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Jones L, Carroll R, Parker G, Steers D, Ormandy J, Filoche S. Developing a transgender and non-binary inclusive obstetrics and gynaecology undergraduate medical curriculum in Aotearoa/New Zealand: Where are we at, and where do we need to be? Aust N Z J Obstet Gynaecol 2024; 64:15-18. [PMID: 37584099 DOI: 10.1111/ajo.13746] [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] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/02/2023] [Indexed: 08/17/2023]
Abstract
Internationally, undergraduate medical education is not currently enabling early career doctors to meet the needs of trans and gender diverse (TGD) people as healthcare consumers. This review outlines inclusion of TGD education in undergraduate medical education more broadly to contextualise curriculum development needs in obstetrics, gynaecology and reproductive medicine in Aotearoa/New Zealand. Limited, and lack of integrated content, teaching capability and current absence of TGD health knowledge as graduate outcomes, compounded by pedagogy (biomedical/binary framing) and more appropriate learning resources are indicators for curricula, and workforce, development.
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Affiliation(s)
- Lilian Jones
- Department of Obstetrics, Gynaecology and Women's Health, University of Otago Wellington, Wellington, New Zealand
| | - Rona Carroll
- Department of Primary Healthcare and General Practice, University of Otago Wellington, Wellington, New Zealand
| | - George Parker
- School of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Denise Steers
- Department of Psychological Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Judy Ormandy
- Department of Obstetrics, Gynaecology and Women's Health, University of Otago Wellington, Wellington, New Zealand
| | - Sara Filoche
- Department of Obstetrics, Gynaecology and Women's Health, University of Otago Wellington, Wellington, New Zealand
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Chan RCH, Suen YT, Leung JSY. Gender identity differences in the experiences of family stressors and violence among transgender and non-binary individuals in China. Fam Process 2024. [PMID: 38169124 DOI: 10.1111/famp.12958] [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] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/30/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024]
Abstract
Emerging research has demonstrated that transgender and non-binary (TNB) individuals face an elevated risk of experiencing family rejection and violence. However, there remains a significant knowledge gap regarding how TNB individuals manage stressors and their gender identity within the family context, particularly in regions where TNB individuals are highly stigmatized and where legal protections against family violence are lacking. The present study represents one of the first pioneering efforts to provide large-scale quantitative data examining the experiences of family stressors, the management of gender identity and expression, and family violence among TNB individuals in China. A national sample of 1063 TNB individuals in China was involved in the study. They completed questionnaires about their experiences of family stressors and violence. The results indicated that 76.0% of TNB individuals reported having encountered at least one form of violence perpetrated by their family members. Transfeminine individuals were more likely to report experiencing emotional and physical abuse, whereas transmasculine individuals were more likely to be subjected to gender identity and/or expression change efforts. Family stressors, including family non-acceptance and the pressure to marry and reproduce, were positively associated with non-disclosure of gender identity, the suppression of gender expression, and family violence. The findings underscore the substantial burden of family violence borne by TNB individuals in China, which warrants immediate legal, institutional, and social responses. Trans-inclusive family violence prevention and intervention are urgently needed, with a focus on Chinese cultural factors and gender identity differences in violence screening and risk assessment.
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Affiliation(s)
- Randolph C H Chan
- Department of Social Work, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yiu Tung Suen
- Gender Studies Programme, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Janice Sin Yu Leung
- Gender Studies Programme, The Chinese University of Hong Kong, Shatin, Hong Kong
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Tordoff DM, Fernandez A, Perry NL, Heberling WB, Minalga B, Khosropour CM, Glick SN, Barbee LA, Duerr A. A Quantitative Intersectionality Analysis of HIV/STI Prevention and Healthcare Access Among Transgender and Nonbinary People. Epidemiology 2023; 34:827-837. [PMID: 37756272 PMCID: PMC10539029 DOI: 10.1097/ede.0000000000001669] [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] [Indexed: 09/29/2023]
Abstract
BACKGROUND Transgender and nonbinary people experience substantial barriers to accessing healthcare, including prevention of HIV and other sexually transmitted infections (HIV/STI), due to structural inequities. We examined differences in insurance, HIV/STI prevalence, testing, and preexposure prophylaxis use among transgender and nonbinary people living in Washington State by race and ethnicity and gender. METHODS We pooled data from five 2019-2021 Washington State HIV/STI surveillance data sources to obtain a large and diverse sample of 1648 transgender and nonbinary participants. We calculated the risk difference (RD) for each outcome and used Poisson regression to estimate a surrogate measure of additive interaction-attributable proportion (AP)-that measures the proportion of the excess prevalence of the outcome observed at the intersection of gendered and racialized experience, beyond that expected from gender or race and ethnicity alone. RESULTS Participants reported overall high levels of poverty (29% incomes <$15,000 and 7% unstable housing). Certain groups, especially racial/ethnic minority transgender women, were disproportionately impacted by HIV/STIs (RDs from 20% to 43% and APs from 50% to 85%) and less likely to currently have insurance (RDs from 25% to 39% and APs from 74% to 93%) than that expected based on gendered or racialized experience alone. CONCLUSIONS Our findings highlight the heterogeneity in insurance access, HIV/STI positivity, and prevention utilization within transgender communities. We observed that a large proportion of increased HIV/STI prevalence among racial/ethnic minority transgender women was attributable to the intersection of gender and race and ethnicity. Our findings highlight the importance of trans-inclusive models of HIV/STI prevention that address multilevel barriers rooted in cissexism and structural racism.
