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Morris E, Teplinskaya A, Olansky E, Rinderle JK, Chapin-Bardales J. Characteristics Associated with Pre-Exposure Prophylaxis Discussion and Use Among Transgender Women Without HIV Infection - National HIV Behavioral Surveillance Among Transgender Women, Seven Urban Areas, United States, 2019-2020. MMWR Suppl 2024; 73:9-20. [PMID: 38261546 PMCID: PMC10826686 DOI: 10.15585/mmwr.su7301a2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
CDC recommends pre-exposure prophylaxis (PrEP) for transgender women who have sex with men and who report sexual behaviors that place them at substantial ongoing risk for HIV exposure, including those who engage in nonsterile syringe sharing. Providing transgender women with access to PrEP is a critical strategy for reducing HIV acquisition and ending the HIV epidemic. Survey results from the National HIV Behavioral Surveillance Among Transgender Women were used to assess characteristics associated with past-year discussions of PrEP with a health care provider and PrEP use. Bivariate analyses were conducted to assess the association between covariates (sociodemographic, HIV-associated characteristics, and gender-affirming care) and each outcome, accounting for sampling design. All covariates that were statistically significant at p<0.05 in the bivariate analyses were included in multivariate models, and manual backward elimination was used to obtain final models that retained statistically significant covariates. Among 902 transgender women from seven urban areas in the United States without HIV infection in the analyses, 57% had recently discussed PrEP with a health care provider, and 32% recently had used PrEP. In the final multivariate model, the following subgroups of transgender women were more likely to report recent PrEP use: those who identified as Black or African American or Hispanic or Latina, had two or more sex partners in the past 12 months, had condomless sex in the past 12 months, reported their last sex partner was infected with HIV, had condomless sex with their last sex partner whose HIV status was positive or unknown, ever had transgender-specific health care, and currently had transgender-specific health insurance coverage. Participants who were less likely to have recently used PrEP were those who wanted to but were not currently taking hormones and those aged <40 years. Providing increased access to gender-affirming care and training health care providers who serve transgender women to incorporate PrEP into existing services might increase PrEP use among transgender women.
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Affiliation(s)
| | | | | | | | | | - National HIV Behavioral Surveillance Among Transgender Women Study Group
- Behavioral and Clinical Surveillance Branch, Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, Georgia; Social & Scientific Systems, Inc., Silver Spring, Maryland; Prevention Communication Branch, Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, Georgia
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2
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Daans CG, Hoornenborg E, de Haseth KB, Özer M, Bouman MB, Conemans E, Kreukels BP, den Heijer M, van der Sluis WB. HIV Prevalence and High-Risk Subgroup Identification in Transgender Women Who Undergo Primary Vaginoplasty in the Netherlands. Transgend Health 2023; 8:226-230. [PMID: 37342478 PMCID: PMC10277977 DOI: 10.1089/trgh.2021.0059] [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: 10/18/2022] Open
Abstract
Purpose Worldwide, transgender women (TGW) bear a high HIV burden. Limited data are available on HIV prevalence and risk factors among TGW in western European countries. Our aim is to assess the prevalence of TGW living with HIV who underwent primary vaginoplasty in an academic reference hospital and to identify high-risk subgroups. Methods All TGW who underwent primary vaginoplasty between January 2000 and September 2019 at our institution were identified. A retrospective chart study was conducted, recording the medical history, age at vaginoplasty, region of birth, use of medication, injecting drug use, history of pubertal suppression, HIV status, and sexual preference at time of surgical intake. High-risk subgroups were identified using logistic regression analysis. Results Between January 2000 and September 2019, a total of 950 TGW underwent primary vaginoplasty, of whom 31 (3.3%) individuals were known to live with HIV. Prevalence of HIV was higher in TGW born outside of Europe (20/145, 13.8%) than among those born in Europe (11/805, 1.4%), p<0.001. In addition, having a sexual preference toward men was significantly associated with HIV. None of the TGW living with HIV had a history of puberty suppression. Conclusion The HIV prevalence in our study population is higher than the reported HIV prevalence in cisgender population in the Netherlands but lower than reported in previous studies in TGW. Further studies should investigate the need and feasibility of routine HIV testing of TGW in Western countries.
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Affiliation(s)
- Ceranza G. Daans
- Department of Internal Medicine, Endocrine Section, Amsterdam UMC, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Elske Hoornenborg
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Kristin B. de Haseth
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, and Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Müjde Özer
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, and Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Mark-Bram Bouman
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, and Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Elfi Conemans
- Department of Internal Medicine, Endocrine Section, Amsterdam UMC, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Baudewijntje P.C. Kreukels
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Martin den Heijer
- Department of Internal Medicine, Endocrine Section, Amsterdam UMC, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Wouter B. van der Sluis
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, and Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
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Wolfe HL, Hughto JMW, Quint M, Hashemi L, Hughes LD. Hepatitis C Virus Testing and Care Cascade Among Transgender and Gender Diverse Individuals. Am J Prev Med 2023; 64:695-703. [PMID: 36759228 PMCID: PMC10121731 DOI: 10.1016/j.amepre.2023.01.005] [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: 08/12/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Hepatitis C virus (HCV) prevalence among transgender and gender-diverse individuals ranges from 1.8% to 15.7% versus 1% in the general population. Previous HCV studies inclusive of transgender and gender-diverse individuals primarily rely on convenience-based sampling methods or are geographically restricted. The purpose of this study is to compare the prevalence of HCV diagnoses, testing, and care engagement between transgender and gender-diverse and cisgender individuals. METHODS Using Optum's de-identified Clinformatics® Data Mart Database, in 2022, the unadjusted prevalence of HCV testing among all adults and people who inject drugs from January 2001 to December 2019 was measured. Multivariable logistic regression was used to compare the adjusted odds of HCV diagnoses and care engagement by gender subgroup. RESULTS The overall unadjusted frequency of HCV diagnoses among transgender and gender-diverse individuals was approximately 3 times that of cisgender individuals (1.06% vs 0.38%, p<0.001), including among people who inject drugs (6.36% vs 2.36%, p=0.007). Compared with cisgender women, transfeminine/nonbinary individuals had over 5 times the adjusted odds of a HCV diagnosis and approximately 3.5 times the odds of being tested for HCV. In addition, compared with cisgender women, transfeminine/nonbinary individuals had significantly increased odds of having a HCV‒related procedure (e.g., abdominal ultrasounds, liver biopsies, Fibroscans). Cisgender men had significantly increased odds of receiving HCV medication compared with cisgender women. CONCLUSIONS Although testing was higher among transgender and gender-diverse individuals, the higher overall frequency of HCV diagnoses among transgender and gender-diverse than among cisgender individuals signals persistent health disparities. Interventions are warranted to prevent HCV and increase ongoing testing and treatment uptake among transgender and gender-diverse populations.
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Affiliation(s)
- Hill L Wolfe
- Department of Health Law, Policy & Management, School of Public Health, Boston University, Boston, Massachussetts.
