RESUMEN
BACKGROUND: Key populations (KP), including men who have sex with men (MSM), female sex workers (FSW), and transgender women (TGW), experience a disproportionate burden of HIV, even in generalized epidemics like South Africa. Given this disproportionate burden and unique barriers to accessing health services, sustained provision of care is particularly relevant. It is unclear how the COVID-19 pandemic and its associated restrictions may have impacted this delivery. In this study, we aimed to describe patterns of engagement in HIV prevention and treatment services among KP in South Africa and assess the impact of different COVID-19 restriction levels on service delivery. METHODS: We leveraged programmatic data collected by the US President's Emergency Plan for AIDS Relief (PEPFAR)-supported KP partners in South Africa. We divided data into three discrete time periods based on national COVID-19 restriction periods: (i) Pre-restriction period, (ii) High-level restriction period, and (iii) After-high level restriction period. Primary outcomes included monthly total HIV tests, new HIV cases identified, new initiations of pre-exposure prophylaxis (PrEP), and new enrollments in antiretroviral therapy (ART). We conducted interrupted time series segmented regression analyses to estimate the impact of COVID-19 restrictions on HIV prevention and treatment service utilization. RESULTS: Between January 2018 and June 2022, there were a total of 231,086 HIV tests, 27,051 HIV positive cases, 27,656 pre-exposure prophylaxis (PrEP) initiations, and 15,949 antiretroviral therapy initiations among MSM, FSW and TGW in PEPFAR-supported KP programs in South Africa. We recorded 90,457 total HIV tests during the 'pre-restriction' period, with 13,593 confirmed new HIV diagnoses; 26,134 total HIV tests with 2,771 new diagnoses during the 'high-level restriction' period; and 114,495 HIV tests with 10,687 new diagnoses during the after high-level restriction period. Our Poisson regression model estimates indicate an immediate and significant decrease in service engagement at the onset of COVID-19 restrictions, including declines in HIV testing, treatment, and PrEP use, which persisted. As programs adjusted to the new restrictions, there was a gradual rebound in service engagement, particularly among MSM and FSW. Towards the end of the high-level restriction period, with some aspects of daily life returning to normal but others still restricted, there was more variability. Some indicators continued to improve, while others stagnated or decreased. CONCLUSION: Service provision rebounded from the initial shock created by pandemic-related restrictions, and HIV services were largely maintained for KP in South Africa. These results suggest that HIV service delivery among programs designed for KP was able to be flexible and resilient to the evolving restrictions. The results of this study can inform plans for future pandemics and large-scale disruptions to the delivery of HIV services.
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COVID-19 , Infecciones por VIH , Análisis de Series de Tiempo Interrumpido , Humanos , Sudáfrica/epidemiología , COVID-19/prevención & control , COVID-19/epidemiología , Infecciones por VIH/prevención & control , Infecciones por VIH/epidemiología , Masculino , Femenino , Adulto , Trabajadores Sexuales/estadística & datos numéricos , Accesibilidad a los Servicios de Salud , Personas Transgénero/estadística & datos numéricos , Homosexualidad Masculina/estadística & datos numéricosRESUMEN
Background: Young men who have sex with men and young transgender women (YMSM-YTW) use online spaces to meet sexual partners with increasing regularity, and research shows that experiences of racism online mimics the real world. Objective: We analyzed differences by race and ethnicity in web-based and mobile apps used to meet sexual partners as reported by Chicago-based YMSM-YTW in 2016-2017. Methods: A racially and ethnically diverse sample of 643 YMSM-YTW aged 16-29 years were asked to name websites or mobile apps used to seek a sexual partner in the prior 6 months, as well as provide information about sexual partnerships from the same period. We used logistic regression to assess the adjusted association of race and ethnicity with (1) use of any website or mobile apps to find a sexual partner, (2) use of a "social network" to find a sexual partner compared to websites or mobile apps predominantly used for dating or hookups, (3) use of specific websites or mobile apps, and (4) reporting successfully meeting a sexual partner online among website or mobile app users. Results: While most YMSM-YTW (454/643, 70.6%) used websites or mobile apps to find sexual partners, we found that Black non-Hispanic YMSM-YTW were significantly less likely to report doing so (comparing White non-Hispanic to Black non-Hispanic: adjusted odds ratio [aOR] 1.74, 95% CI 1.10-2.76). Black non-Hispanic YMSM-YTW were more likely to have used a social network site to find a sexual partner (comparing White non-Hispanic to Black non-Hispanic: aOR 0.20, 95% CI 0.11-0.37), though this was only reported by one-third (149/454, 32.8%) of all app-using participants. Individual apps used varied by race and ethnicity, with Grindr, Tinder, and Scruff being more common among White non-Hispanic YMSM-YTW (93/123, 75.6%; 72/123, 58.5%; and 30/123, 24.4%, respectively) than among Black non-Hispanic YMSM-YTW (65/178, 36.5%; 25/178, 14%; and 4/178, 2.2%, respectively) and Jack'd and Facebook being more common among Black non-Hispanic YMSM-YTW (105/178, 59% and 64/178, 36%, respectively) than among White non-Hispanic YMSM-YTW (6/123, 4.9% and 8/123, 6.5%, respectively). Finally, we found that while half (230/454, 50.7%) of YMSM-YTW app users reported successfully meeting a new sexual partner on an app, Black non-Hispanic YMSM-YTW app users were less likely to have done so than White non-Hispanic app users (comparing White non-Hispanic to Black non-Hispanic: aOR 2.46, 95% CI 1.50-4.05). Conclusions: We found that Black non-Hispanic YMSM-YTW engaged with websites or mobile apps and found sexual partners systematically differently than White non-Hispanic YMSM-YTW. Our findings give a deeper understanding of how racial and ethnic sexual mixing patterns arise and have implications for the spread of sexually transmitted infections among Chicago's YMSM-YTW.
