1
|
de Sousa Mascena Veras MA, Menezes NP, Mocello AR, Leddy AM, Saggese GSR, Bassichetto KC, Gilmore HJ, de Carvalho PGC, Maschião LF, Neilands TB, Sevelius J, Lippman SA. Correlation between gender-based violence and poor treatment outcomes among transgender women living with HIV in Brazil. BMC Public Health 2024; 24:791. [PMID: 38481195 PMCID: PMC10938823 DOI: 10.1186/s12889-024-18224-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Transgender women are disproportionately affected by both HIV and gender-based violence (GBV), defined as physical, sexual, or emotional violence perpetrated against an individual based on their gender identity/expression. While a growing body of evidence demonstrates that GBV leads to poor HIV care and treatment outcomes among cisgender women, less research has examined this association among transgender women. We assessed the impact of lifetime experiences of GBV on subsequent retention in HIV care and laboratory confirmed viral suppression among a sample of transgender women living with HIV (TWH) in Brazil. METHODS A pilot trial of a peer navigation intervention to improve HIV care and treatment among TWH was conducted in São Paulo, Brazil between 2018 and 2019. TWH were recruited and randomized into the intervention or control arm and participated in a baseline and 9-month follow-up survey and ongoing extraction of clinical visit, prescribing, and laboratory data. Generalized linear model regressions with a Poisson distribution estimated the relative risk (RR) for the association of lifetime physical and sexual violence reported at baseline with treatment outcomes (retention in HIV care and viral suppression) at follow-up, adjusting for baseline sociodemographic characteristics. RESULTS A total of 113 TWH participated in the study. At baseline, median age was 30 years, and the prevalence of lifetime physical and sexual violence was 62% and 45%, respectively. At follow-up, 58% (n = 66/113) were retained in care and 35% (n = 40/113) had evidence of viral suppression. In adjusted models, lifetime physical violence was non-significantly associated with a 10% reduction in retention in care (aRR: 0.90, 95% CI: 0.67, 1.22) and a 31% reduction in viral suppression (aRR: 0.69; 95% CI: 0.43, 1.11). Lifetime sexual violence was non-significantly associated with a 28% reduction in retention in HIV care (aRR: 0.72, 95% CI: 0.52, 1.00) and significantly associated with a 56% reduction in viral suppression (aRR: 0.44; 95% CI: 0.24, 0.79). CONCLUSION Our findings are among the first to demonstrate that lifetime experiences with physical and sexual violence are associated with poor HIV outcomes over time among transgender women. Interventions seeking to improve HIV treatment outcomes should assess and address experiences of GBV among this population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03525340.
Collapse
Affiliation(s)
| | - Neia Prata Menezes
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Adrienne Rain Mocello
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Anna M Leddy
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Gustavo Santa Roza Saggese
- Department of Collective Health, Santa Casa School of Medical Sciences, São Paulo, Brazil
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | | | - Hailey J Gilmore
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | | | - Luca Fasciolo Maschião
- Department of Collective Health, Santa Casa School of Medical Sciences, São Paulo, Brazil
| | - Torsten B Neilands
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Jae Sevelius
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Sheri A Lippman
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| |
Collapse
|
2
|
Andrzejewski J, Pines HA, Morris S, Burke L, Bolan R, Sevelius J, Moore DJ, Blumenthal J. Determinants of HIV Pre-Exposure Prophylaxis (PrEP) Retention among Transgender Women: A Sequential, Explanatory Mixed Methods Study. Int J Environ Res Public Health 2024; 21:133. [PMID: 38397624 PMCID: PMC10888369 DOI: 10.3390/ijerph21020133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 02/25/2024]
Abstract
Transgender women (TW) face inequities in HIV and unique barriers to PrEP, an effective biomedical intervention to prevent HIV acquisition. To improve PrEP retention among TW, we examined factors related to retention using a two-phase, sequential explanatory mixed methods approach. In Phase I, we used data from a trial of 170 TW who were provided oral PrEP to examine predictors of 24-week retention. In Phase II, we conducted 15 in-depth interviews with PrEP-experienced TW and used thematic analysis to explain Phase I findings. In Phase I, more participants who were not retained at 24 weeks reported sex work engagement (18% versus 7%) and substantial/severe drug use (18% versus 8%). In Phase II, participants reported drug use as a barrier to PrEP, often in the context of sex work, and we identified two subcategories of sex work. TW engaged in "non-survival sex work" had little difficulty staying on PrEP, while those engaged in "survival sex work" struggled to stay on PrEP. In Phase I, fewer participants not retained at 24 weeks reported gender-affirming hormone therapy (GAHT) use (56% versus 71%). In Phase II, participants prioritized medical gender affirmation services over PrEP but also described the bidirectional benefits of accessing GAHT and PrEP. TW who engaged in "survival sex work" experience barriers to PrEP retention (e.g., unstable housing, drug use) and may require additional support to stay in PrEP care.
Collapse
Affiliation(s)
- Jack Andrzejewski
- San Diego Joint Doctoral Program in Public Health, San Diego State University—University of California San Diego, San Diego, CA 92093, USA
| | - Heather A. Pines
- School of Public Health, San Diego State University, San Diego, CA 92182, USA;
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA 92093, USA
- Department of Medicine, University of California San Diego, La Jolla, CA 92161, USA; (S.M.); (L.B.); (J.B.)
| | - Sheldon Morris
- Department of Medicine, University of California San Diego, La Jolla, CA 92161, USA; (S.M.); (L.B.); (J.B.)
| | - Leah Burke
- Department of Medicine, University of California San Diego, La Jolla, CA 92161, USA; (S.M.); (L.B.); (J.B.)
| | | | - Jae Sevelius
- Department of Psychiatry, Columbia University, New York, NY 10032, USA;
| | - David J. Moore
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA;
| | - Jill Blumenthal
- Department of Medicine, University of California San Diego, La Jolla, CA 92161, USA; (S.M.); (L.B.); (J.B.)
| |
Collapse
|
3
|
Özgen MH, Vos CMD, Yağmur Ö, Sevelius J. Online Group Psychotherapy to Increase Self-acceptance and Reduce Shame Among Transgender Migrants: An Observational Report. Turk Psikiyatri Derg 2024; 35:8-13. [PMID: 38556932 PMCID: PMC11003373 DOI: 10.5080/u27170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/19/2023] [Indexed: 04/02/2024]
Abstract
OBJECTIVE Transgender and gender diverse (TGD) people experience higher levels of stigma, discrimination, and interpersonal violence due to their gender identity and/or expression, particularly TGD people with a migration background. This study aimed to conduct and evaluate group psychotherapy for TGD migrants to provide opportunities for exploring and developing interpersonal skills and relationships. METHOD The group therapy included five individuals who identified as TGD and originated from the Middle East. The TGD group therapy consisted of 12 weekly sessions of 90 minutes each and was facilitated by a psychiatrist. All sessions were conducted online and in Turkish. The sessions were guided by the group process and discussions. RESULTS After completing 12 group therapy sessions, members of the group reported benefiting from observing and emulating others who shared their problem constellation. Through the interpersonal skills that they built up throughout the sessions, they became more open to share their feelings experiencing fewer social barriers, and reduced anxiety. CONCLUSION This observational study indicates the significance of offering group-based psychotherapy to enhance affirmation and social connection within gender minority groups and emphasizes the need to empirically evaluate the effectiveness of group psychotherapy with TGD individuals, with special attention to the unique needs of TGD migrants.
Collapse
Affiliation(s)
- Mihriban Heval Özgen
- Psychiatrist, Intercultural Psychiatry, Parnassia Academy, Den Haag, Netherlands
| | | | - Özgün Yağmur
- Psychiatrist, Brown University, Department of Psychiatry, Boston, USA
| | - Jae Sevelius
- Prof., Department of Clinical Psychology, UCSF, San Francisco, USA
| |
Collapse
|
4
|
Vance SR, Chen D, Garofalo R, Glidden DV, Ehrensaft D, Hidalgo M, Tishelman A, Rosenthal SM, Chan YM, Olson-Kennedy J, Sevelius J. Mental Health and Gender Affirmation of Black and Latine Transgender/Nonbinary Youth Compared to White Peers Prior to Hormone Initiation. J Adolesc Health 2023; 73:880-886. [PMID: 37610390 PMCID: PMC10723039 DOI: 10.1016/j.jadohealth.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 06/13/2023] [Accepted: 06/21/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE To compare baseline mental health symptoms and gender affirmation between Black/Latine versus White transgender/nonbinary youth (BLTY vs. WTY) and examine relationships between gender affirmation and mental health symptoms, and whether associations differed by race/ethnicity subgroup. METHODS Baseline data were analyzed from the gender-affirming hormone cohort of the Trans Youth Care United States Study-a 4-clinic site, observational study. Mental health symptoms assessed included depression, suicidality, and anxiety. Gender affirmation measures included the parental acceptance subscale from the perceived Parental Attitudes of Gender Expansiveness Scale-Youth Report; non-affirmation, internalized transphobia, and community connectedness subscales from the Gender Minority Stress and Resilience Measure-Adolescent; and self-reported living full time in affirmed gender. Fisher exact tests and independent sample t tests compared mental health symptoms and gender affirmation between subgroups. Logistic regression analyses evaluated associations between gender affirmation and mental health symptoms. Interaction analyses assessed differences in associations between subgroups. RESULTS The sample (mean age 16 years, range 12-20 years) included 92 BLTY (35%) and 170 WTY (65%). Subgroups had comparable prevalence of depression and anxiety symptoms. WTY had higher prevalence of lifetime suicidality (73% vs. 59%; p = .02). There were no differences in gender affirmation. Among the whole sample, higher parental acceptance decreased odds of depression symptoms. Not living in affirmed gender increased odds of depression symptoms. Higher non-affirmation and internalized transphobia increased odds of depression and anxiety symptoms and suicidality. Associations did not vary by subgroup. DISCUSSION BLTY and WTY had comparable mental health symptoms. For both subgroups, gender affirmation decreased odds of those symptoms.
