COVID-19 Information, Trust, and Risk Perception Across Diverse Communities in the United States: Initial Findings from a Multistate Community Engagement Alliance (CEAL).

Objectives. To provide initial findings from Community Engagement Alliance (CEAL), a multistate effort funded by the National Institutes of Health, to conduct urgent community-engaged research and outreach focused on COVID-19 awareness, education, and evidence-based response. Methods. We collected survey data (November 2020-November 2022) from 21 CEAL teams from 29 state and regional CEAL sites spanning 19 US states, the District of Columbia, and Puerto Rico, which covered priority populations served and trusted sources of information about COVID-19, including prevention behaviors, vaccination, and clinical trials. Results. A disproportionate number of respondents were Latino (45%) or Black (40%). There was considerable variability between CEAL sites regarding trusted sources of information, COVID-19 prevention, and COVID-19 vaccination. For example, more respondents (70%) reported health care providers as a trusted source of COVID-19 information than any other source (ranging from 6% to 87% by site). Conclusions. CEAL rapidly developed novel infrastructure to engage academic, public health, and community organizations to address COVID-19's impacts on underserved communities. CEAL provides an example of how to respond in future public health emergencies to quickly promote trustworthy, evidence-based information in ways that advance health equity. (Am J Public Health. 2024;114(S1):S112-S123. https://doi.org/10.2105/AJPH.2023.307504).

Bearing (Aguantando) With Intimate Partner Violence: A Grounded Theory Study of Self-Silencing Among Hispanic Women Who Experienced Intimate Partner Violence.

Hispanic women who experience intimate partner violence (IPV) face unique disparities. They have poorer health outcomes and are less likely to seek help than their non-Hispanic counterparts. When women remain in relationships where IPV occurs and refuse to disclose or seek treatment, they may resort to self-silencing, which can also worsen health outcomes. The purpose of this study was to develop a theory that explains how self-silencing evolves among Hispanic women who experience IPV. Participants were recruited from two research studies focused on Hispanic women's health, and from snowball sampling, which involved referrals by previously registered participants. Data were collected via Zoom® and included individual interviews. A total of 25 women participated in this study. Analysis followed constructive grounded theory levels of analysis described by Charmaz and constant comparative methods described by Glaser and Strauss. A grounded theory entitled Bearing (Aguantando) With Intimate Partner Violence emerged from the data. The theory explains the main strategy Hispanic women use to deal with violence while remaining in a relationship where IPV occurs. The theory is constructed of four categories with subcategories. The results of this study provide an initial framework to understand the self-silencing process among Hispanic women who experience IPV. In addition, this study identifies different levels of interventions that can be useful for researchers and healthcare providers to promote Hispanic women's ability to become empowered, use their voices, and seek help.

Factors associated with latino sexual minority men's likelihood and motivation for obtaining a COVID-19 vaccine: a mixed-methods study.

Minoritized communities are underreached by biomedical interventions, such as the COVID-19 vaccine. This mixed-methods study identified factors associated with vaccine likelihood (VL) and uptake (VU) among 187 Latino sexual minority men (LSMM) in South Florida. Regression models with LASSO variable selection and Classification and Regression Trees (CART) assessed determinants of VL and VU while open-ended questions were evaluated using thematic content analysis. VL (range 1-7; M = 6.00, SD = 1.84) and VU (63.6%) was high. LASSO modeling identified being insured, worrying about others, fear of transmitting COVID-19, and financial stress as the most influential factors for VL; working remotely from home was important for VU. Time (weeks) since addition of COVID-19 vaccination-related questions (December 2nd, 2020) was associated with both outcomes across both modeling techniques. Convergence between data suggests capitalizing on altruistic motivations and improving accessibility to vaccine campaigns are valuable assets to increase LSMM's vaccine confidence.

Trusted Sources of Information and COVID-19 Vaccine Uptake in a Sample of Latinx Sexual and Gender Minorities in South Florida.

