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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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2
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Tordoff DM, Minalga B, Perry NL, Gross B, Khosropour CM, Glick SN, Barbee LA, Duerr A. Heterogeneity in HIV/Sexually Transmitted Infection Prevalence and Prevention Among the Partners of Transgender and Nonbinary People. Sex Transm Dis 2023; 50:280-287. [PMID: 36881439 PMCID: PMC11243647 DOI: 10.1097/olq.0000000000001796] [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] [Indexed: 03/08/2023]
Abstract
BACKGROUND Transgender and nonbinary (TNB) people are diverse in their sexual orientation and partnerships. We describe the epidemiology of HIV/sexually transmitted infection (STI) prevalence and prevention utilization among the partners of TNB people in Washington State. METHODS We pooled data from five 2017 to 2021 cross-sectional HIV surveillance data sources to generate a large sample of TNB people and cisgender people who had a TNB partner in the past year. We described characteristics of recent partners of trans women, trans men, and nonbinary people and used Poisson regression to assess if having a TNB partner was associated with self-reported HIV/STIs prevalence, testing, and preexposure prophylaxis (PrEP) use. RESULTS Our analysis included 360 trans women, 316 trans men, 963 nonbinary people, 2896 cis women, and 7540 cis men. Overall, 9% of sexual minority cis men, 13% of sexual minority cis women, and 36% of TNB participants reported having any TNB partners. There was significant heterogeneity in HIV/STI prevalence, testing, and PrEP use among the partners of TNB people by study participant gender and the gender of their sex partners. In regression models, having a TNB partner was associated with a higher likelihood of HIV/STI testing and PrEP use but was not associated with higher HIV prevalence. CONCLUSIONS We observed significant heterogeneity in HIV/STI prevalence and preventative behaviors among the partners of TNB people. Given that TNB people are diverse in their sexual partnerships, there is a need to better understand individual-, dyad-, and structural-level factors that facilitate HIV/STI prevention across these diverse partnerships.
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Affiliation(s)
- Diana M Tordoff
- From the Department of Epidemiology, University of Washington
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3
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Morgan E, Dyar C, Feinstein BA, Ricks J. PrEP use and stigma among a sample of older adults in Columbus, Ohio. Int J STD AIDS 2023; 34:122-129. [PMID: 36424190 PMCID: PMC10113038 DOI: 10.1177/09564624221140967] [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: 11/27/2022]
Abstract
INTRODUCTION Despite older adults (age ≥50 years) continuing to account for 1 in 6 new HIV diagnoses, the majority of research has focused on young adults. Assessing PrEP use and stigma among this understudied population is key to achieving the U.S.'s goals of Ending the HIV Epidemic, a federal initiative focusing on reducing new HIV infections by at least 90% by 2030. METHODS Data for this analysis came from the Columbus Health Aging Project (N = 794). This study was designed to assess several domains of health among adults aged 50 years and older in Columbus, Ohio. Multiple logistic and linear regression models were used to examine the associations between sociodemographic factors and past 6-month PrEP use, PrEP stigma, and concurrent use of PrEP and other prevention methods, adjusting for known confounders. RESULTS Overall, 93 (11.7%) participants reported past 6-month PrEP use. Transgender women (aOR = 6.90; 95% CI: 2.19, 21.72), cisgender gay men (aOR = 5.58; 95% CI: 2.49, 12.50), cisgender lesbians (aOR = 2.24; 95% CI: 1.05, 4.80), and those living with family members or roommates (aOR = 6.59; 95% CI: 3.49, 12.45) were each more likely to report past 6-month PrEP use relative to cisgender women, heterosexuals, and those living with a spouse/partner, respectively. Relative to cisgender women, PrEP-related stigma was lower among transgender women (β = -5.05; 95% CI: -8.44, -1.66) and higher among cisgender men (β = 1.96; 95% CI: 0.46, 3.46). CONCLUSION Future research should aim to continue developing a firm understanding of PrEP use and stigma among older adults to reduce HIV risk among this population and to understand unique needs of sub-populations of older adults.
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Affiliation(s)
- Ethan Morgan
- College of Nursing, The Ohio State University, Columbus, OH
- Infectious Disease Institute, The Ohio State University, Columbus, OH
- College of Public Health, The Ohio State University, Columbus, OH
| | - Christina Dyar
- College of Nursing, The Ohio State University, Columbus, OH
| | - Brian A. Feinstein
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - JaNelle Ricks
- College of Public Health, The Ohio State University, Columbus, OH
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Rivest P. La santé sexuelle des hommes trans : entre problèmes de catégorisation et invisibilisation. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2023; 34:37-48. [PMID: 37336746 DOI: 10.3917/spub.hs2.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
INTRODUCTION Sexual minorities have been disproportionally impacted by the HIV-Aids epidemic. Their high prevalence motivated sexual health research that first focused on gay men, then trans women. Trans men have been considered at very low risk of exposition, Hence the scarce number of research about them. However, an emerging literature is showing diversified and surprising results regarding the reasons for their initial exclusion. PURPOSE OF RESEARCH This article seeks to establish the state of knowledge on trans men's sexual health through a French and international literature review. RESULTS Trans men have a variety of partners, sexual and non-sexual practices (IDU) that leads to categorize them at high risk of HIV exposure. The proportion of trans men who are HIV positive still is difficult to assess. It is estimated to be high in the USA, and close to zero in France. Low screening rates, difficulties accessing health care, and identification problems in the very classification of people suggest that they might be more of them. Trans men also report discriminations in access to health care services, and specific health vulnerabilities. Gynecology and reproductive health are rarely even mentioned. CONCLUSIONS Rethinking the categories used in research would produce a more accurate representation of the varied realities of trans people.
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Affiliation(s)
- Paul Rivest
- Institut d’ethnologie méditerranéenne, européenne et comparative (Idemec) – Aix-Marseille Université – Aix-en-Provence – France
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Chiou PY, Chou SJ, Tsao WW, Yu JM. Feasibility of communication platforms to empower transgender cultural competence among human immunodeficiency virus screeners: A qualitative analysis. Digit Health 2023; 9:20552076231203888. [PMID: 37928330 PMCID: PMC10621292 DOI: 10.1177/20552076231203888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 09/08/2023] [Indexed: 11/07/2023] Open
Abstract
Background Human immunodeficiency virus (HIV) screeners have limited experience of interacting with trans people. The application of communication platforms between them to empower HIV screeners' trans-related cultural competence remains unknown. Objective This study aims to qualitatively explore the follow-up interviews of HIV screeners regarding their opinions on the feasibility of an online platform group discussion and web page to enhance communication between them and trans people and to explore their perspectives on how these components enhanced their promotion of cultural competence. Methods This study was conducted between October 2020 and June 2021. Purposive and snowball sampling were applied to recruit 6 trans persons and 11 HIV screeners. Six online platform group discussions were held on weekday evenings, each group meeting for 60 min, 360 min in total within 3 months, via a video chat room of Google Meet; this was supplemented by a closed web page. The major results were presented through content analysis of the HIV screeners' follow-up interviews. Results The HIV screeners identified the facilitators of participating in the communication platforms, which included a reminder message, easy-to-use interface, visible-audible and readable interaction, recalled and reviewable content and group belonging; the barriers included time and space limitation, device restrictions and operation problem. Two categories of trans-related cultural competence - trans awareness and action taken - were revealed, from which five major themes emerged: provoked to ask questions, improved cognition, reflection, trans-sensitive communication and self-enhancement. Conclusion The results revealed that the communication platforms could facilitate the mutual and vivid discussion between HIV screeners and trans people and empower the trans-related cultural competence of HIV screeners. The highly feasible intervention design of this research can be applied to digital training courses related to gender diversity issues.
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Affiliation(s)
- Piao-Yi Chiou
- School of Nursing, College of Medicine, National Taiwan University, Taipei City, Taiwan
- Department of Nursing, National Taiwan University Hospital, Taipei City, Taiwan
- Research and Development Committee, Taiwan AIDS Nurse Association, Taipei, Taiwan
| | - Szu-Jui Chou
- B.S. School of Nursing, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Wei-Wen Tsao
- B.S. School of Nursing, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Jheng-Min Yu
- M.D., M.A. Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei City, Taiwan
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6
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Radix AE, Larson EL, Harris AB, Chiasson MA. HIV prevalence among transmasculine individuals at a New York City Community Health Centre: a cross-sectional study. J Int AIDS Soc 2022; 25 Suppl 5:e25981. [PMID: 36225145 PMCID: PMC9557011 DOI: 10.1002/jia2.25981] [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: 01/14/2022] [Accepted: 07/30/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Multiple studies have demonstrated elevated incidence and prevalence of HIV among transgender women; however, few studies have been conducted among transmasculine individuals. HIV prevalence among transgender men in the United States is estimated to be 0-4%; however, there have not been any US studies examining HIV prevalence that stratify by the gender of sexual partners. The aim of this research was to examine HIV prevalence and its association with socio-demographic and other factors, including the gender of sexual partners and receipt of gender-affirming care (hormones/surgery), among transmasculine individuals at the Callen-Lorde Community Health Center in New York City. METHODS The Transgender Data Project was an Institutional Review Board-approved retrospective chart review of all transgender and gender diverse clients at the clinic, ages 18+, between 1 January 2009 and 12 December 2010. Charts were reviewed manually. Data included birth sex, gender, race/ethnicity, education, employment, housing, insurance status, gender of sexual partners, HIV screening and status, and receipt of gender-affirming care. Bivariate and multivariable logistic regression models were used to assess the association between HIV status and other variables. RESULTS AND DISCUSSION Five hundred and seventy-seven transmasculine individuals, mean age 32.1 years (18.3-70.5), were included in this analysis. A small majority were White (55% White, 13.9% Black and 11.7% Hispanic). The majority, 78.9%, had received hormones (testosterone) and 41.6% had received at least one gender-affirming surgery. The HIV screening rate was 43.4%. HIV prevalence was 2.8%, (95% CI: 1.13%, 5.68%) among those screened, notably higher than the US population prevalence. HIV prevalence was highest among transmasculine individuals who had sex exclusively with cisgender men (11.1%). In the multivariable model (age, education and gender of sexual partners), the adjusted odds ratio of HIV for those who had sex exclusively with cisgender male partners compared to no cisgender male partners was 10.58 (95% CI: 1.33, 84.17). CONCLUSIONS Although HIV prevalence has been estimated to be low among transgender men, the analysis found heterogeneous results when stratified by gender of sexual partners. The results underscore the need to understand sexual risk among transmasculine individuals and to disaggregate HIV data for those having sex with cisgender men, thus also allowing for better inclusion in HIV prevention efforts.
