Top

Sexuality Research and Social Policy

Published in:

10-11-2021

Inclusive Psychotherapy for Sexual Minority Adults: the Role of the Therapeutic Alliance

Authors: Andrew W. Davis, Anthony Lyons, Christopher A. Pepping

Published in: Sexuality Research and Social Policy | Issue 4/2022

Activate our intelligent search to find suitable subject content or patents.

search-config

AI-assisted search

Off

Abstract

Introduction

Sexual minority adults have more unmet mental health care needs than their heterosexual counterparts. There is widespread acknowledgment that clinical interventions need to be tailored and inclusive to effectively meet the needs of sexual minority adults, yet remarkably little research has examined this issue empirically.

Methods

In a sample of 464 sexual minority adults who recently accessed psychotherapy, we examined whether client-reported psychotherapy inclusiveness was associated with greater client satisfaction and perceived psychotherapy outcome, and whether these associations were mediated via aspects of the therapeutic alliance. Data were collected in 2018.

Results

Greater client-reported psychotherapy inclusiveness was associated with both higher client satisfaction and perceived outcome, and these relationships were mediated by the task component of the therapeutic alliance. Inclusiveness was also associated with client satisfaction via the bond component of the therapeutic alliance.

Social Policy Implications

Results are consistent with calls to tailor clinical interventions to be appropriate and inclusive of sexual minority clients and highlight that the therapeutic alliance may be one mechanism underlying the association between inclusive practice and better clinical outcomes. Implications for social policy and professional practice are discussed, including the importance of disseminating mental health practitioner training in inclusive practice, and the need to develop and evaluate the efficacy of tailored clinical interventions for sexual minority adults.

previous article Experiences and Needs of Sexual and Gender Minority Young Adults with a History of Suicidal Ideation Regarding Formal and Informal Mental Healthcare

next article Employment Loss as a Result of COVID-19: a Nationwide Survey at the Onset of COVID-19 in US LGBTQ+ Populations

Dont have a licence yet? Then find out more about our products and how to get one now:

Springer Professional "Wirtschaft+Technik"

Online-Abonnement

Mit Springer Professional "Wirtschaft+Technik" erhalten Sie Zugriff auf:

über 102.000 Bücher
über 537 Zeitschriften

aus folgenden Fachgebieten:

Automobil + Motoren
Bauwesen + Immobilien
Business IT + Informatik
Elektrotechnik + Elektronik
Energie + Nachhaltigkeit
Finance + Banking
Management + Führung
Marketing + Vertrieb
Maschinenbau + Werkstoffe
Versicherung + Risiko

Jetzt Wissensvorsprung sichern!

inform now

Springer Professional "Wirtschaft"

Online-Abonnement

Mit Springer Professional "Wirtschaft" erhalten Sie Zugriff auf:

über 67.000 Bücher
über 340 Zeitschriften

aus folgenden Fachgebieten:

Bauwesen + Immobilien
Business IT + Informatik
Finance + Banking
Management + Führung
Marketing + Vertrieb
Versicherung + Risiko

Jetzt Wissensvorsprung sichern!

inform now

Alessi, E. J., Dillon, F. R., & Van Der Horn, R. (2019). The therapeutic relationship mediates the association between affirmative practice and psychological well-being among lesbian, gay, bisexual, and queer clients. Psychotherapy, 56(2), 229–240. https://doi.org/10.1037/pst0000210CrossRefPubMed

Antony, M. M., & Barlow, D. H. (Eds.). (2010). Handbook of assessment and treatment planning for psychological disorders (2nd ed.). Guilford Press.

Ardito, R. B., & Rabellino, D. (2011). Therapeutic alliance and outcome of psychotherapy: historical excursus, measurements, and prospects for research. Frontiers in Psychology, 2, 270. https://doi.org/10.3389/fpsyg.2011.00270

Attkisson, C. C., & Zwick, R. (1982). The client satisfaction questionnaire: Psychometric properties and correlations with service utilization and psychotherapy outcome. Evaluation and Program Planning, 5(3), 233–237. https://doi.org/10.1016/0149-7189(82)90074-XCrossRefPubMed

Australian Bureau of Statistics. (2008). National survey of mental health and wellbeing: Summary of results, 2007 (4326.0). Author.

