"They're not feeling the love they need to feel": HIV stigma and other intersecting stigmas among Black gay and bisexual men and transgender women in House and Ball Communities.

Introduction: Stigma negatively influences engagement in HIV prevention and care. This study explores how young Black gay and bisexual men and transgender women (GBT) in the House and Ball Community (HBC) experience HIV and other intersecting stigmas. Method: We conducted phenomenological analysis of interviews with 60 young Black GBT HBC members and 30 older leaders of the HBC. Result: Participants described experiences of enacted, perceived, and internalized HIV stigma and intersecting stigmas related to race, ethnicity, sexuality, gender identity, gender expression, and body size, as well as their responses to HIV stigma. Intersecting stigmas shaped and reinforced one another, leading to isolation and increased HIV vulnerability. Conclusion: Interventions to ameliorate intersectional stigma and its effects are needed to improve primary and secondary HIV prevention in the HBC.

Safer dementia care spaces: Perspectives from LGBTQ+ people with cognitive impairment and caregivers.

The number of caregivers and people living with dementia and other related forms of cognitive impairment is increasing worldwide. Compared to heterosexual and cisgender individuals, studies suggest that lesbian, gay, bisexual, queer, or other sexual and/or gender minority people (LGBTQ+) are at a higher risk for known risk factors for cognitive impairment and dementia, stemming from minority stress experiences. Limited research has explored the distinct obstacles that LGBTQ+ people with cognitive impairment and caregivers encounter, especially within dementia care. The purpose of this study was to deepen our understanding regarding LGBTQ+ people with cognitive impairment and caregivers' experiences with dementia care spaces, and to identify the strategies that they perceive as effective in creating safer and more inclusive spaces. Fourteen LGBTQ+ participants aged 27-78 (M = 58.07), consisting of two individuals with cognitive impairment and 12 caregivers, were interviewed about the care needs of LGBTQ+ people with cognitive impairment and caregivers, and their experiences with dementia care spaces. Using reflexive thematic analysis, we identified three overarching themes from the data, indicating that LGBTQ+ people with cognitive impairment and caregivers feel left "on the margins" of dementia care and express a desire for their identities to be celebrated and recognized. Additionally, they proposed recommendations for policy change to foster safer and more inclusive spaces for dementia care. The findings call attention to the negative experiences of LGBTQ+ people with cognitive impairment and caregivers with dementia care, but also highlight the ways in which care practices can be transformed to effectively address their care needs.

Chemsex Session Typologies and Associated Sociodemographic Factors in Sexual Minority Men: Latent Class Analysis From a Cultural Perspective Using a Cross-Sectional Survey.

Background: Chemsex prevalence is still not well known, and both the lack of homogeneity and cultural component of chemsex practices are usually overlooked. Objective: This study aims to estimate the proportion of sexual minority men (SMM) engaging in chemsex sessions, while understanding the cultural dimension of chemsex, and to analyze distinct session typologies with potential risk differences and the sociodemographic factors associated with engaging in them. Methods: A total of 5711 SMM residing throughout Spain participated in an anonymous web-based survey that assessed chemsex session engagement and characteristics, drug use, and sociodemographic variables. We measured the association of sociodemographic factors with engaging in chemsex sessions by calculating adjusted prevalence ratios, using multivariate Poisson regression analysis. Chemsex typologies were analyzed using latent class analysis, and sociodemographic factors were associated with the different risk classes. Results: Our results determined that 21.1% (1205/5711; 95% CI 20.0%-22.1%) of SMM engaged in chemsex sessions during their lifetime. Participating in sessions was significantly associated with being a migrant, not having a comfortable financial situation, openly living their sexuality, residing in bigger municipalities, older age, using steroids, and living with HIV (adjusted prevalence ratio: range 1.17-2.01; all P values <.05). Three typologies of sessions with different risks were identified with latent class analysis, with 23.2% of SMM engaging in sessions taking part in higher-risk ones, which was associated with younger age, using steroids, living in bigger municipalities, openly living their sexuality, and living with HIV, compared to SMM engaging in lower-risk sessions (odds ratio: range 2.75-4.99). Conclusions: Chemsex is relatively common among SMM in Spain, but it is important to differentiate typologies of sessions with varying risks, and the proportion of SMM engaging in high-risk sessions is low. Chemsex is highly associated with sociodemographic factors. Chemsex should be prioritized in public health programs, which should consider the different forms of sessions with their varying risks and prevalence, while also considering the cultural dimension inherent to chemsex.

