1
|
Coleman TA, Chee K, Chin-See R, Salama R, Sajan M, Narbonne M, Travers R, Coulombe S. Minority Stressors, Social Provisions, and Past-Year Suicidal Ideation and Suicide Attempts in a Sample of Sexual Orientation and Gender Identity/Expression Minority People in Canada. LGBT Health 2024. [PMID: 38557210 DOI: 10.1089/lgbt.2022.0344] [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: 04/04/2024] Open
Abstract
Purpose: Mental health disparities in sexual orientation and/or gender identity and/or expression (SOGIE) minority groups are well-documented, with research consistently showing higher levels of suicidality, even in Canada, considered one of the world's most accepting countries of SOGIE minority groups. Adverse outcomes in these groups are often framed using minority stress theory, with social support frequently studied as an integral buffer to these outcomes. This analysis explores facets of minority stress and social support associated with past-year suicidal ideation and suicide attempts. Methods: A cross-sectional internet survey of SOGIE diverse people in Canada (n = 1542) was conducted. Binary logistic regression calculated bivariate and multivariate factors associated with past-year suicidal ideation and suicide attempts. Backward elimination (retaining sociodemographic factors and self-rated mental health) identified salient minority stress and social support (provisions) factors. Results: Over half (56.72%) of participants had ever thought of dying by suicide, with 24.84% having attempted suicide. During the past year, 26.80% had thought of dying by suicide, with 5.32% having attempted suicide. Victimization events, and guidance (e.g., someone to talk to about important decisions) and attachment (e.g., close relationships providing emotional security) social provision subscales remained salient after backward elimination procedures. Conclusion: Our findings emphasize that a fulsome, multilevel approach considering structural, community, and individual strategies to address overt discrimination, integrating social connections and guidance, is necessary to prevent dying by suicide.
Collapse
Affiliation(s)
- Todd A Coleman
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Kenny Chee
- Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Robert Chin-See
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Ramez Salama
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Maria Sajan
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Macie Narbonne
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Robb Travers
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Simon Coulombe
- Département des relations industrielles, Université Laval, Québec, Québec, Canada
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Logie CH, Newman PA, Admassu Z, MacKenzie F, Chakrapani V, Tepjan S, Shunmugam M, Akkakanjanasupar P. Associations between water insecurity and mental health outcomes among lesbian, gay, bisexual, transgender and queer persons in Bangkok, Thailand and Mumbai, India: Cross-sectional survey findings. Glob Ment Health (Camb) 2024; 11:e31. [PMID: 38572259 PMCID: PMC10988155 DOI: 10.1017/gmh.2024.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 12/29/2023] [Accepted: 02/20/2024] [Indexed: 04/05/2024] Open
Abstract
Background Water insecurity disproportionally affects socially marginalized populations and may harm mental health. Lesbian, gay, bisexual, transgender and queer (LGBTQ) persons are at the nexus of social marginalization and mental health disparities; however, they are understudied in water insecurity research. Yet LGBTQ persons likely have distinct water needs. We explored associations between water insecurity and mental health outcomes among LGBTQ adults in Mumbai, India and Bangkok, Thailand. Methods This cross-sectional survey with a sample of LGBTQ adults in Mumbai and Bangkok assessed associations between water insecurity and mental health outcomes, including anxiety symptoms, depression symptoms, loneliness, alcohol misuse, COVID-19 stress and resilience. We conducted multivariable logistic and linear regression analyses to examine associations between water insecurity and mental health outcomes. Results Water insecurity prevalence was 28.9% in Mumbai and 18.6% in Bangkok samples. In adjusted analyses, in both sites, water insecurity was associated with higher likelihood of depression symptoms, anxiety symptoms, COVID-19 stress, alcohol misuse and loneliness. In Mumbai, water insecurity was also associated with reduced resilience. Conclusion Water insecurity was common among LGBTQ participants in Bangkok and Mumbai and associated with poorer well-being. Findings signal the importance of assessing water security as a stressor harmful to LGBTQ mental health.
