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Houghtaling LM, Manning WD, Dush CMK. Coping Patterns During the COVID-19 Pandemic by Sexual and Gender Identity. JOURNAL OF HOMOSEXUALITY 2024; 71:2719-2739. [PMID: 37782080 PMCID: PMC10985047 DOI: 10.1080/00918369.2023.2260920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
National polls have shown that COVID-19 has been highly stressful, negatively affecting well-being and life satisfaction overall, but few studies have focused on individuals with sexual and gender diverse identities. Pandemic-related stress may increase engagement in adverse or negative health-related coping behaviors and decrease engagement in positive coping strategies, potentially exacerbating existing LGBTQ+ health disparities. Relying on a nationally representative population-based sample, we examine disparities in rates of negative and positive COVID-19 coping behaviors by sexual and gender identities. Using Poisson regression models adjusted for key sociodemographic and pandemic related factors, we found higher rates of negative and positive coping behaviors among certain sexual and gender diverse groups compared to their heterosexual and cisgender counterparts. Specifically, we find that lesbian and gay respondents reported more positive and negative coping strategies compared to heterosexual persons. We also found higher rates of negative coping behaviors among plurisexual (bisexual, pansexual, omnisexual) and noncisgender adults (transgender or other nonbinary gender identity) compared to heterosexual and cisgender adults, respectively. We contribute to prior studies by focusing on both negative and positive pandemic related coping among sexually and gender diverse populations. These responses to the pandemic may have long-term implications for the health and well-being of sexual and gender diverse individuals.
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Affiliation(s)
- Laura M. Houghtaling
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, 300 West Bank Office Building, 1300 S. 2 St., Minneapolis, MN 55454, USA
| | - Wendy D. Manning
- Department of Sociology and Center for Family and Demographic Research, Bowling Green State University, Williams Hall, Bowling Green, Ohio 43408, USA
| | - Claire M. Kamp Dush
- Department of Sociology, University of Minnesota, 1031 Social Sciences Building, 267 19 Ave S., Minneapolis, MN 55455, USA
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Wolfe HL, Jeon A, Goulet JL, Simpson TL, Eleazer JR, Jasuja GK, Blosnich JR, Kauth MR, Shipherd JC, Littman AJ. Non-affirmation minority stress, internalized transphobia, and subjective cognitive decline among transgender and gender diverse veterans aged 45 years and older. Aging Ment Health 2024; 28:1357-1363. [PMID: 38567655 DOI: 10.1080/13607863.2024.2335565] [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] [Received: 12/11/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES To examine the associations of two measures of minority stress, non-affirmation minority stress and internalized transphobia, with subjective cognitive decline (SCD) among transgender and gender diverse (TGD) veterans. METHOD We administered a cross-sectional survey from September 2022 to July 2023 to TGD veterans. The final analytic sample included 3,152 TGD veterans aged ≥45 years. We used a generalized linear model with quasi-Poisson distribution to calculate prevalence ratios (PR) and 95% confidence intervals (CIs) measuring the relationship between non-affirmation minority stress and internalized transphobia and past-year SCD. RESULTS The mean age was 61.3 years (SD = 9.7) and the majority (70%) identified as trans women or women. Overall, 27.2% (n = 857) reported SCD. Adjusted models revealed that TGD veterans who reported experiencing non-affirmation minority stress or internalized transphobia had greater risk of past-year SCD compared to those who did not report either stressor (aPR: 1.09, 95% CI: 1.04-1.15; aPR: 1.19, 95% CI: 1.12-1.27). CONCLUSION Our findings demonstrate that proximal and distal processes of stigma are associated with SCD among TGD veterans and underscore the need for addressing multiple types of discrimination. Above all, these results indicate the lasting sequelae of transphobia and need for systemic changes to prioritize the safety and welfare of TGD people.
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Affiliation(s)
- Hill L Wolfe
- Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, Connecticut, CT, USA
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Section of Biomedical Informatics & Data Science, Yale School of Medicine, New Haven, CT, USA
| | - Amy Jeon
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Joseph L Goulet
- Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, Connecticut, CT, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Tracy L Simpson
- Center of Excellence in Substance Addiction Treatment & Education, VA Puget Sound Healthcare System, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Jacob R Eleazer
- Department of Psychiatry and Psychology, Mayo Clinic Florida, Jacksonville, FL, USA
- Transgender and Intersex Specialty Care Clinic, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Guneet K Jasuja
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - John R Blosnich
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Michael R Kauth
- Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) Health Program, Veterans Health Administration, Washington, DC, USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Jillian C Shipherd
- Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) Health Program, Veterans Health Administration, Washington, DC, USA
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Alyson J Littman
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA, USA
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, US Department of Veterans Affairs, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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Crawford J, Brandt A, Kramer M, Ristock J, Schultz ASH. Gender inclusive and affirming practices across undergraduate nursing curriculum: A scoping review. NURSE EDUCATION TODAY 2024; 141:106320. [PMID: 39098092 DOI: 10.1016/j.nedt.2024.106320] [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: 05/21/2024] [Revised: 07/10/2024] [Accepted: 07/21/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVES There are increasing calls for gender affirming care, yet there remains uncertainty as to how nursing education is preparing students. The purpose of this scoping review was to map gender inclusive and affirming practices across the three levels of curriculum (formal, informal, and hidden) in the education of undergraduate nursing students. This novel approach allows consideration of transgender and gender diverse nurses (students and educators). DESIGN Scoping review as per Arksey and O'Malley and Levac et al. DATA SOURCES: Four databases (Medline, Embase, CINAHL, and Scopus) were searched for literature that addressed transgender and gender diversity, discussed at any level of curriculum. In addition, we searched key schools of nursing websites for inclusion of gender inclusive and affirming practices in documents and faculty profiles. We limited our search of peer-reviewed articles and websites to those in English, from Canada and the USA. REVIEW METHODS The article search and extraction were conducted by two independent reviewers while the school of nursing websites were searched by the lead author. RESULTS Forty-seven articles were included and categorized as either (a) Doing (n = 32) (formal, intervention-based) or (b) Thinking (n = 15) (discussion- or evaluation-based) gender inclusive and affirming practices. Twenty-five of the intervention-based articles were single-instance occurrences of learning, primarily by simulation (n = 17). Recommendations at each level of curriculum are offered. Of the 22 schools of nursing websites searched, less than 2 % of faculty profiles list pronouns. CONCLUSIONS While there has been an uptake of formal interventions on gender affirming care there remains a gap in addressing gender inclusive and affirming practices at the informal and hidden curriculum levels. Gender inclusive and affirming practices across all levels of nursing education can help advance culturally safe practices for TGD patients and experiences for TGD nurses and students.
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Affiliation(s)
- Jess Crawford
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, Manitoba, R3T 5V6, Canada.
| | - Adam Brandt
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, Manitoba, R3T 5V6, Canada.
| | - Marnie Kramer
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, Manitoba, R3T 5V6, Canada.
| | - Janice Ristock
- Women's and Gender Studies, Faculty of Arts, University of Manitoba, Room 218, Isbister Building, Winnipeg, Manitoba, R3T 2N2, Canada.
| | - Annette S H Schultz
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, Manitoba, R3T 5V6, Canada.
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Jovanovic N, Zach V, Crocini C, Bahr LS, Forslund-Startceva SK, Franz K. A gender perspective on diet, microbiome, and sex hormone interplay in cardiovascular disease. Acta Physiol (Oxf) 2024:e14228. [PMID: 39263901 DOI: 10.1111/apha.14228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 07/26/2024] [Accepted: 08/24/2024] [Indexed: 09/13/2024]
Abstract
A unique interplay between body and environment embeds and reflects host-microbiome interactions that contribute to sex-differential disease susceptibility, symptomatology, and treatment outcomes. These differences derive from individual biological factors, such as sex hormone action, sex-divergent immune processes, X-linked gene dosage effects, and epigenetics, as well as from their interaction across the lifespan. The gut microbiome is increasingly recognized as a moderator of several body systems that are thus impacted by its function and composition. In humans, biological sex components further interact with gender-specific exposures such as dietary preferences, stressors, and life experiences to form a complex whole, requiring innovative methodologies to disentangle. Here, we summarize current knowledge of the interactions among sex hormones, gut microbiota, immune system, and vascular health and their relevance for sex-differential epidemiology of cardiovascular diseases. We outline clinical implications, identify knowledge gaps, and place emphasis on required future studies to address these gaps. In addition, we provide an overview of the caveats associated with conducting cardiovascular research that require consideration of sex/gender differences. While previous work has inspected several of these components separately, here we call attention to further translational utility of a combined perspective from cardiovascular translational research, gender medicine, and microbiome systems biology.
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Affiliation(s)
- Nina Jovanovic
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Berlin, Germany
| | - Veronika Zach
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité - Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
| | - Claudia Crocini
- German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Berlin, Germany
- Max Rubner Center for Cardiovascular Metabolic Renal Research (MRC), Deutsches Herzzentrum der Charité (DHZC), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lina Samira Bahr
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Berlin, Germany
- Max Rubner Center for Cardiovascular Metabolic Renal Research (MRC), Deutsches Herzzentrum der Charité (DHZC), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sofia Kirke Forslund-Startceva
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Berlin, Germany
| | - Kristina Franz
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Berlin, Germany
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Martin-Storey A, Mayne K, Beischel W, Craig W. Sleep health among youth outside of the gender binary: Findings from a national Canadian sample. Sleep Health 2024:S2352-7218(24)00169-4. [PMID: 39261146 DOI: 10.1016/j.sleh.2024.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 07/13/2024] [Accepted: 07/19/2024] [Indexed: 09/13/2024]
Abstract
OBJECTIVES Sleep is important for adolescent health. The unique needs of suprabinary youth (youth with gender identities outside of the gender binary), along with the growing number of youth with these identities, underscores the need to better understand sleep health within this population. The current study's objectives were to (1) examine differences in sleep health between suprabinary and binary youth and (2) explore how social support, peer victimization, and technology use accounted for these differences. METHODS Data were drawn from the 2017/2018 Health Behavior in School Aged Children Survey. Adolescents (individuals ages 14 to 17, n = 10,186), indicated whether they were suprabinary (n = 182) or binary (n = 10,004), and completed measures of sleep health (difficulty falling asleep, difficulty staying awake, weekday and weekend sleep length), covariates (age, family affluence, race/ethnicity, depressive symptoms), as well as variables that may account for differences between suprabinary and binary youth (family, friend, and teacher support, as well as peer victimization, and technology use before bed). RESULTS Suprabinary youth reported worse sleep health on all outcomes, and differences persisted for both difficulty falling asleep and weekday sleep hours accounting for covariates. Significant indirect effects between suprabinary status were observed across all sleep outcomes for family support and school climate. Indirect effects for sleep quality were also observed via peer victimization. CONCLUSIONS Findings support the relevance of looking at basic health processes like sleep to better understand how the stressors associated with suprabinary status impact health outcomes among this vulnerable population.
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Affiliation(s)
- Alexa Martin-Storey
- Group de Recherche et d'intervention sur les adaptations sociales de l'enfance, Département de Psychoéducation, Université de Sherbrooke, Longueuil, Québec, Canada.
| | - Kyla Mayne
- Psychology Department, Queen's University, Kingston, Ontario, Canada
| | - Will Beischel
- Psychology Department, Loyola University Chicago, Chicago, Illinois, USA
| | - Wendy Craig
- Psychology Department, Queen's University, Kingston, Ontario, Canada
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Keeton VF, Leon-Martinez D, Robles DC, Martinez E, Lessard L, Garza MA, Kuppermann M, Chambers Butcher BD. Latina Women's Perinatal Experiences and Perspectives Around Discrimination, Anti-immigrant Policies, and Community Violence. J Obstet Gynecol Neonatal Nurs 2024:S0884-2175(24)00262-4. [PMID: 39251084 DOI: 10.1016/j.jogn.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 07/26/2024] [Accepted: 08/13/2024] [Indexed: 09/11/2024] Open
Abstract
OBJECTIVE To describe experiences of Latina women who were currently pregnant or recently gave birth around discrimination, anti-immigrant policies, and community violence during the early COVID-19 pandemic. DESIGN Qualitative secondary analysis. SETTING Online or phone interviews. PARTICIPANTS Latina women who were currently pregnant or recently gave birth (N = 26). METHODS We used reflexive thematic analysis to examine transcribed data from semistructured interviews conducted during the early COVID-19 pandemic with a subgroup of participants enrolled in a larger study related to prenatal care. Participants were English- or Spanish-speaking, Medicaid-eligible, Latina-identifying women who resided in Fresno County, California. We analyzed responses to questions about personal discrimination, the Black Lives Matter movement, and immigration policies using the theoretical frameworks of critical race theory and the political economy of health. RESULTS We identified four major themes: Avoidance of Community Engagement, Chronic Fear and Vigilance, The Role of Media, and Everyday Discrimination and Injustice. CONCLUSION Participant experiences reflect the pervasiveness of fear and socioeconomic inequity and call attention to the racialized structures that affect health and health care access for Latina women. These exposures during the perinatal period may have intergenerational effects. These findings underscore the need for responsive and race-conscious perinatal nursing care for Latina women, assessment of the effect of the current sociopolitical environment on well-being, and policies that support equitable access to health and social care.
