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D'souza S, Ghatole B, Raghuram H, Sukhija S, Singh S, Shaikh A, Bandewar SS, Bhan A. Understanding structural inequities in Covid-19 vaccine access and uptake among disability, transgender and gender-diverse communities in India. Vaccine 2024:126174. [PMID: 39117525 DOI: 10.1016/j.vaccine.2024.126174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 07/20/2024] [Accepted: 07/22/2024] [Indexed: 08/10/2024]
Abstract
INTRODUCTION Undervaccination and vaccination-related anxieties among marginalised communities like the transgender and gender-diverse (TGD) and disability communities are underexplored in the Indian context. Our study seeks to understand the role of structural and historical inequities in shaping COVID-19 vaccine access for the two communities in India. METHODS Using a participatory qualitative research approach, TGD and disabled individuals were involved in and consulted throughout the research process. We interviewed 45 individuals for our study, hailing from the two communities and other key stakeholders and health system representatives involved in vaccination roll-out in India. We conducted an inductive thematic analysis guided by the socio-ecological model and intersectionality approach. RESULTS Despite intent to get vaccinated among most participants, several structural barriers shaped COVID-19 vaccine access for people from the TGD and disability community. This included information and communication gaps with respect to the specific health needs of the two communities, barriers related to vaccine registration, data collection, transport, infrastructure and actual or anticipated mistreatment at vaccine centres. Each emergent structural gap in vaccination had parallels in past health systems experiences, pointing to the longstanding and pervasive inequities within health and allied systems which impact how communities perceive and respond to new health system interventions. CONCLUSION This study uncovers the structural inequities within health systems that have permeated the planning, design and outreach of COVID-19 vaccination programs in India. Moving beyond notions of vaccine hesitancy among the TGD and disability community, we underscore the importance of socio-historical contexts of marginalisation and advocate for systems to recognise these contexts and respond equitably to the vaccination and health needs of the two communities. While some challenges among the two communities were distinct, the study explores how a shared experience of exclusion from public systems can provide avenues for cross-movement advocacy and solidarity, and help inform health system reforms.
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Affiliation(s)
- Sharin D'souza
- Initiative for Health Equity, Advocacy and Research, Bhopal Hub, Sangath, Bhopal, India.
| | - Bhakti Ghatole
- Initiative for Health Equity, Advocacy and Research, Bhopal Hub, Sangath, Bhopal, India
| | - Harikeerthan Raghuram
- Initiative for Health Equity, Advocacy and Research, Bhopal Hub, Sangath, Bhopal, India
| | - Shreyus Sukhija
- Initiative for Health Equity, Advocacy and Research, Bhopal Hub, Sangath, Bhopal, India
| | - Satendra Singh
- Department of Physiology, University College of Medical Sciences, Delhi, India
| | - Aqsa Shaikh
- Department of Community Medicine, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | | | - Anant Bhan
- Initiative for Health Equity, Advocacy and Research, Bhopal Hub, Sangath, Bhopal, India
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Manges ME, Bryan C, Bryan A, Bauder CR, Wastler HM. Suicidal thoughts and behaviors among gender and sexual minorities: Adults ages 18-24 show highest rates of past month suicidal thoughts. Suicide Life Threat Behav 2024. [PMID: 38771173 DOI: 10.1111/sltb.13093] [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: 03/07/2024] [Accepted: 05/03/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION Sexual and gender minority (SGM) people are at increased risk for suicidal thoughts and behaviors relative to their cisgender heterosexual peers. However, most research in this area has focused on youth, limiting our understanding of suicide risk among SGM adults. METHODS To address this gap in the literature, the present study examined suicidal thoughts and behaviors among SGM adults across different age groups using a sample of 10,620 US adults. RESULTS Consistent with the literature on youth, SGM adults showed higher rates of suicidal thoughts and behaviors than cisgender heterosexual adults. When examining prevalence rates across various age groups, young adults (18-24) showed greater lifetime and past month suicidal thoughts and behaviors relative to adults ages 45+. Adults ages 18-24 also showed greater past month suicidal ideation than adults ages 25-44; however, there were no group differences in lifetime suicidal thoughts and behaviors and past month suicidal behavior between adults ages 18-24 and 25-44. CONCLUSIONS Although suicidal thoughts and behaviors are most common among young SGM adults, other age groups do still show concerning rates of suicidal thoughts and behaviors, suggesting that this risk might extend to later years of life. Additional resources for SGM adults that are not only tailored toward youth and young adults are warranted.
