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Fedor J, Krywanczyk A, Redgrave A. Gender Identity in Forensic Death Investigation: A Narrative Review and Suggested Guidelines for Documenting and Reporting. Am J Forensic Med Pathol 2024; 45:231-241. [PMID: 38833352 DOI: 10.1097/paf.0000000000000946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
ABSTRACT In the current body of forensic literature, there is little guidance available regarding death investigations of transgender, intersex, and gender diverse individuals. An increase in the prevalence of gender diverse identifying people and the frequency in which these individuals experience a premature death makes it more likely these deaths will fall under the jurisdiction of the medical examiner's office. The inability to navigate these diverse cases due to a lack of training, education, and support may leave forensic professionals without the tools needed to accurately represent these deaths.This narrative review is intended to provide the foundational knowledge needed by forensic death investigators when investigating gender identity in death, including suggested guidelines for a more effective and empathetic death investigation. A better understanding of the implications and applications of this information when included in reports will bolster the quality and quantity of the data reported and collected. This will lead to more accurate monitoring and reporting of violent, suicidal, and homicidal deaths of transgender, intersex, and other gender diverse individuals, and a higher identification rate of unidentified remains with gender diverse markers.
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Affiliation(s)
- Juniper Fedor
- From the DeKalb County Medical Examiner's Office, Decatur, GA
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Sherman ADF, Peitzmeier S, Cimino AN, Balthazar M, Klepper M, Chand AT, Lawrence C, Allure K, Slink G, Campbell JC. Risks of Severe Assault and Intimate Partner Homicide among Transgender and Gender Diverse Intimate Partner Violence Survivors: Preliminary Findings from Community Listening Sessions. Violence Against Women 2024; 30:2767-2788. [PMID: 37132033 PMCID: PMC10620102 DOI: 10.1177/10778012231172700] [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] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Intimate partner violence (IPV) is an epidemic among transgender and gender diverse (TGD) people. However, intimate partner homicide (IPH) among TGD people is under researched. Thus, thematic content analysis was used to describe and examine antecedents of severe assault and IPH among TGD adults who have experienced IPV (N = 13), via community listening sessions. While some themes resembled known severe assault and IPH risks among cisgender women, several themes were unique to TGD people and should be considered when safety planning with TGD individuals or adapting IPV screening tools for this population.
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Affiliation(s)
| | - Sarah Peitzmeier
- University of Michigan School of Nursing, Department of Health Behavior and Biological Sciences, Ann Arbor, MI, USA
| | - Andrea N. Cimino
- Danger Assessment Training and Technical Assistance Center, Johns Hopkins University, Baltimore, MD, USA
| | - Monique Balthazar
- Nell Hodgson Woodruff School of Nursing at Emory University, Atlanta, GA, USA
- Georgia State University Byrdine F. Lewis College of Nursing and Health Professions, Atlanta, GA, USA
| | - Meredith Klepper
- Johns Hopkins School of Nursing at Johns Hopkins University, Baltimore, MD, USA
| | - Arzina T. Chand
- Georgia State University Byrdine F. Lewis College of Nursing and Health Professions, Atlanta, GA, USA
| | - Carissa Lawrence
- Johns Hopkins School of Nursing at Johns Hopkins University, Baltimore, MD, USA
| | | | - Grayson Slink
- Johns Hopkins School of Nursing at Johns Hopkins University, Baltimore, MD, USA
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3
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Wirtz AL, Poteat T, Borquez A, Linton S, Stevenson M, Case J, Brown C, Lint A, Miller M, Radix A, Althoff KN, Schneider JS, Haw JS, Wawrzyniak AJ, Rodriguez A, Cooney E, Humes E, Pontes C, Seopaul S, White C, Beyrer C, Reisner SL. Enhanced Cohort Methods for HIV Research and Epidemiology (ENCORE): Protocol for a Nationwide Hybrid Cohort for Transgender Women in the United States. JMIR Res Protoc 2024; 13:e59846. [PMID: 39190916 PMCID: PMC11387927 DOI: 10.2196/59846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/12/2024] [Accepted: 06/18/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND In the United States, transgender women are disproportionately impacted by HIV and prioritized in the national strategy to end the epidemic. Individual, interpersonal, and structural vulnerabilities underlie HIV acquisition among transgender women and fuel syndemic conditions, yet no nationwide cohort monitors their HIV and other health outcomes. OBJECTIVE Our objective is to develop a nationwide cohort to estimate HIV incidence, identify risk factors, and investigate syndemic conditions co-occurring with HIV vulnerability or acquisition among US transgender women. The study is informed by the Syndemics Framework and the Social Ecological Model, positing that stigma-related conditions are synergistically driven by shared multilevel vulnerabilities. METHODS To address logistical and cost challenges while minimizing technology barriers and research distrust, we aim to establish a novel, hybrid community hub-supported digital cohort (N=3000). The digital cohort is the backbone of the study and is enhanced by hubs strategically located across the United States for increased engagement and in-person support. Study participants are English or Spanish speakers, are aged ≥18 years, identify as transgender women or along the transfeminine spectrum, reside in 1 of the 50 states or Puerto Rico, and do not have HIV (laboratory confirmed). Participants are followed for 24 months, with semiannual assessments. These include a questionnaire and laboratory-based HIV testing using self-collected specimens. Using residential zip codes, person-level data will be merged with contextual geolocated data, including population health measures and economic, housing, and other social and structural factors. Analyses will (1) evaluate the contribution of hub support to the digital cohort using descriptive statistics; (2) estimate and characterize syndemic patterns among transgender women using latent class analysis; (3) examine the role of contextual factors in driving syndemics and HIV prevention over time using multilevel regression models; (4) estimate HIV incidence in transgender women and examine the effect of syndemics and contextual factors on HIV incidence using Poisson regression models; and (5) develop dynamic, compartmental models of multilevel combination HIV prevention interventions among transgender women to simulate their impact on HIV incidence through 2030. RESULTS Enrollment launched on March 15, 2023, with data collection phases occurring in spring and fall. As of February 24, 2024, a total of 3084 individuals were screened, and 996 (32.3%) met the inclusion criteria and enrolled into the cohort: 2.3% (23/996) enrolled at a hub, and 53.6% (534/996) enrolled through a community hub-supported strategy. Recruitment through purely digital methods contributed 61.5% (1895/3084) of those screened and 42.7% (425/996) of those enrolled in the cohort. CONCLUSIONS Study findings will inform the development of evidence-based interventions to reduce HIV acquisition and syndemic conditions among US transgender women and advance efforts to end the US HIV epidemic. Methodological findings will also have critical implications for the design of future innovative approaches to HIV research. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/59846.
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Affiliation(s)
- Andrea L Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
- Department of Public Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Tonia Poteat
- Division of Healthcare in Adult Populations, Duke University School of Nursing, Durham, NC, United States
| | - Annick Borquez
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, United States
| | - Sabriya Linton
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Megan Stevenson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - James Case
- Johns Hopkins School of Nursing, Baltimore, MD, United States
| | - Carter Brown
- National Black Transgender Advocacy Coalition, Carrolton, TX, United States
| | - Arianna Lint
- Arianna's Center, Fort Lauderdale, FL, United States
| | - Marissa Miller
- Trans Solutions Research and Resource Center, Indianapolis, IN, United States
| | - Asa Radix
- Callen-Lorde Community Health Center, New York, NY, United States
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jason S Schneider
- Division of General Internal Medicine, Department of Medicine, Emory University, Atlanta, GA, United States
| | - J Sonya Haw
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University, Atlanta, GA, United States
| | - Andrew J Wawrzyniak
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Allan Rodriguez
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Erin Cooney
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Elizabeth Humes
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Ceza Pontes
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Shannon Seopaul
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Camille White
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Chris Beyrer
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Sari L Reisner
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MD, United States
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Bell KM, Holmberg D, Chapman ZA. The Perils of the Unknown: Intolerance of Uncertainty and Intimate Partner Violence Across the First Four Pandemic Waves. JOURNAL OF INTERPERSONAL VIOLENCE 2024:8862605241270064. [PMID: 39169733 DOI: 10.1177/08862605241270064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
Theory suggests that intolerance of uncertainty (IU), a tendency to perceive uncertain events as threatening, may serve as a potential risk factor for increased intimate partner violence (IPV) perpetration; however, few studies have investigated this association, and none have taken a longitudinal approach. We investigated the issue in two longitudinal online investigations (initial N = 282 and 1,118), with time periods ranging from just before the COVID-19 pandemic to the fourth pandemic wave, approximately 1.5 years later. IU was a significant predictor of IPV cross-sectionally, and in the short term longitudinally (i.e., over periods of weeks); however, it did not predict IPV over the longer term (i.e., over periods of months or years). In addition, our longitudinal design allowed assessment of IPV trends across pandemic waves. Physical IPV rates remained low and steady across time. Psychological IPV rates showed an increase in the early days of the pandemic, but then dropped and stabilized, albeit at a somewhat higher rate than pre-pandemic. Study 2 had ample representation of LGBTQ+ respondents and showed that the patterns and processes worked similarly for LGBTQ+ and non-LGBTQ+ individuals.
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Leal AF, Cazeiro CC, Mattos ACE, Hentges B, Teixeira LB, Knauth DR, Magno L, Dourado I, Vera MADSM. Profile and experiences during the incarceration of transgender women and travestis (TGW) in Brazil: a cross-sectional study. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2024; 27Suppl 1:e240014.supl.1. [PMID: 39166586 PMCID: PMC11338535 DOI: 10.1590/1980-549720240014.supl.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 08/23/2024] Open
Abstract
OBJECTIVE The objective of the present study is to describe the sociodemographic and behavioral characteristics of a group of transgender women and travestis (TGW) with a history of incarceration and the institutional and social context of this experience in Brazil. METHODS The analyzed data were derived from the TransOdara Study, a cross-sectional study conducted in five Brazilian capitals from December 2019 to July 2021. Participants were recruited using the Respondent-Driven Sampling (RDS) technique, in which, after an initial formative and exploratory stage, the first participants were identified; in turn, these participants recruited up to six other transgender women and travestis for the research. The study's outcome was the experience of incarceration throughout life, captured through the question: "Have you ever been arrested in your life?" RESULTS A total of 1,245 TGW were interviewed, of which 20.3% (n=253) experienced incarceration. Incarceration was more frequent among those aged 33 to 42 years (35.6%), with lower level of education (45.5%, p<0.001), engaged in informal work (30.3%), without a partner (67.2%), and among those who reported illicit drug use (66.4%). The majority (60.9%) of TGW were incarcerated with cisgender men, and the most common reasons for imprisonment were drug trafficking (30.4%) followed by robbery (29.2%). Over a quarter of the interviewees (26.3%) experienced assault, and 13.8% reported experiencing sexual violence during incarceration. CONCLUSION The results emphasize the high prevalence of incarceration among TGW. This incarceration takes place in male wards and in a context of high rates of physical and sexual violence.
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Affiliation(s)
- Andréa Fachel Leal
- Universidade Federal do Rio Grande do Sul, Department of Sociology – Porto Alegre (RS), Brazil
| | - Cristine Coelho Cazeiro
- Universidade Federal do Rio Grande do Sul, Graduate Program in Epidemiology – Porto Alegre (RS), Brazil
| | | | - Bruna Hentges
- Universidade Federal do Rio Grande do Sul, Department of Sociology – Porto Alegre (RS), Brazil
| | | | - Daniela Riva Knauth
- Universidade Federal do Rio Grande do Sul, Department of Social Medicine – Porto Alegre (RS), Brazil
| | - Laio Magno
- Universidade do Estado da Bahia – Salvador (BA), Brazil
- Universidade Federal da Bahia – Salvador (BA), Brazil
| | - Inês Dourado
- Universidade Federal da Bahia – Salvador (BA), Brazil
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Hentges B, Martins RS, da Silva JDRP, Hübner DPG, Leal AF, Teixeira LB, Knauth DR, Veras MADSM. Lifetime sexual violence among transgender women and travestis (TGW) in Brazil: Prevalence and associated factors. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2024; 27Suppl 1:e240013.supl.1. [PMID: 39166585 PMCID: PMC11338532 DOI: 10.1590/1980-549720240013.supl.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 08/23/2024] Open
Abstract
OBJECTIVE To describe the prevalence, characteristics, and factors associated with sexual violence in transgender women and travestis (TGW) in Brazil. METHODS This cross-sectional study was conducted in five Brazilian cities (Campo Grande, Manaus, Porto Alegre, Salvador, and São Paulo) between 2019 and 2021. Participants were recruited using the respondent-driven sampling (RDS) technique. The outcome of interest is the self-reported experience of sexual violence throughout the respondents' lifetime. We evaluated the actions taken by victims of sexual violence and how they dealt with the experience. Logistic regression analysis was employed to examine the associations between sociodemographic and behavioral factors (such as race, income, drug use, sex work, and access to healthcare) and the outcome. RESULTS A total of 1,317 TGW were interviewed. Among them, 53% (n=698) reported experiencing sexual violence. For 64.4% (n=419) of the respondents, sexual violence occurred on more than one occasion. The majority of TGW did not seek health services (93.2%, n=648), disclose the violence (93.9%, n=653), nor seek support from family or friends (86.5%, n=601). A higher prevalence of sexual violence was associated with homelessness (adjusted prevalence ratio - aPR=1.69, 95% confidence interval - 95%CI 1.01-2.84), a history of engaging in sex work (aPR=2.04, 95%CI 1.46-2.85), self-reporting regular, bad, or very bad emotional health (aPR=1.67, 95%CI 1.28-2.19), and experiencing difficulties accessing health services in the previous year (aPR=2.78, 95%CI 1.74-4.43). CONCLUSION The high prevalence of sexual violence, analyzed together with the actions of the victims, indicates a context of high vulnerability and low institutional support. In this scenario, violence can be exacerbated, resulting in severe health consequences.
