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Magno L, Leite BO, Sperandei S, Pereira M, Knauth DR, Leal AF, Veras MADSM, Dourado I. Discrimination based on gender identity against transgender women and travestis in Brazil: a latent class analysis and associated factors. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2024; 27Suppl 1:e240012.supl.1. [PMID: 39166584 PMCID: PMC11338540 DOI: 10.1590/1980-549720240012.supl.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/21/2023] [Accepted: 01/02/2024] [Indexed: 08/23/2024] Open
Abstract
OBJECTIVE To identify groups of transgender women and travestis (TGW) with specific patterns of gender-based discrimination (GBD) and analyze the factors associated with GBD. METHODS A cross-sectional study was conducted with TGW recruited through respondent-driven sampling in five Brazilian cities (2019-2021). Latent class analysis was used to characterize GBD (low, medium, and high) using 14 observable variables. Descriptive analysis was performed, and associations between predictor variables and GBD were estimated by adjusted odds ratios (aOR) using ordinal logistic regression. RESULTS Out of a total of 1,317 TGW, 906 (68.8%) answered questions about GBD. Most were under 34 years old, single, and had a Brown race/skin color. GBD was classified as "low," "medium," and "high," with estimates of 41.7, 44.5, and 13.8%, respectively. Variables positively associated with higher intensity of GBD included living in Manaus compared to São Paulo, being ≤34 years old compared to >34, being homeless compared to living in one's own house or rented apartment, not having legally changed one's name compared to those who had, and reporting physical or sexual violence compared to those who did not report. Variables negatively associated with higher intensity of GBD included having a Brown or Asian race/skin color compared to White and a monthly income ≥1 minimum wage compared to ³1. CONCLUSION A high proportion of GBD was observed in Brazilian TGW, with this outcome associated with more vulnerable sociodemographic characteristics and a history of violence.
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Affiliation(s)
- Laio Magno
- Universidade do Estado da Bahia, Department of Life Sciences – Salvador (BA), Brazil
- Universidade Federal da Bahia, Institute of Public Health – Salvador (BA), Brazil
| | - Beo Oliveira Leite
- Universidade Federal da Bahia, Institute of Public Health – Salvador (BA), Brazil
| | - Sandro Sperandei
- Western Sydney University, Translational Health Research Institute – Penrith (NSW), Austrália
| | - Marcos Pereira
- Universidade Federal da Bahia, Institute of Public Health – Salvador (BA), Brazil
| | - Daniela Riva Knauth
- Universidade Federal do Rio Grande do Sul, School of Medicine, Department of Social Medicine – Porto Alegre (RS), Brazil
| | - Andréa Fachel Leal
- Universidade Federal do Rio Grande do Sul, Institute of Philosophy and Human Sciences, Department of Sociology – Porto Alegre (RS), Brazil
| | | | - Inês Dourado
- Universidade Federal da Bahia, Institute of Public Health – Salvador (BA), Brazil
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Leite BO, Dourado I, Magno L, Sperandei S, Luppi CG, Veras MADSM. Factors associated with prior testing for HIV, Syphilis, and Hepatitis B and C among transgender women and travestis in Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2024; 27Suppl 1:e240008.supl.1. [PMID: 39166580 PMCID: PMC11338533 DOI: 10.1590/1980-549720240008.supl.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/18/2023] [Accepted: 01/03/2024] [Indexed: 08/23/2024] Open
Abstract
OBJECTIVE To investigate the prior testing for HIV, syphilis, hepatitis B (HBV), and hepatitis C (HCV) among transgender women and travestis (TGW) in five Brazilian cities and identify factors associated with each of these previous tests. METHODS This is a cross-sectional study with the recruitment of TGW through respondent-driven sampling (TransOdara Study). The investigated outcome variable was prior testing for HIV, syphilis, HBV, and HCV in the last 12 months. The association between sociodemographic and behavioral factors with the outcome was analyzed using a binomial logistic regression with mixed effects. Adjusted odds ratios (aOR) and 95% confidence intervals (CI95%) were estimated. RESULTS The proportions of individuals with prior testing in the past year were as follows: 56.3% for HIV, 58.0% for syphilis, 42.1% for HBV, and 44.7% for HCV. Negative associations with prior testing were observed for individuals aged 35 years or older, whereas positive associations were found for those with high school education, those who experienced verbal or psychological violence in the last 12 months, and those who had commercial or casual partners in the last 6 months. CONCLUSION There was low frequency of testing in the 12 months preceding the study for HIV, syphilis, HBV, and HCV compared to the guidelines established by the Ministry of Health. Expanding access to and engagement with healthcare and prevention services for TGW is an essential strategy in reducing the transmission chain of HIV and other sexually transmitted infections (STIs).
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Affiliation(s)
- Beo Oliveira Leite
- Universidade Federal da Bahia, Institute of Public Health – Salvador (BA), Brazil
| | - Inês Dourado
- Universidade Federal da Bahia, Institute of Public Health – Salvador (BA), Brazil
| | - Laio Magno
- Universidade Federal da Bahia, Institute of Public Health – Salvador (BA), Brazil
- Universidade do Estado da Bahia, Life Sciences Department – Salvador (BA), Brazil
| | - Sandro Sperandei
- Western Sydney University, Translational Health Research Institute – Penrith, Astralia
| | - Carla Gianna Luppi
- Universidade Federal de São Paulo, Paulista School of Medicine, Preventive Medicine Department – São Paulo (SP), Brazil
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Silva‐Santisteban A, Apedaile D, Perez‐Brumer A, Leon SR, Huerta L, Leon F, Aguayo‐Romero R, Reisner SL. HIV vulnerabilities and psychosocial health among young transgender women in Lima, Peru: results from a bio-behavioural survey. J Int AIDS Soc 2024; 27:e26299. [PMID: 39041820 PMCID: PMC11264345 DOI: 10.1002/jia2.26299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 05/15/2024] [Indexed: 07/24/2024] Open
Abstract
INTRODUCTION Peruvian young transgender women (YTW) ages 16-24 years are a critical but understudied group for primary HIV prevention efforts, due to sharp increases in HIV prevalence among TW ages 25 years and older. METHODS Between February and July 2022, a cross-sectional quantitative study with YTW ages 16-24 years in Peru (N = 211) was conducted consisting of a bio-behavioural survey accompanied by laboratory-based testing for HIV and sexually transmitted infections (STIs). Bivariate and multivariable Poisson regression models were used to estimate prevalence ratios between socio-demographic and behavioural characteristics and HIV status. RESULTS HIV prevalence was 41.5% (95% CI: 33.9-49.4%), recent syphilis acquisition 19.4% (95% CI: 12.7-28.4), chlamydia 6.3% (95% CI: 3.1-11.1) and gonorrhoea 12.3% (95% CI: 7.9-18.7). Almost half (47.9%) reported condomless anal sex in the past 6 months, 50.7% reported sex work in the past 30 days and 13.7% reported accepting more money for condomless sex. There were no significant differences in reported sexual behaviours by HIV status. Only 60.8% of participants reported ever having been tested for HIV, and 25.6% reported a past 6-month STI test. More than two-thirds (67.8%) had not heard of antiretroviral pre-exposure prophylaxis (PrEP) and only 4.7% had taken PrEP in the past month. Current moderate-to-severe psychological distress was endorsed by 20.3%, 10.0% reported attempting suicide in the past 6 months and 85.4% reported alcohol misuse. CONCLUSIONS Findings show that the HIV epidemic for YTW in Lima, Peru is situated in the context of widespread social exclusion, including economic vulnerabilities, violence victimization and the mental health sequelae of transphobic stigma that starts early in life. Future research should aim to further understand the intersection of these vulnerabilities. Moreover, there is an urgent necessity to design and evaluate HIV prevention programmes that address the root systems driving HIV vulnerabilities in YTW and that focus on developmentally specific clusters of stigma-related conditions.
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Affiliation(s)
- Alfonso Silva‐Santisteban
- Center for Interdisciplinary Research in SexualityAIDS and SocietyUniversidad Peruana Cayetano HerediaLimaPeru
| | - Dorothy Apedaile
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Amaya Perez‐Brumer
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Segundo R. Leon
- Escuela Profesional de Tecnología MédicaUniversidad Privada San Juan BautistaLimaPeru
| | | | - Francezka Leon
- Center for Interdisciplinary Research in SexualityAIDS and SocietyUniversidad Peruana Cayetano HerediaLimaPeru
| | - Rodrigo Aguayo‐Romero
- Division of EndocrinologyDiabetes, and HypertensionBrigham and Women's HospitalBostonMassachusettsUSA
- Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- The Fenway InstituteFenway HealthBostonMassachusettsUSA
| | - Sari L. Reisner
- Division of EndocrinologyDiabetes, and HypertensionBrigham and Women's HospitalBostonMassachusettsUSA
- Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- The Fenway InstituteFenway HealthBostonMassachusettsUSA
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Morel Z, Aguilar G, Samudio T, López G, Rios-González CM, Giménez L, Schaerer C, Gómez S, Báez T, Estigarribia G, Méndez J, Muñoz S, McFarland W. Intergenerational sex and early sexual debut are associated with HIV infection among transgender women in Paraguay. HIV Med 2023; 24:990-999. [PMID: 37128161 PMCID: PMC10792994 DOI: 10.1111/hiv.13496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/22/2023] [Indexed: 05/03/2023]
Abstract
INTRODUCTION HIV prevalence among transgender women is high worldwide. The objectives of the present study were to estimate the current prevalence of HIV and identify factors associated with high HIV burden among transgender women in Paraguay. METHODS Transgender women aged ≥15 years in four regions of Paraguay were recruited by Starfish sampling between February and March 2021. RESULTS In total, 322 transgender women were included. Mean age was 31 years (range 15-67), and 102 had positive HIV test results (31.7%, 95% confidence interval [CI] 26.6-37.1). In multivariable analysis, factors associated with HIV infection were age at first intercourse ≤17 years (adjusted odds ratio [aOR] 5.47; 95% CI 1.05-28.42), >10 years difference in age with the last sexual partner (aOR 1.60; 95% CI 1.04-2.46), substance use (mostly cocaine) (aOR 3.00; 95% CI 1.47-6.12), higher risk perception (aOR 3.08; 95% CI 1.53-6.17), not testing for HIV (aOR 1.23; 95% CI 1.09-1.39), and accessed by a peer educator (aOR 3.86; 95% CI 1.77-8.38). CONCLUSIONS Sexual debut as a minor and a large age difference with sexual partners are associated with high burden of HIV among transgender women in Paraguay. Our study corroborates the finding of cocaine use during sex as a risk factor for HIV. Prevention programmes must address structural and social vulnerabilities to stem the tragically high burden of HIV among transgender women.