Avery, A. M., Hellman, R. E., & Sudderth, L. K. (2001). Satisfaction with mental health services among sexual minorities with major mental illness. American Journal of Public Health, 91(6), 990–991. https://doi.org/10.2105/AJPH.91.6.990CrossRefPubMedPubMedCentral

Ayhan, C. H. B., Bilgin, H., Uluman, O. T., Sukut, O., Yilmaz, S., & Buzlu, S. (2020). A systematic review of the discrimination against sexual and gender minority in health care settings. International Journal of Health Services, 50(1), 44–61. https://doi.org/10.1177/0020731419885093CrossRefPubMed

Baier, A. L., Kline, A. C., & Feeny, N. C. (2020). Therapeutic alliance as a mediator of change: A systematic review and evaluation of research. Clinical Psychology Review, 101921. https://doi.org/10.1016/j.cpr.2020.101921

Barlow, D. H. (Ed.). (2014). Clinical handbook of psychological disorders: A step-by-step treatment manual (5th ed.). The Guilford Press.

Bernstein, A. C. (2000). Straight therapists working with lesbians and gays in family therapy. Journal of Marital and Family Therapy, 26(4), 443–454. https://doi.org/10.1111/j.1752-0606.2000.tb00315.xCrossRefPubMed

Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice, 16(3), 252–260. https://doi.org/10.1037/h0085885

Bränström, R. (2017). Minority stress factors as mediators of sexual orientation disparities in mental health treatment: A longitudinal population-based study. Journal of Epidemiology and Community Health, 71(5), 446–452. https://doi.org/10.1136/jech-2016-207943CrossRefPubMed

Burgess, D., Lee, R., Tran, A., & Van Ryn, M. (2007). Effects of perceived discrimination on mental health and mental health services utilization among gay, lesbian, bisexual and transgender persons. Journal of LGBT Health Research, 3(4), 1–14. https://doi.org/10.1080/15574090802226626CrossRefPubMed

Bybee, J. A., Sullivan, E. L., Zielonka, E., & Moes, E. (2009). Are gay men in worse mental health than heterosexual men? The role of age, shame and guilt, and coming-out. Journal of Adult Development, 16(3), 144–154. https://doi.org/10.1007/s10804-009-9059-xCrossRef

Corboz, J., Dowsett, G., Mitchell, A., Couch, M., Agius, P., & Pitts, M. (2008). Feeling queer and blue: A review of the literature on depression and related issues among gay, lesbian, bisexual and other homosexually active people. Australian Research Centre in Sex, Health and Society, La Trobe University. https://www.beyondblue.org.au/docs/default-source/research-project-files/bw0225.pdf?sfvrsn=2

Cronin, T. J., Pepping, C. A., Halford, W. K., & Lyons, A. (2021). Mental health help-seeking and barriers to service access among lesbian, gay, and bisexual Australians. Australian Psychologist, 56, 46–60. https://doi.org/10.1080/00050067.2021.1890981CrossRef

D’augelli, A. R., Grossman, A. H., & Starks, M. T. (2008). Families of gay, lesbian, and bisexual youth: What do parents and siblings know and how do they react? Journal of GLBT Family Studies, 4(1), 95–115. https://doi.org/10.1080/15504280802084506CrossRef

Dunbar, M. S., Sontag-Padilla, L., Ramchand, R., Seelam, R., & Stein, B. D. (2017). Mental health service utilization among lesbian, gay, bisexual, and questioning or queer college students. Journal of Adolescent Health, 61(3), 294–301. https://doi.org/10.1016/j.jadohealth.2017.03.008

Elvins, R., & Green, J. (2008). The conceptualization and measurement of therapeutic alliance: An empirical review. Clinical Psychology Review 28(7) 1167–1187. https://doi.org/10.1016/j.cpr.2008.04.002

Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316–340. https://doi.org/10.1037/pst0000172CrossRefPubMed

Hatcher, R. L., & Gillaspy, J. A. (2006). Development and validation of a revised short version of the Working Alliance Inventory. Psychotherapy Research, 16(1), 12–25. https://doi.org/10.1080/10503300500352500CrossRef

Hatzenbuehler, M. L. (2009). How does sexual minority stigma “get under the skin”? A Psychological Mediation Framework. Psychological Bulletin, 135(5), 707–730. https://doi.org/10.1037/a0016441CrossRefPubMed