OBJECTIVE: To examine factors associated with COVID-19 vaccine uptake in a sample of Latino/a/x sexual and/or gender minority (SGM) individuals in South Florida. DESIGN: Data were collected via an online survey from March 2021 to August 2022, as part of the Community Engagement Alliance Against COVID-19 Disparities. A multivariate regression analysis was fit using completion of a COVID-19 vaccine regimen as the outcome. Key covariates included trusted sources of information (eg, doctor, media), COVID-19-related challenges (eg, accessing medication, transportation), and dominant wave of SARS-CoV-2 at the time of data collection. SETTING: Miami-Dade and Broward counties, Florida. RESULTS: White Latino/a/x, bachelor's educated respondents, and those with high levels of trust in community organizations had significantly greater odds of vaccination. CONCLUSION: Community organizations may be key to improving vaccine uptake among marginalized Latino/a/x SGM for COVID-19 and other emerging communicable diseases, such as meningitis and Mpox (monkeypox). The results of this study suggest that tailored public health messaging and additional funding for vaccine distribution are needed to better equip community organizations with the resources they need to serve this population.

Correlates of Substance Misuse, Transactional Sex, and Depressive Symptomatology Among Partnered Gay, Bisexual and Other Men Who Have Sex with Men in South Africa and Namibia.

Despite having some of the world's highest rates of HIV, there is a lack of knowledge on correlates of transmission risk among gay, bisexual and other men who have sex with men in Southern Africa. There is even less known about the factors that shape HIV risk in male-male couples. Using data from Together Tomorrow, a study of partnered GBMSM in South Africa and Namibia, this study assessed the individual and dyadic correlates of three major HIV risk factors in this population: substance misuse, transactional sex, and depressive symptomatology. Data were collected during November 2016-March 2017 via a quantitative survey conducted with 140 partnered MSM (70 couples) in Windohoek, Keetmanshoop, Walvis Bay, and Swakopmund, Namibia and 300 partnered MSM (150 couples) in Pietermaritzburg and Durban, KwaZulu-Natal, South Africa for a total sample size of 440 partnered MSM (220 couples). Results of multilevel modeling analyses show several significant factors present in partnered GBMSM that differ from studies of single GBMSM, with intimate partner violence being a significant correlate across all three risk factors. Future interventions should consider dyadic approaches and integrate IPV prevention and mitigation efforts to reduce HIV in this population as part of a multisectoral approach. To reduce rates of HIV in partnered GBMSM in Namibia and South Africa multilevel, multisectoral work is needed in policy, social norms change, and relationship-focused dyadic interventions to reduce the social and structural stigma facing male couples.

Family support modifies the effect of changes to same-sex marriage legislation on LGB mental health: evidence from a UK cohort study.

BACKGROUND: Many lesbian, gay and bisexual (LGB) individuals continue to experience unique challenges, such as the lack of family support and access to same-sex marriage. This study examines the effect of the introduction of same-sex marriage in the UK (2013-14) on mental health functioning among sexual minorities, and investigates whether low family support may hamper the positive effects of marriage equality legislation among LGB individuals. METHODS: This analysis included LGB participants (n = 2172) from the UK household longitudinal study waves 3-7, comprising two waves before and two waves after marriage equality legislation passed in England, Wales and Scotland. Individual-level mental health functioning was measured using the mental component score (MCS-12) of the Short Form-12 survey. Fixed-effect panel linear models examined the effect of marriage equality on MCS-12 across varying family support levels. Analyses included adjustment for covariates and survey weights. RESULTS: Legalization of same-sex marriage was independently associated with an increase of 1.17 [95% confidence interval (CI): 0.28-2.05] MCS-12 in men and 1.13 (95% CI: 0.47-2.27) MCS-12 in women. For men, each additional standard deviation of family support modified the effect of legalization on mental health functioning by +0.70 (95% CI: 0.22-1.18) MCS-12 score. No interaction was found in women. CONCLUSIONS: Our findings provide evidence that same-sex marriage will likely improve LGB mental health functioning, and these effects may be generalizable to other European countries. Since male sexual minorities with low family support benefited the least, additional interventions aimed at improving family support and acceptance of this group is required to help reduce mental health disparities.

