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Dearolf MH, D’Angelo AB, Grov C. 'You have to trust their word': transmasculine experiences with sex partners and safety during the early COVID-19 outbreak. CULTURE, HEALTH & SEXUALITY 2024; 26:77-92. [PMID: 36929822 PMCID: PMC10505243 DOI: 10.1080/13691058.2023.2187093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
The early months of the SARS-CoV2 pandemic exacerbated health disparities for vulnerable populations, including transgender (trans) communities, creating unique challenges for navigating sex and dating. This paper aims to expand upon the current literature regarding transmasculine populations by capturing their lived experiences during this critical time. We interviewed 20 assigned female sex at birth (AFAB) adults of the transmasculine spectrum - men, nonbinary, and transmasculine individuals - about their social and sexual experiences in the USA in May and June 2020. Transcripts were analysed using an inductive thematic approach. We found that sex drive decreased and uncertainty about health risks increased. Some participants found alternate ways to date and hook-up that reduced their COVID-19 risk, such as engaging in online sex (e.g. sexting, dating apps). Others expressed discomfort using virtual platforms for both personal/work and sexual lives, along with nuanced feelings around being objectified, compared to pornography, and fetishised as trans bodies. COVID-related shutdowns of queer spaces also amplified pre-existing concerns about interpersonal safety and rejection. When seeking new partners, participants sought behavioural characteristics that instilled trust. Future public health communications can take advantage of safety and sexual health strategies already present in trans communities to bolster wellbeing in trans lives.
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Affiliation(s)
- Michelle H. Dearolf
- Department of Community Health and Social Sciences, City University of New York (CUNY) Graduate School of Public Health and Health Policy, New York, NY, USA
- CUNY Institute for Implementation Science in Population Health (ISPH), New York, NY, USA
| | - Alexis B. D’Angelo
- Department of Community Health and Social Sciences, City University of New York (CUNY) Graduate School of Public Health and Health Policy, New York, NY, USA
- CUNY Institute for Implementation Science in Population Health (ISPH), New York, NY, USA
| | - Christian Grov
- Department of Community Health and Social Sciences, City University of New York (CUNY) Graduate School of Public Health and Health Policy, New York, NY, USA
- CUNY Institute for Implementation Science in Population Health (ISPH), New York, NY, USA
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Lapadula G, Soria A, Modesti M, Vecchi A, Sabbatini F, Monopoli A, Squillace N, Lungu E, Coloma J, Columpsi P, Cristiano V, Bonfanti P. Behavioural survey and street-based HIV and HCV rapid testing programme among transgender sex workers. Sex Transm Infect 2023; 99:41-46. [PMID: 35351815 DOI: 10.1136/sextrans-2021-055270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 03/14/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Transgender women sex workers (TGW-SW) are disproportionally affected by HIV and have reduced access to testing. Moreover, information regarding their behaviours and health needs is scarce. METHODS A behavioural survey and a targeted testing programme in prostitution sites were conducted in Milan and Monza areas. The non-profit organisation 'ALA Milano Onlus' and 'San Gerardo' Hospital (Monza) implemented a mobile HIV testing unit involving a TGW peer educator, four physicians, a counsellor, a psychologist and a cultural mediator. All TGW-SW were offered anonymous HIV and hepatitis C virus (HCV) oral testing and asked to fill a questionnaire on sexual habits, drug abuse, and knowledge and attitudes towards HIV and STDs. RESULTS Between May and July 2017, 130 TGW-SW, predominantly migrants, were contacted during 15 street visits; among them, 78 (60%) were interviewed. HIV and HCV testing were accepted by 53 (42%) and 67 (52%) TGW-SW, respectively. Twenty-five (19.8%) subjects who reported already established HIV infection were not retested. Seven patients received a new diagnosis of HIV, while nobody tested positive for HCV. Overall, HIV prevalence was 13.2% (25% including those with already known HIV infection). Recent arrival in Italy and young age were associated with risk of undiagnosed HIV infection. Inconsistent condom use was commonly reported during commercial sex (27%) and with non-commercial partners (64%). Alcohol and cocaine abuse were common problems which facilitated risky behaviours. CONCLUSIONS Oral rapid HIV and HCV testing for TGW-SW in outreach settings were feasible and acceptable and led to a considerable number of new diagnoses. Interventions tailored to TGW-SW, focused on HIV prevention, testing and engagement in care, are fundamental.
