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The largely binary nature of biological sex and its conflation with the socially constructed concept of gender has created much strife in the last few years. The notion of gender identity and its differences and similarities with sex have fostered much scientific and legal confusion and disagreement. Settling the debate can have significant repercussions for science, medicine, legislation, and people's lives. The present review addresses this debate though different levels of analysis (i.e., genetic, anatomical, physiological, behavioral, and sociocultural), and their implications and interactions. We propose a rationale where both perspectives coexist, where diversity is the default, establishing a delimitation to the conflation between sex and gender, while acknowledging their interaction. Whereas sex in humans and other mammals is a biological reality that is largely binary and based on genes, chromosomes, anatomy, and physiology, gender is a sociocultural construct that is often, but not always, concordant with a person' sex, and can span a multitude of expressions.

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Experiencing HIV and intersectional stigmas in healthcare settings may affect antiretroviral treatment (ART) adherence among people with HIV (PWH), given their need for frequent interactions with clinical settings and healthcare providers. Considering the importance of reducing stigmas to promote well-being and the need to elucidate how stigma influences health across various settings, we examined how experienced HIV stigma in Dominican Republic healthcare settings impacts ART adherence through internalized HIV stigma and whether race or sexual orientation stigma moderates this relationship. Participants were 471 PWH (aged 17-71) who were recruited from two HIV clinics in the Dominican Republic in 2021-2022. Results revealed a significant mediation effect (B=-0.10, SE = 0.05, CI [-0.234, - 0.014]) after adjusting for effect of age and time since HIV diagnosis, suggesting that experienced HIV stigma in healthcare settings was associated with more internalized HIV stigma (B = 0.39, SE = 0.11, p = .001), subsequently linked to lower ART adherence (B=-0.26, SE = 0.11, p = .016). The indirect effect was significant at low levels of race stigma (B=-0.16, SE = 0.09, CI [-0.369, - 0.001]) but not at high levels of race stigma (B=-0.06, SE = 0.05, CI [-0.175, 0.038]). This indirect effect was also significant at low levels of sexual orientation stigma (B=-0.19, SE = 0.10, CI [-0.401, - 0.023]) but not at high levels of sexual orientation stigma (B=-0.04, SE = 0.06, CI [-0.160, 0.074]). These findings suggest that addressing experienced HIV stigma in Dominican Republic healthcare settings, along with various dimensions of HIV-related stigma (e.g., internalized stigma) and intersecting stigmas (e.g., race, sexual orientation), is vital for improving health outcomes, such as optimal ART adherence.

RESUMEN: Experimentar estigmas relacionados con el VIH e interseccionales en entornos de atención médica puede afectar la adherencia al tratamiento antirretroviral (TAR) entre las personas que viven con VIH (PVVIH), dado que necesitan interacciones frecuentes con entornos clínicos y proveedores de atención médica. Considerando la importancia de reducir los estigmas para promover el bienestar y la necesidad de esclarecer cómo el estigma influye en la salud en diversos contextos, examinamos cómo el estigma del VIH experimentado en entornos de atención médica en la República Dominicana impacta la adherencia al TAR a través del estigma internalizado del VIH y si el estigma racial o de orientación sexual modera esta relación. Los participantes fueron 471 PVVIH (de 17 a 71 años) que fueron reclutados de dos clínicas de VIH en la República Dominicana en 2021­2022. Los resultados revelaron un efecto de mediación significativo (B=-0.10, SE = 0.05, CI [-0.234, − 0.014]) después de ajustar por el efecto de la edad y el tiempo desde el diagnóstico de VIH, sugiriendo que el estigma del VIH experimentado en entornos de atención médica estaba asociado con un mayor estigma internalizado del VIH (B = 0.39, SE = 0.11, p = .001), vinculado posteriormente a una menor adherencia al TAR (B=-0.26, SE = 0.11, p = .016). El efecto indirecto fue significativo en niveles bajos de estigma racial (B=-0.16, SE = 0.09, CI [-0.369, − 0.001]) pero no en niveles altos de estigma racial (B=-0.06, SE = 0.05, CI [-0.175, 0.038]). Este efecto indirecto también fue significativo en niveles bajos de estigma por orientación sexual (B=-0.19, SE = 0.10, CI [-0.401, − 0.023]) pero no en niveles altos de estigma por orientación sexual (B=-0.04, SE = 0.06, CI [-0.160, 0.074]). Estos hallazgos sugieren que abordar el estigma del VIH experimentado en entornos de atención médica en la República Dominicana, junto con diversas dimensiones del estigma relacionado con el VIH (por ejemplo, estigma internalizado) y estigmas interseccionales (por ejemplo, raza, orientación sexual), es vital para mejorar los resultados de salud, como la adherencia óptima al TAR.

