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Pignedoli C, Rivest P. The gender of PrEP: Transgender men negotiating legitimacy in France. Soc Sci Med 2024; 348:116842. [PMID: 38593613 DOI: 10.1016/j.socscimed.2024.116842] [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: 08/31/2023] [Revised: 01/05/2024] [Accepted: 03/26/2024] [Indexed: 04/11/2024]
Abstract
Transmasculine people (TM) constitute an invisibilized group within the transgender population. Little is known about their relationship to sexuality in transgender medicine. Their presence and needs are still unacknowledged within HIV prevention research and services. Pre-exposure prophylaxis (or PrEP) is an oral medication that prevents HIV in HIV-negative individuals at risk of infection with the virus. This paper proposes to bring TM back into the focus of PrEP research by questioning how they navigate and situate themselves in relation to existing PrEP categorization and services, and how they think about and (re)shape the meanings of PrEP. It is based on the "interpretative descriptive" method and a transfeminist theoretical framework applied to the analysis of ten semi-structured interviews with TM conducted in France between 2019 and 2023. Findings show that PrEP is gendered. We identify specific barriers to getting PrEP as well as to access healthcare and we show that a cisnormative and homonormative approach to prevention generates them. PrEP use and PrEP disclosure are embedded in structural and symbolic power relations between cisgender and transgender MSM that are reflected in the intimate sphere. TM use PrEP to prevent sexual assault and to alleviate the difficulty of condom negotiation. PrEP comes into play following major changes in TM's sexualities and is integrated post-exposure.
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Affiliation(s)
- Clark Pignedoli
- Université d'Aix-Marseille, SESSTIM - SanteRCom, Faculté de Médecine, 27 Bd Jean Moulin, 13385, Marseille, Cedex 5, France.
| | - Paul Rivest
- Université d'Aix-Marseille, Ideas, 5 rue du Château de l'Horloge, 13090, Aix-en-Provence, France.
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Lauckner C, Takenaka BP, Sesenu F, Brown JS, Kirklewski SJ, Nicholson E, Haney K, Adatorwovor R, Boyd DT, Fallin-Bennett K, Restar AJ, Kershaw T. Combined Motivational Interviewing and Ecological Momentary Intervention to Reduce Hazardous Alcohol Use Among Sexual Minority Cisgender Men and Transgender Individuals: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e55166. [PMID: 38578673 PMCID: PMC11031694 DOI: 10.2196/55166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/14/2024] [Accepted: 02/20/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Sexual minority cisgender men and transgender (SMMT) individuals, particularly emerging adults (aged 18-34 years), often report hazardous drinking. Given that alcohol use increases the likelihood of HIV risk behaviors, and HIV disproportionately affects SMMT individuals, there is a need to test interventions that reduce hazardous alcohol use and subsequent HIV risk behaviors among this population. Ecological momentary interventions (EMIs), which use mobile phones to deliver risk reduction messages based on current location and behaviors, can help to address triggers that lead to drinking in real time. OBJECTIVE This study will test an EMI that uses motivational interviewing (MI), smartphone surveys, mobile breathalyzers, and location tracking to provide real-time messaging that addresses triggers for drinking when SMMT individuals visit locations associated with hazardous alcohol use. In addition, the intervention will deliver harm reduction messaging if individuals report engaging in alcohol use. METHODS We will conduct a 3-arm randomized controlled trial (N=405 HIV-negative SMMT individuals; n=135, 33% per arm) comparing the following conditions: (1) Tracking and Reducing Alcohol Consumption (a smartphone-delivered 4-session MI intervention), (2) Tracking and Reducing Alcohol Consumption and Environmental Risk (an EMI combining MI with real-time messaging based on geographic locations that are triggers to drinking), and (3) a smartphone-based alcohol monitoring-only control group. Breathalyzer results and daily self-reports will be used to assess the primary and secondary outcomes of drinking days, drinks per drinking day, binge drinking episodes, and HIV risk behaviors. Additional assessments at baseline, 3 months, 6 months, and 9 months will evaluate exploratory long-term outcomes. RESULTS The study is part of a 5-year research project funded in August 2022 by the National Institute on Alcohol Abuse and Alcoholism. The first 1.5 years of the study will be dedicated to planning and development activities, including formative research, app design and testing, and message design and testing. The subsequent 3.5 years will see the study complete participant recruitment, data collection, analyses, report writing, and dissemination. We expect to complete all study data collection in or before January 2027. CONCLUSIONS This study will provide novel evidence about the relative efficacy of using a smartphone-delivered MI intervention and real-time messaging to address triggers for hazardous alcohol use and sexual risk behaviors. The EMI approach, which incorporates location-based preventive messaging and behavior surveys, may help to better understand the complexity of daily stressors among SMMT individuals and their impact on hazardous alcohol use and HIV risk behaviors. The tailoring of this intervention toward SMMT individuals helps to address their underrepresentation in existing alcohol use research and will be promising for informing where structural alcohol use prevention and treatment interventions are needed to support SMMT individuals. TRIAL REGISTRATION ClinicalTrials.gov NCT05576350; https://www.clinicaltrials.gov/study/NCT05576350. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/55166.
