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BackgroundLesbian, gay, bisexual, transgender, queer, intersex, aromantic and asexual (LGBTQIA+) communities in the United States experience higher rates of alcohol use than the general population. While experiencing intimate partner violence (IPV) is thought to lead to increased alcohol use in LGBTQIA+ people, little research has investigated the temporal relationship between IPV and alcohol use in this population.MethodsData from two annual questionnaires of The Population Research in Identity and Disparities for Equality Study (The PRIDE Study) longitudinal cohort (n=3,783) were included. Overall IPV and three sub-types (physical, sexual, and emotional) - measured in 2021 using the extended Hurt, Insult, Threaten, Scream (E-HITS) screening tool - was examined as a predictor of Alcohol Use Disorders Identification Test (AUDIT) score in 2022 using multivariable linear regression to assess linear and quadratic associations. Models were adjusted for sociodemographic characteristics and history of alcohol use.ResultsOne-quarter (24.7%) of respondents reported experiencing past-year IPV in 2021. The mean AUDIT score in 2022 was 3.52 (SD = 4.13). In adjusted models, both linear (B: 0.26, 95% CI: 0.14, 0.38) and quadratic (B: -0.03, 95% CI: -0.04, -0.01) terms for overall IPV were significantly associated with next-year AUDIT score. These patterns were mirrored in each IPV sub-type, were not attenuated when accounting for relationship characteristics, and were heterogeneous across gender identity groups.ConclusionsThese results provide evidence of a temporal relationship between IPV and alcohol use in LGBTQIA+ communities, suggesting that efforts to prevent and mitigate IPV may help reduce alcohol use disparities in this population.

BackgroundSexual well-being is fundamental to physical and emotional health, and the ability to achieve it depends on access to comprehensive sexuality information and high-quality sexual health care from evidence-informed, nonjudgmental providers. Adequate and timely delivery of these components to individuals who are at high risk for sexually transmitted infections (STIs), including HIV, and unintended pregnancies promotes sexual health and mitigates consequences arising from risky sexual behavior. Brief interventions that allow health care providers to improve the information available to clients and motivate and help them to develop risk-reduction skills are seen as efficient ways to improve knowledge, change client behavior, and reduce provider stigma regarding sexual health. ObjectiveThe aim of the study is to evaluate five aspects of feasibility (acceptability, willingness, safety, satisfaction, and process) of a brief sexuality-related communication (BSC) intervention based on motivational interviewing and behavior change techniques in primary health care settings in low- and middle-income countries (LMICs). MethodsThis protocol outlines a multisite, multiphase study of feasibility of a BSC intervention in primary health care settings in LMICs that will be examined across four phases of the study. Phases I through III involve the collection of formative, qualitative data to examine provider and client perceptions of the feasibility of the intervention, adaptation of the intervention guide, and training providers on how to implement the final version of the BSC intervention. During phase IV, the feasibility of the intervention will be tested in a nonrandomized pre-post test trial where providers and clients will be followed for 6 months and participate in multiphase data collection. ResultsPhase I is currently underway in Moldova, and phases I and II were completed in Peru in late 2019. Results are expected for the feasibility study in 2021. ConclusionsThis feasibility study will determine whether the implementation of brief intervention programs aimed at improving sexual health outcomes is possible in the constraints of LMIC health systems and will add to our understanding of factors shaping clinical practice among primary care providers. International Registered Report Identifier (IRRID)DERR1-10.2196/15569

Background: Lesbian, gay, bisexual, transgender, queer, intersex, aromantic and asexual (LGBTQIA+) communities in the United States experience higher rates of alcohol use than the general population. While experiencing intimate partner violence (IPV) is thought to lead to increased alcohol use in LGBTQIA+ people, little research has investigated the temporal relationship between IPV and alcohol use in this population. Methods: Data from the two years of The Population Research in Identity and Disparities for Equality Study (The PRIDE Study) longitudinal cohort (n=3,783) were included. Overall IPV and three sub-types (physical, sexual, and emotional), measured in 2021 using the extended Hurt, Insult, Threaten, Scream (E-HITS) screening tool, was examined as a predictor of respondents’ Alcohol Use Disorders Identification Test (AUDIT) score in 2022 using multivariable linear regression to assess linear and quadratic associations. Models were adjusted for sociodemographic characteristics and history of alcohol use disorder. Results: One-quarter (24.7%) of respondents reported experiencing past-year IPV in 2021. The mean AUDIT score in 2022 was 3.52 (SD = 4.13). In adjusted models, both linear (b: 0.32, 95% CI: 0.19, 0.45) and quadratic (b: -0.03, 95% CI: -0.05, -0.01) terms for overall IPV were significantly associated with next-year AUDIT score. These patterns were mirrored in each IPV sub-type and were not attenuated when restricted to those currently in a relationship. Conclusions: These results provide evidence of a temporal relationship between IPV and alcohol use in LGBTQIA+ communities, suggesting that efforts to prevent and mitigate IPV may help reduce alcohol use disparities in this population.

