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Monosexism has been increasingly recognized as a minority stressor uniquely experienced by plurisexual individuals. The present study investigated the effects of monosexist discrimination on mental health and examined the moderating role of gender and sexual identity integration (i.e., negation, authenticity, and disclosure). In a sample of 314 bisexual and pansexual individuals in Hong Kong (73.9% women and 26.1% men), the results showed that monosexist discrimination was associated with higher levels of depression and anxiety symptoms, above and beyond heterosexist discrimination. The association between monosexist discrimination and depression symptoms was stronger among bisexual and pansexual men than women, despite there being no gender differences in vulnerability to monosexist discrimination. Moreover, sexual identity negation, authenticity, and disclosure moderated the associations of monosexist discrimination with depression and anxiety symptoms, such that the associations were not significant among those with more positive integration of sexual identity (i.e., lower levels of sexual identity negation as well as higher levels of sexual identity authenticity and disclosure). This study provides insight into the deleterious impact of monosexism and the protective role of sexual identity integration. Implications for plurisexual-affirming psychological intervention, public policy, and community practice are discussed.

Minority stress remains pervasive in various aspects of life among sexual minorities. Driven by the awareness of social injustice, some sexual minority individuals may undertake collective action to counteract discrimination, but this does not apply to all members of sexual minorities. The present study used a prospective, longitudinal research design to examine how different dimensions of minority stress (i.e., perceived discrimination and internalized stigma) interact to affect group identification and collective action. A total of 628 sexual minority individuals in Hong Kong were involved in the study. The results showed that prior discriminatory experiences were positively associated with collective action at follow-up through increased levels of group identification and commitment to social justice. The moderating effect of internalized stigma was found in which perceived discrimination was not significantly related to group identification and collective action among those with high levels of internalized stigma. The study extends the literature on the rejection-identification model by understanding collective action as a form of group-level coping in the face of discrimination. It highlights the importance of fostering group identification, strengthening collective action, and mitigating internalized stigma among sexual minorities in psychological practice.

Sexual minority stress affects not only lesbian, gay, and bisexual (LGB) individuals, but also their families. Due to the pervasiveness of stigma and discrimination, parents of LGB children often express concerns about the public perception of their child's sexual orientation and its possible impact on children, parents, and families. The concerns are particularly pertinent to parents in Chinese families, where there is a strong bond between parents and children. The present study seeks to understand the different dimensions of concerns among Chinese parents of LGB children and examine how these concerns affect their mental health. A total of 146 parents of LGB children in Hong Kong were recruited to participate in a survey regarding attitudes and concerns about their child's sexual orientation. The results revealed three areas of concern, which reflect parental worries about how a child's LGB identity may negatively impact the child, parent, and family. Parents who viewed homosexuality and bisexuality as innate and accepted their child's sexual orientation were likely to show fewer concerns. The results of structural equation modeling indicated that parental acceptance was negatively related to depression and anxiety symptoms through lower levels of child-oriented and family-oriented concerns. As accepting a child's sexual orientation is the key to reducing parental concerns and mental health problems, family-focused psychoeducation is needed to provide parents with accurate information about sexual orientation and foster supportive attitudes toward their LGB child. Clinicians and human service providers should also address child-oriented and family-oriented concerns among parents of LGB adolescents who are more inclined to be concerned about their child's sexual orientation.

Pre-exposure prophylaxis (PrEP) stigma has been found to be a major barrier to PrEP acceptability and uptake. Research has found that different ethnic/cultural groups display varying levels of PrEP stigma. This article studies sex conservatism and internalized homonegativity as two sexuality- and culture-related aspects that influence PrEP stigma and intention to use PrEP. An online survey of 279 young gay and bisexual men in Hong Kong found that internalized homonegativity was positively associated with PrEP stigma. Respondents who were more conservative about sex showed lower intention to use PrEP, whereas those who had higher income and more positive attitudes about PrEP were more likely to express intention to use PrEP. This study provides novel empirical evidence for understanding PrEP stigma and uptake from a sexuality and cultural perspective. The influence of sexuality- and culture-related factors on PrEP stigma and uptake warrants greater attention, especially in the Asia-Pacific region.

Differentiation of self (DoS) is the self-regulatory capacity to balance intimacy and autonomy in relationships. Accumulating evidence suggests that DoS is fundamental to achieving a satisfying and fulfilling life. The ability may be even more relevant to lesbian, gay, and bisexual (LGB) individuals who are often in a continual struggle between disclosing their sexual identity and gaining social acceptance. However, less is known about whether and how DoS influences their experiences of proximal minority stress and life satisfaction. The present study proposed a dual-process model to explain the association between DoS and life satisfaction among sexual minorities. A total of 219 sexual minority individuals participated in the study and completed a self-report questionnaire on DoS, proximal minority stress, self-esteem, loneliness, and satisfaction in life. The results revealed the intrapersonal and interpersonal processes underlying DoS and life satisfaction, such that the association between DoS and life satisfaction was mediated by self-esteem and loneliness, respectively. Moreover, the results identified a minority stress-specific pathway through which DoS was linked to life satisfaction through reduced levels of proximal minority stress and loneliness. The findings provide empirical evidence for the role of DoS as a crucial factor in shaping how sexual minority individuals negotiate their boundaries and relationships with other people, which may affect their life satisfaction. Implications on social-emotional learning and LGB-affirmative psychological interventions for fostering DoS among sexual minority individuals were discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

