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Anti-gender campaigns in the United States and globally have promoted policies and legislation that significantly limit bodily autonomy for women, transgender, and nonbinary people. This attack on the human rights of women and gender-diverse communities not only reflects implicit and explicit bias but also detrimentally impacts population health and well-being. We outline the domestic and global rise of anti-gender campaigns and their deep historical connections to broader forms of discrimination and inequality to argue that there is an ethical, democratic, and scientific imperative to more critically center and contextualize gender in health research. While the inclusion of gender as a complex concept in research design, implementation, and dissemination is important, we emphasize that gender inequities must be understood as inextricable from other systems of discrimination and exclusion. To that end, this commentary outlines two actions: for researchers to advance critical approaches to gender as part of a broader landscape of discrimination, and for the US National Institutes of Health to integrate both sex and gender into funded research.

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OBJECTIVES: To examine the associations of two measures of minority stress, non-affirmation minority stress and internalized transphobia, with subjective cognitive decline (SCD) among transgender and gender diverse (TGD) veterans. METHOD: We administered a cross-sectional survey from September 2022 to July 2023 to TGD veterans. The final analytic sample included 3,152 TGD veterans aged ≥45 years. We used a generalized linear model with quasi-Poisson distribution to calculate prevalence ratios (PR) and 95% confidence intervals (CIs) measuring the relationship between non-affirmation minority stress and internalized transphobia and past-year SCD. RESULTS: The mean age was 61.3 years (SD = 9.7) and the majority (70%) identified as trans women or women. Overall, 27.2% (n = 857) reported SCD. Adjusted models revealed that TGD veterans who reported experiencing non-affirmation minority stress or internalized transphobia had greater risk of past-year SCD compared to those who did not report either stressor (aPR: 1.09, 95% CI: 1.04-1.15; aPR: 1.19, 95% CI: 1.12-1.27). CONCLUSION: Our findings demonstrate that proximal and distal processes of stigma are associated with SCD among TGD veterans and underscore the need for addressing multiple types of discrimination. Above all, these results indicate the lasting sequelae of transphobia and need for systemic changes to prioritize the safety and welfare of TGD people.

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AIMS: In the United States, lesbian, gay, bisexual, transgender, queer, intersex, asexual and other sexually minoritized and gender expansive (LGBTQ+) young adults are at increased risk for experiencing mental health inequities, including anxiety, depression and psychological distress-related challenges associated with their sexual and gender identities. LGBTQ+ young adults may have unique experiences of sexual and gender minority-related vulnerability because of LGBTQ+-related minority stress and stressors, such as heterosexism, family rejection, identity concealment and internalized homophobia. Identifying and understanding specific LGBTQ+-related minority stress experiences and their complex roles in contributing to mental health burden among LGBTQ+ young adults could inform public health efforts to eliminate mental health inequities experienced by LGBTQ+ young adults. Therefore, this study sought to form empirically based risk profiles (i.e., latent classes) of LGBTQ+ young adults based on their experiences with familial heterosexist experiences, LGBTQ+-related family rejection, internalized LGBTQ+-phobia and LGBTQ+ identity concealment, and then identify associations of derived classes with psychological distress. METHODS: We recruited and enrolled participants using nonprobability, cross-sectional online survey data collected between May and August 2020 (N = 482). We used a three-step latent class analysis (LCA) approach to identify unique classes of response patterns to LGBTQ+-related minority stressor subscale items (i.e., familial heterosexist experiences, LGBTQ+-related family rejection, internalized LGBTQ+-phobia and LGBTQ+ identity concealment), and multinomial logistic regression to characterize the associations between the derived classes and psychological distress. RESULTS: Five distinct latent classes emerged from the LCA: (1) low minority stress, (2) LGBTQ+ identity concealment, (3) family rejection, (4) moderate minority stress and (5) high minority stress. Participants who were classified in the high and moderate minority stress classes were more likely to suffer from moderate and severe psychological distress compared to those classified in the low minority stress class. Additionally, relative to those in the low minority stress class, participants who were classified in the LGBTQ+ identity concealment group were more likely to suffer from severe psychological distress. CONCLUSION: Familial heterosexist experiences, LGBTQ+-related family rejection, internalized LGBTQ+-phobia and LGBTQ+ identity concealment are four constructs that have been extensively examined as predictors for mental health outcomes among LGBTQ+ persons, and our study is among the first to reveal nuanced gradients of these stressors. Additionally, we found that more severe endorsement of minority stress was associated with greater psychological distress. Given our study results and the previously established negative mental health impacts of minority stressors among LGBTQ+ young adults, findings from our study can inform research, practice, and policy reform and development that could prevent and reduce mental health inequities among LGBTQ+ young adults.

