"Mi viaje": Procesos de revelación y aceptación de la orientación sexual en las familias / "My journey": Processes of disclosure and acceptance of the sexual orientation in families

Resumen Según el informe realizado por la Asociación Internacional de Lesbianas, Gays, Bisexuales, Trans e Intersex (ILGA) en el año 2017, menos del 25 % de los territorios del planeta reconocen a la población Lesbianas, Gays, Bisexuales, Transexuales e Intersexuales (LGBTI+) y, de igual forma, aún hay numerosos países, en su mayoría del continente africano, que penalizan, discriminan y rechazan la homosexualidad. Además, diferentes estudios han evidenciado que para muchas familias es difícil separarse de la tradición heteronormativa y aceptar la orientación sexual de un hijo gay o una hija lesbiana o bisexual. Esta investigación buscó comprender el proceso de revelación y aceptación de la orientación sexual en 15 familias con integrantes gays, lesbianas y bisexuales en Cali-Colombia, a través de una entrevista semiestructurada y una línea de tiempo denominada Mi viaje en la que los participantes plasmaban sus narrativas en dibujos. En el presente estudio participaron 15 familias, las cuales estuvieron conformadas tanto por hijos/as entre los 19 y 26 años como por padres/cuidadores entre 41 y 64 años. A partir del análisis temático de las entrevistas realizadas de manera individual, se evidencia que los procesos de revelación de la orientación sexual se generan durante la adolescencia temprana, media y tardía, y la madre fue aquella integrante de la familia a quien le revelaron en un primer momento. Además, se presentan las formas a través de las cuales se dio la revelación, que fueron directas o indirectas y en algunos casos derivaron en secretos familiares. Se concluye que los procesos que atraviesan las familias frente a la revelación y aceptación de la orientación sexual de un hijo gay o una hija lesbiana o bisexual cuentan con fases dinámicas que pueden presentarse en distintos momentos y de diferentes formas, según las características particulares de cada familia y su contexto.

Abstract According to the report carried out by the International Lesbian, Gay, Bisexual, Trans and Intersex Association (ILGA) in 2017, less than 25 % of the territories of the planet recognize Lesbian, Gay, Bisexual, Transgender and Intersex (the LGBTI + population) and, in the same way, there are still numerous countries, mostly from the African continent, who penalize, discriminate and reject homosexuality. In Colombia, between the years 2016, 2017 and until February 2018, 139 homicides of LGBTI+ people were reported. Additionally, in several of its cities, among which are Barranquilla, Medellín, Bogotá and Cali, there has been violence by the National Police against LGBTI+ people because of their sexual orientation and gender identity. In this regard, 21 cases have been reported between 2008 and 2017, of which two were against gay men and three against lesbian women. In addition, in Valle del Cauca, 195 homicides were reported up to the year 2017 which were related to the sexual orientation and gender identity of the victims, specifically located in the city of Santiago de Cali, in which nine murders were reported, four of which were gay men, two lesbian women and three trans women (Colombia Diversa, 2018). Furthermore, different studies have shown that it is difficult for many families to separate from the heteronormative tradition and accept the sexual orientation of a gay son or a lesbian or bisexual daughter. This research sought to characterize the process of disclosure and acceptance of sexual orientation in 15 families with gay sons and lesbian and bisexual daughters in Cali-Colombia, using a semi-structured interview and a timeline called My Journey in which the participants reflected their narratives in drawings. The research was qualitative, with a narrative design by topics (Hernández, Fernández & Baptista, 2014). The results are articulated to the macro project called "Family dynamics in the process of disclosure and acceptance of the sexual orientation of gay sons and lesbian daughters in the city of Cali-Colombia" In the present study, 15 families participated, which were made up of both children and parents / caregivers. From the thematic analysis of the interviews carried out individually, the descriptions made by the families of the moment in which the sons and daughters revealed their sexual orientation are mentioned. This moment corresponds to early, middle and late adolescence, and the mother was the one to whom the sexual orientation was revealed at first. In addition, the forms through which the revelation was given are presented, which were direct or indirect and, in some cases, led to family secrets. It is concluded that the processes that families go through in the face of the disclosure and acceptance of the sexual orientation of a gay son or a lesbian or bisexual daughter have dynamic phases that can occur at different times and in different ways depending on the particular characteristics of each family and its context. It is recommended to promote associations of families and friends united in favor of gender diversity, in such a way that they are configured as elements for decision-making in public policies and actions, which generate care routes for other families that require guidance in any of the stages they are going through and that can provide social support to gay sons, lesbian daughters and their families. From the field of health professionals who accompany families in affirmative processes, it is necessary to strengthen training with a gender perspective and in future studies address the experiences of families with transgender members, taking into account their specific needs and from an intersectional perspective.

