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Vega-Ramirez H, Guillen-Diaz-Barriga C, Luz PM, Torres TS. Perceived risk for HIV acquisition and sexual HIV exposure among sexual and gender minorities: a systematic review. BMC Infect Dis 2024; 24:574. [PMID: 38858666 DOI: 10.1186/s12879-024-09456-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 05/30/2024] [Indexed: 06/12/2024] Open
Abstract
We conducted a systematic review to explore the relationship between perceived risk for HIV acquisition and sexual HIV exposure among sexual and gender minorities. We included 39 studies divided into (i) correlations or associations, (ii) models using sexual HIV exposure as the outcome, and (iii) models using perceived risk for HIV acquisition as the outcome. The sample size range was from 55 to 16,667 participants, primarily cisgender men who have sex with men (73.3%) and White (51.3%). Sexual HIV exposure and perceived risk for HIV acquisition assessments and recall time frames across studies differed markedly. Most of studies (84.6%) found significant correlations, comparisons, or associations between different levels of perceived risk for HIV acquisition and high sexual HIV exposure. In addition, 51.3% of studies reported other variables associated with high sexual HIV exposure (i.e., misuse of substances or alcohol) or with high perceived risk for HIV acquisition (i.e., younger age). In conclusion, the association between perceived risk for HIV acquisition and sexual HIV exposure has shown to be consistent. However, the assessment for perceived risk for HIV acquisition should include more components of perception (i.e., an affective component), or for sexual HIV exposure should consider the different estimated sexual per-acts probability of acquiring HIV.
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Affiliation(s)
- Hamid Vega-Ramirez
- Division of Epidemiology and Psychosocial Research, National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico City, Mexico.
| | - Centli Guillen-Diaz-Barriga
- Division of Graduate Studies and Research, Faculty of Psychology, National Autonomous University of Mexico, Mexico City, Mexico
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI- Fiocruz), Rio de Janeiro, Brazil
| | - Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI- Fiocruz), Rio de Janeiro, Brazil
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Storholm ED, Ogunbajo A, Nacht CL, Opalo C, Horvath KJ, Lyman P, Flynn R, Reback CJ, Blumenthal J, Moore DJ, Bolan R, Morris S. Facilitators of PrEP Persistence among Black and Latinx Transgender Women in a PrEP Demonstration Project in Southern California. Behav Med 2024; 50:63-74. [PMID: 35993278 PMCID: PMC9943802 DOI: 10.1080/08964289.2022.2105794] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 06/28/2022] [Accepted: 07/19/2022] [Indexed: 11/02/2022]
Abstract
Black and Latinx transgender women in the United States (U.S.) are at disproportionately high risk for HIV. Although HIV pre-exposure prophylaxis (PrEP) reduces the risk of HIV infection, uptake and persistence (i.e., ability to continue taking PrEP over time) can be a challenge for Black and Latinx transgender women due to myriad social and structural forces. In this qualitative study, we present unique data on the facilitators of PrEP persistence from Black and Latinx transgender women who initiated PrEP and exhibited varying levels of persistence during a demonstration project in Southern California. PrEP persistence was assessed by collecting quantitative intracellular tenofovir-diphosphate (TFV-DP) levels on dried blood spot (DBS) samples collected at weeks 12 and 48. Informed by the socioecological framework, we conducted and analyzed interviews using qualitative content analysis to determine themes on the facilitators of PrEP persistence. Individual-level facilitators included the use of reminders, having high individual-level HIV risk perception, feeling empowered to take PrEP, and reporting having improved peace of mind and mental health because of taking PrEP. Interpersonal/Community-level facilitators included feeling motivation to prevent HIV in the community, motivation to prevent HIV in the context of sex work, and having high community-level risk perception. Structural-level facilitators included having positive experiences in affirming healthcare settings and having PrEP visits combined with other gender-related healthcare visits. Interventions aiming to increase PrEP uptake and persistence among Black and Latinx transgender women in the U.S. should harness the multiple levels of support exhibited by those who were able to start and persist on PrEP in the face of the myriad social and structural barriers.
