Search Results (94)

Background/Objectives: In England, gay, bisexual, and other men who have sex with men (GBMSM) are eligible for vaccination at NHS sexual health services, including human papillomavirus (HPV), hepatitis A virus (HAV), and hepatitis B virus (HBV) vaccines. However, current research shows limited understanding of the factors influencing vaccination uptake among GBMSM. This study aimed to examine the barriers and facilitators affecting the offer and uptake of these vaccination programmes. Methods: A qualitative interview study following the Person-Based Approach (a systematic method for developing and optimising health interventions) involving GBMSM and sexual health service staff from two regions of England. Purposive sampling aimed to include GBMSM with diverse backgrounds and engagement with sexual health services. Patient and public involvement shaped the study design and interview topic guides. The interviews were recorded, transcribed, and thematically analysed to identify barriers and facilitators which were interpreted using the COM-B model of behaviour change. Results: Twenty GBMSM and eleven staff took part. The findings showed that opportunistic delivery of HPV, HAV, and HBV vaccination within sexual health services is mostly acceptable and feasible for GBMSM and staff, while also highlighting areas for optimization. Despite low knowledge of these viruses and their associated risks, willingness to be vaccinated was high, with healthcare provider recommendations and the convenience of vaccine delivery during routine clinic visits acting as important facilitators. However, the reach of opportunistic models was limited, particularly for individuals underserved by sexual health services or disengaged from GBMSM social networks. System-level barriers such as complex vaccine schedules (particularly when multiple schedules are combined), inconsistent access to vaccination histories, and limited system-level follow-up processes (e.g., automated invites and reminders) were also found to act as obstacles to vaccination uptake and delivery. Conclusions: To improve equitable uptake, sexual health services should explore the feasibility of addressing both individual and structural barriers through additional strategies, including targeted and persuasive communication to increase knowledge, leveraging regular contact with GBMSM to promote uptake, and implementing enhanced approaches to support vaccination completion (e.g., automated prompts or reminders). Full article

In the United States, although the gaps in health insurance coverage by sexual orientation have been closing since the implementation of the Affordable Care Act and legalization of same-sex marriage, the LGB group (i.e., lesbian, gay, bisexual) continues to report healthcare utilization and access inequities such as more delayed or unmet care. The extant research has often examined healthcare utilization and access inequities due to affordability (e.g., out-of-pocket costs). However, healthcare utilization and access inequities are only partially explained by cost reasons; there are non-cost reasons that have not been adequately empirically examined. The present study innovatively includes discrimination structural variables to understand how social structure is associated with healthcare utilization and access inequities of LGB people. It focuses on two routine health services—regular check-ups and prescription medications—for LGB people who have chronic diseases. Additionally, sexual orientation may intersect with sex assigned at birth (sex, hereafter, i.e., male, female) to impact healthcare utilization and access inequities. The current study applies quantitative intersectional analysis to understand healthcare utilization and access inequities from a sexual orientation and sex intersectional lens and for easier and clearer interpretations of intersectional results and more actionable policy implications for inter-categorical groups. Using the 2023 National Health Interview Survey (weighted N = 136,231,053), we conducted quantitative intersectional analysis for logistic regression using complex survey data. First, we fit a series of logistic regression models with sexual orientation–sex interactions for routine healthcare utilization and access outcomes, adjusting for covariates. Second, we calculated average marginal predictions for inter-categorical groups by interacting sexual orientation and sex and other covariates. Third, we computed risk ratios of average marginal predictions for all the covariates. Lastly, we examined the interaction of inter-categorical groups/sexual orientation and structural variables. Our results show that experiencing a higher level of discrimination is positively associated with underutilization of regular check-ups and lower access to prescription medications, and this effect is stronger for LGB people. Further, LGB women are least likely to utilize regular check-ups and LGB men are least likely to access prescription medications among the inter-categorical groups. Highlighting structural issues of healthcare utilization and access offers new evidence on healthcare utilization and access inequities that can inform policies for raising awareness of and addressing structural issues. The intersectional analyses suggest that relevant policies target LGB women and LGB men. Full article

