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Bird K, Arcelus J, Matsagoura L, O'Shea B, Townsend E. Risk and protective factors for self-harm thoughts and behaviours in transgender and gender diverse people: A systematic review. Heliyon 2024; 10:e26074. [PMID: 38468947 PMCID: PMC10925986 DOI: 10.1016/j.heliyon.2024.e26074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 01/17/2024] [Accepted: 02/07/2024] [Indexed: 03/13/2024] Open
Abstract
Background Self-harm (any self-injury or -poisoning regardless of intent) is highly prevalent in transgender and gender diverse (TGD) populations. It is strongly associated with various adverse health and wellbeing outcomes, including suicide. Despite increased risk, TGD individuals' unique self-harm pathways are not well understood. Following PRISMA guidelines we conducted the first systematic review of risk and protective factors for self-harm in TGD people to identify targets for prevention and intervention. Methods We searched five electronic databases (PubMed, PsychInfo, Scopus, MEDLINE, and Web of Science) published from database inception to November 2023 for primary and secondary studies of risk and/or protective factors for self-harm thoughts and behaviours in TGD people. Data was extracted and study quality assessed using Newcastle-Ottawa Scales. Findings Overall, 78 studies published between 2007 and 2023 from 16 countries (N = 322,144) were eligible for inclusion. Narrative analysis identified six key risk factors for self-harm in TGD people (aged 7-98years) were identified. These are younger age, being assigned female at birth, illicit drug and alcohol use, sexual and physical assault, gender minority stressors (especially discrimination and victimisation), and depression or depressive symptomology. Three important protective factors were identified: social support, connectedness, and school safety. Other possible unique TGD protective factors against self-harm included: chosen name use, gender-identity concordant documentation, and protective state policies. Some evidence of publication bias regarding sample size, non-responders, and confounding variables was identified. Interpretation This systematic review indicates TGD people may experience a unique self-harm pathway. Importantly, the risk and protective factors we identified provide meaningful targets for intervention. TGD youth and those assigned female at birth are at increased risk. Encouraging TGD people to utilise and foster existing support networks, family/parent and peer support groups, and creating safe, supportive school environments may be critical for self-harm and suicide prevention strategies. Efforts to reduce drug and alcohol use and experiences of gender-based victimisation and discrimination are recommended to reduce self-harm in this high-risk group. Addressing depressive symptoms may reduce gender dysphoria and self-harm. The new evidence presented in this systematic review also indicates TGD people may experience unique pathways to self-harm related to the lack of social acceptance of their gender identity. However, robust longitudinal research which examines gender-specific factors is now necessary to establish this pathway.
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Affiliation(s)
- K. Bird
- School of Psychology, University of Nottingham, Nottingham, UK
| | - J. Arcelus
- Institute of Mental Health, University of Nottingham, Nottingham, UK
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - L. Matsagoura
- School of Psychology, University of Nottingham, Nottingham, UK
| | - B.A. O'Shea
- School of Psychology, University of Nottingham, Nottingham, UK
- Department of Psychology, Harvard University, Cambridge, MA, USA
- The Centre for the Experimental-Philosophical Study of Discrimination, Aarhus University, Denmark
| | - E. Townsend
- School of Psychology, University of Nottingham, Nottingham, UK
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Chumakov EM, Ashenbrenner YV, Petrova NN, Ventriglio A, Azarova LA, Limankin OV. Mental health, minority stress and discrimination against transgender people: a cross-sectional survey in Russia. Int Rev Psychiatry 2023; 35:331-338. [PMID: 37267033 DOI: 10.1080/09540261.2023.2182668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 06/03/2023]
Abstract
Mental health needs of transgender people in Russia remain unmet and stigmatised as in many other countries around the globe. The aim of this study was to assess the stressors and perceived need for mental health care among transgender people in Russia. A structured online survey was conducted in November 2019. A total of 588 transgender adults (mean age: 24.0 ± 6.7) was included in the final analysis. An overwhelming majority of respondents (95.1%) reported stress in their lives. Financial burden (73.5%), relationships with relatives (59.4%), and intimate relationships (37.9%) were among the most frequently reported sources of stress. Most of respondents (71.8%) indicated that the psychological distress they perceived interfered with their ability to lead a fulfilling social life. More than half of the respondents (52.4%) had visited a mental health professional prior to their gender transition. Virtually half of them (49%) reported problems related to seeking mental healthcare attributed to stigma. Over one third (37.8%) reported taking non-prescription or off-label medications to improve their well-being or mood. Our study confirmed high rates of psychiatric problems in this vulnerable group and problems in help-seeking. The article also discusses the challenges of providing psychiatric care to transgender people in Russia.