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Affiliation(s)
- Carolyn Lauckner
- Center for Health Equity Transformation, University of Kentucky, Lexington, KY, United States
| | - Bryce Puesta Takenaka
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States
| | - Fidelis Sesenu
- Center for Health Equity Transformation, University of Kentucky, Lexington, KY, United States
| | - Jaime S Brown
- Center for Health Equity Transformation, University of Kentucky, Lexington, KY, United States
| | - Sally J Kirklewski
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States
| | - Erin Nicholson
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States
| | - Kimberly Haney
- Center for Health Equity Transformation, University of Kentucky, Lexington, KY, United States
| | - Reuben Adatorwovor
- Department of Biostatistics, University of Kentucky, Lexington, KY, United States
| | - Donte T Boyd
- College of Social Work, The Ohio State University, Columbus, OH, United States
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, United States
| | - Keisa Fallin-Bennett
- Department of Family and Community Medicine, University of Kentucky, Lexington, KY, United States
| | - Arjee Javellana Restar
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States
- Department of Epidemiology, Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Trace Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States
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3
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Scheim AI, Rich AJ, Zubizarreta D, Malik M, Baker KE, Restar AJ, van der Merwe LA, Wang J, Beebe B, Ridgeway K, Baral SD, Poteat T, Reisner SL. Health status of transgender people globally: A systematic review of research on disease burden and correlates. PLoS One 2024; 19:e0299373. [PMID: 38466747 PMCID: PMC10927095 DOI: 10.1371/journal.pone.0299373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 02/08/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Transgender and gender diverse (trans) health research has grown rapidly, highlighting the need to characterize the scientific evidence base. We conducted a systematic review of peer-reviewed research on disease burden and correlates in trans adolescents and adults over a 20-month period to identify knowledge gaps and assess methodological characteristics including measurement of gender identity, community engagement, and study quality. DATA SOURCES, ELIGIBILITY CRITERIA, AND SYNTHESIS METHODS We searched seven databases using terms related to (a) transgender populations and (b) health or disease. Eligible studies were in English, French, or Spanish and reported original quantitative data on mental health or substance use conditions, infectious diseases, or non-communicable conditions in at least 25 trans individuals aged 15+. Quality assessment was performed in duplicate on a 10% sample of articles and findings were summarized using narrative synthesis. RESULTS The 328 included studies were conducted in 45 countries, with most from North America (54%) and limited research from South Asia (3%), Sub-Saharan Africa (3%), and the Middle East and North Africa (2%). Most studies used cross-sectional designs (73%) and convenience sampling (65%). Only 30% of studies reported any form of community engagement. Mental health and substance use disorders were the most studied area (77% of studies) and non-communicable conditions the least (16%). Available data indicated that trans populations experience high disease burden with considerable heterogeneity within and across settings. Of 39 articles assessed for quality, 80% were rated as fair, 18% as poor, and 3% as good quality. CONCLUSIONS AND IMPLICATIONS Geographic, gender-specific, and topical gaps remain in trans health, but we found more research from African countries, with transmasculine people, and on non-communicable conditions than previous syntheses. Areas for growth in trans health research include community engagement, non-binary health, chronic and age-related conditions, and health determinants. REGISTRATION PROSPERO CRD42021234043.
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Affiliation(s)
- Ayden I. Scheim
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, United States of America
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Ashleigh J. Rich
- Department of Social Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Dougie Zubizarreta
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Mannat Malik
- Department of Health Behaviour, Gillings School of Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Kellan E. Baker
- Whitman-Walker Institute, Washington, District of Columbia, United States of America
| | - Arjee J. Restar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Leigh Ann van der Merwe
- Social, Health and Empowerment Feminist Collective of Transgender Women of Africa (S.H.E.), East London, South Africa
| | - June Wang
- Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Bianca Beebe
- School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Kathleen Ridgeway
- School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Stefan D. Baral
- Department of Epidemiology, School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Tonia Poteat
- Department of Social Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Sari L. Reisner
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
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4
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Gordon AR, Roberts S, Silverstein S, Rose KL, Lopez E, Calzo JP. What is needed for eating disorder prevention for transgender and gender diverse young adults? Findings from asynchronous online focus groups. Body Image 2024; 48:101667. [PMID: 38101273 PMCID: PMC10922438 DOI: 10.1016/j.bodyim.2023.101667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 12/01/2023] [Accepted: 12/02/2023] [Indexed: 12/17/2023]
Abstract
Transgender and gender diverse (TGD) young adults face higher risk of eating disorder (ED) symptoms than cisgender peers. Evidence-based ED prevention programs exist but must be adapted to meet the needs of diverse TGD populations. We conducted eight asynchronous online focus groups in 2019 with 66 ethnically and gender diverse TGD young adults (18-30 years) living in the United States. Participants were recruited online; groups took place over four consecutive days. We conducted inductive thematic analysis of participant responses to three prompts about ED prevention needs and advice for program developers. Findings fell into three domains. In Domain 1: Developing Program Content, themes included (1.1) need to address multiple dimensions of gender; (1.2) intersectional representation matters; (1.3) limitations of ED research; (1.4) being responsive to trauma. Domain 2: Program Delivery Considerations, included preferences for (2.1) group composition, (2.2) intervention modality, and (2.3) program leadership. Domain 3: Cultivating Affirming Spaces included themes addressing the need for programs to (3.1) create judgment-free environments and (3.2) center lived experience. TGD young adults in this study described a range of needs and recommendations for ED prevention content and delivery, with relevance to clinicians, program designers, and ED prevention advocates.
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Affiliation(s)
- 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; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Savannah Roberts
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Kelsey L Rose
- Department of Nutrition and Food Sciences, University of Vermont, Burlington, VT, USA
| | | | - Jerel P Calzo
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA; School of Public Health, San Diego State University, San Diego, CA, USA; Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, CA, USA
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5
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Tran NK, Rosendale N, Lunn MR. Advancing Data Collection of Sexual Orientation and Gender Identity in Cardiology. JAMA Cardiol 2024; 9:206-208. [PMID: 38265839 DOI: 10.1001/jamacardio.2023.5264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Affiliation(s)
- Nguyen K Tran
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, California
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Nicole Rosendale
- Department of Neurology, University of California, San Francisco, San Francisco
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, California
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
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6
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Skinner SR, McLamore Q, Donaghy O, Stathis S, Moore JK, Nguyen T, Rayner C, Tait R, Anderson J, Pang KC. Recognizing and responding to misleading trans health research. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2024; 25:1-9. [PMID: 38328590 PMCID: PMC10846477 DOI: 10.1080/26895269.2024.2289318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Affiliation(s)
- S. Rachel Skinner
- Department of Adolescent Medicine, Children’s Hospital Westmead, Sydney Children’s Hospitals Network, Westmead, Australia
- Children’s Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, Australia
| | | | - Olivia Donaghy
- Child and Youth Mental Health Service, Children’s Health Queensland Hospital and Health Service, Brisbane, Australia
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Stephen Stathis
- Child and Youth Mental Health Service, Children’s Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Julia K. Moore
- Child and Adolescent Health Service Gender Diversity Service, Perth Children’s Hospital, Perth, Australia
- School of Psychiatry and School of Paediatrics and Child Health, The University of Western Australia, Nedlands, Australia
| | - Tram Nguyen
- Department of Adolescent Medicine, The Royal Children’s Hospital, Parkville, Australia
| | - Cate Rayner
- Department of Adolescent Medicine, The Royal Children’s Hospital, Parkville, Australia
| | - Robert Tait
- Maple Leaf House, John Hunter Children’s Hospital, Newcastle, Australia
| | | | - Ken C. Pang
- Department of Adolescent Medicine, The Royal Children’s Hospital, Parkville, Australia
- Murdoch Children’s Research Institute, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
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7
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Thompson HM, Wang TM, Talan AJ, Baker KE, Restar AJ. First They Came for Us All: Responding to Anti-Transgender Structural Violence With Collective, Community-Engaged, and Intersectional Health Equity Research and Advocacy. HEALTH EDUCATION & BEHAVIOR 2024; 51:5-9. [PMID: 37746726 DOI: 10.1177/10901981231201146] [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: 09/26/2023]
Abstract
This article is a call for collective action across health equity researchers and advocates to build a more just world. We attempt to make sense of senseless structural and interpersonal brutality in the context of the current political climate across the United States, whereby the spectrum of gender nonconformity has been and continues to be stigmatized. From drag performance to transgender identities to gender-affirming health care, extremists have instrumentalized primary levers of democracy-the courts, legislatures, and social media-to attempt to outlaw and eradicate gender expansiveness and those who provide forms of support and care, including gender-affirming medical care, to transgender, nonbinary, and gender-expansive (TNBGE) individuals.