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Affiliation(s)
- Bruna Hentges
- Universidade Federal do Rio Grande do Sul, Postgraduate Program in Epidemiology –Porto Alegre (RS), Brazil
| | - Rafael Steffens Martins
- Universidade Federal do Rio Grande do Sul, Postgraduate Program in Epidemiology –Porto Alegre (RS), Brazil
| | | | | | - Andréa Fachel Leal
- Universidade Federal do Rio Grande do Sul, Department of Sociology – Porto Alegre (RS), Brazil
| | | | - Daniela Riva Knauth
- Universidade Federal do Rio Grande do Sul, Postgraduate Program in Epidemiology –Porto Alegre (RS), Brazil
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Heidari N, Naji SA, Abdullahzadeh M. Understanding Family Reactions to Transgender Children in Iranian Culture: A Qualitative Study. J Transcult Nurs 2024:10436596241271281. [PMID: 39152740 DOI: 10.1177/10436596241271281] [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: 08/19/2024] Open
Abstract
INTRODUCTION The family plays a crucial role in shaping children's identity and understanding of gender-based roles. This study aims to explore the experiences of Iranian transgender individuals with their families' reactions to their transgender identity disclosure. METHODS In 2018, nurse researchers conducted this qualitative study on 11 transgender individuals in Iran using a phenomenological approach, targeted and snowball sampling, and Colaizzi's seven-step method for data analysis. Rigor was ensured by adhering to Lincoln and Guba's standards. RESULTS The study found varied reactions to transgender children among Iranian families, including abuse to avoid stigma. The study revealed two main themes, maladaptive and adaptive reactions, and identified six categories: denial of reality, mourning, coercion, deprivation, support out of necessity, and compromise of family reactions. DISCUSSION Education and support systems may help address the cultural challenges that face families with transgender children. The findings offer insights for enhancing public awareness of the transgender community in conservative cultures.
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Kane D, Walshe J, Richardson D, Pucillo C, Noonan M, Maher S, Flood K, Eogan M. Storage of evidence and delayed reporting after sexual assault: Rates and impact factors on subsequent reporting. J Forensic Leg Med 2024; 106:102731. [PMID: 39128277 DOI: 10.1016/j.jflm.2024.102731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 07/09/2024] [Accepted: 07/23/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Sexual assault (SA) is alarmingly prevalent, yet reporting rates remain disproportionately low. Forensic examinations (FE) play a crucial role in both immediate medical care and evidence collection, yet many victims/survivors may not report the crime initially, leading to the loss of vital forensic evidence. The storage of evidence "Option 3″ care alternative provides post-SA care including FE without initial police involvement. METHODS This is a cross-sectional study analysing the attendances of people who chose to store evidence at the Dublin Sexual assault Treatment Unit (SATU) between January 1, 2017 and December 31, 2023. RESULTS There were 238 storage of evidence FEs ('Option 3') performed during the study period, which represented 12.8 % of all FEs. The majority identified as female (89.1 %), with an average age of 26.6 years. 31.9 % attended within 24 h of the incident, and 51.3 % self-referred. Most assaults occurred over weekends (64.7 %), with alcohol consumption reported in 82.2 % of cases and drug-facilitated SA concerns in 20.2 %. Genital injuries were present in 17.9 % of females and 19 % of males. Those that availed of storage of evidence (compared with those who initially reported to the police) were significantly more likely to have consumed alcohol (p < 0.001) and the assault was more likely to have occurred indoors (p = 0.002). There was no significant difference in care option choice for those 'unsure' of the assault occurrence (p = 0.353). Among storage of evidence cases, 20.2 % subsequently reported to the police, with females more likely to report (p = 0.02), while people who were uncertain whether an assault had occurred were less likely to report (p = 0.04). Genital injury (p = 0.822), victim-assailant relationship (p = 0.465), assault location (p = 0.487), and substance consumption (p = 0.332) did not significantly affect subsequent reporting rates. CONCLUSIONS The availability of storage of evidence has afforded people the opportunity to access prompt, responsive SATU care including collection of forensic evidence which may have significant evidential value. This approach provides further opportunity for comprehensive detection of a crime, even if reporting to the police is delayed.
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Affiliation(s)
- D Kane
- Department of Obstetrics & Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Parnell Square, Dublin 1, Ireland; Sexual Assault Treatment Unit, Rotunda Hospital, Dublin 1, Ireland.
| | - J Walshe
- Sexual Assault Treatment Unit, Rotunda Hospital, Dublin 1, Ireland
| | - D Richardson
- Sexual Assault Treatment Unit, Rotunda Hospital, Dublin 1, Ireland
| | - C Pucillo
- Sexual Assault Treatment Unit, Rotunda Hospital, Dublin 1, Ireland
| | - M Noonan
- Cork Sexual Assault Treatment Unit, South Infirmary Hospital, Cork, Ireland
| | - S Maher
- Cork Sexual Assault Treatment Unit, South Infirmary Hospital, Cork, Ireland
| | - K Flood
- Department of Obstetrics & Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Parnell Square, Dublin 1, Ireland
| | - M Eogan
- Department of Obstetrics & Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Parnell Square, Dublin 1, Ireland; Sexual Assault Treatment Unit, Rotunda Hospital, Dublin 1, Ireland
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Bhugra D, Liebrenz M, Ventriglio A, Ng R, Javed A, Kar A, Chumakov E, Moura H, Tolentino E, Gupta S, Ruiz R, Okasha T, Chisolm MS, Castaldelli-Maia J, Torales J, Smith A. World Psychiatric Association-Asian Journal of Psychiatry Commission on Public Mental Health. Asian J Psychiatr 2024; 98:104105. [PMID: 38861790 DOI: 10.1016/j.ajp.2024.104105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 04/22/2024] [Accepted: 05/31/2024] [Indexed: 06/13/2024]
Abstract
Although there is considerable evidence showing that the prevention of mental illnesses and adverse outcomes and mental health promotion can help people lead better and more functional lives, public mental health remains overlooked in the broader contexts of psychiatry and public health. Likewise, in undergraduate and postgraduate medical curricula, prevention and mental health promotion have often been ignored. However, there has been a recent increase in interest in public mental health, including an emphasis on the prevention of psychiatric disorders and improving individual and community wellbeing to support life trajectories, from childhood through to adulthood and into older age. These lifespan approaches have significant potential to reduce the onset of mental illnesses and the related burdens for the individual and communities, as well as mitigating social, economic, and political costs. Informed by principles of social justice and respect for human rights, this may be especially important for addressing salient problems in communities with distinct vulnerabilities, where prominent disadvantages and barriers for care delivery exist. Therefore, this Commission aims to address these topics, providing a narrative overview of relevant literature and suggesting ways forward. Additionally, proposals for improving mental health and preventing mental illnesses and adverse outcomes are presented, particularly amongst at-risk populations.
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Affiliation(s)
- Dinesh Bhugra
- Institute of Psychiatry, Psychology and Neurosciences, Kings College, London SE5 8AF, United Kingdom.
| | - Michael Liebrenz
- Department of Forensic Psychiatry, University of Bern, Bern, Switzerland
| | | | - Roger Ng
- World Psychiatric Association, Geneva, Switzerland
| | | | - Anindya Kar
- Advanced Neuropsychiatry Institute, Kolkata, India
| | - Egor Chumakov
- Department of Psychiatry & Addiction, St Petersburg State University, St Petersburg, Russia
| | | | | | - Susham Gupta
- East London NHS Foundation Trust, London, United Kingdom
| | - Roxanna Ruiz
- University of Francisco Moaroquin, Guatemala City, Guatemala
| | | | | | | | | | - Alexander Smith
- Department of Forensic Psychiatry, University of Bern, Bern, Switzerland
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Brown EE, Patel EU, Poteat TC, Mayer K, Wawrzyniak AJ, Radix AE, Cooney EE, Laeyendecker O, Reisner SL, Wirtz AL. Prevalence of Sexually Transmitted Infections Among Transgender Women With and Without HIV in the Eastern and Southern United States. J Infect Dis 2024; 229:1614-1627. [PMID: 38232978 PMCID: PMC11175699 DOI: 10.1093/infdis/jiad605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 10/31/2023] [Accepted: 01/04/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Data on the epidemiology of sexually transmitted infections (STIs) among transgender women (TGW) with and without human immunodeficiency virus (HIV) are limited. METHODS We analyzed baseline data collected from a cohort of adult TGW across 6 eastern and southern US cities between March 2018 and August 2020 (n = 1018). Participants completed oral HIV screening, provided self-collected rectal and urogenital specimens for chlamydia and gonorrhea testing, and provided sera specimens for syphilis testing. We assessed associations with ≥1 prevalent bacterial STI using modified Poisson regression. RESULTS Bacterial STI prevalence was high and differed by HIV status: 32% among TGW with HIV and 11% among those without HIV (demographic-adjusted prevalence ratio = 1.91; 95% confidence interval = 1.39-2.62). Among TGW without HIV, bacterial STI prevalence differed by geographic region, race and ethnicity, and gender identity, and was positively associated with reporting >1 sexual partner, hazardous alcohol use, homelessness, having safety concerns regarding transit to health care, and no prior receipt of gender-affirming health services. Among TGW with HIV, older age was inversely associated with bacterial STI. CONCLUSIONS TGW had a high prevalence of bacterial STIs. The prevalence and correlates of bacterial STI differed by HIV status, highlighting the unique needs and risks of TGW with and without HIV. Tailored interventions may reduce sexual health-related inequities.
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Affiliation(s)
- Erin E Brown
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Baltimore, Maryland, USA
| | - Eshan U Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tonia C Poteat
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kenneth Mayer
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew J Wawrzyniak
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Asa E Radix
- Callen-Lorde Community Health Center, New York, New York, USA
| | - Erin E Cooney
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Oliver Laeyendecker
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Baltimore, Maryland, USA
| | - Sari L Reisner
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Andrea L Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Eustaquio PC, Olansky E, Lee K, Marcus R, Cha S. The Association Between Sexual Violence and Suicidal Ideation Among Transgender Women and the Role of Gender-Affirming Healthcare Providers in Seven Urban Areas in the United States, 2019 to 2020. JOURNAL OF INTERPERSONAL VIOLENCE 2024:8862605241257592. [PMID: 38842225 DOI: 10.1177/08862605241257592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Transgender women are disproportionately affected by sexual violence and corresponding mental health sequelae; however, many do not access healthcare due to experiences with transphobia. This analysis evaluated the association between sexual violence and suicidal ideation and the moderating effect of having a healthcare provider (HCP) with whom transgender women were comfortable discussing gender-related issues ("gender-affirming HCP"). We analyzed cross-sectional data from the Centers for Disease Control and Prevention's National HIV Behavioral Surveillance among Transgender Women (NHBS-Trans). Transgender women were recruited using respondent-driven sampling from seven urban areas from 2019 to 2020 and participated in an HIV biobehavioral survey. This analysis was restricted to transgender women who visited a HCP in the past 12 months ("healthcare-seeking transgender women" [HSTW]) (N = 1,489). Log-linked Poisson regression models provided adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) to estimate the association between sexual violence and suicidal ideation in the past 12 months. The interaction between sexual violence and having a gender-affirming HCP was statistically significant (p-value = .034). Among 1,489 HSTW, 225 (15.1%) experienced sexual violence and 261 (17.5%) reported suicidal ideation; 1,203 (80.8%) reported having a gender-affirming HCP. Sexual violence was associated with suicidal ideation (aPR = 2.65, 95% CI [2.08, 3.38]); the association was notably higher among those who did not have a gender-affirming HCP (aPR = 3.61, [2.17, 6.02]) than among those who did (aPR = 1.87, [1.48, 2.37]). Eliminating transphobia and promoting trauma- and violence-informed approaches in healthcare are necessary for sexual violence and suicide prevention among HSTW.
