As Much As I Can - Utilizing Immersive Theatre to Reduce HIV-Related Stigma and Discrimination Toward Black Sexual Minority Men.

BACKGROUND: Despite advances in biomedical HIV prevention modalities such as pre-exposure prophylaxis to prevent the transmission of HIV, racial/ethnic and sexual/gender minority populations are disproportionately impacted by HIV epidemic. Alarming rates of HIV have persisted among Black gay and bisexual men, particularly in Southern states. METHODS: Utilizing data from the ViiV ACCELERATE! initiative, we explored the impact of As Much As I Can, an immersive theatre production, on HIV-related stigma behaviors. A self-administered post-performance survey was conducted with a cohort (n = 322) of randomly selected audience members. RESULTS: Overall, the results showed participants had a highly favorable experience, rating the performance with a mean score of 9.77/10. Respondents indicated they intended to change behaviors to promote HIV prevention education and to reduce stigma and discrimination including: (1) Say something if I hear stigmatizing language against people living with HIV (75.4%), (2) Say something if I hear anti-gay language (69.7%) and (3) Tell others about HIV prevention options (e.g., PrEP, PEP, condoms (64.1%). The findings show there is an association between HIV-related behavior intention and linkage to HIV care. Respondents who reported they were more likely to say something about HIV stigma were almost three times (O.R. 2.77; 95% C.I. 0.98-7.8) more likely to indicate they would follow up with a healthcare professional. CONCLUSIONS: This study suggests that immersive theatre is an effective method for communicating HIV prevention education and reducing HIV-related structural stigma and discrimination that increases HIV vulnerability for Black sexual minority men.

Lacunas e propostas de práticas educativas de saúde sexual e reprodutiva para população LGBTQIA+: revisão integrativa / Gap and proposals for educational practices of sexual and reproductive health for the LGBTQIA+ population: an integrative review / Lagunas y propuestas de prácticas educativas de salud sexual y reproductiva para la población LGBTQIA+: una revisión integrativa

Objetivo: analisar as publicações científicas nacionais sobre a atenção à saúde sexual e reprodutiva oferecida para população LGBTQIA+ com relação às principais lacunas e possibilidades das práticas educativas referentes a essa temática no contexto brasileiro. Método: revisão integrativa, em seis etapas, com busca dos estudos realizada em junho de 2022 nas bases de dados LILACS, MEDLINE, SCIELO e Web of Science e SCOPUS. Resultados: foram recuperados 5.643 estudos e selecionados 14 para análise e discussão. Destacaram-se os temas: saúde sexual e reprodutiva com foco na reprodução e nas técnicas reprodutivas, infecções sexualmente transmissíveis e educação em saúde sexual e, por fim, direitos sexuais e reprodutivos. Conclusão: foram evidenciadas as principais lacunas quanto ao tema de saúde sexual e reprodutiva, assim como sugestões para práticas educativas ligadas à temática.

Objective: to analyze national scientific publications on the attention to sexual and reproductive health offered to the LGBTQIA+ population about the main gaps and possibilities of educational practices referring to this topic in the Brazilian context. Method: integrative review in six stages, with two studies, carried out in June 2022 in the LILACS, MEDLINE, SCIELO Web of Science, and SCOPUS databases. Results: 5,643 studies were recovered 14 were selected for analysis and discussion. Highlights the topics: sexual and reproductive health with a focus on reproduction and techniques, sexually transmitted infections, education in sexual health, and finally sexual and reproductive rights. Conclusion: found highlighted the main gaps regarding the topics of sexual and reproductive health, as well as suggestions for educational practices.

Objetivos: analizar las publicaciones científicas nacionales sobre la atención a la salud sexual y reproductiva ofrecida para la población LGBTQIA+ con la relación con las principales lagunas y posibilidades de las prácticas educativas referentes a esa temática en el contexto brasileño. Método: revisión integrativa, en seis etapas, con búsqueda de estudios realizados en junio de 2022 en bases de datos LILACS, MEDLINE, SCIELO y Web of Science y SCOPUS. Resultados: foram recuperados 5.643 estudios y seleccionados 14 para análisis y discusión. Destacaram-se os temas: saúde sexual e reprodutiva com foco na reprodução e nas técnicas reproductivas, infecções sexualmente transmissíveis e educação em saúde sexual e, por fim, direitos sexuais e reprodutivos. Conclusión: foram evidenciadas como principales lagunas en cuanto al tema de salud sexual y reproductiva, así como sugerencias para prácticas educativas ligadas a temáticas.

