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2.
Lancet ; 397(10279): 1151-1156, 2021 03 20.
Artículo en Inglés | MEDLINE | ID: mdl-33617770

RESUMEN

With more than 1·2 million people living with HIV in the USA, a complex epidemic across the large and diverse country, and a fragmented health-care system marked by widening health disparities, the US HIV epidemic requires sustained scientific and public health attention. The epidemic has been stubbornly persistent; high incidence densities have been sustained over decades and the epidemic is increasingly concentrated among racial, ethnic, and sexual and gender minority communities. This fact remains true despite extraordinary scientific advances in prevention, treatment, and care-advances that have been led, to a substantial degree, by US-supported science and researchers. In this watershed year of 2021 and in the face of the COVID-19 pandemic, it is clear that the USA will not meet the stated goals of the National HIV/AIDS Strategy, particularly those goals relating to reductions in new infections, decreases in morbidity, and reductions in HIV stigma. The six papers in the Lancet Series on HIV in the USA have each examined the underlying causes of these challenges and laid out paths forward for an invigorated, sustained, and more equitable response to the US HIV epidemic than has been seen to date. The sciences of HIV surveillance, prevention, treatment, and implementation all suggest that the visionary goals of the Ending the HIV Epidemic initiative in the USA might be achievable. However, fundamental barriers and challenges need to be addressed and the research effort sustained if we are to succeed.


Asunto(s)
Epidemias/prevención & control , Infecciones por VIH/epidemiología , Implementación de Plan de Salud/organización & administración , Administración en Salud Pública , Grupos de Población Continentales/estadística & datos numéricos , Monitoreo Epidemiológico , Grupos Étnicos/estadística & datos numéricos , Infecciones por VIH/terapia , Disparidades en el Estado de Salud , Humanos , Grupos Minoritarios/estadística & datos numéricos , Minorías Sexuales y de Género/estadística & datos numéricos , Estigma Social
3.
JAMA Netw Open ; 4(2): e2036136, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33528552

RESUMEN

Importance: Medical trainee burnout is associated with poor quality care and attrition. Medical students in sexual minority groups report fear of discrimination and increased mistreatment, but the association between sexual orientation, burnout, and mistreatment is unknown. Objective: To evaluate whether medical student burnout differs by sexual orientation and whether this association is mediated by experiences of mistreatment. Design, Setting, and Participants: This cross-sectional study surveyed US medical students graduating from Association of American Medical Colleges (AAMC)-accredited US allopathic medical schools who responded to the AAMC graduation questionnaire in 2016 and 2017. Statistical analyses were performed from March 15, 2019, to July 2, 2020, and from November 20 to December 9, 2020. Main Outcomes and Measures: Burnout was measured using the Oldenburg Burnout Inventory for Medical Students, and sexual orientation was categorized as either heterosexual or lesbian, gay, or bisexual (LGB). Logistic regression models were constructed to evaluate the association between sexual orientation and experiencing burnout (defined as being in the top quartile of exhaustion and disengagement burnout dimensions) and to test the mediating association of mistreatment. Results: From 2016 to 2017, 30 651 students completed the AAMC Graduation Questionnaire, and 26 123 responses were analyzed. Most respondents were younger than 30 years (82.9%) and White (60.3%). A total of 13 470 respondents (51.6%) were male, and 5.4% identified as LGB. Compared with heterosexual students, a greater proportion of LGB students reported experiencing mistreatment in all categories, including humiliation (27.0% LGB students vs 20.7% heterosexual students; P < .001), mistreatment not specific to identity (17.0% vs 10.3%; P < .001), and mistreatment specific to gender (27.3% vs 17.9%; P < .001), race/ethnicity (11.9% vs 8.6%; P < .001), and sexual orientation (23.3% vs 1.0%; P < .001). Being LGB was associated with increased odds of burnout (adjusted odds ratio, 1.63 [95% CI, 1.41-1.89]); this association persisted but was attenuated after adjusting for mistreatment (odds ratio, 1.36 [95% CI, 1.16-1.60]). The odds of burnout increased in a dose-response manner with mistreatment intensity. Lesbian, gay, or bisexual students reporting higher mistreatment specific to sexual orientation had and 8-fold higher predicted probability of burnout compared with heterosexual students (19.8% [95% CI, 8.3%-31.4%] vs 2.3% [95% CI, 0.2%-4.5%]; P < .001). Mediation analysis showed that mistreatment accounts for 31% of the total association of LGB sexual orientation with overall burnout (P < .001). Conclusions and Relevance: This study suggests that LGB medical students are more likely than their heterosexual peers to experience burnout, an association that is partly mediated by mistreatment. Further work is needed to ensure that medical schools offer safe and inclusive learning environments for LGB medical students.