Collapse
Affiliation(s)
- Carmen H. Logie
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- United Nations University Institute for Water, Environment, and Health, Hamilton, ON, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
- Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada
| | - Peter A. Newman
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Zerihun Admassu
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Frannie MacKenzie
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | | | | | - Murali Shunmugam
- Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India
| | - Pakorn Akkakanjanasupar
- Department of Educational Policy, Management, and Leadership, Faculty of Education, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
4
|
Pliensak N, Suwan A, Panyakhamlerd K, Bumphenkiatikul T, Wainipitapong S. Mental Health of Transmasculine Adults Receiving Gender-Affirming Hormone Therapy in Thailand. Transgend Health 2023; 8:509-515. [PMID: 38213531 PMCID: PMC10777821 DOI: 10.1089/trgh.2021.0160] [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: 11/12/2022] Open
Abstract
Purpose Many studies have shown conflicting results regarding mental health among transmasculine adults or transgender men (TM). This study aimed to identify the prevalence of depression among Thai TM receiving gender-affirming hormone therapy (GAHT). Methods All TM, over 18 years of age, who received GAHT for at least three consecutive months were invited to complete a self-report questionnaire that covered participants' demographic and clinical data. Mental health, including depression, anxiety, and quality of life (QoL), was assessed. We reported the prevalence of mental illnesses and examined the correlations between mental health scores and other associated data. Results A total of 84 TM were included in the analysis. Major depression and generalized anxiety disorder were detected in 14.3% and 3.6%, respectively. Depression severity was negatively associated with age and QoL. Depression and anxiety severity were found to be positively associated. Conclusions Compared with the general Thai population, the prevalence of mental health problems among Thai TM receiving GAHT was higher. Age of maturity may be a potential mental health protective factor, and assessment in younger individuals may benefit mental health.
Collapse
Affiliation(s)
- Napon Pliensak
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Ammarin Suwan
- Division of Gender, Sexual, and Climacteric Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Transgender Health (CETH), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Krasean Panyakhamlerd
- Division of Gender, Sexual, and Climacteric Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Transgender Health (CETH), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thanapob Bumphenkiatikul
- Center of Excellence in Transgender Health (CETH), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Academic Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sorawit Wainipitapong
- Center of Excellence in Transgender Health (CETH), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| |
Collapse
|
5
|
Muwanguzi PA, Nabunya R, Karis VMS, Nabisere A, Nangendo J, Mujugira A. Nurses' reflections on caring for sexual and gender minorities pre-post stigma reduction training in Uganda. BMC Nurs 2023; 22:50. [PMID: 36823533 PMCID: PMC9947888 DOI: 10.1186/s12912-023-01208-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/14/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Men who have sex with men (MSM) and transgender women (TGW) have a significant HIV burden worldwide. Data from eight countries across sub-Saharan Africa found a pooled HIV prevalence of 14% among MSM and 25% among TGW. Stigma and discrimination among healthcare providers are barriers to healthcare access by these populations. We sought to explore nurses' attitudes before and after sensitivity training to reduce stigma in HIV prevention and care provision to MSM and transgender persons in Uganda. METHODS An explorative qualitative study comprising in-depth interviews. Nineteen nurses who underwent sensitivity training in caring for the vulnerable, priority and key populations in Uganda participated. We interviewed each participant before and after the stigma reduction training and analyzed the data with NVivo. RESULTS Eight (8) themes emerged from the reflections before the training, namely, 'the definition of MSM and transgender persons', 'legal concerns', 'mental illness', 'attitude in health care provision', 'personal perceptions', 'self-efficacy', 'insufficient training preparation', and 'reasons for gender or sexual orientation preference'. The post-training reflections suggested a change in knowledge and attitude. Five themes emerged for MSM: 'stigma reduction', 'sexual practices and sexuality', 'the need for tailored health approaches', 'MSM and the law' and 'corrected misconceptions'. For transmen, 'reproductive health needs', 'social needs', 'safety needs', 'Gender identity recognition' and 'reduced stigma, discrimination, and barriers to care'. Finally, the reflections on their attitudes towards transwomen were on five topics; Gender affirming care', 'Healthcare provision for transwomen', 'Need for further training', 'New knowledge acquired', and 'Sexual violence'. CONCLUSION Nurses' attitudes and empathy for vulnerable and key populations improved following the training. Nursing training programs should consider incorporating sexual and gender minority (SGM) specific health training into their curricula to decrease negative attitudes. There is a need to identify best practices and conduct implementation research to provide culturally sensitive and affirming healthcare delivery in sub-Saharan Africa. Future studies should evaluate the effect of provider sensitivity training on sexual health and HIV outcomes for SGM. Furthermore, interventions targeting higher-level stigma, such as structural and policy levels, are critical because they influence interpersonal stigma reduction efforts and initiatives.