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Affiliation(s)
- Zoilo Morel
- Universidad Nacional de Asunción. Facultad de Ciencias Médicas. Paraguay
| | - Gloria Aguilar
- Universidad Nacional de Asunción. Facultad de Ciencias Médicas. Paraguay
- Departamento de Salud Pública, Universidad de la Frontera. Temuco, Chile
| | - Tania Samudio
- National Control Program for HIV/AIDS/STI, Ministry of Public Health and Social Welfare. Asuncion, Paraguay
| | - Gladys López
- National Control Program for HIV/AIDS/STI, Ministry of Public Health and Social Welfare. Asuncion, Paraguay
| | | | - Liliana Giménez
- National Control Program for HIV/AIDS/STI, Ministry of Public Health and Social Welfare. Asuncion, Paraguay
| | - Christian Schaerer
- Polytechnic School, National University of Asuncion, San Lorenzo. Paraguay
| | - Santiago Gómez
- Universidad Nacional de Asunción. Facultad de Ciencias Médicas. Paraguay
| | | | - Gladys Estigarribia
- Universidad Nacional de Caaguazu. Regional Health Research Institute. Paraguay
| | - Julieta Méndez
- National Control Program for HIV/AIDS/STI, Ministry of Public Health and Social Welfare. Asuncion, Paraguay
- Universidad Nacional de Caaguazu. Regional Health Research Institute. Paraguay
| | - Sergio Muñoz
- Departamento de Salud Pública, Universidad de la Frontera. Temuco, Chile
| | - Willi McFarland
- Center for Public Health Research, San Francisco Department of Public Health. San Francisco, CA, USA
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Wolfe HL, Drainoni ML, Klasko-Foster L, Fix GM, Siegel J, Mimiaga MJ, Reisner SL, Hughto JM. Structural Equation Modeling of Stigma and HIV Prevention Clinical Services Among Transgender and Gender Diverse Adults: The Mediating Role of Substance Use and HIV Sexual Risk. J Acquir Immune Defic Syndr 2023; 92:300-309. [PMID: 36515898 PMCID: PMC9974738 DOI: 10.1097/qai.0000000000003144] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Transgender and gender diverse (TGD) adults experience high levels of stigma that contributes to elevated substance use and HIV sexual risk behaviors. Despite higher burdens of substance use and HIV compared to cisgender adults, TGD individuals may be less likely to engage in health care to avoid further discrimination. SETTING This analysis included 529 TGD adults in Massachusetts and Rhode Island who were HIV negative or had an unknown HIV serostatus and were purposively sampled between March and August 2019. METHODS We used structural equation modeling to test whether substance use, HIV sexual risk behaviors (ie, condom use, sex work, and multiple partners), and receiving gender-affirming hormone therapy mediate any observed association between TGD-related stigma and utilization of HIV prevention clinical services (ie, HIV prevention programs, PrEP use, and HIV testing). RESULTS Substance use and HIV sexual risk mediated the relationship between TGD-related stigma and utilization of HIV prevention clinical services (β = 0.08; 95% CI = 0.05, 0.17; P = 0.03 and β = 0.26; 95% CI = 0.14 to 0.37; P < 0.001). Having a hormone therapy prescription was not a mediator between TGD-related stigma and HIV prevention clinical services. CONCLUSIONS Future interventions that aim to improve HIV prevention clinical services among TGD adults should consider the impact of TGD-related stigma on participants' substance use and sexual risk behaviors. These efforts require that health care organizations and community organizations make a deliberate investment in the reach and success of interventions and programs.
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Affiliation(s)
- Hill L. Wolfe
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA
- Evans Center for Implementation and Improvement Sciences, Boston University, Boston, MA
| | - Lynne Klasko-Foster
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Gemmae M. Fix
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA
| | - Jennifer Siegel
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA
- Transgender Health Program, Massachusetts General Hospital, Boston, MA
| | - Matthew J. Mimiaga
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, RI
- The Fenway Institute, Fenway Health, Boston, MA
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA
- Department of Psychiatry and Biobehavioral Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- University of California Los Angeles Center for LGBTQ Advocacy, Research & Health, Los Angeles, CA
| | - Sari L. Reisner
- The Fenway Institute, Fenway Health, Boston, MA
- General Medicine, Harvard Medical School, Boston, MA
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jaclyn M.W. Hughto
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, Rhode Island
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
- Department of Epidemiology, Brown University School of Public Health, Providence, RI
- The Fenway Institute, Fenway Health, Boston, MA
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Leite BO, Magno L, Soares F, MacCarthy S, Brignol S, Bastos FI, Dourado I. HIV prevalence among transgender women in Northeast Brazil – Findings from two Respondent Driven Sampling studies. BMC Public Health 2022; 22:2120. [DOI: 10.1186/s12889-022-14589-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/10/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background
The HIV epidemic still high among key-populations in Brazil, especially among transgender women (TGW). The aim of this study was to investigate the prevalence of HIV infection among TGW and to analyze factors associated with HIV seropositivity across two cross-sectional surveys conducted in Salvador, Bahia, one of the largest urban centers of Brazil.
Methods
The studies were conducted between 2014 and 2016 and 2016-2017 and employed Respondent-Driven Sampling (RDS) sampling, comprising 127 and 161 TGW residents of Salvador, Bahia. The outcome was the positive rapid antigen testing for HIV infection. Odds ratios (OR) and 95% confidence intervals (95%CI) were obtained using binomial logistic regression.
Results
The HIV prevalence was 9.0% (95%CI: 4.2-18.2) and 24.3% (95%CI: 16.2-34.9). In the first study, factors associated with HIV prevalence were experiencing discrimination by the family (OR 8.22; 95%CI: 1.49-45.48) and by neighbors (OR 6.55; 95%CI: 1.12-38.14) as well as having syphilis (OR 6.56; 95%CI:1.11-38.65); in the subsequent study gender-based discrimination (OR 8.65; 95%CI:1.45-51.59) and having syphilis (OR 3.13; 95%CI: 1.45-51.59) were associated with testing positive for HIV.
Conclusion
We found disproportionately high HIV prevalence among TGW, which underscores the context of vulnerability for this population. The data point to the urgency for intensification and expansion of access to HIV prevention and strategies to stop discrimination in health care and services for this population.
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Paulino-Ramírez R, Hearld KR, Butane SA, Tapia L, Budhwani H, Naar S, Rodriguez-Lauzurique M. Serological Confirmed Syphilis Among Transgender Women in Dominican Republic. Transgend Health 2022; 7:237-241. [PMID: 35785048 PMCID: PMC9245724 DOI: 10.1089/trgh.2020.0173] [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: 02/04/2023] Open
Abstract
Purpose Transgender women (TW) in the Dominican Republic (DR) are at high risk for syphillis infection. Although treatable, infection rates remain at epidemic proportions. Methods In 2016, we conducted a national survey, with serological sampling of TW in the DR (n=255). Results In our sample, syphillis seropositivity was 47.45%. There was a statistically significant association between age (t=-2.93, df, p<0.01), arrest history (χ 2=8.15, p<0.01), exposure to violence (χ 2=3.73, p<0.05), and syphilis seropositivity. Multivariate analyses show TW arrested in the past 6 months have higher odds of seropositivity (odds ratio=2.05, confidence interval: 1.04-4.06, p<0.05). Conclusions There is a need for education and public health campaigns focused on TW specifically.
