Reproduction in cisgender same-sex couples: a scoping review. / Reprodução em casais homoafetivos cisgêneros: uma revisão de escopo.

The aim of this article is to present the state of the art, in the field of public health, on cis homoparental reproduction, from 28 studies addressing barriers to reproduction by homoparental couples for legal, ethical, technical or economic reasons, in addition to prejudice and discrimination. Six studies addressed facilitators, such as receptiveness in services, availability of conception and contraceptive methods and training of health professionals. The results show that the discussion has focused more on the barriers than on the facilitating factors. This may indicate a continuing need to problematise the hegemonic model of a heterosexual, nuclear family.

O objetivo deste artigo é apresentar o estado da arte sobre a reprodução homoparental cis no campo da saúde coletiva. Vinte e oito estudos abordam barreiras para a reprodução de casais homoparentais relacionadas a questões legais, éticas, técnicas e econômicas, além de preconceito e discriminação. Seis abordam facilitadores, tais como acolhimento nos serviços, disponibilidade de métodos conceptivos e contraceptivos e a capacitação de profissionais. Os achados evidenciam que a discussão se volta mais para as barreiras do que para os facilitadores. Isso pode indicar que ainda se faz necessário promover a problematização do modelo hegemônico de família nuclear e heterossexual.

Having children in cross-border contexts: late-family formation among homoparental families in Spain.

Considered until recently unfit to rear children, non-heterosexual people have been excluded from forming families in most countries. Many, worldwide, demand access to family formation, claiming the same aptitudes as heterosexual people for raising children. However, when non-heterosexual singles and couples want to become parents in Spain, they must consider transnational contexts, resorting to inter-country adoption or surrogacy abroad, processes that contribute to delay their family formation. They must consider not only Spanish sociocultural conditions, but other countries' legal restrictions regarding parents' gender, social status, and sexual identity. These families experience great difficulty in gaining access to reproductive health services. Based on multi-site ethnographic fieldwork, this text addresses how, despite legislative changes allowing homoparental family formation in Spain, these parents must overcome complex bureaucratic processes when they decide to have children, while facing homophobic attitudes and policies in their quests to become parents.

What Do Different People Look for in a Partner? Effects of Sex, Sexual Orientation, and Mating Strategies on Partner Preferences.

Partner preferences are an important differential in relationship formation and evolutionary fitness, and vary according to individual, ecological, and social factors. In this study, we evaluated the variation in preference for intelligence, kindness, physical attractiveness, health, and socioeconomic level among individuals of different sexes and sexual orientations in a Brazilian sample. We analyzed the preference scores of 778 heterosexual, bisexual, and homosexual men and women in three budgeted mate design tasks (low vs. medium vs. high budget) and their association with sociosexuality, attachment styles, homogamy, and willingness to engage in short- and long-term relationships. Results indicated a global trait preference order, with intelligence ranking first, followed by kindness, physical attractiveness, health, and lastly by socioeconomic status. Typical sex differences were observed mostly within the heterosexual group, and specific combinations of sex and sexual orientation were linked to variation in preference for physical attractiveness, kindness, and socioeconomic status. We also found unique associations of the other variables with partner preferences and with willingness to engage in short- or long-term relationships. By exploring the partner preferences of non-heterosexual individuals from a Latin American country, an underrepresented group in evolutionary psychology research, our results help understand the universal and specific factors that guide partner preferences and human sexual behavior.

Higher Risk of Many Physical Health Conditions in Sexual Minority Men: Comprehensive Systematic Review and Meta-Analysis in Gay- and Bisexual-Identified Compared with Heterosexual-Identified Men.

Purpose: The purpose of this study was to provide a systematic review and, where possible, meta-analysis on the prevalence of physical health conditions in sexual minority men (SMM, i.e., gay- and bisexual-identified men) compared with heterosexual-identified men. Methods: A systematic literature search in the databases MEDLINE, Embase, CENTRAL, CINAHL, and Web of Science was conducted on epidemiological studies on physical health conditions, classified in the Global Burden of Disease project and published between 2000 and 2021. Meta-analyses comparing odds ratios were calculated. Results: In total, 23,649 abstracts were screened, and 32 studies were included in the systematic review. Main findings were that (1) Largest differences in prevalence by sexual identity were found for chronic respiratory diseases, particularly asthma: overall, SMM were significantly almost 50% more likely to suffer from asthma than heterosexual men. (2) Evidence of higher prevalence was also found for chronic kidney diseases and headache disorders in gay men and for hepatitis B/C in both gay and bisexual men. (3) We found an overall trend that bisexual men were more affected by some of the physical health conditions compared with gay men (e.g., cardiovascular diseases, asthma). However, regarding cancer, headache disorders, and hepatitis, gay men were more affected. Conclusion: We found evidence of physical health disparities by sexual identity, suggesting more health issues in SMM. Since some of these findings rely on few comparisons or small samples of SMM only, this review is intended to be a vehement plea for routinely including sexual identity assessment in health research and clinical practice.