Author(s): Elliott R. Weinstein [sup.1] , Raymond Balise [sup.2] , Nicholas Metheny [sup.3] , Maria Jose Baeza Robba [sup.3] , Daniel Mayo [sup.4] , Cassandra Michel [sup.1] , Bill Chan [...], Minoritized communities are underreached by biomedical interventions, such as the COVID-19 vaccine. This mixed-methods study identified factors associated with vaccine likelihood (VL) and uptake (VU) among 187 Latino sexual minority men (LSMM) in South Florida. Regression models with LASSO variable selection and Classification and Regression Trees (CART) assessed determinants of VL and VU while open-ended questions were evaluated using thematic content analysis. VL (range 1-7; M = 6.00, SD = 1.84) and VU (63.6%) was high. LASSO modeling identified being insured, worrying about others, fear of transmitting COVID-19, and financial stress as the most influential factors for VL; working remotely from home was important for VU. Time (weeks) since addition of COVID-19 vaccination-related questions (December 2nd, 2020) was associated with both outcomes across both modeling techniques. Convergence between data suggests capitalizing on altruistic motivations and improving accessibility to vaccine campaigns are valuable assets to increase LSMM's vaccine confidence.

The HIV incidence rate in Miami-Dade County is among the highest in the United States, with Latinx sexual and gender minority (SGM) groups experiencing a disproportionate burden. Despite extensive efforts by both private and public sectors to curb transmission and improve pre-exposure prophylaxis (PrEP) uptake, Latinx SGM groups continue to have high rates of HIV and low PrEP uptake compared to SGM groups overall. Using data collected from a biobehavioral study of the socio-structural factors affecting HIV susceptibility and PrEP uptake among Latinx SGM subgroups in Miami-Dade County, this paper shares lessons learned and provides concrete recommendations for tailoring survey research and biospecimen collection among a largely immigrant, socioeconomically disadvantaged community that is especially vulnerable to HIV. By drawing inferences from study data and contextualizing these with community partners, we learned: (1) Large parts of the target community may be unfamiliar with the underlying constructs captured in important HIV-related measures; (2) Cash incentives may shift motivation from intrinsic to extrinsic and lead to poorer data quality; (3) Deviations in Spanish go beyond vocabulary used in different Latin American countries, and more formal Spanish may relay concepts in unfamiliar ways that are unapproachable; and (4) community members may be unfamiliar with survey data collection processes and the protections in place to ensure confidentiality. These lessons and associated recommendations may help improve recruitment, study design, analysis, and community engagement in future studies, building trust and ultimately reducing the burden of HIV in these communities. [ABSTRACT FROM AUTHOR]

Background: Latina women in the United States experience intimate partner violence (IPV) at high rates, but evidence suggests Latinas seek help for IPV at lower rates than other communities. Safety planning is an approach that provides those experiencing IPV with concrete actions to increase their safety and referrals to formal services. While safety planning is shown to reduce future incidences of violence, little is known about the safety planning priorities of Latinas. Approach: This study leveraged Group Concept Mapping, a mixed-method process consisting of brainstorming, sorting, rating, and interpreting. First, 17 Latinas who were survivors of IPV and/or professional advocates generated responses to a focal prompt. Next, 19 participants pile-sorted a list of unduplicated responses into categories. Data were analyzed using multidimensional scaling and hierarchical cluster analysis and results were iteratively refined by the study team. Forty-two Latina participants in Chicago and Miami rated each item based on its necessity for safety using two scenarios: if a survivor planned to leave a partner or remain in the relationship. Bivariate correlation analyses were used to examine differences in safety planning priorities across multiple axes. Finally, results were shared with participants for feedback and contextualization. Results: Combined, a total of 46 Latinas participated in data collection activities. Brainstorming and sorting data generated seven clusters of safety planning needs. Statistically significant differences in cluster rating were found for women who intended to leave a relationship (for whom legal services was most necessary) versus those who intended to stay (for whom safety planning services were critical) and those in Chicago versus those in Miami. Conclusions: This study contributes to the small, but growing, literature regarding safety planning needs of Latinas in the US and illustrates potential ways in which future safety planning interventions should be tailored to these communities. [ABSTRACT FROM AUTHOR]

