Discrimination, resilience, and HIV testing frequency among black women seeking services from STD clinics.

RATIONALE: In the United States, Black women are disproportionately affected by HIV, accounting for most new HIV infections diagnosed among women. Socio-structural barriers to HIV testing include stigma and discrimination but may be mitigated by resilience. OBJECTIVE: We aimed to examine the effect of discrimination and resilience on HIV testing behaviors among Black women. METHODS: Between 2016 and 2018, we conducted The ESSENCE Project, a retrospective cohort study on the role of physiological and environmental factors on the association between sexual assault and HIV risk among Black women in Baltimore, Maryland, USA. Black women aged 18-44 were recruited from public health STD clinics and completed an audio-computer-assisted self-interview survey. Hierarchical multiple negative binomial regression models were used to examine the associations of everyday discrimination (subtle and overt) and resilience on HIV testing frequency; resilience and its subscales (relational maintenance, personal fortitude, positive coping, independence and insight) were also examined as moderators. RESULTS: Among 236 Black women reporting HIV testing history, the median number of lifetime HIV tests was 4 (IQR = 2, 6). Mean everyday discrimination was 2.3 (SD = 1.2). Mean resilience was 5.3 (SD = 0.8). Everyday discrimination and its subscales (overt and subtle) were negatively associated with lifetime HIV testing frequency, while overall resilience was not associated with lifetime HIV testing frequency. Accounting for demographics, overall resilience moderated the association of subtle discrimination and lifetime HIV testing frequency. For the resilience subscales, more specifically: (1) associations of subtle discrimination and HIV testing frequency were significant at the lowest relational maintenance and lowest positive coping resilience; and (2) the association of subtle discrimination and HIV testing frequency was significant at the highest resilience for all four subscales. CONCLUSIONS: These findings highlight the need for provider- and community-level interventions addressing the deleterious effects of everyday discrimination and more specifically subtle everyday discrimination to encourage HIV testing.

Associations between LGBTQ+-supportive school and community resources and suicide attempts among adolescents in Massachusetts.

Supportive school and community resources are associated with reduced risk of suicidality among lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ +) adolescents as well as their cisgender, heterosexual peers. This study examined whether adolescents attending schools and living in communities with more versus fewer LGBTQ +-supportive resources were at lower risk of a past-year suicide attempt. Data on sexual orientation and past-year suicide attempt were obtained from student surveys administered in 30 Massachusetts public high schools between 2014 and 2017 (N = 20,790). Data on school resources were obtained from a questionnaire administered to school officials, and community resources were assessed through internet searching. Modified Poisson generalized estimating equations tested associations between school and community LGBTQ +-supports and suicide attempt separately by sex/gender, adjusting for student, school, and community covariates. Several school resources and the availability of community-wide LGBTQ +-supportive resources were associated with lower risk of a suicide attempt among several subgroups of students, even after controlling for the presence of multiple school and community resources and covariates. For example, the risk of a suicide attempt among gay, bisexual and questioning boys in schools with a gender-neutral restroom was approximately half compared to gay, bisexual and questioning boys in schools without this resource. Past year suicide attempts were also significantly lower among questioning, RR = 0.56, CI [0.37-0.86], and heterosexual, RR = 0.59, CI [0.50-0.68], girls living in communities with more supportive resources compared to those in communities with fewer resources. LGBTQ +-supportive resources in schools and communities may be beneficial for all adolescents regardless of sexual orientation. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Racial and Ethnic Differences in COVID-19 Outcomes, Stressors, Fear, and Prevention Behaviors Among US Women: Web-Based Cross-sectional Study.

BACKGROUND: In the United States, racial and ethnic minorities are disproportionately affected by COVID-19, with persistent social and structural factors contributing to these disparities. At the intersection of race/ethnicity and gender, women of color may be disadvantaged in terms of COVID-19 outcomes due to their role as essential workers, their higher prevalence of pre-existing conditions, their increased stress and anxiety from the loss of wages and caregiving, and domestic violence. OBJECTIVE: The purpose of this study is to examine racial and ethnic differences in the prevalence of COVID-19 outcomes, stressors, fear, and prevention behaviors among adult women residing in the United States. METHODS: Between May and June 2020, women were recruited into the Capturing Women's Experiences in Outbreak and Pandemic Environments (COPE) Study, a web-based cross-sectional study, using advertisements on Facebook; 491 eligible women completed a self-administered internet-based cross-sectional survey. Descriptive statistics were used to examine racial and ethnic differences (White; Asian; Native Hawaiian or other Pacific Islander; Black; Hispanic, Latina, or Spanish Origin; American Indian or Alaskan Native; multiracial or some other race, ethnicity, or origin) on COVID-19 outcomes, stressors, fear, and prevention behaviors. RESULTS: Among our sample of women, 16% (73/470) reported COVID-19 symptoms, 22% (18/82) were concerned about possible exposure from the people they knew who tested positive for COVID-19, and 51.4% (227/442) knew where to get tested; yet, only 5.8% (27/469) had been tested. Racial/ethnic differences were observed, with racial/ethnic minority women being less likely to know where to get tested. Significant differences in race/ethnicity were observed for select stressors (food insecurity, not enough money, homeschooling children, unable to have a doctor or telemedicine appointment) and prevention behaviors (handwashing with soap, self-isolation if sick, public glove use, not leaving home for any activities). Although no racial/ethnic differences emerged from the Fear of COVID-19 Scale, significant racial/ethnic differences were observed for some of the individual scale items (eg, being afraid of getting COVID-19, sleep loss, and heart racing due to worrying about COVID-19). CONCLUSIONS: The low prevalence of COVID-19 testing and knowledge of where to get tested indicate a critical need to expand testing for women in the United States, particularly among racial/ethnic minority women. Although the overall prevalence of engagement in prevention behaviors was high, targeted education and promotion of prevention activities are warranted in communities of color, particularly with consideration for stressors and adverse mental health.

"It makes such a difference": An examination of how LGBTQ youth talk about personal gender pronouns.

BACKGROUND AND PURPOSE: The World Health Organization has developed standards for youth-friendly health services to support adolescents and encourage health care utilization among youth. Necessary building blocks for youth-friendly care include strong interpersonal relationships between youth and health care providers. Nurse practitioners (NPs) may be particularly well positioned to form these relationships. This study explored a core aspect for building youth-provider relationships. The study examined how lesbian, gay, bisexual, transgender, and queer (LGBTQ) adolescents discussed use of personal pronouns (e.g., he, she, they, ze) in relation to transgender and gender diverse (TGD) people. METHODS: A secondary qualitative analysis of 66 in-depth interviews with LGBTQ youth from across Minnesota, Massachusetts, and British Columbia, Canada was conducted. Results were sorted into four main themes describing different aspects of personal pronoun use as related to TGD individuals. CONCLUSIONS: Stories and experiences shared by participants illustrate how to assess which pronouns to use for a given person, how to use pronouns in different contexts, why respecting pronouns is important to TGD people, and flexibility as an integral component of the learning process when it comes to appropriate pronoun use. IMPLICATIONS FOR PRACTICE: Understanding how youth discuss personal pronouns could improve practice with TGD youth. Each of the four themes can be applied to clinical encounters to ensure culturally sensitive care. Practice recommendations include asking adolescents what pronouns they prefer clinic staff to use on intake forms and having NPs and clinic staff provide their own pronouns to patients in introductions.