Measure of Internalized Sexual Stigma for Lesbians and Gay Men (MISS-LG) in Taiwan: Psychometric Evidence from Rasch and Confirmatory Factor Analysis

Internalized sexual stigma may hamper the development of self-identity, social interaction, and intimate relationship in lesbian, gay, and bisexual (LGB) individuals. The Measure of Internalized Sexual Stigma for Lesbians and Gay Men (MISS-LG) is an important instrument assessing internalized sexual stigma for LGB individuals. However, its psychometric properties have not been examined in LGB populations outside the Italian community. The present study used advanced psychometric testing to evaluate the traditional Chinese version (the MISS-LG) among LGB individuals in Taiwan. LGB individuals (500 male, 500 female) participated in this study and completed the MISS-LG, HIV and Homosexuality Related Stigma (HHRS), and Acceptance and Action Questionnaire-II (AAQ). Confirmatory factor analysis results confirmed the three-factor structure of the MISS-LG; however, two items for males and one item for females had somewhat low factor loadings on the sexuality factor. Each MISS-LG factor was found to be unidimensional in Rasch results, except for the slight misfit in Item 3 and concurrent validity of the MISS-LG was supported by the positive correlations with HHRS and the AAQ. The Chinese MISS-LG has relatively satisfactory psychometric properties. However, further research is needed to investigate the reasons for problematic fitting of several items.

Case series: Psychosocial challenges of female youth within the Irish Travelling community

Background: The Irish Travelling community are an ethnic minority group known for their distinct identity, traditions and language. Although this group has its roots in Ireland, they are marginalised and discriminated against by every part of Irish society. Irish Travellers are a group who are vulnerable to exclusion and experience health, economic and educational inequalities. Young female Irish Travellers in Ireland are highly susceptible to mental illnesses which makes the engagement of this ethnic group by healthcare services important. Aims: To review the cases of three female adolescents from the Irish Travelling community living in Ireland with a focus on their psycho-social difficulties. Complete a literature review, to complement and inform the three cases reviewed, on the socio-cultural and mental health challenges which effect adolescent females in the Irish Travelling community. Methods: Case series with literature search and review of relevant published articles using a keyword search of databases PubMed, PsycINFO and HSE protocols and reports. Hand searching of relevant references utilised. Informed signed consent obtained from each patient attending child and adolescent services in Ireland. Signed parental consent also obtained. Written consent obtained due to the use of patient history and assessments in the case series. Results: Adolescent females within the Irish Travelling community encounter particular difficulties within the moral constraints and expectations of this community. They encounter specific issues including mental illness, sexual stigma, domestic violence and limitations to the role of women. The three cases outlined give representative examples of the challenges faced by adolescent females within the Travelling community. Conclusions: Psychiatric services need to be aware of this vulnerable group and focus on the recognition of their needs within the context of their community.

Enablers and Barriers to HIV Services for Gay and Bisexual Men in the COVID-19 Era: Fusing Datasets from Two Global Online Surveys Via File Concatenation with Adjusted Weights (Preprint)

BACKGROUND Gay and bisexual men are 26 times more likely to acquire HIV than other adult men and represent nearly 1 in 4 new HIV infections worldwide. There is concern that the COVID-19 pandemic may complicate efforts to prevention new HIV infections, reduce AIDS related deaths, and expand access to HIV services. The impact of the COVID-19 pandemic on gay and bisexual men’s ability to access services is not fully understood. OBJECTIVE To understand access to HIV services at the start of the COVID-19 pandemic. METHODS Our study used data collected from two independent global online surveys conducted with convenient samples of gay and bisexual men. The two datasets fused in the analysis were comprised of 6,188 consenting participants from the GMHR-4 and 13,562 from the COVID-19 Disparities surveys. We used file concatenation with adjusted weights and multiple imputations to explore social/structural enablers of and barriers to HIV service access among gay and bisexual men worldwide using data drawn from the two separate surveys. One survey was implemented prior to the start of the COVID-19 pandemic and the second at the height of its first wave. All predictors and outcomes were treated as continuous variables. Using the smpc command, we generated predicted values for our outcomes from the COVID-19 dataset and predictors from the GMHR-4 as a function of each other, using separate models for each pair of outcomes and predictors, controlling for the demographic characteristics that are jointly observed in both datasets, while defining an assumed partial correlation between the outcomes and predictors. We hypothesized that engagement with gay community and comfort with one’s healthcare provider would be positively associated with HIV service access and negatively associated with poorer mental health and economic instability as the COVID-19 outbreaks took hold. Conversely, we hypothesized that sexual stigma and experiences of discrimination by a healthcare provider would be negatively associated with HIV services access and positively associated with poorer mental health and economic instability. RESULTS With 19,643 observations after combining datasets, our study confirmed hypothesized associations between enablers of and barriers to HIV prevention, care, and treatment. For example, community engagement was positively associated with access to an HIV provider (Coef. = 0.81, 95% CI 0.75-0.86, p=0.00), while sexual stigma was negatively associated with access to HIV treatment (Coef. =-1.39, 95% CI -1.42 – -1.36, p=0.00). CONCLUSIONS The COVID-19 pandemic may be exacerbating existing barriers to HIV service access for gay and bisexual men. Community-led research that utilizes novel methodological approaches can be helpful in times of crisis to inform urgently needed tailored responses that can be delivered in real-time. More research is needed to understand the full impact COVID-19 is having on gay and bisexual me worldwide.

Direct and Moderating Effects of Sexual Minority Identity Dimensions on Mental Health

Sexual minorities experience minority stress, which is associated with mental health disparities. However, specific dimensions of identity may buffer against these disparities. While research in other stigmatized populations has found evidence for direct and moderating effects of identity on mental health, limited research has examined these dimensions in sexual minorities. We explored the potential direct and moderating effects of identity dimensions with regards to sexual stigma and mental health. Findings from 209 lesbian, gay, and bisexual individuals revealed higher centrality of sexual orientation identity and more positive private regard predicted lower psychological distress and more positive private regard predicted higher self-esteem. Additionally, centrality moderated the effect of public stigma, such that those who reported higher centrality did not report decrements to self-esteem in the face of public stigma to the extent of those with low centrality. Findings suggest centrality and private regard contribute to the psychological wellbeing of sexual minorities.