Male-to-female transgenders demonstrated unique perspectives on perceived facial attractiveness and orthognathic surgery need.

PURPOSE: The esthetic preference and decision concerning undergoing orthognathic surgery in the transgender population have not been reported. The aims of this study were to examine the influence of the sagittal mandibular position on the esthetic perception and perceived surgery need in male-to-female transgenders (MTFTs) compared with male and female laypeople. MATERIALS AND METHODS: A questionnaire study was performed by male-to-female transgender, male and female laypeople. Three-dimensional black & white male and female facial images with facial contour angle (FCA) of 3°, 1°, 5°, 9°,13°, 17°, and 21° were shown to the participants. The participants scored the images' perceived facial attractiveness using visual analog scales (VAS) and indicated whether orthognathic surgery was needed. RESULTS: The participants included 85 MTFTs, 85 males, and 85 females. The results revealed that there were significant differences in the VAS scores between the MTFT and male participants. The MTFTs rated the male images with prognathism of 1° and -3°FCA in significantly lower scores compared with the males (P = 0.033, P = 0.010). Female images with prognathism 1°FCA was rated by the MTFTs in significantly lower scores compared with the males (P = 0.041). A significantly higher number of surgery needs was found in the MTFTs compared with the other groups. CONCLUSIONS: Gender influences esthetic perception and the decision to undergo orthognathic surgery. MTFTs have a unique perspective on facial esthetics, being more desirous of surgery than males and females. Clinicians should be aware of the ideal expectation in facial esthetics in MTFTs.

F-Chin/Feminizing the Chin: A Genioplasty Technique with Virtual Planning for Male-to-Female Transgender Patients.

The chin is an essential structure in facial harmony and an important gender marker. Advancing a receding chin is fundamental to improve the facial appearance, particularly in male-to-female transgender patients. However, in patients with microgenia and/or retrognathia, desiring a more feminine appearance, a chin advancement can result in a wider, square shape; an undesirable effect. Genioplasty is a versatile procedure used in facial feminization surgery that allows modifying the natural anatomy of the chin in all three spatial dimensions. The technique herein described proposes a simple genioplasty procedure for feminizing the chin (F-chin genioplasty) in transgender patients where anteroposterior advance is required. Virtual planning was used to establish the landmarks for an anteroposterior advancement with transverse reduction in the chin. A perpendicular line to the Frankfurt plane passing through the incisal edge of the upper central incisor was used to plan the anteroposterior movement, and two vertical lines on the outer wall of the nasal cavity  for the chin transverse measurement. The authors present three case reports with the F-chin genioplasty transgender technique with satisfactory results, ensuring a more feminine facial appearance.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Uptake and impact of COVID-19 vaccination among HIV key populations: a cohort study from Tamil Nadu, India.

Objective: Human Immunodeficiency Virus (HIV) Key Populations (KPs) include Female Sex Workers (FSWs), men who have sex with men (MSM), transgender (TG), and transsexual (TS) persons. This study assessed coronavirus disease 2019 (COVID-19) vaccine uptake among KPs for HIV in India, adverse events following immunization (AEFI), and breakthrough infections among the vaccinated. Materials and Methods: This retrospective cohort study was conducted among 421 KPs enrolled in 41 Targeted Intervention (TI) clusters in 31 districts of the Tamil Nadu State Acquired Immunodeficiency Syndrome (AIDS) Control Society (TANSACS), India, from June to September 2022. A semi-structured, bilingual (English and Tamil), interviewer-administered questionnaire was used to collect data on socio-demographic characteristics, vaccination status, AEFIs, and breakthrough infections among the KPs under the TIs. Results: Among the KPs, 45.4% were FSWs, 37.1% were MSM, 16.2% were TG, and 1.4% were TS persons. Among them, 4.3% had HIV, and 2.9% had syphilis or other sexually transmitted infections (STIs). The COVID-19 vaccine uptake rate was 96%. Among the KPs, TG/TS persons had the highest vaccine uptake (98.6%), followed by FSWs (96.3%) and MSM (94.2%). AEFIs were reported by 85.4% of the participants. HIV positive status was significantly associated with the incidence of AEFI. The breakthrough infection rate was 5.4% among the vaccinated participants. Conclusion: The COVID-19 vaccine uptake among HIV KPs was high in Tamil Nadu. AEFIs and breakthrough infections among COVID-19 vaccinated HIV KPs may be low, with mild AEFIs.

