Everyday Discrimination and HIV Testing Among Partnered Latino/x Sexual Minority Men in the United States: A Stratified Analysis by Birth Location.

We examined the association between everyday discrimination and HIV testing patterns-current (≤ 6 months), recent (7-12 months), and delayed (> 12 months or never tested)-among partnered Latino/x sexual minority men (SMM). Multinomial regression analyses revealed that in the full sample (N = 484) experiencing discrimination based on sexual orientation and race/ethnicity attributions concurrently (vs. no discrimination) was associated with higher odds of delayed (vs. current) HIV testing (AOR = 2.6, 95% CI [1.0, 6.7]). Similarly, in the subset of Latino/x SMM born outside the mainland U.S. (n = 209), experiencing concurrent sexual orientation- and race/ethnicity-based discrimination (vs. no discrimination) was associated with higher odds of recent (AOR = 12.4, 95% CI [1.3, 115.7]) and delayed HIV testing (AOR = 7.3, 95% CI [1.6, 33.0]), compared with current testing. Findings suggest that addressing discrimination may improve HIV testing uptake among partnered Latino/x SMM, particularly those born outside the U.S.

Evaluating Litigation as a Structural Strategy for Addressing Bias-Based Bullying Among Youth.

Importance: Homophobic bullying-which is motivated by actual or perceived sexual orientation-is a common experience among youth and is more strongly associated with adverse outcomes than bullying unrelated to bias. Yet current approaches to reducing homophobic bullying either lack empirical evidence or encounter significant obstacles. Thus, the field requires the identification of strategies that hold promise for reducing homophobic bullying. Objective: To examine whether litigation is associated with reductions in homophobic bullying. Design, Setting, and Participants: In this quasi-experimental study, difference-in-difference analysis was used to estimate the association between litigation and homophobic bullying, comparing students in schools that experienced litigation with students in schools that did not experience litigation, controlling for individual and school characteristics, study year, and county. Survey responses came from high school students from 499 schools participating in the California Healthy Kids Survey, the largest statewide survey of youth risk behaviors and protective factors, between 2001 and 2016. Legal data were collected from September 2018 to September 2019, and data were analyzed from February 2020 to April 2021. Exposures: Outcomes of litigation related to sexual orientation-based harassment and discrimination in California schools occurring after 2000. Main Outcomes and Measures: Student reports of homophobic bullying. Results: Of 1 448 778 included participants, 706 258 (48.7%) were male, 563 973 (38.9%) were White, and the mean (SD) age was 14.6 (1.7) years. For cases where the plaintiff (student) secured monetary and/or injunctive relief through settlement or court decision, there was a 23% reduction in the ratio of odds ratios (ROR) of homophobic bullying in schools directly involved in the litigation relative to schools that did not experience litigation (ROR, 0.77; 95% CI, 0.68-0.86). These benefits of litigation spilled over into schools in the same district as the schools experiencing litigation (ROR, 0.76; 95% CI, 0.70-0.81). However, homophobic bullying slightly increased in the school and district where the defendant (school) avoided adverse legal consequences, suggesting potential backlash. Conclusions and Relevance: Litigation seeking to address alleged violations of the rights of students who are (or are perceived to be) lesbian, gay, bisexual, or transgender under laws prohibiting harassment or discrimination may lead to reductions in rates of homophobic bullying, with effect sizes comparable with that of resource-intensive school-based bullying interventions. These findings set the stage for future studies to evaluate the consequences of different litigation efforts aimed at redressing stigma-based harms among youth.

Moderate-to-Severe Tobacco Use Disorder and Discrimination Among U.S. Sexual Minority Older Adults.

OBJECTIVES: The dearth of research on age-related differences in risk factors for tobacco use disorder (TUD) among sexual minorities, particularly among older adults, can obscure the differential needs of sexual minority age groups for tobacco prevention and cessation. We examined the association of cumulative ethnic/racial discrimination and sexual orientation discrimination with moderate-to-severe TUD among U.S. sexual minority adults aged 50 years and older. METHOD: We analyzed cross-sectional data from the National Epidemiologic Survey of Alcohol and Related Conditions-III (n = 36,309 U.S. adults). Our sample consisted of 1,258 adults (lesbian/gay-, bisexual-, and heterosexual-identified adults with same-sex attraction/behavior) aged ≥50 years. Multivariable logistic regression analyses estimated the association of cumulative lifetime ethnic/racial discrimination and sexual orientation discrimination with past-year moderate-to-severe TUD and tested whether the association differed for adults aged 50-64 years versus those aged ≥65 years. RESULTS: An estimated 8.1% of the sample met criteria for moderate-to-severe TUD. Lifetime ethnic/racial discrimination and sexual orientation discrimination was not significantly associated with moderate-to-severe TUD for adults aged ≥50 years. However, a significant 2-way interaction was found between discrimination and age. In age-stratified analyses, greater discrimination was significantly associated with greater risk for moderate-to-severe TUD for adults aged ≥65 years, but not adults aged 50-64 years. DISCUSSION: Greater cumulative discrimination based on ethnicity/race and sexual orientation was associated with increased risk for moderate-to-severe TUD among sexual minority adults aged ≥65 years. Our findings underscore the importance of age considerations in understanding the role of discrimination in the assessment and treatment of TUD.