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Affiliation(s)
- Patrick C Eustaquio
- Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Evelyn Olansky
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kathryn Lee
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ruthanne Marcus
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susan Cha
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Closson K, Boyce SC, Johns N, Inwards-Breland DJ, Thomas EE, Raj A. Physical, Sexual, and Intimate Partner Violence Among Transgender and Gender-Diverse Individuals. JAMA Netw Open 2024; 7:e2419137. [PMID: 38916887 PMCID: PMC11200137 DOI: 10.1001/jamanetworkopen.2024.19137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 04/26/2024] [Indexed: 06/26/2024] Open
Abstract
Importance Transgender and gender-diverse (TGD) communities experience disproportionate levels of violence, yet due to limitations in measuring TGD identity, few state-representative estimates are available. Objective To assess gender identity differences in experiences of violence among adults. Design, Setting, and Participants Cross-sectional data from the 2023 California Violence Experiences (CalVEX) survey, weighted to provide state-representative estimates, was used to assess associations between gender identity and past-year experiences of violence among adults 18 years and older. Data were analyzed from June to December 2023. Exposure Gender identity (cisgender women, cisgender men, transgender women, transgender men, and nonbinary individuals). Main Outcomes and Measures Experience of physical violence (including physical abuse and threat or use of a weapon), sexual violence (verbal sexual harassment, homophobic or transphobic slurs, cyber and physically aggressive sexual harassment, and forced sex), and intimate partner violence (IPV; emotional, physical, or sexual violence) using age-adjusted logistic regression. Results In total 3560 individuals (weighted cumulative response rate, 5%) completed the 2023 CalVEX survey, with 1978 cisgender women, 1431 cisgender men, 35 transgender women, 52 transgender men, and 64 nonbinary respondents (mean [SD] age, 47.1 [17.5] years; 635 [17%] were Asian, 839 [37%] were Hispanic, and 1159 [37%] were White). Past-year physical violence was reported by 22 transgender men (43%), 9 transgender women (24%), and 9 nonbinary respondents (14%). Past-year sexual violence was reported by 23 transgender men (42%), 11 transgender women (14%), and 31 nonbinary respondents (56%). Compared with cisgender women, transgender women and transgender men had greater risk of past-year physical violence (any form) (transgender women adjusted incidence rate ratio [AIRR], 6.7; 95% CI, 2.5-18.2; transgender men AIRR, 9.7; 95% CI, 5.3-17.7), as well as past-year IPV (any form) (transgender women AIRR, 3.2; 95% CI, 1.3-8.0; transgender men AIRR, 6.7; 95% CI, 4.0-11.3). Relative to cisgender women, transgender men (AIRR, 3.0; 95% CI, 1.7-5.1) and nonbinary respondents (AIRR, 3.3; 95% CI, 2.1-5.2) had greater risk of past-year sexual violence (any form). Conclusions and Relevance In this survey study of adults in California, results showed that TGD individuals, especially transgender men, are at higher risk of experiencing all forms of violence relative to cisgender women. Results highlight the need for gender-affirming violence prevention and intervention services as well as policies that protect TGD individuals from discriminatory violence.
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Affiliation(s)
- Kalysha Closson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Center on Gender Equity and Health, University of California, San Diego
| | | | - Nicole Johns
- Center on Gender Equity and Health, University of California, San Diego
| | | | | | - Anita Raj
- Center on Gender Equity and Health, University of California, San Diego
- Newcomb Institute, Tulane University, New Orleans, Louisiana
- Tulane School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
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13
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Chan RCH, Suen YT, Leung JSY. Gender identity differences in the experiences of family stressors and violence among transgender and non-binary individuals in China. FAMILY PROCESS 2024; 63:1046-1067. [PMID: 38169124 DOI: 10.1111/famp.12958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/30/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024]
Abstract
Emerging research has demonstrated that transgender and non-binary (TNB) individuals face an elevated risk of experiencing family rejection and violence. However, there remains a significant knowledge gap regarding how TNB individuals manage stressors and their gender identity within the family context, particularly in regions where TNB individuals are highly stigmatized and where legal protections against family violence are lacking. The present study represents one of the first pioneering efforts to provide large-scale quantitative data examining the experiences of family stressors, the management of gender identity and expression, and family violence among TNB individuals in China. A national sample of 1063 TNB individuals in China was involved in the study. They completed questionnaires about their experiences of family stressors and violence. The results indicated that 76.0% of TNB individuals reported having encountered at least one form of violence perpetrated by their family members. Transfeminine individuals were more likely to report experiencing emotional and physical abuse, whereas transmasculine individuals were more likely to be subjected to gender identity and/or expression change efforts. Family stressors, including family non-acceptance and the pressure to marry and reproduce, were positively associated with non-disclosure of gender identity, the suppression of gender expression, and family violence. The findings underscore the substantial burden of family violence borne by TNB individuals in China, which warrants immediate legal, institutional, and social responses. Trans-inclusive family violence prevention and intervention are urgently needed, with a focus on Chinese cultural factors and gender identity differences in violence screening and risk assessment.
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Affiliation(s)
- Randolph C H Chan
- Department of Social Work, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yiu Tung Suen
- Gender Studies Programme, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Janice Sin Yu Leung
- Gender Studies Programme, The Chinese University of Hong Kong, Shatin, Hong Kong
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14
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Tubman JG, Lee J, Moore C. Factors Associated with Sexual Victimization Among Transgender Emerging Adults. JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:2832-2852. [PMID: 38158817 DOI: 10.1177/08862605231221836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
This cross-sectional study documented between-group differences in risk factors associated with sexual victimization histories in an ethnically and racially diverse sample of transgender emerging adults (N = 248, ageM = 22.61 years). The sample was recruited using the Internet-based CloudResearch platform to answer questionnaires assessing predictors for recent experiences of intimate partner violence (IPV). Participants were categorized into four groups based on cross-classified self-reports of child sexual abuse (CSA) and recent sexual IPV, prior to the use of multivariate analysis of variance to evaluate mean score differences for past-year substance use, minority stressor, and relationship functioning variables. Participants reporting sexual IPV reported higher scores for all substance use variables, while transfeminine participants reported significantly higher scores for alcohol use problems and negative consequences related to substance use. Participants reporting both CSA and sexual IPV also reported the highest scores for everyday discrimination. Participants who experienced sexual IPV also reported the highest scores for internalized sexual stigma. Sexual revictimization among transgender adults occurs in the context of harmful patterns of substance use and several minority stressors. Our findings have implications for healthcare or counseling services for transgender emerging adults who have experienced multiple forms of victimization, substance use problems, and minority stressors, including the importance of trauma-informed and integrated intervention services, and specialized training for service providers.
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15
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Avalos S. A Comparative Content Analysis of the News Media Framing of Trans Homicide Between Trans Men and Trans Women in the U.S. from 2016 to 2022. JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:2602-2628. [PMID: 38149587 DOI: 10.1177/08862605231220014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Recently, the media's coverage of trans homicides has increased in the U.S. Studies show that the news media's framing has been largely negative but has improved in recent times. Yet, research has mostly analyzed the news media's framing of victims who were trans women, thus limiting our understanding of this issue across different trans groups. The present study employs a mixed method approach to comparatively analyze articles (N = 124) published in online news media outlets of 15 trans men and 15 trans women murdered between 2016 and 2022. The findings indicate news media outlets used more positive and neutral frames than negative for both groups. However, when compared to trans women, trans men were delegitimized at higher rates. These findings highlight the ways that the police, news media, family, friends, and community members simultaneously contribute to the humanization and delegitimization of trans victims of homicide, demonstrating the importance of ensuring all information released about the victims correctly reflects who they were, or the cycle of delegitimization will continue. By studying how the news media frames trans homicide victims, we can look at how the media shapes cultural beliefs and ideologies about trans people, the role of language in reinforcing stereotypes, and the implications of these framings for trans people.
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16
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Daigle LE, Felix SN, Muñoz RB, Hancock KP, Oesterle DW, Gilmore AK. Examining the Risks of Multiple Types of Interpersonal Victimization for Transgender and Gender Non-Conforming College Students. JOURNAL OF INTERPERSONAL VIOLENCE 2024:8862605241254139. [PMID: 38804546 DOI: 10.1177/08862605241254139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Recent research has shown that transgender and gender non-conforming (TGNC) individuals are at risk of experiencing interpersonal violence, yet there may be differences within this group and across victimization types. The current study examined rates of seven types of interpersonal victimization based on six gender identities (cisgender women, cisgender men, trans women, trans men, nonbinary, and another identity) among a national study of college students. Data from the Spring 2021 American College Health Association's National College Health Assessment III (ACHA-NCHA III), a national-level study of U.S. college students, were used. We examined the association between gender identity and seven types of interpersonal violence victimization (violent victimization, sexual victimization, intimate partner violence victimization, stalking, bullying, microaggression, and discrimination) that occurred within the past 12 months. Logistic regression analyses were performed to examine if, when controlling for competing factors, gender identity was associated with an increase in the expected odds of victimization for each victimization type. Analyses revealed that TGNC college students reported experiencing a greater amount of all seven types of victimization compared to cisgender college students. These findings corroborate previous research indicating that rates of interpersonal violence are higher among TGNC college students compared to those who identify as cisgender, even after controlling for sexual orientation, related demographic factors, and substance use. Findings from the current study suggest that there are differences within individuals who identify as TGNC in terms of their risk for interpersonal victimization and that rates differ across victimization types. More work is needed to provide tailored prevention programming for TGNC college students.
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17
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Stöckl H, Sorenson SB. Violence Against Women as a Global Public Health Issue. Annu Rev Public Health 2024; 45:277-294. [PMID: 38842174 DOI: 10.1146/annurev-publhealth-060722-025138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Violence against women, especially intimate partner violence, is recognized as a global public health issue due to its prevalence and global reach. This article outlines the scope of the issue, with respect to its prevalence, health outcomes, and risk factors, and identifies key milestones that led to its global recognition: methodological and data advances, acknowledgment as a criminal justice and health issue, support by the global women's movement, and the robust evidence demonstrating that intimate partner violence is preventable. Key issues for the future include recognition and consideration of intersectionality in research, improvements in the measurement of other forms of violence against women, and the need to scale up prevention efforts that have documented success. Violence against women is an urgent priority as it affects individuals, their families and surroundings, and the entire global health community.
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Affiliation(s)
- Heidi Stöckl
- Institute for Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität in Munich, Munich, Germany;
- Pettenkofer School of Public Health, Munich, Germany
| | - Susan B Sorenson
- School of Social Policy & Practice; Program in Health & Sciences, School of Arts & Sciences; and Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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18
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Goodman-Williams R, Volz J, Fishwick K. Reasons for Not Reporting Among Sexual Assault Survivors Who Seek Medical Forensic Exams: A Qualitative Analysis. JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:1905-1925. [PMID: 37970805 PMCID: PMC10993628 DOI: 10.1177/08862605231211926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
After a sexual assault, survivors have the option of seeking a medical forensic exam, which includes medical evaluation and treatment, as well as forensic evidence collection. Forensic evidence is collected in a sexual assault evidence kit (SAEK) and typically released to police to aid in the investigation and potential prosecution of the assault. However, 20% to 25% of survivors who have a SAEK collected do not report their assault to police at that time and choose instead to have their SAEK stored for possible future use. This study sought to understand the reasons for not reporting among this group of survivors. We examined medical records of 296 individuals aged 18 and older who had documented their reasons for not reporting to police in their medical record and used a non-theory-driven coding framework to conduct a reflexive thematic analysis based on that data. We identified four themes: Reporting Won't Help, Reporting Will Harm, Not Now, and Not What I'm Here For. These data illustrate that survivors are making an active choice which, for many, was based on concerns that reporting would not meaningfully help their situation or may even make their situations worse. For some survivors, the decision to have forensic evidence collected without a police report was based on their needs at that moment, whereas for other survivors it was based on their desire to move on from the assault more permanently. Practice and policy recommendations are discussed, including the importance of providing survivors information about what police reporting would look like in specific circumstances as well as ensuring that financial concerns are not a barrier to survivors receiving post-assault medical care without forensic evidence collection.
