1
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Wesche R, Toman M, Grafsky EL, Gupta S, Tarantino MR. Developing an Inclusive Model of Young Heterosexual and Sexual Minority Women's Sexual Decision-Making. JOURNAL OF SEX RESEARCH 2024:1-15. [PMID: 38687300 DOI: 10.1080/00224499.2024.2320260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Efforts to improve sexual health outcomes among young cisgender women require in-depth understanding of how women with diverse sexual identities make decisions about their sexual health. We conducted semi-structured interviews with 31 young cisgender women with diverse sexual identities and histories (age range 18-29 (M = 23.32); 81% White; 29% bisexual, 26% heterosexual, 16% lesbian, 13% queer, 10% pansexual, 3% gay, 3% demisexual) about their decision-making surrounding sexual risk reduction. By conducting thematic analysis, we found that, regardless of partner sex or gender, women adapted sexual health strategies based on how much commitment, trust, and communication existed in their relationships. Because heteronormative structural influences limited access to information and safer sex options, women had to rely on trust and communication more with other women and partners with vaginas, compared to men and partners with penises. Women did not consider safer sex strategies with partners with vaginas (e.g. hand washing) risk-reduction techniques; instead, they considered them general hygiene or a way to take care of a partner. We propose that an inclusive model of young women's sexual decision-making should: (a) highlight the influence of relationships; (b) frame prevention in terms of overall health instead of pregnancy and STIs; and (c) acknowledge that structural factors, such as heteronormativity and sex-negativity, constrain women's decisions.
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Affiliation(s)
- Rose Wesche
- Department of Human Development and Family Science, Virginia Polytechnic Institute and State University
| | - Madelyn Toman
- Department of Human Development and Family Science, Virginia Polytechnic Institute and State University
| | - Erika L Grafsky
- Department of Human Development and Family Science, Virginia Polytechnic Institute and State University
| | - Shivangi Gupta
- Department of Human Development and Family Science, Virginia Polytechnic Institute and State University
| | - Mari R Tarantino
- Department of Human Development and Family Science, Virginia Polytechnic Institute and State University
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2
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Paine EA, Rivera-Cash D, Lopez JM, LeBlanc AJ, Singh AA, Bockting WO. Latent Constructs of Economic Marginality Associated with Sexual Behavior, Healthcare Access and HIV Outcomes Among Transgender and Nonbinary People in Three U.S. Cities. AIDS Behav 2024; 28:1197-1209. [PMID: 37698637 PMCID: PMC11218028 DOI: 10.1007/s10461-023-04143-8] [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] [Accepted: 07/17/2023] [Indexed: 09/13/2023]
Abstract
Transgender and nonbinary people (TNB) in the U.S. experience high HIV prevalence and diverse economic hardships. Yet a comprehensive understanding of how multiple, simultaneously occurring hardships-termed economic marginality-are together associated with healthcare and HIV outcomes is needed. Leveraging survey data from a sample of 330 TNB people in three U.S. cities, we conducted an exploratory mixed-source principal component analysis of latent factors of economic experience, then estimated their associations with sexual behavior, access to healthcare, HIV status, and HIV testing frequency. Two factors emerged: a traditional socioeconomic factor related to income, education, and employment (SES), and one related to housing precarity and (lack of) assets (Precarity). Higher Precarity scores were associated with sexual behavior, cost-based healthcare avoidance, discrimination-based healthcare avoidance, and more frequent HIV testing. Findings highlight the importance of understanding profiles of economic marginalization among trans and nonbinary people and can inform efforts to address upstream, structural factors shaping healthcare access and HIV outcomes in this key population.
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Affiliation(s)
- Emily Allen Paine
- Department of Psychiatry, Division of Gender, Sexuality, and Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA.
- New York State Psychiatric Institute, 722 W 168th St, New York, NY, 10032, USA.
| | - Dennis Rivera-Cash
- New York State Psychiatric Institute, 722 W 168th St, New York, NY, 10032, USA
| | - Jasmine M Lopez
- New York State Psychiatric Institute, 722 W 168th St, New York, NY, 10032, USA
| | - Allen J LeBlanc
- Health Equity Institute, San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Anneliese A Singh
- Tulane University School of Social Work, 127 Elk Place, New Orleans, LA, 70112, USA
| | - Walter O Bockting
- Department of Psychiatry, Division of Gender, Sexuality, and Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
- New York State Psychiatric Institute, 722 W 168th St, New York, NY, 10032, USA
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3
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Folayan MO, Yakusik A, Enemo A, Sunday A, Muhammad A, Nyako HY, Abdullah RM, Okiwu H, Lamontagne E. Socioeconomic inequality, health inequity and well-being of transgender people during the COVID-19 pandemic in Nigeria. BMC Public Health 2023; 23:1539. [PMID: 37573293 PMCID: PMC10422710 DOI: 10.1186/s12889-023-16482-1] [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: 08/31/2022] [Accepted: 08/08/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND We aimed to explore socioeconomic inequality, health inequity, and the well-being of transgender people during the COVID-19 crisis in Nigeria. METHODS Between June and December 2021, a cross-sectional survey was conducted collaboratively with community-based organisations in Nigeria. Participants living with or at risk of HIV were recruited voluntarily, online and face-to-face, using a combination of venue-based and snowball sampling. We assessed the association between gender identity (transgender and vulnerable cisgender women), and (i) socioeconomic inequality measured with socioeconomic status, social status, economic vulnerability, macrosocial vulnerability; (ii) health inequity measured with self-assessment of health, recency of HIV test, access to HIV and sexual and reproductive health services, gender-affirming care, financial and non-financial barriers to accessing health services; and (iii) well-being, measured with gender-based violence, mental health, psychoeconomic preferences. We used multivariable logistic regressions and controlled for interactions and confounders. RESULTS There were 4072 participants; 62% were under 30, and 47% reported living with HIV. One in ten (11.9%; n = 485) was transgender, and 56.5% reported living with HIV. Compared to vulnerable cisgender women, the results showed significantly higher odds (aOR:3.80) of disruption in accessing HIV services in transgender participants; gender-based violence (aOR:2.63); severe (aOR:2.28) symptoms of anxiety and depression. Among the barriers to accessing health and HIV services, transgender had three-time higher odds of reporting additional non-official fees compared to vulnerable cisgender women. The disclosure of their gender identity or sexual orientation was the most important non-financial barrier to accessing health services (aOR:3.16). Transgender participants faced higher housing insecurity (aOR: 1.35) and lower odds of using drugs (aOR:0.48). Importantly, they are more likely to have performed a recent HIV test and less likely to not know their HIV status (aOR:0.38) compared to vulnerable cisgender women. CONCLUSIONS Socioeconomic inequality, health and well-being inequity in transgender people appear to be exacerbated by the COVID-19 pandemic in Nigeria. Interventions are necessary to mitigate socioeconomic challenges, address structural inequality, and ensure equitable access to health services to meet the Sustainable Development Goals for transgender people.