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Homosexualidad Masculina , Aplicaciones Móviles , Parejas Sexuales , Personas Transgénero , Humanos , Aplicaciones Móviles/estadística & datos numéricos , Masculino , Adolescente , Estudios Transversales , Adulto Joven , Adulto , Femenino , Parejas Sexuales/psicología , Homosexualidad Masculina/estadística & datos numéricos , Homosexualidad Masculina/psicología , Personas Transgénero/estadística & datos numéricos , Personas Transgénero/psicología , Chicago , Etnicidad/estadística & datos numéricos , Etnicidad/psicologíaRESUMEN
BACKGROUND: Transgender women (TGWs) constitute one of the key populations for HIV prevention and control and constitute a high-risk group due to a lack of health services. The aim of this study was to investigate knowledge, attitudes and practices (KAPs) related to HIV and knowledge access and needs amongst transgender women in Chongqing, China. METHODS: A cross-sectional study was conducted from October 2022 to March 2023. A total of 128 self-identified TGWs were recruited in Chongqing, China, via snowball sampling, and a KAP-related questionnaire was completed via Questionnaire Star. RESULTS: For the 128 TGWs surveyed effectively, the total knowledge of AIDS-related knowledge was 82.03%, with significant differences in age, education level, marital status, occupation and average monthly income (p < 0.05). Significant differences were obtained in terms of personal attitudes toward AIDS and place of domicile and literacy (p < 0.05) and subjective norms in terms of literacy (p < 0.05). No significant difference was observed between the groups in terms of HIV-related practices. The corresponding values were assigned to knowledge, attitudes or practices. The total scores of the three aspects were 6.77 ± 1.47 (95% confidence interval [CI]: 3.89-9.65) (range: 0-8), 14.22 ± 2.37 (95% CI: 9.57-18.87) (range: 0-18) and 6.66 ± 1.79 (95% CI: 3.16-10.17) (range: 0-9), respectively. The main approaches for TGWs to acquire AIDS knowledge are 'Internet/smartphone' (81.68%), 'TV/radio' (49.62%) and 'special education on AIDS prevention in schools' (48.09%). TGW is more inclined to accept promotional activities such as 'WeChat push' (58.02%), 'peer education' (44.27%) and 'mobile app management' (37.40%). AIDS knowledge indicates that TGW needs to strengthen publicity, including 'transmission routes' (71.76%), 'voluntary counselling and testing knowledge' (67.94%) and 'virus-related knowledge' (64.89%). CONCLUSIONS: First, the knowledge rate of AIDS amongst TGWs in Chongqing, China, still has room for improvement, and there is a gap between knowledge and behavior. Second, TGWs are tolerant of AIDS and people living with AIDS and have a strong awareness of AIDS prevention. Third, the health department should attach importance to the group of TGW over 35 years old, low-income, and low-educated, and promote social organizations and network platforms to further strengthen the health education and publicity of AIDS from the perspectives of knowledge acquisition and needs.
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Síndrome de Inmunodeficiencia Adquirida , Conocimientos, Actitudes y Práctica en Salud , Personas Transgénero , Humanos , Estudios Transversales , China/epidemiología , Femenino , Adulto , Personas Transgénero/psicología , Personas Transgénero/estadística & datos numéricos , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Síndrome de Inmunodeficiencia Adquirida/psicología , Encuestas y Cuestionarios , Adulto Joven , Masculino , Persona de Mediana Edad , AdolescenteRESUMEN
BACKGROUND: Key population HIV programmes in sub-Saharan Africa require epidemiological information to ensure equitable and universal access to effective services. We aimed to consolidate and harmonise survey data among female sex workers, men who have sex with men, people who inject drugs, and transgender people to estimate key population size, HIV prevalence, and antiretroviral therapy (ART) coverage for countries in mainland sub-Saharan Africa. METHODS: Key population size estimates, HIV prevalence, and ART coverage data from 39 sub-Saharan Africa countries between 2010 and 2023 were collated from existing databases and verified against source documents. We used Bayesian mixed-effects spatial regression to model urban key population size estimates as a proportion of the gender-matched, year-matched, and area-matched population aged 15-49 years. We modelled subnational key population HIV prevalence and ART coverage with age-matched, gender-matched, year-matched, and province-matched total population estimates as predictors. FINDINGS: We extracted 2065 key population size data points, 1183 HIV prevalence data points, and 259 ART coverage data points. Across national urban populations, a median of 1·65% (IQR 1·35-1·91) of adult cisgender women were female sex workers, 0·89% (0·77-0·95) were men who have sex with men, 0·32% (0·31-0·34) were men who injected drugs, and 0·10% (0·06-0·12) were women who were transgender. HIV prevalence among key populations was, on average, four to six times higher than matched total population prevalence, and ART coverage was correlated with, but lower than, the total population ART coverage with wide heterogeneity in relative ART coverage across studies. Across sub-Saharan Africa, key populations were estimated as comprising 1·2% (95% credible interval 0·9-1·6) of the total population aged 15-49 years but 6·1% (4·5-8·2) of people living with HIV. INTERPRETATION: Key populations in sub-Saharan Africa experience higher HIV prevalence and lower ART coverage, underscoring the need for focused prevention and treatment services. In 2024, limited data availability and heterogeneity constrain precise estimates for programming and monitoring trends. Strengthening key population surveys and routine data within national HIV strategic information systems would support more precise estimates. FUNDING: UNAIDS, Bill & Melinda Gates Foundation, and US National Institutes of Health.
