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Reisner SL, Perez-Brumer A, Salazar X, Silva-Santisteban A. Design and pilot evaluation of a brief intervention to reduce transphobia and improve attitudes of government officials to address legal gender affirmation needs of transgender people in Peru. Glob Health Action 2024; 17:2381881. [PMID: 39034831 PMCID: PMC11265303 DOI: 10.1080/16549716.2024.2381881] [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: 03/11/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024] Open
Abstract
Legal gender affirmation - legal name and gender marker change - is an important health-promoting health determinant for transgender people. In Peru, the state's failure to universally recognize transgender people's legal identity limits standardized legal affirmation procedures, including the paucity of government officials trained in gender affirmation strategies. This project, in partnership with Registro Nacional de Identificación y Estado Civil (RENIEC) and transgender communities, designed and piloted a group-based intervention to sensitize government officers to the importance of gender-concordant identity documents. Between August 2017 and February 2018, three in-person group intervention sessions were held (each 3-4 hours) with 51 government officers. Guided by Gender Affirmation and Structural Violence Frameworks, the intervention utilized Adult Learning Theory and applied storytelling and testimonials as pedagogy. Pre-/post-test surveys were administered (19 true/false items, summed to create an index score measuring knowledge and attitudes toward transgender people). Within-person changes in pre-/post-intervention scores were evaluated using paired t-tests. Pre-/post-test data were available for 41 participants. After the intervention, there were improvements in knowledge and more favorable attitudes toward transgender people (pre-test mean = 14.09, SD = 2.33 vs. post-test mean = 15.62, SD = 1.82; difference = 1.53, 95% CL = 0.60, 2.67; t-test = 3.30 [df = 46]; p = 0.002). The intervention was feasible to conduct and garnered high acceptability. The results suggest the promise of this brief intervention for future research and testing before potential later implementation and scale-up to increase the capacity of government officers to address legal gender affirmation for transgender people in Peru.
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Affiliation(s)
- Sari L. Reisner
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Amaya Perez-Brumer
- Division of Social and Behavioural Health Sciences, University of Toronto, Toronto, Canada
- Center for Interdisciplinary Research in Sexuality, AIDS and Society, University of Peru Cayetano, Lima, Peru
| | - Ximena Salazar
- Center for Interdisciplinary Research in Sexuality, AIDS and Society, University of Peru Cayetano, Lima, Peru
| | - Alfonso Silva-Santisteban
- Center for Interdisciplinary Research in Sexuality, AIDS and Society, University of Peru Cayetano, Lima, Peru
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Jamal L, Zayhowski K, Berro T, Baker K. Queering genomics: How cisnormativity undermines genomic science. HGG ADVANCES 2024; 5:100297. [PMID: 38637989 PMCID: PMC11129102 DOI: 10.1016/j.xhgg.2024.100297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 04/11/2024] [Accepted: 04/11/2024] [Indexed: 04/20/2024] Open
Abstract
Over the past century, genetics and genomics ("genomics") have contributed significantly to our knowledge of human biology and disease. Genomics has also bolstered inaccurate and harmful arguments about "essential" differences between socially defined groups. These purported differences have reinforced class hierarchies and justified the mistreatment of groups such as Black people, Indigenous people, and other people of color and/or people with disabilities. With this history in mind, we explore how genomics is used to reinforce scientifically unsound understandings of the relationship between two fundamental aspects of the human experience: sex and gender. We argue that imprecise, inaccurate practices for collecting data and conducting genomic research have adversely influenced genomic science and can contribute to the stigmatization of people whose sex and/or gender challenge binary expectations. The results have been to preclude transgender and intersex people from accessing high-quality, evidence-based healthcare and to hinder their participation in scientifically sound research. In this perspective, we use the lens of queer theory to render this situation more visible. First, we highlight the theoretical contributions queer theory can make to genomic science. Second, we examine practices in research and clinical genomics that exclude and stigmatize transgender and intersex people. Third, we highlight the ways that many current genomic research practices generate false conclusions that are used to support unjust public policies. We conclude by recommending ways that clinicians and researchers can-and should-harness the scientific, social, and cultural power of genomics to advance knowledge and improve lives across the spectra of sex and gender.
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Affiliation(s)
- Leila Jamal
- Genetics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA; Bioethics Department, National Institutes of Health, Bethesda, MD, USA.
