Disclosure Of Sexual Orientation Research Articles

Sexual and preventive behaviors associated with HAV, HBV, and HPV vaccine hesitancy among men who have sex with men in France

ABSTRACT Vaccination coverage against hepatitis A virus (HAV), hepatitis B virus (HBV), and human papillomaviruses (HPV) is insufficient among men who have sex with men (MSM), partly because of their high prevalence of vaccine hesitancy (VH) specific to these vaccines. This study aimed to investigate determinants of specific VH in MSM, focusing on characteristics of their sexual activity, propensity to use prevention tools and medical care, disclosure of sexual orientation to health care professionals (HCPs), and perceived stigmatization. A cross-sectional electronic survey (February – August 2022) collected perceptions of HBV, HAV, and HPV, and of their respective vaccines among 3,730 French MSM and enabled the construction of a specific VH variable. Using agglomerative hierarchical cluster analysis, we constructed a typology of MSM sexual and prevention practices. We identified three MSM clusters (low- (C1, 24%), moderate- (C2, 41%), and high- (C3, 35%) “sexual activity/medical engagement”) that showed an increasing gradient in the use of medical prevention with regular medical care and exposure to high-risk sexual practices. A multiple ordinal logistic regression showed that overall specific VH was higher in the C1 cluster and in men who had not informed their physician of their sexual orientation. This typology could usefully help to adapt vaccination communication strategies for MSM prevention program according to patients’ profiles. HCPs should be encouraged and trained to ask men about their sexual practices and to provide appropriate vaccination recommendations nonjudgmentally.

Can platform use patterns be an indicator of HIV-related risk and sub-group heterogeneity among men who have sex with men in Singapore: a latent class analysis.

Low-level HIV epidemic settings like Singapore face the challenge of reaching men at-risk who have less contact with programmes. We investigated patterns of meeting platform use by men seeking male sexual partners (MSM) as potential marker of risk to differentiate sub-groups for interventions. Latent Class Analysis (LCA) was applied to a survey sample of MSM recruited from bars/clubs, saunas and a smartphone application, using purposive sampling. The best-fit LCA model which identified homogeneous sub-groups with similar patterns of meeting platform was factored in multivariable regression to identify associations with risk behaviors on the pathway to HIV infection. Overall 1,141 MSM were recruited from bars/clubs (n = 426), saunas (n = 531), and online (n = 184). Five patterns emerged, reflecting salient platform use characteristics: Sauna-centric (SC; n = 413), App-centric (AC; n = 276), Multiple-platforms (MP; n = 123), Platform-inactive (PI; n = 257), and "Do not hook up" (DNH; n = 72) classes. Men in the SC and MP classes had high probabilities of using saunas to meet partners; SC were older and less likely to have disclosed their sexual orientation. The MP class had high probabilities of connecting across all platforms in addition to saunas and more likely to have disclosed their sexual orientation, than the PI class. Men in the SC and MP classes had twice the odds of reporting multiple sex partners (aORSC = 2.1; 95%CI: 1.33.2; aORMP = 2.2; 95%CI: 1.14.6). Single/non-partnered MSM and those using alcohol/drugs during sex had 1.7 (95%CI: 1.22.5) and 3.2 (95%CI: 2.05.1) the odds respectively, of reporting multiple sex partners. The SC and MP classes had higher odds of engaging in group sex while MSM using alcohol/drugs during sex had twice the odds of reporting group sex. Alcohol/drugs and group sex were independently associated with condomless sex (as was lower education). Group sex, alcohol/drugs during sex, disclosure of sexual orientation or being Singaporean/permanent resident were associated with recent testing for HIV. The five distinct risk profiles identified can help tailor differentiated HIV interventions-combined with field knowledge and other prevention-to expand HIV self-testing, Pre-Exposure Prophylaxis and other services (e.g., Mpox vaccination) to sub-groups at risk.

Unheard Voices of LGB People in Türkiye on LGB-specific Experiences of Intimate Partner Violence: A Qualitative Analysis.

