Anthony J. Gifford

Background/Objectives: Gay men face mental health inequalities compared to the general population but there is limited evidence concerning the risk of paranoid ideation in this population and none that examines the cognitive-affective factors that may predispose gay men to paranoid ideation or protect against it. Methods: A sample of 257 gay men in the United Kingdom participated in a cross-sectional correlational survey study and completed measures of psychological emptiness, identity loss, loneliness, identity resilience, and subclinical paranoid ideation. Results: Hierarchical multiple regression showed that psychological emptiness was strongly associated with paranoid ideation, followed by identity loss. A moderated mediated generalized linear model showed that psychological emptiness and identity loss were associated directly with higher paranoid ideation and indirectly through the mediation of loneliness. Identity resilience moderated the relationships between identity loss and loneliness and between identity loss and paranoid ideation, essentially weakening them. Conclusions: Psychological emptiness and identity loss may operate as diagnostic cognitive-affective dispositions that are associated with paranoid ideation in gay men. Interventions that focus on developing a stable identity characterized by meaning and purpose may be effective against paranoid ideation and reduce the risk of severe psychopathology.

LGBTQ+ individuals experience disproportionately high rates of mental health challenges, driven largely by exposure to stigma, discrimination, and minority stress. In response, there is growing interest in creative, community-based interventions that support wellbeing. This study evaluates “LGBTQteehee!”, a 10-week stand-up comedy programme designed to promote mental wellbeing and resilience among LGBTQ+ individuals. N = 6 participants took part in post-intervention qualitative data collection via focus group and semi-structured interviews. Data were analysed using Reflexive Thematic Analysis. Two overarching themes were identified: “Standing up Together: A Queer Ensemble” and “Comedy as Catharsis”, each comprising two subthemes. The first theme captured the importance of community, highlighting “Where Comedy Meets Community” and “Where Safety Takes Centre Stage”, emphasising the role of belonging, diversity, and psychological safety. The second theme reflected the transformative potential of comedy, with “Performing (Queer) Resilience” and “Taking the Mic and Owning the Moment” illustrating how participants reframed lived experience into empowering narratives and reported increased confidence and self-expression. Findings suggest that the benefits of the intervention extend beyond humour alone, instead reflecting the interplay between social connection and identity-affirming narrative expression. Participants described how having a space to talk openly about their mental health and receive support from others contributed to their perceptions of both individual and collective resilience. These findings suggest that community-based comedy interventions may offer accessible and identity-affirming spaces through which LGBTQ+ individuals can explore wellbeing, belonging, and resilience. Whilst further evaluation is required, the findings contribute to growing discussions regarding the role of arts-based approaches in supporting LGBTQ+ mental health and wellbeing.

Sociosexuality refers to the proclivity to engage in casual sex without commitment and is generally operationalized in terms of attitudes, behavior, and desire. Moving beyond the dominant focus on sexual risk and pathology in studies of sociosexuality, this study conceptualizes sociosexuality as a positive psychological variable that reflects the enactment of sexual identity among gay and bisexual men. Using cross-sectional correlational survey data from 512 gay and bisexual men in the United Kingdom, the direct associations between sociosexuality and identity resilience and LGBT+ community connectedness, and indirect associations through the mediation of internalized homonegativity, were examined. Results showed that identity resilience was indirectly associated with higher sociosexuality via decreased internalized homonegativity, and that LGBT+ community connectedness was directly and positively associated with sociosexuality and indirectly via decreased internalized homonegativity. The findings suggest that the adaptive self-schema of identity resilience and the adaptive relational schema of community connectedness may militate against internalized homonegativity, which in turn may facilitate sociosexuality among gay and bisexual men. Interventions to support sexual identity enactment should therefore focus on developing these adaptive schemas.

Background: Despite the clinical efficacy of pre-exposure prophylaxis (PrEP) in preventing HIV, uptake remains suboptimal among men who have sex with men (MSM) in the United Kingdom (UK). Sustaining progress in the PrEP cascade requires more than biomedical availability; it demands effective, psychologically informed interventions that address persistent barriers. Psychological factors, such as medical mistrust, low PrEP self-efficacy, and identity-related processes, continue to undermine engagement. This study tested whether narrative persuasion and message framing could influence these barriers. Method: A sample of 253 MSM was recruited to participate in an online experiment and completed baseline measures of identity resilience before being randomly allocated to either the gain-framed (N = 122) or loss-framed (N = 124) narrative condition and then completing post-manipulation measures of medical mistrust and PrEP self-efficacy. After excluding 7 cases due to ineligibility, data from 246 participants were analysed using mediation analysis. Results: Participants in the gain-framed condition reported lower medical mistrust than those in the loss-framed condition. Medical mistrust was, in turn, associated with lower PrEP self-efficacy. Identity resilience was associated with lower medical mistrust and higher PrEP self-efficacy. Discussion: These findings provide novel causal evidence that gain-framed health narratives can reduce mistrust and indirectly enhance PrEP self-efficacy. Identity resilience also emerges as a key psychological factor influencing trust and behavioural confidence. Conclusions: Interventions to improve and sustain PrEP uptake should combine gain-framed, narrative-based messaging with strategies to bolster identity resilience. Such approaches may address psychosocial barriers more effectively and promote equitable PrEP uptake among MSM.