As a common experience for sexual minority individuals, sexual orientation concealment has complex implications. Self-determination theory (SDT) and previous studies suggest a mediation path where hiding sexual orientation is associated with well-being through eroding lesbian, gay, bisexual-specific authenticity and inducing loneliness. However, this relationship has rarely been examined using longitudinal data. This study also built on minority stress theory to determine whether the psychological process of concealment operates differently as a function of perceived acceptance in different contexts. A community sample of 636 sexual minority individuals in Hong Kong (48.3% men, 50.5% women, and 1.3% transgender and nonbinary individuals; mean age = 25.36 years) was recruited through lesbian, gay, bisexual, and transgender (LGBT) social media, nongovernmental organizations, and social venues to complete a baseline and 1-year follow-up survey. The results showed that loneliness mediated the relationship between concealment and well-being. Moreover, the mediation path from concealment to well-being via loneliness was moderated by the perceived LGBT-friendliness of the family. The negative association between concealment and well-being was only significant when the family was perceived as supportive of sexual and gender minorities. The study findings elucidated the complex mechanisms involved in the adverse outcomes of sexual orientation concealment and highlighted the importance of loneliness and family context when working with sexual minority clients on their concerns over sexual orientation concealment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has resulted in the disruption of provision of human immunodeficiency virus (HIV) services. This study examined the factors associated with difficulties in accessing HIV services during the COVID-19 pandemic. METHODS: An online survey of 236 Chinese-speaking gay and bisexual men in Hong Kong conducted in 2020. RESULTS: Among those who expressed a need to access HIV services during the COVID-19 pandemic, 22.9%, 33.9% and 43.2% indicated moderate-to-high, mild and no difficulties in accessing these services, respectively. Difficulties in accessing HIV services were positively related to concerns about potential COVID-19 infection, experience of actual impact on health because of COVID-19, disruption in work/studies, and reduced connection to the LGBT+ community during the pandemic. It was also found that difficulties in accessing HIV services were positively associated with frequency of having sex with casual partners, but were not significantly associated with frequency of having sex with regular partners. CONCLUSIONS: This study provides novel empirical evidence for understanding difficulties in accessing HIV services during the COVID-19 pandemic. It found that disruption in work/studies and frequency of having sex with casual partners were associated with difficulties in accessing HIV services.

COVID-19 not only threatens people's physical health, but also creates disruption in work and social relationships. Parents may even experience additional strain resulting from childcare responsibilities. A total of 129 parents participated in this study. Parents of children with developmental disorders showed higher levels of parenting stress, depressive symptoms, and anxiety symptoms than did parents of children with typical development. Parenting stress and health worries were positively related to mental health symptoms. The association between having a child with developmental disorders and mental health symptoms was mediated by parenting stress. This study provides a timely investigation into the stress and mental health of parents during the COVID-19 pandemic. Implications on web-based parenting skills interventions, online psychological support services, and family-friendly policy initiatives are discussed.

Purpose: Health disparities among sexual minority men remain and continue to demand novel interventions. Other than risk reduction, a promising approach is to identify pathways to health-promoting ...

Previous research has utilized a typological approach to characterizing intergenerational relationships and exploring their associations with children’s socioemotional outcomes. This study applied this method to Taiwanese gay and bisexual men via a tentative typology constituted by two conditions: co-residence with, and outness to, parent(s). Aside from describing the prevalence of different types of living arrangement, we further examined their links with the internal drivers, filial piety and internalized homophobia, and life satisfaction. Age group difference and the moderation effect of typology on the association between internal drivers and life satisfaction were also investigated. A cross-sectional survey was completed by a sample of Taiwanese gay and bisexual men recruited via Facebook. Besides reporting their co-residence and outness status, respondents also completed the Contemporary Filial Piety Scale, Chinese Internalized Homophobia Scale, and Satisfaction with Life Scale. Descriptive statistics, ANCOVA, and moderation analysis were performed for young adults and early middle-aged adults separately. While half of the total sample lived with parents, more than half (65.5%) were not out to them. Comparison of categories shows that closeted young adults reported significantly stronger internalized homophobia. Among early middle-aged men, those who were not out to and living with parent(s) reported the highest filial obligations and lowest life satisfaction compared with other groups. This study contributes to existing knowledge about various forms of family environments and the ways they are involved in Taiwanese gay and bisexual men’s lives. Implications for the use of this typology in social policy and practice are discussed