Scale of Sexual Prejudice Against Bisexuals: evidence of validity / Escala de Preconceito Sexual Contra Bissexuais: evidências de validade / Escala de Prejuicio Sexual Contra Bisexuales: evidencia de validez

Sexual prejudice against bisexuals is widespread in society. However, little research has been done on this phenomenon because it is difficult to measure. The aim of the current study was to validate a short version of the Biphobia Scale for the Brazilian context (EPSB-br). In the first study, the EPSB-br showed unifactorial structure and convergent validity with scales measuring beliefs and stereotypes about bisexuality. Study 2 showed the EPSB-br's convergent-discriminant validity with scales measuring religiosity, right-wing authoritarianism, social dominance orientation, and sleepiness. Finally, Study 3 demonstrated the criterion-related validity of the EPSB-br through an experimental manipulation in which participants watched a video of a pretend teacher and assigned a salary to it. Taken together, these results showed evidence of validity and reliability of the EPSB-br, which introduced a measure of prejudice against bisexual people in Brazil. (AU)

O preconceito sexual contra bissexuais é fortemente presente na sociedade. Entretanto, este fenômeno ainda é pouco estudado, dada a dificuldade em sua mensuração. O presente trabalho teve o objetivo de validar uma versão reduzida da Biphobia Scale para o contexto brasileiro. No primeiro estudo, a Escala de Preconceito Sexual contra Bissexuais (EPSB-br) apresentou uma estrutura unifatorial e uma validade convergente com escalas que mensuram crenças e estereótipos sobre a bissexualidade. O Estudo 2 evidenciou a validade concorrente-discriminante da EPSB-br com a religiosidade, escalas de autoritarismo de direita, orientação à dominância social e sonolência. Por fim, o Estudo 3 demonstrou a validade de critério da EPSB-br a partir de uma manipulação experimental, na qual os participantes assistiram a um vídeo sobre um professor e atribuíram-lhe um salário. A síntese dos resultados mostrou evidências de validade e confiabilidade da EPSB-br, introduzindo uma medida de preconceito contra pessoas bissexuais no Brasil. (AU)

Lo Prejuicio Sexual contra Bisexuales está muy presente en la sociedad. Sin embargo, es un fenómeno poco estudiado, dada la dificultad de medirlo. Este trabajo buscó validar una versión reducida de la Biphobia Scale para el contexto brasileño. En el primer estudio, la EPSB-br presentó una estructura unifactorial y validez convergente con escalas que miden creencias y estereotipos sobre la bisexualidad. El estudio 2 evidenció la validez concurrente-discriminante de la EPSB-br con escalas de religiosidad, autoritarismo de derecha, orientación al dominio social y somnolencia. Finalmente, el Estudio 3 demostró la validez de criterio de la EPSB-br a través de una manipulación experimental, donde los participantes vieron un video sobre un maestro y le asignaron un salario. La síntesis de los resultados mostró evidencia de validez y confiabilidad de la EPSB-br, introduciendo una medida de prejuicio contra las personas bisexuales en Brasil. (AU)

Situaciones estresantes y estrategias de afrontamiento en comunidad LGB / Stressful situations and coping strategies in the LGB community / Situações stressantes e Estratégias de Cópia na Comunidade LGB

Resumen Introducción: El estrés en la comunidad LGB está asociada a su orientación sexual, violencia o discriminación, eventos estresantes los cuales son distintos a los reportados por personas heterosexuales. La literatura reporta relación del nivel de estrés con problemáticas de salud mental, de mayor intensidad y frecuencia en la población LGB. Objetivo: El propósito fue identificar las situaciones estresantes, estrategias de afrontamiento y emociones asociadas en la comunidad LGB. Método: Se realizó un estudio descriptivo con un diseño no experimental de tipo transversal, mediante un muestreo no probabilístico; participaron 272 hombres y mujeres de 14 a 56 años. Se empleó el Cuestionario de Emociones, Estrés y Afrontamiento de Vega et al. (2012). Resultados: Los participantes homosexuales, bisexuales y lesbianas coinciden en reportar en primer lugar situaciones de comunicar su orientación sexual, las situaciones restantes son escolares, laborales y de discriminación por pertenecer a la comunidad LGB. Los participantes usan estrategias de afrontamiento centradas en la acción y en la emoción en proporciones similares (48 %50 %). Las emociones asociadas a situaciones estresantes son ansiedad, temor, vergüenza, culpa. En situaciones placenteras reportan también emociones negativas. Conclusiones: El tipo de situaciones estresantes son distintas en estas poblaciones, debido a que enfrentan con mayor frecuencia eventos relacionados con discriminación o confrontación por su orientación sexual. Se aporta información sobre qué y cómo se afrontan las situaciones que generan estrés en población LGB. Se sugiere generar intervenciones cognitivoconductuales de regulación emocional y afrontamiento efectivo.

Abstract Introduction: Stress in the LGB community is associated with their sexual orientation, violence or discrimination, stressful events which are different from those reported by heterosexual people. The literature reports a relationship between the level of stress and mental health problems, of greater intensity and frequency in the LGB population. Objective: The purpose was to identify stressful situations, coping strategies and associated emotions in the LGB community. Method: A descriptive study was carried out with a non-experimental cross-sectional design, through non-probabilistic sampling, with the participation of 272 men and women aged 14 to 56 years. The Questionnaire of Emotions, Stress and Coping of Vega et al. (2012). Results: Homosexual, bisexual and lesbian participants agree in first reporting situations of communicating their sexual orientation, the remaining situations are school, work and discrimination for belonging to the LGB community. Participants use action-focused and emotion-focused coping strategies in similar proportions (48 % 50 %). Emotions associated with stressful situations are anxiety, fear, shame, guilt. In pleasant situations they also report negative emotions. Conclusions: The type of stressful situations are different in these populations because they more frequently face events related to discrimination or confrontation due to their sexual orientation. Information is provided on what and how situations that generate stress in the LGB population are coped with. It is suggested to generate cognitive behavioral interventions for emotional regulation and effective coping.

