Lesbian, gay, bisexual, and transgender clinical competence of physiotherapy students in Israel.

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

Prepare Romania: study protocol for a randomized controlled trial of an intervention to promote pre-exposure prophylaxis adherence and persistence among gay, bisexual, and other men who have sex with men.

BACKGROUND: Gay, bisexual, and other men who have sex with men (GBMSM) represent a high-risk group for HIV transmission in Romania, yet they possess few resources for prevention. Despite having no formal access to pre-exposure prophylaxis (PrEP) through the health system, GBMSM in Romania demonstrate a high need for and interest in this medication. In anticipation of a national rollout of PrEP, this study tests the efficacy of a novel strategy, Prepare Romania, that combines two evidence-based PrEP promotion interventions for GBMSM living in Romania. METHODS: This study uses a randomized controlled trial design to examine whether GBMSM living in Romania receiving Prepare Romania, a culturally adapted counseling and mobile health intervention (expected n = 60), demonstrate greater PrEP adherence and persistence than those assigned to a PrEP education control arm (expected n = 60). Participants from two main cities in Romania are prescribed PrEP and followed-up at 3 and 6 months post-randomization. PrEP adherence data are obtained through weekly self-report surveys and dried blood spot testing at follow-up visits. Potential mediators (e.g., PrEP use motivation) of intervention efficacy are also assessed. Furthermore, Prepare Romania's implementation (e.g., proportion of enrolled participants attending medical visits, intervention experience) will be examined through interviews with participants, study implementers, and healthcare officials. DISCUSSION: The knowledge gained from this study will be utilized for further refinement and scale-up of Prepare Romania for a future multi-city effectiveness trial. By studying the efficacy of tools to support PrEP adherence and persistence, this research has the potential to lay the groundwork for PrEP rollout in Romania and similar contexts. Trial registration This study was registered on ClinicalTrials.gov, identifier NCT05323123 , on March 25, 2022.

How Gender-Sexuality Alliances cultivate a sense of school belonging from week to week for LGBTQ+ youth.

School belonging can facilitate positive youth development and educational outcomes. Given that LGBTQ+ youth face marginalization in schools, there is a need to identify school supports that could still promote their sense of school belonging. We considered Gender-Sexuality Alliances (GSAs) as LGBTQ+ affirming school clubs. Among 92 LGBTQ+ student members of GSAs in nine states who completed weekly diary surveys over an 8-week period (Mage = 15.83 years, SD = 1.29; 50% youth of color; 51% trans or non-binary), we considered whether a youth's GSA experiences from meeting to meeting predicted their relative levels of school belonging in days following these meetings. There was significant within-individual (37%) and between-individual (63%) variability in youth's sense of school belonging during this time. Youth reported relatively higher school belonging on days following GSA meetings where they perceived greater group support (p = .04) and took on more leadership (p = .01). Furthermore, youth who, on average, reported greater advisor responsiveness (p = .01) and leadership (p = .01) in GSA meetings over the 8-week period reported greater school belonging than others. Findings showcase the dynamic variability in LGBTQ+ youth's sense of school belonging from week to week and carry implications for how schools and GSAs can support LGBTQ+ youth and sustain their ties to school.

Investigating the Interrelationships Among Mental Health, Substance Use Disorders, and Suicidal Ideation Among Lesbian, Gay, and Bisexual Adults in the United States: Population-Based Statewide Survey Study.