La necesaria formación en competencia cultural / The necessary training in cultural competence

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Widespread closure of HIV prevention and care services places youth at higher risk during the COVID-19 pandemic.

BACKGROUND: Central to measuring the impact of the COVID-19 pandemic on HIV is understanding the role of loss of access to essential HIV prevention and care services created by clinic and community-based organization closures. In this paper, we use a comprehensive list of HIV prevention services in four corridors of the US heavily impacted by HIV, developed as part of a large RCT, to illustrate the potential impact of service closure on LGBTQ+ youth. METHODS: We identified and mapped LGBTQ+ friendly services offering at least one of the following HIV-related services: HIV testing; STI testing; PrEP/PEP; HIV treatment and care; and other HIV-related services in 109 counties across four major interstate corridors heavily affected by HIV US Census regions: Pacific (San Francisco, CA to San Diego, CA); South-Atlantic (Washington, DC to Atlanta, GA); East-North-Central (Chicago, IL to Detroit, MI); and East-South-Central (Memphis, TN to New Orleans, LA). RESULTS: There were a total of 831 LGBTQ+ youth-friendly HIV service providers across the 109 counties. There was a range of LGBTQ+ youth-friendly HIV-service provider availability across counties (range: 0-14.33 per 10,000 youth aged 13-24 (IQR: 2.13), median: 1.09); 9 (8.26%) analyzed counties did not have any LGBTQ+ youth-friendly HIV service providers. The Pearson correlation coefficient for the correlation between county HIV prevalence and LGBTQ+ youth-friendly HIV service provider density was 0.16 (p = 0.09), suggesting only a small, non-statistically significant linear relationship between a county's available LGBTQ+ youth-friendly HIV service providers and their HIV burden. CONCLUSIONS: As the COVID-19 pandemic continues, we must find novel, affordable ways to continue to provide sexual health, mental health and other support services to LGBTQ+ youth.

Facilitators and Barriers to Take Up Clinician-Collected and Self-Collected HPV Tests among Chinese Men Who Have Sex with Men.

Regular tests for human papillomavirus (HPV) and early treatment could represent an important strategy for preventing anal cancers among men who have sex with men (MSM). This study investigated facilitators and barriers to take up clinician-collected and self-collected HPV tests among Chinese MSM. This study was based on the baseline sample of a longitudinal study promoting HPV vaccination among 350 Chinese MSM who had never received an HPV vaccination. The baseline survey was conducted from August 2019 to April 2020. The prevalence of any HPV tests uptake in lifetime was 19.1%; 4.9% had HPV infection in anus, genital, oral cavity, and other places. Among the participants, 20% and 76.8% intended to take up self-financed and free clinician-collected HPV tests, and 76.8% intended to use free self-collected HPV tests. After adjusting for significant background characteristics, perceived risk of HPV infection, and perceived benefits, barriers, cue to action, and self-efficacy related to HPV tests in general and/or specific to self-collected HPV tests were associated with behavioral intention to take up free clinician-collected and/or self-collected HPV tests. Less than 20% of Chinese MSM reported HPV tests uptake. Modifying perceptions related to HPV tests may be useful to increase HPV tests coverage in this group.

Girl2Girl: How to develop a salient pregnancy prevention program for cisgender sexual minority adolescent girls.

INTRODUCTION: Although sexual minority girls are more likely than heterosexual girls to be pregnant during adolescence, programs tailored to their needs are non-existent. Here we describe the iterative development of Girl2Girl, a text messaging-based pregnancy prevention program for cisgender lesbian, gay, bisexual and other sexual minority (LGB+) girls across the United States. METHODS: Four activities are described: 1) 8 online focus groups to gain feedback about intended program components (n = 160), 2) writing the intervention content, 3) 4 online Content Advisory Teams that reviewed and provided feedback on the salience of drafted intervention content (n = 82), and 4) a beta test to confirm program functionality, the feasibility of assessments, and the enrollment protocol (n = 27). Participants were 14-18-year-old cisgender LGB+ girls recruited nationally on social media. Across study activities, between 52% and 70% of participants were 14-16 years of age, 10-22% were Hispanic ethnicity, and 30-44% were minority race. RESULTS: Focus group participants were positive about receiving text messages about sexual health, although privacy was of concern. Thus, better safeguards were built into the enrollment process. Teens in the Content Advisory Teams found the content to be approachable and compelling, although many wanted more gender-inclusive messaging. Messages were updated to not assume people with penises were boys. Between 71 and 86% of participants in the beta test provided weekly feedback, most of which was positive; no one withdrew during the seven-week study period. CONCLUSIONS: This careful step-by-step iterative approach appears to have resulted in a high level of intervention feasibility and acceptability.

