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Wiwattarangkul T, Wainipitapong S. Attitudes towards LGBTQ+ individuals among Thai medical students. PLoS One 2023; 18:e0296039. [PMID: 38096311 PMCID: PMC10721166 DOI: 10.1371/journal.pone.0296039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/01/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The global population of individuals with gender diversity or LGBTQ+ people is on the rise. However, negative attitudes towards LGBTQ+ individuals persist, even among healthcare professionals, creating barriers to healthcare access. These attitudes are influenced by cultural variations worldwide and necessitate investigation across diverse cultures and settings. OBJECTIVES This study aimed to evaluate the attitudes towards LGBTQ+ people and describe associated factors with being LGBTQ+ among Thai medical students. METHODS During the 2021 academic year, a survey was conducted at a medical school in Bangkok, Thailand, collecting demographic data and attitudes measured by a standardised Thai questionnaire. Descriptive statistics as well as bivariate and multivariable logistic regression analyses were used to describe characteristics and association. RESULTS A total of 806 medical students participated, with a neutral attitude being the most prevalent (72.2%), followed by a positive attitude (27.2%), and a minority reporting a negative attitude (0.6%). Bivariate and multivariable logistic regression analyses revealed significant associations between positive attitudes and female sexual identity (aOR 2.02, 95%CI 1.45-2.81, p-value < 0.001), having LGBTQ+ family members (aOR 3.57, 95%CI 1.23-10.34, p-value = 0.019), having LGBTQ+ friend (aOR 1.46, 95%CI 1.02-2.11, p-value = 0.040), and coming from areas outside of Bangkok (aOR 1.41, 95%CI 1.01-1.97, p-value = 0.043). CONCLUSION Positive attitude towards the LGBTQ+ community are essential for physicians, emphasising the need to study factors that contribute to positive attitudes in order to foster an LGBTQ+-friendly environment for both patients and medical students.
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Affiliation(s)
- Teeravut Wiwattarangkul
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Sorawit Wainipitapong
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Department of Global Health and Social Medicine, King’s College London, United Kingdom and Center of Excellence in Transgender Health (CETH), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Encina E, Waratworawan W, Kongjareon Y, Desai MM, Guadamuz TE. Sexual orientation disclosure and depression among Thai gay, bisexual, and other men who have sex with men: The roles of social support and intimate partner violence. PLoS One 2023; 18:e0294496. [PMID: 37992077 PMCID: PMC10664870 DOI: 10.1371/journal.pone.0294496] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/02/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Among gay, bisexual, and other men who have sex with men (GBM), sexual orientation disclosure to social groups can act as a significant risk for depression. The primary goal of this research is to understand the association between disclosure and depression, the association of social support and intimate partner violence (IPV) experiences, depression, and disclosure. METHODS This project uses a secondary dataset of Thailand from a larger cross-sectional study distributed in the Greater Mekong Sub-Region. This study utilized web-based answers from 1468 Thai GBM respondents between the ages of 15-24 years. RESULTS Prevalence of depression was over 50%. Across the social groups of interest, those who disclosed to everyone had the lowest depression prevalence. This association was statistically significant for all groups (p<0.050) except for "Family members" (p = 0.052). There was a statistically significant association illustrated between full disclosure to social groups and increased social support. Most respondents (43.9%) had low social support, and additionally this group had the highest level of depression, compared to those with high social support. There was a statistically significant association for lowered depression outcomes and increased social support. IPV experiences that occurred within the last six months had a statistically significant relationship with depression (p = 0.002). There was a notable association between those with experiences of being a victim of IPV, alone and in conjunction with experience of being a perpetrator of IPV, which was associated with increased odds of depression. However, the type of IPV experiences an individual had did not differ based on disclosure status. DISCUSSION This study provides strengthened evidence of the impact that differences in supportive networks can have on mental health outcomes. In addition, they provided a wider consideration for how people may have different IPV experiences, either as a perpetrator, victim, or both, and how those shapes health outcomes of depression. GBM communities still face adversity and challenges that affect their long-term health outcomes, even if they do live in what is considered an accepting country.
