Glossary of terms and concepts relating to diversity, equity, and inclusion to reflect on, debate, and raise awareness of: A report from the Society for Vascular Surgery Diversity, Equity, and Inclusion Committee.

The presented glossary highlights the concepts and terminology related to diversity, equity, and inclusion. Although this list should not be considered all-inclusive, it will provide our vascular surgical community with a common vocabulary to help propel change toward improved diversity, equity, and inclusion policies, practices, and culture. As these concepts and terminology find their place in our everyday lives, the Society for Vascular Surgery and its leadership believe that expanding the diversity, equity, and inclusion of vascular surgical professionals is a mission-critical step. This mission will help us improve patient experience through successfully delivering culturally sensitive care for our diverse community. Now is the time.

Relying on an "Other" Category Leads to Significant Misclassification of Sexual Minority Participants.

Purpose: This study assessed which sexual minority participants selected "Other" if their identity was absent. Methods: This was an online survey; 905 participants saw a limited set of sexual orientation options (bisexual, gay/lesbian, heterosexual, other), and later in the same survey, saw an expanded list. Results: Twenty-one percent of participants chose different orientation labels across questions. When not presented with a "mostly heterosexual" option, 78% of mostly heterosexual participants chose "heterosexual"; 3% chose "other." However, when not presented with an "asexual" label, 100% of asexual participants chose "other." Conclusion: These findings suggest that "other" categories could misclassify a substantial proportion of sexual minority participants.

Acceptability of daily pre-exposure prophylaxis among adolescent men who have sex with men, travestis and transgender women in Brazil: A qualitative study.

BACKGROUND: Adolescents face socio-structural, personal and programmatic barriers to HIV prevention services, highlighting the importance of understanding knowledge and acceptability as essential aspects to promote their broader access to pre-exposure prophylaxis (PrEP). We analyzed the acceptability of PrEP among adolescent men who have sex with men (MSM), travestis and transgender women (TGW). METHODS: A qualitative investigation was conducted as part of the formative research of the PrEP15-19 study, an ongoing demonstration study that analyzes the effectiveness of daily PrEP among adolescent MSM, travestis and TGW aged 15-19 in three Brazilian cities. A total of 37 semi-structured interviews and 6 focus groups were conducted. Building from thematic analysis focusing on participants' sexual encounters, perceptions about PrEP efficacy, and vulnerability contexts, we analyzed prospective acceptability of PrEP. FINDINGS: Knowledge about PrEP was incipient and characterized by adolescents' frequent doubts about its prescription and efficacy. The 'ideal' use of PrEP appeared together with consistent condom use, especially in casual sex. PrEP use was also mentioned as depending on increased learning about prevention management over time. Main barriers to PrEP use included the incorporation of a daily medication into participants' routine and its impact on their social lives, especially related to stigma. Concerns over short- and long-term side effects were also reported as barriers to PrEP use. TGW and travestis contrasted using PrEP with the precarity of their life conditions, and some expressed a critical vision about PrEP by associating it with pharmaceuticalization and trans necropolitics. CONCLUSIONS: Participants' low knowledge and acceptability of PrEP are circumscribed by a rigid perception of condom as the ideal prevention method and the context of their sexual relations. Prospective acceptability highlights that the successful uptake of PrEP depends on overcoming barriers of access to health services and confronting transphobia and homophobia as part of care.

LGBT workplace protections as an extension of the protected class framework.

