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Psychoactive substance use (PSU) among gay men (GM) has been examined through a biomedical-epidemiological lens. While national studies offer a general overview from a biopsychosocial viewpoint, they fail to explore the cultural influences on PSU. The objective was to analyze the cultural aspects of PSU among GM in Mexico by exploring the social construction of identity as men with a non-normative sexual orientation who experience a distinct form of masculinity while engaging in PSU during sexual activities. Utilizing a symbolic approach in anthropology, specifically in identity and gender studies, three focus groups comprising 19 middle-class gay men aged 22 to 42 were conducted in May 2022 via Zoom Meetings. The information was coded and analyzed using targeted content analysis. Identity, masculinity, and homoeroticism play a crucial role in shaping PSU practices among GM in Mexico, with the interplay of these three cultural dimensions manifesting in the ritualistic practice of sexualized drug use (chemsex), particularly concerning crystal meth.

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

Research into intimate partner violence (IPV) has focused on the experience of female victims resulting from dominant theoretical frameworks and societal biases casting females as victims and males as abusers. While emergent studies suggest that gay male victims experience a higher prevalence rate and more severe consequences from IPV than heterosexuals victims (male or female), few studies have explored the impact of IPV on gay male victims personal and working lives. We conducted a qualitative case study analysis using an Interpretive Phenomenological Analysis by interviewing four gay males with experience of IPV. Following a description of each case, a cross-case analysis identified the similarities and differences between the participants' lived experiences according to four main themes: 1) formal support, 2) informal support, 3) workplace support, and 4) workplace performance. We found that the influence of minority stress may amplify the challenges that some gay male victims face when conceptualizing their abuse and seeking support in their personal and working lives. Organizations should develop targeted and inclusive policies that support victims, with LGBTQI±competent Employee Assistance Program (EAP) providers, and gender-neutral language when referring to IPV.

Research on body image among men who have sex with men (MSM) has predominantly been approached with the assumption that all MSM conform to a culturally preferred body, and have a high risk of body image concerns leading to risky behaviors and negative health outcomes. Scholars have called for a more nuanced understanding of how MSM engage with their body images. In response, we conducted 30 semi-structured interviews with Vietnamese MSM to explore their perceptions and feelings of their bodies, including their current body, idealized body, and sexually desired body. Inductive thematic analysis was utilized. The findings highlight the diversity and complexity in Vietnamese MSM's perceptions and feelings about their bodies, which Western measurements of body image and body dissatisfaction might not fully capture. The participants also acknowledge the pressure of physical appearance; however, they do not always conform to the dominant body ideals and have a high risk of body dissatisfaction. We conclude with a call for reframing the approach to gay and bisexual men's body image to understand better how they navigate complex pressures and make sense of their body image instead of assuming they are at risk of body dissatisfaction.

Depression is a prevalent mental health issue for sexual minority men (SMM), with the internalization of sexual identity-based stigma a key risk factor. Self-warmth is a protective factor and self-coldness is a risk factor for depressive symptoms, yet limited research in this area has focused on SMM. In the present study, an international sample of 1,285 gay and 487 bisexual men completed measures of depression, internalized heterosexism, and self-warmth/self-coldness. A multiple linear regression showed that internalized heterosexism explained 0.4% unique variance, self-warmth explained 0.5% unique variance, and self-coldness explained 18.8% unique variance in depressive symptoms. Self-warmth was directly and indirectly related to lower levels of depressive symptoms among SMM. In contrast, self-coldness was directly related to higher levels of depressive symptoms among SMM, and indirectly related to higher levels of depressive symptoms only for gay men. Findings should inform work aiming primarily to reduce self-coldness among SMM, thereby reducing depressive symptoms.

Background: Gay men experience heterosexist harassment, rejection, and discrimination because of their sexual orientation, which leads to mental health problems, such as substance use. Due to anti-gay laws and regulations in Iran, which are based on fundamental interpretations of Islam, gay men are likely to experience more discrimination than in Western countries., Methods: We used the HHRDS to assess heterosexist harassment, rejection, and discrimination and the ASSIST 3.0 to measure substance use in N  = 156 Iranian gay men., Results: Lifetime use was as follows: 64.1% for tobacco products, 36.5% for alcoholic beverages, 25.6% for cannabis, 8.3% for opioids, and 7.1% for sedatives or sleeping pills. All three HHRDS subscales were significantly associated with all substance use scales. In addition, when descriptively comparing HHRDS scores with those of US samples, Iranian gay men reported more discrimination. In a MANOVA, total discrimination strongly predicted tobacco and cannabis consumption, while total discrimination predicted alcohol, opioid, and sedative/sleeping pill use to a moderate degree., Conclusions: Substance use in Iranian gay men can be seen as a primary mental-health issue resulting from discrimination. It also likely reflects a maladaptive coping strategy related to these experiences. To improve Iran gay men's mental health, structural and interpersonal discrimination should be eliminated and specialized psychological services should be established., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2024 Taylor & Francis Group, LLC.)