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Affiliation(s)
- Robert Paulino-Ramírez
- Instituto de Medicina Tropical & Salud Global, Universidad Iberoamericana (UNIBE), Santo Domingo, Dominican Republic
| | - Kristine R Hearld
- School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Seyram A Butane
- Center for Translational Behavioral Science (CTBScience), Florida State University College of Medicine (FSU), Tallahassee, Florida, USA
| | - Leandro Tapia
- Instituto de Medicina Tropical & Salud Global, Universidad Iberoamericana (UNIBE), Santo Domingo, Dominican Republic
| | - Henna Budhwani
- School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Sylvie Naar
- Center for Translational Behavioral Science (CTBScience), Florida State University College of Medicine (FSU), Tallahassee, Florida, USA
| | - Mayra Rodriguez-Lauzurique
- Instituto de Medicina Tropical & Salud Global, Universidad Iberoamericana (UNIBE), Santo Domingo, Dominican Republic.,Centro de Orientación e Investigación Integral (COIN), Santo Domingo, Dominican Republic
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Campbell MH, Gromer J, Emmanuel MK, Harvey A. Attitudes Toward Transgender People Among Future Caribbean Doctors. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:1903-1911. [PMID: 34782942 DOI: 10.1007/s10508-021-02205-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 10/23/2021] [Accepted: 10/25/2021] [Indexed: 06/13/2023]
Abstract
The attitudes of medical students toward transgender people have important implications for the future quality of healthcare for Caribbean transgender patients. This paper examined the attitudes and beliefs of Caribbean medical students toward transgender people, provides psychometric evaluation of a promising instrument, and considers implications for the development of transgender curricula in Caribbean medical education. Medical students (N = 205; 155 women, 43 men, 7 unstated) enrolled at a publicly supported Caribbean university completed the Transgender Attitudes and Beliefs Scale (TABS; Kanamori et al., 2017). Internal consistency was strong for the total TABS (α = .93) and more variable for the three subscales: interpersonal comfort (IC: α = .91), sex/gender beliefs (SGB: α = .89), and human value (HV: α = .74). Confirmatory factor analysis demonstrated acceptable overall fit for the three-factor model. There were no significant gender differences in overall attitudes toward transgender people as measured by the total TABS score; women reported higher IC scores. Scores were not correlated with age or with year in medical school. Students reported significantly more tolerant attitudes on the HV scale than on IC or SGB scales. Psychometric findings establish measurement invariance and provide support for further use of the TABS in the Caribbean. We discuss implications for medical curriculum development, including use of the TABS as a tool for medical students to reflect on their individual attitudes and beliefs regarding transgender people.
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Affiliation(s)
- Michael H Campbell
- Faculty of Medical Sciences, The University of the West Indies-Cave Hill, Bridgetown, BB11000, Barbados.
| | - Jill Gromer
- College of Social Work, Florida State University, Tallahassee, FL, USA
| | - Maisha K Emmanuel
- Faculty of Medical Sciences, The University of the West Indies-Cave Hill, Bridgetown, BB11000, Barbados
| | - Arianne Harvey
- Faculty of Medical Sciences, The University of the West Indies-Cave Hill, Bridgetown, BB11000, Barbados
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Stutterheim SE, van Dijk M, Wang H, Jonas KJ. The worldwide burden of HIV in transgender individuals: An updated systematic review and meta-analysis. PLoS One 2021; 16:e0260063. [PMID: 34851961 PMCID: PMC8635361 DOI: 10.1371/journal.pone.0260063] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 11/02/2021] [Indexed: 12/17/2022] Open
Abstract
Introduction Transgender individuals are at risk for HIV. HIV risks are dynamic and there have been substantial changes in HIV prevention (e.g., pre-exposure prophylaxis [PrEP]). It is thus time to revisit HIV prevalence and burden among transgender individuals. The objective of this systematic review and meta-analysis was thus to examine worldwide prevalence and burden of HIV over the course of the epidemic among trans feminine and trans masculine individuals. Methods We conducted an updated systematic review by searching PsycINFO, PubMed, Web of Science, and Google Scholar, for studies of any research design published in in a peer-reviewed journal in any language that reported HIV prevalence among transgender individuals published between January 2000 and January 2019. Two independent reviewers extracted the data and assessed methodological quality. We then conducted a meta-analysis, using random-effects modelling, to ascertain standardized prevalence and the relative burden of HIV carried by transgender individuals by country and year of data collection, and then by geographic region. We additionally explored the impact of sampling methods and pre-exposure prophylaxis (PrEP). Results Based on 98 studies, overall standardized HIV prevalence over the course of the epidemic, based on weights from each country by year, was 19.9% (95% CI 14.7% - 25.1%) for trans feminine individuals (n = 48,604) and 2.56% (95% CI 0.0% - 5.9%) for trans masculine individuals (n = 6460). Overall OR for HIV infection, compared with individuals over age 15, was 66.0 (95% CI 51.4–84.8) for trans feminine individuals and 6.8 (95% CI 3.6–13.1) for trans masculine individuals. Prevalence varied by geographic region (13.5% - 29.9%) and sampling method (5.4% - 37.8%). Lastly, PrEP effects on prevalence could not be established. Conclusion Trans feminine and trans masculine individuals are disproportionately burdened by HIV. Their unique prevention and care needs should be comprehensively addressed. Future research should further investigate the impact of sampling methods on HIV prevalence, and monitor the potential impact of PrEP.
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Affiliation(s)
- Sarah E. Stutterheim
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
- * E-mail:
| | - Mart van Dijk
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Haoyi Wang
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Kai J. Jonas
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
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Leite BO, de Medeiros DS, Magno L, Bastos FI, Coutinho C, de Brito AM, Cavalcante MS, Dourado I. Association between gender-based discrimination and medical visits and HIV testing in a large sample of transgender women in northeast Brazil. Int J Equity Health 2021; 20:199. [PMID: 34488781 PMCID: PMC8422640 DOI: 10.1186/s12939-021-01541-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/24/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Gender-based discrimination remains a substantial barrier to health care access and HIV prevention among transgender women in Brazil. The aim of this study was to investigate the association between gender-based discrimination and medical visits, as well as with HIV testing among transgender women in the last 12 months in northeast Brazil. METHODS This is a cross-sectional study of 864 transgender women recruited using Respondent-Driven Sampling in three cities in northeastern Brazil in 2016. A socio-behavioral questionnaire was applied. Multivariate analyses were performed using logistic regression, with odds ratio and respective 95% confidence intervals estimation, to estimate the effect of gender-based discrimination on two outcomes: i) medical visits and ii) HIV testing in the last 12 months. RESULTS 547 transgender women (67·0%) had medical visits, and 385 (45·8%) underwent HIV testing in the last 12 months. In the multivariate analysis, gender-based discrimination was associated with a reduced likelihood of medical visits (OR: 0·29; 95%CI: 0·14-0·63) and HIV testing (OR: 0·41; 95%CI: 0·22-0·78) in the last 12 months. CONCLUSION Gender-based discrimination played an essential role in reducing the access of TGW to medical visits and HIV testing services. Furthermore, by confirming the association between gender-based discrimination and medical visits and HIV testing in the multivariate analysis, we have demonstrated how this predictive variable can affect by reducing access to health services. The findings point to the need for non-discriminatory policies based on the defense and promotion of human rights that may foster the access of transgender women to Brazilian health services.
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Affiliation(s)
- Beo Oliveira Leite
- Multidisciplinary Health Institute, Federal University of Bahia, Vitória da Conquista, Bahia, Brazil
- Collective Health Institute, Federal University of Bahia. Av. Basílio da Gama, s/nCampus Universitário do Canela, Salvador, Bahia 40110-040 Brazil
| | | | - Laio Magno
- Collective Health Institute, Federal University of Bahia. Av. Basílio da Gama, s/nCampus Universitário do Canela, Salvador, Bahia 40110-040 Brazil
- Life Sciences Department, Bahia State University, Campus1, Salvador, Bahia Brazil
| | | | | | | | | | - Inês Dourado
- Collective Health Institute, Federal University of Bahia. Av. Basílio da Gama, s/nCampus Universitário do Canela, Salvador, Bahia 40110-040 Brazil
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11
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Wang L, Barile JP, Simoni JM, Harris R, Yue Q, Fu J, Zheng H, Ning Z, Wong FY. Intimate Partner Violence Among Chinese Transwomen: Associations With Sexual Risk Behaviors and HIV Testing. Sex Transm Dis 2021; 48:362-369. [PMID: 33060544 DOI: 10.1097/olq.0000000000001317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Intimate partner violence (IPV) is an emerging risk factor for HIV infection. Given the high vulnerability of and limited research on transwomen in China, we described IPV, sexual risk behaviors, HIV, and sexually transmitted infection (STIs) testing rates and results, and investigated the pathways that link IPV to HIV infection among this population. METHODS We conducted a cross-sectional survey and collected blood samples for HIV and syphilis testing among transwomen in Shanghai, China (n = 199). With logistic regression, we examined sexual risk behaviors and HIV/STI testing history among participants with and without IPV experience. RESULTS More than half of the respondents reported IPV (57.3%), and the prevalence of unprotected sex ranged from 51.9% (with sex workers) to 87.8% (oral sex); 85.9% had ever tested for HIV and 49.3% for other STIs. Self-reported positivity results were as follows: HIV (2.3%), herpes simplex virus type 2 (8.3%), gonorrhea (18.8%), and syphilis (17.8%). Laboratory-confirmed positivity values were 5.0% for HIV and 6.5% for syphilis. Respondents with a history of IPV were significantly less likely to report HIV testing in the past 12 months (adjusted odds ratio, 0.20; 95% confidence interval, 0.10-0.38). CONCLUSIONS Transwomen self-reported a high prevalence of IPV, which was related to a lower probability of HIV testing. The prevalence of HIV and other STIs was lower than reported in previous studies of Chinese transwomen, whereas the HIV/STI testing rates were higher. Findings suggest transwomen in China are at risk for IPV and need enhanced HIV prevention services to promote HIV testing in an IPV setting.