| | - Jaclyn M W Hughto
- Center for Health Promotion and Health Equity, School of Public Health, Brown University, Providence, Rhode Island; Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island; Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island; The Fenway Institute, Fenway Health, Boston, Massachussetts
| | - Meg Quint
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachussetts
| | - Leila Hashemi
- Division of Primary Care, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Landon D Hughes
- Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan; Institute for Social Research, University of Michigan, Ann Arbor, Michigan
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Hughto JMW, Varma H, Babbs G, Yee K, Alpert A, Hughes L, Ellison J, Downing J, Shireman TI. Disparities in health condition diagnoses among aging transgender and cisgender medicare beneficiaries, 2008-2017. Front Endocrinol (Lausanne) 2023; 14:1102348. [PMID: 36992801 PMCID: PMC10040837 DOI: 10.3389/fendo.2023.1102348] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/21/2023] [Indexed: 03/14/2023] Open
Abstract
INTRODUCTION The objective of this research is to provide national estimates of the prevalence of health condition diagnoses among age-entitled transgender and cisgender Medicare beneficiaries. Quantification of the health burden across sex assigned at birth and gender can inform prevention, research, and allocation of funding for modifiable risk factors. METHODS Using 2009-2017 Medicare fee-for-service data, we implemented an algorithm that leverages diagnosis, procedure, and pharmacy claims to identify age-entitled transgender Medicare beneficiaries and stratify the sample by inferred gender: trans feminine and nonbinary (TFN), trans masculine and nonbinary (TMN), and unclassified. We selected a 5% random sample of cisgender individuals for comparison. We descriptively analyzed (means and frequencies) demographic characteristics (age, race/ethnicity, US census region, months of enrollment) and used chi-square and t-tests to determine between- (transgender vs. cisgender) and within-group gender differences (e.g., TMN, TFN, unclassified) difference in demographics (p<0.05). We then used logistic regression to estimate and examine within- and between-group gender differences in the predicted probability of 25 health conditions, controlling for age, race/ethnicity, enrollment length, and census region. RESULTS The analytic sample included 9,975 transgender (TFN n=4,198; TMN n=2,762; unclassified n=3,015) and 2,961,636 cisgender (male n=1,294,690, female n=1,666,946) beneficiaries. The majority of the transgender and cisgender samples were between the ages of 65 and 69 and White, non-Hispanic. The largest proportion of transgender and cisgender beneficiaries were from the South. On average, transgender individuals had more months of enrollment than cisgender individuals. In adjusted models, aging TFN or TMN Medicare beneficiaries had the highest probability of each of the 25 health diagnoses studied relative to cisgender males or females. TFN beneficiaries had the highest burden of health diagnoses relative to all other groups. DISCUSSION These findings document disparities in key health condition diagnoses among transgender Medicare beneficiaries relative to cisgender individuals. Future application of these methods will enable the study of rare and anatomy-specific conditions among hard-to-reach aging transgender populations and inform interventions and policies to address documented disparities.
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Affiliation(s)
- Jaclyn M. W. Hughto
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, United States
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, United States
- The Fenway Institute, Fenway Health, Boston, MA, United States
- *Correspondence: Jaclyn M. W. Hughto,
| | - Hiren Varma
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, United States
- Department of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, United States
| | - Gray Babbs
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, United States
- Department of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, United States
| | - Kim Yee
- Oregon Health & Science University - Portland State University School of Public Health, Portland, OR, United States
| | - Ash Alpert
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, United States
- Department of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, United States
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Landon Hughes
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States
- Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
| | - Jacqueline Ellison
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, PA, United States
- Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh Department of Medicine, Pittsburgh, PA, United States
| | - Jae Downing
- Oregon Health & Science University - Portland State University School of Public Health, Portland, OR, United States
| | - Theresa I. Shireman
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, United States
- Department of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, United States
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Mental health and substance use risks and resiliencies in a U.S. sample of transgender and gender diverse adults. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2305-2318. [PMID: 36112161 DOI: 10.1007/s00127-022-02359-y] [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: 10/13/2021] [Accepted: 09/02/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Victimization contributes to mental and behavioral health inequities among transgender and gender diverse (TGD) people, but few studies have simultaneously examined health-promoting resiliencies. We sought to identify classes of risk and resilience among TGD adults, assess characteristics associated with these classes, and examine their relationship with mental health and substance use outcomes. METHODS Cross-sectional data were from the 2015 US Transgender Survey, a non-probability study including 26,957 TGD adults. Using latent class analysis, we classified patterns of vulnerability and resilience based on risk (past-year denial of equal treatment, verbal harassment, physical attack, bathroom-related discrimination; lifetime sexual assault, intimate partner violence) and protective (activism; family, work, classmate support) factors. Regression models were fit to (1) determine the association between sociodemographic and gender affirmation characteristics and latent classes; (2) model associations between latent classes and mental health (current serious psychological distress, past-year and lifetime suicidal thoughts and attempts, and lifetime gender identity/transition-related counseling) and substance use (current binge alcohol use, smoking, illicit drug use; past-year drug/alcohol treatment) outcomes. RESULTS Three latent classes were identified: high risks, with activism involvement ("risk-activism," 35%); low risks, with not being out about one's TGD identity ("not-out," 25%); and low risks, with high family support ("family-support," 40%). Gender affirmation and sociodemographic characteristics, such as race/ethnicity and sexual orientation, were associated with latent classes. Risk-activism class membership was associated with higher odds of negative mental health and substance use outcomes, while the family-support class had lower odds of these outcomes. CONCLUSIONS Interventions leveraging family support, and policy protections from discrimination and victimization, may promote TGD mental and behavioral health.
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Fletcher OV, Chen JA, van Draanen J, Frost MC, Rubinsky AD, Blosnich JR, Williams EC. Prevalence of social and economic stressors among transgender veterans with alcohol and other drug use disorders. SSM Popul Health 2022; 19:101153. [PMID: 35813187 PMCID: PMC9260617 DOI: 10.1016/j.ssmph.2022.101153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 11/21/2022] Open
Abstract
Transgender persons have high rates of alcohol and other drug use disorders (AUD and DUD, respectively) and commonly experience social and economic stressors that may compound risk for adverse substance-related outcomes. National VA electronic health record data were extracted for all outpatients in each facility with documented alcohol screening 10/1/09-7/31/17. We describe the prevalence of eight individual-level social and economic stressors (barriers to accessing care, economic hardship, housing instability, homelessness, social and family problems, legal problems, military sexual trauma, and other victimization) among transgender patients with and without AUD and DUD (alone and in combination), overall and compared to cisgender patients in a national sample of VA outpatients. Among 8,872,793 patients, 8619 (0.1%) were transgender; the prevalence of AUD, DUD, and both was 8.6%, 7.2%, and 3.1% among transgender patients and 6.1%, 3.9%, and 1.7% among cisgender patients, respectively. Among all patients, prevalence of stressors was higher among those with AUD, DUD, or both, relative to those with neither. Within each of these groups, prevalence was 2-3 times higher among transgender compared to cisgender patients. For instance, prevalence of housing instability for transgender vs. cisgender patients with AUD, DUD, and both was: 40.8% vs 24.1%, 45.8% vs. 36.6%, and 57.4% vs. 47.0%, respectively. (all p-values <0.001). Social and economic stressors were prevalent among patients with AUD, DUD, or both, and the experience of these disorders and social and economic stressors was more common among transgender than cisgender patients in all groups. Further research regarding experiences of transgender persons and influences of stressors on risk of AUD and DUD, substance-related outcomes, and treatment uptake are needed. Routine screening for social and economic stressors among patients with substance use disorders (SUDs) could improve equitable substance-related care and outcomes. Treatment of SUDs among all persons should consider social and economic risk factors.