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BACKGROUND: Globally, the counting of deaths based on gender identity and sexual orientation has been a challenge for health systems. In most cases, non-governmental organizations have dedicated themselves to this work. Despite these efforts in generating information, the scarcity of official data presents significant limitations in policy formulation and actions guided by population needs. Therefore, this manuscript aims to evaluate the accuracy, potential, and limits of probabilistic data relationships to yield information on deaths according to gender identity and sexual orientation in the State of Rio de Janeiro. METHODS: This study evaluated the accuracy of the probabilistic record linkage to obtain information on deaths according to gender and sexual orientation. Data from two information systems were used from June 15, 2015 to December 31, 2020. We constructed nine probabilistic data relationship strategies and identified the performance and cutoff points of the best strategy. RESULTS: The best data blocking strategy was established through logical blocks with the first and last names, birthdate, and mother's name in the pairing strategy. With a population base of 80,178 records, 1556 deaths were retrieved. With an area under the curve of 0.979, this strategy presented 93.26% accuracy, 98.46% sensitivity, and 90.04% specificity for the cutoff point ≥ 17.9 of the data relationship score. The adoption of the cutoff point optimized the manual review phase, identifying 2259 (90.04%) of the 2509 false pairs and identifying 1532 (98.46%) of the 1556 true pairs. CONCLUSION: With the identification of possible strategies for determining probabilistic data relationships, the retrieval of information on mortality according to sexual and gender markers has become feasible. Based on information from the daily routine of health services, the formulation of public policies that consider the LGBTQ + population more closely reflects the reality experienced by these population groups.

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In this study, we analyzed 989 Brazilian individuals identified as flexitarians to explore the relationship between gender, sexual orientation, and meat consumption reduction behavior, while evaluating the impact of motivations driving individuals towards this dietary model. To achieve this goal, we tested the following hypotheses: women consume less meat than men; LGBT women consume less meat than heterosexual women; LGBT men consume less meat than heterosexual men; and women are more motivated by the environmental impact of meat. Our findings revealed that although gender significantly influences motivations, with women showing a greater influence from animal ethics, flexitarians of both genders exhibit similar meat consumption patterns. Neither sexual orientation nor gender influence meat reduction patterns among flexitarians. However, the race/ethnicity of white individuals is a predominant factor among those who reduce meat consumption the most. Consequently, we conclude that (i) the social theories applied to explain gender differences in meat exclusion behavior may not be the most suitable for explaining meat reduction behavior, and (ii) intersectional approaches are needed to investigate flexitarianism.

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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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Type II diabetes is increasingly becoming a problem in Latin American countries such as Peru. People living with diabetes must incorporate several behavioral changes in their everyday lives, which are done outside the purview of medical professionals. Support from friends and family members is essential to the successful management of any chronic condition. Our study discusses the role of family involvement in supporting the management of diabetes among Peruvian men and examines how masculine norms play a role in the way such support is received and perceived, and their influence in motivation to adhere to treatment recommendations. In-depth interviews with 20 men from a low socioeconomic status, aged 27 to 68 with a diagnosis of Type II diabetes were conducted. Our analysis suggests the importance of the close, complex, and integrated experience that connects family members and patients with a chronic condition. Participant accounts demonstrate they receive multiple forms of support from a diverse range of social relationships. The overwhelming majority of the people giving the support were female and were especially significant in supporting management practices. The participants' accounts were able to demonstrate how living with a chronic condition, such as diabetes, affects the whole family-physically, mentally, and emotionally-and they experience the disease as one unit. Our study demonstrates the need for a family health experience approach that considers masculine gender norms around health and provides relevant insights to inform family-based treatments and therapies to allow for more and better targeted health care for men.

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Colombia has extensive laws prohibiting discrimination against sexual minority people. However, violence and discrimination toward sexual minorities are still frequent. While a growing body of research shows that sexual minority people experience elevated rates of discrimination and domestic abuse globally, little research has been conducted on these issues affecting sexual minorities in Colombia specifically. Using minority stress theory as a conceptual framework, this paper aims to fill this gap by examining the prevalence of experiencing intimate partner violence (IPV) and witnessed discrimination and the relationship of these stressors to self-reported health among a national sample of sexual minority Colombians. We found that bisexual individuals experienced higher rates of physical and sexual IPV, compared to lesbian and gay individuals. Additionally, sexual minority Colombians who experienced IPV and witnessed discrimination were more likely to report having poorer health, compared to those who had not. We discuss the implications of our findings for future research and clinicians working with sexual minority clients.