BACKGROUND: Mental health disparities have been documented among lesbian, gay, and bisexual (LGB) adults in the United States. Substance use disorders and suicidal ideation have been identified as important health concerns for this population. However, the interrelationships among these factors are not well understood. OBJECTIVE: This study aims to investigate the interrelationships among mental health, substance use disorders, and suicidal ideation among LGB adults in the United States using a population-based statewide survey. METHODS: Our study was an observational cross-sectional analysis, and the data for this study were collected from a sample of LGB adults who participated in the statewide survey. The survey collected information on mental health, substance use disorders, and suicidal ideation using validated measures. Descriptive statistics and inferential data analysis were conducted to explore the interrelationships among these factors. RESULTS: The results showed that LGB adults who reported higher levels of depression and drug abuse and dependence also reported higher levels of suicidal tendency and mental illness. Inferential data analysis using χ2 tests revealed significant differences in depression score (χ22=458.241; P<.001), drug abuse and dependence score (χ22=226.946; P<.001), suicidal tendency score (χ22=67.795; P<.001), and mental illness score (χ22=363.722; P<.001) among the 3 sexual identity groups. Inferential data analysis showed significant associations between sexual identity and mental health outcomes, with bisexual individuals reporting the highest levels of depression, drug abuse and dependence, suicidal tendency, and mental illness. CONCLUSIONS: This study provides important insights into the interrelationships among mental health, substance use disorders, and suicidal ideation among LGB adults in the United States. The findings underscore the need for targeted interventions and research aimed at addressing the mental health needs of sexual minority populations. Future research should aim to better understand the underlying mechanisms driving these disparities and develop culturally sensitive and tailored interventions that meet the unique needs of LGB individuals. Reducing stigma and discrimination against sexual minority populations is also crucial to improving their mental health outcomes.

A Qualitative Analysis of Shared Values and Motivation for Change Expressed by Sexual Minority Men in Relationships: Use of the Personal Values Card Sort Activity During Motivational Interviewing Sessions Addressing Drug Use and Sexual Health.

The development of tailored interventions that address drug use and sexual risk taking among sexual minority men (SMM) in relationships has garnered increasing interest over the past 20 years. Motivational interviewing (MI) has demonstrated promise in both individual and couples-based applications. The Personal Values Card Sort activity is commonly employed in these interventions; however, relatively little is known about the content of client responses evoked by this intervention task. This study examined how SMM in relationships characterize their values; how their relationship partners influence value attainment; and how they situated drug use and sexual risk taking in the context of their values and primary relationships. A qualitative analysis of intervention transcripts from sessions with 47 SMM aged 18 to 34 was conducted. All respondents were HIV negative and indicated recent (past 30 days) drug use and sexual risk behavior. Participants' high priority values reflected a focus on clarifying personal identity and interpersonal relationships. Values manifested as realized, aspirational, or transformed. Participants described their partners as supporting goal attainment and as a companion with whom they cope with goal-related stressors. Consistent with interdependence theory, participants' responses indicated consideration of their partner and relationship when these aligned with and supported goal-attainment. Conversely, when partners were described as a barrier to realizing their values, participants characterized their relationship as being of lower quality. Implications of this content for the activation of motivation for health behavior are discussed with specific emphasis on applications with SMM in relationships.

HIV Stigma, Sexual Identity Stigma and Online Coping Strategy of Gay, Bisexual and Queer People Living with HIV: A Moderated Mediation Study.

INTRODUCTION: Living with HIV/AIDS is more difficult for gay, bisexual, and queer (G- BQ) people as they face stigma on both the disease and sexuality, which puts significant stress on coping with stressors, and online platforms have become an alternative coping channel. METHOD: This study investigated the use of online coping strategies in moderating the HIV stigma mediated by sexual identity stigma on mental health in Malaysia. 123 GBQ people living with HIV between the ages of 20 and 39 participated in the study, responding to the HIV Stigma - Short Form Scale, adapted China MSM Stigma Scale, Online Coping Inventory, and DASS-21. RESULT: Results were analyzed using OLS, and logistic regression path modeling showed a statisti- cally significant indirect effect of sexual identity stigma mediating HIV stigma on depressive (ab = 0.1362), anxiety (ab = 0.1259), and stress (ab = 0.1636) levels. Problem-focused online coping strategy was found to moderate the indirect association between HIV stigma and depression levels via sexual identity stigma at low (ß = 0.2110, SE = 0.0741, p<.05) and moderate levels (ß = 0.1168, SE = 0.0465, p<.05). The findings demonstrated the compounding link between HIV and sexual identity stigmas on mental health and how online coping strategies can be used as a helpful coping resource to manage depressive symptoms for this community and mental health practition- ers. CONCLUSION: These findings can be beneficial to generate a better understanding of how double stigmas play a role in mental health and the types of online coping strategies adopted to process the stressors for GBQ individuals living with HIV in Malaysia.

How do beliefs about different human papillomavirus-related diseases vary among young gay, bisexual, and other men who have sex with men in the United States?

