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1.
AIDS Behav ; 2020 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-31912274

RESUMO

We present findings from qualitative interviews (N = 67) with 36 staff and 31 participants of nine distinct individual and/or group level interventions to engage transgender women of color (TWOC) in HIV care in the U.S. We examine the commonalities amongst the intervention services (addressing unmet basic needs, facilitating engagement in HIV care, health system navigation, improving health literacy, emotional support), and the relationships formed during implementation of the interventions (between interventionists and participants, among participants in intervention groups, between participants and peers in the community). Interventionists, often TWOC themselves, who provided these services developed caring relationships, promoted personal empowerment, and became role models for participants and the community. Intervention groups engaged participants to reinforce the importance of health and HIV care and provided mutual support. Gender affirming services and caring relationships may be two key characteristics of interventions that address individual and structural-level barriers to engage TWOC in HIV care.

2.
AIDS Care ; : 1-9, 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31482726

RESUMO

Transgender women (TW) are disproportionately affected by HIV. Antiretroviral pre-exposure prophylaxis (PrEP) can reduce TW's vulnerability to HIV, but PrEP uptake has been limited among TW. To explore barriers to PrEP uptake, the study team conducted two semi-structured focus groups with TW in San Francisco at risk for HIV acquisition. A within-case, across-case approach was used to code and analyze emerging themes. Focus group participants were racially and ethnically diverse. A few participants in both groups had heard of PrEP, but some had not. Several said that their health care providers had not told them about PrEP. Participants in both groups had questions about side effects. They expressed medical mistrust and said poverty is an important context for their lives. They described a need for gender affirming health care services and raised concerns about interactions of PrEP with feminizing hormones. Information about side effects and interactions between gender affirming hormones and PrEP need to be explicitly addressed in PrEP education campaigns focusing on TW. Health care institutions and health departments should train clinical staff how to provide affirming care. Gender identity nondiscrimination laws and policies could improve transgender people's ability to earn a living and access health care.

4.
AIDS Behav ; 2019 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-31144131

RESUMO

Transgender women of color are disproportionately impacted by HIV, poor health outcomes, and transgender-related discrimination (TD). We tested the Model of Gender Affirmation (GA) to identify intervention-amenable targets to enhance viral suppression (VS) using data from 858 transgender women of color living with HIV (49% Latina, 42% Black; 36% virally suppressed) in a serial mediation model. Global fit statistics demonstrated good model fit; statistically significant (p ≤ 0.05) direct pathways were between TD and GA, GA and healthcare empowerment (HCE), and HCE and VS. Significant indirect pathways were from TD to VS via GA and HCE (p = 0.036) and GA to VS via HCE (p = 0.028). Gender affirmation and healthcare empowerment significantly and fully mediated the total effect of transgender-related discrimination on viral suppression. These data provide empirical evidence for the Model of Gender Affirmation. Interventions that boost gender affirmation and healthcare empowerment may improve viral suppression among transgender women of color living with HIV.

5.
Am J Public Health ; 107(2): 224-229, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-28075641

RESUMO

To improve health outcomes among transgender women of color living with HIV, the Health Resources and Services Administration's Special Programs of National Significance program funded the Enhancing Engagement and Retention in Quality HIV Care for Transgender Women of Color Initiative in 2012. Nine demonstration projects in four US urban areas implemented innovative, theory-based interventions specifically targeting transgender women of color in their jurisdictions. An evaluation and technical assistance center was funded to evaluate the outcomes of the access to care interventions, and these findings will yield best practices and lessons learned to improve the care and treatment of transgender women of color living with HIV infection.


