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Walters JK, Mew MC, Repp KK. Transgender and Nonbinary Deaths Investigated by the State Medical Examiner in the Portland, Oregon, Metro Area and Their Concordance With Vital Records, 2011-2021. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:64-70. [PMID: 36112168 DOI: 10.1097/phh.0000000000001582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To illustrate possible improvements in recording of gender identity, we investigated discrepancies between gender identity from medical examiner (ME) death investigations and sex as recorded in the final death record. DESIGN Evaluation of a database used to record information related to medicolegal death investigation with matching to state vital records. Kappa analysis was used to measure concordance between both systems. SETTING The Portland, Oregon, metro area (Clackamas, Multnomah, and Washington Counties) and deaths investigated by the Offices of each County Medical Examiner between January 2011 and September 2020. INTERVENTION Epidemiologists identified incongruous data that have significant negative implications for transgender populations. Epidemiologists identified key actions that, if taken by death investigators, death record software, and the federal death certificate form, will rectify harmful data discrepancies. MAIN OUTCOME MEASURE Concordance of gender identity and sex in ME data and death record, respectively. RESULTS We identified 51 deaths in transgender persons; the majority were classified as transgender female (71%). The κ statistic was -0.0657, indicating poor concordance between the gender identity in ME investigation and the death certificate in vital records. CONCLUSIONS Information gathered via medicolegal death investigations is foundational to effective public health/public safety response; MEs and coroners are often the first to document emerging health threats. Discrepancies in official death records impede accurate surveillance of a population disproportionately at risk of violent death.
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Affiliation(s)
- Jaime K Walters
- Multnomah County Health Department, Public Health Division, Community Epidemiology Services, Portland, Oregon (Ms Walters); Clackamas County Health, Housing and Human Services Department, Public Health Division, Oregon City, Oregon (Ms Mew); and Washington County Health and Human Services Department, Public Health Division, Research, Analytics, Informatics, and Data (RAID) Program, Hillsboro, Oregon (Dr Repp)
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Ssekamatte T, Nalugya A, Isunju JB, Naume M, Oputan P, Kiguli J, Wafula ST, Kibira SPS, Ssekamatte D, Orza L, Mugambe RK, Wanyenze RK. Help-seeking and challenges faced by transwomen following exposure to gender-based violence; a qualitative study in the Greater Kampala Metropolitan Area, Uganda. Int J Equity Health 2022; 21:171. [PMID: 36463185 PMCID: PMC9719638 DOI: 10.1186/s12939-022-01786-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 11/10/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The high prevalence of gender-based violence (GBV) among transwomen is a human rights and public health challenge. Nonetheless, there is limited evidence of sources of GBV support services and the challenges faced by transwomen while help-seeking, especially in transphobic settings like Uganda. This study explored the sources of GBV support services and the challenges faced by transwomen in the Greater Kampala Metropolitan Area during help-seeking. METHODS A qualitative study design involving 60 transwomen and 10 key informants was conducted. Respondents were recruited using snowball sampling. An in-depth interview (IDI), and a focus group discussion guide were used to collect data from 20 IDI respondents and six focus group discussants. Each focus group discussion averaged six participants. A key informant interview guide was used for key informant interviews. Data were transcribed verbatim and analysed following a thematic framework, informed by the socio-ecological model. Data were organised into themes and subthemes using NVivo 12.0. RESULTS The sources of support following exposure to GBV included key population-friendly healthcare facilities and civil society organisations (CSOs), and friends and family. Friends and family provided emotional support while key population-friendly healthcare facilities offered medical services including HIV post-exposure prophylaxis. Key population CSOs provided shelter, nutritional support, and legal advice to GBV victims. Lack of recognition of transgender identity; long distances to healthcare facilities; discrimination by healthcare providers and CSO staff, inappropriate questioning of the trans-gender identity by police officers and healthcare providers, and the lack of trans-competent healthcare providers and legal personnel hindered help-seeking following exposure to GBV. CONCLUSION The immediate sources of GBV support services included key population-friendly healthcare facilities and CSOs, police, and friends and family. However, a significant number of transwomen did not report incidences of GBV. Transwomen were discriminated against at some key population healthcare facilities and CSOs, and police, which hindered help-seeking following exposure to GBV. This study highlights the need to tackle internalized stigma and discrimination against transwomen at the existing sources of GBV support. There is also a need to train law enforcers and legal personnel on the right to access healthcare among transwomen in Uganda.
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Affiliation(s)
- Tonny Ssekamatte
- grid.11194.3c0000 0004 0620 0548Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Gate Rd, Kampala, Uganda
| | - Aisha Nalugya
- grid.11194.3c0000 0004 0620 0548Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Gate Rd, Kampala, Uganda
| | - John Bosco Isunju
- grid.11194.3c0000 0004 0620 0548Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Gate Rd, Kampala, Uganda
| | - Muyanga Naume
- Programs Department, Transgender Equality Uganda, Kampala, Uganda
| | - Patience Oputan
- grid.11194.3c0000 0004 0620 0548Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Gate Rd, Kampala, Uganda
| | - Juliet Kiguli
- grid.11194.3c0000 0004 0620 0548Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, New Mulago Gate Rd, Kampala, Uganda
| | - Solomon Tsebeni Wafula
- grid.11194.3c0000 0004 0620 0548Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Gate Rd, Kampala, Uganda
| | - Simon Peter S. Kibira
- grid.11194.3c0000 0004 0620 0548Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, New Mulago Gate Rd, Kampala, Uganda
| | - David Ssekamatte
- grid.442646.60000 0004 0644 3312Department of Management, Uganda Management Institute, Plot 44-52, Jinja Road, Kampala, Uganda
| | | | - Richard K. Mugambe
- grid.11194.3c0000 0004 0620 0548Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Gate Rd, Kampala, Uganda
| | - Rhoda K. Wanyenze
- grid.11194.3c0000 0004 0620 0548Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Gate Rd, Kampala, Uganda
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Nnawulezi N, Rieger A, Shaw J, Greeson M, Lichty L, Allen NE. Reflecting and rejuvenating our work, together: One team's consideration of AJCP publications on gender-based violence. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 70:255-264. [PMID: 35698858 DOI: 10.1002/ajcp.12603] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/10/2022] [Accepted: 04/15/2022] [Indexed: 06/15/2023]
Abstract
Community psychology has long valued reflexive praxis as a critical part advancing our research and action. In this Virtual Special Issue (VSI), we, a group of community psychologists and gender-based violence (GBV) researchers at many different points in our careers, reflected on GBV publications that have appeared in AJCP. We examine the ways in which community psychology broadly and articles in AJCP more specifically have conceptualized GBV as a sociocultural issue, how GBV intersects with other oppressions and forms of violence, the tension when systems that aspire to support survivors are inequitable and focused on ameliorative change, and the importance of interventions being locally informed and locally driven. By highlighting selected GBV-focused articles published in AJCP, this VSI discusses (a) understanding and transforming culture via robust research and local partnerships, (b) targeting effective interventions for survivors, (c) invoking systems and targeting change in institutional environments, and (d) making connections between local efforts and broader social movements. To continue to move forward, we conclude we must reflect, embrace methodological plurality, partner, and push for structural change. Reflective questions regarding research and action are offered, to address gender-based violence.
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Affiliation(s)
- Nkiru Nnawulezi
- Department of Psychology, University of Maryland, Baltimore, Maryland, USA
| | - Agnes Rieger
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA
| | - Jessica Shaw
- Department of Psychology, University of Illinois Chicago, Chicago, Illinois, USA
| | - Megan Greeson
- Department of Psychology, DePaul University, Chicago, Illinois, USA
| | - Lauren Lichty
- School of Interdisciplinary Arts and Sciences, University of Washington, Bothell, Washington, USA
| | - Nicole E Allen
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA
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Kattari SK, Kattari L, Lacombe-Duncan A, Shelton J, Misiolek BA. Differential Experiences of Sexual, Physical, and Emotional Intimate Partner Violence Among Transgender and Gender Diverse Adults. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP23281-NP23305. [PMID: 35271412 DOI: 10.1177/08862605221078805] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Various forms of intimate partner violence (IPV) are unfortunately common amongst adults in the United States, and these rates are devastatingly higher for transgender and gender diverse (TGD) individuals than for the general population. However, the TGD population is not monolithic, and is diverse regarding gender, sexual orientation, age, race/ethnicity, urbanicity, and other sociodemographic categories. This study uses data from the 2018 Michigan Trans Health Survey to explore these within group differences regarding sexual, physical, and emotional forms of IPV using chi-square tests of independence and logistic regressions. Chi square tests of independence found homelessness had significant associations across all outcome variables: "ever experienced physical violence from a partner," "ever experienced forced sex from a partner," "ever been threatened to be outed by a partner," and "ever had gender belittled by a partner." Gender identity and sexual orientation had significant associations with "ever experienced forced sex from a partner," "ever been threatened to be outed by a partner," and "ever had gender belittled by a partner." Urbanicity showed a significant association with "ever being threatened to be outed by a partner." In the logistic regressions, age indicated significantly higher likelihood of IPV physical IPV with each year of age; experiences of homelessness were significantly related to likelihood for all outcomes variables. Gender and sexual orientation were also significant across the models, with differing levels of likeliness depending on identities. Findings demonstrate a need for TGD inclusive programming, and specifically programs that target TGD persons who are older, report additional genders (meaning, multiple identities and/or identities besides transfeminine, transmasculine, or nonbinary), queer sexual orientations, and who are/have experienced homelessness. Programs are needed both in the realms of intimate partner violence prevention work and social services that support survivors of violence, such as mental health clinics, rape crisis centers, and shelters.
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Affiliation(s)
| | | | | | - Jama Shelton
- Hunter College, City University of New York, 366436New York, NY, USA
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Rebchook GM, Chakravarty D, Xavier JM, Keatley JG, Maiorana A, Sevelius J, Shade SB. An evaluation of nine culturally tailored interventions designed to enhance engagement in HIV care among transgender women of colour in the United States. J Int AIDS Soc 2022; 25 Suppl 5:e25991. [PMID: 36225153 PMCID: PMC9557010 DOI: 10.1002/jia2.25991] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 08/02/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Transgender women (TW) worldwide have a high prevalence of HIV, and TW with HIV encounter numerous healthcare barriers. It is critical to develop evidence-informed interventions to improve their engagement in healthcare to achieve durable viral suppression (VS). We evaluated whether participation in one of nine interventions designed specifically for TW was associated with improved engagement in HIV care among transgender women of colour (TWC). METHODS Between 2013 and 2017, nine US organizations implemented nine distinct and innovative HIV care engagement interventions with diverse strategies, including: individual and group sessions, case management and navigation, outreach, drop-in spaces, peer support and/or incentives to engage TWC with HIV in care. The organizations enrolled 858 TWC, conducted surveys, captured intervention exposure data and extracted medical record data. Our evaluation of the interventions employed a pre-post design and examined four outcomes-any HIV care visit, antiretroviral therapy (ART) prescription, retention in HIV care and VS (both overall and among those with a clinic visit and viral load test), at baseline and every 6 months for 24 months. We employed logistic generalized estimating equations to assess the relative odds of each outcome at 12 and 24 months compared to baseline. RESULTS Overall, 79% of participants were exposed to at least one intervention activity. Over 24 months of follow-up, participants received services for a median of over 6 hours (range: 3-69 hours/participant). Compared to baseline, significantly (p<0.05) greater odds were demonstrated at both 12 and 24 months for three outcomes: prescription of ART (ORs: 1.42 at 12 months, 1.49 at 24 months), VS among all participants (ORs: 1.49, 1.54) and VS among those with a clinic visit and viral load test (ORs: 1.53, 1.98). The outcomes of any HIV care visit and retention in HIV care had significantly greater odds (ORs: 1.38 and 1.58, respectively) only at 12 months compared to baseline. CONCLUSIONS These evaluation results illustrate promising approaches to improve engagement in HIV care and VS among TWC with HIV. Continued development, adaptation and scale-up of culturally tailored HIV care interventions for this key population are necessary to meet the UNAIDS 95-95-95 goals.
