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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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2
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Puckett JA, Domínguez S, Matsuno E. Measures of Resilience: Do They Reflect the Experiences of Transgender Individuals? Transgend Health 2024; 9:1-13. [PMID: 38312450 PMCID: PMC10835151 DOI: 10.1089/trgh.2022.0015] [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: 11/07/2022] Open
Abstract
Resilience is often viewed as the ability to bounce back from challenges. This conceptualization tends to be individualistic and can be less fitting for marginalized communities. Research with transgender and gender-diverse (TGD) individuals has shown that resilience can manifest in various ways, such as developing pride in one's identity, connection to a TGD community, or advocating against oppression. Given these conflicting views, we sought to (1) describe common themes in TGD people's experience of resilience by pooling information from qualitative research; and (2) evaluate how well quantitative measures of resilience reflected the ways that TGD people define resilience in qualitative research. We reviewed articles published from January 2010 to January 2020. Our search for research on resilience in TGD samples revealed 33 quantitative articles and 17 qualitative articles. We developed a codebook from the qualitative articles by retrieving information about themes from these past studies (e.g., developing motivation and agency, pride or positive self-image). We also reviewed the quantitative studies and retrieved the measures used to assess resilience, followed by coding these scales to understand whether the themes from the qualitative data were reflected in the quantitative measures of resilience. Overall, themes related to social support were common across the measures. However, other themes were not reflected in any measures, such as self-definition of gender, hope, and self-advocacy. Our research demonstrates the discrepancy between qualitative research on TGD resilience and quantitative measurement of resilience. Measure development that more fully reflects TGD people's experiences is key to advancing this research.
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Affiliation(s)
- Jae A Puckett
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - Sergio Domínguez
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Em Matsuno
- Department of Counseling and Counseling Psychology, Arizona State University, Tempe, Arizona, USA
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3
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Gottvall M, Kissiti R, Ainembabazi R, Bergman H, Eldebo A, Isaac R, Yasin S, Jirwe M, Carlsson T. Mental health and societal challenges among forced migrants of diverse sexual orientations, gender identities and gender expressions: health professionals' descriptions and interpretations. CULTURE, HEALTH & SEXUALITY 2024:1-16. [PMID: 38250794 DOI: 10.1080/13691058.2023.2298479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024]
Abstract
The aim of this study was to explore health professionals' descriptions and interpretations of post-migration mental health and societal challenges among forced migrants with diverse sexual orientations, gender identities and gender expressions. Participants representing seven professions were recruited by a combination of convenience, purposive and snowball sampling. Data were collected through focus groups and individual interviews, analysed with systematic text condensation in a collaborative process involving researchers, clinicians and migrants with lived experiences. Participants described a challenging trajectory for migrants, as migrants venture through an uncertain and demanding journey impacting their mental health. Needing to deal with legal requirements, stressful circumstances and normative expectations during the asylum process were highlighted as major challenges, along with exposure to discrimination, violence, abuse and lack of psychosocial safety. Participants described significant psychological distress among migrants, including loneliness and shame. Challenges were also recognised related to exploring, accepting and expressing sexuality and gender. Loneliness and shame are major challenges in need of further attention in research, which could be addressed through the development and evaluation of actions, programmes and interventions to provide peer support.
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Affiliation(s)
- Maria Gottvall
- The Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden
- The Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Rogers Kissiti
- The Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden
| | - Ronah Ainembabazi
- The Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden
| | - Hannah Bergman
- The Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden
| | - Anna Eldebo
- The Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden
| | - Rummage Isaac
- The Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden
| | - Sumera Yasin
- The Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden
| | - Maria Jirwe
- The Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden
- The Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Solna, Sweden
| | - Tommy Carlsson
- The Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden
- The Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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4
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Chaudhry A, Hebert-Beirne J, Hanneke R, Alessi EJ, Mitchell U, Molina Y, Chebli P, Abboud S. The Health Needs of Sexual and Gender Minority Migrant Women in the United States: A Scoping Review. LGBT Health 2024; 11:1-19. [PMID: 37540144 DOI: 10.1089/lgbt.2022.0392] [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: 08/05/2023] Open
Abstract
Purpose: This scoping review characterizes the peer-reviewed evidence on the health of first-generation sexual and gender minority (SGM) migrant women to the United States and identifies research gaps and future priorities. Methods: On February 1, 2022, the following databases were searched: PubMed (MEDLINE), Embase, CINAHL Plus with Full Text, APA PsycINFO, and PAIS Index. Primary research studies based in the United States, in English, on first-generation SGM migrants (i.e., immigrants, refugees, asylum seekers) were included. Gray literature and review articles were excluded. Health outcome data were not extracted from nonbinary populations nor transgender men. Themes were generated using qualitative content analysis. Results: Thirty-three studies were reviewed, most were qualitative, and 11 focused on transgender women migrants (especially from Latin America), while only one was exclusively on sexual minority women (SMW) migrants. Premigration experiences of violence and discrimination were linked to high prevalence rates of post-traumatic stress disorder, depression, and anxiety. Postmigration stressors included lack of educational and employment opportunities, reduced access to social services, and experiences of stigma and discrimination, which were also associated with the development of depressive symptoms. Transgender women migrants reported not seeking formal medical care, given a lack of gender-affirming services and insurance resulting in reliance on unsafe informal care networks for hormone therapy and feminization procedures. Conclusion: Future interventions should focus on fostering social support networks of SGM migrant women to help improve their mental health outcomes. Research priorities should include studies on SMW migrants and more quantitative research that could identify additional health needs (i.e., sexual health) of SGM migrant women.
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Affiliation(s)
- Aeysha Chaudhry
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Jeni Hebert-Beirne
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Rosie Hanneke
- Department of Information Services & Research, Library of the Health Sciences, University of Illinois Chicago, Chicago, Illinois, USA
| | - Edward J Alessi
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Uchechi Mitchell
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Yamile Molina
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Perla Chebli
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Sarah Abboud
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
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5
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Alessi EJ, Lee YG, Chikalogwe VP, Tarusarira W, Raymond H, Lynn M, Kahn S. Pilot study of an arts- and theatre-based HIV prevention intervention for men who have sex with men and transgender women migrants in South Africa: acceptability, feasibility and preliminary efficacy. HEALTH EDUCATION RESEARCH 2023; 38:392-411. [PMID: 37229526 DOI: 10.1093/her/cyad021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/27/2023]
Abstract
Innovative approaches addressing the elevated human immunodeficiency virus (HIV) risk among men who have sex with men (MSM) or transgender women (TGW) migrants in South Africa are urgently needed. We sought to present the acceptability, feasibility and preliminary efficacy of 'Externalize and Mobilize!', a multi-session arts- and theatre-based HIV prevention group intervention for MSM and TGW migrants in South Africa. Fourteen participants-MSM (n = 7; 50%), genderqueer/nonbinary persons (n = 4; 29%) and TGW (n = 3; 21%)-in Cape Town were recruited and enrolled in the intervention and administered pre- and post-intervention assessments of HIV knowledge, HIV risk-reduction self-efficacy, stigma and resilience. The intervention, delivered over 4 days, was completed by all 14 participants. Scores on HIV knowledge and HIV risk-reduction self-efficacy were statistically significantly higher at post-intervention compared with pre-intervention. Additionally, participants responded affirmatively (i.e. 'Agree' or 'Strongly agree') on all items assessing intervention acceptability. Findings demonstrate the high acceptability, feasibility and preliminary efficacy of an arts- and theatre-based intervention for increasing HIV knowledge and HIV risk-reduction self-efficacy among MSM and TGW migrants in South Africa. This study provides further support for the use of creative and innovative interventions to address entrenched HIV disparities in South Africa.
