1
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Espinosa CC, Crim SM, Carree T, Dasgupta S. Unmet Needs for Ancillary Services and Associations with Clinical Outcomes Among Transgender Women with Diagnosed HIV: Medical Monitoring Project, United States, 2015-2020. LGBT Health 2024; 11:143-155. [PMID: 37851999 DOI: 10.1089/lgbt.2023.0040] [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: 10/20/2023] Open
Abstract
Purpose: Access to ancillary services-including HIV support services, non-HIV clinical services, and subsistence services-can support care engagement and viral suppression and reduce disparities among people with HIV (PWH). We used representative U.S. data to assess differences in unmet needs for ancillary services between transgender women with HIV and other PWH. In addition, we examined associations between unmet needs and clinical outcomes among transgender women. Methods: We analyzed 2015-2020 Medical Monitoring Project data among transgender women (N = 362), cisgender men (N = 17,319), and cisgender women (N = 6016) with HIV. We reported weighted percentages for characteristics, and reported adjusted prevalence ratios (aPRs) controlling for race/ethnicity and age, and 95% confidence intervals (CI) using logistic regression with predicted marginal means to assess differences between groups. Results: Among transgender women, unmet needs were highest for dental care (24.9%), shelter or housing (13.9%), and transportation assistance (12.6%). Transgender women were more likely than cisgender men to have unmet subsistence needs. Among transgender women, unmet needs for ancillary services were negatively associated with many clinical outcomes after adjusting for age and race/ethnicity. Unmet needs for subsistence services were associated with higher levels of antiretroviral therapy nonadherence (aPR: 1.39; 95% CI: 1.13-1.70) and detectable viral loads (aPR: 1.47; 1.09-1.98), emergency room visits (aPR: 1.42; 1.06-1.90), and depression (aPR: 2.74; 1.83-4.10) or anxiety (aPR: 3.20; 2.05-5.00) symptoms. Conclusions: Transgender women with HIV were more likely than cisgender men with HIV to experience unmet needs for subsistence services-likely a reflection of substantial socioeconomic disadvantage. Addressing unmet needs is an essential step for improving care outcomes among transgender women with HIV.
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Affiliation(s)
- Catherine C Espinosa
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stacy M Crim
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tamara Carree
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- DLH Corp, Atlanta, Georgia, USA
| | - Sharoda Dasgupta
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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2
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Marcus R, Trujillo L, Olansky E, Cha S, Hershow RB, Baugher AR, Sionean C, Lee K. Transgender Women Experiencing Homelessness - National HIV Behavioral Surveillance Among Transgender Women, Seven Urban Areas, United States, 2019-2020. MMWR Suppl 2024; 73:40-50. [PMID: 38261599 PMCID: PMC10826682 DOI: 10.15585/mmwr.su7301a5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
Transgender women experience high prevalence of homelessness, which can affect their likelihood of acquiring HIV infection and can lead to poor medical outcomes. CDC analyzed data from the National HIV Behavioral Surveillance Among Transgender Women to identify whether personal characteristics and social factors affecting transgender women were associated with duration of homelessness during the past 12 months. Longer duration and chronic homelessness might indicate greater unmet needs, which increases their likelihood for acquiring HIV infection. Ordinal logistic regression was conducted to calculate adjusted prevalence odds ratios and 95% CIs for transgender women from seven urban areas in the United States experiencing homelessness 30-365 nights, 1-29 nights, and zero nights during the past 12 months. Among 1,566 transgender women, 9% reported 1-29 nights homeless and 31% reported 30-365 nights homeless during the past 12 months. Among participants who reported physical intimate partner violence or forced sex, 50% and 47%, respectively, reported experiencing 30-365 nights homeless. Furthermore, 55% who had been evicted or denied housing because of their gender identity and 58% who had been incarcerated during the past year experienced 30-365 nights homeless. The odds of transgender women experiencing longer duration of homelessness was associated with being younger and having a disability; higher psychological distress scores were associated with longer duration of homelessness. Analysis of social determinants of health found transgender women experiencing longer homelessness to be less educated, living below the Federal poverty level, and having lower social support. Therefore, focusing on HIV prevention and interventions addressing housing instability to reduce the duration of homelessness among transgender women is important. Further, integrating housing services with behavioral health services and clinical care, specifically designed for transgender women, could reduce HIV acquisition risk and improve HIV infection outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | - National HIV Behavioral Surveillance Among Transgender Women Study Group
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, Georgia; Social & Scientific Systems, Inc., Silver Spring, Maryland
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3
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Ghabrial MA, Scheim AI, Chih C, Santos H, Adams NJ, Bauer GR. Change in Finances, Peer Access, and Mental Health Among Trans and Nonbinary People During the COVID-19 Pandemic. LGBT Health 2023; 10:595-607. [PMID: 37347954 PMCID: PMC10712362 DOI: 10.1089/lgbt.2022.0296] [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: 06/24/2023] Open
Abstract
Purpose: Due to structural transphobia, trans and nonbinary (TNB) individuals were particularly vulnerable to the negative effects of social isolation and financial instability resulting from COVID-19. The present study examined the effect of change in finances and access to TNB peer gatherings on anxiety and depression during the COVID-19 pandemic. Methods: Participants were 18 years and older (mean = 30) and completed prepandemic baseline (Fall 2019) and pandemic follow-up (Fall 2020) surveys. Multivariable regressions examined associations between mental health and change in (1) finances and (2) access to TNB peer gatherings (in person or online). Results: Of 780 participants, 50% reported that the COVID-19 pandemic had a negative impact on personal income and 58.3% reported negative impact on access to TNB peer gatherings. Depression and anxiety symptoms increased from prepandemic to follow-up, and most participants were above measurement cutoffs for clinical levels at both time points. Change in finances and access to TNB peer gatherings interacted with prepandemic depression scores to predict depression symptoms during the COVID-19 pandemic. For participants with high prepandemic depression scores, financial stability predicted pandemic depression scores comparable to that predicted by negative financial change. No interaction was found between these variables when predicting anxiety symptoms during the COVID-19 pandemic. Conclusion: Findings underscore the influence of inequality and prepandemic mental health when considering the impact of COVID-19 on wellbeing. Results suggest need for multifaceted programs and services, including financial support and meaningful TNB community engagement, to address barriers to health equity posed by systematic gender oppression.