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Affiliation(s)
- Liying Wang
- From the Department of Psychology, University of Washington, Seattle, WA
| | - John P Barile
- Department of Psychology, University of Hawaii at Mānoa, Honolulu, HI
| | - Jane M Simoni
- From the Department of Psychology, University of Washington, Seattle, WA
| | - Rachel Harris
- College of Social Work, Florida State University, Tallahassee, FL
| | - Qing Yue
- Department of HIV/STD Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention
| | - Jie Fu
- Department of HIV/STD Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention
| | - Huang Zheng
- Shanghai Piaoxue Multicultural Media Ltd., Shanghai, China
| | - Zhen Ning
- Department of HIV/STD Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention
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12
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Lacombe-Duncan A, Logie CH, Li J, Mitchell B, Williams D, Levermore K. Social-ecological factors associated with having a regular healthcare provider among lesbian, gay, bisexual and transgender persons in Jamaica. Glob Public Health 2021; 17:843-856. [PMID: 33650933 DOI: 10.1080/17441692.2021.1887316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Lesbian, gay, bisexual, and transgender (LGBT) people experience a multitude of barriers to healthcare access, particularly in highly stigmatising contexts, such as Jamaica. Access to a regular healthcare source can contribute to uptake of health knowledge and services. Yet social-ecological factors associated with access to a regular healthcare provider among LGBT persons in Jamaica are underexplored. We conducted a cross-sectional survey with LGBT persons in Jamaica to examine socio-demographic and social-ecological factors associated with having a regular healthcare provider. Nearly half (43.6%) of 911 participants reported having a regular healthcare provider. In multivariate analyses, socio-demographic factors (higher age; identifying as a cisgender sexual minority man or woman compared to a transgender woman) were associated with higher odds of having a regular healthcare provider. Socio-demographic (living in Ocho Rios or Montego Bay compared to Kingston), stigma/discrimination (a bad past healthcare experience), and structural factors (insufficient money for housing; reporting medication costs as a barrier; no health insurance) were associated with decreased odds of having a regular healthcare provider. Findings support a multi-level approach to understanding and addressing barriers to having a regular healthcare provider among LGBT people in Jamaica.
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Affiliation(s)
- Ashley Lacombe-Duncan
- School of Social Work, University of Michigan, Ann Arbor, MI, USA.,Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Jane Li
- Biostatistics Department, University of Michigan, Ann Arbor, MI, USA
| | - Brandon Mitchell
- School of Social Work, University of Michigan, Ann Arbor, MI, USA.,Kent School of Social Work, University of Louisville
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13
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Beckford Jarrett S, Flanagan R, Coriolan A, Harris O, Campbell A, Skyers N. Barriers and facilitators to participation of men who have sex with men and transgender women in HIV research in Jamaica. CULTURE, HEALTH & SEXUALITY 2020; 22:887-903. [PMID: 31423952 DOI: 10.1080/13691058.2019.1634222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 06/17/2019] [Indexed: 06/10/2023]
Abstract
To assess potential barriers and facilitators to participation in bio-behavioural surveillance surveys of men who have sex with men and transgender women (trans women) in Jamaica, we recruited participants for individual interviews and focus group discussions. Respondents included 3 trans women; 46 gay, bisexual and other men who have sex with men; and 3 cis gender women. Data from 46 men and 3 trans women were analysed to describe barriers and facilitators to participation in research. Barriers identified were: lack of perceived benefits from research participation due to high socioeconomic status; concerns about confidentiality and unintended disclosure; HIV fatigue and fear of knowing one's HIV status; distrustful inter-group dynamics; and undesirable study location and hours. Facilitators to participation in research were: belonging to a marginalised subgroup of men who have sex with men or trans women; incentives; and trust in researchers and community input in planning the study. Findings emphasise the need to understand the individual, interpersonal and structural factors that shape relationships, disclosure and interactions to successfully enrol diverse samples of men who have sex with men and trans women.
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Affiliation(s)
| | | | | | - Orlando Harris
- School of Nursing, University of California, San Francisco, CA, USA
| | - Andrea Campbell
- Jamaica National Family Board - Sexual Health Agency, Kingston, Jamaica
| | - Nicola Skyers
- HIV/STI/Tb Unit, Ministry of Health, Kingston, Jamaica
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14
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Lacombe-Duncan A, Logie CH, Persad Y, Leblanc G, Nation K, Kia H, Scheim AI, Lyons T, Loutfy M. 'Transgender Education for Affirmative and Competent HIV and Healthcare (TEACHH)': protocol of community-based intervention development and a non-randomised multisite pilot study with pre-post test design in Canada. BMJ Open 2020; 10:e034144. [PMID: 32737085 PMCID: PMC7398088 DOI: 10.1136/bmjopen-2019-034144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Educational workshops are a promising strategy to increase healthcare providers' ability to provide gender-affirming care for transgender (trans) people. This strategy may also reduce healthcare providers' stigma towards trans people and people living with HIV. There is less evidence, however, of educational workshops that address HIV prevention and care among trans women. This protocol details development and pilot testing of the Transgender Education for Affirmative and Competent HIV and Healthcare intervention that aims to increase gender-affirming HIV care knowledge and perceived competency, and to reduce negative attitudes/biases, among providers. METHODS AND ANALYSIS This community-based research (CBR) project involves intervention development and implementation of a non-randomised multisite pilot study with pre-post test design. First, we conducted a qualitative formative phase involving focus groups with 30 trans women and individual interviews with 12 providers to understand HIV care access barriers for trans women and elicit feedback on a proposed workshop. Second, we will pilot test the intervention with 90-150 providers (n=30-50×3 in-person settings). For pilot studies, primary outcomes include feasibility (eg, completion rate) and acceptability (eg, workshop satisfaction). Secondary preintervention and postintervention outcomes, assessed directly preceding and following the workshop, include perceived competency, attitudes/biases towards trans women with HIV, and knowledge needed to provide gender-affirming HIV care. Primary outcomes will be summarised as frequencies and proportions (categorical variables). We will conduct paired-sample t-tests to explore the direction of preintervention and postintervention differences for secondary outcomes. ETHICS AND DISSEMINATION This study has been approved by the University of Toronto HIV Research Ethics Board (Protocol Number: 00036238). Study findings will be disseminated through community forums with trans women and service providers; manuscripts submitted to peer reviewed journals; and conferences. Findings will inform a larger CBR research agenda to remove barriers to engagement in HIV prevention/care among trans women across Canada. TRIAL REGISTRATION NUMBER NCT04096053; Pre-results.
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Affiliation(s)
- Ashley Lacombe-Duncan
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
- Women's College Hospital, Toronto, Ontario, Canada
| | - Carmen H Logie
- Women's College Hospital, Toronto, Ontario, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | | | - Gabrielle Leblanc
- Action Santé Travesti(e)s & Transsexuel(le)s du Québec, Montreal, Québec, Canada
| | - Kelendria Nation
- Prism Education Series, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Hannah Kia
- School of Social Work, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ayden I Scheim
- Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Tara Lyons
- Department of Criminology, Kwantlen Polytechnic University, Surrey, British Columbia, Canada
- Center for Gender & Sexual Health Equity (CGSHE), The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mona Loutfy
- Women's College Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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15
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Hamilton A, Shin S, Taggart T, Whembolua GL, Martin I, Budhwani H, Conserve D. HIV testing barriers and intervention strategies among men, transgender women, female sex workers and incarcerated persons in the Caribbean: a systematic review. Sex Transm Infect 2020; 96:189-196. [PMID: 31506346 PMCID: PMC7062576 DOI: 10.1136/sextrans-2018-053932] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 05/16/2019] [Accepted: 08/13/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND This systematic review summarises evidence on the HIV testing barriers and intervention strategies among Caribbean populations and provides pertinent implications for future research endeavours designed to increase rates of HIV testing in the region. METHODS We used a systematic approach to survey all literature published between January 2008 and November 2018 using four electronic databases (MEDLINE/PubMed, Embase, Web of Science and Global Health). Only peer-reviewed articles published in English that examined HIV testing uptake and interventions in the Caribbean with men, men who have sex with men, female sex workers, transgender women and incarcerated individuals were included. RESULTS Twenty-one studies met the inclusion criteria. Lack of confidentiality, access to testing sites, stigma, discrimination, poverty and low HIV risk perception were identified as key barriers to HIV testing. These barriers often contributed to late HIV testing and were associated with delayed treatment initiation and decreased survival rate. Intervention strategies to address these barriers included offering rapid HIV testing at clinics and HIV testing outreach by trained providers and peers. CONCLUSION HIV testing rates remain unacceptably low across the Caribbean for several reasons, including stigma and discrimination. Future HIV testing interventions should target places where at-risk populations congregate, train laypersons to conduct rapid tests and consider using oral fluid HIV self-testing, which allows individuals to test at home.