Despite persistent stigmatization of people living with HIV (PLHIV) across the globe, group identification among these individuals may serve to counteract the detrimental effect of prejudice and discrimination associated with the stigmatized identity. Drawing on resilience theory and social identity theory, this study examined how multiple dimensions of group identification (i.e., in-group ties, in-group affect, and centrality) function to buffer and neutralize the negative impact of HIV stigma. A total of 281 PLHIV were recruited from the only community-based public HIV clinic in Hong Kong to participate in this study. The results revealed a protective effect of in-group affect, which moderated the relationship between HIV stigma and mental health, such that HIV stigma was not associated with mental health among people with higher positive in-group affect. In addition, a positive compensatory effect of in-group ties was found in people with higher HIV identity centrality. Given the protective effect of in-group affect, it is important to re-story the lives among PLHIV by challenging their maladaptive beliefs about being PLHIV and building a positive sense of identity in their personal narratives. Community-based interventions should be provided to individuals with higher HIV identity centrality by offering peer support groups and engaging them in community work.

As HIV is one of the most stigmatizing health conditions, people living with HIV (PLHIV) continue to experience multiple forms and sources of stigmatization, which negatively impact their quality of life. The present study proposed a dual-process model to understand the different manifestations of HIV stigma and examine how they relate to each other and affect psychological distress and life satisfaction in PLHIV. Two hundred and ninety-one PLHIV in Hong Kong participated in the study and completed a self-report questionnaire on HIV stigma, psychological distress, and life satisfaction. Structural equation modeling was conducted to examine the mechanisms underlying HIV stigma and mental health. Around one-third of the participants experienced HIV-related avoidance and/or discrimination in different domains of life over the past year. Enacted stigma toward PLHIV was highly pronounced in Hong Kong, especially among general healthcare providers. The results revealed the interpersonal and intrapersonal processes underlying HIV stigma and mental health. While enacted stigma had a direct effect on psychological distress and life satisfaction, PLHIV might also internalize the stigmatizing beliefs associated with HIV identity, which were related to greater psychological distress and poorer life satisfaction. Stigma reduction programs that target non-HIV healthcare workers are recommended to confront their misconceptions and biases toward PLHIV. Given the high prevalence of self-stigma, psychological interventions that focus on restructuring negative beliefs about PLHIV and reconstructing a self-empowering and positive identity are necessary to promote better mental health and quality of life.

In recent years, a “business case” has emerged to argue that social policies and practices that exclude sexual minorities are not only socially unjust but also economically costly for an organization and the society. This paper asks: in an era of globally uneven sexual landscape, what are the consequences of non-inclusive policies and practices for the retainment or attrition of sexual minority talents? An online survey with 920 lesbian, gay and bisexual (LGB) people, one of the largest of its kind in Hong Kong, was conducted in 2016. It was found that 52.5% had considered leaving because of the lack of LGB-relevant social policies. It was also found that LGB people who showed a desire and a need to access LGB-relevant social policies, those who perceived LGB-relevant social policies as important, and those who were on higher income levels were more likely to have considered emigration. The top four countries that were named as desired migration destinations by the LGB people were Canada, Taiwan, the USA, and the UK. This paper coins the term “gay brain drain” to connect the research literature on LGB-related social policies, sexual migration, and brain drain. Differential treatment towards sexual minorities is not only socially unjust but also means that the society would lose out on attracting and retaining the best homegrown talents.

Social movement has been recognized as a driving force of structural and/or policy changes in the broader society; however, its psychological effects on the movement participants have rarely been examined. Grounded in psychopolitical validity framework, the present study utilized a longitudinal prospective design to follow a group of civically engaged youth and examined how social movement participation is linked to their political efficacy and well-being. A total of 490 youth participating in the Umbrella Movement in Hong Kong were recruited during the occupation period of the movement and were followed up for three times with a 4-month interval in the year following the movement. The results of latent profile analysis identified four types of participation, namely minimal participation, onsite participation, online participation, and avid participation. Subgroup analysis showed that youth with avid participation exhibited significantly higher levels of psychological and social well-being, stronger leadership competence and policy control, as well as lower perception of responsiveness of the governments during the period of occupation. In the year following the movement, youth with avid participation had a significant decline in psychological and social well-being compared with other groups of youth. Cross-lagged panel analysis showed that perceived responsiveness of the Hong Kong government explained the changes in their psychological and social well-being. Implications for civic engagement and democratic governance on youth’s political efficacy and well-being were discussed.

While China's Constitution says everyone is treated equally before the law, employment discrimination continues to exist. This paper breaks new ground by analysing a quantitative survey of more than 10,000 lesbian, gay, bisexual, transgender and intersex (LGBTI) people, the largest dataset of its kind to date in China. Only 5.1 per cent of respondents were completely open about their gender and sexuality at work. More than one-fifth reported experiencing negative treatment in the workplace. Transgender and intersex people reported higher rates of negative treatment, as did respondents with lower educational levels and lower incomes and those residing in towns. Employer policies against discrimination were rare, but when in place, they were significantly associated with less negative treatment. These findings highlight an almost completely neglected segment of the workforce and document discriminatory experiences that could be addressed by changes in discrimination law and by employer policies and practices related to diversity and inclusion.