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Campbell T, Mann S, Rodgers YVDM, Tran NM. Mental Health of Transgender Youth Following Gender Identity Milestones by Level of Family Support. JAMA Pediatr 2024; 178:870-878. [PMID: 39008285 PMCID: PMC11250281 DOI: 10.1001/jamapediatrics.2024.2035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 05/08/2024] [Indexed: 07/16/2024]
Abstract
Importance Transgender youth are at an elevated risk for adverse mental health outcomes compared with their cisgender peers. Identifying opportunities for intervention is a priority. Objective To estimate differences in the association between gender identity milestones and mental health outcomes among transgender youth, stratified by level of family support. Design, Settings, and Participants This retrospective cohort study compares changes in mental health outcomes among transgender youth who initiate gender identity milestones compared with those who initiate the same milestones 1 year later, stratified by level of family support, using the 2015 US Transgender Survey. The analytic samples included 18 303 transgender adults aged 18 and older who had initiated at least 1 gender identity milestone between ages 4 and 18 years. Exposure Four gender identity milestones: feeling one's gender was different, thinking of oneself as transgender, telling another that one is transgender, and living full-time in one's gender identity, stratified by 3 levels of family support: supportive, neutral, and adverse. Main Outcomes Age at first suicide attempt and at running away. Results Study participants included 18 303 transgender adults (10 288 [56.2%] assigned female at birth; 14 777 [80.7%] White). Initiating a gender identity milestone was associated with a higher risk of suicide attempt and running away from home among transgender youth. This finding was driven by children who live in unsupportive families. For example, thinking of oneself as transgender was associated with a meaningful increase in the overall probability of attempting suicide among those in either adverse families (estimate = 1.75 percentage points; 95% CI, 0.47-3.03) or neutral families (estimate = 1.39 percentage points; 95% CI, 0.72-2.05). Among youth living with supportive families, there were no statistically significant associations between gender identity milestones and adverse mental health outcomes and 95% CIs generally ruled out any meaningful associations. Conclusion These results demonstrate that without a supportive family environment, gender identity development increases the risk of transgender youth attempting suicide or running away from home. Social services and community resources to establish supportive relationships between transgender children and their parents are essential.
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Affiliation(s)
- Travis Campbell
- Department of Economics, Southern Oregon University, Ashland, Oregon
| | | | | | - Nathaniel M. Tran
- Division of Health Policy and Administration, University of Illinois at Chicago, Chicago, Illinois
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Istl AC, Lawton S, Kamaraju S, Stolley M, Petroll AE, Cortina CS. Tumors, Treatments, and Trust: Cancer Characteristics, Outcomes, and Screening Uptake in Transgender and Gender-Diverse Patients. Ann Surg Oncol 2024; 31:5560-5569. [PMID: 38861206 PMCID: PMC11309885 DOI: 10.1245/s10434-024-15319-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/04/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND More than 2.5 million adults in the United States identify as transgender or gender-diverse (TGD), but little data exist on cancer screening and care for this population. We examined cancer characteristics, screening adherence, genetic testing, and provider inclusive language for TGD patients with cancer. METHODS This single institution retrospective cohort study identified TGD patients with cancer between 2000 and 2022. Demographic, clinicopathological, treatment, and screening data were collected, as well as data on gender-affirming care (GAC) and use of patients' personal pronouns in medical records. Descriptive statistics and regression analyses were used to report outcomes. RESULTS Sixty unique patients with 69 cancer diagnoses were included: 63.3% were transgender women, 21.7% transgender men, 6.7% nonbinary, and 8.3% were genderqueer. Sixty-five percent had a family history of cancer. Only 46.2% of those who met genetic testing criteria were referred. On review of recommended cancer screening, colorectal screening had the greatest uptake (62%), followed by breast (48.3%), lung (35.7%), cervical (33.3%), and prostate (32%); 8.5% of cancers were diagnosed on screening. Individuals with Medicare had reduced odds of screening uptake (OR 0.07, 95% CI 0.01-0.58) versus private insurance. With respect to GAC, 73.3% used gender-affirming hormone therapy and 41% had gender-affirming surgery. After initiating GAC and asserting personal pronouns, 75% were referred to by incorrect name/pronouns in provider documentation. CONCLUSIONS Our TGD cancer patient cohort had low rates of disease-specific cancer screening and inadequate genetic referrals. Many providers did not use appropriate patient names/pronouns. Provider and patient interventions are needed to ensure inclusive preventative and oncologic care for this marginalized population.
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Affiliation(s)
- Alexandra C Istl
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Samuel Lawton
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sailaja Kamaraju
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA
| | - Melinda Stolley
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA
| | - Andrew E Petroll
- Division of Infectious Disease, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Froedtert and the Medical College of Wisconsin Inclusion Health Clinic, Milwaukee, WI, USA
| | - Chandler S Cortina
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA
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Boutilier AJ, Clark KD, Bosse JD, Jackman KB, Jewell J, Dawson-Rose C. Social-ecological barriers and facilitators to seeking inpatient psychiatric care among transgender and nonbinary people: A qualitative descriptive study. J Adv Nurs 2024. [PMID: 39206720 DOI: 10.1111/jan.16393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 07/18/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024]
Abstract
AIM(S) To assess barriers and facilitators to seeking inpatient psychiatric treatment among transgender and nonbinary people. DESIGN Qualitative interview study. METHODS Semi-structured interviews were conducted from March 2019 to June 2022 with transgender and nonbinary people admitted to an inpatient psychiatric hospital in the United States during the past 5 years. Data were analysed using thematic analysis and constructed within a modified social-ecological model of stigma. Standards for Reporting Qualitative Research were used for this study. RESULTS Participants (N = 15) described barriers and facilitators across all three social-ecological levels. i) Individual themes included distrust of the mental healthcare system, feeling unsafe, loss of autonomy, minimizing one's own mental health needs, and feelings of accountability to others. ii) Interpersonal themes included: lack of support for transgender/nonbinary identity, limited transgender/nonbinary knowledge among mental healthcare professionals, and allyship. iii) Structural themes included: carceral setting, financial costs, and availability of non-profit treatment options. CONCLUSION Multi-level themes were identified as barriers and facilitators to seeking inpatient psychiatric care for transgender and nonbinary people, providing opportunities among inpatient settings to improve care delivery and engagement. Greater health equity can be achieved by addressing barriers to care. IMPLICATIONS Incorporating inclusive and affirming practices in inpatient psychiatric services presents an opportunity to reduce barriers to seeking care. IMPACT The present study describes the experiences of transgender and nonbinary people as they determine whether to voluntarily seek inpatient psychiatric treatment. This perspective allows nurses, health systems, and policymakers to integrate transgender and nonbinary people's needs to improve healthcare delivery. PATIENT/PUBLIC CONTRIBUTION Transgender and nonbinary participants were recruited in collaboration with community organizations. Members of the transgender and nonbinary community participated in study design development and analysis and were part of the study team.
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Affiliation(s)
- Ava J Boutilier
- School of Medicine, Queens University, Kingston, Ontario, Canada
- College of Liberal Arts, University of new Hampshire, Durham, New Hampshire, USA
| | - Kristen D Clark
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- College of Health and Human Services, Department of Nursing, University of New Hampshire, Durham, New Hampshire, USA
| | - Jordon D Bosse
- College of Nursing, University of Rhode Island, South Kingstown, Rhode Island, USA
| | - Kasey B Jackman
- School of Nursing, Columbia University, New York, New York, USA
- New York-Presbyterian Hospital, New York, New York, USA
| | - Jaylyn Jewell
- College of Health and Human Services, Department of Nursing, University of New Hampshire, Durham, New Hampshire, USA
| | - Carol Dawson-Rose
- Department of Community Health Systems, School of Nursing, University of California san Francisco, San Francisco, California, USA
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Wolfe HL, Boyer TL, Henderson ER, Streed CG, Blosnich JR. The association of depression with all-cause and cardiovascular disease mortality risk among transgender and gender diverse and cisgender patients. J Affect Disord 2024; 366:364-369. [PMID: 39209274 DOI: 10.1016/j.jad.2024.08.174] [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] [Received: 03/28/2024] [Revised: 06/11/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Transgender and gender diverse (TGD) individuals have elevated mental and physical health disparities and a greater mortality risk compared to their cisgender (non-TGD) counterparts. METHODS We assessed differences in the association of depression with all-cause and cardiovascular disease (CVD) mortality among TGD and cisgender Veterans Administration patients. A sample of 8981 TGD patients, matched 1:3 with cisgender patients (n = 26,924) patients, was created from administrative and electronic health record data from October 1, 1999 to December 31, 2016. Cox proportional regression models stratified by gender modality (i.e., TGD and cisgender) were used to assess the hazard of all-cause and CVD mortality associated with a history of depression. RESULTS Adjusted models demonstrated that depression was significantly associated with a greater hazard of all-cause mortality among both TGD (aHR:1.18, 95 % CI: 1.04-1.34) and cisgender (aHR:1.22, 95 % CI: 1.17-1.28) patients. Similar to all-cause mortality, depression was significantly associated with a greater hazard of CVD mortality among cisgender patients ≥65 years (aHR = 1.23, 95 % CI = 1.13-1.35). Findings for TGD patients showed a similar pattern, though results were not significant. LIMITATIONS Hazards may be underestimated since depression may be underdiagnosed. Further, we were unable to adjust for other health-related risk factors tied to mortality (e.g., smoking). CONCLUSION Overall, depression was associated with a greater hazard of all-cause mortality among both TGD and cisgender patients. Future work should assess the equity of reach, quality, and outcomes of treatment for depression for TGD populations given the lack of attention to addressing the needs of this important patient demographic.
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Affiliation(s)
- Hill L Wolfe
- Department of Biomedical Informatics & Data Science, Yale School of Medicine, New Haven, CT, United States.
| | - Taylor L Boyer
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
| | - Emmett R Henderson
- University of Pittsburgh School of Public Health, Pittsburgh, PA, United States
| | - Carl G Streed
- Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States; GenderCare Center, Boston Medical Center, Boston, MA, United States
| | - John R Blosnich
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States; Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
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11
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Alibudbud R. Advancing gender equality and healthcare for transgender individuals: insights from the Philippines. J Public Health (Oxf) 2024; 46:e532-e533. [PMID: 38437510 DOI: 10.1093/pubmed/fdae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 02/08/2024] [Indexed: 03/06/2024] Open
Affiliation(s)
- Rowalt Alibudbud
- Department of Sociology and Behavioral Sciences, De La Salle University, Manila City 1004, Philippines
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Lim HS, Moon WK, Ciszek E. Advertising for Brands and Society: The Role of Perceived Authenticity in Corporate Transgender Advocacy Advertising Campaigns. JOURNAL OF HOMOSEXUALITY 2024; 71:2449-2477. [PMID: 37555702 DOI: 10.1080/00918369.2023.2245522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
While organizations have increasingly engaged in corporate social advocacy (CSA) for sexual and gender diverse populations, transgender people have often been overlooked in LGBTQ advocacy campaigns. Among the different strategic communication tactics that can be used in CSA, advertising is an important channel for organizations to send their prosocial messages as well as to publicly demonstrate their support of particular causes and populations. Given the tension between growing social acceptance of gender diverse populations and anti-transgender political landscape in the USA, only a handful of organizations have recently shown transgender advocacy advertising campaigns. This study explores corporate transgender advocacy advertising campaigns as one contemporary CSA program, attending to the role of authenticity in CSA effectiveness. Findings show cisgender people perceive authenticity from transgender advocacy advertising campaigns regardless of their gender, which in turn, mitigates consumer skepticism and increases the willingness to engage with the campaign on social media and, further, to engage with other transgender advocacy campaigns. Theoretical and practical implications are discussed.
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Affiliation(s)
- Hayoung Sally Lim
- School of Journalism and Communication, University of Oregon, Eugene, Oregon, USA
| | - Won-Ki Moon
- College of Journalism and Communications, University of Florida, Gainesville, Florida, USA
| | - E Ciszek
- Stan Richards School of Advertising & Public Relations, University of Texas at Austin, Austin, Texas, USA
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Leite BO, Dourado I, Magno L, Sperandei S, Luppi CG, Veras MADSM. Factors associated with prior testing for HIV, Syphilis, and Hepatitis B and C among transgender women and travestis in Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2024; 27Suppl 1:e240008.supl.1. [PMID: 39166580 PMCID: PMC11338533 DOI: 10.1590/1980-549720240008.supl.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/18/2023] [Accepted: 01/03/2024] [Indexed: 08/23/2024] Open
Abstract
OBJECTIVE To investigate the prior testing for HIV, syphilis, hepatitis B (HBV), and hepatitis C (HCV) among transgender women and travestis (TGW) in five Brazilian cities and identify factors associated with each of these previous tests. METHODS This is a cross-sectional study with the recruitment of TGW through respondent-driven sampling (TransOdara Study). The investigated outcome variable was prior testing for HIV, syphilis, HBV, and HCV in the last 12 months. The association between sociodemographic and behavioral factors with the outcome was analyzed using a binomial logistic regression with mixed effects. Adjusted odds ratios (aOR) and 95% confidence intervals (CI95%) were estimated. RESULTS The proportions of individuals with prior testing in the past year were as follows: 56.3% for HIV, 58.0% for syphilis, 42.1% for HBV, and 44.7% for HCV. Negative associations with prior testing were observed for individuals aged 35 years or older, whereas positive associations were found for those with high school education, those who experienced verbal or psychological violence in the last 12 months, and those who had commercial or casual partners in the last 6 months. CONCLUSION There was low frequency of testing in the 12 months preceding the study for HIV, syphilis, HBV, and HCV compared to the guidelines established by the Ministry of Health. Expanding access to and engagement with healthcare and prevention services for TGW is an essential strategy in reducing the transmission chain of HIV and other sexually transmitted infections (STIs).
