frequency, data coding and analysis of more frequent themes related to app acceptability, usability, and feasibility. A sub-sample of SGM tested the app and suggested improvements, and the final version was launched in December 2019. RESULTS: Since the app was launched in December 2019, the app recorded 4,114 active SGM users. Most participants are cisgender men (50.9%), self-identified as gay (43.5%), White (47.3%), and aged 29 or less (60.9%). FGDs and IDIs participants discussed the importance of the app in the context of widespread violence toward SGM persons. Study participants perceived this mHealth strategy as an important, effective, and accessible for SGM surviving violence. The CBPR design was highlighted as a key strategy that allowed SGM persons to collaborate in the design of this intervention actively. Some users reported how the panic button saved their lives during violent attacks. CONCLUSIONS: Rainbow Resistance-Dandarah app was endorsed as a powerful tool for enhancing reporting episodes of violence/discrimination against SGM persons and a key strategy to connect users with a safe network of supportive services. Results indicate that the app is an engaging, acceptable, and potentially effective mHealth intervention. Participants reported many advantages of using it, such as being able to report harassment and violence, connect with a safe network and receive immediate support.

Lesbian, gay, bisexual, transgender and or queer patient experiences in Canadian primary care and emergency departments: a literature review.

This literature review synthesises existing evidence and offers a thematic analysis of primary care and emergency department experiences of lesbian, gay, bisexual, transgender, queer and/or any other sexual or gender minority (LGBTQ+) individuals in Canada. Articles detailing first-person primary or emergency care experiences of LGBTQ + patients were included from EMBASE, MEDLINE, PsycINFO and CINHAL. Studies published before 2011, focused on the COVID-19 pandemic, unavailable in English, non-Canadian, specific to other healthcare settings, and/or only discussing healthcare provider experiences were excluded. Critical appraisal was performed following title/abstract screening and full-text review by three reviewers. Of sixteen articles, half were classified as general LGBTQ + experiences and half as trans-specific experiences. Three overarching themes were identified: discomfort/disclosure concerns, lack of positive space signalling, and lack of healthcare provider knowledge. Heteronormative assumptions were a key theme among general LGBTQ + experiences. Trans-specific themes included barriers to accessing care, the need for self-advocacy, care avoidance, and disrespectful communication. Only one study reported positive interactions. LGBTQ + patients continue to have negative experiences within Canadian primary and emergency care - at the provider level and due to system constraints. Increasing culturally competent care, healthcare provider knowledge, positive space signals, and decreasing barriers to care can improve LGBTQ + experiences.

Recruiting and retaining sexual and gender minority couples in intervention research: Lessons learned from trials of tailored relationship education programs.

Relationship interventions, including healthy relationship education, couple therapy, and dyadic approaches to treating mental and physical health issues, hold promise for promoting relationship and individual health among sexual and gender minority (SGM) populations. Because SGM couples live within a context of societal stigma against their minority identities and relationships, they are likely to be best served by targeted, culturally sensitive relationship interventions that are affirming, free of hetero- and cis-normativity, and address the unique stigma-based challenges that they face. Therefore, a key goal for the field today is to conduct research evaluating and refining newly developed relationship interventions designed specifically for SGM couples. In this paper, we offer recommendations for effectively recruiting and retaining large, diverse samples of SGM couples for clinical trials of tailored relationship interventions, grounded in guidelines for psychological practice and conducting research with SGM populations. Throughout, we offer examples and lessons learned from our experiences conducting clinical trials of tailored SGM relationship education programs. We encourage the use of recruitment and retention strategies that involve members of the target SGM community from the outset, are informed by knowledge about SGM individuals and relationships, use currently preferred language for individual identities and relationships, attend to issues of confidentiality regarding sexual/gender identity or relationship involvement, and adhere to the norms of the particular community and recruitment venue.

Wicked Bodies: A Health and Well-Being Toolkit Addressing Eating Disorders Within LGBTQIA2S+ Communities.