Background Lesbian, gay and bisexual (LGB) people often face individual- and system-level barriers in health care. However, LGB people’s experiences of health care in non-European and non-American settings have been scarcely studied. In China, while it has been estimated that there are at least 70 million gender and sexual minorities, there has been no larger-scale study on LGB people’s experiences of health care beyond a focus on gay men and HIV. This study is the first larger-scale quantitative study to investigate LGB people’s experiences of health care in China, where non-heterosexuality is officially silenced and the needs of non-heterosexual people are largely ignored by service providers. Methods An online survey was designed in joint partnership by academic, community groups and the United Nations Development Programme. Targeted and snowball sampling was adopted for participant recruitment. Such unique cross-sectoral partnership made this research possible in the authoritarian state of China where data collection on LGB people is extremely rare. For the analysis in this paper, a sample of 15,611 Chinese LGB people were included. Frequency and descriptive statistics were conducted to describe the LGB respondents’ demographic characteristics and their experiences in health care settings. Chi-square tests were conducted to test how experiences vary across LGB people with different demographic characteristics. Results More than three quarters of the respondents said they would be willing to disclose to their medical care providers their sexual orientation if asked. However, only 5.7% of the respondents said that medical care providers ever asked them about their sexual orientation. About 8.0% of the LGB people surveyed reported having experienced negative treatment in medical care settings. Six percent (5.7%) of the Chinese LGB people said in accessing mental health care services, they were recommended, coaxed into, or provided conversion therapy for sexual orientation, gender identity or gender expression. Conclusions There is a strong need to enhance LGB cultural competence among health care providers. Policymakers in China should also formulate laws, policies, regulations, clearly articulated codes of conduct, and transparent procedures and practices to ensure non-discrimination of LGB people in the health care system, with a particular focus on banning conversion therapy.

Background Although earlier studies have indicated that lesbian, gay, and bisexual (LGB) individuals are at greater risk of psychiatric symptoms than heterosexual individuals, limited attention has been paid to the mental health disparities within LGB populations, especially in non-Western societies. This study examined the disparities in depression, anxiety, and mental well-being between gay/lesbian and bisexual individuals and investigated how the disparities are explained by the greater sexual identity stress experienced by bisexual individuals compared to their gay and lesbian counterparts. Methods The study sample included 931 cisgender LGB individuals in Hong Kong, with 70.1% identifying as gay/lesbian and 29.9% identifying as bisexual. They completed a self-report questionnaire on sexual identity stress and mental health. Results Bisexual individuals showed higher levels of depressive and anxiety symptoms than lesbians and gay men. Structural equation modeling showed that, compared with lesbians and gay men, bisexual individuals were more likely to report identity uncertainty, conceal their sexual orientation, and have a weaker sense of connection to the LGBT community, which were in turn associated with greater affective symptoms and poorer mental well-being. Limitations The use of cross-sectional data does not allow conclusions on causal relationships among variables. Conclusions Given the greater vulnerability of bisexual individuals to common mental health problems, evidence-based psychological interventions that strategically target their identity stress at multiple levels should be developed and made available to those in need. Social and psychoeducational interventions are also necessary to transform the monosexist culture and eradicate binegativity in the LGBT and wider communities.

This paper presents findings from the first large-scale quantitative study into HIV-related behavior among transgender people in Hong Kong. A survey of 195 transgender people found that onl...

The spread of COVID-19 and its subsequent social distancing policies have profoundly impacted the lives of parents and children. Prolonged exposure to parenting-related responsibilities and heightened levels of family conflict under stay-at-home orders coupled with reduced access to support systems and resources have rendered parents and children more prone to stress and mental health difficulties. Drawing on a transactional model of parent-child interactions, the present study applied an actor-partner interdependence model approach to examine the transactional relationship between COVID-19-related stress and mental well-being among parents and children. Data from 109 Chinese parent-child dyads in Hong Kong were included in the study. Parents and their 8- to 10-year-old children completed a questionnaire on COVID-19-related stress, parent-child relationships, and mental well-being. The results showed that 53.2% and 30.3% of the parents and children, respectively, showed poor mental well-being, indicating possible emotional problems. Both actor and partner effects of parent COVID-19-related stress were found. Parent COVID-19-related stress was indirectly related to lower levels of parent and child mental well-being, through the mediation of parent-child conflict. To facilitate psychological adjustment following the COVID-19 outbreak, effective family-based mental health and parenting interventions are needed to promote family cohesion and alleviate stress-induced psychological symptoms. Even in the time of social distancing, telepsychotherapy and other online non-psychotherapeutic interventions can serve as a valid alternative for parents and children who experience excessive distress. Implications for psychological services, family-friendly policies, and social protection measures are also discussed.COVID-19的传播及其随后的保持社交距离政策深刻影响了父母和子女的生活。长时间里都得承担家长有关的责任，在居家令下家庭冲突的加剧，再加上获得支持系统和资源的机会减少，这使得父母和子女更容易承受压力和出现精神健康问题。基于亲子互动的交互作用模型，本研究运用行动者与伙伴相互依存模型方法，研究了父母和子女所感受到与COVID-19相关压力和精神健康之间的相互影响的关系。研究采用了109对在中国香港的父母和子女的数据。父母和他们8-10岁的孩子完成了一份关于COVID-19相关压力、亲子关系和精神健康的问卷。结果显示，53.2%的家长和30.3%的孩子的精神健康状况较差，可能存在情绪问题。研究发现父母所感受到与COVID-19相关压力的行动者效应，也发现了伙伴效应。父母的COVID-19相关压力通过亲子冲突的影响，与父母和子女精神健康水平的降低有间接相关。为促进COVID-19疫情后的心理调整，需要采取有效的家庭精神健康和亲职教养的干预措施，以促进家庭凝聚力，缓解压力引发的心理症状。即使在保持社交距离的时候，远程心理治疗以及其他的在线非心理治疗干预，对于经历过度困扰的父母和子女来说，也可以作为一种有效的选择。本研究还对心理服务、家庭友好政策和社会保护措施的影响进行了讨论。.

