BackgroundPrior studies have noted significant health disadvantages experienced by LGBT (lesbian, gay, bisexual, and transgender) populations in the US. While several studies have identified that fears or experiences of stigma and disclosure of sexual orientation and/or gender identity to health care providers are significant barriers to health care utilization for LGBT people, these studies have concentrated almost exclusively on urban samples. Little is known about the impact of stigma specifically for rural LGBT populations, who may have less access to quality, LGBT-sensitive care than LGBT people in urban centers.MethodologyLBGT individuals residing in rural areas of the United States were recruited online to participate in a survey examining the relationship between stigma, disclosure and “outness,” and utilization of primary care services. Data were collected and analyzed regarding LGBT individuals’ demographics, health care access, health risk factors, health status, outness to social contacts and primary care provider, and anticipated, internalized, and enacted stigmas.ResultsHigher scores on stigma scales were associated with lower utilization of health services for the transgender & non-binary group, while higher levels of disclosure of sexual orientation were associated with greater utilization of health services for cisgender men.ConclusionsThe results demonstrate the role of stigma in shaping access to primary health care among rural LGBT people and point to the need for interventions focused towards decreasing stigma in health care settings or increasing patients’ disclosure of orientation or gender identity to providers. Such interventions have the potential to increase utilization of primary and preventive health care services by LGBT people in rural areas.
Men who have sex with men (MSM) bear a disproportionate burden of HIV incidence
in the United States. Previous study of sexual decision-making and HIV risk
among MSM has not accounted for relationship dynamics. Further research must
examine this connection between relationship dynamics and sexual
decision-making, especially regarding condomless anal intercourse. This study
analyzes data gathered from gay and bisexual men regarding their sexual partners
and sexual decision-making over a 10-week period through personal relationship
diaries (PRDs) and a follow-up in-depth interview (IDI). Through coding and
extraction of relationship dynamics, key patterns of participants’ sexual
decision-making processes were examined based on relationship type, which was
categorized by commitment, formality, and sexual agreement. Participants’ sexual
relationships can be divided into five categories: (a) Uncommitted, one time,
(b) Uncommitted, ongoing, (c) Transitioning or unknown commitment, (d)
Committed, nonmonogamous, and (e) Committed, monogamous. These five categories
correspond to patterns in sexual decision making and consequent sexual
risk-taking behaviors. Each of these influence HIV risk within male–male sexual
encounters in a particular manner, and understanding these is important for
appropriately tailored HIV prevention interventions for MSM. Recommendations are
included for interventions seeking to address HIV risk across a wide variety of
MSM sexual relationships.
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