Assuntos
Infecções por HIV/etnologia , Serviços Urbanos de Saúde/organização & administração , Feminino , Infecções por HIV/terapia , Acesso aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Disparidades em Assistência à Saúde , Humanos , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Qualidade da Assistência à Saúde , Fatores de Risco , Serviço Social/organização & administração , Pessoas Transgênero , Estados Unidos , United States Health Resources and Services Administration , Serviços Urbanos de Saúde/estatística & dados numéricos , População Urbana
6.
Am J Public Health ; 107(2): 207-212, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27997228

RESUMO

Transgender persons are at high risk for HIV infection, but prevention efforts specifically targeting these people have been minimal. Part of the challenge of HIV prevention for transgender populations is that numerous individual, interpersonal, social, and structural factors contribute to their risk. By combining HIV prevention services with complementary medical, legal, and psychosocial services, transgender persons' HIV risk behaviors, risk determinants, and overall health can be affected simultaneously. For maximum health impact, comprehensive HIV prevention for transgender persons warrants efforts targeted to various impact levels-socioeconomic factors, decision-making contexts, long-lasting protections, clinical interventions, and counseling and education. We present current HIV prevention efforts that reach transgender persons and present others for future consideration.


Assuntos
Infecções por HIV/prevenção & controle , Pessoas Transgênero , Feminino , Humanos , Masculino , Fatores de Risco
7.
J Int AIDS Soc ; 19(3 Suppl 2): 20801, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27431472

RESUMO

Transgender (trans) activists and global health partners have collaborated to develop new tools and guidance for assessing and addressing HIV and other health needs within trans populations. Trans women experience a heavy burden of HIV and other sexually transmitted infections (STIs), high incidence of violence and difficulties accessing gender-affirming services. At the same time, little has been published on trans men's health, HIV issues, needs and experiences. Young trans people are especially marginalized and vulnerable, with few programmes and services specifically tailored to their needs. Trans-specific data and guidance are needed to adapt the global response to HIV to meet the needs of the trans population. While the needs of this group have only recently received attention, global, regional and other technical guidance documents are being developed to address these gaps. Regional blueprints for comprehensive care for trans people in Latin America, the Caribbean, and Asia and the Pacific are now available. These tools - supported by the Pan American Health Organization, World Health Organization, US President's Emergency Plan for AIDS Relief and the United Nations Development Programme, in collaboration with regional trans groups - provide a contextual map, indicating opportunities for interventions in health, HIV, violence, stigma and discrimination, social protection and human rights. Global guidance includes the World Health Organization's Policy Brief: Transgender People and HIV, and the interagency publication, Implementing Comprehensive HIV and STI Programmes with Transgender People. Community empowerment and capacity building are the focus of the new tools for global and regional transgender guidance. The goal is to strengthen and ensure community-led responses to the HIV challenge in trans populations. This article describes the new tools and guidance and considers the steps needed to use them to appropriately support and engage transgender populations within national AIDS, STI, and sexual and reproductive health responses and programmes. The time to use these tools and guidance for advocacy, strategic planning, capacity building, programme design and training is now.


Assuntos
Planejamento em Saúde , Pessoas Transgênero , Ásia , Região do Caribe , Assistência Integral à Saúde , Feminino , Infecções por HIV/prevenção & controle , Direitos Humanos , Humanos , América Latina , Masculino , Saúde Reprodutiva , Comportamento Sexual , Doenças Sexualmente Transmissíveis/prevenção & controle , Estigma Social , Pessoas Transgênero/psicologia , Nações Unidas , Organização Mundial da Saúde , Adulto Jovem
8.
J Int AIDS Soc ; 19(3 Suppl 2): 20803, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27431473

RESUMO

INTRODUCTION: The rights of trans people are protected by a range of international and regional mechanisms. Yet, punitive national laws, policies and practices targeting transgender people, including complex procedures for changing identification documents, strip transgender people of their rights and limit access to justice. This results in gross violations of human rights on the part of state perpetrators and society at large. Transgender people's experience globally is that of extreme social exclusion that translates into increased vulnerability to HIV, other diseases, including mental health conditions, limited access to education and employment, and loss of opportunities for economic and social advancement. In addition, hatred and aggression towards a group of individuals who do not conform to social norms around gender manifest in frequent episodes of extreme violence towards transgender people. This violence often goes unpunished. DISCUSSION: The United Nations Development Programme (UNDP) views its work in the area of HIV through the lens of human rights and advances a range of development solutions such as poverty reduction, improved governance, active citizenship, and access to justice. This work directly relates to advancing the rights of transgender people. This manuscript lays out the various aspects of health, human rights, and development that frame transgender people's issues and outlines best practice solutions from transgender communities and governments around the globe on how to address these complex concerns. The examples provided in the manuscript can help guide UN agencies, governments, and transgender activists in achieving better standards of health, access to justice, and social inclusion for transgender communities everywhere. CONCLUSIONS: The manuscript provides a call to action for countries to urgently address the violations of human rights of transgender people in order to honour international obligations, stem HIV epidemics, promote gender equality, strengthen social and economic development, and put a stop to untrammelled violence.