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Affiliation(s)
- Egor M Chumakov
- Department of Psychiatry and Addiction, St. Petersburg State University, St. Petersburg, Russia
- Day in-Patient Clinic, St. Petersburg Psychiatric Hospital No 1 named after P.P. Kaschenko, St. Petersburg, Russia
| | - Yulia V Ashenbrenner
- Day in-Patient Clinic, St. Petersburg Psychiatric Hospital No 1 named after P.P. Kaschenko, St. Petersburg, Russia
| | - Nataliia N Petrova
- Department of Psychiatry and Addiction, St. Petersburg State University, St. Petersburg, Russia
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Larisa A Azarova
- Day in-Patient Clinic, St. Petersburg Psychiatric Hospital No 1 named after P.P. Kaschenko, St. Petersburg, Russia
| | - Oleg V Limankin
- Day in-Patient Clinic, St. Petersburg Psychiatric Hospital No 1 named after P.P. Kaschenko, St. Petersburg, Russia
- Department of Psychotherapy, Medical Psychology and Sexology, North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
- Department of Social Psychiatry and Psychology, St. Petersburg Institute of Postgraduate Improvement of Physicians-experts of the Ministry of Labour and Social Protection, St. Petersburg, Russia
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3
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Abboud S, Veldhuis C, Ballout S, Nadeem F, Nyhan K, Hughes T. Sexual and gender minority health in the Middle East and North Africa Region: A scoping review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100085. [PMID: 38745607 PMCID: PMC11080540 DOI: 10.1016/j.ijnsa.2022.100085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/18/2022] [Accepted: 06/25/2022] [Indexed: 01/05/2023] Open
Abstract
Background Researchers in studies from multiple countries suggest that sexual and gender minority people experience high rates of violence, stigma, and discrimination, as well as mistrust of health care providers and systems. Despite growing evidence related to sexual and gender minority health in North America and Europe, we know little about the health of this population in the Middle East and North Africa. Objectives We aimed to comprehensively examine the literature related to the health of sexual and gender minority people in the Middle East and North Africa and to identify research gaps and priorities. Design We conducted a scoping review informed by the framework recommended by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) tool. Data sources We searched the following databases: PubMed (using Medline All on the Ovid platform), PsycINFO (Ovid), CINAHL (Ebsco), and Embase (Ovid). The search strategy combined terms for the geographic region of interest (Middle East and North Africa) and the population of interest (sexual and gender minority). Each was operationalized using multiple search terms and, where available, controlled vocabulary terms. Review Methods Research articles were identified and assessed for inclusion using an explicit strategy. Relevant information was extracted and synthesized to present a descriptive summary of existing evidence. Results Research designs of the 98 articles we reviewed included quantitative (n = 73), qualitative (n = 20), and mixed methods (n = 5). Most studies were conducted in Lebanon (n = 33), Pakistan (n = 32), and Iran (n = 23) and focused mainly on gender minority individuals (n = 46) and men who have sex with men (n = 32). Five themes emerged from the review: sexual health (52; 53%); mental health (20; 20%); gender identity (17; 17%); violence and discrimination (7; 7%); and experiences with the healthcare system (2; 2%). Although researchers focused on multiple health outcomes in some studies, we included them under the theme most closely aligned with the main objective of the study. Conclusion Although our study is limited to few countries in the Middle East and North Africa region, we found that sexual and gender minority individuals face multiple adverse sexual and mental health outcomes and experience high rates of stigma, discrimination, and violence. More research is needed from countries outside of Lebanon, Pakistan, and Iran, including community-based participatory approaches and multi-level intervention development. Nurses and other healthcare providers in the region need training in providing inclusive care for this population.
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Affiliation(s)
- Sarah Abboud
- University of Illinois Chicago, College of Nursing, Chicago, IL, United States of America
| | - Cindy Veldhuis
- Columbia University, School of Nursing, New York, New York, United States of America
| | - Suha Ballout
- University of Massachusetts Boston, College of Nursing and Health Sciences, Boston, Massachusetts, United States of America
| | | | - Kate Nyhan
- Yale University Cushing/Whitney Medical Library, New Haven, Connecticut, United States of America
| | - Tonda Hughes
- Columbia University, School of Nursing, New York, New York, United States of America
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4
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Sweileh WM. Research Publications on the Mental Health of Transgender People: A Bibliometric Analysis Using Scopus Database (1992–2021). Transgend Health 2022. [DOI: 10.1089/trgh.2022.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Waleed M. Sweileh
- Department of Physiology, Pharmacology/Toxicology, Division of Biomedical Sciences, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
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Hayek SE, Kassir G, Cherro M, Mourad M, Soueidy M, Zrour C, Khoury B. Mental Health of LGBTQ Individuals Who are Arab or of an Arab Descent: A Systematic Review. JOURNAL OF HOMOSEXUALITY 2022:1-23. [PMID: 35499284 DOI: 10.1080/00918369.2022.2060624] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals are at a higher risk of mental illness when compared to their heterosexual and cisgender counterparts. Most research emanates from Western countries, with a paucity of studies in the Arab world. We systematically reviewed studies assessing the mental health of LGBTQ individuals who live in the Arab world or are of Arab descent. Of 261 articles, seven were eligible for analysis. Depression was the most common psychiatric disorder. Suicidal ideations and attempts were frequent in trans women. Post-traumatic stress disorder was also common, with the majority of precipitating traumatic events being related to sexual orientation and/or gender identity. Societal and familial stressors in the Arab culture are major contributors to the increased vulnerability of the LGBTQ community to mental health challenges. Further research is of utmost need while taking into consideration the Arab socio-cultural context.
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Affiliation(s)
- Samer El Hayek
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Jackson Health System, Miami, Florida, USA
| | - Ghida Kassir
- Department of Psychiatry, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Michele Cherro
- Department of Psychiatry, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Marc Mourad
- Department of Psychiatry, Hotel-Dieu de France, Saint-Joseph University, Beirut, Lebanon
| | - Marianne Soueidy
- Department of Psychiatry and Clinical Psychology, Saint George Hospital University Medical Center, Balamand School of Medicine, Beirut, Lebanon
| | - Carmen Zrour
- Department of Psychiatry, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Brigitte Khoury
- Department of Psychiatry, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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Tsang EYH. "Be the Dream Queen": Gender Performativity, Femininity, and Transgender Sex Workers in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11168. [PMID: 34769687 PMCID: PMC8583125 DOI: 10.3390/ijerph182111168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 10/20/2021] [Indexed: 11/29/2022]
Abstract
An under-researched aspect of transgender sex workers in China pertains to their desires and expressions of femininity. Male-to-Female (MTF) transgender sex workers are a high-risk population prone to depression and stress regarding body image, intimate relationships marked by violence, and social stigma, rendering them vulnerable to hate crimes and discrimination. Ethnographic data from in-depth interviews with 49 MTF transgender sex workers indicate that sex, gender and feminine desire are mutable in the construction of self and subjectivity. This study uses the conceptual framework of gender performativity, that is, gender is performative and distinct from physical bodies and binary classifications. It is not only an individual's normative gender expressions which are based on the sex assigned at birth, but it also reinforces the normative gender performances of the gender binary. This article argues that the 49 MTF transgender sex workers are embodiments of gendered performances, displaying femininity to ameliorate hate crimes and discrimination as well as reinforce the masculinity and sexuality of their clients and intimate sex partners. Embracing their femininity constitutes a self-help program, enabling them to build self-confidence and develop a positive self-image in the face of overwhelming social disapproval.