An Assessment of Lesbian, Gay, Bisexual, and Transgender Health Competencies Among Bachelors-Prepared Registered Nurses in Graduate-Level Study.

PURPOSE: To assess graduate nursing students' lesbian, gay, bisexual, and transgender (LGBT)-specific health competencies. METHOD: Using a cross-sectional design, a 13-item multiple response survey, derived from The Joint Commission guidelines and LGBT health competencies proposed by the Association of American Medical Colleges, was administered online to 116 registered nurses enrolled in graduate study. Survey items assessed nurses' knowledge of LGBT health, professionalism, provision of patient care, communication skills, care environment, gaps in learning, and systems-based practice. Descriptive analyses were used to summarize frequencies and proportions of study variables. RESULTS: Respondent nurses' knowledge about health, prevalent conditions, and social factors that influence LGBT health was somewhat limited. Respondents did not rate their knowledge about LGBT health high (µ = 3.11 [1.1], median = 3) and did not feel qualified to educate other colleagues about LGBT health issues (µ = 2.43 [1.26], median = 2). But 58% (n = 65) indicated that they felt comfortable performing prostate exams on transgender female patients (born with male genitalia); 62% (n = 70) felt comfortable doing pap smears for transgender male patients (born with female genitalia). Sixty nurses (52%) stated that they would advocate reforms within existing health care institutions to improve the care of LGBT patients. Cultural competency training was offered in some health care settings and environmental indications of inclusivity were inconsistent. CONCLUSIONS: LGBT health competence among graduate nursing students was limited. There is a need to reevaluate LGBT health-related content in nursing curricula as well as robust assessment of competence in LGBT health.

Medical students' knowledge of and attitudes towards LGBT people and their health care needs: Impact of a lecture on LGBT health.

OBJECTIVES: Lesbian, gay, bisexual, and transgender (LGBT) adolescents have specific health care needs and are susceptible to health care disparities. Lack of skills and knowledge on the part of health care providers have a negative effect on their access to care and health outcomes. This study 1) explores the knowledge and attitudes of medical students regarding LGBT people, and 2) assesses the impact of a one-hour lecture targeting adolescent LGBT health needs. METHODS: Fourth-year medical students attended a compulsory one-hour lecture on sexual orientation and gender identity development in adolescence, highlighting health issues. We created a questionnaire with items to elicit students' knowledge and attitudes about LGBT health issues. Students were invited to complete this questionnaire online anonymously one week before the lecture and one month after the lecture. RESULTS: Out of a total of 157 students, 107 (68.2%) responded to the pre-intervention questionnaire and 96 (61.1%) to the post-intervention questionnaire. A significant proportion-13.7% of all respondents-identified as LGBT or questioning. Our results show that most medical students already show favorable attitudes towards LGBT people and a certain degree of knowledge of LGBT health needs. They demonstrated a large and significant increase in knowledge of LGBT health issues one month after the lecture. DISCUSSION: A single one-hour lecture on sexual orientation and LGBT health issues may increase knowledge among medical students. Medical students and professionals should receive such training to increase their knowledge about LGBT patients as it, together with favorable attitudes, has the potential to improve health outcomes among this vulnerable population.

Nursing students' perspectives on the inclusion of course content on lesbian, gay, bisexual, and transgender health in the nursing curriculum: A descriptive qualitative study.

The aim of the study was to examine nursing students' perspectives on why and how course contents on lesbian, gay, bisexual, and transgender health should be included in the nursing curriculum. This was a descriptive qualitative study. A purposive sample was used, and 17 students participated. Thematic analyses revealed four themes: "The need for knowledge and awareness"; "Communication"; "The need for practice-based learning"; and "Inclusion of course contents on lesbian, gay, bisexual and transgender health in the nursing curriculum". Almost all the students reported that the proportion of the course content that had been allocated to lesbian, gay, bisexual, and transgender health was inadequate and emphasized that it is necessary to improve both the theoretical and practical components of the nursing curriculum.