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Affiliation(s)
- Gregory M. Rebchook
- Division of Prevention ScienceDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Deepalika Chakravarty
- Division of Prevention ScienceDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | | | - JoAnne G. Keatley
- Division of Prevention ScienceDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA,Innovative Response Globally for Transgender Women and HIV (IRGT)San FranciscoCaliforniaUSA
| | - Andres Maiorana
- Division of Prevention ScienceDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Jae Sevelius
- Division of Prevention ScienceDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Starley B. Shade
- Division of Prevention ScienceDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA,Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCaliforniaUSA
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Brown SJ, Carter GJ, Halliwell G, Brown K, Caswell R, Howarth E, Feder G, O'Doherty L. Survivor, family and professional experiences of psychosocial interventions for sexual abuse and violence: a qualitative evidence synthesis. Cochrane Database Syst Rev 2022; 10:CD013648. [PMID: 36194890 PMCID: PMC9531960 DOI: 10.1002/14651858.cd013648.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND It is well-established that experiencing sexual abuse and violence can have a range of detrimental impacts; a wide variety of interventions exist to support survivors in the aftermath. Understanding the experiences and perspectives of survivors receiving such interventions, along with those of their family members, and the professionals who deliver them is important for informing decision making as to what to offer survivors, for developing new interventions, and enhancing their acceptability. OBJECTIVES This review sought to: 1. identify, appraise and synthesise qualitative studies exploring the experiences of child and adult survivors of sexual abuse and violence, and their caregivers, regarding psychosocial interventions aimed at supporting survivors and preventing negative health outcomes in terms of benefits, risks/harms and barriers; 2. identify, appraise and synthesise qualitative studies exploring the experiences of professionals who deliver psychosocial interventions for sexual abuse and violence in terms of perceived benefits, risks/harms and barriers for survivors and their families/caregivers; 3. develop a conceptual understanding of how different factors influence uptake, dropout or completion, and outcomes from psychosocial interventions for sexual abuse and violence; 4. develop a conceptual understanding of how features and types of interventions responded to the needs of different user/survivor groups (e.g. age groups; types of abuse exposure; migrant populations) and contexts (healthcare/therapeutic settings; low- and middle-income countries (LMICs)); 5. explore how the findings of this review can enhance our understanding of the findings from the linked and related reviews assessing the effectiveness of interventions aimed at supporting survivors and preventing negative health outcomes. SEARCH METHODS In August 2021 we searched MEDLINE, Embase, PsycINFO and nine other databases. We also searched for unpublished reports and qualitative reports of quantitative studies in a linked systematic review, together with reference checking, citation searches and contacting authors and other researchers to identify relevant studies. SELECTION CRITERIA We included qualitative and mixed-methods studies (with an identifiable qualitative component) that were linked to a psychosocial intervention aimed at supporting survivors of sexual abuse and violence. Eligible studies focused on at least one of three participant groups: survivors of any age, gender, sexuality, ethnicity or [dis]ability who had received a psychosocial intervention; their carers, family members or partners; and professionals delivering such interventions. We placed no restrictions in respect of settings, locations, intervention delivery formats or durations. DATA COLLECTION AND ANALYSIS Six review authors independently assessed the titles, abstracts and full texts identified. We extracted data using a form designed for this synthesis, then used this information and an appraisal of data richness and quality in order to stratify the studies using a maximum variation approach. We assessed the methodological limitations using the Critical Skills Appraisal Programme (CASP) tool. We coded directly onto the sampled papers using NVivo and synthesised data using a thematic synthesis methodology and used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each finding. We used a narrative synthesis and matrix model to integrate our qualitative evidence synthesis (QES) findings with those of intervention review findings. MAIN RESULTS We identified 97 eligible studies and sampled 37 of them for our analysis. Most sampled studies were from high-income countries, with four from middle-income and two from low-income countries. In 27 sampled studies, the participants were survivors, in three they were intervention facilitators. Two included all three of our stakeholder groups, and five included two of our groups. The studies explored a wide range of psychosocial interventions, with only one type of intervention explored in more than one study. The review indicates that features associated with the context in which interventions were delivered had an impact on how individuals accessed and experienced interventions. This included organisational features, such as staff turnover, that could influence survivors' engagement with interventions; the setting or location in which interventions were delivered; and the characteristics associated with who delivered the interventions. Studies that assess the effectiveness of interventions typically assess their impact on mental health; however, as well as finding benefits to mental health, our QES found that study participants felt interventions also had positive impacts on their physical health, mood, understanding of trauma, interpersonal relationships and enabled them to re-engage with a wide range of areas in their lives. Participants explained that features of interventions and their contexts that best enabled them to benefit from interventions were also often things that could be a barrier to benefiting from interventions. For example, the relationship with the therapist, when open and warm was a benefit, but if such a relationship could not be achieved, it was a barrier. Survivors' levels of readiness and preparedness to both start and end interventions could have positive (if they were ready) or negative (if they were not) impacts. Study participants identified the potential risks and harms associated with completing interventions but felt that it was important to face and process trauma. Some elements of interventions were specific to the intervention type (e.g. faith-based interventions), or related to an experience of an intervention that held particular relevance to subgroups of survivors (e.g. minority groups); these issues could impact how individuals experienced delivering or receiving interventions. AUTHORS' CONCLUSIONS We had high or moderate confidence in all but one of our review findings. Further research in low- and middle-income settings, with male survivors of sexual abuse and violence and those from minority groups could strengthen the evidence for low and moderate confidence findings. We found that few interventions had published quantitative and qualitative evaluations. Since this QES has highlighted important aspects that could enable interventions to be more suitable for survivors, using a range of methodologies would provide valuable information that could enhance intervention uptake, completion and effectiveness. This study has shown that although survivors often found interventions difficult, they also appreciated that they needed to work through trauma, which they said resulted in a wide range of benefits. Therefore, listening to survivors and providing appropriate interventions, at the right time for them, can make a significant difference to their health and well-being.
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Affiliation(s)
- Sarah J Brown
- School of Law and Society, University of the Sunshine Coast, Sippy Downs, Australia
- Faculty of Health and Applied Sciences (HAS), University of the West of England (UWE), Bristol, UK
| | - Grace J Carter
- Institute for Health and Wellbeing, Coventry University, Coventry, UK
| | - Gemma Halliwell
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Katherine Brown
- Department of Psychology and Sports Science, University of Hertfordshire, Hatfield, UK
| | - Rachel Caswell
- Sexual Health and HIV Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Emma Howarth
- School of Psychology, University of East London, London, UK
| | - Gene Feder
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lorna O'Doherty
- Institute for Health and Wellbeing, Coventry University, Coventry, UK
- Department of General Practice, The University of Melbourne, Melbourne, Australia
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Soled KRS, Dimant OE, Tanguay J, Mukerjee R, Poteat T. Interdisciplinary clinicians' attitudes, challenges, and success strategies in providing care to transgender people: a qualitative descriptive study. BMC Health Serv Res 2022; 22:1134. [PMID: 36076288 PMCID: PMC9454229 DOI: 10.1186/s12913-022-08517-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/30/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Access to clinicians competent in transgender health remains a significant barrier and contributor toward health inequity for transgender people. Studies on access and barriers to care have predominantly evaluated transgender patients' perceptions, but scant research has included the perspectives of clinicians. AIMS We conducted a qualitative study to explore how clinicians (meaning physicians and advanced practice providers, in this paper) in the United States: (1) attain and utilize information, (2) perceive barriers and facilitators, and (3) understood gaps in their professional training, in regard to practicing transgender health care. METHODS A Qualitative Descriptive approach guided our conventional content analysis of field notes and interviews with clinicians within a parent study that explored health care access among transgender adults. Transcripts were coded into meaning units that were iteratively abstracted into themes. Standard measures were performed to promote the trustworthiness of the analysis and reduce bias. RESULTS Participants (n = 13) consisted of physicians (n = 8), physician assistants (n = 3), and nurse practitioners (n = 2). The majority were women (n = 11), identified as White (n = 9), cisgender (n = 13), and ages ranged from 31 - 58 years. Five main themes were identified: (1) Knowledge Acquisition: Formal and Informal Pathways to Competency; (2) Perceived Challenges and Barriers: I didn't know what I was doing; (3) Power to Deny: Prescriptive Authority and Gatekeeping; (4) Stigma: This is really strange, and I can't really understand it; (5) Reflections: Strategies for Success, Rewards, and Personal Motivations. DISCUSSION Clinicians gained a sense of comfort and competence with mentorship, self-directed learning, clinical experience, and person-centered, harm-reduction approaches. Stigma, bias, and structural-level factors were barriers to providing care. This study offers a unique perspective of clinicians' motivations and strategies for providing gender-affirming care and elucidates how stigma impacts the delivery of gender-affirming care.
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Affiliation(s)
- Kodiak Ray Sung Soled
- grid.38142.3c000000041936754XDepartment of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA USA ,grid.21729.3f0000000419368729Columbia University School of Nursing, New York, NY USA
| | - Oscar E. Dimant
- grid.415191.90000 0000 9146 3393Rutgers-New Jersey, Medical School, Kessler Institute for Rehabilitation, Newark, NJ USA
| | - Jona Tanguay
- grid.429506.c0000 0004 4670 6287Whitman-Walker Health, Washington, District of Columbia USA
| | - Ronica Mukerjee
- grid.21729.3f0000000419368729Columbia University School of Nursing, New York, NY USA
| | - Tonia Poteat
- grid.410711.20000 0001 1034 1720Department of Social Medicine, University of North Carolina, Chapel Hill, NC USA
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Diana P, Esposito S. LGBTQ+ Youth Health: An Unmet Need in Pediatrics. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1027. [PMID: 35884011 PMCID: PMC9325167 DOI: 10.3390/children9071027] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 11/19/2022]
Abstract
At present, lesbian, gay, bisexual, transgender, queer and intersex people (LGBTQ+) are increasingly being empowered to freely express themselves, particularly young people and rising generations. Although data underline the trend of more open expression of different sexual orientations and gender identities, LGBTQ+ adolescents still suffer discrimination in the health care framework. Inclusive care by providers to look after the health of LGBTQ+ indiviuals is needed. Pediatricians are often the first health care providers for LGBTQ+ youth facing their sexual and gender identities. Unfortunately, pediatricians have limited knowledge about LGBTQ+ issues, which keeps them from fulfilling the specific needs of LGBTQ+ youth. The purpose of this review is to frame the most important aspects of LGBTQ+ youths' lives, including risks, difficulties and needs, that pediatricians should investigate and meet to provide these youth with better and more individualizedassistance regarding their health. A literature analysis showed that pediatricians have insufficient knowledge of and comfort with several items regarding the management of LGBTQ+ youths. Increased awareness and knowledge of the specific and exclusive needs of LGBTQ+ adolescents are mandatory, including dedicated pediatric LGBTQ+ health care training. This would give them the opportunity to forward an inclusive health care system, thus reducing the risks related to stigma, bullying and family rejection and promoting sex education. Further studies are needed to better evaluate the prevalence of LGBTQ+ youths, gender-based medicine in pediatrics and the effects of COVID-19 on the LGBTQ+ younth population due to increased risks of psychosocial suffering, isolation and mental diseases.
