Experiences of sexual violence are often underreported and can lead to comorbidities related to mental health and substance use across all populations, yet little is known about these experiences among sexual and gender diverse youth (SGDY). Drawing from the 2022 LGBTQ National Teen Survey, the current study (N = 10,527) used an intersectional analytic approach to investigate sexual violence at the intersection of sexual orientation, gender identity, race, and ethnicity among SGDY. Participants were selected based on responses to at least one survey item about sexual violence or harassment. Of the included participants, most identified their gender as non-binary (16.5%) or transgender boys (19.65%) and their sexual orientation as gay/lesbian (28.8%). Participants were predominantly white (73%), non-Hispanic/Latina/x/o (83.1%), and between the ages of 13 to 18. Results showed that 14.4% reported having ever been forced to have sex and 30.2% experienced nonconsensual sexual touching in the past 12 months. Using exhaustive chi-square automatic interaction detection, we identified disproportionate intersectional experiences of forced sex among American Indian, Alaska Native, or Native Hawaiian/Pacific Islander adolescents, identifying these populations as almost two times more likely to experience forced sex in comparison to the rest of the sample. In addition, transgender boys, especially those who identified as queer or pansexual, experienced some of the highest rates of sexual violence. Findings can be used to inform sexual violence prevention and treatment programs aimed at bolstering access to more inclusive social services for groups sharing disproportionate burdens of sexual violence.

Methamphetamine use continues to disproportionately affect sexual and gender minority (SGM) communities and is associated with physical, mental, and sexual health harms, including heightened HIV vulnerability. While prior epidemic waves have been well documented, the current resurgence (particularly among SGM individuals), remains underexplored and occurs within an evolving HIV prevention landscape. Persistent challenges within the substance use disorder care continuum (SUDCC), including stigma and limited treatment responsiveness, underscore the need for patient-centered clinical guidance. This study examines treatment navigation experiences of SGM individuals who use methamphetamine and their recommendations for improving their substance use care. Participants were recruited from a U.S. national HIV prevention cohort that oversampled for individuals reporting recent methamphetamine use. Twenty-nine participants completed semi-structured, in-depth interviews between December 2024 and January 2025. Interviews focused on healthcare experiences, treatment navigation, and participants’ recommendations for SUDCC stakeholders. Interviews were recorded and transcribed verbatim into written transcripts, which were analyzed using a codebook approach to thematic analysis. Our findings were organized into four major themes: (1) Variation in Motivation to Use Meth, (2) Need for Destigmatized Care, (3) Desire for SGM-Affirming Care, and (4) A Spectrum of Care Needs. Participants reported a variety of motivations for using meth, including to enhance their sex lives, cognition, and emotion regulation—motivations that providers may benefit from understanding as they aim to address the overlapping physical and psychosocial health needs of patients who use methamphetamine. The importance of reducing stigma in clinical encounters was underscored frequently by participants, and represented a salient theme throughout interviews and across thematic categories. Participants described both experienced and anticipated stigma when underscoring the need for de-stigmatized substance use care, and illustrated how stigma hindered substance use care engagement and use of emergency services. Moreover, many reported a desire for community among other SGM individuals, particularly within group recovery contexts, but also elucidated the risks that accompanied drug network expansion within these treatment environments. This study advances the substance use and treatment literature by amplifying the voices of SGM individuals who use methamphetamine and providing guidance for providers who work directly with these populations.

Ending HIV epidemics hinges on antiretroviral therapies (ART), including their use in pre-exposure prophylaxis (PrEP). Unfortunately, PrEP use remains low among populations that could benefit most. PrEP use is impeded by multiple barriers including concerns about side-effects and erroneous beliefs about hazards of mixing PrEP with alcohol and other drugs. The current study tested the hypothesis that substance use interactive toxicity beliefs would mediate the association between concerns about PrEP side-effects and four separate PrEP use outcomes: past use, current use, uptake, and adherence. Black HIV negative men who have sex with men (n = 436) completed baseline and up to 18-months of follow-up for measures of demographic and health characteristics, PrEP use, concerns about PrEP side-effects, and substance use interactive toxicity beliefs. All participants reported alcohol or other drug use in the past two-months at baseline. Cross-sectional mediation analyses confirmed our hypothesis, showing that concerns about PrEP side-effects were directly associated with past and current PrEP use, and these associations were mediated by interactive toxicity beliefs. Prospective models did not confirm mediation but showed that greater substance use interactive toxicity beliefs significantly predicted PrEP uptake and adherence. These results support the importance of substance use interactive toxicity beliefs as a barrier to PrEP use and warrant interventions to address underlying biases and misinformation.

