Perceptions of Barriers to and Facilitators of Participation in Health Research Among Transgender People

Purpose: Although transgender people may be at increased risk for a range of health problems, they have been the subject of relatively little health research. An important step toward expanding the evidence base is to understand and address the reasons for nonparticipation and dropout. The aim of this study was to explore the perceptions of barriers to and facilitators of participation in health research among a sample of transgender people in San Francisco, CA, and Atlanta, GA. Methods: Twelve in-person focus groups (FGs) were conducted; six (three with transwomen, three with transmen) were conducted in San Francisco and six FGs were conducted in Atlanta (three with transwomen and three with transmen). FGs were audiorecorded, transcribed, and uploaded to MaxQDA software for analysis. A codebook was used to code transcripts; new codes were added iteratively as they arose. All transcripts were coded by at least 2 of the 4 researchers and, after each transcript was coded, the researchers met to discuss any discrepancies, which were resolved by consensus. Results: Among 67 FG participants, 37 (55%) identified as transmen and 30 (45%) identified as transwomen. The average age of participants was ?41 years (range 18?67) and the majority (61%) were non-Hispanic Whites. Several barriers that can hinder participation in health research were identified, including logistical concerns, issues related to mistrust, a lack of awareness about participation opportunities, and psychosocial/emotional concerns related to being ?outed.? A broad range of facilitators were also identified, including the opportunity to gain knowledge, access medical services, and contribute to the transgender community. Conclusion: These findings provide insights about the perceived barriers to and facilitators of research participation and offer some guidance for researchers in our ongoing effort to engage the transgender community in health research.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140297/1/trgh.2016.0023.pd

Acceptability of self-conducted home-based HIV testing among men who have sex with men in Brazil: data from an on-line survey

The Brazilian HIV/AIDS epidemic is concentrated among men who have sex with men (MSM), however HIV testing rates among MSM are not commensurate with their risk. Strategies to expand early diagnosis may include use of self-conducted home-based testing kits, which are now available for purchase in the US. In April 2011 we conducted a survey with Brazilian MSM using Facebook to assess HIV testing preferences and acceptability of home-based testing. Among 356 previously tested, HIV-negative MSM, 47% reported a preference for home-based testing, 27% preferred clinic-based testing, and 26% had no preference. Less frequent testers and those who had considered testing but failed to test were more likely to prefer home-based testing. Close to 90% reported that they would use self-test kits; 62% and 54% said they would use home-based testing to make choices about unprotected sex with regular and new partners, respectively. Concerns included difficulty to understand the tests (32%) and receiving results alone (23%). Overall, home-based testing may appeal to MSM and result in increased testing frequency. Research on feasibility and utilization of self-tests in practice is needed

Intimate Partner Violence and Social Pressure among Gay Men in Six Countries

Introduction: Recent research suggests that men who have sex with men (MSM) experience intimate partner violence (IPV) at significantly higher rates than heterosexual men. Few studies, however, have investigated implications of heterosexist social pressures – namely, homophobic discrimination, internalized homophobia, and heterosexism– on risk for IPV among MSM, and no previous studies have examined cross-national variations in the relationship between IPV and social pressure. This paperexamines reporting of IPV and associations with social pressure among a sample of internet-recruited MSM in the United States (U.S.), Canada, Australia, the United Kingdom, South Africa, and Brazil.Methods: We recruited internet-using MSM from 6 countries through selective banner advertisements placed on Facebook. Eligibility criteria were men age over 18 reporting sex with a man in the past year. Of the 2,771 eligible respondents, 2,368 had complete data and were included in the analysis. Threeoutcomes were examined: reporting recent experience of physical violence, sexual violence, and recent perpetration of physical violence. The analysis focused on associations between reporting of IPV and experiences of homophobic discrimination, internalized homophobia, and heteronormativity.Results: Reporting of experiencing physical IPV ranged from 5.75% in the U.S. to 11.75% in South Africa, while experiencing sexual violence was less commonly reported and ranged from 2.54% in Australia to 4.52% in the U.S. Perpetration of physical violence ranged from 2.47% in the U.S. to 5.76% in South Africa. Experiences of homophobic discrimination, internalized homophobia, and heteronormativity were found to increase odds of reporting IPV in all countries.Conclusion: There has been little data on IPV among MSM, particularly MSM living in low- and middleincome countries. Despite the lack of consensus in demographic correlates of violence reporting, heterosexist social pressures were found to significantly increase odds of reporting IPV in all countries.These findings show the universality of violence reporting amongMSMacross countries, and highlight the unique role of heteronormativity asa risk factor for violence reporting among MSM. The results demonstrate that using internet-based surveys to reachMSMis feasible for certain areas, although modified effortsmay be required to reach diverse samples of MSM. [West J Emerg Med. 2012;13(3):260–271.]