Drawing upon in-depth, semistructured interviews with 26 LGB participants, we explored how LGB individuals experience IPV uniquely in Türkiye. Conducting thematic analysis, we generated four themes: (a) invalidation of sexual identity, (b) controlling sexuality and sexual behaviors, (c) disclosure of sexual orientation, and (d) binegativity. The analysis emphasizes LGB-specific power dynamics influencing IPV. A discussion is provided regarding the extent to which these four themes are specific to IPV in LGB relationships. Additionally, recommendations are offered to mental health professionals on tailoring their approaches and promoting advocacy for the needs of LGB IPV survivors.

Does Attachment Security Matter? A Study of Caregivers’ Reactions to a Child’s Coming out

Disclosing a diverse sexual orientation to caregivers can be a stressful and transformative experience for individuals and families. In this retrospective study, attachment theory is applied to caregivers’ recollection of their children’s disclosure of a diverse sexual orientation, testing the hypothesis that caregivers’ attachment anxiety would significantly predict more negative self-reported reactions to coming out. Caregivers of sexually diverse people (n = 154) completed a survey with measures of self-reported reactions to their child’s coming out, attachment anxiety and avoidance, attitudes toward lesbian women and gay men, conservatism, family functioning and strength of religious faith. Attachment anxiety, but not avoidance, significantly predicted caregivers’ reactions, however this relationship was not significant when covariates were added to the model. Exploratory analyses using t-tests were conducted to examine differences in study variables among LGBTQ+ and non-LGBTQ+ caregivers, and caregivers of cisgender and gender diverse children. The results support previous research, indicating that caregiver’s attitudes and religiosity are predictive of caregivers’ reactions to their children coming out and provide preliminary evidence of differential responses to coming out by caregivers’ LGBTQ+ identity.

#45 - - Greater disclosure of sexual orientation is associated with lower total post- awakening cortisol concentrations in gay men

#45 - - Greater disclosure of sexual orientation is associated with lower total post- awakening cortisol concentrations in gay men

Community and sociodemographic factors associated with disclosure of sexual orientation and comfort in discussing care needs in primary care: Results from the OutLook Study

Lesbian, gay, bisexual, and diverse sexual orientation minorities are disproportionately represented in the prevalence of adverse health conditions, even in Canada, suggested as one of the more progressive countries when it comes to social acceptance and human rights protections. This highlights the inclusion of sexual orientation identity as a point of consideration when providers interact with patients and to consider facilitating sexual orientation identity disclosure when accessing health care. This study explored factors associated with different facets of sexual orientation disclosure to primary care providers. A cross-sectional survey of sexual orientation minority participants, 16 years or older, living, working, or residing in Waterloo Region was distributed ( n = 437). Modified Poisson regression methods modelled (a) comfort sharing sexual orientation with their regular primary care provider (RPCP), (b) disclosure of sexual orientation to their RPCP, and (c) talking to their RPCP about health issues related to their sexual orientation. Increasing outness within one’s social network was consistently significant across all three outcomes of comfort, disclosure, and talking about health issues related to sexual orientation. Self-esteem was also identified as salient in comfort and when talking to providers. The authors also observed significant associations between sexual orientation identity and relationship status variables. Findings highlight important factors to consider in discussing and disclosing sexual orientation identity and associated health issues with health care providers. Implications for practice include training new health care providers and providing opportunities for continued education for established providers to ensure appropriate care is provided based on sexual orientation.

Biographical Work of Parents of Children with Non-Normative Sexual Orientation and/or Gender Identity

This paper aims to reconstruct the biographical work (Corbin and Strauss) undertaken by parents of non-normative people. The initiating event of biographical work is the disclosure of a non-normative sexual orientation and/or gender identity by the child. For many parents, this is an event that causes a breakdown of previous schemes of action, a gradual loss of control, and suffering.
 The empirical data consist of autobiographical narratives of parents of people with non-normative sexual orientation and/or gender identity. The study involved mothers and fathers residing throughout Poland, who were selected according to the snowball procedure. The data were collected through the narrative interview technique and compiled according to the analytical procedure proposed by Fritz Schütze, which is part of the interpretative research paradigm.
 In the course of four parallel biographical processes (contextualizing, coming to terms, reconstituting identity, and recasting biography), the new experience is integrated into the biography, its consequences are understood and accepted, a coherent identity is reconstituted and a new course for one’s life are charted. The analysis of the narrators’ biographical work has made it possible to identify three categories that organize the course of the parents’ lives and identities—stigma, normalization, and activism.