Collapse
Affiliation(s)
- Stanley R Vance
- Child and Adolescent Gender Center, Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, California.
| | - Diane Chen
- Gender and Sex Development Program, Potoscnak Family Division of Adolescent and Young Adult Medicine, and Pritzker Department of Psychiatry and Behavioral Health, Ann and Robert H. Lurie's Children's Hospital, Chicago, Illinois; Department of Psychiatry and Behavioral Sciences, and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Robert Garofalo
- Gender and Sex Development Program, Potoscnak Family Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Ann and Robert H. Lurie's Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David V Glidden
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Diane Ehrensaft
- Child and Adolescent Gender Center, Division of Pediatric Endocrinology, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
| | - Marco Hidalgo
- Gender Health Program, Medicine-Pediatrics Division, General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Amy Tishelman
- Department of Psychology and Neuroscience, Boston College, Chestnut Hill, Massachusetts
| | - Stephen M Rosenthal
- Child and Adolescent Gender Center, Division of Pediatric Endocrinology, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
| | - Yee-Ming Chan
- Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Johanna Olson-Kennedy
- Center for Transyouth Health and Development, Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jae Sevelius
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, California
| |
Collapse
|
5
|
Zamudio-Haas S, Koester K, Venegas L, Salinas A, Herrera C, Gutierrez-Mock L, Welborn L, Deutsch MB, Sevelius J. "Entre Nosotras:" a qualitative study of a peer-led PrEP project for transgender latinas. BMC Health Serv Res 2023; 23:1013. [PMID: 37730598 PMCID: PMC10510224 DOI: 10.1186/s12913-023-09707-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 06/15/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Uptake of HIV pre-exposure prophylaxis (PrEP) remains low among transgender people as compared to other subgroups, despite high rates of HIV acquisition. In California, Latinx people comprise 40% of the population and Latina transgender women experience some of the highest burden of HIV of any subgroup, indicating a critical need for appropriate services. With funding from the California HIV/AIDS Research Programs, this academic-community partnership developed, implemented, and evaluated a PrEP project that co-located HIV services with gender affirming care in a Federally Qualified Heath Center (FQHC). Trans and Latinx staff led intervention adaptation and activities. METHODS This paper engages qualitative methods to describe how a PrEP demonstration project- Triunfo- successfully engaged Spanish-speaking transgender Latinas in services. We conducted 13 in-depth interviews with project participants and five interviews with providers and clinic staff. Interviews were conducted in Spanish or English. We conducted six months of ethnographic observation of intervention activities and recorded field notes. We conducted thematic analysis. RESULTS Beneficial elements of the intervention centered around three intertwined themes: creating trusted space, providing comprehensive patient navigation, and offering social support "entre nosotras" ("between us women/girls"). The combination of these factors contributed to the intervention's success supporting participants to initiate and persist on PrEP, many of whom had previously never received healthcare. Participants shared past experiences with transphobia and concerns around discrimination in a healthcare setting. Developing trust proved foundational to making participants feel welcome and "en casa/ at home" in the healthcare setting, which began from the moment participants entered the clinic and continued throughout their interactions with staff and providers. A gender affirming, bilingual clinician and peer health educators (PHE) played a critical part in intervention development, participant recruitment, and patient navigation. CONCLUSIONS Our research adds nuance to the existing literature on peer support services and navigation by profiling the multifaced roles that PHE served for participants. PHE proved instrumental to empowering participants to overcome structural and other barriers to healthcare, successfully engaging a group who previously avoided healthcare in clinical settings.
Collapse
Affiliation(s)
- Sophia Zamudio-Haas
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA.
| | - Kim Koester
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Luz Venegas
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Ariana Salinas
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Cinthya Herrera
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Luis Gutierrez-Mock
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Layla Welborn
- La Clinica de La Raza, 3451 East 12th Street, CA, 94601, Oakland, USA
| | - Madeline B Deutsch
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Jae Sevelius
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| |
Collapse
|
6
|
Alpert AB, Mehringer JE, Orta SJ, Hernandez T, Redwood EF, Rivers L, Manzano C, Ruddick R, Adams S, Sevelius J, Belanger E, Operario D, Griggs JJ. Transgender People's Experiences Sharing Information With Clinicians: A Focus Group-Based Qualitative Study. Ann Fam Med 2023; 21:408-415. [PMID: 37748898 PMCID: PMC10519763 DOI: 10.1370/afm.3010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 05/07/2023] [Accepted: 05/10/2023] [Indexed: 09/27/2023] Open
Abstract
PURPOSE Investigating transgender people's experiences sharing health information in clinical encounters may yield insights for family medicine clinicians. METHODS This was a qualitative study using a community-based participatory research approach and interpretive description methodology. Seven qualitative focus groups were conducted with 30 transgender adults living in North America. We used purposive sampling to ensure diversity. The focus groups were transcribed verbatim, and 2 investigators independently reviewed and coded each transcript, then they mutually reviewed the transcripts, reconciled their coding, and summarized the codes into themes. Themes were reviewed with community members, participants, and uninvolved clinically oriented investigators for member checking and peer debriefing. RESULTS Four themes were noted: (1) transgender people often perceive clinicians' questions as voyeuristic, stigmatizing, or self-protective; (2) patients describe being pathologized, denied or given substandard care, or harmed when clinicians learned they are transgender; (3) transgender people frequently choose between risking stigma when sharing information and risking ineffective clinical problem solving if clinicians do not have all the information about their medical histories; (4) improving the safety of transgender people is difficult in the context of contemporary medical systems. CONCLUSIONS Transgender people often must choose between stigma and potentially suboptimal care. Improvements in medical culture, policies, procedures, and data collection tools are necessary to improve the quality and safety of clinical care for transgender people. Institutional and systems changes may be required to safely and effectively implement sexual orientation and gender identity (SOGI) data collection in clinical settings.
Collapse
Affiliation(s)
- Ash B Alpert
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut (A.B.A.);
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island (A.B.A., E.B.)
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York (A.B.A.)
| | - Jamie E Mehringer
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York (J.E.M.)
| | - Sunshine J Orta
- University Health Services, University of Rochester, Rochester, New York (S.J.O.)
| | - Tresne Hernandez
- University of Rochester School of Medicine and Dentistry, Rochester, New York (T.H.)
| | - Emile F Redwood
- Department of Obstetrics and Gynecology, New York University Langone Health, New York, New York (L.R., E.R., C.M., R.R.)
| | - Lexis Rivers
- Department of Obstetrics and Gynecology, New York University Langone Health, New York, New York (L.R., E.R., C.M., R.R.)
| | - Charlie Manzano
- Department of Obstetrics and Gynecology, New York University Langone Health, New York, New York (L.R., E.R., C.M., R.R.)
| | - Roman Ruddick
- Department of Obstetrics and Gynecology, New York University Langone Health, New York, New York (L.R., E.R., C.M., R.R.)
| | - Spencer Adams
- Transgender Cancer Patient Project, Ashland, Oregon (S.A.)
| | - Jae Sevelius
- Western Michigan University, Kalamazoo, Michigan (J.S.)
| | - Emma Belanger
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island (A.B.A., E.B.)
| | - Don Operario
- Department of Medicine, University of California San Francisco, San Francisco, California (D.O.)
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia (D.O.)
| | - Jennifer J Griggs
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan (J.J.G.)
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan (J.J.G.)
| |
Collapse
|
7
|
Jain JP, Hill M, Gamarel KE, Santos GM, Johnson MO, Neilands TB, Dilworth SE, Reback CJ, Sevelius J. Socio-ecological Barriers to Viral Suppression Among Transgender Women Living with HIV in San Francisco and Los Angeles, California. AIDS Behav 2023; 27:2523-2534. [PMID: 36682008 PMCID: PMC10362091 DOI: 10.1007/s10461-023-03979-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 01/23/2023]
Abstract
Troubling disparities in viral suppression persist among transgender (trans) women living with HIV in the US. We utilized baseline data from a randomized controlled trial of a behavioral intervention among trans women living with HIV in San Francisco and Los Angeles, to identify the socio-ecological correlates of biologically confirmed viral suppression (< 200 HIV-1 RNA copies/mL). Among 253 participants, the mean age was 43 (SD = 11), 46% identified as Black or African American and 35% were virally non-suppressed. In adjusted Poisson regression models, the following barriers to viral suppression were identified: injection drug use [adjusted risk ratio (aRR) 0.78, 95% CI 0.65-0.93, Z = - 2.64, p = 0.008], methamphetamine use (aRR 0.65, 95% CI 0.51-0.83, Z = - 3.45, p = 0.001), amphetamine use (aRR 0.62, 95% CI 0.44-0.87, Z = - 2.75, p = 0.006), homelessness (aRR 0.79, 95% CI 0.63-0.98, Z = - 2.06, p = 0.039), and sex work (aRR 0.60, 95% CI 0.41-0.86, Z = - 2.77, p = 0.009). These findings underscore the importance of interventions that address the socio-ecological barriers to viral suppression among trans women in urban settings.
Collapse
Affiliation(s)
- Jennifer P Jain
- Department of Community Health Systems, University of California, San Francisco, 2 Koret Way, San Francisco, CA, 94143, USA.
| | - Miranda Hill
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Kristi E Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, USA
| | - Glenn-Milo Santos
- Department of Community Health Systems, University of California, San Francisco, 2 Koret Way, San Francisco, CA, 94143, USA
| | - Mallory O Johnson
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Torsten B Neilands
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Samantha E Dilworth
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Cathy J Reback
- Friends Research Institute, Los Angeles, CA, USA
- Center for HIV Identification, Prevention and Treatment Services, University of California, Los Angeles, Los Angeles, USA
| | - Jae Sevelius
- Department of Medicine, University of California, San Francisco, San Francisco, USA
- Department of Psychiatry, Columbia University, New York, USA
| |
Collapse
|
8
|
Ackley SF, Zimmerman SC, Flatt JD, Riley AR, Sevelius J, Duchowny KA. Discordance in chromosomal and self-reported sex in the UK Biobank: Implications for transgender- and intersex-inclusive data collection. Proc Natl Acad Sci U S A 2023; 120:e2218700120. [PMID: 37094118 PMCID: PMC10161036 DOI: 10.1073/pnas.2218700120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/10/2023] [Indexed: 04/26/2023] Open
Abstract
There is growing need to distinguish between sex and gender. While sex is assigned at birth, gender is socially constructed and may not correspond to one's assigned sex. However, in most research studies, sex or gender is assessed in isolation or the terms are used interchangeably, which has implications for research accuracy and inclusivity. We used data from the UK Biobank to quantify the prevalence of disagreement between chromosomal and self-reported sex and identify potential reasons for discordance. Among approximately 200 individuals with sex discordance, 71% of discordances were potentially explained by the presence of intersex traits or transgender identity. The findings indicate that when describing sex- and/or gender-specific differences in health, researchers may be limited in their ability to draw conclusions regarding specific sex and/or gender health information.
Collapse
Affiliation(s)
- Sarah F. Ackley
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA94158
| | - Scott C. Zimmerman
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA94158
| | - Jason D. Flatt
- Department of Social and Behavioral Science, School of Public Health, University of Nevada, Las Vegas, NV89119
| | - Alicia R. Riley
- Department of Sociology, University of California, Santa Cruz, CA95064
| | - Jae Sevelius
- Center for AIDS Prevention Studies, University of California, San Francisco, CA94158
- Center of Excellence for Transgender Health, University of California, San Francisco, CA94158
| | - Kate A. Duchowny
- Institute for Social Research, University of Michigan, Ann Arbor, MI48104
| |
Collapse
|
9
|
Hill M, Sevelius J, Sherman ADF, Balthazar M, Klepper M, Radix A, Rebchook G, Hansen N. The Helping Networks of Transgender Women Living with HIV. J Community Health 2023; 48:480-488. [PMID: 36662345 DOI: 10.1007/s10900-022-01179-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2022] [Indexed: 01/21/2023]
Abstract
Transgender women living with HIV face significant barriers to healthcare that may be best addressed through community-centered interventions holistically focused on their HIV-related, gender-related, and other important needs. Community health ambassador (CHA) interventions (education and training programs designed to engage communities and community leaders in health promotion) may be an effective option, though information about the natural helping networks of this vulnerable population is too limited to inform the implementation of this approach. This study uses social network analysis to describe the natural helping networks of transgender women living with HIV, their help-seeking patterns for HIV-related, gender-related, and ancillary resources, and the characteristics of potential network ambassadors. From February to August 2019, transgender women living with HIV in the US (N = 231) participated a 30-min online survey asking them to describe their natural helping networks (N = 1054). On average, participants were embedded within natural helping networks consisting of 4-5 people. They were more likely to seek help from informal network members vs. formal service providers (p < .01), and from chosen family and partners/spouses (p < .05) above other social connections. Older network members (p < .01), other transgender women (p < .05), and those with whom they regularly engaged face-to-face (p < .01) (vs. social technology) were identified as potential network ambassadors for HIV-, gender-related, and other important issues. These findings suggest an opportunity to develop CHA interventions that leverage existing help networks and potential network ambassadors to promote equitable access to HIV, gender-affirming, and other crucial resources among this medically underserved group.