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Affiliation(s)
- Erik D. Storholm
- School of Public Health, San Diego State University
- RAND Corporation
- Center for HIV Identification, Prevention and Treatment Services, Department of Family Medicine, University of California Los Angeles
| | - Adedotun Ogunbajo
- RAND Corporation
- Department of Behavioral and Social Sciences, Brown University School of Public Health
| | | | | | | | | | | | - Cathy J. Reback
- Center for HIV Identification, Prevention and Treatment Services, Department of Family Medicine, University of California Los Angeles
- Friends Research Institute
| | - Jill Blumenthal
- AntiViral Research Center, University of California, San Diego School of Medicine
| | - David J. Moore
- AntiViral Research Center, University of California, San Diego School of Medicine
| | | | - Sheldon Morris
- AntiViral Research Center, University of California, San Diego School of Medicine
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3
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Wolfe HL, Drainoni ML, Klasko-Foster L, Fix GM, Siegel J, Mimiaga MJ, Reisner SL, Hughto JM. Structural Equation Modeling of Stigma and HIV Prevention Clinical Services Among Transgender and Gender Diverse Adults: The Mediating Role of Substance Use and HIV Sexual Risk. J Acquir Immune Defic Syndr 2023; 92:300-309. [PMID: 36515898 PMCID: PMC9974738 DOI: 10.1097/qai.0000000000003144] [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] [Received: 07/11/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Transgender and gender diverse (TGD) adults experience high levels of stigma that contributes to elevated substance use and HIV sexual risk behaviors. Despite higher burdens of substance use and HIV compared to cisgender adults, TGD individuals may be less likely to engage in health care to avoid further discrimination. SETTING This analysis included 529 TGD adults in Massachusetts and Rhode Island who were HIV negative or had an unknown HIV serostatus and were purposively sampled between March and August 2019. METHODS We used structural equation modeling to test whether substance use, HIV sexual risk behaviors (ie, condom use, sex work, and multiple partners), and receiving gender-affirming hormone therapy mediate any observed association between TGD-related stigma and utilization of HIV prevention clinical services (ie, HIV prevention programs, PrEP use, and HIV testing). RESULTS Substance use and HIV sexual risk mediated the relationship between TGD-related stigma and utilization of HIV prevention clinical services (β = 0.08; 95% CI = 0.05, 0.17; P = 0.03 and β = 0.26; 95% CI = 0.14 to 0.37; P < 0.001). Having a hormone therapy prescription was not a mediator between TGD-related stigma and HIV prevention clinical services. CONCLUSIONS Future interventions that aim to improve HIV prevention clinical services among TGD adults should consider the impact of TGD-related stigma on participants' substance use and sexual risk behaviors. These efforts require that health care organizations and community organizations make a deliberate investment in the reach and success of interventions and programs.
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Affiliation(s)
- Hill L. Wolfe
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA
- Evans Center for Implementation and Improvement Sciences, Boston University, Boston, MA
| | - Lynne Klasko-Foster
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Gemmae M. Fix
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA
| | - Jennifer Siegel
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA
- Transgender Health Program, Massachusetts General Hospital, Boston, MA
| | - Matthew J. Mimiaga
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, RI
- The Fenway Institute, Fenway Health, Boston, MA
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA
- Department of Psychiatry and Biobehavioral Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- University of California Los Angeles Center for LGBTQ Advocacy, Research & Health, Los Angeles, CA
| | - Sari L. Reisner
- The Fenway Institute, Fenway Health, Boston, MA
- General Medicine, Harvard Medical School, Boston, MA
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jaclyn M.W. Hughto
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, Rhode Island
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
- Department of Epidemiology, Brown University School of Public Health, Providence, RI
- The Fenway Institute, Fenway Health, Boston, MA
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Chyten-Brennan J, Patel VV, Anastos K, Hanna DB. Brief Report: Role of Gender-Affirming Hormonal Care in HIV Care Continuum Outcomes When Comparing Transgender Women With Cisgender Sexual Minority Men. J Acquir Immune Defic Syndr 2022; 91:255-260. [PMID: 36252240 PMCID: PMC9577885 DOI: 10.1097/qai.0000000000003056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 06/28/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transgender women (transwomen) are frequently conflated with cisgender sexual minority men (cis-SMM) in HIV research. We examined the impact of socioeconomic and health conditions, and gender-affirming hormones in comparing HIV-related outcomes between cis-SMM and transwomen. SETTING Large tertiary care health system in the Bronx, NY. METHODS Retrospective cohort study of people with HIV receiving care in 2008-2017. We compared retention in care, antiretroviral therapy (ART) prescription, and viral suppression between cis-SMM and transwomen, using modified Poisson regression, adjusting for demographic and clinical factors. Transwomen were further stratified by receipt of estrogen prescription. RESULTS We included 166 transwomen (1.4%), 1936 cis-SMM (17%), 4715 other cisgender men (41%), and 4745 cisgender women (41%). Transwomen were more likely to have public insurance (78% vs 65%) and mental health (49% vs 39%) or substance use (43% vs 33%) diagnoses than cis-SMM. Compared with cis-SMM, transwomen prescribed estrogen (67% of transwomen) were more likely to be retained [adjusted risk ratio (aRR) 1.15, 95% confidence interval (CI) 1.08 to 1.23), prescribed ART (aRR 1.06, CI 1.01 to 1.11), and virally suppressed (aRR 1.08, CI 1.01 to 1.16). Transwomen not prescribed estrogen were less likely to be retained (aRR 0.92, CI 0.83 to 1.02), prescribed ART (aRR 0.90, CI 0.82 to 0.98), or virally suppressed (aRR 0.85, CI 0.76 to 0.95). CONCLUSIONS In the context of HIV, socioeconomic factors, comorbidities, and gender-affirming care distinguish transwomen from cis-SMM. Compared with cis-SMM, transwomen who were prescribed estrogen had better HIV care continuum outcomes; transwomen not prescribed estrogen had worse outcomes. These differences should be accounted for in HIV-related research.
