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Interpersonal management of homophobic stigma (e.g., selectively constructing ones social network; confronting stigma) is an understudied area of resilience among sexual minority people. Among a sample of cisgender sexual minority men (SMM; N = 798) in midlife and older adulthood, we assessed the psychometric properties and characterized the sociodemographic differences of our newly developed, theory-informed homophobia management scale. Data come from the Healthy Aging substudy of the Multicenter AIDS Cohort Study, which is a prospective longitudinal study implemented to evaluate the natural trajectories of HIV risk and treatment among sexual minority men. Guided by the proactive coping processes model, the Healthy Aging team proposed eight items to measure homophobia management, which were included at four waves of survey data collection completed at semiannual study visits. Using factor analyses and linear regressions, we assessed our scales construct validity, convergent validity, and internal consistency, and characterized scores by age, race/ethnicity, sexual orientation, and HIV status. Factor analyses yielded a six-item scale with adequate construct validity and acceptable internal consistency (Cronbachs alpha = .69). Our final scale exhibited convergent validity given its statistically significant inverse association with internalized homophobia and positive association with psychological connections to the gay community. Bivariate differences in homophobia management emerged by age, race/ethnicity, and sexual orientation but were not statistically significant in multivariable analyses. Our study provides a validated, unidimensional scale to assess homophobia management among SMM in midlife and older adulthood. We provide recommendations to improve the implementation of our scale in future surveillance.

Sexual minority men (SMM) in the US are twice as likely to experience mental health challenges, including depressive symptoms, compared with their heterosexual counterparts. Having a like-mentor, or a sexual minority mentor, is associated with improved mental well-being among SMM mentees. However, few studies have explored the potential benefits to mentors. Using confirmatory factor analysis, we calculated a perceptions of mentoring score that encompasses experiences and beliefs regarding mentoring of SMM from the Healthy Aging Substudy of the Multicenter AIDS Cohort Study. We used a generalized estimating equations model to assess associations between perceptions of mentoring and clinically significant depressive symptoms adjusted for key covariates; models were also stratified by HIV serostatus. Among 1,246 men aged 40+ years, the strongest agreement was with the statement I have encouraged people to be proud of their sexual orientation, for which 770 individuals (72%) indicated Agree or Strongly Agree. Each unit increase in the mean perceptions of mentoring score was associated with 8% decreased odds of having clinically significant depressive symptoms (adjusted odds ratio: 0.92; 95% CI: 0.85-0.99). We show that SMM reported like-mentoring experiences and had positive mentoring beliefs, and that these were associated with a decreased odds of having depressive symptoms. Encouraging SMM to serve as like-mentors could be a way to counter depressive symptoms among this key population. There is a need for increased research regarding how mentoring programs can best be designed to benefit sexual minority mentees and mentors.

ObjectiveThis study examines the association between social support and cognitive function among midlife and older MSM living with or without HIV.DesignWe analyzed longitudinal data from participants enrolled from October 2016 to March 2019 in the Patterns of Healthy Aging Study, a substudy of the Multicenter AIDS Cohort Study.MethodsWe conducted a cross-sectional analysis to estimate the association between social support and three measures of cognitive function [Trail Making Test (TMT) Part A, TMT Part B to A ratio, and Symbol Digit Modalities Tasks (SDMT)]. We also used linear mixed-effects models to estimate the association between baseline social support and cognitive function across four subsequent time points. We evaluated a multiplicative interaction term between baseline social support and time, in order to determine whether cognitive trajectories over time vary by baseline social support.ResultsSocial support was associated with lower TMT Part A scores at baseline and over the subsequent 2 years, indicating better psychomotor ability. Social support was associated with higher SDMT scores at baseline and across 2 years, indicating better information processing. We observed no association between social support and TMT B to A ratio at baseline or across 2 years, indicating no effect on set-shifting ability. Longitudinal cognition outcome trajectories did not vary by the level of baseline social support.ConclusionSocial support and cognitive function were associated in this sample over a short time period. Further research should explore causal relationships over the lifespan.