Provider attitudes towards a brief behavioral intervention for sexual health in Moldova.

BACKGROUND: Brief behavioral interventions are seen as an efficient way to improve knowledge, change behavior, and reduce provider stigma regarding sexual health. When grounded in evidence-based behavioral change techniques and delivered using Brief Sexuality-related Communication (BSC) tools, brief behavioral interventions can address client-driven sexual health goals in a single session with their provider. Evidence for the efficacy of brief interventions for creating gains in sexual health comes largely from resource rich settings, and there is a lack of knowledge of how brief interventions can be implemented in the more resource constrained environments of low- and middle-income countries. As a first step in developing a brief intervention to address sexual health issues in Moldova, this paper reports on qualitative data collected from Moldovan providers to understand their attitudes, willingness and perceived barriers to the brief intervention and its implementation. METHODS: Thirty-nine in-depth interviews (IDI) were conducted between February and March 2020, with health providers recruited from three primary health care institutions, two Youth Friendly Health Centers and counselors from three NGOs who work with key populations in Moldova, including health centers selected from two cites - the capital city, Chisinau and from the Comrat Region. The IDI addressed four domains of provider attitudes: 1) attitudes towards the intervention; 2) willingness and motivation to implement the intervention; 3) logistics of providing the intervention and 4) ability to implement the intervention. A coding analysis approach was applied to all interview transcripts. RESULTS: Providers largely reported being willing to be trained in and implement the brief intervention. Willingness to implement the intervention stemmed from two perceptions: that it would improve the ability of providers to talk with their clients about sex, and that vulnerable groups would benefit from these conversations. However, while there were generally positive attitudes towards the intervention, providers consistently reported structural barriers to their perceived ability to implement the intervention. CONCLUSIONS: While providers reported high levels of initial acceptance of a brief behavioral intervention, care is needed to ensure that brief interventions, and the training of providers on brief interventions, incorporate cultural attitudes and norms around sex, particularly in highly patriarchal settings, and provide opportunities for providers to practice the intervention in ways that address their assumptions and implicit biases.

Design and Development of a Suite of Intimate Partner Violence Screening and Safety Planning Web Apps: User-Centered Approach.

BACKGROUND: The popularity of mobile health (mHealth) technology has resulted in the development of numerous apps for almost every condition and disease management. mHealth and eHealth solutions for increasing awareness about, and safety around, intimate partner violence are no exception. These apps allow women to control access to these resources and provide unlimited, and with the right design features, safe access when these resources are needed. Few apps, however, have been designed in close collaboration with intended users to ensure relevance and effectiveness. OBJECTIVE: The objective of this paper is to discuss the design of a suite of evidence-based mHealth and eHealth apps to facilitate early identification of unsafe relationship behaviors and tailored safety planning to reduce harm from violence including the methods by which we collaborated with and sought input from a population of intended users. METHODS: A user-centered approach with aspects of human-centered design was followed to design a suite of 3 app-based safety planning interventions. RESULTS: This review of the design suite of app-based interventions revealed challenges faced and lessons learned that may inform future efforts to design evidence-based mHealth and eHealth interventions. CONCLUSIONS: Following a user-centered approach can be helpful in designing mHealth and eHealth interventions for marginalized and vulnerable populations, and led to novel insights that improved the design of our interventions.

SEX COMPOSITION OF TWINS AND ASSOCIATIONS WITH MORBIDITY, MORTALITY AND MATERNAL TREATMENT-SEEKING OUTCOMES IN RESOURCE-POOR SETTINGS.

