![]() ![]() Substantial activities to advocate the rights of LGBT populations and alleviate the social stigmatization toward non-heterosexual groups have been developed in the last decades ( Health USDo, 2000 Powell et al., 2016 Winter et al., 2016b Mendos et al., 2020). Moreover, homophobia may constrain the use of HIV prevention and treatment services and worsen the disparities in healthcare access for the LGBT people ( Ayala et al., 2013 Baral et al., 2013b Pachankis et al., 2015). These issues are related to social isolation, and increased risk of psychological distress and low self-esteem ( Díaz et al., 2001), which, consequently, elevate the engagement in the HIV-related risk behaviors (e.g., substance use, condomless use during sexual intercourses or multiple sex partners) and the vulnerability to HIV acquisition in these populations ( Hughes and Eliason, 2002 Díaz et al., 2004 McCabe et al., 2009 Evans et al., 2016). This criminalization facilitates social stigma or rejection, abuse, and violence against homosexual groups ( Dean et al., 2000 Mays et al., 2002 Reisner et al., 2016 Winter et al., 2016a). A recent report of the International Lesbian, Gay, Bisexual, Trans and Intersex Association in 2020 showed that 67/193 countries of the United Nation member states treated same-sex behaviors as illegal acts ( Mendos et al., 2020). Few studies have been conducted to examine the HIV prevalence in sexual minority women, with the range from 1.3% in general women who have sex with women (WSW Lemp et al., 1995) to 42% among WSW who inject drugs ( Diaz et al., 2001).Īlthough homosexuality is no longer classified as an illness ( Association AP, 2013), it does not change the fact that LGBT people are marginalized and often understudied or underrepresented in research and practice ( Wolitski et al., 2008 Graham et al., 2011). ![]() The burden of HIV in trans women who have sex with men and sex workers is even more severe, with the prevalence of HIV in these populations approximately 49 times higher compared with the general population at reproductive age ( Baral et al., 2013a). Another systematic review indicated that in low-and middle-income countries, the HIV prevalence in MSM was 19-fold higher compared with the general population ( Baral et al., 2007). Among MSM, the HIV prevalence was from 3% in the Middle-East and North African countries to 25.4% in Caribbean countries ( Beyrer et al., 2012). Despite global efforts, mounting evidence in different systematic reviews revealed emerging circumstances of HIV/sexually transmitted infections (STIs) in these marginalized groups. Since then, sexual minorities, including lesbian, gay, bisexual, and transgender (LGBT) groups have been considered among the most vulnerable populations to HIV across nations ( Gangamma et al., 2008 Deol and Heath-Toby, 2009 Beyrer et al., 2010, 2012 Marshall et al., 2011). The first case of a syndrome now so-called AIDS was presented in 1981 among healthy American men who have sex with men (MSM CDC, 1981a, b, c).
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