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Fein LA, Brenner S, Nogueira NF, Salazar AS, Rodriguez AE, Jones DL, Alcaide ML. Low Levels of HIV Stigma Among Transgender Women Receiving HIV Care. Transgend Health 2024; 9:180-184. [PMID: 38585240 PMCID: PMC10998008 DOI: 10.1089/trgh.2021.0191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Despite the prevalence of HIV among transgender women (TGW), gaps exist in understanding the impact of HIV-related stigma (HRS) on TGW with HIV. This is a small cross-sectional pilot study examining HRS in TGW (n=18) with HIV in Miami, FL, who completed a survey during an HIV clinical visit. In contrast with previous studies, results demonstrated low levels of HRS and suggest the potential of increasing acceptance of TGW with HIV as a contributing factor. Larger studies are needed to explore factors underlying HRS with the aim of further reducing stigma among TGW with HIV.
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Affiliation(s)
- Lydia A. Fein
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sara Brenner
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nicholas F. Nogueira
- Division of Infectious Disease, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ana S. Salazar
- Division of Infectious Disease, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Allan E. Rodriguez
- Division of Infectious Disease, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Deborah L. Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Maria L. Alcaide
- Division of Infectious Disease, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
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Kim R, Choo S, Lee H, Eom YJ, Yi H, Kim R, Kim SS. Does discrimination prevent transgender and gender diverse people from seeking healthcare?: A nationwide cohort study in South Korea. Int J Transgend Health 2023; 25:283-294. [PMID: 38681498 PMCID: PMC11044721 DOI: 10.1080/26895269.2023.2215750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Introduction Using Asia's first nationwide cohort dataset, this study aimed to assess the prevalence of anti-transgender discrimination and healthcare avoidance and delay (HAD) and examine their associations among transgender and gender diverse (TGD) adults in South Korea. Methods We analyzed a two-wave (2020-2021) longitudinal dataset of 190 Korean TGD adults. Anti-transgender discrimination were classified accordingly: experienced at (1) neither wave, (2) baseline (2020) only, (3) follow-up (2021) only, and (4) both waves. We also asked about HAD in the past 12 months at follow-up for both transition-related and non-transition-related healthcare services. Multivariate modified Poisson regression was used to examine the associations between anti-transgender discrimination and HAD. Results Of 190 participants, 102 (53.7%) experienced anti-transgender discrimination at both waves, and 130 (68.4%) reported HAD at follow-up. Compared to those without any experiences of anti-transgender discrimination, those who experienced it in both waves had a 1.78-times (95% CI: 1.21-2.63) higher prevalence of non-transition-related HAD, but not among those who experienced it in either wave. In contrast, anti-transgender discrimination was not associated with transition-related HAD. Conclusion In order to enhance healthcare access for transgender and gender diverse (TGD) individuals, it is necessary to implement interventions, such as anti-discrimination laws, that protect them from discrimination.
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Affiliation(s)
- Ranyeong Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Sungsub Choo
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Hyemin Lee
- Healthcare Policy Team, Jeju Institute of Public Health & Health Policy, Jeju, Republic of Korea
| | - Yun-Jung Eom
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Horim Yi
- Solidarity for LGBT Human Rights of Korea, Seoul, Republic of Korea
| | - Rockli Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts, USA
| | - Seung-Sup Kim
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Stevens J. Transgender and Gender Diverse Youth in Inpatient and Other Residential Care. Child Adolesc Psychiatr Clin N Am 2023; 32:849-866. [PMID: 37739639 DOI: 10.1016/j.chc.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
Inpatient and other residential care environments require special considerations for safety and unique opportunities to provide affirming care to TGD youth. Gender-positive policies, staff training, communication, placement, programming, and discharge planning are imperative; however, data and literature are limited in regard to affirming the care of TGD youth in such environments. This chapter draws from published research and best practice to support the wellness of TGD individuals in inpatient and similar settings. It offers clinical guidance for an organization's clinicians, administrators, educators, and advocates to provide safer and more effective care for TGD youth in such facilities to best support their mental and physical health.
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Affiliation(s)
- Jaime Stevens
- Affirming Psychiatry LLC, University of Hawai'i, PO Box 22148, Honolulu, HI 96823, USA.
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Folayan MO, Yakusik A, Enemo A, Sunday A, Muhammad A, Nyako HY, Abdullah RM, Okiwu H, Lamontagne E. Socioeconomic inequality, health inequity and well-being of transgender people during the COVID-19 pandemic in Nigeria. BMC Public Health 2023; 23:1539. [PMID: 37573293 PMCID: PMC10422710 DOI: 10.1186/s12889-023-16482-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 08/08/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND We aimed to explore socioeconomic inequality, health inequity, and the well-being of transgender people during the COVID-19 crisis in Nigeria. METHODS Between June and December 2021, a cross-sectional survey was conducted collaboratively with community-based organisations in Nigeria. Participants living with or at risk of HIV were recruited voluntarily, online and face-to-face, using a combination of venue-based and snowball sampling. We assessed the association between gender identity (transgender and vulnerable cisgender women), and (i) socioeconomic inequality measured with socioeconomic status, social status, economic vulnerability, macrosocial vulnerability; (ii) health inequity measured with self-assessment of health, recency of HIV test, access to HIV and sexual and reproductive health services, gender-affirming care, financial and non-financial barriers to accessing health services; and (iii) well-being, measured with gender-based violence, mental health, psychoeconomic preferences. We used multivariable logistic regressions and controlled for interactions and confounders. RESULTS There were 4072 participants; 62% were under 30, and 47% reported living with HIV. One in ten (11.9%; n = 485) was transgender, and 56.5% reported living with HIV. Compared to vulnerable cisgender women, the results showed significantly higher odds (aOR:3.80) of disruption in accessing HIV services in transgender participants; gender-based violence (aOR:2.63); severe (aOR:2.28) symptoms of anxiety and depression. Among the barriers to accessing health and HIV services, transgender had three-time higher odds of reporting additional non-official fees compared to vulnerable cisgender women. The disclosure of their gender identity or sexual orientation was the most important non-financial barrier to accessing health services (aOR:3.16). Transgender participants faced higher housing insecurity (aOR: 1.35) and lower odds of using drugs (aOR:0.48). Importantly, they are more likely to have performed a recent HIV test and less likely to not know their HIV status (aOR:0.38) compared to vulnerable cisgender women. CONCLUSIONS Socioeconomic inequality, health and well-being inequity in transgender people appear to be exacerbated by the COVID-19 pandemic in Nigeria. Interventions are necessary to mitigate socioeconomic challenges, address structural inequality, and ensure equitable access to health services to meet the Sustainable Development Goals for transgender people.
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Affiliation(s)
- Morenike Oluwatoyin Folayan
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria.
- Nigeria Institute of Medical Research, Yaba, Lagos State, Nigeria.
| | - Anna Yakusik
- Joint United Nations Programme on HIV/AIDS, CH, Geneva, Switzerland
| | - Amaka Enemo
- Nigeria Sex Workers Association, Kubwa, Nigeria
| | - Aaron Sunday
- African Network of Adolescent and Young Persons Development, Barnawa, Nigeria
| | - Amira Muhammad
- Northern Nigerian Transgender Initiative, Abuja, Nigeria
| | | | | | | | - Erik Lamontagne
- Joint United Nations Programme on HIV/AIDS, CH, Geneva, Switzerland
- School of Economics, Aix-Marseille University, Marseille, France
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Solovieva NV, Makarova EV, Kremenitskaya SA. Transgender population in the Russian Federation: diversity and trends. Eur J Transl Myol 2023. [PMID: 37325930 PMCID: PMC10388604 DOI: 10.4081/ejtm.2023.11419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/29/2023] [Indexed: 06/17/2023] Open
Abstract
This report presents socio-demographic data of gender incongruent patients, searching for gender affirming medical care (GAMC) in Russia by retrospective medical records analysis of patients. Data of 1117 patients were included in the analysis. Over the period from 2014 to 2021, there was a significant increase in the number of applications (+123.2%). Among all transgender individuals 44.01% were trans femine (MtF) and 55.99% (n=630) were trans masculine (FtM), 1.2% was non-binary persons. The average age for GAMC application in MtF was 26 years and in FtM was 23 years. Majority of patients experienced gender incongruence (GI) since pre-pubertal age (median 11.0). Age of acceptance oneself as a "transgender " was 17.0 years, earlier in FtM, later in MtF. The first coming-out was made at 20 (22 for MtF, 19 for FtM). Depression was diagnosed in 82,4% cases,12.6% of patients have suicide attempts. 53.6%, were already taking hormonal therapy (76.7% MtF, 32.3% FtM). The Russian transgender population is big, stigmatized, ethnically and culturally heterogeneous group, that has little visibility. Further research is essentials for formation of professional attitude in the medical environment.
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Affiliation(s)
- Nadezhda V Solovieva
- JCS "Scientific Center of Personalized Medicine", Moscow, Russia; N.A. Semashko National Research Institute of Public Health, Moscow.
| | - Ekaterina V Makarova
- University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow.
| | - Svetlana A Kremenitskaya
- JCS "Scientific Center of Personalized Medicine", Moscow, Russia; N.A. Semashko National Research Institute of Public Health, Moscow.
