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Hentges B, Martins RS, da Silva JDRP, Hübner DPG, Leal AF, Teixeira LB, Knauth DR, Veras MADSM. Lifetime sexual violence among transgender women and travestis (TGW) in Brazil: Prevalence and associated factors. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2024; 27Suppl 1:e240013.supl.1. [PMID: 39166585 PMCID: PMC11338532 DOI: 10.1590/1980-549720240013.supl.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 08/23/2024] Open
Abstract
OBJECTIVE To describe the prevalence, characteristics, and factors associated with sexual violence in transgender women and travestis (TGW) in Brazil. METHODS This cross-sectional study was conducted in five Brazilian cities (Campo Grande, Manaus, Porto Alegre, Salvador, and São Paulo) between 2019 and 2021. Participants were recruited using the respondent-driven sampling (RDS) technique. The outcome of interest is the self-reported experience of sexual violence throughout the respondents' lifetime. We evaluated the actions taken by victims of sexual violence and how they dealt with the experience. Logistic regression analysis was employed to examine the associations between sociodemographic and behavioral factors (such as race, income, drug use, sex work, and access to healthcare) and the outcome. RESULTS A total of 1,317 TGW were interviewed. Among them, 53% (n=698) reported experiencing sexual violence. For 64.4% (n=419) of the respondents, sexual violence occurred on more than one occasion. The majority of TGW did not seek health services (93.2%, n=648), disclose the violence (93.9%, n=653), nor seek support from family or friends (86.5%, n=601). A higher prevalence of sexual violence was associated with homelessness (adjusted prevalence ratio - aPR=1.69, 95% confidence interval - 95%CI 1.01-2.84), a history of engaging in sex work (aPR=2.04, 95%CI 1.46-2.85), self-reporting regular, bad, or very bad emotional health (aPR=1.67, 95%CI 1.28-2.19), and experiencing difficulties accessing health services in the previous year (aPR=2.78, 95%CI 1.74-4.43). CONCLUSION The high prevalence of sexual violence, analyzed together with the actions of the victims, indicates a context of high vulnerability and low institutional support. In this scenario, violence can be exacerbated, resulting in severe health consequences.
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Affiliation(s)
- Bruna Hentges
- Universidade Federal do Rio Grande do Sul, Postgraduate Program in Epidemiology –Porto Alegre (RS), Brazil
| | - Rafael Steffens Martins
- Universidade Federal do Rio Grande do Sul, Postgraduate Program in Epidemiology –Porto Alegre (RS), Brazil
| | | | | | - Andréa Fachel Leal
- Universidade Federal do Rio Grande do Sul, Department of Sociology – Porto Alegre (RS), Brazil
| | | | - Daniela Riva Knauth
- Universidade Federal do Rio Grande do Sul, Postgraduate Program in Epidemiology –Porto Alegre (RS), Brazil
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2
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Ruiz-Burga E. Perceived risk and condomless sex practice with commercial and non-commercial sexual partners of male migrant sex workers in London, UK. F1000Res 2023; 10:1033. [PMID: 37928318 PMCID: PMC10622860 DOI: 10.12688/f1000research.73248.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
Background: Since the emergence of HIV and the AIDS pandemic, the majority of risk-reduction interventions have been centred on the use of condoms in sex workers. Methods: This qualitative study recruited 25 male migrant sex workers in London to understand their risk perception and condomless sex experiences within the context of sex work and private life. The data was collected using face-to-face interviews, analysed using thematic analysis, and the findings interpreted through the theory of planned behaviour. Results: The themes explain that condomless sex with clients occurred when participants consciously accepted to perform this service deploying a risk assessment of clients, faulty strategies, and sexual practices to reduce their risk; or when they lost control because of recreational drugs, feeling attraction to clients, were in precarious circumstances, or were victims of violence. Conversely, condomless sex with non-commercial partners occurred according to the type of relationship, with formal partners it was rationalised through emotional aspects attached to this kind of relationship, while with casual partners it was connected to sexual arousal and the use of alcohol and drugs. Conclusions: Reinforce educational interventions to deliver STI-HIV information, enhance the use of condoms, and to address specific contextual factors that facilitate condomless practice with commercial and non-commercial sexual partners.
