International Journal of Transgender Health最新文献

Introduction: Transgender people experience health inequities, and stigma often plays an outsize role in shaping the health and lived experiences of transgender persons. We aimed to systematically review the research literature to understand how transphobia is measured and its impacts on the health of trans populations.

Methods: We conducted a systematic search using PRISMA guidelines. Titles and abstracts of articles, and full texts, were screened for inclusion. We extracted the study characteristics, populations, methods, transphobia measurement, health outcomes of study, and the relationship between transphobia and health and created evidence gap maps using R.

Results: This review found 187 studies that measured transphobia and its associations with mental health, substance intake, and physical health outcomes. Transphobia was predominately studied at the individual, interpersonal, and organizational levels. The Gender Minority Stress and Resilience Measure and the Everyday Discrimination Scale were the most recurring scales used to measure transphobia. Victimization, internalized transphobia, and institutional discrimination were the most reported types of transphobia. Across a majority of studies, transphobias were positively associated with poor health outcomes, with heavy emphasis on mental health outcomes, as well as substance intake. Large gaps existed with regard to physical health.

Conclusions: Transphobia negatively impacts the mental health of trans people and often creates elevated substance use. Gaps exist in the measurement of transphobia at the community, organizational and structural levels, and in relation to physical health outcomes.

Background: Few transmasculine health studies have actively engaged members of the community in a participatory process of identifying the health-related issues that are most salient to their lives. Seldom have existing studies have focused their inquiries on the unique experiences of Black transgender men and transmasculine individuals. To address the unique physical and mental health needs of Black transgender men and transmasculine people in the U.S., members of these communities need to be actively engaged in all phases of the research process.

Methods: Through a participatory process with a community-based organization, three community forums were conducted (N = 17) with a sample of majority Black trans men and transmasculine individuals from the Detroit metro area (DMA). Community forums focused on eliciting responses pertaining to how living as Black transgender man or transmasculine person influenced barriers and facilitators to their health.

Results: Four themes arose across the three community forums: strengths, challenges, health topics, and program needs and recommendations. Across all four themes, participants contextualized their responses at multiple levels, from individual to cultural and structural.

Conclusion: This work emphasizes the importance of bringing the voices of Black transgender men and transmasculine people to the center, allowing them to voice their own needs to shape future research and funding agendas. Future directions of research, intervention, and funding initiatives need to prioritize work conducted by and for Black transgender men and transmasculine populations to create sustainable, long-term solutions to address structural oppression faced by this population.

Background: Transgender and gender-diverse (TGD) patients face multifactorial barriers to accessing medically-necessary interventions, including gender-affirming chest surgery (GACS). Surgeons may exacerbate this inequity by imposing preoperative body mass index (BMI) requirements on their patients. Recent studies present conflicting evidence regarding the association between BMI and postoperative complications following GACS; however, no studies have assessed these outcomes in cases of extremely high BMI (>40 kg/m²).

Methods: Assigned female at birth patients ≥ 18 years old undergoing GACS at three institutions were reviewed. Demographic and clinical characteristics were analyzed descriptively between patients with BMI ≤40 and >40 kg/m². A multivariable logistic model was used to determine the effect of BMI on complications.

Results: 647 patients were included, of these, 82 (12.7%) had BMI >40 kg/m². Among patients with BMI >40 kg/m², 21.9% had at least one complication. A significant association was observed between BMI and overall complications (p=0.0026). Adjusted analyses suggested that patients with BMI >40 kg/m2 were 2.34 times more likely to experience at least one complication (95% CI 1.153, 4.733). Overall complications, incisional dehiscence, and major complications (requiring unplanned readmission and/or reoperation) were significantly higher in patients with BMI >40 kg/m².

Conclusions: This multi-institutional retrospective review demonstrates a higher frequency of adverse outcomes in patients with BMI >40 kg/m². GACS can be performed safely in patients with extreme BMI, however appropriate informed consent is necessary. These data will facilitate evidence-based counseling on the risks and benefits of GACS in this patient population.

Background: Antiretroviral therapy (ART) adherence is essential for maintaining viral suppression and reducing HIV transmission risk. However, data on adherence rates among trans women living with HIV in India are scarce, hindering effective intervention efforts. Understanding multilevel syndemic factors, including harmful drinking, depressive symptoms, HIV, and trans women-related stigma, and access to gender-affirmative care, is crucial for improving HIV treatment outcomes in this population.

Methods: Trans women living with HIV (N=150) in Mumbai and New Delhi, India, completed a one-time self-reported assessment of sociodemographic and psychosocial factors and ART adherence and provided recent viral load test results in the ART booklet. Latent class analysis (LCA) identified multilevel syndemic classes. Then, in logistic regression models, we assessed the relationship between syndemic classes and optimal ART adherence (defined as 90% or higher adherence as prescribed).

Results: Optimal ART adherence (defined as 90% or higher adherence to prescribed doses) was reported by 63% of participants. Among those with suboptimal adherence (n=93), common barriers included lack of medication while traveling, forgetting, and alcohol use. The LCA identified two syndemic classes: Class 1, characterized by unidimensional stigma and moderate multilevel syndemic barriers, and Class 2, characterized by intersectional stigma and high multilevel syndemic barriers. In the bivariate analysis, participants in Class 2 had significantly lower odds of optimal ART adherence [OR: 0.27 (95% CI: 0.11 - 0.61), p = 0.003]. After controlling for potential confounders (i.e., city, monthly income, stable housing, and history of sex work), participants in Class 2 still had significantly lower odds of optimal ART adherence [aOR: 0.26 (95% CI: 0.09 - 0.64), p = 0.009].

Conclusion: Findings highlight substantial disparities in ART adherence among trans women living with HIV in India, driven by intersectional stigma and multilevel syndemic barriers. Addressing these factors, particularly HIV and trans women-related stigma, is critical for improving ART adherence and HIV treatment outcomes in this population.

[This corrects the article DOI: 10.1080/26895269.2023.2257062.].

Introduction: This qualitative study aimed to explore the dynamics between transgender women of color and their family members through the lens of the minority stress framework. Transgender women of color are more at risk of negative health and social outcomes compared to other LGBTQIA+ populations due to discrimination and transphobia based on racial/ethnic and transgender identity (minority stress). While caregivers and siblings can help buffer the negative impact of minority stress, behaviors such as rejection, aggression, and indifference to transgender identity can elevate mental and physical health risks.

Methods: A secondary qualitative analysis from in-depth interviews and focus groups (n = 20) of transgender women of color in South Florida was conducted to explore relationship dynamics between participants and their family members.

Results: In response to questions about family member relationships, four overarching themes emerged: 1) family aggression, 2) sociocultural and religious barriers, 3) a spectrum of acceptance, and 4) external support networks. Transgender women of color may experience direct and indirect forms of minority stress by family members, including stressors from those they consider accepting of their transgender identity. Additionally, participants reported having to expend resilience resources even among family members deemed as accepting. In many instances, family attitudes toward transfeminine identity were based on rigid sociocultural norms and religious views.

Conclusions: Given the unique, chronic, and socially constructed stress experienced throughout the lifespan of transgender women of color, culturally competent research should focus on strengthening and educating family member relationships perceived as supportive as well as fostering individual and community resilience strategies.