Gay Men Research Articles

Ostracism Experiences of Sexual Minorities: Investigating Targets' Experiences and Perceptions by Others.

Lesbian, gay, and bisexual (LGB) people face frequent discrimination, maltreatment, and violence for transgressing gender roles upheld in heteronormative societies. Ostracism (i.e., being excluded and ignored) is likely another, understudied form of discrimination against sexual minorities. In a multi-method approach using a nationally representative panel (N = 4104) and experience sampling data (N = 467, 14 days, k = 926 ostracism experiences), we find that LGB individuals report more ostracism experiences than straight individuals. In line with the idea that ostracism toward sexual minorities occurs as a function of gender role nonconformity, lesbians and gay men are rated by an independent rater sample as more likely to be ostracized (k = 10,760 ratings) when they are also rated as more lesbian/gay and less gender role conforming. Our findings speak in favor of ostracism as a discriminatory experience of LGB individuals that is driven by transgressions of heteronormativity.

Z-Drug Use and Benzodiazepine Use and Misuse Among LGB Populations: The Role of Psychological Distress.

Z-drugs (hypnotics such as zolpidem, zopiclone, and zaleplon) and benzodiazepines (BZDs) are sedative medications with misuse liability. The goals of this study are to report the (1) prevalence of past-year any Z-drug use, any BZD use, and any BZD misuse by sexual identity category and psychological distress; (2) associations among these 3 categories between sexual identity and past-year psychological distress; (3) associations among these 3 categories with sexual identity by past-year psychological distress status. Data were collected from the National Survey on Drug Use and Health (years 2015-2019 [n = 210,392]), a yearly representative national household survey of the American population. We report prevalences of any Z-drug use, any BZD use, and any BZD misuse by sexual identity and past-year psychological distress status. We ran logistic regressions with complex survey design with the 3 dichotomous variables described above as the dependent variables, stratified and not-stratified by psychological distress. Prevalence of any Z-drug an BZD use and any BZD misuse were higher among LGB (lesbian/gay/bisexual) populations, especially gay men and bisexual women. Psychological distress was positively associated with any Z-drug and BZD use and any BZD misuse. Women were at higher risk of Z-drug (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.18-1.37) and BZD use (OR, 1.64; 95% CI, 1.55-1.73), but lower risk of BZD misuse (OR, 0.82; 95% CI, 0.76-0.88). When stratifying by psychological distress, differences between LGB and heterosexuals were more pronounced among those without past-year psychological distress, especially gay men and bisexual women. The presence of psychological distress attenuates the disparities between LGB and heterosexual individuals in Z-drug use and BZD use and misuse.

Experiences of professional mental health help-seeking and engagement with services among emerging adult men identifying as gay

ABSTRACT Objective Gay men have higher rates of psychological distress and greater dissatisfaction with mental health services than heterosexual men. Emerging adulthood is a vulnerable period representing a crucial period of sexual identity formation. Understanding of experiences during engagement with professional mental health services by gay men remains limited, especially in emerging adulthood. This study explored emerging adult gay men’s experiences during their engagement with professional mental health help-seeking. Method In-depth semi-structured interviews were conducted with seven gay-identifying cisgender men. Data were analysed using reflexive thematic analysis. Results An overarching theme of perseverance was identified, with two themes of navigating anticipatory heterosexism and renegotiating pathology. Navigating anticipatory heterosexism included subthemes of selective disclosure and seeking “safe” practitioners. In renegotiating pathology, interviewees described delineating distress, thereby separating sexual identity from their mental health presentation, as well as normalising distress resulting from experiences of prejudice and minority stress. These themes encapsulate how participants reported navigating sexual identity-based challenges during the help-seeking process, thereby persevering and continuing with help-seeking. Conclusions Results highlight how mental healthcare can be navigated and underscore the need to: 1) enhance signalling safety to sexually diverse client groups, and 2) increase practitioner cultural competency to reduce stigma or heterosexism in experiences of healthcare.

Male homoparenting and its challenges: an integrative literature review.