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Affiliation(s)
- Eileen Y H Tsang
- Department of Social and Behavioral Sciences, City University of Hong Kong, Hong Kong 852, China
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Vijayakumar L, Ray S, Fernandes TN, Pathare S. A descriptive mapping review of suicide in vulnerable populations in low and middle countries. Asia Pac Psychiatry 2021; 13:e12472. [PMID: 33817993 DOI: 10.1111/appy.12472] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION In 2016, low-and-middle income countries (LMICs) accounted for 79% of the global suicide deaths. In LMICs, vulnerable groups-women, sexual minorities and refugees, and internally displaced persons (IDPs)-are at high risk of suicidal ideation, attempts and deaths by suicide, but information for designing targeted interventions for them is fragmented and missing, making it difficult to address gaps in the existing system. This review highlights these gaps by mapping: (a) risk factors associated with suicides and suicidal behavior including challenges in implementing targeted programmes for vulnerable groups; and (b) recommendations for effective suicide prevention interventions and strategies in LMICs as documented in the literature. METHODS A descriptive mapping review of literature was conducted. Three electronic databases-PubMed, Google Scholar, and Refworld-were searched for specific keywords. The researchers mapped and reviewed 34 studies on suicide and suicide prevention across three main vulnerable groups. RESULTS This review highlighted the need for gender-specific interventions for women and sexual minorities, addressing gender-based discrimination, access to healthcare, abuse and violence, while for refugees and IDPs, critical concerns are monitoring and understanding suicidal behaviors and to address psychological and emotional responses to resettlement. CONCLUSION In LMICs, specific and unique socio-cultural and environmental factors may increase the risk of vulnerable groups to suicidal behaviors. In order to develop effective and comprehensive suicide prevention strategies, it is crucial to evaluate these differential risk factors and develop culturally appropriate and sensitive interventions and strategies.
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Affiliation(s)
- Lakshmi Vijayakumar
- Department of Psychiatry, VHS, SNEHA (Suicide Prevention Agency), Chennai, India.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Somidha Ray
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | | | - Soumitra Pathare
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
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8
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Chumakov EM, Ashenbrenner YV, Petrova NN, Zastrozhin MS, Azarova LA, Limankin OV. Anxiety and Depression Among Transgender People: Findings from a Cross-Sectional Online Survey in Russia. LGBT Health 2021; 8:412-419. [PMID: 34283658 DOI: 10.1089/lgbt.2020.0464] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Purpose: As we still do not know enough about the mental health concerns of gender minority people in Russia, there is a need to initiate research on these issues. We aimed to examine the frequency of anxiety and depression symptoms in a Russian sample of transgender people. Methods: The study consisted of a structured online survey and was conducted throughout November 2019. The Hospital Anxiety and Depression Scale was used for online screening of anxiety and depression symptoms. A total of 588 transgender adults living in all Federal Districts of Russia (mean age 24.0 ± standard deviation 6.7) was included in the final analysis. Results: It was found that 45.1% (n = 265) and 24.0% (n = 141) of transgender people had clinically significant levels of anxiety and depression, respectively. No statistically significant differences in the prevalence of anxiety and depression were found among those who identified as a transgender man, a transgender woman, or other transgender identities. The anxiety and depression mean scores in the sample were statistically significantly higher than in the general Russian population (p < 0.001). No statistically significant differences were found in the level of depression and anxiety symptoms among respondents in Moscow, St. Petersburg, and other Russian cities. Conclusions: We found high rates of clinical symptoms of depression and anxiety among transgender people, consistent with international research. The study highlights the need for further research on the psychological well-being and mental health of transgender people, and the availability of psychiatric care to transgender people living in Russia.