Introduction: Mpox emerged as a multi-country outbreak in 2022 and disproportionately affected gay, bisexual, and other men who have sex with men (GBMSM). Stigma is known to exacerbate health crises by discouraging testing, treatment, and vaccination. This review aimed to explore stigma associated with Mpox among GBMSM from July 2022, when mpox was declared a public health emergency of international concern. Methods: The PICO framework guided this narrative review. A search was conducted across the following databases from inception to June 2025: PubMed/MEDLINE, Embase, CINAHL, and Web of Science. The literature had to be empirical, peer-reviewed research that focused on mpox-related stigma in GBMSM. Results: Forty-seven studies were included in this review. The following themes were derived: (1) healthcare experiences, (2) media influence, (3) internalised and anticipated stigma, (4) public health messaging, (5) community responses, and (6) psychosocial impact. Healthcare experiences were marked by anticipated discrimination; many GBMSM delayed testing or vaccination for fear of being disclosed or labelled promiscuous. This was especially apparent in contexts where same-sex relationships are criminalised, leading some men to self-medicate or seek clandestine services. Media analyses revealed that social and traditional platforms often amplified blame and homophobia, though community-led counter-messaging helped shift narratives. Internalised and anticipated stigma resulted in shame, concealment of symptoms, avoidance of care, and heightened anxiety. Public health messaging that framed mpox as a behaviour-linked rather than identity-linked risk was more acceptable, and flexible vaccination strategies (e.g., offering less conspicuous injection sites) increased uptake. Stigma contributed to psychosocial distress and may have impeded outbreak control. Conclusions: Mpox-related stigma among GBMSM operates at individual, community, and structural levels, echoing patterns from the HIV era. Effective mitigation requires rights-based, destigmatising communication, culturally competent care, and collaboration. Addressing stigma is vital to controlling future outbreaks and ensuring equitable healthcare access. Full article

Nutrition is a cornerstone of public health, yet the unique nutrition needs and considerations of lesbian, gay, bisexual, transgender, and others (LGBT+) communities remain largely invisible in the field of dietetics. These populations face disproportionate burdens of obesity, eating disorders, body dysmorphia, metabolic risks, and food insecurity, often driven by stigma, minority stress, and structural inequities. This narrative review aimed to synthesize current evidence on nutrition-related disparities among LGBT+ populations and identify opportunities for dietitians to advance equity in care. A comprehensive search of PubMed, Scopus, and Web of Science was conducted for studies addressing diet quality, obesity, eating disorders, food insecurity, and metabolic health in sexual and gender minorities. Evidence indicates clear subgroup differences: lesbian and bisexual women are more likely to experience obesity and food insecurity; gay and bisexual men report lower BMI but greater body image concerns and disordered eating; transgender individuals face nutritional challenges linked to gender-affirming therapy and high rates of food insecurity; and people living with HIV encounter additional metabolic risks associated with treatment. Despite these findings, LGBT+ health remains rarely reflected in dietary guidelines or professional training. Embedding inclusivity into dietetic education and clinical encounters, adopting culturally competent and structurally aware practices, and tailoring interventions to subgroup-specific needs are key priorities. Inclusive, equity-driven, and person-centered nutrition care is essential to closing health gaps for LGBT+ populations and ensuring that every patient receives guidance that affirms their identity and lived experience. Full article

Black gay and bisexual older men face numerous barriers across the life course that can contribute to negative health and well-being as they age. Drawing on strengths-based social determinants discussed in the health literature and literature on intersectionality, justice, and critical consciousness, this study examines qualitative data from seventeen Black gay and bisexual older men about sources and strategies of resilience and thriving amidst intersecting systems of power and oppression that shape health inequities. The findings revealed an evolution of positive support networks across their life courses, including biological family and families of choice such as “houses” and support groups. Early and ongoing negative experiences relating to intersecting positionalities (e.g., race, gender, sexual orientation) also provided sources of strength and resilience. Participants identified three strategies for building resilience and thriving: naming external ignorance, acknowledging common struggles, and reconciling contradictions. These strategies reflected various levels of critical consciousness that helped them navigate complex and intersecting systems of power that they encountered as Black gay men across the life course. Overall, the findings underscore the importance of considering intersecting systems of power and critical consciousness when examining resilience and social determinants of health and contribute new insights on a vastly understudied population. Full article