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Affiliation(s)
- Monica A. Ghabrial
- Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Ayden I. Scheim
- Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Caiden Chih
- Mechanical and Industrial Engineering and University of Toronto, Toronto, Ontario, Canada
| | - Heather Santos
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Noah James Adams
- Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada
- Center for Applied Transgender Studies, Chicago, Illinois, USA
- Transgender Professional Association for Transgender Health, Canada
| | - Greta R. Bauer
- Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Institute for Sexual and Gender Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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4
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Rivera AV, Lopez JM, Braunstein SL. Exploring the Association Between Gender Affirmation and PrEP use Among Transgender Women in New York City. AIDS Behav 2023; 27:1523-1530. [PMID: 36574185 PMCID: PMC10191875 DOI: 10.1007/s10461-022-03944-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 12/28/2022]
Abstract
Black and Hispanic/Latina transgender women are inequitably impacted by HIV; yet gaps in PrEP use exist. Among a sample of mostly Black and Hispanic/Latina transgender women in New York City, we aim to examine whether PrEP use was associated with gender affirmation and the use of gender-affirming health services. We found that PrEP use was more prevalent among those who used hormone therapy and those who had a provider they were comfortable speaking to about gender-related issues. In separate models, these associations were attenuated when adjusting for race/ethnicity, with those who use hormones being marginally more likely to report PrEP use and with Hispanic/Latina transgender women being more likely to have used PrEP, compared to Black transgender women. We found evidence of a potential association between medical gender affirmation and PrEP use. More research is needed to explore the social and structural contexts that are influenced by race/ethnicity that may serve to prevent PrEP uptake.
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Affiliation(s)
- Alexis V Rivera
- Bureau of Hepatitis, HIV, and STI, New York City Department of Health and Mental Hygiene, 42-09 28th Street, CN-44, 11101, Queens, NY, USA.
| | - Jasmine M Lopez
- Bureau of Division Management and Systems Coordination, New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - Sarah L Braunstein
- Bureau of Hepatitis, HIV, and STI, New York City Department of Health and Mental Hygiene, 42-09 28th Street, CN-44, 11101, Queens, NY, USA
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5
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Felt D, Xu J, Floresca YB, Fernandez ES, Korpak AK, Phillips G, Wang X, Curry CW, Beach LB. Instability in Housing and Medical Care Access: The Inequitable Impacts of the COVID-19 Pandemic on U.S. Transgender Populations. Transgend Health 2023; 8:74-83. [PMID: 36824386 PMCID: PMC9942178 DOI: 10.1089/trgh.2021.0129] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose To assess whether the COVID-19 pandemic has inequitably impacted key social determinants of health (SDoH), specifically employment, housing, and health care, for U.S. transgender populations. Methods Between April 13, 2020 and August 3, 2020, we conducted a national, cross-sectional online survey of sexual and gender minority individuals (N=870). We used logistic regression to calculate both unadjusted and adjusted odds of unemployment, homelessness/housing instability, and interruptions in medical care owing to the pandemic by gender and gender modality. Adjusted models controlled for age, race/ethnicity, and region. Results In adjusted models, transgender and gender diverse people had 2.12 times the odds of reporting homelessness/housing instability and 2.88 times the odds of reporting medical care interruptions compared with cisgender peers. Transgender men, women, and nonbinary people had 4.12, 3.29, and 3.48 times the adjusted odds of interruptions in medical care compared with cisgender men, respectively. We did not observe significant differences in employment. Conclusions Findings add empirical support to the hypothesis that socioeconomic consequences of COVID-19 are inequitably impacting transgender people. To contextualize our results and support future research in this area, we present a conceptual model of the short- and long-term impacts of COVID-19 on transgender populations using a framework of stigma as a fundamental cause of health inequities. Our findings emphasize that public health professionals must urgently consider-and intervene to address-the pandemic's SDoH-related impacts on transgender populations.