Objectives: Studies have shown that grit-defined as perseverance and passion for achieving one's long-term goals-is associated with improved health outcomes, including lower levels of psychological distress. However, the psychometric properties of the original Grit Scale (Grit-O Scale) has not been validated among sexual minority men (SMM). The present study aimed to validate the Grit-O Scale among a sample of older SMM and assess the relationships between the Grit-O Scale factors and symptoms of psychological distress.Method: We used data from a single visit of participants in the Multicenter AIDS Cohort Study (MACS) Healthy Aging longitudinal study. The sample included 981 older SMM (mean age = 61, SD = 8.5) with and without HIV. We conducted confirmatory factor analysis (CFA) to identify the two factors of the Grit-O Scale: consistency of interest and perseverance of effort. We also conducted a latent profile analysis (LPA) to identify distinct profiles of psychological distress from self-reported scales of depression, anxiety, and perceived stress.Results:The Grit-O Scale showed acceptable reliability estimates for the items with Cronbach's alpha reliability coefficients ranging from 0.77 to 0.82. The CFA identified the two factors of the Grit-O Scale with acceptable model fit (root mean square error of approximation = 0.058 [95% CI = 0.050, 0.067], comparative fit index = 0.95, Tucker-Lewis Index = 0.93, standardized root mean square residual = 0.07). The LPA yielded three mutually exclusive profiles of psychological distress (profile 1: low stress, anxiety, and depression; profile 2: high stress and depression and low anxiety; and profile 3: high stress, anxiety, and depression). In adjusted multinominal logistic regression analysis, we found that both higher levels of consistency of interest and perseverance of effort factors of the Grit-O Scale were significantly associated with decreased odds of being in profiles 2 and 3 compared with being in profile 1.Conclusion: Our findings support the use of the Grit-O Scale among older SMM. Grit factors could explain variability in the negative psychological symptoms among older SMM and warrant further investigation.Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2022.2032594.

PURPOSE In 2018, there were 68 million sexually transmitted infections in the United States. Sexual history screening is an evidence-based practice endorsed by guidelines to identify risk of these infections and adverse sexual health outcomes. In this mixed methods study, we investigated patient- and clinician-level characteristics associated with receipt of sexual history screening, and contextualized these differences in more depth. METHODS We collected sociodemographics of patients from the electronic health record and sociodemographics of their primary care clinicians via a census survey. Semistructured interviews were conducted with key practice staff. We conducted multilevel crossed random effects logistic regression analysis and thematic analysis on quantitative and qualitative data, respectively. RESULTS A total of 53,246 patients and 56 clinicians from 13 clinical sites participated. Less than one-half (42.4%) of the patients had any sexual history screening documented in their health record. Patients had significantly higher odds of documented screening if they were gay or lesbian (OR = 1.23), were cisgender women (OR = 1.10), or had clinicians who were cisgender women (OR = 1.80). Conversely, patients' odds of documented screening fell significantly with age (OR per year = 0.99) and with the number of patients their clinicians had on their panels (OR per patient = 0.99), and their odds were significantly lower if their primary language was not English (OR = 0.91). In interviews, key staff expressed discomfort discussing sexual health and noted assumptions about patients who are older, in long-term relationships, or from other cultures. Discordance of patient-clinician gender and patients' sexual orientation were also noted as barriers. CONCLUSIONS Interventions are needed to address the interplay between the social and contextual factors identified in this study, especially those that elicited discomfort, and the implementation of sexual history screening. Key words: primary care; sexual health; sexually transmitted infections; medical history taking; preventive care; preventive health services; screening; physician-patient relations; ethnic and racial minorities; vulnerable populations; medically underserved area; health care disparities; semistructured interview; mixed methods; health services research, INTRODUCTION Reported rates of sexually transmitted infections (STIs) have consistently increased over time, with a preliminary estimate of 2.5 million cases in the United States in 2021. (1) Sexual history [...]

This study investigated if homophobic and racist discrimination increased depressive symptoms among 960 middle-aged and older men who have sex with men (MSM) and how resilience moderated these relationships. We used five waves of longitudinal data from the Healthy Aging sub-study of the Multicenter AIDS Cohort Study (MACS). We used linear regression analyses to model depressive symptoms as a function of discrimination. We used linear mixed analyses to model changes in mean resilience scores across visits. We used linear regression analyses to model depressive symptoms as a function of changes in resilience and to test the moderation effects of resilience on the relationship between discrimination and depressive symptoms. The models accounted for repeated measures of resilience. Men who experienced external and internal homophobia had greater depressive symptoms (β: 2.08; 95% Confidence Interval: 0.65, 3.51; β: 1.60; 95% Confidence Interval: 0.76, 2.44). Men experienced significant changes in mean resilience levels across visits (F = 2.84, p = 0.02). Men with a greater positive change in resilience had lower depressive symptoms (β: -0.95; 95% Confidence Interval: -1.47, -0.43). Men with higher average resilience levels had lower depressive symptoms (β: -5.08; 95% Confidence Interval: -5.68, -4.49). Men's resilience did not moderate the relationship between homophobia and depressive symptoms. Significant associations of external and internal homophobia with greater depressive symptoms present targets for future research and interventions among middle-aged and older MSM. Significant associations of average and positive changes in resilience with lower depressive symptoms provide aims for future research and interventions with this population.