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Affiliation(s)
| | - Jessica Volz
- Adventist HealthCare Shady Grove Medical Center, Rockville, MD, USA
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19
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Katz-Wise SL, Sarda V, Line EC, Marchwinski B, Budge SL, Godwin EG, Moore LM, Ehrensaft D, Rosal MC, Thomson KA. Longitudinal Family Functioning and Mental Health in Transgender and Nonbinary Youth and Their Families. JOURNAL OF CHILD AND FAMILY STUDIES 2024; 33:1321-1335. [PMID: 39220671 PMCID: PMC11361712 DOI: 10.1007/s10826-023-02738-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 09/04/2024]
Abstract
This study examined concordance of family members' perspectives of family functioning and mental health across two years in families with transgender and/or nonbinary youth (TNBY). Participants were 89 family members (30 TNBY, age 13-17 years; 44 cisgender caregivers; 15 cisgender siblings, age 14-24 years) from 30 families from the U.S. New England region. Family members completed an online survey every 6-8 months for 5 waves between December 2015 and Feb 2019. Surveys assessed family functioning (quality of communication, satisfaction with family) and the following mental health-related outcomes: depression and anxiety symptoms, non-suicidal self-injury, suicidality, self-esteem, and resilience. Analyses tested concordance of family functioning and mental health across family members. Reports of family functioning changed over time, and family members were not consistently concordant in their reports of family functioning. Caregivers perceived a higher quality family communication than TNBY at all waves and higher than siblings at some waves. Perceptions of family satisfaction did not show a clear pattern between family member types across waves. The greatest concordance of perceived family functioning was between caregivers and siblings and between TNBY and siblings. Across all waves, TNBY reported more severe depression and anxiety symptoms than their caregivers and siblings, and more non-suicidal self-injury than their siblings. Compared to siblings, TNBY reported higher self-esteem, but less resilience. This study highlights opportunities for intervention in clinical work with TNBY and their families. Providers working with families with TNBY should use family systems approaches to support the mental health of all family members.
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Affiliation(s)
- Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Vishnudas Sarda
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Emmett C Line
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Teachers College, Columbia University, New York, NY, USA
| | - Breana Marchwinski
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Stephanie L Budge
- Department of Counseling Psychology, University of Wisconsin - Madison, Madison, WI, USA
| | - Eli G Godwin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Lb M Moore
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Diane Ehrensaft
- Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Milagros C Rosal
- Department of Population and Quantitative Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Katharine A Thomson
- Department of Psychology, BC Children's Hospital, Vancouver, BC, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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Kennedy AC, Prock KA, Adams AE, Littwin A, Meier E, Saba J, Vollinger L. Can This Provider Be Trusted? A Review of the Role of Trustworthiness in the Provision of Community-Based Services for Intimate Partner Violence Survivors. TRAUMA, VIOLENCE & ABUSE 2024; 25:982-999. [PMID: 37132638 DOI: 10.1177/15248380231168641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
While there is a growing literature on intimate partner violence (IPV) survivors and service providers, it is limited by its largely atheoretical and descriptive nature, and its emphasis on individual-level survivors' help-seeking. We seek to broaden our understanding by shifting the focus onto organizations and service systems and introducing the concept of these providers' trustworthiness toward survivors. Provider trustworthiness in delivering services includes benevolence (locally available and caring), fairness (accessible to all and non-discriminatory), and competence (acceptable and effective in meeting survivors' needs). Guided by this conceptualization, we conducted an integrative review drawing on four databases: PsycINFO, PubMed, Web of Science, and Westlaw. We identified studies for inclusion that were published between January 2005 and March 2022, and we examined the trustworthiness of community-based providers serving adult IPV survivors in the United States, including domestic violence services, health and mental health care, the legal system, and economic support services (N = 114). Major findings include (1) many survivors live in communities with no shelter beds, mental health care, or affordable housing; (2) many services are inaccessible because they lack, for example, bilingual staff, sliding fees, or telehealth options; (3) too many providers are harmful or discriminatory toward survivors, especially those who are, for example, sexual or gender minorities, immigrants or non-English-speaking, poor, or Native, Black, or Latinx; (4) many providers appear to be incompetent, lack evidence-based training, and are ineffective in meeting survivors' needs. We call on researchers, advocates, and providers to examine provider trustworthiness, and we offer an introduction to measuring it.
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de Sousa Mascena Veras MA, Menezes NP, Mocello AR, Leddy AM, Saggese GSR, Bassichetto KC, Gilmore HJ, de Carvalho PGC, Maschião LF, Neilands TB, Sevelius J, Lippman SA. Correlation between gender-based violence and poor treatment outcomes among transgender women living with HIV in Brazil. BMC Public Health 2024; 24:791. [PMID: 38481195 PMCID: PMC10938823 DOI: 10.1186/s12889-024-18224-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Transgender women are disproportionately affected by both HIV and gender-based violence (GBV), defined as physical, sexual, or emotional violence perpetrated against an individual based on their gender identity/expression. While a growing body of evidence demonstrates that GBV leads to poor HIV care and treatment outcomes among cisgender women, less research has examined this association among transgender women. We assessed the impact of lifetime experiences of GBV on subsequent retention in HIV care and laboratory confirmed viral suppression among a sample of transgender women living with HIV (TWH) in Brazil. METHODS A pilot trial of a peer navigation intervention to improve HIV care and treatment among TWH was conducted in São Paulo, Brazil between 2018 and 2019. TWH were recruited and randomized into the intervention or control arm and participated in a baseline and 9-month follow-up survey and ongoing extraction of clinical visit, prescribing, and laboratory data. Generalized linear model regressions with a Poisson distribution estimated the relative risk (RR) for the association of lifetime physical and sexual violence reported at baseline with treatment outcomes (retention in HIV care and viral suppression) at follow-up, adjusting for baseline sociodemographic characteristics. RESULTS A total of 113 TWH participated in the study. At baseline, median age was 30 years, and the prevalence of lifetime physical and sexual violence was 62% and 45%, respectively. At follow-up, 58% (n = 66/113) were retained in care and 35% (n = 40/113) had evidence of viral suppression. In adjusted models, lifetime physical violence was non-significantly associated with a 10% reduction in retention in care (aRR: 0.90, 95% CI: 0.67, 1.22) and a 31% reduction in viral suppression (aRR: 0.69; 95% CI: 0.43, 1.11). Lifetime sexual violence was non-significantly associated with a 28% reduction in retention in HIV care (aRR: 0.72, 95% CI: 0.52, 1.00) and significantly associated with a 56% reduction in viral suppression (aRR: 0.44; 95% CI: 0.24, 0.79). CONCLUSION Our findings are among the first to demonstrate that lifetime experiences with physical and sexual violence are associated with poor HIV outcomes over time among transgender women. Interventions seeking to improve HIV treatment outcomes should assess and address experiences of GBV among this population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03525340.
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Affiliation(s)
| | - Neia Prata Menezes
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Adrienne Rain Mocello
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Anna M Leddy
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Gustavo Santa Roza Saggese
- Department of Collective Health, Santa Casa School of Medical Sciences, São Paulo, Brazil
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | | | - Hailey J Gilmore
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | | | - Luca Fasciolo Maschião
- Department of Collective Health, Santa Casa School of Medical Sciences, São Paulo, Brazil
| | - Torsten B Neilands
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Jae Sevelius
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Sheri A Lippman
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
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Li J, Jin Y, Xu S, Wilson A, Chen C, Wang Y. The influence of the severity of gender dysphoria on anxiety, depression, suicidal ideation, and non-suicidal self-injury in Chinese transgender, nonbinary, and gender-diverse youth. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2024; 25:456-470. [PMID: 39055632 PMCID: PMC11268234 DOI: 10.1080/26895269.2023.2273360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Background: Gender dysphoria (GD) is frequently reported among transgender, nonbinary, and gender-diverse (TNG) populations, and is closely related to anxiety, depression, suicidal ideation, and non-suicidal self-injury (NSSI). This study aimed to understand how GD influences the four mental health disparities among TNG youth, and to compare these outcomes depending on the severity of GD. Methods: 96,218 College students participated in the survey, of which the analysis was run on an extracted sub-set data of 2,315 (2.40%) TNG youth, with a mean age of 19.46 (SD = 1.52). Self-reported inventories measured sociodemographic factors, the severity of GD (Utrecht Gender Dysphoria Scale-Gender Spectrum), anxiety (seven-item Generalized Anxiety Disorder Questionnaire), depression (nine-item Patient Health Questionnaire), suicidal ideation (Suicidal Behaviors Questionnaire-Revised), and NSSI (Clinician-Rated Severity of Non-Suicidal Self-Injury Scale). Binary logistic regression assessed the association between significant GD and the four psychiatric disorders. Adjusted multiple logistic regression, and directed acyclic graph (DAG) analyses were conducted to explore the activating relationship among GD, sociodemographic factors, and psychiatric disorders. Results: 1,582 (68.30%) TNG youth who experienced significant levels of GD (total scores cutoff >= 46) were entered into the analyses. Binary logistic regression displayed significantly positive associations between significant GD and anxiety, depression, suicidal ideation, and NSSI. Multiple regression models showed risk factors included poor relationship with one's father/mother, tobacco smoking, alcohol consumption, and having a lower subjective social status. While family harmony, a higher father's educational level, and partaking in exercise were protective factors that exerted distinct impacts on these four psychiatric disorders. DAG findings showed a poor relationship with one's father with significant GD via other socio-demographic characteristics, activated psychiatric disorders. Conclusions: TNG youth with higher levels of GD also exhibited more severe anxiety, depression, suicidal ideation, and NSSI. Tailored interventions should be provided to prioritize relieving those with severe GD to protect TNG youth from psychiatric outcomes further.
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Affiliation(s)
- Jiaqi Li
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Yu Jin
- College of Education for the Future, Beijing Normal University, Beijing, China
| | - Shicun Xu
- Northeast Asian Research Center, Jilin University, Changchun, China
- China Center for Aging Studies and Social-Economic Development, Jilin University, Changchun, China
- Department of Population, Resources, and Environment, Northeast Asian Studies College, Jilin University, Changchun, China
| | - Amanda Wilson
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Chang Chen
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Yuanyuan Wang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
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Olaseni AO, Oguntayo R, Nel JA. Mediating role of emotional suppression in the relationship between psychological factors and intimate partner violence among couples with mixed-romantic orientations. Int J Inj Contr Saf Promot 2024; 31:38-47. [PMID: 37724445 DOI: 10.1080/17457300.2023.2258505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/10/2023] [Indexed: 09/20/2023]
Abstract
Intimate partner violence (IPV) is considered a serious public health concern among couples, regardless of the sexual orientation. However, there is a dearth of data about the determining factors of IPV among couples with mixed-romantic orientations, and not much is known about the role that intra-psychic factors play in the relationship between psychological factors and IPV. Therefore, the study set out to examine the mediating role of emotional suppression in the relationship between psychological factors and IPV among couples with mixed-romantic orientations in Nigeria. The study adopted a correlational research design. A total of 241 respondents (61.4% identified as heterosexual and 38.6% as bisexual) in mixed-romantic orientation marriages, were engaged using respondents-driven sampling. Outcomes revealed that emotional suppression (indirectly) mediated the relationship between depressive symptoms [c'-path analysis; b = .029, t(240) = 108, p = <.01; bootstrap =.0573-1715], anxiety [c'-path analysis; b = .027, t(240) = -0.044, p = <.05; bootstrap = .108-.004], stress [c'-path analysis; b = 0.019, t(240) = 0.057, p = <.001; bootstrap = .0247-.0992] and IPV among couples with mixed-romantic orientations. It was concluded that emotional suppression directly and indirectly mediated the relationship between psychological factors and IPV. Recommendations and limitations are discussed.
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Affiliation(s)
- A O Olaseni
- Department of Psychology, College of Human Sciences, University of South Africa (UNISA), Pretoria, South Africa
| | - R Oguntayo
- Department of Psychology, Institute of Social Sciences and Administrations, Universidad Autonoma de Ciudad Juarez, Juarez, Mexico
| | - J A Nel
- Department of Psychology, College of Human Sciences, University of South Africa (UNISA), Pretoria, South Africa
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Puckett JA, Hanson C, Dunn T, Kuehn K, DuBois LZ. An Examination of Predictors of Prejudice Against Transgender Individuals. JOURNAL OF HOMOSEXUALITY 2024; 71:645-665. [PMID: 36250958 DOI: 10.1080/00918369.2022.2131130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
We examined associations between prejudice toward transgender people, aggression proneness, history of family violence, contact and closeness with transgender people, and education about issues that impact transgender individuals. We also examined the moderating effects of contact, education, and closeness on the relations between aggression and history of family violence with prejudice. There were 360 participants (M age = 31.34, SD = 12.47, range 18-75) who completed the survey online. Participants were recruited through social media, websites, and MTurk. Higher levels of aggression proneness were related to higher levels of prejudice. Higher levels of education about issues that impact transgender people and prior contact with a transgender person were associated with less prejudice. In a multiple regression analysis, the strongest predictor of prejudice was education about transgender people and topics. Moderation analyses revealed that prior contact may buffer the effects of aggression proneness on prejudiced beliefs.