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Affiliation(s)
- E J Alessi
- Rutgers University School of Social Work, New Brunswick, NJ 08901, USA
| | - Y G Lee
- Rutgers University School of Social Work, New Brunswick, NJ 08901, USA
| | | | - W Tarusarira
- PASSOP, Cape Town, Western Cape 8001, South Africa
| | - H Raymond
- Rutgers University School of Public Health, Piscataway, NJ 08854, USA
| | - M Lynn
- Rutgers University School of Social Work, New Brunswick, NJ 08901, USA
| | - S Kahn
- McGill University School of Social Work, Montreal, Quebec H3A 1B9, Canada
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6
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Kanamori Y, Jiménez-Etxebarria E, Cornelius-White JHD, Ozamiz-Etxebarria N, Wynne KN, Gorrotxategi MP. Transgender Attitudes and Beliefs Scale-Spanish (TABS-S) Version: Translation and Initial Evaluation of Psychometric Properties. JOURNAL OF HOMOSEXUALITY 2023; 70:831-850. [PMID: 34842511 DOI: 10.1080/00918369.2021.2004797] [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: 06/13/2023]
Abstract
Although the field of transprejudice studies has been growing, the literature suggests a need for quality assessments in languages other than English. To address this need, our study translated the Transgender Attitudes and Beliefs Scale (TABS) and evaluated its psychometric properties for use with Spanish-speaking populations. We recruited participants (N = 605) from American and Spanish samples. Results of the confirmatory factor analysis showed adequate fit, confirming the three-factor structure of TABS-Spanish Version (TABS-S). Correlations with existing measures provided evidence for its convergent and discriminant validity. Known-groups validity of the TABS-S was evidenced through confirming previous findings that females show less transgender prejudice than males. Moreover, the internal consistency of the TABS-S scores was high for the total scale (α = .96) and subscales (α = .87-.96). Overall, there is preliminary evidence to suggest that the TABS-S is a valid and reliable scale appropriate for use with Spanish-speaking populations.
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Affiliation(s)
- Yasuko Kanamori
- Department of Counseling, Leadership, and Special Education, Missouri State University, Springfield, Missouri, USA
| | | | - Jeffrey H D Cornelius-White
- Department of Counseling, Leadership, and Special Education, Missouri State University, Springfield, Missouri, USA
| | - Naiara Ozamiz-Etxebarria
- Department of Developmental and Educational Psychology, University of Basque Country, Leioa, Spain
| | - Kelly N Wynne
- Department of Counseling, Leadership, and Special Education, Missouri State University, Springfield, Missouri, USA
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7
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Morales FR, Nguyen-Finn KL, Haidar M, Mercado A. Humanitarian crisis on the US-Mexico border: Mental health needs of refugees and asylum seekers. Curr Opin Psychol 2022; 48:101452. [PMID: 36084505 DOI: 10.1016/j.copsyc.2022.101452] [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: 07/11/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 01/28/2023]
Abstract
Families and youth from the Northern Triangle of Central America seeking asylum in the U.S. report substantial trauma exposure and post-traumatic stress symptoms. Sexual and gender minorities of this population especially present unique circumstances and thus challenges and needs. However, with immigration along the southern U.S. border at a 21-year high, health and social resources for refugees and asylum seekers are being strained. Accordingly, the primary aim of this review is to raise awareness about migration-related trauma and the mental health needs among Central American and LGBTQ + refugees and asylum seekers in the U.S.-Mexico border. The authors also discuss practical, clinical, and advocacy implications to improve the mental health of refugees and asylum seekers entering the United States.
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Affiliation(s)
- Frances R Morales
- Department of Psychological Science, University of Texas Rio Grande Valley, TX, USA
| | - Kim L Nguyen-Finn
- School of Rehabilitation Services & Counseling, University of Texas Rio Grande Valley, TX, USA
| | - Makram Haidar
- School of Medicine Department of Psychiatry, University of Texas Rio Grande Valley, TX, USA
| | - Alfonso Mercado
- Department of Psychological Science, University of Texas Rio Grande Valley, TX, USA; School of Medicine Department of Psychiatry, University of Texas Rio Grande Valley, TX, USA.
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8
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Castro VA, King WM, Augustaitis L, Saylor K, Gamarel KE. A Scoping Review of Health Outcomes Among Transgender Migrants. Transgend Health 2022; 7:385-396. [PMID: 36644484 PMCID: PMC9829141 DOI: 10.1089/trgh.2021.0011] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose Transgender people constitute diverse populations who experience a range of adverse health outcomes. Despite increasing awareness of adverse health outcomes among migrant populations, there has been a dearth of studies focused on the health of transgender migrants. The goal of this scoping review was to describe common themes and empirical trends in research on the health of transgender migrants and identify gaps for future research and programming. Methods Using a systematic review protocol, we searched PubMed, Embase, Scopus, PsycINFO, CINAHL, and Web of Science with a combination of terms to identify empirical articles that examined health outcomes among transgender migrants. The search included studies published as of May 2019. Results Twenty of 1666 identified records met inclusion criteria. All studies were cross-sectional, and 50% were quantitative designs, 45% were qualitative designs, and 5% were mixed-methods designs. The majority reported on sexually transmitted infections (55%), violence (40%), and mental health (35%). Qualitative studies were generally high quality, while many quantitative studies had high risk of bias. While some adverse health outcomes may abate, stigmatizing social conditions continue to impact transgender migrant's health postmigration. Conclusions Anti-transgender and anti-immigrant stigma may contribute to adverse health outcomes for transgender migrants. Additional research using rigorous inclusive methods to survey a broader range of health domains is needed. The lives of transgender migrants are continuously upended by oppressive policies; therefore, it is vital to continue to expand the breadth of transgender health research.
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Affiliation(s)
- Vanessa A. Castro
- 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
| | - Laima Augustaitis
- University of Michigan School of Information, Ann Arbor, Michigan, USA
| | - Kate Saylor
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan, USA
| | - Kristi E. Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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9
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Estrada F, Jones IJ, Rivera D, Ramirez A, Cerezo A. Trauma and Latinx Sexual- and Gender-Minority Immigrants in the U.S. Curr Opin Psychol 2022; 47:101439. [DOI: 10.1016/j.copsyc.2022.101439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/14/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022]
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10
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Clark KD, Sherman AD, Flentje A. Health Insurance Prevalence Among Gender Minority People: A Systematic Review and Meta-Analysis. Transgend Health 2022; 7:292-302. [PMID: 36033215 PMCID: PMC9398476 DOI: 10.1089/trgh.2020.0182] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Purpose Gender minority (GM) (people whose gender does not align with the sex assigned at birth) people have historically been insured at lower rates than the general population. The purpose of this review is to (1) assess the prevalence of health insurance among GM adults in the United States, (2) examine prevalence by gender, and (3) examine trends in prevalence before and after implementation of the Affordable Care Act. Methods Published articles from PubMed, EMBASE, and Web of Science databases before April 26th, 2019, were included. This review is registered on PROSPERO (CRD42019133627). Analysis was guided by a random-effects model to obtain a meta-prevalence estimate for all GM people and stratified by gender subgroup. Heterogeneity was assessed using a Q-test and I 2 measure. Results Of 55 included articles, a random pooled estimate showed that 75% GM people were insured (95% confidence interval [CI]: 0.71-0.79; p<0.001). Subgroup analysis by gender determined 70% of transgender women (95% CI: 0.64-0.76; p<0.001; I 2=97.16%) and 80% of transgender men (95% CI: 0.77-0.83; p=0.01; I 2=54.51%) were insured. Too few studies provided health insurance prevalence data for gender-expansive participants (GM people who do not identify as solely man or woman) to conduct analysis. Conclusion The pooled prevalence of health insurance among GM people found in this review is considerably lower than the general population. Standardized collection of gender across research and health care will improve identification of vulnerable individuals who experience this barrier to preventative and acute care services.