Wicked Bodies is a toolkit for addressing eating disorder in LGBTQIA2S+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, Two-Spirit, and other sexual and gender minority) communities, an increasing prevalent issue that can have serious consequences on the health and well-being for LGBTQIA2S+ people. The toolkit consists of a series of short films and a discussion guidebook that provide a template that can be used for engaging with LGBTQIA2S+ youth through a lens of compassion and cultural humility. Wicked Bodies does this by presenting the lived experiences of a diverse range of LGBTQIA2S+ individuals navigating sociocultural pressures, gender expectations, and peer-based ideals around body weight and shape. Feedback from three screening events revealed that Wicked Bodies has the potential to be transformative as a health promotion initiative.

Setting the Stage to Flourish: Supporting LGBTQIA2S+ Graduate Students.

The lived experiences of LGBTQIA2S+ (Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, Intersex, Asexual, Two Spirit) doctoral students remain an area for deeper exploration and understanding in the higher education landscape. Higher education administrators and faculty often focus on the well-being and social integration of undergraduate students where the greatest source of revenue is generated. To this end, our story about how doctoral students can educate faculty in this space is of great significance. The term student-centered is often used generically, but each student's center and lived experience are not the same. To be a true student advocate for the LGBTQIA2S+ population involves vulnerability, unearthing uncomfortable truths, and active listening. Thus, support can be an inherently kind word or one that is empty blanket terminology for being nice. We (the faculty) want to do more than be nice, smile politely, and pretend to understand the student; this takes effort, altruism, character, and the ability to say teach me about your lived experiences. The student has to feel a high level of trust and the depth of fortitude to tell their truths that are often painful and not articulated to more than two or three close others, much less faculty members. This article focuses on the lived experiences of two straight faculty and a doctoral student who is part of the LGBTQIA2S+ community. We share our collective narratives, so that you can build yours.

Promoting Awareness to Counter Damaging Attitudes, Beliefs, and Reactions Related to Sexual Assault Against Trans People: A Social Media Campaign for Health and Social Service Providers.

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.

Engaging Sexual and Gender Minority Older Adults to Elicit Concerns and Recommendations for Communicating Care Preferences in Long-Term Care: Focus Group Findings.

OBJECTIVES: 1) Describe sexual and gender minority (SGM) older adults' current practices and concerns for communicating end-of-life (EOL) and daily care preferences in long-term care (LTC); 2) Elicit ideas about adapting a video-based intervention to facilitate communication. METHODS: After consulting a community advisory board, we conducted two focus groups with SGM older adults ≥55 years of age recruited from a community-based service organization (n = 4) and a continuing care retirement community (n = 9). We audio-recorded, transcribed, and coded data using directed content analysis methods and summarized results descriptively. RESULTS: Most participants were cisgender (n = 12), female (n = 11), lesbian (n = 10), White and non-Hispanic (n = 13); mean age was 70.62. Participants' concerns included discrimination, autonomy, chosen family, and community; they linked daily care preferences with personhood and quality of life. They advocated for building intentional community-based support networks to help peers discuss preferences and produce videos before LTC transition and ensure compliance after. CONCLUSIONS: For SGM older adults, asserting and protecting their full personhood, through daily care preferences, is essential to quality of life in LTC. CLINICAL IMPLICATIONS: Video-recorded statements of daily preferences, facilitated and supported by a peer network, could promote culturally competent, person- and community-centered care for SGM older adults in LTC settings.

Community responses to LGBT+ adults with intellectual and developmental disabilities during the COVID-19 confinement in Madrid.

A group of 50 people with intellectual and developmental disabilities (IDDs) as well as diverse sexualities and gender identities in Madrid participated in a feminist community-based project, which supported them through the first wave of the pandemic. Facilitated by professionals, the project offered online meetings twice a month, helping them to articulate their needs and promote their agency over their choices and experiences. Based on their demands, participants chose the topics they wanted to discuss, proposed activities, and were the center of the program, while facilitators set up and maintained the online space, helping with participation and access to information and resources. Through this transformative experience, the members of the group developed friendship networks and started their activism, making public appearances in video campaigns and mainstream newspapers to make their needs visible to peers, families, social workers, policy makers, and nongovernmental organizations (NGOs). This research is part of a larger project that tackles the psychosocial factors that affected Spanish people with sexual and gender diversity during the first wave of the pandemic.

Understanding the Role of Virtual Outreach and Programming for LGBT Individuals in Later Life.

