Feasibility, acceptability, and perceived usefulness of a community-evidence-based harm reduction intervention for sexualized stimulant use among Mexican gay, bisexual, and other men who have sex with men.

BACKGROUND: The use of stimulants and other substances with the purpose of enhancing, maintaining, and prolonging sexual activity is known as sexualized substance use. Also known as chemsex, this pattern of use has been mainly explored in high-income countries. The aim of this article was to assess the feasibility, acceptability, and usefulness of a community- evidence-based harm reduction intervention among Mexican gay, bisexual, and other men who have sex with men (gbMSM) adults who reported sexualized stimulant use in the past 6 months and who were not enrolled in any psychosocial treatment. METHODS: The in-person intervention was designed in partnership with gbMSM who used substances. It consisted of 39 harm reduction strategies before, during, and after episodes of use. The components of the intervention were health and self-care, safety, and psychopharmacology. The intervention was delivered at a university campus, a public recreational space, and an HIV public clinic. Feasibility to deliver the intervention was assessed based on enrolment and completion rates; acceptability through a 28-item, 5-point Likert scale (140 max.) constructed and validated for the Mexican population with good reliability coefficients; usefulness through a 5-point Likert scale ("not useful"-"very useful") for each of the 39 strategies; and potential behavioral change by subtracting the likelihood of implementing each strategy minus the frequency of use of the technique before the intervention. RESULTS: Participants (n = 19; recruitment rate = 35.2%; completion rate = 84.2%) rated the intervention as acceptable with a mean score of 121.6 (SD = 7.5). The highest potential for behavioral change was regarding the use of information about the half-life of stimulants, polysubstance use, and overdose prevention. CONCLUSIONS: This intervention is feasible when provided within public health services where potential participants are already in contact. Harm reduction strategies need to surpass sexually transmitted infections prevention and HIV care and focus on substance use and mental health strategies.

Genetic insights into the dissolution of dioecy in diploid persimmon Diospyros oleifera Cheng.

BACKGROUND: Dioecy, a sexual system of single-sexual (gynoecious/androecious) individuals, is rare in flowering plants. This rarity may be a result of the frequent transition from dioecy into systems with co-sexual individuals. RESULTS: In this study, co-sexual expression (monoecy and hermaphroditic development), previously thought to be polyploid-specific in Diospyros species, was identified in the diploid D. oleifeara historically. We characterized potential genetic mechanisms that underlie the dissolution of dioecy to monoecy and andro(gyno)monoecy, based on multiscale genome-wide investigations of 150 accessions of Diospyros oleifera. We found all co-sexual plants, including monoecious and andro(gyno)monoecious individuals, possessed the male determinant gene OGI, implying the presence of genetic factors controlling gynoecia development in genetically male D. oleifera. Importantly, discrepancies in the OGI/MeGI module were found in diploid monoecious D. oleifera compared with polyploid monoecious D. kaki, including no Kali insertion on the promoter of OGI, no different abundance of smRNAs targeting MeGI (a counterpart of OGI), and no different expression of MeGI between female and male floral buds. On the contrary, in both single- and co-sexual plants, female function was expressed in the presence of a genome-wide decrease in methylation levels, along with sexually distinct regulatory networks of smRNAs and their targets. Furthermore, a genome-wide association study (GWAS) identified a genomic region and a DUF247 gene cluster strongly associated with the monoecious phenotype and several regions that may contribute to andromonoecy. CONCLUSIONS: Collectively, our findings demonstrate stable breakdown of the dioecious system in D. oleifera, presumably also a result of genomic features of the Y-linked region.

"As a psychiatry resident I am invited to explore my identity. But when I accept that invitation, I still encounter a wall." A qualitative study on inclusion experienced by psychiatry residents with a migration background, sexual minority identity and/or working-class background.