Intercategorical and Intracategorical Experiences of Discrimination and HIV Prevalence Among Transgender Women in San Francisco, CA: A Quantitative Intersectionality Analysis.

Objectives. To examine differences in HIV prevalence and experiences of discrimination within the trans women community in California's San Francisco Bay Area.Methods. Intersectional positions were constructed on the basis of race/ethnicity (non-Hispanic White, non-Hispanic Black, Latina) and gender identity (female identifying, transgender identifying). We used baseline data from the Trans*National study (2016-2017) to construct regression models that estimated racial/ethnic differences in the attribution of discrimination experienced and, along with surrogate measures for intersectionality, estimated risk among those who were dually marginalized (racial/ethnic minority and transgender identifying). Margins plots were used to visually compare absolute risk across all intersectional positions.Results. Black and Latina trans women were more likely to be HIV positive than non-Hispanic White trans women. In several of the study domains, we estimated a lower risk of reporting discrimination among dually marginalized trans women than among White female-identifying trans women.Conclusions. Quantitative intersectionality methods highlight the diversity of experiences within the trans women community and reveal potential measurement challenges. Despite facing multiple forms of systemic marginalization, racial/ethnic minority trans women report less discrimination than White trans women. Subjective reporting of discrimination likely undercounts risks among racial/ethnic minorities.

Internalized homophobia and depression levels in LGBT individuals.

PURPOSE: This study was conducted to evaluate internalized homophobia and depression levels in LGBT individuals. DESIGN AND METHODS: This descriptive study, conducted between June and October 2018, included 110 LGBT individuals. FINDINGS: The mean Beck Depression Inventory total score of LGBT individuals was 3.14 ± 4.84. The mean total score of the Internalized Homophobia Scale was 15.5 ± 8.09. It was determined that there was a positive but weak relationship between the mean scores of internalized homophobia of the LGBT individuals and the mean score of depression, and internalized homophobia made a statistically significant contribution to depression. PRACTICE IMPLICATIONS: It is considered that the presence of internalized homophobia should be taken into consideration in the prevention of depression in LGBT individuals or in investigating of existing depressive factors in LGBT individuals.

Internalized homophobia and sexual risk behavior among HIV-infected men who have sex with men in Israel.

Sexual risk behaviors among men who have sex with men (MSM) have been linked to diverse demographic, psychosocial, and behavioral factors. This study assessed the association between internalized homophobia and sexual risk behavior among HIV-infected MSM and the mediating effects of safe-sex self-efficacy and depression on this association, using a theoretical framework based on the Theory of Social Action. Data were collected from 124 HIV-infected MSM attending an AIDS clinic in Israel. No significant association was found between internalized homophobia and sexual risk behavior (unprotected anal intercourse). Examination of mediation effects revealed full mediation by depression, but not by self-efficacy. Depression and self-efficacy were the only significant explanatory variables of sexual risk behavior. Diverse social work interventions with HIV-infected MSM aimed at reducing sexual risk behaviors should include routine screening of IH and its association with depression, and address depression and self-efficacy in CBT and other interventions.

Geographic Mobility, Place Attachment, and the Changing Geography of Sex among African American and Latinx MSM Who Use Substances in Los Angeles.

The places that people go and interact with others, along with the characteristics of those places, determine degrees of sexual health risk and concomitant prevention opportunities for gay, bisexual, and other men who have sex with men (MSM). The objective of this paper is to use syndemic theory to guide analyses of 20 in-depth interviews with African American and Hispanic/Latinx MSM living in Los Angeles. We describe the places in which African American and Latinx MSM interviewees live and socialize, and how these places influence sexual behavior, drug use, and access to health care. We find common spatial patterns in mobility, incongruence in residential and sexual places, and differing geographic patterns of sex by men who use geo-social hook-up apps. Significant instability in home life and varying forms of mobility and risk-taking were a response to cumulative disadvantage and intersecting structural forces including poverty, racism, and homophobia. Our results strongly suggest that geographic mobility is a syndemic factor for HIV risk among MSM in Los Angeles, as mobility amplified negative impacts of other syndemic factors. Innovative place-interventions to reduce HIV incidence and disparities in HIV need to acknowledge the synergistic factors that drive higher HIV incidence among AA and Latinx MSM.

