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Marrow E, Malik M, Pantalone DW, Peitzmeier S. Power and control, resistance and survival: A systematic review and meta-synthesis of the qualitative literature on intimate partner violence against transgender individuals. Soc Sci Med 2024; 342:116498. [PMID: 38227997 DOI: 10.1016/j.socscimed.2023.116498] [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: 06/09/2023] [Revised: 11/10/2023] [Accepted: 12/04/2023] [Indexed: 01/18/2024]
Abstract
Transgender (trans) individuals experience intimate partner violence (IPV) at elevated levels compared to cisgender individuals. Traditional theoretical understandings of IPV as men's patriarchal domination of women, and later, broader theories in which IPV is conceptualized as the relatively privileged partner enacting domination over the relatively oppressed partner, do not fully capture the totality of IPV experiences, including how IPV is perpetrated against trans individuals. We conducted a systematic review and qualitative meta-synthesis of the qualitative and theoretical literatures on IPV against trans individuals (N = 37 articles and books) to generate novel IPV theory inclusive of trans individuals' experiences. We identified five major themes: (1) societal context of IPV, (2) IPV tactics and types, (3) help-seeking, (4) consequences of IPV, and (5) proposed interventions for victims. Synthesizing across themes, we offer a novel theoretical model that demonstrates how abusers can leverage structural discrimination and vulnerabilities against trans victims, regardless of the abuser's own identities. We identify individual power and control tactics abusers use, including identifying a category of IPV that we term leveraging vulnerability, which involves abusers weaponizing their own vulnerabilities to avoid accountability. Reducing IPV in trans communities requires expanding current IPV theory to include trans victims, recognition of a wider range of abuse tactics, and structural interventions that promote the respectful treatment of trans individuals. Our theoretical model of IPV "centers the margins" to make trans victims' experiences, and indeed all victims whose experiences fall outside normative scripts, more legible.
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Affiliation(s)
- Elliot Marrow
- Department of Psychology, University of Massachusetts, Boston, United States.
| | - Mannat Malik
- Department of Health Behavior, University of North Carolina, United States
| | - David W Pantalone
- Department of Psychology, University of Massachusetts, Boston, United States; The Fenway Institute, Fenway Health, Boston, MA, United States
| | - Sarah Peitzmeier
- Department of Health Behavior and Biological Sciences, University of Michigan, United States
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2
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Chaudhry A, Hebert-Beirne J, Hanneke R, Alessi EJ, Mitchell U, Molina Y, Chebli P, Abboud S. The Health Needs of Sexual and Gender Minority Migrant Women in the United States: A Scoping Review. LGBT Health 2024; 11:1-19. [PMID: 37540144 DOI: 10.1089/lgbt.2022.0392] [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] [Indexed: 08/05/2023] Open
Abstract
Purpose: This scoping review characterizes the peer-reviewed evidence on the health of first-generation sexual and gender minority (SGM) migrant women to the United States and identifies research gaps and future priorities. Methods: On February 1, 2022, the following databases were searched: PubMed (MEDLINE), Embase, CINAHL Plus with Full Text, APA PsycINFO, and PAIS Index. Primary research studies based in the United States, in English, on first-generation SGM migrants (i.e., immigrants, refugees, asylum seekers) were included. Gray literature and review articles were excluded. Health outcome data were not extracted from nonbinary populations nor transgender men. Themes were generated using qualitative content analysis. Results: Thirty-three studies were reviewed, most were qualitative, and 11 focused on transgender women migrants (especially from Latin America), while only one was exclusively on sexual minority women (SMW) migrants. Premigration experiences of violence and discrimination were linked to high prevalence rates of post-traumatic stress disorder, depression, and anxiety. Postmigration stressors included lack of educational and employment opportunities, reduced access to social services, and experiences of stigma and discrimination, which were also associated with the development of depressive symptoms. Transgender women migrants reported not seeking formal medical care, given a lack of gender-affirming services and insurance resulting in reliance on unsafe informal care networks for hormone therapy and feminization procedures. Conclusion: Future interventions should focus on fostering social support networks of SGM migrant women to help improve their mental health outcomes. Research priorities should include studies on SMW migrants and more quantitative research that could identify additional health needs (i.e., sexual health) of SGM migrant women.
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Affiliation(s)
- Aeysha Chaudhry
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Jeni Hebert-Beirne
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Rosie Hanneke
- Department of Information Services & Research, Library of the Health Sciences, University of Illinois Chicago, Chicago, Illinois, USA
| | - Edward J Alessi
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Uchechi Mitchell
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Yamile Molina
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Perla Chebli
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Sarah Abboud
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
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3
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Zamudio-Haas S, Koester K, Venegas L, Salinas A, Herrera C, Gutierrez-Mock L, Welborn L, Deutsch MB, Sevelius J. "Entre Nosotras:" a qualitative study of a peer-led PrEP project for transgender latinas. BMC Health Serv Res 2023; 23:1013. [PMID: 37730598 PMCID: PMC10510224 DOI: 10.1186/s12913-023-09707-x] [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: 12/16/2022] [Accepted: 06/15/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Uptake of HIV pre-exposure prophylaxis (PrEP) remains low among transgender people as compared to other subgroups, despite high rates of HIV acquisition. In California, Latinx people comprise 40% of the population and Latina transgender women experience some of the highest burden of HIV of any subgroup, indicating a critical need for appropriate services. With funding from the California HIV/AIDS Research Programs, this academic-community partnership developed, implemented, and evaluated a PrEP project that co-located HIV services with gender affirming care in a Federally Qualified Heath Center (FQHC). Trans and Latinx staff led intervention adaptation and activities. METHODS This paper engages qualitative methods to describe how a PrEP demonstration project- Triunfo- successfully engaged Spanish-speaking transgender Latinas in services. We conducted 13 in-depth interviews with project participants and five interviews with providers and clinic staff. Interviews were conducted in Spanish or English. We conducted six months of ethnographic observation of intervention activities and recorded field notes. We conducted thematic analysis. RESULTS Beneficial elements of the intervention centered around three intertwined themes: creating trusted space, providing comprehensive patient navigation, and offering social support "entre nosotras" ("between us women/girls"). The combination of these factors contributed to the intervention's success supporting participants to initiate and persist on PrEP, many of whom had previously never received healthcare. Participants shared past experiences with transphobia and concerns around discrimination in a healthcare setting. Developing trust proved foundational to making participants feel welcome and "en casa/ at home" in the healthcare setting, which began from the moment participants entered the clinic and continued throughout their interactions with staff and providers. A gender affirming, bilingual clinician and peer health educators (PHE) played a critical part in intervention development, participant recruitment, and patient navigation. CONCLUSIONS Our research adds nuance to the existing literature on peer support services and navigation by profiling the multifaced roles that PHE served for participants. PHE proved instrumental to empowering participants to overcome structural and other barriers to healthcare, successfully engaging a group who previously avoided healthcare in clinical settings.
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Affiliation(s)
- Sophia Zamudio-Haas
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA.
| | - Kim Koester
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Luz Venegas
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Ariana Salinas
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Cinthya Herrera
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Luis Gutierrez-Mock
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Layla Welborn
- La Clinica de La Raza, 3451 East 12th Street, CA, 94601, Oakland, USA
| | - Madeline B Deutsch
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Jae Sevelius
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
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Gamarel KE, Jadwin-Cakmak L, King WM, Reyes LA, Trammell R, Neilands TB, Connolly MD, Jennings Mayo-Wilson L. Community-Led Response to Address Economic Vulnerability due to COVID-19 with, for, and by Transgender Women of Color: A Qualitative Pilot Evaluation. Transgend Health 2023; 8:195-199. [PMID: 37013097 PMCID: PMC10066767 DOI: 10.1089/trgh.2021.0115] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose Intersectional stigma fuels inequities among transgender women of color, which have been exacerbated by coronavirus disease 2019 (COVID-19). This study evaluated a community-led emergency assistance program for transgender women of color. Methods We conducted a pilot program evaluation (n=8). Results Retention was 87.5% over the follow-up. Funds were primarily used for bills, food, and housing. Requesting and receiving funds was described as "somewhat to extremely easy." Participants identified the need for economic empowerment components in future programming, specifically gender affirmation, skill-building for education and employment, and entrepreneurial opportunities. Conclusion Findings highlight the need to invest in community-led strategies to address inequities experienced by transgender women of color.