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Affiliation(s)
- M E Manges
- The Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - C Bryan
- The Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - A Bryan
- The Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - C R Bauder
- The Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - H M Wastler
- The Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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McGibbon E. Applying critical leadership to advance 2SLGBTQIA+ health equity: A complex adaptive systems approach. Healthc Manage Forum 2024; 37:133-140. [PMID: 37982709 DOI: 10.1177/08404704231210868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Health inequities are increasing in Canada and across the globe. They pose a substantial threat to the health and well-being of millions of people. Organizational leadership, if it is to effectively contribute to tackling these inequities, must become more systematically infused with competencies that address power and the structural determinants of health. Health equity contexts for 2SLGBTQIA+ (Two Spirit, Lesbian, Gay, Bisexual, Trans, Queer, Intersex, Asexual, and Plus) remain a neglected area of focus in organizational leadership. The goals of this article are to provide: (1) a concise description of critical perspectives and critical leadership studies, (2) describe the urgency of theoretical and applied leadership approaches that more fulsomely integrate critical perspectives, and (3) illustrate an integration of a complex adaptive systems approach to support critical perspectives in advancing health equity for 2SLGBTQIA+ people.
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Muschialli L, Coduri-Fulford S, Garbett Z, Connolly DJ. Twelve tips for LGBT+-inclusive undergraduate and postgraduate medical education. MEDICAL TEACHER 2024:1-7. [PMID: 38652880 DOI: 10.1080/0142159x.2024.2344617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
Sexual and gender minority (LGBT+) populations continue to experience worse health outcomes and reduced healthcare access compared to their cisgender, heterosexual counterparts, perpetuated by a lack of sufficient LGBT+-specific healthcare education within medical schools. Developing educational material that encourages self-reflective, proactive, and affirmative practice has been identified as a mechanism for increasing the quality of doctor-patient relationships and breaking down barriers in healthcare access for LGBT + communities. In this article, we provide twelve tips for those designing and delivering undergraduate and postgraduate medical curricula. We summarise evidence-based approaches to inclusive care, key overarching concepts that curricula should include and common issues to be avoided. We hope these tips provide a standard against which existing curricula and teaching practices can be appraised and form the basis of future educational material.
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Affiliation(s)
- Luke Muschialli
- University of Cambridge, Cambridge, United Kingdom
- UCL Medical School, UCL, London, United Kingdom
| | | | - Zoë Garbett
- North Central London Integrated Care Board, London, United Kingdom
| | - Dean J Connolly
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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D'souza S, Ghatole B, Raghuram H, Parakh S, Tugnawat D, Shaikh A, Singh S, Bandewar SS, Bhan A. COVID-19 Vaccine decision-making: trust among the transgender and disability communities in India. JOURNAL OF COMMUNICATION IN HEALTHCARE 2024:1-10. [PMID: 38597810 DOI: 10.1080/17538068.2024.2335784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
BACKGROUND Historical marginalisation and ongoing trust deficits in health and government systems shape present-day vaccine perceptions among marginalised communities. This paper sought to understand the role of trust in decision-making about COVID-19 vaccine uptake in the transgender and disability communities in India. METHODS Using a participatory approach we interviewed 24 community representatives, identifying themselves as transgender individuals or as persons with disability, and 21 key informants such as vaccine programme managers, vaccine providers, and community advocates. We undertook an inductive thematic analysis of the data using a socio-ecological model. RESULTS Fear of side effects in relation to specific needs of the two communities and mistrust of systems involved in vaccination shaped four different pathways for vaccine decision-making. Mistrust of systems was influenced by past negative experiences with the health system, creating contexts in which information and misinformation are shared and interpreted. Participants negotiated their doubts about safety and mistrust of systems by interacting with different sources of influence showing patterns of decision-making that are dynamic, context-dependent, and intersectional. CONCLUSION These findings will help in determining the content, strategies and approaches to equitable vaccine communication for these two communities. The two communities ought to be included in vaccine trials. Vaccine information must respond to the specific needs of these two communities which could be enabled by collaboration and engagement with community members and influencers. Finally, long-term investment towards the needs of marginalised communities is vital to dismantle cycles of marginalisation and distrust and in turn improve vaccine acceptance and uptake.