Alcohol, Tobacco, and Comorbid Psychiatric Disorders and Associations With Sexual Identity and Stress-Related Correlates.

OBJECTIVE: The authors examined psychiatric comorbidities associated with alcohol use disorders and tobacco use disorders among heterosexual, bisexual, and gay and lesbian men and women in the United States and whether stress-related factors were predictive of comorbidities. METHODS: The authors used data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (2012-2013, N=36,309) to examine the co-occurrence of past-year alcohol or tobacco use disorder with past-year anxiety disorders, mood disorders, and posttraumatic stress disorder by sexual identity (heterosexual, bisexual, gay or lesbian) and sex. The authors also examined the association of stress-related factors and social support with the presence of comorbidities. RESULTS: Comorbidities were more prevalent among women and sexual minorities, particularly bisexual women. More than half of bisexual (55%) and gay or lesbian (51%) individuals who met criteria for a past-year alcohol use disorder had a psychiatric comorbidity, while only one-third of heterosexual individuals who met criteria for a past-year alcohol use disorder did. Similar differences were found among those who met criteria for a past-year tobacco use disorder. Among sexual minorities, the frequency of sexual orientation discrimination (adjusted odds ratio range=1.08-1.10), number of stressful life events (adjusted odds ratio range=1.25-1.43), and number of adverse childhood experiences (adjusted odds ratio range=1.04-1.18) were significantly associated with greater odds of comorbidities. Greater social support was significantly inversely associated with tobacco use disorder comorbidities (adjusted odds ratio range=0.96-0.97). CONCLUSIONS: This research suggests that integrated substance use and mental health prevention and treatment programs are needed, particularly for individuals who identify as sexual minorities. The increased stressors experienced by sexual minority individuals may be important drivers of these high levels of comorbidities.

Discrimination, work stress, and psychological well-being in LGBTI workers in Spain / La discriminación, el estrés laboral y el bienestar psicológico en personas trabajadoras LGTBI en España

Discrimination and prejudice against LGBTI people in Spain are much lower than they used to be; however, negative attitudes towards them may still persist. The purpose of this study was to analyze whether LGBTI individuals perceive the existence of prejudice or discrimination due to their sexual orientation in the workplace. To assess these perceptions in relative terms, we compared them with those of heterosexual individuals. We also analyzed whether perceived discrimination was associated with work stress, the presence of common mental disorders, and depression. Results revealed that LGBTI employees reported experiencing greater discrimination in the workplace because of their sexualorientation, which in turn led to a greater incidence of work stress, mental disorders, and depression. Our findings confirm that job discrimination against LGBTI people is still present, along with some of its harmful consequences, and highlight the need for interventions to reduce prejudice against LGBTI persons in the workplace

A pesar de que la discriminación y el prejuicio hacia el colectivo LGTBI en España hayan disminuido, es posible que aún pervivan actitudes negativas hacia estas personas. En la presente investigación analizamos si las personas LGTBI perciben la existencia de prejuicio o discriminación hacia ellas en el ámbito laboral debido a su orientación sexual. Para analizar en términos relativos dichas percepciones, las comparamos con las que tienen las personas de orientación heterosexual. Después se examinó si la percepción de discriminación está relacionada con el estrés laboral, la presencia de trastornos mentales y la depresión. Los resultados mostraron que las personas LGTBI experimentaban mayor discriminación en su trabajo en virtud de su orientación sexual, produciéndoles mayor estrés laboral, trastornos mentales y depresión. Estos resultados confirman la pervivencia de discriminación hacia las personas LGTBI en el ámbito laboral y algunas de sus perniciosas consecuencias y muestran la necesidad de intervenciones para la reducción del prejuicio hacia los trabajadores LGTBI

Psychological wellbeing of middle-aged and older queer men in India: A mixed-methods approach.