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Affiliation(s)
- Dylan Felt
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jiayi Xu
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ysabel Beatrice Floresca
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ella Segovia Fernandez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Aaron K. Korpak
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gregory Phillips
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Xinzi Wang
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Caleb W. Curry
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- College of Arts and Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Lauren B. Beach
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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6
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Hsiang E, Gyamerah A, Baguso G, Jain J, McFarland W, Wilson EC, Santos GM. Prevalence and correlates of substance use and associations with HIV-related outcomes among trans women in the San Francisco Bay Area. BMC Infect Dis 2022; 22:886. [PMID: 36435761 PMCID: PMC9701418 DOI: 10.1186/s12879-022-07868-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 11/10/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Trans women face tremendous social inequities as well as disproportionate rates of HIV and substance use, yet disaggregated substance use data specific to trans women remain limited. METHODS We conducted a secondary analysis of baseline data from the Trans*National Study (2016-2017) surveying trans women in the San Francisco Bay Area (n = 629). Multivariable logistic regression was used to analyze socio-demographic and environmental correlates of substance use, and bivariate associations between substance use and HIV-associated outcomes are presented alongside prevalence data. RESULTS Over half (52.9%) reported using substances in the prior year, most frequently marijuana, methamphetamine, and crack/cocaine. Those with unmet gender-affirming health care needs, lack of insurance, or a history of experiencing racial violence, transphobic violence, adult housing instability, or extreme poverty had higher odds of substance use. Sex work and condomless anal sex were also independently associated with substance use. CONCLUSIONS Among this sample of trans women, substance use and substance use concurrent with sex were highly prevalent, and associated with a number of socioeconomic and health care needs. These findings corroborate the need for holistic and intersectional efforts to reduce substance use and HIV risk.
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Affiliation(s)
- Elaine Hsiang
- Department of Emergency Medicine, University of California, San Francisco, 505 Parnassus Avenue, M24, Box 203, San Francisco, CA, 94143, USA.
| | - Akua Gyamerah
- grid.266102.10000 0001 2297 6811Department of Community Health Systems, University of California, San Francisco, San Francisco, CA USA
| | - Glenda Baguso
- grid.266102.10000 0001 2297 6811Center for Public Health Research, San Francisco Department of Public Health, University of California, San Francisco, San Francisco, CA USA
| | - Jennifer Jain
- grid.266102.10000 0001 2297 6811Department of Psychiatry, University of California, San Francisco, San Francisco, CA USA
| | - Willi McFarland
- grid.266102.10000 0001 2297 6811Center for Public Health Research, San Francisco Department of Public Health, University of California, San Francisco, San Francisco, CA USA
| | - Erin C. Wilson
- grid.266102.10000 0001 2297 6811Center for Public Health Research, San Francisco Department of Public Health, University of California, San Francisco, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA USA
| | - Glenn-Milo Santos
- grid.266102.10000 0001 2297 6811Department of Community Health Systems, University of California, San Francisco, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Center for Public Health Research, San Francisco Department of Public Health, University of California, San Francisco, San Francisco, CA USA
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7
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Chiu I, Leathers M, Cano D, Turner CM, Trujillo D, Sicro S, Arayasirikul S, Taylor KD, Wilson EC, McFarland W. HIV prevalence, engagement in care, and risk behavior among trans women, San Francisco: Evidence of recent successes and remaining challenges. Int J STD AIDS 2022; 33:1029-1037. [PMID: 35816424 PMCID: PMC9607899 DOI: 10.1177/09564624221111278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Trans women have high HIV prevalence and lag behind 90–90-90 targets for HIV care. In San Francisco in 2017, 96% of trans women were aware of their status, 75% were on antiretroviral therapy, 88% had viral suppression. Initiatives to address gaps include peer navigators, free gender-affirming surgery, and housing. Our study updates HIV prevalence and engagement in care among trans women. Methods Cross-sectional community-based survey of trans women living in San Francisco sampled by respondent-driven sampling, 7/2019–2/2020 (N = 201). Eligibility was: self-identified trans women or other gender and assigned male at birth; living in San Francisco; English/Spanish-speaking; and 18 years or older. Results HIV prevalence was 42.3% (95%CI 35.4.-49.4) and associated with having a partner who injected drugs (adjusted odds ratio [AOR] 3.30, 95%CI 1.58–6.90), ever injected drugs (AOR 2.28, 95%CI 1.06–4.89), cost not a barrier to healthcare (AOR 2.63, 95%CI 1.02–6.67), emotional support from family (AOR 2.85, 95%CI 1.43–5.65), and Black/African-American (AOR 2.59, 95%CI 1.16–5.79). Of trans women with HIV, 92.9% were previously diagnosed, 89.9% were on ART, 91.5% reported viral suppression. Conclusions Trans women met 90–90–90 targets in 2020, at 93–90–92. Interventions need to reach Black/African-American trans women, trans women who inject drugs, and partners of trans women.
