Prevalence and Risk Correlates of Intimate Partner Violence Among a Multisite Cohort of Young Transgender Women

"I Don't Think the Police Think We're Human": Legal Socialization Among Young Transgender Women

Legal socialization is the process by which individuals develop values, attitudes, and behaviors related to the law and legal authorities. Legal socialization also includes beliefs about procedural justice, police legitimacy, and legal cynicism. To date, few studies have examined the legal socialization processes of transgender women, a worrisome omission given high rates of police contact, arrest, harassment, and violence among transgender women, particularly transgender women of color. This study examines transgender women's experiences with and perceptions about the police, including experiences of procedural injustice and how they impact police legitimacy and cynicism, among a racially diverse sample of transgender women living in Chicago. Participants described undergoing a secondary legal socialization process after beginning to transition. The study also documented strategies transgender women use to prevent police contact and arrest.

Factors Associated with Non-Fatal Strangulation Victimization in Intimate Relationships: A Meta-Analysis

Intimate partner violence (IPV) is a public health crisis across the globe, and one particular act of IPV, non-fatal strangulation, warrants serious attention. Non-fatal strangulation is a risk factor for intimate partner homicide (IPH) and can create long-term negative mental and physical health consequences. In this meta-analysis, we sought to examine factors associated with non-fatal strangulation victimization among women to help inform education and assessment efforts. Using database searches and Boolean search terms, a total of 16 studies met the inclusion criteria. A total of 16 factors that were found in at least two unique studies were examined. The strongest associated factors included physical IPV victimization, physical injury, IPH, and sexual IPV victimization. Other significant associated factors included lower education, anxiety symptoms, perceived risk of harm, post-traumatic stress symptoms, depressive symptoms, stalking victimization, and identifying as a Black woman. Experiencing childhood trauma, the length of the relationship, age, substance use, and identifying as Hispanic were not significantly related to strangulation victimization by an intimate partner. Education and assessment implications are discussed.

"It definitely changed me": Exploring sexual and gender diverse people's experiences with intimate partner violence in Ontario, Canada

INTRODUCTION

Intimate partner violence (IPV) involves an individual committing acts intended to harm or intimidate a current or former romantic partner. The COVID-19 pandemic and subsequent stay-at-home orders often trapped victims with perpetrators and intensified IPV. Although sexual and gender diverse people disproportionately experience IPV compared to cisgender, heterosexual people, their experiences are not well documented in the Canadian context. This study aimed to explore the experiences of Two-Spirit, lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexual and gender diverse (2S/LGBTQIA+) people with IPV in Ontario and how the COVID-19 pandemic affected their IPV experiences.

METHODS

We conducted in-depth, semi-structured interviews with self-identified 2S/LGBTQIA+ people who experienced IPV on/after March 15, 2020. We audio-recorded and transcribed all interviews and coded the transcripts for content and themes using inductive and deductive techniques.

RESULTS

Our 20 participants experienced physical, psychological, sexual, and financial abuse. Technology-facilitated violence extended abuse geographically and temporally. IPV experiences were associated with negative mental health outcomes that were intensified by the COVID-19 pandemic. Participants struggled to see themselves as legitimate victims of IPV. Although participants regretted being victims of violence, many saw their abusive relationship(s) as a learning experience to inform future relationships.

DISCUSSION

Our findings suggest that 2S/LGBTQIA+ people may experience unique forms of identity abuse and may have difficulty recognizing their IPV experiences as abuse. Ensuring that comprehensive sexual health education is trauma-informed, anti-oppressive, and includes information about healthy relationship dynamics, 2S/LGBTQIA+ relationships, and IPV is critical.

Enhancing care for transgender and gender diverse survivors of intimate partner violence: an Ontario-wide survey examining health and social service providers' learning needs

OBJECTIVES

To better understand healthcare and social/community service providers' learning needs associated with supporting transgender and gender diverse (trans) persons who have experienced intimate partner violence (IPV).

SETTING

An online survey was distributed through the trans-LINK Network in Ontario, Canada.

RESPONDENTS

163 of 225 healthcare and social/community service providers completed the survey (72.4% response rate) between November 2022 and February 2023.

MAIN OUTCOME MEASURES

Expertise, training, workplace practices and learning needs related to supporting trans survivors of IPV.

METHOD

Quantitative survey results were analysed descriptively and open-ended responses were organised thematically. In March 2022, survey results were shared with 33 stakeholders who helped define goals and objectives for an e-learning curriculum using Jamboard, data from which were collated and organised into themes.

RESULTS

Most (66.3%) survey respondents described having provided professional support to trans survivors of IPV, but only one-third (38.0%) reported having received relevant training, and many of the trainings cited were in fact focused on other forms of violence or trans health generally. The majority reported a mid (44.9%) or low-mid (28.5%) level of expertise and almost unanimously agreed that they would benefit from (further) training (99.4%). The most commonly recommended goal/objective for a curriculum emerging from the stakeholder consultation was to facilitate collaboration, knowledge sharing and (safe) referrals among organisations.

CONCLUSIONS

The results of this study highlight the critical need for an IPV curriculum specific to trans survivors and responsive to the needs of providers. As no one profession can address this complex issue in isolation, it is important that the curriculum aims to facilitate collaboration across sectors. In the absence of appropriate training and referrals, practitioners may perpetuate harm when caring for trans survivors of IPV.

Negative Associations between Minority Stressors and Self-Reported Health Status among Sexual Minority Adults Living in Colombia

Colombia has extensive laws prohibiting discrimination against sexual minority people. However, violence and discrimination toward sexual minorities are still frequent. While a growing body of research shows that sexual minority people experience elevated rates of discrimination and domestic abuse globally, little research has been conducted on these issues affecting sexual minorities in Colombia specifically. Using minority stress theory as a conceptual framework, this paper aims to fill this gap by examining the prevalence of experiencing intimate partner violence (IPV) and witnessed discrimination and the relationship of these stressors to self-reported health among a national sample of sexual minority Colombians. We found that bisexual individuals experienced higher rates of physical and sexual IPV, compared to lesbian and gay individuals. Additionally, sexual minority Colombians who experienced IPV and witnessed discrimination were more likely to report having poorer health, compared to those who had not. We discuss the implications of our findings for future research and clinicians working with sexual minority clients.