A Scoping Review of Older LGBTI People's Experiences of Homecare

Amidst the global growth of the ageing demographic in the world, an inclusive assessment of the care needs of the older lesbian, gay, bisexual, transgender, and intersex (LGBTI) population is receiving increasing attention, especially in view of reported health inequalities for these minority groups and the position of their sexual orientations and gender identities within a predominantly heteronormative health and social system. This literature review aims to identify and analyse previous research on older LGBTI people’s views, experiences, and perceptions of homecare provision. We searched the CINAHL, Medline, and PsychINFO databases and found a total of 337 records. After an eligibility assessment, 12 studies were selected, comprising 11 qualitative studies, and one mixed methods study. Under an overarching theme of fears of discrimination and of receiving suboptimal care, we further categorised our findings in the following three interlinked subthemes: (a) disclosure of gender identity and sexual orientation; (b) emerging meanings of LGBTI‐competent care; and (c) recommendations for improved quality of LGBTI‐friendly services. The overall surfacing outcome of our analysis of the participants’ experiences described in the studies examined is an aspiration for homecare services ensuring quality of holistic, person‐centred care that recognises this population’s distinct set of requirements, including knowledge and consideration of their histories of inequalities and oppression. Wider awareness about the need to re‐imagine more inclusive care for the LGBTI community has the potential to improve services and practices, reduce access barriers, and prevent inequalities.

Sexual orientation disclosure and depression among Thai gay, bisexual, and other men who have sex with men: The roles of social support and intimate partner violence.

Among gay, bisexual, and other men who have sex with men (GBM), sexual orientation disclosure to social groups can act as a significant risk for depression. The primary goal of this research is to understand the association between disclosure and depression, the association of social support and intimate partner violence (IPV) experiences, depression, and disclosure. This project uses a secondary dataset of Thailand from a larger cross-sectional study distributed in the Greater Mekong Sub-Region. This study utilized web-based answers from 1468 Thai GBM respondents between the ages of 15-24 years. Prevalence of depression was over 50%. Across the social groups of interest, those who disclosed to everyone had the lowest depression prevalence. This association was statistically significant for all groups (p<0.050) except for "Family members" (p = 0.052). There was a statistically significant association illustrated between full disclosure to social groups and increased social support. Most respondents (43.9%) had low social support, and additionally this group had the highest level of depression, compared to those with high social support. There was a statistically significant association for lowered depression outcomes and increased social support. IPV experiences that occurred within the last six months had a statistically significant relationship with depression (p = 0.002). There was a notable association between those with experiences of being a victim of IPV, alone and in conjunction with experience of being a perpetrator of IPV, which was associated with increased odds of depression. However, the type of IPV experiences an individual had did not differ based on disclosure status. This study provides strengthened evidence of the impact that differences in supportive networks can have on mental health outcomes. In addition, they provided a wider consideration for how people may have different IPV experiences, either as a perpetrator, victim, or both, and how those shapes health outcomes of depression. GBM communities still face adversity and challenges that affect their long-term health outcomes, even if they do live in what is considered an accepting country.

“A constant negotiation”: A qualitative exploration and preliminary model of sexual orientation disclosure among gay Chinese/Chinese American male emerging adults

Introduction Disclosing one’s sexual minority identity, known as “coming out,” can be challenging for gay Chinese/Chinese Americans due to cultural values such as collectivism, filial piety, and adherence to traditional gender roles. Method A mixed methods exploratory study was conducted with gay Chinese/Chinese American male emerging adults in New York City. Result Nine participants, average age 22.6 years (SD 2.2, range: 19–25), were interviewed; five were raised in a Western country, four were raised in China. Thematic analysis of the qualitative data yielded five themes: (1) discovery and acceptance of sexual orientation, (2) concealment, (3) deciding to disclose, (4) disclosing to others, and (5) consequences of disclosure. Most participants easily accepted their gay identity though concealed this identity from their families. Participants raised in China took longer to disclose their sexual orientation compared to those raised in Western countries. A preliminary, culturally-tailored model of sexual orientation disclosure is proposed with two parallel processes: the personal self (identity awareness, identity acceptance) and public self (identity concealment, identity negotiation). Conclusion Chinese cultural values influence the expression of sexual minority identities. Disclosure is not static, but rather a “constant negotiation” dependent on context. Clinicians should facilitate exploration of sexual orientation alongside racial/ethnic identity.