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Affiliation(s)
- Jules Chyten-Brennan
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center-Albert Einstein College of Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, United States
| | - Viraj V. Patel
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center-Albert Einstein College of Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, United States
| | - Kathryn Anastos
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center-Albert Einstein College of Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, United States
| | - David B. Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, United States
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Fletcher JB, Reback CJ. Associations Between Gender Identity Control, Gender Identity Non-Verification, and Health Risks among Trans Women of Color Living with HIV. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2003-2014. [PMID: 35445282 PMCID: PMC10462393 DOI: 10.1007/s10508-021-02264-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 06/14/2023]
Abstract
This study applied Identity Theory (IT) metrics to data gathered from a sample of trans women of color living with HIV to determine whether measures of identity control and/or identity non-verification were associated with trans women's self-reported health risks. From February 2014 through August 2016, 139 HIV-positive trans women were enrolled. Cross-sectional time-series regressions indicated that identity control and identity non-verification were both associated with self-reported behavioral and health outcomes. Increased gender identity control was associated with decreased drug and alcohol use (multiple Logit [L]; all p < .05) and decreased likelihood of self-reported infection with a sexually transmitted infection (STI; multiple L; all p < .05); increased perceived identity non-verification was associated with increased severity of depression symptoms (b = 0.09) as well as increased odds of engagement in exchange sex (L = 0.32), increased drug and alcohol use (multiple L p > .05), and increased likelihood of self-reported infection with viral STIs (Lgenital warts = 0.49; Lherpes = 0.69). These findings indicate IT may be a useful theoretical framework through which to understand and analyze behavior among trans women of color living with HIV. Identity verification dynamics in particular may be useful mechanisms to explain engagement in several potentially harmful behaviors.
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Affiliation(s)
- Jesse B Fletcher
- Friends Research Institute Inc., 6910 Santa Monica Blvd., Los Angeles, CA, 90038, USA.
| | - Cathy J Reback
- Friends Research Institute Inc., 6910 Santa Monica Blvd., Los Angeles, CA, 90038, USA
- Center for HIV Identification, Prevention and Treatment Services, University of California, Los Angeles, CA, USA
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Reback CJ, Fletcher JB, Kisler KA. Text Messaging Improves HIV Care Continuum Outcomes Among Young Adult Trans Women Living with HIV: Text Me, Girl! AIDS Behav 2021; 25:3011-3023. [PMID: 34164763 PMCID: PMC10445544 DOI: 10.1007/s10461-021-03352-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 10/21/2022]
Abstract
Young adult trans women living with HIV in the US exhibit suboptimal advancement through the HIV Care Continuum relative to national averages. From December 2016 through May 2018, 134 young adult trans women living with HIV enrolled in Text Me, Girl!, a theory-based, trans-specific text-messaging intervention designed to improve HIV Care Continuum outcomes. Participants (N = 130) averaged 29.5 years, were predominantly Latinx (43%) or African American/Black (40%). Clustered logistic and ordinal logistic multivariable models (n = 105; 366 observations) indicate that through 18-month follow-up, increased exposure to the text-messaging intervention was associated with significant (p < 0.05) increased retention to HIV care (adjusted odds ratio [aOR] 1.33) and biomarker-confirmed viral suppression (aOR 1.51); retention in the intervention was associated with significantly increased likelihood of ART uptake (aOR 2.95) and "excellent" ART adherence (aOR 10.44). Text Me, Girl! offers promising evidence that a unidirectional, automated text-messaging intervention can improve HIV care outcomes among young adult trans women living with HIV.
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Affiliation(s)
- Cathy J Reback
- Friends Research Institute, Inc., 6910 Santa Monica Boulevard, Los Angeles, CA, 90038, USA.
- Department of Family Medicine, Center for HIV Identification, Prevention and Treatment Services, University of California, Los Angeles, CA, USA.
| | - Jesse B Fletcher
- Friends Research Institute, Inc., 6910 Santa Monica Boulevard, Los Angeles, CA, 90038, USA
| | - Kimberly A Kisler
- Friends Research Institute, Inc., 6910 Santa Monica Boulevard, Los Angeles, CA, 90038, USA
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Ruppert R, Kattari SK, Sussman S. Review: Prevalence of Addictions among Transgender and Gender Diverse Subgroups. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168843. [PMID: 34444595 PMCID: PMC8393320 DOI: 10.3390/ijerph18168843] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 12/25/2022]
Abstract
We conducted an analysis of the prevalence of substance and behavioral addictions across different transgender and gender diverse (TGD) subgroups. We performed a scoping review using MEDLINE and Google Scholar databases and examined 12 addictions, including alcohol, nicotine, cannabis, illicit drugs, gambling, eating/food, internet, sex, love, exercise, work, and shopping. We presented prevalence rates for each addiction as a function of an individual’s gender identity (stratified into transgender females, transgender males, and gender nonconforming), and used cisgender women and men as reference groups. We included 55 studies in our final analysis, the majority of which investigated substance use disorders among TGD subgroups. Overall findings indicated that substantial differences in substance use exist among US TGD subgroups. There were far fewer publications that examined the prevalence of behavioral addictions across TGD subgroups. However, despite limited research in this area, findings still suggest that notable differences in behavioral addictions may exist between individual TGD subgroups. The conclusions of our review may provide clinicians with a better ability to screen for and treat at-risk individuals within the TGD community.