American Muslims' Attitudes Toward Homosexuality: Exploring the Effects of Gender, Religiosity, and Income Inequality.

Literature on Muslims and Islam has not empirically assessed the impact of American Muslims' gender, religiosity, income inequality, and the interaction between the latter two factors, on their attitudes toward homosexuality. Using logistic regression models fitted to data from the 2017 Pew Survey of US Muslims (n = 712), this article assesses these factors' effects on their view that society should either accept or discourage homosexuality. Findings reveal that men, compared with women, and more religious individuals tend to express homonegativity; while those from higher-income households are likely to agree that society should accept same-sex relationships. Also, the religiosity-prejudice association is moderated by income inequality. These findings have important religious and social implications. Firstly, the prevailing approach of essentializing Islamic perspectives on homosexuality as being favorable or prejudicial overlooks that they are socially contingent. Secondly, policies contributing to Muslim minorities' economic well-being can encourage them to embrace liberal religious and social values.

Percepções e expectativas de homens trans acerca dos relacionamentos afetivo-sexuais pós-transição / Trans men's perceptions and expectations of post-transition affective-sexual relationships / Percepciones y expectativas de los hombres trans sobre las relaciones afectivo-sexuales después de la transición

As identidades transmasculinas ganharam visibilidade social e acadêmica no Brasil a partir de 2010, contudo, as questões subjetivas dos homens trans ainda são pouco debatidas, em particular temas associados aos relacionamentos afetivos na experiência desses sujeitos. Este estudo qualitativo tem por objetivo identificar as percepções e expectativas dos homens trans acerca dos relacionamentos afetivo-sexuais no cenário pós-transição de gênero. Participaram da pesquisa 15 homens transexuais hormonizados, com idades entre 20 e 41 anos. A coleta de dados foi realizada por meio de entrevista semiestruturada nas modalidades presencial e on-line. Empregou-se análise temática reflexiva, que resultou em dois temas analíticos. Os resultados apontam que os homens trans, ao contrário de suas expectativas iniciais, percebem que tiveram menos oportunidades de relacionamentos afetivo-sexuais depois de sua transição de gênero. Os participantes atribuem essa dificuldade especialmente ao fato de não terem se submetido à cirurgia de redesignação sexual. O desconforto é acentuado por sua materialidade corpórea divergente da cisnormatividade, sistema regulador que associa pessoas pertencentes ao gênero masculino à presença de um pênis. Outra fonte de desconforto é o repúdio social, que alimenta a abjeção, exotização e fetichização dos corpos transmasculinos. Também são descritas as especificidades do relacionamento dos homens trans com mulheres cisgênero, heterossexuais e lésbicas. Os resultados evidenciam que a fixação persistente no genital, como referente e signo determinante do gênero e da sexualidade, modula e regula a busca e o encontro de parceira(o) íntima(o).(AU)

Transmasculine identities have gained social and academic visibility in Brazil since 2010, but subjective issues, especially those associated with affective relationships, are still little discussed. This qualitative study sought to identify trans men's perceptions and expectations regarding post-transition affective-sexual relationships. A total of 15 transsexual men undergoing hormone therapy, aged between 20 and 41 years, participated in the research. Data were collected by means of in-person and online semi-structured interviews and analysed using reflexive thematic analysis, which resulted in two analytical themes. Results show that trans men, differently from their initial expectations, perceive fewer opportunities for affective-sexual relationships after their gender transition. The participants attribute this difficulty, especially, to the fact that they have not undergone sexual reassignment surgery. Discomfort isaccentuated by their bodily materiality diverging from cisnormativity, the regulatory system that associates people belonging to the male gender with the presence of a penis. Another source of discomfort is the social repudiation, which reinforces the abjection, exoticization, and fetishization of transmasculine bodies. The specifics of trans men's relationships with cisgender, heterosexual, and lesbian women are also described. The results show that the persistent fixation on the genital, as a referent and determinant sign of gender and sexuality, modulates and regulates the search for and encounter of intimate partners.(AU)

