Associations between Perceived Homophobia, Community Connectedness, and Having a Primary Care Provider among Gay and Bisexual Men Abstract According to the minority stress model and social evaluation theory, stigma increases negative health outcomes in sexual minorities, and those with greater connection to a community appraise their lives with respect to fellow community members. This study was a secondary analysis of data from the online 2010 Social Justice Sexuality Project and examined associations between perceived homophobia, community connectedness, and having a health care provider among 2281 men who have sex with men (MSM). Approximately 37.9% (n = 840) of the participants were African American/Black, and approximately 68.3% (n = 1559) self-identified as gay. Perceived homophobia was associated with lower odds of having a regular health care provider (AOR = 0.89, 95% CI 0.85–0.96). Income was associated with at least two-fold greater odds of having a regular health care provider, but only for incomes at or above $20,000 (AORs 1.43–2.39, ps < .001). Community connectedness partially mediated and suppressed the negative association between perceived homophobia and having a primary care provider in the overall model (AOR = 0.95, 95% CI 0.90–1.00), and mediated approximately 14.1% of the total effect in the mediation model. Facilitating community connectedness for MSM may reduce the negative association between perceived homophobia and having a primary care provider, and community-based interventions that promote community connectedness may increase long-term engagement in healthcare utilization.

Women in Sex Work and the Risk Environment: Agency, Risk Perception, and Management in the Sex Work Environments of Two Mexico-U.S. Border Cities Abstract Sex work around the world takes place under conditions of structural violence and vulnerability. The Mexico-U.S. border region is characterized by the presence of factors that increase the risk for health harms among female sex workers (FSW); located in this context, the risk environments of Tijuana and Ciudad Juárez have similar yet distinct characteristics that influence how risk is produced and experienced among FSWs. Exploring the ways in which FSWs enact agency in risk environments can illustrate how environmental characteristics shape perceived risks and the strategies that FSWs develop to manage them. This approach also identifies the limits that are placed by environmental characteristics over the capacity for harm reduction and prevention practices among FSWs. We analyzed the role of agency in the work environments of female sex workers and its relationship with risk perception and management in the cities of Tijuana and Cd. Juárez.

Transactional Sex, Substance Use, and Sexual Risk: Comparing Pay Direction for an Internet-Based U.S. Sample of Men Who Have Sex with Men Abstract Demographic, behavioral, and structural factors among four mutually exclusive transactional sex categories were assessed in an online sample of 7217 sexually active US men who have sex with men (MSM): (1) No Trade Sex group (87%); (2) Sellers, accepting money or drugs for sex (5%); (3) Buyers, giving money or drugs for sex (6%); and (4) Sellers and Buyers, accepting and giving money or drugs for sex (2%). Separate multivariable logistic regressions compared men who did not report past 60-day transactional sex with men in the three transactional sex groups. Sellers were more likely to report being black or Asian (versus white), low income, a recent STI diagnosis, six or more recent male anal sex partners, and polydrug use. Buyers were more likely to report being older, higher income, urban residence, incarceration history, a recent STI diagnosis, and having non-main sex partners. Sellers and Buyers were more likely to report a higher income, incarceration history, six or more recent male anal sex partners, and polydrug use. Findings suggest that public health policy and HIV prevention harm reduction strategies should address the distinct sexual and behavioral risk patterns among MSM who engage in transactional sex based on payment direction.

Fijian Adolescent Emotional Well-Being and Sexual and Reproductive Health-Seeking Behaviours Abstract This qualitative study explores how adolescents’ emotional experiences drive their sexual practices and health-seeking behaviours in Fiji. Fourteen focus group discussions with 15–19-year-olds and 40 key informants’ interviews with health workers, educators, government and NGO workers, and religious leaders were conducted. Our findings show that emotional experiences such as shame, embarrassment, expression of love, and intimacy are shaped by the socio-cultural context and were reported by our participants as drivers of their sexual practices and health-seeking behaviours such as condom use and accessing services and support. Based on our findings, we argue that more attention should be paid to emotional well-being when developing sexual and reproductive health policies, programmes, and services and offer recommendations of how to do so.

The Effect of Survival Economy Participation on Transgender Experiences of Service Provider Discrimination Abstract This study determines how transgender involvement in survival economies, namely sex work and drug sales, affects transgender experiences of service provider discrimination, in comparison to discrimination experienced by transgender people not involved in survival economies. It utilizes cross-sectional data from the 2008–2009 National Transgender Discrimination Survey (NTDS). Multivariate logistic regression is conducted on the sample (n = 4927) to determine the strength of association. Logistic regression sub-analysis is used to compare discrimination across different service provider contexts. Compared to those not participating in survival economies, participating in sex work has almost three times greater odds (OR 2.83, CI 2.20–3.63), and those participating in drug sales have approximately 1.5 greater odds (OR 1.52, CI 1.16–1.99), of experiencing discrimination from service providers. Participation in survival economies is a significant predictor of a transgender person’s increased likelihood of experiencing service provider discrimination. Findings suggest that service providers must attend to the specificity of transgender experiences in survival economies. Harm reduction is offered as a suitable intervention approach.