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Affiliation(s)
- Ryan Ruppert
- Keck School of Medicine of USC, Los Angeles, CA 90033, USA;
- Correspondence: or ; Tel.: +1-302-358-6852
| | - Shanna K. Kattari
- School of Social Work, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Steve Sussman
- Keck School of Medicine of USC, Los Angeles, CA 90033, USA;
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8
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Lindley L, Bauerband L, Galupo MP. Using a Comprehensive Proximal Stress Model to Predict Alcohol Use. Transgend Health 2021; 6:164-174. [PMID: 34414271 DOI: 10.1089/trgh.2020.0042] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: The gender minority stress model has been proposed by researchers to explain the high rates of substance use found within transgender communities, but its explanatory power has never been directly tested. Further, qualitative research has noted that premedically transitioned and nonbinary individuals are more likely to engage in avoidant coping such as drinking to cope. As such, the current study tested the relationship between proximal stress (comprised of internalized transphobia, anticipated stigma, concealment, and gender dysphoria), drinking to cope, and problematic alcohol use. Methods: Transgender and nonbinary participants over the age of 18 (N=297) completed an online survey on alcohol use. To test for differences in drinking to cope across gender identity and medical transition, analysis of variance and independent t-tests were conducted. Further, a structural equation model of proximal stress was developed to test whether drinking to cope mediated the relationship between proximal stress and alcohol use. Results: There were no significant differences across gender identity or medical transition status in severity of drinking to cope. Proximal stress was significantly related to problematic alcohol use and the relationship was explained by an indirect relationship with drinking to cope. Conclusion: Findings from this study suggest that drinking to cope is an important aspect of high rates of alcohol use found in the transgender community. Implications for clinical practice with transgender individuals are discussed.
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Affiliation(s)
- Louis Lindley
- Psychology Department, Towson University, Towson, Maryland, USA
| | - Loren Bauerband
- Health Sciences Department, University of Missouri Health, Columbia, Missouri, USA
| | - M Paz Galupo
- Psychology Department, Towson University, Towson, Maryland, USA
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9
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Poteat T, Mayo-Wilson LJ, Pereira N, Wright BN, Smout SA, Sawyer AN, Cathers L, Zimmerman RS, Grigsby SR, Benotsch EG. U.S. transgender women's preferences for microeconomic interventions to address structural determinants of HIV vulnerability: a qualitative assessment. BMC Public Health 2021; 21:1394. [PMID: 34261464 PMCID: PMC8281671 DOI: 10.1186/s12889-021-11471-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 06/29/2021] [Indexed: 11/30/2022] Open
Abstract
Background Transgender women in the United States (U.S.) experience a disproportionate burden of HIV infection and challenges to engagement in HIV prevention and care. This excess burden is driven by structural and economic inequities. Microeconomic interventions may be effective strategies for reducing HIV inequities for this population. However, few studies have explored transgender women’s preferences for microeconomic interventions to address structural determinants of HIV vulnerability. Methods We conducted individual interviews with 19 adult transgender women in 2 U.S. cities (Richmond, VA and St. Louis, MO) who reported one or more sexual risk behaviors and recent economic hardship related to employment/income, housing, or food security. Interviews were recorded, transcribed, and analyzed using thematic content analysis. Results The majority (74%) of transgender women were racial/ethnic minorities with mean age of 26.3 years. 89% were currently economically vulnerable; and 23% were employed full-time. 37% reported living with HIV. Participants expressed strong support for unrestricted vouchers, with many expressing the need for funds to support gender-affirming interventions. Assistance with how to budget and save and support for job acquisition, career planning, and employment sustainment were also preferred, including access to non-stigmatizing employment. Visible transgender leadership, group empowerment, and small (rather than large) numbers of participants were considered important aspects of intervention design for transgender women, including outreach through existing transgender networks to facilitate inclusion. Incorporating HIV counseling and testing to reduce vulnerability to HIV was acceptable. However, transgender women enrolled in the study preferred that HIV not be the focus of an intervention. Conclusions Flexible microeconomic interventions that support gender affirming interventions, improve financial literacy, and provide living-wage non-stigmatizing employment are desired by economically vulnerable transgender women. While not focused on HIV, such interventions have the potential to reduce the structural drivers of HIV vulnerability among transgender women.
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Affiliation(s)
- Tonia Poteat
- Department of Social Medicine, University of North Carolina at Chapel Hill School of Medicine, CB #7240, Chapel Hill, NC, 27516, USA.