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Affiliation(s)
- Akeen Hamilton
- Arnold School of Public Health, Department of Health Promotion, Education, and Behavior, University of South Carolina System, Columbia, SC, USA
| | - Stephen Shin
- University of North Carolina at Chapel Hill, Department of Sociology, Chapel Hill, NC, USA
| | - Tamara Taggart
- George Washington University, Department of Prevention and Community Health, Washington, DC, USA
- Yale School of Public Health, Department of Social and Behavioral Sciences, New Haven, CT, USA
| | - Guy-Lucien Whembolua
- Yale School of Public Health, Department of Social and Behavioral Sciences, New Haven, CT, USA
| | - Indira Martin
- Government of the Bahamas Ministry of Health, Nassau, Bahamas
| | - Henna Budhwani
- University of Alabama at Birmingham, Department of Health Care Organization and Policy, Birmingham, AL, USA
| | - Donaldson Conserve
- Arnold School of Public Health, Department of Health Promotion, Education, and Behavior, University of South Carolina System, Columbia, SC, USA
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16
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Zalla LC, Herce ME, Edwards JK, Michel J, Weir SS. The burden of HIV among female sex workers, men who have sex with men and transgender women in Haiti: results from the 2016 Priorities for Local AIDS Control Efforts (PLACE) study. J Int AIDS Soc 2019; 22:e25281. [PMID: 31287624 PMCID: PMC6615490 DOI: 10.1002/jia2.25281] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 04/05/2019] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Despite the higher risk of HIV among female sex workers (FSWs), men who have sex with men (MSM) and transgender women (TGW), these populations are under-represented in the literature on HIV in Haiti. Here, we present the first nationally representative estimates of HIV prevalence and the first care and treatment cascade for FSWs, MSM and TGW in Haiti. We also examine the social determinants of HIV prevalence in these groups and estimate FSW and MSM population size in Haiti. METHODS Data were collected between April 2016 and February 2017 throughout the 10 geographical departments of Haiti. The Priorities for Local AIDS Control Efforts (PLACE) method was used to: (1) recruit participants for a behavioural survey; (2) provide rapid testing, counselling and linkage to care for syphilis and HIV; and (3) measure viral load using dried blood spots for participants testing HIV positive. RESULTS Study participants included 990 FSWs, 520 MSM and 109 TGW. HIV prevalence was estimated at 7.7% (95% CI 6.2%, 9.6%) among FSWs, 2.2% (0.9%, 5.3%) among MSM and 27.6% (5.0%, 73.5%) among TGW. Of participants who tested positive for syphilis, 17% of FSWs, 19% of MSM and 74% of TGW were co-infected with HIV. Economic instability and intimate partner violence (IPV) were significantly associated with HIV among MSM; food insecurity, economic instability and history of rape were significantly associated with HIV among TGW. Fewer than one-third of participants living with HIV knew their status, and more than a quarter of those who knew their status were not on treatment. While approximately four in five FSW and MSM participants on treatment for HIV were virally suppressed, viral suppression was less common among TGW participants at only 46%. CONCLUSIONS This study demonstrates a need for targeted interventions to prevent and treat HIV among key populations in Haiti. Potential high-impact interventions may include venue-based, peer navigator-led outreach and testing for HIV and syphilis and improving screening and case management for structural violence and IPV. TGW are in urgent need of such interventions due to our observations of alarmingly high HIV prevalence and low frequency of HIV viral suppression among TGW.
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Affiliation(s)
- Lauren C Zalla
- Department of EpidemiologyUniversity of North Carolina at Chapel HillChapel HillNCUSA
- Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Michael E Herce
- Division of Infectious DiseasesDepartment of MedicineUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Jessie K Edwards
- Department of EpidemiologyUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | | | - Sharon S Weir
- Department of EpidemiologyUniversity of North Carolina at Chapel HillChapel HillNCUSA
- Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNCUSA
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17
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Logie CH, Wang Y, Marcus N, Levermore K, Jones N, Ellis T, Bryan N. Syndemic Experiences, Protective Factors, and HIV Vulnerabilities Among Lesbian, Gay, Bisexual and Transgender Persons in Jamaica. AIDS Behav 2019; 23:1530-1540. [PMID: 30600454 DOI: 10.1007/s10461-018-2377-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Syndemics approaches explore the convergence of psychosocial factors that elevate HIV vulnerabilities. Less research has explored syndemics among lesbian, gay, bisexual and transgender (LGBT) persons in contexts where criminalization has downstream impacts on LGBT discrimination, such as Jamaica. We implemented a cross-sectional survey with LGBT persons (n = 911) in Jamaica. We conducted structural equation modeling to examine direct and indirect effects of a latent syndemics construct (binge drinking, depressive symptoms, childhood/adult abuse) on HIV vulnerabilities (lifetime sex partners, perceived HIV risk, condom self-efficacy) and the mediating role of protective factors (social support, resilient coping). Direct paths from syndemics to lifetime sex partners, perceived HIV risk, and condom self-efficacy were significant. Resilient coping and social support partially mediated the association between syndemics and condom use self-efficacy. Resilient coping partially mediated the relationship between syndemics and lifetime sex partners. Interventions can target syndemic issues to reduce HIV vulnerabilities among Jamaican LGBT persons.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street, Toronto, ON, M5S 1V4, Canada.
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
| | - Ying Wang
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street, Toronto, ON, M5S 1V4, Canada
| | - Natania Marcus
- Department of Applied Psychology and Human Development, University of Toronto, Toronto, ON, Canada
| | | | | | - Tyrone Ellis
- Jamaica AIDS Support for Life, Kingston, Jamaica
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Harris OO, Dunn LL. "I Kept It to Myself": Young Jamaican Men Who Have Sex with Men's Experiences with Childhood Sexual Abuse and Sexual Assault. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1227-1238. [PMID: 29951864 DOI: 10.1007/s10508-018-1219-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 04/10/2018] [Accepted: 04/16/2018] [Indexed: 06/08/2023]
Abstract
The prevalence of HIV is exceptionally high among Jamaican men who have sex with men (JMSM) compared to similar populations within the Caribbean. A noticeable gap in the literature is the impact of childhood sexual abuse (CSA) and sexual assault on the state of the epidemic among this population. This study focused on JMSM's experiences with CSA and sexual assault and how these domains relate to HIV prevention. We analyzed qualitative data from 20 semi-structured in-depth interviews and focus group discussions with 10 men. Common themes emerged that highlight the patterns and nature of the abuse, the characteristics of the perpetrators, and the ways in which participants engage agency and resiliency as a basis to reclaim personal power. These findings serve as a catalyst for understanding how experiences with CSA and sexual assault affect the lives of young JMSM; how those experiences may impact attitudes and behaviors regarding HIV testing, engagement in care; and have implications for shaping legal policy, clinical, and mental health services for JMSM survivors.
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Affiliation(s)
- Orlando O Harris
- Department of Community Health Systems, School of Nursing, University of California-San Francisco, 2 Koret Way, N 505E, PO Box 0608, San Francisco, CA, 94143-0608, USA.
| | - Leith Lorraine Dunn
- Gender Development Studies, Mona Campus Unit, University of the West Indies, Kingston, Jamaica
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Magno L, Silva LAVD, Veras MA, Pereira-Santos M, Dourado I. Stigma and discrimination related to gender identity and vulnerability to HIV/AIDS among transgender women: a systematic review. CAD SAUDE PUBLICA 2019; 35:e00112718. [PMID: 30994744 DOI: 10.1590/0102-311x00112718] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 01/28/2019] [Indexed: 01/09/2023] Open
Abstract
HIV prevalence among transgender women is disproportional when compared to the general population in various countries. Stigma and discrimination based on gender identity have frequently been associated with vulnerability to HIV/AIDS. The objective was to conduct a systematic literature review to analyze the relationship between stigma and discrimination related to gender identity in transgender women and vulnerability to HIV/AIDS. This systematic literature review involved the stages of identification, compilation, analysis, and interpretation of results of studies found in five databases: PubMed, Scopus, Web of Science, Science Direct, and LILACS. No publication time period was determined in advance for this review. The studies were assessed according to the inclusion and exclusion criteria. The review included articles in English, Portuguese, or Spanish that related stigma and discrimination to transgender women's vulnerability to HIV. We found 41 studies, mostly qualitative, published from 2004 to 2018, and categorized in three dimensions of stigma: individual, interpersonal, and structural. The data highlighted that the effects of stigma related to gender identity, such as violence, discrimination, and transphobia, are structuring elements in transgender women's vulnerability to HIV/AIDS. The studies showed a relationship between stigma and discrimination and transgender women's vulnerability to HIV/AIDS and indicated the need for public policies to fight discrimination in society.