Resumo Introdução: O estresse na comunidade LGB está associado à sua orientação sexual, violência ou discriminação, eventos estressantes diferentes dos relatados por pessoas heterossexuais. A literatura relata uma relação entre o nível de estresse e problemas de saúde mental, de maior intensidade e frequência na população LGB. Objetivo: O objetivo foi identificar situações estressantes, estratégias de enfrentamento e emoções associadas na comunidade LGB. Método: Foi realizado um estudo descritivo com delineamento transversal não experimental, utilizando amostragem não probabilística, com a participação de 272 homens e mulheres com idades entre 14 e 56 anos. O Questionário de Emoções, Estresse e Enfrentamento de Vega et al. (2012). Resultados: Os participantes homossexuais, bissexuais e lésbicas concordam no primeiro relato de situações de comunicação de sua orientação sexual, as demais situações são escola, trabalho e discriminação por pertencer à comunidade LGB. Os participantes usam estratégias de enfrentamento focadas na ação e na emoção em proporções semelhantes (48 % 50 %). As emoções associadas a situações estressantes são ansiedade, medo, vergonha, culpa. Em situações agradáveis também relatam emoções negativas. Conclusões: Os tipos de situações estressantes são diferentes nestas populações, pois enfrentam mais frequentemente eventos relacionados à discriminação ou confronto devido à sua orientação sexual. São fornecidas informações sobre o que e como as situações geradoras de estresse na população LGB são enfrentadas. Sugere-se gerar intervenções cognitivo-comportamentais para regulação emocional e enfrentamento eficaz.

Socio-cultural factors influencing the buying commercial homosexual sex behaviors among young homosexual/bisexual men / 中华疾病控制杂志

Objective To investigate the buying commercial homosexual sex behaviors among young gay men/bisexual men, and analyze the socio-cultural factors influencing the buying commercial homosexual sex behaviors. Methods A cross-sectional study was performed on risk sexual behaviors for acquired immunodeficiency syndrome (AIDS) with an anonymous questionnaire among 824 young homosexual/bisexual men in Guiyang City, Zunyi City, Anshun City and Tongren City of Guizhou Province in 2016. Respondents were selected by a classified snowball sampling method combined with an interview at AIDS voluntary consultation and testing clinics. Results About 7.8%(95% CI：5.9%-9.6%)of respondents reported the buying commercial homosexual sex behaviors in the last year. The report rate was 13.0% for homosexual men, higher than 5.7% for bisexual men (P＜0.001). The influencing factors of the buying commercial homosexual sex behaviors were average monthly income (OR=6.54, P=0.005), age (OR=3.59, P=0.011), age of liking the same-sex (OR=2.85, P=0.004), marital status (OR=2.62, P=0.005), household registration (OR=2.38, P=0.011), increased risk of oral sex (OR=0.42, P=0.019), possibility of HIV infection (P＜0.005), and the dusckisure of sexual orientation (OR=0.17, P=0.001). Conclusions Young homosexual/bisexual men, especially bisexual men, had a higher report rate of the buying commercial homosexual sex behaviors. The socio-cultural factors influencing the buying commercial homosexual sex behaviors included age of liking the same-sex, increased risk of oral sex, possibility of HIV infection, and the disclosure of sexual orientation.

Revisión del impacto del estigma en la salud mental de jóvenes lesbianas, homosexuales, bisexuales y transgénero / Review of the impact of stigma on the mental health of lesbian, gay, bisexual and transgender youth

OBJETIVOS: Revisar la literatura existente respecto del impacto que genera el estigma en la salud mental de los jóvenes lesbianas, gays, bisexuales y transgénero (LGBT). MÉTODOS: Búsqueda bibliográfica en la base de datos Pubmed de los artículos atingentes al tema de los últimos 5 años en población juvenil, complementado con artículos de importancia histórica y algunos pertenecientes a las referencias de los resultados de la búsqueda. RESULTADOS: La evidencia demuestra que los jóvenes LGBT expuestos a estigma tienen una mayor prevalencia de trastornos depresivos, ansiosos, trastornos por uso de sustancias y suicidalidad que la población general. Este fenómeno no corresponde a una característica intrínseca de esta población, sino más bien, responde a factores tanto individuales como interpersonales que se dan en un contexto sociocultural predominante en donde las minorías son estigmatizadas. CONCLUSIONES: Los equipos sanitarios deben orientar sus esfuerzos a la promoción, prevención y pesquisa de patologías de salud mental en los jóvenes LGBT y deben constituirse como agentes activos en la lucha contra la desestigmatización en sus comunidades.

OBJECTIVES: To review the existing literature regarding the impact of stigma on the mental health of sexual minorities such as lesbian, gay, bisexual and transgender (LGBT) youth. METHODS: Bibliographic search in the Pubmed database of the articles relevant to the topic of the last 5 years in the youth population, supplemented with articles of historical importance and some belonging to the references of the search results. RESULTS: Evidence shows that LGBT youth exposed to stigma have a higher prevalence of depression, anxiety, substance use disorders and suicidality than the general population. This phenomenon does not correspond to an intrinsic characteristic of this population, but rather, responds to both individual and interpersonal factors that occur in a predominant sociocultural context where minorities are stigmatized. CONCLUSIONS: The health teams should direct their efforts to the promotion, prevention and detection of mental health pathologies in LGBT youth and should become active agents in the fight against destigmatization in their communities.