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Affiliation(s)
- Kristi E. Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Laura Jadwin-Cakmak
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Wesley M. King
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | | | - Racquelle Trammell
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
- Trans Sistas of Color Project, Detroit, Michigan, USA
| | - Torsten B. Neilands
- Center for AIDS Prevention Studies, University of California, San Francisco, California, USA
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Gamarel KE, Jadwin-Cakmak L, King WM, Hughes L, Abad J, Trammell R, Maguire A, Shackelford V, Connolly M, Rescoe T, Williams A, Harper GW. Improving Access to Legal Gender Affirmation for Transgender Women Involved in the Criminal-Legal System. JOURNAL OF CORRECTIONAL HEALTH CARE 2023; 29:12-15. [PMID: 36037008 PMCID: PMC10081699 DOI: 10.1089/jchc.21.09.0085] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Transgender women of color experience interlocking systems of oppression rooted in racism and transphobia, which fuel economic vulnerability and overrepresentation in the criminal-legal system. Legal gender affirmation, which refers to changing one's name and gender marker on official documents, has the potential to mitigate these issues by improving access to employment, housing, education, health care, and social services. These services are particularly important for transgender women of color with criminal records, a history of incarceration, or other legal infractions; however, 23 states have policies that restrict access to legal gender affirmation for these individuals. Alongside eliminating restrictive policies to obtain legal gender affirmation, medical-legal partnerships in these states may address recidivism and health inequities among transgender women of color.
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Affiliation(s)
- Kristi E. Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Laura Jadwin-Cakmak
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Wesley M. King
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Landon Hughes
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Julisa Abad
- Trans Sistas of Color Project, Detroit, Michigan, USA
- Fair Michigan Foundation, Detroit, Michigan, USA
| | - Racquelle Trammell
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
- Trans Sistas of Color Project, Detroit, Michigan, USA
| | | | | | - Maureen Connolly
- Department of Pediatrics, Henry Ford Health System, Detroit, Michigan, USA
| | | | | | - Gary W. Harper
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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Leite BO, Magno L, Soares F, MacCarthy S, Brignol S, Bastos FI, Dourado I. HIV prevalence among transgender women in Northeast Brazil – Findings from two Respondent Driven Sampling studies. BMC Public Health 2022; 22:2120. [DOI: 10.1186/s12889-022-14589-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/10/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background
The HIV epidemic still high among key-populations in Brazil, especially among transgender women (TGW). The aim of this study was to investigate the prevalence of HIV infection among TGW and to analyze factors associated with HIV seropositivity across two cross-sectional surveys conducted in Salvador, Bahia, one of the largest urban centers of Brazil.
Methods
The studies were conducted between 2014 and 2016 and 2016-2017 and employed Respondent-Driven Sampling (RDS) sampling, comprising 127 and 161 TGW residents of Salvador, Bahia. The outcome was the positive rapid antigen testing for HIV infection. Odds ratios (OR) and 95% confidence intervals (95%CI) were obtained using binomial logistic regression.
Results
The HIV prevalence was 9.0% (95%CI: 4.2-18.2) and 24.3% (95%CI: 16.2-34.9). In the first study, factors associated with HIV prevalence were experiencing discrimination by the family (OR 8.22; 95%CI: 1.49-45.48) and by neighbors (OR 6.55; 95%CI: 1.12-38.14) as well as having syphilis (OR 6.56; 95%CI:1.11-38.65); in the subsequent study gender-based discrimination (OR 8.65; 95%CI:1.45-51.59) and having syphilis (OR 3.13; 95%CI: 1.45-51.59) were associated with testing positive for HIV.
Conclusion
We found disproportionately high HIV prevalence among TGW, which underscores the context of vulnerability for this population. The data point to the urgency for intensification and expansion of access to HIV prevention and strategies to stop discrimination in health care and services for this population.
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Castro VA, King WM, Augustaitis L, Saylor K, Gamarel KE. A Scoping Review of Health Outcomes Among Transgender Migrants. Transgend Health 2022; 7:385-396. [PMID: 36644484 PMCID: PMC9829141 DOI: 10.1089/trgh.2021.0011] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose Transgender people constitute diverse populations who experience a range of adverse health outcomes. Despite increasing awareness of adverse health outcomes among migrant populations, there has been a dearth of studies focused on the health of transgender migrants. The goal of this scoping review was to describe common themes and empirical trends in research on the health of transgender migrants and identify gaps for future research and programming. Methods Using a systematic review protocol, we searched PubMed, Embase, Scopus, PsycINFO, CINAHL, and Web of Science with a combination of terms to identify empirical articles that examined health outcomes among transgender migrants. The search included studies published as of May 2019. Results Twenty of 1666 identified records met inclusion criteria. All studies were cross-sectional, and 50% were quantitative designs, 45% were qualitative designs, and 5% were mixed-methods designs. The majority reported on sexually transmitted infections (55%), violence (40%), and mental health (35%). Qualitative studies were generally high quality, while many quantitative studies had high risk of bias. While some adverse health outcomes may abate, stigmatizing social conditions continue to impact transgender migrant's health postmigration. Conclusions Anti-transgender and anti-immigrant stigma may contribute to adverse health outcomes for transgender migrants. Additional research using rigorous inclusive methods to survey a broader range of health domains is needed. The lives of transgender migrants are continuously upended by oppressive policies; therefore, it is vital to continue to expand the breadth of transgender health research.
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Affiliation(s)
- Vanessa A. Castro
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Wesley M. King
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Laima Augustaitis
- University of Michigan School of Information, Ann Arbor, Michigan, USA
| | - Kate Saylor
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan, USA
| | - Kristi E. Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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Gamarel KE, Rebchook G, McCree BM, Jadwin‐Cakmak L, Connolly M, Reyes LA, Sevelius JM. The ethical imperative to reduce HIV stigma through community-engaged, status-neutral interventions designed with and for transgender women of colour in the United States. J Int AIDS Soc 2022; 25 Suppl 1:e25907. [PMID: 35818894 PMCID: PMC9274348 DOI: 10.1002/jia2.25907] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/22/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION In the era of biomedical HIV prevention and treatment technologies, such as treatment as prevention (TasP) and pre-exposure prophylaxis (PrEP), there is momentum to develop and rigorously evaluate interventions focused on PrEP among those at risk for HIV acquisition and antiretroviral therapy (ART) adherence among people living with HIV. While HIV status-specific interventions focused on PrEP or ART provide valuable information, status-segregated interventions can create, perpetuate, and even increase HIV stigma among transgender women of colour and other marginalized communities in the United States (US). DISCUSSION Due largely to community advocacy, discourses that support status-neutral approaches have emerged in the scientific literature. Although US-based funding mechanisms have typically designated awards focused on a specific HIV status, intervention developers and implementing agencies find creative ways to design and implement status-neutral programmes despite such restrictions. We present our experience with intervention research in New York, Detroit, New Orleans, Puerto Rico and the San Francisco Bay Area, all Ending the HIV Epidemic (EHE) priority jurisdictions. Kickin it with the Gurlz' was developed to be status-neutral through two grants due to community demands for a unifying approach. The Transgender Women Engagement and Entry to (TWEET) Care Project was designed to improve HIV care engagement for transgender women living with HIV, but developers realized the importance of including participants of any HIV status. Healthy Divas was designed for transgender women living with HIV but subsequent implementing agencies prioritized adapting it to be status-neutral. These examples support the urgency of designing, implementing and evaluating status-neutral interventions. CONCLUSIONS Community-based organizations strive for inclusivity in their programming and are rightly often reluctant to segregate services based on the HIV status of their clients. As researchers, we have an ethical imperative to work to reduce HIV stigma and respond to the needs of those most impacted by HIV, including transgender women of colour. As such, we call upon funders to develop mechanisms that support the development and testing of HIV status-neutral interventions to reduce HIV stigma and support community building, thereby increasing the possibility of fully realizing the benefits of biomedical HIV prevention and treatment technologies for all.
