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Septarini NW, Chih H, Hendriks J, Maycock B, Burns S. Prevalence of Stigma and Discrimination Amongst Men Who have Sex with Men (MSM) and Transgender Women (Waria) in Bali, Indonesia. J Homosex 2024; 71:1419-1441. [PMID: 36826981 DOI: 10.1080/00918369.2023.2174470] [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] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Men who have sex with men (MSM) and transgender women (waria) in Indonesia experience stigma and discrimination. The prevalence of stigma and discrimination experienced by 416 MSM and waria living in Bali, Indonesia and associations with socio-demographic characteristics are described. High levels of stigma were reported by 50.5% of MSM and 62.7% of waria. Discrimination was reported by 35.5% of MSM and 72.4% of waria. Family rejection, or no family awareness of MSM status, equated to higher levels of stigma compared to those where MSM status was accepted. Homosexual and bisexual waria reported lower odds of experiencing stigma compared to heterosexual waria. MSM who were not single were twice as likely to experience discrimination compared to single participants. Non-Hindu MSM were nearly three times as likely to experience discrimination compared to Hindu participants. Waria who were studying were less likely to experience discrimination compared to those who reported regular employment jobs. Specific policy and practice to reduce experiences of stigma and/or discrimination specific to MSM and waria are needed.
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Affiliation(s)
- Ni Wayan Septarini
- Department of Community and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - HuiJun Chih
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Jacqueline Hendriks
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Collaboration for Evidence, Research and Impact in Public Health, Curtin University, Perth, Australia
| | - Bruce Maycock
- European Centre for Environmental and Human Health, College of Medicine and Health, University of Exeter, Devon, The United Kingdom
| | - Sharyn Burns
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Collaboration for Evidence, Research and Impact in Public Health, Curtin University, Perth, Australia
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Yimsaard P, Mootz JJ, Rungnirundorn T, Janamnuaysook R, Samitpol K, Phanuphak N, Wainberg ML. Assessing the acceptability of implementing a Screening, Brief Intervention and Referral to Treatment for alcohol use among transgender women in Bangkok, Thailand: A mixed-method pre-implementation study using the Consolidated Framework for Implementation Research. Addiction 2024; 119:863-874. [PMID: 38168887 PMCID: PMC11009091 DOI: 10.1111/add.16423] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/19/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND AND AIMS Health inequities related to alcohol use exist for transgender individuals. While the Thailand Ministry of Public Health recently published a clinical guideline to implement a Screening, Brief Intervention and Referral to Treatment (SBIRT) in primary care, there has been no study regarding transgender women's (TGW) alcohol use and the acceptability of implementing SBIRT in a Thai context, a gap this study aimed to fill. DESIGN A mixed-method approach was used. In the first phase, TGW service users and health-care providers (HCPs) completed a survey on the acceptability of prospective implementation of SBIRT. TGW service users completed the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C). In the second phase, TGW service users, HCPs, clinic administrators and national-level alcohol, HIV and transgender health policymakers participated in in-depth qualitative interviews. SETTING The Tangerine Clinic, a transgender-led sexual health clinic in Bangkok, Thailand. PARTICIPANTS In the first phase, TGW service users (n = 100) and HCP (n = 8) were surveyed. In the second phase, 22 stakeholders (n = 10 TGW service users; n = 8 HCP; n = 1 clinic administrator; n = 3 policymakers) were interviewed. MEASUREMENTS Simple proportions were calculated for each survey item. Differences in acceptability by various demographic factors were calculated using univariate analysis. The qualitative data were coded using thematic analysis and a deductive approach. The results were mapped to the Consolidated Framework for Implementation Research domains and constructs. The quantitative and qualitative results were triangulated to expand understanding. FINDINGS Fifty per cent of the TGW participants exhibited problematic drinking levels (AUDIT-C ≥ 4). Implementing SBIRT was highly acceptable, as more than 95% of participants reported agreeing or completely agreeing to receive SBIRT for alcohol use. Barriers, such as complexity, time constraint and lack of knowledge and skills, were anticipated. Adaptability, such as tailoring the content of brief intervention to suit TGW health needs and SBIRT to fit with existing clinic procedures, might facilitate successful implementation. CONCLUSION Screening, Brief Intervention and Referral to Treatment (SBIRT) for alcohol use has the potential to be successfully implemented in transgender-led sexual health clinic settings, with some adaptations to overcome anticipated barriers.
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Affiliation(s)
- Pongkwan Yimsaard
- Department of Psychiatry, King Chulalongkorn Memorial Hospital Thai Red Cross Society, Bangkok, Thailand
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jennifer J. Mootz
- Columbia University Department of Psychiatry, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Teerayuth Rungnirundorn
- Department of Psychiatry, King Chulalongkorn Memorial Hospital Thai Red Cross Society, Bangkok, Thailand
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Rena Janamnuaysook
- Institute of HIV Research and Innovation, Bangkok, Thailand
- Center of Excellence in Transgender Health, Chulalongkorn University, Bangkok, Thailand
| | - Kritima Samitpol
- Institute of HIV Research and Innovation, Bangkok, Thailand
- Center of Excellence in Transgender Health, Chulalongkorn University, Bangkok, Thailand
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Rytz CL, Turino Miranda K, Ronksley PE, Saad N, Raj SR, Somayaji R, Dumanski SM, Ganshorn H, Greene DN, Collister D, Newbert AM, Peace L, Ahmed SB. Association between Serum Estradiol and Cardiovascular Health among Transgender Adults Using Gender-Affirming Estrogen Therapy. Am J Physiol Heart Circ Physiol 2024. [PMID: 38578239 DOI: 10.1152/ajpheart.00151.2024] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/02/2024] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Gender-affirming estrogen therapy (GAET) is commonly used for feminization in transgender and non-binary (TNB) individuals, yet the optimal rate of change (ROC) in estradiol levels for cardiovascular health is unclear. We examined the association between serum estradiol levels and cardiovascular-related mortality, adverse events, and risk factors in TNB adults using GAET. METHODS Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE and Web of Science were systematically searched (inception-April 2023) for original articles reporting serum estradiol levels and cardiovascular-related mortality, adverse events, and risk factors in TNB adults using GAET. Data extraction was completed in duplicate following PRISMA guidelines. Stratified random effects meta-analyses using serum estradiol ROC (serum estradiolbaseline-serum estradiolfollow-up/study duration) was used to assess longitudinal studies (Low:0 RESULTS Thirty-five studies (13 cross-sectional, 19 cohort, 3 trials) were included. Two studies collectively reported 50 cardiovascular-related deaths, and four collectively reported 23 adverse cardiovascular events. Nineteen studies reporting cardiovascular risk factors were meta-analyzed by ROC stratum (Low=5; Moderate=6; High=8), demonstrating an association between moderate (0.40, 95%CI: 0.22, 0.59kg/m2, I2=28.2%) and high (0.46, 95%CI:0.15, 0.78kg/m2; I2=0.0%,) serum estradiol ROC and increased body mass index. High (-6.67, 95%CI:-10.65, -2.68mg/dL; I2=0.0%) serum estradiol ROC were associated with decreased low-density lipoproteins. Low (-7.05, 95%CI:-10.40, -3.70mmHg; I2=0.0%) and moderate (-3.69, 95%CI:-4.93, -2.45mmHg; I2=0.0%) serum estradiol ROC were associated with decreases in systolic blood pressure. CONCLUSION In TNB adults using GAET, serum estradiol ROC may influence cardiovascular risk factors, which may have implications for clinical cardiovascular outcomes.
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Affiliation(s)
| | | | | | - Nathalie Saad
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Satish R Raj
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | | | | | | | - Dina N Greene
- Department of Laboratory Medicine, University of Washington, United States
| | - David Collister
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Amarante ICJ, Lippman SA, Sevelius JM, Saggese GSR, da Silva AAM, Veras MADSM. Anticipated Stigma and Social Barriers to Communication Between Transgender Women Newly Diagnosed with HIV and Health Care Providers: A Mediation Analysis. LGBT Health 2024; 11:229-238. [PMID: 37910864 PMCID: PMC11001954 DOI: 10.1089/lgbt.2023.0041] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
Purpose: We assessed whether anticipated stigma (i.e., fear of public mistreatment due to gender identity) impacts communication between transgender women (TGW) living with HIV and health care providers. Methods: This is a secondary analysis of baseline data from Trans Amigas, a study conducted in Brazil, 2018. The study population consisted of TGW living with HIV, older than 18 years, residing in the São Paulo metropolitan area. We used multivariable logistic regression (α = 0.05), mediation, and bootstrapping for the analysis. Results: One hundred and thirteen participants completed the study. Fear of public mistreatment had an adjusted odds ratio (aOR) of 7.42 (p = 0.003) for difficulty reporting new symptoms to providers. Concerning fear of public mistreatment, we found that unemployment had an aOR of 3.62 (p = 0.036); sex work, an aOR of 2.95 (p = 0.041); and issues related to name change in documents, an aOR of 2.71 (p = 0.033). For the indirect effect on difficulty reporting new symptoms, mediated by fear of public mistreatment, unemployment had an aOR of 1.52 (confidence interval [CI] = 0.88-2.24); sex work, an aOR of 1.48 (CI = 0.81-2.52); and name change issues, an aOR of 1.47 (CI = 0.96-2.43). Conclusions: Anticipated stigma was associated with communication difficulties between TGW living with HIV and providers. Our data suggest that structural factors associated with anticipated stigma could indirectly impact on difficulty reporting new symptoms. These findings indicate the importance of considering social contexts that intersect with individual experiences when analyzing communication barriers between providers and patients, and the need to strengthen social policies for TGW in Brazil. Clinical Trial Registration number: R34MH112177.
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Affiliation(s)
- Isabella Chypriades Junqueira Amarante
- Department of Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, São Paulo, Brazil
- Núcleo de Pesquisa em Direitos Humanos e Saúde da População LGBT+ (NUDHES), São Paulo, São Paulo, Brazil
| | - Sheri A Lippman
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jae M. Sevelius
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Gustavo Santa Roza Saggese
- Núcleo de Pesquisa em Direitos Humanos e Saúde da População LGBT+ (NUDHES), São Paulo, São Paulo, Brazil
| | | | - Maria Amélia de Sousa Mascena Veras
- Department of Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, São Paulo, Brazil
- Núcleo de Pesquisa em Direitos Humanos e Saúde da População LGBT+ (NUDHES), São Paulo, São Paulo, Brazil
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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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Moncayo-Quevedo JE, Pérez-Arizabaleta MDM, Rodríguez-Ortiz AR, Villegas-Trujillo LM. A Contextualization of Transgender Women and Condom Use Using the HIV Syndemic Framework: Scoping Review. Int J Sex Health 2024; 36:221-235. [PMID: 38616798 PMCID: PMC11008551 DOI: 10.1080/19317611.2024.2319323] [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] [Received: 07/11/2023] [Accepted: 02/09/2024] [Indexed: 04/16/2024]
Abstract
Objective: To contextualize condom use in the transgender women population utilizing the HIV syndemic framework. Methods: Studies reporting condom use frequency and syndemic factors associated with HIV risk in transgender women were systematically searched. We followed the Scoping Reviews (PRISMA-ScR) checklist. Results: Social factors have a proven relationship with using condoms and HIV among transgender women. Syndemic factors, defined as co-occurring adverse factors that interact to contribute to risk behaviors, deserve a specific analysis to develop strategies to face HIV among transgender women. Conclusions: A syndemic perspective allows to generate specific health intervention and prevention policies to protect transgender women.
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Affiliation(s)
| | | | | | - Lina María Villegas-Trujillo
- Faculty of Health, SIT Consulting – Science, Innovation & Technology, Cali, Colombia
- Department of Research, Faculty of Health, Universidad del Valle, Cali, Colombia
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7
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Lankowski A, Tollefson D, Sánchez H, Cabello R, Hidalgo J, Mathison MN, Molina Y, Duerr A. Acceptability of venue-based HIV testing and prevention interventions for men who have sex with transgender women and transgender women in Lima, Perú: a formative, qualitative study. HIV Res Clin Pract 2024; 25:2331360. [PMID: 38579280] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
BACKGROUND Despite being at elevated risk for HIV, men who have sex with transgender women (MSTW) are an overlooked population in the global HIV response. Venue-based HIV interventions have previously had success reaching other HIV priority populations, including transgender women (TW). Similar approaches could be applied for MSTW. OBJECTIVE To evaluate the prospective acceptability of venue-based HIV testing and prevention interventions for MSTW and TW in Lima, Peru. METHODS In this exploratory qualitative study, we conducted in-depth interviews (IDI) and focus group discussions (FGD) with three types of participants: MSTW (7 IDIs, 1 FGD), TW (1 FGD), and owners of social venues frequented by MSTW/TW in Lima (2 IDIs). We elicited participants' attitudes and perceptions related to the following four hypothetical interventions delivered at social venues in Lima: rapid HIV testing; HIV self-test distribution; condom/lubricant distribution; and enrolment in a mobile app supporting HIV prevention. We performed a mixed deductive-inductive thematic analysis using the framework method, then applied the Theoretical Framework of Acceptability to classify the overall acceptability of each intervention. RESULTS Condom/lubricant distribution and app-based HIV prevention information were highly acceptable among all participant types. The two HIV testing interventions had relatively lower acceptability; however, participants suggested this could be overcome if such interventions focused on ensuring discretion, providing access to healthcare professionals, and offering appropriate incentives. CONCLUSIONS Overall, MSTW and TW shared similar favourable attitudes towards venue-based HIV interventions. Venue-based outreach warrants further exploration as a strategy for engaging MSTW and TW in HIV prevention activities.
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Affiliation(s)
- Alexander Lankowski
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Deanna Tollefson
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | | | | | - Mary N Mathison
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Yamilé Molina
- School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | - Ann Duerr
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
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Thapa S, Ogunleye TT, Shrestha R, Joshi R, Hannes K. Increased Stigma, and Physical and Sexual Violence Against Men Who Have Sex with Men and Transgender Women in Sub-Saharan Africa: A Qualitative Evidence Synthesis Analyzing Social and Structural Barriers to HIV Testing and Coping Behaviors. J Homosex 2024:1-27. [PMID: 38456684 DOI: 10.1080/00918369.2024.2320237] [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: 03/09/2024]
Abstract
In sub-Saharan Africa, accessing HIV testing services is a significant challenge for men who have sex with men (MSM) and transgender women (TGW). In this qualitative evidence synthesis, our aim is to understand social and structural barriers and how they hinder MSM's and TGW's access to HIV testing services in sub-Saharan African countries. We searched four selective databases (PubMed, Web of Science and CINAHL complemented with Google Scholar) for qualitative studies, published in English between January 2005 and December 2023, generated 1507 articles, of which 22 were included. Thematic synthesis was conducted for data synthesis. This led to five barriers that hinder HIV test uptake among MSM and TGW, which included: non-availability of tailored HIV testing services, stigma, lack of trust among service providers, sexual and physical violence, and criminalization of same sex relationship. To navigate these social and structural barriers and cope with fears of discrimination and criminalization, MSM and TGW engaged into riskier behaviors, including avoiding HIV testing, non-disclosure, or relying on informal or alternative sources of HIV testing. Decriminalization of same-sex relationship and peer-led HIV testing services were noted to address structural barriers, including stigma and poor access, and subsequently increase the participation in HIV testing services.