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Internationally, HIV-related stigma and crystal methamphetamine (meth) use have been described as barriers to treatment adherence among gay, bisexual, and other men who have sex with men (gbMSM). Crystal meth use has been increasing among gbMSM in the Metropolitan Area of Mexico City (MAMC). Therefore, this study aimed to determine the association between HIV-related stigma and HIV treatment adherence among gbMSM who use crystal meth in the MAMC. This study was undertaken as part of an exploratory study of crystal meth use in the MAMC. The data were collected from September to December 2021 through an encrypted online survey. Participants (n = 89) were gbMSM adults living with HIV who reported crystal meth use in the past month that were recruited through an online snowball sampling. The online survey included questions about HIV treatment adherence, sexual behaviors, the Alcohol, Smoking, and Substance Involved Screening Test, and the HIV-Related Stigma Mechanisms Scale. Logistic regression analyses assessed the association between HIV-related stigma and HIV treatment adherence. The multivariate logistic regression model showed that, controlling for health insurance [adjusted odds ratio (AOR) = 0.13; 95% confidence intervals (CI)  = 0.02-0.59] and educational level (AOR = 0.16; 95% CI = 0.02-0.88), non-adherence to HIV treatment was independently associated with higher HIV-related stigma (AOR = 1.06; 95% CI = 1.01-1.12). Public health policies must include HIV-related stigma and substance use in treating gbMSM with HIV.

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Partner preferences are an important differential in relationship formation and evolutionary fitness, and vary according to individual, ecological, and social factors. In this study, we evaluated the variation in preference for intelligence, kindness, physical attractiveness, health, and socioeconomic level among individuals of different sexes and sexual orientations in a Brazilian sample. We analyzed the preference scores of 778 heterosexual, bisexual, and homosexual men and women in three budgeted mate design tasks (low vs. medium vs. high budget) and their association with sociosexuality, attachment styles, homogamy, and willingness to engage in short- and long-term relationships. Results indicated a global trait preference order, with intelligence ranking first, followed by kindness, physical attractiveness, health, and lastly by socioeconomic status. Typical sex differences were observed mostly within the heterosexual group, and specific combinations of sex and sexual orientation were linked to variation in preference for physical attractiveness, kindness, and socioeconomic status. We also found unique associations of the other variables with partner preferences and with willingness to engage in short- or long-term relationships. By exploring the partner preferences of non-heterosexual individuals from a Latin American country, an underrepresented group in evolutionary psychology research, our results help understand the universal and specific factors that guide partner preferences and human sexual behavior.

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Mulheres cisgênero lésbicas são confrontadas em seu cotidiano com situações de dupla violência, relacionadas à desqualificação e desvalor atribuídos tanto ao gênero como à orientação sexual. Este estudo teve por objetivo compreender os significados atribuídos às experiências de preconceito e discriminação sofridas por mulheres lésbicas de camadas médias. Trata-se de um estudo clínico-qualitativo fundamentado no olhar interseccional dos estudos de gênero. Participaram seis mulheres brancas de 22 a 59 anos de camadas médias, que se autoidentificavam como lésbicas. Para construção do corpus de análise foram realizadas entrevistas individuais gravadas em áudio. Os dados foram analisados e discutidos na perspectiva da análise temática reflexiva. Foram construídas cinco categorias: ambiente de trabalho, família de origem, relações de amizade, serviços de saúde e pessoas desconhecidas. Os resultados mostram que pessoas que perpetram violência contra lésbicas não toleram a possibilidade de que duas mulheres possam manter relacionamento afetivo-sexual e se utilizam de estratégias de apagamento (insultos, deboche, desrespeito, indiferença) para depreciá-las, invisibilizá-las e discriminá-las. Os ataques recorrentes às lesbianidades têm como função manter a hegemonia do modelo heterocentrado. Examinar os significados atribuídos às experiências de preconceito e discriminação sofridas por mulheres lésbicas pode encorajar o desenvolvimento de intervenções culturalmente sensíveis e a efetivação de políticas públicas voltadas a essa população.