Societal gender inequality and a preference for male children has been shown to be detrimental to girls' health. This is despite females' innate biological advantage early in life. The negative effects of gender inequity on female health are most pronounced in resource-poor countries, where cultural norms supporting a preference for male children are strongest. However, most of what is known about gender inequality and child health comes from studies of singleton births. There is little evidence for how, or if, the disadvantages associated with gender bias and son preference extend to multiple births, a population inherently at risk for a number of health challenges. This analysis examines whether gender bias in health outcomes exists for twins. Data on live twin births from 38 Demographic and Health Surveys were compiled (n=11,528 individuals) and twins were categorized as girl/girl, girl/boy, boy/girl or girl/girl. Gender inequality was measured via the Gender Inequality Index. Multilevel logistic regression models examined associations between twin sex composition, gender inequality and eight outcomes of infant and child morbidity, mortality and mother's treatment-seeking behaviours. Twin pairs containing girls had significantly lower odds of first-year mortality. Higher country-level gender inequality was associated with higher odds of reporting diarrhoea and fever/cough, as well as an increased odds of post-neonatal mortality. Results suggest that the biological advantage for females may be stronger than son preference and gender inequality in the first year of life. Understanding these relationships has the potential to inform efforts to curb the influence of gender preference on the health of female children in resource-poor settings.

Social Stressors and Intoxicated Sex Among an Online Sample of Men who have Sex with Men (MSM) Drawn from Seven Countries.

BACKGROUND: Rates of drug and alcohol use are higher among men who have sex with men (MSM) than the general adult male population, and are often associated with increased sexual risk-taking. OBJECTIVES: We aim to examine the prevalence of drunk or high sex and their associations with socio-demographic characteristics, gay social network size, and social stress among an online sample of MSM drawn from seven countries. METHODS: Sexually-active MSM aged over 18 residing in Australia, Brazil, Canada, South Africa, Thailand, the United Kingdom, or the United States were recruited through Facebook for a quantitative survey (n = 2,403) in 2012. Two outcomes were examined via logistic regression: reporting being buzzed/drunk at last sex, and reporting being high at last sex. RESULTS: Results highlight the role of social stressors in shaping drug use among MSM. Results were context-specific, though commonalities were seen across countries. Being in a male-male sexual relationship was associated with lower odds of being buzzed/drunk at last sex in five countries. Higher scores on measures of external homonegative discrimination and internalized homonegativity were associated with greater odds of reporting being high at last sex in three countries. Conclusions/Importance: Social networks and minority stressors can have significant effects on drug use and sex while drunk or high. This points to the importance of focusing on structural issues when designing interventions for MSM aimed at reducing the transmission of HIV and other STIs.

Intimate partner violence is linked to less HIV testing uptake among high-risk, HIV-negative women in Atlanta.

Increased risk of HIV acquisition among intimate partner violence (IPV) survivors underscores the need for regular HIV testing, but IPV-associated shame, stigma, and control may hinder uptake. Between March and November 2014, we conducted a cross-sectional study of 79 HIV-negative, high-risk women aged 18-50 in Atlanta, Georgia, to explore whether IPV experience was associated with less uptake of HIV testing, and fewer motivations and more reported barriers to HIV testing uptake. Psychological and physical and/or sexual abuse was significantly associated with less past-year HIV testing (p = .022 and p = .030, respectively), longer time since last HIV test (r = 0.282, p = .012, and r = 0.282, p = .012, respectively), and more reported barriers to HIV testing (r = 0.406, p = .004, and r = 0.389, p = .006). While requiring further validation, these preliminary findings suggest IPV survivors need additional support to access HIV testing services.

How the Community Shapes Unmet Need for Modern Contraception: An Analysis of 44 Demographic and Health Surveys.