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Affiliation(s)
- Beo Oliveira Leite
- Universidade Federal da Bahia, Institute of Public Health – Salvador (BA), Brazil
| | - Inês Dourado
- Universidade Federal da Bahia, Institute of Public Health – Salvador (BA), Brazil
| | - Laio Magno
- Universidade Federal da Bahia, Institute of Public Health – Salvador (BA), Brazil
- Universidade do Estado da Bahia, Life Sciences Department – Salvador (BA), Brazil
| | - Sandro Sperandei
- Western Sydney University, Translational Health Research Institute – Penrith, Astralia
| | - Carla Gianna Luppi
- Universidade Federal de São Paulo, Paulista School of Medicine, Preventive Medicine Department – São Paulo (SP), Brazil
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Leal AF, Cazeiro CC, Mattos ACE, Hentges B, Teixeira LB, Knauth DR, Magno L, Dourado I, Vera MADSM. Profile and experiences during the incarceration of transgender women and travestis (TGW) in Brazil: a cross-sectional study. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2024; 27Suppl 1:e240014.supl.1. [PMID: 39166586 PMCID: PMC11338535 DOI: 10.1590/1980-549720240014.supl.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 08/23/2024] Open
Abstract
OBJECTIVE The objective of the present study is to describe the sociodemographic and behavioral characteristics of a group of transgender women and travestis (TGW) with a history of incarceration and the institutional and social context of this experience in Brazil. METHODS The analyzed data were derived from the TransOdara Study, a cross-sectional study conducted in five Brazilian capitals from December 2019 to July 2021. Participants were recruited using the Respondent-Driven Sampling (RDS) technique, in which, after an initial formative and exploratory stage, the first participants were identified; in turn, these participants recruited up to six other transgender women and travestis for the research. The study's outcome was the experience of incarceration throughout life, captured through the question: "Have you ever been arrested in your life?" RESULTS A total of 1,245 TGW were interviewed, of which 20.3% (n=253) experienced incarceration. Incarceration was more frequent among those aged 33 to 42 years (35.6%), with lower level of education (45.5%, p<0.001), engaged in informal work (30.3%), without a partner (67.2%), and among those who reported illicit drug use (66.4%). The majority (60.9%) of TGW were incarcerated with cisgender men, and the most common reasons for imprisonment were drug trafficking (30.4%) followed by robbery (29.2%). Over a quarter of the interviewees (26.3%) experienced assault, and 13.8% reported experiencing sexual violence during incarceration. CONCLUSION The results emphasize the high prevalence of incarceration among TGW. This incarceration takes place in male wards and in a context of high rates of physical and sexual violence.
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Affiliation(s)
- Andréa Fachel Leal
- Universidade Federal do Rio Grande do Sul, Department of Sociology – Porto Alegre (RS), Brazil
| | - Cristine Coelho Cazeiro
- Universidade Federal do Rio Grande do Sul, Graduate Program in Epidemiology – Porto Alegre (RS), Brazil
| | | | - Bruna Hentges
- Universidade Federal do Rio Grande do Sul, Department of Sociology – Porto Alegre (RS), Brazil
| | | | - Daniela Riva Knauth
- Universidade Federal do Rio Grande do Sul, Department of Social Medicine – Porto Alegre (RS), Brazil
| | - Laio Magno
- Universidade do Estado da Bahia – Salvador (BA), Brazil
- Universidade Federal da Bahia – Salvador (BA), Brazil
| | - Inês Dourado
- Universidade Federal da Bahia – Salvador (BA), Brazil
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15
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Dourado I, Magno L, Leite BO, Bastos FI, Mota JCD, Veras MADSM. Prevalence of HIV infection among transgender women and travestis in Brazil: data from the TransOdara study. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2024; 27Suppl 1:e240004.supl.1. [PMID: 39166576 DOI: 10.1590/1980-549720230004.supl.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/03/2024] [Indexed: 08/23/2024] Open
Abstract
OBJECTIVE The aim of this study was to investigate the prevalence of human immunodeficiency virus (HIV) infection among transgender women and travestis and to analyze factors associated with HIV infection in Brazil. METHODS TransOdara was a cross-sectional study on sexually transmitted infections among transgender women and travestis in five Brazilian cities between 2019 and 2021. Self-identified transgender women and travestis aged ≥18 years were recruited using respondent-driven sampling, completed an interviewer-led questionnaire, and provided samples to detect HIV. The outcome was the result of the rapid antigen testing for HIV. Adjusted prevalence ratios (aPR) and 95% confidence intervals (95% CI) were obtained using Poisson regression with robust variance. RESULTS Overall, this population was found to be especially vulnerable, with high levels of unstable housing and engagement in informal work. They usually resort to transactional sex as their main working activity. Half of them earned less than the Brazilian minimum wage, which characterizes a poor population living in dire conditions. The overall HIV prevalence was 34.40%. In the final model, the variables associated with the HIV prevalence were as follows: to be 31 years old or older, not studying at the moment they were interviewed, to be unemployed, and engaged in lifetime transactional sex. CONCLUSION We found disproportionately high HIV prevalence among transgender women and travestis, compared with a low prevalence among respective segments of Brazil's general population, which highlights the context of vulnerability in this population. The data point to the urgency for intensification and expansion of access to HIV prevention and strategies to stop discrimination in health care (among other services and contexts) and provide comprehensive services for this population.
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Affiliation(s)
- Inês Dourado
- Universidade Federal da Bahia, Institute of Public Health - Salvador (BA), Brazil
| | - Laio Magno
- Universidade Federal da Bahia, Institute of Public Health - Salvador (BA), Brazil
- Universidade do Estado da Bahia, Department of Life Sciences - Salvador (BA), Brazil
| | - Beo Oliveira Leite
- Universidade Federal da Bahia, Institute of Public Health - Salvador (BA), Brazil
| | - Francisco Inácio Bastos
- Fundação Oswaldo Cruz, Institute of Scientific and Technological Communication and Information in Health - Rio de Janeiro (RJ), Brazil
| | - Jurema Corrêa da Mota
- Fundação Oswaldo Cruz, Institute of Scientific and Technological Communication and Information in Health - Rio de Janeiro (RJ), Brazil
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16
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McMullan J, Thompson DR, Dixon A, Palumbo A, Dickinson T, Jourdain P, Monaghan C, Quinn B. Exploring perceptions of what increased gender diversity might bring to the nursing profession. J Adv Nurs 2024. [PMID: 39149919 DOI: 10.1111/jan.16246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 04/25/2024] [Accepted: 05/09/2024] [Indexed: 08/17/2024]
Abstract
AIMS To explore university nursing students and academic staff's perceptions of what increased gender diversity might bring to the nursing profession. DESIGN An exploratory study with students and academic staff from two university nursing schools. METHODS Students and staff in two university nursing schools were invited to participate in an anonymous online survey (October-November 2022). The survey focused on gender diversity within nursing and patient care, asking respondents about existing barriers to gender diversity and inviting ideas on increasing gender diversity within nursing. The survey findings helped inform questions, which were used to further explore views and thoughts of gender diversity within nursing through semi-structured one-to-one interviews (January-February 2023). RESULTS Nearly, two-thirds (64%, n = 69) of survey respondents strongly agreed/agreed that the lack of gender diversity in nursing negatively impacted delivering care to a gender-diverse society. Most (84%, n = 90) strongly agreed/agreed that increased gender diversity within the nursing workforce would positively contribute to nursing. Three-quarters (75%, n = 74) strongly agreed/agreed that working with a more gender-diverse nursing workforce would enrich their experience as a nurse. Three themes emerged from the interview data: shared stereotypes; improved care through knowledge, better relations and the presence of a gender-diverse workforce; a culture of welcome: suggested changes for the future. CONCLUSION Most of those who participated in the study believe there are benefits to be gained from greater gender diversity within nursing. This study provides insight into the lack of gender diversity in the nursing environment, highlights how this might impact patient care and suggests actions to make nursing a more inclusive profession. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Practical solutions were suggested, including the greater visibility of trans and non-binary persons in advertisement and recruitment campaigns to ensure nursing is viewed as a career choice for "all". Including a space for considered pronouns on university application forms, hospital documentation and name badges. Gender-neutral titles and uniforms should be considered for all nursing staff, and more gender-neutral toilets should be made available for staff and patients in university and hospital settings. IMPACT This study addressed the lack of gender diversity in nursing and explored what an increase in gender diversity might bring to the nursing profession. The main findings were: (i) Less than a tenth (9%, n = 12) of respondents described their team of colleagues as being "extremely gender diverse". (ii) Most (84%, n = 90) strongly agreed/agreed that increased gender diversity within the nursing workforce would be a positive attribute to nursing. (iii) Three-quarters 75% (n = 74) strongly agreed/agreed that working with a more gender-diverse nursing workforce would enrich their experience as a nurse. (iv) Many stereotypes still exist in nursing and tackling them is important to make the profession more inclusive. (v) A nurse's gender can impact the care they provide. (vi) A more gender-diverse workforce would better reflect the population it serves. (vii) This research will have an impact on the nursing profession globally. REPORTING METHOD The consolidated criteria for reporting qualitative studies (COREQ) was used as a guide throughout data collection and analysis. PATIENT OR PUBLIC CONTRIBUTION Every step of the study, including the survey and interview schedule, was co-constructed using an iterative approach with service users, students and staff who had personal experience of gender diversity and were a core part of the study team.
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Affiliation(s)
- Julie McMullan
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Alexx Dixon
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Alex Palumbo
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Tommy Dickinson
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Praise Jourdain
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Catherine Monaghan
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Barry Quinn
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
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17
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Ljubić A, Stanojević M, Chervenak FA, Kurjak A. Non-binary patients in ART: new challenges and considerations. J Perinat Med 2024; 0:jpm-2024-0256. [PMID: 39146515 DOI: 10.1515/jpm-2024-0256] [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] [Received: 06/04/2024] [Accepted: 07/27/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVES To discuss the increasing visibility of non-binary individuals and inclusive policies and practices in Assisted Reproductive Technologies (ART). METHODS Comparison between traditional ART approach designed for binary genders and propose approach in non-binary individuals. RESULTS Traditional ART services, designed for binary genders, must adapt to address the unique fertility needs of non-binary patients. This includes using gender-neutral language, providing comprehensive fertility assessments, and offering hormone therapy and fertility preservation options. Children of non-binary parents benefit from open communication about gender diversity, enhancing psychological well-being. Positive societal attitudes and inclusive environments in schools are crucial for preventing discrimination and promoting mental health. A systemic approach is required to make ART inclusive. This involves training staff, adjusting facilities, updating documentation, and advocating for supportive legislation. Addressing the reproductive needs of non-binary individuals ensures equitable access to care and supports their family-building goals. CONCLUSIONS Ensuring the well-being of children in non-binary families requires psychological support, inclusive healthcare, legal recognition, social support, and comprehensive education.
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Affiliation(s)
- Aleksandar Ljubić
- Pronatal Belgrade Hospital, International Academy of Perinatal Medicine, International Academy of Science and Arts in Bosnia and Herzegovina, Belgrade, Serbia
| | - Milan Stanojević
- Department of Obstetrics and Gynecology Medical School University of Zagreb Croatia, International Academy of Perinatal Medicine, International Academy of Science and Arts in Bosnia and Herzegovina, Zagreb, Croatia
| | - Frank A Chervenak
- Obstetrics & Gynecology, Lenox Hill Hospital, New York, USA
- Obstetrics & Gynecology, Associate Dean for International Medicine, New York, USA
| | - Asim Kurjak
- Department of Obstetrics and Gynecology Medical School University of Zagreb Croatia, International Academy of Perinatal Medicine, International Academy of Science and Arts in Bosnia and Herzegovina, Zagreb, Croatia
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Gordon AR, Haiken S, Murchison GR, Agénor M, Hughto JMW, Nelson KM. Long-Acting Injectable Pre-Exposure Prophylaxis Perceptions and Preferences Among Transgender and Nonbinary Young Adults in the United States. QUALITATIVE HEALTH RESEARCH 2024:10497323241265943. [PMID: 39095331 DOI: 10.1177/10497323241265943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
Long-acting injectable pre-exposure prophylaxis for HIV prevention (LAI-PrEP) was approved for use in the United States in 2021, yet little is known about perceptions of LAI-PrEP among transgender and nonbinary young adults, a group that faces substantial barriers to HIV prevention. We investigated US transgender and nonbinary young adults' perceptions of and attitudes toward LAI-PrEP and how perceived advantages and disadvantages of LAI-PrEP related to the PrEP continuum of care. We conducted semi-structured interviews with 31 transgender and nonbinary young adults who reported oral PrEP use or were PrEP-eligible. We analyzed responses using both a deductive RADaR approach, to identify LAI-PrEP perceptions relevant to the PrEP continuum of care, and an inductive thematic analysis to explore key themes. In this study, all PrEP-experienced and most PrEP-naïve participants indicated an interest in LAI-PrEP, citing advantages over daily oral medication (e.g., fewer adherence challenges). Three key themes emerged: (1) Some participants linked perceived advantages of LAI-PrEP to experiences with gender-affirming care (e.g., familiarity with needles via hormone use). (2) Participants weighed trade-offs and contextual factors that influenced their LAI-PrEP preferences (e.g., interest contingent on whether location for receiving injection was geographically accessible). (3) Participants envisaged alternative delivery methods that could enhance LAI-PrEP acceptability and uptake (e.g., home injection). HIV prevention programs should incorporate the insights of transgender and nonbinary young adults to ensure that emerging HIV prevention technologies are accessible and responsive to the needs and concerns of people of all gender modalities.
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Affiliation(s)
- Allegra R Gordon
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Samantha Haiken
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Gabriel R Murchison
- Department of Social & Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Madina Agénor
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Jaclyn M W Hughto
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA
| | - Kimberly M Nelson
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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Rahmani B, Park JB, Adebagbo OD, Morgenstern M, Garvey SR, Nickman S, Gettings M, Prospero M, Tobias AM, Cauley RP. Complications after gender-affirming chest masculinization surgery do not impact patient satisfaction. J Plast Reconstr Aesthet Surg 2024; 95:24-27. [PMID: 38865841 DOI: 10.1016/j.bjps.2024.05.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 05/31/2024] [Indexed: 06/14/2024]
Abstract
Chest masculinization surgery is an increasingly common procedure and has offered significant benefits to the gender-diverse community. Although major complications are an infrequent occurrence in chest masculinization surgery, they may still impact surgical success. While the long-term success of chest masculinization surgery has been examined through patient-reported outcome measures, there is no study that has assessed the association between complications and patient-reported outcomes. In this study, patients who underwent double incision or periareolar mastectomies for chest masculinization by a single surgeon were surveyed. Demographic, operative, and postoperative variables were obtained from medical records. The BODY-Q and SCAR-Q modules (Q-Portfolio.org) were used to assess postoperative patient-reported outcomes. There were 151 survey responders (43% response rate), 132 without complications and 19 with complications. No significant differences in patient-reported outcomes were noted when comparing the groups with and without complications. While some providers may be reluctant to offer chest masculinization to patients they deem high risk for complications, patients and providers should be assured that complications do not significantly impact patient satisfaction. LAY SUMMARY: Gender-affirming chest masculinization surgery is increasingly common. We investigated the impact of complications on patient-reported outcomes in chest masculinization. Patients and providers should be assured that complications do not significantly impact patient satisfaction.