Effeminate gay bottoms, or gender nonconforming men who are anally receptive and/or give oral sex to other men who are also "gender nonconforming," are persistently marginalized in gay and LGBTQ+ communities in Britain and the US. For some LGBTQ+ commentators, "twink" has become relexified to mean a young-looking, slim, hairless effeminate bottom, whereas originally the term primarily denoted a body type and age bracket among gay men. This article explores how the twink has come to bear connotations of effeminacy and bottom subjectivity, highlighting the steady erosion of other available cultural terms to denote a bottom whose gender expression does not conform to dominant cultural masculine stereotypes. It offers an analysis of two key historical effeminate bottom identities in Britain and the US, the "fairy" and "queen," and argues that the twink not only now carries connotations originally attached to these historical identities, but that it merges their gendered and sexual connotations with new characteristics concerning age and body type that may cause considerable anxiety among contemporary gay men due to their unsustainable "shelf life."

Problem : Gay men (GMs) and lesbian women (LWs) can be exposed to misunderstanding, pressure, condemnation, obstructed access to public services, social isolation, and discrimination in many countries. They may also encounter various difficulties in accessing health services. Being GM and LW is generally unacceptable in Turkey, and both are perceived as abnormal. Medical students may require education on the subject of sexual orientation to improve their knowledge of and attitudes toward LGBT individuals, to help them remain neutral and avoid prejudice in providing health services for such individuals, and to ensure that such care is unbiased. Intervention : This one-group pretest-post-test design study was performed with third-year students at the Ondokuz Mayıs University Medical Faculty (Samsun-Turkey) on 01-31 September, 2021. Three hundred twenty-five students took part. We evaluated students' attitudes toward homophobia and being GM and LW following a two-week multidisciplinary education program. The program included such topics as "Marginalization," "Interaction between cultures," "Sexual orientation," "Faith-based marginalization," "Sub-cultures," "Health protection," "Gender," and "Marginalized groups." For objective acquisition, we organized small group work, experience-sharing sessions (such as different orientation groups, different ethnic groups, and different behavioral templates), presentations, and panel activities. Context : Some circles in Türkiye regard LGBT individuals as representing an attack on national and spiritual values, and they are used as part of the political discourse. Studies are being performed in some medial faculties in Türkiye concerning the inclusion of subjects related to LGBT individuals in the educational curriculum. However, these studies have not yet assumed the form of a curriculum design including content, method, and testing. It is important for subjects concerning LGBT individuals to be considered more extensively in medical education in Türkiye, and for awareness of the rights of these individuals in the community and of combating discrimination to be improved. Outcome : We observed a significant decrease in students' homophobia after education. Significant decreases were observed in agreement with statements to the effect that being a GM or LW is a disease, that it can be treated, that people can be identified as GMs and LWs based on their behavior, and that they pose a major threat to society. Lessons Learned : It is unclear whether education aimed at all marginalized groups will produce different results to those of programs aimed specifically at GMs and LWs, but we think that applying programs directed toward discrimination and prejudice together will yield more effective results.

Masculinity is validated as a protective factor in mental health for gay population. However, potential mediators between masculinity and mental health remain unclear. Mindfulness, as one of the individual's traits has been proved to play an essential role on mental health. Yet the correlation between mindfulness and masculinity has barely been examined, and whether mindfulness could serve as a key mediator to explain the protective effect masculinity bringing to mental health for gay men remains unknown. To test this hypothesis, we recruited 210 gay men in China to conduct online questionnaires containing scales of FFMQ, BSRI, DASS-21 and demographic features. Based on mediation analysis, we found among gay men, mindfulness significantly mediates the negative relationship between masculinity and stress (SIE (standardized indirect effect) = -.20, 95% CI [-.28 -.11]), anxiety (SIE = -.17, 95% CI [-.26 -.09]) and depression (SIE = -.20, 95% CI [-.29 -.11]). Furthermore, by decomposing sub-dimensions of mindfulness, we found both "describing" and "acting with awareness" exhibit significant mediation effects between masculinity and mental distress. We further found "being analytical", one key sub-dimension of masculinity, positively correlates with mindful describing ( r = .369, p < .001). Our results indicate that trait mindfulness serves as a core mediator between masculinity and mental health, the key trait in masculinity (being analytical) closely connects with the essential element of mindfulness (describing) and low in masculinity might undermine gay men's abilities of acting with awareness (staying focused). Our findings may also shed light on developing gay men-aimed mindfulness-based clinical interventions., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2024 Taylor & Francis Group, LLC.)