OBJECTIVES: Many corporations in the United States have enacted nondiscrimination policies for their LGBT employees, despite that the LGBT community has not been a legally protected class concerning employment discrimination at the national level. We examined whether progressive corporate LGBT-related policies may be an extension of policies and practices designed to foster diversity and create equality for existing legally protected classes (women, ethnic minorities, veterans, and those with disabilities). We also examined whether leadership level diversity (percentage of women and ethnic minorities on company boards of directors) predicted nondiscrimination policies for LGBT employees. HYPOTHESES: We predicted companies that have been recognized and awarded for protected class diversity policies and that have a greater percentage of women and racial/ethnic minorities on their boards of directors would have more progressive LGBT-related corporate policies. METHOD: Using a sample of Fortune 500 companies, we examined protected-class diversity awards and percentage of women and racial/ethnic minorities on boards of directors as predictors of LGBT-related policies. At the company-level, we controlled for the average age of board, company size, and company revenue. At the level of company headquarter location, we controlled for political climate, Christian religiosity, and LGBT employment nondiscrimination laws. We also controlled for U.S. region and industry sector. RESULTS: Multilevel modeling results indicated that protected-class diversity awards and the percentage of women on company boards of directors significantly and independently predicted progressive LGBT policy scores, whereas the percentage of racial/ethnic minorities on boards of directors had less consistent results. CONCLUSION: Companies that address issues of diversity and equality in the workplace have been likely to include the LGBT community among their groups of concern, even in the absence of legal pressures to do so. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Development of the Gender, Sex, and Sexual Orientation ontology: Evaluation and workflow.

OBJECTIVE: The study sought to create an integrated vocabulary system that addresses the lack of standardized health terminology in gender and sexual orientation. MATERIALS AND METHODS: We evaluated computational efficiency, coverage, query-based term tagging, randomly selected term tagging, and mappings to existing terminology systems (including ICD (International Classification of Diseases), DSM (Diagnostic and Statistical Manual of Mental Disorders ), SNOMED (Systematized Nomenclature of Medicine), MeSH (Medical Subject Headings), and National Cancer Institute Thesaurus). RESULTS: We published version 2 of the Gender, Sex, and Sexual Orientation (GSSO) ontology with over 10 000 entries with definitions, a readable hierarchy system, and over 14 000 database mappings. Over 70% of terms had no mapping in any other available ontology. DISCUSSION: We created the GSSO and made it publicly available on the National Center for Biomedical Ontology BioPortal and on GitHub. It includes clarifications on over 200 slang terms, 190 pronouns with linked example usages, and over 200 nonbinary and culturally specific gender identities. CONCLUSIONS: Gender and sexual orientation continue to represent crucial areas of medical practice and research with evolving terminology. The GSSO helps address this gap by providing a centralized data resource.

Are all LGBTQI+ patients white and male? Good practices and curriculum gaps in sexual and gender minority health issues in a Dutch medical curriculum.

Objectives: People marginalized based on their sexual and gender identity face specific health risks and experience barriers to culturally competent care. Insight into how Dutch medical schools address LGBTQI+ health-related learning objectives is scarce. We therefore examined how LGBTQI+ health issues are integrated in the Amsterdam UMC-VUmc medical curriculum by evaluating the year-two course 'Sex, Sexuality and Relationships' for LGBTQI+ content. Methods/Design: We examined written course content (course syllabus, lecture notes, and course literature) of the 2016-2017 course. We used a framework for essential LGBTQI+ content in medical education and an intersectional approach to examine which LGBTQI+ themes and subthemes were addressed. Results: Several essential LGBTQI+ health issues were adequately addressed and integrated into the Amsterdam UMC-VUmc curriculum, but we also identified curriculum gaps. The needs of patients with lesbian, bisexual, or gender non-conforming identities were marginally addressed, and issues related to intersections of minoritized sexual and gender identities with other aspects of diversity such as ethnicity, age and class remained unexplored. The course discussed gender and sexuality as fixed and mainly binary constructs, and only addressed biomedical explanatory models of sex, gender and sexuality. Discussion and conclusion: The absence of complex patient identities in relation to sex, gender and sexuality does not adequately prepare students to provide LGBTQI+ responsive care. If not designed and taught competently, LGBTQI+-related curriculum content may reproduce bias and stereotypes, and contribute to a medical climate where both LGBTQI+ patients, students, and doctors conceal their identities. Further implementation of LGBTQI+ health issues is required in (continuing) medical education to secure culturally competent clinical environments. Educational research is needed to understand how medical education contributes to marginalization of LGBTQI+ identities and thus, to health disparities.

Inequities in depression within a population of sexual and gender minorities.