| | - Kimberly Zayhowski
- Department of Obstetrics and Gynecology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Tala Berro
- Department of Genetics, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Kellan Baker
- Whitman-Walker Institute, Washington, DC, USA; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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MacKinnon KR, Jeyabalan T, Strang JF, Delgado-Ron JA, Lam JSH, Gould WA, Cooper A, Salway T. Discontinuation of Gender-Affirming Medical Treatments: Prevalence and Associated Features in a Nonprobabilistic Sample of Transgender and Gender-Diverse Adolescents and Young Adults in Canada and the United States. J Adolesc Health 2024:S1054-139X(24)00251-9. [PMID: 38944803 DOI: 10.1016/j.jadohealth.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 04/25/2024] [Accepted: 05/20/2024] [Indexed: 07/01/2024]
Abstract
PURPOSE This study investigated the prevalence, correlates, and reasons for discontinuing gender-affirming medical treatment (GAMT) among transgender and gender-diverse adolescents and young adults living in Canada and the United States of America. METHODS This exploratory study used data from an online survey of sexual and gender minority adolescents and young adults aged 15-29 years living in Canada or the United States of America (March-August 2022). The analytic sample was constituted by participants who responded to questions regarding starting and stopping GAMT, as well as reasons for stopping. Correlates of discontinuing GAMT were assessed using univariate logistic regression. RESULTS The mean age of the analytic sample (N = 3,937) was 21.1 years. Participants were predominantly nonbinary (54.2%) and assigned female at birth (80.8%). 75.5% lived in Canada and 24.5% in the United States of America. Among those who had started GAMT, 121 of 720 (16.8%) reported having ever discontinued treatment. Forty five of 121 (37.2%) who ceased GAMT reported "Yes, but I wish I hadn't." The most frequently endorsed reasons for discontinuing GAMT were health reasons (37.3%), a change in gender identity (32.0%), and cost (16.0%). Greater age; nonbinary identity, 'other' gender identity; diagnosis of or self-identifying as living with schizophrenia; residing in the United States of America (relative to Canada); and endorsing a current Christian identity were associated with discontinuation. Ninety seven of 121 (80.2%) who discontinued GAMT reported a current transgender or gender-diverse identity. DISCUSSION Given the dearth of information about the subpopulation who discontinue GAMT, this study advances candidate factors to inform future longitudinal research to better understand the multiple reasons and contexts for stopping GAMT.
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Affiliation(s)
- Kinnon R MacKinnon
- School of Social Work, York University, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Thiyaana Jeyabalan
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
| | - John F Strang
- Center for Neuroscience, Children's National Hospital, Washington, D.C.; George Washington University School of Medicine, Washington, D.C
| | - Jorge Andrés Delgado-Ron
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
| | - June S H Lam
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Gender Identity Clinic, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Wren A Gould
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Alex Cooper
- Department of Interdisciplinary Studies and Psychological Sciences, College of William and Mary, Williamsburg, Virginia
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada; British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
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Chao KY, Chou CC, Chen CI, Cheng W. Gender Self-Identification: Opinions About Transgender Women from a National Online Survey in Taiwan. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1885-1897. [PMID: 38498257 PMCID: PMC11106129 DOI: 10.1007/s10508-024-02819-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 03/20/2024]
Abstract
Gender self-identification (transgender) is not permitted in most Asian countries. In Taiwan, individuals recognized as transgender must meet requirements mandated by the Gender Recognition Act. Currently, lifting the requirement for proof of sex-reassignment surgery is pending. The aim of this study was to survey a large sample of Taiwanese to gain a better understanding of the general population's attitudes toward gender self-identification. A self-report survey, entitled "Opinions of Gender Self-Identification," collected demographic information and responses (agree = 1, disagree = 0) to 14 statements about transgender women and women's safety, personal rights, and the law; one statement discussed rights of transgender men to give birth; total scores ranged from 0 to 14. The online survey was distributed to non-government organizations across Taiwan and the Taiwanese islands and was available between April 16 and 30, 2022. Most of the 10,158 respondents were female (77.4%); ages of respondents ranged from 15 to > 65 years. The mean total score was 0.95 ± 2.27, indicating respondents strongly disagreed with support for transgender females; 91.56% disagreed with all statements. Although there were significant differences in scores between parents and non-parents, and those ≤ 35 years versus ≥ 36 years (p < .01), all strongly disagreed with gender self-identification. Given the majority of respondents were females, survey findings should be regarded with caution. Public acceptance of gender self-identification requires support from its residents. Our findings suggest that gender self-identification has not begun to approach even a moderate level of public support among survey respondents.
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Affiliation(s)
- Kuo-Yu Chao
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chih-Chiang Chou
- Department of Psychiatry, Centro Hospitalar Conde de São Januário, Sé, Macau SAR, China
| | - Ching-I Chen
- Department of Psychiatry, Keelung Hospital, Ministry of Health and Welfare, Kee-Lung, Taiwan
| | - Wei Cheng
- Department of Pathology, Kee-Lung Hospital, Ministry of Health and Welfare, No. 268, Xin 2nd Road Xinyi District, Keelung City, 201203, Taiwan, ROC.
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
- Department of Nursing, Deh Yu College of Nursing and Health, Kee-Lung, Taiwan.
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Rogers SM, Lopez RM, Crossway AK, Moffit DM, Sturtevant J, Hansen A. The Role of the Athletic Trainer in Providing Care to Transgender and Gender-Diverse Patients: Foundational Knowledge and Disparities-Part I. J Athl Train 2024; 59:338-344. [PMID: 36735644 PMCID: PMC11064106 DOI: 10.4085/1062-6050-0311.22] [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] [Indexed: 02/04/2023]
Abstract
Transgender and gender-diverse (TGD) patients experience discrimination, harassment, marginalization, and minority stress at greater rates than their cisgender counterparts, leading to numerous health and health care disparities that negatively affect well-being and access to quality health care.1 Despite being in an opportune position to improve health equity for TGD patients under their care, many athletic trainers (ATs) report having little to no formal education on TGD patient care, leading to a reduction in self-reported competence. As such, to fill this knowledge gap, the purposes of the first part of this 2-part narrative literature review are to (1) provide readers with foundational information and terminology, (2) explore relevant health and health care disparities, and (3) identify the role of the AT within an interprofessional care team treating TGD patients.