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Affiliation(s)
- Kristen D. Clark
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Athena D.F. Sherman
- Nell Hodgson Woodruff School of Nursing at Emory University, Atlanta, Georgia, USA
| | - Annesa Flentje
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, California, USA
- Alliance Health Project, Department of Psychiatry and Behavioral Sciences, School of Medicine, UCSF, San Francisco, California, USA
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11
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Bush J, Blackwell CW. Social Media as a Recruitment Strategy with Transgender-Identified Individuals: Using an Ethical Lens to Direct Methodology. J Transcult Nurs 2022; 33:603-614. [PMID: 35699438 DOI: 10.1177/10436596221101928] [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: 11/16/2022] Open
Abstract
Introduction: Researchers are limited when using traditional recruitment methods to access hidden and vulnerable populations, including transgender persons. Social media platforms such as Facebook can provide access to the transgender population and facilitate recruitment of a representative sample. There is little regulatory guidance for using social media as a recruitment strategy. Methodology: This article presents recruitment recommendations based on a study that generated a diverse sample of transgender-identified persons using Facebook as the sole recruitment method. Results: Despite taking precautions, computer bots penetrated the initial survey. A second survey distribution collected data from a diverse sample of transgender-identified individuals. Discussion: Researchers should design social media recruitment methods with attention to privacy and transparency. Thus, using social media platforms such as Facebook to recruit transgender participants that otherwise would be challenging to reach is a viable and ethically sound alternative to traditional recruitment methods.
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Affiliation(s)
- Jake Bush
- University of West Florida, Pensacola, USA
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12
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Lerner JE, Martin JI, Gorsky GS. To Go or Not to Go: Factors That Influence Health Care Use Among Trans Adults in a Non-Representative U.S. Sample. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:1913-1925. [PMID: 35596036 DOI: 10.1007/s10508-022-02302-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 06/15/2023]
Abstract
Trans people tend to utilize health care at rates lower than cisgender people, which commonly results in short-term and long-term unfavorable health outcomes. Theoretically informed by Andersen's behavioral model of health services use and Lerner and Robles' adapted behavioral model of health services use for transgender people, the current study examined how individual characteristics of trans people along with the external environment and health care service environment they must navigate impact their health care utilization. Binary logistic regression was used to analyze data from the 2015 United States Trans Survey (N = 27,715), the largest trans sample to date. Perception of health care provider (HCP) knowledge, health insurance status, and health care costs each produced the strongest effect on visiting a doctor or HCP in the past year. The results showed that having a provider that had some level of knowledge about trans people was potentially most critical to increase utilization. Discussion points include increasing trans-focused curriculum in health professional schools, utilizing trans standardized patients in health professional schools, and holding insurance companies accountable to provide trans affirming care.
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Affiliation(s)
- Justin E Lerner
- School of Social Work, University of Washington, 4101 15th Avenue NE, Seattle, WA, 98105, USA.
| | - James I Martin
- School of Social Work, New York University, New York, NY, USA
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13
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Pinna F, Paribello P, Somaini G, Corona A, Ventriglio A, Corrias C, Frau I, Murgia R, El Kacemi S, Galeazzi GM, Mirandola M, Amaddeo F, Crapanzano A, Converti M, Piras P, Suprani F, Manchia M, Fiorillo A, Carpiniello B. Mental health in transgender individuals: a systematic review. Int Rev Psychiatry 2022; 34:292-359. [PMID: 36151828 DOI: 10.1080/09540261.2022.2093629] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Several lines of evidence indicate the prevalence of mental health disorders in Transgender (TG) individuals is higher than that of cisgender individuals or the general population. In this systematic review, we aim to propose a summary of some of the most significant research investigating mental health disorders' prevalence among this population. We performed a double-blind systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting (PRISMA) on PUBMED/MEDLINE and SCOPUS, specifically using peer-reviewed articles examining the mental health status of transgender (TG) individuals. This review did not exclude any research based on publication date. The last search was performed in February 2022. The employed search strategy led to the selection of 165 peer-reviewed articles. The majority of these papers presented a cross-sectional design with self-reported diagnoses and symptoms, signaling a significant prevalence of mental health disorders amongst TG Individuals. Of the reviewed articles, 72 examined the prevalence of mood and anxiety disorders; 8 examined eating disorders; 43 examined the prevalence of suicidal or self-harm ideation or behaviors; 5 papers examined the prevalence of trauma and stress-related disorders; 10 examined the frequency of personality disorders; 44 examined substance use disorders; and 9 papers examined the prevalence of autism spectrum disorder. Finally, 22 studies reported on the prevalence of TG individuals diagnosed with co-morbid mental health disorders or unspecified mental disorders. Our findings coincide with existing research, which indicates TG individuals do experience a higher prevalence of mental health disorders than that of the general population or cisgender individuals. However, further research is needed to address the existing gaps in knowledge.
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Affiliation(s)
- Federica Pinna
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Pasquale Paribello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Giulia Somaini
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Alice Corona
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Carolina Corrias
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Ilaria Frau
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Roberto Murgia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Sabrina El Kacemi
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Dipartimento ad attività integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Mirandola
- Department of Diagnostics and Public Health, Infectious Diseases Section, University of Verona, Verona, Italy.,School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Andrea Crapanzano
- Department of Counseling, San Francisco State University, San Francisco, California, USA
| | - Manlio Converti
- Dipartimento di salute mentale, ASL Napoli 2 Nord, Naples, Italy
| | - Paola Piras
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Federico Suprani
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy.,Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Bernardo Carpiniello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
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14
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Jia J, Nie XF, Ke L, Liu B, Wang WR. Mental Health and its Influencing Factors Among Immigrants with Chronic Diseases in China. J Immigr Minor Health 2022; 24:1269-1280. [PMID: 35000054 PMCID: PMC8742701 DOI: 10.1007/s10903-021-01311-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 12/17/2022]
Abstract
Immigrants are a special group in society, and their health is of great concern. Few studies have targeted this population in China. A cross-sectional descriptive correlational study was conducted from July to August 2018 in Hubei Province, China. Chi-square tests, Z-tests and multivariable linear regression analysis were performed to analyze the data using SPSS 24.0. A total of 1068 questionnaires were distributed. The results showed that the variables that affected the mental health of the immigrants with chronic diseases included gender, annual income, life events (L), negative emotion (NE), negative coping styles (NC) and objective support (OS) (p ≤ 0.05). Future research should focus on the physical and mental health of different immigrant groups and design effective, individualized interventions to improve the health status of immigrants, especially those with chronic diseases.
