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BACKGROUND: The number of children in sexual minority parent families has increased. This systematic review aims to synthesise the evidence of disparities in family outcomes between sexual minority and heterosexual families and to identify specific social risk factors of poor family outcomes. METHODS: We systematically searched PubMed, the Web of Science, Embase, the Cochrane Library and APA PsycNet for original studies that compared family outcomes between sexual minority and heterosexual families. Two reviewers independently selected studies and assessed the risk of bias of included studies. Narrative synthesis and meta-analysis were conducted to synthesise evidence. RESULTS: Thirty-four articles were included. The narrative synthesis results revealed several significant findings for children's gender role behaviour and gender identity/sexual orientation outcomes. Overall, 16 of 34 studies were included in the meta-analyses. The quantitative synthesis results suggested that sexual minority families may perform better in children's psychological adjustment and parent-child relationship than heterosexual families (standardised mean difference (SMD) -0.13, 95% CI -0.20 to -0.05; SMD 0.13, 95% CI 0.06 to 0.20), but not couple relationship satisfaction (SMD 0.26, 95% CI -0.13 to 0.64), parental mental health (SMD 0.00, 95% CI -0.16 to 0.16), parenting stress (SMD 0.01, 95% CI -0.20 to 0.22) or family functioning (SMD 0.18, 95% CI -0.11 to 0.46). CONCLUSION: Most of the family outcomes are similar between sexual minority and heterosexual families, and sexual minority families have even better outcomes in some domains. Relevant social risk factors of poor family outcomes included stigma and discrimination, poor social support and marital status, etc. The next step is to integrate multiple aspects of support and multilevel interventions to reduce the adverse effects on family outcomes with a long-term goal of influencing policy and law making for better services to individuals, families, communities and schools.
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Identidad de Género , Heterosexualidad , Masculino , Humanos , FemeninoRESUMEN
INTRODUCTION: HIV self-testing (HIVST) provides a key measure for the early detection of HIV infection in men who have sex with men (MSM). However, dual HIV/syphilis self-testing in the MSM population has not been studied. We describe a randomised controlled trial to evaluate the effect of dual HIV/syphilis self-testing on the testing frequency among MSM in China. METHODS AND ANALYSIS: This randomised controlled trial will be implemented in Guangxi, China. 330 MSM, including 255 frequent testers and 75 less frequent testers, will be recruited and randomly assigned in a 1:1:1 ratio into one of three arms: a site-based testing arm, a single HIVST arm and a dual HIV/syphilis self-testing arm. Participants in the single HIVST arm and dual HIV/syphilis self-testing arm will receive two free finger-prick-based HIVST or HIV/syphilis self-testing kits at enrolment. The data will be collected at five separate times: baseline, 3 months, 6 months, 9 months and 12 months. The primary outcome is the mean frequency of HIV testing used by MSM after intervention comparing each group during the study period. The secondary outcome includes changes in sex behaviours (eg, number of male sex partners and the proportion of consistent condom use) and the mean number of HIV tests used by the social network members over the study period. ETHICS AND DISSEMINATION: The study protocol was reviewed and approved by the Medical Ethics Committee of Guangxi Medical University, China (20210173). The study results will be disseminated through conferences and academic journals. TRIAL REGISTRATION NUMBER: ChiCTR2100050898.
