Abstract
Purpose: Sexual and gender minority youth (SGMY, ages 16–24 years) face disparities in sexually transmitted infections (STIs) and HIV, in part, due to exposure to settings and behaviors that may harm youth's physical and mental health. This study examines the scope of sexual health and HIV services available to youth living with serious mental illness (SMI), including SGMY, seeking care at publicly funded outpatient mental health programs.Methods: Between 2018 and 2019, we surveyed 183 managers of mental health programs serving youth living with SMI of ages 16–24 years, including SGMY, in San Diego and Los Angeles counties. Participants reported on programs' target populations, sexual health/HIV service provision, and the use of peer providers. Descriptive statistics and Pearson chi-square tests were used to describe sexual health/HIV services and identify programmatic characteristics associated with providing these services.Results: Overall, 46% of all programs surveyed provided sexual health/HIV services. Of these, 62% provided HIV education, 81% provided sexual/reproductive health education, and 69% provided sexual/reproductive health education tailored for lesbian, gay, bisexual, queer, intersex (LGBQI) youth. Peers often provided these services. Chi-squared tests showed that programs employing peer specialists (p=0.009) and targeting LGBQI youth (p=0.045) were significantly more likely to provide sexual health/HIV services.Conclusion: The use of peer providers may reduce stigma around sexual/HIV service utilization and promote SGMY's trust. Publicly funded outpatient mental health programs serving youth and especially those actively engaging SGMY may consider also offering onsite HIV, STI, and sexual health services, creating a one-stop-shop approach.
Highlights
This study examines the scope of sexual health and HIV services available to youth living with serious mental illness (SMI), including Sexual and gender minority youth (SGMY), seeking care at publicly funded outpatient mental health programs
Using the Gelberg–Andersen Model of Behavioral Health Services Utilization,[34,35] we focus on enabling factors—that is, we describe the extent to which sexual health and HIV services are available to SGMY within publicly funded mental health programs that serve young adults of ages 16–24 years in California’s two largest counties: Los Angeles (2019 population: *10.3 million) and San Diego counties (*3.4 million).[65]
Our study illustrates the challenges that youth living with mental illness may face in accessing sexual health and HIV services through mental health outpatient programs and underscores potential areas of expansion when addressing the integration of mental health and sexual health services (HSs) for youth and SGMY living with SMI
Summary
Sexual and gender minority youth (SGMY; e.g., lesbian, gay, bisexual, transgender, queer, intersex, of ages 16–24 years) experience overlapping social identities (e.g., gender, sexual orientation, race/ethnicity, and immigrant status) due to the diverse social groups to which they belong.[1,2,3,4] exclusion, stigmatization, and discrimination of these intersecting identities may adversely impact SGMY’s mental and physical health outcomes.[1,5] SGMY are at high risk of experiencing mental health disparities while being at disproportionate risk for sexually transmitted infections (STIs) and HIV.[6,7,8,9] This study describes the availability of sexual health, STI, and HIV services by publicly funded mental health programs that serve SGMY in Southern California, a highly diverse region.Departments of 1Family Medicine and Public Health and 2Medicine, University of California, San Diego School of Medicine, La Jolla, California, USA.
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