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Affiliation(s)
- Jae A Puckett
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - Cylie Hanson
- School of Education, University of South Dakota, Vermillion, South Dakota, USA
| | - Terra Dunn
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - Kelsi Kuehn
- Department of Anthropology, University of Oregon, Eugene, Oregon, USA
| | - L Zachary DuBois
- Department of Anthropology, University of Oregon, Eugene, Oregon, USA
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Sinko L, Ghazal LV, Fauer A, Wheldon CW. It takes more than rainbows: Supporting sexual and gender minority patients with trauma-informed cancer care. Cancer 2024; 130:507-516. [PMID: 38009962 PMCID: PMC11132316 DOI: 10.1002/cncr.35120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND/PURPOSE The American Society of Clinical Oncology has called for an increased priority to improve cancer care for sexual and gender minority (SGM) populations because of heightened risk of receiving disparate treatment and having suboptimal experiences, including perceived discrimination. We demonstrate how integrating trauma-informed care (TIC) principles across the cancer continuum is a key strategy to improving care delivery and outcomes among SGM populations. METHOD This empirically informed perspective expands on the concepts generated through the American Society of Clinical Oncology position statement and uses the Substance Abuse and Mental Health Services Association's "Four Rs" Toward Trauma Informed Care: Realize, Recognize, Response, and Resist Traumatization. RESULTS Recommendations for each component of TIC include: (1) Realize: Implement SGM cultural humility training, including modules on SGM-specific trauma, discrimination, harassment, and violence; (2) Recognize: Routinely screen for emotional distress using methods to ensure privacy, and/or normalize mental health screenings to cancer patients; (3) Respond: Create and widely disseminate policies and patients' rights that prohibit discrimination and ensure access to gender-neutral clinical environments; and (4) Resist Traumatization: Establish and respond to quality metrics (e.g., standardized patients, patient satisfaction surveys) that are informed by a community advisory board with the purpose of ensuring and maintaining quality care. CONCLUSIONS AND IMPLICATIONS Integrating TIC principles into cancer care for SGM populations is crucial to address disparities in treatment and clinical outcomes. Our recommendations offer practical approaches for oncology teams to implement TIC care and ensure equitable and inclusive cancer care for patients and their families.
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Affiliation(s)
- Laura Sinko
- Department of Nursing, Temple University College of Public Health, Philadelphia, Pennsylvania, USA
| | - Lauren V Ghazal
- University of Rochester School of Nursing and Wilmot Cancer Institute, Rochester, New York, USA
| | - Alex Fauer
- Betty Irene Moore School of Nursing at UC Davis, Sacramento, California, USA
- UC Davis Comprehensive Cancer Center, Sacramento, California, USA
| | - Christopher W Wheldon
- Department of Social & Behavioral Sciences, Temple University College of Public Health, Philadelphia, Pennsylvania, USA
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Eustaquio PC, Olansky E, Lee K, Marcus R, Cha S. Social Support and the Association Between Certain Forms of Violence and Harassment and Suicidal Ideation Among Transgender Women - National HIV Behavioral Surveillance Among Transgender Women, Seven Urban Areas, United States, 2019-2020. MMWR Suppl 2024; 73:61-70. [PMID: 38261633 PMCID: PMC10826681 DOI: 10.15585/mmwr.su7301a7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
Violence and harassment toward transgender women are associated with suicidal thoughts and behaviors, and social support might moderate such association. This analysis explored the association between certain forms of violence and harassment and suicidal ideation and moderation by social support. Better understanding of these associations could guide mental health services and structural interventions appropriate to lived experiences of transgender women. This cross-sectional analysis used data from CDC's National HIV Behavioral Surveillance Among Transgender Women. During 2019-2020, transgender women were recruited via respondent-driven sampling from seven urban areas in the United States for an HIV biobehavioral survey. The association between experiencing certain forms of violence and harassment (i.e., gender-based verbal and physical abuse or harassment, physical intimate partner abuse or harassment, and sexual violence) and suicidal ideation was measured using adjusted prevalence ratios and 95% CIs generated from log-linked Poisson regression models controlling for respondent-driven sampling design and confounders. To examine moderation, the extents of social support from family, friends, and significant others were assessed for interaction with certain forms of violence and harassment; if p interaction was <0.05, stratified adjusted prevalence ratios were presented. Among 1,608 transgender women, 59.7% experienced certain forms of violence and harassment and 17.7% reported suicidal ideation during the past 12 months; 75.2% reported high social support from significant others, 69.4% from friends, and 46.8% from family. Experiencing certain forms of violence and harassment and having low-moderate social support from any source was associated with higher prevalence of suicidal ideation. Social support from family moderated the association between experiencing certain forms of violence and harassment and suicidal ideation (p interaction = 0.01); however, even in the presence of high family social support, experiencing certain forms of violence and harassment was associated with higher prevalence of suicidal ideation. Social support did not completely moderate the positive association between experiencing violence and harassment and suicidal ideation. Further understanding of the social support dynamics of transgender women might improve the quality and use of social support. Policymakers and health care workers should work closely with transgender women communities to reduce the prevalence of violence, harassment, and suicide by implementing integrated, holistic, and transinclusive approaches.
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Hu X, Wang H. Gender and Sexuality Disparities in Perception, Attitude and Social Intimacy Among Sinophone Youth Toward Transgender and Gender Non-Conforming Individuals: Based on an Internet Survey. JOURNAL OF HOMOSEXUALITY 2024:1-22. [PMID: 38227489 DOI: 10.1080/00918369.2023.2287031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
The study aims at assessing gender and sexuality characteristics (GSC) in perception, attitude, and social intimacy among Sinophone youth toward transgender and gender non-conforming (TGNC) people. Based on an internet survey with 3 825 valid questionnaires, we distinguished the general public into TGNC, cisgender heterosexual, and cisgender non-heterosexual individuals. Then we classified TGNC individuals into trans females, trans males, and non-binary/genderqueer people and cisgender individuals into cisgender females and cisgender males. The chi-square test, one-way analysis of variance (ANOVA), and multiple linear regression were used. We found that the evident gender and sexuality disparities in perception, attitude, and social intimacy toward TGNC individuals exist both in and out of TGNC individuals. Negative perceptions and attitudes as well as alienated social intimacy were most pronounced among cisgender heterosexual people (Chi-square test, one-way ANOVA, and multiple linear regression: all p < .001). Cisgender females exhibit higher levels of supportiveness compared to cisgender males. Trans females were the most positive while they also had more concerns regarding public space and gender expression-related issues. The findings are practical for community-based advocacy for raising public awareness of the presences and experiences of TGNC people in Sinophone societies.
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Affiliation(s)
- Xiyuan Hu
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Heng Wang
- Women and Gender Studies Institute, University of Toronto, Toronto, Canada
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Edwards KM, Kumar M, Waterman EA, Mullet N, Madeghe B, Musindo O. Programs to Prevent Violence Against Children in Sub-Saharan Africa: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:593-612. [PMID: 36964686 DOI: 10.1177/15248380231160742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Violence against children-which includes maltreatment (including physical, sexual, psychological and emotional violence, and neglect), bullying (including cyberbullying), youth violence (including physical assault with or without weapons), intimate partner violence (including exposure to domestic violence and direct involvement in teen dating violence), and sexual violence-continues to present itself as a significant public health crisis in Sub-Saharan Africa (SSA) leading to numerous short- and long-term deleterious outcomes. As such, the prevention of violence against children in SSA is a critical public health priority. In this systematic literature review, we identified 45 articles that reported on results from 22 programs that seek to reduce violence against children in SSA. Results suggested that programs that focus on (1) economic strengthening, (2) teachers schools, (3) entire families, (4) caregivers only, and (5) children only are generally effective in reducing violence against children by promoting focused action on the mechanisms of change (e.g., parenting skills, enhanced parent-child relationships, resistance skills for children). To date, no research in SSA has examined the impact of policy interventions on childhood victimization or community-level interventions to change norms and values that support violence against children. Future research is needed to examine the impacts of comprehensive efforts to prevent violence against children in SSA as well as factors that predict uptake and sustainability of such prevention efforts in SSA.
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Sherman ADF, Higgins MK, Balthazar MS, Hill M, Klepper M, Schneider JS, Adams D, Radix A, Mayer KH, Cooney EE, Poteat TC, Wirtz AL, Reisner SL. Stigma, social and structural vulnerability, and mental health among transgender women: A partial least square path modeling analysis. J Nurs Scholarsh 2024; 56:42-59. [PMID: 38228564 PMCID: PMC10792251 DOI: 10.1111/jnu.12906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 03/22/2023] [Accepted: 04/20/2023] [Indexed: 01/18/2024]
Abstract
INTRODUCTION Existing literature suggests that transgender women (TW) may be at high risk for adverse mental health due to stress attributed to combined experiences of stigma and complex social and structural vulnerabilities. Little research has examined how these co-occurring experiences relate to mental health. We aimed to test a theoretically driven conceptual model of relationships between stigma, social and structural vulnerabilities, and mental health to inform future intervention tailoring. DESIGN/METHODS Partial least square path modeling followed by response-based unit segmentation was used to identify homogenous clusters in a diverse community sample of United States (US)-based TW (N = 1418; 46.2% White non-Hispanic). This approach examined associations between latent constructs of stigma (polyvictimization and discrimination), social and structural vulnerabilities (housing and food insecurity, unemployment, sex work, social support, and substance use), and mental health (post-traumatic stress and psychological distress). RESULTS The final conceptual model defined the structural relationship between the variables of interest within stigma, vulnerability, and mental health. Six clusters were identified within this structural framework which suggests that racism, ethnicism, and geography may be related to mental health inequities among TW. CONCLUSION Our findings around the impact of racism, ethnicism, and geography reflect the existing literature, which unfortunately shows us that little change has occurred in the last decade for TW of color in the Southern US; however, the strength of our evidence (related to sampling structure and sample size) and type of analyses (accounting for co-occurring predictors of health, i.e., stigma and complex vulnerabilities, reflecting that of real-world patients) is a novel and necessary addition to the literature. Findings suggest that health interventions designed to offset the negative effects of stigma must include anti-racist approaches with components to reduce or eliminate barriers to resources that contribute to social and structural vulnerabilities among TW. Herein we provide detailed recommendations to guide primary, secondary, and tertiary prevention efforts. CLINICAL RELEVANCE This study demonstrated the importance of considering stigma and complex social and structural vulnerabilities during clinical care and design of mental health interventions for transgender women who are experiencing post-traumatic stress disorder and psychological distress. Specifically, interventions should take an anti-racist approach and would benefit from incorporating social support-building activities.
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Affiliation(s)
| | - Melinda K. Higgins
- Nell Hodson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Monique S. Balthazar
- Nell Hodson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
- Georgia State University Byrdine F. Lewis College of Nursing and Health Professions, Atlanta, Georgia, USA
| | - Miranda Hill
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Jason S. Schneider
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dee Adams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Asa Radix
- Department of Medicine, Callen-Lorde Community Health Center, New York, New York, USA
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
| | - Erin E. Cooney
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tonia C. Poteat
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Andrea L. Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sari L. Reisner
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Harruff RC, Johnston R, Lubin M, Perera ULMS. Analysis of female strangulation homicides in King County, Washington, from 1978 to 2022. J Forensic Sci 2024; 69:199-204. [PMID: 37753824 DOI: 10.1111/1556-4029.15384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/02/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023]
Abstract
Asphyxia due to strangulation is an uncommon but important modality of homicide that tends to disproportionately involve female victims. The present study was designed to investigate the circumstances, motivations, and injuries associated with strangulation homicides of females and to measure trends in incidence over time. Electronic records of the King County Medical Examiner's Office in Seattle, Washington, were used to compile a data set of all homicides in King County from 1995 through 2022. A second data set of female homicides due to strangulation was constructed with additional records prior to 1995, supplemented with data abstracted from autopsy reports, and linked to the Washington Attorney General's Office Homicide Investigation Tracking System database. This comprehensive data set was used to analyze demographics, circumstances, motives, and injuries of female strangulation homicides from 1978 through 2016. The results found that, from 1995 through 2022, females accounted for 22.8% of 2394 homicides but 80.3% of strangulation homicides. The average annual rate of all strangulation homicides decreased until 2020. Mean ages of female decedents were 27.7 years in homicides associated with sexual assault, 36.8 years with domestic violence, and 63.9 years with robbery. Lethal assaults most often occurred in private homes, and perpetrators were usually well known to the victim. Injuries included petechiae in 83%; ligature marks in 20%; fingernail marks in 1.4%; hyoid fractures in 23%; and thyroid cartilage fractures in 31%. Fractures were more common in manual strangulation and in decedents of ages over 40 years.
