What Did Obergefell Change? Clearance of Intimate Partner Violence Before and After the Legalization of Same-Sex Marriage.

Historically, same-sex intimate partner violence (IPV) was ignored, and victims often experienced high rates of harassment and intimidation from police, leading to low reporting of same-sex IPV incidents, victims' unwillingness to cooperate with the police, and common arrests in such incidents. Although the Supreme Court's decision in Obergefell v. Hodges (2015) legalized and legitimized same-sex marriages and relationships in the U.S., mandating the inclusion of same-sex partners in protective order laws and yielding collateral benefits for victims of same-sex IPV, it is unclear if the decision has had a positive effect on same-sex IPV clearance rates. This study uses National Incident-Based Reporting System data to compare IPV clearance (arrest, dual arrest, victim noncooperation, and prosecution declined) pre (2013/2014) and post (2016/2017) Obergefell v. Hodges (2015). Regression results show no substantial changes in same-sex IPV clearance after Obergefell v. Hodges (2015). Compared to opposite-sex IPV, same-sex IPV was less likely to be cleared by arrest but much more likely to be cleared by dual arrest, victim noncooperation, and prosecution declined. Same-sex IPV involving Black couples and married partners were also less likely to be cleared by arrest but more likely to be cleared by dual arrest than Black/White same-sex IPV and incidents involving unmarried partners, respectively. Moreover, same-sex IPV victims experience unfavorable criminal justice outcomes in states with mandatory arrest policies but fare better in states that supported same-sex relationships prior to Obergefell. The implications of these findings for practice and research are discussed.

An anthropometric study of sexual orientation and gender identity in Thailand.

The biodevelopment of psychological sex differentiation is putatively reflected in several anthropometrics. We examined eight anthropometrics in 1404 Thai participants varying in sex, sexual orientation, and gender identity/expression: heterosexual men and women, gay men, lesbian women, bisexual women, sao praphet song (transgender birth-assigned males), toms (transgender birth-assigned females), and dees (birth-assigned females attracted to toms). Exploratory factor analyses indicated the biomarkers should be analyzed independently. Using regressions, in birth-assigned males, less male-typical second-to-fourth digit ratios in the left hand were associated with sexual orientation towards men regardless of gender identity/expression, whereas shorter height and long-bone growth in the arms and legs were more evident among sao praphet song-who are both sexually oriented towards men and markedly feminine. In birth-assigned females, there were no clear sexual orientation effects, but there were possible gender-related effects. Groups of individuals who tend to be more masculine (i.e., toms, lesbians) showed more male-typical patterns on weight and leg length than some groups of individuals who tend to be less masculine (i.e., heterosexual women, dees). Thus, it appears the various anthropometrics inform separate biodevelopmental processes that differentially relate to sexual orientation and gender identity/expression depending on the measure in question as well as birth-assigned sex.

Differences in Health Care Access and Satisfaction Across Intersections of Race/Ethnicity and Sexual Identity.

PURPOSE: Racial/ethnic and sexual minorities experience numerous health disparities compared with their White and heterosexual counterparts, which may be exacerbated when these social identities intersect. The authors tested for differences in health care access and satisfaction across intersections of sexual identity and race/ethnicity. METHOD: A cross-sectional secondary data analysis of the 2012-2018 waves of the Association of American Medical Colleges biannual online Consumer Survey of Health Care Access was conducted. This survey captures a national sample of U.S. adults who reported needing health care in the past 12 months. The analytic sample included 29,628 participants. Sixteen possible combinations of sexual identity and race/ethnicity were examined. Health care access and satisfaction were measured with 10 items and an index created from these items. Cumulative prevalence ratios (PRs) for the index and PRs across sexual identity, both individually and in combination with race/ethnicity, for each health care access and satisfaction item were generated. RESULTS: Compared with White heterosexuals, all other groups had significantly more barriers to care before adjustment. The greatest barriers were observed among non-Hispanic Asian/Pacific Islander/Hawaiian gay/lesbian (unadjusted PR = 3.08; 95% confidence interval [CI]: 2.45, 3.88; adjusted PR = 2.01; 95% CI: 1.59, 2.53), non-Hispanic Black bisexual (unadjusted PR = 2.73; 95% CI: 2.28, 3.27; adjusted PR = 1.83; 95% CI: 1.52, 2.20), non-Hispanic Black other sexual identity (unadjusted PR = 2.27; 95% CI: 1.69, 3.06; adjusted PR = 2.07; 95% CI: 1.53, 2.78), and Hispanic/Latino other sexual identity (unadjusted PR = 2.06; 95% CI: 1.60, 2.65; adjusted PR = 1.39; 95% CI: 1.08, 1.79) participants. CONCLUSIONS: Persons of both racial/ethnic and sexual minority status generally had less health care access and satisfaction than White heterosexuals. An intersectional perspective is critical to achieving equity in quality health care access.