Homoparenting as a public health issue: a scoping review.

To map global scientific production on homoparenting in the field of collective health or public health. In terms of methodological procedures, a scoping review was carried out, guided by the following question: What are the aspects addressed in global scientific production regarding homoparental families in the field of collective or public health? The searches were carried out in seven sources of scientific literature, including 58 studies, involving scientific articles and dissertations. The analytical treatment given to the studies, most of which were qualitative, followed the content analysis technique in the thematic modality. The results indicate that the perceptions of homosexuals and professionals about the care provided and health services in general was the topic addressed by the largest number of studies (n = 31), followed by heteronormative context of health services (n = 26); disclosure of sexual orientation (n = 20); fertilization (n = 14); educational information and actions (n = 5). Although the issue of same-sex parenthood has been discussed in some health sectors, there is awareness that it is necessary to rely on a consolidated basis through numerous studies when discussing this issue. It is concluded that, among other aspects, the scope of this review is not sufficiently problematized within the scope of health professionals' training and performance.

When Stigma, Disclosure, and Access to Care Collide: An Ethical Reflection of mpox Vaccination Outreach.

Experiences of stigma in health care encounters among LGBTQ+ populations (lesbian, gay, bisexual, transgender, and queer and questioning) have long been a barrier to care. Marginalization and historically grounded fears of stigmatization have contributed to a reluctance to disclose sexual behavior and/or gender identity to health care providers. We reflect on how student nurses grappled with the ethics of patient disclosure while providing mobile outreach in Chicago for mpox (formerly monkeypox) from fall 2022 to spring 2023. Student nurses addressed how requiring disclosure of sexual behavior or sexual orientation may serve as a barrier to accessing preventive care, such as mpox vaccination. Accounts of stigma and criminalization experienced by LGBTQ+ people provide insight on challenges historically associated with disclosure in health care.

55.1 A Qualitative Exploration and New Model of Sexual Orientation Disclosure Among Gay Chinese/Chinese American Male Transitional-Aged Youth

55.1 A Qualitative Exploration and New Model of Sexual Orientation Disclosure Among Gay Chinese/Chinese American Male Transitional-Aged Youth

Exploring the Challenges of Sexual Orientation Disclosure Among Lesbian, Gay, Bisexual, Transgender, Queer Individuals

This qualitative study sought to understand lesbian, gay, bisexual, transgender, queer (LGBTQ) individuals’ experiences of sexual orientation disclosure in health care settings and ways health care providers (HCPs) can create supportive and inclusive relationships with patients. Participants (n = 375) responded to questions about disclosure in health care settings on an anonymous online survey. Results identified themes of ease, difficulty, and safety in disclosure, and ways HCPs can provide outward support of LGBTQ individuals, such as nonjudgmental communication, elimination of provider assumptions, and increased LGBTQ awareness and knowledge. HCPs can offer safe, inclusive spaces that demonstrate acceptance, and they should educate themselves on how discrimination, marginalization, and inequities affect LGBTQ individuals.

Participation, Barriers, and Facilitators of Cancer Screening Among LGBTQ+ Populations: A Review of the Literature

