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Goldenberg T, Tanner AE, Jibriel MSE, Erausquin JT, Mertus S, Phillips KA, Rodgers GK, Barrington C. A scoping review examining measurement of anti-transgender stigma in low- and middle-income countries. PLOS GLOBAL PUBLIC HEALTH 2025; 5:e0004490. [PMID: 40305444 PMCID: PMC12043131 DOI: 10.1371/journal.pgph.0004490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 03/19/2025] [Indexed: 05/02/2025]
Abstract
Globally, transgender and other gender diverse (trans) people experience widespread prejudice, discrimination, violence, and other forms of stigma, which contribute to negative health outcomes. Most anti-trans stigma research has been conducted in high-income countries. Measurement of anti-trans stigma in low- and middle-income countries (LMICs) is important for understanding and improving the health of trans populations globally. Accordingly, this scoping review explores the use of quantitative anti-trans stigma measures in LMICs. This scoping review follows the guidance of the PRISMA extension for Scoping Reviews (PRISMA-ScR) Checklist and examines empirical research with trans populations in LMICs published in English, Spanish, Arabic, and Russian between 2001-2024. Study eligibility criteria included: 1) trans study population, 2) LMIC study location, 3) quantitative or mixed-method study design, and 4) quantitative measurement of anti-trans stigma. The search yielded 82 articles (representing 65 unique studies) from 34 LMICs. Most articles were published since 2018. No articles focused exclusively on trans men. About 62% of articles included a primary focus on stigma; health outcomes primarily examined HIV and mental health. Nearly all articles (95%) measured enacted stigma; other forms of stigma (e.g., internalized and anticipated) were less commonly measured, and structural stigma was only measured in 4 articles. More than half of the articles (55%) measured stigma both broadly and within specific contexts (e.g., from family, in health care). More research exploring anti-trans stigma is needed, especially with trans-masculine and other gender diverse people, measuring outcomes beyond HIV and mental health, and measuring forms of stigma beyond enacted stigma. Expanding and improving measurement of anti-trans stigma in LMICs can improve our understanding of the mechanisms shaping health equity to inform context specific and tailored health interventions to support trans communities worldwide.
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Affiliation(s)
- Tamar Goldenberg
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, North Carolina, United States of America
| | - Amanda E. Tanner
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, North Carolina, United States of America
| | - Mohammed Sheikh Eldin Jibriel
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, North Carolina, United States of America
| | - Jennifer Toller Erausquin
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, North Carolina, United States of America
| | - Sulianie Mertus
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, North Carolina, United States of America
| | - Keenan A. Phillips
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, North Carolina, United States of America
| | - Grayson K. Rodgers
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, North Carolina, United States of America
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, United States of America
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Restar AJ, Quilantang MI, Wickersham J, Adia A, Guigayoma J, Bermudez AN, Galárraga O, Flores DD, Cu‐Uvin S, Nazareno J, Operario D, Sison O. Predictors of PrEP awareness, PrEP discussion and interest in long-acting injectable PrEP among Filipina transfeminine adults. J Int AIDS Soc 2023; 26:e26080. [PMID: 37306123 PMCID: PMC10258862 DOI: 10.1002/jia2.26080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/08/2023] [Indexed: 06/13/2023] Open
Abstract
INTRODUCTION Transfeminine adults are impacted by the HIV epidemic in the Philippines, and newly approved modalities of pre-exposure prophylaxis (PrEP), including long-acting injectable (LAI-PrEP), could be beneficial for this group. To inform implementation, we analysed PrEP awareness, discussion and interest in taking LAI-PrEP among Filipina transfeminine adults. METHODS We utilized secondary data from the #ParaSaAtin survey that sampled Filipina transfeminine adults (n = 139) and conducted a series of multivariable logistic regressions with lasso selection to explore factors independently associated with PrEP outcomes, including awareness, discussion with trans friends and interest in LAI-PrEP. RESULTS Overall, 53% of Filipina transfeminine respondents were aware of PrEP, 39% had discussed PrEP with their trans friends and 73% were interested in LAI-PrEP. PrEP awareness was associated with being non-Catholic (p = 0.017), having previously been HIV tested (p = 0.023), discussing HIV services with a provider (p<0.001) and having high HIV knowledge (p = 0.021). Discussing PrEP with friends was associated with older age (p = 0.040), having experienced healthcare discrimination due to transgender identity (p = 0.044), having HIV tested (p = 0.001) and having discussed HIV services with a provider (p < 0.001). Very interested in LAI-PrEP was associated with living in Central Visayas (p = 0.045), having discussed HIV services with a provider (p = 0.001) and having discussed HIV services with a sexual partner (p = 0.008). CONCLUSIONS Implementing LAI-PrEP in the Philippines requires addressing systemic improvements across personal, interpersonal, social and structural levels in healthcare access, including efforts to create healthcare settings and environments with providers who are trained and competent in transgender health and can address the social and structural drivers of trans health inequities, including HIV and barriers to LAI-PrEP.