Cyber violence has emerged as a new source of minority stress over the past decade. Due to the anonymous and unrestrictive nature of the internet, cyber violence is even more blatant and pervasive than in person violence for sexual minority individuals. The present study aimed to examine whether and how online and offline experiences of heterosexism are related to physical and mental health. A total of 941 sexual minority individuals participated in a community-based online survey study. The findings indicated that online heterosexist experiences explained variance in physical and mental health, beyond the contribution of offline heterosexist experiences. Among sexual minority young adults, the effect of online heterosexist experiences on mental health was stronger than that of offline heterosexist experiences, whereas the association between online heterosexist experiences and health problems was not observed in the adult sample. The results of mediation analysis showed that heterosexist experiences were related to heightened expectations of rejection, which, in turn, were related to poor physical and mental health. The association of heterosexist experiences and mental health was also mediated by negative affect. Given the detrimental effect of online heterosexist experiences, effective interventions are needed to combat cyber violence motivated by sexual orientation and enhance the coping and confrontation strategies in response to harmful online content.

In this study, the authors investigated the longitudinal effect of the recovery attributes of peer support workers (PSWs) on users of mental health services in Hong Kong over a 9-month period.Recovery attributes were measured among PSWs (N=26) employed by four local nongovernmental organizations before their commencement of service. The recovery-related outcomes of regular service users (N=181) were measured every 3 months for 9 months. Multilevel mixed-effects linear regression analyses with restricted maximum likelihood were used to analyze the possible association of PSWs' qualities on service users' recovery outcomes. The Holm-Bonferroni method was used to adjust for p values to account for multiple comparisons.Results showed that levels of hope and self-esteem among PSWs were statistically significantly associated with improvements in hope and empowerment among service users over time.PSWs' recovery attributes may benefit service users' personal recovery. Future exploration on the specific pathways of recovery attributes of PSWs on service users' recovery is suggested.

Lesbian and gay adults’ self-reported experiences of violence from family of origin in adulthood have been less examined in previous research on interpersonal violence from intimate others. In China, while it has been understood that lesbians and gay men face mounting pressure to marry and have children, there is little empirical evidence on their experiences of violence from family of origin. This paper analyzes self-reported experiences of negative treatment and violence from a larger-scale study in China of 11,048 Chinese lesbian and gay cisgender adults. The majority of Chinese lesbians and gay men felt pressure to get married and have children (70.4%), and experienced different forms of negative treatment and violence from their family members based on sexual orientation (54.2%). A significant gender difference was observed. This paper provides novel empirical evidence for the lived experiences of lesbians and gay men in China and bears implications for China’s Anti-domestic Violence Law.

As HIV is one of the most stigmatizing health conditions, people living with HIV (PLHIV) continue to experience multiple forms and sources of stigmatization, which negatively impact their quality of life. The present study proposed a dual-process model to understand the different manifestations of HIV stigma and examine how they relate to each other and affect psychological distress and life satisfaction in PLHIV.Two hundred and ninety-one PLHIV in Hong Kong participated in the study and completed a self-report questionnaire on HIV stigma, psychological distress, and life satisfaction. Structural equation modeling was conducted to examine the mechanisms underlying HIV stigma and mental health.Around one-third of the participants experienced HIV-related avoidance and/or discrimination in different domains of life over the past year. Enacted stigma toward PLHIV was highly pronounced in Hong Kong, especially among general healthcare providers. The results revealed the interpersonal and intrapersonal processes underlying HIV stigma and mental health. While enacted stigma had a direct effect on psychological distress and life satisfaction, PLHIV might also internalize the stigmatizing beliefs associated with HIV identity, which were related to greater psychological distress and poorer life satisfaction.Stigma reduction programs that target non-HIV healthcare workers are recommended to confront their misconceptions and biases toward PLHIV. Given the high prevalence of self-stigma, psychological interventions that focus on restructuring negative beliefs about PLHIV and reconstructing a self-empowering and positive identity are necessary to promote better mental health and quality of life.