Raising the alarm: Mental health status of the transgender community in Pakistan.

In Pakistan, the transgender community faces many challenges. Transgender identity is considered taboo and people tend to distance themselves from them without knowing their issues. They face difficulties seeking education, jobs, and even basic human rights. They also face violence and social exploitation. Due to the lack of support from their family members, they're more prone to develop psychological problems and suicidality. Trans rights are human rights - the purpose of our paper is to expose the dire state of mental health of the transgender community in Pakistan on an international platform. We aim to bring a global concern to this problem because we hope that it will spur the relevant authorities to take steps to mitigate the current situation. Special attention should be paid to the protection and education of transgender individuals. If they're suffering from any psychiatric disorder, healthcare professionals should be there to help them.

The pattern of tobacco use and the associated socio-demographic factors among Transgenders living in Chennai city of Tamil Nadu, India.

Introduction: The tobacco epidemic is one of the biggest public health threats the world has ever faced, which kills more than 8 million people a year around the world. Transgenders are prone to use and abuse substances including tobacco and alcohol as a coping mechanism to manage minority stress experienced due to high levels of discrimination and lack of acceptance by society. Objectives: Among transgenders living in Chennai city, Tamil Nadu, (1) we aimed to estimate the prevalence and describe the pattern of tobacco use and (2) identify the sociodemographic factors associated with tobacco use. Methods: A community-based cross-sectional analytical study was conducted among 734 transgender adults living in the Chennai city of Tamil Nadu. A pre-tested, semi-structured interview schedule was used. Descriptive statistics such as frequency and proportions were used for categorical variables. Chi-square test was applied to find the significance of the association between tobacco use and sociodemographic factors. Results: The prevalence of the current use of any form of tobacco products among transgenders was 64.4%. About 27% had tried to stop using tobacco during the past 1 year. Education status, socioeconomic class, and occupation were significantly associated with the current use of any form of tobacco and trying to quit tobacco use. Conclusion: The prevalence of tobacco use among transgenders is alarming. The present study findings highlight the need to increase awareness activities by health authorities and non-government organizations (NGOs)/community-based organizations (CBOs) to generate awareness about the health hazards of tobacco use among transgenders. Tobacco control programs focussing on transgenders are essential.

Chemsex and its risk factors associated with human immunodeficiency virus among men who have sex with men in Hong Kong.

We were intrigued by Hanum et al, who published a study on the prevalence of human immunodeficiency virus (HIV) in homosexual, bisexual, and other men who have sex with men at sexual health clinics in England and the relationship between baseline variables and future HIV occurrence. Chemically-enhanced sexual experience (chemsex) is becoming a global phenomenon. There are increasing medical and academic concerns about chemsex, where substances are used to boost sexual satisfaction, which is prevalent in groups, especially among homosexuals. Lesbians, gays, bisexuals, transgenders, and queers have become increasingly visible, valued, and committed community. However, chemsex requires urgent attention.

Assessment of oral health status and treatment needs of HIV positive transgenders in Odisha - a cross-sectional study.

Introduction: Human Immunodeficiency virus (HIV) causes the human immunodeficiency infection which is a major global health problem. Oral health status of people infected by HIV is also compromised. There is limited literature on oral health status of HIV/AIDS transgenders in Odisha. Aim: This study was conducted to assess the oral health status of HIV-positive transgenders. Methodology: A cross-sectional study was conducted among the HIV positive transgenders in Odisha. Snowball sampling technique was employed to reach the population. Oral health was recorded using modified WHO 2013 proforma. Clinical examination using disposable mouth mirror and explorer. Chi square statistics was used for finding the association between the socio-demographic variables and DMFT, CPI, and LOA scores. Results: The study included 153 participants out of which seventy participants belonged to the age group 18-30 years. Majority of the participants were unemployed and most of them had spent around 6-10 years in school. Majority of the participants used toothbrush for cleaning their teeth and the average duration of cleaning tooth was less than two minutes. Toothpick was the most common method used for cleaning interdental areas and none of the participants used dental floss or interdental brushes. The mean DMFT score which was recorded to be 1.424. Around 28.10% (43) inmates had pockets of depth 4 mm to 5 mm. Loss of attachment of 6 mm to 8 mm was found in majority (57, 37.25%) of the participants. Most of the participants did not require any prosthesis both in the upper and lower arches. Around 32 participants (20.91%) had very mild fluorosis, 29 participants (18.95%) exhibited signs of moderate fluorosis. Age was found to be significantly associated with loss of attachment score (p = 0.023). Occupation had an association with the DMFT score (p = 0.002) while years in school was found to be significantly associated with CPI score (p = 0.045). Conclusion: The oral health status of transgenders is poor and needs immediate attention.

