Gender Minority Research Articles

Legal protections for sexual and gender minority youth in foster care: A review of Preventing Sex Trafficking and Strengthening Families Act (Normalcy Standards)

The aim of this study was to investigate legal protections for sexual and gender minority (SGM) youth population who identify as lesbian, gay, bisexual, transgender, queer, intersex (LGBTQ+), or any nonheterosexual orientation, gender identity, or expression (SOGIE) within the context of the United States (US) publicly administered state child welfare foster care system through federal Public Law 113–183 (Preventing Sex Trafficking and Strengthening Families Act – Prudent Parenting for short). SGM youth are identified in foster care 2.5 times higher than their heterosexual peers and often report worse outcomes. There are some federal recommendations for SGM youth, but it does not include normalcy or other activities that are federally supported. A state-by-state analysis of legislation, policy, implementation policy and youth bill of rights was conducted. While there was significant variance across the USA, many states provided levels of support in their legislation, policy implementation and youth bill of rights that could assist SGM youth impact normalcy efforts. More research is needed to investigate if SGM youth in foster care experience protections in the states that have legal protections.

11.O. Scientific session: Mental Health Among Sexual and Gender Minority Populations in Diverse Structural Stigma Environments

Abstract Research conducted across numerous countries finds that sexual minority (e.g., lesbian, gay, and bisexual [LGB]) and gender minority (e.g., transgender [T]) individuals represent high-risk populations for poor mental health and suicidality. These disparities are believed to be a consequence of a stigmatizing environment and sexual and gender minority individuals’ disproportionate exposure to stigma-based stress compared to cisgender (i.e., non-transgender) heterosexuals. Stigma occurs at multiple levels to compromise LGBT individuals’ health. At the structural level, stigma manifests as unjust laws, policies, and cultural norms that deny, or fail to protect, the equal rights of LGBT individuals. At the interpersonal level, stigma manifests as discrimination in social interactions, social exclusion, and outright victimization. At the individual level, stigma can tax LGBT individuals’ coping resources by requiring costly behavioral strategies such as concealment of one’s LGBT identity. In this workshop, four studies from different regional environment with varying degree of structural stigma will be presented, i.e., the USA, Switzerland, Rwanda, and Kenya. They resent novel findings on the processes and mechanism underlying LGBT populations increased risk of mental health and links between stigma experiences at different levels. Dr. Clark will present a study of how negative news media coverage influence suicidality among LGBT young adults in the USA using intensive longitudinal assessments. Dr. Pfister will present findings from in-depth interviews concerning suicidality with individuals representing a wide variety of sexual and gender minority identities in Switzerland. Dr. van der Star will present a study exploring how structural stigma environments are linked to interpersonal and individuals level stigma experiences in sexual minorities representing different generations of LGBT populations. Dr. Stojanovski will present data from surveys and interviews of LGBT populations in Kenya and Rwanda focusing on experiences of discrimination and mental health. Key messages • Negative media reporting, discrimination, and barriers to health care can influence mental health and suicidality among LGBT individuals. • Identity concealment may represent a mechanism through which sexual minorities navigate structurally stigmatizing climates.

Bridging gaps: A closer look at the health of sexual and gender minorities in Austria