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Affiliation(s)
- Giuseppe Lapadula
- School of Medicine, University of Milan-Bicocca, Monza, Italy .,Clinic of Infectious Diseases, San Gerardo Hospital - ASST Monza, Monza, Italy
| | - Alessandro Soria
- Clinic of Infectious Diseases, San Gerardo Hospital - ASST Monza, Monza, Italy
| | | | | | - Francesca Sabbatini
- Clinic of Infectious Diseases, San Gerardo Hospital - ASST Monza, Monza, Italy
| | | | - Nicola Squillace
- Clinic of Infectious Diseases, San Gerardo Hospital - ASST Monza, Monza, Italy
| | | | | | - Paola Columpsi
- Clinic of Infectious Diseases, San Gerardo Hospital - ASST Monza, Monza, Italy
| | | | - Paolo Bonfanti
- School of Medicine, University of Milan-Bicocca, Monza, Italy.,Clinic of Infectious Diseases, San Gerardo Hospital - ASST Monza, Monza, Italy
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Byrne JL, Tan KKH, Saxton PJ, Bentham RM, Veale JF. PrEP awareness and protective barrier negotiation among transgender people attracted to men in Aotearoa New Zealand. J Int AIDS Soc 2022; 25 Suppl 5:e25980. [PMID: 36225159 PMCID: PMC9557014 DOI: 10.1002/jia2.25980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 07/30/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Internationally, trans women are disproportionately impacted by HIV, encounter specific barriers navigating safer sex and face inequities accessing HIV prevention, including pre‐exposure prophylaxis (PrEP). Aotearoa/New Zealand (hereafter Aotearoa) was one of the first countries internationally to publicly fund PrEP in 2018, including for trans people. However, few data exist on PrEP awareness or sexual negotiation among trans populations to guide implementation. We present the first Aotearoa data on trans people's ability to negotiate barrier protection and awareness of PrEP efficacy and availability. Methods We used data from a large, diverse community‐based nationwide survey of trans (including non‐binary) people in Aotearoa: Counting Ourselves (N = 1178) conducted from 21 June to 30 September 2018. Generalized regression analyses were carried out among participants who have had sex (n = 704; Mage = 32.5) to identify associations between demographic factors (age, gender and sexual attraction, ethnicity, income, education qualification and current sex work involvement) and the Trans‐Specific Barrier Negotiation Self‐Efficacy (T‐Barrier) Scale and PrEP awareness. Results The mean value of a 40‐point T‐Barrier Scale was 33.45 (SD: 6.89), suggesting a relatively high perceived ability among our participants to negotiate protective barrier usages in different situations. Asian participants scored 3.46 points lower compared to Pākehā (White) participants, and trans women attracted to men (cisgender and/or trans men) scored 2.40 points higher than trans women not attracted to men. Three‐fifths (59.7%) were aware that PrEP reduced HIV risks and did not prevent sexually transmitted infections (STI) transmission, and only two‐fifths (40.2%) knew PrEP was publicly funded for trans people. In multivariate models, we found participants who were older, trans women or those with lower education qualifications were less likely to have increased levels of PrEP awareness. Conclusions Participants attracted to men have a higher potential need for PrEP and were more likely to report PrEP awareness and that they could negotiate protective barrier usage. However, trans women and those with lower educational qualifications reported lower levels of PrEP awareness. More trans‐competent sexual health education, drawing on the newly released PrEP guidelines, is needed to promote the benefits of PrEP in the Aotearoa HIV epidemic context, particularly for trans women.
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Affiliation(s)
- Jack L. Byrne
- Trans Health Research LabSchool of PsychologyUniversity of WaikatoHamiltonNew Zealand
| | - Kyle K. H. Tan
- Trans Health Research LabSchool of PsychologyUniversity of WaikatoHamiltonNew Zealand,Faculty of Māori and Indigenous StudiesUniversity of WaikatoHamiltonNew Zealand
| | - Peter J. Saxton
- School of Population HealthFaculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand,AIDS Epidemiology GroupDepartment of Preventive and Social MedicineUniversity of OtagoDunedinNew Zealand
| | - Ryan M. Bentham
- Trans Health Research LabSchool of PsychologyUniversity of WaikatoHamiltonNew Zealand
| | - Jaimie F. Veale
- Trans Health Research LabSchool of PsychologyUniversity of WaikatoHamiltonNew Zealand
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Abdilah A, Kadir H, Mani K, Muthiah G. Effectiveness of a Safe Sex Education Module in Improving Condom Use among People Living with HIV: A Randomised Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10004. [PMID: 36011639 PMCID: PMC9408083 DOI: 10.3390/ijerph191610004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/11/2022] [Accepted: 03/11/2022] [Indexed: 06/15/2023]
Abstract
The Human Immunodeficiency Virus (HIV) epidemic in Malaysia has transitioned to occurring through more sexual transmission than injecting drugs in 2018. According to reports, the increase was caused by poor condom compliance and a lack of health programmes to prevent sexually transmitted infections (STIs) among people living with HIV (PLWH). The purpose of the study was to create, implement, and evaluate the impact of a safe sex education module on condom use among PLWH. A single-blinded, parallel randomised controlled trial was conducted at Seremban district. The intervention group received additional health information geared toward safe sex education based on Social Cognitive Theory (SCT). The study primary analysis was the intention to treat, and the overall effects of the intervention were assessed using a generalised linear mixed model (GLMM). There was no significant difference between groups in terms of sociodemographics, sexual history, mean condom usage frequency score, or STI incidence at the study baseline. Receiving the module was linked to increased condom usage frequency (β = 1.228, % CI = 0.850, 1.606). When compared to conventional treatment provided in Seremban health clinics, this module effectively increases condom usage frequency among PLWH.