Collapse
Affiliation(s)
- Patience A. Muwanguzi
- Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, P. O. Box 7072, Uganda
| | - Racheal Nabunya
- Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, P. O. Box 7072, Uganda
| | - Victoria M. S. Karis
- Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, P. O. Box 7072, Uganda
| | - Allen Nabisere
- Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, P. O. Box 7072, Uganda
| | - Joan Nangendo
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, P.O. BOX 7072, Uganda
| | - Andrew Mujugira
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, P. O Box 22418, Uganda
| |
Collapse
|
6
|
Fatima A, Jami H, Irwin JA. Barriers faced by trans men (female to male transgender persons) in gender transitioning in Pakistan. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2023. [DOI: 10.1080/19359705.2022.2156648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Arooj Fatima
- National Institute of Psychology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Humaira Jami
- National Institute of Psychology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Jay A. Irwin
- Department of Sociology and Anthropology, University of Nebraska at Omaha, Omaha, Nebraska, USA
| |
Collapse
|
7
|
Ganbaatar D, Vaughan C, Akter S, Bohren MA. Exploring the identities and experiences of young queer people in Mongolia using visual research methods. CULTURE, HEALTH & SEXUALITY 2022; 24:1695-1712. [PMID: 34743678 DOI: 10.1080/13691058.2021.1998631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/21/2021] [Indexed: 06/13/2023]
Abstract
There is limited evidence about the lives of queer Mongolian youth. This is despite mental health problems being a pressing concern among young Mongolians, and international evidence suggesting queer youth may experience more mental health challenges than their non-queer peers. We explored the experiences of queer youth in their immediate environments and navigation of their identities in Mongolian society. In this study, twelve young queer-identifying people aged 18-25 from Ulaanbaatar, Mongolia participated in photo-elicitation interviews. Visual research methods allowed participants to generate rich (visual, textual, and oral) data about their lived experiences. We analysed data using a thematic approach and identified three main themes, each with three sub-themes. Participants reported that peer bullying and gendered expectations at school, heteronormativity and gender role expectation in family settings, along with strong stereotypes about queerness in broader society, substantially impacted participants' mental and physical wellbeing. Mongolian queer youth need strong support from their immediate environments, such as school and family. Stigma and misconception around queerness remain persistent among the public but young people are continuously resisting the prejudice expressed towards them. Understanding these challenges is crucial to increasing inclusivity in policies and programmes to enhance the wellbeing of young queer Mongolians.
Collapse
Affiliation(s)
- Dorjjantsan Ganbaatar
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
- Health Programme, LGBT Centre (Mongolia), Ulaanbaatar, Mongolia
| | - Cathy Vaughan
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Shahinoor Akter
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Meghan A Bohren
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| |
Collapse
|
8
|
Bothma R, O'Connor C, Nkusi J, Shiba V, Segale J, Matsebula L, Lawrence JJ, van der Merwe LL, Chersich M, Hill N. Differentiated HIV services for transgender people in four South African districts: population characteristics and HIV care cascade. J Int AIDS Soc 2022; 25 Suppl 5:e25987. [PMID: 36225147 PMCID: PMC9557019 DOI: 10.1002/jia2.25987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 07/30/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Transgender people in South Africa are disproportionately affected by HIV, discrimination and stigma. Access to healthcare and health outcomes are poor. Although integrating gender-affirming healthcare with differentiated HIV prevention, care and treatment services has shown improvement in HIV service uptake and health outcomes among transgender people, evidence is lacking on the implementation of differentiated service delivery models in southern Africa. This article describes a differentiated service delivery model across four South African sites and transgender individuals who access these services. We assess whether hormone therapy (HT) is associated with continued use of pre-exposure prophylaxis (PrEP) and viral load suppression. METHODS In 2019, differentiated healthcare centres for transgender individuals opened in four South African districts, providing gender-affirming healthcare and HIV services at a primary healthcare level. Routine programme data were collected between October 2019 and June 2021. Descriptive statistics summarized patient characteristics and engagement with HIV prevention and treatment services. We conducted a multivariate logistic regression analysis to determine whether HT was associated with viral load suppression and PrEP continued use. RESULTS In the review period, we reached 5636 transgender individuals through peer outreach services; 86% (4829/5636) of them accepted an HIV test and 62% (3535/5636) were linked to clinical services. Among these, 89% (3130/3535) were transgender women, 5% (192/3535) were transgender men and 6% (213/3535) were gender non-conforming individuals. Of those who received an HIV test, 14% (687/4829) tested positive and 91% of those initiated antiretroviral treatment. Viral load suppression was 75% in this cohort. PrEP was accepted by 28% (1165/4142) of those who tested negative. Five percent (161/3535) reported ever receiving HT through the public healthcare system. Service users who received HT were three-fold more likely to achieve viral load suppression. We did not find any association between HT and continued use of PrEP. CONCLUSIONS A differentiated HIV and gender-affirming service delivery model at a primary healthcare level is feasible and can enhance service access in South Africa. HT can improve HIV clinical outcomes for transgender people. As trust is established between the providers and population, uptake of HIV testing and related services may increase further.