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Affiliation(s)
- Elisa Ruiz-Burga
- University College London - Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
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3
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Davis DA, Muessig KE, Matthews DD, Angeles G, McNaughton-Reyes L, Guzmán K, Northbrook S, Barrington C. 'She showed me a new path, a way forward': exploring how navigation influences mental health among Guatemalan gay and bisexual men living with HIV. Health Promot Int 2023; 38:daab188. [PMID: 34849870 PMCID: PMC9233178 DOI: 10.1093/heapro/daab188] [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: 11/14/2022] Open
Abstract
Mental health problems, including anxiety and depression, are a common comorbidity among gay, bisexual and other men who have sex with men (GBMSM) living with HIV. Informed by social support theory, health navigation is a strengths-based intervention that has been demonstrated to improve HIV care outcomes. The purpose of this study was to explore how health navigation influences the mental health of GBMSM living with HIV. We analyzed longitudinal qualitative in-depth interviews conducted with GBMSM (n = 29) in a 12-month multi-component intervention to improve HIV care outcomes, including health navigation. We used narrative and thematic analytic approaches to identify salient themes, including if and how themes changed over time. Participants described that navigator support helped them maintain good mental health, prevent crises and respond to crises. Navigator support included providing motivational messaging, facilitating participants' control over their health and improving access to care, which aided with supporting mental health. Navigators also responded to acute crises by providing guidance for those newly diagnosed with HIV and support for those experiencing critical life events. Participants emphasized the importance of feeling heard and valued by their navigators and gaining hope for the future as key to their wellbeing. In conclusion, health navigation may be an effective intervention for promoting mental health among GBMSM living with HIV. Additional research is needed to examine mediating pathways between navigation and mental health, including informational support, or if navigator support moderates the relationship between stressors and mental health outcomes for GBMSM.
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Affiliation(s)
- Dirk A Davis
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive Chapel Hill, NC 27599-7400, USA
| | - Kathryn E Muessig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive Chapel Hill, NC 27599-7400, USA
| | - Derrick D Matthews
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive Chapel Hill, NC 27599-7400, USA
| | - Gustavo Angeles
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive Chapel Hill, NC 27599-7400, USA
| | - Luz McNaughton-Reyes
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive Chapel Hill, NC 27599-7400, USA
| | - Karla Guzmán
- HIV Central America Regional Program, Center for Health Studies, Universidad del Valle de Guatemala, 18 Avenida 11-95, Zona 15, Vista Hermosa III, Guatemala City, Guatemala
| | - Sanny Northbrook
- US Center for Disease Control and Prevention (CDC) Central America Region, 11 calle 15-79, Zona 15, Vista Hermosa III, Guatemala City, Guatemala
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive Chapel Hill, NC 27599-7400, USA
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4
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Miwa T, Yamaguchi M, Ohtsuki T, Oshima G, Wakabayashi C, Nosaka S, Hayashi K, Ikushima Y, Tarui M. Associations between Drug Use and Sexual Risk Behaviours among Men Who Have Sex with Men in Japan: Results from the Cross-Sectional LASH Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6275. [PMID: 37444124 PMCID: PMC10341636 DOI: 10.3390/ijerph20136275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/22/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023]
Abstract
This study assessed drug use patterns among men who have sex with men (MSM) in Japan, and evaluated their potential associations with sexual risk behaviours. Between September and October 2016, study subjects were recruited through a cross-sectional survey (LASH: Love Life and Sexual Health) using a geosocial networking application for MSM. Of the participants, 25.4% (1756/6921) reported ever having used drugs, and 11.3% (780/6921) reported having done so in the past six months. Those who used drugs were more likely to have greater knowledge of HIV/sexually transmitted infections (STIs). Drug use in the past six months was independently associated with each of the following sexual risk behaviours in the same period: (i) six or more sexual partners (adjusted odds ratio [aOR] = 2.70, 95% confidence interval [CI]: 2.30-3.17); (ii) condomless anal intercourse (aOR = 2.88, 95% CI: 2.43-3.42); (iii) group sex (aOR = 2.60, 95% CI: 2.22-3.05); and (iv) sex work (aOR = 2.30, 95% CI: 1.67-3.16). These results suggest that MSM in Japan who use drugs are more likely to report sexual risk behaviours, while also having greater knowledge of HIV/STIs. Supporting MSM to minimise the harm from drug use may be helpful in reducing HIV transmission among this priority population.
