المؤلفون: Erin C. Wilson, Glenda N. Baguso, Jerry Quintana, Bow Suprasert, Sean Arayasirikul

المصدر: BMC Women's Health, Vol 24, Iss 1, Pp 1-11 (2024)

مصطلحات موضوعية: Transgender women, HIV, Mental health, Substance use, Gynecology and obstetrics, RG1-991, Public aspects of medicine, RA1-1270

الوصف: Abstract Background Substance use and mental distress are known barriers to HIV care engagement among trans women. Less is known about access and utilization of mental health and substance use care among trans women and the relationship between unmet behavioral health needs and HIV viral suppression. We examined the relationship between mental health and substance use on HIV viral load among trans women living with HIV. We also examined the relationship between mental health and substance use services needs with HIV care engagement and having a detectable viral load by comparing engagement in care cascades. Methods Data are from a 2022 baseline assessment for an intervention with trans women living with HIV (n = 42) in San Francisco. Chi-Squared or Fisher’s exact tests were conducted to determine associations between HIV viral load, mental health, and substance use. We also examine characteristics associated with each step in the HIV, mental health, and substance use care cascades. Results Most participants were trans women of color (85.7%), 40 years of age or older (80.9%), with low income (88.1%), and almost half were unstably housed (47.6%). Of the 32 participants who screened positive for depression, anxiety and/or psychological distress, 56.3% were referred for mental health services in the past 12 months. Of those who were referred, 44.4% received mental health services. Of the 26 participants who screened positive for a substance use disorder, 34.6% were referred to substance use services in the past 12 months. Of those referred, 33.3% received substance use services in the past 3 months. Latina trans women had a low referral rate to meet their mental health needs (50%) and only 16.7% of African American/Black trans women who screened positive for a substance use disorder were referred for services, while trans women of other race/ethnicities had high referral and services utilization. No significant results were found between HIV viral load and screening positive for a mental health disorder. Methamphetamine use was statistically associated with having a detectable HIV viral load (p = 0.049). Conclusions We identified significant unmet mental health and substance use services needs and noted racial/ethnic disparities in the context of high HIV care engagement among trans women living with HIV. We also found that methamphetamine use was a barrier to having an undetectable viral load for trans women living with HIV. To finally end the HIV epidemic, integration of behavioral health screening, linkage, and support are needed in HIV care services for populations most impacted by HIV, especially trans women. Trial registration NCT, NCT 21–34,978. Registered January 19, 2022.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1472-6874Test

الوصول الحر: https://doaj.org/article/e20069e787a64a558ca8e77db7c38c48Test

المؤلفون: Cristina M. Jalil, Emilia M. Jalil, Brenda Hoagland, Sandra W. Cardoso, Rodrigo Scarparo, Carolina Coutinho, Mayara Secco Torres Silva, Valdilea G. Veloso, Erin C. Wilson, Willi McFarland, Thiago S. Torres, Beatriz Grinsztejn

المصدر: The Lancet Regional Health. Americas, Vol 36, Iss , Pp 100798- (2024)

مصطلحات موضوعية: Sexual and gender minorities, Young MSM, HIV prevention, Pre-exposure prophylaxis (PrEP), Brazil, Latin America, Public aspects of medicine, RA1-1270

