Exploring Health Care Access Among Lesbian, Gay, Bisexual, and Transgender Populations in Orange County, California: A Pilot Cross-sectional Study.

There are approximately 90 000 lesbian, gay, bisexual, and transgender (LGBT) individuals in Orange County, California. LGBT individuals have significant health disparities, particularly if they are from racial or ethnic minority groups and/or have a disability. There are structural and access barriers in the health care system that increase these health disparities. These individuals experience discriminatory situations when accessing health care and mental health services, which may affect their health-seeking behaviors. The purpose of this pilot quantitative cross-sectional study was to gather information about the current health care experiences and needs of this LGBT population including priority health issues, physical and mental health care utilization, and perceived adequacy of LGBT-friendly physical and mental health care providers. These findings will inform organizational strategies for nursing administrators and other health care leaders when tailoring, planning, and redesigning structures that meaningfully address the service needs of this at-risk group. Seventy-five participants were recruited from 2 organizations serving the LGBT community to complete an online survey. Findings include trouble finding an LGBT competent provider, delays or being unable to access care, and worried about losing insurance. Most participants needed to visit multiple different locations to receive care and preferred a 1-stop shop.

Substance use experiences of HIV-positive and HIV-negative black, non-hispanic men who have sex with men (msm) ages 18-34 in the Bay Area: A qualitative narrative perspective.

OBJECTIVE: Young Black men who have sex with men (MSM) represent the majority of individuals with new HIV infections in the U.S. Substance use is related to risk and acquisition t of HIV. The purpose of this study was to explore the perceptions and experiences about the role substance use plays in the lives HIV-positive and HIV-negative young Black MSM between the ages of 18-34. METHODS: Using a qualitative, narrative perspective, we recruited and then interviewed participants in partnership with AIDS Service Organizations. Narrative and thematic analysis was used to analyze these Black men's personal stories with harm reduction used as the conceptual approach. RESULTS: Nine HIV-positive and 3 HIV-negative participants(n = 12) shared stories about their own personal experiences with family relationships and substance use. Themes related to family included early exposure and initiation of substance use, substance use as a response to stigma around sexual orientation, kicked out of house, asked to leave or left home so they could be themselves and perceived benefits and advantages of methamphetamine. CONCLUSIONS: The participants are subjected to adverse and stressful childhood experiences. These are important stories to understand if we expect to mount an adequate response, utilizing harm reduction, to the growing number of young Black MSM at-risk for HIV.

Exploring substance use and mental health for minority transgender youth: Implications for advanced practice nurses.

BACKGROUND: Transgender youth, particularly if they are transgender female and of a minority racial or ethnic group (i.e., minority transgender youth [MTY]), are known to have higher incidence of new HIV infections, substance abuse, and suicidality when compared with cisgender youth. Mental health disparities and substance use among MTY, between the ages of 13-24 years, have been underexplored in the United States, although they have serious public health concerns contributing to morbidity and mortality. OBJECTIVES: To examine the US literature to discover what is known about the intersection of substance use, mental health disorders, and associated health risks for MTY. DATA SOURCES: An integrative review exploring experimental and nonexperimental research was conducted from 2010 to 2018 using Cumulative Index for Nursing and Allied Health (CINAHL), PsycINFO, and PubMed. Articles were selected if the research identified MTY, mental health and/or substance use risks, data-driven outcomes, or considerations that could potentially influence MTY outcomes. Ten articles were included in the final selection. CONCLUSIONS: All studies addressed mental health, substance use, and/or health risks, although many of the articles explored all transgender youth outcomes without a particular focus on MTY. Identified factors linked to poor health outcomes included socioeconomic vulnerability, substance use, mood disorders, self-harm, and risky sexual behaviors. IMPLICATIONS FOR PRACTICE: The authors have provided recommendations regarding culturally appropriate, compassionate, evidence-informed practices for engaging MTY and their families to promote greater well-being for all youth, regardless of gender identity.

Experiences and Perceptions of Black Men Who Have Sex with Men About Acquiring HIV: A Qualitative Narrative Perspective.

In the United States, Black men who have sex with men (MSM), between the ages of 18 and 34 years, have the highest rates of new HIV infections. The prevalence of HIV in this population is three to four times higher than their White MSM counterparts. Twelve Black MSM from the Bay Area, nine with HIV and three without HIV, were interviewed regarding their experiences and perceived risks of acquiring HIV. Narrative analysis revealed these themes: (a) tested regularly for HIV, (b) HIV knowledge varied before arriving in San Francisco, (c) condom use typically nonexistent when under the influence of alcohol and other drugs, (d) inability to negotiate sex and condom usage, and (e) sense of anticipation, resignation, and acceptance about acquiring HIV. Implications of this study highlight the need for Black MSM to have earlier HIV prevention education, including condom negotiation skills, particularly when under the influence of drugs and/or alcohol.

Pilot trial of an expressive writing intervention with HIV-positive methamphetamine-using men who have sex with men.

Among men who have sex with men (MSM), the co-occurrence of trauma and stimulant use has negative implications for HIV/AIDS prevention. HIV-positive, methamphetamine-using MSM were recruited to pilot test a 7-session, multicomponent resilient affective processing (RAP) intervention that included expressive writing exercises targeting HIV-related traumatic stress. An open-phase pilot with 10 participants provided support for feasibility of intervention delivery such that 99% of the RAP sessions were completed in a 1-month period. Subsequently, 23 additional participants were enrolled in a pilot randomized controlled trial of the RAP intervention (n = 12) versus an attention-control condition that included writing exercises about neutral topics (n = 11). Acceptability was evidenced by participants randomized to RAP expressing significantly more negative emotions in their writing and reporting greater likelihood of recommending expressive writing exercises to a friend living with HIV. Over the 3-month follow-up period, attention-control participants reported significant decreases in HIV-related traumatic stress while RAP intervention participants reported no significant changes. Compared to attention-control participants, those in the RAP intervention reported significant reductions in the frequency of methamphetamine use immediately following the 1-month RAP intervention period. Thematic analyses of RAP expressive writing exercises revealed that multiple negative life events characterized by social stigma or loss contribute to the complex nature of HIV-related traumatic stress. Findings support the feasibility and acceptability of an exposure-based intervention targeting HIV-related traumatic stress. However, more intensive intervention approaches that simultaneously target trauma and stimulant use will likely be needed to optimize HIV/AIDS prevention efforts with this population. (PsycINFO Database Record