Background: Chemsex is a subtype of sexualized drug use which is increasingly more prevalent amongst gay, bisexual, and other men who have sex with men (MSM). This use of psychoactive substances in sexual contexts poses an emerging public health concern, since it has been associated with an array of health risks, including mental health risks. Objective: As Chemsex appears to be increasing in the UK, this study aimed to explore Chemsex patterns and mental health amongst Chemsex users in the UK. Methods: Chemsex/drug use patterns and the prevalence of coexisting depression and anxiety, based on the Hospital Anxiety and Depression Scale (HADS), were assessed in an MSM sample via an anonymous online survey between December 2023 and February 2024. Results: A total of 141 UK adults participated in the survey (age range: 26–41 years). High overall use of the three common Chemsex-related substances was reported, including γ-hydroxybutyrate/γ-butyrolactone (GHB/GBL) (77.3%), synthetic cathinones (64.5%), and methamphetamine (47.5%). Injecting (“slamming”) was less prevalent (17.0%), although this practice was the most common amongst weekly Chemsex users (54.2%). Based on provided HADS responses, a high incidence of anxiety (49.9%) was reported among the study population, with the highest (abnormal) anxiety scores observed among weekly Chemsex users (44.4%). The incidence of depression was lower overall (27.0%), whilst the highest (abnormal) scores were also observed in weekly Chemsex users (61.5%). Conclusions: As relevant UK data remain limited, this study offers novel insight into Chemsex patterns and mental health challenges among MSM in the UK, suggesting unmet needs for targeted interventions on mental health issues among this population. Further large-scale and prospective studies are necessary to explore the nuanced interplay between the frequency of Chemsex use and its impact on mental health. Full article

Background: Since 2020, there has been a significant increase in sexually transmitted infections (STIs), especially in young people, and these include syphilis, gonorrhea, chlamydia, and lymphogranuloma venereum, which are often asymptomatic but with the potential for transmission. In addition, certain risk behaviors, such as the use of dating apps, pornography, and substance use, reduce adherence to barrier methods, especially in men, thus facilitating the spread of these infections. Methods: This observational, cross-sectional study aimed to explore the relationship between the use of dating apps, drug and pornographic material consumption, and STI history in university students of the health sciences. Results: The sample consisted of 730 participants. The results indicated that individuals who identified as gay, lesbian, or bisexual reported significantly higher rates of dating app use, drug use, and pornography consumption compared to those who identified as heterosexual. Also, these groups showed lower adherence to contraceptive and protective methods. A statistical analysis revealed a relationship between the use of dating apps and increased sexual risk behaviors, suggesting that the accessibility of these platforms could influence the frequency and type of sexual contact. Conclusions: The increase in the prevalence of STIs in recent years has highlighted the urgency of strengthening prevention and sexual health promotion strategies, especially in young and high-risk populations. This study emphasizes the need for early and targeted interventions in high-risk groups to reduce the incidence of STIs and promote responsible sexual health practices. Full article

Attitudes toward sexual and gender minority people is a generative field of study leading to theoretical and practical advances. Adding to this body of literature, we sought to investigate relationships between attitudes toward different sexual orientation and gender identity (SOGI) minority groups. University student participants (N = 495) were asked to rate 11 targets using a 101-point feeling thermometer scale. The targets included trans, bisexual, asexual, and polyamorous men and women, along with lesbians, gay men, and gender non-conforming persons. Heterosexual men and women targets were included for comparison. Analyses addressed two main question areas: (1) Were the various SOGI minority targets rated similarly/differently? (2) Do ratings of the targets differ as a function of target and participant demographic characteristics? Generally, SOGI ratings were favourable (78–85%) except for polyamorous targets (66%). While there were some statistically significant rating differences between some SOGI targets (e.g., lesbians were rated more favourably than asexual women; 85% versus 83%, respectively), data reduction analyses (i.e., Principal Components Analysis) with the 11 SOGI target ratings supported the possibility of aggregating attitudes into a single SOGI target group variable. The second research goal involved exploring whether ratings differed as a function of participant characteristics, including sexual orientation, gender, and religiosity. The analysis revealed that attitudes significantly differed based on all three participant factors. In general, those who rated the targets most favourably were those who were queer, women, or not-at-all religious. However, the SOGI target gender did not result in differences in target ratings (e.g., asexual women and asexual men were equal). The findings further the literature on attitudes toward various SOGI minorities, providing support for the theory that there is a latent factor underlying perceiver attitudes toward SOGI minorities and indicating a need to consider demographic characteristics of social perceivers. Full article