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Affiliation(s)
- Takeshi Miwa
- Positive Living and Community Empowerment Tokyo (PLACE TOKYO), 4-11-5-403 Takadanobaba, Shinjuku-ku, Tokyo 169-0075, Japan
| | - Masazumi Yamaguchi
- Hakujikai Choju Rehabilitation Hospital, 5-13-7 Shikahama, Adachi-ku, Tokyo 123-0864, Japan
| | - Tomoko Ohtsuki
- Positive Living and Community Empowerment Tokyo (PLACE TOKYO), 4-11-5-403 Takadanobaba, Shinjuku-ku, Tokyo 169-0075, Japan
| | - Gaku Oshima
- School of Information and Communication, Meiji University, 1-1 Kanda Surugadai, Chiyoda-ku, Tokyo 101-8301, Japan
| | - Chihiro Wakabayashi
- School of Health and Social Services, Saitama Prefectural University, 820 Sannomiya, Koshigaya-shi, Saitama 343-8540, Japan
| | - Sachiko Nosaka
- Graduate School of Human Sciences, Osaka University, 1-2 Yamadaoka, Suita-shi, Osaka 565-0871, Japan
| | - Kanna Hayashi
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - Yuzuru Ikushima
- Positive Living and Community Empowerment Tokyo (PLACE TOKYO), 4-11-5-403 Takadanobaba, Shinjuku-ku, Tokyo 169-0075, Japan
| | - Masayoshi Tarui
- Positive Living and Community Empowerment Tokyo (PLACE TOKYO), 4-11-5-403 Takadanobaba, Shinjuku-ku, Tokyo 169-0075, Japan
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5
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Culbreth RE, Salazar LF, Spears CA, Crosby R, Hayat MJ, Aycock DM. Stressors Associated with Tobacco Use Among Trans Women. Transgend Health 2023; 8:282-292. [PMID: 37342482 PMCID: PMC10277983 DOI: 10.1089/trgh.2020.0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose Tobacco use is prevalent among sexual and gender minorities (SGM), yet few studies have examined the specific drivers of tobacco use among trans women. The purpose of this study is to examine the impact of proximal, distal, and structural stressors associated with tobacco use among trans women. Methods This study is based on a cross-sectional sample of trans women (n=162) living in Chicago and Atlanta. Analyses were conducted to examine the association between stressors, protective factors, and tobacco use using a structural equation modeling framework. Proximal stressors (transgender roles scale, transgender congruence scale, internalized stigma, and internalized moral acceptability) were operationalized as a higher order latent factor, while distal stressors were operationalized as observed variables (discrimination, intimate partner violence, sex work, rape, child sexual abuse, HIV, and violence). Protective factors included social support, trans-related family support, and trans-related peer support. All analyses adjusted for sociodemographic variables (age, race/ethnicity, education, homelessness and health insurance). Results The prevalence of smoking among trans women in this study was 42.9%. In the final model, homelessness (odds ratio [OR]: 3.78; 95% confidence interval [CI]: 1.97, 7.25), intimate partner violence (OR: 2.14; 95% CI: 1.07, 4.28), and commercial sex work (OR: 2.22; 95% CI: 1.09, 4.56) were all associated with tobacco use. There was no association between proximal stressors and tobacco use. Conclusion Among trans women, tobacco use prevalence was high. Tobacco use was associated with homelessness, intimate partner violence, and commercial sex work. Targeted tobacco cessation programs should account for the co-occurring stressors that trans women face.
