Healthcare providers perspectives on digital, self-guided mental health programs for LGBTQIA+ individuals: A cross-sectional online survey.

Digital, self-guided mental health programs are a promising avenue for mental health support for LGBTQIA+ (lesbian, gay, bisexual, trans, Queer, intersex, asexual plus additional sexuality, gender, and romantic identities) people - however, healthcare providers (HCPs) perspectives on programs are largely unknown. The aim of this study was to explore these perspectives. A cross-sectional online survey was distributed across Australia, with a final sample of 540 HCPs from a range of disciplines. Most respondents (419, 81.2 %), reported that digital, self-guided mental health programs would be useful, but 74.5 % (n = 380) also reported that they had concerns. Thematic analysis of open-text responses showed that HCPs believe programs may help overcome access barriers and could be useful as part of a wider care journey. Others were concerned about patient safety, and whether programs could be appropriately tailored to LGBTQIA+ experiences. Content analysis of open-text responses showed affirming language and imagery, content on LGBTQIA+ people's unique challenges, wider health information, and connections to community were important to include in programs. HCPs advocated for programs that offered broad and sub-population specific information. These findings show that HCPs are enthusiastic about digital, self-guided mental health programs, but care should be taken to address key concerns to facilitate future implementation.

Ending the HIV epidemic PrEP equity recommendations from a rapid ethnographic assessment of multilevel PrEP use determinants among young Black gay and bisexual men in Atlanta, GA.

BACKGROUND: Efforts to mitigate HIV transmission among gay and bisexual men have not been sufficient to level persistent racial inequities which now extend to the use of daily oral pre-exposure prophylaxis (PrEP) for HIV prevention. Community-involved ethnographic research is crucial to galvanizing collaboration between patients, researchers, and policymakers to identify the social determinants of emerging PrEP inequities. In partnership with community key informants, we conducted a Rapid Ethnographic Assessment (REA) of multilevel PrEP use determinants among young Black gay and bisexual (YBGBM) men in the metropolitan Atlanta area to inform the development and coordination of local HIV programs. METHODS: In the assessment, we drew upon the perspectives of local clinicians, community-based organization leaders, health educators, and PrEP clients to identify barriers and facilitators to PrEP use among YBGBM through interviews (N = 23). Data were collected from September 2020 -to January 2021 and were analyzed through a staged deductive-inductive thematic analysis. The themes were later summarized and presented to community stakeholder participants to facilitate member-checking. RESULTS: Our analyses revealed structural, cultural, relationship, and developmental factors which shaped PrEP use. The most prominent being "ease of access to PrEP" (structural level), "provider support" (interpersonal), and "life-stage traits" (individual). Our results also contribute novel information concerning the axes of intersectional stigma (spatial, racial, sexual identity, and HIV) among YBGBM in Atlanta and its divergent effects on PrEP use. CONCLUSION: Increased PrEP use among YBGBM, particularly among those living in the south, is essential to ending the domestic HIV epidemic. Altogether, our results emphasize the need for PrEP program modifications, which increase flexibility in methods and modes of access and are culturally adapted to the needs of YBGBM. There is also a need for resources that holistically focus on mental health, trauma, and racism as critical components of support.

Dispositional Mindfulness in Heterosexual and Lesbian/Bisexual Women: Associations with Sexual Prejudice and Internalized Sexual Stigma.

This research investigated the effect of dispositional mindfulness on the reduction of sexual prejudice and internalized sexual stigma in heterosexual and lesbian/bisexual women, who still represent a population that is under-represented in the scientific literature. Participants were 203 Italian women, both heterosexual (N = 104, 51.2%) and lesbian/bisexual (N= 99, 48.8%), ranging between 18 and 68 years old. They responded to a questionnaire containing demographic information and measures of dispositional mindfulness, need for cognitive closure, and adherence to traditional gender roles. Dominance analyses were run to test the predictive power of mindfulness' dimensions on internalized sexual stigma and on sexual prejudice over and above the other predictors. Results showed that having a mindful nonjudging attitude toward one's inner experience is associated with less internalized sexual stigma in lesbian and bisexual women. On the contrary, dispositional mindfulness was not associated with heterosexual women's sexual prejudice against gay and lesbian individuals.