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Affiliation(s)
- Olivia V. Fletcher
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 S Columbia Way, Seattle, WA, 98108, USA
| | - Jessica A. Chen
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 S Columbia Way, Seattle, WA, 98108, USA
- Department of Psychiatry and Behavioral Science, University of Washington, 1959 NE Pacific St, Box 356560, Seattle, WA, 98195, USA
| | - Jenna van Draanen
- Department of Health Systems and Population Health, University of Washington School of Public Health, 3980 15th Ave NE, Box 351621, Seattle, WA, 98195, USA
- Department of Child, Family, and Population Health Nursing, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Madeline C. Frost
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 S Columbia Way, Seattle, WA, 98108, USA
- Department of Health Systems and Population Health, University of Washington School of Public Health, 3980 15th Ave NE, Box 351621, Seattle, WA, 98195, USA
| | - Anna D. Rubinsky
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 S Columbia Way, Seattle, WA, 98108, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th St, San Francisco, CA, 94158, USA
| | - John R. Blosnich
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W 34th St, Los Angeles, CA, 90089, USA
- Health Services Research & Development (HSR&D) Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, University Drive C, Pittsburgh, PA, 15240, USA
| | - Emily C. Williams
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 S Columbia Way, Seattle, WA, 98108, USA
- Department of Health Systems and Population Health, University of Washington School of Public Health, 3980 15th Ave NE, Box 351621, Seattle, WA, 98195, USA
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Pinna F, Paribello P, Somaini G, Corona A, Ventriglio A, Corrias C, Frau I, Murgia R, El Kacemi S, Galeazzi GM, Mirandola M, Amaddeo F, Crapanzano A, Converti M, Piras P, Suprani F, Manchia M, Fiorillo A, Carpiniello B. Mental health in transgender individuals: a systematic review. Int Rev Psychiatry 2022; 34:292-359. [PMID: 36151828 DOI: 10.1080/09540261.2022.2093629] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Several lines of evidence indicate the prevalence of mental health disorders in Transgender (TG) individuals is higher than that of cisgender individuals or the general population. In this systematic review, we aim to propose a summary of some of the most significant research investigating mental health disorders' prevalence among this population. We performed a double-blind systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting (PRISMA) on PUBMED/MEDLINE and SCOPUS, specifically using peer-reviewed articles examining the mental health status of transgender (TG) individuals. This review did not exclude any research based on publication date. The last search was performed in February 2022. The employed search strategy led to the selection of 165 peer-reviewed articles. The majority of these papers presented a cross-sectional design with self-reported diagnoses and symptoms, signaling a significant prevalence of mental health disorders amongst TG Individuals. Of the reviewed articles, 72 examined the prevalence of mood and anxiety disorders; 8 examined eating disorders; 43 examined the prevalence of suicidal or self-harm ideation or behaviors; 5 papers examined the prevalence of trauma and stress-related disorders; 10 examined the frequency of personality disorders; 44 examined substance use disorders; and 9 papers examined the prevalence of autism spectrum disorder. Finally, 22 studies reported on the prevalence of TG individuals diagnosed with co-morbid mental health disorders or unspecified mental disorders. Our findings coincide with existing research, which indicates TG individuals do experience a higher prevalence of mental health disorders than that of the general population or cisgender individuals. However, further research is needed to address the existing gaps in knowledge.
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Affiliation(s)
- Federica Pinna
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Pasquale Paribello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Giulia Somaini
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Alice Corona
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Carolina Corrias
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Ilaria Frau
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Roberto Murgia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Sabrina El Kacemi
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Dipartimento ad attività integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Mirandola
- Department of Diagnostics and Public Health, Infectious Diseases Section, University of Verona, Verona, Italy.,School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Andrea Crapanzano
- Department of Counseling, San Francisco State University, San Francisco, California, USA
| | - Manlio Converti
- Dipartimento di salute mentale, ASL Napoli 2 Nord, Naples, Italy
| | - Paola Piras
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Federico Suprani
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy.,Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Bernardo Carpiniello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
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Cotaina M, Peraire M, Boscá M, Echeverria I, Benito A, Haro G. Substance Use in the Transgender Population: A Meta-Analysis. Brain Sci 2022; 12:brainsci12030366. [PMID: 35326322 PMCID: PMC8945921 DOI: 10.3390/brainsci12030366] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/03/2022] [Accepted: 03/08/2022] [Indexed: 02/06/2023] Open
Abstract
(1) Background: This meta-analysis aimed to assess the relationship between identifying as transgender and substance use. (2) Methods: We searched for relevant studies in PubMed, Scopus, the Web of Science, and PsycINFO on 21 July 2021. (3) Results: Twenty studies comparing transgender and cisgender people were included in this work, accounting for a total of 2,376,951 participants (18,329 of whom were transgender). These articles included data on current tobacco use, current tobacco use disorder, current alcohol use, current alcohol use disorder, lifetime substance (all) use, current substance use (excluding tobacco and alcohol), current use of specific substances (excluding tobacco and alcohol and including cocaine, amphetamines, methamphetamines, ecstasy, stimulants, heroin, opiates, cannabis, marijuana, LSD, hallucinogens, steroids, inhalants, sedatives, Ritalin or Adderall, diet pills, cold medicine, prescription medications, polysubstance, other club drugs, and other illegal drugs), and current substance use disorder (excluding tobacco and alcohol). We used the ORs and their 95% CIs to state the association between identifying as transgender and those variables. The control reference category used in all cases was cisgender. We employed a random-effects model. Transgender people were more likely to use tobacco (odds ratio (OR) = 1.65; 95% CI [1.37, 1.98]), have used substances throughout their lives (OR = 1.48; 95% CI [1.30, 1.68]), and present current use of specific substances (OR = 1.79; 95% CI [1.54, 2.07]). When current alcohol and substance use in general and tobacco, alcohol, and substance use disorders specifically were considered, the likelihood did not differ from that of cisgender people. (4) Conclusions: The presence of substance use disorders did not differ between transgender and cisgender people. Considering this population as consumers or as addicted may be a prejudice that perpetuates stigma. Nonetheless, transgender people were more likely to use tobacco and other substances, but not alcohol. Hypothetically, this might be an emotional regulation strategy, a maladaptive mechanism for coping with traumatic experiences, or could respond to minority stress, produced by stigma, prejudice, discrimination, and harassment. It is of particular importance to implement policies against discrimination and stigmatisation and to adapt prevention and treatment services so that they are inclusive of the 2SLGBTQIA+ community.
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Affiliation(s)
- Miriam Cotaina
- TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, 12006 Castellon de la plana, Spain; (M.C.); (M.P.); (I.E.); (G.H.)
- Department of Mental Health, Consorcio Hospitalario Provincial de Castellón, 12002 Castellon de la plana, Spain;
| | - Marc Peraire
- TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, 12006 Castellon de la plana, Spain; (M.C.); (M.P.); (I.E.); (G.H.)
- Department of Mental Health, Consorcio Hospitalario Provincial de Castellón, 12002 Castellon de la plana, Spain;
| | - Mireia Boscá
- Department of Mental Health, Consorcio Hospitalario Provincial de Castellón, 12002 Castellon de la plana, Spain;
| | - Iván Echeverria
- TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, 12006 Castellon de la plana, Spain; (M.C.); (M.P.); (I.E.); (G.H.)
- Department of Mental Health, Consorcio Hospitalario Provincial de Castellón, 12002 Castellon de la plana, Spain;
| | - Ana Benito
- TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, 12006 Castellon de la plana, Spain; (M.C.); (M.P.); (I.E.); (G.H.)
- Torrente Mental Health Unit, Hospital General de Valencia, 46900 Torrente, Spain
- Correspondence:
| | - Gonzalo Haro
- TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, 12006 Castellon de la plana, Spain; (M.C.); (M.P.); (I.E.); (G.H.)
- Department of Mental Health, Consorcio Hospitalario Provincial de Castellón, 12002 Castellon de la plana, Spain;
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Dangerfield DT, Cooper J, Heidari O, Allen S, Winder TJA, Lucas GM. Nursing and Health Care Preferences Among Opioid and Stimulant Using Black Sexual Minority Men: An Exploratory Study. J Assoc Nurses AIDS Care 2021; 32:e30-e39. [PMID: 32809988 DOI: 10.1097/jnc.0000000000000201] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
ABSTRACT Black sexual minority men (BSMM) experience the worst HIV treatment outcomes in the United States. Drug use increases HIV transmission risks and reduces health care engagement. Perceived health care provider stigma and medical mistrust minimizes treatment efforts. This study identified nursing and health care preferences among drug-using BSMM. In-depth qualitative interviews were conducted among 30 BSMM who reported drug use in Baltimore City, MD, from December 2018 to March 2019. Analysis identified themes as client preferences for nursing practices and gaps in clinical services. Participants' ages ranged from 23 to 63 years (M = 41.1). Most (91%) reported living with HIV. The following themes were identified as nursing and health care preferences: (a) being genuine, (b) knowing drug treatment and social services, (c) understanding drug use effects, (d) providing mental health services, and (e) clarifying treatment recommendations. Nurses and health care facilities can improve cultural competency for drug-using BSMM. Future research should identify the impact of these preferences on HIV care outcomes among BSMM.