'GP services are still heteronormative': Sexual minority cisgender women's experiences of UK menopause healthcare - Health equity implications.

OBJECTIVE: This article reports on UK sexual minority cisgender women's experiences of menopause health and healthcare, based on a data subset from a study exploring lesbian, gay, bisexual, and queer (LGBTQ+) menopause. METHODS: An online survey was conducted with UK LGBTQ + individuals who went through/are going through the menopause. Quantitative data were analysed using simple descriptive statistics. Qualitative data were analysed using thematic analysis. RESULTS: Cisgender respondents comprised 51 lesbian, gay, bisexual, pansexual, queer, and 'other' women, aged between 17 and 89 years. They reported similar types and levels of menopause symptoms as heterosexual cisgender women in other studies, apart from higher levels of anxiety and depression, especially bisexual women. Dissatisfaction regarding menopause healthcare services related to access, information, and heteronormative/heterosexist provision. CONCLUSIONS: Healthcare providers must ensure they provide inclusive menopause services to sexual minority cisgender women.

Syphilis testing, incidence, and reinfection among gay and bisexual men in Australia over a decade spanning HIV PrEP implementation: an analysis of surveillance data from 2012 to 2022.

Background: Gay and bisexual men (GBM) remain overrepresented among syphilis diagnoses in Australia and globally. The extent to which changes in sexual networks associated with HIV pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) may have influenced syphilis transmission among GBM at the population-level is poorly understood. We describe trends in syphilis testing and incidence among GBM in Australia over eleven years spanning widespread uptake of HIV PrEP and TasP. Methods: We analysed linked clinical data from GBM aged 16 years or older across a sentinel surveillance network in Australia from January 1, 2012, to December 31, 2022. Individuals with at least two clinic visits and with at least two syphilis tests during the observations period were included in testing and incidence analyses, respectively. Annual rates of testing and infectious syphilis incidence from 2012 to 2022 were disaggregated by HIV status and PrEP use (record of PrEP prescription; retrospectively categorised as ever or never-PrEP user). Cox regression explored associations between demographics, PrEP use and history of bacterial sexually transmissible infections (STIs) and infectious syphilis diagnosis. Findings: Among 129,278 GBM (mean age, 34.6 years [SD, 12.2]) included in testing rate analyses, 7.4% were living with HIV at entry and 31.1% were prescribed PrEP at least once during the study period. Overall syphilis testing rate was 114.0/100 person-years (py) and highest among GBM with HIV (168.4/100 py). Syphilis testing increased from 72.8/100 py to 151.8/100 py; driven largely by increases among ever-PrEP users. Among 94,710 GBM included in incidence analyses, there were 14,710 syphilis infections diagnosed over 451,560 person-years (incidence rate = 3.3/100 py). Syphilis incidence was highest among GBM with HIV (6.5/100 py), followed by ever-PrEP users (3.5/100 py) and never-PrEP users (1.4/100 py). From 2012 to 2022, syphilis incidence increased among ever-PrEP users from 1.3/100 py to 5.1/100 py, and fluctuated between 5.4/100 py and 6.6/100 py among GBM with HIV. In multivariable Cox regression, previous syphilis diagnosis (adjusted hazard ratio [aHR] = 1.98, 95% CI = 1.83-2.14), living with HIV (aHR = 1.83, 95% CI = 1.12-1.25) and recent (past 12 m) prescription of PrEP (aHR = 1.78, 95% CI = 1.61-1.97) were associated with syphilis diagnosis. Interpretation: Syphilis trends between GBM with HIV and GBM with evidence of PrEP use have converged over the past decade in Australia. Our findings recommend targeting emergent syphilis control strategies (e.g. doxycycline post-exposure prophylaxis) to GBM with prior syphilis diagnoses, using HIV PrEP or who are living with HIV. Funding: Australian Department of Health and Aged Care, National Health and Medical Research Council.

Psychometric Assessment of a Homophobia Management Scale Among Cisgender Sexual Minority Men in Midlife and Older Adulthood.