Toward the conceptualization and measurement of transphobia-driven intimate partner violence

Transgender and gender expansive (trans) people face high rates of violence, including unique forms of abuse from intimate partners that specifically leverage transphobia. Past qualitative studies have explored trans-specific intimate partner violence (IPV) and transgender IPV; we propose a new term, transphobia-driven IPV, investigated in this paper. The goals of this study were two-fold: (1) to qualitatively identify the subdomains and boundaries of transphobia-driven IPV with the explicit intention of new scale development; and (2) to examine the degree to which existing trans-focused IPV measurement scales adequately assess the construct. We recruited US-based, English-speaking trans survivors of IPV, aged 18 years and older, online through community-based organizations and Facebook/Instagram advertising. Twenty people participated in the study, of which 60 percent were white, 55 percent were assigned female at birth, and 60 percent were nonbinary. Through thematic analysis of the 20 in-depth interviews, we identified four subdomains of transphobia-driven IPV: pressure to perform, disrupting gender affirmation, belittling gender identity, and intentional misgendering. When examining nine existing screening tools and measures that ask about IPV related to the survivor's trans identity, only one measure included questions related to all four subdomains. Further, the existing measures were either not psychometrically validated, only validated with a subpopulation of the trans community, or validated with a larger LGBTQ sample of which trans survivors comprised a small percentage. This study lays a foundation for new valid measures of transphobia-driven IPV that reflect the various ways in which transphobia can be leveraged by abusers and may be relevant across subpopulations of the trans community.

Intimate Partner Sexual Violence, Gender, and Psychological Distress Among Northern Irish University Students

While substantial prevalence rates of intimate partner sexual violence (IPSV) have been found among university students for decades in North America, there is a specific gap in published studies on this issue in the United Kingdom and Ireland. The present analysis used data from a larger survey study of students in one Northern Irish university. The analyses reported here were used to examine relationships among IPSV victims, gender (males and females only), unhealthy alcohol use, and psychological distress among university students (n = 654) since the age of 16 and during the previous year. The results of this study are consistent with previous research indicating that women (n = 248) experience IPSV more often than men (n = 37; 50% vs. 23%, respectively). Nonetheless, IPSV is experienced by both men and women with statistically significant associations with alcohol use, posttraumatic stress, depression, and generalized anxiety compared with those who did not report any IPSV experience.

'Sometimes, we don't know if we're getting abused': discussions of intimate partner violence and HIV risk among transgender women

Transgender women are among the populations at highest risk for HIV in the USA and have elevated risk for intimate partner violence (IPV). There is an urgent need for integrated HIV-IPV prevention interventions for transgender women. Using qualitative methods, we explored transgender women's lived experiences of IPV and the relationship between IPV and HIV risk. Using thematic analysis, we identified four key concepts that warrant inclusion in the development of models for IPV and HIV interventions: (1) considering the boundaries of IPV; (2) normalising expectations of chronic violence; (3) relationship safety; (4) calls for trans-affirming and empowering services.

Improving Policy and Treatment Interventions for Sexual and Gender Minority Perpetrators of Intimate Partner Violence to Reduce Adverse Health Outcomes

Intimate partner violence (IPV), understood as physical, sexual, and psychological aggression, is a pernicious health problem that is as or more prevalent in sexual and gender minority (SGM) relationships as in heterosexual and cisgender ones. IPV has many impacts, including physical and psychological health consequences. Effective treatment of abusers is needed to reduce IPV in SGM communities. Yet IPV in SGM relationships is understudied, making it difficult to determine whether current treatment, designed for people who identify as cisgender and heterosexual, is effective for SGM IPV abusers. This perspective identifies policy barriers to and recommendations for improving IPV perpetrator treatment for SGM individuals.

Preliminary Pilot-Testing of Intimate Partner Violence Screening for Transgender and Gender Diverse (TGD) Individuals in Med-Peds and Family Medicine

INTRODUCTION

Transgender and gender diverse (TGD) individuals, comprised of those whose gender identity does not correspond with the sex they were assigned at birth, represent approximately 1.4 million people in the U.S., with a higher prevalence among those 18-24 years old. TGD individuals experience high levels of intimate partner violence (IPV), which leads to disproportionately negative mental and physical health outcomes for this population. As a result, there is a resounding need to connect TGD populations to health-promoting services, supports and resources. Med-Peds and Family Medicine clinics may be particularly well-positioned to support these efforts due to physicians' focus on transitional-aged youth and young adults under 30.

METHODS

The current manuscript reports on processes and outcomes related to a quality improvement (QI) initiative that aimed to test the feasibility and acceptability of implementing IPV screening within both a Med-Peds and a Family Medicine specialty clinic serving TGD populations in Los Angeles, CA. This QI initiative included screeners that capture IPV in cisgender/non-TGD populations (Humiliation, Afraid, Rape, Kick [HARK]) as well as in TGD populations specifically (IPV-T). We utilized a mixed-methods approach to both quantify and qualify responses to existing IPV screening as well as informal feedback from clinic "champions" in each clinic.

RESULTS

Quantitative and qualitative findings from this QI initiative, featuring both general and TGD-specific IPV screening measures with 140 TGD individuals, elucidated several important processes that can support effective IPV screening and referral to supports and services. These include the importance of interdisciplinary teams, the utility of an iterative approach to screener roll-out, and the essential role of solidifying a referral process in these efforts. This project additionally shed light on the potential utility and challenges of implementing both general and TGD-specific IPV screening measures. Our pilot test did not support the necessity of a TGD-specific IPV screener for identifying and responding to IPV in this population, yet additional data is critical to generate more conclusive recommendations.

CONCLUSION

We recommend larger-scale data collection efforts to evaluate the utility of integrating general and TGD-specific screeners into clinic workflows to ensure optimal health promotion for the TGD population in Med-Peds and Family Medicine clinics.

The prevalence of childhood sexual experiences and intimate partner violence among transgender women in China: Risk factors for lifetime suicidal ideation

Objective

Several studies highlighted childhood sexual experiences (CSEs) and intimate partner violence (IPV) as risk factors that affected lifetime suicidal ideation. TW had higher rates of CSEs and IPV than cisgender people. The aim of this study was to comprehensively assess the prevalence of CSEs and IPV among TW and their association with lifetime suicidal ideation.

Methods

A cross-sectional survey was conducted among 247 TW in Shenyang and Kunming, China, from April to September 2018. CSEs, IPV, and lifetime suicidal ideation were assessed. Logistic regression models were used to examine the association between self-reported CSEs under 18 years of age, IPV in adulthood, and lifetime suicidal ideation.