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Affiliation(s)
- Derek T Dangerfield
- Derek T. Dangerfield II, PhD, is an Assistant Professor, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA. Jessica Cooper, BS, RN, is a Graduate Research Assistant, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA. Omeid Heidari, MSN, MPH, RN, is a Graduate Research Assistant and Doctoral Candidate, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA. Sophia Allen, BA, is a Research Assistant, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA. Terrell J.A. Winder, PhD, is an Assistant Professor, Department of Sociology, University of California Santa Barbara, Santa Barbara, California, USA. Gregory M. Lucas, MD, PhD, is a Professor, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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10
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Poteat T, Mayo-Wilson LJ, Pereira N, Wright BN, Smout SA, Sawyer AN, Cathers L, Zimmerman RS, Grigsby SR, Benotsch EG. U.S. transgender women's preferences for microeconomic interventions to address structural determinants of HIV vulnerability: a qualitative assessment. BMC Public Health 2021; 21:1394. [PMID: 34261464 PMCID: PMC8281671 DOI: 10.1186/s12889-021-11471-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 06/29/2021] [Indexed: 11/30/2022] Open
Abstract
Background Transgender women in the United States (U.S.) experience a disproportionate burden of HIV infection and challenges to engagement in HIV prevention and care. This excess burden is driven by structural and economic inequities. Microeconomic interventions may be effective strategies for reducing HIV inequities for this population. However, few studies have explored transgender women’s preferences for microeconomic interventions to address structural determinants of HIV vulnerability. Methods We conducted individual interviews with 19 adult transgender women in 2 U.S. cities (Richmond, VA and St. Louis, MO) who reported one or more sexual risk behaviors and recent economic hardship related to employment/income, housing, or food security. Interviews were recorded, transcribed, and analyzed using thematic content analysis. Results The majority (74%) of transgender women were racial/ethnic minorities with mean age of 26.3 years. 89% were currently economically vulnerable; and 23% were employed full-time. 37% reported living with HIV. Participants expressed strong support for unrestricted vouchers, with many expressing the need for funds to support gender-affirming interventions. Assistance with how to budget and save and support for job acquisition, career planning, and employment sustainment were also preferred, including access to non-stigmatizing employment. Visible transgender leadership, group empowerment, and small (rather than large) numbers of participants were considered important aspects of intervention design for transgender women, including outreach through existing transgender networks to facilitate inclusion. Incorporating HIV counseling and testing to reduce vulnerability to HIV was acceptable. However, transgender women enrolled in the study preferred that HIV not be the focus of an intervention. Conclusions Flexible microeconomic interventions that support gender affirming interventions, improve financial literacy, and provide living-wage non-stigmatizing employment are desired by economically vulnerable transgender women. While not focused on HIV, such interventions have the potential to reduce the structural drivers of HIV vulnerability among transgender women.
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Affiliation(s)
- Tonia Poteat
- Department of Social Medicine, University of North Carolina at Chapel Hill School of Medicine, CB #7240, Chapel Hill, NC, 27516, USA.
| | - Larissa Jennings Mayo-Wilson
- Department of Applied Health Sciences, Indiana University School of Public Health, 1025 E. 7th Street, Bloomington, IN, 47405, USA.,Global & Public Health Division, Johns Hopkins University School of Nursing, Community, 525 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Nastacia Pereira
- Department of Social Medicine, University of North Carolina at Chapel Hill School of Medicine, CB #7240, Chapel Hill, NC, 27516, USA
| | - Brittanni N Wright
- Department of Applied Health Sciences, Indiana University School of Public Health, 1025 E. 7th Street, Bloomington, IN, 47405, USA
| | - Shelby A Smout
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Richmond, VA, 23284, USA
| | - Ashlee N Sawyer
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Richmond, VA, 23284, USA
| | - Lauretta Cathers
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Richmond, VA, 23284, USA
| | - Rick S Zimmerman
- Wayne State University, College of Nursing, 5557 Cass Avenue, Detroit, MI, 48202, USA
| | - Sheila R Grigsby
- University of Missouri St. Louis, College of Nursing, 221 NAB South Campus, University Blvd, St. Loius, MO, 63121, USA
| | - Eric G Benotsch
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Richmond, VA, 23284, USA
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11
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Williams EC, Chen JA, Frost MC, Rubinsky AD, Edmonds AT, Glass JE, Lehavot K, Matson TE, Wheat CL, Coggeshall S, Blosnich JR. Receipt of evidence-based alcohol-related care in a national sample of transgender patients with unhealthy alcohol use: Overall and relative to non-transgender patients. J Subst Abuse Treat 2021; 131:108565. [PMID: 34274175 DOI: 10.1016/j.jsat.2021.108565] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 06/29/2021] [Accepted: 07/04/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND/OBJECTIVE Evidence-based alcohol-related care-brief intervention for all patients with unhealthy alcohol use and specialty addictions treatment and/or pharmacotherapy for patients with alcohol use disorder (AUD)-should be routinely offered. Transgender persons may be particularly in need of alcohol-related care, given common experiences of social and economic hardship that may compound the adverse effects of unhealthy alcohol use. We examined receipt of alcohol-related care among transgender patients compared to non-transgender patients in a large national sample of Veterans Health Administration (VA) outpatients with unhealthy alcohol use. METHODS We extracted electronic health record data for patients from all VA facilities who had an outpatient visit 10/1/09-7/31/17 and a documented positive screen for unhealthy alcohol use (AUDIT-C ≥ 5). We identified transgender patients with a validated approach using transgender-related diagnostic codes. We fit modified Poisson models, adjusted for demographics and comorbidities, to estimate the average predicted prevalence of brief intervention (documented 0-14 days following most recent positive screening), specialty addictions treatment for AUD (documented 0-365 days following screening), and filled prescriptions for medications to treat AUD (documented 0-365 days following screening) for transgender patients, and compared to that of non-transgender patients. RESULTS Among transgender Veterans with unhealthy alcohol use (N = 1392), the adjusted prevalence of receiving brief intervention was 75.4% (95% CI 72.2-78.5), specialty addictions treatment for AUD was 15.7% (95% CI 13.7-17.7), and any AUD pharmacotherapy was 19.0% (95% CI 17.1-20.8). Receipt of brief intervention did not differ for transgender relative to non-transgender patients (Prevalence Ratio [PR] 1.01, 95% CI 0.98-1.04, p = 0.574). However, transgender patients were more likely to receive specialty addictions treatment (PR 1.24, 95% CI 1.12-1.37, p < 0.001) and pharmacotherapy (PR 1.16, 95% CI 1.06-1.28, p = 0.002). CONCLUSIONS Findings suggest the majority of transgender VHA patients with unhealthy alcohol use receive brief intervention, though a quarter still do not. Nonetheless, rates of specialty addictions treatment and pharmacotherapy are low overall, although transgender patients may be receiving this care at greater rates than non-transgender patients. Further research is needed to investigate these findings and to increase receipt of evidence-based care overall.
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Affiliation(s)
- Emily C Williams
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA; Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA 98108, USA.