Is mental health related to expressions of homonegative stigma and community connectedness in Mexican lesbian and bisexual women? / ¿La salud mental se relaciona con expresiones de estigma homofóbico y conexión comunitaria? Mujeres mexicanas lesbianas y bisexuales

Abstract Despite the need to understand lesbian and bisexual women's vulnerability to mental health affections in connection with expressions of stigma, LGBT studies in Mexico often do not take them into consideration. Current data show that among lesbians and bisexual women, variables such as internalized homonegativity and community connectedness correlate with mental health indicators. The specific relationship between mental health outcomes, community connectedness, and stigma in the forms of internalized homonegativity, discrimination, and violence has not been explored for Mexican lesbian and bisexual women. This paper attempts to identify if this relationship exists through the participation of 150 lesbian and bisexual women who were asked to answer a survey at the annual Sexual Diversity and Pride March in Mexico City 2015. The same survey was available online; both explored internalized homonegativity, community connectedness, discrimination, violence, depression, and alcohol use and abuse. Results show that internalized homonegativity and community connectedness are the strongest predictors of mental health. These results are indicative of how lesbian and bisexual women suffer from the cognitive and emotional consequences of homonegativity in connection to mental health rather than direct discrimination and violence. Lastly, it is recommended that more research be undertaken on this relationship to find interventions that focus on the eradication of discrimination and violence against non-heterosexual women.

Resumen A pesar de la importancia de conceptualizar sobre la vulnerabilidad a la que se enfrentan las mujeres bisexuales y lesbianas en México en conexión con indicadores de salud mental, ellas no han sido incluidas en la investigación sobre salud mental en estudios LGBT. La información disponible señala que variables como homonegatividad internalizada y conexión comunitaria correlacionan con indicadores de salud mental de mujeres lesbianas y bisexuales. Las relaciones entre salud mental, conexión comunitaria y expresiones de estigma por homofobia como discriminación, violencia y homonegatividad internalizada no han sido exploradas en este grupo de mujeres en México. Este documento tiene como propósito explorar esa relación, a través de la participación de 150 mujeres bisexuales y lesbianas reclutadas en la Marcha del Orgullo y Diversidad Sexual de la Ciudad de México 2015 y de manera virtual para contestar un cuestionario que exploraba homonegatividad internalizada, conexión comunitaria, discriminación, violencia, depresión y uso y abuso de alcohol. Los resultados muestran que la homonegatividad internalizada y la conexión comunitaria son los predictores más importantes de la depresión y uso y abuso de alcohol y que la discriminación y violencia no se relacionan con la salud mental. Estos resultados indican que las mujeres lesbianas y bisexuales sufren de las consecuencias cognitivas y emocionales de la homonegatividad y por tal, se requiere de más investigación para explorar el contenido de estas relaciones, así como intervenciones enfocadas a la erradicación de la homonegatividad.

Development of Bisexual Identity / Desenvolvimento da identidade bisexual

Abstract Bisexuality is the sexual, romantic, emotional and physical attraction that a person experiments for both of the biological sexes (men and women). Since the Venezuelan society is built under a heteronormative paradigm sometimes is considered that those sexualities, that drift apart from the social reality, are not comprehended thus generating a reject. Therefore, we conducted a study that was titled "Construction of Bisexual Identity in Venezuelan Adults: 'It is Not a transition, I Just Simply Am Like That'" that had as a general objective the understanding of the bisexual identity in Venezuelan adults. This article contemplates one dimension of this major project degree. In-depths interviews were carried out to willing participants and the obtained data were analyzed with the constant comparative method following an emerging design. Among the results four major categories were described, however, in this article we will be only focusing on the development of the bisexual identity.

Resumo Bissexualidade é a atração sexual, romântica, emocional e física que uma pessoa experimenta para ambos os sexos biológicos (homens e mulheres). Uma vez que a sociedade venezuelana é construída sob um paradigma heteronormativo, às vezes, considera-se que aquelas sexualidades, que se afastam da realidade social, não são compreendidas, gerando assim um rejeito. Por isso, realizamos um estudo intitulado "Construção da identidade bissexual em adultos venezuelanos: 'Não é uma transição, simplesmente sou assim"' que teve como objetivo geral a compreensão da identidade bissexual em adultos venezuelanos. Este artigo contempla uma dimensão deste grande grau de projeto. Entrevistas em profundidade foram realizadas para os participantes dispostos e os dados obtidos foram analisados com o método comparativo constante seguindo um design emergente. Entre os resultados, quatro grandes categorias foram descritas, no entanto, neste artigo iremos focar apenas no desenvolvimento da identidade bissexual.

Indicadores de bem-estar subjetivo e saúde mental em mulheres de diferentes orientações sexuais / Subjective well being and mental health of women of diverse sexual orientations / Bienestar subjetivo y salud mental de mujeres de diferentes orientaciones sexuales

Mulheres lésbicas e bissexuais apresentam altos índices de psicopatologias, como depressão e ansiedade. Este estudo buscou comparar os índices de felicidade subjetiva, satisfação com a vida, depressão, ansiedade e estresse em mulheres lésbicas, bissexuais e heterossexuais. Participaram desse estudo 736 mulheres (heterossexuais = 414; lésbicas = 143; bissexuais = 194), maiores de 18 anos (M = 27,37; DP = 13,44). As participantes responderam a um questionário online composto por questionário sociodemográfico e escalas para avaliação das variáveis psicológicas citadas. Lésbicas e bissexuais apresentaram menores níveis de bem-estar e maiores de psicopatologias do que as heterossexuais. Bissexuais apresentaram menores índices de bem-estar e maiores de psicopatologias comparadas a lésbicas e a heterossexuais. Acredita-se que esses indicadores podem ser explicados pela condição de vulnerabilidade psicossocial a qual as mulheres não heterossexuais se encontram. Pesquisas mais amplas devem ser conduzidas para a obtenção maior compreensão das variáveis preditoras dos desfechos de saúde mental nesse grupo.

