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Agénor M, Zubizarreta D, Geffen S, Ramanayake N, Giraldo S, McGuirk A, Caballero M, Bond K. "Making a Way Out of No Way:" Understanding the Sexual and Reproductive Health Care Experiences of Transmasculine Young Adults of Color in the United States. Qual Health Res 2022; 32:121-134. [PMID: 34851198 PMCID: PMC10921419 DOI: 10.1177/10497323211050051] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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] [Indexed: 06/13/2023]
Abstract
Research focusing on the specific and unique sexual and reproductive health care experiences of transmasculine young adults of color are extremely scarce. We conducted five focus group discussions with 19 Black, Latinx, Asian, Native, and other transmasculine individuals of color aged 18-25 years in the greater Boston area. Using thematic analysis, we found that transmasculine young adults of color experienced cissexism, heterosexism, and racism in accessing and utilizing sexual and reproductive health services. These multiple forms of discrimination undermined participants' receipt of high-quality sexual and reproductive health information and care from competent health care providers who shared their lived experiences. Participants relied on support from their lesbian, gay, bisexual, transgender, and queer peers to obtain needed sexual and reproductive health resources and minimize harm during clinical encounters. Multilevel interventions are needed to promote access to person-centered and structurally competent sexual and reproductive health care among transmasculine young adults of color.
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Affiliation(s)
- Madina Agénor
- Department of Behavioral and Social Sciences, 174610Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Center for Health Promotion and Health Equity, Brown University School of Public Health, , Providence, RI, USA
| | - Dougie Zubizarreta
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sophia Geffen
- 15851Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | | | - Shane Giraldo
- Department of Sociology, 1849Simmons University, Boston, MA, USA
| | - Allison McGuirk
- Department of Counseling Psychology, 1810University of Wisconsin at Madison, Madison, WI, USA
| | - Mateo Caballero
- Department of Communication Studies, 1848Northeastern University, Boston, MA, USA
| | - Keosha Bond
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY, USA
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Poteat TC, Adams MA, Malone J, Geffen S, Greene N, Nodzenski M, Lockhart AG, Su IH, Dean LT. Delays in breast cancer care by race and sexual orientation: Results from a national survey with diverse women in the United States. Cancer 2021; 127:3514-3522. [PMID: 34287838 DOI: 10.1002/cncr.33629] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/19/2020] [Accepted: 01/19/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Despite known differences in breast cancer by both race and sexual orientation, data on the intersectional experiences of Black sexual minority women (BSMW) along the care continuum are scant. This study sought to understand delays in breast cancer care by examining the intersection of race and sexual orientation. METHODS This online, cross-sectional survey enrolled racially and sexually diverse women aged ≥ 35 years who had been diagnosed with breast cancer within the prior 10 years or had an abnormal screening in the prior 24 months. The authors calculated summary statistics by race/sexual orientation categories, and they conducted univariate and multivariable modeling by using multiple imputation for missing data. RESULTS BSMW (n = 101) had the highest prevalence of care delays with 5.17-fold increased odds of a care delay in comparison with White heterosexual women (n = 298) in multivariable models. BSMW reported higher intersectional stigma and lower social support than all other groups. In models adjusted for race, sexual orientation, and income, intersectional stigma was associated with a 2.43-fold increase in care delays, and social support was associated with a 32% decrease in the odds of a care delay. CONCLUSIONS Intersectional stigma may be an important driver of breast cancer inequities for BSMW. Reducing stigma and ensuring access to appropriate social support that addresses known barriers can be an important approach to reducing inequities in the breast cancer care continuum.
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Affiliation(s)
- Tonia C Poteat
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mary Anne Adams
- ZAMI NOBLA: National Organization of Black Lesbians on Aging, Atlanta, Georgia
| | - Jowanna Malone
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sophia Geffen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Naomi Greene
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Michael Nodzenski
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alexandre G Lockhart
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - I-Hsuan Su
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland
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Fontenot HB, Cahill SR, Wang T, Geffen S, White BP, Reisner S, Conron K, Harper CR, Johns MM, Avripas SA, Michaels S, Dunville R. Transgender Youth Experiences and Perspectives Related to HIV Preventive Services. Pediatrics 2020; 145:peds.2019-2204. [PMID: 32184336 DOI: 10.1542/peds.2019-2204] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In the United States, transgender youth are at especially high risk for HIV infection. Literature regarding HIV prevention strategies for this vulnerable, often-hidden population is scant. Before effective, population-based HIV prevention strategies may be adequately developed, it is necessary to first enhance the contextual understanding of transgender youth HIV risk and experiences with HIV preventive services. METHODS Two 3-day, online, asynchronous focus groups were conducted with transgender youth from across the United States to better understand participant HIV risk and experiences with HIV preventive services. Participants were recruited by using online advertisements posted via youth organizations. Qualitative data were analyzed by using content analysis. RESULTS A total of 30 transgender youth participated. The average age was 18.6 years, and youth reported a wide range of gender identities (eg, 27% were transgender male, 17% were transgender female, and 27% used ≥1 term) and sexual orientations. Four themes emerged: (1) barriers to self-efficacy in sexual decision-making; (2) safety concerns, fear, and other challenges in forming romantic and/or sexual relationships; (3) need for support and education; and (4) desire for affirmative and culturally competent experiences and interactions (eg, home, school, and health care). CONCLUSIONS Youth discussed experiences and perspectives related to their gender identities, sexual health education, and HIV preventive services. Findings should inform intervention development to improve support and/or services, including the following: (1) increasing provider knowledge and skills to provide gender-affirming care, (2) addressing barriers to services (eg, accessibility and affordability as well as stigma and discrimination), and (3) expanding sexual health education to be inclusive of all gender identities, sexual orientations, and definitions of sex and sexual activity.