| | - Jessica A Chen
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA 98108, USA; Department of Psychiatry and Behavioral Science, University of Washington, Seattle, WA 98195, USA
| | - Madeline C Frost
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA; Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA 98108, USA
| | - Anna D Rubinsky
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA 98108, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Amy T Edmonds
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA; Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA 98108, USA
| | - Joseph E Glass
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA; Department of Psychiatry and Behavioral Science, University of Washington, Seattle, WA 98195, USA; Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA
| | - Keren Lehavot
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA; Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA 98108, USA; Department of Psychiatry and Behavioral Science, University of Washington, Seattle, WA 98195, USA
| | - Theresa E Matson
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA; Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA 98108, USA; Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA
| | - Chelle L Wheat
- Primary Care Analytics Team, Department of Veterans Affairs, Seattle, WA 98108, USA
| | - Scott Coggeshall
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA 98108, USA
| | - John R Blosnich
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA; Health Services Research & Development (HSR&D) Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh, PA, USA
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12
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Williams EC, Frost MC, Rubinsky AD, Glass JE, Wheat CL, Edmonds AT, Chen JA, Matson TE, Fletcher OV, Lehavot K, Blosnich JR. Patterns of Alcohol Use Among Transgender Patients Receiving Care at the Veterans Health Administration: Overall and Relative to Nontransgender Patients. J Stud Alcohol Drugs 2021. [PMID: 33573731 DOI: 10.15288/jsad.2021.82.132] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Alcohol use is understudied among transgender persons--persons whose sex differs from their gender identity. We compare patterns of alcohol use between Veterans Health Administration (VA) transgender and nontransgender outpatients. METHOD National VA electronic health record data were used to identify all patients' last documented Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) screen (October 1, 2009-July 31, 2017). Transgender patients were identified using diagnostic codes. Logistic regression models estimated four past-year primary outcomes: (a) alcohol use (AUDIT-C > 0); (b) unhealthy alcohol use (AUDIT-C ≥ 5); (c) high-risk alcohol use (AUDIT-C ≥ 8); and (d) heavy episodic drinking (HED; ≥6 drinks on ≥1 occasion). Two secondary diagnostic-based outcomes, alcohol use disorder (AUD) and alcohol-specific conditions, were also examined. RESULTS Among 8,872,793 patients, 8,619 (0.10%) were transgender. For transgender patients, unadjusted prevalence estimates were as follows: 52.8% for any alcohol use, 6.6% unhealthy alcohol use, 2.8% high-risk use, 10.4% HED, 8.6% AUD, and 1.3% alcohol-specific conditions. After adjustment for demographic characteristics, transgender patients had lower odds of patient-reported alcohol use but higher odds of alcohol-related diagnoses compared with nontransgender patients. Differences in alcohol-related diagnoses were attenuated after adjustment for comorbid conditions and utilization. CONCLUSIONS This is the largest study of patterns of alcohol use among transgender persons and among the first to directly compare patterns to nontransgender persons. Findings suggest nuanced associations with patterns of alcohol use and provide a base for further disparities research to explore alcohol use within the diverse transgender community. Research with self-reported measures of gender identity and sex-at-birth and structured assessment of alcohol use and disorders is needed.
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Affiliation(s)
- Emily C Williams
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington.,Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Madeline C Frost
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington.,Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Anna D Rubinsky
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Joseph E Glass
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Chelle L Wheat
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Amy T Edmonds
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington.,Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Jessica A Chen
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington.,Department of Psychiatry and Behavioral Science, University of Washington, Seattle, Washington
| | - Theresa E Matson
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington.,Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.,Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Olivia V Fletcher
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Keren Lehavot
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington.,Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.,Department of Psychiatry and Behavioral Science, University of Washington, Seattle, Washington
| | - John R Blosnich
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California.,Health Services Research & Development (HSR&D) Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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13
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Gass BV, Horvath KJ, Marrow E, Rood BA, Pantalone DW. Associations Between Social Support Availability and HIV Risk and Protective Factors in a U.S. Sample of Adults with Diverse Transgender Identities. LGBT Health 2020; 8:60-67. [PMID: 33370219 DOI: 10.1089/lgbt.2020.0035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: There is conflicting evidence on how different types of social support may attenuate human immunodeficiency virus (HIV) risk or may even promote health behaviors in transgender (trans) and nonbinary populations. Drawing on Social Support Theory, we assessed associations between emotional, instrumental, and informational social support and HIV risk and protective factors in a U.S. sample of trans and nonbinary adults. We investigated whether such associations differed for trans men, trans women, and nonbinary individuals. Methods: Data were drawn from the Transgender Stress and Health Study, an online survey (N = 300), conducted in 2014-2015. We used Poisson regressions to measure the relationship between social support availability and HIV testing, substance use, and sexual risk behaviors for each gender subgroup. Results: Multivariate analyses revealed that, controlling for social support availability, nonbinary individuals were less likely to report past year HIV testing (incidence rate ratio [IRR] = 0.56; 95% confidence interval [CI] 0.36-0.89) than trans men (ref). Instrumental support availability was associated with substance use (IRR = 1.3; 95% CI 1.01-1.6), and this association was stronger for trans women (IRR = 2.1; 95% CI 1.1-4.04). Trans women were more likely to report sexual risk behavior across all types of social support, controlling for social support availability. Conclusion: We found key differences in social support availability, HIV testing, substance use, and sexual risk behavior. Our results suggest that trans men, trans women, and nonbinary individuals may have unique HIV prevention needs, and should be treated as distinct study groups in further research.
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Affiliation(s)
- Bobbi V Gass
- Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Elliot Marrow
- Department of Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Brian A Rood
- Division of Research and Development, UnitedHealth Group, Minnetonka, Minnesota, USA
| | - David W Pantalone
- Department of Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA.,The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
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14
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Aggarwal NK, Consavage KE, Dhanuka I, Clement KW, Bouey JH. Health and Health Care Access Barriers Among Transgender Women Engaged in Sex Work: A Synthesis of U.S.-Based Studies Published 2005-2019. LGBT Health 2020; 8:11-25. [PMID: 33297834 DOI: 10.1089/lgbt.2019.0243] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Purpose: Transgender women (TW) are likely to experience job discrimination and engage in commercial sex transactions. As a group, they have the highest risk for HIV/AIDS. However, little is known about the health needs of transgender women sex workers (TWSW) in the United States and the structural and psychosocial barriers to their health care access. The objective of this systematic review was to systematically document these needs and barriers by using a framework approach. Methods: We searched PubMed, JSTOR, and Google Scholar for primary and secondary studies published in 2005-2019 that addressed the health of TWSW in the United States. We used a standardized data extraction form to gather data from eligible articles. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used to assess study quality. Results: Fifty-three articles met the inclusion criteria, including mentioning health-related topics among TWSW. More articles appeared in recent years. Most studies collected data with convenience samples in urban areas. Structural barriers reported included transphobia, lack of pre-exposure prophylaxis targeted at TW, and lack of health insurance coverage. Psychosocial barriers included distrust of the health care system, self-esteem, alcohol and substance use, and mental health. Conclusions: TWSW have unique health care needs that are not being addressed due to barriers to health care access. More research is required to identify non-HIV-related health burdens and details about psychosocial barriers to health care access.
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Affiliation(s)
- Neena K Aggarwal
- Department of International Health, School of Nursing and Health Studies, Georgetown University, Washington, District of Columbia, USA
| | - Katherine E Consavage
- Department of International Health, School of Nursing and Health Studies, Georgetown University, Washington, District of Columbia, USA
| | - Ida Dhanuka
- Department of Biology, Georgetown University, Washington, District of Columbia, USA
| | - Kesiah W Clement
- Department of International Health, School of Nursing and Health Studies, Georgetown University, Washington, District of Columbia, USA
| | - Jennifer H Bouey
- Department of International Health, School of Nursing and Health Studies, Georgetown University, Washington, District of Columbia, USA
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15
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Prevalence and correlates of substance use among transgender adults: A systematic review. Addict Behav 2020; 111:106544. [PMID: 32717497 DOI: 10.1016/j.addbeh.2020.106544] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 06/23/2020] [Accepted: 07/05/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Minority stress theories suggest that high rates of discrimination experienced by transgender people are precipitants of substance use. This risk is likely exacerbated by an inadequate provision of trans-inclusive substance misuse services. However, the exclusion of transgender people from the general substance misuse literature makes it difficult to determine the extent to which transgender status influences substance use. A systematic review was undertaken to better understand the prevalence, patterns and correlates of substance use among this group. METHODS In accordance with the PRISMA guidance, a literature search was conducted to 29th May 2019 on PubMed, PsycINFO, Embase and Global Health databases. Primary quantitative studies, published in English, that reported the prevalence, patterns or correlates of substance use by transgender people were included, with no restriction on methodological design. RESULTS 653 unique records were identified, and 41 studies were included. Half the studies reported on both transgender men and transgender women and half transgender women only. There was high and excess prevalence of substance use among transgender compared with cisgender people, but insufficient evidence to estimate prevalence or quantify the risk for substance use. Correlates of substance use included transphobic discrimination or violence, unemployment and sex work, gender dysphoria, high visual gender non-conformity and intersectional sexual minority status. CONCLUSIONS The sparse findings lend support to the minority stress model. However, the overreliance of the literature on disproportionate investigation of transgender women with multiple intersectional disadvantages, means there are significant gaps regarding the wider transgender community. To ensure substance use treatment services are inclusive, gender identity should be recorded and targeted interventions available. Clinicians should be aware of the multiple, complex drivers of substance use and be prepared to ask about substance use and offer support. Given the high prevalence of trauma experienced by transgender people, trauma-informed psychosocial interventions may be useful in the management of problematic substance use in transgender adults.