Diversity in terms of class, sexual identity and migration background among medical students in high income countries has increased greatly in recent decades. Some research into the experiences of these new groups of doctors has been performed. However, no previous research into the experiences of psychiatry residents specifically, is known. This qualitative study investigates how psychiatry residents, from these minoritized groups, experience their training regarding inclusion. Inclusion is defined as the degree to which one's needs for connection and for being valued in one's uniqueness, is satisfied. In-depth interviews with 16 psychiatry residents were conducted. These interviews were transcribed and coded using MaxQDA software. Initial themes that were constructed, were explored further in subsequent interviews and linked to literature. Finally, the developed themes were ordered in a model conceptualizing inclusion. Participants reported high belongingness within psychiatry training. Their experienced value in uniqueness, however, was generally quite low. Participants reported to experience little interest in and sensitivity for their perspectives and lived experiences from their co-workers. When faced with stigmatization and discrimination, participants reported lack of support from their colleagues. Assimilation was found to be the most frequently used coping strategy in dealing with diversity. Participants seemed to conform to the 'neutral' norm and experienced barriers in expressing themselves. Through this mechanism of assimilation, the added value that participants might bring with their unique knowledge and lived experiences was not used, both in patient care and in creating an inclusive climate within the organization. Moreover, assimilation is associated with psychological strain.

Social Reactions and Trauma Symptoms Among Gender and Sexual Minority Students Disclosing Sexual Violence.

Addressing the higher rates of sexual violence experienced by gender and sexual minority students in university contexts requires an understanding of responses to disclosures of sexual violence. Using data from a large-scale study of sexual violence in university contexts, the current study examined (1) whether gender and sexual minority status was associated with responses to sexual violence disclosure and (2) how disclosure responses were associated with trauma symptoms among these students. Linear regression indicated that university students' (n = 1,464) reports of responses to disclosures of sexual violence did not differ across gender or sexual minority status. Focusing on gender and sexual minority participants (n = 327), linear regression linked turning against the victim and positive responses to higher levels of trauma symptoms.

Culture clash: responses to sexual diversity in residential aged care.

This paper explores attitudes of staff, residents and family members towards sexually diverse persons based on data from the first national study of its kind in Aotearoa New Zealand. The study was a two-arm mixed-method cross-sectional study using a concurrent triangulation design. The quantitative arm included the results of 433 staff surveys related to knowledge, attitudes, behaviours and beliefs about sexuality, intimacy and ageing. The qualitative arm included interviews with 77 participants including staff, residents and family members. This paper focuses only on sexual diversity. A generational cultural effect was noted among all respondents; younger participants expressed the most open and accepting views of diversity. Residents were aware that they mostly held the views of their generation; nonetheless they also looked to staff to set the tone. Staff held varying views and felt that residents would be less accepting; some staff felt the issue of intimate relationships was not something they were willing to discuss at intake. Facilities will want to establish policies about sexuality and intimacy and communicate those policies and practices to staff, residents and family members. Facilities may also wish to consider specific educational events about sexual diversity for residents.

Gender-Related Aspects in Osteoarthritis Development and Progression: A Review.

Osteoarthritis (OA) is a common degenerative joint disease treated mostly symptomatically before approaching its definitive treatment, joint arthroplasty. The rapidly growing prevalence of OA highlights the urgent need for a more efficient treatment strategy and boosts research into the mechanisms of OA incidence and progression. As a multifactorial disease, many aspects have been investigated as contributors to OA onset and progression. Differences in gender appear to play a role in the natural history of the disease, since female sex is known to increase the susceptibility to its development. The aim of the present review is to investigate the cues associated with gender by analyzing various hormonal, anatomical, molecular, and biomechanical parameters, as well as their differences between sexes. Our findings reveal the possible implications of gender in OA onset and progression and provide evidence for gaps in the current state of art, thus suggesting future research directions.

Translating Knowledge of Sexual Configurations Theory via Instructional Videos.

Gender/sex and sexual diversity are increasingly understood by the public as complex. But, scientific frameworks that address the complexity of gender/sex and sexual diversity are few and not well situated for the public. Sexual configurations theory (SCT; van Anders, 2015) is one approach that provides a visual framework for understanding and measuring gender/sex and sexual diversity. But how might knowledge users and creators actually use it? To make SCT more accessible to researchers, educators, clinicians, and the general public, we created three instructional videos (individual gender/sex, gender/sex sexuality, and partner number sexuality) that explained SCT and demonstrated how to use its diagrams. Participants (N = 242) of diverse gender/sex and sexual identities, including professionals who work in gender/sex- and sexuality-related fields, watched one of the three videos, filled out the diagrams, and evaluated the video and diagrams via scaled and open-ended questions. Results demonstrated that the SCT videos were sufficient for most participants to fill out the diagrams. Participants evaluated the video generally positively, with some variation by condition, identity group, and professional status. These results indicate that instructional videos are able to translate SCT, potentially facilitating uptake of SCT by clinicians, researchers, and educators as well as increasing awareness of gender/sex and sexual diversity more broadly within the public.