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Affiliation(s)
| | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy;
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Sherman ADF, Balthazar MS, Daniel G, Bonds Johnson K, Klepper M, Clark KD, Baguso GN, Cicero E, Allure K, Wharton W, Poteat T. Barriers to accessing and engaging in healthcare as potential modifiers in the association between polyvictimization and mental health among Black transgender women. PLoS One 2022; 17:e0269776. [PMID: 35709158 PMCID: PMC9202936 DOI: 10.1371/journal.pone.0269776] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/27/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Black transgender women endure pervasive polyvictimization (experiencing multiple forms of violence throughout the lifespan). Polyvictimization is associated with poor mental health. Black transgender women also face barriers in access to healthcare, but the extent that such barriers modify the association between polyvictimization and poor mental health has not been described using convergent mixed-methods analysis. METHODS This convergent mixed-methods secondary analysis employs an intersectional lens and integrates two inter-related datasets to describe barriers to healthcare and the extent that such barriers modify the association between polyvictimization and mental health among Black transgender women. Investigators used survey data (n = 151 participants) and qualitative interview data (n = 19 participants) collected from Black transgender women (age 18 years and older) in Baltimore, MD and Washington, DC between 2016 and 2018. Analyses include thematic content analysis, bivariate analysis, joint display, and multivariate linear regression analysis examining mediation and moderation. RESULTS Joint display illuminated three domains to describe how barriers to healthcare present among Black transgender women-Affordability, Accessibility, and Rapport and Continuity. Independent t-tests revealed significantly higher polyvictimization, Post Traumatic Stress Disorder (PTSD), and depression scores among participants who reported at least one barrier to healthcare (BHI) compared to those who reported no barriers. BHI significantly moderated and partially mediated the association between polyvictimization and PTSD symptom severity and BHI fully mediated the association between polyvictimization and depressive symptom severity-when accounting for age and location. DISCUSSION Findings highlight the importance of access to healthcare in modifying the association between polyvictimization and PTSD and depression symptom severity among Black transgender women. Findings call for immediate interventions aimed at reducing barriers to healthcare and improved training for clinical providers serving Black transgender women.
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Affiliation(s)
- Athena D. F. Sherman
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States of America
| | - Monique S. Balthazar
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States of America
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, Georgia, United States of America
| | - Gaea Daniel
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States of America
| | - Kalisha Bonds Johnson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States of America
| | - Meredith Klepper
- Johns Hopkins School of Nursing, Baltimore, Maryland, United States of America
| | - Kristen D. Clark
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, California, United States of America
| | - Glenda N. Baguso
- Center for AIDS Prevention Studies, University of California, San Francisco, California, United States of America
| | - Ethan Cicero
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States of America
| | - Kisha Allure
- Casa Ruby, Washington, DC, United States of America
| | - Whitney Wharton
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States of America
| | - Tonia Poteat
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
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Hughes LD, King WM, Gamarel KE, Geronimus AT, Panagiotou OA, Hughto JM. Differences in All-Cause Mortality Among Transgender and Non-Transgender People Enrolled in Private Insurance. Demography 2022; 59:1023-1043. [PMID: 35548863 PMCID: PMC9195044 DOI: 10.1215/00703370-9942002] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Few studies have analyzed mortality rates among transgender (trans) populations in the United States and compared them to the rates of non-trans populations. Using private insurance data from 2011 to 2019, we estimated age-specific all-cause mortality rates among a subset of trans people enrolled in private insurance and compared them to a 10% randomly selected non-trans cohort. Overall, we found that trans people were nearly twice as likely to die over the period as their non-trans counterparts. When stratifying by gender, we found key disparities within trans populations, with people on the trans feminine to nonbinary spectrum being at the greatest risk of mortality compared to non-trans males and females. While we found that people on the trans masculine to nonbinary spectrum were at a similar risk of overall mortality compared to non-trans females, their overall mortality rate was statistically smaller than that of non-trans males. These findings provide evidence that some trans and non-trans populations experience substantially different mortality conditions across the life course and necessitate further study.
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Affiliation(s)
- Landon D. Hughes
- School of Public Health and Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Wesley M. King
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Arline T. Geronimus
- School of Public Health and Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
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Wilson EC, Hernandez CJ, Arayasirikul S, Scheer S, Trujillo D, Sicro S, Turner CM, McFarland W. In Their Own Words: How Trans Women Acquired HIV Infection. AIDS Behav 2022; 26:2091-2098. [PMID: 35031891 DOI: 10.1007/s10461-021-03555-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 11/01/2022]
Abstract
Despite high HIV prevalence, the reasons trans women acquire HIV are not well understood. Trans women are often mis-classified or aggregated with men who have sex with men (MSM) in epidemiologic studies and HIV surveillance data. Trans women enrolled in the 2019/2020 National HIV Behavioral Surveillance Study in San Francisco were asked an open-ended question about how they were infected with HIV. The most common responses were "Sex with a straight cisgender man partner when the respondent identified as a trans woman" (43.0%); "Sexual assault" (13.9%); "Injection drug use (IDU)" (10.1%); "IDU or sexual contact" (7.6%) and "Sex with a partner who injected drugs" (7.6%). Sex with a cisgender man partner prior to identifying as a trans women (MSM contact) was not mentioned by any respondent. HIV prevention strategies targeting MSM will fail to reach trans women and many of their cisgender men partners.
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Albarracin M, Poirier P. Enacting Gender: An Enactive-Ecological Account of Gender and Its Fluidity. Front Psychol 2022; 13:772287. [PMID: 35615182 PMCID: PMC9125095 DOI: 10.3389/fpsyg.2022.772287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
This paper aims to show that genders are enacted, by providing an account of how an individual can be said to enact a gender and explaining how, consequently, genders can be fluid. On the enactive-ecological view we defend, individuals first and foremost perceive the world as fields of affordances, that is, structured sets of action possibilities. Fields of natural affordances offer action possibilities because of the natural properties of organisms and environments. Handles offer graspability to humans because of physical-structural properties of handles and the anatomical-physiological properties of humans. Although humans live in fields of bodily, action, and cultural affordances, our work focuses on cultural affordances, where action possibilities are offered to individuals because of the normative responses of individuals in that culture. Knocking on a door affords entrance because knocking provides cultured individuals on the other side of the door an affordance to which they themselves behave normatively. Usually, behaving normatively in response to cultural affordances brings about sequences of perception-action loops, which we will call "scripts": for instance, closed doors afford knocking, which affords the individual inside opening the door, which affords an interpersonal meeting, which (may) afford entrance. Although the notion of script has a strong cognitivist flavor, one of the aims of the paper to provide an ecological account of scripts, to show that what cognitivists viewed as representations (or representational structures) are in fact environmentally structured perception-action loops. On our account of gender, gendered cultures build and maintain gendered cultural affordance landscapes, that is, landscapes in which the action possibilities individuals face are normed according to a specific body type or situation; most often (assigned) biological sex. Individuals enact a given gender when they come to perceive the affordances reserved for one gender by their culture and respond in the culturally normative way, thus enacting gendered sequences of perception-action loops (i.e., gendered scripts). With the shifting landscapes of cultural affordances brought about by several recent social, technological, and epistemic developments in some cultures, the gendered landscapes of affordances offered to individuals in these cultures have become more varied and less rigid, thus increasing the variety and flexibility of scripts individuals can enact. This entails that individuals in such cultures have an increased possibility for gender fluidity, which may in part explain the increasing number of people currently identifying outside the binary.
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Affiliation(s)
- Mahault Albarracin
- Department of Computer Science, Université du Québec à Montréal, Montréal, QC, Canada
- Institut de Recherche et d'Études Féministes, Université du Québec à Montréal, Montréal, QC, Canada
| | - Pierre Poirier
- Department of Philosophy, Université du Québec à Montréal, Montréal, QC, Canada
- Institut des Sciences Cognitives, Université du Québec à Montréal, Montréal, QC, Canada
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Taha-Thomure R, Milne AS, Kavanagh EJ, Stirling AE. Gender-Based Violence Against Trans* Individuals: A Netnography of Mary Gregory's Experience in Powerlifting. Front Psychol 2022; 13:854452. [PMID: 35602722 PMCID: PMC9121919 DOI: 10.3389/fpsyg.2022.854452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/25/2022] [Indexed: 11/13/2022] Open
Abstract
In the context of sport, a growing body of research has reported the prevalence of violence against athletes, including sexual, physical, and psychological violence and neglect, experienced by both women and men in sport. Preliminary research has reported that gender-diverse individuals, specifically transgender athletes, may have a greater vulnerability to experiences of violence in sport, but this remains an under-researched population. In addition to limited research specifically on violence experienced by transgender athletes in sport, there is also only emerging research on virtual violence against athletes, with previous research on virtual violence in sporting spaces highlighting how online spaces are sites that can foster widespread hostility and violence. This study builds on previous research by examining discourses of virtual violence faced by transgender powerlifter, Mary Gregory, following her expulsion from the 100% Raw Powerlifting Federation. This research used a netnographic approach-an online ethnographic case study design. Data were collected from online news sources, as well as social media platforms, including Instagram, Twitter, and YouTube and were analyzed using reflexive thematic analysis. The data provided an insight into the cyberculture of powerlifting, and the negotiation of space, or lack thereof, for Mary Gregory within this physical culture. Five themes of were generated, including invalidation of gender identity, dehumanization, infliction of derogatory and crude language, accusations of cheating, and being compared to cisgender athletes without nuance. The study highlights the presence of significant vitriol across virtual platforms directed at Mary Gregory and the underlying presence of negative gender-based violence again trans* (GBV-T*) discourse. This case provides examples of virtual gender-based violence and transphobia in sport, a lack of readiness to accept trans* athletes, and concerns for the safety of trans* athletes in sporting spaces.
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Affiliation(s)
- Raiya Taha-Thomure
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Aalaya S. Milne
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Emma J. Kavanagh
- Faculty of Health and Social Sciences, Bournemouth University, Poole, United Kingdom
| | - Ashley E. Stirling
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
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Gamarel KE, Jadwin-Cakmak L, King WM, Lacombe-Duncan A, Trammell R, Reyes LA, Burks C, Rivera B, Arnold E, Harper GW. Stigma Experienced by Transgender Women of Color in Their Dating and Romantic Relationships: Implications for Gender-based Violence Prevention Programs. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP8161-NP8189. [PMID: 33256510 PMCID: PMC8164638 DOI: 10.1177/0886260520976186] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Although transgender women of color, specifically Black and Latina experience gender-based violence in a variety of contexts, one of the most consistently reported is from a dating or romantic partner. This qualitative study sought to understand the manifestations and consequences of stigma experienced by transgender women of color in their dating or romantic relationships. Between January and February 2019, we purposively recruited 33 transgender women of color to participate in five focus group discussions and complete a brief survey. We employed both inductive and deductive approaches to coding and thematic analysis. We identified different forms of anti-transgender interpersonal stigma experienced by transgender women of color seeking romantic relationships and by those in romantic relationships. For those dating and seeking relationships, anti-transgender interpersonal stigma took the form of dehumanizing stereotypes and sexual objectification. While these manifestations of anti-transgender interpersonal stigma persisted for some within relationships, concealment behaviors from partners was the predominant type of anti-transgender interpersonal stigma. Each of these forms of anti-transgender interpersonal stigma had significant gender-based violence consequences, specifically encountering physical violence, experiencing psychological trauma, and engaging in survival strategies. In the current climate of COVID-19, which is exacerbating risks of gender-based violence, there is an urgent need to understand and address the nuanced manifestations of stigma in relationships and their consequences on the lives of transgender women of color. Culturally grounded gender-based violence prevention policies and programs with transgender women should address these forms of stigma and build on community strengths. Findings also highlight the importance of future research and gender-based violence prevention programming with cisgender men in/seeking partnerships with transgender women of color.