Asunto(s)
Agotamiento Profesional/epidemiología , Heterosexualidad/estadística & datos numéricos , Minorías Sexuales y de Género/estadística & datos numéricos , Discriminación Social , Estudiantes de Medicina/estadística & datos numéricos , Adulto , Bisexualidad , Agotamiento Profesional/psicología , Estudios de Casos y Controles , Estudios Transversales , Grupos Étnicos , Femenino , Heterosexualidad/psicología , Homofobia , Homosexualidad , Humanos , Modelos Logísticos , Masculino , Racismo , Sexismo , Minorías Sexuales y de Género/psicología , Estudiantes de Medicina/psicología , Encuestas y Cuestionarios , Estados Unidos/epidemiología
4.
MMWR Morb Mortal Wkly Rep ; 70(5): 149-154, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33539330

RESUMEN

Sexual minority persons experience health disparities associated with sexual stigma and discrimination and have a high prevalence of several health conditions that have been associated with severe coronavirus disease 2019 (COVID-19) (1,2). Current COVID-19 surveillance systems do not capture information about sexual orientation. To begin bridging the gap in knowledge about COVID-19 risk among sexual minority adults, CDC examined disparities between sexual minority and heterosexual adults in the prevalence of underlying conditions with strong or mixed evidence of associations with severe COVID-19-related illness (3), by using data from the 2017-2019 Behavioral Risk Factor Surveillance System (BRFSS).* When age, sex, and survey year are adjusted, sexual minority persons have higher prevalences than do heterosexual persons of self-reported cancer, kidney disease, chronic obstructive pulmonary disease (COPD), heart disease (including myocardial infarction, angina, or coronary heart disease), obesity, smoking, diabetes, asthma, hypertension, and stroke. Sexual minority adults who are members of racial/ethnic minority groups disproportionately affected by the pandemic also have higher prevalences of several of these health conditions than do racial/ethnic minority adults who are heterosexual. Collecting data on sexual orientation in COVID-19 surveillance and other studies would improve knowledge about disparities in infection and adverse outcomes by sexual orientation, thereby informing more equitable responses to the pandemic.


Asunto(s)
/etnología , Grupos de Población Continentales/estadística & datos numéricos , Grupos Étnicos/estadística & datos numéricos , Disparidades en el Estado de Salud , Minorías Sexuales y de Género/estadística & datos numéricos , Adulto , Sistema de Vigilancia de Factor de Riesgo Conductual , Comorbilidad , Femenino , Humanos , Masculino , Factores de Riesgo , Estados Unidos/epidemiología
5.
J Acquir Immune Defic Syndr ; 87(1): 639-643, 2021 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-33512848

RESUMEN

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has had unforeseen consequences on the delivery of HIV and sexually transmitted disease (STD) prevention services. However, little is known about how the pandemic has impacted pre-exposure prophylaxis (PrEP)-using men who have sex with men (MSM). METHODS: Data come from an online cohort of PrEP-using MSM in the Southern United States from October 2019 to July 2020. Participants were administered 10 surveys in total, including 1 ad hoc survey specifically on COVID-19. We conducted a cross-sectional analysis of this ad hoc survey (n = 56) and present changes in sexual behaviors and utilization of and access to sexual health services. Using linear mixed-effect regression models, we also analyzed data from the larger cohort and document how sexual behaviors and PrEP use varied longitudinally across several months. RESULTS: A fifth of participants discontinued or changed how often they take PrEP because of COVID-19. A quarter of the cohort documented challenges when attempting to access PrEP, HIV testing, or STD testing. For all sexual behaviors examined longitudinally-number of male sexual partners, anal sex acts, condomless anal sex, and oral sex (all measured in the past 2 weeks)-there was a decrease from February to April followed by an increase from April to June. DISCUSSION: Our findings suggest reduced access to and utilization of STD and HIV services coupled with a continuation of behaviors which confer STD/HIV risk. Ensuring appropriate delivery of STD/HIV prevention services during this pandemic is imperative.


Asunto(s)
/epidemiología , Homosexualidad Masculina/estadística & datos numéricos , Profilaxis Pre-Exposición/estadística & datos numéricos , Conducta Sexual/estadística & datos numéricos , Adolescente , Adulto , Fármacos Anti-VIH/uso terapéutico , Estudios de Cohortes , Estudios Transversales , Infecciones por VIH/tratamiento farmacológico , Humanos , Estudios Longitudinales , Masculino , Cumplimiento de la Medicación , Pandemias , Sexo Seguro , Minorías Sexuales y de Género/estadística & datos numéricos , Encuestas y Cuestionarios , Estados Unidos/epidemiología , Adulto Joven
6.
J Acquir Immune Defic Syndr ; 87(1): 644-651, 2021 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-33443963