Hatzenbuehler, M. L., McLaughlin, K. A., Keyes, K. M., & Hasin, D. S. (2010). The impact of institutional discrimination on psychiatric disorders in lesbian, gay, and bisexual populations: A prospective study. American Journal of Public Health, 100(3), 452–459. https://doi.org/10.2105/AJPH.2009.168815CrossRefPubMedPubMedCentral

Hayes, A. F. (2012). Process: A versatile computational tool for observed variable mediation, moderation, and conditional process modeling [White paper]. Retrieved from http://www.afhayes.com/public/process2012.pdf

Heck, J. E., Sell, R. L., & Gorin, S. S. (2006). Health care access among individuals involved in same-sex relationships. American Journal of Public Health, 96(6), 1111–1118. https://doi.org/10.2105/AJPH.2005.062661CrossRefPubMedPubMedCentral

Horvath, A. O., & Greenberg, L. S. (1989). Development and validation of the Working Alliance Inventory. Journal of Counseling Psychology, 36(2), 223–233. https://doi.org/10.1037/0022-0167.36.2.223CrossRef

Hottes, T. S., Bogaert, L., Rhodes, A. E., Brennan, D. J., & Gesink, D. (2016). Lifetime prevalence of suicide attempts among sexual minority adults by study sampling strategies: A systematic review and meta-analysis. American Journal of Public Health, 106(5), e1–e12. https://doi.org/10.2105/AJPH.2016.303088CrossRefPubMedPubMedCentral

Katz-Wise, S. L., & Hyde, J. S. (2012). Victimization experiences of lesbian, gay, and bisexual individuals: A meta-analysis. Journal of Sex Research, 49(2–3), 142–167. https://doi.org/10.1080/00224499.2011.637247CrossRefPubMed

King, M., Semlyen, J., Tai, S. S., Killaspy, H., Osborn, D., Popelyuk, D., & Nazareth, I. (2008). A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry, 8(1), 70–87. https://doi.org/10.1186/1471-244X-8-70CrossRefPubMedPubMedCentral

Lambert, M. J., & Barley, D. E. (2001). Research summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy: Theory, Research, Practice, Training, 38(4), 357. https://doi.org/10.1037/0033-3204.38.4.357

Larsen, D. L., Attkisson, C. C., Hargreaves, W. A., & Nguyen, T. D. (1979). Assessment of client/patient satisfaction: Development of a general scale. Evaluation and Program Planning, 2(3), 197–207. https://doi.org/10.1016/0149-7189(79)90094-6CrossRefPubMed

Lefevor, G. T., Janis, R. A., & Park, S. Y. (2017). Religious and sexual identities: An intersectional, longitudinal examination of change in therapy. The Counseling Psychologist, 45(3), 387–413. https://doi.org/10.1177/0011000017702721CrossRef

Lelutiu-Weinberger, C., & Pachankis, J. E. (2017). Acceptability and preliminary efficacy of a lesbian, gay, bisexual, and transgender-affirmative mental health practice training in a highly stigmatizing national context. LGBT Health, 4(5), 360–370. https://doi.org/10.1089/lgbt.2016.0194CrossRefPubMedPubMedCentral

Lelutiu-Weinberger, C., & Pachankis, J. (2018). Evaluation of an LGBT-affirmative mental health practice training in a stigmatizing national context. European Journal of Public Health, 28(cky213.863). https://doi.org/10.1093/eurpub/cky213.863

Leonard, W., Lyons, A., & Bariola, E. (2015). A closer look at private lives 2: Addressing the mental health and well-being of lesbian, gay, bisexual and transgender (LGBT) Australians (No. 103; Monograph Series). Australian Research Centre in Sex, Health and Society, La Trobe University. https://doi.org/10.4225/50/557E58D55A595

Lucksted, A. (2004). Lesbian, gay, bisexual, and transgender people receiving services in the public mental health system: Raising issues. Journal of Gay & Lesbian Psychotherapy, 8(3/4), 25–42. https://doi.org/10.1300/J236v08n03_03CrossRef