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Affiliation(s)
- Izzy Chiu
- 1438University of California Berkeley, Berkeley, CA, USA.,Center for Public Health Research, 7152San Francisco Department of Public Health, San Francisco, CA, USA
| | - Matisse Leathers
- 1438University of California Berkeley, Berkeley, CA, USA.,Center for Public Health Research, 7152San Francisco Department of Public Health, San Francisco, CA, USA
| | - Damiana Cano
- 1438University of California Berkeley, Berkeley, CA, USA.,Center for Public Health Research, 7152San Francisco Department of Public Health, San Francisco, CA, USA
| | - Caitlin M Turner
- Center for Public Health Research, 7152San Francisco Department of Public Health, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Dillon Trujillo
- Center for Public Health Research, 7152San Francisco Department of Public Health, San Francisco, CA, USA
| | - Sofia Sicro
- Center for Public Health Research, 7152San Francisco Department of Public Health, San Francisco, CA, USA
| | - Sean Arayasirikul
- Center for Public Health Research, 7152San Francisco Department of Public Health, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Kelly D Taylor
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Erin C Wilson
- Center for Public Health Research, 7152San Francisco Department of Public Health, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Willi McFarland
- Center for Public Health Research, 7152San Francisco Department of Public Health, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
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8
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Trujillo D, Arayasirikul S, Xie H, Sicro S, Meza J, Bella M, Daza E, Torres F, McFarland W, Wilson EC. Disparities in Sexually Transmitted Infection Testing and the Need to Strengthen Comprehensive Sexual Health Services for Trans Women. Transgend Health 2022; 7:230-236. [PMID: 36643058 PMCID: PMC9829146 DOI: 10.1089/trgh.2020.0133] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose Few studies have examined the importance of improving the sexual health delivery system beyond HIV among trans women. We assessed survey data from the National HIV Behavioral Surveillance Transgender Woman (NHBS-Trans) Study in San Francisco to characterize the utilization of sexual health services among HIV-negative trans women and to explore opportunities to improve sexual health services for trans women. Methods Trans women were recruited through respondent-driven sampling from July 2019 to February 2020. The analytic sample was restricted to 116 HIV-negative trans women. We identified trends in data using chi-squared tests to assess significance between sexual risk behavior and the use of preventative sexual health services and built logistic regression models to assess the relationships between sexual risk behaviors and sexually transmitted infection (STI) testing. Results The majority of sample was trans women of color with most identifying as Latinx (42.2%). Over half were low income (56%), and majority had been homeless in past 12 months (62.9%). The prevalence of condomless receptive anal sex was 52.6% with about two-thirds (62.1%) recently having an STI test. Participants who engaged in recent condomless receptive anal sex had more than fivefold greater odds of having a recent STI test compared to their counterparts who did not (adjusted odds ratio [aOR] 5.60, 95% confidence interval [CI] 1.83-17.11; p=0.003). We also found age- and education-related disparities in STI testing. Conclusion This study characterized the utilization of sexual health services among HIV-negative trans women and identified important disparities in STI testing. We discuss opportunities to strengthen sexual health care delivery systems.
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Affiliation(s)
- Dillon Trujillo
- Trans Research Unit for Equity, San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, USA.,Address correspondence to: Dillon Trujillo, MPH, Trans Research Unit for Equity (TRUE), San Francisco Department of Public Health, Center for Public Health Research, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102, USA,
| | - Sean Arayasirikul
- Trans Research Unit for Equity, San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, USA.,Department of Pediatrics, University of California San Francisco, San Francisco, California, USA.,Department of Psychiatry and University of California San Francisco, San Francisco, California, USA
| | - Hui Xie
- Trans Research Unit for Equity, San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, USA
| | - Sofia Sicro
- Trans Research Unit for Equity, San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, USA
| | - Joaquin Meza
- Trans Research Unit for Equity, San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, USA
| | - Mackie Bella
- Trans Research Unit for Equity, San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, USA
| | - Emperatriz Daza
- Trans Research Unit for Equity, San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, USA
| | - Francisco Torres
- Trans Research Unit for Equity, San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, USA
| | - Willi McFarland
- Trans Research Unit for Equity, San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, USA.,Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, California, USA
| | - Erin C. Wilson
- Trans Research Unit for Equity, San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, USA.,Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, California, USA
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9
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Sexual Orientation Discrimination and Exclusive, Dual, and Polytobacco Use among Sexual Minority Adults in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106305. [PMID: 35627843 PMCID: PMC9142070 DOI: 10.3390/ijerph19106305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/11/2022] [Accepted: 05/14/2022] [Indexed: 11/16/2022]
Abstract
Research on whether sexual orientation discrimination is associated with multiple tobacco product use among sexual minority (SM) adults is limited. Thus, we explored the associations between sexual orientation discrimination and exclusive, dual, and polyuse among a subset of SM adults (18+) (n = 3453) using the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions-III. We evaluated six indicators of prior-to-past-year sexual orientation discrimination separately and as a summary scale and defined past-year exclusive, dual, and polyuse based on cigarette, electronic nicotine delivery systems, other combustible (cigars and traditional pipe), and smokeless tobacco products. Using multinomial logistic regression, we estimated adjusted associations between sexual orientation discrimination and exclusive, dual, and polyuse. Experiencing discrimination in public places, being called names, and being bullied, assaulted, or threatened were associated with dual use, while experiencing discrimination when obtaining health care or insurance and when receiving health care were associated with polyuse. Each one-unit increase in the sexual orientation discrimination summary scale was associated with 5% and 10% higher odds of dual (95% CI: 1.01–1.10) and polyuse (95% CI: 1.02–1.18), respectively. To conclude, we advise health professionals to consider the salience of discrimination against SM adults and how these experiences lead to dual/polyuse.
