While research to understand and address sexuality-related issues is broadly conducted in multiple settings, cultures, and populations, some contexts are understudied. There is limited evidence of sex research conducted in Puerto Rico. Most of the sexuality research conducted in Puerto Rico has been implemented in the last two decades. It heavily focuses on sexually transmitted infections and the experiences of sexual and gender minority populations. Further, there is limited evidence of how research findings have translated to interventions or programs to create conditions for enjoying the multiple aspects of sexuality in Puerto Rico. During this plenary, the presenters will discuss the history of sex research in Puerto Rico and the challenges to conducting sexuality research with different populations. Similarly, they will discuss the current research been undertaken to improve the sexual health of those disproportionally affected by the HIV epidemic and sexual and gender minorities. These research experiences and findings will be contextualized for the development, implementation, and evaluation interventions with different Puerto Rico populations.

Identity is a core sense of self-sameness and continuity over time of who one is, including who one is in relation to and connected to others (Erikson, 1980). My research has focused on sexual identity development among cisgender individuals, most particularly lesbian, gay, bisexual, and other sexual minority (LGB+) youth. I have defined identity as consisting of two major components of formation and integration and have specified their parsimonious dimensions. Identity formation concerns self-discovery and exploration of the identity. For sexual identity development, it involves becoming aware of one’s sexual orientation, questioning whether one might be a sexual minority, and having sex with same-sex and perhaps other-sex partners. Identity integration concerns increasing commitment to the identity and forging connections to others based on the identity. For sexual identity development, it consists of engaging in LGB-related social activities, working through negative attitudes toward homosexuality or bisexuality, feeling comfortable with nonspecific others knowing about the identity, and disclosing that identity to specific others. Sexual identity formation and integration may unfold in different ways and at different speeds and developmental ages. These hypotheses were empirically confirmed (Ott et al., 2011; Rosario, Schrimshaw, Hunter, et al., 2006; Rosario et al., 2008b; Rosario, 2019).

Sexual Identity Development and Health and Other Adaptation 
Identity has implications for adaptation because prices are paid for arrested development of the self. The strength of the relation varies with the importance of the identity and extent of its integration. Sexual identity composes an important identity, potentially affecting many facets of one’s life. My research shows that sexual identity development is related to less psychological distress, fewer sexual risk behaviors, and less substance use among youth (Rosario et al., 2001, 2004, 2011; Rosario, Schrimshaw, & Hunter, 2006). Some relations are complex. For example, initial involvement in LGB-related social activities was associated with substance use, but, over time, more involvement was related to less substance use (Rosario et al., 2004), perhaps suggesting that initial substance use gradually subsided as the anxiety of entering a new community and learning its ways diminshed. Although some results found identity formation, whether occurring recently or sometime ago, was unrelated to psychological distress and self-esteem (Rosario et al., 2011), other findings indicated that identity formation in early adolescence was related to subsequent psychological distress (Katz-Wise et al., 2017b). The latter may suggest that enhanced cognitive capabilities are need to manage identity formation and its implications. Identity integration was related to subsequent adaptation: those with low identity integration reported elevated psychological distress and low self-esteem, and those with high integration had the lowest levels of distress and highest self-esteem (Rosario et al., 2011).

Sexual Identity Development and Stress 
Identity exists in relation to and informed by others; thus, it may be respected or stigmatized by others. Minority or sexual minority stress refers to experiencing society’s stigmatization of homosexuality/bisexuality and of anyone considered to be a sexual minority. LGB+ youth experience more victimization than heterosexual peers (Russell et al., 2014). Comparable stressful events are related to subsequent discomfort with their sexuality (Rosario et al., 2002), as well as more psychological distress (Rosario et al., 2002) and substance use (Rosario et al., 2008a). The stress is not just external; it is internalized, ensuring that sexual minority individuals must work through their negative attitudes toward and discomfort with their identity as part of their development. Indeed, stress and sexual identity development may overlap; for example, sexual identity disclosure is a marker of identity integration, but disclosure proves stressful if the individual is rejected (Rosario, Schrimshaw, & Hunter, 2009). Whether it is a challenging sexual identity developmental process or elevated stress, LGB+ youth are at risk for poor health in the short- and long-term relative to heterosexual peers. The poor health extends beyond mental to physical health. They engage in cancer risk behaviors (Rosario, Corliss, Everett, Reisner, Austin, et al., 2014). The behaviors persist over time (Rosario et al., 2016) and victimization partly explains the disparities in the cancer risk behaviors between LGB+ and heterosexual youth (Rosario, Corliss, Everett, Russell, Buchting, et al., 2014). Nevertheless, identity integration is beneficial for the health of LGB+ youth (Rosario et al., 2011).