| | - Larissa Jennings Mayo-Wilson
- Department of Applied Health Sciences, Indiana University School of Public Health, 1025 E. 7th Street, Bloomington, IN, 47405, USA.,Global & Public Health Division, Johns Hopkins University School of Nursing, Community, 525 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Nastacia Pereira
- Department of Social Medicine, University of North Carolina at Chapel Hill School of Medicine, CB #7240, Chapel Hill, NC, 27516, USA
| | - Brittanni N Wright
- Department of Applied Health Sciences, Indiana University School of Public Health, 1025 E. 7th Street, Bloomington, IN, 47405, USA
| | - Shelby A Smout
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Richmond, VA, 23284, USA
| | - Ashlee N Sawyer
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Richmond, VA, 23284, USA
| | - Lauretta Cathers
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Richmond, VA, 23284, USA
| | - Rick S Zimmerman
- Wayne State University, College of Nursing, 5557 Cass Avenue, Detroit, MI, 48202, USA
| | - Sheila R Grigsby
- University of Missouri St. Louis, College of Nursing, 221 NAB South Campus, University Blvd, St. Loius, MO, 63121, USA
| | - Eric G Benotsch
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Richmond, VA, 23284, USA
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10
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Valente PK, Biello KB, Edeza A, Klasko-Foster L, Kuhns LM, Reisner SL, Garofalo R, Mimiaga MJ. Psychosocial Problems and Vulnerability to HIV in a Multi-City Prospective Cohort of Young Transgender Women in the United States: A Structural Equation Modeling Study. J Acquir Immune Defic Syndr 2021; 86:544-551. [PMID: 33661822 DOI: 10.1097/qai.0000000000002615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/21/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Gender-based stigma contributes to increased HIV prevalence, but little is known about psychosocial mechanisms linking stigma and HIV risk among young transgender women (YTW). SETTING This study uses data from Project LifeSkills, a randomized controlled efficacy trial of an empowerment-based HIV prevention intervention for YTW (N = 233). YTW were recruited in Boston, MA, and Chicago, IL, between 2012 and 2015 and completed study assessment visits at baseline and months 4 and 12. METHODS Using autoregressive structural equation modeling, we examined whether poor social support and psychological distress at 4 months mediate the prospective relationship between gender-based stigma at baseline and condomless anal and vaginal sex (CAVS) acts at 4 and 12 months; all models were adjusted for treatment arm, HIV serostatus, study site, and sociodemographics. RESULTS Gender-based stigma at baseline was directly associated with increased CAVS at 4 months [adjusted incidence rate ratio (aIRR) = 1.18, 95% confidence interval (CI): (1.05 to 1.33)] and 12 months [aIRR = 1.17, 95% CI: (1.02 to 1.34)]. Gender-based stigma was also associated with higher psychological distress at 4 months [b = 0.70, 95% CI: (0.13 to 1.27)], which in turn was marginally associated with increased CAVS at 12 months [aIRR = 1.03, 95% CI: (1.00 to 1.06)]. Contrary to expectations, poor social support at 4 months was associated with decreased CAVS at 12 months [aIRR = 0.40, 95% CI: (0.28 to 0.59)]. CONCLUSIONS Future HIV prevention interventions with YTW should consider addressing experiences of gender-based stigma and the psychological distress that may ensue from gender-based stigma. More research is needed to understand the influence of poor social support on sexual behaviors in this population.
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Affiliation(s)
- Pablo K Valente
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI
| | - Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI
- Department of Epidemiology, Brown University School of Public Health, Providence, RI
- The Fenway Institute, Fenway Health, Boston, MA
| | - Alberto Edeza
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI
| | - Lynne Klasko-Foster
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI
| | - Lisa M Kuhns
- Division of Adolescent Medicine, Ann and Robert H. Lurie Children's Hospital, Chicago, IL
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Sari L Reisner
- The Fenway Institute, Fenway Health, Boston, MA
- Brigham and Women's Hospital, Boston, MA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA; and
| | - Robert Garofalo
- Division of Adolescent Medicine, Ann and Robert H. Lurie Children's Hospital, Chicago, IL
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Matthew J Mimiaga
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI
- Department of Epidemiology, Brown University School of Public Health, Providence, RI
- The Fenway Institute, Fenway Health, Boston, MA
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA
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11
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Aggarwal NK, Consavage KE, Dhanuka I, Clement KW, Bouey JH. Health and Health Care Access Barriers Among Transgender Women Engaged in Sex Work: A Synthesis of U.S.-Based Studies Published 2005-2019. LGBT Health 2020; 8:11-25. [PMID: 33297834 DOI: 10.1089/lgbt.2019.0243] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Purpose: Transgender women (TW) are likely to experience job discrimination and engage in commercial sex transactions. As a group, they have the highest risk for HIV/AIDS. However, little is known about the health needs of transgender women sex workers (TWSW) in the United States and the structural and psychosocial barriers to their health care access. The objective of this systematic review was to systematically document these needs and barriers by using a framework approach. Methods: We searched PubMed, JSTOR, and Google Scholar for primary and secondary studies published in 2005-2019 that addressed the health of TWSW in the United States. We used a standardized data extraction form to gather data from eligible articles. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used to assess study quality. Results: Fifty-three articles met the inclusion criteria, including mentioning health-related topics among TWSW. More articles appeared in recent years. Most studies collected data with convenience samples in urban areas. Structural barriers reported included transphobia, lack of pre-exposure prophylaxis targeted at TW, and lack of health insurance coverage. Psychosocial barriers included distrust of the health care system, self-esteem, alcohol and substance use, and mental health. Conclusions: TWSW have unique health care needs that are not being addressed due to barriers to health care access. More research is required to identify non-HIV-related health burdens and details about psychosocial barriers to health care access.