RESUMEN

BACKGROUND: The coronavirus pandemic has necessitated a range of population-based measures to stem the spread of infection. These measures may be associated with disruptions to other health services including for gay, bisexual, and other men who have sex with men (MSM) at risk for or living with HIV. Here, we assess the relationship between stringency of COVID-19 control measures and interruptions to HIV prevention and treatment services for MSM. SETTING: Data for this study were collected between April 16, 2020, and May 24, 2020, as part of a COVID-19 Disparities Survey implemented by the gay social networking app, Hornet. Pandemic control measures were quantified using the Oxford Government Response Tracker Stringency Index: each country received a score (0-100) based on the number and strictness of 9 indicators related to restrictions, closures, and travel bans. METHODS: We used a multilevel mixed-effects generalized linear model with Poisson distribution to assess the association between stringency of pandemic control measures and access to HIV services. RESULTS: A total of 10,654 MSM across 20 countries were included. Thirty-eight percent (3992/10,396) reported perceived interruptions to in-person testing, 55% (5178/9335) interruptions to HIV self-testing, 56% (5171/9173) interruptions to pre-exposure prophylaxis, and 10% (990/9542) interruptions to condom access. For every 10-point increase in stringency, there was a 3% reduction in the prevalence of perceived access to in-person testing (aPR: 0·97, 95% CI: [0·96 to 0·98]), a 6% reduction in access to self-testing (aPR: 0·94, 95% CI: [0·93 to 0·95]), and a 5% reduction in access to pre-exposure prophylaxis (aPR: 0·95, 95% CI: [0·95 to 0·97]). Among those living with HIV, 20% (218/1105) were unable to access their provider; 65% (820/1254) reported being unable to refill their treatment prescription remotely. CONCLUSIONS: More stringent responses were associated with decreased perceived access to services. These results support the need for increasing emphasis on innovative strategies in HIV-related diagnostic, prevention, and treatment services to minimize service interruptions during this and potential future waves of COVID-19 for gay men and other MSM at risk for HIV acquisition and transmission.


Asunto(s)
/epidemiología , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/prevención & control , Homosexualidad Masculina/estadística & datos numéricos , Minorías Sexuales y de Género/estadística & datos numéricos , Adulto , Humanos , Masculino , Persona de Mediana Edad , Profilaxis Pre-Exposición/estadística & datos numéricos , Conducta Sexual , Red Social , Encuestas y Cuestionarios , Adulto Joven
8.
Am J Public Health ; 111(2): 318-326, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33351656

RESUMEN

Objectives. To estimate US nonlethal violent victimization rates for lesbian, gay, and bisexual (LGB) males and females aged 16 years and older and to compare disparities among LGB and straight males and females, controlling for other correlates of victimization.Methods. We used data from the 2017 and 2018 National Crime Victimization Survey (NCVS) to provide nationally representative rates of various forms of violent victimization for self-identified LGB and straight persons. Multivariable models assessed the risk for violence associated with LGB status.Results. Total violence rates were 2 to 9 times higher among LGB persons compared with heterosexuals. For some forms of violence (e.g., rape and sexual assault, violence with serious injuries, and multiple offender violence) there were notably high disparities between bisexuals and heterosexuals. With adjustment for covariates, LGB orientation was associated with odds ratios nearly 2 to 4 times those of heterosexuals.Conclusions. This is one of the first known uses of NCVS data to estimate LGB victimization, revealing substantially higher rates of violence directed at LGB individuals.Public Health Implications. Sexual orientation and gender identity questions in federal surveys such as the NCVS enable monitoring of violent victimization rates and should continue. Collecting these data can help researchers understand victimization risk and guide appropriate resources toward victim services, especially important given the high violent crime levels experienced by LGB individuals.


Asunto(s)
Acoso Escolar/estadística & datos numéricos , Víctimas de Crimen/estadística & datos numéricos , Delitos Sexuales/estadística & datos numéricos , Minorías Sexuales y de Género/estadística & datos numéricos , Violencia/estadística & datos numéricos , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Estados Unidos/epidemiología , Adulto Joven
9.
PLoS One ; 15(12): e0244448, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33382743