Extant research has explored factors that promote adolescents to seek help from school personnel when experiencing victimization. Yet, little is known about how reporting peer harassment to teachers and staff is associated with emotional distress among adolescents with stigmatized sexual and/or gender identities experiencing discriminatory harassment. The present study leveraged a large national sample of sexual and gender diverse youth who had experienced peer harassment in the past year (Mage = 15.44, SD = 1.36) and explored how talking with school personnel about harassment and perceptions of staff responses were associated with psychological distress. Structural equation modeling revealed that, over and above experiences of harassment, sexual and gender diverse youth who talked with school personnel about their experienced harassment tended to report lower levels of psychological distress (β = -0.07, p < .001); however, the protection provided by reporting harassment was dampened among students experiencing frequent gender-based harassment (βnever reported = 0.14, p < .001; βreported = 0.22, p < .001). Among youth who had reported, perceived reporting effectiveness moderated the association between gender-based harassment and distress (β = -0.06, p = .03), such that sexual and gender diverse youth who experienced frequent gender-based harassment were less likely to report elevated psychological distress the more they felt that school personnel responded to their reports effectively. The associations between reporting experiences and psychological distress did not depend on sexuality- and gender-expression-based harassment (β = 0.04, p = .14; β = -0.00, p = .95). These findings highlight a need for school systems to cultivate effective responses among school personnel when students report their experiences with discriminatory harassment. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Background:Pre-exposure prophylaxis (PrEP) significantly reduces the risk of contracting HIV among all individuals. The success of PrEP has led to the development of targeted health campaigns for encouraging the uptake of PrEP among sexual and gender diverse communities, who account for some of the highest HIV transmission rates in the U.S. PrEP uptake among Black sexual and gender-diverse populations (BSGD) remains low, which is worrisome given that BSGD populations have an elevated risk of HIV seroconversion. Scholars have investigated psychosocial barriers to PrEP uptake in BSGD populations, but little is known about positive and promotive factors associated with PrEP use. Method:Leveraging baseline data from an ongoing longitudinal PrEP study (N = 380), the current study investigated what factors may be associated with lifetime use and current use of PrEP in BSGD populations. We used a cross-sectional design to examine the associations between psychosocial barriers (i.e., HIV microaggression, PrEP stereotypes, and PrEP stigma) and positive promotive factors (i.e., resiliency, sex positivity, and social support) among two outcome variables, current and lifetime use of PrEP. Results:Using binary logistic regression models, we found that sex positivity was strongly positively associated with both lifetime and current PrEP use, and HIV microaggressions were negatively associated with current PrEP use. Conclusion:Our findings indicate that sex positivity may be an important strengths-based factor related to PrEP use. HIV prevention strategies should consider including sex-positive messaging to increase PrEP usage and bolster sexual empowerment in BSGD populations in order to dismantle HIV and PrEP stigmas.

BACKGROUND:Sexual minority populations experience higher rates of substance use and related problems, but little is known about their specific involvement in driving under the influence (DUI) of alcohol (DUIA) and cannabis (DUIC) incidents. METHODS:Using data from the 2016 to 2019 National Survey on Drug Use and Health, we used logistic regression models to estimate the interactive effects of sexual identity, race/ethnicity, and gender on past-year DUIA among adults who used alcohol and DUIC among adults who used cannabis, accounting for covariates. Using model estimates and linear combinations, we calculated the predicted probabilities of each outcome and compared sexual identity differences within and across race/ethnicity and gender. RESULTS:With few exceptions, the predicted probabilities of DUIA and DUIC were significantly higher among sexual minority women than heterosexual women of similar race/ethnicity. The results were more variable among men with the probabilities of DUIA and DUIC being significantly higher for some groups of sexual minority men and some groups having probabilities equal to or lower than similar heterosexual men. Some of the largest sexual minority gaps in DUIA and DUIC were observed among Hispanic and Other lesbian women and Black gay men. CONCLUSIONS:Sexual minority individuals are more likely to report DUI than their heterosexual counterparts; however, the risk of DUI among sexual minority populations varies by racial/ethnic and gender subgroup. Our findings indicate the importance of applying an intersectional framework when addressing substance-use-related disparities and when designing effective DUI prevention interventions for sexual minority populations.

