scholarly journals Perceived Barriers and Facilitators to Integrating HIV Prevention and Treatment with Cross-Sex Hormone Therapy for Transgender Women in Lima, Peru

2017 ◽  
Vol 21 (12) ◽  
pp. 3299-3311 ◽  
Author(s):  
Sari L. Reisner ◽  
Amaya G. Perez-Brumer ◽  
Sarah A. McLean ◽  
Javier R. Lama ◽  
Alfonso Silva-Santisteban ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Hormone Therapy ◽  
Transgender Women ◽  
Sex Hormone ◽  
Perceived Barriers ◽  
Barriers And Facilitators ◽  
Prevention And Treatment

scholarly journals Integration of Gender-Affirming Primary Care and Peer Navigation With HIV Prevention and Treatment Services to Improve the Health of Transgender Women: Protocol for a Prospective Longitudinal Cohort Study (Preprint)

2019 ◽  
Author(s):  
Javier R Lama ◽  
Kenneth H Mayer ◽  
Amaya G Perez-Brumer ◽  
Leyla Huerta ◽  
Hugo Sanchez ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Hiv Prevention ◽  
Hormone Therapy ◽  
Transgender Women ◽  
Treatment Services ◽  
Prevention And Treatment ◽  
Gender Affirmation ◽  
Peer Navigation ◽  
Living With Hiv

BACKGROUND Public health strategies are urgently needed to improve HIV disparities among transgender women, including holistic intervention approaches that address those health needs prioritized by the community. Hormone therapy is the primary method by which many transgender women medically achieve gender affirmation. Peer navigation has been shown to be effective to engage and retain underserved populations living with HIV in stable primary medical care. OBJECTIVE This study aims to assess the feasibility and acceptability of an integrated innovative HIV service delivery model designed to improve HIV prevention and care by combining gender-affirming primary care and peer navigation with HIV prevention and treatment services. METHODS A 12-month, nonrandomized, single-arm cohort study was implemented in Lima, Peru, among adult individuals, assigned a male sex at birth, who identified themselves as transgender women, regardless of initiation or completion of medical gender affirmation, and who were unaware of their HIV serostatus or were living with HIV but not engaged in HIV treatment. HIV-negative participants received quarterly HIV testing and were offered to initiate pre-exposure prophylaxis. HIV-positive participants were offered to initiate antiretroviral treatment and underwent quarterly plasma HIV-1 RNA and peripheral CD4+ lymphocyte cell count monitoring. All participants received feminizing hormone therapy and adherence counseling and education on their use. Peer health navigation facilitated retention in care by visiting participants at home, work, or socialization venues, or by contacting them by social media and phone. RESULTS Patient recruitment started in October 2016 and finished in March 2017. The cohort ended follow-up on March 2018. Data analysis is currently underway. CONCLUSIONS Innovative and culturally sensitive strategies to improve access to HIV prevention and treatment services for transgender women are vital to curb the burden of HIV epidemic for this key population. Findings of this intervention will inform future policies and research, including evaluation of its efficacy in a randomized controlled trial. CLINICALTRIAL ClinicalTrials.gov NCT03757117; https://clinicaltrials.gov/ct2/show/NCT03757117 INTERNATIONAL REGISTERED REPOR DERR1-10.2196/14091

scholarly journals High levels of mild to moderate depression among men who have sex with men and transgender women in Lima, Peru: implications for integrated depression and HIV care

2020 ◽  
Author(s):  
Jerome T. Galea ◽  
Stephanie Marhefka ◽  
Segundo R. León ◽  
Guitele Rahill ◽  
Elena Cyrus ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Transgender Women ◽  
Hiv Care ◽  
Depression Care ◽  
Care Services ◽  
Treatment Services ◽  
Moderate Depression ◽  
Prevention And Treatment ◽  
Patient Health ◽  
Sex With Men