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Affiliation(s)
- Neena K Aggarwal
- Department of International Health, School of Nursing and Health Studies, Georgetown University, Washington, District of Columbia, USA
| | - Katherine E Consavage
- Department of International Health, School of Nursing and Health Studies, Georgetown University, Washington, District of Columbia, USA
| | - Ida Dhanuka
- Department of Biology, Georgetown University, Washington, District of Columbia, USA
| | - Kesiah W Clement
- Department of International Health, School of Nursing and Health Studies, Georgetown University, Washington, District of Columbia, USA
| | - Jennifer H Bouey
- Department of International Health, School of Nursing and Health Studies, Georgetown University, Washington, District of Columbia, USA
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12
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Application of the "syndemics" theory to explain unprotected sex and transactional sex: A crosssectional study in men who have sex with men (MSM), transgender women, and non-MSM in Colombia. ACTA ACUST UNITED AC 2020; 40:391-403. [PMID: 32673465 PMCID: PMC7505518 DOI: 10.7705/biomedica.5082] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Indexed: 01/28/2023]
Abstract
Introduction: Men who have sex with men (MSM) and transgender women (TW) in Colombia are highly affected by HIV. To improve understanding of the role of HIV risk behaviors in HIV acquisition, we used the syndemic framework, a useful concept to inform prevention efforts. Objective: To examine the effect of four psychosocial conditions, namely, forced sex, history of childhood sexual abuse, frequent alcohol use, and illicit drug use on unprotected sex and the synergistic effects (“syndemic” effects) of these conditions on HIV risk behavior. Materials and methods: We enrolled a total of 812 males (54.7% men who have sex with men, MSM; 7.3% transgender women, and 38% non-MSM). The participants were recruited from neighborhoods of low socioeconomic status through free HIV-counseling and-testing campaigns. We performed Poisson regression analysis to test the associations and interactions between the four psychosocial conditions and unprotected sex with regular, occasional, and transactional partners. To test the “syndemic” model, we assessed additive and multiplicative interactions. Results: The prevalence of any psychosocial condition was 94.9% in transgender women, 60.1% in MSM, and 72.2% in non-MSM. A higher likelihood of transactional sex was associated in MSM (prevalence ratio (PR)=7.41, p<0.001) and non-MSM (PR=2.18, p< 0.001) with three or all four conditions compared to those with one condition. Additive interactions were present for all combinations of psychosocial problems on transactional sex in MSM. No cumulative effect or additive interaction was observed in transgender women. Conclusions: Our study highlights the need for bundled mental health programs addressing childhood sexual abuse, illicit drug use, and frequent alcohol use with other HIV prevention programs.
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13
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Jennings Mayo-Wilson L, Benotsch EG, Grigsby SR, Wagner S, Timbo F, Poteat T, Cathers L, Sawyer AN, Smout SA, Zimmerman RS. Combined effects of gender affirmation and economic hardship on vulnerability to HIV: a qualitative analysis among U.S. adult transgender women. BMC Public Health 2020; 20:782. [PMID: 32456674 PMCID: PMC7249630 DOI: 10.1186/s12889-020-08902-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 05/12/2020] [Indexed: 02/06/2023] Open
Abstract
Background Transgender women (“trans women”), particularly African-American and Latina trans women, have disproportionately high prevalence of HIV in the United States (U.S.). In order to decrease gender dysphoria and overcome discrimination, trans women affirm their gender through social and medical transition, often in contexts of economic hardship and sexual risk. This study qualitatively examined how gender-affirming behaviors enhance or diminish vulnerability to HIV in light of structural and economic barriers to gender transition. Methods We conducted individual interviews with 19 adult trans women in two U.S. cities (Richmond, VA and St. Louis, MO) who reported one or more sexual risk behaviors and recent economic hardship related to employment/income, housing, or food security. Interviews were recorded, transcribed, and analyzed using thematic content analysis. Results The majority (74%) of trans women were racial/ethnic minorities with mean age of 26.3 years. Gender-affirming behaviors varied with 58% of trans women having legally changed their name and gender marker; 79% having initiated hormone therapy; and 11% having not initiated any medical or legal changes. None had undertaken surgical changes. Findings suggested that the process of gender transitioning resulted in both increasing and decreasing HIV risk. The high need for gender affirmation by male sex partners contributed to trans women’s exposure to sexual objectification, sexual risk behaviors, and conflicting interests in HIV prevention messaging. Loss of housing and employment due to transition along with the high costs of transition products and medical visits increased reliance on sex work and created new obstacles in accessing HIV services. Trans women experienced lower HIV risk as they acquired legal and medical transition services, reshaped interactions with sex partners, and received gender-affirming support by others, including health providers, employers, peers, and housing professionals. Sexual abstinence was viewed as a negative consequence of incomplete transition, although characterized as a period of low HIV risk. Conclusions Structural and policy initiatives that promote safe gender transition and economic stability in trans women may play a critical role in reducing HIV in this population. Addressing the harmful pressures for U.S. trans women to conform to perceived feminine stereotypes may also serve an important role.
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Affiliation(s)
- Larissa Jennings Mayo-Wilson
- Indiana University School of Public Health, Department of Applied Health Sciences, Center for Sexual Health Promotion, 1025 E. 7th Street, Bloomington, IN, 47405, USA. .,Johns Hopkins Bloomberg School of Public Health, Department of International Health, Social and Behavioral Interventions Program, 615 N. Wolfe Street, Room E5038, Baltimore, MD, 21205, USA.