Assuntos
Direitos Humanos , Distância Social , Pessoas Transgênero , Emprego , Infecções por HIV , Humanos , Pobreza , Nações Unidas , Violência
10.
Lancet ; 388(10042): 412-436, 2016 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-27323919

RESUMO

Transgender people are a diverse population affected by a range of negative health indicators across high-income, middle-income, and low-income settings. Studies consistently document a high prevalence of adverse health outcomes in this population, including HIV and other sexually transmitted infections, mental health distress, and substance use and abuse. However, many other health areas remain understudied, population-based representative samples and longitudinal studies are few, and routine surveillance efforts for transgender population health are scarce. The absence of survey items with which to identify transgender respondents in general surveys often restricts the availability of data with which to estimate the magnitude of health inequities and characterise the population-level health of transgender people globally. Despite the limitations, there are sufficient data highlighting the unique biological, behavioural, social, and structural contextual factors surrounding health risks and resiliencies for transgender people. To mitigate these risks and foster resilience, a comprehensive approach is needed that includes gender affirmation as a public health framework, improved health systems and access to health care informed by high quality data, and effective partnerships with local transgender communities to ensure responsiveness of and cultural specificity in programming. Consideration of transgender health underscores the need to explicitly consider sex and gender pathways in epidemiological research and public health surveillance more broadly.


Assuntos
Saúde Global/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Pessoas Transgênero/estatística & dados numéricos , Transexualismo/epidemiologia , Humanos , Transtornos Mentais/epidemiologia , Transtornos Mentais/etiologia , Saúde Mental/estatística & dados numéricos , Saúde Reprodutiva/estatística & dados numéricos , Estigma Social , Pessoas Transgênero/psicologia , Transexualismo/psicologia
12.
Glob Public Health ; 11(7-8): 1060-75, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26963756

RESUMO

The frequent conflation of transgender ('trans') women with 'men who have sex with men (MSM)' in HIV prevention obscures trans women's unique gender identities, social and behavioural vulnerabilities, and their disproportionately high rates of HIV infection. Pre-exposure prophylaxis (PrEP) is an efficacious biomedical HIV prevention approach. However, trans women are underrepresented in PrEP research, and are often aggregated with MSM without consideration for their unique positions within sociocultural contexts. This study examined PrEP acceptability among trans women via three focus groups and nine individual interviews (total N = 30) in San Francisco. While knowledge of PrEP was low, interest was relatively high once participants were informed. Due to past negative healthcare experiences, ability to obtain PrEP from a trans-competent provider was cited as essential to PrEP uptake and adherence. Participants noted that PrEP could address situations in which trans women experience reduced power to negotiate safer sex, including sex work. Trans-specific barriers included lack of trans-inclusive marketing of PrEP, prioritisation of hormone use, and medical mistrust due to transphobia. Findings underscore the importance of disaggregating trans women from MSM in HIV prevention strategies to mitigate disparate risk among this highly vulnerable population.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/prevenção & controle , Promoção da Saúde/métodos , Marketing de Serviços de Saúde/métodos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Profilaxia Pré-Exposição/estatística & dados numéricos , Pessoas Transgênero/psicologia , Adulto , Feminino , Grupos Focais , Identidade de Gênero , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Promoção da Saúde/normas , Humanos , Entrevistas como Assunto , Masculino , Marketing de Serviços de Saúde/normas , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pesquisa Qualitativa , Fatores de Risco , São Francisco/epidemiologia , Pessoas Transgênero/estatística & dados numéricos , Populações Vulneráveis , Adulto Jovem
14.
J Am Med Inform Assoc ; 20(4): 700-3, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23631835