Assessment of oral mucosal lesions among HIV positive transgenders residing in Odisha with and without Antiretroviral therapy.

Purpose/Background: Transgenders are a highly vulnerable subset within the high-risk group for human immunodeficiency virus (HIV) in India. Oral manifestations are among the early signs of HIV infection. This study was conducted with the aim to assess the oral mucosal lesions among the HIV-positive transgenders in Odisha taking antiretroviral therapy as well as those not taking antiretroviral therapy. Methods: A cross-sectional study was carried out among HIV-positive transgenders in four districts of Odisha. Snowball nonprobability sampling technique was adopted, and type IV clinical examination was performed using the modified WHO record form for oral manifestations in HIV/AIDS (2013). Independent sample t test was used to compare mean age among those taking ART with those not taking ART. Chi-square test was used to detect the associations among categorical variables. Results: The study comprised of 163 participants, 109 (71.24%) who were taking antiretroviral therapy, while 44 (28.76%) not taking antiretroviral therapy. The mean age was 32.56 + 7.69 years. Sex work was the most predominant occupation. Majority of the participants reported of having hyperpigmentation of different parts of oral mucosa. Aphthous ulcer and angular cheilitis was noticed in 14.72% and 9.20%, respectively. Other manifestations noticed included erythematous candidiasis, pseudomembranous candidiasis, oral hairy leukoplakia, necrotizing ulcerative gingivitis, necrotizing ulcerative periodontitis, herpetic stomatitis/gingivitis and/or labialis, herpes zoster, warty like lesions/human papillomavirus, other ulcerations (not otherwise specified/necrotizing ulcerative stomatitis), and dry mouth due to decreased salivary flow. Conclusion: Careful evaluation of oral manifestations can improve the quality of life of these marginalized, highly vulnerable population.

Stroke in Male-to-Female Transgenders: A Systematic Review and Meta-Analysis.

BACKGROUND: The effect of hormonal therapy has been extensively studied in women. However, similar data on male-to-female (MTF) transgenders, another important population that receives hormonal therapy is lacking. Existing studies in MTF transgenders are skewed toward mental health and health-harming behaviors while few have focused on chronic health conditions. Our study aims to review the existing data on stroke in MTF transgenders and perform a quantitative analysis on the frequency of this condition in this special population. METHODS: PubMed, Cochrane, Scopus, Embase, ClinicalTrials.gov, and Web of Science were systematically searched for studies that reported data on the occurrence of cerebrovascular diseases in MTF transgenders. We reported the hormonal regimens, clinical characteristics, and outcomes of stroke in MTF transgenders. A meta-analysis of proportions was performed by the random-effects model to compute for the frequency of cerebrovascular events in MTF transgenders. RESULTS: Fourteen studies were included in the qualitative analysis while five studies were included in the quantitative analysis. A total of 109 MTF transgenders (Mean 14; range 1-53) suffered a cerebrovascular event. Random-effect modeling analysis showed an overall estimated frequency of 2% for cerebrovascular events in transgenders with a moderate degree of heterogeneity (I2 = 62%). CONCLUSION: Hormonal therapy in MTF transgenders may confer cardiovascular risks in this population. However, more population-based studies that include clinical characteristics and outcomes of chronic health diseases in MTF transgenders are warranted. Such studies may be crucial in directing future guidelines on the health care and management of MTF transgenders.

Level of Resilience Among Transgenders in Selected Areas of Puducherry, India: An Exploratory Research.