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Affiliation(s)
- Subash Thapa
- Rural Health Research Institute, Charles Sturt University, Orange, Australia
| | - Tadese Tewogbola Ogunleye
- Unit for Health Promotion, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Roman Shrestha
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ranjila Joshi
- Unit for Health Promotion, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Karin Hannes
- Research Group SoMeTHin'K (Social, Methodological and Theoretical Innovation/Kreative), Faculty of Social Sciences, Katholieke Universiteit, Leuven, Belgium
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Miranda KT, Greene DN, Collister D, Krasowski MD, Ahmed SB, Cirrincione LR, Rosas SE, Saad N, Pierre CC. A Holistic Framework for the Evaluation of Kidney Function in a Gender-Diverse Landscape. Am J Kidney Dis 2024:S0272-6386(24)00632-2. [PMID: 38458377 DOI: 10.1053/j.ajkd.2024.01.522] [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] [Received: 09/05/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 03/10/2024]
Abstract
The most commonly used equations to estimate glomerular filtration rate incorporate a binary male-female sex coefficient, which has important implications for the care of transgender, gender-diverse, and non-binary (TGD) people. Whether "sex assigned at birth" or a binary "gender identity" is most appropriate for the computation of estimated glomerular filtration rate (eGFR) is unknown. Furthermore, the use of gender-affirming hormone therapy (GAHT) for the development of physical changes to align TGD people with their affirmed gender is increasingly common, and may result in changes in serum creatinine and cystatin C, biomarkers commonly used to estimate glomerular filtration rate. The paucity of current literature evaluating chronic kidney disease (CKD) prevalence and outcomes in TGD individuals on GAHT makes it difficult to assess any effects of GAHT on kidney function. Whether alterations in serum creatinine reflect changes in glomerular filtration rate or simply changes in muscle mass is unknown. Therefore, we propose a holistic framework to evaluate kidney function in TGD people. The framework focuses on kidney disease prevalence, risk factors, sex hormones, eGFR, other kidney function assessment tools, and the mitigation of health inequities in TGD people.
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Affiliation(s)
- Keila Turino Miranda
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dina N Greene
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, United States of America; LetsGetChecked Laboratories, Monrovia, California, United States of America
| | - David Collister
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew D Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, States of America
| | - Sofia B Ahmed
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Alberta Kidney Disease Network, Calgary, Alberta, Canada
| | - Lauren R Cirrincione
- Department of Pharmacy, University of Washington, Seattle, Washington, United States of America
| | - Sylvia E Rosas
- Kidney and Hypertension Unit, Joslin Diabetes Center, Boston, Massachusetts, United States of America; Department of Nephrology, Beth Israel Deaconess Medical Centre, Boston, Massachusetts, United States of America; Harvard Medical School, Boston, Massachusetts, United States of America
| | - Nathalie Saad
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christina C Pierre
- Department of Pathology and Laboratory Medicine, Penn Medicine Lancaster General Health, Lancaster, Pennsylvania, United States of America; Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania.
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Wahome E, Otieno FO, Kimani J, Boyd A, Okall D, Nzioka J, Gichuru E, van der Elst E, Mehta SD, Bailey RC, Graham SM, Sanders EJ. Impact of coronavirus disease 2019-related clinic closures on HIV incidence in young adult MSM and transgender women in Kenya. AIDS 2024; 38:407-413. [PMID: 37939103 PMCID: PMC10842664 DOI: 10.1097/qad.0000000000003782] [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: 07/18/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Little is known about the impact that the COVID-19 pandemic had on risk of HIV acquisition in sub-Saharan Africa. We assessed the impact of COVID-19-related clinic closures on HIV incidence in a cohort of gay, bisexual, and other men who have sex with men (MSM) and transgender women in Kenya. METHODS MSM and transgender women enrolled in a prospective, multicentre cohort study were followed quarterly for HIV testing, behaviour assessments, and risk. We estimated the HIV incidence rate and its 95% credible intervals (CrI) among participants who were HIV-negative before COVID-19-related clinic closure, comparing incidence rate and risk factors associated with HIV acquisition before vs. after clinic reopening, using a Bayesian Poisson model with weakly informative priors. RESULTS A total of 690 (87%) participants returned for follow-up after clinic reopening (total person-years 664.3 during clinic closure and 1013.3 after clinic reopening). HIV incidence rate declined from 2.05/100 person-years (95% CrI = 1.22-3.26, n = 14) during clinic closures to 0.96/100 person-years (95% CrI = 0.41-2.07, n = 10) after clinic reopening (IRR = 0.47, 95% CrI = 0.20-1.01). The proportion of participants reporting hazardous alcohol use and several sexual risk behaviours was higher during clinic closures than after clinic reopening. In multivariable analysis adjusting for study site and participant characteristics, HIV incidence was lower after clinic reopening (IRR 0.57, 95% CrI = 0.23-1.33). Independent risk factors for HIV acquisition included receptive anal intercourse (IRR 1.94, 95% CrI = 0.88-4.80) and perceived risk of HIV (IRR 3.03, 95% CRI = 1.40-6.24). CONCLUSION HIV incidence during COVID-19-related clinic closures was moderately increased and reduced after COVID-19 restrictions were eased. Ensuring access to services for key populations is important during public health emergencies.
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Affiliation(s)
| | | | - Joshua Kimani
- Sex Worker Outreach Program (SWOP), and Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Anders Boyd
- Public Health Service of Amsterdam, Department of Infectious Diseases
- Stichting HIV Monitoring
- Amsterdam UMC location University of Amsterdam, Infectious Diseases
| | - Duncan Okall
- Sex Worker Outreach Program (SWOP), and Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Joseph Nzioka
- Sex Worker Outreach Program (SWOP), and Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | | | - Elise van der Elst
- KEMRI/Wellcome Trust Research Programme, Kilifi
- Department of Global Health, University of Amsterdam, Amsterdam, Netherlands
| | | | - Robert C. Bailey
- Nyanza Reproductive Health Society, Kisumu
- University of Illinois at Chicago, IL
| | - Susan M. Graham
- KEMRI/Wellcome Trust Research Programme, Kilifi
- Nyanza Reproductive Health Society, Kisumu
- University of Washington, Seattle, WA, USA
| | - Eduard J. Sanders
- KEMRI/Wellcome Trust Research Programme, Kilifi
- Department of Global Health, University of Amsterdam, Amsterdam, Netherlands
- University of Oxford, Headington, UK
- The Aurum Institute, Johannesburg, South Africa
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Magalhães LS, Dos Santos KC, Diniz E Silva BV, Filho GFS, Vaddiparti K, Gonzalez RIC, Pillon SC, Carneiro MADS, Caetano KAA, Cook RL, Teles SA. Alarming patterns of moderate and high-risk alcohol use among transgender women in Goiás, Central Brazil. Front Public Health 2024; 12:1333767. [PMID: 38420026 PMCID: PMC10899442 DOI: 10.3389/fpubh.2024.1333767] [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: 11/07/2023] [Accepted: 01/26/2024] [Indexed: 03/02/2024] Open
Abstract
Background Scant studies have examined alcohol consumption among transgender women in Latin America. This cross-sectional study estimated the prevalence and associated factors of risky alcohol use among transgender women in Goiás, a state located in the center of Brazil. Methods Participants were 440 transgender women (median age = 35 years, interquartile range = 9) recruited through respondent-driven sampling. All participants were interviewed about sociodemographic characteristics, violence, and risk behavior. Alcohol use was assessed using the alcohol use disorders identification test (AUDIT). An AUDIT score greater than or equal to eight was considered as risky alcohol consumption. Logistic regression analysis was used to examine predictors of risky alcohol use, and p-values <0.05 were considered significant. Results The majority were young, single, sex workers. Most transgender women had used alcohol in the previous year (85.7%), and more than half (56.6%) reported binge drinking and risky alcohol consumption (60.2%). There was a high overlap between sexual behavior, drugs, and alcohol use. Using alcohol during sex (adjusted odds ratio [aOR]: 2.9; 95% confidence interval [CI]: 1.7-4.8), cocaine/crack use (aOR: 2.3; 95% CI: 1.5-3.7) and having a drug user as a sexual partner (aOR: 2.9; 95% CI: 1.5-5.9) were independently associated with risky alcohol consumption. Conclusion Alcohol consumption was highly prevalent, and drugs seem to play an important role in risky alcohol consumption among transgender women Goiás. These findings support stakeholders to promote intervention strategies to reduce this pattern of alcohol consumption and reduce the burden of substance use disorders among transgender women.
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Affiliation(s)
| | | | | | | | - Krishna Vaddiparti
- Department of Epidemiology, University of Florida, Gainesville, FL, United States
| | | | | | | | | | - Robert Lewis Cook
- Department of Epidemiology, University of Florida, Gainesville, FL, United States
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12
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Cespedes MS, Das M, Yager J, Prins M, Krznaric I, de Jong J, Xiao D, Shao Y, Wong P, Kintu A, Carter C, Hoornenborg E, Ruane P, Phoenix J, Younis I, Halperin J. Gender Affirming Hormones Do Not Affect the Exposure and Efficacy of F/TDF or F/TAF for HIV Preexposure Prophylaxis: A Subgroup Analysis from the DISCOVER Trial. Transgend Health 2024; 9:46-52. [PMID: 38312459 PMCID: PMC10835152 DOI: 10.1089/trgh.2022.0048] [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: 11/12/2022] Open
Abstract
Purpose Transgender women are disproportionately affected by HIV and are underutilizing preexposure prophylaxis (PrEP). The lower uptake of PrEP by transgender women may be, in part, owing to the perception that taking PrEP may lower the efficacy of gender-affirming hormone therapy (GAHT) or to provider concerns that GAHT may lower the efficacy of PrEP. Methods DISCOVER was a randomized, double-blind, noninferiority trial comparing emtricitabine (FTC, F) and tenofovir alafenamide (F/TAF) versus emtricitabine and tenofovir disoproxil fumarate (F/TDF) as PrEP among transgender women and cisgender men who have sex with men (MSM). This nested substudy of the DISCOVER trial compared the exposure of the active intracellular metabolites of FTC and tenofovir (TFV), FTC triphosphate (FTC-TP) and TFV diphosphate (TFV-DP), in peripheral blood mononuclear cells (PBMC) among transgender women receiving GAHT versus MSM within the F/TAF and F/TDF groups. Results Our results demonstrate that TFV-DP and FTC-TP levels in PBMC were comparable between transgender women on GAHT and MSM receiving F/TAF, and between transgender women on GAHT and MSM receiving F/TDF. TFV-DP concentrations remained above the EC90 of 40 fmol/106 cells across all groups. No clinically significant drug-drug interactions of GAHT were observed with either F/TAF or F/TDF in this subanalysis. Conclusions These findings are consistent with the clinical pharmacology of GAHT, FTC, TDF, and TAF reported in previous studies, and support the continued use of F/TAF and F/TDF for PrEP in transgender women. Clinicaltrials.gov registration number: NCT02842086.
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Affiliation(s)
- Michelle S Cespedes
- Division of Infectious Disease, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Moupali Das
- Gilead Sciences, Foster City, California, USA
| | - Jenna Yager
- Gilead Sciences, Foster City, California, USA
| | - Maria Prins
- Department of Infectious Diseases, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers (UMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Ivanka Krznaric
- Zentrum für Infektiologie Berlin Prenzlauer Berg, Berlin, Germany
| | - Jan de Jong
- Gilead Sciences, Foster City, California, USA
| | - Deqing Xiao
- Gilead Sciences, Foster City, California, USA
| | - Yongwu Shao
- Gilead Sciences, Foster City, California, USA
| | - Pamela Wong
- Gilead Sciences, Foster City, California, USA
| | | | | | - Elske Hoornenborg
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Peter Ruane
- Ruane Clinical Research Group, Inc., Los Angeles, California, USA
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13
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Winiker AK, Eschliman EL, Kisanga EP, Poku OB, Candelario J, Takahashi LM, Tobin K. Multilevel experiences of carceral violence in Los Angeles, California: first-hand accounts from a racially diverse sample of transgender women. Cult Health Sex 2024; 26:159-173. [PMID: 36995142 PMCID: PMC10731923 DOI: 10.1080/13691058.2023.2194353] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 03/20/2023] [Indexed: 03/31/2023]
Abstract
Transgender women face a disproportionate burden of carceral violence, or violence related to policing and the criminal legal system, with transgender women of colour experiencing even greater disparities. Several frameworks conceptualise the mechanisms through which violence impacts transgender women. However, none of them directly explore the role of carceral violence, particularly as it is experienced by transgender women themselves. Sixteen in-depth interviews were conducted with a racially/ethnically diverse sample of transgender women in Los Angeles between May and July 2020. Participants were between 23 - 67 years old. Participants identified as Black (n = 4), Latina (n = 4), white (n = 2), Asian (n = 2), and Native American (n = 2). Interviews assessed experiences of multilevel violence, including from police and law enforcement. Deductive and inductive coding methods were used to identify and explore common themes concerning carceral violence. Experiences of law enforcement-perpetrated interpersonal violence were common and included physical, sexual and verbal abuse. Participants also highlighted structural violence, including misgendering, the non-acceptance of transgender identities, and police intentionally failing to uphold laws that could protect transgender women. These results demonstrate the pervasive, multilevel nature of carceral violence perpetrated against transgender women and suggest avenues for future framework development, trans-specific expansions of carceral theory, and system-wide institutional change.
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Affiliation(s)
- Abigail K. Winiker
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Evan L. Eschliman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Edwina P. Kisanga
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ohemaa B. Poku
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, Columbia University and New York Psychiatric Institute, New York, NY, USA
| | | | - Lois M. Takahashi
- Sol Price School of Public Policy, University of Southern California, Sacramento, CA, USA
| | - Karin Tobin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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14
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Algarin AB, Smith LR, Pines HA, Zapien-Vasquez MF, Padilla-Garcia R, Navarro-Alvarez S, Pitpitan EV. The Gender Minority Stress and Resilience Measure: Psychometric Validity for Use in Spanish. Transgend Health 2024; 9:24-33. [PMID: 38312447 PMCID: PMC10835158 DOI: 10.1089/trgh.2021.0190] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 11/12/2022] Open
Abstract
Purpose Stigma is a fundamental driver of HIV disparities among transgender women (TW). The gender minority stress and resilience (GMSR) measure has not been validated in Spanish-speaking, resource-limited settings. We examined the psychometric properties of a translated and abbreviated GMSR among TW in Tijuana, Mexico. Methods From 2020 to 2021, 152 participants were recruited through social media and venue-based sampling. We collected information on the abbreviated GMSR, psychosocial factors (e.g., depressive symptoms), and sociodemographics. The abbreviated GMSR assessed 7 factors (Discrimination, Rejection, Internalized Transphobia, Negative Expectations, Nondisclosure, Pride, and Community Connectedness). Confirmatory factor analysis, Cronbach's alphas, and McDonald's omegas assessed structural validity. Pearson's partial correlations assessed criterion, convergent, and discriminant validities. Results The 7-factor structure solution had acceptable fit (root mean square error of approximation [95% confidence interval]=0.05 [0.05-0.06]; comparative fit index/Tucker-Lewis index=0.92/0.91); and internal reliability (α=0.62-0.89; ω=0.62-0.89). Depressive (r=0.22-0.43; p<0.001-0.007), post-traumatic stress disorder (PTSD; r=0.20-0.34; p<0.001-0.017) symptoms, and perceived stress (r=0.19-0.41; p≤0.001-0.030) were all positively associated with all stress factors (e.g., Discrimination, Rejection, Internalized Transphobia, Negative Expectations, and Nondisclosure). The resilience factor Pride was associated with fewer PTSD symptoms (r=-0.18; p=0.027), lower perceived life stress (r=-0.21; p=0.012), and greater general resilience (r=0.26; p=0.002). The Community Connectedness resilience factor was associated with fewer depressive symptoms (r=-0.22; p=0.007). Constructs were conceptually distinct with factor correlations below 0.60. Conclusion Findings suggest that the Spanish-translated, abbreviated GMSR is a reliable and valid measure. These data expand the usability of the GMSR to TW in a Latin American, Spanish-speaking context.
