Intimate Partner Violence in Transgender Populations: Systematic Review and Meta-analysis of Prevalence and Correlates

The Associations Between Intimate Partner Violence and Mental Health Outcomes Among Sexual Minority Men: A Systematic Review and Meta-Analysis

Sexual minority men (SMM) experience intimate partner violence (IPV) at a substantially high rate and also bear high burdens of adverse mental health outcomes. This systematic review and meta-analysis aimed to consolidate existing evidence on the associations between experiencing IPV and adverse mental health outcomes (depressive symptoms, anxiety, stress, etc.) among SMM. Following the Preferred Reporting Items For Systematic Reviews and Meta-Analyses guideline, we identified 22 published studies encompassing data from 18,454 individuals, all of which were cross-sectional in design and half of which were conducted in the U.S. We found that experiencing IPV was associated with an increased risk of depressive symptoms and anxiety with a pooled Adjusted Odds Ratios (AORs) of 1.71 (95% CI [1.43, 2.05]) and 1.89 (95% CI [1.46, 2.43]), respective. Studies also found that IPV was positively associated with suicide-related risk (AOR = 2.71, 95% CI [2.21, 3.32] and perceived loneliness. Studies varied in their IPV measures and recall periods and used diverse mental health measurement tools like PHQ-9/GAD-7, Perceived Stress Scale, and the Suicide Behaviors Questionnaire-Revised. This systematic review and meta-analysis revealed an urgent need to examine the effects of IPV on SMM's mental well-being in low- and middle-income countries using standardized IPV measurement tools. Future research should employ a longitudinal design to track the long-term effects of IPV on the mental well-being of SMM and explore potential interventions for mitigating these impacts over time. These insights are crucial for enhancing IPV screening within healthcare settings and identifying key intervention targets aimed at improving the mental health of SMM.

Healthcare for Sexual and Gender Minority Adolescents

Primary care providers have a unique opportunity to provide high-quality care to lesbian, gay, bisexual, transgender, queer, intersex, asexual and other identities not encompassed (LGBTQIA+) adolescents. Providers should be familiar with the various identities and definitions in the LGBTQIA + community, as well as social determinants of health and health disparities amongst LGBTQIA + adolescents. Providers should also understand how to foster a welcoming clinical environment, address gender affirming care to adolescents, and demonstrate clinical comfort with pre-exposure human immunodeficiency virus prophylaxis.

The Impact of Intimate Partner Violence on the Mental and Physical Health of Sexual and Gender Minorities: A Comprehensive Review of Quantitative Research

The aim of this review was to investigate the mental and physical health outcomes of intimate partner violence (IPV) victimization among sexual and gender minority (SGM) individuals. This study addressed an existing gap in research concerning IPV outcomes among SGM populations. A systematic review was conducted through PubMed, APA PsycInfo, APA PsycNet, and manual searches on Google Scholar using specific keywords. Inclusion criteria included peer-reviewed publications and quantitative studies specifically assessing the impacts of IPV among SGM individuals. A total of 35 studies meeting these criteria were included in the review. Our review showed significant associations between IPV victimization and adverse mental and physical health outcomes, including posttraumatic stress disorder, depression, anxiety, suicidal ideation and attempts, substance use, and risky sexual behaviors among SGM individuals. IPV victimization poses mental and physical health risks for SGM populations. Our findings highlight the need for comprehensive, tailored intervention and prevention efforts that consider the diverse needs of individuals with multiple minoritized identities in the context of IPV victimization.

Barriers and Facilitators Along the PrEP Continuum of Care Among Latinx Sexual Minoritized Men and Transgender Women: A Systematic Review

Latinx cisgender sexually minoritized men (SMM) and transgender women (TW) in the U.S. are disproportionately affected by HIV. Although pre-exposure prophylaxis (PrEP) is a highly effective strategy for HIV prevention, rates of PrEP use among Latinx SMM and TW remain suboptimal. The main purpose of this systematic review was to (1) describe engagement in the various stages of the PrEP care continuum among Latinx SMM and TW, and (2) identify multilevel determinants that function as barriers or facilitators to engagement in the PrEP continuum of care for Latinx SMM and TW. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement (PRISMA). Five databases (MEDLINE, CINAHL, PsycINFO, Embase, Scopus) were searched to examine the available qualitative, quantitative, and mixed method studies relevant to the research question. A total of 56 studies were included, with the majority focusing on SMM and being cross-sectional in design. Barriers included PrEP knowledge, risk perception, intersecting stigma, and structural conditions. Community resources, social support, and PrEP navigation services facilitated engagement in the PrEP continuum of care. This review highlights the complex factors that influence PrEP care engagement among Latinx SMM and TW. These findings call for comprehensive, multilevel approaches to address inequities disparities in PrEP care engagement among these groups.

How Do People Make Sense of Intimate Partner Violence (IPV) in the Context of Perpetrator PTSD Diagnostic Status and Gender Identity?

Background: Intimate partner violence (IPV) has profound effects on victim physical and mental health, considerable social and economic costs and is a significant public health concern. Research suggests that the way the public make sense of IPV may vary in different contexts, as certain contextual factors may be used to explain, excuse or legitimise IPV. PTSD diagnostic status and perpetrator gender may be such contextual factors, but little research exists in this area. Objectives: This study explored how the public make sense of IPV in the context of perpetrator diagnostic status (PTSD or no PTSD) and gender identity (female, male or nonbinary) by exploring IPV ratings and IPV discourses. Methods: Two hundred and sixty-five (265) community participants were recruited via snowball sampling and presented one of six versions of the same story containing an account of IPV. Stories were identical across conditions bar perpetrator diagnostic status and gender identity. Participants rated the degree to which they thought the behaviour in the story constituted IPV. Approximately half the participants also completed a story completion task, and stories were analysed for themes. Results: IPV ratings were weighted towards abuse and did not vary with diagnostic status or gender identity. Five themes were identified in participant stories: (i) characterise the behaviour; (ii) trajectory of IPV; (iii) show compassion towards victim of IPV; (iv) hold victim of IPV responsible; and (v) context influences decision-making. Limitations, implications and directions for future research are discussed.

Lesbian, Gay, Bisexual, Transgender and Queer People's Experiences of Stigma Across the Spectrum of Inpatient Psychiatric Care: A Systematic Review

Lesbian, gay, bisexual, transgender, queer and other diverse sexual orientations and gender identity groups (LGBTQ+) face high rates of poor mental health. In the most severe and emergent of instances, inpatient psychiatric care may be required. LGBTQ+ people report experiences of mistreatment in healthcare settings broadly, such as denial of healthcare services and harassment from healthcare providers and other patients. However, little is known about the experiences of LGBTQ+ people in inpatient psychiatric care settings, specifically. The purpose of this review was to assess the existing literature for descriptions of LGBTQ+ people's experiences within inpatient psychiatric care. We searched multiple databases (i.e., PubMed, PsychINFO, CINAHL, Web of Science and Google Scholar) for peer-reviewed articles that described the experiences of LGBTQ+ people within inpatient psychiatric care that were published in English. The included articles (N = 14) were analysed using a conceptual model of stigma and organised within those strata (structural, interpersonal and individual stigma) across the inpatient experience, (admission, inpatient unit, and discharge). Themes identified included: noninclusive intake tools and pervasive misgendering during the admission process; lack of healthcare infrastructure, inadequate training and lack of cultural humility, pervasive discrimination and victimization, silencing of LGBTQ+ patients, and feelings of fear and shame while on inpatient units, and lack of community resources during the discharge process. Clinicians should consider the perspectives and experiences of LGBTQ+ people to enact identity-affirming care practices that may increase mental healthcare engagement and improve long-term mental health outcomes.