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Affiliation(s)
| | | | - Ali J Talan
- Whitman-Walker Institute, Washington, DC, USA
| | | | - Arjee J Restar
- School of Public Health, University of Washington, Seattle, WA, USA
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8
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Morgan LL. Consideration of Gender on Hormone Therapy Management. Nurs Clin North Am 2023; 58:627-637. [PMID: 37833004 DOI: 10.1016/j.cnur.2023.06.006] [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: 10/15/2023]
Abstract
Hormone therapy is a common treatment method for adult males, females, and transgender and gender-diverse individuals. Both men, women, and transgender and gender-diverse people may use hormone therapy at some point in their lives. There are notable differences and similarities in risk factors related to hormone therapy use based on genetics, sex, gender, personal history, and the type of hormone therapy used. Provider awareness in gender-inclusive hormone therapy management with the consideration of nonmodifiable and modifiable risk factors, prevention of complications, and monitoring parameters is essential in clinical practice.
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Affiliation(s)
- Lindsay L Morgan
- University of Wisconsin Oshkosh, College of Nursing, 800 Algoma Boulevard, Oshkosh, WI 54901, USA.
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9
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Abesamis LEA. Contending with precarity: Digital pathways to sexual and reproductive healthcare among transgender Filipinos during the COVID-19 pandemic. Soc Sci Med 2023; 336:116284. [PMID: 37820496 DOI: 10.1016/j.socscimed.2023.116284] [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: 04/06/2023] [Revised: 08/17/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023]
Abstract
Stringent lockdowns during the COVID-19 pandemic and the cisnormative framing of sexual and reproductive health (SRH) in the Philippines cultivated precarious access to SRH systems among transgender (trans) communities during the public health crisis. With the shift toward digital health initiatives, this study aimed to explore the experiences of the local trans community in using digital health initiatives (DHIs) to access SRH care and gender-affirming services, information, and providers during the COVID-19 pandemic. Online interviews with 13 self-identified trans Filipinos living in the Philippines during the pandemic were conducted and analyzed using interpretative phenomenological analysis. First, the narratives of trans Filipinos illustrate how DHIs can address discontinuities of care that emerged during the COVID-19 pandemic. However, because of long-standing geographic, economic, and social barriers to trans-responsive healthcare in the Philippines, local trans communities navigate alternative pathways to care established within digital spaces (e.g., social media) by trans individuals and groups. These online communities of care not only connect trans Filipinos to culturally competent and affordable care but also foster a sense of belongingness and support. Taken together, this study underscores the need to go beyond technical access to care to ensure that trans-inclusive and trans-responsive sources and providers of care are made available throughout the healthcare system. As the narratives of trans Filipinos illustrate, the narratives, experiences, and practices within their online communities of care may be the key to actualizing such a healthcare system not only in the Philippines but all over the world.
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Affiliation(s)
- Luis Emmanuel A Abesamis
- Department of Sociology and Behavioral Sciences, De La Salle University Manila, Manila, Philippines; Department of Behavioral Sciences, University of the Philippines Manila, Manila, Philippines.
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10
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Babu TM, Wald A, Restar AJ. Health equity necessitates the inclusion of gender identity data in COVID-19 clinical trials. Ann Epidemiol 2023; 85:3-5. [PMID: 37391114 PMCID: PMC10303319 DOI: 10.1016/j.annepidem.2023.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/14/2023] [Accepted: 06/26/2023] [Indexed: 07/02/2023]
Abstract
COVID-19 has highlighted the importance of studying differences by sex and gender. The under-reporting of gender identity in COVID-19 studies limits the generalizability of study results to nonbinary persons. Some of the data on sex-assigned associated complications of both COVID-19 infection and COVID-19 immunizations is presented in this manuscript.
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Affiliation(s)
- Tara M Babu
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle; Department of Behavioral and Social Sciences, Yale University School of Public Health, New Haven, CT.