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Affiliation(s)
- Asa E. Radix
- Department of MedicineCallen‐Lorde Community Health CenterNew York CityNew YorkUSA,Department of EpidemiologyColumbia University Mailman School of Public HealthNew York CityNew YorkUSA
| | - Elaine L. Larson
- Department of EpidemiologyColumbia University Mailman School of Public HealthNew York CityNew YorkUSA
| | - Alexander B. Harris
- Department of MedicineCallen‐Lorde Community Health CenterNew York CityNew YorkUSA
| | - Mary Ann Chiasson
- Department of EpidemiologyColumbia University Mailman School of Public HealthNew York CityNew YorkUSA,Division of Infectious Diseases, Department of MedicineColumbia University Irving Medical CenterNew York CityNew YorkUSA
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Olakunde BO, Pharr JR, Adeyinka DA, Conserve DF. Nonuptake of HIV Testing Among Transgender Populations in the United States: Results from the 2015 U.S. Transgender Survey. Transgend Health 2022; 7:430-439. [PMID: 36644483 PMCID: PMC9829162 DOI: 10.1089/trgh.2020.0141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose In this study, we examined the nonuptake of HIV testing and the main reasons for never testing among transgender populations. Methods Data on 26,927 respondents from the 2015 U.S. Transgender Survey were analyzed in this study. The main reasons for never testing were categorized as low risk perception; access related; fear or HIV-related stigma; and others. We performed weighted descriptive statistics and multivariable logistic regression analyses, controlling for sociodemographic characteristics and sexual orientation. Results Forty-five percent of the respondents had never tested for HIV. Trans women (adjusted odds ratio [aOR]=1.1, 95% confidence interval [CI]=1.07-1.25) and assigned female at birth genderqueer/nonbinary individuals (AFAB GQ/NB) (aOR=1.3, 95% CI=1.16-1.35) had significantly higher odds of reporting never testing for HIV compared with trans men. The most reported reason for never testing was low risk perception (87%). AFAB GQ/NB (aOR=1.4, 95% CI=1.22-1.66) had significantly higher odds of reporting low risk perception as the main reason for never testing for HIV relative to trans men. AFAB GQ/NB were less likely to report access related as the main reason for never testing (aOR=0.8, 95% CI=0.56-0.95). The odds of trans women and assigned male at birth GQ/NB individuals reporting fear or HIV-related stigma as the main reason for never testing were 1.7 (95% CI=1.13-2.55) and 2.8 (95% CI=1.69-4.70) times that of trans men. Both trans women (aOR=0.8, 95% CI=0.65-0.97) and AFAB GQ/NB (aOR=0.7, 95% CI=0.60-0.88) had lower odds of reporting others. The main reasons for never testing also varied by sociodemographic factors, including age, educational attainment, race/ethnicity, employment status, poverty, and sexual orientation. Conclusions HIV testing is suboptimal among transgender populations. Our findings also suggest that barriers to HIV testing vary by transgender populations, thus interventions for improved uptake should be population specific.
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Affiliation(s)
- Babayemi O. Olakunde
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Jennifer R. Pharr
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Daniel A. Adeyinka
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
| | - Donaldson F. Conserve
- Department of Prevention and Community Health, Milken Institute of Public Health, George Washington University, Washington, District of Columbia, USA
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8
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Regencia ZJG, Castelo AV, Eustaquio PC, Araña YS, Corciega JOL, Rosadiño JDT, Pagtakhan RG, Baja ES. Non-uptake of HIV testing among trans men and trans women: cross-sectional study of client records from 2017 to 2019 in a community-based transgender health center in Metro Manila, Philippines. BMC Public Health 2022; 22:1755. [PMID: 36114481 PMCID: PMC9479240 DOI: 10.1186/s12889-022-14158-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/05/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Transgender individuals are considered at high risk of contracting HIV infection. Integrating HIV testing and counseling (HTC) services into current transgender health programs is necessary to increase its uptake. Our study aimed to describe the characteristics of trans men (TM) and trans women (TW) who accessed HTC services in a community-based transgender health center in Metro Manila, Philippines, and to examine the relationship between gender identity and their non-uptake of HIV testing. METHODS: We conducted a cross-sectional study of TM and TW seeking care from 2017 to 2019. Medical records of clients were reviewed to ascertain their age, gender identity, year and frequency of clinic visits, lifestyle factors, and non-uptake of HIV testing. The effect of gender identity on the non-uptake of HIV testing was estimated using a generalized linear model with Poisson distribution, log link function, and a robust variance, adjusted for confounding variables. RESULTS: Five hundred twenty-five clients were included in the study, of which about 82.3% (432/525) of the clients declined the HTC services being offered. In addition, the prevalence of non-uptake of HIV testing was 48% higher (Adjusted Prevalence Ratio: 1.48; 95% Confidence Interval: 1.31-1.67) among TM compared to TW. Approximately 3.7% (1/27) and 10.6% (7/66) of the TM and TW, respectively, who accessed the HTC services were reactive. Moreover, most reactive clients were on treatment 87.5% (7/8); three were already virally suppressed, four were on ART but not yet virally suppressed, and one TW client was lost to follow up. CONCLUSION The non-uptake of HTC service of TM and TW is high. HIV program implementers should strategize solutions to reach this vulnerable population for increased and better HTC service uptake and linkage to care.
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Affiliation(s)
- Zypher Jude G Regencia
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, City of Manila, 1000, Philippines
- Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, City of Manila, 1000, Philippines
| | - Aisia V Castelo
- LoveYourself Inc, Mandaluyong City, 1552, Metro Manila, Philippines
| | | | - Yanyan S Araña
- LoveYourself Inc, Mandaluyong City, 1552, Metro Manila, Philippines
| | | | - John Danvic T Rosadiño
- LoveYourself Inc, Mandaluyong City, 1552, Metro Manila, Philippines
- Faculty of Management and Development Studies, University of the Philippines - Open University, Los Baños, 4031, Laguna, Philippines
| | | | - Emmanuel S Baja
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, City of Manila, 1000, Philippines.
- Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, City of Manila, 1000, Philippines.
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Hughto JMW, Fernández Y, Restar A, Klasko-Foster LB, Deutsch MB, Peitzmeier S, Potter J, Mimiaga MJ, Reisner SL. High Awareness but Low Uptake of Pre-Exposure Prophylaxis in a Community Sample of Trans Masculine Adults in Massachusetts. AIDS Patient Care STDS 2022; 36:249-253. [PMID: 35727649 PMCID: PMC9464045 DOI: 10.1089/apc.2022.0080] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jaclyn M W Hughto
- Department of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA.,Center for Health Promotion and Health Equity, Brown University, Providence, Rhode Island, USA.,The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Yohansa Fernández
- Department of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA.,Center for Health Promotion and Health Equity, Brown University, Providence, Rhode Island, USA.,Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Arjee Restar
- Department of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA.,Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Lynne B Klasko-Foster
- Department of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA.,Center for Health Promotion and Health Equity, Brown University, Providence, Rhode Island, USA.,Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Madeline B Deutsch
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA.,UCSF Center of Excellence for Transgender Health, University of California, San Francisco, San Francisco, California, USA
| | - Sarah Peitzmeier
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Jennifer Potter
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA.,Division of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew J Mimiaga
- Department of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA.,Center for Health Promotion and Health Equity, Brown University, Providence, Rhode Island, USA.,The Fenway Institute, Fenway Health, Boston, Massachusetts, USA.,Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
| | - Sari L Reisner
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA.,Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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10
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Lentz C, Lopez-Rios J, Dolezal C, Kutner BA, Rael CT, Balán IC. Negotiating Use of a Blood-Based, Dual HIV and Syphilis Test with Potential Sexual Partners Among a Sample of Cisgender Men and Transgender Women Who Have Sex with Men in New York City. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2015-2025. [PMID: 35449365 PMCID: PMC9197957 DOI: 10.1007/s10508-021-02275-3] [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] [Received: 02/12/2021] [Revised: 11/17/2021] [Accepted: 12/21/2021] [Indexed: 05/03/2023]
Abstract
Cisgender men who have sex with men (cMSM) and transgender women (TGW) are disproportionally burdened by HIV. Among these populations, HIV partner-testing is a highly acceptable harm reduction tool. Particularly, cMSM and TGW report a stronger preference for blood-based tests that include assays for multiple STIs. However, no existing research has explored how these populations negotiate blood-based testing with sexual partners. In the SMARTtest study, 48 sexually active cMSM and TGW took home dual, blood-based HIV/Syphilis kits for self- and partner-testing. After 3 months, they completed a follow-up assessment and in-depth interviews about their experiences initiating testing. Of the 42 responding participants, 27 (64%) reported that it had been "fairly" or "very easy" to raise the idea of testing with partners. Participants predominantly employed partner-conscious communication strategies, including framing the testing proposal as a mandatory, non-personal component of their participation in a research study, gradually incorporating testing mentions into discussions about sexual health, and using the kits to facilitate joint testing. Yet, 21 (44%) participants reported having sex with at least one partner they did not ask to test. Concern regarding partner reactions emerged as a significant barrier to discussing test use; similarly, many partners were averse to taking a blood-based test in the context of a casual sexual encounter. Nonetheless, these findings suggest that dual, blood-based HIV/STI rapid tests may represent acceptable harm reduction tools among similar populations of cMSM and TGW, particularly if future partner-testing research is broadened to consider key couples' dynamics that may impact test usage.
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Affiliation(s)
- Cody Lentz
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Javier Lopez-Rios
- Department of Community Health and Prevention, Dornsife School of Public Health at Drexel University, Philadelphia, PA, USA
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Bryan A Kutner
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Christine Tagliaferri Rael
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
- College of Nursing, Anschutz Medical Campus at Colorado University, Aurora, CO, USA
| | - Iván C Balán
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA.
- Center for Translational Behavioral Science, Florida State University College of Medicine, 2010 Levy Avenue Building B, Suite B0266, Tallahassee, FL, 32310, USA.