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Affiliation(s)
- Kristi E. Gamarel
- Department of Health Behavior and Health EducationUniversity of Michigan School of Public HealthAnn ArborMichiganUSA
| | - Greg Rebchook
- Division of Prevention SciencesDepartment of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Breonna M. McCree
- Division of Prevention SciencesDepartment of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Laura Jadwin‐Cakmak
- Department of Health Behavior and Health EducationUniversity of Michigan School of Public HealthAnn ArborMichiganUSA
| | - Maureen Connolly
- Department of PediatricsHenry Ford Health SystemDetroitMichiganUSA
| | | | - Jae M. Sevelius
- Division of Prevention SciencesDepartment of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
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Lett E, Asabor EN, Tran N, Dowshen N, Aysola J, Gordon AR, Agénor M. Sexual Behaviors Associated with HIV Transmission Among Transgender and Gender Diverse Young Adults: The Intersectional Role of Racism and Transphobia. AIDS Behav 2022; 26:3713-3725. [PMID: 35661016 DOI: 10.1007/s10461-022-03701-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 12/31/2022]
Abstract
HIV prevalence and engagement in sexual behaviors associated with HIV transmission are high among transgender people of color. Per intersectionality, this disproportionate burden may be related to both interpersonal and structural racism and transphobia. The goal of this study was to estimate the association between interpersonal and structural discrimination and sexual behaviors among transgender and gender diverse (TGD) U.S. young adults. We used logit models with robust standard errors to estimate the individual and combined association between interpersonal and structural racism and transphobia and sexual behaviors in a national online sample of TGD young adults of color (TYAOC) aged 18-30 years (N = 228). Racism was measured at the interpersonal and structural level using the Everyday Discrimination Scale and State Racism Index, respectively. Transphobia was measured at the interpersonal and structural level using the Gender Minority Stress Scale and the Gender Identity Tally, respectively. We found that interpersonal racism was associated with transactional sex, and interpersonal transphobia was associated with alcohol/drug consumption prior to sex and transactional sex among TYAOC. We also found evidence of a strong joint association of interpersonal and structural racism and transphobia with alcohol/drug consumption prior to sex (OR 3.85, 95% CI 2.12, 7.01) and transactional sex (OR 3.54, 95% CI 0.99, 12.59) among TYAOC. Racism and transphobia have a compounding impact on sexual behaviors among TYAOC. Targeted interventions that reduce discrimination at both the interpersonal and structural level may help reduce the HIV burden in this marginalized population.
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Affiliation(s)
- Elle Lett
- Center for Applied Transgender Studies, Chicago, IL, USA.
- Perelman School of Medicine, University of Pennsylvania, Blockley Hall, Philadelphia, PA, 19146, USA.
| | | | - Nguyen Tran
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Nadia Dowshen
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jaya Aysola
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Allegra R Gordon
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Madina Agénor
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
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Abreu RL, Gonzalez KA, Lindley L, Capielo Rosario C, Lockett GM, Teran M. “Why can’t I Have the Office Jobs?”: Immigrant Latinx Transgender Peoples’ Experiences with Seeking Employment. JOURNAL OF CAREER DEVELOPMENT 2021. [DOI: 10.1177/08948453211062951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Research has documented the experiences of transgender people in seeking employment. To date, no scholarship has explored the experiences of immigrant Latinx transgender people seeking employment in the United States. Using an intersectionality framework, the present study aimed to uncover the experiences of immigrant Latinx transgender people as they sought employment in the United States. A community sample of 18 immigrant Latinx transgender people from a large metropolitan city in Florida engaged in semi-structured interviews. Thematic analysis revealed five themes related to participants’ experiences seeking employment, including: (1) discrimination, (2) limited options, (3) positive experiences, (4) momentary de-transition, and (5) disability benefits as financial relief. Future directions such as exploring ways in which immigrant Latinx transgender people resist discrimination while seeking job opportunities are discussed. Implications for practice and advocacy such as advocating for equitable employment policies that acknowledge the intersectional experiences of this community are presented.
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Affiliation(s)
- Roberto L. Abreu
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | | | - Louis Lindley
- Department of Psychology, University of Wisconsin-Madison, Madison, WI, USA
| | | | | | - Manuel Teran
- Department of Psychology, University of California, Irvine, CA, USA
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11
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Gamarel K, King WM, Mouzoon R, Xie H, Stanislaus V, Iwamoto M, Baxter K, Suico S, Nemoto T, Operario D. A "tax" on gender affirmation and safety: costs and benefits of intranational migration for transgender young adults in the San Francisco Bay area. CULTURE, HEALTH & SEXUALITY 2021; 23:1763-1778. [PMID: 32924839 PMCID: PMC7956137 DOI: 10.1080/13691058.2020.1809711] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 08/10/2020] [Indexed: 06/02/2023]
Abstract
Many transgender (trans) young adults migrate to urban enclaves with known infrastructures to fulfil gender affirmation needs such as obtaining trans-inclusive healthcare and support. This study sought to explore experiences of intranational migration (i.e. migration within a single country) for gender affirmation among trans young adults who relocated to San Francisco. A convenience sample of 61 trans young adults aged 18 to 29 (32% nonbinary, 28% trans women, and 40% trans men; 84% identified as a person of colour) participated in a one-time qualitative interview as part of a larger study. Thematic analysis was used to develop and refine the codes and themes. Three overarching themes became apparent regarding intranational migration and gender affirmation needs: (1) access to basic gender affirmation needs; (2) safety; and (3) the price of gender affirmation. Migration for gender affirmation and safety placed informants at risk for structural vulnerabilities including homelessness, unemployment and racism. Despite these structural vulnerabilities, participants were willing to "pay" the price in order to gain gender affirmation and safety. Findings underscore the importance of moving beyond individual-level risk factors to understand how unmet gender affirmation needs may place trans young adults in structurally vulnerable positions that can affect health and wellness.
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Affiliation(s)
- Kristi Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Wesley M. King
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Raha Mouzoon
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Hui Xie
- Public Health Institute, Oakland, CA, USA
| | | | | | | | | | | | - Don Operario
- Department of Behavior and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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12
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Alessi EJ, Cheung S, Kahn S, Yu M. A Scoping Review of the Experiences of Violence and Abuse Among Sexual and Gender Minority Migrants Across the Migration Trajectory. TRAUMA, VIOLENCE & ABUSE 2021; 22:1339-1355. [PMID: 34812109 DOI: 10.1177/15248380211043892] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Violence against sexual and gender minority (SGM) individuals has continued to proliferate globally. Yet, less is known about victimization among subgroups of SGM individuals, especially SGM immigrants, refugees, and asylum seekers. There has been a steady increase in this vulnerable group of migrants over the years, and emerging evidence has pointed to their heightened risk of victimization. We conducted a scoping review of the peer-reviewed literature that examined violence, abuse, and mental health among SGM individuals who migrate internationally. One hundred ninety-nine articles were identified by searching five scholarly databases and hand searching. Twenty-six articles met inclusion criteria. We first used the migration framework, which outlines the distinct phases of the migration trajectory (predeparture, travel, interception, destination, and return), to categorize findings and then identified four overarching themes to capture SGM migrants' experiences at each phase: severe and prolonged violence and abuse related to sexual orientation or gender identity (predeparture); continued victimization and high-risk for sexual violence (travel); detainment- and deportation-related violence and abuse (interception and return); and new manifestations of violence and abuse while living with past trauma (destination). Violence and abuse began in childhood and continued in the host country, where they faced discrimination while managing posttraumatic stress disorder and depression. Findings indicate that SGM migrants are extremely vulnerable to victimization. There is an immediate need for policies to protect SGM individuals worldwide and for affirmative, culturally informed practices to help SGM migrants manage trauma and the structural barriers impeding recovery.
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Affiliation(s)
| | | | | | - Melanie Yu
- Rutgers University, New Brunswick, NJ, USA
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13
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Galvan FH, Chen YT, Contreras R, O’Connell B. Violence Inflicted on Latina Transgender Women Living with HIV: Rates and Associated Factors by Perpetrator Type. AIDS Behav 2021; 25:116-126. [PMID: 31811444 DOI: 10.1007/s10461-019-02751-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Many transgender individuals report violence directed against them. This study examined violence inflicted on transgender Latinas with HIV by primary partners, sexual partners and acquaintances/strangers. Logistic regression was used for analysis. 150 transgender Latinas were recruited. Rates of violence from different perpetrator types were 47-50%. For violence by primary partners, social support from cisgender people was associated with a lower likelihood of violence (AOR 0.56; CI 0.32, 0.98; p < 0.05). For violence by sexual partners, a history of childhood sexual abuse was associated with a higher likelihood of violence (AOR 2.64; CI 1.10, 6.34; p < 0.05). For violence by acquaintances/strangers, discrimination was associated with a higher likelihood of violence (AOR 2.84; CI 1.16, 6.94; p < 0.05) and social support from cisgender people with a lower likelihood (AOR 0.58; CI 0.37, 0.92; p < 0.05). Interventions are needed at individual, institutional and systemic levels to eradicate such violence.