Borrowing concepts from public health, we examined the association of several social determinants with the mental health of middle-aged and older queer men in India by combining quantitative and qualitative methodologies. A cross-sectional survey guided by Meyer's Minority Stress Model was carried out to assess the links between minority stressors (internalized homophobia and degree of closetedness), age-related stressors (ageism and fear of ageing) and psychological wellbeing (loneliness, depressive symptoms and sexual compulsivity) among 207 Indian men (aged 40 years and above) who identified themselves as non-heterosexuals. Results from simple and multivariable linear regression models showed significant positive associations of ageism, internalized homophobia, and fear of ageing with loneliness, even after accounting for sociodemographic and stress mitigating factors. Ageism was not significantly related to depressive symptoms. However, fear of ageing and internalized homophobia was positively associated with depressive symptoms after accounting for covariates. Further, regression models demonstrated a consistent and statistically significant inverse association between income and adverse psychological outcomes suggesting the centrality of social class in the lived experience of Indian gay and bisexual men. The qualitative inquiry addressed the same research questions as the quantitative survey through in-depth interviews of thirty middle-aged and older gay and bisexual men in Mumbai. We found that older and midlife gay and bisexual men with higher income (a proxy for social class) found ways to manage their masculinities with no discernible adverse psychological outcomes. Depressive symptoms and loneliness in this population made them further vulnerable to excessive sexual impulses, especially in the older queer men who were passing off as heterosexuals. Overall, the theory-driven empirical findings suggest that even in India, where family and friends are social insurance for later life, the issues of ageism and internalized homophobia have the potential to lead to worse mental health outcomes among older queer men.

Experienced homophobia and gene expression alterations in Black and Latino men who have sex with men in Los Angeles County.

Men who have sex with men (MSM) experience high rates of homophobic victimization, which is linked to myriad chronic physical and mental health disparities. Social adversity such as rejection, isolation, and racial discrimination can induce a conserved transcriptional response to adversity (CTRA) involving upregulation of proinflammatory genes and downregulation of type I interferon and antibody synthesis genes. This study specifically examines whether homophobic victimization is associated with expression of CTRA profiles in Black and Latino MSM living in Los Angeles. Analyses linked behavioral survey data with quantified RNA from leukocytes from blood samples of 70 participants over 12 months. CTRA gene expression was increased by 3.1-fold in MSM who experienced homophobic victimization while adjusting for major leukocyte subsets and sociodemographics. Accounting for all these factors, CTRA gene expression was significantly enhanced in MSM who identified as Black compared to Latino. Our findings identify experiences of homophobic victimization as drivers of inflammatory and type I interferon gene expression profiles, which can contribute to physical and mental health challenges in Black and Latino MSM.

"Getting to Zero" Among Men Who Have Sex with Men in China: a Review of the HIV Care Continuum.

PURPOSE OF REVIEW: To review the literature on progress towards UNAIDS 90-90-90 targets for HIV prevention and treatment among men who have sex with men (MSM) in China. RECENT FINDINGS: China has made progress towards UNAIDS 90-90-90 targets among MSM. However, socio-structural barriers, including HIV-related stigma and homophobia, persist at each stage of the HIV care continuum, leading to substantial levels of attrition and high risk of forward HIV transmission. Moreover, access to key prevention tools, such as pre-exposure prophylaxis, is still limited. Multilevel interventions, many using digital intervention, have been shown effective in pragmatic randomized controlled trials in China. Multilevel interventions incorporating digital health have led to significant improvement in engagement of Chinese MSM in the HIV care continuum. However, interventions that address socio-structural determinants, including HIV-related stigma and discrimination, towards Chinese MSM are needed.

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.

Severity and Influencing Factors of Homophobia in Korean Nursing Students.

Sexual minorities are people with non-cis and non-heterosexual gender identities, including LGBT (lesbian, gay, bisexual, and transgender) identities. Korean society is prejudiced against sexual minorities-in our study, we will broadly label this prejudice homophobia. It is possible that sexual minorities do not receive appropriate health management owing to such prejudices. Therefore, it is necessary to reduce homophobia in nursing students. This study aims to measure the degree of homophobia in Korean nursing students and identify the factors that affect homophobia. Our study is a cross-sectional study, which surveys attitudes of 265 nursing students toward homophobia in five Korean cities in January to March, 2019. The average homophobia score was 74.5 out of a possible 120; 92.9% of the participants were classified as homophobic, and 42.3% as highly homophobic. We found that participants who were male, religious, had low self-esteem, and had no family members or acquaintances who might belong to a sexual minority group, were more likely to be homophobic. Nursing students in Korea still exhibit high levels of homophobia. As high levels of homophobia can negatively affect health management and nursing, especially in the case of sexual minorities, we suggest that educational programs should be set up to reduce homophobia in nursing students.

The Influence of Internalized Homophobia on Health-Related Quality of Life and Life Satisfaction Among Gay and Bisexual Men in China.