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Affiliation(s)
- Egor M Chumakov
- Day in-Patient Clinic, St. Petersburg Psychiatric Hospital No 1 named after P.P. Kaschenko, St. Petersburg, Russia.,Department of Psychiatry and Addiction, St. Petersburg State University, St. Petersburg, Russia
| | - Yulia V Ashenbrenner
- Day in-Patient Clinic, St. Petersburg Psychiatric Hospital No 1 named after P.P. Kaschenko, St. Petersburg, Russia
| | - Nataliia N Petrova
- Department of Psychiatry and Addiction, St. Petersburg State University, St. Petersburg, Russia
| | - Michael S Zastrozhin
- Department of Addictology, Moscow Research and Practical Centre on Addictions, Moscow Department of Healthcare, Moscow, Russia.,Department of Addictology, Russian Medical Academy of Continuous Professional Education, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Larisa A Azarova
- Day in-Patient Clinic, St. Petersburg Psychiatric Hospital No 1 named after P.P. Kaschenko, St. Petersburg, Russia
| | - Oleg V Limankin
- Day in-Patient Clinic, St. Petersburg Psychiatric Hospital No 1 named after P.P. Kaschenko, St. Petersburg, Russia.,Department of Psychotherapy, Medical Psychology and Sexology, North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia.,Department of Social Psychiatry and Psychology, St. Petersburg Institute of Postgraduate Improvement of Physicians-Experts of the Ministry of Labour and Social Protection, St. Petersburg, Russia
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9
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Al-Hajj S, Pawliuk C, Smith J, Zheng A, Pike I. History of injury in a developing country: a scoping review of injury literature in Lebanon. J Public Health (Oxf) 2021; 43:e24-e44. [PMID: 32323720 DOI: 10.1093/pubmed/fdaa043] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 12/01/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Lebanon, an Eastern Mediterranean country, suffers a large burden of injury as a consequence of conflict and war, political instability, and the lack of policies and safety regulations. This article aims to systematically map and comprehensively describe the injury research literature in Lebanon and, to identify gaps for future research. METHODS MEDLINE, Embase, Eric and SafetyLit, and the grey literature, including conference proceedings, theses and dissertations, government and media reports, were searched without any date or language limits. Data were extracted from 467 documents using REDCap. RESULTS War-related injuries were the most prevalent type of injury in Lebanon, followed by homicide and other forms of violence. While existing literature targeted vulnerable and at-risk populations, the vast majority focused solely on reporting the prevalence of injuries and associated risk factors. There are considerable gaps in the literature dealing with the integration of preventive programs and interventions across all populations. CONCLUSIONS Lebanon, historically and currently, experiences a high number of injuries from many different external causes. To date, efforts have focused on reporting the prevalence of injuries and making recommendations, rather than implementing and evaluating interventions and programs to inform policies. Future injury related work should prioritize interventions and prevention programs.
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Affiliation(s)
- Samar Al-Hajj
- Health Management and Policy Department, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Colleen Pawliuk
- BC Children's Hospital Research Institute, Vancouver, BC V6H3V4, Canada
| | - Jennifer Smith
- BC Injury Research and Prevention Unit, BC Children's Hospital Research Institute, Vancouver, BC V6H3V4, Canada
| | - Alex Zheng
- BC Injury Research and Prevention Unit, BC Children's Hospital Research Institute, Vancouver, BC V6H3V4, Canada
| | - Ian Pike
- BC Children's Hospital Research Institute, Vancouver, BC V6H3V4, Canada.,BC Injury Research and Prevention Unit, BC Children's Hospital Research Institute, Vancouver, BC V6H3V4, Canada.,Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC V6H3V4, Canada
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10
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Clark K, Pachankis J, Khoshnood K, Bränström R, Seal D, Khoury D, Fouad FM, Barbour R, Heimer R. Stigma, displacement stressors and psychiatric morbidity among displaced Syrian men who have sex with men (MSM) and transgender women: a cross-sectional study in Lebanon. BMJ Open 2021; 11:e046996. [PMID: 33986065 PMCID: PMC8126317 DOI: 10.1136/bmjopen-2020-046996] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Displaced Syrians face psychiatric morbidity often resulting from displacement-related stressors (eg, resource scarcity). Both men who have sex with men (MSM) and transgender women among the displaced Syrians are particularly vulnerable to mental health challenges given that they also often face stigma-related stressors (eg, discrimination). METHODS Between January and December 2019 in greater Beirut, 258 Lebanese-born MSM and transgender women and 230 displaced Syrian MSM and transgender women were recruited via respondent-driven sampling to complete an in-person survey assessing displacement-related stressors, stigma-related stressors, depression, anxiety and post-traumatic stress disorder. In the total sample, we first documented the prevalence of psychiatric morbidity among the displaced Syrians; we then assessed associations among displacement-related and stigma-related stressors and each psychiatric outcome. RESULTS Sixty-three per cent of Syrian participants met criteria for depression compared with 43.8% of Lebanese participants (p<0.001); 21.3% of Syrians met criteria for severe anxiety compared with 13.1% of Lebanese participants (p<0.05) and 33.0% of Syrians met criteria for post-traumatic stress disorder compared with 18.4% of Lebanese participants (p<0.001). Among Syrian MSM and transgender women, sociodemographic characteristics, displacement-related stressors and stigma-related stressors were uniquely associated with psychiatric morbidity. CONCLUSION Displaced Syrian MSM and transgender women experience higher levels of psychiatric comorbidities than Lebanese MSM and transgender women in part due to compounding exposure to displacement-related stressors and stigma-related stressors. Informed by tenets of minority stress theory and intersectionality theory, we discuss mental health intervention implications and future directions.