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De Brier N, Van Schuylenbergh J, Van Remoortel H, Van den Bossche D, Fieuws S, Molenberghs G, De Buck E, T’Sjoen G, Compernolle V, Platteau T, Motmans J. Prevalence and associated risk factors of HIV infections in a representative transgender and non-binary population in Flanders and Brussels (Belgium): Protocol for a community-based, cross-sectional study using time-location sampling. PLoS One 2022; 17:e0266078. [PMID: 35404977 PMCID: PMC9000107 DOI: 10.1371/journal.pone.0266078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 03/11/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction HIV prevalence and sexual risk have been estimated very high for transgender people. However, the limited sampling and data collection methods used in current research on transgender people potentially led to overrepresentation and generalisation of people at risk for HIV. Current HIV prevalence estimates in transgender populations are generalised from studies mainly focusing on transgender women engaging in sex work. Moreover, studies focusing on non-binary people, who identify with a broad range of identities beyond the traditional male and female gender identities, are scarce. Objectives To estimate the HIV prevalence rate in the Flemish and Brussels (Belgium) transgender population, including transgender women, transgender men and non-binary people, and to identify the associated risk factors. Methods In this community-based cross-sectional study, self-identified transgender and non-binary (TGNB) people will be recruited through a two-stage time-location sampling approach. First, community settings in which TGNB people gather will be mapped to develop an accurate sampling frame. Secondly, a multistage sampling design is applied involving a stratification based on setting type (healthcare facilities vs outreach events), a selection of clusters by systematic sampling and a simple random selection of TGNB people within each cluster. Participants will complete an electronic self-reported survey to measure sociological, sexual and drug-using behaviors (risk factors) and oral fluid aliquots will be collected and tested for HIV antibodies. Logistic regression models will be used to evaluate risk factors independently associated with HIV infection. The presented study is registered at ClinicalTrials.gov (NCT04930614). Discussion This study will be the first to investigate the HIV prevalence rates and associated risk behaviors in an accurate representation of the TGNB population in a Western European country. The findings will globally serve as a knowledge base for identifying subgroups at risk for becoming infected with HIV within TGNB people and to set up targeted prevention programs.
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Affiliation(s)
- Niels De Brier
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
- * E-mail:
| | | | - Hans Van Remoortel
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | | | - Steffen Fieuws
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), University of Leuven and Hasselt University, Leuven, Belgium
| | - Geert Molenberghs
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), University of Leuven and Hasselt University, Leuven, Belgium
| | - Emmy De Buck
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Guy T’Sjoen
- Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Veerle Compernolle
- Blood Service, Belgian Red Cross, Mechelen, Belgium
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Tom Platteau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Joz Motmans
- Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
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12
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Muzakkir M, Darwis D, Yunding J, Irfan I. Knowledge of HIV AIDS and Sexual Risk Transgender Women Behavior on Suburban City of Indonesia. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective: Transvestites are male sex-oriented women and look like women, transvestites physically want to look like women and psychologically they identify themselves as women. The purpose of this study was to determine the relationship between knowledge about HIV AIDS and risky sexual behavior in transvestites. Method: The research design used was Analytical Observational with a Crossectional Study approach. The number of samples of 103 people was selected by Purposive Sampling from all transvestites in Majene Regency. Retrieving data using knowledge questionnaires and risky sexual behavior. Data were analyzed using Fisher's Exact Test. Results: Average age of 25.33 years (SD = 4.43). Only about 13% had received university or higher education. The results of this study indicate that 33.0% with high level knowledge categories and 67.0% categories of lower level knowledgeableThe results showed a value of P: 0.007. Conclusion: There is a relationship between knowledge about HIV AIDS and risky sexual behavior in transvestites with p 0.007.
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Kisler KA, Fletcher JB, Fehrenbacher AE, Reback CJ. Age Is Associated With HIV Sexual Risk Behaviors Among Trans Women in Los Angeles County. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021; 33:483-494. [PMID: 34874757 PMCID: PMC10445543 DOI: 10.1521/aeap.2021.33.6.483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Little is known about how HIV risk varies among trans women of different ages. From January 2010 to February 2021, 2,242 trans women were assessed via outreach encounters consisting of health education and risk reduction information, and queries of recent sexual behaviors. Generalized linear models provide adjusted rates of engagement in condomless anal intercourse (CAI), in exchange sex, and CAI with exchange partners in the past 30 days for each year from age 18 to 60. Most participants identified as Hispanic/Latina (52%) and most were HIV negative (80%). Engagement in exchange sex remained prevalent from participants' early 20s through their mid-40s, though CAI with such partners never exceeded an average estimated prevalence of 15%. Condomless behaviors with non-exchange partners was more common, with at least 20% reporting engagement in non-exchange CAI regardless of age. The need for trans-specific sexual risk reduction interventions that take age into account is underscored.
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Affiliation(s)
- Kimberly A. Kisler
- Friends Research Institute, Inc
- Department of Public Health, Rongxiang Xu College of Health & Human Services, California State University, Los Angeles
| | | | - Anne E. Fehrenbacher
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
- Center for HIV Identification, Prevention and Treatment Services, Department of Family Medicine, University of California, Los Angeles
| | - Cathy J. Reback
- Friends Research Institute, Inc
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles
- Center for HIV Identification, Prevention and Treatment Services, Department of Family Medicine, University of California, Los Angeles
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14
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Garcia Saiz E, Sarda V, Pletta DR, Reisner SL, Katz-Wise SL. Family Functioning as a Protective Factor for Sexual Risk Behaviors Among Gender Minority Adolescents. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3023-3033. [PMID: 34586546 PMCID: PMC9116415 DOI: 10.1007/s10508-021-02079-5] [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] [Received: 12/03/2020] [Revised: 04/12/2021] [Accepted: 06/10/2021] [Indexed: 06/13/2023]
Abstract
Gender minority (GM) youth are more likely to engage in sexual behaviors that increase risk of exposure to sexually transmitted infections, including HIV. However, family functioning may be protective against sexual risk taking. We characterized longitudinal associations between family functioning (family communication and family satisfaction) and sexual risk behaviors across two years in a community sample of 30 GM adolescents, ages 13-17 years. Participants were purposively recruited from community-based venues, through social media, and peer referrals throughout the New England area and completed surveys every 6 months, with measures of family functioning, sexual risk behaviors, risk factors (depressive and anxious symptoms, perceived stress related to parents), and protective factors (social support, gender-related pride, and community connectedness). Results indicated that higher levels of family communication, improved family satisfaction, and increased social support were protective for sexual risk taking, in general, and specifically for condom use for anal/vaginal sex. In contrast, increased depressive symptoms were associated with lower likelihood of anal/vaginal condom use. Associations between family functioning and sexual risk taking were not attenuated by adding risk and protective factors to the model; thus, these factors did not explain the observed associations between family functioning and sexual risk taking. These findings suggest improved family functioning, greater social support, and lower depressive symptoms are associated with reduced sexual risk taking among gender minority youth, thus making these factors an important target for future prevention efforts.
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Affiliation(s)
| | - Vishnudas Sarda
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - David R Pletta
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Sari L Reisner
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
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15
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Olakunde BO, Pharr JR, Adeyinka DA, Conserve DF, Duncan DT. Spatial analysis of HIV infection and the associated correlates among transgender persons in the United States. AIDS Care 2021; 34:1000-1007. [PMID: 34029150 DOI: 10.1080/09540121.2021.1929817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Identifying the geographic hotspots of HIV infection among high-risk populations such as transgender people is critical to ending the HIV epidemic in the United States (U.S.). This study examined the spatial pattern of HIV positivity rate and the associated correlates among transgender persons in the 48 contiguous states and the District of Columbia in the U.S. The data source was the 2015 U.S. Transgender Survey (n = 27,715). We conducted spatial analyses, with state as the unit of analysis. We fitted a spatial lag regression model to assess demographic, social, and behavioral risk variables associated with HIV. The HIV positivity rate ranged by state from 0.5% to 17.1%, with a mean of 2.9%. There was a significant positive global spatial autocorrelation (global Moran's I = 0.42, p = 0.001). The identified spatial clusters of high values (hot spots i.e., states with high HIV positivity rates surrounded by states with similarly high rates) included five neighboring states (Arkansas, Louisiana, Mississippi, Alabama, and Tennessee) in the Southern region. HIV positivity rate was positively associated with the percentage of transgender persons who were non-Hispanic Black, had no high school education, living in poverty, and engaged in sex work. Structural interventions are needed to address education, poverty, racial discrimination, and sex work that predispose transgender persons to HIV.
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Affiliation(s)
- Babayemi O Olakunde
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV, USA
| | - Jennifer R Pharr
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV, USA
| | - Daniel A Adeyinka
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
| | - Donaldson F Conserve
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Dustin T Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
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16
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Smith AD, Kimani J, Kabuti R, Weatherburn P, Fearon E, Bourne A. HIV burden and correlates of infection among transfeminine people and cisgender men who have sex with men in Nairobi, Kenya: an observational study. Lancet HIV 2021; 8:e274-e283. [PMID: 33631101 DOI: 10.1016/s2352-3018(20)30310-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Transgender people are disproportionately affected by HIV and other sexually transmitted infections (STIs) worldwide, and culturally competent prevention and treatment services are often unavailable or inaccessible. Despite recent improvements in national HIV responses for many key populations in east Africa, evidence of effective responses informed by transgender sexual health needs is sparse. We aimed to assess gender identity among men and transgender people who have sex with men in Kenya, and to explore its associations with sexual health-related outcomes, risk behaviours, and uptake of HIV prevention and care interventions. METHODS We did a cross-sectional study in Nairobi, Kenya, and recruited adult cisgender men and transfeminine people who reported having sex with men, through respondent-driven sampling. Inclusion criteria were possession of a valid study coupon, being aged 18 years or older, having male sex assignment at birth or male gender identification currently, living within 50 km of Nairobi, and having had consensual anal or oral sexual activity with a man in the previous 12 months. Seed participants were identified by three community organisations that provide targeted health-care services to gay, bisexual, or other men who have sex with men (MSM) communities in Nairobi. We assessed gender identity, sociodemographics, sexual behaviour, and HIV prevention and care uptake, by self-completed survey. Participants were tested for HIV, syphilis, and rectal and urethral gonorrhoea and chlamydia. We compared prevalence of sexual health outcomes, risk behaviour, and HIV prevention and care service uptake among transfeminine and cisgender participants, using multivariable robust Poisson regression models, with gender identity as the independent variable. FINDINGS Between May 4 and Dec 8, 2017, we enrolled 618 participants. Six participants did not answer the questions on sex assigned at birth and gender identity and so were excluded from the analyses. 522 (sample-weighted percentage 86%) of 612 participants were classified as cisgender men, 70 (11%) as transfeminine, and three (<1%) as transmasculine. 17 participants (2%) did not identify as male, female, or transgender. Compared with cisgender men, transfeminine people were more likely to be HIV-positive (28 [41%] of 70 transfeminine vs 151 [25%] of 521 cisgender men; p=0·0009) and to report current symptoms consistent with a rectal STI (eight [16%] of 67 vs 38 [7%] of 518; p=0·014). Transfeminine people reported higher numbers of recent male sexual partners (22 [27%] of 70 transfeminine people reported four or more male sexual partners in the past 3 months vs 112 [13%] of 522 cisgender men; p=0·042) and were more likely to report condomless anal intercourse with men (43 [62%] of 70 vs 208 [39%] of 522; p=0·0009) and receptive anal intercourse (54 [76%] of 70 vs 252 [46%] of 522; p<0·0001) in the past 3 months, and transactional sex with men (42 [57%] of 69 vs 240 [42%] of 518; p=0·023) and experience of sexual assault (16 [23%] of 69 vs 65 [11%] of 520; p=0·019) in the past 12 months. Use of pre-exposure prophylaxis and post-exposure prophylaxis was low in both groups. INTERPRETATION Transfeminine people who have sex with men have a higher burden of HIV and associated risk behaviours compared with cisgender MSM in the same context, yet their uptake of prevention and care services is poor. Policies should acknowledge the specific needs of transfeminine people as distinct from cisgender MSM, and support health-care providers to address these needs. FUNDING Evidence for HIV Prevention in Southern Africa (EHPSA), UK Aid.