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Background: The difficulties in defining hate crime, hate incidents and hate speech, and in finding a common conceptual basis constitute a key barrier toward operationalisation in research, policy and programming. Definitions disagree about issues such as the identities that should be protected, the types of behaviours that should be referred to as hateful, and how the 'hate element' should be assessed. The lack of solid conceptual foundations is reflected in the absence of sound data. These issues have been raised since the early 1990s (Berk, 1990; Byers & Venturelli, 1994) but they proved to be an intractable problem that continues to affect this research and policy domain. Objectives: Our systematic review has two objectives that are fundamentally connected: mapping (1) original definitions and (2) original measurement tools of hate crime, hate speech, hate incidents and surrogate terms, that is, alternative terms used for these concepts (e.g., prejudice-motivated crime, bias crime, among many others). Search Methods: We systematically searched over 19 databases to retrieve academic and grey literature, as well as legislation. In addition, we contacted 26 country experts and searched 211 websites, as well as bibliographies of published reviews of related literature, and scrutiny of annotated bibliographies of related literature. Inclusion Criteria: This review included documents published after 1990 found in academic literature, grey literature and legislation. We included academic empirical articles with any study design, as well as theoretical articles that focused specifically on defining hate crime, hate speech, hate incidents or surrogate terms. We also reviewed current criminal or civil legislation that is intended to regulate forms of hate speech, hate incidents and hate crimes. Eligible countries included Canada, USA, UK, Ireland, Germany, France, Italy, Spain, Australia and New Zealand. For documents to be included in relation to research objective (1), they had to contain at least one original definition of hate speech, hate incidents or hate crimes, or any surrogate term. For documents to be included in relation to research objective (2), they had to contain at least one original measurement tool of hate speech, hate incidents or hate crimes, or any surrogate term. Documents could be included in relation to both research objectives. Data Collection and Analysis: The systematic search covered 1 January 1990 to 31 December 2021, with searches of academic databases conducted between 8th March and 12th April 2022 yielding 35,191 references. We carried out country-specific searches for grey literature published in the same time period between 27th August and 2nd December 2021. These searches yielded a total of 2748 results. We coded characteristics of the definitions and measurement tools, including the protected characteristics, the approaches to categorise the 'hate element' and other variables. We used univariate and bivariate statistical methods for data analysis. We also carried out a social network analysis. Main Results: We provide as annex complete lists of the original definitions and measurement tools that met our inclusion criteria, for the use of researchers and policy makers worldwide. We included 423 definitions and 168 measurement tools in academic and grey literature, and 83 definitions found in legislation. To support future research and policy work in this area, we included a synthetic assessment of the (1) the operationalisability of each definition and (2) the theoretical robustness and transparency of each measurement tool. Our mapping of the definitions and measurement tools revealed numerous significant trends, clusters and differences between and within definitions and measurement tools focusing on hate crime, hate speech and hate incidents. For example, definitions and measurement tools tend to focus more on ethnic and religious identities (e.g., racism, antisemitism, Islamophobia) compared to sexual, gender and disability-related identities. This gap is greater in the definitions and measurement tools of hate speech than hate crime. Our analysis showed geographical patterns: hate crime definitions and measurement tools are more likely to originate from Anglophonic countries, especially the USA, but hate speech definitions and measurement tools are more likely to originate from continental Europe. In terms of disciplinary fragmentation, our social network analysis revealed that the collaboration and exchange of conceptual frameworks and methodological tools between social sciences and computer science is limited, with most definitions and measurement tools clustering along disciplinary lines. More detailed findings are presented in the results section of the report. Authors' Conclusions: There is an urgent need to close the research and policy gap between the protections of 'ethnic and religious identities' and other (less) protected characteristics such as gender and sexual identities, age and disability. There is also an urgent need to improve the quality of methodological and reporting standards in research examining hate behaviours, including transparency in methodology and data reporting, and discussion of limitations (e.g., bias in data). Many of the measurement tools found in the academic literature were excluded because they did not report transparently how they collected and analysed the data. Further, 41% of documents presenting research on hate behaviours did not provide a definition of what they were looking at. Given the importance of this policy domain, it is vital to raise the quality and trustworthiness of research in this area. This review found that researchers in different disciplinary areas (e.g., social sciences and computer science) rarely collaborate. Future research should attempt to build on existing definitions and measurement tools (instead of duplicating efforts), and engage in more interdisciplinary collaborations. It is our hope that that this review can provide a solid foundation for researchers, government, and other bodies to build cumulative knowledge and collaboration in this important field.

