Search Results (485)

Background/Objectives: This study presents a comprehensive and updated epidemiological and public health assessment of human immunodeficiency virus (HIV) in Romania during 2022–2024, situated within the wider European context. Methods: For this retrospective descriptive study, we analyzed national surveillance data from the National Institute of Infectious Diseases “Prof. Dr. Matei Balș” and European Centre for Disease Prevention and Control (ECDC) reports, between 1985–2024, focusing especially on 2022–2024 period. Key indicators included incidence, mortality, transmission routes, age and gender distribution, and treatment coverage. Comparative analyses were performed between Romania and European Union (EU)/Eastern Europe data. Results: Between 1985 and 2024, Romania registered a cumulative total of 28,793 HIV cases, with 18,768 individuals living with HIV (PLHIV) as of 2024. In that year, 810 new HIV cases were diagnoses, indicating a modest uptick compared with 2022–2023. Heterosexual transmission continued to predominate (59.4%), followed by cases among men who have sex with men (MSM) (30.5%) and intravenous drug users (IDUs) (5.2%). Men represented more than three-quarters of all new infections. Mortality displayed considerable year-to-year variability, increasing from 125 HIV-related deaths in 2023 to 193 in 2024. Despite this, treatment coverage improved steadily, with 16,464 individuals receiving antiretroviral therapy (ART) by the end of 2024. At 2.51 cases per 100,000 population, Romania’s incidence remained below the European average of 3.5 per 100,000. Nonetheless, the proportion of infections attributable to MSM transmission rose sharply—from 3.91% in 2007 to 32% in 2024—bringing Romania’s epidemiological profile increasingly in line with broader trends observed in Eastern Europe. Conclusions: These findings suggest that although Romania maintains a comparatively lower HIV incidence than the European average, the evolving transmission dynamics—most notably the substantial increase in MSM-related cases—signal a shifting epidemiological landscape that warrants strengthened, population-specific prevention measures and continued investment in comprehensive treatment and monitoring frameworks. Full article

Sexual and gender minority (SGM) people report considerable dissatisfaction with health services compared to heterosexual and/or cisgender people, with health professionals highlighting insufficient training. Teaching about the health of SGM people is not mandated in UK health professionals’ educational curricula. A review of published and unpublished surveys and of UK training courses evaluating LGBTQ+ content, in the UK and Ireland, examining the teaching of the health of SGM people to health professionals was conducted. Fifteen surveys from the perspectives of educators and students were compared and contrasted. Surveys were found from educators from undergraduate medicine, nursing and midwifery, and pharmacy schools, from students at dental, medical, and pharmacy schools, and from qualified doctors and paramedics. Students and clinical staff perceived that they have insufficient training in SGM health, although there is a contradiction in the perception of teaching amount between students and educational staff. Two curriculum reviews of Royal College postgraduate medical training showed either no or very few requirements on SGM health. Although some courses make considerable efforts to fully incorporate SGM health into mandatory curricula appropriately, professionals mention insufficient training. Until curriculum setters mandate SGM health, patient complaints will continue. Full article

The objectives of our study were to determine the mortality rates, causes, and risk factors of people living with HIV in the modern antiretroviral therapy era, in a major HIV center in Israel. We retrospectively collected data from 1547 patients treated during 2001–2021. We used the Shapiro–Wilk test, Fisher’s exact test, Student’s t test, and chi-square to compare between patients who died and those who did not, and between patients who died from AIDS-related and non-AIDS-related causes. In total, 206 (13.3%) patients died. The causes of death were AIDS-defining diseases (33.5%), cardiovascular diseases (21.8%), non-AIDS infections (16%), and hepatic disorders (7%). The annual mortality rate was 1.31 ± 0.3%. Despite an increase in age (35 ± 13.2 in 2001, 49 ± 13.6 years in 2021; p < 0.001), the mortality rate decreased (2.12% during 2005–2008, 0.71% during 2018–2021; p = 0.0001). AIDS-defining diseases caused 75% of deaths during 2001–2002, and only 25% during 2019–2021. The proportion of cardiovascular deaths increased (8.3% in 2001–2003, 33.3% in 2019–2021; p < 0.001). Low CD4 and high viral load at diagnosis, male gender, non-MSM HIV acquisition (heterosexual transmission and people who inject drugs), and inability to achieve viral suppression because of non-compliance were risk factors for mortality. Mortality rates decreased during 2001–2021; however, the proportion of non-AIDS deaths increased. Early cardiovascular comorbidity screening and targeted adherence interventions in non-MSM populations and in patients with low CD4 are needed. Full article