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Affiliation(s)
- Rachel E. Culbreth
- Department of Respiratory Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, Georgia, USA
- Center for Research on Interpersonal Violence, Georgia State University, Atlanta, Georgia, USA
| | - Laura F. Salazar
- Center for Research on Interpersonal Violence, Georgia State University, Atlanta, Georgia, USA
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Claire A. Spears
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Richard Crosby
- Department of Health Behavior and Society, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
- Kinsey Institute for Research on Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
| | - Matthew J. Hayat
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Dawn M. Aycock
- School of Nursing, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, Georgia, USA
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6
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Afiqah SN, Rashid A, Iguchi Y. Transition experiences of the Malay Muslim Trans women in Northern Region of Malaysia: A qualitative study. DIALOGUES IN HEALTH 2022; 1:100033. [PMID: 38515923 PMCID: PMC10953884 DOI: 10.1016/j.dialog.2022.100033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/07/2022] [Accepted: 08/08/2022] [Indexed: 03/23/2024]
Abstract
Transgender topics are controversial in Malaysia and trans people are subject to stigma and persecution. In this study context, the transition is defined as a phase where a person changes from one gender to the gender that an individual chooses. Little is known about the transgender people's transition experiences in Malaysia. Studies have shown that transition helps boost transgender individuals in most aspects. This study seeks to understand the transition experiences of the Malay Muslim Trans women in Northern Malaysia. A qualitative study using a snowball sampling method was used to interview in-depth 13 trans women. The interviews focused on their gender transition experiences, support systems, family and friends' reactions, and coping strategies. The study found four primary themes: transition, reaction, support system, and coping method. Most of the respondents agreed that they felt conflicted about their gender at a young age and started transitioning when they were adolescents. Overall acceptance and reaction of family and society to their transition was low and not good. Most mentioned the importance of a good support system and that they received essential support from their peers in the transgender community. However, they acknowledged that family support was also crucial for them. All of the respondents specified that they did not regret their gender transition. Although this study gained insight, more is needed to understand in depth a very sensitive subject such as this.
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Affiliation(s)
- Siti Nur Afiqah
- Unit for Research on Women and Gender, School of Social Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Department of Public Health RCSI & UCD Malaysia Campus, Penang, Malaysia
| | - Abdul Rashid
- Department of Public Health RCSI & UCD Malaysia Campus, Penang, Malaysia
| | - Yufu Iguchi
- Ritsumeikan Asia Pacific University, College of Asia Pacific Studies, Oita, Japan
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7
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Pandey AK, Seelman K. History of Sex Work Is Associated with Increased Risk of Adverse Mental Health and Substance Use Outcomes in Transgender Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15908. [PMID: 36497981 PMCID: PMC9735961 DOI: 10.3390/ijerph192315908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/17/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
Understanding factors influencing mental health and substance use in transgender and gender diverse people is critical to reducing disparities in this population. We sought to investigate whether a history of sex work was associated with increased prevalence of poor mental health, substance use, and a negative experience within drug and alcohol treatment facilities. We conducted a secondary analysis of the data of 25,204 transgender respondents of the 2015 United States Transgender Survey. We estimated multiple logistic regressions to assess the association between a history of sex work and adverse mental health and substance use outcomes. We then estimated mean prevalence of adverse outcomes by type of sex work. Finally, we performed chi-square analysis to explore differences in mistreatment at drug and alcohol treatment facilities. Respondents with a history of sex work were significantly more likely to have poorer psychological health, suicidality, and substance use after adjusting for covariates. Among those who visited drug and alcohol treatment facilities, those with a history of sex work were significantly more likely to report adverse experiences (26.34% vs. 11.63%). Our findings highlight the increased risk of adverse outcomes in transgender sex workers and emphasize the need for interventions targeting this subgroup of transgender people.
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Affiliation(s)
- Ajay Keshav Pandey
- Department of Biological Sciences, Augusta University, Augusta, GA 30912, USA
| | - Kristie Seelman
- School of Social Work, Georgia State University, Atlanta, GA 30302, USA
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8
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Davis DA, Duarte G, Villatoro D, Letona P, Barrington C, Wheeler J. Interpersonal violence victimisation, HIV-related behaviours and STIs among adult, urban Indigenous and non-Indigenous gay, bisexual and other men who have sex with men in Guatemala. CULTURE, HEALTH & SEXUALITY 2022; 24:1531-1547. [PMID: 34506249 PMCID: PMC8907936 DOI: 10.1080/13691058.2021.1974948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/27/2021] [Indexed: 06/13/2023]
Abstract
Gay, bisexual and other men who have sex with men are disproportionately affected by HIV in Guatemala; interpersonal violence may increase behaviours that augment the risk of HIV in this group. Although 44% of Guatemalans identify as Indigenous, little information exists on the experiences of Indigenous sexual minority individuals. In this study, we sought to compare different forms of violence and HIV-related behaviours by Indigenous identity among gay, bisexual and other men who have sex with men; and determine if associations between violence and HIV-related behaviours differed by Indigenous identity. We used cross-sectional survey data from 716 Spanish-speaking, adult men recruited from urban centres to examine the prevalence of and relationship between different forms of interpersonal violence and HIV-related behaviours using logistic regression analyses, including the moderating effect of Indigenous identity. In general, fewer Indigenous participants reported interpersonal violence victimisation and HIV-related behaviours compared to their non-Indigenous counterparts. In weighted multivariable analyses, non-Indigenous participants who reported physical and/or sexual violence were over five times as likely to report transactional sex (OR = 5.17, 95% CI 2.11-12.68, p < 0.001), but the relationship was not significant for Indigenous participants. Findings suggest that Indigenous sexual minority men have unique contexts and that additional strengths-based research is needed to ensure that actions and efforts to promote violence and HIV prevention meet their needs.