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Affiliation(s)
- Eduardo Encina
- Mahidol Center for Health, Behavior and Society, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States of America
| | - Worawalan Waratworawan
- Mahidol Center for Health, Behavior and Society, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand
| | - Yamol Kongjareon
- Mahidol Center for Health, Behavior and Society, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Mayur M. Desai
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States of America
| | - Thomas E. Guadamuz
- Mahidol Center for Health, Behavior and Society, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- John F. Kennedy School of Government, Harvard University, Cambridge, MA, United States of America
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Mireles L, Horvath KJ, Guadamuz TE, Waratworawan W, Kongjareon Y, Meyers-Pantele SA. The Moderating Role of Social Support and HIV Stigma on the Association Between Depression and ART Adherence Among Young Thai Men Who Have Sex with Men. AIDS Behav 2023; 27:2959-2968. [PMID: 37000384 PMCID: PMC10524997 DOI: 10.1007/s10461-023-04018-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 04/01/2023]
Abstract
In Thailand, antiretroviral therapy (ART) programs still have difficulties reaching and promoting adherence among a key population - young men who have sex with men (YMSM) living with HIV. As such, we sought to examine potential psychosocial barriers that may contribute to suboptimal levels of ART adherence for this population. Data were drawn from a study of 214 YMSM living with HIV from Bangkok, Thailand. Linear regression models tested the association between depression and ART adherence, and whether social support and HIV-related stigma moderated that relationship. Multivariable models demonstrated social support was significantly associated with higher levels of ART adherence, and that there was a three-way interaction between depression, social support, and HIV-related stigma on ART adherence. These results further our understanding of the role of depression, stigma, and social support in ART adherence among Thai YMSM living with HIV, and that additional supports for YMSM with depression and HIV-related stigma are needed.
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Affiliation(s)
- Linda Mireles
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Thomas E Guadamuz
- Center of Excellence in Research on Gender, Sexuality and Health, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand.
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand.
- John F. Kennedy School of Government, Harvard University, Cambridge, MA, USA.
| | - Worawalan Waratworawan
- Center of Excellence in Research on Gender, Sexuality and Health, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand
| | - Yamol Kongjareon
- Center of Excellence in Research on Gender, Sexuality and Health, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand
| | - Stephanie A Meyers-Pantele
- Department of Psychology, San Diego State University, San Diego, CA, USA
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, San Diego, CA, USA
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Pike I, Kraus-Perrotta C, Ngo TD. A scoping review of survey research with gender minority adolescents and youth in low and middle-income countries. PLoS One 2023; 18:e0279359. [PMID: 36626382 PMCID: PMC9831317 DOI: 10.1371/journal.pone.0279359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/05/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Survey data that categorizes gender identity in binary terms and conflates sex and gender limits knowledge around the experience of gender minority populations, whose gender identity or expression does not align with the sex they were assigned at birth. In this review, we outline the existing survey research on the experience of a gender minority demographic for whom there is particularly limited data: adolescents and youth in low and middle-income countries (LMICs). METHODS This paper is a scoping review of peer-reviewed articles, published in English, that use survey data to examine the experience of gender minority adolescents and youth in LMICs. We conducted a search on two major databases using key terms related to gender identity, adolescence and youth, and country and region. This search yielded 385 articles. Following a team-conducted review, we retained 33 articles for the final analysis. RESULTS Our review shows that surveys with adolescents and youth in LMICs are increasingly including questions and taking sampling approaches that allow gender minority populations to be visible in survey data. Surveys that do so are largely focused in upper middle-income countries (n = 24), rather than lower middle-income or low-income countries, with South East Asia a notable sub-region of focus (n = 15). Sexual health, mental health, and violence are key topics of interest. Most of the surveys rely on some form of network-driven sampling focused on sexual and/or gender minorities (n = 22). The studies vary in how they ask about gender identity, both in terms of question formulation and the answer categories that are offered, as well as the extent to which they describe the questions in the article text. CONCLUSIONS This review reveals a growing body of work that provides important insights into the experiences of gender minority adolescents and youth in LMICs. More studies could integrate these approaches, but it must be done in a way that is thoughtful about cultural and political context. Given the relatively nascent nature of such research, we encourage scholars to continue providing details on methodology, including around participant recruitment and the development of gender identity questions. This information would be valuable for researchers seeking to better include gender minorities and their experiences in survey research, but who might be daunted methodologically.