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Wirtz AL, Humes E, Althoff KN, Poteat TC, Radix A, Mayer KH, Schneider JS, Haw JS, Wawrzyniak AJ, Cannon CM, Stevenson M, Cooney EE, Adams D, Case J, Beyrer C, Laeyendecker O, Rodriguez AE, Reisner SL. HIV incidence and mortality in transgender women in the eastern and southern USA: a multisite cohort study. Lancet HIV 2023; 10:e308-e319. [PMID: 36868260 PMCID: PMC10164681 DOI: 10.1016/s2352-3018(23)00008-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Epidemiological monitoring of HIV among transgender women is minimal despite prioritisation of this group in the US National HIV/AIDS Strategy (2022-2025). We aimed to estimate HIV incidence in a multisite cohort of transgender women in the eastern and southern USA. Participant deaths were identified during follow-up; thus, we felt it was an ethical imperative to report mortality alongside HIV incidence. METHODS In this study, we established a multisite cohort across two modes: a site-based, technology-enhanced mode in six cities (Atlanta, Baltimore, Boston, Miami, New York City, and Washington, DC) and an exclusively digital mode that spanned 72 eastern and southern US cities that matched the six site-based cities based on population size and demographics. Trans feminine adults (≥18 years) who were not living with HIV were eligible and followed up for at least 24 months. Participants completed surveys and oral fluid HIV testing with clinical confirmation. We ascertained deaths through community and clinical sources. We estimated HIV incidence and mortality using the number of HIV seroconversions and deaths, respectively, divided by person-years accumulated from enrolment. Logistic regression models were used to identify predictors of HIV seroconversion (primary outcome) or death. FINDINGS Between March 22, 2018, and Aug 31, 2020, we enrolled 1312 participants with 734 (56%) in site-based and 578 (44%) in digital modes. At the 24-month assessment, 633 (59%) of 1076 eligible participants consented to extending participation. 1084 (83%) of 1312 participants were retained at this analysis based on the study definition of loss to follow-up. As of May 25, 2022, the cohort participants had contributed 2730 accumulated person-years to the analytical dataset. Overall HIV incidence was 5·5 (95% CI 2·7-8·3) per 1000 person-years and incidence was higher among Black participants and those living in the south. Nine participants died during the study. The overall mortality rate was 3·3 (95% CI 1·5-6·3) per 1000 person-years, and the rate was higher among Latinx participants. Identical predictors of HIV seroconversion and death included residence in southern cities, sexual partnerships with cisgender men, and use of stimulants. Participation in the digital cohort and seeking care for gender transition were inversely associated with both outcomes. INTERPRETATION As HIV research and interventions are increasingly delivered online, differences by mode highlight the need for continued community and location-based efforts to reach the most marginalised transgender women. Our findings underscore community calls for interventions that address social and structural contexts that affect survival and other health concerns alongside HIV prevention. FUNDING National Institutes of Health. TRANSLATION For the Spanish translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Andrea L Wirtz
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA; Department of International Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Elizabeth Humes
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Tonia C Poteat
- Center for Health Equity Research, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Asa Radix
- Callen-Lorde Community Health Center, New York, NY, USA
| | - Kenneth H Mayer
- Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Jason S Schneider
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - J Sonya Haw
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Andrew J Wawrzyniak
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | | | - Meg Stevenson
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
| | - Erin E Cooney
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA; Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | - Dee Adams
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
| | - James Case
- Johns Hopkins Bloomberg School of Public Health, School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Chris Beyrer
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA; Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Oliver Laeyendecker
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Allan E Rodriguez
- Division of Infectious Diseases, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Sari L Reisner
- Department of Medicine, Harvard University, Boston, MA, USA; Harvard Medical School and Department of Epidemiology, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA; Division of Endocrinology, Diabetes, and Hypertension, Brigham Women's Hospital, Boston, MA, USA
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Nguyen TT, Do AL, Nguyen LH, Vu GT, Dam VAT, Latkin CA, Hall BJ, Ho CSH, Zhang MWB, Ho RCM. Scholarly literature in HIV-related lesbian, gay, bisexual, and transgender studies: A bibliometric analysis. Front Psychol 2023; 14:1028771. [PMID: 36844310 PMCID: PMC9945527 DOI: 10.3389/fpsyg.2023.1028771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/13/2023] [Indexed: 02/11/2023] Open
Abstract
Introduction Lesbian, gay, bisexual, and transgendered (LGBT) people are marginalized and understudied. Analyzing research activity worldwide is vital to better understand their needs in confronting the HIV epidemic. This study aimed to evaluate the global literature to identify the research collaboration, content, and tendency in HIV-related issues among the LGBT populations. Methods Peer-reviewed original articles and reviews were achieved from the Web of Science Core Collection database. Country's collaborations and co-occurrence of most frequent terms were illustrated by VOSviewer software. The Latent Dirichlet Allocation (LDA) and the linear regression model were utilized to uncover the hidden topics and examine the research trend. Results From 1990 to 2019, a total of 13,096 publications were found. Stigma, sexual risk behaviors and HIV testing were the major topics in the LGBT research during the study period. Among 15 topics, topics about HIV/Sexually transmitted infections (STIs) prevalence, Outcomes of HIV/AIDS care and treatment, and Opportunistic infections in HIV-positive LGBT people showed decreasing attention over years, while other topics had a slight to moderate increase. Discussion Our study underlined the exponential growth of publications on the LGBT population in HIV research, and suggested the importance of performing regional collaborations in improving research capacity. Moreover, further research should focus on examining the manner to increase the coverage of HIV testing and treatment, as well as implement HIV-interventions with low cost and easy to scale-up.
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Affiliation(s)
- Tham Thi Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam,Faculty of Medicine, Duy Tan University, Da Nang, Vietnam,*Correspondence: Tham Thi Nguyen, ✉
| | - Anh Linh Do
- Institute of Health Economics and Technology, Hanoi, Vietnam
| | - Long Hoang Nguyen
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Giang Thu Vu
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, QLD, Australia
| | - Vu Anh Trong Dam
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam,Faculty of Medicine, Duy Tan University, Da Nang, Vietnam
| | - Carl A. Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Brian J. Hall
- School of Global Public Health, New York University, New York, NY, United States
| | - Cyrus S. H. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Melvyn W. B. Zhang
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Roger C. M. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore,Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
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Cunningham GB, Watanabe NM, Buzuvis E. Anti-transgender rights legislation and internet searches pertaining to depression and suicide. PLoS One 2022; 17:e0279420. [PMID: 36548266 PMCID: PMC9778603 DOI: 10.1371/journal.pone.0279420] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
The purpose of this study was to examine whether anti-transgender rights legislation among state legislators is associated with increased suicide- and depression-related Internet searches. Employing a quasi-experimental non-equivalent control group design, we focused on bills that were introduced to state legislatures from July 2019 to July 2020. As our panel is constructed of 51 states/territories over a 52-week time frame, our final dataset is composed of 2,652 observations. Results showed that states' passing of anti-transgender rights bills were linked with suicide- and depression-related Internet searches. Second, introducing or debating the bills did not have an association with Internet searches. Third, the defeat of anti-transgender bills was linked with fewer depression-related searches. Finally, the LGBT context in the state affected the results: anti-transgender legislation had a particularly strong association with suicide-related Internet searches when the state had a high LGBT population density.
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Affiliation(s)
- George B. Cunningham
- Laboratory for Diversity in Sport, Department of Sport Management, University of Florida, Gainesville, Florida, United States of America
- * E-mail:
| | - Nicholas M. Watanabe
- Department of Sport and Entertainment Management, University of South Carolina, Columbia, South Carolina, United States of America
| | - Erin Buzuvis
- School of Law at Western New England University, Springfield, Massachusetts, United States of America
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Pirnia B, Pirnia K. Sex Reassignment Surgery in Iran, Re-Birth or Human Rights Violations against Transgender People? Iran J Public Health 2022; 51:2632-2633. [PMID: 36561249 PMCID: PMC9745420 DOI: 10.18502/ijph.v51i11.11183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/23/2022] [Indexed: 11/21/2022]
Abstract
The Article Abstract is not available.
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Affiliation(s)
- Bijan Pirnia
- Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Corresponding Author:
| | - Kambiz Pirnia
- Bijan Center for Substance Abuse Treatment, Tehran, Iran
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Ziegler E, Charnish E, Carroll B, Layman-Pleet L. A Critical Review of Clinical Practice Guidelines for Care of Transgender and Gender Diverse Children and Youth for Use by Primary Care Practitioners. Transgend Health 2022; 7:397-406. [PMID: 36644485 PMCID: PMC9829138 DOI: 10.1089/trgh.2020.0185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose To examine and critique international clinical practice guidelines (CPGs) related to transgender and gender diverse children and youth and to assess the applicability of the guidelines to ethical and affirming primary care practice. Methods A review was conducted to obtain English language clinical guidelines. Guidelines were obtained from electronic databases, medical associations, government agencies, and community organizations. Guidelines were critiqued by all authors using the AGREE II instrument. Results Nine documents were reviewed. Overall, there was agreement among reviewers that the scope, purpose, and clarity of presentation of the guidelines was carried out well. Areas identified for improvement in all guidelines included clarity/rigor of methodologic development, inclusion of community stakeholders, and transparency of editorial independence. The Endocrine Society Clinical Practice Guideline scored highest overall. Despite lower overall scores, other guidelines were identified as having strengths of practical utility within primary care and/or in the discussion of specific social, ethical, and cultural considerations of transgender care in differing contexts worldwide. Conclusion The use of specific, high-quality CPGs can support primary care practitioners to provide gender-affirming care to children and youth. Methodologic improvement in the development of these CPGs is needed to ensure the best possible quality of care is being outlined.
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Affiliation(s)
- Erin Ziegler
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
| | - Erin Charnish
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
| | - Benjamin Carroll
- School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Leah Layman-Pleet
- Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
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Coleman E, Radix AE, Bouman WP, Brown GR, de Vries ALC, Deutsch MB, Ettner R, Fraser L, Goodman M, Green J, Hancock AB, Johnson TW, Karasic DH, Knudson GA, Leibowitz SF, Meyer-Bahlburg HFL, Monstrey SJ, Motmans J, Nahata L, Nieder TO, Reisner SL, Richards C, Schechter LS, Tangpricha V, Tishelman AC, Van Trotsenburg MAA, Winter S, Ducheny K, Adams NJ, Adrián TM, Allen LR, Azul D, Bagga H, Başar K, Bathory DS, Belinky JJ, Berg DR, Berli JU, Bluebond-Langner RO, Bouman MB, Bowers ML, Brassard PJ, Byrne J, Capitán L, Cargill CJ, Carswell JM, Chang SC, Chelvakumar G, Corneil T, Dalke KB, De Cuypere G, de Vries E, Den Heijer M, Devor AH, Dhejne C, D'Marco A, Edmiston EK, Edwards-Leeper L, Ehrbar R, Ehrensaft D, Eisfeld J, Elaut E, Erickson-Schroth L, Feldman JL, Fisher AD, Garcia MM, Gijs L, Green SE, Hall BP, Hardy TLD, Irwig MS, Jacobs LA, Janssen AC, Johnson K, Klink DT, Kreukels BPC, Kuper LE, Kvach EJ, Malouf MA, Massey R, Mazur T, McLachlan C, Morrison SD, Mosser SW, Neira PM, Nygren U, Oates JM, Obedin-Maliver J, Pagkalos G, Patton J, Phanuphak N, Rachlin K, Reed T, Rider GN, Ristori J, Robbins-Cherry S, Roberts SA, Rodriguez-Wallberg KA, Rosenthal SM, Sabir K, Safer JD, Scheim AI, Seal LJ, Sehoole TJ, Spencer K, St Amand C, Steensma TD, Strang JF, Taylor GB, Tilleman K, T'Sjoen GG, Vala LN, Van Mello NM, Veale JF, Vencill JA, Vincent B, Wesp LM, West MA, Arcelus J. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. Int J Transgend Health 2022; 23:S1-S259. [PMID: 36238954 PMCID: PMC9553112 DOI: 10.1080/26895269.2022.2100644] [Citation(s) in RCA: 455] [Impact Index Per Article: 227.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.
