Medical-Legal Partnerships: a promising approach for addressing health-harming legal needs among people with HIV.

Introduction: People with HIV (PWH), particularly those at the intersection of sexual and gender identities, face enduring obstacles to accessing HIV care, including structural stigma, structural racism and discrimination, housing instability, and limited access to health insurance. To address these challenges, Medical-Legal Partnerships (MLPs) in HIV care offer an innovative approach that integrates medical and legal services. By targeting health-harming legal needs (HHLN), MLPs aim to enhance the HIV care continuum outcomes for PWH. Methods: This study examines the benefits and challenges of MLPs within organizations serving PWH through the social-ecological model. MLP providers (n=111) identified organizational-level challenges such as funding limitations, resource integration issues, and staffing constraints. Results: MLPs demonstrated numerous benefits, including patient impact and benefits, comprehensive service provision, enhanced staff support and capacity, and potential for policy influence. Discussion: These results underscore the feasibility of MLPs while offering valuable insights into their efficacy and challenges, guiding the implementation of MLPs to address health-harming legal needs, including discrimination, and thereby improving HIV care outcomes.

The Relationship Between Gender-Affirming Procedures, Body Image Quality of Life, and Gender Affirmation.

This study explored whether self-reported barriers to accessing a health care provider, gender-affirming procedures, and relevant psychosocial measures were related to experienced gender affirmation in a cross-sectional sample of trans individuals (N=101). Body image quality of life [b=0.181, t(4.277), p<0.001] and the number of gender-affirming procedures [b=0.084, t(2.904), p=0.005] were significant predictors of transgender congruence, a measure of gender affirmation, and accounted for 40% of the adjusted variance in transgender congruence scores F(2, 89)=31.363, p<0.001, R2=0.413. Results suggest that experiencing a barrier to gender-affirming health care is associated with anticipation of discrimination and provides further evidence that gender-affirming health care is associated with positive psychosocial outcomes.

"Unprecedented Times:" Experiences of Social Work and Public Health Professionals during Times of Public Crises.

Social workers and public health professionals in the U.S. were profoundly impacted by COVID-19, systemic racism, and the 2020 U.S. presidential election. This study examined their external job support, burnout, and job satisfaction in the context of these circumstances. The findings suggest respondents, who had graduate degrees in social work or public health, overemphasized their job satisfaction and underemphasized their burnout. While social work and public health professionals felt satisfied with their labor, not acknowledging burnout limits the amount of support they may access to effectively continue the work. Interestingly, participants who had more administrative functions reported higher job satisfaction scores and lower burnout scores. Traditionally, those in administrative positions have more control over their schedule and work responsibilities. Findings suggest that more training, opportunities for self-care, and discussions about safety and systemic racism are needed in the workplace for social workers and public health professionals.

Psychosocial Differences Between Transgender Individuals With and Without History of Nonsurgical Facial Injectables.

BACKGROUND: Considerable research has explored psychosocial characteristics of individuals who seek aesthetic procedures as well as psychological changes experienced after successful treatment. Little research, however, has explored the experiences of transgender individuals who have undergone nonsurgical injectable procedures (NSIPs). OBJECTIVES: This study examined theoretically relevant psychosocial characteristics of transgender individuals who have and have not undergone NSIPs. METHODS: An online survey of demographic and psychosocial constructs was disseminated through transgender-specific support groups and Facebook groups from December 2019 to February 2020. Psychosocial measures included self-esteem (Rosenberg Self-Esteem Inventory), anticipated discrimination (Intersectional-Anticipated Discrimination), gender identity and physicality congruence (Transgender Congruence Scale), body image (Body Image Quality of Life Inventory), and overall satisfaction with facial appearance (FACE-Q Face Overall). The Mann-Whitney U test assessed differences by history of NSIPs, and the Kruskal-Wallis test assessed gender and racial differences. A P-value of <0.05 was considered significant. RESULTS: Participants (N = 101) were transfeminine (n = 58), transmasculine (n = 31), gender-diverse (n = 12), and mostly (71%) white. Almost two-thirds of respondents (62%) reported using NSIPs; 6 participants reported undergoing NSIPs from non-licensed providers. History of NSIPs was associated with greater self-esteem (P < 0.01), less anticipated discrimination (P < 0.01), greater physicality and gender identity congruence(P < 0.001), greater body image quality of life (P < 0.001), and greater satisfaction with overall facial appearance (P < 0.01). CONCLUSIONS: Use of NSIPs was associated with more positive psychosocial symptoms. Experiences with NSIPs may play an important role in psychosocial functioning for transgender individuals.