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Affiliation(s)
- Dirk A. Davis
- Department of Health Behavior, University of North Carolina
at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Paola Letona
- Population Services International (PSI) Guatemala,
Guatemala City, Guatemala
| | - Clare Barrington
- Department of Health Behavior, University of North Carolina
at Chapel Hill, Chapel Hill, NC, USA
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9
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Pinna F, Paribello P, Somaini G, Corona A, Ventriglio A, Corrias C, Frau I, Murgia R, El Kacemi S, Galeazzi GM, Mirandola M, Amaddeo F, Crapanzano A, Converti M, Piras P, Suprani F, Manchia M, Fiorillo A, Carpiniello B. Mental health in transgender individuals: a systematic review. Int Rev Psychiatry 2022; 34:292-359. [PMID: 36151828 DOI: 10.1080/09540261.2022.2093629] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Several lines of evidence indicate the prevalence of mental health disorders in Transgender (TG) individuals is higher than that of cisgender individuals or the general population. In this systematic review, we aim to propose a summary of some of the most significant research investigating mental health disorders' prevalence among this population. We performed a double-blind systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting (PRISMA) on PUBMED/MEDLINE and SCOPUS, specifically using peer-reviewed articles examining the mental health status of transgender (TG) individuals. This review did not exclude any research based on publication date. The last search was performed in February 2022. The employed search strategy led to the selection of 165 peer-reviewed articles. The majority of these papers presented a cross-sectional design with self-reported diagnoses and symptoms, signaling a significant prevalence of mental health disorders amongst TG Individuals. Of the reviewed articles, 72 examined the prevalence of mood and anxiety disorders; 8 examined eating disorders; 43 examined the prevalence of suicidal or self-harm ideation or behaviors; 5 papers examined the prevalence of trauma and stress-related disorders; 10 examined the frequency of personality disorders; 44 examined substance use disorders; and 9 papers examined the prevalence of autism spectrum disorder. Finally, 22 studies reported on the prevalence of TG individuals diagnosed with co-morbid mental health disorders or unspecified mental disorders. Our findings coincide with existing research, which indicates TG individuals do experience a higher prevalence of mental health disorders than that of the general population or cisgender individuals. However, further research is needed to address the existing gaps in knowledge.
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Affiliation(s)
- Federica Pinna
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Pasquale Paribello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Giulia Somaini
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Alice Corona
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Carolina Corrias
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Ilaria Frau
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Roberto Murgia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Sabrina El Kacemi
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Dipartimento ad attività integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Mirandola
- Department of Diagnostics and Public Health, Infectious Diseases Section, University of Verona, Verona, Italy.,School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Andrea Crapanzano
- Department of Counseling, San Francisco State University, San Francisco, California, USA
| | - Manlio Converti
- Dipartimento di salute mentale, ASL Napoli 2 Nord, Naples, Italy
| | - Paola Piras
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Federico Suprani
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy.,Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Bernardo Carpiniello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
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10
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Davis DA, Orellana ER, Estrada-Villalta S, Brouwer KC. COVID-19, violence, and mental health among Indigenous gay and bisexual men in Guatemala: An urgent call from key stakeholders. Glob Public Health 2022; 17:652-661. [PMID: 35282763 PMCID: PMC9118334 DOI: 10.1080/17441692.2022.2049844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We explored how the COVID-19 pandemic has affected the health and wellbeing of Indigenous gay and bisexual men (GBM) in Guatemala, a group that experiences intersectional stigma and structural barriers to health. Between February and May 2021, we conducted in-depth qualitative interviews via Zoom with key stakeholders (n = 11) working with Indigenous GBM throughout Guatemala. We coded thematically and conducted narrative analysis to identify the most salient themes. Participants described that prior to the COVID-19 pandemic, many Indigenous GBM migrated to urban centres to avoid stigma and violence from families and rural communities. After the onset of COVID-19, many Indigenous GBM lost their jobs and were forced to move back in with families. For Indigenous GBM who returned, participants described a perceived increase in the severity of physical and psychological violence. Participants attributed this increase in severity to retribution from families and communities for having left. Most Indigenous GBM-serving organisations reported a drastic increase in demand for mental health services. Organisations serving Indigenous GBM have an urgent need to scale up their mental health services and find innovative ways to provide these services remotely during the pandemic and beyond. Technology-based mental health interventions that require little 'live' interaction may be appropriate.