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Affiliation(s)
- Benjamin Rahmani
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - John B Park
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Oluwaseun D Adebagbo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; Tufts University School of Medicine, Boston, MA 02111, USA
| | - Monica Morgenstern
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Shannon R Garvey
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Sasha Nickman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Macie Gettings
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Matthew Prospero
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Adam M Tobias
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Ryan P Cauley
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
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20
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Garoosi K, Yoon Y, Hale E, Kahan R, Kalia N, Higuchi T, Mathes D, Hudish T, Kaoutzanis C. Association between genital gender-affirming surgery and psychiatric comorbidities in individuals with gender incongruence. J Sex Med 2024; 21:729-733. [PMID: 38972664 DOI: 10.1093/jsxmed/qdae077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 05/09/2024] [Accepted: 06/20/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Previous studies present mixed evidence on the relationship between psychiatric comorbidities and genital gender-affirming surgery (GGAS) in individuals with gender incongruence (GI). AIM This research aims to investigate the psychiatric comorbidity rates post-GGAS in the GI population-namely, depressive disorders, anxiety disorders, posttraumatic stress disorders, substance abuse disorder, and suicidality. METHODS Based on the TriNetX health care database, an international database with >250 million patients, a cross-sectional study was executed comparing psychiatric comorbidity rates among cases of GI with and without GGAS. Individuals were matched for demographic and health-related variables, which included history of cardiovascular disease, diabetes, and obesity. OUTCOMES The main focus was to establish the rates and changes in psychiatric comorbidities following GGAS. RESULTS Among individuals with GI, the study identified 4061 with GGAS and 100 097 without. At 1 year post-GGAS, there was a significant decrease in depression (odds ratio [OR], 0.748; 95% CI, 0.672-0.833; P < .0001), anxiety (OR, 0.730; 95% CI, 0.658-0.810; P < .0001), substance use disorder (OR, 0.730; 95% CI, 0.658-0.810; P < .0001), and suicidality (OR, 0.530; 95% CI, 0.425-0.661; P < .0001), and these reductions were maintained or improved on at 5 years, including posttraumatic stress disorder (OR, 0.831; 95% CI, 0.704-0.981; P = .028). CLINICAL IMPLICATIONS The findings indicate that GGAS may play a crucial role in diminishing psychiatric comorbidities among individuals with GI. STRENGTHS AND LIMITATIONS This is the largest known study to evaluate the effect of GGAS on psychiatric comorbidities in the GI population, offering robust evidence. The reliance on the precision of CPT and ICD-10 codes for data extraction poses a limitation due to potential coding inaccuracies. CONCLUSION The evidence suggests a significant association between GGAS and reduced psychiatric comorbidities in individuals with GI.
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Affiliation(s)
- Kassra Garoosi
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - YooJin Yoon
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Elijah Hale
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Riley Kahan
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Nargis Kalia
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Ty Higuchi
- Division of Urology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - David Mathes
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Tyler Hudish
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Christodoulos Kaoutzanis
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
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Stamatiou R, Kararigas G. Participation of transgender and gender diverse persons in cardiovascular clinical trials. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 44:100420. [PMID: 39070126 PMCID: PMC11282972 DOI: 10.1016/j.ahjo.2024.100420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/01/2024] [Accepted: 06/25/2024] [Indexed: 07/30/2024]
Abstract
Study objective Transgender persons face increased risk in developing cardiovascular diseases due to administration of hormonal therapy used for gender expression, or due to the presence of other risk factors, such as minority stress and difficulty to have full access to health care. Even though the need for gender diversity in research has been identified, the number of clinical trials including transgender persons remains low. The aim of this study was to highlight gaps in inclusion of transgender individuals in cardiovascular clinical research. Design setting A search in the pubmed.com database, as well as in the clinicaltrials.gov repository, was performed with search terms regarding transgender persons and cardiovascular diseases. Main outcome measures The inclusion of transgender persons in cardiovascular clinical trials was evaluated. Results and conclusions This study revealed that there is only a small number of cardiovascular clinical trials including or studying transgender persons. This finding demonstrates the overall lack of clinical trials regarding cardiovascular health in transgender individuals and is indicative of their under-representation in clinical research.
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Affiliation(s)
- Rodopi Stamatiou
- Department of Physiology, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- School of Biology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Kararigas
- Department of Physiology, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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Fleischman A, Russell M, Russell AN, Qi Y, Jewell V. Life Satisfaction and Gender Congruence in Transgender Individuals: A Role for Occupational Therapy. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024:15394492241264467. [PMID: 39077898 DOI: 10.1177/15394492241264467] [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: 07/31/2024]
Abstract
Societal restrictions impact transgender individuals' ability to engage in occupations that match their internal gender identity preventing gender affirmation. The aim was to explore transgender individuals' perceived levels of gender congruence and life satisfaction. A cross-sectional survey with a nonprobability sample of transgender adults was used to provide a preliminary exploration of transgender individuals' gender congruence and life satisfaction using the Gender Congruence and Life Satisfaction and World Health Organization Quality of Life-BREF. When comparing the means of the physical, psychological, social, and environmental domains to the population norm, the respondents demonstrated statistically lower scores in all four domains of the WHOQOL-BREF. In both the WHOQOL-BREF and GCLS, the mean score in psychological health and life satisfaction were the lowest. Transgender individuals prioritize self-care activities, such as hairstyling, and body image to affirm internal gender identity. Occupational therapy can assist with supporting gender transition in several occupational contexts.
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23
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Littman AJ, Jeon A, Fort CL, Dashtestani K, Korpak A, Kauth MR, Shipherd JC, Jasuja GK, Wolfe HL, Neira PM, Caballero J, Garcia S, Williamson C, Collongues B, Simpson TL. Receipt of Gender-Affirming Surgeries Among Transgender and Gender Diverse Veterans. J Gen Intern Med 2024:10.1007/s11606-024-08917-1. [PMID: 39060784 DOI: 10.1007/s11606-024-08917-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Gender-affirming surgery (GAS) can be an important part of comprehensive care for transgender and gender diverse (TGD) individuals, but this care is not provided by the Department of Veterans Affairs (VA) because of an exclusion in the medical benefits package. OBJECTIVE To describe the receipt of GAS by veterans and assess the associations between key sociodemographic characteristics and receipt of chest ("top") and genital ("bottom") surgeries. DESIGN Cross-sectional national survey (the GendeR Affirming Care Evaluation (GRACE)), among TGD Veterans conducted between September 2022 and July 2023. PARTICIPANTS A total of 6653 Veterans (54% response rate) completed the survey. MAIN MEASURES Self-reported "top" and "bottom" GAS were key outcomes. Covariates included gender identity, sex assigned at birth, age, race, ethnicity, income, employment status, education, relationship status, sexual orientation, and geographic region. KEY RESULTS Among all respondents, 39% had ≥ 1 GAS. Among the 4430 veterans interested in top surgery, 38% received it; 23% of 3911 veterans interested in bottom surgery had received it. In multivariable models, older age (50 + vs. 18-39) was associated with higher receipt of top and bottom surgery while nonbinary gender identity (vs. binary gender identity), lower household income (< $50,000 vs. > $75,000), less education (less than a college graduate vs. Master's degree or more), sexual orientations other than heterosexual, and residing in a region other than the Pacific were associated with lower receipt of top and bottom surgery. Individuals assigned male (vs. assigned female) at birth had lower receipt of top surgery and higher receipt of bottom surgery. CONCLUSIONS GAS receipt was low and there were important disparities by gender, sex, income, education, sexual orientation, and region. By removing the exclusion to providing GAS, VA could reduce barriers to accessing GAS and decrease disparities among TGD veterans.
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Affiliation(s)
- Alyson J Littman
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA.
| | - Amy Jeon
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Carolyn L Fort
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Krista Dashtestani
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Anna Korpak
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Michael R Kauth
- Office of Patient Care Services, Department of Veterans Affairs, LGBTQ+ Health Program, Washington, DC, USA
- Department of Psychiatry, TH Chan School of Medicine, UMass Chan Medical School, Worcester, MA, USA
| | - Jillian C Shipherd
- Office of Patient Care Services, Department of Veterans Affairs, LGBTQ+ Health Program, Washington, DC, USA
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Guneet K Jasuja
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Hill L Wolfe
- VA Pain Research, Informatics, Multi-Morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Biomedical Informatics & Data Science, Yale School of Medicine, New Haven, CT, USA
| | - Paula M Neira
- Johns Hopkins Medicine Office of Diversity, Inclusion and Health Equity, Baltimore, USA
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Josie Caballero
- National Center for Transgender Equality, Washington, DC, USA
- Transgender American Veterans Association, Washington, DC, USA
| | - Sady Garcia
- Transgender American Veterans Association, Washington, DC, USA
| | | | | | - Tracy L Simpson
- VA Puget Sound Center of Excellence in Substance Addiction Treatment and Education, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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Zulu JM, Budhwani H, Wang B, Menon A, Kim D, Zulu M, Nyamaruze P, Govender K, Armstrong R. Living a private lie: intersectional stigma, depression and suicidal thoughts for selected young key populations living with HIV in Zambia. BMC Public Health 2024; 24:1937. [PMID: 39030515 PMCID: PMC11264630 DOI: 10.1186/s12889-024-19278-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 06/26/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND Limited research has been conducted on the forms, manifestations and effects of intersectional stigma among young HIV-positive men who have sex with men (MSM) and transgender women (TGW) in Zambia. In this study, we aimed to address this gap by elucidating the experiences of these in a small group of young, HIV + MSM and TGW in Zambia. METHODS We applied a mixed-methods design. Data were collected from January 2022 to May 2022. Qualitative data were collected using in-depth interviews while quantitative data were collected using a questionnaire. Qualitative transcripts were coded using thematic analysis while paper-based questionnaire data were entered into Kobo Connect. Descriptive statistics, using chi-squared tests were calculated using Excel. In this paper, we provide a descriptive profile of the sample and then focus on the qualitative findings on intersectional stigma, depression, and contemplation of suicide. RESULTS We recruited 56 participants from three sites: Lusaka, Chipata, and Solwezi districts. Participants' mean age was 23 years. The study found that 36% of all participants had moderate to significant symptoms of depression, 7% had major depression, 30% had moderate signs of anxiety, 11% had high signs of anxiety, 4% had very high signs of anxiety and 36% had contemplated suicide at least once. A greater proportion of TGW had moderate to significant symptoms of depression (40%) or major depression (10%) compared to MSM, at 33% and 6%, respectively (X2 = 0.65; p = 0.42). Similarly, more TGW (55%) had contemplated suicide than MSM peers (36%, X2=1.87; p = 0.17). In the qualitative data, four emergent themes about the forms, manifestations, and effects of intersectional stigma were (1) HIV, sexual orientation, and gender identity disclosure; (2) Dual identity; (3) Challenges of finding and maintaining sexual partners; (4) Coping and resilience. Overall, having to hide both one's sexuality and HIV status had a compounding effect and was described as living "a private lie." CONCLUSION Effectively addressing stigmas and poor mental health outcomes among young HIV-positive MSM and TGW will require adopting a socio-ecological approach that focuses on structural interventions, more trauma-informed and identity-supportive care for young people with HIV, as well as strengthening of authentic community-informed public health efforts.
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Affiliation(s)
- Joseph Mumba Zulu
- Department of Health Policy and Management, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia.
- Center for Community Health Systems and Implementation Research, Lusaka, Zambia.
| | - Henna Budhwani
- Institute on Digital Health and Innovation, College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Bo Wang
- Department of Population and Quantitative Health Sciences, UMass Chan Medical, School 368 Plantation Street, Worcester, MA, 01605, US
| | - Anitha Menon
- Department of Psychology, School of Humanities and Social Sciences, University of Zambia, Box 32379, Lusaka, Zambia
- Psychology Program, School of Liberal Studies, University of Petroleum and Energy Sciences, Dehradun, India
- Liberal Arts Department, Rochester Institute of Technology, Dubai, UAE
| | - Deogwoon Kim
- Department of Population and Quantitative Health Sciences, UMass Chan Medical, School 368 Plantation Street, Worcester, MA, 01605, US
| | - Mirriam Zulu
- Department of Health Policy and Management, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia
| | - Patrick Nyamaruze
- Health Economics and HIV/AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Kaymarlin Govender
- Health Economics and HIV/AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Russell Armstrong
- Health Economics and HIV/AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
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25
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Ersoy G, Akrep A, Gönen AÇ, Gölge ZB. Attitudes among physicians towards transgender and gender diverse people in Turkey: Relationship with religiousness, political view and conservatism. SOCIOLOGY OF HEALTH & ILLNESS 2024. [PMID: 39024014 DOI: 10.1111/1467-9566.13809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 05/20/2024] [Indexed: 07/20/2024]
Abstract
According to several recent studies, physicians in various medical branches have some differences in attitudes towards transgender and gender-diverse (TGD) persons based on religious or political beliefs. Our study aims to uncover the attitudes of the general physician community in Turkey, which has a youthful profile, regarding TGD individuals. The attitudes towards transgender individuals scale (ATTI) and the general conservatism scale, along with a form that asks about socio-demographic factors, political beliefs, and level of religion, were administered online to physicians. The ATTI score of physicians (mean = 77.8) is favourable and did not vary among branches. Being female, being close to TGD, having left-wing views, low conservatism and low religious belief scores were associated with positive attitudes towards TGD individuals. The physician profile's moderate religious belief and left-wing views can be interpreted as a country-specific dynamic and did not prevent the approach from being positive. Despite physicians' positive attitude towards TGD individuals on a professional level, there is resistance to contacting them in their daily lives. The possibility of the partial contribution of socially desirable response behaviour to positive scores should not be ignored.