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10
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Chavez-Baray SM, Martinez O, Chaparro P, Moya EM. The Use of Photovoice Methodology to Assess Health Needs and Identify Opportunities Among Migrant Transgender Women in the U.S.-Mexico Border. Front Public Health 2022; 10:865944. [PMID: 35664104 PMCID: PMC9160798 DOI: 10.3389/fpubh.2022.865944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/11/2022] [Indexed: 11/21/2022] Open
Abstract
Psychosocial, social and structural conditions have rarely been studied among transgender women in the U.S.-Mexico Border. This study used Photovoice methodology to empower migrant transgender women of color (TWC) to reflect on realities from their own perspectives and experiences and promote critical dialogue, knowledge, and community action. Sixteen participants documented their daily experiences through photography, engaged in photo-discussions to assess needs and identify opportunities, and developed a community-informed Call to Action. Four major themes emerged from the participants' photographs, discussions, and engagement: (1) mental health, (2) migration experiences and challenges, (3) stigma, discrimination, and resiliency, and (4) impact of the COVID-19 pandemic. Through active community engagement, a Call to Action was developed. A binational advisory committee of decision makers and scholars reviewed a set of recommendations to better respond to the needs of TWC in the U.S.-Mexico Border. Photovoice served as an empowerment tool for TWC to assess the myriad of syndemic conditions, including mental health, stigma, discrimination and COVID-19, affecting them daily and identify initiatives for change.
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Affiliation(s)
- Silvia M. Chavez-Baray
- Department of Social Work, University of Texas at El Paso, El Paso, TX, United States,Chicano Studies, College of Liberal Arts, University of Texas at El Paso, El Paso, TX, United States,Border Biomedical Research Center, College of Science, University of Texas at El Paso, El Paso, TX, United States,*Correspondence: Silvia M. Chavez-Baray
| | - Omar Martinez
- School of Social Work, College of Public Health, Temple University Philadelphia, Philadelphia, PA, United States,Omar Martinez
| | - Perla Chaparro
- Department of Social Work, University of Texas at El Paso, El Paso, TX, United States
| | - Eva M. Moya
- Department of Social Work, University of Texas at El Paso, El Paso, TX, United States,Border Biomedical Research Center, College of Science, University of Texas at El Paso, El Paso, TX, United States,Eva M. Moya
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11
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Jackson A, Hernandez C, Scheer S, Sicro S, Trujillo D, Arayasirikul S, McFarland W, Wilson EC. Prevalence and Correlates of Violence Experienced by Trans Women. J Womens Health (Larchmt) 2022; 31:648-655. [PMID: 35576131 DOI: 10.1089/jwh.2021.0559] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives: To measure the prevalence and correlates of intimate partner, physical, and sexual violence experienced by trans women. Materials and Methods: A National HIV Behavioral Surveillance (NHBS) Study of 201 trans women was conducted in San Francisco from July 2019 to February 2020 using respondent-driven sampling. Prevalence ratio tests were used to test differences in the prevalence of violence by demographic characteristics including housing status. Results: Among 201 trans women interviewed, 26.9% were currently homeless. In the past year, 59.7% had been homeless, 34.3% changed housing, 60.7% had a housing situation other than renting or owning. Experiences of violence were common: 36.8% experienced any form of violence, including sexual (16.9%), intimate partner (14.9%), and other physical (25.4%) in the past year. Experiences of violence were significantly associated with multiple measures of housing insecurity. Younger age, being misgendered, and substance use were also associated with experiences of violence. Conclusions: Trans women face dual crises in housing and violence. Affordable, subsidized, and safe housing has the potential to reduce the exposure and vulnerability to violence faced by trans women.
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Affiliation(s)
- Akira Jackson
- The Transgender Advocates for Justice and Accountability Coalition, San Leandro, California, USA
| | - Christopher Hernandez
- Trans Research Unit for Equity, San Francisco Department of Public Health, San Francisco, California, USA
| | - Susan Scheer
- Trans Research Unit for Equity, San Francisco Department of Public Health, San Francisco, California, USA
| | - Sofia Sicro
- Trans Research Unit for Equity, San Francisco Department of Public Health, San Francisco, California, USA
| | - Dillon Trujillo
- Trans Research Unit for Equity, San Francisco Department of Public Health, San Francisco, California, USA
| | - Sean Arayasirikul
- Trans Research Unit for Equity, San Francisco Department of Public Health, San Francisco, California, USA
| | - Willi McFarland
- Trans Research Unit for Equity, San Francisco Department of Public Health, San Francisco, California, USA
| | - Erin C Wilson
- Trans Research Unit for Equity, San Francisco Department of Public Health, San Francisco, California, USA
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12
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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: 1.5] [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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13
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Shelton SA, Lester AOS. A narrative exploration of the importance of intersectionality in a Black trans woman's mental health experiences. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 23:108-121. [PMID: 35403106 PMCID: PMC8986210 DOI: 10.1080/26895269.2020.1838393] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Background: The current United States presidential administration's statements and policies have, in a shockingly short time, catastrophically affected people of color and LGBTQIA + communities. And although these numerous discriminatory policies and policy revisions have negatively affected both US people of color and LGBTQIA + people, trans women of color have been disproportionately affected. Even more specifically, when focusing on vulnerability to violence-including murder-it is Black trans women who are most directly affected by the intersections of transphobia and racism in the US. This article explores a Black trans woman's experiences with mental health professionals across two decades and different regions of the US. Aims: This article argues for the necessity of understanding trans people's mental health experiences as necessarily intersectional, in order to more fully appreciate and address the degrees to which factors such as race, socioeconomic class, and geographic context matter in trans people's efforts to access ethical and effective mental healthcare. Methods: Using a theoretical framework informed by Kimberlé Crenshaw's single-axis concept, the authors fully center Aryah's intersectional experiences and counter a single-axis in exploring trans mental health issues, our article relies on a narrative-based approach. As narrative inquiry is a broad field, we selected Butler-Kisber's narrative analytic approach, "Starting with the Story" as our method. The narratives are pulled from approximately 10 intensive qualitative interviews over the course of several months. Discussion: These narratives disrupt the common threads in the literature that ignore the degrees to which race and class matter alongside being a trans woman. In addition, as we noted that nearly all of the mental health literature relied on large-scale survey-based data, this article offers a qualitative narrative exploration of Aryah's experiences and works to humanize trans mental health challenges and needs, while emphasizing the multilayered oppressions and obstacles that affected Aryah.
