Transgender and gender diverse adults' reflections on alcohol counseling and recommendations for providers.

Transgender and gender diverse (TGD) populations experience health disparities due to societal stigma that increases TGD individuals' sources of stress and decreases access to health protective resources. Research has linked experiences of stigma to risky alcohol use, yet there remains a dearth of culturally sensitive alcohol use interventions that meet the needs of TGD people. The present study was conducted to inform modifications to the content and delivery of an existing brief, telehealth, motivational intervention to decrease at-risk alcohol use among TGD adults. Individual semi-structured in-depth qualitative interviews were conducted with TGD adults who reported recent alcohol use (n = 18) to explore factors that facilitate positive interactions with health care providers and identify relevant information for alcohol use disorder treatment. Participants were recruited from an LGBTQ +-focused health center in Los Angeles, California. Two major themes and recommendations emerged: (a) A multicultural orientation of humility is important to develop productive therapeutic relationships with TGD clients when delivering motivational interviewing; (b) Due to insufficient appropriate data on alcohol use and health in TGD populations, feedback used in motivational alcohol counseling needs to be modified to better serve TGD clients. These findings show that counselors' philosophy and behavior, as well as session content, need to be considered when working with TGD populations within the context of alcohol counseling. These findings also have implications for intervention development, clinical treatment, and future research. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

"I'm Gay With an Asterisk": How Intersecting Identities Influence LGBT Strengths.

Research attributes health disparities between sexual minority (those whose sexual orientation and/or practices differ from society, [SM]) and heterosexual populations to social marginalization. LGBT strengths (e.g., resiliency derived from LGBT identity) may reduce the impact of social marginalization. However, it is unclear how LGBT strengths are impacted by SMs' other identities (e.g., racial/ethnic and/or gender). To address this knowledge gap, the present study examined data from the LGBT Stress/Strength project, a qualitative research study investigating minority stress and LGBT strengths in relation to drinking. Participants (N = 22) were self-identified SMs in the northeastern U.S. Transcripts from in-depth interviews were coded using thematic analysis. Participants reported social support from other SMs and empathy toward others were forms of LGBT strength. Sampled SMs assigned female at birth had more intergenerational friendships and relied more on social support than those assigned male at birth. In addition, Black, indigenous, and people of color (BIPOC) participants described social marginalization from within the LGBT community, which reduced their reliance on social support. Our results suggest that LGBT strengths are influenced by LGBT community members intersecting identities. More research can expand upon these results by investigating how the confluence of SMs identities and LGBT strengths impact health disparities.

Association between experience of racial discrimination and hazardous alcohol use among Maori in Aotearoa New Zealand.

AIMS: To test whether there is a positive association between experience of racial discrimination and hazardous alcohol use among New Zealand Maori and whether racial discrimination mediates hazardous alcohol use in this group. DESIGN: A cross-sectional mediation analysis using a stratified and nationally representative cross-sectional health survey collected from 2016 to 2017 in New Zealand. SETTING: New Zealand. PARTICIPANTS: We used data from 9884 participants who identified as New Zealand European (7341; 56.9% female) or Maori (2543; 60.5% female) in the 2016-17 New Zealand Health Survey. MEASUREMENTS: We included reports from demographic items (sex, age, ethnicity), the Alcohol Use Disorder Identification Test (AUDIT) and experiences of past year discrimination. We conducted mediation analysis with Maori identification as the predictor, hazardous drinking as the binary outcome (0 = AUDIT score less than 8, 1 = 8+) and discrimination as the binary mediator (0 = no discrimination, 1 = experienced racial discrimination). Age, sex and deprivation index were included as covariates. FINDINGS: Maori were more likely to experience discrimination than New Zealand Europeans, and both Maori identification and experiencing discrimination were associated with elevated levels of hazardous alcohol use, P < 0.05. The association between Maori ethnicity on hazardous drinking was partially mediated by discrimination (34.7%, 95% confidence interval 9.70%, 59.60%). CONCLUSION: The association between Maori ethnicity and hazardous drinking in New Zealand may be partially mediated by experience of discrimination.

From efficacy to effectiveness: facilitators and barriers to PrEP acceptability and motivations for adherence among MSM and transgender women in New York City.

This study examined potential facilitators and barriers to pre-exposure prophylaxis (PrEP) use and their association with PrEP acceptability and motivations for adherence among 184 MSM and transgender women living in New York City. Participants were presented with educational information about PrEP and completed a computerized survey. Overall, 55.4% of participants reported willingness to take PrEP. The most highly endorsed barriers to PrEP use were health concerns, including both long-term impacts and short-term side effects, questions about PrEP's impact on future drug resistance, and concerns that PrEP does not provide complete protection against HIV. The most highly endorsed facilitator was free access to PrEP, followed by access to support services such as regular HIV testing, sexual health care/monitoring, and access to one-on-one counseling. Participants of color rated both barriers and facilitators as more important than their White counterparts. In multivariate models, barrier and facilitator scores significantly predicted not only PrEP acceptability, but also motivation for PrEP adherence among those who were likely to use PrEP. PrEP implementation programs should consider addressing these barriers and facilitators in protocol and policy development. Findings underscore the importance of support services, such as sexual health counseling, to the success of PrEP as a prevention strategy.