| | - Anna Wald
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle; Department of Laboratory Medicine and Pathology, University of Washington, Seattle; Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology, School of Public Health, University of Washington, Seattle; Department of Behavioral and Social Sciences, Yale University School of Public Health, New Haven, CT
| | - Arjee J Restar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle; Department of Behavioral and Social Sciences, Yale University School of Public Health, New Haven, CT
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11
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Streed CG, Lett E, Restar A. Assessing the Health Status of Sexual and Gender Minority Adults: What We Can Learn When We Include All of Us. JAMA Netw Open 2023; 6:e2324948. [PMID: 37523189 DOI: 10.1001/jamanetworkopen.2023.24948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Affiliation(s)
- Carl G Streed
- Department of Medicine, Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- GenderCare Center, Boston Medical Center, Boston, Massachusetts
| | - Elle Lett
- Center for Applied Transgender Studies, Chicago, Illinois
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Arjee Restar
- Departments of Epidemiology and Health Systems Population Health, University of Washington School of Public Health, Seattle
- Department of Social and Behavioral Sciences, Yale University, New Haven, Connecticut
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12
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Restar A, Minalga BJ, Quilantang MI, Adamson T, Dusic E, van der Merwe LA, Millet G, Rosadiño D, Laguing T, Lett E, Everhart A, Phillips G, Janamnuaysook R, Seekaew P, Baker K, Ashley F, Wickersham J, Wallace SE, Operario D, Gamarel KE. Mapping Community-Engaged Implementation Strategies with Transgender Scientists, Stakeholders, and Trans-Led Community Organizations. Curr HIV/AIDS Rep 2023; 20:160-169. [PMID: 37012537 PMCID: PMC10071255 DOI: 10.1007/s11904-023-00656-y] [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] [Accepted: 03/07/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE OF REVIEW Pre-exposure prophylaxis (PrEP) represents one of the most effective methods of prevention for HIV, but remains inequitable, leaving many transgender and nonbinary (trans) individuals unable to benefit from this resource. Deploying community-engaged PrEP implementation strategies for trans populations will be crucial for ending the HIV epidemic. RECENT FINDINGS While most PrEP studies have progressed in addressing pertinent research questions about gender-affirming care and PrEP at the biomedical and clinical levels, research on how to best implement gender-affirming PrEP systems at the social, community, and structural levels remains outstanding. The science of community-engaged implementation to build gender-affirming PrEP systems must be more fully developed. Most published PrEP studies with trans people report on outcomes rather than processes, leaving out important lessons learned about how to design, integrate, and implement PrEP in tandem with gender-affirming care. The expertise of trans scientists, stakeholders, and trans-led community organizations is essential to building gender-affirming PrEP systems.
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Affiliation(s)
- Arjee Restar
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA.
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA.
| | | | - Ma Irene Quilantang
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Tyler Adamson
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emerson Dusic
- Department of Biostatistics, University of Washington School of Public Health, Seattle, WA, USA
| | - Leigh-Ann van der Merwe
- Social, Health and Empowerment Feminist Collective of Transgender Women of Africa, East London, South Africa
| | - Greg Millet
- The Foundation for AIDS Research, amfAR, amfAR, Washington, D.C, USA
| | | | - Tanya Laguing
- LoveYourself Inc, Manila, Philippines
- DIOSSA Inc, Taguig, Philippines
| | - Elle Lett
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, USA
| | - Avery Everhart
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Gregory Phillips
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rena Janamnuaysook
- Institute of HIV Research and Innovation, Bangkok, Thailand
- Tangerine Community Health Clinic, Bangkok, Thailand
| | - Pich Seekaew
- Institute of HIV Research and Innovation, Bangkok, Thailand
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Kellan Baker
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Whitman-Walker Institute, Washington, D.C, USA
| | - Florence Ashley
- Faculty of Law and Joint Centre for Bioethics, University of Toronto, Toronto, ON, Canada
| | - Jeffrey Wickersham
- Section of Infectious Disease, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Stephaun E Wallace
- Fred Hutchinson Cancer Center, Seattle, WA, USA
- Global Health, University of Washington, Seattle, WA, USA
| | - Don Operario
- Department of Behavioral, Social, and Health Education Sciences, Emory Rollins School of Public Health, Atlanta, GA, USA
| | - Kristi E Gamarel
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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13
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Lett E, Ivory JM, Roberson ML. Envisioning trans-inclusive and trans-specific cancer care. Nat Rev Clin Oncol 2023; 20:351-352. [PMID: 37046009 DOI: 10.1038/s41571-023-00764-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Affiliation(s)
- Elle Lett
- Center for Applied Transgender Studies, Chicago, IL, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joannie M Ivory
- Division of Hematology & Oncology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mya L Roberson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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King WM, Gamarel KE, Iwamoto M, Suico S, Nemoto T, Operario D. Structural Needs, Substance Use, and Mental Health Among Transgender and Nonbinary Young Adults in the San Francisco Bay Area: Findings from the Phoenix Study. J Urban Health 2023; 100:190-203. [PMID: 36595118 PMCID: PMC9918689 DOI: 10.1007/s11524-022-00700-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 01/04/2023]
Abstract
Transgender and nonbinary (trans) young adults report high rates of substance use and adverse mental health outcomes; however, few studies have examined how social, economic, and legal factors may contribute to health inequities in this population. Guided by the structural vulnerability framework, this study sought to explore structural needs and whether these needs were associated with substance use and mental health outcomes among trans young adults. Between 2019 and 2021, 215 trans young adults aged 18-29 from San Francisco Bay Area were recruited into a longitudinal study. Baseline data were used to examine bivariate and multivariable associations between structural needs and substance use and mental health outcomes. There were bivariate differences in the number of structural needs by education, income source, incarceration history, and ethnicity, and the number of unmet structural needs was associated with education and income source. After adjusting for sociodemographics, the number of structural needs was associated with daily marijuana use (AOR 1.29, 95% CI: 1.10-1.49) and suicidal ideation (AOR 1.24, 95% CI: 1.06-1.45), and the number of unmet structural needs was associated with daily marijuana use (AOR 1.30, 95% CI: 1. 10-1.55) and depressive symptoms (β 2.00, 95% CI: 1.00-3.00). Additionally, both numbers of structural needs and unmet structural needs mediated the relationship between income source (traditional employment vs. other income only) and depressive symptoms (TIE β 2.51, 95% CI: 0.99-4.04; β 1.37, 95% CI: 0.23-2.52, respectively). Findings highlight a need for multisector efforts to address structural vulnerabilities among trans young adults.