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Affiliation(s)
- Stephanie Anne Shelton
- Educational Studies in Psychology, Research Methodology, and Counseling, The University of Alabama, Tuscaloosa, Alabama, USA
- CONTACT Stephanie Anne Shelton Educational Studies in Psychology, Research Methodology, and Counseling, The University of Alabama, Carmichael Hall 308, Box 870231, Tuscaloosa, AL35487, USA
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14
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Fraser B, Chisholm E, Pierse N. "You're so powerless": Takatāpui/LGBTIQ+ people's experiences before becoming homeless in Aotearoa New Zealand. PLoS One 2021; 16:e0259799. [PMID: 34928948 PMCID: PMC8687556 DOI: 10.1371/journal.pone.0259799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/27/2021] [Indexed: 11/18/2022] Open
Abstract
Little is known in Aotearoa New Zealand about experiences of homelessness amongst Takatāpui/LGBTIQ+ identifying people, despite growing international literature regarding LGBTIQ+ homelessness. Using data from semi-structured interviews with eight people who identified as Takatāpui/LGBTIQ+ and had experienced homelessness, this paper explores their experiences prior to becoming homeless. These experiences are placed into the categories of: the pervasiveness of instability (especially in regards to family relationships, finances, and housing), having to grow up fast due to social and material conditions, experiences of looking for housing in stressed markets, and systems failures that resulted in a lack of autonomy. These results show that instability and systems failures are key contributors to Takatāpui/LGBTIQ+ people becoming homeless in Aotearoa New Zealand.
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Affiliation(s)
- Brodie Fraser
- He Kāinga Oranga, Department of Public Health, University of Otago, Wellington, Aoteaora New Zealand
- * E-mail:
| | - Elinor Chisholm
- He Kāinga Oranga, Department of Public Health, University of Otago, Wellington, Aoteaora New Zealand
| | - Nevil Pierse
- He Kāinga Oranga, Department of Public Health, University of Otago, Wellington, Aoteaora New Zealand
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de Sousa Mascena Veras MA, Saggese GSR, Gomez JL, Silveira P, Paiatto B, Ferreira D, de Souza PA, Calado R, Castejon MJ, Yamashiro R, de Macedo Brígido LF, Turner C, Lin J, Wilson EC, McFarland W. Brief Report: Young Age and Sex Work Are Associated With HIV Seroconversion Among Transgender Women in São Paulo, Brazil. J Acquir Immune Defic Syndr 2021; 88:e1-e4. [PMID: 34050104 PMCID: PMC8373663 DOI: 10.1097/qai.0000000000002737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/10/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Transgender women worldwide have the highest prevalence of HIV and the lowest access to prevention among groups at risk of HIV. However, few longitudinal studies have directly measured HIV incidence and identified predictors of HIV acquisition among transgender women. SETTING São Paulo, Latin America's largest city. METHODS We conducted a longitudinal study among transgender women in São Paulo. Participants were recruited by a long-chain peer referral process from May 2017 to July 2019. Those aged 18 years and older and who were HIV-negative at baseline were retested every 6 months up to 18 months. HIV incidence was calculated by dividing the number of seroconversions by the person-years (PYs) of follow-up; 95% confidence intervals (CIs) were constructed assuming a Poisson distribution. Conditional maximum likelihood ratios assessed differences in HIV incidence by risk factors. RESULTS A racially/ethnically diverse sample of 545 HIV-negative transgender women was enrolled. In 485.5 PYs of follow-up, 13 seroconversions were observed, yielding an incidence of 2.68 per 100 PYs (95% CI: 1.43 to 4.58). HIV incidence was significantly higher among transgender women aged 18-24 years (rate ratio 3.85, 95% CI: 1.24 to 12.93) and among those who engaged in sex work in the preceding month (rate ratio 5.90, 95% CI: 1.71 to 26.62). CONCLUSIONS HIV transmission continues at a high rate among transgender women in Brazil. Factors such as young age, lower level of education, and limited employment opportunities may lead to dependence on sex work that in turn increases HIV risk. Transgender-friendly prevention services, particularly programs delivering pre-exposure prophylaxis, are urgently needed.
