Incarceration as a Health Determinant for Sexual Orientation and Gender Minority Persons.

Incarceration is considerably more prevalent among sexual and gender minority persons (SGM) than among the general population. Once behind bars, they are at the greatest risk for health-related harms. Although a growing number of studies have assessed health disparities produced by mass incarceration, scholars are yet to systematically assess the health consequences of incarceration on the basis of sexual orientation and gender identity. We invite public health scholars to study the effects of incarceration on health in the SGM population and provide a roadmap to aid these research efforts. First, we document the disproportionate presence of SGM persons in jails and prisons. Second, we note health-related risks that are the most salient for this population. Third, we recommend examining heterogeneity in the effects of incarceration by teasing out distinct risks for groups defined by sexual orientation, gender identity, and race/ethnicity. Fourth, we note methodological challenges with respect to measurement and assessing causality. Finally, we discuss the importance of health care access and quality and the need to study health during incarceration and afterward.

Possible impacts of sea level rise on disease transmission and potential adaptation strategies, a review.

Sea levels are projected to rise in response to climate change, causing the intrusion of sea water into land. In flat coastal regions, this would generate an increase in shallow water covered areas with limited circulation. This scenario raises a concern about the consequences it could have on human health, specifically the possible impacts on disease transmission. In this review paper we identified three categories of diseases which are associated with water and whose transmission can be affected by sea level rise. These categories include: mosquitoborne diseases, naturalized organisms (Vibrio spp. and toxic algae), and fecal-oral diseases. For each disease category, we propose comprehensive adaptation strategies that would help minimize possible health risks. Finally, the City of Key West, Florida is analyzed as a case study, due to its inherent vulnerability to sea level rise. Current and projected adaptation techniques are discussed as well as the integration of additional recommendations, focused on disease transmission control. Given that sea level rise will likely continue into the future, the promotion and implementation of positive adaptation strategies is necessary to ensure community resilience.

"You just can't trust everybody": the impact of sexual risk, partner type and perceived partner trustworthiness on HIV-status disclosure decisions among HIV-positive black gay and bisexual men.

HIV remains an intractable public health concern in the USA, with infection rates notably concentrated among Black gay and bisexual men. Status disclosure by HIV-positive individuals can be an important aspect of risk reduction but doing so poses dilemmas concerning privacy, stigma and self-protection, especially among populations subjected to multiple types of stigmatisation. Understanding the factors related to the disclosure process can help to inform prevention efforts. Using exploratory in-depth interviews, this qualitative study examines the disclosure process among a sample of twenty HIV-positive Black gay and bisexual men (mean age = 40) recruited through a non-profit health centre in a mid-western city in the USA. Data were analysed using a thematic analysis approach with HIV-disclosure as an a priori sensitising concept. Fears of stigma and secondary disclosure within social networks were critical barriers to talking about HIV with sexual partners and disclosure decisions involved a complex process centred on three primary themes: degree of sexual risk, partner type and perceived partner trustworthiness. The unique combinations of these contextual factors resulted in increased or decreased likelihood of disclosure. A conceptual model explicating a potential process by which these contextual factors influence disclosure decisions is presented.

"You're an open target to be abused": a qualitative study of stigma and HIV self-disclosure among Black men who have sex with men.

The HIV/AIDS epidemic is a health crisis among Black men who have sex with men (MSM). HIV-related stigma presents a primary barrier to sexual communication and effective HIV prevention. Using in-depth, qualitative interviews conducted with 20 HIV-positive Black MSM between 2007 and 2008 in Chicago, Illinois, we explored the themes related to HIV-related stigma and the underlying messages HIV-positive Black MSM receive regarding their status. Stigmatizing messages stem from family, churches, and the gay community and from negative, internalized, beliefs HIV-positive Black MSM held about infected individuals before their own infection. HIV stigma influences sexual silence around HIV disclosure, especially to sexual partners.

"It's crazy being a Black, gay youth." Getting information about HIV prevention: a pilot study.

