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Mehta V, Negi S, Mathur A, Tripathy S, Oberoi S, Shamim MA, Karobari I. Oral health status among the transgender population of India: A systematic review and meta-analysis. SPECIAL CARE IN DENTISTRY 2024. [PMID: 38807264 DOI: 10.1111/scd.13027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/11/2024] [Accepted: 05/13/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND The invisibility of the transgender population within official records, combined with other socio-economic factors, impacts oral health status among transgender people. Hence, our systematic review and meta-analysis aim to generate a pooled estimate of the oral health status of the transgender community in India. MATERIAL AND METHODS A systematic search was performed across four databases. The studies included a quantitative research design conducted in India and involved self-identified transgender individuals. The pooled prevalence was determined at a 95% confidence interval (CI). Q-statistics and the I2 test were utilized to evaluate the source of heterogeneity. Leave-one-out analysis and Baujat plots were used to detect outliers within the studies. A Doi plot and LFK index were employed to assess the publication bias. RESULTS A total of 12 studies comprising 1566 transgender participants were included. The pooled prevalence of toothbrush use among transgenders in India was found at 83% (95% CI: 0.73-0.91), smoking = 12% (CI: 0.03-0.26), smokeless tobacco = 53% (CI = 0.38-0.68), dental caries = 78% (CI: 67%-88%), calculus = 65% (CI: 0.4-0.86), and bleeding 18% (CI:0.08-0.32). CONCLUSION Oral health disparities among Indian transgender individuals are evident in the low toothbrush usage, an elevated prevalence of tobacco use, and dental disorders such as calculus, cavities, and bleeding. Tailored dental health programs that include inclusive healthcare services and awareness are essential. PROSPERO REGISTRATION CRD42023468872.
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Affiliation(s)
- Vini Mehta
- Department of Dental Research Cell, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri Pune, India
| | - Sapna Negi
- Department of Dental Research Cell, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri Pune, India
| | - Ankita Mathur
- Department of Dental Research Cell, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri Pune, India
| | - Snehasish Tripathy
- Department of Dental Research Cell, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri Pune, India
| | - Simmi Oberoi
- Department of Community Medicine, Government Medical College, Patiala, Punjab, India
| | | | - Isaqali Karobari
- Dental Research Unit, Center for Global Health Research, Saveetha Institute of Medical and Technical Sciences, Saveetha Medical College and Hospital, Saveetha University, Chennai, Tamil Nadu, India
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Raj P, Dubey A. Comprehending Health of the Transgender Population in India Through Bibliometric Analysis. Int J Public Health 2024; 69:1606598. [PMID: 38665638 PMCID: PMC11043523 DOI: 10.3389/ijph.2024.1606598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
Objective: In India research on health issues of transgender populations are very recent and limited though transgenders are an important sub-group of the population. Hence, this study attempts to understand the state of transgender health research in India through a systematic review of literature. Methods: A systematic literature review was conducted using bibliometric analysis. Initially, 132 studies were identified, and only 37 articles meeting selection criteria were subsequently selected for review using PRISMA 2020 guidelines. The research landscape was examined with tools such as Biblioshiny, Arc-GIS (10.1), and Vos-Viewer. Results: The review highlights that existing literature on transgender health in India mainly focuses on sexual health while neglecting their overall health status. It also emphasises the skewed geographical coverage of these studies. Based on the analysis, the interdisciplinary nature of the subject is illustrated in a three-field plot and through term co-occurrence. These indicate the need for culture-specific gender-affirmative services promoting a holistic approach to comprehend the health of transgender populations in India. Conclusion: In India research on transgender health is lopsided and at an initial stage. There is a need to develop diverse research focus on various health issues of transgenders that should also be geographically representative. Future in-depth research on this subject will enable optimizing resource allocation, developing effective gender-inclusive policies, and support holistic planning for better health status of transgender people in India, and other countries with similar socio-cultural background.