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Infecciones por VIH , Humanos , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , África del Sur del Sahara/epidemiología , Femenino , Adulto , Masculino , Prevalencia , Adolescente , Adulto Joven , Persona de Mediana Edad , Trabajadores Sexuales/estadística & datos numéricos , Densidad de Población , Antirretrovirales/uso terapéutico , Personas Transgénero/estadística & datos numéricos , Teorema de Bayes , Homosexualidad Masculina/estadística & datos numéricosRESUMEN
Young transgender women (YTGW) who sell or trade sex have among the highest HIV incidence rates in Thailand. Using qualitative methods, we assessed perceived acceptability, feasibility, and optimal design of a combination HIV prevention intervention including PrEP for YTGW. Key informant interviews were conducted during July 2016-July 2018 with 21 YTGW, aged 18-26 years, who sold sex and resided in Bangkok or Pattaya, Thailand. Grounded theory and content analysis were used for data analysis. Most YTGW interviewed reported high interest in HIV prevention research and believed participation in it supported sexual health. However, participants perceived HIV studies as complicated and time-consuming. Regarding PrEP, participants suggested more PrEP options beyond daily oral PrEP and expressed concerns related to perceived side effects of PrEP, including interaction with gender-affirming hormone therapy. Improving PrEP knowledge, being able to self-assess HIV risk, and reducing HIV/PrEP stigma could increase interest in research and PrEP uptake among YTGW.
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Fármacos Anti-VIH , Estudios de Factibilidad , Infecciones por VIH , Conocimientos, Actitudes y Práctica en Salud , Profilaxis Pre-Exposición , Investigación Cualitativa , Personas Transgénero , Humanos , Tailandia , Personas Transgénero/psicología , Personas Transgénero/estadística & datos numéricos , Infecciones por VIH/prevención & control , Femenino , Profilaxis Pre-Exposición/métodos , Adulto Joven , Adulto , Adolescente , Fármacos Anti-VIH/administración & dosificación , Fármacos Anti-VIH/uso terapéutico , Aceptación de la Atención de Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/psicología , Masculino , Teoría Fundamentada , Entrevistas como Asunto , Trabajadores Sexuales/psicología , Trabajadores Sexuales/estadística & datos numéricosRESUMEN
Our study assessed the association between methamphetamine (i.e., crystal meth, CM) use and awareness and interest in event-driven (ED) PrEP among HIV-negative and those with unknown serostatus cisgender males and transgender people. We performed log-binomial regression analysis to predict awareness (i.e., having heard of ED PrEP) and being interested in ED PrEP. We found that participants who recently used CM were less likely to know of ED PrEP (aPR = 0.83, 95% CI [0.69, 0.99]) but more interested in ED PrEP (aPR = 1.12, 95% CI [1.01, 1.30]), after accounting for demographic and HIV-related behaviors. Opportunities to expand PrEP uptake and improve adherence among individuals who report CM use are essential to impact the HIV epidemic significantly. Continued research on the needs and best practices to work with this community is needed to ensure a successful rollout and implementation of ED PrEP.
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Infecciones por VIH , Conocimientos, Actitudes y Práctica en Salud , Metanfetamina , Profilaxis Pre-Exposición , Minorías Sexuales y de Género , Humanos , Masculino , Metanfetamina/administración & dosificación , Infecciones por VIH/prevención & control , Adulto , Minorías Sexuales y de Género/estadística & datos numéricos , Minorías Sexuales y de Género/psicología , Profilaxis Pre-Exposición/métodos , Fármacos Anti-VIH , Persona de Mediana Edad , Trastornos Relacionados con Anfetaminas/epidemiología , Trastornos Relacionados con Anfetaminas/psicología , Adulto Joven , Homosexualidad Masculina/estadística & datos numéricos , Homosexualidad Masculina/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/psicología , Personas Transgénero/estadística & datos numéricos , Personas Transgénero/psicología , AdolescenteRESUMEN
BACKGROUND: Transgender people comprise an estimated 0.3-0.5% (25 million) of the global population. The public health agenda focuses on understanding and improving the health and well-being of gender minorities. Transgender (TG) persons often have complex healthcare needs and suffer significant health disparities in multiple arenas. The international literature suggests that this community is at a higher risk of depression, and other mental health problems, including HIV. Many transgender people experience gender dysphoria and seek specific medical needs such as sex reassignment surgeries, implants, hormonal therapies, etc., but are unable to access these services due to financial or social reasons. The objective of this study was to assess the healthcare needs and associated barriers experienced by transgender people in Western Rajasthan. METHODOLOGY: A qualitative study was carried out in which multilevel stakeholder interviews were conducted using interview and focus group discussion guides. Data was analyzed using the qualitative thematic analysis technique. RESULTS: Findings reveal that transgender people have expressed their need to access health services for general health needs, including but not limited to mental health, non-communicable diseases, and infectious diseases. Barriers to healthcare services were identified on 3 levels: health system, social and personal. Health system barriers include policy, accessibility, affordability, and acceptability issues. Social factors such as inadequate housing, education, and job opportunities also play an important role in affecting the individual's health-seeking behavior. The knowledge of healthcare providers in this context was also limited in context of health insurance schemes, package of services available for transgenders and the importance of gender sensitive healthcare. CONCLUSION: Transgender people expressed the need for mental health services, programs targeting nutritional improvement, gender-affirmation procedures besides regular screening of non-communicable diseases as operational for males and females. Levels of barriers have been identified at various levels ranging from absence of targeted policies to individual behavior.
