First name
Elle
Last name
Lett

Title

Sexual Behaviors Associated with HIV Transmission Among Transgender and Gender Diverse Young Adults: The Intersectional Role of Racism and Transphobia.

Year of Publication

2022

Number of Pages

Date Published

06/2022

ISSN Number

1573-3254

Abstract

HIV prevalence and engagement in sexual behaviors associated with HIV transmission are high among transgender people of color. Per intersectionality, this disproportionate burden may be related to both interpersonal and structural racism and transphobia. The goal of this study was to estimate the association between interpersonal and structural discrimination and sexual behaviors among transgender and gender diverse (TGD) U.S. young adults. We used logit models with robust standard errors to estimate the individual and combined association between interpersonal and structural racism and transphobia and sexual behaviors in a national online sample of TGD young adults of color (TYAOC) aged 18-30 years (N = 228). Racism was measured at the interpersonal and structural level using the Everyday Discrimination Scale and State Racism Index, respectively. Transphobia was measured at the interpersonal and structural level using the Gender Minority Stress Scale and the Gender Identity Tally, respectively. We found that interpersonal racism was associated with transactional sex, and interpersonal transphobia was associated with alcohol/drug consumption prior to sex and transactional sex among TYAOC. We also found evidence of a strong joint association of interpersonal and structural racism and transphobia with alcohol/drug consumption prior to sex (OR 3.85, 95% CI 2.12, 7.01) and transactional sex (OR 3.54, 95% CI 0.99, 12.59) among TYAOC. Racism and transphobia have a compounding impact on sexual behaviors among TYAOC. Targeted interventions that reduce discrimination at both the interpersonal and structural level may help reduce the HIV burden in this marginalized population.

DOI

10.1007/s10461-022-03701-w

Alternate Title

AIDS Behav

PMID

35661016
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Title

Transgender Youth Experiences with Implantable GnRH Agonists for Puberty Suppression.

Year of Publication

2022

Number of Pages

364-368

Date Published

08/2022

ISSN Number

2688-4887

Abstract

This descriptive study reports caregiver experiences with GnRH agonist implants among a cohort of youth followed in a pediatric hospital-based gender clinic. We administered a survey to 36 of 55 eligible caregivers ascertaining demographics and satisfaction, with a medical record review of any surgical complications. The overwhelming majority (97.1%) reported satisfaction with the procedure and would undergo the implant procedure again (94.4%). The most frequent challenges noted were about affordability (39.8%) and insurance denials (39.8%). Implantable GnRH agonist can be used successfully in pediatric patients with gender dysphoria. Future policy should seek to address concerns regarding insurance approval and reimbursement.

DOI

10.1089/trgh.2021.0006

Alternate Title

Transgend Health

PMID

36033209
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Title

Characterizing Health Inequities for the U.S. Transgender Hispanic Population Using the Behavioral Risk Factor Surveillance System.

Year of Publication

2021

Number of Pages

275-283

Date Published

2021 Oct

ISSN Number

2688-4887

Abstract

<p>This study aims to describe health inequities experienced by transgender Hispanic (TH) individuals in the United States. This retrospective case-control study used the Behavioral Risk Factor Surveillance System (BRFSS) data from 2014 to 2018. Propensity score matching and logistic and negative binomial regression were used to compare TH survey respondents with other relevant populations across the following outcomes: health care access, health risk factors, self-reported chronic conditions, and perceived health status. Relative to transgender White (TW) respondents, TH respondents (=414) were less likely to report having health insurance (odds ratio [OR]: 0.35, &lt;0.001), a regular provider (OR=0.40, &lt;0.001), and were more likely to report cost barriers to care (OR=1.85, &lt;0.001) and HIV risk factors (OR=2.41, &lt;0.001). Similar results were found when comparing outcomes with cisgender White respondents. TH respondents reported fewer days of poor health (rate ratio [RR]=0.67, &lt;0.001), activity limited days (RR=0.64, =0.011), and were less likely to report depression (OR=0.44, &lt;0.001) than TW respondents. Relative to cisgender Hispanic (CH) respondents, TH respondents experienced more cost barriers (OR=1.56, =0.003), higher HIV risk (OR=3.38, &lt;0.001), and more activity limited days (RR=2.93, &lt;0.001). Our results demonstrate that TH individuals may be less likely to have access to health care and have poorer health-related quality-of-life when compared with either CH or TW individuals. It is vital that additional research further elucidate the challenges faced by this multiply marginalized population including racism and transphobia. Further health care solutions should be responsive to the unique challenges of the TH population at the individual and institutional level.</p>

DOI

10.1089/trgh.2020.0095

Alternate Title

Transgend Health

PMID

34993300
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Title

Intersectionality and Health Inequities for Gender Minority Blacks in the U.S.

Year of Publication

2020

Number of Pages

Date Published

2020 Aug 05

ISSN Number

1873-2607

Abstract

<p><strong>INTRODUCTION: </strong>Gender minority blacks represent the intersection of multiply marginalized populations that experience severe health inequities in the U.S. However, few studies focus on the unique health experiences of this multiply disadvantaged population. This study quantifies the health inequities experienced by gender minority blacks in the U.S. using an intersectional framework.</p>

<p><strong>METHODS: </strong>This cross-sectional study analyzed data in 2018/2019 from the Behavioral Risk Factor Surveillance System, including all cisgender black, gender minority black, and gender minority white survey respondents who completed the gender identity module between 2014 and 2018. Investigators compared demographics, healthcare access, behavioral risk factors, chronic conditions, and perceived health status of gender minority blacks with those of cisgender blacks and gender minority whites.</p>

<p><strong>RESULTS: </strong>In the primary analysis of weighted survey data, gender minority blacks were more likely to report experiencing severe mental distress (AOR=1.99, 95% CI=1.14, 3.47, p=0.02), longer periods of being physically or mentally unwell (adjusted RR=1.36, 95% CI=1.17, 1.59, p&lt;0.001), and longer periods of activity limitations owing to poor health (adjusted RR=1.53, 95% CI=1.01, 1.41, p=0.003) than cisgender blacks. In a matched analysis, gender minority blacks had worse self-reported health than both cisgender blacks (OR=1.32, 95%: CI=1.05, 1.67, p=0.02) and gender minority whites (OR=1.53, 95% CI=1.15, 2.04, p=0.003).</p>

<p><strong>CONCLUSIONS: </strong>Gender minority blacks have health experiences that are distinct from those of both the cisgender black and gender minority populations with which they intersect. Health policies and programs, including data collection efforts, must specifically consider this multiply marginalized population to effectively advance health equity.</p>

DOI

10.1016/j.amepre.2020.04.013

Alternate Title

Am J Prev Med

PMID

32792281
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