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Affiliation(s)
- E Coleman
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A E Radix
- Callen-Lorde Community Health Center, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - W P Bouman
- Nottingham Centre for Transgender Health, Nottingham, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - G R Brown
- James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
- James H. Quillen VAMC, Johnson City, TN, USA
| | - A L C de Vries
- Department of Child and Adolescent Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M B Deutsch
- Department of Family & Community Medicine, University of California-San Francisco, San Francisco, CA, USA
- UCSF Gender Affirming Health Program, San Francisco, CA, USA
| | - R Ettner
- New Health Foundation Worldwide, Evanston, IL, USA
- Weiss Memorial Hospital, Chicago, IL, USA
| | - L Fraser
- Independent Practice, San Francisco, CA, USA
| | - M Goodman
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - J Green
- Independent Scholar, Vancouver, WA, USA
| | - A B Hancock
- The George Washington University, Washington, DC, USA
| | - T W Johnson
- Department of Anthropology, California State University, Chico, CA, USA
| | - D H Karasic
- University of California San Francisco, San Francisco, CA, USA
- Independent Practice at dankarasic.com
| | - G A Knudson
- University of British Columbia, Vancouver, Canada
- Vancouver Coastal Health, Vancouver, Canada
| | - S F Leibowitz
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - H F L Meyer-Bahlburg
- New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
| | | | - J Motmans
- Transgender Infopunt, Ghent University Hospital, Gent, Belgium
- Centre for Research on Culture and Gender, Ghent University, Gent, Belgium
| | - L Nahata
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- Endocrinology and Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - T O Nieder
- University Medical Center Hamburg-Eppendorf, Interdisciplinary Transgender Health Care Center Hamburg, Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Hamburg, Germany
| | - S L Reisner
- Harvard Medical School, Boston, MA, USA
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - C Richards
- Regents University London, UK
- Tavistock and Portman NHS Foundation Trust, London, UK
| | | | - V Tangpricha
- Division of Endocrinology, Metabolism & Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - A C Tishelman
- Boston College, Department of Psychology and Neuroscience, Chestnut Hill, MA, USA
| | - M A A Van Trotsenburg
- Bureau GenderPRO, Vienna, Austria
- University Hospital Lilienfeld-St. Pölten, St. Pölten, Austria
| | - S Winter
- School of Population Health, Curtin University, Perth, WA, Australia
| | - K Ducheny
- Howard Brown Health, Chicago, IL, USA
| | - N J Adams
- University of Toronto, Ontario Institute for Studies in Education, Toronto, Canada
- Transgender Professional Association for Transgender Health (TPATH)
| | - T M Adrián
- Asamblea Nacional de Venezuela, Caracas, Venezuela
- Diverlex Diversidad e Igualdad a Través de la Ley, Caracas, Venezuela
| | - L R Allen
- University of Nevada, Las Vegas, NV, USA
| | - D Azul
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - H Bagga
- Monash Health Gender Clinic, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | - K Başar
- Department of Psychiatry, Hacettepe University, Ankara, Turkey
| | - D S Bathory
- Independent Practice at Bathory International PLLC, Winston-Salem, NC, USA
| | - J J Belinky
- Durand Hospital, Guemes Clinic and Urological Center, Buenos Aires, Argentina
| | - D R Berg
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J U Berli
- Oregon Health & Science University, Portland, OR, USA
| | - R O Bluebond-Langner
- NYU Langone Health, New York, NY, USA
- Hansjörg Wyss Department of Plastic Surgery, New York, NY, USA
| | - M-B Bouman
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Plastic Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - M L Bowers
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mills-Peninsula Medical Center, Burlingame, CA, USA
| | - P J Brassard
- GrS Montreal, Complexe CMC, Montreal, Quebec, Canada
- Université de Montreal, Quebec, Canada
| | - J Byrne
- University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa
| | - L Capitán
- The Facialteam Group, Marbella International Hospital, Marbella, Spain
| | | | - J M Carswell
- Harvard Medical School, Boston, MA, USA
- Boston's Children's Hospital, Boston, MA, USA
| | - S C Chang
- Independent Practice, Oakland, CA, USA
| | - G Chelvakumar
- Nationwide Children's Hospital, Columbus, OH, USA
- The Ohio State University, College of Medicine, Columbus, OH, USA
| | - T Corneil
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - K B Dalke
- Penn State Health, PA, USA
- Penn State College of Medicine, Hershey, PA, USA
| | - G De Cuypere
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
| | - E de Vries
- Nelson Mandela University, Gqeberha, South Africa
- University of Cape Town, Cape Town, South Africa
| | - M Den Heijer
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Endocrinology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - A H Devor
- University of Victoria, Victoria, BC, Canada
| | - C Dhejne
- ANOVA, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - A D'Marco
- UCTRANS-United Caribbean Trans Network, Nassau, The Bahamas
- D M A R C O Organization, Nassau, The Bahamas
| | - E K Edmiston
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - L Edwards-Leeper
- Pacific University, Hillsboro, OR, USA
- Independent Practice, Beaverton, OR, USA
| | - R Ehrbar
- Whitman Walker Health, Washington, DC, USA
- Independent Practice, Maryland, USA
| | - D Ehrensaft
- University of California San Francisco, San Francisco, CA, USA
| | - J Eisfeld
- Transvisie, Utrecht, The Netherlands
| | - E Elaut
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
- Department of Clinical Experimental and Health Psychology, Ghent University, Gent, Belgium
| | - L Erickson-Schroth
- The Jed Foundation, New York, NY, USA
- Hetrick-Martin Institute, New York, NY, USA
| | - J L Feldman
- Institute for Sexual and Gender Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A D Fisher
- Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy
| | - M M Garcia
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Departments of Urology and Anatomy, University of California San Francisco, San Francisco, CA, USA
| | - L Gijs
- Institute of Family and Sexuality Studies, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | | | - B P Hall
- Duke University Medical Center, Durham, NC, USA
- Duke Adult Gender Medicine Clinic, Durham, NC, USA
| | - T L D Hardy
- Alberta Health Services, Edmonton, Alberta, Canada
- MacEwan University, Edmonton, Alberta, Canada
| | - M S Irwig
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - A C Janssen
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - K Johnson
- RMIT University, Melbourne, Australia
- University of Brighton, Brighton, UK
| | - D T Klink
- Department of Pediatrics, Division of Pediatric Endocrinology, Ghent University Hospital, Gent, Belgium
- Division of Pediatric Endocrinology and Diabetes, ZNA Queen Paola Children's Hospital, Antwerp, Belgium
| | - B P C Kreukels
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - L E Kuper
- Department of Psychiatry, Southwestern Medical Center, University of Texas, Dallas, TX, USA
- Department of Endocrinology, Children's Health, Dallas, TX, USA
| | - E J Kvach
- Denver Health, Denver, CO, USA
- University of Colorado School of Medicine, Aurora, CO, USA
| | - M A Malouf
- Malouf Counseling and Consulting, Baltimore, MD, USA
| | - R Massey
- WPATH Global Education Institute
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - T Mazur
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- John R. Oishei Children's Hospital, Buffalo, NY, USA
| | - C McLachlan
- Professional Association for Transgender Health, South Africa
- Gender DynamiX, Cape Town, South Africa
| | - S D Morrison
- Division of Plastic Surgery, Seattle Children's Hospital, Seattle, WA, USA
- Division of Plastic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - S W Mosser
- Gender Confirmation Center, San Francisco, CA, USA
- Saint Francis Memorial Hospital, San Francisco, CA, USA
| | - P M Neira
- Johns Hopkins Center for Transgender Health, Baltimore, MD, USA
- Johns Hopkins Medicine Office of Diversity, Inclusion and Health Equity, Baltimore, MD, USA
| | - U 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
| | - J M Oates
- La Trobe University, Melbourne, Australia
- Melbourne Voice Analysis Centre, East Melbourne, Australia
| | - J Obedin-Maliver
- Stanford University School of Medicine, Department of Obstetrics and Gynecology, Palo Alto, CA, USA
- Department of Epidemiology and Population Health, Stanford, CA, USA
| | - G Pagkalos
- Independent PracticeThessaloniki, Greece
- Military Community Mental Health Center, 424 General Military Training Hospital, Thessaloniki, Greece
| | - J Patton
- Talkspace, New York, NY, USA
- CytiPsychological LLC, San Diego, CA, USA
| | - N Phanuphak
- Institute of HIV Research and Innovation, Bangkok, Thailand
| | - K Rachlin
- Independent Practice, New York, NY, USA
| | - T Reed
- Gender Identity Research and Education Society, Leatherhead, UK
| | - G N Rider
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J Ristori
- Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy
| | | | - S A Roberts
- Harvard Medical School, Boston, MA, USA
- Division of Endocrinology, Boston's Children's Hospital, Boston, MA, USA
| | - K A Rodriguez-Wallberg
- Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - S M Rosenthal
- Division of Pediatric Endocrinology, UCSF, San Francisco, CA, USA
- UCSF Child and Adolescent Gender Center
| | - K Sabir
- FtM Phoenix Group, Krasnodar Krai, Russia
| | - J D Safer
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Center for Transgender Medicine and Surgery, New York, NY, USA
| | - A I Scheim
- Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
| | - L J Seal
- Tavistock and Portman NHS Foundation Trust, London, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - K Spencer
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - C St Amand
- University of Houston, Houston, TX, USA
- Mayo Clinic, Rochester, MN, USA
| | - T D Steensma
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - J F Strang
- Children's National Hospital, Washington, DC, USA
- George Washington University School of Medicine, Washington, DC, USA
| | - G B Taylor
- Atrium Health Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Charlotte, NC, USA
| | - K Tilleman
- Department for Reproductive Medicine, Ghent University Hospital, Gent, Belgium
| | - G G T'Sjoen
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
- Department of Endocrinology, Ghent University Hospital, Gent, Belgium
| | - L N Vala
- Independent Practice, Campbell, CA, USA
| | - N M Van Mello
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - J F Veale
- School of Psychology, University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa
| | - J A Vencill
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - B Vincent
- Trans Learning Partnership at https://spectra-london.org.uk/trans-learning-partnership, UK
| | - L M Wesp
- College of Nursing, University of Wisconsin MilwaukeeMilwaukee, WI, USA
- Health Connections Inc., Glendale, WI, USA
| | - M A West
- North Memorial Health Hospital, Robbinsdale, MN, USA
- University of Minnesota, Minneapolis, MN, USA
| | - J Arcelus
- School of Medicine, University of Nottingham, Nottingham, UK
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
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Veale JF, Deutsch MB, Devor AH, Kuper LE, Motmans J, Radix AE, Amand CS. Setting a research agenda in trans health: An expert assessment of priorities and issues by trans and nonbinary researchers. Int J Transgend Health 2022; 23:392-408. [PMID: 36324879 PMCID: PMC9621229 DOI: 10.1080/26895269.2022.2044425] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND This article is by a group of trans and nonbinary researchers and experts in the field of trans health who have conducted an analysis of trans health research needs. AIMS To highlight topics that need further research and to outline key considerations for those conducting research in our field. METHODS The first author conducted semi-structured interviews with all coauthors, and these were used to create a first draft of this manuscript. This draft was circulated to all authors, with edits made until consensus was reached among the authors. RESULTS More comprehensive long-term research that centers trans people's experiences is needed on the risks and benefits of gender affirming hormones and surgeries. The trans health research field also needs to have a broader focus beyond medical transition or gender affirmation, including general health and routine healthcare; trans people's lives without, before, and after medical gender affirmation; and sexuality, fertility, and reproductive healthcare needs. More research is also needed on social determinants of health, including ways to make healthcare settings and other environments safer and more supportive; social and legal gender recognition; the needs of trans people who are most marginalized; and the ways in which healing happens within trans communities. The second part of this article highlights key considerations for researchers, the foremost being acknowledging trans community expertise and centering trans community members' input into research design and interpretation of findings, in advisory and/or researcher roles. Ethical considerations include maximizing benefits and minimizing harms (beneficence) and transparency and accountability to trans communities. Finally, we note the importance of conferences, grant funding, working with students, and multidisciplinary teams. DISCUSSION This article outlines topics and issues needing further consideration to make the field of trans health research more responsive to the needs of trans people. This work is limited by our authorship group being mostly White, all being Anglophone, and residing in the Global North.
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Affiliation(s)
- Jaimie F. Veale
- School of Psychology, University of Waikato, Hamilton, New Zealand
| | - Madeline B. Deutsch
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Aaron H. Devor
- Chair in Transgender Studies, University of Victoria, British Columbia, Victoria, Canada
| | - Laura E. Kuper
- Department of Psychiatry, Southwestern Medical Center, University of Texas, Dallas, TX, USA
- Department of Endocrinology, Children’s Health System of Texas, Dallas, TX, USA
| | - Joz Motmans
- Department of Language and Cultures, Ghent University, Gent, Belgium
- University Hospital of Ghent, Gent, Belgium
| | - Asa E. Radix
- Department of Medicine, New York University Langone Health, New York, USA
- Callen-Lorde Community Health Center, New York, USA
| | - Colt St. Amand
- Department of Family Medicine, Mayo Clinic Rochester, Rochester, NY, USA
- Department of Psychology, University of Houston, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine,Houston, TX, USA
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Pillay SR, Ntetmen JM, Nel JA. Queering global health: an urgent call for LGBT+ affirmative practices. The Lancet Global Health 2022. [DOI: 10.1016/s2214-109x(22)00001-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/16/2021] [Accepted: 12/22/2021] [Indexed: 12/23/2022] Open
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O'Connor AM, Seunik M, Radi B, Matthyse L, Gable L, Huffstetler HE, Meier BM. Transcending the Gender Binary under International Law: Advancing Health-Related Human Rights for Trans* Populations. J Law Med Ethics 2022; 50:409-424. [PMID: 36398651 PMCID: PMC9679587 DOI: 10.1017/jme.2022.84] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Despite a recent wave in global recognition of the rights of transgender and gender-diverse populations, referred to in this text by the umbrella label of trans*, international law continues to presume a cisgender binary definition of gender - dismissing the lived realities of trans* individuals throughout the world. This gap in international legal recognition and protection has fundamental implications for health, where trans* persons have been and continue to be subjected to widespread discrimination in health care, longstanding neglect of health needs, and significant violations of bodily autonomy.
