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Bird K, Arcelus J, Matsagoura L, O'Shea B, Townsend E. Risk and protective factors for self-harm thoughts and behaviours in transgender and gender diverse people: A systematic review. Heliyon 2024; 10:e26074. [PMID: 38468947 PMCID: PMC10925986 DOI: 10.1016/j.heliyon.2024.e26074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 01/17/2024] [Accepted: 02/07/2024] [Indexed: 03/13/2024] Open
Abstract
Background Self-harm (any self-injury or -poisoning regardless of intent) is highly prevalent in transgender and gender diverse (TGD) populations. It is strongly associated with various adverse health and wellbeing outcomes, including suicide. Despite increased risk, TGD individuals' unique self-harm pathways are not well understood. Following PRISMA guidelines we conducted the first systematic review of risk and protective factors for self-harm in TGD people to identify targets for prevention and intervention. Methods We searched five electronic databases (PubMed, PsychInfo, Scopus, MEDLINE, and Web of Science) published from database inception to November 2023 for primary and secondary studies of risk and/or protective factors for self-harm thoughts and behaviours in TGD people. Data was extracted and study quality assessed using Newcastle-Ottawa Scales. Findings Overall, 78 studies published between 2007 and 2023 from 16 countries (N = 322,144) were eligible for inclusion. Narrative analysis identified six key risk factors for self-harm in TGD people (aged 7-98years) were identified. These are younger age, being assigned female at birth, illicit drug and alcohol use, sexual and physical assault, gender minority stressors (especially discrimination and victimisation), and depression or depressive symptomology. Three important protective factors were identified: social support, connectedness, and school safety. Other possible unique TGD protective factors against self-harm included: chosen name use, gender-identity concordant documentation, and protective state policies. Some evidence of publication bias regarding sample size, non-responders, and confounding variables was identified. Interpretation This systematic review indicates TGD people may experience a unique self-harm pathway. Importantly, the risk and protective factors we identified provide meaningful targets for intervention. TGD youth and those assigned female at birth are at increased risk. Encouraging TGD people to utilise and foster existing support networks, family/parent and peer support groups, and creating safe, supportive school environments may be critical for self-harm and suicide prevention strategies. Efforts to reduce drug and alcohol use and experiences of gender-based victimisation and discrimination are recommended to reduce self-harm in this high-risk group. Addressing depressive symptoms may reduce gender dysphoria and self-harm. The new evidence presented in this systematic review also indicates TGD people may experience unique pathways to self-harm related to the lack of social acceptance of their gender identity. However, robust longitudinal research which examines gender-specific factors is now necessary to establish this pathway.
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Affiliation(s)
- K. Bird
- School of Psychology, University of Nottingham, Nottingham, UK
| | - J. Arcelus
- Institute of Mental Health, University of Nottingham, Nottingham, UK
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - L. Matsagoura
- School of Psychology, University of Nottingham, Nottingham, UK
| | - B.A. O'Shea
- School of Psychology, University of Nottingham, Nottingham, UK
- Department of Psychology, Harvard University, Cambridge, MA, USA
- The Centre for the Experimental-Philosophical Study of Discrimination, Aarhus University, Denmark
| | - E. Townsend
- School of Psychology, University of Nottingham, Nottingham, UK
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2
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Wiginton JM, Murray S, Kall M, Maksut JL, Augustinavicius J, Delpech V, Baral SD. HIV-related Stigma and Discrimination in Health Care and Health-related Quality of Life among People Living with HIV in England and Wales: A Latent Class Analysis. STIGMA AND HEALTH 2023; 8:487-496. [PMID: 38292669 PMCID: PMC10824403 DOI: 10.1037/sah0000299] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Though life expectancy of people living with HIV (PLHIV) is now comparable to that of HIV-negative persons, their health-related quality of life (HRQoL) lags behind. Lower HRQoL among PLHIV may vary meaningfully, shaped in part by social factors, including stigma. Using data from Positive Voices, a national cross-sectional probability survey of adults ≥ 18 years living with HIV and accessing HIV care services in England and Wales (N = 4,422), we conducted latent class analysis on responses to a HRQoL measure (problems with mobility, usual activities, self-care, pain/discomfort, anxiety/depression) to identify HRQoL patterns, followed by multinomial logistic regression to examine relationships between HRQoL classes and a 4-item measure of HIV-related stigma and discrimination in health care. Four classes emerged: All Problems (18% prevalence); Pain and Distress (18%); Pain and Mobility (9%); No Problems (55%). Scale scores of HIV-related stigma and discrimination in health care were positively, significantly associated with membership in the All Problems (adjusted odds ratio [aOR] = 2.05; 95% confidence interval [CI] = 1.85, 2.28), Pain and Distress (aOR = 1.56; CI = 1.41, 1.73), and Pain and Mobility classes (aOR = 1.33; CI = 1.16, 1.52) compared to the No Problems class. A similar trend was observed for individual stigma and discrimination items. HRQoL among PLHIV in England and Wales varies and may be underpinned or exacerbated by HIV-related stigma and discrimination in health care. Ensuring stigma-mitigation interventions reach all health care systems/providers and emotional support services reach all PLHIV may improve HRQoL for PLHIV.