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Affiliation(s)
- Holly B Fontenot
- The Fenway Institute, Fenway Health, Boston, Massachusetts; .,W.F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts
| | - Sean R Cahill
- The Fenway Institute, Fenway Health, Boston, Massachusetts.,School of Public Health, Boston University, Boston, Massachusetts; and.,Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Timothy Wang
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Sophia Geffen
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Bradley P White
- W.F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts
| | - Sari Reisner
- The Fenway Institute, Fenway Health, Boston, Massachusetts.,Division of Endcrinology, Diabetes, and Hypertension, Brigham and Women's Hosptial, Boston, Massachusetts
| | - Kerith Conron
- The Fenway Institute, Fenway Health, Boston, Massachusetts.,The Williams Institute on Sexual Orientation and Gender Identity Law and Public Policy, University of California, Los Angeles, Los Angeles, California
| | - Christopher R Harper
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michelle M Johns
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Abstract
Hormone therapy is medically necessary for many transgender individuals. The U.S. Food and Drug Administration (FDA) and pharmaceutical companies' failure to guarantee a supply of injectable estrogen in 2016 and 2017 for transgender individuals is a violation of their right to comprehensive medical treatment, free of discrimination. A series of advocacy actions eventually led to all formulations of injectable estrogen being restored to market; however, long-term solutions to supply interruptions of injectable estrogen are needed. Long-term solutions should address the lack of federally funded research and, consequently, evidence-based practice on hormone therapy for gender affirmation.
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Affiliation(s)
- Sophia Geffen
- Department of Health Policy Research, The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Tim Horn
- HIV and HCV Programs, Treatment Action Group, New York, New York
| | - Kimberleigh Joy Smith
- Community Health Planning and Policy, Callen-Lorde Community Health Center, New York, New York
| | - Sean Cahill
- Department of Health Policy Research, The Fenway Institute, Fenway Health, Boston, Massachusetts.,Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts
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Geffen S, Panagoda C. The makings of a bionic man: first use of osseo-integrated prostheses in a quadruple amputee. Intern Med J 2015; 45:683-4. [DOI: 10.1111/imj.12771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 11/02/2014] [Indexed: 11/27/2022]
Affiliation(s)
- S. Geffen
- Mater Private Hospital; Brisbane Queensland Australia
| | - C. Panagoda
- Mater Private Hospital; Brisbane Queensland Australia
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Geffen S, Shum K, Tan HM. Novel use of modafinal to treat severe physical and cognitive impairment post-stroke. Intern Med J 2013; 43:338. [PMID: 23441663 DOI: 10.1111/imj.12073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 09/23/2012] [Indexed: 11/30/2022]
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Geffen S, Wilson S. New hands reduce handicap. Disabil Rehabil 1998; 20:428-30. [PMID: 9846243 DOI: 10.3109/09638289809166105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This case study concerns Mr AH, a 93 year old man who suffered bilateral traumatic transcarpal amputations at the age of 17. METHOD His presentation and the prescription of cosmetic hand prostheses illustrate several interesting points. RESULTS These include that advanced age and lengthy period since amputation do not preclude prosthetic provision. CONCLUSIONS Bilateral upper limb amputees can lead long, productive and fulfilling lives and the psychological benefits of cosmetic prostheses are of primary concern in the upper limb amputee.
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Affiliation(s)
- S Geffen
- Department of Aged Care and Rehabilitation Medicine, Royal North Shore Hospital, Australia
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Abstract
PURPOSE The report describes the mechanisms and sequelae of the first case of thoracic vertebral fracture to be reported in a rugby league footballer. CASE SUMMARY The injury was sustained as the result of a legal shoulder tackle. The player exhibited no sign other than dorsal midthoracic tenderness and paraspinal muscle spasm. Investigations commenced the next day because of persistent pain. CT and MRI revealed complex T6/7 fractures not evident on plain x-ray. The player was managed conservatively with analgesia and rest and has made a full recovery. DISCUSSION Football is the most common cause of cervical spinal fractures in sport, whereas thoracic spinal fractures are very rare. Although in this case significant damage occurred to the posterior elements of the column, there were no neurological complications. RELEVANCE The anatomical and physiological bracing of the thoracic spine accounts for the rarity of fractures in contact sport and favors conservative management.
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Affiliation(s)
- S Geffen
- Cognitive Psychophysiology Laboratory, University of Queensland, Brisbane, Australia
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