"This must really come from within": Kurdish diasporic narratives of solidarity as resistance and existence in Belgium.

Sexual and gender minorities (SGM) experience detriments across many physical and mental health outcomes compared with heterosexual and cisgender people. But little is known about health outcomes for those who are both gender minorities and sexual minorities. Motivated by theories of double disadvantage and leveraging advancements in data collection and measurement, we examine physical and mental health disparities across sexual and gender minority statuses: cisgender heterosexuals, gender minority heterosexuals, cisgender sexual minorities, and people who are both gender and sexual minorities. Using Gallup's National Health and Well-Being Index (N = 93,144) and the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System (N = 543,717), we estimate multivariable logistic regression models to examine how sexual and gender minority statuses are associated with poor/fair self-rated health, functional limitations, and diagnosed depression. Regression models adjusting for sociodemographic characteristics show marked physical and mental health disparities: people who are both gender and sexual minorities report greater odds of poor/fair self-rated health, functional limitations, and depression relative to cisgender heterosexuals and, in some cases, relative to gender minority heterosexuals and cisgender sexual minorities. Our results add to a growing body of research documenting the association between multiple disadvantaged statuses and health and provide novel information on SGM health disparities.

Background Sexual and gender minorities face high levels of stigma, discrimination, and violence. In many countries, they are often criminalized and are at risk of mental health challenges. In Zambia, little is known about the psychosocial challenges and coping strategies of sexual and gender minorities. This study sought to explore psychosocial challenges and coping strategies among sexual and gender minority populations in Lusaka, Zambia to inform mental health and human rights promotion for this population. Methods The study used a qualitative phenomenological study design. Data were collected through in-depth interviews with 16 sexual and gender minority participants (lesbian, gay, bisexual, and transgender) and four key informants. The sexual minorities included four lesbian, five gay, and three bisexual participants while the gender minorities included two transgender men and two transgender women. Interviews with gender and sexual minorities were mostly focused on the lived experiences of participants, while those of key informants focused on their work with sexual and gender minorities. Snowball strategy was used to recruit participants, while purposive sampling was used to select key informants. All interviews were recorded and transcribed verbatim. Thematic analysis was carried out with the aid of Nvivo 12 software. Results Psychosocial challenges included victimization in the form of threats and physical assault. Stigma and discrimination were experienced in different settings such as healthcare, the workplace, and school. Participants reported having experienced feelings of depression. Rejection from family members was experienced by those who revealed their sexual or gender minority status. Reported coping strategies included social support, self-concealment, listening to music, and substance use. Conclusion This study suggests that sexual and gender minorities in Zambia experience various psychosocial challenges related to their sexuality and gender identity. To assist them cope better with the obstacles they experience, improved psychosocial counseling and mental health services are needed.

This study evaluated short- and long-term impact of a 4-day training intervention to reduce negative perspectives of religious leaders in Kenya on sexual and gender minorities, adopting a one-group pretest-posttest-follow-up design. Religious leaders’ perspectives play an important role in maintaining the negative status quo for sexual and gender minorities, especially in Africa, where religion’s impact is ubiquitous and holding negative attitudes against these populations is perceived as an expression of doctrinal orthodoxy. The training, developed by a community-based organization, employs a variety of strategies, including education, storytelling, and in-person contact. Data were collected directly before and after the training, and at 3- to 4-months follow-up. After the training, acceptance of lesbian women and gay men and gender diversity had increased, while attitudes toward gender and sexual minorities became more positive. Interaction effect analysis showed that compared to women, men changed more, as did those who scored higher on religious fundamentalism. Changes in attitudes were maintained at follow-up (three to four months). Although it is not clear whether the training had an impact on the religious leaders’ interactions with members of their congregation, these findings suggest that intensive trainings may promote positive changes in their perspective on gender and sexual minorities.