Interpersonal management of homophobic stigma (e.g., selectively constructing one's social network; confronting stigma) is an understudied area of resilience among sexual minority people. Among a sample of cisgender sexual minority men (SMM; N = 798) in midlife and older adulthood, we assessed the psychometric properties and characterized the sociodemographic differences of our newly developed, theory-informed homophobia management scale. Data come from the Healthy Aging substudy of the Multicenter AIDS Cohort Study, which is a prospective longitudinal study implemented to evaluate the natural trajectories of HIV risk and treatment among sexual minority men. Guided by the proactive coping processes model, the Healthy Aging team proposed eight items to measure homophobia management, which were included at four waves of survey data collection completed at semiannual study visits. Using factor analyses and linear regressions, we assessed our scale's construct validity, convergent validity, and internal consistency, and characterized scores by age, race/ethnicity, sexual orientation, and HIV status. Factor analyses yielded a six-item scale with adequate construct validity and acceptable internal consistency (Cronbach's alpha = .69). Our final scale exhibited convergent validity given its statistically significant inverse association with internalized homophobia and positive association with psychological connections to the gay community. Bivariate differences in homophobia management emerged by age, race/ethnicity, and sexual orientation but were not statistically significant in multivariable analyses. Our study provides a validated, unidimensional scale to assess homophobia management among SMM in midlife and older adulthood. We provide recommendations to improve the implementation of our scale in future surveillance.

Dating Apps and Shifting Sexual Subjectivities of Men Seeking Men Online.

Leading theories of the recent history of sexuality have pointed to trends toward detraditionalization and precarity in intimate relations, but also to democratization and innovation. This study grounded in 79 qualitative interviews with men seeking men online considers their experiences in light of these theories. The rise of dating apps has generated sexual fields that have shaped the sexual subjectivities of the current era in multiple ways. The narratives of study participants show much more than the hook-up culture that dating apps are best known for. They speak to experiences of superficiality, unmet expectations, and sometimes bruising intersections with hierarchies defined by age, race, body type, gender expression, and serostatus. Yet at the same time, they show a strong aspiration to sociability, social network building, and reach for a language of affiliation beyond the kin and friendship terms of the larger society. Generational comparisons indicate the shifting sexual subjectivities that dating apps have shaped by constituting virtual sexual fields.

Sexual minority men's experiences of, and strategies for emotional intimacy in intimate partner relationships.

Emotional intimacy is key to intimate partner relationship quality and satisfaction. For sexual minority men, queer and feminist theorists consistently link emotional intimacy to diverse sexual practices and partnership dynamics formulated within the relationship. This Photovoice study adds to those insights by drawing on individual photovoice interviews with 16 sexual minority men to describe participant's experiences of, and strategies for emotional intimacy in their intimate relationships. Analysis revealed three distinct yet entwined themes: (i) embracing vulnerabilities to drive self-acceptance; (ii) building relationality with partners; and (iii) securing connections with family, friends and community. By embracing vulnerabilities to drive self-acceptance, participants spoke to embodied courage and autonomy as key components for addressing wide-ranging emotional intimacy challenges in their relationships. In theme two, building relationality with partners, participants described how empathy, trust and reciprocity underpinned collaborative work to foster emotional intimacy. Lastly, in securing connections with family, friends and community, acceptance and inclusion were key to participants' sense of belonging and legitimacy which aided their emotional intimacy with partners. The findings provide guidance for tailored programmatic efforts to assist sexual minority men build intimate relationships.

Mediating effect of loneliness on the associations of perceived and internalized sexual stigma with suicide in gay and bisexual men.

BACKGROUND/PURPOSE: Loneliness is prevalent among gay and bisexual men (GBM). This study evaluated the mediating effect of loneliness on the associations of perceived sexual stigma (PSS) and internalized sexual stigma (ISS) with suicide in 400 GBM. METHODS: A moderated mediation model was used to test the mediating effects of loneliness between the associations of PSS from family members and ISS with suicide and the moderating effects of sexual orientation, age, and education level on the mediating effects. RESULTS: The results indicated that both PSS and ISS were positively associated with suicide through the full mediation of loneliness. The association of ISS with loneliness was stronger in older GBM. CONCLUSIONS: Intervention programs promoting changes in attitudes toward GBM are warranted to prevent the development of PSS and ISS, loneliness, and suicide in this population.