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Affiliation(s)
- Azline Abdilah
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Hayati Kadir
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
- Malaysian Research Institute of Ageing (MyAgeing), Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Kulanthayan Mani
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Ganesh Muthiah
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
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Alpert AB, Scout NFN, Schabath MB, Adams S, Obedin-Maliver J, Safer JD. Gender- and Sexual Orientation- Based Inequities: Promoting Inclusion, Visibility, and Data Accuracy in Oncology. Am Soc Clin Oncol Educ Book 2022; 42:1-17. [PMID: 35658501 DOI: 10.1200/edbk_350175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Sexual and gender minority (SGM) people, including agender, asexual, bisexual, gay, gender diverse, genderqueer, genderfluid, intersex, lesbian, nonbinary, pansexual, queer, and transgender people, comprise approximately 10% or more of the U.S. population. Thus, most oncologists see SGM patients whether they know it or not. SGM people experience stigma and structural discrimination that lead to cancer disparities. Because of the lack of systematic and comprehensive data collection, data regarding SGM cancer incidence, outcomes, and treatment responses are limited. Collection of data regarding sexual orientation, gender identity, transgender identity and/or experience, anatomy, and serum hormone concentrations in oncology settings would drastically increase collective knowledge about the impact of stigma and biologic markers on cancer outcomes. Increasing the safety of oncology settings for SGM people will require individual, institutional, and systems changes that will likely improve oncologic care for all patients.
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Affiliation(s)
- Ash B Alpert
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI.,Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
| | - N F N Scout
- National LGBT Cancer Network, Providence, RI
| | - Matthew B Schabath
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Spencer Adams
- School of Interdisciplinary Health Programs, Western Michigan University, Kalamazoo, MI
| | - Juno Obedin-Maliver
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, CA
| | - Joshua D Safer
- Division of Endocrinology, Icahn School of Medicine at Mount Sinai, New York, NY.,Mount Sinai Center for Transgender Medicine and Surgery, New York, NY
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Dacakis G, Erasmus J, Nygren U, Oates J, Quinn S, Södersten M. Development and Initial Psychometric Evaluation of the Self-Efficacy Scale for Voice Modification in Trans Women. J Voice 2022:S0892-1997(22)00078-9. [PMID: 35513936 DOI: 10.1016/j.jvoice.2022.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To develop a self-efficacy questionnaire for voice modification related to gender affirmation and to examine the internal consistency and test-retest reliability of the questionnaire among a cohort of trans women. METHODS This study was undertaken in two phases. In phase I, four Speech- Language Pathologists (SLPs) and four trans women informed the development of the Self-Efficacy Scale for Voice Modification in Trans Women (SES-VMTW). In phase II, using classical test theory, data from 31 Australian and 27 Swedish trans women who completed the SES-VMTW twice with an interim period of 3-6 weeks were analyzed for internal consistency and test-retest reliability. During this second phase, the 19 items of the SES-VMTW were subcategorized by consensus among the authors into like groups. RESULTS Phase I resulted in the 19-item SES-VMTW and four subcategories were identified: 1) Change (items related to changing voice); 2) Perception (items related to the ability to perceive changes in voice; 3) Psychological (items related to engaging in voice practice despite psychological barriers; 4) Logistical (items related to engaging in voice practice despite logistical barriers). In Phase II, initial psychometric analysis was applied to the full questionnaire as well as to the subcategories. The Cronbach's alpha for the full questionnaire (α = 0.86) at both the test and retest timepoints indicates a high level of internal consistency. Item-total correlation analysis indicated that individual items correlated with the questionnaire total score, but that they generally correlated more strongly with the total score for the relevant subcategory. The Cronbach's alpha for the four subcategories of the SES-VMTW were variable but all coefficients exceeded 0.6, thus supporting the reliability of the new scale. Good test-retest reliability was demonstrated for the full questionnaire (intraclass correlation coefficient = 0.84; 95% confidence interval, 0.73-0.90, P < 0.001) and was moderate to good for the four subcategories. CONCLUSION The findings of the current study are promising, suggesting that both the full SES-VMTW and the four subcategories can provide consistent and reliable insight into self-efficacy for trans women aiming to modify their voice as part of their gender affirmation.
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Affiliation(s)
- Georgia Dacakis
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.
| | - Jaco Erasmus
- Gender Clinic, Monash Health, Clayton, Victoria, Australia
| | - Ulrika Nygren
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Jennifer Oates
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Sterling Quinn
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Maria Södersten
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden
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