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Attitudes toward sexual minorities, HIV-positive people among physicians are changing

Research finds that there have been substantive declines over a 35-year period in the prevalence of stigmatizing attitudes toward sexual minorities and HIV-positive people among physician respondents.

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Medical practitioners are among the sources of LGBT- and HIV-related discrimination; but this may be changing… even if slowly.

This is according to “Physician Attitudes Toward Homosexuality and HIV: The PATHH-III Survey“, a study by R. Marlin, A. Kadakia, B. Ethridge and W.C. Mathews, and published in LGBT Health.

The study eyed to (1) to evaluate current physician attitudes toward homosexuality and homosexual, transgender, and HIV-positive individuals; and (2) to compare current attitudes of those from prior surveys of the same population, the San Diego County medical community.

For this study, an online survey was conducted during November-December 2017 to assess general attitudes toward homosexuality and medically focused items that addressed homosexual orientation, transgender identity, and HIV. Responses were weighted for nonresponse. Predictors of stigma were assessed using generalized linear models. Trends across three surveys of the same population in 1982, 1999, and 2017 using common items were assessed using unweighted responses.

Of 4,418 physicians, 491 (11.1%) responded (median age 55 years, 38% female and 8.7% gay or bisexual). Regarding admission to medical school, 1% opposed admitting a homosexual applicant, 2% a transgender applicant, and 5% an HIV-positive applicant. Regarding consultative referral to a pediatrician, 3% would discontinue referral to a homosexual pediatrician, 5% to a transgender pediatrician, and 10% to an HIV-positive pediatrician. Regarding discomfort treating patients, 7% reported discomfort treating homosexual patients, 22% transgender patients, and 13% HIV-positive patients. Earlier year of graduation from medical school, male gender, and heterosexual orientation were significant predictors of stigma-associated responses.

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Compared with the results from surveys in 1982 and 1999, the current results suggest substantively less stigma associated with homosexuality and HIV.

Even with health insurance, lesbian, gay and bi adults more likely to delay medical care

For the researchers, it is worth noting that – finally – “there have been substantive declines over a 35-year period in the prevalence of stigmatizing attitudes toward sexual minorities and HIV-positive people among physician respondents.”

There’s hope yet, after all.

Health & Wellness

Little link found on popper use and dependency; no correlation with mental health or psychological stress

A survey of more than 800 men aged 18 to 35 found little evidence of typical dependency characteristics, including health, social, legal and financial problems, and no correlation between popper use and mental health or psychological stress.

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Young gay and bisexual men are frequent users of alkyl nitrites, or poppers, but few show signs of addiction, risky consumption habits or other psychosocial problems. This is according to ‘Harmless? A hierarchical analysis of poppers use among young gay and bisexual men’, by Dr Daniel Demant and Dr Oscar Oviedo-Trespalacios, and published in Drug and Alcohol Review.

A survey of more than 800 men aged 18 to 35 found little evidence of typical dependency characteristics, including health, social, legal and financial problems, and no correlation between popper use and mental health or psychological stress.

The study is particularly noteworthy considering some efforts to control popper use and distribution – e.g. in Australia. Dr. Daniel Demant, public health researcher at the University of Technology Sydney (UTS), who conducted the study, said that the decision by Australia’s Therapeutic Goods Administration (TGA) to step back from prohibiting poppers is commendable. The TGA, instead, elected to classify them as a Schedule 3 drug, available over the counter in pharmacies from February 2020.

An interim decision by the TGA in 2018 recommended poppers be classed as a prohibited substance, in the same category as methamphetamine and heroin, which would have made “overnight criminals” of the estimated 100,000 plus Australian users.

“What we see with this research is that poppers are a very commonly used drug in the LGBT community, both recently and over their lifetime,” Demant said. “Most of the users are already oppressed or marginalized based on their social identity as gay or bisexual men. This creates a question as to whether there would have been a discriminatory element in banning a substance with such a low risk profile.”

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Demant added that banning a substance that is used by so many people would create a “new class of criminals, basically overnight.”

Currently, poppers are available on prescription from pharmacies, but they are more commonly bought illicitly, in sex-on-premises venues and LGBT bars. A vial containing 25-30mL of the clear, strong-smelling fluid, possibly labelled as “VHS tape cleaner”, “leather cleaner” or “room deodorizer”, sells for up to $50 (or equivalent in countries like the Philippines), despite costing a couple of cents to manufacture.

The new TGA decision to regulate poppers rather than banning them hopefully paves the way for some measure of quality control as well as the removal of the “extreme profit margin” that exists now, Demant said.