Cisgender lesbian women face situations of double violence in their daily lives with situations of double violence, related to the disqualification and devaluation attributed to both gender and sexual orientation. This study aimed to understand the meanings attributed to middle-class lesbian women's experiences of prejudice and discrimination. This is a clinical qualitative study based on the intersectional look of gender studies. Six white, middle-class women ages 22 to 59, who self-identified as lesbians, participated. Individual interviews were conducted and recorded to create the analysis corpus. The data were analyzed and discussed from the perspective of reflective thematic analysis. Five categories were constructed: work environment, family of origin, friendship relations, health services, and unknown people. The results show that people who perpetrate violence against lesbians do not tolerate the possibility that two women can have an affective-sexual relationship and use erasure strategies (insults, debauchery, disrespect, indifference) to depreciate, invisibilize them, and discriminate against them. The recurrent attacks on lesbianities have the function of maintaining the hegemony of the heterocentric model. Examining the meanings attributed to the experiences of prejudice and discrimination suffered by lesbian women can encourage the development of culturally sensitive interventions and public policies targeting this population.

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BACKGROUND: Population surveys involving the monitoring of high-risk sexual behavior have been recognized as important public health tools to control the HIV epidemic and other sexually transmitted infections (STIs). METHODS: Using data from the Knowledge, Attitudes, and Practices survey (PCAP-2013) and from the National Health Survey (PNS-2019), indicators of sexual behavior were compared according to sociodemographic characteristics among individuals aged 18-64 years, including size (%) estimates of men who have sex with men (MSM) and women who have sex with women (WSW). Specifically, the PNS-2019 prevalence estimates of homosexual, bisexual, heterosexual males and females were compared with those from the PCAP-2013. To compare PCAP and PNS proportional distributions, the Pearson's chi-square test, adjusted by the Rao-Scott's correction, was applied. RESULTS: Size (%) estimates of MSM and WSW obtained by direct questions from the PCAP-2013, showed higher homosexuality prevalence estimates than those resulting from the PNS-2019 self-declared sexual orientation. Significant differences were found between the MSM proportions according to the PCAP-2013 (3.7%; 95% CI 3.1-4.4%) and to the PNS-2019 (2.2%; 95% CI 1.9-2.5), and between the WSW proportions (4.6%; 95% CI 4.0-5.4%) and (2.1%; 95% CI 1.8-2.4), respectively. Results from both surveys showed MSM and WSW prevalence estimates increase with educational level, decrease with age, and is larger among people who do not live with partner, live in urban areas and in state capitals. Regarding condom use at last sexual intercourse, no differences between the PCAP-2013 and the PNS-2019 estimates were found at the national level, but significant improvements were found for MSM, people aged 18-24 and 25-34 years, and individuals not living with a partner. CONCLUSIONS: The underestimation of MSM and WSW prevalence by self-declared sexual orientation suggests that sexual minorities face many difficulties related to disclosing their sexuality and reinforces the importance of developing public health interventions for changing population attitudes and promoting sexual orientation disclosure. Moreover, the low use of condoms in both surveys (PCAP-2013 and PNS-2019) carried out 6 years apart highlights the need of public policies to expand prevention strategies for HIV infection and other STIs.

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Introduction: Recent research highlight increasing at-risk online sexual activities and behaviors during the COVID-19 pandemic among young adults. Specifically, sexting refers to exchanging sexually suggestive messages, photos, and videos through technological devices, and it can be placed on a continuum from safer to riskier behavior. This study aims to improve our knowledge about sexting behaviors in Italian and Colombian young adults before and during the COVID-19 pandemic. Methods: A survey online was filled in by all recruited participants through a snowball sampling procedure (from December 2019 to June 2021) both in Italy and Colombia, resulting in a total of 2931 participants (2051 from Italy and 880 from Colombia) aged 18 to 35 years old (Mage = 23.85; SDage = 3.63; 67.6% girls). Results: Italian youth were more engaged in risky sexting than Colombian participants, while Colombians indicated being more engaged in non-consensual sexting than Italians. Sexual minority people reported more sharing their own sexts, higher levels of sexting under pressure, and 3.2 times more risky sexting than exclusively heterosexual counterparts. During the pandemic period, participants sent their own sexts 1.5 times more and were less involved in non-consensual sexting than in the pre-pandemic era. Conclusions: The present research could help understand better the cultural dynamics underlying the differences in sexting behaviors, suggesting the relevance of investigating how sexting behaviors and online at-risk activities have changed since the pandemic started. Policy Implications: Results provide implications for educational and prevention programs to improve young people's awareness of sexting behaviors.