Las identidades transmasculinas han ganado visibilidad social y académica en Brasil desde 2010, sin embargo, las cuestiones subjetivas de los hombres trans son aún poco discutidas, en particular las cuestiones asociadas a las relaciones afectivas en la experiencia de estos sujetos. Este estudio cualitativo tiene como objetivo identificar las percepciones y expectativas de los hombres trans sobre las relaciones afectivo-sexuales después de la transición de género. Participaron en la investigación 15 hombres transexuales hormonados, de edades comprendidas entre los 20 y los 41 años. La recopilación de datos se realizó mediante una entrevista semiestructurada en las modalidades presencial y en línea. Se realizó un análisis temático reflexivo, que dio como resultado dos temas analíticos. Los resultados muestran que los hombres trans, al contrario de sus expectativas iniciales, perciben que han tenido menos oportunidades de relaciones afectivo-sexuales después de su transición de género. Los participantes atribuyen esta dificultad especialmente al hecho de no haberse sometido a cirugía de reasignación sexual. La incomodidad se acentúa por su materialidad corpórea divergente de la cisnormatividad, un sistema normativo según el cual las personas pertenecientes al género masculino deben tener pene. Otra fuente de malestar es el repudio social, que alimenta la abyección, la exotización y la fetichización de los cuerpos transmasculinos. También se describen las especificidades de las relaciones de los hombres trans con las mujeres heterosexuales, cisgénero y lesbianas. Los resultados muestran que la persistente fijación en los genitales, como referente y signo determinante del género y la sexualidad, modula y regula la búsqueda y el encuentro de parejas íntimas.(AU)

Um capítulo esquecido na história da psicologia? sexualidades desviantes, psicopatologia e normalidade / A forgotten chapter in the history of psychology? deviant sexualities, psychopathology, and normality / ¿Un capítulo olvidado en la historia de la psicología? sexualidades desviadas, psicopatología y normalidad

Este artigo tem como objetivo produzir uma análise histórica sobre as intersecções entre Psicologia e sexualidade desviantes da norma no Brasil, de fins do século XIX a meados da década de 1980. Esta temporalidade foi escolhida por abarcar o surgimento das pesquisas científicas sobre sexualidade e desvios sexuais, a consolidação dos estudos psicológicos sobre a temática e o processo mais recente de despatologização da homossexualidade. Em termos teóricos e metodológicos, foram adotados os pressupostos da História Social da Psicologia e da historiografia das homossexualidades no Brasil. Desse modo, buscou-se compreender como as ideias, concepções e práticas psicológicas foram mudando ao longo do tempo, em conexão com as transformações socioculturais e políticas que ocorreram durante o século XX. Para isto, foram utilizadas fontes primárias e secundárias de pesquisa com vistas à produção de interpretações sobre as conexões entre as ideias, os atores e os eventos narrados. Argumenta-se, ao longo do artigo, que as ideias e práticas psicológicas estão intrinsecamente conectadas aos contextos socioculturais e políticos de seu tempo, sendo os movimentos dinâmicos e os conflitos presentes nesses contextos fatores determinantes para a sua constituição.(AU)

This article aims to produce a historical analysis of the intersections between Psychology and sexualities that deviate from the norm in Brazil, from the late 19th century to the mid-1980s. This period was chosen because it encompasses the emergence of scientific research on sexuality and sexual deviations, the consolidation of psychological studies on the subject and the most recent process of de-pathologization of homosexuality. Theoretically and methodologically, the assumptions of the Social History of Psychology and the historiography of homosexualities in Brazil were adopted. Therefore, we sought to understand how psychological ideas, conceptions and practices have changed over time, in connection with the sociocultural and political transformations that occurred throughout the 20th century. For this, primary and secondary sources of research were used to produce interpretations about the connections between the ideas, the actors and the narrated events. It is argued, throughout the article, that the psychological ideas and practices are intrinsically connected to the sociocultural and political contexts of their time, being the dynamic movements and conflicts present in these contexts determining factors for their constitution.(AU)

Este artículo tiene como objetivo realizar un análisis histórico de las intersecciones entre la Psicología y las sexualidades desviadas de la norma en Brasil desde finales del siglo XIX hasta mediados de la década de 1980. Esta temporalidad fue elegida por abarcar el surgimiento de las investigaciones científicas sobre sexualidad y desvíos sexuales, la consolidación de los estudios psicológicos sobre el tema y el más reciente proceso de despatologización de la homosexualidad. En el marco teórico y metodológico, se adoptaron los presupuestos de la Historia Social de la Psicología y de la historiografía de las homosexualidades en Brasil. De esta manera, se pretende comprender cómo las ideas, concepciones y prácticas psicológicas han cambiado a lo largo del tiempo, en conexión con las transformaciones socioculturales y políticas ocurridas durante el siglo XX. Para ello, se utilizaron las fuentes de investigación primarias y secundarias con miras a generar interpretaciones sobre las conexiones entre las ideas, los actores y los eventos narrados. Se argumenta, a lo largo de este artículo, que las ideas y las prácticas psicológicas están intrínsecamente conectadas a los contextos socioculturales y políticos de su tiempo, y los movimientos dinámicos y los conflictos presentes en estos contextos fueron los factores determinantes para su constitución.(AU)

Addressing Health Disparities in LGBTQ Youth Through Professional Development of Middle School Staff.