Collapse
Affiliation(s)
- Miranda Hill
- Department of Medicine, University of California San Francisco, 550 16th St., San Francisco, CA, 94158, USA.
| | - Jae Sevelius
- Department of Medicine, University of California San Francisco, 550 16th St., San Francisco, CA, 94158, USA
| | - Athena D F Sherman
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Monique Balthazar
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, USA
| | - Meredith Klepper
- John Hopkins University School of Nursing, John Hopkins University, Baltimore, MD, USA
| | - Asa Radix
- Callen-Lorde Community Health Center, New York, NY, USA
| | - Greg Rebchook
- Department of Medicine, University of California San Francisco, 550 16th St., San Francisco, CA, 94158, USA
| | - Nathan Hansen
- Department of Health Promotion & Behavior, University of Georgia, Athens, GA, USA
| |
Collapse
|
10
|
Bassichetto KC, Saggese GSR, Maschião LF, Carvalho PGCD, Gilmore H, Sevelius J, Lippman SA, Veras MADSM. Factors associated with the retention of travestis and transgender women living with HIV in a peer navigation intervention in São Paulo, Brazil. CAD SAUDE PUBLICA 2023; 39:e00147522. [PMID: 37132720 DOI: 10.1590/0102-311xpt147522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 02/27/2023] [Indexed: 05/04/2023] Open
Abstract
Travestis and transgender women (TrTGW) constitute the groups with the highest HIV prevalence in the world, with higher probability of infection compared with the general population and lower adherence to prevention and treatment strategies than other vulnerable groups. Considering these challenges, this study describes the factors associated with the retention of TrTGW with HIV to the TransAmigas project. Participants were recruited from April 2018 to September 2019 in a public health service in São Paulo, Brazil. A total of 113 TrTGW were randomly assigned to either a peer navigation intervention (75) or a control group (38) and followed up for nine months. To analyze the association between the selected variables and the outcome ("retention at nine months", regardless of contact at three months, defined by the "full completion of the final questionnaire"), bivariate and multivariate logistic regression models were used. Peer contact forms were qualitatively assessed to validate and complement the previous selection of quantitative component variables. Of the 113 participants, 79 (69.9%) participated in the interview after nine months, of which 54 (72%) were from the intervention group and 25 (66%) from the control group. In the final multivariate model, contact at three months (adjusted odds ratio - aOR = 6.15; 95% confidence interval - 95%CI: 2.16-17.51) and higher schooling level (≥ 12 years) (aOR = 3.26; 95%CI: 1.02-10.42) remained associated with the outcome, adjusted by race/skin color, age ≤ 35 years, and HIV serostatus disclosure. Future studies with TrTGW should include contact at regular intervals, with additional efforts aimed at participants with lower schooling level.
Collapse
|
11
|
Rebchook GM, Chakravarty D, Xavier JM, Keatley JG, Maiorana A, Sevelius J, Shade SB. An evaluation of nine culturally tailored interventions designed to enhance engagement in HIV care among transgender women of colour in the United States. J Int AIDS Soc 2022; 25 Suppl 5:e25991. [PMID: 36225153 PMCID: PMC9557010 DOI: 10.1002/jia2.25991] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 08/02/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Transgender women (TW) worldwide have a high prevalence of HIV, and TW with HIV encounter numerous healthcare barriers. It is critical to develop evidence-informed interventions to improve their engagement in healthcare to achieve durable viral suppression (VS). We evaluated whether participation in one of nine interventions designed specifically for TW was associated with improved engagement in HIV care among transgender women of colour (TWC). METHODS Between 2013 and 2017, nine US organizations implemented nine distinct and innovative HIV care engagement interventions with diverse strategies, including: individual and group sessions, case management and navigation, outreach, drop-in spaces, peer support and/or incentives to engage TWC with HIV in care. The organizations enrolled 858 TWC, conducted surveys, captured intervention exposure data and extracted medical record data. Our evaluation of the interventions employed a pre-post design and examined four outcomes-any HIV care visit, antiretroviral therapy (ART) prescription, retention in HIV care and VS (both overall and among those with a clinic visit and viral load test), at baseline and every 6 months for 24 months. We employed logistic generalized estimating equations to assess the relative odds of each outcome at 12 and 24 months compared to baseline. RESULTS Overall, 79% of participants were exposed to at least one intervention activity. Over 24 months of follow-up, participants received services for a median of over 6 hours (range: 3-69 hours/participant). Compared to baseline, significantly (p<0.05) greater odds were demonstrated at both 12 and 24 months for three outcomes: prescription of ART (ORs: 1.42 at 12 months, 1.49 at 24 months), VS among all participants (ORs: 1.49, 1.54) and VS among those with a clinic visit and viral load test (ORs: 1.53, 1.98). The outcomes of any HIV care visit and retention in HIV care had significantly greater odds (ORs: 1.38 and 1.58, respectively) only at 12 months compared to baseline. CONCLUSIONS These evaluation results illustrate promising approaches to improve engagement in HIV care and VS among TWC with HIV. Continued development, adaptation and scale-up of culturally tailored HIV care interventions for this key population are necessary to meet the UNAIDS 95-95-95 goals.
Collapse
Affiliation(s)
- Gregory M. Rebchook
- Division of Prevention ScienceDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Deepalika Chakravarty
- Division of Prevention ScienceDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | | | - JoAnne G. Keatley
- Division of Prevention ScienceDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA,Innovative Response Globally for Transgender Women and HIV (IRGT)San FranciscoCaliforniaUSA
| | - Andres Maiorana
- Division of Prevention ScienceDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Jae Sevelius
- Division of Prevention ScienceDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Starley B. Shade
- Division of Prevention ScienceDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA,Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | | |
Collapse
|
12
|
Stauffer CS, Brown MR, Adams D, Cassity M, Sevelius J. MDMA-assisted psychotherapy; Inclusion of transgender and gender diverse people in the frontiers of PTSD treatment trials. Front Psychiatry 2022; 13:932605. [PMID: 36299539 PMCID: PMC9589439 DOI: 10.3389/fpsyt.2022.932605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Transgender and gender diverse (TGD) people experience stigma, discrimination, trauma, and post-traumatic stress disorder (PTSD) at higher rates compared to the general population; however, TGD people have been underrepresented in PTSD research. Clinical trials of 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy demonstrate promising safety and efficacy for the treatment of PTSD. Issues related to equitable access, power imbalances in the therapeutic relationship, and vulnerable states of consciousness occasioned by MDMA are magnified when working with people affected by structural vulnerabilities and health disparities, and community engagement in research planning and implementation is essential. To inform the inclusion and safety of TGD people in future MDMA-assisted psychotherapy research, the aims of the current study were to: characterize TGD experiences with trauma-related mental health care, assess openness of TGD people to participate in experimental PTSD research, and to gather specific feedback on protocol design for conducting MDMA-assisted psychotherapy with TGD people. Materials and methods We conducted three virtual focus group discussions (FGDs) with 5-6 participants each (N = 17). Eligible TGD participants had a history of receiving trauma-related mental health care. Each FGD was facilitated by two licensed clinicians who identified as TGD. Qualitative data analysis was conducted via an iterative process of identification of recurrent patterns and themes. Results We have identified several key issues TGD people face when seeking and engaging in trauma-related mental health care, including barriers to receiving adequate gender-affirming and trauma-informed mental health care and frustration with providers lacking cultural humility. Suggested amendments to MDMA-assisted psychotherapy protocols include: routine collection of trans-inclusive gender identity data, implementing an explicit gender-affirming treatment approach, ensuring a culturally safe setting, and diversifying co-therapy dyads. Discussion The inclusion of TGD voices in early conversations about emerging experimental PTSD interventions promotes equitable access, in the context of health and healthcare disparities, and helps researchers understand the needs of the community and tailor research to meet those needs. Through an ongoing conversation with the TGD community, we aim to incorporate a gender-affirming approach into existing research protocols and inform future applications of MDMA-assisted psychotherapy in addressing the effects of minority stress and boosting resilience.
Collapse
Affiliation(s)
- Christopher S Stauffer
- Social Neuroscience and Psychotherapy Lab, Oregon Health and Science Institute, Department of Psychiatry, Portland, OR, United States
- Portland VA Health Care System, Department of Mental Health, Portland, OR, United States
| | - Melanie R Brown
- School of Public Health, Oregon Health and Science University-Portland State University, Portland, OR, United States
| | - Dee Adams
- Center for Public Health and Human Rights, Department of Epidemiology, John Hopkins University, Baltimore, MD, United States
| | - Marca Cassity
- Social Neuroscience and Psychotherapy Lab, Oregon Health and Science Institute, Department of Psychiatry, Portland, OR, United States
- Portland VA Health Care System, Department of Mental Health, Portland, OR, United States
| | - Jae Sevelius
- Center of Excellence for Transgender Health, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|
13
|
Abstract
Purpose The primary purpose of this study was to characterize the health care experiences of diverse patients with nonbinary gender identities across a range of geographic locations. A secondary aim was to use the qualitative findings to inform recommendations for clinics and providers to create gender-affirming health care environments for nonbinary patients. Methods We conducted 3 focus group discussions with 7-9 participants, for a total of 24 unique participants. To be eligible, participants were required to be 18 years of age or older, live in the United States, speak English, have the ability to access Zoom in a private room, have a nonbinary gender identity, and be able to attend one of three scheduled focus groups. Results Participants reported frequent negative health care experiences, including misgendering, invalidation, and pathologization, even within clinics that signaled alliance with transgender communities. Participants described strategies they use to cope with negative experiences, including health care avoidance, identity concealment, and seeking out providers that are matched in terms of gender minority status and/or race. Conclusion Recommendations for the provision of gender-affirming health care for nonbinary patients include nonbinary-inclusive intake forms and electronic health records, having providers be proactive in eliciting preferred names and pronouns, and requiring education for providers and staff at all levels on the provision of nonbinary-inclusive gender-affirming health care.
Collapse
Affiliation(s)
- Jay Bindman
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Azze Ngo
- Center of Excellence for Transgender Health, Division of Prevention Sciences, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Sophia Zamudio-Haas
- Center of Excellence for Transgender Health, Division of Prevention Sciences, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Jae Sevelius
- Center of Excellence for Transgender Health, Division of Prevention Sciences, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
14
|
Hope DA, Holt NR, Woodruff N, Meyer H, Puckett JA, Eyer J, Craig S, Feldman J, Irwin J, Pachankis J, Rawson KJ, Sevelius J, Butler S. Bridging the Gap Between Practice Guidelines and the Therapy Room: Community-Derived Practice Adaptations for Psychological Services with Transgender and Gender Diverse Adults in the Central United States. Prof Psychol Res Pr 2022; 53:351-361. [PMID: 37994310 PMCID: PMC10665020 DOI: 10.1037/pro0000448] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Individuals who identify as transgender or gender diverse (TGD) are presenting at mental health clinicians' offices with increasing frequency. Many TGD clients are seeking care related to affirming their gender identity but also may present with anxiety, depression, trauma, substance abuse, or other problems for which a clinician may commonly provide services. Some clinicians may hesitate to accept TGD clients into their practice if they have little specialized training to work with this population in an affirming manner, especially in more underserved areas where a generalist practice is the norm. Numerous professional associations and experts have developed guidelines for affirmative behavioral health care for TGD people. However, what is needed are community informed recommendations to bridge from the official guidelines to clinicians' in-session activities. The Trans Collaborations Practice Adaptations for Psychological Interventions for Transgender and Gender Diverse Adults are derived from iterative interviews with TGD community members and affirming mental health clinicians in the Central United States. The 12 practice adaptations are intended to guide clinicians to adapt their usual treatment approach to be TGD affirming, especially in underserved and rural areas. The practice adaptations cover numerous aspects of practice including the office setting and paperwork, understanding gender identity and incorporating it into the case conceptualization, therapist's self-awareness, and referrals. The Trans Collaborations Practice Adaptations will help clinicians work confidently and competently with adult TGD clients, regardless of the presenting problem, to ensure TGD communities receive the best interventions for their behavioral health concerns.