College students with disabilities (SWDs) experience elevated rates of sexual violence and intimate partner violence compared with their non-disabled peers. While tailored interventions for these pressing health issues are needed, current research lacks investigation into how SWDs conceptualize relevant key concepts, such as consent and healthy relationships. This descriptive qualitative study explored these concepts through semi-structured interviews with college SWDs (n = 49), 18-24 years old, in Pennsylvania and West Virginia. The results culminated in six rich, descriptive themes addressing: 1) interpersonal and intrapersonal skills necessary for relationship health; 2) normalization of unhealthy treatment by a partner due to manipulation, denial, and love for the partner; 3) how dichotomous definitions of consent interfere with practical application in lived experiences; 4) how active consent can be both facilitated and hindered within the context of a romantic relationship; 5) perceptions that healthcare providers aim to elicit disclosures of abuse rather than initiate a discussion about relationship health; and 6) students' reticence to disclose abuse to healthcare providers due to mistrust and fear over loss of agency. These results contradict historic narratives that SWDs do not have the same sexual and relationship beliefs and experiences as other students and highlight the perspectives of this marginalized population. Implications for campus prevention programming and healthcare practices include incorporating intersections of disability and violence, discussing the nuances of consent and substance use, and creating conversations about relationship health that are transparent, non-judgmental, and include a broad range of types of abuse., Author(s): Jocelyn C. Anderson [sup.1] , Rachael K. Richter [sup.2] , Mary Hawk [sup.3] , James Egan [sup.3] , Elizabeth Miller [sup.2] , Kelli Lampe [sup.4] [sup.5] , Courtney R. [...]

BACKGROUND: High school staff can play a key role in supporting students with LGBTQ+ identities through informal strategies; however, more research is needed to understand how staff are employing these strategies. METHODS: We conducted semi‐structured interviews, collecting information on informal strategies used to support students identifying as LGBTQ+ from a diverse sample of 23 school staff from high schools across the United States. RESULTS: Staff employed informal support strategies across social ecological levels: within the school community, staff interacted with parents/guardians of students and advocated for more inclusive policies. Within the classroom, staff created inclusive physical environments, implemented inclusive curricula, and employed bullying prevention strategies. Interpersonally, staff listened to and affirmed students and collaborated to employ support strategies. Intrapersonal qualities, including having a personal connection to the LGBTQ+ community and demonstrating open‐mindedness, facilitated staff efforts to support students. CONCLUSIONS: Supporting staff in the implementation of the strategies we identified could foster more inclusive school environments, advancing equity for students identifying as LGBTQ+. [ABSTRACT FROM AUTHOR]

Objectives: Advance care planning (ACP) specifies decision-making surrogates and preferences for serious illness or end-of-life medical care. ACP research has largely neglected sexual minority men (SMM), a population that experiences disparities in health care and health status. Methods: We examined formal and informal ACP among SMM ages 40+ in the Multicenter AIDS Cohort Study (N = 1,071). Results: For informal ACP (50%), younger SMM and men with past cardiovascular events had greater odds of planning; single men had lower odds of planning. For formal ACP (39%), SMM with greater socioeconomic status had greater odds of planning; SMM who were younger, of racial/ethnic minority identities, who were single or in a relationship without legal protections, and who lacked a primary care home had lower odds of planning. Discussion: Findings warrant further exploration of both informal and formal planning. More equitable, culturally-humble engagement of SMM may facilitate access, uptake, and person-centered planning. [ABSTRACT FROM AUTHOR]