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Affiliation(s)
| | - Rebecca M Lopez
- School of Physical Therapy & Rehabilitation Sciences; Department of Orthopaedics & Sports Medicine, University of South Florida, Tampa
| | | | - Dani M Moffit
- Physical Therapy & Athletic Training Department, Idaho State University, Pocatello
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Scheim AI, Rich AJ, Zubizarreta D, Malik M, Baker KE, Restar AJ, van der Merwe LA, Wang J, Beebe B, Ridgeway K, Baral SD, Poteat T, Reisner SL. Health status of transgender people globally: A systematic review of research on disease burden and correlates. PLoS One 2024; 19:e0299373. [PMID: 38466747 PMCID: PMC10927095 DOI: 10.1371/journal.pone.0299373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 02/08/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Transgender and gender diverse (trans) health research has grown rapidly, highlighting the need to characterize the scientific evidence base. We conducted a systematic review of peer-reviewed research on disease burden and correlates in trans adolescents and adults over a 20-month period to identify knowledge gaps and assess methodological characteristics including measurement of gender identity, community engagement, and study quality. DATA SOURCES, ELIGIBILITY CRITERIA, AND SYNTHESIS METHODS We searched seven databases using terms related to (a) transgender populations and (b) health or disease. Eligible studies were in English, French, or Spanish and reported original quantitative data on mental health or substance use conditions, infectious diseases, or non-communicable conditions in at least 25 trans individuals aged 15+. Quality assessment was performed in duplicate on a 10% sample of articles and findings were summarized using narrative synthesis. RESULTS The 328 included studies were conducted in 45 countries, with most from North America (54%) and limited research from South Asia (3%), Sub-Saharan Africa (3%), and the Middle East and North Africa (2%). Most studies used cross-sectional designs (73%) and convenience sampling (65%). Only 30% of studies reported any form of community engagement. Mental health and substance use disorders were the most studied area (77% of studies) and non-communicable conditions the least (16%). Available data indicated that trans populations experience high disease burden with considerable heterogeneity within and across settings. Of 39 articles assessed for quality, 80% were rated as fair, 18% as poor, and 3% as good quality. CONCLUSIONS AND IMPLICATIONS Geographic, gender-specific, and topical gaps remain in trans health, but we found more research from African countries, with transmasculine people, and on non-communicable conditions than previous syntheses. Areas for growth in trans health research include community engagement, non-binary health, chronic and age-related conditions, and health determinants. REGISTRATION PROSPERO CRD42021234043.
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Affiliation(s)
- Ayden I. Scheim
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, United States of America
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Ashleigh J. Rich
- Department of Social Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Dougie Zubizarreta
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Mannat Malik
- Department of Health Behaviour, Gillings School of Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Kellan E. Baker
- Whitman-Walker Institute, Washington, District of Columbia, United States of America
| | - Arjee J. Restar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Leigh Ann van der Merwe
- Social, Health and Empowerment Feminist Collective of Transgender Women of Africa (S.H.E.), East London, South Africa
| | - June Wang
- Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Bianca Beebe
- School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Kathleen Ridgeway
- School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Stefan D. Baral
- Department of Epidemiology, School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Tonia Poteat
- Department of Social Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Sari L. Reisner
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
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DuBois LZ, Puckett JA, Jolly D, Powers S, Walker T, Hope DA, Mocarski R, Huit TZ, Lash BR, Holt N, Ralston A, Miles M, Capannola A, Tipton C, Eick G, Juster RP. Gender minority stress and diurnal cortisol profiles among transgender and gender diverse people in the United States. Horm Behav 2024; 159:105473. [PMID: 38190769 DOI: 10.1016/j.yhbeh.2023.105473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 01/10/2024]
Abstract
The field of behavioral neuroendocrinology has only begun to explore the lived experiences of transgender and gender diverse (TGD) people exposed to stigma. In light of escalating attacks and legislation targeting TGD people in the United States, it is crucial to examine the physiological pathways through which gender minority stressors become embodied, impact health, and contribute to health inequities. The Trans Resilience and Health Study included baseline data collection from fall 2019 to spring 2020 from a sample of 124 TGD people, reflecting a diversity of gender identities (e.g., trans masculine, trans feminine, and nonbinary) and ages (range = 19-70 years old; M = 34.10), living in Michigan, Nebraska, Oregon, and Tennessee. These analyses examine experiences of gender-related enacted stigma in association with hypothalamic-pituitary-adrenal (HPA)-axis functioning. Among those experiencing the highest levels of enacted stigma, findings show a blunted cortisol awakening response and sluggish daily decline that resulted in elevated concentrations at bedtime compared to those experiencing less enacted stigma. These results of flattened diurnal activity are consistent with an emergent literature on discrimination as a social determinant of potential stress pathophysiology. In contrast, community connectedness was associated with a larger, more dynamic cortisol awakening response. These findings emphasize the importance of incorporating gender-minority stress and resilience measures when studying HPA-axis functioning among TGD people.