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Affiliation(s)
- Angel B. Algarin
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, California, USA
| | - Laramie R. Smith
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, California, USA
| | - Heather A. Pines
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California, USA
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California, USA
| | | | | | | | - Eileen V. Pitpitan
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, California, USA
- School of Social Work, San Diego State University, San Diego, California, USA
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15
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Espinosa CC, Crim SM, Carree T, Dasgupta S. Unmet Needs for Ancillary Services and Associations with Clinical Outcomes Among Transgender Women with Diagnosed HIV: Medical Monitoring Project, United States, 2015-2020. LGBT Health 2024; 11:143-155. [PMID: 37851999 DOI: 10.1089/lgbt.2023.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
Purpose: Access to ancillary services-including HIV support services, non-HIV clinical services, and subsistence services-can support care engagement and viral suppression and reduce disparities among people with HIV (PWH). We used representative U.S. data to assess differences in unmet needs for ancillary services between transgender women with HIV and other PWH. In addition, we examined associations between unmet needs and clinical outcomes among transgender women. Methods: We analyzed 2015-2020 Medical Monitoring Project data among transgender women (N = 362), cisgender men (N = 17,319), and cisgender women (N = 6016) with HIV. We reported weighted percentages for characteristics, and reported adjusted prevalence ratios (aPRs) controlling for race/ethnicity and age, and 95% confidence intervals (CI) using logistic regression with predicted marginal means to assess differences between groups. Results: Among transgender women, unmet needs were highest for dental care (24.9%), shelter or housing (13.9%), and transportation assistance (12.6%). Transgender women were more likely than cisgender men to have unmet subsistence needs. Among transgender women, unmet needs for ancillary services were negatively associated with many clinical outcomes after adjusting for age and race/ethnicity. Unmet needs for subsistence services were associated with higher levels of antiretroviral therapy nonadherence (aPR: 1.39; 95% CI: 1.13-1.70) and detectable viral loads (aPR: 1.47; 1.09-1.98), emergency room visits (aPR: 1.42; 1.06-1.90), and depression (aPR: 2.74; 1.83-4.10) or anxiety (aPR: 3.20; 2.05-5.00) symptoms. Conclusions: Transgender women with HIV were more likely than cisgender men with HIV to experience unmet needs for subsistence services-likely a reflection of substantial socioeconomic disadvantage. Addressing unmet needs is an essential step for improving care outcomes among transgender women with HIV.
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Affiliation(s)
- Catherine C Espinosa
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stacy M Crim
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tamara Carree
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- DLH Corp, Atlanta, Georgia, USA
| | - Sharoda Dasgupta
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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16
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Andrzejewski J, Pines HA, Morris S, Burke L, Bolan R, Sevelius J, Moore DJ, Blumenthal J. Determinants of HIV Pre-Exposure Prophylaxis (PrEP) Retention among Transgender Women: A Sequential, Explanatory Mixed Methods Study. Int J Environ Res Public Health 2024; 21:133. [PMID: 38397624 PMCID: PMC10888369 DOI: 10.3390/ijerph21020133] [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] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 02/25/2024]
Abstract
Transgender women (TW) face inequities in HIV and unique barriers to PrEP, an effective biomedical intervention to prevent HIV acquisition. To improve PrEP retention among TW, we examined factors related to retention using a two-phase, sequential explanatory mixed methods approach. In Phase I, we used data from a trial of 170 TW who were provided oral PrEP to examine predictors of 24-week retention. In Phase II, we conducted 15 in-depth interviews with PrEP-experienced TW and used thematic analysis to explain Phase I findings. In Phase I, more participants who were not retained at 24 weeks reported sex work engagement (18% versus 7%) and substantial/severe drug use (18% versus 8%). In Phase II, participants reported drug use as a barrier to PrEP, often in the context of sex work, and we identified two subcategories of sex work. TW engaged in "non-survival sex work" had little difficulty staying on PrEP, while those engaged in "survival sex work" struggled to stay on PrEP. In Phase I, fewer participants not retained at 24 weeks reported gender-affirming hormone therapy (GAHT) use (56% versus 71%). In Phase II, participants prioritized medical gender affirmation services over PrEP but also described the bidirectional benefits of accessing GAHT and PrEP. TW who engaged in "survival sex work" experience barriers to PrEP retention (e.g., unstable housing, drug use) and may require additional support to stay in PrEP care.
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Affiliation(s)
- Jack Andrzejewski
- San Diego Joint Doctoral Program in Public Health, San Diego State University—University of California San Diego, San Diego, CA 92093, USA
| | - Heather A. Pines
- School of Public Health, San Diego State University, San Diego, CA 92182, USA;
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA 92093, USA
- Department of Medicine, University of California San Diego, La Jolla, CA 92161, USA; (S.M.); (L.B.); (J.B.)
| | - Sheldon Morris
- Department of Medicine, University of California San Diego, La Jolla, CA 92161, USA; (S.M.); (L.B.); (J.B.)
| | - Leah Burke
- Department of Medicine, University of California San Diego, La Jolla, CA 92161, USA; (S.M.); (L.B.); (J.B.)
| | | | - Jae Sevelius
- Department of Psychiatry, Columbia University, New York, NY 10032, USA;
| | - David J. Moore
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA;
| | - Jill Blumenthal
- Department of Medicine, University of California San Diego, La Jolla, CA 92161, USA; (S.M.); (L.B.); (J.B.)
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17
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Arrington-Sanders R, Galai N, Falade-Nwulia O, Hammond C, Wirtz A, Beyrer C, Arteaga A, Celentano D. Patterns of Polysubstance Use in Young Black and Latinx Sexual Minority Men and Transgender Women and Its Association with Sexual Partnership Factors: The PUSH Study. Subst Use Misuse 2024; 59:317-328. [PMID: 38146133 DOI: 10.1080/10826084.2023.2267655] [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: 12/27/2023]
Abstract
Background: Adult studies have demonstrated that polysubstance use increases HIV acquisition risk through increased sexual behaviors, however, few studies have examined polysubstance in young Black and Latinx sexual minority men (SMM) and transgender women (TW). Methods: We used cross-sectional data from 466 young Black and Latinx SMM and TW living in four high HIV-burden US cities enrolled in the PUSH Study, a status-neutral randomized control trial to increase HIV prevention and treatment adherence. We examined data for patterns of polysubstance use comparing age differences of use and explored associations between substance use and sexual partnership factors - inconsistent condom use, pressure to have condomless anal sex, and older partner, using bivariate and multivariate analyses. Results: Most participants described prior substance use with alcohol and cannabis being most common (76% each) and 23% described other illicit drug use, including stimulants, cocaine, hallucinogens, sedatives, opioids, and inhalants. Polysubstance use was common with nearly half (47%) of participants reporting alcohol and cannabis use, 20% reporting alcohol, cannabis, and one other illicit drug use, and 19% reporting alcohol or cannabis use plus one other illicit drug use. Polysubstance use was associated with greater adjusted odds of pressure to have condomless anal sex, older partner (>5 years older), and inconsistent condom use. Conclusions: Associations of polysubstance use with sexual practices and sexual partnerships that are known predictors of HIV acquisition or transmission among Black and Latinx SMM and TW underscore the need for combination interventions that include substance use treatment alongside antiretroviral-based and partner-based HIV prevention and treatment interventions.Trial Registration: ClinicalTrials.gov Identifier: NCT03194477.
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Affiliation(s)
- Renata Arrington-Sanders
- Department of Pediatrics, Division of Adolescent & Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Medicine, Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia Perelman School of Medicine, University of Pennsylvania
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Statistics, University of Haifa, Mt Carmel, Israel
| | - Oluwaseun Falade-Nwulia
- Department of Medicine, Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher Hammond
- Department of Pediatrics, Division of Adolescent & Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrea Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Chris Beyrer
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Aubrey Arteaga
- Department of Pediatrics, Division of Adolescent & Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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18
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Brown EE, Patel EU, Poteat TC, Mayer K, Wawrzyniak AJ, Radix AE, Cooney EE, Laeyendecker O, Reisner SL, Wirtz AL. Prevalence of sexually transmitted infections among transgender women living with and without HIV in the eastern and southern United States. J Infect Dis 2024:jiad605. [PMID: 38232978 DOI: 10.1093/infdis/jiad605] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 10/31/2023] [Accepted: 01/04/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Data on the epidemiology of sexually transmitted infections (STIs) among transgender women (TGW) with and without HIV are limited. METHODS We analyzed baseline data collected from a cohort of adult TGW across 6 eastern and southern US cities between March 2018-August 2020 (n = 1,018). Participants completed oral HIV screening, provided self-collected rectal and urogenital specimens for chlamydia and gonorrhea testing, and provided sera specimens for syphilis testing. We assessed associations with ≥1 prevalent bacterial STI using modified Poisson regression. RESULTS Bacterial STI prevalence was high and differed by HIV status: 32% among TGW with HIV and 11% among those without HIV (demographic-adjusted prevalence ratio = 1.91 [95%CI = 1.39-2.62]). Among TGW without HIV, bacterial STI prevalence differed by geographic region, race and ethnicity, and gender identity, and was positively associated with reporting >1 sexual partner, hazardous alcohol use, homelessness, having safety concerns regarding transit to healthcare, and no prior receipt of gender-affirming health services. Among TGW with HIV, older age was inversely associated with bacterial STI. CONCLUSIONS TGW had a high prevalence of bacterial STIs. The prevalence and correlates of bacterial STI differed by HIV status, highlighting the unique needs and risks of TGW with and without HIV. Tailored interventions may reduce sexual health-related inequities.
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Affiliation(s)
- Erin E Brown
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Baltimore, MD, USA
| | - Eshan U Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tonia C Poteat
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kenneth Mayer
- The Fenway Institute and Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Andrew J Wawrzyniak
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Asa E Radix
- Callen-Lorde Community Health Center, New York, NY, USA
| | - Erin E Cooney
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Oliver Laeyendecker
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Baltimore, MD, USA
| | | | - Andrea L Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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19
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Silhol R, Anderson RL, Stevens O, Stannah J, Booton RD, Baral S, Dimitrov D, Mitchell KM, Donnell D, Bershteyn A, Brown T, Kelly SL, Kim HY, Johnson LF, Maheu-Giroux M, Martin-Hughes R, Mishra S, Peerapatanapokin W, Stone J, Stover J, Teng Y, Vickerman P, Garcia SA, Korenromp E, Imai-Eaton JW, Boily MC. Measuring HIV Acquisitions Among Partners of Key Populations: Estimates From HIV Transmission Dynamic Models. J Acquir Immune Defic Syndr 2024; 95:e59-e69. [PMID: 38180739 PMCID: PMC10769162 DOI: 10.1097/qai.0000000000003334] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND Key populations (KPs), including female sex workers (FSWs), gay men and other men who have sex with men (MSM), people who inject drugs (PWID), and transgender women (TGW) experience disproportionate risks of HIV acquisition. The UNAIDS Global AIDS 2022 Update reported that one-quarter of all new HIV infections occurred among their non-KP sexual partners. However, this fraction relied on heuristics regarding the ratio of new infections that KPs transmitted to their non-KP partners to the new infections acquired among KPs (herein referred to as "infection ratios"). We recalculated these ratios using dynamic transmission models. SETTING One hundred seventy-eight settings (106 countries). METHODS Infection ratios for FSW, MSM, PWID, TGW, and clients of FSW were estimated from 12 models for 2020. RESULTS Median model estimates of infection ratios were 0.7 (interquartile range: 0.5-1.0; n = 172 estimates) and 1.2 (0.8-1.8; n = 127) for acquisitions from FSW clients and transmissions from FSW to all their non-KP partners, respectively, which were comparable with the previous UNAIDS assumptions (0.2-1.5 across regions). Model estimates for female partners of MSM were 0.5 (0.2-0.8; n = 20) and 0.3 (0.2-0.4; n = 10) for partners of PWID across settings in Eastern and Southern Africa, lower than the corresponding UNAIDS assumptions (0.9 and 0.8, respectively). The few available model estimates for TGW were higher [5.1 (1.2-7.0; n = 8)] than the UNAIDS assumptions (0.1-0.3). Model estimates for non-FSW partners of FSW clients in Western and Central Africa were high (1.7; 1.0-2.3; n = 29). CONCLUSIONS Ratios of new infections among non-KP partners relative to KP were high, confirming the importance of better addressing prevention and treatment needs among KP as central to reducing overall HIV incidence.
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Affiliation(s)
- Romain Silhol
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- HIV Prevention Trials Network Modelling Centre, Imperial College London, London, United Kingdom
| | - Rebecca L. Anderson
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Oliver Stevens
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - James Stannah
- Department of Epidemiology and Biostatistics, School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
| | - Ross D. Booton
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Dobromir Dimitrov
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Kate M. Mitchell
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- HIV Prevention Trials Network Modelling Centre, Imperial College London, London, United Kingdom
- Department of Nursing and Community Health, Glasgow Caledonian University London, London, United Kindom
| | - Deborah Donnell
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Anna Bershteyn
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Tim Brown
- Research Program, East-West Center, Honolulu, HI
| | | | - Hae-Young Kim
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Leigh F. Johnson
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Mathieu Maheu-Giroux
- Department of Epidemiology and Biostatistics, School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
| | | | - Sharmistha Mishra
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | | | - Yu Teng
- Avenir Health, Glastonbury, CT
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | | | | | - Jeffrey W. Imai-Eaton
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Marie-Claude Boily
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- HIV Prevention Trials Network Modelling Centre, Imperial College London, London, United Kingdom
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Sherman ADF, Higgins MK, Balthazar MS, Hill M, Klepper M, Schneider JS, Adams D, Radix A, Mayer KH, Cooney EE, Poteat TC, Wirtz AL, Reisner SL. Stigma, social and structural vulnerability, and mental health among transgender women: A partial least square path modeling analysis. J Nurs Scholarsh 2024; 56:42-59. [PMID: 38228564 PMCID: PMC10792251 DOI: 10.1111/jnu.12906] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 03/22/2023] [Accepted: 04/20/2023] [Indexed: 01/18/2024]
Abstract
INTRODUCTION Existing literature suggests that transgender women (TW) may be at high risk for adverse mental health due to stress attributed to combined experiences of stigma and complex social and structural vulnerabilities. Little research has examined how these co-occurring experiences relate to mental health. We aimed to test a theoretically driven conceptual model of relationships between stigma, social and structural vulnerabilities, and mental health to inform future intervention tailoring. DESIGN/METHODS Partial least square path modeling followed by response-based unit segmentation was used to identify homogenous clusters in a diverse community sample of United States (US)-based TW (N = 1418; 46.2% White non-Hispanic). This approach examined associations between latent constructs of stigma (polyvictimization and discrimination), social and structural vulnerabilities (housing and food insecurity, unemployment, sex work, social support, and substance use), and mental health (post-traumatic stress and psychological distress). RESULTS The final conceptual model defined the structural relationship between the variables of interest within stigma, vulnerability, and mental health. Six clusters were identified within this structural framework which suggests that racism, ethnicism, and geography may be related to mental health inequities among TW. CONCLUSION Our findings around the impact of racism, ethnicism, and geography reflect the existing literature, which unfortunately shows us that little change has occurred in the last decade for TW of color in the Southern US; however, the strength of our evidence (related to sampling structure and sample size) and type of analyses (accounting for co-occurring predictors of health, i.e., stigma and complex vulnerabilities, reflecting that of real-world patients) is a novel and necessary addition to the literature. Findings suggest that health interventions designed to offset the negative effects of stigma must include anti-racist approaches with components to reduce or eliminate barriers to resources that contribute to social and structural vulnerabilities among TW. Herein we provide detailed recommendations to guide primary, secondary, and tertiary prevention efforts. CLINICAL RELEVANCE This study demonstrated the importance of considering stigma and complex social and structural vulnerabilities during clinical care and design of mental health interventions for transgender women who are experiencing post-traumatic stress disorder and psychological distress. Specifically, interventions should take an anti-racist approach and would benefit from incorporating social support-building activities.