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Affiliation(s)
- Jia Jia
- School of Nursing, Hubei University of Medicine, 30 Renmin South Rd., Shi Yan, 422000, Maojian District, China
| | - Xiao-Fei Nie
- School of Nursing, Hubei University of Medicine, 30 Renmin South Rd., Shi Yan, 422000, Maojian District, China.
| | - Li Ke
- School of Nursing, Hubei University of Medicine, 30 Renmin South Rd., Shi Yan, 422000, Maojian District, China
| | - Bing Liu
- School of Nursing, Hubei University of Medicine, 30 Renmin South Rd., Shi Yan, 422000, Maojian District, China
| | - Wen-Ru Wang
- School of Nursing, Hubei University of Medicine, 30 Renmin South Rd., Shi Yan, 422000, Maojian District, China
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15
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Alessi EJ, Cheung S, Kahn S, Yu M. A Scoping Review of the Experiences of Violence and Abuse Among Sexual and Gender Minority Migrants Across the Migration Trajectory. TRAUMA, VIOLENCE & ABUSE 2021; 22:1339-1355. [PMID: 34812109 DOI: 10.1177/15248380211043892] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Violence against sexual and gender minority (SGM) individuals has continued to proliferate globally. Yet, less is known about victimization among subgroups of SGM individuals, especially SGM immigrants, refugees, and asylum seekers. There has been a steady increase in this vulnerable group of migrants over the years, and emerging evidence has pointed to their heightened risk of victimization. We conducted a scoping review of the peer-reviewed literature that examined violence, abuse, and mental health among SGM individuals who migrate internationally. One hundred ninety-nine articles were identified by searching five scholarly databases and hand searching. Twenty-six articles met inclusion criteria. We first used the migration framework, which outlines the distinct phases of the migration trajectory (predeparture, travel, interception, destination, and return), to categorize findings and then identified four overarching themes to capture SGM migrants' experiences at each phase: severe and prolonged violence and abuse related to sexual orientation or gender identity (predeparture); continued victimization and high-risk for sexual violence (travel); detainment- and deportation-related violence and abuse (interception and return); and new manifestations of violence and abuse while living with past trauma (destination). Violence and abuse began in childhood and continued in the host country, where they faced discrimination while managing posttraumatic stress disorder and depression. Findings indicate that SGM migrants are extremely vulnerable to victimization. There is an immediate need for policies to protect SGM individuals worldwide and for affirmative, culturally informed practices to help SGM migrants manage trauma and the structural barriers impeding recovery.
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Affiliation(s)
| | | | | | - Melanie Yu
- Rutgers University, New Brunswick, NJ, USA
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16
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Gailits N, Pastor-Bravo MM, Gastaldo D, Bajwa U, Bilbao-Joseph C, Castro C, Godoy S. Fighting for inclusion across borders: Latin American Trans women's health in Canada. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2021; 23:5-23. [PMID: 35403120 PMCID: PMC8986298 DOI: 10.1080/26895269.2021.1988877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Worldwide, Trans women from Latin America experience some of the highest rates of violence, which has led many to emigrate. There is limited research exploring the experiences of Trans migrants, and most LGBTQI2S + migrant research focuses on immigrant gay men. This study uses the frameworks of Intersectionality and the Social Determinants of Health (SDoH) to examine the impact of migration on the health and wellbeing of Latin American Trans women living in Toronto, Canada. METHODOLOGY This qualitative arts-based study included nine participants and used hand mapping, a sociodemographic questionnaire, and focus groups to generate data. Data analysis encompassed inductive and deductive approaches and rigor was maintained through reflexivity and several verification strategies. RESULTS While migration was used as a safety strategy, participants' multiple identities as immigrants, Trans women, and Latinas, produced compounded experiences of oppression post-migration. Facing transphobia and xenophobia simultaneously, participants were forced to navigate precarious housing and employment, minimal social capital, and low social position. This limited their ability to exercise power and ultimately caused poor health and wellbeing post-migration; however, participants used sophisticated strategies to resist asymmetrical power relations, actively searching for safety and community participation, and caring for themselves and each other. CONCLUSION The participants fought for inclusion across borders of economic exclusion and gender identity, borders of power and social position, as well as geopolitical borders. Their intersectional experiences across these "borders" should be understood in the context of migration without liberation, consumption without income, compounding oppressions, as well as positive intersectionality. While the women's resistance and strength are positive by-products of fighting oppression, they cannot be the solution. Access to health and wellbeing should not be a privilege for some; it must be a right for all.
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Affiliation(s)
- Nicola Gailits
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Global Migration & Health Initiative, University of Toronto, Toronto, Canada
| | - M. M. Pastor-Bravo
- Global Migration & Health Initiative, University of Toronto, Toronto, Canada
- Nursing School of Cartagena, University of Murcia, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca, University of Murcia, Murcia, Spain
| | - D. Gastaldo
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Global Migration & Health Initiative, University of Toronto, Toronto, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - U. Bajwa
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Global Migration & Health Initiative, University of Toronto, Toronto, Canada
| | - C. Bilbao-Joseph
- Global Migration & Health Initiative, University of Toronto, Toronto, Canada
- The Centre for Spanish Speaking Peoples, Toronto, Canada
| | - C. Castro
- Family Service Association, Toronto, Canada
- Ryerson School of Social Work, Ryerson University, Toronto, Canada
| | - S. Godoy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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17
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Hawkey AJ, Ussher JM, Liamputtong P, Marjadi B, Sekar JA, Perz J, Ryan S, Schmied V, Brook E, Dune T. Trans Women's Responses to Sexual Violence: Vigilance, Resilience, and Need for Support. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3201-3222. [PMID: 34697692 DOI: 10.1007/s10508-021-01965-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 05/12/2023]
Abstract
Despite experiencing high rates of sexual violence, there is limited research that explores coping and support needs among trans women of color and those from migrant backgrounds. This article examines the impact of sexual violence, as well as responses and support needs in relation to sexual violence, among 31 trans women of color, aged between 18-54 years, living in Australia. Women were recruited using purposive and snowball sampling, local LGBTQI + networks, and social media. Study advertisements invited participation from people 18 years and older, who identified as a "trans woman of color" or "trans woman from a non-English speaking background," to take part in a study about their lives as trans women of color and experiences of sexual violence. In-depth interviews and photovoice took place between September 2018 and September 2019. Findings were analyzed through thematic analysis, drawing on intersectionality theory. Sexual violence was reported to be associated with fear, anxiety, and depression, and, for a minority of women, self-blame. While women reported hypervigilance and avoiding going out in public as measures to anticipate and protect themselves from sexual violence, they also demonstrated agency and resilience. This included putting time and effort into appearing as a cisgender woman, naming violence, seeking support, rejecting self-blame, and engaging in self-care practices to facilitate healing. Trans women highlighted the need for multi-faceted sexual violence prevention activities to encourage education, empowerment and cultural change across the general population and support services, in order to promote respect for gender, sexuality and cultural diversity.