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Affiliation(s)
| | - Robert Johnston
- King County Medical Examiner's Office, Seattle, Washington, USA
| | - Micheline Lubin
- King County Medical Examiner's Office, Seattle, Washington, USA
| | - U L M S Perera
- King County Medical Examiner's Office, Seattle, Washington, USA
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31
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Lantz B, Faulkner L, M Mills J. A Descriptive Account of the Nature and Extent of Transgender Homicide in America, 2010 to 2021. JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:341-368. [PMID: 37705402 DOI: 10.1177/08862605231197139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
There is a growing acknowledgment of transgender homicide as a serious social and public health issue; indeed, the American Medical Association has even referred to violence against transgender people as an "epidemic." Addressing this issue, however, requires understanding the patterns associated with this violence. Yet, reliable data for doing so does not currently exist, especially in recent years. As such, the prevalence of these incidents and their key features are not easily understood. The current study addresses this issue using a comprehensive nationwide database on 305 instances of homicide directed against transgender people between 2010 and 2021, collected through extensive open-source data collection methods. The descriptive analyses of these incidents demonstrate pronounced increases in homicide victimization over time, and clear geographic clustering by state, such that roughly one in four incidents occurred in just three states: Texas, Florida, and California. After accounting for the estimated size of the transgender population, Louisiana, Mississippi, and Missouri emerge as the most dangerous states with the highest risk of homicide victimization. The results also clearly demonstrate the intersectional nature of transgender homicide, in finding that most homicide victims are young Black or Hispanic transgender women. We conclude by emphasizing the need for multipronged policy responses to this issue that recognize the uniquely dangerous intersection of social problems that contribute to the vulnerable social position of many transgender people, including their vulnerability to homicide victimization.
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Small LA, Godoy SM, Lau C, Franke T. Gender-Based Violence and Suicide Among Gender-Diverse Populations in the United States. Arch Suicide Res 2024; 28:107-122. [PMID: 36353845 DOI: 10.1080/13811118.2022.2136023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Transgender populations report higher suicidal ideation (SI) and suicide attempts than the general population. This study sought to identify predictors of suicide in individuals with diverse gender identities, including transgender women; transgender men; and gender-nonbinary, genderqueer, and crossdressing individuals within various racial/ethnic groups. METHODS Secondary analyses were conducted using the United States Transgender Survey (N = 27,204). The dependent variables were SI and suicide attempts in the past 12 months. The independent variables were gender, race, employment status, transactional sex, exposure to violence, and age. Bivariate, multivariable, and nested models were used to examine the association between variables. RESULTS Findings reveal transgender women to be more likely to report SI than other gender groups. White and Hispanic/Latino participants were more likely to have SI than Black participants. Transgender men and gender-nonbinary groups were significantly less likely to attempt suicide than transgender women, and crossdressers were not significantly different in suicide attempts than transgender women. Increased exposure to violence was associated with increased SI and suicide attempts. Increased age and part- or full-time employment were associated with decreased SI and suicide attempts. White transgender women were more likely to have attempted suicide than white transgender men and gender-nonbinary groups. Asian and biracial transgender women were more likely to have attempted suicide than the other gender groups. CONCLUSIONS Findings illuminate differences in suicide among individuals with diverse racial and gender identities and support the call for continued research on mental health experiences of these populations.HighlightsSuicide ideation and attempts varies by race and gender, including for people with diverse gender identitiesTransgender women and crossdressers are more likely to have attempted suicide than transgender men or gender-nonbinary individualsSuicide ideation and suicide attempts are associated with gender, race, employment, survival and transactional sex, violence exposure, and age.
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33
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Singh P, Keshri VR. Missing gender diversity in burns care. Burns 2023; 49:1773-1775. [PMID: 37802710 DOI: 10.1016/j.burns.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/21/2023] [Accepted: 09/10/2023] [Indexed: 10/08/2023]
Affiliation(s)
| | - Vikash Ranjan Keshri
- The George Institute for Global Health, New Delhi, India; The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
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Katz CC, Okpych NJ, Charles P, Wall E, Courtney ME. Prevalence and Predictors of Intimate Partner Violence Among Youth With Foster Care Histories. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:10611-10639. [PMID: 37300333 DOI: 10.1177/08862605231175910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A small but growing body of research suggests that adolescents and young adults involved with the child welfare system and those transitioning out of foster care are at heightened risk of experiencing intimate partner violence (IPV). Understanding the factors that place youth at risk of IPV is central to prevention and treatment of this public health problem. However, questions remain about the prevalence and correlates of IPV among youth in foster care. Additionally, emotional abuse, a particular form of IPV in intimate partnerships, remains an understudied area in this population. This study aimed to address these gaps in research by exploring factors associated with IPV using longitudinal data from a representative sample of older youth in California Foster Care who participated in the California Youth Transitions to Adulthood Study (CalYOUTH). Our IPV outcome measures included victimization, perpetration, bidirectional IPV, and emotional abuse. Findings suggest that approximately one-fifth (20.4%) of CalYOUTH respondents had experienced some form of IPV at age 23, with emotional abuse and bidirectional violence being the most commonly reported types of IPV. Females reported emotional abuse, as well as bidirectional violence, at nearly double the rates of their male counterparts. Self-identified sexual minority youth (SMY; lesbian, gay, bisexual, transgender, queer, or questioning) were more likely to report IPV victimization, IPV perpetration, and bidirectional violence than their non-SMY peers. Youth with histories of emotional abuse, caregiver IPV victimization, sexual abuse in foster care, placement instability, substance use, anxiety, and incarceration were also at heightened risk of IPV involvement. Emotional abuse was most prevalent with SMY. The findings contribute to the growing research on IPV among transition-age foster youth with important implications for future research, practice, and policy.
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Baćak V. Looking Back: Victimization of Transgender Persons and the Criminal Legal System. Am J Public Health 2023; 113:1043-1045. [PMID: 37561970 PMCID: PMC10484126 DOI: 10.2105/ajph.2023.307393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Affiliation(s)
- Valerio Baćak
- Valerio Baćak is with the School of Criminal Justice, Rutgers University-Newark, Newark, NJ
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36
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Stewart AN. International Association of Forensic Nurses President's Message for 2023. JOURNAL OF FORENSIC NURSING 2023; 19:E42-E43. [PMID: 37590948 DOI: 10.1097/jfn.0000000000000448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Affiliation(s)
- Ashley N Stewart
- Author Affiliations: President, International Association of Forensic Nurses, Duquesne University, and Klinic Sexual Assault Crisis Response & Healing Program
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37
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Flaherty TM, Byrnes JF, Maddalena A. Misgendering a transgender woman using FORDISC 3.1: A case study. Forensic Sci Int Synerg 2023; 7:100342. [PMID: 37415608 PMCID: PMC10320518 DOI: 10.1016/j.fsisyn.2023.100342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 07/08/2023]
Abstract
•FORDISC was unable to classify a transgender woman despite her extensive gender-affirming medical care, including Facial Feminization Surgeries.•This case study demonstrates that there is a need for forensic anthropologists to educate themselves on cases that may involve transgender people.•The use of a biocultural approach will allow forensic anthropologists to better identify marginalized individuals, including transgender women.
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Muyanga N, Isunju JB, Ssekamatte T, Nalugya A, Oputan P, Kiguli J, Kibira SPS, Wafula ST, Ssekamatte D, Mugambe RK, Wanyenze RK, Orza L. Understanding the effect of gender-based violence on uptake and utilisation of HIV prevention, treatment, and care services among transgender women: a qualitative study in the greater Kampala metropolitan area, Uganda. BMC Womens Health 2023; 23:250. [PMID: 37161437 PMCID: PMC10170825 DOI: 10.1186/s12905-023-02402-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/28/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Transwomen (also known as transgender women) are disproportionately affected by all forms of gender-based violence (GBV). The high prevalence of physical, sexual and emotional violence not only predisposes transwomen to HIV infection but also limits the uptake/access to HIV prevention, care, and treatment services. Despite the high prevalence of HIV infection and GBV among transwomen, there is limited evidence on how GBV affects the uptake and utilisation of HIV prevention, care, and treatment services. Therefore, this qualitative study explored how GBV affects uptake and utilisation of HIV prevention, treatment, and care services among transwomen in the Greater Kampala Metropolitan Area (GKMA), Uganda. METHODS This participatory qualitative study was conducted among transwomen in the GKMA. A total of 20 in-depth interviews, 6 focus group discussions, and 10 key informant interviews were conducted to explore how GBV affects the uptake and utilisation of HIV prevention, treatment, and care services among transwomen. Data were analysed using a thematic content analysis framework. Data were transcribed verbatim, and NVivo version 12 was used for coding. RESULTS At the individual level, emotional violence suffered by transwomen led to fear of disclosing their HIV status and other health conditions to intimate partners and healthcare providers respectively; inability to negotiate condom use; and non-adherence to antiretroviral therapy (ART). Sexual violence compromised the ability of transwomen to negotiate condom use with intimate partners, clients, and employers. Physical and emotional violence at the community level led to fear among transwomen traveling to healthcare facilities. Emotional violence suffered by transwomen in healthcare settings led to the limited use of pre-exposure prophylaxis and HIV testing services, denial of healthcare services, and delays in receiving appropriate care. The fear of emotional violence also made it difficult for transwomen to approach healthcare providers. Fear of physical violence such as being beaten while in healthcare settings made transwomen shun healthcare facilities. CONCLUSION The effects of GBV on the uptake and utilisation of HIV prevention, care, and treatment services were observed in individual, community, and healthcare settings. Across all levels, physical, emotional, and sexual violence suffered by transwomen led to the shunning of healthcare facilities, denial of healthcare services, delays in receiving appropriate care, and the low utilisation of post-exposure prophylaxis, and HIV testing services. Given its effects on HIV transmission, there is a need to develop and implement strategies/ interventions targeting a reduction in GBV. Interventions should include strategies to sensitize communities to accept transwomen. Healthcare settings should provide an enabling environment for transwomen to approach any healthcare provider of their choice without fear of experiencing GBV.
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Affiliation(s)
- Naume Muyanga
- Programs Department, Transgender Equality Uganda, Kampala, Uganda
| | - John Bosco Isunju
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hill Road, Mulago Kampala, Uganda
| | - Tonny Ssekamatte
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hill Road, Mulago Kampala, Uganda.