Background The coronavirus disease 2019 (COVID-19) outbreak has fundamentally changed daily routine, including sexual activity. However, most research on sexual activity during the COVID-19 pandemic focused on heterosexual individuals. The only study so far on men who have sex with men was conducted in the United States. Aim Our study expands the understanding of sexual activity during the COVID-19 pandemic by studying gay and bisexual men in Hong Kong. Although sexual desire and sexual activity continue to be important aspects of one's life during the COVID-19 pandemic, there are COVID-19–related barriers to having sex. This study therefore examined the association between sexual desire, COVID-19–related barriers, and whether to engage in sexual activity or not during the COVID-19 pandemic. Methods 857 cisgender sexual minority people in Hong Kong participated in an online survey study, and for this article, only male participants were included in the analysis, yielding an analytical sample of 376 gay and bisexual men. Outcomes Participants were asked to assess their sexual desire (ie, sexual drive and sexual motivation), COVID-19–related barriers (ie, perceived difficulties to have sex with another person during the pandemic and perceived risk of COVID-19 infection), and sexual activity during the COVID-19 pandemic. Results It was found that while sexual desire remained prevalent among the gay and bisexual men, COVID-19–related barriers were also commonly observed. Sexual drive and sexual motivation were positively associated with sexual activity. Perceived difficulties to have sex with another person during the pandemic and perceived risk of COVID-19 infection were negatively predictive of engaging in sexual activity, after controlling for general sexual desire. Clinical Implications Understanding the ambivalence and driving and inhibiting factors for having sex during the COVID-19 pandemic can provide a new framework for understanding people's sexual activity during an unprecedented scale of the pandemic. It is likely that abstinence would not work as the respondents expressed strong sexual desire and that the pandemic is going to last for a long time. Governments, policy makers, and sexual scientists need to work together to come up with practicable, feasible, and easy-to-follow guidelines for having sex during the pandemic. Strength & Limitations This is one of the first studies to examine the impact of COVID-19 on sexual activity among gay and bisexual men. The results should be interpreted with caution because of the use of cross-sectional design and nonprobability sampling. Conclusion Sexual desire and COVID-19–related barriers serve as driving and inhibiting factors in explaining whether or not people have sex during the COVID-19 pandemic. Suen YT, Chan RCH, Wong EMY. To Have or Not to Have Sex? COVID-19 and Sexual Activity Among Chinese-Speaking Gay and Bisexual Men in Hong Kong. J Sex Med 2021;18:29–34.

In the context of HIV-related stigma and discrimination, people living with HIV (PLHIV) might be vulnerable to a &lsquo, syndemic&rsquo, of co-occurring psychosocial challenges that can affect sexual behavior. The present study examined how HIV-related discrimination contributes to co-occurring psychosocial syndemic problems and results in inconsistent condom use among PLHIV in Hong Kong. Two-hundred and ninety-one PLHIV were recruited to complete a self-report questionnaire. More than one-quarter of the sample experienced two or more psychosocial syndemic problems, and 74.1% of the participants who had sex with steady partners reported inconsistent condom use over the past three months. The results indicated that HIV-related discrimination was positively predictive of the number of psychosocial syndemic problems. HIV-related discrimination and psychosocial syndemics were associated with increased odds of inconsistent condom use with steady partners (AOR = 5.40 and AOR = 3.09 respectively). Findings from structural equation modeling showed that psychosocial syndemics mediated the effect of HIV-related discrimination on condom use consistency with steady partners. PLHIV in Hong Kong suffered from the syndemic effects of stigma, social isolation, and poor mental health, which rendered them vulnerable to condomless sex. In order to curb the rapidly increasing incidence of HIV, multi-level strategies should be adopted to concurrently address the structural inequities and psychosocial syndemics faced by PLHIV.

A theme emerging from the current literature is that Chinese gay and bisexual men are likely to struggle to accept themselves because of the cultural emphasis on filial piety. However, our understanding of this culturally particular process remains partial because most research has operationalized filial piety as either a component of Chinese values or an aggregate construct itself. To pinpoint this mechanism, this study deconstructed filial piety into pragmatic obligations and compassionate reverence to test a mediation model in which internalized homonegativity served as a mediator between filial piety and depressive symptoms among Taiwanese gay and bisexual men. With the aid of Facebook advertisements, a total of 1,381 respondents (Mean age = 26.56, SD = 6) were recruited to complete a web-based survey comprising the Contemporary Filial Piety Scale, the Chinese Internalized Homophobia Scale, and the Patient Health Quesionanire-9. Structural equation modeling was performed to test the mediation paths. Results showed that pragmatic obligations are directly and negatively associated with depressive symptoms without yielding significant correlation with internalized homonegativity. A full mediation path was found in that compassionate reverence is positively correlated with internalized homonegativity and in turn associated with higher depressive symptoms. Whereas filial piety still assumes salience among Taiwanese gay and bisexual men, this study provides novel evidence for the intricate effect of the value of filial piety on Taiwanese gay and bisexual men's self-acceptance and mental health. The results highlight the importance of a relational and cultural focus to address mental health disparities among sexual minorities. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Social technologies such as social networking sites, Wikis and blogs have gained popularity not only in social communication but also in other areas, such as in enhancing learning experience among students in tertiary education. This study investigated how blogs and Facebook scaffolded students’ learning during their internships in tertiary education. A mix-method approach was employed to examine students’ perceptions of blogs and Facebook in improving their internship learning experience. The results showed that blogs and Facebook encouraged students and facilitated their engagement in problem solving, information sharing and knowledge construction during their internships. In particular, Facebook showed more promising results, assisting students in reflecting on their experiences. Moreover, students acknowledged that Facebook was a better platform for online interaction and collaborative learning than blogs. This study provides empirical evidence for the use of social media tools in pedagogical scaffolding and collaborative learning during internships.