Collapse
Affiliation(s)
- Rutendo Bothma
- Wits Reproductive Health and HIV Institute (Wits RHI)University of the WitwatersrandJohannesburgSouth Africa
| | - Cara O'Connor
- Wits Reproductive Health and HIV Institute (Wits RHI)University of the WitwatersrandJohannesburgSouth Africa
| | - Jolie Nkusi
- Wits Reproductive Health and HIV Institute (Wits RHI)University of the WitwatersrandJohannesburgSouth Africa
| | - Vusi Shiba
- Wits Reproductive Health and HIV Institute (Wits RHI)University of the WitwatersrandJohannesburgSouth Africa
| | - Jacob Segale
- Wits Reproductive Health and HIV Institute (Wits RHI)University of the WitwatersrandJohannesburgSouth Africa
| | - Luyanda Matsebula
- Wits Reproductive Health and HIV Institute (Wits RHI)University of the WitwatersrandJohannesburgSouth Africa
| | - J. Joseph Lawrence
- United States Agency for International Development/Southern AfricaCity of TshwaneSouth Africa
| | | | - Matthew Chersich
- Wits Reproductive Health and HIV Institute (Wits RHI)University of the WitwatersrandJohannesburgSouth Africa
| | - Naomi Hill
- Wits Reproductive Health and HIV Institute (Wits RHI)University of the WitwatersrandJohannesburgSouth Africa
| |
Collapse
|
9
|
Sweileh WM. Research Publications on the Mental Health of Transgender People: A Bibliometric Analysis Using Scopus Database (1992–2021). Transgend Health 2022. [DOI: 10.1089/trgh.2022.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Waleed M. Sweileh
- Department of Physiology, Pharmacology/Toxicology, Division of Biomedical Sciences, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| |
Collapse
|
10
|
Tanner AE, Goldenberg T, Erausquin JT, Mertus S, Jibriel MSE, Barrington C. Measuring anti-transgender stigma in low-income and middle-income countries: a scoping review protocol. BMJ Open 2022; 12:e061691. [PMID: 35798529 PMCID: PMC9263898 DOI: 10.1136/bmjopen-2022-061691] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Globally, transgender and other gender diverse (trans) people face pervasive stigma, which contributes to health inequities across multiple health outcomes. Stigma is a fundamental cause of health inequities because it simultaneously limits access to resources, contributes to systemic vulnerability and generates chronic stress. Anti-trans stigma occurs across multiple socioecological levels, resulting in multiple possible definitions and measurements of trans stigma. Understanding how trans stigma has been measured in low-income and middle-income countries (LMICs) is critical to health promotion efforts for trans communities. Accordingly, this scoping review will identify and examine how anti-trans stigma has been measured in existing LMIC-specific research to inform best practices for measurement of anti-trans stigma that includes consideration of local context. METHODS AND ANALYSIS This is the protocol for a scoping review of anti-trans stigma in LMICs. We will search (from January 2001 to December 2021) PubMed, WHO Global Medicus and EBSCO. Study selection will conform to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews Checklist. Original studies in English, Spanish, Arabic or Russian will be included. Reviewers will independently screen all citations, full-text articles and abstract data. Data analysis will involve quantitative and qualitative methods. A narrative summary of findings will be conducted. ETHICS AND DISSEMINATION As a scoping review (no direct interaction with participants), this study is exempt from human subjects oversight. Understanding context-specific ways to measure anti-trans stigma is urgently needed to support trans health globally. The planned scoping review will help to address this gap. Results of the review will be disseminated in a peer-reviewed journal and likely in other media such as conferences, seminars and symposia. PROTOCOL REGISTRATION NUMBER: osf.io/qcs2v.