Background: Substantial evidence has demonstrated that sexual minorities (gay, lesbian, and bisexual people) and gender minorities (transgender and gender non-binary people) (SGM) experience poorer mental health than heterosexual and cisgender individuals. Meanwhile, less attention has been given to inequities within SGM populations.Aims: This study investigated depression within a sample of Canadian SGM who took part in an online survey (n = 2778).Methods: Multivariable regression was used to identify social characteristics associated with depression, as measured by the Patient Health Questionnaire (PHQ-9) (p < 0.05). The sample was then stratified by gender and sexual identity and the multivariable analysis was repeated for each stratum.Results: PHQ-9 scores were associated with every social position investigated, with the largest coefficients observed for non-binary and transgender individuals and those with a lower level of educational attainment. In stratified analysis, statistically significant associations were observed for cisgender respondents identifying as bisexual, queer, or pansexual (relative to gay/lesbian) and for transgender women from ethnic minority groups or with lower income.Conclusions: These results provide evidence of depression inequities within SGM along multiple social positions. Interventions to reduce depression should be prioritized for these sub-groups of SGM who experience the highest rates of depression.

Identification and characterization of latent classes based on drug use among men who have sex with men at risk of sexually transmitted infections in Amsterdam, the Netherlands.

BACKGROUND AND AIMS: Men who have sex with men (MSM) are at high risk for both drug use and sexually transmitted infections (STI). We aimed to (1) identify subgroups of drug use during sex among MSM in Amsterdam and after classifying participants and (2) compare sexual behaviour and STI across groups. DESIGN: Cross-sectional study. Latent class analysis was used to identify subgroups with similar drug use patterns, between which sexual behaviour and STI prevalence were compared. SETTING: Four different studies conducted at the STI out-patient clinic in Amsterdam, the Netherlands, between January 2014 and June 2016. PARTICIPANTS: A total of 1130 self-declared MSM, aged ≥ 18 years. MEASUREMENTS: Self-reported drug use, laboratory-confirmed STI, socio-demographics, sexual behaviour (including number of partners), condom use. FINDINGS: Median age was 40 years [interquartile range (IQR) = 32-47]. We identified five latent classes of users, which we labelled: 'no substance' (n = 162), 'alcohol' (n = 159), 'nitrites and erectile dysfunction drugs (EDD)' (n = 286), 'polydrug' (n = 257) and 'chems' (n = 266). Median number of sex partners significantly differed across classes (P < 0.001), ranging from two (IQR = 1-6) in the 'no substance' class to 20 (IQR = 10-45) in the 'chems' class. The proportion of MSM reporting condomless anal sex also differed across classes (P < 0.001), ranging from 45.6% in the 'no substance' class to 86.5% in the 'chems' class. Compared with the 'no substance' class, the odds of STI were 3.9-fold [95% confidence interval (CI) = 1.1-14.4] higher in the 'alcohol' class, 8.9-fold (95% CI = 2.7-29.2) higher in the 'nitrites and EDD' class, 12.8-fold (95% CI = 3.9-41.9) higher in the 'polydrug' class and 15.0-fold (95% CI = 4.6-48.8) higher in the 'chems' class. CONCLUSION: There are five distinct classes of drug use in a sexual context among men who have sex with men in Amsterdam, the Netherlands. Classes with higher levels of drug use appear to coincide with higher levels of sexual risk behaviour and sexually transmitted infections.

Sexual orientation and mental health over the life course in a birth cohort.