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Affiliation(s)
- Wesley M King
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
| | - Kristi E Gamarel
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | | | | | - Don Operario
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, GA, USA
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15
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Hughto JMW, Varma H, Babbs G, Yee K, Alpert A, Hughes L, Ellison J, Downing J, Shireman TI. Disparities in health condition diagnoses among aging transgender and cisgender medicare beneficiaries, 2008-2017. Front Endocrinol (Lausanne) 2023; 14:1102348. [PMID: 36992801 PMCID: PMC10040837 DOI: 10.3389/fendo.2023.1102348] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/21/2023] [Indexed: 03/14/2023] Open
Abstract
INTRODUCTION The objective of this research is to provide national estimates of the prevalence of health condition diagnoses among age-entitled transgender and cisgender Medicare beneficiaries. Quantification of the health burden across sex assigned at birth and gender can inform prevention, research, and allocation of funding for modifiable risk factors. METHODS Using 2009-2017 Medicare fee-for-service data, we implemented an algorithm that leverages diagnosis, procedure, and pharmacy claims to identify age-entitled transgender Medicare beneficiaries and stratify the sample by inferred gender: trans feminine and nonbinary (TFN), trans masculine and nonbinary (TMN), and unclassified. We selected a 5% random sample of cisgender individuals for comparison. We descriptively analyzed (means and frequencies) demographic characteristics (age, race/ethnicity, US census region, months of enrollment) and used chi-square and t-tests to determine between- (transgender vs. cisgender) and within-group gender differences (e.g., TMN, TFN, unclassified) difference in demographics (p<0.05). We then used logistic regression to estimate and examine within- and between-group gender differences in the predicted probability of 25 health conditions, controlling for age, race/ethnicity, enrollment length, and census region. RESULTS The analytic sample included 9,975 transgender (TFN n=4,198; TMN n=2,762; unclassified n=3,015) and 2,961,636 cisgender (male n=1,294,690, female n=1,666,946) beneficiaries. The majority of the transgender and cisgender samples were between the ages of 65 and 69 and White, non-Hispanic. The largest proportion of transgender and cisgender beneficiaries were from the South. On average, transgender individuals had more months of enrollment than cisgender individuals. In adjusted models, aging TFN or TMN Medicare beneficiaries had the highest probability of each of the 25 health diagnoses studied relative to cisgender males or females. TFN beneficiaries had the highest burden of health diagnoses relative to all other groups. DISCUSSION These findings document disparities in key health condition diagnoses among transgender Medicare beneficiaries relative to cisgender individuals. Future application of these methods will enable the study of rare and anatomy-specific conditions among hard-to-reach aging transgender populations and inform interventions and policies to address documented disparities.
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Affiliation(s)
- Jaclyn M. W. Hughto
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, United States
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, United States
- The Fenway Institute, Fenway Health, Boston, MA, United States
- *Correspondence: Jaclyn M. W. Hughto,
| | - Hiren Varma
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, United States
- Department of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, United States
| | - Gray Babbs
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, United States
- Department of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, United States
| | - Kim Yee
- Oregon Health & Science University - Portland State University School of Public Health, Portland, OR, United States
| | - Ash Alpert
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, United States
- Department of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, United States
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Landon Hughes
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States
- Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
| | - Jacqueline Ellison
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, PA, United States
- Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh Department of Medicine, Pittsburgh, PA, United States
| | - Jae Downing
- Oregon Health & Science University - Portland State University School of Public Health, Portland, OR, United States
| | - Theresa I. Shireman
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, United States
- Department of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, United States
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16
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Adamson T, Lett E, Glick J, Garrison-Desany HM, Restar A. Experiences of violence and discrimination among LGBTQ+ individuals during the COVID-19 pandemic: a global cross-sectional analysis. BMJ Glob Health 2022; 7:bmjgh-2022-009400. [PMID: 36130772 PMCID: PMC9494011 DOI: 10.1136/bmjgh-2022-009400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives To characterise the extent to which the levels of violence and discrimination against lesbian, gay, bisexual, transgender and queer (LGBTQ+) people have changed amid COVID-19. Design Cross-sectional, secondary analysis. Setting 79 countries. Participants All adults (aged ≥18 years) who used the Hornet social networking application and provided consent to participate. Main outcome measure The main outcome was whether individuals have experienced less, or the same or more levels of discrimination and violence from specific groups (eg, police and/or military, government representatives, healthcare providers). Results 7758 LGBTQ+ individuals provided responses regarding levels of discrimination and violence. A majority identified as gay (78.95%) and cisgender (94.8%). Identifying as gay or queer was associated with increased odds of experiencing the same or more discrimination from government representatives (OR=1.89, 95% CI 1.04 to 3.45, p=0.045) and healthcare providers (OR=2.51, 95% CI 0.86 to 7.36, p=0.002) due to COVID-19. Being a member of an ethnic minority was associated with increased odds of discrimination and violence from police and/or military (OR=1.32, 95% CI 1.13 to 1.54, p=0.0) and government representatives (OR=1.47, 95% CI 1.29 to 1.69, p=0.0) since COVID-19. Having a disability was significantly associated with increased odds of violence and discrimination from police and/or military (OR=1.38, 95% CI 1.15 to 1.71, p=0.0) and healthcare providers (OR=1.35, 95% CI 1.07 to 1.71, p=0.009). Conclusions Our results suggest that despite the upending nature of the COVID-19 pandemic, around the world, government representatives, policymakers and healthcare providers continue to perpetuate systemic discrimination and fail to prevent violence against members of the LGBTQ+ community.
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Affiliation(s)
- Tyler Adamson
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elle Lett
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Applied Transgender Studies, Chicago, Illinois, USA
| | - Jennifer Glick
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Henri M Garrison-Desany
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Arjee Restar
- Center for Applied Transgender Studies, Chicago, Illinois, USA.,Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
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Salas-Hernández L, DeVylder JE, Cooper HLF, Duarte CDP, Sewell AA, Walker ER, Haardörfer R. Latent Class Profiles of Police Violence Exposure in 4 US Cities and Their Associations with Anticipation of Police Violence and Mental Health Outcomes. J Urban Health 2022; 99:655-668. [PMID: 35668136 PMCID: PMC9360379 DOI: 10.1007/s11524-022-00643-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 01/31/2023]
Abstract
While studying polyvictimization is well established within the broader violence literature and applied to other types of violence, it has yet to be documented whether polyvictimization also presents in patterns of police violence exposure (i.e., neglectful, psychological, physical, and sexual police violence). Our objective was to analyze latent patterns of co-occurring police contact and their associations with mental health. By applying latent class analysis (LCA) methods to the 2016 and 2017 Surveys of Police-Public Encounters (N = 2615), conducted in 4 Northeastern US cities, we identified classes of direct and vicarious police violence and compared sociodemographic characteristics among classes using multinomial regression. Classes were regressed on mental health outcomes. LCA identified four classes of police contact. Compared to Positive Police Contact (33.0%) class members, members of the (a) Extreme Police Violence (4.0%) class reported higher anticipation of future police victimization, psychological distress, and suicide ideations and attempts; they were more likely to be Black, cisgender men, and Latinx; (b) members of the High Police Violence (23.6%) class reported higher anticipation of future police victimization and psychological distress; they were more likely to be Black, Native American, and multiracial; members of the (c) Low Police Contact (39.5%) class had comparable mental health outcomes; they were more likely to report a household income < $19,999. Notably, no participants were unexposed to police contact. Polyvictimization presents in experiences of police violence and disproportionately impacts structurally marginalized people.
