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BACKGROUND: HIV disproportionately affects sexual minority men (SMM; eg, gay, bisexual, and other men who have sex with men) in Lima, Peru; epidemiological data estimate that 32% to 39% of new HIV infections occur among adult cisgender SMM within primary partnerships (ie, male couples). Most HIV prevention-care research in Lima, Peru, has focused on SMM as individuals and not couples. To help address this critical gap in prevention care, we developed Para Ti, Para Mí, Para Nosotros (P3): a couples-based, digital HIV serostatus-neutral intervention (DHI) for adult cisgender SMM couples in Lima, Peru. The P3 DHI is designed to facilitate couples with skill-building, communication, decision-making, and working together to form and adhere to a detailed prevention care plan that aligns with their explicit sexual agreement. The P3 DHI is theoretically informed, self-guided, directed, sequential, and fully automated. OBJECTIVE: This pilot randomized controlled trial (RCT) aims to examine the preliminary effects of P3 on couples' formation and adherence to a detailed prevention care plan containing evidence-based strategies that also aligns with their explicit sexual agreement over time. In addition, the feasibility of enrollment and retention and couples' acceptability of P3 will be assessed. METHODS: The research implements a prospective, 6-month pilot RCT with a 3-month delayed control condition. After baseline, 60 enrolled SMM couples will be randomized to 1 of 2 conditions. Couples randomized to the unmatched, delayed control condition will receive access to the P3 DHI to use during the last 3 months of the trial after the 3-month assessment. Couples randomized to the immediate intervention condition will immediately receive access to the P3 DHI for 6 months. Study assessments will occur at baseline and months 3 and 6. Descriptive, comparative, qualitative, and longitudinal analyses using generalized linear mixed-effect, multilevel, and actor-partner interdependence models will be conducted to address the specific aims. RESULTS: The 6-month pilot RCT is ongoing. Recruitment, enrollment, and data collection began in January 2023 and ended in April 2024. A total of 74 adult cisgender SMM couples met all inclusion criteria, provided consent, and were enrolled in the pilot RCT. Retention was 92% (68/74) at month 6. Data are currently being analyzed to address the 3 specific aims regarding feasibility, acceptability, and preliminary efficacy. CONCLUSIONS: Findings from this research will reveal whether couples deemed the P3 DHI to be acceptable. Findings will also highlight the preliminary efficacy of the P3 DHI on couples managing their vulnerability to HIV and other sexually transmitted infections (STIs) over time via alignment of their prevention-care plan and sexual agreement. Trial findings will help shape the future direction of the P3 DHI while addressing the existing gap in prevention and care services for couples in the local context. TRIAL REGISTRATION: ClinicalTrials.gov NCT05873855; https://clinicaltrials.gov/study/NCT05873855. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/63106.

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Background: Several systems of oppression combine in complex ways to impact the lives of minority populations. Following an intersectionality framework, we assessed the frequency and perceived reasons for discrimination among gay, bisexual, and other cisgender men who have sex with men (MSM) and transgender and non-binary individuals (TGNB), stratified by race. Methods: Online survey among MSM and TGNB ≥18 years living in Brazil, between November/2021 and January/2022. We used the 18-item Explicit Discrimination Scale to assess day-to-day experiences of differential treatment, and perceived discrimination. For each item, participants indicated their perceived reasons for differential treatment using 14 pre-defined options. Negative binomial regression models assessed if race was a significant predictor of discrimination. Subsequent models, stratified by race, examined associations of perceived reasons and number of reasons with perceived discrimination. Findings: Of 8464 MSM and TGNB, 4961 (58.6%) were White, 2173 (25.7%) Pardo (Brazil's official term for admixed populations), and 1024 (12.1%) Black. Black participants' scores for perceived discrimination (mean, standard deviation) were higher (10.2, 8.8) [Pardo (6.5, 6.8), White (5.2, 5.7)], and race was both the main reason for and the strongest predictor of perceived discrimination. The number of reasons participants used to interpret their discriminatory experiences was also a predictor of discrimination score among White, Pardo, and Black participants. Interpretation: LGBTQIA+phobia was highly prevalent among all participants. Additionally, our results indicated that Black MSM and TGNB participants were more frequently discriminated against than other racial groups, with racial discrimination uniquely contributing these experiences. Funding: Fundação Oswaldo Cruz, Conselho Nacional de Desenvolvimento Científico e Tecnológico, Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro.