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Affiliation(s)
- Gökhan Ersoy
- Department of Medical Sciences, Institute of Forensic Sciences and Legal Medicine, Istanbul University - Cerrahpaşa, Istanbul, Turkey
| | - Aytunç Akrep
- Department of Medical Sciences, Institute of Forensic Sciences and Legal Medicine, Istanbul University - Cerrahpaşa, Istanbul, Turkey
| | - Anıl Çakır Gönen
- Department of Psychiatry, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Zeynep Belma Gölge
- Department of Social Sciences, Institute of Forensic Sciences and Legal Medicine, Istanbul University - Cerrahpaşa, Istanbul, Turkey
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Hockman BE, Qi M, Rotblatt H, Borenstein L, Flynn RA, Muldrow RA, Rajagopalan S, Greene DN. Overcoming analytical and preanalytical challenges associated with extragenital home collected STI specimens. J Clin Microbiol 2024; 62:e0031124. [PMID: 38836570 PMCID: PMC11250113 DOI: 10.1128/jcm.00311-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/09/2024] [Indexed: 06/06/2024] Open
Abstract
Home sample collection for sexually transmitted infection (STI) screening options can improve access to sexual healthcare across communities. For Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), genital infections have classically been the focus for remote collection options. However, infections may go undiagnosed if sampling is limited to urogenital sites because some individuals only participate in oral and/or anal intercourse. Here we evaluated samples for CT/NG detection after several pre-analytical collection challenges. A paired provider to self-collection validation was performed on rectal [n = 162; 22 + for CT and 9 + for NG by provider-collected (PC)] and throat (N = 158; 2 + for CT and 11 + for NG by provider-collected) swabs. The positive percent agreement for CT and NG ranged from 90.9% to 100%. The discrepancies were more often positive on self-collected (SC) (n = 9 SC+/PC-; n = 1 PC+/SC-; n = 1 PC+/SC Equiv.; n = 2 PC-/SC Equiv.). An empirical limit of detection (LoD) lower than the manufacturer's claim (0.031 vs 2.5 IFU/mL for CT and 0.063 vs 124.8 CFU/ml for NG, respectively) was used to challenge additional variables. Common hand contaminants, including soap, hand sanitizer, lotion, and sunscreen were added to known positive (3× empirical LoD) or negative samples and did not influence detection. Samples at 2× and 10× the empirical LoD were challenged with extreme temperature cycling and extended room temperature storage. Detection was not affected by these conditions. These results indicate that remote self-collection is an appropriate method of sample acquisition for detecting extragenital CT/NG infections. Additionally, they provide a foundation towards meeting the regulatory standards for commercial testing of home collected extragenital samples. IMPORTANCE There is a clinical need for expanded extragenital bacterial sexually transmitted infection (STI) testing options, but the current regulatory landscape limits the wide-spread promotion and adoption of such services. Improved access, particularly for the LGBTQ+ community, can be achieved by validating testing for specimens that are self-collected at a remote location and arrive at the laboratory via a postal carrier or other intermediary route. Here we provide valuable data showing that self-collected samples for anal and oropharyngeal STI testing are equally or increasingly sensitive compared with those collected by a provider. We systematically consider the effects of storage time, exposure to temperature extremes, and the addition of common toiletries on results.
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Affiliation(s)
- B. E. Hockman
- LetsGetChecked Laboratories, Monrovia, California, USA
| | - M. Qi
- LetsGetChecked Laboratories, Monrovia, California, USA
| | - H. Rotblatt
- Los Angeles County Department of Public Health Division of HIV and STD Programs, Los Angeles, California, USA
| | - L. Borenstein
- Los Angeles County Department of Public Health Laboratory, Los Angeles, California, USA
| | - R. A. Flynn
- Los Angeles LGBT Center Clinic, Los Angeles, California, USA
| | - R. A. Muldrow
- LetsGetChecked Laboratories, Monrovia, California, USA
| | - S. Rajagopalan
- Los Angeles County Department of Public Health Division of HIV and STD Programs, Los Angeles, California, USA
| | - D. N. Greene
- LetsGetChecked Laboratories, Monrovia, California, USA
- Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
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Abesamis LEA. Transgender Health Dilemmas: An Intersectional Analysis of the Therapeutic Itineraries of Transgender Communities in the Philippines. JOURNAL OF HOMOSEXUALITY 2024:1-20. [PMID: 38989969 DOI: 10.1080/00918369.2024.2378772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
This study leverages an intersectional lens to characterize the therapeutic itineraries of local transgender (trans) communities vis-à-vis salient cisnormative and capitalist structures in Philippine society that produce trans health inequities. Interpretative phenomenological analysis of online interviews with thirteen (13) self-identified trans Filipinos reveals how the inaccessibility of trans-responsive care in the Philippines fosters trans health dilemmas, or the dilemmatic decision-making circumstances and processes that force trans Filipinos to choose between their trans-specific health needs and other needs. Such dilemmas valorize the deprioritization of trans health, disengagement with the health system, and the pursuit of alternative pathways to care oftentimes at the expense of their overall well-being. Addressing these dilemmas entails research, policy, and advocacy work that contend with the implicated structures of domination through systemic interventions initiated in partnership with local trans communities.
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Affiliation(s)
- Luis Emmanuel A Abesamis
- Department of Sociology and Behavioral Sciences, De La Salle University Manila, Manila, Philippines
- Center for Women's and Gender Studies, University of the Philippines, Quezon City, Philippines
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Kaltsas A, Stavropoulos M, Symeonidis EN, Kratiras Z, Zachariou A, Zikopoulos A, Chrisofos EE, Dimitriadis F, Sofikitis N, Chrisofos M. Endometriosis in Transgender Men: Bridging Gaps in Research and Care-A Narrative Review. Biomedicines 2024; 12:1481. [PMID: 39062054 PMCID: PMC11274608 DOI: 10.3390/biomedicines12071481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Revised: 06/25/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024] Open
Abstract
Endometriosis is a debilitating gynecological condition commonly seen in individuals designated female at birth; however, there has been limited research focused on its prevalence and impact among transgender men. This narrative review aims to fill a critical knowledge gap by exploring the epidemiology, clinical manifestations, management strategies, and quality-of-life implications of endometriosis among transgender individuals who identify as male. Specifically, this study seeks to estimate the prevalence rates and describe the symptoms experienced by transgender men undergoing testosterone therapy. Additionally, it addresses the diagnostic challenges posed by hormonal treatments and the lack of culturally competent healthcare services for this population. Recent molecular studies indicate that hormonal imbalances, such as increased estrogen synthesis and progesterone resistance, are significant factors in the persistence of endometriosis symptoms despite testosterone therapy. Moreover, evidence suggests that testosterone therapy may not always suppress endometrial activity completely, contributing to the persistence of symptoms in some individuals. Endometriosis in transgender men requires personalized approaches that consider both testosterone therapy and its interactions with endometriosis, as well as fertility preservation and the psychosocial aspects of treatment. This review emphasizes the necessity of taking an inclusive approach in both research and clinical practice to improve healthcare outcomes for this underserved population. The results demonstrate how continued research, education, and healthcare services tailored specifically to transgender men are necessary to better understand and treat endometriosis, thus improving both their overall health and quality of life.
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Affiliation(s)
- Aris Kaltsas
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (M.S.); (Z.K.)
| | - Marios Stavropoulos
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (M.S.); (Z.K.)
| | - Evangelos N. Symeonidis
- Department of Urology II, European Interbalkan Medical Center, 55535 Thessaloniki, Greece; (E.N.S.); (N.S.)
| | - Zisis Kratiras
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (M.S.); (Z.K.)
| | - Athanasios Zachariou
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece;
| | - Athanasios Zikopoulos
- Department of Obstetrics and Gynecology, Royal Cornwall Hospital, Truro TR1 3LJ, UK;
| | | | - Fotios Dimitriadis
- Department of Urology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Nikolaos Sofikitis
- Department of Urology II, European Interbalkan Medical Center, 55535 Thessaloniki, Greece; (E.N.S.); (N.S.)
| | - Michael Chrisofos
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (M.S.); (Z.K.)
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Silva‐Santisteban A, Apedaile D, Perez‐Brumer A, Leon SR, Huerta L, Leon F, Aguayo‐Romero R, Reisner SL. HIV vulnerabilities and psychosocial health among young transgender women in Lima, Peru: results from a bio-behavioural survey. J Int AIDS Soc 2024; 27:e26299. [PMID: 39041820 PMCID: PMC11264345 DOI: 10.1002/jia2.26299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 05/15/2024] [Indexed: 07/24/2024] Open
Abstract
INTRODUCTION Peruvian young transgender women (YTW) ages 16-24 years are a critical but understudied group for primary HIV prevention efforts, due to sharp increases in HIV prevalence among TW ages 25 years and older. METHODS Between February and July 2022, a cross-sectional quantitative study with YTW ages 16-24 years in Peru (N = 211) was conducted consisting of a bio-behavioural survey accompanied by laboratory-based testing for HIV and sexually transmitted infections (STIs). Bivariate and multivariable Poisson regression models were used to estimate prevalence ratios between socio-demographic and behavioural characteristics and HIV status. RESULTS HIV prevalence was 41.5% (95% CI: 33.9-49.4%), recent syphilis acquisition 19.4% (95% CI: 12.7-28.4), chlamydia 6.3% (95% CI: 3.1-11.1) and gonorrhoea 12.3% (95% CI: 7.9-18.7). Almost half (47.9%) reported condomless anal sex in the past 6 months, 50.7% reported sex work in the past 30 days and 13.7% reported accepting more money for condomless sex. There were no significant differences in reported sexual behaviours by HIV status. Only 60.8% of participants reported ever having been tested for HIV, and 25.6% reported a past 6-month STI test. More than two-thirds (67.8%) had not heard of antiretroviral pre-exposure prophylaxis (PrEP) and only 4.7% had taken PrEP in the past month. Current moderate-to-severe psychological distress was endorsed by 20.3%, 10.0% reported attempting suicide in the past 6 months and 85.4% reported alcohol misuse. CONCLUSIONS Findings show that the HIV epidemic for YTW in Lima, Peru is situated in the context of widespread social exclusion, including economic vulnerabilities, violence victimization and the mental health sequelae of transphobic stigma that starts early in life. Future research should aim to further understand the intersection of these vulnerabilities. Moreover, there is an urgent necessity to design and evaluate HIV prevention programmes that address the root systems driving HIV vulnerabilities in YTW and that focus on developmentally specific clusters of stigma-related conditions.
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Affiliation(s)
- Alfonso Silva‐Santisteban
- Center for Interdisciplinary Research in SexualityAIDS and SocietyUniversidad Peruana Cayetano HerediaLimaPeru
| | - Dorothy Apedaile
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Amaya Perez‐Brumer
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Segundo R. Leon
- Escuela Profesional de Tecnología MédicaUniversidad Privada San Juan BautistaLimaPeru
| | | | - Francezka Leon
- Center for Interdisciplinary Research in SexualityAIDS and SocietyUniversidad Peruana Cayetano HerediaLimaPeru
| | - Rodrigo Aguayo‐Romero
- Division of EndocrinologyDiabetes, and HypertensionBrigham and Women's HospitalBostonMassachusettsUSA
- Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- The Fenway InstituteFenway HealthBostonMassachusettsUSA
| | - Sari L. Reisner
- Division of EndocrinologyDiabetes, and HypertensionBrigham and Women's HospitalBostonMassachusettsUSA
- Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- The Fenway InstituteFenway HealthBostonMassachusettsUSA
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Chakkour E, Simone M, Askew AJ, Blashill AJ. The association between gender-affirming care and disordered eating in transgender and gender diverse individuals: Exploring appearance congruence and gender-related motivating factors for weight loss. Int J Eat Disord 2024; 57:1576-1588. [PMID: 38549493 PMCID: PMC11262982 DOI: 10.1002/eat.24202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/21/2024] [Accepted: 03/10/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE The objective of this study is to explore between-group differences across different stages of gender-affirming care, and associations between appearance congruence, gender-related motivations for weight loss, and disordered eating in transgender and gender expansive (TGE) individuals. METHOD A total of 160 TGE adults (aged 18-30) were recruited across the United States. Participants completed a comprehensive online survey. Data were analyzed using generalized linear models and bivariate correlations. RESULTS Significant differences in appearance congruence among participants at different transition stages were revealed, with the group that achieved their desired transition reporting the highest appearance congruence compared to all other groups. Furthermore, gender-related motivations for weight loss were significantly lower in individuals who achieved their desired transition compared to those with no plans to transition. DISCUSSION Findings suggest significantly higher appearance congruence in those who achieved their desired transition compared to other groups, and individuals who attained their desired transition exhibited significantly reduced gender-related motivations for weight loss compared to those with no plans to transition. These findings underscore the potential psychological benefits associated with successful gender-affirming care, highlighting its role not only in fostering appearance congruence but also in mitigating gender-related motivations for weight loss among TGE individuals. Future research should include larger and more diverse samples, longitudinal designs, and considerations of other factors influencing body image outcomes in this population. PUBLIC SIGNIFICANCE This study sheds light on the crucial relationship between gender-affirming care and body image outcomes in TGE individuals. Understanding how appearance congruence and gender-related motivations for weight loss are associated with disordered eating can inform tailored support and interventions. By recognizing the association of gender affirming care and well-being, healthcare providers can enhance care for TGE individuals.