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Grupos Focales , Accesibilidad a los Servicios de Salud , Necesidades y Demandas de Servicios de Salud , Investigación Cualitativa , Personas Transgénero , Humanos , Personas Transgénero/psicología , Personas Transgénero/estadística & datos numéricos , Masculino , Femenino , Adulto , India , Persona de Mediana Edad , Entrevistas como Asunto , Adulto JovenRESUMEN
BACKGROUND: Prepubertal transgender, nonbinary, and gender-diverse (TGD) children (ie, those asserting gender identity, expressing gender-role behavior outside of culturally defined norms for their sex registered at birth, or both) are presenting in greater numbers to pediatric gender clinics across the United States and abroad. A large subset of TGD children experiences gender dysphoria, that is, distress that arises from the incongruence between gender identity and sex registered at birth. A lack of consensus exists regarding care for prepubertal TGD children due, in part, to a dearth of empirical research on longitudinal developmental trajectories of gender identity, role behavior, and gender dysphoria (when present). OBJECTIVE: The objective of this National Institutes of Health-funded study is to provide evidence to inform clinical care for prepubertal TGD children by establishing a US longitudinal cohort (N=248) of prepubertal TGD children and their caregivers that is followed prospectively at 6-month intervals across 18 months. METHODS: At each timepoint, clinical and behavioral data are collected via web-based visit from child and caregiver reporters. Latent class analysis, among other methods, is used to identify subgroups and longitudinally characterize the gender identity and gender-role behavior of TGD children. These models will define longitudinal patterns of gender identity stability and characterize the relationship between TGD classes and mental and behavioral health outcomes, including the moderating role of social gender transition (when present), on these associations. RESULTS: Baseline data collection (N=248) is complete, and the identification of TGD subgroups based on gender identity and expression using latent class analysis is anticipated in 2024. The completion of all 4 waves of data collection is anticipated in July 2024, coinciding with the start of a no-cost study extension period. We anticipate longitudinal analyses to be completed by winter 2024. CONCLUSIONS: Through a longitudinal observational design, this research involving prepubertal TGD children and their caregivers aims to provide empirical knowledge on gender development in a US sample of TGD children, their mental health symptomology and functioning over time, and how family initiated social gender transition may predict or alleviate mental health symptoms or diagnoses. The research findings have promise for clinicians and families aiming to ensure the best developmental outcome for these children as they develop into adolescents. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55558.
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Salud Mental , Humanos , Masculino , Niño , Femenino , Estudios Longitudinales , Estados Unidos/epidemiología , Identidad de Género , Disforia de Género/psicología , Disforia de Género/terapia , Personas Transgénero/psicología , Personas Transgénero/estadística & datos numéricos , PreescolarRESUMEN
ABSTRACT: Long-acting injectable cabotegravir (CAB-LA) was US Food and Drug Administration-approved in 2021. However, little is known about providers' CAB-LA knowledge, attitudes, challenges, and prescribing preferences for transgender women patients. Understanding this is critical to developing new pre-exposure prophylaxis (PrEP) interventions tailored to transgender women. We conducted 45-min, in-depth Zoom interviews (IDIs) with United States-based health care providers who prescribe PrEP to transgender women. IDIs focused on providers' CAB-LA knowledge/acceptability, willingness to prescribe CAB-LA to transgender women, potential challenges, and solutions to mitigate challenges. Providers ( N = 17) had a mean age of 43 years, and 35.4% ( n = 6) identified as people of color. Most ( n = 12) had basic knowledge of CAB-LA but wanted additional training. All participants found CAB-LA acceptable and were willing to prescribe. Most ( n = 11) anticipated minimal challenges to implementation. Others ( n = 4) reported potential issues, including logistical/scheduling concerns that impede CAB-LA integration and staffing concerns. Many providers expressed support for self-injection ( n = 13) and injections at "drop-in" clinics ( n = 8) to overcome challenges.