Prevalence of self-harm among lesbian, gay, bisexual, and transgender adolescents: a comparison of personal and social adversity with a heterosexual sample in Ghana.

OBJECTIVES: We sought to estimate the prevalence of self-reported self-harm among adolescents identifying as lesbian, gay, bisexual, and transgender (LGBT) in Ghana, and compare self-reported personal and social adversities related to self-harm in this group to those in a random sample of heterosexual adolescents from the same locality. RESULTS: A total of 444 adolescents aged 13-21 years, comprising 74 LGBT adolescents and 370 heterosexual adolescents, provided data. The lifetime prevalence estimate of self-harm was higher in the LGBT group (47%) than the heterosexual group (23%). The LGBT group reported a higher rate of self-harm during the previous 12 months (45%), compared to the heterosexual group (18%). LGBT adolescents reported more alcohol and substance use and more personal social adversities, including various forms of victimisation, than heterosexual adolescents. They were no more likely to report difficulty in making and keeping friends or schoolwork problems than were heterosexual adolescents.

Mapping out a spectrum of the Chinese public's discrimination toward the LGBT community: results from a national survey.

BACKGROUND: China has the world's largest lesbian, gay, bisexual, and transgender (LGBT) population. This study assessed the discrimination experienced by LGBT individuals in China in a comprehensive way, covering discrimination perpetrated by family, media, medical services, religious communities, schools, social services, and in the workplace. METHODS: The current study involved a national survey of 31 provinces and autonomous regions. Discrimination was measured both in terms of heterosexual participants' attitudes towards LGBT individuals, and LGBT participants' self-perceived discrimination. Pearson correlation analysis was performed to examine the difference between heterosexual participants' attitudes towards LGBT individuals and LGBT participants' self-perceived discrimination. Linear regression was used to investigate the association between gross domestic product per capita and discrimination. RESULTS: Among 29,125 participants, 2066 (7.1%) identified as lesbian, 9491 (32.6%) as gay, 3441 (11.8%) as bisexual, 3195 (11.0%) as transgender, and 10,932 (37.5%) as heterosexual. Heterosexual people were generally friendly towards the LGBT community with a mean score of 21.9 (SD = 2.7, total scale score = 100) and the grand averaged score of self-perceived discrimination by LGBT participants was 49.9 (SD = 2.5). Self-perceived discrimination from family and social services is particularly severe. We created a series of provincial level choropleth maps showing heterosexual participants' acceptance towards the LGBT community, and self-perceived discrimination reported by members of the LGBT community. We found that a higher level of economic development in provinces was associated with a decrease in discrimination, and we identified that every 100 thousand RMB increase in per capita GDP lead to a 6.4% decrease in discriminatory events perpetrated by heterosexuals. CONCLUSIONS: Chinese LGBT groups consistently experience discrimination in various aspects of their daily lives. The prevalence of this discrimination is associated with the economic development of the province in which it occurs. In order to reduce discrimination, it is important for future studies to discover the underlying reasons for discrimination against LGBT individuals in China.

Same-Sex Couples' Shared Time in the United States.

This study examines and compares shared time for same-sex and different-sex coresident couples using large, nationally representative data from the 2003-2016 American Time Use Survey (ATUS). We compare the total time that same-sex couples and different-sex couples spend together; for parents, the time they spend together with children; and for both parents and nonparents, the time they spend together with no one else present and the time they spend with others (excluding children). After we control for demographic and socioeconomic characteristics of the couples, women in same-sex couples spend more time together, both alone and in total, than individuals in different-sex arrangements and men in same-sex couples, regardless of parenthood status. Women in same-sex relationships also spend a larger percentage of their total available time together than other couples, and the difference in time is not limited to any specific activity.