Psychometric Properties of the Sexual Subjectivity Inventory among Lesbian, Gay, and Bisexual Emerging Adults.

Research highlights the significance of positive sexual self-perceptions for general and sexual health. Yet, most research on the sexuality of lesbian, gay, and bisexual (LGB) individuals has been risk-oriented, leaving a critical gap in knowledge about normative and healthy sexuality among sexual minorities. In part, this gap is due to a lack of sexual health measures with established psychometric properties for LGB individuals. The current study examined the factor structure, reliability, factorial invariance, and validity of the Sexual Subjectivity Inventory (SSI) in a sample of 746 lesbian (n = 123), gay (n = 204), and bisexual (n females = 234; n males = 185) emerging adults (Mage = 23.4 years). Factor analyses revealed the same five-factor structure found in similar aged heterosexual samples and strict factorial invariance by sexual and cisgender identities. Factor scores were internally consistent and associated with indicators of sexual well-being (i.e., safe sex self-efficacy, internalized homonegativity) and general well-being (life satisfaction, identity achievement) in theoretically meaningful ways. Sexual subjectivity was largely unrelated to health risk behavior. Results support the use of the SSI with LGB emerging adults for advancing holistic perspectives on LGB sexuality.

Ações dos enfermeiros na Atenção Primária à Saúde da mulher lésbica e bissexual / Nursing actions in Primary Health Care to lesbian and bisexual women

RESUMO Objetivo investigar as ações de enfermeiros a mulheres lésbicas e bissexuais no contexto da Política Nacional de Saúde Integral de Lésbicas, Gays, Bissexuais, Travestis e Transexuais. Métodos estudo qualitativo, que envolveu 25 enfermeiros da Estratégia Saúde da Família por meio de contato eletrônico. Foi aplicado formulário contendo dados sociodemográficos e investigação de ações na assistência à saúde. Adotou-se análise de conteúdo temática. Resultados constataram-se ações de capacitação profissional, acolhimento de demandas e fortalecimento do trabalho interprofissional. Contudo, evidenciou-se falta de conhecimento referente à assistência à saúde direcionada a mulheres lésbicas e bissexuais. Conclusão percebe-se a permanência de preconceitos, dificuldades de acesso, baixa assiduidade de mulheres lésbicas e bissexuais nos serviços de saúde, déficit de apoio ao desenvolvimento de ações de saúde e ausência de monitoramento. Contribuições para a prática: destaca-se a importância científica, profissional e social, que atenta para a necessidade de humanizar o cuidado às mulheres lésbicas e bissexuais, servindo como material de apoio para pesquisadores e profissionais de enfermagem e possibilitando direcionar a atenção para um cuidado holístico e integral a estas mulheres, além de servir como fomento para estudos comparativos.

ABSTRACT Objective to investigate the actions of nurses in regard to lesbian and bisexual women in the context of the National Policy for the Integral Health of Lesbians, Gays, Bisexuals, Cross-Dressers and Transgender Persons. Methods qualitative study involving 25 nurses from the Family Health Strategy, contacted via electronic means. We applied a form containing sociodemographic data and an investigation of actions in primary health care, as well as a thematic content analysis. Results we found there are professional capacitation activities, embracing of demands, and enhanced interprofessional work. Nonetheless, there were shortcomings in the knowledge regarding health care towards lesbian and bisexual women. Conclusion there are still prejudices, difficulty to access, and little attendance of lesbian and bisexual women in health services, as well as a deficit in the support to health actions and lack of monitoring. Contributions to practice: the importance of the scientific, professional, and social experiences stand out, regarding the need to humanize the care to lesbian and bisexual women. It is a supporting material for researchers and nursing professionals, enabling them to direct their care to a holistic and integral care to be provided to these women, in addition to being an encouragement to further comparative studies.

