Antitrans Policy Environment and Depression and Anxiety Symptoms in Transgender and Nonbinary Adults.

Importance: With the increasing legislation restricting health care access for transgender and nonbinary (trans) populations in recent years, there has been limited research on how awareness of and concerns about legislative restrictions and protections influence mental health outcomes. Objective: To examine whether awareness of and concerns about the current policy environment regarding trans individuals are associated with depression and anxiety symptoms among trans adults. Design, Setting, and Participants: This study uses cross-sectional data collected between March and April 2023 from the Washington Priority Assessment in Trans Health (PATH) Project, an online study designed by, with, and for trans communities. All participants were trans adults, aged 18 years or older, living in Washington state. Exposure: Awareness and concerns about the antitrans policy environment. Main Outcomes and Measures: The primary outcomes were depression and anxiety symptoms, assessed via the Patient Health Questionnaire-4. A series of multivariable regression models was used to assess the association between awareness and concerns about the antitrans policy environment and depression and anxiety symptoms. Models were adjusted for covariates, including demographics, social marginalization, and health care experiences. Results: A total of 797 participants (653 women [81.93%]; 455 aged 18-29 years [57.09%]) were included. The majority screened positive for current depression (689 individuals [86.45%]) and anxiety (686 individuals [86.07%]) symptoms. Trans individuals who were concerned or worried about their rights being taken away (vs not) had significantly higher odds of current depression symptoms (adjusted odds ratio [aOR], 1.66; 95% CI, 1.08-2.54), as well as current anxiety symptoms (aOR, 2.67; 95% CI, 1.63-4.36). Those who knew (vs did not know) about state-level protective legislation had significantly lower odds of current depression symptoms (aOR, 0.44; 95% CI, 0.28-0.67), as well as current anxiety symptoms (aOR, 0.11; 95% CI, 0.04-0.25). When examining interaction effect estimates, trans individuals who correctly knew about the protective policies and were not worried about having their rights taken away reported the lowest odds of depression and anxiety. Conclusions and Relevance: The findings of this cross-sectional study are consistent with research elucidating the negative mental health consequences of policies limiting health care access and provide insights into informing policies and interventions that target trans populations' worsened mental health outcomes as a result of antitrans legislation.

Perceptions of Sexual Risk, PrEP Services, and Peer Navigation Support among HIV-Negative Latinx and Black Men who have Sex with Men (MSM) Residing in Western Washington.

Introduction: HIV PrEP (pre-exposure prophylaxis) is underutilized among Latinx and Black men who have sex with men (MSM) in the United States. Although peer navigation approaches may increase PrEP uptake and adherence, it remains unclear what strategies work best for MSM of color. Methods: From July 2017 to August 2018, we conducted semi-structured in-depth interviews with 25 purposively sampled Latinx and Black cisgender MSM to evaluate how the intersectionality of race/ethnicity, sexual orientation, and other identities influenced men's views on PrEP in general and on peer navigation specifically. Thematic analysis was used to identify and analyze emergent themes. Results: Emergent themes included: (1) awareness of vulnerability in intimate relationships; (2) barriers to PrEP initiation including perceived side effects, stigma, and financial concerns; (3) a wish to connect with other Latinx and Black MSM in a health and prevention space; and (4) the desire for peer matching based on identity considerations and lived experience. Younger men and Spanish-speaking Latinx men were most interested in peer navigation to access PrEP, while bisexual men had confidentiality concerns. Conclusions: In our study, Latinx and Black MSM viewed peer navigation services favorably, especially if they addressed men's desire to connect with other MSM of color. Policy Implications: Developing culturally-congruent peer navigation programming could help improve PrEP uptake and care engagement for Latinx and Black MSM. Programs should recruit peers from the racial/ethnic minority communities most impacted by HIV and prioritize matching peers to clients based on identity concerns, needs, and preferences.

What's PrEP?: peer navigator acceptability among minority MSM in Washington.

BACKGROUND: Peer navigation is a promising strategy to link at-risk minority men who have sex with men (MSM) to HIV prevention services including pre-exposure prophylaxis (PrEP). METHODS: Thirty-two Black and 63 Latinx HIV-negative MSM living in western Washington completed a survey examining attitudes towards peer navigation and PrEP. Factor analysis derived a score for peer navigator acceptability, and linear regression identified associations with this outcome. RESULTS: Forty-eight percent were interested in peer navigation. Being insured, higher sexual stigma, and higher PHQ-9 score were associated with higher acceptability, while higher income and having a regular medical provider were associated with lower acceptability. In multivariable analysis, higher sexual stigma predicted higher acceptability, while higher income predicted lower acceptability. Men preferred that peers be matched on sexual orientation, race, age and culture. CONCLUSION: Peer navigation interventions to reach minority men should address stigma, focus on lower-income men, and try to match peers to clients to the extent possible.