High HIV Incidence Among Young and Racial/Ethnic Minority Transgender Women in San Francisco: Results of a Longitudinal Cohort Study

JAIDS Journal of Acquired Immune Deficiency Syndromes, Год журнала: 2020, Номер 84(1), С. e7 - e10

Опубликована: Фев. 7, 2020

To the Editors: The past decade has seen progress toward getting to zero HIV infections in San Francisco overall. New diagnoses dropped from 521 2008 197 2018, a 62% decrease.1 incidence estimated by CD4 model2 corroborates parallel, commensurate drop incident infections, projected 330 2013 190 2017.1 Unfortunately, there is insufficient sample size estimate separately for smaller populations who may have elevated risk. Directly measured rates of seroconversion observed longitudinal studies are logistically difficult and costly therefore rare.3 Limitations resources substantial estimating or measuring among transgender women (hereafter "trans women"), population with highest burden Francisco1,4 many parts world.5 We report results TransNational Study Francisco, primary aims which measure rate identify predictors acquisition trans women. present analysis focuses on identifying demographic disparities risk, particularly testing hypotheses whether higher young, members racial/ethnic minority groups, living poverty, homeless based differences prevalence recent trends new Francisco.1 Trans were defined being assigned male sex at birth currently as other than gender. enrolled into cohort using long-chain peer-referral method previously used accrue young Francisco6 men (MSM) Nanjing, China.7 In brief, initial seeds identified diverse social networks instructed refer eligible study. Participants interviewed face-to-face demographics risk behaviors tested HIV. negative 18 years older eligible. retested 6, 12, months. seroconverted linked care. an density approach (ie, number events divided person-time follow-up) calculate seroconversion. Incidence ratios compare subgroups assuming Poisson distribution. When subgroup had seroconversions, we calculated 97.5% one-sided confidence intervals (CI) compared groups Z-test. Referrals prevention programs, including pre-exposure prophylaxis (PrEP), offered each visit. given $55 completion survey their visit, increasing $70 18-month $20 referral protocol was approved Human Research Protection Program University California Francisco. provided written informed consent. Of 415 enrollment agreed follow-up, 377 visit 8 time (92.6% retention). seroconversions occurred over 604 person-years (py) follow-up 1.3 per 100 py (95% CI: 0.7 2.7) (Table 1).TABLE 1.: Among Women Longitudinal Cohort, 2017–2019Several noted. aged 18–24 significantly (3.7 py; 95% 1.2 11.6) those 25 (1.0 0.4 2.3, P = 0.04). Age categories above collapsed because they similar magnitude. Latina/x (2.6 1.1 6.1, 0.03) color (2.2 4.3, 0.01) white been incarcerated (2.3 4.8, 0.04) without health insurance (5.8 1.5 23.2, 0.02) also incidence. estimates comparison rare. Twenty ago, retrospective cohort, arriving 7.8 4.6 12.3).8 suggests decline current level. Serial cross-sectional surveys show infection sustained high levels several years.4 recognize overinterpreting data seroconversions. Small numbers miss true associations population. acknowledge potential Hawthorne effects. Multiple assessments, testing, such PrEP, likely dampen incidence, underestimating Other note challenges iPrEx trial PrEP efficacy able enroll 339 2499 total participants across 11 sites.9 researchers cite difficulties determining preventive effects specifically them. combine MSM separate them analysis.5 For example, key Bangkok 10 unable distinguish between women.10 concur these strong need trans-specific studies, benchmark measures randomized controlled trials endpoints. On hand, fact that find some speaks magnitude Significant correlates found our echo concerns emerging citywide surveillance data.1 Despite decreases overall, increased black/African Americans people. Prior color.4,8 History incarceration lack point structural drivers continued must be addressed. Structural risks housing instability, low income, education factors work more prevalent color.11–13 Instability preclude completing steps required establish care public system where biomedical available. disproportionately affecting tied poor outcomes suboptimal access use.14,15 Such exacerbated city, wide wealth, housing, employment opportunities.16 Perhaps, most disheartening finding nearly four-fold youth predicts continuing come. era intensifying efforts get 2030,17 any 1 worrisome reminder endgame eliminating see diminishing returns remaining cases occur marginalized communities.

Язык: Английский

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Intercategorical and Intracategorical Experiences of Discrimination and HIV Prevalence Among Transgender Women in San Francisco, CA: A Quantitative Intersectionality Analysis

American Journal of Public Health, Год журнала: 2021, Номер 111(3), С. 446 - 456

Опубликована: Янв. 21, 2021

Objectives. To examine differences in HIV prevalence and experiences of discrimination within the trans women community California's San Francisco Bay Area.Methods. Intersectional positions were constructed on basis race/ethnicity (non-Hispanic White, non-Hispanic Black, Latina) gender identity (female identifying, transgender identifying). We used baseline data from Trans*National study (2016-2017) to construct regression models that estimated racial/ethnic attribution experienced and, along with surrogate measures for intersectionality, risk among those who dually marginalized (racial/ethnic minority Margins plots visually compare absolute across all intersectional positions.Results. Black Latina more likely be positive than White women. In several domains, we a lower reporting female-identifying women.Conclusions. Quantitative intersectionality methods highlight diversity reveal potential measurement challenges. Despite facing multiple forms systemic marginalization, report less Subjective undercounts risks minorities.