Background Resilience is the process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress, and it is a predictor of mental health status that specifically indicates self-esteem, perceived social support, emotion-oriented coping, and a sense of personal mastery. The third gender known better as transgender has existed in every culture, race, class, and religion since the inception of human life has been recorded and analyzed. In spite of many advances and reforms, the current plight of transgender is far from being satisfactory. The social integration of transgender with the mainstream community is practically non-existent even today. Aim and objective The objective of the study is to assess the level of resilience among transgenders at selected areas in Puducherry, India, and to find out the association between the levels of resilience among transgenders with the selected demographic variables. Methods A descriptive cross-sectional study was conducted in the selected areas of Puducherry, India, adopting a linear snowball sampling method after consultation with the Nayaks (heads of transgenders) of the transgender groups, and 100 transgenders were enrolled who fulfilled the inclusion criteria and consented to participate in the research. Results About 29 (29%) transgenders were in the age group of 31-40 years, 28 (28%) were in the age group of 21-30 years, 24 (24%) were in the group of 41-50 years, and 19 (19%) were in the age group of 51 and above. In education status, 38 (38%) had secondary education, 23 (23%) had primary education, 20 (20%) had higher secondary education, 12 (12%) had graduation and above, and seven (7%) were diploma holders. Moreover, 54 (54%) were employed, and 46 (46%) were unemployed; 81 (81%) were residing in rural areas, and 19 (19%) were residing in urban areas. The study revealed that 53 (53%) of them had average resilience, 28 (28%) had the least resilience, and 19 (19%) had the highest resilience among transgenders. The minimum score was 28.0, and the maximum score was 52.0. The mean score was 42.50 with a standard deviation of 4.61. The median value was 43.0. Conclusion Transgenders exhibit low and average resilience that reflects poor mental health status among them. The educational status was found to be associated with the level of resilience. Proper education among transgenders would help in improving their resilience and betterment of their life.

Exploring the barriers for eye care among transgenders and commercial sex workers in Pune, Maharashtra.

PURPOSE: To explore all possible barriers faced by transgenders (TG) and commercial sex workers (CSW) in accessing eye care in Pune city in western India. METHODS: This qualitative study was conducted at a tertiary eye care center in Pune. Interview topic guides for face-to-face interviews and focused group discussions were developed. Comprehensive eye check-up was organized in the residential localities of TG and CSW communities in Pune. Those with severe visual impairment or blindness were identified. A sample of TGs and CSWs from this group was purposively selected and invited to participate in this study. Face-to-face interviews were conducted with each TG and CSW. A group of health care providers and NGO workers serving these communities were invited to participate in focused group discussions. All interviews/discussions were audio recorded, transcribed, and translated into English. A qualitative software (N vivo 12, QRS International, Australia) was used to identify various themes and subthemes under each domain of barriers. RESULTS: A total of 24 people (6 each from TGs, CSWs, health care provider, and NGO worker groups) participated in this study. The most common barriers reported were social stigma, discrimination, poverty, financial exclusion, and mental health factors. Non availability of gender-neutral facilities in clinics was a unique barrier reported by TGs. CONCLUSION: Marginalized communities of TGs and CSWs in Pune face several previously unexplored and unique barriers for access to eye care despite the availability of services in the vicinity.

Coming Out of the Closet, Also on the News? A Longitudinal Content Analysis of Patterns in Visibility, Tone and Framing of LGBTs on Television News (1986-2017).

This study documents the results of a longitudinal content analysis of television news about LGBT people in terms of visibility, active representation, tone and framing in Flanders (1986-2017). While attention for LGBT issues has increased over time, LGBTs are not more likely to be visually represented or granted a voice. Gay men are more often actively represented than lesbians and transgender people. News remains negatively biased, although news stories in which LGBT people are depicted as the cause of negativity have become less prevalent. Patterns in framing have shifted: Deviance and abnormality frames have decreased in favor of a rise in equal rights and victim frames. Patterns in tone and framing were similar for gay men, lesbians and transgender people. Results suggest that journalists have shifted from problematizing homosexuality to problematizing homophobia. Implications of news as a source of mass-mediated contact to promote tolerance toward LGBT people are discussed.