Purpose: To determine how beliefs about various disease outcomes caused by human papillomavirus (HPV) infection differ among young gay, bisexual, and other men who have sex with men (YGBMSM). Methods: From 2019 to 2021, we recruited cisgender YGBMSM ages 18-25 in the United States who were unvaccinated against HPV (n = 1,227). Survey items examined three disease outcomes (genital warts, anal cancer, and oropharyngeal cancer) for each of three different beliefs (perceived vulnerability, perceived severity, and worry). Results: Participants reported lower perceived vulnerability to and worry about anal cancer and oropharyngeal cancer compared to genital warts (all p < 0.001). Participants also reported greater perceived severity of anal cancer and oropharyngeal cancer compared to genital warts (all p < 0.001). Some patterns of beliefs differed by participant characteristics. Conclusions: The beliefs of YGBMSM varied by HPV-related disease outcome. Findings can guide future HPV vaccination communication efforts for YGBMSM by informing how to better frame messages and increase relevance.

'Sometimes white doctors are not very friendly or inclusive': a Critical Race Theory analysis of racism within and beyond sexual health settings.

Many Two-Spirit, gay, bisexual, transgender, and other queer Black, Indigenous, people of colour in Canada encounter racism when testing for sexually transmitted and blood-borne infections. Our objective in this study was to understand how racism shapes testing experiences for these communities in Ontario, Canada. Four peer researchers conducted recruitment and data collection in consultation with a community advisory board. Focus groups and interviews took place with 21 participants and their narrative accounts were analysed using reflexive thematic analysis. Participants identified three interrelated issues when testing: (1) experiencing judgement and discomfort due to racism; (2) lack of community and cultural indicators in testing spaces; and (3) barriers to accessing testing centres and services. Systemic racism was linked to each of these barriers, including increased distance to testing centres due to racial segregation. Participant accounts signal the need for antiracist testing spaces and practices. Key implications include the need for antiracism training for health service providers and others working with Two-Spirit, gay, bisexual, transgender, and other queer Black, Indigenous, people of colour, and the organisations that serve them, in order to make testing spaces safer. Dismantling systemic racism is imperative to achieve health equity for members of these communities.

"It's another gay disease": an intersectional qualitative approach contextualizing the lived experiences of young gay, bisexual, and other sexual minoritized men in the United States during the mpox outbreak.

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

Eating Disorders in Sexual and Gender Minority Adolescents.

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

"It definitely changed me": Exploring sexual and gender diverse people's experiences with intimate partner violence in Ontario, Canada.

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

Human PapillomaVirus vaccination in gay and bi men: Predictors, dynamic norms, and connectedness to the LGBT+ community.

OBJECTIVES: This study tested social cognitive predictors of vaccination and a dynamic norms intervention for increasing HPV vaccination intentions in gay, bisexual, and other men who have sex with men (gbMSM). DESIGN: The study employed an experiment embedded in a cross-sectional survey. METHODS: Participants (N = 217; gbMSM aged 18-45 in Ireland) provided cross-sectional data on sociodemographic constructs and constructs from the Theory of Planned Behaviour and the Health Belief Model. Unvaccinated participants (n = 94) were randomised to one of three experimental conditions (no norms, static norms, dynamic norms) and presented with information on HPV vaccine uptake in gbMSM in Ireland before reporting vaccination intentions. RESULTS: In an adjusted logistic regression, significant predictors of vaccination included being in a relationship (OR = 8.69 [1.09, 38.91]), perceived susceptibility (OR = 1.11 [1.04, 1.19]), healthcare provider recommendation (OR = 107.24 [26.87, 427.99]), and perceived barriers (OR = 0.83 [.7, 0.98]). Adjusted linear regression models showed no significant differences in HPV vaccination intentions between no norms and static norms (B = -1.24 [-4.6, 2.12]), dynamic norms and static norms (B = -0.62 [-3.86, 2.63]), and dynamic norms and no norms (B = 0.62 [-2.74, 3.98]). Connectedness to the LGBT+ community did not moderate these differences. CONCLUSIONS: The need for greater awareness of susceptibility, the impact of barriers, and the strong influence of a recommendation from a healthcare provider in predicting HPV vaccination among gbMSM are critical considerations for policymakers. Dynamic norm messaging may be less effective for vaccination than other behaviours more easily influenced by social norms. Efforts to implement dynamic norm-based interventions in gbMSM should consider the limited evidence of efficacy.