RESUMEN

This study explored familiarity with, attitudes toward, uptake and discontinuation of PrEP (Pre-exposure prophylaxis) among a national probability sample of gay and bisexual men. PrEP is one of the most effective biomedical HIV prevention strategies; however, use among gay and bisexual men remains low within the United States. This study used a national probability sample of gay and bisexual men from three age cohorts of men (18-25, 34-41, and 52-59 years at wave 1) who completed three annual surveys between March 2016 and March 2018 (N at wave 1 = 624). Recruitment occurred through a Gallup dual-frame sampling procedure; results for this study came from eligible individuals who consented to be part of the self-administered online or mailed survey questionnaire. We used descriptive data with sampling weights to understand trends in PrEP familiarity, PrEP attitudes and PrEP use across all three time points. Next, PrEP uptake and discontinuation were assessed among men completing all three surveys and who remained eligible for PrEP at all three time points (N = 181). PrEP familiarity increased considerably between 2016 and 2018 among those eligible for PrEP (from 59.8% from wave 1 to 92.0% at wave 3). Favorable attitudes toward PrEP increased more modestly (from 68.3% at wave 1 to 72.7% at wave 3). While PrEP use increased by 90% between the two time points (from 4.1% in 2016 to 7.8% in 2018), this represented a small percentage of overall uptake among eligible participants across time (6.6%). Among respondents who reported PrEP use at wave 1 or wave 2, 33.3% subsequently discontinued PrEP use at a later wave. Findings indicate modest increases in PrEP use between 2016 and 2018 in a national probability sample of sexually-active gay and bisexual men. PrEP discontinuation was high and suggests the need for further research into gay and bisexual men's PrEP discontinuation and persistence.


Asunto(s)
Infecciones por VIH/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Cumplimiento de la Medicación/estadística & datos numéricos , Profilaxis Pre-Exposición/estadística & datos numéricos , Minorías Sexuales y de Género/psicología , Adolescente , Adulto , Infecciones por VIH/transmisión , Humanos , Estudios Longitudinales , Masculino , Cumplimiento de la Medicación/psicología , Persona de Mediana Edad , Muestreo , Minorías Sexuales y de Género/estadística & datos numéricos , Estados Unidos , Adulto Joven
10.
J Am Heart Assoc ; 9(24): e018233, 2020 12 15.
Artículo en Inglés | MEDLINE | ID: mdl-33317368

RESUMEN

Background Sexual minority, or lesbian, gay, and bisexual (LGB), individuals are at increased risk for cardiovascular disease attributable to elevated rates of health risk factors. However, although there is clear evidence that statin use can prevent cardiovscular disease in certain adult populations, no studies have examined how statins are being used among the LGB population. This study aimed to examine the prevalence and predictors of statin use among LGB and non-LGB individuals using Facebook-delivered online surveys. Methods and Results We conducted a cross-sectional online survey about statin use in adults ≥40 years of age between September and December 2019 using Facebook advertising (n=1531). We calculated the prevalence of statin use by age, sexual orientation, and statin benefit populations. We used multivariable logistic regression to examine whether statin use differed by sexual orientation, adjusting for covariates. We observed a significantly lower rate of statin use in the LGB versus non-LGB respondents (20.8% versus 43.8%; P<0.001) in the primary prevention population. However, the prevalence of statin use was not statistically different in the LGB versus non-LGB respondents in the secondary prevention population. Adjusting for the covariates, the LGB participants were less likely to use statins than the non-LGB respondents in the primary prevention population (odds ratio, 0.37; 95% CI, 0.19-0.70). Conclusions Our results are the first to emphasize the urgent need for tailored, evidence-based cardiovascular disease prevention programs that aim to promote statin use, and thus healthy aging, in the LGB population.


Asunto(s)
Enfermedades Cardiovasculares/tratamiento farmacológico , Enfermedad de la Arteria Coronaria/complicaciones , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Minorías Sexuales y de Género/estadística & datos numéricos , Adulto , Anciano , Bisexualidad/estadística & datos numéricos , Enfermedades Cardiovasculares/prevención & control , Estudios de Casos y Controles , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Prevención Primaria/estadística & datos numéricos , Factores de Riesgo , Conducta Sexual/etnología , Conducta Sexual/estadística & datos numéricos , Medios de Comunicación Sociales/instrumentación , Encuestas y Cuestionarios/estadística & datos numéricos
11.
JAMA Netw Open ; 3(12): e2030806, 2020 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-33355675