Improving the care management of trans patients: Focus groups of nursing students' perceptions.

AIM: To know the perspectives of nursing students in trans patients' care and their access to health services and how to improve the quality of care in trans patients, related to the barriers identified by nursing students. BACKGROUND: Lesbian, gay, bisexual, transgender, queer and plus (LGBTQ+) find barriers related to the health care access, including stigma, discrimination and lack of education. In addition, to the transphobia reported in some health care providers. METHODS: A descriptive qualitative study was performed through 12 focus group interviews in nursing students. Data analysis was based on content analysis. RESULTS: 124 first-year nursing students participated. The qualitative analysis resulted in three major themes: (a) Exposing an invisible reality, (b) Interprofessional communication: a starting point to arise awareness and (c) Care with pride as a link between individuality and professionalism. CONCLUSIONS: Our findings suggest that both LGBTQ+ content and institutional resources are the cornerstone for nursing students and professionals' practice in order to develop and provide a well-informed and high-quality care delivery to these patients. IMPLICATIONS FOR NURSING MANAGEMENT: Policymakers, senior charge nurses and other managers should be aware of the structural-level changes identified and ongoing mentoring needed to guarantee trans patients' privacy and safety.

High levels of non-communicable diseases risk factors among transgenders in Puducherry, South India.

CONTEXT: Identification and documentation of risk factors for non-communicable diseases (NCDs) among an 'invisible community' like the transgenders (TGs) will throw light on the prevailing health status of one of the most marginalized populations in India, thereby paving way for initiating measures that would cater to their healthcare needs. AIMS: To estimate prevalence of risk factors for NCDs among TGs registered in a community-based organization in Puducherry. SETTINGS AND DESIGN: A cross-sectional descriptive study among adult (≥18 years) TGs in a community-based organization in Puducherry. METHODS AND MATERIAL: Data on sociodemographic details, selected risk factors of NCDs-alcohol use, tobacco use, physical inactivity, obesity, unhealthy diet, hypertension, and self-reported diabetes mellitus (DM) were collected using a pre-tested structured questionnaire. Dependence levels on tobacco and/or alcohol were obtained using "Fagerstrom Addiction Scale" and "Alcohol Use Disorder Identification Test" scales, respectively. STATISTICAL ANALYSIS USED: Data were single entered using EpiData and analyzed using EpiData Analysis. RESULTS: Of the 200 TGs included in the study, mean (SD) age was 30 (8.8) years. Around 47% belonged to upper-lower socioeconomic class. About 90% of the participants had unhealthy dietary practice, 84% were physically inactive, 41% had high waist hip ratio, 36% were obese, 16% had high blood pressure, and 8% had self-reported DM. Prevalence of tobacco use was 43.5% with high nicotine dependence noted in 29% (23/79) of smokeless tobacco users and 12% (2/17) of smokers. Alcohol use was reported among 64.5% of which one fifth had possible dependence. CONCLUSION: Prevalence of selected risk factors for NCDs was high among TGs when compared to general population in Puducherry, which warrants targeted health interventions and priority in policy planning.

Influence of Sexual Genotype and Gender Self-Perception on Sociosexuality and Self-Esteem among Transgender People.

Empirical data from studies with both heterosexual and homosexual individuals have consistently indicated different tendencies in mating behavior. However, transgenders' data are often overlooked. This exploratory study compared levels of sociosexuality and self-esteem between transgenders and non-transgender (cisgender) individuals. The aim was to verify whether either sexual genotype or gender self-perception had more influence on the examined variables in transgenders. Correlations between self-esteem and sociosexuality levels were also investigated. The sample consisted of 120 Brazilian individuals (51 transgenders) from both sexes. Sociosexuality scores indicated mostly sex-typical patterns for transgenders of both sexes across the construct's three dimensions (behavior, attitude, and desire), except for female-to-male transgenders' behavioral sociosexuality. Unique associations between the dimensions of sociosexuality were found for transgender participants. No differences in self-esteem were observed and no correlations between self-esteem and sociosexuality were found. The results suggest that transgenders' sociosexuality is largely influenced by their sexual genotype despite their incongruent gender self-perception and that the relationships between behavior, attitude, and sociosexual desire are different from those observed in cisgenders.