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Affiliation(s)
- Laio Magno
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, Brasil.,Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
| | | | - Maria Amélia Veras
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brasil
| | - Marcos Pereira-Santos
- Centro de Ciências Biológicas e da Saúde, Universidade Federal do Oeste da Bahia, Barreiras, Brasil
| | - Ines Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
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20
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Evens E, Lanham M, Santi K, Cooke J, Ridgeway K, Morales G, Parker C, Brennan C, de Bruin M, Desrosiers PC, Diaz X, Drago M, McLean R, Mendizabal M, Davis D, Hershow RB, Dayton R. Experiences of gender-based violence among female sex workers, men who have sex with men, and transgender women in Latin America and the Caribbean: a qualitative study to inform HIV programming. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2019; 19:9. [PMID: 30832664 PMCID: PMC6399914 DOI: 10.1186/s12914-019-0187-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/09/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Female sex workers, MSM, and transgender women-collectively referred to as key populations (KPs)-are disproportionately affected by gender-based violence (GBV) and HIV, yet little is known about the violence they face, its gender-based origins, and responses to GBV. The purpose of this study was to understand the nature and consequences of GBV experienced, to inform HIV policies and programming and to help protect KPs' human rights. METHODS Using a participatory approach, FSWs, MSM, and transgender women in Barbados, El Salvador, Trinidad and Tobago, and Haiti conducted 278 structured interviews with peers to understand their experiences of and responses to GBV. Responses to open-ended questions were coded in NVivo and analyzed using an applied thematic analysis. RESULTS Nearly all participants experienced some form of GBV. Emotional and economic GBV were the most commonly reported but approximately three-quarters of participants reported sexual and physical GBV and other human rights violations. The most common settings for GBV were at home, locations where sex work took place such as brothels, bars and on the street; public spaces such as parks, streets and public transport, health care centers, police stations and-for transgender women and MSM-religious settings and schools. The most common perpetrators of violence included: family, friends, peers and neighbors, strangers, intimate partners, sex work clients and other sex workers, health care workers, police, religious leaders and teachers. Consequences included emotional, physical, and sexual trauma; lack of access to legal, health, and other social services; and loss of income, employment, housing, and educational opportunities. Though many participants disclosed experiences of GBV to friends, colleagues and family, they rarely sought services following violence. Furthermore, less than a quarter of participants believed that GBV put them at risk of HIV. CONCLUSIONS Our study found that across the four study countries, FSWs, MSM, and transgender women experienced GBV from state and non-state actors throughout their lives, and much of this violence was directly connected to rigid and harmful gender norms. Through coordinated interventions that address both HIV and GBV, this region has the opportunity to reduce the national burden of HIV while also promoting key populations' human rights.
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Affiliation(s)
- Emily Evens
- FHI 360, 359 Blackwell Street, Durham, NC 27707 USA
| | | | - Karin Santi
- United Nations Development Programme, Panama City, Panama
| | - Juana Cooke
- United Nations Development Programme, Panama City, Panama
| | | | | | - Caleb Parker
- FHI 360, 359 Blackwell Street, Durham, NC 27707 USA
| | | | - Marjan de Bruin
- University of the West Indies, Mona Campus, Kingston, Jamaica
| | | | - Xenia Diaz
- United Nations Development Programme, San Salvador, El Salvador
| | - Marta Drago
- United Nations Development Programme, San Salvador, El Salvador
| | - Roger McLean
- Centre for Health Economics, The University of the West Indies St. Augustine Campus, St Augustine, Trinidad and Tobago
| | - Modesto Mendizabal
- Asociación Diké de Hombres y Mujeres Transgénero y LGBTI+, San Salvador, El Salvador
| | - Dirk Davis
- FHI 360, 359 Blackwell Street, Durham, NC 27707 USA
| | - Rebecca B. Hershow
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| | - Robyn Dayton
- FHI 360, 359 Blackwell Street, Durham, NC 27707 USA
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Turan JM, Elafros MA, Logie CH, Banik S, Turan B, Crockett KB, Pescosolido B, Murray SM. Challenges and opportunities in examining and addressing intersectional stigma and health. BMC Med 2019; 17:7. [PMID: 30764816 PMCID: PMC6376691 DOI: 10.1186/s12916-018-1246-9] [Citation(s) in RCA: 370] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 12/19/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND 'Intersectional stigma' is a concept that has emerged to characterize the convergence of multiple stigmatized identities within a person or group, and to address their joint effects on health and wellbeing. While enquiry into the intersections of race, class, and gender serves as the historical and theoretical basis for intersectional stigma, there is little consensus on how best to characterize and analyze intersectional stigma, or on how to design interventions to address this complex phenomenon. The purpose of this paper is to highlight existing intersectional stigma literature, identify gaps in our methods for studying and addressing intersectional stigma, provide examples illustrating promising analytical approaches, and elucidate priorities for future health research. DISCUSSION Evidence from the existing scientific literature, as well as the examples presented here, suggest that people in diverse settings experience intersecting forms of stigma that influence their mental and physical health and corresponding health behaviors. As different stigmas are often correlated and interrelated, the health impact of intersectional stigma is complex, generating a broad range of vulnerabilities and risks. Qualitative, quantitative, and mixed methods approaches are required to reduce the significant knowledge gaps that remain in our understanding of intersectional stigma, shared identity, and their effects on health. CONCLUSIONS Stigmatized identities, while often analyzed in isolation, do not exist in a vacuum. Intersecting forms of stigma are a common reality, yet they remain poorly understood. The development of instruments and methods to better characterize the mechanisms and effects of intersectional stigma in relation to various health conditions around the globe is vital. Only then will healthcare providers, public health officials, and advocates be able to design health interventions that capitalize on the positive aspects of shared identity, while reducing the burden of stigma.
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Affiliation(s)
- Janet M. Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL 35294 USA
| | | | - Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, Toronto, ON Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON Canada
| | - Swagata Banik
- Department of Public Health & Prevention Sciences, Baldwin Wallace University, Berea, OH USA
| | - Bulent Turan
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL USA
| | - Kaylee B. Crockett
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL USA
| | | | - Sarah M. Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Factors Associated With Syphilis Testing and a History of Syphilis Infection Among a Sample of Transgender Women in Jamaica. Sex Transm Dis 2019; 45:158-162. [PMID: 29420443 DOI: 10.1097/olq.0000000000000715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Globally, social inequalities contribute to elevated sexually transmitted infections (STIs) rates among transgender women. High syphilis prevalence has been documented among transgender women in Latin America. Little is known, however, of syphilis testing uptake among transgender women in Jamaica, where homosexuality is criminalized. The study objective was to understand factors associated with opting-in for syphilis testing and a syphilis infection history among transgender women in Jamaica. METHODS We conducted a cross-sectional tablet-based survey of 137 transgender women between March and November 2015 in Jamaica. Bivariate analyses were used to assess differences across sociodemographic, intrapersonal, interpersonal, and structural factors based on syphilis infection history. We conducted univariable and multivariable logistic regression to determine the odds ratio for opting-in for syphilis testing for all factors associated with testing uptake at a P value of less than 0.05 in bivariate analyses, controlling for sociodemographic characteristics. RESULTS Among 137 participants, 83 (60.6%) opted in for syphilis screening and 8 (9.6%) had positive rapid test results. One quarter of participants (n = 26; 25.2%) reported being HIV positive. Opting-in for syphilis testing was associated with the following: 1 health (HIV-positive serostatus: adjusted odds ratio [AOR], 4.33; 95% confidence interval [CI], 1.31-14.26), 1 intrapersonal (perceived STI risk: AOR, 1.58; 95% CI, 1.04-2.40), 1 interpersonal (childhood sexual abuse: AOR, 2.80; 95% CI, 1.03-7.62), and 1 structural (incarceration: AOR, 0.27; 95% CI, 0.11-0.71) factor. CONCLUSIONS This study identified factors (HIV-positive serostatus, perceived STI risk, childhood sexual abuse, no incarceration history) associated with syphilis testing uptake among transgender women. Findings can inform multilevel STI testing, prevention, and care strategies tailored for transgender women in Jamaica.
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Rutledge R, Morozova O, Gibson BA, Altice FL, Kamarulzaman A, Wickersham JA. Correlates of Recent HIV Testing Among Transgender Women in Greater Kuala Lumpur, Malaysia. LGBT Health 2018; 5:484-493. [PMID: 30481120 DOI: 10.1089/lgbt.2018.0021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE In Malaysia, an estimated 9.7%-12.4% of transgender women (TW) are HIV positive, with higher estimates among those engaged in sex work. According to the 90-90-90 Joint United Nations Programme on HIV/AIDS strategy, HIV testing is the first crucial step in curbing the HIV epidemic. This study examines correlates of recent HIV testing among TW in Greater Kuala Lumpur, Malaysia. METHODS TW (N = 199) in Greater Kuala Lumpur completed a survey on healthcare access and utilization, including HIV testing history. Bivariate logistic regression and penalized multivariate logistic regression were used to explore correlates of HIV testing in the last 12 months. RESULTS Overall, 41.7% of TW reported having ever been tested for HIV. Among participants who were HIV negative or not sure of their HIV status (n = 187), only 18.7% (n = 35) had been tested for HIV in the last 12 months. The multivariate analysis indicated that having a primary care provider (PCP), being 26-40 years of age, and having higher mental health functioning were positively associated with recent HIV testing. Active amphetamine use and previous depression diagnosis were also associated with recent HIV testing. CONCLUSION HIV testing is the first step in linking individuals to prevention and treatment interventions. Our findings suggest that having a PCP can improve engagement in HIV testing. Moreover, PCPs can serve as a valuable link to HIV treatment and prevention services. Current interventions that target social and behavioral risk factors for HIV, on their own, may be insufficient at engaging all HIV-vulnerable TW.
