Mental health in the Chilean LGBT population in times of COVID-19 / Salud mental en población LGBT chilena en tiempos de la COVID-19

Abstract Introduction There are few reports on mental health among the lesbian, gay, bisexual, and transgender (LGBT) population in the context of COVID-19, especially in South America. Objective To describe the prevalence of symptoms associated with mental health disorders, as well as to analyze the risk of their occurrence, in different groups of the Chilean LGBT population in the context of COVID-19. Method A total of 1,181 LGBT people, ranged from 18 to 64 years participated in an online survey, using the Depression Anxiety Stress Scales-DASS-21. The central tendency measures were analyzed, then cut-off points were used to establish prevalence according to sex and sexual orientation. Finally, the probability of symptoms was analyzed using odds ratio. Results Lower levels of mental health were identified among the bisexual and other sexual orientations (pansexual, demisexual, asexual, etc.) population as compared with gays and lesbians, finding a greater presence of depressive symptoms (p = .000), anxious (p = .000) and related to stress (p<.001). Similarly, bisexual women are more likely to present symptoms associated with mental health disorders than men, as lesbians do, as compared with gays in the case of anxiety. Gays are at a higher risk of stress than lesbians. Discussion and conclusion Even though the pandemic affected the entire population, results give evidence of disparities among the various LGBT communities, showing the need to focus on preventive interventions and the implications of increased risk in bisexual population, particularly women, who are affected by various cross discriminations.

Resumen Introducción Existen pocos reportes sobre la salud mental en poblaciones de lesbianas, gays, bisexuales y transexuales (LGBT) en el contexto del COVID-19, especialmente en Sudamérica. Objetivo Describir la prevalencia de síntomas asociados a problemas de salud mental, así como analizar su riesgo de ocurrencia en diferentes grupos de población LGBT chilena en el contexto de la pandemia del COVID-19. Método Participaron en una encuesta en línea un total de 1,181 personas LGBT, con edades comprendidas entre los 18 y los 64 años, quienes completaron el cuestionario DASS-21 (del inglés Depression Anxiety Stress Scales). Primero se analizaron las medidas de tendencia central, luego se estableció la prevalencia según sexo y orientación sexual y finalmente se analizó la probabilidad de presentar síntomas mediante el odss ratio. Resultados Se identificaron menores niveles de salud mental en la población bisexual y otras orientaciones sexuales (pansexual, demisexual, asexual, etc.), en comparación con gays y lesbianas, debido a una mayor presencia de sintomatología depresiva (p = .000), ansiosa (p = .000) y vinculada al estrés (p<.001). Asimismo, las mujeres bisexuales fueron más propensas que los hombres a presentar síntomas asociados a trastornos de salud mental, al igual que las lesbianas, en comparación con los gays en el caso de la ansiedad. Los gays tienen un mayor riesgo de estrés que las lesbianas. Discusión y conclusión Aun cuando la pandemia afectó a toda la población, los resultados evidencian las disparidades entre las distintas comunidades LGBT, mostrando la necesidad de centrarse en las intervenciones preventivas y las implicaciones de un mayor riesgo en la población bisexual, especialmente en las mujeres, que se ven afectadas por diversas discriminaciones cruzadas.

Propiedades psicométricas de la versión en español de la Escala de Intimidad Emocional en personas heterosexuales, gais y lesbianas en pareja / Psychometric properties of the Spanish version of the Emotional Intimacy Scale with heterosexual, gay and lesbian individuals in couple relationships

Resumen: La Escala de Intimidad Emocional (EIE) es un instrumento de auto-informe que evalúa la intimidad emocional en relaciones cercanas. El objetivo de esta investigación fue examinar las propiedades psicométricas de la EIE para su uso en personas heterosexuales, gais y lesbianas involucradas en una relación de pareja. La muestra incluyó 883 personas chilenas (404 hombres y 479 mujeres; 565 heterosexuales y 318 homosexuales), entre 18 y 72 años. Mediante un Análisis Factorial Confirmatorio, se replicó la estructura unidimensional de la escala logrando un buen nivel de ajuste a los datos, mientras que el análisis multigrupo reveló que la EIE-E (versión en español) es invariante según sexo y orientación sexual. Los índices de consistencia interna mediante el alfa de Cronbach y McDonald Omega fueron apropiados y se observó una asociación positiva entre la intimidad emocional y la satisfacción con la relación de pareja. Finalmente, se identificó que las mujeres lesbianas evidencian mayores niveles de intimidad que el resto de los grupos. Se concluye que la EIE-E es un instrumento apropiado para el estudio de la intimidad emocional en personas que se encuentran en una relación de pareja, sean estas hombres o mujeres heterosexuales, gais o lesbianas.