الوصف: Summary: Background: Young gay, bisexual, and other men who have sex with men (YMSM) in Latin America experience disproportionately high rates of HIV. While new case numbers have stabilised in other demographics, the incidence of HIV in this particular group continues to rise. We estimated the prevalence of HIV and sexually transmitted infections (STI) and identified correlates of new HIV diagnoses among YMSM in Brazil. Methods: Conectad@s was a respondent-driven sampling-based study to recruit and engage YMSM in HIV prevention and treatment services in Rio de Janeiro, Brazil (November 2021–October 2022). Eligibility criteria were age 18–24 years and self-identification as MSM (cis/trans) or non-binary person who have sex with men. Participants underwent HIV/STI testing and completed a socio-behavioural questionnaire. We described baseline characteristics by HIV status and used logistic regression models to identify correlates of new HIV diagnoses. Trial ID: DERR1-10.2196/34885. Findings: Among 409 participants, 370 (90.5%) self-identified as cisgender men, nine (2.2%) transgender men, and 30 (7.3%) non-binary. Median age was 21 years (IQR: 20–23), with 80 (19.6%) aged 18–19 years. Most self-identified as Black or Pardo (70.6%); 109 (26.7%) never tested for HIV. HIV prevalence was 9.8%; 50% (n = 20/40) were newly diagnosed with HIV. Only nine participants ever used PrEP and three were currently using it. Overall, 133 (32.5%) reported sexual violence in their lifetime and 102 (24.9%) reported a suicide attempt. Prevalence of active syphilis, chlamydia, and gonorrhoea were 14.4%, 15.9%, and 14.7%, respectively. New HIV diagnoses were positively associated with engaging in high-risk behaviour (aOR 4.88 [95% CI: 1.88–13.40]) and anxiety (aOR 2.67 [95% CI: 1.01–7.70]), and negatively associated with ever disclosing sexual orientation (aOR 0.19 [95% CI: 0.04–0.92]) and HIV knowledge (aOR 0.77 [95% CI: 0.59–1.01]). Interpretation: High prevalence of HIV coupled with a high proportion of new HIV diagnoses underscore a potentially growing HIV epidemic among YMSM in Brazil. Funding: National Institutes of Health (NIH), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and Ministry of Health of Brazil.

وصف الملف: electronic resource

العلاقة: http://www.sciencedirect.com/science/article/pii/S2667193X2400125XTest; https://doaj.org/toc/2667-193XTest

الوصول الحر: https://doaj.org/article/636aebaf1a514c08a6650b15adc096b4Test

المؤلفون: Ricardo de Mattos Russo Rafael, Helena Gonçalves de Souza Santos, Jaime Alonso Caravaca-Morera, Erin C. Wilson, Karen Lucas Breda

المصدر: Escola Anna Nery, Vol 27 (2023)

مصطلحات موضوعية: Direitos Humanos, Identidade de Gênero, Identificação Social, Registro Civil, Violência, Nursing, RT1-120

الوصف: Resumo Objetivo refletir sobre as implicações e os riscos associados ao novo registro de identificação do Brasil para a população trans. Método trata-se de estudo reflexivo que explora o conceito de identidade social como um fenômeno complexo, fundamentado nos princípios da autodeterminação e da dignidade humana. São consideradas perspectivas feministas pós-humanistas e críticas, que desafiam o essencialismo biológico dos indivíduos, com foco especial na teoria de Judith Butler. Resultados o Brasil está atualmente implementando um registro nacional de identificação capaz de reconhecer a identidade de gênero das pessoas trans. Este estudo aborda as implicações do novo sistema nacional de identificação, incluindo possíveis retrocessos e avanços na luta pelos direitos das pessoas trans. Para proteger a identidade e a segurança dessas pessoas, este artigo defende a criação de um novo sistema de identificação emitido pelo governo que armazene informações pessoais em bancos de dados, exibindo apenas o nome social e o marcador de gênero no cartão. Considerações finais e implicações para a prática as altas taxas de violência contra pessoas trans no Brasil destacam a necessidade urgente do novo sistema. O reconhecimento precoce e o respeito pela identidade de gênero são fundamentais para promover o sucesso do novo sistema.