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Farvid P, Vance TA, Klein SL, Nikiforova Y, Rubin LR, Lopez FG. The health and wellbeing of transgender and gender
non‐conforming
people of colour in the United States: A systematic literature search and review. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2021. [DOI: 10.1002/casp.2555] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Panteá Farvid
- Psychology, Schools of Public Engagement The New School New York New York USA
| | - Thomas A. Vance
- Psychology, Schools of Public Engagement The New School New York New York USA
- Boys and Girls Clubs of America Atlanta Georgia USA
| | - Samantha L. Klein
- Psychology, School for Social Research The New School New York New York USA
| | | | - Lisa R. Rubin
- Psychology, School for Social Research The New School New York New York USA
| | - Felix G. Lopez
- Psychology, School for Social Research The New School New York New York USA
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15
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Gyamerah AO, Baguso G, Santiago-Rodriguez E, Sa'id A, Arayasirikul S, Lin J, Turner CM, Taylor KD, McFarland W, Wilson EC, Wesson P. Experiences and factors associated with transphobic hate crimes among transgender women in the San Francisco Bay Area: comparisons across race. BMC Public Health 2021; 21:1053. [PMID: 34078334 PMCID: PMC8173924 DOI: 10.1186/s12889-021-11107-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 05/17/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Trans women experience high rates of gender-based violence (GBV)-a risk factor for adverse health outcomes. Transphobic hate crimes are one such form of GBV that affect trans women. However, little is understood about factors that shape transphobic hate crimes and racial/ethnic variation in these experiences. To contextualize GBV risk and police reporting, we examined self-reported types and correlates of transphobic hate crimes by racial/ethnic group of trans women in the San Francisco Bay Area. METHODS From 2016 to 2018, trans women participated in a longitudinal cohort study of HIV. Secondary data analyses (N = 629) examined self-reported experiences of transphobic hate crimes (i.e., robbery, physical assault, sexual assault, and battery with weapon) by race/ethnicity, and whether hate crimes were reported to the police. Chi-square tests and simple logistic regression examined demographic, sociocultural, and gender identity factors associated with transphobic violence experiences and police reporting. RESULTS About half (45.8%) of participants reported ever experiencing a transphobic hate crime; only 51.1% of these were reported to the police. Among those who reported a hate crime experience, Black (47.9%) and Latina (49.0%) trans women reported a higher prevalence of battery with a weapon; White (26.7%) and trans women of "other" race/ethnicities (25.0%) reported a higher prevalence of sexual assault (p = 0.001). Having one's gender questioned, history of sex work, homelessness as a child and adult, and a history incarceration were associated with higher odds of experiencing a transphobic hate crime. Trans women who felt their gender identity questioned had lower odds of reporting a hate crime to the police compared to those did not feel questioned. CONCLUSIONS A high proportion of trans women experienced a transphobic hate crime, with significant socio-structural risk factors and racial differences by crime type. However, crimes were underreported to the police. Interventions that address structural factors, especially among trans women of color, can yield violence prevention benefits.
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Affiliation(s)
- Akua O Gyamerah
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, California, USA.
- Department of Community Health Systems, School of Nursing, University of California, 2 Koret Way, San Francisco, CA, 94143, USA.
| | - Glenda Baguso
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, California, USA
| | - Edda Santiago-Rodriguez
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, California, USA
| | - Aria Sa'id
- Transgender District, San Francisco, USA
| | - Sean Arayasirikul
- San Francisco Department of Public Health, Trans Research Unit for Equity, San Francisco, USA
| | - Jess Lin
- Department of Public Health, Center for Public Health Research, San Francisco, USA
| | - Caitlin M Turner
- San Francisco Department of Public Health, Trans Research Unit for Equity, San Francisco, USA
| | - Kelly D Taylor
- Institute for Global Health Sciences, University of California, San Francisco, USA
| | - Willi McFarland
- Department of Public Health, Center for Public Health Research, San Francisco, USA
| | - Erin C Wilson
- Department of Public Health, Center for Public Health Research, San Francisco, USA
| | - Paul Wesson
- Department of Epidemiology & Biostatistics, University of California, San Francisco, USA
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16
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Ornelas IJ, Yamanis TJ, Ruiz RA. The Health of Undocumented Latinx Immigrants: What We Know and Future Directions. Annu Rev Public Health 2021; 41:289-308. [PMID: 32237989 DOI: 10.1146/annurev-publhealth-040119-094211] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Undocumented Latinx immigrants experience unique factors prior to migration, during migration, and after migration that shape their health. Our review summarizes the limited but growing literature highlighting how exposure to trauma, immigration enforcement, changes to social networks, and discrimination negatively affect the mental and physical health of undocumented Latinx immigrants. We also discuss how policies and social ties can promote their health. We focus on areas of particular concern, including health care, mental health, and HIV. Future research should use interdisciplinary approaches and intersectional frameworks to understand and address health inequities. Conducting research with undocumented Latinx immigrant communities requires community engagement, assurance of confidentiality, and creative recruitment and retention strategies. Recommendations for public health practice include investing in community health centers and organizations to ensure access to health and social services; presenting results with sufficient contextualization to interpret their generalizability; and advocating for federal-, state-, and local-level policy changes that reduce the negative health consequences associated with being undocumented.
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Affiliation(s)
- India J Ornelas
- Department of Health Services, University of Washington, Seattle, Washington 98195, USA; ,
| | - Thespina J Yamanis
- School of International Service, American University, Washington, DC 20016-8071, USA;
| | - Raymond A Ruiz
- Department of Health Services, University of Washington, Seattle, Washington 98195, USA; ,
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Martinez O. A review of current strategies to improve HIV prevention and treatment in sexual and gender minority Latinx (SGML) communities. Expert Rev Anti Infect Ther 2021; 19:323-329. [PMID: 32902348 PMCID: PMC10718306 DOI: 10.1080/14787210.2020.1819790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/27/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The HIV epidemic continues to disproportionately impact sexual and gender minority Latinxs (SGML). Several syndemic conditions have been linked with HIV acquisition and transmission among SGML including immigration, discrimination, environmental racism, substance use, and mental health. AREAS COVERED We provide a summary of biomedical, behavioral, and social/structural interventions to reduce risks for acquiring HIV and improve outcomes along the HIV care continuum among SGML. We also discuss intervention approaches and opportunities that respond at the intersection of HIV and COVID-19 prevention and treatment. EXPERT OPINION There is a dire need for the combination of biomedical, behavioral, and social/structural interventions to reduce risks for acquiring HIV and improve outcomes along the HIV care continuum. Interventions and combination approaches should be driven by community-based participatory action research. The inclusion of community members in all stages of the research process can assure successful implementation of program activities and deliverables, including the provision of culturally and linguistically appropriate services. Given the current COVID-19 pandemic, which is disproportionately impacting individuals living with HIV and other comorbidities, the elderly, and under-resourced communities with a ferocity not seen in other communities, intervention approaches that respond at the intersection of HIV and COVID-19 prevention and treatment are also urgently needed.
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Affiliation(s)
- Omar Martinez
- School of Social Work, College of Public Health, Temple University, Philadelphia, PA, USA
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18
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Yamanis TJ, del Río-González AM, Rapoport L, Norton C, Little C, Barker SL, Ornelas IJ. UNDERSTANDING FEAR OF DEPORTATION AND ITS IMPACT ON HEALTHCARE ACCESS AMONG IMMIGRANT LATINX MEN WHO HAVE SEX WITH MEN. ADVANCES IN MEDICAL SOCIOLOGY 2021; 21:103-131. [PMID: 38863904 PMCID: PMC11165931 DOI: 10.1108/s1057-629020210000021010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
Purpose Fear of deportation and its relationship to healthcare access has been less studied among immigrant Latinx men who have sex with men (MSM), a population at risk for HIV and characterized by their multiple minority statuses. The first step is to accurately measure their fear of deportation. Approach We used an exploratory sequential mixed methods design. Eligibility criteria were that research participants be ages 18-34 years; Latinx; cisgender male; having had sex with another male; residing in the District of Columbia metro area; and not a US citizen or legal permanent resident. In Study 1, we used in-depth interviews and thematic analysis. Using participants' interview responses, we inductively generated 15 items for a fear of deportation scale. In Study 2, we used survey data to assess the scale's psychometric properties. We conducted independent samples t-test on the associations between scale scores and barriers to healthcare access. Findings For the 20 participants in Study 1, fear of deportation resulted in chronic anxiety. Participants managed their fear through vigilance, and behaviors restricting their movement and social network engagement. In Study 2, we used data from 86 mostly undocumented participants. The scale was internally consistent (α = 0.89) and had a single factor. Those with higher fear of deportation scores were significantly more likely to report avoiding healthcare because they were worried about their immigration status (p = 0.007). Originality We described how fear of deportation limits healthcare access for immigrant Latinx MSM. Research implications Future research should examine fear of deportation and HIV risk among immigrant Latinx MSM.