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Affiliation(s)
| | | | - Blas Radi
- UNIVERSITY OF BUENOS AIRES, BUENOS AIRES, ARGENTINA
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Du Mont J, Kosa SD, Abavi R, Kia H, Macdonald S. Toward Affirming Care: An Initial Evaluation of a Sexual Violence Treatment Network's Capacity for Addressing the Needs of Trans Sexual Assault Survivors. J Interpers Violence 2021; 36:NP12436-NP12455. [PMID: 31789091 PMCID: PMC8581708 DOI: 10.1177/0886260519889943] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
There is a global call to action to improve transgender (trans) health to achieve health equity for people of all gender identities. Trans persons experience high rates of sexual assault and have historically had limited or no access to health care that meets their needs. As an initial step in addressing this, we evaluated a sexual assault treatment network's capacity for addressing the needs of trans sexual assault survivors. Working with an Advisory Group comprising trans community members and their allies who have expertise in trans health, a short online questionnaire was developed and distributed to the program leaders of Ontario's 35 hospital-based Sexual Assault/Domestic Violence Centres (SA/DVTCs). A total of 27 program leaders completed the questionnaire for a response rate of 77%. The majority of respondents reported that their program collaborates with trans-positive services within their community (70.4%). However, only two in five (40.7%) program leaders indicated that the patient bill of rights at their hospital included a statement pledging nondiscrimination on the basis of gender, gender identity, and/or gender expression. All (100%) program leaders felt that the nurses and physicians working within their programs would benefit from (further) training in the care of trans persons who have been sexually assaulted. This study represents an important step in a research program aimed at enhancing Ontario SA/DVTCs' response to trans persons.
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Affiliation(s)
- Janice Du Mont
- Women’s College Hospital, Toronto, Ontario, Canada
- University of Toronto, Ontario, Canada
| | - Sarah D. Kosa
- Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, Toronto, Canada
| | | | - Hannah Kia
- Women’s College Hospital, Toronto, Ontario, Canada
| | - Sheila Macdonald
- Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, Toronto, Canada
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Dalton MR, Veasey AW, Norton AM. Supervising with a Feminist Lens: Improving Transgender Competency. Contemp Fam Ther 2021. [DOI: 10.1007/s10591-021-09611-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lunde CE, Spigel R, Gordon CM, Sieberg CB. Beyond the Binary: Sexual and Reproductive Health Considerations for Transgender and Gender Expansive Adolescents. Front Reprod Health 2021; 3:670919. [PMID: 36304055 PMCID: PMC9580725 DOI: 10.3389/frph.2021.670919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 08/31/2021] [Indexed: 01/10/2023] Open
Abstract
Awareness and visibility of transgender individuals have grown exponentially. However, conceptualizing sexual and reproductive health (SRH) as “women's” or “men's” health services further marginalizes transgender and gender-expansive (TGE) youth. Multiple reviews and commentaries have been published on the topic of SRH care for adults under the umbrella term of sexual and gender minorities, all with a call to action for more inclusive care and the need for more clinical research involving TGE individuals, and notably, TGE youth. Results from adult TGE studies are often translated to describe adolescent models. However, models specific to adolescent TGE populations are needed to understand their unique SRH needs. This review will describe the current literature relating to SRH needs of TGE youth and adults, highlighting key areas with significant disparities in need of further research. This comprehensive summary will also provide recommendations for clinicians and researchers with the goal of improving SRH care and obtaining wider representation in both clinical settings and research directed toward TGE youth.
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Affiliation(s)
- Claire E. Lunde
- Biobehavioral Pediatric Pain Lab, Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, MA, United States
- Pain & Affective Neuroscience Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
- Nuffield Department of Women's and Reproductive Health, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Rebecca Spigel
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Catherine M. Gordon
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Christine B. Sieberg
- Biobehavioral Pediatric Pain Lab, Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, MA, United States
- Pain & Affective Neuroscience Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- *Correspondence: Christine B. Sieberg
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Benbow SM, Eost-telling C, Kingston P. A narrative review of literature on the use of health and social care by older trans adults: what can United Kingdom services learn? Ageing and Society. [DOI: 10.1017/s0144686x21000039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Abstract
We carried out a narrative review and thematic analysis of literature on the physical health care, mental health care and social care of trans older adults to ascertain what is known about older trans adults’ contacts with and use of health and social care. Thirty papers were found: a majority originated in the United States of America. Five themes were identified: experience of discrimination/prejudice and disrespect; health inequalities; socio-economic inequalities; positive practice; and staff training and education. The first three themes present challenges for providers and service users. Experiences of discrimination/prejudice and disrespect over the course of their lives powerfully influence how older trans adults engage with care services and practitioners. Health and socio-economic inequalities suggest that older trans adults are likely to have greater need of services and care. The remaining two themes offer opportunities for service improvement. We conclude that more research is needed, that there is a strong argument for taking a lifecourse perspective in a spirit of cultural humility, and that contextual societal factors influence service users and providers. We identify positive trans-inclusive practices which we commend to services. More needs to be done now to make older adult services appropriate and welcoming for trans service users.
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Patel V, Nolan IT, Card E, Morrison SD, Bared A. Facial Hair Transplantation for Transgender Patients: A Literature Review and Guidelines for Practice. Aesthet Surg J 2021; 41:NP42-NP51. [PMID: 33565575 DOI: 10.1093/asj/sjaa430] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Facial hair transplantation has become an increasingly popular modality to create a more masculine appearance for transmasculine patients. OBJECTIVES This aim of this study was to review the current literature regarding facial hair transplantation and provide recommendations and best practices for transgender patients. METHODS A comprehensive literature search of the PubMed, MEDLINE, and Embase databases was conducted for studies published through April 2020 for publications discussing facial hair transplant in transmasculine patients, in addition to the nontransgender population. Data extracted include patient demographics, techniques, outcomes, complications, and patient satisfaction. RESULTS We identified 2 articles discussing facial hair transplantation in transmasculine patients. Due to the paucity of publications describing facial hair transplantation in transmasculine patients, data regarding facial hair transplant from the cisgender population were utilized to augment our review and recommendations. CONCLUSIONS Facial hair transplant is a safe and effective means of promoting a masculine appearance for transgender patients. Nevertheless, facial hair transplantation should be deferred until at least 1 year after the initiation of testosterone therapy to allow surgeons to more accurately identify regions that would benefit the most from transplantation. Additionally, providers should engage patients in discussions about any plans to undergo facial masculinization surgery because this can alter the position of transplanted hairs. Currently, follicular unit extraction from the occipital scalp is the preferred technique, with use of the temporal scalp if additional grafts are needed. Patients should be advised that a secondary grafting procedure may be needed a year after initial transplant to achieve desired density. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Viren Patel
- Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ian T Nolan
- Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Elizabeth Card
- Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Shane D Morrison
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
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Abstract
PURPOSE OF REVIEW To review the current understanding of the ethical and societal difficulties of penile transplantation. RECENT FINDINGS Penile transplantation, as with other forms of vascularized composite allotransplantation, has increasing acceptance in society but is still not entirely accepted. Guidelines aiming to help guide future penile transplant programs in an ethical and scientific safe manner were created. Controversies regarding the economic impact, patient safety, and the rights of the patients choosing penile transplant remains. SUMMARY Penile transplantation has excellent functional and cosmetic results in the short-term and medium-term. The penis, similar to the face in facial transplantation, carries emotional gravity that relates to visible body parts of another that live forth in a tangible manner contributing to psychological and ethical challenges for both the individual and society more broadly, healthcare administrators, and healthcare workers. In the context of these challenges, controversies emerge related to issues of judgment about what society can and wants to afford. Effects of toxic immunosuppression in a nonlife saving life-enhancing procedure, as well as costs, become arguments that have to be considered in the context of ethical and societal challenges.
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21
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Mont JD, Kosa SD, Hemalal S, Cameron L, Macdonald S. Formation of an intersectoral network to support trans survivors of sexual assault: A survey of health and community organizations. Int J Transgend Health 2020; 22:243-252. [PMID: 34240068 PMCID: PMC8118235 DOI: 10.1080/26895269.2020.1787911] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND To address the growing international recognition of the inequities faced by transgender (trans) persons and the lack of services that attend to the specific concerns of trans sexual assault survivors, we undertook the development of an intersectoral network of hospital-based violence treatment centers and trans-positive community organizations to enhance available supports. AIMS To examine anticipated involvement of organizations in the network and determine network activities, deliverables, and values. METHODS We developed a survey with guidance from an advisory group of trans community members and their allies. Items on the survey related to network activities, deliverables, and values, which were also informed by key insights from earlier network planning meetings, were rated on a 5-point Likert scale for their importance (1 = not important at all, 5 = very important). RESULTS Sixty-four out of 93 organizations invited responded to the survey, giving a response rate of 69%. The highest prioritized network activities were: improve access to support services for trans survivors, educate trans survivors on their rights/what to expect when seeking supports and information on organizations, provide ongoing education/training for service providers on trans-affirming care, and inform guidelines on appropriate and sensitive standards of care/better practices for trans survivors (means = 4.6). The highest prioritized deliverables were: provision of standardized sensitivity training on violence against trans persons for professionals and development of an online directory/resource list of trans-affirming service providers and organizations that is continuously updated (means = 4.5). Trauma- and violence-informed and trans-guided were the most highly rated values (means = 4.8). CONCLUSION These findings have implications for healthcare and community leaders seeking to collaborate across sectors to address the inequities faced by trans persons experiencing sexual assault.
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Affiliation(s)
- Janice Du Mont
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sarah Daisy Kosa
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
- Ontario Network of Sexual Assault/Domestic Violence Treatments Centres, Toronto, Canada
| | - Shilini Hemalal
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
| | | | - Sheila Macdonald
- Ontario Network of Sexual Assault/Domestic Violence Treatments Centres, Toronto, Canada
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Operario D, Restar A. Gender-affirmative systems needed for PrEP implementation. Lancet HIV 2020; 7:e799-e800. [PMID: 32622371 DOI: 10.1016/s2352-3018(20)30191-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 04/29/2020] [Accepted: 04/29/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA.
| | - Arjee Restar
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA
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Society for Adolescent Health and Medicine. Promoting Health Equality and Nondiscrimination for Transgender and Gender-Diverse Youth. J Adolesc Health 2020; 66:761-5. [PMID: 32473724 DOI: 10.1016/j.jadohealth.2020.03.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/17/2020] [Indexed: 11/17/2022]
Abstract
Adolescent and young adult health-care providers often care for transgender and gender-diverse (TGD) youth-youth whose gender identity is incongruent with the gender assigned to them at birth. This patient population faces health challenges distinct from their cisgender peers (i.e., youth whose gender identity aligns with their assigned gender at birth), which include the health impacts from gender dysphoria and from societal stigma and discrimination. SAHM encourages adolescent and young adult health-care providers to receive training in providing culturally effective, evidence-based care for TGD youth; calls for more research on gender-affirming health care; and advocates for policies that protect the rights of TGD youth and minimize barriers to attaining healthcare. Consistent with other medical organizations, the Society for Adolescent Health and Medicine promotes the call for gender affirmation as a mainstay of treatment and is opposed to the notion that diversity in gender is pathological.