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Fármacos Anti-VIH , Infecciones por VIH , Personal de Salud , Profilaxis Pre-Exposición , Piridonas , Investigación Cualitativa , Personas Transgénero , Humanos , Personas Transgénero/psicología , Personas Transgénero/estadística & datos numéricos , Femenino , Adulto , Estados Unidos , Masculino , Profilaxis Pre-Exposición/métodos , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/prevención & control , Personal de Salud/psicología , Fármacos Anti-VIH/administración & dosificación , Fármacos Anti-VIH/uso terapéutico , Piridonas/administración & dosificación , Piridonas/uso terapéutico , Persona de Mediana Edad , Conocimientos, Actitudes y Práctica en Salud , Inyecciones , Accesibilidad a los Servicios de Salud , Preparaciones de Acción Retardada , Actitud del Personal de Salud , Entrevistas como Asunto , DicetopiperazinasRESUMEN
INTRODUCTION: Transgender women are at increased risk of acquiring HIV. Earlier studies reported lower retention in HIV care, antiretroviral therapy uptake, adherence and viral suppression. We assessed the stages of the HIV care continuum of transgender women in the Netherlands over an 11-year period. In addition, we assessed new HIV diagnoses and late presentation, as well as disengagement from care, between 2011 and 2021. METHODS: Using data from the Dutch national ATHENA cohort, we separately assessed viral suppression, as well as time to achieving viral suppression, among transgender women for each year between 2011 and 2021. We also assessed trends in new HIV diagnoses and late presentation (CD4 count of <350 cells/µl and/or AIDS at diagnosis), and disengagement from care. RESULTS: Between 2011 and 2021, a total of 260 transgender women attended at least one HIV clinical visit. Across all years, <90% of transgender women were virally suppressed (207/239 [87%] in 2021). The number of new HIV diagnoses fluctuated for transgender women (ptrend = 0.053) and late presentation was common (ranging between 10% and 67% of new HIV diagnoses). Of the 260 transgender women, 26 (10%) disengaged from care between 2011 and 2021 (incidence rate = 1.10 per 100 person-years, 95% confidence interval = 0.75-1.61). CONCLUSIONS: Between 2011 and 2021, less than 90% of transgender women linked to HIV care were virally suppressed. Late presentation at the time of diagnosis and disengagement from care were common. Efforts are needed to identify barriers to early HIV diagnosis and to optimize the different steps across the care continuum for transgender women.
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Continuidad de la Atención al Paciente , Infecciones por VIH , Personas Transgénero , Humanos , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Infecciones por VIH/diagnóstico , Femenino , Personas Transgénero/estadística & datos numéricos , Países Bajos/epidemiología , Adulto , Continuidad de la Atención al Paciente/estadística & datos numéricos , Persona de Mediana Edad , Estudios de Seguimiento , Masculino , Fármacos Anti-VIH/uso terapéutico , Adulto Joven , Estudios de Cohortes , Recuento de Linfocito CD4 , Carga ViralRESUMEN
BACKGROUND: Transgender women have a high prevalence of suicidal ideation, with stress and low interpersonal needs as its main risk factors. This study aimed to investigate the mediating role of interpersonal needs on the relationship between perceived stress and suicidal ideation among transgender women in China. METHODS: A cross-sectional study was conducted in Shenyang and Kunming from April to September 2018. 247 transgender women were recruited. Sociodemographic statistics, perceived stress, interpersonal needs and suicidal ideation were obtained. Correlation analysis and mediation analysis were performed to test the relationship among perceived stress, suicidal ideation and interpersonal needs. RESULTS: 14.6 % of the participants reported suicidal ideation within a year. Perceived stress was positively correlated with suicidal ideation (r = 0.228, p < 0.001), interpersonal needs and its three dimensions (r = 0.300-0.583, ps < 0.001)-thwarted belongingness, perceived burdensomeness and social exclusion. Interpersonal needs and its three dimensions were also positively correlated with suicidal ideation (r = 0.148-0.299, ps < 0.05). Interpersonal needs, perceived burdensomeness and social exclusion partly mediated the relationship between perceived stress and suicidal ideation, while thwarted belongingness didn't play a mediating role. LIMITATIONS: Cross-sectional study limited confirmation of causality between variables. The investigation didn't aim at the specific stressors of sexual minorities. And that participants came from only two regions might affect the generalization of the results. CONCLUSIONS: We found a partial mediating role of interpersonal needs between stress and suicidal ideation. Stress reduction and increased social inclusion are needed to reduce suicidal ideation in transgender women.
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Estrés Psicológico , Ideación Suicida , Personas Transgénero , Humanos , Femenino , China/epidemiología , Estudios Transversales , Adulto , Personas Transgénero/psicología , Personas Transgénero/estadística & datos numéricos , Estrés Psicológico/psicología , Estrés Psicológico/epidemiología , Adulto Joven , Relaciones Interpersonales , Masculino , Factores de Riesgo , Distancia Psicológica , Adolescente , Persona de Mediana EdadRESUMEN
Importance: With the increasing legislation restricting health care access for transgender and nonbinary (trans) populations in recent years, there has been limited research on how awareness of and concerns about legislative restrictions and protections influence mental health outcomes. Objective: To examine whether awareness of and concerns about the current policy environment regarding trans individuals are associated with depression and anxiety symptoms among trans adults. Design, Setting, and Participants: This study uses cross-sectional data collected between March and April 2023 from the Washington Priority Assessment in Trans Health (PATH) Project, an online study designed by, with, and for trans communities. All participants were trans adults, aged 18 years or older, living in Washington state. Exposure: Awareness and concerns about the antitrans policy environment. Main Outcomes and Measures: The primary outcomes were depression and anxiety symptoms, assessed via the Patient Health Questionnaire-4. A series of multivariable regression models was used to assess the association between awareness and concerns about the antitrans policy environment and depression and anxiety symptoms. Models were adjusted for covariates, including demographics, social marginalization, and health care experiences. Results: A total of 797 participants (653 women [81.93%]; 455 aged 18-29 years [57.09%]) were included. The majority screened positive for current depression (689 individuals [86.45%]) and anxiety (686 individuals [86.07%]) symptoms. Trans individuals who were concerned or worried about their rights being taken away (vs not) had significantly higher odds of current depression symptoms (adjusted odds ratio [aOR], 1.66; 95% CI, 1.08-2.54), as well as current anxiety symptoms (aOR, 2.67; 95% CI, 1.63-4.36). Those who knew (vs did not know) about state-level protective legislation had significantly lower odds of current depression symptoms (aOR, 0.44; 95% CI, 0.28-0.67), as well as current anxiety symptoms (aOR, 0.11; 95% CI, 0.04-0.25). When examining interaction effect estimates, trans individuals who correctly knew about the protective policies and were not worried about having their rights taken away reported the lowest odds of depression and anxiety. Conclusions and Relevance: The findings of this cross-sectional study are consistent with research elucidating the negative mental health consequences of policies limiting health care access and provide insights into informing policies and interventions that target trans populations' worsened mental health outcomes as a result of antitrans legislation.