BACKGROUND: Access and adoption of HIV prevention information are important criteria for reducing HIV infection rates among men who have sex with men. METHODS: Using focus group data, researchers sought to identify sources of HIV prevention information and barriers to adopting protective behaviors among young African American men who have sex with men. Adolescents ages 18-24 were recruited for this study. Focus group data were analyzed to identify themes related to sources of HIV prevention information and barriers to adopting protective behaviors. RESULTS: Researchers documented that family and friends, formal education, television, and the LGBT community were major sources for HIV prevention information. However, motivation for adopting such information was hampered by apathy, homophobia, and racism. CONCLUSION: Feelings of powerlessness need to be addressed when targeting Black MSM with HIV prevention information.

Ethnic differences in HIV-disclosure and sexual risk.

Little is known about ethnic differences in HIV-disclosure to sexual partners or the relationship between HIV-disclosure and sexual risk. Differences in HIV-disclosure rates between African-American and White men who have sex with men (MSM) were analyzed using data from the Treatment Advocacy Program. In general, the findings suggest that African-Americans are less likely than Whites to disclose their HIV status to sexual partners. The findings also suggest that the African-American participants who disclosed to HIV-negative partners were significantly less likely to engage in unprotected anal sex with HIV-negative partners and partners whose HIV status was unknown than those participants who did not disclosure to HIV-negative partners. Although HIV-disclosure appears to be an important factor to consider in HIV-prevention efforts, there are unique factors that influence HIV-disclosure decisions for African-American MSM. Interventions should consider these unique challenges before focusing on HIV-disclosure as a primary tool for reducing the transmission of HIV.

Moral Panic and Social Justice: A Guide for Analyzing Social Problems.

Professional social work has long been concerned with social justice, social policy, and the relationship between social treatment and social control. However, at times, potential threats to social cohesion become exaggerated in the service of supporting suppressive policies. British sociologist Stanley Cohen referred to such periods as moral panics, which assign unwarranted blame and stigma to sociopolitically weaker, unpopular groups. By constructing those associated with a given social problem as deviant and downplaying underlying structural causes, moral panics foster the enactment of social policies that entrench social disparity and injustice. Understanding how moral panics influence perceptions of social problems and resultant policies will enable social workers to identify whether particular societal groups are unjustly targeted. By synthesizing theoretical and empirical literature on moral panics in U.S. policy arenas relevant to social workers (such as illicit drugs, sexuality, and immigration), this article offers guidance for practitioners, policy advocates, and researchers on assessing their presence.

"Knowing Your Status and Knowing Your Partner's Status Is Really Where It Starts": A Qualitative Exploration of the Process by Which a Sexual Partner's HIV Status Can Influence Sexual Decision Making.

Gay and bisexual men are at disproportionate risk for human immunodeficiency virus (HIV) infection. While prevention efforts often emphasize consistent condom use, there is growing evidence that men are using seroadaptive safer-sex strategies, such as serosorting and seropositioning. This qualitative analysis of 204 HIV-negative and HIV-positive gay and bisexual men explored the ways that a sexual partner's HIV status can influence safer-sex strategies and sexual decisions. The majority of the respondents reported that they were influenced by their partners' HIV status. Those respondents who reported no influence discussed adhering to safer-sex rules that were not dependent on partner status and a lack of concern about HIV. Conversely, respondents who reported influence identified three primary areas of influence: psychological impacts, partner preference and selection, and specific behavioral intentions and strategies. A conceptual model explicating a potential process by which respondents use partner serostatus information in shaping sexual decisions is presented.

"I Had to Go to the Streets to Get Love": Pathways From Parental Rejection to HIV Risk Among Young Gay and Bisexual Men.

Young, gay, and bisexual men (YGBM) are at increased risk of family rejection, which is related to HIV infection. What remains unknown is how family rejection leads to HIV risk. In this exploratory study, qualitative interviews were conducted with 21 HIV-positive YGBM aged 18 to 24. Most participants reported family rejection, which decreased instrumental and emotional support and resulted in participants using riskier ways to support themselves, such as engaging in survival sex. Conceptualizing the findings using a family systems framework, we present a tentative conceptual model to describe the potential relationships between family rejection and HIV risk for YGBM.

Subjective well-being in school environments: promoting positive youth development through evidence-based assessment and intervention.