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Wozniak RJ, Cerqueira NB, Dantas MCS, Mahafe B, Barros DAC, Alves de Medeiros E, Soares de Oliveira AC, Sabino T, Roggenbuck A, Avelino-Silva VI, Johnston CD, Marston JL, Bidegain SC, Magnus M, Kallas EG, Nixon DF, Donini CS. Factors associated with attitudes towards HIV cure research among transgender women and travestis: a cross-sectional survey in São Paulo, Brazil. BMJ Open 2020; 10:e040092. [PMID: 33177141 PMCID: PMC7661370 DOI: 10.1136/bmjopen-2020-040092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Characterising the perceptions of groups most affected by HIV is fundamental in establishing guidelines for biomedical advancement. Although Brazil has successfully fought HIV/AIDS through several measures, transgender women still have a likelihood of HIV infection 55 times higher than the general population. This study aimed to better understand the perception and awareness of HIV cure research among the trans-identifying population in São Paulo, Brazil, and to determine factors that motivate or discourage participation in HIV cure studies. SETTING This cross-sectional study analysed data collected from a questionnaire administered to 118 transgender women and travestis at 5 sites within the city of São Paulo. It uses quantitative methodology to describe the perspectives of transgender and travesti people in relation to HIV cure research and the context in which such perspectives are produced. RESULTS Of 118 participants, most participants (73%) had some knowledge of HIV cure research and were most willing to participate in online surveys (52%), interviews (52%), focus groups (52%) and studies involving blood draws (57%). Those with a higher education or employment status were more likely to agree that someone had been cured of HIV, people living with HIV are discriminated against, and more information about HIV cure research is needed before the community embraces it. Only 55% of participants completely trusted their physician. The biggest motivational factors included gaining additional knowledge about HIV infection (77%) and the potential for a longer, healthier life for all (73%). CONCLUSIONS As a primary analysis of HIV cure attitudes among the transgender and travesti population as well as the social context in which they are formed, this study identifies opportunities to strengthen the dialogue and develop more educational collaborations between scientific investigators, community educators and the trans-identifying population to ensure that HIV cure research is inclusive of diverse perspectives.
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Affiliation(s)
- Robert J Wozniak
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Natalia B Cerqueira
- Department of Infectious and Parasitic Diseases, University of Sao Paulo, São Paulo, São Paulo, Brazil
| | - Maria Candida S Dantas
- Department of Infectious and Parasitic Diseases, University of Sao Paulo, São Paulo, São Paulo, Brazil
| | - Bianca Mahafe
- Department of Infectious and Parasitic Diseases, University of Sao Paulo, São Paulo, São Paulo, Brazil
| | - Daniel A C Barros
- Department of Infectious and Parasitic Diseases, University of Sao Paulo, São Paulo, São Paulo, Brazil
| | | | | | - Thiago Sabino
- Department of Infectious and Parasitic Diseases, University of Sao Paulo, São Paulo, São Paulo, Brazil
| | - Albert Roggenbuck
- Department of Infectious and Parasitic Diseases, University of Sao Paulo, São Paulo, São Paulo, Brazil
| | - Vivian Iida Avelino-Silva
- Department of Infectious and Parasitic Diseases, University of Sao Paulo, São Paulo, São Paulo, Brazil
| | - Carrie D Johnston
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Jez L Marston
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Sebastian C Bidegain
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Manya Magnus
- Department of Epidemiology, The George Washington University, Washington, District of Columbia, USA
| | - Esper G Kallas
- Department of Infectious and Parasitic Diseases, University of Sao Paulo, São Paulo, São Paulo, Brazil
| | - Douglas F Nixon
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Camila S Donini
- Department of Infectious and Parasitic Diseases, University of Sao Paulo, São Paulo, São Paulo, Brazil
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17
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Jennings Mayo-Wilson L, Benotsch EG, Grigsby SR, Wagner S, Timbo F, Poteat T, Cathers L, Sawyer AN, Smout SA, Zimmerman RS. Combined effects of gender affirmation and economic hardship on vulnerability to HIV: a qualitative analysis among U.S. adult transgender women. BMC Public Health 2020; 20:782. [PMID: 32456674 PMCID: PMC7249630 DOI: 10.1186/s12889-020-08902-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 05/12/2020] [Indexed: 02/06/2023] Open
Abstract
Background Transgender women (“trans women”), particularly African-American and Latina trans women, have disproportionately high prevalence of HIV in the United States (U.S.). In order to decrease gender dysphoria and overcome discrimination, trans women affirm their gender through social and medical transition, often in contexts of economic hardship and sexual risk. This study qualitatively examined how gender-affirming behaviors enhance or diminish vulnerability to HIV in light of structural and economic barriers to gender transition. Methods We conducted individual interviews with 19 adult trans women in two U.S. cities (Richmond, VA and St. Louis, MO) who reported one or more sexual risk behaviors and recent economic hardship related to employment/income, housing, or food security. Interviews were recorded, transcribed, and analyzed using thematic content analysis. Results The majority (74%) of trans women were racial/ethnic minorities with mean age of 26.3 years. Gender-affirming behaviors varied with 58% of trans women having legally changed their name and gender marker; 79% having initiated hormone therapy; and 11% having not initiated any medical or legal changes. None had undertaken surgical changes. Findings suggested that the process of gender transitioning resulted in both increasing and decreasing HIV risk. The high need for gender affirmation by male sex partners contributed to trans women’s exposure to sexual objectification, sexual risk behaviors, and conflicting interests in HIV prevention messaging. Loss of housing and employment due to transition along with the high costs of transition products and medical visits increased reliance on sex work and created new obstacles in accessing HIV services. Trans women experienced lower HIV risk as they acquired legal and medical transition services, reshaped interactions with sex partners, and received gender-affirming support by others, including health providers, employers, peers, and housing professionals. Sexual abstinence was viewed as a negative consequence of incomplete transition, although characterized as a period of low HIV risk. Conclusions Structural and policy initiatives that promote safe gender transition and economic stability in trans women may play a critical role in reducing HIV in this population. Addressing the harmful pressures for U.S. trans women to conform to perceived feminine stereotypes may also serve an important role.
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Affiliation(s)
- Larissa Jennings Mayo-Wilson
- Indiana University School of Public Health, Department of Applied Health Sciences, Center for Sexual Health Promotion, 1025 E. 7th Street, Bloomington, IN, 47405, USA. .,Johns Hopkins Bloomberg School of Public Health, Department of International Health, Social and Behavioral Interventions Program, 615 N. Wolfe Street, Room E5038, Baltimore, MD, 21205, USA.