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Affiliation(s)
- Em Chakkour
- Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, United States
| | - Melissa Simone
- Department of Psychology, University of Colorado Denver, 1200 Larimer Street, Denver, CO, 80217, United States
| | - Autumn J. Askew
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, United States
| | - Aaron J. Blashill
- Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, United States
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, United States
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Kirby AV, Krebs E, Hiatt L, Docherty A, Mihalopoulos NL, Keeshin BR, Peifer E, Craker M, Staley M, Bakian AV, Coon H. " It's not the 'being trans,' it's everything around that": Trans Community Perspectives for Suicide Prevention. BULLETIN OF APPLIED TRANSGENDER STUDIES 2024; 3:69-97. [PMID: 39007095 PMCID: PMC11244576 DOI: 10.57814/ec38-hh59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
Trans people are at significantly elevated risk of suicide death, suicide attempts, and suicidal ideation than their cisgender peers. Suicide prevention efforts are needed that address the most important issues to the trans community. In this qualitative study conducted in the United States in 2021, we aimed to broadly explore trans community member perspectives on suicidality and suicide prevention needs. We conducted four virtual focus groups-including one exclusively for trans people of color. We also solicited additional online responses to the same focus group questions. A total of 56 trans individuals with a history of suicidality participated. We utilized reflexive thematic analysis to develop themes to inform suicide prevention efforts for the trans community. The themes were multicontextual, representing needs across healthcare, legal and political arenas, workplaces, community groups, and interpersonal relationships. The central organizing theme identified as crucial for suicide prevention was 'Having (Real) Rights and Respect.' Supporting themes were 'Being in Control of Our Own Bodies,' 'Being Safe as Ourselves,' and 'Feeling Support and Acceptance,' which also included a subtheme of 'Embracing Diversity within the Trans Community.' We provide suggestions and directions for suicide prevention, which build on these themes.
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Affiliation(s)
- Anne V Kirby
- Department of Occupational and Recreational Therapies, University of Utah, 520 Wakara Way, Salt Lake City, UT 84108, USA
| | - Emily Krebs
- Current: Emily Krebs is now at the Department of Communication and Media Studies, Fordham University, 2540 Belmont Ave, Bronx, NY 10458, USA. Former: Department of Communication, University of Utah, 255 S Central Campus Dr., Salt Lake City, UT 84112, USA
| | - Laurel Hiatt
- Department of Human Genetics, University of Utah, 15 N 2030 E, Salt Lake City 84112, UT, USA
| | - Anna Docherty
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, 501 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Nicole L Mihalopoulos
- Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Brooks R Keeshin
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, 501 Chipeta Way, Salt Lake City, UT 84108, USA
- Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108, USA
- Department of Public Health and Caring Science, Child Health and Parenting (CHAP), Uppsala University, Uppsala, Sweden
| | - Elese Peifer
- Department of Occupational and Recreational Therapies, University of Utah, 520 Wakara Way, Salt Lake City, UT 84108, USA
| | - Marlee Craker
- Department of Occupational and Recreational Therapies, University of Utah, 520 Wakara Way, Salt Lake City, UT 84108, USA
| | - Michael Staley
- Office of the Medical Examiner, Utah Department of Health and Human Services, 4451 2700 W, Taylorsville, UT 84129, USA
| | - Amanda V Bakian
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, 501 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Hilary Coon
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, 501 Chipeta Way, Salt Lake City, UT 84108, USA
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Dutta MJ, Mahtani R, Ho V, Sherqueshaa S, Thomas S, Jalleh-Hosey AA, Pitaloka D, Zapata D, Elers P. Culturally Centering the Voices of Transgender Sex Workers in Singapore: Health, Materiality and Violence. HEALTH COMMUNICATION 2024:1-9. [PMID: 38918887 DOI: 10.1080/10410236.2024.2365487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
The transgender sex worker experience of health in Singapore is multidimensional, working at the intersections of culture, social class, and gendered marginalization. Drawing on in-depth interviews with transgender sex workers in the context of Singapore's extreme neoliberalism and located within a larger culture-centered intervention that emerged through an academic-activist-community partnership, this study foregrounds the everyday meanings of health among transgender sex workers who are marginalized. We offer a discursive register for theorizing violence as disruption of health. Participants narrate health as the negotiation of stigmas coded into their everyday lives, the forms of material violence they experience, and the struggles with accessing secure housing. The theorizing of violence as threat to health by transgender sex workers shapes the health advocacy and health activism that takes the form of a 360 degrees campaign. This essay pushes the literature on the culture-centered approach (CCA) by centering voice as the basis for structurally transformative articulations amidst neoliberal authoritarianism.
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Affiliation(s)
- Mohan J Dutta
- Center for Culture-Centered Approach to Research and Evaluation (CARE), Massey University
| | | | | | | | | | | | - Dyah Pitaloka
- Center for Culture-Centered Approach to Research and Evaluation (CARE), Massey University
| | - Dazzelyn Zapata
- Center for Culture-Centered Approach to Research and Evaluation (CARE), Massey University
| | - Phoebe Elers
- Center for Culture-Centered Approach to Research and Evaluation (CARE), Massey University
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Sevelius J, Veras MASM, Gomez JL, Saggese G, Mocello AR, Bassichetto KC, Neilands TB, Lippman SA. Reducing intersectional stigma among transgender women in Brazil to promote uptake of HIV testing and PrEP: study protocol for a randomised controlled trial of Manas por Manas. BMJ Open 2024; 14:e076878. [PMID: 38908840 PMCID: PMC11328665 DOI: 10.1136/bmjopen-2023-076878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 05/29/2024] [Indexed: 06/24/2024] Open
Abstract
INTRODUCTION Globally, transgender ('trans') women experience extreme social and economic marginalisation due to intersectional stigma, defined as the confluence of stigma that results from the intersection of social identities and positions among those who are oppressed multiple times. Among trans women, gender-based stigma intersects with social positions such as engagement in sex work and substance use, as well as race-based stigma to generate a social context of vulnerability and increased risk of HIV acquisition. In Brazil, trans women are the 'most at-risk' group for HIV, with 55 times higher estimated odds of HIV infection than the general population; further, uptake of HIV testing and pre-exposure prophylaxis (PrEP) among trans women is significantly lower than other at-risk groups. Through extensive formative work, we developed Manas por Manas, a multilevel intervention using HIV prevention strategies with demonstrated feasibility and acceptability by trans women in Brazil, to address intersectional stigma and increase engagement in the HIV prevention continuum. METHODS AND ANALYSIS We are conducting a two-arm randomised wait-list controlled trial of the intervention's efficacy in São Paulo, Brazil, to improve uptake of HIV testing and PrEP among transgender women (N=400). The primary outcomes are changes in HIV testing (self-testing and clinic based), changes in PrEP uptake and changes in PrEP persistence at baseline and follow-up assessment for 12 months at 3-month intervals. ETHICS AND DISSEMINATION This study was approved by University of California, San Francisco Institutional Review Board (15-17910) and Comissão Nacional de Ética em Pesquisa (Research Ethics National Commission, CAAE: 25215219.8.0000.5479) in Brazil. Participants provided informed consent before enrolment. We are committed to collaboration with National Institutes of Health officials, other researchers, and health and social services communities for rapid dissemination of data and sharing of materials. The results will be published in peer-reviewed academic journals and scientific presentations. TRIAL REGISTRATION NUMBER NCT03081559.
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Affiliation(s)
- Jae Sevelius
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Jose Luis Gomez
- Department of Public Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Gustavo Saggese
- Department of Public Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Adrienne Rain Mocello
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Katia Cristina Bassichetto
- Department of Public Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Torsten B Neilands
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Sheri A Lippman
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, USA
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Carvalho SA, Lapa T, Pascoal PM. The Need to Look at Transgender and Gender Diverse People's Health: A Preliminary Descriptive Report on Pain, Sexual Distress, and Health Profile of Five Transmasculine People and One Non-Binary Person with Endometriosis. Healthcare (Basel) 2024; 12:1229. [PMID: 38921344 PMCID: PMC11204261 DOI: 10.3390/healthcare12121229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 06/11/2024] [Accepted: 06/14/2024] [Indexed: 06/27/2024] Open
Abstract
The sexual health of transgender and gender diverse (TGD) people with endometriosis has been overlooked, and important emotional experiences, such as sexual distress and its correlates, have been ignored. This has prevented a more comprehensive look at the health experiences of TGD individuals. This descriptive online survey study preliminarily explored the experiences of pain symptoms, sexual distress, and mental health of N = 6 TGD individuals diagnosed with endometriosis. Descriptive results showed a mean delay of 10 years from the onset of symptoms to the diagnosis. Endometriosis-related pain was a common symptom, although with low to moderate intensity. Results also showed higher mean levels of pain impact, powerlessness and lack of control, somatization, depression, anxiety, and sexual distress, and lower mean levels of emotional well-being, social support, and worse self-image compared to reports on cisgender women with endometriosis in the literature. These results suggested that sexual and mental health in the context of TGD people with endometriosis has specificities and may be associated with factors that need to be accounted for to provide comprehensive and socially just healthcare, such as the recognition of the impact of endometriosis treatment on symptoms of gender dysphoria. To achieve sexual health equity for TGD people, continuous and updated professional training and inclusive research with multiple informants are necessary.
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Affiliation(s)
- Sérgio A. Carvalho
- University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), 3000-115 Coimbra, Portugal;
| | - Teresa Lapa
- Anesthesiology Departament, Hospitais da Universidade de Coimbra, 3004-561 Coimbra, Portugal;
- Faculty of Health Sciences, Universidade da Beira Interior, 6200-506 Covilhã, Portugal
| | - Patrícia M. Pascoal
- Lusófona University, HEI-Lab: Digital Human-Environment Interaction Labs, 1700-097 Lisbon, Portugal
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Teren K. Depathologization of trans* experience in ICD-11: Suggestions for context-sensitive psychotherapeutic work. BEHAVIORAL SCIENCES & THE LAW 2024. [PMID: 39031882 DOI: 10.1002/bsl.2683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 06/04/2024] [Accepted: 06/10/2024] [Indexed: 07/22/2024]
Abstract
The current changes to the treatment recommendations and the diagnostic categorization of trans* identities in the ICD-11 require a new consideration of past therapeutic methods and approaches. The depathologization of trans* lives in the ICD-11 finally enables trans* people to access psychotherapeutic services more freely, as the compulsory therapy that has thus far been required for access to transition-related treatments, as well as the so-called "diagnosis" and "treatment" of "transsexuality", have been removed. Trans* people will nevertheless be interested in qualified psychotherapeutic treatment options. Due to the decades-long discrimination and treatment in the health system that has disregarded the human rights of trans* people, a trans*-affirmative approach is necessary, one that takes into account the context of the treatment and critically reflects upon one's own position as a health professional. This affirmative and self-reflective approach provides the basis upon which therapeutic concerns and topics related to a life lived in accordance with a self-determined (gender) identity, related needs, and the fulfillment of those needs, can be discussed. The consequences of experiences of discrimination, violence and exclusion are, moreover, important elements of therapy that require a structural and social contextualization in order to address internalized trans*-negativity and to empower trans* people in their self-assertion.
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Choo S, Kim R, Lee H, Eom YJ, Yi H, Kim R, Williams DR, Kim SS. Heightened vigilance and its associations with suicidal ideation and suicide attempt among 285 Korean transgender and nonbinary adults: Effect modification by connectedness to the LGBTQ+ community. Suicide Life Threat Behav 2024. [PMID: 38888372 DOI: 10.1111/sltb.13104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 05/19/2024] [Accepted: 06/06/2024] [Indexed: 06/20/2024]
Abstract
INTRODUCTION Anti-transgender stigma presents threats of discrimination to transgender and nonbinary (TGNB) individuals, prompting them to stay vigilant. Using a longitudinal data of 285 South Korean TGNB adults, we examined vigilance and its associations with suicidal ideation and suicide attempt and explored the protective role of connectedness to the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community. METHODS Data were collected in October 2021 (baseline) and October 2022 (follow-up). Vigilance was measured using the 4-item Heightened Vigilance Scale at baseline. At follow-up, 12-month suicidal ideation and suicide attempt, and connectedness to the LGBTQ+ community were measured. RESULTS Having heightened levels of vigilance was associated with increased prevalence of suicidal ideation (Prevalence Ratio [PR]: 1.33, 95% Confidence Interval [CI]: 1.09-1.62) and suicide attempt (PR: 2.18, 95% CI: 1.23-3.86), after adjusting for covariates including anti-transgender discrimination experiences and lifetime suicidality at baseline. When stratified by connectedness to the LGBTQ+ community, the associations between vigilance and suicidality remained statistically significant among those with low connectedness whereas no statistically significant association was observed among those with high connectedness. CONCLUSION The study provides empirical evidence for policies and interventions that ensure safety of TGNB individuals from discrimination and promote connectedness to the LGBTQ+ community to reduce the suicide risk among TGNB individuals.