Due to health disparities LGBT older adults may have more health care needs, but they are likely to have less informal sources of support. While efforts have been made to serve LGBT older adults, traditional forms of in person outreach and service may still be inaccessible to those living in rural areas, with restricted mobility, due to lack of transportation, during inclement weather, or in public health situations as the Covid-19 pandemic. We conducted focus group discussions to understand the role of virtual outreach in serving LGBT individuals' needs in their later years of life. Study participants expressed a desire for dating, community, aging in place, and affirming health care. However, their experience of internalized and institutional homophobia and ageism may act as barriers in fulfilling those needs. A dedicated virtual space has the potential to overcome these barriers by facilitating online get-togethers, support groups, dating events, having coming out resources, and exchanging information on LGBT friendly health services. Having a space to express their generativity may make such virtual services more empowering. Lack of technological access and privacy concerns may hinder the use of virtual services but can be overcome with training and education.

Opportunities to Harness Technology to Deliver HIV Prevention / Healthy Sexuality Programming to Sexual and Gender Minority Adults Living in East Africa.

Because of stigmatization of and discrimination against lesbian, gay, bisexual, transgender, and other sexual and gender minority (SGM) people in East Africa, there is paucity of SGM-focused sexual health research. Technology-based outreach efforts may represent a feasible way to reach and engage this population. They also may be a way to deliver important yet sensitive sexual health information in a stigma-free, anonymous atmosphere. We explored the feasibility of recruiting and surveying East African SGM adults online, and examined their interest in technology-based sexual health programming. Over a 14-month period, 2451 respondents were surveyed. They were, on average, 26.7 years of age. Fifty-four percent identified as lesbian, gay, and/or bisexual (LGB); a similar percentage (49%) reported having sex with a same-sex partner. Sixteen percent identified as gender minority (i.e. transgender or non-binary); and 29% were assigned female at birth. Almost half (48%) of SGM adults expressed interest in an SGM-focused healthy sexuality program delivered online. Enthusiasm also was noted for email (43%) and text messaging (41%). Compared to face-to-face settings, technology-based settings were more commonly  appraised  as the safest mode through which one could engage in sexual health programming. People who had a same sex partner and those who identified as sexual minority were especially likely to want to engage in technology-based programs. Interest in technology-based programming was similar for adults across gender identities, sex assigned at birth, and age however. Findings suggest that technology may be an underutilized opportunity to reach and engage SGM East Africans in a safe and private manner. Given levels of acceptability indicated by SGM adults across age, sex assigned at birth, and gender and sexual identities in this study, it seems possible that technology-based sexual health and HIV prevention and intervention programs could have the potential to be transformative in East Africa.

Debido a la estigmatización y discriminación contra lesbianas, gays, bisexuales, transgénero y otras personas de minorías sexuales y de género en África Oriental, hay limitadas investigaciones sobre salud sexual centradas en minorías sexuales y de género. Los esfuerzos de divulgación basados en la tecnología pueden representar una forma factible de llegar e involucrar a esta población. También pueden ser una forma de entregar información importante pero sensible sobre la salud sexual en una atmósfera anónima y libre de estigma. Exploramos la viabilidad de reclutar y encuestar a adultos de minorías sexuales y de género de África Oriental en línea y examinamos su interés en la programación de salud sexual basada en tecnología. Durante un período de 14 meses, 2451 personas fueron encuestadas. Tenían, en promedio, 26.7 años. El cincuenta y cuatro por ciento se identificó como lesbiana, gay y / o bisexual (LGB); un porcentaje similar (49%) reporto haber tenido relaciones sexuales con una pareja del mismo sexo. El dieciséis por ciento se identificó como una minoría de género (es decir, transgénero o no binario); y al 29% se les asignó mujeres al nacer. Casi la mitad (48%) de los adultos de minorías sexuales y de género expresaron interés en un programa de sexualidad saludable centrado en minorías sexuales y de género que se ofrece en línea. También se notó entusiasmo por el correo electrónico (43%) y los mensajes de texto (41%). En comparación con los entornos cara a cara, los entornos basados en la tecnología se consideraban más comúnmente el modo más seguro a través del cual uno podía participar en programas de salud sexual. Las personas que tenían una pareja del mismo sexo y las que se identificaban como minorías sexuales eran especialmente propensas a querer participar en programas basados en tecnología. Sin embargo, el interés en la programación basada en tecnología fue similar para los adultos en todas las identidades de género, sexo asignado al nacer y edad. Este estudio sugiere que la tecnología podría ser una oportunidad aún subutilizada para llegar e involucrar a los africanos del este de minoría sexual y de género de una manera segura y privada. Dados los niveles de aceptabilidad indicados por los adultos de minoría sexual y de género de todas las edades, el sexo asignado al nacer, y las identidades sexuales y de género en este estudio, parece posible que los programas de prevención e intervención del VIH basados en la tecnología puedan ser transformadores en África Oriental.