| | - Eric G Benotsch
- Virginia Commonwealth University, Department of Psychology, 806 West Franklin Street, Richmond, VA, 23284, USA
| | - Sheila R Grigsby
- University of Missouri - St. Louis, College of Nursing, 221 NAB South Campus, University Blvd St. Louis, St. Louis, MO, 63121, USA
| | - Sarah Wagner
- Indiana University School of Public Health, Department of Applied Health Sciences, Center for Sexual Health Promotion, 1025 E. 7th Street, Bloomington, IN, 47405, USA
| | - Fatmata Timbo
- Indiana University School of Public Health, Department of Applied Health Sciences, Center for Sexual Health Promotion, 1025 E. 7th Street, Bloomington, IN, 47405, USA
| | - Tonia Poteat
- University of North Carolina, Department of Social Medicine, CB #7240, Chapel Hill, NC, 27516, USA
| | - Lauretta Cathers
- University of Missouri - St. Louis, College of Nursing, 221 NAB South Campus, University Blvd St. Louis, St. Louis, MO, 63121, USA
| | - Ashlee N Sawyer
- Virginia Commonwealth University, Department of Psychology, 806 West Franklin Street, Richmond, VA, 23284, USA
| | - Shelby A Smout
- Virginia Commonwealth University, Department of Psychology, 806 West Franklin Street, Richmond, VA, 23284, USA
| | - Rick S Zimmerman
- Louisiana State University Health New Orleans School of Nursing, 1900 Gravier Street, Room 5B14, New Orleans, LA, 70112, USA
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18
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Restar AJ, Jin H, Ogunbajo A, Goedel WC, Millett G, Sherwood J, Kuhns L, Reisner SL, Garofalo R, Mimiaga MJ. Prevalence and Risk Factors of Nonmedical Prescription Opioid Use Among Transgender Girls and Young Women. JAMA Netw Open 2020; 3:e201015. [PMID: 32176305 PMCID: PMC7076341 DOI: 10.1001/jamanetworkopen.2020.1015] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Nonmedical prescription opioid use is a pressing public health issue in the United States. Transgender youth, including adolescent girls and young women who were assigned male at birth and currently identify as women, female, transgender women, or another diverse gender identity along the transfeminine gender spectrum, are more likely than their cisgender peers to report illicit substance use and meet diagnostic criteria for substance use disorders. However, relatively little is known about the experiences of these populations in the current era of opioid addiction and misuse. OBJECTIVE To report the prevalence of and risk factors associated with lifetime nonmedical prescription opioid use in a high-risk community sample of transgender adolescent girls and young women who are sexually active. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used 2012 to 2015 baseline data from Project LifeSkills, a randomized clinical trial of a behavioral intervention to reduce the risk of HIV acquisition and transmission among a diverse sample of transgender adolescent girls and young women recruited from Boston, Massachusetts, and Chicago, Illinois. A total of 297 transgender girls and women aged 16 to 29 years who were sexually active were included in this analysis. Data were analyzed from June 2019 to August 2019. EXPOSURES Transgender woman identification. MAIN OUTCOMES AND MEASURES Self-reported lifetime nonmedical prescription opioid use. RESULTS Among 297 transgender adolescent girls and young women (mean [SD] age, 23.4 [3.5] years), 145 (48.8%) identified as non-Hispanic/Latinx black, 76 (25.6%) identified as non-Hispanic/Latinx white, 37 (12.5%) identified as Hispanic/Latinx, 7 (2.4%) identified as non-Hispanic/Latinx Asian, and 32 (10.8%) identified as multiracial or other race/ethnicity. Thirty-five participants (11.8%) reported lifetime nonmedical prescription opioid use. Young transgender women who smoked cigarettes monthly or less (adjusted odds ratio, 3.92; 95% CI, 1.10-13.89) and who smoked daily (adjusted odds ratio, 5.69; 95% CI, 1.87-17.33) had greater odds of nonmedical prescription opioid use compared with those who did not smoke. Additionally, participants who identified as a sexual orientation other than heterosexual, gay, lesbian, or bisexual had significantly greater odds of lifetime nonmedical prescription opioid use compared with those who identified as heterosexual (adjusted odds ratio, 3.69; 95% CI, 1.07-12.72). CONCLUSIONS AND RELEVANCE These findings suggest that transgender adolescent girls and young women have similar prevalence of lifetime nonmedical prescription opioid use compared with the US general population prevalence of 12.5%. These findings may serve as a call-to-action for public health surveillance studies and evidence-based interventions to be comprehensively tailored to examine and respond to specific trends of substance use, particularly opioid use disorder, among transgender populations.
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Affiliation(s)
- Arjee J. Restar
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
- Center for Health Equity Research, Brown University, Providence, Rhode Island
- amfAR, The Foundation for AIDS Research, New York, New York
| | - Harry Jin
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Adedotun Ogunbajo
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
- Center for Health Equity Research, Brown University, Providence, Rhode Island
| | - William C. Goedel
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | | | | | - Lisa Kuhns
- Division of Adolescent Medicine, Ann and Robert H. Lurie Children’s Hospital, Chicago, Illinois
- Feinberg School of Medicine, Department of Pediatrics, Northwestern University, Chicago, Illinois
| | - Sari L. Reisner
- Boston Children’s Hospital, Division of General Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Robert Garofalo
- Feinberg School of Medicine, Department of Pediatrics, Northwestern University, Chicago, Illinois
- Boston Children’s Hospital, Division of General Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Matthew J. Mimiaga
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
- Center for Health Equity Research, Brown University, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
- The Fenway Institute, Fenway Health, Boston, Massachusetts
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19
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Yeung H, Luk KM, Chen SC, Ginsberg BA, Katz KA. Dermatologic care for lesbian, gay, bisexual, and transgender persons: Epidemiology, screening, and disease prevention. J Am Acad Dermatol 2019; 80:591-602. [PMID: 30744875 PMCID: PMC6375301 DOI: 10.1016/j.jaad.2018.02.045] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Lesbian, gay, bisexual, and transgender (LGBT) persons face important health issues relevant to dermatologists. Men who have sex with men (MSM) are at higher risk of certain infectious diseases, including HIV, syphilis and other sexually transmitted diseases (STDs), methicillin-resistant Staphylococcus aureus infections, and invasive meningococcal disease, and might be at higher risk of non-infectious conditions, including skin cancer. Recommendations for preventive health care, including screening for HIV and other STDs, sexual health-related vaccinations, and HIV pre-exposure prophylaxis, differ for MSM compared with non-MSM. Women who have sex with women experience disparities in STDs, including chlamydia and HPV. Transgender patients have unique, and often unmet, dermatologic needs during gender transition (also called gender affirmation), related to hormonal therapy and gender-affirming surgery. Familiarity with LGBT health issues and disease-prevention guidelines can enable dermatologists to provide medically appropriate and culturally competent care to LGBT persons.
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Affiliation(s)
- Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.
| | - Kevin M Luk
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Suephy C Chen
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia; Division of Dermatology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Brian A Ginsberg
- Department of Dermatology, Mount Sinai Hospital, New York, New York
| | - Kenneth A Katz
- Department of Dermatology, Kaiser Permanente, San Francisco, California
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20
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Bastos FI, Bastos LS, Coutinho C, Toledo L, Mota JC, Velasco-de-Castro CA, Sperandei S, Brignol S, Travassos TS, dos Santos CM, Malta MS. HIV, HCV, HBV, and syphilis among transgender women from Brazil: Assessing different methods to adjust infection rates of a hard-to-reach, sparse population. Medicine (Baltimore) 2018; 97:S16-S24. [PMID: 29794601 PMCID: PMC5991532 DOI: 10.1097/md.0000000000009447] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Different sampling strategies, analytic alternatives, and estimators have been proposed to better assess the characteristics of different hard-to-reach populations and their respective infection rates (as well as their sociodemographic characteristics, associated harms, and needs) in the context of studies based on respondent-driven sampling (RDS). Despite several methodological advances and hundreds of empirical studies implemented worldwide, some inchoate findings and methodological challenges remain. The in-depth assessment of the local structure of networks and the performance of the available estimators are particularly relevant when the target populations are sparse and highly stigmatized. In such populations, bottlenecks as well as other sources of biases (for instance, due to homophily and/or too sparse or fragmented groups of individuals) may be frequent, affecting the estimates.In the present study, data were derived from a cross-sectional, multicity RDS study, carried out in 12 Brazilian cities with transgender women (TGW). Overall, infection rates for HIV and syphilis were very high, with some variation between different cities. Notwithstanding, findings are of great concern, considering the fact that female TGW are not only very hard-to-reach but also face deeply-entrenched prejudice and have been out of the reach of most therapeutic and preventive programs and projects.We cross-compared findings adjusted using 2 estimators (the classic estimator usually known as estimator II, originally proposed by Volz and Heckathorn) and a brand new strategy to adjust data generated by RDS, partially based on Bayesian statistics, called for the sake of this paper, the RDS-B estimator. Adjusted prevalence was cross-compared with estimates generated by non-weighted analyses, using what has been called by us a naïve estimator or rough estimates.