Demant said that with poppers becoming a pharmacy-only medicine, safety standards would have to be met and pharmacy staff could provide guidance in cases where poppers might react badly with users’ other medications, particularly Viagra.

“We could stop pretending that poppers are sold for anything other than getting people high. And once we do offer it in pharmacies, we would have something made to the highest standards for people to use,” Demant ended.

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LGBT people more likely to develop dementia, according to study

More than 14% of sexual and gender minorities (SGM) reported subjective cognitive decline, significantly higher (p<0.0001) than the 10% rate among cisgender heterosexual participants.

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More than 14% of sexual and gender minorities (SGM) reported subjective cognitive decline, significantly higher (p<0.0001) than the 10% rate among cisgender heterosexual participants. Even after adjusting for factors such as income, age and race, SGM participants were 29% more likely to report subjective cognitive decline (SCD).

This is according to a study presented at the Alzheimer’s Association International Conference (AAIC) 2019 in Los Angeles in the US. The study noted that to date, few studies have investigated the symptoms and disease progression of Alzheimer’s and other dementias in the LGBT community. And so to examine these associations, Jason Flatt, PhD, MPH, assistant professor at the Institute for Health & Aging at the University of California, San Francisco, and colleagues analyzed data from the 2015 Behavioral Risk Factor Surveillance System (BRFSS), a large phone-based survey led by the Centers for Disease Control and Prevention.

The study analyzed data from 44,403 adults aged 45 and older across nine states in the US (Georgia, Hawaii, Illinois, Minnesota, Nevada, Ohio, Virginia, West Virginia and Wisconsin) that participated in the 2015 BRFSS optional modules on the Healthy Brain Initiative, which included subjective cognitive decline and Sexual Orientation and Gender Identity. Roughly three percent of participants (1,253) identified as a sexual or gender minority (SGM). Subjective cognitive decline was defined as self-reported confusion or memory problems that have been getting worse over the past year.

The study – as noted – found higher rates of subjective cognitive decline among LGBT people compared to their cisgender heterosexual counterparts.

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“Given that one in seven adults who identified as a sexual or gender minority reported subjective cognitive decline, it is critical that more opportunities exist for people in these communities to receive regular evaluation for cognitive impairment and Alzheimer’s disease,” Flatt said. “There is also a need for greater education on Alzheimer’s risk, signs and symptoms, and training of health care providers to ensure inclusive and welcoming care for LGBTQ+ populations.”

Flatt added that “while we do not yet know for certain why sexual or gender minority individuals had higher subjective cognitive decline, we believe it may be due to higher rates of depression, inability to work, high stress, and a lack of regular access to healthcare.”

According to Flatt, less than half of SGM adults with SCD in the study talked to their health care provider about it. SGM adults with SCD were also more likely to report that they had to give up day-to-day activities (39% vs. 29%, p=0.003) and needed help with household tasks (44% vs. 35%, p=0.01) than cisgender heterosexual participants. Both groups were similar in terms of talking to their health care provider about their SCD.

LGBT people living with dementia and their caregivers often have difficulty accessing information and support services, which can be especially challenging when memory loss and dementia enter the equation.
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To advance research into Alzheimer’s in the LGBT community, Karen Fredriksen-Goldsen, PhD, professor and director of Healthy Generations Hartford Center of Excellence at the University of Washington, created the “Aging with Pride: Innovations in Dementia Empowerment and Action (IDEA)” study. A multisite study in Seattle, San Francisco and Los Angeles, this is the first federally-funded study on dementia intervention specifically designed for LGBT older adults with dementia and their caregivers.

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The researchers had previously identified unique risk factors of LGBT older adults living with dementia through the first longitudinal study of this population (Aging with Pride: National Health, Aging, and Sexuality/Gender Study). Using longitudinal data with three time points (2014, 2015 and 2016), modifiable factors predicting physical functioning and quality of life (QOL) among LGBT older adults with dementia (n=646) were identified.

LGBT older adults living with dementia were significantly more likely to live alone (nearly 60%), not be partnered or married (65%), not have children (72%), and not have a caregiver (59%), when compared to older non-LGBT adults living with dementia. Previous experiences of discrimination and victimization (b=-0.19, p<.001) were negatively associated with QOL among LGBT older adults living with dementia. Socializing with friends or family (b=1.11, p<.05) was positively associated with QOL, and physical activity (b = 0.26, p<.001) were associated with better physical functioning.

Also as reported at AAIC 2019, “Aging with Pride: IDEA” includes a tailored approach in which trained coaches identify and modify challenging behaviors that are adversely affecting older adults living with dementia and their caregivers, either of whom are LGBT. The coaches delivered an individualized program of exercise, and behavioral and coping strategies designed to improve physical function, independence and QOL.