High-risk Human Papillomavirus (HPV) is a sexually transmissible virus that causes cancer. Vaccination against HPV is available up to age 45. Gay and bisexual men (GBM) are at high risk for oropharyngeal and anal cancers caused by HPV. As part of a larger study of HPV prevention in GBM, we obtained anal swabs for HPV and offered HPV vaccination to GBM in Dar es Salaam, Tanzania. Participants were recruited by an outreach worker experienced with the GBM subculture using Respondent-Driven Sampling (RDS) from seeds. Eighty-three of a possible one hundred participants (mean age 26) were enrolled, tested, and given a first vaccination dose. Anal swabs were tested for twenty-eight HPV genotypes, both high and low risk for carcinogenicity, and a median of seven different HPV genotypes was found in participants. A total of 87% of participants carried at least one HPV genotype, and 76% carried at least one high-risk genotype. As a result of harassment and unanticipated risk to participants and staff at the unmarked community-based site, this study was terminated before the sample size was reached. Since a full course of vaccine was the standard of care, participants were contacted using the contact method they had provided to arrange follow-up vaccination doses at an alternative clinical site. Twenty-nine percent received the additional vaccination. A further 6% made appointments but did not attend, and another 10% would have received the second vaccination if they were incentivized to attend. The rate of HPV in anal samples was significantly higher than in our study using the same recruitment method in the same city in 2011–2012. The HIV rate was 45%. Anal HPV rates, including high-risk HPV rates, were significantly higher than in a similar population of gay and bisexual men 12 years ago. It is possible to provide HPV vaccination to gay and bisexual men in Tanzania and have approximately 45% potentially re-attend for a second dose if they are incentivized. Great care must be used to situate vaccination to avoid stigma leading to harassment, especially where homosexuality is criminalized. We infer that the high-risk harassment faced by participants and lack of incentive for the second visit depressed the return rate for revaccination. Full article

Background: Most research on ‘Chemsex’ has been conducted with gay, bi-sexual, and men who have sex with men (GBMSM) in large cities with well-established infrastructures. Therefore, this study aimed to explore the ‘Chemsex’ risks and responsibilities of GBMSM who lived outside of the queer metropolis. This study also aimed to understand how stigma and mental health present in the absence of a well-established community infrastructure. Methods: This study utilized mixed methods in Leicester, Leicestershire, and Rutland, a location in the East Midlands of England. The quantitative component consisted of a survey. The qualitative component comprised three case studies based on in-depth interviews, using interpretative phenomenological analysis. Results: Of the 123 survey respondents, 86% engaged in riskier sex during sessions and 35% no longer enjoyed sober sex. In the interviews, the three men balanced risk management and personal responsibility, positioning themselves as mature, considerate, and well-educated users. All were alienated by the term ‘Chemsex’. The findings are considered using theoretical frameworks, or how discourses of ‘moral threat’ operate within the micro-politics of regulating GBMSM’s pleasure and stigma. Conclusions: The complexities of understanding this practice for researchers and practitioners are discussed and recommendations are made for reframing education and support services for GBMSM. Full article

In recent years, there has been an increase in the practice of chemsex, which is becoming an increasingly serious public health problem. The complex interaction between chemsex and mental health underscores the need to understand the psychological, social, and environmental factors that influence this practice. Methods: A qualitative descriptive phenomenological study was conducted in the community of Madrid, Spain to explore the depth of the chemsex phenomenon through a thematic analysis. Between April and June 2024, interviews were conducted with 15 MSM (gay, bisexual, and other men who have sex with men) who participate in these practices, using purposive and snowball sampling. Results: three main themes were identified, namely, (T1) contextualization of the practice, (T2) factors associated with chemsex, and (T3) strategies and interventions for risk and harm reduction. Conclusion: Chemsex is a phenomenon that combines sexual practices with substance use in complex social environments, presenting significant risks to physical, mental, and sexual health. It is necessary to implement public health interventions to mitigate these risks. Full article

Background: Chemsex has been defined as the deliberate use of drugs for prolonged sexual intercourse between gay and bisexual men and other men who have sex with men (MSM). Drugs associated with chemsex can trigger mental health problems such as anxiety, depression, risk of psychosis and suicidal ideation, social isolation, stigmatization, and even loss of impulse control and lack of coping strategies. Currently, the increase in illicit drugs in a sexual context is considered an outbreak of a public health emergency. Objective: The aim of this study is the construction and validation of the Chem-Sex Inventory (CSI), a new scale to assess the mental health risk of chemsex behaviors. Methods: A cross-sectional design was conducted to study 563 participants. Data were collected through an online questionnaire between January and April 2023, and the construct validity of the CSI was assessed through exploratory and confirmatory factor analysis. Results: The sample was, on average, 36 years old (SD: ±9.2). The majority of gender identity was cisgender (97.7%). A factor structure was found that can be summarized in four dimensions: emotional instability, risk of psychosis, altered body perception, and risk of suicide. The confirmatory factor analysis (CFA) presents adequate reliability values, with a Cronbach’s alpha above 0.87 for all dimensions and a McDonald’s omega above 0.88 with a good fit of the 42 items. Conclusions: Our study has shown that the Chem-Sex Inventory (CSI) scale has factorial validity and could be used in clinical practice and research to measure the behavioral contribution of the chemsex phenomenon in MSM. Full article