ABSTRACT Compared with cisgender and heterosexual individuals, members of the LGBTQ+ community experience worse health outcomes. This is due to a combination of structural inequities and life experiences, including higher rates of mental illness and suicidality, sexually transmitted infections, and certain cancers. Men who have sex with men are at higher risk of anal cancer, and lesbian and bisexual women are often diagnosed with breast cancer at younger ages than heterosexual women partly due to lower parity and higher bodyweight. Despite these increased risks, some evidence shows the LGBTQ+ population is less likely to participate in early detection and cancer screening programs; however, the etiology of this is unknown. This review aims to summarize the current literature on cancer screening uptake in the LGBTQ+ population, including barriers and facilitators associated with screening participation. Studies published between January 2001 and April 2022 involving individuals identified as a gender or sexual minority that assessed participation in and/or facilitators and barriers to a cancer screening procedure were included. Barriers and facilitators identified in quantitative studies were reported on the individual-, provider-, and administrative/system-level scale. A total of 50 publications were included, 38 of which were quantitative, 10 were qualitative, and 2 used mixed methods. Among 16 relevant studies, considerable variation was identified when analyzing whether sexual minority women had lower participation in cervical cancer screening programs. Among 15 studies assessing the participation of sexual minority women compared with heterosexual women in breast cancer screening, 5 studies found no difference, whereas the remainder suggested lower rates of screening among sexual minority women. Fewer studies assessed screening among sexual minority men; however, sexual minority men were more likely to report anal cancer screening than heterosexual men. Cervical cancer screening participation among transgender men and gender diverse participants was lower than cisgender participants in almost all studies. Of 9 studies reporting breast cancer screening among gender diverse or transgender individuals, 5 found lower participation among transgender or gender diverse individuals compared with cisgender women. One study identified greater odds of up-to-date mammography among transgender men compared with cisgender women. The most common individual-level barriers to screening are related to knowledge of the screening tests themselves, including screening guidelines, procedures, pain, embarrassment, and a fear of results. One of the strongest correlates in studies was perceived discrimination from health care providers, which often resulted in lack of disclosure of sexual orientation or gender identity. Provider-level factors mostly included provider communication and relationship with the patient, and patients preferred providers experienced with LGBTQ+ clients and that used sexuality-inclusive language. Having open communication about sexual orientation and gender identity was a positive facilitator for all patients. System-level barriers included inclusive documentation and physical environments in health care. This review highlights key disparities including the lower screening rates among transgender patients in all categories and lower screening rates for cervical cancer and mammography among sexual minority women. It also highlights a significant need for representative data on all LGBTQ+ populations.

Sexual behavior and self-declaration of sexual orientation among people 18–64 years in Brazil: results from the Knowledge, Attitudes, and Practices survey, 2013 and the National Health Survey, 2019

BackgroundPopulation surveys involving the monitoring of high-risk sexual behavior have been recognized as important public health tools to control the HIV epidemic and other sexually transmitted infections (STIs).MethodsUsing data from the Knowledge, Attitudes, and Practices survey (PCAP-2013) and from the National Health Survey (PNS-2019), indicators of sexual behavior were compared according to sociodemographic characteristics among individuals aged 18–64 years, including size (%) estimates of men who have sex with men (MSM) and women who have sex with women (WSW). Specifically, the PNS-2019 prevalence estimates of homosexual, bisexual, heterosexual males and females were compared with those from the PCAP-2013. To compare PCAP and PNS proportional distributions, the Pearson's chi-square test, adjusted by the Rao-Scott’s correction, was applied.ResultsSize (%) estimates of MSM and WSW obtained by direct questions from the PCAP-2013, showed higher homosexuality prevalence estimates than those resulting from the PNS-2019 self-declared sexual orientation. Significant differences were found between the MSM proportions according to the PCAP-2013 (3.7%; 95% CI 3.1–4.4%) and to the PNS-2019 (2.2%; 95% CI 1.9–2.5), and between the WSW proportions (4.6%; 95% CI 4.0–5.4%) and (2.1%; 95% CI 1.8–2.4), respectively. Results from both surveys showed MSM and WSW prevalence estimates increase with educational level, decrease with age, and is larger among people who do not live with partner, live in urban areas and in state capitals. Regarding condom use at last sexual intercourse, no differences between the PCAP-2013 and the PNS-2019 estimates were found at the national level, but significant improvements were found for MSM, people aged 18–24 and 25–34 years, and individuals not living with a partner.ConclusionsThe underestimation of MSM and WSW prevalence by self-declared sexual orientation suggests that sexual minorities face many difficulties related to disclosing their sexuality and reinforces the importance of developing public health interventions for changing population attitudes and promoting sexual orientation disclosure. Moreover, the low use of condoms in both surveys (PCAP-2013 and PNS-2019) carried out 6 years apart highlights the need of public policies to expand prevention strategies for HIV infection and other STIs.