BACKGROUND: Significant health disparities exist for sexual minority youth (SMY). While supportive adults in schools have been shown to improve mental wellbeing and academic outcomes for students, most teachers do not receive training specific to lesbian, gay, bisexual, transgender and queer or questioning (LGBTQ) students. METHODS: The project aimed at providing staff from a Hawaii middle school with "Safe Space" professional training to increase knowledge and comfort in supporting SMY. Pre- and post-training surveys were used to measure knowledge of LGBTQ issues and comfort in supporting LGBTQ students and a 2-week and 3-month survey assessed staff's application of newly learned material. RESULTS: Sixty-four staff participated in the first of 2 training sessions with 59 completing both sessions. Results from the pre- and post-survey showed a 34.9% increase in knowledge of LGBTQ issues (effect size = 1.22) and a 5.5% increase in self-rated comfort level in supporting LGBTQ students (effect size = 0.22). A 3-month follow-up indicated that 52.9% of the respondents were actively applying knowledge learned within their school setting. CONCLUSIONS: The project results demonstrate the value of the training not only in the short term but also staff's ability to apply the knowledge they learned. Given the success of implementation, expansion to other schools could facilitate ally-building attitudes and behaviors as a protective factor for SMY throughout the state.

The Direct Reproductive Cost of Same-Sex Attraction: Evidence from Two Nationally Representative U.S. Samples.

Same-sex attraction is associated with a direct reproductive cost, i.e., a reduced number of biological children. The current study aimed to assess this cost for different forms of sexual attraction (i.e., only attracted to opposite sex, mostly attracted to opposite sex, equally attracted to both sexes, mostly attracted to same-sex, only attracted to same-sex), using two large nationally representative datasets (N = 15,208) from the USA. The results indicated that same-sex attraction was associated with substantial loss in direct reproductive output. More specifically, significant differences between the different types of same-sex attraction were found: Exclusive and mostly homosexual orientation identities were associated with the highest direct reproductive cost, while mostly attracted to opposite sex orientation and bisexuality identities were associated with lower direct reproductive costs. In addition, bisexual women did not differ significantly from exclusively heterosexual women in terms of their reproductive output. The implications of these findings for the evolutionary origins of same-sex attraction are further discussed.

Conhecendo as demandas de cuidado em saúde mental de jovens homoafetivos / Conociendo las demandas de cuidado en salud mental de jóvenes homoafectivos / Knowing the demands of mental health care of the young homoaffective

Objetivo: conhecer as demandas de cuidado em saúde mental de jovens homoafetivos. Método: pesquisa qualitativa, realizada com 18 jovens homoafetivos, estudantes universitários, em Santa Catarina. A produção de informações ocorreu em 2016, por meio de entrevista semiestruturada, com questões sobre percepções em relação à própria saúde mental, a homoafetividade e expectativas frente ao cuidado de saúde. As informações foram interpretadas mediante análise de conteúdo. Resultados: foram identificadas vulnerabilidades individuais, sociais e programáticas dos jovens homoafetivos, que podem interferir na saúde mental, levando-os a buscar suporte profissional. Foram relatadas fragilidades dos serviços de saúde para este cuidado. Considerações finais: os jovens homoafetivos vivenciam situações de vulnerabilidades, havendo demandas de cuidados que são negligenciadas nos serviços de saúde. Eles carecem de inovações, sobretudo em saúde mental, uma vez que sofrem agressões, opressões e estigmas, que colaboram para o uso de drogas. Ainda, questionam sobre atendimentos igualitários, resolutivos, livres de preconceitos e assistência humanizada.

Objetivo: conocer las demandas de cuidado en salud mental de jóvenes homoafectivos. Método: investigación cualitativa, realizada con 18 jóvenes homoafectivos, estudiantes universitarios, en Santa Catarina. La producción de información ocurrió en 2016, por medio de entrevista semiestructurada, con cuestiones sobre percepciones en relación a la propia salud mental, la homoafectividad y expectativas frente al cuidado de salud. La información se ha interpretado mediante análisis de contenido. Resultados: se identificaron vulnerabilidades individuales, sociales y programáticas de los jóvenes homoafectivos, que pueden interferir en la salud mental, llevándolos a buscar apoyo profesional. Se han reportado debilidades de los servicios de salud para este cuidado. Consideraciones finales: los jóvenes homoafectivos experimentan situaciones de vulnerabilidad, habiendo demandas de atención que son descuidadas en los servicios de salud. Carecen de innovaciones, sobre todo en salud mental, ya que sufren agresiones, opresiones y estigmas, que colaboran para el uso de drogas. Aún, cuestionan sobre atenciones igualitarias, resolutivos, libres de prejuicios y asistencia humanizada.