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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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A growing number of studies show that transgender people are at higher risk for psychiatric morbidities. This increased vulnerability can result from the discrimination, violence, and other forms of stigma transgender people experience. Several studies have assessed the stigma by studying the public attitudes and beliefs towards transgender people. Using the Genderism and Transphobia Scale, we evaluated how citizens of a metropolitan city in Iran think and feel about transgender people. A total number of 1202 participants, with a mean age of 41.57 years ± 13.41 (27.4% cisgender men and 72.6% cisgender women), were recruited via a random cluster sampling. Demographic data and socioeconomic status were collected for all the participants. The findings showed a notable level of transphobia. Participants identifying as men, being single, personally acquainted with a transgender individual, possessing a higher education, and having a higher socioeconomic standing displayed significantly more positive views towards transgender people. Iranian transgender people, living under a theocratic state, experience more challenges compared to those live in Western countries. Our findings demonstrate that educational level accounted for much of the variance in transgender attitudes. Therefore, representing transgender issues in social media can educate the general population and positively change attitudes and behaviors.

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Post-apartheid, South Africa has come a long way in making the inclusion of gender and sexuality equality explicit in its Constitution. To make schools more inclusive for lesbian, gay, bisexual, transgender, intersex and queer (LGBTIQ+) identifying learners, the Department of Basic Education has developed what it claims are South Africa's first guidelines regarding sexual orientation, gender identity and sex characteristics (SOGIESC). Despite the emphasis on equality in South Africa's post-apartheid policies, which set out to protect the rights of LGBTIQ+ individuals, there has been a backlash from conservative advocacy groups, many with links to the US Christian Right. This paper argues that contrary to the disinformation being propagated by anti-LGBTIQ + groups, it is queer and transgender individuals who experience extreme levels of violence and marginalisation in schools. The empirical research makes explicit the bullying and exclusion that transgender and gender-diverse youth experience in school; however, this evidence is neglected in conservative claims that SOGIESC (SOGIESC) guidelines and Comprehensive Sexuality Education (CSE) endanger other learners. Notably, and in stark contrast to those advocating for measures to make schools safer for LGBTIQ + learners, far-right advocacy groups have no empirical basis to support their claims.

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It is important to understand the differential impact of COVID-19 on the health of older lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, and people with other sexual orientations and forms of gender expression (LGBTQIA+). The objective of this study is to systematically review the impact of COVID-19 on LGBTQIA+ older adults' health including risk and protective factors. We reviewed a total of 167 records including LGBTQIA+ older adults published since 2019. Two independent reviewers screened titles and abstracts and extracted information of 21 full-text records meeting inclusion criteria using COVIDENCE software. The results show that the negative health consequences are exacerbated by personal risk (e.g., perceived homo/transphobia and ageism in LGBTQIA+ communities) and environmental factors (e.g., heterosexism within health services). The negative impact seems to be reduced by personal protective (e.g., resilience, spirituality, and hobbies) and environmental factors (e.g., technology use to increase social participation and social rituals). In conclusion, the health of LGBTQIA+ older adults has been disproportionately affected during the pandemic associated to the latest coronavirus (COVID-19). The experiences of LGBTQIA+ older adults during the pandemic are integrated in a Model of Health and Disease for LGBTQIA+ older adults. Specific strategies to promote health and well-being in this community are provided.