This study aims to elucidate the challenges faced in the exercise of male homoparenting, through an integrative literature review. Following PRISMA guidelines, empirical studies from the last 22 years were analyzed, independently collected by four researchers using the PubMed and APA PsychNet databases, with the descriptors "Homosexuality, Male" and "Father". The results reveal the unique and complex reality faced by homosexual men in the parental context. While some studies highlight significant challenges, such as stigmas and social prejudices, others do not observe such difficulties. The decision to become a father among homosexual men is influenced by factors specific to their reality, in a context where parenthood is not widely accepted. The findings of this study emphasize the need to understand the complex interactions among individual, social, and cultural factors in male homoparenting. In summary, this study highlights the need for inclusive and diversity-sensitive approaches to support family well-being.

Adapting Amidst Vulnerability: An Interpretative Phenomenological Analysis Study on Gay Men Living With HIV.

HIV represents a "biographical disruption", interrupting the continuity of life and fostering a sense of vulnerability. The transition of HIV into a chronic condition, coupled with extended life expectancy, necessitates significant lifestyle adjustments, making adaptation and navigation through uncertainties essential. Interpretative phenomenological analysis was used to investigate the lived experiences and adaptation processes of gay men in Greece who are living with HIV. Semi-structured interviews were conducted with seven HIV-positive gay men, recruited from two Greek NGOs that support individuals living with HIV. Investigator triangulation was used to interpret textual material, heightening credibility and reducing bias, thereby enhancing the findings' reliability. The analysis identified a superordinate theme, "Being Vulnerable Enough: Negotiating Uncertainties and Adapting in the HIV Experience", which encompasses three themes: "The Moment of Division: Fear, Uncertainty, and Vulnerability after an HIV Diagnosis", "Grief and Negotiation: Navigating Daily Life Through the Lens of Loss", and "Reclaiming Self: Shaping 'My HIV Identity' to Fit on My Terms". The initial shock of HIV diagnosis introduces a sense of vulnerability, with participants confronting fear, despair, and grief over the loss of health and the disruption of their anticipated life flow. Being vulnerable enough enables individuals to adapt to life with HIV by managing uncertainties through creating certainties with small daily decisions, in a non-linear, ongoing process of negotiation and reassessment, without the need to eliminate all uncertainties.

191 Ethnoracial Disparities in Subjective Cognitive Decline Among Sexual Minority Men in the U.S.

OBJECTIVES/GOALS: Sexual minority men (SMM) of color are at greater dementia risk than their White and non-SMM counterparts. The purpose of this study is to examine the relative effects of ethnoracial minority status, sexual minority status, and the intersection of both on dementia risk for men in the U.S. using subjective cognitive decline (SCD) as a proxy for dementia. METHODS/STUDY POPULATION: Data will be weighed to represent population estimates from 35 states’ 2019-2022 Behavioral Risk Factor Surveillance System Survey to describe SCD among 4 study groups consisting of SMM and non-SMM who are from minoritized ethnoracial groups (i.e., minoritized ethnoracial gay and bisexual men, minoritized ethnoracial heterosexual men), and White SMM and White non-SMM (i.e., White gay and bisexual men, White heterosexual men) aged ≥45 years. Logistic regressions and adjusted odds ratios will determine SCD prevalences and test for differences between prevalence and demographic characteristics (i.e., education, employment, income, marital status, health coverage, and depression). RESULTS/ANTICIPATED RESULTS: Due to excess chronic stress from belonging to multiple intersecting marginalized identities, we expect that SMM from minoritized ethnoracial groups will have a greater prevalence and higher odds of SCD after accounting for demographic factors when compared to groups that benefit from both “White Privilege” and heterosexism (White non-SMM, White SMM, and minoritized ethnoracial non-SMM). We also expect the odds of SCD to be higher in minoritized ethnoracial SMM when compared to White non-SMM and minoritized ethnoracial non-SMM. The odds of SCD are expected to be higher in White SMM compared to White non-SMM. DISCUSSION/SIGNIFICANCE: This is the first population-based study to apply an intersectional lens to examine dementia risk across the axes of race, sexual orientation, and gender identity. Findings from this study can inform targeted interventions to address the needs and experiences of LGBTQ+ subgroups at risk or living with dementia.

