1
|
Eustaquio PC, Olansky E, Lee K, Marcus R, Cha S. The Association Between Sexual Violence and Suicidal Ideation Among Transgender Women and the Role of Gender-Affirming Healthcare Providers in Seven Urban Areas in the United States, 2019 to 2020. JOURNAL OF INTERPERSONAL VIOLENCE 2024:8862605241257592. [PMID: 38842225 DOI: 10.1177/08862605241257592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Transgender women are disproportionately affected by sexual violence and corresponding mental health sequelae; however, many do not access healthcare due to experiences with transphobia. This analysis evaluated the association between sexual violence and suicidal ideation and the moderating effect of having a healthcare provider (HCP) with whom transgender women were comfortable discussing gender-related issues ("gender-affirming HCP"). We analyzed cross-sectional data from the Centers for Disease Control and Prevention's National HIV Behavioral Surveillance among Transgender Women (NHBS-Trans). Transgender women were recruited using respondent-driven sampling from seven urban areas from 2019 to 2020 and participated in an HIV biobehavioral survey. This analysis was restricted to transgender women who visited a HCP in the past 12 months ("healthcare-seeking transgender women" [HSTW]) (N = 1,489). Log-linked Poisson regression models provided adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) to estimate the association between sexual violence and suicidal ideation in the past 12 months. The interaction between sexual violence and having a gender-affirming HCP was statistically significant (p-value = .034). Among 1,489 HSTW, 225 (15.1%) experienced sexual violence and 261 (17.5%) reported suicidal ideation; 1,203 (80.8%) reported having a gender-affirming HCP. Sexual violence was associated with suicidal ideation (aPR = 2.65, 95% CI [2.08, 3.38]); the association was notably higher among those who did not have a gender-affirming HCP (aPR = 3.61, [2.17, 6.02]) than among those who did (aPR = 1.87, [1.48, 2.37]). Eliminating transphobia and promoting trauma- and violence-informed approaches in healthcare are necessary for sexual violence and suicide prevention among HSTW.
Collapse
Affiliation(s)
- Patrick C Eustaquio
- Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Evelyn Olansky
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kathryn Lee
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ruthanne Marcus
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susan Cha
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
2
|
Palich R, Rodger AJ, Nicholls EJ, Wright T, Samba P, Chu IYH, Burns FM, Weatherburn P, Trevelion R, McCabe L, Witzel TC. Experiences with health care services and HIV testing after sexual assault in cisgender gay, bisexual and other men who have sex with men and transgender people. HIV Med 2024; 25:746-753. [PMID: 38433523 DOI: 10.1111/hiv.13629] [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: 03/23/2023] [Accepted: 02/22/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES This qualitative sub-study aimed to explore how cisgender gay, bisexual, and other men who have sex with men (cis-GBMSM) and transgender people who reported non-consensual sex (NCS) accessed health care services, what barriers they faced, and how this experience influenced subsequent HIV testing. METHODS SELPHI is an online randomized controlled trial evaluating both acceptability and efficiency of HIV-self testing among cis-GBMSM and transgender people. Semi-structured interviews were conducted, audio-recorded, transcribed, and analysed through a framework analysis, as a qualitative sub-study. We identified narratives of NCS from interviews and investigated experiences of cis-GBMSM and transgender people accessing health care services following sexual assault. RESULTS Of 95 participants, 15 (16%) spontaneously reported NCS. Participants reported a broad range of NCS, including partner's coercive behaviours, non-consensual removal of condoms, and rapes. All feared HIV transmission, leading them to test for HIV, underlining a marked lack of awareness of post-exposure prophylaxis (PEP). Most had negative experiences in communicating with reception staff in sexual health clinics following these incidents. A lack of confidentiality and empathy was described in these situations of psychological distress. Clinic visits were primarily focused on testing for HIV and sexually transmitted infection, and generally no specific psychological support was offered. Getting a negative HIV result was a key step in regaining control for people who experienced NCS. CONCLUSIONS Sexual health care providers should take care to more fully address the issue of NCS with cis-GBMSM and transgender people when it arises. Recognizing and managing the emotional impact of NCS on affected patients would prevent negative experiences and increase confidence in care.