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Affiliation(s)
- Sharin D'souza
- Initiative for Health Equity Advocacy and Research, Bhopal Hub, Sangath, Bhopal, India
| | - Bhakti Ghatole
- Initiative for Health Equity Advocacy and Research, Bhopal Hub, Sangath, Bhopal, India
| | - Harikeerthan Raghuram
- Initiative for Health Equity Advocacy and Research, Bhopal Hub, Sangath, Bhopal, India
| | - Sana Parakh
- Initiative for Health Equity Advocacy and Research, Bhopal Hub, Sangath, Bhopal, India
| | - Deepak Tugnawat
- Initiative for Health Equity Advocacy and Research, Bhopal Hub, Sangath, Bhopal, India
| | - Aqsa Shaikh
- Initiative for Health Equity Advocacy and Research, Bhopal Hub, Sangath, Bhopal, India
- Department of Community Medicine, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Satendra Singh
- Initiative for Health Equity Advocacy and Research, Bhopal Hub, Sangath, Bhopal, India
- Department of Physiology, University College of Medical Sciences, Delhi, India
| | - Sunita Sheel Bandewar
- Initiative for Health Equity Advocacy and Research, Bhopal Hub, Sangath, Bhopal, India
- Forum for Medical Ethics Society, Mumbai, India
- Vidhayak Trust, Pune, India
| | - Anant Bhan
- Initiative for Health Equity Advocacy and Research, Bhopal Hub, Sangath, Bhopal, India
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Greenfield M, Darwin Z. LGBTQ+ new and expectant parents' experiences of perinatal services during the UK's first COVID-19 lockdown. Birth 2024; 51:134-143. [PMID: 37803934 DOI: 10.1111/birt.12780] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/09/2023] [Accepted: 09/15/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND COVID-19 created specific challenges for new and expectant parents and perinatal services. Services changed rapidly in the United Kingdom (UK), including the withdrawal of home birth services, birth center closures, and restrictions on the number of birth partners allowed in the birth room. The purpose of this study was to examine how these changes affected the experiences of LGBTQ+ parents in the UK. METHODS An online survey was conducted in April 2020 to provide real-time data capture of new and expectant families' experiences. It was open to those in the third trimester, or to those who had given birth since the beginning of the first UK lockdown period, and their partners. The survey asked open-ended questions about perinatal experiences. Demographic data were also collected, including sexual orientation and gender. Responses were collected from 1754 participants, including 76 who self-identified as LGBTQ+. RESULTS Thematic analysis identified that LGBTQ+ new and expectant parents faced similar issues to cisgendered, heterosexual expectant parents, though additional concerns were also noted relating to support and recognition. Heterocentric policies negatively affect lesbian families. Non-birthing co-mothers feared invalidation as parents. Sexual minority pregnant women were more likely than heterosexual pregnant women to consider additional birth supporters and to consider freebirthing. DISCUSSION Service changes introduced in the pandemic were cisheteronormative, creating additional challenges for LGBTQ+ new and expectant parents and compounding existing inequalities. When planning, changing, or evaluating perinatal services, specific consideration is needed to include birthing parents who are not mothers and mothers who did not give birth. If appropriate care is not available, consequences may include impaired perinatal wellbeing and restricted birth choices. Including sexual orientation and gender in data collection enables different perspectives to be considered.
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Affiliation(s)
- Mari Greenfield
- Faculty of Life Sciences and Medicine, King's College, London, UK
- The Open University, Milton Keynes, UK
| | - Zoe Darwin
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
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Zwickl S, Ruggles T, Wong AFQ, Ginger A, Angus LM, Eshin K, Cook T, Cheung AS. Disruption of gender-affirming health care, and COVID-19 illness, testing, and vaccination among trans Australians during the pandemic: a cross-sectional survey. Med J Aust 2024; 220:23-28. [PMID: 37994182 PMCID: PMC10952718 DOI: 10.5694/mja2.52169] [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: 05/16/2023] [Accepted: 08/23/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVES To assess rates of disruption of gender-affirming health care, of coronavirus disease 2019 (COVID-19) illness, testing, and vaccination, and of discrimination in health care among Australian trans people during the COVID-19 pandemic. DESIGN, SETTING Online cross-sectional survey (1-31 May 2022); respondents were participants recruited by snowball sampling for TRANSform, an Australian longitudinal survey-based trans health study, 1 May - 30 June 2020. PARTICIPANTS People aged 16 years or older, currently living in Australia, and with a gender different to their sex recorded at birth. MAIN OUTCOME MEASURES Proportions of respondents who reported disruptions to gender-affirming health care, COVID-19 illness, testing, and vaccination, and positive and negative experiences during health care. RESULTS Of 875 people invited, 516 provided valid survey responses (59%). Their median age was 33 years (interquartile range, 26-45 years); 193 identified as women or trans women (37%), 185 as men or trans men (36%), and 138 as non-binary (27%). Of 448 respondents receiving gender-affirming hormone therapy, 230 (49%) reported disruptions to treatment during the pandemic; booked gender-affirming surgery had been cancelled or postponed for 37 of 85 respondents (44%). Trans-related discrimination during health care was reported by a larger proportion of participants than in a pre-pandemic survey (56% v 26%). COVID-19 was reported by 132 respondents (26%), of whom 49 reported health consequences three months or more after the acute illness (37%; estimated Australian rate: 5-10%). Three or more COVID-19 vaccine doses were reported by 448 participants (87%; Australian adult rate: 70%). CONCLUSIONS High rates of COVID-19 vaccination among the trans people we surveyed may reflect the effectiveness of LGBTIQA+ community-controlled organisation vaccination programs and targeted health promotion. Training health care professionals in inclusive services for trans people could improve access to appropriate health care and reduce discrimination.