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Affiliation(s)
- Arjee Javellana Restar
- Department of EpidemiologyUniversity of Washington School of Public HealthSeattleWashingtonUSA
- Department of Behavioral and Social Sciences, Research Education Institute for Diverse Scholars (REIDS)Yale University School of Public HealthNew HavenConnecticutUSA
- Philippines Health Initiative for Research, Service & Training (PHIRST)Brown University School of Public HealthProvidenceRhode IslandUSA
| | - Ma Irene Quilantang
- Philippines Health Initiative for Research, Service & Training (PHIRST)Brown University School of Public HealthProvidenceRhode IslandUSA
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRhode IslandUSA
- Department of Behavioral SciencesUniversity of Philippines‐ManilaManilaPhilippines
| | - Jeffrey Wickersham
- Department of Behavioral and Social Sciences, Research Education Institute for Diverse Scholars (REIDS)Yale University School of Public HealthNew HavenConnecticutUSA
- Department of Internal MedicineYale University School of MedicineNew HavenConnecticutUSA
| | - Alex Adia
- Philippines Health Initiative for Research, Service & Training (PHIRST)Brown University School of Public HealthProvidenceRhode IslandUSA
- Division of Health Policy and ManagementUniversity of California – Berkeley School of Public HealthBerkeleyCaliforniaUSA
| | - John Guigayoma
- Philippines Health Initiative for Research, Service & Training (PHIRST)Brown University School of Public HealthProvidenceRhode IslandUSA
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRhode IslandUSA
| | - Amiel Nazer Bermudez
- Philippines Health Initiative for Research, Service & Training (PHIRST)Brown University School of Public HealthProvidenceRhode IslandUSA
- Department of EpidemiologyBrown University School of Public HealthProvidenceRhode IslandUSA
- Department of Epidemiology and BiostatisticsUniversity of Philippines‐ManilaManilaPhilippines
| | - Omar Galárraga
- Department of Health Services, Policy, and PracticeBrown University School of Public HealthProvidenceRhode IslandUSA
| | - Dalmacio Dennis Flores
- Department of Behavioral and Social Sciences, Research Education Institute for Diverse Scholars (REIDS)Yale University School of Public HealthNew HavenConnecticutUSA
- Department of Family and Community HealthUniversity of Pennsylvania School of NursingPhiladelphiaPennsylvaniaUSA
| | - Susan Cu‐Uvin
- Philippines Health Initiative for Research, Service & Training (PHIRST)Brown University School of Public HealthProvidenceRhode IslandUSA
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRhode IslandUSA
| | - Jennifer Nazareno
- Philippines Health Initiative for Research, Service & Training (PHIRST)Brown University School of Public HealthProvidenceRhode IslandUSA
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRhode IslandUSA
| | - Don Operario
- Philippines Health Initiative for Research, Service & Training (PHIRST)Brown University School of Public HealthProvidenceRhode IslandUSA
- Department of Behavioral, Social, and Health Education SciencesEmory University Rollins School of Public HealthAtlantaGeorgiaUSA
| | - Olivia Sison
- Philippines Health Initiative for Research, Service & Training (PHIRST)Brown University School of Public HealthProvidenceRhode IslandUSA
- Department of EpidemiologyBrown University School of Public HealthProvidenceRhode IslandUSA
- Institute of Clinical Epidemiology, National Institutes of HealthUniversity of Philippines‐ManilaManilaPhilippines
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Pike I, Kraus-Perrotta C, Ngo TD. A scoping review of survey research with gender minority adolescents and youth in low and middle-income countries. PLoS One 2023; 18:e0279359. [PMID: 36626382 PMCID: PMC9831317 DOI: 10.1371/journal.pone.0279359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/05/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Survey data that categorizes gender identity in binary terms and conflates sex and gender limits knowledge around the experience of gender minority populations, whose gender identity or expression does not align with the sex they were assigned at birth. In this review, we outline the existing survey research on the experience of a gender minority demographic for whom there is particularly limited data: adolescents and youth in low and middle-income countries (LMICs). METHODS This paper is a scoping review of peer-reviewed articles, published in English, that use survey data to examine the experience of gender minority adolescents and youth in LMICs. We conducted a search on two major databases using key terms related to gender identity, adolescence and youth, and country and region. This search yielded 385 articles. Following a team-conducted review, we retained 33 articles for the final analysis. RESULTS Our review shows that surveys with adolescents and youth in LMICs are increasingly including questions and taking sampling approaches that allow gender minority populations to be visible in survey data. Surveys that do so are largely focused in upper middle-income countries (n = 24), rather than lower middle-income or low-income countries, with South East Asia a notable sub-region of focus (n = 15). Sexual health, mental health, and violence are key topics of interest. Most of the surveys rely on some form of network-driven sampling focused on sexual and/or gender minorities (n = 22). The studies vary in how they ask about gender identity, both in terms of question formulation and the answer categories that are offered, as well as the extent to which they describe the questions in the article text. CONCLUSIONS This review reveals a growing body of work that provides important insights into the experiences of gender minority adolescents and youth in LMICs. More studies could integrate these approaches, but it must be done in a way that is thoughtful about cultural and political context. Given the relatively nascent nature of such research, we encourage scholars to continue providing details on methodology, including around participant recruitment and the development of gender identity questions. This information would be valuable for researchers seeking to better include gender minorities and their experiences in survey research, but who might be daunted methodologically.
