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The coming out (CO) process is fundamental for identity integration among LGBQ+ people, and its impact can vary greatly depending on personal and contextual factors. The historical, cultural, and social contexts in which LGBQ+ people develop their sexual identity can mediate the relationship between CO and health outcomes. The present study aimed at clarifying the CO process in three generations of Italian LGBQ+ people (young adults: aged 20–40 years; middle adults: aged 41–60 years; older adults: aged 61–80 years) by providing data on: (a) sexual orientation milestones, such as age of first awareness, age of first self-label, and age of first CO, as well as the rate of disclosure during different life stages; (b) the rate and average age of CO to significant others; and (c) CO within the religious context and its effect on participants’ minority stress experiences. A total of 266 Italian LGBQ+ people participated in the study, with ages ranging from 20 to 80 years (M = 41.15, SD = 16.13). Findings indicated that, on average, the older adult group became self-aware, self-labeled, and disclosed their sexual identity at a significantly older age than the other groups. Older adults were also more Catholic and had CO more frequently to their Catholic community, relative to young and middle adults. CO within the Catholic context was associated with distal and proximal minority stressors, such as discrimination, vigilance, and internalized sexual stigma. Catholic community reactions to participants’ CO were distinguished through thematic analysis in three main types: unconditional acceptance, invitation to change, and open rejection. The present research extended current knowledge on CO and minority stress experiences in different generations of LGBQ+ people. Several differences emerged between generational groups on sexual orientation milestones, highlighting the potential impact of historical and cultural contexts in determining sexual minorities’ experiences related to sexual identity. It is recommended that mental health professionals working with LGBQ+ clients implement targeted interventions based on their clients’ multiple salient aspects, including age and religious background. Clinicians should also be aware of the potentially detrimental effects of CO within an unsupportive context, rather than encouraging CO tout court.

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Background Chemsex is a novel phenomenon referring to the consumption of illicit drugs to facilitate, enhance, and prolong the sexual experience in men who have sex with men (MSM). Aim The present study aims to investigate contexts, patterns of substance use, first chemsex experience, and harm reduction in a group of MSM practicing chemsex in Italy. Methods Thirty MSM involved in chemsex activities were interviewed between February and July 2019. Outcomes The interviews were conducted using an ad hoc grid exploring general characteristics of Italian chemsex, patterns of substance use, first chemsex experience, and harm reduction opinions. Results Chemsex in Italy showed important peculiarities and patterns because of sociocultural background. Chemsex was mainly reported in private venues within couple and group sexual activities. Most participants attended chemsex sessions about 1-2 times per month often concurring with men-only club events. Freebase cocaine emerged among the most relevant substances consumed together with gamma-hydroxybutyrate/gamma-butyrolactone, crystal methamphetamine, and mephedrone. A rare use of injected substances compared with other European Union countries was shown. Given the high prevalence of erectile problems, a large use of phosphodiesterase type 5 inhibitors was reported, and noncoital sexual activities were usually preferred (eg, oral sex, fist fucking). The first chemsex experiences were usually accessed by geolocation-based dating apps and sexual partners and were generally described as positive experiences, with some negative consequences at the end of the session (dysphoric mental states, guilt, craving). Taking part in international gay events seems to favor the first experience of chemsex for some participants. Moreover, some MSM practiced chemsex only abroad or in other cities in Italy so as not to be recognized as chem users in their daily environment. Clinical Translation Implications for ad hoc harm reduction programs are discussed. Strengths & Limitations Despite the methodological limitations due to participants’ number and the absence of interviews audio recording, results highlighted some relevant characteristics of chemsex in Italy, such as freebase cocaine use, attitudes regarding slamming, geographical movements, and secrecy. Conclusion The results revealed a need for greater scientific and public attention on chemsex to act with the most specific and effective prevention and harm reduction tools.

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Transgender refugees are at risk of experiencing increased minority stress due to experiences of trauma in their country of origin, and the intersection of multiple marginalized identities in their host country. Adopting a transfeminist and decolonial approach, the present study aimed at exploring transgender refugees’ experiences of life and migration. A semi-structured interview protocol was developed, grounded in the perspectives of minority stress and intersectionality. Participants were five transgender refugees (four women and one non-binary) from different cultural/geographic contexts, professing different religions. Using thematic analysis, the researchers identified three themes: pre- and post-migration minority stress and transphobia; religion as a protective factor for gender affirmation; and individuation and the synthesis of social identities. Participants reported traumatic experiences and the inability to openly live out their gender identity in their country of origin as the main push factors to migration. They also reported feelings of isolation and experiences of victimization during interactions with the Italian asylum services, due to a lack of adequate training, racial prejudice, and transphobia. Participants demonstrated positive individuation, linked to gender affirmation treatments and religious protective factors. The interview protocol may be used by social operators to support the claims of transgender asylum seekers, and to clinically assess transgender people with an immigrant background.

Background: A paradoxical profile of greater elevated sympathetic vasoconstriction (increased total peripheral resistance, TPR) and increased vagally-mediated heart rate variability (HRV) -the so-called Cardiovascular Conundrum- has been reported in African Americans (AAs) both at rest and in response to orthostasis. Whereas some authors have attributed this pattern to genetic factors, others have pointed to the potential role of coping with repeated racial discrimination.Objective: To disentangle between these alternative explanations, we have examined the hemodynamic profile of another population that is likely to be exposed to episodes of discrimination, i.e., sexual minorities.Methods: The first study was conducted on a sample of AAs and European Americans (EAs) with the aim of replicating previous results on the Cardiovascular Conundrum. In the second study, lesbian, gay, and bisexual (LGB) people, matched by age and sex with heterosexual participants, underwent a hemodynamic and autonomic assessment at rest and during an emotional (in the experimental group, both LGB-related and non LGB related), and a cognitive stressor.Results: The first study confirmed a pattern of higher resting HRV, paired with higher TPR, in AAs compared to EAs. In the second study, compared to heterosexuals, the LGB group showed the Cardiovascular Conundrum pattern, characterized by greater HRV and higher TPR at baseline and a more vascular hemodynamic profile and prominent compensation deficit in response to both tasks, and particularly during the LGB-related emotional task. However, in LGB only, the vascular response was negatively correlated with perceived discrimination.Conclusion: Present preliminary results are discussed in terms of maladaptive physiological consequences of exposure to chronic stress and the chronic use of dysfunctional emotion regulation strategies such as suppression.