Nascent Sexual Identity and Its Implications 
Understanding of sexual identity development must extend beyond the individual’s awareness of being a sexual minority. Indirect evidence of the prenatal roots of same-sex behavior has existed for some time (Rosario & Schrimshaw, 2014) and the genetic markers of such behavior have been identified by others (Ganna et al., 2019). Therefore, a nascent LGB+ child may exist at birth. Although the child is unaware of the sexual identity, others may infer it by means of gender nonconforming behaviors, which are more common among nascent LGB+ than heterosexual children (Roberts et al., 2012a). The behaviors may affect how others respond to the child. By the time the child becomes aware of the sexual minority identity, a great deal of sexual minority stress may have been experienced. Childhood maltreatment is more common among sexual minority individuals than heterosexual peers, as a meta-analysis by others found (Friedman et al., 2011). The maltreatment is partly attributed to gender nonconformity (Roberts et al., 2012b) and gender nonconformity is related to subsequent psychological distress (Roberts et al., 2012b, 2013). Attachment—the profound sense of safety and security, or its absence, that begins in infancy—is also affected, given the maltreatment. Sexual minority individuals report less secure attachment to their mothers than do heterosexual peers and attachment mediates disparities by sexual orientation in subsequent psychological distress and substance use (Rosario, Reisner, Corliss, Wypij, Calzo, et al., 2014; Rosario, Reisner, Corliss, Wypij, Frazier, et al., 2014). Hypotheses concerning the role of attachment in stress and sexual identity development have been advanced (Rosario, 2015).

Future Endeavors 
1. Careful focus is needed on early childhood experiences with known implications for subsequent adaptation: adverse childhood experiences (ACEs) of maltreatment and family dysfunction, attachment, gender nonconformity, and peer relationships. Of interest is the experiences of LGB+ and heterosexual individuals in these areas and the implications of the experiences and those of sexual identity development for subsequent health and other adaptation.
2. Sexual identity development continues to unfold in the middle years of life and potentially throughout life. Why? For whom? Under what circumstances? What was happening in the years preceding the change? 
3. Sexual identity is but one identity; the individual has others, such as sex, gender, ethnic or racial identity. How multiple identities interact requires attention. Some work has been done on the interaction of sex and sexual identity among cisgender individuals, but more is needed. Too little work has investigated differences by ethnicity or race. Even less is known about sexual identity and gender identity. For example, how do transgender individuals experience their sexual identity? How do researchers conceptualize their sexual identity?

Sex work occupies a legally gray space in Johannesburg, South Africa, and police attitudes towards it are inconsistent and largely unregulated. This results in both room for negotiation that can benefit sex workers and also extreme precarity in which the security police officers provide can be offered and taken away at a moment's notice. Sex work straddles the line between formal and informal. Attitudes about beauty and subjective value are manifest in formal tasks, including police activities, which are often conducted in a seemingly ad hoc manner. However, high-level organizational directives intended to regulate police obligations and duties toward sex workers also influence police action and tilt the exercise of discretion to the formal. In this liminal space, this talk will consider how sex work is policed and how it should be policed. Challenging discourses about sexuality and gender that inform its regulation, this presentation will expose the limitations of dominant feminist arguments regarding the legal treatment of sex work. It will illustrate the tension between enforcing a country's laws and protecting citizens' human rights.

Britney Spears’ struggle against the conservatorship she is under has attracted a lot of media publicity to the topic of guardianship and conservatorship in the United States and the struggles that people face when they face the “Civil Death” that such a process is. At the same time, a major goal of the LGBTQ movement is the banning of the discredited attempts at changing a vulnerable person’s gender identity or sexual orientation, known as conversion therapy. The goal of this lecture is to discuss the ways in which guardianship/conservatorship intersect with the need to protect LGBTQ people from conversion therapy, particularly those with developmental, intellectual, and mental health disabilities who find themselves under a guardianship or conservatorship. This talk advocates for changes to the law to protect said vulnerable populations, as well as reforms to the overall system of guardianship and conservatorship.