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19
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Phillips Ii G, McCuskey DJ, Felt D, Raman AB, Hayford CS, Pickett J, Shenkman J, Lindeman PT, Mustanski B. Geospatial perspectives on health: The PrEP4Love campaign and the role of local context in health promotion messaging. Soc Sci Med 2020; 265:113497. [PMID: 33187750 DOI: 10.1016/j.socscimed.2020.113497] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/05/2020] [Accepted: 10/30/2020] [Indexed: 12/18/2022]
Abstract
Pre-exposure prophylaxis (PrEP) remains one of the most effective biomedical interventions for the prevention of HIV transmission. However, uptake among populations most impacted by the HIV epidemic remains low. La rge-scale awareness and mobilization campaigns have sought to address gaps in knowledge and motivation in order to improve PrEP diffusion. Such campaigns must be cognizant of the historical, physical, and structural contexts in which they exist. In urban contexts, neighborhood segregation has the potential to impact health outcomes and amplify disparities. Therefore, we present novel geospatial approaches to the evaluation of a Chicago-based PrEP messaging campaign (PrEP4Love) in a 2018 cohort of men who have sex with men and transgender women, contextualizing results within the localized infrastructure and public health landscape, and examining associations between geographic location and campaign efficacy. Results revealed notable variance in rates of PrEP uptake associated with campaign exposure by Chicago planning area, which are likely explained by the historical and contemporary impacts of racist structures on physical environment and city infrastructure. Findings have important implications for the evaluation and implementation of future messaging campaigns, which should take the unique historical, structural, and geospatial factors of their particular settings into account in order to achieve maximum impact.
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Affiliation(s)
- Gregory Phillips Ii
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave., 14th Floor, Suite 1400, Chicago, IL, 60611, USA; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, 60611, USA; Third Coast Center for AIDS Research, 625 N Michigan Ave., 14th Floor, Suite 1400, Chicago, IL, 60611, USA.
| | - David J McCuskey
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave., 14th Floor, Suite 1400, Chicago, IL, 60611, USA; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, 60611, USA
| | - Dylan Felt
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave., 14th Floor, Suite 1400, Chicago, IL, 60611, USA; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, 60611, USA
| | - Anand B Raman
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave., 14th Floor, Suite 1400, Chicago, IL, 60611, USA; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, 60611, USA
| | - Christina S Hayford
- Third Coast Center for AIDS Research, 625 N Michigan Ave., 14th Floor, Suite 1400, Chicago, IL, 60611, USA
| | - Jim Pickett
- AIDS Foundation of Chicago, 200 W. Monroe St., Suite 1150, Chicago, IL, 60606, USA
| | - Julia Shenkman
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave., 14th Floor, Suite 1400, Chicago, IL, 60611, USA; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, 60611, USA
| | - Peter T Lindeman
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave., 14th Floor, Suite 1400, Chicago, IL, 60611, USA; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, 60611, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave., 14th Floor, Suite 1400, Chicago, IL, 60611, USA; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, 60611, USA; Third Coast Center for AIDS Research, 625 N Michigan Ave., 14th Floor, Suite 1400, Chicago, IL, 60611, USA
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20
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Gonzalez KA, Abreu RL, Rosario CC, Koech JM, Lockett GM, Lindley L. "A center for trans women where they help you": Resource needs of the immigrant Latinx transgender community. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2020; 23:60-78. [PMID: 35403119 PMCID: PMC8986257 DOI: 10.1080/26895269.2020.1830222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Immigrant Latinx transgender people often migrate to the United States because of a desire for increased safety and more opportunities. However, after migrating to the United States, immigrant Latinx transgender people often struggle to access basic needs, including health care, jobs, and stable finances. These struggles are exacerbated for undocumented immigrant Latinx transgender people. There is a gap in the literature regarding needed resources for immigrant Latinx transgender community members living in the United States. AIMS Utilizing a critical intersectionality framework, the aim of the present study was to investigate the resource needs of immigrant Latinx transgender community members living in the United States. METHODS A community sample of 18 immigrant Latinx transgender people living in a large metropolitan city in Florida participated in individual semi-structured interviews to explore their community resource needs. RESULTS Thematic analysis revealed five themes related to resources that participants needed including: 1) Transgender healthcare/resources, 2) Public education, 3) Financial aid resources, 4) Homelessness resources, and 5) Addictions care. Two resource need-related themes were identified that pertain specifically to undocumented immigrant Latinx transgender people, including: 1) Documentation papers for access, and 2) Legal aid. CONCLUSIONS Findings suggest that immigrant Latinx transgender community members in this study provided guidance about broad resources needed to enhance their wellness and safety, and promote liberation of community members. Participants' resource needs suggest the importance of policy and structural level changes from institutions with power that consider and enhance the wellness of immigrant Latinx transgender people. Findings also suggest the need for more tailored interventions and case work to better support immigrant Latinx transgender people.
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Affiliation(s)
- Kirsten A. Gonzalez
- Department of Psychology, University of Tennessee, Knoxville, Tennessee, USA
| | - Roberto L. Abreu
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | | | - Jasmine M. Koech
- Department of Psychology, University of Tennessee, Knoxville, Tennessee, USA
| | - Gabriel M. Lockett
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Louis Lindley
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, Wisconsin, USA
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21
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Socio-structural Factors Associated with Mental Health, Substance Use, and HIV Risk Among Black Sexual and Gender Minorities in the House and Ball Community. AIDS Behav 2020; 24:2319-2326. [PMID: 31955359 DOI: 10.1007/s10461-020-02791-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The House and Ball Community (HBC), a tight-knit social and cultural network comprised primarily of Black sexual and gender minorities (SGM), offers unique opportunities for HIV prevention that leverage naturally occurring social support networks. However, experiences of socioeconomic marginalization, stigma, violence, and trauma may impede HIV prevention efforts. This study analyzed data from 551 Black SGM recruited at HBC events in 2 cities over 24 months. Logistic regression with generalized estimating equations examined associations between socio-structural stressors, mental health, substance use, and sexual behavior among HBC participants. Findings indicated high prevalence of depressive symptoms, history of trauma, intimate partner violence, and substance use, and significant associations between socioeconomic marginalization and depressive symptoms, substance use, and condomless anal sex. Future research is needed to better elucidate the temporal relationships between socioeconomic marginalization, mental health and substance use, and HIV transmission dynamics. Results highlight a need for integration of mental health services, substance use treatment, and HIV prevention for this community.
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22
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Özdener-Poyraz AE, Slugocki M, Kalabalik-Hoganson J, Han J. Pre-Exposure Prophylaxis (PrEP) in the Prevention of HIV: Strategies, Target Populations and Upcoming Treatments. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 12:283-293. [PMID: 32801927 PMCID: PMC7395680 DOI: 10.2147/hiv.s216024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 07/09/2020] [Indexed: 12/26/2022]
Abstract
Pre-exposure prophylaxis (PrEP) against HIV infection with tenofovir/emtricitabine is proven to be effective yet uptake of this preventive measure has been difficult due to several barriers such as cost, access, and misinformation. Certain subpopulations are disproportionately affected by this problem. Several methods have been developed to close the gap in care. New antiretroviral treatment strategies are being investigated for safety and efficacy in preventing HIV infection.
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Affiliation(s)
- Ayşe Elif Özdener-Poyraz
- Fairleigh Dickinson University, School of Pharmacy and Health Sciences, Department of Pharmacy Practice, Florham Park, NJ 07932, USA
| | - Malgorzata Slugocki
- Fairleigh Dickinson University, School of Pharmacy and Health Sciences, Department of Pharmacy Practice, Florham Park, NJ 07932, USA
| | - Julie Kalabalik-Hoganson
- Fairleigh Dickinson University, School of Pharmacy and Health Sciences, Department of Pharmacy Practice, Florham Park, NJ 07932, USA
| | - Jayoung Han
- Fairleigh Dickinson University, School of Pharmacy and Health Sciences, Department of Pharmacy Practice, Florham Park, NJ 07932, USA
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23
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Hernandez CJ, Santos GM, Wilson EC. Association of Documentation of Legal Residency Status with Nonprescribed Hormone Use Among Hispanic/Latina Trans Women in San Francisco. Health Equity 2020; 4:263-271. [PMID: 34095696 PMCID: PMC8175253 DOI: 10.1089/heq.2019.0104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2020] [Indexed: 11/13/2022] Open
Abstract
Undocumented immigrant trans Latinas face significant barriers to attaining gender-affirming health care and may use nonprescribed feminizing hormones. Without medical supervision, nonprescribed hormone use may lead to adverse health outcomes. This study aimed to determine if a history of being an undocumented immigrant was associated with nonprescribed hormone use among trans Latinas. We conducted a secondary analysis using baseline data from the 2016 Trans National study done in the San Francisco Bay Area. Two hundred five trans Latinas participated in the study, of whom 75 (37%) reported a history of being undocumented. We fitted a multivariable logistic regression model to determine whether having a history of being an undocumented immigrant was associated with nonprescribed hormone use while controlling for age, income, time living in San Francisco, history of sex work, and history of problems with accessing health care. The prevalence of nonprescribed hormone use was 55.9% among trans Latinas overall; however, for trans Latinas with a history of undocumented immigration status, the prevalence was 68%. There was a significant, independent association between nonprescribed hormone use and undocumented status (adjusted odds ratio [aOR]=3.20; 95% confidence interval [CI]=1.47–6.97). We also found that having a history of sex work was associated with nonprescribed hormone use (aOR=5.72; 95% CI=2.69–12.18). The prevalence of nonprescribed hormone use among trans Latinas was high and is associated with a history of undocumented status and sex work. These associations may indicate health care avoidance related to concerns of being criminalized due to their documentation status or source of income (i.e., sex work) among trans Latinas. These findings underscore the need to reduce barriers in gender-affirming care to increase access to medically supervised hormone use, particularly among individuals with a history of undocumented status and engaged in sex work.