| | - Eric G Benotsch
- Virginia Commonwealth University, Department of Psychology, 806 West Franklin Street, Richmond, VA, 23284, USA
| | - Sheila R Grigsby
- University of Missouri - St. Louis, College of Nursing, 221 NAB South Campus, University Blvd St. Louis, St. Louis, MO, 63121, USA
| | - Sarah Wagner
- Indiana University School of Public Health, Department of Applied Health Sciences, Center for Sexual Health Promotion, 1025 E. 7th Street, Bloomington, IN, 47405, USA
| | - Fatmata Timbo
- Indiana University School of Public Health, Department of Applied Health Sciences, Center for Sexual Health Promotion, 1025 E. 7th Street, Bloomington, IN, 47405, USA
| | - Tonia Poteat
- University of North Carolina, Department of Social Medicine, CB #7240, Chapel Hill, NC, 27516, USA
| | - Lauretta Cathers
- University of Missouri - St. Louis, College of Nursing, 221 NAB South Campus, University Blvd St. Louis, St. Louis, MO, 63121, USA
| | - Ashlee N Sawyer
- Virginia Commonwealth University, Department of Psychology, 806 West Franklin Street, Richmond, VA, 23284, USA
| | - Shelby A Smout
- Virginia Commonwealth University, Department of Psychology, 806 West Franklin Street, Richmond, VA, 23284, USA
| | - Rick S Zimmerman
- Louisiana State University Health New Orleans School of Nursing, 1900 Gravier Street, Room 5B14, New Orleans, LA, 70112, USA
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14
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Kidd JD, Levin FR, Dolezal C, Hughes TL, Bockting WO. Understanding predictors of improvement in risky drinking in a U.S. multi-site, longitudinal cohort study of transgender individuals: Implications for culturally-tailored prevention and treatment efforts. Addict Behav 2019; 96:68-75. [PMID: 31039507 PMCID: PMC6571154 DOI: 10.1016/j.addbeh.2019.04.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/16/2019] [Accepted: 04/18/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE While transgender people report higher rates of risky drinking than the general population, no studies have examined transgender alcohol use longitudinally. This study investigated minority stress and identity development predictors of improvement in risky drinking among transgender individuals. METHODS Data come from a multi-site, longitudinal cohort study of U.S. transgender individuals (N = 330) and include measures of enacted stigma, felt stigma, identity development, and risky alcohol use. Theory-driven, hierarchical multivariable logistic regression was used to investigate the hypothesis that minority stress and identity development factors are related to improvement in risky drinking between baseline and 1-year follow-up. RESULTS Baseline risky drinkers (n = 106; 37.1%) were younger and more likely to have female sex assigned at birth. At 1-year follow-up, 68 baseline risky drinkers (64.2%) reported persistent risky drinking, while 38 (35.8%) reported improved drinking. Controlling for demographics and study site, female sex assigned at birth and enacted stigma were associated with lower odds of improved drinking. Non-white/Hispanic race/ethnicity, felt stigma, change in gender role/expression for 1-5 years, and diffuse-avoidant identity style were associated with higher odds of improvement. CONCLUSIONS/IMPORTANCE This is the first study to identity predictors of improvement in risky drinking among transgender individuals. Compared to trans-feminine individuals (assigned male at birth), trans-masculine individuals (assigned female at birth) were more likely to report risky drinking at baseline and had lower odds of improvement at 1-year follow-up. Improved drinking may be facilitated by preventing anti-transgender discrimination. Felt stigma and diffuse-avoidant identity style may lower alcohol risk via avoidance of drinking venues. Further research is needed to explicate these relationships and to inform culturally-tailored alcohol interventions for this at-risk population.
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Affiliation(s)
- Jeremy D Kidd
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032, United States of America; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America.
| | - Frances R Levin
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032, United States of America; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America.
| | - Curtis Dolezal
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America.
| | - Tonda L Hughes
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032, United States of America; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America; Columbia University School of Nursing, 560 W. 168th Street, New York, NY 10032, United States of America.
| | - Walter O Bockting
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032, United States of America; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America; Columbia University School of Nursing, 560 W. 168th Street, New York, NY 10032, United States of America.
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15
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Abstract
Although sexual minority women (SMW) and transgender women have become increasingly visible in recent years and have made progress in achieving civil rights, they continue to face significant levels of discrimination, stigma, and physical violence. As a result, each group faces a wide variety of health disparities, including mental illness and substance use disorders. Overall, both SMW and transgender women experience higher rates of mood and anxiety disorders, suicidality, and substance use disorders than their heterosexual and cisgender counterparts. This article is a general introduction to these issues and concludes with recommendations for working with sexual minority and transgender women.
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Affiliation(s)
- Julie K Schulman
- Department of Psychiatry, Allen Hospital, 5141 Broadway, 3 River East, New York, NY 10034, USA.