| | - Aisha Nalugya
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hill Road, Mulago Kampala, Uganda
| | - Patience Oputan
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hill Road, Mulago Kampala, Uganda
| | - Juliet Kiguli
- Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, New Mulago Hill Road, Mulago Kampala, Uganda
| | - Simon Peter S Kibira
- Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, New Mulago Hill Road, Mulago Kampala, Uganda
| | - Solomon Tsebeni Wafula
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hill Road, Mulago Kampala, Uganda
| | - David Ssekamatte
- Department of Management, Uganda Management Institute, K.A.R. Road, Kampala, Uganda
| | - Richard K Mugambe
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hill Road, Mulago Kampala, Uganda
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hill Road, Mulago Kampala, Uganda
| | - Luisa Orza
- Frontline AIDS, 35 New England Street, Brighton, United Kingdom
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Wirtz AL, Humes E, Althoff KN, Poteat TC, Radix A, Mayer KH, Schneider JS, Haw JS, Wawrzyniak AJ, Cannon CM, Stevenson M, Cooney EE, Adams D, Case J, Beyrer C, Laeyendecker O, Rodriguez AE, Reisner SL. HIV incidence and mortality in transgender women in the eastern and southern USA: a multisite cohort study. Lancet HIV 2023; 10:e308-e319. [PMID: 36868260 PMCID: PMC10164681 DOI: 10.1016/s2352-3018(23)00008-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Epidemiological monitoring of HIV among transgender women is minimal despite prioritisation of this group in the US National HIV/AIDS Strategy (2022-2025). We aimed to estimate HIV incidence in a multisite cohort of transgender women in the eastern and southern USA. Participant deaths were identified during follow-up; thus, we felt it was an ethical imperative to report mortality alongside HIV incidence. METHODS In this study, we established a multisite cohort across two modes: a site-based, technology-enhanced mode in six cities (Atlanta, Baltimore, Boston, Miami, New York City, and Washington, DC) and an exclusively digital mode that spanned 72 eastern and southern US cities that matched the six site-based cities based on population size and demographics. Trans feminine adults (≥18 years) who were not living with HIV were eligible and followed up for at least 24 months. Participants completed surveys and oral fluid HIV testing with clinical confirmation. We ascertained deaths through community and clinical sources. We estimated HIV incidence and mortality using the number of HIV seroconversions and deaths, respectively, divided by person-years accumulated from enrolment. Logistic regression models were used to identify predictors of HIV seroconversion (primary outcome) or death. FINDINGS Between March 22, 2018, and Aug 31, 2020, we enrolled 1312 participants with 734 (56%) in site-based and 578 (44%) in digital modes. At the 24-month assessment, 633 (59%) of 1076 eligible participants consented to extending participation. 1084 (83%) of 1312 participants were retained at this analysis based on the study definition of loss to follow-up. As of May 25, 2022, the cohort participants had contributed 2730 accumulated person-years to the analytical dataset. Overall HIV incidence was 5·5 (95% CI 2·7-8·3) per 1000 person-years and incidence was higher among Black participants and those living in the south. Nine participants died during the study. The overall mortality rate was 3·3 (95% CI 1·5-6·3) per 1000 person-years, and the rate was higher among Latinx participants. Identical predictors of HIV seroconversion and death included residence in southern cities, sexual partnerships with cisgender men, and use of stimulants. Participation in the digital cohort and seeking care for gender transition were inversely associated with both outcomes. INTERPRETATION As HIV research and interventions are increasingly delivered online, differences by mode highlight the need for continued community and location-based efforts to reach the most marginalised transgender women. Our findings underscore community calls for interventions that address social and structural contexts that affect survival and other health concerns alongside HIV prevention. FUNDING National Institutes of Health. TRANSLATION For the Spanish translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Andrea L Wirtz
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA; Department of International Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Elizabeth Humes
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Tonia C Poteat
- Center for Health Equity Research, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Asa Radix
- Callen-Lorde Community Health Center, New York, NY, USA
| | - Kenneth H Mayer
- Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Jason S Schneider
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - J Sonya Haw
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Andrew J Wawrzyniak
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | | | - Meg Stevenson
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
| | - Erin E Cooney
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA; Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | - Dee Adams
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
| | - James Case
- Johns Hopkins Bloomberg School of Public Health, School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Chris Beyrer
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA; Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Oliver Laeyendecker
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Allan E Rodriguez
- Division of Infectious Diseases, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Sari L Reisner
- Department of Medicine, Harvard University, Boston, MA, USA; Harvard Medical School and Department of Epidemiology, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA; Division of Endocrinology, Diabetes, and Hypertension, Brigham Women's Hospital, Boston, MA, USA
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Applin S, Simpson JM, Curtis A. Men Have Gender and Women Are People: A Structural Approach to Gender and Violence. Violence Against Women 2023; 29:1097-1118. [PMID: 35938287 DOI: 10.1177/10778012221104844] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The relationship between violence and patriarchal gender systems is structural and coconstitutive; yet structural analyses that account for gender in explanations and conceptualizations of violence are often absent from violence scholarship. Additionally, there are numerous underassessed areas in more gender-nuanced, "gender-based" violence paradigms. We address the shortcomings of both types of research and propose a cohesive theoretical framework that captures the ways in which violence is patriarchy-enhancing and patriarchy-facilitated. Violence shapes and influences gender performances and structures and, concomitantly, the gender order shapes and influences violence in given contexts.
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Winiker AK, White S, Candelario J, Takahashi LM, Tobin KE. "Through the Things That Have Happened to Me, They've Made Me Stronger": Individual and Interpersonal Sources of Violence and Resilience Among a Diverse Sample of Transgender Women in Los Angeles. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:5019-5043. [PMID: 36062750 DOI: 10.1177/08862605221120896] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Within the United States, transgender women face a disproportionate burden of violence, experiencing increased rates of multiple forms of violence compared with cisgender women and other sexual/gender minority groups. Among transgender women, further racial/ethnic disparities in experiences of violence exist. Resilience has been shown to be protective against the adverse impacts of violence on mental and physical health outcomes, yet little is known about unique sources of resilience, coping, and strength among transgender women. Sixteen in-depth interviews were conducted with a racially diverse sample of transgender women between May and July, 2020 in Los Angeles. Participants were between the ages of 23 and 67 years. Four participants identified as African American/Black, four as Latina, four as White, two as Asian, and two as Native American. Participants were recruited from a local social service organization. Interview questions assessed social network characteristics, experiences of violence, coping mechanisms, and sources of resilience in response to violence. Deductive and inductive coding schemes were used to identify common themes, and data analysis focused upon experiences of violence and sources of resilience/coping. Violence was common among members of the sample, with every participant reporting a history of multiple forms of violence. Violence perpetration came from many sources, including cisgender male strangers, family members, intimate partners, and other transgender women. Women also reported multiple sources of strength and coping, including engaging in self-care and leisure activities, behavioral adaptations, mentorship/support from other transgender women, and striving to "pass" as cisgender. Despite having faced extensive violence, the participants in this sample were resilient, demonstrating many internal and external coping mechanisms and sources of strength. These findings can inform programs and services that target transgender women, providing participants with opportunities to build resilience and other coping mechanisms to buffer the harmful mental and physical health impacts of exposure to violence.
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Affiliation(s)
| | - Sydney White
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Lois M Takahashi
- Sol Price School of Public Policy - University of Southern California, Sacramento, CA, USA
| | - Karin E Tobin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Wirtz AL, Adams D, Poteat TC, Beckham SW, Miller M, Brown C, Reisner SL. SARS-CoV-2 Infection and Testing Experiences in a Nationwide Sample of Transgender and Gender-Diverse Adults, June-December 2021. Public Health Rep 2023; 138:357-368. [PMID: 36560869 PMCID: PMC9790855 DOI: 10.1177/00333549221138853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES COVID-19 surveillance data are rarely collected or disaggregated by gender identity in the United States. We quantified COVID-19 testing experiences and SARS-CoV-2 infection history among transgender and gender-diverse (TGD) people to inform testing strategies and public health responses. METHODS From June 14 through December 16, 2021, TGD adults enrolled in a US nationwide online survey with optional SARS-CoV-2 antibody testing. We used multinomial regression analyses to identify correlates of suspected and confirmed SARS-CoV-2 infection (vs no known infection). We identified correlates of inability to access COVID-19 testing when needed using generalized linear models for binomial variables. RESULTS Participants (N = 2092) reported trans masculine (30.5%), trans feminine (27.3%), and nonbinary (42.2%) gender identities. Ten percent of respondents had a confirmed history of SARS-CoV-2 infection, and 29.8% had a history of suspected SARS-CoV-2 infection. Nonbinary gender (adjusted prevalence ratio [aPR] = 1.68; 95% CI, 1.12-2.53), experiencing homelessness (aPR = 1.65; 95% CI, 1.05-2.60), and food insecurity (aPR = 1.45; 95% CI, 1.03-2.04) were associated with confirmed SARS-CoV-2 infection. Food insecurity (aPR = 1.38; 95% CI, 1.10-1.72), chronic physical health condition (aPR = 1.44; 95% CI, 1.15-1.80), chronic mental health condition (aPR = 3.65; 95% CI, 2.40-5.56), and increased anticipated discrimination scores (aPR = 1.03; 95% CI, 1.01-1.05) were associated with suspected SARS-CoV-2 infection. Thirty-four percent (n = 694 of 2024) of participants reported an inability to access COVID-19 testing when needed, which was associated with Latinx or Hispanic ethnicity, inconsistent telephone access, homelessness, disability, and transportation limitations. The majority (79.4%) reported a complete COVID-19 vaccine course at the time of participation. CONCLUSIONS Inclusion of TGD people in public health surveillance and tailored public health strategies to address TGD communities' social and structural vulnerabilities may reduce barriers to COVID-19 testing.
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Affiliation(s)
- Andrea L. Wirtz
- Center for Public Health and Human
Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD, USA
| | - Dee Adams
- Center for Public Health and Human
Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD, USA
| | - Tonia C. Poteat
- Department of Social Medicine,
University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - S. Wilson Beckham
- Department of Health, Behavior and
Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Marissa Miller
- Trans Solutions Research and Resource
Center, Indianapolis, IN, USA
| | - Carter Brown
- Black Transgender Advocacy Coalition,
Carrollton, TX, USA
| | - Sari L. Reisner
- Division of Endocrinology, Diabetes and
Hypertension, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical
School, Boston, MA, USA
- Department of Epidemiology, Harvard
T.H. Chan School of Public Health, Boston, MA, USA
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Bergman ME, Gaskins VA, Allen T, Cheung HK, Hebl M, King EB, Sinclair RR, Siuta RL, Wolfe C, Zelin AI. The Dobbs Decision and the Future of Occupational Health in the US. OCCUPATIONAL HEALTH SCIENCE 2023; 7:1-37. [PMID: 36843836 PMCID: PMC9940085 DOI: 10.1007/s41542-023-00143-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 02/25/2023]
Abstract
Access to abortion care has a profound impact on women's ability to participate in the workforce. In the US, restrictions on abortion care have waxed and waned over the years, including periods when abortion was broadly permitted across the nation for most pregnant people for a substantial proportion of pregnancy and times when restrictions varied across states, including states where abortion is banned for nearly all reasons. Additionally, access to abortion care has always been a reproductive justice issue, with some people more able to access this care than others even when it is structurally available. In June 2022, the US Supreme Court handed down the Dobbs v. Jackson Women's Health Organization, returning to states the ability to determine restrictions on abortion, including near-total bans on abortion. In this anthology, ten experts share their perspectives on what the Dobbs decision means for the future, how it will exacerbate existing, well-researched issues, and likely also create new challenges needing investigation. Some contributions are focused on research directions, some focus on implications for organizations, and most include both. All contributions share relevant occupational health literature and describe the effects of the Dobbs decision in context.
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Kipke MD, Karimipour N, Wolfe N, Orechwa A, Stoddard L, Rubio-Diaz M, North G, Dezfuli G, Murphy S, Phelps A, Kagan J, De La Haye K, Perry C, Baezconde-Garbanati L. Community-Based Public Health Vaccination Campaign (VaccinateLA) in Los Angeles' Black and Latino Communities: Protocol for a Participatory Study. JMIR Res Protoc 2023; 12:e40161. [PMID: 36757953 PMCID: PMC9989912 DOI: 10.2196/40161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 10/27/2022] [Accepted: 02/07/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has significantly affected Los Angeles County and disproportionately impacted Black and Latino populations who experienced disparities in rates of infection, hospitalizations, morbidity, and mortality. The University of Southern California (USC), USC Keck School of Medicine, Southern California Clinical and Translational Science Institute, USC Mann School of Pharmacy and Pharmaceutical Sciences, Annenberg School for Journalism and Communication, and Children's Hospital Los Angeles will launch a collaborative public health campaign called VaccinateLA. OBJECTIVE VaccinateLA will implement a community-based, community-partnered public health campaign that (1) delivers culturally tailored information about COVID-19 and available vaccines; and (2) addresses misinformation and disinformation, which serves as a barrier to vaccine uptake. The campaign will be targeted to communities in Los Angeles with the highest rates of COVID-19 infection and the lowest vaccination rates. Using these criteria, the campaign will be targeted to neighborhoods located in 34 zip codes in the Eastside and South Los Angeles. The primary aim of VaccinateLA will be to design and deliver an evidence-based multimedia public health campaign tailored for Black and Latino populations. A secondary aim will be to train and deploy community vaccine navigators to deliver COVID-19 education, help individuals overcome barriers to getting vaccinated (eg, transportation and challenges registering), and assist with delivering vaccinations in our targeted communities. METHODS We will use a community-based, participatory research approach to shape VaccinateLA's public health campaign to address community members' attitudes and concerns in developing campaign content. We will conduct focus groups, establish a community advisory board, and engage local leaders and stakeholders to develop and implement a broad array of educational, multimedia, and field-based activities. RESULTS As of February 2023, target communities have been identified. The activities will be initiated and evaluated over the course of this year-long initiative, and dissemination will occur following the completion of the project. CONCLUSIONS Engaging the community is vital to developing culturally tailored public health messages that will resonate with intended audiences. VaccinateLA will serve as a model for how an academic institution can quickly mobilize to address a pressing public health crisis, particularly in underrepresented and underresourced communities. Our work has important implications for future public health campaigns. By leveraging community partnerships and deploying community health workers or promotores into the community, we hope to demonstrate that urban universities can successfully partner with local communities to develop and deliver a range of culturally tailored educational, multimedia, and field-based activities, which in turn may change the course of an urgent public health crisis, such as the COVID-19 pandemic. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/40161.