This study aimed to understand young gay men's experiences of social support, relationships, community networks, talking about psychological distress, and their impact on distress and wellbeing. Eight verbatim transcriptions from semi-structured interviews with gay men aged 18-35 years were analyzed using Interpretative Phenomenological Analysis. Three super-ordinate themes were developed; 1) Growing up gay in a straight world: Developmental traumas, regarding men's experiences of homophobic abuse and exclusion and the internalized impact on their identities and identity concealment. 2) Belonging and not belonging within LGBTQ+ communities, encompassing men's varied experiences of LGBTQ+ communities and the corresponding impacts upon their wellbeing. 3) Relational responses to rejection, describing how men made sense of and managed their relationships within the context of the developmental traumas they had experienced growing up as gay men. These findings illuminate the psychological impact of experiencing multiple developmental traumas related to one's identity as a gay man, and how this influences lifelong relational behavior; and how experiences of social support, relationships and LGBTQ+ communities influence men's mental health. They provide a strong rationale for psychological interventions to acknowledge and address gay men's unique and adverse social experiences within their relationships, communities and societies.

This study investigates factors influencing the psychological well-being of gay and lesbian individuals in Romania. Participants (N = 172) included 61.6% gay and 38.4% lesbians, currently in relationships, aged between 18 and 62 years (M = 28.28; SD = 9.53). Surveys assessed relationship satisfaction, depression, and problematic pornography use. Significant associations were found among these variables, with gender differences observed. We tested a regression model for problematic pornography use, where depression provided additional explanatory power to the initial model. Age, gender, and depression accounted for 18% of the variance in problematic pornography use. The theoretical and practical implications are discussed., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper., (© 2024 Taylor & Francis Group, LLC.)

Objectives: The focus on physical appearance among gay men has potential implications for anti-fat attitudes, including those directed toward romantic partners. Partners often influence each other's behaviors including those linked to weight, but most research has examined the consequences of these influence strategies versus their antecedents. To address this research gap, we examined how men's own and their partners' anti-fat attitudes were related to both health-promoting (control) and health-compromising (undermining) types of diet-related influence and whether these associations differed by weight status., Methods and Results: Analyzing data from a cross-sectional online survey of 450 U.S. adult gay married men (225 couples), Actor-Partner Interdependence Models revealed that individuals' own anti-fat attitudes (all types) were positively associated with more frequent receipt of spousal control and undermining. Additionally, partner's fears about gaining weight were positively associated with more frequent receipt of spousal control and dislike of higher weight people and fear of gaining weight (among those of higher weight status) were positively associated with more frequent receipt of spousal undermining., Conclusion: Our findings add to the literature on diet-related interactions among gay married men, highlight the value of examining these processes dyadically, and suggest the importance of including both members of couples in health promotion and intervention efforts.

Internationally, gay men have been found to be at a higher risk of mental health problems than heterosexual men. However, there is little information about the mental health situation of Iranian gay men, a population facing serious legal repercussions. Additionally, there is limited international data on the effect of the COVID-19 pandemic on the mental health of gay men. The aim of this study was to evaluate Iranian gay men's mental health during this pandemic. We assessed depression, anxiety, and stress with the DASS and insomnia with the ISI in N  = 176 Iranian gay men. We compared their DASS subscores with those of the general male population during the COVID-19 pandemic. 65.9% of Iranian gay men showed mild to extremely severe depression symptoms, 63.6% reported mild to extremely severe anxiety symptoms, 65.3% had mild to extremely severe stress symptoms, and 43.3% had mild to severe insomnia symptoms. Compared to the general Iranian male population, gay men reported significantly more depressive, anxiety, and stress symptoms. Iranian gay men show a high number of depression, anxiety, stress, and insomnia symptoms during the COVID-19 pandemic. Gay men reported significantly more mental health symptoms in the DASS subscores than the general population of Iranian men recruited during the pandemic. They showed descriptively more insomnia symptoms than Iranian adults before the pandemic. The mental health of Iranian gay men should be improved by abolishing punishments for same-sex sexual activities and establishing specialized mental health units for this population.

The aim of this qualitative study is to explore the experience of loneliness among Israeli gay men in their early and mid-adulthood, ages 30-50 (N = 14). The findings demonstrate three main categories of loneliness that study participants experienced: childhood loneliness as an initial experience of gay identity; loneliness in the context of other gay men, via sexual encounters, friendships, and the use of dating apps; and loneliness in the context of heterosexual society. The findings point to the centrality of the experience of loneliness among Israeli gay men in their mid-adulthood years and emphasize how this loneliness is rooted in socio-cultural and political perceptions concerning hetero-normative as well as gay identities.

