Longitudinal cohort of HIV-negative transgender women of colour in New York City: protocol for the TURNNT ('Trying to Understand Relationships, Networks and Neighbourhoods among Transgender women of colour') study.

IntroductionIn the USA, transgender women are among the most vulnerable to HIV. In particular, transgender women of colour face high rates of infection and low uptake of important HIV prevention tools, including pre-exposure prophylaxis (PrEP). This paper describes the design, sampling methods, data collection and analyses of the TURNNT ('Trying to Understand Relationships, Networks and Neighbourhoods among Transgender women of colour') study. In collaboration with communities of transgender women of colour, TURNNT aims to explore the complex social and environmental (ie, neighbourhood) structures that affect HIV prevention and other aspects of health in order to identify avenues for intervention.Methods and analysesTURNNT is a prospective cohort study, which will recruit 300 transgender women of colour (150 Black/African American, 100 Latina and 50 Asian/Pacific Islander participants) in New York City. There will be three waves of data collection separated by 6 months. At each wave, participants will provide information on their relationships, social and sexual networks, and neighbourhoods. Global position system technology will be used to generate individual daily path areas in order to estimate neighbourhood-level exposures. Multivariate analyses will be conducted to assess cross-sectional and longitudinal, independent and synergistic associations of personal relationships (notably individual social capital), social and sexual networks, and neighbourhood factors (notably neighbourhood-level social cohesion) with PrEP uptake and discontinuation.Ethics and disseminationThe TURNNT protocol was approved by the Columbia University Institutional Review Board (reference no. AAAS8164). This study will provide novel insights into the relationship, network and neighbourhood factors that influence HIV prevention behaviours among transgender women of colour and facilitate exploration of this population's health and well-being more broadly. Through community-based dissemination events and consultation with policy makers, this foundational work will be used to guide the development and implementation of future interventions with and for transgender women of colour

Physician Attitudes Toward Homosexuality and HIV: The PATHH-III Survey.

PurposeThe aims of this study were (1) to evaluate current physician attitudes toward homosexuality and homosexual, transgender, and HIV-positive individuals and (2) to compare current attitudes of those from prior surveys of the same population, the San Diego County medical community.MethodsAn online survey was conducted during November-December 2017 to assess general attitudes toward homosexuality and medically focused items that addressed homosexual orientation, transgender identity, and HIV. Responses were weighted for nonresponse. Predictors of stigma were assessed using generalized linear models. Trends across three surveys of the same population in 1982, 1999, and 2017 using common items were assessed using unweighted responses.ResultsOf 4418 eligible physicians, 491 (11.1%) responded (median age 55 years, 38% female and 8.7% gay or bisexual). Regarding admission to medical school, 1% opposed admitting a homosexual applicant, 2% a transgender applicant, and 5% an HIV-positive applicant. Regarding consultative referral to a pediatrician, 3% would discontinue referral to a homosexual pediatrician, 5% to a transgender pediatrician, and 10% to an HIV-positive pediatrician. Regarding discomfort treating patients, 7% reported discomfort treating homosexual patients, 22% transgender patients, and 13% HIV-positive patients. Earlier year of graduation from medical school, male gender, and heterosexual orientation were significant predictors of stigma-associated responses. Compared with the results from surveys in 1982 and 1999, the current results suggest substantively less stigma associated with homosexuality and HIV.ConclusionThere have been substantive declines over a 35-year period in the prevalence of stigmatizing attitudes toward sexual minorities and HIV-positive people among physician respondents in three survey waves of the San Diego County medical community

Health considerations for transgender women and remaining unknowns : a narrative review

Transgender (trans) women (TW) were assigned male at birth but have a female gender identity or gender expression. The literature on management and health outcomes of TW has grown recently with more publication of research. This has coincided with increasing awareness of gender diversity as communities around the world identify and address health disparities among trans people. In this narrative review, we aim to comprehensively summarize health considerations for TW and identify TW-related research areas that will provide answers to remaining unknowns surrounding TW's health. We cover up-to-date information on: (1) feminizing gender-affirming hormone therapy (GAHT); (2) benefits associated with GAHT, particularly quality of life, mental health, breast development and bone health; (3) potential risks associated with GAHT, including cardiovascular disease and infertility; and (4) other health considerations like HIV/AIDS, breast cancer, other tumours, voice therapy, dermatology, the brain and cognition, and aging. Although equally deserving of mention, feminizing gender-affirming surgery, paediatric and adolescent populations, and gender nonbinary individuals are beyond the scope of this review. While much of the data we discuss come from Europe, the creation of a United States transgender cohort has already contributed important retrospective data that are also summarized here. Much remains to be determined regarding health considerations for TW. Patients and providers will benefit from larger and longer prospective studies involving TW, particularly regarding the effects of aging, race and ethnicity, type of hormonal treatment (e.g. different oestrogens, anti-androgens) and routes of administration (e.g. oral, parenteral, transdermal) on all the topics we address

Healthcare Access and Utilization by Transgender Populations: A United States Transgender Survey Study