Attending to Power: Stakeholder Perspectives on Training Physicians to Address Intimate Partner Violence

Intimate partner violence (IPV) is associated with a wide range of mental and physical health concerns. Research suggests that many physicians lack knowledge and skills to adequately respond to patients experiencing IPV. In order to better integrate physicians' contributions into intersectoral responses to IPV, we asked stakeholders with expertise and experience related to IPV about the knowledge, skills, attitudes, and behaviors they wanted them to have. Guided by principles of interpretive description, and using a key informant method, we conducted unstructured interviews with 18 stakeholders in IPV-related frontline, managerial, or policy roles in Ontario, Canada. Data collection and analysis proceeded iteratively through 2022; "thoughtful practitioners" outside the research team were recruited at key junctures to provide feedback on formative findings. Stakeholders suggested that "attending to power" should be a core principle for medical practice related to IPV. Attending to power encompassed understanding interactional, organizational, and structural power dynamics related to IPV and purposefully engaging with power, by taking action to empower people subjected to violence. Specific recommendations for practice concerned four focal contexts: relationships between partners, between patients and providers, between providers, and in social systems and structures. Strengthening physicians' capacity to attend to power dynamics relevant to their IPV practice is an important step in both improving medical care for people experiencing IPV and integrating physician contributions into other services and supports.

Mapping Multilevel Contributions to the Sexual Victimization of Trans Women and Trans Feminine People: A Qualitative Intersectional Stigma Analysis

We aimed to characterize and conceptually organize multilevel factors associated with the sexual victimization experiences of trans women and trans feminine people to advance violence prevention interventions for health-equity. Between October 2020 and July 2021, we conducted in-depth interviews with 17 expert informants in New York City, which we transcribed, coded, and analyzed. Qualitative insights were derived through an intensive, team-based iterative coding strategy resulting in the development of an exhaustive set of consensus codes which were organized and interpreted in a multi-level structure. Findings revealed a complex constellation of intersecting macro- and micro-structural mechanisms reinforcing sexual violence. Unique characteristics of this violence were characterized hierarchically in terms of: 1) violence forms (e.g. murder, fetishization), 2) perpetrators (e. g. safety-staff; group assault), 3) contexts (e.g. public accommodations), 4) functions (e.g. gender policing), 5) ideological reinforcers (e.g. transphobia, racism), and 6) structural reinforcers (e.g. legislation; linking access to material means of survival to poverty/illness). Results indicate that acute incidents of sexual victimization are "the tip of the iceberg" of the violence impacting trans communities. The community experts we interviewed (e.g. trans women, violence prevention practitioners, social workers) understand chronic functional, ideological, and structural oppression as inextricable from sexual violence. Multi-level determinants of violence therefore constitute essential targets of sexual violence prevention intervention for this population.

"Using the right tools and addressing the right issue": A qualitative exploration to support better care for intimate partner violence, brain injury, and mental health

BACKGROUND

Intimate partner violence (IPV) is a global public health crisis. Often repetitive and occurring over prolonged periods of time, IPV puts survivors at high risk of brain injury (BI). Mental health concerns are highly prevalent both among individuals who have experienced IPV and those who have experienced BI, yet the interrelatedness and complexity of these three challenges when experienced together is poorly understood. This qualitative study explored care provision for IPV survivors with BI (IPV-BI) and mental health concerns from the perspectives of both survivors and providers.

METHODS

This qualitative interpretive description study was part of a broader research project exploring employment, mental health, and COVID-19 implications for survivors of IPV-BI. Participants (N = 24), including survivors and service providers, participated in semi-structured group and individual interviews between October 2020 and February 2021. Interviews were recorded, transcribed, and thematically analyzed.

FINDINGS

Four themes were developed from interview findings: 1) identifying BI and mental health as contributing components to survivors' experiences is critical to getting appropriate care; 2) supporting survivors involves a "toolbox full of strategies" and a flexible approach; 3) connecting and collaborating across sectors is key; and 4) underfunding and systemic barriers hinder access to care. Finally, we share recommendations from participants to better support IPV survivors.

CONCLUSIONS

Identifying both BI and mental health concerns among IPV survivors is critical to providing appropriate supports. Survivors of IPV experiencing BI and mental health concerns benefit from a flexible and collaborative approach to care; health and social care systems should be set up to support these collaborative approaches.

What Guidance Do Violence Journals Provide for Reporting on Sexual and Gender Diversity? A Document Analysis

BACKGROUND

Gender-based violence is a worldwide health and social problem with negative short- and long-term health impacts. Sexual and gender minority people experience more gender-based violence and significant barriers to support. These populations are often not included in, or are actively excluded from, gender-based violence research, and sexual orientation and gender are generally poorly measured and reported. One recommendation put forth to improve the evidence base with regard to sexual and gender diversity is higher standards of research and reporting by academic journals. Given the leading role of nurse researchers in this area of women's health, this is a topic of particular importance for nursing research and education.

AIMS

We examined the sexual and gender diversity-related guidance provided by academic violence journals to authors, editors and peer-reviewers.

METHODS

We conducted a descriptive document analysis. Two researchers independently searched for, and coded, guidance related to sexual and gender diversity from 16 websites of academic journals focused on violence research.

RESULTS

While most journals included some mention of diversity or inclusion, only about half provided in-depth guidance for authors, editors and/or peer-reviewers. Guidance related to gender was more common than guidance for sexual diversity. The journals gave varied prominence to diversity-related guidance, and it was often difficult to locate.

CONCLUSIONS

To reflect the spectrum of lived experiences of gender and sexuality, publishers must actively direct authors, editors and reviewers to include, measure and report these experiences. This has not yet been fully achieved in the important area of gender-based violence research, and is of direct concern to nurse researchers who contribute significantly to this body of knowledge.

The Psychosocial Consequences of Sexual Violence Stigma: A Scoping Review

Over the past decade, scholars have explored whether the stigma associated with sexual violence (SV) represents a risk factor for psychopathology and related comorbidities following SV. We conducted a scoping review to summarize and evaluate the state of this burgeoning literature. We included studies from Pubmed, APA PsychInfo, Embase, CINAHL Plus, Social Science Premium, and Web of Science that quantified stigma related to SV. Studies were screened and abstracted in accordance with the PRISMA-SCR guidelines for scoping reviews. Our final sample contained 62 studies. We address two key questions about SV stigma. First, is SV a stigmatized status? Articles (n = 14) provided evidence for SV stigma among potential stigmatizers (e.g., individuals who may perpetuate stigma) across a range of methods (e.g., vignettes) and outcomes (e.g., desire for social distance). Additional work (n = 20) corroborates perceptions of SV stigma among targets (i.e., SV survivors). Second, what are the psychosocial consequences of SV stigma? We reviewed studies (n = 28) demonstrating that SV stigma is correlated with a range of adverse psychosocial outcomes-including anxiety, depression, posttraumatic stress disorder, problematic drinking, and somatic symptoms-among individuals experiencing multiple types of SV (e.g., childhood sexual abuse and sexual assault). Thus, emerging evidence suggests that SV stigma may be a critical determinant of risk and recovery following SV exposure. However, a number of limitations were observed, including that SV stigma has not been consistently measured and that the literature has not fully incorporated stigma constructs, such as concealment and structural stigma. We offer several recommendations to advance this line of work.