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Affiliation(s)
| | - Melinda K. Higgins
- Nell Hodson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Monique S. Balthazar
- Nell Hodson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
- Georgia State University Byrdine F. Lewis College of Nursing and Health Professions, Atlanta, Georgia, USA
| | - Miranda Hill
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Jason S. Schneider
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dee Adams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Asa Radix
- Department of Medicine, Callen-Lorde Community Health Center, New York, New York, USA
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
| | - Erin E. Cooney
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tonia C. Poteat
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Andrea L. Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sari L. Reisner
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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21
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Cartujano-Barrera F, Mejia RM, Radusky PD, Cardozo N, Duarte M, Fabian S, Caballero R, Zalazar V, Ramos-Pibernus A, Alpert AB, Cupertino AP, Frola C, Aristegui I. Prevalence and correlates of current cigarette smoking among transgender women in Argentina. Front Public Health 2023; 11:1279969. [PMID: 38115852 PMCID: PMC10728477 DOI: 10.3389/fpubh.2023.1279969] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
Objective To assess the prevalence of current cigarette smoking among transgender women in Argentina, and to examine the unique associations of current cigarette smoking with demographic and psychosocial factors. Methods This study is a secondary data analysis of the TransCITAR - a prospective cohort study of transgender individuals living in Buenos Aires, Argentina - baseline data. The baseline survey collected information on sociodemographic characteristics, perceived health status, depressive symptoms, suicide attempts, current cigarette smoking, alcohol use disorder, and substance use. Participants were also asked about lifetime experiences of physical and sexual violence perpetrated by partners, clients and/or the police, and experiences of gender identity stigma in the past year from healthcare workers and the police. Lastly, participants were asked if they had ever been arrested. Fisher's exact test was used to compare proportions in categorical variables and student t-test was used for continuous variables. Significant associations with current cigarette smoking were tested in a logistic regression model adjusted for all significant associations. Results A total of 41.7% of participants (n = 393) reported current cigarette smoking. Compared to their non-smoking counterparts, participants who reported current cigarette smoking (1) had completed less education, (2) were more likely to be born in Argentina, (3) more likely to had migrated to Buenos Aires from other parts of the country, (4) more likely to report a history of sex work, (5) more likely to perceive their health as excellent, (6) more likely to screen positive for hazardous alcohol drinking, (7) more likely to report any substance and cocaine use in the past year, (8) more likely to experience gender identity stigma from the police in the past year, and (9) more likely to being arrested in their lifetime (all p's < 0.05). After controlling for all significant associations, education level of less than high school (AOR = 1.79, 95% CI 1.02-2.12), hazardous drinking (AOR = 2.65, 95% CI 1.30-5.37), and any substance use in the last year (AOR = 2.14, 95% CI 1.16-3.94) were positively and independently associated with current cigarette smoking. Conclusion Among transgender women in Argentina, current cigarette smoking was more than double the rate for cisgender women. Current cigarette smoking was associated with education, hazardous drinking, and any drug use. These results will inform future smoking cessation interventions among transgender women in Argentina.
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Affiliation(s)
| | - Raul M. Mejia
- Division of Implementation Research, Fundación Huésped, Buenos Aires, Argentina
- Department of Ambulatory Care, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Pablo D. Radusky
- Division of Implementation Research, Fundación Huésped, Buenos Aires, Argentina
| | - Nadir Cardozo
- Division of Implementation Research, Fundación Huésped, Buenos Aires, Argentina
- Asociación de Travestis, Transexuales y Transgéneros de Argentina, Buenos Aires, Argentina
| | - Mariana Duarte
- Division of Implementation Research, Fundación Huésped, Buenos Aires, Argentina
- Casa Trans, Buenos Aires, Argentina
| | - Solange Fabian
- Division of Implementation Research, Fundación Huésped, Buenos Aires, Argentina
- Hotel Gondolín, Buenos Aires, Argentina
| | - Romina Caballero
- Division of Implementation Research, Fundación Huésped, Buenos Aires, Argentina
| | - Virginia Zalazar
- Division of Implementation Research, Fundación Huésped, Buenos Aires, Argentina
| | - Alixida Ramos-Pibernus
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce, PR, United States
| | - Ash B. Alpert
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
- Division of Hematology, Department of Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Ana Paula Cupertino
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, United States
| | - Claudia Frola
- Division of Implementation Research, Fundación Huésped, Buenos Aires, Argentina
| | - Ines Aristegui
- Division of Implementation Research, Fundación Huésped, Buenos Aires, Argentina
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22
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Cooney EE, Saleem HT, Stevenson M, Aguayo‐Romero RA, Althoff KN, Poteat TC, Beckham SW, Adams D, Radix AE, Wawrzyniak AJ, Cannon CM, Schneider JS, Haw JS, Rodriguez AE, Mayer KH, Beyrer C, Reisner SL, Wirtz AL. PrEP initiation and discontinuation among transgender women in the United States: a longitudinal, mixed methods cohort study. J Int AIDS Soc 2023; 26:e26199. [PMID: 38123897 PMCID: PMC10733152 DOI: 10.1002/jia2.26199] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Transgender women in the United States experience high HIV incidence and suboptimal Pre-exposure prophylaxis (PrEP) engagement. We sought to estimate PrEP initiation and discontinuation rates and characterize PrEP discontinuation experiences among a prospective cohort of transgender women. METHODS Using a sequential, explanatory, mixed-methods design, 1312 transgender women at risk for HIV acquisition were enrolled from March 2018 to August 2020 and followed through July 2022 (median follow-up 24 months; interquartile range 15-36). Cox regression models assessed predictors of initiation and discontinuation. In-depth interviews were conducted among 18 participants, including life history calendars to explore key events and experiences surrounding discontinuations. Qualitative and quantitative data were integrated to generate typologies of discontinuation, inform meta-inferences and facilitate the interpretation of findings. RESULTS 21.8% (n = 286) of participants reported taking PrEP at one or more study visits while under observation. We observed 139 PrEP initiations over 2127 person-years (6.5 initiations/100 person-years, 95% CI: 5.5-7.7). Predictors of initiation included identifying as Black and PrEP indication. The rate of initiation among those who were PrEP-indicated was 9.6 initiations/100 person-years (132/1372 person-years; 95% CI: 8.1-11.4). We observed 138 PrEP discontinuations over 368 person-years (37.5 discontinuations/100 person-years, 95% CI: 31.7-44.3). Predictors of discontinuation included high school education or less and initiating PrEP for the first time while under observation. Four discontinuation typologies emerged: (1) seroconversion following discontinuation; (2) ongoing HIV acquisition risk following discontinuation; (3) reassessment of HIV/STI prevention strategy following discontinuation; and (4) dynamic PrEP use coinciding with changes in HIV acquisition risk. CONCLUSIONS PrEP initiation rates were low and discontinuation rates were high. Complex motivations to stop using PrEP did not consistently correspond with HIV acquisition risk reduction. Evidence-based interventions to increase PrEP persistence among transgender women with ongoing acquisition risk and provide HIV prevention support for those who discontinue PrEP are necessary to reduce HIV incidence in this population.
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Affiliation(s)
- Erin E. Cooney
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Haneefa T. Saleem
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Meg Stevenson
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Rodrigo A. Aguayo‐Romero
- Division of Endocrinology, Diabetes, and HypertensionBrigham and Women's HospitalBostonMassachusettsUSA
- Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
- Fenway HealthThe Fenway InstituteBostonMassachusettsUSA
| | - Keri N. Althoff
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Tonia C. Poteat
- Department of Social MedicineUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - S. Wilson Beckham
- Department of HealthBehavior and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Dee Adams
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Asa E. Radix
- Callen‐Lorde Community Health CenterNew YorkNew YorkUSA
| | - Andrew J. Wawrzyniak
- Department of Psychiatry and Behavioral SciencesUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | | | - Jason S. Schneider
- Department of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - J. Sonya Haw
- Division of Endocrinology, Metabolism and LipidsEmory University School of MedicineAtlantaGeorgiaUSA
| | - Allan E. Rodriguez
- Division of Infectious DiseasesDepartment of MedicineUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Kenneth H. Mayer
- Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
- Fenway HealthThe Fenway InstituteBostonMassachusettsUSA
| | - Chris Beyrer
- Duke UniversityGlobal Health InstituteDurhamNorth CarolinaUSA
| | - Sari L. Reisner
- Division of Endocrinology, Diabetes, and HypertensionBrigham and Women's HospitalBostonMassachusettsUSA
- Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
- Fenway HealthThe Fenway InstituteBostonMassachusettsUSA
- Department of EpidemiologyHarvard TH Chan School of Public HealthBostonMassachusettsUSA
| | - Andrea L. Wirtz
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
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23
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Knox JR, Dolotina B, Moline T, Matthews I, Durrell M, Hanson H, Almirol E, Hotton A, Pagkas-Bather J, Chen YT, English D, Manuzak J, Rower JE, Miles C, Millar B, Jean-Louis G, Rendina HJ, Martins SS, Grov C, Hasin DS, Carrico AW, Shoptaw S, Schneider JA, Duncan DT. HIV Prevention and Care Among Black Cisgender Sexual Minority Men and Transgender Women: Protocol for an HIV Status-Neutral Cohort Study Using an Observational-Implementation Hybrid Approach. JMIR Res Protoc 2023; 12:e48548. [PMID: 38039075 PMCID: PMC10724817 DOI: 10.2196/48548] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Black cisgender gay, bisexual, and other sexual minority men (SMM) and transgender women (TW) continue to be heavily affected by HIV. Further research is needed to better understand HIV prevention and care outcomes in this population. In particular, there is a need for research examining the impact of substance use and sleep health on HIV prevention and treatment outcomes among Black SMM and TW. OBJECTIVE This paper outlines the study methods being used in the recently launched follow-up study to the Neighborhoods and Networks (N2) study, which we refer to as N2 Part 2 (N2P2). N2P2 aims to address this gap in the literature, build off the findings of the original N2 study, and identify socioenvironmental determinants of health, including whether neighborhood and network factors mediate and moderate these relationships. METHODS Building on the N2 cohort study in Chicago from 2018 to 2022, N2P2 used a prospective longitudinal cohort design and an observational-implementation hybrid approach. With sustained high levels of community engagement, we aim to recruit a new sample of 600 Black SMM and TW participants residing in the Chicago metropolitan statistical area. Participants are asked to participate in 3 study visits across an 18-month study period (1 visit every 9 months). Four different forms of data are collected per wave: (1) an in-person survey, (2) biological specimen collection, (3) a daily remote ecological momentary assessment for 14 days after each study visit, and (4) data from electronic health records. These forms of data collection continue to assess neighborhood and network factors and specifically explore substance use, sleep, immune function, obesity, and the implementation of potential interventions that address relevant constructs (eg, alcohol use and pre-exposure prophylaxis adherence). RESULTS The N2P2 study was funded in August 2021 by the National Institute of Drug Abuse (R01DA054553 and R21DA053156) and National Heart, Lung, and Blood Institute (R01HL160325). This study was launched in November 2022. Recruitment and enrollment for the first wave of data collection are currently ongoing. CONCLUSIONS The N2P2 study is applying innovative methods to comprehensively explore the impacts of substance use and sleep health on HIV-related outcomes among an HIV status-neutral cohort of Black SMM and TW in Chicago. This study is applying an observational-implementation hybrid design to help us achieve findings that support rapid translation, a critical priority among populations such as Black SMM and TW that experience long-standing inequities with regard to HIV and other health-related outcomes. N2P2 will directly build off the findings that have resulted from the original N2 study among Black SMM and TW in Chicago. These findings provide a better understanding of multilevel (eg, individual, network, and neighborhood) factors that contribute to HIV-related outcomes and viral suppression among Black SMM and TW. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48548.
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Affiliation(s)
- Justin R Knox
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Brett Dolotina
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Tyrone Moline
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Isabella Matthews
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Mainza Durrell
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Hillary Hanson
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Ellen Almirol
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Anna Hotton
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Jade Pagkas-Bather
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Yen-Tyng Chen
- Department of Psychiatry, Rutgers University, New Brunswick, NJ, United States
| | - Devin English
- Department of Psychiatry, Rutgers University, New Brunswick, NJ, United States
| | - Jennifer Manuzak
- Division of Immunology, School of Medicine, Tulane University, New Orleans, LA, United States
| | - Joseph E Rower
- Center for Human Toxicology, University of Utah, Salt Lake City, UT, United States
| | - Caleb Miles
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Brett Millar
- Department of Psychiatry, Rutgers University, New Brunswick, NJ, United States
| | - Girardin Jean-Louis
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Coral Gables, FL, United States
| | - H Jonathon Rendina
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Silvia S Martins
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Christian Grov
- Einstein-CUNY-Rockefeller Center for AIDS Research, School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Deborah S Hasin
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Adam W Carrico
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Coral Gables, FL, United States
| | - Steve Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - John A Schneider
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Dustin T Duncan
- Mailman School of Public Health, Columbia University, New York, NY, United States
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Wang L, Harris R, Simoni JM, Yue Q, Fu J, Zheng H, Ning Z, Xavier Hall CD, Burns PA, Wong FY. Health Service Utilization and Its Associations with Depression and Sexual Risk Behaviors Among Transgender Women in Shanghai, China. Transgend Health 2023; 8:516-525. [PMID: 38130986 PMCID: PMC10732171 DOI: 10.1089/trgh.2021.0009] [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: 11/12/2022] Open
Abstract
Purpose Given the limited research on health care utilization among transgender women in China, we described the use of primary health care and gender-affirming health care, and the associations between utilization of gender-affirming health care and depression and sexual risk behaviors. Methods We conducted a cross-sectional survey in 2017 among a purposive sample of transgender women in Shanghai, China (N=199). We examined correlates of health care utilization and its association with depression and sexual risk behaviors with Chi-square (χ2), Fisher's exact tests, and analysis of variance. Results The majority of the sample (78.5%) only had physician appointments when having an illness, while about one-fifth of the sample had physician appointments for yearly checkups. Nineteen out of 199 participants (9.5%) received gender-affirming surgery, among which only five used hormone therapy prescribed by a doctor (26.3%). Receiving some form of gender-affirming surgery was associated with higher depression scores [Welch's F(2, 12.22)=4.16, p=0.04], engagement in sex work (p=0.001), having 7 or more male sexual partners in the last 30 days (p=0.003), lifetime unprotected sex with a man (p=0.050), and unprotected sex with a main partner (p=0.043). Compared with transgender women who received both breast augmentation and vulvo-vaginoplasty (mean=5.86), those who received breast augmentation only (mean=12.33) scored higher on depression (p=0.04). Conclusions Access to gender-affirming health care is low among transgender women in this study. The utilization of gender-affirming surgery is associated with depression and sexual risk behaviors. Findings suggest China should establish national guidelines on transgender-related health care and set up more clinics to provide consultation and services for the transgender population in China.
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Affiliation(s)
- Liying Wang
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Rachel Harris
- Center for Population Sciences and Health Equity, Florida State University, Tallahassee, Florida, USA
- College of Social Work, Florida State University, Tallahassee, Florida, USA
| | - Jane M. Simoni
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Qing Yue
- Department of HIV/STD Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Jie Fu
- Department of HIV/STD Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Huang Zheng
- Shanghai Piaoxue Multicultural Media Ltd., Shanghai, China
| | - Zhen Ning
- Department of HIV/STD Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Casey D. Xavier Hall
- Institute for Sexual and Gender Minority Health and Wellbeing (ISGMH), Northwestern University, Evanston, Illinois, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA
| | - Paul A. Burns
- Department of Population Health Science, John D. Bower School of Population Health, University Mississippi Medical Center, Jackson, Mississippi, USA
| | - Frank Y. Wong
- Center for Population Sciences and Health Equity, Florida State University, Tallahassee, Florida, USA
- Department of Population Health Science, John D. Bower School of Population Health, University Mississippi Medical Center, Jackson, Mississippi, USA
- Department of Psychology, University of Hawaiʽi at Mānoa, Honolulu, Hawaiʽi, USA
- School of Public Health, Fudan University, Shanghai, China
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25
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Yaish I, Gindis G, Greenman Y, Moshe Y, Arbiv M, Buch A, Sofer Y, Shefer G, Tordjman K. Sublingual Estradiol Offers No Apparent Advantage Over Combined Oral Estradiol and Cyproterone Acetate for Gender-Affirming Hormone Therapy of Treatment-Naive Trans Women: Results of a Prospective Pilot Study. Transgend Health 2023; 8:485-493. [PMID: 38130980 PMCID: PMC10732161 DOI: 10.1089/trgh.2023.0022] [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: 12/23/2023] Open
Abstract
Purpose Chronic gender-affirming hormone therapy (GAHT) with sublingual estradiol (SLE) has not been studied. We aimed to compare GAHT with SLE only, to combined oral (CO) estradiol and cyproterone acetate, in treatment-naive trans women. Methods Twenty-two trans women enrolled into either the CO arm or the SLE-only arm (0.5 mg four times daily) in this 6-month prospective study. Anthropometric and laboratory variables were collected at baseline and 3 and 6 months. At the study beginning and end, body composition was measured by dual-energy X-ray absorptiometry and bioelectrical impedance, and gender dysphoria, sexual desire, and function were assessed by validated questionnaires. Results Subjects in the SLE were older, 26.3±5.8 years versus 20.1±2.3 years, p=0.006. All anthropometric, body composition, and laboratory variables were identical at baseline. Although dysphoria appeared greater, and sexual function lower at baseline in the CO group, this canceled out after age adjustment. Both treatments induced similar biochemical and hormonal changes. Creatinine, hemoglobin and cholesterol decreased significantly, while testosterone was suppressed to the same level in both groups: 3.22 [1.47-5.0] nmol/L in the SLE group and 2.41 [0.55-8.5] nmol/L in the CO, p=0.65. Significant changes in body composition toward a more feminine body were noted in both groups. Dysphoria did not significantly improve in either group, while sexual desire and function decreased at six months in both, p<0.001. Conclusions Both treatments achieved similar clinical changes. At this stage, SLE, which repeatedly induces alarming excursions of serum estradiol throughout the day, appears to offer no advantage over the CO approach.