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Affiliation(s)
- Sungsub Choo
- Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
| | - Ranyeong Kim
- Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
| | - Hyemin Lee
- Department of Psychology, University of Maryland College Park, College Park, Maryland, USA
| | - Yun-Jung Eom
- Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
| | - Horim Yi
- Solidarity for LGBT Human Rights of Korea, Seoul, South Korea
| | - Rockli Kim
- Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
- Division of Health Policy and Management, College of Health Science, Korea University, Seoul, South Korea
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Seung-Sup Kim
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea
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Chauma-Ludaka SS, Wan C, Marley G, Dong W, Tucker JD, Tang W. Gender Identity Disclosure and Healthcare Services Uptake Among Chinese Transgender Individuals in China: Results from a Cross-Sectional Study. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2024; 36:384-390. [PMID: 39148925 PMCID: PMC11323871 DOI: 10.1080/19317611.2024.2367515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 05/24/2024] [Accepted: 06/08/2024] [Indexed: 08/17/2024]
Abstract
Purpose Culture and stigma-relevant issues discourage transgender individuals in China from gender identity disclosure, which may limit their access to comprehensive health care services. This study evaluates how gender identity disclosure to healthcare professionals would facilitate healthcare services in China. Methods A cross-sectional study was conducted in nine cities across mainland China from December 2019 to June 2020 among transgender individuals. Participants completed questions covering socio-demographic information, Human Immuno-Deficiency Virus and Sexually Transmitted Infections (HIV/STI) testing habits, sexual risk behaviors, and access to medical and mental health services for the past 3 months. Results A total of 277 eligible transgender individuals with a mean age of 29 ± 8 years old completed the survey. Overall, 56.0% (155/277) had disclosed their gender identity to health professionals. 83.9% had ever tested for HIV (with HIV prevalence of 12.9%), 54.2% had tested for STIs, 62.6% had used hormone therapy, and 12.3% had undergone gender-affirming surgery. Multivariable logistic regression showed that participants who had ever disclosed their gender identity to healthcare professionals were more likely to have tested for STIs (aOR = 1.94, 95%CI: 1.12-3.39) and HIV (aOR = 1.72, 95% CI 0.82-3.39), received hormone intervention therapy (aOR = 2.81, 95%CI: 1.56-5.05), and used pre-exposure prophylaxis (PrEP) (aOR= 3.51, 95%CI: 1.12-10.97) compared to non-disclosers. Conclusions Our study demonstrated strong correlations between gender identity disclosure and healthcare services usage among Chinese transgender individuals. Facilitating the gender identity disclosure of transgender individuals to healthcare professionals with caution would be useful for improving their access to care.
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Affiliation(s)
- Shamen Susan Chauma-Ludaka
- School of Public Health, Southern Medical University, Guangzhou, China
- Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Chengsong Wan
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Gifty Marley
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- University of North Carolina at Chapel Hill Project China, Guangzhou, China
| | - Willa Dong
- Gilling’s Global School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joseph D. Tucker
- University of North Carolina at Chapel Hill Project China, Guangzhou, China
- Institute of Global Health and Infectious Diseases, the University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- University of North Carolina at Chapel Hill Project China, Guangzhou, China
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Fowler JA, Warzywoda S, Franks N, Mendis M, Lazarou M, Bisshop F, Wood P, Dean JA. Highs, Lows, and Hormones: A Qualitative Metasynthesis of Transgender Individuals' Experiences Undergoing Gender-Affirming Hormone Therapy. JOURNAL OF HOMOSEXUALITY 2024; 71:1652-1683. [PMID: 36884002 DOI: 10.1080/00918369.2023.2186759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Gender Affirming Hormone Therapy (GAHT) is a key therapeutic approach which aims to help trans and gender diverse (or simply "trans") individuals' transition from their sex-presumed-at-birth to their experienced gender identity. Previous reviews have focused on synthesizing quantitative experiences; however, a qualitative lens is important to understand the personal journey of GAHT. This review provides a qualitative meta-synthesis of the experiences of trans people around the world who have undergone GAHT to elicit contextualized understanding of the changes experienced. Systematic searches of eight databases identified an initial 2670 papers, refined to a final 28 papers. Overall, findings suggested that the GAHT journey is unique and elicited a myriad of changes which, whilst challenging at times, were life-changing and brought about positive psychological, physical, and social changes. Other themes explored GAHT not being treated as a fix-all for associated mental health issues, the rules that govern appraisal of physical changes, how privilege and social identity evolve, and the power of affirmation. This work offers important recommendations to improve the care offered to trans people undergoing GAHT. Namely, person-centered support is essential, and peer-navigation may be a useful future direction to explore.
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Affiliation(s)
- James A Fowler
- Faculty of Medicine, School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Sarah Warzywoda
- Faculty of Medicine, School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Nia Franks
- School of Psychology and Counselling, Faculty of Health, Engineering and Sciences, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, Queensland, Australia
| | - Marini Mendis
- Faculty of Medicine, School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Mattea Lazarou
- Faculty of Medicine, School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Fiona Bisshop
- Holdsworth House Medical Practice, Brisbane, Queensland, Australia
| | - Penny Wood
- Alexander Heights Family Practice, Perth, Western Australia, Australia
| | - Judith A Dean
- Faculty of Medicine, School of Public Health, The University of Queensland, Herston, Queensland, Australia
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, Queensland, Australia
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Fowler JA, Warzywoda S, Reyment M, Crilly T, Franks N, Bisshop F, Wood P, Dean JA. One person, many changes: a socioecological qualitative analysis of the experiences of transfeminine individuals undergoing feminising gender-affirming hormone therapy. CULTURE, HEALTH & SEXUALITY 2024:1-17. [PMID: 38829652 DOI: 10.1080/13691058.2024.2358099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/17/2024] [Indexed: 06/05/2024]
Abstract
Gender-affirming hormone therapy (GAHT) comes with many physical, psychological, and social changes that are often considered in isolation. This research uses a socioecological lens with a sample of 15 Australian transfeminine individuals to investigate the changes experienced during GAHT. Semi-structured interviews were conducted in 2022, with verbatim transcripts analysed using deductive thematic analysis with Bronfenbrenner's Socioecological Model (SEM) as a framework. Analyses revealed two themes intersecting multiple levels of the SEM. Theme 1 contained two sub-themes and broadly encapsulated how interactions with others influenced GAHT experiences. Sub-theme 1 spoke to how stigma creates positive or negative experiences (through the macrosystem, the exosystem, and proximal processes), while sub-theme 2 described how GAHT causes internal changes that promoted stronger interpersonal relationships (person and proximal processes). Theme 2 described how changes occurred over time, with some changes being temporary, and others being delayed (person and time). These themes highlight the interconnected nature of the physical, psychological, and social changes and experiences that can occur during GAHT. Best-practice care for trans people undergoing GAHT needs to be multi-faceted and holistic in order to embed support across different SEM components.
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Affiliation(s)
- James A Fowler
- The University of Queensland, Faculty of Medicine, School of Public Health, Herston, QLD, Australia
| | - Sarah Warzywoda
- The University of Queensland, Faculty of Medicine, School of Public Health, Herston, QLD, Australia
| | - Mera Reyment
- The University of Queensland, Faculty of Health and Behavioural Sciences, School of Psychology, St Lucia, QLD, Australia
| | - Tyson Crilly
- The University of Queensland, Faculty of Health and Behavioural Sciences, School of Psychology, St Lucia, QLD, Australia
| | - Nia Franks
- School of Psychology and Counselling, Faculty of Health, Engineering and Sciences, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, QLD, Australia
| | - Fiona Bisshop
- Holdsworth House Medical Practice, Brisbane, QLD, Australia
| | - Penny Wood
- Alexander Heights Family Practice, Perth, WA, Australia
| | - Judith A Dean
- The University of Queensland, Faculty of Medicine, School of Public Health, Herston, QLD, Australia
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Kearns S, Hardie P, O’Shea D, Neff K. Instruments used to assess gender-affirming healthcare access: A scoping review. PLoS One 2024; 19:e0298821. [PMID: 38829881 PMCID: PMC11146745 DOI: 10.1371/journal.pone.0298821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/30/2024] [Indexed: 06/05/2024] Open
Abstract
PURPOSE The overall aim of this scoping review was to identify, explore and map the existing literature pertaining to healthcare access for transgender and non-binary individuals. DESIGN The scoping review followed Arksey and O'Malley's methodological framework, and the reporting adhered to the guidelines provided by the PRISMA Extension for Scoping Reviews. METHODS To gather relevant articles, a comprehensive search strategy was employed across four electronic databases, with the assistance of a university librarian. In addition, manual and internet searches were conducted for grey literature. From the initial search, a pool of 2,452 potentially relevant articles was retrieved, which was supplemented by an additional 23 articles from the supplemental search. After an independent review by two researchers, 93 articles were assessed, resulting in the inclusion of 41 articles in the review. RESULTS The literature highlights the identification of barriers and enablers, spanning across 32 individual data sets that affect healthcare accessibility for transgender and non-binary individuals. Leveque's five dimensions of healthcare access, namely approachability, acceptability, availability and accommodation, affordability, and appropriateness, were utilized to categorise these 42 factors. Some of the key themes that emerged in these dimensions include challenges in accessing information about services, concerns about acceptance from family and peers, past experiences of discrimination in healthcare settings, considerations related to cost and insurance, and the difficulty in finding appropriately trained competent providers. CONCLUSIONS The review focused on the most commonly researched aspects of healthcare access and identified gaps in research and opportunities for future studies. The findings provide recommendations for policy and practice, which could guide the development of interventions aimed at addressing the barriers faced by transgender individuals seeking gender-affirming care.
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Affiliation(s)
- Seán Kearns
- School of Medicine, University College Dublin, Dublin, Ireland
- St Columcille’s Hospital, Dublin, Ireland
| | - Philip Hardie
- Nursing Programme, Hibernia College, Dublin, Ireland
| | - Donal O’Shea
- School of Medicine, University College Dublin, Dublin, Ireland
- St Columcille’s Hospital, Dublin, Ireland
| | - Karl Neff
- School of Medicine, University College Dublin, Dublin, Ireland
- St Columcille’s Hospital, Dublin, Ireland
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Inclusive language and environment to welcome lesbian, gay, bisexual, transgender, queer, questioning, intersex, and asexual+ patients. Fertil Steril 2024; 121:954-960. [PMID: 38430081 DOI: 10.1016/j.fertnstert.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 03/03/2024]
Abstract
Using inclusive language and creating an inclusive clinical environment to serve lesbian, gay, bisexual, transgender, queer, questioning, intersex, and asexual+ patients is vital to optimizing access to care and patient outcomes. Practical recommendations are made for increasing inclusivity in the clinic, and a glossary of current terms is included.
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Suarez NA, McKinnon II, Krause KH, Rasberry CN, Pampati S, Michael Underwood J. Disparities in behaviors and experiences among transgender and cisgender high school students - 18 U.S. states, 2021. Ann Epidemiol 2024; 94:113-119. [PMID: 38734191 PMCID: PMC11134401 DOI: 10.1016/j.annepidem.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/02/2024] [Accepted: 05/06/2024] [Indexed: 05/13/2024]
Abstract
PURPOSE Transgender youth (those whose gender identity differs from their sex assigned at birth) experience stigma and discrimination that can place them at increased risk for poor health outcomes compared with cisgender youth (those whose gender identity aligns with their sex assigned at birth). Limited population-based data exist on disparities among transgender and cisgender youth. METHODS We examined differences in experiences of violence, substance use, mental health, suicide, sexual behavior, unstable housing, parental monitoring, and school connectedness among 98,174 transgender and cisgender high school students using data from 18 states that included an item to assess transgender identity on their 2021 Youth Risk Behavior Survey. RESULTS Overall, 2.9% of students identified as transgender and 2.6% questioned whether they were transgender. Among transgender students, 71.5% reported that their mental health was not good, 32.3% had attempted suicide, and 29.0% experienced sexual violence. Transgender students were more likely than cisgender students to report experiences of violence, substance use, poor mental health, suicide risk, some sexual risk behaviors, and unstable housing, and were less likely to report feeling connected to others at school. CONCLUSIONS Interventions that can address the causes of these adverse outcomes and promote the health and wellbeing of transgender youths are warranted.
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Affiliation(s)
- Nicolas A Suarez
- Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, CDC 4770 Buford Hwy NE, Atlanta, GA 30341, USA.
| | - Izraelle I McKinnon
- Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, CDC 4770 Buford Hwy NE, Atlanta, GA 30341, USA
| | - Kathleen H Krause
- Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, CDC 4770 Buford Hwy NE, Atlanta, GA 30341, USA
| | - Catherine N Rasberry
- Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, CDC 4770 Buford Hwy NE, Atlanta, GA 30341, USA
| | - Sanjana Pampati
- Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, CDC 4770 Buford Hwy NE, Atlanta, GA 30341, USA
| | - J Michael Underwood
- Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, CDC 4770 Buford Hwy NE, Atlanta, GA 30341, USA
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Kelly PJ, Myers-Matthews P, Collins AB, Wolfe HL, Miller-Jacobs C, Davis M, Adrian H, Briody V, Fernández Y, Operario D, Hughto JM. A qualitative study of reasons to use substances and substance use treatment experiences among transgender and gender diverse adults in Rhode Island. SSM. QUALITATIVE RESEARCH IN HEALTH 2024; 5:100399. [PMID: 38854803 PMCID: PMC11157666 DOI: 10.1016/j.ssmqr.2024.100399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Affiliation(s)
- Patrick J.A. Kelly
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
- Center for Promotion and Health Equity, Brown University School of Public Health, Box G-121-8, Providence, RI, 02912, USA
| | | | - Alexandra B. Collins
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - Hill L. Wolfe
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA
| | - Cameron Miller-Jacobs
- Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - Madison Davis
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - Haley Adrian
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - Victoria Briody
- Warren Alpert School of Medicine, Brown University, 222 Richmond Street, Providence, RI, 02903, USA
| | - Yohansa Fernández
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
- Warren Alpert School of Medicine, Brown University, 222 Richmond Street, Providence, RI, 02903, USA
| | - Don Operario
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30329, USA
| | - Jaclyn M.W. Hughto
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
- Center for Promotion and Health Equity, Brown University School of Public Health, Box G-121-8, Providence, RI, 02912, USA
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
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LeBlanc ME, Trinh MH, Zubizarreta D, Reisner SL. Healthcare stereotype threat, healthcare access, and health outcomes in a probability sample of U.S. transgender and gender diverse adults. Prev Med Rep 2024; 42:102734. [PMID: 38659996 PMCID: PMC11039338 DOI: 10.1016/j.pmedr.2024.102734] [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: 12/19/2023] [Revised: 04/14/2024] [Accepted: 04/16/2024] [Indexed: 04/26/2024] Open
Abstract
Background Health inequities among transgender and gender diverse (TGD) populations are well-documented and may be partially explained by the complex social power dynamics that lead to stigmatization. Healthcare Stereotype Threat (HCST) refers to the fear and threat of being perceived negatively based on identity-related stereotypes and may influence health and healthcare experiences. Few studies have investigated associations of HCST with healthcare access and health outcomes for TGD individuals. Methods We analyzed the U.S. Transgender Population Health Survey, a cross-sectional national probability sample of 274 TGD adults recruited April 2016-December 2018. Participants self-reported HCST through a 4-item scale. We estimated prevalence ratios (PR) for the association between HCST and binary healthcare access indicators and health outcomes using Poisson models with robust variance. Prevalence ratios (PR) were estimated using negative binomial models for the association between HCST and number of past-month poor physical and mental health days. Models adjusted for sociodemographics and medical gender affirmation. Results The mean age was 34.2 years; 30.9 % identified as transgender men, 37.8 % transgender women, and 31.3 % genderqueer/nonbinary. HCST threat was associated with increased prevalence of not having a personal doctor/healthcare provider (PR = 1.25; 95 %CI = 1.00-1.56) and reporting fair/poor general health vs good/very good/excellent health (PR = 1.92; 95 %CI = 1.37-2.70). Higher HCST was also associated with more frequent past-month poor physical (PR = 1.34; 95 %CI = 1.12-1.59) and mental (PR = 1.49; 95 %CI = 1.33-1.66) health days. Conclusion HCST may contribute to adverse healthcare access and health outcomes in TGD populations, though prospective studies are needed. Multilevel interventions are recommended to create safe, gender-affirming healthcare environments that mitigate HCST.