Sexual Violence on Campus: Differences Across Gender and Sexual Minority Status

Experiencing sexual violence is an important risk factor for trauma symptoms, and these symptoms significantly impair psychosocial functioning. Sexual and gender minority university students are more likely than their heterosexual and cisgender peers to experience sexual violence (e.g., sexual harassment, unwanted sexual contact, or sexual coercion) while attending university, but research on the consequences of these experiences is needed to inform service provision to these vulnerable populations. Using a large-scale study of university-based sexual violence in Quebec, the current study examined how gender and sexual minority status were associated with the severity of trauma symptoms among students who experienced sexual violence (N = 1,196). Findings indicated that compared with their cisgender peers, gender minority students experienced significantly higher levels of trauma symptoms as a result of sexual violence, controlling for the severity of sexual violence behaviors experienced and other variables. Among cisgender women, but not cisgender men, sexual minority identity was also associated with higher levels of trauma symptoms, controlling for severity of sexual violence behaviors experienced and other variables. Furthermore, gender of perpetrator and amount of sexual violence moderated the associations between sexual identity and trauma symptoms among cisgender women. These findings not only suggest that gender minority and some sexual minority university students are more likely to experience sexual violence, but that they are also more likely to experience negative psychological sequelae as a consequence of these experiences. Ultimately, these findings may suggest the need for services that are more supportive of the specific needs of gender and sexual minority students with regard to sexual violence.

Introduction: Sexual minority (SM) and gender minority (GM) students make up a growing portion of medical student bodies and face unique challenges that shape their career decisions. Identifying what specialties draw interest from SM and GM medical students is crucial for anticipating the composition of an increasingly diverse clinical workforce and understanding what contribution these students could make to addressing health disparities faced by LGBTQIA+ patient populations.Aim and objective: To study specialty choices and intent to work in underserved contexts among graduating SM and GM medical students in the United States and determine whether these differed from their heterosexual and cisgender counterparts.Methods: We completed a secondary analysis of data from the 2022-2024 American Association of Medical Colleges’ Graduation Questionnaire (GQ), which included responses from 50,185 graduating allopathic medical school students. Respondents were stratified by gender identity, as well as sexual orientation and sex. Descriptive statistics were calculated to examine the specialty choices of SM and GM students. χ2 tests were used to compare intention to pursue primary care or surgical specialties and intention to work in underserved areas or with underserved populations.Results: GM and SM medical students were more likely to intend to work in underserved areas (GM: n = 241/473, 50.95% vs. cisgender: n = 13,378/46,413, 28.82%; p < 0.001; SM: n = 2,205/5,713, 38.60% vs. heterosexual: n = 11,308/40,796, 27.72%, p < 0.001) and with underserved populations (GM: n = 326/473, 68.92% vs. cisgender: n = 18,454/46,409, 39.76%, p < 0.001; SM: n = 3,070/5,719, 53.68% vs. heterosexual: n = 15,563/40,787, 38.16%, p < 0.001) than their cisgender and heterosexual peers. GM and SM students were also less likely to pursue surgical specialties than their cisgender and heterosexual peers (GM: n = 96/469, 20.47% vs. cisgender: n = 12,120/46,117, 26.28%. p < 0.01; SM: n = 1,312/5,660, 23.18% vs. heterosexual: n = 10,812/40,553, 26.66%, p < 0.001). Family medicine (n = 93, 19.70%) and psychiatry (n = 69, 14.62%) were the most popular preferred specialties among graduating GM students, while internal medicine (n = 848, 14.85%) and psychiatry (n = 685, 11.99%) were most popular among SM students.Conclusion: These results illustrate how GM and SM medical students are drawn toward specialties such as family medicine and psychiatry, which may be informed by these fields' perception as inclusive spaces. In addition, our findings demonstrate a decreased interest in surgical fields among GM and SM medical students. GM and SM students showed a greater propensity for intending to work in underserved clinical contexts and may become a core part of the clinical workforce supporting communities in need, such as LGBTQIA+ patients.