Lyons, A., Alba, B., Waling, A., Minichiello, V., Hughes, M., Barrett, C., Fredriksen-Goldsen, K., Edmonds, S., & Pepping, C. A. (2020). Comfort among older lesbian and gay people in disclosing their sexual orientation to health and aged care services. Journal of Applied Gerontology. https://doi.org/10.1177/0733464820925330CrossRefPubMed

Lyons, A., Rozbroj, T., Pitts, M., Mitchell, A., & Christensen, H. (2015). Improving e-therapy for mood disorders among lesbians and gay men (No. 102; Monograph Series). Australian Research Centre in Sex, Health and Society, La Trobe University. https://doi.org/10.4225/50/557E580C4E5F7

Martin, D. J., Garske, J. P., & Davis, M. K. (2000). Relation of the therapeutic alliance with outcome and other variables: A meta-analytic review. Journal of Consulting, 68(3), 438–450. https://doi.org/10.1037/0022-006X.68.3.438CrossRef

Mayer, K. H., Bradford, J. B., Makadon, H. J., Stall, R., Goldhammer, H., & Landers, S. (2008). Sexual and gender minority health: What we know and what needs to be done. American Journal of Public Health, 98(6), 989–995. https://doi.org/10.2105/AJPH.2007.127811CrossRefPubMedPubMedCentral

Mays, V. M., & Cochran, S. D. (2001). Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United States. American Journal of Public Health, 91(11), 1869–1876. https://doi.org/10.2105/AJPH.91.11.1869CrossRefPubMedPubMedCentral

Meads, C., Pennant, M., McManus, J., & Bayliss, S. (2009). A systematic review of lesbian, gay, bisexual and transgender health in the West Midlands region of the UK compared to published UK research (No. 71). Unit of Public Health, Epidemiology and Biostatistics, University of Birmingham. http://www.birmingham.ac.uk/Documents/college-mds/haps/projects/WMHTAC/REPreports/2009/LGBThealth030409finalversion.pdf

Mereish, E. H., & Poteat, V. P. (2015). A relational model of sexual minority mental and physical health: The negative effects of shame on relationships, loneliness, and health. Journal of Counseling Psychology, 62(3), 425–437. https://doi.org/10.1037/cou0000088CrossRefPubMedPubMedCentral

Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36(1), 38–56. https://doi.org/10.2307/2137286CrossRefPubMed

Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. https://doi.org/10.1037/0033-2909.129.5.674CrossRefPubMedPubMedCentral

Moradi, B., van den Berg, J. J., & Epting, F. R. (2009). Threat and guilt aspects of internalized antilesbian and gay prejudice: An application of personal construct theory. Journal of Counseling Psychology, 56(1), 119. https://doi.org/10.1037/a0014571CrossRef

Munder, T., Wilmers, F., Leonhart, R., Linster, H. W., & Barth, J. (2010). Working Alliance Inventory-Short Revised (WAI-SR): Psychometric properties in outpatients and inpatients. Clinical Psychology & Psychotherapy: An International Journal of Theory & Practice, 17(3), 231–239. https://doi.org/10.1002/cpp.658CrossRef

Newcomb, M. E., & Mustanski, B. (2010). Internalized homophobia and internalizing mental health problems: A meta-analytic review. Clinical Psychology Review, 30(8), 1019–1029. https://doi.org/10.1016/j.cpr.2010.07.003CrossRefPubMed

Pachankis, J. E. (2018). The scientific pursuit of sexual and gender minority mental health treatments: Toward evidence-based affirmative practice. American Psychologist, 73(9), 1207–1219. https://doi.org/10.1037/amp0000357CrossRefPubMed

Pachankis, J. E., & Goldfried, M. R. (2004). Clinical issues in working with lesbian, gay, and bisexual clients. Psychotherapy: Theory, Research, Practice, Training, 41(3), 227. https://doi.org/10.1037/0033-3204.41.3.227

Pachankis, J. E., & Goldfried, M. R. (2006). Social anxiety in young gay men. Journal of Anxiety Disorders, 20(8), 996–1015. https://doi.org/10.1016/j.janxdis.2006.01.001CrossRefPubMed

Pachankis, J. E., Goldfried, M. R., & Ramrattan, M. E. (2008). Extension of the rejection sensitivity construct to the interpersonal functioning of gay men. Journal of Consulting and Clinical Psychology, 76(2), 306–317. https://doi.org/10.1037/0022-006X.76.2.306CrossRefPubMed