Despite the availability of pre-exposure prophylaxis (PrEP) in the United Kingdom (UK), uptake among men who have sex with men (MSM) remains inconsistent, signalling a persistent ‘PrEP Gap’. Empirical studies show the important role of psychosocial factors (e.g., stigma, identity, trust in science, and sexual behaviours) in PrEP acceptability and uptake. This study aimed to identify subgroups of MSM in the UK based on psychosocial predictors of PrEP acceptability. A cross-sectional survey of MSM (N = 500) was conducted between June and September 2023. Participants completed validated measures assessing identity resilience, internalised homonegativity, LGBTQ+ connectedness, trust in science, NHS perceptions, HIV stigma, PrEP self-efficacy, condom self-efficacy, sociosexual orientation, perceived HIV risk, and PrEP acceptability. Latent Profile Analysis (LPA) was used to identify distinct subgroups based on these psychosocial dimensions. Four psychosocial profiles were defined: (1) PrEP Ambivalent (15%); (2) PrEP Accepting (36.2%); (3) PrEP Hesitant (37%); and (4) PrEP Rejecting (11.8%). These profiles provide evidence for varied combinations of personal and structural factors influencing PrEP acceptability. PrEP acceptability among MSM in the UK is shaped by distinct psychosocial configurations, influenced by identity, stigma, trust, and perceived risk. These findings highlight the need for differentiated and targeted interventions for enhancing PrEP acceptability based on psychosocial profile. Audience segmentation strategies offer a promising pathway to bridge the awareness-to-engagement gap and address the nuanced barriers facing diverse subgroups within the MSM community.

Most research assessing human immunodeficiency virus (HIV) anxiety relies on single-item measures or psychometric measures that are outdated in terms of concepts and language. There is a critical need for a robust, reliable, and contemporary measure to identify populations at risk of avoiding HIV testing, treatment, and prevention, thereby supporting global HIV eradication goals. Focus groups informed the initial development of the HIV Anxiety Scale (HAS), revised through expert feedback. The factor structure was assessed in two studies. In Study 1, an Exploratory Factor Analysis (EFA) was conducted with 251 participants. In Study 2, a Confirmatory Factor Analysis (CFA) with 200 participants was performed alongside validity, internal consistency, and measurement invariance assessments. Studies 1 and 2 elicited a 3-factor model, resulting in a 16-item measure with the following subscales: Psychosocial Implications of HIV, Lifestyle Implications of HIV, and HIV Testing Anxiety. The HAS demonstrated a good factor structure, acceptable validity and excellent internal consistency across diverse groups in Study 2. The HAS provides a contemporary, robust measure of HIV anxiety, addressing limitations of previous tools and contributing to efforts to identify and support populations at risk of HIV avoidance behaviours. We recommend that future research continue to validate and test this new measure, but it offers a standardised tool to inform targeted interventions for HIV testing, prevention, and treatment.

Introduction: Pre‐exposure prophylaxis (PrEP) is medication used to prevent the spread of HIV. Populations with increased need of HIV prevention (e.g., men who have sex with men [MSM]) are eligible for free PrEP in the UK. However, HIV surveillance reports indicate stagnated uptake of the drug, alongside increasing rates of HIV acquisition. As such, psychosocial research is needed to explore the social barriers to PrEP uptake. This study aimed to explore the role of identity resilience (i.e., ability to maintain a positive and stable sense of self) as a predictor for PrEP usage. We hypothesized that PrEP self‐efficacy (i.e., belief in one's ability to take PrEP) would be positively predicted by PrEP acceptability. We also hypothesized that identity worth and identity continuity (components of identity resilience) would be associated with PrEP acceptability and PrEP self‐efficacy. These would be mediated by mistrust in science, PrEP stigma, and perceived risk of HIV. Methods: In total, 500 MSM who were assigned male at birth, were aged ≥18 years, and did not have HIV participated in an online cross‐sectional, psychometric study between June and September 2023. Participants had to be based in the UK but could either be PrEP users or non‐users. Structural equation modelling was used to explore a model of best fit to test the hypotheses. Results: Participants were aged 18–73 years (mean 35.61, standard deviation [SD] 9.95), mostly (91.2%) white, educated to an undergraduate level or above (70.9%), and non‐users of PrEP (58.2%). Model fit was satisfactory: χ ² = 4.51, degrees of freedom = 3, p ‐value = 0.209, comparative fit index 0.997, Tucker Lewis Index 0.972, root mean square of approximation 0.032, and standardized root mean square residual 0.011. Identity worth was positively associated with PrEP self‐efficacy. Identity worth was indirectly associated with PrEP acceptability and PrEP self‐efficacy. The positive association of identity worth and PrEP acceptability was mediated through lower mistrust of science and lower PrEP stigma but not perceived risk of HIV. Conclusions: Results indicate that the decision to take PrEP is associated with the constructs of identity worth (i.e., self‐esteem, self‐efficacy, and distinctiveness) rather than risk‐based appraisals alone. The reasons for accessing and using PrEP may no longer be motivated by an inherent perceived risk of HIV acquisition. When trying to increase PrEP uptake, addressing specific parts of identity resilience may be beneficial. For example, therapeutic interventions (e.g., counselling) could include interventions to improve positive sexual identities and self‐esteem.