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Affiliation(s)
- Adrian D Smith
- Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Joshua Kimani
- Partners for Health and Development, Nairobi, Kenya; Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Rhoda Kabuti
- Partners for Health and Development, Nairobi, Kenya
| | - Peter Weatherburn
- Sigma Research, Department of Public Health, Environments, and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Elizabeth Fearon
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Adam Bourne
- Australian Research Centre in Sex, Health, and Society, La Trobe University, Melbourne, VIC, Australia
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17
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Duan Z, Wang L, Guo M, Ding C, Huang D, Yan H, Wilson A, Li S. Psychosocial characteristics and HIV-related sexual behaviors among cisgender, transgender, and gender non-conforming MSM in China. BMC Psychiatry 2021; 21:196. [PMID: 33865353 PMCID: PMC8053274 DOI: 10.1186/s12888-021-03189-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 03/30/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND While a growing number of studies focus on men who have sex with men (MSM), they typically ignore the heterogeneity of gender minorities within the MSM population. The recognition of new sub-groups among gender minorities (i.e., transgender and gender non-conforming), who also identify as MSM, play a considerable role in new HIV infections in China. Information on the psychosocial factors and HIV-related sexual behaviors require further consideration to understand the prevalence of HIV infection among MSM within these gender minority sub-groups. METHODS From September 2017 to January 2018, MSM without HIV were recruited in Wuhan, Nanchang, and Changsha cities in China. Participants were asked to fill out a structured self-administered questionnaire to assess depression, perceived social support, resilience, identity concealment, and HIV-related risky sexual behaviors. RESULTS A total of 715 MSM completed the structured questionnaire, the number of MSM identifying as gender minorities were 63 and accounted for 8.8% of the population. Compared to the cisgender MSM population, transgender MSM were more likely to have a one-night stand/occasional partner (AOR = 3.49, 95% CI =1.02-11.98), to have sex after drug use in the past 6 months (AOR = 2.57, 95%CI =1.05-6.29), and to have reported a significantly lower likelihood of identity concealment (mean difference = - 3.30, 95%CI = -5.86, - 0.74, P = 0.01). CONCLUSIONS The findings highlight the significance of providing targeted interventions for different gender minorities within the MSM population. Research is required to further understand the relationship between gender identity, mental health, and HIV-related sexual behaviors.
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Affiliation(s)
- Zhizhou Duan
- School of Health Sciences, Wuhan University, Wuhan, Hubei Province, China
| | - Liyin Wang
- School of Health Sciences, Wuhan University, Wuhan, Hubei Province, China
| | - Menglan Guo
- School of Health Sciences, Wuhan University, Wuhan, Hubei Province, China
| | - Changmian Ding
- The medical record department, The affiliated Dehong People's Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Danqin Huang
- School of Health Sciences, Wuhan University, Wuhan, Hubei Province, China
- Institute for Infectious Disease Control and prevention, Hubei provincial Center for Disease Control and Prevention, Wuhan, Hubei Province, China
| | - Hong Yan
- School of Health Sciences, Wuhan University, Wuhan, Hubei Province, China.
| | - Amanda Wilson
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Shiyue Li
- School of Health Sciences, Wuhan University, Wuhan, Hubei Province, China
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18
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Abstract
With the growing number of transgender and gender-nonbinary individuals who are becoming visible, it is clear that there is a need to develop a rigorous evidence base to inform care practice. Transgender health research is often limited to HIV/AIDS or mental health research and is typically subsumed in larger studies with general LGBTQ focus. Although the number of knowledgeable health care providers remains modest, the model for the medical approach to transgender health is shifting owing to growing social awareness and an appreciation of a biological component. Gender-affirming medicine facilitates aligning the body of the transgender person with the gender identity; typical treatment regimens include hormone therapy and/or surgical interventions. While broadly safe, hormone treatments require some monitoring for safety. Exogenous estrogens are associated with a dose-dependent increase in venous thromboembolic risk, and androgens stimulate erythropoiesis. The degree to which progressing gender-affirming hormone treatment changes cancer risk, cardiac heart disease risk, and/or bone health remains unknown. Guidelines referencing the potential exacerbation of cancer, heart disease, or other disease risk often rely on physiology models, because conclusive clinical data do not exist. Dedicated research infrastructure and funding are needed to address the knowledge gap in the field.
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19
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Gass BV, Horvath KJ, Marrow E, Rood BA, Pantalone DW. Associations Between Social Support Availability and HIV Risk and Protective Factors in a U.S. Sample of Adults with Diverse Transgender Identities. LGBT Health 2020; 8:60-67. [PMID: 33370219 DOI: 10.1089/lgbt.2020.0035] [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] [Indexed: 11/13/2022] Open
Abstract
Purpose: There is conflicting evidence on how different types of social support may attenuate human immunodeficiency virus (HIV) risk or may even promote health behaviors in transgender (trans) and nonbinary populations. Drawing on Social Support Theory, we assessed associations between emotional, instrumental, and informational social support and HIV risk and protective factors in a U.S. sample of trans and nonbinary adults. We investigated whether such associations differed for trans men, trans women, and nonbinary individuals. Methods: Data were drawn from the Transgender Stress and Health Study, an online survey (N = 300), conducted in 2014-2015. We used Poisson regressions to measure the relationship between social support availability and HIV testing, substance use, and sexual risk behaviors for each gender subgroup. Results: Multivariate analyses revealed that, controlling for social support availability, nonbinary individuals were less likely to report past year HIV testing (incidence rate ratio [IRR] = 0.56; 95% confidence interval [CI] 0.36-0.89) than trans men (ref). Instrumental support availability was associated with substance use (IRR = 1.3; 95% CI 1.01-1.6), and this association was stronger for trans women (IRR = 2.1; 95% CI 1.1-4.04). Trans women were more likely to report sexual risk behavior across all types of social support, controlling for social support availability. Conclusion: We found key differences in social support availability, HIV testing, substance use, and sexual risk behavior. Our results suggest that trans men, trans women, and nonbinary individuals may have unique HIV prevention needs, and should be treated as distinct study groups in further research.
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Affiliation(s)
- Bobbi V Gass
- Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Elliot Marrow
- Department of Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Brian A Rood
- Division of Research and Development, UnitedHealth Group, Minnetonka, Minnesota, USA
| | - David W Pantalone
- Department of Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA.,The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
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Watson CWM, Pasipanodya E, Savin MJ, Ellorin EE, Corado KC, Flynn RP, Opalo C, Lampley E, Henry BL, Blumenthal J, Bolan R, Morris S, Moore DJ. Barriers and Facilitators to PrEP Initiation and Adherence Among Transgender and Gender Non-Binary Individuals in Southern California. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2020; 32:472-485. [PMID: 33779208 PMCID: PMC10953836 DOI: 10.1521/aeap.2020.32.6.472] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
While transgender and gender non-binary (trans/nb) individuals are disproportionately affected by HIV, pre-exposure prophylaxis (PrEP) uptake remains low in this underserved population. We conducted four focus groups with 37 trans/nb individuals in San Diego and Los Angeles to assess barriers and facilitators of PrEP usage. Transcripts were coded for qualitative themes. Although overall PrEP awareness was high, participants reported limited knowledge and misinformation about PrEP. Barriers to PrEP use included: structural access (e.g., discrimination from health care providers, lack of trans-inclusive services, financial barriers), mental health struggles limiting ability to access PrEP, and concerns about potential side effects, drug-drug interactions with hormone therapy, and lack of other STI protection. Facilitators of PrEP usage included: increased PrEP availability, prior experience taking daily medications, and motivation to have active and healthy lives without fear of contracting HIV. Addressing both structural and psychosocial/behavioral factors in trans-affirming health care environments is crucial to designing inclusive, effective PrEP interventions.