Background: Bullying in university settings is a significant yet understudied contributor to psychological distress. Differentiating the sources of victimization, may reveal distinct risk profiles associated with mental health and substance use outcomes. Objective: To evaluate the frequency and risk factors associated with bullying victimization among medical students, and to identify associations with mental disorders and substance use. Methods: A nested case–control cohort study was conducted with 124 medical students. Participants completed nine validated psychometric instruments evaluating neurobehavioral traits, emotional distress, substance use, and scholar bullying. Bivariate and multivariate regression models were used to estimate coefficients and odds ratios for key outcomes. Results: 42.7% of the students reported victimization, with teacher harassment (37.1%) more frequent than peer harassment (27.4%); 22.6% experienced both. Teacher harassment was primarily characterized by intentional harm (78%); peer harassment involved abuse of authority (63%). ADHD, severe stress, and substance use were associated with teacher-related victimization, while peer victimization was linked to ADHD, stress, impulsivity, and suicide risk. Childhood abuse, high stress levels, and non-heterosexual orientation as predictors of teacher harassment (p < 0.05). Notably, students with a non-heterosexual orientation were over six times more likely to report teacher harassment, highlighting the disproportionate vulnerability of sexual minorities within academic power dynamics. Conclusions: Teacher- and peer-related harassment are prevalent and often co-occur, with teacher-perpetrated bullying emerging as both more frequent and more strongly associated with mental health and identity-based vulnerabilities. Students with ADHD, high stress levels, and non-heterosexual orientation are at significantly greater risk. These findings emphasize the need for institutional accountability, inclusive academic policies, and targeted mental health support to protect vulnerable students and prevent harm within educational environments. Full article

Background: Sexualized substance use (SSU) describes the use of psychotropic substances in the context of sexual activity. Less is known about the role of sexualized substance use among individuals with substance use disorders (SUD) and its effect on the course of the disorder, e.g., regarding relapses after abstinence. Methods: A convenience sample of individuals undergoing SUD rehabilitation in Germany was surveyed. A questionnaire asked about SSU, sex as a risk factor for relapse, and the importance of sexuality in treatment. Results: N = 490 (30.1% female) participated; 55% of men and 63% of women reported SSU, and 56.5% of heterosexual and 82.9% of homosexual men reported SSU (p < 0.017; r = 0.20). Stimulant users are more likely to report SSU than alcohol (p < 0.001) and sedative users (p < 0.001; r = 0.296 and r = 0.261). Furthermore, 15% of women and 18% of men consider sexual activity a risk factor for relapse; homosexual men (65%) consider it significantly more often than heterosexual men (14%), while 41.2% of heterosexual women and 55% of homosexual women consider it a factor. Additionally, 27.4% of heterosexual and 69.4% identified sexuality as an important topic for therapy, while 19.8% of heterosexual women, 30% of homosexual women, 13.5% of heterosexual men, and 47.2% of homosexual men reported that sexuality had been addressed in their therapy. Conclusions: SSU was reported by individuals with a SUD who were undergoing rehabilitation treatment. Furthermore, patients consider sexual activity as a potential risk factor for relapse, with this being particularly the case for stimulant users. The topic of sexuality is highly important for patients and should, therefore, be given greater consideration in therapy in the future. Full article

Background: Human papillomavirus (HPV) is the leading cause of sexually transmitted infections (STIs). It is found in extragenital regions, including the oropharyngeal cavity. Its presence in this area is linked to the increased prevalence of oral and pharyngeal cancer cases in young individuals, which is associated with current sexual practices in the young population. Objective, the objective of this study was to estimate the prevalence of HPV infection in the oropharyngeal cavity and identify associated factors within the student community of the Engineering and Chemical Sciences Unit of the University of Veracruz. Methods: an observational, descriptive, and transversal study was conducted. The study included 136 sexually active students aged 18 to 25 without oropharyngeal infection. After obtaining informed consent from all participants, mouthwashes were collected from the oropharyngeal cavity for subsequent detection of viral DNA and HPV genotyping using the PCR-RFLP technique. Risk factors were further assessed through a private questionnaire. For statistical analysis, a bivariate analysis of the main risk factors was performed, and Odds Ratios (OR) and 95% Confidence Intervals (CI) were calculated. Results: The results showed that HPV was detected in 6 participants, resulting in a prevalence of 4.4% (95% CI, 0.92–7.91), with genotypes 11, 52 and 58 identified. Notably, participants with a sexual orientation other than heterosexual had a 7.5-fold higher association with HPV. Conclusions: these findings indicate that low- and high-risk HPV infection in the oropharyngeal cavity is associated with risky sexual behavior in young individuals. Therefore, understanding the specifics of sexual activities is necessary to better comprehend viral transmission and spread among HPV-positive students. Full article