Collapse
Affiliation(s)
- Amanda E Tanner
- Department of Public Health Education, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Tamar Goldenberg
- Department of Public Health Education, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Jennifer Toller Erausquin
- Department of Public Health Education, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Sulianie Mertus
- Department of Public Health Education, University of North Carolina at Greensboro, Greensboro, NC, USA
| | | | - Clare Barrington
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|
11
|
Chakrapani V, Scheim AI, Newman PA, Shunmugam M, Rawat S, Baruah D, Bhatter A, Nelson R, Jaya A, Kaur M. Affirming and negotiating gender in family and social spaces: Stigma, mental health and resilience among transmasculine people in India. CULTURE, HEALTH & SEXUALITY 2022; 24:951-967. [PMID: 33847243 PMCID: PMC7612960 DOI: 10.1080/13691058.2021.1901991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 03/08/2021] [Indexed: 06/12/2023]
Abstract
Research on transmasculine people's health is scant globally, including in India. We explored transmasculine people's experiences in affirming their gender in family and social spaces, and how those experiences impact mental health. In 2019, we conducted four focus groups (n = 17 participants) and 10 in-depth interviews with transmasculine people in Mumbai and Chennai. Data analyses were guided by minority stress theory and the gender affirmation model. Within family, the pressure to conform to assigned gender roles and gender policing usually began in adolescence and increased over time. Some participants left parental homes due to violence. In educational settings, participants described the enforcement of gender-normative dress codes, lack of faculty support, and bullying victimisation, which led some to quit schooling. In the workplace, experiences varied depending on whether participants were visibly trans or had an incongruence between their identity documents and gender identity. Everyday discrimination experiences in diverse settings contributed to psychological distress. Amidst these challenges, participants reported resilience strategies, including self-acceptance, connecting with peers, strategic (non)disclosure, and circumventing gendered restrictions on dress and behaviour. Interventions at social-structural, institutional, family and individual levels are needed to reduce stigma and discrimination faced by transmasculine people in India and to promote their mental health.
Collapse
Affiliation(s)
- Venkatesan Chakrapani
- Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India
- The Humsafar Trust, Mumbai, India
| | - Ayden I. Scheim
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Peter A. Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Murali Shunmugam
- Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India
| | | | | | | | - Ruban Nelson
- Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India
- The Humsafar Trust, Mumbai, India
| | - A Jaya
- Sahodaran, Chennai, India
| | - Manmeet Kaur
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| |
Collapse
|
12
|
Queering global health: an urgent call for LGBT+ affirmative practices. THE LANCET GLOBAL HEALTH 2022; 10:e574-e578. [DOI: 10.1016/s2214-109x(22)00001-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/16/2021] [Accepted: 12/22/2021] [Indexed: 12/23/2022] Open
|
13
|
Manzoor I, Khan ZH, Tariq R, Shahzad R. Health Problems & Barriers to Healthcare Services for the Transgender Community in Lahore, Pakistan. Pak J Med Sci 2022; 38:138-144. [PMID: 35035415 PMCID: PMC8713213 DOI: 10.12669/pjms.38.1.4375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 08/05/2021] [Accepted: 08/26/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives: To find out the major health problems and barriers in getting health care by transgender community in Lahore, Pakistan. Methods: An analytical cross-sectional study was conducted in transgender community of Lahore from January to October 2020. The study included 214 participants from different areas of Lahore by targeting their “gurus”. Non-probability, snow-ball sampling technique was used to collect required sample size. Data was collected by using a structured questionnaire. Data were analyzed using SPSS version 23. Results were generated in form of tables and graphs. Chi square test and Fischer’s exact test were used to find out associations between health seeking behavior with their transgender status and p value was fixed as ≤ 0.05 as significant. Results: Among total 214, 78.5% were transgender females and 21.5% were transgender male. Among the common health problems were depression (56%), anxiety (59%) and genital tract ulcers (45%). About 70% transgender seek health care from government hospitals. Among total 214 participants, 70% reported that they receive poor quality of health care. The main reasons of not getting proper care is non acceptance (20.7%), feeling ashamed (28.7%), non-availability of CNIC (44.5%) and un-affordability (6.1%). Significant association of transgender female with consultation with doctors (p=0.013), seeking care at government hospitals (p =0.038) poor experience at health care facility (0.050), neglect during medical treatment (p=0.015) and feeling of discrimination during treatment (p= 0.042). Conclusion: Transgender community face physical, mental, social and reproductive health issues. About 70% trans-genders receive poor quality of health care services. Non acceptance, feeling ashamed, non-availability of CNIC and non-affordability have been reported as major barriers in getting desired health care.