Recent discussions of gay male bottom identity have been cautious about positioning bottoms in relation to a gendered identity, and thereby colluding with stereotypes about gay bottoms being effeminate and effeminate gays being bottoms. In wider LGBTQ media in Europe and North America there is an effort to destigmatize effeminate gay men in a dating culture that privileges "masc4masc." While this is welcome, it obscures the existence of effeminate gay bottom fantasies that are gender stratified and which insist on a connection between sex role preference, sex object choice, and gender presentation. This paper analyses sexual fantasy narratives on the social media platform, Tumblr, and interrogates a deep structure of gender-stratified male androphilia that finds thematic similarities in non-Western settings, where "egalitarian" or Western "gay" expressions of male same-sex unions compete with traditional "heterogender" forms. It concludes by reaffirming the need to consider gender positionality among gay bottoms' narratives in Western contexts, and for further research on Western gay men to recognize the heterogeneity of gay identities and experiences.

Proximal minority stressors (i.e., internalized homonegativity, anticipation of rejection, and concealment of sexual identity) lead to depression and anxiety. General psychological factors mediate the association of proximal stressors with depression and anxiety. Based on this, the present study aimed to investigate the sequential mediating roles of shame and forgiveness of self on the relations of proximal stressors with depression and anxiety in a sample of self-identified gay men in Turkey ( N = 200). The findings revealed that proximal stressors significantly predicted depression and anxiety indirectly through shame and self-forgiveness. Thus, the link between minority stress and shame should be considered in clinical practice, and self-forgiveness should be integrated into intervention programs to eliminate the negative impacts of shame on depression and anxiety among this population. Limitations and directions for future studies are presented.

HIV remains a principal inequity for queer men across the United States. Biomedical practices all but dominate interventions, and HIV-related stress persists among queer men. Regarding HIV as discourse is not well represented in prevention and care. This study is a response, then, to this need that seeks to build an HIV-informed model of praxis, entitled HIV Stress Exchange . A Queer Discourse Study was conducted with 20 queer men across two generations, pre-AIDS and post-AIDS. The data included in-depth interviews and material resources participants brought to the conversation. In all, this data speaks to the ways in which HIV is given life in discourse and what meaning it holds in embodied lives. Resultantly, five themes materialized, inclusive of all ages and sero-statuses: HIV provided meaning as in-/validated, un-/voiced, un-/intelligible, holding intimacy/-ies, and being PrEP/-ared. Based on the findings, the conceptual model for HIV Stress Exchange is presented along with an HIV-informed model of practice.

Negative beliefs and stigmatization of all that is not heterosexual still have an adverse impact on the mental health of the homosexual population in many countries. The purpose of the present study was to comparatively assess how sociocultural differences regarding the level of homosexuality acceptance impact the adult attachment dimensions and emotion regulation strategies among three groups of Iranian and Dutch gay men. A community sample of 124 gay men (40 of Iranians residing in their home country, 41 of Iranians immigrated to the Netherlands and 43 Dutch) participated in the study and completed Revised Adult Attachment Scale (RAAS) and Emotion Regulation Questionnaire (ERQ). MANOVA and follow-up post-hoc Tukey tests were conducted in order to analyze the data. Results demonstrated a noticeable difference in both studied variables, attachment dimensions (close, anxiety, and depend) and emotion regulation strategies (cognitive reappraisal and expressive suppression), among the three groups of participants. As the Iranian (residing in Iran) group showed the greatest levels of anxiety and emotional suppression with the lowest levels of close (convenience of getting intimate to others), depend (trust and depend on others to be availabale when needed) and cognitive reappraisal (ability to alter the emotion caused by an event, before experiencing it by reinterpreting the situation), while the highest levels of depend, close and cognitive reappraisal and the lowest levels of anxiety and emotional suppression were seen in the Dutch group. Finally, Iranian gay immigrants came half way between. This data highlights the role of cultural differences in terms of homosexuality acceptance or stigmatization, in the way gay men exhibit their attachment and manage their emotions either by reappraisal or suppression. Comparative cross-cultural studies are possibly able to open paths to new research on psychological factors of non-heterosexuals in different countries with various cultures and religions.