The exercise intervention is a low-impact physical exercise program including nine one-hour sessions over six weeks designed to improve physical functioning and maintain independence. The behavior and coping strategies include: techniques for working with LGBT-specific trauma, identity management and disclosure of their LGBT identities to providers and others, plus support engagement in the LGBT community and dementia services. Testing of the intervention is now underway and will be delivered to 225 pairs of LGBT older adults living with dementia and their caregivers.

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“Given their lifetime experiences of victimization, discrimination and bias, many LGBT older adults forgo seeking needed medical care,” said Fredriksen-Goldsen. “LGBT people living with dementia and their caregivers often have difficulty accessing information and support services, which can be especially challenging when memory loss and dementia enter the equation.”

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Psychotherapy should be first-line treatment for depression in young people, trial finds

If antidepressants have a role, they have more of a role in people at the older end of the age range. The take-home message from the study is that the first-line treatment for young people with depression should be psychotherapy.

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Young people seeking support for depression should be offered psychotherapy as the first line of treatment, a clinical trial by researchers at Orygen, the National Centre of Excellence in Youth Mental Health, has found.

Associate Professor Christopher Davey, head of mood disorder research at Orygen, said the clinical trial results emphasised the importance of a multi-faceted approach to treating depression in young people.

“The results suggest that we should really be focusing on providing good quality psychotherapy, such as cognitive behavioural therapy, to young people and keeping medication as the second line of treatment,” Associate Professor Davey said.

Psychotherapy refers to a range of psychological therapies provided by a counsellor, psychologist or psychiatrist. Cognitive behavioural therapy is the most common psychotherapy for treating depression in young people.

The randomized, double blind, placebo-controlled clinical trial involved 153 young people aged 15-25 who had been diagnosed with depression and were being treated at youth mental health services in north-west Melbourne. All trial participants received cognitive behavior therapy for 12 weeks coupled with either the common antidepressant fluoxetine or a placebo medication.

The trial results have been published in The Lancet Psychiatry.

Associate Professor Davey said at the end of treatment there were no significant differences in symptom improvement between the two groups, suggesting that the addition of fluoxetine did not affect the participants’ mental health outcomes.

However, this does not suggest that antidepressants should not be used in treating depression.

“Antidepressants can be very useful for some people,” Associate Professor Davey said. “Anyone considering the role of antidepressants in their treatment should discuss this with their doctor or clinician.

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“Our study found some evidence to suggest that if antidepressants have a role, they have more of a role in people at the older end of our age range. The take-home message from the study is that the first-line treatment for young people with depression should be psychotherapy.”

This is of particular interest to members of the LGBTQIA community because 41% of non-binary people said they harmed themselves in the last year compared to 20% of LGBT women and 12% of GBT men. One in six LGBT people (16%) said they drank alcohol almost every day over the last year.


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In Europe, syphilis notifications up by 70% since 2010

Syphilis diagnoses were consistently higher among men, with rates doubling from 6.1 per 100,000 in 2010 to 12.1 in 2017. Between 2007 and 2017, close to two-thirds (62%) were reported among men who have sex with men. Heterosexual men contributed 23% of cases and women 15%.

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The number of syphilis cases has been consistently going up across Europe since 2010, mostly affecting men who have sex with men living in urban areas. In 2017, notification rates reached an all-time high in the EU/EEA countries with more than 33 000 reported cases. An in-depth ECDC study describes the factors behind this increase and outlines the evidence-based options for public health control of syphilis, including case finding and management as well as educational activities.

Overall, more than 260 000 confirmed syphilis cases were reported from 30 EU/EEA countries between 2007 and 2017. While annual notifications decreased slightly between 2007 and 2010 (from almost 20 000 to a low of some 19 000 cases), they continuously rose to more than 33 000 cases in 2017. An all-time high since the start of ECDC surveillance recording.

This trend results from notification data of the 23 countries with comprehensive surveillance systems reporting consistently between 2007 and 2017. The rate dropped to a low of 4.2 per 100 000 persons in 2010, before reaching an EU/EEA peak of 7.1 per 100 000 population in 2017 – an increase of 70% compared with the notification rate in 2010. This means that for the first time since the early 2000s, the EU/EEA countries report more syphilis than HIV cases.

Striking country variations in Europe

Between 2010 and 2017, 15 countries reported an increase in the notification rate of more than 15%. However, this varied greatly among countries with rates more than doubling in five countries: Iceland (876%), Ireland (224%), the United Kingdom (153%), Germany (144%) and Malta (123%). On the other hand, Estonia and Romania reported a drop of 50% or more over the same period.