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Affiliation(s)
- Christopher J Hernandez
- University of California, Berkeley School of Public Health, Division of Infectious Diseases and Vaccinology, Berkeley, California, USA.,San Francisco Department of Public Health, San Francisco, California, USA
| | - Glenn-Milo Santos
- San Francisco Department of Public Health, San Francisco, California, USA.,University of California, San Francisco, School of Nursing, California, San Francisco, USA
| | - Erin C Wilson
- San Francisco Department of Public Health, San Francisco, California, USA.,University of California, San Francisco, Department of Epidemiology & Biostatistics, San Francisco, USA
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24
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Abreu RL, Gonzalez KA, Mosley DV, Pulice-Farrow L, Adam A, Duberli F. "They feel empowered to discriminate against las chicas": Latina transgender women's experiences navigating the healthcare system. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2020; 23:178-193. [PMID: 35403109 PMCID: PMC8986233 DOI: 10.1080/26895269.2020.1767752] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Transgender Women of Color are more likely to experience oppression at the hands of healthcare providers than their transgender White counterparts. However, there is a paucity of research on the experiences of Latina transgender women in the United States. AIMS Using an intersectionality theory framework, the present study aimed to investigate the factors that contribute to Latina transgender women's decision to seek or refuse healthcare services and Latina transgender women's experiences with healthcare providers in the United States. METHODS A community sample of 15 Latina transgender women at a large metropolitan city in Florida participated in a focus group to explore their experiences with seeking out and accessing healthcare services. RESULTS Thematic analysis revealed five themes: 1) experiences in seeking healthcare, 2) the effects of hormones on mental health, 3) resistance, 4) imparting collective knowledge, and 5) recommendations to healthcare providers. CONCLUSIONS Through collective dialog these women gave voice to their needs and pains in the context of healthcare while also positioning themselves as agentic, resistant, and aware of the power of collectivism in the process of healing. The current findings support and extend calls for training improvements related to transgender populations, giving voice not only to the need for training but specifying immigrant Latina transgender women's desire for such training. Also, elements related to Latinx cultural values (e.g., convivencia, familismo) must be considered when working with Latina transgender women.
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Affiliation(s)
- Roberto L. Abreu
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Kirsten A. Gonzalez
- Department of Psychology, University of Tennessee, Knoxville, Tennessee, USA
| | - Della V. Mosley
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Lex Pulice-Farrow
- Department of Psychology, University of Tennessee, Knoxville, Tennessee, USA
| | - Alissa Adam
- Department of Psychology, University of Florida, Gainesville, Florida, USA
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25
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Adedimeji A, Shi Q, Haddad L, Holman S, Edmonds A, Weber K, Kassaye S, Karim R, Bolivar H, Reid M, Kempf M, Golub E, Hoover DR, Anastos K. Women from afar: an observational study of demographic characteristics and mortality among foreign-born women living with HIV in the Women's Interagency HIV Study (WIHS) in the United States 1994-2016. J Int AIDS Soc 2020; 23:e25486. [PMID: 32437092 PMCID: PMC7241263 DOI: 10.1002/jia2.25486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 03/06/2020] [Accepted: 03/13/2020] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Foreign-born persons comprise ~13% of the US population. Immigrants, especially women, often face a complex set of social and structural factors that negatively impact health outcomes including greater risk of HIV infection. We described socio-demographic, clinical and immunological characteristics and AIDs and non-AIDS death among foreign-born women living with HIV (FBWLWH) participating in the US Women's Interagency HIV Study (WIHS) in the US from 1994 to 2016. We hypothesized that FBW will experience higher AIDS-related mortality compared to US-born women (USBW). METHODS The WIHS is a multicenter prospective observational cohort study of mostly women living with HIV (WLWH). The primary exposure in this analysis, which focused on 3626 WLWH, was self-reported country of birth collapsed into foreign-born and US born. We assessed the association of birthplace with categorized demographic, clinical and immunological characteristics, and AIDS/non-AIDS mortality of WLWH, using chi-squared tests. Proportional hazard models examined the association of birthplace with time from enrolment to AIDS and non-AIDS death. RESULTS Of the 628 FBW, 13% were born in Africa, 29% in the Caribbean and 49% in Latin America. We observed significant differences by HIV status in socio-demographic, clinical and immunological characteristics and mortality. For both AIDS and non-AIDS caused deaths FBW WLWH had lower rates of death. Adjusting for year of study enrolment and other demographic/clinical characteristics mitigated FBW's statistical survival advantage in AIDS deaths Relative Hazard (RH = 0.91 p = 0.53), but did not substantively change the survival advantage in non-AIDS deaths RH = 0.33, p < 0.0001). CONCLUSION Foreign-born WLWH exhibited demographic, clinical and immunological characteristics that are significantly different compared with women born in the US or US territory. After adjusting for these characteristics, the FB WLWH had a significantly lower hazard of non-AIDS but not AIDS mortality compared to women born in the US or a US territory. These findings of non-increased mortality can help inform models of care to optimize treatment outcomes among FBWLWH in the United States.
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Affiliation(s)
- Adebola Adedimeji
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNYUSA
| | - Qiuhu Shi
- Department of Epidemiology and Community HealthSchool of Health Sciences and PracticeNew York Medical CollegeValhallaNYUSA
| | - Lisa Haddad
- Department of Gynecology and ObstetricsEmory University School of MedicineAtlantaGAUSA
| | - Susan Holman
- State University of New YorkDownstate Medical CenterBrooklynNYUSA
| | - Andrew Edmonds
- Department of EpidemiologyThe University of North Carolina at Chapel HillNCUSA
| | | | - Seble Kassaye
- Department of Infectious DiseasesGeorgetown UniversityWashingtonDCUSA
| | - Roksana Karim
- Division of Disease Prevention, Policy and Global HealthKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
| | | | - Michael Reid
- Institute of Global Health SciencesDivision of HIV, Infectious Disease and Global MedicineUniversity of California at San FranciscoCAUSA
| | - Mirjam‐Colette Kempf
- Schools of Nursing, Public Health and MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| | - Elizabeth Golub
- Department of EpidemiologyJohns Hopkins UniversityBaltimoreMDUSA
| | | | - Kathryn Anastos
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNYUSA
- Department of MedicineMontefiore Medical CenterBronxNYUSA
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Yamanis TJ, Zea MC, Ramé Montiel AK, Barker SL, Díaz-Ramirez MJ, Page KR, Martinez O, Rathod J. Immigration Legal Services as a Structural HIV Intervention for Latinx Sexual and Gender Minorities. J Immigr Minor Health 2019; 21:1365-1372. [PMID: 30465116 PMCID: PMC6551294 DOI: 10.1007/s10903-018-0838-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Lack of legal immigration status is associated with poor HIV-related outcomes for immigrant Latinx sexual and gender minorities (LSGM). LSGM often meet eligibility criteria for legal immigration relief. A Medical-Legal Partnership (MLP) may thus be strategic to improve their health. We know little about the challenges LSGM face during the immigration legal process. We conducted in-depth interviews with six key informants and sixteen LSGM who recently applied for immigration legal relief. We coded and analyzed the data for emergent themes. Challenges to instituting an MLP for LSGM included lack of specialized training on working with SGM for immigration attorneys, and for clients: knowledge about legal deadlines, lack of housing and family support, and re-traumatizing experiences. Clients' outcomes were positive when attorneys and mental health providers collaborated. For LSGM, the benefits of immigration relief included reduced HIV risk. An MLP that addresses the surmountable challenges could improve HIV-related outcomes among LSGM.