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Affiliation(s)
- Iris Yaish
- Institute of Endocrinology, Metabolism, and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Guy Gindis
- Institute of Endocrinology, Metabolism, and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Yona Greenman
- Institute of Endocrinology, Metabolism, and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Yaffa Moshe
- Institute of Endocrinology, Metabolism, and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Mira Arbiv
- Institute of Endocrinology, Metabolism, and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Assaf Buch
- Institute of Endocrinology, Metabolism, and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Yael Sofer
- Institute of Endocrinology, Metabolism, and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Gabi Shefer
- Institute of Endocrinology, Metabolism, and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Karen Tordjman
- Institute of Endocrinology, Metabolism, and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
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Marzinke MA, Hanscom B, Wang Z, Safren SA, Psaros C, Donnell D, Richardson PA, Sullivan P, Eshleman SH, Jennings A, Feliciano KG, Jalil E, Coutinho C, Cardozo N, Maia B, Khan T, Singh Y, Middelkoop K, Franks J, Valencia J, Sanchez N, Lucas J, Rooney JF, Rinehart AR, Ford S, Adeyeye A, Cohen MS, McCauley M, Landovitz RJ, Grinsztejn B. Efficacy, safety, tolerability, and pharmacokinetics of long-acting injectable cabotegravir for HIV pre-exposure prophylaxis in transgender women: a secondary analysis of the HPTN 083 trial. Lancet HIV 2023; 10:e703-e712. [PMID: 37783219 PMCID: PMC10842527 DOI: 10.1016/s2352-3018(23)00200-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/19/2023] [Accepted: 08/04/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND The HIV Prevention Trials Network (HPTN) 083 trial showed that long-acting injectable cabotegravir was more effective than tenofovir disoproxil fumarate plus emtricitabine in preventing HIV in cisgender men and transgender women who have sex with men. We aimed to characterise the cohort of transgender women included in HPTN 083. METHODS HPTN 083 is an ongoing, phase 2b/3, randomised, multicentre, double-blind, double-dummy clinical trial done at 43 sites in seven countries (Argentina, Brazil, Peru, the USA, South Africa, Thailand, and Viet Nam). HIV-negative participants were randomly assigned (1:1) to receive injectable cabotegravir or tenofovir disoproxil fumarate plus emtricitabine. The study design and primary outcomes of the blinded phase of HPTN 083 have already been reported. An enrolment minimum of 10% transgender women was set for the trial. Here we characterise the cohort of transgender women enrolled from Dec 6, 2016, to May 14, 2020, when the study was unblinded. We report sociodemographic characteristics, use of gender affirming hormone therapy, and behavioural assessments of the transgender women participants. Laboratory testing and safety evaluations are also reported. The trial is registered at ClinicalTrials.gov, NCT02720094. FINDINGS HPTN 083 enrolled 570 transgender women (304 tenofovir disoproxil fumarate plus emtricitabine; 266 injectable cabotegravir). Transgender women were primarily from Asia (225 [39%]) and Latin America (205 [36%]); 330 (58%) reported using gender affirming hormone therapy. Intimate partner violence was common (270 [47%] reported emotional abuse and 172 [30%] reported physical abuse) and 323 (57%) reported a history of childhood sexual abuse. 159 (28%) transgender women disagreed that they were at risk for HIV, and 142 (25%) screened positive for depressive symptoms. During study follow-up, incidence of syphilis was 16·25% (95% CI 13·28-19·69), rectal gonorrhoea was 11·66% (9·14-14·66), and chlamydia was 20·61% (17·20-24·49). Frequency of adverse events was similar between the treatment groups. Nine seroconversions occurred among transgender women during the blinded phase of the study (seven in the tenofovir disoproxil fumarate plus emtricitabine group and two in the injectable cabotegravir group); overall incidence was 1·19 per 100 person-years (95% CI 0·54-2·25): 1·80 per 100 person-years (0·73-3·72) in the tenofovir disoproxil fumarate plus emtricitabine group and 0·54 per 100 person-years (0·07-1·95) in the injectable cabotegravir group (hazard ratio 0·34 [95% CI 0·08-1·56]). Cabotegravir concentrations did not differ by gender affirming hormone therapy use. INTERPRETATION HIV prevention strategies for transgender women cannot be addressed separately from social and structural vulnerabilities. Transgender women were well represented in HPTN 083 and should continue to be prioritised in HIV prevention studies. Our results suggest that injectable cabotegravir is a safe and effective pre-exposure prophylaxis option for transgender women. FUNDING National Institute of Allergy and Infectious Diseases and ViiV Healthcare.
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Affiliation(s)
| | | | - Zhe Wang
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | | | | | | | | | | | | | | | - Emilia Jalil
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Manguinhos, Rio de Janeiro, Brazil
| | - Carolina Coutinho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Manguinhos, Rio de Janeiro, Brazil
| | | | | | | | - Yashna Singh
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Keren Middelkoop
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | | | | | | | | | | | | | | | - Myron S Cohen
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Raphael J Landovitz
- Center for Clinical AIDS Research and Education, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Manguinhos, Rio de Janeiro, Brazil.
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Lake JE, Miao H, Bowman ER, Clark JL, Hyatt AN, Kettelhut A, Lama JR, Reisner SL, Mayer KH, Perez-Brumer A, Funderburg N. Gender-affirming hormone therapy decreases d-dimer but worsens insulin sensitivity in transgender women. HIV Med 2023; 24:1144-1149. [PMID: 37386803 PMCID: PMC10755063 DOI: 10.1111/hiv.13522] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/12/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVES Gender-affirming hormonal therapies (GAHT) and HIV increase cardiovascular risk for transgender women (TW), yet there is a paucity of data quantifying cardiometabolic changes following GAHT initiation, particularly among TW with HIV. METHODS The Féminas study enrolled TW from October 2016 to March 2017 in Lima, Peru. Participants reported sexual activity that was high risk for HIV acquisition or transmission. All were tested for HIV/ sexually transmitted infection and were given access to GAHT (oestradiol valerate and spironolactone), HIV pre-exposure prophylaxis (PrEP) or antiretroviral therapy (ART) for 12 months. Biomarker measurement was done on stored serum, whereas fasting glucose and lipids were measured in real time. RESULTS In all, 170 TW (32 with HIV, 138 without HIV) had median age 27 years and 70% prior GAHT use. At baseline, PCSK9, sCD14, sCD163, IL-6, sTNFRI/II, CRP and EN-RAGE levels were significantly higher in TW with HIV than in TW without HIV. High-density lipoprotein and total cholesterol were lower and insulin and glucose parameters were similar. All TW with HIV started ART, but only five achieved virological suppression at any time. No TW without HIV initiated PrEP. Over 6 months, all participants initiated GAHT and had worsening insulin, glucose and HOMA-IR. Large d-dimer decreases also occurred. Similar changes occurred in TW with and without HIV. CONCLUSIONS In this unique cohort of TW, GAHT decreased d-dimer but worsened insulin sensitivity. Because PrEP uptake and ART adherence were very low, observed effects are primarily attributed to GAHT use. Further study is needed to better understand cardiometabolic changes in TW by HIV serostatus.
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Affiliation(s)
- Jordan E. Lake
- University of Texas Health Science Center at Houston, 6431 Fannin St. MSB 2.112, Houston, TX 77030, USA
| | - Hongyu Miao
- Florida State University, 600 W College Ave, Tallahassee, FL 32306, USA
| | - Emily R. Bowman
- The Ohio State University, 453 West 10 Ave, Columbus, OH 43210, USA
| | - Jesse L. Clark
- University of California, Los Angeles, 405 Hilgard Ave., Los Angeles 90095, CA, USA
| | - Ana N. Hyatt
- University of Texas Health Science Center at Houston, 6431 Fannin St. MSB 2.112, Houston, TX 77030, USA
| | - Aaren Kettelhut
- The Ohio State University, 453 West 10 Ave, Columbus, OH 43210, USA
| | - Javier R. Lama
- Asociación Civil Impacta Salud y Educación, Av. Almte. Miguel Grau 1010, Lima 15063, Peru
| | - Sari L. Reisner
- Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA
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Martinez CA, Rikhi R, Fonseca Nogueira N, Pester MS, Salazar AS, Ashinne B, Aguilar N, Melara A, Porras V, Parker M, Mendez A, Cyrus E, De Santis JP, Jones DL, Brown TT, Hurwitz BE, Alcaide ML. Estrogen-Based Gender-Affirming Hormone Therapy and Subclinical Cardiovascular Disease in Transgender Women with HIV. LGBT Health 2023; 10:576-585. [PMID: 37459150 PMCID: PMC10712365 DOI: 10.1089/lgbt.2023.0010] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
Purpose: Transgender women (TW) are disproportionately affected by HIV infection and cardiovascular disease (CVD). This study evaluated whether estrogen-based gender-affirming hormone therapy (GAHT) in TW with HIV (TWH-GAHT) is associated with indices of subclinical CVD. Methods: Of the 40 HIV-seropositive persons enrolled, 20-60 years of age, on antiretroviral treatment with undetectable viral load, assessments were performed on 15 TWH; of these persons, 11 were GAHT treated. These TWH-GAHT were matched with HIV+ cisgender men and women based on age, ethnicity/race, body mass index, and antihypertensive medication use. Sex hormones, and cardiometabolic (waist circumference, blood pressure, insulin resistance, lipid profile, and C-reactive protein), vascular (flow-mediated dilation [FMD] and arterial stiffness), and proinflammatory measures were obtained. Results: TWH-GAHT displayed elevated estradiol and suppressed testosterone levels relative to normative ranges. Analyses indicated the TWH-GAHT displayed lower low-density lipoprotein compared with cisgender groups (p < 0.05). Although no difference was seen on FMD, the central augmentation index of aortic stiffness was higher in cisgender HIV+ women than cisgender HIV+ men (p < 0.05). No other group difference on subclinical CVD markers was observed. For TWH, partial correlations indicated associations of certain sex hormones with selected cardiometabolic outcomes and the inflammatory cytokine, interleukin-8. Conclusion: When well matched to HIV+ cisgender men and women, subclinical CVD pathophysiology did not appear elevated in TWH-GAHT, although tendencies emerged suggesting that some subclinical CVD indices may be higher, but others lower than cisgender groups. Longitudinal studies of TWH are needed to more precisely evaluate the moderating effect of GAHT on cardiometabolic pathophysiology.
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Affiliation(s)
- Claudia A. Martinez
- Division of Cardiovascular Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Rishi Rikhi
- Division of Cardiology, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Nicholas Fonseca Nogueira
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mollie S. Pester
- Behavioral Medicine Research Center and Department of Psychology, University of Miami, Miami/Coral Gables, Florida, USA
| | - Ana S. Salazar
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Beteal Ashinne
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Natalie Aguilar
- Division of Cardiovascular Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Abraham Melara
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Valeria Porras
- Division of Cardiovascular Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Meela Parker
- Behavioral Medicine Research Center and Department of Psychology, University of Miami, Miami/Coral Gables, Florida, USA
| | - Armando Mendez
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Elena Cyrus
- Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Joseph P. De Santis
- School of Nursing and Health Studies, University of Miami, Miami, Florida, USA
| | - Deborah L. Jones
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
- Behavioral Medicine Research Center and Department of Psychology, University of Miami, Miami/Coral Gables, Florida, USA
| | - Todd T. Brown
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Barry E. Hurwitz
- Behavioral Medicine Research Center and Department of Psychology, University of Miami, Miami/Coral Gables, Florida, USA
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Maria L. Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
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Oliveira CM, Marques LM, de Medeiros DS, Salgado VDJ, Soares F, Magno L, Dourado I, da Silva ÁMB, de Brito HIL, Figueiredo TB, Campos GB. Prevalence of Neisseria gonorrhoeae and Chlamydia trachomatis infections among adolescent men who have sex with men and transgender women in Salvador, Northeast Brazil. Epidemiol Infect 2023; 151:e196. [PMID: 37869965 PMCID: PMC10728983 DOI: 10.1017/s095026882300170x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 09/29/2023] [Accepted: 10/08/2023] [Indexed: 10/24/2023] Open
Abstract
Adolescent men who have sex with men (AMSM) and transgender women (ATGW) enrolled as part of the PrEP1519 study between April 2019 and February 2021 in Salvador were tested for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) infections.We performed real-time polymerase chain reaction using oropharyngeal, anal, and urethral swabs; assessed factors associated with NG and CT infections using multivariable Poisson regression analysis with robust variance; and estimated the prevalence ratios (PRs) and 95% confidence intervals (95% CIs). In total, 246 participants were included in the analyses (median age: 18.8; IQR: 18.2-19.4 years). The overall oropharyngeal, anal, and urethral prevalence rates of NG were 17.9%, 9.4%, 7.6%, and 1.9%, respectively. For CT, the overall, oropharyngeal, anal, and urethral prevalence rates were 5.9%, 1.2%, 2.4%, and 1.9%, respectively. A low level of education, clinical suspicion of STI (and coinfection with Mycoplasma hominis were associated with NG infection. The prevalence of NG and CT, especially extragenital infections, was high in AMSM and ATGW. These findings highlight the need for testing samples from multiple anatomical sites among adolescents at a higher risk of STI acquisition, implementation of school-based strategies, provision of sexual health education, and reduction in barriers to care.
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Affiliation(s)
| | - Lucas Miranda Marques
- Multidisciplinary Institute for Health, Federal University of Bahia, Salvador, Brazil
- State University of de Santa Cruz, Ilhéus, Brazil
| | | | | | - Fabiane Soares
- Collective Health Institute, Federal University of Bahia, Salvador, Brazil
| | - Laio Magno
- Collective Health Institute, Federal University of Bahia, Salvador, Brazil
- Department of Life Sciences, State University of Bahia, Salvador, Brazil
| | - Inês Dourado
- Collective Health Institute, Federal University of Bahia, Salvador, Brazil
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Thammajaruk N, Ramautarsing RA, Hiransuthikul A, Suriwong S, Tasomboon W, Thapwong P, Phunkron A, Saiwaew S, Sangpasert T, Pankam T, Avery M, Mills S, Phanuphak P, Phanuphak N. Pooled Pharyngeal, Rectal, and Urine Specimens for the Point-of-Care Detection of Chlamydia trachomatis and Neisseria gonorrhoeae by Lay Providers in Key Population-Led Health Services in Thailand. Pathogens 2023; 12:1268. [PMID: 37887784 PMCID: PMC10609829 DOI: 10.3390/pathogens12101268] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023] Open
Abstract
Routine testing for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in people with heightened risk is lacking in Thailand. This study aimed to assess the performance of the Cepheid Xpert CT/NG assay, conducted by key population (KP) lay providers, for CT and NG detection on single-site and pooled specimens from the pharynx, rectum, and urine. Between August and October 2019, 188 men who have sex with men and 11 transgender women were enrolled. Participants collected urine specimens while trained KP lay providers obtained pharyngeal and rectal swabs. Compared to single-site testing with the Abbott RealTime CT/NG assay by medical technologists, the Xpert assay missed one pharyngeal NG infection out of 199 single-site specimens, giving a 93.3% sensitivity for pharyngeal NG and one missed pharyngeal NG infection out of fifty pooled specimens, giving an 88.9% sensitivity for pharyngeal NG. There was no discrepancy between the two assays for CT detection. The Cohen's Kappa coefficient of pooled specimen testing by the Xpert was 0.93 for NG and 1 for CT when compared to single-site testing by Abbott. Implementing pooled specimen testing by KP lay providers can be a cost-saving strategy to enhance the uptake of CT/NG services for populations facing increased risk.