وصف الملف: electronic resource

العلاقة: http://revodonto.bvsalud.org/scielo.php?script=sci_arttext&pid=S1414-81452023000100505&lng=pt&tlng=ptTest; http://revodonto.bvsalud.org/pdf/ean/v27/1414-8145-ean-27-e20230117.pdfTest; https://doaj.org/toc/2177-9465Test

الوصول الحر: https://doaj.org/article/df47238f3b6949b8a1322412fd23d0d4Test

المؤلفون: Elaine Hsiang, Akua Gyamerah, Glenda Baguso, Jennifer Jain, Willi McFarland, Erin C. Wilson, Glenn-Milo Santos

المصدر: BMC Infectious Diseases, Vol 22, Iss 1, Pp 1-11 (2022)

مصطلحات موضوعية: Substance use, Transgender persons, HIV, Social determinants of health, Discrimination, Infectious and parasitic diseases, RC109-216

الوصف: Abstract Background Trans women face tremendous social inequities as well as disproportionate rates of HIV and substance use, yet disaggregated substance use data specific to trans women remain limited. Methods We conducted a secondary analysis of baseline data from the Trans*National Study (2016–2017) surveying trans women in the San Francisco Bay Area (n = 629). Multivariable logistic regression was used to analyze socio-demographic and environmental correlates of substance use, and bivariate associations between substance use and HIV-associated outcomes are presented alongside prevalence data. Results Over half (52.9%) reported using substances in the prior year, most frequently marijuana, methamphetamine, and crack/cocaine. Those with unmet gender-affirming health care needs, lack of insurance, or a history of experiencing racial violence, transphobic violence, adult housing instability, or extreme poverty had higher odds of substance use. Sex work and condomless anal sex were also independently associated with substance use. Conclusions Among this sample of trans women, substance use and substance use concurrent with sex were highly prevalent, and associated with a number of socioeconomic and health care needs. These findings corroborate the need for holistic and intersectional efforts to reduce substance use and HIV risk.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1471-2334Test

الوصول الحر: https://doaj.org/article/7e41522a7d0946ebb711a0d8c47eae28Test

المؤلفون: Glenda N. Baguso, Karen Aguilar, Sofia Sicro, Malaya Mañacop, Jerry Quintana, Erin C. Wilson

المصدر: BMC Health Services Research, Vol 22, Iss 1, Pp 1-7 (2022)

مصطلحات موضوعية: Trans women, Qualitative, Mental health, And substance use services, Public aspects of medicine, RA1-1270

الوصف: Abstract Background Little is known about the barriers to mental health and substance use services for trans women living with HIV. We conducted a qualitative study with trans women living with HIV and providers to explore barriers to mental health and substance use services in San Francisco. Methods We conducted focus group discussions and key informant interviews with a total of 15 medical, mental health, substance use, and social service providers and trans women living with HIV. We identified, analyzed, and reported themes using thematic analysis and derived themes directly from the data. Results Our study participants identified two main themes and three subthemes. One main theme is that trans women and providers have lost trust in the system due to (a) lack of a linkage system between referrals and services, (b) structural barriers such as service location, language capacity, clinic hours, and (c) constant changes in services available. Another main theme is anti-trans and mental health stigma. Conclusions Interventions to coordinate linkage from medical to mental health and substance use (MHSU) services are urgently needed to facilitate the utilization of MHSU services. Other interventions to improve quality monitoring and system improvement, and to address multiple stigmas broadly in society are needed to improve unmet MHSU service needs among trans women living with HIV in San Francisco.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1472-6963Test

الوصول الحر: https://doaj.org/article/16cbecb335cd42b9888fd28591622a7bTest

المؤلفون: Sean Arayasirikul, Caitlin Turner, Dillon Trujillo, Sofia L. Sicro, Susan Scheer, Willi McFarland, Erin C. Wilson

المصدر: International Journal for Equity in Health, Vol 21, Iss 1, Pp 1-11 (2022)

مصطلحات موضوعية: Transgender women, Discrimination, Violence, Social determinants of health, Health disparities, Health inequities, Public aspects of medicine, RA1-1270