Militância enquanto convite ao diálogo: o caso da militância monodissidente / Activism as an invitation for the dialogue: the case of monodissident activism / La militancia como invitación al diálogo: el caso de la militancia monodisidente

Este artigo é uma produção teórica de caráter reflexivo que focaliza a relação entre pesquisa e militância a partir do construtivismo semiótico-cultural em psicologia, tendo como base o caso da militância monodissidente. A noção de monodissidência foi cunhada no percurso da militância bissexual para se referir a uma ferramenta analítica de ordem político-comunitária que contempla todas as pessoas que se atraem sexual e/ou romanticamente por mais de um gênero. São contrapostas concepções distintas de militância político-social em psicologia: de um lado, militância é entendida a partir de um autocentramento do militante, vinculado a uma rede de exclusões, negações, vedação e defesas psicológicas em relação à experiência; de outro, há uma compreensão dialógica de militância. Metodologicamente, a proposta de pesquisa se fundamenta no campo da participação observante, entendendo que o pesquisador está, primeiro, na condição de participante de certo campo sociocultural, a partir do qual passa a observar e refletir sobre fenômenos que ocorrem nele. Tomamos como ilustração a trajetória de construção da militância monodissidente do primeiro autor, trazendo tensionamentos dialógicos para a análise, postos em discussão com outras reflexões situadas sobre o tema. O conjunto de tensionamentos dialógicos emergidos nesse percurso foi mapeado e compreendido como um processo de multiplicação dialógica no encontro de self pesquisador com o self militante.(AU)

This paper is a theoretical production of reflective character that focuses on the relationship between research and activism from the semiotic-cultural constructivism in psychology, based on the case of monodissident activism. The notion of monodissent was coined during bisexual activism to refer to an analytical tool of a political-community order that includes all people who are sexually and/or romantically attracted to more than one gender. Different conceptions of political-social activism in psychology are opposed: on the one hand, activism is understood from the militant's self-centeredness, linked to a network of exclusions, denials, gatekeeping, and psychological defenses regarding experience; on the other hand, there is a dialogical understanding of activism. Methodologically, the research proposal is based on the field of observant participation, understanding that the researcher is, first, in the condition of a participant in a certain sociocultural field, from which he starts to observe and reflect on phenomena that occur there. We take as an illustration the trajectory of the construction of the monodissident activism of the first author, bringing dialogical tensions to the analysis, discussed with other reflections on the subject. The set of dialogic tensions that emerged in this path was mapped and understood as a process of dialogic multiplication in the encounter of the researcher self with the activist self.(AU)

Este artículo realiza una producción teórica y reflexiva sobre la relación entre investigación y activismo desde el constructivismo semiótico-cultural en Psicología, a partir del caso del activismo monodisidente. La noción de monodisidencia fue acuñada en el transcurso de la militancia bisexual para referirse a una herramienta analítica de orden político-comunitario que incluye a todas las personas que se sienten atraídas sexual y / o románticamente por más de un género. Se contraponen distintas concepciones de la militancia político-social en Psicología: por un lado, la militancia se entiende desde el egocentrismo del militante, vinculado a un entramado de exclusiones, negaciones, sellamientos y defensas psicológicas con relación a la experiencia; por otro, existe una comprensión dialógica de la militancia. La investigación utiliza como metodología la participación del observador, entendiendo que el investigador se encuentra, en primer lugar, en la condición de participante de determinado campo sociocultural, desde donde comienza a observar y reflexionar sobre los fenómenos que allí ocurren. Tomamos como ilustración la trayectoria de la construcción de la militancia monodisidente del primer autor, trayendo tensiones dialógicas al análisis, discutidas con otras reflexiones sobre el tema. El conjunto de tensiones dialógicas que surgieron en este camino se caracteriza y se comprende como un proceso de multiplicación dialógica en el encuentro del self investigador con el self militante.(AU)

A Computable Phenotype for the Identification of Sexual and Gender Minorities in Electronic Health Records.