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Affiliation(s)
- Ronnye Rutledge
- 1 AIDS Program, Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Olga Morozova
- 2 Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Britton A Gibson
- 1 AIDS Program, Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Frederick L Altice
- 1 AIDS Program, Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.,2 Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut.,3 Centre of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adeeba Kamarulzaman
- 1 AIDS Program, Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.,3 Centre of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jeffrey A Wickersham
- 1 AIDS Program, Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.,3 Centre of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Logie CH, Abramovich A, Schott N, Levermore K, Jones N. Navigating stigma, survival, and sex in contexts of social inequity among young transgender women and sexually diverse men in Kingston, Jamaica. REPRODUCTIVE HEALTH MATTERS 2018; 26:72-83. [PMID: 30475167 DOI: 10.1080/09688080.2018.1538760] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Social inequities, including stigma, criminalisation of same-sex practices, and poverty, elevate HIV exposure among young transgender women and sexually diverse men in Jamaica. Yet the ways transgender women and sexually diverse men in Jamaica navigate sex and HIV in contexts of social inequity are underexplored. The study objective was to explore experiences and perceptions of sexual decision-making and HIV risk among young (aged 18-30) sexually diverse men and transgender women in Kingston, Jamaica. We conducted a community-based qualitative study in Kingston that involved in-depth individual interviews (transgender women: n = 20; sexually diverse men: n = 20), 2 focus groups (transgender women: n = 8; sexually diverse men: n = 10) and 13 key informant interviews. Focus groups and interviews were digitally recorded, transcribed verbatim, and analysed with a thematic approach. Findings suggest that transgender women and sexually diverse men in Kingston are aware of, and managing survival challenges and HIV risks in contexts of social inequity. Daily survival challenges include stigma and a lack of human rights protections that contributed to barriers to employment, housing, healthcare, education, and exposure to violence. Challenges maintaining sexual relationships included the need to hide for safety, often resulting in difficulties forming lasting relationships. These survival and relationship challenges converged to lower self-esteem and self-acceptance. In the face of these challenges, participants navigated sexual risk and pleasure. Findings provide insight into agency and sexual decision-making processes in contexts of social inequities. Findings can inform multi-level strategies to promote social equity, sexual health, and HIV prevention with young transgender women and sexually diverse men in Jamaica.
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Affiliation(s)
- Carmen H Logie
- a Associate Professor, Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , ON , Canada.,b Adjunct Scientist, Women's College Research Institute , Women's College Hospital , Toronto , ON , Canada
| | - Alex Abramovich
- c Independent Scientist , Centre for Addiction and Mental Health , Toronto , ON , Canada
| | - Nicole Schott
- d Doctoral Candidate, Ontario Institute for Studies in Education (OISE) , University of Toronto , Toronto , ON , Canada
| | - Kandasi Levermore
- e Executive Director , Jamaica AIDS Support for Life , Kingston , Jamaica
| | - Nicolette Jones
- f Research Coordinator , Jamaica AIDS Support for Life , Kingston , Jamaica
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Abstract
Rigorous HIV-related data for the homeless population in Jamaica is limited. A cross-sectional survey using a venue-based sampling approach was conducted in 2015 to derive HIV prevalence and associated risk factors. Three hundred twenty-three homeless persons from the parishes of St. James, St. Ann, Kingston, and St. Andrew (the main urban centers) participated. HIV prevalence was 13.8%, with a difference in gender (males 11.6%, females 26.7%, P = .007). Sex work, multiple partnerships, incarceration, non-injecting drug use, and female rape were common among the participants. Long-term, multilayered, HIV-specific, female-focused interventions are required for the population, along with additional female-centric research.
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Affiliation(s)
- Nicola Skyers
- HIV/STI/Tb Unit, Ministry of Health, Kingston, Jamaica.
| | | | - Willi McFarland
- University of California, San Francisco, San Francisco, CA, USA
| | - Dahlia Cole
- National Council of Drug Abuse, Kingston, Jamaica
| | - Uki Atkinson
- National Council of Drug Abuse, Kingston, Jamaica
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Poteat TC, Malik M, Beyrer C. Epidemiology of HIV, Sexually Transmitted Infections, Viral Hepatitis, and Tuberculosis Among Incarcerated Transgender People: A Case of Limited Data. Epidemiol Rev 2018; 40:27-39. [PMID: 29554240 PMCID: PMC5982724 DOI: 10.1093/epirev/mxx012] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 10/02/2017] [Accepted: 10/02/2017] [Indexed: 11/13/2022] Open
Abstract
Transgender people experience a disproportionate burden of human immunodeficiency virus (HIV) and incarceration. Discrimination, victimization, poverty, and poor mental health drive vulnerability to HIV and related infections, as well as risk of arrest, detention, and incarceration. In this paper, we systematically review published data on HIV, sexually transmitted infections, viral hepatitis, and tuberculosis among incarcerated transgender people; describe potential structural determinants of HIV risk and transmission; identify gaps in the literature; and make recommendations for research and interventions to address this neglected population. We found that HIV and related infections among incarcerated transgender people have received little attention in the epidemiologic literature. The limited data available, which date from 1992, demonstrate high prevalence of HIV and sexually transmitted infections in this population internationally. Transgender people who had not had genital surgery were typically placed in jails and prisons corresponding to birth-assigned sex rather than gender identity. Once incarcerated, they routinely faced harassment, physical abuse, and sexual violence from inmates and staff and denial of access to medically necessary gender-affirming therapies. More HIV research with incarcerated transgender populations is urgently needed to inform correctional policy change that centers human rights and structural interventions, such as stigma reduction, pre-arrest diversion, and access to HIV prevention methods and gender-affirming care during incarceration.
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Affiliation(s)
- Tonia C Poteat
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Mannat Malik
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Chris Beyrer
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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Yi S, Tuot S, Chhim S, Chhoun P, Mun P, Mburu G. Exposure to gender-based violence and depressive symptoms among transgender women in Cambodia: findings from the National Integrated Biological and Behavioral Survey 2016. Int J Ment Health Syst 2018; 12:24. [PMID: 29853990 PMCID: PMC5975411 DOI: 10.1186/s13033-018-0206-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 05/18/2018] [Indexed: 01/02/2023] Open
Abstract
Background Transgender women are at significant risk of HIV, and they face intersecting barriers to health, social, and legal services. However, data regarding the unique needs and experiences of transgender women are globally scant. This study examined the relationship between gender-based violence and depressive symptoms among transgender women in Cambodia. Methods This cross-sectional study included 1375 sexually active transgender women recruited by using the respondent-driven sampling method in the capital city of Phnom Penh and 12 provinces between December 2015 and February 2016. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression scale (CES-D). Multivariate regression analysis was conducted to explore factors independently associated with depressive symptoms. Results Of total, 45.0% of the participants had depressive symptoms, and 21.8% had severe depressive symptoms. After controlling for potential confounders, transgender women with depressive symptoms remained significantly more likely to report several negative experiences of gender-based violence such as a feeling that co-workers or classmates were not supportive regarding their transgender identity (AOR = 2.00, 95% CI = 1.22-3.28), having difficulties in getting a job (AOR = 1.67, 95% CI = 1.29-2.16), having been denied or thrown out of housing (AOR = 1.53, 95% CI = 1.02-2.26), having difficulties in getting health services (AOR = 2.40, 95% CI = 1.50-3.82), having been physically abused (AOR = 1.54, 95% CI = 1.15-2.08), and having been fearful of being arrested by police or authorities (AOR = 2.18, 95% CI = 1.64-2.91) because of their transgender identity. Regarding their childhood experiences, transgender women with depressive symptoms remained significantly more likely to report that someone had tried to touch them or make them touch in a sexual way when they were growing up (AOR = 2.08, 95% CI = 1.61-2.68). Conclusions Transgender women in Cambodia experience high levels of gender-based violence and depressive symptoms. To address these concerns, a combination of service and policy interventions are required. These may include training and sensitization of trained and lay health providers in screening for depressive symptoms and integration of mental health services into facility- and community-based HIV services with enforcement of policies and laws that protect the rights of transgender women against gender-based violence.
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Affiliation(s)
- Siyan Yi
- KHANA Center for Population Health Research, No. 33, Street 71, Phnom Penh, Cambodia.,2Center for Global Health Research, Touro University California, Vallejo, USA
| | - Sovannary Tuot
- KHANA Center for Population Health Research, No. 33, Street 71, Phnom Penh, Cambodia
| | | | - Pheak Chhoun
- KHANA Center for Population Health Research, No. 33, Street 71, Phnom Penh, Cambodia
| | - Phalkun Mun
- 4National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Gitau Mburu
- 5Division of Health Research, Lancaster University, Lancaster, UK
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Magno L, Dourado I, Silva LAVD. Estigma e resistência entre travestis e mulheres transexuais em Salvador, Bahia, Brasil. CAD SAUDE PUBLICA 2018; 34:e00135917. [DOI: 10.1590/0102-311x00135917] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 12/07/2017] [Indexed: 01/26/2023] Open
Abstract
Resumo: Trata-se de um estudo qualitativo, com base na análise de narrativas produzidas por travestis e mulheres transexuais em Salvador, Bahia, Brasil, com o objetivo de analisar suas experiências de estigmatização, descrevendo acontecimentos, atores e contextos que marcam as suas trajetórias de vida, e também compreender a relação entre o estigma e suas performances femininas. As narrativas são provenientes de 19 entrevistas em profundidade realizadas ao longo de um inquérito epidemiológico. Foram orientadas por um roteiro prévio que explorou a produção de narrativas sobre as experiências e modos de vida das travestis e mulheres transexuais na cidade de Salvador. As histórias de vida que emergiram do campo foram transcritas e analisadas sob uma perspectiva teórico-narrativa. Observou-se que muitas travestis e mulheres transexuais apresentaram em suas narrativas a descrição de uma performance de gênero “afeminada”, que é identificada desde à infância por membros da família e da comunidade. Essa performance é apresentada como uma insubordinação ao poder estabelecido pelo sistema jurídico da sociedade heteronormativa. O processo de estigmatização começa a operar quando as expectativas sociais sobre a coerência entre “sexo biológico” e “performance de gênero” são frustradas nas interações sociais, submetendo as pessoas à discriminação e violência. Desse modo, o processo de estigmatização é operado por meio do poder exercido pelas leis da heterossexualidade compulsória sobre os corpos. Entretanto, durante as trajetórias de vida das travestis e mulheres transexuais, estratégias de resistência contra o estigma são produzidas com o potencial de transformação dos quadros estabelecidos.