ABSTRACTDepression disproportionally affects people at risk of acquiring or living with HIV and is associated with worse health outcomes; however, depression care is not routinely integrated with HIV prevention and treatment services. Selection of the best depression intervention(s) for integration depends both on the prevalence and severity of depression among potential users. To inform depression care integration in a community-based setting in Lima, Peru, we retrospectively analyzed routinely collected depression screening data from men who have sex with men and transgender women seeking HIV prevention and care services (N=185). Depression was screened for using the Patient Health Questionnaire-9. Prevalence of any depression (PHQ-9 ≥5) was 42% and was significantly associated with the last sexual partner being “casual” (p=0.01). Most (81%) depressive symptoms were mild to moderate (≥5 PHQ-9 ≤14). Integrating depression care with HIV prevention and treatment services in Peru should begin by implementing interventions targeting mild to moderate depression.

scholarly journals SUN-052 Effects of Cross-Sex Hormone Therapy on Lipid Metabolism in Transgender Women and Men

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Carly Kelley ◽  
Andrea D Coviello
Keyword(s):  
Lipid Metabolism ◽  
Hormone Therapy ◽  
Transgender Women ◽  
Small Sample ◽  
Sex Hormone ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Transgender Persons ◽  
Lipid Panel ◽  
Increased Risk

Abstract Sex hormone therapy in cisgender persons (i.e. postmenopausal women and hypogonadal men and women) leads to changes in lipid metabolism and weight, but it is unclear to what extent this occurs in transgender persons receiving higher doses of cross-sex hormone therapy (CSHT) for the purpose of gender transition.Objective: To determine changes in lipid metabolism among transgender women (TW) and transgender men (TM) on CSHT.Methods: We conducted a retrospective chart review of patients identified at a transgender-specific clinic within an academic medical center. Data were collected on age, ethnicity, hormone therapies, lipid lowering therapy (LLT), surgical status, lipid panel, A1C, LFTs, BMI, and weight before and after initiation of HT. Patients on stable LLT were included but those with LLT initiated after baseline observation were excluded. Changes from baseline to post CSHT in TW and TM groups were evaluated with paired t-tests.Results: We identified 18 TW and 22 TM for whom laboratory data were available. Mean±SD age of TW was 33±13 years and for TM was 28±12 years; the majority (78%) were Caucasian. Mean±SD duration of HT in TW was 10.1±4.5 months and in TM 6.7±4.4 months. No patients had undergone gonadectomy at any time prior to or during the data collection period. One TW and one TM were on stable LLT during the observation period. All TW were treated with estradiol (78% oral, 11% patch) and spironolactone. In TW, there was a significant 10% increase in HDL from 48±17 mg/dl to 53±15 mg/dl (p=0.02) but there were no significant changes in other lipid fractions, A1c, or weight/BMI. The majority of TM (82%) were treated with weekly intramuscular testosterone-esters injections and the remainder with daily testosterone gel. More substantial and unfavorable metabolic changes occurred in the TM with a 15% decrease in HDL from 55±15 mg/dl to 47±10 mg/dl (p=0.004), increase in A1c from 5.07±0.45% to 5.22 ± 0.39%(p=0.04), increase in BMI from 29±10 kg/m2 to 31±10 kg/m2 (p=0.002), and a trend toward increased triglycerides (96±64 mg/dl to 110±80 mg/dl, p=0.07). Hemoglobin and hematocrit significantly increased in TM but there was no significant change in LFT in either group. Limitations include lack of data on body composition to determine relative changes in adipose tissue or muscle mass in relation to weight changes and small sample size.Conclusion: Our study suggests that CSHT has a neutral to slightly favorable impact on lipid metabolism in TW and a negative impact on lipids and glucose in TM. Larger, prospective studies are needed to determine whether these changes persist over the longer duration of CSHT and whether this translates to an increased risk of cardiovascular disease and mortality. Clinicians should inform TM patients about these potential negative effects of CSHT on lipid metabolism so that their patients can adopt healthy lifestyle interventions early on to optimize their cardiovascular risk.