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Ansiedad , Depresión , Personas Transgénero , Humanos , Femenino , Adulto , Masculino , Estudios Transversales , Personas Transgénero/psicología , Personas Transgénero/estadística & datos numéricos , Depresión/epidemiología , Depresión/psicología , Ansiedad/epidemiología , Ansiedad/psicología , Persona de Mediana Edad , Washingtón/epidemiología , Adolescente , Adulto Joven , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Política de Salud/legislación & jurisprudenciaRESUMEN
OBJECTIVES: There are increasing calls for gender affirming care, yet there remains uncertainty as to how nursing education is preparing students. The purpose of this scoping review was to map gender inclusive and affirming practices across the three levels of curriculum (formal, informal, and hidden) in the education of undergraduate nursing students. This novel approach allows consideration of transgender and gender diverse nurses (students and educators). DESIGN: Scoping review as per Arksey and O'Malley and Levac et al. DATA SOURCES: Four databases (Medline, Embase, CINAHL, and Scopus) were searched for literature that addressed transgender and gender diversity, discussed at any level of curriculum. In addition, we searched key schools of nursing websites for inclusion of gender inclusive and affirming practices in documents and faculty profiles. We limited our search of peer-reviewed articles and websites to those in English, from Canada and the USA. REVIEW METHODS: The article search and extraction were conducted by two independent reviewers while the school of nursing websites were searched by the lead author. RESULTS: Forty-seven articles were included and categorized as either (a) Doing (n = 32) (formal, intervention-based) or (b) Thinking (n = 15) (discussion- or evaluation-based) gender inclusive and affirming practices. Twenty-five of the intervention-based articles were single-instance occurrences of learning, primarily by simulation (n = 17). Recommendations at each level of curriculum are offered. Of the 22 schools of nursing websites searched, less than 2 % of faculty profiles list pronouns. CONCLUSIONS: While there has been an uptake of formal interventions on gender affirming care there remains a gap in addressing gender inclusive and affirming practices at the informal and hidden curriculum levels. Gender inclusive and affirming practices across all levels of nursing education can help advance culturally safe practices for TGD patients and experiences for TGD nurses and students.
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Curriculum , Bachillerato en Enfermería , Estudiantes de Enfermería , Humanos , Curriculum/tendencias , Bachillerato en Enfermería/métodos , Estudiantes de Enfermería/estadística & datos numéricos , Estudiantes de Enfermería/psicología , Personas Transgénero/estadística & datos numéricos , CanadáRESUMEN
BACKGROUND: Transgender, non-binary and gender non-conforming (herein, "TGNC") youth (15-24 years old) face overlapping minority stressors (e.g., gender discrimination, lack of access to gender-affirming care, rejection, violence) that contribute to mental health inequities. TGNC youth also use substances at higher rates when compared to cisgender youth, including some of the highest rates of cannabis use in Canada. METHODS: This community-based participatory research study provides an in-depth qualitative, photovoice-based analysis examining how cannabis use features within the gender experiences of a sample of TGNC youth in British Columbia (BC). We conducted in-depth, semi-structured interviews with 27 TGNC youth (15-24 years old) from across British Columbia. Interviews were designed to elicit discussions about the photos youth had taken as well as various gender and mental health experiences related to their cannabis use. Analysis and identification of emergent themes was guided by social constructivist grounded theory as well as queer and trans theorizing and informed by community-based research approaches through regular meetings with our team's Substance Use Beyond the Binary Youth Action Committee comprised of TGNC youth who use substances. RESULTS: Three overarching themes pertaining to cannabis use and gender experiences amongst TGNC youth in our study were generated. First, participants used cannabis purposefully and strategically to enact diverse gender expressions and embodiments. Second, participants leveraged cannabis to support introspection whilst mobilizing identity discovery and development. Finally, participants mobilized cannabis as a vehicle for accessing moments of gender euphoria and affirmation. CONCLUSIONS: These findings identify how some TGNC youth use cannabis to purposefully and strategically facilitate their mental health, well-being, identity development and self-expression. This research reveals critically important experiential and embodied dimensions of cannabis use that have not historically been considered in cannabis-related policy and the provision of care, including mental health and substance use-related care.