Abstract: The Emotional Intimacy Scale (EIE) is a self-report instrument that assesses emotional intimacy in close relationships. The aim of this research was to examine the psychometric properties of the EIE for its use in heterosexual, gay and lesbian people who are currently involved in a couple relationship. The sample consisted of 883 Chileans, (404 men and 479 women; 565 heterosexuals and 318 homosexual), between the ages of 18 and 72. Using a Confirmatory Factor Analysis, the one-dimensional structure of the scale was replicated, achieving a good fit to the data, while the multi-group analysis revealed that the EIE-E (Spanish version) is invariant according to sex and sexual orientation. The internal consistency indices using Cronbach's alpha and McDonald Omega were appropriate, and a positive association was observed between emotional intimacy and relationship satisfaction. Finally, results showed that lesbian women showed higher levels of intimacy relative to the other groups. It is concluded that the EIE-E is an appropriate instrument for the study of emotional intimacy in people who are in a couple relationship, be they heterosexual men or women, gays or lesbians.

Salud mental en población transgénero y género no conforme en Chile

Background: Transgender population is at a higher risk of suffering mental health problems than cisgender population (people whose sex and gender identity are in agreement) and other sexual minorities (gays, lesbians, and bisexuals), partly due to the greater stress that they suffer or for being victims of sexual prejudice. Aim: To describe positive and negative mental health indicators in a sample of transgender people living in Chile. Material and Methods: An intentional sample of 377 transgender individuals older than 18 years, living in the country's northern, center and southern zones were studied. Sociodemographic and well-being features, negative emotional symptoms, suicidal behavior, and substance consumption were assessed. Results: A precarious mental health was confirmed among participants. A high frequency of depression, ideation and suicide attempts, and high levels of depression, anxiety, and stress symptoms were identified. Also, a high frequency of substance abuse was found. These mental health indicators varied according to the sex assigned at birth and gender self-identification. Conclusions: Transgender people experience precariousness and vulnerability in their mental health.

Propuesta de valores de referencia para la Escala de Dificultades de Regulación Emocional (DERS-E) en población adulta chilena / Cut-off points of the difficulties in Emotion Regulation Scale for the Chilean population

Background: There are no reference values for the Difficulties in Emotion Regulation Scale (DERS-E) for the Chilean population. Aim: To elaborate reference values for the interpretation of the DERS-E for the Chilean population. Material and Methods: The Difficulties in Emotion Regulation Scale was answered by participants from the general population (1,153 heterosexual men and women and 467 gay and lesbian individuals) and a group of 351 participants with emotional complaints. Receiver operating characteristic (ROC) curves were used to obtain the reference values. A concordance index was determined, and the odds ratio was calculated to evaluate the probability of having mental health problems comparing participants with emotional complaints with those from the general population. Results: The DERS-E cut-off score was 73 points for the Chilean population. No differences were detected for emotional regulation difficulties between men and women or by sexual orientation. Age had a weak association with emotional regulation difficulties. Conclusions: DERS-E has an adequate diagnostic capacity, allowing to differentiate between those who have high or low emotional regulation difficulties.

Medidas de salud mental y bienestar subjetivo en una muestra de hombres gays y mujeres lesbianas en Chile / Health and wellbeing of sexual minorities

Background: Most of the information in Chile about health and wellbeing of sexual minorities refers to risk behaviors. Aim: To assess health and wellbeing in a sample of Chilean homosexual men and women. Material and Methods: Spanish versions of the Satisfaction With Life Scale and Outcome Questionnaire-45 (OQ-45) were answered by 191 homosexual women and 256 homosexual men aged 18 to 67 years, from four Chilean cities. Results: Lesbian women have better levels of satisfaction with life and adjustment in personal relationships than homosexual men. Eight percent of respondents had suicidal thoughts in some moment of their life. Conclusions: The information gathered in this work could help in the development of mental health policies for sexual minorities.