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Affiliation(s)
- John Mark Wiginton
- Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sarah Murray
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Meaghan Kall
- HIV/STI Department, National Infection Service, Public Health England, London, UK
| | - Jessica L Maksut
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jura Augustinavicius
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Valerie Delpech
- HIV/STI Department, National Infection Service, Public Health England, London, UK
| | - Stefan D Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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3
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Belfort EL, Brown B. Individual Affirming Care: Psychological and Social Approaches to Trans and Gender-Diverse Youth. Child Adolesc Psychiatr Clin N Am 2023; 32:761-773. [PMID: 37739633 DOI: 10.1016/j.chc.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
Clinicians working with youth encounter transgender and gender-diverse youth and play a role in supporting the psychological and social well-being of youth and their families. Mental health clinicians start with a thorough assessment, development of a biopsychosocial formulation of the youth, and a collaborative treatment plan. Determining if the youth meets diagnostic criteria for Gender Dysphoria and identifying comorbid mental health diagnoses inform recommendations for psychiatric medication management, individual and/or family therapy interventions, and/or referrals to medical or surgical colleagues. Supporting development of a coherent identity narrative and healthy interpersonal attachments with others is an important goal of treatment interventions.
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Affiliation(s)
- Erin L Belfort
- Maine Medical Center, Tufts University School of Medicine, 66 Bramhall Street, Portland, ME 04102, USA.
| | - Brandy Brown
- Maine Medical Center, Tufts University School of Medicine, The Gender Clinic, 1577 Congress Street, 2nd Floor, Portland, ME 04102, USA
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4
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Kota KK, Luo Q, Beer L, Dasgupta S, McCree DH. Stigma, Discrimination, and Mental Health Outcomes Among Transgender Women With Diagnosed HIV Infection in the United States, 2015-2018. Public Health Rep 2023; 138:771-781. [PMID: 36129230 PMCID: PMC10467496 DOI: 10.1177/00333549221123583] [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: 11/16/2022] Open
Abstract
OBJECTIVE Transgender women with diagnosed HIV experience social and structural factors that could negatively affect their overall health and HIV-related health outcomes. We describe estimates from the Centers for Disease Control and Prevention Medical Monitoring Project (MMP) of sociodemographic characteristics, HIV stigma, discrimination, and mental health outcomes among transgender women with diagnosed HIV. METHODS We analyzed pooled data of all transgender women with diagnosed HIV (N = 217) from the 2015 through 2018 MMP cycles. We reported unweighted frequencies, weighted percentages, and 95% CIs for all characteristics. We post-stratified data to known population totals by age, race and ethnicity, and sex at birth from the National HIV Surveillance System. RESULTS Approximately 46% of transgender women with diagnosed HIV identified as Black or African American, 67% lived at or below the federal poverty level, 18% had experienced homelessness in the past year, 26% experienced mild to severe symptoms of depression, 30% experienced mild to severe anxiety symptoms, 32% reported physical violence by an intimate partner, and 30% reported forced sex during their lifetime. Despite 80% being very satisfied with their current HIV care, 94% experienced current HIV stigma and 20% experienced health care-related discrimination since being diagnosed with HIV. Among transgender women with diagnosed HIV who experienced discrimination, 46% and 51% experienced health care discrimination attributed to their gender and sexual orientation or sexual practices, respectively. CONCLUSIONS Our findings underscore a need to address unmet ancillary services, such as housing, intimate partner violence, and mental health needs, and the need for strategies to reduce experiences with HIV stigma and discrimination in care for transgender women with diagnosed HIV in the United States.