Abstract Austria has long lacked comprehensive data on the health and well-being of sexual and gender minorities (SGMs). The 2022 LGBTIQ+ Health Report addresses this gap by presenting a comprehensive overview of the health status of SGMs in Austria. To contextualize SGM health issues, a review of the literature, health surveys, and action plans across Europe was conducted in the initial project phase. Then a questionnaire was developed in collaboration with an expert group for quantitative data collection. A total of 1,047 individuals participated in the survey; analyses of the quantitative data were enriched by insights from ten qualitative interviews. Detailed findings cover SGMs’ health status and experiences of discrimination as well as access to healthcare and health-promoting factors. Participants rated their health status lower than the average in Austria. A high number reported encountering discrimination in healthcare, especially among intersex and trans participants. While approximately half of the respondents were satisfied with healthcare provision, around 16% expressed dissatisfaction. Finally, a significant proportion of participants reported having foregone healthcare services at least once despite having health issues. Our work underscores the importance of recognizing the diverse needs of distinct groups within the SGM spectrum. It is crucial to avoid oversimplification by grouping them into a single SGM category as this obscures the unique challenges and inequalities faced by each subgroup. The rapid evolution of terms adds complexity to this work. Moreover, attention should be directed towards intersectionality within these groups as some are hard to reach with an online survey. Navigating the seas of public health innovation, our exploration of SGM health in Austria reveals not only the challenges but also the imperative for inclusive and tailored healthcare strategies. Key messages • The 2022 LGBTIQ+ Health Report Austria reveils SGM health realities: lower health status, discrimination, and unmet healthcare needs, urging targeted interventions. • Acknowledging diverse SGM groups and evolving terminologies, our study underscores the need for nuanced, intersectional healthcare approaches.

‘We do not include tests and treatment for those [STI] conditions’: the trouble in navigating access and care for STIs among gay, bisexual men and transgender and other MSM in Kenya and Rwanda

Abstract Background Lesbian, gay, bisexual men, and transgender persons (LGBT) in Kenya and Rwanda have a hard time accessing healthcare, in particular sexual health screening. We used a social norms and values framework to examine determinants of access to healthcare, with specific attention to sexual healthcare. Methods We draw on cross-sectional mixed methods research in Kenya and Rwanda that examined the lived experiences of sexual and gender minorities in access to health services. A cross-sectional quantitative survey in Rwanda (n = 499) and Kenya (n = 1,550) was conducted with LGBT people. We conducted key informant interviews (n = 81), in-depth interviews (n = 48), digital storytelling (n = 3), and focus group discussions (n = 30). We used a mixed-methods thematic and content analysis to integrate quantitative and qualitative findings. Findings Accessibility and quality of care were the main barriers to healthcare services. The results indicate widespread discrimination and stigma toward LGBT people in service provision. Approximately half of the survey participants, 47%, reported challenges accessing health services, and 25% indicated they experienced discrimination in healthcare. Qualitative results link low quality of care to stigma and discrimination. “Mostly at the hospitals, there are times people take too much time discussing who we are instead of giving us the treatment we seek, and send us to mental health to first deal with our sexuality issues since they think it is a ‘sickness.’” (Focus group, Muhanga, Rwanda). Our study highlights challenges in navigating sexual healthcare in government, faith-based, and donor-funded health facilities. Conclusions Access to healthcare services, particularly sexual health screening and prevention, is a growing issue for LGBT people in Kenya and Rwanda. Stigma acts as a significant barrier to high-quality healthcare. Sensitivity training and educational opportunities for healthcare professionals are urgently needed to address stigma.

Disparities in Mental Health and the Social Determinants of Health Among Privately Insured Transgender Patients in the United States

Abstract Objectives The purpose of this study was to examine disparities in mental health and the social determinants of health (SDoH) among privately insured transgender and gender minority (TGM) patients in the United States. Methods Data came from FAIR Health, a repository of private health insurance claims data covering over 150 million individuals in the United States. TGM patients (n = 274,479) were identified with medical claims that included a diagnosis for gender dysphoria or gender identity disorder. A random 5% selection of cisgender patients (n = 7,456,823) was used as a comparison group. We estimated descriptive statistics and used multivariable logistic regression models to compare health outcomes between TGM and cisgender patients. Results TGM patients were more likely to have anxiety (odds ratio [OR]=7.02; 95% confidence interval [CI]=6.94-7.09), depression (OR = 9.27; 95% CI = 9.16-9.37), post-traumatic stress disorder (OR = 9.03; 95% CI = 8.86-9.21), and substance use disorder (OR = 2.93; 95% CI = 2.86-3.00) compared to their cisgender peers. TGM patients were also more likely to have problems with education and literacy (OR = 5.95; 95% CI = 5.64-6.28), employment (OR = 3.67; 95% CI = 3.44-3.92), economic circumstances (OR = 5.74; 95% CI = 5.39-6.12), and social exclusion (OR = 7.35; 95% CI = 6.91-7.81). Compared to TGM patients living in states with transphobic policy environments, TGM patients in states with comprehensive protections from discrimination fared better. Conclusions We found wide disparities in mental health and the SDoH among privately insured TGM. More research is critically needed to better understand the health and social needs of TGM populations. Meanwhile, policymakers should consider enacting policies that would prohibit discrimination against TGM people throughout the SDoH -- or the conditions where we live, learn, work, play, and age. Health care providers should also receive education on the unique health needs of TGM patients to advance health equity.