Relation between HIV status, risky sexual behavior, and mental health in an MSM sample from three Chilean cities / Relación entre el estado de seropositividad al VIH, el comportamiento sexual arriesgado y la salud mental en una muestra de HSH de tres ciudades chilenas

ABSTRACT Objective To explore the association among HIV status; negative psychological symptoms (anxiety, depression, and hostility); and risky sexual behaviors (multiple sexual partners and unprotected sexual intercourse) in a Chilean sample of men who have sex with men (MSM). Methods This study had a cross-sectional design and a sample of 325 MSM whose ages ranged from 18 to 64 years (mean: 30.8; standard deviation: 9.8). Association tests (chi-squared) and group mean comparisons (Student’s t-tests and F-tests) were performed. Results No statistically significant differences were found for condom use or for the number of sexual partners between HIV-positive men and those who are not infected. In both groups, about 50% reported sexual encounters without condom use in the past six months. There were statistically significant differences in symptoms associated with depression between the two groups. Conclusions These results reveal the need to strengthen messages about the importance of condom use, as the only way to prevent HIV, and as a means of preventing HIV infection and reinfection, in national prevention and self-care programs for sexually active subjects. More studies are needed in Latin America to advance HIV prevention efforts for the MSM population. The data generated by this study can be used to inform the development of HIV prevention programming strategies and interventions targeting the MSM population in Latin America.

RESUMEN Objetivo Explorar la relación entre el estado con respecto a la infección por el VIH, los síntomas psicológicos negativos (ansiedad, depresión y hostilidad) y el comportamiento sexual arriesgado (varios compañeros sexuales y relaciones sexuales sin protección) en una muestra de hombres que tienen relaciones sexuales con otros hombres (HSH) de Chile. Métodos Este estudio tuvo un diseño transversal y una muestra de 325 HSH de 18 a 64 años (media: 30,8; desviación estándar: 9,8). Se efectuaron pruebas de asociación (ji al cuadrado) y comparaciones entre las medias grupales (prueba de la t de Student y prueba F). Resultados No se observaron diferencias estadísticamente significativas respecto del uso de preservativos o del número de compañeros sexuales entre los hombres seropositivos al VIH y los no infectados. En los dos grupos, más del 50 % refirió que había tenido algún encuentro sexual sin protección en los seis meses anteriores. Se observaron diferencias estadísticamente significativas entre los dos grupos en cuanto a los síntomas asociados a la depresión. Conclusiones Estos resultados muestran la necesidad de fortalecer los mensajes acerca de la importancia del uso de preservativos como la única manera de prevenir el VIH y como un medio de prevenir la infección y la reinfección por este virus, en los programas nacionales de prevención y autocuidado destinados a las personas sexualmente activas. Es necesario efectuar más estudios en América Latina para impulsar las medidas de prevención de la infección por el VIH orientadas a la población de HSH. Los datos generados por este estudio pueden servir para formular estrategias programáticas de prevención e intervenciones dirigidas a esta población en América Latina.

Situación social y legal de gays, lesbianas y personas transgénero y la discriminación contra estas poblaciones en América Latina / A situação social e legal de gays, lésbicas e pessoas trans e a discriminação contra estas populações na América Latina / The social and legal status of gay men, lesbians and transgender persons, and discrimination against these populations in Latin America

Resumen: Este artículo revisa brevemente algunas de las condiciones socioculturales y legales que favorecen -o desfavorecen- la vida de gays, lesbianas y personas transgéneros en América Latina y recopila algunos datos comparativos disponibles sobre la situación legal de dichas poblaciones y la discriminación ejercida ellas. Se concluye indicando el alcance y persistencia del prejuicio y la discriminación hacia gays, lesbianas y personas transgénero en la región.

Resumo: Este artigo revisa brevemente algumas das condições sócio-culturais e legais que favorecem - ou desfavorecem - a vida de gays, lésbicas e pessoas trans na América Latina e apresenta alguns dados comparativos disponíveis sobre a situação legal destas populações e a discriminação contra elas exercida. Conclui indicando o escopo e persistência do preconceito e discriminação contra gays, lésbicas e pessoas trans na região.