Sexual and gender minority (SGM) adults in South Africa face high levels of violence and poor mental health outcomes. Interventions to prevent these negative health implications are hampered by a lack of representative data among this population. This study aims to quantify the associations between three forms of violent victimization and depressive symptoms in a sub-sample of SGM drawn from a population-based cross-sectional study in Gauteng, South Africa. Data come from the sixth Quality of Life survey conducted in South Africa's Gauteng province. Brief screeners assessed childhood sexual abuse (CSA), past-year intimate partner violence (IPV), non-partner violence, and depressive symptoms. Three survey-weighted logistic regression analyses were fit to model associations between elevated depressive symptoms and CSA, past-year IPV, and past-year non-partner violence, controlling for socio-demographics (age, race, sex, area of residence, education, socioeconomic status, and recent employment). N = 1,328 SGM respondents were included. Over 40% (n = 537) reported depressive symptoms, while 17% (n = 222) reported CSA, 5% (n = 67) reported IPV, and 16% (n = 208) reported non-partner violence. CSA and non-partner violence were associated with significantly higher odds of reporting depressive symptoms (aOR: 1.51, 95% CI [1.03, 2.23]; aOR: 1.84, [1.24, 2.73], respectively). IPV was not associated with elevated depressive symptoms (aOR: 1.17, [0.64, 2.16]). In all models, employment in the past 7 days was associated with significantly lower odds of reporting depressive symptoms. Recent and childhood violence is a major burden that is associated with elevated symptoms of depression among SGM in urban South Africa. Community-tailored interventions and policy-related advocacy related to employment and violence prevention may alleviate depressive symptoms in SGM adults in Gauteng. [ABSTRACT FROM AUTHOR]

The article focuses on promoting health equity to address gender-based violence (GBV) through innovative research, practice, and advocacy. Topics include violence training and education for healthcare professionals, the barriers and facilitators of help-seeking behaviors among GBV survivors, and the intergenerational and long-term effects of violence on health outcomes.

Context: LGBTQIA+ people worldwide experience discrimination, violence, and stigma that lead to poor health outcomes. Policy plays a crucial role in ensuring health equity and safety for LGBTQIA+ communities. Given Lancet Commissions' substantial impact on health policy across domains, we aimed to determine how LGBTQIA+ communities and their care needs are incorporated throughout Lancet Commission reports and recommendations. Methods: Using critical discourse analysis, we analyzed 102 Commissions for inclusion of and reference to LGBTQIA+ communities using 36 key terms. Three levels of analysis were conducted: 1) micro-level (overview of terminology use); 2) meso-level (visibility and placement of LGBTQIA+ references); and 3) macro-level (outlining characterizations and framing of references with consideration of broader social discourses). Findings: 36 of 102 (35%) Commissions referenced LGBTQIA+ communities with 801 mentions in total. There were minimal (9/36) references made in the "Executive Summary," "Recommendations," and/or "Key Messages" sections of reports. LGBTQIA+ communities were most frequently discussed in reports related to HIV/AIDS and sexual and reproductive health. Few Commissions related to public health, or chronic conditions (9/60) referenced LGBTQIA+ communities. Some reports made non-specific or unexplained references; many discussed the LGBTQIA+ population without specific reference to sub-groups. LGBTQIA+ communities were often listed alongside other marginalized groups without rationale or a description of shared needs or experiences. We identified framings (legal, vulnerability, risk) and characterizations (as victims, as blameworthy, as a problem) of LGBTQIA+ communities that contribute to problematizing discourse. Conclusions: LGBTQIA+ people were rarely included in the Commissions, resulting in an inadvertent marginalization of their health needs. Policy initiatives must consider LGBTQIA+ groups from a strengths-based rather than problematizing perspective, integrating evidence-based approaches alongside community-based stakeholder engagement to mitigate inequities and promote inclusive care and policymaking. [ABSTRACT FROM AUTHOR]

Violence against children (VAC) in the home, or by household members, is a human rights and social problem with long-lasting consequences for individuals and society. Global policy instruments like the INSPIRE package have proposed strategies to prevent VAC, including Implementation and enforcement of laws, Norms and values, Safe environments, Parent and caregiver support, Income and economic strengthening, Response and support services, and Education and life skills. This systematic review of reviews aimed to synthesize the recent evidence base (i.e., published since 2000) for each INSPIRE strategy to reduce VAC in the home or by household members. We searched four databases using controlled vocabularies and keywords and searched for additional records in prior reviews of reviews. A total of 67 studies were included in this review, including literature reviews, meta-analyses, systematic reviews, and other types of reviews. We found extensive evidence supporting the effectiveness of parent and caregiver support interventions. However, reviews on other INSPIRE strategies were scarce. We also found a vast underrepresentation of samples from low- and- middle-income countries, children with disabilities, and families affected by forced displacement and conflict. In sum, this systematic review suggests that there are several promising strategies to prevent VAC (e.g., home visiting and parent education), but further research is necessary to strengthen the current body of evidence and effectively inform the implementation and scale-up of evidence-based interventions to protect children from violence globally. [ABSTRACT FROM AUTHOR]