RESUMEN

Importance: There have been concerns that HIV preexposure prophylaxis (PrEP) may be associated with increases in sexually transmitted infections (STIs) because of subsequent reductions in condom use and/or increases in sexual partners. Objective: To determine trends in STI test positivity among high-risk men who have sex with men (MSM) before and after the start of HIV PrEP. Design, Setting, and Participants: A before-after analysis was conducted using a subcohort of a single-group PrEP implementation study cohort in New South Wales, Australia (Expanded PreEP Implementation in Communities in New South Wales [EPIC-NSW]), from up to 1 year before enrollment if after January 1, 2015, and up to 2 years after enrollment and before December 31, 2018. STI testing data were extracted from a network of 54 sexual health clinics and 6 primary health care clinics Australia-wide, using software to deidentify, encrypt, and anonymously link participants between clinics. A cohort of MSM dispensed PrEP for the first time during the study, with 2 or more STI tests in the prior year and who tested during follow-up, were included from the EPIC-NSW cohort of HIV-negative participants with high-risk sexual behavior. Data analysis was performed from June to December 2019. Exposures: Participants were dispensed coformulated tenofovir disoproxil fumarate (300 mg) and emtricitabine (200 mg) as HIV PrEP. Main Outcomes and Measures: The main outcome was STI, measured using test positivity, defined as the proportion of participants testing positive for an STI at least once per quarter of follow-up. Outcomes were calculated for Chlamydia trachomatis and Neisseria gonorrhoea by site of infection (anorectal, pharyngeal, urethral, or any) and for syphilis. Results: Of the EPIC-NSW cohort of 9709 MSM, 2404 were included in the before-after analysis. The mean (SD) age of the participants was 36 (10.4) years, and 1192 (50%) were Australia-born. STI positivity was 52% in the year after PrEP (23.3% per quarter; 95% CI, 22.5%-24.2% per quarter) with no significant trend (mean rate ratio [RR] increase of 1.01 per quarter [95% CI, 0.99-1.02]; P = .29), compared with 50% positivity in the year prior to PrEP (20.0% per quarter [95% CI, 19.04%-20.95% per quarter]; RR for overall STI positivity, 1.17 [95% CI, 1.10-1.24]; P < .001), with an increase in quarterly STI positivity (mean RR of 1.08 per quarter, or an 8% increase per quarter [95% CI, 1.05-1.11]; P < .001; RR, 0.93 [95% CI, 0.90-0.96]; P < .001). Findings were similar when stratified by specific STIs and anatomical site. Conclusions and Relevance: STI rates were high but stable among high-risk MSM while taking PrEP, compared with a high but increasing trend in STI positivity before commencing PrEP. These findings suggest the importance of considering trends in STIs when describing how PrEP use may be associated with STI incidence.


Asunto(s)
Emtricitabina/uso terapéutico , Infecciones por VIH , Profilaxis Pre-Exposición , Minorías Sexuales y de Género , Enfermedades de Transmisión Sexual , Tenofovir/uso terapéutico , Adulto , Fármacos Anti-VIH/uso terapéutico , Australia/epidemiología , Estudios de Cohortes , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Conductas de Riesgo para la Salud , Humanos , Incidencia , Masculino , Profilaxis Pre-Exposición/métodos , Profilaxis Pre-Exposición/estadística & datos numéricos , Conducta Sexual , Minorías Sexuales y de Género/psicología , Minorías Sexuales y de Género/estadística & datos numéricos , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/epidemiología
12.
JAMA Netw Open ; 3(12): e2031357, 2020 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-33369662

RESUMEN

Importance: Identification of subgroups at greatest risk for suicide mortality is essential for prevention efforts and targeting interventions. Sexual minority individuals may have an increased risk for suicide compared with heterosexual individuals, but a lack of sufficiently powered studies with rigorous methods for determining sexual orientation has limited the knowledge on this potential health disparity. Objective: To investigate suicide mortality among sexual minority veterans using Veterans Health Administration (VHA) electronic health record data. Design, Setting, and Participants: This retrospective population-based cohort study used data on 8.1 million US veterans enrolled in the VHA after fiscal year 1999 that were obtained from VHA electronic health records from October 1, 1999 to September 30, 2017. Data analysis was carried out from March 1, 2020 to October 31, 2020. Exposure: Veterans with documentation of a minority sexual orientation. Documentation of sexual minority status was obtained through natural language processing of clinical notes and extraction of structured administrative data for sexual orientation in VHA electronic health records. Main Outcomes and Measures: Suicide mortality rate using data on the underlying cause of death obtained from the National Death Index. Crude and age-adjusted mortality rates were calculated for all-cause death and death from suicide among sexual minority veterans compared with the general US population and the general population of veterans. Results: Among the 96 893 veterans with at least 1 sexual minority documentation in the electronic health record, the mean (SD) age was 46 (16) years, 68% were male, and 70% were White. Of the 12 591 total deaths, 3.5% were from suicide. Veterans had a significantly higher rate of mortality from suicide (standardized mortality ratio, 4.50; 95% CI, 4.13-4.99) compared with the general US population. Suicide was the fifth leading cause of death in 2017 among sexual minority veterans (3.8% of deaths) and the tenth leading cause of death in the general US population (1.7% of deaths). The crude suicide rate among sexual minority veterans (82.5 per 100 000 person-years) was higher than the rate in the general veteran population (37.7 per 100 000 person-years). Conclusions and Relevance: The results of this population-based cohort study suggest that sexual minority veterans have a greater risk for suicide than the general US population and the general veteran population. Further research is needed to determine whether and how suicide prevention efforts reach sexual minority veterans.