Collapse
Affiliation(s)
- Romain Palich
- University College London, Institute for Global Health, Royal Free Hospital, NHS, London, UK
| | - Alison J Rodger
- University College London, Institute for Global Health, Royal Free Hospital, NHS, London, UK
| | - Emily Jay Nicholls
- University College London, Institute for Global Health, Royal Free Hospital, NHS, London, UK
| | - Talen Wright
- University College London, Division of Psychiatry, London, UK
| | | | - Isaac Yen-Hao Chu
- University College London, Institute for Global Health, Royal Free Hospital, NHS, London, UK
- London School of Hygiene and Tropical Medicine, Department of Public Health, Environments and Society, London, UK
| | - Fiona M Burns
- University College London, Institute for Global Health, Royal Free Hospital, NHS, London, UK
| | - Peter Weatherburn
- London School of Hygiene and Tropical Medicine, Department of Public Health, Environments and Society, London, UK
| | | | - Leanne McCabe
- University College London, MRC Clinical Trials Unit, London, UK
| | - T Charles Witzel
- University College London, Institute for Global Health, Royal Free Hospital, NHS, London, UK
| |
Collapse
|
3
|
Marrow E, Malik M, Pantalone DW, Peitzmeier S. Power and control, resistance and survival: A systematic review and meta-synthesis of the qualitative literature on intimate partner violence against transgender individuals. Soc Sci Med 2024; 342:116498. [PMID: 38227997 DOI: 10.1016/j.socscimed.2023.116498] [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: 06/09/2023] [Revised: 11/10/2023] [Accepted: 12/04/2023] [Indexed: 01/18/2024]
Abstract
Transgender (trans) individuals experience intimate partner violence (IPV) at elevated levels compared to cisgender individuals. Traditional theoretical understandings of IPV as men's patriarchal domination of women, and later, broader theories in which IPV is conceptualized as the relatively privileged partner enacting domination over the relatively oppressed partner, do not fully capture the totality of IPV experiences, including how IPV is perpetrated against trans individuals. We conducted a systematic review and qualitative meta-synthesis of the qualitative and theoretical literatures on IPV against trans individuals (N = 37 articles and books) to generate novel IPV theory inclusive of trans individuals' experiences. We identified five major themes: (1) societal context of IPV, (2) IPV tactics and types, (3) help-seeking, (4) consequences of IPV, and (5) proposed interventions for victims. Synthesizing across themes, we offer a novel theoretical model that demonstrates how abusers can leverage structural discrimination and vulnerabilities against trans victims, regardless of the abuser's own identities. We identify individual power and control tactics abusers use, including identifying a category of IPV that we term leveraging vulnerability, which involves abusers weaponizing their own vulnerabilities to avoid accountability. Reducing IPV in trans communities requires expanding current IPV theory to include trans victims, recognition of a wider range of abuse tactics, and structural interventions that promote the respectful treatment of trans individuals. Our theoretical model of IPV "centers the margins" to make trans victims' experiences, and indeed all victims whose experiences fall outside normative scripts, more legible.
Collapse
Affiliation(s)
- Elliot Marrow
- Department of Psychology, University of Massachusetts, Boston, United States.
| | - Mannat Malik
- Department of Health Behavior, University of North Carolina, United States
| | - David W Pantalone
- Department of Psychology, University of Massachusetts, Boston, United States; The Fenway Institute, Fenway Health, Boston, MA, United States
| | - Sarah Peitzmeier
- Department of Health Behavior and Biological Sciences, University of Michigan, United States
| |
Collapse
|
4
|
Mohammadi F, Masoumi SZ, Tehranineshat B, Oshvandi K, Bijani M. Young transgender individuals' lived experiences of facing life's challenges: a qualitative study in Iran. Front Public Health 2023; 11:1134237. [PMID: 37404273 PMCID: PMC10317014 DOI: 10.3389/fpubh.2023.1134237] [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: 12/30/2022] [Accepted: 05/11/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction In recent years, several studies have addressed the challenges and psychological issues that transgender individuals face. However, only a few studies have explored the experiences of this population in Iran. Life experiences are heavily influenced by the dominant religious and cultural conditions and common beliefs in a society. The present study aimed to investigate transgender individuals' lived experiences of facing life's challenges in Iran. Methods This is a qualitative study with a descriptive and phenomenological design conducted from February to April 2022. Data were collected using semi-structured, in-depth interviews with 23 transgender individuals (13 AFAB and 10 AMAB). The collected data were analyzed using Colaizzi's method. Results Analysis of the qualitative data resulted in the emergence of three themes and 11 subthemes. The three main themes included mental health disparities (fear of having one's secret revealed, depression and despair, suicidal thoughts, and secrecy in the family), gender dysphoria (contradictory gender identity and contradictory behaviors), and stigma and insecurity (sexual abuse, social discrimination, disrupted occupational performance, a lack of support, disrepute, and disgrace). Conclusions The findings of the study indicated that transgender people in Iran are exposed to considerable mental health disparities. In addition to disrepute, infamy, and stigma, transgender people face sexual abuse, social discrimination, and a lack of family social support. The results of the present study can help mental health experts and the healthcare system as a whole to adjust their mental and physical health programs according to the needs and experiences of transgender people and their families. It is recommended that future research address the problems and psychological challenges that transgender people's families have to confront.