Inclusive Mentorship for the Next Generation of Veterinary Professionals.

Veterinary medicine is one of the least diverse professions in terms of race and ethnicity. Inclusive mentorship has the potential to increase representation and retention of BIPOC (black, indigenous, people of color) individuals and individuals with other marginalized identities in the field. Inclusive mentorship benefits not only the mentors and mentees but also the veterinary profession and the communities we serve. It is critical to incorporate inclusion principles throughout the mentoring relationship, starting with creating an inclusive environment and considering inclusion in program design and mentor training. Inclusion is an ongoing process that requires dedication and maintenance.

The impact of COVID-19 restrictions on HIV prevention and treatment services for key populations in South Africa: an interrupted time series analysis.

BACKGROUND: Key populations (KP), including men who have sex with men (MSM), female sex workers (FSW), and transgender women (TGW), experience a disproportionate burden of HIV, even in generalized epidemics like South Africa. Given this disproportionate burden and unique barriers to accessing health services, sustained provision of care is particularly relevant. It is unclear how the COVID-19 pandemic and its associated restrictions may have impacted this delivery. In this study, we aimed to describe patterns of engagement in HIV prevention and treatment services among KP in South Africa and assess the impact of different COVID-19 restriction levels on service delivery. METHODS: We leveraged programmatic data collected by the US President's Emergency Plan for AIDS Relief (PEPFAR)-supported KP partners in South Africa. We divided data into three discrete time periods based on national COVID-19 restriction periods: (i) Pre-restriction period, (ii) High-level restriction period, and (iii) After-high level restriction period. Primary outcomes included monthly total HIV tests, new HIV cases identified, new initiations of pre-exposure prophylaxis (PrEP), and new enrollments in antiretroviral therapy (ART). We conducted interrupted time series segmented regression analyses to estimate the impact of COVID-19 restrictions on HIV prevention and treatment service utilization. RESULTS: Between January 2018 and June 2022, there were a total of 231,086 HIV tests, 27,051 HIV positive cases, 27,656 pre-exposure prophylaxis (PrEP) initiations, and 15,949 antiretroviral therapy initiations among MSM, FSW and TGW in PEPFAR-supported KP programs in South Africa. We recorded 90,457 total HIV tests during the 'pre-restriction' period, with 13,593 confirmed new HIV diagnoses; 26,134 total HIV tests with 2,771 new diagnoses during the 'high-level restriction' period; and 114,495 HIV tests with 10,687 new diagnoses during the after high-level restriction period. Our Poisson regression model estimates indicate an immediate and significant decrease in service engagement at the onset of COVID-19 restrictions, including declines in HIV testing, treatment, and PrEP use, which persisted. As programs adjusted to the new restrictions, there was a gradual rebound in service engagement, particularly among MSM and FSW. Towards the end of the high-level restriction period, with some aspects of daily life returning to normal but others still restricted, there was more variability. Some indicators continued to improve, while others stagnated or decreased. CONCLUSION: Service provision rebounded from the initial shock created by pandemic-related restrictions, and HIV services were largely maintained for KP in South Africa. These results suggest that HIV service delivery among programs designed for KP was able to be flexible and resilient to the evolving restrictions. The results of this study can inform plans for future pandemics and large-scale disruptions to the delivery of HIV services.

Preparing to play: a thematic analysis of bottom training in gay men's fist-play.

Anal fisting amongst gay men has been characterised as a risky form of sexual play, particularly for the bottoming (receptive) playmate. This view may be oversimplistic and fail to recognise how fist-bottoms ready themselves for fist-play through preparatory journeys of bottom training. This study explored how gay men who bottom in fist-play understand bottom training and how this understanding informs their personal sense of pleasure, risk, and safety. Unstructured individual interviews were conducted with 8 gay men who play as fist-bottoms. An inductive thematic analysis was conducted on the data, from which four main themes were developed: (1) training the body to play; (2) training for headspace; (3) training to understand pleasure; and (4) training by rules. Taken together, the findings highlight how fist-bottoms understand their bottom training as both a formative and transformative process that shapes their corporeal, psychological, erotic, and subcultural knowledge and skills to navigate play. Through bottom training, fist-bottoms explore and attune their understanding of what is safe and pleasurable, as well as riskier play.

