Exploring Social Identity Threat and Safety Cues for Lesbian, Gay, Bisexual, Pansexual, and Queer Cisgender Women in OB/GYN Care

Lesbian, gay, bisexual, pansexual and queer (LGBPQ) cisgender women (CW) experience a number of health inequities compared to heterosexual cisgender women related to sexual and reproductive health. Heterosexist health care cultures may signal social identity threat for LGBPQ-CW that may undermine their health care engagement and outcomes. In three online studies, I examined the effects of two heterosexist cultures (i.e., gender essentialism and pronatalism) as well as two potentially identity-safe alternatives (i.e., gender diversity and reproductive/sexual autonomy) on the identity threat and health care engagement experiences of LGBPQ-CW in OB/GYN care. In Study 1 (n = 213), I used a within-subjects experimental design to pilot test fictional health clinic materials in the form of digital intake forms and posters. In Studies 2 and 3, I used a between-subjects experimental design to examine how health clinic materials representing the different constructs of interest affected health care engagement intentions at a hypothetical clinic through the mediators of anxiety, trust, and belonging. In Study 2 (n = 265), gender cue condition (gender essentialism vs gender diversity) predicted trust and belonging, which in turn predicted health care engagement intentions. This indirect effect was moderated by identity centrality, such that gender essentialism cues produced more identity threat for those higher in with sexual identity centrality. In Study 3 (n = 264), reproduction cue condition (pronatalism vs reproductive/sexual autonomy) predicted trust and belonging, which in turn predicted health care engagement intentions. This indirect effect was moderated by parenthood attitudes, such that pronatalism cues produced more identity threat for those with more negative attitudes towards parenthood. Exploratory sociodemographic patterns are discussed. The present work enhances our understanding of how heterosexist ideologies perceptible in OB/GYN care environments, namely gender essentialism and pronatalism, undermine LGBPQ-CW health care engagement in sexual and reproductive health care. Gender diversity and reproductive/sexual autonomy may be useful frameworks for creating identity-safe alternatives to heterosexist cultures to promote LGBPQ-CW well-being in health care settings

Recognizing and disrupting stigma in implementation of HIV prevention and care: a call to research and action

Introduction: There is robust evidence that stigma negatively impacts both people living with HIV and those who might benefit from HIV prevention interventions. Within healthcare settings, research on HIV stigma has focused on intra-personal processes (i.e. knowledge or internalization of community-level stigma that might limit clients’ engagement in care) or inter-personal processes (i.e. stigmatized interactions with service providers). Intersectional approaches to stigma call us to examine the ways that intersecting systems of power and oppression produce stigma not only at the individual and interpersonal levels, but also within healthcare service delivery systems. This commentary argues for the importance of analysing and disrupting the way in which stigma may be (intentionally or unintentionally) enacted and sustained within HIV service implementation, that is the policies, protocols and strategies used to deliver HIV prevention and care. We contend that as HIV researchers and practitioners, we have failed to fully specify or examine the mechanisms through which HIV service implementation itself may reinforce stigma and perpetuate inequity. Discussion: We apply Link and Phelan’s five stigma components (labelling, stereotyping, separation, status loss and discrimination) as a framework for analysing the way in which stigma manifests in existing service implementation and for evaluating new HIV implementation strategies. We present three examples of common HIV service implementation strategies and consider their potential to activate stigma components, with particular attention to how our understanding of these dynamics can be enhanced and expanded by the application of intersectional perspectives. We then provide a set of sample questions that can be used to develop and test novel implementation strategies designed to mitigate against HIV-specific and intersectional stigma. Conclusions: This commentary is a theory-informed call to action for the assessment of existing HIV service implementation, for the development of new stigma-reducing implementation strategies and for the explicit inclusion of stigma reduction as a core outcome in implementation research and evaluation. We argue that these strategies have the potential to make critical contributions to our ability to address many system-level form stigmas that undermine health and wellbeing for people living with HIV and those in need of HIV prevention services

How Can I Get COVID?: Understanding Diferences in American Heterosexual and Sexual Minority Men’s Risk Perception

Men are more vulnerable to COVID-19 infections compared to women, but their risk perceptions around COVID-19 are persis - tently lower. Further, men often engage in less health promotion behavior because self-care in this capacity is seen as weak or less masculine. This combination has consequences for mortality; thus, a better understanding of men’s COVID-19 cognitions and individual diference factors is critical. In a web-based survey conducted during the beginning stages of the pandemic in the U.S., we collected risk perceptions of various sexual and non-sexual behaviors from heterosexual ( n = 137) and gay/bisexual men ( n = 108). There were no signifcant sexual orientation diferences for perceptions of COVID-19 risk from routine activities or in overall risk estimates. However, gay/bisexual men did report engaging in more precautionary behavior while socializing (i.e., masking, social distancing) and reported higher risk perceptions than did heterosexual men for nearly all intimate and sexual activities. A more nuanced understanding of cognitions around COVID-19 is needed to better understand motivation for—and especially motivation against—pursuing vaccinations and continuing precautionary behavior

Changes in Utilization of Birth Control and PrEP During COVID‑19 in the USA: A Mixed‑Method Analysis

In the USA, the COVID-19 pandemic has created challenges beyond the direct consequences of the infection. Because of shifting resources in response to need, many domains within the healthcare sector unrelated to COVID-19 have had inter - rupted abilities to provide care. In the current study, we focus on preventative sexual health care during the pandemic. In a sample of 511 (mean age = 27.7) people, we examined quantitative data regarding continuation and discontinuation of birth control and PrEP during the pandemic, along with qualitative data illustrating the underlying reasons for participants’ (dis) continuation. Results showed that most (92.5%) of birth control users reported continuation of their birth control, with the predominant reasons reported being use for health reasons, long-acting reversible contraceptive use, access to remote health - care services, and increased vigilance over pregnancy prevention. Conversely, around half (52.6%) of PrEP-using participants reported already discontinuing or planning to discontinue their PrEP regimen. Temporary abstinence and concerns about accessing in-person health care were the predominant reasons for PrEP discontinuation. These results have implications for both researchers and sexual healthcare providers. Disruptions to preventative sexual health care should be considered in ongoing research about patient needs, and healthcare providers may wish to consider particular challenges faced by PrEP users concerning re-start and continuation

Medical avoidance among marginalized groups: the impact of the COVID‑19 pandemic

Medical avoidance is common among U.S. adults, and may be emphasized among members of marginalized communities due to discrimination concerns. In the current study, we investigated whether this disparity in avoidance was maintained or exacerbated during the onset of the COVID-19 pandemic. We assessed the likelihood of avoiding medical care due to general-, discrimination-, and COVID-19-related concerns in an online sample ( N = 471). As hypothesized, marginalized groups (i.e., non-White race, Latinx/e ethnicity, non-heterosexual sexual orientation, high BMI) endorsed more general- and discrimina - tion-related medical avoidance than majoritized groups. However, marginalized groups were equally likely to seek COVID-19 treatment as majoritized groups. Implications for reducing medical avoidance among marginalized groups are discussed