In this study, we examined how mental health inequities by gender and sexual identity changed from before the COVID-19 pandemic to during the early phase of the pandemic. Sexual and gender minority (SGM) adults and non-SGM adults were recruited through social media to complete online questionnaires. Results indicate a worsening change in depression from before the pandemic to during the early phase of the pandemic that was significantly greater for gender minorities compared to cisgender (cis) women. Anxiety and loneliness scores did not change differentially for gender minorities (vs cis women) or sexual minorities (vs heterosexuals). Overall, COVID-19 had a greater negative impact on depression for gender minorities compared with cis women. [ABSTRACT FROM AUTHOR]

Objectives: Mental health concerns (e.g. depression, anxiety) that negatively impact gay, bisexual, and other men who have sex with men (GBMSM) persist over the life course and into old age, but less is known about potential contributors to GBMSM's mental health. Close relationships can be a source of risk or resilience from stress, exerting direct relationships on mental health, and may mediate well-established associations between minority stress and mental health. This study examined whether primary partner relationship support and strain were uniquely associated with, and mediated the association between internalized homophobia, and mental health among older GBMSM. Methods: GBMSM (N = 517, M age = 60) from the Multicenter AIDS Cohort Study, who were in primary relationships with men, provided self-report data at four timepoints. We used multilevel modeling to examine longitudinal associations among relationship support and strain and internalized homophobia with depression and anxiety. Results: Relationship strain, but not support, was positively associated with mental health concerns longitudinally. There was a significant, positive indirect effect of internalized homophobia on depression and anxiety through strain, but no support. Internalized homophobia was positively associated with relationship strain, which was positively associated with mental health symptoms longitudinally. Conclusions: Relationship strain was associated with depression and anxiety longitudinally among middle-aged and older GBMSM and mediated associations of internalized homophobia with mental health. The role of partner support warrants further investigation. Mental health interventions are critically needed for older GBMSM and, for partnered GBMSM, should include strategies for reducing relationship strain to foster well-being. [ABSTRACT FROM AUTHOR]

HIV remains a significant health issue for women, and multiple overlapping factors shape women's HIV-related risk. Pre-exposure prophylaxis (PrEP) offers critical advantages over other existing options, yet it remains significantly underused among women in the USA where limited work has explored women's opinions on barriers to potential PrEP use. Using open-ended text responses from a sample of women seeking care at a US urban family planning health centre, this study aimed to understand perceptions of factors affecting potential PrEP use. Three themes concerning key factors impacting potential PrEP use emerged: HIV risk assessment, relationship dynamics, and anticipated stigma. Women's assessment of HIV risk suggests that identifying women in clinical settings as having low self-perceived risk may overlook the complexity of how women determine HIV-related risk and prevention needs. Women frequently referenced relationship dynamics when considering PrEP and discussed anticipated partner reactions about use contributing to non-use. Fear or worry of stigma were expressed as motivations to not use PrEP. Study results highlight the importance of public health and health care professionals normalising PrEP as a strategy in women's HIV prevention and sexual health decision-making. Woman-centred PrEP education, screening and communication strategies reflective of their unique HIV-related risk context are needed. [ABSTRACT FROM AUTHOR]

Background: Paramagnetic species such as O2 and free radicals can enhance T1 and T2 relaxation times. If the change in relaxation time is sufficiently large, the contrast will be generated in magnetic resonance images. Since radiation is known to be capable of altering the concentration of O2 and free radicals during water radiolysis, it may be possible for radiation to induce MR signal change. Purpose: We present the first reported instance of x‐ray‐induced MR signal changes in water phantoms and investigate potential paramagnetic relaxation enhancement mechanisms associated with radiation chemistry changes in oxygen and free radical concentrations. Methods: Images of water and 10 mM coumarin phantoms were acquired on a 0.35 T MR‐linac before, during, and after a dose delivery of 80 Gy using an inversion‐recovery dual‐echo sequence with water nullified. Radiation chemistry simulations of these conditions were performed to calculate changes in oxygen and free radical concentrations. Published relaxivity values were then applied to calculate the resulting T1 change, and analytical MR signal equations were used to calculate the associated signal change. Results: Compared to pre‐irradiation reference images, water phantom images taken during and after irradiation showed little to no change, while coumarin phantom images showed a small signal loss in the irradiated region with a contrast‐to‐noise ratio (CNR) of 1.0–2.5. Radiation chemistry simulations found oxygen depletion of −11 µM in water and −31 µM in coumarin, resulting in a T1 lengthening of 24 ms and 68 ms respectively, and a simulated CNR of 1.0 and 2.8 respectively. This change was consistent with observations in both direction and magnitude. Steady‐state superoxide, hydroxyl, hydroperoxyl, and hydrogen radical concentrations were found to contribute less than 1 ms of T1 change. Conclusion: Observed radiation‐induced MR signal changes were dominated by an oxygen depletion mechanism. Free radicals were concluded to play a minor secondary role under steady‐state conditions. Future applications may include in vivo FLASH treatment verification but would require an MR sequence with a better signal‐to‐noise ratio and higher temporal resolution than the one used in this study. [ABSTRACT FROM AUTHOR]