Sexting, Risk Behavior, and Mental Health in Adolescents: An Examination of 2015 Pennsylvania Youth Risk Behavior Survey Data.

BACKGROUND: Sexting, the sharing of sexually suggestive photos, may be a gateway behavior to early sexual activity and increase the likelihood of social ostracism. METHODS: Youth Risk Behavior Survey (N = 6021) data from 2015 among Pennsylvania 9th-12th grade students were used to examine associations between consensual and nonconsensual sexting and substance use, mental health, neighborhood safety, and demographic variables. RESULTS: Almost one-third (29%) of students reported consensual sexting, while 3% reported nonconsensual sexting. Female students were 49% less likely to report consensual sexting (OR = .69, 95% confidence interval [CI]: [0.54, 0.87]); consensual sexting was significantly more likely in students who reported depressive symptoms (OR = 1.39, 95% CI: [1.10, 1.75]), electronic bullying (OR = 1.46, 95% CI: [1.05, 2.04]), suicide attempts (OR = 1.96, 95% CI: [1.22, 3.17]), current tobacco use (OR = 1.99, 95% CI: [1.30, 3.03]), current alcohol use (OR = 4.23, 95% CI: [3.04, 5.89]), ever having sex (OR = 5.21, 95% CI: [3.87, 7.02]), and reported both ever having sex, and current alcohol use (OR = 7.74, 95% CI: [5.37, 11.14]). CONCLUSIONS: High school students, particularly men, that report sexting may be more likely to participate in other risk behaviors and experience negative mental health outcomes. Further research should clarify the temporality of links between sexting, cyberbullying, depression, and suicide to inform mental health screening and treatment availability in high schools.

Predictors of Sexual Activity in Haitian-American Adolescents.

This study examined the impact of individual, peer, family, school, and neighborhood level variables on sexual activity among 276 Haitian-American adolescents. Differences between those who were sexually active and those who were not were analyzed using Chi square and t tests. Significant factors at p ≤ 0.1 were entered into logistic regression for the full group and for girls-only. Half of males and 36.6 % of females were sexually active. The multivariable model revealed that adolescents were more likely to be sexually active if they reported delinquent behaviors; had sexually active friends; and were living with only one parent, friends or relatives. For girls, living with both parents was protective against sexual activity, while substance use and emotional distress were risk factors. No language or acculturation measures were associated with sexual activity. Haitian-American adolescents may benefit from interventions that focus on gender-specific, contextual and cultural factors to prevent early sexual activity.

Cognitive behavioral HIV risk reduction in those receiving psychiatric treatment: a clinical trial.

Among severely mentally ill (SMI) substance abusers, HIV rates are elevated and HIV risk reduction interventions have been shown to be less effective. An enhanced cognitive behavioral HIV risk reduction intervention (E-CB) for SMI was compared to a health promotion condition (HPC) in 222 psychiatric outpatients at 6 months postintervention. Compared to females, males in the E-CB improved on intention to practice safer sex and in condom use skills and in unprotected vaginal sex, but did not differ in HIV knowledge, perceived susceptibility, anxiety, condom attitudes, safer sex self-efficacy, unprotected vaginal sex acts, or sex partners. Across intervention groups, there were improvements in all areas except self-efficacy and number of partners. Risk reduction among SMI may be facilitated by increasing awareness of health related behaviors and HIV-targeted content. However, meaningful changes in critical risk reduction skills and intentions may require a more focused intervention and may vary by gender.