Notícias sobre a nova classificação das identidades trans: uma análise das fontes citadas em reportagens publicadas no Brasil / News about the recent classification of trans identities: an analysis of the sources cited in reports published in Brazil / Noticias sobre la nueva clasificación de las identidades trans: un análisis de las fuentes citadas en reportajes publicados en Brasil

A divulgação da décima primeira edição da Classificação Estatística Internacional de Doenças e Problemas Relacionados com a Saúde (CID-11), em junho de 2018, mereceu atenção da imprensa internacional e nacional. Nessa versão, as identidades trans deixaram de ser classificadas como doença mental e foram categorizadas como incongruência de gênero no novo capítulo relacionado à saúde sexual. Considerando que práticas discursivas conformam e são conformadas por práticas sociais e que o processo de despatologização é marcado pelos conceitos de medicalização e biomedicalização, este trabalho identifica e analisa as fontes citadas na cobertura jornalística produzida no Brasil. O objetivo é entender, a partir dos atores sociais que foram selecionados, entrevistados e citados como fontes, os sentidos construídos pelos principais jornais do país sobre o tema. Observa-se que fontes institucionais do campo da saúde concorrem com outras do campo jurídico, com representantes de movimentos sociais e pessoas trans, que falam por si.

The release of the eleventh edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) in June 2018 received international and national press coverage. In this version, transgender identities are no longer described as a mental health condition. Instead, they are classified as gender incongruence in the chapter on sexual health. Considering that discursive practices conform and are conformed by social practices and that the process of despatologization is marked by the concepts of medicalization and biomedicalization, this work identifies and analyzes the sources quoted in the journalistic coverage produced in Brazil. This study, focusing on social actors quoted as sources, aims to understand the meanings constructed by the main Brazilian newspaper about this subject. It concludes that institutional sources in the health field compete with others in the legal field, with members of social movements and trans people, who speak for themselves.

La divulgación de la undécima edición de la Clasificación Estadística Internacional de Enfermedades y Problemas relacionados con la Salud (CID-11), en junio de 2018, mereció atención de la prensa internacional y nacional. En esa revisión, las identidades trans dejaron de ser clasificadas como enfermedad mental y fueron categorizadas como incongruencia de género en el nuevo capítulo relacionado a la salud sexual. Considerando que las prácticas discursivas conforman y son conformadas por prácticas sociales y que el proceso de despatologización está marcado por los conceptos de medicalización y biomedicalización, este trabajo identifica y analiza las fuentes citadas en la cobertura periodística producida en Brasil. El objetivo es entender, a partir de los actores sociales que fueron seleccionados, oídos y citados como fuentes, los sentidos construidos por los principales diarios del país sobre el tema. Observa que fuentes institucionales del campo de la salud concurren con otras del campo jurídico, con representantes de movimientos sociales y personas trans, que hablan por sí.

Righting the Misperceptions of Men Having Sex with Men: A Pre-Requisite for Protecting and Understanding Gender Incongruence in Vietnam.

Protecting the rights of the lesbians, gays, bisexuals, transgender, intersex, and queers (LGBTIQ) population requires, first and foremost, a proper understanding of their sexual orientation and gender identity. This study highlights a severe misunderstanding and lack of knowledge among health professionals in Vietnam with regard to the men who have sex with men (MSM) and transgenders. This study uses (i) a survey based on the convenience sampling method among 150 health workers that covered 61 questions and (ii) 12 in-depth interviews in two metropolitan centres in Vietnam, Hanoi and Ho Chi Minh city. Three main topics are explored: (i) the general knowledge of healthcare workers about MSM and transgenders; (ii) their knowledge about the sexual reproductive health and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) risks of MSM and transgenders; and (iii) their attitudes and behaviors towards MSM and transgenders. One of the notable findings is how prevalent the misperceptions are across the board, namely, in staff of both sexes, in both cities, at various kinds of medical facilities, at different work positions and educational levels. Half of the respondents consider transgenders to have a curable mental problem while 45% say MSM only have sex with males. Most remarkably, 12.7% state if they have any choice, they want nothing to do with MSM and transgenders. The study finds there is a considerable percentage of health professionals who lack knowledge about the diversity of sexual orientation, gender identity, and health issues related to the sexual minorities and gender non-conforming population. To improve the clinical process for serving these at-risk groups, the study suggests the continual education for the health workers needs to be added to their formal as well as in-job training.

