Experiences and Well-Being of Sexual and Gender Diverse Youth in Foster Care in New York City

This is the first survey to report on the proportion of youth in foster care in New York City who are LGBTQAI+ and differences in their experiences compared to those of youth who are not LGBTQAI+. The acronym LGBTQAI+ comprises persons who because of their gender and sexuality have specific needs and are treated differently than other persons, which might negatively affect their well-being. The letters stand for lesbian, gay, bisexual, transgender, queer or questioning, agender or asexual, and intersex. This survey was commissioned by the New York City Administration for Children's Services (ACS), which is committed to serving youth in foster care that are LGBTQAI+. The survey was implemented with generous support from the Annie E. Casey Foundation, the Redlich Horwitz Foundation, and the NYC Unity Project. This report provides the detailed findings from this survey. A separate document LG BTQ+ Action Plan produced by ACS identifies the steps taken to date to provide services and supports to LGBTQAI+ youth and plans to move forward in response to the survey findings. According to the survey: LGBTQAI+ youth are overrepresented in foster care. More than one out of three youths (34.1%), ages 13-20, in New York City foster care is LG BTQAI+. This is substantially higher than the proportion of LG BTQAI+ youth in the general population. LGBTQAI+ youth in foster care are more frequently youth of color. With almost three quarters of the sample identifying as African American and almost a third identifying as Latinx, the sample reflects the population of New York City youth in foster care, in which people of color are disproportionally represented. Within this already racially and ethnically disproportionate group, LGBTQAI+ youth are less likely to be white and more likely to be Latinx. The placements of LGBTQAI+ youth in foster care differ from those of non-LGBTQAI+ youth in foster care. Compared to non-LGBTQAI+ youth, LGBTQAI+ youth were more likely to be placed in group homes or residential care and less likely to be placed in family-based care. LGBTQAI+ youth were less satisfied with their current placement. LGBTQAI+ youth were more likely to say that they experienced little to no control over their lives in foster care and to have heard staff or other people refer to them as “hard to place.” The family experiences of LGBTQAI+ youth in foster care can be challenging. While LGBTQAI+ youth were more likely to be in touch with family members, they saw these family members less frequently. Furthermore, LGBTQAI+ youth experienced family members as less supportive than non-LGBTQAI+ youth did. Fewer LGBTQAI+ youth reported that there were adults in their lives, other than family members, who they could rely on and by whom they felt supported. LGBTQAI+ young people have more struggles with institutional systems and higher risk factors for depression. LGBTQAI+ youth had been absent without permission from their foster care placements for significantly more days than non-LGBTQAI+ youth; they also were more likely to have been homeless and to have had negative confrontations with the police. In addition, LGBTQAI+ youth were more likely to have been criticized for behaving and for dressing too much like the other sex. These risk factors were associated with differences in well-being: LGBTQAI+ youth reported to experience more depressive symptoms and fewer feelings of optimism compared to non-LGBTQAI+ youth

Associations Between Alcohol Use and Intimate Partner Violence Among Men Who Have Sex with Men

Purpose: Intimate partner violence (IPV) research among men who have sex with men (MSM) has primarily focused on the prevalence of IPV victimization and perpetration. Although alcohol use is a known trigger of IPV in opposite sex relationships, less is known about alcohol use and IPV perpetration and victimization in same-sex couples. The aim of this study was to examine associations between alcohol use and different types of IPV victimization and perpetration among MSM. Methods: MSM in New York City were recruited at gay-friendly venues and events to participate in an online survey assessing sociodemographics, alcohol use, and victimization/perpetration of IPV with both regular and casual sex partners. Logistic regression was used to examine associations between alcohol use and different types of IPV victimization and perpetration. Results: Among 189 participants, 103 (54.5%) reported experiencing at least one incidence of IPV perpetrated by a regular partner and 92 (48.7%) reported having perpetrated IPV against a regular partner in the past 12 months. Higher levels of alcohol use were significantly associated with (1) physical/sexual and HIV-related IPV victimization by a regular partner, (2) physical/sexual, monitoring, and controlling IPV victimization by a casual partner, (3) physical/sexual, emotional, controlling, and HIV-related IPV perpetration against a regular partner, and (4) physical/sexual and emotional IPV perpetration against a casual partner. Conclusions: The association of high levels of alcohol use with different types of IPV perpetration and IPV victimization suggests a need for targeted services that address the co-occurring issues of alcohol use and IPV.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140163/1/lgbt.2016.0057.pd

HIV-Untested Men who have Sex with Men in South Africa: The perception of not being at risk and fear of being tested.