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Affiliation(s)
| | | | | | | | - Lachlan M Angus
- The University of MelbourneMelbourneVIC
- Austin HealthMelbourneVIC
| | | | | | - Ada S Cheung
- The University of MelbourneMelbourneVIC
- Austin HealthMelbourneVIC
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Ziegler E, Carroll B. Primary care in Northern Ontario for transgender people in the context of the COVID-19 pandemic: A qualitative secondary analysis. J Nurs Scholarsh 2024; 56:76-86. [PMID: 37415313 DOI: 10.1111/jnu.12909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/23/2023] [Accepted: 04/19/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE To examine changes to primary care practice for transgender clients resulting from government mandated public health measures in response to COVID-19 in Northern Ontario. DESIGN Secondary analysis of qualitative data using interview transcripts from a dataset that included 15 interviews conducted between October 2020 and April 2021. METHODS The dataset came from a convergent mixed method study exploring the delivery of primary care services to transgender individuals in Northern Ontario. Qualitative interviews with primary care practitioners including nurse practitioners, nurses, physicians, social workers, psychotherapists, and pharmacists providing care for transgender people in Northern Ontario were included in the secondary analysis. RESULTS Fifteen primary care practitioner providing care to transgender individuals in Northern Ontario participated in the parent study. Practitioners described their understanding of the effect of the early stages of the COVID-19 pandemic changes on their practice and the care experience for their transgender patients. Two themes were identified and described by participants: (1) a change in the delivery of care; and (2) barriers and facilitators to care. CONCLUSIONS Practitioners' primary care experiences in the early waves of COVID suggest the integral use of telehealth in Northern Ontario transgender care. Nurses working in advance practice and nurse practitioners are essential in providing continuity of care for their transgender clients. CLINICAL RELEVANCE/SIGNIFICANCE Identification of initial practice changes for the primary care of trans people will illuminate avenues for further research. The urban, rural, and remote practice settings in Northern Ontario provide an opportunity for increasing access for gender diverse people in these areas and for developing increased understanding of uptake of telemedicine practice. Nurses are integral to primary care for transgender patients in Northern Ontario.
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Affiliation(s)
- Erin Ziegler
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Sigma Lambda Pi at Large Chapter, Toronto, Ontario, Canada
| | - Benjamin Carroll
- School of Nursing, Queen's University, Kingston, Ontario, Canada
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Manges ME, Bryan CJ, Bryan AO, Bauder CR, Wastler HM. Suicidal thoughts and behaviors among gender and sexual minorities: Adults ages 25-44 show highest rates of past month suicidal thoughts. Suicide Life Threat Behav 2023. [PMID: 38100270 DOI: 10.1111/sltb.13029] [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: 06/30/2023] [Revised: 10/26/2023] [Accepted: 11/27/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION Sexual and gender minority (SGM) people are at increased risk for suicidal thoughts and behaviors relative to their cisgender heterosexual peers. However, most research in this area has focused on youth, limiting our understanding of suicide risk among SGM adults. METHODS To address this gap in the literature, the present study examined suicidal thoughts and behaviors among SGM adults across different age groups using a sample of 10,620 US adults. RESULTS Consistent with the literature on youth, SGM adults showed higher rates of suicidal thoughts and behaviors than cisgender heterosexual adults. When examining prevalence rates across various age groups, young adults (18-25) showed greater suicidal thoughts and behaviors relative to adults ages 45+. However, adults ages 25-44 actually showed the highest rate of past month suicidal thoughts compared to adults ages 18-25. CONCLUSION These findings suggest that suicide risk for SGM extends beyond youth and highlights the need for more research on middle-age SGM adults. Additional resources for SGM adults that are not only tailored toward youth and young adults are warranted.