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Affiliation(s)
- L Zachary DuBois
- Department of Anthropology, 1218 University of Oregon, Eugene, OR 97403, United States.
| | - Jae A Puckett
- Department of Psychology, Michigan State University, 316 Physics Road, East Lansing, MI 48824, United States.
| | - Dee Jolly
- Department of Anthropology, 1218 University of Oregon, Eugene, OR 97403, United States.
| | - Sally Powers
- Department of Psychological and Brain Sciences, University of Massachusetts at Amherst, 135 Hicks Way, Amherst, MA 01003, United States.
| | - Tian Walker
- Department of Anthropology, 1218 University of Oregon, Eugene, OR 97403, United States.
| | - Debra A Hope
- Department of Psychology, University of Nebraska-Lincoln, 238 Burnette Hall, Lincoln, NE 68588, United States; Office of Graduate Studies, University of Nebraska-Lincoln, Lincoln, NE 68588, United States.
| | - Richard Mocarski
- Office of Research, San José State University, One Washington Square, San José, CA, United States.
| | - T Zachary Huit
- Department of Psychology, University of Nebraska-Lincoln, 238 Burnette Hall, Lincoln, NE 68588, United States
| | - Brenna R Lash
- Department of Psychology, University of Nebraska-Lincoln, 238 Burnette Hall, Lincoln, NE 68588, United States
| | - Natalie Holt
- Department of Psychology, University of Nebraska-Lincoln, 238 Burnette Hall, Lincoln, NE 68588, United States
| | - Allura Ralston
- Department of Psychology, University of Nebraska-Lincoln, 238 Burnette Hall, Lincoln, NE 68588, United States
| | - Makinna Miles
- College of Public Health and Human Sciences, Oregon State University, 160 SW 26th St, Corvallis, OR 97331, United States
| | - A Capannola
- Department of Child & Family Studies, The University of Tennessee at Knoxville, 1215 W. Cumberland Ave., Knoxville, TN 37996, United States.
| | - Clove Tipton
- Department of Sociology, The University of Tennessee at Knoxville, 901 McClung Tower, Knoxville, TN 37996, United States.
| | - Geeta Eick
- Department of Anthropology, 1218 University of Oregon, Eugene, OR 97403, United States
| | - Robert-Paul Juster
- Department of Psychiatry and Addiction, University of Montreal, Research Center of the Montreal Mental Health University Institute, 7331 Hochelaga, FS-145-12, Montreal, Quebec H1N 3V2, Canada.
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Decriminalisation and the end of AIDS: keep the promise, follow the science, and fulfill human rights. Sex Reprod Health Matters 2023; 31:2194188. [PMID: 37351922 PMCID: PMC10291907 DOI: 10.1080/26410397.2023.2194188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
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Akande M, Del Farno A, Adrian H, Fogwell NT, Johnson DM, Zlotnick C, Operario D. 'Sometimes, we don't know if we're getting abused': discussions of intimate partner violence and HIV risk among transgender women. CULTURE, HEALTH & SEXUALITY 2023; 25:1101-1115. [PMID: 36309824 PMCID: PMC10148920 DOI: 10.1080/13691058.2022.2134929] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/07/2022] [Indexed: 05/03/2023]
Abstract
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.
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Affiliation(s)
- Morayo Akande
- Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Alexander Del Farno
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Haley Adrian
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | | | - Dawn M. Johnson
- Department of Psychology, University of Akron, Akron, OH, USA
| | - Caron Zlotnick
- Department of Psychiatry and Human Behaviour, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Don Operario
- Department of Behavioural, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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King WM, Jadwin-Cakmak L, Trammell R, Gamarel KE. Structural vulnerability as a conceptual framework for transgender health research: findings from a community needs assessment of transgender women of colour in Detroit. CULTURE, HEALTH & SEXUALITY 2023; 25:681-697. [PMID: 35736653 PMCID: PMC9780405 DOI: 10.1080/13691058.2022.2086709] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/02/2022] [Indexed: 06/02/2023]
Abstract
The concept of structural vulnerability explains how systems of oppression drive health inequities by reducing access to survival resources (e.g. food, housing) for marginalised populations. Indicators of structural vulnerability such as housing instability, violent victimisation and poverty are often interconnected and result from intersectional oppression. We sought to demonstrate the utility of the structural vulnerability framework for transgender health research by examining patterns of structural vulnerability indicators among transgender women of colour in Detroit. We conducted latent class analysis and tested associations between classes and mental health and substance use outcomes. Membership to the Lowest Vulnerability class was negatively associated with post-traumatic stress disorder (PTSD) (aOR = 0.10, 95% CI: 0.02-0.59). High Economic Vulnerability membership was associated with daily marijuana use (aOR = 4.61, 95% CI: 1.31-16.16). Complex Multi-Vulnerability membership was associated with PTSD (aOR = 9.75, 95% CI: 2.55-37.29), anxiety (aOR = 4.12, 95% CI: 1.22-13.97), suicidality (aOR = 6.20, 95% CI: 1.39-27.70), and club drug use (aOR = 4.75, 95% CI: 1.31-17.29). Substantively different findings emerged when testing relationships between each indicator and each outcome, highlighting the value of theoretically grounded quantitative approaches to understanding health inequities. Community-driven interventions and policy changes that reduce structural vulnerability may improve mental health and substance use outcomes among structurally vulnerable trans women of colour.
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Affiliation(s)
- Wesley M King
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
| | - Laura Jadwin-Cakmak
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
| | - Racquelle Trammell
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
- Trans Sistas of Colour Project, Detroit, MI, USA
| | - Kristi E Gamarel
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
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11
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Holland MR, Kahlor LA. A Google Trends Analysis of Interest in Nonbinary Identities. CYBERPSYCHOLOGY, BEHAVIOR AND SOCIAL NETWORKING 2023. [PMID: 37140556 DOI: 10.1089/cyber.2022.0304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Emerging research on stigma suggests that society's mistreatment of nonbinary individuals can, in part, be attributed to public uncertainty and a lack of knowledge about nonbinary identities. In response to this, this study drew upon the theoretical framework of uncertainty management to explore research questions related to nonbinary identity and information behaviors by investigating uncertainty management as evidenced by longitudinal Google Trends data related to nonbinary gender identities. If individuals were found to be engaging in information seeking, the result of this behavior may be that they become less likely to hold stigmatizing attitudes toward nonbinary people, and ultimately be less likely to engage in discrimination toward them. Results indicated that indeed there has been an increase in search volume interest related to nonbinary identities in the past decade. The study concludes by presenting the need for further research to clarify the nature of the relationship between stigma and information seeking, as well as presenting a quandary for researchers regarding the desire for more detailed demographic data, as balanced with concerns for privacy.