A community-based needs assessment among men who have sex with men (MSM) in South Africa found that 27 % (n = 280/1,045) of MSM had never been tested for HIV. The most frequently reported reasons for not having been tested were the perception of not being at risk (57 %) and fear of being tested (52 %). This article explores factors associated with these two reasons among the untested MSM. In multiple logistic regressions, the perception of not being at risk of HIV infection was negatively associated with being black, coloured or Indian, being sexually active, knowing people living with HIV, and a history of sexually transmitted infections (STIs) in the past 24 months (adj. OR = .24, .32, .38, and .22, respectively). Fear of being tested for HIV was positively associated with being black, coloured or Indian, preferred gender expression as feminine, being sexually active, a history of STIs, and experience of victimization on the basis of sexual orientation (adj. OR = 2.90, 4.07, 4.62, 5.05, and 2.34, respectively). Results suggest that HIV prevention programs directed at South African MSM will be more effective if testing and treatment of STIs are better integrated into HIV testing systems. Finally, social exclusion on the basis of race and sexual orientation ought to be addressed in order to reach hidden, at-risk, populations of MSM.College of Human Science

Exploring the Relationship Between Gender Nonconformity and Mental Health Among Black South African Gay and Bisexual Men

This study used data collected by LGBT community organizations in South Africa, including OUT LGBT Well-Being, Triangle Project, and the Durban Lesbian and Gay Community and Health Centre, in collaboration with the Centre for Applied Psychology at the University of South Africa. The research was commissioned by the South African Joint Working Group (JWG); JWG is a national network of several South African LGBT-focused community organizations. Special acknowledgment is due to Louise Polders, Helen Wells, Glenn de Swardt and Nonhlanhla Mkhize for assistance in the surveys in the respective community centers. The study was supported by grants from Atlantic Philanthropies, the Multi Agency Grants Initiative administered by HIVOS, and the National Institute of Mental Health grant P30-MH to the HIV Center for Clinical and Behavioral Studies

Validation of depressive symptoms, social support, and minority stress scales among gay, bisexual, and other men who have with men (GBMSM) in Nigeria, Africa: a mixed methods approach

Background Gay, bisexual, and other men who have sex with men (GBMSM) in Nigeria experience social marginalization, discrimination and violence due to their sexual identity, which may negatively impact physical, mental, and sexual health outcomes. Studies on GBMSM in Africa utilize measurement scales developed largely for populations in the Global North. The validity and reliability of these instruments—to our knowledge—have never been thoroughly investigated among GBMSM in Nigeria. The aim of the current study was to determine the validity and reliability of the English versions of the Center for Epidemiologic Studies Depression Scale (CESD-R), Multidimensional Scale of Perceived Social Support (MSPSS), and LGBT Minority Stress Measure among a large multi-state sample of GBMSM Nigeria. Methods Between January and June 2019, we conducted cognitive interviews (N = 30) and quantitative assessments (N = 406) with GBMSM in Nigeria. The cognitive interviews assessed comprehension of scale items and elicited suggestions for scale modifications. The quantitative assessment was used to gather psychosocial health data and to evaluate psychometric properties and construct validity of the modified scales. We utilized confirmatory factor analysis to assess factor structure, correlation coefficients, and Cronbach’s alpha to examine scale validity and internal consistency. Results Based on participant feedback from the cognitive interviews, we made slight modifications (i.e., culturally appropriate word substitutions) to all three scales. Results of quantitative analyses indicated good psychometric properties including high factor loadings, internal consistency and construct validity among the CESD-R, MSPSS, and LGBT Minority Stress Measure among GBMSM in Nigeria. Conclusion These results suggests that modifying research scales to be more culturally relevant likely do not jeopardize their validity and reliability. We found that modified scales measuring depressive symptoms, perceived social support, and minority stress among GBMSM in Nigeria remained valid. More research is needed to explore whether the psychometric properties remain if the scales are translated into broken English (Pidgin) and other traditional Nigerian languages (Yoruba, Igbo and Hausa)

The Mpumalanga Men's Study (MPMS): results of a baseline biological and behavioral HIV surveillance survey in two MSM communities in South Africa

The Mpumalanga Men's Study (MPMS) is the assessment of the Project Boithato HIV prevention intervention for South African MSM. Boithato aims to increase consistent condom use, regular testing for HIV-negative MSM, and linkage to care for HIV-positive MSM. The MPMS baseline examined HIV prevalence and associated risk behaviors, and testing, care, and treatment behaviors among MSM in Gert Sibande and Ehlanzeni districts in Mpumalanga province, South Africa in order to effectively target intervention activities. We recruited 307 MSM in Gert Sibande and 298 in Ehlanzeni through respondent-driven sampling (RDS) between September 2012-March 2013. RDS-adjusted HIV prevalence estimates are 28.3% (95% CI 21.1%-35.3%) in Gert Sibande, and 13.7% (95% CI 9.1%-19.6%) in Ehlanzeni. Prevalence is significantly higher among MSM over age 25 [57.8% (95% CI 43.1%-72.9%) vs. 17.9% (95% CI 10.6%-23.9%), P <0.001 in Gert Sibande; 34.5% (95%CI 20.5%-56.0%) vs. 9.1% (95% CI 4.6%-13.9%), P <0.001 in Ehlanzeni]. In Gert Sibande, prevalence is higher among self-identified gay and transgender MSM vs. other MSM [39.3% (95%CI, 28.3%-47.9%), P <0.01], inconsistent condom users [38.1% (18.1%-64.2%), P <0.05], those with a current regular male partner [35.0% (27.1%-46.4%), P<0.05], and those with lifetime experience of intimate partner violence with men [40.4%, (95%CI 28.9%-50.9%), P <0.05]. Prevalence of previous HIV testing was 65.8% (95%CI 58.8%-74.0%) in Gert Sibande, and 69.3% (95%CI 61.9%-76.8%) in Ehlanzeni. Regular HIV testing was uncommon [(34.6%, (95%CI 27.9%-41.4%) in Gert Sibande; 31.0% (95%CI 24.9%-37.8%) in Ehlanzeni]. Among HIV-positive participants, few knew their status (28.1% in Gert Sibande and 14.5% in Ehlanzeni), or were appropriately linked to care (18.2% and 11.3%, respectively), or taking antiretroviral therapy (13.6% and 9.6% respectively). MPMS results demonstrate the importance of implementing interventions for MSM to increase consistent condom use, regular HIV testing, and linkage and engagement in care for HIV-infected MSM