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Affiliation(s)
- Morenike Oluwatoyin Folayan
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria.
- Nigeria Institute of Medical Research, Yaba, Lagos State, Nigeria.
| | - Anna Yakusik
- Joint United Nations Programme on HIV/AIDS, CH, Geneva, Switzerland
| | - Amaka Enemo
- Nigeria Sex Workers Association, Kubwa, Nigeria
| | - Aaron Sunday
- African Network of Adolescent and Young Persons Development, Barnawa, Nigeria
| | - Amira Muhammad
- Northern Nigerian Transgender Initiative, Abuja, Nigeria
| | | | | | | | - Erik Lamontagne
- Joint United Nations Programme on HIV/AIDS, CH, Geneva, Switzerland
- School of Economics, Aix-Marseille University, Marseille, France
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4
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Fortenberry JD, Hensel DJ. Sexual Modesty in Sexual Expression and Experience: A Scoping Review, 2000 - 2021. JOURNAL OF SEX RESEARCH 2022; 59:1000-1014. [PMID: 35138961 DOI: 10.1080/00224499.2021.2016571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Sexual modesty is the social, cultural, interpersonal, and psychological systems - defined by the tenets of Script Theory - that regulate individuals' sexual expression and experience at the social, legal, and interpersonal boundaries of acceptable/not-acceptable, private/public, and personal/social. Almost all aspects of sexual expression and experience are touched by the pervasive modesty standards for sexual communication, sexual display, sexual relations, and sexual behaviors. Sexual modesty influences an array of sexual and reproductive health outcomes. Many aspects of sexual modesty are enforced by legal as well as social, cultural, and religious proscriptions, including social shaming and ostracism as well as corporal and capital punishments. The purpose of this paper is to summarize a diverse literature related to sexual modesty from the years 2000 to 2021 in order to clarify its role in sexual health and sexual wellbeing and to identify directions for new research.
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Affiliation(s)
| | - Devon J Hensel
- Department of Pediatrics, Indiana University School of Medicine
- Department of Sociology, Indiana University/Purdue University at Indianapolis
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5
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Naz-McLean S, Clark JL, Reisner SL, Prenner JC, Weintraub B, Huerta L, Salazar X, Lama JR, Mayer KH, Perez-Brumer A. Decision-Making at the Intersection of Risk and Pleasure: A Qualitative Inquiry with Trans Women Engaged in Sex Work in Lima, Peru. AIDS Behav 2022; 26:843-852. [PMID: 34436712 PMCID: PMC9897010 DOI: 10.1007/s10461-021-03445-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] [Accepted: 08/16/2021] [Indexed: 02/06/2023]
Abstract
To inform culturally relevant HIV prevention interventions, we explore the complexity of sex work among Peruvian transgender women. In 2015, we conducted twenty in-depth interviews and demographic surveys with transgender women in Lima, Peru to examine how transgender women enact individual- and community-level resistance strategies within a context of pervasive marginalization. Although 40% self-identified as "sex workers," 70% recently exchanged sex for money. Participants described nuanced risk-benefit analyses surrounding paid sexual encounters. Classification of clients as "risky" or "rewarding" incorporated issues of health, violence, and pleasure. Interviews highlighted context-informed decision-making (rejecting disrespectful clients, asserting condom use with specific partner types) demonstrating that motivations were not limited to HIV prevention or economic renumeration, but considered safety, health, attraction, gender validation, hygiene, and convenience. These findings underscore the complex risk assessments employed by Peruvian trans women. These individual-level decision-making and context-specific health promotion strategies represent critical frameworks for HIV prevention efforts.
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Affiliation(s)
- Sarah Naz-McLean
- Department of Medicine, Division of Infectious Diseases, Brigham and Women's Hospital, 181 Longwood Ave, Boston, MA, 02115, USA.
| | - Jesse L Clark
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Sari L Reisner
- Department of Medicine, Division of Infectious Diseases, Brigham and Women's Hospital, 181 Longwood Ave, Boston, MA, 02115, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Joshua C Prenner
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Javier R Lama
- Asociación Civil Impacta Salud Y Educación, Lima, Peru
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Kenneth H Mayer
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Beth Israel Lahey Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Amaya Perez-Brumer
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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6
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Grov C, Westmoreland DA, D’Angelo AB, Pantalone DW. How Has HIV Pre-Exposure Prophylaxis (PrEP) Changed Sex? A Review of Research in a New Era of Bio-behavioral HIV Prevention. JOURNAL OF SEX RESEARCH 2021; 58:891-913. [PMID: 34180743 PMCID: PMC9729849 DOI: 10.1080/00224499.2021.1936440] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
In 2012, the U.S. FDA approved the first drug for use as HIV Pre-Exposure Prophylaxis (PrEP), which is nearly 99% effective when taken as prescribed. Although the manifest function of PrEP is to prevent HIV infection in the event of exposure, the drug has also had a significant impact on various facets of sexuality. In this review, we focus on research that emerged in the near decade since PrEP's approval, with a specific focus on the ways in which different elements of sex and sexuality have been impacted by gay, bisexual, and other men who have sex with men (GBMSM), cisgender women, and transgender individuals. We highlight evidence showing how PrEP has enhanced sexual self-esteem, improved sexual pleasure, reduced sexual anxiety, and has increased sexual agency for those taking it. For many, PrEP also serves as a gateway to improve routine health and increase sexual health-care utilization. Additionally, we review the question of whether PrEP is associated with increased sexual risk taking (i.e. risk compensation), and note that, although some data are mixed, PrEP is not intended as an intervention to reduce condomless anal sex or STIs: it aims to prevent HIV. Finally, our review highlights that, although the volume of research on PrEP among GBMSM is robust, it is underdeveloped for cisgender women and transgender populations and insufficient for inclusion in such a review for cisgender heterosexual men was. PrEP research with these populations is an important direction for future research. Finally, from 2012 to 2019, a single PrEP formulation and delivery method was FDA approved (oral emtricitabine/tenofovir disoproxil fumarate). As additional drug formulations (ie.g., emtricitabine/tenofovir alafenamide) and delivery methods (e.g., microbiocides, vaginal ring, injectable) come to market, it will be important to examine how these, too, impact the spectrum of sexuality.
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Affiliation(s)
- Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY
- CUNY Institute for Implementation Science in Population Health, New York, NY
| | | | - Alexa B. D’Angelo
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY
- CUNY Institute for Implementation Science in Population Health, New York, NY
| | - David W. Pantalone
- Department of Psychology, University of Massachusetts Boston
- The Fenway Institute, Fenway Health, Boston, MA
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7
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Rubinsky V. Toward A Typology of Identity Gaps in "Non-Normative" Sexual Partner Communication. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1551-1567. [PMID: 33903968 DOI: 10.1007/s10508-020-01870-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 10/14/2020] [Accepted: 10/21/2020] [Indexed: 06/12/2023]
Abstract
The present study presents a typology of identity gaps (Hecht, 1993), or cognitive, affective, and behavioral discrepancies between and among different parts of the self, that emerge in sexual partner communication. A total of 504 individuals in relationships they identified as or others ascribed as less common or less accepted than other kinds of relationships, including LGBQ, transgender and non-binary, BDSM, polyamorous, and interracial relationships, described instances in which parts of the self were in tension amid their intimate partner communication. These identity gaps occurred in tension with personal identity, or sense of self, or communal identity as a member of particular sexual and gender minority groups. Implications and areas for future research are discussed.