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Affiliation(s)
- Papia Raj
- Department of Humanities and Social Sciences, Indian Institute of Technology Patna, Patna, Bihar, India
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Luz PM, Spaeth H, Scott JA, Grinsztejn B, Veloso VG, Freedberg KA, Losina E. Variability in life expectancy among people with HIV in Brazil by gender and sexual orientation. Braz J Infect Dis 2024; 28:103722. [PMID: 38369294 PMCID: PMC10897846 DOI: 10.1016/j.bjid.2024.103722] [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: 10/23/2023] [Revised: 12/24/2023] [Accepted: 01/24/2024] [Indexed: 02/20/2024] Open
Abstract
INTRODUCTION In Brazil, though Antiretroviral Therapy (ART) is available to all, the benefits may not be experienced uniformly. We projected Life Expectancy (LE) for People Living with HIV (PLHIV) in care as currently observed and estimated the impact of guideline-concordant care. METHODS Using a microsimulation model, we projected LE for a cohort of PLHIV and for four population groups: cisgender Men who have Sex with Men (MSM), cisgender Men who have Sex with Women (MSW), Cisgender Women (CGW), and Transgender Women (TGW). Cohort data from Evandro Chagas National Institute of Infectious Diseases/Oswaldo Cruz Foundation (INI/Fiocruz) informed model parameters. We modeled five scenarios: 1) Current care: ART initiation, adherence, and retention in care as currently observed, 2) Guideline-concordant care: immediate ART initiation, full adherence to treatment, and consistent retention in care, 3) Immediate ART initiation with observed adherence to treatment and retention in care, 4) Full adherence to treatment with observed timing of ART initiation and retention in care, and 5) Consistent retention in care with observed timing of ART initiation and adherence. RESULTS With current care, LE from age 15 would be 45.9, 44.4, 54.2, and 42.3 years, for MSM, MSW, CGW, and TGW. With guideline-concordant care, LE would be 54.2, 54.4, 63.1, and 53.2 years, for MSM, MSW, CGW and TGW, with TGW experiencing the greatest potential increase in LE (10.9 years). When investigating the components of care separately, MSW and CGW would gain most LE with immediate ART initiation, whereas for MSM and TGW consistent retention in care would be most impactful. CONCLUSIONS In settings like INI/Fiocruz, MSW and CGW would benefit most from interventions focused on earlier diagnosis and linkage to care, whereas TGW and MSM would benefit from interventions to sustain engagement in care. Assessment of the HIV care continuum for specific populations should inform care priorities.
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Affiliation(s)
- Paula M Luz
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil.
| | - Hailey Spaeth
- Massachusetts General Hospital, Medical Practice Evaluation Center, Department of Medicine, Boston, MA, United States
| | - Justine A Scott
- Massachusetts General Hospital, Medical Practice Evaluation Center, Department of Medicine, Boston, MA, United States
| | - Beatriz Grinsztejn
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Valdilea G Veloso
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Kenneth A Freedberg
- Massachusetts General Hospital, Division of Infectious Diseases, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Massachusetts General Hospital, Division of General Internal Medicine, Boston, MA, United States; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Elena Losina
- Harvard Medical School, Boston, MA, United States; Harvard University Center for AIDS Research, Harvard Medical School, Boston, MA, United States; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, United States; Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States; Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
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Chaudhary S, Ray R, Glass BD. “I don't know much about providing pharmaceutical care to people who are transgender”: A qualitative study of experiences and attitudes of pharmacists. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 9:100254. [PMID: 37095891 PMCID: PMC10121476 DOI: 10.1016/j.rcsop.2023.100254] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Background Globally, with the increased visibility, the number of transgender people accessing healthcare services has risen in the last decade. Although pharmacists are required to provide equitable and respectful care to all patients, their experiences interacting with trans and gender-diverse (TGD) people and attitudes towards the provision of care are largely unknown. Objectives This study aimed to determine the experiences and attitudes of pharmacists providing care to TGD people in Queensland, Australia. Methods Within a transformative paradigm, this study used semi-structured interviews conducted in person, over the phone, or through the Zoom app. Data were transcribed and analyzed by applying the constructs of the Theoretical Framework of Accessibility (TFA). Results A total of 20 participants were interviewed. Analysis revealed all seven constructs across interview data, with affective attitude and self-efficacy being the most frequently coded constructs, followed by burden and perceived effectiveness. The least coded constructs included ethicality, intervention coherence, and opportunity cost. Pharmacists had positive attitudes towards providing care and interacting professionally with TGD people. Prime challenges in delivering care were being unaware of inclusive language and terminology, difficulty building trusted relationships, privacy and confidentiality at the pharmacy, inability to locate appropriate resources, and lack of training in TGD health. Pharmacists felt rewarded when they established rapport and created safe spaces. However, they requested communication training and education to improve their confidence in delivering care to TGD people. Conclusion Pharmacists demonstrated a clear need for further education on gender-affirming therapies and training in communication with TGD people. Including TGD care in pharmacy curricula and continuous professional development activities is seen as an essential step towards pharmacists improving health outcomes for TGD people.