Collapse
Affiliation(s)
- Iram Manzoor
- Dr. Iram Manzoor, MBBS, FCPS, MSc, MCPS-HPE, PhD. Department of Community Medicine, Akhtar Saeed Medical and Dental College, Lahore, Pakistan
| | - Zartasha Hanan Khan
- Dr. Zartasha Khan, MBBS, MCPS Trainee. Department of Community Medicine, Akhtar Saeed Medical and Dental College, Lahore, Pakistan
| | - Rafia Tariq
- Dr. Rafia Tariq, 4 year MBBS student. Akhtar Saeed Medical and Dental College, Lahore, Pakistan
| | - Rijah Shahzad
- Dr. Rijah Shahzad, 4 year MBBS student. Akhtar Saeed Medical and Dental College, Lahore, Pakistan
| |
Collapse
|
14
|
Mujugira A, Kasiita V, Bagaya M, Nakyanzi A, Bambia F, Nampewo O, Kamusiime B, Mugisha J, Nalumansi A, Twesigye CC, Muwonge TR, Baeten JM, Wyatt MA, Tsai AC, Ware NC, Haberer JE. "You are not a man": a multi-method study of trans stigma and risk of HIV and sexually transmitted infections among trans men in Uganda. J Int AIDS Soc 2021; 24:e25860. [PMID: 34965322 PMCID: PMC8716065 DOI: 10.1002/jia2.25860] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 12/06/2021] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Transgender (trans) men in sub-Saharan Africa are a hidden and vulnerable population who may engage in sex work due to socio-economic exclusion and lack of alternative employment opportunities. Little is known about HIV and sexually transmitted infection (STI) risk among trans men in this setting. We conducted a multi-method study to characterize HIV/STI risk among trans men in Uganda. METHODS Between January and October 2020, we enrolled 50 trans men into a cross-sectional study through snowball sampling. Data were collected on socio-demographic characteristics, sexual practices and depression. We conducted 20 qualitative interviews to explore: (1) descriptions of sexual practices that could increase HIV/STI exposure; (2) experiences of accessing public healthcare facilities; (3) perceptions of HIV or STI testing; (4) HIV and STI service delivery; and (5) drug and alcohol use. We used an inductive content analytic approach centring on descriptive category development to analyse the data. RESULTS The median age was 25 years (interquartile range 23-28). The prevalence of HIV, syphilis and hepatitis B was 4%, 6% and 8%, respectively. We observed multiple levels of intersecting individual, interpersonal and structural stigmas. (1) Trans men reported transphobic rape motivated by interpersonal stigma that was psychologically traumatizing to the survivor. The resultant stigma and shame hindered healthcare access. (2) Structural stigma and economic vulnerability led to sex work, which increased the risk of HIV and other STIs. Sex work stigma further compounded vulnerability. (3) Individualized stigma led to fear of disclosure of gender identity and HIV status. Concealment was used as a form of stigma management. (4) Multiple levels of stigma hampered access to healthcare services. Preference for trans-friendly care was motivated by stigma avoidance in public facilities. Overall, the lived experiences of trans men highlight the intertwined relationship between stigma and sexual health. CONCLUSIONS In this sample from Uganda, trans men experienced stigma at multiple levels, highlighting the need for gender-sensitive healthcare delivery. Stigma reduction interventions, including provider training, non-discrimination policies, support groups and stigma counselling, could strengthen uptake and utilization of prevention services by this marginalized population.
Collapse
Affiliation(s)
- Andrew Mujugira
- Infectious Diseases Institute, Makerere University, Kampala, Uganda.,Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda.,Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Vicent Kasiita
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Monica Bagaya
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Agnes Nakyanzi
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Felix Bambia
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Oliva Nampewo
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Brenda Kamusiime
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Jackson Mugisha
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | | | | | - Jared M Baeten
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Monique A Wyatt
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Harvard Global, Cambridge, Massachusetts, USA
| | - Alexander C Tsai
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Norma C Ware
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jessica E Haberer
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
15
|
Mabire X, Robin-Radier S, Ferraz D, Preau M. FOREST protocol: a qualitative study exploring health and sexuality of transmasculine individuals in France. BMJ Open 2021; 11:e052748. [PMID: 34848520 PMCID: PMC8634350 DOI: 10.1136/bmjopen-2021-052748] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 11/03/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION While current research on sexuality and health often explores sexual behaviours among heterosexual and gay cisgender individuals, little is known about the sexualities of transgender people, especially transmasculine people. When data are available, sexual health is often reduced to risk exposure, not considering in detail social context and determinants that could contribute to a more comprehensive approach, such as general health, class, race, exposure to violence or social representations. Recognising this gap, identified in both national (French) and international scientific literature, this study aims to explore the sexual health of transmasculine people, employing an intersectional approach and considering both positive and negative health determinants. METHODS This 2-year research based in the disciplinary field of social psychology, with a gender perspective, and will apply qualitative methods. We adopt a community-based research approach, integrating one university and one community-based organisation in the coordination of the study. In a triangulation perspective, two rounds of semistructured interviews will be performed with key informants (medical practitioners, community-based support services workers, etc) and with people self-identifying as transmasculine. Focus groups will complement data collection. ETHICS AND DISSEMINATION FOREST protocol was approved by the Comité d'Évaluation Éthique (CEEI) de l'Institut National de la Santé Et de la Recherche Médicale (CEEI/International Review Board 00003888). The research adopts the principles of open science, and findings will be published assuring participants' confidentiality. Informative flyers and videos will be elaborated to communicate study findings to participants, stakeholders and the transcommunities at large, and data will be stored in lasting archives.