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Affiliation(s)
- Kirsty Clark
- Social and Behavioral Sciences, Yale University School of Public Health, New Haven, Connecticut, USA
| | - John Pachankis
- Social and Behavioral Sciences, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Kaveh Khoshnood
- Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA
| | | | - David Seal
- Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | | | | | - Russell Barbour
- Biostatistics, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Robert Heimer
- Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA
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11
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Kia H, MacKinnon KR, Abramovich A, Bonato S. Peer support as a protective factor against suicide in trans populations: A scoping review. Soc Sci Med 2021; 279:114026. [PMID: 34010778 DOI: 10.1016/j.socscimed.2021.114026] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/19/2021] [Accepted: 05/07/2021] [Indexed: 11/19/2022]
Abstract
RATIONALE There is a growing body of research involving transgender (trans) individuals that foregrounds elevated rates of suicidality in trans populations. Although peer support is increasingly studied as a protective factor against suicide among trans persons, the scholarship in this area continues to be limited and has yet to be synthesized and appraised. OBJECTIVE In this paper, we address this existing gap in the literature by presenting the results of a scoping review of the literature examining the significance and function of peer support in mitigating suicide risk in trans populations. METHODS This scoping review is based on an analysis of 34 studies that were included following the execution of a methodical search and selection process. Drawing on scoping review methodology, along with PRISMA-P guidelines, we selected peer-reviewed empirical works, published between 2000 and 2020, which examined relationships between providing, seeking, and/or receiving peer support and suicide risk in trans populations. RESULTS Our findings, which are conceptualized using the minority stress model as a guiding theoretical framework, reveal that while the literature generally substantiates the protective significance of peer support for trans persons, a small body of work also uncovers novel and unanticipated sources of peer support, including social support offered by trans peers online, which are infrequently and inconsistently examined in this body of scholarship. CONCLUSIONS Using our appraisal of the literature, we outline the need for future research to further elucidate the significance and function of peer support in protecting against suicide among trans persons. In particular, we discuss the need for exploratory inquiry to inform a conceptualization and operationalization of peer support that more fully and consistently accounts for how such support (including online and community-based support) is sought, received, and experienced among trans persons in the context of suicide.
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Affiliation(s)
- Hannah Kia
- School of Social Work, The University of British Columbia, Vancouver, Canada.
| | | | - Alex Abramovich
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Sarah Bonato
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
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12
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Khoury B, El Khoury J, Fresán Orellana A, Daouk S, Khauli N, Ramadan Z, Reed GM, Robles R. The ICD-11 classification of gender incongruence of adolescence and adulthood: adequacy among transgender people in Lebanon. CULTURE, HEALTH & SEXUALITY 2021; 23:131-142. [PMID: 32031503 DOI: 10.1080/13691058.2019.1692907] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 11/11/2019] [Indexed: 06/10/2023]
Abstract
The aim of this study was to evaluate the adequacy of the then proposed International Classification of Diseases version 11 (ICD-11) diagnostic guidelines for Gender Incongruence of Adolescence and Adulthood in a sample of transgender people accessing multi-disciplinary health care services at specialised organisations in Lebanon. The cross-sectional study reported here was part of the ICD-11 field test studies that took place in several countries. Twenty-eight Arab transgender adults residing in Lebanon were recruited after giving consent to participate in a structured interview with a mental health professional. The questions asked of them consisted of the following: socio-demographic data; medical history related to gender identity; experiences of gender incongruence; psychological distress; rejection; violence; and functional impairment. Results showed that Arab transgender individuals living in Lebanon report being the victims of violence, abuse, discrimination and rejection from family, peers and society in general. As a result, they develop psychological distress that is better explained by the social context in which they live, rather than by their transgender identity. Reformulating ICD-10 Transsexualism as Gender Incongruence of Adolescence and Adulthood in ICD-11 and moving this diagnosis out of the chapter on mental disorders chapter would be favourable to the Lebanese sample.
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Affiliation(s)
- Brigitte Khoury
- Department of Psychiatry, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Joseph El Khoury
- Department of Psychiatry, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ana Fresán Orellana
- Department of Clinical Epidemiology, Sub-Direction of Clinical Research, National Institute of Psychiatry 'Ramón de la Fuente Muñíz', Ministry of Health, Mexico City, Mexico
| | - Sariah Daouk
- Department of Psychiatry, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nicole Khauli
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Zeina Ramadan
- Department of Psychiatry, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Geoffrey M Reed
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Center for Research in Global Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñíz - National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Rebecca Robles
- Department of Models of Attention, Direction of Epidemiological and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñíz, Ministry of Health, Mexico City, Mexico
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Naal H, Abboud S, Harfoush O, Mahmoud H. Examining the Attitudes and Behaviors of Health-care Providers Toward LGBT Patients in Lebanon. JOURNAL OF HOMOSEXUALITY 2020; 67:1902-1919. [PMID: 31125288 DOI: 10.1080/00918369.2019.1616431] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The present cross-sectional descriptive study examined the attitudes and behaviors of health-care providers toward LGBT patients in Lebanon. Participants (N = 141) generally showed positive attitudes and behaviors toward LGBT patients. Mental health providers were significantly less likely to believe that homosexuality is a mental health disorder or that it is unnatural to identify with a gender identity other than one's biological sex when compared to non-mental health providers. Mental health providers were also more likely to be willing to address transgender people by their gender pronouns, and to believe that homosexuality is a natural variation on the sexual orientation spectrum when compared to non-mental health providers. Findings show favorable attitudes and behaviors of health-care providers toward LGBT individuals when compared to previous investigations in Lebanon. Implications on the educational, research, and policy levels are discussed.
