Objective Among people in psychiatric care worldwide, the majority is sexually active, and sharply elevated rates of HIV infection compared to the general population have been shown. Recovery-oriented treatment does not routinely address sexuality. We examined the relationship between gender, severe mental illness diagnosis, and stigma experiences related to sexuality among people in psychiatric outpatient care. Method 641 sexually active adults attending eight public outpatient psychiatric clinics in Rio de Janeiro were interviewed for psychiatric diagnosis and stigma experiences. Stigma mechanisms well established in the literature but not previously examined in relation to sexuality were measured with the Mental Illness Sex Stigma Questionnaire, a 27-item interview about stigma in sexual situations and activities. Results Experiences of stigma were reported by a majority of participants for 48% of questionnaire items. Most people reported supportive attitudes toward their sexuality from providers and family members. Those with severe mental illness diagnoses showed greater stigma on Individual Discrimination and Structural Stigma mechanisms than those with non-severe mental illness diagnoses, while there was no difference on the Social Psychological Processes (internalized stigma) mechanism. Regardless of diagnosis or gender, a majority of participants devalued themselves as sexual partners. Conclusions and Implications for Practice Adults in psychiatric outpatient care frequently reported stigma experiences related to aspects of their sexual lives. From the perspectives of both HIV prevention and recovery from mental illness, examining the consequences of stigma in the sexual lives of people in psychiatric care and improving their measurement would have wide applicability.

This article updates previous content analyses that identified a relative paucity of U.S.-based psychological research on lesbian, gay, bisexual, and transgender (LGBT) people of color by extending the period covered to 2018. In addition to documenting how many such studies occurred and when, it considers the research questions asked, funding sources, impact, and journal outlets. This richer description of this research area allowed us to describe historically not only when LGBT people of color in the United States were studied but why they were studied, which journals published this work, and which published studies were most influential. We found that the literature starts in 1988 for LGB people of color and in 2009 for transgender people of color and that a significant shift occurred in 2009, with the majority of the articles being published in the last 10 years. Findings suggest that U.S. federal funding and support for LGBT research as well as divisions of the American Psychological Association focused on minoritized identities and their journals played a role in the recent increase. Half of the studies investigated psychological symptoms, and more than a third of studied experiences and psychological processes related to holding multiple minority statuses, many of which focused on potentially deleterious aspects of these identities. These findings indicate that this literature has a significant focus on pathology. Underrepresented groups included cisgender and transgender women; transgender men; older individuals; Asian Americans, Native Hawaiians, and Pacific Islanders; American Indians and Alaska Natives; and multiracial individuals. Public Significance StatementWe found that the body of research with lesbian, gay, bisexual, and transgender people of color in the United States has grown substantially in the past 10 years and that this increase is related to shifts in U.S. research funding and the journals of divisions of the American Psychological Association focused on marginalized groups.

We examined motivations for migration to the United States (US) among 482 Brazilian, Colombian, and Dominican men who have sex with men (MSM). Participants' most common reason for migration was to improve their financial situation (49%), followed by sexual migration in order to affirm their sexual orientation (40%). Fewer endorsed sexual migration motivated by avoiding persecution due to being gay (13%). We conducted further analyses among 276 participants who migrated after age 15 and were HIV-negative at the time of migration. We hypothesized that sexual migration would be associated with greater likelihood of HIV acquisition post-migration. Hierarchical logistic regression analysis indicated that sexual migration motivated by avoiding persecution due to being gay was associated with increased odds of contracting HIV after arrival in the US whereas sexual migration to lead a gay life was not. Our findings highlight the importance of addressing the negative impact of anti-gay discrimination in countries of origin.

Objective: Human immunodeficiency virus (HIV) prevention efficacy trials with psychiatric patients have been conducted in research settings in high-resourced countries, establishing short-term efficacy for reducing sexual risk behavior. None has been implemented within systems of care. In the last decade, overcoming this research-to-practice gap has become a focus of implementation science. This paper describes the first and only HIV Prevention intervention trial for psychiatric patients conducted in real-world outpatient psychiatric settings facilitated by trained clinic-based providers. Methods: The HIV Prevention intervention, which uses the Information-Motivation-Behavioral Skills model to achieve sexual risk-reduction, was rigorously adapted to the local context and clinic services' needs. Participants from eight clinics were randomized to HIV Prevention or Health Promotion conditions. Results: HIV Prevention participants showed significant improvement in Information-Motivation-Behavioral domains; in this group, behavioral intentions were associated with significantly fewer unprotected sex occasions, but reduction of unprotected sex occasions was similar in both conditions. Conclusion: Our trial was conducted before implementation studies became widely funded. Transporting an intervention to a new culture or into real-world practice settings may require adaptations. Our results demonstrate that clear guidelines are needed regarding whether to conduct efficacy, effectiveness, and/or implementation research as the most appropriate next step. Clinical trial registration: NCT00881699

Colombia endured 70 years of internal conflict, but despite a peace agreement, violence continues to be significant in the post-conflict era. Violence degrades the health and well-being of affected populations and it engenders psychological distress. Little is known about the impact of violence on the mental health of sexual and gender minority populations in Colombia. This study aimed to examine the frequency and sources of violence among cisgender men who have sex with men (MSM) and transgender women and their association with depressive symptoms and substance use. We administered a survey to 942 MSM and 58 transgender women recruited using respondent-driven sampling. We estimated the relationship between mental health indicators and experiences of violence using stepwise logistic and linear regressions, controlling for income, education, age, race, and mistreatment for being effeminate when younger. Respondent-driven sampling adjusted prevalence of any type of violence was 60.9% for the total sample, 59.8% for MSM, and 75.1% for transgender women. Experiences of violence were significantly related to depressive symptoms, binge drinking and drug use for the MSM sample. Violence perpetrated by family members or acquaintances was associated with greater depressive symptoms, and violence perpetrated by partners and strangers was associated with increased binge drinking and drug use. These results provide significant evidence of the negative association of experiences of violence and the mental health of sexual and gender minority people, a vulnerable population in Colombia. This study addresses issues of diversity regarding sexual orientation and gender identity in a Latin American middle-income country.