Practical justice as an innovative approach to addressing inequalities facing gender and sexually diverse people: a case example from Papua New Guinea.

Cultural values and practices influence many aspects of sexual and reproductive health and rights - from access to and quality of health education and services, to gender roles and responsibilities, to family planning and sexual freedoms. Culture is frequently marginalised in epidemiologically driven analyses of sexual and reproductive health and rights yet remains central to the ways in which inequalities within these fields manifest themselves and are engaged with in society. Using Papua New Guinea (PNG) as a case example, this paper sheds light on the enabling and restrictive role of culture in efforts to work towards equity and justice for gender and sexually diverse people. Drawing on four case stories, we offer insight into where culture can and has been deployed to redress serious inequalities in what is often a hostile environment. In these stories we illustrate how practical justice provides an innovative way to approach issues to do with sexual and reproductive health, particularly as they relate to enhancing the lives of people in visible, grassroots ways. In this way, given evidence, good normative judgement and the opportunity to do good and be fair, practical justice may be seen to be taking place.

[DEPATHOLOGIZE TRANS SUBJECTIVITIES, EDUCATE IN DIVERSITY. A DEBT OF PSYCHIATRY]. / Despatologizar las subjetividades trans, educar en la diversidad: una deuda de la psiquiatría.

This article proposes to succinctly go through the process of pathologization of trans subjectivity from the birth of Sexology and the struggle of militant groups in defense of their rights to the present day. Today, psychiatry is responsible for depathologizing trans subjectivities; to learn through the theoretical and experiential developments that have produced trans activists and to in-fluence to make decriminalization and depathologization universal and that the essential cultural changes that enable coexistence in diversity occur.

Sexual and Gender Diversity Among Sexual and Gender/Sex Majorities: Insights via Sexual Configurations Theory.

Recent research on gender and sexual majority individuals suggests that their attractions, identities, and experiences may not be as homogenous or easily generalizable as is often assumed. Sexual configurations theory (SCT; van Anders, 2015) is a framework for conceptualizing individuals' partnered sexualities and gender/sexes with a focus on gender/sex and sexual diversity. SCT has been successfully used in recent empirical work with gender and sexual minority individuals (Schudson, Manley, Diamond, & van Anders, 2018), but it has not yet been tested with heterosexual, cisgender individuals. In the present study, we tested the use of SCT in qualitative interviews with 26 gender and sexual majority participants to address the following research questions: What are the strengths and weaknesses of SCT for representing heterosexual, cisgender individuals' gender/sexes and partnered sexualities? How do gender and sexual majority individuals use SCT to express their gender/sexes and partnered sexualities? And, what insights about sexual and gender diversity can be gained from using SCT with a gender and sexual majority sample? Using thematic analysis, we evaluated how participants interacted with SCT and the SCT diagrams. Results showed that our participants used components of SCT to convey comprehensive and nuanced interests, which included gender/sex and sexual diversity outside of what is typically expected in research on heterosexual, cisgender individuals. We discuss findings and challenges specific to working with majority participants and offer implications for future work on gender/sex and sexual majorities and on gender/sex and sexual diversity in general.

A Qualitative Exploration of LGBTQ+ and Intersecting Identities Within Physical Activity Contexts.