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Affiliation(s)
| | - Jordan E DeVylder
- Graduate School of Social Work, Fordham University, New York, NY, USA
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18
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Yee K, Lind BK, Downing J. Change in Gender on Record and Transgender Adults' Mental or Behavioral Health. Am J Prev Med 2022; 62:696-704. [PMID: 34920916 PMCID: PMC9035075 DOI: 10.1016/j.amepre.2021.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/30/2021] [Accepted: 10/18/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Within gender-diverse populations, gender-affirming changes in gender on record may improve mental or behavioral health. This study uses claims data to investigate whether sex assigned at birth modifies the association between change in gender on record and mental or behavioral health. METHODS Adult Oregon Medicaid beneficiaries with gender identity-related diagnoses and enrolled during 2010-2019 were included. Sex assigned at birth was inferred from medical and pharmacy claims and was categorized as assigned female, assigned male, or unknown sex assigned at birth. Self-reported gender ascertained at initial enrollment differing from sex assigned at birth indicated a change in gender on record. Multivariable logistic regression estimated the association between change in gender on record and mental (anxiety, depression, suicidal ideation, post-traumatic stress disorder) or behavioral (alcohol, substance, or tobacco use disorders) health. Analyses were conducted in February 2021. RESULTS This study included 2,940 transgender and nonbinary adults. Of the 1,451 self-reporting female gender and 1,489 self-reporting male gender, 449 (30.9%) were assigned male at birth, and 303 (20.3%) were assigned female at birth, classified as changing their gender on record. Predicted probability of mental or behavioral conditions was significantly lower in those who changed their gender on record. Sex assigned at birth modified the association with mental health: assigned female at birth reporting female gender had the highest burdens, followed by assigned male at birth reporting male. Secondary analyses using a modified change in gender definition or alternative sex assigned at birth inference method found similar trends. CONCLUSIONS Oregon Medicaid gender-diverse beneficiaries who changed their gender on record had a meaningfully lower probability of mental and behavioral health conditions. Those assigned female at birth reporting female gender had the highest burdens.
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Affiliation(s)
- Kimberly Yee
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon.
| | - Bonnie K Lind
- Center for Health Systems Effectiveness, Oregon Health and & Science University, Portland, Oregon
| | - Jae Downing
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon
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19
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Sherwood J, Lankiewicz E, Castellanos E, O'Connor N, Theron L, Restar A. Assessing inclusion of trans people in HIV national strategic plans: a review of 60 high HIV prevalence countries. J Int AIDS Soc 2021; 24:e25837. [PMID: 34761871 PMCID: PMC8582022 DOI: 10.1002/jia2.25837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/13/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Trans people are disproportionately impacted by HIV yet have not been adequately prioritized in national HIV responses or policy documents. This review aims to understand the extent of meaningful inclusion of trans people in national strategic plans (NSPs) for HIV/AIDS as an essential step in ensuring that HIV policy aligns with epidemiologic data, and trans-specific programming is funded, implemented and sustained. METHODS HIV NSPs from 60 countries, across five global regions, were assessed for the level of inclusion of trans populations between January and March 2021. The most recently available NSP for each country, published after 2011, was obtained through publicly accessible online sources or through researcher networks. Data were manually extracted from NSPs using a framework of indicators focusing on trans inclusion in these five major sections of NSPs: (1) narratives; (2) epidemiological data; (3) monitoring and evaluation (M&E) indicators and targets; (4) activities; and (5) budgets. RESULTS AND DISCUSSION Within all reviewed NSPs, 65.0% (39/60) mentioned trans people in at least one of the five key sections but only 8.3% (5/60) included trans people in all five key sections. Trans people were more commonly mentioned in the background/narratives of NSPs (61.7%, 37/60) but less commonly included NSP activities (38.3%, 23/60), in M&E indicators and targets (23.7%, 14/60), in epidemiological data (20.0% 12/60), and in NSP budgets (13.3%, 8/60). Countries in the Asia and Pacific region most frequently included trans people in all five key sections (38%, 5/13), while no countries in Eastern and Southern Africa included trans people in all NSP sections. CONCLUSIONS This analysis finds substantial gaps in the inclusion of trans populations in NSPs globally. Results highlight the pressing need for states, technical partners, and international funders to engage with trans communities to improve trans-inclusion in all key sections of NSPs. Trans inclusion in NSPs is an essential step towards reaching the populations most at risk of HIV and ultimately achieving country-level epidemic control.