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Affiliation(s)
- Madeleine R Holland
- Department of Communication Studies, The University of Texas at Austin, Austin, Texas, USA
| | - Lee Ann Kahlor
- School of Advertising and Public Relations, The University of Texas at Austin, Austin, Texas, USA
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12
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Chakrapani V, Newman PA, Shunmugam M, Rawat S, Mohan BR, Baruah D, Tepjan S. A scoping review of lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI+) people's health in India. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001362. [PMID: 37079524 PMCID: PMC10118178 DOI: 10.1371/journal.pgph.0001362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 03/18/2023] [Indexed: 04/21/2023]
Abstract
Amid incremental progress in establishing an enabling legal and policy environment for lesbian, gay, bisexual, transgender and queer-identified people, and people with intersex variations (LGBTQI+) in India, evidence gaps on LGBTQI+ health are of increasing concern. To that end, we conducted a scoping review to map and synthesize the current evidence base, identify research gaps, and provide recommendations for future research. We conducted a scoping review using the Joanna Briggs Institute methodology. We systematically searched 14 databases to identify peer-reviewed journal articles published in English language between January 1, 2010 and November 20, 2021, that reported empirical qualitative, quantitative or mixed methods data on LGBTQI+ people's health in India. Out of 3,003 results in total, we identified 177 eligible articles; 62% used quantitative, 31% qualitative, and 7% mixed methods. The majority (55%) focused on gay and other men who have sex with men (MSM), 16% transgender women, and 14% both of these populations; 4% focused on lesbian and bisexual women, and 2% on transmasculine people. Overall, studies reported high prevalence of HIV and sexually transmitted infections; multilevel risk factors for HIV; high levels of mental health burden linked to stigma, discrimination, and violence victimization; and non-availability of gender-affirmative medical care in government hospitals. Few longitudinal studies and intervention studies were identified. Findings suggest that LGBTQI+ health research in India needs to move beyond the predominant focus on HIV, and gay men/MSM and transgender women, to include mental health and non-communicable diseases, and individuals across the LGBTQI+ spectrum. Future research should build on largely descriptive studies to include explanatory and intervention studies, beyond urban to rural sites, and examine healthcare and service needs among LGBTQI+ people across the life course. Increased Indian government funding for LGBTQI+ health research, including dedicated support and training for early career researchers, is crucial to building a comprehensive and sustainable evidence base to inform targeted health policies and programs moving forward.
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Affiliation(s)
- Venkatesan Chakrapani
- Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India
- The Humsafar Trust, Mumbai, India
| | - Peter A. Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- VOICES-Thailand Foundation, Chiang Mai, Thailand
| | - Murali Shunmugam
- Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India
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Espinoza SM, Brown C, Gower AL, Eisenberg ME, McPherson LE, Rider GN. Sport and Physical Activity Among Transgender, Gender Diverse, and Questioning Adolescents. J Adolesc Health 2023; 72:303-306. [PMID: 36411209 DOI: 10.1016/j.jadohealth.2022.09.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 08/22/2022] [Accepted: 09/09/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE We compared rates of sport and physical activity (PA) of transgender and gender diverse adolescents and adolescents questioning their gender (TGDQ) with those of cisgender adolescents. Additionally, we tested for differences in sport and PA among TGDQ youth. METHODS We used 2019 Minnesota Student Survey data (N = 125,375). We calculated descriptive statistics, then used chi-squares and one-way analyses of variance to test for differences in involvement in sports, PA lessons, and PA between TGDQ and cisgender adolescents. Then, we used the same tests to compare participation among all TGDQ adolescents, considering their gender identity and sex assigned at birth. RESULTS Overall, TGDQ adolescents participated in sport and PA less than cisgender adolescents; TGD youth participated less than questioning youth. Within sex assigned at birth, participation varied by gender identity. DISCUSSION TGDQ adolescents need support to participate in sport and PA. Adults should remain cognizant that sport restrictions could impair TGDQ adolescents' health.
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Affiliation(s)
- Sarah M Espinoza
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.
| | - Camille Brown
- School of Nursing, University of Minnesota, Minneapolis, Minnesota
| | - Amy L Gower
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Marla E Eisenberg
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Lauren E McPherson
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - G Nic Rider
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
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14
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Transgender identity: Development, management and affirmation. Curr Opin Psychol 2022; 48:101467. [PMID: 36219930 DOI: 10.1016/j.copsyc.2022.101467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/04/2022] [Accepted: 09/08/2022] [Indexed: 01/28/2023]
Abstract
In this review, I discuss recent research on transgender identity development, management and affirmation, situating key topics within a social feedback model of transgender identity. This model foregrounds the dynamic interplay between internal and external influences on transgender identity. Furthermore, issues of intersectionality are highlighted throughout and located within broader socio-political contexts. Collectively, research on topics such as gender euphoria, passing, identity affirmation and social transitions, among others, points to the pivotal role of supportive social relationships and social environments in the healthy development and expression of transgender identities. Future work should prioritize longitudinal studies with careful and rigorous assessment of identity-related constructs in order to further examine these and other topics.