RESUMO

Transgender patients have particular needs with respect to demographic information and health records; specifically, transgender patients may have a chosen name and gender identity that differs from their current legally designated name and sex. Additionally, sex-specific health information, for example, a man with a cervix or a woman with a prostate, requires special attention in electronic health record (EHR) systems. The World Professional Association for Transgender Health (WPATH) is an international multidisciplinary professional association that publishes recognized standards for the care of transgender and gender variant persons. In September 2011, the WPATH Executive Committee convened an Electronic Medical Records Working Group comprised of both expert clinicians and medical information technology specialists, to make recommendations for developers, vendors, and users of EHR systems with respect to transgender patients. These recommendations and supporting rationale are presented here.


Assuntos
Registros Eletrônicos de Saúde , Pessoas Transgênero , Feminino , Humanos , Masculino , Sociedades Médicas , Pessoas Transgênero/classificação
15.
Arch Sex Behav ; 36(6): 768-77, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17674180

RESUMO

Prior research has shown that male-to-female (MTF) transgender women of color in the United States have a high rate of HIV infection and often engage in sex work for economic survival. With the exception of studies on HIV prevalence and behavioral risk, little research exists to elucidate the social context and determinants of sex work and related health risks among these women. Through a qualitative analysis of seven focus groups with 48 transgender women of color, we examined why and how participants became involved in sex work, documented risks associated with sex work, and explored what motivated participants to remain in sex work. Participants reported on how social networks and cultural norms, immigration issues, and experiences of racism, sexism, and transphobia influenced their decisions to enter and the risks encountered in sex work. Findings revealed that transgender women of color who engage in sex work have unique needs and experiences that must be addressed through structural and social network-based interventions to minimize their vulnerability to social and public health harms.


Assuntos
Grupos Étnicos/psicologia , Trabalho Sexual/etnologia , Trabalho Sexual/psicologia , Percepção Social , Travestismo/etnologia , Travestismo/psicologia , Mulheres Trabalhadoras/psicologia , Adulto , Afro-Americanos/psicologia , Americanos Asiáticos/psicologia , Feminino , Grupos Focais , Infecções por HIV/etnologia , Necessidades e Demandas de Serviços de Saúde , Hispano-Americanos/psicologia , Humanos , Relações Interpessoais , Modelos Logísticos , Masculino , Análise Multivariada , Fatores de Risco , São Francisco , Caracteres Sexuais
16.
Am J Public Health ; 94(7): 1193-9, 2004 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-15226142

RESUMO

OBJECTIVES: The authors examined HIV risk behaviors among African American, Asian/Pacific Islander (API), and Latina male-to-female (MTF) transgender persons in order to improve HIV prevention programs. METHODS: Individual survey interviews with MTF transgender persons of color (n = 332; 112 African Americans, 110 Latinas, and 110 APIs) were conducted. RESULTS: Prevalence and correlates of receptive anal sex and unprotected receptive anal sex (URAS) varied by type of partner (primary, casual, or commercial sex partners). URAS with primary partners was associated with drug use before sex; URAS with casual partners was associated with HIV-positive status and drug use before sex; and URAS with commercial sex partners was associated with African American ethnicity and low income. CONCLUSIONS: Findings on current risk behaviors among MTF transgender persons provided meaningful implications for HIV prevention interventions.


Assuntos
Afro-Americanos/etnologia , Americanos Asiáticos/etnologia , Infecções por HIV/etnologia , Hispano-Americanos/etnologia , Assunção de Riscos , Comportamento Sexual/etnologia , Transexualismo/etnologia , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Americanos Asiáticos/estatística & dados numéricos , Atitude Frente a Saúde/etnologia , Feminino , Grupos Focais , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Conhecimentos, Atitudes e Prática em Saúde , Hispano-Americanos/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Determinação de Necessidades de Cuidados de Saúde , Pesquisa Qualitativa , Fatores de Risco , São Francisco/epidemiologia , Comportamento Sexual/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/etnologia , Inquéritos e Questionários , Transexualismo/epidemiologia , População Urbana/estatística & dados numéricos
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