Sexual and gender minority (SGM) groups have been historically underrepresented in neurologic research, and their brain health disparities are unknown. We aim to evaluate whether SGM persons are at higher risk of adverse brain health outcomes compared with cisgender straight (non-SGM) individuals. We conducted a cross-sectional study in the All of Us Research Program, a US population-based study, including all participants with information on gender identity and sexual orientation. We used baseline questionnaires to identify sexual minority (lesbian, gay, bisexual, diverse sexual orientation; nonstraight sexual orientation) and gender minority (gender diverse and transgender; gender identity different from sex assigned at birth) participants. The primary outcome was a composite of stroke, dementia, and late-life depression, assessed using electronic health record data and self-report. Secondarily, we evaluated each disease separately. Furthermore, we evaluated all subgroups of gender and sexual minorities stratified by sex assigned at birth. We used multivariable logistic regression (adjusted for age, sex assigned at birth, race/ethnicity, cardiovascular risk factors, other relevant comorbidities, and neighborhood deprivation index) to assess the relationship between SGM groups and the outcomes. Of 413,457 US adults enrolled between May 31, 2017, and June 30, 2022, we included 393,041 participants with available information on sexual orientation and gender identity (mean age 51 [SD 17] years), of whom 39,632 (10%) belonged to SGM groups. Of them, 38,528 (97%) belonged to a sexual minority and 4,431 (11%) to a gender minority. Compared with non-SGM, SGM persons had 15% higher odds of the brain health composite outcome (odds ratio [OR] 1.15, 95% CI 1.08-1.22). In secondary analyses, these results persisted across sexual and gender minorities separately (all 95% CIs > 1). Assessing individual diseases, all SGM groups had higher odds of dementia (SGM vs non-SGM: OR 1.14, 95% CI 1.00-1.29) and late-life depression (SGM vs non-SGM: OR 1.27, 95% CI 1.17-1.38) and transgender women had higher odds of stroke (OR 1.68, 95% CI 1.04-2.70). In a large US population study, SGM persons had higher odds of adverse brain health outcomes. Further research should explore structural causes of inequity to advance inclusive and diverse neurologic care.

While scarce, literature suggests that women at the intersection of HIV status and gender and/or sexual minority identities experience heightened social and health disparities within health care systems. This study examines the association between sexual and/or gender minority identities and: (1) experiences of poor treatment by health professionals and (2) being unable to access health services among a cohort of women living with HIV in Metro Vancouver, Canada. Data were drawn from a longitudinal community-based cohort of women living with HIV (Sexual Health and HIV/AIDS Women's Longitudinal Needs Assessment). We examined associations between sexual and/or gender minority identities and the two outcomes. We drew on explanatory variables to measure sexual minority and gender minority identities independently and a combined variable measuring sexual and/or gender minority identities. The associations between each of these three variables and each outcome were analysed using bivariate and multivariable logistic regression models with generalized estimating equations for repeated measures over time. Adjusted odds ratios and 95% confidence intervals are reported. The study sample included 1460 observations on 315 participants over 4.5 years (September 2014 to February 2019). Overall, 125 (39.7%) reported poor treatment by health professionals and 102 (32.4%) reported being unable to access health care services when needed at least once over the study period. A total of 110 (34.9%) of participants reported sexual and/or gender minority identities, 106 (33.7%) reporting sexual minority identities, with 29 (9.2%) reporting gender minority identities. In multivariable analysis, adjusting for confounders, sexual minority identities, and combined sexual and/or gender minority identities were significantly associated with increased odds of experiencing poor treatment by health professionals (sexual minority adjusted odds ratio = 1.39 (0.94-2.05); sexual and/or gender minority adjusted odds ratio = 1.48 (1.00-2.18)) and being unable to access health services (sexual minority adjusted odds ratio = 1.89 (1.20-2.97); sexual and/or gender minority adjusted odds ratio = 1.91 (1.23-2.98)). In multivariable analysis, gender minority identities were not significantly associated with increased odds of experiencing poor treatment by health professionals (gender minority adjusted odds ratio = 1.38; 95% CI = 0.76-2.52) and being unable to access health services (gender minority adjusted odds ratio = 1.72; 95% CI = 0.89-3.31) possibly due to low sample size among women with gender minority identities. Our findings suggest the need for access to inclusive, affirming, trauma-informed health care services tailored specifically for and by women living with HIV with sexual and/or gender minority identities.