الوصف: Abstract Background To determine if improvements in social determinants of health for trans women and decreases in transphobic discrimination and violence occurred over three study periods during which extensive local programs were implemented to specifically address longstanding inequities suffered by the transgender community. Methods Interviewer-administered surveys from repeated cross-sectional Transwomen Empowered to Advance Community Health (TEACH) studies in 2010, 2013 and 2016-2017 in San Francisco collected experiences with transphobia violence and discrimination. Respondent-driven sampling was used to obtain a sample of participants who identified as a trans woman. Results Violence due to gender identity was prevalent; in each study period, verbal abuse or harassment was reported by over 83% of participants, and physical abuse or harassment was reported by over 56%. Adverse social determinants of health including homelessness, living below the poverty limit, methamphetamine use, depression, PTSD, and anxiety all significantly increased from 2010 to 2016. When testing for trends, housing discrimination and physical violence were both more likely in 2016-2017 compared to the two earlier study periods. Housing discrimination (aOR 1.41, 95% CI 1.00-1.98) and physical violence due to gender identity/presentation (aOR 1.39, 95% CI 1.00-1.92) both significantly increased from 2010 to 2016. Conclusion Our findings are particularly alarming during a period when significant public health resources and community-based initiatives specifically for trans women were implemented and could have reasonably led us to expect improvements. Despite these efforts, physical violence and housing discrimination among trans women worsened during the study periods. To ensure future improvements, research and interventions need to shift the focus and burden from trans people to cisgender people who are the perpetuators of anti-trans sentiment, stigma, discrimination and victimization.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1475-9276Test

الوصول الحر: https://doaj.org/article/6677817563344304b2e42ed9fcad778dTest

المؤلفون: Erin C. Wilson, Caitlin M. Turner, Manisha Dhakal, Sanjay Sharma, Anuj Rai, Rajesh Lama, Swagata Banik, Sean Arayasirikul

المصدر: PLOS Global Public Health, Vol 3, Iss 3 (2023)

مصطلحات موضوعية: Public aspects of medicine, RA1-1270

الوصف: Stigma towards trans women in Nepal creates individual and system-level risks for HIV. A critical protective factor is access to HIV prevention. Research is needed to determine the impact of stigma on HIV testing among trans women in Nepal. We conducted a secondary analysis of data collected using respondent driven sampling in 2019 on HIV risk among trans women in Nepal. Data analysis was restricted to trans women who were HIV negative at testing through the parent study. Descriptive statistics, tests for bivariable associations between HIV testing and stigma variables, and binomial Poisson regression were conducted to examine HIV testing outcomes. There were 173 participants who tested negative for HIV in our sample. The majority were under age 35 (59%) and most had a grade school education or less (64.7%). No trans women were homeless and most rented a room (70.5%) or owned their home (19.7%). The majority were currently sex workers (57.8%). Almost all HIV-negative trans women had ever been tested for HIV (90.8%), but only 53.5% in the last 3 months. The most frequently cited reason for not having been tested was thinking they were at low risk for HIV (40.9%) and being afraid of receiving a positive test result (22.7%). HIV and anti-trans stigma were high across most measures, including that almost all (94.2%) believed that most people in Nepal would discriminate against people with HIV. And most participants thought trans women were not accepted in Nepali Society (65.9%). Most participants also reported high social support (70.5%). Social cohesion among participants varied, with most experiencing medium (41.6%) or high (33.5%) social cohesion. Just over half had high social participation (55.5%). Participants who reported current sex work had lower prevalence of not testing for HIV in the last 3 months (prevalence ratio, PR = 0.54, 95% confidence interval, 95%CI = 0.32–0.92, p = 0.02). Every one-unit increase in social cohesion was associated with 1.05 times the prevalence of not testing for HIV in the last 3 months (95%CI = 1.01–1.09, p-value = 0.02). Trans women who did sex work were more likely to be HIV tested while those who were more socially connected to peers were less likely to have recently been tested for HIV. HIV stigma may result in fear of social rejection from peers if one tests positive. Interventions that focus on addressing stigma within trans women’s social networks and strategies to mitigate HIV stigma in society may result in increased frequency of HIV testing among trans women in Nepal.