Self-Identity Among Chinese Gay Men on social media: Real Challenges in A Virtual World

This literature review synthesizes research on the experiences of Chinese gay men in online spaces. Social media provides opportunities for marginalized sexuality exploration and selective disclosure, allowing connection with hidden peers despite conservative cultural norms. However, substantial identity tensions persist between liberatory potential online and enduring offline constraints like family pressures, stigma, and censorship. Key themes examined include online identity construction under cultural influences, sequencing from anonymous to identifiable disclosure, struggles for empowering representation, and risks around involuntary outing that temper mental health benefits of online support. While virtual platforms expand Expression, full integration with real-world contexts remains challenging. Enduring harassment and victimization, amplified by state suppression of LGBTQ+ content, exacerbate psychological distress. Studies emphasize the need for aligned technological, cultural, and legal advances to translate online safe havens into greater wellbeing for this vulnerable population. Overall, this review highlights the complex interplay of opportunities and threats as Chinese gay men navigate old and new media to develop holistic identities between familial duties and sexual desires, social constraints and hopes for greater openness. Progress requires addressing biases and stigma pervading both online and offline spheres.

Translanguaging for Doing Gender in English-Medium Classrooms in Hong Kong: Towards Critical CLIL in Plurilingual Settings

ABSTRACT Critical content and language-integrated learning (CLIL) has been advocated to attest raciolingusitic ideologies in plurilingual educational settings. However, little is known about how to help students in contesting inequalities about other structures of domination in bilingual education programs. This study aims to address this gap by examining the construction of gender identities in Secondary 4 (Grade 11) English-medium Liberal Studies lessons, which aimed to enhance awareness of gender equality and subject-specific English skills about the topic. The study shows that gender was constructed and reconstructed by conflicting multilingual and multimodal gendered discourses, including the formal curriculum, school lesson materials, and classroom interaction. The paper reveals that teachers and students jointly constructed masculinities of “real men,” “good men” and “gay men” in CLIL classrooms imbedded in curriculum contexts infused with gender dualism and alternative gender values began to emerge after the CLIL lessons. The results suggest that CLIL teachers can facilitate development of critical literacies about gender by enabling encounters of different voices in translanguaging and trans-registering spaces created by students’ familiar L1 everyday discourses and multimodal practices. Pedagogical implications were also discussed.

The Politics and Aesthetics of Male Homosexuality in Malayalam Cinema: Contextualizing the Film Ka Bodyscapes (2016)

ABSTRACT Focusing on the Malayalam film Ka Bodyscapes (2016), this article attempts to historically trace and critically engage with the representations of gay sexuality in Malayalam cinema from the South Indian state of Kerala. It interrogates how Ka Bodyscapes brought to the forefront hitherto unexplored visual dynamics of the gay male body and homoeroticism on screen while troubling the heterosexual dynamics of the Malayalam film industry. By situating this film within the history of representation of male homosexuality in Malayalam cinema and the changing regimes of queer politics and feminist interventions in Kerala in the last decade, the article argues how the film’s radical visual representation of gay sexuality at the intersection of caste and religion problematizes the heterosexual family/state, thereby challenging the patriarchal masculinity that marginalizes women and sexual minorities in Kerala.

Military service and health-related quality of life among gay and bisexual prostate cancer survivors: Results from the Restore-2 study

IntroductionThere are notable disparities in health-related quality of life (HRQOL) between gay and bisexual men (GBM) and heterosexual patients with prostate cancer (PCa); however, the role of past military service...

Development and validation of the Japanese version of the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale.

The Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS) is a validated self-assessment tool for health and mental health professionals who provide healthcare for sexual and gender minority patients. This study aimed to develop and validate a Japanese version of LGBT-DOCSS (LGBT-DOCSS-JP) and examine its psychometric properties. LGBT-DOCSS was translated into Japanese and cross-culturally validated using cognitive debriefing. We then evaluated the structural validity, convergent and discriminant validity, internal consistency, and test-retest reliability of LGBT-DOCSS-JP using an online survey. Data were analyzed for 381 health and mental health professionals aged 20 years or older from three suburban medical institutions. The confirmatory factor analysis indicated that the original three-factor model did not fit well with LGBT-DOCSS-JP. Exploratory factor analysis revealed four new factors: Attitudinal Awareness, Basic Knowledge, Clinical Preparedness, and Clinical Training. Convergent and discriminant validity were supported using four established scales that measured attitudes toward lesbians and gay men, genderism and transphobia, authoritarianism and conventionalism, and social desirability. The internal consistency of LGBT-DOCSS-JP was supported by the Cronbach's alpha values for the overall scale (0.84), and for each of its subscales (Attitudinal Awareness and Basic Knowledge both 0.87, Clinical Preparedness 0.78, and Clinical Training 0.97). The test-retest reliability for the overall LGBT-DOCSS-JP was supported by an intraclass correlation coefficient score of 0.86. LGBT-DOCSS-JP has the potential to serve as a valuable tool in the development and assessment of effective curricula for LGBT healthcare education, as well as a means to promote self-reflection among trainees and professionals.

Determining The Attitudes of Nurses Towards Lesbians and Gays and The Factors Driving Their Attitudes

This study was conducted to determine the attitudes of clinical nurses towards lesbian and gay individuals and the factors affecting these attitudes. The universe of the research consisted of 254 clinical nurses. The data collection tools used were “The Personal Information Form” and “Attitude towards Lesbians and Gay Men Scale (ATLG)”. In addition, the mean scores of the nurses who encountered lesbian/gay individuals, wanted to meet lesbian/gay individuals, and knew lesbian/gay individuals from the Attitudes towards Lesbian and Gays Scale were found to be statistically significant and high (p

Changing norms of older men’s sexuality in the sexological discourse during Czechoslovak socialism: Dementia as an interpretative lens to make sense of sexual expressions in later life

This article examines the development of medical (primarily sexological) knowledge about older men’s sexuality during Czechoslovak socialism. Analysing medical and criminological journals, sexological textbooks and popular-science publications, and inspired by Ian Hacking’s theory of making up people (1995), we track how Czechoslovak experts created new kinds of older people. We show that the founder of Czechoslovak sexology, Josef Hynie, implemented the kind of older men with dementia with pathological sexuality into sexological discourse in 1940. In the following decades, medical experts omitted older men’s sexuality or debated it solely in the context of paedophilic delinquency, thus perpetuating Hynie’s ideas about the pathological sexuality of men with dementia until the second half of the 1970s. We explain how the classification was subsequently replaced by a new kind of healthy older men with active sexuality, which the sexologists made up hand in hand with incorporating new knowledge about sexual delinquents and changing ideas about active ageing. We argue that dementia served for the experts as a tool for defining what could be seen as normal or pathological ageing as well as normal or pathological ageing male sexuality. Finally, we highlight that the liberalisation of ageing male sexuality occurred in socialist Czechoslovakia at approximately the same time as in Western capitalist countries.

(PM-20) INFLUENCE OF RELIGION ON FEMALE SEXUALITY: REVIEW OF NARRATIVE LITERATURE

Abstract Introduction Sexuality influences thoughts, feelings, actions and interactions and therefore also affects our physical and mental health. It is a complex part of life, shaped by many factors, including religious ones. Religiosity can guide the sexual and loving experience, directly influencing the individual's sexual understanding, such as the use or not of condoms during sexual practice. Therefore, the present study aims to identify in the literature the influence of religion on female sexuality. Methodology A narrative review of the literature was carried out in the PubMed database. Articles published in English, Spanish, Portuguese and Arabic from January 2017 to December 2022 were included, such as: clinical trials, meta-analysis and systematic review, which exclusively addressed female sexuality and religion. Studies that addressed male sexuality were excluded. Results 74 articles were found, of which 28 were selected for reading according to the summary and 10 studies met the inclusion criteria and were analyzed. Most of the studies were on the Muslim, Islamic and Christian religions. Important points related to religious beliefs were identified, such as non-use of contraceptive methods, lack of knowledge about reproductive health, religious conflicts, marital status, virginity, sexual submission and menstrual taboos that negatively influence the quality of sexual life of religious women. . Studies with greater methodological rigor are needed to address this important issue. Conclusion This review showed that religion can have an adverse impact on the sexual health and quality of life of Islamic, Christian and Muslim women. Highlighting the need to conduct research in this area to understand and address this relationship. Financing No conflict.