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Affiliation(s)
- Dirk A. Davis
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, USA
| | | | - Sara Estrada-Villalta
- Department of Psychology, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Kimberly C. Brouwer
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, USA
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Shan D, Ning Z, Yu M, Zheng H, Yang J, Gong H, Li J, Liu H, Liu L, Wang V, Ran X, Han M, Zhang D. HIV incidence and risk factors among transgender women and cisgender men who have sex with men in two cities of China: a prospective cohort study. Infect Dis Poverty 2022; 11:26. [PMID: 35256001 PMCID: PMC8900389 DOI: 10.1186/s40249-022-00947-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 02/14/2022] [Indexed: 02/07/2023] Open
Abstract
Background HIV epidemic among men who have sex with men (MSM) remains a major public health concern in China. Despite a growing body of research on transgender women worldwide, little is known about Chinese transgender women within MSM. We sought to estimate HIV incidence and distinguish risk factors of HIV acquisition among them from that among cisgener (non-transgender) MSM (cis-MSM). Methods We conducted an open cohort study among Chinese MSM, including those who were identified as transgender in Shanghai and Tianjin. Participants were initially recruited by local community-based organizations from January to June, 2016, and were followed up approximately every 6 months until June 2018. At each visit, a structured questionnaire was used to gather information on demographics, sexual risk behaviors, and HIV status. HIV incidence was calculated as the number of seroconversions divided by total number of person-years of follow-up among HIV-negatives at baseline. Risk factors of HIV acquisition were assessed by univariate and multivariate Cox regression models with time-dependent variables. Results A total of 1056 participants contributed 1260.53 person-years (PYs) of follow-up, 33 HIV seroconversions occurred during the follow-up period, yielding an estimated HIV incidence of 2.62 (95% CI 1.80–3.68) per 100 PYs. HIV incidence among transgender women was 4.42 per 100 PYs, which was significantly higher than that of 1.35 per 100 PYs among cis-MSM, demonstrating a threefold higher odds of HIV infection than cis-MSM. For transgender women, those lived locally ≤ 2 years (adjusted hazard ratio [aHR] = 1.76, 95% CI 1.13–2.76) and unprotected anal sex last time (aHR = 4.22, 95% CI 1.82–9.79) were more likely to acquire HIV. For cis-MSM, factors associated with HIV acquisition were frequency of anal sex ≥ 3 times in past one month (aHR = 4.19, 95% CI 1.06–16.47) and unprotected anal sex last time (aHR = 5.33, 95% CI 1.52–18.73). Conclusions Compared to cis-MSM, transgender women were at higher risk of HIV acquisition, highlighting an urgent need of tailored prevention. Future HIV program should consider to include them to ensure that this population in China are not left behind. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40249-022-00947-3.
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Naz-McLean S, Clark JL, Reisner SL, Prenner JC, Weintraub B, Huerta L, Salazar X, Lama JR, Mayer KH, Perez-Brumer A. Decision-Making at the Intersection of Risk and Pleasure: A Qualitative Inquiry with Trans Women Engaged in Sex Work in Lima, Peru. AIDS Behav 2022; 26:843-852. [PMID: 34436712 PMCID: PMC9897010 DOI: 10.1007/s10461-021-03445-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 02/06/2023]
Abstract
To inform culturally relevant HIV prevention interventions, we explore the complexity of sex work among Peruvian transgender women. In 2015, we conducted twenty in-depth interviews and demographic surveys with transgender women in Lima, Peru to examine how transgender women enact individual- and community-level resistance strategies within a context of pervasive marginalization. Although 40% self-identified as "sex workers," 70% recently exchanged sex for money. Participants described nuanced risk-benefit analyses surrounding paid sexual encounters. Classification of clients as "risky" or "rewarding" incorporated issues of health, violence, and pleasure. Interviews highlighted context-informed decision-making (rejecting disrespectful clients, asserting condom use with specific partner types) demonstrating that motivations were not limited to HIV prevention or economic renumeration, but considered safety, health, attraction, gender validation, hygiene, and convenience. These findings underscore the complex risk assessments employed by Peruvian trans women. These individual-level decision-making and context-specific health promotion strategies represent critical frameworks for HIV prevention efforts.