Results

In the study, 14.2% (35/247) of the sample participants reported CSEs under 18 years of age; 44.9% (111/247) reported experiencing IPV in adulthood, including 18.6% (44/247) of physical IPV, 27.1% (67/247) of trans-specific identity IPV, 31.6% (78/247) of verbal IPV, and 19.4% (48/247) of sexual IPV; and 26.3% (65/247) had thought about attempting suicide at least one time. CSEs and any form of IPV were significantly associated with suicidal ideation in this sample population. A final stepwise multivariate logistic regression model found that both physical and verbal IPVs were significantly associated with suicidal ideation when controlling for other factors (ORm₁ = 2.58, 95% confidence interval (CI) = 1.163-5.724; ORm₂ = 2.72, 95% CI = 1.334-5.547).

Conclusions

The findings highlight the effects of CSEs and IPV among TW and suggest the need for research on suicide in the future. Suicide prevention efforts for this invisible and vulnerable population should focus on those with physical and verbal IPV.

Differential Experiences of Sexual, Physical, and Emotional Intimate Partner Violence Among Transgender and Gender Diverse Adults

Various forms of intimate partner violence (IPV) are unfortunately common amongst adults in the United States, and these rates are devastatingly higher for transgender and gender diverse (TGD) individuals than for the general population. However, the TGD population is not monolithic, and is diverse regarding gender, sexual orientation, age, race/ethnicity, urbanicity, and other sociodemographic categories. This study uses data from the 2018 Michigan Trans Health Survey to explore these within group differences regarding sexual, physical, and emotional forms of IPV using chi-square tests of independence and logistic regressions. Chi square tests of independence found homelessness had significant associations across all outcome variables: "ever experienced physical violence from a partner," "ever experienced forced sex from a partner," "ever been threatened to be outed by a partner," and "ever had gender belittled by a partner." Gender identity and sexual orientation had significant associations with "ever experienced forced sex from a partner," "ever been threatened to be outed by a partner," and "ever had gender belittled by a partner." Urbanicity showed a significant association with "ever being threatened to be outed by a partner." In the logistic regressions, age indicated significantly higher likelihood of IPV physical IPV with each year of age; experiences of homelessness were significantly related to likelihood for all outcomes variables. Gender and sexual orientation were also significant across the models, with differing levels of likeliness depending on identities. Findings demonstrate a need for TGD inclusive programming, and specifically programs that target TGD persons who are older, report additional genders (meaning, multiple identities and/or identities besides transfeminine, transmasculine, or nonbinary), queer sexual orientations, and who are/have experienced homelessness. Programs are needed both in the realms of intimate partner violence prevention work and social services that support survivors of violence, such as mental health clinics, rape crisis centers, and shelters.

Sleep characteristics among black cisgender sexual minority men and black transgender women during the COVID-19 pandemic: The role of multi-level COVID-19-related stressors

OBJECTIVES

To determine the association between individual, network, and structural COVID-19-related stressors and changes in sleep duration and quality among Black cisgender sexual minority men (SMM) and Black transgender women during the COVID-19 peak infectivity rate in Chicago.

METHODS

From April 20, 2020 to July 31, 2020, we conducted the N2 COVID Study in Chicago (n = 226). The survey included questions regarding multi-level COVID-19-related stressors (eg, food unavailability, partner violence, housing instability, concern about neighborhood COVID-19), sleep duration, and sleep quality.

RESULTS

About 19.5% of our sample reported a shorter duration of sleep during the initial peak COVID-19 infectivity, while 41.2% reported more sleep and 38.9% reported about the same. Compared to the prepandemic period, 16.8% reported that their sleep quality worsened in the COVID-19 pandemic, while 27.9% reported their sleep quality had improved and 55.3% reported it was about the same. In multivariable models, we found that ≥1 day of physical stress reaction, worrying about being infected with COVID-19, traveling during COVID-19 being a financial burden, not having enough medication, knowing someone who was diagnosed with COVID-19, partner violence and housing instability were associated with poor sleep health in the COVID-19 pandemic (adjusted risk ratio: 1.82-3.90, p < .05).

CONCLUSIONS

These data suggest that COVID-19-related stressors impacted poor sleep duration and quality during the pandemic among this cohort. Multi-level interventions to reduce COVID-19-related stressors (eg, meditation, intimate partner violence prevention and housing programs) may be useful for improving sleep health among Black cisgender sexual minority men and Black transgender women.

Sociodemographic Differences in Intimate Partner Violence Prevalence, Chronicity, and Severity Among Young Sexual and Gender Minorities Assigned Male at Birth: The P18 Cohort Study

Intimate partner violence (IPV) is prevalent among young sexual and gender minorities assigned male at birth (YSGM-AMAB). However, few studies have examined the chronicity or distinguished between minor and severe forms of IPV among YSGM-AMAB. Furthermore, while past research has documented differences in IPV by race/ethnicity, sexual identity, gender identity, income, and education in other populations, few studies have examined these sociodemographic characteristics in relation to IPV in YSGM-AMAB. Thus, the present study aims to: (1) estimate past year prevalence and chronicity of minor and severe forms of IPV victimization and perpetration in a diverse sample of (N = 665) YSGM-AMAB in New York City, and (2) examine differences in IPV prevalence and chronicity by the aforementioned sociodemographic characteristics. Cross-sectional data from [BLINDED] informed these descriptive and inferential analyses. Nearly half of all participants reported past year IPV victimization and approximately 40% reported perpetration. Psychological violence was the most common form of victimization, followed by sexual, physical, and injury victimization. Psychological violence was the most common form of perpetration, followed by physical, sexual, and injury perpetration. Regarding sociodemographic differences in last year IPV prevalence, bisexual, transgender, and lower income YSGM-AMAB were more likely to report several subtypes of IPV victimization. Whereas Asian/API, bisexual, transgender, and lower income participants were more likely to report several subtypes of IPV perpetration. Regarding last year IPV chronicity, non-graduate YSGM-AMAB reported more instances of two subtypes of IPV victimization, while Black, White, cisgender, upper income, non-graduate participants reported more instances of several subtypes of IPV perpetration. These findings may be used to develop IPV prevention and intervention programs, inform future research endeavors, and develop and strengthen policies that reduce sociodemographic inequalities and promote more favorable sociopolitical conditions for YSGM-AMAB.

Prevalence and Correlates of Violence Experienced by Trans Women

Objectives: To measure the prevalence and correlates of intimate partner, physical, and sexual violence experienced by trans women. Materials and Methods: A National HIV Behavioral Surveillance (NHBS) Study of 201 trans women was conducted in San Francisco from July 2019 to February 2020 using respondent-driven sampling. Prevalence ratio tests were used to test differences in the prevalence of violence by demographic characteristics including housing status. Results: Among 201 trans women interviewed, 26.9% were currently homeless. In the past year, 59.7% had been homeless, 34.3% changed housing, 60.7% had a housing situation other than renting or owning. Experiences of violence were common: 36.8% experienced any form of violence, including sexual (16.9%), intimate partner (14.9%), and other physical (25.4%) in the past year. Experiences of violence were significantly associated with multiple measures of housing insecurity. Younger age, being misgendered, and substance use were also associated with experiences of violence. Conclusions: Trans women face dual crises in housing and violence. Affordable, subsidized, and safe housing has the potential to reduce the exposure and vulnerability to violence faced by trans women.