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Infecciones por VIH , Minorías Sexuales y de Género , Sífilis , China/epidemiología , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Prueba de VIH , Homosexualidad Masculina , Humanos , Masculino , Ensayos Clínicos Controlados Aleatorios como Asunto , Autoevaluación , Encuestas y Cuestionarios , Sífilis/diagnósticoRESUMEN
INTRODUCTION: This study aimed to investigate sexual orientation disclosure and mental health among young men who have sex with men (YMSMs). To this end, we constructed a chained multimediator model of sexual minority stigma, sexual minority identity, social support, and resilience, with the moderator of sexual orientation disclosure. METHODS: We conducted a cross-sectional survey of 345 YMSMs in Nanning, China. Bivariate analysis was used to evaluate factors associated with sexual orientation disclosure. Sexual minority stigma was used to predict identity, with social support as the step 1 mediator and resilience as the step 2 mediator. Sexual minority identity was analyzed using a chained moderated mediation model; sexual orientation disclosure was included as a moderator in all models to control its confounding effect. RESULTS: The average age of YMSMs was 20.0 ± 1.3 years. Bivariate analysis indicated that YMSMs who disclosed sexual orientation may have experienced less stigma (15.49 ± 3.02 vs 16.21 ± 2.74), obtained more social support (65.98 ± 11.18 vs 63.19 ± 11.13), had strong psychological resilience (37.40 ± 8.57 vs 35.39 ± 7.73), and had a more positive self-identity (104.12 ± 21.10 vs 95.35 ± 16.67); differences between subgroups were statistically significant (p < 0.05). Sexual minority stigma, perceived stigma, and enacted stigma were significantly associated with social support and resilience. The association between sexual minority stigma and sexual minority identity was significantly mediated by social support (indirect effect [95% CI] = - 3.307 [- 4.782, - 1.907]). Resilience significantly mediated the same association for identity (- 2.544 [- 4.052, - 1.114]). The chained relationship from sexual minority stigma to social support, resilience, and identity was also significant, with an indirect effect of - 0.404 [- 0.621, - 0.249]. CONCLUSION: Among YMSMs in China, sexual minority stigma affects sexual minority identity through social support and resilience. Given the psychological effects of stigma, social support and resilience must be considered to better promote positive self-identity and mental health among YMSMs.
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Minorías Sexuales y de Género , Adolescente , Adulto , Estudios Transversales , Revelación , Femenino , Homosexualidad Masculina , Humanos , Masculino , Conducta Sexual , Identificación Social , Estigma Social , Apoyo Social , Adulto JovenRESUMEN
INTRODUCTION: Key populations such as men who have sex with men (MSM), drug users and sex workers are at high risk of HIV infection, but they are marginalised and hidden. Social network strategy (SNS) is purposeful to use social networks to generate social influence, accelerate behaviour change and achieve desirable outcomes among individuals or communities and have been increasingly used for HIV interventions. This study aims to investigate the effects of SNS on HIV prevention among key populations. METHODS: We searched six databases, including PubMed, Web of Science, Embase, Cochrane Library, ScienceDirect and Wiley for randomised controlled trials published between January 1999 and May 2019. Eligibility criteria included SNS conducted among key populations for HIV interventions, with a comparator group. Outcomes included changes in HIV high-risk behaviour, HIV seroconversion and other HIV outcomes. We used the risk ratio (RR) or mean difference with associated 95% confidence interval (CI) to assess the comparative efficacy between SNS and control methods on the selected outcomes. The GRADE system was used to assess the quality of evidence for the studies. RESULTS: Of 2818 citations identified, 28 trails from 24 papers met the inclusion criteria. The results showed that SNS was associated with less unprotected intercourse (RR 0.79, 95% CI 0.72 to 0.86) and sex with multiple partners (0.46, 95% CI 0.33 to 0.65). Additionally, relative to the control methods, SNS significantly reduced HIV seroconversion (0.65, 95% CI 0.53 to 0.81), improved HIV testing uptake (1.11, 95% CI 1.07 to 1.15) and promoted participant retention (1.03, 95% CI 1.00 to 1.06) among key populations. The Grading of Recommendations Assessment, Development and Evaluation system showed that trails were of moderate quality. CONCLUSIONS: This review provides evidence that SNS can reach key populations who are currently not being reached by existing programmes and deliver HIV interventions through social networks, which decreases HIV sexual risk behaviour and HIV incidence and increases HIV testing uptake and participant retention. TRIAL REGISTRATION NUMBER: CRD42019140533.