Collapse
Affiliation(s)
- Fateme Mohammadi
- Department of Nursing, Chronic Diseases (Home Care) Research Center and Autism Spectrum Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyedeh Zahra Masoumi
- Department of Midwifery, School of Nursing and Midwifery, Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Banafsheh Tehranineshat
- Department of Nursing, Faculty of Nursing and Midwifery, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Khodayar Oshvandi
- Department of Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mostafa Bijani
- Department of Medical Surgical Nursing, School of Nursing, Fasa University of Medical Sciences, Fasa, Iran
| |
Collapse
|
5
|
Kennis M, Kreukels BPC, Dewitte M. Sex & relationships in trans people. Best Pract Res Clin Obstet Gynaecol 2023; 86:102294. [PMID: 36635133 DOI: 10.1016/j.bpobgyn.2022.102294] [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: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
Everyone has sexual rights and is entitled to enjoy sex, regardless of gender identity or expression. It is therefore encouraging to witness a recent growth in research on sexuality in transgender individuals. We provide a short overview of extant research on sex and relationships in this population and argue that current research has mostly been conducted from a medical and functional approach; there is a strong focus on negative experiences and prevention; and there is a lack of data regarding psychological and socio-relational variables. Furthermore, many studies have been conducted in a cis- and hetero-normative setting and have methodological shortcomings such as applying questionnaires that have not been validated in a transgender population. We encourage researchers to expand their focus to positive variables such as sexual pleasure and (in accordance with the biopsychosocial model) investigate subjective experiences and relationship variables when studying sexuality in transgender individuals.
Collapse
Affiliation(s)
- Mathilde Kennis
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands; Department of Cognitive Neuroscience, Maastricht University, Maastricht, Netherlands; Maastricht Brain Imaging Center, Maastricht, Netherlands.
| | - Baudewijntje P C Kreukels
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Location VU University, Amsterdam, Netherlands
| | - Marieke Dewitte
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
| |
Collapse
|
6
|
Trinidad AC. Double-Edged Sisterhoods: Transgender Identity, Peer Groups and the Commercial Sexual Exploitation of Transgender Girls. JOURNAL OF CHILD SEXUAL ABUSE 2022; 31:948-966. [PMID: 36217646 DOI: 10.1080/10538712.2022.2133040] [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: 01/30/2022] [Revised: 06/28/2022] [Accepted: 09/18/2022] [Indexed: 06/16/2023]
Abstract
One of the existing gaps in the literature on the commercial sexual exploitation (CSE) of children is on transgender (trans) girls. Most of the available literature is heavily skewed toward experiences of cisgender girls. However, there is an undeniable need to understand the experiences of trans children given their unique experiences and vulnerabilities to CSE related to their identity. This article is a case study on the complex interaction between trans identity, peer influence, and other micro, meso, and macro factors that have predisposed trans girls to CSE. The paper is based on interviews with six trans girls, complemented by interviews with four social workers, research notes, and a review of related literature. Data was analyzed thematically. Based on the findings, peer groups provide critical support to trans girls, particularly, in terms of trans identity formation, gender transition information, security and protection, and other forms of support. Ironically, they play the contradictory role of priming and initiating them to CSE. Various structural and personal factors have compounded these and predisposed them to victimization. An interplay of macro (societal), meso (interpersonal), and micro (individual) factors have come into play in the commercial sexual exploitation of these trans girls.