Sexual gender minorities, including lesbian, gay, and bisexual (LGB) individuals face unique challenges due to discrimination, stigma, and marginalization, which negatively impact their well-being. Electronic health record (EHR) systems present an opportunity for LGB research, but accurately identifying LGB individuals in EHRs is challenging. Our study developed and validated a rule-based computable phenotype (CP) to identify LGB individuals and their subgroups using both structured data and unstructured clinical narratives from a large integrated health system. Validating against a sample of 537 chart-reviewed patients, our three best performing CP algorithms balancing different performance metrics, each achieved sensitivity of 1.000, PPV of 0.982, and F1-score of 0.875 in identifying LGB individuals, respectively. Applying the three best-performing CPs, our study also found that the LGB population is younger and experiences a disproportionate burden of adverse health outcomes, particularly mental health distress.

Psychometric Testing of the Daily Spiritual Experiences Scale (DSES) Among Black Gay, Bisexual, and Other Sexual Minority Men (SMM) and Black Transwomen in the Deep South: The MARI Study.

Spirituality is a well-established protective psychosocial determinant of health. The current study examined the psychometric properties of the Daily Spiritual Experiences Scale (DSES) among Black gay, bisexual and other sexual minority men (SMM) and Black transwomen (TW) in the Deep South. Data were collected via self-interview technology and analyzed using factor analyses and correlation coefficients. We demonstrated a single-factor structure of the DSES with high internal consistency (Cronbach's α = 0.96). DSES was positively and significantly associated with multiple dimensions of religion, resilience, optimism and social support and not significantly associated with cynicism and anger expressions. Spirituality should be included in HIV prevention, treatment and care strategies focused on Black SMM and Black TW, especially those residing in the Deep South, USA.

Prostate cancer disclosure and sexual orientation: Understanding outness to healthcare providers as a situational or consistent phenomenon.

OBJECTIVE: In this study, we investigated if outness is more a situational or a consistent characteristic in gay, bisexual, and other men who have sex with men (GBM) treated for prostate cancer and how the disclosure of sexual orientation impacts provider discussions of sexual side effects. METHODS: Data came from Restore, an online cross-sectional survey of 193 GBM prostate cancer survivors living in North America and were analyzed using various statistical models. RESULTS: Disclosure of sexual orientation and of living with prostate cancer were not significantly correlated. Participants who were out regarding sexual orientation were more likely to report that their surgeons and urologists discussed the sexual side effects of treatment. CONCLUSION: Outness appears to be a situational phenomenon. GBM prostate cancer survivors who were out regarding sexual orientation received more discussion surrounding sexual side effects of prostate cancer treatment from their providers. PRACTICE IMPLICATIONS: It is important for healthcare providers to inquire about patient's sexual orientation to provide holistic care to these patients to address health disparities within this group.

Sexual orientation-related disparities in health conditions that elevate COVID-19 severity.

PURPOSE: The Veterans Health Administration (VA) is the largest single integrated healthcare system in the US and is likely the largest healthcare provider for people with minoritized sexual orientations (e.g., gay, lesbian, bisexual). The purpose of this study was to use electronic health record (EHR) data to replicate self-reported survey findings from the general US population and assess whether sexual orientation is associated with diagnosed physical health conditions that may elevate risk of COVID-19 severity among veterans who utilize the VA. METHODS: A retrospective analysis of VA EHR data from January 10, 1999-January 07, 2019 analyzed in 2021. Veterans with minoritized sexual orientations were included if they had documentation of a minoritized sexual orientation within clinical notes identified via natural language processing. Veterans without minoritized sexual orientation documentation comprised the comparison group. Adjusted prevalence and prevalence ratios (aPR) were calculated overall and by race/ethnicity while accounting for differences in distributions of sex assigned at birth, age, calendar year of first VA visit, volumes of healthcare utilization, and VA priority group. RESULTS: Data from 108,401 veterans with minoritized sexual orientation and 6,511,698 controls were analyzed. After adjustment, veterans with minoritized sexual orientations had a statistically significant elevated prevalence of 10 of the 11 conditions. Amongst the highest disparities observed were COPD (aPR:1.24 [95% confidence interval:1.23-1.26]), asthma (1.22 [1.20-1.24]), and stroke (1.26 [1.24-1.28]). CONCLUSIONS: Findings largely corroborated patterns among the general US population. Further research is needed to determine if these disparities translate to poorer COVID-19 outcomes for individuals with minoritized sexual orientation.