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Affiliation(s)
- Valerie Rubinsky
- Social Science Program, University of Maine at Augusta, 46 University Drive, Augusta, ME, 04330, USA.
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8
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McQuillan MT, Kuhns LM, Miller AA, McDade T, Garofalo R. Gender Minority Stress, Support, and Inflammation in Transgender and Gender-Nonconforming Youth. Transgend Health 2021; 6:91-100. [PMID: 33937526 DOI: 10.1089/trgh.2020.0019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose: Transgender and gender-nonconforming (TGNC) youth often report higher rates of chronic social stressors such as victimization, discrimination, and rejection. Some of these gender-based stressors may have long-range physical health consequences through inflammation pathways. This study evaluates the feasibility and acceptability of adding biological measures of inflammation to an ongoing prospective clinical study of TGNC youth (ages 9-20 years), initiating affirming medical therapy at a large, urban children's hospital (N=56). We also examine the relationship between gender-based sources of stress and support with inflammation. This is the first study to explore how gender identity, social stressors, and social supports may contribute to poorer health in TGNC youth through inflammation and immune dysregulation pathways. Methods: Between October 2016 and August 2018, the study team collected dried blood spot (DBS) samples and health measures during clinical visits. Participants also completed computer-assisted surveys assessing gender minority stress and support during these visits. We used regression analysis to evaluate differences in C-reactive protein (CRP) controlling for demographics, health, gender-based stress, and supports. Results: The results from this study indicate that adding DBS samples to assess inflammation was feasible and acceptable in a clinical sample of TGNC youth seeking affirming-medical interventions. We found an association between greater inflammation and the composite score for greater gender-based stressors and lower gender-based supports using the Gender Minority Stress and Resilience Tool (GMSR); however, we did not find statistically significant differences in CRP associated with any of the individual GMSR subscales assessing various types of gender-based supports or stressors. Conclusion: More research is necessary to evaluate how different sources of gender-based support and stress relate to inflammation with larger sample sizes.
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Affiliation(s)
- Mollie T McQuillan
- Department of Educational Leadership and Policy Analysis, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Lisa M Kuhns
- Department of Pediatrics, Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Aaron A Miller
- Department of Anthropology, Northwestern University, Evanston, Illinois, USA
| | - Thomas McDade
- Department of Anthropology, Northwestern University, Evanston, Illinois, USA
| | - Robert Garofalo
- Department of Pediatrics, Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
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9
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Aggarwal NK, Consavage KE, Dhanuka I, Clement KW, Bouey JH. Health and Health Care Access Barriers Among Transgender Women Engaged in Sex Work: A Synthesis of U.S.-Based Studies Published 2005-2019. LGBT Health 2020; 8:11-25. [PMID: 33297834 DOI: 10.1089/lgbt.2019.0243] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Purpose: Transgender women (TW) are likely to experience job discrimination and engage in commercial sex transactions. As a group, they have the highest risk for HIV/AIDS. However, little is known about the health needs of transgender women sex workers (TWSW) in the United States and the structural and psychosocial barriers to their health care access. The objective of this systematic review was to systematically document these needs and barriers by using a framework approach. Methods: We searched PubMed, JSTOR, and Google Scholar for primary and secondary studies published in 2005-2019 that addressed the health of TWSW in the United States. We used a standardized data extraction form to gather data from eligible articles. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used to assess study quality. Results: Fifty-three articles met the inclusion criteria, including mentioning health-related topics among TWSW. More articles appeared in recent years. Most studies collected data with convenience samples in urban areas. Structural barriers reported included transphobia, lack of pre-exposure prophylaxis targeted at TW, and lack of health insurance coverage. Psychosocial barriers included distrust of the health care system, self-esteem, alcohol and substance use, and mental health. Conclusions: TWSW have unique health care needs that are not being addressed due to barriers to health care access. More research is required to identify non-HIV-related health burdens and details about psychosocial barriers to health care access.
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Affiliation(s)
- Neena K Aggarwal
- Department of International Health, School of Nursing and Health Studies, Georgetown University, Washington, District of Columbia, USA
| | - Katherine E Consavage
- Department of International Health, School of Nursing and Health Studies, Georgetown University, Washington, District of Columbia, USA
| | - Ida Dhanuka
- Department of Biology, Georgetown University, Washington, District of Columbia, USA
| | - Kesiah W Clement
- Department of International Health, School of Nursing and Health Studies, Georgetown University, Washington, District of Columbia, USA
| | - Jennifer H Bouey
- Department of International Health, School of Nursing and Health Studies, Georgetown University, Washington, District of Columbia, USA
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10
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Chyten-Brennan J, Patel VV, Ginsberg MS, Hanna DB. Algorithm to identify transgender and gender nonbinary individuals among people living with HIV performs differently by age and ethnicity. Ann Epidemiol 2020; 54:73-78. [PMID: 33010416 DOI: 10.1016/j.annepidem.2020.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/28/2020] [Accepted: 09/18/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE HIV research among transgender and gender nonbinary (TGNB) people is limited by lack of gender identity data collection. We designed an EHR-based algorithm to identify TGNB people among people living with HIV (PLWH) when gender identity was not systematically collected. METHODS We applied EHR-based search criteria to all PLWH receiving care at a large urban health system between 1997 and 2017, then confirmed gender identity by chart review. We compared patient characteristics by gender identity and screening criteria, then calculated positive predictive values for each criterion. RESULTS Among 18,086 PLWH, 213 (1.2%) met criteria as potential TGNB patients and 178/213 were confirmed. Positive predictive values were highest for free-text keywords (91.7%) and diagnosis codes (77.4%). Confirmed TGNB patients were younger (median 32.5 vs. 42.5 years, P < .001) and less likely to be Hispanic (37.1% vs. 62.9%, P = .03) than unconfirmed patients. Among confirmed patients, 15% met criteria only for prospective gender identity data collection and were significantly older. CONCLUSION EHR-based criteria can identify TGNB PLWH, but success may differ by ethnicity and age. Retrospective versus intentional, prospective gender identity data collection may capture different patients. To reduce misclassification in epidemiologic studies, gender identity data collection should address these potential differences and be systematic and prospective.