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Affiliation(s)
- C Wei-Ming Watson
- University of California, San Diego
- San Diego State University/University of California San Diego
| | - Elizabeth Pasipanodya
- University of California, San Diego
- Santa Clara Valley Medical Center, Fruitdale, California
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21
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Beyond Gender Identity Disorder Diagnoses Codes: An Examination of Additional Methods to Identify Transgender Individuals in Administrative Databases. Med Care 2020; 58:903-911. [PMID: 32925416 DOI: 10.1097/mlr.0000000000001362] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Large administrative databases often do not capture gender identity data, limiting researchers' ability to identify transgender people and complicating the study of this population. OBJECTIVE The objective of this study was to develop methods for identifying transgender people in a large, national dataset for insured adults. RESEARCH DESIGN This was a retrospective analysis of administrative claims data. After using gender identity disorder (GID) diagnoses codes, the current method for identifying transgender people in administrative data, we used the following 2 strategies to improve the accuracy of identifying transgender people that involved: (1) Endocrine Disorder Not Otherwise Specified (Endo NOS) codes and a transgender-related procedure code; or (2) Receipt of sex hormones not associated with the sex recorded in the patient's chart (sex-discordant hormone therapy) and an Endo NOS code or transgender-related procedure code. SUBJECTS Seventy-four million adults 18 years and above enrolled at some point in commercial or Medicare Advantage plans from 2006 through 2017. RESULTS We identified 27,227 unique transgender people overall; 18,785 (69%) were identified using GID codes alone. Using Endo NOS with a transgender-related procedure code, and sex-discordant hormone therapy with either Endo NOS or transgender-related procedure code, we added 4391 (16%) and 4051 (15%) transgender people, respectively. Of the 27,227 transgender people in our cohort, 8694 (32%) were transmasculine, 3959 (15%) were transfeminine, and 14,574 (54%) could not be classified. CONCLUSION In the absence of gender identity data, additional data elements beyond GID codes improves the identification of transgender people in large, administrative claims databases.
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22
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High Rates of PrEP Eligibility but Low Rates of PrEP Access Among a National Sample of Transmasculine Individuals. J Acquir Immune Defic Syndr 2020; 82:e1-e7. [PMID: 31232834 DOI: 10.1097/qai.0000000000002116] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Transmasculine individuals have been largely ignored in HIV prevention research, and there is a lack of data regarding this population's eligibility for and utilization of HIV pre-exposure prophylaxis (PrEP). SETTING National online survey conducted in the United States. METHODS Between May and July 2017, we surveyed 1808 transmasculine individuals (aged 18-60 years; 30% people of color and/or Latinx), asking questions about sexual behavior and receipt of sexual health care, including PrEP. We examined the number of individuals who would meet eligibility criteria for PrEP and then used log-linked Poisson regression with robust variance estimation to examine predictors of PrEP eligibility. RESULTS Almost one-quarter of the sample (n = 439; 24.3%) met one or more criterion for PrEP eligibility. PrEP eligibility did not differ by age, race/ethnicity, education, or binary gender identity. PrEP eligibility was lower among heterosexual-identified and higher income participants, and was higher among participants who were in open relationships and reported substance use. Among PrEP-eligible individuals, 64.9% had received an HIV test in the past year, 33.9% had received PrEP information from a provider, and 10.9% (n = 48) had received a PrEP prescription. PrEP-eligible individuals who had received a PrEP prescription were more likely to have a binary gender identity, identify as gay, and be taking testosterone. CONCLUSIONS A substantial proportion of transmasculine individuals meet PrEP eligibility criteria, but few are receiving adequate PrEP services. Enhanced efforts should be made by providers, programs, and systems to assess HIV-related risk in transmasculine patients and engage them in comprehensive sexual health care.
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Bockting WO, Miner MH, Swinburne Romine RE, Dolezal C, Robinson B“BE, Rosser BS, Coleman E. The Transgender Identity Survey: A Measure of Internalized Transphobia. LGBT Health 2020; 7:15-27. [PMID: 31880493 PMCID: PMC6983734 DOI: 10.1089/lgbt.2018.0265] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: We describe the development of a measure of internalized transphobia, defined as discomfort with one's transgender identity as a result of internalizing society's normative gender expectations. Methods: An item pool was created based on responses from a small clinical sample (N = 12) to an open-ended questionnaire. Expert judges reviewed the items, resulting in a 60-item instrument for empirical testing. We conducted exploratory factor analysis (EFA) by using a community sample of 430 transgender individuals (aged 18-72, mean [M] = 37.4, standard deviation [SD] = 12.0), and confirmatory factor analysis (CFA) by using an online sample of 903 transgender individuals (aged 18-66, M = 31.6, SD = 11.1). Construct validity was examined by using correlations with instruments assessing related constructs administered to the online sample. Results: EFA resulted in a 52-item instrument with four subscales: Pride, Passing, Alienation, and Shame. CFA, after removal of half of the items, retained the four-factor structure. The final 26-item scale showed excellent internal consistency (0.90) and test-retest reliability (0.93). The factors showed a pattern of association with crossgender identity, gender ideology, outness, felt stigma, self-esteem, and psychological distress consistent with moderate-to-good construct validity. Conclusion: Internalized transphobia can be conceptualized as four inter-related dimensions: pride in transgender identity (reverse scored), investment in passing as a cisgender person, alienation from other transgender people, and shame. The Transgender Identity Survey reliably assesses this construct, useful in research to understand the impact of minority stress on transgender people's health. It can also be used in clinical practice to assess internalized transphobia at intake and follow-up.
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Affiliation(s)
- Walter O. Bockting
- Program for the Study of LGBT Health, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Columbia Psychiatry and the Columbia University School of Nursing, New York, New York
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Michael H. Miner
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | | | - Curtis Dolezal
- Program for the Study of LGBT Health, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Columbia Psychiatry and the Columbia University School of Nursing, New York, New York
| | - Beatrice “Bean” E. Robinson
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | - B.R. Simon Rosser
- HIV/STI Intervention and Prevention Studies Program, Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Eli Coleman
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
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24
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Safer JD. The prevalence of sexually transmissible infections in transgender people. Med J Aust 2019; 211:401. [PMID: 31595513 DOI: 10.5694/mja2.50369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Joshua D Safer
- Mount Sinai Center for Transgender Medicine and Surgery, New York, New York, United States of America
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25
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Iwamoto SJ, Defreyne J, Rothman MS, Van Schuylenbergh J, Van de Bruaene L, Motmans J, T’Sjoen G. Health considerations for transgender women and remaining unknowns: a narrative review. Ther Adv Endocrinol Metab 2019; 10:2042018819871166. [PMID: 31516689 PMCID: PMC6719479 DOI: 10.1177/2042018819871166] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 07/31/2019] [Indexed: 12/17/2022] Open
Abstract
Transgender (trans) women (TW) were assigned male at birth but have a female gender identity or gender expression. The literature on management and health outcomes of TW has grown recently with more publication of research. This has coincided with increasing awareness of gender diversity as communities around the world identify and address health disparities among trans people. In this narrative review, we aim to comprehensively summarize health considerations for TW and identify TW-related research areas that will provide answers to remaining unknowns surrounding TW's health. We cover up-to-date information on: (1) feminizing gender-affirming hormone therapy (GAHT); (2) benefits associated with GAHT, particularly quality of life, mental health, breast development and bone health; (3) potential risks associated with GAHT, including cardiovascular disease and infertility; and (4) other health considerations like HIV/AIDS, breast cancer, other tumours, voice therapy, dermatology, the brain and cognition, and aging. Although equally deserving of mention, feminizing gender-affirming surgery, paediatric and adolescent populations, and gender nonbinary individuals are beyond the scope of this review. While much of the data we discuss come from Europe, the creation of a United States transgender cohort has already contributed important retrospective data that are also summarized here. Much remains to be determined regarding health considerations for TW. Patients and providers will benefit from larger and longer prospective studies involving TW, particularly regarding the effects of aging, race and ethnicity, type of hormonal treatment (e.g. different oestrogens, anti-androgens) and routes of administration (e.g. oral, parenteral, transdermal) on all the topics we address.
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Affiliation(s)
- Sean J. Iwamoto
- University of Colorado School of Medicine, Division of Endocrinology, Metabolism and Diabetes, 12801 East 17th Avenue, Mail Stop: 8106, Aurora, CO 80045, USA
- UCHealth Integrated Transgender Program, Anschutz Medical Campus, Aurora, CO, USA
- Division of Endocrinology, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | - Justine Defreyne
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Micol S. Rothman
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
- UCHealth Integrated Transgender Program, Anschutz Medical Campus, Aurora, CO, USA
| | | | | | - Joz Motmans
- Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
- Center for Research on Culture and Gender, Ghent University, Ghent, Belgium
| | - Guy T’Sjoen
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
- Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
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Abstract
Transgender persons are a diverse group whose gender identity differs from their sex recorded at birth. Some choose to undergo medical treatment to align their physical appearance with their gender identity. Barriers to accessing appropriate and culturally competent care contribute to health disparities in transgender persons, such as increased rates of certain types of cancer, substance abuse, mental health conditions, infections, and chronic diseases. Thus, it is important that clinicians understand the specific medical issues that are relevant to this population.
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Affiliation(s)
- Joshua D Safer
- Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, New York (J.D.S.)
| | - Vin Tangpricha
- Emory University School of Medicine and Atlanta VA Medical Center, Atlanta, Georgia (V.T.)
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27
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MacCarthy S, Poteat T, Xia Z, Roque NL, Hyun Jin Kim A, Baral S, Reisner SL. Current research gaps: a global systematic review of HIV and sexually transmissible infections among transgender populations. Sex Health 2019; 14:456-468. [PMID: 29216970 DOI: 10.1071/sh17096] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 08/21/2017] [Indexed: 11/23/2022]
Abstract
Transgender populations are heavily burdened by HIV and other sexually transmissible infections (STIs). However, data on co-infection with HIV and STIs among transgender people are limited. A systematic review was conducted of peer-reviewed articles and conference abstracts between January 2010 and November 2015 that focussed on HIV and STI infections among transgender populations globally. The literature was synthesised and opportunities for improving health research were commented on. Few studies reported HIV-STI co-infection (n=4), while the majority of studies reported HIV and STI infections separately (n=23). Most studies were conducted outside of the USA (n=19), and all but one of these studies reported data on transgender women only. Among USA-based studies (n=8), several reported data on both transgender men and transgender women (n=3), whereas other studies reported exclusively on transgender men (n=1) or transgender women (n=4). Understanding HIV and STIs among transgender people requires research that simultaneously considers multilevel drivers of vulnerabilities. More data are needed on how the interaction of individual determinants, including biological risks of transmission, programmatic determinants such as service-delivery models and policy-level determinants including institutionalised stigma in healthcare settings, influence the HIV- and STI-related outcomes of transgender populations. Leveraging the knowledge of transgender-specific determinants of HIV and STIs should guide the content and approaches to future HIV and STI prevention and treatment efforts.