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PURPOSE: Transgender adults face increasingly discriminatory laws/policies and prejudicial attitudes in many regions of the United States (US), yet research has neither quantified state-level transphobia using indicators of both, nor considered their collective association with transgender adults' psychological wellbeing, hindering the identification of this potential social determinant of transgender mental health inequity. METHODS: We therefore used factor analysis to develop a more comprehensive structural transphobia measure encompassing 29 indicators of transphobic laws/policies and attitudes at the state level, which we linked to individual-level mental health data from a large national sample of 27,279 transgender adults (ages 18-100) residing in 45 US states and the District of Columbia (DC). RESULTS: Controlling for individual- (i.e., demographics), interpersonal- (i.e., perceived discrimination), and state- (i.e., income inequality, religiosity) level covariates, transgender adults from US states with higher (vs. lower) levels of structural transphobia reported more severe past-month psychological distress and were more likely to endorse past-year and lifetime suicidal thoughts, plans, and attempts. CONCLUSION: Findings provide novel evidence that state-level transphobic laws/policies and attitudes collectively shape a range of important mental health outcomes among transgender adults in the US. Multilevel intervention strategies, such as affirming mental health treatments, provider-training interventions, and supportive legislation, are needed to address structural transphobia's multifaceted nature and negative mental health consequences.

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PURPOSE: LGBTQ + medical trainees experience significant discrimination. These individuals are stigmatized within a hetero- and cis-normative system, resulting in poorer outcomes in mental health and increased stress regarding career trajectory compared with their hetero- and cis-identifying counterparts. However, literature on the barriers experienced during medical training in this marginalized group is limited to small heterogeneous studies. This scoping review collates and explores prominent themes in existing literature on the personal and professional outcomes of LGBTQ + medical trainees. METHODS: We searched five library databases (SCOPUS, Ovid-Medline, ERIC, PsycINFO and EMBASE) for studies that investigated LGBTQ + medical trainees' academic, personal, or professional outcomes. Screening and full text review were performed in duplicate, and all authors participated in thematic analysis to determine emerging themes, which were iteratively reviewed to consensus. RESULTS: From 1809 records, 45 met inclusion criteria (κ = 0.57). Major themes that emerged in the literature included the prevalence of discrimination and mistreatment faced by LGBTQ + medical trainees from colleagues and superiors, concerns regarding disclosure of sexual and/or gender minority identity, and overall negative impacts on mental health including higher rates of depression, substance use, and suicidal ideation. There was a noted lack of inclusivity in medical education and having an LGBTQ + identity had a large impact on career trajectory. Community with peers and mentors was an important determinant of success and belonging. There was a noteworthy lack of research on intersectionality or positive interventions that improved outcomes for this population. CONCLUSION: This scoping review highlighted important barriers facing LGBTQ + medical trainees, identifying substantial gaps in the existing literature. Research on supportive interventions and predictors of training success is lacking and will be important to foster an inclusive education system. These findings provide critical insights for education leaders and researchers to help create and evaluate inclusive and empowering environments for trainees.

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Transgender and gender expansive (trans) people face high rates of violence, including unique forms of abuse from intimate partners that specifically leverage transphobia. Past qualitative studies have explored trans-specific intimate partner violence (IPV) and transgender IPV; we propose a new term, transphobia-driven IPV, investigated in this paper. The goals of this study were two-fold: (1) to qualitatively identify the subdomains and boundaries of transphobia-driven IPV with the explicit intention of new scale development; and (2) to examine the degree to which existing trans-focused IPV measurement scales adequately assess the construct. We recruited US-based, English-speaking trans survivors of IPV, aged 18 years and older, online through community-based organizations and Facebook/Instagram advertising. Twenty people participated in the study, of which 60 percent were white, 55 percent were assigned female at birth, and 60 percent were nonbinary. Through thematic analysis of the 20 in-depth interviews, we identified four subdomains of transphobia-driven IPV: pressure to perform, disrupting gender affirmation, belittling gender identity, and intentional misgendering. When examining nine existing screening tools and measures that ask about IPV related to the survivor's trans identity, only one measure included questions related to all four subdomains. Further, the existing measures were either not psychometrically validated, only validated with a subpopulation of the trans community, or validated with a larger LGBTQ sample of which trans survivors comprised a small percentage. This study lays a foundation for new valid measures of transphobia-driven IPV that reflect the various ways in which transphobia can be leveraged by abusers and may be relevant across subpopulations of the trans community.