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Affiliation(s)
- Francisco I. Bastos
- Institute of Communication and Information on Science and Technology in Health
| | | | - Carolina Coutinho
- Institute of Communication and Information on Science and Technology in Health
| | - Lidiane Toledo
- Institute of Communication and Information on Science and Technology in Health
| | - Jurema Corrêa Mota
- Institute of Communication and Information on Science and Technology in Health
| | - Carlos Augusto Velasco-de-Castro
- Department of Clinical Pathology, National Institute of Women, Child and Adolescent Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro
| | - Sandro Sperandei
- Institute of Communication and Information on Science and Technology in Health
- Scientific Computing Program
| | - Sandra Brignol
- Department of Epidemiology and Biostatistics, Institute of Collective Health, Fluminense Federal University, Niterói
| | | | | | - Monica Siqueira Malta
- Social Science Department, National School of Public Health, Fiocruz, Rio de Janeiro, Brazil
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore MD
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21
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Blosnich JR, Lehavot K, Glass JE, Williams EC. Differences in Alcohol Use and Alcohol-Related Health Care Among Transgender and Nontransgender Adults: Findings From the 2014 Behavioral Risk Factor Surveillance System. J Stud Alcohol Drugs 2018; 78:861-866. [PMID: 29087820 DOI: 10.15288/jsad.2017.78.861] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Little is known regarding patterns of alcohol use and alcohol-related care among transgender adults. This study examined alcohol use and alcohol-related care across transgender status in a probability sample of U.S. adults. METHOD We conducted secondary analyses of the 2014 Behavioral Risk Factor Surveillance System survey, focusing on adults in eight states that administered both an Alcohol Screening and Brief Intervention module and a Gender Identity module (n = 58,381). Measurements included transgender status, sociodemographic characteristics, alcohol consumption (any alcohol use, risky drinking, heavy episodic drinking, and any unhealthy alcohol use), and alcohol-related care (alcohol screening during healthcare visits and advice about unhealthy alcohol use). We tested the association between transgender status and alcohol consumption and alcohol-related care using multivariable logistic regression models adjusted for sociodemographic characteristics. RESULTS Approximately 0.6% of respondents (n = 283) self-identified as transgender. Overall, there were no significant differences in alcohol consumption or screening between transgender and nontransgender adults. A greater proportion of transgender than nontransgender adults reported being advised to reduce alcohol use (20.7% vs. 7.8%, p = .012). However, this difference was not significant after adjusting for other sociodemographic characteristics (adjusted odds ratio = 2.31, 95% CI [0.91, 5.86], p = .077). CONCLUSIONS In this representative sample from eight U.S. states, we did not find differences related to transgender status in rates of alcohol use or of alcohol-related care.
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Affiliation(s)
- John R Blosnich
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Keren Lehavot
- Denver-Seattle Center of Innovation for Veteran-Centered Value-Driven Care, Veterans Affairs Puget Sound Health Services Research & Development, Seattle, Washington.,Department of Psychiatry and Behavioral Science, University of Washington, Seattle, Washington.,Department of Health Services, University of Washington, Seattle, Washington
| | - Joseph E Glass
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Emily C Williams
- Denver-Seattle Center of Innovation for Veteran-Centered Value-Driven Care, Veterans Affairs Puget Sound Health Services Research & Development, Seattle, Washington.,Department of Health Services, University of Washington, Seattle, Washington
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22
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Poteat T, Malik M, Scheim A, Elliott A. HIV Prevention Among Transgender Populations: Knowledge Gaps and Evidence for Action. Curr HIV/AIDS Rep 2018; 14:141-152. [PMID: 28752285 DOI: 10.1007/s11904-017-0360-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the available evidence-based HIV prevention interventions tailored for transgender people. RECENT FINDINGS A limited number of evidence-based HIV prevention interventions have been tested with transgender populations. Most existing interventions target behavior change among transgender women, with only one HIV prevention program evaluated for transgender men. Studies addressing biomedical interventions for transgender women are ongoing. Few interventions address social and structural barriers to HIV prevention, such as stigma, discrimination, and poverty. Evidence-based multi-level interventions that address the structural, biomedical, and behavioral risks for HIV among transgender populations, including transgender men, are needed to address disparities in HIV prevalence. Future research should address not only pre-exposure prophylaxis uptake and condom use but also structural barriers that limit access to these prevention strategies.
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Affiliation(s)
- Tonia Poteat
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E7138, Baltimore, MD, 21205, USA.
| | - Mannat Malik
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E7138, Baltimore, MD, 21205, USA
| | - Ayden Scheim
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, K201 Kresge Building, London, ON, N6B 3J6, Canada
| | - Ayana Elliott
- Director of Clinical Operations, City of Hope South Pasadena, 209 Fair Oaks Avenue, South Pasadena, CA, 91030, USA
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23
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Scheim AI, Bauer GR, Shokoohi M. Drug use among transgender people in Ontario, Canada: Disparities and associations with social exclusion. Addict Behav 2017; 72:151-158. [PMID: 28411424 DOI: 10.1016/j.addbeh.2017.03.022] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 03/16/2017] [Accepted: 03/29/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION We identified the prevalence and correlates of past-year illicit drug use among transgender people in Ontario, Canada, and disparities with the age-standardized non-transgender population. METHODS Data on transgender persons aged 16+ (n=406) were obtained from Trans PULSE, a respondent-driven sampling (RDS) survey (2009-2010). Overall and sex-specific estimates of past-year drug use (cocaine and amphetamines, based on data availability) in the reference population were obtained from Ontario residents aged 16+ (n=39, 980) in the Canadian Community Health Survey (2009-2010), and standardized to the overall and gender-specific transgender age distributions. For regression analyses with Trans PULSE data, past-year drug use included drug types associated with high risk of physical, psychological, and social harm to the user, and RDS-II weights were applied to frequencies and prevalence ratios (PR) derived from blockwise logistic regression models. RESULTS An estimated 12.3% (95% CI: 7.7, 17.0) of transgender Ontarians had used at least one of the specified drugs in the past year, with no significant difference by gender identity. Transgender Ontarians were more likely to use both cocaine (standardized prevalence difference; SPD=6.8%; 95% CI=1.6, 10.9) and amphetamines (SPD=SPD=1.3%, 95% CI=0.2, 3.1) as compared to the age-standardized non-transgender population. History of transphobic assault, homelessness or underhousing, and sex work were associated with greater drug use among transgender persons. CONCLUSIONS The prevalence of cocaine and amphetamine use among transgender people in Ontario, Canada was higher than in the age-standardized reference population. Social exclusion predicted within-group variation in drug use among transgender persons.
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Affiliation(s)
- Ayden I Scheim
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, K201 Kresge Building, London, ON N6A 5C1, Canada.
| | - Greta R Bauer
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, K201 Kresge Building, London, ON N6A 5C1, Canada
| | - Mostafa Shokoohi
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, K201 Kresge Building, London, ON N6A 5C1, Canada
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24
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Glynn TR, van den Berg JJ. A Systematic Review of Interventions to Reduce Problematic Substance Use Among Transgender Individuals: A Call to Action. Transgend Health 2017; 2:45-59. [PMID: 28861547 PMCID: PMC5549596 DOI: 10.1089/trgh.2016.0037] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Persons who are transgender (i.e., individuals who are assigned one sex at birth, but who do not identify with that sex) are at elevated risk for developing problematic substance use. Recent studies indicate that transgender persons have high rates of alcohol use, illicit drug use, and nonmedical use of prescription drugs and evince more severe misuse of these substances compared with nontransgender individuals. Despite the high rates of substance use among transgender persons and the multiple conceptual and narrative recommendations for substance use treatments, there is a lack of consensus or awareness of empirically tested interventions and programs effective for this population. Thus, it is critical to examine current substance use interventions for transgender individuals to identify gaps in the field and to immediately put forth efforts to reduce problematic substance use. This systematic review is the first to attempt a comprehensive identification and synthesis of the available evidence on interventions for reducing problematic substance use among transgender persons. Reflective of the state of the field regarding transgender care for substance use, we found a deficiency of studies to include in this systematic review (n=2). Perhaps the most important conclusion of this review is that well-designed, theoretically informed culturally sensitive research focused on developing and rigorously testing interventions for substance use among transgender individuals is alarmingly scarce. This review discusses barriers to intervention design and synthesizes treatment recommendations for future work.
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Affiliation(s)
- Tiffany R. Glynn
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
- Department of Psychology, University of Miami, Coral Gables, Florida
| | - Jacob J. van den Berg
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island
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