Search Results (90)

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

Oropharyngeal cancers (OPCa) caused by HPV have emerged as one of the leading causes of malignancies caused by HPV infection. They are also significantly more likely to occur in males and in people with a history of oral sex with multiple partners. Gay and bisexual men are disproportionately affected by HPV-positive oropharyngeal cancers. We studied 1699 gay and bisexual men on 2 major dating sites in the US to assess their knowledge about HPV-related OPCa, attitudes toward screening for it, beliefs about oropharyngeal cancer screening based on the Health Belief Model, and attitudes toward possible screening approaches for OPCa. Knowledge on a 12-item scale was low, with a median of 5 items correct: 72% knew of the benefits of HPV vaccination. Significant predictors of needing OPCa screening included perception of risk for OPCa, seeing it as severe, having lower barriers, fewer reasons to avoid screening, higher knowledge, and being HPV vaccinated were significant predictors, explaining half the total variance. Most participants would accept routine, virtual/online doctor or dental appointments, and over half would accept an in-person screening. Nearly two-thirds stated that they would accept getting checked for OPCa if they could do self-screening at home, and half were prepared to use an online screening tool or app, where they could take an “oral selfie” and send it to a healthcare provider for examination. One-third stated that they would trust the results of a home screening completed by themselves and posted to a website equally as cancer screening completed online by a healthcare provider. Data indicate that despite low OPCA knowledge levels, the risk of HPV-associated OPCa was known. Being at personal risk and having knowledge of disease severity had 70% of the sample thinking about, or preparing to get, screening. Self-screening by a smartphone “oral selfie” transmitted to a screening website was acceptable to many gay and bisexual men, and online screening by a doctor or dentist was acceptable to most. OPCa screening in this population using electronic technology, together with the increasing incidence of HPV-associated OPCa in gay and bisexual men, brings together an opportunity to detect OPCa early. Full article

Background: Sexualized drug use (SDU) has become a public health concern in recent years. This study aimed to estimate the prevalence of SDU in gay, bisexual, and other men who have sex with men living with HIV (HIV + GBMSM) in Madrid during 2019/2020 and compare it with data from 2016/2017 in order to detect changes in patterns. Methods: We analyzed the frequency of SDU in a sample of HIV + GBMSM attending HIV clinics, who participated in an anonymous online survey regarding sexual behavior and recreational drug use. The association between SDU, sexual risk behaviors, and STIs was evaluated. Results: This study included 424 HIV + GBMSM, with a mean age of 40 (10.43) years. Overall, 94% (396) reported being sexually active. Additionally, 33% (140) had been diagnosed with an STI within the previous year. Moreover, 54% (229) had used drugs in the last year, 25% (107) engaged in SDU, and 16% (17) reported engagement in slamsex. After adjusting for confounding factors, SDU was associated with STIs, fisting, unprotected anal intercourse, and having >24 sexual partners in the last year. According to the DUDIT test scores, 80% (81) probably had problematic drug use (≥6 points), and 8% (8) probable drug dependence (≥25 points). When comparing the U-SEX-1 (2016/2017) data with the U-SEX-2 (2019/2020) data, no significant differences were found in the proportion of participants practicing SDU or slamming. Conclusions: The prevalence of SDU among HIV + GBMSM has remained high in recent years and without significant changes. The risk of problematic drug use among those who practice SDU is high. We observed a clear association between SDU, high-risk sexual behaviors, and STIs. Full article

Introduction: Body dissatisfaction is a well-established risk factor for emotional problems and low levels of well-being indicators, such as sexual health. Cognitive models propose that dissatisfaction with one’s body can cause cognitive distraction related to physical appearance during sexual activity. This may compromise sexual response, namely, sexual satisfaction in heterosexual cis women. However, this relationship has only been studied within heterosexual samples. The present study aims to test a mediation model using cognitive distraction related to body appearance during sexual activity as a mediator between body dissatisfaction and sexual satisfaction in LGB+ cis people (lesbian, gay, bisexual, and other minority sexual orientations). Methods: This cross-sectional online study comprised 165 cisgender LGB+ participants (n = 67 cis women, 40.6%; n = 98 cis men, 59.4%). Self-report questionnaires were used: the Global Body Dissatisfaction Scale, the Body Appearance Distraction Scale, and a Single-Item Measure of Sexual Satisfaction. Results: Cis women and cis men experience similar levels of body dissatisfaction, cognitive distraction with body appearance during sexual activity, and sexual satisfaction. Body appearance cognitive distraction during sexual activity mediated the relationship between body dissatisfaction and sexual satisfaction only in the men’s sample. Discussion: Overall, in terms of gender and body dissatisfaction, our results reveal a reversed pattern than those found in heterosexual samples. This may be because LGB+ cis women may conform less to societal pressure, leading to less meaning given to body dissatisfaction in relation to sexuality, which may lead to more positive sexual outcomes. Likewise, LGB+ cis men present higher body dissatisfaction and experience lower sexual satisfaction, possibly due to the emphasis on physical appearance in the gay subculture. The results confirm the validity of cognitive models of sexual response. Full article

Chemsex is understood as “the intentional use of stimulant drugs to have sex for an extended time among gay, bisexual, and other men who have sex with men”. It is a public health problem because of the increased incidence of cases and because of the consequences on the physical and mental health of those who practice it. Aim: This study aimed to analyze, with the help of the Delphi method, the content validity of a new instrument to assess the risk of behaviors associated with the chemsex phenomenon. Method: First, a bank of items identified from the literature was elaborated. Secondly, 50 experts with knowledge of the chemsex phenomenon at the national level were contacted. A Delphi group was formed with them to carry out two rounds of item evaluation. The linguistic evaluation (comprehension and appropriateness) was assessed using a Likert scale from 1 to 5 for each item. Items that did not reach a mean score of 4 were eliminated. Content assessment was calculated using each item’s content validity index (CVI) and Aiken’s V (VdA). A minimum CVI and VdA value of 0.6 was established to include the items in the questionnaire. Results: A total of 114 items were identified in the literature. In the first round of Delphi evaluation, 36 experts evaluated the items. A total of 58 items were eliminated for obtaining a CVI or VdA of less than 0.6, leaving 56 items. In a second Delphi round, 30 experts re-evaluated the 56 selected items, where 4 items were eliminated for being similar, and 10 items were also eliminated for not being relevant to the topic even though they had values higher than 0.6, leaving the scale finally composed of 52 items. Conclusion: A questionnaire has been designed to assess the risk of behaviors associated with the chemsex phenomenon. The items that make up the questionnaire have shown adequate content and linguistic validity. The Delphi method proved to be a helpful technique for the proposed objective. Full article