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Affiliation(s)
- Alexandra J Hawkey
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia.
| | - Jane M Ussher
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Pranee Liamputtong
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Brahmaputra Marjadi
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Jessica Aasha Sekar
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Janette Perz
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Samantha Ryan
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Virginia Schmied
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | | | - Tinashe Dune
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
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18
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Estrada F, Cerezo A, Ramirez A. An Examination of Posttraumatic Stress Disorder-Related Symptoms Among a Sample of Latinx Sexual- and Gender-Minority Immigrants. J Trauma Stress 2021; 34:967-976. [PMID: 34216504 DOI: 10.1002/jts.22714] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 04/03/2021] [Accepted: 05/11/2021] [Indexed: 11/06/2022]
Abstract
Latinx sexual- and gender- minority (SGM) immigrants experience stress across multiple axes of identity, which can lead to negative health consequences. Using an intersectional-cultural theory of stress, the current study sampled 194 Latinx SGM immigrants to examine the association between intersectional discrimination (i.e., race- and sexual orientation-based), acculturative stress, symptoms related to posttraumatic stress disorder (PTSD), and somatic distress. We used moderated hierarchical linear regression analysis to determine whether social support moderated the associations among intersectional discrimination, acculturative stress, and PTSD symptoms. The results showed that after controlling for time in the United States, PTSD symptoms were associated with intersectional discrimination, β = .57, SE = 3.14, p < .001, and acculturative stress, β = .42, SE = 2.47, p < .001, at higher levels of social support. The variability in outcome explained by the variables of interest was approximately 47%. These findings offer important and timely data that can inform future research and clinical applications in this underserved and understudied community.
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Affiliation(s)
- Fernando Estrada
- Department of Specialized Programs in Professional Psychology, Loyola Marymount University, Los Angeles, California, USA
| | - Alison Cerezo
- Department of Counseling, Clinical, and School Psychology, University of California Santa Barbara, Santa Barbara, California, USA
| | - Amaranta Ramirez
- Department of Counseling, Clinical, and School Psychology, University of California Santa Barbara, Santa Barbara, California, USA
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19
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Ciaramella M, Monacelli N, Cocimano LCE. Promotion of Resilience in Migrants: A Systematic Review of Study and Psychosocial Intervention. J Immigr Minor Health 2021; 24:1328-1344. [PMID: 34324124 PMCID: PMC9388436 DOI: 10.1007/s10903-021-01247-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/29/2022]
Abstract
This systematic review aimed to contribute to a better and more focused understanding of the link between the concept of resilience and psychosocial interventions in the migrant population. The research questions concerned the type of population involved, definition of resilience, methodological choices and which intervention programmes were targeted at migrants. In the 90 articles included, an heterogeneity in defining resilience or not well specified definition resulted. Different migratory experiences were not adequately considered in the selection of participants. Few resilience interventions on migrants were resulted. A lack of procedure’s descriptions that keep in account specific migrants’ life-experiences and efficacy’s measures were highlighted.
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Affiliation(s)
- Maria Ciaramella
- Department of Letters, Arts, History and Society, University of Study of Parma, Via Kennedy, 6, 43125, Parma, PR, Italy.
| | - Nadia Monacelli
- Department of Economics and Business Sciences, University of Study of Parma, Parma, Italy
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20
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Maiorana A, Sevelius J, Keatley J, Rebchook G. "She is Like a Sister to Me." Gender-Affirming Services and Relationships are Key to the Implementation of HIV Care Engagement Interventions with Transgender Women of Color. AIDS Behav 2021; 25:72-83. [PMID: 31912274 PMCID: PMC7223907 DOI: 10.1007/s10461-020-02777-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We present findings from qualitative interviews (N = 67) with 36 staff and 31 participants of nine distinct individual and/or group level interventions to engage transgender women of color (TWOC) in HIV care in the U.S. We examine the commonalities amongst the intervention services (addressing unmet basic needs, facilitating engagement in HIV care, health system navigation, improving health literacy, emotional support), and the relationships formed during implementation of the interventions (between interventionists and participants, among participants in intervention groups, between participants and peers in the community). Interventionists, often TWOC themselves, who provided these services developed caring relationships, promoted personal empowerment, and became role models for participants and the community. Intervention groups engaged participants to reinforce the importance of health and HIV care and provided mutual support. Gender affirming services and caring relationships may be two key characteristics of interventions that address individual and structural-level barriers to engage TWOC in HIV care.
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Affiliation(s)
- Andres Maiorana
- Center for AIDS Prevention Studies, University of California San Francisco, 550 16th Street, 3rd floor, Box 0886, San Francisco, CA, 94143, USA.
| | - Jae Sevelius
- Center for AIDS Prevention Studies and Center of Excellence for Transgender Health, University of California San Francisco, San Francisco, CA, USA
| | - JoAnne Keatley
- Center of Excellence for Transgender Health, University of California San Francisco, San Francisco, CA, USA
| | - Greg Rebchook
- Center for AIDS Prevention Studies, University of California San Francisco, 550 16th Street, 3rd floor, Box 0886, San Francisco, CA, 94143, USA
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21
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Farvid P, Vance TA, Klein SL, Nikiforova Y, Rubin LR, Lopez FG. The health and wellbeing of transgender and gender
non‐conforming
people of colour in the United States: A systematic literature search and review. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2021. [DOI: 10.1002/casp.2555] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Panteá Farvid
- Psychology, Schools of Public Engagement The New School New York New York USA
| | - Thomas A. Vance
- Psychology, Schools of Public Engagement The New School New York New York USA
- Boys and Girls Clubs of America Atlanta Georgia USA
| | - Samantha L. Klein
- Psychology, School for Social Research The New School New York New York USA
| | | | - Lisa R. Rubin
- Psychology, School for Social Research The New School New York New York USA
| | - Felix G. Lopez
- Psychology, School for Social Research The New School New York New York USA
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22
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Somatic, Anxiety, and Depressive (SAD) Symptoms in Young Adult Latinx Immigrants: Prevalence and Predictors. J Immigr Minor Health 2021; 23:956-964. [PMID: 34043112 DOI: 10.1007/s10903-021-01218-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
Certain immigration factors may increase somatic, anxiety, and depressive (SAD) symptoms in Latinx immigrants. Our study examined prevalence of SAD symptoms in Latinx immigrants 18-29 presenting to primary care with correlates of acculturation, immigration, and legal status. SAD symptoms were measured using the PHQ-14, GAD-7 and PHQ-8. Moderate somatization (37%), anxiety (20%), and depression (25%) were common. Multivariable analysis found five immigration factors predicted a higher composite SAD score and the presence of each additional factor increased likelihood of a SAD score ≥ 20 (OR 1.7; 95% CI, 1.1 to 2.5). SAD scores increased in a dose-response fashion (8.3, 10.5, 14.8, 17.1, 21.7, 29.3) with the added presence of each factor. Elevated SAD scores were not associated with gender, marital status, education, income, country of origin, or acculturation. Screening with our five factor immigration distress index may help identify patients at risk for higher SAD scores during a primary care visit.