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Affiliation(s)
- Isabel Pike
- Department of Anthropology and Sociology, Graduate Institute of International and Development Studies (IHEID), Geneva, Switzerland
| | - Cara Kraus-Perrotta
- Social and Behavioral Science Research and GIRL Center, Population Council, One Dag Hammarskjold Plaza, New York, NY, United States of America
| | - Thoai D. Ngo
- Social and Behavioral Science Research and GIRL Center, Population Council, One Dag Hammarskjold Plaza, New York, NY, United States of America
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Doyle DM. Transgender identity: Development, management and affirmation. Curr Opin Psychol 2022; 48:101467. [PMID: 36219930 DOI: 10.1016/j.copsyc.2022.101467] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/04/2022] [Accepted: 09/08/2022] [Indexed: 01/28/2023]
Abstract
In this review, I discuss recent research on transgender identity development, management and affirmation, situating key topics within a social feedback model of transgender identity. This model foregrounds the dynamic interplay between internal and external influences on transgender identity. Furthermore, issues of intersectionality are highlighted throughout and located within broader socio-political contexts. Collectively, research on topics such as gender euphoria, passing, identity affirmation and social transitions, among others, points to the pivotal role of supportive social relationships and social environments in the healthy development and expression of transgender identities. Future work should prioritize longitudinal studies with careful and rigorous assessment of identity-related constructs in order to further examine these and other topics.
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Arayasirikul S, Turner C, Trujillo D, Sicro SL, Scheer S, McFarland W, Wilson EC. A global cautionary tale: discrimination and violence against trans women worsen despite investments in public resources and improvements in health insurance access and utilization of health care. Int J Equity Health 2022; 21:32. [PMID: 35241094 PMCID: PMC8896315 DOI: 10.1186/s12939-022-01632-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/11/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND To determine if improvements in social determinants of health for trans women and decreases in transphobic discrimination and violence occurred over three study periods during which extensive local programs were implemented to specifically address longstanding inequities suffered by the transgender community. METHODS Interviewer-administered surveys from repeated cross-sectional Transwomen Empowered to Advance Community Health (TEACH) studies in 2010, 2013 and 2016-2017 in San Francisco collected experiences with transphobia violence and discrimination. Respondent-driven sampling was used to obtain a sample of participants who identified as a trans woman. RESULTS Violence due to gender identity was prevalent; in each study period, verbal abuse or harassment was reported by over 83% of participants, and physical abuse or harassment was reported by over 56%. Adverse social determinants of health including homelessness, living below the poverty limit, methamphetamine use, depression, PTSD, and anxiety all significantly increased from 2010 to 2016. When testing for trends, housing discrimination and physical violence were both more likely in 2016-2017 compared to the two earlier study periods. Housing discrimination (aOR 1.41, 95% CI 1.00-1.98) and physical violence due to gender identity/presentation (aOR 1.39, 95% CI 1.00-1.92) both significantly increased from 2010 to 2016. CONCLUSION Our findings are particularly alarming during a period when significant public health resources and community-based initiatives specifically for trans women were implemented and could have reasonably led us to expect improvements. Despite these efforts, physical violence and housing discrimination among trans women worsened during the study periods. To ensure future improvements, research and interventions need to shift the focus and burden from trans people to cisgender people who are the perpetuators of anti-trans sentiment, stigma, discrimination and victimization.
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Affiliation(s)
- Sean Arayasirikul
- Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102, USA. .,Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA. .,Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, CA, USA.
| | - Caitlin Turner
- grid.410359.a0000 0004 0461 9142Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102 USA
| | - Dillon Trujillo
- grid.410359.a0000 0004 0461 9142Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102 USA
| | - Sofia L. Sicro
- grid.410359.a0000 0004 0461 9142Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102 USA
| | - Susan Scheer
- grid.410359.a0000 0004 0461 9142Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102 USA
| | - Willi McFarland
- grid.410359.a0000 0004 0461 9142Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102 USA ,grid.266102.10000 0001 2297 6811Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, CA USA
| | - Erin C. Wilson
- grid.410359.a0000 0004 0461 9142Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102 USA ,grid.266102.10000 0001 2297 6811Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, CA USA
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