Parents of children with autism spectrum disorders (ASD) reported higher stress than those of typically developing children. The role of child problem behaviors in the relationship between autism spectrum symptoms and parenting stress is little known. A total of 731 parents of 177 children with ASD and 554 typically developing children in primary schools (6-11 years old) completed an ASD screening survey containing measures of parenting stress and child problem behaviors. While autism spectrum symptoms were positively associated with parenting stress, the relationship was mediated by child problem behaviors. Results suggest neither the severity of autism spectrum symptoms nor knowledge of ASD diagnosis was a primary source of parenting stress. A hypothesized path model was tested using structural equation modeling.

Considering the lack of existing measures on attitudes toward personal recovery and the need to acknowledge the cultural milieu in recovery attitude assessment, the present study developed and validated the Attitudes towards Recovery Questionnaire (ARQ) in a sample of people in recovery of mental illness, family carers, and mental health service providers in Hong Kong. The ARQ was developed based on existing literature and measures of recovery, and focus group discussions with various stakeholders. Findings of the multi-sample confirmatory factor analyses supported a five-factor structure: (1) resilience as a person in recovery, (2) self-appreciation and development, (3) self-direction, (4) family involvement, and (5) social ties and integration. The ARQ was positively correlated with recovery outcomes, empowerment, recovery knowledge, and recovery orientation of mental health services. As a tool for examining recovery attitudes, the ARQ informs us of the mindset across stakeholders and areas that need enhancement to facilitate the recovery process.

The promotion of insight among people with schizophrenia spectrum disorders has posed a dilemma to service providers as higher insight has been linked to positive clinical outcomes but negative psychological outcomes. The negative meaning that people attached to the illness (self-stigma content) and the recurrence of such stigmatizing thoughts (self-stigma process) may explain why increased insight is associated with negative outcomes. The present study examined how the presence of high self-stigma content and self-stigma process may contribute to the negative association between insight and life satisfaction. A total of 181 people with schizophrenia spectrum disorders were assessed at baseline. 130 and 110 participants were retained and completed questionnaire at 6-month and 1-year follow-up, respectively. Results showed that baseline insight was associated with lower life satisfaction at 6-month when self-stigma process or self-stigma content was high. Furthermore, baseline insight was predictive of better life satisfaction at 1-year follow-up when self-stigma process was low. Findings suggested that the detrimental effects of insight can be a result from both the presence of cognitive content and habitual process of self-stigma. Future insight promotion interventions should also address self-stigma content and process among people with schizophrenia spectrum disorders so as to maximize the beneficial effects of insight.

Background As a fundamental means for transforming and advancing the conditions of lesbian, gay, bisexual, and transgender (LGBT) individuals, collective action has gained increasing attention in research, policy, and practice over the past decade. While collective action is influential in driving public awareness and policy changes, less is known about its psychological effects on individuals undertaking collective action. Methods The present study developed a scale to measure collective action for LGBT rights and examined the underlying dimensions of collective action in a sample of 1050 LGBT individuals in Hong Kong. The moderating roles of collective action on the relationship between perceived discrimination and depressive symptoms were also examined. Results The LGBT Collective Action Scale measured two dimensions of collective action, i.e., private and public collective action. Private collective action moderated the association between perceived discrimination and depressive symptoms among sexual minority men and women; however, the moderating effect of public collective action was only found in sexual minority women. Conclusions These differential moderating effects could be attributed to gender role socialization and gender-specific coping mechanisms in response to minority stress. Although public collective action is more powerful in triggering structural changes than private collective action, individuals in less democratic societies may not necessarily have access to public collective action due to the absence of opportunity structures. Private collective action, which is able to be initiated and undertaken individually, can be directed to transform heterosexist biases in interpersonal context. For LGBT individuals in less democratic societies, private collective action may be a more manageable way to maintain mental health in the face of stigmatization.

The present study examined whether, when, and how motivational messaging can boost the response rate of postal surveys for physicians based on Higgin’s regulatory focus theory, accounting for its cost-effectiveness. A three-arm, blinded, randomized controlled design was used. A total of 3,270 doctors were randomly selected from the registration list. Results showed that motivational messaging was effective in boosting response rate among younger physicians at relatively low cost when the messages were sent during the delivery of generic invitation letter and questionnaire. However, message framing had no significant impact on postal surveys’ response rate. Future postal surveys can consider using motivational messaging to maximize survey participation in physician population without incurring much extra cost.