Background and Objective: Research related to anxiety among sexual minority men (SMM) typically focuses on risk factors. It has seldom examined factors that may be associated with lower levels of anxiety. This gap in the literature represents an opportunity to explore positive psychological factors that may be related to lower levels of anxiety among this group. Spirituality and self-compassion are two positive psychological factors that have been associated with reduced anxiety in general samples but have been understudied among SMM. This study aimed to determine the longitudinal associations between spirituality, self-compassion, and anxiety., Design and Methods: Guided by an Afrocentric psychological framework, we conducted a secondary quantitative analysis with data from a racially and ethnically diverse sample of 697 U.S. SMM., Results: Utilizing Hayes PROCESS Macro Model 4, we found that spirituality at baseline was positively associated with self-compassion at baseline, which in turn was inversely associated with anxiety at 12-month follow-up., Conclusions: Overall, our findings provide evidence that spirituality and self-compassion are two positive psychological factors that are inversely associated with anxiety among SMM.

Studies have documented gay men's engagement in collective sex (e.g., group sex in public or commercial environments) but little attention has been paid to these men's relationship desires or agreements. We report on qualitative interviews with 20 gay men who attended private sex clubs in New York City, asking how participants navigated sometimes conflicting desires for collective sex and committed relationships. Participants felt that collective sex was either a) incompatible with relationships, which should be monogamous; b) complementary to a primary non-monogamous relationship; or c) at least as important as relationships. Gay men attending sex clubs attribute different value to collective sex and to committed relationships, and experience different challenges in satisfying their desires for intimacy. Resources could help gay men navigating these apparently conflicting desires and making suitable choices regarding their relationships and/or sexual agreements.

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.

This study argues that institutional psychiatry's pathologizing stance on homosexuality persisted after 1973, when the American Psychiatric Association removed homosexuality from the Diagnostic and Statistical Manual of Mental Disorders . It persisted not only through the well-known diagnoses of "ego-dystonic homosexuality" and "gender identity disorder of childhood," but also through case studies published in four editions of the DSM Casebooks (1981, 1989, 1994, 2002), the APA publications advertised as a "learning companion to the Diagnostic and Statistical Manual ." These publications contained harmful and false homosexual stereotypes, associating gay men with child abuse, violence, and sexual sadism; associating homosexuality with mental disturbance while failing to similarly mark heterosexuality or bisexuality; associating psychopathology with gay social contexts while failing to similarly mark non-gay social contexts. This study provides evidence that the DSM Casebooks portrayed homosexual women and bisexuals as invisible, and homosexual men as narcissistic, predatory, and dangerous.

Similarities between developing a deaf identity and a sexual minority identity have been postulated upon the parallel experience of oppressed minority positions. Sign language interviews with eight deaf gay British men explored their intersectional understanding of deaf-gay lived experiences, analyzed through Interpretative Phenomenological Analysis. During their adolescence deaf gay men sometimes experienced being in a position where they were trying hard to be something they were not: oral and heterosexual for hearing non-signing others (including heterosexual members of their family of origin). Participants spoke of increasingly being drawn toward a welcoming signing cultural world that supported them against deaf minority stress. Coming out as gay presented not only potential family of origin difficulties, but also threatened connection with the deaf community, leaving participants intensely fearful of gay visibility and stigma. Self-fulfillment and community building was sought through positions that ranged from oralist-heteronormativity through to the deaf-gay community. Along the way these journeys included experiences of pride and success alongside those of struggle. Our findings extend research on intersectionality by presenting a distinct set of obstacles, caveats, and nuances to identity conjunction.

The Minority Stress Model has proposed that connectedness to a specific minority community may be a protective factor for stigmatized groups. This study evaluated the mediational role of connectedness with the gay men's and lesbian women's community on the relationship between two minority stressors (internalized homophobia and perceived sexual stigma) with anxiety-depressive symptomatology and life satisfaction. The sample consisted of 467 Chilean self-identified as gay men (57%) and lesbian women (43%). Results revealed that the two minority stressors were associated with anxiety-depressive symptomatology, but only internalized homophobia was associated with life satisfaction. The mediation hypothesis was partially supported by the relationship between internalized homophobia and life satisfaction. Unexpectedly, we found a negative association between connectedness with the gay men's and lesbian women's community and life satisfaction. This finding introduces a view that contrasts with the literature, which proposes that connectedness with the specific community would be a protective factor against sexual stigma.

Objectives: The purpose of this study was to explore the impacts of sexual stigma experiences on the mental health of older gay and bisexual men in Portugal., Methods: Self-identified older gay and bisexual men ( n  = 210) between 50 and 80 years old (mean age = 60.03; SD = 6.33) participated in this study. Measurement instruments included a sociodemographic questionnaire, the Brief Symptom Inventory-18, measures of suicidal ideation and intention, and the Sexual Stigma Scale., Results: Older gay and bisexual men with higher levels of sexual stigma presented significantly higher anxiety, depression, somatization, and suicidal ideation scores. Correlational analyses showed significant correlations among mental health variables and sexual stigma variables. Regression analyses showed that sexual stigma explained 11% of anxiety symptoms, 10% of depression symptoms, and 9% of somatization symptoms., Discussion: Sexual stigma has a negative impact on older gay and bisexual men's mental health. Mental health professionals should be aware of how sexual stigma affects sexual minority men's quality of life and work toward the reduction/elimination of sexual stigma in society.