Relationship Of Suicide Attempt With Depression And Other Socio-Demographic Factors Among The Transgenders.

BACKGROUND: This study was conducted assess the frequency of suicide attempt among the transgender population and analyse the relationship of depression and other socio-demographic factors with the suicide attempt Cross-sectional study. METHODS: The sample population comprised of one hundred and forty-eight transgender people of Rawalpindi and Islamabad. Suicidal attempt was assessed by the simple question that "Have you ever performed an action with the intent to take your own life in your life time?" Answer of yes or no was recorded. Hamilton rating scale for Depression (HAM-D) was used to look for the presence of depression among the target population. Relationship of the age, smoking, family income, illicit substance use and depression was studied with the presence of suicidal attempt among these transgender population of twin cities of Pakistan. RESULTS: A total of 148 transgender people were included in the final analysis. Mean age of the study participants was 38.24±3.18. Out of these, 70.9% had no suicidal attempt in their whole life while 29.1% had one or more suicidal attempts during the course of their life. Twelve had more than one suicidal attempt while 19 had attempt in last one year. Fifty-five did not showed depression while 93 had depression on HAM-D. With binary logistic regression we found that presence of depression and low income had significant association with the presence of suicidal attempt among the target population. CONCLUSIONS: This study showed a high prevalence of suicidal attempts among the transgender population of twin cities of Pakistan. Routine screening for mental health problems should be performed on this high-risk group and adequate employment resources should be generated in order to enable them to earn their livelihood and prevent them from making attempts to take their own life.

Relationship between network operators and risky sex behaviors among female versus transgender commercial sex workers in Pakistan.

Unprotected sex among commercial sex workers (CSWs) remains a leading cause of HIV transmission internationally. Previous research on condom use among CSWs has focused on females, with limited research among transgenders or on the role of network operators who mediate paid sexual transactions. We test whether network operators increase the likelihood of condom use among female and transgender CSWs in four Pakistan provinces using the 2011 Integrated Behavioral and Biological Survey. We find that transgender CSWs recruiting clients through network operators had higher odds of consistently using condoms compared with female CSWs recruiting clients through another source (relative OR: 2·80, 95% CI: 1·67, 4·70). While transgender CSWs in Pakistan using network operators have higher rates of condom use, however, this protective effect does not hold among females. This suggests that network operators may be a valuable group to target for HIV prevention efforts.

An update on HIV in transgenders of Pakistan

Objective: HIV is a worldwide contagious disease and recent emergence in transgenders reflecting the alarming situation in Pakistan. Transgender people are one of the most affected groups by the HIV epidemic and are 49 times more likely to be living with HIV than the general population. HIV is an emerging disease in Pakistan. Transgender people in Pakistan often face legal, economic, social and religious exclusion. Even though research on HIV/AIDS has conducted since several years ago, still we have a little knowledge about HIV in transgender people. This study aims to investigate the current status of HIV infection among Pakistan transgender population. Methods: Overall cases of HIV in 2017 were retrieved from all four provinces of Pakistan by using all available published data. Results: In 2017, totally 66 264 positive HIV cases were reported in transgenders from Punjab (n=52 656), Sindh (n=13 596) and KPK (n=22) provinces of Pakistan. In Sindh province majority of the patients were from Karachi (n=9 123) followed by Hyderabad (n=1 062), Sukkur (n=1 609), Larkana (n=1 130), Mirpurkhas (n=289) and Nawabshah (n=383), respectively while in Khyber Pakhtunkhwa (KPK), the number of HIV/AIDS transgender patients increased up to 450, out of which 22 cases were registered under provincial AIDS control program in 2017. Conclusions: More efforts by international agencies are needed to combat HIV among transgender communities in Pakistan. Government and NGOs should collaborate to find some strategies for control and prevention of HIV. Social and human rights activists should help and encourage them mainly at the point where their legal rights are not respected. Transgender communities and health department should go hand in hand. Initiatives should be taken to link social justice, human rights, health and advocacy to prevent HIV among transgender in near future.