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23
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Ornelas IJ, Yamanis TJ, Ruiz RA. The Health of Undocumented Latinx Immigrants: What We Know and Future Directions. Annu Rev Public Health 2021; 41:289-308. [PMID: 32237989 DOI: 10.1146/annurev-publhealth-040119-094211] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Undocumented Latinx immigrants experience unique factors prior to migration, during migration, and after migration that shape their health. Our review summarizes the limited but growing literature highlighting how exposure to trauma, immigration enforcement, changes to social networks, and discrimination negatively affect the mental and physical health of undocumented Latinx immigrants. We also discuss how policies and social ties can promote their health. We focus on areas of particular concern, including health care, mental health, and HIV. Future research should use interdisciplinary approaches and intersectional frameworks to understand and address health inequities. Conducting research with undocumented Latinx immigrant communities requires community engagement, assurance of confidentiality, and creative recruitment and retention strategies. Recommendations for public health practice include investing in community health centers and organizations to ensure access to health and social services; presenting results with sufficient contextualization to interpret their generalizability; and advocating for federal-, state-, and local-level policy changes that reduce the negative health consequences associated with being undocumented.
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Affiliation(s)
- India J Ornelas
- Department of Health Services, University of Washington, Seattle, Washington 98195, USA; ,
| | - Thespina J Yamanis
- School of International Service, American University, Washington, DC 20016-8071, USA;
| | - Raymond A Ruiz
- Department of Health Services, University of Washington, Seattle, Washington 98195, USA; ,
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24
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Yamanis TJ, del Río-González AM, Rapoport L, Norton C, Little C, Barker SL, Ornelas IJ. UNDERSTANDING FEAR OF DEPORTATION AND ITS IMPACT ON HEALTHCARE ACCESS AMONG IMMIGRANT LATINX MEN WHO HAVE SEX WITH MEN. ADVANCES IN MEDICAL SOCIOLOGY 2021; 21:103-131. [PMID: 38863904 PMCID: PMC11165931 DOI: 10.1108/s1057-629020210000021010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
Purpose Fear of deportation and its relationship to healthcare access has been less studied among immigrant Latinx men who have sex with men (MSM), a population at risk for HIV and characterized by their multiple minority statuses. The first step is to accurately measure their fear of deportation. Approach We used an exploratory sequential mixed methods design. Eligibility criteria were that research participants be ages 18-34 years; Latinx; cisgender male; having had sex with another male; residing in the District of Columbia metro area; and not a US citizen or legal permanent resident. In Study 1, we used in-depth interviews and thematic analysis. Using participants' interview responses, we inductively generated 15 items for a fear of deportation scale. In Study 2, we used survey data to assess the scale's psychometric properties. We conducted independent samples t-test on the associations between scale scores and barriers to healthcare access. Findings For the 20 participants in Study 1, fear of deportation resulted in chronic anxiety. Participants managed their fear through vigilance, and behaviors restricting their movement and social network engagement. In Study 2, we used data from 86 mostly undocumented participants. The scale was internally consistent (α = 0.89) and had a single factor. Those with higher fear of deportation scores were significantly more likely to report avoiding healthcare because they were worried about their immigration status (p = 0.007). Originality We described how fear of deportation limits healthcare access for immigrant Latinx MSM. Research implications Future research should examine fear of deportation and HIV risk among immigrant Latinx MSM.
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25
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Gonzalez KA, Abreu RL, Rosario CC, Koech JM, Lockett GM, Lindley L. "A center for trans women where they help you": Resource needs of the immigrant Latinx transgender community. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2020; 23:60-78. [PMID: 35403119 PMCID: PMC8986257 DOI: 10.1080/26895269.2020.1830222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Immigrant Latinx transgender people often migrate to the United States because of a desire for increased safety and more opportunities. However, after migrating to the United States, immigrant Latinx transgender people often struggle to access basic needs, including health care, jobs, and stable finances. These struggles are exacerbated for undocumented immigrant Latinx transgender people. There is a gap in the literature regarding needed resources for immigrant Latinx transgender community members living in the United States. AIMS Utilizing a critical intersectionality framework, the aim of the present study was to investigate the resource needs of immigrant Latinx transgender community members living in the United States. METHODS A community sample of 18 immigrant Latinx transgender people living in a large metropolitan city in Florida participated in individual semi-structured interviews to explore their community resource needs. RESULTS Thematic analysis revealed five themes related to resources that participants needed including: 1) Transgender healthcare/resources, 2) Public education, 3) Financial aid resources, 4) Homelessness resources, and 5) Addictions care. Two resource need-related themes were identified that pertain specifically to undocumented immigrant Latinx transgender people, including: 1) Documentation papers for access, and 2) Legal aid. CONCLUSIONS Findings suggest that immigrant Latinx transgender community members in this study provided guidance about broad resources needed to enhance their wellness and safety, and promote liberation of community members. Participants' resource needs suggest the importance of policy and structural level changes from institutions with power that consider and enhance the wellness of immigrant Latinx transgender people. Findings also suggest the need for more tailored interventions and case work to better support immigrant Latinx transgender people.
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Affiliation(s)
- Kirsten A. Gonzalez
- Department of Psychology, University of Tennessee, Knoxville, Tennessee, USA
| | - Roberto L. Abreu
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | | | - Jasmine M. Koech
- Department of Psychology, University of Tennessee, Knoxville, Tennessee, USA
| | - Gabriel M. Lockett
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Louis Lindley
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, Wisconsin, USA
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26
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Sherman AD, Poteat TC, Budhathoki C, Kelly U, Clark KD, Campbell JC. Association of Depression and Post-Traumatic Stress with Polyvictimization and Emotional Transgender and Gender Diverse Community Connection Among Black and Latinx Transgender Women. LGBT Health 2020; 7:358-366. [DOI: 10.1089/lgbt.2019.0336] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Athena D.F. Sherman
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Tonia C. Poteat
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Chakra Budhathoki
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ursula Kelly
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
- Atlanta VA Health Care System, Atlanta, Georgia, USA
| | - Kristen D. Clark
- School of Nursing, University of California San Francisco, San Francisco, California, USA
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27
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Peitzmeier SM, Malik M, Kattari SK, Marrow E, Stephenson R, Agénor M, Reisner SL. Intimate Partner Violence in Transgender Populations: Systematic Review and Meta-analysis of Prevalence and Correlates. Am J Public Health 2020; 110:e1-e14. [PMID: 32673114 DOI: 10.2105/ajph.2020.305774] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background: Transgender individuals experience unique vulnerabilities to intimate partner violence (IPV) and may experience a disproportionate IPV burden compared with cisgender (nontransgender) individuals.Objectives: To systematically review the quantitative literature on prevalence and correlates of IPV in transgender populations.Search Methods: Authors searched research databases (PubMed, CINAHL), gray literature (Google), journal tables of contents, and conference abstracts, and consulted experts in the field. Authors were contacted with data requests in cases in which transgender participants were enrolled in a study, but no disaggregated statistics were provided for this population.Selection Criteria: We included all quantitative literature published before July 2019 on prevalence and correlates of IPV victimization, perpetration, or service utilization in transgender populations. There were no restrictions by sample size, year, or location.Data Collection and Analysis: Two independent reviewers conducted screening. One reviewer conducted extraction by using a structured database, and a second reviewer checked for mistakes or omissions. We used random-effects meta-analyses to calculate relative risks (RRs) comparing the prevalence of IPV in transgender individuals and cisgender individuals in studies in which both transgender and cisgender individuals were enrolled. We also used meta-analysis to compare IPV prevalence in assigned-female-sex-at-birth and assigned-male-sex-at-birth transgender individuals and to compare physical IPV prevalence between nonbinary and binary transgender individuals in studies that enrolled both groups.Main Results: We identified 85 articles from 74 unique data sets (ntotal = 49 966 transgender participants). Across studies reporting it, the median lifetime prevalence of physical IPV was 37.5%, lifetime sexual IPV was 25.0%, past-year physical IPV was 16.7%, and past-year sexual IPV was 10.8% among transgender individuals. Compared with cisgender individuals, transgender individuals were 1.7 times more likely to experience any IPV (RR = 1.66; 95% confidence interval [CI] = 1.36, 2.03), 2.2 times more likely to experience physical IPV (RR = 2.19; 95% CI = 1.66, 2.88), and 2.5 times more likely to experience sexual IPV (RR = 2.46; 95% CI = 1.64, 3.69). Disparities persisted when comparing to cisgender women specifically. There was no significant difference in any IPV, physical IPV, or sexual IPV prevalence between assigned-female-sex-at-birth and assigned-male-sex-at-birth individuals, nor in physical IPV prevalence between binary- and nonbinary-identified transgender individuals. IPV victimization was associated with sexual risk, substance use, and mental health burden in transgender populations.Authors' Conclusions: Transgender individuals experience a dramatically higher prevalence of IPV victimization compared with cisgender individuals, regardless of sex assigned at birth. IPV prevalence estimates are comparably high for assigned-male-sex-at-birth and assigned-female-sex-at-birth transgender individuals, and for binary and nonbinary transgender individuals, though more research is needed.Public Health Implications: Evidence-based interventions are urgently needed to prevent and address IPV in this high-risk population with unique needs. Lack of legal protections against discrimination in employment, housing, and social services likely foster vulnerability to IPV. Transgender individuals should be explicitly included in US Preventive Services Task Force recommendations promoting IPV screening in primary care settings. Interventions at the policy level as well as the interpersonal and individual level are urgently needed to address epidemic levels of IPV in this marginalized, high-risk population.