ABSTRACTLesbian, gay, bisexual, transgender, or other sexual orientations and gender identities (LGBT+) people report poorer oral health outcomes compared to their heterosexual and gender‐binary counterparts due to social and structural inequities. As such, there is a need for robust integration of social determinants of health (SDOH) and their intersectionality with oral health among LGBT+ people. An SDOH framework was adapted, based on education, organization, and community domains, to integrate the LGBT+ teaching and content into already established dental curricula. The education domain emphasizes the integration of didactic and experiential education to address the person‐centered oral health needs of sexual and gender minorities. This includes didactic content delivery by LGBT+ people and representation from diverse gender and sexual backgrounds in case‐based learning and community service‐learning. The organization domain encourages the embedment of health equity and the development of inclusive environments supportive of gender and sexual minorities into the mission statements of dental schools and the continuing professional development. Important measures include the integration of preferred pronouns at all levels of the organization, diverse gender representation on patient intake forms, and dedicated safe spaces for all minorities, including sexual and gender minorities. Lastly, the community domain emphasizes the development of partnerships between LGBT+ community organizations and dental schools to develop community‐integrated educational models for the teaching of SDOH and the addressal of unmet LGBT+ oral health needs. Integrating this adapted SDOH framework will provide learners, faculty, and staff with a comprehensive understanding of the person‐centered needs of LGBT+ community members. This will encourage learners to approach gender and sexual minorities with empathy and cultural humility while providing trauma‐informed, person‐centered care.

Objectives. To determine the levels and differentials in health care stereotype threat experienced during the COVID-19 pandemic by individuals with sexual or gender minority identities. Methods. The National Couples' Health and Time Use Study is a national cross-sectional US population‒ based sample of partnered individuals interviewed during the pandemic between September 2020 and April 2021 with oversamples of sexual and gender minority individuals. The analytic sample consisted of 3614 individuals (n = 2043 heterosexual and n = 1571 sexual minority individuals along with 3489 cisgender and 125 noncisgender people). Results. Individuals with sexual minority identities experienced significantly more health care stereotype threat than heterosexual people. Cisgender women and those with another gender identity experienced significantly more health care stereotype threat than cisgender men. These results persisted after the inclusion of indicators of health conditions, insurance, COVID-19 experience, and sociodemographic factors. Conclusions. Gender and sexual minority‒identifying people reported high levels of worries about health discrimination. Our work suggests that providing positive health care experiences may reduce these worries and offer a potential antidote to sexual and gender minority health disparities that are driven by structural and interpersonal discrimination. These findings support calls for the further education and transformation of health care provision and systems. (Am J Public Health. 2025;115(3):425-433. https://doi.org/10.2105/AJPH.2024.307926).

BackgroundPeople identifying as sexual and gender minorities (SGM) may have higher risk for subjective cognitive decline and Alzheimer’s disease, although the risk for Parkinson’s disease dementia (PDD) has not been investigated. Male sex is associated with a higher risk for PDD, it is unclear whether SGM status impacts the risk.MethodsData were obtained from Fox Insight on April 5th, 2023. The analysis included people (1) with adult‐onset Parkinson’s, (2) responding to questions on sex assigned at birth, gender identity, sexual orientation, (3) with at least one available Penn Parkinson’s Daily Activities Questionnaire‐15 (PDAQ‐15), (4) without dementia at baseline, based on the first PDAQ‐15 (&gt;43). Groups consisted of people identifying as (1) SGM with female sex assigned at birth (SGM‐F, n = 75); (2) cisgender, heterosexual women (CHW, n = 2,046); (3) SGM with male sex assigned at birth (SGM‐M, n = 84); (4) cisgender, heterosexual men (CHM, n = 2,056). Sex assigned at birth and SGM status effects on dementia likelihood during follow‐up were assessed with generalized linear mixed models.ResultsOut of 159 people identifying as SGM, eight (5.0%) identified as gender minorities, 144 (90.6%) identified as sexual minorities, seven (4.4%) identified as both gender and sexual minorities. At baseline, people with female sex had better PDAQ‐15 scores than people with male sex assigned at birth; SGM‐M had the lowest scores. SGM‐M had a higher dementia likelihood compared to people not identifying as SGM. After adjusting for age, education, employment status, income, perceived discrimination level, age at Parkinson’s diagnosis, baseline PDAQ‐15 scores, that differed across groups at baseline, dementia likelihood was lower for CHW compared to people with male sex assigned at birth.ConclusionsFor PDD, SGM‐M can be at a higher risk than CHM; people with female sex can have a lower risk than people with male sex assigned at birth. Socioeconomic disadvantages can alter the sex effect on PDD risk, by putting SGM‐M at a higher risk and females at a similar risk level compared to people with male sex assigned at birth, as shown in unadjusted models. Socioeconomic disadvantages should be acknowledged and addressed to support the well‐being of SGM with Parkinson’s.