Self-Reported PrEP Use and Risk of Bacterial STIs Among Ontarian Men Who Are Gay or Bisexual or Have Sex With Men.

PURPOSE: HIV pre-exposure prophylaxis (PrEP) may increase rates of bacterial sexually transmitted infections (STIs) among gay, bisexual, and other men who have sex with men (GBM) through risk compensation (eg, an increase in condomless sex or number of partners); however, longitudinal studies exploring the time-dependent nature of PrEP uptake and bacterial STIs are limited. We used marginal structural models to estimate the effect of PrEP uptake on STI incidence. METHODS: We analyzed data from the iCruise study, an online longitudinal study of 535 Ontarian GBM from July 2017 to April 2018, to estimate the effects of PrEP uptake on incidence of self-reported bacterial STIs (chlamydia, gonorrhea, and syphilis) collected with 12 weekly diaries. The incidence rate was calculated as the number of infections per 100 person-months, with evaluation of the STIs overall and individually. We used marginal structural models to account for time-varying confounding and quantitative bias analysis to evaluate the sensitivity of estimates to nondifferential outcome misclassification. RESULTS: Participating GBM were followed up for a total of 1,623.5 person-months. Overall, 70 participants (13.1%) took PrEP during the study period. Relative to no uptake, PrEP uptake was associated with an increased incidence rate of gonorrhea (incidence rate ratio = 4.00; 95% CI, 1.67-9.58), but not of chlamydia or syphilis, and not of any bacterial STI overall. Accounting for misclassification, the median incidence rate ratio for gonorrhea was 2.36 (95% simulation interval, 1.08-5.06). CONCLUSIONS: We observed an increased incidence rate of gonorrhea associated with PrEP uptake among Ontarian GBM that was robust to misclassification. Although our findings support current guidelines for integrating gonorrhea screening with PrEP services, additional research should consider the long-term impact of PrEP among this population.Annals Early Access article.

Gay and Bisexual Men's Perceptions about a Potential HIV Vaccine within a Post-COVID-19 Era: A Qualitative Study.

To end the HIV epidemic, there is need for targeted strategies to reduce HIV incidence for those most vulnerable, including an HIV vaccine. This study seeks to understand the perceptions that non-PrEP using gay and bisexual men and other men who have sex with men (GBMSM) have about a potential HIV vaccine, while contextualizing their perspectives within the context of heightened vaccine hesitancy that has emerged since the COVID-19 pandemic. Between March and May of 2022, GBMSM (N = 20) participated in in-depth interviews, which assessed their perceptions about an HIV vaccine. Interviews were analysed using a codebook approach to thematic analysis. We oversampled for those unvaccinated against COVID-19 as a proxy for vaccine hesitation. Participants expressed a range of enthusiastic support, cautious optimism and skepticism when presented with the possibility of an HIV vaccine. Factors that drove willingness to receive an HIV vaccine included community-oriented altruism, individualized risk-benefit assessment, and/or the perception that a vaccine could provide a beneficial shift in sexual experiences. Participants also expressed hesitations about receiving an HIV vaccine, including concerns about potential side-effects and efficacy, as well as mistrust in the vaccine development process. Notably, participants often evaluated the vaccine in comparison to PrEP and condoms. Participants offered specific insights into information they would like to receive about an HIV and where/how they would like to receive it. Our findings can help inform future HIV vaccine implementation efforts by offering insights into the factors that motivate and deter GBMSM to receive an HIV vaccine.

Using Low-cost Videoscopes to Obtain Accurate Video "Oral Selfies" as Screening for HPV-associated Oropharyngeal Cancer: A New Screening Technology?