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Tan KK, Watson RJ, Byrne JL, Veale JF. Barriers to Possessing Gender-Concordant Identity Documents are Associated with Transgender and Nonbinary People's Mental Health in Aotearoa/New Zealand. LGBT Health 2022; 9:401-410. [PMID: 35605017 PMCID: PMC9536333 DOI: 10.1089/lgbt.2021.0240] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: This study sought to expand on previous scholarship focused on gender-concordant identity documents (IDs) as a social determinant of health. We examined the association between barriers to legal gender recognition and the mental health of transgender and nonbinary people in Aotearoa/New Zealand. Methods: We used data from a 2018 nationwide community-based survey of trans and nonbinary people in Aotearoa (N = 818). Variables of investigation included: gender-concordant IDs, mental health (past-month psychological distress, past-year nonsuicidal self-injury, past-year suicidality) and barriers to changing gender markers on a birth certificate or passport. Associations between gender-concordant IDs and mental health were determined using generalized linear regression models. Results: In total, 34.8% reported the correct name on all of their IDs. The proportion with the correct gender marker on both birth certificates and passports was 16.0%. Participants with gender-concordant IDs were more likely to be older, have higher levels of income and education, and have had genital reconstruction. In addition, 68.7% of participants reported experiencing at least one barrier to changing gender markers on their IDs, and these participants had significantly higher average points of psychological distress scores (b = 2.39) and greater odds of suicidal ideation (odds ratio = 2.02) than those with gender-concordant IDs, after adjusting for sociodemographic variables. Conclusion: We present novel findings on higher levels of mental health problems among trans and nonbinary people who faced barriers in trying to obtain gender-concordant IDs compared with those with gender-concordant IDs. Removing barriers to legal gender recognition may be an effective way to improve mental health.
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Affiliation(s)
- Kyle K.H. Tan
- Faculty of Māori and Indigenous Studies, University of Waikato, Hamilton, New Zealand
- Transgender Health Research Lab, School of Psychology, University of Waikato, Hamilton, New Zealand
| | - Ryan J. Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Jack L. Byrne
- Transgender Health Research Lab, School of Psychology, University of Waikato, Hamilton, New Zealand
- TransAction, Auckland, New Zealand
| | - Jaimie F. Veale
- Transgender Health Research Lab, School of Psychology, University of Waikato, Hamilton, New Zealand
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Hughes LD, Gamarel KE, King WM, Goldenberg T, Jaccard J, Geronimus AT. State-Level Policy Stigma and Non-Prescribed Hormones Use among Trans Populations in the United States: A Mediational Analysis of Insurance and Anticipated Stigma. Ann Behav Med 2022; 56:592-604. [PMID: 34390573 PMCID: PMC9242548 DOI: 10.1093/abm/kaab063] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Medical gender affirmation (i.e., hormone use) is one-way transgender (trans) people affirm their gender and has been associated with health benefits. However, trans people face stigmatization when accessing gender-affirming healthcare, which leads some to use non-prescribed hormones (NPHs) that increase their risk for poor health. PURPOSE We examined whether healthcare policy stigma, as measured by state-level trans-specific policies, was associated with NPHs use and tested mediational paths that might explain these associations. Because stigmatizing healthcare policies prevent trans people from participation in healthcare systems and allow for discrimination by healthcare providers, we hypothesized that healthcare policy stigma would be associated with NPHs use by operating through three main pathways: skipping care due to anticipated stigma in healthcare settings, skipping care due to cost, and being uninsured. METHODS We conducted analyses using data from the 2015 U.S. Transgender Survey. The analytic sample included trans adults using hormones (N = 11,994). We fit a multinomial structural equation model to examine associations. RESULTS Among trans adults using hormones, we found that healthcare policy stigma was positively associated with NPHs use and operated through insurance coverage and anticipating stigma in healthcare settings. The effect sizes on key predictor variables varied significantly between those who use supplemental NPHs and those who only use NPHs suggesting the need to treat NPHs use as distinct from those who use supplemental NPHs. CONCLUSIONS Our work highlights the importance of healthcare policy stigma in understanding health inequities among trans people in the USA, specifically NPHs use.
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Affiliation(s)
- Landon D Hughes
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Kristi E Gamarel
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Wesley M King
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Tamar Goldenberg
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James Jaccard
- Silver School of Social Work, New York University, New York, NY, USA
| | - Arline T Geronimus
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
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17
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Cui J, Prankumar SK, Wong HT, Addo IY, Tumwine C, Noor MN. Protocol for a scoping review of the use of information and communication technology platforms for the delivery and utilisation of transgender healthcare. BMJ Open 2022; 12:e055914. [PMID: 35649592 PMCID: PMC9161065 DOI: 10.1136/bmjopen-2021-055914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 05/12/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION In recent years, there has been strong interest in making digital health and social tools more accessible, particularly among vulnerable and stigmatised groups such as transgender people. While transgender people experience unique physical, mental and sexual health needs, not much is currently known about the extent to which they use information and communication technologies such as short messaging service and videoconferencing to access health services. In this paper, we discuss our protocol for a scoping review of the literature about the delivery and utilisation of digitally mediated health services for transgender populations. METHODS AND ANALYSIS This scoping review of the provision and experience of telemedicine among transgender people will follow the methodological framework developed by Arksey and O'Malley. The search will be conducted using three online databases, namely PubMed, CINAHL and Scopus, with additional literature explored using Google Scholar to identify grey literature. Relevant English-language studies will be shortlisted after completing a title and abstract review based on defined inclusion criteria. Following that, a final list of included studies will be compiled after a full-text review of the shortlisted articles has been completed. To enable the screening process, a team of researchers will be assigned refereed publications explicitly referring to the provision and experience of transgender healthcare through telemedicine. Screening performed independently will then collaboratively be reviewed to maintain consistency. ETHICS AND DISSEMINATION The research is exempt from ethics approval since our analysis is based on extant research into the use of digital technologies in providing healthcare to transgender people. The results of this study will be disseminated through peer-reviewed academic publications and presentations. Our analysis will guide the design of further research and practice relating to the use of digital communication technologies to deliver healthcare services to transgender people.