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Strauss P, Cook A, Winter S, Watson V, Wright Toussaint D, Lin A. Mental Health Issues and Complex Experiences of Abuse Among Trans and Gender Diverse Young People: Findings from Trans Pathways. LGBT Health 2020; 7:128-136. [DOI: 10.1089/lgbt.2019.0232] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Penelope Strauss
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Angus Cook
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Sam Winter
- School of Public Health, Curtin University, Perth, Australia
| | - Vanessa Watson
- Youth Mental Health, North Metropolitan Health Service, Western Australia Department of Health, Perth, Australia
| | | | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
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Abstract
Trans people are exposed to multiple human right violations in clinical practice and research. From 1975 on, gender transition processes have been classified as a mental disorder in diagnostic classification manuals, a classification that was removed recently from ICD, International Classification of Diseases, and continues in DSM, Diagnostic and Statistical Manual of Mental Disorders. Trans people in different world regions are forced to accept psychiatric diagnoses and assessment in order to get access to trans health care, subject to reparative therapies and exposed to transphobic institutional and social discrimination and violence. In many countries, gender identity laws include medical requirements, such as psychiatric diagnosis, hormone treatment, genital surgery, or sterilization. In the scientific literature, a frequent pathologization of trans experiences can be identified, by means of pathologizing conceptualizations, terminologies, visual representations, and practices, as well as ethnocentric biases. Trans activism and scholarship have questioned widely the pathologization of trans people in clinical practice and research. Over the last decade, an international trans depathologization movement emerged, demanding, among other claims, the removal of the diagnostic classification of transexuality as a mental disorder, as well as changes in the health care and legal context. International and regional bodies built up a human rights framework related to sexual, gender and bodily diversity that constitute a relevant reference point for trans depathologization activism. The Yogyakarta Principles, published in 2007 and extended in 2017 by means of the Yogyakarta Principles plus 10, establish an application of international human rights law in relation to sexual orientation, gender expression, gender identity, and sex characteristics. International and regional human rights bodies included demands related to depathologization in their agenda. More recently, advancements towards trans depathologization can be observed in the diagnostic classifications, as well as in the health care and legal context. At the same time, trans people continue being exposed to pathologization and transphobic violence. The Human Rights in Patient Care (HRPC) framework offers a human right-based approach on health care practices. The paper aims at analyzing the shared human rights focus and potential alliances between the trans depathologization perspective and the HRPC framework.
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Affiliation(s)
- Amets Suess Schwend
- Research Group "Others. Feminist Perspectives in Social Research" (SEJ-430), University of Granada, Granada, Spain
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26
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de Vries E, Kathard H, Müller A. Debate: Why should gender-affirming health care be included in health science curricula? BMC Med Educ 2020; 20:51. [PMID: 32059721 PMCID: PMC7023748 DOI: 10.1186/s12909-020-1963-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 02/07/2020] [Indexed: 05/04/2023]
Abstract
BACKGROUND Every person who seeks health care should be affirmed, respected, understood, and not judged. However, trans and gender diverse people have experienced significant marginalization and discrimination in health care settings. Health professionals are generally not adequately prepared by current curricula to provide appropriate healthcare to trans and gender diverse people. This strongly implies that health care students would benefit from curricula which facilitate learning about gender-affirming health care. MAIN BODY Trans and gender diverse people have been pathologized by the medical profession, through classifications of mental illness in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Disease (ICD). Although this is changing in the new ICD-11, tension remains between depathologization discourses and access to gender-affirming health care. Trans and gender diverse people experience significant health disparities and an increased burden of disease, specifically in the areas of mental health, Human Immunodeficiency Virus, violence and victimisation. Many of these health disparities originate from discrimination and systemic biases that decrease access to care, as well as from health professional ignorance. This paper will outline gaps in health science curricula that have been described in different contexts, and specific educational interventions that have attempted to improve awareness, knowledge and skills related to gender-affirming health care. The education of primary care providers is critical, as in much of the world, specialist services for gender-affirming health care are not widely available. The ethics of the gatekeeping model, where service providers decide who can access care, will be discussed and contrasted with the informed-consent model that upholds autonomy by empowering patients to make their own health care decisions. CONCLUSION There is an ethical imperative for health professionals to reduce health care disparities of trans and gender diverse people and practice within the health care values of social justice and cultural humility. As health science educators, we have an ethical duty to include gender-affirming health in health science curricula in order to prevent harm to the trans and gender diverse patients that our students will provide care for in the future.
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Affiliation(s)
- Elma de Vries
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Harsha Kathard
- Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
| | - Alex Müller
- Gender, Health and Justice Research Unit, University of Cape Town, Cape Town, South Africa
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Jones RK, Witwer E, Jerman J. Transgender abortion patients and the provision of transgender-specific care at non-hospital facilities that provide abortions. Contracept X 2020; 2:100019. [PMID: 32550534 PMCID: PMC7286144 DOI: 10.1016/j.conx.2020.100019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/09/2020] [Accepted: 01/15/2020] [Indexed: 11/25/2022] Open
Abstract
Objective To estimate the number of transgender and gender non-binary (TGNB) individuals who obtained abortions in the United States and the extent to which abortion facilities offer transgender-specific health services. Study design We collected survey data from all known health care facilities that provided abortions in 2017. For the first time, the questionnaire included items about TGNB abortion patients and services. Results We estimate that 462 to 530 TGNB individuals obtained abortions in 2017 and that 23% of clinics provide transgender-specific care. Conclusion Several hundred abortions were provided to TGNB individuals in 2017, primarily at facilities that did not provide transgender-specific health services. Implications Findings from this study support efforts to implement and expand gender-inclusive and affirming care at health care facilities that provide abortion.
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Affiliation(s)
| | | | - Jenna Jerman
- Planned Parenthood Federation of America, New York, NY
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Arora M, Walker K, Luu J, Duvivier RJ, Dune T, Wynne K. Education of the medical profession to facilitate delivery of transgender health care in an Australian health district. Aust J Prim Health 2019; 26:PY19102. [PMID: 31738874 DOI: 10.1071/py19102] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 09/06/2019] [Indexed: 02/04/2023]
Abstract
Transgender individuals who desire medical transition need to access care through their local healthcare system. This is the first study to explore the perceptions of the community and attitudes of healthcare providers towards the delivery of transgender health care in an Australian context. An anonymous survey was conducted of trans and gender-diverse community members; and physicians and trainees in the Hunter New England Local Health District of New South Wales, Australia. Community members were surveyed about their healthcare experiences. Medical students, GPs and hospital physicians were surveyed on their attitudes towards the delivery of transgender health care before and after a 1-h education session that included the lived experience of a community member. Community members expressed a need for increased education for healthcare providers in transgender medicine. Following the intervention, significantly more healthcare providers felt confident to facilitate transgender health care for adults, adolescents and children; and more healthcare providers agreed that medical and surgical treatment should be offered to transgender patients if desired. The positive safety profile of treatment was felt to be the most persuasive factor for the provision of care. Healthcare providers identified a need for health education in transgender medicine; easy access to evidence-based resources; and local referral pathways as key strategies to improving transgender health care.
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Affiliation(s)
- Maansi Arora
- University of New England, Armidale, NSW 2351, Australia
| | - Kaete Walker
- Department of Mental Health, Hunter New England Local Health District, Newcastle, NSW 2305, Australia
| | - Judy Luu
- University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia; and Department of Diabetes & Endocrinology, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia
| | - Robbert J Duvivier
- University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia; and Parnassia Psychiatric Institute, Passievruchtstraat 2, 2552, The Hague, The Netherlands
| | - Tinashe Dune
- School of Science & Health, Western Sydney University, Penrith, NSW 2751, Australia
| | - Katie Wynne
- University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia; and Department of Diabetes & Endocrinology, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia; and Corresponding author
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Winter S, Ehrensaft D, Telfer M, T'sjoen G, Koh J, Pickstone-taylor S, Kruger A, Griffin L, Foigel M, De Cuypere G, Karasic D. ICD-11 and gender incongruence of childhood: a rethink is needed. The Lancet Child & Adolescent Health 2019; 3:671-3. [DOI: 10.1016/s2352-4642(19)30263-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 07/23/2019] [Accepted: 07/24/2019] [Indexed: 11/18/2022]
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MacCarthy S, Poteat T, Xia Z, Roque NL, Hyun Jin Kim A, Baral S, Reisner SL. Current research gaps: a global systematic review of HIV and sexually transmissible infections among transgender populations. Sex Health 2019; 14:456-468. [PMID: 29216970 DOI: 10.1071/sh17096] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 08/21/2017] [Indexed: 11/23/2022]
Abstract
Transgender populations are heavily burdened by HIV and other sexually transmissible infections (STIs). However, data on co-infection with HIV and STIs among transgender people are limited. A systematic review was conducted of peer-reviewed articles and conference abstracts between January 2010 and November 2015 that focussed on HIV and STI infections among transgender populations globally. The literature was synthesised and opportunities for improving health research were commented on. Few studies reported HIV-STI co-infection (n=4), while the majority of studies reported HIV and STI infections separately (n=23). Most studies were conducted outside of the USA (n=19), and all but one of these studies reported data on transgender women only. Among USA-based studies (n=8), several reported data on both transgender men and transgender women (n=3), whereas other studies reported exclusively on transgender men (n=1) or transgender women (n=4). Understanding HIV and STIs among transgender people requires research that simultaneously considers multilevel drivers of vulnerabilities. More data are needed on how the interaction of individual determinants, including biological risks of transmission, programmatic determinants such as service-delivery models and policy-level determinants including institutionalised stigma in healthcare settings, influence the HIV- and STI-related outcomes of transgender populations. Leveraging the knowledge of transgender-specific determinants of HIV and STIs should guide the content and approaches to future HIV and STI prevention and treatment efforts.
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Affiliation(s)
- Sarah MacCarthy
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA
| | - Tonia Poteat
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615N. Wolfe Street, Baltimore, MD 21205, USA
| | - Zhiyu Xia
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615N. Wolfe Street, Baltimore, MD 21205, USA
| | - Nicolette L Roque
- Department of Acute and Chronic Care, Johns Hopkins School of Nursing, 525N. Wolfe Street, Baltimore, MD 21205, USA
| | | | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615N. Wolfe Street, Baltimore, MD 21205, USA
| | - Sari L Reisner
- Division of General Pediatrics, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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Nisly NL, Imborek KL, Miller ML, Kaliszewski SD, Williams RM, Krasowski MD. Unique Primary Care Needs of Transgender and Gender Non-Binary People. Clin Obstet Gynecol 2018; 61:674-86. [PMID: 30339607 DOI: 10.1097/GRF.0000000000000404] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
It is important for the practicing primary care provider to become familiar with the unique health care needs for people who identify as transgender men, transgender women, and non-binary people, who are all within the scope of practice of a general obstetrician-gynecologist and other primary care providers. A review of the unique health needs and essential terminology is presented. This knowledge is a basic foundation to develop a welcoming and inclusive practice for people who are gender nonconforming. This fund of knowledge is essential the practicing primary care providers and support staff.