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Affiliation(s)
| | | | - José Luis Gomez
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Paula Silveira
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
- Faculdade de Saúde Pública, Universidade de São Paulo, Brazil
| | - Beatriz Paiatto
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Denis Ferreira
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Paola Alves de Souza
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
- Faculdade de Psicologia Social, Universidade de São Paulo, Brazil
| | - Rodrigo Calado
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Márcia Jorge Castejon
- Instituto Adolfo Lutz, Controle de Doenças, Secretaria de Estado da Saúde de São Paulo, Brazil
| | - Rosemeire Yamashiro
- Instituto Adolfo Lutz, Controle de Doenças, Secretaria de Estado da Saúde de São Paulo, Brazil
| | | | - Caitlin Turner
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA USA
| | - Jess Lin
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Erin C Wilson
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA USA
| | - Willi McFarland
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA USA
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16
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Gyamerah AO, Baguso G, Santiago-Rodriguez E, Sa'id A, Arayasirikul S, Lin J, Turner CM, Taylor KD, McFarland W, Wilson EC, Wesson P. Experiences and factors associated with transphobic hate crimes among transgender women in the San Francisco Bay Area: comparisons across race. BMC Public Health 2021; 21:1053. [PMID: 34078334 PMCID: PMC8173924 DOI: 10.1186/s12889-021-11107-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 05/17/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Trans women experience high rates of gender-based violence (GBV)-a risk factor for adverse health outcomes. Transphobic hate crimes are one such form of GBV that affect trans women. However, little is understood about factors that shape transphobic hate crimes and racial/ethnic variation in these experiences. To contextualize GBV risk and police reporting, we examined self-reported types and correlates of transphobic hate crimes by racial/ethnic group of trans women in the San Francisco Bay Area. METHODS From 2016 to 2018, trans women participated in a longitudinal cohort study of HIV. Secondary data analyses (N = 629) examined self-reported experiences of transphobic hate crimes (i.e., robbery, physical assault, sexual assault, and battery with weapon) by race/ethnicity, and whether hate crimes were reported to the police. Chi-square tests and simple logistic regression examined demographic, sociocultural, and gender identity factors associated with transphobic violence experiences and police reporting. RESULTS About half (45.8%) of participants reported ever experiencing a transphobic hate crime; only 51.1% of these were reported to the police. Among those who reported a hate crime experience, Black (47.9%) and Latina (49.0%) trans women reported a higher prevalence of battery with a weapon; White (26.7%) and trans women of "other" race/ethnicities (25.0%) reported a higher prevalence of sexual assault (p = 0.001). Having one's gender questioned, history of sex work, homelessness as a child and adult, and a history incarceration were associated with higher odds of experiencing a transphobic hate crime. Trans women who felt their gender identity questioned had lower odds of reporting a hate crime to the police compared to those did not feel questioned. CONCLUSIONS A high proportion of trans women experienced a transphobic hate crime, with significant socio-structural risk factors and racial differences by crime type. However, crimes were underreported to the police. Interventions that address structural factors, especially among trans women of color, can yield violence prevention benefits.
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Affiliation(s)
- Akua O Gyamerah
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, California, USA.
- Department of Community Health Systems, School of Nursing, University of California, 2 Koret Way, San Francisco, CA, 94143, USA.
| | - Glenda Baguso
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, California, USA
| | - Edda Santiago-Rodriguez
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, California, USA
| | - Aria Sa'id
- Transgender District, San Francisco, USA
| | - Sean Arayasirikul
- San Francisco Department of Public Health, Trans Research Unit for Equity, San Francisco, USA
| | - Jess Lin
- Department of Public Health, Center for Public Health Research, San Francisco, USA
| | - Caitlin M Turner
- San Francisco Department of Public Health, Trans Research Unit for Equity, San Francisco, USA
| | - Kelly D Taylor
- Institute for Global Health Sciences, University of California, San Francisco, USA
| | - Willi McFarland
- Department of Public Health, Center for Public Health Research, San Francisco, USA
| | - Erin C Wilson
- Department of Public Health, Center for Public Health Research, San Francisco, USA
| | - Paul Wesson
- Department of Epidemiology & Biostatistics, University of California, San Francisco, USA
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17
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Wesson P, Vittinghoff E, Turner C, Arayasirikul S, McFarland W, Wilson E. Intercategorical and Intracategorical Experiences of Discrimination and HIV Prevalence Among Transgender Women in San Francisco, CA: A Quantitative Intersectionality Analysis. Am J Public Health 2021; 111:446-456. [PMID: 33476238 PMCID: PMC7893335 DOI: 10.2105/ajph.2020.306055] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2020] [Indexed: 11/04/2022]
Abstract
Objectives. To examine differences in HIV prevalence and experiences of discrimination within the trans women community in California's San Francisco Bay Area.Methods. Intersectional positions were constructed on the basis of race/ethnicity (non-Hispanic White, non-Hispanic Black, Latina) and gender identity (female identifying, transgender identifying). We used baseline data from the Trans*National study (2016-2017) to construct regression models that estimated racial/ethnic differences in the attribution of discrimination experienced and, along with surrogate measures for intersectionality, estimated risk among those who were dually marginalized (racial/ethnic minority and transgender identifying). Margins plots were used to visually compare absolute risk across all intersectional positions.Results. Black and Latina trans women were more likely to be HIV positive than non-Hispanic White trans women. In several of the study domains, we estimated a lower risk of reporting discrimination among dually marginalized trans women than among White female-identifying trans women.Conclusions. Quantitative intersectionality methods highlight the diversity of experiences within the trans women community and reveal potential measurement challenges. Despite facing multiple forms of systemic marginalization, racial/ethnic minority trans women report less discrimination than White trans women. Subjective reporting of discrimination likely undercounts risks among racial/ethnic minorities.