[End of the road for the « homosexuality gene ¼]. / Clap de fin pour le « gène de l'homosexualité ¼ - Chroniques génomiques.

Evidence for a "homosexuality gene" was claimed in the early 1990's on the basis of linkage studies that, by current criteria, were woefully underpowered. Indeed, follow up studies gave contradictory results. Genome-wide association studies, and very large databases with detailed genetic and phenotypic data, have made possible a re-examination of this issue. While modest heritability (ca. 0.3) for homosexuality is confirmed, no major locus is found and the genetic influence appears extremely polygenic. Thus, there is no single gene, or even small set of genes, that have a strong influence on homosexuality.

Links between sexuality, impulsivity, compulsivity, and addiction in a large sample of university students.

OBJECTIVE: Non-heterosexual populations experience poorer mental health outcomes than their heterosexual counterparts. Few studies, however, have examined how mental health varies across the continuum of sexual orientation. Nor has any study examined possible links between sexual orientation and traits of impulsivity and compulsivity, which contribute to functional impairment across a broad spectrum of psychiatric disorders. To address these limitations, the present study sought to identify addictive and impulsive/compulsive problems associated with sexuality in a university sample. METHODS: A 156-item anonymous survey was distributed via email to 9449 students at a public university in the United States. Sexual orientation was assessed using the Klein Sexual Orientation Grid, a modification of the Kinsey scale. Current use of alcohol and drugs, mental health status, and academic performance were also assessed, along with valid trait measures of impulsivity and compulsivity. RESULTS: Same-sex attractions were significantly correlated with a range of mental health problems and substance use. Additionally, same-sex attraction was significantly correlated with certain behavioral addictions (compulsive sexual behavior and binge eating disorder) as well as impulsive/compulsive traits. There was no relationship between academic performance and sexual attraction. CONCLUSION: Same-sex sexuality is associated with impulsive/compulsive behavior and addiction. These health disparities may be related to stable individual differences in self-control.

Research Note on Whether Sexual Minority Individuals Are Over-Represented Among Suicide's Casualties.

Background: Past studies have repeatedly shown higher suicidal thoughts and attempts among sexual minority members, yet have remained opaque on whether these groups are more prone to taking their own lives. Aims: This short report focuses on suicide deaths among sexual minority members. Method: We utilized two large-scale surveys: one, among adults, the updated Cumulative General Social Surveys, and the other, among adolescents, The National Longitudinal Study of Adolescent Health (Add Health), where respondents' data were cross-linked to National Death Index death records. Results: Results confirmed pre-existent findings showing elevated suicide rates among sexual minority females but not among sexual minority males. Limitations: The shortfall of female adolescent suicides in the Add Health sample prevented us from examining the question of female sexual minority suicides within this population. Conclusion: Although ample evidence demonstrates higher suicidal thoughts and attempts among sexual minority males, three studies presently do not confirm their greater propensity to die by suicide, compared with heterosexual males; yet, for sexual minority females the evidence is steadily mounting showing their greater suicide risks.

Perspectives and Recommendations From Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning Youth of Color Regarding Engagement in Biomedical HIV Prevention.

PURPOSE: Young people of color have high HIV incidence rates and suffer the greatest health inequities with regard to daily oral pre-exposure prophylaxis. Although the next generation of biomedical HIV prevention products is already under clinical development, little research has examined whether such products address the needs of this population or identified specific strategies for educating this population about prevention options that might result in the greatest interest in and uptake of new prevention modalities. METHODS: We analyzed data from seven focus groups (n = 93) conducted between July 2016 and March 2017 in partnership with a lesbian, gay, bisexual, transgender, and queer/questioning youth-serving community-based organization in the northeastern U.S. The study aimed to understand concerns, priorities, and preferences around biomedical HIV prevention modalities (i.e., daily oral pill, long-acting injectable, and topical microbicide) among lesbian, gay, bisexual, transgender, and queer/questioning youth of color. RESULTS: Our findings identified four key dynamics specific to educating young people about biomedical prevention, including (1) providing information with a sufficient level of detail and complexity, (2) contextualizing messaging in terms of young people's existing knowledge and beliefs, (3) providing detailed information about side effects, drug- and multi-method interactions, and dosing/usage contingencies, and (4) working proactively to support transgender youth and ensure that prevention products are accessible to them. CONCLUSIONS: As we plan for a future of choice in biomedical HIV prevention, we should consider how novel products can address inequities in pre-exposure prophylaxis access and HIV incidence by valuing the concerns and needs of this highest priority population.