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Vaitses Fontanari AM, Zanella GI, Feijó M, Churchill S, Rodrigues Lobato MI, Costa AB. HIV-related care for transgender people: A systematic review of studies from around the world. Soc Sci Med 2019; 230:280-294. [PMID: 31035207 DOI: 10.1016/j.socscimed.2019.03.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 02/12/2019] [Accepted: 03/10/2019] [Indexed: 01/08/2023]
Abstract
RATIONALE Transgender people face unique challenges, such as structural, interpersonal, and individual vulnerabilities to chronic diseases. Stigma and prejudice may hamper their access to health care and prevent their inclusion in the labor market, as well as cause exposition to violence. Labor market exclusion contributes to engagement in survival sex work, which increases HIV infection vulnerability. HIV continuum of care combines HIV prevention (including antiretroviral pre-exposure prophylaxis (PrEP), antiretroviral post-exposure prophylaxis (PEP) and HIV testing) with linkage to care (that is, initiating, maintaining and monitoring antiretroviral therapy). Currently, many studies evaluate the access barriers and facilitators to HIV care for transgender people. OBJECTIVE The present systematic review aimed to provide a clear summary of the current literature on HIV-related care for transgender men, transgender women and gender diverse people. METHOD Inclusion criteria were peer-reviewed quantitative studies, published through April 04, 2018, concerning transgender women, transgender men and gender diverse people and HIV-related care, which was any intervention aiming to prevent, treat or alleviate the impact of HIV on these populations. RESULTS From 6,585 references, 62 articles were included: Three articles had results on PEP, 18 on PrEP, 29 on HIV-testing, 17 on access to health care, and 13 on adherence to treatment. CONCLUSIONS The present study is the first systematic review evaluating HIV-related care for transgender people. Data collection is still scarce regarding transgender men and gender diverse people. Worldwide, testing for HIV infection does not necessarily enable access to the HIV continuum of care for transgender populations or even guarantee awareness of HIV seropositivity.
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Affiliation(s)
- Anna Martha Vaitses Fontanari
- Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | | | - Marina Feijó
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Maria Inês Rodrigues Lobato
- Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Milner AN, Hearld KR, Abreau N, Budhwani H, Mayra Rodriguez-Lauzurique R, Paulino-Ramirez R. Sex work, social support, and stigma: Experiences of transgender women in the Dominican Republic. INT J TRANSGENDERISM 2019; 20:403-412. [PMID: 32999625 DOI: 10.1080/15532739.2019.1596862] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Transgender populations, and especially those in resource-limited settings, are at an elevated risk of experiencing stigma and discrimination. Aims: This study sought to examine the relationship between parental, familial, and other social support, experiences of stigma and discrimination, quality of life, and sex work in a national sample of transgender women in the Dominican Republic (n = 291). Methods: Descriptive analyses for the outcome variable, sex work, as well as for measures associated with socio-demographics, social support, stigma, quality of life, and experiences of abuse and violence were performed. Bivariate analysis examined differences between respondents involved in sex work and those not involved in sex work. Results: We found that participation in sex work was associated with low social support and quality of life and increased experiences of stigma, discrimination, and abuse. Specifically, Dominican transgender women involved in sex work received less social support than their non-sex working peers; they experienced heightened arguments and problems with non-parental family members, professors or bosses, classmates, and close friends, as well of loss of friendships. Involvement in sex work was also associated with higher levels of stigma and discrimination, lower quality of life, and experiences of sexual abuse, torture, and experiences of attempted murder on one's life. Discussion: Transgender women participating in sex work require more rather than less social support from family members and loved ones, especially in areas where workplace discrimination policies that affect transgender individuals are nebulous, such as the Dominican Republic.
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Affiliation(s)
| | | | - Nicole Abreau
- Universidad Iberoamericana-UNIBE, Santo Domingo, Dominican Republic
| | - Henna Budhwani
- University of Alabama at Birmingham, Birmingham, AL, USA
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Deardorff J, Hoyt LT, Carter R, Shirtcliff EA. Next Steps in Puberty Research: Broadening the Lens Toward Understudied Populations. J Res Adolesc 2019; 29:133-154. [PMID: 30869847 PMCID: PMC6827435 DOI: 10.1111/jora.12402] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Decades of puberty research have yielded key scientific discoveries. Building on the field's rich history, we highlight four understudied populations: youth of color, boys, sexual minority youth, and gender minority youth. We explore why scientific study has been slow to evolve in these groups and propose paths forward for exciting new work. For ethnically racially diverse youth, we discuss the need to incorporate culture and context. For boys, we highlight methodological issues and challenges of mapping existing conceptual models onto boys. For sexual and gender minority youth, we discuss unique challenges during puberty and suggest ways to better capture their experiences. With an eye toward a new era, we make recommendations for next steps and underscore the importance of transdisciplinary research.
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Lanham M, Ridgeway K, Dayton R, Castillo BM, Brennan C, Davis DA, Emmanuel D, Morales GJ, Cheririser C, Rodriguez B, Cooke J, Santi K, Evens E. "We're Going to Leave You for Last, Because of How You Are": Transgender Women's Experiences of Gender-Based Violence in Healthcare, Education, and Police Encounters in Latin America and the Caribbean. Violence Gend 2019; 6:37-46. [PMID: 30937323 PMCID: PMC6442261 DOI: 10.1089/vio.2018.0015] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Transgender (trans) women experience gender-based violence (GBV) throughout their lives, which impedes their access to services and contributes to poor health outcomes and quality of life. To inform policies and health programs, trans women worked with the United States Agency for International Development (USAID)- and President's Emergency Plan for AIDS Relief (PEPFAR)-supported LINKAGES project, the United Nations Development Programme, The University of the West Indies, and local organizations to document experiences of GBV and transphobia in healthcare, education, and police encounters. Trans women conducted 74 structured interviews with other trans women in El Salvador, Trinidad and Tobago, Barbados, and Haiti in 2016. We conducted qualitative applied thematic analysis to understand the nature and consequences of GBV and transphobia and descriptive quantitative analysis to identify the proportion who experienced GBV in each context. A high proportion experienced GBV in education (85.1%), healthcare (82.9%), from police (80.0%), and other state institutions (66.1%). Emotional abuse was the most common in all contexts and included gossiping, insults, and refusal to use their chosen name. Participants also experienced economic, physical, and sexual violence, and other human rights violations based on their gender identity and expression. At school, participants were physically threatened and assaulted, harassed in bathrooms, and denied education. In healthcare, participants were given lower priority and received substandard care. Healthcare workers and police blamed participants for their health and legal problems, and denied them services. From police, participants also experienced physical and sexual assault, theft, extortion for sex or money, and arbitrary arrest and detention. Participants had difficulty obtaining identification documents that matched their gender identity, sometimes being forced to alter their appearance or being denied an identification card. Service providers not only failed to meet the specific needs of trans women but also discriminated against them when they sought services, exacerbating their economic, health, and social vulnerability. Although international and regional resolutions call for the legal protection of transgender people, states do not meet these obligations. To respect, promote, and fulfill trans women's human rights, governments should enact and enforce antidiscrimination and gender-affirming laws and policies. Governments should also sensitize providers to deliver gender-affirming services.
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Affiliation(s)
- Michele Lanham
- FHI 360, Durham, North Carolina
- Address correspondence to: Michele Lanham, MPH, FHI 360, 359 Blackwell Street, No. 200, Durham, NC 27701
| | | | | | | | | | | | - Dadrina Emmanuel
- Community Education Empowerment & Development, Bridgetown, Barbados
| | | | | | - Brandy Rodriguez
- Trinidad and Tobago Transgender Coalition, Port of Spain, Trinidad and Tobago
| | - Juana Cooke
- HIV, Health and Development, United Nations Development Programme, Panama City, Panama
| | - Karin Santi
- HIV, Health and Development, United Nations Development Programme, Panama City, Panama
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Gruskin S, Everhart A, Olivia DF, Baral S, Reisner SL, Kismödi E, Cruz D, Klemmer C, Reich MR, Ferguson L. "In transition: ensuring the sexual and reproductive health and rights of transgender populations." A roundtable discussion. Reprod Health Matters 2019; 26:1490624. [PMID: 30070172 DOI: 10.1080/09688080.2018.1490624] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
This roundtable discussion is the result of a research symposium entitled In Transition: Gender [Identity], Law & Global Health where participants took up the challenge to engage with the question: What will it take to ensure the sexual and reproductive health and rights (SRHR) of transgender populations across the globe? The barriers to overcome are fierce, and include not only lack of access to health services and insurance but also stigma and discrimination, harassment, violence, and violations of rights at every turn. Transgender people must of course lead any sort of initiatives to improve their lives, even as partnerships are needed to build capacity, translate lived experience into usable data, and to make strategic decisions. The SRHR of transgender people can only be addressed with attention to the social, cultural, legal, historical, and political contexts in which people are situated, with social, psychological, medical, and legal gender affirmation as a key priority shaping any intervention. Bringing together nine diverse yet complementary perspectives, our intent is to jumpstart a global and multigenerational conversation among transgender activists, lawyers, policy-makers, programmers, epidemiologists, economists, social workers, clinicians and all other stakeholders to help think through priority areas of focus that will support the needs, rights, and health of transgender populations. Making the changes envisioned here is possible but it will require not only the advocacy, policy, programmatic and research directions presented here but also struggle and action locally, nationally, and globally.
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Affiliation(s)
- Sofia Gruskin
- a Professor and Director, Program on Global Health and Human Rights, Institute for Global Health , University of Southern California , Los Angeles , CA , USA
| | - Avery Everhart
- b Ph.D. Candidate, Dana and David Dornsife College of Letters, Arts and Sciences , University of Southern California , Los Angeles , CA , USA
| | - Diana Feliz Olivia
- c Transgender Health Program Manager , St. John's Well Child and Family Center , Los Angeles , CA , USA
| | - Stefan Baral
- d Associate Professor, Center for Public Health and Human Rights , Johns Hopkins University , Baltimore , MD , USA
| | - Sari L Reisner
- e Assistant Professor, T.H. Chan School of Public Health , Boston Children's Hospital/Harvard Medical School , Boston , MA , USA
| | - Eszter Kismödi
- f International Human Rights Lawyer on Sexuality, Gender Diversity and Sexual and Reproductive Health and Human Rights, Hungary/Switzerland
| | - David Cruz
- g Professor of Law, Gould School of Law , University of Southern California , Los Angeles , CA , USA
| | - Cary Klemmer
- h Ph.D. Student, Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , CA , USA
| | - Michael R Reich
- i Taro Takemi Research Professor of International Health Policy, Department of Global Health and Population , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - Laura Ferguson
- j Assistant Professor and Associate Director, Program on Global Health and Human Rights, Institute for Global Health , University of Southern California , Los Angeles , CA , USA
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Martinez-Velez JJ, Melin K, Rodriguez-Diaz CE. A Preliminary Assessment of Selected Social Determinants of Health in a Sample of Transgender and Gender Nonconforming Individuals in Puerto Rico. Transgend Health 2019; 4:9-17. [PMID: 30719502 PMCID: PMC6360392 DOI: 10.1089/trgh.2018.0045] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Purpose: Transgender and gender nonconforming (GNC) people continue to experience suboptimal health care, social exclusion, and lower quality of life. Globally, lack of access to services, institutional violence, and public harassment have been reported. However, there is limited data on transgender health in Puerto Rico and the Caribbean. The purpose of this study is to assess the social determinants of health and wellbeing of transgender and GNC people living in Puerto Rico. Methods: Utilizing a community-based participatory research approach, 52 self-identified transgender and GNC individuals living in Puerto Rico completed a survey, which included questions on access to health care services, social support, and violence, among others. Data were collected from March to Ma y of 2015 and descriptive statistical analysis was conducted. Results: Most of the participants reported experiences of discrimination across multiple social settings, most commonly at school (70.6%) and work (67.4%). Regarding experiences of violence, more than half (65.4%) had been verbally attacked in a public space. Many reported that access to gender-affirming health care services is difficult in Puerto Rico (88.5%) due to lack of knowledgeable providers (59.6%) and discomfort during the encounter (55.8%). The main perceived priority for their wellbeing was a transgender health care center. Conclusion: Although the LGBT equality movement has reached great milestones, access to gender-affirming health services and safe educational and work spaces are still needed. Findings from the study provide guidance for actions to reduce health disparities by addressing the needs for health and wellbeing among transgender and GNC individuals.