LGBTQ+ (lesbian, gay, bisexual, transgender, queer, etc.) individuals face an array of challenges to physical activity participation, such as discrimination and exclusion. The purpose of this study was to gain an understanding of LGBTQ+ experiences in physical activity. Eight focus groups of LGBTQ+ individuals (N = 42) were conducted using a semistructured interview guide, and broad discussions about personal physical activity experiences were encouraged. All focus groups were audio-recorded, transcribed verbatim, and subject to thematic analysis. Three main themes emerged with the following considerations: (a) intersectionality-an intersectional approach is required to explore the complexity of LGBTQ+ experiences within physical activity; (b) the contested concept of "athlete"-LGBTQ+ communities have unique conceptions associated with "athlete" that can render sport, and by extension physical activity contexts, elitist and inaccessible; and (c) "a safe space for us"-LGBTQ+-friendly physical activity practices should be explored to provide practical suggestions for inclusive practices.

Development of an Instrument to Assess Health and Social Care Professionals' Knowledge and Attitudes Towards Later-Life Intimacy and Sexuality (HSCP-KALLIS): A Delphi Study.

AIMS: We aimed to ascertain the content validity of an instrument to assess health and social care professionals' knowledge and attitudes towards later-life intimacy and sexuality (HSCP-KALLIS). BACKGROUND: For older adults, intimacy and sexuality are important in maintaining their quality of life and well-being. However, addressing these needs remains challenging for health and social care professionals, particularly for nursing staff providing 24-h direct care to older people with dementia or those identified as lesbian, gay, bisexual, transgender, intersex or queer/questioning individuals. Existing instruments assessing knowledge and attitudes towards later-life intimacy and sexuality are dated and fail to adequately address dementia and sexual diversity. DESIGN: A two-round modified Delphi study was conducted. METHODS: Initially, 79 knowledge and attitude items were generated through an integrative review. Panellists rated each item's clarity and importance using online questionnaires. The content validity index for the individual and overall items was calculated. The panellists' written feedback-along with their knowledge level of later-life intimacy and sexuality-was obtained. RESULTS: Panellists included health and social care professionals (n = 9); healthcare-related educators (n = 2); researchers specialising in later-life intimacy, sexuality, dementia care and sexual diversity support (n = 7); and family carers of older people with dementia (n = 2). The instrument was revised based on the feedback received. The components of dementia, LGBTIQ+ and the provision of sex worker services in healthcare settings were highlighted by the panellists. Notably, 46 knowledge and 40 attitude items fulfilled the consensus criteria for clarity and importance. CONCLUSIONS: Acceptable content validity was established for the knowledge and attitude items. Further research is required to establish the psychometric properties of the HSCP-KALLIS. This instrument has implications for clinical practice-specifically, in nursing care-by addressing issues to improve awareness regarding later-life intimacy and sexuality in healthcare settings. IMPLICATIONS FOR PRACTICE: The HSCP-KALLIS has the potential to inform the educational needs regarding knowledge and attitudes towards later-life intimacy and sexuality for health and social care professionals, specifically nursing staff. The findings of the HSCP-KALLIS can be used for the development of competencies for later-life intimacy and sexuality, establishing policies and guidelines to support older adults' intimacy and sexuality needs in health care settings.

Early adversity and sexual diversity: the importance of self-reported and neurobiological sexual reward sensitivity.

Work shows that sexually-diverse individuals face high rates of early life adversity and in turn increased engagement in behavioral outcomes traditionally associated with adversity, such as sexual risk taking. Recent theoretical work suggests that these associations may be attributable to heightened sexual reward sensitivity among adversity-exposed women. We aimed to test these claims using a combination of self-report and EEG measures to test the relationship between early adversity, sexual reward sensitivity (both self-reported and EEG measured) and sexual risk taking in a sexually diverse sample of cis-gender women (N = 208) (Mage = 27.17, SD = 6.36). Results showed that childhood SES predicted self-reported sexual reward sensitivity which in turn predicted numbers of male and female sexual partners. In contrast we found that perceived childhood unpredictability predicted neurobiological sexual reward sensitivity as measured by EEG which in turn predicted male sexual partner number. The results presented here provide support for the notion that heightened sexual reward sensitivity may be a pathway through which early life adversity augments future sexual behavior, and underscores the importance of including greater attention to the dynamics of pleasure and reward in sexual health promotion.

Sexual health and wellbeing and the menopause: An EMAS clinical guide.