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Affiliation(s)
- Isabel Pike
- Department of Anthropology and Sociology, Graduate Institute of International and Development Studies (IHEID), Geneva, Switzerland
| | - Cara Kraus-Perrotta
- Social and Behavioral Science Research and GIRL Center, Population Council, One Dag Hammarskjold Plaza, New York, NY, United States of America
| | - Thoai D. Ngo
- Social and Behavioral Science Research and GIRL Center, Population Council, One Dag Hammarskjold Plaza, New York, NY, United States of America
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Tan KKH, Saw ATW. Prevalence and correlates of mental health difficulties amongst LGBTQ people in Southeast Asia: A systematic review. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2022. [DOI: 10.1080/19359705.2022.2089427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Kyle K. H. Tan
- Trans Health Research Lab, School of Psychology, University of Waikato, Hamilton, New Zealand
- Faculty of Māori and Indigenous Studies, University of Waikato, Hamilton, New Zealand
| | - Andrew T. W. Saw
- Labuan Faculty of International Finance, Univerisiti Malaysia Sabah, Sabah, Malaysia
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Kongjareon Y, Samoh N, Peerawaranun P, Guadamuz TE. Pride-based violence, intoxicated sex and poly-drug use: a vocational school-based study of heterosexual and LGBT students in Bangkok. BMC Psychiatry 2022; 22:148. [PMID: 35209859 PMCID: PMC8867669 DOI: 10.1186/s12888-022-03777-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/11/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND In Thailand, drug use is widely observed, especially among vocational-school students, who are more inclined to use various types of drugs and to experience pride-based violence (violence based on institutional pride, honor, or on seniority status) than any other groups of students. Drug use contexts differ based on sexual orientation and gender identity (e.g., clubs). This study aims to examine the prevalence and correlates of poly-drug use (the use of at least three types of drugs) among vocational-school students, with a focus on sexual orientation and gender identity. METHODS In this study, 638 vocational school students living in Bangkok metropolitan area participated in a three-year longitudinal survey of four vocational schools. Experiences of violence, sexual behaviours, and poly-drug use were assessed and analyzed using multivariable logistic regression. RESULTS About one tenth of all students (11.3%) reported poly-drug use, a fifth among Lesbian, Gay, Bisexual and Transgender (LGBT) students (20.2%) and almost a tenth of heterosexual students (9.8%). In the multivariable logistic model of LGBT students, GPA, pride-based violence, intoxicated sex, and counseling needs were significantly associated with poly-drug use (AOR = 4.62; 95% CI 1.17-18.29, AOR = 6.01; 95% CI 1.31-27.32, AOR = 5.17; 95% CI 1.10-24.28, AOR = 4.64; 95% CI 1.16-18.54, respectively). Likewise, among heterosexual students, GPA and intoxicated sex were significantly associated with poly-drug use (AOR = 2.02; 95% CI 1.09-3.75, AOR = 5.31; 95% CI 2.81-10.04, respectively). CONCLUSIONS LGBT vocational-school students have significantly higher prevalence of poly-drug use than their heterosexual peers. Correlates include lower GPA, having experienced pride-based violence and intoxicated sex. School-based intervention programs should also address pride-based violence and intoxicated sex in their harm reduction programs.