"Saying 'I'm not okay' is extremely risky": Postpartum mental health, delayed help-seeking, and fears of the child welfare system among queer parents.

Parent mental health challenges in the postpartum and early parenthood have profound implications for parent, child, and family well-being. Little research has focused on postpartum mental health challenges and barriers to help-seeking among queer birthing people, including members of this community who may be particularly vulnerable to mental health difficulties, such as queer cis women partnered with men, trans/nonbinary parents, and queer parents who are young, low-income, and/or of color. This mixed-methods study of queer parents (n = 99), all of whom were assigned female at birth (AFAB) and gave birth to a child within the past several years, explores parents' postpartum mental health difficulties and perceived barriers to seeking help. Using a structural stigma framework, this study found that participants reported high rates of postpartum mental health difficulties (89%) and reported various barriers to seeking support including fears of discrimination and being deemed "unfit" by providers, which might lead to child welfare system involvement. Young parents and low-income parents were particularly fearful of child welfare system contact and potential child removal. Factors that encouraged help-seeking (e.g., desire to be a good parent; partner pressure to seek help) and implications for family practitioners are discussed.

Cancer in people who identify as lesbian, gay, bisexual, transgender, queer, or gender-nonconforming.

BACKGROUND: Individuals who identify as lesbian, gay, bisexual, transgender, queer, intersex, or gender-nonconforming (LGBTQ+) experience discrimination and minority stress that may lead to elevated cancer risk. METHODS: In the absence of population-based cancer occurrence information for this population, this article comprehensively examines contemporary, age-adjusted cancer risk factor and screening prevalence using data from the National Health Interview Survey, Behavioral Risk Factor Surveillance System, and National Youth Tobacco Survey, and provides a literature review of cancer incidence and barriers to care. RESULTS: Lesbian, gay, and bisexual adults are more likely to smoke cigarettes than heterosexual adults (16% compared to 12% in 2021-2022), with the largest disparity among bisexual women. For example, 34% of bisexual women aged 40-49 years and 24% of those 50 and older smoke compared to 12% and 11%, respectively, of heterosexual women. Smoking is also elevated among youth who identify as lesbian, gay, or bisexual (4%) or transgender (5%) compared to heterosexual or cisgender (1%). Excess body weight is elevated among lesbian and bisexual women (68% vs. 61% among heterosexual women), largely due to higher obesity prevalence among bisexual women (43% vs. 38% among lesbian women and 33% among heterosexual women). Bisexual women also have a higher prevalence of no leisure-time physical activity (35% vs. 28% among heterosexual women), as do transgender individuals (30%-31% vs. 21%-25% among cisgender individuals). Heavier alcohol intake among lesbian, gay, and bisexual individuals is confined to bisexual women, with 14% consuming more than 7 drinks/week versus 6% of heterosexual women. In contrast, prevalence of cancer screening and risk reducing vaccinations in LGBTQ+ individuals is similar to or higher than their heterosexual/cisgender counterparts except for lower cervical and colorectal cancer screening among transgender men. CONCLUSIONS: People within the LGBTQ+ population have a higher prevalence of smoking, obesity, and alcohol consumption compared to heterosexual and cisgender people, suggesting a higher cancer burden. Health systems have an opportunity to help inform these disparities through the routine collection of information on sexual orientation and gender identity to facilitate cancer surveillance and to mitigate them through education to increase awareness of LGBTQ+ health needs.

Developing an mHealth program to improve HIV care continuum outcomes among young Black gay and bisexual men.