The purpose of this study was to explore the perceptions of loneliness among gay and bisexual men in Portugal over 60 years old. Despite the growth of the older population in Portugal, the social isolation and loneliness experiences in older gay and bisexual men is only beginning to be understood. A structured electronic inquiry with 35 gay and bisexual men over 60 years of age from Portugal (mean age was 66.45 years (SD = 4.45) was used, ranging from 60 to 77 years). Data were analyzed using thematic analysis, comparing self-perceived loneliness levels by sexual orientation and by levels of loneliness. The recurrent themes in the narratives of loneliness perception of the participants in the study were as follows: Mental Health, Support System, Dating and Relationships, Discrimination, Coping, Personal Characteristics, and Coming-out issues. Differences between sexual orientation and levels of loneliness were also found.

This paper expands the scope of inquiry into HIV and aging through an ethnographic exploration of a small group of older, long-term (20 or more years) HIV+ gay white men in Toronto who meet fortnightly to discuss and reflect on everyday challenges of living with HIV but do not want to be affiliated with existing HIV/AIDS support organizations. Their discussions reveal a critique of professionalization and biomedical bias in contemporary mainstream Canadian HIV/AIDS discourses and support services, reflecting their shared experiences and memories of the HIV/AIDS epidemic in Canada over many decades. I argue that their frustration with and disengagement from contemporary mainstream HIV/AIDS discourses and support services, based on shared experiences and memories, produces a particular form of "queer viral time," developed through the intersectional dynamics of epidemiological time, gender, age, race and sexual orientation. Queer viral time draws attention to the temporal dimensions of socio-sexual subject formations, social inequalities, and health governance.

Objectives: This study sought to examine the association between perpetrator gender and victim gender and the use of sexually aggressive tactics (e.g., persistent enticement, verbal pressure, taking advantage of the inability to consent, and ignoring explicit non-consent). Methods: Participants were recruited from research panels to complete an online survey. They were asked to indicate which, if any, of 39 sexually aggressive tactics-representing four categories and nine subcategories-they had used to obtain sex, answering based on the gender with whom they most often have sex. Participants included 132 men who answered based on experiences with men (MSM), 131 men who answered based on experiences with women (MSW), 232 women who answered based on experiences with men (WSM), and 56 women who answered based on experiences with women (WSW). Results: MSM were more likely than all other groups to use enticement and more likely than WSM to engage in explicitly nonconsensual sex. WSM were more likely than MSW and WSW to take advantage of their partner's impaired ability to consent. There was no difference among groups in use of verbal pressure. Conclusions: Gendered sexual stereotypes may contribute to the types of tactics used by men and women against men and women., Competing Interests: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper., (© 2022 Taylor & Francis Group, LLC.)

This study explored experiences of HIV stigma among gay men in Finland and the impact of these experiences on decision-making concerning HIV status disclosure. Seventeen gay men living with HIV in Finland participated in a qualitative interview study and the data were analyzed using thematic analysis. The results focus on the following themes: (1) "Social support impedes social stigma;" (2) "Social support and the risk of HIV stigma," which describes how the pursuit of social support can expose some individuals to stigma; and (3) "HIV concealment motivation as a coping strategy," focusing on the motivation to conceal one's HIV status from others to avoid stigma. It is necessary to promote awareness and understanding of HIV in Finnish society, to challenge HIV stigma and, crucially, to facilitate access to social support among those diagnosed with HIV. This is likely to have favorable implications for both psychological and public health.

This qualitative study employed a cross sectional focus group design to explore how older gay men living with HIV, experience, perceive, and engage with advance care planning (ACP). Seven gay men 50+, residing in Montreal, Canada, participated in a focus group that was audio-recorded, transcribed, and thematically analyzed. Findings suggested that social isolation, preoccupations with day-to-day living, and managing disclosures related to sexual orientation and HIV status created barriers to these men's capacities to think about let alone talk about future care. These findings challenge current conceptualizations of ACP, which position reflection as an individual process that precedes allocating a decision-maker and communicating care preferences. Analyses further revealed that relational connections helped create a space where ACP could occur for participants. Hence, improving the uptake of ACP amongst older gay men with HIV may require interventions that embed such discussions into broader programs aimed at building support and community.