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Affiliation(s)
- Margaret E Manges
- The Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Craig J Bryan
- The Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - AnnaBelle O Bryan
- The Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Christina Rose Bauder
- The Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Heather M Wastler
- The Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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A Scoping Review on COVID-19 Vaccine Hesitancy among the Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual (LGBTQIA+) Community and Factors Fostering Its Refusal. Healthcare (Basel) 2023; 11:healthcare11020245. [PMID: 36673613 PMCID: PMC9859126 DOI: 10.3390/healthcare11020245] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/07/2023] [Accepted: 01/08/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The ramifications of the existing crisis caused by the coronavirus pandemic are sensed in all walks of life. Among the various efforts made to curb the spread of this novel infection, the development of COVID-19 vaccines had a profound role in flattening the pandemic curve. Even though the rapid vaccine drive received a highly welcoming response among people, the reluctance and ignorance of a part of the population towards available safe vaccines stand as impediments to achieving the desired outcome. The LGBTQIA+ (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual) communities are the least studied groups in this regard. OBJECTIVE The purpose of this study is to extensively review and report on COVID-19 vaccine uptake and refusal among the LGBTQIA+ population and enumerate the factors contributing to vaccine hesitancy. The study extends further to outline a conceptual framework for interventions to enhance COVID-19 vaccine acceptance among the LGBTQIA+ population. METHODS We performed a systematic search using key terms on Google Scholar and PubMed. The obtained results were filtered using the eligibility criteria framed for this study. The initial search provided an extensive result of 4510 articles which were later screened at various levels to arrive at the final inclusive collection of manuscripts adding to 17. The studies were analyzed by the authors individually, and the data were categorized using variables. The results are interpreted using charts and graphs. The whole manuscript has been structured in accordance with the PRISMA extension for scoping reviews. RESULT The comprehensive search yielded 17 eligible articles for this review. Most of the studies were conducted in the United States (n = 17), and predominantly cross-sectional studies have been conducted. The major comparative factor was the HIV status of the LGBTQIA+ population. HIV-affected patients were more willing to take up COVID-19 vaccination. However, social stigma, discrimination, lack of access and non-prioritization in vaccine drives were found to be the major factors contributing to vaccine hesitancy among this population. CONCLUSION The invention of the COVID-19 vaccination revolutionized the healthcare systems burdened with COVID-19. Although this is a breakthrough scientific contribution, many factors are associated with the rate of vaccine acceptance, especially among sexual and gender minorities. The reviewed studies have revealed numerous factors that influence vaccine uptake and refusal with the commonest being concerns on discrimination, social stigma, inequitable access to healthcare, vaccine safety, efficacy, potency, side effects and lack of trust in medical workers. These impediments in vaccine coverage should be meticulously addressed to ensure optimum LGBTQIA+ physical and mental health as well as for providing non-discriminative, equitable and quality healthcare service regardless of the gender or sexual orientation of individuals.
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Barber A, Flach A, Bonnington J, Pattinson EM. LGBTQ+ Healthcare Teaching in UK Medical Schools: An Investigation into Medical Students' Understanding and Preparedness for Practice. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231164893. [PMID: 37008793 PMCID: PMC10052488 DOI: 10.1177/23821205231164893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 03/04/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES Lesbian, gay, bisexual, trans* and queer/questioning + (LGBTQ+) healthcare teaching within UK medical schools is currently lacking, potentially impacting on patients' confidence in health services and ability to access care. The current study conducted a multi-site analysis aiming to investigate medical students' perceptions towards the teaching of LGBTQ+ healthcare in UK medical schools, as well as to gain a greater understanding of medical students' level of knowledge of LGBTQ+ healthcare, and preparedness for working with LGBTQ+ patients. METHODS Medical students (N = 296) from 28 UK institutions responded to a 15-question online survey distributed via course leads and social media. Thematic analysis of qualitative data was conducted, as well as statistical analysis of quantitative data using SPSS. RESULTS Only 40.9% of students reported having any teaching on LGBTQ+ healthcare, 96.6% of whom said this was one-off or very irregular sessions. Only 1 in 8 felt their knowledge and skills on LGBTQ+ healthcare was sufficient. 97.2% of students questioned wanted more knowledge on LGBTQ+ healthcare. CONCLUSION The current study highlighted that UK medical students felt underprepared for working with LGBTQ+ patients due to insufficient education. Given that teaching on LGBTQ+ healthcare is often optional and extra-curricular, it may not be reaching those who need it most. The authors are calling for the mandatory inclusion of LGBTQ+ healthcare in the teaching of all UK medical schools, within their individual curriculum frameworks, and with regulatory support from the General Medical Council. This will ensure a wider understanding among medical students, and subsequently qualified doctors, of the health inequities and unique health issues LGBTQ+ people face, which will better equip them to provide high-quality care to LGBTQ+ patients, and start to tackle the inequities they face.