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Affiliation(s)
| | | | | | | | - Racquelle Trammell
- University of Michigan, Ann Arbor, MI, USA
- Trans Sistas of Color Project, Detroit, MI, USA
| | | | | | - Bré Rivera
- Trans Sistas of Color Project, Detroit, MI, USA
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McQuillan K, Hyland P, Vallières F. Prevalence, correlates, and the mitigation of ICD-11 CPTSD among homeless adults: The role of self-compassion. CHILD ABUSE & NEGLECT 2022; 127:105569. [PMID: 35240370 DOI: 10.1016/j.chiabu.2022.105569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 02/08/2022] [Accepted: 02/16/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND In 2018, Complex Post-Traumatic Stress Disorder (CPTSD) was accepted into the International Classification of Diseases, edition 11 (ICD-11) to capture symptoms associated with exposure to chronic, inescapable trauma. Thereafter, the disorder's links with interpersonal trauma have been established. OBJECTIVE Within a sample of homeless adults in Ireland, the (1) prevalence of ICD-11 disorders specifically associated with stress; Post Traumatic Stress Disorder (PTSD) and CPTSD, (2) nature of interpersonal trauma exposure, self-identified index events, and their association with the diagnostic criteria of CPTSD, and (3) relationship between cumulative interpersonal trauma exposure and CPTSD via self-compassion were examined. PARTICIPANTS AND SETTING Adults using homeless services (N = 56) completed self-report measures of socio-demographics, trauma-history, PSTD, CPTSD, and self-compassion. METHODS The data were analysed using chi-squared and mediation analyses (via PROCESS). RESULTS CPTSD was highly prevalent (33.9%) among the sample, but PTSD was not (3.6%). Emotional neglect was the most prevalent interpersonal trauma and the most common index event. Only lifetime sexual abuse (from someone other than a parent or guardian) was associated with CPTSD diagnostic status (χ2 = 3.94, (1), p = .047). When adjusted for gender, relationship status, and living situation, self-compassion mediated the relationship between cumulative interpersonal trauma exposure and CPTSD severity (B = 1.30, SE = 0.50, 95% CI = [0.43-2.35]). CONCLUSION Findings support the relevance of CPTSD to understanding psychopathology in homeless adults and the potential role of self-compassion in interventions. Further, they open debate on the nature of events that are considered traumatic - subjectively and in psychiatric canon.
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Affiliation(s)
- Katie McQuillan
- School of Counselling Psychology, Trinity College, The University of Dublin, Dublin 2, Ireland; Spirasi, The National Centre for the Rehabilitation of Victims of Torture, Phibsborough, Dublin, Ireland.
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland; Centre for Global Health, Trinity College Dublin, The University of Dublin, Ireland.
| | - Frédérique Vallières
- Centre for Global Health, Trinity College Dublin, The University of Dublin, Ireland.
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Ensuring interdisciplinary partnerships and commitment to Contextual Behavioral Science (CBS) principles among diverse scholars who serve diverse communities. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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67
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Lacombe-Duncan A, Olawale R. Context, Types, and Consequences of Violence Across the Life Course: A Qualitative Study of the Lived Experiences of Transgender Women Living With HIV. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:2242-2266. [PMID: 32639854 DOI: 10.1177/0886260520935093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Violence is a known driver of HIV vulnerability among transgender (trans) women, who are disproportionately impacted by HIV globally. Violence is also a barrier to accessing HIV prevention, treatment, and support. Yet, little is known about the everyday experiences of violence faced by trans women living with HIV, who live at the intersection of a marginalized gender identity and physical health condition. To address this gap, this study draws on semi-structured, individual interviews conducted 2017-2018 with a purposive sample (selected based on diverse identities) of trans women living with HIV (n = 11) participating in a large, community-based cohort study in three Canadian provinces. Framework analysis was used to identify key themes, patterns within themes between participants, and patterns across themes among participants. Findings showed that trans women living with HIV experience specific contexts of violence shaped at the intersection of stigma based on gender identity, gender expression, and HIV status, among other identities/experiences. Violence experienced in childhood (e.g., familial rejection, bullying) increased trans women's likelihood of being exposed to a violent social context in young adulthood (e.g., state violence perpetuated by the police, interpersonal violence perpetuated by sexual partners, and community violence perpetuated by society-at-large/the general public), which increased trans women's HIV vulnerability; once living with HIV trans women were subjected to discursive violence from healthcare providers. These multiple forms of violence have serious consequences for trans women living with HIV's ongoing social, mental, and physical well-being. The findings suggest that interventions are urgently needed to reduce violence against trans women in childhood and young adulthood, in addition to reducing violence against trans women living with HIV perpetuated by healthcare providers in adulthood, to both proactively and responsively promote their safety, health, and well-being.
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Sherman ADF, Allgood S, Alexander KA, Klepper M, Balthazar MS, Hill M, Cannon CM, Dunn D, Poteat T, Campbell J. Transgender and Gender Diverse Community Connection, Help-Seeking, and Mental Health Among Black Transgender Women Who Have Survived Violence: A Mixed-Methods Analysis. Violence Against Women 2022; 28:890-921. [PMID: 34167394 PMCID: PMC9171078 DOI: 10.1177/10778012211013892] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Black transgender women are disproportionately affected by violence and poor care-delivery, contributing to poor mental health. Little is known regarding the effect of transgender and gender diverse (TGD) community connection (TCC) on health. This analysis (a) explores relationships between TCC, polyvictimization, and mental health and (b) analyzes how TCC influenced help-seeking following violent experiences among Black transgender women. Mixed-methods data from 19 Black transgender women were analyzed using correlational and thematic content analyses. Findings suggest that TCC is associated with improved help-seeking and mental health among Black transgender women, highlighting a need for longitudinal research to identify approaches for leveraging TCC.
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Affiliation(s)
| | - Sarah Allgood
- Johns Hopkins University School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Kamila A. Alexander
- Johns Hopkins University School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Meredith Klepper
- Johns Hopkins University School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Monique S. Balthazar
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, USA,Monique S. Balthazar, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, 140 Decatur St SE, Atlanta, GA 30303, USA.
| | - Miranda Hill
- University of California San Francisco, San Francisco, CA, USA
| | | | | | - Tonia Poteat
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Jacquelyn Campbell
- Johns Hopkins University School of Nursing, Johns Hopkins University, Baltimore, MD, USA
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Stangl AL, Pliakas T, Izazola-Licea JA, Ayala G, Beattie TS, Ferguson L, Orza L, Mathur S, Pulerwitz J, Iovita A, Bendaud V. Removing the societal and legal impediments to the HIV response: An evidence-based framework for 2025 and beyond. PLoS One 2022; 17:e0264249. [PMID: 35192663 PMCID: PMC8863250 DOI: 10.1371/journal.pone.0264249] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/07/2022] [Indexed: 02/04/2023] Open
Abstract
Societal and legal impediments inhibit quality HIV prevention, care, treatment and support services and need to be removed. The political declaration adopted by UN member countries at the high-level meeting on HIV and AIDS in June 2021, included new societal enabler global targets for achievement by 2025 that will address this gap. Our paper describes how and why UNAIDS arrived at the societal enabler targets adopted. We conducted a scoping review and led a participatory process between January 2019 and June 2020 to develop an evidence-based framework for action, propose global societal enabler targets, and identify indicators for monitoring progress. A re-envisioned framework called the '3 S's of the HIV response: Society, Systems and Services' was defined. In the framework, societal enablers enhance the effectiveness of HIV programmes by removing impediments to service availability, access and uptake at the societal level, while service and system enablers improve efficiencies in and expand the reach of HIV services and systems. Investments in societal enabling approaches that remove legal barriers, shift harmful social and gender norms, reduce inequalities and improve institutional and community structures are needed to progressively realize four overarching societal enablers, the first three of which fall within the purview of the HIV sector: (i) societies with supportive legal environments and access to justice, (ii) gender equal societies, (iii) societies free from stigma and discrimination, and (iv) co-action across development sectors to reduce exclusion and poverty. Three top-line and 15 detailed targets were recommended for monitoring progress towards their achievement. The clear articulation of societal enablers in the re-envisioned framework should have a substantial impact on improving the effectiveness of core HIV programmes if implemented. Together with the new global targets, the framework will also galvanize advocacy to scale up societal enabling approaches with proven impact on HIV outcomes.
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Affiliation(s)
- Anne L. Stangl
- Hera Solutions, Baltimore, MD, United States of America
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Triantafyllos Pliakas
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Impact Epilysis, Thessaloniki, Greece
| | | | - George Ayala
- Alameda County Public Health Department, Oakland, CA, United States of America
- MPact Global Action for Gay Men’s Health and Rights, Oakland, CA, United States of America
| | - Tara S. Beattie
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Laura Ferguson
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, United States of America
| | - Luisa Orza
- Frontline AIDS, Brighton, United Kingdom
| | - Sanyukta Mathur
- Population Council, Washington, DC, United States of America
| | - Julie Pulerwitz
- Population Council, Washington, DC, United States of America
| | | | - Victoria Bendaud
- Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland
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Peitzmeier SM, Gardner IH, Weinand J, Corbet A, Acevedo K. Chest binding in context: stigma, fear, and lack of information drive negative outcomes. CULTURE, HEALTH & SEXUALITY 2022; 24:284-287. [PMID: 34839781 DOI: 10.1080/13691058.2021.1970814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/17/2021] [Indexed: 06/13/2023]
Abstract
Chest binding or 'binding' is a practice used by many trans and nonbinary people assigned a female sex at birth to achieve a flatter chest contour and affirm their gender. Binding allows individuals to affirm their gender in a temporary, reversible way. While many individuals who bind report negative physical symptoms, binding also often carries significant benefits for mental health and safety. In this commentary, we explain what the data do and do not say about the physical risks of binding and describe how decreasing stigma around binding will substantially reduce physical risks associated with binding and increase the benefits of the practice. As with any intervention, individuals should make an informed decision about the risks and benefits of binding. If negative physical symptoms arise, individuals can consider adjusting their binding practice or working with a healthcare provider to address these concerns.
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Affiliation(s)
- Sarah M Peitzmeier
- School of Nursing Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Ivy H Gardner
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Jamie Weinand
- Southern New Mexico Family Medicine Residency Program, NM, USA
| | - Alix Corbet
- School of Public Health, Boston University, Boston, MA, USA
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Nnawulezi N, Hacskaylo M. Identifying and Responding to the Complex Needs of Domestic Violence Housing Practitioners at the Onset of the COVID-19 Pandemic. JOURNAL OF FAMILY VIOLENCE 2022; 37:915-925. [PMID: 33424112 PMCID: PMC7783298 DOI: 10.1007/s10896-020-00231-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2020] [Indexed: 05/07/2023]
Abstract
The social, financial, and emotional repercussions of the COVID-19 pandemic has left many organizations that support survivors of intimate partner violence questioning how to maintain core services while addressing compounding individual, organizational, and public health issues. Stay-at-home orders and other COVID-19 mitigation strategies have resulted in reduced shelter availability and increased intimate partner violence rates. Coupled with the economic impact of the pandemic, these factors have threatened financial and housing stability. To better understand these challenges and provide immediate support, The National Alliance for Safe Housing (NASH) co-hosted a peer support call to provide a virtual platform for practitioners to ask questions, discuss challenges, and share strategies for quality service provision during the COVID-19 pandemic. Over 800 practitioners from across the United States participated in the NASH call, most of whom were advocates, program directors, and managers. NASH gathered data on practitioners' needs from a brief survey from the registration form analyzed using conventional inductive content analysis. Practitioners' primary concerns were situated within eight questions, which we categorized into four meta-categories: (1) managing residential housing programs; (2) getting survivors materials resources; (3) keeping staff safe; and (4) maintaining organizational operations. The paper concludes with community-grounded and empirically supported practice recommendations aligned with practitioners' expressed needs.
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Affiliation(s)
| | - Margaret Hacskaylo
- National Alliance for Safe Housing, Inc (NASH), 712 H St, NE, Washington, DC, USA
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72
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Abstract
This study assessed potential correlates to past-year suicide ideation among a national sample of transgender adults in the United States. A secondary analysis of the 2015 Transgender Survey was conducted. The 2015 Transgender Survey is the first and largest survey assessing health behaviors among transgender individuals living in the United States. Participants were recruited by several methods (e.g., social media, random sampling, photobooth campaigns. Weighted logistic regression analyses adjusting for covariates were conducted to investigate potential associations to whether or not an individual thought about suicide. A total of 27,795 individuals who self-identified as transgender participated in the study. Of the sample, 34.0% identified as a man, 29.8% identified as a woman, 20.6% identified as non-binary, and 15.5% identified as part time one gender/part time another. Nearly half of participants (48.5%) reported past year suicide ideation. Significant predictors included gender identity, age, income, race, low family support, and self-reported physical and sexual assault. This is one of the first studies that we are aware of examining past-year suicidal ideation among a large, nationally representative sample of transgender individuals. Interventions (e.g., acceptance therapy, evaluation, focus groups) are desperately needed to address this burgeoning problem among transgender individuals.