Objective: to know the demands of mental health care of young homosexuals. Method: qualitative research, conducted with 18 young homoaffective, university students in Santa Catarina. The production of information occurred in 2016, through semi-structured interviews, with questions about perceptions regarding mental health, homoaffectivity and expectations regarding health care. The information was interpreted through content analysis. Results: individual, social and programmatic vulnerabilities of young homosexuals were identified, which can interfere with mental health, leading them to seek professional support. Weaknesses of health services for this care were reported. Final considerations: young homosexuals experience situations of vulnerability, with demands for care that are neglected in health services. They lack innovations, especially in mental health, since they suffer aggression, oppression and stigma, which contribute to drug use. Still, they question about equal care, problem-solving, free of prejudice and humanized assistance.

A psicologia e a questão da diversidade sexual no Brasil: a Resolução CFP nº 1/99 / Psychology and the issue of sexual diversity in Brazil: Resolution CFP nº 1/99

Nesta tese indagamos acerca do lugar da psicologia no debate público sobre diversidade sexual no Brasil da atualidade. Através da análise de publicações, fontes documentais públicas e entrevistas, exploramos diversos modos em que o saber e autoridade da profissão de psicólogo são invocados para sustentar posicionamentos públicos sobre a questão homossexual no país. Nesse âmbito, destacamos a Resolução nº 1/99 do Conselho Federal de Psicologia (CFP), que estabelece normas de atuação para os psicólogos em relação à questão da orientação sexual. Há mais de vinte anos essa normativa é um marco na conquista dos direitos LGBTQIA+ no país. Para essa discussão, reconstruímos os debates que precederam as condições institucionais e o contexto de elaboração da Resolução. Os efeitos da mesma extrapolam o âmbito da regulação profissional da psicologia. A seguir, abordamos as trajetórias de figuras com diferentes perfis de atuação que ganharam notoriedade por atacar publicamente a Resolução, suscitando, desta maneira, polêmicas em torno da mesma. Em seguida, exploramos as frequentes contestações à Resolução CFP nº 1/99 que se deram na arena legislativa e o deslocamento dessas ofensivas para a arena da justiça e para a disputa pela condução dos Conselhos de Psicologia em 2019. A compreensão destes processos como cenas de uma controvérsia pública busca jogar luz sobre a disputa entre diferentes visões da diversidade sexual e de gênero, que transitam pela ciência, religião e política. Acreditamos que esta investigação contribua para expandir a compreensão da evolução, dos efeitos e dos desafios que se colocam à expansão de abordagens afirmativas da diversidade sexual e de gênero no campo da Psicologia.

In this thesis, we inquire about the place of psychology in the public debate on sexual diversity in Brazil today. Through the analysis of publications, public documentary sources, and interviews, we explore different ways in which the knowledge and authority of Psychology as a profession are invoked to support public positions on homosexuality as an issue in the country. In this context, we highlight Resolution 1/99 of the Federal Council of Psychology (CFP), that establishes standards of action for psychologists in relation to the issue of sexual orientation. For over decades, this regulation has been a milestone in the achievement of LGBTQIA+ rights in the country. For this discussion, we reconstructed the debates that preceded the institutional conditions and the context in which the Resolution was drafted. Its effects go beyond the regulation of professional psychology. Next, we address the trajectories of figures with different profiles of action who gained notoriety for publicly attacking the Resolution, thus raising controversies around it. Then, we explore the frequent challenges to Resolution CFP 1/99, that took place in the legislative arena, and the migration of these offensives to the arena of justice, and to the dispute for the presidence of the Psychology Councils in 2019. An understanding of these processes as scenes of a public controversy sheds light on the dispute between different visions of sexual and gender diversity, which transit through science, religion and politics.. This investigation expand the understanding of the evolution, effects and challenges facing the expansion of affirmative approaches to sexual and gender diversity in the field of Psychology.

Differences in Health Care Access and Satisfaction Across Intersections of Race/Ethnicity and Sexual Identity.