Collapse
|
7
|
Messinger AM, Guadalupe-Diaz XL, Kurdyla V. Transgender Polyvictimization in the U.S. Transgender Survey. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP18810-NP18836. [PMID: 34463599 DOI: 10.1177/08862605211039250] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Relative to cisgender people, transgender individuals not only are at an elevated risk of experiencing at least one form of physical or sexual violence, but also at an increased risk of polyvictimization: that is, exposure to multiple types of violence over the life course. Given that polyvictimization increases vulnerability to adverse mental and physical health sequelae, there is a pressing need to identify which sociodemographic subgroups of transgender people are at greater risk of polyvictimization. Understanding these risk profiles will have important implications for developing transgender-specific models for violence prevention, screening, and intervention. Responding to this need in the literature, the present article offers secondary data analyses of the 2015 U.S. Transgender Survey, the largest study to-date of transgender people in the United States (N = 27,715 transgender adults), with participants selected from all 50 states and Washington, D.C., as well as several U.S. territories and overseas military bases. Multiple variable regressions examine sociodemographic predictors of five distinct forms of violence, as well as how many of these five violence types were experienced. The examined sociodemographic predictors included gender, sexual orientation, race-ethnicity, citizenship status, ever been homeless, has a disability, transgender outness, gender visual conformity, household income, and age. The five assessed violence victimization types included intimate partner violence, nonpartner sexual assault, antitransgender family violence, antitransgender physical violence during Kindergarten through 12th grade, and past-year antitransgender physical violence. With some exceptions, results indicate that more marginalized segments of transgender communities have a greater likelihood of experiencing polyvictimization. Recommendations are discussed for future research and service provision.
Collapse
|
8
|
Sweileh WM. Research Publications on the Mental Health of Transgender People: A Bibliometric Analysis Using Scopus Database (1992–2021). Transgend Health 2022. [DOI: 10.1089/trgh.2022.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Waleed M. Sweileh
- Department of Physiology, Pharmacology/Toxicology, Division of Biomedical Sciences, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| |
Collapse
|
9
|
Ussher JM, Hawkey A, Perz J, Liamputtong P, Sekar J, Marjadi B, Schmied V, Dune T, Brook E. Crossing Boundaries and Fetishization: Experiences of Sexual Violence for Trans Women of Color. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP3552-NP3584. [PMID: 32783523 DOI: 10.1177/0886260520949149] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Transgender (trans) women are at higher risk of sexual violence than cisgender women, with trans women of color reported to be at highest risk. This study examined subjective experiences of sexual violence for 31 trans women of color living in Australia, average age 29 (range 18-54), through in-depth interviews. An additional photovoice activity and follow-up interviews were completed by 19 women. Data were analyzed through thematic analysis and feminist intersectionality theory, identifying the following themes. The first theme, "'A sexually tinged violation of boundaries': Defining sexual violence," examined women's definition of sexual violence, including staring and verbal abuse, nonconsensual touching and sexual assault, in both public and private contexts. The second theme, "'Crossing people's boundaries': Sexual harassment in the public domain," examined the frequent sexual harassment women experienced in their daily lives. This included the subtheme, "A hostile gaze: Public staring and 'weird looks'" and "Mockery and transphobic abuse: Verbal abuse is sexual violence." The third theme, "'Crossing bodily boundaries': Experiences of sexual assault," included the subthemes "'Unwanted sexual touch': Groping and forced sex by strangers," "Danger in relationships: Sexual assault and manipulation," "Sexual violence in the context of sex work," and "'We're turned into something we're not': Fetishization and the sexual other." The poor health outcomes experienced by many trans women are closely associated with their exposure to sexual violence and the social inequities and transphobia to which they are subjected. Trans women of color may experience additional prejudice and discrimination due to the intersection of gender, sexuality, race, and social class. Our research suggests that understanding these intersectionalities is integral in understanding the sexual violence experiences of trans women of color.
Collapse
Affiliation(s)
- Jane M Ussher
- Western Sydney University, Penrith, New South Wales, Australia
| | | | - Janette Perz
- Western Sydney University, Penrith, New South Wales, Australia
| | | | - Jessica Sekar
- Western Sydney University, Penrith, New South Wales, Australia
| | | | | | - Tinashe Dune
- Western Sydney University, Penrith, New South Wales, Australia
| | - Eloise Brook
- The Gender Centre, Sydney, New South Wales, Australia
| |
Collapse
|
10
|
Sizemore KM, Talan A, Gray S, Forbes N, Park HH, Rendina HJ. Attachment buffers against the association between childhood sexual abuse, depression, and substance use problems among transgender women: a moderated-mediation model. PSYCHOLOGY & SEXUALITY 2021. [DOI: 10.1080/19419899.2021.2019095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- K. Marie Sizemore
- Department of Psychiatry, Rutgers University, New Brunswick, NJ, United States
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NY, United States
| | - Ali Talan
- Whitman-Walker Institute, Washington, District of Columbia, United States
| | - Shannon Gray
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NY, United States