Lesbian and bisexual women present high rates of psychopathologies, such as depression and anxiety. This study aimed to compare the subjective happiness, life satisfaction, depression, anxiety, and stress levels in lesbian, bisexual and heterosexual women. Participated in this study 736 women (heterosexuals = 414, lesbian = 143, bisexuals = 194), older than 18 years (M = 27.37, SD = 13.44). Participants answered an online questionnaire composed of a sociodemographic questionnaire and scales for the evaluation of the mentioned psychological variables. Lesbians and bisexuals had lower levels of well-being and greater psychopathologies than heterosexuals. Bisexuals had lower rates of well-being and higher rates of psychopathology when compared to lesbians and heterosexuals. It is believed that these indicators can be explained by the condition of psychosocial vulnerability to which non-heterosexual women meet. Larger research should be conducted to gain a better understanding of the predictors of mental health outcomes in this group.

Mujeres lesbianas y bisexuales presentan altos índices de psicopatologías. Este estudio comparó los índices de felicidad subjetiva, satisfacción con la vida, depresión, ansiedad y estrés en mujeres lesbianas, bisexuales y heterosexuales. Las participantes fueran 736 mujeres (heterosexuales = 414, lesbianas = 143, bisexuales = 194), mayores de 18 años (M = 27,37, DP = 13,44). Fue respondido un cuestionario online compuesto por cuestionario sociodemográfico y escalas para la evaluación de las variables psicológicas citadas. Lesbianas y bisexuales presentaron menores niveles de bienestar y mayores de psicopatologías que heterosexuales. Bisexuales presentaron menores índices de bienestar y mayores de psicopatologías cuando comparadas a lesbianas y heterosexuales. Se cree que estos indicadores pueden ser explicados por la condición de vulnerabilidad psicosocial a la que se encuentran las mujeres no heterosexuales. Investigaciones más amplias deben ser conducidas para obtener mayor comprensión de las variables predictoras de los resultados de salud mental en ese grupo.

Discursos de profesionales de la salud sobre la salud sexual de mujeres lesbianas y bisexuales / Health professional discourse on the sexual health of lesbian and bisexual women / Discursos de profissionais de saúde sobre a saúde sexual de mulheres lésbicas e bissexuais

Mundialmente se han reconocido diversas problemáticas que afectan la salud sexual de las mujeres lesbianas y bisexuales, pero poco se conoce sobre la realidad en Colombia. Factores como la homofobia y el heterosexismo en la atención en salud retrasan el diagnóstico y el tratamiento, e impiden el acceso a este servicio. Por tanto, es importante comprender las perspectivas de los proveedores. Este estudio cualitativo explora los discursos y las prácticas de seis profesionales de la salud en Cali, Colombia sobre la salud sexual de esta población. Los participantes, provenientes de diferentes áreas de la salud, tenían entre 15 y 30 años de experiencia en su campo. Los resultados señalan brechas en el conocimiento y en la praxis en la atención en salud, que deben ser fortalecidas para proveer una atención de calidad y que reconozca las necesidades de las poblaciones diversas.(AU)

Although factors affecting the sexual health of lesbian and bisexual women are widely recognized, little is known about the reality in Colombia. Attitudes such as homophobia and heterosexism in healthcare services delay diagnosis and treatment and hinder access to services. It is therefore important to understand the perspectives of the people who provide these services. This qualitative study explores the discourse and practices of health professionals working in different areas of healthcare in Cali, Colombia, in relation to this group. Six professionals with between 15 and 30 years of experience in their field took part in the study. The findings reveal gaps in knowledge and in the praxis of healthcare, which must be strengthened to provide the quality of healthcare and the recognition of the needs of diverse populations.(AU)

Embora o mundo todo reconheça várias questões que afetam a saúde sexual de mulheres lésbicas e bissexuais, pouco se sabe sobre a realidade na Colômbia. Fatores como a homofobia e heterossexismo na atenção à saúde retardam o diagnóstico e tratamento e impedem o acesso aos serviços, por isso é importante compreender as perspectivas dos provedores. Este estudo qualitativo explora os discursos e as práticas de seis profissionais de saúde em Cali, Colômbia sobre a saúde sexual dessa população. São profissionais de diferentes áreas da saúde, com idades entre 15 e 30 anos de experiência no seu campo. Os resultados apontam lacunas no conhecimento e na práxis da atenção à saúde, que deve ser fortalecida para prover uma atenção de qualidade e o reconhecimento das necessidades das diversas populações.(AU)

"La solución es la tijera": Programa de Salud Sexual para Mujeres Lesbianas y Bisexuales / "La solución es la tijera": Programa de Saúde Sexual Orientado a Mulheres Lésbicas e Bissexuais / "La Solución es la Tijera" (The Solution is Scissors): Sexual Health Programme Oriented to Lesbian and Bisexual Women

RESUMEN La inclusión de las mujeres lesbianas y bisexuales en las agendas de promoción de la salud sexual es escasa. Sin embargo, los riesgos en sus prácticas sexuales han sido reconocidos científicamente. Este artículo presenta los resultados principales del programa de intervención "La solución es la tijera" dirigido a mujeres lesbianas y bisexuales jóvenes de Cali, Colombia. Participaron 23 mujeres entre los 18 y los 25 años de edad (X= 21.7; DS=1.78). La evaluación se realizó de manera pre- post a través de una metodología mixta. Se encontró un cambio significativo en los niveles de conocimientos y las actitudes frente al VIH. Asimismo, se reportó el fortalecimiento de la identidad, el empoderamiento en su sexualidad y los conocimientos sobre derechos sexuales y reproductivos.