To Speak to Me, Address Us: Insights From LGBT Young Adults to Inform Public Education Campaigns.

Draft advertising concepts were tested in a series of focus groups among 140 lesbian, gay, bisexual, and transgender (LGBT) young adults aged 18 to 24 in seven U.S. cities in 2015. In this secondary analysis of focus group transcripts, young adult responses to tested concepts belie deeper lessons that have broader application for public education campaigns among LGBT young adult audiences. Respondents valued seeing both individuals who were like them and also unlike them, preferring a diverse portrayal of the fuller spectrum of LGBT communities, a finding which has implications for campaign segmentation of LGBT audiences. More broadly tailored communications for LGBT audiences can be appropriate as long as portrayals are diverse. These young adults expressed the desire to see nuanced, humanizing content that avoids playing into existing stereotypes. These findings also show how qualitative research can benefit segmentation and how research and communications can address the needs of subgroups within diverse segments.

Recommendations From Black Sexual Minority Men: Building Trust to Improve Engagement and Impact of HIV/STI Research.

As demonstrated by the consistently documented disproportionately high rates of HIV and STIs (sexually transmitted infections) among Black sexual minority men (BSMM), current efforts to develop responsive interventions to reduce HIV and other STIs within this population have not been sufficient. It is therefore critical that public health researchers reflect meaningfully on the ways in which they investigate HIV and STIs. Engagement with BSMM is crucial in addressing the disproportionately high rates of HIV and STIs experienced, and thus the goal of the current research was to identify community-developed strategies that may enhance community engagement in research with BSMM. Seven focus groups (N = 38) were held with cisgender BSMM ages 18 to 45 years in Baltimore, Maryland to explore how to better engage this population and improve HIV and STI research. Data analysis of the text was conducted using an iterative, thematic constant comparison process informed by grounded theory. Four distinct themes related to trust-building within the broader community emerged: (1) authentic engagement with the community, (2) increased transparency of the research process, (3) capacity building of research staff from the community, and (4) a balance of research and action. Strategies for researchers to build community trust were identified that are related to, but slightly distinct from, common discussions in the community engaged research literature that are centered more specifically on trust-building within community-academic partnerships. Engagement with BSMM is crucial in addressing HIV and STI health disparities. It is critical that community engagement also be a priority to policy makers, research institutions, and funding institutions.

Conceptualizing LGBT Stigma and Associated HIV Vulnerabilities Among LGBT Persons in Lesotho.

Social marginalization harms lesbian, gay, bisexual, and transgender (LGBT) persons' wellbeing in Lesotho. Socio-cultural mechanisms linking LGBT stigma, depression, substance use, and HIV among LGBT persons in Lesotho are understudied. We explore associations between LGBT stigma, mental health stressors, and HIV vulnerabilities among LGBT persons in Lesotho. We conducted in-depth, semi-structured interviews with 46 LGBT persons and six key informants (e.g. healthcare providers). Participants described depression, substance use, and HIV as mutually reinforcing and situated in larger social contexts of stigma. Alcohol use was a stigma coping strategy and a way to build LGBT connections. At the same time, alcohol use elevated HIV vulnerabilities by lowering condom use uptake. Pervasive stigma reinforced barriers to healthcare engagement. Community-led support and services were leveraged to navigate stigma, reduce HIV vulnerabilities, and ultimately improve health. Findings emphasize the key role contexts play in shaping sexual and mental health among LGBT persons in Lesotho.