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ABSTRACT Objective: to describe the process of developing, validating and assessing an educational booklet to prevent transphobic bullying at school. Method: this is a methodological study, carried out from February to December 2022 at a public school in João Pessoa, Paraíba, Brazil. The educational booklet was developed in accordance with the methodological trajectory proposed by Echer, and submitted to content validity and semantic assessment by expert judges and Elementary School II teachers, respectively. In data analysis, content validity and Intraclass Correlation Coefficients were used, in addition to semantic agreement index. Results: the educational booklet had its content validated with a validity coefficient of 0.981 and an Intraclass Correlation Coefficient of 0.833 for the set of items in the assessment instrument. In semantic assessment, teachers considered the booklet understandable, with a minimum agreement level of 94%. Conclusion: the booklet developed was considered valid by judges, to be used with teachers, individually and in continuing education or health actions, in order to contribute to preventing transphobic bullying at school.

RESUMEN Objetivo: describir el proceso de desarrollo, validación y evaluación de una cartilla educativa para prevenir el acoso escolar transfóbico. Método: se trata de un estudio metodológico, realizado de febrero a diciembre de 2022 en una escuela pública de João Pessoa, Paraíba, Brazil. La cartilla educativa fue elaborada de acuerdo con la trayectoria metodológica propuesta por Echer, y sometida a validación de contenido y evaluación semántica por jueces expertos y docentes de la Escuela Primaria II, respectivamente. En el análisis de los datos, se utilizaron los coeficientes de validez de contenido y de correlación intraclase, y el índice de concordancia semántica. Resultados: la cartilla educativa tuvo su contenido validado con un coeficiente de validez de 0,981 y un coeficiente de correlación intraclase de 0,833 para el conjunto de ítems del instrumento de evaluación. En la evaluación semántica, los docentes consideraron comprensible el cuadernillo, con un nivel mínimo de acuerdo del 94%. Conclusión: la cartilla desarrollada fue considerada válida por los jueces, para ser utilizada con docentes, de manera individual y en acciones de educación continua o de salud, con el fin de contribuir a la prevención del acoso escolar transfóbico en la escuela.

RESUMO Objetivo: Descrever o processo de desenvolvimento, validação e avaliação de cartilha educacional para prevenção do bullying transfóbico na escola. Método: Trata-se de um estudo metodológico, realizado no período de fevereiro a dezembro de 2022 em uma escola pública de João Pessoa, Paraíba, Brasil. A cartilha educacional foi desenvolvida de acordo com a trajetória metodológica proposta por Echer, e submetida à validação de conteúdo e avaliação semântica por juízes especialistas e professores do Ensino Fundamental II, respectivamente. Na análise dos dados, utilizaram-se os coeficientes de validade de conteúdo e correlação intraclasse, e o índice de concordância semântica. Resultados: A cartilha educacional teve seu conteúdo validado com coeficiente de validade de 0,981 e coeficiente de correlação intraclasse de 0,833 para o conjunto de itens do instrumento de avaliação. Na avaliação semântica, os professores consideraram a cartilha compreensível, com nível de concordância mínima de 94%. Conclusão: A cartilha desenvolvida foi considerada válida por juízes, para ser utilizada com professores, de forma individual e em ações de educação permanente ou em saúde, a fim de contribuir na prevenção do bullying transfóbico na escola.