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Affiliation(s)
- Sarah MacCarthy
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA
| | - Tonia Poteat
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615N. Wolfe Street, Baltimore, MD 21205, USA
| | - Zhiyu Xia
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615N. Wolfe Street, Baltimore, MD 21205, USA
| | - Nicolette L Roque
- Department of Acute and Chronic Care, Johns Hopkins School of Nursing, 525N. Wolfe Street, Baltimore, MD 21205, USA
| | | | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615N. Wolfe Street, Baltimore, MD 21205, USA
| | - Sari L Reisner
- Division of General Pediatrics, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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28
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Shan D, Yu MH, Yang J, Zhuang MH, Ning Z, Liu H, Liu L, Han MJ, Zhang DP. Correlates of HIV infection among transgender women in two Chinese cities. Infect Dis Poverty 2018; 7:123. [PMID: 30509315 PMCID: PMC6276265 DOI: 10.1186/s40249-018-0508-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 11/16/2018] [Indexed: 11/17/2022] Open
Abstract
Background In an era when HIV transmission has been on the rise among men who have sex with men (MSM), transgender women may play a considerable role in China’s current HIV epidemic as a potential “bridge” of HIV transmission between homosexual and heterosexual populations. We sought to understand the risk behaviours and factors associated with HIV infection among transgender women in two cities in China. Methods From January to December 2016, we recruited transgender women with the help of community-based organizations (CBOs) through a wide range of methods, including snowball sampling. After recruitment, we asked participants to fill out a structured questionnaire including questions about socio-demographics, sexual behaviours, condom use, substance use and uptake of health care services. HIV infection status was determined by using two different rapid testing reagents. Results Among 498 subjects enrolled in this study, 233 were from Shanghai and 265 were from Tianjin. The median age was 30 years (range: 18–68; IQR: 24–33). Of them, 337 (67.7%) preferred feminine dress, 13 (2.6%) had undergone transsexual operation and 68 (13.7%) had used hormones for transition purposes. Nearly half (45.6%) reported having regular partners, and 351 (70.5%) had casual partners. Regarding condom use, 81.5% reported not always using condoms with stable partners, and 70.9% reported not using condoms with casual partners. Twenty-five (5.0%) had a history of buying sex and fifty-one (10.2%) had a history of selling sex in the past three months. A total of 200 (40.2%) participants had used at least one kind of controlled substance in the past six months. The most commonly used substances were amyl nitrates (rush popper) (99.5%) and 5-MeO-DiPT (20.0%). Among rush popper users, 170 (85.4%) reported always having sex while on the drug, and 177 (88.9%) reported increased sexual pleasure after using the drug. The HIV infection risk factors identified in our study were being located in Shanghai (aOR = 9.35, 95% CI = 3.89–22.49), selling sex in the past three months (aOR = 3.44, 95% CI = 1.31–9.01), and substance use in the past six months (aOR = 5.71, 95% CI = 2.63–12.41). Conclusions Transgender women bear a high HIV burden in the two Chinese cities. Those involved in commercial sex tended to have inconsistent condom use, leading to high risk of HIV infection. Substance use was an independent risk factor of HIV infection by increasing sexual activities and unprotected sex, which indicated an aggravated and complex situation with possible interacting syndemic factors that could cumulatively facilitate sexual risk behaviours and HIV infection in transgender women. There is an urgent need for innovative and appropriate HIV prevention programmes targeting this unique population. Efforts should be made to provide them with tailored services including persuasive communication on consistent condom use, substance use counselling and related referral services, all with the goal of reducing HIV epidemic among transgender women. Electronic supplementary material The online version of this article (10.1186/s40249-018-0508-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Duo Shan
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, People's Republic of China
| | - Mao-He Yu
- Division of AIDS Control and Prevention, Tianjin Centers for Disease Control and Prevention, Tianjin, 300011, People's Republic of China
| | - Jie Yang
- Shenlan Public Health Consultation Service Center in Tianjin, Tianjin, 300171, People's Republic of China
| | - Ming-Hua Zhuang
- Division of AIDS Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336, People's Republic of China
| | - Zhen Ning
- Division of AIDS Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336, People's Republic of China
| | - Hui Liu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, People's Republic of China
| | - Lu Liu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, People's Republic of China
| | - Meng-Jie Han
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, People's Republic of China
| | - Da-Peng Zhang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, People's Republic of China.
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29
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Fisher CB, Fried AL, Desmond M, Macapagal K, Mustanski B. Perceived Barriers to HIV Prevention Services for Transgender Youth. LGBT Health 2018; 5:350-358. [PMID: 30070960 DOI: 10.1089/lgbt.2017.0098] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Many transgender youth lack access to transgender affirming care, which may put them at risk for HIV. This study explored transgender youth's perceptions regarding encounters with primary care providers (PCPs) related to gender and sexual minority (GSM) identity and sexual health. METHODS Youth ages 14-21 (N = 228; 45% trans masculine, 41% trans feminine, 14% gender nonbinary) completed a survey on GSM identity disclosure and acceptance, gender-affirming services, sexual health attitudes and behaviors, and interactions with PCPs involving GSM identity and concerns about stigma and confidentiality. RESULTS A factor analysis yielded three scales: GSM Stigma, Confidentiality Concerns, and GSM-Sexual Health Information. Items from the GSM Stigma scale showed that nearly half of respondents had not disclosed their GSM identity to their PCP due to concern about an unaccepting PCP. One-quarter of youth were less inclined to discuss GSM identity and sexual health with their PCP due to concern that their provider would disclose this information to parents; these concerns were greater among adolescents <18 and those not out to parents about their gender identity. Only 25% felt their PCP was helpful about GSM-specific sexual health issues. Youth who were out to parents about their gender identity and had received gender-affirming hormone therapy were more likely to report receiving GSM-specific sexual health information. CONCLUSIONS Transgender youth may not discuss their GSM identity or sexual health with PCPs because they anticipate GSM stigma and fear being "outed" to parents. PCPs should receive transgender-inclusive training to adequately address youths' sexual health needs and privacy concerns.
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Affiliation(s)
- Celia B Fisher
- 1 Center for Ethics Education, Fordham University , Bronx, New York
| | - Adam L Fried
- 1 Center for Ethics Education, Fordham University , Bronx, New York
| | - Margaret Desmond
- 1 Center for Ethics Education, Fordham University , Bronx, New York
| | - Kathryn Macapagal
- 2 Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University , Chicago, Illinois
| | - Brian Mustanski
- 2 Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University , Chicago, Illinois
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30
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McRee AL, Gower AL, Reiter PL. Preventive healthcare services use among transgender young adults. INT J TRANSGENDERISM 2018; 19:417-423. [PMID: 31105477 PMCID: PMC6519967 DOI: 10.1080/15532739.2018.1470593] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND/AIMS Existing research on the health of transgender young adults focuses largely on gender-related care with little attention to important preventive healthcare services such as well-visits, vaccination and screening. METHODS We analyzed data from a national sample of transgender young adults in the United States who were 18-26 years of age and completed an online survey during Fall 2013 (n=34). Most respondents were 22-26 years old (59%) and non-Hispanic White (68%). We calculated descriptive statistics (i.e., frequencies and percentages) to describe transgender young adults use of preventive healthcare services, with particular attention to vaccination against human papillomavirus (HPV) and sexual health services. We also examined the acceptability of home-based self-testing for sexually-transmitted infections (STIs), which could be a novel strategy for increasing screening among this population. RESULTS Only 35% of respondents reported either receiving a routine check-up (past year) or initiating the HPV vaccination series (≥1 dose). Among unvaccinated respondents, the most commonly reported reasons for not getting HPV vaccine were: not being sexually active (32%); having only 1 sexual partner (23%); and being unaware of the vaccine (23%). Fewer than half of respondents had been tested for STIs (47%) but most (71%) were willing to use an STI self-test at home. DISCUSSION Findings suggest that the healthcare needs of transgender young adults are not being adequately addressed. Efforts to increase providers' capacity to effectively and appropriately serve transgender young adults-such as a wider variety of exam, preventive services, and testing options (e.g., self-collected samples)-are needed.
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Affiliation(s)
- Annie-Laurie McRee
- Division of General Pediatrics and Adolescent Health, University of Minnesota, 717 Delaware St., 3 Floor, Minneapolis, MN 55414, USA, ,
| | - Amy L Gower
- Division of General Pediatrics and Adolescent Health, University of Minnesota, Minneapolis, MN 55414, USA,
| | - Paul L Reiter
- Division of Cancer Prevention and Control, The Ohio State University College of Medicine, Columbus, Ohio 43201, USA,
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31
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Rich A, Scott K, Johnston C, Blackwell E, Lachowsky N, Cui Z, Sereda P, Moore D, Hogg R, Roth E. Sexual HIV risk among gay, bisexual and queer transgender men: findings from interviews in Vancouver, Canada. CULTURE, HEALTH & SEXUALITY 2017; 19:1197-1209. [PMID: 28367724 PMCID: PMC5624835 DOI: 10.1080/13691058.2017.1299882] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Gay, bisexual, queer and other men who have sex with men are disproportionately affected by HIV in Canada. While up to 63% of transgender men identify as gay, bisexual or queer and report a variety of HIV sexual risk behaviours, transgender men are often overlooked within epidemiological HIV surveillance and research. While a growing body of research has begun to examine sexual risk for transgender gay, bisexual and queer men, most studies have been conducted in the USA. This study explored sexual HIV risk for this population in the Canadian context, specifically in British Columbia, in an environment of publically funded universal access to healthcare, including HIV testing and treatment. We conducted interviews with 11 gay, bisexual and queer transgender men. Participants' narratives suggest that HIV risk for these transgender men is shaped by a diversity of sexual behaviours, including inconsistent condom use, seeking partners online for greater safety and accessing HIV/STI testing and other healthcare services despite facing transition-related barriers. Public health prevention and health education must recognise the presence of transgender men and ensure health services and broader population health promotion meet the unique sexual health needs of this sub-population of gay, bisexual and queer men.