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Affiliation(s)
- Sarah Naz-McLean
- Department of Medicine, Division of Infectious Diseases, Brigham and Women's Hospital, 181 Longwood Ave, Boston, MA, 02115, USA.
| | - Jesse L Clark
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Sari L Reisner
- Department of Medicine, Division of Infectious Diseases, Brigham and Women's Hospital, 181 Longwood Ave, Boston, MA, 02115, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Joshua C Prenner
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Javier R Lama
- Asociación Civil Impacta Salud Y Educación, Lima, Peru
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Kenneth H Mayer
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Beth Israel Lahey Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Amaya Perez-Brumer
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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13
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Pellicane MJ, Ciesla JA. Associations between minority stress, depression, and suicidal ideation and attempts in transgender and gender diverse (TGD) individuals: Systematic review and meta-analysis. Clin Psychol Rev 2022; 91:102113. [PMID: 34973649 DOI: 10.1016/j.cpr.2021.102113] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 02/07/2023]
Abstract
Minority stress theory posits that transgender and gender diverse (TGD) individuals exhibit greater rates of depression and suicidality due to internal (proximal) and external (distal) stressors related to their TGD identity. Yet, the magnitude of the relationship between minority stress processes and mental health outcomes has not been quantitatively summarized. The current research meta-analyzed the relationship between minority stress constructs and depression, suicidal ideation, and suicide attempt. Results from 85 cross-sectional quantitative studies indicate that distal stress, expectations of rejection, internalized transphobia, and concealment are significantly associated with increased depression, suicidal ideation, and suicide attempt. Greater effect sizes were observed for expectations of rejection and internalized transphobia when compared to distal stress and concealment. Future research on the relationship between minority stress, depression, and suicide would benefit from longitudinal designs and more diverse and representative samples of TGD individuals.
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14
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Khan SI, Khan MNM, Irfan SD, Rumayan Hasan AM, Ross AG, Horng LMS, Lachowsky N, Knudson G, Azim T. The Effects of Methamphetamine Use on the Sexual Lives of Gender and Sexually Diverse People in Dhaka, Bangladesh: A Qualitative Study. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:479-493. [PMID: 32239362 PMCID: PMC7529687 DOI: 10.1007/s10508-020-01674-2] [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: 10/03/2019] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 06/11/2023]
Abstract
Methamphetamine use has increased among gender and sexually diverse people in several countries, including Bangladesh. This study aimed to explore the effects of methamphetamine on the sexual lives of these people in Dhaka, Bangladesh. An exploratory qualitative study was conducted, comprising 30 in-depth interviews with gender and sexually diverse people including males having sex with males, male sex workers, and transgender women (hijra) under HIV intervention coverage. Ten key informant interviews were also conducted with individuals who have expertise in relevant disciplines such as drug use, harm reduction, and HIV and AIDS. Digitally recorded data were manually analyzed under the thematic analysis framework. Findings indicated that many participants reported that methamphetamine brought changes in their sexual lives such as increased sexual drive, engagement in group sex, the increased ability to perform serial sex, transactional sex, impulsive and coercive sex, initiation and switching of male-to-male sexual practices, and limited condom use. Key informants noted that there is a dearth of methamphetamine-related services in Bangladesh. Methamphetamine use was found to lead to diverse effects on the sexual lives of gender and sexually diverse people, thus making it a driving force for shaping sexual practices and, hence, sexual risks. Therefore, it is essential for policy-level stakeholders and program managers to consider the risks of methamphetamine use due to their negative ramifications on sexual health, including HIV risks.