The factors influencing the psychological distress of transgender women in Shandong, China: a cross-sectional study

Background

As a group at high-risk for acquired immune deficiency syndrome (AIDS) infection, the psychological distress of transgender women cannot be ignored while preventing and controlling AIDS risks. Transgender women are a vulnerable group, and their psychological distress deserves attention. The purpose of this study was to evaluate the psychological distress of transgender women and further determine the influences of factors on the psychological distress of transgender women.

Methods

From March 2021 to August 2021, a cross-sectional survey was conducted in Shandong province, China. Data were collected by a questionnaire designed for transgender women, and the GHQ-12 scale was used to measure their psychological distress. The questionnaire combined sociodemographic characteristics, HIV/AIDS cognition, related behaviors, substance abuse, social support, gender identity and other factors. Univariate logistic regression and multivariate logistic regression models were used to explore the psychological factors of transgender women.

Results

In this study, the rate of transgender women with psychological distress was 20.08%. Earned monthly income between 10,000–15,000 yuan (OR:0.16, 95% CI:0.06–0.45) and a monthly income greater than 15,000 yuan (OR:0.07, 95% CI:0.01–0.43) were protective factors in the psychology of transgender women. Transgender women who never disclosed sexual orientation and identity (OR: 0.19, 95% CI: 0.06–0.58), who only disclosed their sexual orientation and identity to families or friends (OR: 0.41, 95% CI: 0.18–0.93) were also less likely to have psychological distress. Additionally, transgender women who did not desire to be identified with their sexual orientation and identity (OR: 3.31, 95%CI: 1.08–10.16) and who reported that the Internet did not play an essential role in helping determine sexual orientation (OR: 5.96, 95% CI: 2.91–12.20) were more likely to have psychological distress.

Conclusion

Transgender women were at risk of psychological distress. Earning more money can help transgender women's psychological health. When formulating measures for transgender women, we should pay attention to enhance social inclusion and social acceptance of their gender identity and sexual orientation. Strengthening the role of the internet in transgender women's confirmation of sexual orientation and improving the social acceptance of transgender women will have a positive impact on the psychological status of transgender women.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13357-9.

The Shadow Pandemic: A Qualitative Exploration of the Impacts of COVID-19 on Service Providers and Women Survivors of Intimate Partner Violence and Brain Injury

BACKGROUND

Intimate partner violence (IPV) affects up to 1 in 3 women over their lifetime and has intensified during the COVID-19 pandemic. Although most injuries are to the head, face, and neck, the intersection of IPV and brain injury (BI) remains largely unrecognized. This article reports on unexplored COVID-19-related impacts on service providers and women survivors of IPV/BI.

OBJECTIVES

To explore the impact of the COVID-19 pandemic on survivors and service providers.

PARTICIPANTS

Purposeful sampling through the team's national Knowledge-to-Practice (K2P) network and snowball sampling were used to recruit 24 participants across 4 categories: survivors, executive directors/managers of organizations serving survivors, direct service providers, and employer/union representatives.

DESIGN

This project used a qualitative, participatory approach using semistructured individual or group interviews. Interviews were conducted via videoconferencing, audio-recorded, and transcribed. Transcripts were thematically analyzed by the research team to identify themes.

FINDINGS

COVID-19 has increased rates and severity of IPV and barriers to services in terms of both provision and uptake. Three main themes emerged: (1) implications for women survivors of IPV/BI; (2) implications for service delivery and service providers supporting women survivors of IPV/BI; and (3) key priorities. Increased risk, complex challenges to mental health, and the impact on employment were discussed. Adaptability and flexibility of service delivery were identified as significant issues, and increased outreach and adaptation of technology-based services were noted as key priorities.

CONCLUSIONS

The COVID-19 pandemic has intensified IPV/BI, increased challenges for women survivors and service providers, and accentuated the continued lack of IPV/BI awareness. Recommendations for service delivery and uptake are discussed.

The Dark Side of the Rainbow: Queer Women's Experiences of Intimate Partner Violence

Intimate partner violence (IPV) is a worldwide issue that, although often thought of as a very gendered and heteronormative crime (male perpetrators and female victims within heterosexual relationships), occurs in all kinds of relationships. The purpose of this study is to examine and raise awareness of how IPV operates within female same-gender relationships. Researchers utilized a narrative inquiry framework, as well as thematic analysis, in order to conduct a qualitative synthesis of articles that examined IPV in female same-gender relationships. Articles were identified through database searches for studies published between 2000 and 2019 using key search terms. Studies were included if they were qualitative in nature (including direct quotes from participants), examined IPV within female same-gender relationships, and were written in English. A total of 19 studies were included in the qualitative synthesis. Findings were categorized as barriers to help and support, themes within experiences of IPV, or recommendations for helping professionals. Themes within categories included, among others, a lack of framework to identify abuse; mistrust of law enforcement; power dynamics related to parenthood, race, and gender presentation; and fears of contributing to heterosexism. Findings from this study can serve to better inform helping professionals about considerations to keep in mind when working within lesbian, gay, bisexual, transgender, plus various additional sexual minorities' communities and survivors of female same-gender violence.

The Intersection of Intimate Partner Violence and Traumatic Brain Injury: Findings From an Emergency Summit Addressing System-Level Changes to Better Support Women Survivors

BACKGROUND

Traumatic brain injury (TBI) occurring during intimate partner violence (IPV) is a largely unrecognized but significant public health crisis. One in 3 women will experience IPV in their lifetime, up to 75% of whom will sustain a TBI as a result. This article reports on the systems-level findings from a national summit to address barriers, needs, and priorities related to healthcare and support services for women survivors of IPV-TBI.

OBJECTIVES

(1) To identify key needs, facilitators, and barriers to care for women survivors of IPV presenting with TBI; and (2) to cocreate ideas for resources and principles for identification, clinical care, and support for healthcare practitioners who treat women exposed to IPV and TBI.

