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

Exercise as a Mitigator of Poor Mental Health Among Lesbian, Gay, and Bisexual Adults

Introduction: There is a positive association between exercise and improved mental health in the general population. Although there is a greater burden of psychological distress among lesbian, gay, and bisexual (LGB) people, little is known about the association between exercise and mental health in this population. The authors explored the association between exercise and poor mental health reported by LGB adults in the United States. Methods: Our analyses used data from the 2017 Behavioral Risk Factor Surveillance System survey. Multiple regression analyses were used to determine the association between exercising and mental health days adjusting for sociodemographic characteristics. Results: Data were available for 6371 LGB participants. LGB adults who participated in any exercise reported almost 1.0 day less of poor mental health in the past 30 days compared with LGB adults who did not exercise (P=.01). LGB adults who met one or both of the physical activity guidelines had between 1.2 and 1.7 days less of poor mental health compared with those who did not meet the guidelines (P=.01). Conclusion: Fewer days of poor mental health were reported by LGB adults who exercised. Determining whether physical activity interventions, including aerobic and strengthening exercises, could improve mental health outcomes in LGB adults should be studied

The Use of Social Marketing Campaigns to Increase HIV Testing Uptake: A Systematic Review

Social marketing campaigns have been increasingly used in HIV prevention efforts to address barriers to HIV testing. The purpose of this review is to evaluate the social marketing campaigns in the past ten years (2008–2017) that have targeted HIV testing or intent to test as an outcome, and synthesize the results to determine which campaigns work or do not work. The search was conducted using PubMed, Scopus, PsycINFO, EMBASE, and ABI/Inform. The quality assessment tool for quantitative studies developed by the Effective Public Health Practice Project was used to assess study quality. The search generated 373 articles, of which 13 articles met the inclusion criteria. These articles were from 13 distinct campaigns carried out in 9 countries, twelve of which were in high income countries. Sixty-nine percent (n = 9) of the campaigns targeted MSM, gay men, or MSMW, 23% (n = 3) targeted the general population, while 8% (n = 1) focused on African-American women. The study designs for evaluating the campaigns were predominantly cross-sectional, with 4 of the articles combining two or three study designs to evaluate their campaign. Overall, 38% (n = 5) of the campaigns had an increase in HIV testing outcomes, 23% (n = 3) reported no change in HIV testing outcomes, and the remaining 38% (n = 5) of the studies reported mixed outcomes. The results of the quality rating showed that 69% (n = 9) of the papers had weak global ratings, while 31% (n = 4) had moderate rating. None of the articles had a strong rating. This review displayed that social marketing campaigns intended to increase HIV testing uptake were effective in some context. Social marketing practitioners will need to come up with a standardized way of communicating the results of campaign exposure and impact so as to enhance comparison among the multitude of campaigns

Changes in Body Mass Index Among People Living with HIV Who are New on Highly Active Antiretroviral Therapy: A Systematic Review and Meta-Analysis

In the era of highly active antiretroviral therapy (HAART), obesity is increasingly being reported among people living with HIV (PLHIV). In this study, we reviewed published literature on body mass index (BMI) changes among treatment-naïve adult PLHIV who started HAART and remained on treatment for at least six months. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, four databases were searched, and results of included studies were synthesized to describe the BMI trend among PLHIV on treatment. The search generated 4948 studies, of which 30 were included in the qualitative synthesis and 18 were eligible for the meta-analysis. All the studies showed an increase in group BMI. HAART was associated with increase in BMI (pooled effect size [ES] = 1.58 kg/m2; 95% CI: 1.36, 1.81). The heterogeneity among the 18 studies was high (I2 = 85%; p \u3c .01). Subgroup analyses showed pooled ES of 1.54 kg/m2 (95% CI: 1.21, 1.87) and 1.63 kg/m2 (95% CI: 1.34, 1.91) for studies with follow-up ≤1 year and \u3e1 year, respectively. We conclude that the greatest gain in BMI is in the initial 6–12 months on treatment, with minor gains in the second and subsequent years of treatment