An Evaluation of Resilience as a Protective Factor for Mental Health Among Sexual and Gender Minority Young People.

Purpose: Sexual and gender minority (SGM) individuals often face minority stressors that negatively affect their mental health, making it important to identify protective factors against the adverse psychological effects of minority stress. We investigated the potential protective effect of trait resilience in SGM individuals assigned female at birth (SGM-AFAB), who are understudied despite being at particularly high risk for mental health problems. Methods: As part of an ongoing longitudinal cohort study, 452 SGM-AFAB young people (age 16-31 years) completed measures of resilience, minority stressors (victimization, microaggressions, internalized heterosexism, and cisgenderism), and mental health (depression, anxiety, suicidal ideation) in 2017-2018. Moderating effects of resilience on associations between the minority stressors and mental health outcomes were tested using regression analyses. Results: Resilience attenuated the positive associations of microaggressions with both depression and anxiety and of internalized cisgenderism with depression (in transgender and gender-diverse participants), suggesting protective effects. Resilience did not moderate any other associations. Conclusion: These findings suggest that resilience serves as a protective factor against depressive and anxiety symptoms following experiences of microaggressions and against depressive symptoms following internalized cisgenderism among diverse SGM-AFAB individuals. These results underscore the importance of identifying factors that bolster resilience and developing intervention strategies aimed at promoting resilience within SGM-AFAB individuals, especially following experiences of microaggressions and internalized cisgenderism.

Gender Nonconformity, Minority Stress, and Psychological Distress Among Sexual Minority Adolescents.

Purpose: Sexual minority adolescents (SMAs) have disproportionate experiences of mental health symptoms during adolescence, and minority stress contributes to mental health inequities among SMAs. Gender nonconformity (GNC) could place SMAs at higher risk for minority stress and subsequent mental health symptoms. The current study was designed to examine associations between GNC, minority stress, and psychological distress among SMAs. Method: SMAs ages 12-17 years (n = 455; mean age = 15.52 years) in the United States completed a cross-sectional online survey from February to July 2022, including measures of GNC, peer victimization, family rejection, negative expectations, negative disclosure experiences, internalized homonegativity, and psychological distress. We conducted path analysis to examine associations between GNC, minority stressors, and psychological distress, including indirect effects of GNC on psychological distress via minority stress. Results: In multivariable path analysis adjusted for demographic characteristics, GNC was associated with higher levels of peer victimization and negative expectations and lower internalized homonegativity among SMAs. Higher levels of peer victimization and negative expectations were associated with higher psychological distress. GNC was indirectly related to higher levels of psychological distress via higher peer victimization. Conclusions: The current study is the first to document associations between GNC and multiple minority stress experiences among SMAs, and GNC was indirectly related to psychological distress among SMAs via peer victimization. Although all SMAs would benefit from interventions designed to reduce peer victimization and increase their capacity to cope with minority stress, such interventions may be particularly beneficial for SMAs who are gender nonconforming.