Unmet need for modern contraception is a major public health concern in resource-constrained countries. Recent research supports the application of social-ecological theories to explain how characteristics of a woman's community shape modern contraception use. However, this research focuses largely on individual countries and uses a limited number of community-level effects. We fitted three random-effects logistic regression models to examine associations between 13 community-level variables and the odds of reporting unmet need, unmet need for spacing, and unmet need for limiting for all parous, female respondents in 44 DHS surveys collected in 2010-2015 (n=528,101). Community variables explain significant variance in unmet need between communities. Associations between community variables and unmet need differ by urban and rural residence. The results highlight several commonalities in how the community shapes unmet need across resource-constrained settings and may help in designing structural-level interventions.

Disclosure of Sexual Orientation and Uptake of HIV Testing and Hepatitis Vaccination for Rural Men Who Have Sex With Men.

PURPOSE: The decision and ability of primary care clinician to make recommendations for routine human immunodeficiency virus (HIV) testing and hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccines are shaped by knowledge of their patient's risk behaviors. For men who have sex with men, such knowledge requires disclosure of same-sex sexual behavior or sexual identity. METHODS: Data were analyzed from a national survey of rural men who have sex with men (N = 319) to understand whether the disclosure of sexual identity to clinicians was associated with increased uptake of HIV testing and hepatitis vaccinations. RESULTS: We found that disclosure of sexual identity to clinicians was significantly associated (OR = 1.26; 95% CI, 1.08-1.47) with uptake of routine HIV testing and HAV/HBV vaccination. CONCLUSION: Our finding reinforces the need for safe, nonjudgmental settings for patients to discuss their sexual identities freely with their clinicians.

Violence Victimization and Depressive Symptoms Among a Sub-Sample of Sexual and Gender Minority Adults in a Population-Based South African Study.

Sexual and gender minority (SGM) adults in South Africa face high levels of violence and poor mental health outcomes. Interventions to prevent these negative health implications are hampered by a lack of representative data among this population. This study aims to quantify the associations between three forms of violent victimization and depressive symptoms in a sub-sample of SGM drawn from a population-based cross-sectional study in Gauteng, South Africa. Data come from the sixth Quality of Life survey conducted in South Africa's Gauteng province. Brief screeners assessed childhood sexual abuse (CSA), past-year intimate partner violence (IPV), non-partner violence, and depressive symptoms. Three survey-weighted logistic regression analyses were fit to model associations between elevated depressive symptoms and CSA, past-year IPV, and past-year non-partner violence, controlling for socio-demographics (age, race, sex, area of residence, education, socioeconomic status, and recent employment). N = 1,328 SGM respondents were included. Over 40% (n = 537) reported depressive symptoms, while 17% (n = 222) reported CSA, 5% (n = 67) reported IPV, and 16% (n = 208) reported non-partner violence. CSA and non-partner violence were associated with significantly higher odds of reporting depressive symptoms (aOR: 1.51, 95% CI [1.03, 2.23]; aOR: 1.84, [1.24, 2.73], respectively). IPV was not associated with elevated depressive symptoms (aOR: 1.17, [0.64, 2.16]). In all models, employment in the past 7 days was associated with significantly lower odds of reporting depressive symptoms. Recent and childhood violence is a major burden that is associated with elevated symptoms of depression among SGM in urban South Africa. Community-tailored interventions and policy-related advocacy related to employment and violence prevention may alleviate depressive symptoms in SGM adults in Gauteng.

Swipe Left on Sexual Harassment: Understanding and Addressing Technology-Facilitated Sexual Violence on Dating Apps.