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Affiliation(s)
- Jennifer Sherwood
- Public Policy OfficeamfARFoundation for AIDS ResearchWashingtonDCUSA
| | - Elise Lankiewicz
- Public Policy OfficeamfARFoundation for AIDS ResearchWashingtonDCUSA
| | | | | | | | - Arjee Restar
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
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20
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del Río‐González AM, Lameiras‐Fernández M, Modrakovic D, Aguayo‐Romero R, Glickman C, Bowleg L, Zea MC. Global scoping review of HIV prevention research with transgender people: Transcending from trans-subsumed to trans-centred research. J Int AIDS Soc 2021; 24:e25786. [PMID: 34473421 PMCID: PMC8412127 DOI: 10.1002/jia2.25786] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 07/19/2021] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Globally, transgender populations are disproportionally impacted by HIV and effective HIV prevention interventions targeting these populations are critically needed. Such interventions require research focused on the specific needs and experiences of transgender people. This methodological review aims to determine the extent to which HIV prevention research has included transgender participants by subsuming them into non-transgender populations, or by centring them either in comparison with other groups or as the sole focus of research. METHODS We searched five electronic databases (e.g. SCOPUS) for empirical studies that focused on HIV prevention and included transgender participants, published through 31 December 2020. For each study, we extracted information on: (a) types of inclusion of transgender participants; (b) total sample size and number/percentage of transgender participants; (c) country(ies) where study was conducted; (d) HIV research topics; (e) methods (i.e. quantitative, qualitative or mixed-methods research) and (f) gender identity of transgender participants. RESULTS AND DISCUSSION Of 667 HIV prevention studies included in the review, 38.5% subsumed transgender participants into cisgender populations (most frequently combining transgender women with cisgender men who have sex with men), 20.4% compared transgender and cisgender participants and 41.1% focused exclusively on transgender populations. Our global scoping review also revealed that these three types of transgender inclusion in HIV prevention research vary greatly over time, place and thematic areas. Transgender women are the focus of the majority of reviewed studies, whereas transgender men and gender expansive people are rarely included as participants. CONCLUSIONS Inclusion of transgender persons as participants in HIV prevention research has significantly increased, particularly in the last decade. Further research centred on transgender participants and their experiences are needed to develop effective HIV prevention interventions for transgender populations. We advocate for HIV prevention research to move from subsuming transgender people, to trans-centred research that asks questions that focus on their specific needs and experiences. We provide recommendations to move from trans-subsumed to trans-centred HIV prevention research.
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Affiliation(s)
- Ana María del Río‐González
- Department of Psychological and Brain SciencesThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | | | - Djordje Modrakovic
- Department of Psychological and Brain SciencesThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Rodrigo Aguayo‐Romero
- Brigham and Women's Hospital/Harvard Medical School/The Fenway InstituteBostonMassachusettsUSA
| | - Courtney Glickman
- Department of Psychological and Brain SciencesThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Lisa Bowleg
- Department of Psychological and Brain SciencesThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Maria Cecilia Zea
- Department of Psychological and Brain SciencesThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
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21
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Restar A, Garrison-Desany HM, Baker KE, Adamson T, Howell S, Baral SD, Operario D, Beckham SW. Prevalence and associations of COVID-19 testing in an online sample of transgender and non-binary individuals. BMJ Glob Health 2021; 6:e006808. [PMID: 34518208 PMCID: PMC8438577 DOI: 10.1136/bmjgh-2021-006808] [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: 07/03/2021] [Accepted: 08/27/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Testing for COVID-19 and linkage to services is fundamental to successful containment and control of transmission. Yet, knowledge on COVID-19 testing among transgender and non-binary communities remains limited. METHODS Between October 2020 and November 2020, we examined the prevalence and associations of COVID-19 testing in an online sample of transgender and non-binary people (n=536). Multivariable hierarchical logistic regression analyses examined associations between COVID-19 testing and participants' sociodemographic, mental health, substance use, gender affirmation, economic changes and healthcare experiences. RESULTS Prevalence of COVID-19 testing in this sample was 35.5% (n=190/536). In the final model, transgender and non-binary participants from upper socioeconomic income background and Europe, who reported having active alcohol use disorder, limited access to gender-affirming surgery, had more than 20% reduction in income, and experienced mistreatment in a health facility due to gender identity had significantly increased odds of COVID-19 testing (all p<0.05); those who reported recent tobacco use had significantly lower odds of COVID-19 testing (p=0.007). CONCLUSIONS These findings highlight structural disparities in COVID-19 testing and reinforce the importance of increasing testing strategies for transgender and non-binary populations.
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Affiliation(s)
- Arjee Restar
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Behavioral and Social Science, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Henri M Garrison-Desany
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kellan E Baker
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tyler Adamson
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Stefan David Baral
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Don Operario
- Department of Behavioral and Social Science, Brown University School of Public Health, Providence, Rhode Island, USA
| | - S Wilson Beckham
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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22
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Kneale D, Bécares L. Discrimination as a predictor of poor mental health among LGBTQ+ people during the COVID-19 pandemic: cross-sectional analysis of the online Queerantine study. BMJ Open 2021; 11:e049405. [PMID: 34172551 PMCID: PMC8238529 DOI: 10.1136/bmjopen-2021-049405] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To assess the mental health and experiences of discrimination among lesbian, gay, bisexual, transgender, queer (LGBTQ) people at the start of the COVID-19 pandemic. DESIGN Data come from a cross-sectional online survey targeted at LGBTQ+ people, which collected data on mental health, experiences of discrimination and a number of other pandemic-related experiences. To examine the association between sexual orientation and gender and mental health and experiences of discrimination, we conducted regression analyses that adjusted for a range of sociodemographic variables. SETTING A web-based survey was used to collect data between the end of April and mid July 2020. PARTICIPANTS An analytical sample of 310 LGBTQ+ respondents aged 18 and above. MAIN OUTCOME MEASURES We assessed mental health with the 4-item Perceived Stress Scale and with the 10-item Center for Epidemiological Studies Depression scale (CES-D-10). We asked respondents about discriminatory experiences because of their LGBTQ+ identity during the coronavirus pandemic. RESULTS Perceived stress scores among our LGBTQ+ sample were high (mean: 7.67; SD: 3.22). Based on a score of 10 or more on the CES-D-10, the majority of participants had high levels of depressive symptoms (72%). Around one-in-six respondents reported some form of discrimination since the start of the pandemic because they were LGBTQ+ (16.7%). The average score for perceived stress increased by 1.44 points (95% CI 0.517 to 2.354) for respondents who had experienced discrimination versus those who had not. Similarly, the odds of exhibiting significant depressive symptomology increased threefold among those who had experienced discrimination compared with those who had not (OR: 3.251; 95% CI 1.168 to 9.052). CONCLUSIONS The LGBTQ+ community exhibited high levels of depression, stress and experienced discrimination during the coronavirus pandemic. High levels of poor mental health were partially explained by experiences of discrimination, which had a large, consistent and pernicious impact on mental health.