وصف الملف: electronic resource

العلاقة: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10022763/?tool=EBITest; https://doaj.org/toc/2767-3375Test

الوصول الحر: https://doaj.org/article/990604dca5ec4179a055b92806de091aTest

المؤلفون: Arianne Reis, Sandro Sperandei, Paula Galdino Cardin de Carvalho, Thiago Félix Pinheiro, Ferdinando Diniz de Moura, José Luis Gomez, Patrícia Porchat, Francisco Inácio Bastos, Willi McFarland, Erin C. Wilson, Maria Amélia Veras

المصدر: BMC Psychiatry, Vol 21, Iss 1, Pp 1-13 (2021)

مصطلحات موضوعية: Transgender women, Mental health, Suicidal ideation, Suicide attempt, Risk factors, Psychiatry, RC435-571

الوصف: Abstract Background Trans women have been shown to experience disproportionately poor outcomes in physical and mental health. Although it is common to talk about the violence against trans people, little is still known about mental health outcomes and experiences of suicidality among trans women, particularly in developing countries. This study aims to investigate risk factors and associations with mental health, suicide ideation and suicide attempts among trans women in the largest metropolitan area in Brazil. Methods Trans women living in São Paulo were recruited between May 2017 and July 2019 using the long-chain peer referral method Respondent-Driven Sampling. Multivariate regression models were used to investigate the associations with K10 score classification (logistic) and suicidal ideation/suicide attempt (ordinal logistic). Results A total of 763 trans women were included in the study. Over one quarter (26.5%) of trans women had been diagnosed with anxiety in the past, and close to one in five (19.1%) trans women had received a diagnosis of depression. More than two in five (41.9%) trans women had moderate to severe psychological distress. More than half of all participating trans women reported having previously either experienced suicidal ideation or attempted to take their own lives (25.0 and 31.2% respectively). In multivariate regression, moderate to severe psychological distress was associated with homelessness, income, current sex work, use of stimulant drugs, history of physical abuse, depression diagnosis and access to mental health treatment. Suicidal ideation and suicide attempts were associated with race/skin color, living arrangements, marital status, current sex work, history of sexual violence, depression and PTSD diagnoses, access to mental health treatment and psychological distress. Conclusions This study showed that there is a significant association between mental health conditions, lack of treatment for these conditions and suicidality among trans gender women. Findings point to the need for a structural transformation in Brazil that enables a reduction in the social inequality and violence that impact the mental health of trans women. A number of recommendations to achieve this are provided.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1471-244XTest

الوصول الحر: https://doaj.org/article/00f21ff2b09444648a3fc5545b04566eTest

المؤلفون: Akua O. Gyamerah, Glenda Baguso, Edda Santiago-Rodriguez, Aria Sa’id, Sean Arayasirikul, Jess Lin, Caitlin M. Turner, Kelly D. Taylor, Willi McFarland, Erin C. Wilson, Paul Wesson

المصدر: BMC Public Health, Vol 21, Iss 1, Pp 1-15 (2021)

مصطلحات موضوعية: Transgender women, Hate crimes, Violence, Transphobia, Gender-based violence, Public aspects of medicine, RA1-1270