The aim of this study was to examine the influences of internalized homophobia on Chinese gay and bisexual men's quality of life and life satisfaction. Four hundred and eighty-three participants completed the Internalized Homophobia Scale, Chinese SF-12 Health Survey Version 2, and Satisfaction With Life Scale via the Internet. Scores for quality of life in several domains and life satisfaction were significantly lower than the heterosexuals' norm scores. The present study revealed that internalized homophobia significantly negatively correlated with the mental component summary score and life satisfaction. The mental component summary score mediated the relationship between internalized homophobia and life satisfaction. Sexual orientation moderated the relationship between internalized homophobia and mental component score. Gay and bisexual men in China experience poorer quality of life and less satisfaction with life compared to heterosexuals, and internalized homophobia contributes to both.

Facilitating and Inhibiting Factors for Self-Reports of Same-Gender Attraction in Cisgender Heterosexual-Identifying Women and Men.

We sought to identify psychosocial predictors of homoerotic motivations (viz., same-gender attraction) in heterosexual identifying cisgender women and men. We recruited participants from Amazon's Mechanical Turk to complete measures of (a) antipathy towards lesbians and gay men, (b) gender role beliefs, (c) felt-pressure to conform to gender stereotypes, and (d) openness to experience. In Study 1, we found that same-gender attraction was (a) negatively related to antipathy towards same-gender homosexual targets and (b) positively related to felt-pressure to conform to gender stereotypes for both women and men. In Study 2, both effects replicated for men at p < .05, but women only showed the antipathy effect at p < .05, even while the felt-pressure effect size was similar to that in Study 1. Additionally, men showed a significant negative relationship between openness and same-gender attraction. Thus, both anti-gay attitudes and felt-pressure to conform to gender stereotypes appear to be reliably associated with same-gender attraction.

Minority Stress, Activism, and Health in the Context of Economic Precarity: Results from a National Participatory Action Survey of Lesbian, Gay, Bisexual, Transgender, Queer, and Gender Non-Conforming Youth.

Lesbian, gay, bisexual, transgender, queer, and gender non-conforming (LGBTQ & GNC) youth experience more economic hardship and social stress than their heterosexual and cisgender peers. However, the ways that LGBTQ & GNC youth resist these damaging social factors and the corresponding implications for their health have not been addressed. Data were analyzed from a national participatory survey of LGBTQ & GNC youth ages 14-24 (N = 5,860) living in the United States. Structural equation models indicated that economic precarity was associated with experiences of health problems. This association was mediated by the negative influence of minority stress on health as well as by activism, which had a positive association with health. Findings suggest that minority stress explanations of health inequalities among LGBTQ & GNC youth can benefit from including a focus on economic precarity; both in terms of its deleterious impact on health and its potential to provoke resistance to structural oppression in the form of activism.

Resilience, condom use self-efficacy, internalized homophobia, and condomless anal sex among black men who have sex with men, New York City.

BACKGROUND: Black men who have sex with men, who account for less than 1% of the U.S. population, account for approximately 25% of new HIV infections annually. Condomless anal sex contributes to HIV infection among black men who have sex with men. The capacity to recover quickly from difficulties (resilience) may be protective against condomless anal sex, but has been understudied among black men who have sex with men. Psychosocial factors related to resilience, i.e., condom use self-efficacy and internalized homophobia, may also affect condomless anal sex. We assessed the association between resilience, condom use self-efficacy, internalized homophobia and condomless anal sex among black men who have sex with men. METHODS: Data are from a 2010-2011 study examining condomless anal sex (past 60 days) among black men who have sex with men in New York City. Validated scales assessed resilience (theoretical range = 0-100), condom use self-efficacy (theoretical range = 27-135), and internalized homophobia (theoretical range = 9-36). We described continuous variables using median and interquartile range (IQR). Univariable and multivariable Poisson regression models assuming a robust variance estimator were used to compute unadjusted and adjusted prevalence ratios, respectively, and their corresponding 95% confidence intervals (CI). Adjusted prevalence ratios (aPR) examined the association of resilience, condom use self-efficacy, and internalized homophobia with condomless anal sex, while controlling for potential confounders (e.g., having >1 sex partner). RESULTS: The median resilience score within our sample (N = 228) was 75 (IQR = 66-83). Many black men who have sex with men reported condomless anal sex (55.7%) and >1 sex partner (58.8%). Decreased condomless anal sex was associated with increased levels of condom use self-efficacy (aPR: 0.94 per 10-point increase in condom use self-efficacy score; CI: 0.90-0.97; p-value: 0.001). Condomless anal sex was not associated with resilience or internalized homophobia. CONCLUSIONS: Within this sample of black men who have sex with men, condomless anal sex was prevalent. Greater resilience was not protective against condomless anal sex. Interventions that support condom use are warranted for black men who have sex with men.