In this paper, we present the findings of a qualitative study aimed at conceptualizing the service needs of aging gay men living with HIV (GMLH). Our analysis is based on interview data from 16 gay-identified men living with HIV, ages 50 and over. Drawing on a framework of intersectionality, which theoretically accounts for interlocking expressions of marginalization in groups affected by multiple systems of oppression, we highlight the practical, social, and mental health needs of this population, as well as services that could be designed or adapted to address these concerns. We also emphasize the relevance of specialized training for caring professionals serving older GMLH, and articulate the need for initiatives that more fully engage gay men aging with HIV in the development and delivery of services intended for their use.

HIV continues to be a pressing problem, particularly for men who have sex with men (MSM). Pre-exposure prophylaxis (PrEP) is a highly effective means of preventing HIV infection, but adoption of it by MSM has been sluggish. Though there are many reasons for PrEP's limited adoption, healthcare providers' lack of skill in communicating with MSM likely plays a role. This study employed in-depth interviews with MSM who have adopted PrEP to explore how effective patient-provider communication surrounding PrEP takes place. Findings revealed that healthcare providers utilized five strategies to communicate with their MSM patients about PrEP. These strategies included (1) disclosure of identity and personal information; (2) knowledge of information that may be relevant to MSM patients; (3) positivity; (4) relationship inquiries; and (5) remaining calm. Employing the strategies uncovered in this study may be useful in improving communication between healthcare providers and their MSM patients and may help to increase MSM's adoption of PrEP.

Living alone is a risk factor for depressive symptoms among older gay men. It is likely this relationship strengthens as gay men age, due to social isolation and fewer family supports. This study investigated whether the relationship between living alone and depressive symptoms was moderated by age among older gay men. A community sample of 270 Australian gay men aged 60 to 91 years ( M = 68.81, SD  = 8.69) completed the Center for Epidemiologic Studies-Depression Scale. Results supported the moderation model. The Johnson-Neyman analysis indicated that living alone was associated with depressive symptoms among gay men aged older than 66.28 years. Results imply that gay men older aged in their mid-sixties and older who live alone are at increased risk of depressive symptoms, and are a group of men that need targeted interventions to reduce depressive symptoms.

We refined and replicated an efficacious brief intervention to reduce internalized homonegativity (IH) with a sample of gay and exclusively same-sex attracted men recruited from outside of LGBT community networks using Amazon Mechanical Turk. We sought to 1) determine if levels of IH differed between the original study's community-based sample and our non-community-based sample, 2) examine the efficacy of the replicated intervention, and 3) assess for longitudinal effects of the intervention at a 30-day follow-up. Four hundred eighty-four participants completed either the intervention or a stress management control condition. Mean levels of IH were higher in the current sample compared with the earlier study's community sample. The intervention was efficacious at reducing global IH, reducing personal homonegativity, and increasing gay affirmation. Ninety-six participants completed the follow-up; follow-up results were not significant and may have been affected by high rates of attrition. Implications for research and practice are discussed.

The LGBT community faces disproportionate healthcare disparities; poorly trained providers and stigma are likely contributors. Objectives: To evaluate the attitudes, opinions, and knowledge level of medical students regarding LGBT people and to examine which demographic variables are associated with more negative attitudes toward LGBT people. A cross-sectional study surveyed 561 medical students at Hanoi Medical University. Students held positive or very positive attitudes of both lesbians (96.3%) and gay men (88.1%). Students who were younger, female, and those with close relationships to LGBT people tended to have more positive attitudes toward gays and lesbians. The average score for the knowledge scale was 12.5 (total 32 questions) with a standard deviation of 4.7. Knowledge scores and positives attitudes were significantly, directly associated. Most students responded that there should be more LGBT-related content added in the curriculum. More research is needed regarding students in other health professions and at other institutions.

Homonegativity research tends to focus on the identities of gay men and lesbian women through inauthentic means such as vignettes and signifiers like t-shirts with pro-gay slogans. Such research also tends to neglect sexual behavior. These issues were addressed in the present mixed-methods study. Heterosexual male ( n = 196) and female ( n = 219) participants were asked to complete measures of old-fashioned and modern homonegativity toward gay men and lesbian women after viewing a set of stimuli depicting gay male, lesbian female, or heterosexual couples. Participants also completed an interview with the researcher where he self-identified as a gay male and observed any changes in behavior following his disclosure. Findings indicated that male participants showed higher levels of modern homonegativity than female participants, regardless of the images viewed, and had higher odds of exhibiting negative behavioral change in response to the researcher's self-disclosure. Also, participants who viewed images of lesbian couples kissing or embracing had lower odds of showing negative behavioral change.