Cultural Adaptation and Evaluation of Evidence for Validity of a Gender Minority Stress Measure among Transgender Women and Transfeminine People in China

Cultural Adaptation and Evaluation of Evidence for Validity of a Gender Minority Stress Measure among Transgender Women and Transfeminine People in China

Development of a first intervention for tobacco cessation for sexual and gender minority individuals in Romania

Abstract Background Data on tobacco use among SGM in Romania indicate high use rates, yet tailored smoking cessation efforts do not exist. We collected data from SGM individuals in Romania on tobacco use and cessation attitudes, facilitators and barriers to quitting, and intervention components acceptability to inform the first smoking cessation intervention for SGM in Romania, adapted from a U.S.-based intervention with mobile app support. Methods SGM individuals (≥ 18 years old, current smokers) recruited through community outreach in March 2024 completed a brief assessment and participated in a focus group regarding tobacco use, attitudes, norms, risks knowledge, facilitators and barriers to quitting, and intervention acceptability. Results Focus groups were held with 36 participants characterized as 45% cis male, 40% gender-diverse, 15% cis female; 40% gay, 33% bisexual, 10% queer, 8% pansexual; 6% lesbian, 3% heterosexual; M age=27, SD = 7.62. 70% smoked daily; median age of first cigarette was 17. Participants reported smoking up to 2 packs a day, with 50%-98% of people in their circles being smokers. Common reasons for smoking included to alleviate stress and “fit in.” Most did not receive support to quit from their social circles or within healthcare. While smoking was communal, quitting was individual and siloed, suggesting a preference for a group-based intervention, along with robust strategies to replace the function of smoking with adaptive habits. The app was evaluated positively, especially for its daily smoking tracking, reminders for alternative healthy activities, positive achievements, and forum for support. Conclusions Findings provide a solid platform for creating a first smoking cessation intervention for SGM individuals in Romania. Next steps include iterative testing of the mobile app to examine comprehension, usability, and satisfaction with content and functionality, in preparation for a randomized controlled trial testing the intervention’s efficacy.

Gender identity differences in age of first mental health diagnosis: A population-based study of childhood and adolescence

Abstract Introduction Gender minority (GM; i.e., trans, non-binary, and other gender diverse) individuals have an increased risk of mental health disorders, but few studies have explored disparities using population-based samples or the age of onset of this risk. Objectives The aim of the current study was to identify the age at which the gender identity disparity in physician-assessed psychiatric diagnosis and treatment for common mental health disorders can be first identified in a population-based sample linked to national health care registries. Methods All individuals aged 16 to 25 (n = 18,793) participating in the nationwide probability-based Swedish National Public Health Survey in 2018, 2020, or 2021 were included in the analyses. This sample could be linked to mental health care treatment history data in nationally comprehensive health care registries starting at age 8 years old. Results Individuals reporting a GM identity in adulthood were seven times more likely to having been diagnosed with depression and/or anxiety and about five times more likely to having been diagnosed with a neurodevelopmental disorder during childhood or adolescence compared to individuals with a cisgender identity. GM individuals’ increased likelihood of being diagnosed with depression and/or anxiety was significantly elevated from age 13, while their neurodevelopmental disorder diagnosis risk was significantly elevated from age 10, compared to cisgender individuals. Conclusions The results from this study are the first population-based evidence to show that GM individuals are more likely to be diagnosed and treated for mental health disorders early during childhood and adolescence compared to cisgender individuals. The early emergence of this increased risk requires further inquiry into causes of these early disparities. It also suggests a potential benefit of interventions that facilitate social belonging and inclusion and reduce stressors related to societal expectations of gender.

Strategies to promote safety for sexual and gender minority youth in secondary schools: A longitudinal analysis.

In order to promote school safety for sexual and gender minority youth (SGMY), many schools implement strategies such as SGM-focused policies and gender-sexuality alliances (GSAs). Little is known about the effects such strategies have over time on feelings of safety at school for SGMY. Hierarchical Linear Models were conducted using longitudinal data from 417 SGMY attending secondary schools to examine trajectories of feelings of safety and the effects of SGM-focused policies, GSA presence, or GSA membership on feelings of safety. Findings indicate that SGM-focused policies and GSAs had direct benefits for safety at school SGMY, both independently and in combination; however, GSA membership was not. Schools should implement a combination of school strategies to promote safer environments for SGMY.