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Affiliation(s)
- Ashleigh Rich
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Kai Scott
- Momentum Health Study Team, Vancouver, Canada
| | - Caitlin Johnston
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | | | - Nathan Lachowsky
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Zishan Cui
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Paul Sereda
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - David Moore
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Eric Roth
- Department of Anthropology, University of Victoria, Victoria, Canada
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Clark H, Babu AS, Wiewel EW, Opoku J, Crepaz N. Diagnosed HIV Infection in Transgender Adults and Adolescents: Results from the National HIV Surveillance System, 2009-2014. AIDS Behav 2017; 21:2774-2783. [PMID: 28035497 PMCID: PMC5491368 DOI: 10.1007/s10461-016-1656-7] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Publications on diagnosed HIV infection among transgender people have been limited to state- or local-level data. We analyzed data from the National HIV Surveillance System and present results from the first national-level analysis of transgender people with diagnosed HIV infection. From 2009 to 2014, HIV surveillance jurisdictions from 45 states plus the District of Columbia identified and reported at least one case of newly diagnosed HIV infection for transgender people; jurisdictions from 5 states reported no cases for transgender people. Of 2351 transgender people with newly diagnosed HIV infection during 2009-2014, 84.0% were transgender women (male-to-female), 15.4% were transgender men (female-to-male), and 0.7% were additional gender identity (e.g., gender queer, bi-gender). Over half of both transgender women (50.8%; 1002/1974) and men (58.4%; 211/361) with newly diagnosed HIV infection were non-Hispanic black/African American. Improvements in data collection methods and quality are needed to gain a better understanding of HIV burden among transgender people.
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Affiliation(s)
- Hollie Clark
- National Center for HIV, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., NE, MS-E46, Atlanta, GA, 30333, USA.
| | | | - Ellen Weiss Wiewel
- Division of Disease Control, New York City Department of Health and Mental Hygiene, New York City, NY, USA
| | - Jenevieve Opoku
- District of Columbia Department of Health, HIV/AIDS, Hepatitis, STD and TB Administration, Strategic Information Division, Government of the District of Columbia, Washington, DC, USA
| | - Nicole Crepaz
- National Center for HIV, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., NE, MS-E46, Atlanta, GA, 30333, USA
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Rowniak S, Ong-Flaherty C, Selix N, Kowell N. Attitudes, Beliefs, and Barriers to PrEP Among Trans Men. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2017; 29:302-314. [PMID: 28825860 DOI: 10.1521/aeap.2017.29.4.302] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The study examined the attitudes and knowledge of transgender men (trans men) regarding pre-exposure prophylaxis (PrEP) for HIV. Three focus groups of trans men were conducted with a trans male facilitator for a total of 21 participants. Six themes were identified; the range of information about PrEP and possible side effects, the economic realities for trans men, finding a trans-competent provider, trans male sexuality, the importance of contraception, and condom use. Despite identified risk and some information that has been disseminated, many trans men still lack adequate information regarding PrEP. There exist significant barriers to PrEP access for trans men. Participants commented that many providers avoid important discussions regarding sexuality and contraception. The education of health care professionals must include competency in working with transgender populations. More research is needed with regard to interactions between PrEP, testosterone, and hormonal contraception.
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Affiliation(s)
- Stefan Rowniak
- School of Nursing and Health Professions, University of San Francisco, San Francisco, California
| | - Chenit Ong-Flaherty
- School of Nursing and Health Professions, University of San Francisco, San Francisco, California
| | - Nancy Selix
- School of Nursing and Health Professions, University of San Francisco, San Francisco, California
| | - Niko Kowell
- Asian Pacific Islander Wellness Center, San Francisco
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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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Fisher CB, Fried AL, Desmond M, Macapagal K, Mustanski B. Facilitators and Barriers to Participation in PrEP HIV Prevention Trials Involving Transgender Male and Female Adolescents and Emerging Adults. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2017; 29:205-217. [PMID: 28650227 PMCID: PMC5768197 DOI: 10.1521/aeap.2017.29.3.205] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Despite the disproportionate burden of HIV facing transgender youth, they continue to be under-represented in studies to provide an empirical basis for pre-exposure prophylaxis (PrEP) programs that can meet the unique needs of this population. This study examined facilitators and barriers to participation in a PrEP adherence study, determined through an online survey administered to 90 transgender male and 60 transgender female 14-21-year-olds attracted to cisgender male sexual partners. Approximately 50% reported likely to participate in the PrEP study. Participation facilitators included prior sexual and health service experiences and study access to PrEP and health services. Participation barriers included lack of concern about HIV, potential medication side effects, the logistics of quarterly meetings, remembering to take PrEP daily, and reluctance to discuss gender identity with study staff. Results suggest that successful recruitment and retention of transgender youth in PrEP prevention studies warrant protocols designed to address these barriers.
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Affiliation(s)
- Celia B Fisher
- Fordham University Center for Ethics Education, Bronx, New York
| | - Adam L Fried
- Fordham University Center for Ethics Education, Bronx, New York
| | | | - Kathryn Macapagal
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Brian Mustanski
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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Poteat T, Scheim A, Xavier J, Reisner S, Baral S. Global Epidemiology of HIV Infection and Related Syndemics Affecting Transgender People. J Acquir Immune Defic Syndr 2016; 72 Suppl 3:S210-9. [PMID: 27429185 PMCID: PMC4969059 DOI: 10.1097/qai.0000000000001087] [Citation(s) in RCA: 263] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Transgender populations have been underrepresented in HIV epidemiologic studies and consequently in HIV prevention, care, and treatment programs. Since 2012, there has been a dramatic increase in research focused on transgender people. Studies highlight the burden of HIV and risk determinants, including intersecting stigmas, as drivers of syndemics among transgender populations. This review synthesizes the most recent global epidemiology of HIV infection and describes current gaps in research and interventions to inform prioritization of HIV research for transgender populations. METHODS A systematic review was conducted of the medical literature published between January 1, 2012 and November 30, 2015. The data focused on HIV prevalence, determinants of risk, and syndemics among transgender populations. RESULTS Estimates varied dramatically by location and subpopulation. Transfeminine individuals have some of the highest concentrated HIV epidemics in the world with laboratory-confirmed prevalence up to 40%. Data were sparse among trans masculine individuals; however, they suggest potential increased risk for trans masculine men who have sex with men (MSM). No prevalence data were available for transgender people across Sub-Saharan Africa or Eastern Europe/Central Asia. Emerging data consistently support the association of syndemic conditions with HIV risk in transgender populations. DISCUSSION Addressing syndemic conditions and gender-specific challenges is critical to ensure engagement and retention in HIV prevention by transgender populations. Future research should prioritize: filling knowledge gaps in HIV epidemiology; elucidating how stigma shapes syndemic factors to produce HIV and other deleterious effects on transgender health; and understanding how to effectively implement HIV interventions for transgender people.
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Affiliation(s)
- Tonia Poteat
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ayden Scheim
- Department of Epidemiology and Biostatistics, Western University, London, Canada
| | - Jessica Xavier
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Rockville, Maryland; and
| | - Sari Reisner
- Boston Children's Hospital/Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Reisner SL, Poteat T, Keatley J, Cabral M, Mothopeng T, Dunham E, Holland CE, Max R, Baral SD. Global health burden and needs of transgender populations: a review. Lancet 2016; 388:412-436. [PMID: 27323919 PMCID: PMC7035595 DOI: 10.1016/s0140-6736(16)00684-x] [Citation(s) in RCA: 747] [Impact Index Per Article: 93.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Transgender people are a diverse population affected by a range of negative health indicators across high-income, middle-income, and low-income settings. Studies consistently document a high prevalence of adverse health outcomes in this population, including HIV and other sexually transmitted infections, mental health distress, and substance use and abuse. However, many other health areas remain understudied, population-based representative samples and longitudinal studies are few, and routine surveillance efforts for transgender population health are scarce. The absence of survey items with which to identify transgender respondents in general surveys often restricts the availability of data with which to estimate the magnitude of health inequities and characterise the population-level health of transgender people globally. Despite the limitations, there are sufficient data highlighting the unique biological, behavioural, social, and structural contextual factors surrounding health risks and resiliencies for transgender people. To mitigate these risks and foster resilience, a comprehensive approach is needed that includes gender affirmation as a public health framework, improved health systems and access to health care informed by high quality data, and effective partnerships with local transgender communities to ensure responsiveness of and cultural specificity in programming. Consideration of transgender health underscores the need to explicitly consider sex and gender pathways in epidemiological research and public health surveillance more broadly.
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Affiliation(s)
- Sari L Reisner
- Division of General 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; Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Tonia Poteat
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - JoAnne Keatley
- Center of Excellence for Transgender Health, University of California San Francisco, San Francisco, CA, USA
| | - Mauro Cabral
- Global Action for Trans* Equality, Buenos Aires, Argentina and New York, NY, USA
| | | | - Emilia Dunham
- Fenway Institute, Fenway Health, Boston, MA, USA; Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Claire E Holland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ryan Max
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stefan D Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Scheim AI, Santos GM, Arreola S, Makofane K, Do TD, Hebert P, Thomann M, Ayala G. Inequities in access to HIV prevention services for transgender men: results of a global survey of men who have sex with men. J Int AIDS Soc 2016; 19:20779. [PMID: 27431466 PMCID: PMC4949311 DOI: 10.7448/ias.19.3.20779] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 04/18/2016] [Accepted: 04/25/2016] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Free or low-cost HIV testing, condoms, and lubricants are foundational HIV prevention strategies, yet are often inaccessible for men who have sex with men (MSM). In the global context of stigma and poor healthcare access, transgender (trans) MSM may face additional barriers to HIV prevention services. Drawing on data from a global survey of MSM, we aimed to describe perceived access to prevention services among trans MSM, examine associations between stigma and access, and compare access between trans MSM and cisgender (non-transgender) MSM. METHODS The 2014 Global Men's Health and Rights online survey was open to MSM (inclusive of trans MSM) from any country and available in seven languages. Baseline data (n=3857) were collected from July to October 2014. Among trans MSM, correlations were calculated between perceived service accessibility and anti-transgender violence, healthcare provider stigma, and discrimination. Using a nested matched-pair study design, trans MSM were matched 4:1 to cisgender MSM on age group, region, and HIV status, and conditional logistic regression models compared perceived access to prevention services by transgender status. RESULTS About 3.4% of respondents were trans men, of whom 69 were included in the present analysis. The average trans MSM participant was 26 to 35 years old (56.5%); lived in western Europe, North America, or Oceania (75.4%); and reported being HIV-negative (98.6%). HIV testing, condoms, and lubricants were accessible for 43.5, 53.6, and 26.1% of trans MSM, respectively. Ever having been arrested or convicted due to being trans and higher exposure to healthcare provider stigma in the past six months were associated with less access to some prevention services. Compared to matched cisgender controls, trans MSM reported significantly lower odds of perceived access to HIV testing (OR=0.57, 95% CI=0.33, 0.98) and condom-compatible lubricants (OR=0.54, 95% CI=0.30, 0.98). CONCLUSIONS This first look at access to HIV prevention services for trans MSM globally found that most reported inadequate access to basic prevention services and that they were less likely than cisgender MSM to have access to HIV testing and lubricants. Results indicate the need to enhance access to basic HIV prevention services for trans MSM, including MSM-specific services.