INTRODUCTION: Sexual health and wellbeing are significant aspects of quality of life. However, taking a sexual history is often avoided in medical practice, leaving a void in management and awareness. As the menopause can have a major impact on sexual health, it is imperative that healthcare providers are appropriately trained in sexual health and wellbeing and the aligned disciplines in order to achieve optimal care. AIM: To provide an evidence-based clinical guide for the assessment and management of sexual problems at the menopause and beyond. MATERIALS AND METHODS: Review of the literature and consensus of expert opinion. RESULTS AND CONCLUSION: The assessment of sexual problems includes history taking, examination and laboratory investigation (if indicated), and occasionally the use of specific validated questionnaires. Management of sexual problems requires a multidimensional approach using biopsychosocial measures. Medical management and psychosexual counselling include pharmacological and non-pharmacological interventions, and sex therapy and psychoeducation. Furthermore, perimenopausal women should be advised about the need for contraception if they wish to avoid pregnancy. Also, sexually transmitted diseases can be acquired at any age. To conclude, taking a sexual history should be incorporated into medical practice and healthcare providers should be appropriately trained to assess and manage sexual problems at the menopause and beyond.

Faculty Training on Navigating Gender and Sex in Medical Education.

Introduction: Language that assumes gender and sex are binary and aligned is pervasive in medicine and is often used when teaching on physiology and pathology. Information presented through this lens oversimplifies disease mechanisms and poorly addresses the health of gender and sexually diverse (GSD) individuals. We developed a training session to help faculty reference gender and sex in a manner that would be accurate and inclusive of GSD health. Methods: The 1-hour session for undergraduate and graduate medical educators highlighted cisgender and binary biases in medical teachings and introduced a getting-to-the-root mindset that prioritized teaching the processes underlying differences in disease profiles among gender and sex subpopulations. The training consisted of 30 minutes of didactic teaching and 20 minutes of small-group discussion. Medical education faculty attended and self-reported knowledge and awareness before and after the training. Results were compared using paired t tests. Expenses included fees for consultation and catering. Results: Forty faculty participated (pretraining survey n = 36, posttraining survey n = 21). After the training, there was a significant increase in self-reported awareness of the difference between gender and sex (p = .002), perceived relevance of gender to teachings (p = .04), and readiness to discuss physiological drivers of sex-linked disease (p = .005). Discussion: Participants reported increased understanding and consideration of gender and sex in medical education; feedback emphasized a desire for continued guidance. This easily adaptable session can provide an introduction to a series of medical teachings on gender and sex.

Sexual diversity on college campuses: using a BDSM framework to discuss consent.

Sexual assault in higher education is a continuing concern. At the same time, college students are engaging in a range of consensual sexual behaviors that could appear to be sexual violence. Sexuality education on college campuses should address the spectrum of sexual behaviors and college health professionals and administrators need to be able to distinguish consensual rough sex from sexual violence. Common consent negotiations in BDSM (bondage and discipline, dominance and submission, sadism and masochism) contexts may serve as an appropriate model for acquiring consent. This viewpoint article aims to (1) review the increased participation of college students in diverse sexual behaviors, and (2) introduce the consent process of BDSM as a framework for college health professionals to discuss consent for other sexual behaviors.

"Classifying D/s Profiles Without Prior Assumptions: An Application of Cluster Analysis to Social Data".

Dominant/submissive role-play (D/s) is associated with specialized roles including Mistress, Master, Slave, Switch, Sadist, and Masochist. The current study uses cluster analysis to provide empirical evidence that no binary opposition or single spectrum constitutes a workable typology of individuals based on their affinities for these roles. The optimality of a particular choice of clustering scheme, including the number of clusters, is established using a replication technique which is presented in detail. A large number (n = 236,353) of individualized results (profiles) generated by the BDSM Test, a popular anonymous web survey, were analyzed. We hypothesize a two-dimensional typology of D/s profiles as the inferential result of our cluster analyses.

UN ETEROCLITO BABUINO: On Giordano Bruno's Candelaio and the Infinitization of the Sexes.