Breaking the Silence: Addressing Domestic Abuse in Mental Health Settings-Identification, Screening, and Responding

Individuals experiencing domestic abuse (DA) struggle to disclose victimization, but as frequent users of mental health services, this is a pivotal setting for identification and addressing DA. This systematic review of 20 studies investigates DA identification, screening, and responses within mental health settings. Three databases were searched using these inclusion criteria: adults aged 18 and older accessing mental health services, samples comprising mental health professionals (or combination). No geographical restrictions were applied. All studies were peer-reviewed and published in English between January 2000 and December 2023. Studies had to incorporate screening for DA between (ex-)partners and/or response to disclosure within mental health settings. The findings revealed considerable variation in DA screening methods from direct screening tools to retrospective analyses of patient files. Professionals report barriers in identifying DA, including uncertainty about their role, time constraints, and the importance of building trust with service users. Nonetheless, many highlight the importance of routinely asking about DA. A small number of interventions have been effective in enhancing professionals' readiness to address DA, but it remains unclear what format of training is most effective. Service users report feelings of shame and fear of not being believed when disclosing DA, but are aided by therapeutic engagement and enhanced professional awareness. There is a lack of diverse inclusion in the research. In summary, there is considerable scope to develop good practice to support mental health professionals' ability to identify and respond to DA across assessment tool and training, but also in understanding what facilitates service users to disclose.

Beyond the binary female/male sex classification: The impact of (trans)gender on the identification of human remains

In cases of unidentified deceased persons, sex determination is a routine task in forensic medicine. However, the binary biological sex categories 'female' and 'male' may be challenged if it is not clear whether the information in the missing persons databases refers to the biological sex or the (felt and lived) gender. An umbrella term for people who do not identify with their birth sex (which usually is the biological, chromosomal sex) is 'transgender'. In recent decades, the legal and social situation of transgender people has changed in many countries making it easier to live their felt gender more openly. This development highlights the issue of potential challenges in the postmortem identification of transgender individuals. Serious problems in corresponding cases may be rare-but they must be considered and addressed in forensic practice to minimize the risk of delayed or failed identification. The impact of (trans)gender on the identification of human remains was examined by a narrative literature review under special consideration of the prevalences of transgender identities in general populations and in the group of unidentified deceased; possible actions to avoid problems in the postmortem identification of transgender persons in forensic practice are being proposed. One can assume that 1 of 200 people in the United States, the European Union and comparable societies is transgender with an opposite-sex identification, and 2 to 3 of 100 people live outside the typical female/male binary, with numbers increasing. If legally possible, an increasing number of transgender individuals will change their name and gender in civil registration. Transgender individuals are likely to be overrepresented in suicides and in victims of homicides. Although there are no precise data on the prevalence of transgender individuals in the group of unidentified deceased, the remarkably high reported prevalence in the general population and the over-representation of transgender individuals in suicides and homicides suggest that the topic is relevant to forensic practice. An autopsy does not always provide evidence of transgender identity, for example in skeletal remains. Particularly in unsolved cases, the possibility that an unidentified person may have been transgender should be considered. Knowledge and awareness of forensic practitioners on this topic should be strengthened by research and training. Databases and data reporting should be optimized. Recording in antemortem databases should clearly distinguish between 'biological sex' and 'apparent sex /lived gender identity'. When collecting postmortem data, a clear distinction should be made between "chromosomal sex" and "sex based on morphological findings". CLINICAL TRIAL NUMBER: Not applicable (review article).

"No one told me how this could be pleasurable" A Qualitative Focus Group Study into Experiences and Needs of Transgender People in Addressing Sexuality in the Context of Gender-Affirming Medical Care in The Netherlands

Various studies show that transgender people may experience diverse challenges to attaining sexual well-being. Receiving gender-affirming medical care (GAMC) may influence one's sexual experiences, but there is little insight into the way sexuality is addressed in GAMC. We conducted a qualitative focus group study among transgender individuals on their experiences and needs related to the way sexuality is addressed in the GAMC context. We included 28 participants (aged 21-60) who were assigned to six groups based on their GAMC trajectories and treatment goals. Each group convened twice for two hours (12 focus groups in total). We analyzed the data using reflexive thematic analysis and identified three main themes. Regarding sexuality in GAMC, participants articulated the need for 1) personalized and balanced information, 2) insight into the experiences of others, and 3) the opportunity for support and guidance concerning sexuality by a healthcare provider. This study highlights the necessity to improve information provision and guidance to promote sexual well-being of people receiving GAMC. Such information ought to transcend cis- and heteronormative sexual assumptions and needs to be tailored to an individual's experiences. Finally, GAMC organizations and their healthcare providers should foster an environment where questions and concerns related to sexuality can be discussed.

In their own words: Perspectives of IPV survivors on obtaining support within the healthcare system

BACKGROUND

Almost half of all women in the US experience intimate partner violence (IPV) in their lifetime. The US Preventive Services Task Force recommends IPV screening paired with intervention for women of reproductive age. We aim to understand clinical practices and policies that are beneficial, detrimental, or insufficient to support survivors of IPV in a safety-net healthcare system.

METHODS

We sampled 45 women who were 18-64 years old, had experienced IPV within the prior year and were patients in the San Francisco Health Network. We conducted in-depth, semi-structured interviews to elicit their perspectives on disclosing IPV and obtaining support within the healthcare system. We analyzed our data using thematic analysis and grounded theory practices informed by ecological systems theory.

FINDINGS

We identified four themes regarding factors that impeded or facilitated discussing and addressing IPV across interpersonal and systemic levels relating to relationship-building, respect, autonomy and resources. (1) Interpersonal barriers included insufficient attention to relationship-building, lack of respect or concern for survivor circumstances, and feeling pressured to disclose IPV or to comply with clinicians' recommended interventions. (2) Interpersonal facilitators consisted of patient-centered IPV inquiry, attentive listening, strength-based counseling and transparency regarding confidentiality. (3) Systemic barriers such as visit time limitations, clinician turn-over and feared loss of autonomy from involvement of governmental systems leading to separation from children or harm to partners, negatively affected interpersonal dynamics. (4) Systemic facilitators involved provision of resources through IPV universal education, on-site access to IPV services, and community partnerships.

CONCLUSIONS

Women experiencing IPV in our study reported that relationship-building, respect, autonomy, and IPV-related resources were essential components to providing support, promoting safety, and enabling healing in the healthcare setting. Successful trauma-informed transformation of healthcare systems must optimize interpersonal and systemic factors that improve survivor wellbeing while eliminating barriers.

Oppression-Based Stress and Alcohol Inequities Among Sexual and Gender Minority People: An Intersectional Multilevel Framework

PURPOSE

Sexual and gender minority (SGM) people are at heightened risk for alcohol use, hazardous drinking, and alcohol use disorder compared to heterosexual and cisgender individuals. This paper: (a) presents an oppression framework that integrates intersectionality, stress, stigma, and addiction-based theories to examine the complex and nuanced ways oppression-based stress (e.g., minority stress) leads to sexual orientation and gender identity inequities in alcohol use; (b) conducts a narrative review that summarizes recent and novel advancements in the literature on the impact of oppression-based stressors on alcohol use outcomes across structural, interpersonal, and intrapersonal domains among SGM people; and (c) provides future research and intervention directions for the alcohol field.