Men who have sex with men (MSM) over 45 years of age are more likely to report loneliness and bear a disproportionate percentage of the Human Immunodeficiency Virus (HIV) disease burden than their heterosexual peers. Social support is a buffer against loneliness and is also associated with improved HIV health. To investigate the perceived social support of older MSM and the methods they used to communicate with people in their support networks, we surveyed 1,066 middle age and aging men in the Multicenter AIDS Cohort Study. We found that 24.6% of participants reported primarily communicating electronically with people in their support networks, and that these participants were more likely to be HIV-positive, to have lower social support scores, and lower support satisfaction. The findings of this study suggest that one in four older HIV-positive MSM may face barriers to obtaining social support in person, and that interventions to increase in-person support may be warranted. [ABSTRACT FROM AUTHOR]

Sexual and gender minority youth (SGMY) are more likely to experience bullying and violence compared to the youth who do not identify as SGMY, leading to increased risk of poor mental and physical health outcomes, and poor academic performance. Few studies explore the entire range of bullying experienced by sexual and gender minority youth (SGMY). The purpose of this study was to qualitatively describe the ways in which SGMY experience bullying victimization. We conducted semi-structured interviews with a diverse sample of 20 SGMY aged 14–18 years (median age 16 years) recruited from online social media. The sample included 10 participants who identified as cisgender girls, 4 who identified as cisgender boys, 2 who identified as transgender, and 4 who identified as another gender identity. Ten participants identified as bisexual, six identified as lesbian, and four identified as gay. Findings indicated six common experiences of bullying among the participants: (a) verbal harassment; (b) gender policing; (c) physical violence; (d) sexual harassment; (e) treated as sexual perpetrators and deviants; and (f) and social exclusion. SGMY described how bullying victimization ranged from overt to concealed attitudes and behaviors, and they articulated how several forms of bullying are likely not experienced by heterosexual and cisgender youth. These results support findings from prior qualitative studies and suggest that efforts to address school-based bullying may benefit from a more complete awareness of the range of bullying victimization experienced by SGMY. Development of multi-item scales of bullying that reflect the six common experiences of bullying presented in this study would allow researchers to quantitatively explore the range of bullying behaviors experienced by SGMY, and would aid in the conceptualization and successful implementation of anti-bullying interventions. [ABSTRACT FROM AUTHOR]

Objectives Connections to the gay community may elicit negative self-appraisals among men who have sex with men (MSM), which may be exacerbated for people with HIV (PWH). Fitness engagement may mediate self-appraisals by maintaining or improving appearance and health. We hypothesized that gay community connections would be positively related to negative self-appraisal and explored whether this association would be mediated by fitness engagement and moderated by HIV status. Method Data were obtained from the Multicenter AIDS Cohort Healthy Aging study (N = 1,026; PWH n = 525; people without HIV [PWOH] n = 501). Structural equation modeling (SEM) examined associations between gay community connections, negative self-appraisal (body image dissatisfaction, self-perception of aging), and fitness engagement (physical activity, motivation to be fit). Multiple-group SEM tested the moderating effects of HIV serostatus. Results The SEM fit the data well (root mean square error of approximation = 0.056; 90% CI: 0.046, 0.066). Connection to the gay community was inversely related to negative self-appraisals and positively related to fitness engagement. Fitness engagement mediated the association between community connections and negative self-appraisal and was inversely related to negative self-appraisals. Among PWH, the association between community connections and self-appraisal was weaker and the effect of fitness engagement on negative self-appraisal was stronger compared to PWOH. Discussion Connection to the gay community may be a source of resilience for aging MSM by lessening negative self-appraisals and promoting strategies that address body image dissatisfaction and self-perceptions of aging. Interventions facilitating connections to the gay community may support healthy aging in this population. [ABSTRACT FROM AUTHOR]