| | - Nicola Forbes
- Department of Applied Developmental Psychology, Fordham University, New York, NJ, United States
| | - Hannah Hyejin Park
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NY, United States
| | - H. Jonathon Rendina
- Whitman-Walker Institute, Washington, District of Columbia, United States
- The George Washington University- Milken Institute School of Public Health, Washington, District of Columbia, United States
| |
Collapse
|
11
|
Hawkey AJ, Ussher JM, Liamputtong P, Marjadi B, Sekar JA, Perz J, Ryan S, Schmied V, Brook E, Dune T. Trans Women's Responses to Sexual Violence: Vigilance, Resilience, and Need for Support. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3201-3222. [PMID: 34697692 DOI: 10.1007/s10508-021-01965-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 05/12/2023]
Abstract
Despite experiencing high rates of sexual violence, there is limited research that explores coping and support needs among trans women of color and those from migrant backgrounds. This article examines the impact of sexual violence, as well as responses and support needs in relation to sexual violence, among 31 trans women of color, aged between 18-54 years, living in Australia. Women were recruited using purposive and snowball sampling, local LGBTQI + networks, and social media. Study advertisements invited participation from people 18 years and older, who identified as a "trans woman of color" or "trans woman from a non-English speaking background," to take part in a study about their lives as trans women of color and experiences of sexual violence. In-depth interviews and photovoice took place between September 2018 and September 2019. Findings were analyzed through thematic analysis, drawing on intersectionality theory. Sexual violence was reported to be associated with fear, anxiety, and depression, and, for a minority of women, self-blame. While women reported hypervigilance and avoiding going out in public as measures to anticipate and protect themselves from sexual violence, they also demonstrated agency and resilience. This included putting time and effort into appearing as a cisgender woman, naming violence, seeking support, rejecting self-blame, and engaging in self-care practices to facilitate healing. Trans women highlighted the need for multi-faceted sexual violence prevention activities to encourage education, empowerment and cultural change across the general population and support services, in order to promote respect for gender, sexuality and cultural diversity.
Collapse
Affiliation(s)
- Alexandra J Hawkey
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia.
| | - Jane M Ussher
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Pranee Liamputtong
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Brahmaputra Marjadi
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Jessica Aasha Sekar
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Janette Perz
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Samantha Ryan
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Virginia Schmied
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | | | - Tinashe Dune
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| |
Collapse
|
12
|
Suarez NA, Peitzmeier SM, Potter J, Samandur A, Reisner SL. Preliminary findings for adverse childhood experiences and associations with negative physical and mental health and victimization in transmasculine adults. CHILD ABUSE & NEGLECT 2021; 118:105161. [PMID: 34146966 DOI: 10.1016/j.chiabu.2021.105161] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 05/26/2021] [Accepted: 06/01/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Studies highlight the impact of adverse childhood experiences (ACEs) on risk for negative health outcomes in adulthood, including cancer, cardiovascular disease, substance use, and mental health. Lesbian, gay, bisexual, and transgender (LGBT) people report higher rates of ACEs than non-LGBT people, with transgender people at greatest risk. OBJECTIVE This study aims to comprehensively assess the prevalence of ACEs and association with health outcomes among transmasculine individuals. PARTICIPANTS AND SETTING A sample of 131 transmasculine individuals enrolled in a clinical trial on preventive cervical cancer screening between March 2015 and September 2016 in the United States were surveyed about ACEs and health outcomes. METHODS Pearson's chi-squared tests and logistic regression models were used to examine associations between self-reported ACEs prior to age 18 and the risk of various negative health outcomes in adulthood. ACEs were categorized as 0-1 ACEs, 2-3 ACEs, and 4+ ACEs. RESULTS Over 90% of the sample (120/131) reported at least 1 ACE; 45% (59/131) reported 4+ ACEs. Report of 4 or more ACEs increased risk for negative health outcomes and risk factors compared to 0-1 ACEs, including: depression (AOR = 5.3, 95%CI = 1.7, 16.2), suicidality (AOR = 5.2, 95%CI = 1.4, 18.8), post-traumatic stress disorder (AOR = 6.0, 95%CI (1.6, 22.8)), intimate partner violence (AOR = 5.3, 95%CI = 1.4, 18.8), and obesity (AOR = 8.2, 95%CI = 1.8, 37.2). Report of 2-3 ACEs was also significantly associated with obesity (AOR = 5.9, 95%CI = 1.3, 26.2). CONCLUSIONS ACEs are highly prevalent in this sample, and more attention is needed for research and intervention. This exploratory study is the first to comprehensively highlight patterns of physical and mental health risk and victimization associated with report of ACEs among transmasculine individuals. Trauma-informed screening and intervention efforts tailored to the unique needs of this population are needed to provide appropriate and effective care. Clinicians should consider routinely screening for ACEs among transmasculine youth and engage in prevention strategies to reduce health disparities. Further research is warranted to validate these findings among larger, more representative samples to better reflect the diversity of experiences and identities of transmasculine individuals and produce more reliable findings.