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Affiliation(s)
- Krishna Kiran Kota
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | | | - Linda Beer
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sharoda Dasgupta
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Donna Hubbard McCree
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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5
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Matouk KM, Schulman JK, Case JAC. Mental Health Disparities in Sexual Minority and Transgender Women: Implications and Considerations for Treatment. Psychiatr Clin North Am 2023; 46:583-595. [PMID: 37500252 DOI: 10.1016/j.psc.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Minority stress theory offers an explanation of how discrimination, marginalization, harassment, and violence against sexual minority and transgender women are connected to mental health disparities. Particularly, these groups are vulnerable to body image issues, disordered eating, higher rates of mood and anxiety disorders, suicide and nonsuicidal self-injury, and substance use. Discrimination is also experienced within clinical settings, which may lead this population to postpone or avoid treatment. Clinicians play a crucial role in reducing barriers to health care by developing cultural competency and ensuring safe and affirming spaces within their practice.
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Affiliation(s)
- Kareen M Matouk
- Department of Psychiatry, Columbia University Irving Medical Center, 710 West 168th Street, 12th Floor, New York, NY 10032, USA.
| | - Julie K Schulman
- Department of Psychiatry, Columbia University Irving Medical Center, 5141 Broadway, 3 River East, New York, NY 10034, USA
| | - Julia A C Case
- Department of Psychiatry, Columbia University Irving Medical Center, 710 West 168th Street, 12th Floor, New York, NY 10032, USA
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6
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Weiss SJ, Simeonova DI, Koleva H, Muzik M, Clark KD, Ozerdem A, Cooper B, Ammerman RT. Potential paths to suicidal ideation and suicide attempts among high-risk women. J Psychiatr Res 2022; 155:493-500. [PMID: 36183603 DOI: 10.1016/j.jpsychires.2022.09.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 08/22/2022] [Accepted: 09/16/2022] [Indexed: 10/31/2022]
Abstract
Although men are more likely to die by suicide, women experience a greater and more rapidly increasing rate of suicidal ideation (SI) and are 3 times more likely to attempt suicide than men. Despite this increased risk, little is known about factors that contribute to SI or suicide attempts (SA) among women. We examined factors associated with SI and SA among women and identified mood-related symptoms that differentiate women who reported attempting suicide from those who did not. Women at elevated risk for depression from across the U.S. (N = 3372; age 18 to 90) completed a survey regarding depression, anxiety, sociodemographic and reproductive status, behavioral/mental health history, and exposure to adversity. Structural equation modeling and logistic regression were used to analyze the data. Variables with the most significant relationships to SI were severity of depression (OR = 5.2, p = 0.000) and perceived stress (OR = 1.18, p = 0.000) while frequency of suicidal thoughts (OR = 3.3, p = 0.000), family history of a depression diagnosis (OR = 1.6, p = 0.000) and exposure to violence (OR = 1.9, p = 0.000) had the strongest association with SA. Childhood abuse/trauma was associated with SA (OR = 1.13, p = 0.000) but not SI. 'Feeling bad about themselves, a failure, or having let themselves or their family down' was the symptom that most clearly differentiated women who attempted suicide from women who reported suicidal ideation but no SA. The salience of childhood abuse and domestic/community violence to women's risk for a suicide attempt reinforces previous findings that these adversities may differentiate suicide risk for women versus men. Continued research is essential to understand varied paths that may lead to suicidal behavior among women, some which appear unrelated to the frequency or intensity of their suicidal thoughts.
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Affiliation(s)
- Sandra J Weiss
- University of California, 2 Koret Way, Box 0608, San Francisco, CA, 94143, USA.
| | - Diana I Simeonova
- Emory University, 12 Executive Park Drive NE, Atlanta, GA, 30329, USA.
| | - Hristina Koleva
- University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
| | - Maria Muzik
- University of Michigan, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA.
| | - Kristen D Clark
- University of New Hampshire, 4 Library Way, Hewitt Hall, Durham, NH, 03824, USA.
| | - Aysegul Ozerdem
- Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Bruce Cooper
- University of California, 2 Koret Way, Box 0610, San Francisco, CA, 94143, USA.
| | - Robert T Ammerman
- University of Cincinnati, Cincinnati Children's Hospital, 333 Burnet Avenue, ML7039, Cincinnati, OH, 45229, USA.
