Purpose: We describe the timing of suicidality across the life span in three cohorts of sexual minority adults. We hypothesized that suicide attempts coincide with the coming out period and that younger sexual minority people, who grew up in more accepting social environments, will have lower prevalence of suicide attempts than older generations. Methods: A U.S. national probability sample of 1518 sexual minority adults in three age cohorts of 18-25, 34-41, and 52-59 years (collected 2016-2018) completed a self-administered survey. Results: Sexual minority adults had high prevalence of lifetime suicidal thoughts, plans, and attempts, with the highest attempted suicides in the younger cohort (30.8%, 95% confidence interval [CI] = 26.8-35.1) compared with the middle (23.7%, 95% CI = 19.0-29.1) and older (20.3%, 95% CI = 16.3-25.1) cohorts. There were no differences in suicidal behavior by race and ethnicity or between men and women, but gender nonbinary people had higher prevalence of suicidal thoughts. The mean age at suicidal thoughts, plans, and attempts tracked closely with age of first realization of sexual minority identity. Most suicide attempts (60.9%) occurred within 5 years of realizing one's sexual minority identity, but a significant proportion of attempts (39.1%) occurred outside this range. Conclusion: Our findings are contrary to the hypothesis that younger cohorts of sexual minority people are at lower risk of suicidality.

Despite advances in clinical care, safer conception services are not utilised in many high HIV prevalence countries, including Botswana. We conducted in-depth interviews with 10 HIV healthcare providers and 10 women living with HIV to develop a deeper understanding of attitudes surrounding childbearing and pregnancy planning. Interviews were analysed using a phenomenological approach. Providers felt it was a human right and normative for women living with HIV to have children but also expressed concern about women living with HIV having children. Women themselves anticipated stigma from providers regarding childbearing, although most described supportive care and had not experienced stigmatising treatment. Although providers believed pregnancies amongst women living with HIV were unplanned, women described discussing pregnancy desires with sexual partners. Despite providers voicing a rights-based approach to childbearing amongst women living with HIV, hesitancy towards pregnancy remains. This is felt by women living with HIV and perceived as stigma, which may make them less likely to seek fertility and safer conception advice. Safer conception interventions are unlikely to be successful if women do not feel comfortable discussing childbearing with health-care providers.

This article presents findings from a qualitative evaluation of an HIV/STI (sexually transmitted infection) prevention intervention for urban African American youth (Project ÒRÉ), which was delivered to groups of 3 to 8 adolescents who were members of the same friendship network. Sixteen focus groups (N = 63) were conducted with youth following their participation in the intervention. Results demonstrate high acceptability of the intervention. Both males and females revealed multiple benefits of attending the intervention with friends including feeling more comfortable, experiencing general satisfaction with the program, experiencing greater ease in talking and expressing self, being able to reveal sensitive information, and being able to relate to each other's experiences. Additional themes were presented only by males including feeling a sense of cohesion, the ability to protect each other from HIV/STIs in the future, and feeling safe. These results suggest that delivering HIV/STI and other prevention interventions within adolescents' friendship networks may offer unique benefits not found with traditional programs that include random groupings of youth who are not familiar with each other. © The Author(s) 2012.

Safe and effective low-cost safer conception (SC) methods are increasingly available and being integrated into national guidelines in sub-Saharan African contexts. Sero-different couples of childbearing age can benefit from such services and the routine provision of SC counselling. Pre-exposure prophylaxis (PrEP) to prevent HIV acquisition to uninfected partners can reduce the chances of HIV transmission when trying to achieve pregnancy. Botswana has a strong commitment to reducing new HIV infections but PrEP is not yet widely available and little guidance has been offered on counselling sero-different couples. We conducted qualitative in-depth interviews in Gaborone, Botswana with 10 HIV healthcare providers and 10 women living with HIV of childbearing age because they act as a key conduit for reaching sero-different partners with information about PrEP. We examined knowledge and attitudes towards PrEP to assess the viability and develop a deeper understanding of this SC option. Interviews were analysed using an interpretive phenomenological approach. Three themes emerged: (1) awareness of PrEP is limited, (2) providers and women overwhelmingly showed interest in PrEP and (3) women living with HIV and providers have concerns about PrEP use. With the correct support, PrEP could be a useful SC option for sero-different couples in Botswana and other sub-Saharan contexts.

Reducing HIV incidence among adolescents represents an urgent global priority. Structural change approaches to HIV prevention may reduce youth risk by addressing the economic, social, cultural, and political factors that elevate it. We assessed whether achievement of structural changes made by eight Connect-to-Protect (C2P) coalitions were associated with improvements in youth's views of their community over the first 4 years of coalitions' mobilization. We recruited annual cross-sectional samples of targeted youth from each C2P community. We sampled youth in neighborhood venues. We interviewed a total of 2461 youth over 4 years. Males (66 %) and youth of color comprised the majority (52 % Hispanic/Latinos; 41 % African Americans) of those interviewed. By year 4, youth reported greater satisfaction with their community as a youth-supportive setting. They reported their needs were better met by available community resources compared with year 1. However, these findings were moderated by risk population such that those from communities where C2P focused on young men who have sex with men (YMSM) reported no changes over time whereas those from communities focused on other at-risk youth reported significant improvements over time in satisfaction and resource needs being met. Internalized HIV stigma increased over time among those from communities serving other at-risk youth and was unchanged among those from YMSM communities. The very different results we observe over time between communities focused on YMSM versus other at-risk youth may suggest it is unreasonable to assume identical chains of structural causality across youth populations who have such different historical relationships to HIV and who encounter very different kinds of entrenched discrimination within their communities.

Purpose: Multi-level hostility toward sexual minority (SM; includes, but is not limited to those identifying as gay, lesbian, bisexual, queer, or same-gender loving) and other minority populations (e.g., racial/ethnic) increased after the 2016 U.S. presidential election. This may generate stress and mental health problems among those groups, and particularly among SM people of color. This study assessed whether the mental health of Black and Latinx SM adults declined after the 2016 U.S. presidential election. Methods: Data were from a daily national probability survey (thus, mean changes in mental health outcomes over time may reflect population shifts in mental health) of Black and Latinx SM adults (N = 537), recruited 7 months before and 17 months after the November 8, 2016 election. Using a between-subjects design, spline-based regressions (spline set at election date), adjusted for sociodemographic characteristics, estimated four mental health outcomes (past-month number of "poor mental health" days and psychological distress, past-year suicidal ideation, and social wellbeing) as a function of survey completion date. Results: There was marked worsening in each of the mental health outcomes over the postelection period (past-month poor mental health days, B = 0.05, standard error [SE] = 0.02, p < 0.05; psychological distress, B = 0.28, SE = 0.14, p < 0.05; suicidal ideation, odds ratio = 1.13, 95% confidence interval >1.00-1.26, p < 0.05; and social wellbeing, B = -0.05, SE = 0.02, p < 0.05). None of the outcomes varied over the pre-election period. Conclusions: This study provides evidence of worsening mental health among Black and Latinx SM adults in the United States during the 1.5 years after the 2016 U.S. presidential election.