Black sexually minoritized men (SMM) and transgender women (TW) are subgroups with lower rates of substance use and comparable rates of condom use relative to White SMM and TW yet experience heightened vulnerability to HIV. This study sought to explore associations of substance use, including sex-drug use (i.e., drug or alcohol use during sex to enhance sex), and condomless sex among Black SMM and TW. Data were collected from Black SMM and TW living in Chicago, Illinois, enrolled in the Neighborhoods and Networks (N2) cohort study, from November 2018 to April 2019. We used bivariate analyses followed by a multilevel egocentric network analysis to identify factors associated with condomless sex. We conducted Spearman correlation coefficients to examine correlations between pairs of sex-drugs to enhance sex. We used a bipartite network analysis to identify correlates of sex-drug use and condomless sex. A total of 352 Black SMM and TW (egos) provided information about 933 sexual partners (alters). Of respondents, 45

Research suggests that sexual minority individuals are at increased risk of suicide compared with the general population. As technology continues to develop in sophistication and accessibility, a growing number of research and therapeutic interventions utilize web-based assessments. To facilitate future research on assessing and responding to suicidal thoughts and behaviors, we describe the implementation of procedures for doing so in the context of a limited-interaction, remote cohort study. We describe factors associated with suicidal thoughts and behaviors among sexual minority men (SMM) that can guide risk/benefit assessments in future studies. Descriptive statistics were used to characterize the sample in terms of self-injury/suicidality. Bivariate χ2tests were conducted to explore differences in these indicators by age, race and ethnicity, sexual orientation, health insurance, region, education, and self-ranked socioeconomic status. Additionally, logistic regressions were used to examine associations between demographic characteristics, various psychosocial syndemic factors, and the four measures of self-injury/suicidality. In addition, we describe the experiences completing the suicidality follow-up protocol within the study. We conducted a nationwide study of 10,607 participants and found that 27.8% had a history of self-injury, 5.6% in the past year, 21.0% had attempted suicide, 18.2% experienced suicidal ideation, and 9.4% had thoughts of killing themselves. Logistic regressions revealed that depression, everyday discrimination based on sexual orientation, childhood sexual assault, and intimate partner violence were the strongest predictors of self-injury and suicidality. Study participants experienced high rates of self-injury and suicidality. Effective protocols can be developed to assess and respond to suicide risk in web-based SMM studies.

Although sexual minority men experience elevated rates of childhood sexual abuse (CSA) and equal or greater rates of intimate partner violence (IPV) victimization compared to heterosexual individuals, little research has examined mechanisms linking these forms of victimization in this high-need population. We examined general (i.e., emotion regulation difficulties) and sexual minority specific (i.e., internalized homophobia) mediational pathways between CSA and IPV victimization in a longitudinal sample of 940 sexual minority men. Path analyses revealed significant associations between CSA and internalized homophobia, between internalized homophobia and emotion regulation difficulties, and between emotion regulation difficulties and IPV victimization. No indirect effects of CSA on IPV via general or minority specific pathways were observed. Findings suggest that minority stress specific (i.e., internalized homophobia) and general psychological risk factors (i.e., emotion regulation difficulties) co-occur and may function along independent pathways to link CSA to IPV revictimization. Future work is needed to investigate how mitigation of these modifiable pathways may be targeted to inform violence prevention interventions for sexual minority men.

Background Sexual minority men (SMM) experience higher suicidal ideation and suicide attempts than the general population. We examined the associations of adverse childhood experiences (ACES) and protective and compensatory childhood experiences (PACES) with suicidal ideation and suicide attempts in adulthood via thwarted belongingness and perceived burdensomeness among SMM. Methods Data are from the UNITE study, a national longitudinal cohort study of HIV-negative SMM from the 50 U.S. states and Puerto Rico. Between 2017 and 2019, participants (N = 6303) completed web-based assessments at baseline and 12-month follow-up. ACES and PACES occurring before the age of 18, and current symptoms of thwarted belongingness and perceived burdensomeness were assessed at baseline. Past-week suicidal ideation and past-year suicide attempt were assessed at follow-up. Results 424 (6.7%) participants reported past-week suicidal ideation and 123 (2.0%) reported a past-year suicide attempt. The results of our multivariate model suggest that each additional adverse childhood experience was prospectively associated with 14% higher odds of past-week suicidal ideation (AOR = 1.14, 95% CI 1.09-1.19) and 19% higher odds of past-year suicide attempt (AOR = 1.19, 95% CI 1.11-1.29). Each additional protective childhood experience was prospectively associated with 15% lower odds of past-week suicidal ideation (AOR = 0.85, 95% CI 0.81-0.90) and 11% lower odds of past-year suicide attempt (AOR = 0.89, 95% CI 0.82-0.98). Perceived burdensomeness partially mediated these prospective associations. Conclusion To reduce suicide, screening and treating perceived burdensomeness among SMM with high ACES may be warranted. PACES may decrease perceived burdensomeness and associated suicide risk.