Collapse
|
15
|
Grant RM, Pellegrini M, Defechereux PA, Anderson PL, Yu M, Glidden DV, O’Neal J, Yager J, Bhasin S, Sevelius J, Deutsch MB. Sex Hormone Therapy and Tenofovir Diphosphate Concentration in Dried Blood Spots: Primary Results of the Interactions Between Antiretrovirals And Transgender Hormones Study. Clin Infect Dis 2021; 73:e2117-e2123. [PMID: 32766890 PMCID: PMC8492111 DOI: 10.1093/cid/ciaa1160] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/03/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Sex hormone and preexposure prophylaxis (PrEP) drug interactions among transgender women (TGW), transgender men (TGM), and cisgender men (CGM) are not fully understood. METHODS TGM and TGW on at least 6 months of stable sex hormone therapy containing testosterone or estradiol (respectively) were enrolled in a 4-week study of directly observed dosing of daily oral coformulated emtricitabine and tenofovir disoproxil fumarate (FTC/TDF). TFV-DP in dried blood spots and sex hormones in serum were measured at weekly intervals. TFV-DP was compared with 2- and 4-week samples from Directly Observed Therapy Dried Blood Spots (DOT-DBS) Study (NCT02022657). RESULTS From May 2017 to June 2018, 24 TGM and 24 TGW were enrolled. Testosterone (total and free) and estradiol concentrations were comparable before and after 4 weeks of PrEP use in TGM and TGW, respectively. Historical controls included 17 cisgender women (CGW) and 15 CGM. TFV-DP concentrations at week 4 were comparable between TGW and TGM (mean difference, -6%; 95% confidence interval [CI], -21% to 12%; P = .47), comparable between TGW and CGM (mean difference, -12%; 95% CI, -27% to 7%; P = .21) and were lower among TGM compared with CGW (mean difference, -23%; 95% CI, -36% to -7%; P = .007). All persons in all groups were projected to reach the TFV-DP threshold that has been associated with high protection from human immunodeficiency virus. CONCLUSIONS CGM, TGM, and TGW had comparable TFV-DP concentrations in dried blood spots after 4 weeks of directly observed daily FTC/TDF PrEP use. Serum hormone concentrations were not affected by FTC/TDF PrEP use. CLINICAL TRIALS REGISTRATION NCT04050371.
Collapse
Affiliation(s)
- Robert M Grant
- Department of Medicine, University of California–San Francisco, San Francisco, California, USA
| | | | - Patricia A Defechereux
- Department of Medicine, University of California–San Francisco, San Francisco, California, USA
| | - Peter L Anderson
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michelle Yu
- Department of Medicine, University of California–San Francisco, San Francisco, California, USA
| | - David V Glidden
- Department of Epidemiology and Biostatistics, University of California - San Francisco, San Francisco, California, USA
| | - Joshua O’Neal
- San Francisco AIDS Foundation, San Francisco, California, USA
| | - Jenna Yager
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Shalender Bhasin
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jae Sevelius
- Department of Medicine, University of California–San Francisco, San Francisco, California, USA
| | - Madeline B Deutsch
- Department of Medicine, University of California–San Francisco, San Francisco, California, USA
| |
Collapse
|
16
|
D'Avanzo PA, Bass SB, Kelly PJ, Brajuha J, Gutierrez-Mock L, Sevelius J. Community Belonging and Attitudes Towards HIV Pre-Exposure Prophylaxis (PrEP) Among Transgender Women. AIDS Behav 2021; 25:2728-2742. [PMID: 33575901 DOI: 10.1007/s10461-021-03183-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2021] [Indexed: 11/26/2022]
Abstract
For transgender (trans) women, community belonging may play an important role in shaping perceptions of HIV Pre-exposure Prophylaxis (PrEP). A cluster analysis was performed using data obtained from a survey administered to 128 trans women residing in Philadelphia, PA and the San Francisco Bay area, CA. Six items assessing feelings of community belongingness among trans women produced three distinct clusters. Associations were examined between cluster membership and perceptual items including beliefs about PrEP, experiences with healthcare, patient self-advocacy, and perceived trusted sources for PrEP information. Clusters were demographically comparable apart from age. There were significant differences noted between trust in various communication channels and perceptions of PrEP; the least community-connected cluster had less trust and more negative perceptions of PrEP. Analyses suggest that psychographic differences exist based on perceived community belongingness in this population, and this in turn may be consequential in determining how information about PrEP is communicated and diffused to trans women for whom PrEP may be indicated.
Collapse
Affiliation(s)
- Paul A D'Avanzo
- Department of Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, PA, USA.
- Risk Communication Laboratory, Temple University College of Public Health, Philadelphia, PA, USA.
| | - Sarah Bauerle Bass
- Department of Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, PA, USA
- Risk Communication Laboratory, Temple University College of Public Health, Philadelphia, PA, USA
| | - Patrick J Kelly
- Department of Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, PA, USA
- Risk Communication Laboratory, Temple University College of Public Health, Philadelphia, PA, USA
| | - Jesse Brajuha
- Risk Communication Laboratory, Temple University College of Public Health, Philadelphia, PA, USA
| | - Luis Gutierrez-Mock
- Center of Excellence for Transgender Health, University of California, San Francisco, San Francisco, CA, USA
| | - Jae Sevelius
- Center of Excellence for Transgender Health, University of California, San Francisco, San Francisco, CA, USA
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| |
Collapse
|
17
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
18
|
Sevelius J, Chakravarty D, Neilands TB, Keatley J, Shade SB, Johnson MO, Rebchook G. Evidence for the Model of Gender Affirmation: The Role of Gender Affirmation and Healthcare Empowerment in Viral Suppression Among Transgender Women of Color Living with HIV. AIDS Behav 2021; 25:64-71. [PMID: 31144131 DOI: 10.1007/s10461-019-02544-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Transgender women of color are disproportionately impacted by HIV, poor health outcomes, and transgender-related discrimination (TD). We tested the Model of Gender Affirmation (GA) to identify intervention-amenable targets to enhance viral suppression (VS) using data from 858 transgender women of color living with HIV (49% Latina, 42% Black; 36% virally suppressed) in a serial mediation model. Global fit statistics demonstrated good model fit; statistically significant (p ≤ 0.05) direct pathways were between TD and GA, GA and healthcare empowerment (HCE), and HCE and VS. Significant indirect pathways were from TD to VS via GA and HCE (p = 0.036) and GA to VS via HCE (p = 0.028). Gender affirmation and healthcare empowerment significantly and fully mediated the total effect of transgender-related discrimination on viral suppression. These data provide empirical evidence for the Model of Gender Affirmation. Interventions that boost gender affirmation and healthcare empowerment may improve viral suppression among transgender women of color living with HIV.
Collapse
|
19
|
Sevelius J, Jackson A, Harzke AJ. Call for Special Issue Papers: Transgender Health and Corrections. J Correct Health Care 2021. [PMID: 34232774 DOI: 10.1089/jchc.2021.29000.cfp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Jae Sevelius
- Associate professor of medicine at the University of California San Francisco School of Medicine, Cofounder of the Center of Excellence for Transgender Health
| | - Akira Jackson
- Clinical research coordinator at the University of California San Francisco School of Medicine, Executive Director of Transgender Advocates for Justice and Accountability Coalition
| | - A J Harzke
- Journal of Correctional Health Care, Senior biostatistician, Correctional Managed Care, Assistant professor, Preventive Medicine and Community Health at University of Texas Medical Branch
| |
Collapse
|
20
|
Auerbach JD, Moran L, Weber S, Watson C, Keatley J, Sevelius J. Implementation Strategies for Creating Inclusive, All-Women HIV Care Environments: Perspectives From Trans and Cis Women. Womens Health Issues 2021; 31:332-340. [PMID: 33941451 PMCID: PMC9351440 DOI: 10.1016/j.whi.2021.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 04/04/2021] [Accepted: 04/05/2021] [Indexed: 11/26/2022]
Abstract
Introduction: Transgender (trans) women in the United States have disproportionately high rates of HIV acquisition, yet there remains a dearth of culturally appropriate and gender affirming HIV care services for them. Trans women often are aggregated with men who have sex with men based on biological essentialism and behaviorally defined characteristics, even though they have more in common with cisgender (cis) women, such as gender identity and psychosocial factors that influence HIV risk. As a result, trans women often are rendered invisible and underserved in the HIV response. We explore the feasibility of constructing inclusive, all-women HIV care environments as a way to redress the dearth of appropriate services for trans women living with HIV and to affirm their gender identity as women. Methods: Thirty-eight women living with HIV and five providers participated in a qualitative focus group and interview study between April 2016 and January 2017, exploring the desirability and practicality of including trans women in HIV treatment and support services traditionally focused on cis women. Transcripts were coded and template analysis was employed to discern key themes. Results: Participants identified concrete strategies for implementation of inclusive, all-women HIV care related to representation and visibility of trans women, community input, education and training, aspects of the clinic environment, and flexibility and creativity. The impact of trauma and the need for safety and gender affirmation were emphasized throughout. Conclusions: Trans and cis women found the idea of inclusive, all-women’s HIV care environments attractive and feasible, notwithstanding cultural and structural challenges to creating them.
Collapse
Affiliation(s)
- Judith D Auerbach
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California.