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Affiliation(s)
- Thespina J Yamanis
- School of International Service, American University, 4400 Massachusetts Ave NW, Washington, DC, 20016, USA.
| | - Maria Cecilia Zea
- Department of Psychology, The George Washington University, Washington, DC, USA
| | - Ana Karen Ramé Montiel
- School of International Service, American University, 4400 Massachusetts Ave NW, Washington, DC, 20016, USA
| | - Suyanna L Barker
- Health Equity and Community Action Department, La Clínica del Pueblo, Washington, DC, USA
| | - Manuel J Díaz-Ramirez
- Health Equity and Community Action Department, La Clínica del Pueblo, Washington, DC, USA
| | - Kathleen R Page
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Omar Martinez
- College of Public Health, Temple University, Philadelphia, PA, USA
| | - Jayesh Rathod
- Washington College of Law, American University, Washington, DC, USA
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Martinez O. HIV-related Stigma as a Determinant of Health Among Sexual and Gender Minority Latinxs. HIV SPECIALIST 2019; 11:14-17. [PMID: 31396600 PMCID: PMC6687337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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De Jesus M, Williams DR. The Care and Prevention in the United States Demonstration Project: A Call for More Focus on the Social Determinants of HIV/AIDS. Public Health Rep 2019; 133:28S-33S. [PMID: 30457952 DOI: 10.1177/0033354918801353] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Maria De Jesus
- 1 School of International Service and Center on Health, Risk, and Society, American University, Washington, DC, USA
| | - David R Williams
- 2 Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,3 Department of African and African American Studies, Harvard University, Cambridge, MA, USA
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Magno L, Silva LAVD, Veras MA, Pereira-Santos M, Dourado I. Stigma and discrimination related to gender identity and vulnerability to HIV/AIDS among transgender women: a systematic review. CAD SAUDE PUBLICA 2019; 35:e00112718. [PMID: 30994744 DOI: 10.1590/0102-311x00112718] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 01/28/2019] [Indexed: 01/09/2023] Open
Abstract
HIV prevalence among transgender women is disproportional when compared to the general population in various countries. Stigma and discrimination based on gender identity have frequently been associated with vulnerability to HIV/AIDS. The objective was to conduct a systematic literature review to analyze the relationship between stigma and discrimination related to gender identity in transgender women and vulnerability to HIV/AIDS. This systematic literature review involved the stages of identification, compilation, analysis, and interpretation of results of studies found in five databases: PubMed, Scopus, Web of Science, Science Direct, and LILACS. No publication time period was determined in advance for this review. The studies were assessed according to the inclusion and exclusion criteria. The review included articles in English, Portuguese, or Spanish that related stigma and discrimination to transgender women's vulnerability to HIV. We found 41 studies, mostly qualitative, published from 2004 to 2018, and categorized in three dimensions of stigma: individual, interpersonal, and structural. The data highlighted that the effects of stigma related to gender identity, such as violence, discrimination, and transphobia, are structuring elements in transgender women's vulnerability to HIV/AIDS. The studies showed a relationship between stigma and discrimination and transgender women's vulnerability to HIV/AIDS and indicated the need for public policies to fight discrimination in society.
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Affiliation(s)
- Laio Magno
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, Brasil.,Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
| | | | - Maria Amélia Veras
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brasil
| | - Marcos Pereira-Santos
- Centro de Ciências Biológicas e da Saúde, Universidade Federal do Oeste da Bahia, Barreiras, Brasil
| | - Ines Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
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Yamanis T, Malik M, Del Río-González AM, Wirtz AL, Cooney E, Lujan M, Corado R, Poteat T. Legal Immigration Status is Associated with Depressive Symptoms among Latina Transgender Women in Washington, DC. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1246. [PMID: 29895781 PMCID: PMC6025023 DOI: 10.3390/ijerph15061246] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 05/30/2018] [Accepted: 06/08/2018] [Indexed: 11/24/2022]
Abstract
Latina transgender women (LTW) are disproportionately vulnerable to depression, although the role of immigration/documentation status (legal authority to live/work in the U.S.) in depression has not been explored. LTW in Washington, DC were recruited into a cross-sectional study via convenience sampling. Most were Spanish-speaking Central American immigrants. Participants completed rapid HIV tests, and a Spanish-language survey assessing recent depressive symptoms (PHQ-2), sociodemographics, and factors from the minority stress framework: structural stressors (documentation status, stable housing), social stressors (discrimination, fear of deportation, violence) and coping resources (social support, resilience). Among immigrant LTW (n = 38), 24 were undocumented. Among the undocumented, the average PHQ-2 score was 2.7, and among the documented, the average PHQ-2 score was 1.4 (p < 0.05). Undocumented LTW were significantly more likely to experience employment discrimination, recent unstable housing, and fear of deportation. Bivariate and multiple linear regressions were performed to assess the relationship between documentation status and other correlates of past two week depressive symptoms. In multivariate analysis, PHQ-2 scores were inversely associated with being documented (p < 0.01), having an income above the federal poverty level, higher friends' social support, and increased resiliency. Documentation status is an important correlate of depressive symptoms among LTW that should be considered within the context of health interventions.
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Affiliation(s)
- Thespina Yamanis
- School of International Service, American University, 4400 Massachusetts Ave NW, Washington, DC 20016, USA.
| | - Mannat Malik
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
| | | | - Andrea L Wirtz
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
| | - Erin Cooney
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
| | - Maren Lujan
- School of International Service, American University, 4400 Massachusetts Ave NW, Washington, DC 20016, USA.
| | - Ruby Corado
- Casa Ruby, 7530 Georgia Ave NW, Washington, DC 20012, USA.
| | - Tonia Poteat
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
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Magno L, Dourado I, Silva LAVD. Estigma e resistência entre travestis e mulheres transexuais em Salvador, Bahia, Brasil. CAD SAUDE PUBLICA 2018; 34:e00135917. [DOI: 10.1590/0102-311x00135917] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 12/07/2017] [Indexed: 01/26/2023] Open
Abstract
Resumo: Trata-se de um estudo qualitativo, com base na análise de narrativas produzidas por travestis e mulheres transexuais em Salvador, Bahia, Brasil, com o objetivo de analisar suas experiências de estigmatização, descrevendo acontecimentos, atores e contextos que marcam as suas trajetórias de vida, e também compreender a relação entre o estigma e suas performances femininas. As narrativas são provenientes de 19 entrevistas em profundidade realizadas ao longo de um inquérito epidemiológico. Foram orientadas por um roteiro prévio que explorou a produção de narrativas sobre as experiências e modos de vida das travestis e mulheres transexuais na cidade de Salvador. As histórias de vida que emergiram do campo foram transcritas e analisadas sob uma perspectiva teórico-narrativa. Observou-se que muitas travestis e mulheres transexuais apresentaram em suas narrativas a descrição de uma performance de gênero “afeminada”, que é identificada desde à infância por membros da família e da comunidade. Essa performance é apresentada como uma insubordinação ao poder estabelecido pelo sistema jurídico da sociedade heteronormativa. O processo de estigmatização começa a operar quando as expectativas sociais sobre a coerência entre “sexo biológico” e “performance de gênero” são frustradas nas interações sociais, submetendo as pessoas à discriminação e violência. Desse modo, o processo de estigmatização é operado por meio do poder exercido pelas leis da heterossexualidade compulsória sobre os corpos. Entretanto, durante as trajetórias de vida das travestis e mulheres transexuais, estratégias de resistência contra o estigma são produzidas com o potencial de transformação dos quadros estabelecidos.