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INTRODUCTION: The non-expression of sexual orientation and gender identity can affect mental health in the lesbian, gay, bisexual, transgender, and intersex population in Peru. METHOD: Secondary, observational, analytical, and cross-sectional analyses of data from the "First Virtual Survey on the LGBTI population" were conducted with a population (n = 11,345) of LGBTI adults aged 18 years old or more. The variables of mental health and expression of sexual orientation and/or gender identity were measured using a self-reported questionnaire that did not include a validated scale; questions with multiple alternatives that included "yes" and "no" options were used. Prevalence ratios (PR) and 95% confidence intervals (95% CI) were obtained by glm log Poisson regression models. RESULTS: The median age of the participants was 25 years (IQR: 21-30), and the majority of the population identified as gay, followed by lesbian and bisexual. Individuals who expressed their sexual orientation and/or gender identity were 17% less likely to have had perceived mental health problems in the last 12 months (PR: 0.83, 95% CI: 0.76-0.90, p < 0.001). CONCLUSIONS: The non-expression of sexual orientation and/or gender identity has a significant negative effect on the mental health problems of the LGBTI population. These results highlight the importance of promoting the expression of sexual orientation and gender identity in our community.

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Resumen En tiempos recientes, la literatura en psicología sobre orientación sexual ha pasado de centrarse en aspectos negativos experimentados por personas no heterosexuales a examinar factores que potencien el bienestar de estas. Estos estudios se han enfocado mayoritariamente en lesbianas y hombres gay (orientación hacia un único género o monosexual), mientras la inclusión de otras orientaciones, como bisexual y pansexual (orientaciones hacia más de un género o plurisexual) es un interés emergente. En Latinoamérica, un tema poco explorado en este sentido es la satisfacción vital y las variables asociadas, como el apoyo social y el revelar la orientación sexual, y cómo estas pueden variar entre personas de distintas orientaciones no heterosexuales. Por ello, el objetivo general de este estudio fue comparar el grado de revelación de la orientación sexual, el apoyo social percibido, la conexión con la comunidad LGBTIQ+ (sigla que incluye a lesbianas, gay, bisexual, transgénero, transexual, travesti, intersexual y queer) y la satisfacción vital entre estudiantes universitarios lesbianas y gays (LG), y bisexuales y pansexuales (BP). La muestra fue tomada entre 82 estudiantes universitarios LGBP, quienes respondieron un cuestionario en línea que incluía datos sociodemográficos y escalas destinadas a evaluar las variables en estudio. Los resultados mostraron que estudiantes universitarios LG revelan más su orientación sexual que estudiantes BP. Igualmente, se destaca la asociación positiva entre el apoyo social percibido y satisfacción vital, y entre la conexión con la comunidad LGBTIQ+ y la revelación de la orientación sexual. Este estudio contribuye al conocimiento sobre variables asociadas a la satisfacción vital según la orientación sexual, diferenciando entre estudiantes universitarios lesbianas y gays y estudiantes bisexuales y pansexuales.