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7
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Sun M, Ji H, Chen X, Xu J, Lu J, Yi Y, Pan Y, Wu R, Chen Y, Duan Y, Dou X, Zhou L. The factors influencing the psychological distress of transgender women in Shandong, China: a cross-sectional study. BMC Public Health 2022; 22:955. [PMID: 35549903 PMCID: PMC9101853 DOI: 10.1186/s12889-022-13357-9] [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: 10/12/2021] [Accepted: 04/25/2022] [Indexed: 11/15/2022] Open
Abstract
Background As a group at high-risk for acquired immune deficiency syndrome (AIDS) infection, the psychological distress of transgender women cannot be ignored while preventing and controlling AIDS risks. Transgender women are a vulnerable group, and their psychological distress deserves attention. The purpose of this study was to evaluate the psychological distress of transgender women and further determine the influences of factors on the psychological distress of transgender women. Methods From March 2021 to August 2021, a cross-sectional survey was conducted in Shandong province, China. Data were collected by a questionnaire designed for transgender women, and the GHQ-12 scale was used to measure their psychological distress. The questionnaire combined sociodemographic characteristics, HIV/AIDS cognition, related behaviors, substance abuse, social support, gender identity and other factors. Univariate logistic regression and multivariate logistic regression models were used to explore the psychological factors of transgender women. Results In this study, the rate of transgender women with psychological distress was 20.08%. Earned monthly income between 10,000–15,000 yuan (OR:0.16, 95% CI:0.06–0.45) and a monthly income greater than 15,000 yuan (OR:0.07, 95% CI:0.01–0.43) were protective factors in the psychology of transgender women. Transgender women who never disclosed sexual orientation and identity (OR: 0.19, 95% CI: 0.06–0.58), who only disclosed their sexual orientation and identity to families or friends (OR: 0.41, 95% CI: 0.18–0.93) were also less likely to have psychological distress. Additionally, transgender women who did not desire to be identified with their sexual orientation and identity (OR: 3.31, 95%CI: 1.08–10.16) and who reported that the Internet did not play an essential role in helping determine sexual orientation (OR: 5.96, 95% CI: 2.91–12.20) were more likely to have psychological distress. Conclusion Transgender women were at risk of psychological distress. Earning more money can help transgender women's psychological health. When formulating measures for transgender women, we should pay attention to enhance social inclusion and social acceptance of their gender identity and sexual orientation. Strengthening the role of the internet in transgender women's confirmation of sexual orientation and improving the social acceptance of transgender women will have a positive impact on the psychological status of transgender women. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13357-9.
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Affiliation(s)
- Meng Sun
- School of Public Health, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Haoqiang Ji
- School of Public Health, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Xu Chen
- School of Public Health, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Jia Xu
- School of Public Health, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Jiachen Lu
- School of Public Health, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Yaohui Yi
- School of Public Health, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Yuanping Pan
- School of Public Health, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Ruiheng Wu
- School of Public Health, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Yunting Chen
- School of Public Health, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Yuxin Duan
- School of Public Health, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Xiaofeng Dou
- School of Public Health, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Ling Zhou
- School of Public Health, Dalian Medical University, Dalian, 116044, Liaoning, China.
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8
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Pinna F, Paribello P, Somaini G, Corona A, Ventriglio A, Corrias C, Frau I, Murgia R, El Kacemi S, Galeazzi GM, Mirandola M, Amaddeo F, Crapanzano A, Converti M, Piras P, Suprani F, Manchia M, Fiorillo A, Carpiniello B. Mental health in transgender individuals: a systematic review. Int Rev Psychiatry 2022; 34:292-359. [PMID: 36151828 DOI: 10.1080/09540261.2022.2093629] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Several lines of evidence indicate the prevalence of mental health disorders in Transgender (TG) individuals is higher than that of cisgender individuals or the general population. In this systematic review, we aim to propose a summary of some of the most significant research investigating mental health disorders' prevalence among this population. We performed a double-blind systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting (PRISMA) on PUBMED/MEDLINE and SCOPUS, specifically using peer-reviewed articles examining the mental health status of transgender (TG) individuals. This review did not exclude any research based on publication date. The last search was performed in February 2022. The employed search strategy led to the selection of 165 peer-reviewed articles. The majority of these papers presented a cross-sectional design with self-reported diagnoses and symptoms, signaling a significant prevalence of mental health disorders amongst TG Individuals. Of the reviewed articles, 72 examined the prevalence of mood and anxiety disorders; 8 examined eating disorders; 43 examined the prevalence of suicidal or self-harm ideation or behaviors; 5 papers examined the prevalence of trauma and stress-related disorders; 10 examined the frequency of personality disorders; 44 examined substance use disorders; and 9 papers examined the prevalence of autism spectrum disorder. Finally, 22 studies reported on the prevalence of TG individuals diagnosed with co-morbid mental health disorders or unspecified mental disorders. Our findings coincide with existing research, which indicates TG individuals do experience a higher prevalence of mental health disorders than that of the general population or cisgender individuals. However, further research is needed to address the existing gaps in knowledge.