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.

Factors Associated with PrEP Stigma Among Gay, Bisexual, and Other Men Who Have Sex with Men (gbMSM): A Systematic Review

ABSTRACT Gay, bisexual, and other men who have sex with men (gbMSM) are disproportionately affected by HIV. While pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV acquisition, uptake of PrEP among gbMSM is low, which may in part be due to stigma associated with PrEP use. This systematic review aimed to explore experiences of PrEP stigma and to identify factors associated with this. Four databases were searched for papers including terms relating to (i) gbMSM, (ii) PrEP, and (iii) stigma, with narrative synthesis used to analyze results. After screening, 70 studies were included in the final analysis. Experiences of PrEP stigma were found to be characterized by a number of stereotypes and came from a range of sources. Five categories of factors were associated with stigma: (i) healthcare-related factors, (ii) cultural and contextual factors, (iii) sociodemographic factors, (iv) peer-discussion, and (v) psychosocial factors. These findings suggest that stigma can be a common experience for gbMSM. However, some are more at risk than others. Interventions aimed at reducing PrEP stigma may be useful in increasing uptake.

„Das klingt echt schwul“ – Eine soziophonetische Untersuchung zum stereotypen schwulen Sprechen im Deutschen

Abstract This article examines stereotypical gay speaking using a performative and speaker-centered approach. For this, the default and staged gay ways of speaking of four speakers were quantitatively and qualitatively analyzed and compared with each other, supplemented by a perception test. It is argued that stereotypical gay pronunciation can refer to a particular gay persona (i. e., an affected, diva-like extroverted gay man) by analysing which characteristics the speakers used in which way to construct this persona. The results show general usage patterns and the selective use of variants, more specifically an increase in (1) mean pitch, (2) vowel duration, (3) first and second formant of /ɛ/, and (4) intensity as well as de-/nasality and enhanced precision of articulation. The constructions of a persona occur locally, i. e., in a specific context and in combination with other linguistic features. Based on this study’s approach and results, this article contributes to previous studies on the connection between language and sexuality in German speakers.

Alternative Books in black and white: race and homoeroticism in South African male nude photography from the apartheid period

ABSTRACT Representations of black-white homoeroticism and sensuality between men of colour in apartheid-era male nude photography aimed at white gay men, which, in South Africa, were exclusive to selected titles published by Alternative Books (AB) (1981–1991), are remarkable yet neglected in queer African studies. In this article, I explore how sexual apartheid was respectively maintained and transgressed in the historical reception of such photographs by two radically different readerships: that is, by censors involved in proscribing homoerotic commodities, and by AB’s intended audiences. Drawing from historical censorship reports on AB’s titles, I propose that the inconsistent treatment of photographs from these publications according to the racial categories of the men depicted is a particularly revealing iteration of selective homophobia and ‘official’ perceptions of homosexuality during apartheid. Considering, then, that AB’s titles anticipated a historical minority readership comprised of queer insiders rather than homophobic outsiders, I make the case for a corrective by ‘outing’ the queer and anti-racist potential of such diverse homoerotic images, which rendered intelligible possibilities for intimacy repressed elsewhere in consumer markets that catered to predominantly white gay audiences and that were, in a sense, complicit with the state’s whitewashing of male homosexual identity and desire.