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Affiliation(s)
- Paul Wesson
- Paul Wesson, Eric Vittinghoff, and Caitlin Turner are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Sean Arayasirikul, Willi McFarland, and Erin Wilson are with the Center for Public Health Research, San Francisco Department of Public Health
| | - Eric Vittinghoff
- Paul Wesson, Eric Vittinghoff, and Caitlin Turner are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Sean Arayasirikul, Willi McFarland, and Erin Wilson are with the Center for Public Health Research, San Francisco Department of Public Health
| | - Caitlin Turner
- Paul Wesson, Eric Vittinghoff, and Caitlin Turner are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Sean Arayasirikul, Willi McFarland, and Erin Wilson are with the Center for Public Health Research, San Francisco Department of Public Health
| | - Sean Arayasirikul
- Paul Wesson, Eric Vittinghoff, and Caitlin Turner are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Sean Arayasirikul, Willi McFarland, and Erin Wilson are with the Center for Public Health Research, San Francisco Department of Public Health
| | - Willi McFarland
- Paul Wesson, Eric Vittinghoff, and Caitlin Turner are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Sean Arayasirikul, Willi McFarland, and Erin Wilson are with the Center for Public Health Research, San Francisco Department of Public Health
| | - Erin Wilson
- Paul Wesson, Eric Vittinghoff, and Caitlin Turner are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Sean Arayasirikul, Willi McFarland, and Erin Wilson are with the Center for Public Health Research, San Francisco Department of Public Health
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18
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High HIV Incidence Among Young and Racial/Ethnic Minority Transgender Women in San Francisco: Results of a Longitudinal Cohort Study. J Acquir Immune Defic Syndr 2020; 84:e7-e10. [PMID: 32032305 DOI: 10.1097/qai.0000000000002315] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Hernandez CJ, Santos GM, Wilson EC. Association of Documentation of Legal Residency Status with Nonprescribed Hormone Use Among Hispanic/Latina Trans Women in San Francisco. Health Equity 2020; 4:263-271. [PMID: 34095696 PMCID: PMC8175253 DOI: 10.1089/heq.2019.0104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2020] [Indexed: 11/13/2022] Open
Abstract
Undocumented immigrant trans Latinas face significant barriers to attaining gender-affirming health care and may use nonprescribed feminizing hormones. Without medical supervision, nonprescribed hormone use may lead to adverse health outcomes. This study aimed to determine if a history of being an undocumented immigrant was associated with nonprescribed hormone use among trans Latinas. We conducted a secondary analysis using baseline data from the 2016 Trans National study done in the San Francisco Bay Area. Two hundred five trans Latinas participated in the study, of whom 75 (37%) reported a history of being undocumented. We fitted a multivariable logistic regression model to determine whether having a history of being an undocumented immigrant was associated with nonprescribed hormone use while controlling for age, income, time living in San Francisco, history of sex work, and history of problems with accessing health care. The prevalence of nonprescribed hormone use was 55.9% among trans Latinas overall; however, for trans Latinas with a history of undocumented immigration status, the prevalence was 68%. There was a significant, independent association between nonprescribed hormone use and undocumented status (adjusted odds ratio [aOR]=3.20; 95% confidence interval [CI]=1.47–6.97). We also found that having a history of sex work was associated with nonprescribed hormone use (aOR=5.72; 95% CI=2.69–12.18). The prevalence of nonprescribed hormone use among trans Latinas was high and is associated with a history of undocumented status and sex work. These associations may indicate health care avoidance related to concerns of being criminalized due to their documentation status or source of income (i.e., sex work) among trans Latinas. These findings underscore the need to reduce barriers in gender-affirming care to increase access to medically supervised hormone use, particularly among individuals with a history of undocumented status and engaged in sex work.
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Affiliation(s)
- Christopher J Hernandez
- University of California, Berkeley School of Public Health, Division of Infectious Diseases and Vaccinology, Berkeley, California, USA.,San Francisco Department of Public Health, San Francisco, California, USA
| | - Glenn-Milo Santos
- San Francisco Department of Public Health, San Francisco, California, USA.,University of California, San Francisco, School of Nursing, California, San Francisco, USA
| | - Erin C Wilson
- San Francisco Department of Public Health, San Francisco, California, USA.,University of California, San Francisco, Department of Epidemiology & Biostatistics, San Francisco, USA
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