RESUMO A inclusão das mulheres lésbicas e bissexuais na agenda de promoção de saúde é escassa. No entanto, os riscos existentes em suas práticas sexuais foram cientificamente reconhecidos. Este artigo pretende apresentar os principais resultados do programa "La Solución es la Tijera" orientado para mulheres lésbicas e bissexuais de Cali, na Colômbia. Vinte e três mulheres entre 18 e 25 anos de idade (X = 21,7; DS = 1,78) participaram deste estudo. A avaliação do programa foi realizada com um design de pre-post, usando metodologias mistas. Foram encontradas alterações significativas nos níveis de conhecimento e atitudes em relação a HIV. Da mesma forma, relatou-se reforço em sua identidade e empoderamento em sua sexualidade e conhecimento sobre direitos sexuais e reprodutivos.

ABSTRACT The inclusion of lesbian and bisexual women on health promotion agenda is scarce. However, the existing risks in their sexual practices have been scientifically recognized. This article presents the main results of the program "La Solución es la Tijera" oriented to lesbian and bisexual women from Cali, Colombia. Twenty-three women between 18 and 25 years old ((X= 21.7; DS=1.78) participated in this study. The program evaluation was conducted with a pre-post design, using mixed methodologies. Significant changes in the knowledge level and attitudes towards HIV were found. Likewise, a strengthening in their identity and an empowerment in their sexuality and knowledge about sexual and reproductive rights was reported by the participants.

Modelos parentales y su relación con la violencia en las parejas del mismo sexo / Parental models and their relation to violence among same-sex couples / Modelos parentais e sua relação com a violência em casais do mesmo sexo

Este artículo forma parte de una investigación más amplia cuyo objetivo fue describir los elementos relacionados con la violencia en parejas gays y lésbicas. Abordamos los resultados sobre la relación de los modelos parentales con la violencia ejercida al interior de estas y otras relaciones interpersonales. Seguimos un método descriptivo cualitativo y utilizamos grupos focales para recopilar la información, en donde participaron ocho hombres gays, seis mujeres lesbianas y una mujer bisexual, reclutados por disponibilidad. Encontramos que presenciar violencia entre los padres o ser expuestos a experiencias tempranas de maltrato destacan como principios favorecedores de futuras dinámicas violentas de pareja; y que el rechazo parental tras "salir del closet", junto con la dificultad para distinguir la violencia fuera del contexto heterosexual familiar, son obstáculos para detectar y afrontar la violencia.

This article is part of a wider study that has the objective of describing the elements related to violence among gay and lesbian couples. The authors analyze the results of looking at the relation between the parental model and violence inflicted within these and other interpersonal relationships. We used a qualitative descriptive method and focal groups to collect information with participation from 8 gay men, 6 lesbian women and 1 bisexual woman, who were selected based on their availability. The authors concluded that witnessing violence between parents or being exposed to early violent experiences were significant factors in encouraging violent dynamics within. In addition, parental rejection after "coming out of the closet" along with the difficulty with identifying violence outside of the generally accepted heterosexual family context were obstacles for identifying different types of violence.

Este artigo é parte de uma pesquisa mais ampla cujo objetivo foi descrever os elementos relacionados com a violência em casais homoafetivos. Abordamos os resultados da influência dos modelos parentais sobre a violência nestes relacionamentos e outras relações interpessoais. Seguimos um método descritivo qualitativo e utilizamos grupos focais como técnica de coleta de informaçõe. Participaram 8 homens gays, 6 mulheres lésbicas e 1 mulher bissexual. Descobrimos que testemunhar a violência entre os pais ou ser expostos a experiências precoces de abuso posicionaram-se como elementos que provocaram dinã¢micas violentas entre eles; e que a rejeição dos pais depois de " sair do armário", juntamente com a dificuldade que eles experimentaram para distinguir a violência fora do contexto heterossexual familiar foram os obstáculos para detectar a violência.

PROPIEDADES PSICOMÉTRICAS DE UNA PRUEBA DE HOMONEGATIVIDAD / Psychometric properties of an internalized homonegativity test in colombian homosexual and bisexual men

El objetivo de este estudio fue analizar las propiedades psicométricas de la Prueba de Homo-fobia Internalizada (PHI), adaptada para autoinforme por Herek y Glunt en 1995. Un diseño instrumental de tipo psicométrico fue implementado. El muestreo fue no probabilístico tipo Bola de Nieve. 328 varones autoidentificados como homosexuales y bisexuales residentes en tres ciudades colombianas, con edades entre 14 y 67 años, contestaron la PHI. Se presenta evidencia de validez de contenido, nomológica y constructo. Se analiza la confiabilidad total y por subpruebas calculada mediante alfa de Cronbach a partir de los factores que arrojó el Análisis Factorial Exploratorio. Entre jueces expertos hubo concordancia significativa sobre coherencia, suficiencia, claridad y grado de aceptación pero no sobre relevancia de los ítems; PHI posee buena validez nomológica, al correlacionarse significativamente con otros cons-tructos como roles de género (r=.36; p=.001), preocupación por la imagen corporal (r=.35; p=.002) y estrés minoritario (r=.25; p=.033). Análisis factorial exploratorio arrojó dos factores que explican el 54 % de la varianza. La PHI tiene confiabilidad aceptable (a total = .71; al = .84; a2 = .60). Se concluye que esta prueba posee características psicométricas adecuadas.