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Affiliation(s)
| | | | - Akarin Hiransuthikul
- Institute of HIV Research and Innovation (IHRI), Bangkok 10330, Thailand
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Sujittra Suriwong
- Institute of HIV Research and Innovation (IHRI), Bangkok 10330, Thailand
| | - Waranya Tasomboon
- Institute of HIV Research and Innovation (IHRI), Bangkok 10330, Thailand
| | - Prasopsuk Thapwong
- The Service Workers In Group Foundation (SWING), Bangkok 10500, Thailand
| | - Atachai Phunkron
- The Service Workers In Group Foundation (SWING), Bangkok 10500, Thailand
| | - Somporn Saiwaew
- Rainbow Sky Association of Thailand (RSAT), Bangkok 10240, Thailand
| | | | - Tippawan Pankam
- Thai Red Cross Anonymous Clinic, Thai Red Cross AIDS Research Centre (TRCARC), Bangkok 10330, Thailand
| | - Matthew Avery
- USAID/EpiC Thailand project, FHI 360, Bangkok 10330, Thailand
| | - Stephen Mills
- USAID/EpiC Thailand project, FHI 360, Bangkok 10330, Thailand
| | - Praphan Phanuphak
- Institute of HIV Research and Innovation (IHRI), Bangkok 10330, Thailand
| | - Nittaya Phanuphak
- Institute of HIV Research and Innovation (IHRI), Bangkok 10330, Thailand
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31
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Carosella EA, Huerta L, Galea JT, Lecca L, Ramos K, Hernández NG, Franke MF, Peinado J. A Cross-Sectional Analysis of Self-Reported Needs and Health Service Utilization Among Transgender Women in Lima, Perú. LGBT Health 2023; 10:535-543. [PMID: 37093035 DOI: 10.1089/lgbt.2022.0054] [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] [Indexed: 04/25/2023] Open
Abstract
Purpose: Globally, transgender women (TGW) experience wide-ranging barriers to health and care, with disproportionately high risks of infectious and chronic diseases. Yet, research on transgender populations' access to care in low- and middle-income countries remains limited, focused on human immunodeficiency virus (HIV) infection, and assesses TGW as a homogenous group. We analyzed morbidity and health service uptake patterns among TGW in Lima, Perú, to understand health outreach and service needs to inform targeting and design of community-level interventions. Methods: This cross-sectional study surveyed a convenience sample of 301 TGW in metropolitan Lima during September-October 2020. We report descriptive statistics and bivariable and multivariable regression model results as adjusted prevalence ratios (aPRs). Results: Health coverage and access to care were suboptimal. Less education and older age were positively associated with illness and negatively associated with HIV and tuberculosis (TB) testing. In the first study to quantitatively examine health utilization by gender identity subgroup (i.e., woman, trans or transgender, transsexual, "transformista," "travesti," and other) in Perú, TGW who identified as women were more likely to ever test for HIV (aPR = 1.49, 95% confidence interval [CI]: 1.16-1.91) and use pre-exposure prophylaxis (PrEP) (aPR = 2.36, 95% CI: 1.15-4.80). Both awareness and interest regarding PrEP were low, as was usage among those who were interested in taking PrEP. Conclusion: Public health efforts should be tailored to meet TGW's diverse needs, expand TB testing, bridge the gap between PrEP interest and use, and increase insurance coverage and access to trans-friendly services for improved health.
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Affiliation(s)
- Elizabeth A Carosella
- Department of Epidemiology and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Jerome T Galea
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- School of Social Work, University of South Florida, Tampa, Florida, USA
| | - Leonid Lecca
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Partners In Health/Socios En Salud Sucursal Perú, Lima, Perú
| | - Karen Ramos
- Partners In Health/Socios En Salud Sucursal Perú, Lima, Perú
| | | | - Molly F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jesús Peinado
- Partners In Health/Socios En Salud Sucursal Perú, Lima, Perú
- Faculty of Health Sciences, School of Medicine, Peruvian University of Applied Sciences, Lima, Perú
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Moncayo JE, Pérez-Arizabaleta MDM, Villegas-Trujillo LM, Rodríguez-Ortiz A. Adherence to Oral Pre-Exposure Prophylaxis Intervention by Transgender Women: A Systematic Review. AIDS Educ Prev 2023; 35:362-375. [PMID: 37843906 DOI: 10.1521/aeap.2023.35.5.362] [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] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Prevalence of human immunodeficiency virus (HIV) is higher in transgender populations. Pre-exposure prophylaxis (PrEP) intervention is successful in reducing HIV acquisition. We aimed to investigate the adherence to oral PrEP by HIV-negative transgender women (TW). We followed the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA Statement. We searched in WoS, OVID, Scopus, MEDLINE, and the Cochrane Central Register of Controlled Trials databases. Participation and adherence to the intervention were low for TW compared to cisgender men who have sex with men (cMSM), and it was measured mostly by self-report (72.7%) or tenofovir-diphosphate/emtricitabine triphosphate dried blood spot (45.5%). Awareness should increase and the effect of oral PrEP on gender-affirming hormone therapy should be explained to TW at the beginning of the trials. One limitation is that our sample size was dominated by two Thai studies with TW sex workers. Future studies should evaluate adherence to new PrEP modalities.
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Affiliation(s)
| | - María Del Mar Pérez-Arizabaleta
- Faculty of Psychology, Universidad Antonio Nariño, Cali, Colombia
- Faculty of Psychology, Universidad Cooperativa de Colombia-Campus Cali
| | - Lina María Villegas-Trujillo
- Faculty of Health, Universidad del Valle, Cali, Colombia
- SIT Consulting-Science, Innovation & Technology, Cali, Colombia
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Xu L, Chang R, Wang H, Xu C, Yu X, Chen H, Wang R, Liu S, Liu Y, Wang Y, Cai Y. Validation of the Patient Health Questionnaire-9 for Suicide Screening in Transgender Women. Transgend Health 2023; 8:450-456. [PMID: 37810941 PMCID: PMC10551761 DOI: 10.1089/trgh.2021.0075] [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: 11/12/2022] Open
Abstract
Purpose High prevalence of depression in transgender women highlights the importance of validating the measure to assess depression. Moreover, depression is significantly associated with suicide across research studies. The aims of the current study were to validate a Chinese-language version of the Patient Health Questionnaire-9 (PHQ-9) and to assess operating characteristics of the PHQ-9 for suicide screening in transgender women. Methods With the approval of an Institutional Review Board (IRB), a total of 198 transgender women living in Shenyang, China, were recruited, and asked to complete the PHQ-9, including measures of their suicidal ideation, planning and attempt. Results A one-factor model of the PHQ-9 was supported in the current sample, showing good reliability and validity. The best cutoff point for the PHQ-9 in suicidal ideation was 17, with a sensitivity/specificity of 77.78%; the best cutoff point for PHQ-9 in suicidal planning was 17, with a sensitivity of 81.82% and a specificity of 73.26%; and the best cutoff point for PHQ-9 in suicidal attempt was 20, with a sensitivity of 75% and a specificity of 90.21%. Conclusion Findings supported the validity of the PHQ-9. With potential clinical or research application, the PHQ-9 can be an efficient instrument for suicide screening in transgender women.
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Affiliation(s)
- Lulu Xu
- Department of Student Affairs, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruijie Chang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huwen Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen Xu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyue Yu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Chen
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rongxi Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shangbin Liu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yujie Liu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Cai
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Braun RA, Erenrich RK, Coyle KK, Doan THP, Klausner JD. Effectiveness, Acceptability, and Feasibility of a Telehealth HIV Pre-Exposure Prophylaxis Care Intervention Among Young Cisgender Men and Transgender Women Who Have Sex With Men: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e47932. [PMID: 37713244 PMCID: PMC10541640 DOI: 10.2196/47932] [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] [Received: 04/05/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Despite its promise for HIV prevention, the uptake of pre-exposure prophylaxis (PrEP) has been slow, and there have been substantial inequities in PrEP access. Young men who have sex with men and transgender women of color are most in need of PrEP and least likely to have that need fulfilled. PrEP telehealth care, which provides remote PrEP care via electronic communication, seems well suited to address several of the challenges of PrEP provision, including discomfort with stigmatizing and difficult-to-access health care systems, transportation challenges, and privacy concerns, and address disparities in PrEP access. Research suggests that PrEP telehealth care has promise and is a favored option for many prospective recipients of PrEP. However, despite growing attention to telehealth approaches as an avenue for increasing access to PrEP amidst the COVID-19 pandemic, there have been no published randomized controlled trials (RCTs) on PrEP telehealth care to date, making it difficult to draw strong conclusions about the advantages or disadvantages of telehealth compared with usual PrEP care. We developed PrEPTECH, a telehealth intervention that focuses specifically on alleviating issues of stigma, access, cost, and confidentiality for young people with risk factors for HIV infection who are seeking PrEP care. Leveraging data from the 2017 observational pilot study, we redesigned and enhanced PrEPTECH. OBJECTIVE This study aims to assess the effectiveness, acceptability, and feasibility of a telehealth HIV PrEP care intervention, PrEPTECH, in increasing PrEP uptake. METHODS This is the protocol for an RCT of young cisgender men and transgender women who have sex with men in 4 regions within the United States: the San Francisco Bay Area, California; Los Angeles County, California; Miami-Dade County, Florida; and Broward County, Florida. Participants in the intervention arm received access to a web-based telehealth program, PrEPTECH, which offers a fully web-based pathway to PrEP, whereas those in the control arm received access to a dynamic web page containing publicly available informational resources about PrEP. Follow-up data collection occurred at 3 and 6 months. An analysis will be conducted on outcomes, including PrEP initiation, persistence, adherence, coverage, and medication prescription, as well as PrEPTECH acceptability and feasibility. RESULTS The study was funded in 2019 and received institutional review board approval in 2020. The PrEPTECH intervention was developed over the next 1.5 years. Study recruitment was launched in February 2022 and completed in September 2022, with 229 participants recruited in total. Data collection was completed in April 2023. CONCLUSIONS The results of this RCT will offer valuable evidence regarding the effectiveness, acceptability, and feasibility of telehealth HIV PrEP care interventions among young cisgender men and transgender women who have sex with men. TRIAL REGISTRATION ClinicalTrials.gov NCT04902820; https://clinicaltrials.gov/ct2/show/NCT04902820. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/47932.
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Affiliation(s)
| | | | | | | | - Jeffrey D Klausner
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Kota KK, Luo Q, Beer L, Dasgupta S, McCree DH. Stigma, Discrimination, and Mental Health Outcomes Among Transgender Women With Diagnosed HIV Infection in the United States, 2015-2018. Public Health Rep 2023; 138:771-781. [PMID: 36129230 PMCID: PMC10467496 DOI: 10.1177/00333549221123583] [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: 11/16/2022] Open
Abstract
OBJECTIVE Transgender women with diagnosed HIV experience social and structural factors that could negatively affect their overall health and HIV-related health outcomes. We describe estimates from the Centers for Disease Control and Prevention Medical Monitoring Project (MMP) of sociodemographic characteristics, HIV stigma, discrimination, and mental health outcomes among transgender women with diagnosed HIV. METHODS We analyzed pooled data of all transgender women with diagnosed HIV (N = 217) from the 2015 through 2018 MMP cycles. We reported unweighted frequencies, weighted percentages, and 95% CIs for all characteristics. We post-stratified data to known population totals by age, race and ethnicity, and sex at birth from the National HIV Surveillance System. RESULTS Approximately 46% of transgender women with diagnosed HIV identified as Black or African American, 67% lived at or below the federal poverty level, 18% had experienced homelessness in the past year, 26% experienced mild to severe symptoms of depression, 30% experienced mild to severe anxiety symptoms, 32% reported physical violence by an intimate partner, and 30% reported forced sex during their lifetime. Despite 80% being very satisfied with their current HIV care, 94% experienced current HIV stigma and 20% experienced health care-related discrimination since being diagnosed with HIV. Among transgender women with diagnosed HIV who experienced discrimination, 46% and 51% experienced health care discrimination attributed to their gender and sexual orientation or sexual practices, respectively. CONCLUSIONS Our findings underscore a need to address unmet ancillary services, such as housing, intimate partner violence, and mental health needs, and the need for strategies to reduce experiences with HIV stigma and discrimination in care for transgender women with diagnosed HIV in the United States.
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Affiliation(s)
- Krishna Kiran Kota
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | | | - Linda Beer
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sharoda Dasgupta
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Donna Hubbard McCree
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Ramadhani HO, Crowell TA, Nowak RG, Adebajo S, Kayode BO, Ononaku U, Baral SD, Ndembi N, Charurat ME. Determinants of Preexposure Prophylaxis Cascade Among Sexual and Gender Minorities in Nigeria. Sex Transm Dis 2023; 50:559-566. [PMID: 37277897 PMCID: PMC10527664 DOI: 10.1097/olq.0000000000001841] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Preexposure prophylaxis (PrEP) is effective in preventing human immunodeficiency virus (HIV) infection among sexual and gender minorities (SGMs). We evaluated the characteristics associated with engagement in 7 steps of the PrEP cascade among SGMs in Nigeria. METHODS Sexual and gender minorities without HIV from the Abuja site of TRUST/RV368 cohort who were surveyed on awareness of and willingness to use PrEP were approached for PrEP initiation upon availability of oral daily PrEP. To understand gaps in the uptake of oral daily PrEP, we categorized the HIV PrEP cascade as (i) education about PrEP, (ii) interest in PrEP, (iii) successful contact, (iv) appointment scheduled, (v) appointment attendance, (vi) PrEP initiation, and (vii) plasma protective levels of tenofovir disoproxil fumarate. Multivariable logistic regression models were used to determine factors associated with each of the 7 steps in the HIV PrEP cascade. RESULTS Of 788 participants, 718 (91.1%) showed interest in taking oral daily PrEP every day and/or after a sexual act, 542 (68.8%) were successfully contacted, 433 (54.9%) scheduled an appointment, 409 (51.9%) attended a scheduled appointment, 400 (50.8%) initiated oral daily PrEP, and 59 (7.4%) had protective levels of tenofovir disoproxil fumarate. Of initiators of PrEP, 23 (5.8%) seroconverted at a rate of 13.9 cases/100 person-years. Better social support, larger network density, and higher education were associated with engagement in 4 to 5 components of the cascade. CONCLUSIONS Our data highlight a gap between willingness and actual PrEP use. Despite PrEP's effectiveness in preventing HIV, the optimal impact of PrEP for SGMs in sub-Saharan Africa will require multifaceted approaches that combine social support, education, and destigmatization.