There is a lack of research regarding dietary supplement (DS) use among Gay, Bisexual, Transgender, Two-Spirit, Queer (GBT2Q) men and non-binary individuals, despite the higher prevalence of body image issues and societal pressure within this community. This study aimed to investigate patterns and predictors of DS use in this population, including types of DS used, sources of information, and reasons for DS use. A validated and anonymous online questionnaire was completed by 204 participants (52.5% men, 43.1% gay, mean age 29.34 + 6.77 years) across Canada, who were consuming DS at the time of the study. Analyses included descriptive statistics to characterize the sample based on gender, sexuality, age, ethnicity, and other demographic attributes, using Pearson’s chi-square tests and multi-way cross-tabulation analyses. Additionally, regression analyses, including binary and logistic regressions, were employed to identify predictors of DS use. Data analysis concluded that vitamins/minerals (92.2%), proteins (84.3%) and carbohydrates (75.5%) were the most consumed types of supplements. Identifying as certain genders and sexualities was significantly associated with supplement preferences, such that men reported higher use of amino acids (p = 0.033) and non-vitamins/mineral antioxidants compared to individuals identifying as other genders (p = 0.006). Moreover, bisexual participants consumed amino acids (p = 0.043) and carbohydrates (p = 0.026) more frequently when compared to non-bisexual participants. The most listed reason for DS use was to improve immunity (60.3%), with health care professionals being listed as the source of information by most participants (51.0%). Findings from this study can serve as a foundation for further research in this area and can guide the formulation and implementation of adequate policies targeting this underserved population. Full article

Epidemiologic studies have established that mpox (formerly known as monkeypox) outbreaks worldwide in 2022–2023, due to Clade IIb mpox virus (MPXV), disproportionately affected gay, bisexual, and other men who have sex with men. More than 35% and 40% of the mpox cases suffer from co-infection with HIV and sexually transmitted infections (STIs) (e.g., Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, and herpes simplex virus), respectively. Bacterial superinfection can also occur. Co-infection of MPXV and other infectious agents may enhance disease severity, deteriorate outcomes, elongate the recovery process, and potentially contribute to the morbidity and mortality of the ensuing diseases. However, the interplays between MPXV and HIV, bacteria, other STI pathogens and host cells are poorly studied. There are many open questions regarding the impact of co-infections with HIV, STIs, or bacterial superinfections on the diagnosis and treatment of MPXV infections, including clinical and laboratory-confirmed mpox diagnosis, suboptimal treatment effectiveness, and induction of antiviral drug resistance. In this review article, we will discuss the progress and knowledge gaps in MPXV biology, antiviral therapy, pathogenesis of human MPXV and its co-infection with HIV, STIs, or bacterial superinfections, and the impact of the co-infections on the diagnosis and treatment of mpox disease. This review not only sheds light on the MPXV infection and co-infection of other etiologies but also calls for more research on MPXV life cycles and the molecular mechanisms of pathogenesis of co-infection of MPXV and other infectious agents, as well as research and development of a novel multiplex molecular testing panel for the detection of MPXV and other STI co-infections. Full article

Although several studies have found disparities in health outcomes between heterosexual and lesbian, gay, and bisexual (LGB)-identifying individuals, few studies have focused on subjective well-being and protective factors for health and well-being. The purpose of this work is twofold: (1) to examine the relevance of sexual orientation to health and well-being in women and men; (2) to identify protective and risk factors for psychological distress, self-rated health, and well-being for gay men, lesbian women, bisexual women and men, and heterosexual women and men. The sample consisted of 908 women and 586 men from the general Spanish population aged 16–64, half of whom identified themselves as LGB and half as heterosexual. All were assessed using eight questionnaires and inventories. The results showed that differences varied depending on the health indicator considered. In general, bisexuals had the poorest health, with lower self-rated health and lower self-esteem. In all groups, self-esteem was a protective factor against psychological distress and was associated with better health and well-being. To a lesser extent, social support served as a protective factor against psychological distress and was associated with greater well-being in all groups. It is concluded that although sexual orientation is relevant to the health and well-being of individuals, there are differences among sexual minorities, with bisexuals having lower self-esteem than homosexuals. Full article