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Mujugira A, Kasiita V, Bagaya M, Nakyanzi A, Bambia F, Nampewo O, Kamusiime B, Mugisha J, Nalumansi A, Twesigye CC, Muwonge TR, Baeten JM, Wyatt MA, Tsai AC, Ware NC, Haberer JE. "You are not a man": a multi-method study of trans stigma and risk of HIV and sexually transmitted infections among trans men in Uganda. J Int AIDS Soc 2021; 24:e25860. [PMID: 34965322 PMCID: PMC8716065 DOI: 10.1002/jia2.25860] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 12/06/2021] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Transgender (trans) men in sub-Saharan Africa are a hidden and vulnerable population who may engage in sex work due to socio-economic exclusion and lack of alternative employment opportunities. Little is known about HIV and sexually transmitted infection (STI) risk among trans men in this setting. We conducted a multi-method study to characterize HIV/STI risk among trans men in Uganda. METHODS Between January and October 2020, we enrolled 50 trans men into a cross-sectional study through snowball sampling. Data were collected on socio-demographic characteristics, sexual practices and depression. We conducted 20 qualitative interviews to explore: (1) descriptions of sexual practices that could increase HIV/STI exposure; (2) experiences of accessing public healthcare facilities; (3) perceptions of HIV or STI testing; (4) HIV and STI service delivery; and (5) drug and alcohol use. We used an inductive content analytic approach centring on descriptive category development to analyse the data. RESULTS The median age was 25 years (interquartile range 23-28). The prevalence of HIV, syphilis and hepatitis B was 4%, 6% and 8%, respectively. We observed multiple levels of intersecting individual, interpersonal and structural stigmas. (1) Trans men reported transphobic rape motivated by interpersonal stigma that was psychologically traumatizing to the survivor. The resultant stigma and shame hindered healthcare access. (2) Structural stigma and economic vulnerability led to sex work, which increased the risk of HIV and other STIs. Sex work stigma further compounded vulnerability. (3) Individualized stigma led to fear of disclosure of gender identity and HIV status. Concealment was used as a form of stigma management. (4) Multiple levels of stigma hampered access to healthcare services. Preference for trans-friendly care was motivated by stigma avoidance in public facilities. Overall, the lived experiences of trans men highlight the intertwined relationship between stigma and sexual health. CONCLUSIONS In this sample from Uganda, trans men experienced stigma at multiple levels, highlighting the need for gender-sensitive healthcare delivery. Stigma reduction interventions, including provider training, non-discrimination policies, support groups and stigma counselling, could strengthen uptake and utilization of prevention services by this marginalized population.
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Affiliation(s)
- Andrew Mujugira
- Infectious Diseases Institute, Makerere University, Kampala, Uganda.,Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda.,Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Vicent Kasiita
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Monica Bagaya
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Agnes Nakyanzi
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Felix Bambia
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Oliva Nampewo
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Brenda Kamusiime
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Jackson Mugisha
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | | | | | - Jared M Baeten
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Monique A Wyatt
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Harvard Global, Cambridge, Massachusetts, USA
| | - Alexander C Tsai
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Norma C Ware
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jessica E Haberer
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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74
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Sevelius JM, Glidden DV, Deutsch M, Welborn L, Contreras A, Salinas A, Venegas L, Grant RM. Uptake, Retention, and Adherence to Pre-exposure Prophylaxis (PrEP) in TRIUMPH: A Peer-Led PrEP Demonstration Project for Transgender Communities in Oakland and Sacramento, California. J Acquir Immune Defic Syndr 2021; 88:S27-S38. [PMID: 34757990 PMCID: PMC8579996 DOI: 10.1097/qai.0000000000002808] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND TRIUMPH (Trans Research-Informed communities United in Mobilization for the Prevention of HIV) was a community-led, transgender-specific pre-exposure prophylaxis (PrEP) demonstration project at 2 community-based clinical sites in California. TRIUMPH used peer health education, community mobilization, and clinical integration of PrEP with hormone therapy to promote PrEP knowledge and acceptability. The goal of this study was to evaluate PrEP uptake, retention, and adherence among TRIUMPH participants and examine site-based differences. METHODS Eligible participants were adult transgender and gender diverse people interested in PrEP. Participants were seen at baseline and at 1, 3, 6, 9, and 12 months for PrEP provision, clinical visits, and HIV testing. PrEP uptake was defined as dispensation of PrEP, PrEP retention was defined as proportion of expected visits completed among those who initiated PrEP, and PrEP adherence was assessed by measuring tenofovir diphosphate concentrations in dried blood spots. Logistic regression models quantified the association of variables with PrEP outcomes. RESULTS TRIUMPH enrolled 185 participants; the median age was 28 years (interquartile range: 23-35), 7% was Black, and 58% was Latinx. PrEP uptake was as follows: 78% in Oakland and 98% in Sacramento; 91% among trans women, 96% among trans men, and 70% among nonbinary participants. Almost half (47%) rarely/never believed about HIV, and 42% reported condomless sex act in the past 3 months. Participants who reported higher numbers of sex partners were more likely to be retained and adherent; other predictors of adherence included not having a primary partner and not experiencing violence in the past 3 months. CONCLUSIONS This community-led, trans-specific PrEP demonstration project documents high levels of PrEP initiation in a young transgender and gender diverse cohort at risk of HIV acquisition.
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Kruse MI, Voloshin D, Wan M, Clarizio A, Bigham BL, Upadhye S. Care of Sexual and Gender Minorities in the Emergency Department: A Scoping Review. Ann Emerg Med 2021; 79:196-212. [PMID: 34785088 DOI: 10.1016/j.annemergmed.2021.09.422] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/03/2021] [Accepted: 09/10/2021] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE This scoping review was conducted to collate and summarize the published research literature addressing sexual and gender minority care in the emergency department (ED). METHODS Using PRISMA-ScR criteria, an electronic search was conducted of CINAHL, Embase, Ovid Medline, and Web of Science for all studies that were published after 1995 involving sexual and gender minorities, throughout all life stages, presenting to an ED. We excluded non-US and Canadian studies and editorials. Titles and abstracts were screened, and full-text review was performed independently with 4 reviewers. Abstraction focused on study design, demographics, and outcomes, and the resulting data were analyzed using an ad hoc iterative thematic analysis. RESULTS We found 972 unique articles and excluded 743 after title and abstract screening. The remaining 229 articles underwent full-text review, and 160 articles were included. Themes identified were HIV in sexual and gender minorities (n=61), population health (n=46), provider training (n=29), ED avoidance or barriers (n=23), ED use (n=21), and sexual orientation/gender identity information collection (n=9). CONCLUSION The current literature encompassing ED sexual and gender minority care cluster into 6 themes. There are considerable gaps to be addressed in optimizing culturally competent and equitable care in the ED for this population. Future research to address these gaps should include substantial patient stakeholder engagement in all aspects of the research process to ensure patient-focused outcomes congruent with sexual and gender minority values and preferences.
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Affiliation(s)
- Michael I Kruse
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada.
| | - Daniel Voloshin
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Melissa Wan
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Alexandra Clarizio
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Blair L Bigham
- Division of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA
| | - Suneel Upadhye
- Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
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76
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Reis A, Sperandei S, de Carvalho PGC, Pinheiro TF, de Moura FD, Gomez JL, Porchat P, Bastos FI, McFarland W, Wilson EC, Veras MA. A cross-sectional study of mental health and suicidality among trans women in São Paulo, Brazil. BMC Psychiatry 2021; 21:557. [PMID: 34758758 PMCID: PMC8579408 DOI: 10.1186/s12888-021-03557-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 10/20/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Trans women have been shown to experience disproportionately poor outcomes in physical and mental health. Although it is common to talk about the violence against trans people, little is still known about mental health outcomes and experiences of suicidality among trans women, particularly in developing countries. This study aims to investigate risk factors and associations with mental health, suicide ideation and suicide attempts among trans women in the largest metropolitan area in Brazil. METHODS Trans women living in São Paulo were recruited between May 2017 and July 2019 using the long-chain peer referral method Respondent-Driven Sampling. Multivariate regression models were used to investigate the associations with K10 score classification (logistic) and suicidal ideation/suicide attempt (ordinal logistic). RESULTS A total of 763 trans women were included in the study. Over one quarter (26.5%) of trans women had been diagnosed with anxiety in the past, and close to one in five (19.1%) trans women had received a diagnosis of depression. More than two in five (41.9%) trans women had moderate to severe psychological distress. More than half of all participating trans women reported having previously either experienced suicidal ideation or attempted to take their own lives (25.0 and 31.2% respectively). In multivariate regression, moderate to severe psychological distress was associated with homelessness, income, current sex work, use of stimulant drugs, history of physical abuse, depression diagnosis and access to mental health treatment. Suicidal ideation and suicide attempts were associated with race/skin color, living arrangements, marital status, current sex work, history of sexual violence, depression and PTSD diagnoses, access to mental health treatment and psychological distress. CONCLUSIONS This study showed that there is a significant association between mental health conditions, lack of treatment for these conditions and suicidality among trans gender women. Findings point to the need for a structural transformation in Brazil that enables a reduction in the social inequality and violence that impact the mental health of trans women. A number of recommendations to achieve this are provided.
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Affiliation(s)
- Arianne Reis
- grid.1029.a0000 0000 9939 5719School of Health Sciences, Western Sydney University, Penrith, Australia ,grid.1029.a0000 0000 9939 5719Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - Sandro Sperandei
- grid.1029.a0000 0000 9939 5719Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | | | - Thiago Félix Pinheiro
- grid.419014.90000 0004 0576 9812Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, Brazil
| | - Ferdinando Diniz de Moura
- grid.419014.90000 0004 0576 9812Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, Brazil
| | - José Luis Gomez
- grid.419014.90000 0004 0576 9812Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, Brazil
| | - Patrícia Porchat
- grid.410543.70000 0001 2188 478XSchool of Sciences, São Paulo State University, Bauru, Brazil
| | - Francisco Inácio Bastos
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Willi McFarland
- grid.410359.a0000 0004 0461 9142San Francisco Department of Public Health, Center for Public Health Research, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Department of Epidemiology and Statistics, University of California, San Francisco, CA USA
| | - Erin C. Wilson
- grid.410359.a0000 0004 0461 9142San Francisco Department of Public Health, Trans Research unit for Equity (TRUE), San Francisco, CA USA
| | - Maria Amélia Veras
- Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, Brazil.
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77
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Capriotti MR, Donaldson JM. "Why don't behavior analysts do something?" 1 Behavior analysts' historical, present, and potential future actions on sexual and gender minority issues. J Appl Behav Anal 2021; 55:19-39. [PMID: 34633066 DOI: 10.1002/jaba.884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 11/11/2022]
Abstract
For thousands of years, societies actively practiced the oppression, persecution, and dehumanization of sexual and gender minority (SGM) people (e.g., lesbian, gay, bisexual, transgender, and queer individuals). Rekers and Lovaas' (1974) study is part of that history within behavior analysis. Following requests for retraction, the Society for the Experimental Analysis of Behavior and LeBlanc (2020) issued a formal Expression of Concern about the work. Continued conversation and debate have followed. First, we contextualize debate around retraction of Rekers and Lovaas and the history of behavior analysts' work on SGM issues. Second, we propose 5 steps that leaders in behavior analysis can take with relative immediacy, and we describe 5 research areas that individual behavior analysts could pursue. We conclude that behavior analysts can contribute much toward the liberation of SGM individuals if we begin to bring our science to bear on pressing, socially significant issues facing SGM communities.