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Affiliation(s)
- Michele D Kipke
- Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, CA, United States
- Department of Pediatrics, Keck School of Medicine of University of Southern California, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Office of the Senior Vice President of Health Affairs, University of Southern California, Los Angeles, CA, United States
| | - Nicki Karimipour
- Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, CA, United States
| | - Nicole Wolfe
- Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, CA, United States
| | - Allison Orechwa
- Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, CA, United States
| | - Laura Stoddard
- Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, CA, United States
| | - Mayra Rubio-Diaz
- Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, CA, United States
| | - Gemma North
- Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, CA, United States
| | - Ghazal Dezfuli
- Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, CA, United States
| | - Sheila Murphy
- Annenberg School for Communication and Journalism, University of Southern California, Los Angeles, CA, United States
| | - Ashley Phelps
- Annenberg School for Communication and Journalism, University of Southern California, Los Angeles, CA, United States
| | - Jeremy Kagan
- Annenberg School for Communication and Journalism, University of Southern California, Los Angeles, CA, United States
| | - Kayla De La Haye
- Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, CA, United States
| | - Christina Perry
- Department of Population and Public Health Science, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
| | - Lourdes Baezconde-Garbanati
- Department of Population and Public Health Science, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
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From Trauma to Transformation: the Role of the Trauma Surgeon in the Care of Black Transgender Women. CURRENT TRAUMA REPORTS 2023. [DOI: 10.1007/s40719-023-00254-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Storholm ED, Huang W, Ogunbajo A, Horvath KJ, Reback CJ, Blumenthal J, Moore DJ, Flynn RP, Bolan RK, Corado KC, Morris SR. Gender-Based Violence and Post-traumatic Stress Disorder Symptoms Predict HIV PrEP Uptake and Persistence Failure Among Transgender and Non-binary Persons Participating in a PrEP Demonstration Project in Southern California. AIDS Behav 2023; 27:745-759. [PMID: 36053404 PMCID: PMC9908815 DOI: 10.1007/s10461-022-03807-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 11/28/2022]
Abstract
Gender-based violence (GBV) against transgender and nonbinary (TGNB) persons is a pervasive public health issue. GBV has been linked to mental health problems such as depression and posttraumatic stress disorder (PTSD), as well has risk for HIV seroconversion and HIV treatment nonadherence. However, the impact of GBV on HIV pre-exposure prophylaxis (PrEP) use among TGNB persons has yet to be investigated. In the current study we assessed longitudinal PrEP persistence data from dried blood spots (DBS) collected from 172 racially and ethnically diverse TGNB participants during a 48-week PrEP demonstration project in Southern California from June 2017 to September 2020. Participants were categorized into three levels of PrEP uptake and persistence based on their PrEP levels at the start and end of the study: low-low, high-low, and high-high. Individual-, social-, and structural-level variables were then entered into multinomial logistic regression models to predict levels of PrEP uptake and persistence based on hypotheses informed by syndemic and minority stress theories. The models demonstrated that experience of GBV predicted significantly lower odds of PrEP uptake and persistence and greater PTSD symptoms predicted significantly greater odds of early PrEP discontinuation. Higher levels of coping skills, already being on PrEP at baseline, and being in a steady relationship were associated with greater odds of PrEP uptake and persistence. Implications for future GBV research, advocacy, interventions, and much needed structural changes focused on improving the health and safety of TGNB individuals are discussed.
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Affiliation(s)
- Erik D Storholm
- School of Public Health, San Diego State University, San Diego, CA, USA.
- RAND Corporation, Santa Monica, CA, USA.
- Center for HIV Identification, Prevention and Treatment Services, Department of Family Medicine, University of California Los Angeles, Los Angeles, CA, USA.
| | | | - Adedotun Ogunbajo
- RAND Corporation, Santa Monica, CA, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Cathy J Reback
- Center for HIV Identification, Prevention and Treatment Services, Department of Family Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Friends Research Institute, Los Angeles, CA, USA
| | - Jill Blumenthal
- AntiViral Research Center, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - David J Moore
- AntiViral Research Center, University of California, San Diego School of Medicine, San Diego, CA, USA
| | | | | | | | - Sheldon R Morris
- AntiViral Research Center, University of California, San Diego School of Medicine, San Diego, CA, USA
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Gamarel KE, Jadwin-Cakmak L, King WM, Hughes L, Abad J, Trammell R, Maguire A, Shackelford V, Connolly M, Rescoe T, Williams A, Harper GW. Improving Access to Legal Gender Affirmation for Transgender Women Involved in the Criminal-Legal System. JOURNAL OF CORRECTIONAL HEALTH CARE 2023; 29:12-15. [PMID: 36037008 PMCID: PMC10081699 DOI: 10.1089/jchc.21.09.0085] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Transgender women of color experience interlocking systems of oppression rooted in racism and transphobia, which fuel economic vulnerability and overrepresentation in the criminal-legal system. Legal gender affirmation, which refers to changing one's name and gender marker on official documents, has the potential to mitigate these issues by improving access to employment, housing, education, health care, and social services. These services are particularly important for transgender women of color with criminal records, a history of incarceration, or other legal infractions; however, 23 states have policies that restrict access to legal gender affirmation for these individuals. Alongside eliminating restrictive policies to obtain legal gender affirmation, medical-legal partnerships in these states may address recidivism and health inequities among transgender women of color.
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Affiliation(s)
- Kristi E. Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Laura Jadwin-Cakmak
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Wesley M. King
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Landon Hughes
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Julisa Abad
- Trans Sistas of Color Project, Detroit, Michigan, USA
- Fair Michigan Foundation, Detroit, Michigan, USA
| | - Racquelle Trammell
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
- Trans Sistas of Color Project, Detroit, Michigan, USA
| | | | | | - Maureen Connolly
- Department of Pediatrics, Henry Ford Health System, Detroit, Michigan, USA
| | | | | | - Gary W. Harper
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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48
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Rogers EM, Krajewski AT, Shuster SM. The Disproportionate Mental Health Burden Among Incarcerated Transgender and Gender Diverse People. JOURNAL OF CORRECTIONAL HEALTH CARE 2023; 29:39-46. [PMID: 36577007 DOI: 10.1089/jchc.21.10.0109] [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: 12/30/2022]
Abstract
This article examines the distribution of self-reported mental health conditions and clinical contact among incarcerated transgender and gender diverse (TGD) individuals compared to cisgender women and men. Data are derived from the 2016 Survey of Prison Inmates. Results indicate that TGD respondents report more mental health symptoms, conditions, and clinical contact than their cisgender counterparts. The findings have important implications for the mental health disadvantages experienced by TGD people currently in prison.
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Affiliation(s)
- Ethan M Rogers
- Public Policy Center, University of Iowa, Iowa City, Iowa, USA
| | - Andrew T Krajewski
- School of Economic, Political and Policy Sciences, University of Texas-Dallas, Dallas, Texas, USA
| | - Stef M Shuster
- Lyman Briggs College and Department of Sociology, Michigan State University, East Lansing, Michigan, USA
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49
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Ribeiro A, Trevizol AP, Bosso RA, Gianna MC, Vieira DL, Bernardini VB, Brietzke E, Ribeiro M, Fidalgo TM. The Interactions Between Vulnerabilities for HIV and Syphilis among Cisgender and Transgender People Who Use Drugs. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:733-740. [PMID: 36369415 DOI: 10.1007/s10508-022-02460-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
In Brazil, transgender people are most affected by HIV, and crack cocaine addiction may contribute to social vulnerability and exposure to sexual and violence-related risks. This cross-sectional study comprised 2393 individuals seeking addiction treatment, consisting of 43 trans women, 1995 cisgender men, and 355 cisgender women. Records of rapid test results for HIV and syphilis and screening responses of trans women were compared to both cisgender groups using a logistic regression model to identify associated risk factors. HIV prevalence was higher in the transgender group (39.5%) than in cis women and men (5.9% and 3.6%, respectively). Our study showed an eightfold higher chance of a positive HIV test among transgender individuals who used drugs (OR: 8.79, p < .01, 95% CI: 3.90-19.78) compared to cisgender people who used drugs. A lifetime history of syphilis infection was more common in transgender people (60.0%) and cis women (32.8%) than in cis men (9.5%). Active syphilis was also more common in the transgender population (OR: 5.46, p < .01, 95% CI: 2.63 11.32). In our sample, 44.2% of transgender individuals had a history of at least one suicide attempt in their lifetime. Our results showed that transgender women were at higher risk of crack cocaine use (OR: 5.51, p < .01, 95% CI: 2.16-14.06) than cisgender men and women. The study showed that trans women had a higher prevalence of syphilis and HIV, and a greater chance of being homeless. The synergy of these vulnerabilities may have led to our findings of high psychotic symptoms and a history of suicide attempts in transgender individuals.
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Affiliation(s)
- Ariadne Ribeiro
- Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
- The Joint United Nations Program on HIV/AIDS, UN HOUSE Conjunto C, Quadra 802, Lote 17, Federal District, Brasília, 70800-400, Brazil.
| | - Alisson Paulino Trevizol
- CAMH - Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Maria Clara Gianna
- Reference and Training Center for STI and AIDS, Sao Paulo State Secretariat of Health, Sao Paulo, SP, Brazil
| | - Denise Leite Vieira
- Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Elisa Brietzke
- Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
| | - Marcelo Ribeiro
- Reference Center for Alcohol, Tobacco and Other Drugs, Sao Paulo State Secretariat of Health, Sao Paulo, SP, Brazil
- Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Thiago M Fidalgo
- Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
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50
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Kirakosian N, Stanton AM, McKetchnie SM, King D, Dolotina B, O'Cleirigh C, Grasso C, Potter J, Mayer KH, Batchelder AW. Suicidal Ideation Disparities Among Transgender and Gender Diverse Compared to Cisgender Community Health Patients. J Gen Intern Med 2023; 38:1357-1365. [PMID: 36650322 PMCID: PMC9844943 DOI: 10.1007/s11606-022-07996-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Transgender and gender diverse (TGD) individuals experience more severe psychological distress and may be at higher risk for suicide compared to cisgender individuals. The existing literature largely consists of small-sample studies that do not assess subgroup differences. OBJECTIVE To examine rates of self-reported suicidal ideation among four TGD groups compared to cisgender individuals. DESIGN Data were extracted from the electronic health records of patients receiving primary care at a community health center specializing in sexual and gender minority health. A logistic regression was used to examine the relationship between sociodemographic variables and the presence of current suicidal ideation. PARTICIPANTS 29,988 patients receiving care at a community health center in Northeastern US between 2015 and 2018. MAIN MEASURES Demographic questionnaire, 9-item Patient Health Questionnaire KEY RESULTS: Younger age, sexual and gender minority identity, and public/grants-based insurance were associated with significantly higher odds of suicidal ideation. Relative to cisgender men, transgender men (OR=2.08; 95% CI=1.29-3.36; p=.003), transgender women (OR=3.08; 95% CI=2.05-4.63; p<.001), nonbinary (NB) individuals assigned male at birth (AMAB; OR=3.55; 95% CI=1.86-6.77; p<001), and NB individuals assigned female at birth (AFAB; OR=2.49; 95% CI=1.52-4.07; p<001) all endorsed significantly higher odds of current suicidal ideation, controlling for age, race, ethnicity, sexual orientation, and insurance status. Larger proportions of transgender women (23.6%) and NB AMAB individuals (26.7%) reported suicidal ideation not only compared to cisgender men (6.1%) and women (6.6%), but also compared to transgender men (17.4%; χ2[5, n=25,959]=906.454, p<0.001). CONCLUSIONS TGD patients were at significantly increased risk of suicidal ideation, even after accounting for age, race, ethnicity, sexual orientation, and insurance status. Findings suggest distinct risk profiles by assigned sex at birth. Consistent assessment of and intervention for suicidal ideation should be prioritized in settings that serve TGD patients.
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Affiliation(s)
- Norik Kirakosian
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Amelia M Stanton
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Samantha M McKetchnie
- School of Social Work, Boston College, Newton, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Dana King
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Brett Dolotina
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Conall O'Cleirigh
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Chris Grasso
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Jennifer Potter
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Abigail W Batchelder
- The Fenway Institute, Fenway Health, Boston, MA, USA.
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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