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Affiliation(s)
- Alice Barber
- School of Medicine, University of Leeds, Leeds, UK
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Chen S, Wang Y, She R, Qin P, Ming WK. Disparities in the unmet mental health needs between LGBTQ+ and non-LGBTQ+ populations during COVID-19 in the United States from 21 July 2021 to 9 May 2022. Front Med (Lausanne) 2022; 9:995466. [PMID: 36425114 PMCID: PMC9679212 DOI: 10.3389/fmed.2022.995466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Evidence highlighted the likelihood of unmet mental health needs (UMHNs) among LGBTQ+ than non-LGBTQ+ populations during COVID-19. However, there lacks evidence to accurately answer to what extent the gap was in UMHN between LGBTQ+ and non-LGBTQ+ populations. We aim to evaluate the difference in UMHN between LGBTQ+ and non-LGBTQ+ during COVID-19. Methods Cross-sectional data from Household Pulse Survey between 21 July 2021 and 9 May 2022 were analyzed. LGBTQ+ was defined based on self-reported sex at birth, gender, and sexual orientation identity. UMHN was assessed by a self-reported question. Multivariable logistic regressions generated adjusted odds ratios (AODs) of UMHN, both on overall and subgroups, controlling for a variety of socio-demographic and economic-affordability confounders. Findings 81267 LGBTQ+ and 722638 non-LGBTQ+ were studied. The difference in UMHN between LGBTQ+ and non-LGBTQ+ (as reference) varied from 4.9% (95% CI 1.2-8.7%) in Hawaii to 16.0% (95% CI 12.2-19.7%) in Utah. In multivariable models, compared with non-LGBTQ+ populations, LGBTQ+ had a higher likelihood to report UMHN (AOR = 2.27, 95% CI 2.18-2.39), with the highest likelihood identified in transgender (AOR = 3.63, 95% CI 2.97-4.39); compared with LGBTQ+ aged 65+, LGBTQ+ aged 18-25 had a higher likelihood to report UMHN (AOR = 1.34, 95% CI 1.03-1.75); compared with White LGBTQ+ populations, Black and Hispanic LGBTQ+ had a lower likelihood to report UMHN (AOR = 0.72, 95% CI 0.63-0.82; AOR = 0.85, 95% CI 0.75-0.97, respectively). Interpretation During the COVID-19, LGBTQ+ had a substantial additional risk of UMHN than non-LGBTQ+. Disparities among age groups, subtypes of LGBTQ+, and geographic variance were also identified.
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Affiliation(s)
- Shanquan Chen
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Yuqi Wang
- Department of Mathematics, Imperial College London, London, United Kingdom
- Department of Computer Science, University College London, London, United Kingdom
| | - Rui She
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Shatin, Hong Kong SAR, China
| | - Pei Qin
- Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, China
- School of Public Health, Shenzhen University Health Science Center, Shenzhen, China
| | - Wai-Kit Ming
- Massachusetts General Hospital and Harvard Medical School, Harvard University, Boston, MA, United States
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR, China
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Bender Ignacio RA, Shapiro AE, Nance RM, Whitney BM, Delaney JAC, Bamford L, Wooten D, Karris MY, Mathews WC, Kim HN, Keruly J, Burkholder G, Napravnik S, Mayer KH, Jacobson J, Saag M, Moore RD, Eron JJ, Willig AL, Christopoulos KA, Martin J, Hunt PW, Crane HM, Kitahata MM, Cachay ER. Racial and ethnic disparities in coronavirus disease 2019 disease incidence independent of comorbidities, among people with HIV in the United States. AIDS 2022; 36:1095-1103. [PMID: 35796731 PMCID: PMC9273020 DOI: 10.1097/qad.0000000000003223] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To define the incidence of clinically detected coronavirus disease 2019 (COVID-19) in people with HIV (PWH) in the United States and evaluate how racial and ethnic disparities, comorbidities, and HIV-related factors contribute to risk of COVID-19. DESIGN Observational study within the CFAR Network of Integrated Clinical Systems cohort in seven cities during 2020. METHODS We calculated cumulative incidence rates of COVID-19 diagnosis among PWH in routine care by key characteristics including race/ethnicity, current and lowest CD4+ cell count, and geographic area. We evaluated risk factors for COVID-19 among PWH using relative risk regression models adjusted with disease risk scores. RESULTS Among 16 056 PWH in care, of whom 44.5% were black, 12.5% were Hispanic, with a median age of 52 years (IQR 40-59), 18% had a current CD4+ cell count less than 350 cells/μl, including 7% less than 200; 95.5% were on antiretroviral therapy (ART), and 85.6% were virologically