Collapse
Affiliation(s)
- Nicolas A Suarez
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States of America..
| | - Sarah M Peitzmeier
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States of America.; Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, United States of America
| | - Jennifer Potter
- The Fenway Institute, Fenway Health Boston, MA, United States of America.; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Avani Samandur
- University of Michigan School of Public Health, Ann Arbor, MI, United States of America
| | - Sari L Reisner
- The Fenway Institute, Fenway Health Boston, MA, United States of America.; Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, United States of America.; Department of Medicine, Harvard Medical School, Boston, MA, United States of America.; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| |
Collapse
|
13
|
Galvan FH, Chen YT, Contreras R, O’Connell B. Violence Inflicted on Latina Transgender Women Living with HIV: Rates and Associated Factors by Perpetrator Type. AIDS Behav 2021; 25:116-126. [PMID: 31811444 DOI: 10.1007/s10461-019-02751-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Many transgender individuals report violence directed against them. This study examined violence inflicted on transgender Latinas with HIV by primary partners, sexual partners and acquaintances/strangers. Logistic regression was used for analysis. 150 transgender Latinas were recruited. Rates of violence from different perpetrator types were 47-50%. For violence by primary partners, social support from cisgender people was associated with a lower likelihood of violence (AOR 0.56; CI 0.32, 0.98; p < 0.05). For violence by sexual partners, a history of childhood sexual abuse was associated with a higher likelihood of violence (AOR 2.64; CI 1.10, 6.34; p < 0.05). For violence by acquaintances/strangers, discrimination was associated with a higher likelihood of violence (AOR 2.84; CI 1.16, 6.94; p < 0.05) and social support from cisgender people with a lower likelihood (AOR 0.58; CI 0.37, 0.92; p < 0.05). Interventions are needed at individual, institutional and systemic levels to eradicate such violence.
Collapse
|
14
|
Peitzmeier SM, Malik M, Kattari SK, Marrow E, Stephenson R, Agénor M, Reisner SL. Intimate Partner Violence in Transgender Populations: Systematic Review and Meta-analysis of Prevalence and Correlates. Am J Public Health 2020; 110:e1-e14. [PMID: 32673114 PMCID: PMC7427218 DOI: 10.2105/ajph.2020.305774] [Citation(s) in RCA: 140] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2020] [Indexed: 11/04/2022]
Abstract
Background: Transgender individuals experience unique vulnerabilities to intimate partner violence (IPV) and may experience a disproportionate IPV burden compared with cisgender (nontransgender) individuals.Objectives: To systematically review the quantitative literature on prevalence and correlates of IPV in transgender populations.Search Methods: Authors searched research databases (PubMed, CINAHL), gray literature (Google), journal tables of contents, and conference abstracts, and consulted experts in the field. Authors were contacted with data requests in cases in which transgender participants were enrolled in a study, but no disaggregated statistics were provided for this population.Selection Criteria: We included all quantitative literature published before July 2019 on prevalence and correlates of IPV victimization, perpetration, or service utilization in transgender populations. There were no restrictions by sample size, year, or location.Data Collection and Analysis: Two independent reviewers conducted screening. One reviewer conducted extraction by using a structured database, and a second reviewer checked for mistakes or omissions. We used random-effects meta-analyses to calculate relative risks (RRs) comparing the prevalence of IPV in transgender individuals and cisgender individuals in studies in which both transgender and cisgender individuals were enrolled. We also used meta-analysis to compare IPV prevalence in assigned-female-sex-at-birth and assigned-male-sex-at-birth transgender individuals and to compare physical IPV prevalence between nonbinary and binary transgender individuals in studies that enrolled both groups.Main Results: We identified 85 articles from 74 unique data sets (ntotal = 49 966 transgender participants). Across studies reporting it, the median lifetime prevalence of physical IPV was 37.5%, lifetime sexual IPV was 25.0%, past-year physical IPV was 16.7%, and past-year sexual IPV was 10.8% among transgender individuals. Compared with cisgender individuals, transgender individuals were 1.7 times more likely to experience any IPV (RR = 1.66; 95% confidence interval [CI] = 1.36, 2.03), 2.2 times more likely to experience physical IPV (RR = 2.19; 95% CI = 1.66, 2.88), and 2.5 times more likely to experience sexual IPV (RR = 2.46; 95% CI = 1.64, 3.69). Disparities persisted when comparing to cisgender women specifically. There was no significant difference in any IPV, physical IPV, or sexual IPV prevalence between assigned-female-sex-at-birth and assigned-male-sex-at-birth individuals, nor in physical IPV prevalence between binary- and nonbinary-identified transgender individuals. IPV victimization was associated with sexual risk, substance use, and mental health burden in transgender populations.Authors' Conclusions: Transgender individuals experience a dramatically higher prevalence of IPV victimization compared with cisgender individuals, regardless of sex assigned at birth. IPV prevalence estimates are comparably high for assigned-male-sex-at-birth and assigned-female-sex-at-birth transgender individuals, and for binary and nonbinary transgender individuals, though more research is needed.Public Health Implications: Evidence-based interventions are urgently needed to prevent and address IPV in this high-risk population with unique needs. Lack of legal protections against discrimination in employment, housing, and social services likely foster vulnerability to IPV. Transgender individuals should be explicitly included in US Preventive Services Task Force recommendations promoting IPV screening in primary care settings. Interventions at the policy level as well as the interpersonal and individual level are urgently needed to address epidemic levels of IPV in this marginalized, high-risk population.