The aim of this study was to analyze the psychometric properties of the test Internalized Homophobia IHP, accessible and Herek auto Glunt report in 1995. A design of psychometric instruments was implemented. The sampling was non probabilistic type Snowball. 328 self-identified as homosexual men and bisexuals in three Colombian cities residents, aged 14 and 67, they answered the PHI. Evidence of content validity, and construct nomological is presented. Total reliability is analyzed and sub test was calculated by Cronbach's Alpha from the factors that threw the Exploratory Factor Analysis. Among expert judges there was significant agreement on consistency, adequacy, clarity and acceptability but not relevance of items; PHI has good nomological validity when correlated significantly with other cons-tructs such as gender roles (r = .36, p = .001), concern about body image (r = .35, p = .002) and minority stress (r = .25; p = .033). Exploratory factor analysis yielded two factors that explain 54% of variance. PHI has acceptable reliability (a total= .71; al = .84; a2 = .60). We conclude that this test has adequate psychometric characteristics.

Differences in Perceived Health Status Outcomes among Heterosexual, Homosexual (Gay or Lesbian) and Bisexual Korean adolescents / Diferencias en el estatus de salud percibido entre adolescentes coreanos heterosexuales, homosexuales (gays o lesbianas) y bisexuales

The purpose of this study was to examine differences in perceived health status outcomes among heterosexual, homosexual (gay or lesbian), and bisexual Korean adolescents. Originally, in 2012, over 70,000 adolescents aged 12-18 years participated in the Eighth Korea Youth Risk Behavior Web-based Survey (KYRBWS -VIII). However, only 11,829 adolescents provided information on their sexual experiences and behaviors, such as kissing, fondling, and sexual orientations, i.e., homosexual (gay or lesbian), bisexual, or heterosexual. Therefore, data from only 11,829 adolescents surveyed were analyzed using a one -way analysis of variance, with a Scheffe post-hoc test, to determine the differences in perceived health status outcomes among Korean adolescents of the different sexual orientation groups. Boys across all 3 groups showed significant differences in general health status (p = 0.004), happiness (p = 0.045), and getting sufficient sleep (p = 0.004). Further, Scheffe post-hoc comparisons of group mean scores revealed that homosexual (gay) boys had poorer overall health (p = 0.004) and bisexual boys had less sufficient sleep (p = 0.017); however, there were no significant differences in happiness between homosexual (gay) (p = 0.651) and bisexual boys (p = 0.064) as compared to heterosexual boys. Moreover, there were no significant differences in general body shape (p = 0.320) and oral health (p = 0.549) among the 3 groups we studied. Girls differed significantly in general body shape (p = 0.026) across all 3 groups in the results of the one-way ANOVA we performed. However, according to Scheffe post-hoc analyses, no significant differences existed in general body shape among girls in both the homosexual (lesbian) and bisexual groups (p = 0.112 and 0.204, respectively). Additionally, there were no significant differences in general health status (p = 0.113), happiness (p = 0.602), oral health (p = 0.290), and getting sufficient sleep (p = 0.481) among adolescent girls in all 3 groups. From these results, we concluded that, in general, homosexual (gay or lesbian) and bisexual Korean teens do not differ significantly from heterosexual Korean teens in perceived health status outcomes.

El propósito de este estudio fue examinar las diferencias en los resultados del estado de salud percibido entre adolescentes coreanos heterosexuales, homosexuales (gays o lesbianas) y bisexuales. Originalmente, en 2012, más de 70.000 adolescentes de 12 a 18 años participaron en la Octava Encuesta Coreana para la Juventud sobre comportamientos riesgosos (KYRBWS-VIII). Sin embargo, sólo 11.829 adolescentes proporcionaron información sobre sus experiencias sexuales y comportamientos, como los besos, las caricias, y orientaciones sexuales, es decir, homosexual (gay o lesbiana), bisexual o heterosexual. Por lo tanto, los datos de sólo 11.829 adolescentes encuestados fueron analizados mediante un análisis de varianza, con una prueba post-hoc de Scheffe, para determinar las diferencias en los resultados del estado de salud percibido entre los adolescentes coreanos de los diferentes grupos de orientación sexual. Jóvenes en todos los 3 grupos mostraron diferencias significativas en el estado de salud general (p = 0,004), la felicidad (p = 0,045), y dormir lo suficiente (p = 0,004). Además, las comparaciones de grupo post-hoc de Scheffe muestran las puntuaciones significativas que revelan que los homosexuales (gay) chicos tenían peor salud general (p = 0,004) y los chicos bisexuales presentaban una deficiencia en el sueño (p = 0,017); sin embargo, no hubo diferencias significativas en la felicidad entre homosexual (Gay) (p = 0,651) y chicos bisexuales (p = 0,064) en comparación con los niños heterosexuales. Por otra parte, no hubo diferencias significativas en la forma general del cuerpo (p = 0,320) y la salud oral (p = 0,549) entre los 3 grupos estudiados. Las niñas difieren significativamente en la forma del cuerpo general (p = 0,026) en todos los 3 grupos en los resultados de la ANOVA de una vía. Sin embargo, de acuerdo con el análisis post-hoc de Scheffe, no existen diferencias significativas en forma general del cuerpo de las niñas, tanto en el homosexual (lesbiana) y bisexuales (p = 0,112 y 0,204, respectivamente). Además, no hubo diferencias significativas en el estado de salud general (p = 0,113), la felicidad (p = 0,602), la salud oral (p = 0,290), y dormir lo suficiente (p = 0,481) entre las adolescentes en los 3 grupos. A partir de estos resultados, se concluye que, en general, los adolescentes homosexuales (gays o lesbianas) y bisexuales de Corea no difieren significativamente de los adolescentes coreanos heterosexuales en los resultados del estado de salud percibido.