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Affiliation(s)
- Jialiang Cui
- Department of Social Work, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Sujith Kumar Prankumar
- Centre for Social Research in Health, UNSW, Sydney, New South Wales, Australia
- ARC Centre of Excellence for Automated Decision-Making and Society, Swinburne University, Melbourne, Victoria, Australia
| | - Horas Th Wong
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- t150 Transgender Health Service, Population and Community Health, NSW Health, Sydney, New South Wales, Australia
| | - Isaac Yeboah Addo
- Quality and System Performance Unit, Cancer Institute NSW, Sydney, New South Wales, Australia
| | | | - Muhammad Naveed Noor
- Department of pathology and laboratory medicine, The Aga Khan University, Karachi, Sindh, Pakistan
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18
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Scheim AI, Baker KE, Restar AJ, Sell RL. Health and Health Care Among Transgender Adults in the United States. Annu Rev Public Health 2021; 43:503-523. [PMID: 34882432 DOI: 10.1146/annurev-publhealth-052620-100313] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Transgender (trans) communities in the USA and globally have long organized for health and social equity but have only recently gained increased visibility within public health. In this review, we synthesize evidence demonstrating that trans adults in the USA are affected by disparities in physical and mental health and in access to health care, relative to cisgender (nontrans) persons. We draw on theory and data to situate these disparities in their social contexts, explicating the roles of gender affirmation, multilevel and intersectional stigmas, and public policies in reproducing or ameliorating trans health disparities. Until recently, trans health disparities were largely made invisible by exclusionary data collection practices. We highlight the importance of, and methodological considerations for, collecting inclusive sex and gender data. Moving forward, we recommend routine collection of gender identity data, an emphasis on intervention research to achieve trans health equity, public policy advocacy, and investment in supporting gender-diverse public health leadership. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Ayden I Scheim
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA; .,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Kellan E Baker
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Whitman-Walker Institute, Whitman-Walker Health, Washington, DC, USA
| | - Arjee J Restar
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington 98195, USA
| | - Randall L Sell
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
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Restar A, Garrison-Desany HM, Baker KE, Adamson T, Howell S, Baral SD, Operario D, Beckham SW. Prevalence and associations of COVID-19 testing in an online sample of transgender and non-binary individuals. BMJ Glob Health 2021; 6:e006808. [PMID: 34518208 PMCID: PMC8438577 DOI: 10.1136/bmjgh-2021-006808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 08/27/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Testing for COVID-19 and linkage to services is fundamental to successful containment and control of transmission. Yet, knowledge on COVID-19 testing among transgender and non-binary communities remains limited. METHODS Between October 2020 and November 2020, we examined the prevalence and associations of COVID-19 testing in an online sample of transgender and non-binary people (n=536). Multivariable hierarchical logistic regression analyses examined associations between COVID-19 testing and participants' sociodemographic, mental health, substance use, gender affirmation, economic changes and healthcare experiences. RESULTS Prevalence of COVID-19 testing in this sample was 35.5% (n=190/536). In the final model, transgender and non-binary participants from upper socioeconomic income background and Europe, who reported having active alcohol use disorder, limited access to gender-affirming surgery, had more than 20% reduction in income, and experienced mistreatment in a health facility due to gender identity had significantly increased odds of COVID-19 testing (all p<0.05); those who reported recent tobacco use had significantly lower odds of COVID-19 testing (p=0.007). CONCLUSIONS These findings highlight structural disparities in COVID-19 testing and reinforce the importance of increasing testing strategies for transgender and non-binary populations.