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During this period, syphilis diagnoses were consistently higher among men, with rates doubling from 6.1 per 100 000 in 2010 to 12.1 in 2017. Between 2007 and 2017, close to two-thirds (62%, 94 015 of the 152 233 cases where sexual orientation was known) were reported among men who have sex with men. Heterosexual men contributed 23% of cases and women 15%. The proportion of cases diagnosed among men who have sex with men ranged from below 20% in Latvia, Lithuania and Romania to more than 80% in France, Germany, Ireland, the Netherlands, Sweden and the United Kingdom.

The ECDC study looked at more than 60 studies reporting on rising syphilis trends in high-income countries since the early 2000s.

“There is a clear relationship between sexual risk behaviour and the risk of syphilis and other sexually transmitted diseases”, states Andrew Amato-Gauci, Head of the ECDC programme on HIV, STI and viral hepatitis. “The increases in syphilis infections that we see across Europe, as well as other countries around the world, are a result of several factors such as people having sex without condoms and multiple sexual partners combined with a reduced fear of acquiring HIV”, Amato continues. “To reverse this trend, we need to encourage people to use condoms consistently with new and casual partners. Regular tests for syphilis and other sexually transmitted infections should also be part of the parcel, especially if there has been a risk of infection.”

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In addition, response measures should be informed by sound epidemiological data and targeted towards affected population groups taking into account the main determinants of transmission.

The response to syphilis outbreaks or programmatic control should include a combination of:

  • case finding, including screening of at-risk groups, partner notification and surveillance activities,
  • case management with appropriate treatment following diagnosis,
  • educational activities directed at the general population, those at-risk of syphilis infection, and at healthcare providers.

Decrease among women and congenital syphilis

Congenital syphilis rates in the EU/EEA have been decreasing since 2005. During this time, rates of syphilis among women have decreased consistently in the EU/EEA, particularly in eastern Europe. This contributed to the reduction of the risk of mother-to-child transmission of syphilis in Europe that is in contrast to increasing congenital syphilis rates in many other parts of the western world. Despite this, underreporting of congenital syphilis is likely in several Member States of the EU/EEA and there is some concern regarding increasing syphilis rates among women in some western EU/EEA countries. Effective national antenatal screening programmes together with interventions to control syphilis transmission among heterosexual populations are key in order to sustain the low rates of congenital syphilis.

The diagnosis and treatment of syphilis are both accessible and cost effective. Left untreated, syphilis infection can lead to severe complications and also facilitates transmission of HIV infection. Untreated syphilis during pregnancy can severely compromise pregnancy outcomes, leading to foetal loss, stillbirth or congenital syphilis in the newborn.

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Study finds transgender, non-binary autism link

A study found that 14% of the transgender and non-binary group had a diagnosis of autism, while a further 28% of this group reached the cut off point for an autism diagnosis, suggesting a high number of potentially undiagnosed individuals.

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New research indicates that transgender and non-binary individuals are significantly more likely to have autism or display autistic traits than the wider population – a finding that has important implications for gender confirmation treatments.

The study, led by Dr Steven Stagg of Anglia Ruskin University (ARU) and published in the journal European Psychiatry, is one of the first pieces of research to focus on people who identify as non-binary.

It found that 14% of the transgender and non-binary group had a diagnosis of autism, while a further 28% of this group reached the cut off point for an autism diagnosis, suggesting a high number of potentially undiagnosed individuals.

These figures were primarily driven by high scoring amongst those whose assigned gender was female at birth, supporting recent evidence that there is a large population of undiagnosed women with an autism spectrum disorder.

The authors also found higher levels of systematizing (a tendency to analyze, control and use rule-based systems) and lower levels of empathy amongst the transgender and non-binary group, characteristics often found in individuals with an autism spectrum disorder.

The study of 177 people reported an autism diagnosis of 4% for the cisgender group (those whose gender identity matches their gender at birth). This is higher than previously-reported estimates for the wider population and the authors believe self-selection for the study could be responsible.

Dr Stagg, Senior Lecturer in Psychology at Anglia Ruskin (ARU), said: “We found that a significant proportion of the transgender and non-binary group either had a diagnosis of autism or displayed autistic traits, including a difficulty in empathising and an overreliance on systematic, rule-based reasoning.

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“One of the striking findings was the number of individuals born female who met the cut off for autism spectrum disorder. This is particularly important given that individuals born female are twice as likely to be referred to gender identity clinics.

“Problems interpreting social signals, a literal understanding of language and difficulty recognizing and interpreting one’s own emotions could mean that individuals struggle with therapeutic interventions.