A community-driven survey of 106 transgender people (the first such survey in Hong Kong) showed that: (1) more than half the sample (50.9%) had a university degree or higher qualification; (2) despite this, 43.4% had a monthly income below HK$6,000 (about USD$775); (3) 66% reported "fair" or "poor" quality of life; (4) 67% of the sample (87.1% of respondents aged 15-24 years) had contemplated suicide; and (5) 20.8% of the sample (35.5% of respondents aged 15-24 years) had attempted suicide. It was found that (1) those who were single, had a lower monthly income, and identified as transgender women reported lower quality of life; and (2) those who were younger and on a lower income expressed higher suicidality. The findings suggest that service providers and policy makers urgently need to address the mental health needs of transgender people, particular younger transgender people.

Although the negative association between discrimination and recovery has been established, only a few studies have attempted to investigate the underlying mechanism of how perceived discrimination dampens both clinical and personal recovery among people with psychiatric disorders. This study aimed to examine the mediating roles of self-stigma and mental health service engagement in the relationship between perceived discrimination and recovery.A total of 374 people (half men and half women; mean±SD age=43.47±12.76) living in Hong Kong and in recovery with a primary diagnosis of a psychotic disorder, mood disorder, or substance use disorder responded to a cross-sectional questionnaire on discrimination, self-stigma, mental health service adherence, recovery orientation of services, clinical recovery, and personal recovery. Multisample structural equation modeling was conducted to examine whether the hypothesized model for perceived discrimination and recovery produced results that could be generalized across people with various psychiatric diagnoses.Findings indicated that respondents perceived discrimination from the general public and from health care professionals, which was positively associated with self-stigmatization and service disengagement and was negatively associated with clinical and personal recovery across three different types of psychiatric disorder.This study showed that the influence of perceived discrimination on recovery was universal and could be generalized across people with different psychiatric diagnoses. Multipronged stigma reduction interventions targeting the general public, health care professionals, and people in recovery, along with policies that avert discrimination and uphold human rights in health care settings and beyond, should be implemented.

Transgender women (TW) and men who have sex with men (MSM) are highly affected by the rising HIV epidemic in the Philippines. HIV providers are essential to curbing the epidemic. Between July and August 2017, we conducted one-on-one qualitative interviews with 15 HIV providers in Manila, Philippines. Overall, providers reported tension between willingness to provide care versus actual competencies. Most discussed treating every patient equally regardless of gender or sexual identities. However, many expressed hesitancies in providing HIV services due to (a) not knowing the health needs of TW and MSM, (b) having little to no training in HIV, and (c) difficulty being sensitive to patient gender and sexuality. Although providers were unsure about how to prioritize HIV services for TW and MSM, some expressed interest in learning and engaging these populations in their practices. Our findings suggest the importance of provider-focused interventions to prioritize TW and MSM health needs.

Despite persistent stigmatization of people living with HIV (PLHIV) across the globe, group identification among these individuals may serve to counteract the detrimental effect of prejudice and discrimination associated with the stigmatized identity. Drawing on resilience theory and social identity theory, this study examined how multiple dimensions of group identification (i.e., in-group ties, in-group affect, and centrality) function to buffer and neutralize the negative impact of HIV stigma. A total of 281 PLHIV were recruited from the only community-based public HIV clinic in Hong Kong to participate in this study. The results revealed a protective effect of in-group affect, which moderated the relationship between HIV stigma and mental health, such that HIV stigma was not associated with mental health among people with higher positive in-group affect. In addition, a positive compensatory effect of in-group ties was found in people with higher HIV identity centrality. Given the protective effect of in-group affect, it is important to re-story the lives among PLHIV by challenging their maladaptive beliefs about being PLHIV and building a positive sense of identity in their personal narratives. Community-based interventions should be provided to individuals with higher HIV identity centrality by offering peer support groups and engaging them in community work.

Critical consciousness represents the transformation from a passive target of oppression to an active actor with an increased capacity to analyze and negotiate conditions of oppression. It is considered as an antidote for oppression that can liberate people from oppressive ideologies and empower them to resist social injustice. Building on the theory of critical consciousness and the Social Identity Model of Collective Action, this paper examined the liberating and empowering effects of critical reflection on collective action for minority rights. Results of a cross-sectional study in 1,050 LGBT individuals (Study 1) showed that critical reflection was associated with lower levels of internalized oppression and higher levels of collective efficacy, which in turn were associated with greater intentions to undertake collective action for LGBT rights. Findings from a prospective longitudinal study in 428 cisgender heterosexual individuals (Study 2) indicated that critical reflection was associated with lower levels of internalized domination and heightened levels of efficacious beliefs, which positively predicted actual participation in collective action at a subsequent wave. The findings supported the effects of critical reflection on collective action mobilization and offered leads for future research and praxis on how to orient different sectors of society to work toward social equity.