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78
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Hawkey AJ, Ussher JM, Liamputtong P, Marjadi B, Sekar JA, Perz J, Ryan S, Schmied V, Brook E, Dune T. Trans Women's Responses to Sexual Violence: Vigilance, Resilience, and Need for Support. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3201-3222. [PMID: 34697692 DOI: 10.1007/s10508-021-01965-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 05/12/2023]
Abstract
Despite experiencing high rates of sexual violence, there is limited research that explores coping and support needs among trans women of color and those from migrant backgrounds. This article examines the impact of sexual violence, as well as responses and support needs in relation to sexual violence, among 31 trans women of color, aged between 18-54 years, living in Australia. Women were recruited using purposive and snowball sampling, local LGBTQI + networks, and social media. Study advertisements invited participation from people 18 years and older, who identified as a "trans woman of color" or "trans woman from a non-English speaking background," to take part in a study about their lives as trans women of color and experiences of sexual violence. In-depth interviews and photovoice took place between September 2018 and September 2019. Findings were analyzed through thematic analysis, drawing on intersectionality theory. Sexual violence was reported to be associated with fear, anxiety, and depression, and, for a minority of women, self-blame. While women reported hypervigilance and avoiding going out in public as measures to anticipate and protect themselves from sexual violence, they also demonstrated agency and resilience. This included putting time and effort into appearing as a cisgender woman, naming violence, seeking support, rejecting self-blame, and engaging in self-care practices to facilitate healing. Trans women highlighted the need for multi-faceted sexual violence prevention activities to encourage education, empowerment and cultural change across the general population and support services, in order to promote respect for gender, sexuality and cultural diversity.
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Affiliation(s)
- Alexandra J Hawkey
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia.
| | - Jane M Ussher
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Pranee Liamputtong
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Brahmaputra Marjadi
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Jessica Aasha Sekar
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Janette Perz
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Samantha Ryan
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Virginia Schmied
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | | | - Tinashe Dune
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
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79
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Gallagher NM, Bodenhausen GV. Gender essentialism and the mental representation of transgender women and men: A multimethod investigation of stereotype content. Cognition 2021; 217:104887. [PMID: 34537593 DOI: 10.1016/j.cognition.2021.104887] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 08/09/2021] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
The growing visibility of transgender women and men in the US challenges a dominant cultural model of gender in which dichotomous sex assigned at birth gives rise to dichotomous gender identity in adulthood. How are these groups - verbally marked as atypical relative to their cisgender counterparts - stereotyped? Moreover, how do gender essentialist beliefs predict the content of such stereotypes? Across four studies with diverse methods of stereotype measurement, we assessed characteristics that cisgender people associate with transgender women and men, comparing these to their stereotypes of cisgender women and men. In our final study, we directly assessed how cisgender people mentally position transgender groups relative to cisgender groups. Across these studies, transgender categories were characterized in less positive ways than cisgender ones, and there was as a lower level of consensus about transgender than cisgender stereotypes. On average, transgender groups were de-gendered relative to cisgender groups, such that transgender women and men were not strongly differentiated on traditionally-gendered stereotype dimensions. Finally, we showed that participants higher in gender essentialism (relative to participants lower in gender essentialism) evaluated cisgender groups more positively and were more likely to stereotype transgender groups based on their sex assigned at birth.
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Affiliation(s)
| | - Galen V Bodenhausen
- Northwestern University, Department of Psychology, USA; Kellogg School of Management, Marketing Department, USA
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80
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Osborn M. U.S. News Coverage of Transgender Victims of Fatal Violence: An Exploratory Content Analysis. Violence Against Women 2021; 28:2033-2056. [PMID: 34435524 DOI: 10.1177/10778012211025995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Media portrayals of crime help shape public perceptions of victims and the demographic groups to which they belong. For transgender people, who already face heightened disparities and stigma, news coverage may reinforce negative stereotypes and minimize the wider context of transphobic violence. The present study, a content analysis of news articles (n = 316) pertaining to 27 transgender people killed in the United States in 2016, addresses positive and negative depictions of victims, use of language affirming and delegitimizing transgender identities, and framing of transphobia as a systemic problem. Themes, implications, and future research directions are discussed.
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Affiliation(s)
- Max Osborn
- 14775John Jay College of Criminal Justice, NY, USA.,The Graduate Center, 14772CUNY, NY, USA
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81
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Polizopoulos-Wilson N, Kindratt TB, Hansoti E, Pagels P, Cano JP, Day P, Gimpel N. A Needs Assessment Among Transgender Patients at an LGBTQ Service Organization in Texas. Transgend Health 2021; 6:175-183. [PMID: 34414272 DOI: 10.1089/trgh.2020.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Transgender adults have difficulty accessing health care due to multiple barriers. This study examined the health care-related needs of transgender patients in Dallas, Texas. Methods: This study examined cross-sectional data from a survey completed by 62 patients who identified as transgender. Results: Many participants reported depression (50%) and anxiety (51%). Over half did not receive preventive screenings (60%) or health care (61%) elsewhere. One-third of patients felt their primary care physician outside the clinic was not transgender-friendly. Conclusion: These findings provide evidence that transgender patients demonstrate increased reported mental health disorders and decreased access to medical care.
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Affiliation(s)
- Natalie Polizopoulos-Wilson
- Department of Physician Assistant Studies, School of Health Professions, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Tiffany B Kindratt
- Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas, USA
| | - Esha Hansoti
- Department of Family and Community Medicine, University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Patti Pagels
- Department of Family and Community Medicine, University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - J P Cano
- Resource Center, Dallas, Texas, USA
| | - Philip Day
- Department of Family and Community Medicine, University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Nora Gimpel
- Department of Family and Community Medicine, University of Texas Southwestern Medical School, Dallas, Texas, USA
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82
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Tollit MA, May T, Maloof T, Telfer MM, Chew D, Engel M, Pang K. The clinical profile of patients attending a large, Australian pediatric gender service: A 10-year review. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2021; 24:59-69. [PMID: 36713143 PMCID: PMC9879187 DOI: 10.1080/26895269.2021.1939221] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Objectives: To better understand the clinical profile of patients attending a large Australian pediatric gender service. Retrospective clinical audit of patients seen at the Royal Children's Hospital Gender Service (RCHGS) over 10 years (2007-16). Setting: The RCHGS: Australia's largest pediatric gender service. Participants: Patients were eligible for inclusion if they had an appointment with the RCHGS between January 2007 - December 2016, and had either a self-reported gender which differed from what was presumed for them at birth or sought guidance regarding gender identity/expression. Main outcome measures: Demographic/developmental history, clinical presentation including information about gender identity/dysphoria, comorbidities, self-harm, suicidal ideation, gender-affirming treatment, psychosocial functioning. Results: 359 patients were first seen during the study period. Assigned females (54%) slightly outnumbered assigned males (46%), and presented at an older age (14.8 vs 12.4 years. Patients predominantly identified as transgender (87.2%) or non-binary (7.2%). Across the cohort, gender diversity was evident from a young age (median age 3), and symptoms of gender dysphoria were noted earlier in assigned males (median age 4) than assigned females (median age 11). Although 81% of patients met eligibility for GD, rates of hormonal treatment were much lower, with 29% of young people ≥10 years of age receiving puberty blocking treatment and 38% of adolescents ≥ 16 years of age receiving gender-affirming hormones (i.e. testosterone or estrogen). Many patients had mental health difficulties and/or neurodevelopment disorders, including major depressive disorder/low mood (51%), self-harm (25%), suicidal ideation (30%) and autism spectrum disorder (16%). Conclusion: This audit illustrates the complex profile and needs of transgender and gender diverse children and adolescents presenting to specialist gender services. Supplemental data for this article is available online at https://doi.org/10.1080/26895269.2021.1939221 .
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Affiliation(s)
- Michelle A. Tollit
- Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Adolescent Medicine, The Royal Children’s Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Tamara May
- Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Tiba Maloof
- Department of Adolescent Medicine, The Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - Michelle M. Telfer
- Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Adolescent Medicine, The Royal Children’s Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Denise Chew
- Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Melanie Engel
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ken Pang
- Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Adolescent Medicine, The Royal Children’s Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Inflammation Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
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83
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Galvan FH, Chen YT, Contreras R, O’Connell B. Violence Inflicted on Latina Transgender Women Living with HIV: Rates and Associated Factors by Perpetrator Type. AIDS Behav 2021; 25:116-126. [PMID: 31811444 DOI: 10.1007/s10461-019-02751-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Many transgender individuals report violence directed against them. This study examined violence inflicted on transgender Latinas with HIV by primary partners, sexual partners and acquaintances/strangers. Logistic regression was used for analysis. 150 transgender Latinas were recruited. Rates of violence from different perpetrator types were 47-50%. For violence by primary partners, social support from cisgender people was associated with a lower likelihood of violence (AOR 0.56; CI 0.32, 0.98; p < 0.05). For violence by sexual partners, a history of childhood sexual abuse was associated with a higher likelihood of violence (AOR 2.64; CI 1.10, 6.34; p < 0.05). For violence by acquaintances/strangers, discrimination was associated with a higher likelihood of violence (AOR 2.84; CI 1.16, 6.94; p < 0.05) and social support from cisgender people with a lower likelihood (AOR 0.58; CI 0.37, 0.92; p < 0.05). Interventions are needed at individual, institutional and systemic levels to eradicate such violence.
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84
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Gyamerah AO, Baguso G, Santiago-Rodriguez E, Sa'id A, Arayasirikul S, Lin J, Turner CM, Taylor KD, McFarland W, Wilson EC, Wesson P. Experiences and factors associated with transphobic hate crimes among transgender women in the San Francisco Bay Area: comparisons across race. BMC Public Health 2021; 21:1053. [PMID: 34078334 PMCID: PMC8173924 DOI: 10.1186/s12889-021-11107-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 05/17/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Trans women experience high rates of gender-based violence (GBV)-a risk factor for adverse health outcomes. Transphobic hate crimes are one such form of GBV that affect trans women. However, little is understood about factors that shape transphobic hate crimes and racial/ethnic variation in these experiences. To contextualize GBV risk and police reporting, we examined self-reported types and correlates of transphobic hate crimes by racial/ethnic group of trans women in the San Francisco Bay Area. METHODS From 2016 to 2018, trans women participated in a longitudinal cohort study of HIV. Secondary data analyses (N = 629) examined self-reported experiences of transphobic hate crimes (i.e., robbery, physical assault, sexual assault, and battery with weapon) by race/ethnicity, and whether hate crimes were reported to the police. Chi-square tests and simple logistic regression examined demographic, sociocultural, and gender identity factors associated with transphobic violence experiences and police reporting. RESULTS About half (45.8%) of participants reported ever experiencing a transphobic hate crime; only 51.1% of these were reported to the police. Among those who reported a hate crime experience, Black (47.9%) and Latina (49.0%) trans women reported a higher prevalence of battery with a weapon; White (26.7%) and trans women of "other" race/ethnicities (25.0%) reported a higher prevalence of sexual assault (p = 0.001). Having one's gender questioned, history of sex work, homelessness as a child and adult, and a history incarceration were associated with higher odds of experiencing a transphobic hate crime. Trans women who felt their gender identity questioned had lower odds of reporting a hate crime to the police compared to those did not feel questioned. CONCLUSIONS A high proportion of trans women experienced a transphobic hate crime, with significant socio-structural risk factors and racial differences by crime type. However, crimes were underreported to the police. Interventions that address structural factors, especially among trans women of color, can yield violence prevention benefits.
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Affiliation(s)
- Akua O Gyamerah
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, California, USA.