Transgender communities in the United States are highly marginalized and have been systematically and infrastructurally ignored due to the widespread fundamental belief that gender exists as a binary classification. The dichotomous theoretical framework of sex and gender prevented public recognition of this community as a population of interest for public health research and targeted intervention. Sexual and gender minority (SGM) populations have fought for basic human rights, including access to affordable healthcare. The National Center for Transgender Equality (NCTE) was founded in 2003 to advocate for the advancement of equality for transgender people. In 2015, the NCTE conducted the United States Transgender Survey (USTS) to collect data on people who identify on the transgender spectrum (n=27,715). For this research, data from the USTS respondents were segmented into two general populations, “binary” and “non-binary”. The “binary” population was further segmented into broad categories: trans-femme/trans-feminine (TF), trans-masc/trans-masculine (TM). The “nonbinary” (NB) category encompassed gender non-conforming (GNC) identities and individuals who did not adhere to binary identifiers. The purpose of this study was to elucidate health disparities regarding access to and utilization of healthcare in the transgender community to determine the need for policy changes and public health interventions. Additionally, an analysis was conducted to determine the relationships between identity and terminology for the purpose of assessing the feasibility of data collection for sexual orientation and gender identity (SOGI) in government surveys based on self-reported data. USTS data reported disparities in access to healthcare within gender identity categories, and TM and TF were more likely to report postponement of healthcare utilization due to fear of discrimination than NB respondents. NB respondents were significantly less likely to desire access to transgender specific care, but they were likely to identify with the term transgender. Participants from all gender identity categories were likely to answer SOGI questions on a national survey if asked. This research adds to the growing body of knowledge concerning inclusion of SOGI questions on population surveys. Results from this USTS analysis indicate the need for further research on the intersectional and diverse population of SGM to classify health disparities and to work towards solutions for health equity for transgender people

"She is Like a Sister to Me." Gender-Affirming Services and Relationships are Key to the Implementation of HIV Care Engagement Interventions with Transgender Women of Color.

We present findings from qualitative interviews (N = 67) with 36 staff and 31 participants of nine distinct individual and/or group level interventions to engage transgender women of color (TWOC) in HIV care in the U.S. We examine the commonalities amongst the intervention services (addressing unmet basic needs, facilitating engagement in HIV care, health system navigation, improving health literacy, emotional support), and the relationships formed during implementation of the interventions (between interventionists and participants, among participants in intervention groups, between participants and peers in the community). Interventionists, often TWOC themselves, who provided these services developed caring relationships, promoted personal empowerment, and became role models for participants and the community. Intervention groups engaged participants to reinforce the importance of health and HIV care and provided mutual support. Gender affirming services and caring relationships may be two key characteristics of interventions that address individual and structural-level barriers to engage TWOC in HIV care

"Things Are Different Now But": Older LGBT Adults' Experiences and Unmet Needs in Health Care.

Background: Approximately 2.7 million U.S. older adults self-identify as lesbian, gay, bisexual, and transgender (LGBT). Many felt unsafe revealing their sexual orientation until relatively recently, and may still not be "out" to medical providers. The aim of this study was to increase understanding of the experiences and needs of older LGBT adults when accessing care. Method: Individual semistructured interviews were conducted with 10 individuals aged 65 years or older from a local LGBT community. Interviews were audio taped and transcribed verbatim. Transcripts were analyzed via thematic analysis. Results: Major themes were "Outness," "Things are Different Now," and "Additional Resources." These describe participant comfort with being "out"; how treatment they received changed over time, and needed services or other options from the community. Conclusion: While many older LGBT adults are accustomed to navigating social mores to avoid negative experiences, nurses as well as other health care providers must be prepared to create trusting relationships with these individuals to provide truly comprehensive care

Factors Associated with PrEP and PEP Uptake Among the LatinX Population

Advanced Undergraduate Winner Uptake of PrEP and PEP amongst LatinX population has been low, despite being a population disproportionately affected by HIV. Systemic barriers and cultural factors affect general LatinX approaches to healthcare and may impact uptake of these medications. The purpose of this study is to assess the factors that are associated with the likelihood to take PrEP and PEP in the LatinX population. In this cross-sectional study, survey data was collected from 169 LatinXs from January - March 2020. Using the Sexual Health Model as the theoretical framework, the survey examined the following four constructs to identify factors associated with PrEP and PEP uptake: talking about sex, culture and sexual identity, sexual health care and safer sex, and spirituality. Descriptive statistics, chi-square tests, correlations, and logistic regressions were calculated. The likelihood to take PrEP ( p \u3c 0.001) significantly predicted the likelihood of taking PrEP if it were free, as did the likelihood to take PEP (p \u3c 0.001) to the likelihood of taking PEP if it were free. While sexual comfort was not a predictor of the likelihood of taking PrEP or PEP, it had a significant positive correlation with the likelihood of uptake for both. The factors HIV knowledge, HIV/STI-related behaviors, Machismo beliefs, and folk illness beliefs were not statistically significant. The findings contribute to the literature regarding the barriers of PrEP and PEP uptake among LatinXs. The results suggest that LatinXs must become better informed of these prevention strategies and lessen possible worries regarding drug expenses and side-effects

Intersectional Discrimination Is Associated with Housing Instability among Trans Women Living in the San Francisco Bay Area.

Trans women face numerous structural barriers to health due to discrimination. Housing instability is an important structural determinant of poor health outcomes among trans women. The purpose of this study was to determine if experiences of intersectional anti-trans and racial discrimination are associated with poor housing outcomes among trans women in the San Francisco Bay Area. A secondary analysis of baseline data from the Trans *National study (n = 629) at the San Francisco Department of Public Health (2016-2018) was conducted. Multivariable logistic regression was used to analyze the association between discrimination as an ordered categorical variable (zero, one to two, or three or more experiences) and housing status adjusting for age, years lived in the Bay Area, and gender identity. We found that the odds of housing instability increased by 1.25 for every categorical unit increase (1-2, or 3+) in reported experiences of intersectional (both anti-trans and racial) discrimination for trans women (95% CI = 1.01-1.54, p-value < 0.05). Intersectional anti-trans and racial discrimination is associated with increased housing instability among trans women, giving some insight that policies and programs are needed to identify and address racism and anti-trans stigma towards trans women. Efforts to address intersectional discrimination may positively impact housing stability, with potential for ancillary effects on increasing the health and wellness of trans women who face multiple disparities