METHODS

Using a community-based participatory research approach, we engaged 30 stakeholders-drawn from a national IPV-TBI Knowledge-to-Practice (K2P) Network including diverse women survivors, service providers, researchers, and decision makers-in 2 half-day virtual meetings. Data were gathered through small group breakout sessions using semistructured discussion guides. Sessions were recorded, transcribed verbatim, and analyzed using thematic analysis techniques. Stakeholders contributed to the analysis and knowledge translation through member-checking activities. Ethics approval was obtained through the University of Toronto.

FINDINGS

Three main systems-level themes arose during these discussions: (1) the need for trauma-informed, anti-racist, and equitable health and social care systems; (2) the need for cross-pollination of knowledge between disciplines; and (3) the need for systems-level support for integrated and coordinated care. This article explores these needs and provides recommendations and suggestions for paths forward.

CONCLUSIONS

The findings of this project enhance understanding of system-level needs among women survivors and provide a template for a national agenda for IPV-TBI research and practice.

Doing the right thing and getting it right: professional perspectives in social work on supporting parents from gender diverse communities

BACKGROUND

Despite significant shifts in legislative, political, cultural and social contexts, which have improved our understanding of diverse gender identities and family life, this remains under-explored within social work and social care. Trans and non-binary (TNB) parenting experiences are marginalized within mainstream professional practice and action is required to address these inequalities.

AIMS

This study explored the practices and meaning of 'parenting' and 'caring' for care professionals in families with parents with diverse gender identities in the UK. It aimed to capture a snapshot of the current state of practice knowledge and perceived practice challenges.

METHODS

A qualitative study design involving thematic analysis from detailed consultation with twenty-five relevant stakeholders in the proxy roles identified from a systematic review on what is known about trans parenting from the research evidence.

RESULTS

The complexity of systems for supporting families creates barriers to change, with a lack of training and development in the knowledge and skills of the workforce. Intersecting these themes was a strong values framework and examples of best practice provided, which social workers can use to navigate, understand, and support TNB parents and their experiences, particularly at an individual level, as a means to effect change.

DISCUSSION

Focusing on human rights, tailoring work to the specific needs of individuals and families, and affirming the diversity of family life requires professionals to take active responsibility and be more accountable in educating themselves and others on these rights. Professionals also need to reach out to the TNB community to include them in improving services as well as being active in their own organizations to ensure these are inclusive and responsive.

The transgender-specific intimate partner violence scale for research and practice: Validation in a sample of transgender women

STUDY/RESEARCH OBJECTIVE

To develop and validate a brief intimate partner violence (IPV) scale that screens for controlling behaviors and psychological abuse tactics directed toward transgender individuals.

RATIONALE

Transgender individuals are at elevated risk of physical and sexual IPV compared to cisgender individuals. IPV often takes on unique dimensions against transgender individuals, such as when an abusive partner threatens to "out" the transgender person, or use other tactics that weaponize transphobia within the relationship. Standard IPV screeners do not assess this type of transgender-specific IPV (T-IPV).

METHODS

Between March 2018 and October 2019, a T-IPV scale was tested in two samples (in-person and online) of transfeminine adults (i.e. assigned a male sex at birth and identify with femininity) from the eastern and southern U.S. Exploratory factor analysis (EFA) was conducted with the in-person sample (N = 661) to assess construct validity. Confirmatory factor analysis (CFA) was then used in an independent online sample (N = 481). Using the combined sample (N = 1137), convergent validity was assessed using correlations with other forms of victimization. Multivariable regression models were fit to estimate the relationship between T-IPV and health outcomes.

RESULTS

Factor analyses yielded an 8-item unidimensional scale with moderate to good fit. Nearly half the sample (48.7%) experienced at least one scale item. Internal consistency reliability was strong (KR-20 = 0.827). Significant correlations with other forms of victimization indicated convergent validity. Lifetime T-IPV was significantly associated with psychological distress (adjusted prevalence ratio [aPR] = 1.32, 95% CI = 1.13, 1.53), PTSD (aPR = 1.50, 95%CI = 1.31, 1.72), alcohol abuse (aPR = 1.21, 95%CI = 1.01, 1.44), and drug use disorder (aPR = 1.30, 95%CI = 1.06, 2.59).

CONCLUSIONS

This T-IPV scale is a reliable and unidimensional measure with strong construct validity. T-IPV is independently associated with mental health burden and substance use. Service providers working with transgender clients should screen for T-IPV to avoid missing cases of IPV, and refer to violence response services.

Exploring Multiple Forms of Intimate Partner Violence in a Gender and Racially/Ethnically Diverse Sample of Transgender Adults

Intimate partner violence (IPV) is highly prevalent in transgender (trans) populations in the United States; however, details about its manifestations and correlates have not been well captured. Using data from the 2015 U.S. Transgender Survey, we analyzed weighted data from 23,999 adult transgender participants to estimate the prevalence and explore correlates of five IPV subtypes: psychological IPV, physical IPV, trans-related IPV, stalking, and forced sex committed by an intimate partner. Regression models examined race/ethnicity, gender identity, past-year incarceration, past-year sex work, and lifetime homelessness, and adjusted for annual household income, highest level of education, age, birthplace, Census region, and relationship status. The sample was racially/ethnically diverse (62.6% White, 0.7% Alaskan Native/American Indian, 4.7% Asian/Native Hawaiian/Pacific Islander, 12.7% Black/African American, 16.5% Latinx/Hispanic, 0.4% Middle Eastern/North African, 2.5% Multiracial/Not Listed), and comprised of 31.2% transgender men, 34.2% transgender women, 27.5% assigned-female-at-birth nonbinary participants, and 7.1% assigned-male-at-birth nonbinary participants. Rates of IPV were high, with variability by IPV subtype: 42.0% endorsed psychological IPV, 39.9% endorsed physical IPV, 30.4% endorsed trans-related IPV, 18.0% endorsed stalking, and 21.5% endorsed forced sex by an intimate partner. We observed disparities in IPV subtypes by race/ethnicity, gender identity, and experiences of social marginalization. Results highlight the need for targeted, trans-inclusive IPV screening practices and interventions. Future studies should examine the syndemic effects of IPV, social marginalization, and health outcomes related to HIV, substance use, and mental health in trans populations.

HIV burden and correlates of infection among transfeminine people and cisgender men who have sex with men in Nairobi, Kenya: an observational study

BACKGROUND

Transgender people are disproportionately affected by HIV and other sexually transmitted infections (STIs) worldwide, and culturally competent prevention and treatment services are often unavailable or inaccessible. Despite recent improvements in national HIV responses for many key populations in east Africa, evidence of effective responses informed by transgender sexual health needs is sparse. We aimed to assess gender identity among men and transgender people who have sex with men in Kenya, and to explore its associations with sexual health-related outcomes, risk behaviours, and uptake of HIV prevention and care interventions.