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Affiliation(s)
- Federica Pinna
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Pasquale Paribello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Giulia Somaini
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Alice Corona
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Carolina Corrias
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Ilaria Frau
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Roberto Murgia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Sabrina El Kacemi
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Dipartimento ad attività integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Mirandola
- Department of Diagnostics and Public Health, Infectious Diseases Section, University of Verona, Verona, Italy.,School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Andrea Crapanzano
- Department of Counseling, San Francisco State University, San Francisco, California, USA
| | - Manlio Converti
- Dipartimento di salute mentale, ASL Napoli 2 Nord, Naples, Italy
| | - Paola Piras
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Federico Suprani
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy.,Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Bernardo Carpiniello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
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9
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Rucinski K, Masankha Banda L, Olawore O, Akolo C, Zakaliya A, Chilongozi D, Schwartz S, Wilcher R, Persaud N, Ruberintwari M, Baral S. HIV Testing Approaches to Optimize Prevention and Treatment for Key and Priority Populations in Malawi. Open Forum Infect Dis 2022; 9:ofac038. [PMID: 35265725 PMCID: PMC8900928 DOI: 10.1093/ofid/ofac038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/28/2022] [Indexed: 12/04/2022] Open
Abstract
Background Despite progress in improving antiretroviral therapy (ART) for people with HIV in Malawi, the burden of HIV infections and HIV treatment outcomes among key populations is suboptimal. Client-centered differentiated service delivery approaches may facilitate addressing HIV prevention and treatment needs of key populations in Malawi. Methods De-identified program data routinely collected as part of the LINKAGES project–Malawi were assembled from October 2017 to September 2019. HIV case finding was compared across different testing modalities for each population. Poisson regression was used to estimate the association between testing modalities and ART initiation. Results Of the 18 397 people included in analyses, 10 627 (58%) were female sex workers (FSWs), 2219 (12%) were men who have sex with men (MSM), and 4970 (27%) were clients of FSWs. HIV case finding varied by modality and population, with index testing and enhanced peer outreach demonstrating high yield despite reaching relatively few individuals. FSWs who tested positive through risk network referral testing were more likely to initiate ART within 30 days compared with those who tested positive through clinic-based testing (adjusted risk ratio [aRR], 1.50; 95% CI, 1.23–1.82). For MSM, index testing (aRR, 1.45; 95% CI, 1.06–2.00) and testing through a drop-in center (aRR, 1.82; 95% CI, 1.19–2.78) were associated with 30-day ART initiation. Conclusions These data suggest that differentiated HIV testing and outreach approaches tailored to the needs of different key populations may facilitate improved ART initiation in Malawi. Achieving 0 new infections by 2030 suggests the need to adapt treatment strategies given individual and structural barriers to treatment for key populations with HIV in high-prevalence settings.
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Affiliation(s)
- Katherine Rucinski
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Oluwasolape Olawore
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | | | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | | | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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10
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Baćak V, Wilson L, Bright K. Gendered association between sexual self-identification and police encounters perceived as unfair. Ann Epidemiol 2021; 63:41-45. [PMID: 34333136 DOI: 10.1016/j.annepidem.2021.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 07/23/2021] [Accepted: 07/25/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Policing is a critical public health issue for minority populations. Yet few studies have examined policing among sexual minority persons, a group that has long been a target of punitive action by law enforcement. The purpose of this study is to examine whether sexual self-identification is associated with ever having been unfairly stopped, searched, or questioned by the police. METHODS The cross-sectional data are from Wave 5 of the National Longitudinal Study of Adolescent to Adult Health collected between 2016 and 2018 (N = 11,592). We used gender-stratified multivariable logistic regression models to examine associations with police encounters perceived as unfair. RESULTS Across all groups of women identifying as a sexual minority, the odds of experiencing a police encounter perceived as unfair were higher relative to women who identified as "100% heterosexual (straight)." The association among men was only consistent for men who identified as "100% homosexual (gay)," but in the opposite direction from the association among women. CONCLUSION Our findings suggest that policing should be examined as a significant public health concern for sexual minority women, specifically because of the adverse health consequences of involuntary police encounters that minority populations perceive as unfair.
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Affiliation(s)
- Valerio Baćak
- School of Criminal Justice, Rutgers University, 123 Washington Street, Newark, NJ 07102-3094.
| | - Lauren Wilson
- School of Criminal Justice, Rutgers University, 123 Washington Street, Newark, NJ 07102-3094.
| | - Katherine Bright
- School of Criminal Justice, Rutgers University, 123 Washington Street, Newark, NJ 07102-3094.
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