Collapse
Affiliation(s)
- Sarah M Peitzmeier
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
| | - Mannat Malik
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
| | - Shanna K Kattari
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
| | - Elliot Marrow
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
| | - Rob Stephenson
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
| | - Madina Agénor
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
| | - Sari L Reisner
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
| |
Collapse
|
15
|
Livingston NA, Berke D, Scholl J, Ruben M, Shipherd JC. Addressing Diversity in PTSD Treatment: Clinical Considerations and Guidance for the Treatment of PTSD in LGBTQ Populations. ACTA ACUST UNITED AC 2020; 7:53-69. [PMID: 32421099 PMCID: PMC7223966 DOI: 10.1007/s40501-020-00204-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose of review Trauma exposure is widespread but is especially common among lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals. LGBTQ individuals also experience higher rates of discrimination, victimization, and minority stress which can complicate posttraumatic stress disorder (PTSD) treatment but also represent independent intervention targets. In this review, we highlight existing evidence-based practices, current limitations, and provide recommendations for care in the absence of established guidelines for treatment PTSD among LGBTQ patients. Recent findings Trauma-focused therapies (e.g., CPT, PE) and medications (e.g., SSRIs, SNRIs) have shown benefit for people with PTSD. However, evaluations of these interventions have failed to examine the role of LGBTQ identities in recovery from trauma, and existing PTSD treatments do not account for ongoing threat to safety or the pervasive minority stress experienced by LGBTQ patients. In addition, many LGBTQ patients report negative experiences with healthcare, necessitating increased education and cultural awareness on the part of clinicians to provide patient-centered care and, potentially, corrective mental health treatment experiences. Summary Providers should routinely assess trauma exposure, PTSD, and minority stress among LGBTQ patients. We provide assessment and screening recommendations, outline current evidence-based treatments, and suggest strategies for integrating existing treatments to treat PTSD among LGBTQ patients.
Collapse
Affiliation(s)
- Nicholas A Livingston
- National Center for PTSD, Behavioral Science Division, Boston, MA USA.,2Department of Psychiatry, Boston University School of Medicine, Boston, MA USA.,3VA Boston Healthcare System, Boston, MA USA
| | - Danielle Berke
- 4Hunter College of the City University of New York, New York City, NY USA.,5The Graduate Center, City University of New York, New York City, NY USA
| | - James Scholl
- 2Department of Psychiatry, Boston University School of Medicine, Boston, MA USA.,3VA Boston Healthcare System, Boston, MA USA
| | - Mollie Ruben
- 6Department of Psychology, University of Maine, Orono, ME USA
| | - Jillian C Shipherd
- National Center for PTSD, Behavioral Science Division, Boston, MA USA.,National Center for PTSD, Women's Health Sciences Division, Boston, MA USA.,8Lesbian, Gay, Bisexual, and Transgender (LGBT) Health Program, Veterans Health Administration, Washington, DC USA
| |
Collapse
|
16
|
Tobin V, Delaney KR. Child abuse victimization among transgender and gender nonconforming people: A systematic review. Perspect Psychiatr Care 2019; 55:576-583. [PMID: 31104337 DOI: 10.1111/ppc.12398] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 04/24/2019] [Accepted: 04/28/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Conduct a systematic review of abuse of transgender and gender nonconforming (TGNC) people in childhood. DESIGN AND METHODS Scopus, PubMed, PsychInfo databases were searched. Articles included in final analysis were those with respondents who reported childhood abuse and were either transgender adults or described gender nonconforming traits in childhood. Of 186 articles originally identified, 14 are included in the final review. FINDINGS Research on TGNC individuals and child abuse varied in how populations were identified and methodology used. Those who are transgender and those who display gender nonconforming traits in childhood are at risk for child abuse and sequelae. CONCLUSION Research should use the two-step methodology of identifying transgender people. Recalled Childhood Gender Identity Scale should be used. Providers should screen for child abuse.