Let’s Talk About Sexual Immaturity in Adolescence: Implications for School-Based Sex Education Abstract While rates of sexual activity among adolescents have declined, they remain high among adolescents living in poverty. Risky sexual behaviors are often compounded, placing adolescents at greater risk for increased prevalence of sexual behaviors during later adolescence and other behaviors that may compromise later life chances. Sexual immaturity may influence sexual initiation and trajectories of sexual behavior. In the current study, using a growth curve framework, data from the Mobile Youth and Poverty Study are used to model how sexual immaturity develops across adolescence as a function of age, gender, and sex education. Results suggest that girls are less sexually immature than boys, regardless of exposure to school-based sex education. For girls, sexual immaturity trajectories were similar throughout adolescence. However, during early adolescence, boys receiving school-based sex education had more immature sexual beliefs than those who had not. By middle adolescence, these differences had disappeared, and by late adolescence, boys receiving sex education had more mature attitudes boys who had not. Our results suggest that school-based sex education curricula should take into consideration how sexual maturity is portrayed among adolescents, particularly those who live in impoverished communities.

Canadian Sex Workers Weigh the Costs and Benefits of Disclosing Their Occupational Status to Health Providers Abstract Prostitution stigma has been shown to negatively affect the work, personal lives, and health of sex workers. Research also shows that sex workers have much higher unmet health care needs than the general population. Less is known about how stigma obstructs their health-seeking behaviors. For our thematic analysis, we explored Canadian sex workers’ accounts (N = 218) of accessing health care services for work-related health concerns. Results show that participants had mixed feelings about revealing their work status in health care encounters. Those who decided not to disclose were fearful of negative treatment or expressed confidentiality concerns or lack of relevancy. Those who divulged their occupational status to a health provider mainly described benefits, including nonjudgment, relationship building, and comprehensive care, while a minority experienced costs that included judgment, stigma, and inappropriate health care. Overall, health professionals in Canada appear to be doing a good job relating to sex workers who come forward for care. There is still a need for some providers to learn how to better converse with, diagnose, and care for people in sex work jobs that take into account the heavy costs associated with prostitution stigma.

Transgender Under Fire: Hetero-cis-normativity and Military Students’ Attitudes Toward Trans Issues and Trans Service Members Post DADT Abstract The repeal of “Don’t Ask, Don’t Tell, Don’t Pursue” (DADT) was a victory for lesbian, gay, and bisexual (LGB) military members but left most transgender (trans) military members closeted and failed to address trans military inclusion. The purpose of the current study is to explore military students’ attitudes toward trans issues and trans service members in the year 2012 (post DADT) through a framework of hetero-cis-normativity: a system of prejudice whereby it is “normal” to be both heterosexual and cisgender and it is not normal (and therefore acceptable to be prejudiced toward) non-heterosexual and non-cisgender individuals. Specifically, this study utilizes both closed- and open-ended survey responses from a college student sample of active and veteran members of the United States Reserve Officer Training Core (ROTC) and/or United States Armed Forces (Army, Navy, Air Force, Marines, Coast Guard, National Guard, and Reserves) enrolled at a southern US university (N = 374) to understand how gender, infantry/combat military occupation, and combat zone deployment (and interactions among these) as well as feminist identity and LGB supportive attitudes play a role in military students’ attitudes toward trans men and women, perspectives about gender-affirming surgeries (i.e., “sex change operations”), and opinions about trans individuals serving openly in the U.S. Armed Forces in the immediate aftermath of the DADT repeal. Consistent with the hetero-cis-normativity framework, both the qualitative and quantitative findings revealed that being a woman, being a feminist, being supportive of gay and bisexual men, infantry/combat military occupation, and combat zone deployment were all significantly related to military students’ trans perspectives. In addition, the qualitative findings situated military students across a spectrum of support of trans military service, with most students overall in the “do nothing to help trans people serve” category but a large percentage of women and LGB respondents comprising the “do more to help trans people serve” category. Implications for future research and policy recommendations are provided.

Understanding Associations between Personal Definitions of Pornography, Using Pornography, and Depression Abstract Pornography has received increased scholarly and policy attention, as the rate of online pornography consumption has increased and the availability of sexually explicit material grows. However, few studies have taken into consideration how personal definitions of what sexual material is perceived as pornographic may influence the correlates and outcomes associated with such consumption. Using a sample of 1639 individuals sampled online from the MTurk website, we explored how definitions of sexual material as pornographic are related to actual use and how differences between the perceptions of sexual material as pornography and use of such material were associated with depressive symptoms. Results suggested that the perception of sexual material as pornographic was significantly related to usage patterns and that this pattern varied based on how explicit the material was. Results also suggested that individual differences between perception and use were significantly related to depression. Specifically, viewing sexual material one does not deem as pornographic was related to higher levels of depressive symptoms. However, global acceptance of pornography and the general perception of sexual content as pornographic or not did not moderate associations between pornography use and depressive symptoms. Implications for future research and for the further understanding of the effects of pornography use are discussed.

Improving the Health of Cisgender Men Who Identify as Bisexual: What Do They Want from Interventions? Abstract Self-identified bisexual men are at increased risk for negative health outcomes, but there are no interventions tailored to their unique needs. In order to develop interventions for this population, it is first necessary to understand their preferences. As part of a larger study, 128 cisgender men who identified as bisexual reported on their preferences for different intervention components. Large proportions of participants prioritized addressing both health (e.g., mental health, HIV/STI) and psychosocial experiences (e.g., dating/relationships, discrimination/victimization). A slightly larger proportion of participants preferred an intervention for gay and bisexual men together compared to an intervention for bisexual men only. However, those who reported more discrimination and recent female sexual partners were more likely to prefer an intervention for bisexual men only. Larger proportions of participants preferred a group intervention compared to an individual intervention and an in-person intervention compared to an online intervention. These findings highlight the importance of addressing both health and psychosocial experiences in tailored interventions for self-identified bisexual men. Further, while in-person and group interventions may appeal to larger proportions of self-identified bisexual men, the appeal of an intervention for gay and bisexual men together compared to an intervention for bisexual men only may depend on individual and social/contextual factors.