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Affiliation(s)
- Hady Naal
- Department of Psychology, Haigazian University , Beirut, Lebanon
- Lebanese Medical Association for Sexual Health , Beirut, Lebanon
| | - Sarah Abboud
- Lebanese Medical Association for Sexual Health , Beirut, Lebanon
- College of Nursing, University of Illinois at Chicago , Chicago, Illinois, USA
| | - Omar Harfoush
- Lebanese Medical Association for Sexual Health , Beirut, Lebanon
- Department of Internal Medicine, Medstar Health Internal Medicine Residency Program , Baltimore, Maryland, USA
| | - Hossam Mahmoud
- Department of Psychiatry, Tufts University School of Medicine , Boston, Massachusetts, USA
- Regroup Therapy , Chicago, Illinois, USA
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Rowniak S, Bolt L, Sharifi C. Effect of cross-sex hormones on the quality of life, depression and anxiety of transgender individuals: a quantitative systematic review. ACTA ACUST UNITED AC 2020; 17:1826-1854. [PMID: 31021971 DOI: 10.11124/jbisrir-2017-003869] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of the review was to evaluate the effectiveness of cross-sex hormone use in improving quality of life and the related measures of depression and anxiety in transgender individuals. INTRODUCTION Transgender medicine as a specialty is still in its infancy and is beginning to attract more primary care providers. The use of hormones to aid in gender transition is expected to provide benefit with regard to quality of life, but there have been few high-quality studies. Two previous systematic reviews were found. One review included studies where participants had gender-affirming surgery, and the other review considered only prospective studies. Both reviews found a benefit with the use of hormones, despite the lack of high-quality studies. To describe outcomes specifically associated with hormone therapy, this review focused on patients who had not yet had surgical interventions, with an aim to inform primary care providers who are considering providing gender transition related-care in their office or clinic. INCLUSION CRITERIA Eligible studies included participants who were transgender (trans) women, trans men or who did not identify with the gender binary and were using cross-sex hormones. This review only considered studies where hormone use was under medical supervision. Studies that included participants who already had any form of gender-affirming surgery were excluded, as were studies that did not use a validated tool to measure quality of life, depression or anxiety. METHODS A comprehensive database search of PubMed, CINAHL, Embase and PsycINFO was conducted in August and September of 2017. The search for unpublished studies and gray literature included Google, the New York Academy of Medicine and the World Professional Association for Transgender Health (WPATH) Conference Proceedings. No date limits were used in any part of the search. Study selection, critical appraisal and data extraction were conducted by two independent reviewers using the JBI protocols, standardized critical appraisal and data extraction tools. RESULTS Seven observational studies met the inclusion criteria for this review. The total number of transgender participants in all the included studies was 552. Population sizes in the studies ranged from 14 to 163. In general, the certainty of the findings was low to very low due to issues with imprecision and indirectness. The use of cross-sex hormones was associated with improved quality of life, depression and anxiety scores, although no causation can be inferred. CONCLUSIONS Transgender participants who were prescribed cross-sex hormones had statistically significant scores demonstrating improvement on the validated scales that measured quality of life, anxiety and depression when compared to transgender people who had enrolled in a sex-reassignment clinic but had not yet begun taking cross-sex hormones. However, because the certainty of this evidence was very low to low, recommendations for hormone use to improve quality of life, depression and anxiety could not be made. High-quality research on this issue is needed, as is the development of a quality-of-life tool specific to the transgender population.
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Affiliation(s)
- Stefan Rowniak
- School of Nursing and Health Professionals, University of San Francisco, San Francisco, USA
| | - Lindsay Bolt
- Institute for Nursing Excellence, University of California, San Francisco (UCSF) Health, San Francisco, USA.,UCSF Centre for Evidence Synthesis & Implementation: a Joanna Briggs Institute Centre of Excellence
| | - Claire Sharifi
- University of San Francisco Gleeson Library, Geschke Center, University of San Francisco, San Francisco, USA
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15
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Hallit S, Obeid S, Haddad C, Hallit R, Akel M, Haddad G, Soufia M, Khansa W, Khoury R, Kheir N, Abi Elias Hallit C, Sacre H, Salameh P. Construction of the Lebanese Anxiety Scale (LAS-10): a new scale to assess anxiety in adult patients. Int J Psychiatry Clin Pract 2020; 24:270-277. [PMID: 32228282 DOI: 10.1080/13651501.2020.1744662] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective: The study objectives were (1) to create a new 10-item scale, the 'Lebanese Anxiety Scale' (LAS-10), inspired by the diagnostic criteria of DSM-5, and the HAM-A and STAI scales and (2) to evaluate the performance of this new scale on a sample of Lebanese individuals.Methods: This cross-sectional study enrolled 1332 community dwelling participants between November 2017 and March 2018.Results: In sample 1, the participants' mean age was 28.08 years (63.9% females). The LAS items converged over a solution of two factors that had an Eigenvalue over 1, explaining a total of 51.97% of the variance (αCronbach=0.857). The optimal cut-off between healthy controls and anxious patients was 13.50 according to the ROC curve. The sensitivity and specificity were good at this cut-off (77.5% and 70.8%, respectively). The area under the curve was high: 0.811 [0.778-0.845]; p < .001. The positive predicted value of the LAS-10 score in sample 1 was 26.9%, whereas the negative predicted value was 95.2%.Conclusion: The results of the present study show that the LAS-10 is a tool that can be used in clinical practice and research to screen for anxiety.KEY POINTSThe positive predicted value of the LAS-10 score was 26.9%.Its negative predicted value was 95.2%.People with scores above 13.5 be referred to a health care professional for further assessment.The LAS-10 is a tool can be used in clinical practice and research to screen for anxiety.Future studies are needed to validate the LAS-10 in other countries.