SEARCH METHODS

A select review of the literature was conducted on July 10, 2023, using multiple electronic databases (i.e., PsycInfo, PubMed, Web of Science) and focusing on studies that had examined the associations between oppression-based stressors and alcohol use outcomes across structural, interpersonal, and intrapersonal levels. Search terms focused on alcohol consumption; SGM people, particularly SGM people of color; and oppression-based stress. Cross-sectional studies that focused on heterosexism-based and anti-bisexual oppression-based stressors at the interpersonal or intrapersonal levels and alcohol use outcomes were excluded as they have been included in prior reviews of the literature.

SEARCH RESULTS

The initial and combined search across the databases resulted in 3,205 articles. Of those, the narrative review included 50 peer-reviewed articles that focused on the following four areas of the literature on the associations between oppression-based stressors and alcohol use outcomes: (1) experimental, longitudinal, and experience sampling studies of heterosexism- and anti-bisexual oppression-based stressors (22 articles); (2) any studies of cissexism-based stressors (12 articles); (3) any studies of intersectional oppression among SGM people of color (seven articles, one article overlapped with the first category and another overlapped with the fourth category); and (4) any studies of structural oppression (11 articles).

DISCUSSION AND CONCLUSIONS

Results of this narrative review indicate that mounting evidence implicates oppression-based stress in inequities in alcohol use, hazardous drinking, and alcohol use disorder in SGM populations. This reflects SGM people's embodiment of oppression and injustice at the structural, interpersonal, and intrapersonal levels. Given some inconsistent and mixed patterns of findings, future research needs greater specificity in drinking inclusion criteria, robust and well-validated measures, more attention to culturally and developmentally relevant moderating and mediating mechanisms across the lifespan, application of sophisticated methodologies, and integration of intersectional and addiction frameworks.

Interventions for intimate partner violence during the perinatal period: A scoping review: A systematic review

Background

Intimate partner violence (IPV) is a prevalent global health problem. IPV that occurs before pregnancy often continues during the perinatal period, resulting in ongoing violence and many adverse maternal, obstetrical, and neonatal outcomes.

Objectives

This scoping review is designed to broadly capture all potential interventions for perinatal IPV and describe their core components and measured outcomes.

Search Methods

We conducted a search for empirical studies describing IPV interventions in the perinatal population in June 2022. The search was conducted in MEDLINE, EMBASE, PsycInfo, CINAHL, Cochrane Central Register of Controlled Trials, Web of Science, Applied Social Sciences Index & Abstracts, ClinicalTrials.gov and MedRxiv. Hand searching of references from select articles was also performed.

Selection Criteria

Included studies described an intervention for those experiencing IPV during the perinatal period, including 12 months before pregnancy, while pregnant or in the 12 months post-partum. The search encompassed January 2000 to June 2022 and only peer-reviewed studies written in either English or French were included. Included interventions focused on the survivor exposed to IPV, rather than healthcare professionals administering the intervention. Interventions designed to reduce IPV revictimization or any adverse maternal, obstetrical, or neonatal health outcomes as well as social outcomes related to IPV victimization were included.

Data Collections and Analysis

We used standard methodological procedures expected by The Campbell Collaboration.

Main Results

In total, 10,079 titles and abstracts were screened and 226 proceeded to full text screening. A total of 67 studies included perinatal IPV interventions and were included in the final sample. These studies included a total of 27,327 participants. Included studies originated from 19 countries, and the majority were randomized controlled trials (n = 43). Most studies were of moderate or low quality. Interventions included home visitation, educational modules, counseling, and cash transfer programs and occurred primarily in community obstetrician and gynecologist clinics, hospitals, or in participants' homes. Most interventions focused on reducing revictimization of IPV (n = 38), improving survivor knowledge or acceptance of violence, knowledge of community resources, and actions to reduce violence (n = 28), and improving maternal mental health outcomes (n = 26). Few studies evaluated the effect of perinatal IPV interventions on obstetrical, neonatal or child health outcomes.

Authors' Conclusions

The majority of intervention studies for perinatal IPV focus on reducing revictimization and improving mental health outcomes, very few included obstetrical, neonatal, and other physical health outcomes. Future interventions should place a larger emphasis on targeting maternal and neonatal outcomes to have the largest possible impact on the lives and families of IPV survivors and their infants.

Intimate Partner Violence and HIV Pre-Exposure Prophylaxis Care Engagement Among Sexual Minority Men: A Systematic Review

Sexual minority men (SMM) who experience intimate partner violence (IPV) may also be at increased risk for HIV; however, little is known about the relationship between these experiences and the utilization of pre-exposure prophylaxis (PrEP) for HIV prevention. This systematic review aimed to synthesize available literature to examine the complex interplay between IPV experiences and engagement in the PrEP care continuum among SMM. A comprehensive search following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines in Embase, PubMed, PsycINFO, Web of Science, Medline, and CINAHL identified only 13 relevant articles, most of which were conducted in the United States (n = 9) and only two in low- and middle-income countries (LMICs). Nearly all studies (n = 12, 92.3%) were quantitative in design and used cross-sectional data. The findings of this review identified critical gaps in measuring IPV and PrEP outcomes and revealed mixed findings regarding the complex interplay between IPV and PrEP care engagement in the context of syndemics experienced by SMM. The results highlight the critical need for future research to understand the impact of IPV on PrEP uptake and adherence and its underlying mechanisms. This includes investigating the effects of different types of IPV (e.g., emotional, physical, sexual) on PrEP utilization and how these experiences influence PrEP preferences, such as daily PrEP versus on-demand PrEP or long-acting injectable PrEP. The implications of this review call for comprehensive public health policies and integrated health care practices that provide tailored interventions for IPV screening in PrEP care settings to deliver IPV services and promote engagement in the PrEP care continuum among SMM, as well as further investigation in LMICs.

Risks of Severe Assault and Intimate Partner Homicide among Transgender and Gender Diverse Intimate Partner Violence Survivors: Preliminary Findings from Community Listening Sessions

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.

Intimate partner violence survivors' reported experiences of discrimination in mental health treatment settings

Research indicates that survivors of intimate partner violence (IPV) face substantial stigma and discrimination, with varying impacts based on demographic factors such as race and income. This study explored perceived discrimination among 88 IPV survivors across different racial backgrounds and income levels in mental health settings. Participants completed a mixed-method electronic survey assessing discrimination experiences related to survivor status, income, and race within mental health treatment. Results revealed high levels of perceived discrimination based on survivor status among both racially minoritized and majoritized survivors. However, racially minoritized survivors reported greater racial discrimination and associated stress within mental healthcare settings. Regardless of income level, all survivors reported significant discrimination experiences. Qualitative analysis highlighted factors perceived as helpful or unhelpful within mental health settings. This study underscores the need for further research on socioeconomic influences on stigma experiences among IPV survivors and suggests implications for provider training to better support survivors, especially those from diverse racial backgrounds.

Social-ecological barriers and facilitators to seeking inpatient psychiatric care among transgender and nonbinary people: A qualitative descriptive study

AIM(S)

To assess barriers and facilitators to seeking inpatient psychiatric treatment among transgender and nonbinary people.

DESIGN

Qualitative interview study.

METHODS

Semi-structured interviews were conducted from March 2019 to June 2022 with transgender and nonbinary people admitted to an inpatient psychiatric hospital in the United States during the past 5 years. Data were analysed using thematic analysis and constructed within a modified social-ecological model of stigma. Standards for Reporting Qualitative Research were used for this study.