Understanding How Coming Out Goes Well for Sexual and Gender Minorities

ABSTRACT Coming out is often seen as a positive event that bolsters well-being for sexual and gender minorities (SGMs). However, the relationship between coming out and well-being is more complex among SGMs. We set out to evaluate the reliability and validity of two recent scales related to coming out: the Coming Out Vigilance and Positive Coming Out Responses scales. Using a sample of 437 SGMs and supporting previous work, we found evidence supporting the reliability and convergent, divergent, predictive, and incremental validity of both scales. Both scales evidenced substantial relationships with well-being, with the Coming Out Vigilance scale being related to all facets of well-being except relationships, and the Positive Coming Out Responses scale being related to all facets of well-being. Most importantly, we found that the scales accounted for variation in well-being above and beyond that accounted for by LGBTQ+ Hypervigilance and Parental Acceptance, respectively. Finally, we did not find evidence that the Coming Out Vigilance scale moderated the relationship between outness and well-being, nor did we find evidence that the Positive Coming Out Responses scale mediated the relationship between outness and well-being.

Discussion of HIV and Other Sexually Transmitted Infections with Sex Partners of Nigerian Men who have Sex with Men and Transgender Women: Implications for Interventions to Promote Safer Sex Practices.

Discussion of HIV and other sexually transmitted infections (STIs) among sex partners facilitates risk reduction. We evaluated HIV/STI-related communications, including broad assessment of any self-reported discussion of the topic and specific discussion of each partners' HIV status, among a historically marginalized and presently criminalized community of sexual and gender minorities (SGM) in Nigeria. From 2013-2018, we enrolled SGM aged 18+ in Lagos or 16+ in Abuja who reported anal sex with men. At enrollment and 3-, 9-, and 15-month follow-up visits, participants were asked about their sexual behaviors and communications with main sexual partners (MSP) and casual sexual partners (CSP). Questions included "have you talked with your [MSP/CSP] about sexually transmitted infections and HIV?" Multivariable robust Poisson regression with generalized estimating equations was used to estimate adjusted relative risks (aRRs) and 95% confidence intervals (CIs) for factors potentially associated with HIV/STI-related communications with some or all of each type of sexual partner. Among 2795 SGM enrolled with median age 23 years (interquartile range 20-27), questions about HIV/STI-related communications with MSP were answered by 2436 (87.2%) and with CSP by 2398 (85.9%). Communication with MSP was reported by 68.1% (1659/2436), of whom 897 (54.1%) discussed their own HIV status and 925 (55.8%) discussed their partner's status. Communication with CSP was reported by 43.9% (1052/2398), of whom 389 (37.0%) discussed their own HIV status and 385 (36.6%) discussed their partner's status. Among participants with both MSP and CSP, HIV/STI-related communication with MSP was more common among participants with higher than secondary education (aRR 1.40 [95%CI 1.24-1.58)], who were divorced/separated/widowed (aRR 1.19 [95% CI 1.06-1.33]), who discussed their HIV status with CSP (aRR 1.18 [95%CI 1.10-1.25]), discussed CSP's HIV status (aRR 1.20 [95%CI 1.13-1.27]), and used a condom at last sex with CSP (aRR 1.16 [95%CI 1.08-1.25]). HIV/STI-related communication with CSP was more common among participants with higher than secondary education (aRR 1.36 [95%CI 1.12-1.66]); who were divorced/separated/widowed (aRR 1.38 [95%CI 1.13-1.69]), who discussed their HIV status with MSP (aRR 1.47 [95%CI 1.27-1.69]), who discussed CSP's HIV status (aRR 1.22 [95%CI 1.06-1.40]) and used a condom at last sex with CSP (aRR 1.22 (95%CI 1.08-1.38]). HIV/STI-related communications with main and casual sex partners were both associated with safer sex with CSP. HIV prevention and treatment programs for SGM should promote open communications in sexual relationships and consider deployment of modern strategies to facilitate disclosure, especially in settings with criminalizing legislation.