Suicide among persons who entered same-sex and opposite-sex marriage in Denmark and Sweden, 1989-2016: a binational, register-based cohort study.

BACKGROUND: People belonging to sexual minority groups have higher levels of suicidality than heterosexuals. However, findings regarding suicide death are sparse. Using unique national data from two countries, we investigated whether individuals entering a same-sex marriage (SSM), a proxy group of sexual minority individuals, had higher suicide rates than those entering opposite-sex marriage (OSM). METHODS: A cohort study of all males and females who entered an SSM (n=28 649) or OSM (n=3 918 617) in Denmark and Sweden during 1989-2016 was conducted. Incidence rate ratios (IRRs) for suicide were calculated using adjusted Poisson regression models. RESULTS: In total, 97 suicides occurred among individuals who had entered an SSM compared with 6074 among those who entered an OSM, corresponding to an adjusted IRR of 2.3 (95% CI 1.9 to 2.8). For people who entered SSM, a 46% decline was noted over time from an IRR of 2.8 (95% CI 1.9 to 4.0) during 1989-2002 to 1.5 (95% CI 1.2 to 1.9) during 2003-2016. The excess suicide mortality was present in all age groups but most pronounced among younger individuals aged 18-34 years of age (IRR 2.7, 95% CI 1.5 to 4.8) and females (IRR 2.7, 95% CI 1.8 to 3.9). CONCLUSION: This large register-based study found higher suicide rates among individuals who entered an SSM, compared with those who entered an OSM. A lower suicide rate was noted for individuals in SSMs in recent years. More research is needed to identify the unique suicide risk and protective factors for sexual minority people.

Factors associated with homophobia in medical students from eleven Peruvian universities. / Factores asociados a la homofobia en estudiantes de Medicina de once universidades peruanas.

BACKGROUND: The consequences of homophobia can affect the integrity, mental and physical health of homosexual individuals in society. There are few studies in Peru that have evaluated homophobia in the medical student population. OBJECTIVE: To establish the social, educational and cultural factors associated with homophobia among Peruvian medical students. METHODS: A cross-sectional analytical study was conducted in 12 medicine schools in Peru. Homophobia was defined according to a validated test, which was associated with other variables. Statistical associations were identified. RESULTS: The lowest percentages of homophobic students (15-20%) were found in the four universities in Lima, while universities in the interior of the country had the highest percentages (22-62%). Performing a multivariate analysis, we found that the frequency of homophobia was lower for the following variables: the female gender (PRa=0.74; 95% CI, 0.61-0.92; p=0.005), studying at a university in Lima (PRa=0.57; 95% CI, 0.43-0.75; p<0.001), professing the Catholic religion (PRa=0.53; 95% CI, 0.37-0.76; p<0.001), knowing a homosexual (PRa=0.73; 95% CI, 0.60-0.90; p=0.003) and having treated a homosexual patient (PRa=0.76; 95% CI, 0.59-0.98; p=0.036). In contrast, the frequency of homophobia increased in male chauvinists (PRa=1.37; 95% CI, 1.09-1.72; p=0.007), adjusted by four variables. CONCLUSIONS: Homophobia was less common in women, in those who study in the capital, those who profess Catholicism and those who know/have treated a homosexual. In contrast, male chauvinists were more homophobic.

Young people's health and risk behaviours in relation to their sexual orientation: A cross-sectional study of Thailand and Sweden.