الوصف: Abstract Background Trans women experience high rates of gender-based violence (GBV)—a risk factor for adverse health outcomes. Transphobic hate crimes are one such form of GBV that affect trans women. However, little is understood about factors that shape transphobic hate crimes and racial/ethnic variation in these experiences. To contextualize GBV risk and police reporting, we examined self-reported types and correlates of transphobic hate crimes by racial/ethnic group of trans women in the San Francisco Bay Area. Methods From 2016 to 2018, trans women participated in a longitudinal cohort study of HIV. Secondary data analyses (N = 629) examined self-reported experiences of transphobic hate crimes (i.e., robbery, physical assault, sexual assault, and battery with weapon) by race/ethnicity, and whether hate crimes were reported to the police. Chi-square tests and simple logistic regression examined demographic, sociocultural, and gender identity factors associated with transphobic violence experiences and police reporting. Results About half (45.8%) of participants reported ever experiencing a transphobic hate crime; only 51.1% of these were reported to the police. Among those who reported a hate crime experience, Black (47.9%) and Latina (49.0%) trans women reported a higher prevalence of battery with a weapon; White (26.7%) and trans women of “other” race/ethnicities (25.0%) reported a higher prevalence of sexual assault (p = 0.001). Having one’s gender questioned, history of sex work, homelessness as a child and adult, and a history incarceration were associated with higher odds of experiencing a transphobic hate crime. Trans women who felt their gender identity questioned had lower odds of reporting a hate crime to the police compared to those did not feel questioned. Conclusions A high proportion of trans women experienced a transphobic hate crime, with significant socio-structural risk factors and racial differences by crime type. However, crimes were underreported to the police. Interventions that address structural factors, especially among trans women of color, can yield violence prevention benefits.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1471-2458Test

الوصول الحر: https://doaj.org/article/70e2c171e800466ba39ea1846bf3fbd6Test

المؤلفون: Erin C. Wilson, Manisha Dhakal, Sanjay Sharma, Anuj Rai, Rajesh Lama, Sirish Chettri, Caitlin M. Turner, Hui Xie, Sean Arayasirikul, Jess Lin, Swagata Banik

المصدر: BMC Infectious Diseases, Vol 21, Iss 1, Pp 1-9 (2021)

مصطلحات موضوعية: Stigma, HIV prevalence, Intersectionality, Lived experience, Transgender persons, Trans women, Infectious and parasitic diseases, RC109-216

الوصف: Abstract Background Transgender women (trans women) in Nepal are underserved in the HIV response. Data are needed to determine the HIV prevalence disaggregated from other key populations and to identify the particular risks faced by this community. Trans women are marginalized around the world and research is also needed to determine the impact of stigma on HIV risk to inform trans-specific interventions. Methods In 2019, we conducted the first population-based HIV behavioral surveillance study of trans women disaggregated from other key populations using respondent driven sampling (RDS). We estimated the HIV prevalence for trans women, and bivariate and multivariate Poisson binomial regression models were constructed to examine the relationship between HIV risk and stigma. Results Trans women participants (N = 200) had a mean age of 33 years old (SD = 10.96). We found a weighted HIV prevalence of 11.3% (95% CI 6·82% - 18·13). We found that depression and anxiety (aPR 0.81; 95% CI 0.67–0.97; p = 0·02) and current engagement in sex work (aPR 1.31; 95% CI 1.01–1.71; p = 0·046) were significantly associated with greater prevalence of condomless receptive anal intercourse. We found that experienced stigma of ever being verbally abused due to gender identity was significantly associated with lower prevalence of depression and anxiety (aPR 0.42; 95% CI 0.20–0.87; p = 0·002). Feeling unaccepted in Nepali society and believing people thought they were a criminal because of their trans identity was significantly associated greater prevalence of current sex work (aPR 1.36; 95% CI 1.03–1.78; p = 0·03; aPR 1.45; 95% CI 1.03–2.07; p = 0.04). Every measure of experienced stigma assessed was significantly associated with greater prevalence of current engagement in sex work. Conclusions Trans women are highly stigmatized in Nepal, leading to individual and systems factors that impact their risk for HIV. Interventions are needed that support the economic and mental wellbeing of trans women to prevent their heighted risk of HIV from stigma.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1471-2334Test

الوصول الحر: https://doaj.org/article/356eaaf3721b4150bf65110d87d38a0aTest