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Affiliation(s)
- Diana M. Tordoff
- University of Washington, Department of Epidemiology, Seattle, WA
| | | | - Nicole Lynn Perry
- Lavender Rights Project, Washington Black Trans Task Force, Seattle, WA
| | | | | | | | - Sara N. Glick
- University of Washington, School of Medicine, Seattle, WA
- Public Health-Seattle & King County HIV/STD Program, Seattle, WA
| | - Lindley A. Barbee
- University of Washington, School of Medicine, Seattle, WA
- Public Health-Seattle & King County HIV/STD Program, Seattle, WA
| | - Ann Duerr
- Fred Hutchinson Cancer Center, Seattle, WA
- Department of Global Health, University of Washington, Seattle, WA
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Hassan B, Zeitouni F, Ascha M, Sanders R, Liang F. Temporal Trends in Gender Affirmation Surgery Among Transgender and Non-Binary Minors. Cureus 2023; 15:e45948. [PMID: 37885491 PMCID: PMC10599689 DOI: 10.7759/cureus.45948] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Over the last decade, a greater number of transgender or non-binary (TGNB) minors have been seeking gender affirmation surgery (GAS). Given the recent concerns about the potential harm of GAS in TGNB minors, we sought to determine the incidence and postoperative outcomes of GAS among TGNB minors. METHODS We retrospectively reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Pediatric database, 2018-2021, for minors aged 17 years or younger. The primary outcome was the frequency and type of GAS plotted over time. The secondary outcome was the incidence of postoperative complications within 30 days following GAS. Descriptive statistics were calculated. Linear regression was performed to assess the association between the incidence of GAS and time in years. RESULTS A total of 108 TGNB minors were identified. The mean (SD) age was 16.9 (0.8) years without significant variation over time. There was a significant increase in the number of GAS per year over four years (P<.001). Nevertheless, only two (1.9%) patients underwent GAS below the age of 15 (13.9 and 14.5 years). Chest masculinization surgery (CMS) was the predominant procedure type among TGNB minors (n=102, 94.4%). There was no incidence of major complications (mortality, bleeding, sepsis, unplanned intubation) except for unplanned reoperation for hematoma evacuation (n=3, 2.8%). The incidence of minor complications (surgical site infection, wound dehiscence) was low (n=1, 0.9%), each). CONCLUSIONS AND RELEVANCE GAS in minors, primarily in the form of CMS, has been increasing over time. CMS in minors is a safe procedure with rare complications.
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Affiliation(s)
- Bashar Hassan
- Center for Transgender and Gender Expansive Health, Johns Hopkins University, Baltimore, USA
| | - Ferris Zeitouni
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
- Center for Transgender and Gender Expansive Health, Johns Hopkins University, Baltimore, USA
| | - Mona Ascha
- Center for Transgender and Gender Expansive Health, Johns Hopkins University, Baltimore, USA
| | - Renata Sanders
- Center for Transgender and Gender Expansive Health, Johns Hopkins University, Baltimore, USA
| | - Fan Liang
- Center for Transgender and Gender Expansive Health, Johns Hopkins University, Baltimore, USA
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Tordoff DM, Zangeneh S, Khosropour CM, Glick SN, McClelland RS, Dimitrov D, Reisner S, Duerr A. Geographic Variation in HIV Testing Among Transgender and Nonbinary Adults in the United States. J Acquir Immune Defic Syndr 2022; 89:489-497. [PMID: 35001041 PMCID: PMC9058176 DOI: 10.1097/qai.0000000000002909] [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: 06/23/2021] [Accepted: 12/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transgender and nonbinary (TNB) populations are disproportionately affected by HIV and few local health departments or HIV surveillance systems collect/report data on TNB identities. Our objective was to estimate the prevalence of HIV testing among TNB adults by US county and state, with a focus on the Ending the HIV Epidemic (EHE) geographies. METHODS We applied a Bayesian hierarchical spatial small area estimation model to data from the 2015 US Transgender Survey, a large national cross-sectional Internet-based survey. We estimated the county- and state-level proportion of TNB adults who ever tested or tested for HIV in the last year by gender identity, race/ethnicity, and age. RESULTS Our analysis included 26,100 TNB participants with valid zip codes who resided in 1688 counties (54% of all 3141 counties that cover 92% of the US population). The median county-level proportion of TNB adults who ever tested for HIV was 44% (range 10%-80%) and who tested in the last year was 17% (range 4%-44%). Within most counties, testing was highest among transgender women, black respondents, and people aged ≥25 years. HIV testing was lowest among nonbinary people and young adults aged <25 years. The proportion of TNB adults who tested within the last year was very low in most EHE counties and in all 7 rural states. CONCLUSIONS HIV testing among TNB adults is likely below national recommendations in the majority of EHE geographies. Geographic variation in HIV testing patterns among TNB adults indicates that testing strategies need to be tailored to local settings.
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Affiliation(s)
- Diana M. Tordoff
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Sahar Zangeneh
- RTI International, Seattle WA
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Sara N. Glick
- School of Medicine, University of Washington, Seattle, WA
| | - R. Scott McClelland
- Department of Epidemiology, University of Washington, Seattle, WA
- School of Medicine, University of Washington, Seattle, WA
- Department of Global Health, University of Washington, Seattle, WA
| | | | - Sari Reisner
- Departments of Medicine and Epidemiology, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA
- The Fenway Institute, Fenway Health, Boston, MA
| | - Ann Duerr
- Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Global Health, University of Washington, Seattle, WA
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