Intimate Partner Violence and Social Pressure among Gay Men in Six Countries

Introduction: Recent research suggests that men who have sex with men (MSM) experience intimate partner violence (IPV) at significantly higher rates than heterosexual men. Few studies, however, have investigated implications of heterosexist social pressures – namely, homophobic discrimination, internalized homophobia, and heterosexism– on risk for IPV among MSM, and no previous studies have examined cross-national variations in the relationship between IPV and social pressure. This paperexamines reporting of IPV and associations with social pressure among a sample of internet-recruited MSM in the United States (U.S.), Canada, Australia, the United Kingdom, South Africa, and Brazil.Methods: We recruited internet-using MSM from 6 countries through selective banner advertisements placed on Facebook. Eligibility criteria were men age over 18 reporting sex with a man in the past year. Of the 2,771 eligible respondents, 2,368 had complete data and were included in the analysis. Threeoutcomes were examined: reporting recent experience of physical violence, sexual violence, and recent perpetration of physical violence. The analysis focused on associations between reporting of IPV and experiences of homophobic discrimination, internalized homophobia, and heteronormativity.Results: Reporting of experiencing physical IPV ranged from 5.75% in the U.S. to 11.75% in South Africa, while experiencing sexual violence was less commonly reported and ranged from 2.54% in Australia to 4.52% in the U.S. Perpetration of physical violence ranged from 2.47% in the U.S. to 5.76% in South Africa. Experiences of homophobic discrimination, internalized homophobia, and heteronormativity were found to increase odds of reporting IPV in all countries.Conclusion: There has been little data on IPV among MSM, particularly MSM living in low- and middleincome countries. Despite the lack of consensus in demographic correlates of violence reporting, heterosexist social pressures were found to significantly increase odds of reporting IPV in all countries.These findings show the universality of violence reporting amongMSMacross countries, and highlight the unique role of heteronormativity asa risk factor for violence reporting among MSM. The results demonstrate that using internet-based surveys to reachMSMis feasible for certain areas, although modified effortsmay be required to reach diverse samples of MSM. [West J Emerg Med. 2012;13(3):260–271.]

Perceptions of Barriers to and Facilitators of Participation in Transgender Health Research