Research on subjective well-being indicates that it is associated with academic success and positive school functioning. Despite a wealth of empirical research demonstrating the benefits of interventions aimed at increasing middle and high school students' well-being, few educational institutions have adopted evidence-based curricula that address this construct as a means of promoting future academic and social achievement. In addition, numerous studies have begun to identify several factors that contribute to well-being and thus have helped children and adolescents to be successful in both academic and social domains. These critical factors include personal goal setting, structured mentoring or life coaching, increasing gratitude, problem solving, and interpersonal skills. The present article provides a broad discussion of relevant research findings on these factors and advocates for the adoption of curricula that incorporate these components in order to ensure that best practices are utilized in the school environment and for positive youth development. Lastly, a theoretical proposal for empirically based assessment and interventions that encompass key components associated with increased child and adolescent well-being is provided.

The impact of role models on health outcomes for lesbian, gay, bisexual, and transgender youth.

PURPOSE: There is little research on the impact of role models on health outcomes for lesbian, gay, bisexual, and transgender (LGBT) youth. This exploratory study describes the presence and availability of LGBT-affirming role models, and examines the relationship between the accessibility of role models and health outcomes among a community-based sample of LGBT youth. METHODS: A convenience sample of 496 ethnically diverse, 16-24-year-old LGBT youth was recruited to complete a computer-assisted interview, using standardized instruments validated with adolescents. The prevalence and characteristics of role models were described. Differences in subgroup distribution were assessed using Pearson χ(2) test (p < .05). Differences in health outcomes for those with and without role models and the nature of those role models were determined using analysis of covariance models, with post hoc Bonferroni tests to probe significant global findings. RESULTS: Sixty percent of the participants reported having a role model, with younger participants significantly more likely to report having a role model. A majority of the participants reported having inaccessible role models, especially among younger participants. The presence and accessibility of a role model did not have a significant relationship to binge drinking, drug use, or sexually transmitted infection diagnoses; however, participants with inaccessible role models showed increased psychological distress versus those with accessible or no role models. CONCLUSIONS: Inaccessible role models may not be sufficient for protecting youth from negative outcomes, and formal mechanisms for connecting LGBT youth with caring adults who can serve as role models, such as mentoring programs, are critical.

A conceptual model of HIV disclosure in casual sexual encounters among men who have sex with men.

HIV/AIDS continues to disproportionately impact men who have sex with men (MSM). Advances in highly active antiretroviral therapies (HAART) have successfully helped HIV-infected individuals lead longer, healthier, and presumably more sexually active lives. Consequently, secondary prevention approaches aimed at reducing the rate of HIV transmission have raised important questions about the role of sexual communication, namely HIV disclosure, as a primary target for intervention. This paper proposes a conceptual model of HIV disclosure in casual sexual encounters among MSM informed by Goffman's work on stigma and based on existing empirical research. The article concludes with an agenda for research based in this integrative model.

African American adolescents living and coping with community violence on Chicago's southside.

This study explores community violence exposures among African American adolescents and whether coping strategies were gendered. In-depth interviews are conducted with a sample of 32 African American high school students. Data are analyzed using a thematic analysis. The primary forms of violence exposures are physical attacks, fighting, and incidents involving police, gun violence, and murders. Boys report more exposure to violence as victims and witnesses, whereas girls are more likely to hear about violent acts. Coping styles range from "getting through," which included both an acceptance of community conditions; "getting along," which included self-defense techniques; "getting away," which included avoidance coping strategies; and "getting back," which consisted of confrontational coping strategies. Boys report more confrontational coping styles than are girls, who utilized more avoidance approaches. Widespread school-based interventions are warranted, given the high prevalence of community violence exposure among these youth and may provide important supports for coping against such trauma.

What African American male adolescents are telling us about HIV infection among their peers: cultural approaches for HIV prevention.

This study explored the beliefs of African American male adolescents concerning the high rates of HIV infection among their peers and their reasons for those beliefs. In-depth interviews were conducted with a sample of 16 male African Americans, and a thematic analysis of the data was conducted. Half of the participants believed that peers were not becoming infected at higher rates than white youths and reported high rates of sexual risk taking. Conspiracy beliefs and high rates of sexual adventurism for all teenagers were among the reasons offered to support this belief. Participants who believed the uneven incidence rates reported low levels of sexual risk taking. These participants identified early and unsafe sexual activity -- in conjunction with social factors such as negative peer and media influences, poor parental supervision, and dangerous neighborhood environments -- as contributing reasons for these disparate rates. Sexual behaviors were markedly different among both groups. The implications of these findings are discussed in the context of culturally relevant approaches to prevention of HIV infection among this group.