scholarly journals Gender and Power Dynamics of Social Relationships Shape Willingness to Participate in Biomedical HIV Prevention Research Among South African Adolescents and Young Adults

2021 ◽  
Vol 3 ◽  
Author(s):  
Kalysha Closson ◽  
Laura Lee ◽  
Janan J. Dietrich ◽  
Mags E. Beksinska ◽  
Stefanie Hornschuh ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
South African ◽  
Young Women ◽  
Ecological Model ◽  
Perceived Barriers ◽  
Barriers And Facilitators ◽  
Power Dynamics ◽  
Prevention Research ◽  
Willingness To Participate ◽  
Biomedical Hiv Prevention

Background: Understanding young women and men's perceived barriers and facilitators to participation in biomedical HIV prevention research is important for designing youth friendly services (YFS) and acceptable technologies, which are necessary for preventing high sustained HIV incidence in South Africa. This study explores the multileveled barriers and facilitators to young men and women's willingness to participate in hypothetical biomedical HIV prevention research.Methods: Eight age- (16–18 and 19–24 years) and gender-stratified focus group discussions (FGDs) were conducted using semi-structured interview guides to explore young South African women and men's willingness, perceived barriers, and facilitators to participating in biomedical HIV prevention research. FGD transcripts were uploaded to NVivo and coded collaboratively with youth study team members. Thematic analysis using Bronfenbrenner's ecological model (individual, inter-personal, community, and societal) was used to guide a deductive coding procedure, which was documented and compared by gender.Results: Thirty-one participants from Durban and 34 from Soweto participated in FGDs. Individual facilitators for participation were discussed more by young men and included financial incentives and altruism. Concerns about side-effects of biomedical products were a common barrier. Interpersonal relationships with peers, intimate partners and caregivers influenced young people's willingness to participate in HIV prevention research, more so among young women. For young women, gendered power dynamics and distrust of intimate partners and parents influenced both communication regarding participation and willingness to participate in research that is often stigmatized, due to societal norms around women's sexuality. On a societal level, participants expressed distrust in medical and research institutions, however a sense of community that was developed with the study staff of this project, was a motivator to participate in future studies.Discussion: At each level of the ecological model, we found participants expressed gendered barriers and facilitators for participation. Gender norms as well as distrust of partners, parents, and health care professionals were key barriers that cut across all levels. At each level participants discussed facilitators that were youth-engaged, underscoring the need to implement YFS, establish trust and address gender inequities within future biomedical HIV prevention studies wishing to engage and retain South African youth.

Barriers and Facilitators to HIV Prevention, Testing, and Treatment among Young Transgender Women

2016 ◽  
Vol 58 (2) ◽  
pp. S81-S82
Author(s):  
Nadia Dowshen ◽  
Susan S. Lee ◽  
Marné Castillo ◽  
Linda Hawkins ◽  
Frances K. Barg
Keyword(s):  
Hiv Prevention ◽  
Transgender Women ◽  
Barriers And Facilitators

Factors associated with self-reported adherence to daily oral pre-exposure prophylaxis among men who have sex with man and transgender women: PrEP Brasil study

2021 ◽  
pp. 095646242110317
Author(s):  
Luana Monteiro Spindola Marins ◽  
Thiago Silva Torres ◽  
Paula Mendes Luz ◽  
Ronaldo I Moreira ◽  
Iuri C Leite ◽  
...  
Keyword(s):  
Multivariable Analysis ◽  
Transgender Women ◽  
Perceived Barriers ◽  
Barriers And Facilitators ◽  
Open Label ◽  
Stimulant Use ◽  
Factors Associated ◽  
The Past ◽  
Exposure Prophylaxis ◽  
Oral Prep