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RESUMO A população LGBTQIA+, ao buscar assistência à saúde, é constantemente exposta a vulnerabilidades evidenciadas por práticas preconceituosas decorrentes de atendimentos que reproduzem discriminação. Considerando a importância do debate relativo à diversidade sexual e de gênero, e em contraposição ao atendimento baseado em uma cis-heteronormatividade presumida, discriminatória e desconectada das necessidades das pessoas usuárias, este trabalho partiu de inquietações advindas do campo de atuação da enfermagem. Como a enfermeira percebe o corpo sob seus cuidados? Como se relaciona com esse indivíduo no contexto do processo de enfermagem? A enfermeira está preparada para assistir à população LGBTQIA+? Quais as melhores práticas que podem ser adotadas? Essa profissional tem conhecimento sobre os riscos de uma assistência ineficaz para as pessoas LGBTQIA+? Este estudo qualitativo foi desenvolvido mediante questionário semiestruturado aplicado a 17 enfermeiras atuantes no Hospital Maternidade Theresa Sacchi de Moura/Hospital da Mulher, no município de Barra Mansa, interior do Rio de Janeiro. No processo de pesquisa científica, foi adotada a técnica de análise de discurso a partir das falas compiladas que apontaram despreparo em relação às especificidades da comunidade LGBTQIA+, resultando na reprodução de violências e, consequentemente, tornando-se uma barreira ao acesso dos serviços de saúde.

ABSTRACT When seeking health care, the LGBTQIA+ population is constantly exposed to vulnerabilities evidenced by prejudiced practices resulting from assistance that reproduces discrimination. Considering the importance of the debate on sexual and gender diversity, and in opposition to care based on presumed cisheteronormativity, which is discriminatory and disconnected from the needs of the people who use the service, this work was based on concerns arising from the field of nursing. How does the nurse perceive the body under her care? How do they relate to this individual in the context of the nursing process? Are nurses prepared to assist the LGBTQIA+ population? What best practices can be adopted? Are they aware of the risks of ineffective care for LGBTQIA+ people? This qualitative study was carried out using a semi-structured questionnaire applied to 17 nurses working at the Hospital Maternidade Theresa Sacchi de Moura/Hospital da Mulher, in Barra Mansa, countryside of Rio de Janeiro, in the municipality of Barra Mansa, in the interior of Rio de Janeiro. In the process of scientific research, the technique of discourse analysis was adopted based on the statements compiled, which pointed to a lack of preparation in relation to the specificities of the LGBTQIA+ community, resulting in the reproduction of violence and, consequently, becoming a barrier to access to health services.

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INTRODUCCIÓN: Los humanos son seres sexuados, gran parte de ellos mantienen una vida sexual activa y comienzan a una edad temprana; sin embargo, esto puede llegar a ser un problema si no se cuenta con una base óptima de educación sexual, ya que ésta fomenta el autoconocimiento de cada persona, permitiendo una vida sexual plena. OBJETIVO: Relacionar la educación sexual con la percepción de la satisfacción sexual y el conocimiento de los genitales externos del sexo opuesto en mujeres y hombres heterosexuales cis-género. MATERIALES Y MÉTODOS: Estudio cuantitativo observacional analítico transversal, mediante la clasificación de preguntas y respuestas estructuradas, cuantificables realizada a estudiantes cis heterosexuales entre 18 y 25 años. RESULTADOS: Los resultados de esta investigación demostraron las diversas edades de inicio de actividad sexual, cantidad de parejas sexuales y la percepción de la vida sexual actual de los encuestados, reflejando que la mayoría de los mismos comenzaron su vida sexual tempranamente y, sin embargo, mantenían una baja cantidad de parejas sexuales. Aun con estos condicionantes, los sujetos refieren mantener una buena satisfacción sexual, queriendo conservar su vida sexual actual. CONCLUSIONES: Aún se aprecia la brecha de conocimientos desde los distintos niveles de educación, asimismo, se puede evidenciar la poca investigación en relación con la satisfacción sexual que existe en Chile. Por otra parte, la importancia que posee el/la profesional matrón/a es fundamental en cada una de las variables estudiadas ya que, es el profesional más capacitado para abordar este ámbito.

INTRODUCTION: Humans are sexed beings, which many of them maintain an active sexual life and begin at an early age however, this could be a problem if there is not an optimal base of sexual education. OBJECTIVE: To relate sexual education with the perception of sexual satisfaction and knowledge of the external genitalia of the opposite sex in cis-gender heterosexual women and men. MATERIALS AND METHODS: Cross-sectional analytical observational quantitative study, through the classification of structured questions and answers, quantifiable carried out to cis heterosexual students between 18 and 25 years. RESULTS: The results of this research, demonstrated the different ages of initiation of sexual activity, number of sexual partners and the perception of the current sexual life of the respondents, reflecting that most of the respondents began their sexual life early, however they maintained a low number of sexual partners, even so these refer to maintain a good sexual satisfaction wanting to maintain their current sexual life. CONCLUSIONS: The knowledge gap between the different levels of education is still evident, as well as the lack of research on sexual satisfaction in Chile. On the other hand, the importance of the professional midwife is fundamental in each of the variables studied, since he/she is the most qualified professional to address this area.