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Affiliation(s)
- Jose J. Martinez-Velez
- University of Puerto Rico-Medical Sciences Campus, School of Public Health, Center for Sociomedical Research and Evaluation, San Juan, Puerto Rico
| | - Kyle Melin
- University of Puerto Rico-Medical Sciences Campus, School of Pharmacy, Department of Pharmacy Practice, San Juan, Puerto Rico
| | - Carlos E. Rodriguez-Diaz
- University of Puerto Rico-Medical Sciences Campus, School of Public Health, Center for Sociomedical Research and Evaluation, San Juan, Puerto Rico
- The George Washington University, Milken Institute School of Public Health, Department of Prevention and Community Health, Washington, District of Columbia
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Hearld KR, Milner AN, Budhwani H, Abreau N, Rodriguez-Lauzurique RM, Charow R, Paulino-Ramirez R. Alcohol Use, High Risk Behaviors, and Experiences of Discrimination Among Transgender Women in the Dominican Republic. Subst Use Misuse 2019; 54:1725-1733. [PMID: 31046549 DOI: 10.1080/10826084.2019.1608253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: This study examines associations between alcohol use, high risk sexual behaviors, and experiences of stigma among transgender women across the Dominican Republic. Data from the 2015 Transgender Health Needs Study were analyzed using bivariate analyses (N = 291). Results: High rates of stigma, verbal abuse, alcohol use, and sex work are found and are associated with each other. Almost 45% of regular alcohol users are engaging in sex work (43.6%), compared with 31.1% of the non-regular alcohol users (χ2=4.82, p < .05). Having sex under the influence of alcohol is statistically associated with high risk behaviors, such as engaging in sex work, sometimes or never using a condom when receiving anal sex, and higher numbers of sexual partners. Furthermore, transgender women who have had sex under the influence of alcohol report statistically significantly higher levels of verbal abuse, discrimination, and levels of perceived transgender stigma. Conclusions/Importance: Findings suggest that although anti-discrimination laws exist, policies may not protect transgender women from experiencing stigma and discrimination at work, potentially forcing them to seek alternative careers and engage in behaviors that expose them to greater personal risk and harm. This intersection of factors may indicate a notable public health gap in transgender health in the Dominican Republic.
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Affiliation(s)
| | | | - Henna Budhwani
- a University of Alabama at Birmingham , Birmingham , Alabama , USA
| | - Nicole Abreau
- c Instituto de Medicina Tropical and Salud Global , Universidad Iberoamericana-UNIBE , Los Rios , Santo Domingo , República Dominicana
| | - Rosa Mayra Rodriguez-Lauzurique
- c Instituto de Medicina Tropical and Salud Global , Universidad Iberoamericana-UNIBE , Los Rios , Santo Domingo , República Dominicana.,d Centro de Orientacion e Investigacion Integral (COIN) , Santo Domingo , República Dominicana
| | - Rebecca Charow
- c Instituto de Medicina Tropical and Salud Global , Universidad Iberoamericana-UNIBE , Los Rios , Santo Domingo , República Dominicana
| | - Robert Paulino-Ramirez
- c Instituto de Medicina Tropical and Salud Global , Universidad Iberoamericana-UNIBE , Los Rios , Santo Domingo , República Dominicana.,d Centro de Orientacion e Investigacion Integral (COIN) , Santo Domingo , República Dominicana
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Nolan IT, Morrison SD, Arowojolu O, Crowe CS, Massie JP, Adler RK, Chaiet SR, Francis DO. The Role of Voice Therapy and Phonosurgery in Transgender Vocal Feminization: . J Craniofac Surg 2019; 30:1368-75. [DOI: 10.1097/scs.0000000000005132] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Nisly NL, Imborek KL, Miller ML, Dole N, Priest JB, Sandler L, Krasowski MD, Hightower M. Developing an Inclusive and Welcoming LGBTQ Clinic. Clin Obstet Gynecol 2018; 61:646-62. [DOI: 10.1097/grf.0000000000000405] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Budhwani H, Hearld KR, Milner AN, Charow R, McGlaughlin EM, Rodriguez-Lauzurique M, Rosario S, Paulino-Ramirez R. Transgender Women's Experiences with Stigma, Trauma, and Attempted Suicide in the Dominican Republic. Suicide Life Threat Behav 2018; 48:788-796. [PMID: 28950402 DOI: 10.1111/sltb.12400] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 06/29/2017] [Indexed: 12/01/2022]
Abstract
Studies on attempted suicide in transgender populations, particularly those in resource-limited settings, are scarce. We examined the relationships between stigma, trauma, and suicide attempts in a national sample of transgender women from the Dominican Republic. Bivariate analysis examined differences between suicide attempters and nonattempters (n = 298). Multivariate analysis reported odds ratios with attempted suicide as the outcome (n = 260). About a quarter of respondents (23.9%) experienced sexual abuse, 12.3% were tortured, and 20.3% experienced a murder attempt. More than a quarter reported using illegal drugs. Independent sample t tests found significant differences between suicide attempters and nonattempters. Attempters were more likely to have experienced sexual abuse, psychological abuse, torture, and a murder attempt (p < .001 for all). Respondents who experienced psychological abuse had over three times higher odds of attempting suicide, compared to respondents who had not (OR = 3.203, p < .01). Experience with torture and attempted murder were associated with higher odds of attempting suicide (OR = 2.967, p < .05 and OR = 2.894, p < .05, respectively). Although some nations have implemented antidiscrimination policies protecting transgender citizens, these policies are often not consistently enforced. Eliminating stigmatizing policies may reduce rates of negative health outcomes and subsequently improving population health.
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Affiliation(s)
- Henna Budhwani
- University of Alabama at Birmingham, University Boulevard, Birmingham, USA
| | - Kristine R Hearld
- University of Alabama at Birmingham, University Boulevard, Birmingham, USA
| | | | - Rebecca Charow
- Centro de Orientación e Investigación Integral (COIN), Santo Domingo, Dominican Republic
| | | | - Mayra Rodriguez-Lauzurique
- Centro de Orientacion e Investigación Integral (COIN), Santo Domingo, and Institute for Tropical Medicine & Global Health, Universidad Iberoamericana, Santo Domingo, Dominican Republic
| | - Santo Rosario
- Centro de Orientación e Investigación Integral (COIN), Santo Domingo, Dominican Republic
| | - Robert Paulino-Ramirez
- Institute for Tropical Medicine & Global Health, Universidad Iberoamericana, Santo Domingo, and Centro de Orientación e Investigación Integral (COIN), Santo Domingo, Dominican Republic
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Vargas-Huicochea I, Robles R, Real T, Fresán A, Cruz-Islas J, Vega-Ramírez H, Medina-Mora ME. A Qualitative Study of the Acceptability of the Proposed ICD-11 Gender Incongruence of Childhood Diagnosis Among Transgender Adults Who Were Labeled Due to Their Gender Identity Since Childhood. Arch Sex Behav 2018; 47:2363-2374. [PMID: 29971651 DOI: 10.1007/s10508-018-1241-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 04/07/2018] [Accepted: 05/23/2018] [Indexed: 06/08/2023]
Abstract
For the forthcoming ICD-11, the ICD-10 category of Gender Identity Disorder of Childhood has been reformulated as Gender Incongruence of Childhood (GIC) and moved out of the mental disorders chapter. Proponents of eliminating the GIC diagnosis altogether claim that it is unnecessary and inherently harmful, although they do not eschew the diagnosis for adolescents and adults. Using a qualitative methodology, this study examined the impact of receiving a diagnosis related to gender identity as a child among transgender people who had had this experience, and evaluated participants' views of the acceptability and usefulness of the ICD-11 GIC proposal. Participants receiving health services at a specialized public clinic for transgender health in Mexico City who had received some form of diagnosis in childhood were referred to participate in a semistructured interview. A sample of 12 transgender people (eight transgender women and four transgender men; ages 18-49) was necessary to reach saturation. Diagnoses received were non-specific rather than formal gender identity diagnoses, were experienced by participants as negative, and were used to justify potentially harmful interventions. However, when participants reviewed the ICD-11 proposals for GIC, all indicated that the category was necessary and important and could have a range of personal, familial, and social benefits. They agreed with its placement in a new chapter on Conditions Related to Sexual Health and endorsed the proposed definition and name of the category. Although this study involved a small and specific sample, the results raise questions about the claim that the diagnosis is inherently harmful and universally deplored by transgender people.
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Affiliation(s)
- Ingrid Vargas-Huicochea
- Department of Psychiatry and Mental Health, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Rebeca Robles
- Epidemiological and Psychosocial Research Directorate, National Institute of Psychiatry Ramón de la Fuente Muñiz, Calzada México-Xochimilco 101, San Lorenzo Huipulco, Tlalpan, 14370, México, D.F., Mexico.
| | - Tania Real
- Epidemiological and Psychosocial Research Directorate, National Institute of Psychiatry Ramón de la Fuente Muñiz, Calzada México-Xochimilco 101, San Lorenzo Huipulco, Tlalpan, 14370, México, D.F., Mexico
| | - Ana Fresán
- Clinical Research Directorate, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Jeremy Cruz-Islas
- Mental Health Service, "Condesa" Specialized Clinic, Mexico City, Mexico
| | - Hamid Vega-Ramírez
- Mental Health Service, "Condesa" Specialized Clinic, Mexico City, Mexico
| | - María Elena Medina-Mora
- Office of the Director General, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
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Abstract
Even after long-term hormone therapy, many transwomen still have challenges in the size and shape of their breasts and also of the contour of their trunk areas. Though distinct anthropomorphic differences in skeletal structure exist and pose limitations to an ideal result, considerable improvements can be obtained through breast augmentation and trunk feminization. There are challenges that are unique to the transfeminine chest and trunk, and important considerations for the priority of fat grafting to the buttocks and hips when grafted fat is in short supply.
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Affiliation(s)
- Shane D Morrison
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, University of Washington, Harborview Medical Center, 7th Floor Center Tower Room 73.1, 325 9th Avenue, Mail Stop #359796, Seattle, WA 98104, USA
| | - Stelios C Wilson
- Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, 305 East 33rd Street Lower Level, New York, NY 10016, USA
| | - Scott W Mosser
- Private Practice, The Gender Confirmation Center of San Francisco, Suite 1010, 450 Sutter Street, San Francisco, CA 94108, USA.
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Nambiar K, Pinto-Sander N, Davis J, Woodroffe T, Richardson D. Hormone self-medicating: A concern for transgender sexual health services. Int J STD AIDS 2018; 29:732-733. [DOI: 10.1177/0956462418773213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Kate Nambiar
- Brighton & Sussex University Hospitals NHS Trust, Brighton, UK
| | | | - Julia Davis
- Brighton & Sussex University Hospitals NHS Trust, Brighton, UK
| | | | - Daniel Richardson
- Brighton & Sussex University Hospitals NHS Trust, Brighton, UK
- Brighton & Sussex Medical School, Brighton, UK
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Sweileh WM. Bibliometric analysis of peer-reviewed literature in transgender health (1900 - 2017). BMC Int Health Hum Rights 2018; 18:16. [PMID: 29562909 PMCID: PMC5863490 DOI: 10.1186/s12914-018-0155-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/14/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Transgender community is marginalized and under-researched. Analysis of peer-reviewed literature in transgender health is needed to better understand health needs and human rights of transgender people. Therefore, the aim of this study was to analyze global research activity in transgender health published in peer-reviewed journals. METHODS Peer-reviewed documents in transgender health were retrieved using Scopus database. VOSviewer was used to map frequently encountered author keywords while ArcGIS 10.1 was used to map the geographical distribution of the retrieved documents. Most active countries, institutions, and authors were presented. The study period was set from 1900 to 2017. RESULTS In total, 5772 peer-reviewed documents were obtained. English (5008; 86.8%) was the most frequently encountered language. A dramatic increase in the number of publications was seen in the last decade. The retrieved documents had an average of 12.1 citations per document and h-index of 92. Most frequently encountered author keywords were Human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS), mental health, and discrimination. Authors from 80 different countries contributed to publishing the retrieved documents. Publications originated mainly from Northern America, certain European countries, Australia, and Brazil. Professor Gooren, L.J.G. was the most active author in this field with 104 (1.88%) publications. Top active authors were in the fields of endocrinology, plastic surgery, psychiatry/psychology, public health, and sexology. Five of the top ten active authors were from the USA, three were from the Netherlands, and two were from Belgium. The most active institution was the VU University Medical Center (Netherlands) (184; 3.2%) followed by the University of California, San Francisco (USA) (157; 2.7%). The International Journal of Transgenderism was most active (284; 4.9%) in publishing articles in transgender health. However, documents published in the American Journal of Public Health had the highest impact with 53.5 citations per article. CONCLUSION There was a noticeable growth of research in transgender health in the last decade. Researchers from different world regions need to get involved in health and human rights research of transgender community.