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Affiliation(s)
- Laio Magno
- Universidade do Estado da Bahia, Brazil; Universidade Federal da Bahia, Brazil
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Magno L, Dourado I, da Silva LAV, Brignol S, Amorim L, MacCarthy S. Gender-based discrimination and unprotected receptive anal intercourse among transgender women in Brazil: A mixed methods study. PLoS One 2018; 13:e0194306. [PMID: 29641528 PMCID: PMC5894986 DOI: 10.1371/journal.pone.0194306] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 02/16/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Discrimination related to gender identity may directly influence vulnerability to HIV through increased exposure to unprotected receptive anal intercourse (URAI). Little is known about the relationship between gender-based discrimination (GBD) and URAI with stable partners among transgender women. METHODS This mixed-methods research began with a cross-sectional survey conducted between 2014 and 2016 with transgender women in Salvador, the capital city in one of the poorest regions in Brazil. Respondent-driven sampling was used to recruit the study population. GBD was defined through Latent Class Analysis. Additionally, 19 semi-structured interviews with participants were transcribed and analyzed through thematic content analysis. RESULTS URAI with stable partners was commonly reported (37.3%). GDB was positively associated with URAI among stable partners (OR = 6.47; IC 95%: 1.67-25.02). The analysis of the interviews illustrated how GBD impacted transgender women in diverse ways. Experiences with GBD perpetrated by the family often initiated a trajectory of economic vulnerability that led many to engage in survival sex work. The constant experience with GBD contributed to participants feeling an immense sense of trust with their stable partners, ultimately diminished their desire to use condoms. Further, the high frequency of GBD contributed to poor mental health overall, though some participants said engagement in transgender advocacy efforts provided a vital source of resilience and support. CONCLUSION Our mixed-method study capitalizes upon the strengths of diverse data sets to produce a holistic understanding of GBD and URAI with stable partners. Furthermore, by confirming the association between greater GBD and URAI, we have demonstrated how GBD can impact condom negotiation in diverse relationships.
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Affiliation(s)
- Laio Magno
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, Bahia, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Luís Augusto V. da Silva
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Instituto de Humanidades, Artes & Ciências Professor Milton Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Sandra Brignol
- Instituto de Saúde Coletiva, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
| | - Leila Amorim
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Instituto de Matemática e Estatística, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Sarah MacCarthy
- Rand Corporation, Santa Monica, California, United States of America
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Understanding and Addressing Human Immunodeficiency Virus and Sexually Transmitted Disease Disparities among Transgender Persons. Sex Transm Dis 2018; 43:412-3. [PMID: 27322039 DOI: 10.1097/olq.0000000000000485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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34
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Keuroghlian AS, McDowell MJ, Stern TA. Providing Care for Lesbian, Gay, Bisexual, and Transgender Immigrants at Health Centers and Clinics. PSYCHOSOMATICS 2018; 59:193-198. [DOI: 10.1016/j.psym.2017.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/08/2017] [Accepted: 10/17/2017] [Indexed: 10/18/2022]
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35
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High Stakes for the Health of Sexual and Gender Minority Patients of Color. J Gen Intern Med 2017; 32:1390-1395. [PMID: 28798997 PMCID: PMC5698216 DOI: 10.1007/s11606-017-4138-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 05/09/2017] [Accepted: 07/07/2017] [Indexed: 12/19/2022]
Abstract
As clinicians, educators, and researchers, our ability to provide the best possible care to our patients who are sexual and gender minority (SGM) people of color is increasingly challenged. Relative to the general population, SGM patients often have worse health outcomes, and among SGM patients, racial and ethnic minorities are particularly vulnerable. Healthcare policies proposed by the current administration, along with an increasingly hostile and dangerous social climate, have the potential to seriously harm SGM patients of color. In this paper, we discuss these key policy issues impacting the health of SGM patients of color. We then suggest questions for clinicians to consider to help them decide which advocacy activities are right for them, recommending self-examination, skills development, and political action. We end by outlining concrete, actionable steps to advocate for SGM patients of color in patient care, healthcare organizations, medical education, research, and public policy.
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Abstract
PURPOSE OF REVIEW The current article reviews recent literature related to three groups whose health is affected by barriers to the healthcare system: refugee and immigrant populations; youth who are lesbian, gay, bisexual, transgender, queer, or questioning; and those with mental health problems. RECENT FINDINGS Refugee and immigrant populations are increasing worldwide, and recent work has focused on improving their access to mental, dental, and preventive care. Lesbian, gay, bisexual, transgender, queer, or questioning youth have unique healthcare needs but frequently lack a support system and may not be forthcoming about their sexuality or sex identity. A rising number of children are being diagnosed with mental health disorders, but due to multiple factors, youth are not receiving the care they need. SUMMARY Pediatric healthcare providers should be aware of the unique challenges faced by youth displaced from their country of origin, who are lesbian, gay, bisexual, or transgender or are questioning their sexuality or sex identity, and who struggle with mental health disorders. Toolkits, other educational resources, and novel technological advances can assist pediatricians in ensuring optimal health care of these at-risk groups.
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Page KR, Martinez O, Nieves-Lugo K, Zea MC, Grieb SD, Yamanis TJ, Spear K, Davis WW. Promoting Pre-exposure Prophylaxis to Prevent HIV Infections Among Sexual and Gender Minority Hispanics/Latinxs. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2017; 29:389-400. [PMID: 29068715 PMCID: PMC5765546 DOI: 10.1521/aeap.2017.29.5.389] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Sexual and gender minority Hispanics/Latinxs (henceforth: Latinxs) continue to be disproportionately impacted by HIV/AIDS in the U.S. Pre-exposure prophylaxis (PrEP) is a biomedical prevention approach which holds significant promise for at risk and vulnerable populations. We discuss barriers and facilitators to uptake of PrEP among sexual and gender minority Latinxs living in the U.S. through an ecosocial lens that takes into account structural, community, and individual contexts. The impact of immigration status on PrEP uptake emerges as a major and recurrent theme that must be understood and addressed by HIV prevention programs aiming to promote an inclusive strategy for sexual and gender minority Latinxs living in the U.S.
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Affiliation(s)
- Kathleen R Page
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Omar Martinez
- College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Karen Nieves-Lugo
- Department of Psychology, George Washington University, Washington, D.C
| | - Maria Cecilia Zea
- Department of Psychology, George Washington University, Washington, D.C
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Correlates of Sexual Risk among Recent Gay and Bisexual Immigrants from Western and Eastern Africa to the USA. J Urban Health 2017; 94:330-338. [PMID: 28258531 PMCID: PMC5481211 DOI: 10.1007/s11524-017-0135-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We examined correlates of sexual risk among gay and bisexual men, who recently migrated from western and eastern African countries to the USA and lived in New York City and who are HIV negative or of unknown status. These men migrate from countries where same-sex sexuality is socially rejected and mostly illegal contributing to the motivation to migrate. Their background might predispose these men to engagement in sexual risk practices, while they are not specifically addressed in HIV prevention programming. Participants (N = 62) reported in face-to-face interviews on pre- and postmigration experiences, psychosocial determinants of sexual risk, and current sexual practices. Operationalization of sexual risk was based on the number of men with whom they had condomless receptive and/or insertive anal sex. Over a third of the men reported always having used condoms in the past year; among the other men, sexual risk varied. Multivariate analyses showed that sexual risk was lower among men with a stronger motivation to avoid HIV infection and higher among men who currently engaged in transactional sex. Further analyses indicated that housing instability was independently associated with reduced motivation to avoid HIV infection and with engagement in transactional sex in the USA. In recent western and eastern African gay and bisexual immigrants to the USA, structural factors, including housing instability, are strongly associated with sexual risk.
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Hill BJ, Rosentel K, Bak T, Silverman M, Crosby R, Salazar L, Kipke M. Exploring Individual and Structural Factors Associated with Employment Among Young Transgender Women of Color Using a No-Cost Transgender Legal Resource Center. Transgend Health 2017; 2:29-34. [PMID: 28795154 PMCID: PMC5546788 DOI: 10.1089/trgh.2016.0034] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose: The purpose of this study was to explore individual and structural factors associated with employment among young transgender women (TW) of color. Methods: Sixty-five trans women of color were recruited from the Transgender Legal Defense and Education Fund to complete a 30-min interviewer-assisted survey assessing sociodemographics, housing, workplace discrimination, job-seeking self-efficacy, self-esteem, perceived public passability, and transactional sex work. Results: Logistic regression models revealed that stable housing (structural factor) and job-seeking self-efficacy (individual factor) were significantly associated with currently being employed. Conclusion: Our findings underscore the need for multilevel approaches to assist TW of color gain employment.
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Affiliation(s)
- Brandon J Hill
- Department of Obstetrics and Gynecology, Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3), The University of Chicago, Chicago, Illinois.,Section of Family Planning and Contraceptive Research, Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois.,The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana
| | - Kris Rosentel
- Department of Obstetrics and Gynecology, Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3), The University of Chicago, Chicago, Illinois.,School of Social Service Administration, University of Chicago, Chicago, Illinois
| | - Trevor Bak
- Department of Obstetrics and Gynecology, Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3), The University of Chicago, Chicago, Illinois
| | - Michael Silverman
- Transgender Legal Defense & Education Fund, Inc., New York, New York
| | - Richard Crosby
- The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana.,College of Public Health, University of Kentucky, Lexington, Kentucky
| | - Laura Salazar
- School of Public Health, Georgia State University, Atlanta, Georgia
| | - Michele Kipke
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
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