Author(s): Nicholas Metheny [sup.1] [sup.2] , Rob Stephenson [sup.1] [sup.2] Author Affiliations: (1) grid.214458.e, 0000000086837370, University of Michigan School of Nursing, , 400 North Ingalls St, 48109, Ann Arbor, MI, [...], Women in India experience high rates of intimate partner violence (IPV) and low rates of adherence to World Health Organization (WHO) breastfeeding guidelines, contributing to poor maternal and child health outcomes. However, there is little evidence for how IPV might influence ability to adhere to these guidelines in India. This study examines how different forms and severity levels of IPV are associated with current infant feeding behavior throughout the first year of life in an effort to begin to fill this gap in the literature and provide information to improve infant feeding programs. Data are analyzed from the 2015 Indian National Family Health Survey. The sample comprised women who reported initiating breastfeeding in the past 12 months and who were selected for the Domestic Violence Module (n = 6812). Two outcome variables were created to measure current adherence to the WHO breastfeeding guidelines for mothers of 1) infants 6 months and younger and 2) infants 7 to 12 months. Two logistic regression models were fit to measure associations between the outcome variables and non-severe physical violence, severe physical violence, and sexual violence. Less than one-third of women reported adhering to WHO breastfeeding guidelines. Only severe physical violence was significantly associated with lower odds of current exclusive breastfeeding among mothers of infants 0 to 6 months. This analysis advances the understanding of how IPV is associated with suboptimal breastfeeding behavior by categorizing the severity of violence and including infants through the first year of life. The results suggest it may be crucial to focus intervention efforts on mothers with younger infants if the negative health effects of early weaning are to be avoided. Additional study of IPV in mothers of older infants should focus on the temporality of violence, which may elucidate additional findings regarding IPV and breastfeeding in this population.

Author(s): Nicholas Metheny [sup.1] [sup.2] , Rob Stephenson [sup.1] [sup.2] Author Affiliations: (Aff1) 0000000086837370, grid.214458.e, University of Michigan School of Nursing, , 400 North Ingalls St., 48109, Ann Arbor, MI, [...], Ongoing internal conflict, high gender inequality, and a patriarchal society contribute to a high prevalence of intimate partner violence towards women (IPV) in Afghanistan. Seeking help from formal and informal sources can provide social support to IPV survivors, buffering negative health consequences. The purpose of this study is to examine the individual, interpersonal, and community-level factors associated with help-seeking for physical, sexual, and emotional IPV in Afghanistan using a nationally-representative sample of women aged 15-49. Data for this analysis comes from the 2015 Afghanistan Demographic and Health Survey. The outcome variable is a binary measure of informal or formal help-seeking behavior among women who reported physical, sexual, or emotional IPV in the last 12 months. Drawing on existing theory of help-seeking for IPV, key covariates included summative indices of health care use, decision-making power, and barriers to accessing health care measured at both the individual and community levels using multilevel modeling. Nearly half (46%) of women in the dataset reported experiencing some type of IPV in the past 12 months. Among the 20% of women who reported seeking help for IPV, informal sources of support were used almost universally. Engagement with the health care system, barriers to accessing health care, and decision-making power were all significantly associated with seeking help for IPV. IPV is widespread in Afghanistan and help-seeking is uncommon. A better understanding of what shapes help-seeking in this context may allow more women to disclose violence, increasing social support and reducing the negative health effects of IPV.

Debates on how sex, gender, and sexual identity relate to intimate partner violence (IPV) are longstanding. Yet the role that measurement plays in how we understand the distribution of IPV has been understudied. We investigated whether people respond differently to IPV items by sex and sexual identity and the implications this has for understanding differences in IPV burdens. Our sample was 2,412 randomly selected residents of Toronto, Canada, from the Neighborhood Effects on Health and Well-being (NEHW) study. IPV was measured using short forms of the Physical and Nonphysical Partner Abuse Scales (20 items). We evaluated the psychometric properties of this measure by sex and sexual identity. We examined whether experiences of IPV differed by sex and sexual identity (accounting for age and neighborhood clustering) and the impacts of accounting for latent structure and measurement variance. We identified differential item functioning by sex for six items, mostly related to nonphysical IPV (e.g., partner jealousy). Males had higher probabilities of reporting five of the six items compared to females with the same latent IPV scores. Being female and identifying as lesbian, gay, or bisexual were positively associated with experiencing IPV. However, the association between female sex and IPV was underestimated when response bias was not accounted for and outcomes were dichotomized as "any IPV." Common practices of assuming measurement invariance and dichotomizing IPV can underestimate the association between sex or gender and IPV. Researchers should continue to attend to gender-based and intersectional differences in IPV but test for measurement invariance prior to comparing groups and analyze scale (as opposed to binary) measures to account for chronicity or intensity. [ABSTRACT FROM AUTHOR]