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Affiliation(s)
- Souheil Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,INSPECT-LB, Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie, Beirut, Lebanon
| | - Sahar Obeid
- Research and Psychology Departments, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Chadia Haddad
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Rabih Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Marwan Akel
- INSPECT-LB, Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie, Beirut, Lebanon.,School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Georges Haddad
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,Research and Psychology Departments, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Michel Soufia
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Wael Khansa
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Rony Khoury
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Nelly Kheir
- Faculty of Pedagogy, Holy Family University, Batroun, Lebanon
| | | | - Hala Sacre
- INSPECT-LB, Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie, Beirut, Lebanon.,Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Lebanon
| | - Pascale Salameh
- INSPECT-LB, Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie, Beirut, Lebanon.,Faculty of Pharmacy, Lebanese University, Beirut, Lebanon.,Faculty of Medicine, Lebanese University, Beirut, Lebanon
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16
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Kaplan RL, El Khoury C, Wehbe S, Lize N, Mokhbat J. Pilot Results from the First HIV/AIDS Intervention Among Transgender Women in the Middle East: Gender Affirmation and Social Support from Within Trans Communities in Beirut, Lebanon. AIDS Res Hum Retroviruses 2020; 36:501-512. [PMID: 31914788 PMCID: PMC7262636 DOI: 10.1089/aid.2019.0203] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Transgender women are 49 times more likely to become HIV positive than all adults worldwide. Data were unavailable for trans women's sexual and mental health in the Middle East and North Africa until 2015-2016, when HIV prevalence (10%) and suicide attempt (46%) rates were established in Lebanon. Because of the lack of evidence-based interventions for this marginalized group, the purpose of this study was to pilot test an adapted intervention, "Baynetna," to assess preliminary impact on mental and sexual health. Using the gender affirmative model and community connectedness and social cohesion constructs, we pilot tested Baynetna among sixteen trans women, who attended 6 weekly 3-h trans-facilitated group-delivered sessions in Beirut with post-test assessments at 1, 3, and 6 months. Each participant acted as her own control; we used paired t-tests to assess changes at follow-up to evaluate potential differences in outcomes. Positive directionality in intervention impact on gender affirmation satisfaction, community connectedness, and social cohesion was demonstrated. An increase in HIV testing proportion between 6 months before and after enrollment was achieved. Higher social cohesion was associated with less suicidal thoughts (p = .05). There was a significant (p = .019) relationship between more community connectedness and lower depression scores. War event exposure was associated with higher anxiety (p = .02; p = .004). Those who reported never having had a sexually transmitted infection had higher gender affirmation satisfaction scores (7.5, 95% confidence interval: 1.4-13.6) (p = .019). Increases in community connectedness, social cohesion, and gender affirmation satisfaction scores confirm Baynetna's proposed mechanisms of impact. Proportional HIV testing increases demonstrate prevention objectives' progress. The significant results contribute to confidence in Baynetna's mechanisms of action and support the hypothesis that the Gender Affirmation model is applicable to the Lebanese context. We have shown for the first time that the adapted intervention, and its constructs, are applicable in this context outside the United States.
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Affiliation(s)
- Rachel L. Kaplan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco (UCSF), San Francisco, California, USA
| | | | | | | | - Jacques Mokhbat
- School of Medicine, Lebanese American University, Beirut, Lebanon
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Lozano-Verduzco I, Melendez R. Transgender individuals in Mexico: exploring characteristics and experiences of discrimination and violence. PSYCHOLOGY & SEXUALITY 2019. [DOI: 10.1080/19419899.2019.1698449] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Rita Melendez
- Department of Sociology and Sexuality Studies, San Francisco State University, San Francisco, CA, USA
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18
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Kaplan RL, El Khoury C, Lize N, Wehbe S, Mokhbat J. Feasibility and Acceptability of a Behavioral Group Support Intervention Among Transgender Women: A Sexual and Mental Health Mixed-Methods Pilot Study in Beirut, Lebanon. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2019; 31:246-258. [PMID: 31145003 PMCID: PMC6594385 DOI: 10.1521/aeap.2019.31.3.246] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Transgender women are among the most at risk of populations for HIV infection and transmission globally. Feasible and acceptable intervention strategies that are culturally and contextually appropriate are urgently needed to address the burden of disease worldwide. The first study to address the unique health needs of transgender women in the Middle East and North Africa, this mixed-methods pilot (N = 16) demonstrated high levels of feasibility and acceptability among adult transgender women in Lebanon as measured quantitatively and qualitatively in the domains of: time allotment, venue, group dynamics, facilitation, content, and retention. The intervention, adapted from an existing trans-facilitated group support intervention, addresses the sexual and mental health of transgender women with mixed HIV status. Next steps should include scale-up, randomization, and testing to determine larger-scale feasibility, acceptability, and efficacy for mitigating sexual and mental health risk and promoting community connectedness and social cohesion.
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Affiliation(s)
- Rachel L Kaplan
- University of California, San Francisco, Department of Obstetrics, Gynecology, and Reproductive Sciences / Bixby Center for Global Reproductive Health and San Francisco State University Center for Research and Education on Gender and Sexuality, San Francisco, California
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Naal H, Abboud S, Mahmoud H. Developing an LGBT-affirming healthcare provider directory in Lebanon. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2018. [DOI: 10.1080/19359705.2018.1538919] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Hady Naal
- Lebanese Medical Association for Sexual Health, Beirut, Lebanon
- Department of Psychology, Haigazian University, Beirut, Lebanon
| | - Sarah Abboud
- Lebanese Medical Association for Sexual Health, Beirut, Lebanon
- Women, Children, and Family Health Sciences, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Hossam Mahmoud
- Lebanese Medical Association for Sexual Health, Beirut, Lebanon
- Department of Psychiatry, Tufts University School of Medicine, Boston, Massachusetts, USA
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20
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Budhwani H, Hearld KR, Milner AN, Charow R, McGlaughlin EM, Rodriguez-Lauzurique M, Rosario S, Paulino-Ramirez R. Transgender Women's Experiences with Stigma, Trauma, and Attempted Suicide in the Dominican Republic. Suicide Life Threat Behav 2018; 48:788-796. [PMID: 28950402 DOI: 10.1111/sltb.12400] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 06/29/2017] [Indexed: 12/01/2022]
Abstract
Studies on attempted suicide in transgender populations, particularly those in resource-limited settings, are scarce. We examined the relationships between stigma, trauma, and suicide attempts in a national sample of transgender women from the Dominican Republic. Bivariate analysis examined differences between suicide attempters and nonattempters (n = 298). Multivariate analysis reported odds ratios with attempted suicide as the outcome (n = 260). About a quarter of respondents (23.9%) experienced sexual abuse, 12.3% were tortured, and 20.3% experienced a murder attempt. More than a quarter reported using illegal drugs. Independent sample t tests found significant differences between suicide attempters and nonattempters. Attempters were more likely to have experienced sexual abuse, psychological abuse, torture, and a murder attempt (p < .001 for all). Respondents who experienced psychological abuse had over three times higher odds of attempting suicide, compared to respondents who had not (OR = 3.203, p < .01). Experience with torture and attempted murder were associated with higher odds of attempting suicide (OR = 2.967, p < .05 and OR = 2.894, p < .05, respectively). Although some nations have implemented antidiscrimination policies protecting transgender citizens, these policies are often not consistently enforced. Eliminating stigmatizing policies may reduce rates of negative health outcomes and subsequently improving population health.