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Affiliation(s)
- Sharful Islam Khan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Avenue, Mohakhali, Dhaka, Bangladesh.
| | - Mohammad Niaz Morshed Khan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Avenue, Mohakhali, Dhaka, Bangladesh
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Samira Dishti Irfan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Avenue, Mohakhali, Dhaka, Bangladesh
| | - A M Rumayan Hasan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Avenue, Mohakhali, Dhaka, Bangladesh
| | - Allen G Ross
- Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Lily Ming-Sha Horng
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Nathan Lachowsky
- Faculty of Human and Social Development, School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
| | - Gail Knudson
- Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | - Tasnim Azim
- International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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15
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Santana ADDS, Araújo ECD, Abreu PDD, Lyra J, Lima MSD, Moura JWDS. HEALTH VULNERABILITIES OF TRANSGENDER SEX WORKERS: AN INTEGRATIVE REVIEW. TEXTO & CONTEXTO ENFERMAGEM 2021. [DOI: 10.1590/1980-265x-tce-2020-0475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to identify the health vulnerabilities of transgender sex workers. Method: an integrative review conducted in July 2020 in the PubMed, Web of Science, SCOPUS, CINAHL, IBECS and LILACS databases, with no language or time restrictions. The following descriptors indexed in DeCS and MESH and their respective synonyms were used: “Transgender persons”, “Sex workers” and “Health vulnerability”. The data were analyzed based on thematic analysis. Results: a total of 547 articles were retrieved and, after the selection and analysis process, 34 were included in this review. Four thematic classes emerged: “Knowledge, prevention and exposure to STIs in sex work”; “Use (and abuse) of illegal substances and alcohol”; “The social and structural dimension of vulnerabilities: from weakened support networks to violence reproduced against dissident bodies”; and “Psychosocial diseases, discrimination and challenges of transgender sex workers”. Conclusion: the health vulnerabilities experienced by transgender sex workers are marked by discrimination, social exclusion, stigma, incarceration contexts, physical, psychological and sexual violence and use of illegal substances and alcohol, in addition to difficulties in accessing essential services such as health, education and leisure.
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Affiliation(s)
| | | | | | - Jorge Lyra
- Universidade Federal de Pernambuco, Brasil
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16
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Fan X, Lau JTF, Cai Y, Li J, Ma T, Gu J, Wang Z. Prevalence and associated factors of sexualized drug use in sex work among transgender women sex workers in China. AIDS Care 2020; 33:1098-1106. [PMID: 33258694 DOI: 10.1080/09540121.2020.1851017] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Sexualized drug use (SDU) is associated with a higher risk of HIV transmission. There is a dearth of study investigating the association between sex work characteristics and SDU in sex work among transgender women sex workers. To address these gaps, we conducted a secondary analysis of a cross-sectional study among 220 transgender women sex workers in Shenyang, China. The prevalence of SDU in sex work was 20.9% in the past month. After adjustment for age, HIV status, education, monthly income and duration of stay in Shenyang, performing sex work mainly in hotel rooms, charging higher per episode of commercial sex, depressive symptoms and anxiety symptoms were associated with higher likelihood of SDU in sex work. Future SDU prevention programmes SDU targeting transgender women sex workers should focus on those who charged higher and performed sex work in hotel rooms, and integrate mental health promotion as an essential component.
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Affiliation(s)
- Xiaoyan Fan
- School of Public Health, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Joseph T F Lau
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, People's Republic of China.,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, People's Republic of China
| | - Yong Cai
- Department of Community Health and Family Medicine, School of Public Health, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Jinghua Li
- School of Public Health, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Tiecheng Ma
- Shenyang Consultation Centre of AIDS Aid and Health Service, Shenyang, People's Republic of China
| | - Jing Gu
- School of Public Health, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Zixin Wang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, People's Republic of China.,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, People's Republic of China
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Characterizing the role of intersecting stigmas and sustained inequities in driving HIV syndemics across low-to-middle-income settings. Curr Opin HIV AIDS 2020; 15:243-249. [PMID: 32487815 DOI: 10.1097/coh.0000000000000630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW In 2020, key populations around the world still have disproportionate risks for HIV acquisition and experiencing HIV-related syndemics. This review presents current data around HIV-related syndemics among key populations globally, and on the role of intersecting stigmas in producing these syndemics in low-to-middle-income settings. RECENT FINDINGS Sex workers, sexual and gender minorities, prisoners, and people who use drugs experience high burdens of tuberculosis, sexually transmitted infections, viral hepatitis, and violence linked to heightened HIV-related risks or acquisition. Adverse sexual, reproductive, and mental health outcomes are also common and similarly amplify HIV acquisition and transmission risks, highlighting the need for psychosocial and reproductive health services for key populations. SUMMARY Achieving the promise of biomedical interventions to support HIV care and prevention requires action towards addressing syndemics of HIV, and the stigmas that reproduce them, among those most marginalized globally.
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