Asunto(s)
Minorías Sexuales y de Género/estadística & datos numéricos , Suicidio/estadística & datos numéricos , Veteranos/estadística & datos numéricos , Adulto , Femenino , Disparidades en el Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Minorías Sexuales y de Género/psicología , Suicidio/psicología , Estados Unidos/epidemiología , United States Department of Veterans Affairs , Veteranos/psicología
14.
Clín. salud ; 31(3): 147-153, nov. 2020. tab
Artículo en Español | IBECS | ID: ibc-197170

RESUMEN

Todos los estudiantes sufren el riesgo de ser víctima de conductas agresivas de bullying durante el transcurso de su vida. Sin embargo, existen colectivos con mayor riesgo de sufrir estas conductas, en especial, el colectivo LGTB. Este estudio tiene tres objetivos: (1) analizar la prevalencia de víctimas y agresores de bullying entre adolescentes de secundaria, (2) explorar diferencias en función del sexo y (3) conocer las diferencias en función de la orientación sexual. Una muestra compuesta por 1,748 adolescentes del País Vasco cumplimentó dos cuestionarios. Los resultados evidencian (1) un elevado porcentaje de víctimas (41.6% globales, 11% severas) y de agresores (28.5% globales, 2,7% severos), (2) que las chicas muestran mayor victimización y los chicos agresión y (3) que hay un mayor porcentaje de víctimas no-heterosexuales, en especial de gais y bisexuales. En conclusión, las personas LGTB muestran una mayor vulnerabilidad a sufrir acoso escolar, por lo que es necesario desarrollar e implementar programas antidiscriminatorios en la comunidad educativa


Every student is at risk of aggressive bullying behavior during their lifetime. However, there are groups with a higher risk of suffering these aggressive behaviors, especially the LGTB group. This study has three objectives: (1) to analyze the prevalence of victims and aggressors of bullying among high school adolescents; (2) to explore differences based on sex; and (3) to identify differences based on sexual orientation. A sample consisting of 1,748 adolescents from the Basque Country completed two questionnaires. The results show (1) a high percentage of victims (41.6% global, 11% severe), as well as aggressors (28.5% global, 2.7% severe); (2) that girls show greater victimization and boys show aggression; and (3) a higher percentage of non-heterosexual victims, especially gay and bisexual. In conclusion, LGTB people show greater vulnerability to suffer bullying and, therefore, the need to develop and implement anti-discrimination programs in the educational community


Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Acoso Escolar/estadística & datos numéricos , Conducta Sexual/estadística & datos numéricos , Minorías Sexuales y de Género/estadística & datos numéricos , Conducta del Adolescente/psicología , Estudios Transversales , Conducta Sexual/psicología , Minorías Sexuales y de Género/psicología , Factores Sexuales , Encuestas y Cuestionarios , Sexismo/psicología , Sexismo/estadística & datos numéricos , Estudiantes/psicología , Estudiantes/estadística & datos numéricos , España
15.
PLoS One ; 15(10): e0239750, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33002013

RESUMEN

BACKGROUND: Swingers, heterosexuals who, as couples, practice mate swapping or group sex with other couples or heterosexual singles, are at risk for sexually transmitted infections (STIs). Therefore, the aim of this study was to assess changes in sexual behaviour and STI testing behaviour, as well as predictors of STI testing. METHODS: Two cross-sectional studies were performed, using the same internet survey in 2011 and 2018. For trend analysis, sexual behaviour and STI testing behaviour were used. Socio-demographics, swinger characteristics, sexual behaviour, and psycho-social variables were used to assess predictors of STI testing in the past year, using multivariable regression analysis. RESULTS: A total of 1173 participants completed the survey in 2011, and 1005 in 2018. Condom use decreased for vaginal (73% vs. 60%), oral (5% vs. 2%), and anal sex (85% vs. 75%). STI positivity was reported in 23% and 30% of the participants, respectively, although testing for STI was comparable between both years (~65%). The following predictors of STI testing were significant: being female (OR = 1.9, 95%CI: 1.2-2.9), having a high swinging frequency (>12 times a year, OR = 3.7, 95%CI: 1.9-7.3), swinging at home (OR = 1.6, 95%CI: 1.0-2.7), receiving a partner notification (OR = 1.7, 95%CI: 1.2-2.6), considering STI testing important (OR = 4.3, 95%CI: 2.2-8.5), experiencing no pressure from a partner to test (OR = 0.6, 95%CI: 0.3-0.9), partners test for STI regularly (OR = 10.0, 95%CI: 6.2-15.9), perceiving STI testing as an obligation (OR = 2.1, 95%CI: 1.3-3.5), experiencing no barriers such as being afraid of testing (OR = 1.9, 95%CI: 1.2-3.1), limited opening hours (OR = 1.6, 95%CI: 1.0-2.4), and forgetting to plan appointments (OR = 3.0, 95%CI: 2.0-4.6). CONCLUSIONS: Swingers exhibit self-selection for STI testing based on their sexual behaviour. However, STI prevention efforts are still important considering the increasing numbers of reported STIs, the decreased use of condom use, and the one-third of swingers who were not tested in the previous year.