HIV risk perception and sexual behavior among HIV-uninfected men and transgender women who have sex with men in sub-Saharan Africa: Findings from the HPTN 075 qualitative sub-study.

There remains a limited understanding of how men who have sex with men (MSM) and transgender women (TGW) in sub-Saharan Africa (SSA) perceive their risk for HIV and how risk influences behavior during sexual interactions. We performed thematic analysis on in-depth interviews from the qualitative sub-study of HPTN 075 in Kenya, Malawi, and South Africa. Using the Integrated Behavioral Model (IBM) constructs, we found that most MSM and TGW perceived themselves to be at risk for HIV, leading them to regularly engage in safer sexual behaviors. Notably, even though these MSM and TGW perceived themselves to be at risk for HIV, some of them reported engaging in transactional sex, sex under the influence of alcohol, and intentional non-use of condoms. This indicates that HIV risk perception was not always associated with safer sexual behaviors or a reduction in risk behaviors. Attitudes (negative attitudes toward condom use), perceived norms (social pressures), and environment constraints (contextual barriers) were related to MSM and TGW not engaging in safe sexual behavior. Hearing the perspectives of MSM and TGW on their sexual behavior continues to be important for the development and implementation of effective prevention policies and interventions. Eliminating structural barriers such as stigma, discrimination, and criminalization of same-sex sexuality is a crucial prerequisite for the success of interventions to promote sexual health among MSM and TGW in SSA

"As long as they behave themselves": Heterosexual recuperation in South Africans' talk about homosexuality

Several qualitative researchers using discursive methodologies have noted how opposition to homosexuality has not necessarily diminished, despite the general expression of liberal tolerance in many settings. Instead, heterosexist rhetoric has shifted to accommodate political change. Our research builds on this observation within the South African context, using a discursive psychology approach. We examine rhetorical strategies of “heterosexual recuperation”: the ways that heterosexual boundaries and the dominance of heterosexuality are maintained by speakers, at the same time as they attempt to avoid being heard as heterosexist. Drawing on data from a qualitative study conducted with heterosexual-identifying Black South Africans from four provinces, we focus on talk that was resourced by a “discourse of tolerance” and characterised by speakers’ concern to avoid the attribution of heterosexism. This talk was analysed using thematic analysis, to which discursive psychology techniques were applied. We identified two ways of speaking that relied on this discourse – (1) “As long as they do it in private”, and (2) “Flashing their homosexuality” – and show how they ultimately worked to recuperate heterosexuality and marginalise non-normative sexualities. We discuss the implications of these findings in relation to a critical psychology that works to challenge hetero-patriarchal norms.http://www.pins.org.za/issue.php?num=51am2017Humanities Educatio

To switch or not to switch: Intentions to switch to injectable PrEP among gay and bisexual men with at least twelve months oral PrEP experience.

BACKGROUND:Phase III trials of long-acting injectable (LAI) PrEP, currently underway, have great potential for expanding the menu of HIV prevention options. Imagining a future in which multiple PrEP modalities are available to potential users of biomedical HIV prevention, we investigated which factors might help direct a patient-physician shared-decision making process to optimize the choice of biomedical HIV prevention method. METHODS:Participants (n = 105; ages 19-63; 46.7% men of color) were former participants in a PrEP demonstration project and had taken daily oral PrEP for ≥ 12 months. Participants were given information about LAI PrEP and asked whether they would be interested in switching from oral to LAI PrEP. Participants were also asked about specific pros/cons of LAI PrEP, PrEP attitudes and experiences, and personality factors. RESULTS:Two-thirds (66.7%) of current oral PrEP users would switch to LAI PrEP. Intention to switch was associated with product-level and psychosocial factors. Attitudes towards logistical factors (i.e. getting to regular clinic visits for recurring shots) featured more prominently than factors related to the physical experience of PrEP modality (i.e., concerns about injection pain) as motivators for switching. In a multivariate regression model, psychosocial factors including the emotional burden of daily pill taking, deriving a sense of responsibility from PrEP use, and self-identifying as an early adopter, were the strongest predictors of switching. CONCLUSIONS:These data underscore the importance of attending not only to product-level factors, but also to the logistical and psychological experience of prevention methods for users. Findings have significant implications for the development of patient education materials and patient-provider shared decision aids