Abstract In recent years, there has been a growing shift in research on sexual orientation. This focus has moved from centering on negative experiences, related to psychopathology and stigmatization, to examining subjective well-being factors in individuals belonging to these populations. In Latin American countries such as Chile, a scarcely explored link in this regard is satisfaction with life -the cognitive component of subjective well-being- and associated variables. The minority stress model indicates that individuals who belong to minority groups are exposed to additional stressors to which the general population is not exposed. These specific stressors are related to the marginalization, prejudice and exclusion suffered by the minority group of belonging. Researchers have shown that these stressors and their consequences may result in lower life satisfaction in non-heterosexual people compared to their heterosexual peers. Furthermore, different non-heterosexual orientations face specific forms of prejudice and, therefore, could experience a different impact on their life satisfaction. In this paper, the distinction is made between individuals with a monosexual orientation (towards one gender) and those with a plurisexual orientation, (towards more than one gender or independently of gender); namely, lesbians and gay men (LG) on the one hand, and bisexuals and pansexuals (BP) on the other. Research indicates that BP people experience lower levels of well-being than LG individuals. Compared to the latter, BP individuals tend to disclose their sexual orientation to a lesser extent, perceive less social support, and experience greater exclusion from community spaces destined to the general community of lesbian, gay, bisexual, transgender, intersex, and other queer identities (LGBTIQ+). Moreover, these differences between non-heterosexual orientations in terms of life satisfaction have been little explored in Latin American university students. To fill this gap in the literature, the general objective of this study was to compare the levels of disclosure of sexual orientation, perceived social support, connectedness with the LGBTIQ+ community, and life satisfaction among lesbian, gay, bisexual, and pansexual university students. Four hypotheses were proposed that addressed the comparisons between LG and BP participants for these variables. A non-probability sample of 82 LGBP university students was recruited to answer an online questionnaire. Of the sample, 32.9 % were lesbian or gay, and 67.1 % were bisexual or pansexual. Most participants were women (67.1 %), compared to 29.3 % men and 3.7 % of another gender. The questionnaire consisted of a section of sociodemographic data, a sexual orientation disclosure scale, the Multidimensional Scale of Perceived Social Support, the LGBTIQ + Community Connectedness Scale, and the Life Satisfaction Scale. Analyses included comparisons of means between groups. A confirmatory factor analysis (CFA) was conducted for the Connectedness Scale to test its validity. Results showed that LG and BP students reported similar levels of perceived social support, community connectedness, and life satisfaction, while LG students tended to disclose their sexual orientation to more people than BP students. A positive association was also found between perceived social support and life satisfaction, and between connectedness and disclosure of sexual orientation. The CFA showed that the Connectedness Scale is valid for its use in university samples in Chile and other Latin American populations. Limitations regarding sample size and recommendations for future research are discussed. This study contributes to the knowledge about variables associated with life satisfaction in non-heterosexual university students, highlighting the differential needs for support of those with a monosexual orientation (lesbians and gays) and those with a plurisexual orientation (bisexual and pansexual).

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Resumen Según el informe realizado por la Asociación Internacional de Lesbianas, Gays, Bisexuales, Trans e Intersex (ILGA) en el año 2017, menos del 25 % de los territorios del planeta reconocen a la población Lesbianas, Gays, Bisexuales, Transexuales e Intersexuales (LGBTI+) y, de igual forma, aún hay numerosos países, en su mayoría del continente africano, que penalizan, discriminan y rechazan la homosexualidad. Además, diferentes estudios han evidenciado que para muchas familias es difícil separarse de la tradición heteronormativa y aceptar la orientación sexual de un hijo gay o una hija lesbiana o bisexual. Esta investigación buscó comprender el proceso de revelación y aceptación de la orientación sexual en 15 familias con integrantes gays, lesbianas y bisexuales en Cali-Colombia, a través de una entrevista semiestructurada y una línea de tiempo denominada Mi viaje en la que los participantes plasmaban sus narrativas en dibujos. En el presente estudio participaron 15 familias, las cuales estuvieron conformadas tanto por hijos/as entre los 19 y 26 años como por padres/cuidadores entre 41 y 64 años. A partir del análisis temático de las entrevistas realizadas de manera individual, se evidencia que los procesos de revelación de la orientación sexual se generan durante la adolescencia temprana, media y tardía, y la madre fue aquella integrante de la familia a quien le revelaron en un primer momento. Además, se presentan las formas a través de las cuales se dio la revelación, que fueron directas o indirectas y en algunos casos derivaron en secretos familiares. Se concluye que los procesos que atraviesan las familias frente a la revelación y aceptación de la orientación sexual de un hijo gay o una hija lesbiana o bisexual cuentan con fases dinámicas que pueden presentarse en distintos momentos y de diferentes formas, según las características particulares de cada familia y su contexto.