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Affiliation(s)
- Arjee Restar
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Behavioral and Social Science, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Henri M Garrison-Desany
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kellan E Baker
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tyler Adamson
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Stefan David Baral
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Don Operario
- Department of Behavioral and Social Science, Brown University School of Public Health, Providence, Rhode Island, USA
| | - S Wilson Beckham
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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20
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Hughto JMW, Restar AJ, Wolfe HL, Gordon LK, Reisner SL, Biello KB, Cahill SR, Mimiaga MJ. Opioid pain medication misuse, concomitant substance misuse, and the unmet behavioral health treatment needs of transgender and gender diverse adults. Drug Alcohol Depend 2021; 222:108674. [PMID: 33773869 PMCID: PMC8058310 DOI: 10.1016/j.drugalcdep.2021.108674] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/16/2021] [Accepted: 02/24/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Limited research has explored risk factors for opioid pain medication misuse, concomitant substance misuse, and the unmet behavioral health treatment (BHTx) needs of transgender and gender diverse (TGD) adults. METHODS In 2019, TGD adults (N = 562) in Massachusetts and Rhode Island were purposively recruited and completed a psychosocial and behavioral health survey (95 % online; 5% in-person). Multivariable logistic regression was used to examine factors associated with past 12-month opioid pain medication misuse and unmet BHTx needs. RESULTS Overall, 24.4 % of participants were trans women; 32.0 % trans men; and 43.6 % were non-binary. Past-year substance misuse included: marijuana (56.8 %), hazardous drinking (37.5 %), hallucinogens (9.8 %), benzodiazepines (8.2 %), and opioid pain medication (8.0 %). Among participants with past-year substance misuse and BHtx need (n = 326), 81.3 % received BHtx and 18.7 % had unmet BHtx needs. Being a trans woman, having HIV, stigma in healthcare, and number of substances misused were associated with increased odds of past-year opioid pain medication misuse; high social connectedness was associated with decreased odds of opioid pain medication misuse (p-values<0.05). Younger age, stigma in healthcare, and misusing opioid pain medications were associated with increased odds of unmet BHTx needs; post-traumatic stress disorder and family support were associated with decreased odds of unmet BHtx needs (p-values<0.05). CONCLUSIONS Addressing disparities in opioid pain medication misuse among TGD people requires systematic improvements in healthcare access, including efforts to create TGD-inclusive BHtx environments with providers who are equipped to recognize and treat the social and structural drivers of TGD health inequities, including opioid pain medication misuse.
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Affiliation(s)
- Jaclyn M W Hughto
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, United States; Department of Epidemiology, School of Public Health, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, United States; Center for Promotion and Health Equity, Brown University, Box G-121-8, Providence, RI 02912, United States; The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, United States.
| | - Arjee J Restar
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States
| | - Hill L Wolfe
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, United States; Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Building 70, Bedford, MA, 01730, United States
| | - Lily K Gordon
- Warren Alpert School of Medicine, for Brown University, 222 Richmond Street, Providence, RI, 02903, United States
| | - Sari L Reisner
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, United States; General Medicine, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, United States; Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, United States
| | - Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, United States; Department of Epidemiology, School of Public Health, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, United States; Center for Promotion and Health Equity, Brown University, Box G-121-8, Providence, RI 02912, United States; The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, United States
| | - Sean R Cahill
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, United States; Bouve College of Health Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, United States
| | - Matthew J Mimiaga
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, United States; Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, BOX 951772, 71-267 CHS, Los Angeles, CA, 90095, United States; Department of Psychiatry and Biobehavioral Science, David Geffen School of Medicine, University of California Los Angeles, BOX 951772, 71-267 CHS, Los Angeles, CA, 90095, United States; UCLA Center for LGBTQ Advocacy, Research & Health, BOX 951772, 71-267 CHS, Los Angeles, CA, 90095, United States.
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Scheim A, Kacholia V, Logie C, Chakrapani V, Ranade K, Gupta S. Health of transgender men in low-income and middle-income countries: a scoping review. BMJ Glob Health 2020; 5:e003471. [PMID: 33239337 PMCID: PMC7689587 DOI: 10.1136/bmjgh-2020-003471] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/03/2020] [Accepted: 10/21/2020] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Despite the rapid growth of research on transgender (trans) health globally, the extent of research on trans men and other transmasculine persons assigned the female sex at birth remains unclear. We, therefore, conducted a scoping review on trans men's health in low-income and middle-income countries (LMICs). METHODS The review included peer-reviewed articles and conference abstracts, and grey literature published from 1 January 1999 to 5 July 2019 in English, French, Hindi or Spanish and reporting original quantitative and/or qualitative data on the health of trans men or transmasculine persons living in LMIC. Studies were excluded if they did not disaggregate data for trans men or if they only described surgical techniques or laboratory values. RESULTS We included 53 studies (42 peer-reviewed and 11 grey literature) from 19 LMIC. Most were conducted in higher-middle-income countries (n=12) and in Latin America (n=16, 30.2%), the Middle East (n=14, 26.4%) or Sub-Saharan Africa (n=12, 22.6%) and published in 2014 or later (n=44, 83.0%). Approximately half of studies used quantitative methods (52.8%, n=28), of which 64.3% (n=18) had fewer than 50 participants and 14.2% (n=4) had over 150. Across study designs, social determinants of health and gender-affirming care were the most commonly represented domains (49.1% and 47.1% of studies respectively), with common themes including gender-based violence, coercion and discrimination as well as unprescribed hormone use. Other domains represented included mental health (32.1%), sexual and reproductive health (24.5%), general healthcare access (18.9%), physical health (9.4%) and substance use (9.4%). CONCLUSION Greater inclusion and disaggregation of trans men and transmasculine persons in global health research is needed to support sex- and gender-based analyses of trans health. Community-based research approaches and theoretically driven research may help to increase the relevance and rigour of such research. Funders should invest in research on trans men's health in LMIC.
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Affiliation(s)
- Ayden Scheim
- Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
| | - Vibhuti Kacholia
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Carmen Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Venkatesan Chakrapani
- The Humsafar Trust, Mumbai, Maharashtra, India
- Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, Tamil Nadu, India
| | - Ketki Ranade
- School of Social Work, Tata Institute of Social Sciences, Mumbai, Maharashtra, India
| | - Shaman Gupta
- TWEET Foundation (Transgender Welfare Equity and Empowerment Trust), New Delhi, India
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