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Affiliation(s)
- Merrily E. LeBlanc
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, United States
- Department of Sociology and Anthropology, Northeastern University, 900 Renaissance Park, 1135 Tremont St, Boston, MA 02120, United States
| | - Mai-Han Trinh
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States
| | - Dougie Zubizarreta
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States
| | - Sari L. Reisner
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, United States
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States
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Velez BL, Scheer JR, Adames CN, Cavic E, Breslow AS. Development and validation of the Gender Identity and Expression Microaggressions in Therapy Scale (GIEMTS). Psychotherapy (Chic) 2024; 61:110-124. [PMID: 38635212 PMCID: PMC11098710 DOI: 10.1037/pst0000523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Developing affirming interventions for transgender and nonbinary (TNB) therapy clients requires understanding their experiences with microaggressions in psychotherapy, yet no self-report measure of anti-TNB microaggressions in this context exists. Moreover, few studies have tested the associations between anti-TNB microaggressions and therapy processes. To better address the burden of unmet mental health care needs among TNB people, this three-study investigation designed and tested the psychometric properties of the Gender Identity and Expression Microaggressions in Therapy Scale (GIEMTS), a measure of TNB individuals' encounters with microaggressions in psychotherapy. Study 1 (N = 225) identified a four-factor model, comprising the themes of Educational Burdening, Lack of Affirmation, Inflation, and Invalidation. These subscales exhibited strong internal consistency reliabilities and demonstrated convergent and discriminant validity. The results of Study 2 (N = 435) replicated the four-factor structure through confirmatory factor analysis. However, bifactor analysis revealed that the Educational Burdening, Inflation, and Invalidation subscale scores were mostly accounted by a General Anti-TNB Microaggressions scale score-though Lack of Affirmation showed evidence of its independence. Also in Study 2, both scales were uniquely negatively associated with the working alliance. Study 3 (N = 151) found evidence for the test-retest reliability of GIEMTS scores over a 2-3-week period. Overall, the GIEMTS emerged as a robust and psychometrically sound instrument that captures the experiences of TNB individuals in therapy settings. The study concludes with valuable recommendations for training and clinical practice to bolster TNB mental health. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Maung HH. Gender Affirming Hormone Treatment for Trans Adolescents: A Four Principles Analysis. JOURNAL OF BIOETHICAL INQUIRY 2024; 21:345-363. [PMID: 38240914 PMCID: PMC11289353 DOI: 10.1007/s11673-023-10313-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/11/2023] [Indexed: 07/31/2024]
Abstract
Gender affirming hormone treatment is an important part of the care of trans adolescents which enables them to develop the secondary sexual characteristics congruent with their identified genders. There is an increasing amount of empirical evidence showing the benefits of gender affirming hormone treatment for psychological health and social well-being in this population. However, in several countries, access to gender affirming hormone treatment for trans adolescents has recently been severely restricted. While much of the opposition to gender affirming hormone treatment for trans adolescents has in part been ideologically motivated, it also reflects a debate about whether there are harms that outweigh the benefits of the treatment. Accordingly, a systematic and comprehensive philosophical analysis of the ethics of gender affirming hormone treatment for trans adolescents is needed. Herein, I offer such an analysis that draws on the four principles of biomedical ethics by Tom Beauchamp and James Childress. Based on the considerations of beneficence, nonmaleficence, autonomy, and justice, I argue that the provision of access to gender affirming hormone treatment for consenting trans adolescents is ethically required and that the current restrictions to such treatment are ethically wrong.
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Affiliation(s)
- Hane Htut Maung
- Department of Politics, Philosophy, and Religion, Lancaster University, Lancaster, LA1 4YL, United Kingdom.
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Graetz DE, Velasquez T, Chitsike I, Halalsheh H, Cáceres-Serrano A, Fuentes L, Chokwenda N, Matsikidze E, Ferrara G, Bilbeisi T, Williams A, Bhakta N, Jeha S, Rodriguez Galindo C, Mack JW, Santana VM. Stigma in Pediatric Cancer: An Exploratory Study of Osteosarcoma and Retinoblastoma in Guatemala, Jordan, and Zimbabwe. JCO Glob Oncol 2024; 10:e2400017. [PMID: 38905576 PMCID: PMC11191872 DOI: 10.1200/go.24.00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/18/2024] [Accepted: 04/22/2024] [Indexed: 06/23/2024] Open
Abstract
PURPOSE Stigma is an understudied barrier to health care acceptance in pediatric oncology. We sought to explore the stigma experience, including its impact on cancer treatment decision making, and identify strategies to mitigate stigma for patients with osteosarcoma and retinoblastoma in Guatemala, Jordan, and Zimbabwe. METHODS Participants included caregivers, adolescent patients (age 12-19 years), and health care clinicians. A semistructured interview guide based on The Health Stigma and Discrimination Framework (HSDF) was adapted for use at each site. Interviews were conducted in English, Spanish, Arabic, or Shona, audio-recorded, translated, and transcribed. Thematic analysis focused on stigma practices, experiences, outcomes, drivers, mitigators, and interventions. RESULTS We conducted 56 interviews (28 caregivers, 19 health care clinicians, nine patients; 20 in Guatemala, 21 in Jordan, 15 in Zimbabwe). Major themes were organized into categories used to adapt the HSDF to global pediatric cancer care. Themes were described similarly across all sites, ages, and diagnoses, with specific cultural nuances noted. Pediatric cancer stigma was depicted as an isolating and emotional experience beginning at diagnosis and including internalized and associative stigma. Stigma affected decision making and contributed to negative outcomes including delayed diagnosis, treatment abandonment, regret, and psychosocial fragility. Overcoming stigma led to positive outcomes including resilience, treatment adherence, pride, and advocacy. Identified stigma drivers and mitigators were linked to potential interventions. CONCLUSION Participants describe a shared stigma experience that transcends geography, cultural context, age, and diagnosis. Stigma manifestations have the potential to impact medical decision making and affect long-term psychological outcomes. Stigma assessment tools and interventions aimed at stigma mitigation including educational initiatives and support groups specific to pediatric cancer should be the focus of future research.
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Affiliation(s)
| | - Thelma Velasquez
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | - Inam Chitsike
- University of Zimbabwe and Parirenyatwa Hospital, Harare, Zimbabwe
| | | | | | - Lucia Fuentes
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | - Nester Chokwenda
- University of Zimbabwe and Parirenyatwa Hospital, Harare, Zimbabwe
| | - Edith Matsikidze
- University of Zimbabwe and Parirenyatwa Hospital, Harare, Zimbabwe
| | - Gia Ferrara
- St Jude Children's Research Hospital, Memphis, TN
| | | | | | | | - Sima Jeha
- St Jude Children's Research Hospital, Memphis, TN
| | | | - Jennifer W. Mack
- Dana Farber Cancer Institute/Boston Children's Hospital, Boston, MA
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Jardine L, Edwards C, Janeway H, Krempasky C, Macias‐Konstantopoulos W, Whiteman P, Hsu A. A guide to caring for patients who identify as transgender and gender diverse in the emergency department. J Am Coll Emerg Physicians Open 2024; 5:e13217. [PMID: 38903764 PMCID: PMC11187815 DOI: 10.1002/emp2.13217] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 05/17/2024] [Accepted: 05/23/2024] [Indexed: 06/22/2024] Open
Abstract
Through a review of current research, standards of care, and best practices, this paper serves as a resource for emergency physicians (EPs) caring for persons who identify as transgender and gender diverse (T/GD) in the emergency department (ED). Both patient- and physician-based research have identified existent potential knowledge gaps for EPs caring for T/GD in the ED. T/GD have negative experiences related to their gender identity when seeking emergency medical care and may even delay emergency care for fear of discrimination. Through the lens of cultural humility, this paper aims to address potential knowledge gaps for EPs, identify and reduce barriers to care, highlight gender-affirming hospital policies and protocols, and improve the care and experience of T/GD in the ED.
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Affiliation(s)
- Logan Jardine
- Mount Sinai Beth Israel Department of Emergency MedicineNew YorkNew YorkUSA
| | | | - Hannah Janeway
- White Memorial Medical Center/West Los Angeles VAUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | | | - Wendy Macias‐Konstantopoulos
- Center for Social Justice and Health Equity, Department of Emergency MedicineMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | | | - Antony Hsu
- Department of Emergency MedicineTrinity Health Ann ArborYpsilantiMichiganUSA
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Schinasi LH, Lawrence JA. Everyday discrimination and satisfaction with nature experiences. FRONTIERS IN EPIDEMIOLOGY 2024; 4:1212114. [PMID: 38872717 PMCID: PMC11169619 DOI: 10.3389/fepid.2024.1212114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/07/2024] [Indexed: 06/15/2024]
Abstract
Introduction There is growing interest in creating public green spaces to promote health. Yet, discussions about these efforts often overlook how experiences of chronic discrimination-which may manifest as racism, sexism, or homophobia, and more-could undermine satisfaction with nature experiences. Methods Using data from the 2018 wave of the National Opinion Research Center (NORC) General Social Survey (GSS), we quantified associations of frequency of everyday discrimination, operationalized using the Everyday Discrimination Scale (EDS, the primary independent variable), with respondents' perceptions of nature experiences and with their reported time spent in nature. Specifically, we quantified associations with the following three variables: (1) dissatisfaction with day-to-day experiences of nature, (2) not spending as much time as they would like in natural environments, and (3) usually spending at least one day per week in nature. We used survey-weighted robust Poisson models to estimate overall associations, and also stratified analyses by racial/ethnic and gender identity categories. Results Of 768 GSS respondents, 14% reported dissatisfaction with nature experiences, 36% reported not spending as much time as they would like in nature, and 33% reported that they did not spend at least one day per week in nature. The median non-standardized EDS, coded such that a higher value indicates greater frequency of discrimination, was 11 (interquartile range: 8, 15). Prevalence of reporting dissatisfaction with day-to-day experiences in nature was 7% higher in association with every one unit increase in EDS score above the median (PR: 1.07, 95% CI: 1.02-1.11). The prevalence of reporting not spending as much time as one would like in nature was 2% higher for every unit increase in higher than median everyday discrimination frequency (PR: 1.02, 95% CI: 1.00-1.05). Higher than median frequency in everyday discrimination was not associated with spending less than one day per week in nature. Race/ethnicity and gender identity did not modify associations. Conclusion Greater frequency of everyday discrimination is associated with less satisfaction with experiences in nature. This relationship could undermine efforts to promote health equity through green interventions.
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Affiliation(s)
- Leah H. Schinasi
- Department of Environmental and Occupational Health, Drexel University, Philadelphia, PA, United States
- Urban Health Collaborative, Drexel University, Philadelphia, PA, United States
| | - Jourdyn A. Lawrence
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA, United States
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Septarini NW, Chih H, Hendriks J, Maycock B, Burns S. Prevalence of Stigma and Discrimination Amongst Men Who have Sex with Men (MSM) and Transgender Women (Waria) in Bali, Indonesia. JOURNAL OF HOMOSEXUALITY 2024; 71:1419-1441. [PMID: 36826981 DOI: 10.1080/00918369.2023.2174470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Men who have sex with men (MSM) and transgender women (waria) in Indonesia experience stigma and discrimination. The prevalence of stigma and discrimination experienced by 416 MSM and waria living in Bali, Indonesia and associations with socio-demographic characteristics are described. High levels of stigma were reported by 50.5% of MSM and 62.7% of waria. Discrimination was reported by 35.5% of MSM and 72.4% of waria. Family rejection, or no family awareness of MSM status, equated to higher levels of stigma compared to those where MSM status was accepted. Homosexual and bisexual waria reported lower odds of experiencing stigma compared to heterosexual waria. MSM who were not single were twice as likely to experience discrimination compared to single participants. Non-Hindu MSM were nearly three times as likely to experience discrimination compared to Hindu participants. Waria who were studying were less likely to experience discrimination compared to those who reported regular employment jobs. Specific policy and practice to reduce experiences of stigma and/or discrimination specific to MSM and waria are needed.
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Affiliation(s)
- Ni Wayan Septarini
- Department of Community and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - HuiJun Chih
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Jacqueline Hendriks
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Collaboration for Evidence, Research and Impact in Public Health, Curtin University, Perth, Australia
| | - Bruce Maycock
- European Centre for Environmental and Human Health, College of Medicine and Health, University of Exeter, Devon, The United Kingdom
| | - Sharyn Burns
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Collaboration for Evidence, Research and Impact in Public Health, Curtin University, Perth, Australia
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