Background/Aims: Research regarding the health of transgender and gender-nonconforming (T/GNC) individuals and, moreover, methodological considerations for recruitment of this population, is scarce. As part of a larger effort to understand the feasibility of developing a cohort study to examine long-term health outcomes of hormonal therapy, we conducted focus group discussions to qualitatively explore attitudes toward health research involving T/GNC individuals. Specifically, we aimed to explore the potential facilitators and barriers to recruitment and enrollment and to identify points of influence that would aid future recruitment. Methods: Data were drawn from 12 in-person focus group discussions with 75 self-identified T/GNC men and women in Atlanta (n = 37) and San Francisco Bay Area (n = 38). Discussions were stratified by gender and project site and were audio-recorded. The resulting transcripts were then reviewed for potential conceptual categories using the focus group discussion questions as initial categories. Emergent themes were identified based on both recurrence and similarities/differences noted across transcripts. Results: Preliminary analyses suggest that individuals who identify as T/GNC experience several barriers to research participation. These include: 1) being unaware of the research, 2) having transportation and financial challenges, 3) believing that the research questions are irrelevant to the lives of T/GNC individuals, and 4) feeling distrustful of the medical and research community. Suggestions for how to improve research participation by individuals in the T/GNC community include: 1) recruiting in diverse community-based locations using face-to-face referral/snowball-based methods; 2) scheduling research visits in locations accessible via public transportation and offering a variety of days/times to accommodate personal and professional responsibilities; 3) providing incentives including cash/gift cards, food and free/discounted health services; and 4) prioritizing transparency regarding the research questions and how the results will benefit the T/GNC community. Additional analyses of the transcripts using MAXQDA software will be conducted prior to the conference. Conclusion: T/GNC individuals form a sizeable, unique and underserved community. Understanding the barriers and facilitators of successful enrollment and retention in research studies is critical to addressing health disparities experienced by this community. Results from these analyses will help to identify points of influence that would aid recruitment of T/GNC individuals into future observational studies and intervention trials

A Qualitative Exploration of Perceived Health Issues Among Transgender Individuals in Atlanta and San Francisco

Background/Aims: To date, health literature concerning lesbian, gay, bisexual and transgender (LGBT) persons has grouped these individuals into a single LGBT community. Lack of knowledge about transgender or gender-nonconforming (T/GNC) individuals, specifically, precludes T/GNC health from the public health agenda. To address this gap, we undertook a qualitative exploratory study to examine the perceptions of health issues among T/GNC individuals, including the perceived barriers to accessing health care and reliable information about health care services. Methods: Data were drawn from 12 focus group discussions with 75 self-identified T/GNC men and women in Atlanta (n = 37) and San Francisco Bay Area (n = 38). Focus group discussions were stratified by gender and project site and were audio-recorded. The resulting transcripts were then reviewed for potential conceptual categories. Emergent themes were identified based on recurrence and on similarities/differences noted across the transcripts. Results: Preliminary analyses suggest that T/GNC participants are most concerned about HIV/AIDS, mental illness related to trauma and depression, cancer risk and the long-term effects of hormone use. Participants reported experiencing many barriers to receiving timely and effective health care services. These barriers included: 1) poor access to affordable care (primarily due to cost/lack of health insurance coverage), 2) poor availability of culturally competent care, 3) perceived discrimination by health care providers, 4) difficulties navigating complex health care systems, and 5) lack of reliable information about transgender health care services. Though participants felt that the Internet can be a helpful resource for identifying information about providers and services, many participants expressed concerns that online information was not always accurate and was frequently confusing and inadequate. Word-of-mouth and social media resources were perceived to be most helpful. Additional analyses using MAXQDA software will be conducted prior to the conference. Conclusion: Prior research demonstrates a deficiency in information regarding long-term health outcomes for T/GNC individuals. Our preliminary results indicate that T/GNC participants express concerns regarding the long-term effects of cross-sex hormones and surgery on chronic conditions like cancer, diabetes and cardiovascular disease. Additionally, despite recent advances in transgender care, many individuals experience significant barriers to accessing affordable, timely and culturally competent care and reliable information. Lessons learned from this study may inform future behavior-, health system- and policy-level interventions

Acceptability of self-conducted home-based HIV testing among men who have sex with men in Brazil: data from an on-line survey