BACKGROUND: Young Black gay and bisexual men (YBGBM) in the United States face significant disparities in HIV care outcomes. Mobile health (mHealth) interventions have shown promise with improving outcomes for YBGBM across the HIV care continuum. METHODS: We developed an mHealth application using human-centered design (HCD) from 2019-2021 in collaboration with YBGBM living with HIV and with HIV service providers. Our HCD process began with six focus groups with 50 YBGBM and interviews with 12 providers. These insights were used to inform rapid prototyping, which involved iterative testing and refining of program features and content, with 31 YBGBM and 12 providers. We then collected user feedback via an online survey with 200 YBGBM nationwide and usability testing of a functional prototype with 21 YBGBM. RESULTS: Focus groups and interviews illuminated challenges faced by YBGBM living with HIV, including coping with an HIV diagnosis, stigma, need for social support, and a dearth of suitable information sources. YBGBM desired a holistic approach that could meet the needs of those newly diagnosed as well as those who have been living with HIV for many years. Program preferences included video-based content where users could learn from peers and experts, a range of topics, a community of people living with HIV, and tools to support their health and well-being. Providers expressed enthusiasm for an mHealth program to improve HIV care outcomes and help them serve clients. Rapid prototyping resulted in a list of content topics, resources, video characteristics, community features, and mHealth tools to support adherence, retention, goal setting, and laboratory results tracking, as well as tools to help organization staff to support clients. Online survey and usability testing confirmed the feasibility, acceptability, and usability of the content, tools, and features. CONCLUSIONS: This study demonstrates the potential of a video-based mHealth program to address the unique needs of YBGBM living with HIV, offering support and comprehensive information through a user-friendly interface and videos of peers living with HIV and of experts. The HCD approach allowed for continuous improvements to the concept to maximize cultural appropriateness, utility, and potential effectiveness for both YBGBM and HIV service organizations.

Black social media influencers engage higher percentages of Black gay and bisexual men in online outreach for HIV prevention research relative to paid ads.

Background: Influencer-based social media marketing campaigns are a popular strategy to engage customers in many non-research industries (e.g., retail), but have been increasingly used in public health campaigns to reach and engage specific populations. However, few studies have directly compared the performance of influencer-based marketing with other ad strategies (e.g., paid ads) in achieving these goals. Methods: From March to September 2023, we conducted an influencer-focused marketing campaign in which we identified and partnered with predominantly Black LGBTQ + influencers in the United States South to promote engagement in our ongoing research. We then used web analytics and interest form data to compare performance of influencer posts versus paid ads over the same time period. Results: We contacted a total of 358 influencers, 20 of whom ultimately agreed to post (85% Black/African American) and made a total of 28 posts on our behalf. A significantly higher percentage of users who clicked through influencer posts were Black (40% vs. 15%), were not currently using pre-exposure prophylaxis (PrEP) (67% vs. 62%), had no history of PrEP use (78% vs. 72%), and reported higher medical mistrust (12% vs. 8%) compared to those who clicked through paid ads. The percentage of Black men who have sex with men who were at high HIV risk, who were not taking PrEP, had no history of PrEP, or were high in mistrust, were all 2-3 times higher among those who clicked through influencer posts relative to paid ads. Conclusions: Influencer-focused marketing may be a powerful tool to efficiently reach and engage high-priority and hard to reach populations.

Desiring support on a winding road with challenging intersections: Social and professional support for sexual minority forced migrant men.

AIM: To explore experiences of social and health professional support among sexual minority forced migrant men. DESIGN: Exploratory qualitative study. METHODS: Individual semi-structured interviews were conducted in 2023 with 15 participants recruited through convenience, purposive and snowball sampling. Interviews were audio recorded, transcribed and analysed with systematic text condensation in a collaborative process between researchers and experts by lived experience. RESULTS: The first category was 'desiring support along a road with challenging intersections'. Participants encountered a harsh reality and dangers in the host country. They sought social connections and communicated with others whilst in a social labyrinth within a new and reserved society. Although social support was desired and highly appreciated, the process involved a spectrum of both belonging and exclusion. The second category was 'navigating uncharted waters when seeking affirming health services'. A range of barriers to health services were encountered in a complex health system. Participants emphasized the importance of safe and affirming spaces that accommodate the vulnerability of disclosure. CONCLUSION: Ensuring respectful and affirming support for sexual minority forced migrants is essential. Barriers in accessing health services need to be addressed, including informing about rights and ensuring safety. IMPLICATION FOR THE PROFESSIONAL AND PATIENT CARE: Nurses and other health professionals can consider social support as a potentially valuable resource for health promotion. However, there is a need for more research investigating its mental health effects. IMPACT: The intersectional disadvantages and discrimination encountered by sexual minority forced migrants call attention to the need for further advancements in inclusion health and affirming care. REPORTING METHOD: This study adhered to the Consolidated Criteria for Reporting Qualitative Research. PATIENT OR PUBLIC CONTRIBUTION: Three sexual minority forced migrants were members of the research team. They were involved in the data collection, analysis and reporting in close collaboration with researchers.