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Affiliation(s)
- Dylan Kneale
- EPPI-Centre, UCL Social Research Institute, University College London, London, UK
| | - Laia Bécares
- Social Work and Social Care, University of Sussex, Falmer, Sussex, UK
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23
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Restar AJ, Garrison-Desany HM, Adamson T, Childress C, Millett G, Jarrett BA, Howell S, Glick JL, Beckham SW, Baral S. HIV treatment engagement in the context of COVID-19: an observational global sample of transgender and nonbinary people living with HIV. BMC Public Health 2021; 21:901. [PMID: 33980193 PMCID: PMC8114659 DOI: 10.1186/s12889-021-10977-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/29/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND HIV services, like many medical services, have been disrupted by the COVID-19 pandemic. However, there are limited data on the impacts of the COVID-19 pandemic on HIV treatment engagement outcomes among transgender (trans) and nonbinary people. This study addresses a pressing knowledge gap and is important in its global scope, its use of technology for recruitment, and focus on transgender people living with HIV. The objective of this study is to examine correlates of HIV infection and HIV treatment engagement outcomes (i.e., currently on ART, having an HIV provider, having access to HIV treatment without burden, and remote refills) since the COVID-19 pandemic began. METHODS We utilized observational data from the Global COVID-19 Disparities Survey 2020, an online study that globally sampled trans and nonbinary people (n = 902) between April and August 2020. We conducted a series of multivariable logistic regressions with lasso selection to explore correlates of HIV treatment engagement outcomes in the context of COVID-19. RESULTS Of the 120 (13.3%) trans and nonbinary people living with HIV in this survey, the majority (85.8%) were currently on HIV treatment. A smaller proportion (69.2%) reported having access to an HIV provider since COVID-19 control measures were implemented. Less than half reported being able to access treatment without burdens related to COVID-19 (48.3%) and having the ability to remotely refill HIV prescription (44.2%). After adjusting for gender in the multivariable models, younger age and anticipated job loss were significantly associated with not having access to HIV treatment without burden. Outcomes also significantly varied by geographic region, with respondents reporting less access to an HIV provider in nearly every region outside of South-East Asia. CONCLUSION Our results suggest that currently taking ART, having access to an HIV provider, and being able to access HIV treatment without burden and remotely refill HIV medication are suboptimal among trans and nonbinary people living with HIV across the world. Strengthening support for HIV programs that are well-connected to trans and nonbinary communities, increasing remote access to HIV providers and prescription refills, and providing socioeconomic support could significantly improve HIV engagement in trans and nonbinary communities.
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Affiliation(s)
- Arjee Javellana Restar
- Department of Epidemiology, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
| | - Henri M Garrison-Desany
- Department of Epidemiology, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Tyler Adamson
- Department of Health, Policy, and Management, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Chase Childress
- School of Law and School of Criminology and Criminal Justice, Northeastern University, Boston, MA, USA
| | | | - Brooke A Jarrett
- Department of Epidemiology, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | | | - Jennifer L Glick
- Department of Health, Behavior, and Society, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - S Wilson Beckham
- Department of Health, Behavior, and Society, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
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Jarrett BA, Peitzmeier SM, Restar A, Adamson T, Howell S, Baral S, Beckham SW. Gender-affirming care, mental health, and economic stability in the time of COVID-19: a global cross-sectional study of transgender and non-binary people. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.11.02.20224709. [PMID: 33173876 PMCID: PMC7654856 DOI: 10.1101/2020.11.02.20224709] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Transgender and non-binary people are disproportionately burdened by barriers to quality healthcare, mental health challenges, and economic hardship. This study examined the impact of the novel coronavirus disease (COVID-19) pandemic and subsequent control measures on gender-affirming care, mental health, and economic stability among transgender and non-binary people globally. METHODS We collected global cross-sectional data from 964 transgender and non-binary adult users of the Hornet and Her apps from April to August 2020 to characterize changes in gender-affirming care, mental health, and economic stability as a result of the COVID-19 pandemic. We conducted Poisson regression models to assess if access to gender-affirming care and ability to live according to one's gender were related to depressive symptoms, anxiety, and changes in suicidal ideation. RESULTS Individuals resided in 76 countries, including Turkey (27.4%,n=264/964) and Thailand (20.6%,n=205). A majority were non-binary (66.8%,n=644) or transfeminine (29.4%,n=283). Due to the COVID-19 pandemic, 55.0% (n=320/582) reported reduced access to gender- affirming resources, and 38.0% (n=327/860) reported reduced time lived according to their gender. About half screened positive for depression (50.4%,442/877) and anxiety (45.8%,n=392/856). One in six (17.0%,n=112/659) expected losses of health insurance, and 77.0% (n=724/940) expected income reductions. The prevalence of depressive symptoms, anxiety, and increased suicidal ideation were 1.63 (95% CI: 1.36-1.97), 1.61 (95% CI: 1.31-1.97), and 1.74 (95% CI: 1.07-2.82) times higher for individuals whose access to gender- affirming resources was reduced versus not. DISCUSSION The COVID-19 pandemic has reduced access to gender-affirming resources and the ability of transgender and non-binary people to live according to their gender worldwide. These reductions may drive the increased depressive symptoms, anxiety, and suicidal ideation reported in this sample. To improve transgender and non-binary health globally, increased access to gender-affirming resources should be achieved through policies (e.g., digital prescriptions), flexible interventions (e.g., telehealth), and support for existing transgender health initiatives.
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Affiliation(s)
- Brooke A. Jarrett
- Department of Epidemiology; Bloomberg School of Public Health, Johns Hopkins University
| | - Sarah M. Peitzmeier
- Department of Health Behavior and Biological Sciences; School of Nursing; University of Michigan
| | - Arjee Restar
- Department of Epidemiology; Bloomberg School of Public Health, Johns Hopkins University
| | - Tyler Adamson
- Department of Health, Policy, and Management; Bloomberg School of Public Health; Johns Hopkins University
| | | | - Stefan Baral
- Department of Epidemiology; Bloomberg School of Public Health, Johns Hopkins University
| | - S. Wilson Beckham
- Department of Health, Behavior, and Society; Department of International Health; Bloomberg School of Public Health; Johns Hopkins University
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