Human papillomavirus (HPV)-related oropharyngeal cancers associated with sexual contact are increasing, with high rates in men who have sex with men. HPV-related cancers have the advantage of being frequently detectable through oropharyngeal visual examination and having much higher survival rates than classic oropharyngeal cancers. It has been demonstrated that gay and bisexual men can take smartphone oropharyngeal "selfies" of sufficient quality for screening. However, there is an issue with the inability to move the tongue to allow a clear view of the palatine tonsils, where a majority of oropharyngeal cancer cases occur. We attempted to investigate the feasibility of using commercially available videoscopes to visualize the oropharynx. Fourteen healthy volunteers used a provided low-cost commercial endoscope to video their oropharynx. Participants used the videoscope connected to a laptop and could visualize the oropharynx on the screen. Attempts were observed, and the process was noted. A focus group of participants was carried out immediately afterwards to ascertain barriers and facilitators to using the videoscopes. All participants were able to use the videoscope and obtain videos of sufficient clarity to note major oropharyngeal landmarks. The palatine tonsils were initially difficult to visualize because the tongue could not be sufficiently controlled. Participants were given time to practice using visual cues to control the position of the tongue, which helped in obtaining good videos. Videoscopes can be used effectively with minimal instruction and provide a better view than still images, as they illuminate and magnify the site. Low-cost commercially available videoscopes may be an improvement over smartphone "selfies".

Depression and Anxiety Among Sexual Minorities in the United States: A Cross-Sectional Analysis of the National Health Interview Survey.

Background and objective Sexual minorities experience large-scale mental health disparities, yet recent national data on them remains scarce. This study aimed to examine the prevalence of depressive and anxiety symptoms by sexual orientation in a nationally representative sample of adults in the United States (US). Methods This cross-sectional analysis utilized data from 26,311 adults in the 2022 National Health Interview Survey. Sexual orientation was classified as sexual minority (gay/lesbian, bisexual, or other non-heterosexual identity) or heterosexual. Self-reported depression was assessed using the eight-item Patient Health Questionnaire (PHQ-8), and anxiety was evaluated using the seven-item Generalized Anxiety Disorder Scale (GAD-7). Logistic regression models were employed to compare mental health outcomes between sexual minority and heterosexual respondents. Results Sexual minorities comprised 6.6% of the weighted sample. Compared to heterosexuals, sexual minorities were younger, more often female, unmarried, and had higher poverty despite greater employment (all p<0.001). Approximately half of sexual minorities screened positive for depression (49.0%) and anxiety (44.3%), compared to 19.5% and 16.4% of heterosexuals, respectively. After covariate adjustment, sexual minorities had over three-fold higher odds of depression [odds ratio (OR): 3.27; 95% confidence interval (CI): 2.86-3.73] and anxiety (OR: 2.97; 95% CI: 2.57-3.42). The prevalence was highest among sexual minority youth, with depression in 54.9-61.1% and anxiety in 49.0-59.2%, depending on income levels. Conclusions In this nationally representative study, sexual minorities demonstrated a high burden of depression and anxiety symptoms compared to heterosexuals. Sexual orientation independently predicted mental health disparities beyond other sociodemographic characteristics. Targeted interventions are recommended to address psychiatric disease disparities that disproportionately impact vulnerable sexual minority subgroups.

Midlife Satisfaction Disparities by Sexual Orientation: Findings from the Health and Retirement Study.

Midlife is a pivotal stage shaping healthy aging, and sexual minorities may face more challenges in midlife than heterosexual individuals, due to cumulative social, economic, and health disadvantages. Yet, few studies have examined how life satisfaction in midlife varies by sexual identity. Using data from the 2016 Health and Retirement Study (N=3,630), we conducted logit regressions and Karlson-Holm-Breen (KHB) decomposition analysis to examine how health-related, socioeconomic, and sociopsychological factors contribute to disparities in life satisfaction across sexual orientation groups in middle adulthood. The results show that bisexual individuals, but not gay or lesbian individuals, reported significantly lower life satisfaction than their heterosexual peers because of their poorer health status and behaviors, fewer social resources, and lower socioeconomic status. Our findings suggest that public policies should target continuing the reduction in sexuality-based stigma, particularly biphobia, to mitigate the health, social, and economic disparities linked to diminished well-being among middle-aged bisexual individuals.

Prevalence, severity and risk factors for mental disorders among sexual and gender minority young people: a systematic review of systematic reviews and meta-analyses.