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Affiliation(s)
| | | | - Rebecca G Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore
| | - Sylvia Adebajo
- Center for International Health Education and Biosecurity, Maryland Global Initiatives Corporation (MGIC)-an affiliate of the University of Maryland Baltimore
| | - Blessing O Kayode
- Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Uchenna Ononaku
- Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria
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Massa P, de Souza Ferraz DA, Magno L, Silva AP, Greco M, Dourado I, Grangeiro A. A Transgender Chatbot (Amanda Selfie) to Create Pre-exposure Prophylaxis Demand Among Adolescents in Brazil: Assessment of Acceptability, Functionality, Usability, and Results. J Med Internet Res 2023; 25:e41881. [PMID: 37351920 PMCID: PMC10337301 DOI: 10.2196/41881] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 08/16/2022] [Revised: 03/01/2023] [Accepted: 04/18/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND HIV incidence rates have increased in adolescent men who have sex with men (AMSM) and adolescent transgender women (ATGW). Thus, it is essential to promote access to HIV prevention, including pre-exposure prophylaxis (PrEP), among these groups. Moreover, using artificial intelligence and online social platforms to create demand and access to health care services are essential tools for adolescents and youth. OBJECTIVE This study aims to describe the participative process of developing a chatbot using artificial intelligence to create demand for PrEP use among AMSM and ATGW in Brazil. Furthermore, it analyzes the chatbot's acceptability, functionality, and usability and its results on the demand creation for PrEP. METHODS The chatbot Amanda Selfie integrates the demand creation strategies based on social networks (DCSSNs) of the PrEP1519 study. She was conceived as a Black transgender woman and to function as a virtual peer educator. The development process occurred in 3 phases (conception, trial, and final version) and lasted 21 months. A mixed methodology was used for the evaluations. Qualitative approaches, such as in-depth adolescent interviews, were used to analyze acceptability and usability, while quantitative methods were used to analyze the functionality and result of the demand creation for PrEP based on interactions with Amanda and information from health care services about using PrEP. To evaluate Amanda's result on the demand creation for PrEP, we analyzed sociodemographic profiles of adolescents who interacted at least once with her and developed a cascade model containing the number of people at various stages between the first interaction and initiation of PrEP (PrEP uptake). These indicators were compared with other DCSs developed in the PrEP1519 study using chi-square tests and residual analysis (P=.05). RESULTS Amanda Selfie was well accepted as a peer educator, clearly and objectively communicating on topics such as gender identity, sexual experiences, HIV, and PrEP. The chatbot proved appropriate for answering questions in an agile and confidential manner, using the language used by AMSM and ATGW and with a greater sense of security and less judgment. The interactions with Amanda Selfie combined with a health professional were well evaluated and improved the appointment scheduling. The chatbot interacted with most people (757/1239, 61.1%) reached by the DCSSNs. However, when compared with the other DCSSNs, Amanda was not efficient in identifying AMSM/ATGW (359/482, 74.5% vs 130/757, 17.2% of total interactions, respectively) and in PrEP uptake (90/359, 25.1% vs 19/130, 14.6%). The following profiles were associated (P<.001) with Amanda Selfie's demand creation, when compared with other DCS: ATGW and adolescents with higher levels of schooling and White skin color. CONCLUSIONS Using a chatbot to create PrEP demand among AMSM and ATGW was well accepted, especially for ATGW with higher levels of schooling. A complimentary dialog with a health professional increased PrEP uptake, although it remained lower than the results of the other DCSSNs.
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Affiliation(s)
- Paula Massa
- Faculdade de Medicina Preventiva, Universidade de São Paulo, São Paulo, Brazil
| | - Dulce Aurélia de Souza Ferraz
- Unité Mixte de Recherche 1296 Radiations: défense, santé et environnements, Lyon 2 University, Lyon, France
- Escola de Governo em Saúde, Gerencia Regional Brasília, Fundação Oswaldo Cruz, Brasília, Brazil
| | - Laio Magno
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, Brazil
| | - Ana Paula Silva
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Marília Greco
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Alexandre Grangeiro
- Faculdade de Medicina Preventiva, Universidade de São Paulo, São Paulo, Brazil
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Anderson EJ, Marlow H, Izugbara C. Epidemiological Profile of Intimate Partner Homicides of Sexual and Gender Minority Women in the United States, 2003 to 2017. J Interpers Violence 2023; 38:7143-7169. [PMID: 36600607 DOI: 10.1177/08862605221141863] [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: 05/09/2023]
Abstract
Sexual and gender minority (SGM) women are among the many victims killed by intimate partner homicide (IPH) each year, though the differences between different SGM groups (and how these groups compare to non-SGM IPH) have not been well established. The objective of this article was to identify practicable, correlated risk factors of IPH of SGM women that may have utility in prevention of future IPH among these populations in the U.S. Homicide data from the National Violent Death Reporting System spanning 2003 to 2017 were used to identify a profile of IPH specific to SGM women compared to women who were neither sexual nor gender minorities. Situational and individual characteristics significantly differentiated sexual minority (SM) women from non-SGM women victims of IPH, including substance abuse history (adjusted odds ratio [AOR] = 4.80 [2.42, 9.51]), having themselves used a weapon during the incident (AOR = 3.63 [1.44, 9.16]), and the type of weapon(s) used, such as firearms (AOR = 0.61 [0.40, 0.91]), with notably different differentiating characteristics for gender minority (GM) women (vs. non-SGM women) such as the likelihood that the victim was known to have experienced interpersonal violence victimization in the previous month (AOR = 0.50 [0.07, 3.67]). Lesbian and bisexual women homicide victims were far more likely to have been killed via IPH than non-SGM women (AOR for Black SM women = 7.84 [3.65, 16.88], AOR for White SM women = 2.30 [1.03, 5.17]). There was no corresponding difference for GM women victims, whose likelihood of being killed by an intimate partner was similar to that of non-SGM women. Based on these findings, actionable public health recommendations-centered around evidence that neither "all women" nor "all LGBTQ people" are appropriate intimate partner violence prevention umbrellas-are proposed.
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Affiliation(s)
| | - Heather Marlow
- International Center for Research on Women, Washington, DC, USA
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Hamill MM, Hu F, Adebajo S, Kokogho A, Tiamiyu AB, Parker ZF, Charurat ME, Ake JA, Baral SD, Nowak RG, Crowell TA. Food and Water Insecurity in Sexual and Gender Minority Groups Living With HIV in Lagos, Nigeria. J Acquir Immune Defic Syndr 2023; 93:171-180. [PMID: 36881816 PMCID: PMC10293107 DOI: 10.1097/qai.0000000000003183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 02/22/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Food and water insecurity are associated with poor health outcomes that may be exacerbated by social marginalization and barriers to health care experienced by sexual and gender minorities (SGM) in resource-limited settings. We explored factors associated with food and water insecurity in SGM with HIV. SETTING A longitudinal study of 357 men who have sex with men, transgender women, and other gender-identifying people in Lagos, Nigeria. METHODS Laboratory testing, interviews, food and water assessments, and anthropometry were performed quarterly. Robust Poisson regression with generalized estimating equations was used to evaluate factors potentially associated with food and water insecurity. RESULTS From 2014 to 2018, 357 SGM with HIV completed either the food or water assessments. At baseline, participants identified as cisgender men who have sex with men 265 (74.2%), transgender women 63 (17.7%), or as nonbinary/other gender 29 (8.1%). Food insecurity and water insecurity were reported by 63/344(18.3%) and 113/357(31.7%), respectively, at any visit. Food and water insecurity each decreased with ongoing study participation. Food insecurity was associated with nonpartnered relationship status, CD4 count <500 cells/mm 3 , and lack of access to piped water. Water insecurity was associated with age 25 years or older, living with a man, transactional sex, and food insecurity. CONCLUSIONS Food and water insecurity were common among SGM in Nigeria and decreased with continued study participation, suggesting amenability to intervention when SGM are successfully engaged in care. Targeted interventions to support food and water security may improve HIV-related outcomes, such as CD4 count.
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Affiliation(s)
- Matthew M. Hamill
- Division of Infectious Diseases, Johns Hopkins Medicine, Baltimore, USA
| | - Fengming Hu
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, USA
| | - Sylvia Adebajo
- Maryland Global Initiatives Corporation, University of Maryland Baltimore, Baltimore, USA
| | - Afoke Kokogho
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, USA
| | - Abdulwasiu B. Tiamiyu
- HJF Medical Research International, Abuja, Nigeria
- US Army Medical Research Directorate-Africa/Nigeria, Abuja, Nigeria
| | - Zahra F. Parker
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, USA
- US Army Medical Research Directorate-Africa/Nigeria, Abuja, Nigeria
| | - Manhattan E. Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Julie A. Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, USA
| | - Stefan D. Baral
- Department of Epidemiology, Johns Hopkins University, Baltimore, USA
| | - Rebecca G. Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Trevor A. Crowell
- Division of Infectious Diseases, Johns Hopkins Medicine, Baltimore, USA
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, USA
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Gray SS, Sizemore KM, Rendina HJ. Coping Strategies as a Moderator for the Association between Intimate Partner Violence and Depression and Anxiety Symptoms among Transgender Women. Int J Environ Res Public Health 2023; 20:5927. [PMID: 37297531 PMCID: PMC10253188 DOI: 10.3390/ijerph20115927] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023]
Abstract
Evidence suggests that intimate partner violence (IPV) is associated with negative mental health outcomes. There is currently limited research on the impact of IPV on the outcomes of mental health for transgender women. The current study aimed to examine the relationship between intimate partner violence, coping skills, depression, and anxiety in a sample of transgender women. Hierarchical regression analyses were conducted examining the relationship of IPV and depression and anxiety symptoms, where coping skills moderate this relationship. The results suggest that those with experiences of IPV are more likely to have symptoms of depression and anxiety. For individuals with no experiences of IPV and low depression, high levels of emotional processing coping and acceptance coping buffered this relationship. For individuals with more experiences of IPV and more depressive symptoms, coping skills did not show to buffer this relationship. These same coping skills did not show evidence for buffering anxiety symptoms for transgender women with low or high levels of IPV. The results, implications, and limitations of this study and suggestions for further research are discussed.
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Affiliation(s)
- Shannon S. Gray
- Institute for Health, Healthcare Policy, and Aging Research, Rutgers University, 112 Paterson St., New Brunswick, NJ 08901, USA;
| | - Kayla Marie Sizemore
- Institute for Health, Healthcare Policy, and Aging Research, Rutgers University, 112 Paterson St., New Brunswick, NJ 08901, USA;
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, 125 Paterson Street, New Brunswick, NJ 08901, USA
| | - H. Jonathon Rendina
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave, NW, Washington, DC 20052, USA;
- Whitman-Walker Institute, 1377 R St., NW, Suite 200, Washington, DC 20009, USA
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Thompson HM, Feasley K, Ortiz R, Reyes K, Seanior A, Karnik NS. An Implementation of a Community-Engaged, Group-Level Mental Health Pilot for Black and Latina Transgender Women. Health Promot Pract 2023:15248399231172191. [PMID: 37171050 DOI: 10.1177/15248399231172191] [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: 05/13/2023]
Abstract
The primary aim is to assess the implementation of an eight-session, group therapy pilot for Black and Latina transgender women in Chicago in terms of implementation outcomes regarding intervention effectiveness, acceptability, appropriateness, and feasibility. The Exploration Preparation Implementation Sustainment (EPIS) framework guided implementation processes, including community engagement as an implementation strategy, and an implementation taxonomy was used to evaluate outcomes of acceptability, appropriateness, and feasibility, in addition to intervention effectiveness regarding anxiety and community connectedness. Two rounds of the pilot were completed in 2020, during the COVID-19 pandemic, at a community-based organization serving LGBTQ+ (lesbian, gay, bisexual, transgender, queer/questioning) youth on Chicago's West Side. Participants (N = 14) completed a baseline and postintervention assessment and evaluations after each of eight intervention modules. Descriptive statistics show improvement across measures of anxiety and community connectedness, and high mean scores across domains of acceptability, appropriateness, and feasibility. Pilot findings indicate intervention effectiveness, acceptability, appropriateness, and feasibility to address mental health and social support of Black and Latina transgender women. Additional resources are needed for transgender community-engaged mental health programs and research to establish core and adaptable intervention elements, scaled-up evidence for clinical effectiveness, and, most importantly, to improve mental health outcomes and the sustainability of such interventions.
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Affiliation(s)
- Hale M Thompson
- Rush University Medical Center, Chicago, IL, USA
- Howard Brown Health, Chicago, IL, USA
| | | | - Reyna Ortiz
- TaskForce Community and Prevention Services, Chicago, IL, USA
| | - Karen Reyes
- Rush University Medical Center, Chicago, IL, USA
| | | | - Niranjan S Karnik
- Rush University Medical Center, Chicago, IL, USA
- University of Illinois at Chicago, Chicago, IL, USA
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Fitzgerald N, Coltart H, Dominguez L, Flanagan K, Gilleece Y. PrEP for women in Europe: a systematic literature review. HIV Med 2023. [PMID: 37088558 DOI: 10.1111/hiv.13458] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 01/03/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Prevention of HIV transmission is fundamental to ending the HIV epidemic. Pre-exposure prophylaxis (PrEP) with oral tenofovir-emtricitabine (TDF-FTC) is an established HIV-prevention method; however, most PrEP services in Europe have been targeted at men who have sex with men (MSM). A survey in 2021 by Women Against Viruses in Europe (WAVE) showed considerable variation in PrEP access and guidance for women throughout Europe. WAVE therefore commissioned this systematic review to provide insight into PrEP provision and barriers to uptake for women in Europe. METHODS PubMed, Embase, and Scopus were searched for studies (January 2013-May 2021) that reported on actual (e.g., efficacy and safety) or hypothetical (e.g., awareness, barriers, PrEP impact models) use of oral PrEP involving women (including cis, transgender, pregnant, migrant, and breastfeeding women). Search terms included HIV, pre-exposure prophylaxis (specifically TDF-FTC), and women. Studies performed outside of the World Health Organization European region were excluded. RESULTS The search identified 4716 unique citations, and 45 peer-reviewed articles (44 studies) were included. The majority of these studies (34/44 [77%]) included recipients or potential recipients of PrEP, representing 4699 women (243 transgender women). However, few studies were women focused (4/34 [12%]) or took place outside of Western Europe (3/34 [9%]). Across the three clinical studies that reported women-specific outcomes (60 transgender women, 13 pregnant, and 19 cis women), no breakthrough infections were recorded during the use of PrEP. Lack of awareness of PrEP, low self-estimation of HIV acquisition risk, concerns about stigma, lack of protection against other sexually transmitted infections, and PrEP interaction with hormones (for transgender women) were identified as barriers to use. The remaining studies examined healthcare professionals' perceptions of PrEP (9/44 [20%]), asked for public opinion (2/44 [5%]), or modelled the potential of PrEP for HIV prevention (1/44 [2%]). CONCLUSIONS This review revealed a notable lack of literature on PrEP for cis and transgender women in Europe. This is synonymous with a lack of PrEP provision for women in this region. Barriers to PrEP uptake are complex and rooted in institutional and societal stigma, which must be addressed at policy level. HIV prevention with PrEP is not 'one size fits all' and requires a nuanced gender-responsive approach. Further research into the use of PrEP in cis, pregnant, breastfeeding, and transgender women is essential if we are to stop HIV transmission by 2030.
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Affiliation(s)
| | | | | | | | - Yvonne Gilleece
- Brighton & Sussex Medical School, Brighton, UK
- The Lawson Unit, Royal Sussex County Hospital, Brighton, UK
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Gamarel KE, Jadwin-Cakmak L, King WM, Reyes LA, Trammell R, Neilands TB, Connolly MD, Jennings Mayo-Wilson L. Community-Led Response to Address Economic Vulnerability due to COVID-19 with, for, and by Transgender Women of Color: A Qualitative Pilot Evaluation. Transgend Health 2023; 8:195-199. [PMID: 37013097 PMCID: PMC10066767 DOI: 10.1089/trgh.2021.0115] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose Intersectional stigma fuels inequities among transgender women of color, which have been exacerbated by coronavirus disease 2019 (COVID-19). This study evaluated a community-led emergency assistance program for transgender women of color. Methods We conducted a pilot program evaluation (n=8). Results Retention was 87.5% over the follow-up. Funds were primarily used for bills, food, and housing. Requesting and receiving funds was described as "somewhat to extremely easy." Participants identified the need for economic empowerment components in future programming, specifically gender affirmation, skill-building for education and employment, and entrepreneurial opportunities. Conclusion Findings highlight the need to invest in community-led strategies to address inequities experienced by transgender women of color.