RESULTS

Participants (N = 15) described barriers and facilitators across all three social-ecological levels. i) Individual themes included distrust of the mental healthcare system, feeling unsafe, loss of autonomy, minimizing one's own mental health needs, and feelings of accountability to others. ii) Interpersonal themes included: lack of support for transgender/nonbinary identity, limited transgender/nonbinary knowledge among mental healthcare professionals, and allyship. iii) Structural themes included: carceral setting, financial costs, and availability of non-profit treatment options.

CONCLUSION

Multi-level themes were identified as barriers and facilitators to seeking inpatient psychiatric care for transgender and nonbinary people, providing opportunities among inpatient settings to improve care delivery and engagement. Greater health equity can be achieved by addressing barriers to care.

IMPLICATIONS

Incorporating inclusive and affirming practices in inpatient psychiatric services presents an opportunity to reduce barriers to seeking care.

IMPACT

The present study describes the experiences of transgender and nonbinary people as they determine whether to voluntarily seek inpatient psychiatric treatment. This perspective allows nurses, health systems, and policymakers to integrate transgender and nonbinary people's needs to improve healthcare delivery.

PATIENT/PUBLIC CONTRIBUTION

Transgender and nonbinary participants were recruited in collaboration with community organizations. Members of the transgender and nonbinary community participated in study design development and analysis and were part of the study team.

Implementation and Impact of Intimate Partner Violence Screening Expansion in the Veterans Health Administration: Protocol for a Mixed Methods Evaluation

BACKGROUND

Intimate partner violence (IPV) is a significant public health problem with far-reaching consequences. The health care system plays an integral role in the detection of and response to IPV. Historically, the majority of IPV screening initiatives have targeted women of reproductive age, with little known about men's IPV screening experiences or the impact of screening on men's health care. The Veterans Health Administration (VHA) has called for an expansion of IPV screening, providing a unique opportunity for a large-scale evaluation of IPV screening and response across all patient populations.

OBJECTIVE

In this protocol paper, we describe the recently funded Partnered Evaluation of Relationship Health Innovations and Services through Mixed Methods (PRISM) initiative, aiming to evaluate the implementation and impact of the VHA's IPV screening and response expansion, with a particular focus on identifying potential gender differences.

METHODS

The PRISM Initiative is guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) and Consolidated Framework for Implementation Research (CFIR 2.0) frameworks. We will use mixed methods data from 139 VHA facilities to evaluate the IPV screening expansion, including electronic health record data and qualitative interviews with patients, clinicians, and national IPV program leadership. Quantitative data will be analyzed using a longitudinal observational design with repeated measurement periods at baseline (T0), year 1 (T1), and year 2 (T2). Qualitative interviews will focus on identifying multilevel factors, including potential implementation barriers and facilitators critical to IPV screening and response expansion, and examining the impact of screening on patients and clinicians.

RESULTS

The PRISM initiative was funded in October 2023. We have developed the qualitative interview guides, obtained institutional review board approval, extracted quantitative data for baseline analyses, and began recruitment for qualitative interviews. Reports of progress and results will be made available to evaluation partners and funders through quarterly and end-of-year reports. All data collection and analyses across time points are expected to be completed in June 2026.

CONCLUSIONS

Findings from this mixed methods evaluation will provide a comprehensive understanding of IPV screening expansion at the VHA, including the implementation and impact of screening and the scope of IPV detected in the VHA patient population. Moreover, data generated by this initiative have critical policy and clinical practice implications in a national health care system.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/59918.

Lifetime sexual violence among transgender women and travestis (TGW) in Brazil: Prevalence and associated factors

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.

Improving Knowledge and Competency in Gender-Affirming Patient Care Among New Nurses in Sexual and Reproductive Health Care

OBJECTIVE

To improve knowledge and competency in providing gender-affirming patient care among newly licensed registered nurses (RNs) working in sexual and reproductive health (SRH).

DESIGN

Pilot, pretest/posttest, descriptive design.

SETTING AND PARTICIPANTS

Participating RNs were employed at a large academic health center in the southeastern United States. All RNs were providing SRH nursing and participating in the health center's new nurse residency program.

METHODS AND INTERVENTION

Participants completed an online synchronous training that introduced topics such as sex versus gender, gender dysphoria, and health disparities. This education was followed by in-person training, where an unfolding case study applied concepts to theoretical patient scenarios specific to reproductive health. Participants completed a 20-item survey with a single assessment retrospective pre-post design to measure change in knowledge and competency.

RESULTS

Twelve RNs participated in this pilot study. Fewer than half had previously received instruction on providing care to trans∗ persons. Seven self-perceived knowledge and competency areas were evaluated with paired retrospective pre-post design questions. All areas measured showed increases from pretraining to posttraining. Participants also had the opportunity to respond to open-ended questions. Common themes identified in these responses include participants planning to maintain a greater awareness and intentionality with language and abandoning cisgender assumptions. Several participants also described health care-specific systemic barriers that could prevent a trans∗ patient from feeling comfortable.

CONCLUSION

Providing new graduate nurses with education specific to trans∗ patients may help them to feel more knowledgeable and competent when caring for these individuals in SRH settings.

"I Don't Think the Police Think We're Human": Legal Socialization Among Young Transgender Women

Legal socialization is the process by which individuals develop values, attitudes, and behaviors related to the law and legal authorities. Legal socialization also includes beliefs about procedural justice, police legitimacy, and legal cynicism. To date, few studies have examined the legal socialization processes of transgender women, a worrisome omission given high rates of police contact, arrest, harassment, and violence among transgender women, particularly transgender women of color. This study examines transgender women's experiences with and perceptions about the police, including experiences of procedural injustice and how they impact police legitimacy and cynicism, among a racially diverse sample of transgender women living in Chicago. Participants described undergoing a secondary legal socialization process after beginning to transition. The study also documented strategies transgender women use to prevent police contact and arrest.

The association between emotional and physical intimate partner violence and COVID-19 vaccine uptake in a community-based U.S. Cohort

Objective

To estimate risk of being unvaccinated against COVID-19 by experience of intimate partner violence (IPV).

Methods

Among 3,343 partnered individuals in a community-based U.S. cohort, we quantified emotional and physical IPV experienced between March and December 2020 and estimated risk of being unvaccinated against COVID-19 through June 2021 by experience of IPV. Experience of recent IPV was defined as endorsement of more frequent or severe IPV since the start of the pandemic or report of any past-month IPV in at least one of four follow-up surveys conducted by the end of December 2020. We created a three-level composite variable - no experience of IPV, experience of emotional but not physical IPV, and experience of physical IPV.

Results

Cisgender women, non-binary, or transgender individuals who reported experiencing emotional, but not physical, IPV and those who reported experiencing physical IPV were both at significantly higher risk of being unvaccinated for COVID-19 compared to those who reported experiencing no IPV (ARRemotional violence: 1.28 [95 % CI: 1.09 - 1.51]; ARRphysical violence: 1.70 [95 % CI: 1.41 - 2.05]). Cisgender men who reported experiencing physical IPV were also at significantly higher risk of being unvaccinated for COVID-19 (ARRphysical violence: 1.52 [95 % CI: 1.15 - 2.02]).

Conclusions

IPV may increase the risk of low vaccine uptake. Results highlight the need to incorporate IPV prevention and support into public health responses, with targeted resources and consideration for reducing barriers to public health interventions among those impacted.