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Affiliation(s)
- Jules Chyten-Brennan
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, NY.
| | - Viraj V Patel
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, NY
| | - Mindy S Ginsberg
- Department of Epidemiology and Population Health, Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, NY
| | - David B Hanna
- Department of Epidemiology and Population Health, Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, NY
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11
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Basu A, Ketheeswaran N, Cusanno BR. Localocentricity, mental health and medical poverty in communication about sex work, HIV and AIDS among trans women engaged in sex work. CULTURE, HEALTH & SEXUALITY 2020; 24:1-13. [PMID: 32996407 DOI: 10.1080/13691058.2020.1817562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/27/2020] [Indexed: 06/11/2023]
Abstract
Trans women engaged in sex work live at the intersections of discrimination against sex workers, women and transgender people. Dominant public health approaches have constructed trans women in sex work as a group at high risk of HIV infection. This study employed localocentricity, situated within a cultured-centred approach, as a theoretical framework to document health narratives among 29 trans women who had knowledge of or experience in sex work. This theoretical framing draws attention to the articulations between health and illness expressed by trans women in sex work in USA. Research participants emphasised how their health was affected by extreme socio-political-cultural marginalisation as well as medical poverty and mental health issues.
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Affiliation(s)
- Ambar Basu
- Department of Communication, University of South Florida, Tampa, FL, USA
| | | | - Brianna R Cusanno
- Department of Communication, University of South Florida, Tampa, FL, USA
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12
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Tanner D. The body politic: The changing face of psychotherapy and transgender. PSYCHOTHERAPY AND POLITICS INTERNATIONAL 2019. [DOI: 10.1002/ppi.1507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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13
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Dharma C, Scheim AI, Bauer GR. Exploratory Factor Analysis of Two Sexual Health Scales for Transgender People: Trans-Specific Condom/Barrier Negotiation Self-Efficacy (T-Barrier) and Trans-Specific Sexual Body Image Worries (T-Worries). ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1563-1572. [PMID: 31172396 DOI: 10.1007/s10508-018-1383-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 12/14/2018] [Accepted: 12/15/2018] [Indexed: 05/28/2023]
Abstract
Few sexual health measures have been validated for transgender (trans) populations. Condom/barrier self-efficacy and sexual body image worries are interrelated constructs that may contribute to enhanced and poor sexual health, respectively. We report on the development and initial validation of trans-specific scales designed to measure these constructs. Trans people in Ontario, Canada, who had ever had sex completed these scales as a part of a larger Trans PULSE survey (n = 323). Using exploratory factor analysis, a one-factor solution fit the 8-item Condom/Barrier Negotiation Self-Efficacy Scale (T-Barrier). Two factors were identified for the 7-item Sexual Body Image Worries Scale (T-Worries): "general body image worries" and "trans-related image worries," while two items were recommended for deletion. The scales demonstrated convergent validity with measures such as self-esteem, sexual anxiety, sexual satisfaction, sexual fear, and experiences of transphobia. Further evaluation to confirm these structures within an independent trans sample would be valuable. We recommend the use of these scales for studies of sexual health within trans populations, to enhance our ability to better understand and promote sexual health within trans communities.
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Affiliation(s)
- Christoffer Dharma
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, N6A 5C1, Canada
| | - Ayden I Scheim
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, N6A 5C1, Canada
| | - Greta R Bauer
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, N6A 5C1, Canada.
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14
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Mimiaga MJ, Hughto JM, Biello KB, Santostefano CM, Kuhns LM, Reisner SL, Garofalo R. Longitudinal Analysis of Syndemic Psychosocial Problems Predicting HIV Risk Behavior Among a Multicity Prospective Cohort of Sexually Active Young Transgender Women in the United States. J Acquir Immune Defic Syndr 2019; 81:184-192. [PMID: 30839380 PMCID: PMC6522320 DOI: 10.1097/qai.0000000000002009] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Worldwide, young transgender women (YTW) contend with exceptionally high risks of HIV infection. Cross-sectional studies have suggested that co-occurring epidemics or "syndemics" of psychosocial problems may accelerate HIV acquisition and transmission through elevated sexual risk behavior among transgender women. We aimed to examine how a syndemic of 7 psychosocial problems potentiates HIV sexual risk behavior among a multicity, longitudinal cohort of sexually active YTW in the United States. METHODS Between 2012 and 2015, 233 YTW from Boston, MA, and Chicago, IL, completed behavioral surveys at baseline, 4, 8, and 12 months. We used generalized estimating equations to examine the prospective relationship of overlapping psychosocial problems and HIV sexual risk behavior (ie, condomless anal or vaginal sex) among YTW. RESULTS The prevalence of 7 psychosocial syndemic problems was substantial at baseline and remained high at each time point: 6.4% reported polydrug use in the past 4 months (excluding stimulants); 7.7% reported heavy alcohol use in the past 4 months; 10% reported a history of childhood sexual abuse; 15.9% reported stimulant use in the past 4 months; 41.7% reported experiencing lifetime intimate partner violence; 42.1% reported clinically significant depressive symptoms; and 68.6% reported lifetime transgender-specific victimization. We identified a statistically significant positive "dose-response" relationship between the number of psychosocial syndemic problems and condomless anal or vaginal sex over time. CONCLUSIONS The accumulation of "syndemic" psychosocial problems predicted HIV sexual risk behavior in a prospective cohort of YTW. Given the high prevalence of psychosocial problems and HIV sexual risk behavior, as well as having the highest HIV incidence among any risk group, the HIV prevention agenda requires a shift toward improved assessment of psychosocial comorbidities and stronger integration with gender-affirming and supportive mental health, violence recovery, and addiction treatment services for this population.
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Affiliation(s)
- Matthew J. Mimiaga
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Jaclyn M.W. Hughto
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Katie B. Biello
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | | | - Lisa M. Kuhns
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sari L. Reisner
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Pediatrics, Boston Children’s Hospital/Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H Chan School of Public Health, Boston, MA, USA
| | - Robert Garofalo
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Yi S, Plant A, Tuot S, Mun P, Chhim S, Chann N, Chhoun P, Brody C. Factors associated with condom use with non-commercial partners among sexually-active transgender women in Cambodia: findings from a national survey using respondent-driven sampling. BMC Public Health 2019; 19:326. [PMID: 30894165 PMCID: PMC6427883 DOI: 10.1186/s12889-019-6656-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 03/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, the prevalence of HIV among transgender women is much higher than that of the general adult population. This can be explained by the persistently low rate of consistent condom use among this population. This study was therefore conducted to explore factors associated with consistent condom use among sexually-active transgender women in Cambodia, specifically with their non-commercial partners. METHODS Data used for this study were collected as part of the National Integrated Biological and Behavioral Survey 2016. Participants were recruited from the capital city of Phnom Penh and 12 other provinces with high burden of HIV using the Respondent-Driven Sampling (RDS) method. Face-to-face interviews were conducted using a structured questionnaire. Weighted multivariate logistic regression analysis was conducted to explore independent factors associated with consistent condom use. RESULTS This study included 1202 transgender women who reported having anal sex with at least one male partner not in exchange for money or gifts in the past three months. The mean age of the participants was 26.0 (SD = 7.0) years. Of the total, 41.5% reported always using condoms with male non-commercial partners in the past three months. After adjustment, the likelihood of consistent condom use was significantly higher among participants who resided in an urban community (AOR = 1.7, 95% CI = 1.1-2.6), had attained at least 10 years of formal education (AOR = 1.8, 95% CI = 1.2-2.7), perceived that they were likely or very likely to be HIV infected (AOR = 2.9, 95% CI = 2.0-4.1), reported drinking alcohol two to three times per week (AOR = 3.1, 95% CI = 1.1-8.3), reported using amphetamine-type stimulants (AOR = 1.9, 95% = 1.1-3.8) or other drugs (AOR = 7.6, 95% CI = 1.5-39.5), and reported inconsistent condom use with male commercial partners in the past three months (AOR = 4.3, 95% CI = 1.8-10.4) compared to that of their respective reference group. CONCLUSIONS This study confirms the low rates of condom use, particularly in non-commercial relationship, among transgender women in Cambodia. To address these concerns, efforts towards education about effects of multiple, concurrent relationships, and inconsistent condom use should be reinforced among transgender women.