Evidence suggests heightened prevalence and severity of mental disorders among sexual minority (SM) and gender minority (GM) young people. Several risk factors have been associated with these disparities. A systematic review of systematic reviews and meta-analysis was conducted to provide a comprehensive overview of the literature and to determine the field's current position. MEDLINE, PsycInfo, Scopus and Web of Science were searched in March 2022 and updated January 2024. Eligibility criteria were systematic reviews or meta-analyses assessing contemporaneous prevalence, severity and/or risk factors of mental disorders among SM or GM young people aged 25 and under. 42 reviews were included, all of which were low quality. The prevalence of depression among SM was 26% (95% CI 21-32%), and among GM was 46% (95% CI 36-56%). Greater depression severity was found among SM compared to heterosexual young people, with a significant albeit small effect size (Hedges' g = 0.38, 95% CI = 0.25 to 0.50); effect sizes were similar when separating by gender. GM also reported greater symptom severity compared to cisgender young people. Other mental disorders were more prevalent compared to those reported in the general population, and of greater severity compared to heterosexual/cisgender young people. Several proximal and distal risk factors were focused upon within the systematic reviews identified. Past systematic reviews consistently indicate a heightened risk of mental disorders among SM and GM young people. Services need to be aware of these disparities and adapt their care accordingly.

Factors associated with human papillomavirus, hepatitis A, hepatitis B and mpox vaccination uptake among gay, bisexual and other men who have sex with men in the UK- findings from the large community-based RiiSH-Mpox survey.

BACKGROUND: Gay, bisexual, and other men who have sex with men (GBMSM) face a disproportionate burden of sexually transmitted infections and are eligible for targeted vaccinations for hepatitis A (HAV), hepatitis B (HBV), human papilloma virus (HPV) and mpox. This study examines the sociodemographic characteristics, sexual behaviours, and sexual healthcare service (SHS) use associated with vaccination uptake. METHODS: We undertook analyses of RiiSH-Mpox - an online, community-based survey with GBMSM recruited via social media and dating apps. We calculated vaccination uptake (≥1 dose) among eligible GBMSM. Bivariate and multivariable logistic regression was performed to identify factors independently associated with vaccination uptake among eligible participants. RESULTS: Reported uptake in eligible GBMSM was around two-thirds for each of the vaccinations considered: mpox 69% (95% confidence interval (CI): 66%-72%), HAV 68% (CI:65%-70%), HBV 72% (CI:69%-74%) and HPV 65% (CI:61%-68%). Vaccination course completion (receiving all recommended doses) ranged from 75% (HBV) to 89% (HAV) among eligible GBMSM. Individuals who represented missed opportunities for vaccination ranged from 22 to 30% of eligible SHS attendees. Younger participants, individuals identifying as bisexual, reporting lower educational qualifications, or being unemployed reported lower uptake across multiple GBMSM-selective vaccinations. Individuals who reported greater levels of sexual behaviour and recent SHS use were more likely to report vaccinations. CONCLUSION: Eligible participants reported high uptake of vaccinations; however, uptake was lower amongst young GBMSM and self-identifying bisexual men. Awareness of groups with lower vaccination uptake will help inform practice, delivery strategies and health promotion, to improve the reach and impact of vaccinations amongst GBMSM.

Self-Perceived Reasons for Suicide Attempts in Sexual and Gender Minorities in Canada.

The aim of this study was to examine the self-perceived reasons of suicide attempts among sexual and gender minorities (SGM). We surveyed SGM living in Canada (n = 2778) and respondents who had attempted suicide answered open-ended questions about their perceived reason(s) of their first/only attempt (FOA) and last attempt (LA) (for those who attempted multiple times). Responses were double-coded and categorized as discrete findings. A quarter (25%, n = 695) of the total sample reported a history of suicide attempt, of whom 72% reported multiple attempts. Respondents described a wide variety of reasons for their suicide attempts, with an important number of individuals reporting multiple reasons (corresponding to 47.5% of FOA and 43% of LA). Emotional issues (FOA:42.1%, LA:44.0%) were the most prevalent category of reasons for suicide attempts followed by experience of mental illness (FOA:30.1%, LA:36.1%). Other common reasons included violence (FOA:23.2%, LA:10.2%), interpersonal conflict (FOA:13.4%, LA:6.0%), stress related to life circumstances (FOA:9.5%, LA:16.7%), relationship issues (FOA:7.9%, LA:13.3%), and minority stress related to sexuality (FOA:11.1%, LA:6.2%) and gender identity (FOA:5.0%, LA:6.8%). SGM assessments of the reasons underlying their suicide attempts yielded a variety of factors, many of which were absent from the literature on SGM suicide but amenable to tailored interventions.