| | - Lissa Moran
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California
| | - Shannon Weber
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| | - Caroline Watson
- Women's Health Center, OB/GYN Clinic, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California
| | - JoAnne Keatley
- Innovative Response Globally for Transgender Women and HIV (IRGT), San Francisco, California
| | - Jae Sevelius
- Department of Medicine, Center for AIDS Prevention Studies, Center of Excellence for Transgender Health, University of California, San Francisco, San Francisco, California
| |
Collapse
|
21
|
Abstract
IMPORTANCE Black and Latinx transgender youth experience stigma that may increase their susceptibility to mental health symptoms. OBJECTIVE To compare past-year mental health symptoms and psychosocial factors among Black and Latinx transgender youth, White transgender youth, and Black and Latinx cisgender youth. DESIGN, SETTING, AND PARTICIPANTS This survey study used data from the 2015-2017 Biennial California Healthy Kids Survey with a weighted sample (N = 45 269) representative of California's secondary school population. The analytic sample (n = 19 780) included Black and Latinx transgender youth, White transgender youth, and Black and Latinx cisgender youth in the 9th and 11th grades. Data analysis was conducted from July 2020 to February 2021. MAIN OUTCOMES AND MEASURES Outcomes include past-year depressive symptoms and suicidality. Psychosocial risk factors include school-based victimization, gender-based harassment, sexuality-based harassment, and race-based harassment; protective factors include school connectedness and caring adult relationships. RESULTS The analytic sample of 19 780 participants (in 9th grade: weighted percentage, 51% [95% CI, 50% to 52%]; female participants: weighted percentage, 50% [95% CI, 49% to 51%]) included 252 Black and Latinx transgender youth (weighted percentage, 1.3% [95% CI, 1.1% to 1.5%]), 104 White transgender youth (weighted percentage, 0.7% [95% CI, 0.6% to 0.8%]), and 19 424 Black and Latinx cisgender youth (weighted percentage, 98.0% [95% CI, 97.8% to 98.2%]). For Black and Latinx transgender youth, estimated prevalence of depressive symptoms and suicidality were 50% (95% CI, 44% to 57%) and 46% (95% CI, 39% to 52%), respectively. Logistic regression models adjusted for grade, living arrangement, and reported sex indicated that compared with White transgender youth, Black and Latinx transgender youth had similar odds of depressive symptoms (adjusted odds ratio, 0.6; 95% CI, 0.4 to 1.1) and suicidality (adjusted odds ratio, 1.1; 95% CI, 0.6 to 1.8) and similar odds of all forms of harassment (eg, race-based harassment: adjusted odds ratio, 1.5; 95% CI, 0.8 to 2.6). Regression models indicated that compared with White transgender youth, Black and Latinx transgender youth had similar levels of victimization (adjusted linear regression coefficient, 0.5; 95% CI, -0.3 to 1.3) and caring adult relationships (adjusted linear regression coefficient, -0.6; 95% CI, -1.4 to 0.09) but lower levels of school connectedness (adjusted linear regression coefficient, -1.6; 95% CI, -2.9 to -0.4). With similar analyses, compared with Black and Latinx cisgender youth, Black and Latinx transgender youth had higher odds of depressive symptoms (adjusted odds ratio, 2.7; 95% CI, 2.0 to 3.7) and suicidality (adjusted odds ratio, 5.9; 95% CI, 4.3 to 8.0), higher odds and levels of all forms of harassment and victimization (eg, race-based harassment: adjusted odds ratio, 3.2; 95% CI, 2.4 to 4.5), and lower levels of school connectedness (adjusted linear regression coefficient, -2.6; 95% CI -3.3 to -1.8) and caring adult relationships (adjusted linear regression coefficient, -0.9; 95% CI -1.3 to -0.5). CONCLUSIONS AND RELEVANCE In this study, Black and Latinx transgender youth had high rates of mental health symptoms, with rates comparable with White transgender youth but higher than Black and Latinx cisgender youth. Their unique pattern of psychosocial risk and protective factors for these mental health symptoms should be factored in clinical preventive services and school-based interventions to support them.
Collapse
Affiliation(s)
- Stanley Ray Vance
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco
| | - Cherrie B Boyer
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco
| | - David V Glidden
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Jae Sevelius
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco
| |
Collapse
|
22
|
Williams MT, Bartlett A, Michaels T, Sevelius J, George JR. Dr. Valentina Wasson: Questioning what we think we know about the foundations of psychedelic science. JPS 2021. [DOI: 10.1556/2054.2020.00140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AbstractEquity and diversity are essential to the development of inclusive psychedelic research. However, oversights and misattributions are common, particularly when it comes to accounts of important psychedelic moments and key figures. Dr. Valentina Pavlovna Wasson is an important early contributor to the growth of Western psychedelic science but remains under-recognized. Psychedelic researchers must continue to address the glaring need to ask questions and examine the foundations of what we think we know about psychedelic studies—to question our assumptions with a critical and intersectional eye to resist replicating social and cultural inequalities in psychedelic research and history.
Collapse
Affiliation(s)
| | - Amy Bartlett
- 2Department of Classics and Religious Studies, University of Ottawa, Ottawa, ON, Canada
| | - Tim Michaels
- 3Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
- 4Department of Pediatrics, University of California, Davis Medical Center, Sacramento, CA, USA
| | - Jae Sevelius
- 5Department of Medicine, University of California, San Francisco, CA, USA
| | - Jamilah R. George
- 3Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| |
Collapse
|
23
|
Poteat TC, van der Merwe LLA, Sevelius J, Keatley J. Inclusion as illusion: erasing transgender women in research with MSM. J Int AIDS Soc 2021; 24:e25661. [PMID: 33496381 PMCID: PMC7836207 DOI: 10.1002/jia2.25661] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/07/2020] [Indexed: 01/11/2023] Open
Affiliation(s)
- Tonia C Poteat
- Department of Social MedicineUniversity of North CarolinaChapel HillNCUSA
| | | | - Jae Sevelius
- Department of MedicineUniversity of CaliforniaSan FranciscoCAUSA
| | - JoAnne Keatley
- Innovative Response Globally for Trans Women and HIVOaklandCAUSA
| |
Collapse
|
24
|
Suen LW, Lunn MR, Katuzny K, Finn S, Duncan L, Sevelius J, Flentje A, Capriotti MR, Lubensky ME, Hunt C, Weber S, Bibbins-Domingo K, Obedin-Maliver J. What Sexual and Gender Minority People Want Researchers to Know About Sexual Orientation and Gender Identity Questions: A Qualitative Study. Arch Sex Behav 2020; 49:2301-2318. [PMID: 32875381 PMCID: PMC7497435 DOI: 10.1007/s10508-020-01810-y] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 05/19/2023]
Abstract
Sexual and gender minority (SGM) people-including members of the lesbian, gay, bisexual, transgender, and queer communities-are understudied and underrepresented in research. Current sexual orientation and gender identity (SOGI) questions do not sufficiently engage SGM people, and there is a critical gap in understanding how SOGI questions reduce inclusion and accurate empirical representation. We conducted a qualitative study to answer the question, "For SGM people, what are the major limitations with current SOGI questions?" Focus groups probed reactions to SOGI questions adapted from prior national surveys and clinical best practice guidelines. Questions were refined and presented in semi-structured cognitive interviews. Template analysis using a priori themes guided analysis. There were 74 participants: 55 in nine focus groups and 19 in cognitive interviews. Participants were diverse: 51.3% identified as gender minorities, 87.8% as sexual minorities, 8.1% as Hispanic/Latinx, 13.5% as Black or African-American, and 43.2% as Non-white. Two major themes emerged: (1) SOGI questions did not allow for identity fluidity and complexity, reducing inclusion and representation, and (2) SOGI question stems and answer choices were often not clear as to which SOGI dimension was being assessed. To our knowledge, this represents the largest body of qualitative data studying SGM perspectives when responding to SOGI questions. We present recommendations for future development and use of SOGI measures. Attention to these topics may improve meaningful participation of SGM people in research and implementation of such research within and for SGM communities.
Collapse
Affiliation(s)
- Leslie W Suen
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, USA
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, USA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Katie Katuzny
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, USA
- Alliance Health Project, Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Sacha Finn
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Laura Duncan
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Jae Sevelius
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, USA
- Division of Prevention Science, Department of Medicine, Center of Excellence for Transgender Health, University of California, San Francisco, San Francisco, CA, USA
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, USA
- School of Nursing-Community Health Systems, University of California, San Francisco School of Nursing, San Francisco, CA, USA
| | | | - Micah E Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, USA
- School of Nursing-Community Health Systems, University of California, San Francisco School of Nursing, San Francisco, CA, USA
| | - Carolyn Hunt
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, USA
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Shannon Weber
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kirsten Bibbins-Domingo
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, USA.
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA.
| |
Collapse
|
25
|
Auerbach JD, Moran L, Watson C, Weber S, Keatley J, Sevelius J. We Are All Women: Barriers and Facilitators to Inclusion of Transgender Women in HIV Treatment and Support Services Designed for Cisgender Women. AIDS Patient Care STDS 2020; 34:392-398. [PMID: 32813571 DOI: 10.1089/apc.2020.0056] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Transgender women share more in common with cisgender women, with respect to sociocultural context and factors influencing HIV risk and outcomes, than they do with "men who have sex with men", a behavioral risk category in which they often are included. However, it is not yet clear whether both transgender and cisgender women would find integrated, all-women HIV programs and services desirable and beneficial. We Are All Women was a qualitative study conducted in the San Francisco Bay Area from April 2016 to January 2017, using a conceptual framework based on gender affirmation and trauma-informed care, to explore barriers and facilitators to inclusion of transgender women in HIV treatment and support services traditionally focused on cisgender women. Thirty-eight women (10 trans, 25 cis, and 3 "other" gender) participated in six semistructured, facilitated focus groups. In addition, five HIV care providers participated in semistructured, in-depth interviews. Both trans and cis women identified the desire for gender affirmation, a feeling of safety (specifically space without men), and potential community building within a care and healing context as powerful facilitators of an inclusive all-women care environment. At the same time, they recognized that tensions do exist between idealized visions of such an environment, deep-seated sentiments and behaviors among some cis women toward trans women, and the practical realities of creating the optimal spaces for all women. Opportunities for dialog between trans and cis women to mitigate gender-associated phobias and misperceptions are a valuable first step in creating HIV care environments that serve all women.
Collapse
Affiliation(s)
- Judith D. Auerbach
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
| | - Lissa Moran
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
| | - Caroline Watson
- HIVE, University of California, San Francisco, San Francisco, California, USA
| | - Shannon Weber
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA
| | - JoAnne Keatley
- Innovative Response Globally for Transgender Women and HIV (IRGT), San Francisco, California, USA
| | - Jae Sevelius
- Department of Medicine, Center for AIDS Prevention Studies, Center of Excellence for Transgender Health, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
26
|
Callander D, Schneider JA, Radix A, Chaix B, Scheinmann R, Love G, Smith J, Regan SD, Kawachi I, St James K, Ransome Y, Herrera C, Reisner SL, Doroshow C, Poteat T, Watson K, Bluebond-Langner R, Toussaint N, Garofalo R, Sevelius J, Duncan DT. Longitudinal cohort of HIV-negative transgender women of colour in New York City: protocol for the TURNNT ('Trying to Understand Relationships, Networks and Neighbourhoods among Transgender women of colour') study. BMJ Open 2020; 10:e032876. [PMID: 32241785 PMCID: PMC7170618 DOI: 10.1136/bmjopen-2019-032876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION In the USA, transgender women are among the most vulnerable to HIV. In particular, transgender women of colour face high rates of infection and low uptake of important HIV prevention tools, including pre-exposure prophylaxis (PrEP). This paper describes the design, sampling methods, data collection and analyses of the TURNNT ('Trying to Understand Relationships, Networks and Neighbourhoods among Transgender women of colour') study. In collaboration with communities of transgender women of colour, TURNNT aims to explore the complex social and environmental (ie, neighbourhood) structures that affect HIV prevention and other aspects of health in order to identify avenues for intervention. METHODS AND ANALYSES TURNNT is a prospective cohort study, which will recruit 300 transgender women of colour (150 Black/African American, 100 Latina and 50 Asian/Pacific Islander participants) in New York City. There will be three waves of data collection separated by 6 months. At each wave, participants will provide information on their relationships, social and sexual networks, and neighbourhoods. Global position system technology will be used to generate individual daily path areas in order to estimate neighbourhood-level exposures. Multivariate analyses will be conducted to assess cross-sectional and longitudinal, independent and synergistic associations of personal relationships (notably individual social capital), social and sexual networks, and neighbourhood factors (notably neighbourhood-level social cohesion) with PrEP uptake and discontinuation. ETHICS AND DISSEMINATION The TURNNT protocol was approved by the Columbia University Institutional Review Board (reference no. AAAS8164). This study will provide novel insights into the relationship, network and neighbourhood factors that influence HIV prevention behaviours among transgender women of colour and facilitate exploration of this population's health and well-being more broadly. Through community-based dissemination events and consultation with policy makers, this foundational work will be used to guide the development and implementation of future interventions with and for transgender women of colour.