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Affiliation(s)
- Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore. .,KHANA Center for Population Health Research, Phnom Penh, Cambodia. .,Center for Global Health Research, Touro University California, Vallejo, USA.
| | - Amelia Plant
- Reproductive Rights and Programming Consultant, Cairo, Egypt
| | - Sovannary Tuot
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Phalkun Mun
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | | | - Navy Chann
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Pheak Chhoun
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Carinne Brody
- Center for Global Health Research, Touro University California, Vallejo, USA
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Willie TC, Chakrapani V, White Hughto JM, Kershaw TS. Victimization and Human Immunodeficiency Virus-Related Risk Among Transgender Women in India: A Latent Profile Analysis. VIOLENCE AND GENDER 2017; 4:121-129. [PMID: 29279854 PMCID: PMC5734163 DOI: 10.1089/vio.2017.0030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Globally, transgender women (TGW) experience multiple forms of victimization such as violence and discrimination that can place them at risk for poor sexual health. To date, research overlooks the heterogeneity in experiences of victimization among TGW. Furthermore, few studies have examined the association between victimization and sexual risk among TGW in India, despite the high burden of HIV and victimization in this community. Latent profile analysis was performed to identify patterns of victimization in a convenience sample of 299 TGW recruited from nongovernmental organizations across four states in India. Analysis of covariance was performed to examine differences in sexual risk (i.e., alcohol use before sex; inconsistent condom use with a male regular partner, a male causal partner, and a male paying partner; and having multiple sexual partners) between latent profiles. Five distinct profiles of Indian TGW were identified based on the type and severity of victimization: (1) Low victimization, (2) High verbal police victimization, (3) High verbal and physical police victimization, (4) Moderate victimization, and (5) High victimization. While controlling for age, education, income, HIV status, and marital status, results revealed that TGW in the moderate victimization and high victimization profiles had higher sexual risk than TGW in the low victimization and high verbal police victimization profiles. In addition, TGW in high verbal and physical police victimization profile had higher sexual risk than TGW in low victimization profile. These findings underscore the importance of tailoring sexual risk reduction interventions to the specific needs of TGW based on patterns of victimization.
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Affiliation(s)
- Tiara C. Willie
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
| | - Venkatesan Chakrapani
- Postgraduate Institute of Medical Education and Research (PGIMER), School of Public Health, Chandigarh, India
- Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India
| | - Jaclyn M. White Hughto
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Trace S. Kershaw
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
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Behavioral Interventions to Prevent HIV Transmission and Acquisition for Transgender Women: A Critical Review. J Acquir Immune Defic Syndr 2017; 72 Suppl 3:S220-5. [PMID: 27429186 PMCID: PMC4969058 DOI: 10.1097/qai.0000000000001084] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Worldwide, transgender women are at disproportionately higher risk of HIV infection, with the primary mode of infection being condomless anal intercourse. Although very few HIV prevention interventions have been developed and tested specifically for transgender women, growing evidence suggests that behavioral HIV risk reduction interventions for other marginalized groups are efficacious. We outline the current state of knowledge and areas in need of further development in this area.
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HIV-Related Sexual Risk Among Transgender Men Who Are Gay, Bisexual, or Have Sex With Men. J Acquir Immune Defic Syndr 2017; 74:e89-e96. [PMID: 27798432 DOI: 10.1097/qai.0000000000001222] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study is among the first to examine factors associated with HIV-related sexual risk among transgender men and other transmasculine persons who are gay, bisexual, or have sex with men (T-GBMSM). METHODS In 2009-2010, 433 transgender people in Ontario, Canada, participated in a multimode respondent-driven sampling survey, including 158 T-GBMSM. Analyses were weighted using respondent-driven sampling II methods to adjust for differential recruitment probabilities; confidence intervals (CI) were adjusted for clustering by shared recruiter. Prevalence ratios (PR) for associations with past-year high sexual risk (condomless intercourse outside a seroconcordant monogamous relationship) were estimated using average marginal predictions from logistic regression. RESULTS Of T-GBMSM (mean age = 29.8; 52% living full time in felt gender; 25% Aboriginal or persons of color; 0% self-reported HIV positive), 10% had high sexual risk activity in the past year. Among the 34% with a past-year cisgender (non-transgender) male sex partner, 29% had high sexual risk. In multivariable analyses, older age, childhood sexual abuse (adjusted PR, APR = 14.03, 95% CI: 2.32 to 84.70), living full time in one's felt gender (APR = 5.20, 95% CI: 1.11 to 24.33), and being primarily or exclusively attracted to men (APR = 5.54, 95% CI: 2.27 to 13.54) were each associated with sexual risk. Of psychosocial factors examined, past-year stimulant use (APR = 4.02, 95% CI: 1.31 to 12.30) and moderate depressive symptoms (APR = 5.77, 95% CI: 1.14 to 29.25) were associated with higher sexual risk. CONCLUSIONS T-GBMSM seem to share some HIV acquisition risk factors with their cisgender counterparts. HIV prevention interventions targeting T-GBMSM who are predominantly attracted to men and interventions addressing sequelae of childhood sexual abuse may be warranted.
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De Santis JP, Hauglum SD, Deleon DA, Provencio-Vasquez E, Rodriguez AE. HIV Risk Perception, HIV Knowledge, and Sexual Risk Behaviors among Transgender Women in South Florida. Public Health Nurs 2016; 34:210-218. [PMID: 27921325 DOI: 10.1111/phn.12309] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Transgender women experience a variety of factors that may contribute to HIV risk. The purpose of this study was to explore links among HIV risk perception, knowledge, and sexual risk behaviors of transgender women. DESIGN AND SAMPLE A descriptive, correlational study design was used. Fifty transgender women from the South Florida area were enrolled in the study. MEASURES Transgender women completed a demographic questionnaire and standardized instruments measuring HIV risk perception, knowledge, and sexual risk behaviors. RESULTS Transgender women reported low levels of HIV risk perception, and had knowledge deficits regarding HIV risk/transmission. Some participants engaged in high-risk sexual behaviors. Predictors of sexual risk behaviors among transgender women were identified. CONCLUSIONS More research is needed with a larger sample size to continue studying factors that contribute to sexual risk behaviors in the understudied population of transgender women. Evidence-based guidelines are available to assist public health nurses in providing care for transgender women. Nurses must assess HIV perception risk and HIV knowledge and provide relevant education to transgender women on ways to minimize sexual risk.