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Affiliation(s)
- Sarah M Peitzmeier
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
| | - Mannat Malik
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
| | - Shanna K Kattari
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
| | - Elliot Marrow
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
| | - Rob Stephenson
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
| | - Madina Agénor
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
| | - Sari L Reisner
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
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Abstract
PURPOSE OF REVIEW Transgender (trans) populations are heavily impacted by HIV, yet face structural, social, and individual barriers to engagement in HIV prevention and care. In this review, we summarize the data on barriers and facilitators and discuss evidence-informed strategies to facilitate access to and engagement in HIV prevention and care by trans communities. RECENT FINDINGS Intersectional stigma and discrimination at structural, community, individual levels present substantial impediments to HIV prevention and optimal care. Access to gender-affirming health care is a priority for trans communities. Where trans communities are highly networked, these networks may provide a strong infrastructure for disseminating HIV innovations and reaching individuals who are not engaged in HIV services. Efforts to engage trans people in HIV prevention and care must address stigma, provide gender-affirming services, and build on community strengths and priorities to ensure trans populations achieve maximum benefit from advances in HIV prevention and care. SUMMARY Combination approaches that respond to the complex drivers of HIV in trans communities represent promising strategies for engaging trans people and their partners in HIV prevention and care.
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Yamanis TNJ, Morrissey T, Bochey L, Cañas N, Sol C. " Hay que seguir en la lucha": An FQHC's Community Health Action Approach to Promoting Latinx Immigrants' Individual and Community Resilience. Behav Med 2020; 46:303-316. [PMID: 32701390 DOI: 10.1080/08964289.2020.1738320] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Latinx immigrants have poorer access to health care, compared to non-Latinx Whites. Federally-Qualified Health Centers (FQHCs) provide clinical and community programing to address their clients' health needs. One mechanism by which FQHC's may strengthen Latinx immigrant well-being is by promoting their individual and community resilience. We partnered with La Clínica del Pueblo (La Clínica), an FQHC serving Latinx immigrants in Washington, DC and Prince George's County, Maryland. We conducted in-depth interviews in Spanish with 30 La Clínica clients to explore the daily adversities they faced, how they coped, and how La Clínica helped them cope. We conducted thematic analysis using Dedoose software. All participants were from Central America; 37% were undocumented. Participants were 18-78 years old, 70% cis-females, 23% cis-males (10% gay men), and 7% transgender. 57% reported a serious health issue, including diabetes. Participants identified three main adversities: immigration legal status, language, and isolation/depression. Residents of Prince George's, compared to DC, as well as sexual/gender minorities, reported more barriers to accessing health care. Sources of individual resilience for participants included fighting to improve their children's lives, relying on supportive networks, and using La Clínica as a safety net to overcome health access barriers. Sources of community resilience included La Clínica's safe spaces, support groups, referrals to outside legal service providers, and health promoter training. Latinx immigrants face multiple daily adversities, but we find evidence that La Clínica's community health action approach promotes their resilience. We offer a conceptual model for how FQHCs can foster resilience and strengthen immigrant health.
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Affiliation(s)
| | | | - Lisa Bochey
- School of International Service, American University
| | - Natalia Cañas
- School of International Service, American University
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Abreu RL, Gonzalez KA, Mosley DV, Pulice-Farrow L, Adam A, Duberli F. "They feel empowered to discriminate against las chicas": Latina transgender women's experiences navigating the healthcare system. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2020; 23:178-193. [PMID: 35403109 PMCID: PMC8986233 DOI: 10.1080/26895269.2020.1767752] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Transgender Women of Color are more likely to experience oppression at the hands of healthcare providers than their transgender White counterparts. However, there is a paucity of research on the experiences of Latina transgender women in the United States. AIMS Using an intersectionality theory framework, the present study aimed to investigate the factors that contribute to Latina transgender women's decision to seek or refuse healthcare services and Latina transgender women's experiences with healthcare providers in the United States. METHODS A community sample of 15 Latina transgender women at a large metropolitan city in Florida participated in a focus group to explore their experiences with seeking out and accessing healthcare services. RESULTS Thematic analysis revealed five themes: 1) experiences in seeking healthcare, 2) the effects of hormones on mental health, 3) resistance, 4) imparting collective knowledge, and 5) recommendations to healthcare providers. CONCLUSIONS Through collective dialog these women gave voice to their needs and pains in the context of healthcare while also positioning themselves as agentic, resistant, and aware of the power of collectivism in the process of healing. The current findings support and extend calls for training improvements related to transgender populations, giving voice not only to the need for training but specifying immigrant Latina transgender women's desire for such training. Also, elements related to Latinx cultural values (e.g., convivencia, familismo) must be considered when working with Latina transgender women.
