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Lacombe-Duncan A, Olawale R. Context, Types, and Consequences of Violence Across the Life Course: A Qualitative Study of the Lived Experiences of Transgender Women Living With HIV. J Interpers Violence 2022; 37:2242-2266. [PMID: 32639854 DOI: 10.1177/0886260520935093] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Violence is a known driver of HIV vulnerability among transgender (trans) women, who are disproportionately impacted by HIV globally. Violence is also a barrier to accessing HIV prevention, treatment, and support. Yet, little is known about the everyday experiences of violence faced by trans women living with HIV, who live at the intersection of a marginalized gender identity and physical health condition. To address this gap, this study draws on semi-structured, individual interviews conducted 2017-2018 with a purposive sample (selected based on diverse identities) of trans women living with HIV (n = 11) participating in a large, community-based cohort study in three Canadian provinces. Framework analysis was used to identify key themes, patterns within themes between participants, and patterns across themes among participants. Findings showed that trans women living with HIV experience specific contexts of violence shaped at the intersection of stigma based on gender identity, gender expression, and HIV status, among other identities/experiences. Violence experienced in childhood (e.g., familial rejection, bullying) increased trans women's likelihood of being exposed to a violent social context in young adulthood (e.g., state violence perpetuated by the police, interpersonal violence perpetuated by sexual partners, and community violence perpetuated by society-at-large/the general public), which increased trans women's HIV vulnerability; once living with HIV trans women were subjected to discursive violence from healthcare providers. These multiple forms of violence have serious consequences for trans women living with HIV's ongoing social, mental, and physical well-being. The findings suggest that interventions are urgently needed to reduce violence against trans women in childhood and young adulthood, in addition to reducing violence against trans women living with HIV perpetuated by healthcare providers in adulthood, to both proactively and responsively promote their safety, health, and well-being.
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Lacombe-Duncan A, Logie CH, Persad Y, Leblanc G, Nation K, Kia H, Scheim AI, Lyons T, Horemans C, Olawale R, Loutfy M. Implementation and evaluation of the 'Transgender Education for Affirmative and Competent HIV and Healthcare (TEACHH)' provider education pilot. BMC Med Educ 2021; 21:561. [PMID: 34732178 PMCID: PMC8566115 DOI: 10.1186/s12909-021-02991-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 04/20/2021] [Accepted: 10/21/2021] [Indexed: 05/14/2023]
Abstract
BACKGROUND Transgender (trans) women face constrained access to gender-affirming HIV prevention and care. This is fueled in part by the convergence of limited trans knowledge and competency with anti-trans and HIV-related stigmas among social and healthcare providers. To advance gender-affirming HIV service delivery we implemented and evaluated 'Transgender Education for Affirmative and Competent HIV and Healthcare (TEACHH)'. This theoretically-informed community-developed intervention aimed to increase providers' gender-affirming HIV prevention and care knowledge and competency and reduce negative attitudes and biases among providers towards trans women living with and/or affected by HIV. METHODS Healthcare and social service providers and providers in-training (e.g., physicians, nurses, social workers) working with trans women living with and/or affected by HIV (n = 78) participated in a non-randomized multi-site pilot study evaluating TEACHH with a pre-post-test design. Pre- and post-intervention surveys assessed participant characteristics, intervention feasibility (e.g., workshop completion rate) and acceptability (e.g., willingness to attend another training). Paired sample t-tests were conducted to assess pre-post intervention differences in perceived competency, attitudes/biases, and knowledge to provide gender-affirming HIV care to trans women living with HIV and trans persons. RESULTS The intervention was feasible (100% workshop completion) and acceptable (91.9% indicated interest in future gender-affirming HIV care trainings). Post-intervention scores indicated significant improvement in: 1) knowledge, attitudes/biases and perceived competency in gender-affirming HIV care (score mean difference (MD) 8.49 (95% CI of MD: 6.12-10.86, p < 0.001, possible score range: 16-96), and 2) knowledge, attitudes/biases and perceived competency in gender-affirming healthcare (MD = 3.21; 95% CI of MD: 1.90-4.90, p < 0.001, possible score range: 9-63). Greater change in outcome measures from pre- to post-intervention was experienced by those with fewer trans and transfeminine clients served in the past year, in indirect service roles, and having received less prior training. CONCLUSIONS This brief healthcare and social service provider intervention showed promise in improving gender-affirming provider knowledge, perceived competency, and attitudes/biases, particularly among those with less trans and HIV experience. Scale-up of TEACHH may increase access to gender-affirming health services and HIV prevention and care, increase healthcare access, and reduce HIV disparities among trans women. TRIAL REGISTRATION ClinicalTrials.gov ( NCT04096053 ).
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Affiliation(s)
- Ashley Lacombe-Duncan
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI, 48109-1106, USA.
- Center for Sexuality and Health Disparities, University of Michigan, 400 North Ingalls Street, Ann Arbor, MI, 48109-5482, USA.