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BACKGROUND: Efforts to increase HIV testing, diagnosis and care are critical to curbing HIV epidemics among cisgender men who have sex with men (MSM) and transgender women (TW) in low- and middle-income countries (LMIC). We compared the effectiveness of respondent-driven sampling (RDS) and venue-based sampling (VBS) for identifying previously undiagnosed HIV infection among MSM and TW in Tijuana, Mexico. METHODS: Between March 2015 and December 2018, we conducted RDS within the social networks of MSM and TW and VBS at venues frequented by MSM and TW to socialize and meet sexual partners. Those reached by RDS/VBS who reported at least 18 years of age, anal sex with MSM or TW, and no previous HIV diagnosis were eligible for HIV testing. RESULTS: Of those screened following recruitment via RDS (N = 1232; 98.6% MSM; 1.3% TW), 60.8% (749/1232) were eligible for HIV testing and 97.5% (730/749) were tested for HIV infection, which led to the identification of 36 newly diagnosed HIV infections (4.9%). Of those screened following recruitment via VBS (N = 2560; 95.2% MSM; 4.6% TW), 56.5% (1446/2560) were eligible for HIV testing and 92.8% (1342/1446) were tested for HIV infection, which led to the identification of 82 newly diagnosed HIV infections (6.1%). The proportion of new HIV diagnoses did not differ by recruitment method (ratio = 0.81, 95% confidence interval: 0.55 to 1.18). Compared to those recruited via RDS, those tested following recruitment via VBS were younger, more likely to identify as gay, and more likely to identify as TW. Compared to those recruited via VBS, those newly diagnosed with HIV infection following recruitment via RDS reported higher levels of internalized stigma and were more likely to report injection drug use and a history of deportation from the United States. CONCLUSIONS: Despite RDS and VBS being equally effective for identifying undiagnosed HIV infection, each recruitment method reached different subgroups of MSM and TW in Tijuana. Our findings suggest that there may be benefits to using both RDS and VBS to increase the identification of previously undiagnosed HIV infection and ultimately support HIV care engagement among MSM and TW in Mexico and other similar LMIC.

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Resumo O objetivo neste artigo é aproximar a discussão sobre as questões de gênero que constituem o campo de saber da psicologia e as críticas dos saberes transfeministas às práticas e discursos normativos e patologizantes sobre as vivências de pessoas trans. Utiliza-se para tal análise as noções de cisgeneridade, como forma de nomear um lugar a partir do qual as identidades trans são enunciadas, e da cisnormatividade como dispositivo que regula e determina sentidos de coerência para os processos de constituição de gênero. Esses conceitos funcionam como operadores analíticos e políticos que fazem contraponto à naturalização da cisgeneridade como pressuposto fundante das verdades do gênero e dos modos de subjetivação. Problematiza-se, portanto, como a psicologia participa dos arranjos cisnormativos relacionados aos modos de reconhecimento das pessoas trans e às possibilidades de enunciação sobre suas vivências.

Resumen El objetivo de este artículo es aproximar la discusión sobre las cuestiones de género que constituyen el campo del saber de la psicología, así como las críticas de los saberes transfeministas, a las prácticas y discursos normativos y patologizantes sobre las vivencias de las personas trans. Para el análisis se utilizan las nociones de cisgeneridad como forma de nombrar un lugar a partir del cual las identidades trans son enunciadas, y de cisnormatividad como dispositivo que regula y pauta un sentido de coherencia a los procesos de constitución de género. Estos conceptos funcionan como operadores analíticos y políticos que generan un contrapunto a la naturalización de la cisgeneridad como presupuesto instituyente de las verdades del género y los modos de subjetivación. Se problematiza, por tanto, cómo la psicología participa de los acuerdos cisnormativos relacionados con los modos de reconocimiento de las personas trans, así como de las posibilidades de enunciación de sus vivencias.

Abstract This article aims to articulate the discussion about the gender issues that constitute psychology's knowledge field and the critiques of the trans-feminist knowledge to normative and pathological practices and discourses about the experiences of trans people. The notion of cisgenerity is used for such analysis as a way of naming a place from which trans identities are enunciated. Moreover, the notion of cis-normativity is used as an apparatus that regulates and determines meanings of coherence to the processes of gender constitution. These concepts function as analytical and political operators that make a counterpoint to the naturalization of cisgenerity as a founding presupposition of the truths of gender and the modes of subjectivation. Therefore, it is problematized how psychology participates in the cis-normative arrangements related to the modes of recognition of trans people and to the possibilities of enunciation about their experiences.