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Affiliation(s)
- Joseph P De Santis
- University of Miami School of Nursing & Health Studies, Coral Gables, Florida
| | - Shayne D Hauglum
- University of Miami School of Nursing & Health Studies, Coral Gables, Florida
| | - Diego A Deleon
- University of Miami School of Nursing & Health Studies, Coral Gables, Florida
| | | | - Allan E Rodriguez
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida
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Ramos-Pibernus AG, Rodríguez-Madera SL, Padilla M, Varas-Díaz N, Vargas Molina R. Intersections and evolution of 'Butch-trans' categories in Puerto Rico: Needs and barriers of an invisible population. Glob Public Health 2016; 11:966-80. [PMID: 27142002 DOI: 10.1080/17441692.2016.1180703] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Public health research among transgender populations globally has primarily focused on HIV/AIDS. However, trans men remain outside of this conceptual framework, with distinct but overlapping social contexts and needs. In Puerto Rico (PR), the trans men population has remained largely hidden within the 'butch' lesbian community. The objective of this article is to document the identity construction of trans men and 'buchas' (local term to refer to butch lesbians) in PR and its relation to their bodily practices and overall health. We conducted an exploratory qualitative study with 29 trans men and buchas based on ethnographic observation, focus groups, audio-recorded in-depth interviews, and critical discourse analysis. Findings emphasise two domains to be addressed by health policies and initiatives: (1) bodily representations and gender performance, and (2) the meanings of female biological processes. This small-scale ethnographic study represents an initial step towards understanding the social context of this 'invisible' community and significant implications for their health and well-being. We provide several recommendations to address public health concerns of this understudied, marginalised community.
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Affiliation(s)
- Alíxida G Ramos-Pibernus
- a Department of Social Science , University of Puerto Rico-Medical Sciences Campus , San Juan , Puerto Rico
| | - Sheilla L Rodríguez-Madera
- a Department of Social Science , University of Puerto Rico-Medical Sciences Campus , San Juan , Puerto Rico
| | - Mark Padilla
- b Global and Sociocultural Studies , Florida International University , Miami , FL , USA
| | - Nelson Varas-Díaz
- c Institute for Psychological Research, University of Puerto Rico , San Juan , Puerto Rico
| | - Ricardo Vargas Molina
- a Department of Social Science , University of Puerto Rico-Medical Sciences Campus , San Juan , Puerto Rico
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Reisner SL, Murchison GR. A global research synthesis of HIV and STI biobehavioural risks in female-to-male transgender adults. Glob Public Health 2016; 11:866-87. [PMID: 26785800 DOI: 10.1080/17441692.2015.1134613] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
There is a growing interest in HIV infection and sexually transmitted infection (STI) disease burden and risk among transgender people globally; however, the majority of work has been conducted with male-to-female transgender populations. This research synthesis comprehensively reviews HIV and STI research in female-to-male (FTM) transgender adults. A paucity of research exists about HIV and STIs in FTMs. Only 25 peer-reviewed papers (18 quantitative, 7 qualitative) and 11 'grey literature' reports were identified, most in the US or Canada, that include data identifying HIV and STI risks in FTMs (five with fully laboratory-confirmed HIV and/or STIs, and five with partial laboratory confirmation). Little is known about the sexual and drug use risk behaviours contributing to HIV and STIs in FTMs. Future directions are suggested, including the need for routine surveillance and monitoring of HIV and STIs globally by transgender identity, more standardised sexual risk assessment measures, targeted data collection in lower- and middle-income countries, and explicit consideration of the rationale for inclusion/exclusion of FTMs in category-based prevention approaches with MSM and transgender people. Implications for research, policy, programming, and interventions are discussed, including the need to address diverse sexual identities, attractions, and behaviours and engage local FTM communities.
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Affiliation(s)
- Sari L Reisner
- a Division of General Pediatrics , Boston Children's Hospital/Harvard Medical School , Boston , MA , USA.,b Department of Epidemiology , Harvard T.H. Chan School of Public Health , Boston , MA , USA.,c Fenway Health , The Fenway Institute , Boston , MA , USA
| | - Gabriel R Murchison
- d Department of Chronic Disease Epidemiology , Yale School of Public Health , New Haven , CT , USA
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Palazzolo SL, Yamanis TJ, De Jesus M, Maguire-Marshall M, Barker SL. Documentation Status as a Contextual Determinant of HIV Risk Among Young Transgender Latinas. LGBT Health 2015; 3:132-8. [PMID: 26669583 DOI: 10.1089/lgbt.2015.0133] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The purpose of this study was to explore the contextual factors that determine or mitigate vulnerability to HIV among Latina transgender women. Documentation status (legal authorization to live in the United States) has been cited by other studies as a barrier to recruitment or engagement in HIV-related care among immigrant Latinos, but not explored as a determinant of HIV risk for transgender immigrant Latinas. METHODS We collaborated with a community-based organization to explore these contextual, including social and structural, factors. In-depth interviews in Spanish captured life histories of eight 18- to 29-year-old transgender Latinas, who collectively self-identify as chicas trans. Codes were assigned deductively from the interview guide, and emerging themes were identified throughout data collection. RESULTS Most participants migrated to the United States from Central America after experiencing discrimination and violence in their countries of origin. Participants emphasized documentation status as a critical factor in three areas related to social and structural determinants of HIV risk: gender identity expression, access to services, and relationship power dynamics. Chicas trans who gained legal asylum reported greater control over sexual relationships, improved access to services, and less risky employment. CONCLUSIONS Documentation status emerged as a key HIV risk factor for this population. For undocumented transgender Latinas, legal asylum appears to be a promising HIV-related protective factor. Further research could assess whether legal assistance combined with wraparound support services affects HIV prevention for this population.