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, Ontario, M5G 1N8, Canada.
| | - Carmen H Logie
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, Ontario, M5G 1N8, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, M5S 1V4, Canada
- Center for Gender & Sexual Health Equity (CGSHE), 1190 Hornby Street, Vancouver, V6Z 2K5, Canada
| | - Yasmeen Persad
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, Ontario, M5G 1N8, Canada
| | - Gabrielle Leblanc
- Action Santé Travesti(e)s & Transsexuel(le)s du Québec (ASTT(E)Q), 1300 Sanguinet, Montréal, H2X 3E7, Canada
| | - Kelendria Nation
- Prism Education Series, Vancouver Coastal Health, 1128 Hornby Street, Vancouver, V6Z 2L4, Canada
| | - Hannah Kia
- School of Social Work, University of British Columbia, 2080 West Mall, Vancouver, V6T 1Z2, Canada
| | - Ayden I Scheim
- Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA, 19104, USA
| | - Tara Lyons
- Center for Gender & Sexual Health Equity (CGSHE), 1190 Hornby Street, Vancouver, V6Z 2K5, Canada
- Department of Criminology, Kwantlen Polytechnic University, 12666 72 Avenue, Surrey, V3W 2M8, Canada
| | - Chavisa Horemans
- CIHR Canadian HIV Trials Network, 588-1081 Burrard Street, Vancouver, V6Z 1Y6, Canada
| | - Ronke Olawale
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI, 48109-1106, USA
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, Ontario, M5G 1N8, Canada
- Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, M5S 1A8, Canada
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Ellis KR, Hecht HK, Young TL, Oh S, Thomas S, Hoggard LS, Ali Z, Olawale R, Carthron D, Corbie-Smith G, Eng E. Chronic Disease Among African American Families: A Systematic Scoping Review. Prev Chronic Dis 2020; 17:E167. [PMID: 33416471 PMCID: PMC7784550 DOI: 10.5888/pcd17.190431] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Chronic diseases are common among African Americans, but the extent to which research has focused on addressing chronic diseases across multiple members of African American families is unclear. This systematic scoping review summarizes the characteristics of research addressing coexisting chronic conditions among African American families, including guiding theories, conditions studied, types of relationships, study outcomes, and intervention research. METHODS The literature search was conducted in PsycInfo, PubMed, Social Work Abstracts, Sociological Abstracts, CINAHL, and Family and Society Studies Worldwide to identify relevant articles published from January 2000 through September 2016. We screened the title and abstracts of 9,170 articles, followed by full-text screening of 530 articles, resulting in a final sample of 114 articles. Fifty-seven percent (n = 65) of the articles cited a guiding theory/framework, with psychological theories (eg, social cognitive theory, transtheoretical model) being most prominent. The most common conditions studied in families were depression (70.2%), anxiety (23.7%), and diabetes (22.8%), with most articles focusing on a combination of physical and mental health conditions (47.4%). RESULTS In the 114 studies in this review, adult family members were primarily the index person (71.1%, n = 81). The index condition, when identified (79.8%, n = 91), was more likely to be a physical health condition (46.5%, n = 53) than a mental health condition (29.8%, n = 34). Among 343 family relationships examined, immediate family relationships were overwhelmingly represented (85.4%, n = 293); however, extended family (12.0%, n = 41) and fictive kin (0.6%, n = 2) were included. Most (57.0%, n = 65) studies focused on a single category of outcomes, such as physical health (eg, obesity, glycemic control), mental health (eg, depression, anxiety, distress), psychosocial outcomes (eg, social support, caregiver burden), or health behaviors (eg, medication adherence, disease management, health care utilization); however, 43.0% (n = 49) of studies focused on outcomes across multiple categories. Sixteen intervention articles (14.0%) were identified, with depression the most common condition of interest. CONCLUSION Recognizing the multiple, simultaneous health issues facing families through a lens of family comorbidity and family multimorbidity may more accurately mirror the lived experiences of many African American families and better elucidate intervention opportunities than previous approaches.
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Affiliation(s)
- Katrina R Ellis
- University of Michigan, School of Social Work, Room 3849, Ann Arbor, MI 48109.
| | - Hillary K Hecht
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Policy and Management, Chapel Hill, North Carolina
| | - Tiffany L Young
- University of North Carolina at Chapel Hill, North Carolina Translational Research and Clinical Sciences Institute, Chapel Hill, North Carolina
- Lenell and Lillie Consulting, LLC, New Bern, North Carolina
| | - Seyoung Oh
- University of Michigan, School of Social Work, Ann Arbor, Michigan
| | - Shikira Thomas
- University of North Carolina at Chapel Hill, Cecil G. Sheps Center for Health Services Research, Chapel Hill, North Carolina
| | - Lori S Hoggard
- Rutgers University-New Brunswick, Department of Psychology, New Brunswick, New Jersey
| | - Zaire Ali
- Rutgers University-New Brunswick, Department of Psychology, New Brunswick, New Jersey
| | - Ronke Olawale
- University of Michigan, School of Social Work, Ann Arbor, Michigan
| | - Dana Carthron
- North Carolina Central University, College of Behavioral Sciences, Durham, North Carolina
| | - Giselle Corbie-Smith
- University of North Carolina at Chapel Hill, School of Medicine, Department of Social Medicine, Chapel Hill, North Carolina
| | - Eugenia Eng
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Behavior, Chapel Hill, North Carolina
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Affiliation(s)
- A. A. Amusan
- Department of Soil Science, Faculty of Agriculture, Obafemi Awolowo University , Ile-Ife, Nigeria
| | - D.V. Ige
- Department of Soil Science, Faculty of Agriculture, Obafemi Awolowo University , Ile-Ife, Nigeria
| | - R. Olawale
- Department of Chemistry, Faculty of Science, Obafemi, Awolowo University , Ile-Ife, Nigeria
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