Introduction: Women and LGBTQ+ undergraduates face higher rates of sexual assault and rape compared to cisgender male peers—the overwhelming majority of perpetrators. Federal policies have aimed to curb campus sexual violence, yet questions remain about the efficacy of consent education, particularly among cisgender heterosexual men. Methods: This study surveyed 1567 undergraduate students at a large Northeastern public university in 2017 and 2022. Responses to a nine-item consent scale were analyzed by gender, sexuality, and demographic factors. Results: Cisgender heterosexual (cis-het) men had poorer understanding of consent compared to women and LGBTQ+ students, both in 2017 and 2022. Cis-het men’s consent scores showed no improvement, and for some items worsened from 2017 to 2022, while other groups showed significant improvements in recognizing the nuances of consent. Conclusions: Findings suggest that, despite increased focus on sexual assault prevention and social awareness campaigns like #MeToo, cisgender heterosexual men’s understanding of consent has not improved, highlighting the persistent challenge in shifting deeply ingrained beliefs about consent. Educational efforts should address these beliefs more directly, focusing on transforming societal norms around masculinity and sexual entitlement. Policy Implications: These results underscore the need for more comprehensive, gender-transformative education on consent. Current programs primarily focus on victims rather than perpetrators, which fails to address the root causes of sexual violence. To reduce sexual assault, consent education, delivered K-12 and in higher education, must consistently challenge harmful gender norms and promote equitable relationships. More targeted strategies are necessary to engage cisgender heterosexual men in these discussions. Full article

The increasing proportion of HIV-1 infections transmitted via non-marital non-commercial heterosexual contact (NMNCHC) in China necessitates a deeper understanding of its local characteristics. This study investigated the epidemiological, molecular network, and drug-resistant profiles among 400 newly diagnosed HIV-1 patients infected via non-marital heterosexual contact (NMHC), specifically its non-commercial subtype, in Lishui from 2020–2024. HIV-1 pol gene sequences were analyzed for subtypes, drug resistance mutations, and transmission clusters using phylogenetic and network methods (genetic distance threshold: 0.9%). The overall prevalence of transmitted drug resistance (TDR) was 13.3%, an intermediate level exceeding the national average, driven predominantly by NNRTI resistance (6.3%). High-level resistance to NVP (3.0%) and EFV (2.75%) was observed. CRF08_BC (43.8%) was the dominant subtype. Multivariate analysis identified female gender and higher education as significant risk factors for NMNCHC acquisition. Molecular network analysis incorporated 55.3% of cases, revealing clusters predominantly composed of middle-aged and elderly males, with CRF08_BC and CRF01_AE showing higher NMNCHC transmission risk within networks. These findings underscore an evolving epidemic with significant TDR and highlight the urgent need for targeted interventions, including enhanced resistance surveillance and focused strategies for the concealed NMNCHC population, to curb local HIV-1 transmission. Full article

Romantic relationship satisfaction is widely recognized as a foundational contributor to both psychological and physical well-being. However, research on its association with other key constructs, such as body appreciation, sexual esteem and sexual assertiveness, is still lacking, especially in reference to romantic relationships. The present study investigates the interplay between body appreciation, sexual esteem, and sexual assertiveness, and their combined influence on relationship satisfaction in individuals in heterosexual relationships in Italy. Participants were 473 adults (50.1% men, 49.7% women, 0.2% other; age range 18–49). Structural equation modeling revealed that while body appreciation was indirectly associated with sexual assertiveness, it significantly predicted sexual esteem. Sexual assertiveness, but not sexual esteem, was positively associated with relationship satisfaction. No significant gender differences were found in the structural relationships among the variables. These findings underscore a process through which sexual assertiveness and body appreciation can enhance relational well-being and inform educational programs aimed at promoting healthy romantic relationships. Full article

The ‘Parents as Partners’ (PasP) coparenting programme was delivered to heterosexual parents of infants they described as showing a highly reactive temperament (HRT) following the completion of the Infant Behaviour Questionnaire–Revised (IBQ-R) during a standard post-natal visit in their local Health Centre Well Baby Clinic in Malta. Fifty-two participating Maltese couples, all coparenting a highly reactive infant of 8 to 12 months, were randomly assigned into an experimental (n = 30 couples) or control group (n = 25). The IBQ-R, Coparenting Relationship Scale (CRS), and Parental Stress Index (PSI-4 SF) at pre- and post-intervention periods were filled out by randomised participants. Intervention group couples followed the 16-week PasP programme. All randomised couples were followed by a case manager monthly. Post-intervention results compared with controls showed reduced couple conflict occurring in front of the child, reduced parent–child dysfunctional interaction, and a reduction in negative child reactivity. Implications point to the importance of including fathers and reducing coparenting conflict in interventions designed to reduce behavioural difficulties in infants and young children. Full article