Collapse
Affiliation(s)
- Xavier Mabire
- PHASE (Psychology of Health, Aging and Sport Examination), University of Lausanne Faculty of Social and Political Science, Lausanne, Vaud, Switzerland
- UMR 1296 "Radiations: Défense, Santé, Environnement", Université Lyon 2, Lyon, Auvergne-Rhône-Alpes, France
| | - Suzanne Robin-Radier
- UMR 1296 "Radiations: Défense, Santé, Environnement", Université Lyon 2, Lyon, Auvergne-Rhône-Alpes, France
- Community-Based Organization, OUTrans NGO, Paris, Île-de-France, France
| | - Dulce Ferraz
- PHASE (Psychology of Health, Aging and Sport Examination), University of Lausanne Faculty of Social and Political Science, Lausanne, Vaud, Switzerland
- UMR 1296 "Radiations: Défense, Santé, Environnement", Université Lyon 2, Lyon, Auvergne-Rhône-Alpes, France
- Escola FIOCRUZ de Governo, Fundação Oswaldo Cruz, Brasília, Brazil
| | - Marie Preau
- UMR 1296 "Radiations: Défense, Santé, Environnement", Université Lyon 2, Lyon, Auvergne-Rhône-Alpes, France
| |
Collapse
|
16
|
Sims LB, Appenroth MN. Contraceptive technology research & development: a call for inclusion of trans and gender diverse individuals assigned female at birth. EUR J CONTRACEP REPR 2021; 27:142-147. [PMID: 34845964 DOI: 10.1080/13625187.2021.2000960] [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: 10/19/2022]
Abstract
OBJECTIVE Increased research efforts over the past decade provide a more in-depth understanding of the diverse fertility desires and family planning needs of trans and gender diverse individuals assigned female at birth (TGD AFAB). Despite this increased understanding and unmet need, global health researchers and contraceptive product developers have yet to include TGD AFAB individuals and considerations of their needs in the product development process, marginalising this historically underrepresented population. The aim of this perspective is to present the case for inclusion of TGD AFAB individuals in contraceptive research. MAIN OUTCOMES This perspective summarises the most recent literature characterising contraceptive access and use within TGD AFAB populations as well as the barriers to use. Furthermore, this perspective offers insight into how novel contraceptive technologies in the research and development pipeline could potentially appeal to TGD AFAB populations and recommends steps product developers can make towards being more inclusive. CONCLUSIONS With current research efforts in contraceptive product development aimed at expanding the method mix to appeal to a more diverse population of potential users, it behoves product developers to be more inclusive of TGD AFAB individuals in the development process and consider them as stakeholders of an expanded contraceptive method mix.
Collapse
Affiliation(s)
- Lee B Sims
- United States Agency for International Development, Global Health Technical Professionals Program, Public Health Institute
| | - Max N Appenroth
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
17
|
"Existimos": Health and social needs of transgender men in Lima, Peru. PLoS One 2021; 16:e0254494. [PMID: 34339444 PMCID: PMC8328288 DOI: 10.1371/journal.pone.0254494] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 06/24/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The health of transgender men (trans men)-individuals who identify as men and were assigned a female sex assigned at birth-is overlooked globally. This mixed-methods exploratory study sought to understand the lived experiences, health, and social needs of trans men in Lima, Peru to bring visibility to specific health needs and inform responsive and holistic public health efforts. METHODS Between July 2016-January 2017, 46 trans men in Lima, Peru participated in a mixed-methods study. Four focus group discussions were conducted, complemented with 10 one-on-one interviews to explore in-depth issues that arose in groups. Two individuals participated in both a focus group and an interview. All participants completed a brief survey assessing sociodemographic characteristics and experiences with healthcare, mental health, and stigma. Audio files were transcribed verbatim and analyzed using an immersion crystallization approach to identify themes. RESULTS Participants had a mean age of 24 years (range 18-48). Trans men reported a lack of awareness and information among medical providers, avoidance of healthcare due to discrimination and maltreatment, an absence of public services for medical gender affirmation (hormones, surgeries), and unmet mental health needs. Trans men described health as multidimensional and influenced by social, economic, and legal contexts including family, school, employment and work, legal identity recognition, discrimination in public spaces, and peer support. Violence, stigma, and intersecting forms of oppression were described as limiting social and legal recognition of trans identity a central dimension of health. Peer support, often in an online environment, was described as important to resistance and well-being. CONCLUSIONS Findings demonstrate that the physical and mental health of trans men, as well as unmet needs for healthcare services, are influenced by a complex set of social, economic, and legal challenges due to the social exclusion of trans people in Peruvian society. Results are a call to action for stakeholders in Peru to guarantee the rights, health, and wellbeing of this community.