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Affiliation(s)
- Kristi E. Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Laura Jadwin-Cakmak
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Wesley M. King
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | | | - Racquelle Trammell
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
- Trans Sistas of Color Project, Detroit, Michigan, USA
| | - Torsten B. Neilands
- Center for AIDS Prevention Studies, University of California, San Francisco, California, USA
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Chakrapani V, Gulfam FR, Arumugam V, Aher A, Shaikh S, Prasad R, Safren S, Golub SA, Patel VV. Intersectional stigma and gender non-affirmation hinder HIV care engagement among transgender women living with HIV in India. AIDS Care 2023; 35:572-580. [PMID: 35819879 PMCID: PMC9834431 DOI: 10.1080/09540121.2022.2099511] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/04/2022] [Indexed: 01/14/2023]
Abstract
Among transgender women living with HIV (TGWLH) in India, little is understood about the mechanisms through which multiple intersecting stigmas impact HIV care engagement, or intervention strategies that might mitigate this impact. We conducted focus groups with TGWLH (N = 30) in three Indian cities and analysed data using theoretical frameworks related to HIV stigma, gender affirmation, and syndemics. Findings revealed that enacted and anticipated stigma due to transgender identity, HIV, or sex work status, and lack of gender affirmation (e.g., misgendering) in healthcare settings delayed ART initiation and promoted care disengagement. Having supportive physicians and counsellors within ART centres and peer outreach workers facilitated ART initiation, adherence, and retention. Findings also revealed that HIV stigma within TGW communities led to concealment of HIV status or syndemic conditions such as depression and alcohol use, thereby affecting care engagement. However, the TGW community itself was also described as a resilience resource, offering emotional, psychological and tangible support that decreased the impact of discrimination on care engagement. HIV care engagement efforts among Indian TGWLH could be strengthened by reducing intersecting stigmas in healthcare settings and within TGW communities, providing gender-affirming and culturally competent healthcare, addressing psychosocial syndemic conditions, and strengthening support within transgender communities.
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Affiliation(s)
| | | | | | | | | | | | - Steven Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Sarit A. Golub
- Department of Psychology, Hunter College of the City University of New York, New York, NY, USA
| | - Viraj V. Patel
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY, USA
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Fisher MR, Turner C, McFarland W, Breslow AS, Wilson EC, Arayasirikul S. Through a Different Lens: Occupational Health of Sex-Working Young Trans Women. Transgend Health 2023; 8:200-206. [PMID: 37013087 PMCID: PMC10066761 DOI: 10.1089/trgh.2021.0109] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose Sex work is a common form of work among young trans women (YTW). Methods Using an occupational health frame, we measured associations between demographics, sex work, and vocational outcomes in 18-month visit data from the SHINE study (n=263, San Francisco). Results Overall, 41.8% reported lifetime sex work, primarily escorting/paid sex. Motivations included "better pay" and "can't get a job due to gender discrimination." Occupational injuries included anxiety (53.6%) and depression (50%), with significantly higher relative risk for YTW doing multiple types of sex work. Criminalization experiences (i.e., incarceration, arrests, and police interaction) were common. Conclusion Results echo calls for sex worker-affirming mental health care for YTW.
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Affiliation(s)
- Marla Renee Fisher
- Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health/University of California San Francisco, San Francisco, California, USA
- Department of Psychiatry and Behavioral Sciences, PRIME Center for Health Equity, Albert Einstein College of Medicine, Bronx, New York, USA
- The Einstein–Rockefeller–City University of New York Center for AIDS Research, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Caitlin Turner
- Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health/University of California San Francisco, San Francisco, California, USA
| | - Willi McFarland
- Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health/University of California San Francisco, San Francisco, California, USA
- Department of Biostatistics and Epidemiology and University of California San Francisco, San Francisco, California, USA
| | - Aaron Samuel Breslow
- Department of Psychiatry and Behavioral Sciences, PRIME Center for Health Equity, Albert Einstein College of Medicine, Bronx, New York, USA
- The Einstein–Rockefeller–City University of New York Center for AIDS Research, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Erin C. Wilson
- Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health/University of California San Francisco, San Francisco, California, USA
- Department of Biostatistics and Epidemiology and University of California San Francisco, San Francisco, California, USA
| | - Sean Arayasirikul
- Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health/University of California San Francisco, San Francisco, California, USA
- Department of Biostatistics and Epidemiology and University of California San Francisco, San Francisco, California, USA
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
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L C, M C, P N, T D, K T, P T, P S, P P, V P, J S, L D, N T, J N, M M. Providing HIV pre-exposure prophylaxis to men who have sex with men and transgender women in hospitals and community-led clinics in Thailand: acceptance, patterns of use, trends in risk behaviors, and HIV incidence. AIDS Care 2023; 35:524-537. [PMID: 36726288 PMCID: PMC10121879 DOI: 10.1080/09540121.2022.2159312] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 12/13/2022] [Indexed: 02/03/2023]
Abstract
From May 2015 to June 2018, we conducted a PrEP demonstration project at two hospitals and four community-led clinics in Bangkok and Pattaya. HIV-negative, MSM and TGW aged ≥18 years old, reporting sex without a condom, were offered daily PrEP. Participants received HIV testing and completed a computer-based questionnaire at enrollment, 6 and 12 months. We collected self-reported PrEP adherence at months 1, 3, 6, 9, and 12. We used logistic regression to determine factors associated with the decision to take PrEP and calculated HIV incidence among baseline HIV-negative participants. Of 803 participants enrolled, 349 (43.5%) started PrEP. Participants were more likely to start PrEP if they were sex workers, had moderate or high self-perceived risk of HIV, or a high PrEP-knowledge score. Participants used PrEP for a median of 6.1 months. Reported condom use increased and the number of sex partners decreased during follow-up regardless of PrEP use. Six participants not-taking PrEP acquired HIV (HIV incidence 2.2 per 100 person-years), and five taking PrEP acquired HIV (HIV incidence 2.1 per 100 person-years). All five reported taking <4 pills the weeks before study visits.
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Affiliation(s)
- Cheewanan L
- Division of AIDS and STIs, Ministry of Public Health, Bangkok, Thailand
| | - Chomnad M
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Nonthaburi, Thailand
| | - Nittaya P
- Institute of HIV Research and Innovation, Bangkok, Thailand
| | - Deondara T
- Institute of HIV Research and Innovation, Bangkok, Thailand
| | - Thana K
- Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Tharee P
- Department of Medical Services, Ministry of Public Health, Lerdsin hospital, Bangkok, Thailand
| | - Supabhorn P
- Institute of HIV Research and Innovation, Bangkok, Thailand
| | - Patcharaporn P
- Division of AIDS and STIs, Ministry of Public Health, Bangkok, Thailand
| | - Prin V
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Nonthaburi, Thailand
| | - Surang J
- Service Workers in Group Foundation (SWING), Bangkok, Thailand
| | - Danai L
- Rainbow Sky Association of Thailand, Bangkok, Thailand
| | | | - Nuchapong J
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Nonthaburi, Thailand
| | - Michael M
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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Srikummoon P, Oonarom A, Manojai N, Maneeton B, Maneeton N, Wiriyacosol P, Chiawkhun P, Kawilapat S, Homkham N, Traisathit P. Experiences of Being Bullied and the Quality of Life of Transgender Women in Chiang Mai Province, Thailand. Transgend Health 2023; 8:175-187. [PMID: 37013090 PMCID: PMC10066783 DOI: 10.1089/trgh.2021.0068] [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: 11/12/2022] Open
Abstract
Purpose The objective of this study is to identify factors associated with depression and the quality of life of Thai transgender women (TGW) from Chiang Mai province, Thailand, who have experienced being bullied. Methods We conducted the study on TGW ≥18 years of age in Chiang Mai province, Thailand, from May to November 2020. Data were collected using self-reporting questionnaires at the MPlus Chiang Mai foundation. Binary logistic regression analysis was used to examine the association between potential factors associated with depression and quality of life. Results Of the 205 TGW individuals who participated in this study with a median age of 24 years, most were students (43.3%), and the most common type of bullying was verbal (30.9%). The prevalence of depression among the TGW participants was 30.1%, although most of the participants had a good overall quality of life (53.4%). The impacts of being physically bullied at primary or secondary school and experiencing cyberbullying at primary school were associated with a higher risk of depression. The impacts of being cyberbullied within the previous 6 months and physically bullied at primary or secondary school were associated with a fair quality of life. Conclusion Our results show that many TGW had experienced bullying in their childhood and within the previous 6 months. Screening for experiences of having been bullied and psychological problems might be advantageous for the wellbeing of TGW, while counseling programs or psychotherapy should be provided for those who have experienced bullying to mitigate depression and improve their quality of life.
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Affiliation(s)
- Pimwarat Srikummoon
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
- Data Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Awirut Oonarom
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Benchalak Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Narong Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Punjaree Wiriyacosol
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phisanu Chiawkhun
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Suttipong Kawilapat
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nontiya Homkham
- Faculty of Public Health, Thammasat University, Pathumthani, Thailand
| | - Patrinee Traisathit
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
- Data Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
- Research Center in Bioresources for Agriculture, Industry and Medicine, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
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Karnik NS, Kuhns LM, Hotton AL, Del Vecchio N, McNulty M, Schneider J, Donenberg G, Keglovitz Baker K, Diskin R, Muldoon A, Rivera J, Summersett Williams F, Garofalo R. Findings From the Step Up, Test Up Study of an Electronic Screening and Brief Intervention for Alcohol Misuse in Adolescents and Young Adults Presenting for HIV Testing: Randomized Controlled Efficacy Trial. JMIR Ment Health 2023; 10:e43653. [PMID: 36989027 PMCID: PMC10131684 DOI: 10.2196/43653] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/16/2023] [Accepted: 03/02/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Substance use, particularly binge drinking of alcohol and noninjection substance use, is associated with increased risk for HIV infection among youth, but structured substance use screening and brief intervention are not often provided as part of HIV risk reduction. OBJECTIVE The purpose of the study was to test the efficacy of a fully automated electronic screening and brief intervention, called Step Up, Test Up, to reduce alcohol misuse among adolescents and young adults presenting for HIV testing. Secondary objectives were reduction in sexual risk and uptake of pre-exposure prophylaxis (PrEP) for HIV prevention. METHODS Youth aged 16 years to 25 years who presented for HIV testing at community-based locations were recruited for study participation. Those who screened at moderate to high risk on the Alcohol Use Disorders Identification Test were randomized (1:1) to either an electronic brief intervention or a time-attention control. The primary outcome was change in alcohol use at 1, 3, 6, and 12-month follow-ups. Negative binomial and log binomial regression analyses with generalized estimating equations were conducted to evaluate the intervention efficacy. RESULTS Among a sample of 329 youth, there were no significant differences in alcohol use outcomes between conditions over time or at the 1, 3, 6, or 12-month time points. In terms of secondary outcomes, there was evidence of reduction in condomless insertive anal sex under the influence of alcohol and drugs at 12 months compared with 3 months in the intervention versus the attention control condition (incidence rate ratio=0.15, 95% CI 0.05-0.44); however, there were no other significant differences in sexual risk and no difference in PrEP engagement. CONCLUSIONS We found no effect of electronic brief intervention to reduce alcohol use and some effect on sexual risk among youth aged 16 years to 25 years who present for HIV testing. TRIAL REGISTRATION ClinicalTrials.gov number NCT02703116; https://clinicaltrials.gov/ct2/show/NCT02703116. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12889-020-8154-6.
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Affiliation(s)
- Niranjan S Karnik
- Institute for Juvenile Research, Department of Psychiatry, University of Illinois Chicago, Chicago, IL, United States
| | - Lisa M Kuhns
- The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Anna L Hotton
- The Chicago Center for HIV Elimination, The University of Chicago, Chicago, IL, United States
| | - Natascha Del Vecchio
- The Chicago Center for HIV Elimination, The University of Chicago, Chicago, IL, United States
| | - Moira McNulty
- The Chicago Center for HIV Elimination, The University of Chicago, Chicago, IL, United States
| | - John Schneider
- The Chicago Center for HIV Elimination, The University of Chicago, Chicago, IL, United States
| | - Geri Donenberg
- Center for Dissemination and Implementation Science, University of Illinois Chicago, Chicago, IL, United States
| | | | - Rose Diskin
- The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Abigail Muldoon
- The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Juan Rivera
- Center for Education, Research & Advocacy, Howard Brown Health, Chicago, IL, United States
| | - Faith Summersett Williams
- The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Robert Garofalo
- The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
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Guillen-Diaz-Barriga C, Diaz-Sosa D, Torres TS, Konda KA, Robles-Garcia R, Hoagland B, Benedetti M, Pimenta C, Grinsztejn B, Caceres CF, Veloso VG, Vega-Ramirez H. HIV Risk Perception and Pre-Exposure Prophylaxis (PrEP) Awareness Among Transgender Women from Mexico. AIDS Behav 2023; 27:992-1002. [PMID: 36121550 DOI: 10.1007/s10461-022-03836-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 11/01/2022]
Abstract
This study aimed to identify factors associated with HIV risk perception among Mexican transgender women (TGW). This cross-sectional survey was conducted online and at a public HIV clinic in Mexico City. Participants were ≥ 18 years old, self-identified as TGW, and reported not living with HIV. They answered questions on sexual behavior, HIV risk perception, and pre-exposure prophylaxis (PrEP) awareness. We performed a multivariate logistic regression to accomplish the study's objective. One hundred ninety-one TGW completed the survey. High HIV risk perception was associated with > 5 sexual partners, condomless receptive anal sex, sex with a male partner(s) of unknown HIV status, and PrEP awareness. Although most TGW reported low HIV risk perception, over half had risk sexual behavior, reflecting inaccurate risk assessment. Future interventions to improve accurate risk perception among TGW should promote HIV transmission and prevention knowledge and increase PrEP awareness and uptake.
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50
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Teng F, Sha Y, Fletcher LM, Welsch M, Burns P, Tang W. Barriers to uptake of PrEP across the continuum among transgender women: A global scoping review. Int J STD AIDS 2023; 34:299-314. [PMID: 36793197 DOI: 10.1177/09564624231152781] [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: 02/17/2023]
Abstract
BACKGROUND Although preexposure prophylaxis (PrEP) has demonstrated high efficacy for HIV prevention, rates of PrEP uptake remain low among the transgender population, especially in transgender women (TGW). We conducted this scoping review to assess and characterize barriers to PrEP use along the PrEP care continuum among TGW. METHODS We conducted this scoping review by searching studies in Embase, PubMed, Scopus, and Web of Science. Eligibility criteria included: reporting a PrEP related quantitative result among TGW; peer-reviewed and published in English between 2010-2021. RESULTS Globally, high willingness (80%) to use PrEP was found, yet uptake and adherence (35.4%) were low. TGW experiencing hardship, including poverty, incarceration, and substance use, were associated with higher odds of PrEP awareness but lower odds of PrEP use. Structural and social barriers such as stigma, medical mistrust, and perceived racism can be important barriers for PrEP continuation. High social cohesion and hormone replacement therapy were associated with greater odds of awareness. In addition, our study confirmed prior research showing that PrEP does not lower feminizing hormone levels in TGW. CONCLUSIONS Significant demographic factors among TGW that are associated with PrEP engagement. It is imperative to focus on TGW as a population with independent needs, requiring specific PrEP care guidelines and tailored resource allocation, that fully considers individual-, provider-, and community/structural-level barriers and facilitators. The present review also indicates that combining PrEP care with GAHT or broader gender-affirmation care may facilitate PrEP use.
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Affiliation(s)
- Fei Teng
- Department of Population Health Science, John D. Bower School of Population Health, 21693University of Mississippi Medical Center, Jackson, MS, USA
| | - Yongjie Sha
- 568921University of North Carolina Project-China, Guangzhou, China
| | - Lauren M Fletcher
- Department of Academic Affairs, Rowland Medical Library, 21693University of Mississippi Medical Center, Jackson, MS, USA
| | - Michael Welsch
- Department of Population Health Science, John D. Bower School of Population Health, 21693University of Mississippi Medical Center, Jackson, MS, USA
| | - Paul Burns
- Department of Population Health Science, John D. Bower School of Population Health, 21693University of Mississippi Medical Center, Jackson, MS, USA
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, 568921University of North Carolina Project-China, Guangzhou, China
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