OBJECTIVES: This study examined the associations between sexual orientation of young people and their health and risk behaviours in Thailand and Sweden, and to explore similarities and differences between the countries. STUDY DESIGN: A cross-sectional study using data from the Life and Health - Young surveys in Thailand and Sweden. Three different statistical analyses were used to examine the associations of the variables. RESULTS: In total, 3869 students aged 16-18 years old were included: 1488 Thai students and 2381 Swedish students. Significantly more Thai (20%) than Swedish (9%) students identified themselves as bisexual, homosexual or unsure (p < .001). Bivariate analysis showed that, in Thailand, self-harm was more often reported by the homosexual, unsure, and bisexual groups than by the heterosexual group (p = .005). In Sweden, early sexual debut was more often reported by the unsure, bisexual, and homosexual groups than by the heterosexual group (p = .033). Multiple logistic regression analysis showed that homosexual and unsure sexual orientations were significantly associated with self-harm (p < .05) among Thai students. Unsure sexual orientation was significantly associated with early sexual debut (p = .04) among Swedish students. Multiple correspondence analysis indicated that sexual orientation was associated with health and risk behaviours, and varied by different subcategories of students' backgrounds such as country, sexual orientation, family structure and adult support. CONCLUSIONS: Sexual minority young people reported more risk behaviours and poorer health than their heterosexual counterparts. The findings are useful for policy programmes on sexual and reproductive health and rights of young people.

Parejas sexuales de personas que viven con VIH / sida: orientación sexual, aspectos sociodemográficos, clínicos y comportamentales / Parcerias sexuais de pessoas vivendo com HIV/Aids: orientação sexual, aspectos sociodemograficos, clinicos e comportamentais / Sexual partnerships of people living with HIV / Aids: sexual orientation, sociodemographic, clinical and behavioral aspects

Objetivo: Analizar la influencia de la orientación sexual de las variables socio-demográficas, clínicas y de comportamiento entre las parejas sexuales de las personas que viven con el Virus de la inmunodeficiencia humana/Síndrome de inmunodeficiencia adquirida. Métodos: Estudio transversal realizado en un servicio de asistencia médica especializada en el tratamiento de personas con el Virus de la Inmunodeficiencia Humana, con 173 participantes. En el análisis de los resultados se utilizó el test Chi-cuadrado de Pearson o exacto de Fisher. Resultados: Se identificó asociación entre la orientación sexual y las variables: sexo, edad, estado civil, grupo de edad, escolaridad, renta, forma de exposición, tipo de asociación, uso consistente del preservativo, presencia de infección, práctica sexual, presencia del compañero en las consultas de rutina, divulgación del VIH al compañero y considerar importante la divulgación de su condición serológica para el compañero. Conclusión: Establecer un emparejamiento sexual en el contexto del VIH y tener una orientación no heterosexual presentó diferencias estadísticas entre las variables sociodemográficas y comportamentales

Objetivo: Analisar a influência da orientação sexual sobre as variáveis sociodemograficas, clínicas e comportamentais entre parcerias sexuais de pessoas que vivem com vírus da imunodeficiência humana/Síndrome da imunodeficiência adquirida. Métodos: Estudo transversal realizado em um serviço de assistência médica especializada no tratamento de pessoas com o Vírus da Imunodeficiência Humana, com 173 participantes. Na análise dos resultados utilizou-se o teste Qui-quadrado de Pearson ou exato de Fisher. Resultados: Identificou-se associação entre a orientação sexual e as variáveis: sexo, idade, estado civil, faixa etária, escolaridade, renda, forma de exposição, tipo de parceria, uso consistente do preservativo, presença de infecção, prática sexual, acompanhamento do parceiro nas consultas de rotina, divulgação do HIV para o parceiro e considerar importante a divulgação da sua condição sorológica para o parceiro. Conclusão: Estabelecer uma parceria sexual no contexto do HIV e ter uma orientação não-heterossexual apresentou diferenças estatísticas entre as variáveis sociodemográficas e comportamentais

Objective: To analyze the influence of sexual orientation on sociodemographic, clinical and behavioral variables among sexual partners of people living with Human immunodeficiency virus/Acquired immunodeficiency syndrome. Methods: A cross-sectional study carried out in a medical assistance service specialized in the treatment of people with Human Immunodeficiency Virus, with 173 participants. Pearson's Chi-square or Fisher's exact test was used to analyze the results. Results: We identified an association between sexual orientation and variables such as gender, age, marital status, age, education, income, type of exposure, type of birth, consistent condom use, presence of infection, sexual practice, partner in routine consultations, disclosure of HIV to the partner and considers disclosure of their condition to the partner. Conclusion: Establishing a sexual partnership in the context of HIV and having a non-heterosexual orientation presented statistical differences between sociodemographic and behavioral variables

Does the association between substance use and sexual risk behaviors among high school students vary by sexual identity?