Abstract According to the report carried out by the International Lesbian, Gay, Bisexual, Trans and Intersex Association (ILGA) in 2017, less than 25 % of the territories of the planet recognize Lesbian, Gay, Bisexual, Transgender and Intersex (the LGBTI + population) and, in the same way, there are still numerous countries, mostly from the African continent, who penalize, discriminate and reject homosexuality. In Colombia, between the years 2016, 2017 and until February 2018, 139 homicides of LGBTI+ people were reported. Additionally, in several of its cities, among which are Barranquilla, Medellín, Bogotá and Cali, there has been violence by the National Police against LGBTI+ people because of their sexual orientation and gender identity. In this regard, 21 cases have been reported between 2008 and 2017, of which two were against gay men and three against lesbian women. In addition, in Valle del Cauca, 195 homicides were reported up to the year 2017 which were related to the sexual orientation and gender identity of the victims, specifically located in the city of Santiago de Cali, in which nine murders were reported, four of which were gay men, two lesbian women and three trans women (Colombia Diversa, 2018). Furthermore, different studies have shown that it is difficult for many families to separate from the heteronormative tradition and accept the sexual orientation of a gay son or a lesbian or bisexual daughter. This research sought to characterize the process of disclosure and acceptance of sexual orientation in 15 families with gay sons and lesbian and bisexual daughters in Cali-Colombia, using a semi-structured interview and a timeline called My Journey in which the participants reflected their narratives in drawings. The research was qualitative, with a narrative design by topics (Hernández, Fernández & Baptista, 2014). The results are articulated to the macro project called "Family dynamics in the process of disclosure and acceptance of the sexual orientation of gay sons and lesbian daughters in the city of Cali-Colombia" In the present study, 15 families participated, which were made up of both children and parents / caregivers. From the thematic analysis of the interviews carried out individually, the descriptions made by the families of the moment in which the sons and daughters revealed their sexual orientation are mentioned. This moment corresponds to early, middle and late adolescence, and the mother was the one to whom the sexual orientation was revealed at first. In addition, the forms through which the revelation was given are presented, which were direct or indirect and, in some cases, led to family secrets. It is concluded that the processes that families go through in the face of the disclosure and acceptance of the sexual orientation of a gay son or a lesbian or bisexual daughter have dynamic phases that can occur at different times and in different ways depending on the particular characteristics of each family and its context. It is recommended to promote associations of families and friends united in favor of gender diversity, in such a way that they are configured as elements for decision-making in public policies and actions, which generate care routes for other families that require guidance in any of the stages they are going through and that can provide social support to gay sons, lesbian daughters and their families. From the field of health professionals who accompany families in affirmative processes, it is necessary to strengthen training with a gender perspective and in future studies address the experiences of families with transgender members, taking into account their specific needs and from an intersectional perspective.

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OBJECTIVE: To analyze aspects of sexual life and fertility desire among 46, XY DSD people, including those who changed their gender. METHODS: It is a cross-sectional study including 127 adults (> 16 years of age) with 46, XY DSD (83 females; 44 males) from a Single Brazilian Tertiary-Care Medical Center. RESULTS: Sexual fantasies and masturbation were more frequent in 46, XY DSD males, whereas orgasm and sexual life satisfaction were similar in both genders. More 46, XY DSD men than women had a long-term romantic relationship. 46, XY DSD women with prenatal androgen exposure reported more fear of being romantically rejected. External genitalia appearance at birth did not impact the sexuality of 46, XY DSD women after surgical genital treatment had been completed. Overall, the sexual life was similar between 46, XY men assigned as males and those who changed to the male gender. Regarding sexual orientation, most self-reported as heterosexual (91% and 92% of women and men, respectively). The desire for fertility had a similar prevalence in both genders, but more women than men considered infertility a barrier to a long-term romantic relationship. Twelve individuals (7 males) had children; 10 out of 12 have adopted children. CONCLUSION: Fertility desire was shared among 46, XY DSD people, regardless of gender. Prenatal androgen exposure reduced the desire for motherhood in 46, XY women. 46, XY DSD people who changed from female to male gender presented similar sexual parameters as those assigned as males. Among females, virilized genitalia at birth did not affect sexuality once the surgical treatment is completed.

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BACKGROUND: Antiretroviral therapy use has led to a decline in HIV-related mortality yet disparities by gender and/or sexual orientation may exist. In this study, we estimated hazards of death in people living with HIV (PLWH) according to gender and sexual orientation. METHODS: We included PLWH ≥ 18 years enrolled between 2000 and 2018 at INI/Fiocruz, Rio de Janeiro, Brazil. Participants were grouped as cisgender or transgender women, cisgender men who have sex with men (MSM) or men who have sex with women, or cisgender men with unknown sexual orientation. We assessed disparities in the hazard of death using Cox proportional hazards models. RESULTS: Among 5,576 PLWH, median age at enrollment was 35 years, 39% were MSM, 28% cisgender women, 23% men who have sex with women, 5% transgender women, and 5% men with unknown sexual orientation. A total of 795 deaths occurred in 39,141 person-years of follow-up. Mortality rates per 1,000 person-years were: 82.4 for men with unknown sexual orientation, 24.5 for men who have sex with women, 18.3 for cisgender, 16.6 for transgender women, and 15.1 for MSM. Compared to MSM, men with unknown sexual orientation had the highest death hazard ratio (adjusted hazard ratio [aHR] 2.93, 95% confidence interval [CI] 2.35-3.81), followed by men who have sex with women (aHR 1.17, 95%CI 0.96, 1.43); death hazard ratios for cisgender and transgender women were not statistically different. CONCLUSION: We observed disparities in the hazard of death for men with unknown sexual orientation and men who have sex with women despite universal access to antiretroviral therapy in Brazil. Future work should characterize and assist men with unknown sexual orientation with tailored policies and interventions. Increased hazard of death was not observed for transgender women, which probably results from interventions implemented in our service to reach, engage, retain, and support this population.