Dating violence is a pervasive issue that has become increasingly complex to address as technologies mediating interpersonal connections become more widely utilized. The incidence and ways in which violence manifests through digital media are not fully understood. This study aimed to better understand the relationship between geolocational dating apps like Tinder, Bumble, and Grindr and technology-facilitated sexual violence (TFSV) among university students. An anonymous survey was electronically administered to a convenience sample of 1,000 undergraduates at a large private university in the southeastern United States. Participants indicated their dating app usage and the frequency of specific TFSV experiences they had encountered. Chi-square tests were conducted to identify relationships between demographic characteristics and experiences of TFSV. Multivariate logistic regression was conducted to predict TFSV based on respondent characteristics. A total of 910 respondents completed the survey, with more than half (54%) of respondents reporting some type of TFSV while using dating apps. Women and non-heterosexual students experience significantly more TFSV than male and heterosexual students. While participants' academic year (first-year through senior) and participation in extracurricular activities were not associated with TFSV, dating app selection was a significant predictor of the likelihood to report TFSV, with Grindr users being significantly more likely to report. Major Implications Due to the near-ubiquitous use of dating apps in this population, interventions to address campus social norms, comprehensive sexuality education, and consent education, and improved regulation of TFSV by technology companies should be implemented- especially for cisgender, heterosexual women, and gender and sexual minorities.

Intimate partner violence is related to future alcohol use among a nationwide sample of LGBTQIA+ people: Results from The PRIDE Study.

BACKGROUND: Lesbian, gay, bisexual, transgender, queer, intersex, aromantic and asexual (LGBTQIA+) communities in the United States experience higher rates of alcohol use than the general population. While experiencing intimate partner violence (IPV) is thought to lead to increased alcohol use in LGBTQIA+ people, little research has investigated the temporal relationship between IPV and alcohol use in this population. METHODS: Data from two annual questionnaires of The Population Research in Identity and Disparities for Equality Study (The PRIDE Study) longitudinal cohort (n=3,783) were included. Overall IPV and three sub-types (physical, sexual, and emotional) - measured in 2021 using the extended Hurt, Insult, Threaten, Scream (E-HITS) screening tool - was examined as a predictor of Alcohol Use Disorders Identification Test (AUDIT) score in 2022 using multivariable linear regression to assess linear and quadratic associations. Models were adjusted for sociodemographic characteristics and history of alcohol use. RESULTS: One-quarter (24.7%) of respondents reported experiencing past-year IPV in 2021. The mean AUDIT score in 2022 was 3.52 (SD = 4.13). In adjusted models, both linear (B: 0.26, 95% CI: 0.14, 0.38) and quadratic (B: -0.03, 95% CI: -0.04, -0.01) terms for overall IPV were significantly associated with next-year AUDIT score. These patterns were mirrored in each IPV sub-type, were not attenuated when accounting for relationship characteristics, and were heterogeneous across gender identity groups. CONCLUSIONS: These results provide evidence of a temporal relationship between IPV and alcohol use in LGBTQIA+ communities, suggesting that efforts to prevent and mitigate IPV may help reduce alcohol use disparities in this population.

Strategies to Prevent Violence Against Children in the Home: A Systematic Review of Reviews.

Violence against children (VAC) in the home, or by household members, is a human rights and social problem with long-lasting consequences for individuals and society. Global policy instruments like the INSPIRE package have proposed strategies to prevent VAC, including Implementation and enforcement of laws, Norms and values, Safe environments, Parent and caregiver support, Income and economic strengthening, Response and support services, and Education and life skills. This systematic review of reviews aimed to synthesize the recent evidence base (i.e., published since 2000) for each INSPIRE strategy to reduce VAC in the home or by household members. We searched four databases using controlled vocabularies and keywords and searched for additional records in prior reviews of reviews. A total of 67 studies were included in this review, including literature reviews, meta-analyses, systematic reviews, and other types of reviews. We found extensive evidence supporting the effectiveness of parent and caregiver support interventions. However, reviews on other INSPIRE strategies were scarce. We also found a vast underrepresentation of samples from low- and- middle-income countries, children with disabilities, and families affected by forced displacement and conflict. In sum, this systematic review suggests that there are several promising strategies to prevent VAC (e.g., home visiting and parent education), but further research is necessary to strengthen the current body of evidence and effectively inform the implementation and scale-up of evidence-based interventions to protect children from violence globally.

Prevalence, Determinants, and Trends in the Experience and Perpetration of Intimate Partner Violence Among a Cohort of Gay, Bisexual, and Other Men Who Have Sex with Men in Montréal, Toronto, and Vancouver, Canada (2017-2022).