Язык: Английский

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A narrative exploration of the importance of intersectionality in a Black trans woman’s mental health experiences

International Journal of Transgender Health, Год журнала: 2020, Номер unknown, С. 1 - 14

Опубликована: Ноя. 9, 2020

Background: The current United States presidential administration's statements and policies have, in a shockingly short time, catastrophically affected people of color LGBTQIA + communities. And although these numerous discriminatory policy revisions have negatively both US people, trans women been disproportionately affected. Even more specifically, when focusing on vulnerability to violence-including murder-it is Black who are most directly by the intersections transphobia racism US. This article explores woman's experiences with mental health professionals across two decades different regions Aims: argues for necessity understanding people's as necessarily intersectional, order fully appreciate address degrees which factors such race, socioeconomic class, geographic context matter efforts access ethical effective healthcare. Methods: Using theoretical framework informed Kimberlé Crenshaw's single-axis concept, authors center Aryah's intersectional counter exploring issues, our relies narrative-based approach. As narrative inquiry broad field, we selected Butler-Kisber's analytic approach, "Starting Story" method. narratives pulled from approximately 10 intensive qualitative interviews over course several months. Discussion: These disrupt common threads literature that ignore race class alongside being woman. In addition, noted nearly all relied large-scale survey-based data, this offers exploration works humanize challenges needs, while emphasizing multilayered oppressions obstacles Aryah.

Язык: Английский

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Brief Report: Young Age and Sex Work Are Associated With HIV Seroconversion Among Transgender Women in São Paulo, Brazil

JAIDS Journal of Acquired Immune Deficiency Syndromes, Год журнала: 2021, Номер 88(1), С. e1 - e4

Опубликована: Май 30, 2021

Transgender women worldwide have the highest prevalence of HIV and lowest access to prevention among groups at risk HIV. However, few longitudinal studies directly measured incidence identified predictors acquisition transgender women.São Paulo, Latin America's largest city.We conducted a study in São Paulo. Participants were recruited by long-chain peer referral process from May 2017 July 2019. Those aged 18 years older who HIV-negative baseline retested every 6 months up months. was calculated dividing number seroconversions person-years (PYs) follow-up; 95% confidence intervals (CIs) constructed assuming Poisson distribution. Conditional maximum likelihood ratios assessed differences factors.A racially/ethnically diverse sample 545 enrolled. In 485.5 PYs follow-up, 13 observed, yielding an 2.68 per 100 (95% CI: 1.43 4.58). significantly higher 18-24 (rate ratio 3.85, 1.24 12.93) those engaged sex work preceding month 5.90, 1.71 26.62).HIV transmission continues high rate Brazil. Factors such as young age, lower level education, limited employment opportunities may lead dependence on that turn increases risk. Transgender-friendly services, particularly programs delivering pre-exposure prophylaxis, are urgently needed.

Язык: Английский

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Considering intersectionality in acculturation: Bringing theory to practice

International Journal of Intercultural Relations, Год журнала: 2022, Номер 91, С. 150 - 157

Опубликована: Окт. 7, 2022

Язык: Английский

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High and Stable Human Immunodeficiency Virus Prevalence Among Transwomen With Low Income Recruited With Respondent-driven Sampling, San Francisco, 2010–2016

Sexually Transmitted Diseases, Год журнала: 2018, Номер 46(2), С. 118 - 124

Опубликована: Сен. 26, 2018

Studies have documented high human immunodeficiency virus (HIV) prevalence among transwomen in the United States; however, to our knowledge, no studies trends HIV this population.We used respondent-driven sampling sample San Francisco for 3 and behavioral surveys 2010, 2013, 2016. Our analysis of point estimates were weighted method.Human by serological testing survey was 38.8% (95% confidence interval [CI], 32.4-45.2), 33.7% CI, 25.9-41.5), 31.6% 12.2-38.1) 2016, respectively. Disparities higher black, Latino, Asian race/ethnicity lower education level persisted through 2016.Based on a statistical test trend, has remained stable from 2010 Human infection is still highest at compared any other group Francisco. We also observed that older had significantly odds living with than younger women over last 2 waves data collection. Taken together, these suggest there declining incidence new infections low-income Moreover, transwomen, disproportionately affects color.

Язык: Английский

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Exploring the Association Between Gender Affirmation and PrEP use Among Transgender Women in New York City

AIDS and Behavior, Год журнала: 2022, Номер 27(5), С. 1523 - 1530

Опубликована: Дек. 27, 2022

Язык: Английский

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Prevalence and correlates of substance use and associations with HIV-related outcomes among trans women in the San Francisco Bay Area

BMC Infectious Diseases, Год журнала: 2022, Номер 22(1)

Опубликована: Ноя. 26, 2022

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

Язык: Английский

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“Scars on Your Heart and PTSD in Your Mind”: Transmisogynoir and the Well-Being of Black Transgender Women in Los Angeles

Journal of Prevention and Health Promotion, Год журнала: 2024, Номер unknown

Опубликована: Июль 26, 2024

Black transgender women (BTW) are subjected to transmisogynoir, as intersectional minority stress and violence that increases their risk of negative well-being. The purpose this study was explore themes well-being in a group BTW Los Angeles, California, from perspectives. Ten participants were interviewed, data analyzed using consensual qualitative research. This article focused on around transmisogynoir (a) mental well-being, (b) social determinants health, (c) help seeking. Recommendations for interventions future directions promote wellness provided.

Язык: Английский

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Gender-affirming healthcare for incarcerated transgender and gender diverse people: an international scoping review

International Journal of Transgender Health, Год журнала: 2024, Номер unknown, С. 1 - 19

Опубликована: Дек. 20, 2024

Background Transgender and gender diverse (TGD) people face unique challenges have distinct needs while incarcerated. Gender-affirming healthcare improves mental health outcomes supports transition. While in recent years, correctional institutions begun to recognize address the gender-affirming of TGD people, there is a lack understanding awareness people's experiences when accessing

Язык: Английский

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