Giordano Bruno (Nola 1548 - Rome 1600) published in 1582 Candelaio, a comedy that anticipates the core arguments he developed in the six dialogs written in volgare during the philosopher's stay in England (1583-1585). In the comedy, the term candelaio (candlebearer) is deployed not only as a trope for light and illumination, but also as a slang designation for sodomite. Thus, sexual dissident Bonifacio, the tragicomic personage to which the title refers, brings to light the mostly unavowed or denigrated, albeit ineradicable complexities of every sexual individuality. In this framework, the personality, lifestyle, and views of disruptive Bonifacio/Candelaio serve as narrative support for a critical stance aiming at undoing the validity claims of the man/woman dichotomy. At the antipodes of the finitization of sexuality fostered by Christian creationism, Bruno's sexual approach is framed within a conception of "natura naturante," the all-pervasive, inexhaustible and animating power, which enables the emergence of utterly diversified beings throughout the infinitude of the existing worlds. Having dismantled the epistemic pretentions of sexual binarity and its possible closed supplementations, Bruno effectively frees Bonifacio's sexual heteroclisis from the stigma of unnaturalness. Notwithstanding the trailblazing traits of Bruno's sexual thought and its ontological framework, Brunian scholarship to the present has ignored that the philosopher from Nola posed the arguably most profound and consistent challenge to binary sexuality and its finite suppletions in pre-Darwinian Modernity. In view of the critiques of patriarchy and anti-feminism that began to develop at the turn to the twentieth century, it is striking that no systematic effort has been undertaken to relate Bruno's principled reversion of the form/matter hierarchy to his advocacy for the axiological restauration of femaleness in the masculinist-centered culture of the West. In accordance with Bruno's explicit design to "turn upside down the reversed world," his philosophy seeks to reveal the endless profusion of sexual forms not as creations of an omnipotent paternal figure, but as emergences from an inexhaustible source, which he signally terms "the maternal womb of Nature."

Recommendations from LGBTQ+ adults for increased inclusion within physical activity: a qualitative content analysis.

For decades, physical activity contexts have been inherently exclusionary toward LGBTQ+ participation through their perpetuation of practices and systems that support sexuality- and gender-based discrimination. Progress toward LGBTQ+ inclusivity within physical activity has been severely limited by a lack of actionable and practical suggestions. The purpose of this study was to garner an extensive account of suggestions for inclusivity from LGBTQ+ adults. Using an online cross-sectional survey, LGBTQ+ adults (N = 766) were asked the following open-ended question, "in what ways do you think physical activity could be altered to be more inclusive of LGBTQ+ participation?" The resulting texts were coded using inductive qualitative content analysis. All coding was subject to critical peer review. Participants' suggestions have been organized and presented under two overarching points of improvement: (a) creation of safe(r) spaces and (b) challenging the gender binary. Participants (n = 558; 72.8%) outlined several components integral to the creation and maintenance of safe(r) spaces such as: (i) LGBTQ+ memberships, (ii) inclusivity training for fitness facility staff, (iii) informative advertisement of LGBTQ+ inclusion, (iv) antidiscrimination policies, and (v) diverse representation. Suggestions for challenging the gender binary (n = 483; 63.1%) called for the creation of single stalls or gender-neutral locker rooms, as well as for the questioning of gender-based stereotypes and binary divisions of gender within physical activity (e.g., using skill level and experience to divide sports teams as opposed to gender). The findings of this study represent a multitude of practical suggestions for LGBTQ+ inclusivity that can be applied to a myriad of physical activity contexts.

Physical activity contexts have a long history of being exclusionary toward people who identify as LGBTQ+. To better understand how to improve physical activity contexts, LGBTQ+ adults were asked, "in what ways do you think physical activity could be altered to be more inclusive of LGBTQ+ participation?" using an online survey. From the 766 responses collected, 72.8% detailed approaches to create safer spaces for LGBTQ+ participation, such as: clearly advertising if the space is LGBTQ+ friendly, the creation of LGBTQ+-only classes (specifically beginner courses) or times, creating LGBTQ+ exclusive gym spaces, comprehensive antidiscrimination policies, and LGBTQ+ sensitivity staff training. Additionally, 63.1% of responses provided suggestions to better support gender diverse participation through either the addition of single changing stalls or the creation of gender-neutral locker rooms, as well as through the reorganization of sport from gender categories (men vs. women) to categories based on age or experience. Respondents also recommended that common gender-based stereotypes should be questioned and eventually debunked.