Providing Culturally Sensitive Care to Women Who Are in the Sexual Minority or Are Gender Nonconforming

Women who are in the sexual minority or are gender nonconforming experience more physical and mental health disparities compared with those in the sexual majority. Individuals in the minority have reported a fear of being judged or a feeling of being invisible to health care providers. Many nurses believe that they treat all patients the same, but they may be unaware of the special cultural needs of individuals in the minority. In this article, we describe health disparities experienced by lesbian, gay, bisexual, transgender, questioning/queer, and intersex (LGBTQI) populations; explain definitions and terms to improve communication; and discuss best practices to provide inclusive environments for these individuals. We also discuss the process of coming out and how nurses can best meet the needs of individuals in the different stages of coming out.     

Willingness to use and preferences for long-acting injectable PrEP among sexual and gender minority populations in the southern United States, 2021–2022: cross-sectional study

Introduction

Long-acting injectable (LAI) pre-exposure prophylaxis (PrEP) for HIV prevention was approved by the U.S. Food and Drug Administration in 2021. LAI PrEP is more effective than oral PrEP. However, it is not clear whether the groups most at risk of HIV in the United States will use LAI PrEP. Willingness to use LAI PrEP and preference for LAI versus oral PrEP has not been reported for sexual and gender minority (SGM) people in the southern United States, where the HIV epidemic is concentrated. Our goal was to assess willingness to use LAI PrEP and preference for oral versus LAI PrEP among SGM people in the southern United States and to assess differences in willingness by demographics and sexual behaviour.

Methods

We conducted an online, cross-sectional survey of SGM people aged 15–34 years in the southern United States (n = 583). Participants reported willingness to use LAI PrEP and preferences for LAI PrEP versus daily oral PrEP. We assessed bivariate associations and adjusted prevalence ratios for the LAI-PrEP-related outcomes and key demographic and behavioural characteristics.

Results

Overall, 68% of all participants (n = 393) reported being willing to use LAI PrEP that provides protection against HIV for 3 months. Of those, most (n = 320, 81%) indicated a preference for using LAI PrEP, compared to a daily oral pill or no preference. Willingness to use LAI PrEP was more common among transgender and non-binary participants and participants who engaged in condomless anal intercourse in the last 6 months. Hispanic participants were more likely and non-Hispanic Black participants were less likely to report willingness to use LAI PrEP compared to non-Hispanic White participants.

Conclusions

Willingness to use LAI PrEP was high among SGM people in the southern United States, although there were some important differences in willingness based on demographic characteristics. Decreased willingness to use LAI PrEP among groups who are disproportionately affected by the HIV epidemic, such as non-Hispanic Black SGM people, could exacerbate existing disparities in HIV incidence. LAI PrEP is an acceptable option among SGM populations in the southern United States, but strategies will be needed to ensure equitable implementation.     

Lesbian,gay, bisexual and transgender older people in Ireland: Mental health issues

International policy initiatives have highlighted the need to include older lesbian, gay, bisexual and transgender (LGBT) issues in the provision of appropriate health and social care. However, empirical studies in the area remain sparse. The aim of this study was to investigate the experiences and needs of LGBT people over the age of 55 years living in Ireland and this article reports on specific mental health issues. Mixed methods were used involving 144 surveys and 36 semi-structured in-depth interviews. The findings revealed that a significant number of the survey respondents had experienced a mental health problem at some point in their lives with interview participants providing further details of their concerns. It is recommended that policy makers address the mental health needs of older LGBT people in future strategic directives and develop standards of care that support the principles of equality, inclusion and respect for diversity.     

Fertility care for persons considering gender transition

Referrals to the gender identity development service and gender identity clinics are increasing. Gender affirming medical interventions can adversely impact on fertility potential of the individual. Discussion about possible impact of various treatments such as GnRH agonists and cross over hormones (oestrogen or testosterone) and surgery of genitalia and reproductive organs should be discussed. Opportunity should be provided to discuss options for fertility preservation and assisted decision-making. It should be appreciated that transgender individuals have an increased incidence of mental health problems and barriers to care.Oocyte and sperm cryopreservation provide options for biological parenthood.     

Primary Care for Lesbian,Gay, Bisexual,Transgender, and Queer/Questioning (LGBTQ) Patients

The lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) community is a vulnerable populace that accounts for 4.5% of the United States population. Unfortunately, this group of individuals faces discrimination. They need access to quality, prejudice-free health care. This article initiates the discussion of how nurse practitioners, primary care, and family practice providers can provide inclusive, unbiased, quality care to this community that is evidence based. Information is provided about common barriers preventing this population from receiving equitable care. Evidence-based methods are outlined for screening this population for common health conditions, paying particular attention to an established HIV risk assessment and its application in clinical settings to identify candidates for pre-exposure prophylaxis. Finally, pharmacologic information about preexposure prophylaxis and transgender hormone therapy is presented. The information presented prepares nurse practitioners to begin caring for this population.