Sex workers were disproportionately affected by the COVID-19 pandemic due to precarious working conditions. This cross-sectional study was conducted in 2022 among 264 sex workers in Chiang Mai, Thailand, during the transition to the endemic phase, to evaluate their COVID-19 knowledge and preventive practices. Face-to-face interviews were used. Descriptive statistics were used to describe sample characteristics. Factors associated with knowledge and preventive practices were identified using the Mann–Whitney U test or Kruskal–Wallis test as appropriate. Independent factors associated with preventive practices were assessed through linear regression. The median scores for knowledge and preventive practices were 10 (interquartile range (IQR) = 9–10) and 5 (IQR = 3–5), respectively. In univariate analysis, females scored higher in knowledge than males. For preventive practices, females vs. males, older vs. younger, heterosexual vs. homosexual/bisexual, longer vs. shorter career, worked in massage parlors vs. pubs/bars, and having child vs. none showed higher rates. In multivariate analysis, being male (β = −1.87; 95%CI; −0.87 to −0.88) and single (β = −1.15; 95%CI; −2.28 to −0.02) were independent predictors of lower rates of preventive practices. Despite having good knowledge, certain groups of sex workers’ COVID-19 preventive behaviors remain inadequate, emphasizing the need for targeted interventions to enhance pandemic preparedness. Full article

Background/Objectives: Despite progress in recognizing sexual diversity, homophobic bullying persists. This study had four objectives: (1) to identify the prevalence of homophobic bullying (victims, perpetrators, and bystanders); (2) to explore whether differences exist between victims and perpetrators as a function of sexual orientation with respect to emotional factors and psychopathological symptoms; (3) to analyze whether victims and perpetrators of homophobic bullying have sought psychological assistance significantly more often; and (4) to identify predictive variables of victimization and perpetration of homophobic bullying. Methods: The sample comprised 1558 Bolivian students aged 13 to 17 years (M = 14.64; SD = 0.96), who completed six standardized assessment instruments. Results: (1) A substantial percentage of students reported homophobic bullying behaviors. Victims: 76.6% reported experiencing homophobic behaviors, with significantly higher rates among non-heterosexual students (χ² = 7.40, p < 0.01) and no gender differences (χ² = 0.013, p > 0.05). Perpetrators: 11.8% admitted engaging in homophobic aggressive behaviors, with no differences by sexual orientation (χ² = 0.306, p > 0.05) but significantly higher rates among males (χ² = 8.49, p < 0.01). Bystanders: 51.9% reported witnessing homophobic behaviors, with significantly higher prevalence among non-heterosexual students (χ² = 7.03, p < 0.01) and females (χ² = 4.98, p < 0.05). (2) Analyses of variance showed that non-heterosexual victims scored significantly lower on emotional regulation, empathic joy, overall empathy, and happiness, and significantly higher on fear of negative social evaluation, overall social anxiety, all psychopathological symptom dimensions assessed (somatization, obsession–compulsion, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism), and the global severity index. Non-heterosexual perpetrators also displayed significantly higher scores on several psychopathological symptoms (depression, anxiety, hostility, paranoid ideation, psychoticism) and on the global severity index. Effect sizes were moderate for psychopathological symptoms and small for emotional variables. (3) Victims (OR = 1.392, 95% CI [1.04, 1.86], p = 0.024) and perpetrators (OR = 1.507, 95% CI [1.07, 2.10], p = 0.017) of homophobic bullying reported significantly higher rates of seeking psychological assistance in the past year compared to those uninvolved in bullying. (4) Hierarchical regression analyses identified significant predictors of victimization (R² = 18.6%): non-heterosexual orientation, male gender, higher somatization, paranoid ideation, fear of negative evaluation, and lower happiness. For perpetration, only being male and higher levels of phobic anxiety emerged as significant predictors in the final model, explaining 5.1% of the variance. Conclusions: The findings underscore the urgency of implementing school-based psychoeducational anti-bullying prevention programs that include activities designed to foster tolerance toward sexual diversity. Full article