BACKGROUND: Sexual minority individuals consistently report higher rates of mental disorder than heterosexuals. However, much of the research has methodological limitations related to the classification of sexuality, the use of cross-sectional data and problematic sampling procedures such as using convenience samples. METHODS: We used longitudinal data from a birth cohort enrolled in the Christchurch Health and Development Study (n = 1040). Latent class analysis was used to classify participants sexuality based on self-report data of sexual behaviour, attraction, identity and fantasy, gathered over five assessments between the ages of 18 and 35 years. Mental health and substance use outcome data were gathered at four assessments between the ages of 21 and 35 years. Potential covariate variables were collected during childhood. RESULTS: The latent class analysis identified four groups interpreted as: 'heterosexual' 82%, 'mostly heterosexual' 12.6%, 'bisexual' 3.5% and 'gay/lesbian' 1.9%. In the sexual minority groups, women outnumbered men by at least 2:1. Pooled rates for mental health disorders of depression, anxiety disorders, suicidal ideation, cannabis abuse and total disorders, after adjustment for childhood covariate variables, were significantly higher in the sexual minority groups (p < 0.01). The strength of association between sexuality group and mental health outcomes did not differ according to sex. Fluidity in sexuality reports appeared unrelated to risk of mental health outcomes. CONCLUSIONS: Over the life course, membership of a sexual minority group is clearly associated with mental health problems of depression, anxiety and suicidal ideation regardless of the age when same-sex attraction, behaviour, identity or fantasy is expressed.

In vivo evidence that the cannabinoid receptor 2-63 RR variant is associated with the acquisition and/or expansion of HIV infection.

OBJECTIVES: The aim of the study was to investigate whether the rs35761398 variants of the cannabinoid receptor 2 (CB2) gene may influence the acquisition of HIV infection and the clinical presentation of HIV/hepatitis C virus (HCV) coinfection. METHODS: We compared 166 HIV/HCV-coinfected patients with 186 HCV-monoinfected patients, all with biopsy-proven chronic hepatitis (using the Ishak scoring system), naïve for anti-HCV treatment and tested for the CB2 rs35761398 polymorphism (using the TaqMan assay). RESULTS: The HIV/HCV-coinfected patients were more frequently male (P < 0.002), were younger (P < 0.001), and had lower median BMI (P < 0.001) and HCV RNA (P < 0.05) and higher median aspartate aminotransferase (AST; P < 0.001), alanine aminotransferase (ALT; P < 0.001) and gamma glutamyl transferase (GGT; P < 0.001) levels than the HCV-monoinfected patients. The CB2 RR variant predominated in HIV/HCV-coinfected patients (45.8% vs. 31.2% in HCV-monoinfected patients; P < 0.001) and the CB2 QR variant in HCV-monoinfected patients (57.5% vs. 38.6% in HIV/HCV-coinfected patients; P < 0.00001), and the CB2 QQ variant was equally distributed. Focusing on patients with the CB2 QQ variant, the 26 HIV/HCV-coinfected patients, compared with the 21 HCV-monoinfected patients, showed less severe liver necroinflammation [lower histological activity index (HAI)] (P < 0.05). Of the patients with the CB2 RR variant, the 76 HIV/HCV-coinfected patients, compared with the 58 HCV-monoinfected patients, were more frequently male (P < 0.05), were younger (P < 0.001), and had a lower median body mass index (BMI; P < 0.001), a higher median AST level (P < 0.001), a higher mean HAI score (P < 0.05) and a higher rate of cases with severe steatosis (P = 0.05). In an analysis of variance (anova) of HCV/HIV-coinfected and HCV-monoinfected patient data, those with the CB2 RR variant (P = 0.003) and of male sex (P = 0.002) were more prevalent in the HCV/HIV-coinfected group. CONCLUSIONS: There is the suggestion of a positive effect of the CB2 RR variant on HIV acquisition and/or spread, which is in accordance with previous in vitro observations.

Predator, Pet Lesbian, or Just The Nanny? LGBTQ Parents of Children With Disabilities Describe Categorization.

How are lesbian/gay/bisexual/trans/queer (LGBTQ) parents of children with disabilities categorized by service providers, and how do parents anticipate, interpret, and respond to such categorizations? This intersectional study investigated the experiences of LGBTQ parents of children with disabilities with service providers in Toronto, Canada. Parents described pressures to "fit" into providers' limited understanding of family. Some parents described facing overt discrimination, including one parent who was seen as a possible sexual predator. Some described being perceived as representatives of "diversity" for organizations, or "pet lesbians" in the words of one couple. Others described being misread as a non-parent, as in "just the nanny," particularly in conjunction with their racial minority status. Parents described how their experiences of being "outside the mainstream" helped them challenge systems and normative beliefs. Findings suggest that a context of scarce disability resources shapes parents' experiences of how LGBTQ identity comes to matter.