Substantial empirical evidence suggests that individuals who belong to sexual and gender minorities experience more anxiety and depression than heterosexual and cisgender people. Many previous studies have not, however, used population-based samples. There is also a shortage of evidence about certain sexual and gender minorities (e.g., nonbinary individuals). We examined differences in levels of anxiety and depression within sexual and gender minorities, as well as compared to the heterosexual and cisgender majority in a population-based Finnish sample (N = 8,589). We also explored if individuals who belong to both a gender and a sexual minority (double minority) reported higher rates of anxiety and depression than individuals who hold either a gender or a sexual minority status (single minority). Individuals who belonged to either a sexual or a gender minority overall experienced significantly higher rates of anxiety and depression than cisgender and heterosexual individuals. Among the different sexual and gender minorities, bisexual, emerging identity, and nonbinary individuals reported the highest rates of anxiety and depression. We found no differences in anxiety and depression between single minority and double minority individuals. Our results suggest that even though Finland is a country with an inclusive social climate, sexual and gender minorities are, nevertheless, disproportionately affected by mental health issues. The present study gives further support to the claim that individuals holding a sexual or gender minority status experience higher levels of depression and anxiety compared to cisgender and heterosexual individuals and pinpoints the need to acknowledge these issues both in the context of health care and in the society at large.

Substantial empirical evidence suggests that individuals who belong to sexual and gender minorities experience more anxiety and depression than heterosexual and cisgender people. Many previous studies have not, however, used population-based samples. There is also a shortage of evidence about certain sexual and gender minorities (e.g., nonbinary individuals). We examined differences in levels of anxiety and depression within sexual and gender minorities, as well as compared to the heterosexual and cisgender majority in a population-based Finnish sample (N = 8,589). We also explored if individuals who belong to both a gender and a sexual minority (double minority) reported higher rates of anxiety and depression than individuals who hold either a gender or a sexual minority status (single minority). Individuals who belonged to either a sexual or a gender minority overall experienced significantly higher rates of anxiety and depression than cisgender and heterosexual individuals. Among the different sexual and gender minorities, bisexual, emerging identity, and nonbinary individuals reported the highest rates of anxiety and depression. We found no differences in anxiety and depression between single minority and double minority individuals. Our results suggest that even though Finland is a country with an inclusive social climate, sexual and gender minorities are, nevertheless, disproportionately affected by mental health issues. The present study gives further support to the claim that individuals holding a sexual or gender minority status experience higher levels of depression and anxiety compared to cisgender and heterosexual individuals and pinpoints the need to acknowledge these issues both in the context of health care and in the society at large.

Sexual and gender minority youth are at higher risk for nicotine/tobacco use than cisgender and/or heterosexual youth. Little is known about how the use of multiple tobacco/nicotine products differs among youth by sexual orientation and gender identity. This study sought to determine whether the lifetime number of tobacco/nicotine products differs by sexual orientation and gender identity. This study is a cross-sectional analysis of nationally representative data on 14 457 students ages 9-19+ who participated in the 2023 National Youth Tobacco Survey. Weighted means, adjusted odds ratios, and adjusted incidence rate ratios were used to assess differences in the number of lifetime tobacco/nicotine products used by students in the following groups: cisgender heterosexual; cisgender sexual minority; gender minority heterosexual; and gender and sexual minority youth. Adjusting for age, race/ethnicity, and sex, gender minority heterosexual youth used more than twice as many tobacco/nicotine products as their cisgender heterosexual peers, with an adjusted incidence rate ratio (aIRR) of 2.47; 95% confidence interval (CI), 1.10-5.56; p=.030. Gender and sexual minority youth also used twice as many methods as their cisgender heterosexual peers (aIRR, 2.05; 95% CI, 1.40-2.98; p<.001). Among youth aged 9-19+ years, gender minority youth of any sexual orientation used a higher lifetime number of tobacco/nicotine products than did cisgender heterosexual youth. Prevention, harm reduction, and cessation programs for youth are needed to respond to the upward trend of multiple tobacco product use among youth and the specific needs of gender minority youth.

Improving the Experiences of Sexual and Gender Minority-Identifying Trainees in Gastroenterology and Hepatology