OBJECTIVE: Limited information exists on whether associations between substance use behaviors (SUBs) and sexual risk behaviors (SRBs) vary by sexual identity. METHODS: Data from the 2015 national Youth Risk Behavior Survey (n = 15,624), were analyzed to assess associations between SUBs (cigarette smoking, alcohol use, binge drinking, marijuana use, prescription drug misuse, injection drug use, illicit drug use) and SRBs (sexual activity, number of partners, condom use). Logistic regression models calculated adjusted prevalence ratios (aPR), stratified by sexual identity, and interaction effects for sexual identity were introduced to models to determine if associations varied by sexual identity. RESULTS: All SUBs had significant associations with current sexual activity and 4+ sexual partners for both heterosexual and LGB students. No condom use during last sexual intercourse was significantly associated with all SUBs except alcohol use among heterosexual students, while no condom use was only significantly associated with injection drug use among LGB students. Associations between current sexual activity and SUBs were significantly stronger among heterosexual compared to LGB students for smoking (aPR = 2.39;95% CI:2.15,2.65 vs aPR = 1.49;95% CI:1.14,1.95), marijuana use (2.41;2.15,2.71 vs 1.86;1.58,2.19) and prescription drug misuse (2.10;1.93,2.28 vs 1.60;1.28,2.00). Associations between no condom use and SUBs were significantly stronger for heterosexual compared to LGB students only for smoking (1.32;1.16,1.50 vs 0.96;0.73,1.25) and marijuana use (1.22;1.07,1.38 vs 0.90;0.72,1.12). CONCLUSIONS: The relationship between most SUBs and SRBs did not vary significantly by sexual identity. These findings underscore the importance coordinating school-based programs to prevent substance use and promote sexual health.

Victimization Disparities Between Heterosexual and Sexual Minority Youth From Ages 9 to 15.

Mental health disparities between heterosexual and sexual minority youth are partly explained by the higher rates of victimization experienced by sexual minority youth. The onset and progression of these victimization disparities, however, are poorly understood. Using multirater longitudinal data, trajectories of victimization starting at age 9 were compared among youth who did and did not report same-sex attraction at age 15 (N = 310). Self and teacher, but not primary caregivers, reported victimization was significantly higher among sexual minority youth starting at age 9, but did not vary across time. The findings underscore the importance of understanding homophobic experiences of sexual minority youth during late childhood and early adolescence in order to inform prevention programs.

Messaging Lesbian, Gay, Bisexual, and Transgender Health Inequities: A Qualitative Exploration.

BACKGROUND: There are substantial health inequities for lesbian, gay, bisexual, and transgender (LGBT) people compared to their straight/cisgendered counterparts. As evidence of these inequities has become unequivocal, better strategies to address them are needed. One approach is to leverage communications and media advocacy efforts to raise awareness about inequities. However, some research suggests that highlighting health inequities can have negative consequences. This study aimed to explore how LGBT leaders view communication about health inequities. METHOD: We used an inductive qualitative approach and conducted 12 semistructured phone interviews with LGBT community leaders in North Carolina between September and October 2017. RESULTS: Four themes emerged in the data. There was support for reporting health differences between LGBT and straight/cisgendered people to raise awareness of health issues facing LGBT communities. However, participants were concerned about the stigmatizing effects of messages and worried about their effectiveness. CONCLUSION: Emphasizing health differences between LGBT and straight people can be problematic; our findings suggest that health educators (1) must be cautious, (2) must be aware of the audience, and (3) should consider focusing messages on finding a solution to the identified problem. Future work should explore how to best craft messages that address health inequities for LGBT communities.

Late Presentation and Missed Opportunities for HIV Diagnosis in Guatemala.