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Affiliation(s)
- Sarah L Palazzolo
- 1 School of International Service, American University , Washington, District of Columbia
| | - Thespina J Yamanis
- 1 School of International Service, American University , Washington, District of Columbia
| | - Maria De Jesus
- 1 School of International Service, American University , Washington, District of Columbia
| | - Molly Maguire-Marshall
- 1 School of International Service, American University , Washington, District of Columbia
| | - Suyanna L Barker
- 2 Community Health Action Department , La Clínica del Pueblo, Washington, District of Columbia
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Chang TK, Chung YB. Transgender Microaggressions: Complexity of the Heterogeneity of Transgender Identities. JOURNAL OF LGBTQ ISSUES IN COUNSELING 2015. [DOI: 10.1080/15538605.2015.1068146] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Habarta N, Wang G, Mulatu MS, Larish N. HIV Testing by Transgender Status at Centers for Disease Control and Prevention-Funded Sites in the United States, Puerto Rico, and US Virgin Islands, 2009-2011. Am J Public Health 2015; 105:1917-25. [PMID: 26180964 DOI: 10.2105/ajph.2015.302659] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined HIV testing services, seropositivity, and the characteristics associated with newly identified, confirmed HIV-positive tests among transgender individuals. METHODS We analyzed data (2009-2011) using bivariate and multivariable logistic regression to examine the relationships between HIV positivity and sociodemographic and risk characteristics among male-to-female transgender individuals. RESULTS Most of the testing was conducted in females (51.1%), followed by males (48.7%) and transgender individuals (0.17%). Tests in male-to-female transgender individuals had the highest, newly identified confirmed HIV positivity (2.7%), followed by males (0.9%), female-to-male transgender individuals (0.5%), and females (0.2%). The associated characteristics with an HIV-positive test among male-to-female transgender individuals included ages 20 to 29 and 40 to 49 years (adjusted odds ratio [AOR] = 2.8; 95% confidence interval [CI] = 1.4, 5.6 and AOR = 2.8; 95% CI = 1.3, 5.9, respectively), African American (AOR = 4.6; 95% CI = 2.7, 7.9) or Hispanic/Latino (AOR = 2.6; 95% CI = 1.5, 4.5) race/ethnicity, and reporting sex without condom within the past year (AOR = 1.9; 95% CI = 1.3, 2.6), sex with an HIV-positive person (AOR = 1.5; 95% CI = 1.1, 2.0), or injection drug use (AOR = 2.0; 95% CI = 1.3, 3.0). CONCLUSIONS High levels of HIV positivity among transgender individuals, particularly male-to-female transgender individuals, underscore the necessity for targeted HIV prevention services that are responsive to the needs of this population.
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Affiliation(s)
- Nancy Habarta
- Nancy Habarta and Nili Larish are with the Prevention Communication Branch, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Guoshen Wang and Mesfin S. Mulatu are with the Program Evaluation Branch, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
| | - Guoshen Wang
- Nancy Habarta and Nili Larish are with the Prevention Communication Branch, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Guoshen Wang and Mesfin S. Mulatu are with the Program Evaluation Branch, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
| | - Mesfin S Mulatu
- Nancy Habarta and Nili Larish are with the Prevention Communication Branch, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Guoshen Wang and Mesfin S. Mulatu are with the Program Evaluation Branch, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
| | - Nili Larish
- Nancy Habarta and Nili Larish are with the Prevention Communication Branch, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Guoshen Wang and Mesfin S. Mulatu are with the Program Evaluation Branch, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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Hightow-Weidman LB, Muessig KE, Pike EC, LeGrand S, Baltierra N, Rucker AJ, Wilson P. HealthMpowerment.org: Building Community Through a Mobile-Optimized, Online Health Promotion Intervention. HEALTH EDUCATION & BEHAVIOR 2015; 42:493-9. [PMID: 25588932 DOI: 10.1177/1090198114562043] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Both young Black men who have sex with men as well as young Black transgender women (YBMSM/TW) continue to experience a significant increase in HIV incidence. HealthMpowerment.org (HMP) is a mobile phone-optimized, online intervention for both YBMSM/TW to build community and facilitate supportive relationships. METHODS To assess the feasibility, acceptability, and preliminary outcomes, a 1-month pilot trial of HMP among 15 YBMSM/TW was conducted. RESULTS Retention was 100%. Mean age was 26 years, 60% were HIV-infected, 87% earned <$21,000, and 67% were uninsured. Despite the small sample size and limited intervention length, statistically significant improvements were seen in social support (p = .012), social isolation (p = .050), and depressive symptoms (p = .045). CONCLUSION The HMP pilot trial demonstrated feasibility and acceptability. Given the burden of the epidemic among YBMSM/TW, there is an imperative to develop, test, and scale up culturally appropriate interventions to both prevent HIV acquisition and limit onward transmission.
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Affiliation(s)
| | | | - Emily C Pike
- University of North Carolina at Chapel Hill, NC, USA
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Idrus NI, Hymans TD. Balancing benefits and harm: chemical use and bodily transformation among Indonesia's transgender waria. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 25:789-97. [PMID: 25091633 PMCID: PMC4154068 DOI: 10.1016/j.drugpo.2014.06.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 06/09/2014] [Accepted: 06/10/2014] [Indexed: 12/03/2022]
Abstract
Background Members of Indonesia's diverse male-to-female transgender community often describe themselves as waria. Waria do not equate being feminine with being female. They do not want to be women; they aspire to be like women. It entails cultivating mannerisms and wearing make-up and women's clothes, shaving one's legs and styling one's hair. But some go further in their practices of self-administered, chemically assisted bodily transformation. Methods Field research took place in Makassar, the capital city of South Sulawesi; in a smaller town in the regency of Bulukumba on the south coast of Sulawesi; and in the special region of Yogyakarta in Java. Data were collected through repeated in-depth interviews with ten waria youths aged between 18 and 26 in each site; interviews with pharmacists, drug and cosmetics store clerks; three focus group discussions at each site; and participant observation. Results Our respondents saw their bodies as ‘projects’ they can manipulate with pharmaceutical products and cosmetics. To lighten their skin, they experimented with different brands of exfoliating liquid, whitening cream, powder, foundation, face soap and skin scrub. To grow breasts and reduce muscle mass, they experimented with different brands and dosages of contraceptive pills and injections in order to get faster, better and longer-lasting results. Conclusion Harm reduction programs often neglect chemicals that are not narcotics, not related to sexually transmitted infections, and which are legally and freely available. Safety issues arise when otherwise safe products are used off-label in large quantities. Drug policy-makers are paying insufficient attention to the safety of cosmetics.
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Affiliation(s)
- Nurul Ilmi Idrus
- Department of Anthropology, Faculty of Social and Political Sciences, Hasanuddin University, Makassar, Indonesia; European Research Council Chemical Youth project, University of Amsterdam, The Netherlands.
| | - Takeo David Hymans
- European Research Council Chemical Youth project, University of Amsterdam, The Netherlands.