Preparing for the Implementation of Long-Acting Injectable Cabotegravir for HIV Pre-Exposure Prophylaxis Within the Brazilian Public Health System (ImPrEP CAB Brasil): Qualitative Study.

Although long-acting, injectable cabotegravir (CAB-LA) pre-exposure prophylaxis (PrEP) has proven efficacious for HIV prevention in clinical trials, research is needed to guide effective implementation in real-world settings. Formative work with community members and health care providers (HCPs) is important to provide insight into the needs and contexts of specific populations and reveal potential barriers and facilitators for implementation projects. We aimed to describe the results from formative work to develop an implementation package for CAB-LA PrEP within the ImPrEP CAB Brasil study. ImPrEP CAB Brasil is an implementation study of same-day delivery of CAB-LA PrEP for young sexual and gender minority (SGM) groups (aged 18-30 years) in 6 existing oral PrEP public health clinics. We conducted formative research to prepare for the implementation of ImPrEP CAB Brasil through community mobilization, process mapping with HCPs with experience in CAB-LA, and focus group discussions (FGDs) with young SGM groups (n=92) and HCPs (n=20) to identify initial perceptions of facilitators and barriers for CAB-LA PrEP implementation, refine the mobile health (mHealth) educational tool, and evaluate the acceptability of using a text message appointment reminder intervention through WhatsApp. FGDs were recorded, transcribed, systematically coded, and analyzed with thematic categorization by trained researchers using a qualitative data analysis program ATLAS.ti (version 7). A community mobilization team comprising 34 SGM community leaders collaborated in creating a prototype for an mHealth educational tool and contributed to the planning of peer education activities. We created 3 process maps for each site to describe the initial visit, follow-up visits, and laboratory flow. The main challenge identified for same-day CAB-LA PrEP delivery was the extended duration of clinic visits due to the numerous laboratory tests and HIV counseling steps required. Proposed solutions included having point-of-care HIV rapid tests instead of laboratory tests and additional counseling staff. Barriers for CAB-LA PrEP implementation identified through FGDs were the training of HCPs, support for adherence to injection appointments, and stigma or discrimination against SGM groups and persons using PrEP. The mHealth educational tool and WhatsApp reminders were highly acceptable by SGM groups and HCPs, indicating their potential to support PrEP choice and adherence. Content analysis on the cultural appropriateness of the language and overall clarity of the material contributed to the refinement of the mHealth tool. Structured formative work with SGM persons and HCPs generated important refinements to context-specific materials and plans to launch ImPrEP CAB Brasil in public health clinics. Ongoing implementation monitoring will use the process maps to identify additional barriers and potential solutions to same-day delivery of CAB-LA PrEP. Summative evaluations are needed to measure the effectiveness of the mHealth educational tool to support PrEP choice and the use of WhatsApp appointment reminders.

Battle Against Effects of Discrimination with Belonging and Support: Mental Health Risk and Protective Factors Among Sexual and Gender Minority Youth

Battle Against Effects of Discrimination with Belonging and Support: Mental Health Risk and Protective Factors Among Sexual and Gender Minority Youth

Prevalence, Correlates, and Impacts of Displacement Because of Natural Disasters in the United States From 2022 to 2023.