Pachankis, J. E., Hatzenbuehler, M. L., Rendina, H. J., Safren, S. A., & Parsons, J. T. (2015). LGB-affirmative cognitive-behavioral therapy for young adult gay and bisexual men: A randomized controlled trial of a transdiagnostic minority stress approach. Journal of Consulting and Clinical Psychology, 83(5), 875–889. https://doi.org/10.1037/ccp0000037CrossRefPubMedPubMedCentral

Pachankis, J. E., McConocha, E. M., Reynolds, J. S., Winston, R., Adeyinka, O., Harkness, A., Burton, C. L., Behari, K., Sullivan, T. J., Eldahan, A. I., Esserman, D. A., Hatzenbuehler, M. L., & Safren, S. A. (2019). Project ESTEEM protocol: A randomized controlled trial of an LGBTQ-affirmative treatment for young adult sexual minority men’s mental and sexual health. BMC Public Health, 19(1), 1086. https://doi.org/10.1186/s12889-019-7346-4CrossRefPubMedPubMedCentral

Pallant, J. (2016). SPSS survival manual: A step by step guide to data analysis using IBM SPSS (6th ed.). Open University Press.

Pennant, M. E., Bayliss, S. E., & Meads, C. A. (2009). Improving lesbian, gay and bisexual healthcare: A systematic review of qualitative literature from the UK. Diversity in Health and Care, 6(3), 193–203.

Pepping, C. A., & Halford, W. K. (2014). Relationship education and therapy for same-sex couples. Australian and New Zealand Journal of Family Therapy, 35(4), 431–444. https://doi.org/10.1002/anzf.1075CrossRef

Pepping, C. A., Halford, W. K., Cronin, T. J., & Lyons, A. (2020). Couple relationship education for same-sex couples: A preliminary evaluation of Rainbow CoupleCARE. Journal of Couple & Relationship Therapy. https://doi.org/10.1080/15332691.2020.1746458CrossRef

Pepping, C. A., Lyons, A., & Morris, E. M. J. (2018). Affirmative LGBT psychotherapy: Outcomes of a therapist training protocol. Psychotherapy, 55(1), 52–62. https://doi.org/10.1037/pst0000149CrossRefPubMed

Rimes, K. A., Ion, D., Wingrove, J., & Carter, B. (2019). Sexual orientation differences in psychological treatment outcomes for depression and anxiety: National cohort study. Journal of Consulting and Clinical Psychology, 87(7), 577. https://doi.org/10.1037/ccp0000416CrossRefPubMed

Romanelli, M., & Hudson, K. D. (2017). Individual and systemic barriers to health care: Perspectives of lesbian, gay, bisexual, and transgender adults. The American Journal of Orthopsychiatry, 87(6), 714–728. https://doi.org/10.1037/ort0000306CrossRefPubMed

Rozbroj, T., Lyons, A., Pitts, M., Mitchell, A., & Christensen, H. (2014). Assessing the applicability of e-therapies for depression, anxiety, and other mood disorders among lesbians and gay men: Analysis of 24 web- and mobile phone-based self-help interventions. Journal of Medical Internet Research, 16(7), e166. https://doi.org/10.2196/jmir.3529CrossRefPubMedPubMedCentral

Rozbroj, T., Lyons, A., Pitts, M., Mitchell, A., & Christensen, H. (2015). Improving self-help e-therapy for depression and anxiety among sexual minorities: An analysis of focus groups with lesbians and gay men. Journal of Medical Internet Research, 17(3), e66. https://doi.org/10.2196/jmir.4013CrossRefPubMedPubMedCentral

Rutherford, K., McIntyre, J., Daley, A., & Ross, L. E. (2012). Development of expertise in mental health service provision for lesbian, gay, bisexual and transgender communities. Medical Education, 46(9), 903–913. https://doi.org/10.1111/j.1365-2923.2012.04272.xCrossRefPubMed

Scheer, J. R., Harney, P., Esposito, J., & Woulfe, J. M. (2020). Self-reported mental and physical health symptoms and potentially traumatic events among lesbian, gay, bisexual, transgender, and queer individuals: The role of shame. Psychology of Violence, 10(2), 131–142. https://doi.org/10.1037/vio0000241CrossRefPubMed