Early HIV diagnosis remains a challenge in many regions with delayed diagnosis resulting in increased morbidity and mortality. We conducted a retrospective cohort study of people living with HIV receiving outpatient care at a large tertiary referral center in Guatemala to describe the proportion of late presenters (LP) and missed opportunities for HIV diagnosis. Of 3686 patients, 2990 (81.1%) were LP who were more likely to be male (60.2% vs. 48.0%, p < 0.0001), heterosexual (88.0% vs. 78.0%, p < 0.0001) and rural dwellers (43.7% vs. 33.8%. p < 0.0001). The proportions of patients who presented late or with AIDS at diagnosis decreased over time. Only 665 patients (18.2%) sought care in the 2 years prior to HIV diagnosis. This study, the first of its kind in Central America to focus on late presenters and missed opportunities for HIV diagnosis, demonstrates extremely high rates of LP in Guatemala. Although in recent years rates of LP have improved somewhat, the need for screening outside of traditional healthcare settings is apparent.

Malestar psicológico como mediador entre la homofobia interiorizada y riesgo suicida en hombres chilenos / Psychological distress as mediator between internalized homophobia and suicidal risk among Chilean men

Este trabajo tuvo como propósito evaluar el efecto mediador del malestar psicológico entre la homofobia interiorizada y el riesgo suicida en una muestra de hombres que pertenecen a minorías sexuales en Arica (Chile). La muestra estuvo compuesta por 157 hombres de entre 18 y 53 años de edad (M= 24,4; DT= 5,49), reclutados por disponibilidad y técnica de bola de nieve, a los que se administraron la "Escala de homofobia interiorizada", el "Inventario breve de síntomas" y la "Escala de riesgo suicida". Los resultados obtenidos dan cuenta de un efecto mediador del malestar psicológico entre la homofobia interiorizada y el riesgo suicida. Es decir, se incrementa el riesgo suicida, en la medida que se incluyen en el modelo la homofobia interiorizada y el malestar psicológico como tercera variable. Se destaca la importancia de que en las intervenciones psicosociales con hombres chilenos de minorías sexuales se consideren la disminución de la homofobia interiorizada y el malestar psicológico, con el propósito de hacer aportaciones al desarrollo de la salud mental de este colectivo

The aim of this research was to evaluate the mediating effect of psychological distress, between internalized homophobia and suicidal risk in a sample of men belonging to sexual minorities in the city of Arica (Chile). The sample consisted of 157 men between 18 and 53 years of age (M= 24.4, DT= 5.49), recruited by availability and snowball technique. The Internalized Homophobia Scale, the Symptom Inventory and the Scale of Suicide Risk were applied. The results obtained account for a mediating effect of psychological distress between internalized homophobia and suicidal risk, that is, the suicidal risk increases when internalized homophobia and psychological discomfort as a third variable are included in the model. In conclusion, the importance of the reduction of internalized homophobia and psychological distress should be emphasized in psychosocial interventions with men of sexual minorities with the purpose of contributing to the development of their mental health

Bias From Potentially Mischievous Responders on Large-Scale Estimates of Lesbian, Gay, Bisexual, or Questioning (LGBQ)-Heterosexual Youth Health Disparities.

OBJECTIVES: To determine how sensitive estimates of lesbian, gay, bisexual, or questioning (LGBQ)-heterosexual youth health disparities are to the presence of potentially mischievous responders. METHODS: We used US data from the 2015 Youth Risk Behavior Survey, pooled across jurisdictions that included a question about sexual identity for a total sample of 148 960 students. We used boosted regressions (a machine-learning technique) to identify unusual patterns of responses to 7 screener items presumably unrelated to LGBQ identification, which generated an index of suspected mischievousness. We estimated LGBQ-heterosexual youth disparities on 20 health outcomes; then we removed 1% of suspected mischievous responders at a time and re-estimated disparities to assess the robustness of original estimates. RESULTS: Accounting for suspected mischievousness reduced estimates of the average LGBQ-heterosexual youth health disparity by up to 46% for boys and 23% for girls; however, screening did not affect all outcomes equally. Drug- and alcohol-related disparities were most affected, particularly among boys, but bullying and suicidal ideation were unaffected. CONCLUSIONS: Including screener items in public health data sets and performing rigorous sensitivity analyses can support the validity of youth health estimates.