Concepts and Approaches in the Management of Transgender and Gender-Diverse Patients

The terms transgender and gender diverse (TGD) describe persons whose gender is different from the sex assigned to them at birth. While TGD persons have experienced a rise in cultural and social visibility in recent decades, they continue to experience significant health inequities, including adverse health outcomes and multiple barriers to accessing medical care. Transgender and gender-diverse persons are at a higher risk for pain conditions than their cisgender counterparts, but research on chronic pain management for TGD persons is lacking. Clinicians from all disciplines must be informed of best practices for managing chronic pain in the TGD population. This includes all aspects of care including history, physical examination, diagnosis, treatment, and perioperative management. Many TGD persons report delaying or avoiding care because of negative interactions with medical practitioners who do not have sufficient training in navigating the specific health care needs of TGD patients. Furthermore, TGD persons who do seek care are often forced to educate their practitioners on their specific health care needs. This paper provides an overview of existing knowledge and recommendations for physicians to provide culturally and medically appropriate care for TGD persons.

Intimate partner violence is related to future alcohol use among a nationwide sample of LGBTQIA+ people: Results from The PRIDE Study

BACKGROUND

Lesbian, gay, bisexual, transgender, queer, intersex, aromantic and asexual (LGBTQIA+) communities in the United States experience higher rates of alcohol use than the general population. While experiencing intimate partner violence (IPV) is thought to lead to increased alcohol use in LGBTQIA+ people, little research has investigated the temporal relationship between IPV and alcohol use in this population.

METHODS

Data from two annual questionnaires of The Population Research in Identity and Disparities for Equality Study (The PRIDE Study) longitudinal cohort (n=3,783) were included. Overall IPV and three sub-types (physical, sexual, and emotional) - measured in 2021 using the extended Hurt, Insult, Threaten, Scream (E-HITS) screening tool - was examined as a predictor of Alcohol Use Disorders Identification Test (AUDIT) score in 2022 using multivariable linear regression to assess linear and quadratic associations. Models were adjusted for sociodemographic characteristics and history of alcohol use.

RESULTS

One-quarter (24.7%) of respondents reported experiencing past-year IPV in 2021. The mean AUDIT score in 2022 was 3.52 (SD = 4.13). In adjusted models, both linear (B: 0.26, 95% CI: 0.14, 0.38) and quadratic (B: -0.03, 95% CI: -0.04, -0.01) terms for overall IPV were significantly associated with next-year AUDIT score. These patterns were mirrored in each IPV sub-type, were not attenuated when accounting for relationship characteristics, and were heterogeneous across gender identity groups.

CONCLUSIONS

These results provide evidence of a temporal relationship between IPV and alcohol use in LGBTQIA+ communities, suggesting that efforts to prevent and mitigate IPV may help reduce alcohol use disparities in this population.

Identifying best practices for substance-related intimate partner violence screening and referral: a narrative review

Introduction

Substance use is strongly associated with intimate partner violence (IPV) and is a modifiable risk factor for IPV. However, lack of comprehensive screening and referral for co-occurring IPV and substance use, along with their psychiatric sequalae, limits the identification and implementation of effective interventions for substance-related IPV. This narrative review (1) investigates the literature on screening and referral practices for IPV, and if these include screening for substance use or other psychiatric comorbidities, (2) provides recommendations for current best practices, and (3) suggests future directions for research and practice aimed at identifying and reducing substance-related IPV.

Methods

A narrative literature review examined studies investigating IPV screening and referral programs in clinics. Selected studies were reviewed for: (1) effectiveness, (2) barriers to implementation and sustainability, and (3) responsivity to psychiatric comorbidity, including substance use and substance use disorders (SUD).

Results

Findings suggest that effective IPV screening and referral programs have been developed, but disparities in IPV screening exist and many programs only screen for IPV victimization. Barriers to the implementation and sustainability of IPV screening programs include lack of ongoing provider training, funding or institutional support, and direct connection to referral services. Further, many IPV screening programs lack assessment of and referral for comorbid psychiatric conditions, including substance use, and tend not to be routinely implemented in SUD clinics.

Discussion

Additional systematic work is needed to develop universal and comprehensive screening and referral programs for substance-related IPV and address issues of long-term sustainability, particularly within SUD treatment settings.

Associations among intimate partner violence, suicidal ideation, suicide behaviors, non-suicidal self-injury, and psychological well-being in Black American emerging adults

BACKGROUND

Suicidal ideation and behavior and non-suicidal self-injury (NSSI) among Black emerging adults is a major public health concern. Intimate partner violence (IPV) is a significant risk factor for suicidal ideation and behavior and NSSI, but there is little work examining the buffering effect of psychological well-being (PWB). The purpose of this study was to examine the associations between IPV, suicide ideation and behavior, and NSSI, and the moderating role of PWB on these associations.

METHOD

Secondary data analyses were conducted using a subsample of Black American emerging adults (N = 4694) from the National College Health Assessment.

RESULTS

IPV was associated with greater odds of suicide ideation, past-year suicide attempt, and NSSI. PWB was associated with lower odds of suicide ideation, past-year suicide attempt, and NSSI. PWB did not moderate the relationships between IPV and the outcomes.

CONCLUSIONS

IPV was a risk factor for suicidal ideation, suicide attempt, and NSSI among Black American emerging adults. PWB was associated with lower suicidal ideation and behavior and NSSI engagement, suggesting it can be a protective factor. Bolstering PWB in Black communities may be beneficial in intervention and prevention efforts.

Prevalence, Determinants, and Trends in the Experience and Perpetration of Intimate Partner Violence Among a Cohort of Gay, Bisexual, and Other Men Who Have Sex with Men in Montréal, Toronto, and Vancouver, Canada (2017-2022)

Purpose: Longitudinal data on the experience and perpetration of intimate partner violence (IPV) among gay, bisexual, and other men who have sex with men (GBM) are limited. We estimated the prevalence of past 6-month (P6M) physical and/or sexual IPV (hereafter IPV) experience and perpetration, identified their determinants, and assessed temporal trends, including the impact of the coronavirus disease (COVID)-19 pandemic. Methods: We used data from the Engage Cohort Study (2017-2022) of GBM recruited using respondent-driven sampling in Montréal, Toronto, and Vancouver. Adjusted prevalence ratios (aPRs) for determinants and self-reported P6M IPV were estimated using generalized estimating equations, accounting for attrition (inverse probability of censoring weights) and relevant covariates. Longitudinal trends of IPV were also assessed. Results: Between 2017 and 2022, 1455 partnered GBM (median age 32 years, 82% gay, and 71% White) had at least one follow-up visit. At baseline, 31% of participants experienced IPV in their lifetime and 17% reported ever perpetrating IPV. During follow-up, IPV experience was more common (6%, 95% confidence interval [CI]: 5%-7%) than perpetration (4%, 95% CI: 3%-5%). Factors associated with P6M IPV experience included prior IPV experience (aPR: 2.68, 95% CI: 1.76-4.08), lower education (aPR: 2.31, 95% CI: 1.32-4.04), and substance use (injection aPR: 5.05, 95% CI: 2.54-10.05, non-injection aPR: 1.68, 95% CI: 1.00-2.82). Similar factors were associated with IPV perpetration. IPV was stable over time; periods of COVID-19 restrictions were not associated with IPV changes in this cohort. Conclusion: Prevalence of IPV was high among GBM. Determinants related to marginalization were associated with an increased risk of IPV. Interventions should address these determinants to reduce IPV and improve health.