Asunto(s)
Conducta Sexual/estadística & datos numéricos , Enfermedades de Transmisión Sexual/diagnóstico , Adolescente , Adulto , Trazado de Contacto/estadística & datos numéricos , Estudios Transversales , Escolaridad , Relaciones Extramatrimoniales/psicología , Femenino , Heterosexualidad/psicología , Heterosexualidad/estadística & datos numéricos , Humanos , Internet , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Conducta Sexual/psicología , Minorías Sexuales y de Género/psicología , Minorías Sexuales y de Género/estadística & datos numéricos , Enfermedades de Transmisión Sexual/etiología , Enfermedades de Transmisión Sexual/prevención & control , Encuestas y Cuestionarios , Adulto Joven
16.
Rev Bras Enferm ; 73(suppl 2): e20200913, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33111784

RESUMEN

OBJECTIVE: To evaluate the presence of flu-like syndrome suggestive of COVID-19 in men who have sex with men (MSM) and engaged in casual sex during a period of social isolation. METHOD: National epidemiological survey, applied in April and May 2020, by adaptation of Respondent Drive Sampling. RESULTS: 1,337 MSM participated in the survey, of which 514 (38.4%) had fever associated with another sign or symptom of flu-like syndrome. Social, demographic characteristics, sexual practices and activities during the period of social isolation were statistically associated with the presence of flu-like syndrome. There was a statistical difference (p < 0.001) in the average of partners between those who had signs and symptoms of flu-like syndrome (3.5) and those who did not (1.7). CONCLUSION: Evidence of signs and symptoms indicative of flu-like syndrome suggestive of COVID 19 in Brazilian MSM who were involved in casual sex during the period of social isolation.


Asunto(s)
Betacoronavirus , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Homosexualidad Masculina , Neumonía Viral/diagnóstico , Minorías Sexuales y de Género , Evaluación de Síntomas , Adulto , Brasil , Encuestas Epidemiológicas , Homosexualidad Masculina/estadística & datos numéricos , Humanos , Gripe Humana/diagnóstico , Masculino , Persona de Mediana Edad , Redes Sociales en Línea , Pandemias , Cuarentena , Minorías Sexuales y de Género/estadística & datos numéricos , Adulto Joven
17.
J Med Internet Res ; 22(11): e24361, 2020 11 06.
Artículo en Inglés | MEDLINE | ID: mdl-33108315

RESUMEN

BACKGROUND: Family violence (including intimate partner violence/domestic violence, child abuse, and elder abuse) is a hidden pandemic happening alongside COVID-19. The rates of family violence are rising fast, and women and children are disproportionately affected and vulnerable during this time. OBJECTIVE: This study aims to provide a large-scale analysis of public discourse on family violence and the COVID-19 pandemic on Twitter. METHODS: We analyzed over 1 million tweets related to family violence and COVID-19 from April 12 to July 16, 2020. We used the machine learning approach Latent Dirichlet Allocation and identified salient themes, topics, and representative tweets. RESULTS: We extracted 9 themes from 1,015,874 tweets on family violence and the COVID-19 pandemic: (1) increased vulnerability: COVID-19 and family violence (eg, rising rates, increases in hotline calls, homicide); (2) types of family violence (eg, child abuse, domestic violence, sexual abuse); (3) forms of family violence (eg, physical aggression, coercive control); (4) risk factors linked to family violence (eg, alcohol abuse, financial constraints, guns, quarantine); (5) victims of family violence (eg, the LGBTQ [lesbian, gay, bisexual, transgender, and queer or questioning] community, women, women of color, children); (6) social services for family violence (eg, hotlines, social workers, confidential services, shelters, funding); (7) law enforcement response (eg, 911 calls, police arrest, protective orders, abuse reports); (8) social movements and awareness (eg, support victims, raise awareness); and (9) domestic violence-related news (eg, Tara Reade, Melissa DeRosa). CONCLUSIONS: This study overcomes limitations in the existing scholarship where data on the consequences of COVID-19 on family violence are lacking. We contribute to understanding family violence during the pandemic by providing surveillance via tweets. This is essential for identifying potentially useful policy programs that can offer targeted support for victims and survivors as we prepare for future outbreaks.