Purpose: Longitudinal data on the experience and perpetration of intimate partner violence (IPV) among gay, bisexual, and other men who have sex with men (GBM) are limited. We estimated the prevalence of past 6-month (P6M) physical and/or sexual IPV (hereafter IPV) experience and perpetration, identified their determinants, and assessed temporal trends, including the impact of the coronavirus disease (COVID)-19 pandemic. Methods: We used data from the Engage Cohort Study (2017-2022) of GBM recruited using respondent-driven sampling in Montréal, Toronto, and Vancouver. Adjusted prevalence ratios (aPRs) for determinants and self-reported P6M IPV were estimated using generalized estimating equations, accounting for attrition (inverse probability of censoring weights) and relevant covariates. Longitudinal trends of IPV were also assessed. Results: Between 2017 and 2022, 1455 partnered GBM (median age 32 years, 82% gay, and 71% White) had at least one follow-up visit. At baseline, 31% of participants experienced IPV in their lifetime and 17% reported ever perpetrating IPV. During follow-up, IPV experience was more common (6%, 95% confidence interval [CI]: 5%-7%) than perpetration (4%, 95% CI: 3%-5%). Factors associated with P6M IPV experience included prior IPV experience (aPR: 2.68, 95% CI: 1.76-4.08), lower education (aPR: 2.31, 95% CI: 1.32-4.04), and substance use (injection aPR: 5.05, 95% CI: 2.54-10.05, non-injection aPR: 1.68, 95% CI: 1.00-2.82). Similar factors were associated with IPV perpetration. IPV was stable over time; periods of COVID-19 restrictions were not associated with IPV changes in this cohort. Conclusion: Prevalence of IPV was high among GBM. Determinants related to marginalization were associated with an increased risk of IPV. Interventions should address these determinants to reduce IPV and improve health.

LGBTQIA+ inclusion in the global health policy agenda: A critical discourse analysis of the Lancet Commission report archive.

CONTEXT: LGBTQIA+ people worldwide experience discrimination, violence, and stigma that lead to poor health outcomes. Policy plays a crucial role in ensuring health equity and safety for LGBTQIA+ communities. Given Lancet Commissions' substantial impact on health policy across domains, we aimed to determine how LGBTQIA+ communities and their care needs are incorporated throughout Lancet Commission reports and recommendations. METHODS: Using critical discourse analysis, we analyzed 102 Commissions for inclusion of and reference to LGBTQIA+ communities using 36 key terms. Three levels of analysis were conducted: 1) micro-level (overview of terminology use); 2) meso-level (visibility and placement of LGBTQIA+ references); and 3) macro-level (outlining characterizations and framing of references with consideration of broader social discourses). FINDINGS: 36 of 102 (35%) Commissions referenced LGBTQIA+ communities with 801 mentions in total. There were minimal (9/36) references made in the "Executive Summary," "Recommendations," and/or "Key Messages" sections of reports. LGBTQIA+ communities were most frequently discussed in reports related to HIV/AIDS and sexual and reproductive health. Few Commissions related to public health, or chronic conditions (9/60) referenced LGBTQIA+ communities. Some reports made non-specific or unexplained references; many discussed the LGBTQIA+ population without specific reference to sub-groups. LGBTQIA+ communities were often listed alongside other marginalized groups without rationale or a description of shared needs or experiences. We identified framings (legal, vulnerability, risk) and characterizations (as victims, as blameworthy, as a problem) of LGBTQIA+ communities that contribute to problematizing discourse. CONCLUSIONS: LGBTQIA+ people were rarely included in the Commissions, resulting in an inadvertent marginalization of their health needs. Policy initiatives must consider LGBTQIA+ groups from a strengths-based rather than problematizing perspective, integrating evidence-based approaches alongside community-based stakeholder engagement to mitigate inequities and promote inclusive care and policymaking.