METHODS

We did a cross-sectional study in Nairobi, Kenya, and recruited adult cisgender men and transfeminine people who reported having sex with men, through respondent-driven sampling. Inclusion criteria were possession of a valid study coupon, being aged 18 years or older, having male sex assignment at birth or male gender identification currently, living within 50 km of Nairobi, and having had consensual anal or oral sexual activity with a man in the previous 12 months. Seed participants were identified by three community organisations that provide targeted health-care services to gay, bisexual, or other men who have sex with men (MSM) communities in Nairobi. We assessed gender identity, sociodemographics, sexual behaviour, and HIV prevention and care uptake, by self-completed survey. Participants were tested for HIV, syphilis, and rectal and urethral gonorrhoea and chlamydia. We compared prevalence of sexual health outcomes, risk behaviour, and HIV prevention and care service uptake among transfeminine and cisgender participants, using multivariable robust Poisson regression models, with gender identity as the independent variable.

FINDINGS

Between May 4 and Dec 8, 2017, we enrolled 618 participants. Six participants did not answer the questions on sex assigned at birth and gender identity and so were excluded from the analyses. 522 (sample-weighted percentage 86%) of 612 participants were classified as cisgender men, 70 (11%) as transfeminine, and three (<1%) as transmasculine. 17 participants (2%) did not identify as male, female, or transgender. Compared with cisgender men, transfeminine people were more likely to be HIV-positive (28 [41%] of 70 transfeminine vs 151 [25%] of 521 cisgender men; p=0·0009) and to report current symptoms consistent with a rectal STI (eight [16%] of 67 vs 38 [7%] of 518; p=0·014). Transfeminine people reported higher numbers of recent male sexual partners (22 [27%] of 70 transfeminine people reported four or more male sexual partners in the past 3 months vs 112 [13%] of 522 cisgender men; p=0·042) and were more likely to report condomless anal intercourse with men (43 [62%] of 70 vs 208 [39%] of 522; p=0·0009) and receptive anal intercourse (54 [76%] of 70 vs 252 [46%] of 522; p<0·0001) in the past 3 months, and transactional sex with men (42 [57%] of 69 vs 240 [42%] of 518; p=0·023) and experience of sexual assault (16 [23%] of 69 vs 65 [11%] of 520; p=0·019) in the past 12 months. Use of pre-exposure prophylaxis and post-exposure prophylaxis was low in both groups.

INTERPRETATION

Transfeminine people who have sex with men have a higher burden of HIV and associated risk behaviours compared with cisgender MSM in the same context, yet their uptake of prevention and care services is poor. Policies should acknowledge the specific needs of transfeminine people as distinct from cisgender MSM, and support health-care providers to address these needs.

FUNDING

Evidence for HIV Prevention in Southern Africa (EHPSA), UK Aid.

Sexuality and Gender Issues in Individuals with Autism Spectrum Disorder

This article reviews relevant literature on sexuality in individuals with autism spectrum disorder (ASD). Findings reveal a growing awareness of desire for sexual and intimate relationships in individuals with ASD. However, core impairments of ASD lead to difficulties establishing requisite knowledge and skills necessary to attain a healthy sexuality and facilitate relationships. Consequently, individuals with ASD present with increased risk of engaging in inappropriate sexual behaviors and sexual victimization than their typically developing peers. The literature asserts the need to implement effective sexual education programs to assist in development of healthy sexual identity and relationships that meet each individual's needs.

Population-based HIV prevalence, stigma and HIV risk among trans women in Nepal

BACKGROUND

Transgender women (trans women) in Nepal are underserved in the HIV response. Data are needed to determine the HIV prevalence disaggregated from other key populations and to identify the particular risks faced by this community. Trans women are marginalized around the world and research is also needed to determine the impact of stigma on HIV risk to inform trans-specific interventions.

METHODS

In 2019, we conducted the first population-based HIV behavioral surveillance study of trans women disaggregated from other key populations using respondent driven sampling (RDS). We estimated the HIV prevalence for trans women, and bivariate and multivariate Poisson binomial regression models were constructed to examine the relationship between HIV risk and stigma.

RESULTS

Trans women participants (N = 200) had a mean age of 33 years old (SD = 10.96). We found a weighted HIV prevalence of 11.3% (95% CI 6·82% - 18·13). We found that depression and anxiety (aPR 0.81; 95% CI 0.67-0.97; p = 0·02) and current engagement in sex work (aPR 1.31; 95% CI 1.01-1.71; p = 0·046) were significantly associated with greater prevalence of condomless receptive anal intercourse. We found that experienced stigma of ever being verbally abused due to gender identity was significantly associated with lower prevalence of depression and anxiety (aPR 0.42; 95% CI 0.20-0.87; p = 0·002). Feeling unaccepted in Nepali society and believing people thought they were a criminal because of their trans identity was significantly associated greater prevalence of current sex work (aPR 1.36; 95% CI 1.03-1.78; p = 0·03; aPR 1.45; 95% CI 1.03-2.07; p = 0.04). Every measure of experienced stigma assessed was significantly associated with greater prevalence of current engagement in sex work.

CONCLUSIONS

Trans women are highly stigmatized in Nepal, leading to individual and systems factors that impact their risk for HIV. Interventions are needed that support the economic and mental wellbeing of trans women to prevent their heighted risk of HIV from stigma.

Attitudes towards Violence in Adolescents and Youth Intimate Partner Relationships: Validation of the Spanish Version of the EAV

The main purpose of the present study was to analyze the psychometric properties of the Attitudes Scale Towards Violence (Escala de Actitudes hacia la Violencia, EAV) in adolescents. The EAV is a questionnaire devoted to assess attitudes towards violence. Additionally, the relationship between EAV and violence manifestations and depressive symptoms was analyzed. The final sample comprised a total of 1248 students in a cross-sectional survey. The EAV, the Modified Conflict Tactics Scale (M-CTS), and the Reynolds Adolescent Depression Scale (RADS) were used. The analysis of the internal structure of the EAV yielded a two-factor structure as the most adequate. The EAV scores showed measurement invariance across gender and age. The McDonald’s Omega was 0.862 and 0.872 for the two hypothesized factors. Furthermore, self-reported attitudes towards violence were associated with violence manifestations both as a victim and as a perpetrator and depressive symptoms. These results support that the EAV is a brief and easy tool to assess self-reported violence attitudes in intimate partner relationships in adolescents from the general population. The assessment of these attitudes, and its associations with violence and depressive manifestations, may help us to enhance the possibility of an early identification of adolescents potentially at risk for suffering violence as a victim or as a perpetrator.