Abstract P173: Examining Sexual Identity Differences in Ideal Cardiovascular Health

Introduction: Recent evidence suggests that sexual minority (e.g., gay, lesbian, bisexual, queer) adults in the United States are at increased risk of cardiovascular disease compared to heterosexual adults. However, the majority of cardiovascular health (CVH) research among sexual minority adults has focused on investigating differences in individual CVH metrics rather than comprehensive measures of CVH. Methods: We analyzed nationally representative data from the National Longitudinal Study of Adolescent to Adult Health to examine sexual identity differences in ideal CVH (i.e., individual CVH metrics and cumulative ideal CVH score) among adults. Participants received a score of 0 (poor), 1 (intermediate), or 2 (ideal) for each CVH metric, and scores were summed to calculate cumulative ideal CVH scores (continuous; range 0-12). We ran sex-stratified multiple logistic and linear regression models to examine sexual identity differences in ideal CVH. Models were adjusted for demographics, health insurance coverage, and adverse childhood experiences. Results: The final sample included 3,492 participants with a mean age of 21.8 (+/- 1.76) years. Approximately 60% were female, over 76% were White and around 90% were non-Hispanic. Compared to exclusively heterosexual women, mostly heterosexual (AOR 0.89, 95% CI = 0.79-0.99) and lesbian (AOR 0.73, 95% CI = 0.55-0.91) women had lower odds of meeting ideal criteria for tobacco use. In contrast, lesbian women had higher odds of meeting ideal criteria for glycosylated hemoglobin (AOR 1.22, 95% CI = 1.09-1.35). Among men, compared to exclusively heterosexual men, mostly heterosexual (AOR 0.87, 95% CI = 0.76-0.97) and bisexual (AOR 0.86, 95% CI = 0.74-0.97) men had lower odds of meeting ideal criteria for tobacco use and blood pressure, respectively. Gay (AOR 0.79, 95% CI = 0.67-0.90) and bisexual (AOR 0.75, 95% CI = 0.54-0.96) men had lower odds of meeting ideal criteria for physical activity, but gay men had higher odds of meeting ideal criteria for body mass index (AOR 1.25, 95% CI = 1.00-1.55). No sexual identity differences were observed for cumulative ideal CVH scores among women and men. Conclusions: As one of the first studies to use nationally representative longitudinal data to examine sexual identity differences in ideal CVH, this study makes an important contribution to the literature on CVH among sexual minority adults. Findings highlight significant CVH disparities in sexual minority adults and suggest there is a need to develop interventions that focus on improving their CVH. Future research is needed to investigate factors that may contribute to the CVH disparities observed among sexual minority adults in this study.

Abstract P169: Cardiovascular Disease Incidence Among Male Veterans by Sexual Orientation and Race

Introduction: Studies of cardiovascular disease (CVD) in sexual minority (SM) men (i.e., gay, bisexual) vs. heterosexual men are limited by small sample sizes and lack of objective CVD ascertainment. Small samples also hinder study at the intersection of race and sexual orientation on CVD events. We used the Veterans Healthcare Administration Lesbian, Gay, Bisexual, Transgender Electronic Health Record cohort to fill these knowledge gaps. Methods: We studied 919,404 male cisgender veterans who were free of prevalent CVD and classified as SM or non-SM by a natural language processing tool. We defined incident CVD as first instance of AMI, ischemic stroke, cardiac revascularization, or CVD death between baseline and date of death or 8/31/22. We stratified sample statistics by SM status and race. We used Cox proportional hazards regression to assess the intersection of sexual orientation and race with incident CVD; we adjusted for Hispanic ethnicity and age. Based on the minority stress model, non-SM White men were the referent. Results: Within races, traditional CVD risk factors were similarly distributed by SM status but SM men had greater prevalence of stress-associated characteristics like substance use, depression, and anxiety. Heterosexual, gay, and bisexual Asian men had lower CVD risk than non-SM White men, while Black/African American and Multiracial men had persistently increased CVD risk ( Table ). White and American Native gay men had increased CVD risk vs. non-SM White men. With the exception of Asians, all unclassified SM men had increased CVD incidence vs. non-SM White men. Risk was highest in among Black or Multiracial SM men. Conclusion: This is one of the first studies to examine the intersection of sexual orientation and race on CVD risk in male veterans. CVD risk appears increased or decreased in certain racial groups regardless of sexual orientation but this is not always true and invites further study into the mechanisms by which stress results in inequitable CVD events across groups.