Do Spirituality, Rurality, and LGBTQ Support Increase Outness and Quality of Health in Gay and Bisexual Men?

Although the existing research suggests that spirituality may positively affect health outcomes for gay and bisexual men, it is unclear to what extent it improves the quality of health over and above sociodemographic factors. Furthermore, there remains conflicting evidence regarding the role of residential location on levels of outness for gay and bisexual men. To that end, the present study used hierarchical linear regression analyses to examine the role of spirituality, rurality, and LGBTQ connectedness in outness and quality of health. The sample comprised 2,202 self-identified gay and bisexual men aged 18 and older who responded to the Social Justice Sexuality Project survey; participants represented all 50 states and Puerto Rico. The results indicate that whereas spirituality was positively associated with a greater quality of life, there was no significant difference in outness between rural versus nonrural participants. Moreover, bisexual men endorsed significantly lower levels of outness compared to their gay counterparts. Implications for future research regarding the role of spirituality and rurality in sexual minority health are discussed.

Mental health, potential minority stressors and resilience: evidence from a cross-sectional survey of gay, bisexual and other men who have sex with men within the Celtic nations.

BACKGROUND: Gay, bisexual and other men who have sex with men (GBMSM) are at a greater risk of mental health problems, such as anxiety and depression, than heterosexual adults. Numerous factors and stressors have been reported to impact men's mental health, although it has been suggested that resilience could have a protective effect. The aim of this study is to explore mental health, minority stressors, and resilience among a large online cross-sectional survey of GBMSM in the Celtic nations. METHODS: Data for this cross-sectional study were collected from the Social Media, GBMSM and Sexual and Holistic Health (SMMASH2) self-report online survey. Participants (n = 3077) were recruited via gay sociosexual media in Scotland, Wales, Northern Ireland, and the Republic of Ireland. Binary logistic regression analyses were conducted to identify factors that increased the odds of moderate-to-severe anxiety and depression. Potentially relevant variables (p < 0.05) were carried forward in hierarchal logistic regression analyses. RESULTS: The prevalence of moderate-to-severe anxiety and depression was 19.9 and 14.4%, respectively. Having a disability (OR = 1.73) and having financial worries sometimes/all of the time (OR = 1.93) increased the odds of having moderate-to-severe depression and anxiety, respectively. No minority stressors were associated with depression, whereas experiencing any form of relationship abuse in the last 12 months significantly increased the odds of anxiety (OR = 1.50). Resilience, namely a sense of coherence, had a protective effect and significantly reduced the odds of moderate-to-severe depression (OR = 0.85) and anxiety (OR = 0.89). CONCLUSIONS: Disability and financial worries were associated with increased depression and anxiety, respectively, while resilience had a protective effect for GBMSM in the SMMASH2 study. Future research is needed to better understand the role of resilience and the challenges and stresses of everyday life and intersecting health problems. Future research is also needed that incorporates the perspectives of those most affected by mental ill-health to co-develop effective solutions that respond to their contextual surroundings.

LGBTQ+ People's Mental Health and Pets: Novel Strategies of Coping and Resilience.