Exploring Medical Personnel's Discourses on the Sexual Health of Lesbian and Bisexual Women in Greater Lisbon, Portugal / Exploración del Discurso del Personal Médico Sobre la Salud Sexual de Mujeres Lesbianas y Bisexuales en Gran Lisboa, Portugal / Explorando os Discursos da Equipe Médica Sobre a Saúde Sexual de Mulheres Lésbicas e Bissexuais na Grande Lisboa, Portugal

This qualitative exploratory study analysed the discourses of medical personnel on lesbian and bisexual women's sexual health. We aimed at identifying the best practices to eradicate heteronormativity in this sector and enhance health care provision for this population. We interviewed 16 physicians in the metropolitan area of Lisbon using semi-structured interviews. The thematic analysis identified a lack of professional knowledge in dealing with non-heterosexual patients, despite the consensual discourse on the necessity of non-discriminatory practices.

Este estudio cualitativo exploratorio analizó los discursos del personal médico sobre la salud sexual de mujeres lesbianas y bisexuales, con el fin de identificar las mejores prácticas para erradicar la heteronormatividad en este sector y contribuir a la mejora de la prestación de servicios sanitarios para esta población. Entrevistamos a 16 médicos/as del área metropolitana de Lisboa a través de entrevistas semiestructuradas. El análisis temático mostró que a pesar de tener un discurso consensual sobre la necesidad de llevar a cabo prácticas no discriminatorias, los/las profesionales de la salud muestran una falta de conocimiento sobre sus pacientes no heterosexuales.

Este estudo qualitativo e exploratório analisou os discursos de pessoal médico sobre a saúde sexual das mulheres lésbicas e bissexuais. Tem como objetivo identificar as melhores práticas para erradicar a heteronormatividade nesse setor e melhorar a prestação de cuidados de saúde para essa população. Foram entrevistados 16 médicos da área metropolitana de Lisboa, através de entrevistas semiestruturadas. As análises temáticas identificaram a falta de conhecimento profissional em lidar com pacientes não heterossexuais, apesar do discurso consensual sobre a necessidade de práticas não discriminatórias.

Study on high-risk behaviour and suicide associated risk factors related to HIV/AIDS among gay or bisexual men / 中华流行病学杂志

Objective Characteristics on AIDS high-risk behaviors in gay or bisexual men with suicide ideas were explored and analyzed.Methods A cross-sectional survey was conducted with the snowball sampling method adopted.Subjects with suicide ideas were collected from responses to the valid questionnaires and subjects with no suicide ideas were collected from the age comparable men.Results The overall rate of gays or bisexuals with suicide ideas was 20.2％ in this survey.The attitude for homogeneity and marital status among the unmarried was more than that among the comparable group (P＜0.05).The rate of AIDS high-risk behaviors as same-sex sexual harassment,bleeding during sexual intercourse in the last year,coitus with unfamiliar same-sex partners in cities,suffering from adult same-sex sexual abuse before the age of 16,having had sexual abuse and abusive behavior,having had active or passive anal kiss,having had active or passive coitus with fingers,alcohol consumption weekly at least once or more,hurt by gays because of attitude and/or same-sex sexual activity and hurt by heterosexual men because of attitude and/or same-sex sexual activity were significantly higher in gays and bisexual men with suicide ideas than those without (P＜0.05).Data from multivariate logistic regression models suggested that harm from gays (Waldx2=6.637,P=0.010) and heterosexual men (Waldx2=5.835,P=0.016) due to attitude on homosexual activity appear to be the risk factors causing the suicide ideas.Conclusion Reducing the social discrimination and harm towards gays and bisexual men could reduce the occurrence of the suicide ideas and have a positive effect on curbing the prevalence of AIDS.

Epidemiological characteristics of HIV infected homosexuals in Korea(1992) / 예방의학회지

In order to investigate psychological and behavioral characteristics homosexuals and to present evidence that homosexuals are in danger of HIV infection in Korea, this study was done by self-administered questionnaire and then direct interview with the 28(35%) HIV infected homosexual/bisexuals of 79 HIV infected persons reported in 1992. Homosexuals without heterosexual activity were 9 and the others were bisexuals. Sixty-five percent of respondents had a guilty conscience for their homosexual activity. Twenty(71%) were in twenties and 5(18%) in thirties. Twelve(43%) were detected via health card checking by health office, 21% by blood donation, 18% by hospital visit, and 7% by partner notification. Motivations for homosexual activity were curiosity(36%), temptation or recommendation(14%) and compulsion(11%). Eighteen(72%) never used condom on anal sex. Nine of 26 respondents had experience for anal sex with foreigners. Fourteen(54%) of 26 respondents had history for sexually transmitted diseases. Fightly percent did not have sexual contact after HIV infection and the others usually used condom. It was confirmed that over 57% of the respondents were infected within 1 year before HIV diagnosis and over 82% within 2 years. These data suggest that HIV infection among homosexual group is rapidly spreading.