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Baptista Silva A, Malta M, da Silva CMFP, Kalume CC, Filha IGA, LeGrand S, Whetten K. The Dandarah App: An mHealth Platform to Tackle Violence and Discrimination of Sexual and Gender Minority Persons Living in Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:280. [PMID: 36612598 PMCID: PMC9819566 DOI: 10.3390/ijerph20010280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
Discrimination and violence are widely experienced by sexual and gender minority (SGM) persons worldwide. More than one SGM person is murdered every day in Brazil because of their sexuality or gender identity, which is the highest reported homicide rate in the world. Alt-hough discrimination and violence against SGM persons in Brazil are considered to be hate crimes, reporting is still suboptimal due to fear of police SGM phobia and victim blaming. Accessible and easily disseminated interventions are urgently needed. Herein, we describe the develop-ment of an mHealth solution to help address violence against SGM persons, namely the Rainbow Resistance: Dandarah App, with a synthesis of key results and feedback from the SGM community after 24 months of using the app. Twenty-two focus group discussions (FGDs) were conducted with SGM persons living in six Brazilian states: Bahia, Federal District, São Paulo, Rio de Janeiro, Minas Gerais, Sergipe, and Pará. A total of 300 SGM persons participated in the FGDs. A thematic analysis was performed to interpret the qualitative data. Content themes related to aesthetics, us-ability, barriers to resources, and likes/dislikes about the intervention arose from the FGDs. Participants found the intervention to be user-friendly, endorsed more likes than dislikes, and suggested a few changes to the app. The findings suggest that the intervention is usable and fit for future ef-fectiveness testing, and that it could fill an important gap in the well-being of SGM persons living in a country with high levels of discrimination and violence towards this community, i.e., Brazil.
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Affiliation(s)
- Angélica Baptista Silva
- Department of Human Rights, Health and Cultural Diversity, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Mônica Malta
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON M5S 2S1, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Cosme Marcelo Furtado Passos da Silva
- Department of Epidemiology and Quantitative Methods in Health, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Clarice Cavalcante Kalume
- Department of Human Rights, Health and Cultural Diversity, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Ianê Germano Andrade Filha
- Department of Human Rights, Health and Cultural Diversity, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Sara LeGrand
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC 27710, USA
| | - Kathryn Whetten
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC 27710, USA
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Moncayo Quevedo JE, Pérez-Arizabaleta MDM, Reyes Sevillano WH. Condom use and non-use among transgender women in Colombia: a qualitative analysis based on the IMB model. Rev Saude Publica 2022; 56:84. [PMID: 36169523 PMCID: PMC9529206 DOI: 10.11606/s1518-8787.2022056004145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/03/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Review the reasons for condom use and non-use among transgender women in Colombia based on the information, motivation and behavioral skills (IMB) model. METHOD Qualitative study in which an iterative process analysis was carried out. A focal group participated in person, and in-depth interviews were conducted virtually. RESULTS First study carried out in Colombia on condom use among transgender women under the IMB model. The information component finds that traditional sexual education does not have a positive impact. Regarding motivational aspects, the importance of family support and follow-up and community-based organizations to motivate sexual health care and condom use is highlighted. Regarding behavioral skills, it was found that distrust towards sexual partners and the acquisition of condoms promote their use. CONCLUSIONS It is important to create spaces for sexual education delivered by and for the LGBTIQ population, followed by the medical knowledge of health centers, to have positive impacts on the sexual health of transgender women; studies with sexual partners of transgender women are encouraged in order to know the reasons why they request the non-use of condoms.
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Porcino C, de Oliveira JF, Coelho MTÁD, Silva DDO, Suto CSS, Couto PLS, Cortes HM, Gomes AMT. (Re)Construction of the body of transgender women: daily search for (in)satisfaction and care? Rev Bras Enferm 2022; 75:e20210512. [PMID: 35946620 PMCID: PMC9749498 DOI: 10.1590/0034-7167-2021-0512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 04/03/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To analyze the structure and contents of transgender women's social representations of their bodies and body modification practices. METHODS Research conducted with 92 women using the Snowball technique. The data were collected using the free evocation of words technique and processed by the Evoc software, which organized the central and peripheral elements. RESULTS The representation of the real body includes two structuring aspects: one related to the need to adapt/modify the body conformation according to the self-reported gender, because of the dissatisfaction with the body itself; the second reveals the happiness/satisfaction considering the results obtained through the body modification/adaptation practices adopted in the transition. FINAL CONSIDERATIONS The body is constituted as a complex object and was represented by elements that reinforce the understanding of body modifications as needs, with a view to satisfaction, personal fulfillment, and care of one's own body.