Getting the terminology right in sexual health research: the importance of accurately classifying fuck buddies among men who have sex with men.

OBJECTIVE: The aim of this report was to raise the issue of the definition and classification of partner terminology in men who have sex with men (MSM) research, particularly in regards to 'fuck buddies'. If definitions in research differ from general consensus in the MSM population, it is possible that public health strategies will be ineffective as the target population may be inaccurate. METHODS: Thirty semistructured interviews with MSM attending the Melbourne Sexual Health Centre were conducted, focusing on the willingness to change sexual practices to reduce the risk of pharyngeal gonorrhoea. As part of these interviews, men were also asked their views on the terminology they used to describe their relationships and sexual partners. RESULTS: The degree of emotional attachment often defined the type or classification of relationships. There was a consensus among men that partners they engaged with for 'sex only' were classified as casual partners and partners with whom there was an emotional attachment or formalisation of the relationship were classified as 'regular partners'. However, the classification of 'fuck buddy' as a regular or casual partner was less clear. CONCLUSIONS: Further research is needed to ascertain the ways in which men conceptualise sexual relationships and define or classify partner types, particularly 'fuck buddy' relationships. A third category for sexual relationships should be considered to encapsulate fuck buddy relationships.

Suicide Acceptability and Sexual Orientation: Results from the General Social Survey 2008-2014.

Lesbian, gay, and bisexual (LGB) individuals have higher prevalence of lifetime suicide ideation and attempt than their heterosexual peers, but less is known about differences in suicide acceptability (i.e., believing suicide is a viable answer to a problem). The purpose of this study was to examine if LGB adults had greater suicide acceptability than heterosexual adults. A total of 4 items in the General Social Surveys from 2008 to 2014 assessed whether a nationally representative sample of U.S. adult respondents (n = 5,037) thought it acceptable for individuals to kill themselves if one: goes bankrupt, dishonors their family, is tired of living, or has an incurable disease. Multiple logistic regression analyses were used to assess the association of sexual orientation with suicide acceptability items after adjusting for confounding factors. Compared with heterosexuals, lesbians/gays had higher odds of reporting suicide acceptability if one goes bankrupt (OR = 1.92; 95% CI: 1.06, 3.46), dishonors family (OR = 1.83; 95% CI: 1.01, 3.28), or is tired of living (OR = 2.25; 95% CI: 1.30, 3.90). Bisexual and heterosexual groups were largely similar across the 4 suicide acceptability items. No sexual orientation differences were observed for reporting acceptability of suicide in the instance of an incurable disease. Post hoc analyses revealed significant interactions between sex and sexual orientation, such that differences in suicide acceptability seemed to be driven by sexual minority women rather than by sexual minority men. Suicide acceptability differs by sexual orientation, and community-level interventions around changing norms about suicide may be a prevention strategy for sexual minority individuals.

Acoustic correlates of sexual orientation and gender-role self-concept in women's speech.

Compared to studies of male speakers, relatively few studies have investigated acoustic correlates of sexual orientation in women. The present investigation focuses on shedding more light on intra-group variability in lesbians and straight women by using a fine-grained analysis of sexual orientation and collecting data on psychological characteristics (e.g., gender-role self-concept). For a large-scale women's sample (overall n = 108), recordings of spontaneous and read speech were analyzed for median fundamental frequency and acoustic vowel space features. Two studies showed no acoustic differences between lesbians and straight women, but there was evidence of acoustic differences within sexual orientation groups. Intra-group variability in median f0 was found to depend on the exclusivity of sexual orientation; F1 and F2 in /iː/ (study 1) and median f0 (study 2) were acoustic correlates of gender-role self-concept, at least for lesbians. Other psychological characteristics (e.g., sexual orientation of female friends) were also reflected in lesbians' speech. Findings suggest that acoustic features indexicalizing sexual orientation can only be successfully interpreted in combination with a fine-grained analysis of psychological characteristics.