Abstract: This paper briefly examines some of the sociocultural and legal conditions either helping or hindering the life of gay men, lesbians, and transgender individuals in Latin America. Some comparative data available about the legal situation and discrimination towards these populations is presented. In conclusion, the scope and persistence of prejudice and discrimination against gays, lesbians, and transgender individuals in the region is discussed.

Discrimination and victimization against gay men and lesbians in Chile: Two patterns or just one?

La marcha por el Orgullo Lésbico, Gay, Bisexual y Transgénero se realiza cada año en Santiago de Chile y aglutina a minorías sexuales, pero también a heterosexuales que asisten para apoyar a dicha población en la reinvindación de sus derechos. Específicamente, el propósito del estudio realizado fue describir a gay y lesbianas participantes en la Marcha del Orgullo desde el punto de vista de la discriminación y la victimización. Se centró solo en dicha población ya que mayoritariamente es la que asiste a la marcha y porque no existen estudios previos que comparen en el país a ambos grupos. Además, tuvo como objetivo mostrar que los hombres gay sufren más discriminación y victimización que las lesbianas. La muestra consistió en 203 gay y lesbianas mayores de 18 años. Con respecto a los resultados, la proporción de gay que reportaron haber percibido eventos de discriminación fue igual al 72.7% y 79.6% en las lesbianas. Asimismo, el 81.8% del total de los gay reportaron eventos de victimización y un 75.3% del total de las lesbianas. Se observan diferencias significativas entre gay y lesbianas, afectando solo a las últimas, en la prohibición de entrada o permanencia en lugares de entretención, discriminación ejercida por agentes de seguridad y discriminación laboral. Entre los eventos de victimización, gay informaron más burlas que las lesbianas. Se concluye que hay similaridades en los eventos de discriminación y victimización percibidos por gay y lesbianas, pero también algunas diferencias. La existencia de un patrón diferenciado entre gay y lesbianas deberá ser confirmada en futuros estudios.

The Lesbian, Gay men, Bisexual and Trans -gender (LGBT) Pride Parade takes place in Santiago (Chile) every year. It gathers sexual minorities and also heterosexuals who attend to support LGBT population rights vindication. Specifically, the objective of the study was to describe gay men and lesbians who participate in the LGBT Pride Parade, from the viewpoint of discrimination and victimization. In this sense, this study is innovating because it is based on questionnaires administered in the context of LGBT Pride Parades. In Chile, data on this issue are scarce. There are few previous studies on the topic, revealing that many LGBT people report discrimination and victimization in different situations and contexts. Nevertheless, these studies have not clearly stated the existing differences in the patterns of discrimination and victimization events that affect the different groups (for example, those that affect gay men and lesbians). So, the study focused only on this population for two reasons: first, mainly LGBT subjects attend the parade and secondly, there were no previous studies to compare both groups in the country. Second, the study also aimed at showing that gay men suffer greater discrimination and victimization than lesbians. A non-probabilistic sample of 343 participants was collected. From this sample, 140 subjects were excluded as they did not identify themselves as gay men or lesbians, thus totaling a sample of 203 participants. There were a total of 110 gay men (54.2%) and 93 lesbians (45.8%), aging from 18 to 53 years (M = 24.62 and SD = 6.62). Concerning results, 72.7% of gay men reported discrimination events perceived, as compared to 79.6% of lesbians. In addition, 81.8% of gay men reported victimization events, while lesbians reported 75.3 %. Significant differences are observed between gay men and lesbians, affecting only the latter in: prohibition to enter or stay in entertainment venues, discrimination by security guards, and discrimination at work. Among victimization events, gays reported more mockery than lesbians. This study has various implications. One of them is the fact that an important place where gay men and particularly lesbians are discriminated is their workplace. Future studies will have to focus on investigating the impact of discrimination due to sexual orientation in a work context. In addition, future studies should further examine whether verbal mockery-type victimization and its impact on the gay men population is a common pattern of victimization toward the country's LGBT population. Likewise, it would be necessary to study whether other relevant dimensions in the country, such as social class and religion, contribute to experiencing this type of victimization. Also, there are therapists in Chile who consider homosexuality as an illness and apply reconversive therapies, thus contributing to stigmatization and violence toward sexual minorities. Therefore, this study may contribute to the training of future therapists and health personnel assisting gay men and lesbians since sexual minorities have reported that they face various barriers that prevent them from having equal access to health services, a fact that could have a great impact on their quality of life. Finally, considering the differences in discrimination and victimization found between gay men and lesbians in Chile: Do gay men experience more discrimination and victimization events than lesbians? Are there two different patterns of discrimination and victimization or, instead, a general one that affects both gay men and lesbians in Chile? Data are not conclusive. They indicate that there are many similarities in the discrimination and victimization events perceived by gay men and lesbians, but they also reveal two different patterns. Therefore, the existence of a differentiated pattern of discrimination and victimization between gay men and lesbians should be confirmed by future studies.