suppressed. Overall in 2020, 649 PWH were diagnosed with COVID-19 for a rate of 4.94 cases per 100 person-years. The cumulative incidence of COVID-19 was 2.4-fold and 1.7-fold higher in Hispanic and black PWH respectively, than non-Hispanic white PWH. In adjusted analyses, factors associated with COVID-19 included female sex, Hispanic or black identity, lowest historical CD4+ cell count less than 350 cells/μl (proxy for CD4+ nadir), current low CD4+ : CD8+ ratio, diabetes, and obesity. CONCLUSION Our results suggest that the presence of structural racial inequities above and beyond medical comorbidities increased the risk of COVID-19 among PWH. PWH with immune exhaustion as evidenced by lowest historical CD4+ cell count or current low CD4+ : CD8+ ratio had greater risk of COVID-19.
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Affiliation(s)
- Rachel A Bender Ignacio
- Division of Allergy and Infectious Diseases, Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington, USA
- Fred Hutchinson Cancer Research Center
| | - Adrienne E Shapiro
- Division of Allergy and Infectious Diseases, Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington, USA
- Fred Hutchinson Cancer Research Center
| | - Robin M Nance
- Division of Allergy and Infectious Diseases, Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington, USA
| | - Bridget M Whitney
- Division of Allergy and Infectious Diseases, Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington, USA
| | - Joseph A C Delaney
- Division of Allergy and Infectious Diseases, Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington, USA
- College of Pharmacy, Department of Epidemiology of Manitoba, Winnipeg, Canada
| | - Laura Bamford
- Division of Infectious Disease and Global Public Health, University of California San Diego, San Diego, California
| | - Darcy Wooten
- Division of Infectious Disease and Global Public Health, University of California San Diego, San Diego, California
| | - Maile Y Karris
- Division of Infectious Disease and Global Public Health, University of California San Diego, San Diego, California
| | - William C Mathews
- Division of Infectious Disease and Global Public Health, University of California San Diego, San Diego, California
| | - Hyang Nina Kim
- Division of Allergy and Infectious Diseases, Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington, USA
| | - Jeanne Keruly
- Departments of Medicine and Epidemiology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Greer Burkholder
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sonia Napravnik
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kenneth H Mayer
- Division of Infectious Diseases, Fenway Health and Harvard Medical School, Boston, Massachusetts
| | - Jeffrey Jacobson
- Division of Infectious Diseases, Case Western Reserve University, Cleveland, Ohio
| | - Michael Saag
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama
| | - Richard D Moore
- Departments of Medicine and Epidemiology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Joseph J Eron
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Amanda L Willig
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama
| | - Katerina A Christopoulos
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, San Francisco, Carolina, USA
| | - Jeffrey Martin
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, San Francisco, Carolina, USA
| | - Peter W Hunt
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, San Francisco, Carolina, USA
| | - Heidi M Crane
- Division of Allergy and Infectious Diseases, Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington, USA
| | - Mari M Kitahata
- Division of Allergy and Infectious Diseases, Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington, USA
| | - Edward R Cachay
- Division of Infectious Disease and Global Public Health, University of California San Diego, San Diego, California
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Shapiro AE, Bender Ignacio RA, Whitney BM, Delaney JA, Nance RM, Bamford L, Wooten D, Keruly JC, Burkholder G, Napravnik S, Mayer KH, Webel AR, Kim HN, Van Rompaey SE, Christopoulos K, Jacobson J, Karris M, Smith D, Johnson MO, Willig A, Eron JJ, Hunt P, Moore RD, Saag MS, Mathews WC, Crane HM, Cachay ER, Kitahata MM. Factors associated with severity of COVID-19 disease in a multicenter cohort of people with HIV in the United States, March-December 2020. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.10.15.21265063. [PMID: 34704092 PMCID: PMC8547524 DOI: 10.1101/2021.10.15.21265063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Understanding the spectrum of SARS-CoV-2 infection and COVID-19 disease in people with HIV (PWH) is critical to provide clinical guidance and implement risk-reduction strategies. OBJECTIVE To characterize COVID-19 in PWH in the United States and identify predictors of disease severity. DESIGN Observational cohort study. SETTING Geographically diverse clinical sites in the CFAR Network of Integrated Clinical Systems (CNICS). PARTICIPANTS Adults receiving HIV care through December 31, 2020. MEASUREMENTS COVID-19 cases and severity (hospitalization, intensive care, death). RESULTS Of 16,056 PWH in care, 649 were diagnosed with COVID-19 between March-December 2020. Case fatality was 2%; 106 (16.3%) were hospitalized and 12 died. PWH with current CD4 count <350 cells/mm 3 (aRR 2.68; 95%CI 1.93-3.71; P<.001) or lowest recorded CD4 count <200 (aRR 1.67; 95%CI 1.18-2.36; P<.005) had greater risk of hospitalization. HIV viral load suppression and antiretroviral therapy (ART) status were not associated with hospitalization, although the majority of PWH were suppressed (86%). Black PWH were 51% more likely to be hospitalized with COVID-19 compared to other racial/ethnic groups (aRR 1.51; 95%CI 1.04-2.19, P=.03). Chronic kidney disease (CKD), chronic obstructive pulmonary disease, diabetes, hypertension, obesity, and increased cardiovascular and hepatic fibrosis risk scores were associated with higher risk of hospitalization. PWH who were older, not on ART, with current CD4 <350, diabetes, and CKD were overrepresented amongst PWH who required intubation or died. LIMITATIONS Unable to compare directly to persons without HIV; underestimate of total COVID-19 cases. CONCLUSIONS PWH with CD4 <350 cells/mm 3 , low CD4/CD8 ratio, and history of CD4 <200, have a clear excess risk of severe COVID-19, after accounting for comorbidities also associated with severe outcomes. PWH with these risk factors should be prioritized for COVID-19 vaccination, early treatment, and monitored closely for worsening illness.
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Garg I, Hanif H, Javed N, Abbas R, Mirza S, Javaid MA, Pal S, Shekhar R, Sheikh AB. COVID-19 Vaccine Hesitancy in the LGBTQ+ Population: A Systematic Review. Infect Dis Rep 2021; 13:872-887. [PMID: 34698208 PMCID: PMC8544378 DOI: 10.3390/idr13040079] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 09/24/2021] [Accepted: 10/02/2021] [Indexed: 12/24/2022] Open
Abstract
The coronavirus 2019 (COVID-19) pandemic has disproportionately impacted lesbian, gay, bisexual, transgender, queer (LGBTQ+) people. Despite developing safe and effective COVID-19 vaccines, LGBTQ+ communities still faces challenges due to inequitable access and vaccine hesitancy. Vaccine hesitancy is a delay in the acceptance or refusal of vaccines despite the availability of vaccination services. Various studies have explored and tried to address factors influencing vaccine hesitancy. However, the LGBTQ+ population remains under- and misrepresented in many of these studies. According to the few studies that have focused on the LGBTQ+ population, several factors influencing vaccine hesitancy have been identified, with the most common factors in studies being concern about vaccine safety, vaccine efficacy, and history of bad experiences with healthcare providers. In order to rebuild the confidence of LGBTQ+ people in vaccines, governments, healthcare policymakers, and healthcare providers need to start by acknowledging, and then resolving, these disparities; building trust; dismantling systemic suppression and discrimination; and prioritizing the inclusion of LGBTQ+ people in research studies and public health policies.
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Affiliation(s)
- Ishan Garg
- Department of Internal Medicine, Maimonides Medical Center, Brooklyn, New York, NY 11219, USA;
| | - Hamza Hanif
- Department of General Surgery, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA;
| | - Nismat Javed
- Department of Medicine, Shifa International Hospital, Islamabad 44000, Pakistan;
| | - Ramsha Abbas
- Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad 44000, Pakistan;
| | - Samir Mirza
- Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan; (S.M.); (M.A.J.)
| | - Muhammad Ali Javaid
- Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan; (S.M.); (M.A.J.)
| | - Suman Pal
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA; (S.P.); (R.S.)
| | - Rahul Shekhar
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA; (S.P.); (R.S.)
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA; (S.P.); (R.S.)
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