Background: This study’s objective was to be the first to explore the ethnicity/cultural origins, gender identity, ability/disability, sexual orientation, socioeconomic background, and harassment/discrimination experiences of Canadian radiation oncologists (ROs). Methods: Following a literature review and input from content experts, an ethics-approved national cross-sectional electronic survey was developed in English and French and electronically distributed to all ROs in Canada (n = 598). Descriptive statistics summarized responses. Comparisons between groups were performed using Chi-square tests, and content analysis was performed on open-ended responses. Results: The survey was completed in full by 42.5% of ROs (254/598). Most respondents were male (62.9%), 35–44 years old (39.2%), and heterosexual (94.3%). 41.2% identified as belonging to a racialized group, which is higher than the overall Canadian population (27%), but Black, Indigenous, and Southeast Asian ROs were underrepresented (1.9% vs. 4%, <1% vs. 5% and 1.6% compared to 4%, respectively). A significant subset analysis showed that only 20% (21/105) of racialized ROs were women, whereas Caucasian women comprised 49.3% (74/150) of Caucasian respondents (p < 0.001). While 75.4% of respondents reported job satisfaction, 42.1% reported experiencing workplace discrimination/harassment within the past 5 years; most commonly, this was perpetrated by fellow faculty (31.7%; 58/183) or patients or their family members (31.7%; 58/183). Respondents felt that gender, race/ethnicity, and age were the three top reasons for discrimination/harassment, with double the amount of racialized ROs reporting harassment compared to White ROs (p < 0.001). Nearly half (45.2%; 114/252) did not understand how to report, or felt uncomfortable reporting, workplace discrimination/harassment. Conclusions: This study highlights high harassment and discrimination rates amongst Canadian ROs, especially amongst racialized women, which may affect career satisfaction and attrition rates. Compared to census data, Black, Indigenous, and Southeast Asian ROs were underrepresented, and amongst racialized ROs, racialized women were significantly underrepresented. These findings underscore the need for targeted diversity initiatives, improved mentorship programs, and stronger institutional policies to address harassment and foster an inclusive work environment. Full article

This study critically examines the civil–religious influence of Korean conservative Protestantism, which mobilizes heteronormative strategies to oppose anti-discrimination and family rights legislation, through the lens of Christian normativity. These movements justify heteronormative values by appealing to the immutability of the “creation order” in Genesis. Yet such literalist interpretations disregard contemporary findings in evolutionary biology and animal behavior that document same-sex phenomena across species, thereby framing creation and evolution in rigid opposition. Imported from American fundamentalism, “creation science” has further fueled an anti-intellectual public sentiment that naturalizes heterosexuality as divine law. The absolutism of the creation order and special revelation exposes deep theological contradictions when confronted with the existence of diverse sexual and gender identities. In response, this study turns to process theology, which reimagines creation as open-ended, dynamic, and co-creative. Engaging Catherine Keller’s apophatic theology to reopen theological space for sexual minorities, it further develops Justin Sabia-Tanis’s interpretation of transgender transformation as a process of co-evolution, in dialogue with Donna Haraway’s notion of cyborg hybridity. Moreover, drawing on John B. Cobb Jr.’s “persuasive political theology,” it argues that participation in divine co-creation must be expanded into the socio-political sphere. Ultimately, this study seeks to resist anti-intellectualism and advocate for a transformative Christian civil religion in Korea—one oriented toward justice, inclusion, and continual co-creation. Full article

Previous research has shown that Two-Spirit Indigenous people may experience more trauma, interracial violence, and violent crimes than youth from other cultural backgrounds. This study aims to examine how identifying as Two-Spirit, an identity that integrates both non-cisgender and non-heterosexual identities, as well as Indigenous identities simultaneously and congruently, may allow one to feel more resilient and empowered. The sample consisted of Indigenous, sexual gender minority emerging adults (N = 91) with ages ranging from 18 to 29 with an average age of 24.78 (SD = 2.35). This sample reported perceived discrimination for being Indigenous, for their gender identity, and for their sexual orientation. The amount of discrimination for each of these categories was not significantly different, but the source was, and the predominant source for all three types was White individuals. The combined effects were related to lower self-esteem; more psychological symptoms of anxiety, depression, and somatization; and greater identity distress and higher scores on disturbed identity and lack of identity. In this study, Two-Spirit identification did not reduce the negative effects of discrimination by connecting with historical memory through this identity, but that does not necessarily mean that it cannot, only that its potential has yet to be fulfilled. Many participants did not have a full understanding of the label and its history. Further research into this idea is another area of study that might be fruitful. Full article