Asunto(s)
Infecciones por Coronavirus , Violencia Doméstica/estadística & datos numéricos , Pandemias/estadística & datos numéricos , Neumonía Viral , Medios de Comunicación Sociales/estadística & datos numéricos , Aprendizaje Automático no Supervisado , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Brotes de Enfermedades/estadística & datos numéricos , Violencia Doméstica/legislación & jurisprudencia , Femenino , Humanos , Violencia de Pareja/legislación & jurisprudencia , Violencia de Pareja/estadística & datos numéricos , Masculino , Neumonía Viral/epidemiología , Minorías Sexuales y de Género/estadística & datos numéricos
19.
Top Antivir Med ; 28(2): 439-454, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32886464

RESUMEN

At the 2020 Conference on Retroviruses and Opportunistic Infections, held virtually as a result of the emerging COVID-19 pandemic, trends in the HIV epidemic were highlighted, with decreasing HIV incidence reported across several countries, although key regions remain heavily impacted, including the US South. Adolescent girls and young women, men who have sex with men (MSM), transgender persons, and people who inject drugs continue to experience a high burden of new infections. Sexually transmitted infections during pregnancy can lead to a number of adverse outcomes in infants; novel strategies to detect and treat these infections are needed. Innovative HIV testing strategies, including self-testing and assisted partner services, are expanding the reach of testing; however, linkage to care can be improved. Novel preexposure prophylaxis (PrEP) delivery strategies are increasing uptake of PrEP in different groups, although adherence and persistence remain a challenge. Use of on-demand PrEP is increasing among MSM in the US. Strategies are needed to address barriers to PrEP uptake and persistence among cis- and transgender women. Several novel regimens for postexposure prophylaxis show promise.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por Coronavirus/epidemiología , Infecciones por VIH/epidemiología , Neumonía Viral/epidemiología , Profilaxis Pre-Exposición/organización & administración , Salud Pública , Enfermedades de Transmisión Sexual/epidemiología , Congresos como Asunto , Infecciones por Coronavirus/diagnóstico , Femenino , Salud Global , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/epidemiología , Pandemias/prevención & control , Neumonía Viral/diagnóstico , Prevención Primaria/organización & administración , Proyectos de Investigación , Infecciones por Retroviridae/diagnóstico , Infecciones por Retroviridae/epidemiología , Factores de Riesgo , Minorías Sexuales y de Género/estadística & datos numéricos , Enfermedades de Transmisión Sexual/prevención & control , Estados Unidos , Interfaz Usuario-Computador
20.
PLoS One ; 15(9): e0238761, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32881946

RESUMEN

The psychological impacts of the lockdown due to the Covid-19 pandemic are widely documented. In India, a family-centric society with a high population density and extreme social stratification, the impact of the lockdown might vary across diverse social groups. However, the patterning in the psychological impact of the lockdown among LGBT adults and persons known to be at higher risk of the complications of Covid-19 (such as persons with comorbidities or a history of mental illness) is not known in the Indian context. We used mixed methods (online survey, n = 282 and in-depth interviews, n = 14) to investigate whether the psychological influence of the lockdown was different across these groups of Indian adults. We fitted linear and logistic regression models adjusted for sociodemographic covariates. Thematic analysis helped us identify emergent themes in our qualitative narratives. Anxiety was found to be higher among LGBT adults (ß = 2.44, CI: 0.58, 4.31), the high-risk group (persons with comorbidities) (ß = 2.20, CI:0.36, 4.05), and those with a history of depression/loneliness (ß = 3.89, CI:2.34, 5.44). Persons belonging to the LGBT group reported a greater usage of pornography than the heterosexuals (ß = 2.72, CI: 0.09, 5.36) during the lockdown. Qualitative findings suggested that LGBT adults likely used pornography and masturbation to cope with the lockdown, given the limited physical access to sexual partners in a society that stigmatizes homosexuality. Moreover, both qualitative and quantitative study findings suggested that greater frequency of calling family members during lockdown could strengthen social relationships and increase social empathy. The study thereby urgently calls for the attention of policymakers to take sensitive and inclusive health-related decisions for the marginalized and the vulnerable, both during and after the crisis.


Asunto(s)
Ansiedad/epidemiología , Infecciones por Coronavirus/psicología , Depresión/epidemiología , Neumonía Viral/psicología , Cuarentena/psicología , Estrés Psicológico/epidemiología , Adulto , Anciano , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Femenino , Humanos , India , Masculino , Persona de Mediana Edad , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Cuarentena/estadística & datos numéricos , Minorías Sexuales y de Género/psicología , Minorías Sexuales y de Género/estadística & datos numéricos
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