Collapse
|
18
|
Restar AJ, Jin H, Jarrett B, Adamson T, Baral SD, Howell S, Beckham SW. Characterising the impact of COVID-19 environment on mental health, gender affirming services and socioeconomic loss in a global sample of transgender and non-binary people: a structural equation modelling. BMJ Glob Health 2021; 6:e004424. [PMID: 33753401 PMCID: PMC7985976 DOI: 10.1136/bmjgh-2020-004424] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND We characterised the impact of COVID-19 on the socioeconomic conditions, access to gender affirmation services and mental health outcomes in a sample of global transgender (trans) and non-binary populations. METHODS Between 16 April 2020 and 3 August 2020, we conducted a cross-sectional survey with a global sample of trans and non-binary people (n=849) through an online social networking app. We conducted structural equational modelling procedures to determine direct, indirect and overall effects between poor mental health (ie, depression and anxiety) and latent variables across socioecological levels: social (ie, reduction in gender affirming services, socioeconomic loss impact) and environmental factors (ie, COVID-19 pandemic environment). RESULTS Anxiety (45.82%) and depression (50.88%) in this sample were prevalent and directly linked to COVID-19 pandemic environment. Adjusted for gender identity, age, migrant status, region, education and level of socioeconomic status, our final model showed significant positive associations between relationships of (1) COVID-19 pandemic environment and socioeconomic loss impact (β=0.62, p<0.001), (2) socioeconomic loss impact and reduction in gender affirming services (β=0.24, p<0.05) and (3) reduction in gender affirming services and poor mental health (β=0.19, p<0.05). Moreover, socioeconomic loss impact and reduction in gender affirming services were found to be partial mediators in this model. CONCLUSION The study results supported the importance of bolstering access to gender affirming services and strengthening socioeconomic opportunities and programmatic support to buffer the impact of COVID-19 pandemic environment on poor mental health among trans and non-binary communities globally.
Collapse
Affiliation(s)
- Arjee Javellana Restar
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Harry Jin
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Brooke Jarrett
- Department of Epidemiology, 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
| | | | - S Wilson Beckham
- Department of Health Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
19
|
Wadhwa N, Arora T, Pandhi D, Diwaker P, Arora V. Transgenders are the most vulnerable amongst individuals engaging in receptive anal intercourse: A cross-sectional study from North India. J Family Med Prim Care 2021; 10:4463-4470. [PMID: 35280623 PMCID: PMC8884333 DOI: 10.4103/jfmpc.jfmpc_634_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 07/17/2021] [Accepted: 07/19/2021] [Indexed: 11/24/2022] Open
Abstract
Background: In India, sexuality not confirming to hetero-conjugal and peno-vaginal norm is abhorred and discriminated against. Individuals engaging in Receptive Anal Intercourse (RAI) are marginalized. Reappraisal of their sexual health conditions is likely to promote inclusive health care. Methods: Eighty-five consenting adults with RAI history were recruited from a tertiary care hospital in Delhi. Clinico-demographic data was noted and anal cytology samples were reported by Bethesda 2014 terminology. Results: There were 29 transgenders (TGs), 51 males (31 bisexual) and five females. Fifty-four subjects were Human Immunodeficiency Virus (HIV) infected (22 TGs, 31 males (17 bisexual) and one female) and 52 were receiving anti-retroviral treatment (ART). Thirty-one subjects had anal warts (6 TGs, 20 males, five females). Anal cytology revealed squamous intra-epithelial lesions (SIL) in 20 (5 TGs, 13 males, two females). TGs had significantly risker sexual practices than homosexual males, bisexual males and females, with consistently earlier age of first RAI exposure and frequent childhood (≤16 years) RAI experience compared to homosexual males, bisexual males and females, even after stratification by HIV status, warts and SIL. Conclusions: TGs had the highest sexual health risk profile including higher frequency of HIV infection compared to other subjects with RAI history. Bisexuality was common; their risk profile was variably lower than homosexual males. Mindfulness of above is likely to help overcome barriers to health care access and promote compassionate approach at all levels including primary care physicians.
Collapse
|