"All of My Lovers Fit Into This Scale": Sexual Minority Individuals' Responses to Two Novel Measures of Sexual Orientation.

Previous qualitative research on traditional measures of sexual orientation raise concerns regarding how well these scales capture sexual minority individuals' experience of sexuality. The present research focused on the critique of two novel scales developed to better capture the way sexual and gender minority individuals conceptualize sexuality. Participants were 179 sexual minority (i.e., gay, lesbian, bisexual, pansexual, queer, asexual) individuals who identified as cisgender (n = 122) and transgender (n = 57). Participants first completed the new scales, then provided qualitative responses regarding how well each scale captured their sexuality. The Sexual-Romantic Scale enabled the measurement of sexual and romantic attraction to each sex independently (same-sex and other-sex). Participants resonated with the way the Sexual-Romantic scale disaggregated sexual and romantic attraction. Although cisgender monosexual (lesbian/gay) individuals positively responded to the separation of same- and other-sex attraction, individuals with either plurisexual (bisexual, pansexual, or fluid) or transgender identities found the binary conceptualization of sex/gender problematic. The Gender-Inclusive Scale incorporated same- and other-sex attraction as well as dimensions of attraction beyond those based on sex (attraction to masculine, feminine, androgynous, and gender non-conforming individuals). The incorporation of dimensions of sexual attraction outside of sex in the Gender-Inclusive Scale was positively regarded by participants of all identities. Findings indicate that the Sexual-Romantic and Gender-Inclusive scales appear to address some of the concerns raised in previous research regarding the measurement of sexual orientation among sexual minority individuals.

HIV vulnerability and the erasure of sexual and gender diversity in Abidjan, Côte d'Ivoire.

In the fight against concentrated HIV epidemics, men who have sex with men (MSM) are often framed as a homogeneous population, with little attention paid to sexual and gender diversity and its impact on HIV vulnerability. This article draws on ethnographic research conducted in Abidjan, Côte d'Ivoire among les branchés - a local term encompassing several categories of same-sex desire and practice. In the context of increased HIV prevention programming targeting Ivoirian sexual and gender minorities, such diversity is effectively erased. This obfuscation of difference has particularly negative impacts for travestis, who may be at higher risk for HIV infection, though research and prevention efforts in which they are grouped with 'MSM' render them underrepresented and make their vulnerability difficult to quantify. Branchés whose class and/or ethnic backgrounds compound their stigmatised status as sexual and gender minorities also bear the burden of this exclusion. Furthermore, some branchés deploy 'MSM' as a form of self-identification, further complicating who such categories represent. By highlighting the ways in which constructions of gender and sexuality within HIV/AIDS programming obscure complex social realities, I aim to reorient thinking around the development of purposeful HIV programming that engages the complexity of sexual and gender minority experience.

When identities collide: Conflicts in allegiances among LGB people of color.

Little research has examined the management of multiple minority identities among lesbian, gay, and bisexual (LGB) people of color, despite a growing theoretical literature on such identity intersections. The present study focused on the intersectional construct of conflicts in allegiances (CIA), defined as perceived incompatibility between one's racial/ethnic and sexual orientation identities. CIA was investigated in relation to experiences of parental heterosexism, racism in LGB communities, outness, and racial/ethnic and sexual orientation group identity. Participants were 124 LGB people of color (main sample) and 124 LGB White people (comparison sample) who completed self-report measures of the main variables as part of a larger survey of same-sex couples. CIA was positively correlated with experiences of racism within LGB communities and perceived heterosexism in one's mother (but not one's father), and negatively correlated with outness to family (but not outness to others in one's everyday life). An interaction was found between racial/ethnic and LGB group identity with respect to behavioral engagement: CIA levels were highest among participants with high racial/ethnic behavioral engagement and low sexual orientation behavioral engagement. Results highlight the role of minority and family contexts in CIA among LGB people of color, and, more broadly, the potential value of studying intersectional variables using quantitative methods. Longitudinal and experimental studies are needed to address questions about direction of influence raised by findings.