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Affiliation(s)
- Henna Budhwani
- University of Alabama at Birmingham, University Boulevard, Birmingham, USA
| | - Kristine R Hearld
- University of Alabama at Birmingham, University Boulevard, Birmingham, USA
| | | | - Rebecca Charow
- Centro de Orientación e Investigación Integral (COIN), Santo Domingo, Dominican Republic
| | | | - Mayra Rodriguez-Lauzurique
- Centro de Orientacion e Investigación Integral (COIN), Santo Domingo, and Institute for Tropical Medicine & Global Health, Universidad Iberoamericana, Santo Domingo, Dominican Republic
| | - Santo Rosario
- Centro de Orientación e Investigación Integral (COIN), Santo Domingo, Dominican Republic
| | - Robert Paulino-Ramirez
- Institute for Tropical Medicine & Global Health, Universidad Iberoamericana, Santo Domingo, and Centro de Orientación e Investigación Integral (COIN), Santo Domingo, Dominican Republic
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21
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Kaplan RL, El Khoury C, Lize N. Discussions about the health of women should include transgender women. THE LANCET PUBLIC HEALTH 2018; 3:e269. [DOI: 10.1016/s2468-2667(18)30093-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 04/30/2018] [Indexed: 10/14/2022] Open
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22
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Kaplan RL, El Khoury C. The Elephants in the Room: Sex, HIV, and LGBT Populations in MENA. Intersectionality in Lebanon Comment on "Improving the Quality and Quantity of HIV Data in the Middle East and North Africa: Key Challenges and Ways Forward". Int J Health Policy Manag 2017; 6:477-479. [PMID: 28812848 PMCID: PMC5553217 DOI: 10.15171/ijhpm.2016.149] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 11/23/2016] [Indexed: 11/10/2022] Open
Abstract
In response to this insightful editorial, we wish to provide commentary that seeks to highlight recent successes and illuminate the often unspoken hurdles at the intersections of culture, politics, and taboo. We focus on sexual transmission and draw examples from Lebanon, where the pursuit of data in quality and quantity is teaching us lessons about the way forward and where we are experiencing many of the challenges referenced in the editorial such as discrepancies between national statistics and rates derived via research as well as the impact of protracted political conflict and displacement. Two important points were raised in the editorial about HIV in Middle East and North Africa (MENA) that we would like to expand further: (1) The epidemic is largely driven by drug-related and sexual behavior among key populations; and (2) Several key populations continue to be criminalized and excluded from surveillance programs.
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HIV prevalence and demographic determinants of condomless receptive anal intercourse among trans feminine individuals in Beirut, Lebanon. J Int AIDS Soc 2016; 19:20787. [PMID: 27431468 PMCID: PMC4949314 DOI: 10.7448/ias.19.3.20787] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 04/14/2016] [Accepted: 04/25/2016] [Indexed: 11/28/2022] Open
Abstract
Introduction Growing evidence suggests increased HIV incidence in the Middle East and North Africa among “key populations.” To date, epidemiological data have not accurately included and measured HIV prevalence and risk among trans feminine individuals in the region. Through the lens of the Gender Affirmation Framework, we assessed demographic correlates of risk behaviour and the prevalence of HIV among trans feminine individuals in Lebanon. Methods Long-chain referral sampling was used to recruit 53 participants for completion of a behavioural survey and optional free rapid HIV tests. Data were collected using interviewer-administered questionnaires. A multivariable logistic regression model was used to identify demographic determinants of HIV risk behaviour. Results Fifty-seven percent of participants reported condomless receptive anal intercourse (CRAI) with male partner(s) in the last three months, 40% of whom reported not knowing the HIV status of the partner(s). Of the participants tested for HIV as part of the study or via self-report, four (10%) were HIV positive; 13 declined HIV testing. Forty percent of the sample had no prior history of HIV testing. A history of trauma such as sexual abuse/assault was reported by almost half of the participants (49%). Sixty-eight percent reported experiencing physical violence and 32% police arrest, because of gender identity or presentation. A staggering 98% reported having experienced gender identity or gender presentation-related discrimination. Sixty-six percent of the sample reported current sex work; sex work was correlated with CRAI but was not significant in multivariate analysis. In regression analysis, “openness”/“outness” about transgender identity at work or school was significantly associated with CRAI. Surprisingly, a history of sexual abuse/assault was negatively correlated with CRAI, suggesting the need for further inquiry. Conclusions The results of this study provide implications for how to address sexual health among trans feminine individuals in Lebanon and the greater Middle East and North Africa region.
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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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