Individual-level behavior can be influenced by injunctive and descriptive social network norms surrounding that behavior. There is a need to understand how the influence of social norms within an individual's social networks may influence individual-level sexual behavior. We aimed to typologize the network-level norms of sexual behaviors within the social networks of Black sexual and gender minoritized groups (SGM) assigned male at birth. Survey data were collected in Chicago, Illinois, USA, between 2018 and 2019 from Black SGM. A total of 371 participants provided individual-level information about sociodemographic characteristics and HIV vulnerability from sex (i.e., condomless sex, group sex, use of alcohol/drugs to enhance sex) and completed an egocentric network inventory assessing perceptions of their social network members' (alters') injunctive and descriptive norms surrounding sexual behaviors with increased HIV vulnerability. We used Latent Profile Analysis (LPA) to identify network-level norms based on the proportion of alters' approval of the participant engaging in condomless sex, group sex, and use of drugs to enhance sex (i.e., injunctive norms) and alters' engagement in these behaviors (i.e., descriptive norms). We then used binomial regression analyses to examine associations between network-level norm profiles and individual-level HIV vulnerability from sex. The results of our LPA indicated that our sample experienced five distinct latent profiles of network-level norms: (1) low HIV vulnerability network norm, (2) moderately high HIV vulnerability network norm, (3) high HIV vulnerability network norm, (4) condomless sex dominant network norm, and (5) approval of drug use during sex dominant network norm. Condomless anal sex, group sex, and using drugs to enhance sex were positively and significantly associated with higher HIV vulnerability social network norm profiles, relative to low HIV vulnerability norm profiles. To mitigate Black SGM's HIV vulnerability, future HIV risk reduction strategies can consider using network-level intervention approaches such as opinion leaders, segmentation, induction, or alteration, through an intersectionality framework.

This study examined associations between structural racism, anti-LGBTQ policies, and suicide risk among young sexual minority men (SMM). Participants were a 2017-2018 Internet-based U.S. national sample of 497 Black and 1536 White SMM (ages 16-25). Structural equation modeling tested associations from indicators of structural racism, anti-LGBTQ policies, and their interaction to suicide risk factors. For Black participants, structural racism and anti-LGBTQ policies were significantly positively associated with depressive symptoms, heavy drinking, perceived burdensomeness, thwarted belongingness, self-harm, and suicide attempt. There were significant interaction effects: Positive associations between structural racism and several outcomes were stronger for Black participants in high anti-LGBTQ policy states. Structural racism, anti-LGBTQ policies, and their interaction were not significantly associated with suicide risk for White SMM.

Despite advancements in HIV prevention, such as pre-exposure prophylaxis (PrEP), there remain inequities in accessing PrEP among Black and Hispanic/Latinx cisgender sexual minority men and transgender women (SMMTW). Researchers have documented multiple barriers to PrEP uptake, yet the relative impacts of PrEP internalized stigma and logistical barriers (e.g., Cost; time) to PrEP use are understudied. It may be meaningful to investigate potential interactions between internalized stigma and logistical barriers to PrEP use. We utilized data from 827 Black and Hispanic/Latinx SMMTW (Mage = 25.09) in the US and found that greater PrEP-related internalized stigma and greater PrEP logistical barriers were independently significantly associated with lower likelihood of current PrEP use, but PrEP-related internalized stigma became a non-significant predictor when included in a multivariable model. We found a significant interaction between PrEP-related internalized stigma and logistical barriers to PrEP use, such that the association between internalized stigma and likelihood of current PrEP use was only significant at lower levels of logistical barriers to PrEP use. Findings highlight the need to reduce logistical barriers to PrEP use, and for clinicians to acknowledge the role of stigma for individuals who otherwise do not report logistical barriers.

Most new HIV diagnoses in the US occur among sexual minority men (SMM). The majority (69%) of new HIV diagnoses among US SMM are due to transmission from main sex partners. We identified multilevel correlates of unprotected anal intercourse (UAI; condomless anal intercourse while not using a biomedical strategy) among SMM couples using the Actor Partner Interdependence Model (APIM). Participants were US SMM over 18 years, with a primary male partner > 6 months. Couples were recruited online from April 2016 until June 2017 and interviewed using self-administered computer-assisted surveys. We used a series of APIM regressions to assess multilevel associations with UAI. We also tested the moderating role of an individual’s binge drinking on the relationship between HIV status similarity and UAI. Among 798 participants (n = 411 couples), 61% reported UAI in the past 6 months. Binge drinking (52%) and physical intimate partner violence (IPV; 34%) were considerably high within our sample. Actor’s binge drinking, reporting experiencing and/or perpetrating physical IPV, and partner’s trust were positively associated with UAI. Actor having other sexual partner(s), using illegal drugs (not marijuana), and length of relationship were negatively associated with UAI. Binge drinking positively moderated UAI among HIV serostatus similar partners. HIV prevention programming should integrate components on IPV and binge drinking reduction- especially among HIV serostatus similar couples.