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Affiliation(s)
- Laio Magno
- Universidade do Estado da Bahia, Brazil; Universidade Federal da Bahia, Brazil
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Magno L, Dourado I, da Silva LAV, Brignol S, Amorim L, MacCarthy S. Gender-based discrimination and unprotected receptive anal intercourse among transgender women in Brazil: A mixed methods study. PLoS One 2018; 13:e0194306. [PMID: 29641528 PMCID: PMC5894986 DOI: 10.1371/journal.pone.0194306] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 02/16/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Discrimination related to gender identity may directly influence vulnerability to HIV through increased exposure to unprotected receptive anal intercourse (URAI). Little is known about the relationship between gender-based discrimination (GBD) and URAI with stable partners among transgender women. METHODS This mixed-methods research began with a cross-sectional survey conducted between 2014 and 2016 with transgender women in Salvador, the capital city in one of the poorest regions in Brazil. Respondent-driven sampling was used to recruit the study population. GBD was defined through Latent Class Analysis. Additionally, 19 semi-structured interviews with participants were transcribed and analyzed through thematic content analysis. RESULTS URAI with stable partners was commonly reported (37.3%). GDB was positively associated with URAI among stable partners (OR = 6.47; IC 95%: 1.67-25.02). The analysis of the interviews illustrated how GBD impacted transgender women in diverse ways. Experiences with GBD perpetrated by the family often initiated a trajectory of economic vulnerability that led many to engage in survival sex work. The constant experience with GBD contributed to participants feeling an immense sense of trust with their stable partners, ultimately diminished their desire to use condoms. Further, the high frequency of GBD contributed to poor mental health overall, though some participants said engagement in transgender advocacy efforts provided a vital source of resilience and support. CONCLUSION Our mixed-method study capitalizes upon the strengths of diverse data sets to produce a holistic understanding of GBD and URAI with stable partners. Furthermore, by confirming the association between greater GBD and URAI, we have demonstrated how GBD can impact condom negotiation in diverse relationships.
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Affiliation(s)
- Laio Magno
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, Bahia, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Luís Augusto V. da Silva
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Instituto de Humanidades, Artes & Ciências Professor Milton Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Sandra Brignol
- Instituto de Saúde Coletiva, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
| | - Leila Amorim
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Instituto de Matemática e Estatística, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Sarah MacCarthy
- Rand Corporation, Santa Monica, California, United States of America
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Beckford Jarrett S, De La Haye W, Miller Z, Figueroa JP, Duncan J, Harvey K. High prevalence of psychiatric and substance use disorders among persons seeking treatment for HIV and other STIs in Jamaica: a short report. AIDS Care 2017; 30:604-608. [PMID: 28971701 DOI: 10.1080/09540121.2017.1384786] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This cross-sectional study explored the range of psychiatric and substance use disorders and unmet need for mental health care among 84 HIV-positive and 44 HIV-negative public clinic attendees in Jamaica. We used a brief interviewer-administered diagnostic tool, the Client Diagnostic Questionnaire. Two-thirds (65.6%) screened positive for at least one psychiatric disorder; 30.5% screened positive for multiple disorders. The most common disorders were post-traumatic stress disorder (PTSD) (41.4%), alcohol abuse (22.7%), and depressive disorders (21.9%). One in fourteen (7.1%) participants with at least one diagnosis received care in the last 6 months. Adjusting for age and sex, PTSD was associated with non-adherence to antiretroviral treatment (AOR = 5.32), anxiety disorders (AOR = 5.82), depression (AOR = 4.29), and suicidal ideation (AOR = 8.17). Psychiatric and substance use disorders, particularly PTSD, were common among STI/HIV clinic attendees in Jamaica. Such clinics may be efficient places to screen, identify, and treat patients with psychiatric disorders in low- and middle- income countries.
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Affiliation(s)
- Sharlene Beckford Jarrett
- a Global Health Sciences , University of California San Francisco , San Francisco , CA , USA.,b Ministry of Health , Kingston , Jamaica
| | | | | | - J Peter Figueroa
- c Community Health and Psychiatry , The University of the West Indies , Mona , Jamaica
| | | | - Kevin Harvey
- e AIDS Health Care Foundation, Caribbean Region , Kingston , Jamaica
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Juarez-Cuellar A, Chang YP. HIV Testing in Urban Transgender Individuals: A Descriptive Study. Transgend Health 2017; 2:151-155. [PMID: 29159309 PMCID: PMC5685202 DOI: 10.1089/trgh.2016.0047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
HIV testing is considered the initial component of HIV eradication strategies. This study aimed to describe HIV testing in urban, transgender individuals in western New York. The study uses HIV testing intake data from a sample of self-identified transgender males and females volunteering for an HIV test at a community-based healthcare organization. Transgender individuals with some characteristics were found to have more HIV tests including female gender, black, HIV status (positive), a history of incarceration, sex worker, housing situation, and self-referral. The findings can be used to tailor future interventions to encourage HIV testing in transgender populations.
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Affiliation(s)
- Adrian Juarez-Cuellar
- School of Nursing, The State University of New York, University at Buffalo, Buffalo, New York
| | - Yu-Ping Chang
- School of Nursing, The State University of New York, University at Buffalo, Buffalo, New York
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Hines DD, Draucker CB, Habermann B. HIV Testing and Entry to Care Among Trans Women in Indiana. J Assoc Nurses AIDS Care 2017; 28:723-736. [PMID: 28652131 PMCID: PMC5572502 DOI: 10.1016/j.jana.2017.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
Abstract
Trans women in the United States are disproportionately affected by HIV infection. To improve HIV services for this population, more information is needed about their experiences in early stages of the HIV Care Continuum. Trans women in states such as Indiana, which has moderate HIV incidence but little public health investment in HIV prevention and treatment, experience special challenges. Our qualitative descriptive study describes the circumstances influencing HIV testing and entry to care by 18 trans women living with HIV in Central Indiana. In-depth interviews regarding participants' HIV care experiences were analyzed using standard content analysis. Participants discussed three main topics: (a) HIV testing circumstances, (b) facilitators and barriers to entering care, and (c) motivators for entering care after a delay. Findings indicate that social relationships play a significant role in trans women's care experiences and that stigma, discrimination, and adverse life circumstance are powerful deterrents to care. Practice and policy implications are discussed.
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Affiliation(s)
- Dana D. Hines
- Assistant Professor of Nursing, George Washington University, Washington, DC, USA
| | - Claire Burke Draucker
- Angela Barron McBride Endowed Professor in Psychiatric Mental Health Nursing, Indiana University School of Nursing, Indianapolis, Indiana, USA
| | - Barbara Habermann
- Nannie Longfellow Professor of Nursing Science, University of Delaware, Newark, Delaware, USA
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Barriers and facilitators to HIV testing among young men who have sex with men and transgender women in Kingston, Jamaica: a qualitative study. J Int AIDS Soc 2017; 20:21385. [PMID: 28406274 PMCID: PMC5515029 DOI: 10.7448/ias.20.1.21385] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction: Young men who have sex with men (MSM) in Jamaica have the highest HIV prevalence in the Caribbean. There is little information about HIV among transgender women in Jamaica, who are also overrepresented in the Caribbean epidemic. HIV-related stigma is a barrier to HIV testing among Jamaica’s general population, yet little is known of MSM and transgender women’s HIV testing experiences in Jamaica. We explored perceived barriers and facilitators to HIV testing among young MSM and transgender women in Kingston, Jamaica. Methods: We implemented a community-based research project in collaboration with HIV and lesbian, gay, bisexual and transgender (LGBT) agencies in Kingston. We held two focus groups, one with young (aged 18–30 years) transgender women (n = 8) and one with young MSM (n = 10). We conducted 53 in-depth individual semi-structured interviews focused on HIV testing experiences with young MSM (n = 20), transgender women (n = 20), and community-based key informants (n = 13). We conducted thematic analysis to identify, analyze, and report themes. Results: Participant narratives revealed social-ecological barriers and facilitators to HIV testing. Barriers included healthcare provider mistreatment, confidentiality breaches, and HIV-related stigma: these spanned interpersonal, community and structural levels. Healthcare provider discrimination and judgment in HIV testing provision presented barriers to accessing HIV services (e.g. treatment), and resulted in participants hiding their sexual orientation and/or gender identity. Confidentiality concerns included: clinic physical arrangements that segregated HIV testing from other health services, fear that healthcare providers would publicly disclose their status, and concerns at LGBT-friendly clinics that peers would discover they were getting tested. HIV-related stigma contributed to fear of testing HIV-positive; this intersected with the stigma of HIV as a “gay” disease. Participants also anticipated healthcare provider mistreatment if they tested HIV positive. Participants identified individual (belief in benefits of knowing one’s HIV status), social (social support) and structural (accessible testing) factors that can increase HIV testing uptake. Conclusions: Findings suggest the need for policy and practice changes to enhance confidentiality and reduce discrimination in Jamaica. Interventions to challenge HIV-related and LGBT stigma in community and healthcare settings can enhance access to the HIV prevention cascade among MSM and transgender youth in Jamaica.
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