Collapse
Affiliation(s)
- Denton Callander
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - John A Schneider
- Department of Public Health Sciences, University of Chicago School of Medicine, Chicago, Illinois, USA
- Howard Brown Health Center, Chicago, Illinois, USA
| | - Asa Radix
- Callen-Lorde Community Health Center, New York, New York, USA
| | - Basile Chaix
- Institut Pierre Louis d'Épidémiologie et de Santé Publique, Sorbonne Université, Paris, Île-de-France, France
| | - Roberta Scheinmann
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Gia Love
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Jordyn Smith
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Seann D Regan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kiara St James
- New York Transgender Advocacy Group, New York, New York, USA
| | - Yusuf Ransome
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | | | - Sari L Reisner
- Harvard Medical School, Boston, Massachusetts, USA
- Fenway Institute, Boston, Massachusetts, USA
| | - Ceyenne Doroshow
- Gay and Lesbians Living in a Transgender Society, New York, New York, USA
| | - Tonia Poteat
- Department of Social Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Kim Watson
- Community Kinship Life, New York, New York, USA
| | - Rachel Bluebond-Langner
- Hansjorg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, New York, USA
| | - Nala Toussaint
- Callen-Lorde Community Health Center, New York, New York, USA
| | - Robert Garofalo
- Department of Pediatrics & Preventive Medicine, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jae Sevelius
- Center for Excellence for Transgender Health, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Dustin T Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| |
Collapse
|
27
|
Cahill SR, Keatley J, Wade Taylor S, Sevelius J, Elsesser SA, Geffen SR, Wang T, Mayer KH. "Some of us, we don't know where we're going to be tomorrow." Contextual factors affecting PrEP use and adherence among a diverse sample of transgender women in San Francisco. AIDS Care 2019; 32:585-593. [PMID: 31482726 DOI: 10.1080/09540121.2019.1659912] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Transgender women (TW) are disproportionately affected by HIV. Antiretroviral pre-exposure prophylaxis (PrEP) can reduce TW's vulnerability to HIV, but PrEP uptake has been limited among TW. To explore barriers to PrEP uptake, the study team conducted two semi-structured focus groups with TW in San Francisco at risk for HIV acquisition. A within-case, across-case approach was used to code and analyze emerging themes. Focus group participants were racially and ethnically diverse. A few participants in both groups had heard of PrEP, but some had not. Several said that their health care providers had not told them about PrEP. Participants in both groups had questions about side effects. They expressed medical mistrust and said poverty is an important context for their lives. They described a need for gender affirming health care services and raised concerns about interactions of PrEP with feminizing hormones. Information about side effects and interactions between gender affirming hormones and PrEP need to be explicitly addressed in PrEP education campaigns focusing on TW. Health care institutions and health departments should train clinical staff how to provide affirming care. Gender identity nondiscrimination laws and policies could improve transgender people's ability to earn a living and access health care.
Collapse
Affiliation(s)
- Sean R Cahill
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Department of Health Sciences, Bouve College of Health Sciences, Northeastern University, Boston, MA, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - JoAnne Keatley
- Center of Excellence for Transgender Health, University of California San Francisco, San Francisco, CA, USA
| | - S Wade Taylor
- The Fenway Institute, Fenway Health, Boston, MA, USA.,School of Social Work, Boston University, Boston, MA, USA
| | - Jae Sevelius
- Center of Excellence for Transgender Health, University of California San Francisco, San Francisco, CA, USA
| | - Steven A Elsesser
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Tim Wang
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Beth Israel Deaconess Medical Center, Boston, MA, USA
| |
Collapse
|
28
|
George JR, Michaels TI, Sevelius J, Williams MT. The psychedelic renaissance and the limitations of a White-dominant medical framework: A call for indigenous and ethnic minority inclusion. Journal of Psychedelic Studies 2019. [DOI: 10.1556/2054.2019.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
In recent years, the study of psychedelic science has resurfaced as scientists and therapists are again exploring its potential to treat an array of psychiatric conditions, such as depression, post-traumatic stress disorder, and addiction. The scientific progress and clinical promise of this movement owes much of its success to the history of indigenous healing practices; yet the work of indigenous people, ethnic and racial minorities, women, and other disenfranchised groups is often not supported or highlighted in the mainstream narrative of psychedelic medicine. This review addresses this issue directly: first, by highlighting the traditional role of psychedelic plants and briefly summarizing the history of psychedelic medicine; second, through exploring the historical and sociocultural factors that have contributed to unequal research participation and treatment, thereby limiting the opportunities for minorities who ought to be acknowledged for their contributions. Finally, this review provides recommendations for broadening the Western medical framework of healing to include a cultural focus and additional considerations for an inclusive approach to treatment development and dissemination for future studies.
Collapse
Affiliation(s)
- Jamilah R. George
- 1 Department of Psychiatry, Yale University, New Haven, CT, USA
- 2 Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Timothy I. Michaels
- 2 Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Jae Sevelius
- 3 Department of Medicine, University of California, San Francisco, CA, USA
| | - Monnica T. Williams
- 2 Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
- 4 School of Psychology, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
29
|
Kendig NE, Cubitt A, Moss A, Sevelius J. Developing Correctional Policy, Practice, and Clinical Care Considerations for Incarcerated Transgender Patients Through Collaborative Stakeholder Engagement. J Correct Health Care 2019; 25:277-286. [PMID: 31242806 DOI: 10.1177/1078345819857113] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Transgender persons are at increased risk of victimization during incarceration and have unique health care needs. We convened a symposium of 27 key stakeholders to develop consensus on correctional policy, practice, and clinical care considerations for incarcerated transgender persons. Participants included formerly justice-involved transgender persons, correctional leaders, government authorities, academicians, advocates, health care providers, and expert consultants. Consensus considerations were developed in four areas: correctional practices that promote safety and respectful interactions with transgender inmates, training of correctional staff, health care delivery, and reentry to the community. Gaps in knowledge and practice in these four areas were also identified. A collaborative stakeholder model is an effective strategy to convene disparate groups who infrequently communicate with one another to help advance correctional policies and clinical care.
Collapse
Affiliation(s)
- Newton E Kendig
- 1 School of Medicine & Health Sciences, George Washington University, Washington, DC, USA
| | - Andrea Cubitt
- 1 School of Medicine & Health Sciences, George Washington University, Washington, DC, USA
| | | | - Jae Sevelius
- 3 Center of Excellence for Transgender Health, University of California, San Francisco, CA, USA
| |
Collapse
|
30
|
Sevelius J, Murray LR, Fernandes NM, Veras MA, Grinsztejn B, Lippman SA. Optimising HIV programming for transgender women in Brazil. Cult Health Sex 2019; 21:543-558. [PMID: 30378463 PMCID: PMC6483864 DOI: 10.1080/13691058.2018.1496277] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 06/27/2018] [Accepted: 06/29/2018] [Indexed: 05/20/2023]
Abstract
In Brazil, little data is available to inform HIV prevention programming for travestis and transgender ('trans') women, despite the existence of a social movement that has gained strength in recent years. We conducted formative research in Rio de Janeiro to gather trans women's perspectives on combination HIV prevention approaches. Framing the analysis within the model of gender affirmation, we found that several social and contextual factors inhibited participants' access to HIV prevention and treatment. Experienced and anticipated gender-related discrimination and HIV stigma were linked to the avoidance of HIV testing, health services and HIV status disclosure. Participants recommended HIV prevention interventions which combined socio-structural interventions, such as peer-based empowerment and social support, with biomedical interventions such as pre-exposure prophylaxis (PrEP). Participants expressed a preference for programmes and interventions that emphasised a gender-affirmative approach, promoted autonomy and aimed to reduce stigma and discrimination in public health services.
Collapse
Affiliation(s)
- Jae Sevelius
- Department of Medicine, Division of Prevention Sciences, University of California, San Francisco, CA, USA
| | - Laura Rebecca Murray
- Department of Health Policy, Planning, and Administration, Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Maria Amelia Veras
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas-Fiocruz, Rio de Janeiro, Brazil
| | - Sheri A. Lippman
- Department of Medicine, Division of Prevention Sciences, University of California, San Francisco, CA, USA
| |
Collapse
|
31
|
D’Avanzo PA, Bass SB, Brajuha J, Gutierrez-Mock L, Ventriglia N, Wellington C, Sevelius J. Medical Mistrust and PrEP Perceptions Among Transgender Women: A Cluster Analysis. Behav Med 2019; 45:143-152. [PMID: 31343968 PMCID: PMC6943929 DOI: 10.1080/08964289.2019.1585325] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 02/06/2019] [Accepted: 02/16/2019] [Indexed: 02/06/2023]
Abstract
Transgender (trans) women experience unique barriers in accessing preventative health services such as HIV preexposure prophylaxis (PrEP). These barriers may be exacerbated by past real or anticipated mistreatment in health care settings, but little is known about the relationship between medical mistrust and poor PrEP uptake and knowledge. Using a multistep approach, this study used a novel survey instrument administered to a pilot sample of 78 trans women. Item responses on a 0-10 scale were subjected to a TwoStep cluster analysis to explore how perceptions of PrEP and experiences with health care vary among trans women. Two distinct clusters (C1,C2) were defined on the basis of race (C1: 82% White, C2: 69% Black) and highest level of education completed (C1: 53% college or above, C2: 42% high school diploma or GED). Analyses suggest that varying levels of medical mistrust exist between clusters. Higher mean scores on medical mistrust items were reported in C1. A similar relationship was found on attitudes toward PrEP. Differences in intention to use PrEP and differences in past PrEP use were not significant; however, C2 members were more likely to have heard of PrEP from a doctor. Results suggest that levels of medical mistrust and PrEP perceptions vary among distinct subpopulations in this community, which may affect willingness to use PrEP. Interventions aimed at addressing unique perceptions in subpopulations could move trans women from intention to PrEP use.
Collapse
Affiliation(s)
- Paul A. D’Avanzo
- Department of Social and Behavioral Sciences, Temple University College of Public Health
- Risk Communication Laboratory, Temple University College of Public Health
| | - Sarah Bauerle Bass
- Department of Social and Behavioral Sciences, Temple University College of Public Health
- Risk Communication Laboratory, Temple University College of Public Health
| | - Jesse Brajuha
- Risk Communication Laboratory, Temple University College of Public Health
| | - Luis Gutierrez-Mock
- Center of Excellence for Transgender Health, University of California, San Francisco
| | - Nicole Ventriglia
- Risk Communication Laboratory, Temple University College of Public Health
| | - Carine Wellington
- Risk Communication Laboratory, Temple University College of Public Health
| | - Jae Sevelius
- Center of Excellence for Transgender Health, University of California, San Francisco
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco
| |
Collapse
|
32
|
Abstract
Purpose The purpose of this paper is to briefly address three interrelated areas of concerns - victimization, housing placement and healthcare provision - related to the health and welfare of transgender women in jails, prisons and other types of detention facilities. Design/methodology/approach Drawing on a growing body of research on health risks for transgender women who are detained in facilities in California and elsewhere, the authors provide recommendations for policy and practice that constitutes gender-affirming healthcare for transgender women behind bars. Findings Policymakers, correctional leaders, and prison-based clinicians have a number of opportunities to address the welfare of transgender women in jails, prisons and other types of detention facilities. Originality/value This policy brief offers concrete steps government officials can take to better meet their professional and constitutional obligations, provide higher quality care for transgender women involved in the criminal justice system, and effectuate positive changes in transgender women's health and welfare both inside and outside of carceral environments.