Optimizing Individual HIV Testing and Counseling for Emerging Adult Sexual Minority Men (Aged 18 to 24) in Relationships: A Pilot Randomized Controlled Trial of Adjunct Communication Components.

The majority of new HIV infections in the US occur among sexual minority men (SMM) with older adolescent and emerging adult SMM at the highest risk. Those in relationships face unique HIV prevention challenges. Existing sexual HIV transmission risk interventions for male couples often encounter implementation challenges and engaging younger SMM early in relationships may be particularly difficult. This pilot randomized controlled trial evaluated the acceptibility and feasibility of We Test HIV testing - a behavioral health intervention tailored for younger SMM in realtionships - and generated preliminary estimates of effect size. The intervention comprises two adjunct moduls - video-based communication skills training as well as communication goal setting and planning - delivered in conjunction with routine HIV testing and counseling in individual or dyadic formats. A sample of 69 SMM aged 17 to 24 were recruited online. Following baseline assessment, youth were randomized to receive either the experimental, We Test, intervention or routine HIV testing (the control condition). Follow-up assessments were completed 3 and 6 months post-baseline. Results suggested the study was feasible and the individually delivered format was acceptible. We Test HIV testing was associated with significant improvements in communication skills. In addition, youth who remained in a relationship experienced an increase in communal coping to reduce HIV infection risk and relationship power. While groups did not differ with respect to condomless anal sex with casual partners, these psycho-social constructs (communication, communal coping with HIV prevention, and relationship power) may serve as mediators of intervention effects on sexual risk reduction in a larger study.

Assisted Reproduction for a Same-Sex Couple: Interdisciplinary Preclinical Active Learning Module Combining Case-Based Small Group Discussion and Patient Panel.

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

A Web-Based Intervention to Support the Mental Well-Being of Sexual and Gender Minority Young People: Mixed Methods Co-Design of Oneself.

BACKGROUND: Sexual and gender minority youth are at greater risk of compromised mental health than their heterosexual and cisgender peers. This is considered to be due to an increased burden of stigma, discrimination, or bullying resulting in a heightened experience of daily stress. Given the increasing digital accessibility and a strong preference for web-based support among sexual and gender minority youth, digital interventions are a key means to provide support to maintain their well-being. OBJECTIVE: This paper aims to explicate the co-design processes and underpinning logic of Oneself, a bespoke web-based intervention for sexual and gender minority youth. METHODS: This study followed a 6-stage process set out by Hagen et al (identify, define, position, concept, create, and use), incorporating a systematic scoping review of existing evidence, focus groups with 4 stakeholder groups (ie, sexual and gender minority youth, professionals who directly support them, parents, and UK public health service commissioners), a series of co-design workshops and web-based consultations with sexual and gender minority youth, the appointment of a digital development company, and young adult sexual and gender minority contributors to create content grounded in authentic experiences. RESULTS: Oneself features a welcome and home page, including a free accessible to all animation explaining the importance of using appropriate pronouns and the opportunity to create a user account and log-in to access further free content. Creating an account provides an opportunity (for the user and the research team) to record engagement, assess users' well-being, and track progress through the available content. There are three sections of content in Oneself focused on the priority topics identified through co-design: (1) coming out and doing so safely; (2) managing school, including homophobic, biphobic, or transphobic bullying or similar; and (3) dealing with parents and families, especially unsupportive family members, including parents or caregivers. Oneself's content focuses on identifying these as topic areas and providing potential resources to assist sexual and gender minority youth in coping with these areas. For instance, Oneself drew on therapeutic concepts such as cognitive reframing, stress reduction, and problem-solving techniques. There is also a section containing relaxation exercises, a section with links to other recommended support and resources, and a downloads section with more detailed techniques and strategies for improving well-being. CONCLUSIONS: This study contributes to research by opening up the black box of intervention development. It shows how Oneself is underpinned by a logic that can support future development and evaluation and includes diverse co-designers. More interactive techniques to support well-being would be beneficial for further development. Additional content specific to a wider range of intersecting identities (such as care-experienced Asian sexual and gender minority youth from a minority faith background) would also be beneficial in future Oneself developments. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/31036.