Gendered Expectations: Strategies for Navigating Structural Challenges in Support of Transgender and Nonbinary Trainees in Academic Medicine.

Members of the lesbian, gay, bisexual, transgender, and queer community experience marginalization, bias, and discrimination, including in the world of academic medicine. People who are transgender and nonbinary (TGNB) experience further marginalization compared with individuals who are lesbian, gay, bisexual, and queer. According to a recent survey, more than half of medical students who are TGNB chose not to disclose their gender identities during training due to fears of discrimination, feeling a lack of support, and concerns about future career options. Academic medicine has historically pathologized TGNB individuals, perpetuating discrimination structurally and reinforcing discriminatory behaviors of peers and faculty. In this Perspective, the authors provide a comprehensive overview of the challenges that administrators and educators face in creating a learning environment that is inclusive of TGNB trainees. They outline opportunities for change and provide strategies to address administrative and educational challenges, including those related to institutional climate, policies, data collection, physical spaces, health care, curriculum, mentoring, and the evaluation of TGNB trainees. Finally, the authors issue a call to action for medical educators and administrators to create environments in which trainees who are TGNB can fulfill their educational mission: to learn the practice of medicine.

If We Build It, Will They Come? Challenges of Adapting and Implementing a Smoking Cessation Program for the LGBTQ Community in Southcentral Texas.

Studies indicate that tobacco use among lesbian, gay, bisexual, transgender, or queer (LGBTQ) community members is consistently higher than the general population. The Last Drag is a tobacco cessation program developed and implemented in 1991 in San Francisco, California, that has shown promise in assisting LGBTQ members with tobacco cessation. This article describes the practical challenges of adapting The Last Drag to be implemented in a southcentral Texas community. Primary challenges included short time line to expected implementation, issues with culturally insensitive language, and barriers to participant recruitment. Acknowledging and overcoming these challenges can assist public health educators who are addressing tobacco cessation in LGBTQ populations.

The Normalization Project: The Progress and Limitations of Promoting LGBTQ Research and Teaching in Mainland China.

This article reflects on the author's own experience of promoting LGBTQ research and teaching in mainland China, where the fight for institutional legitimacy and recognition has been a core element in this journey. After a historical survey of how Chinese LGBTQ research has grown out of the particular sociopolitical milieu, it focuses on a discussion of the "normalization project"-a key approach to both create and expand the institutional space for LGBTQ studies. Apart from the positive effects this project entails, this article also critically examines its limitations by bringing into the picture certain critical perspectives.

25 Years On: The State and Continuing Development of LGBTQ Studies Programs.

This article serves as the introduction to "25 Years On: The State and Continuing Development of LGBTQ Studies Programs." It begins by placing the current issue in a commemorative context: marking the anniversary of a 1993 special issue of the Journal of Homosexuality dedicated to the emergence of "Gay and Lesbian Studies" and edited by Howard L. Minton. The introduction continues by providing an overview of early phases of academic transformations, primarily in the United States, with notes on particular legacies. This is followed by a brief survey of scholarship published since 1993 that pays particular attention to curricular and pedagogical concerns. It concludes by identifying themes articulated by the essays selected for this issue as well as commentary on their individual, yet richly interrelated, contributions.

"It's Not About You": Disappointment as Queer Pedagogy in Community-Engaged Service-Learning.

Increasingly popular in the neoliberal university, community-engaged service-learning (CESL) courses offer rich yet contradictory opportunities for LGBTQ studies students to synthesize queer critiques of community and identity with experiences in LGBTQ communities. Much CESL scholarship has focused on the tensions between benefits to community and to students, prioritizing either radical social change or student satisfaction. Beside such debates, I propose the queer ethical, pedagogical, and political value of disappointment in the tedium and contradictions of community itself. Such queer disappointment, I contend, might enable students to cultivate the emotional and critical capacities to engage in community work on sustainable, dedramatized, and unentitled terms.

Intersectionality Is Not a Choice: Reflections of a Queer Scholar of Color on Teaching, Writing, and Belonging in LGBTQ Studies and Academia.