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Investigación Participativa Basada en la Comunidad , Personas Transgénero , Humanos , Adolescente , Masculino , Femenino , Adulto Joven , Colombia Británica , Personas Transgénero/psicología , Personas Transgénero/estadística & datos numéricos , Minorías Sexuales y de Género/psicología , Investigación Cualitativa , Entrevistas como Asunto , Salud Mental , Fumar Marihuana/psicología , Uso de la Marihuana/epidemiologíaRESUMEN
This paper provides the first rigorous account of the diverse characteristics of transgender individuals at the population level, using data from Danish population registers. We observe three transgender subpopulations within the same national setting: all who changed thier legal sex (T-Legal, n = 1,995), all who have been assigned trans-related diagnostic codes (T-ICD, n = 1,594), and those who self-identified as transgender in a representative survey (T-Survey, n = 197, weighted n = 44,958). Results show significant differences in the subpopulations' backgrounds, family, education and labour market characteristics, and healthcare use. These differences extend beyond comparisons with the general population to great variations between each of the transgender subpopulations. Individuals with legal sex changes, and particularly those with trans-related diagnostic codes, face substantial disadvantages across various outcomes. Compared to the general population and the T-Survey subpopulation, the T-Legal subpopulation and the T-ICD subpopulation have significantly higher numbers of psychiatric hospital visits, lower educational attainment, lower annual earnings, and reduced employment rates, also when controlling for background characteristics. Earnings and employment rates remained significantly lower also when controlling for educational attainment. Our results show that the strategy chosen to identify trans individuals in population data has a great impact on the characteristics observed, and that trans individuals captured by surveys do not necessarily represent all transgender individuals, including those who seek to medically or legally transition. Furthermore, our results indicate that high numbers of trans individuals observed in surveys do not necessarily correspond to high demands for gender-affirming treatments or legal sex change. Finally, we show that transgender individuals who seek gender-affirming healthcare constitute a distinct and significantly disadvantaged group, also compared to other trans subpopulations.
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Personas Transgénero , Humanos , Dinamarca/epidemiología , Personas Transgénero/estadística & datos numéricos , Personas Transgénero/psicología , Masculino , Femenino , Adulto , Persona de Mediana Edad , Adolescente , Adulto Joven , AncianoRESUMEN
BACKGROUND: In the United States, transgender women are disproportionately impacted by HIV and prioritized in the national strategy to end the epidemic. Individual, interpersonal, and structural vulnerabilities underlie HIV acquisition among transgender women and fuel syndemic conditions, yet no nationwide cohort monitors their HIV and other health outcomes. OBJECTIVE: Our objective is to develop a nationwide cohort to estimate HIV incidence, identify risk factors, and investigate syndemic conditions co-occurring with HIV vulnerability or acquisition among US transgender women. The study is informed by the Syndemics Framework and the Social Ecological Model, positing that stigma-related conditions are synergistically driven by shared multilevel vulnerabilities. METHODS: To address logistical and cost challenges while minimizing technology barriers and research distrust, we aim to establish a novel, hybrid community hub-supported digital cohort (N=3000). The digital cohort is the backbone of the study and is enhanced by hubs strategically located across the United States for increased engagement and in-person support. Study participants are English or Spanish speakers, are aged ≥18 years, identify as transgender women or along the transfeminine spectrum, reside in 1 of the 50 states or Puerto Rico, and do not have HIV (laboratory confirmed). Participants are followed for 24 months, with semiannual assessments. These include a questionnaire and laboratory-based HIV testing using self-collected specimens. Using residential zip codes, person-level data will be merged with contextual geolocated data, including population health measures and economic, housing, and other social and structural factors. Analyses will (1) evaluate the contribution of hub support to the digital cohort using descriptive statistics; (2) estimate and characterize syndemic patterns among transgender women using latent class analysis; (3) examine the role of contextual factors in driving syndemics and HIV prevention over time using multilevel regression models; (4) estimate HIV incidence in transgender women and examine the effect of syndemics and contextual factors on HIV incidence using Poisson regression models; and (5) develop dynamic, compartmental models of multilevel combination HIV prevention interventions among transgender women to simulate their impact on HIV incidence through 2030. RESULTS: Enrollment launched on March 15, 2023, with data collection phases occurring in spring and fall. As of February 24, 2024, a total of 3084 individuals were screened, and 996 (32.3%) met the inclusion criteria and enrolled into the cohort: 2.3% (23/996) enrolled at a hub, and 53.6% (534/996) enrolled through a community hub-supported strategy. Recruitment through purely digital methods contributed 61.5% (1895/3084) of those screened and 42.7% (425/996) of those enrolled in the cohort. CONCLUSIONS: Study findings will inform the development of evidence-based interventions to reduce HIV acquisition and syndemic conditions among US transgender women and advance efforts to end the US HIV epidemic. Methodological findings will also have critical implications for the design of future innovative approaches to HIV research. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/59846.