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ABSTRACT Objective: To understand the narratives of transgender women and travestis (TGW) from four Brazilian cities regarding access to and use of health services. Methods: Qualitative study carried out within the scope of the TransOdara project, cross-sectional multicenter mixed methods research conducted between 2019-2021. Fifty-two in-depth interviews with TGW in Manaus, Campo Grande, Porto Alegre and São Paulo were analyzed. The analysis was guided by philosophical hermeneutics. Results: Reports of discrimination, stigmatization and pathologization reiterate the difficulties faced by TGW in seeking healthcare. The recurrence of disrespect for the social/corrected name reveals obstacles to the recognition of transgender identities and, in some cases, the intention of inhibiting transsexuality-travestilidade. Other difficulties arise from actions that disregard the health specificities of TGW or the precarious social conditions that affect some of them. On the other hand, based on experiences of respect and adequate care, participants identify an ongoing change, which is expressed in greater availability of services and improved assistance. There is an expectation of continued expansion of services, technologies and training of health professionals. Conclusions: The identified change has been undertaken at the interface of public health policies with LGBT+ activism and the production of knowledge about TGW health needs. Although the identified advances are insufficient to change the scenario of the historical exclusion experienced by TGW in health services, they point to promising ways to improve their health conditions.

RESUMO Objetivo: Compreender as narrativas de Mulheres Trans e Travestis (MTT) de quatro cidades brasileiras acerca do acesso e do uso de serviços de saúde. Métodos: Estudo qualitativo realizado no âmbito do projeto TransOdara, pesquisa transversal multicêntrica de métodos mistos, conduzida entre 2019 e 2021. São analisadas 52 entrevistas em profundidade com MTT em Manaus, Campo Grande, Porto Alegre e São Paulo. O tratamento analítico foi orientado pela hermenêutica filosófica. Resultados: Relatos de discriminação, estigmatização e patologização reafirmam as dificuldades enfrentadas por MTT na busca por cuidado com a saúde. A recorrência do desrespeito ao nome social/retificado revela obstáculos ao reconhecimento das identidades trans e, em alguns casos, a intenção de inibir a transexualidade-travestilidade. Outras dificuldades decorrem de ações que desconsideram as especificidades de saúde das MTT ou as condições sociais precárias que afetam algumas delas. No entanto, a partir de experiências de respeito e atendimento adequado, as participantes identificam uma mudança em curso, que se expressa em uma maior disponibilidade de serviços e na melhoria da assistência. Há uma expectativa de continuidade da ampliação de serviços, tecnologias e capacitação dos/as profissionais de saúde. Conclusão: A mudança identificada tem sido empreendida na interface das políticas públicas de saúde com o ativismo LGBT+ e a produção de conhecimento acerca das questões de saúde das MTT. Os avanços empreendidos, ainda que insuficientes para mudar o cenário da histórica exclusão vivida por elas nos serviços de saúde, apontam caminhos promissores na melhoria de suas condições de saúde.

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Resumo O sistema capitalista e cisheteropatriarcal se desenvolveu através da opressão e exploração de classe, raça e sexo no estabelecimento de relações desiguais e hierarquizadas de poder, e uma dessas opressões é o uso da violência contra os corpos considerados errantes e transgressores dentro dessa estrutura. Dentre os diversos tipos de violência, o foco deste estudo está na violência obstétrica, compreendida como uma violência patriarcal de gênero que visa a retirada de direitos, autonomia e protagonismo de mulheres e homens trans durante o período gestacional, do parto e puerpério ou em processos de abortamento. Esse artigo tem como objetivo refletir sobre a violência obstétrica e seu impacto nas homoparentalidades de mulheres lésbicas e de homens trans, pois compreende-se que a população LGBTQIA+ é uma das mais vulnerabilizadas e que está mais distante dos serviços de saúde, justamente pela violência institucional que acomete esses corpos. Dessa forma, pretende-se compreender, através de uma análise social e histórica, como os atravessamentos dessas violações sexistas e heteropatriarcais se entrelaçam e refletem na assistência à saúde dessas pessoas, gerando ainda mais formas de opressão contra essa população.

Abstract The cisheteropatriarchal capitalist system has developed by class, racial and sexual oppression and exploitation in establishing unequal, hierarchical power relations. One of these kinds of oppression involves the use of violence against bodies considered wayward and transgressive within this structure. Of the different types of violence, this study focused on obstetric violence, understood as patriarchal gender violence designed to remove the rights, autonomy and agency of trans women and men during the processes of pregnancy, childbirth, postpartum and abortion. This article reflects on obstetric violence and its impacts on homo-parenthood for lesbian women and trans men, on the understanding that the LGBTQIA+ population is one of the most vulnerable and removed from health services, mainly because of the institutional violence suffered by these bodies. Accordingly, the intention is to understand, through social and historical analysis, how these sexist, heteropatriarchal violations, interlacing and reflecting in health care for these people, generate even more forms of oppression against this population.