"It definitely changed me": Exploring sexual and gender diverse people's experiences with intimate partner violence in Ontario, Canada

INTRODUCTION

Intimate partner violence (IPV) involves an individual committing acts intended to harm or intimidate a current or former romantic partner. The COVID-19 pandemic and subsequent stay-at-home orders often trapped victims with perpetrators and intensified IPV. Although sexual and gender diverse people disproportionately experience IPV compared to cisgender, heterosexual people, their experiences are not well documented in the Canadian context. This study aimed to explore the experiences of Two-Spirit, lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexual and gender diverse (2S/LGBTQIA+) people with IPV in Ontario and how the COVID-19 pandemic affected their IPV experiences.

METHODS

We conducted in-depth, semi-structured interviews with self-identified 2S/LGBTQIA+ people who experienced IPV on/after March 15, 2020. We audio-recorded and transcribed all interviews and coded the transcripts for content and themes using inductive and deductive techniques.

RESULTS

Our 20 participants experienced physical, psychological, sexual, and financial abuse. Technology-facilitated violence extended abuse geographically and temporally. IPV experiences were associated with negative mental health outcomes that were intensified by the COVID-19 pandemic. Participants struggled to see themselves as legitimate victims of IPV. Although participants regretted being victims of violence, many saw their abusive relationship(s) as a learning experience to inform future relationships.

DISCUSSION

Our findings suggest that 2S/LGBTQIA+ people may experience unique forms of identity abuse and may have difficulty recognizing their IPV experiences as abuse. Ensuring that comprehensive sexual health education is trauma-informed, anti-oppressive, and includes information about healthy relationship dynamics, 2S/LGBTQIA+ relationships, and IPV is critical.

Physical, Sexual, and Intimate Partner Violence Among Transgender and Gender-Diverse Individuals

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.

Factors Associated with Sexual Victimization Among Transgender Emerging Adults

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.

Predictors of Adolescent Intimate Partner Sexual Violence Victimization: Patterns of Intersectional Social Positions in a Statewide, School-based Sample

Intimate partner sexual violence (IPSV) is a substantial public health issue faced by youth, with disparities along lines of race, gender, and sexual orientation. Using an intersectional framework, the current study describes the prevalence of self-reported IPSV victimization across intersecting social positions among adolescents. High school students who completed the 2019 Minnesota Student Survey were asked whether they had ever experienced IPSV. Using exhaustive Chi-Square Automatic Interaction Detection (eCHAID), responses were modeled using five indicators: racial/ethnic identity, transgender/genderqueer/genderfluid identity, sex assigned at birth, sexual orientation, and school location. The prevalence of IPSV victimization within each end group identified by the eCHAID varied from 2.6% to 32.0%. The highest prevalence of IPSV among all students was observed in subgroups defined by multiple marginalized social positions; for example, 32.0% among lesbian, gay, bisexual, queer, pansexual, or questioning (LGBQ+) students of color who were transgender, genderqueer, genderfluid or unsure of their gender, and assigned male at birth; 22.8% among LGBQ+ students assigned female at birth and enrolled in a Greater Minnesota (outside of the Twin Cities) school; and 22.2% among Native+ or missing race LGBQ+ students assigned female at birth and enrolled in a metropolitan school. Within the eCHAID decision tree, several subsamples of students were split into two more subsamples with a twofold or greater statistically significant difference in IPSV victimization prevalence between them. Findings from this study highlight notable disparities in the prevalence of IPSV victimization among Minnesota youth and demonstrate the importance of detailing the distribution of interpersonal violence outcomes across youth with multiple marginalized identities. Findings suggest that disparities reported along one categorical axis only may miss important nuances in how risk for IPSV is distributed. Population health researchers should utilize methods that allow for the explication of complex intersections that characterize individuals' social positions in estimating the prevalence of sexual violence.

Reducing stigma and promoting HIV wellness/mental health of sexual and gender minorities: RCT results from a group-based programme in Nigeria

INTRODUCTION

High levels of HIV stigma as well as stigma directed towards sexual and/or gender minorities (SGMs) are well documented in the African setting. These intersecting stigmas impede psychosocial wellbeing and HIV prevention and care. Yet, there are few if any evidence-based interventions that focus on reducing internalized stigma and promoting mental health and HIV wellness for SGMs in Africa. We developed and evaluated a group-based intervention drawing on cognitive behavioural therapy (CBT) strategies for men who have sex with men (MSM) and transgender women (TGW) at risk for or living with HIV in Lagos, Nigeria.

METHODS

The intervention comprised four weekly in-person group sessions facilitated by community health workers. We conducted a delayed intervention group randomized controlled trial (April-September 2022), with pre-post surveys plus 3-month follow-up (immediate group only), as well as qualitative research with participants and programme staff. Outcomes included internalized stigma related to SGM and HIV status, depression, resiliency/coping and pre-exposure prophylaxis (PrEP)/HIV treatment use.

RESULTS

Mean age of the 240 participants was 26 years (range 18-42). Seventy-seven percent self-identified as MSM and 23% TGW; 27% were people with HIV. Most (88%) participants attended all four sessions, and 98% expressed high intervention satisfaction. There was significant pre-post improvement in each psychosocial outcome, in both the immediate and delayed arms. There were further positive changes for the immediate intervention group by 3-month follow-up (e.g. in intersectional internalized stigma, depression). While baseline levels of ever-PrEP use were the same, 75% of immediate-group participants reported currently using PrEP at 3 months post-intervention versus 53% of delayed-group participants right after the intervention (p<0.01). Participants post-intervention described (in qualitative interviews) less self-blame, and enhanced social support and resilience when facing stigma, as well as motivation to use PrEP, and indicated that positive pre-intervention changes in psychosocial factors found in the delayed group mainly reflected perceived support from the study interviewers.

CONCLUSIONS

This study demonstrated the feasibility and acceptability of a group-based CBT model for MSM and TGW in Nigeria. There were also some indications of positive shifts related to stigma, mental health and PrEP, despite issues with maintaining the randomized design in this challenging environment.

Examining the Risks of Multiple Types of Interpersonal Victimization for Transgender and Gender Non-Conforming College Students

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.

Emotional Clarity and Psychopathology in Women Who Have Experienced Physical Intimate Partner Violence

Intimate partner violence (IPV) is a chronic, traumatic stressor related to posttraumatic stress (PTS), depression, and anxiety. As psychological symptoms are exacerbated in those with poor emotional clarity, the present study evaluates the relationship between emotional clarity and PTS, dissociation, depression, and worry in women who experienced at least one instance of physical IPV (n = 88). Hierarchical regression analyses, controlling for childhood trauma, IPV abuse severity, and IPV-related brain injury, found that lack of emotional clarity was significantly related to greater PTS, dissociative experiences, depression, and worry. Results suggest that emotional clarity may be a relevant therapeutic target for individuals with a history of IPV and psychological distress.

Daily and Momentary Associations Between Gender Minority Stress and Resilience With Alcohol Outcomes

BACKGROUND AND PURPOSE

Minority stressors have been linked with alcohol use among transgender and gender diverse (TGD); however, no ecological momentary assessment studies have examined daily links between minority stress and alcohol use specifically among TGD. This study examined gender minority stressors and resilience as predictors of same-day or momentary alcohol-related outcomes. Feasibility and acceptability of procedures were evaluated.