“People with autism are also more likely to seek unequivocal answers to the complex issues surrounding gender identity. Our study suggests it is important that gender identity clinics screen patients for autism spectrum disorders and adapt their consultation process and therapy accordingly.”

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Self-injuring young girls overestimate negative feedback in social media simulation

Adolescent girls who self-injure feel that they receive more negative feedback than they actually receive, and are more sensitive to “thumbs down” responses, compared to other adolescent girls.

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Adolescent girls who self-injure feel that they receive more negative feedback than they actually receive, and are more sensitive to “thumbs down” responses, compared to other adolescent girls. These are the findings presented by Irene Perini, researcher at Center for Social and Affective Neuroscience (CSAN) at Linköping University, in a recently published article.

“Brain-based classification of negative social bias in adolescents with nonsuicidal self-injury: Findings from simulated online social interaction” was written by Perini with Per A Gustafsson, J Paul Hamilton, R Kämpe, Leah M Mayo, Markus Heilig and Maria Zetterqvist from the Center for Social and Affective Neuroscience of Linköping University and Region Östergötland. The study appeared in EClinicalMedicine.

Perini has previously examined what happens in the brains of adolescents when they use social media. She used images taken in a magnetic resonance camera to show that it is an expectation of social judgement that initiates processes in the brain. Those areas of the brain that direct our attention towards what is most relevant for us, which form what is known as the salience network, are particularly strongly affected.

“When we post a picture or a comment on social media, the brain registers an expectation of being judged, receiving affirmation, as something important,” Perini explains.

She has continued to examine the effect more deeply and compared a group of 27 healthy girls with 27 girls with nonsuicidal self-injury (NSSI), which refers to the intentional destruction of one´s own body tissue without suicidal intent and for purposes not socially sanctioned. The project is a collaboration with other scientists, including Maria Zetterqvist, clinical psychologist and CSAN researcher, who works with adolescents with NSSI.

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“We know that healthy social interactions are particularly important for teenagers, and we also know that social stress and self-injuring are linked in young people. Interpersonal stress, perceived criticism, and perceived social rejection are common triggers of NSSI,” says Perini.

The girls who self-injured believed that they had received thumbs down significantly more often than was actually the case, and the negative feedback affected them more strongly than the control group. Their liking for their opponent was lower, and their liking for their own face was also lower than the control group.
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In the test, she used an online game that simulates the interaction between young people on social media. They were asked to decide whether they liked the other players, and they were themselves judged. No matter how they interacted, they received an equal number of thumbs up and thumbs down.

With respect to the activation of the salience network, the experiment found no difference between the two groups. However, they were also asked to reply to several questions about the game. How often did you get a thumbs down? How did it make you feel? Do you like to see your own face (a selfie)?

The replies to these questions differed significantly between the two groups.

The girls who self-injured believed that they had received thumbs down significantly more often than was actually the case, and the negative feedback affected them more strongly than the control group. Their liking for their opponent was lower, and their liking for their own face was also lower than the control group.

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“The quality of the interaction was kept artificially neutral, in order to investigate potential bias in interpreting social experiences. Indeed, girls with NSSI manifested a clear negative bias,” says Perini.

Detailed analysis of the images from the magnetic resonance camera (fMRI) has shown that another part of the brain is activated during expectation in the group of girls who self-injure, the part that is usually associated with emotions and reflection.

“But we must be careful when interpreting images from fMRI, particularly until the results can be reproduced in further studies,” she points out.

She is at the same time hopeful that the results from the work can help therapists to make advances, now that they know that there is a negative bias – that the patients interpret the situation as being worse than it is.

Should therapists recommend care when using social media?

“It’s probably a good idea if parents and therapists make it clear to adolescents with NSSI that they are more sensitive and that they overinterpret the negative,” Perini ends.

Bullying and its connection to self-harm is of interest to members of the LGBTQIA community because – generally – gender non-conforming people experience this more. For instance, a study found that bullying is more prevalent in birth-assigned females and in out individuals, commonly consisting of homophobic/transphobic (particularly in socially transitioned individuals) or appearance-related (particularly in out individuals) name calling.

Yet another study found that 35.2% of gay/bisexual men who had experienced frequent school-age bullying experience frequent workplace bullying. Among lesbian women, the figure was 29%.

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Not surprisingly, according to the study Growing Up Online – Connected Kids, conducted by Kaspersky Lab and iconKids & Youth, cyberbullying is a far more dangerous threat to children than many parents think. The consequences for the majority of young victims of online harassment include serious problems with health and socialization.

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