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Safika I, Johnson TP, Cho YI, Praptoraharjo I. Condom Use Among Men Who Have Sex With Men and Male-to-Female Transgenders in Jakarta, Indonesia. Am J Mens Health 2013; 8:278-88. [PMID: 24203992 DOI: 10.1177/1557988313508430] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This article examined differences in condom use during anal intercourse among men who have sex with men (MSM) and male-to-female transgender women in Jakarta, Indonesia. A cross-sectional design, structured interviews, and hierarchical linear modeling were used to examine condom use among MSM recruited from entertainment places (EPs; e.g., discotheques/dance clubs/karaoke bars), massage parlors (MPs), and among transgender women who congregated and/or sought sexual partners on streets/parks (S/P). The sample consisted of 91, 97, and 114 of MSM-EP, MSM-MP, and transgender-S/P, respectively. Respondents reported on 641 unique sexual partner encounters, which were "nested" within 302 respondents. Reported condom use was high, 66%, 84%, and 83% for MSM-EP, MSM-MP, and transgender-S/P, respectively, and varied across type of respondent. At the individual level, depressive symptoms and history of physical abuse during childhood and adulthood were associated with lower condom use (p < .05). By contrast, having a higher level of education was associated with more condom use (p < .05). At the partner level, condom use was associated with type of partners and the use of club drugs before sex. HIV-prevention efforts should take into account the multilevel determinants of condom use within these populations.
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Affiliation(s)
- Iko Safika
- University of Illinois at Chicago, Chicago, IL, USA
| | | | - Young Ik Cho
- University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Wilson EC, Arayasirikul S, Johnson K. Access to HIV Care and Support Services for African American Transwomen Living with HIV. Int J Transgend 2013; 14:182-195. [PMID: 24817835 DOI: 10.1080/15532739.2014.890090] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Low access to HIV care and support has led to survival rates for transwomen that are half that of other populations at risk for HIV. Within the population, HIV disproportionately impacts African American transwomen. Interventions to increase access to HIV care and support are needed to better serve those most affected and vulnerable within the population. We conducted a study of barriers and facilitators to care and support services for African American transwomen to fill a gap in the literature to improve access for this particularly impacted population. A total of 10 in-depth interviews were conducted with African American transwomen living with HIV who lived outside the metro area of San Francisco. Three overarching thematic topics emerged-gender stigma, peer, and institutional distrust - giving insight into African American transwomen's barriers to HIV care and support services. A number of factors within these themes impacted access, such as whether organizations offered gender-related care, the geography of organizations as it relates to safe transportation and location, confidentiality and trust of peers and organizations, and trauma. Specific instrumental, institutional and emotional supports are provided that that may increase access to care and support services for African American transwomen living with HIV.
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Affiliation(s)
- Erin C Wilson
- Senior Research Scientist in the Center for Public Health Research at the San Francisco Department of Public Health in San Francisco, California, USA
| | - Sean Arayasirikul
- Doctoral student in the Medical Sociology program at the University of California, San Francisco and a Project Coordinator at the Center for Public Health Research at the San Francisco Department of Public Health
| | - Kelly Johnson
- Research Analyst with the Prevention and Public Health Group at the University of California, San Francisco and a Research Associate at the San Francisco Department of Public Health
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Benotsch EG, Zimmerman R, Cathers L, McNulty S, Pierce J, Heck T, Perrin PB, Snipes D. Non-medical use of prescription drugs, polysubstance use, and mental health in transgender adults. Drug Alcohol Depend 2013; 132:391-4. [PMID: 23510637 DOI: 10.1016/j.drugalcdep.2013.02.027] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 01/24/2013] [Accepted: 02/23/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND In recent years, the non-medical use of prescription drugs (NMUPD) has increased dramatically and has been associated with adverse health outcomes. Prior work has not examined this behavior in large samples of transgender adults. METHODS Transgender adults (N=155) recruited from community venues in the Mid-Atlantic region completed anonymous, self-administered surveys assessing demographic information, NMUPD and other substance use, the non-medical use of hormones, psychosocial factors, and psychiatric symptoms. RESULTS Overall, 26.5% of participants reported lifetime NMUPD with the most commonly reported medications used non-medically being prescription analgesics (23.9%), anxiolytics (17.4%), stimulants (13.5%), and sedatives (8.4%). Non-medical use of hormones was also frequently reported (30.3%). Participants reporting NMUPD were also more likely to report the use of illicit drugs. NMUPD, but not the non-medical use of hormones, was associated with lower self-esteem, more gender identity-based discrimination, and more self-reported symptoms of anxiety, depression, and somatic distress. Psychiatric symptoms remained statistically associated with NMUPD after controlling for demographic factors and other substance use. CONCLUSIONS Prescription drug misuse was relatively common in this sample and was robustly associated with emotional distress. Substance use and mental health interventions for this population may benefit from incorporating the assessment and treatment of NMUPD.
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Affiliation(s)
- Eric G Benotsch
- Virginia Commonwealth University, Department of Psychology, PO Box 842018, Richmond, VA 23284, United States.
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Gelaude DJ, Sovine ML, Swayzer R, Herbst JH. HIV Prevention Programs Delivered by Community-Based Organizations to Young Transgender Persons of Color: Lessons Learned to Improve Future Program Implementation. Int J Transgend 2013. [DOI: 10.1080/15532739.2013.824846] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Bauer GR, Redman N, Bradley K, Scheim AI. Sexual Health of Trans Men Who Are Gay, Bisexual, or Who Have Sex with Men: Results from Ontario, Canada. Int J Transgend 2013; 14:66-74. [PMID: 24971043 PMCID: PMC4059421 DOI: 10.1080/15532739.2013.791650] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Recent reports have addressed the sexual health of female-to-male transgender or transsexual people who are gay, bisexual, and/or have sex with men (trans GB-MSM) using urban convenience samples. The Trans PULSE Project conducted a multimode, respondent-driven sampling survey in Ontario, Canada, in 2009-2010. Weighted estimates were calculated for trans GB-MSM (n = 173) for sexual orientation, behavior, partners, and HIV-related risk, as well as for psychosocial stressors and sexual satisfaction. An estimated 63.3% (95% CI [50.4, 73.5]) of trans men were GB-MSM (173/227). Results indicate great diversity in sexual behavior and experiences. Implications for sexual health promotion, counseling, and medical care are addressed.
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Affiliation(s)
- Greta R Bauer
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, at The University of Western Ontario in London, Ontario, Canada ; Trans PULSE Project
| | | | - Kaitlin Bradley
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, at The University of Western Ontario in London, Ontario, Canada ; Trans PULSE Project
| | - Ayden I Scheim
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, at The University of Western Ontario in London, Ontario, Canada ; Trans PULSE Project
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HIV in transgender communities: syndemic dynamics and a need for multicomponent interventions. J Acquir Immune Defic Syndr 2011; 55 Suppl 2:S91-3. [PMID: 21406995 DOI: 10.1097/qai.0b013e3181fbc9ec] [Citation(s) in RCA: 164] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Transgender communities are among the groups at highest risk for HIV infection in the United States. Using syndemic theory, we examine how HIV risk in transgender communities is embedded in multiple co-occurring public health problems, including poor mental health, substance use, violence and victimization, discrimination, and economic hardship. Although safer sex counseling and testing programs are essential platforms for HIV intervention, these modalities alone may be insufficient in reducing new infections. Multicomponent interventions are necessary to respond to the complex interacting syndemic factors that cumulatively determine HIV vulnerability in transgender individuals.
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