Understanding the factors associated with pre-exposure prophylaxis (PrEP) adherence may help in the development of strategies to support, motivate and sustain PrEP use. This study estimated self-reported adherence, described perceived barriers and facilitators and investigated factors associated with adherence to daily oral PrEP among men who have sex with man (MSM) and transgender women after 1 year of PrEP use in Brazil. PrEP Brasil was a prospective, multicentre, open-label demonstration study with MSM and transgender women at high risk for HIV infection. We used logistic regression to evaluate factors associated with complete adherence (not forgetting to take any pills in the past 30 days) at week 48. Of 338 participants included in this analysis, 60% reported complete adherence to daily oral PrEP at week 48. Perceived barriers and facilitators to daily oral PrEP were reported by 38.2% and 98.5%, respectively. The most reported barrier and facilitator were ‘I forgot to take my pills’ (19.2%) and ‘Associate PrEP with a daily activity/task’ (58.6%), respectively. In final multivariable analysis, living in Rio de Janeiro (aOR: 0.38; 95% CI: 0.20–0.73), being transgender women (aOR: 0.22; 95% CI: 0.07–0.73), reporting stimulant use (a OR: 0.40; 95% CI: 0.20–0.80) and having any perceived barriers to daily oral PrEP (aOR: 0.12; 95% CI: 0.07–0.23) were associated with decreased odds of complete adherence. Our findings provide information for developing the best practices to promote PrEP adherence in the Brazilian context.

Lupus nephritis in a transgender woman on cross-sex hormone therapy: a case for the role of oestrogen in systemic lupus erythematosus

Lupus ◽  
2020 ◽  
Vol 29 (13) ◽  
pp. 1807-1810
Author(s):  
Brittany G Hill ◽  
Bonnie Hodge ◽  
Richard Misischia
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Nephritis ◽  
Hormone Therapy ◽  
Lupus Erythematosus ◽  
Transgender Women ◽  
Sex Hormone ◽  
High Dose ◽  
Therapy Outcomes ◽  
Systemic Lupus ◽  
Specific Patient

We present the case of a 22-year-old African American transgender women (male to female), who was admitted for fatigue, abdominal pain and lower extremity edema and was diagnosed with systemic lupus erythematosus (SLE) and lupus nephritis. Treatment with high-dose steroids and mycophenolate mofetil helped resolve her symptoms. She has remained off oestrogen therapy since admission and has not experienced any major complications. It is important to consider therapy outcomes in this specific patient population. A review of four other cases of transgender women on cross-sex hormone therapy who were diagnosed with lupus is also presented.

ÜBER DIE BILDUNG VON ENDOMETRIALEN KÖRNCHENZELLEN BEI KASTRATINNEN UNTER HORMONEINFLUSS

1960 ◽  
Vol XXXIII (II) ◽  
pp. 261-276 ◽  
Author(s):  
G. Hellweg ◽  
J. Ferin ◽  
K. G. Ober
Keyword(s):  
Hormone Therapy ◽  
Stromal Cells ◽  
Sex Hormone ◽  
Substitution Therapy ◽  
Secretory Phase ◽  
Hormone Substitution ◽  
Endometrial Stromal Cells ◽  
Endometrial Stroma ◽  
K Cells

ABSTRACT 65 endometrial biopsies from castrated women who had received either natural or artificial sex hormone therapy were studied microscopically. Attention was paid to various histologic criteria, especially to the number of endometrial granulocytes (»K« cells, KZ). The following was obtained: The »K« cells are completely absent when no hormone substitution therapy is given. They were also lacking when the castrated patients were treated only with oestrogens, even if the dose given was ten-times that found in women during the reproductive ages. In contrast, the »K« cells developed from the endometrial stromal cells only under influence of progesterone, usually appearing first 8–10 days after the administration of the gestagen. The »K« cells were demonstrable in the number corresponding to a normal secretory phase only then, when the oestrogen-progesterone dosage ratio had induced a fully-developed secretory change, as measured by the usual histologic criteria. With an overdosage of oestrogen the »K« cells were either absent or were very sparse. Contrarily, an overdosage of progesterone had no influence on their number. The development of endometrial glands does not always entirely parallel that of the stroma in castrated patients following hormone therapy. A more exact indicator for the proper dose for the production of a secretory phase by hormone therapy seems to be the number of »K« cells in the endometrial stroma.

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