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Purpose: We compared the prevalence of depression, hazardous alcohol use, daily tobacco use, and hazardous alcohol and tobacco use (HATU) by sexual orientation and sex among Brazilian adults. Methods: Data were obtained from a national health survey conducted in 2019. This study included participants aged 18 years and older (N = 85,859). Adjusted prevalence ratios (APRs) and confidence intervals were estimated using Poisson regression models stratified by sex to examine the association between sexual orientation, depression, daily tobacco use, hazardous alcohol use, and HATU. Results: After controlling for the covariates, gay men showed a higher prevalence of depression, daily tobacco use, and HATU compared with heterosexual men (APR ranged from 1.71 to 1.92). Furthermore, bisexual men showed a higher prevalence (almost three times) of depression compared with heterosexual men. Lesbian women showed a higher prevalence of binge and heavy drinking, daily tobacco use, and HATU compared with heterosexual women (APR ranged from 2.55 to 4.44). Among bisexual women, the results were significant for all analyzed outcomes (APR ranged from 1.83 to 3.26). Conclusions: This study was the first to use a nationally representative survey to assess sexual orientation disparities related to depression and substance use by sex in Brazil. Our findings highlight the need for specific public policies aimed at the sexual minority population and for greater recognition and better management of these disorders by health professionals.

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The HIV epidemic affects men who have sex with men (MSM) disproportionally in Brazil, and pre-exposure prophylaxis (PrEP) is effective for preventing HIV in this population. However, low perceived risk of HIV may influence the acceptability and decision to use PrEP. This study estimated the association between self-perception of HIV risk and acceptability of daily oral PrEP among Brazilian MSM. Respondent-driven sampling (RDS) was used for behavioral and biological surveillance to recruit 4,176 MSM 18 years or over in 12 Brazilian cities in 2016. Results were weighted using Gile's estimator in RDS Analyst software. Adjusted odds rations (OR) with 95% confidence intervals were calculated using multivariate logistic regression. Acceptability of daily oral PrEP was high (69.7%) among the 3,544 MSM available for analysis. Most participants self-reported low or moderate risk of HIV infection (67.2%) and a small proportion (9.3%) reported high risk. A dose-response relationship was observed between acceptability of PrEP and self-reported risk: PrEP acceptability was 1.88 times higher (OR 1.8; 95% CI: 1.24-2.85) among MSM whose perceived risk of HIV infection was low or moderate, and 5 times higher (OR 5.68; 95% CI: 2.54-12.73) among those who self-reported high risk compared to MSM reporting no HIV risk. MSM with the highest risk perception of HIV reported higher rates of PrEP acceptability. Given the availability of daily oral PrEP in the public health care system in Brazil, we suggest emphasizing counseling about self-perception of HIV risk as part of routine HIV prevention services.

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OBJECTIVE: To investigate the association between sexual orientation and sexual violence in Hispanic women living in Puerto Rico. METHODS: Secondary data analysis of a cross-sectional study. An anonymous web-based questionnaire was distributed in Puerto Rico between February and April 2016. Variables included history of sexual violence, sexual orientation, and age of first sexual experiences. Data were analyzed using χ2 testing and a P value less than 0.05 was considered significant. RESULTS: Sociodemographic characteristics were similar between groups except for age in the 476 participants. The most common age of first sexual experiences was between 7 and 12 years, 13-18 years for penile vaginal and oral sex, and 22-29 years for penile anal sex in the overall population of the study. These did not differ except that more bisexual women 40 (71.4%) had their first oral sex experience at 13-18 years compared with 164 (50.7%) heterosexual and 35 (55.2%) lesbian women (P = 0.045). Of the 19.2% of participants who reported sexual violence, there were 50 (18.4%) heterosexual, 8 (12.2%) lesbian, and 17 (34.7%) bisexual women. Bisexual women were more likely to disclose sexual violence (P = 0.007). CONCLUSION: Most women stated having a sexual experience at a young age. Significant proportions reported sexual violence with bisexual women being the most likely. Screening for sexual violence must be routinely performed by health professionals.

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