Drawing on my experience as a queer, genderqueer, Puerto Rican counselor educator, this article considers how LGBTQAI+ studies and academia can expand to better include people with multiple marginalized identities. This article highlights some of the contradictions that educators face when engaging in the liberatory praxis that connects and creates a sense of belonging during these tumultuous times. This reflection suggests a decolonizing approach to intersectionality and highlights the importance of transcending binary discourse to engage in deconstructing the multiple layers of colonization in our internal and external spaces that is necessary for liberatory praxis. Finally, a few recommendations for how LGBTQAI+ studies and academia can support scholars with multiple marginalized identities are identified.

Addressing Cancer Disparities in SGM Populations: Recommendations for a National Action Plan to Increase SGM Health Equity Through Researcher and Provider Training and Education.

Reducing health disparities for sexual and gender minority (SGM) people is a priority of the National Institutes of Health. SGM populations face barriers in cancer prevention, treatment, and survivorship care. These barriers are due to deficits in researcher and provider training and education, as well as limited National Cancer Institute funding opportunities directed at the many different SGM populations. SGM status intersects with race and ethnicity, education, geography, and poverty to exacerbate disparities further. SGM cancer research will inform SGM patient cancer care guidelines and promote best practices in care among cancer providers. Cancer professionals may benefit from tailored training to enhance their research readiness for SGM cancer care. Research readiness can promote conduct of high-impact SGM cancer research and expand the limited knowledge of SGM cancer care disparities. Here, we propose a coordinated national plan for the training and education of health science researchers and oncology providers as a key strategy to reduce SGM cancer health disparities experienced along the cancer care continuum. We describe unrecognized clinical cancer care needs of SGM patients and unmet opportunities for research partnership and offer strategies for developing flexible educational training programs, courses, and workshops to prepare researchers and healthcare providers to promote health equity and quality cancer care for members of the SGM community.

Poor Queer Studies: Class, Race, and the Field.

This study asks, What are the material conditions under which queer studies is done in the academy? It finds a longstanding association of queer studies with the well-resourced, selective colleges and flagship campuses that are the drivers of class and race stratification in higher education in the U.S. That is, the field of queer studies, as a recognizable academic formation, has been structured by the material and intellectual resources of precisely those institutions that most steadfastly refuse to adequately serve poor and minority students, including poor and minority queer students. In response, "poor queer studies" calls for a critical reorientation of queer studies toward working-poor schools, students, theories, and pedagogies. Taking the College of Staten Island, CUNY as a case study, it argues for structural crossing over or "queer-class ferrying" between high-status institutions that have so brilliantly dominated queer studies' history and low-status worksites of poor queer studies.

Educating New Generations: Standpoints in Women's and Gender Studies and Implications for the Inclusion of LGBTQ Studies in Italian University Courses.

It should not be surprising that in Italy, one of the latest European countries to recognize same-sex couples, LGBTIQ+ concerns are not included in students' academic curricula. Therefore, following the historical path of gender studies (GS) and women's studies (WS), this article explores the current feminist and gender discourse in order to catch a glimpse of what will be needed to fill this gap. To clarify which women's and gender studies standpoints are taught to new generations in Italy, lexicometric and correspondence analysis were performed on the descriptions of universities courses teaching WS and GS perspectives. Although the international spread of these two perspectives in academia is still wide, the results indicate a consistent lack of these courses in Italian institutions of higher education and, moreover, separate viewpoints associated with the two perspectives.

Results and implications from a gender minority health education module for advance practice nursing students.

Nursing literature has recognized deficits in lesbian, gay, bisexual, transgender, queer-specific care. Of particular concern is lack of knowledge about gender minorities. Lack of knowledge remains despite this populations' increased health disparities. This pilot study investigates pre- and post-knowledge of medical guidelines, disparities, policies, and attitudes specific to gender minorities among advanced practice nursing students attending a gender minority health module. All participants in this pilot study completed a questionnaire on content and a transphobia scale to evaluate its effect on attitudes. Students were also surveyed on previous experience with gender minority patients. Students indicated sex and gender identity as female, with a mean age of 33.5 years. Twenty-seven percent of the students reported experience with gender minority patients. Wilcoxon signed rank test indicated statistically significant improvement in knowledge and improved scores on transphobia. This study demonstrated a module on the health of gender minorities is an effective method for increasing student knowledge of gender minority health care.