Collapse
Affiliation(s)
- Jae Sevelius
- University of California , San Francisco, San Francisco, California, USA
| | | |
Collapse
|
33
|
Hoffkling A, Obedin-Maliver J, Sevelius J. From erasure to opportunity: a qualitative study of the experiences of transgender men around pregnancy and recommendations for providers. BMC Pregnancy Childbirth 2017; 17:332. [PMID: 29143629 PMCID: PMC5688401 DOI: 10.1186/s12884-017-1491-5] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Some transgender men retain their uterus, get pregnant, and give birth. However, societal attitudes about gender have erected barriers to openly being pregnant and giving birth as a transgender man. Little research exists regarding transgender men’s reproductive needs. Anecdotal observations suggest that social change and increasing empowerment of transgender men may result in increasing frequency and openness about pregnancy and birth. Specific needs around conception, pregnancy, and newborn care may arise from transphobia, exogenous testosterone exposure, or from having had (or desiring) gender-affirming surgery. We undertook a qualitative study to understand the needs of transgender men who had given birth. Methods We interviewed 10 transgender men who had been recruited for a recently published online cross-sectional survey of individuals (n = 41). Subjects had given birth while identifying as male. Interviews were recorded, transcribed, and systematically coded. Analysis used a priori and emergent codes to identify central themes and develop a framework for understanding participant experiences. Results Participants reported diverse experiences and values on issues including prioritization and sequencing of transition versus reproduction, empowerment in healthcare, desire for external affirmation of their gender and/or pregnancy, access to social supports, and degree of outness as male, transgender, or pregnant. We identified structural barriers that disempowered participants and describe healthcare components that felt safe and empowering. We describe how patients’ strategies, and providers’ behaviors, affected empowerment. Anticipatory guidance from providers was central in promoting security and empowerment for these individuals as patients. Conclusions Recognizing diverse experiences has implications in supporting future patients through promoting patient-centered care and increasing the experiential legibility. Institutional erasure creates barriers to transgender men getting routine perinatal care. Identifying this erasure helps shape recommendations for how providers and clinics can provide appropriate care. Specific information regarding reproduction can be helpful to patients. We provide recommendations for providers’ anticipatory guidance during the pre-transition, pre-conception, prenatal, and postpartum periods. Ways to support and bring visibility to the experience of transgender men are identified. Improving clinical visibility and affirming gender will likely enhance patient experience and may support patient-centered perinatal healthcare services. Electronic supplementary material The online version of this article (10.1186/s12884-017-1491-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Alexis Hoffkling
- School of Medicine, University of California San Francisco, 2926 Otis St., Berkeley, CA, 94703, USA.
| | - Juno Obedin-Maliver
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.,Department of General Internal Medicine, San Francisco Department of Veterans Affairs, 4150 Clement Street, Building 18, 111A1, San Francisco, CA, 94142, USA
| | - Jae Sevelius
- Center for Excellence in Transgender Health, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| |
Collapse
|
34
|
Abstract
According to the 'Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations' there are five groups of people at elevated risk of HIV, including 'transgender women or transgender men who have receptive anal sex with men'. Although cost effectiveness strategies and best practice lessons recommend targeting specific populations for HIV prevention, existing risk categories lack specificity, and may in fact cause further confusion. Existing categories of risk often perpetuate notions of gender and sexuality that can erroneously exclude, alienate, and stigmatise those who are at the highest risk and thus should be prioritised. We review the troubled history of the MSM category and the problematic conflation of trans feminine individuals and MSM in much of the existing HIV literature, and how this practice has stymied progress in slowing the HIV epidemic in the most at-risk groups, including those who do not fit neatly into binary notions of gender and sex. We draw from examples in the field, specifically among trans feminine people in Beirut and San Francisco, to illustrate the lived experiences of individuals whose identities may not fit into Euro-Atlantic constructs of HIV prevention categories.
Collapse
Affiliation(s)
- Rachel Kaplan
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Jae Sevelius
- Center for AIDS Prevention Studies, Center of Excellence for Transgender Health, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Kira Ribeiro
- Université Paris 8, Vincennes Saint-Denis, CRESPPA-LabToP, Villejuif, France
| |
Collapse
|
35
|
Sevelius J, Deutsch MB, Glidden DV, Grant RM. PrEP adherence among trans women in Brazil—access needed for this key population – Authors' reply. The Lancet HIV 2016; 3:e200-1. [DOI: 10.1016/s2352-3018(16)30023-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 04/14/2016] [Indexed: 10/21/2022]
|
36
|
Pollock L, Silva-Santisteban A, Sevelius J, Salazar X. 'You should build yourself up as a whole product': Transgender female identity in Lima, Peru. Glob Public Health 2016; 11:981-93. [PMID: 27080150 DOI: 10.1080/17441692.2016.1167932] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Transgender women in Lima, Peru have, until recently, been grouped together with gay and bisexual men in the category MSM, or men who have sex with men, with little consideration of their unique situation and needs. Transgender women, self-identified in Peru as travesti, are a socially vulnerable population with many unmet health needs, including an HIV prevalence of 30%. Understanding specific transgender identities and their contexts will contribute to the improvement and development of HIV prevention programs. Through qualitative open-ended interviews with trans-identified women in Lima, Peru, this study found that the non-normative travesti identity is constructed within a conservative homophobic and heteronormative social context. Participants strive towards appearances and relationships perceived as feminine, seeking out silicone injections and abusive men as social markers of this femininity. Sex work is the primary economic activity available and travestis are often alienated from their families and communities. Work is needed to increase self-esteem and decrease violence, stigma, and discrimination. There is a need for multilevel HIV prevention campaigns prioritising travesti in Lima, utilising a human rights framework.
Collapse
Affiliation(s)
- Lealah Pollock
- a Department of Family and Community Medicine , University of California, San Francisco , San Francisco , CA , USA
| | - Alfonso Silva-Santisteban
- b Center for Interdisciplinary Research on Sexuality, AIDS, and Society , Cayetano Heredia University (Centro de Investigación Interdisciplinaria en Salud, Sida, y Sociedad de la Universidad Peruana Cayetano Heredia) , Lima , Peru
| | - Jae Sevelius
- c Department of Medicine , Center for AIDS Prevention Studies, Center of Excellence for Transgender Health, University of California, San Francisco , San Francisco , CA , USA
| | - Ximena Salazar
- b Center for Interdisciplinary Research on Sexuality, AIDS, and Society , Cayetano Heredia University (Centro de Investigación Interdisciplinaria en Salud, Sida, y Sociedad de la Universidad Peruana Cayetano Heredia) , Lima , Peru
| |
Collapse
|
37
|
Lippman SA, Moran L, Sevelius J, Castillo LS, Ventura A, Treves-Kagan S, Buchbinder S. Acceptability and Feasibility of HIV Self-Testing Among Transgender Women in San Francisco: A Mixed Methods Pilot Study. AIDS Behav 2016; 20:928-38. [PMID: 26511864 DOI: 10.1007/s10461-015-1236-2] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
An estimated one in four transgender women (trans women) in the U.S. are infected with HIV. Rates of HIV testing are not commensurate with their risk, necessitating alternative strategies for early detection and care. We explored the feasibility and acceptability of HIV self-testing (HIVST) with 50 HIV-negative adult trans women in San Francisco. Participants received three self-test kits to perform once a month. Acceptability and behavioral surveys were collected as were 11 in-depth interviews (IDIs). Among 50 participants, 44 reported utilizing HIVST at least once; 94 % reported the test easy to use; 93 % said results were easy to read; and 91 % would recommend it to others. Most participants (68 %) preferred HIVST to clinic-based testing, although price was a key barrier to uptake. IDIs revealed a tension between desires for privacy versus support found at testing sites. HIVST for trans women was acceptable and feasible and requires careful consideration of linkage to support services.
Collapse
Affiliation(s)
- Sheri A Lippman
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94158-2549, USA.
| | - Lissa Moran
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94158-2549, USA
| | - Jae Sevelius
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94158-2549, USA
| | - Leslie S Castillo
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94158-2549, USA
- University of California, Berkeley, School of Public Health, Berkeley, CA, USA
| | - Angel Ventura
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94158-2549, USA
| | - Sarah Treves-Kagan
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94158-2549, USA
| | - Susan Buchbinder
- San Francisco Department of Public Health, Bridge HIV, San Francisco, CA, USA
| |
Collapse
|
38
|
Bockting W, Coleman E, Deutsch MB, Guillamon A, Meyer I, Meyer W, Reisner S, Sevelius J, Ettner R. Adult development and quality of life of transgender and gender nonconforming people. Curr Opin Endocrinol Diabetes Obes 2016; 23:188-97. [PMID: 26835800 PMCID: PMC4809047 DOI: 10.1097/med.0000000000000232] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW Research on the health of transgender and gender nonconforming people has been limited with most of the work focusing on transition-related care and HIV. The present review summarizes research to date on the overall development and quality of life of transgender and gender nonconforming adults, and makes recommendations for future research. RECENT FINDINGS Pervasive stigma and discrimination attached to gender nonconformity affect the health of transgender people across the lifespan, particularly when it comes to mental health and well-being. Despite the related challenges, transgender and gender nonconforming people may develop resilience over time. Social support and affirmation of gender identity play herein a critical role. Although there is a growing awareness of diversity in gender identity and expression among this population, a comprehensive understanding of biopsychosocial development beyond the gender binary and beyond transition is lacking. SUMMARY Greater visibility of transgender people in society has revealed the need to understand and promote their health and quality of life broadly, including but not limited to gender dysphoria and HIV. This means addressing their needs in context of their families and communities, sexual and reproductive health, and successful aging. Research is needed to better understand what factors are associated with resilience and how it can be effectively promoted.
Collapse
Affiliation(s)
- Walter Bockting
- aDivision of Gender, Sexuality, and Health New York State Psychiatric Institute/Columbia Psychiatry and the School of Nursing, Columbia University Medical Center, New York bProgram in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota cSchool of Medicine, University of California, San Francisco, California dDepartment of Psychobiology, National Distance Education University, Madrid, Spain eThe Williams Institute, University of California, Los Angeles School of Law, Los Angeles, California fDivision of Psychiatry, University of Texas Medical Branch, Galveston, Texas gFenway Institute, Fenway Health hDepartment of Epidemiology, Harvard T.H. Chan School of Public Health iDivision of General Pediatrics, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts jSchool of Medicine, University of California, San Fransisco, California kPrivate Practice, Evanston, Illinois
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
PURPOSE OF REVIEW Transgender persons suffer significant health disparities and may require medical intervention as part of their care. The purpose of this manuscript is to briefly review the literature characterizing barriers to healthcare for transgender individuals and to propose research priorities to understand mechanisms of those barriers and interventions to overcome them. RECENT FINDINGS Current research emphasizes sexual minorities' self-report of barriers, rather than using direct methods. The biggest barrier to healthcare reported by transgender individuals is lack of access because of lack of providers who are sufficiently knowledgeable on the topic. Other barriers include: financial barriers, discrimination, lack of cultural competence by providers, health systems barriers, and socioeconomic barriers. SUMMARY National research priorities should include rigorous determination of the capacity of the US healthcare system to provide adequate care for transgender individuals. Studies should determine knowledge and biases of the medical workforce across the spectrum of medical training with regard to transgender medical care; adequacy of sufficient providers for the care required, larger social structural barriers, and status of a framework to pay for appropriate care. As well, studies should propose and validate potential solutions to address identified gaps.