Health disparities persist for lesbian, gay, bisexual, transgender, and/or queer (LGBTQ+)-identified people, often shaped by minority stress through anti-LGBTQ+ stigma. Resilience and coping are important for LGBTQ+ people widely, especially through social supports, but further examination is needed into more diverse, expansive mental health assets. Companion animals, or pets, have significant positive mental health benefits in the general population, but more understanding is needed to validate LGBTQ+ people's lived experiences of minority stress, mental health challenges, and pet-based sources of resilience. We employ the minority resilience framework to ask: What role do pets play in how LGBTQ+ people navigate and cope with stress? This U.S.-based study centers the voices of 45 LGBTQ+ people's qualitative interview narratives characterizing the diverse coping and resilience-building processes they develop through pet relationships. Findings demonstrate diverse processes surrounding pets as contributing to resilience, as participants emphasized the unique beneficial emotional connections pets provided. Second, pet family members were conceptualized as vital sources of support that promoted thriving. Finally, pet relationships fostered happiness and life enjoyment that augmented participants' life satisfaction. This study delineates more diverse understandings of how LGBTQ+ people manage stress through their pet relationships, which can provide vital information to service providers and policymakers in more holistically attending to marginalized communities' health needs.

The Holistic Health Status of Chinese Homosexual and Bisexual Adults: A Scoping Review.

Background: Same-sex marriage is currently not legalized in China, despite the considerably large number of homosexual and bisexual Chinese populations. At the same time, their holistic health status remains unclear. This is the first scoping review conducted to comprehensively examine all the available literature and map existing evidence on the holistic health of homosexual and bisexual Chinese. Methods: This scoping review used the framework of Arksey and O'Malley and followed the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for scoping reviews (PRISMA-ScR). A comprehensive search strategy was carried out across 20 English (EN) and Chinese (both traditional and simplified) electronic databases from January 1, 2001, to May 31, 2020. Two reviewers conducted the reference screening and study selection independently and consulted a third senior reviewer whenever a consensus must be achieved. Data extraction was conducted using a structured data form based on the Cochrane template, after which a narrative synthesis of the findings was performed. Results: A total of 2,879 references were included in the final analysis, with 2,478 research articles, 167 reviews, and 234 theses. Regarding the study populations, the vast majority of studies centered on men only (96.46%), especially men who have sex with men (MSM). Only 1.32% of the studies targeted female sexual minorities. The geographical distribution of all research sites was uneven, with most of them being conducted in mainland China (95.96%), followed by Hong Kong (2.05%), Taiwan (2.02%), and Macau (0.06%). Regarding the specific study focus in terms of the health domain, around half of the studies (45.93%) focused on sexual health only, and an additional quarter of the studies (24.15%) investigated both sexual health and social well-being. Meanwhile, the studies focusing on mental health only accounted for approximately 15% of the total. Conclusions: This scoping review revealed that previous research focused more on male than female sexual minorities, on disease-centered surveys than person-centered interventions, and investigations on negative health conditions than positive health promotion. Therefore, investigations centered on the female sexual minorities and corresponding person-centered interventions are highly needed. Review Registration: The protocol of this review has been registered within Open Science Framework (https://osf.io/82r7z) on April 27, 2020.

Examining LGBTI+ inclusive sexual health education from the perspective of both youth and facilitators: a systematic review.

OBJECTIVES: To critically appraise and synthesise the evidence in relation to both the receipt and delivery of LGBTI+ (Lesbian, Gay, Bisexual, Transgender, Intersex) inclusive sexual health education. DESIGN: A systematic review and narrative synthesis. DATA SOURCES: A systematic search of three online databases (EMBASE, PsychINFO and SocINDEX) from January 1990 to May 2021 was conducted. ELIGIBILITY CRITERIA: Studies included were (1) peer-reviewed; (2) English; (3) quantitative, qualitative and mixed methods; that evaluated (4) inclusive sexual health in an educational or online setting and (5) focused on training or educating. Studies were excluded if (1) the population was not LGBTI+ inclusive; (2) the studies did not focus on original data or (3) the study was not available in full text. DATA EXTRACTION AND SYNTHESIS: The studies that met the inclusion criteria were assessed using the Critical Appraisal Skills Programme tool. A narrative synthesis was then completed employing content analysis focusing on the results section of each article. RESULTS: Of the 5656 records retrieved, 24 studies met the inclusion criteria. The majority of studies noted that both LGBTI+ youth and those who facilitate sexual health education are turning to online sources of information. Current sexual health education programmes operate mainly from a heterosexual perspective, creating a sense of exclusion for LGBTI+ youth. This is compounded by a lack of training, or provision of an inclusive curricula, resulting in facilitators feeling ill equipped or inhibited by their personal biases. CONCLUSIONS: LGBTI+ youth are not experiencing inclusive and comprehensive sexual health education. In parallel, educators report poor access to information, training and resources remain the primary reasons. There is a need to standardise sexual health curricula, making them LGBTI+ inclusive and incorporate holistic aspects of health such as pleasure and healthy relationships. Online approaches should be considered in the future, as they represent equality of access for both sexual health education professionals and LGBTI+ youth alike.