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Affiliation(s)
- Waleed M Sweileh
- Department of Physiology, Pharmacology/Toxicology, Division of Biomedical Sciences, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
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Budhwani H, Hearld KR, Hasbun J, Charow R, Rosario S, Tillotson L, McGlaughlin E, Waters J. Transgender female sex workers' HIV knowledge, experienced stigma, and condom use in the Dominican Republic. PLoS One 2017; 12:e0186457. [PMID: 29095843 PMCID: PMC5667872 DOI: 10.1371/journal.pone.0186457] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 10/02/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Not only do transgender female sex workers have some of the highest rates of sexually transmitted infections (STI), human immunodeficiency virus (HIV), and experienced stigma, they also have higher likelihood of early sexual debut and some of the lowest levels of educational attainment compared to other stigmatized populations. Some of the most common interventions designed to reduce transmission of HIV and STIs seek to educate high-risk groups on sexual health and encourage condom use across all partner types; however, reaching stigmatized populations, particularly those in resource-limited settings, is particularly challenging. Considering the importance of condom use in stopping the spread of HIV, the aim of this study was two-fold; first to characterize this hard-to-reach population of transgender female sex workers in the Dominican Republic, and second, to assess associations between their HIV knowledge, experienced stigma, and condom use across three partner types. METHODS We analyzed self-reported data from the Questionnaire for Transgender Sex Workers (N = 78). Respondents were interviewed at their workplaces. Univariate and bivariate analyses were employed. Fisher Chi-square tests assessed differences in HIV knowledge and experienced stigma by condom use across partner types. RESULTS HIV knowledge was alarmingly low, condom use varied across partner type, and the respondents in our sample had high levels of experienced stigma. Average age of first sexual experience was 13.12 years with a youngest age reported of 7. Dominican Republic statutory rape laws indicate 18 years is the age of consent; thus, many of these transgender women's first sexual encounters would be considered forcible (rape) and constitute a prosecutable crime. On average, respondents reported 8.45 sexual partners in the prior month, with a maximum of 49 partners. Approximately two thirds of respondents used a condom the last time they had sex with a regular partner. This was considerably lower than condom use reported with coercive partners (92.96%) and clients (91.78%). Bivariate analyses revealed two trends: experienced stigma was associated with lower rates of condom use, and lower HIV knowledge was associated with lower rates of condom use. The former provides additional evidence that experienced stigma may become internalized, affecting individual-level behaviors-lowering self-confidence and resilience-making it more difficult to negotiate condom use due to lack of self-efficacy and desire to show trust in one's partner. The latter supports public health research that suggests gaps in HIV knowledge persist and are pronounced in highly stigmatized populations. DISCUSSION The vulnerabilities experienced by transgender persons, particularly in environments that vehemently adhere to conservative ideologies related to sex and gender, are significant and harm this population. These vulnerabilities could potentially be addressed through critically examining of impact of policies that indirectly promote or allow victimization of transgender citizens and subsequently diminish the effectiveness of public health and educational interventions. By taking action through the revocation of such laws, the Dominican Republic has the opportunity to improve overall population health, to protect some of its most stigmatized citizens, and to become the flag bearer of enhanced human rights in the Caribbean and Latin America.
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Affiliation(s)
- Henna Budhwani
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Kristine R. Hearld
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Julia Hasbun
- Centro de Orientación e Investigación Integral (COIN), Calle Arzobispo Meriño, Santo Domingo, Dominican Republic
| | - Rebecca Charow
- Caribbean Vulnerable Communities Coalition (CVC), Kingston, Jamaica
| | - Santo Rosario
- Centro de Orientación e Investigación Integral (COIN), Calle Arzobispo Meriño, Santo Domingo, Dominican Republic
| | - Louise Tillotson
- Centro de Orientación e Investigación Integral (COIN), Calle Arzobispo Meriño, Santo Domingo, Dominican Republic
| | | | - John Waters
- Caribbean Vulnerable Communities Coalition (CVC), Kingston, Jamaica
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Budhwani H, Hearld KR, Milner AN, McGlaughlin E, Charow R, Rodriguez-Lauzurique RM, Rosario S, Paulino-Ramirez R. Transgender Women's Drug Use in the Dominican Republic. Transgend Health 2017; 2:188-194. [PMID: 29142909 PMCID: PMC5684664 DOI: 10.1089/trgh.2017.0032] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Studies on drug use in transgender populations, particularly those in resource-limited settings, are scarce. Considering that drug use can be a coping mechanism to deal with stigma and traumatic experiences, we examined associations between stigma, trauma, and drug use in a national sample of transgender women from the Dominican Republic. Methods: Bivariate analyses examined differences between drug users and abstainers (n=287). Multivariate analyses reported odds ratios (OR) with general drug, marijuana, and cocaine use as outcomes (n=243). Results: A quarter of respondents (24.5%) experienced sexual abuse, 12.1% were tortured, and 20.1% experienced a murder attempt. More than a quarter reported using illegal drugs (26.1%). Drug users had lower socioeconomic status; 30.0% of drug users had a primary level of education or less (18.2% of abstainers) and 17.6% of drug users had higher income, defined as greater than 10,001 pesos (∼$210 United States Dollars, USD) per month (28.1% of abstainers). More than half of drug users experienced some form of trauma (51.4%) compared to 43.5% of abstainers, and 28.4% of drug users, compared to 17.1% of abstainers, experienced a murder attempt on her life. Independent sample t-tests found significant differences between drug users and abstainers. Transgender women who experienced sexual abuse had three times high odds of using cocaine. Drug users were more likely to have experienced sexual abuse and attempted suicide (p<0.05 for both). Respondents who attempted suicide had higher odds of using drugs generally and using marijuana specifically, compared to respondents who had not attempted suicide (OR=2.665 and 3.168, respectively). Higher scores on the stigma scale were associated with higher odds of any drug use and cocaine use (OR=1.132 and 1.325, respectively). Conclusions: Although some nations have implemented antidiscrimination policies protecting transgender citizens, these policies are not consistently enforced. Eliminating stigma and stigmatizing policies may reduce rates of drug use as a coping mechanism.
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Affiliation(s)
- Henna Budhwani
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - Elaine McGlaughlin
- United Nations Family Planning Association (UNFPA), Tegucigalpa, Honduras
| | - Rebecca Charow
- Institute for Tropical Medicine and Global Health, Universidad Iberoamericana, Santo Domingo, República Dominicana
| | | | - Santo Rosario
- Centro de Orientación e Investigación Integral (COIN), Santo Domingo, Dominican Republic
| | - Robert Paulino-Ramirez
- Institute for Tropical Medicine and Global Health, Universidad Iberoamericana, Santo Domingo, República Dominicana
- Centro de Orientación e Investigación Integral (COIN), Santo Domingo, Dominican Republic
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Frey JD, Poudrier G, Thomson JE, Hazen A. A Historical Review of Gender-Affirming Medicine: Focus on Genital Reconstruction Surgery. J Sex Med 2017; 14:991-1002. [DOI: 10.1016/j.jsxm.2017.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/22/2017] [Accepted: 06/24/2017] [Indexed: 10/19/2022]
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Spencer S, Meer T, Müller A. "The care is the best you can give at the time": Health care professionals' experiences in providing gender affirming care in South Africa. PLoS One 2017; 12:e0181132. [PMID: 28704458 PMCID: PMC5507544 DOI: 10.1371/journal.pone.0181132] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 06/27/2017] [Indexed: 11/19/2022] Open
Abstract
Background While the provision of gender affirming care for transgender people in South Africa is considered legal, ethical, and medically sound, and is—theoretically—available in both the South African private and public health sectors, access remains severely limited and unequal within the country. As there are no national policies or guidelines, little is known about how individual health care professionals providing gender affirming care make clinical decisions about eligibility and treatment options. Method Based on an initial policy review and service mapping, this study employed semi-structured interviews with a snowball sample of twelve health care providers, representing most providers currently providing gender affirming care in South Africa. Data were analysed thematically using NVivo, and are reported following COREQ guidelines. Results Our findings suggest that, whilst a small minority of health care providers offer gender affirming care, this is almost exclusively on their own initiative and is usually unsupported by wider structures and institutions. The ad hoc, discretionary nature of services means that access to care is dependent on whether a transgender person is fortunate enough to access a sympathetic and knowledgeable health care provider. Conclusion Accordingly, national, state-sanctioned guidelines for gender affirming care are necessary to increase access, homogenise quality of care, and contribute to equitable provision of gender affirming care in the public and private health systems.
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Affiliation(s)
- Sarah Spencer
- Gender Health and Justice Research Unit, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Talia Meer
- Gender Health and Justice Research Unit, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Alex Müller
- Gender Health and Justice Research Unit, University of Cape Town, Cape Town, Western Cape, South Africa
- * E-mail:
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Smith LR, Yore J, Triplett DP, Urada L, Nemoto T, Raj A; Kaiser Permanente Community-Based HIV Test and Treat Study Team. Impact of Sexual Violence Across the Lifespan on HIV Risk Behaviors Among Transgender Women and Cisgender People Living With HIV. J Acquir Immune Defic Syndr 2017; 75:408-16. [PMID: 28653970 DOI: 10.1097/QAI.0000000000001423] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND To examine sexual violence across the lifespan among transgender and cisgender people living with HIV and its associations with recent risk behaviors. SETTING Seven community-based sites serving priority populations disproportionately affected by HIV in the United States, including major metropolitan areas in the West and East Coast, as well as the suburban Mid-Atlantic and rural Southeastern regions. METHODS From 2013 to 2016, baseline survey data were collected from participants (N = 583) of a multisite community-based HIV linkage to/retention in care study conducted at 7 sites across the United States. Adjusted mixed-effects logistic regression models with random effect for site-assessed associations of sexual violence and gender identity with risk outcomes including condomless sex, sex trade involvement, and substance use-related harms. RESULTS One-third of participants reported a history of sexual violence; transgender [adjusted odds ratio (AOR) = 5.1, 95% confidence interval (CI): 2.6 to 10.1] and cisgender women (AOR = 3.8, 95% CI: 2.3 to 6.4) were more likely than cisgender men to experience sexual violence. Sexual violence was associated with experiencing drug-related harms (AOR = 2.6, 95% CI: 1.2 to 5.5). Transgender women were more likely than cisgender men to have sold sex (AOR = 9.3, 95% CI: 1.7 to 50.0). CONCLUSIONS A history of sexual violence is common among transgender and cisgender women PLWH, and it increases risk for drug-related harms. Transgender women are also more likely to report selling sex.
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