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Este trabalho investiga e discute o paradoxo da proteção e da cidadania de adolescentes transexuais e travestis, com foco nas adolescências em situação de restrição ou privação de liberdade. O material apresentado baseia-se em análise documental, referenciais teóricos sobre adolescência, diversidade de gênero, socioeducação e direitos das infâncias e adolescências, além de material obtido por meio de conversações realizadas com adolescentes transgêneros privados de liberdade e profissionais que atuam no sistema socioeducativo. Inclui também dados de uma audiência pública realizada em Belo Horizonte para abordar episódios de transfobia dentro de unidades socioeducativas e propor formas de enfrentamento e eliminação de tal fenômeno. A premissa da pesquisa foi o convite feito ao Programa de Extensão Janela da Escuta (UFMG) para contribuir com um plano de enfrentamento à transfobia no socioeducativo. Os objetivos são a discutir como se manifesta a violência transfóbica em relação às/os adolescentes em cumprimento de medidas socioeducativas privativas ou restritivas de liberdade, bem como entender a forma como a transfobia é elemento estruturante para a desproteção desses sujeitos. O material coletado e a discussão feita apontam para um quadro onde o preconceito e o rechaço desses sujeitos demarcam uma situação de desproteção, vulnerabilização e dificuldades de acesso a políticas públicas e à proteção. A dissertação está organizada em dois grandes artigos. O primeiro artigo, organizado em cinco seções, foca na discussão sobre a noção de adolescência para a psicanálise, aspectos da singularidade das transições e um panorama de segregação e desproteção desse público no Brasil. O segundo artigo, organizado em sete seções, se detém mais a elementos da política de socioeducação, as adolescências trans em cumprimento de medidas socioeducativas e a vivência de situações transfóbicas como manifestações de rechaço a essas pessoas.

This study investigates and discusses the paradox of protection and citizenship of transgender and transvestite adolescents, focusing on adolescents in situations of restriction or deprivation of liberty. The presented material is based on documental analysis, theoretical references on adolescence, gender diversity, socio-education, and the rights of children and adolescence, as well as material obtained through conversations with transgender adolescents deprived of liberty and professionals who work in the socio-educational system. It also includes data from a public hearing held in Belo Horizonte to address episodes of transphobia within socio-educational units and propose ways to confront and eliminate this phenomenon. The premise of the research was the invitation extended to the Janela da Escuta Extension Program (UFMG) to contribute to a plan to combat transphobia in the socio-educational system. The objectives are to discuss how transphobic violence manifests itself in relation to adolescents serving socio-educational measures of deprivation or restriction of liberty, as well as to understand how transphobia is a structuring element of the lack of protection for these individuals. The collected material and the discussion carried out point to a scenario where prejudice and rejection of these individuals mark a situation of lack of protection, vulnerability, and difficulties in accessing public policies and protection. The dissertation is organized into two major articles. The first article, organized into five sections, focuses on the discussion of the notion of adolescence for psychoanalysis, aspects of the singularity of transitions, and an overview of segregation and lack of protection for this group in Brazil. The second article, organized into seven sections, focuses more on elements of socio-educational policy, the experiences of transgender adolescents serving socio-educational measures, and the experience of transphobic situations as manifestations of rejection of these people.

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Traumatic stress increases the risk for mental health conditions and adversely impacts health, academic performance, and coping. Transgender and gender diverse (TGD) youth experience higher rates of abuse and maltreatment and interpersonal and community-embedded discrimination than their cisgender peers. Neurobiologic stress responses and social stress theory provide useful frameworks for understanding the effects of discrimination, stigma, and rejection. Despite facing higher rates of interpersonal trauma, TGD youth are quite resilient when able to access supports and affirming trauma-informed services. Clinicians play an important role in identifying and addressing traumatic stress impacting TGD youth and bolstering resilience.