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Affiliation(s)
- Ayden I Scheim
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, Canada;
| | - Glenn-Milo Santos
- Community Health Systems, School of Nursing (G-M Santos), Department of Medicine (TD Do), University of California, San Francisco, CA, USA
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Sonya Arreola
- The Global Forum on MSM & HIV (MSMGF), Oakland, CA, USA
- Human Sexuality Program, California Institute of Integral Studies, San Francisco, CA, USA
| | | | - Tri D Do
- Community Health Systems, School of Nursing (G-M Santos), Department of Medicine (TD Do), University of California, San Francisco, CA, USA
| | | | - Matthew Thomann
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - George Ayala
- The Global Forum on MSM & HIV (MSMGF), Oakland, CA, USA
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HIV epidemics among transgender populations: the importance of a trans-inclusive response. J Int AIDS Soc 2016. [DOI: 10.7448/ias.19.3.21259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Bockting W, Coleman E, Deutsch MB, Guillamon A, Meyer I, Meyer W, Reisner S, Sevelius J, Ettner R. Adult development and quality of life of transgender and gender nonconforming people. Curr Opin Endocrinol Diabetes Obes 2016; 23:188-97. [PMID: 26835800 PMCID: PMC4809047 DOI: 10.1097/med.0000000000000232] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW Research on the health of transgender and gender nonconforming people has been limited with most of the work focusing on transition-related care and HIV. The present review summarizes research to date on the overall development and quality of life of transgender and gender nonconforming adults, and makes recommendations for future research. RECENT FINDINGS Pervasive stigma and discrimination attached to gender nonconformity affect the health of transgender people across the lifespan, particularly when it comes to mental health and well-being. Despite the related challenges, transgender and gender nonconforming people may develop resilience over time. Social support and affirmation of gender identity play herein a critical role. Although there is a growing awareness of diversity in gender identity and expression among this population, a comprehensive understanding of biopsychosocial development beyond the gender binary and beyond transition is lacking. SUMMARY Greater visibility of transgender people in society has revealed the need to understand and promote their health and quality of life broadly, including but not limited to gender dysphoria and HIV. This means addressing their needs in context of their families and communities, sexual and reproductive health, and successful aging. Research is needed to better understand what factors are associated with resilience and how it can be effectively promoted.
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Affiliation(s)
- Walter Bockting
- aDivision of Gender, Sexuality, and Health New York State Psychiatric Institute/Columbia Psychiatry and the School of Nursing, Columbia University Medical Center, New York bProgram in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota cSchool of Medicine, University of California, San Francisco, California dDepartment of Psychobiology, National Distance Education University, Madrid, Spain eThe Williams Institute, University of California, Los Angeles School of Law, Los Angeles, California fDivision of Psychiatry, University of Texas Medical Branch, Galveston, Texas gFenway Institute, Fenway Health hDepartment of Epidemiology, Harvard T.H. Chan School of Public Health iDivision of General Pediatrics, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts jSchool of Medicine, University of California, San Fransisco, California kPrivate Practice, Evanston, Illinois
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Reisner SL, Deutsch MB, Bhasin S, Bockting W, Brown GR, Feldman J, Garofalo R, Kreukels B, Radix A, Safer JD, Tangpricha V, T’Sjoen G, Goodman M. Advancing methods for US transgender health research. Curr Opin Endocrinol Diabetes Obes 2016; 23:198-207. [PMID: 26845331 PMCID: PMC4916925 DOI: 10.1097/med.0000000000000229] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW This article describes methodological challenges, gaps, and opportunities in US transgender health research. RECENT FINDINGS Lack of large prospective observational studies and intervention trials, limited data on risks and benefits of sex affirmation (e.g., hormones and surgical interventions), and inconsistent use of definitions across studies hinder evidence-based care for transgender people. Systematic high-quality observational and intervention-testing studies may be carried out using several approaches, including general population-based, health systems-based, clinic-based, venue-based, and hybrid designs. Each of these approaches has its strength and limitations; however, harmonization of research efforts is needed. Ongoing development of evidence-based clinical recommendations will benefit from a series of observational and intervention studies aimed at identification, recruitment, and follow-up of transgender people of different ages, from different racial, ethnic, and socioeconomic backgrounds and with diverse gender identities. SUMMARY Transgender health research faces challenges that include standardization of lexicon, agreed upon population definitions, study design, sampling, measurement, outcome ascertainment, and sample size. Application of existing and new methods is needed to fill existing gaps, increase the scientific rigor and reach of transgender health research, and inform evidence-based prevention and care for this underserved population.
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Affiliation(s)
- Sari L. Reisner
- The Fenway Institute, Fenway Health, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Division of General Pediatrics, Boston Children’s Hospital/Harvard Medical School, Boston, MA
| | - Madeline B. Deutsch
- Department of Family & Community Medicine, University of California – San Francisco, San Francisco, CA
| | - Shalender Bhasin
- Research Program in Men’s Health: Aging and Metabolism Brigham and Women’s Hospital, Harvard Medical School Boston, MA
| | - Walter Bockting
- LGBT Health Initiative, New York State Psychiatric Institute/Columbia Psychiatry and the Columbia University School of Nursing
| | - George R. Brown
- Quillen College of Medicine, East Tennessee State University, Johnson City, TN
| | - Jamie Feldman
- Department of Family Medicine and Community Health, University of Minnesota, School of Medicine, Minneapolis, MN
| | - Rob Garofalo
- Department of Pediatrics, Northwestern University/Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Baudewijntje Kreukels
- Center of Expertise on Gender Dysphoria, Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
| | - Asa Radix
- Callen-Lorde Community Health Center, New York, NY
| | - Joshua D. Safer
- Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Boston University, School of Medicine
| | - Vin Tangpricha
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA
- The Atlanta VA Medical Center, Decatur, GA
| | - Guy T’Sjoen
- Department of Endocrinology and Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta GA
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Fleming PJ, Agnew-Brune C. Current Trends in the study of Gender Norms and Health Behaviors. Curr Opin Psychol 2015; 5:72-77. [PMID: 26075291 DOI: 10.1016/j.copsyc.2015.05.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Gender norms are recognized as one of the major social determinants of health and gender norms can have implications for an individual's health behaviors. This paper reviews the recent advances in research on the role of gender norms on health behaviors most associated with morbidity and mortality. We find that (1) the study of gender norms and health behaviors is varied across different types of health behaviors, (2) research on masculinity and masculine norms appears to have taken on an increasing proportion of studies on the relationship between gender norms and health, and (3) we are seeing new and varied populations integrated into the study of gender norms and health behaviors.
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Affiliation(s)
- Paul J Fleming
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 302 Rosenau Hall, Chapel Hill, NC 27599-7440, (tel) 630-777-0160, (fax) 919-966-2921
| | - Christine Agnew-Brune
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 302 Rosenau Hall, Chapel Hill, NC 27599-7440
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Pinheiro Júnior FML, Kendall C, Martins TA, Mota RMS, Macena RHM, Glick J, Kerr-Correa F, Kerr L. Risk factors associated with resistance to HIV testing among transwomen in Brazil. AIDS Care 2015; 28:92-7. [PMID: 26274065 DOI: 10.1080/09540121.2015.1066751] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Transwomen are a high-risk population for HIV/AIDS worldwide. However, many transwomen do not test for HIV. This study aimed to identify factors associated with resistance to HIV testing among transwomen in Fortaleza/CE. A cross-sectional study was conducted between August and December 2008 with a sample of 304 transwomen recruited through respondent-driven sampling. Data analysis utilized Respondent-Driven Sampling Analysis Tool and SPSS 11.0. Univariate, bivariate, and multivariate analyses examined risk factors associated with resistance to HIV testing. Less than 18 years of age (OR = 4.221; CI = 2.419-7.364), sexual debut before 10 years of age (OR = 6.760; CI = 2.996-15.256), using illegal drugs during sex (OR = 2.384; CI = 1.310-4.339), experience of discrimination (OR = 3.962; CI = 1.540-10.195) and a belief that the test results were not confidential (OR = 3.763; CI = 2.118-6.688) are independently associated with resistance to testing. Intersectoral and targeted strategies aimed at encouraging the adoption of safer sexual behaviors and testing for HIV among transwomen are required.
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Affiliation(s)
| | - C Kendall
- b Department of Global Community Health and Behavioral Sciences , Tulane University , New Orleans , LA , USA
| | - T A Martins
- c Ministry of Health of Ceará State , Fortaleza , Brazil
| | - R M S Mota
- d Department of Statistics and Applied Mathematics , Federal University of Ceará , Fortaleza , Brazil
| | - R H M Macena
- a Department of Community Health , Federal University of Ceará , Fortaleza , Brazil
| | - J Glick
- b Department of Global Community Health and Behavioral Sciences , Tulane University , New Orleans , LA , USA
| | - F Kerr-Correa
- e Department of Neurology and Psychiatry of São Paulo State University , Botucatu , Brazil
| | - L Kerr
- a Department of Community Health , Federal University of Ceará , Fortaleza , Brazil
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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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Wilkerson JM, Iantaffi A, Grey JA, Bockting WO, Simon Rosser BR. Recommendations for internet-based qualitative health research with hard-to-reach populations. QUALITATIVE HEALTH RESEARCH 2014; 24:561-74. [PMID: 24623662 PMCID: PMC4077019 DOI: 10.1177/1049732314524635] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Researchers new to online qualitative health research frequently have questions about how to transfer knowledge of offline data collection to an online environment. In this article, we present best-practice guidelines derived from the literature and our experience to help researchers determine if an online qualitative study design is appropriate for their research project and, if so, when to begin data collection with a hard-to-reach population. Researchers should reflect on administrative, population, and data collection considerations when deciding between online and offline data collection. Decisions must be made regarding whether to conduct interviews or focus groups, to collect data using asynchronous or synchronous methods, and to use only text or to incorporate visual media. Researchers should also reflect on human subjects, recruitment, research instrumentation, additional data collection, and public relations considerations when writing protocols to guide the research team's response to various situations. Our recommendations direct researchers' reflection on these considerations.
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Affiliation(s)
| | - Alex Iantaffi
- University of Minnesota, Minneapolis, Minnesota, USA
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