Discursos sobre sexología en Chile: ambivalencias del discurso profesional sobre la sexología en Chile / The ambivalence of professional discourse on sexology in Chile

En este artículo se explora el campo de la sexología en Chile, se analiza cómo lo ven y cómo lo definen los profesionales que se desempeñan en dicho campo. Se hizo un estudio cualitativo basado en entrevistas a 11 profesionales. Entre los principales hallazgos encontramos que los profesionales estudiados no se reconocen en la definición de sexólogo/a. Esta definición es imprecisa como campo disciplinario y no tiene especialización científica. La sexología sin referencia institucional disciplinaria o gremial, carecería de estándares de calidad. La sexología desregulada institucionalmente queda expuesta a déficits de control y fines no legítimos. El/la profesional queda sin designación, ni reconocimiento profesional (no es especialidad o subespecialidad de alguna disciplina), ni tampoco sujeto a control o autoridad científica o gremial especializada. El profesional queda con una definición social construida principalmente a partir de su exposición pública y carente de una autodefinición afirmativa.

This paper explores the professional field of sexology in Chile and also shows how sexologists see and define themselves. A qualitative study was conducted and 11 professionals were interviewed. Main findings indicate that sexology can be defined as a clinical field disciplinarily associated with medicine (urology, gynecology, and to a lesser extent, psychiatry) and psychology (clinical psychology). Sexology appears as private professional practice, though not in public health, and as a professional field, rather than a research area. In addition, there is a two-fold development concerning its conceptual, methodological, and technological approach: sexual medicine and sexual therapy. Finally, interviewees do not recognize themselves as sexologists and there is no evidence of the use of this term in the past.

HIV prevalence, AIDS knowledge, and condom use among female sex workers in Santiago, Chile

This paper describes HIV seroprevalence, knowledge of HIV transmission, and condom use among female sex workers (FSW) attending five specialized sexually transmitted disease (STD) clinics in Santiago, Chile. A short questionnaire with socio-demographic, AIDS knowledge, and condom-use variables was administered to 626 FSW. HIV seroprevalence was estimated with a blood test sent to the Chilean Public Health Institute. ELISA was used to confirm HIV in suspected cases. HIV prevalence was 0 percent. FSW showed adequate overall knowledge of HIV, even better than reported for the Chilean general population on some items. Condom use with clients was high ("always" = 93.4 percent), although regular use with steady partners was low ("always" = 9.9 percent). The zero HIV seroprevalence and consistent condom use with clients confirms the positive impact of intervention strategies for FSW, increasing both correct knowledge of AIDS and condom use with clients and helping decrease these women's HIV/AIDS vulnerability.

Este artículo examina la prevalencia del VIH, los conocimientos respecto a su infección y, además, describe el uso del condón en mujeres que ejercen el comercio sexual en Santiago de Chile y que son atendidas en cinco centros especializados de enfermedades de transmisión sexual. Se aplicó una encuesta que indagaba sobre las características sociodemográficas, el conocimiento sobre el VIH/SIDA y el uso del condón a 626 mujeres. La prevalencia del VIH fue evaluada mediante un examen de ELISA. La prevalencia del VIH fue 0. El conocimiento del VIH fue bueno e, incluso, mejor que en población general, en algunos indicadores. El uso del condón con los clientes fue alto, aunque su uso regular con las parejas estables fue bajo. La prevalencia cero del VIH y el uso consistente de condones con los clientes confirma el impacto positivo que han tenido las estrategias de intervención implementadas para estos grupos, incrementando el conocimiento adecuado sobre el SIDA y el uso del condón con los clientes, contribuyendo a la disminución de la vulnerabilidad de estas mujeres hacia el.