- Department of Community Health Systems, School of Nursing, University of California, 2 Koret Way, San Francisco, CA, 94143, USA.
| | - Glenda Baguso
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, California, USA
| | - Edda Santiago-Rodriguez
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, California, USA
| | - Aria Sa'id
- Transgender District, San Francisco, USA
| | - Sean Arayasirikul
- San Francisco Department of Public Health, Trans Research Unit for Equity, San Francisco, USA
| | - Jess Lin
- Department of Public Health, Center for Public Health Research, San Francisco, USA
| | - Caitlin M Turner
- San Francisco Department of Public Health, Trans Research Unit for Equity, San Francisco, USA
| | - Kelly D Taylor
- Institute for Global Health Sciences, University of California, San Francisco, USA
| | - Willi McFarland
- Department of Public Health, Center for Public Health Research, San Francisco, USA
| | - Erin C Wilson
- Department of Public Health, Center for Public Health Research, San Francisco, USA
| | - Paul Wesson
- Department of Epidemiology & Biostatistics, University of California, San Francisco, USA
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85
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Wirtz AL, Cooney EE, Stevenson M, Radix A, Poteat T, Wawrzyniak AJ, Cannon CM, Schneider JS, Haw JS, Case J, Althoff KN, Humes E, Mayer KH, Beyrer C, Rodriguez AE, Reisner SL. Digital Epidemiologic Research on Multilevel Risks for HIV Acquisition and Other Health Outcomes Among Transgender Women in Eastern and Southern United States: Protocol for an Online Cohort. JMIR Res Protoc 2021; 10:e29152. [PMID: 33900202 PMCID: PMC8111508 DOI: 10.2196/29152] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 03/31/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The HIV epidemic disproportionately impacts transgender women in the United States. Cohort studies identify unique risks for affected populations, but use of facility-based methods may bias findings towards individuals living in research catchment areas, more engaged in health services, or, in the case of transgender populations, those who are open about their transgender identity. Digital clinical trials and other online research methods are increasingly common, providing opportunity to reach those not commonly engaged in research. Simultaneously, there is a need to understand potential biases associated with digital research, how these methods perform, and whether they are accepted across populations. OBJECTIVE This study aims to assess the feasibility of developing and implementing an online cohort of transgender women to assess risks for HIV acquisition and other health experiences. Further, this study aims to evaluate how an online cohort compares to a site-based, technology-enhanced cohort for epidemiologic research. The overarching goal is to estimate incidence of HIV and other health outcomes among transgender women in eastern and southern United States. METHODS This substudy is part of a larger multisite prospective cohort (LITE) conducted among transgender women, which also includes a site-based, technology-enhanced cohort in 6 eastern and southern US cities. The online cohort was launched to enroll and follow participants across 72 cities in the same region and with similar demographic characteristics as the site-based cohort. Participants are followed for 24 months. Adult transgender women are recruited via convenience sampling (eg, peer referrals, social media, and dating apps). Participants reporting negative or unknown HIV status are enrolled in a baseline study visit, complete a sociobehavioral survey, and provide oral fluid specimens to test for HIV. Participants not living with HIV (lab-confirmed) at baseline are offered enrollment into the cohort; follow-up assessments occur every 6 months. RESULTS Enrollment into the online cohort launched in January 2019. Active recruitment stopped in May 2019, and enrollment officially closed in August 2020. A total of 580 participants enrolled into and are followed in the cohort. A recruitment-enrollment cascade was observed across screening, consent, and completion of study activities. Implementation experiences with HIV test kits highlight the need for heavy staff engagement to support participant engagement, visit completion, and retention, even with automated digital procedures. CONCLUSIONS This study is responsive to increasing research interest in digital observational and intervention research, particularly for populations who are most affected by the HIV epidemic and for those who may otherwise not participate in person. The progression across stages of the recruitment-enrollment cascade provides useful insight for implementation of cohort studies in the online environment. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/29152.
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Affiliation(s)
- Andrea L Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Erin E Cooney
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Megan Stevenson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Asa Radix
- Callen-Lorde Community Health Center, New York, NY, United States
| | - Tonia Poteat
- Center for Health Equity Research, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Andrew J Wawrzyniak
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Christopher M Cannon
- Research and Evaluation, Whitman-Walker Institute, Washington DC, DC, United States
| | | | - J Sonya Haw
- Emory University School of Medicine, Atlanta, GA, United States
| | - James Case
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Elizabeth Humes
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Kenneth H Mayer
- Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard University, Boston, MA, United States.,The Fenway Institute, Fenway Health, Boston, MA, United States
| | - Chris Beyrer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Allan E Rodriguez
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Sari L Reisner
- The Fenway Institute, Fenway Health, Boston, MA, United States.,Division of Endocrinology, Diabetes, and Hypertension, Brigham Women's Hospital, Boston, MA, United States.,Department of Medicine, Harvard Medical School, Harvard University, Boston, MA, United States.,Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, United States
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- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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Hammack PL, Hughes SD, Atwood JM, Cohen EM, Clark RC. Gender and Sexual Identity in Adolescence: A Mixed-Methods Study of Labeling in Diverse Community Settings. JOURNAL OF ADOLESCENT RESEARCH 2021. [DOI: 10.1177/07435584211000315] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Understandings of sexual and gender identity have expanded beyond traditional binaries, yet we know little about adolescents’ appropriation of identity labels across diverse communities. In a mixed-methods study of adolescents recruited from lesbian, gay, bisexual, transgender, and queer (LGBTQ+) spaces in communities differing in support of sexual and gender diversity, seven patterns emerged: (a) frequent use of nonbinary gender identity labels (23.9% of survey sample), especially in high-support communities; (b) greater comfort among adolescents assigned female at birth (AFAB) with diverse gender expression, which informants attributed to pressures to conform to compulsive masculinity for boys; (c) frequent use of plurisexual (60.8%) and asexual (9.9%) labels, especially among those AFAB, and discussion of online settings as a resource; (d) intersectional patterning of “queer” to describe sexual identity (12.4% of survey sample), with White youth in high-support communities signifying an intellectual/political stance and non-White youth in low-support communities using queer as an umbrella term; (e) resistance to labeling and ambivalence about labels due to intra-community dynamics; (f) labeling challenges among boys of color; and (g) challenges with stigma, sexualization, and violence for transgender and nonbinary youth. Findings highlight how contemporary adolescents engage with and challenge received conceptions of gender and sexuality and how this process is shaped by intersectional identities.
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Sherman AD, Poteat TC, Budhathoki C, Kelly U, Clark KD, Campbell JC. Association of Depression and Post-Traumatic Stress with Polyvictimization and Emotional Transgender and Gender Diverse Community Connection Among Black and Latinx Transgender Women. LGBT Health 2020; 7:358-366. [DOI: 10.1089/lgbt.2019.0336] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Athena D.F. Sherman
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Tonia C. Poteat
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Chakra Budhathoki
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ursula Kelly
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
- Atlanta VA Health Care System, Atlanta, Georgia, USA
| | - Kristen D. Clark
- School of Nursing, University of California San Francisco, San Francisco, California, USA
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Peitzmeier SM, Malik M, Kattari SK, Marrow E, Stephenson R, Agénor M, Reisner SL. Intimate Partner Violence in Transgender Populations: Systematic Review and Meta-analysis of Prevalence and Correlates. Am J Public Health 2020; 110:e1-e14. [PMID: 32673114 PMCID: PMC7427218 DOI: 10.2105/ajph.2020.305774] [Citation(s) in RCA: 140] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2020] [Indexed: 11/04/2022]
Abstract
Background: Transgender individuals experience unique vulnerabilities to intimate partner violence (IPV) and may experience a disproportionate IPV burden compared with cisgender (nontransgender) individuals.Objectives: To systematically review the quantitative literature on prevalence and correlates of IPV in transgender populations.Search Methods: Authors searched research databases (PubMed, CINAHL), gray literature (Google), journal tables of contents, and conference abstracts, and consulted experts in the field. Authors were contacted with data requests in cases in which transgender participants were enrolled in a study, but no disaggregated statistics were provided for this population.Selection Criteria: We included all quantitative literature published before July 2019 on prevalence and correlates of IPV victimization, perpetration, or service utilization in transgender populations. There were no restrictions by sample size, year, or location.Data Collection and Analysis: Two independent reviewers conducted screening. One reviewer conducted extraction by using a structured database, and a second reviewer checked for mistakes or omissions. We used random-effects meta-analyses to calculate relative risks (RRs) comparing the prevalence of IPV in transgender individuals and cisgender individuals in studies in which both transgender and cisgender individuals were enrolled. We also used meta-analysis to compare IPV prevalence in assigned-female-sex-at-birth and assigned-male-sex-at-birth transgender individuals and to compare physical IPV prevalence between nonbinary and binary transgender individuals in studies that enrolled both groups.Main Results: We identified 85 articles from 74 unique data sets (ntotal = 49 966 transgender participants). Across studies reporting it, the median lifetime prevalence of physical IPV was 37.5%, lifetime sexual IPV was 25.0%, past-year physical IPV was 16.7%, and past-year sexual IPV was 10.8% among transgender individuals. Compared with cisgender individuals, transgender individuals were 1.7 times more likely to experience any IPV (RR = 1.66; 95% confidence interval [CI] = 1.36, 2.03), 2.2 times more likely to experience physical IPV (RR = 2.19; 95% CI = 1.66, 2.88), and 2.5 times more likely to experience sexual IPV (RR = 2.46; 95% CI = 1.64, 3.69). Disparities persisted when comparing to cisgender women specifically. There was no significant difference in any IPV, physical IPV, or sexual IPV prevalence between assigned-female-sex-at-birth and assigned-male-sex-at-birth individuals, nor in physical IPV prevalence between binary- and nonbinary-identified transgender individuals. IPV victimization was associated with sexual risk, substance use, and mental health burden in transgender populations.Authors' Conclusions: Transgender individuals experience a dramatically higher prevalence of IPV victimization compared with cisgender individuals, regardless of sex assigned at birth. IPV prevalence estimates are comparably high for assigned-male-sex-at-birth and assigned-female-sex-at-birth transgender individuals, and for binary and nonbinary transgender individuals, though more research is needed.Public Health Implications: Evidence-based interventions are urgently needed to prevent and address IPV in this high-risk population with unique needs. Lack of legal protections against discrimination in employment, housing, and social services likely foster vulnerability to IPV. Transgender individuals should be explicitly included in US Preventive Services Task Force recommendations promoting IPV screening in primary care settings. Interventions at the policy level as well as the interpersonal and individual level are urgently needed to address epidemic levels of IPV in this marginalized, high-risk population.
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Affiliation(s)
- Sarah M Peitzmeier
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
| | - Mannat Malik
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
| | - Shanna K Kattari
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
| | - Elliot Marrow
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
| | - Rob Stephenson
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
| | - Madina Agénor
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
| | - Sari L Reisner
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
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Bromberg DJ, Mayer KH, Altice FL. Identifying and managing infectious disease syndemics in patients with HIV. Curr Opin HIV AIDS 2020; 15:232-242. [PMID: 32487816 PMCID: PMC7376494 DOI: 10.1097/coh.0000000000000631] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW We will present recent articles focusing on HIV synergistic interactions with other sexually transmitted infections, tuberculosis, and hepatitis, as well as recent advances in the study of social and behavioral determinants that facilitate this clustering of infectious disease. For each synergistic interaction, we highlight evidence-based interventions that clinicians and policymakers should consider to tackle HIV and infectious disease syndemics. RECENT FINDINGS Significant advances in understanding the behavioral and structural determinants of HIV and other infectious disease synergisms have been made in the past years. Intervention strategies based on these new models have also been developed. It is now well understood that treating infectious disease syndemics will require a multidisciplinary and multipronged approach. SUMMARY HIV is synergistic with multiple other infectious diseases because the risk behaviors that lead to HIV acquisition may be similar to the other infections. The influence of HIV on the other infection may be due to immunosuppression associated with disease progression resulting in increased susceptibility (e.g., HIV and tuberculosis), especially when patients are not virologically suppressed using antiretroviral therapy. In reverse, another infectious disease may, when not treated, influence HIV disease progression. Social/structural determinants like homelessness, mass incarceration, and structural discrimination precipitate psychiatric comorbidity, substance use, and risky sex behavior which lead to the spread and co-occurrence of infectious disease.