METHODS

Twenty-five TGD adults (mean age = 32.60, SD = 10.82; 88% White) were recruited Canada-wide and participated remotely. They completed 21 days of ecological momentary assessment with daily morning and random surveys (assessing alcohol outcomes, risk processes, gender minority stressors, resilience), and an exit interview eliciting feedback.

RESULTS

Gender minority stress had significant and positive within-person relationships with same-day alcohol use (incidence risk ratio (IRR) = 1.12, 95% confidence interval [CI] [1.02, 1.23]), alcohol-related harms (IRR = 1.14, 95% CI [1.02, 1.28]), and coping motives (IRR = 1.06, 95% CI [1.03, 1.08]), as well as momentary (past 30-min) alcohol craving (IRR = 1.32, 95% CI [1.18, 1.47]), coping motives (IRR = 1.35, 95% CI [1.21, 1.51]), and negative affect (IRR = 1.28, 95% CI [1.20, 1.36]). Gender minority stress indirectly predicted same-day drinking via coping motives (ab = 0.04, 95% CI [0.02, 0.08]). Resilience was positively associated with same-day alcohol use (IRR = 1.25, 95% CI [1.03, 1.51]) but not harms.

CONCLUSIONS

TGD adults may use alcohol to cope with gender minority stress, which can increase the risk for alcohol-related harms. Interventions are needed to eliminate gender minority stressors and support adaptive coping strategies.

Violence Against Women as a Global Public Health Issue

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.

Adverse childhood experiences and intimate partner violence: A meta-analysis

Intimate partner violence (IPV) represents a significant public health concern. Adverse childhood experiences (ACEs) represent one risk factor for IPV, however, the results of existing research on the association between ACEs and IPV demonstrate mixed findings. The present research sought to meta-analytically examine the association between ACEs and (a) IPV perpetration and (b) IPV victimization. Moderator analyses were conducted to determine factors that may impact the association between ACEs and IPV involvement. Electronic searches were conducted in MEDLINE, Embase, and PsycINFO in August of 2021. One-hundred and twenty-three records were screened for inclusion. All studies included a measure of ACEs and IPV victimization or perpetration. Among the 27 studies and 41 samples included in the meta-analysis, 65,330 participants were included. The results of the meta-analyses demonstrated that ACEs were positively associated with IPV perpetration and victimization. Significant methodological and measurement moderators further inform our understanding of ACEs and IPV involvement. The present meta-analyses demonstrates that trauma-informed approaches to IPV screening, prevention, and intervention may be useful, given that individuals who are involved with IPV may be more likely to possess a history of ACEs exposure.

Routine Sensitive Enquiry of Adult Interpersonal Trauma in Community Mental Health Teams: An Audit of the Initial Assessment Tool

This audit aimed to evaluate the utility of the Initial Assessment Tool (IAT) in documenting routine sensitive enquiry of adult interpersonal trauma within three Community Mental Health Teams (CMHTs) in North-East Glasgow. In addition, it sought to evaluate if disclosures informed patient risk assessments and if patients were signposted to additional support services. 57% of 90 IATs had evidence of routine sensitive enquiry. Of 51 casefiles with evidence of routine sensitive enquiry, 61% had evidence of the information informing their risk assessments and 14% had documented recommendations of support organisations. The IAT appeared able to assist clinicians with routine sensitive enquiry in adulthood. However, there may be advantage in supporting staff understanding of how to ask questions to specific populations and to use this information to inform treatment planning. Given the prevalence of adult interpersonal trauma experienced by patients presenting to CMHTs, trauma-informed approaches to care should be implemented.

Preventive and Sexual Health in LGBTQ+ Older Adults

Sexual health is an important but often overlooked health concern of LGBTQ + older adults. Multiple factors influence sexual health including intersecting identities; adverse life events; coping mechanisms; and psychological, social, and physical health domains. Thus, the use of a culturally competent and comprehensive person-centered approach to sexual health is warranted. In this review, we discuss approaches to engaging LGBTQ + older adults to ensure they are able to achieve their sexual health priorities and prevent new human immunodeficiency virus infections. We also discuss doxycycline postexposure prophylaxis to prevent other sexually transmitted infections and the impact of chemsex.

"Nobody has written the book about what non-binary people should put forward in relationships": Exploring gender equity in relationships of queer, trans, and non-monogamous young women and non-binary youth in British Columbia, Canada

Understanding the unique ways in which queer, trans, and non-monogamous young women and non-binary youth navigate and negotiate equitable intimate relationships is a first step toward strong research, programs/resources, and policies to support healthy relationship dynamics across the life course. Using a youth-engaged collaborative Reflexive Thematic Analysis, we aimed to explore how youth of diverse genders and relationship experiences understand gender equity in their relationships. Thirty cis- and transgender inclusive young women (46.7%) and non-binary youth (53.3%) aged 17-29 who were in a current (76.6%) or recent (in past 12 months, 23.4%) non-heterosexual and/or non-monogamous intimate relationship and residing in British Columbia, Canada, completed qualitative interviews between August and November 2022. Of the 30 youth, 53.3% reported having experience living as a trans person, 33.3% identified only as bisexual and 10% identified as only lesbian or gay, whereas the remaining 56.7% identified with ≥1 of: queer, pansexual, and demisexual. Participants identified that relationship equity requires: 1) Moving away from cis-heteronormative conceptualizations of gender roles and norms; 2) Actively working to dismantle hierarchal power structures by sharing power, responsibility, labour, and decision-making; and 3) Accommodating and affirming each person's unique needs and identities in a relationship. For theme one, youth further described the ways in which they re-imagined relationship norms and discussed the various challenges to resisting ingrained hierarchical cis-heteronormativity. This research contributes a greater understanding of how to create equitable and healthy relationships and has important implications for healthcare providers, educators, and policymakers working with queer, transgender, and non-monogamous youth.

The Link Between Intimate Partner Violence and Food Insecurity: A Review of Quantitative and Qualitative Studies

Intimate partner violence (IPV) and food insecurity are global health issues that affect millions of people worldwide. Numerous studies show that IPV and food insecurity are linked; however, there is a lack of synthesis of this research. Using a systematic search and review, we examined the international quantitative and qualitative research published on the link between IPV and food insecurity. We searched for peer-reviewed, English-language articles with participants above the age of 16 in 4 large online databases. Fifty-six studies were included from around the world that discussed the link between food insecurity and IPV perpetration and/or victimization. We found evidence in both qualitative and quantitative studies for a meaningful connection between these two global health isues. We also reviewed the literature on moderators and mediators (e.g., mental health). Our findings indicate the importance of implementing IPV prevention strategies which also address household food insecurity, and the potential for food insecurity resources to provide IPV resources. Future research should focus more frequently on IPV perpetration as opposed to victimization, and further examine the moderating and mediating mechanisms that inform the link between IPV and food insecurity.

Correlation between gender-based violence and poor treatment outcomes among transgender women living with HIV in Brazil

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.

Gynecologic Care for Sexual and Gender Minority Patients

Sexual and gender minority (SGM) people, including lesbian, gay, bisexual, transgender, and queer individuals, are a diverse population with a wide spectrum of gynecologic needs. Institutionalized cisheteronormativity, stigmatization, lack of provider training, and fear of discrimination contribute to health disparities in this patient population. In this article, we review key topics in the gynecologic care of SGM patients and provide strategies to enable gynecologists to provide SGM people with equitable and inclusive full spectrum reproductive health care.