PURPOSE: Racial/ethnic and sexual minorities experience numerous health disparities compared with their White and heterosexual counterparts, which may be exacerbated when these social identities intersect. The authors tested for differences in health care access and satisfaction across intersections of sexual identity and race/ethnicity. METHOD: A cross-sectional secondary data analysis of the 2012-2018 waves of the Association of American Medical Colleges biannual online Consumer Survey of Health Care Access was conducted. This survey captures a national sample of U.S. adults who reported needing health care in the past 12 months. The analytic sample included 29,628 participants. Sixteen possible combinations of sexual identity and race/ethnicity were examined. Health care access and satisfaction were measured with 10 items and an index created from these items. Cumulative prevalence ratios (PRs) for the index and PRs across sexual identity, both individually and in combination with race/ethnicity, for each health care access and satisfaction item were generated. RESULTS: Compared with White heterosexuals, all other groups had significantly more barriers to care before adjustment. The greatest barriers were observed among non-Hispanic Asian/Pacific Islander/Hawaiian gay/lesbian (unadjusted PR = 3.08; 95% confidence interval [CI]: 2.45, 3.88; adjusted PR = 2.01; 95% CI: 1.59, 2.53), non-Hispanic Black bisexual (unadjusted PR = 2.73; 95% CI: 2.28, 3.27; adjusted PR = 1.83; 95% CI: 1.52, 2.20), non-Hispanic Black other sexual identity (unadjusted PR = 2.27; 95% CI: 1.69, 3.06; adjusted PR = 2.07; 95% CI: 1.53, 2.78), and Hispanic/Latino other sexual identity (unadjusted PR = 2.06; 95% CI: 1.60, 2.65; adjusted PR = 1.39; 95% CI: 1.08, 1.79) participants. CONCLUSIONS: Persons of both racial/ethnic and sexual minority status generally had less health care access and satisfaction than White heterosexuals. An intersectional perspective is critical to achieving equity in quality health care access.

Spirituality and Religious Engagement, Community Involvement, Outness, and Family Support: Influence on LGBT+ Muslim Well-Being.

The current study utilized data from the Social Justice Sexuality Project to investigate influences on psychological well-being of LGBT+ Muslims (N = 75) in the United States. Specifically, path analyses were used to examine the association between spiritual and religious engagement, LGBT community involvement, outness, and family support with psychological well-being. Control variables included lifespan Islam involvement, age, income, and the age at which the participant came out to themselves. Findings illustrate spiritual and religious engagement, outness, and income were all positively related to psychological well-being. Moreover, individuals who had converted to Islam but were not raised in the faith had significantly lower psychological well-being than those who had a consistent experience with Islam from their childhood until the time of the study. The present investigation provides critical contributions to the study of gender and sexual minorities in the United States and the experiences of currently practicing LGBT+ Muslims and those who were raised Muslim. Clinical implications and future research suggestions are discussed.

Introduction to Special Issue: Impacts of the COVID-19 Pandemic on LGBTQ+ Health and Well-Being.

This special issue on the impacts of COVID-19 on LGBTQ+ health and well-being reports findings from nine articles with varied study designs, including data from multiple countries and all segments of LGBTQ+ communities. Key findings included the observation that pre-COVID mental health disparities predispose LGBTQ+ people to poorer outcomes; that technological communication aids are essential in maintaining some sense of community; and that substance use is perceived by sexual minority women as a means of coping with fears, stress, loneliness, and boredom. Studies in this special issue also document that community support is still a critical need, particularly among those who are sheltering at home with families of origin. Findings underscore the importance of addressing structural inequities, including advocating for rights; providing financial support for LGBTQ+ community organizations and networks; ensuring access to competent and affirming healthcare; and including vulnerable communities in disaster response and planning.

Smoking and Quitting Behavior by Sexual Orientation: A Cross-Sectional Survey of Adults in England.