Objectives. To quantify the prevalence, correlates, and impacts of displacement because of natural disasters in the United States. Methods. We pooled data across 10 independent survey samples from the Census Bureau Household Pulse Survey from December 2022 to September 2023. Survey questions asked about displacement from home because of natural disasters, duration of displacement, and impacts of disasters. Results. In our weighted sample of 213 234 003 adults, 3 166 500 (1.5%) reported displacement in the past year because of a natural disaster. People of color, sexual and gender minority populations, and those with lower incomes, disabilities, or unfavorable social determinants of health (SDOH) such as food insecurity were more likely to report displacement. Long-term displacement was more common with fires compared with other disasters. Disaster impacts, including food and water shortage, electricity loss, unsanitary conditions, feeling isolated, and experiencing scams, were more common among people of color and individuals with lower education or income. Conclusions. Many people in the United States, particularly from health disparity populations, are displaced because of natural disasters. Addressing SDOH and other vulnerability factors may help improve disaster preparedness and mitigate postdisaster impacts. (Am J Public Health. Published online ahead of print October 24, 2024:e1-e11. https://doi.org/10.2105/AJPH.2024.307854).

Characterizing Collegiate Recovery Programs in the US and Canada: A Survey of Program Directors.

Collegiate Recovery Programs (CRPs) play a vital and expanding role in supporting students in recovery from substance use disorders and behavioral addictions at higher education institutions. Despite their importance, there is a lack of comprehensive research characterizing CRPs, including their program directors and the nature and influence of their funding streams. A survey was administered to 70 CRP directors across the US and Canada. Directors reported on their CRPs across a variety of site physical features, policy and program offerings, and funding sources, with "sustainable" funding defined as two or more sources. CRP directors were predominantly non-Hispanic, White, and female, with representation from gender and sexual minorities. The highest concentration of directors responding were in the US states of North Carolina, California, and Texas. CRPs with more than one funding source served twice as many students and had significantly more space, drop-in facilities, and relapse management policies. CRP directors had positive perceptions of harm reduction principles. Additionally, results highlighted the robust availability of All Recovery meetings and the wide diversity of mutual-help group meetings offered within CRPs and directors' positive perceptions of these meetings. This research lays a foundation for enhancing CRPs within higher education settings, emphasizing the significance of sustained funding and an inclusive support framework for the program directors that run CRPs. Future studies should further explore the effectiveness of CRPs and their impacts on the schools and students they serve.

Brain Health Outcomes in Sexual and Gender Minority Groups: Results From the All of Us Research Program.

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.

The collateral effects of the COVID-19 pandemic: A gender-specific systematic review of disordered eating behaviour in the general population.

The COVID-19 pandemic initiated public health measures, impacting mental health and exacerbating disordered eating behaviours (DEB). This study aims to fill gaps in understanding DEB in the general population during the pandemic, emphasising gender dynamics and the experiences of gender and/or sexual minority (SGM) individuals. A systematic literature review followed PRISMA guidelines to investigate DEB during the pandemic, focusing on gender-sensitive analyses and SGM populations. Outcomes from the included studies were synthesised to identify patterns and associations related to DEB, particularly considering gender dynamics and SGM experiences. Significant gender associations with DEB were observed, with women consistently exhibiting higher scores. SGM populations also showed elevated DEB symptoms. Longitudinal studies indicated changes in DEB over time, with some decreases observed among men. The review underscores significant gender differences in DEB during the pandemic, with women exhibiting higher symptom levels. Lockdown measures had nuanced impacts on DEB, varying across studies. Various factors including pandemic-related stressors influenced DEB. Consideration of these factors can inform tailored interventions for DEB in the general population. Overall, the review enhances our understanding of how gender intersects with the pandemic's impact on DEB, emphasising the need for diverse approaches to address these behaviours.

Navigating Stigma Against At-Risk Sexual and Gender Minority Populations to End the HIV Epidemic in Sub-Saharan Africa.

In the past year, new laws criminalizing same-sex conduct and the promotion of lesbian, gay, bisexual, transgender, and queer (LGBTQ) rights have emerged as barriers to addressing the HIV epidemic in sub-Saharan Africa (SSA). An augmented approach to addressing HIV within the region's disproportionately affected LGBTQ populations, particularly transgender women and gay, bisexual, and other men who have sex with men (MSM), is imperative for achieving the international goal of ending the HIV epidemic by 2030. In this article, we present recommendations to bolster the continuum of HIV care for MSM and transgender women in SSA.