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Affiliation(s)
- Carle Porcino
- Universidade Federal da Bahia. Salvador, Bahia, Brazil
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Joshi N, Vinu V, Jois SN, Begum F, Salagame KK. The Need, Feasibility and Willingness to Explore "Meditation on Twin Hearts" as a Self-administered Tool for Mental Health Management among Transgender Women: An Exploratory Survey. Community Ment Health J 2022; 58:666-672. [PMID: 34255215 PMCID: PMC8276206 DOI: 10.1007/s10597-021-00869-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/27/2021] [Indexed: 11/30/2022]
Abstract
Hijras are the transgender community and have been socio-economically marginalized and hence their mental healthcare needs to be addressed. This was a descriptive, qualitative study, conducted in Mysore, India to examine the mental health status of 33 transgender women (TGW) and their response to the "Meditation on Twin Hearts (MTH)" intervention. Assessment of anxiety, depression and suicidality was carried out before the meditative session followed by a single session of MTH. Their feedback on meditation experience was collected, coded, and transformed into quantitative data. Among total participants, 39.4% of TGW exhibited severe anxiety, 21.2% has severe depression and 75.8% of them were at suicidal risk. Depression was positively correlated with anxiety and suicidal behavior. Most participants reported MTH was useful with signs of improvements in mental state. Thus, a single session of MTH has shown good signs of improvement in mental state among TGW.
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Affiliation(s)
- Neha Joshi
- Public Health Research Institute of India, Mysuru, India
| | - V Vinu
- World Pranic Healing Foundation-India Research Center, Mysuru, India
| | - Srikanth N Jois
- World Pranic Healing Foundation-India Research Center, Mysuru, India.
| | - Fazila Begum
- Public Health Research Institute of India, Mysuru, India
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Chakrapani V, Lakshmi PVM, Newman PA, Kaur J, Tsai AC, Vijin PP, Singh B, Kumar P, Rajan S, Kumar R. Syndemic violence victimization, alcohol and drug use, and HIV transmission risk behavior among HIV-negative transgender women in India: A cross-sectional, population-based study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000437. [PMID: 36962491 PMCID: PMC10021466 DOI: 10.1371/journal.pgph.0000437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/29/2022] [Indexed: 03/26/2023]
Abstract
Transgender women globally are disproportionately burdened by HIV. Co-occurring epidemics of adverse psychosocial exposures accelerate HIV sexual risk, including among transgender women; however, studies using additive models fail to examine synergies among psychosocial conditions that define a syndemic. We examined the impact of synergistic interactions among 4 psychosocial exposures on condomless anal sex (CAS) among transgender women in India. A national probability-based sample of 4,607 HIV-negative transgender women completed the Indian Integrated Biological and Behavioural Surveillance survey, 2014-2015. We used linear probability regression and logistic regression to assess 2-, 3-, and 4-way interactions among 4 psychosocial exposures (physical violence, sexual violence, drug use, and alcohol use) on CAS. Overall, 27.3% reported physical and 22.3% sexual violence victimization (39.2% either physical or sexual violence), one-third (33.9%) reported frequent alcohol use and 11.5% illicit drug use. Physical violence was associated with twofold higher odds of CAS in the main effects model. Statistically significant two- and three-way interactions were identified, on both the multiplicative and the additive scales, between physical violence and drug use; physical and sexual violence; physical violence, sexual violence, and alcohol use; and physical violence, alcohol use and drug use. Physical and sexual violence victimization, and alcohol and drug use are highly prevalent and synergistically interact to increase CAS among HIV-negative transgender women in India. Targeted and integrated multilevel initiatives to improve the assessment of psychosocial comorbidities, to combat systemic transphobic violence, and to provide tailored, trauma-informed alcohol and substance use treatment services may reduce HIV risk among transgender women.
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Affiliation(s)
- Venkatesan Chakrapani
- Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India
- Postgraduate Institute of Medical Education and Research (PGIMER), School of Public Health, Chandigarh, India
| | - P V M Lakshmi
- Postgraduate Institute of Medical Education and Research (PGIMER), School of Public Health, Chandigarh, India
| | - Peter A Newman
- University of Toronto, Factor-Inwentash Faculty of Social Work, Toronto, Canada
| | - Jasvir Kaur
- Postgraduate Institute of Medical Education and Research (PGIMER), School of Public Health, Chandigarh, India
| | - Alexander C Tsai
- Massachusetts General Hospital and Harvard Medical School, Boston, United States of America
| | - P P Vijin
- Postgraduate Institute of Medical Education and Research (PGIMER), School of Public Health, Chandigarh, India
| | - Bhawani Singh
- National AIDS Control Organisation, New Delhi, India
| | - Pradeep Kumar
- National AIDS Control Organisation, New Delhi, India
| | - Shobini Rajan
- National AIDS Control Organisation, New Delhi, India
| | - Rajesh Kumar
- Postgraduate Institute of Medical Education and Research (PGIMER), School of Public Health, Chandigarh, India
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