OBJECTIVE: To assess associations between sexual orientation and smoking and quitting behavior among adults in England. METHODS: Data were collected from 112 537 adults (≥16 years) participating in a nationally representative monthly cross-sectional survey between July 2013 and February 2019. Sexual orientation was self-reported as heterosexual, bisexual, lesbian/gay, or prefer-not-to-say. Main outcomes were smoking status, e-cigarette use, cigarettes per day, time to first cigarette, motivation to stop smoking, motives for quitting, use of cessation support, and past-year quit attempts. Associations were analyzed separately for men and women using multivariable regression models adjusted for relevant covariates. RESULTS: Smoking prevalence is now similar between gay (21.6%), prefer-not-to-say (20.5%) and heterosexual men (20.0%), and lesbian (18.3%) and heterosexual women (16.9%), but remains higher among bisexual men (28.2%, adjusted odds ratio [ORadj] = 1.41, 95% confidence interval [CI] = 1.11 to 1.79) and bisexual women (29.8%, ORadj = 1.64, 95% CI = 1.33 to 2.03) and lower among prefer-not-to-say women (14.5%, ORadj = 0.85, 95% CI = 0.72 to 0.99). Among smokers, bisexuals were less addicted than heterosexuals, with bisexual men smoking fewer cigarettes per day (Badj = -2.41, 95% CI = -4.06 to -0.75) and bisexual women less likely to start smoking within 30 min of waking (ORadj = 0.66, 95% CI = 0.45 to 0.95) than heterosexuals. However, motivation to stop smoking and quit attempts did not differ significantly. CONCLUSIONS: In England, differences in smoking prevalence among people with different sexual orientations have narrowed, primarily driven by a larger decline in smoking rates among sexual minority groups than heterosexuals. Bisexual men and women remain more likely to smoke but have lower levels of addiction while being no less likely to try to quit. IMPLICATIONS: This population-based study provides an up-to-date picture of smoking and quitting behavior in relation to sexual orientation among adults in England. Findings suggest that widely documented disparities in smoking prevalence have narrowed over recent years, with gay men and lesbian women no longer significantly more likely to smoke than heterosexuals, although smoking remains more common among bisexual men and women. Insights into differences in level of addiction, use of cessation support, and motives for quitting may help inform the development of targeted interventions to further reduce smoking among sexual minority groups.

Using Queer Phenomenology to Disrupt Heteronormativity and Deconstruct Homosexuality.

Stigma is structurally embedded and preexists a person's involvement in-the-world. This is understood to create the conditions necessary for what is described here as a priori homophobia, which is defined as a projection of structurally embedded stigma that extends into the mind of 2SLGBTQ individuals and causes them to hide their identities out of fear. With this in mind and by way of queer phenomenology, heteronormativity will be disrupted and the inherently negative notion of "homosexuality" will be deconstructed to understand the role of stigma as a root cause of 2SLGBTQ mental health disparities. Implications for practice are offered so health service providers can understand heteronormativity as a source of everyday harm for 2SLGBTQ and be responsive to the ways in which stigma influences 2SLGBTQ mental health outcomes.

Mapping out a spectrum of the Chinese public's discrimination toward the LGBT community: results from a national survey.

BACKGROUND: China has the world's largest lesbian, gay, bisexual, and transgender (LGBT) population. This study assessed the discrimination experienced by LGBT individuals in China in a comprehensive way, covering discrimination perpetrated by family, media, medical services, religious communities, schools, social services, and in the workplace. METHODS: The current study involved a national survey of 31 provinces and autonomous regions. Discrimination was measured both in terms of heterosexual participants' attitudes towards LGBT individuals, and LGBT participants' self-perceived discrimination. Pearson correlation analysis was performed to examine the difference between heterosexual participants' attitudes towards LGBT individuals and LGBT participants' self-perceived discrimination. Linear regression was used to investigate the association between gross domestic product per capita and discrimination. RESULTS: Among 29,125 participants, 2066 (7.1%) identified as lesbian, 9491 (32.6%) as gay, 3441 (11.8%) as bisexual, 3195 (11.0%) as transgender, and 10,932 (37.5%) as heterosexual. Heterosexual people were generally friendly towards the LGBT community with a mean score of 21.9 (SD = 2.7, total scale score = 100) and the grand averaged score of self-perceived discrimination by LGBT participants was 49.9 (SD = 2.5). Self-perceived discrimination from family and social services is particularly severe. We created a series of provincial level choropleth maps showing heterosexual participants' acceptance towards the LGBT community, and self-perceived discrimination reported by members of the LGBT community. We found that a higher level of economic development in provinces was associated with a decrease in discrimination, and we identified that every 100 thousand RMB increase in per capita GDP lead to a 6.4% decrease in discriminatory events perpetrated by heterosexuals. CONCLUSIONS: Chinese LGBT groups consistently experience discrimination in various aspects of their daily lives. The prevalence of this discrimination is associated with the economic development of the province in which it occurs. In order to reduce discrimination, it is important for future studies to discover the underlying reasons for discrimination against LGBT individuals in China.

Same-Sex Couples' Shared Time in the United States.

This study examines and compares shared time for same-sex and different-sex coresident couples using large, nationally representative data from the 2003-2016 American Time Use Survey (ATUS). We compare the total time that same-sex couples and different-sex couples spend together; for parents, the time they spend together with children; and for both parents and nonparents, the time they spend together with no one else present and the time they spend with others (excluding children). After we control for demographic and socioeconomic characteristics of the couples, women in same-sex couples spend more time together, both alone and in total, than individuals in different-sex arrangements and men in same-sex couples, regardless of parenthood status. Women in same-sex relationships also spend a larger percentage of their total available time together than other couples, and the difference in time is not limited to any specific activity.