Seligman, M. E. (1995). The effectiveness of psychotherapy: The Consumer Reports study. American Psychologist, 50(12), 965. https://doi.org/10.1037/0003-066X.50.12.965CrossRefPubMed

Simeonov, D., Steele, L. S., Anderson, S., & Ross, L. E. (2015). Perceived satisfaction with mental health services in the lesbian, gay, bisexual, transgender, and transsexual communities in Ontario, Canada: An internet-based survey. Canadian Journal of Community Mental Health, 34(1), 31–44. https://doi.org/10.7870/cjcmh-2014-037CrossRef

Smith, D. M., & Mathews, W. C. (2007). Physicians’ attitudes toward homosexuality and HIV: Survey of a California medical society-revisited (PATHH-II). Journal of Homosexuality, 52(3–4), 1–9. https://doi.org/10.1300/J082v52n03_01CrossRefPubMed

Solomonov, N., & Barber, J. P. (2015). What we know, what we do not know, and where are we heading? Efficacy and acceptability of psychological interventions for depression. Epidemiology and Psychiatric Sciences, 25(4), 1–8. https://doi.org/10.1017/S2045796015000815CrossRef

Steele, L. S., Daley, A., Curling, D., Gibson, M. F., Green, D. C., Williams, C. C., & Ross, L. E. (2017). LGBT identity, untreated depression, and unmet need for mental health services by sexual minority women and trans-identified people. Journal of Women’s Health, 26(2), 116–127. https://doi.org/10.1089/jwh.2015.5677CrossRefPubMed

Tabachnick, B. G., & Fidell, L. S. (2013). Using multivariate statistics (6th ed.). Pearson.

Thompson, B., & Hill, C. (1993). Client perceptions of therapist competence. Psychotherapy Research, 3(2), 124–130. https://doi.org/10.1080/10503309312331333729CrossRef

Verrelli, S., White, F. A., Harvey, L. J., & Pulciani, M. R. (2019). Minority stress, social support, and the mental health of lesbian, gay, and bisexual Australians during the Australian Marriage Law Postal Survey. Australian Psychologist, 54(4), 336–346. https://doi.org/10.1111/ap.12380CrossRef

Williams, K. A., & Chapman, M. V. (2011). Comparing health and mental health needs, service use, and barriers to services among sexual minority youths and their peers. Health & Social Work, 36(3), 197–206. https://doi.org/10.1093/hsw/36.3.197CrossRef

Wolfe, B. E., & Goldfried, M. R. (1988). Research on psychotherapy integration: Recommendations and conclusions from an NIMH workshop. Journal of Consulting and Clinical Psychology, 56(3), 448–451. https://doi.org/10.1037/0022-006X.56.3.448CrossRefPubMed

Title: Inclusive Psychotherapy for Sexual Minority Adults: the Role of the Therapeutic Alliance
Authors: Andrew W. Davis
Anthony Lyons
Christopher A. Pepping
Publication date: 10-11-2021
Publisher: Springer US
Published in: Sexuality Research and Social Policy / Issue 4/2022
Print ISSN: 1868-9884
Electronic ISSN: 1553-6610
DOI: https://doi.org/10.1007/s13178-021-00654-y

Springer Professional

Abstract

Introduction

Methods

Results

Social Policy Implications

Please log in to get access to your license.

Dont have a licence yet? Then find out more about our products and how to get one now:

Springer Professional "Wirtschaft+Technik"

Springer Professional "Wirtschaft"

Other articles of this Issue 4/2022

Sexuality-based Stigma and Inclusion Among Southern Protestant Religious Leaders

Uptake of Human Papillomavirus Vaccination by HIV Status and HIV Pre-exposure Prophylaxis (PrEP) Care Engagement Among Young Sexual Minority Men 17–24 Years Old in the USA

“This is not What God Intended”: Attitudes Toward Adoption by Same-sex Couples in Ecuador

Healthcare Mistreatment, State-Level Policy Protections, and Healthcare Avoidance Among Gender Minority People

Religiosity and Homophobia: Examining the Impact of Perceived Importance of Childbearing, Hostile Sexism and Gender

Beliefs About the Need to Control One’s Thoughts and Cognitive Self-consciousness Are Associated with Sexual Stigma