O.O.10.1 - Sexual Orientation and Gender Identity Disclosure Among Oncology Patients: Describing Current Trends: Presenter(s): Viktor Clark, Virginia Commonwealth University, United States; Richard Brown, Virginia Commonwealth University, United States

O.O.10.1 - Sexual Orientation and Gender Identity Disclosure Among Oncology Patients: Describing Current Trends: Presenter(s): Viktor Clark, Virginia Commonwealth University, United States; Richard Brown, Virginia Commonwealth University, United States

A secondary mixed methods analysis examining midwives’ responses regarding patient sexual orientation and gender identity (SOGI) disclosure

ObjectiveRecent research suggests that midwives generally have positive attitudes towards sexual and gender minority (SGM) clients; however, little research has examined whether and how these attitudes translate into specific clinical practices. In this study, we performed a secondary mixed methods analysis to examine midwives’ beliefs and practices regarding the importance of asking and knowing their patients’ sexual orientation and gender identity (SOGI). MethodsA confidential, anonymous paper survey was mailed to all midwifery practice groups (n = 131) in Ontario, Canada. Participants were midwives who were members of the Association of Ontario Midwives who responded to the survey (n = 267). Sequential explanatory mixed methods analysis was employed: quantitative SOGI questions were analyzed first, followed by qualitative open response comments to explain and contextualize the quantitative findings. FindingsMidwives’ responses indicated that it was not important to know or ask about clients’ SOGI because (1) it is not necessary to be able to provide the best care to everyone, and (2) the onus is on the client to disclose SOGI. Midwives indicated that they would like more training and knowledge to be able to confidently care for SGM. Key Conclusions and Implications for PracticeMidwives’ hesitancy to ask or know SOGI demonstrates that positive attitudes do not necessarily translate into current best practices for obtaining SOGI data in the context of SGM care provision. Midwifery education and training programs should address this gap.

12. “I felt like I wanted to disclose more and more”: Impact of Disclosure of Sexual Orientation and Gender Identity on the Well-being and Sexual Health of Young Black and Latinx Sexual Minority Men and Transgender Women in Healthcare Settings

12. “I felt like I wanted to disclose more and more”: Impact of Disclosure of Sexual Orientation and Gender Identity on the Well-being and Sexual Health of Young Black and Latinx Sexual Minority Men and Transgender Women in Healthcare Settings

The influence of care continuity and disclosure of sexual orientation in general practice on lesbian, bi+ and queer cisgender women's engagement with mental health services.

Lesbian, bisexual+ and queer (LBQ+) cisgender women have considerable unmet mental health needs. The aims of this study were to examine LBQ+ cisgender women's prior engagement with general practitioners (GPs), and how this relationship shaped their mental health service use. Data from 2707 cisgender LBQ+ women were drawn from a national survey of adults who are lesbian, gay, bisexual, trans, intersex, queer or questioning, asexual and other diverse sexuality and gender identities (LGBTIQA+) in Australia. Multivariable logistic regression analyses examined demographic predictors of continuity of care with GPs and GPs' awareness of LBQ+ women's sexual orientation. The relationship between these variables and recent mental health service use was then analysed, comparing LBQ+ women's engagement with services known to be LGBTIQA+ inclusive and those without an inclusive reputation. LBQ+ cisgender women with a regular GP had greater odds of having accessed mental health services in the last 12months. Two-thirds had a regular GP, with the lowest odds among women aged 18-35years and highest odds among women with a disability. LBQ+ women who did not believe their regular GP knew of their sexuality had lower odds of having accessed LGBTIQA+ inclusive mental health services. These individuals were typically aged below 25years, bisexual+ or queer identified, had below undergraduate-level education, earned <$2000 AUD per week, or lived in an outer-suburban or regional area. GPs may be missing opportunities to promote continuity of care through developing trusting relationships with specific sub-populations of LBQ+ women, which in turn appears to sustain inequitable access to mental health care. To offer appropriate care and referrals for this population, GPs should provide safe and inclusive environments to enable comfortable and supportive discussions about sexual orientation when this is relevant to a person's health care.