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Affiliation(s)
- Yamol Kongjareon
- grid.10223.320000 0004 1937 0490Center of Excellence in Research on Gender, Sexuality and Health, Faculty of Social Sciences and Humanities, Mahidol University, 999 Phuttamonthon 4 Road Salaya, Nakhon Pathom, 73170 Thailand
| | - Nattharat Samoh
- grid.10223.320000 0004 1937 0490Center of Excellence in Research on Gender, Sexuality and Health, Faculty of Social Sciences and Humanities, Mahidol University, 999 Phuttamonthon 4 Road Salaya, Nakhon Pathom, 73170 Thailand
| | - Pimnara Peerawaranun
- grid.10223.320000 0004 1937 0490Center of Excellence in Research on Gender, Sexuality and Health, Faculty of Social Sciences and Humanities, Mahidol University, 999 Phuttamonthon 4 Road Salaya, Nakhon Pathom, 73170 Thailand
| | - Thomas E. Guadamuz
- grid.10223.320000 0004 1937 0490Center of Excellence in Research on Gender, Sexuality and Health, Faculty of Social Sciences and Humanities, Mahidol University, 999 Phuttamonthon 4 Road Salaya, Nakhon Pathom, 73170 Thailand ,grid.10223.320000 0004 1937 0490Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand
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Wichaidit W, Assanangkornchai S, Chongsuvivatwong V. Disparities in behavioral health and experience of violence between cisgender and transgender Thai adolescents. PLoS One 2021; 16:e0252520. [PMID: 34048495 PMCID: PMC8162664 DOI: 10.1371/journal.pone.0252520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 05/15/2021] [Indexed: 11/28/2022] Open
Abstract
Background The term "transgender" refers to an individual whose gender identity is different from their sex assigned at birth, whereas the term "cisgender" refers to an individual whose gender identity is the same as their sex assigned at birth. In Thailand, studies on health outcomes and quality of life of Thai transgender youths have not included assessments from nationally-representative samples. The objective of this study is to assess the extent that behavioral health outcomes and exposure to violence varied by gender among respondents of the National School Survey on Alcohol Consumption, Substance Use and Other Health-Risk Behaviors. Methods We used data from a nationally-representative self-administered survey of secondary school students in years 7, 9 and 11 and classified participants as cisgender boys, cisgender girls, transgender boys, and transgender girls. Participants also answered questions on depressive experience, suicidality, sexual behaviors, alcohol and tobacco use, drug use, and past-year experience of violence. We analyzed data using descriptive statistics and modified multivariate Poisson regression with adjustment for sampling weights to calculate adjusted prevalence ratios (APR) with 95% confidence intervals. Results A total of 31,898 respondents (82.8% of those who returned complete and valid questionnaires) answered questions on sex and gender identity and were included in the analyses (n = 31,898 respondents), approximately 2.5% of whom identified as transgender. Transgender boys had a higher prevalence suicidal ideation than cisgender boys (APR = 2.97; 95% CI = 1.89, 4.67) and cisgender girls (APR = 2.29; 95% CI = 1.55, 3.40). Transgender girls were less likely than cisgender boys and girls to be ever drinkers, while transgender boys were more likely than cisgender boys and girls to be ever drinkers. Transgender girls had higher past-year exposure to sexual violence than cisgender boys (APR = 2.74; 95% CI = 1.52, 4.95) and cisgender girls (APR = 4.93; 95% CI = 2.52, 9.67). Conclusion We found disparities in behavioral health and experience of violence between transgender and cisgender adolescents in Thailand. The findings highlighted the need for program managers and policy makers to consider expanding local efforts to address health gaps in the LGBTQ community to also include school-going youth population.
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Affiliation(s)
- Wit Wichaidit
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
- Centre for Alcohol Studies, Hat Yai, Thailand
- * E-mail:
| | - Sawitri Assanangkornchai
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
- Centre for Alcohol Studies, Hat Yai, Thailand
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