Vivências de atendimentos ginecológicos por mulheres lésbicas e bissexuais: (in)visibilidades e barreiras para o exercício do direito à saúde / Experiences of gynecological care by lesbian and bisexual women: (in)visibility and barriers to the exercise of the right to health

Resumo Embora lésbicas e mulheres bissexuais tenham sido incluídas nas políticas de saúde, na busca por uma atenção integral e que inclua o reconhecimento da diversidade sexual, a discriminação persiste nos espaços de atenção à saúde, especialmente nas consultas clínicas. Este trabalho, de vertente qualitativa, teve por objetivo discutir, a partir das percepções e vivências dessas mulheres, as relações estabelecidas nas consultas ginecológicas, abordando especificamente a (não) revelação da condição de lésbica/bissexual, as experiências com exames e orientações pertinentes à sexualidade e as dificuldades de negociação de condutas. A produção dos dados empíricos deu-se por meio de entrevistas semiestruturadas com doze lésbicas e cinco mulheres bissexuais. Os resultados apontam para a invisibilidade bissexual no contexto clínico, para as dificuldades na consulta ginecológica tanto para lésbicas quanto bissexuais e para o temor das mulheres quanto à exposição da orientação sexual, bem como o não reconhecimento de sua sexualidade. Nesse sentido, as consultas em ginecologia continuam centradas em pressupostos heteronormativos, preponderando aspectos reprodutivos em detrimento dos aspectos sexuais da vida.

Abstract Although lesbian and bisexual women have been included in health policies, in the search for comprehensive care, including the recognition of sexual diversity, discrimination persists in health care spaces, especially in clinical consultations. Based on the perceptions and experiences of these women, this qualitative study discusses, the relationships established in gynecological consultations, addressing the disclosure of the status of being lesbian/bisexual, experiences with exams and guidelines relevant to sexuality and the difficulties of negotiating conduct. The production of empirical data took place through semi-structured interviews with twelve lesbians and five bisexuals. The results point to bisexual invisibility in the clinical context. Difficulties in gynecological consultation involve fears regarding the exposure of sexual orientation, as well as the non-validation of their sexuality. Consultations in gynecology remain centered on heteronormative assumptions. Thus, they operate with a preponderance of reproductive aspects to the detriment of sexual aspects of life.

Applying a Capabilities Approach to Understanding Older LGBT People's Disclosures of Identity in Community Primary Care.

Internationally, there is increasing recognition that lesbian, gay, bisexual and trans (LGBT) populations experience substantial public health inequalities and require interventions to address these inequalities, yet data on this population is often not routinely collected. This paper considers the case study of the UK, where there are proposals to improve government and health data collection on LGBT populations, but also a degree of apparent uncertainty over the purpose and relevance of information about LGBT status in healthcare. This paper applies a health capabilities framework, arguing that the value of health information about LGBT status should be assessed according to whether it improves LGBT people's capability to achieve good health. We draw upon 36 older LGBT people's qualitative accounts of disclosing LGBT status within UK general practice healthcare. Participants' accounts of the benefits and risks of disclosure could be mapped against multiple domains of capability, including those that closely align with biomedical accounts (e.g., longevity and physical health), but also more holistic considerations (e.g., emotion and affiliation). However, across all domains, individuals tend to assess capabilities at an individual level, with relatively little reference to population-level impact of disclosure. Clearer articulation of the benefits of disclosure and data collection for the collective capabilities of LGBT populations may be a beneficial strategy for improving the quality of information on LGBT populations.