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Affiliation(s)
- Daniel J Bromberg
- Department of Social and Behavioral Sciences, Yale University School of Public Health
- Yale Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Frederick L Altice
- Yale Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
- Section of Infectious Diseases, Department of Medicine, Yale University School of Medicine
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut, USA
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90
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Brownhalls J, Duffy A, Eriksson L, Overall N, Sibley CG, Radke HRM, Barlow FK. Make it Safe at Night or Teach Women to Fight? Sexism Predicts Views on Men’s and Women’s Responsibility to Reduce Men’s Violence Toward Women. SEX ROLES 2020. [DOI: 10.1007/s11199-020-01159-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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A Gap Between Willingness and Uptake: Findings From Mixed Methods Research on HIV Prevention Among Black and Latina Transgender Women. J Acquir Immune Defic Syndr 2020; 82:131-140. [PMID: 31180995 DOI: 10.1097/qai.0000000000002112] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Black and Latina transgender women (BLTW) face significant HIV disparities with estimated HIV prevalence up to 50% and annual incidence rates as high as 2.8 per 100 person-years. However, few studies have evaluated the acceptability and uptake of high-impact HIV prevention interventions among BLTW. SETTING Data collection took place in Baltimore, MD and Washington, DC from May 2015 to May 2017. METHODS This mixed methods study included quantitative interviewer-administered surveys, key informant interviews, and focus group discussions. Rapid HIV testing followed each survey. Logistic regression models tested associations between legal gender affirmation (ie, desired name and gender marker on identity documents), transgender pride, history of exchange sex, HIV risk perception, and willingness to take pre-exposure prophylaxis (PrEP). Transcripts of qualitative data were coded to identify common themes related to engagement in HIV prevention. RESULTS Among 201 BLTW, 56% tested HIV-positive and 87% had heard of PrEP. Only 18% who had heard of PrEP had ever taken it. Of the 72 self-reported HIV-negative or status-unknown BLTW who had never taken PrEP, 75% were willing to take it. In multivariable analyses, history of exchange sex was associated with willingness to take PrEP, whereas greater HIV knowledge and transgender pride were associated with lower likelihood of willingness to take PrEP. Concern about drug interactions with hormone therapy was the most frequently reported barrier to PrEP uptake. CONCLUSIONS Noting the disconnect between PrEP willingness and uptake among BLTW, HIV prevention programs could bridge this gap by responding to identified access barriers and incorporating community-derived strategies.
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Wirtz AL, Poteat T, Radix A, Althoff KN, Cannon CM, Wawrzyniak AJ, Cooney E, Mayer KH, Beyrer C, Rodriguez AE, Reisner SL. American Cohort to Study HIV Acquisition Among Transgender Women in High-Risk Areas (The LITE Study): Protocol for a Multisite Prospective Cohort Study in the Eastern and Southern United States. JMIR Res Protoc 2019; 8:e14704. [PMID: 31584005 PMCID: PMC6802485 DOI: 10.2196/14704] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/31/2019] [Accepted: 08/07/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND In the United States, transgender women (TW) are disproportionately burdened by HIV infection. Cohort studies are needed to evaluate factors driving HIV acquisition among TW over time. These will require implementation strategies that are acceptable to the TW community and feasible to implement. OBJECTIVE This study aims to investigate the rate and correlates of HIV acquisition and other health outcomes among TW in eastern and southern United States. METHODS LITE is a multisite prospective cohort in 6 eastern and southern US cities, which will be followed across 24 months of technology-enhanced biobehavioral follow-up. Adult TW, regardless of HIV status, are recruited via convenience sampling (eg, peer referrals, social media, and dating apps). Participants are enrolled in a baseline study visit, complete a sociobehavioral survey, and test for HIV and sexually transmitted infections. Participants who are not living with HIV at baseline are offered enrollment into the cohort (N=1100); follow-up assessments occur quarterly. RESULTS Cohort assembly was informed by synchronous Web-based focus group discussions with TW (n=41) and by continuing engagement with community advisory board members from each site. Enrollment launched in March 2018. The study is underway in the Atlanta; Baltimore; Boston; Miami; New York City; and Washington, DC, metro areas. As of March 2019, 795 TW completed a baseline visit (mean age 35 years). The majority of the participants are racial/ethnic minorities, with 45% of the TW identifying as black and 28% of the TW identifying as Hispanic/Latinx. More than one-quarter (28%) of the TW are living with HIV infection (laboratory-confirmed). Online recruitment methods support engagement with TW, although peer referral and referral through trusted health facilities and organizations remain most effective. CONCLUSIONS This study is responsive to increasing research interest in technology-enhanced methods for cohort research, particularly for hard-to-reach populations. Importantly, the diversity of literacy, technology use, and overall socioeconomic situations in this sample of TW highlights the need to leverage technology to permit a flexible, adaptive methodology that enhances engagement of potential participants living in marginalized contexts while still ensuring rigorous and sound study design. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/14704.
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Affiliation(s)
- Andrea L Wirtz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Tonia Poteat
- University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Asa Radix
- Callen-Lorde Community Health Center, New York, NY, United States
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | - Andrew J Wawrzyniak
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Erin Cooney
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | - Chris Beyrer
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Allan E Rodriguez
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Sari L Reisner
- The Fenway Institute, Boston, MA, United States
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, United States
- Pediatrics, Harvard Medical School, Boston, MA, United States
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, United States
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Leddy AM, Weiss E, Yam E, Pulerwitz J. Gender-based violence and engagement in biomedical HIV prevention, care and treatment: a scoping review. BMC Public Health 2019; 19:897. [PMID: 31286914 PMCID: PMC6615289 DOI: 10.1186/s12889-019-7192-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 06/17/2019] [Indexed: 12/17/2022] Open
Abstract
Background While gender-based violence (GBV) has been shown to increase women’s risk of HIV acquisition, the role of GBV in the HIV testing to care continuum is less clear. Clarifying how GBV may act as a barrier to accessing HIV services, treatment and care - such as anti-retroviral treatment (ART) or pre-exposure prophylaxis (PrEP) - will not only provide insights into how to best meet individual women’s HIV care needs, but also inform public health oriented HIV epidemic control strategies. Methods Through a comprehensive scoping review, we synthesized and analyzed existing evidence regarding the influence of GBV on engagement in PrEP and the HIV care continuum among women living with HIV, including members of key populations (female sex workers, transgender women and women who use drugs). We explored PubMed, Scopus and Web of Science for peer-reviewed studies published in 2003–2017. Of the 279 sources identified, a subset of 51 sources met the criteria and were included in the scoping review. Results Studies were identified from 17 countries. The majority of studies utilized quantitative cross-sectional designs (n = 33), with the rest using longitudinal (n = 4), qualitative (n = 10) or mixed methods (n = 4) designs. Taken together, findings suggest that GBV impedes women’s uptake of HIV testing, care, and treatment, yet this can vary across different geographic and epidemic settings. Substantial gaps in the literature do still exist, including studies on the impact of GBV on engagement in PrEP, and research among key populations. Conclusions This scoping review contributes to our knowledge regarding the role GBV plays in women’s engagement in PrEP and the HIV care continuum. Findings reveal the need for more longitudinal research to provide insights into the causal pathways linking GBV and HIV care and treatment outcomes. Research is also needed to illuminate the impact of GBV on PrEP use and adherence as well as the impact of GBV on engagement along the HIV care continuum among key populations. It is critical that programs and research keep pace with these findings in order to reduce the global burden of GBV and HIV among women.
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Affiliation(s)
- Anna M Leddy
- Division of Prevention Science, Center for AIDS Prevention Studies, University of California, San Francisco, 550 16th St., 3rd Floor, San Francisco, CA, 94158, USA.
| | - Ellen Weiss
- Population Council, 4301 Connecticut Ave. NW, # 280, Washington, DC, 20008, USA
| | - Eileen Yam
- Population Council, 4301 Connecticut Ave. NW, # 280, Washington, DC, 20008, USA
| | - Julie Pulerwitz
- Population Council, 4301 Connecticut Ave. NW, # 280, Washington, DC, 20008, USA
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Jordan SP, Mehrotra GR, Fujikawa KA. Mandating Inclusion: Critical Trans Perspectives on Domestic and Sexual Violence Advocacy. Violence Against Women 2019; 26:531-554. [DOI: 10.1177/1077801219836728] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In 2013, the Violence Against Women Act became one of the first federal laws to explicitly prohibit discrimination against transgender people, yet little is known about its impact in practice. This qualitative study draws on in-depth interviews with transgender people working in domestic and sexual violence advocacy organizations. Building on critical and intersectional perspectives, the findings suggest that the persistence of inequities for trans survivors are tied to the reliance on criminal legal responses, contingent access to gender-specific services, compliance-focused approaches to inclusion, operating theories of gender-based violence, and the diversion of responsibility to LGBTQ (lesbian, gay, bisexual, transgender and queer) programs. This study highlights the participants’ recommendations for change.
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Martinez-Velez JJ, Melin K, Rodriguez-Diaz CE. A Preliminary Assessment of Selected Social Determinants of Health in a Sample of Transgender and Gender Nonconforming Individuals in Puerto Rico. Transgend Health 2019; 4:9-17. [PMID: 30719502 PMCID: PMC6360392 DOI: 10.1089/trgh.2018.0045] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Purpose: Transgender and gender nonconforming (GNC) people continue to experience suboptimal health care, social exclusion, and lower quality of life. Globally, lack of access to services, institutional violence, and public harassment have been reported. However, there is limited data on transgender health in Puerto Rico and the Caribbean. The purpose of this study is to assess the social determinants of health and wellbeing of transgender and GNC people living in Puerto Rico. Methods: Utilizing a community-based participatory research approach, 52 self-identified transgender and GNC individuals living in Puerto Rico completed a survey, which included questions on access to health care services, social support, and violence, among others. Data were collected from March to Ma y of 2015 and descriptive statistical analysis was conducted. Results: Most of the participants reported experiences of discrimination across multiple social settings, most commonly at school (70.6%) and work (67.4%). Regarding experiences of violence, more than half (65.4%) had been verbally attacked in a public space. Many reported that access to gender-affirming health care services is difficult in Puerto Rico (88.5%) due to lack of knowledgeable providers (59.6%) and discomfort during the encounter (55.8%). The main perceived priority for their wellbeing was a transgender health care center. Conclusion: Although the LGBT equality movement has reached great milestones, access to gender-affirming health services and safe educational and work spaces are still needed. Findings from the study provide guidance for actions to reduce health disparities by addressing the needs for health and wellbeing among transgender and GNC individuals.
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Affiliation(s)
- Jose J. Martinez-Velez
- University of Puerto Rico-Medical Sciences Campus, School of Public Health, Center for Sociomedical Research and Evaluation, San Juan, Puerto Rico
| | - Kyle Melin
- University of Puerto Rico-Medical Sciences Campus, School of Pharmacy, Department of Pharmacy Practice, San Juan, Puerto Rico
| | - Carlos E. Rodriguez-Diaz
- University of Puerto Rico-Medical Sciences Campus, School of Public Health, Center for Sociomedical Research and Evaluation, San Juan, Puerto Rico
- The George Washington University, Milken Institute School of Public Health, Department of Prevention and Community Health, Washington, District of Columbia
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Abstract
PURPOSE OF REVIEW This review highlights recent research on sex- and gender-related factors in the prevalence, symptom expression, and treatment of PTSD. Further discoveries about the underlying mechanisms of sex and gender effects have the potential to shape innovative directions for research. RECENT FINDINGS The prevalence of PTSD is substantially higher among women, but women show a modest advantage with respect to treatment response. There is evidence of greater heritability among females. Women are more likely to experience sexual and intimate violence, childhood trauma exposure, and repeated trauma exposures. Specific characteristics of social contexts act as gender-linked risks for PTSD. Among individuals diagnosed with PTSD, men and women are similar in phenotypic expression. Though research has yet to fully account for the factors that explain sex- and gender- related effects on PTSD, emerging research suggests these effects occur across multiple levels. Shared risk factors for trauma exposure and PTSD merit further investigation. Both social and biological contexts merit investigation to understand sex-linked differences in heritability.
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Affiliation(s)
- Rachel Kimerling
- National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, USA.
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA.
| | - Monica C Allen
- National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, USA
- Pacific Graduate School of Psychology-Stanford Psy.D. Consortium, Palo Alto, CA, USA
| | - Laramie E Duncan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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