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Affiliation(s)
- Roberto L. Abreu
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Kirsten A. Gonzalez
- Department of Psychology, University of Tennessee, Knoxville, Tennessee, USA
| | - Della V. Mosley
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Lex Pulice-Farrow
- Department of Psychology, University of Tennessee, Knoxville, Tennessee, USA
| | - Alissa Adam
- Department of Psychology, University of Florida, Gainesville, Florida, USA
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A Gap Between Willingness and Uptake: Findings From Mixed Methods Research on HIV Prevention Among Black and Latina Transgender Women. J Acquir Immune Defic Syndr 2020; 82:131-140. [PMID: 31180995 DOI: 10.1097/qai.0000000000002112] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Black and Latina transgender women (BLTW) face significant HIV disparities with estimated HIV prevalence up to 50% and annual incidence rates as high as 2.8 per 100 person-years. However, few studies have evaluated the acceptability and uptake of high-impact HIV prevention interventions among BLTW. SETTING Data collection took place in Baltimore, MD and Washington, DC from May 2015 to May 2017. METHODS This mixed methods study included quantitative interviewer-administered surveys, key informant interviews, and focus group discussions. Rapid HIV testing followed each survey. Logistic regression models tested associations between legal gender affirmation (ie, desired name and gender marker on identity documents), transgender pride, history of exchange sex, HIV risk perception, and willingness to take pre-exposure prophylaxis (PrEP). Transcripts of qualitative data were coded to identify common themes related to engagement in HIV prevention. RESULTS Among 201 BLTW, 56% tested HIV-positive and 87% had heard of PrEP. Only 18% who had heard of PrEP had ever taken it. Of the 72 self-reported HIV-negative or status-unknown BLTW who had never taken PrEP, 75% were willing to take it. In multivariable analyses, history of exchange sex was associated with willingness to take PrEP, whereas greater HIV knowledge and transgender pride were associated with lower likelihood of willingness to take PrEP. Concern about drug interactions with hormone therapy was the most frequently reported barrier to PrEP uptake. CONCLUSIONS Noting the disconnect between PrEP willingness and uptake among BLTW, HIV prevention programs could bridge this gap by responding to identified access barriers and incorporating community-derived strategies.
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Fox SD, Griffin RH, Pachankis JE. Minority stress, social integration, and the mental health needs of LGBTQ asylum seekers in North America. Soc Sci Med 2020; 246:112727. [DOI: 10.1016/j.socscimed.2019.112727] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 11/28/2019] [Accepted: 12/06/2019] [Indexed: 11/29/2022]
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Wirtz AL, Poteat T, Radix A, Althoff KN, Cannon CM, Wawrzyniak AJ, Cooney E, Mayer KH, Beyrer C, Rodriguez AE, Reisner SL. American Cohort to Study HIV Acquisition Among Transgender Women in High-Risk Areas (The LITE Study): Protocol for a Multisite Prospective Cohort Study in the Eastern and Southern United States. JMIR Res Protoc 2019; 8:e14704. [PMID: 31584005 PMCID: PMC6802485 DOI: 10.2196/14704] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/31/2019] [Accepted: 08/07/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND In the United States, transgender women (TW) are disproportionately burdened by HIV infection. Cohort studies are needed to evaluate factors driving HIV acquisition among TW over time. These will require implementation strategies that are acceptable to the TW community and feasible to implement. OBJECTIVE This study aims to investigate the rate and correlates of HIV acquisition and other health outcomes among TW in eastern and southern United States. METHODS LITE is a multisite prospective cohort in 6 eastern and southern US cities, which will be followed across 24 months of technology-enhanced biobehavioral follow-up. Adult TW, regardless of HIV status, are recruited via convenience sampling (eg, peer referrals, social media, and dating apps). Participants are enrolled in a baseline study visit, complete a sociobehavioral survey, and test for HIV and sexually transmitted infections. Participants who are not living with HIV at baseline are offered enrollment into the cohort (N=1100); follow-up assessments occur quarterly. RESULTS Cohort assembly was informed by synchronous Web-based focus group discussions with TW (n=41) and by continuing engagement with community advisory board members from each site. Enrollment launched in March 2018. The study is underway in the Atlanta; Baltimore; Boston; Miami; New York City; and Washington, DC, metro areas. As of March 2019, 795 TW completed a baseline visit (mean age 35 years). The majority of the participants are racial/ethnic minorities, with 45% of the TW identifying as black and 28% of the TW identifying as Hispanic/Latinx. More than one-quarter (28%) of the TW are living with HIV infection (laboratory-confirmed). Online recruitment methods support engagement with TW, although peer referral and referral through trusted health facilities and organizations remain most effective. CONCLUSIONS This study is responsive to increasing research interest in technology-enhanced methods for cohort research, particularly for hard-to-reach populations. Importantly, the diversity of literacy, technology use, and overall socioeconomic situations in this sample of TW highlights the need to leverage technology to permit a flexible, adaptive methodology that enhances engagement of potential participants living in marginalized contexts while still ensuring rigorous and sound study design. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/14704.
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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, United States
| | - Tonia Poteat
- University of North Carolina School of Medicine, Chapel Hill, NC, 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
| | | | - Andrew J Wawrzyniak
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Erin Cooney
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | - Chris Beyrer
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Allan E Rodriguez
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Sari L Reisner
- The Fenway Institute, Boston, MA, United States
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, United States
- Pediatrics, Harvard Medical School, Boston, MA, United States
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, United States
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Rosen JG, Malik M, Cooney EE, Wirtz AL, Yamanis T, Lujan M, Cannon C, Hardy D, Poteat T. Antiretroviral Treatment Interruptions Among Black and Latina Transgender Women Living with HIV: Characterizing Co-occurring, Multilevel Factors Using the Gender Affirmation Framework. AIDS Behav 2019; 23:2588-2599. [PMID: 31263998 PMCID: PMC6768710 DOI: 10.1007/s10461-019-02581-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Black and Latina transgender women (BLTW) are disproportionately impacted by HIV but remain underrepresented in HIV and health services research. Between March 2016 and May 2017, BLTW (N = 201) were recruited in Baltimore, Maryland and Washington, DC through convenience sampling for a survey assessing multilevel determinants of HIV risk and treatment outcomes. Interviews concluded with a rapid oral HIV test. Bivariate and multivariable logistic regression modeling was performed to identify gender affirmation-related correlates of self-reported HIV treatment interruptions (HIVTIs) among BLTW living with HIV who had initiated antiretroviral therapy (ART) (n = 96). Among them, 57.3% (n = 55) reported at least one HIVTI. Unmet surgical needs (aOR = 1.6), past-year marijuana use (aOR = 14.6), and no current hormone use (aOR = 24.9) were significantly (p < 0.05) associated with HIVTIs in multivariable analysis. Unmet need for gender affirmation may inhibit ART adherence, highlighting opportunities to mitigate care interruptions in alignment with community needs and goals.
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Affiliation(s)
- Joseph G Rosen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mannat Malik
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Erin E Cooney
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrea L Wirtz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Thespina Yamanis
- School of International Service, American University, Washington, DC, USA
| | - Maren Lujan
- School of International Service, American University, Washington, DC, USA
| | | | - David Hardy
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tonia Poteat
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Department of Social Medicine, University of North Carolina School of Medicine, 333 South Columbia Street, MacNider Hall, Room #348/CB #7240, Chapel Hill, NC, 27599-7240, USA.
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Martinez O. HIV-related Stigma as a Determinant of Health Among Sexual and Gender Minority Latinxs. HIV SPECIALIST 2019; 11:14-17. [PMID: 31396600 PMCID: PMC6687337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Erratum: Yamanis, T., et al. Legal Immigration Status is Associated with Depressive Symptoms among Latina Transgender Women in Washington, DC. Int. J. Environ. Res. Public Health 2018, 15, 1246. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122619. [PMID: 30467280 PMCID: PMC6313461 DOI: 10.3390/ijerph15122619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 11/06/2018] [Indexed: 12/18/2022]
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