Proibição de doação sanguínea por pessoas homoafetivas: estudo bioético / Ban on blood donation from homoaffective people: a bioethical study / Prohibición de donaciones de sangre por homosexuales: un estudio bioético

Resumo Este estudo teve o objetivo de identificar e discutir aspectos bioéticos que envolvem a proibição de doação sanguínea por pessoas homoafetivas. Trata-se de revisão integrativa da literatura, com abordagem crítico-reflexiva de artigos disponíveis na Biblioteca Virtual em Saúde e publicados entre 2013 e 2018. Foram selecionados sete estudos que contemplaram a temática, a partir dos quais surgiram quatro categorias: "inaptidão para doação de sangue"; "só homossexuais praticam sexo anal?"; "saúde pública ou heterossexismo na saúde?"; e "considerações da bioética principialista para doação sanguínea de pessoas homoafetivas", remetendo aos quatro pilares da teoria principialista. A bioética promove reflexões sociais, direciona linhas de pensamento ou questionamento e cria novos espaços para discussão do assunto. Os dilemas envolvidos nessa abordagem dizem respeito à negação dos quatro pilares bioéticos aos sujeitos homoafetivos, induzindo maleficência a esse grupo vulnerável e aos receptores do tecido sanguíneo.

Abstract This study aimed to identify and discuss bioethical aspects that involve the ban on blood donation from homo-affective people. This is an integrative review of the literature, with a critical-reflexive approach to articles available in the Virtual Health Library and published between 2013 and 2018. Seven studies were selected that covered the theme, from which four categories emerged: "unfit for blood donation"; "are homosexuals the only ones who practice anal sex?"; "public health or heterosexism in health?"; and "considerations of principlist bioethics for blood donation from homo-affective people", referring to the four pillars of the principlist theory. Bioethics promotes social reflections, directs lines of thought or questioning and creates new avenues for discussing the subject. The dilemmas involved in this approach are related to the denial of the four bioethical pillars to homoaffective subjects, inducing maleficence to this vulnerable group and to blood tissue recipients.

Resumen Este estudio tiene el objetivo de identificar y discutir algunos aspectos bioéticos que implican la prohibición de donaciones de sangre por homosexuales. Se trata de una revisión integrativa de la literatura con el abordaje crítico y reflexivo elaborada con artículos incluidos en la Biblioteca Virtual en Salud y publicados entre 2013 y 2018. Se seleccionaron siete estudios para abordar el tema, de los que resultaron cuatro categorías: "imposibilidad de donar sangre"; "¿Solo los homosexuales practican el sexo anal?"; "¿Salud pública o heterosexismo en la salud?"; y "consideraciones de la bioética principialista para la donación de sangre de las personas homoafectivas", abordando los cuatro principios de la teoría principialista. La bioética promueve la reflexión social, dirige las líneas de pensamiento o el cuestionamiento y crea nuevos espacios de debate. Los dilemas de este enfoque se refieren a la negación de los cuatro pilares bioéticos a los sujetos homoafectivos, lo que induce a la maleficencia a este grupo vulnerable y a los receptores de tejidos sanguíneos.

[Sexual and gender diversity and care for older people-intersectional perspectives and the relevance of situations and contexts]. / Sexuelle und geschlechtliche Vielfalt in der Altenhilfe ­ Intersektionale Perspektiven und die Relevanz von Situationen und Kontexten.

BACKGROUND: There have been relatively few studies concerning gender and sexual identity in research on ageing and nursing or care. Non-heterosexual older people and those in need of care describe fears of rejection and the dependence on third parties in their use of health and social care services in old age. OBJECTIVE: This article examines the question of how gender and sexual diversity can be respected in older adult social services. It focuses on the question of how sexual and gender identity become relevant in particular contexts and how these categories interact with other categories of identity. MATERIAL AND METHODS: Qualitative data from the same sex and nursing in old age (GLEPA) research project with older lesbian, gay, bisexual, trans*and inter* (LGBTI*) people in need of care or help are used. For the analysis, biographical case reconstructions are combined with an intersectional perspective. RESULTS AND CONCLUSION: The analysis of the data shows how sexual and gender identities of older LGBTI* people are represented in differing contexts and depend on their experiences across the course of life. It also shows how specific strategies associated with these identity categories are developed and can be distinguished. Particularly in the act of personal care, the interplay between age, body and gender identity shows how the interviewees experience the normative and sometimes violent, structures of long-term care. Regarding sexual identity, the data show the continuing relevance of life situations and lifestyles for LGBTI* people into old age, demonstrating the importance of taking an intersectional perspective for person-centered care with older adults.