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Infecciones por VIH , Personas Transgénero , Humanos , Personas Transgénero/estadística & datos numéricos , Personas Transgénero/psicología , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Estados Unidos/epidemiología , Femenino , Estudios de Cohortes , Adulto , Masculino , Incidencia , Adolescente , Adulto Joven , Factores de RiesgoRESUMEN
BACKGROUND: Transgender and gender diverse (TGD) individuals have elevated mental and physical health disparities and a greater mortality risk compared to their cisgender (non-TGD) counterparts. METHODS: We assessed differences in the association of depression with all-cause and cardiovascular disease (CVD) mortality among TGD and cisgender Veterans Administration patients. A sample of 8981 TGD patients, matched 1:3 with cisgender patients (n = 26,924) patients, was created from administrative and electronic health record data from October 1, 1999 to December 31, 2016. Cox proportional regression models stratified by gender modality (i.e., TGD and cisgender) were used to assess the hazard of all-cause and CVD mortality associated with a history of depression. RESULTS: Adjusted models demonstrated that depression was significantly associated with a greater hazard of all-cause mortality among both TGD (aHR:1.18, 95 % CI: 1.04-1.34) and cisgender (aHR:1.22, 95 % CI: 1.17-1.28) patients. Similar to all-cause mortality, depression was significantly associated with a greater hazard of CVD mortality among cisgender patients ≥65 years (aHR = 1.23, 95 % CI = 1.13-1.35). Findings for TGD patients showed a similar pattern, though results were not significant. LIMITATIONS: Hazards may be underestimated since depression may be underdiagnosed. Further, we were unable to adjust for other health-related risk factors tied to mortality (e.g., smoking). CONCLUSION: Overall, depression was associated with a greater hazard of all-cause mortality among both TGD and cisgender patients. Future work should assess the equity of reach, quality, and outcomes of treatment for depression for TGD populations given the lack of attention to addressing the needs of this important patient demographic.
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Enfermedades Cardiovasculares , Depresión , Personas Transgénero , Humanos , Enfermedades Cardiovasculares/mortalidad , Masculino , Femenino , Persona de Mediana Edad , Personas Transgénero/estadística & datos numéricos , Personas Transgénero/psicología , Adulto , Depresión/epidemiología , Depresión/mortalidad , Anciano , Estados Unidos/epidemiología , Causas de Muerte , Factores de Riesgo , Modelos de Riesgos Proporcionales , Veteranos/estadística & datos numéricos , Veteranos/psicologíaRESUMEN
This qualitative study used an artificial intelligence (AI) large language model and social media to investigate challenges encountered by transgender individuals during breast and gynecological cancer care.
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Disparidades en Atención de Salud , Neoplasias , Medios de Comunicación Sociales , Personas Transgénero , Humanos , Medios de Comunicación Sociales/estadística & datos numéricos , Personas Transgénero/estadística & datos numéricos , Personas Transgénero/psicología , Neoplasias/terapia , Femenino , Masculino , Inteligencia ArtificialRESUMEN
BACKGROUND: With increasing numbers of people seeking medical gender reassignment, the scientific community has become increasingly aware of the issue of detransitioning from social, hormonal or even surgical gender reassignment (GR). This study aimed to assess the proportion of patients who discontinued their established hormonal gender transition and the risk factors for discontinuation. METHODS: A nationwide register-based follow-up was conducted. Data were analysed via cross-tabulations with chi-square statistics and t tests/ANOVAs. Multivariate analyses were performed via Cox regression, which accounts for differences in follow-up times. RESULTS: Of the 1,359 subjects who had undergone hormonal GR in Finland from 1996 to 2019, 7.9% discontinued their established hormonal treatment during an average follow-up of 8.5 years. The risk for discontinuing hormonal GR was greater among later cohorts. The hazard ratio was 2.7 (95% confidence interval 1.1-6.1) among those who had accessed gender identity services from 2013 to 2019 compared with those who had come to contact from 1996 to 2005. Discontinuing also appeared to be emerging earlier among those who had entered the process in later years. CONCLUSIONS: The risk of discontinuing established medical GR has increased alongside the increase in the number of patients seeking and proceeding to medical GR. The threshold to initiate medical GR may have lowered, resulting in a greater risk of unbalanced treatment decisions. TRIAL REGISTRATION NUMBER (TRN): Not applicable (the paper does not present a clinical trial).
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Sistema de Registros , Humanos , Femenino , Masculino , Sistema de Registros/estadística & datos numéricos , Adulto , Finlandia , Procedimientos de Reasignación de Sexo/estadística & datos numéricos , Adulto Joven , Persona de Mediana Edad , Adolescente , Estudios de Seguimiento , Personas Transgénero/estadística & datos numéricos , Transexualidad , Factores de RiesgoRESUMEN
OBJECTIVE: The aim of this study was to investigate the prevalence of human immunodeficiency virus (HIV) infection among transgender women and travestis and to analyze factors associated with HIV infection in Brazil. METHODS: TransOdara was a cross-sectional study on sexually transmitted infections among transgender women and travestis in five Brazilian cities between 2019 and 2021. Self-identified transgender women and travestis aged ≥18 years were recruited using respondent-driven sampling, completed an interviewer-led questionnaire, and provided samples to detect HIV. The outcome was the result of the rapid antigen testing for HIV. Adjusted prevalence ratios (aPR) and 95% confidence intervals (95% CI) were obtained using Poisson regression with robust variance. RESULTS: Overall, this population was found to be especially vulnerable, with high levels of unstable housing and engagement in informal work. They usually resort to transactional sex as their main working activity. Half of them earned less than the Brazilian minimum wage, which characterizes a poor population living in dire conditions. The overall HIV prevalence was 34.40%. In the final model, the variables associated with the HIV prevalence were as follows: to be 31 years old or older, not studying at the moment they were interviewed, to be unemployed, and engaged in lifetime transactional sex. CONCLUSION: We found disproportionately high HIV prevalence among transgender women and travestis, compared with a low prevalence among respective segments of Brazil's general population, which highlights the context of vulnerability in this population. The data point to the urgency for intensification and expansion of access to HIV prevention and strategies to stop discrimination in health care (among other services and contexts) and provide comprehensive services for this population.