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Sex, gender and sexual orientation are diverse, as are the ways of living associated with them. The extent to which people can live a free and self-determined life according to their own body, gender, sexuality and way of life influences their social resources, opportunities for participation and discrimination and has an influence on their life situation and health. A narrative review of lesbian, gay, bisexual, transgender and intersex (LGBTI) health was conducted including international and German reviews, meta-analyses and population-based studies. The focus of this article is the legal, social and medical recognition as well as health status of LGBTI people in Germany. While the legal framework in Germany for homosexual and bisexual people has gradually improved, many civil society stakeholders have pointed to major deficits in the medical and legal recognition of transgender and intersex people. In addition, scientific findings frequently have not yet found its way into medical practice to an adequate extent. Available data on LGBTI health indicate a need for action in the areas of mental health and health care provision. However, due to a lack of comprehensive data, conclusions cannot be drawn on the general health situation and health resources of LGBTI people. For the concrete planning and implementation of measures as well as the differentiated portrayal of the situation in Germany, the databases must be expanded, not least via population-representative surveys.

Geschlechter, sexuelle Orientierungen und die damit verbundenen Lebensweisen sind heterogen. Inwieweit Menschen ihr Geschlecht, ihre Sexualität und ihre Lebensform selbstbestimmt und frei leben können, und mit welchen gesellschaftlichen Ressourcen, Teilhabechancen und Diskriminierungen dies verbunden ist, beeinflusst ihre Lebenslagen und damit auch ihre gesundheitliche Situation. Es wurde ein narratives Review zur gesundheitlichen Situation von lesbischen, schwulen, bisexuellen, trans- und intergeschlechtlichen Personen (LSBTI) durchgeführt und dazu internationale und deutsche Reviews, Metaanalysen und bevölkerungsbezogene Studien herangezogen. Der Beitrag beschreibt schlaglichtartig den Stand der rechtlichen, gesellschaftlichen und medizinischen Anerkennung in Deutschland sowie die gesundheitliche Lage von LSBTI-Personen. Die rechtlichen Rahmenbedingungen in Deutschland haben sich für homo- und bisexuelle Menschen schrittweise verbessert, während für trans- und intergeschlechtliche Personen aus Sicht vieler Akteur*innen bezüglich sowohl der medizinischen als auch rechtlichen Anerkennung noch große Defizite bestehen und wissenschaftliche Erkenntnisse noch ungenügend Eingang in die medizinische Praxis gefunden haben. Die verfügbaren Daten zur gesundheitlichen Situation von LSBTI-Personen verweisen auf Handlungsbedarfe im Bereich der psychischen Gesundheit und der Gesundheitsversorgung. Die Datenlage ist jedoch sehr lückenhaft und lässt kaum Aussagen über die allgemeine gesundheitliche Lage und über gesundheitliche Ressourcen von LSBTI-Personen zu. Für die konkrete Planung und Umsetzung von Maßnahmen und die differenzierte Beschreibung der Situation in Deutschland bedarf es eines Ausbaus der Datengrundlagen, nicht zuletzt auch in bevölkerungsrepräsentativen Erhebungen.

AbstractIntroductionUntil September 2019, pre‐exposure prophylaxis (PrEP) with tenofovir disoproxil/emtricitabine for HIV prevention was not covered by health insurance plans in Germany, and was only available through private prescriptions with self‐pay or through informal non‐prescription sources. The objective of this study was to investigate the proportion of informal PrEP use among PrEP users and to identify factors of public health relevance that might be associated with informal PrEP use.MethodsWe conducted a cross‐sectional study recruiting PrEP users independent of their PrEP source. Clients from anonymous community testing checkpoints, users of three dating apps for men who have sex with men residing in Germany and users of a PrEP community website, were recruited to complete a short anonymous online survey. Participants were recruited between 24 July and 3 September 2018. The results were analysed using univariable and multivariable logistic regressions.ResultsWe recruited 2005 participants currently using PrEP. The median age was 38 years, and 80.3% of the participants identified themselves as male (missing: 19.1%). Overall, 71.6% obtained PrEP through medical services with a private prescription or a clinical trial, and 17.4% obtained PrEP through informal sources (missing: 11.0%). The most common informal sources were ordering online from another country (8.8%), travel abroad (3.6%), and friends (2.5%). Factors associated with informal PrEP use were on demand/intermittent dosing (adjusted OR: 3.5, 95% CI 2.5 to 5.0) and not receiving medical tests during PrEP use (adjusted OR: 3.2, 95% CI 2.0 to 5.2). In addition, informal PrEP users who did not take PrEP daily had a strongly increased risk of starting PrEP without prior medical tests (adjusted stratum‐specific OR = 31.7, 95% CI 4.6 to 219.5).ConclusionsInformal PrEP use was associated with a higher risk of not getting tested before and during PrEP use, which could lead to HIV infections resistant to tenofovir and emtricitabine if people with undiagnosed HIV use PrEP. Health insurance plans that cover PrEP and the accompanying routine tests could ensure adequate medical supervision of PrEP users and reduce barriers to PrEP use. Our findings strongly support the implementation of PrEP programmes in countries with similar patterns of informal PrEP use.

AbstractIntroductionThe population of men‐who‐have‐sex‐with‐men (MSM) includes people who are on the masculine spectrum but were assigned female at birth (AFAB), that is trans MSM. This study aims to identify current circumstances regarding sexual happiness and safety among German trans MSM. To date, there is no health information about trans MSM in Germany, limiting the ability of MSM sexual health programmes to meet their needs.MethodsData were used from the European MSM Internet Survey (EMIS‐2017), where people identifying as men and/or trans men were recruited through dating apps for MSM, community websites and social media to participate in an online survey. We analysed parameters on sexual happiness and satisfaction with sexual safety among Germany‐based trans MSM and compared those to outcomes of MSM assigned male at birth (cis MSM) living in Germany using descriptive methods and logistic regression models adjusting for age.ResultsIn total, 23,001 participants from Germany were included, of which 122 (0.5%) indicated to be AFAB (i.e. trans MSM). Trans MSM were markedly younger than cis participants (median age: 28.5 vs. 39 years).Trans MSM more often reported being unhappy with their current sex life (adjusted odds ratio [aOR] = 1.82, 95% CI 1.24–2.67), had higher odds of disagreeing with the statements "the sex I have is always as safe as I want" ([aOR] = 1.82, 95% CI 1.24–2.67) and "I find it easy to say no to sex that I don't want" ([aOR] = 1.80, 95% CI 1.18–2.77).Trans MSM were more likely to not be living comfortably financially ([aOR] = 2.43, 95% CI 1.60–3.67) and to be living with severe anxiety and/or depression ([aOR] = 3.90, 95% CI 2.22–6.83). Trans MSM were less likely to have ever tested for HIV ([aOR] = 0.63, 95% CI 0.43–0.93).ConclusionsSexual happiness, control of sexual boundaries, satisfaction with sexual safety, financial security, mental wellbeing and HIV testing were all lower in German trans MSM compared with cis MSM. Tailored sexual health interventions, contextualized with regard to needs and vulnerabilities, could address this inequality.