Collapse
Affiliation(s)
- Valerie Tobin
- Department of Community, Systems, and Mental Health Nursing, College of Nursing, Rush University, Chicago, Illinois
| | - Kathleen R Delaney
- Director of PMHNP Program in the Department of Community, Systems, and Mental Health Nursing, College of Nursing, Rush University, Chicago, Illinois
| |
Collapse
|
17
|
Murchison GR, Agénor M, Reisner SL, Watson RJ. School Restroom and Locker Room Restrictions and Sexual Assault Risk Among Transgender Youth. Pediatrics 2019; 143:peds.2018-2902. [PMID: 31061223 PMCID: PMC8849575 DOI: 10.1542/peds.2018-2902] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Transgender and gender nonbinary adolescents experience high rates of peer victimization, but the prevalence of sexual assault in this population has not been established. Some schools restrict transgender and nonbinary students from using restrooms and locker rooms that match their gender identity, with unknown effects on sexual assault risk. We tested whether these restrictions were associated with the 12-month prevalence of sexual assault victimization. METHODS Survey responses were analyzed from 3673 transgender and nonbinary US adolescents in grades 7 through 12 who participated in the cross-sectional 2017 LGBTQ Teen Study. We estimated the association between school restroom and locker room restrictions and sexual assault, adjusting for potential social and behavioral confounders, using logistic regression. We also tested potential mediators. RESULTS The 12-month prevalence of sexual assault was 26.5% among transgender boys, 27.0% among nonbinary youth assigned female at birth, 18.5% among transgender girls, and 17.6% among nonbinary youth assigned male at birth. Youth whose restroom and locker room use was restricted were more likely to experience sexual assault compared with those without restrictions, with risk ratios of 1.26 (95% confidence interval [CI]: 1.02-1.52) in transgender boys, 1.42 (95% CI: 1.10-1.78) in nonbinary youth assigned female at birth, and 2.49 (95% CI: 1.11-4.28) in transgender girls. Restrictions were not associated with sexual assault among nonbinary youth assigned male at birth. CONCLUSIONS Pediatricians should be aware that sexual assault is highly prevalent in transgender and nonbinary youth and that restrictive school restroom and locker room policies may be associated with risk.
Collapse
Affiliation(s)
- Gabriel R. Murchison
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, USA 02115
| | - Madina Agénor
- Department of Community Health, Tufts University, 574 Boston Ave Suite 208, Medford, MA 02155.,The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, USA, 02215
| | - Sari L. Reisner
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, USA, 02215,Division of General Pediatrics, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA, USA 02115,Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA, USA 02115,Department of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, USA 02115
| | - Ryan J. Watson
- Department of Human Development and Family Studies, University of Connecticut, 348 Mansfield Road U1058, Storrs, CT, USA, 06269
| |
Collapse
|
18
|
Fernández-Rouco N, Carcedo RJ, Yeadon-Lee T. Transgender Identities, Pressures, and Social Policy: A Study Carried Out in Spain. JOURNAL OF HOMOSEXUALITY 2018; 67:620-638. [PMID: 30507295 DOI: 10.1080/00918369.2018.1550330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This article draws on a qualitative research project concerning the relationship between trans people's mental health and wellbeing, pressures, social policy, and heteronormative gender norms in Spain. Drawing on interviews carried out with trans people from all regions and generations, we use an ecological framework to illustrate how a socially entrenched heteronormativity pressures trans people to comply with gender norms that impact negatively their mental health and wellbeing. The article argues that the legal changes in Spain are not enough in themselves to bring about social change, but, rather, Spanish social policy makers also need to challenge gender categorization and work toward transforming public discourses on gender issues if trans people are to gain full social recognition and equal social rights.
Collapse
Affiliation(s)
| | - Rodrigo J Carcedo
- Department of Developmental and Educational Psychology, University of Salamanca, Salamanca, Spain
| | - Tray Yeadon-Lee
- Department of Behavioral & Social Sciences, University of Huddersfield, Huddersfield, UK
| |
Collapse
|