The mediating effect of perceived social support on the influence of insecure attachment orientations on internalized homophobia was assessed in a group of 70 Italian gay men (mean age = 28.8, SD = 6.2, range: 19-46 years). Participants completed self-report measures of adult attachment (Experiences in Close Relationships-Revised), perceived social support (Multidimensional Scale of Perceived Social Support), and internalized homophobia (Measure of Internalized Sexual Stigma for Lesbians and Gay). Higher levels of attachment anxiety and avoidance, and perceptions of lower social support were correlated with higher levels of internalized homophobia. The mediation analyses showed that only attachment anxiety, but not avoidance, may have a direct link with internalized homophobia, while both anxiety and avoidance may have an indirect influence on internalized homophobia mediated by perceived social support. Improving social support can reduce the negative effects of homophobia on gay men, thus mitigating the detrimental fallout of any insecure attachment orientations.

The number of gay, bisexual, and other men who have sex with men taking pre-exposure prophylaxis (PrEP) has grown since its approval in Canada. While there are sound clinical data on PrEP efficacy, there is less research describing outcomes in routine clinical practice. We conducted a cross-sectional study with 113 men attending our PrEP clinic. Participants completed a one-time survey and chart reviews were conducted. We found that men in our clinic were educated and affluent. While PrEP did not lead to more reported sexual partners, condom use declined, as did sexual anxiety. These results reinforce that PrEP benefits extend beyond HIV prevention., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2021 Taylor & Francis Group, LLC.)

In the United States, legal marriage has found itself simultaneously serving as a pact made by two individuals, an agreement under the state's control, and a legal status with social implications. The influences of legal marriage on social levels are not monolithic, as a result, there is not a comprehensive definition of marriage that supports the diverse relationships that exist, including same-sex marriage. Moreover, explicit attention to verbal communication in reference to these relationships has rarely been documented. Utilizing a qualitative framework and semi-structured interviews, this study investigated the relationship between marriage equality and its impact on language appropriation for 28 gay men living in various parts of the United States. Results of analysis situated in grounded theory via the constant comparative method indicated that for many in this sample, access to legal marriage facilitated unapologetic use of language associated with marriage, irrespective of one's own marital status. These findings are in stark contrast to studies exploring adoption of marriage language by lesbian women. Implications across private and public arenas are discussed.

Nationally representative data comparing demographic, risk, and clinical information among bisexual men with other MSM or heterosexuals are lacking. We described differences in demographic characteristics, behaviors, and clinical outcomes among self-identified HIV-positive bisexual, gay, and heterosexual men receiving HIV medical care in the United States. We analyzed data from the 2009-2013 cycles of the Medical Monitoring Project (MMP), a surveillance system that provides nationally representative estimates of behavioral and clinical characteristics of adults with diagnosed HIV in medical care. Altogether, 10% (95% confidence interval [CI] 9-11) of men self-identified as bisexual, 56% (CI 51-61) as gay, and 32% (CI 28-37) as heterosexual. We observed significant differences in demographic factors, clinical outcomes, drug use, and sexual behavior among bisexual men compared with gay and heterosexual men. Providers should consider sexual identities as well as sexual behaviors when developing and implementing prevention programs.

Research has suggested that men in relationships are more physically active than men who are single. This study provides a weighted analysis of physical activity by coupling status for men of different sexual orientations. Aggregated data from the United States 2013-2014 National Health Interview Survey were used to conduct multivariate logistic regression analyses. Compared to straight men ( n = 29,926), gay men ( n = 623) were less likely to be in a relationship (AOR 0.32, CI: 0.25-0.41). Coupled gay men did more physical activity than coupled straight men and were 1.62 (CI: 1.05-2.50) times more likely to be active, 1.67 (CI: 1.10-2.51) times more likely to be high active, 1.89 (CI: 1.24-2.89) times more likely to engage in muscle-strengthening activities, and 2.00 (CI: 1.28-3.11) times more likely to meet aerobic and muscle-strengthening recommendations. Coupling facilitates physical activity for men. However, more research is needed to help explore underlying mechanisms for differences by sexuality.

Several studies have highlighted the relationship between internalized sexual stigma (ISS) and dissociation. The aim of the present study was to empirically investigate this relationship through a quantitative study. The Measure of Internalized Sexual Stigma for Lesbians and Gay Men (MISS-LG) and the Dissociation Scale (DIS) of the Trauma Symptom Inventory (TSI) were administered to 120 Caucasian participants who self-identified as gay men. Findings suggested that dissociative symptomatology, as measured by DIS-an estimation of the use of dissociation as a defense mechanism-was positively associated with MISS general index and all dimensions of MISS, especially the sexuality dimension (ISS-S). Moreover, the effect of the ISS-S on DIS was amplified in Catholic participants, suggesting a moderating role of religiosity. Implications for future research and clinical practice are discussed.