| | - Laura Erickson-Schroth
- Department of Psychiatry, Mount Sinai Beth Israel, 10 Nathan D. Perlman Place, New York, NY 10003, USA
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16
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Mimiaga MJ, Hughto JM, Biello KB, Santostefano CM, Kuhns LM, Reisner SL, Garofalo R. Longitudinal Analysis of Syndemic Psychosocial Problems Predicting HIV Risk Behavior Among a Multicity Prospective Cohort of Sexually Active Young Transgender Women in the United States. J Acquir Immune Defic Syndr 2019; 81:184-192. [PMID: 30839380 PMCID: PMC6522320 DOI: 10.1097/qai.0000000000002009] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Worldwide, young transgender women (YTW) contend with exceptionally high risks of HIV infection. Cross-sectional studies have suggested that co-occurring epidemics or "syndemics" of psychosocial problems may accelerate HIV acquisition and transmission through elevated sexual risk behavior among transgender women. We aimed to examine how a syndemic of 7 psychosocial problems potentiates HIV sexual risk behavior among a multicity, longitudinal cohort of sexually active YTW in the United States. METHODS Between 2012 and 2015, 233 YTW from Boston, MA, and Chicago, IL, completed behavioral surveys at baseline, 4, 8, and 12 months. We used generalized estimating equations to examine the prospective relationship of overlapping psychosocial problems and HIV sexual risk behavior (ie, condomless anal or vaginal sex) among YTW. RESULTS The prevalence of 7 psychosocial syndemic problems was substantial at baseline and remained high at each time point: 6.4% reported polydrug use in the past 4 months (excluding stimulants); 7.7% reported heavy alcohol use in the past 4 months; 10% reported a history of childhood sexual abuse; 15.9% reported stimulant use in the past 4 months; 41.7% reported experiencing lifetime intimate partner violence; 42.1% reported clinically significant depressive symptoms; and 68.6% reported lifetime transgender-specific victimization. We identified a statistically significant positive "dose-response" relationship between the number of psychosocial syndemic problems and condomless anal or vaginal sex over time. CONCLUSIONS The accumulation of "syndemic" psychosocial problems predicted HIV sexual risk behavior in a prospective cohort of YTW. Given the high prevalence of psychosocial problems and HIV sexual risk behavior, as well as having the highest HIV incidence among any risk group, the HIV prevention agenda requires a shift toward improved assessment of psychosocial comorbidities and stronger integration with gender-affirming and supportive mental health, violence recovery, and addiction treatment services for this population.
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Affiliation(s)
- Matthew J. Mimiaga
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Jaclyn M.W. Hughto
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Katie B. Biello
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | | | - Lisa M. Kuhns
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sari L. Reisner
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of 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
| | - Robert Garofalo
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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17
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Rood BA, Reisner SL, Puckett JA, Surace FI, Berman AK, Pantalone DW. Internalized transphobia: Exploring perceptions of social messages in transgender and gender-nonconforming adults. Int J Transgend 2017. [DOI: 10.1080/15532739.2017.1329048] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Brian A. Rood
- Department of Psychology, Augsburg College, Minneapolis, MN, USA
| | - 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
- Fenway Institute, Fenway Health, Boston, MA, USA
| | - Jae A. Puckett
- Department of Psychology, University of South Dakota, Vermillion, SD, USA
| | | | - Ariel K. Berman
- Department of Psychology, Western Michigan University, Kalamazoo, MI, USA
| | - David W. Pantalone
- Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychology, University of Massachusetts, Boston, MA, USA
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18
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Abstract
Although sexual minority women (SMW) and transgender women have become increasingly visible in recent years and have made progress in achieving civil rights, they continue to face significant levels of discrimination, stigma, and physical violence. As a result, each group faces a wide variety of health disparities, including mental illness and substance use disorders. Overall, both SMW and transgender women experience higher rates of mood and anxiety disorders, suicidality, and substance use disorders than their heterosexual and cisgender counterparts. This article is a general introduction to these issues and concludes with recommendations for working with sexual minority and transgender women.
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Affiliation(s)
- Julie K Schulman
- Department of Psychiatry, Allen Hospital, 5141 Broadway, 3 River East, New York, NY 10034, USA.
| | - Laura Erickson-Schroth
- Department of Psychiatry, Mount Sinai Beth Israel, 10 Nathan D. Perlman Place, New York, NY 10003, USA
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19
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Poteat T, Scheim A, Xavier J, Reisner S, Baral S. Global Epidemiology of HIV Infection and Related Syndemics Affecting Transgender People. J Acquir Immune Defic Syndr 2016; 72 Suppl 3:S210-9. [PMID: 27429185 PMCID: PMC4969059 DOI: 10.1097/qai.0000000000001087] [Citation(s) in RCA: 248] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Transgender populations have been underrepresented in HIV epidemiologic studies and consequently in HIV prevention, care, and treatment programs. Since 2012, there has been a dramatic increase in research focused on transgender people. Studies highlight the burden of HIV and risk determinants, including intersecting stigmas, as drivers of syndemics among transgender populations. This review synthesizes the most recent global epidemiology of HIV infection and describes current gaps in research and interventions to inform prioritization of HIV research for transgender populations. METHODS A systematic review was conducted of the medical literature published between January 1, 2012 and November 30, 2015. The data focused on HIV prevalence, determinants of risk, and syndemics among transgender populations. RESULTS Estimates varied dramatically by location and subpopulation. Transfeminine individuals have some of the highest concentrated HIV epidemics in the world with laboratory-confirmed prevalence up to 40%. Data were sparse among trans masculine individuals; however, they suggest potential increased risk for trans masculine men who have sex with men (MSM). No prevalence data were available for transgender people across Sub-Saharan Africa or Eastern Europe/Central Asia. Emerging data consistently support the association of syndemic conditions with HIV risk in transgender populations. DISCUSSION Addressing syndemic conditions and gender-specific challenges is critical to ensure engagement and retention in HIV prevention by transgender populations. Future research should prioritize: filling knowledge gaps in HIV epidemiology; elucidating how stigma shapes syndemic factors to produce HIV and other deleterious effects on transgender health; and understanding how to effectively implement HIV interventions for transgender people.
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Affiliation(s)
- Tonia Poteat
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ayden Scheim
- Department of Epidemiology and Biostatistics, Western University, London, Canada
| | - Jessica Xavier
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Rockville, Maryland; and
| | - Sari Reisner
- Boston Children's Hospital/Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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