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Our aim was to better understand Human Papillomavirus (HPV) vaccine acceptance among Mexican adults including people with and without HIV, cisgender men who have sex with men (MSM) or with women (MSW), cisgender and transgender women. A computer-assisted, self-administered questionnaire was completed by healthcare users and participants recruited through community organizations, and the first dose of the quadrivalent HPV vaccine was offered at no cost at a large sexual health clinic in Mexico City, from May to December 2018. Socio-demographic characteristics and factors associated with HPV vaccine acceptance were analyzed using logistic regression.The sample of 1915 participants included 1341 cisgender men (70.9%, 1247 MSM and 94 MSW), 396 (20.7%) cisgender women and 178 (9.3%) transwomen; 615 people (32.1%) were HIV positive. Uptake of the HPV vaccine was higher in men and transwomen (91.5% and 87%, respectively) than among cisgender women (81.8%; p < .001). Cisgender women (OR 0.43, 95%CI 0.30-0.61, p < .05) were less likely to accept HPV vaccination than men. Married/partnered people were less likely to accept HPV vaccination compared to those who were single (OR 0.70, 95%CI 0.51-0.97). People living with HIV were not significantly more likely to accept HPV vaccination (OR 1.7; 95%CI 0.86-1.61).HPV vaccine acceptance was high among adult Mexican study participants; it may be higher than among other Mexican adults given most of these individuals are engaged in care. Modifications will be needed in national and international recommendations on HPV vaccination in adults if healthcare personnel are to recommend the vaccine to the population groups studied.

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Una persona transgénero es aquella en la cual el género autopercibido difiere del asignado al nacer, mientras que el término cisgénero es utilizado en aquellos individuos no trans. El tratamiento hormonal cruzado (THC) constituye una opción para lograr caracteres sexuales secundarios deseados. Es conocido que los esteroides sexuales desempeñan un rol fundamental en la adquisición de la densidad mineral ósea (DMO) durante la pubertad. Por lo tanto, el impacto del THC sobre la masa ósea se ha convertido en materia de estudio. En estadios puberales tempranos, los análogos de la hormona liberadora de gonadotrofinas (GnRH) son utilizados con un efecto reversible. Si bien la DMO parece mantenerse estable, cuando se compara con una población de referencia del mismo sexo biológico y edad, el Z-score se encuentra por debajo de lo esperado. En adultos, durante el THC no se informaron disminuciones en la DMO. Está reportado que las mujeres trans antes del inicio del TH presentan características densitométricas diferentes de los hombres cisgénero. Hasta el momento, la carga de datos para los calculadores del riesgo de fractura y el software del equipo DXA se basan en el sexo biológico y no en identidad de género. Recientemente, la International Society for Clinical Densitometry (ISCD) emitió sus recomendaciones para la evaluación de la masa ósea en personas transgénero y en aquellos individuos no conformes con el género. Si bien la ISCD sugiere realizar la evaluación únicamente en aquellos pacientes con factores de riesgo, es de importancia realizar DXA basal, sobre todo en mujeres transgénero, para determinar el riesgo inicial de dicha población. En este artículo se revisa la evidencia disponible sobre el impacto del THC en la salud ósea de personas transgénero. (AU)

Cross sex hormone therapy (CSHT) in transgender women (TW) it is an option to achieve desired secondary sexual characteristics. It is known that sex steroids play a fundamental role in the acquisition of bone mineral density during puberty, in addition to determining a different characteristic bone pattern between both biological sexes. So the impact of affirming HT on bone is it has become in subject of study. In early pubertal stages, GnRH analogs are used with a reversible effect. Although bone mineral density (BMD) seems to remain stable, when compared with a reference population of the same biological sex and age, the Z-score is lower than expected. In adults, during CSHT no decreases in BMD were reported. However, it was reported that TW prior to starting CSHT present different densitometric characteristics than cisgender men. So far, the data load for the fracture risk calculators and DXA software is based on biological sex and not gender identity. Recently the ISCD issued its recommendations for the evaluation of bone mass in transgender subjects and in those non-conforming to gender. Although the ISCD suggests performing the evaluation only in those patients with risk factors, our group recognizes that baseline DXA, especially in TW, constitutes a useful tool to determine the initial risk of this population. Our proposal arises from our own experience and from that compiled in the international literature, where it is observed that even without starting CSHT, transgender women have lower BMD. DXA. This article reviews the available evidence regarding the effect of CSHT on health bone in transgender people. (AU)

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