Collapse
Affiliation(s)
- Joshua D. Safer
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, MA
| | - Eli Coleman
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
| | - Jamie Feldman
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
| | - Robert Garofalo
- Division of Adolescent Medicine, Department of Pediatrics. Ann & Robert H. Lurie Children’s Hospital of Chicago/Northwestern University, Chicago, IL, USA
| | - Wylie Hembree
- Program of Developmental Psychoendocrinology, Division of Gender, Sexuality, and Health, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY and NYS Psychiatric Institute, New York, NY
| | - Asa Radix
- Callen-Lorde Community Health Center, New York, NY
| | - Jae Sevelius
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA
| |
Collapse
|
40
|
Deutsch MB, Glidden DV, Sevelius J, Keatley J, McMahan V, Guanira J, Kallas EG, Chariyalertsak S, Grant RM. HIV pre-exposure prophylaxis in transgender women: a subgroup analysis of the iPrEx trial. Lancet HIV 2015; 2:e512-9. [PMID: 26614965 PMCID: PMC5111857 DOI: 10.1016/s2352-3018(15)00206-4] [Citation(s) in RCA: 208] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 10/06/2015] [Accepted: 10/06/2015] [Indexed: 11/17/2022]
Abstract
Background Oral emtricitabine-tenofovir disoproxil fumarate (FTC/TDF) pre-exposure prophylaxis (PrEP) is used to prevent the sexual acquisition of HIV. Transgender women (TGW) have unique characteristics that may relate to PrEP use, effectiveness, and safety. Methods The iPrEx trial was a randomized controlled trial (RCT) of oral FTC/TDF PrEP versus placebo among men who have sex with men (MSM) and TGW, followed by an open label extension (OLE). Drug concentrations were measured in blood by liquid chromatography and tandem mass spectroscopy. Findings Of the 2499 participants enrolled in the RCT, 29 (1%) identified as women, 296 (12%) identified as “trans”, 14 (1%) identified as men but reported use of feminizing hormones, such that 339 (14%) reported one or more of these characteristics (TGW). Compared with MSM, TGW more frequently reported transactional sex, receptive anal intercourse without a condom, or more than 5 partners in the past 3 months. Among TGW, there were 11 HIV infections in the active arm and 10 in the placebo arm, representing a hazard ratio of 1.1 (95% CI: 0.5 to 2.7). Among active arm participants, drug was detected in none of the TGW at the seroconversion visit, 18% (6/37) of seronegative TGW (P=0.31), and 52% (58/111) of seronegative MSM (P < 0.0001). PrEP use was not linked to behavioral indicators of HIV risk among TGW, while MSM at highest risk were more adherent. Interpretation There were no HIV infections among TGW having drug concentrations commensurate with use of 4 or more FTC/TDF tablets per week. TGW receiving PrEP had low drug concentrations, especially at times of potential HIV exposure, leading to no PrEP effectiveness among this subgroup. Funding U.S. National Institutes of Health and the Bill and Melinda Gates Foundation; study medication was donated by Gilead Sciences.
Collapse
Affiliation(s)
| | | | - Jae Sevelius
- University of California, San Francisco, CA, USA
| | | | | | | | | | | | - Robert M Grant
- University of California, San Francisco, CA, USA; Gladstone Institutes, San Francisco, CA, USA; San Francisco AIDS Foundation, San Francisco, CA, USA.
| |
Collapse
|
41
|
Reisner SL, White Hughto JM, Pardee D, Sevelius J. Syndemics and gender affirmation: HIV sexual risk in female-to-male trans masculine adults reporting sexual contact with cisgender males. Int J STD AIDS 2015; 27:955-66. [PMID: 26384946 DOI: 10.1177/0956462415602418] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 07/31/2015] [Indexed: 11/16/2022]
Abstract
Female-to-male trans masculine adults who have sex with cisgender (non-transgender) males (TMSM) represent an understudied population in relation to HIV/sexually transmitted infection (STI) risk. This study examined the role of syndemic conditions and social gender affirmation processes (living full-time in one's identified gender) in potentiating sexual risk among TMSM adults in Massachusetts, US. Cross-sectional data were restricted to TMSM who reported lifetime sexual behaviour with a cisgender male (n = 173; mean age = 29.4, SD = 9.6; 18.5% people of colour; 93.1% non-heterosexual identity; 56.1% hormones/surgery). Sexual risk outcomes were: lifetime STI diagnoses, three or more sexual partners in the previous six months, and condomless anal/vaginal sex at last encounter with a cisgender male. Age- and survey mode-adjusted logistic regression models regressed sexual risk outcomes on the main effect of syndemics (six indicators summed: binge drinking, substance use, depression, anxiety, childhood abuse, intimate partner violence), followed by the interaction of syndemics and social gender affirmation. Syndemics were associated with increased odds of all sexual risk indicators (adjusted odds ratios [aORs] = 1.32-1.55; p < 0.0001). Social gender affirmation moderated the association between syndemics and condomless anal/vaginal sex at last encounter with a cisgender male (p < 0.0001). Syndemics were associated with sexual risk in TMSM who had socially affirmed their gender (aOR = 1.79; 95% CI = 1.42-2.25; p < 0.001), but not among those TMSM who had not (aOR = 0.86; 95% CI = 0.63-1.19; p = 0.37). Findings suggest that syndemic pathways to sexual risk are similar for TMSM who have socially gender affirmed as for cisgender MSM. Integration of syndemics and gender affirmation frameworks is recommended in interventions to address TMSM sexual risk.
Collapse
Affiliation(s)
- Sari L Reisner
- Division of General Pediatrics, Boston Children's Hospital/Harvard Medical School, Boston, MA, USA Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Jaclyn M White Hughto
- The Fenway Institute, Fenway Health, Boston, MA, USA Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Dana Pardee
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Jae Sevelius
- Center of Excellence for Transgender Health, University of California, San Francisco, CA, USA
| |
Collapse
|
42
|
Reisner SL, Bailey Z, Sevelius J. Racial/ethnic disparities in history of incarceration, experiences of victimization, and associated health indicators among transgender women in the U.S. Women Health 2015; 54:750-67. [PMID: 25190135 DOI: 10.1080/03630242.2014.932891] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Limited national data document the prevalence of incarceration among transgender women, experiences of victimization while incarcerated, and associations of transgender status with health. Data were from the National Transgender Discrimination Survey (NTDS), a large convenience sample of transgender adults in the U.S., collected between September 2008 and March 2009. Respondents who indicated a transfeminine gender identity were included in the current study (n = 3,878). Multivariable logistic regression was used to model ever being incarcerated and experiencing victimization while incarcerated as a function of race/ethnicity and health-related indicators. Overall, 19.3% reported having ever been incarcerated. Black and Native American/Alaskan Native transgender women were more likely to report a history of incarceration than White (non-Hispanic) respondents, and those with a history of incarceration were more likely to report negative health-related indicators, including self-reporting as HIV-positive. Among previously incarcerated respondents, 47.0% reported victimization while incarcerated. Black, Latina, and mixed race transgender women were more likely to report experiences of victimization while incarcerated. Transgender women reported disproportionately high rates of incarceration and victimization while incarcerated, as well as associated negative health-related indicators. Interventions and policy changes are needed to support transgender women while incarcerated and upon release.
Collapse
Affiliation(s)
- Sari L Reisner
- a Department of Epidemiology , Harvard School of Public Health , Boston , Massachusetts , USA
| | | | | |
Collapse
|
43
|
Deutsch MB, Keatley J, Sevelius J, Shade SB. Collection of gender identity data using electronic medical records: survey of current end-user practices. J Assoc Nurses AIDS Care 2014; 25:657-63. [PMID: 24880490 DOI: 10.1016/j.jana.2014.04.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 04/03/2014] [Indexed: 11/18/2022]
|
44
|
Abstract
PURPOSE Trans women of color contend with multiple marginalizations; the purpose of this study is to examine associations between experiencing discriminatory (racist/transphobic) events and depression symptoms. It uses a categorical measure of combined discrimination, and examines a protective association of transgender identity on depression symptoms. DESIGN/METHODOLOGY/APPROACH Data from a subset of trans women of color participants in the Sheroes study were analyzed with linear and logistic regression. Associations of depression symptoms with racist and transphobic events, combined discrimination, coping self-efficacy, and transgender identity were assessed with odds ratios. FINDINGS Exposure to discriminatory events and combined discrimination positively associated with depression symptom odds. Increased transgender identity associated with increased coping self-efficacy, which negatively associated with depression symptom odds. RESEARCH LIMITATIONS/IMPLICATIONS Cross-sectional study data prohibits inferring causality; results support conducting longitudinal research on discrimination's health effects, and research on transgender identity. Results also support operationalizing intersectionality in health research. The study's categorical approach to combined discrimination may be replicable in studies with hard to reach populations and small sample sizes. PRACTICAL IMPLICATIONS Health programs could pursue psychosocial interventions and anti-discrimination campaigns. Interventions might advocate increasing participants' coping self-efficacy while providing space to explore and develop social identity. SOCIAL IMPLICATIONS There is a need for policy and health programs to center trans women of color concerns. ORIGINALITY/VALUE This study examines combined discrimination and identity in relation to depression symptoms among trans women of color, an underserved population. PAPER TYPE Research paper.
Collapse
Affiliation(s)
- Kevin Jefferson
- Rollins School of Public Health, Emory Universty, Atlanta, Georgia, USA
| | - Torsten B Neilands
- Center for AIDS Prevention Studies, University of California, San Francisco, California, USA
| | - Jae Sevelius
- Center for AIDS Prevention Studies, University of California, San Francisco, California, USA
| |
Collapse
|
45
|
Sevelius J. "There's no pamphlet for the kind of sex I have": HIV-related risk factors and protective behaviors among transgender men who have sex with nontransgender men. J Assoc Nurses AIDS Care 2009; 20:398-410. [PMID: 19732698 DOI: 10.1016/j.jana.2009.06.001] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Accepted: 06/12/2009] [Indexed: 10/20/2022]
Abstract
Preliminary evidence has suggested that some transgender men who have sex with nontransgender men ("trans MSM") may be at risk for HIV and sexually transmitted infections and that their prevention needs are not being met. Quantitative (n =45) and qualitative (n =15) interviews explored risk behaviors, protective strategies, and perceptions of the impact of transgender identity on sexual decision making among trans MSM. A majority of the participants reported inconsistent condom use during receptive vaginal and anal sex with nontrans male partners; HIV prevalence was 2.2%. Risk factors included barriers to sexual negotiation such as unequal power dynamics, low self-esteem, and need for gender identity affirmation. Protective strategies included meeting and negotiating with potential partners online. Results of this study provide initial evidence that current risk behaviors could lead to rising HIV prevalence rates among trans MSM. Prevention programs must tailor services to include issues unique to trans MSM and their nontrans male partners.
Collapse
Affiliation(s)
- Jae Sevelius
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, USA
| |
Collapse
|
46
|
Operario D, Burton J, Underhill K, Sevelius J. Men who have sex with transgender women: challenges to category-based HIV prevention. AIDS Behav 2008; 12:18-26. [PMID: 17705095 DOI: 10.1007/s10461-007-9303-y] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Accepted: 07/25/2007] [Indexed: 11/26/2022]
Abstract
Although transgender women are acknowledged as a priority population for HIV prevention, there is little knowledge on men who have sex with transgender women (MSTGWs). MSTGWs challenge conventional sexual orientation categories in public health and HIV prevention research, and warrant increased attention from the public health community. This paper used qualitative techniques to analyze how MSTGWs describe their sexual orientation identities, and to explore the correspondence between men's identities and sexual behaviors with transgender women. We conducted in-depth semi-structured individual interviews with 46 MSTGWs in San Francisco. We observed a diversity in the ways participants identified and explained their sexual orientation, and found no consistent patterns between how men described their sexual orientation identity versus their sexual behavior and attraction to transgender women. Findings from this qualitative study question the utility of category-based approaches to HIV prevention with MSTGWs and offer insights into developing HIV interventions for these men.
Collapse
Affiliation(s)
- Don Operario
- Department of Social Policy and Social Work, University of Oxford, 32 Wellington Square, Oxford, OX1 2ER, UK.
| | | | | | | |
Collapse
|