Young Transgender Women Survivors of Intimate Partner Violence: A Latent Class Analysis of Protective Processes

Research is critically needed to understand protective processes that may lessen the impact of intimate partner violence (IPV) on negative outcomes for transgender individuals. The current study utilized a latent class analysis to identify combinations of protective processes (i.e., collective self-esteem and social support) in relation to internalizing mental health symptoms among young transgender women (YTW) survivors of IPV. Data from Project LifeSkills (2012-2015), a multisite trial for HIV sexual risk reduction intervention, were used for the present study. A subsample of 78 YTW (ages 16 to 29) who were IPV survivors (i.e., indicated lifetime IPV) were included in the analyses. Participants completed measures of general social support, perceived social support from their mother and friends, and collective self-esteem, as well as mental health symptoms. Three latent classes emerged: 1) YTW who perceived high levels of social support and collective self-esteem (48%), 2) YTW who perceived low levels of collective self-esteem, but average to high levels of social support from mother and friends (23%), and 3) YTW who perceived low levels of collective self-esteem and low to average levels of social support from mother and friends (29%). YTW in the overall low class had significantly higher levels of depressive, anxiety, and somatization symptoms, compared to the other two classes. These findings highlight how low levels of social support and collective self-esteem can place YTW survivors of IPV at significant risk for experiencing negative internalizing mental health symptoms.

Intimate Partner Violence in Transgender Populations: Systematic Review and Meta-analysis of Prevalence and Correlates

Background: Transgender individuals experience unique vulnerabilities to intimate partner violence (IPV) and may experience a disproportionate IPV burden compared with cisgender (nontransgender) individuals.Objectives: To systematically review the quantitative literature on prevalence and correlates of IPV in transgender populations.Search Methods: Authors searched research databases (PubMed, CINAHL), gray literature (Google), journal tables of contents, and conference abstracts, and consulted experts in the field. Authors were contacted with data requests in cases in which transgender participants were enrolled in a study, but no disaggregated statistics were provided for this population.Selection Criteria: We included all quantitative literature published before July 2019 on prevalence and correlates of IPV victimization, perpetration, or service utilization in transgender populations. There were no restrictions by sample size, year, or location.Data Collection and Analysis: Two independent reviewers conducted screening. One reviewer conducted extraction by using a structured database, and a second reviewer checked for mistakes or omissions. We used random-effects meta-analyses to calculate relative risks (RRs) comparing the prevalence of IPV in transgender individuals and cisgender individuals in studies in which both transgender and cisgender individuals were enrolled. We also used meta-analysis to compare IPV prevalence in assigned-female-sex-at-birth and assigned-male-sex-at-birth transgender individuals and to compare physical IPV prevalence between nonbinary and binary transgender individuals in studies that enrolled both groups.Main Results: We identified 85 articles from 74 unique data sets (n_total = 49 966 transgender participants). Across studies reporting it, the median lifetime prevalence of physical IPV was 37.5%, lifetime sexual IPV was 25.0%, past-year physical IPV was 16.7%, and past-year sexual IPV was 10.8% among transgender individuals. Compared with cisgender individuals, transgender individuals were 1.7 times more likely to experience any IPV (RR = 1.66; 95% confidence interval [CI] = 1.36, 2.03), 2.2 times more likely to experience physical IPV (RR = 2.19; 95% CI = 1.66, 2.88), and 2.5 times more likely to experience sexual IPV (RR = 2.46; 95% CI = 1.64, 3.69). Disparities persisted when comparing to cisgender women specifically. There was no significant difference in any IPV, physical IPV, or sexual IPV prevalence between assigned-female-sex-at-birth and assigned-male-sex-at-birth individuals, nor in physical IPV prevalence between binary- and nonbinary-identified transgender individuals. IPV victimization was associated with sexual risk, substance use, and mental health burden in transgender populations.Authors' Conclusions: Transgender individuals experience a dramatically higher prevalence of IPV victimization compared with cisgender individuals, regardless of sex assigned at birth. IPV prevalence estimates are comparably high for assigned-male-sex-at-birth and assigned-female-sex-at-birth transgender individuals, and for binary and nonbinary transgender individuals, though more research is needed.Public Health Implications: Evidence-based interventions are urgently needed to prevent and address IPV in this high-risk population with unique needs. Lack of legal protections against discrimination in employment, housing, and social services likely foster vulnerability to IPV. Transgender individuals should be explicitly included in US Preventive Services Task Force recommendations promoting IPV screening in primary care settings. Interventions at the policy level as well as the interpersonal and individual level are urgently needed to address epidemic levels of IPV in this marginalized, high-risk population.

Gender identity, sexual orientation and adverse sexual experiences in autistic females

BACKGROUND

There is growing recognition that autistic females present with more diverse gender and sexual identities than their non-autistic counterparts. Likewise, autistic females are also at an increased risk of adverse sexual experiences. As higher rates of sexual victimisation are observed in individuals with diverse sexual identities in the broader population, rates of negative sexual experiences among autistic females remain unclear. This study aimed to investigate the representation of gender and sexual diversity within autistic females and examine their rates of regretted, and unwanted, sexual encounters among females with a transgender gender identity and non-heterosexual sexual orientation.

METHODS

Two hundred and ninety-five females completed the Sexual Behaviour Scale-III (SBS-III) online. Self-reported gender identity and sexual orientation were compared between 134 autistic (M_age= 26.2 years, SD = 8.7) and 161 non-autistic females (M_age = 22.0 years, SD = 4.6). Differences in the prevalence of negative sexual experiences were compared across diagnosis and each gender identity and sexual orientation label.

RESULTS

Autistic females were more likely to identify with a transgender gender identity (p < .05) and non-heterosexual sexual orientation (p < .007) compared to non-autistic females. Autistic homosexual females were more likely to have experienced a range of negative sexual experiences than autistic heterosexual females (OR ≥ 3.29; p < .01) and were more likely to have experienced unwanted sexual experiences than non-autistic females regardless of sexual orientation (OR ≥ 2.38; p < .05). There were no differences in rates of negative sexual experiences between autistic bisexual and both autistic heterosexual and non-autistic bisexual females. Non-autistic bisexual females (OR = 0.24; p = .018) presented with a reduced risk of regretted sexual experiences than non-autistic heterosexual peers. There were no differences in negative sexual experiences across gender identity in the autistic sample.

LIMITATIONS

The use of fixed format response items may have restricted participants' abilities to provide rich responses pertaining to their sexual identities and nature of negative sexual experiences. The small number of participants who identified as transgender (n = 40) limits the reliability of results pertaining to sexual experiences across gender identity. Moreover, although multiple recruitment methods were used in this study, non-representative may bias estimates of prevalence rates. Thus, the data may not be representative of the broader population.