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In recent years, the rights of trans people in the United Kingdom and elsewhere have been increasingly under scrutiny. This paper considers forms of resistance to Trans Exclusionary Radical Feminism (TERF) and neo-fascist gender conservative movements in Edinburgh, Scotland through an analysis of trans-positive stickers in public space. Using an archive of 461 images of trans-rights-related stickers photographed in Edinburgh between August 2018 and May 2022, we explore how trans-positive activism is publicly (en)countering transphobic politics and discourses. Our analysis begins by examining palimpsests of conflict, or the layerings of trans-positive and transphobic stickers - removed, written on, or covered up - in the materiality of public space. We then turn to the transformative potential of stickers as materials of resistance, arguing that trans-positive stickers can undermine transnormative, TERF and neo-fascist gender conservative ideologies and political tactics. Stickers offer public expressions of allyship, communicate political solidarity across social justice movements and marginalised communities, and also provide representations of non-normative trans identities and embodiments. Through this analysis, we present the political potential of stickers as important materials of public resistance that intervene in transphobic political and cultural discourses to produce trans-affirming encounters in public space.

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BACKGROUND: Migration is recognized as a key determinant of health. Yet, limited research addresses the arc of intranational migration and, even less, the experiences of transgender (trans) adolescents and women migrants and the associated health vulnerabilities. Using intersectional stigma as a theoretical frame, this study seeks to better understand the sexual health vulnerabilities and needs of trans women migrants in Peru. METHODS: Between October and November 2016, in-depth interviews (n = 14) and two focus groups (n = 20) were conducted in Spanish with trans women in three Peruvian cities. To explore pre- and during migration experiences, focus groups were conducted in Pucallpa and Iquitos, key cities in the Amazon where trajectories often originate. To assess during migration and post-migration experiences, we conducted interviews in Pucallpa, Iquitos, and Lima to better understand processes of relocation. Audio files were transcribed verbatim and analysed via an immersion crystallization approach, an inductive and iterative process, using Dedoose (v.6.1.18). RESULTS: Participants described migration as an arc and, thus, results are presented in three phases: pre-migration; during migration; and post-migration. Intersectional stigma was identified as a transversal theme throughout the three stages of migration. The pre-migration stage was characterized by poverty, transphobia, and violence frequently motivating the decision to migrate to a larger city. Exploitation was also described as pervasive during migration and in relocation. Many participants spoke of their introduction to sex work during migration, as key to economic earning and associated violence (police, clients). CONCLUSION: Findings advance understandings of intranational migration and forced displacement as key determinants of trans women's health. Dimensions of violence at the intersection of classism and cisgenderism render trans women highly vulnerable at every step of their migratory journeys. Experiences of intranational mobility and relocation were described as uniquely tied to age, intersectional transphobic stigma, engagement in sex work, and multiple forms of violence, which impact and can magnify sexual health vulnerabilities for transgender women in Peru who migrated intranationally.

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PURPOSE: Prior studies have identified a significant relationship between internalized transphobia and poor mental health among transgender and gender-diverse (TGD) adults; however, this relationship has not been extensively examined among youth. Further, little research has sought to explore protective factors, such as identity pride, and their influence on this relationship. We examined the association between internalized transphobia and depression and anxiety symptoms among TGD youth and explored the moderating role of gender identity pride on these associations. METHODS: Participants were 315 TGD youth ages 12-20 years (mean = 16; standard deviation = 1.89) seeking gender-affirming hormone treatment at one of four major pediatric hospitals across the United States. At the time of enrollment, participants were naïve to gender-affirming hormone treatment. Participants self-reported mental health, internalized transphobia, and identity pride. Multiple regression models were used with depression and anxiety symptoms as outcomes and age, designated sex at birth, and perceived parental support included as covariates. RESULTS: Greater internalized transphobia was associated with greater depressive symptoms, and gender identity pride moderated this relationship, such that greater gender identity pride was associated with fewer depressive symptoms. Greater internalized transphobia was significantly associated with greater anxiety symptoms; no moderation effect was observed for this relationship. DISCUSSION: Gender identity pride influenced mental health symptoms for youth experiencing internalized transphobia and represents a potential key protective factor. These results support efforts to further develop, test, and implement clinical inventions to bolster identity pride for TGD youth.

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