Severity of DSM-5 cannabis use disorders in a nationally representative sample of sexual minorities.

Background: Our study is the first using a national sample to examine the severity of Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) cannabis use disorder (CUD) in sexual minorities. Drawing from current literature, we expected that bisexual individuals would have the highest prevalence of CUD and the most severe form of CUD. Methods: The National Epidemiological Survey on Alcohol and Related Conditions-III (NESARC-III; 2012-2013) provides a nationally representative adult sample (N = 36,309), including one of the largest samples of sexual minorities. The NESARC-III is large enough to compare subpopulations of sexual minorities on dimensions of substance use disorder severity. Results: Lesbians and gay men were more likely to report mild CUD, whereas bisexuals and respondents "not sure" of their sexual identity were more likely to report severe CUD when compared with heterosexuals. Sexual minorities and heterosexuals who reported lifetime use of medical cannabis had higher odds of having a severe CUD. Sexual minorities had significantly higher odds of lifetime medical cannabis use (adjusted odds ratio [AOR] = 2.39, 95% confidence interval [CI] = 1.42-3.66, P < .001) when compared with heterosexuals, with bisexuals having the highest odds (AOR = 2.81, 95% CI = 1.66-4.75, P < .001). Conclusions: Sexual minorities have the highest odds compared with heterosexuals of developing any CUD. Moreover, the higher rates of severe CUD among bisexuals and those "not sure" have implications for drug prevention with these particularly high-risk groups. It appears that lifetime medical marijuana use may play a role in the development of CUD, although more rigorous measures of medical marijuana use are needed to determine the nature of the relations.

Exploring Religiosity and Spirituality in the Sexual Decision-Making of Black Gay and Bisexual Men.

Many Black gay and bisexual men (BGBM) practice consistent religious worship and spirituality in order to cope with social challenges. This study utilized data from in-depth qualitative interviews conducted to explore personal meanings of religiosity and spirituality and how these constructs affect partner choices and sexual behaviors among BGBM. Interviews were conducted with 26 BGBM in Los Angeles, California, from September to November 2015. In-depth interviews yielded themes related to BGBM's understanding of religiosity and spirituality and how their personal beliefs influenced their partner choices and sexual risks. Implications for church-based and community-based interventions are discussed.

Determining the Roles that Club Drugs, Marijuana, and Heavy Drinking Play in PrEP Medication Adherence Among Gay and Bisexual Men: Implications for Treatment and Research.

Researchers have established that substance use interferes with anti-retroviral medication adherence among gay and bisexual men (GBM) living with HIV. There is limited parallel examination of pre-exposure prophylaxis (PrEP) adherence among HIV-negative GBM. We conducted retrospective 30-day timeline follow-back interviews and prospective semi-weekly diary data for 10 weeks with 104 PrEP-using GBM, half of whom engaged in club drug use (ketamine, ecstasy, GHB, cocaine, or methamphetamine)-generating 9532 days of data. Participants reported their day-by-day PrEP, club drug, marijuana, and heavy alcohol use (5 + drinks in one sitting). On average, club drug users were no more likely to miss a dose of PrEP than non-club drug users (M = 1.6 doses, SD = 3.0, past 30 days). However, we found that club drug use (at the event level) increased the odds of missing a dose on the same day by 55% and the next day (e.g., a "carryover effect") by 60%. Further, missing a dose on one day increased the odds of missing a dose the following day by eightfold. We did not identify an event-level effect of marijuana use or heavy drinking on PrEP adherence. Our data suggest club drug users could have greater protective effects from daily oral or long-acting injectable PrEP compared to a time-driven PrEP regimen because of the concurrence of club drug use and PrEP non-adherence.