Submitted by Fábio Marques ([email protected]) on 2018-07-09T14:58:20Z No. of bitstreams: 1 Acceptability of self-conducted home-based HIV testing_Beatriz_grinsztejn_etal_INI_Lapclin_2014.pdf: 59648 bytes, checksum: ec23fcbaf858ba45574cae9cc70e2eea (MD5)Approved for entry into archive by Regina Costa ([email protected]) on 2018-08-28T13:49:27Z (GMT) No. of bitstreams: 1 Acceptability of self-conducted home-based HIV testing_Beatriz_grinsztejn_etal_INI_Lapclin_2014.pdf: 59648 bytes, checksum: ec23fcbaf858ba45574cae9cc70e2eea (MD5)Made available in DSpace on 2018-08-28T13:49:27Z (GMT). No. of bitstreams: 1 Acceptability of self-conducted home-based HIV testing_Beatriz_grinsztejn_etal_INI_Lapclin_2014.pdf: 59648 bytes, checksum: ec23fcbaf858ba45574cae9cc70e2eea (MD5) Previous issue date: 2014Center for AIDS Prevention Studies, University of California, San Francisco, U.S.AFundação Oswaldo Cruz, Escola Nacional de Saúde Pública Sergio Arouca, Rio de Janeiro, BrasilFundação Oswaldo Cruz, Instituto de Pesquisa Clinica Evandro Chagas, Rio de Janeiro, BrasilRollins School of Public Health, Emory University, Atlanta, U.S.ABridge HIV, San Francisco Department of Public Health, San Francisco, U.S.ARollins School of Public Health, Emory University, Atlanta, U.S.AFundação Oswaldo Cruz, Instituto de Pesquisa Clinica Evandro Chagas, Rio de Janeiro, BrasilThe Brazilian HIV/AIDS epidemic is concentrated among men who have sex with men (MSM), however HIV testing rates among MSM are not commensurate with their risk. Strategies to expand early diagnosis may include use of self-conducted home-based testing kits, which are now available for purchase in the US. In April 2011 we conducted a survey with Brazilian MSM using Facebook to assess HIV testing preferences and acceptability of home-based testing. Among 356 previously tested, HIV-negative MSM, 47% reported a preference for home-based testing, 27% preferred clinic-based testing, and 26% had no preference. Less frequent testers and those who had considered testing but failed to test were more likely to prefer home-based testing. Close to 90% reported that they would use self-test kits; 62% and 54% said they would use home-based testing to make choices about unprotected sex with regular and new partners, respectively. Concerns included difficulty to understand the tests (32%) and receiving results alone (23%). Overall, home-based testing may appeal to MSM and result in increased testing frequency. Research on feasibility and utilization of self-tests in practice is needed

Ehlers-Danlos syndrome: prevalence and outcomes in gender affirming surgery - a single institution experience

Aim: Patients with Ehlers-Danlos Syndrome (EDS) are considered to have an increased risk for wound healing complications. Surgeons may therefore be hesitant to offer elective surgeries, including gender-affirming surgeries (GAS), to EDS patients. At our center, we frequently encountered patients presenting for GAS evaluation with the co-existing diagnosis of EDS. This study aims to establish the prevalence of EDS diagnosis in our GAS patients and compare their post-operative complications to patients without EDS diagnosis.Methods: This is a single-institution retrospective case-control study on all patients who underwent GAS from 2016-2020. Data include EDS diagnosis, demographics, operation, and complications (including minor wound healing issues).Results: Of 1363 patients presenting for GAS, 36 (2.6%) had EDS diagnoses and were matched with 108 control patients. Major complications requiring surgical intervention in the OR occurred in 6 patients (4.2%), (2.8% EDS vs. 5.4% controls; P = 0.63), while 8.3% of EDS and 14% of controls required minor interventions (P = 0.38). The rate of wound healing issues of any severity was 28% in EDS vs. 47% in control groups (P = 0.04).Conclusion: The prevalence of EDS diagnosis in our patient population is 132 times the highest reported prevalence in the general population. Wound healing issues and the need for additional post-operative interventions in the group with EDS diagnosis were not significantly different from the control group. Our findings suggest that patients with a diagnosis of EDS undergoing GAS have comparable outcomes to patients without EDS. Concerns for post-operative complications should not be a barrier to offering GAS to patients presenting with an EDS diagnosis