CONCLUSIONS

Results indicate that autistic females present with greater diversity in their sexual identities than individuals without autism, with those with a homosexual sexual orientation being at greater risk of experiencing adverse sexual encounters. Findings suggest the importance of increased clinical attention to this diversity and the need to provide support to facilitate the development of a healthy sexual identity and reduce the risks identified in this study.

Sexuality and Gender Issues in Individuals with Autism Spectrum Disorder

This article reviews relevant literature on sexuality in individuals with autism spectrum disorder (ASD). Findings reveal a growing awareness of desire for sexual and intimate relationships in individuals with ASD. However, core impairments of ASD lead to difficulties establishing requisite knowledge and skills necessary to attain a healthy sexuality and facilitate relationships. Consequently, individuals with ASD present with increased risk of engaging in inappropriate sexual behaviors and sexual victimization than their typically developing peers. The literature asserts the need to implement effective sexual education programs to assist in development of healthy sexual identity and relationships that meet each individual's needs.

Intimate Partner Violence Against Transgender Women: Prevalence and Correlates in Lima, Peru (2016-2018)

Limited data exists on intimate partner violence (IPV) among transgender women (TW), though global trends suggest IPV is associated with HIV risk in this population. We describe the prevalence of verbal, physical, and/or sexual violence as well as participant- and partner-level correlates of IPV among TW in Lima, Peru. Among 389 respondents, 15.2% reported IPV with one or more of their last three sexual partners: 9.2% verbal, 8.2% physical, and 2.3% sexual violence. Physical and verbal violence were more common with stable partners (aPR 3.46, 95% CI 1.17-10.25, aPR 2.46, 95% CI 1.14-5.28, respectively). Physical violence was associated with condomless receptive anal intercourse (cRAI) (aPR 2.22, 95% CI 1.19-4.13) and partner alcohol use (aPR 4.38, 95% CI 1.56-12.33) while verbal violence correlated with participant inebriation (aPR 4.86, 95% CI 1.63-14.46). Our results link IPV with stable partnerships, alcohol use, and cRAI, suggesting TW in Peru may benefit from multidimensional IPV prevention strategies to foster supportive relationships and reduce HIV transmission.

Transgender stigma: A critical scoping review of definitions, domains, and measures used in empirical research

RATIONALE

A growing body of transgender (trans) health research has explored the relationship between stigma and health; yet, studies have conceptualized and operationalized anti-trans stigma in multiple ways.

OBJECTIVE

This scoping review aims to critically analyze quantitative measures of anti-trans stigma in the U.S. using a socioecological framework.

METHOD

We organized and appraised measures from 126 included articles according to socioecological level: structural, interpersonal, or individual.

RESULTS

Of the identified articles, 36 measured anti-trans stigma at the structural level (i.e., institutional structures and policies), 102 measured anti-trans at the interpersonal level (i.e., community interactions), and 44 measured anti-trans stigma at the individual level (i.e., internalized or anticipated stigma). Definitions of anti-trans stigma varied substantially across articles. Most measures were adapted from measures developed for other populations (i.e., sexual minorities) and were not previously validated for trans samples.

CONCLUSIONS

Studies analyzing anti-trans stigma should concretely define anti-trans stigma. There is a need to develop measures of anti-trans stigma at all socioecological levels informed by the lived experiences of trans people.

Intimate Partner Violence and Depression among Black Transgender Women in the USA: The Potential Suppressive Effect of Perceived Social Support

Depression among Black transgender women (BTW) in the USA is an often understudied mental health concern with far-reaching consequences for overall physical and mental health at both the individual and community levels. Intimate partner violence (IPV) among BTW is also a frequently understudied and important social determinant of health in need of further exploration. This study sought to address the gap in research on the relationship between IPV and depression among BTW using a time- and location-based community sample of BTW from six US cities. In addition, it sought to explore the potential protective or suppressive effect of perceived social support on this relationship. Generalized structural equation models were used to assess conditional direct and indirect effects of IPV on depression via the suppression effect of perceived social support. Evidence was found of a statistically significant conditional direct effect of IPV on depression as well as a statistically significant suppression effect for perceived social support. Specifically, there was a 20% lower likelihood of increased depressive symptomatology for every 1-unit increase in perceived social support reported by participants. These findings indicated that perceived social support may be an important intervention point for helping to improve the mental health and well-being of BTW.

Intimate Partner Violence and Depression among Black Transgender Women in the USA: The Potential Suppressive Effect of Perceived Social Support

Depression among Black transgender women (BTW) in the USA is an often understudied mental health concern with far-reaching consequences for overall physical and mental health at both the individual and community levels. Intimate partner violence (IPV) among BTW is also a frequently understudied and important social determinant of health in need of further exploration. This study sought to address the gap in research on the relationship between IPV and depression among BTW using a time- and location-based community sample of BTW from six US cities. In addition, it sought to explore the potential protective or suppressive effect of perceived social support on this relationship. Generalized structural equation models were used to assess conditional direct and indirect effects of IPV on depression via the suppression effect of perceived social support. Evidence was found of a statistically significant conditional direct effect of IPV on depression as well as a statistically significant suppression effect for perceived social support. Specifically, there was a 20% lower likelihood of increased depressive symptomatology for every 1-unit increase in perceived social support reported by participants. These findings indicated that perceived social support may be an important intervention point for helping to improve the mental health and well-being of BTW.

Increasing Access to Pre-Exposure Prophylaxis Among Transgender Women and Transfeminine Nonbinary Individuals

In the United States, transgender women and transfeminine nonbinary individuals (TGWNBI) are a highly vulnerable and marginalized population at high risk for HIV. Despite disproportionate rates of HIV, a striking lack of research exists on pre-exposure prophylaxis (PrEP) use among TGWNBI. We conducted 30 semi-structured interviews with TGWNBI both on PrEP and those not on PrEP. Questions explored PrEP access, initiation, and factors to increase broad interest and participation in PrEP. Qualitative data were coded and analyzed using thematic analysis. Participants identified five components to increase PrEP use among TGWNBI: (1) eliminating the practice of conflating TGWNBI with cisgender men who have sex with men, (2) recognition of and support for the contextual factors associated with HIV risk among TGWNBI, (3) ensuring the design and development of transgender-inclusive and gender-affirming sexual health programs that include PrEP, (4) active provider engagement and assistance around PrEP, and (5) identification and implementation of strategies to bolster existing community mobilization/activism around PrEP.